Cardiovascular Drugs and Therapy最新文献

{"title":"Candidate Residual Inflammatory Risk in HFpEF: A Multiorgan Framework for Longitudinal Phenotyping, Trial Enrichment, and Therapeutic Evidence Appraisal.","authors":"Zhaoqi Yan, Xiangyi Pu, Tiantian Ren, Yongyuan Cai, Yifeng Xu, Jiamei Chen, Xing Chang, Yanli Wang, Zhiming Liu, Ruxiu Liu","doi":"10.1007/s10557-026-07941-z","DOIUrl":"https://doi.org/10.1007/s10557-026-07941-z","url":null,"abstract":"<p><p>Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome in which ejection fraction, natriuretic peptides, and resting diastolic indices do not fully explain disease initiation, progression, or treatment response. The dominant contemporary phenotype is frequently cardiorenal-metabolic, characterized by obesity, visceral and epicardial adiposity, insulin resistance, diabetes, hypertension, kidney dysfunction, endothelial dysfunction, and chronic low-grade inflammation. In this setting, candidate residual inflammatory risk (RIR) is best conceptualized not as an isolated elevation of C-reactive protein or interleukin-6, but as a persistent multiorgan immunometabolic state that may continue to drive symptoms, organ remodeling, and clinical events despite control of congestion and indication-appropriate management of comorbidities. Adipose-tissue expansion, immune-cell activation, endothelial adhesion and oxidative stress, impaired nitric oxide-cyclic guanosine monophosphate-protein kinase G signaling, cardiomyocyte stiffening, extracellular-matrix remodeling, renal amplification, skeletal-muscle bioenergetic failure, and gut-liver metabolic inputs form a self-reinforcing disease network. Biomarker, proteomic, imaging, and phenomapping studies indicate that inflammatory burden in HFpEF is layered rather than binary, ranging from obesity-linked high-CRP states to pan-inflammatory phenotypes with cardiorenal dysfunction, fibrosis signals, and worse outcomes. This framework may explain why broad anti-inflammatory therapy has produced limited benefit, whereas upstream phenotype-matched therapies, including sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonism, obesity-directed incretin therapy, and structured lifestyle interventions, appear more effective in selected populations. Candidate RIR remains a research construct without a validated diagnostic cutoff or treatment-predictive biomarker. Framing cardiometabolic and cardiorenal HFpEF through candidate RIR may improve mechanistic stratification, longitudinal phenotyping, trial enrichment, and mechanism-matched therapy.</p>","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering the Association Between GLP-1 Receptor Agonists and Atrial Fibrillation Risk in Chronic Kidney Disease.","authors":"Wei Chen, Xiqin Wang, Yue Xiao","doi":"10.1007/s10557-026-07939-7","DOIUrl":"https://doi.org/10.1007/s10557-026-07939-7","url":null,"abstract":"","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Environmental Exposure Profiles with Temporal Transcriptomics: An Explainable Machine Learning Model for Cardiovascular Disease Risk Prediction and Biological Validation.","authors":"Ning Sun, Wen-Qiang Cui, Xiang-Qing Xu, Hong-Yun Wu","doi":"10.1007/s10557-026-07943-x","DOIUrl":"https://doi.org/10.1007/s10557-026-07943-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiovascular disease (CVD) pathogenesis is strongly associated with environmental exposures and metabolic factors. This study aimed to investigate the relationship between urinary levels of volatile organic compounds (VOCs), heavy metals, and serum biomarkers with CVD, and to develop a high-accuracy, interpretable predictive model, while elucidating the potential underlying biological mechanisms from a molecular temporal-dynamic perspective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES, 2011-2020 cycles), including 8,165 eligible participants. Sixty-six metabolic-related features were systematically selected from blood and urine samples. To address class imbalance, and given that the primary objective of this study was to improve the identification of cardiovascular disease (CVD) cases rather than to estimate the population prevalence distribution, the Synthetic Minority Over-sampling Technique (SMOTE) was applied exclusively to the training set for class balancing during model development. NHANES survey weights were retained for descriptive analyses and population characteristic estimation to preserve the representativeness of the survey data and minimize potential impacts on population-level inference. Least Absolute Shrinkage and Selection Operator (LASSO) regression identified the top 20 features most predictive of CVD. Seven machine learning models-including XGBoost, LightGBM, Support Vector Machine (SVM), and others-were constructed. Model performance was comprehensively evaluated using the area under the receiver operating characteristic curve (AUC-ROC), area under the precision-recall curve (AUC-PR), sensitivity, specificity, F1-score, and other metrics. The optimal model was interpreted using SHapley Additive exPlanations (SHAP) values to assess feature importance. To further validate the biological plausibility of the identified predictors, we integrated clinical transcriptomic data and conducted longitudinal analyses of differential gene expression and pathway enrichment across four critical time points (acute phase: 1 day; subacute phase: 4-6 days; recovery phase: 1 month; chronic phase: 6 months).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among all models, XGBoost demonstrated superior predictive performance and stability, achieving an AUC of 0.845 and an accuracy of 78.24%. The 20 key features identified by LASSO regression included urinary VOC-related metabolites (e.g., ATCA and NAE), urinary inorganic arsenic species As (III), metal/element biomarkers (e.g., iodine, cadmium, and cesium), and serum biomarkers such as creatinine, glycated hemoglobin (HbA1c), and alkaline phosphatase (ALP). SHAP analysis quantified the contribution of these features to CVD risk and effectively stratified individuals into high- and low-risk groups, suggesting that the model has reasonable risk-stratification ability and interpretabilit","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous ST-Segment Elevation in Right Precordial Leads Following Cardiac Arrest: Literature Review and Management Proposal for Ruling out Brugada Syndrome.","authors":"Pierangelo Calvelli, Vincenzo Racco, Antonio Curcio","doi":"10.1007/s10557-026-07937-9","DOIUrl":"https://doi.org/10.1007/s10557-026-07937-9","url":null,"abstract":"<p><strong>Purpose: </strong>Electrocardiogram (ECG) evaluation after return of spontaneous circulation (ROSC) represents a crucial step in the diagnostic work-up of sudden cardiac death (SCD) survivors. Among ECG patterns, the Brugada syndrome (BrS) type 1 morphology, characterized by coved ST-segment elevation in right precordial leads, requires a prompt differential diagnosis, as it may reflect either a true BrS, or a BrS phenocopy, or yet an acquired sodium channel dysfunction.</p><p><strong>Methods: </strong>This focused narrative review provides an analysis of Brugada-like ECG patterns occurring in the post-ROSC setting, summarizing the pathophysiological mechanisms, diagnostic criteria, and distinctive features of each potential etiology.</p><p><strong>Results: </strong>BrS is an inherited arrhythmogenic disorder associated with an increased risk of ventricular arrhythmias and SCD. Conversely, Brugada phenocopies are transient Brugada-like ECG patterns triggered by reversible conditions, including ischemia, pulmonary embolism, pneumothorax, hypothermia, electrolyte and metabolic disturbances, myocardial or pericardial inflammation, or intracranial hemorrhage. A diagnostic algorithm is proposed to guide clinicians through rapid evaluation, prioritizing the exclusion of life-threatening and reversible causes before considering primary electrical disorders.</p><p><strong>Conclusions: </strong>Early recognition and targeted management of these entities are fundamental, as prompt correction of the underlying condition often leads to complete ECG normalization, avoiding misdiagnosis. Understanding the spectrum of Brugada mimics is essential for improving diagnostic accuracy and optimizing therapeutic strategies in the acute management of post-cardiac arrest patients.</p>","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Epigenetic Memory: A Proposed Immune-redox Framework for Coronary Microvascular Dysfunction in Diabetes.","authors":"Siddarth Raajasekar","doi":"10.1007/s10557-026-07940-0","DOIUrl":"https://doi.org/10.1007/s10557-026-07940-0","url":null,"abstract":"","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apixaban Versus Low-Molecular-Weight Heparin in Cancer-Associated Thrombosis: An Indication-Stratified Systematic Review and Meta-Analysis of Treatment and Postoperative Prophylaxis.","authors":"Chao Huang, Shoufang Li, Jianping He","doi":"10.1007/s10557-026-07908-0","DOIUrl":"https://doi.org/10.1007/s10557-026-07908-0","url":null,"abstract":"<p><strong>Background: </strong>Apixaban is increasingly used as an alternative to low-molecular-weight heparin (LMWH) in patients with cancer, but evidence spans distinct clinical settings, including treatment of established cancer-associated thrombosis/venous thromboembolism (CAT/VTE) and postoperative thromboprophylaxis. We performed an indication-stratified systematic review and meta-analysis comparing apixaban with LMWH in patients with cancer.</p><p><strong>Methods: </strong>PubMed, Scopus, and Web of Science were searched from inception to April 2026 for comparative studies evaluating apixaban versus LMWH in adults with cancer. Studies were categorized as treatment of established CAT/VTE or postoperative thromboprophylaxis after cancer surgery. Outcomes included major bleeding (MB), VTE, clinically relevant non-major bleeding (CRNMB), deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality. Random-effects models generated pooled risk ratios (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Seventeen studies involving 31,632 patients were included. Apixaban was not associated with a significant increase in major bleeding in postoperative thromboprophylaxis studies (RR, 0.79; 95% CI, 0.29-2.12) or treatment studies (RR, 0.93; 95% CI, 0.56-1.55). In treatment studies, apixaban was associated with a significantly lower risk of recurrent VTE than LMWH (RR, 0.62; 95% CI, 0.51-0.75). In postoperative thromboprophylaxis studies, apixaban showed a numerically lower but non-significant risk of incident postoperative VTE (RR, 0.56; 95% CI, 0.30-1.06). CRNMB was lower with apixaban in postoperative studies (RR, 0.60; 95% CI, 0.38-0.95), but not in treatment studies.</p><p><strong>Conclusions: </strong>Apixaban may be an effective alternative to LMWH for selected patients with established CAT/VTE and was associated with a lower risk of recurrent VTE. No clear increase in major bleeding was observed, but this finding should be interpreted cautiously because the certainty of evidence for bleeding outcomes was low. Evidence for postoperative thromboprophylaxis is promising but less definitive.</p>","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Methodological Considerations Regarding 'Impact of Nitric Oxide Metabolites on Early Perioperative Biochemical Changes and Postoperative Complications in High-BMI Patients Undergoing On-Pump CABG'\".","authors":"Maria Wołuń-Cholewa, Karolina Iwona Kulinska","doi":"10.1007/s10557-026-07933-z","DOIUrl":"https://doi.org/10.1007/s10557-026-07933-z","url":null,"abstract":"","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injectable Lipid-Lowering Therapies in Advanced Chronic Kidney Disease: Efficacy, Safety and the Dialysis Paradox.","authors":"Aikaterini Damianaki, Emelina Stambolliu, Panagiotis Iliakis, Panagiotis Theofilis, Aggeliki Vakka, Evangelia Kalliakouda, Polykarpos Christos Patsalis, Dimitrios Konstantinidis, Dimitrios Petras","doi":"10.1007/s10557-026-07934-y","DOIUrl":"https://doi.org/10.1007/s10557-026-07934-y","url":null,"abstract":"<p><p>Cardiovascular (CV) disease represents the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), particularly in those with advanced stages and dialysis dependence. Dyslipidemia is highly prevalent in this population and displays distinct features, substantially affected by multiple factors such inflammation and dialysis modality. Although statins remain the cornerstone of lipid-lowering therapy in earlier CKD stages, their benefit becomes less certain in advanced disease and predominantly end-stage kidney disease. This phenomenon, termed the dialysis paradox, is further confounded by reverse epidemiology, wherein lower cholesterol paradoxically associates with worse outcomes due to malnutrition and inflammation. Injectable lipid-lowering therapies, including proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (evolocumab, alirocumab), small interfering RNA (inclisiran), and emerging agents targeting ANGPTL3, apolipoprotein C-III, and lipoprotein(a), offer novel mechanisms of action with pharmacokinetic profiles largely preserved across CKD stages. Available evidence demonstrates substantial low-density lipoprotein (LDL) reduction without renal toxicity, though patients with advanced CKD and dialysis dependence remain critically underrepresented in clinical trials. Current guidelines diverge significantly for dialysis populations, reflecting this persistent evidence gap. This review synthesizes the biological rationale, pharmacologic properties, and available clinical evidence for injectable lipid-lowering therapies in advanced CKD. Moreover, it highlights why their integration into the care of this high-risk population merits serious consideration - not only for their potent and durable lipid-lowering effects, but also for their ability to target other paths that contribute to the excess CV risk not captured by LDL alone. However, key unresolved questions require dedicated investigation.</p>","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiotoxicity of Targeted Cancer Therapies: Expanding the Translational Horizon.","authors":"Minmin Pan, Yifan Li, Jizhou Zhang","doi":"10.1007/s10557-026-07927-x","DOIUrl":"https://doi.org/10.1007/s10557-026-07927-x","url":null,"abstract":"","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unaddressed Sources of Exposure and Detection Bias in the TriNetX Analysis of GLP-1 Receptor Agonists and Atrial Fibrillation in CKD.","authors":"Muhammad Shaheer Ahmad Baloch","doi":"10.1007/s10557-026-07935-x","DOIUrl":"https://doi.org/10.1007/s10557-026-07935-x","url":null,"abstract":"","PeriodicalId":9557,"journal":{"name":"Cardiovascular Drugs and Therapy","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}