European Heart Journal最新文献

Background and aims: While the prevalence, drivers, and impact of cardiometabolic risk factors are known to differ between women and men, less is known about sex differences in the cardiovascular-kidney-metabolic (CKM) syndrome.

Methods: In this prespecified analysis, individual participant-level data were pooled from two trials of chronic kidney disease and type 2 diabetes (FIDELIO-DKD and FIGARO-DKD) and a trial of heart failure (HF) with mildly reduced or preserved ejection fraction (FINEARTS-HF). The risk of first HF hospitalization, cardiovascular death, major adverse cardiovascular events, kidney composite outcome, and all-cause death, was compared between men and women using adjusted Cox regression models. Treatment effect heterogeneity in response to finerenone was evaluated using interaction analyses.

Results: Of the 18 991 participants in FINE-HEART, 6664 (35%) were women. Compared with men, women were slightly older (69 vs 67 years) and had a lower median urine albumin-to-creatinine ratio (183 vs 337 mg/g). Women were more likely to have Stage 4 CKM syndrome but less likely to receive medical therapies commonly indicated for the management of CKM conditions at baseline, such as aspirin, statins, renin-angiotensin system inhibitors, sodium-glucose co-transporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists. During a median follow-up of 2.9 years, both women and men had similarly high rates of HF hospitalization or cardiovascular death (4.8 vs 3.9 per 100 patient-years, adjusted hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.89-1.06, P = .52) but lower risk of all-cause mortality (adjusted HR 0.83, 95% CI 0.76-0.91, P < .001) compared with men. There was no evidence of treatment heterogeneity by sex with finerenone in reducing cardiovascular, kidney, and mortality outcomes (all Pinteraction >.05).

Conclusions: In this pooled analysis of individuals with advanced CKM syndrome, women had a higher burden of multimorbidity and were less likely to receive commonly indicated CKM therapies than men. Finerenone conferred consistent benefits in women and men, reinforcing its use while underscoring persistent sex-based treatment disparities in CKM care.

Registration: PROSPERO identifier: CRD42024570467.

The field of reverse cardio-oncology examines how subclinical and overt cardiometabolic dysfunction-such as obesity-fuels breast cancer (BCa) risk and altered tumour biology through shared mechanisms such as chronic inflammation, hormonal dysregulation, and cellular senescence. Limitations of body mass index (BMI) have prompted the development of refined obesity phenotypes, including metabolically healthy vs unhealthy obesity and sarcopenic obesity that more accurately stratify BCa risk. Reverse cardio-oncology is conceptually distinguished from traditional cardio-oncology by focusing on how cardiometabolic impairment-even in the absence of manifest cardiovascular disease-increases BCa incidence and worsens prognosis. Within a common-soil framework, senescent adipose tissue is recognized as a key driver of breast tumour microenvironment remodelling through senescence-associated secretory phenotype (SASP), epigenetic reprogramming, and immunosenescence. Emerging translational strategies-including lifestyle modification, cardiometabolic therapies such as GLP-1 receptor agonists and SGLT2 inhibitors, and senolytic approaches-highlight opportunities to integrate cardiovascular and oncologic prevention and treatment in women with or at risk for BCa. Overall, this review synthesizes current knowledge on obesity's mechanistic links to BCa within a reverse cardio-oncology paradigm and provides a conceptual foundation for improved risk stratification and interdisciplinary clinical management.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and inflammation has been suggested as a predisposing factor for AF. Systemic inflammatory disorders (including autoimmune disorder, diabetes mellitus, and obesity) or local inflammation of the heart or pericardium are linked to AF. Inflammation is known to trigger various signalling pathways and to directly influence proinflammatory cytokines, in turn promoting structural and electrical changes in the atria, increasing the susceptibility to AF. Inflammation induces oxidative stress and an imbalance in the autonomic nervous system, and enhances atrial or pulmonary vein arrhythmogenesis by modulating electrophysiological characteristics and fibrogenesis. This review explores the complex pathophysiological processes linking inflammation to AF and identifies potential novel therapeutic targets.

Parasitic infections are an underrecognized but important cause of cardiovascular disease, primarily in endemic regions and increasingly in non-endemic settings as a consequence of global migration and travel. Cardiac involvement may result from direct parasitic invasion or, more commonly, from immune-mediated and inflammatory mechanisms, with predominant effects on the myocardium and pericardium. Clinical manifestations include acute myocarditis, dilated or restrictive cardiomyopathy, pericardial effusion, tamponade, constrictive pericarditis, and occasionally cystic lesions identified on cardiac imaging. Parasitic aetiologies should be considered in patients with unexplained myocardial or pericardial disease, particularly in those with relevant epidemiological exposure, immunosuppression, fever, or eosinophilia. This narrative review offers an updated overview of cardiac involvement in parasitic infections, integrating current evidence on epidemiology, clinical manifestations, diagnosis, and management of parasitic cardiac disease, providing practical, clinically oriented guidance supported by figures, algorithms, and summary tables designed to enhance clinical applicability.

Cardiovascular disease (CVD) has remained a predominant cause of mortality in China for several decades, experiencing notable epidemiological transitions. Numerous recent studies have provided valuable observational data on the evolution of CVD epidemiology across various dimensions. However, there is a paucity of comprehensive reviews that synthesize these findings and analyse their interrelationships. To address this gap, this review summarizes the key features from complex data presented in various literature reports and additional analyses of available databases. The impact of the primary drivers of these changed features and their intricate interconnections on total CVD and major subtypes, including ischaemic heart disease (IHD), ischaemic stroke (IS), and haemorrhagic stroke (HS), was quantitatively evaluated across different periods from 1990 to 2021. Four prominent transitional features of CVD mortality and the impact of underlying drivers elucidate not only new challenges for CVD prevention and control but also highlight the hidden effects of national efforts on CVD prevention. The analysis also indicated that despite a similar pattern in age-specific mortality for HS, IS, and IHD over the past decade, only the decline in HS mortality was largely attributed to the benefits of primary CVD prevention. In contrast, the declining age-specific IHD and IS mortality was due to reduced fatal events from improved medical care. The implications of these evolving features of CVD over time for further decision-making in CVD prevention strategies are discussed in depth.

Wearable devices are transforming cardiovascular medicine by enabling continuous monitoring of physiologic and behavioural measures outside of traditional clinical settings. Smartwatches and activity trackers, the most widely used wearables, employ motion and biometric sensors to measure physical activity, sleep quality, heart rate, and rhythm. By converting health goals into objective, quantifiable measures, wearable devices empower patients to assume a more active role in their health while providing clinicians with novel opportunities for longitudinal, real-world assessment. Clinical applications span the cardiovascular continuum from lifestyle interventions targeting physical activity and sleep to the remote management of chronic conditions such as heart failure. Widespread clinical adoption of wearables remains limited by challenges, such as variability in device methodology, data outputs, validation, and intended use; incompatibility with existing electronic health records; and the lack of standardized, evidence-based workflows for clinicians to efficiently interpret and act upon wearable data. This review summarizes the current landscape of wearable technologies in cardiovascular medicine by highlighting key clinical applications, evidence gaps in the existing literature, the role of artificial intelligence, and barriers to implementation. We discuss strategies to enhance clinical integration and strengthen the current evidence base while also providing practical guidance to help clinicians navigate commonly encountered clinical scenarios.