Pub Date : 2025-09-15DOI: 10.1016/j.ahj.2025.07.018
Ahson Afzal , Omar Khalid Samir Abdelkader , Mohamed Abd-ElGawad , Yomna E. Dean , Moataz Aboeldahb , Helen A.O. Popoola-Samuel , Anas Hamdy , Rafeek Walid Elmezayen , Amir Elalem , Nadir Zulfiqar Aziz , Anandita Thakur , Armaan Jain , Hassan Nassr Al Dhneem , Hamza Mohamed Hamed Elkasaby , Raneem Atta , Ileana Anghel , Webster Donaldy , Eman Toraih , Hani Aiash
Background
Menstrual irregularities are associated with various health risks, but their connection to cardiovascular disease (CVD) remains unclear. This meta-analysis aims to evaluate the link between irregular menstruation and cardiovascular and metabolic outcomes in women.
Methods
A systematic search of online databases was conducted for studies comparing cardiovascular and metabolic outcomes between women with irregular and regular menstrual cycles. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated adopting a random effects model.
Results
Eight observational studies involving 354,419 women were analyzed. Women with irregular menstrual cycles had a significantly higher risk of developing cardiovascular disease overall (RR: 1.43, 95% CI: 1.01–2.03) compared to those with regular cycles. Subgroup analyses showed an increased risk of coronary artery disease (RR: 1.29, 95% CI: 1.14–1.46), hypertension (RR: 1.50, 95% CI: 1.23–1.82), and heart failure (RR: 1.45, 95% CI: 1.11–1.89) among women with irregular cycles. Cerebrovascular disease risk was elevated in this group (RR: 1.62, 95% CI: 1.10–2.40). Furthermore, women with irregular cycles demonstrated a greater likelihood of developing diabetes mellitus (RR: 1.75, 95% CI: 1.31–2.34) and hypercholesterolemia (RR: 1.33, 95% CI: 1.16–1.52).
Conclusion
Menstrual irregularities are linked to an increased risk of various cardiovascular, cerebrovascular, and metabolic conditions. This underscores the need for regular medical check-ups to aid in early detection and prevention of these diseases.
{"title":"Association Between Menstrual Cycle Irregularities and Cardiometabolic Risks: A Systematic Review and Meta-Analysis","authors":"Ahson Afzal , Omar Khalid Samir Abdelkader , Mohamed Abd-ElGawad , Yomna E. Dean , Moataz Aboeldahb , Helen A.O. Popoola-Samuel , Anas Hamdy , Rafeek Walid Elmezayen , Amir Elalem , Nadir Zulfiqar Aziz , Anandita Thakur , Armaan Jain , Hassan Nassr Al Dhneem , Hamza Mohamed Hamed Elkasaby , Raneem Atta , Ileana Anghel , Webster Donaldy , Eman Toraih , Hani Aiash","doi":"10.1016/j.ahj.2025.07.018","DOIUrl":"10.1016/j.ahj.2025.07.018","url":null,"abstract":"<div><h3>Background</h3><div>Menstrual irregularities are associated with various health risks, but their connection to cardiovascular disease (CVD) remains unclear. This meta-analysis aims to evaluate the link between irregular menstruation and cardiovascular and metabolic outcomes in women.</div></div><div><h3>Methods</h3><div>A systematic search of online databases was conducted for studies comparing cardiovascular and metabolic outcomes between women with irregular and regular menstrual cycles. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated adopting a random effects model.</div></div><div><h3>Results</h3><div>Eight observational studies involving 354,419 women were analyzed. Women with irregular menstrual cycles had a significantly higher risk of developing cardiovascular disease overall (RR: 1.43, 95% CI: 1.01–2.03) compared to those with regular cycles. Subgroup analyses showed an increased risk of coronary artery disease (RR: 1.29, 95% CI: 1.14–1.46), hypertension (RR: 1.50, 95% CI: 1.23–1.82), and heart failure (RR: 1.45, 95% CI: 1.11–1.89) among women with irregular cycles. Cerebrovascular disease risk was elevated in this group (RR: 1.62, 95% CI: 1.10–2.40). Furthermore, women with irregular cycles demonstrated a greater likelihood of developing diabetes mellitus (RR: 1.75, 95% CI: 1.31–2.34) and hypercholesterolemia (RR: 1.33, 95% CI: 1.16–1.52).</div></div><div><h3>Conclusion</h3><div>Menstrual irregularities are linked to an increased risk of various cardiovascular, cerebrovascular, and metabolic conditions. This underscores the need for regular medical check-ups to aid in early detection and prevention of these diseases.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psoriatic arthritis (PsA) and type 2 diabetes mellitus (T2DM) are independently associated with increased cardiovascular risk. However, the impact of obesity on cardiovascular outcomes in patients with both conditions remains poorly understood.
Methods
Using the TriNetX global federated health research network, we conducted a retrospective cohort study comparing cardiovascular outcomes between patients with PsA and T2DM stratified by BMI. Cohort 1 included non-obese patients (BMI <30 kg/m²; n=9,762) and Cohort 2 included obese patients (BMI 30-60 kg/m²; n=9,762) matched by propensity score across demographic and clinical characteristics. Outcomes were assessed over a 5-year follow-up period.
Results
After propensity score matching, the risk of all-cause mortality was significantly higher in non-obese patients compared to obese patients (9.1% vs 5.9%, risk difference 3.2%, 95% CI 2.5-4.0%; p<0.001). Non-obese patients demonstrated lower survival probability at the end of the 5-year follow-up (84.7% vs 90.2%, p<0.001) with a hazard ratio of 1.65 (95% CI 1.49-1.83). The non-obese cohort also exhibited higher incidence of cardiac arrest (2.5% vs 1.1%), cerebral infarction (6.6% vs 4.3%), heart failure (17.1% vs 9.6%), and pulmonary embolism (3.3% vs 2.0%) compared to the obese cohort (all p<0.001).
Conclusions
In patients with concurrent PsA and T2DM, those with BMI <30 kg/m² demonstrated significantly higher cardiovascular risk compared to matched obese patients. This apparent "obesity paradox" warrants further investigation into underlying mechanisms, including potential disease severity, inflammatory burden, and metabolic differences between these populations.
背景银屑病关节炎（PsA）和2型糖尿病（T2DM）与心血管风险增加独立相关。然而，肥胖对这两种疾病患者心血管预后的影响仍知之甚少。方法利用TriNetX全球联合健康研究网络，我们进行了一项回顾性队列研究，比较了PsA和T2DM患者的心血管结局。队列1包括非肥胖患者（BMI <30 kg/m²；n= 9762），队列2包括肥胖患者（BMI 30-60 kg/m²；n= 9762），通过人口统计学和临床特征的倾向评分匹配。结果在5年随访期间进行评估。结果倾向评分匹配后，非肥胖患者的全因死亡风险明显高于肥胖患者（9.1% vs 5.9%，风险差3.2%,95% CI 2.5-4.0%; p<0.001）。非肥胖患者在5年随访结束时生存率较低（84.7% vs 90.2%, p<0.001），风险比为1.65 （95% CI 1.49-1.83）。与肥胖组相比，非肥胖组的心脏骤停（2.5%比1.1%）、脑梗死（6.6%比4.3%）、心力衰竭（17.1%比9.6%）和肺栓塞（3.3%比2.0%）的发生率也更高（p < 0.001）。结论在伴有PsA和T2DM的患者中，BMI≤30 kg/m²的患者心血管风险明显高于匹配的肥胖患者。这种明显的“肥胖悖论”值得进一步研究潜在的机制，包括潜在的疾病严重程度、炎症负担和这些人群之间的代谢差异。
{"title":"Impact of Obesity on Cardiovascular Outcomes in Patients with Psoriatic Arthritis and Type 2 Diabetes Mellitus","authors":"Godbless Ajenaghughrure M.D. , Sila Mateo Faxas M.D. , Kim Nguyen M.D. , Gurjot Singh M.D. , Nirys Mateo Faxas M.D. , Dharana Gelal M.D. , Karldon Nwazeaupu M.D. , Nicole Tejeda Zoz M.D. , Kimberly Ramirez Bonetti M.D. , Erick Perez Mejias M.D.","doi":"10.1016/j.ahj.2025.07.022","DOIUrl":"10.1016/j.ahj.2025.07.022","url":null,"abstract":"<div><h3>Background</h3><div>Psoriatic arthritis (PsA) and type 2 diabetes mellitus (T2DM) are independently associated with increased cardiovascular risk. However, the impact of obesity on cardiovascular outcomes in patients with both conditions remains poorly understood.</div></div><div><h3>Methods</h3><div>Using the TriNetX global federated health research network, we conducted a retrospective cohort study comparing cardiovascular outcomes between patients with PsA and T2DM stratified by BMI. Cohort 1 included non-obese patients (BMI <30 kg/m²; n=9,762) and Cohort 2 included obese patients (BMI 30-60 kg/m²; n=9,762) matched by propensity score across demographic and clinical characteristics. Outcomes were assessed over a 5-year follow-up period.</div></div><div><h3>Results</h3><div>After propensity score matching, the risk of all-cause mortality was significantly higher in non-obese patients compared to obese patients (9.1% vs 5.9%, risk difference 3.2%, 95% CI 2.5-4.0%; p<0.001). Non-obese patients demonstrated lower survival probability at the end of the 5-year follow-up (84.7% vs 90.2%, p<0.001) with a hazard ratio of 1.65 (95% CI 1.49-1.83). The non-obese cohort also exhibited higher incidence of cardiac arrest (2.5% vs 1.1%), cerebral infarction (6.6% vs 4.3%), heart failure (17.1% vs 9.6%), and pulmonary embolism (3.3% vs 2.0%) compared to the obese cohort (all p<0.001).</div></div><div><h3>Conclusions</h3><div>In patients with concurrent PsA and T2DM, those with BMI <30 kg/m² demonstrated significantly higher cardiovascular risk compared to matched obese patients. This apparent \"obesity paradox\" warrants further investigation into underlying mechanisms, including potential disease severity, inflammatory burden, and metabolic differences between these populations.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 4-5"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-15DOI: 10.1016/j.ahj.2025.07.043
Manahil Bahrawar, Amna Inayat, Mushaim Gillani, Haris Aslam, Ahmad Akhtar
GLP-1RAs have emerged as a significant therapeutic option for managing cardiovascular outcomes in patients with T2DM, demonstrating promise in preserving ejection fraction and reducing the risk of MACE
Methods: Databases such as Pubmed and Cochrane were used.
Studies like SOUL, SUSTAIN-6, and REWIND trials helped to assess the clinical outcomes of GLP-1RAs. The SOUL trial focused on semaglutide, a GLP-1RA in patients with established ASCVD or CKD, and STEP-HFpEF trial, centered on its effectiveness against obesity related heart failure, revealed 101 serious adverse effects in contrast to 301 in the placebo group. Tirzepatide, the first approved dual therapy for T2DM, shows better glycemic control and weight loss than GLP-1RAs, hence potentially a better treatment option for obesity related heart failure. While these therapies have a proven effect on reducing systolic blood pressure and MACE, one study showed that there was no significant effect on unstable angina. An ongoing study, the SURPASS-CVOT, is underway for the cardiovascular safety of tirzepatide, a GIP/GLP-1RA, and its superiority to dulaglutide. Statistical evidence supports the role tirzepatide has in mitigating ischemic stroke, however, customized RCTs are required to unveil the effects of GLP-1RAs
Conclusion: Some variability in patients’ results, depending on the quality of evidence shows that personalized treatment plans are the best approach. For cost-effective scientific trials, predictive analysis may be used, such as mathematical models that may lead to early termination of the SOUL trial.
{"title":"Evaluating the Cardiovascular Efficacy of GLP-1 and Dual GLP-1/GIP Agonists in Type 2 Diabetes: A Critical Review","authors":"Manahil Bahrawar, Amna Inayat, Mushaim Gillani, Haris Aslam, Ahmad Akhtar","doi":"10.1016/j.ahj.2025.07.043","DOIUrl":"10.1016/j.ahj.2025.07.043","url":null,"abstract":"<div><div>GLP-1RAs have emerged as a significant therapeutic option for managing cardiovascular outcomes in patients with T2DM, demonstrating promise in preserving ejection fraction and reducing the risk of MACE</div><div><strong>Methods:</strong> Databases such as Pubmed and Cochrane were used.</div><div>Studies like SOUL, SUSTAIN-6, and REWIND trials helped to assess the clinical outcomes of GLP-1RAs. The SOUL trial focused on semaglutide, a GLP-1RA in patients with established ASCVD or CKD, and STEP-HFpEF trial, centered on its effectiveness against obesity related heart failure, revealed 101 serious adverse effects in contrast to 301 in the placebo group. Tirzepatide, the first approved dual therapy for T2DM, shows better glycemic control and weight loss than GLP-1RAs, hence potentially a better treatment option for obesity related heart failure. While these therapies have a proven effect on reducing systolic blood pressure and MACE, one study showed that there was no significant effect on unstable angina. An ongoing study, the SURPASS-CVOT, is underway for the cardiovascular safety of tirzepatide, a GIP/GLP-1RA, and its superiority to dulaglutide. Statistical evidence supports the role tirzepatide has in mitigating ischemic stroke, however, customized RCTs are required to unveil the effects of GLP-1RAs</div><div><strong>Conclusion:</strong> Some variability in patients’ results, depending on the quality of evidence shows that personalized treatment plans are the best approach. For cost-effective scientific trials, predictive analysis may be used, such as mathematical models that may lead to early termination of the SOUL trial.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 16"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takotsubo syndrome (TTS) is associated with significant cardiovascular morbidity. While diabetes has been identified as a risk factor in TTS patients, the impact of prediabetes on outcomes remains poorly characterized. This study investigated whether prediabetes affects cardiovascular outcomes and mortality in patients with TTS.
Methods
Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of TTS patients aged 18-79 years. Patients with prediabetes (n=3,316) were compared to those without prediabetes (n=34,909) after propensity score matching (3,316 per cohort). Outcomes were analyzed over a 5-year follow-up period (1-1,825 days post-diagnosis). Statistical analyses included risk ratios, hazard ratios, and survival analyses.
Results
After matching, prediabetic TTS patients demonstrated significantly lower all-cause mortality (11.5% vs 19.4%; RR=0.59, p<0.001), acute kidney injury (7.7% vs 10.0%; RR=0.77, p=0.008), and acute myocardial infarction (9.3% vs 12.1%; RR=0.77, p=0.018) compared to non-prediabetic patients. Heart failure trended toward significance (19.3% vs 22.2%; RR=0.87, p=0.051). Kaplan-Meier survival analysis showed significantly better outcomes for prediabetic patients in mortality (HR=0.53, p<0.001), heart failure (HR=0.79, p=0.003), syncope (HR=0.73, p=0.005), atrial fibrillation/flutter (HR=0.80, p=0.042), acute kidney injury (HR=0.69, p<0.001), acute myocardial infarction (HR=0.69, p=0.001), and pulmonary hypertension (HR=0.75, p=0.031). No significant differences were observed in cardiogenic shock, ventricular tachycardia, or stroke risks.
Conclusion
Contrary to expected outcomes, TTS patients with prediabetes demonstrated significantly better cardiovascular outcomes and lower mortality compared to those without prediabetes. This finding suggests a potential metabolic paradox in TTS that warrants further investigation. Possible explanations include earlier medical intervention, more aggressive risk factor management, or distinct pathophysiological mechanisms in prediabetic TTS patients.
背景：takotsubo综合征（TTS）与显著的心血管疾病相关。虽然糖尿病已被确定为TTS患者的一个危险因素，但糖尿病前期对预后的影响仍不清楚。本研究调查了糖尿病前期是否会影响TTS患者的心血管结局和死亡率。方法利用TriNetX全球协作网络，对18-79岁TTS患者进行回顾性队列研究。倾向评分匹配后，将前驱糖尿病患者（n= 3316）与无前驱糖尿病患者（n= 34909）进行比较（每个队列3316）。结果分析了5年随访期（诊断后1- 1825天）。统计分析包括风险比、危险比和生存分析。结果匹配后，糖尿病前期TTS患者的全因死亡率（11.5% vs 19.4%， RR=0.59, p= 0.001）、急性肾损伤（7.7% vs 10.0%， RR=0.77, p=0.008）和急性心肌梗死（9.3% vs 12.1%， RR=0.77, p=0.018）均显著低于非糖尿病前期患者。心力衰竭倾向于显著性（19.3% vs 22.2%； RR=0.87, p=0.051）。Kaplan-Meier生存分析显示，糖尿病前期患者在死亡率（HR=0.53, p=0.001）、心力衰竭（HR=0.79, p=0.003）、晕厥（HR=0.73, p=0.005）、心房颤动/扑动（HR=0.80, p=0.042）、急性肾损伤（HR=0.69, p=0.001）、急性心肌梗死（HR=0.69, p=0.001）和肺动脉高血压（HR=0.75, p=0.031）方面的预后显著改善。在心源性休克、室性心动过速或卒中风险方面没有观察到显著差异。结论与预期结果相反，伴有前驱糖尿病的TTS患者心血管预后明显优于无前驱糖尿病患者，死亡率明显低于无前驱糖尿病患者。这一发现提示了TTS中潜在的代谢悖论，值得进一步研究。可能的解释包括早期的医疗干预，更积极的危险因素管理，或糖尿病前期TTS患者独特的病理生理机制。
{"title":"Prediabetes in Takotsubo Syndrome: Impact on Cardiovascular Outcomes and Mortality in a Propensity-Matched Cohort Study","authors":"Karldon Iwuchukwu Nwaezeapu, Godbless Ajenaghughrure, Ekow Essien, Abena Agyekum","doi":"10.1016/j.ahj.2025.07.055","DOIUrl":"10.1016/j.ahj.2025.07.055","url":null,"abstract":"<div><h3>Background</h3><div>Takotsubo syndrome (TTS) is associated with significant cardiovascular morbidity. While diabetes has been identified as a risk factor in TTS patients, the impact of prediabetes on outcomes remains poorly characterized. This study investigated whether prediabetes affects cardiovascular outcomes and mortality in patients with TTS.</div></div><div><h3>Methods</h3><div>Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of TTS patients aged 18-79 years. Patients with prediabetes (n=3,316) were compared to those without prediabetes (n=34,909) after propensity score matching (3,316 per cohort). Outcomes were analyzed over a 5-year follow-up period (1-1,825 days post-diagnosis). Statistical analyses included risk ratios, hazard ratios, and survival analyses.</div></div><div><h3>Results</h3><div>After matching, prediabetic TTS patients demonstrated significantly lower all-cause mortality (11.5% vs 19.4%; RR=0.59, p<0.001), acute kidney injury (7.7% vs 10.0%; RR=0.77, p=0.008), and acute myocardial infarction (9.3% vs 12.1%; RR=0.77, p=0.018) compared to non-prediabetic patients. Heart failure trended toward significance (19.3% vs 22.2%; RR=0.87, p=0.051). Kaplan-Meier survival analysis showed significantly better outcomes for prediabetic patients in mortality (HR=0.53, p<0.001), heart failure (HR=0.79, p=0.003), syncope (HR=0.73, p=0.005), atrial fibrillation/flutter (HR=0.80, p=0.042), acute kidney injury (HR=0.69, p<0.001), acute myocardial infarction (HR=0.69, p=0.001), and pulmonary hypertension (HR=0.75, p=0.031). No significant differences were observed in cardiogenic shock, ventricular tachycardia, or stroke risks.</div></div><div><h3>Conclusion</h3><div>Contrary to expected outcomes, TTS patients with prediabetes demonstrated significantly better cardiovascular outcomes and lower mortality compared to those without prediabetes. This finding suggests a potential metabolic paradox in TTS that warrants further investigation. Possible explanations include earlier medical intervention, more aggressive risk factor management, or distinct pathophysiological mechanisms in prediabetic TTS patients.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 23-24"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spontaneous coronary artery dissection (SCAD) and peripartum cardiomyopathy (PPCM) are distinct cardiovascular conditions affecting predominantly female patients, yet comparative data on their long-term outcomes remains limited. This study compared mortality, arrhythmic events, and other cardiovascular outcomes between propensity-matched cohorts of patients with these conditions.
Methods
This retrospective cohort study utilized the TriNetX Research Network, analyzing de-identified electronic health record data from 131 healthcare organizations. We identified 12,250 patients with PPCM and 8,261 with SCAD. After propensity score matching for age, race, ethnicity, and key comorbidities, cohorts of 2,814 patients each were analyzed. Outcomes were assessed using risk analysis, Kaplan-Meier survival analysis, and number of instances analysis over a five-year follow-up period.
Results
All-cause mortality did not differ significantly between groups (PPCM 3.8% vs SCAD 3.9%, p=0.883). Patients with PPCM had significantly higher risks of cardiogenic shock (HR 1.654, 95% CI 1.093-2.504, p=0.016), heart failure (HR 2.072, 95% CI 1.755-2.447, p<0.001), ventricular tachycardia (HR 1.498, 95% CI 1.126-1.994, p=0.005), acute kidney injury (HR 1.738, 95% CI 1.336-2.261, p<0.001), and pacemaker implantation (HR 1.848, 95% CI 1.377-2.480, p<0.001). Conversely, SCAD patients demonstrated higher risks of cerebrovascular disease (HR 0.378, 95% CI 0.299-0.479, p<0.001) and coronary artery disease (HR 0.132, 95% CI 0.110-0.158, p<0.001).
Conclusion
Despite similar mortality rates, PPCM and SCAD exhibit distinct cardiovascular outcome profiles, suggesting different pathophysiological mechanisms and highlighting the need for condition-specific management strategies. PPCM patients face greater risks of heart failure, arrhythmias, and device therapy, while SCAD patients have higher cerebrovascular and progressive coronary disease burdens.
自发性冠状动脉夹层（SCAD）和围产期心肌病（PPCM）是两种不同的心血管疾病，主要影响女性患者，但其长期预后的比较数据仍然有限。本研究比较了这些疾病患者倾向匹配队列之间的死亡率、心律失常事件和其他心血管结局。方法本回顾性队列研究利用TriNetX研究网络，分析来自131家医疗机构的去识别电子健康记录数据。我们确定了12250例PPCM患者和8261例SCAD患者。在对年龄、种族、民族和主要合并症进行倾向评分匹配后，对每组2814例患者进行分析。使用风险分析、Kaplan-Meier生存分析和5年随访期间的病例数分析来评估结果。结果两组间全因死亡率无显著差异（PPCM 3.8% vs SCAD 3.9%, p=0.883）。PPCM患者发生心源性休克（HR 1.654, 95% CI 1.093-2.504, p=0.016）、心力衰竭（HR 2.072, 95% CI 1.755-2.447, p= 0.001）、室性心动心动（HR 1.498, 95% CI 1.126-1.994, p=0.005）、急性肾损伤（HR 1.738, 95% CI 1.336-2.261, p= 0.001）和起搏器植入（HR 1.848, 95% CI 1.377-2.480, p= 0.001）的风险显著增高。相反，SCAD患者出现脑血管疾病（HR 0.378, 95% CI 0.299-0.479, p<0.001）和冠状动脉疾病（HR 0.132, 95% CI 0.110-0.158, p<0.001）的风险更高。结论：尽管死亡率相似，但PPCM和SCAD表现出不同的心血管结局，提示不同的病理生理机制，并强调需要针对特定疾病的治疗策略。PPCM患者面临更大的心力衰竭、心律失常和器械治疗的风险，而SCAD患者有更高的脑血管和进行性冠状动脉疾病负担。
{"title":"Comparative Analysis of Cardiovascular Outcomes Between Patients Diagnosed with Spontaneous Coronary Artery Dissection and Those with Peripartum Cardiomyopathy: A Propensity-Matched Analysis Using the TriNetX Research Network","authors":"Abena Korwaa Agyekum MD , Ekow Essien MD , Karldon Nwaezeapu MD , Godbless Ajenaghughrure MD , Gloria Amoako MD , Nana Osei MD , Esther Obeng-Danso MD , Suzette Graham-Hill MD , Samy Macfarlane MD","doi":"10.1016/j.ahj.2025.07.051","DOIUrl":"10.1016/j.ahj.2025.07.051","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous coronary artery dissection (SCAD) and peripartum cardiomyopathy (PPCM) are distinct cardiovascular conditions affecting predominantly female patients, yet comparative data on their long-term outcomes remains limited. This study compared mortality, arrhythmic events, and other cardiovascular outcomes between propensity-matched cohorts of patients with these conditions.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized the TriNetX Research Network, analyzing de-identified electronic health record data from 131 healthcare organizations. We identified 12,250 patients with PPCM and 8,261 with SCAD. After propensity score matching for age, race, ethnicity, and key comorbidities, cohorts of 2,814 patients each were analyzed. Outcomes were assessed using risk analysis, Kaplan-Meier survival analysis, and number of instances analysis over a five-year follow-up period.</div></div><div><h3>Results</h3><div>All-cause mortality did not differ significantly between groups (PPCM 3.8% vs SCAD 3.9%, p=0.883). Patients with PPCM had significantly higher risks of cardiogenic shock (HR 1.654, 95% CI 1.093-2.504, p=0.016), heart failure (HR 2.072, 95% CI 1.755-2.447, p<0.001), ventricular tachycardia (HR 1.498, 95% CI 1.126-1.994, p=0.005), acute kidney injury (HR 1.738, 95% CI 1.336-2.261, p<0.001), and pacemaker implantation (HR 1.848, 95% CI 1.377-2.480, p<0.001). Conversely, SCAD patients demonstrated higher risks of cerebrovascular disease (HR 0.378, 95% CI 0.299-0.479, p<0.001) and coronary artery disease (HR 0.132, 95% CI 0.110-0.158, p<0.001).</div></div><div><h3>Conclusion</h3><div>Despite similar mortality rates, PPCM and SCAD exhibit distinct cardiovascular outcome profiles, suggesting different pathophysiological mechanisms and highlighting the need for condition-specific management strategies. PPCM patients face greater risks of heart failure, arrhythmias, and device therapy, while SCAD patients have higher cerebrovascular and progressive coronary disease burdens.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 21-22"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-15DOI: 10.1016/j.ahj.2025.07.059
Ekow Essien, Abraham Carboo, Karldon Nwaezeapu, Abena Agyekum, Patrick Berchie, Justice Owusu-Achiaw, Kwame Mensa-Yawson, Edmund Mireku Bediako
Background
Inflammation plays a crucial role in heart failure pathophysiology, but the prognostic value of high-sensitivity C-reactive protein (hs-CRP) in heart failure with reduced ejection fraction (HFrEF) remains incompletely characterized. This study aimed to compare clinical outcomes between HFrEF patients with elevated versus normal hs-CRP levels.
Methods
We performed a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing electronic medical records across 130 healthcare organizations. Adult patients (18-90 years) with HFrEF (left ventricular ejection fraction ≤40%) were stratified by hs-CRP levels: high (≥3.1 mg/L) versus low (≤3.0 mg/L). After propensity score matching for baseline characteristics, cohorts of 2,374 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular, respiratory, and renal complications over a five-year follow-up period.
Results
Elevated hs-CRP was associated with significantly higher all-cause mortality (39.0% vs 28.7%; HR 1.542, 95% CI 1.396-1.704; p<0.001). Patients with high hs-CRP demonstrated increased risk of acute kidney injury (27.0% vs 21.2%; HR 1.511, 95% CI 1.299-1.757; p<0.001), chronic kidney disease (21.7% vs 17.3%; HR 1.495, 95% CI 1.268-1.762; p<0.001), coronary artery disease (24.4% vs 19.0%; HR 1.591, 95% CI 1.253-2.020; p<0.001), pulmonary edema (12.3% vs 9.5%; HR 1.489, 95% CI 1.219-1.818; p<0.001), and pulmonary embolism (2.4% vs 1.4%; HR 1.966, 95% CI 1.260-3.068; p=0.002).
Conclusion
In HFrEF patients, elevated hs-CRP levels independently predict higher all-cause mortality and increased risk of cardiovascular, pulmonary, and renal complications. These findings suggest that hs-CRP may serve as a valuable prognostic marker to identify high-risk patients who might benefit from more intensive monitoring and targeted anti-inflammatory interventions.
背景：炎症在心力衰竭病理生理中起着至关重要的作用，但高敏c反应蛋白（hs-CRP）在心力衰竭伴射血分数降低（HFrEF）中的预后价值仍未完全确定。本研究旨在比较hs-CRP水平升高与正常HFrEF患者的临床结果。方法我们使用TriNetX全球协作网络进行了一项回顾性队列研究，分析了130家医疗机构的电子病历。HFrEF（左室射血分数≤40%）的成年患者（18-90岁）按hs-CRP水平分层：高（≥3.1 mg/L）与低（≤3.0 mg/L）。在基线特征的倾向评分匹配后，分析了每个2,374例患者的队列。主要结局为全因死亡率。在5年的随访期间，次要结局包括心血管、呼吸和肾脏并发症。结果hs-CRP升高与全因死亡率显著升高相关（39.0% vs 28.7%; HR 1.542, 95% CI 1.396 ~ 1.704; p<0.001）。高hs-CRP患者表现出急性肾损伤（27.0% vs 21.2%; HR 1.511, 95% CI 1.499 -1.757; p=0.002）、慢性肾脏疾病（21.7% vs 17.3%; HR 1.495, 95% CI 1.268-1.762; p<0.001）、冠状动脉疾病（24.4% vs 19.0%; HR 1.591, 95% CI 1.252 -2.020; p<0.001）、肺水肿（12.3% vs 9.5%; HR 1.489, 95% CI 1.219-1.818; p<0.001）和肺栓塞（2.4% vs 1.4%; HR 1.966, 95% CI 1.260-3.068; p=0.002）的风险增加。结论在HFrEF患者中，hs-CRP水平升高独立预测了更高的全因死亡率和心血管、肺部和肾脏并发症的风险增加。这些发现表明hs-CRP可以作为一种有价值的预后标志物，用于识别高危患者，这些患者可能受益于更密集的监测和有针对性的抗炎干预。
{"title":"High-Sensitivity C-Reactive Protein as a Prognostic Indicator in Heart Failure with Reduced Ejection Fraction: Evidence from the TriNetX Database","authors":"Ekow Essien, Abraham Carboo, Karldon Nwaezeapu, Abena Agyekum, Patrick Berchie, Justice Owusu-Achiaw, Kwame Mensa-Yawson, Edmund Mireku Bediako","doi":"10.1016/j.ahj.2025.07.059","DOIUrl":"10.1016/j.ahj.2025.07.059","url":null,"abstract":"<div><h3>Background</h3><div>Inflammation plays a crucial role in heart failure pathophysiology, but the prognostic value of high-sensitivity C-reactive protein (hs-CRP) in heart failure with reduced ejection fraction (HFrEF) remains incompletely characterized. This study aimed to compare clinical outcomes between HFrEF patients with elevated versus normal hs-CRP levels.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing electronic medical records across 130 healthcare organizations. Adult patients (18-90 years) with HFrEF (left ventricular ejection fraction ≤40%) were stratified by hs-CRP levels: high (≥3.1 mg/L) versus low (≤3.0 mg/L). After propensity score matching for baseline characteristics, cohorts of 2,374 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular, respiratory, and renal complications over a five-year follow-up period.</div></div><div><h3>Results</h3><div>Elevated hs-CRP was associated with significantly higher all-cause mortality (39.0% vs 28.7%; HR 1.542, 95% CI 1.396-1.704; p<0.001). Patients with high hs-CRP demonstrated increased risk of acute kidney injury (27.0% vs 21.2%; HR 1.511, 95% CI 1.299-1.757; p<0.001), chronic kidney disease (21.7% vs 17.3%; HR 1.495, 95% CI 1.268-1.762; p<0.001), coronary artery disease (24.4% vs 19.0%; HR 1.591, 95% CI 1.253-2.020; p<0.001), pulmonary edema (12.3% vs 9.5%; HR 1.489, 95% CI 1.219-1.818; p<0.001), and pulmonary embolism (2.4% vs 1.4%; HR 1.966, 95% CI 1.260-3.068; p=0.002).</div></div><div><h3>Conclusion</h3><div>In HFrEF patients, elevated hs-CRP levels independently predict higher all-cause mortality and increased risk of cardiovascular, pulmonary, and renal complications. These findings suggest that hs-CRP may serve as a valuable prognostic marker to identify high-risk patients who might benefit from more intensive monitoring and targeted anti-inflammatory interventions.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 26"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-15DOI: 10.1016/j.ahj.2025.07.061
Ekow Essien, Justice Owusu-Achiaw, Abraham Carboo, Karldon Nwaezeapu, Abena Agyekum, Patrick Berchie, Kwame Mensa-Yawson, Edmund Mireku Bediako
Background
Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) frequently coexist and independently increase cardiovascular risk. However, the impact of glycemic control on cardiovascular outcomes in patients with both conditions remains incompletely characterized.
Methods
We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data from 128 healthcare organizations. Patients with OSA and T2DM were stratified by glycemic control (HbA1c ≥7.0% vs. ≤6.9%). After propensity score matching for demographics and comorbidities, cohorts of 404,399 patients each were analyzed. Outcomes were assessed using risk analysis and Kaplan-Meier survival analysis with a 5-year follow-up period.
Results
In propensity-matched populations, poorly-controlled diabetes was associated with significantly higher all-cause mortality compared to well-controlled diabetes (11.3% vs. 10.8%; Risk Ratio [RR] 1.046, 95% CI 1.033-1.059; p<0.001). Poorly-controlled diabetes was also associated with increased risk of heart failure (12.4% vs. 11.1%; RR 1.118, 95% CI 1.103-1.134; p<0.001), acute kidney injury (13.8% vs. 12.0%; RR 1.152, 95% CI 1.137-1.166; p<0.001), chronic kidney disease (13.6% vs. 11.8%; RR 1.159, 95% CI 1.143-1.174; p<0.001), and coronary artery disease (13.4% vs. 12.3%; RR 1.085, 95% CI 1.070-1.100; p<0.001). No significant difference was observed in ventricular tachycardia risk between groups.
Conclusion
Among OSA patients with T2DM, poor glycemic control is associated with significantly worse cardiovascular and renal outcomes. These findings emphasize the importance of optimal diabetes management in OSA patients to mitigate cardiovascular risk.
背景：阻塞性睡眠呼吸暂停（OSA）和2型糖尿病（T2DM）经常共存并独立增加心血管风险。然而，血糖控制对两种疾病患者心血管预后的影响仍不完全明确。方法采用TriNetX全球协作网络进行回顾性队列研究，分析来自128家医疗机构的数据。根据血糖控制情况（HbA1c≥7.0% vs≤6.9%）对OSA和T2DM患者进行分层。在人口统计学和合并症的倾向评分匹配后，分析了404,399名患者的队列。结果评估采用风险分析和Kaplan-Meier生存分析，随访5年。结果在倾向匹配人群中，控制不良的糖尿病患者的全因死亡率明显高于控制良好的糖尿病患者（11.3% vs. 10.8%；风险比[RR] 1.046, 95% CI 1.033-1.059; p<0.001）。控制不良的糖尿病还与心力衰竭（12.4%比11.1%;RR 1.118, 95% CI 1.103-1.134; p<0.001）、急性肾损伤（13.8%比12.0%;RR 1.152, 95% CI 1.137-1.166; p<0.001）、慢性肾脏疾病（13.6%比11.8%;RR 1.159, 95% CI 1.143-1.174; p<0.001）和冠状动脉疾病（13.4%比12.3%;RR 1.085, 95% CI 1.070-1.100; p<0.001）的风险增加相关。两组间室性心动过速风险无显著差异。结论在OSA合并T2DM患者中，血糖控制不良与心血管和肾脏预后显著恶化相关。这些发现强调了对OSA患者进行最佳糖尿病管理以降低心血管风险的重要性。
{"title":"Cardiovascular Risk in Obstructive Sleep Apnea: Impact of Glycemic Control in Diabetes — Insights from the TriNetX Network","authors":"Ekow Essien, Justice Owusu-Achiaw, Abraham Carboo, Karldon Nwaezeapu, Abena Agyekum, Patrick Berchie, Kwame Mensa-Yawson, Edmund Mireku Bediako","doi":"10.1016/j.ahj.2025.07.061","DOIUrl":"10.1016/j.ahj.2025.07.061","url":null,"abstract":"<div><h3>Background</h3><div>Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) frequently coexist and independently increase cardiovascular risk. However, the impact of glycemic control on cardiovascular outcomes in patients with both conditions remains incompletely characterized.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data from 128 healthcare organizations. Patients with OSA and T2DM were stratified by glycemic control (HbA1c ≥7.0% vs. ≤6.9%). After propensity score matching for demographics and comorbidities, cohorts of 404,399 patients each were analyzed. Outcomes were assessed using risk analysis and Kaplan-Meier survival analysis with a 5-year follow-up period.</div></div><div><h3>Results</h3><div>In propensity-matched populations, poorly-controlled diabetes was associated with significantly higher all-cause mortality compared to well-controlled diabetes (11.3% vs. 10.8%; Risk Ratio [RR] 1.046, 95% CI 1.033-1.059; p<0.001). Poorly-controlled diabetes was also associated with increased risk of heart failure (12.4% vs. 11.1%; RR 1.118, 95% CI 1.103-1.134; p<0.001), acute kidney injury (13.8% vs. 12.0%; RR 1.152, 95% CI 1.137-1.166; p<0.001), chronic kidney disease (13.6% vs. 11.8%; RR 1.159, 95% CI 1.143-1.174; p<0.001), and coronary artery disease (13.4% vs. 12.3%; RR 1.085, 95% CI 1.070-1.100; p<0.001). No significant difference was observed in ventricular tachycardia risk between groups.</div></div><div><h3>Conclusion</h3><div>Among OSA patients with T2DM, poor glycemic control is associated with significantly worse cardiovascular and renal outcomes. These findings emphasize the importance of optimal diabetes management in OSA patients to mitigate cardiovascular risk.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 27"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spontaneous coronary artery dissection (SCAD) increasingly causes acute coronary syndrome, especially in young women without traditional cardiovascular risk factors. This systematic review examines multimodality imaging approaches for SCAD diagnosis and management.
Methods
Following PRISMA-DTA guidelines, we searched four databases (MEDLINE, Embase, Cochrane Library, Web of Science) using comprehensive search terms. Independent reviewers screened studies, extracted data, and assessed quality with QUADAS-2. Eligible studies evaluated diagnostic approaches including invasive coronary angiography (ICA), optical coherence tomography (OCT), intravascular ultrasound (IVUS), coronary computed tomographic angiography (CCTA), and cardiac magnetic resonance (CMR).
Results
Multidetector Computed Tomography showed superior diagnostic performance to Coronary Angiography for SCAD detection (sensitivity 98.6% vs 77.8%, specificity 89.7% vs 79.4%). MDCT identified “sleeve-like” wall thickening in 71% of cases, along with “plaque-like” appearances, visible intimal flaps, or total occlusions. CMR revealed myocardial delayed enhancement in 83% of patients with 44% showing microvascular obstruction. OCT and IVUS served as reference standards, revealing intramural hematoma as the predominant finding. MDCT and CAG showed excellent correlation in stenosis grading (ICC = 0.8; p = 0.004). CCT identified SCAD in 78% of acute presentation lesions.
Conclusions
Each imaging modality offers unique diagnostic strengths. While invasive coronary angiography remains first-line, MDCT shows promise as a non-invasive alternative with high sensitivity and specificity. CMR provides valuable information about myocardial injury, while OCT and IVUS offer detailed vessel wall characterization. A multimodality imaging approach optimizes diagnosis, guides management, and assesses prognosis in SCAD.
自发性冠状动脉夹层（SCAD）越来越多地引起急性冠状动脉综合征，特别是在没有传统心血管危险因素的年轻女性中。本系统综述探讨了SCAD诊断和管理的多模态成像方法。方法按照PRISMA-DTA指南，采用综合检索词对MEDLINE、Embase、Cochrane Library、Web of Science四个数据库进行检索。独立审稿人筛选研究，提取数据，并使用QUADAS-2评估质量。符合条件的研究评估了诊断方法，包括侵入性冠状动脉造影（ICA）、光学相干断层扫描（OCT）、血管内超声（IVUS）、冠状动脉计算机断层造影（CCTA）和心脏磁共振（CMR）。结果多探头ct对SCAD的诊断效果优于冠状动脉造影（灵敏度98.6% vs 77.8%，特异性89.7% vs 79.4%）。MDCT显示71%的病例出现“袖样”壁增厚，同时出现“斑块样”外观，可见内膜瓣或完全闭塞。CMR显示83%的患者心肌延迟增强，44%的患者出现微血管阻塞。以OCT和IVUS为参考标准，颅内血肿为主要表现。MDCT与CAG对狭窄分级的相关性极好（ICC = 0.8;p = 0.004）。CCT在78%的急性表现病变中发现SCAD。结论各成像方式具有独特的诊断优势。虽然有创冠状动脉造影仍然是一线，但MDCT作为一种具有高灵敏度和特异性的非侵入性替代方法显示出了希望。CMR提供心肌损伤的宝贵信息，而OCT和IVUS提供详细的血管壁特征。多模态成像方法可优化SCAD的诊断、指导管理和评估预后。
{"title":"Diagnostic Approaches for Spontaneous Coronary Artery Dissection: A Systematic Review of Multimodality Imaging","authors":"Ekow Essien MD, Karldon Nwaezeapu MD, Abena Agyekum MD, Godbless Ajenaghughrure MD, Justice Owusu-Achiaw MD, Edmund Mireku Bediako MD","doi":"10.1016/j.ahj.2025.07.027","DOIUrl":"10.1016/j.ahj.2025.07.027","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous coronary artery dissection (SCAD) increasingly causes acute coronary syndrome, especially in young women without traditional cardiovascular risk factors. This systematic review examines multimodality imaging approaches for SCAD diagnosis and management.</div></div><div><h3>Methods</h3><div>Following PRISMA-DTA guidelines, we searched four databases (MEDLINE, Embase, Cochrane Library, Web of Science) using comprehensive search terms. Independent reviewers screened studies, extracted data, and assessed quality with QUADAS-2. Eligible studies evaluated diagnostic approaches including invasive coronary angiography (ICA), optical coherence tomography (OCT), intravascular ultrasound (IVUS), coronary computed tomographic angiography (CCTA), and cardiac magnetic resonance (CMR).</div></div><div><h3>Results</h3><div>Multidetector Computed Tomography showed superior diagnostic performance to Coronary Angiography for SCAD detection (sensitivity 98.6% vs 77.8%, specificity 89.7% vs 79.4%). MDCT identified “sleeve-like” wall thickening in 71% of cases, along with “plaque-like” appearances, visible intimal flaps, or total occlusions. CMR revealed myocardial delayed enhancement in 83% of patients with 44% showing microvascular obstruction. OCT and IVUS served as reference standards, revealing intramural hematoma as the predominant finding. MDCT and CAG showed excellent correlation in stenosis grading (ICC = 0.8; p = 0.004). CCT identified SCAD in 78% of acute presentation lesions.</div></div><div><h3>Conclusions</h3><div>Each imaging modality offers unique diagnostic strengths. While invasive coronary angiography remains first-line, MDCT shows promise as a non-invasive alternative with high sensitivity and specificity. CMR provides valuable information about myocardial injury, while OCT and IVUS offer detailed vessel wall characterization. A multimodality imaging approach optimizes diagnosis, guides management, and assesses prognosis in SCAD.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 7"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peripartum cardiomyopathy (PPCM) is a rare, potentially life-threatening condition. The prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in PPCM remains incompletely characterized. This study aimed to compare mortality, cardiovascular events, and other clinical outcomes between PPCM patients with high versus low NT-proBNP levels.
Methods
We performed a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data across 131 healthcare organizations. PPCM patients (ICD-10 code O90.3) aged 18-50 years were stratified by NT-proBNP levels: high (≥300 pg/mL) versus low (<300 pg/mL). After propensity score matching for baseline demographics and comorbidities, cohorts of 1,140 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular events, arrhythmias, and hospitalizations over a five-year follow-up period.
Results
In propensity-matched cohorts, PPCM patients with high NT-proBNP levels exhibited significantly higher all-cause mortality compared to those with low levels (4.5% vs 0.9%; risk ratio [RR] 5.11, 95% CI 2.61-10.01; p<0.001). The high NT-proBNP group also demonstrated increased risks of cardiogenic shock (RR 5.70, 95% CI 2.92-11.13; p<0.001), ventricular tachycardia (RR 1.76, 95% CI 1.17-2.67; p=0.006), atrial fibrillation (RR 2.93, 95% CI 1.70-5.05; p<0.001), acute kidney injury (RR 3.65, 95% CI 2.40-5.55; p<0.001), cerebrovascular disease (RR 2.80, 95% CI 1.67-4.70; p<0.001), and other adverse outcomes.
Conclusion
High NT-proBNP levels in PPCM patients are associated with significantly higher mortality and adverse cardiovascular outcomes. These findings suggest that NT-proBNP may serve as a valuable prognostic biomarker in PPCM and could help identify high-risk patients requiring more intensive monitoring and therapy.
背景围产期心肌病（PPCM）是一种罕见的、可能危及生命的疾病。脑钠素n端前肽（NT-proBNP）在PPCM中的预后价值尚未完全确定。本研究旨在比较NT-proBNP水平高与低的PPCM患者的死亡率、心血管事件和其他临床结果。方法我们使用TriNetX全球协作网络进行了一项回顾性队列研究，分析了131家医疗机构的数据。年龄18-50岁的PPCM患者（ICD-10代码O90.3）按NT-proBNP水平分层：高（≥300 pg/mL）和低（<300 pg/mL）。在对基线人口统计学和合并症进行倾向评分匹配后，对每组1,140例患者进行分析。主要结局为全因死亡率。次要结局包括心血管事件、心律失常和5年随访期间的住院情况。结果在倾向匹配的队列中，高NT-proBNP水平的PPCM患者的全因死亡率明显高于低NT-proBNP水平的患者（4.5% vs 0.9%；风险比[RR] 5.11, 95% CI 2.61-10.01; p<0.001）。高NT-proBNP组还显示心源性休克（RR 5.70, 95% CI 2.92-11.13; p<0.001）、室性心动心动（RR 1.76, 95% CI 1.17-2.67; p=0.006）、房颤（RR 2.93, 95% CI 1.70-5.05; p<0.001）、急性肾损伤（RR 3.65, 95% CI 2.40-5.55; p<0.001）、脑血管疾病（RR 2.80, 95% CI 1.67-4.70; p<0.001）和其他不良结局的风险增加。结论PPCM患者NT-proBNP水平高与较高的死亡率和不良心血管结局相关。这些发现表明NT-proBNP可能作为PPCM中有价值的预后生物标志物，可以帮助识别需要更密切监测和治疗的高危患者。
{"title":"Impact of NT-proBNP Levels on Clinical Outcomes in Peripartum Cardiomyopathy: A Propensity-Matched Analysis Using the TriNetX Research Network","authors":"Abena Korwaa Agyekum MD , Ekow Essien MD , Karldon Nwaezeapu MD , Godbless Ajenaghughrure MD , Nana Osei MD , Esther Obeng-Danso MD , Samuel Governor MD , Gloria Amoako MD , Inna Bukharovich MD , Suzette Graham-Hill MD","doi":"10.1016/j.ahj.2025.07.036","DOIUrl":"10.1016/j.ahj.2025.07.036","url":null,"abstract":"<div><h3>Background</h3><div>Peripartum cardiomyopathy (PPCM) is a rare, potentially life-threatening condition. The prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in PPCM remains incompletely characterized. This study aimed to compare mortality, cardiovascular events, and other clinical outcomes between PPCM patients with high versus low NT-proBNP levels.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data across 131 healthcare organizations. PPCM patients (ICD-10 code O90.3) aged 18-50 years were stratified by NT-proBNP levels: high (≥300 pg/mL) versus low (<300 pg/mL). After propensity score matching for baseline demographics and comorbidities, cohorts of 1,140 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular events, arrhythmias, and hospitalizations over a five-year follow-up period.</div></div><div><h3>Results</h3><div>In propensity-matched cohorts, PPCM patients with high NT-proBNP levels exhibited significantly higher all-cause mortality compared to those with low levels (4.5% vs 0.9%; risk ratio [RR] 5.11, 95% CI 2.61-10.01; p<0.001). The high NT-proBNP group also demonstrated increased risks of cardiogenic shock (RR 5.70, 95% CI 2.92-11.13; p<0.001), ventricular tachycardia (RR 1.76, 95% CI 1.17-2.67; p=0.006), atrial fibrillation (RR 2.93, 95% CI 1.70-5.05; p<0.001), acute kidney injury (RR 3.65, 95% CI 2.40-5.55; p<0.001), cerebrovascular disease (RR 2.80, 95% CI 1.67-4.70; p<0.001), and other adverse outcomes.</div></div><div><h3>Conclusion</h3><div>High NT-proBNP levels in PPCM patients are associated with significantly higher mortality and adverse cardiovascular outcomes. These findings suggest that NT-proBNP may serve as a valuable prognostic biomarker in PPCM and could help identify high-risk patients requiring more intensive monitoring and therapy.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 12-13"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity and obstructive sleep apnea (OSA) are strongly associated with adverse cardiovascular outcomes. Both bariatric surgery and tirzepatide have shown efficacy for weight reduction, but their comparative cardiovascular effects in patients with OSA remain poorly characterized. This study aimed to compare cardiovascular outcomes between these treatment modalities in obese patients with sleep apnea.
Methods
We performed a retrospective cohort study using the TriNetX Research Network, analyzing data across 128 healthcare organizations. Patients with sleep apnea and BMI ≥30 kg/m² treated with either bariatric surgery or tirzepatide were identified. After propensity score matching for demographics and comorbidities, cohorts of 32,780 patients each were analyzed. The primary outcomes included mortality, heart failure, arrhythmias, cerebrovascular events, and other cardiovascular complications over a five-year follow-up period.
Results
Bariatric surgery was associated with significantly higher all-cause mortality compared to tirzepatide (1.6% vs 0.6%; risk ratio [RR] 2.84, 95% CI 2.41-3.35; p<0.001). Bariatric surgery patients also had higher rates of cardiogenic shock (RR 1.92, 95% CI 1.28-2.87), heart failure (RR 1.34, 95% CI 1.20-1.49), ventricular tachycardia (RR 1.57, 95% CI 1.26-1.96), pulmonary embolism (RR 1.92, 95% CI 1.54-2.41), and peripheral vascular disease (RR 1.21, 95% CI 1.04-1.41). Tirzepatide was associated with higher rates of type 2 diabetes (6.5% vs 4.2%; RR 0.65, 95% CI 0.59-0.71).
Conclusion
In obese patients with sleep apnea, tirzepatide treatment was associated with significantly lower all-cause mortality and fewer cardiovascular complications compared to bariatric surgery over five years of follow-up. These findings may inform treatment selection when considering intervention options for this high-risk population.
背景：肥胖和阻塞性睡眠呼吸暂停（OSA）与不良心血管结局密切相关。减肥手术和替西帕肽都显示出减轻体重的效果，但它们对OSA患者心血管的比较作用仍然不清楚。本研究旨在比较这些治疗方式对肥胖睡眠呼吸暂停患者的心血管预后。方法我们利用TriNetX研究网络进行了一项回顾性队列研究，分析了128家医疗机构的数据。确定了接受减肥手术或替西帕肽治疗的睡眠呼吸暂停和BMI≥30 kg/m²的患者。在人口统计学和合并症的倾向评分匹配后，分析了32780名患者的队列。主要结局包括5年随访期间的死亡率、心力衰竭、心律失常、脑血管事件和其他心血管并发症。结果与替西帕肽相比，减肥手术的全因死亡率明显更高（1.6% vs 0.6%；风险比[RR] 2.84, 95% CI 2.41-3.35; p<0.001）。减肥手术患者的心源性休克（RR 1.92, 95% CI 1.28-2.87）、心力衰竭（RR 1.34, 95% CI 1.20-1.49）、室性心动过速（RR 1.57, 95% CI 1.26-1.96）、肺栓塞（RR 1.92, 95% CI 1.54-2.41）和外周血管疾病（RR 1.21, 95% CI 1.04-1.41）的发生率也较高。替西帕肽与较高的2型糖尿病发病率相关（6.5% vs 4.2%; RR 0.65, 95% CI 0.59-0.71）。结论在伴有睡眠呼吸暂停的肥胖患者中，与减肥手术相比，替西帕肽治疗可显著降低全因死亡率和心血管并发症。这些发现可能会在考虑对这一高危人群进行干预时为治疗选择提供信息。
{"title":"Cardiovascular Outcomes in Obese Patients with Sleep Apnea Treated with Tirzepatide Versus Bariatric Surgery: A Propensity-Matched Analysis Using the TriNetX Research Network","authors":"Ekow Essien MD, Karldon Nwaezeapu MD, Abena Agyekum MD, Godbless Ajenaghughrure MD, Justice Owusu-Achiaw MD, Edmund Mireku Bediako MD","doi":"10.1016/j.ahj.2025.07.039","DOIUrl":"10.1016/j.ahj.2025.07.039","url":null,"abstract":"<div><h3>Background</h3><div>Obesity and obstructive sleep apnea (OSA) are strongly associated with adverse cardiovascular outcomes. Both bariatric surgery and tirzepatide have shown efficacy for weight reduction, but their comparative cardiovascular effects in patients with OSA remain poorly characterized. This study aimed to compare cardiovascular outcomes between these treatment modalities in obese patients with sleep apnea.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using the TriNetX Research Network, analyzing data across 128 healthcare organizations. Patients with sleep apnea and BMI ≥30 kg/m² treated with either bariatric surgery or tirzepatide were identified. After propensity score matching for demographics and comorbidities, cohorts of 32,780 patients each were analyzed. The primary outcomes included mortality, heart failure, arrhythmias, cerebrovascular events, and other cardiovascular complications over a five-year follow-up period.</div></div><div><h3>Results</h3><div>Bariatric surgery was associated with significantly higher all-cause mortality compared to tirzepatide (1.6% vs 0.6%; risk ratio [RR] 2.84, 95% CI 2.41-3.35; p<0.001). Bariatric surgery patients also had higher rates of cardiogenic shock (RR 1.92, 95% CI 1.28-2.87), heart failure (RR 1.34, 95% CI 1.20-1.49), ventricular tachycardia (RR 1.57, 95% CI 1.26-1.96), pulmonary embolism (RR 1.92, 95% CI 1.54-2.41), and peripheral vascular disease (RR 1.21, 95% CI 1.04-1.41). Tirzepatide was associated with higher rates of type 2 diabetes (6.5% vs 4.2%; RR 0.65, 95% CI 0.59-0.71).</div></div><div><h3>Conclusion</h3><div>In obese patients with sleep apnea, tirzepatide treatment was associated with significantly lower all-cause mortality and fewer cardiovascular complications compared to bariatric surgery over five years of follow-up. These findings may inform treatment selection when considering intervention options for this high-risk population.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 14"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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