American heart journal最新文献_第10页

Association Between Glycemic Control and Adverse Outcomes in Atrial Fibrillation: Evidence from a Large Real-World Cohort 房颤患者血糖控制与不良结局之间的关系：来自大型现实世界队列的证据

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal

Pub Date : 2025-09-15 DOI: 10.1016/j.ahj.2025.07.064

Ekow Essien, Justice Owusu-Achiaw, Abraham Carboo, Karldon Nwaezeapu, Abena Agyekum, Patrick Berchie, Kwame Mensa-Yawson, Edmund Mireku Bediako, Ashley E Kodjo

Background

Diabetes mellitus and atrial fibrillation frequently coexist, but the impact of glycemic control on outcomes in patients with both conditions remains incompletely characterized. This study aimed to compare adverse cardiovascular and renal outcomes between atrial fibrillation patients with poorly controlled versus well-controlled diabetes.

Methods

We conducted a retrospective cohort study using the TriNetX Research Network, a global federated health research platform. Patients with atrial fibrillation and type 2 diabetes were stratified by hemoglobin A1c (HbA1c) levels: poorly controlled (HbA1c ≥7.0%) versus well-controlled (HbA1c ≤6.9%). After propensity score matching for demographic and clinical characteristics, cohorts of 332,060 patients each were analyzed. Primary outcomes included all-cause mortality, heart failure, cardiogenic shock, and renal complications. Outcomes were analyzed using risk analysis and Kaplan-Meier survival analysis with hazard ratios (HR) and 95% confidence intervals (CI) over a five-year follow-up period.

Results

In this propensity-matched cohort, patients with poorly controlled diabetes demonstrated significantly higher all-cause mortality compared to those with well-controlled diabetes (26.3% vs 25.6%; HR 1.070, 95% CI 1.060-1.080; p<0.001). Poorly controlled diabetes was also associated with increased risk of heart failure (23.1% vs 22.8%; HR 1.071, 95% CI 1.056-1.086; p<0.001), acute kidney injury (19.8% vs 18.3%; HR 1.132, 95% CI 1.117-1.148; p<0.001), and chronic kidney disease (19.4% vs 17.8%; HR 1.161, 95% CI 1.145-1.178; p<0.001).

Conclusion

In patients with atrial fibrillation and type 2 diabetes, poor glycemic control is associated with increased mortality, heart failure, and renal complications. These findings highlight the importance of optimal diabetes management in this high-risk population.

糖尿病和房颤经常共存，但血糖控制对两种情况患者预后的影响尚未完全确定。本研究旨在比较控制不良与控制良好的糖尿病房颤患者的不良心血管和肾脏预后。方法：我们利用TriNetX研究网络（一个全球联合健康研究平台）进行了一项回顾性队列研究。心房颤动和2型糖尿病患者按血红蛋白A1c （HbA1c）水平分层：控制不良（HbA1c≥7.0%）和控制良好（HbA1c≤6.9%）。在人口统计学和临床特征的倾向评分匹配后，分析了332,060名患者的队列。主要结局包括全因死亡率、心力衰竭、心源性休克和肾脏并发症。结果分析采用风险分析和Kaplan-Meier生存分析，在5年随访期间采用风险比（HR）和95%可信区间（CI）。结果在这个倾向匹配的队列中，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（26.3% vs 25.6%; HR 1.070, 95% CI 1.060-1.080; p<0.001）。控制不良的糖尿病还与心力衰竭（23.1% vs 22.8%; HR 1.071, 95% CI 1.056-1.086; p<0.001）、急性肾损伤（19.8% vs 18.3%; HR 1.132, 95% CI 1.117-1.148; p<0.001）和慢性肾脏疾病（19.4% vs 17.8%; HR 1.161, 95% CI 1.145-1.178; p<0.001）的风险增加相关。结论房颤合并2型糖尿病患者血糖控制不良与死亡率增加、心力衰竭和肾脏并发症相关。这些发现强调了对这一高危人群进行最佳糖尿病管理的重要性。

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引用次数: 0

Impact of Relacorilant on Blood Pressure and Antihypertensive Medication Burden in Patients With Hypercortisolism and Hypertension: Results From the GRACE Study 抗凝剂对高皮质醇血症和高血压患者血压和降压药物负担的影响：GRACE研究结果

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal

Pub Date : 2025-09-15 DOI: 10.1016/j.ahj.2025.07.045

Serge Jabbour , Giorgio Arnaldi , Richard J. Auchus , Corin Badiu , Salvatore Cannavo , Ulrich Dischinger , Rogelio García-Centeno , Georgiana A. Dobri , Diane M. Donegan , Zeina C. Hannoush , Rosario Pivonello , Aurelian-Emil Ranetti , Antonio Stigliano , Christina Wang , Austin L. Hand , Katherine A. Araque , Andreas G. Moraitis

In the phase 3 GRACE study (NCT03697109) in adults with endogenous hypercortisolism and hypertension, hyperglycemia, or both, relacorilant significantly improved blood pressure (BP), meeting the primary endpoint. We report on the impact of relacorilant on BP and antihypertensive medication use among study participants with hypertension. GRACE comprised a 22-week, open-label (OL) phase of relacorilant 100–400 mg once daily followed by a 12-week, double-blind, placebo-controlled randomized withdrawal phase. Hypertension was defined as mean systolic blood pressure (SBP) 135–170 mm Hg and/or diastolic blood pressure (DBP) 85–110 mm Hg. Among participants with hypertension at OL baseline (n=102), mean SBP and DBP were 141 and 89 mm Hg, respectively, and 76% (78/102) were taking ≥1 antihypertensive medication. The most common (≥15%) antihypertensive classes were calcium channel blockers (31%), angiotensin-converting enzyme (ACE) inhibitors (26%), angiotensin II receptor blockers (ARBs) (25%), beta blockers (22%), and aldosterone antagonists (20%). Relacorilant significantly improved BP from baseline to week 22 (P<0.0001), and 19% (15/78) of those taking antihypertensive medications discontinued and/or decreased use by week 22 or their early termination visit. Medication reductions were most common with aldosterone antagonists (10%) and ARBs (8%). Complete discontinuation was highest for loop diuretics (31%) and calcium channel blockers (19%), followed by aldosterone antagonists (10%), ACE inhibitors (7%), beta blockers (5%), and ARBs (4%). In summary, in GRACE, relacorilant improved BP and resulted in antihypertensive medication decreases/discontinuations for participants with hypertension.

在3期GRACE研究（NCT03697109）中，患有内源性高皮质醇血症和高血压、高血糖或两者兼有的成人，relacorilant显著改善了血压（BP），达到了主要终点。我们报道了抗凝剂对高血压患者血压和抗高血压药物使用的影响。GRACE包括一个22周的开放标签（OL）期，每日1次，100 - 400mg，然后是一个12周的双盲，安慰剂对照的随机停药期。高血压定义为平均收缩压（SBP） 135-170毫米汞柱和/或舒张压（DBP） 85-110毫米汞柱。在OL基线时患有高血压的参与者中（n=102），平均收缩压和舒张压分别为141和89毫米汞柱，76%（78/102）服用≥1种降压药。最常见（≥15%）的降压药物是钙通道阻滞剂（31%）、血管紧张素转换酶（ACE）抑制剂（26%）、血管紧张素II受体阻滞剂（ARBs）（25%）、受体阻滞剂（22%）和醛固酮拮抗剂（20%）。Relacorilant显著改善了从基线到第22周的血压（P<0.0001）， 19%（15/78）服用降压药的患者在第22周或早期终止就诊时停止和/或减少使用降压药。醛固酮拮抗剂（10%）和arb（8%）的减量最为常见。完全停药最多的是利尿剂（31%）和钙通道阻滞剂（19%），其次是醛固酮拮抗剂（10%）、ACE抑制剂（7%）、受体阻滞剂（5%）和arb（4%）。总之，在GRACE试验中，抗凝剂改善了血压，导致高血压患者的降压药减少或停药。

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引用次数: 0

Impact of Depression on Clinical Outcomes Among Spontaneous Coronary Artery Dissection Patients: A Propensity-Matched Analysis Using the TriNetX Research Network 抑郁症对自发性冠状动脉夹层患者临床结果的影响：使用TriNetX研究网络的倾向匹配分析

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal

Pub Date : 2025-09-15 DOI: 10.1016/j.ahj.2025.07.037

Abena Korwaa Agyekum MD , Ekow Essien MD , Karldon Nwaezeapu MD , Godbless Ajenaghughrure MD , Nana Osei MD , Maureen Masara MD , Gloria Amoako MD , Esther Obeng-Danso MD , Inna Bukharovich , Suzette Graham-Hill MD

Background

Spontaneous coronary artery dissection (SCAD) is a major cause of acute coronary syndrome in young women without traditional cardiovascular risk factors. Depression is common among SCAD survivors, but its impact on clinical outcomes is poorly understood. We compared mortality, cardiovascular events, and other clinical outcomes in SCAD patients with and without depression.

Methods

We conducted a retrospective cohort study using the TriNetX Research Network (130 healthcare organizations). SCAD patients (ICD-10 I25.42) with depression (F32, F32A, F33, and F33.1) were compared to those without. After propensity score matching for baseline demographics and comorbidities, 3,247 patients per group were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included heart failure (HF), atrial fibrillation (AF), cardiogenic shock, cerebrovascular disease (CVD), acute kidney injury (AKI), and pacemaker implantation.

Results

In propensity-matched cohorts (3,247 patients per group), depression was associated with increased risk of HF (16.8% vs 12.2%; risk ratio [RR] 1.376, 95% CI 1.191-1.591; p<0.001), CVD (12.8% vs 9.9%; RR 1.287, 95% CI 1.104-1.501; p=0.001), AKI (9.8% vs 5.5%; RR 1.768, 95% CI 1.453-2.152; p<0.001), and AF (7.0% vs 5.4%; RR 1.288, 95% CI 1.045-1.588; p=0.017). There was no significant difference in all-cause mortality, cardiogenic shock, and pacemaker implantation.

Conclusion

Among SCAD patients, comorbid depression is associated with significantly higher risk of adverse outcomes including HF, CVD, AKI and AF. These findings underscore the importance of mental health screening and integrated cardiovascular care in this population.

背景：自发性冠状动脉夹层（SCAD）是无传统心血管危险因素的年轻女性发生急性冠状动脉综合征的主要原因。抑郁症在SCAD幸存者中很常见，但其对临床结果的影响尚不清楚。我们比较了伴有和不伴有抑郁的SCAD患者的死亡率、心血管事件和其他临床结果。方法采用TriNetX研究网络（130家医疗机构）进行回顾性队列研究。将伴有抑郁（F32、F32A、F33、F33.1）的SCAD患者（ICD-10 I25.42）与不伴有抑郁的SCAD患者进行比较。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3247例患者进行分析。主要结局为全因死亡率。次要结局包括心力衰竭（HF）、心房颤动（AF）、心源性休克、脑血管疾病（CVD）、急性肾损伤（AKI）和起搏器植入。结果在倾向匹配的队列中（每组3247例患者），抑郁症与HF （16.8% vs 12.2%；风险比[RR] 1.376, 95% CI 1.191-1.591; p<0.001）、CVD （12.8% vs 9.9%; RR 1.287, 95% CI 1.104-1.501; p=0.001）、AKI （9.8% vs 5.5%; RR 1.768, 95% CI 1.453-2.152; p<0.001）和AF （7.0% vs 5.4%; RR 1.288, 95% CI 1.045-1.588; p=0.017）相关。两组在全因死亡率、心源性休克和起搏器植入方面无显著差异。结论在SCAD患者中，共病性抑郁与HF、CVD、AKI和AF等不良结局的风险显著升高相关。这些发现强调了在这一人群中进行心理健康筛查和心血管综合护理的重要性。

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引用次数: 0

Comparative Cardiovascular Outcomes Between Carvedilol and Metoprolol in Patients with Takotsubo Syndrome: A Propensity-Matched Cohort Study 卡维地洛和美托洛尔对Takotsubo综合征患者心血管预后的比较：一项倾向匹配的队列研究

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal

Pub Date : 2025-09-15 DOI: 10.1016/j.ahj.2025.07.054

Karldon Iwuchukwu Nwaezeapu , Godbless Ajenaghughrure , Ekow Essien , Abena Agyekum

Background

Takotsubo syndrome presents significant cardiovascular complications requiring beta-blocker therapy. This study investigated outcome differences between carvedilol and metoprolol in patients with Takotsubo syndrome.

Methods

Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of patients aged 18-79 years with Takotsubo syndrome. Carvedilol-treated patients (n=4,141) were compared to metoprolol-treated patients (n=18,071) after propensity score matching (4,139 per cohort). Outcomes were analyzed over a 5-year follow-up period (1-1,825 days post-treatment initiation). Statistical analyses included risk ratios, hazard ratios, and survival analyses.

Results

After matching, carvedilol-treated patients demonstrated significantly lower all-cause mortality (11.3% vs 16.0%; RR=0.71, p<0.001), heart failure (16.7% vs 19.6%; RR=0.85, p=0.009), ventricular tachycardia (1.7% vs 2.4%; RR=0.71, p=0.033), atrial fibrillation/flutter (3.8% vs 6.0%; RR=0.63, p<0.001), acute myocardial infarction (6.2% vs 8.4%; RR=0.73, p=0.004), and pulmonary hypertension (2.7% vs 3.5%; RR=0.76, p=0.033). No significant differences were observed in stroke, cardiogenic shock, or acute kidney injury outcomes.

Conclusion

Carvedilol treatment in Takotsubo syndrome patients is associated with significantly improved cardiovascular outcomes compared to metoprolol, particularly in mortality, heart failure, and arrhythmias. These findings suggest carvedilol may be the preferred beta-blocker for Takotsubo syndrome management, potentially due to its additional alpha-blocking and antioxidant properties. Prospective studies are warranted to confirm these observations.

takotsubo综合征表现出明显的心血管并发症，需要β受体阻滞剂治疗。本研究调查了卡维地洛和美托洛尔治疗Takotsubo综合征的疗效差异。方法使用TriNetX全球协作网络，我们对18-79岁Takotsubo综合征患者进行了回顾性队列研究。在倾向评分匹配后，将卡维地洛治疗的患者（n= 4141）与美托洛尔治疗的患者（n= 18071）进行比较（每个队列4139）。结果分析了5年随访期（治疗开始后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，卡维地洛治疗患者的全因死亡率（11.3% vs 16.0%， RR=0.71, p= 0.001）、心力衰竭（16.7% vs 19.6%， RR=0.85, p=0.009）、室性心动心动（1.7% vs 2.4%， RR=0.71, p=0.033）、心房颤动/扑动（3.8% vs 6.0%， RR=0.63, p= 0.001）、急性心肌梗死（6.2% vs 8.4%， RR=0.73, p=0.004）和肺动脉高压（2.7% vs 3.5%， RR=0.76, p=0.033）均显著降低。在卒中、心源性休克或急性肾损伤结局方面未观察到显著差异。结论与美托洛尔相比，卡维地洛治疗Takotsubo综合征患者的心血管预后显著改善，特别是在死亡率、心力衰竭和心律失常方面。这些发现表明，卡维地洛可能是治疗Takotsubo综合征的首选β受体阻滞剂，可能是由于其额外的α阻断和抗氧化特性。有必要进行前瞻性研究来证实这些观察结果。

{"title":"Comparative Cardiovascular Outcomes Between Carvedilol and Metoprolol in Patients with Takotsubo Syndrome: A Propensity-Matched Cohort Study","authors":"Karldon Iwuchukwu Nwaezeapu , Godbless Ajenaghughrure , Ekow Essien , Abena Agyekum","doi":"10.1016/j.ahj.2025.07.054","DOIUrl":"10.1016/j.ahj.2025.07.054","url":null,"abstract":"<div><h3>Background</h3><div>Takotsubo syndrome presents significant cardiovascular complications requiring beta-blocker therapy. This study investigated outcome differences between carvedilol and metoprolol in patients with Takotsubo syndrome.</div></div><div><h3>Methods</h3><div>Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of patients aged 18-79 years with Takotsubo syndrome. Carvedilol-treated patients (n=4,141) were compared to metoprolol-treated patients (n=18,071) after propensity score matching (4,139 per cohort). Outcomes were analyzed over a 5-year follow-up period (1-1,825 days post-treatment initiation). Statistical analyses included risk ratios, hazard ratios, and survival analyses.</div></div><div><h3>Results</h3><div>After matching, carvedilol-treated patients demonstrated significantly lower all-cause mortality (11.3% vs 16.0%; RR=0.71, p<0.001), heart failure (16.7% vs 19.6%; RR=0.85, p=0.009), ventricular tachycardia (1.7% vs 2.4%; RR=0.71, p=0.033), atrial fibrillation/flutter (3.8% vs 6.0%; RR=0.63, p<0.001), acute myocardial infarction (6.2% vs 8.4%; RR=0.73, p=0.004), and pulmonary hypertension (2.7% vs 3.5%; RR=0.76, p=0.033). No significant differences were observed in stroke, cardiogenic shock, or acute kidney injury outcomes.</div></div><div><h3>Conclusion</h3><div>Carvedilol treatment in Takotsubo syndrome patients is associated with significantly improved cardiovascular outcomes compared to metoprolol, particularly in mortality, heart failure, and arrhythmias. These findings suggest carvedilol may be the preferred beta-blocker for Takotsubo syndrome management, potentially due to its additional alpha-blocking and antioxidant properties. Prospective studies are warranted to confirm these observations.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 23"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060950","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}

引用次数: 0

Influence of Obstructive Sleep Apnea on Long-Term Cardiovascular Outcomes in Heart Transplant Recipients: A Retrospective Database Study 阻塞性睡眠呼吸暂停对心脏移植受者长期心血管预后的影响：回顾性数据库研究

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal

Pub Date : 2025-09-15 DOI: 10.1016/j.ahj.2025.07.062

Abena Agyekum, Nana Osei, Ekow Essien, Abraham Carboo, Karldon Nwaezeapu

Background

Obstructive sleep apnea (OSA) is commonly observed in cardiovascular patients, but its impact on heart transplant recipients remains incompletely characterized. This study aimed to compare cardiovascular outcomes between heart transplant recipients with and without OSA.

Methods

We performed a retrospective cohort study using the TriNetX Global Collaborative Network. Adult patients (18-90 years) with heart transplant status were stratified by OSA diagnosis. After propensity score matching for demographics and comorbidities, cohorts of 7,486 patients each were analyzed. Primary outcome was all-cause mortality. Secondary outcomes included cardiovascular complications over a five-year follow-up period.

Results

Heart transplant recipients with OSA demonstrated no significant difference in all-cause mortality compared to those without OSA (20.0% vs 19.0%; HR 1.004, 95% CI 0.934-1.080; p=0.908). However, OSA was associated with significantly higher risk of cardiogenic shock (8.5% vs 6.2%; HR 1.303, 95% CI 1.130-1.502; p<0.001), heart failure (32.2% vs 21.8%; HR 1.438, 95% CI 1.281-1.614; p<0.001), ventricular tachycardia (9.3% vs 6.7%; HR 1.335, 95% CI 1.159-1.537; p<0.001), atrial fibrillation (14.3% vs 11.7%; HR 1.161, 95% CI 1.032-1.306; p=0.013), and pulmonary hypertension (17.4% vs 12.0%; HR 1.399, 95% CI 1.255-1.560; p<0.001).

Conclusion

In heart transplant recipients, OSA is associated with significantly higher risk of cardiovascular complications despite similar mortality rates. These findings suggest that screening for and treating OSA should be considered in the comprehensive care of heart transplant recipients.

背景：阻塞性睡眠呼吸暂停（OSA）常见于心血管患者，但其对心脏移植受者的影响尚未完全明确。本研究旨在比较心脏移植受者有无OSA的心血管结局。方法采用TriNetX全球协作网络进行回顾性队列研究。对接受心脏移植的成年患者（18-90岁）进行OSA诊断分层。在人口统计学和合并症的倾向评分匹配后，分析了7486名患者的队列。主要结局为全因死亡率。次要结局包括5年随访期间的心血管并发症。结果OSA心脏移植受者的全因死亡率与非OSA心脏移植受者无显著性差异（20.0% vs 19.0%; HR 1.004, 95% CI 0.934-1.080; p=0.908）。然而，OSA与心源性休克（8.5% vs 6.2%; HR 1.303, 95% CI 1.130-1.502; p<0.001）、心力衰竭（32.2% vs 21.8%; HR 1.438, 95% CI 1.281-1.614; p<0.001）、室性心动过速（9.3% vs 6.7%; HR 1.335, 95% CI 1.159-1.537; p<0.001）、房颤（14.3% vs 11.7%; HR 1.161, 95% CI 1.032-1.306; p=0.013）和肺动脉高压（17.4% vs 12.0%; HR 1.399, 95% CI 1.255-1.560; p<0.001）相关。结论在心脏移植受者中，尽管死亡率相似，但OSA与心血管并发症的风险显著升高相关。这些发现表明，在心脏移植受者的综合护理中应考虑筛查和治疗阻塞性睡眠呼吸暂停。

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引用次数: 0

Tirzepatide vs Semaglutide in Coronary Artery Disease and Obesity: Real-World Cardiovascular Outcomes Analysis from the TriNetX Research Network 替西帕肽vs西马鲁肽治疗冠状动脉疾病和肥胖：来自TriNetX研究网络的真实世界心血管结局分析

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal

Pub Date : 2025-09-15 DOI: 10.1016/j.ahj.2025.07.060

Ekow Essien , Gloria Amoako , Abena Agyekum , Godslove Bonnah , Abraham Carboo , Karldon Nwaezeapu , Aba Kwakomah Dapaah

Background

Novel incretin-based therapies have demonstrated cardiovascular benefits beyond glycemic control. This study compared cardiovascular outcomes between patients with coronary artery disease (CAD) and obesity treated with tirzepatide versus semaglutide.

Methods

Using the TriNetX Research Network, we identified adults with CAD and obesity (BMI ≥30 kg/m²) prescribed either tirzepatide (n=43,023) or semaglutide (n=110,544). After propensity score matching, 43,019 patients remained in each cohort. The primary outcome was all-cause mortality. Secondary outcomes included heart failure, arrhythmias, renal complications, and pulmonary outcomes.

Results

Tirzepatide treatment was associated with lower all-cause mortality compared to semaglutide (1.1% vs 1.7%, HR 0.65, 95% CI 0.58-0.73; p<0.001). Tirzepatide use also demonstrated reduced incidence of heart failure (4.1% vs 5.4%, HR 0.76, 95% CI 0.70-0.81; p<0.001), atrial fibrillation (2.3% vs 2.9%, HR 0.79, 95% CI 0.72-0.87; p<0.001), cardiogenic shock (0.3% vs 0.4%, HR 0.74, 95% CI 0.58-0.94; p=0.012), and acute kidney injury (3.5% vs 4.0%, HR 0.86, 95% CI 0.80-0.93; p<0.001). Similar benefits were observed for pulmonary embolism, pulmonary edema, and cerebrovascular disease.

Conclusion

In patients with CAD and obesity, tirzepatide was associated with lower mortality and reduced risk of cardiovascular and renal complications compared to semaglutide, suggesting differences in cardiorenal protection between these incretin-based therapies.

背景：新的以肠促胰岛素为基础的治疗方法已经证明了除血糖控制外的心血管益处。本研究比较了替西帕肽与西马鲁肽治疗冠心病（CAD）和肥胖症患者的心血管结局。方法使用TriNetX研究网络，我们确定患有CAD和肥胖（BMI≥30 kg/m²）的成年人，他们服用替西帕肽（n=43,023）或西马鲁肽（n=110,544）。在倾向评分匹配后，每个队列中仍有43019名患者。主要结局为全因死亡率。次要结局包括心力衰竭、心律失常、肾脏并发症和肺部结局。结果与西马鲁肽相比，司他帕肽治疗的全因死亡率较低（1.1% vs 1.7%, HR 0.65, 95% CI 0.58-0.73; p<0.001）。替西帕肽的使用还能降低心力衰竭（4.1% vs 5.4%, HR 0.76, 95% CI 0.70-0.81; p<0.001）、房颤（2.3% vs 2.9%, HR 0.79, 95% CI 0.72-0.87; p<0.001）、心源性休克（0.3% vs 0.4%, HR 0.74, 95% CI 0.58-0.94; p=0.012）和急性肾损伤（3.5% vs 4.0%, HR 0.86, 95% CI 0.80-0.93; p<0.001）的发生率。在肺栓塞、肺水肿和脑血管疾病中也观察到类似的益处。结论：在冠心病和肥胖患者中，与西马鲁肽相比，替西帕肽的死亡率更低，心血管和肾脏并发症的风险也更低，这表明这两种以肠促胰岛素为基础的治疗在心肾保护方面存在差异。

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引用次数: 0

The Design of MOMENTUM: A Prospective Study of the Prevalence of Endogenous Hypercortisolism in Individuals With Resistant Hypertension 动量的设计：内源性高皮质醇血症在顽固性高血压患者患病率的前瞻性研究

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal

Pub Date : 2025-09-15 DOI: 10.1016/j.ahj.2025.07.044

Jorge Plutzky , Richard J. Auchus , Jan N. Basile , Deepak L. Bhatt , Michael J. Bloch , Matthew A. Cavender , James W. Findling , Yehuda Handelsman , Silvio E. Inzucchi , Norman E. Lepor , Neha J. Pagidipati , Raymond R. Townsend , Matthew R. Weir , Iulia Cristina Tudor , Daniel Einhorn

Hypertension affects up to 50% of US adults and resistant hypertension (rHTN) occurs in 10-20% of cases. Endogenous hypercortisolism (eHC) may contribute to rHTN in some individuals, but the prevalence of eHC in individuals with rHTN is currently unknown. The CATALYST study assessing eHC prevalence in individuals with difficult-to-control type 2 diabetes, reported a 40% prevalence of eHC in participants with systolic blood pressure (BP) ≥135 mm Hg despite taking ≥3 BP medications (Handelsman Y, et al. WCIRDC 2024. Poster 0050). MOMENTUM is the first large, prospective study to examine the prevalence of eHC in people with rHTN in the US.

MOMENTUM is an observational study of ∼1,000 adults with rHTN using American Heart Association criteria. Key exclusion criteria are investigator-determined white coat hypertension, nonadherence to BP medications, and individuals in whom the dexamethasone suppression test is difficult to interpret. The primary endpoint is to assess the eHC prevalence in this population. Key secondary endpoints are to assess clinical and laboratory features associated with increased eHC risk. Hyperaldosteronism will also be screened for. Descriptive statistics will be used to characterize participants with and without eHC.

In conclusion, the MOMENTUM study, as designed and currently enrolling, will provide an estimate of eHC prevalence and its associated clinical characteristics in people with rHTN. (ClinicalTrials.gov Identifier: NCT06829537)

高血压影响高达50%的美国成年人，顽固性高血压（rHTN）发生在10-20%的病例中。内源性高皮质醇血症（eHC）可能在某些个体中导致rHTN，但目前尚不清楚eHC在rHTN患者中的患病率。CATALYST研究评估了难以控制的2型糖尿病患者eHC的患病率，报告收缩压(BP)≥135 mm Hg的参与者，尽管服用了≥3bp的药物，eHC的患病率仍为40% （Handelsman Y, et al.）。WCIRDC 2024。海报0050)。MOMENTUM是美国第一个大型前瞻性研究，旨在调查rHTN患者中eHC的患病率。MOMENTUM是一项观察性研究，采用美国心脏协会标准，纳入约1000名患有rHTN的成人。主要的排除标准是研究者确定的白大衣高血压，不坚持降压药物，以及地塞米松抑制试验难以解释的个体。主要终点是评估该人群的eHC患病率。关键的次要终点是评估与eHC风险增加相关的临床和实验室特征。高醛固酮增多症也将被筛查。描述性统计将用于描述有和没有eHC的参与者。总之，根据设计和目前的招募情况，MOMENTUM研究将提供rHTN患者eHC患病率及其相关临床特征的估计。（ClinicalTrials.gov识别码：NCT06829537）

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引用次数: 0

High Medication Burden in Individuals With Difficult-to-Control Type 2 Diabetes: Clinical Characteristics From the CATALYST Study 难以控制的2型糖尿病患者的高药物负担：来自CATALYST研究的临床特征

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal

Pub Date : 2025-09-15 DOI: 10.1016/j.ahj.2025.07.046

Ralph A. DeFronzo , John Buse , Bradley Eilerman , Vivian Fonseca , Yehuda Handelsman , Harold J. Miller , John C. Parker , Richard Pratley , Julio Rosenstock , Michael H. Shanik , Guillermo Umpierrez , Iulia Cristina Tudor , Austin L. Hand , Daniel Einhorn

CATALYST (NCT05772169) was the largest prospective study to date to assess the prevalence of hypercortisolism in individuals with difficult-to-control type 2 diabetes (T2D), finding a prevalence of 23.8% (n=252/1,057). With a participant cohort of >1,000, the study was uniquely positioned to explore demographic and clinical characteristics associated with difficult-to-control T2D. Here we describe the characteristics of the CATALYST Part 1 population. Individuals with hemoglobin A1c (HbA1c) 7.5–11.5%, despite taking multiple antihyperglycemic medications, were screened for hypercortisolism using the 1-mg overnight dexamethasone suppression test (DST). Those with known causes of false-positive DSTs were excluded. The study population had a mean age of 60.7 years, 45% were female, 71% were White, 19% were African American, and 24% were Hispanic/Latino. Mean HbA1c was 8.8%, and mean systolic blood pressure (SBP) was 127.6 mmHg. 31% had SBP ≥135 mm/Hg. 43% were taking ≥4 glucose-lowering medications, including sodium-glucose cotransporter 2 inhibitors (52%), glucagon-like peptide-1 receptor agonists (48%), and tirzepatide (10%). Antihypertensive medications were used by 82% of participants, with 27% taking ≥3 antihypertensives. Lipid-modifying medications (primarily statins) were used by 83%, psychiatric medication by 30%, and analgesic medications by 30% of participants. Cardiac disorders were present in 33% and 21% of participants and hypertension was present in 89% and 79% of participants with and without hypercortisolism, respectively. In summary, CATALYST participants had a high medication and comorbid disease burden, with T2D that remained difficult to control despite multiple glucose-lowering medications. In addition, many participants had elevated SBP despite extensive use of antihypertensive medications.

CATALYST （NCT05772169）是迄今为止评估难以控制的2型糖尿病（T2D）患者高皮质醇症患病率的最大前瞻性研究，发现患病率为23.8% （n=252/ 1057）。该研究纳入了1000名参与者，旨在探索与难以控制的T2D相关的人口学和临床特征。在这里，我们描述了CATALYST第1部分人口的特征。糖化血红蛋白（HbA1c）为7.5-11.5%的个体，尽管服用了多种降糖药物，但使用1毫克地塞米松抑制试验（DST）筛查高皮质醇血症。排除了已知DSTs假阳性原因的患者。研究人群的平均年龄为60.7岁，45%为女性，71%为白人，19%为非洲裔美国人，24%为西班牙裔/拉丁裔。平均HbA1c为8.8%，平均收缩压（SBP）为127.6 mmHg。31%的患者收缩压≥135 mm/Hg。43%的患者服用≥4种降糖药物，包括钠-葡萄糖共转运蛋白2抑制剂（52%）、胰高血糖素样肽-1受体激动剂（48%）和替西肽（10%）。82%的参与者使用抗高血压药物，27%服用≥3种抗高血压药物。83%的参与者使用降脂药物（主要是他汀类药物），30%的参与者使用精神药物，30%的参与者使用镇痛药物。33%和21%的参与者存在心脏疾病，89%和79%的参与者存在高血压，伴有和不伴有高皮质醇血症。总之，CATALYST参与者有很高的药物和合并症疾病负担，尽管使用多种降糖药物，T2D仍然难以控制。此外，尽管广泛使用抗高血压药物，许多参与者仍有升高的收缩压。

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引用次数: 0

Global Trends and Sociodemographic Disparities in LDL-Attributable Cardiovascular Disease: GBD 2021 Analysis (1990–2021) ldl归因心血管疾病的全球趋势和社会人口差异：GBD 2021分析（1990-2021）

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal

Pub Date : 2025-09-15 DOI: 10.1016/j.ahj.2025.07.047

Rohan Raj , Ujjwal Mishra , Nikhil Jain , Kanishka Kumar Awasthi

Background

Elevated low-density lipoprotein (LDL) cholesterol is a major modifiable risk factor for cardiovascular disease (CVD). While global trends in LDL-attributable CVD have been previously reported, disparities across sociodemographic development levels remain insufficiently explored.

Objective

To assess global, regional, and SDI-specific trends in the CVD burden attributable to high LDL cholesterol from 1990 to 2021.

Methods

We utilized Global Burden of Disease (GBD) 2021 data to evaluate CVD mortality and disability-adjusted life years (DALYs) attributable to high LDL cholesterol. Trends were assessed using annual percentage change (APC) in age-standardized mortality rate (ASMR), age-standardized DALYs rate (ASDR), and age-standardized years lived with disability (ASYLD) by Socio-demographic Index (SDI), sex, and location.

Results

From 1990 to 2021, global ASMR and ASDR attributable to high LDL cholesterol declined. In 2021, ASMR and ASDR were lowest in high SDI regions. Israel recorded the largest decrease in APC for both ASMR and ASDR, while Lesotho exhibited the highest increase. Over the same period, Singapore showed the greatest decline in APC of ASYLD, whereas Tanzania had the most pronounced increase. The greatest reductions in APC of ASMR and ASDR from 1990 to 2021 were observed in high SDI countries, particularly during the decade 2000–2010. Females consistently showed declining APCs of ASMR across all SDI quintiles, whereas in males, APCs declined only in high and high-middle SDI countries.

Conclusion

Persistent disparities in CVD burden attributable to high LDL across SDI quintiles highlight the need for equitable, tailored lipid-lowering and cardiometabolic prevention strategies.

背景低密度脂蛋白（LDL）胆固醇升高是心血管疾病（CVD）的一个主要可改变的危险因素。虽然低密度脂蛋白引起的心血管疾病的全球趋势以前已经报道过，但社会人口发展水平之间的差异仍然没有得到充分的探讨。目的评估1990年至2021年全球、地区和sdi特异性高LDL胆固醇导致的心血管疾病负担趋势。方法利用全球疾病负担（GBD） 2021数据评估高LDL胆固醇导致的CVD死亡率和残疾调整生命年（DALYs）。根据社会人口指数（SDI）、性别和地区，使用年龄标准化死亡率（ASMR）、年龄标准化DALYs率（ASDR）和年龄标准化残疾生活年数（ASYLD）的年百分比变化（APC）来评估趋势。结果从1990年到2021年，全球高LDL胆固醇导致的ASMR和ASDR下降。2021年，高SDI地区的ASMR和ASDR最低。以色列ASMR和ASDR的APC下降幅度最大，而莱索托的APC增长幅度最大。在同一时期内，新加坡的残疾儿童综合福利费用下降幅度最大，而坦桑尼亚的增加幅度最大。从1990年到2021年，高SDI国家的ASMR和ASDR的APC减少幅度最大，特别是在2000-2010十年期间。在所有SDI五分位数中，女性的ASMR apc持续下降，而在男性中，apc仅在高和中高SDI国家下降。结论：高LDL导致的心血管疾病负担在SDI五分位数中持续存在差异，这凸显了制定公平、量身定制的降脂和心脏代谢预防策略的必要性。

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引用次数: 0

Comparative Analysis of Arrhythmia Risk: SGLT2 inhibitors versus GLP-1 Receptor Agonists in Patients with Type 2 Diabetes and Inflammatory Arthritis 2型糖尿病和炎性关节炎患者的心律失常风险：SGLT2抑制剂与GLP-1受体激动剂的比较分析

IF 3.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal

Pub Date : 2025-09-15 DOI: 10.1016/j.ahj.2025.07.021

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.

Background

Both SGLT2 inhibitors and GLP-1 receptor agonists have demonstrated cardiovascular benefits in type 2 diabetes (T2D), but their comparative arrhythmogenic profiles in patients with comorbid inflammatory polyarthropathy remain unclear. This study aimed to evaluate the differential risk of cardiac arrhythmias between these two drug classes in this specific patient population.

Methods

In this retrospective cohort study using the TriNetX global federated health research network, we identified adult patients with T2D and inflammatory polyarthropathy who were initiated on either SGLT2 inhibitors (n=3,278) or GLP-1 receptor agonists (n=4,612). After propensity score matching (n=2,838 per group), we compared the incidence of various arrhythmias including atrial fibrillation, ventricular tachycardia, ventricular fibrillation, sick sinus syndrome, and need for pacemaker implantation over a 5-year follow-up period.

Results

Patients treated with SGLT2 inhibitors demonstrated significantly higher rates of atrial fibrillation (10.4% vs 7.8%, HR 1.552, 95% CI 1.303-1.848, p<0.001) and ventricular tachycardia (4.8% vs 2.2%, HR 2.467, 95% CI 1.825-3.334, p<0.001) compared to those receiving GLP-1 receptor agonists. Ventricular fibrillation was also more common in the SGLT2 inhibitor group (2.4% vs 0.8%, HR 3.451, 95% CI 2.131-5.590, p<0.001). Sick sinus syndrome occurred more frequently in SGLT2 inhibitor users (1.0% vs 0.7%), though this difference was not statistically significant. Pacemaker implantation rates were higher in the SGLT2 inhibitor cohort (5.1% vs 3.9%, HR 1.466, 95% CI 1.144-1.878, p=0.002).

Conclusion

Among patients with T2D and inflammatory polyarthropathy, treatment with GLP-1 receptor agonists was associated with significantly lower risk of major cardiac arrhythmias compared to SGLT2 inhibitors. These findings suggest that GLP-1 receptor agonists may represent a preferred option for patients with T2D and inflammatory arthritis who are at increased risk for cardiac arrhythmias. Further investigation is warranted to elucidate the mechanisms underlying these differences.

背景：SGLT2抑制剂和GLP-1受体激动剂均已证实对2型糖尿病（T2D）的心血管有益，但它们在合并炎性多关节病患者的心律失常发生率比较尚不清楚。本研究旨在评估这两种药物在这一特定患者群体中发生心律失常的风险差异。方法在这项使用TriNetX全球联合健康研究网络的回顾性队列研究中，我们确定了患有T2D和炎性多关节病的成年患者，他们开始使用SGLT2抑制剂（n=3,278）或GLP-1受体激动剂（n=4,612）。经过倾向评分匹配（每组2838例），我们比较了5年随访期间各种心律失常的发生率，包括房颤、室性心动过速、室颤、病态窦性综合征和起搏器植入需求。结果与接受GLP-1受体激动剂治疗的患者相比，接受SGLT2抑制剂治疗的患者房颤（10.4% vs 7.8%, HR 1.552, 95% CI 1.303-1.848, p<0.001）和室性心动过速（4.8% vs 2.2%, HR 2.467, 95% CI 1.825-3.334, p<0.001）的发生率显著高于接受GLP-1受体激动剂治疗的患者。心室颤动在SGLT2抑制剂组中也更为常见（2.4% vs 0.8%, HR 3.451, 95% CI 2.131-5.590, p<0.001）。SGLT2抑制剂使用者的窦病综合征发生率更高（1.0% vs 0.7%），但差异无统计学意义。SGLT2抑制剂组的起搏器植入率更高（5.1% vs 3.9%, HR 1.466, 95% CI 1.144-1.878, p=0.002）。结论在t2dm和炎性多关节病患者中，与SGLT2抑制剂相比，GLP-1受体激动剂治疗与重大心律失常的风险显著降低相关。这些发现表明，GLP-1受体激动剂可能是T2D和炎症性关节炎患者心律失常风险增加的首选。需要进一步的研究来阐明这些差异背后的机制。

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引用次数: 0