Pub Date : 2025-09-17DOI: 10.1016/j.ahj.2025.09.008
Yilin Yoshida PhD , Yuanhao Zu MS , David Aguilar MD , Keith C. Ferdinand MD , Vivian A. Fonseca MD
We investigated whether cumulative fasting glucose (FG) and insulin resistance (IR) over 20 years are associated with midlife cardiac dysfunction in young adults with or without type 2 diabetes (T2D)/prediabetes. We included young adults with T2D/prediabetes (N = 279) and matched euglycemic individuals (N = 514) who had repeated measures of fasting glucose (FG) and insulin resistance (IR) and echocardiography assessment from the Coronary Artery Risk Development in Young Adults study (CARDIA). We found that cumulative hyperglycemia is associated with midlife diastolic dysfunction in patients with early-onset T2D, and sustained IR negatively affects systolic and diastolic function regardless of T2D status.
{"title":"Cumulative effect of hyperglycemia and insulin resistance on cardiac dysfunction: The coronary artery risk development in young adults (CARDIA) study","authors":"Yilin Yoshida PhD , Yuanhao Zu MS , David Aguilar MD , Keith C. Ferdinand MD , Vivian A. Fonseca MD","doi":"10.1016/j.ahj.2025.09.008","DOIUrl":"10.1016/j.ahj.2025.09.008","url":null,"abstract":"<div><div>We investigated whether cumulative fasting glucose (FG) and insulin resistance (IR) over 20 years are associated with midlife cardiac dysfunction in young adults with or without type 2 diabetes (T2D)/prediabetes. We included young adults with T2D/prediabetes (N = 279) and matched euglycemic individuals (N = 514) who had repeated measures of fasting glucose (FG) and insulin resistance (IR) and echocardiography assessment from the Coronary Artery Risk Development in Young Adults study (CARDIA). We found that cumulative hyperglycemia is associated with midlife diastolic dysfunction in patients with early-onset T2D, and sustained IR negatively affects systolic and diastolic function regardless of T2D status.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107276"},"PeriodicalIF":3.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091098","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 : 2025-09-16DOI: 10.1016/j.ahj.2025.09.009
Joshua Wong MBBS , Joel Smith MSc , Cheng Hwee Soh PhD , Erin Howden PhD , Jack S. Talbot PhD , Mark Nolan MBBS, PhD , Kristyn Whitmore BSN , Leah Wright PhD , Ashleigh-Georgia Sherriff BSMRes , Eswar Sivaraj MSc , Greg Wheeler MBBS , Kirsty Wiltshire MBBS , Phillip Campbell MB,ChB , Satish Ramkumar MBBS, BMedSci, MMed, PhD , Constantine Tam MBBS, MD , Thomas H. Marwick MBBS, PhD, MPH
Background
Adult cancer survivors are at increased risk of heart failure (HF) due to standard risk factors and cancer treatment-related cardiac dysfunction. However, the prevalence and treatment of subclinical/stage B heart failure (SBHF) in this population are not well defined.
Objectives
The REDEEM (Risk-guided Disease managEment plan to prevEnt heart failure in patients treated with previous cardiotoxic cancer treatMents) trial will evaluate HF screening and targeted intervention in long-term cancer survivors.
Methods
Survivors ≥40 years old, ≥5 years post potentially-cardiotoxic therapy, and with ≥1 HF risk factor were screened by echocardiography for SBHF (abnormal global longitudinal shortening [GLS], left ventricular hypertrophy [LVH], diastolic dysfunction or abnormal 3-dimensional left ventricular ejection fraction [3D-LVEF]). Those with SBHF were randomized to multidisciplinary cardio-oncology disease management plan (CO-DMP), including neurohormonal blockade, exercise training and risk factor optimization, or usual care. The primary endpoint is change in cardiorespiratory fitness (VO2peak) over 6 months.
Results
Of 1,124 survivors screened, 604 underwent echocardiography, and 145 (24%) had SBHF (age 68±18 years; 81% women). Of those eligible for randomization, 64% had breast cancer and 35% had hematological malignancy. Although baseline 3D-LVEF was preserved (52.8 ± 6.8%), subclinical LV dysfunction was common (GLS 15.6 ± 2.1%) and 39% had evidence of functional impairment (VO2peak≤18ml/kg/min−1). Abnormal GLS was associated with age, BMI, diabetes and anthracycline exposure, whereas functional impairment was only associated with age. Abnormal GLS and functional impairment were not significantly associated (OR 0.90 [95% CI 0.72–1.11], P = .360).
Conclusions
Risk-based screening can identify a high-risk subpopulation of cancer survivors with SBHF.
{"title":"Risk-guided disease management to prevent heart failure in adult cancer survivors of previous cardiotoxic cancer treatments: Baseline results of the REDEEM trial","authors":"Joshua Wong MBBS , Joel Smith MSc , Cheng Hwee Soh PhD , Erin Howden PhD , Jack S. Talbot PhD , Mark Nolan MBBS, PhD , Kristyn Whitmore BSN , Leah Wright PhD , Ashleigh-Georgia Sherriff BSMRes , Eswar Sivaraj MSc , Greg Wheeler MBBS , Kirsty Wiltshire MBBS , Phillip Campbell MB,ChB , Satish Ramkumar MBBS, BMedSci, MMed, PhD , Constantine Tam MBBS, MD , Thomas H. Marwick MBBS, PhD, MPH","doi":"10.1016/j.ahj.2025.09.009","DOIUrl":"10.1016/j.ahj.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Adult cancer survivors are at increased risk of heart failure (HF) due to standard risk factors and cancer treatment-related cardiac dysfunction. However, the prevalence and treatment of subclinical/stage B heart failure (SBHF) in this population are not well defined.</div></div><div><h3>Objectives</h3><div>The REDEEM (<em>Risk-guided Disease managEment plan to prevEnt heart failure in patients treated with previous cardiotoxic cancer treatMents</em>) trial will evaluate HF screening and targeted intervention in long-term cancer survivors.</div></div><div><h3>Methods</h3><div>Survivors ≥40 years old, ≥5 years post potentially-cardiotoxic therapy, and with ≥1 HF risk factor were screened by echocardiography for SBHF (abnormal global longitudinal shortening [GLS], left ventricular hypertrophy [LVH], diastolic dysfunction or abnormal 3-dimensional left ventricular ejection fraction [3D-LVEF]). Those with SBHF were randomized to multidisciplinary cardio-oncology disease management plan (CO-DMP), including neurohormonal blockade, exercise training and risk factor optimization, or usual care. The primary endpoint is change in cardiorespiratory fitness (VO<sub>2</sub>peak) over 6 months.</div></div><div><h3>Results</h3><div>Of 1,124 survivors screened, 604 underwent echocardiography, and 145 (24%) had SBHF (age 68±18 years; 81% women). Of those eligible for randomization, 64% had breast cancer and 35% had hematological malignancy. Although baseline 3D-LVEF was preserved (52.8 ± 6.8%), subclinical LV dysfunction was common (GLS 15.6 ± 2.1%) and 39% had evidence of functional impairment (VO<sub>2</sub>peak≤18ml/kg/min<sup>−1</sup>). Abnormal GLS was associated with age, BMI, diabetes and anthracycline exposure, whereas functional impairment was only associated with age. Abnormal GLS and functional impairment were not significantly associated (OR 0.90 [95% CI 0.72–1.11], <em>P</em> = .360).</div></div><div><h3>Conclusions</h3><div>Risk-based screening can identify a high-risk subpopulation of cancer survivors with SBHF.</div></div><div><h3>Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT04962711, <span><span>https://www.clinicaltrials.gov/study/NCT04962711</span><svg><path></path></svg></span></div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107277"},"PeriodicalIF":3.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084960","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.2025.07.064
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。
{"title":"Association Between Glycemic Control and Adverse Outcomes in Atrial Fibrillation: Evidence from a Large Real-World Cohort","authors":"Ekow Essien, Justice Owusu-Achiaw, Abraham Carboo, Karldon Nwaezeapu, Abena Agyekum, Patrick Berchie, Kwame Mensa-Yawson, Edmund Mireku Bediako, Ashley E Kodjo","doi":"10.1016/j.ahj.2025.07.064","DOIUrl":"10.1016/j.ahj.2025.07.064","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 28"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061447","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.2025.07.045
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.
{"title":"Impact of Relacorilant on Blood Pressure and Antihypertensive Medication Burden in Patients With Hypercortisolism and Hypertension: Results From the GRACE Study","authors":"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","doi":"10.1016/j.ahj.2025.07.045","DOIUrl":"10.1016/j.ahj.2025.07.045","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 17-18"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061515","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) 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。
{"title":"Impact of Depression on Clinical Outcomes Among Spontaneous Coronary Artery Dissection Patients: 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 , Maureen Masara MD , Gloria Amoako MD , Esther Obeng-Danso MD , Inna Bukharovich , Suzette Graham-Hill MD","doi":"10.1016/j.ahj.2025.07.037","DOIUrl":"10.1016/j.ahj.2025.07.037","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 13"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061568","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 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}
Pub Date : 2025-09-15DOI: 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。
{"title":"Influence of Obstructive Sleep Apnea on Long-Term Cardiovascular Outcomes in Heart Transplant Recipients: A Retrospective Database Study","authors":"Abena Agyekum, Nana Osei, Ekow Essien, Abraham Carboo, Karldon Nwaezeapu","doi":"10.1016/j.ahj.2025.07.062","DOIUrl":"10.1016/j.ahj.2025.07.062","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</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":"145061445","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}
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。
{"title":"Tirzepatide vs Semaglutide in Coronary Artery Disease and Obesity: Real-World Cardiovascular Outcomes Analysis from the TriNetX Research Network","authors":"Ekow Essien , Gloria Amoako , Abena Agyekum , Godslove Bonnah , Abraham Carboo , Karldon Nwaezeapu , Aba Kwakomah Dapaah","doi":"10.1016/j.ahj.2025.07.060","DOIUrl":"10.1016/j.ahj.2025.07.060","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</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":"145061475","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.2025.07.044
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）
{"title":"The Design of MOMENTUM: A Prospective Study of the Prevalence of Endogenous Hypercortisolism in Individuals With Resistant Hypertension","authors":"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","doi":"10.1016/j.ahj.2025.07.044","DOIUrl":"10.1016/j.ahj.2025.07.044","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>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)</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 16-17"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061514","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.2025.07.046
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.
{"title":"High Medication Burden in Individuals With Difficult-to-Control Type 2 Diabetes: Clinical Characteristics From the CATALYST Study","authors":"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","doi":"10.1016/j.ahj.2025.07.046","DOIUrl":"10.1016/j.ahj.2025.07.046","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 18"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061516","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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