Cardiovascular Therapeutics最新文献

Background

The 2024 European Society of Cardiology (ESC) guideline newly recommended clopidogrel as a safe and effective alternative to aspirin monotherapy in patients with chronic coronary disease (CAD). We aimed to validate the 2024 ESC guideline recommendation by comparing the prognosis of patients with chronic CAD treated with P2Y12 inhibitor monotherapy and aspirin monotherapy.

Methods

This retrospective cohort study included patients with chronic CAD (18 months after percutaneous coronary intervention [PCI] with drug-eluting stents [DES] in 2019–2023), based on a nationwide health claims database in Korea. A 1:1 propensity score matching was performed between P2Y12 inhibitors and aspirin monotherapy groups. The primary composite outcome included all-cause death, myocardial infarction, ischemic stroke, and major bleeding. Stratified Cox regression models were used to compare risks between groups.

Results

Of 127,127 patients with chronic CAD (mean age: 63.1 years; 73.7% men), 84,440 (66.4%) patients received P2Y12 inhibitor monotherapy, and 42,727 (33.6%) received aspirin monotherapy. After propensity score matching, 42,692 pairs were generated. During a median follow-up of 3 years, P2Y12 inhibitor monotherapy did not reduce the risk of the primary composite outcome (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.92–1.05; p = 0.577) compared with aspirin monotherapy. In secondary analyses, P2Y12 inhibitors showed a trend toward reduced major bleeding (HR: 0.86; 95% CI: 0.72–1.02; p = 0.082) and a significant reduction in major gastrointestinal bleeding (HR: 0.79; 95% CI: 0.63–0.97; p = 0.027).

Conclusions

Among Korean patients with chronic CAD in the long-term maintenance period after PCI using DES, P2Y12 inhibitor monotherapy demonstrated overall outcomes comparable with aspirin monotherapy, with a potential advantage in reducing bleeding, particularly of gastrointestinal origin. These findings support the safety and feasibility of P2Y12 inhibitor monotherapy, in line with the 2024 ESC guideline recommendations, while emphasizing the need for further prospective studies to confirm its clinical benefit.

Objective

Hyperhomocysteinemia is a risk factor for cardiovascular disease, but its impact on valve disease is lacking in research. This study was aimed at investigating the impact of hyperhomocysteinemia on rheumatic mitral valve calcification and prognosis in patients undergoing surgery.

Methods

This study included 672 patients with severe rheumatic mitral valve stenosis who underwent surgery between January 2016 and December 2022. Patients were stratified by preoperative homocysteine levels. Mitral valve pathology was assessed by echocardiography and coronary CTA, with all-cause mortality as the primary mid-term endpoint.

Results

Among this surgical cohort of 672 patients with severe rheumatic mitral stenosis, 208 (31.0%) patients were identified with hyperhomocysteinemia. Imaging assessment revealed that these patients had a higher Agatston score for mitral valve calcification (37.47 vs. 17.19, p = 0.038) after adjusting baseline data. Restricted cubic splines revealed a significant dose–response relationship, with mitral valve calcification increasing progressively with higher homocysteine levels (p < 0.001). The Kaplan–Meier survival analysis showed that patients with hyperhomocysteinemia had significantly lower mid-term survival rates (log-rank p = 0.004). Through univariate and multivariate COX regression analyses, it was found that hyperhomocysteinemia was an independent risk factor affecting mid-term postoperative survival (HR, 2.257; p = 0.048).

Conclusions

In patients undergoing surgery for rheumatic heart disease, hyperhomocysteinemia was associated with the formation of rheumatic mitral valve calcification and increased mid-term postoperative mortality.

Trial Registration: Chinese Clinical Trial Registry identifier ChiCTR2200067151

Background

Atherosclerotic cardiovascular disease (ASCVD) pathogenesis is closely associated with macrophages. This study sought to explore the role of phagocytosis by monocyte-derived macrophages (MDMs) in the blood in the context of coronary heart disease (CHD) and acute coronary syndromes (ACSs).

Methods

This study employed a matched case–control design. Individuals with suspected CHD were recruited and allocated to a control cohort or a CHD cohort, with the latter further stratified into stable angina pectoris and ACS subgroups according to clinical diagnoses. Clinical data were collected, MDMs were isolated, and macrophage phagocytic activity was evaluated using fluorescent-labeled latex microspheres.

Results

Macrophage phagocytic rates were significantly reduced in the CHD group relative to the control group, with further decreases observed in the ACS subgroup. Multivariable linear regression revealed that age, low-density lipoprotein cholesterol (LDL-C), high-sensitivity C-reactive protein (hs-CRP), and fibrinogen were independently and negatively correlated with macrophage phagocytic rates. Multivariable analyses suggested that diminished macrophage phagocytic rates were linked to an elevated risk of both CHD and ACS. Receiver operating characteristic (ROC) curve analysis identified the optimal cutoff values of macrophage phagocytic rates for predicting CHD and ACS as 62.6% and 63.4%, respectively, with the area under the curves (AUCs) measured at 0.679 and 0.669.

Conclusions

Macrophage phagocytic activity is reduced in CHD patients, particularly in those with ACS. Diminished macrophage phagocytic function is linked to CHD and ACS. Macrophage phagocytosis could act as a protective biomarker in CHD and ACS, providing new insights into the pathophysiology of ASCVD.

Purpose

The purpose of the study is to analyze the clinicopathological characteristics of essential hypertension (EH) in high-altitude regions of China and provide evidence-based guidance for rational diagnosis and treatment strategies in these areas.

Methods

This cross-sectional retrospective study enrolled two cohorts of EH patients from Qinghai (high altitude, ≥ 2500 m) and Chengdu (low altitude, 500 m) between 2020 and 2022. Participants were stratified based on their residential altitude. Clinical parameters, biochemical markers, cardiac imaging data, and antihypertensive regimens were systematically compared. Statistical analyses were conducted using SPSS software (Version 26.0).

Results

Compared with patients with EH at low altitude, high-altitude EH patients had a higher mean systolic/diastolic blood pressure and a lower percentage of compliance with blood pressure lowering and were more likely to have hyperuricemia (HUA) and abnormally elevated metabolic function (p = 0.03). Significant cardiac structural changes occurred in patients with high-altitude EH: increased pulmonary artery internal diameter (p < 0.001). In addition, the proportion of angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, β-blocker, and diuretic use was lower in patients with high-altitude EH, while the proportion of SPC combination use was higher; conversely, the proportion of diuretic use was higher in patients with high-altitude EH with comorbid HUA.

Conclusion

EH in high-altitude populations demonstrates distinct clinicopathological manifestations, including right ventricular overload and compensatory left cardiac adaptation. These findings underscore the necessity for altitude-specific clinical guidelines to optimize hypertension management in these regions.

Background/Objectives

Dual antiplatelet therapy (DAPT), which combines aspirin with a P2Y12 receptor inhibitor for platelets, is crucial for the prevention of cardiac and systemic ischemic events in patients with coronary artery disease who have undergone revascularization procedures. Although indobufen is suggested as an alternative for individuals who exhibit intolerance to aspirin, the long-term safety and efficacy of indobufen-based DAPT treatment for the prevention of cardiac and systemic ischemic events in these patients remain ambiguous. This meta-analysis seeks to examine the long-term safety and efficacy of DAPT based on indobufen in the context of revascularization procedures for patients.

Methods

A thorough search was performed across PubMed, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov, and CNKI, covering all records from each database’s inception to October 10, 2024. Included were randomized trials analyzing oral DAPT antiplatelet agents for coronary artery disease patients who received revascularization. Two reviewers independently handled the selection process: screening articles, overview, extracting data, and assessing study quality in accordance with PRISMA guidelines. The pooled data were later subjected to analysis using a random-effects model meta-analysis.

Results

The final analysis included three randomized controlled trials, which yielded the following findings regarding major adverse cardiovascular and cerebrovascular events (MACCEs): The relative risk (RR) was 1.58 (95% CI, 0.72–3.38); for BARC Type 2, 3, or 5 bleeding events, the RR was 0.35 (95% CI, 0.18–0.67); and for gastrointestinal intolerance events, the RR was 0.06 (95% CI, 0.03–0.18).

Conclusions

Indobufen-based DAPT may potentially increase the risk of ischemic events without compromising safety for revascularization, as its upper RR limit exceeds 1 for MACCEs.

Objective

This study is aimed at comparing the efficacy and safety of dronedarone, amiodarone, and propafenone in preventing early recurrence of atrial arrhythmias during the blanking period following catheter ablation in patients with nonparoxysmal atrial fibrillation.

Methods

We retrospectively analyzed 408 patients with nonparoxysmal atrial fibrillation who underwent their first catheter ablation. Patients were divided into three groups based on the postoperative antiarrhythmic drug prescribed: dronedarone, amiodarone, or propafenone. A propensity score matching (PSM) analysis was performed as the primary analysis to compare early recurrence rates and drug-related adverse events. An inverse probability of treatment weighting (IPW) analysis was conducted as a sensitivity analysis.

Results

Of the 408 patients, 65 (15.9%) experienced early recurrence. The early recurrence rate was significantly lower in the dronedarone group (9.2%) compared to propafenone (27.2%), but not significantly different from amiodarone (14.0%). The dronedarone group showed a lower recurrence rate of atrial flutter compared to both the propafenone and amiodarone groups (p < 0.05). After PSM, the recurrence rate of atrial flutter remained significantly lower in the dronedarone group compared to propafenone and amiodarone. Regarding drug-related adverse events, 73 patients (17.9%) experienced adverse reactions, with the amiodarone group showing a significantly higher incidence (24.2%) compared to the propafenone (13.6%) and dronedarone (11.8%) groups.

Conclusion

In this retrospective study of patients with nonparoxysmal atrial fibrillation after catheter ablation, dronedarone and amiodarone showed a trend toward better efficacy than propafenone in preventing overall early recurrence. Dronedarone demonstrated a specific advantage in preventing early recurrence of atrial flutter.

Purpose

The purpose of this study is to analyze clinical characteristics of patients with Kawasaki disease (KD) aged below 1 year and identify risk factors for coronary aneurysm (CA) and its associated prognosis.

Methods

A retrospective study enrolling infants (under 1 year of age) with KD admitted to a children’s hospital between January 1, 2012, and August 30, 2024, was conducted. Patients were divided into two groups based on CA presence. Clinical records, including demographics, clinical manifestations, treatments, laboratory parameters, and cardiac ultrasound examination, were collected and analyzed.

Results

Of 381 infants with KD, 96 developed CA. Male sex (adjusted odds ratio [aOR] = 1.982, p = 0.04), duration of fever (aOR = 1.143, p = 0.03), illness days of initial intravenous immunoglobulin (IVIG) (aOR = 1.319, p < 0.01), and higher C-reactive protein (CRP) (aOR = 1.007, p = 0.02) were associated with CA development in infants with KD in multivariable analysis. Specifically, an increase of 10 mg/L in CRP is associated with a 7.2% elevation in risk of CA development. Among patients diagnosed with CA, 30, 42, and 24 had small aneurysm (sAN), medium aneurysm (mAN), and giant aneurysm (gAN), respectively. The complete regression proportion and regression times of sAN, mAN, and gAN were 86.7%, 76.2%, and 33.3% and 3.9 ± 9.2, 12.8 ± 17.2, and 20.7 ± 11.2 months, respectively.

Conclusions

CA incidence was higher in infants with KD and was associated with male sex, fever duration, days of initial IVIG, and higher CRP. The ability and time of regression depend on the size of the CA; however, giant CA in infant patients has a greater tendency to regress than those in older patients with KD.

Backgrounds

Anemia is associated with poor prognosis in heart failure patients. Erythropoiesis-stimulating agents have been used for the treatment of renal anemia, but they increase the risk of thrombotic events. Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) have emerged as a new treatment for renal anemia. HIF-PHIs are expected to have pleiotropic effects beyond correcting anemia. Evidence regarding the effects of HIF-PHIs in cardiorenal anemia syndrome has not been established.

Methods and Results

The present study is a single-center, retrospective analysis of patients with heart failure and renal anemia who were treated with HIF-PHIs or oral iron supplementation at Kyushu University Hospital (n = 39 and n = 26). Both treatments significantly raised hemoglobin levels (HIF-PHIs 9.1 [8.6–9.6] vs. 10.3 [9.5–11.8], p < 0.001; oral iron 10.1 [9.3–11.0] vs. 11.8 [10.6–13.2], p < 0.001). Log-transformed BNP level (logBNP) decreased in the HIF-PHI-treated patients but not in those treated with oral iron despite the similar improvement in hemoglobin levels (HIF-PHIs 2.74 [2.28–2.99] vs. 2.47 [2.16–2.66], p = 0.005; oral iron 2.38 [1.89–2.66] vs. 2.37 [1.90–2.50], p = 0.711). The levels of iron metabolism–related parameters after treatment were comparable between the two groups. ΔlogBNP/ΔHb slope was significantly steeper in the HIF-PHI group than the oral iron supplementation group (−0.100 vs. −0.047, p = 0.039), meaning that HIF-PHIs further reduced BNP levels than anticipated by the increase of hemoglobin with conventional treatment.

Conclusion

HIF-PHIs reduce BNP levels more than anticipated by the elevation of hemoglobin levels compared to oral iron supplementation. HIF-PHIs may have therapeutic benefits against heart failure beyond the correction of anemia in the heart failure patients.

Background

Heart failure (HF) is a major global public health problem, and identifying modifiable environmental risk factors is important for prevention. We evaluated the association between blood cadmium levels and the risk of HF in US adults.

Methods

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2009–2014. A total of 10,542 adults with complete information on blood cadmium and HF status were included. Weighted multivariable logistic regression models were used to assess the relationship between blood cadmium and self-reported HF. Restricted cubic spline (RCS) regression and two-piecewise linear models were applied to explore potential dose–response relationships.

Results

A cohort of 10,542 US adults from the NHANES 2009–2014 dataset was analyzed, including 321 individuals diagnosed with HF. In fully adjusted, weighted logistic regression models, elevated blood cadmium levels were significantly correlated with an increased prevalence of HF. Specifically, each 1 μg/L increment in blood cadmium was associated with a 42% higher likelihood of HF (odds ratio [OR] = 1.42; 95% confidence interval [CI]: 1.18–1.72; p < 0.001). Participants in the highest quartile of blood cadmium levels exhibited more than a threefold increase in the odds of HF compared to those in the lowest quartile (OR = 3.15; 95% CI: 1.81–5.50; p < 0.001), with a significant linear trend observed across quartiles (p < 0.001). RCS analysis demonstrated a monotonic positive relationship, with an apparent inflection point at approximately 0.13 μg/L, beyond which the risk continued to escalate. This association was generally consistent across various subgroups but was notably stronger among smokers (p for interaction < 0.05).

Conclusions

Elevated blood cadmium is an independent risk factor for HF in the United States. These findings suggest that reducing cadmium exposure may be a novel strategy for HF prevention. Prospective studies are warranted to clarify causal relationships and underlying mechanisms.