Anthropometric Measures, Cardiovascular Outcomes, and Treatment Effects of Finerenone in Cardiovascular-Kidney-Metabolic Disease: Pooled Participant-Level Analysis of Three Global Trials.

Background: Obesity is a core pathophysiological contributor to cardiovascular, kidney, and metabolic (CKM) conditions. However, the association between different adiposity-related anthropometrics and cardiovascular outcomes in persons with CKM conditions has not been rigorously explored.

Objectives: To examine cardiovascular outcomes and treatment effects of finerenone according to different adiposity-related anthropometrics.

Nonsteroidal and Steroidal Mineralocorticoid Antagonists: Rationale, Evidence, and Unanswered Questions.

Steroidal mineralocorticoid receptor antagonists (MRAs), such as spironolactone and eplerenone, have demonstrated substantial benefits in randomized controlled trials for patients with heart failure with reduced ejection fraction. However, their effectiveness in heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction remains uncertain, and the implementation of this class has remained low, in part due to its side effects and tolerability profile. Emerging therapies that target the mineralocorticoid receptor and/or the production of aldosterone may offer alternative strategies to treat the aldosterone-mineralocorticoid receptor axis.

Medicare Coverage Gap Status, Adherence to Oral Anticoagulation, and Stroke Rates in Patients with Atrial Fibrillation.

Background: Prior to 2025, Medicare Part D included a coverage gap during which beneficiaries were responsible for substantially higher portions of medication costs. The impact of this on oral anticoagulant (OAC) prescription fills and subsequent stroke in patients with atrial fibrillation (AF) is not known.

Methods: Using Centers for Medicare and Medicaid Services claims data from 2016-2018, we evaluated OAC prescription fills in patients with AF by assessing their proportion of days covered on OAC before, during, and after their coverage gap.

Secondary analysis of the EMPACT-MI trial reveals cardiovascular-kidney efficacy and safety of empagliflozin after acute myocardial infarction.

Data on the cardiovascular-kidney effects and safety of empagliflozin among patients with acute myocardial infarction are limited. EMPACT-MI (Study to Evaluate the Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction) was a double-blind, multicenter clinical trial that randomized 6,522 patients with acute myocardial infarction and risk for heart failure to empagliflozin or placebo. Here we show in this secondary analysis that the mean estimated glomerular filtration rate at baseline was 76.

2025 ACC Scientific Statement on the Management of Obesity in Adults With Heart Failure: A Report of the American College of Cardiology.

Obesity confers increased risks of HF, coronary artery disease, and stroke, and weight loss can reduce cardiovascular disease risk. Given emerging evidence of the benefits of semaglutide and tirzepatide in individuals with HFpEF and obesity in concert with healthy behavioral interventions, clinicians should be aware of optimal diagnosis, risk assessment, and management of obesity in individuals with HF. Despite the early promise of anti-obesity medications in HFpEF, challenges remain, including whether BMI is the optimal metric to identify obesity and subsequent benefit from anti-obesity medications; the safety profile of anti-obesity medications for individuals with HF, particularly HFrEF; and whether the benefits of anti-obesity medications are attributed mainly to the magnitude of weight loss or due to other mechanisms of action.

Incretin-based therapies for individuals with obesity and heart failure with mildly reduced or preserved ejection fraction: A systematic review and meta-analysis of randomized controlled trials.

Aims: Obesity is a major risk factor for heart failure with mildly reduced or preserved ejection fraction (HFpEF). This meta-analysis of randomised clinical trials (RCTs) evaluated the effects of incretin-based therapies (IBTs), including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GIP/GLP-1 RAs, on clinical outcomes in individuals with the obesity-HFpEF phenotype.

Materials And Methods: A systematic search of PubMed, EMBASE and Web of Science through December 2024 identified RCTs comparing IBTs with placebo in patients with HFpEF and obesity.

Structural abnormalities and effects of sacubitril/valsartan in patients with mildly reduced or preserved ejection fraction and worsening heart failure: The PARAGLIDE-HF trial.

Background: PARAGLIDE-HF showed significantly greater reduction in NT-proBNP in patients with LVEF>40% and worsening HF with sacubitril/valsartan (sac/val) vs valsartan (val). The impact of structural abnormalities on the effects of sac/val in this context is unknown. This study aimed to evaluate the impact of left ventricular hypertrophy (LVH) and left atrial enlargement (LAE) on sac/val in patients with LVEF>40% and worsening HF.

Heart failure with preserved ejection fraction therapeutics: in search of the pillars.

Heart failure (HF) affects nearly 8 million individuals in the USA, with approximately half diagnosed with heart failure with preserved ejection fraction (HFpEF). HFpEF is associated with high morbidity and mortality, with fewer than 25% of patients surviving beyond 5 years after diagnosis. Historically, poor outcomes have been largely attributed to a lack of effective disease-modifying therapies.

Advances in the management of obesity and heart failure: latest evidence from clinical trials.

Purpose Of Review: Obesity is an important risk factor for heart failure with preserved ejection fraction (HFpEF). In patients who already have HFpEF, obesity contributes to high symptom burden and increased risk for heart failure (HF) hospitalization. This review examines the latest clinical trials assessing the efficacy of pharmacological interventions in the treatment of obesity-related HFpEF.

Empagliflozin in acute myocardial infarction in patients with and without type 2 diabetes: A pre-specified analysis of the EMPACT-MI trial.

Aims: In the EMPACT-MI trial, empagliflozin reduced heart failure (HF) hospitalizations but not mortality in acute myocardial infarction (MI). Contemporary reports of clinical event rates with and without type 2 diabetes mellitus (T2DM) in acute MI trials are sparse. The treatment effect of empagliflozin in those with and without T2DM in acute MI is unknown.

Implementing guideline-directed medical therapy: Stakeholder-identified barriers and facilitators.

Background: Despite strong evidence and Class I recommendations to support the use of guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF), use of these medications remain suboptimal. There is a great need to understand 1) what barriers to implementation of these therapies exist and 2) effective ways to support implementation of these therapies.

Methods: Using the Consolidated Framework for Implementation Research framework, we conducted a broad array of interviews with stakeholders in the care of patients with HFrEF across 26 health systems to determine the barriers to GDMT implementation that health systems face, and to identify any factors that facilitated GDMT implementation and titration.

Participant Engagement and Preference Study for Clinical Outcomes Associated With Atrial Fibrillation: The PEARL-AF Study.

Background: Quantifying patients' preferences for health outcomes associated with atrial fibrillation (AF) and its treatments offers a replicable approach to considering the patient perspective in regulatory decision-making.

Objective: The authors conducted a preference survey to estimate the relative importance of AF-related events for use in clinical trial analyses to estimate net health benefits with anticoagulants.

Methods: The survey included nontechnical descriptions of three severities of stroke, systemic embolism, myocardial infarction (MI) with or without subsequent heart failure (HF), major bleeding, clinically relevant nonmajor bleeding, and death.

Effects of fortified eggs and time-restricted eating on cardiometabolic health: The prosperity trial.

Background: Given the increasing interest in dietary interventions to improve cardiovascular health, this trial assessed the impact of fortified eggs (FE) versus nonegg supplemented diet and time-restricted eating (TRE) versus usual care diet on cardiovascular biomarkers.

Methods: The study was a unblinded, 2-by-2 factorial design, which randomized patients, with either a prior cardiovascular event or 2 cardiovascular risk factors, to FE or a nonegg supplemented diet and TRE or usual care diet. Patients randomized to FE were instructed to consume at least 12 FE/week (with eggs provided); those on a nonegg supplemented diet restricted egg consumption to <2 eggs/week.

Asundexian versus Apixaban in Patients with Atrial Fibrillation.

Background: Stroke prevention with direct-acting oral anticoagulant agents in patients with atrial fibrillation confers a risk of bleeding and limits their use. Asundexian, an activated factor XI (XIa) inhibitor, is an oral anticoagulant that may prevent strokes with less bleeding.

Methods: In a phase 3, international, double-blind trial, we randomly assigned high-risk patients with atrial fibrillation in a 1:1 ratio to receive asundexian at a dose of 50 mg once daily or standard-dose apixaban.

Anti-Obesity Medications in Patients With Heart Failure: Current Evidence and Practical Guidance.

Obesity is a significant risk factor for heart failure (HF) development, particularly HF with preserved ejection fraction and as a result, many patients with HF also have obesity. There is growing clinical interest in optimizing strategies for the management of obesity in patients with HF across the spectrums of both ejection fraction and disease severity. The emergence of anti-obesity medications with cardiovascular outcomes benefits, principally glucagon-like peptide-1 receptor agonists, has made it possible to study the impact of anti-obesity medications for patients with baseline cardiovascular conditions, including HF.

Deep Learning Resolves Myovascular Dynamics in the Failing Human Heart.

The adult mammalian heart harbors minute levels of cycling cardiomyocytes (CMs). Large numbers of images are needed to accurately quantify cycling events using microscopy-based methods. CardioCount is a new deep learning-based pipeline to rigorously score nuclei in microscopic images.

Anti-obesity medications in the management of heart failure with preserved ejection fraction: available evidence and next STEPS.

Obesity is associated with an increased risk of incident heart failure with preserved ejection fraction (HFpEF) and, among patients with existing heart failure, is associated with worse quality of life, higher symptom burden, and more HF hospitalizations. Anti-obesity medication (AOM) semaglutide has been shown to be efficacious at both causing intentional weight loss and improving HF symptom burden, with some evidence to suggest that HF clinical events may also be reduced. Additional ongoing trials of AOM in patients with cardiovascular disease, including HFpEF, will further improve insight into the potential role of managing obesity to improve HF status among patients with HFpEF and obesity.