Circulation

No abstract text is available yet for this article.

BACKGROUND: Myocardial utilization of 3-hydroxybutyrate (3-OHB) is increased in patients with heart failure and reduced ejection fraction (HFrEF). However, the cardiovascular effects of increased circulating P-3-OHB levels in these patients are unknown. Consequently, our aim was to modulate circulating 3-OHB levels in HFrEF patients and evaluate: 1) changes in cardiac output (CO), 2) a potential dose-response relationship between 3-OHB levels and CO, 3) the impact on myocardial external energy efficiency (MEE) and oxygen consumption (MVO2 ), and 4) whether the cardiovascular response differed between HFrEF patients and age-matched volunteers...

Cardiovascular disease (CVD) is increasingly common among new cancer patients, with a reported prevalence near 30% at diagnosis.1,2 Cancer patients with concurrent CVD have poorer outcomes than those without CVD.1-3 Despite the high prevalence of CVD and its prognostic significance, there is limited evidence to guide the care of this increasing population. One possible explanation may be the exclusion of CVD patients from clinical trials.3 In the US, pivotal clinical trials of anticancer drugs are reviewed by the Food and Drug Administration (FDA) for adequate representation and safety prior to approval and release...

BACKGROUND: Sodium glucose transporter-2 inhibitors (SGLT2i) reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) and a history of atherosclerotic cardiovascular (CV) disease (ASCVD). Because of their baseline risk, patients with prior myocardial infarction (MI) may derive even greater benefit from SGLT2i therapy. METHODS: DECLARE TIMI-58 randomized 17,160 patients with T2DM and either established ASCVD (n = 6,974) or multiple risk factors (MRF) (n = 10,186) to dapagliflozin versus placebo...

BACKGROUND: In DECLARE-TIMI 58, the sodium glucose co-transporter 2 inhibitor (SGLT2i) dapagliflozin reduced the composite endpoint of cardiovascular (CV) death/ hospitalization for heart failure (HHF) in a broad population of patients with T2DM. However, the impact of baseline left ventricular ejection fraction (EF) on the clinical benefit of SGLT2i is unknown. METHODS: In the DECLARE-TIMI 58 trial, baseline HF status was collected from all patients and EF where available...

Diabetes intersects with cardiovascular disease at every level. While there has been much focus on understanding atherosclerotic complications, less well appreciated is the relationship between diabetes and heart failure. In addition to being a key and independent risk factor for the development of heart failure,1 diabetes is also one of the most important adverse prognostic factors in those with established heart failure with either reduced or preserved ejection fraction. 1,2 Diabetes is associated with a high prevalence of unrecognized left ventricular diastolic and systolic dysfunction, and accelerates the development of overt heart failure compared to similar patients without diabetes...

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BACKGROUND: End-stage renal disease patients on dialysis are reported to be at high risk of sudden cardiac death (SCD) and, to date, no therapy has been shown to be effective in reducing this. The feasibility and value of prophylactic implantable cardioverter-defibrillator (ICD) implantation to prevent SCD is uncertain. METHODS: We conducted the ICD2 trial, a prospective, randomized controlled study investigating the value and safety of ICD implantation to prevent SCD in 200 patients on dialysis with a left ventricular ejection fraction ≥35%, after adequate screening and optimization of other treatments...

Patients with type 2 diabetes mellitus are at high risk of developing heart failure (HF).1 Sodium glucose co-transporter 2 (SGLT2) inhibitors have been demonstrated, in large scale trials, to reduce the risk of HF events in patients with type 2 diabetes deemed to be at high risk based on established cardiovascular disease or multiple risk factors.2-4 However, it is unclear whether benefits are experienced across the broad spectrum of HF patients that includes those with preserved (HFpEF) as well as reduced ejection fraction (HFrEF)...

BACKGROUND: The multicenter, international, randomized, blinded, sham-controlled RADIANCE-HTN SOLO trial demonstrated a 6.3 mmHg greater reduction in daytime ambulatory systolic blood pressure (BP) at 2 months by endovascular ultrasound renal denervation (RDN) compared with a sham procedure among patients not treated with antihypertensive medications. We report 6-month results following the addition of a recommended standardized stepped-care antihypertensive treatment (SSAHT) to the randomized endovascular procedure under continued blinding to initial treatment...

Stroke is a devastating complication of atrial fibrillation (AF) the odds of which can be reduced by use of oral anticoagulation based on the stroke risk score.1,2 Patients with asymptomatic clinical AF have a similar stroke risk as patients with symptomatic clinical AF.3 Thus far, electrocardiographic- (ECG) or Holter monitor-detected AF is a prerequisite before use of oral anticoagulation,1,2 because the guideline recommendations are based on studies that included only ECG- or Holter-detected AF ('clinical' AF)...

BACKGROUND: Device-detected atrial fibrillation (AF) is associated with increased risk of stroke. However, there are no clearly-defined thresholds of AF burden for which to initiate oral anticoagulation (OAC). We sought to describe OAC prescription practice variation in response to new device-detected AF and the association to outcomes. METHODS: We performed a retrospective cohort study using data from the Veterans Health Administration linked to remote monitoring data that included day-level AF burden...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Much of the cardiovascular disease burden and mortality can be traced back to four adverse health behaviors (smoking, poor diet, elevated body mass index, sedentary lifestyle) and three major risk factors (hypercholesterolemia, hypertension, diabetes). Ideal cardiovascular health defined as having all seven factors at goal is very rare among US adults. It is estimated that 87% of middle-aged US adults and 95% of individuals ≥60 years old meet ≤4 of these health metrics.1 Detailed guidelines are available that discuss cardiovascular risk assessment, lifestyle management, and treatment of individual risk factors...

BACKGROUND: Molecular targeted chemotherapies have been shown to significantly improve cancer patient outcomes, but often cause cardiovascular side effects that limit their use and impair patients' quality of life. Cardiac dysfunction induced by these therapies, especially trastuzumab, shows a distinct cardiotoxic clinical phenotype compared to cardiotoxicity induced by conventional chemotherapies. METHODS: We employed the human induced pluripotent stem cell-derived cardiomyocyte (iPSC-CM) platform to determine the underlying cellular mechanisms in trastuzumab-induced cardiac dysfunction...

The advent of new tobacco products such as electronic cigarettes and the dramatic rise in their use, especially by adolescents and young adults, are significant public health concerns. Electronic cigarettes have become the most popular tobacco products for youth and adolescents in the United States and are attracting youth to new avenues for nicotine addiction. Although these products may have benefit by helping some smokers quit or to move to a less harmful product, the long-term health effects of these products and the net public health effect associated with their use remain unclear and widely debated...

Cardiorenal syndrome encompasses a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in 1 organ may induce acute or chronic dysfunction in the other organ. It represents the confluence of heart-kidney interactions across several interfaces. These include the hemodynamic cross-talk between the failing heart and the response of the kidneys and vice versa, as well as alterations in neurohormonal markers and inflammatory molecular signatures characteristic of its clinical phenotypes...

Tobacco smoking with a water pipe or hookah is increasing globally. There are millions of water pipe tobacco smokers worldwide, and in the United States, water pipe use is more common among youth and young adults than among adults. The spread of water pipe tobacco smoking has been abetted by the marketing of flavored tobacco, a social media environment that promotes water pipe smoking, and misperceptions about the addictive potential and potential adverse health effects of this form of tobacco use. There is growing evidence that water pipe tobacco smoking affects heart rate, blood pressure regulation, baroreflex sensitivity, tissue oxygenation, and vascular function over the short term...

The cardiovascular community has been debating for decades whether to treat mild-tomoderate hypertriglyceridemia. Results of the Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT)1 position this controversy as front matter for deliberation. For lipid experts, dominating the discourse will be the strength of experimental evidence, mechanism of benefit, identification of treatment response parameters, and prioritizing treatment options. For the practitioner, the question ultimately will be whether potential gains are worth the disruption to clinical care that accompanies a new paradigm in prevention...