BACKGROUND: Despite statin therapy, cardiovascular disease remains a leading cause of mortality. CSL112 enhances HDL function and reverses cholesterol transport, offering a novel strategy for atherosclerotic cardiovascul...BACKGROUND: Despite statin therapy, cardiovascular disease remains a leading cause of mortality. CSL112 enhances HDL function and reverses cholesterol transport, offering a novel strategy for atherosclerotic cardiovascular disease (CVD). METHODS: Following PRISMA guidelines, databases including PubMed, the Cochrane Library, Scopus, Google Scholar, and EMBASE were searched from inception to May 2025 for studies evaluating efficacy and safety of CSL112 in adults at risk of atherosclerotic CVD. Data were analyzed using RevMan version 5.4 with a random-effects model. RESULTS: Six trials ( = 1,824) showed that CSL112 significantly increased total cholesterol efflux capacity (CEC), most notably with the 6 g dose (MD 11.90; < 0.00001), including ABCA1-dependent (MD 5.88; < 0.00001) and ABCA1-independent CEC (MD 4.68; < 0.0001) at 2 hr. HDL-C levels increased significantly (MD 6.89; < 0.00001) without meaningful change in apolipoprotein A-I. Safety analyses showed no increased risk of serious adverse events (RR 1.05) or treatment-emergent adverse events (RR 0.88) versus placebo. CONCLUSION: CSL112 significantly enhances CEC and HDL-C levels with favorable safety profile with the 6 g dose at 2 hr, supporting its use as an adjunctive therapy for immediate cardiovascular protection. Large outcome-driven trials are warranted to define long-term clinical benefits.
INTRODUCTION: The aims of this paper are as follows: 1) To analyze the evolution of understanding of hypertensive target organ damages (TODs); 2) To see if the concept of 'acute-on-chronic TOD' is commented so far and to...INTRODUCTION: The aims of this paper are as follows: 1) To analyze the evolution of understanding of hypertensive target organ damages (TODs); 2) To see if the concept of 'acute-on-chronic TOD' is commented so far and to provide rationale for its use. AREAS COVERED: Need for the division of hypertensive TODs into acute and chronic is already recognized. Now we propose another subgroup of TODs: 'acute-on-chronic' TODs. The episodes of very high blood pressure are the situations when 'acute-on-chronic TOD' can be expected. The benefit of this category of hypertensive TODs is primary in the clinical setting - enhanced awareness of the possibility of 'acute-on-chronic' TOD may improve our diagnostic decisions. EXPERT OPINION: In the next period of five years, hypertensive TODs are to be classified (as acute, chronic and 'acute-on-chronic') in guidelines on HTN. Additionally, a more precise listing of entities will be agreed upon. Following the analysis of existing and forthcoming studies and registries, with a little help of artificial intelligence, we may obtain a valuable basis to predict future acute hypertensive TODs. Together with improved recognition of acute TODs, it may result in saving of numerous lives worldwide.
INTRODUCTION: Patients presenting with acute coronary syndrome (ACS) and a history of cancer are high-risk. Prior studies suggest differences in acute treatment and discharge prescribing compared with non-cancer patients...INTRODUCTION: Patients presenting with acute coronary syndrome (ACS) and a history of cancer are high-risk. Prior studies suggest differences in acute treatment and discharge prescribing compared with non-cancer patients. METHODS: PubMed, Scopus, Embase, andClinicalTrials.gov were searched on 24 January 2025, for studies published between 2000 and 2025. Studies comparing ACS management and medication use in patients with versus without a history of malignancy were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: Seventeen studies were included. During hospitalization, cancer patients with ACS were significantly less likely to undergo percutaneous coronary intervention (PCI), receive drugeluting stents, or receive glycoprotein IIb/IIIa inhibitors (all < 0.001), compared to non-cancer patients. No significant differences were observed in the administration of beta-blockers ( = 0.26) or P2Y12 inhibitors ( = 0.39). At discharge, cancer patients were less likely to be prescribed dual antiplatelettherapy ( = 0.02), aspirin ( < 0.001), beta-blockers ( = 0.03), and statins ( = 0.02). No significant differences were found in prescriptions for P2Y12 inhibitors, oral anticoagulants, nitrates, calcium channel blockers, or ACE inhibitors/ARBs. CONCLUSIONS: Differences in treatment persist in both in-hospital management and discharge prescribing for cancer patients with ACS, underscoring the need for standardized, evidence-based protocols to ensure equitable care. REGISTRATION: This meta-analysis was prospectively registered with PROSPERO (CRD420251275640.).
INTRODUCTION: Hypertriglyceridemia (HTG) is a heterogeneous metabolic disorder driven by both genetic susceptibility and secondary factors. Most patients with severe HTG (triglyceride [TG] >10 mmol/L [>885 mg/dL]) have m...INTRODUCTION: Hypertriglyceridemia (HTG) is a heterogeneous metabolic disorder driven by both genetic susceptibility and secondary factors. Most patients with severe HTG (triglyceride [TG] >10 mmol/L [>885 mg/dL]) have multifactorial chylomicronemia syndrome (MCS) while only a few have familial chylomicronemia syndrome (FCS), a rare autosomal recessive condition. AREAS COVERED: We summarize the pathophysiology of severe HTG, emphasizing impaired intravascular lipolysis of TG-rich lipoproteins and the regulatory role of apolipoproteins (apo), particularly apo C-III. We outline features that distinguish FCS from MCS and discuss diagnostic strategies, including clinical scoring systems and targeted genetic testing. Current management approaches, including responses to conventional TG-lowering therapies and emerging biologic therapies targeting apo C-III, are examined. We searched PubMed for all English language literature focusing on the search terms 'chylomicronemia,' 'familial chylomicronemia syndrome,' 'multifactorial chylomicronemia syndrome,' 'hypertriglyceridemia,' 'APOC3 inhibition,' 'antisense oligonucleotides,' and 'apolipoprotein C-III.' EXPERT OPINION: Differentiating FCS from MCS is critical because RNA-based inhibition of apo C-III has transformed the therapeutic landscape for FCS patients. These agents provide substantial, durable TG lowering, and meaningful reductions in pancreatitis risk, although cardiovascular benefit remains uncertain. Future efforts should focus on optimizing diagnostic pathways, assessing cardiovascular outcomes, and determining long-term safety of these novel biologic therapies.
INTRODUCTION: Biodegradable devices for transcatheter patent foramen ovale (PFO) closure offer an alternative to nitinol occluders by enabling effective closure without leaving a permanent implant. Metallic devices have...INTRODUCTION: Biodegradable devices for transcatheter patent foramen ovale (PFO) closure offer an alternative to nitinol occluders by enabling effective closure without leaving a permanent implant. Metallic devices have excellent success but can cause inflammation, device-related complications, and challenges for future transseptal procedures. Biodegradable platforms, including collagen matrices and fully polymeric frames, aim to provide early stability followed by controlled resorption and tissue replacement. AREAS COVERED: Preclinical studies show rapid endothelialization, favorable biocompatibility, and organized tissue ingrowth during degradation. Early human experience with BioSTAR, Mallow, ABSNow, and Carag devices demonstrates high procedural success, good short-term occlusion, and imaging evidence of resorption. Recent multicenter studies and a randomized trial report non-inferior closure rates compared with nitinol devices and near-complete resorption within 12 to 24 months. Device-related issues such as transient thrombus, residual shunting, and structural limitations indicate the need for tailored antithrombotic therapy and careful follow-up. EXPERT OPINION: Biodegradable occluders may be valuable for younger patients or those who may need future left-sided interventions. Early results are promising, but long-term clinical data are limited, and definitive evidence of reduced late complications or better stroke-prevention outcomes is still lacking. Further optimization of materials, standardized imaging endpoints, and long-term comparative studies remain priorities.
BACKGROUND: Asymptomatic mitral regurgitation (MR) can lead to long-term morbidity and mortality. While sex differences are well established in cardiovascular disease, data for asymptomatic MR are limited. Systemic facto...BACKGROUND: Asymptomatic mitral regurgitation (MR) can lead to long-term morbidity and mortality. While sex differences are well established in cardiovascular disease, data for asymptomatic MR are limited. Systemic factors such as cancer may affect prognosis through shared pathways. RESEARCH DESIGN AND METHODS: We conducted a cohort study using German claims data from the BARMER health insurance, identifying asymptomatic MR by repeated outpatient diagnoses without baseline complications or interventions, matched 1:1 by age and sex to controls without cardiovascular disease. Outcomes included 10-year MR-related complications, mitral valve interventions, incident cancer, and all-cause mortality. Multivariable Cox models adjusted for age, comorbidity (Elixhauser index), and cancer status. RESULTS: Among 56.577 asymptomatic MR patients (67% female, median age 68), males had higher MR-related complication rates (51.5% vs 44.0%) and lower 10-year survival (73.8% vs 81.8%, both < 0.001). Cancer increased mortality risk (adjusted hazard ratios [aHR] 1.88, 95% CI 1.79-1.98), while male sex remained an independent predictor for mortality (aHR 1.42, 95% CI 1.36-1.47). CONCLUSIONS: Asymptomatic MR follows a progressive clinical trajectory, with high complication rates despite low intervention rates. Within this trajectory, males showed a significant survival disadvantage after adjusting for comorbidity and cancer, supporting risk-based and sex-aware follow-up strategies.
BACKGROUND: Concomitant surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) generally carries a higher operative mortality than isolated SAVR or CABG but also conveys survival benefit. Our...BACKGROUND: Concomitant surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) generally carries a higher operative mortality than isolated SAVR or CABG but also conveys survival benefit. Our aim was to identify factors associated with adverse short and long-term outcomes in this patient group. RESEARCH DESIGN AND METHODS: All consecutive patients undergoing first-time SAVR & CABG in two cardiac surgery centers between 2004 and 2024 were included. Primary outcomes were in-hospital & 1-year mortality and overall survival. Secondary outcomes were post-operative complications and post-operative length of stay (PLOS). Cox multivariable regression was used to identify variables independently associated with overall survival. RESULTS: 2617 patients were included. Mean age was 73.5 years (±8.1) and 26.7% ( = 700) were female. In-hospital and 1-year mortality were 3.1% ( = 82) and 7.0% ( = 182), respectively. The incidence of post-operative stroke was 3.6% ( = 94). Median follow-up time was 82 months (49-119) and estimated median overall survival was 106 months (102-110). Despite higher early mortality, receiving a greater number of grafts was independently associated with improved long-term survival. CONCLUSIONS: Findings from this study suggest that SAVR & CABG remains a safe and effective treatment option for appropriately selected patients with acceptable peri-operative morbidity and reassuring long-term durability.
BACKGROUND: Endovascular aneurysm repair (EVAR) and open surgical repair (OSR) are both used for elective unruptured infrarenal abdominal aortic aneurysm (AAA), but their relative cost-effectiveness in the UK NHS remains...BACKGROUND: Endovascular aneurysm repair (EVAR) and open surgical repair (OSR) are both used for elective unruptured infrarenal abdominal aortic aneurysm (AAA), but their relative cost-effectiveness in the UK NHS remains uncertain. RESEARCH DESIGN AND METHODS: A lifetime Markov cohort model compared EVAR and OSR, incorporatingwaiting-list and perioperative mortality, postoperative survival, reinterventions, and imaging surveillance. Time-varying mortality effects were derived from reconstructed individual-patient-data meta-analysis, with equal long-term mortality assumed in the base case. Costs and QALYs were discounted at 3.5%. Uncertainty was explored through deterministic, probabilistic (10,000 iterations), and scenario analyses using alternative survival models. RESULTS: EVAR had higher lifetime costs (£17,710 vs £16,191) but greater QALYs (6.373 vs 6.219), yielding an ICER of £9,865/QALY. Probabilistic analysis produced a mean ICER of £9,793/QALY, with EVAR cost-effective in 56.1% and 62.2% of simulations at £20,000 and £30,000/QALY thresholds, respectively. Results were sensitive to survival modeling assumptions, EVAR device costs, perioperative mortality, and surveillance intensity. CONCLUSIONS: Under contemporary time-varying mortality assumptions, EVAR is likely cost-effective versus OSR at standard UK thresholds, though conclusions depend on long-term survival assumptions and surveillance intensity.
INTRODUCTION: Aortic stenosis (AS), the leading cause of valvular heart disease related mortality, affects 12% of individuals over 75 years and is set to expand as the population ages. Once symptoms develop, severe sympt...INTRODUCTION: Aortic stenosis (AS), the leading cause of valvular heart disease related mortality, affects 12% of individuals over 75 years and is set to expand as the population ages. Once symptoms develop, severe symptomatic AS carries an average survival of approximately two years. The only management currently available is aortic valve replacement (AVR), either surgically or via transcatheter aortic valve implantation, but this addresses only the end stage of the disease process which is often associated with irreversible myocardial remodeling. There are currently no pharmacotherapies proven to treat AS. The development of this condition is an active pathophysiological process which involves complex metabolic signaling cascades providing myriad potential therapeutic targets. AREAS COVERED: This review looks at recent and ongoing clinical trials of novel pharmacotherapies for AS, including lipid lowering therapy, nitrous oxide pathway targeting, vitamin K supplementation, renin-angiotensin-aldosterone system blockade, repurposing diabetic pharmacotherapies, colchicine, and transthyretin stabilizers. EXPERT OPINION: AS is an active, pathological disease which should be amenable to pharmacological modulation. A wide spectrum of pharmacotherapeutic agents are currently being investigated and the authors of this review are optimistic that we might be on the cusp of a breakthrough.
INTRODUCTION: Retrograde Type A aortic dissection (RTAD) is a life-threatening complication following thoracic endovascular aortic repair (TEVAR) or hybrid arch repair. Expanding use of endovascular arch interventions ha...INTRODUCTION: Retrograde Type A aortic dissection (RTAD) is a life-threatening complication following thoracic endovascular aortic repair (TEVAR) or hybrid arch repair. Expanding use of endovascular arch interventions has heightened the need to better understand its mechanisms, risk factors, prevention strategies, and diagnostic challenges. AREAS COVERED: This Special Report reviews current evidence regarding the mechanisms, risk factors, clinical presentation, and management of RTAD following TEVAR. A structured literature search was conducted using PubMed/MEDLINE, Embase, and Scopus to identify relevant studies published from database inception through February 2026. Device-related, procedural, anatomic, and hemodynamic contributors are discussed, with particular emphasis on optimal device sizing, deployment technique, and surveillance. Advanced imaging modalities, including dynamic computed tomography angiography and four-dimensional flow magnetic resonance imaging, are examined for their potential to identify hemodynamically significant flow disturbances and refine risk stratification beyond static morphologic assessment. EXPERT OPINION: RTAD remains uncommon but catastrophic. Greater emphasis on patient selection, procedural planning, graft design optimization, and early multimodality imaging may reduce incidence. Future progress will depend on standardized reporting, improved computational and imaging-based risk predictors, and next-generation aortic devices engineered specifically for the arch.
INTRODUCTION: Adult atrial septal defect (ASD) is no longer regarded as a benign congenital lesion, as long-term follow-up studies have demonstrated substantial risks of atrial arrhythmias, heart failure (HF), pulmonary...INTRODUCTION: Adult atrial septal defect (ASD) is no longer regarded as a benign congenital lesion, as long-term follow-up studies have demonstrated substantial risks of atrial arrhythmias, heart failure (HF), pulmonary hypertension (PH), and excess mortality. Optimal treatment selection in adults therefore requires risk stratification beyond defect size and shunt magnitude alone. Importantly, adult ASD management increasingly demands a physiology-driven and patient-centered approach rather than a purely anatomical paradigm. AREAS COVERED: This narrative expert review summarizes contemporary evidence on treatment strategies for adult ASD, focusing on surgical and transcatheter closure and the role of individualized risk stratification. A structured literature search was performed using PubMed and Embase databases, covering studies published up to 2024, including observational cohorts, registry data, and guideline documents addressing long-term outcomes, timing of intervention, and predictors of adverse events in adult ASD populations. EXPERT OPINION: Risk-based decision-making should be central to adult ASD management, integrating age, atrial arrhythmia burden, right ventricular (RV) remodeling, pulmonary vascular disease, and comorbidities This review translates existing evidence into a practical decision-oriented framework. Future strategies should move away from a 'one-size-fits-all' closure approach toward personalized treatment pathways within specialized adult congenital heart disease (ACHD) programs.
INTRODUCTION: Hormone deficiency states are increasingly recognized as important, yet often underappreciated, contributors to cardiovascular (CV) disease. Deficits affecting pituitary, thyroid, parathyroid, adrenal, and...INTRODUCTION: Hormone deficiency states are increasingly recognized as important, yet often underappreciated, contributors to cardiovascular (CV) disease. Deficits affecting pituitary, thyroid, parathyroid, adrenal, and gonadal axes influence myocardial function, vascular biology, and metabolic homeostasis, leading to increased cardiovascular morbidity and mortality. AREAS COVERED: This narrative review summarizes current evidence on the CV impact of major hormonal deficiencies, including hypopituitarism, growth hormone deficiency, hypoprolactinemia, hypothyroidism, hypoparathyroidism, adrenal insufficiency, and hypogonadism. Hormone-specific CV phenotypes, underlying pathophysiological mechanisms, effects of replacement therapies, residual cardiovascular risk, and prognostic markers are discussed. The literature search was conducted in PubMed/MEDLINE and included studies published between January 2000 and December 2025, with emphasis on systematic reviews, meta-analyses, large observational cohorts, and key clinical trials. EXPERT OPINION: Despite advances in hormone replacement, many patients retain excess CV risk that is not captured by conventional prediction models. Endocrine-adapted risk stratification, individualized replacement strategies considering dose and chronobiology, and integration of emerging tools such as artificial intelligence - based models may improve risk prediction. Dedicated cardiovascular outcome trials in endocrine populations remain a major unmet need.
BACKGROUND: Cardiogenic shock (CS) remains highly lethal despite advances in care. Preexisting heart failure (HF) is common in CS, but its effect on outcomes and management is unclear. RESEARCH DESIGN AND METHODS: Using...BACKGROUND: Cardiogenic shock (CS) remains highly lethal despite advances in care. Preexisting heart failure (HF) is common in CS, but its effect on outcomes and management is unclear. RESEARCH DESIGN AND METHODS: Using the 2016-2019 National Inpatient Sample, we identified adults (≥18 years) hospitalized with CS and categorized them by presence of preexisting HF. The primary outcome was in-hospital mortality; secondary outcomes included pulmonary artery catheterization, mechanical circulatory support (MCS), renal replacement therapy, major bleeding, length of stay, and hospital charges. Multivariable logistic regression adjusted for demographics, comorbidities, and hospital characteristics. RESULTS: Of 640,660 CS admissions, 65.4% had HF. They were older, had more comorbidities, and were more often treated in large urban teaching hospitals. HF was associated with lower in-hospital mortality (adjusted odds ratio [aOR] 0.58; 95% CI 0.56-0.60; < 0.001), but greater use of pulmonary artery catheterization (aOR 1.76), MCS (aOR 1.33), and renal replacement therapy (aOR 1.11). HF patients had longer stays (+1.6 days), higher charges (+$23,197), and less major bleeding (aOR 0.74; < 0.001). CONCLUSIONS: Preexisting HF is associated with a distinct CS phenotype, including lower in-hospital mortality and higher resource utilization, highlighting the need for phenotype-specific strategies and refined risk models in CS management.
BACKGROUND: The presence of atrial fibrillation (AF) in patients with heart failure (HF) is common and increases the risk of adverse events. Whether the benefit of mineralocorticoid receptor antagonists (MRAs) in patient...BACKGROUND: The presence of atrial fibrillation (AF) in patients with heart failure (HF) is common and increases the risk of adverse events. Whether the benefit of mineralocorticoid receptor antagonists (MRAs) in patients with HF varies according to AF remains to be understood. RESEARCH DESIGN AND METHODS: We systematically searched MEDLINE and EMBASE and included all studies reporting prevalence of AF and incidence of a composite primary outcome of cardiovascular death and HF hospitalization. Random-effects models were used to estimate pooled odds ratios (OR), 95% confidence intervals (CI), and prediction intervals (PI). RESULTS: Two thousand five hundred and eighty-two articles were screened, and five studies were included. Prevalence of AF in HF patients was 34.5% (95% CI: 24.8-45.8%; 95% PI: 9.4-72.8%). MRAs appeared similarly effective in reducing the risk of the primary outcome among HF patients with AF (OR: 0.91; 95% CI: 0.63-1.31) and without AF patients (OR: 0.80; 95% CI: 0.71-0.90) (subgroup difference = 0.495). Meta-regression identified female sex, hypertension, prior HF hospitalization, and beta-blocker use as potential moderators of the risk of the primary outcome in patients with HF and AF. CONCLUSIONS: One-third of HF patients included in RCT trials on MRAs have AF. MRAs improved outcomes with an effect that results not different in HF patients with and without AF. REGISTRATION: The PROSPERO identification number is CRD420251007396.
INTRODUCTION: High bleeding risk (HBR) affects over one-third of patients undergoing percutaneous coronary intervention (PCI) and is associated with elevated mortality due to both hemorrhagic and ischemic complications....INTRODUCTION: High bleeding risk (HBR) affects over one-third of patients undergoing percutaneous coronary intervention (PCI) and is associated with elevated mortality due to both hemorrhagic and ischemic complications. Optimizing the management of these patients remains a critical challenge in contemporary interventional cardiology. AREAS COVERED: This review summarizes advances in bleeding risk assessment and management strategies in HBR patients. Literature was evaluated regarding validated risk tools (ARC-HBR, PRECISE-HBR), procedural approaches (radial access, intravascular imaging-guided PCI), device selection (contemporary drug-eluting and polymer-free stents, drug-eluting balloons), and pharmacologic optimization (shortened dual antiplatelet therapy, minimization of triple therapy, proton pump inhibitor prophylaxis). Emerging approaches, including artificial intelligence-enhanced risk prediction, biomarker-based phenotyping, and pharmacogenomic-guided antiplatelet selection, are also discussed. Dedicated HBR care pathways and multidisciplinary programs supporting best-practice implementation are highlighted. EXPERT OPINION: Despite contemporary strategies reducing bleeding risk, HBR patients continue to experience disproportionate mortality. Precision medicine approaches, including continuous risk quantification, next-generation antithrombotics with improved safety, and standardized, data-driven HBR management frameworks, are needed to further optimize outcomes and guide future trials in this high-risk population.
INTRODUCTION: Ischemic heart disease (IHD) remains a leading cause of global morbidity and mortality. Mitochondrial dysfunction is central to ischemia - reperfusion injury, contributing to bioenergetic failure, oxidative...INTRODUCTION: Ischemic heart disease (IHD) remains a leading cause of global morbidity and mortality. Mitochondrial dysfunction is central to ischemia - reperfusion injury, contributing to bioenergetic failure, oxidative stress, calcium overload, and impaired adaptive responses, making mitochondria an important therapeutic target. AREAS COVERED: This review integrates mechanistic and translational evidence linking mitochondrial dysfunction, structural injury, and adaptive-response failure in IHD. Key pathways discussed include reverse electron transport - driven reactive oxygen species generation, mitochondrial permeability transition pore activation, disrupted fusion - fission dynamics, mitophagy imbalance, and proteostasis collapse. Emerging therapeutic strategies such as mitochondria-targeted antioxidants, cardiolipin-stabilizing peptides, metabolic modulators, mitochondrial transplantation, and genome-directed approaches are evaluated alongside diagnostic innovations, including circulating mitochondrial DNA, mitomiRs, and molecular imaging. A structured literature search was conducted using PubMed/MEDLINE, Scopus, and Web of Science for English-language studies published between January 2000 and March 2025. EXPERT OPINION: Precision targeting of mitochondrial injury and adaptive failure offers stage-specific therapeutic opportunities in IHD; however, successful translation requires biomarker-guided stratification, optimized delivery systems, and temporally aligned clinical trial design.
Elazab A, Hageen AW, Elbataa A
… +13 more, Mansour A, Labeeb EE, Najah Q, Elbahloul MA, Elnady MI, Abdelsatar SM, Mansour A, Elkasaby MH, Odat RM, Rhabneh L, Nassar M, Turkmani M, Hakim D
INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis but carries a risk of stroke and cerebral embolism. Cerebral embolic protection devices (CEPD), including...INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic stenosis but carries a risk of stroke and cerebral embolism. Cerebral embolic protection devices (CEPD), including filter-based and deflection-based systems (Sentinel and TriGUARD), aim to reduce embolic complications; however, their clinical benefit remains uncertain. This study evaluated the efficacy and safety of CEPD during TAVR using trial sequential analysis (TSA) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. METHODS: Randomized controlled trials (RCTs) comparing TAVR with and without CEPD were identified through four electronic databases from inception to April 2025. Primary outcomes were all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), stroke, and disabling stroke. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated. TSA was conducted with a 5% type I error and 80% power. RESULTS: Nine RCTs including 11,876 patients were analyzed. CEPD use showed no significant reduction in mortality, MACCE, stroke, or disabling stroke. Secondary and subgroup analyses yielded consistent findings. TSA demonstrated that the accrued evidence was insufficient to confirm a clinical benefit. CONCLUSIONS: Current evidence does not support the routine use of CEPD during TAVR, given the lack of significant benefit in key clinical outcomes. REGISTRATION: The protocol of this study was registered at Prospero CRD420251036308.
INTRODUCTION: Endocrine hypertension (EH) represents a small yet clinically significant subset of secondary hypertension with curative potential. Recent advances in multiomics and artificial intelligence (AI) are transfo...INTRODUCTION: Endocrine hypertension (EH) represents a small yet clinically significant subset of secondary hypertension with curative potential. Recent advances in multiomics and artificial intelligence (AI) are transforming the diagnostic and therapeutic paradigms of EH, enabling earlier detection, precise subtyping, and personalized treatment strategies. AREAS COVERED: This review integrates evidence from PubMed, Scopus, and Web of Science (2000-July 2025) addressing the role of genomics, transcriptomics, proteomics, and metabolomics combined with AI in the diagnosis and management of EH, including primary aldosteronism, Cushing's syndrome, pheochromocytoma/paraganglioma, and thyroid-related hypertension. It highlights the shift toward molecularly informed clinical pathways, noninvasive biomarkers, and predictive algorithms for subtype differentiation and therapeutic optimization. EXPERT OPINION: The convergence of multiomics and AI heralds a transformative era in EH care. While proof-of-concept studies demonstrate diagnostic accuracy comparable to invasive tests, translation into routine practice is limited by infrastructural inequities, lack of data harmonization, and gaps in clinician digital literacy. Future efforts should prioritize federated data systems, longitudinal multiomic integration, and hybrid models of human - machine collaboration. Within a decade, endocrine hypertension management will likely evolve from static, phenotype-based diagnosis to dynamic, data-driven systems medicine, integrating continuous biosensing and AI-guided decision support for truly individualized care.