Cardiology In Review[JOURNAL]
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200 papers
Contemporary Management Strategies for Patent Ductus Arteriosus.
Seyam O, Frishman WH, Aronow WS
Cardiol Rev · 2026 Feb · PMID 41680985 · Publisher ↗
Patent ductus arteriosus (PDA) is one of the most prevalent congenital cardiac abnormalities. It is more common in preterm newborns and is inversely correlated with gestational age. Whether to treat PDA remains a subject...
Patent ductus arteriosus (PDA) is one of the most prevalent congenital cardiac abnormalities. It is more common in preterm newborns and is inversely correlated with gestational age. Whether to treat PDA remains a subject of considerable debate partly attributable to the limited evidence demonstrating long-term benefits of the interventions studied. In the past, surgical ligations or cyclooxygenase inhibitor medications were used to close the PDA. Transcatheter PDA closure is one alternative treatment for this population because comorbidities linked to the PDA have increased with improved survival of extremely preterm newborns.
Left Ventricular Noncompaction Syndrome.
Strubchevska K, Strubchevska O, Kozyk M … +2 more , Frishman WH, Aronow WS
Cardiol Rev · 2026 Feb · PMID 41680975 · Publisher ↗
Left ventricular noncompaction (LVNC) has been classified as a primary cardiomyopathy, predominantly involving the left ventricle, although right ventricular and biventricular involvement have also been reported. The con...
Left ventricular noncompaction (LVNC) has been classified as a primary cardiomyopathy, predominantly involving the left ventricle, although right ventricular and biventricular involvement have also been reported. The condition may coexist with neuromuscular disorders, congenital cardiac anomalies, and chromosomal abnormalities. Despite its established recognition, LVNC continues to pose a significant challenge, with divergent classifications among major societies: the American Heart Association categorizes LVNC as a primary genetic cardiomyopathy, whereas the European Society of Cardiology and the World Health Organization consider it an unclassified cardiomyopathy. This discordance reflects the condition's marked heterogeneity; while historically attributed to embryogenic arrest, contemporary evidence supports a complex genetic landscape with substantial phenotypic overlap with hypertrophic and dilated cardiomyopathies. Consequently, the traditional classification remains controversial, as diagnostic criteria based on the ratio of trabeculated to compacted myocardium have been identified in up to 20% of individuals without cardiomyopathy and have also been observed in physiological states such as pregnancy and in athletes, likely reflecting adaptive responses to increased preload. Although LVNC is frequently asymptomatic, a subset of patients is at increased risk of thromboembolic events, left ventricular systolic dysfunction, malignant arrhythmias, and sudden cardiac death.
Differentiation and Management of Intracranial Atherosclerosis-Related Cognitive Impairment From Vascular Dementia.
Al Homsi KM, Hadid S, Frishman WH … +1 more , Aronow WS
Cardiol Rev · 2026 Feb · PMID 41680973 · Publisher ↗
Dementia affects more than 6 million individuals in the United States and represents a growing public health challenge. Intracranial atherosclerotic disease (ICAD) is highly prevalent in older adults and is increasingly...
Dementia affects more than 6 million individuals in the United States and represents a growing public health challenge. Intracranial atherosclerotic disease (ICAD) is highly prevalent in older adults and is increasingly recognized as an important contributor to cognitive impairment. However, vascular dementia (VaD) is also a major cause of cognitive impairment, and it is often very difficult to distinguish these common but separate conditions based on symptoms and even imaging alone. These conditions often coexist and have similar pathophysiologies. Differentiating ICAD-related cognitive impairment from VaD is essential as management strategies differ. Here, a narrative review of the literature was conducted focusing on epidemiology, diagnostic definitions, neuroimaging modalities, and treatment approaches for ICAD-associated cognitive impairment and VaD. Emphasis was placed on magnetic resonance imaging, positron emission tomography, and standardized neuroimaging criteria, as well as contemporary pharmacologic and interventional therapies. We found that advanced imaging techniques such as positron emission tomography metabolic patterns, magnetic resonance imaging markers of small vessel disease, and standardized grading systems such as the Fazekas scale can improve diagnostic accuracy. Management of both conditions centers on risk factor modification, but treatment strategies diverge slightly with respect to antiplatelet therapy and revascularization goals.
Accelerated Aging and Risk of Cardiovascular Disease.
Manolis TA, Manolis AA, Manolis AS
Cardiol Rev · 2026 Feb · PMID 41668255 · Publisher ↗
Aging is an intricate process with physiological dysregulation across many systems; mechanisms like chronic inflammation and telomere attrition are key to the progressive deterioration of the organism. Although aging is...
Aging is an intricate process with physiological dysregulation across many systems; mechanisms like chronic inflammation and telomere attrition are key to the progressive deterioration of the organism. Although aging is universal, its rate varies widely among individuals, even among those of the same chronological age. Biological age reflects one's physiological status and is a measure for assessing aging rate and acceleration. There is also organ-specific aging with varying trajectories, with the molecular basis of this heterogeneity apparent across several organ systems, ascribed to complex genetic associations between blood-based epigenetic and organ-specific aging, demonstrating both homogeneity and heterogeneity. Chronic diseases may accelerate aging of the respective biological systems or subsystems and organs, with organ- and/or blood-specific epigenetic clocks determining aging heterogeneity. Aging is universal; its rate varies widely among individuals, even among those of the same chronological age. Biological age reflects an individual's physiological condition and is a useful measure for estimating aging rate and accelerated aging. Recently, the interest is growing regarding the link of accelerated aging with cardiovascular disease and mortality. Data indicate that persons with accelerated aging are at higher risk of progressing to multimorbidity and death. Elucidating these associations is crucial for informing strategies to prevent cardiovascular disease and premature death. Hopefully, a more specific quantitative assessment of individual aging may more precisely disclose one's aging and biological status. There is hope that pharmacologic intervention may tard the aging process, and also decrease or eliminate health disparities, which could foster better cardiovascular and general health for all populations.
Statins in Gastroenterology: Mechanisms, Human Evidence, and Safety.
Al Refaei A, Basta D, Msinjili L … +1 more , Lebovics E
Cardiol Rev · 2026 Feb · PMID 41661228 · Publisher ↗
Statins, originally developed as lipid-lowering agents, have effects that extend well beyond cholesterol. By altering inflammatory signaling, vascular tone, fibrogenesis, and immune regulation, they engage pathways that...
Statins, originally developed as lipid-lowering agents, have effects that extend well beyond cholesterol. By altering inflammatory signaling, vascular tone, fibrogenesis, and immune regulation, they engage pathways that shape a wide range of gastrointestinal diseases. Human data now suggest that these biological actions carry clinical weight. In metabolic dysfunction-associated steatotic liver disease and its progressive form, metabolic dysfunction-associated steatohepatitis, alcohol-associated liver disease, and chronic viral hepatitis (HBV and HCV), statin exposure is safe and associated with slower disease progression, fewer episodes of decompensation, and lower incidence of hepatocellular carcinoma. Randomized studies in cirrhosis show reductions in portal pressure, with cohort data linking use to fewer variceal bleeds, ascites, and hepatic encephalopathy. In inflammatory bowel disease, large registries and pilot trials indicate reduced flares, lower corticosteroid requirements, and decreased need for surgery, with early biomarker evidence supporting an anti-inflammatory effect. Smaller studies hint at benefits in other gastrointestinal contexts, though the evidence remains fragmented. Across these populations, true hepatotoxicity is rare; risk of myopathy is modest and largely confined to advanced cirrhosis or drug-drug interactions. Collectively, these findings support cautious repurposing of statins in gastroenterology and underline the need for definitive randomized trials to resolve class effects, optimize dose and duration, and identify reliable biomarkers of response.
Effect of Remote Ischemic Conditioning on Outcomes for Acute Ischemic Stroke Patients Undergoing Alteplase Intravenous Thrombolysis: A Systematic Review and Meta-Analysis With Trial Sequential Analysis.
Kurmasha YH, Hamzah KA, Shweliya MA … +10 more , Al-Shammari AS, Khan M, Morshed MI, Alghazal A, Grmasha M, Al-Waeli ARA, Al-Ibraheem AMT, Hamzah ZA, Michaelson NM, Sattar Y
Cardiol Rev · 2026 Feb · PMID 41656549 · Publisher ↗
Remote ischemic conditioning (RIC) is a simple, noninvasive intervention hypothesized to reduce ischemia-reperfusion injury in acute ischemic stroke (AIS). Its role as an adjunct to intravenous thrombolysis (IVT) remains...
Remote ischemic conditioning (RIC) is a simple, noninvasive intervention hypothesized to reduce ischemia-reperfusion injury in acute ischemic stroke (AIS). Its role as an adjunct to intravenous thrombolysis (IVT) remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials assessing RIC in AIS patients treated exclusively with IVT. Major databases were searched through February 2025 (PROSPERO: CRD420251144277). The risk of bias was evaluated using the Cochrane tool, and evidence certainty was assessed with Grading of Recommendations Assessment, Development, and Evaluation. Trial sequential analysis was also performed. Six randomized controlled trials (n = 955; RIC = 502, control = 453) met eligibility. Safety outcomes were comparable between groups, with no significant differences in stroke recurrence [risk ratio (RR) = 0.97; 95% confidence interval (CI), 0.63-1.48], hemorrhagic transformation (RR = 1.24; 95% CI, 0.67-2.31), or 90-day mortality (RR = 1.19; 95% CI, 0.46-3.07). RIC did not significantly improve excellent functional outcome (modified Rankin Scale 0-1 at 90 days: RR = 1.07; 95% CI, 0.95-1.20) or functional independence (modified Rankin Scale 0-2: RR = 1.03; 95% CI, 0.89-1.03). Barthel Index scores showed a nonsignificant trend toward benefit (mean difference = 2.77; 95% CI, -1.51-7.06), and National Institutes of Health Stroke scores at 24 hours, 7 days, 30 days, and follow-up were unchanged. Trial sequential analysis showed the required information size was not reached, and the Grading of Recommendations Assessment, Development, and Evaluation certainty was low to very low. RIC is safe but has not yet been shown to significantly improve functional or neurological outcomes in AIS patients treated with IVT. Future trials should assess RIC in patients receiving different types of thrombolysis (alteplase vs tenecteplase).
Right Ventricular Hypertrophy: Pathophysiology, Multimodality Imaging, and Clinical Implications.
Demir G, Özden Kayhan Ö, Çetin Güvenç R … +1 more , Güvenç TS
Cardiol Rev · 2026 Feb · PMID 41645391 · Publisher ↗
Right ventricular (RV) hypertrophy is the principal adaptive response to increased afterload. This response can be appropriate, preserving RV systolic function and RV-pulmonary artery coupling, or maladaptive, leading to...
Right ventricular (RV) hypertrophy is the principal adaptive response to increased afterload. This response can be appropriate, preserving RV systolic function and RV-pulmonary artery coupling, or maladaptive, leading to RV dilatation and failure. While pure pressure overload typically induces adaptive hypertrophy, concomitant myocardial injury and ischemia often drive maladaptive changes. Multimodality imaging plays a crucial role in distinguishing these states by characterizing the relationship between RV mass, volume, and function. Cardiac magnetic resonance imaging, in particular, provides the reference standard for quantifying these parameters and offers unique insights through myocardial tissue characterization. This narrative review outlines the pathophysiology of RV hypertrophy and the application of cardiovascular imaging for its clinical assessment. We conclude by highlighting the critical clinical utility of evaluating RV hypertrophy for screening for pulmonary hypertension, risk stratification, and as a potential therapeutic target.
Lean Mass Loss in Glucagon-Like Peptide-1/GIP Therapy: Clinical Implications for Obesity and Cardiovascular Care.
Haner Wasserstein D, Whitford T, Whiteson HZ … +1 more , Frishman WH
Cardiol Rev · 2026 Feb · PMID 41636548 · Publisher ↗
Glucagon-like peptide-1 receptor agonists and glucose-dependent insulinotropic polypeptide coagonists have revolutionized the treatment of type 2 diabetes and obesity. They demonstrate significant cardiovascular benefits...
Glucagon-like peptide-1 receptor agonists and glucose-dependent insulinotropic polypeptide coagonists have revolutionized the treatment of type 2 diabetes and obesity. They demonstrate significant cardiovascular benefits, including a reduction in major adverse cardiovascular events and heart failure hospitalizations. However, these medications are associated with substantial lean body mass loss, comprising 15-45% of total weight reduction. This review examines the pathophysiological mechanisms underlying muscle loss with incretin-based therapies, analyzes clinical trial data on body composition changes, explores the bidirectional relationship between sarcopenia and cardiovascular disease, and evaluates emerging pharmacological and lifestyle interventions to preserve muscle mass. Understanding and mitigating muscle loss is critical for optimizing cardiovascular outcomes, particularly in older adults and those with established heart disease, where sarcopenia is associated with increased mortality and functional decline.
Temporal Trends of Mortality Associated With Coronary Artery Disease-Chronic Obstructive Pulmonary Disease Comorbidity in the United States.
Faheem MSB, Hassan ST, Asghar T … +3 more , Najmi OEM, Neppala S, Alraies MC
Cardiol Rev · 2026 Feb · PMID 41634924 · Publisher ↗
Coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD) exhibit a significant bidirectional relationship, whereby the presence of 1 condition significantly increases the risk of developing the othe...
Coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD) exhibit a significant bidirectional relationship, whereby the presence of 1 condition significantly increases the risk of developing the other, resulting in their frequent co-occurrence. We seek to assess demographic and geographic disparities and examine mortality trends from CAD and COPD in the United States from 1999 to 2023. We retrieved mortality data for patients with CAD and COPD from the Centres for Disease Control and Prevention, Wide-Ranging Online Data for Epidemiologic Research Multiple Cause of Death database from 1999 to 2023. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, and trends were analyzed using the Joinpoint regression model to estimate the annual percent change (APC) in AAMR. Mortality data were stratified by age, sex, race/ethnicity, urbanization, and Census regions. A total of 1,471,054 mortalities showed the existence of CAD and COPD on death certification. The AAMR decreased from 61.1 to 41.8 from 1999 to 2023. The AAMR declined sharply until 2018 (APC -1.9), followed by a significant incline till 2021 (APC 4), after which it continued to decrease significantly until 2023 (APC -6.12). AAMR was twofold greater in males (71.7) than in females (34.3). Among races/ethnicities, non-Hispanic Whites (52.7) had the top AAMR. Mortality rates were 13 times greater among older adults than among middle-aged adults. From geographics, nonmetropolitan areas (63.3) and the Midwest region (55.2) had the highest AAMRs. These disparities across demographic and geographical variables necessitate appropriate resource allocation and targeted interventions to reduce the CAD-COPD mortality burden.
Valve Choice in Women of Reproductive Age: Timing, Pregnancy, and Lifelong Tradeoffs.
Yang J, Zhao J
Cardiol Rev · 2026 Feb · PMID 41634923 · Publisher ↗
Guidelines and much of the literature favor bioprosthetic heart valves in women with pregnancy desire, yet most evidence is restricted to pregnancy and the first decade after surgery, a period when bioprostheses are usua...
Guidelines and much of the literature favor bioprosthetic heart valves in women with pregnancy desire, yet most evidence is restricted to pregnancy and the first decade after surgery, a period when bioprostheses are usually functionally intact, and late structural valve degeneration and reintervention are underrepresented. This review synthesizes data across the life course and examines how time-window bias may magnify early advantages of bioprostheses while obscuring long-term tradeoffs. Evidence suggests that bioprostheses often yield better fetal outcomes and fewer anticoagulation-related complications around pregnancy, whereas beyond 10-15 years, cumulative risks of degeneration, valve-in-valve limitations, and prosthesis-patient mismatch may erode these early benefits. In carefully selected patients, particularly in higher-risk positions such as the mitral valve, mechanical valves can provide superior long-term durability when high-quality anticoagulation and multidisciplinary pregnancy planning are feasible. Individualized decision-making should integrate valve position, anticoagulation capacity, pregnancy timing, patient preferences, and health system resources. Future studies should extend follow-up beyond 15 years, apply standardized definitions of structural degeneration, use competing-risk and modern causal methods, and incorporate decision-analytic modeling to quantify lifetime tradeoffs and support shared decisions.
Advances in the Management of Pediatric Heart Failure: From Medical Therapy to Mechanical Support and Transplantation.
Ahmad R, Kumar M, Khan S … +7 more , Niaz M, Frangaj K, Arslan FS, Hussain SS, Maheta D, Frishman WH, Aronow WS
Cardiol Rev · 2026 Feb · PMID 41634903 · Publisher ↗
Pediatric heart failure is a heterogeneous, high-risk clinical syndrome that differs fundamentally from adult heart failure in its etiologies, pathophysiology, and therapeutic responses. Although its absolute prevalence...
Pediatric heart failure is a heterogeneous, high-risk clinical syndrome that differs fundamentally from adult heart failure in its etiologies, pathophysiology, and therapeutic responses. Although its absolute prevalence is lower, children experience disproportionate morbidity and mortality, with up to 40% of patients with symptomatic cardiomyopathy progressing to death or transplantation within 2 years of diagnosis. Congenital heart disease, cardiomyopathies, and genetic or metabolic disorders dominate the etiologic spectrum, while developmental differences in myocardial signaling, neurohormonal activation, and ventricular remodeling limit direct extrapolation of adult guideline-directed medical therapy. Evidence supporting pharmacologic treatment remains limited, and most therapies are symptom-modifying rather than outcome-modifying, particularly in single-ventricle physiology. Advances in mechanical circulatory support and heart transplantation have substantially improved survival, yet pose unique anatomic, physiological, and ethical challenges in children. This review synthesizes contemporary evidence across medical, device-based, and transplant therapies, highlights lesion- and age-specific considerations, and identifies critical research gaps needed to advance outcomes in pediatric heart failure.
The Cardiovascular Effects of Acute and Chronic Hypoglycemia.
Dintakurti A, Parikh MA, Silver RJ … +2 more , Frishman WH, Peterson SJ
Cardiol Rev · 2025 Oct · PMID 41632550 · Publisher ↗
Large-scale clinical trials of intensive glycemic control have failed to show cardiovascular benefit, with hypoglycemia implicated as a key factor. Increasing evidence suggests hypoglycemia is not merely a complication o...
Large-scale clinical trials of intensive glycemic control have failed to show cardiovascular benefit, with hypoglycemia implicated as a key factor. Increasing evidence suggests hypoglycemia is not merely a complication of diabetes therapy but an independent risk factor for cardiovascular disease. Acutely, hypoglycemia triggers sympathoadrenal activation leading to tachycardia, increased contractility, and blood pressure changes, alongside electrophysiological disturbances such as QTc prolongation and arrhythmias. It also induces platelet activation, endothelial dysfunction, and a prothrombotic state, creating a myocardial oxygen demand-supply mismatch that predisposes to acute coronary events. Chronically, recurrent hypoglycemia contributes to cumulative cardiac injury, structural remodeling with fibrosis, impaired contractile reserve, heart failure development, and potential electrophysiological adaptation that heightens arrhythmic vulnerability. Together, these acute and chronic effects highlight that like hyperglycemia, hypoglycemia also confers significant cardiovascular risk. Glucose-lowering strategies, especially in diabetic individuals already at higher cardiovascular risk, should therefore be individualized with careful avoidance of both extremes to optimize outcomes and minimize harm.
Intracoronary Cryotherapy for Vulnerable Plaque Stabilization.
Basha NR, Ahmad R, Khan S … +3 more , Alsaeed R, Frishman WH, Aronow WS
Cardiol Rev · 2026 Feb · PMID 41630013 · Publisher ↗
Acute coronary syndromes most commonly arise from rupture of biologically vulnerable, rather than hemodynamically severe, coronary plaques. Advances in intravascular and noninvasive imaging techniques, including intravas...
Acute coronary syndromes most commonly arise from rupture of biologically vulnerable, rather than hemodynamically severe, coronary plaques. Advances in intravascular and noninvasive imaging techniques, including intravascular ultrasound, optical coherence tomography, near-infrared spectroscopy, and coronary computed tomography angiography, have enabled precise identification of high-risk plaque features such as thin fibrous caps, large lipid cores, and high plaque burden. While intensive lipid-lowering therapy favorably modifies plaque composition and reduces cardiovascular risk, interventional strategies are needed to directly stabilize nonflow-limiting but biologically vulnerable plaques. Intracoronary cryotherapy has emerged as a novel, investigational approach aimed at modifying plaque biology through controlled thermal modulation without permanent intracoronary implantation. Preclinical studies demonstrate increased fibrous cap thickness and collagen content following cryotherapy, consistent with plaque stabilization. Early first-in-human experience suggests technical feasibility and short-term safety. This review summarizes contemporary approaches to vulnerable plaque identification, existing pharmacologic and interventional strategies, and the evolving role of intracoronary cryotherapy as a potential plaque-directed therapy.
Cardiovascular Effects of Growth Hormone: From Deficiency to Acromegaly.
Neshat N, Adrejiya P, Khan ZM … +2 more , Frishman WH, Aronow WS
Cardiol Rev · 2026 Feb · PMID 41622549 · Publisher ↗
Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) form an endocrine axis with broad cardiovascular relevance because their receptors in cardiomyocytes and vascular cells link hormonal signaling to myocardial g...
Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) form an endocrine axis with broad cardiovascular relevance because their receptors in cardiomyocytes and vascular cells link hormonal signaling to myocardial growth and performance, vascular tone, endothelial nitric oxide biology, and cardiometabolic risk. This review synthesizes mechanistic, clinical, and epidemiologic evidence to clarify cardiovascular effects across GH/IGF-1 deficiency and excess, and to highlight implications for therapeutic decision making. Key themes include receptor-driven pathways, imaging, and functional phenotyping that distinguishes a "small-heart" pattern with microvascular and endothelial dysfunction in adult GH deficiency from concentric remodeling, diastolic impairment, arrhythmias, and a stiffness/volume-expanded hemodynamic profile in acromegaly, and evidence that timely endocrine control or replacement can yield partial reverse remodeling while residual abnormalities may persist with longer disease duration. Clinically, the review emphasizes that cardiometabolic tradeoffs differ across GH-directed therapies, so biochemical control alone may not capture risk. Major gaps include heterogeneous cohorts, confounding by comorbidities and concurrent hormone replacement, variable endpoints, and limited event-driven prospective data, motivating standardized phenotyping, hard-outcome studies, and validation of IGF-system biomarkers for risk stratification and treatment selection.
Efficacy and Safety of Apixaban in Cancer-Associated Thromboembolism: A Narrative Review.
Aperna F, Kumar M, Ahmad R … +6 more , Niaz M, Khan S, Vakhshoori M, Arslan FS, Frishman WH, Aronow WS
Cardiol Rev · 2026 Feb · PMID 41622537 · Publisher ↗
Cancer-associated venous thromboembolism (CA-VTE) is a leading, severe, and potentially life-threatening complication in patients with malignancy. Low-molecular-weight heparin has historically been the standard of care;...
Cancer-associated venous thromboembolism (CA-VTE) is a leading, severe, and potentially life-threatening complication in patients with malignancy. Low-molecular-weight heparin has historically been the standard of care; however, direct oral anticoagulants, particularly direct factor Xa inhibitors, have emerged as effective alternatives. These agents offer the convenience of oral administration, predictable pharmacokinetics, elimination of routine laboratory monitoring, and improved adherence. Despite the expanding role of direct oral anticoagulants in CA-VTE management, concerns regarding bleeding risk-particularly in patients with gastrointestinal and genitourinary malignancies-remain central to clinical decision-making. In this narrative review, we evaluate the efficacy, safety, and clinical applicability of apixaban for the treatment and prophylaxis of CA-VTE. Current evidence from randomized controlled trials, including CARAVAGGIO and AMPLIFY, demonstrates that apixaban has noninferior efficacy compared with low-molecular-weight heparin and conventional anticoagulation strategies, with comparable or lower rates of recurrent venous thromboembolism. In addition, apixaban appears to have a favorable safety profile, with no statistically significant increase in major bleeding in selected cancer populations, including those without active gastrointestinal lesions. Apixaban's pharmacokinetic properties, including limited renal clearance and stable drug exposure, further enhance its clinical utility in oncologic populations. However, evidence supporting apixaban use across all cancer subtypes remains limited and heterogeneous, highlighting the need for additional comparative and real-world studies.
Cardiovascular Complications of Hypoglycemia.
Opi T, Frishman WH, Aronow WS
Cardiol Rev · 2026 Feb · PMID 41622535 · Publisher ↗
Hypoglycemia is defined as low blood glucose levels. While it is uncommon in healthy adults, diabetics and other vulnerable patient populations remain at increased risk. The neuroglycopenic symptoms of hypoglycemia, such...
Hypoglycemia is defined as low blood glucose levels. While it is uncommon in healthy adults, diabetics and other vulnerable patient populations remain at increased risk. The neuroglycopenic symptoms of hypoglycemia, such as dizziness, lethargy, loss of consciousness, etc., are well known. However, hypoglycemia has significant cardiovascular manifestations. During an acute hypoglycemic episode, sympathoadrenal activation causes increased epinephrine release. Epinephrine directly increases myocardial workload via stimulating β1 adrenoreceptors; in vulnerable populations, increased cardiac stress may provoke ischemia and infarction. Additionally, epinephrine may induce hypokalemia via stimulating β2 adrenoreceptors on various cells; electrolyte disturbances induce electrocardiogram changes, increasing the risk of cardiac arrhythmias. Endothelial dysfunction may also arise due to epinephrine-mediated adrenergic activation. This article reviews the current literature addressing pathogenesis, diagnostic criteria, and cardiovascular complications of hypoglycemia.
Obesity-Driven Hypertension: Exploring the Mechanisms and Modern Treatment Strategies.
Sindhwani N, Moudgil P, Thukral J … +8 more , Shah RK, Kaur H, Kumar R, Thukral N, Raval M, Agrawal SP, Frishman WH, Aronow WS
Cardiol Rev · 2026 Feb · PMID 41622529 · Publisher ↗
Obesity and hypertension are interdependent chronic conditions that substantially elevate global cardiovascular risk. Rising obesity prevalence has led to a parallel increase in hypertension, driven by complex physiologi...
Obesity and hypertension are interdependent chronic conditions that substantially elevate global cardiovascular risk. Rising obesity prevalence has led to a parallel increase in hypertension, driven by complex physiological disturbances that extend beyond excess body weight alone. This review synthesizes current evidence on the mechanisms linking adiposity to blood pressure elevation, emphasizing the roles of sympathetic nervous system overactivity, insulin resistance, renal sodium retention, and adipose-derived hormonal and inflammatory dysregulation. Particular attention is given to visceral adiposity, which exerts adverse vascular, renal, and metabolic effects that accelerate development of hypertension-mediated organ damage, including left ventricular hypertrophy, arterial stiffness, and early renal injury. The manuscript also evaluates therapeutic strategies for obesity-related hypertension. Lifestyle interventions-caloric restriction, structured physical activity, and behavioral therapy-remain the cornerstone of management, producing clinically meaningful reductions in body weight and blood pressure. However, sustained weight loss is difficult for many individuals, necessitating adjunctive approaches. Contemporary pharmacotherapies, particularly glucagon-like peptide-1 receptor agonists such as semaglutide, have demonstrated substantial benefits in both weight reduction and blood pressure control. For patients with severe obesity or inadequate response to medical therapy, metabolic and bariatric procedures offer the most durable outcomes, improving cardiometabolic profiles and reducing antihypertensive medication burden.
A Critical Review of the 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Whiteson HZ, Whitford T, Haner Wasserstein D … +1 more , Frishman WH
Cardiol Rev · 2026 Feb · PMID 41622524 · Publisher ↗
The Utstein Formula for Survival, the ethos of the American Heart Association's 2025 guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, is a conceptual model for survival of out-of-hospital c...
The Utstein Formula for Survival, the ethos of the American Heart Association's 2025 guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, is a conceptual model for survival of out-of-hospital cardiac arrest that equally weighs medical science, educational efficiency, and local implementation. With this formula in mind, the American Heart Association has put forth new guidelines that emphasize not only high-quality chest compressions and early defibrillation but also robust systems of care, equitable access, advanced resuscitation techniques, and postcardiac arrest recovery. The 2025 updates carry significant weight for health policy, clinical practice, education, and ethical discussions. In this review, we highlight the major changes, discuss their implications, and propose directions for future research and implementation.
Vitamin Supplementation and Cardiovascular Disease.
Lipman ET, Frishman WH
Cardiol Rev · 2026 Feb · PMID 41622521 · Publisher ↗
Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. Given the global burden, the potential role of micronutrients-particularly vitamins-in modifying cardiovascular risk has been a topic...
Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. Given the global burden, the potential role of micronutrients-particularly vitamins-in modifying cardiovascular risk has been a topic of intense investigation. This review synthesizes current evidence on the associations between various vitamins and cardiovascular health. It explores biological mechanisms, including antioxidant activity, endothelial function, lipid modulation, homocysteine metabolism, and vascular calcification. Vitamins D, C, E, K, and several B-complex vitamins are highlighted for their relevance. While observational data often support associations between deficiencies and adverse cardiovascular outcomes, large-scale randomized controlled trials have yielded mixed or null results, particularly regarding supplementation efficacy in primary or secondary prevention. Despite a high prevalence of supplement use in the United States, with over half of adults reporting intake, robust evidence supporting cardiovascular benefit remains limited. In some subgroups-such as individuals with hypertension, heart failure, or vitamin deficiencies-certain vitamins may offer modest benefits. However, indiscriminate supplementation has generally not been proven effective and, in some cases, may carry risks. The review emphasizes the need for targeted interventions, individualized assessment, and further high-quality research to clarify the role of vitamins in cardiovascular prevention and treatment.
Social Isolation as a Risk Factor in Cardiovascular Disease.
Nurenberg JM, Nurenberg JR, Frishman WH
Cardiol Rev · 2026 Feb · PMID 41622519 · Publisher ↗
Multiple academic sites have reported that social isolation can pose a public health hazard, specifically premature cardiovascular disease and cerebrovascular disease. This article reports on cardiovascular complications...
Multiple academic sites have reported that social isolation can pose a public health hazard, specifically premature cardiovascular disease and cerebrovascular disease. This article reports on cardiovascular complications discovered by clinicians and public health researchers. In addition, there are reports that social isolation is associated with pulmonary disease, cancer, autoimmune disease, and even adverse outcomes during pregnancy. Social isolation has been a known factor for serious adverse outcomes in psychiatric circles since the time of Emil Kraepelin, Paul Eugen Bleuler, and Emile Durkheim before the 20th century. In the past, there have also been sporadic case reports from biologically oriented psychiatrists reporting severe medical conditions in these patients, mostly regarded as due to poor access to medical assessments of patients with social isolation. While still a valid pathway for the explanation of some findings, recently, there has been a great deal of interest in the discovery of pathophysiological mechanisms as causative of deadly outcomes in victims of social isolation. This is based on the robust association between social isolation and the development of premature cardiovascular disease. Using Scopus, PubMed, and the Bernard Becker Medical Library at Washington University, the authors reviewed articles from Europe, England, North America, and East Asia published within the past 2 years. Descriptions of pathophysiological mechanisms published in the past 20 years are included in this paper.
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