J Am Coll Cardiol
· 2026 Jun · PMID 42307497
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Hypertension management is at an inflection point. Over the past 4 years, landmark trials have definitively established that intensive blood pressure (BP) lowering to systolic targets below 120 mm Hg reduces cardiovascul...Hypertension management is at an inflection point. Over the past 4 years, landmark trials have definitively established that intensive blood pressure (BP) lowering to systolic targets below 120 mm Hg reduces cardiovascular events and mortality across diverse high-risk populations, and the 2025 American Heart Association/American College of Cardiology (AHA/ACC) hypertension guideline has incorporated these findings into a universal <130/80 mm Hg goal with encouragement to achieve systolic BP <120 mm Hg when feasible. At the same time, novel pharmacological and device-based therapies have engaged mechanistic pathways previously left unopposed-endothelin, aldosterone biosynthesis, hepatic angiotensinogen, and renal sympathetic nerves-ending a >15-year drought in new antihypertensive mechanisms. This review synthesizes these converging developments and frames them within an emerging phenotype-driven framework that matches therapy to the dominant driver of uncontrolled or difficult-to-treat hypertension. The implications for cardiovascular disease prevention are substantial: more aggressive targets are now achievable through more precise therapies, and the coming years will require a shift from 1-size-fits-all stepped care toward individualized precision management.
Ferrazzi P, Spirito P, Binaco I
… +9 more, Zyrianov A, Boni L, Poggio D, Grillo M, Chioffi M, Sorropago A, Casati V, Paleari S, Vaccari G
J Am Coll Cardiol
· 2026 Jun · PMID 42307496
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BACKGROUND: The recent introduction of cardiac myosin inhibitors has modified the therapy of left ventricular outflow obstruction in patients with hypertrophic cardiomyopathy (HCM) and is raising uncertainties regarding...BACKGROUND: The recent introduction of cardiac myosin inhibitors has modified the therapy of left ventricular outflow obstruction in patients with hypertrophic cardiomyopathy (HCM) and is raising uncertainties regarding the future role of surgery in the management of obstructive HCM. However, it is likely that a proportion of patients will continue to present with advanced, highly symptomatic HCM, despite medical therapy, and require surgical intervention. We previously reported the short-term results of cutting anterior mitral leaflet secondary chordae in combination with septal myectomy in patients with obstructive HCM. This operative approach has shown excellent results in several short-term studies from our and other centers. However, no data are currently available regarding the long-term outcome of this novel surgical procedure. OBJECTIVES: The study sought to investigate the long-term results of myectomy associated with chordal cutting. METHODS: Long-term results were assessed in 350 consecutive patients with obstructive HCM who underwent this operation at our center over a 5-year period. Median follow-up was 5.6 years (Q1-Q3: 4.2-6.3 years). RESULTS: Including 2 in-hospital deaths (surgical mortality 0.6%), 6-year overall survival after surgery was 96% and did not differ from that of the general Italian population matched for age and sex (P = 0.331). Follow-up information was available in 344 (99%) patients. At the most recent evaluation, 271 (79%) patients were asymptomatic in NYHA functional class I, 65 (19%) were in NYHA functional class II, and 8 (2%) were in NYHA functional class III. During follow-up, there were 14 deaths, 6 of which were unrelated to HCM. At most recent echocardiographic evaluation, ≥95% of patients had no residual left ventricular outflow gradient, clinically significant mitral regurgitation, or impaired systolic function. CONCLUSIONS: Our results show that cutting thickened and/or retracted secondary chordae of the anterior mitral leaflet in association with septal myectomy has excellent long-term clinical and hemodynamic results in patients with obstructive HCM. These findings may further increase the number of myectomy referral centers and the availability of the surgical option for severely symptomatic HCM patients unresponsive to medical treatment.
Gong J, Chiu N, Clinch KA
… +3 more, Qian Y, Ho JE, Wadhera RK
J Am Coll Cardiol
· 2026 Jun · PMID 42307495
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BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome highlights the inter-related nature of cardiometabolic risk factors, kidney disease, and cardiovascular disease (CVD) and represents an important target for inte...BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome highlights the inter-related nature of cardiometabolic risk factors, kidney disease, and cardiovascular disease (CVD) and represents an important target for intervention amid rising cardiovascular mortality in the United States. However, contemporary treatment patterns of major cardiometabolic risk factors in this high-risk population are not well defined. OBJECTIVES: The purpose of this study was to characterize national treatment rates of hypertension, diabetes, and hyperlipidemia among U.S. adults with CKM syndrome and to assess risk factor control among treated individuals from 2015 through 2023. METHODS: We analyzed data from adults aged ≥20 years with CKM stage 2 and above who participated in the National Health and Nutrition Examination Survey from 2015 through August 2023. Treatment rates for hypertension, diabetes, and hyperlipidemia and rates of blood pressure, glycemic, and cholesterol control among treated individuals were estimated using age- and sex-adjusted analyses that accounted for the complex survey design. RESULTS: The study included 6,384 adults with CKM stage 2 and above (weighted mean age 44.2 years; 51.2% women). Only approximately one-half of adults with hypertension (51.3% [95% CI: 49.7%-52.8%]) or hyperlipidemia (48.8% [95% CI: 46.7%-51.0%]) were receiving treatment, while diabetes treatment rates were higher (83.4% [95% CI: 80.1%-86.6%]). Among treated individuals, blood pressure control was achieved in 44.7% (95% CI: 41.6%-47.7%), glycemic control in 47.3% (95% CI: 42.7%-51.8%), and cholesterol control in 68.2% (95% CI: 65.2%-71.1%). Treatment rates for hypertension and hyperlipidemia increased across higher risk strata, while blood pressure and glycemic control were lower among treated adults with higher 10-year CVD risk. Adults aged 20-44 years consistently had the lowest treatment rates across all 3 conditions (hypertension 27.6% [95% CI: 24.8%-30.3%], diabetes 73.7% [95% CI: 63.8%-83.7%], hyperlipidemia 19.7% [95% CI: 15.2%-24.3%]), while women were less likely than men to receive treatment for diabetes and hyperlipidemia. Among racial and ethnic subgroups, Hispanic adults had the lowest treatment rates for hypertension and hyperlipidemia. CONCLUSIONS: Among U.S. adults with CKM syndrome, treatment of hypertension and hyperlipidemia was low, and fewer than one-half of treated individuals achieved blood pressure or glycemic control. Gaps in treatment initiation were most pronounced among young adults, women, and Hispanic adults, and inadequate risk factor control was particularly evident among those with higher cardiovascular risk. These findings highlight substantial opportunities to improve cardiometabolic care in this high-risk population.
Zhang T, Zhang Y, Lee DH
… +4 more, Rezende LFM, Wang X, Zheng C, Giovannucci E
J Am Coll Cardiol
· 2026 May · PMID 42307492
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BACKGROUND: Long-term resistance training may influence cardiovascular health, but evidence in women, particularly in the context of aerobic activity and sedentary behavior, remains limited. OBJECTIVES: This study sought...BACKGROUND: Long-term resistance training may influence cardiovascular health, but evidence in women, particularly in the context of aerobic activity and sedentary behavior, remains limited. OBJECTIVES: This study sought to examine the association between long-term resistance training and risk of major cardiovascular disease (CVD) in women, and to evaluate joint associations with aerobic activity, sedentary television viewing, and key training-related characteristics. METHODS: We conducted a prospective cohort study among 117,025 women from the Nurses' Health Study (N = 45,669; 2002-2020) and Nurses' Health Study II (N = 71,356; 2003-2017), with up to 5 repeated assessments of physical activity. Resistance training was reported every 4 years, and time-varying cumulative averages were calculated to represent long-term exposure. The primary outcome was incident major CVD, defined as nonfatal or fatal myocardial infarction (MI), stroke, coronary artery bypass grafting, or percutaneous coronary intervention. RESULTS: Over a mean of 14.5 years of follow-up (1,630,964 person-years), 5,459 incident major CVD events occurred. Compared with no resistance training, women performing ≥2 h/wk had a 20% lower risk of major CVD (HR: 0.80; 95% CI: 0.69-0.92; P for trend = 0.007), and each additional 1 h/wk was associated with a 5% lower risk (HR per 1 h/wk: 0.95; 95% CI: 0.92-0.99). The inverse association was stronger for MI (HR for ≥2 h/wk vs none: 0.56; 95% CI: 0.41-0.76) but not evident for stroke (HR: 0.99; 95% CI: 0.80-1.23). Women who met recommendations for aerobic activity (≥15 metabolic equivalent of task hours per week), resistance training (≥1 h/wk), and low sedentary television viewing (<2 h/d) had a lower risk of major CVD (HR: 0.60; 95% CI: 0.53-0.69), than those meeting aerobic and low sedentary television viewing recommendations but not resistance training (HR: 0.73; 95% CI: 0.67-0.80). Greater consistency in maintaining resistance training (≥75% of follow-up) and engaging in both upper and lower limb training were associated with stronger inverse associations. CONCLUSIONS: In this large prospective study of U.S. women, consistent resistance training, especially when integrated with recommended levels of aerobic activity and reduced sedentary television viewing, was associated with a substantially lower risk of major CVD, particularly MI.
Thourani VH, von Stein P, Mack MJ
… +23 more, Nazif TM, Babaliaros V, Alkhouli M, Fischbein MP, Desai ND, Satler L, Zidar FJ, Kodali SK, Kron IL, Zajarias A, Brinkman W, Kapadia S, Dewey TM, Gössl M, Bodenhamer RM, Ma Y, Cohen DJ, Sharma R, Pibarot P, Hahn RT, Leon MB, Makkar RR, PARTNER 2 Investigators
J Am Coll Cardiol
· 2026 Jun · PMID 42300821
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BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement for symptomatic severe aortic stenosis, but long-term, comparative clinical outcomes and echoca...BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement for symptomatic severe aortic stenosis, but long-term, comparative clinical outcomes and echocardiography data are lacking. OBJECTIVES: Our goal was to compare 10-year clinical and echocardiographic outcomes after balloon-expandable TAVR or surgery in intermediate-risk surgical patients in the PARTNER 2A randomized trial. METHODS: Between 2011 and 2013, patients with severe, symptomatic aortic stenosis at intermediate surgical risk were randomized at 57 centers to TAVR with the balloon-expandable SAPIEN XT system (Edwards Lifesciences) or to surgery. Randomization was stratified by anatomical suitability for transfemoral (TF) or transthoracic (transapical/transaortic [TA/TAo]) access. Ten-year outcomes were evaluated in the valve implant population and included all-cause mortality, aortic valve reintervention, and core laboratory-adjudicated echocardiographic outcomes. To obtain 10-year data, patient reconsent at 5 years was required, and vital status sweeps were implemented to improve data completeness for all-cause mortality. RESULTS: Among 1,910 randomized patients who received a valve, 974 underwent TAVR (TF: 749/974 [76.9%]) and 936 had surgery. Mean patient age was 81.6 years, 45.4% were women, and the mean Society of Thoracic Surgeons score was 5.8%. At 10 years, vital status was available for 881 of 974 patients (90.5%) and 838 of 936 patients (89.5%). All-cause 10-year mortality with vital status sweeps was 86.1% after TAVR and 82.8% after surgery (HR: 1.13; 95% CI: 1.02-1.25; P = 0.02). When stratified by access route, rates of all-cause mortality for TAVR and surgery in the TF group were similar (83.9% vs 82.1%, respectively; P = 0.27), whereas mortality was higher for TAVR in the TA/TAo group (93.2% vs 85.1%; P < 0.01; P for interaction = 0.03). Cumulative incidence rates of aortic valve reintervention at 10 years were 6.3% for TAVR and 1.6% for surgery (P < 0.001). Of the 24 TAVR and 35 surgical patients with available echocardiographic data at 10 years, mean gradients were 12.6 mm Hg and 12.7 mm Hg, respectively. CONCLUSIONS: At the 10-year follow-up, TAVR in intermediate-risk patients with the SAPIEN XT prosthesis compared with surgery was associated with lower survival rates, with differences predominantly observed in the TA/TAo access cohort. TAVR with the XT valve was also associated with significantly higher rates of aortic valve reintervention. (PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - XT Intermediate and High Risk [PII A]; NCT01314313).
Nazif TM, Simonato M, Makkar RR
… +27 more, Thourani VH, Desai ND, Babaliaros V, Greason K, Rovin J, Waxman S, Davidson C, Kereiakes DJ, Gupta A, Satler L, Schwartz R, Kapadia S, Wong SC, Smalling RW, Ghani M, Teirstein P, George I, Potluri S, Szerlip M, Xu K, Cohen DJ, Sharma RP, Pibarot P, Hahn RT, Mack MJ, Leon MB, PARTNER 2 Investigators
J Am Coll Cardiol
· 2026 Jun · PMID 42300820
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BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis. However, long-term outcomes data are lacking for TAVR...BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis. However, long-term outcomes data are lacking for TAVR, particularly with newer-generation transcatheter heart valves. OBJECTIVES: The purpose of this study was to compare 10-year outcomes of intermediate-risk patients who underwent TAVR with the third-generation, balloon-expandable SAPIEN 3 valve in the PARTNER 2 SAPIEN 3 Intermediate-risk Registry (P2S3i) with those who underwent surgery in the PARTNER 2A (P2A) randomized trial. METHODS: Intermediate-risk patients were enrolled in the P2A trial from 2011 through 2013 and in the P2S3i registry in 2014. These prospective, multicenter studies used the same eligibility criteria and stratified patients based on suitability for transfemoral or transthoracic (transapical/transaortic) access. Ten-year outcomes were evaluated, including all-cause mortality, aortic valve reintervention, and core laboratory-adjudicated echocardiographic outcomes. Patient reconsent was required at 5 years for extended 10-year follow-up, and vital status sweeps were implemented to improve data completeness for all-cause mortality. To account for potential baseline differences and reduce confounding, P2S3i TAVR patients were propensity score-matched 1:1 to P2A surgical patients. RESULTS: Among 2,005 patients who received a valve, 1,069 underwent TAVR in P2S3i and 936 underwent surgery in P2A. After propensity score matching (N = 783 patients in each group), baseline characteristics were similar between groups: mean age was approximately 82 years, 43% were female, and mean Society of Thoracic Surgeons score was 5.5%. At 10 years, all-cause mortality rate was 83.4% after TAVR and 82.3% after surgery, respectively (HR: 1.01 [95% CI: 0.91-1.13]; P = 0.82). Aortic valve reintervention rates adjusted for competing mortality were 2.0% for TAVR and 1.9% for surgery (P = 0.47). Among 32 TAVR and 30 surgical patients with available echocardiographic data at 10 years, mean gradients were 11.0 mm Hg and 12.6 mm Hg, respectively. CONCLUSIONS: At 10 years, TAVR with the SAPIEN 3 valve and surgery resulted in similar rates of mortality and aortic valve reintervention, and similar hemodynamics in intermediate-risk patients with symptomatic severe aortic stenosis. This analysis highlights challenges associated with extended long-term follow-up of clinical trials, including differential loss to follow-up and the competing risk of mortality in elderly populations. (PARTNER 2A Trial; NCT01314313; PARTNER 2 SAPIEN 3 Intermediate-Risk Registry; NCT03222128).
Brener MI, Chuang ML, Nishimura R
… +14 more, Hamid NB, Snyder C, Thompson JB, Ungarten J, Takahashi K, Poterucha TJ, Elias P, Lindman BR, Shimbo D, Pocock SJ, Granada JF, Mack MJ, Leon MB, Cohen DJ
J Am Coll Cardiol
· 2026 Jun · PMID 42300818
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BACKGROUND: Valvular heart disease (VHD) is associated with substantial morbidity, mortality, and health care costs, yet its contemporary prevalence among older adults in the United States is unknown. OBJECTIVES: We perf...BACKGROUND: Valvular heart disease (VHD) is associated with substantial morbidity, mortality, and health care costs, yet its contemporary prevalence among older adults in the United States is unknown. OBJECTIVES: We performed a decentralized study of older adults (PREVUE-VALVE) to determine the population prevalence of VHD among older Americans. METHODS: Individuals 65-85 years old who previously filled a prescription at CVS or Walgreens pharmacies were randomly selected; contacted via e-mail, direct mail, or text messaging; and invited to participate. Enrolled participants completed study procedures in their homes, including a comprehensive transthoracic echocardiogram. The primary endpoint was the prevalence of moderate or greater (≥ moderate) VHD, weighted to reflect the U.S. POPULATION: The co-primary endpoint was the prevalence of clinically significant VHD, which also included mild-to-moderate regurgitant disease. RESULTS: The study sample (n = 3,000) was representative of older Americans (median age 71 years, 57.1% female, 14.6% non-Hispanic Black, 9.4% Hispanic). The weighted prevalence of ≥ moderate VHD was 8.2% (95% CI: 7.0%-9.5%), which increased to 18.4% (95% CI: 16.7%-20.2%) for clinically significant VHD. Tricuspid regurgitation was the most common lesion, followed by aortic stenosis, mitral regurgitation, aortic regurgitation, and mitral stenosis. Older age, but not sex, was associated with greater prevalence. In age- and sex-adjusted analyses, non-Hispanic Black individuals had a lower prevalence of any VHD compared with non-Hispanic White individuals (adjusted RR: 0.91; 95% CI: 0.83-0.99), driven predominantly by lower rates of aortic stenosis and regurgitation. There were no significant adjusted differences in VHD prevalence between Hispanic and non-Hispanic individuals. Extrapolation of these data to the U.S. population indicates that at least 4.7 million 65-85-year-olds currently have ≥ moderate VHD, and 10.6 million currently have clinically significant VHD-values that are projected to increase to 6.5 and 14.7 million, respectively, by 2060. CONCLUSIONS: In this national in-home echocardiography study, VHD was common among older adults, with important age-related and valve-specific patterns. PREVUE-VALVE establishes the feasibility of large-scale decentralized cardiovascular imaging studies and provides a contemporary foundation for clinical and policy planning related to the burden of VHD. (Age- and Sex-Specific Prevalence of Acquired Valvular Heart Disease (PREVUE-VALVE; NCT05357404).