Defining Cardiovascular Endpoints in Oncology Trials: Challenges and Opportunities: A Scientific Statement From the American Heart Association

Defining Cardiovascular Endpoints in Oncology Trials: Challenges and Opportunities: A Scientific Statement From the American Heart Association

Baseline Angina in Patients with Severe Aortic Stenosis and Coronary Artery Disease: A Secondary Analysis of the NOTION-3 Randomized Controlled Trial

Abstract Background Angina is common in patients with coronary artery disease and severe aortic stenosis. Whether angina should guide coronary revascularization in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) remains uncertain. Aims To assess whether angina modifies the effect of percutaneous coronary intervention (PCI) on clinical outcomes and whether percutaneous coronary intervention influences angina burden after TAVI. Methods and results This prespecified secondary analysis of the NOTION-3 trial included patients with severe aortic stenosis and significant coronary artery disease randomized to TAVI with percutaneous coronary intervention or optimal medical therapy (OMT). Baseline angina was assessed by Seattle Angina Questionnaire-7 Angina Frequency score, supplemented by Canadian Cardiovascular Society class when questionnaire data were missing. Of 454 patients, 229 (50%) had angina and 225 (50%) had no angina. In the baseline angina subgroup, the primary outcome MACE, a composite of death from any cause, myocardial infarction, or urgent revascularization, occurred in 27% randomized to PCI versus 37% randomized to OMT. Without angina, rates were 26% versus 35%. Hazard ratios for PCI versus OMT were 0.71 (95%-CI 0.45–1.13) in patients with angina and 0.69 (95%-CI 0.43–1.12) in those without, with no interaction by baseline angina (P=0.97). SAQ-7 summary scores improved at 1 year in angina groups, with no between-group difference in change (16 vs. 17; P=0.78). Conclusion We found no evidence that baseline angina modified the relative effect of PCI on clinical outcomes, although the study was not powered to exclude clinically meaningful heterogeneity.

Beta-blockers after myocardial infarction: indication, ejection fraction, and de-escalation pathway

Beta-blocker therapy after myocardial infarction requires tailored management based on specific clinical indications, patient ejection fraction, and appropriate de-escalation pathways.

Randomized Controlled Trial of Internet‐Delivered Cognitive Behavioral Therapy After Myocardial Infarction With Nonobstructive Coronary Arteries or Takotsubo Syndrome

An internet-delivered cognitive behavioral therapy program did not significantly increase the proportion of patients with normalized stress and anxiety levels (OR 2.37; 95% CI 0.88-6.38; P=0.09).

Association Between Home-Based Exercise Modality and Improvements in Exercise Capacity During Outpatient Cardiac Rehabilitation　― A Retrospective Observational Study ―

Ergometer-based home exercises were associated with higher post-intervention peak oxygen uptake compared to walking-based exercises (MD -1.472, p=0.030) during outpatient cardiac rehabilitation.

Cardiac Rehabilitation for Angina with Non-Obstructive Coronary Arteries: A Scoping Review

A scoping review of 26 studies found cardiac rehabilitation for ANOCA appears safe and is associated with consistent improvements in patient-reported outcomes like angina symptoms.

Olezarsen for Hypertriglyceridemia: A New Therapy Update with Systematic Review and Meta-Analysis

Hypertriglyceridemia is a frequently seen lipid disorder. It is linked to a higher risk of cardiovascular diseases and adds a significant burden on healthcare systems. Olezarsen, a novel antisense therapy targeting apolipoprotein C-III, offers effective triglyceride reduction with the convenience of infrequent dosing. This meta-analysis evaluates the safety and efficacy of olezarsen in hypertriglyceridemia to guide clinical decision-making. A comprehensive literature search across major databases identified randomized control trials comparing olezarsen with usual care in patients with hypertriglyceridemia. Data extraction and bias assessment were conducted independently, using RoB 2.0 and the GRADE framework. A meta-analysis was performed using RevMan 5.4.1, applying random effects models and assessing heterogeneity with the I2 statistic. Eight randomized controlled trials were included. Olezarsen significantly reduced triglycerides (MD -58.57, 95% CI -63.10 to -54.04; I2 = 13%) and apolipoprotein C-III (MD -69.81, 95% CI -75.77 to -63.84; I2 = 56%). Significant improvements were also observed in apolipoprotein B, nonhigh-density lipoprotein cholesterol, and achievement of TAG targets (<150 mg/dL). There was no increase in overall or serious adverse events, although injection-site reactions, liver enzyme elevations, and treatment discontinuation were higher with olezarsen. Olezarsen significantly improves TAG levels and atherogenic lipid parameters in patients with hypertriglyceridemia, demonstrating robust efficacy across multiple outcomes. It maintains an overall favorable safety profile, supporting its role as a promising therapeutic option, although monitoring for liver enzymes and injection-site reactions is warranted.

Understanding participants’ experiences of a behaviour change intervention within cardiac rehabilitation: A nested process evaluation within the STRENGTH randomised controlled trial

Background The STRENGTH (Self-management and Theory-based Rehabilitation Encouraging New Gateways to Healthy-Hearts) study evaluated a behaviour change intervention embedded within cardiac rehabilitation for individuals with coronary heart disease. This manuscript reports the process evaluation, which aimed to explore participants’ experiences of physical activity, barriers and facilitators to maintaining physical activity, and contextual and process-related factors influencing engagement with the intervention. Methods A process evaluation was nested within a two-arm cluster randomised controlled trial. Semi-structured interviews were conducted with participants from both intervention and control groups, focus groups were conducted with intervention participants. Thematic analysis examined factors influencing physical activity maintenance, including context, implementation, mechanisms of impact and perceived outcomes. Quantitative procedures measured intervention fidelity through attendance records and participant diaries. Results Both groups highlighted environmental, social, and personal factors influencing participation in cardiac rehabilitation, such as social support, professional oversight, and structured programming. Trainers and peer interactions were valued for motivation and perceived safety. The intervention group reported additional facilitators, including tailored support, external accountability, and self-monitoring, which increased awareness and reinforced adherence. Mechanisms of impact included increased awareness of physical activity, greater exercise confidence, and a sense of accomplishment. A perceived lack of exercise confidence may have hindered independent physical activity engagement. Conclusions While behaviour change strategies can enhance engagement in cardiac rehabilitation, their impact on measurable health outcomes remains unclear. Social support, professional oversight, and structured programming appear effective in maintaining physical activity levels, but future interventions should prioritise exercise confidence and education to promote sustained behaviour change. Trial registration Registered with ClinicalTrials.gov on 26-01-2023 (ID: NCT05705310 ).

Social Frailty in Heart Failure: A Scoping Review of Prevalence, Impact and Critical Knowledge Gaps

Social frailty in heart failure is consistently linked to adverse outcomes such as diminished quality of life, increased rehospitalisation risk, and higher mortality.