Star Update Podcast - Cardiology News Summaries

Heart Failure Outcomes with SGLT2 Inhibitors in Adults with Type 2 Diabetes: A Systematic Review and Meta-AnalysisDOI: https://doi.org/10.3390/medicina62010069AbstractBackground and Objectives: Type 2 diabetes mellitus (T2DM) substantially increases the risk of heart failure (HF) and worsens its prognosis. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed for glycemic control, have shown important cardiovascular benefits. This systematic review and meta-analysisevaluated the effects of SGLT2i on HF hospitalizations, cardiovascular (CV) death, and renal outcomes, as well as their safety profile, in patients with T2DM and established HF. Materials and Methods: Following PRISMA 2020 guidelines, we systematically searched PubMed, the Cochrane Library, and Web of Science for randomized controlled trials (RCTs) comparing SGLT2i with placebo in adults with T2DM and HF. Data on HF hospitalizations, CV death, other clinical outcomes, and adverse events were extracted. Risk of bias was assessed using the Cochrane RoB2 tool, and pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using RevMan 5.4.1. Results: Ten RCTs including more than 21,000 participants met the inclusion criteria. Most were large, international, double-blind trials with overall low risk of bias. SGLT2i reduced the composite of worsening HF or CV death by about 21% (pooled HR 0.79, 95% CI 0.69–0.89), mainly driven by a consistent reduction in HF hospitalizations across trials. Effects on CV death alone were directionallyfavorable but not uniformly significant. Furthermore, SGLT2i were associated with beneficial effects on cardiac function and patient-reported health status and showed consistent renoprotective effects. The safety profile was favorable, with a small increase in genital infections and no excess of hypoglycemia or other serious adverse events. Conclusions: In patients with T2DM and HF, SGLT2i meaningfully reduce HF events and provide additional renal benefits with good tolerability. Our findings consolidate and update the current evidence by focusing specifically on RCTs enrolling patients with both T2DM and established HF across the spectrum of ejection fraction, thereby reinforcing the role of SGLT2i as a key component of guideline-directedtherapy in this high-risk population.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Potent P2Y12 Inhibitor Monotherapy Versus Dual Antiplatelet Therapy After Percutaneous Coronary Intervention for Acute Coronary Syndromes: A Systematic Review and Meta-AnalysisDOI: 10.1177/10760296261422490AbstractBackgroundThe optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) remains debated. While DAPT with aspirin and a P2Y12 inhibitor prevents ischemic events, it increases bleeding risk. This meta-analysis evaluates whether early aspirin discontinuation with P2Y12 inhibitor monotherapy offers comparable efficacy andimproved safety versus standard long-term DAPT.MethodsThis review, conducted according to PRISMA guidelines, searched PubMed, Cochrane Central and Clinicaltrials.gov up to September 2025 for RCTs comparing short-term DAPT (≤3 months) followed by P2Y12 inhibitor monotherapy with standard-duration DAPT (≥6-12 months). Outcomes included NACE, MACE, all-cause and cardiovascular mortality, myocardial infarction, stroke, stent thrombosis,and BARC 3 or 5 bleeding. Random-effects models were applied to estimate pooled risk ratios and 95% CIs.ResultsTen RCTs involving 35,277 patients were included. Compared with standard DAPT, short-term DAPT followed by P2Y12 inhibitor monotherapy significantly reduced NACE (RR = 0.80, 95% CI0.71-0.90; p = 0.0002; I2 = 38%), and BARC type 3 or 5 bleeding (RR = 0.48, 95% CI 0.40-0.58; p < 0.001; I2 = 0%), without significant differences in MACE (RR: 1.01 [0.86, 1.19]; p = 0.87; I2 = 41%) or all-cause mortality (RR: 0.96 [0.80, 1.16]; p = 0.69; I2 = 4%).ConclusionEarly transition to P2Y12 inhibitor monotherapy after 1-3 months of DAPT in ACS patients undergoing PCI significantly reduces bleeding without increasing ischemic events. Ticagrelor- or prasugrel-based monotherapy represents a safe and effective alternative to conventional 12-month DAPT.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Aspirin Combined With Ticagrelor or Clopidogrel in STEMI Patients With Diabetes Mellitus and Poor Glycemic Control Undergoing Primary PCI: A Multicenter Retrospective Cohort StudyDOI: 10.1002/ccd.70503 AbstractBackground: The safety and efficacy of aspirin combined with ticagrelor or clopidogrel remain unclear in ST-segment elevation myocardial infarction (STEMI) patients with Diabetes mellitus (DM) and poor glycemic control.Aims: This study aims to assess the efficacy and safety of ticagrelor versus clopidogrel-based dual antiplatelet therapy in STEMI patients with DM and poor glycemic control undergoing pPCI.Methods: We evaluated 2732 STEMI patients with DM and poor glycemic control who underwent primary percutaneous coronary intervention (pPCI) and were registered in the "Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS)" program between November 2014 and December 2019. Using propensity score matching (PSM) and cox proportional hazards regression, we compared the in-hospital risk of major adverse cardiovascular events (MACCE), TIMI bleeding events, and net adverse clinical events (NACE) between patients receiving aspirin combined with either ticagrelor or clopidogrel.Results: After PSM, the risk of in-hospital MACCE (HR = 0.545, 95% CI: 0.321-0.926, p = 0.025), Cardiac death (HR = 0.380, 95% CI: 0.149-0.971, p = 0.043) and NACE (HR = 0.728, 95% CI: 0.560-0.947, p = 0.018) was significantly lower in the ticagrelor group compared with the clopidogrel group(p < 0.05), while no significant difference was observed in the incidence of TIMI-bleeding events between the two groups (p > 0.05).Conclusion: Among STEMI patients with DM and poor glycemic control undergoing pPCI, ticagrelor use was associated with a low rate of MACCE, without an excessive risk of bleeding.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysisof randomised controlled trialsLancet-2025 Sep 13;406(10508):1128-1137.doi: 10.1016/S0140-6736(25)01592-2. Epub 2025 Aug 30.AbstractBackground: The effects of β-blocker therapy on clinical outcomes in patients with myocardial infarction and mildly reduced (40-49%) left ventricular ejection fraction (LVEF) are largely unknown. Four recently conducted randomised trialstested the efficacy of β blockers after a recent myocardial infarction in patients without reduced LVEF (LVEF ≥40%). However, none were individually powered to assess these effects in the subgroup of patients with mildly reducedLVEF. We aimed to assess the efficacy of β blockers in patients with myocardial infarction and mildly reduced LVEF during the index hospitalisation.Methods: We conducted an individual patient-level meta-analysis of patients with mildly reduced LVEF and no history or signs of heart failure from four recent clinical trials. These studies were included because they were randomised controlledtrials testing long-term effects (median follow-up >1 year) of oral β-blocker therapy in patients who recently had a myocardial infarction (randomisation within 14 days) and had mildly reduced LVEF. No further studies were found in a systematic review (Jan 1, 2020 to June 26, 2025). A one-stage,fixed-effects, Cox proportional hazards regression model was used to assess the treatment effect of β blockers on the predefined primary composite endpoint of all-cause death, new myocardial infarction, or heart failure. All endpointswere independently adjudicated. This meta-analysis was registered with PROSPERO (CRD420251023480).Findings: 1885 patients with myocardial infarction and mildly reduced LVEF were included in the meta-analysis: 979 from the REBOOT trial, 422 from the BETAMI trial, 430 from the DANBLOCK trial, and 54 from the CAPITAL-RCT trial. Overall, 991 patients were assigned to β blockers and 894 to control (no β blockers). The primary composite endpoint occurred in 106 patients (32·6 events per 1000 patient-years) in theβ-blocker group and 129 patients (43·0 per 1000 patient-years) in the no β-blocker group (hazard ratio 0·75 [95% CI0·58-0·97]; p=0·031). No heterogeneity between the trials (trial-by-treatment pinteraction=0·95) or between countries of enrolment was observed (pinteraction=0·98).Interpretation: In patients with acute myocardial infarction with mildly reduced LVEF without history or clinical signs of heart failure, β-blocker therapy was associated with a reduction in the composite of all-cause death, new myocardialinfarction, or heart failure. These results extend the known benefits of these agents in patients with myocardial infarction with reduced LVEF to the subgroup with mildly reduced LVEF.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Circadian variation in ST-segment elevation myocardial infarction: a nationwide analysis of onset, treatmentdelays, and culprit artery patternsPol Arch Intern Med. 2026 Jan 7:17188. doi: 10.20452/pamw.17188AbstractIntroduction: ST-segment elevation myocardialinfarction (STEMI) onset follows a circadian rhythm, yet data from large contemporary national registries remain limited, particularly regarding how onset time influences treatment delays and coronary pathology.Objectives: To examine circadian patterns of ST-segmentelevation myocardial infarction onset and their impact on treatment delays, culprit vessel involvement, and periprocedural mortality.Patients and methods: We retrospectively analyzed 1,53,543ST-segment elevation myocardial infarction patients from the Polish National PCI Registry (ORPKI) between 2014 and 2022. We examined the hourly distribution of symptom onset and its associations with patient characteristics, treatmentdelays, and infarct-related artery location.Results: ST-segment elevation myocardial infarctiononset showed pronounced circadian variation, peaking at 8:00 AM. Although the overall pattern was similar between sexes (P for interaction = 0.15), median onset timeoccurred significantly earlier in males than females (10:00 AM vs. 11:00 AM, P = 0.007). Nocturnal onset (e.g., 3:00 AM) was associated with substantially longer median pain-to-first-medical-contact times compared with daytime onset (180 vs. 90 minutes at 1:00 PM; P <0.001). We identified a novel opposing circadian rhythm for the infarct-related artery location: left anterior descending (LAD) artery identified as the infarct-related artery peaked during nocturnal hours with a nadir at noon, while right coronary artery (RCA) involvement demonstrated the inverse pattern (P <0.001). Despite delayed presentation, periprocedural mortality did not vary significantly by onset time.Conclusions: This large nationwide cohort demonstrates that ST-segment elevation myocardial infarction onset follows arobust circadian pattern significantly affecting system delays. The discovery of opposing circadian rhythms for left anterior descending versus right coronary artery involvement suggests that time of day influences not only ST-segmentelevation myocardial infarction triggering but also its pathophysiological manifestation. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website. 

Impact of Early Percutaneous Coronary Intervention on Long-Term Survival in Patients With Acute Myocardial InfarctionCureus 18(1): e101145. DOI 10.7759/cureus.101145 Abstract Background: Early percutaneous coronary intervention(PCI) is the recommended standard of care for acute myocardial infarction (AMI), but long-term outcomes in mixed real-world cohorts remain underreported. This study evaluated the effects of early percutaneous coronary intervention (≤24 hours) compared with delayed or no percutaneous coronary intervention on short- and long-term clinical outcomes. Materials and methods: A five-year mixed cohort studywas conducted and included 891 consecutive acute myocardial infarction patients (early PCI, n = 446;delayed/no PCI, n = 445). Demographics, clinical characteristics, procedural data, and in-hospital outcomes were collected. Long-term outcomes, such as all-cause mortality, cardiovascular mortality, recurrent myocardialinfarction (MI), heart failure (HF) hospitalization, and major adverse cardiovascular events (MACE), were assessed over a median follow-up of 48 months. Propensity score matching and Cox proportional hazards models were usedto adjust for confounding. Statistical analyses were done in the IBM SPSS Statistics software, version 27.0 (IBM Corp., Armonk, NY, USA). Results: Early percutaneous coronary intervention wasassociated with lower in-hospital mortality (18/446, 4.0% vs 35/445, 7.9%; p = 0.01), shorter door-to-balloon time (median65 vs 210 minutes; p < 0.001), and better left ventricular function (mean left ventricular ejection fraction (LVEF) 48.7% vs 46.2%; p < 0.001). Over a median follow-upof 48 months, early percutaneous coronary intervention significantly reduced all-cause mortality (62/446,13.9% vs 112/445, 25.2%; adjusted hazard ratio (HR) 0.54, 95% CI 0.40-0.73, p < 0.001), cardiovascular mortality (44/446, 9.9% vs 82/445, 18.4%; adjusted HR 0.53, 95% CI 0.37-0.77, p = 0.001), heart failure hospitalization (56/446, 12.6% vs 84/445, 18.9%; adjusted HR 0.66, 95% CI 0.47-0.93, p = 0.02), and major adverse cardiovascular events (92/446,20.6% vs 138/445, 31.0%; adjusted HR 0.63, 95% CI 0.49-0.82, p < 0.001). Recurrent myocardial infarction was slightly lower with early percutaneous coronary intervention (38/446,8.5% vs 49/445, 11.0%; adjusted HR 0.78, 95% CI 0.52-1.16, p = 0.21) but did not reach statistical significance. Conclusion:Early percutaneous coronary intervention confers substantial short- and long-term survival benefits in acute myocardial infarction patients, with significant reductions in all-cause and cardiovascular mortality, heart failure hospitalization, and major adverse cardiovascular events. These findingsunderscore the critical importance of timely reperfusion, supporting guideline-driven early percutaneous coronary intervention strategies in real-world practice.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website. 

Lower Ticagrelor Dosing in the Dual Antiplatelet Regimen for Neurointerventional Procedureshttps://doi.org/10.1136/jnis-2024-022536 AbstractBackground Ticagrelor, a P2Y12 inhibitor, offersa rapid onset and consistent platelet inhibition, making it a viable alternative for dual antiplatelet therapy (DAPT). The optimal ticagrelor dose for neurointerventional procedures, however, remains unclear. We report our experience with ticagrelor 60 mg twice daily plus aspirin 81 mg daily compared with the standard aspirin and clopidogrel regimen forintracranial stenting.Methods We conducted a retrospective analysis ofa prospectively maintained database, identifying consecutive patients who underwent intracranial stenting for aneurysm treatment or intracranial atherosclerosis. Patients received either ticagrelor 60 mg with aspirin or aspirin with clopidogrel 75 mg daily. Primary outcomes included peri-procedural ischemic and/or hemorrhagic events within 30 days.Secondary outcomes were the median P2Y12 reaction unit and in-stent stenosis rates at 6-month follow-up.Results Among 119 patients, 59 received ticagrelor and 60 (50.4%) received clopidogrel. Baseline characteristics including age and gender were comparable between the two groups, although the ticagrelor group had a higher proportion of African-American patients. The majority of patients underwent aneurysm treatment (n=105; 88.23%), while the remainder received stenting for intracranial atherosclerosis (n=14; 11.77%). No ischemic events occurred in either group and intracranial hemorrhage rates were comparable (1.7% in both groups). The median P2Y12 reaction unit was significantly lower in the ticagrelor group (69 vs 126, P<0.001).In-stent stenosis rates were lower with ticagrelor (5% vs 21%).Conclusion Ticagrelor 60 mg for dual antiplatelet therapy in intracranial stenting is safe and effective. Larger prospective studies may be required to validate these findings.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website. 

Initiation of SGLT2 inhibitors versus mineralocorticoid receptor antagonists as third-line therapy in heart failurewith reduced ejection fraction: a nationwide cohort studyLancet Reg Health Eur . 2025 Oct 27:60:101510. doi:10.1016/j.lanepe.2025.101510.AbstractBackground: Heart failure with reduced ejection fraction (HFrEF) guidelines recommend early initiation of four foundational therapies-renin-angiotensin system inhibitors (RASI), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose co-transporter 2 (SGLT2) inhibitors. In clinical practice, these drugs are usually introduced sequentially, and optimal sequencing remains uncertain. This study investigated the effectiveness of initiating sodium-glucose co-transporter 2  inhibitors versus mineralocorticoid receptor antagonists as the third foundational therapy following RASI and beta-blockers.Methods: This was a nationwide non-interventional study in Denmark, July 2020-2023. Patients with HFrEF (leftventricular ejection fraction ≤40%) aged ≥45 years on background RASI and beta-blockers were included. An active-comparator new-user design was used to emulatea trial-like comparison. Baseline characteristics were balanced using inverse-probability of treatment weighting based on propensity scores. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular death, heart failure hospitalization, and their composite.Weighted hazard ratios (wHRs) were estimated using proportional hazards regression.Findings: The study included 4185 new mineralocorticoidreceptor antagonists users (63% spironolactone, 37% eplerenone) and 2565 new sodium-glucose co-transporter 2 inhibitor users (74% dapagliflozin, 26% empagliflozin). All-cause mortality occurred in 423 mineralocorticoid receptor antagonists users (unweighted rate 6.3 per 100 person-years) and 155 sodium-glucose co-transporter 2  inhibitor users (5.8 per 100 person-years). In weighted analysis comparing sodium-glucose co-transporter 2 inhibitors to mineralocorticoid receptor antagonists, the wHR was 0.70 (95% CI 0.57-0.86; absolute risk difference -2.1 per 100person-years, 95% CI -0.9 to -3.2). For the composite secondary outcome, the wHR was 0.83 (95% CI 0.71-0.97); for cardiovascular death, 0.65 (95% CI 0.49-0.87); and for heart failure hospitalization, 0.89 (95% CI 0.74-1.07).Interpretation: Initiating sodium-glucose co-transporter 2 inhibitors as the third foundational therapy after RASI andbeta-blockers was associated with significantly lower risk of all-cause mortality compared to mineralocorticoid receptor antagonists. These findings support the prioritization of sodium-glucose co-transporter 2 inhibitors in treatment sequencing for Heart failure with reduced ejection fraction.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Incidence and In-Hospital Outcomes of Bradycardia or Atrioventricular Conduction Disorder in Patients With Type 2Myocardial Infarction: A Nationwide Inpatient Analysishttps://doi.org/10.1002/joa3.70243ABSTRACTBackgroundType 2 myocardial infarction (T2MI), caused by an imbalancebetween oxygen supply and demand without significant coronary obstruction, is increasingly recognized yet remains underexplored, particularly regarding conduction abnormalities.MethodsWe conducted a retrospective cohort study using the NationalInpatient Sample from 2017 to 2022. Adult patients hospitalized with Type 2 myocardial infarction were identified by ICD-10-CM code. Bradycardia or atrioventricular (AV) conduction delay was defined using diagnostic codes forbradycardia and all degrees of atrioventricular block. We compared baseline characteristics, comorbidities, and causes of Type 2 myocardial infarction, and used multivariable logistic regression to evaluate associations with in-hospitalmortality and cardiogenic shock.ResultsAmong 1 960 410 patients with Type 2 myocardial infarction, 118 025 (6.0%) had bradycardia or atrioventricular conduction delay. These patients were older, more often male, and had higher rates of hypertension, heart failure, chronic kidney disease, and diabetes. The pacemaker implantation wassignificantly more prevalent (8.7% vs. 0.3%, p < 0.01). They also showed an increase in in-hospital mortality (10.4% vs. 9.8%, p < 0.01), cardiogenic shock (5.1% vs. 3.2%, p < 0.01), and AKI (47.9% vs. 46.3%, p < 0.01). After adjustment, conduction disorders remained associated with higher odds of mortality (aOR 1.09, 95% CI 1.04–1.14) and cardiogenic shock (aOR 1.71, 95% CI 1.61–1.83). ConclusionsBradycardia or atrioventricular conduction delay occurred in6% of Type 2 myocardial infarction hospitalizations and wasindependently linked to worse in-hospital outcomes, underscoring the need for close monitoring in this population. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website. 

Pharmacological Evaluation of Ticagrelor and Aspirin Versus Clopidogrel and Aspirin Pretreatment on Infarct Artery Flowin Patients with Acute STEMI Pharmaceuticals 2025, 18(12), 1856; https://doi.org/10.3390/ph18121856AbstractBackground and Objectives: Dual antiplatelet therapy(DAPT) with aspirin and a P2Y12 inhibitor is standard in ST-segment elevation myocardial infarction (STEMI). Guidelines favor ticagrelor over clopidogrel, but their effect on infarct artery flow prior to percutaneous coronary intervention(PCI) remains debated. Objective was to compare the effects of aspirin + clopidogrel versus aspirin + ticagrelor pretreatment on infarct arteryThrombolysis in Myocardial Infarction (TIMI) flow in ST-segment elevation myocardial infarction patients. Materials and Methods: This retrospective cohortstudy included first-time ST-segment elevation myocardial infarction patients ≥ 18 years admitted to the Military Medical Academy, Belgrade (January 2016–January 2022), who received pretreatment with aspirin + clopidogrel or aspirin + ticagrelor and underwent percutaneous coronary intervention. Thrombolysis in Myocardial Infarction flow was graded  before and after percutaneous coronary intervention. Primary outcomes were pre- and post- percutaneous coronary intervention Thrombolysis in Myocardial Infarctionflow; secondary outcome was in-hospital mortality. Results: Of 299 ST-segment elevation myocardialinfarction patients, 174 received aspirin + ticagrelor and 125 received aspirin + clopidogrel. Pre- percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow was significantly higher in the ticagrelor group (p < 0.001), whilepost- percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow (p = 0.056) and in-hospital mortality (p = 0.083) did not significantly differ between groups. After exclusion of patients receiving glycoprotein IIb/IIIa  inhibitors, the difference in percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow grade after percutaneous coronary intervention becamestatistically significant (p = 0.007), favoring the aspirin + ticagrelor group. In multivariate analysis, male gender, drug-eluting stent implantation, and glycoprotein IIb/IIIa inhibitor use were independently associated with reduced in-hospitalmortality. Conclusions: In ST-segment elevation myocardial infarction patients, ticagrelor-based Dual antiplatelet therapy was associated with better initial coronary flow compared to clopidogrel. However, this advantage was not evident after percutaneous coronary intervention. Male gender, drug-eluting stent implantation, and glycoprotein IIb/IIIa inhibitoruse were associated with improved survival.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Intravascular imaging-guided percutaneous coronary intervention for acute myocardial infarction according to ACC/AHA lesion classificationhttps://doi.org/10.1016/j.rec.2025.12.001AbstractIntroduction and objectives: Despite the favorableprognosis associated with intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) for complex coronary lesions, it is still unclear whether intravascular imaging -guided percutaneous coronary intervention forsuch lesions provides clinical benefit in patients with acute myocardial infarction (AMI) according to the ACC/AHA lesion classification.Methods: This study was a patient-level pooled analysis of 2 nationwide Korean acute myocardial infarction registries. We identified 23 051 patients from KAMIR-V and KAMIR-NIH who underwent successful percutaneous coronary intervention for an infarct-related artery and stratified them by the ACC/AHAlesion classification. Clinical outcomes were compared between intravascular imaging -guided and angiography-guided percutaneous coronary intervention. Theprimary endpoint was major adverse cardiac events (MACE), a composite of cardiac death, acute myocardial infarction, repeat revascularization, and stent thrombosis, at 3 years.Results: intravascular imaging -guided percutaneouscoronary intervention demonstrated a lower incidence of MACE compared with angiography-guided percutaneous coronary intervention in patients with type B2/C lesions (adjusted HR, 0.78; 95%CI, 0.70-0.88; P < .001), but not inpatients with type A/B1 lesions (adjusted HR, 0.81, 95%CI, 0.60-1.11; P = .190). In both non–ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction, a significantly lower risk of major adversecardiac events following intravascular imaging -guided percutaneous coronary intervention than angiography-guided percutaneous coronary intervention was observed in patients with type B2/C lesions (non–ST-segment elevation myocardial infarction: adjusted HR, 0.73; 95%CI, 0.63-0.84; P < .001; ST-segment elevation myocardial infarction: adjusted HR, 0.86, 95%CI, 0.75-0.98; P = .027), but not in those with type A/B1 lesions.Conclusions: Among patients with acute myocardialinfarction, intravascular imaging -guided percutaneous coronary intervention was associated with a significantly lower risk of major adverse cardiac events in those with type B2/C lesions, but not in those with type A/B1 lesions. Theprognostic benefit of intravascular imaging -guided percutaneous coronary intervention increased with greater lesion complexity in the infarct-related artery.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

β-blocker and clinical outcomes in patients after myocardial infarction: a systematic review and meta-analysisEur J Clin Pharmacol. 2025 Dec;81(12):1807-1817.AbstractBackground and objective: While current clinicalguidelines generally advocate for beta-blocker therapy following acute myocardial infarction (AMI), conflicting findings have surfaced through large-scale observational studies and meta-analyses. We conducted this systematic review and meta-analysis of published observational studies to quantify the long-term therapeutic impact of beta-blocker across heterogeneous acutemyocardial infarction populations.Methods: We conducted comprehensive searches ofthe PubMed, Embase, Cochrane, and Web of Science databases for articles published from 2000 to 2025 that examine the link between beta-blocker therapy and clinical outcomes (last search update: March 1, 2025). We used the odds ratio (OR) with its 95% confidence interval (95% CI) to evaluate the effect of beta-blocker therapy on all-cause mortality, cardiac death, or major adverse cardiac events (MACE) in acute myocardial infarction patients. Our analysisstratified these effects by study type, ejection fraction (EF), sample size, follow-up duration, and patient characteristics including primary coronary revascularization, ST segmentelevation status, and comorbidities.Results: This meta-analysis incorporated 34 observational studies covering 233,303  acute myocardial infarction patients. Our results showed beta-blockers reducedall-cause (OR = 0.73, 95% CI = 0.64-0.82) and cardiac mortality (OR = 0.79, 95% CI = 0.70-0.89) in post- acute myocardial infarction patients, with no significant effect on major adversecardiac events. In these patients, post-PCI and STEMI patients, beta-blockers lowered all-cause mortality but not MACE risk. Subgroup analysis revealed that beta-blockers decreased all-cause death in post- acute myocardial infarction patients with diabetes and COPD, but not in those with hypertension and AF. Stratified by EF, beta-blockers were beneficial for all-cause death (OR = 0.75, 95% CI = 0.60-0.93),cardiac death (OR = 0.72, 95% CI = 0.56-0.92), and MACE (OR = 0.85, 95% CI = 0.76-0.96) in post- acute myocardialinfarction patients with reduced ejection fraction and only decreased all-cause death in those with preserved ejection fraction.Conclusions: Our meta-analysis suggests beta-blockers may offer long-term clinical benefits to acute myocardialinfarction patients, particularly those with reduced ejection fraction. However, this is not conclusive for acute myocardial infarction patients with comorbidities or preserved ejection fraction.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Efficacy and safety of ticagrelor versus clopidogrel in acute myocardial infarction-associated cardiogenic shock: apropensity score-matched analysishttps://doi.org/10.1093/eurheartj/ehaf784.2070 AbstractBackgroundCardiogenic shock secondary to acute myocardial infarction (AMICS) is a critical condition with significant hemostatic challenges. Despite the widespread use of P2Y12 inhibitors, current evidence comes primarily from stable populations. This study aimed to compare the efficacy and safety of ticagrelor versus clopidogrel in a propensity-matched cohort of acute myocardial infarction patients. MethodsWe conducted a single-center retrospective study to evaluate the impact of ticagrelor versus clopidogrel in acutemyocardial infarction patients receiving dual antiplatelet therapy (DAPT), hospitalized between 2016 and 2024. Propensity score matching was performed on a cohort of 151 patients (103 on clopidogrel; 48 on ticagrelor) using a 1:1matching protocol without replacement (matching tolerance 20%). Matching variables included age, sex, chronic kidney disease (CKD), peak troponin levels (pTn), occurrence of cardiac arrest, and initial SCAI shock classification. Theprimary endpoint was 30-day all-cause mortality. Secondary endpoints included major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, myocardial reinfarction, stroke or transient ischemicattack, and embolic events, as well as major bleeding events, defined as BARC ≥3. ResultsA total of 88 patients were included, 44 within each group, with a mean age of 60.5 ± 11 years, 71.6% male, 44.3%presenting in SCAI-C, and 47.7% on mechanical circulatory support (MCS), including IABP, VA-ECMO, and/or Impella. At 30-day follow-up, 39 patients (44.3%) had died. Baseline characteristics were well balanced between groups,including age (p=0.138), sex (p=0.813) and SCAI shock classification (p=0.910)–Table 1. Although not statistically significant, other antithrombotic therapies showed numerical variations between groups. Anticoagulation was morecommon in clopidogrel-treated patients (70.5% vs. 56.8%), whereas Gp IIb/IIIa antagonists were more frequent in those receiving ticagrelor (20.5% vs. 11.4%). Ticagrelor was associated with a significantly lower 30-day mortality rate (34.1% vs. 54.6%; Log-rank p=0.018) -Figure 1, and reduced major adverse cardiovascular events incidence (34.1% vs 56.8%; Log-rank p=0.018) -Figure 2. In the subgroup with MCS the magnitude of benefit was similar (OR 0.419 [95% CI=0.159-1.101]; p=0.078), despite not reaching statistical significance. No significant differences were observed between groups regarding the incidence of major bleeding events (63.6% vs.59.1%; OR 1.212 [95% CI=0.513 - 2.861]; p=0.662). ConclusionsIn this propensity score-matched analysis of acutemyocardial infarction patients receiving dual antiplatelet therapy, ticagrelor was associated with significantly lower 30-day mortality and major adverse cardiovascular events rates compared to clopidogrel, without a correspondingincrease in major bleeding risk. These findings may suggest a potential benefit of ticagrelor in this high-risk population; however, further prospective studies are needed.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website. 

Differential Impact of Metoprolol Formulations on Heart Failure Outcomes: A Multi-center Studyhttps://doi.org/10.1016/j.yjcafi.2025.10.010 ABSTRACT Background Despite widespread use of metoprolol formulations in heart failure (HF), direct comparative evidence of theirclinical outcomes remains limited. MethodsIn this retrospective cohort study using the TriNetX Research Network (2010-2024), we compared outcomes between metoprolol succinate and tartrate in heart failure withreduced ejection fraction HFrEF (EF ≤40%) and HFmrEF HeartFailure with Mid-range Ejection Fraction (EF 41-49%) patients. After propensity score matching (761 pairs for HFrEF, 732 pairs for HFmrEF), we evaluated a primary composite outcome of hospitalizations and all-cause mortality, and secondary outcomes of individual components over one year follow-up. ResultsBaseline characteristics were well-balanced between cohorts in both HF populations. For the primary composite outcome, both heart failure with reduced ejection fraction and Heart Failure with Mid-range Ejection Fraction patients receiving succinate formulation demonstrated significantly betterevent-free survival compared to tartrate (HFrEF: 64.12% vs 51.22%, log-rank p<0.001; HFmrEF: 67.57% vs 56.04%, log-rank p<0.001). Secondary analysis revealed these benefits were driven by improvements in both hospitalizations andall-cause mortality. ConclusionsMetoprolol succinate was associated with significantly improved event-free survival compared to tartrate in Kaplan-Meier analyses for both heart failure with reduced ejectionfraction and Heart Failure with Mid-range Ejection Fraction populations, despite modest differences in crude event rates. These findings suggest that formulation-specific pharmacokinetics influence long-term outcomes in heartfailure management, supporting current guidelines favoring succinate over tartrate.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Prognostic Implications of Heart Failure Rehospitalization in Adults with CHD & Clinical Benefits of Medical Therapyhttps://doi.org/10.1016/j.ijcchd.2025.100640 ABSTRACTBackground The risk factors for heart failure (HF) rehospitalization, and the effect of guideline directed medical therapy (GDMT)are poorly understood in adults with congenital heart disease (ACHD). We aimed to describe the outcomes of heart failure hospitalization and to assess the clinical benefits of guideline directed medical therapy for heart failure. MethodsWe conducted a retrospective cohort study of adults with congenital heart disease hospitalized for heart failure at MayoClinic from 2003 to 2023. Cox proportional hazard models were used to determine the predictors of heart failure rehospitalization and all-cause mortality, and to assess the association between death and guideline directed medical therapy, as measured by the Heart Failure Collaborative score. ResultsOf the 324 patients, 164 were rehospitalized for heart failure and 149 died. The 10-year cumulative incidence of rehospitalization was 75.8% (95% CI 70.1%-81.5%), and the 10-year survival rate from mortality was 47.3% (95%CI 40.9%-54.7%). Chronic kidney disease (HR 1.46, 95% CI 1.06-2.01, p=0.021) and Fontan physiology (HR 1.59, 95%CI 1.02-2.49, p=0.043) were associated with heart failurerehospitalization. Heart failure rehospitalization within 1 year was associated with nearly a 3-fold increased risk of mortality (HR 2.88, 95% CI 2.00-4.15, p<0.001). The HFC score was associated with a lower risk of all-cause mortality (HR 0.77, 95% CI 0.62-0.95, p= 0.016) in the subgroup of patients with reduced ejection fraction. ConclusionsAmong adults with congenital heart disease hospitalized for heart failure, half of the patients were rehospitalized for heartfailure. Rehospitalization within 1 year of the index heart failure hospitalization was associated with mortality. The use of guideline-directed medical therapy for heart failure was associated with improved survival in patients with reduced ejection fraction. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.  

Beta-Blockers after Myocardial Infarction in Patients without Heart FailureN Engl J Med . 2025 Nov 13;393(19):1901-1911. doi: 10.1056/NEJMoa2505985 AbstractBackground: The evidence supporting beta-blockertherapy after myocardial infarction was established before the introduction of modern coronary reperfusion therapy and secondary prevention strategies.Methods: In an open-label, randomized trial withblinded end-point evaluation, conducted in Denmark and Norway, we assigned patients who had had a myocardial infarction and who had a left ventricular ejection fraction of at least 40%, in a 1:1 ratio, to receive long-term beta-blocker therapy within 14 days after the event or no beta-blocker therapy. The primary end point was a composite of death from any cause or major adverse cardiovascular events (new myocardial infarction, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventriculararrhythmias).Results: A total of 5574 patients underwent randomization and were included in the main analyses - 2783 in the beta-blocker group and 2791 in the no-beta-blocker group. After a median follow-up of 3.5 years (interquartile range, 2.2 to 4.6), a primary end-point event had occurred in 394 patients (14.2%) in the beta-blocker group and in 454 patients (16.3%) in the no-beta-blocker group (hazard ratio, 0.85; 95% confidence interval [CI], 0.75 to 0.98; P = 0.03). Death from any cause occurred in 4.2% of the patients in the beta-blocker group and in 4.4% of those in the no-beta-blocker group; myocardial infarction occurred in 5.0% and 6.7%, respectively (hazard ratio, 0.73; 95% CI, 0.59 to 0.92), unplanned coronary revascularization in 3.9% and 3.9%, ischemic stroke in 1.6%and 1.3%, heart failure in 1.5% and 1.9%, and malignant ventricular arrhythmias in 0.5% and 0.6%. No apparent differences in safety outcomes were observedbetween the groups.Conclusions: Among patients with a myocardialinfarction and a left ventricular ejection fraction of at least 40%, beta-blocker therapy led to a lower risk of death or major adverse cardiovascular events than no beta-blocker therapy. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Impact of digoxin versus beta-blocker in patients withcoexistent atrial fibrillation and heart failure: a target trial emulationBMC Med . 2025 Oct 21;23(1):575. doi: 10.1186/s12916-025-04408-0. AbstractBackground: This study aimed to compare the impact of digoxin versus beta-blocker on adverse clinical outcomes in patients with coexisting atrial fibrillation (AF) and heart failure (HF).Methods: This study employed a target trial emulation with a clone-censor-weight approach to analyze data from 28,377patients diagnosed with both atrial fibrillation and heart failure in the Clinical Data Analysis and Reporting System (CDARS) in Hong Kong between January 1, 2005, and December 31, 2017. Patients were followed up for up to 3years or until the occurrence of clinical outcomes. The exposures were digoxin (N = 5351) versus beta-blocker (N = 7655) within a 90-day grace period. Absolute risks (ARs),risk differences, and risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using weighted pooled logistic regression adjusted for demographic characteristics, comorbidities, and medication use. The primary outcome was all-cause mortality, while secondary outcomes includedcardiovascular (CV) mortality, heart failure hospitalization, acute ischemic stroke, acute myocardial infarction, and pacemaker implantation.Results: Over 3 years, digoxin was associated with a significantly higher risk of all-cause mortality (AR: 51.2% vs. 42.2%; RR: 1.21; 95% CI: 1.17 to 1.26), cardiovascular mortality (AR: 25.1% vs. 21.0%; RR: 1.20; 95% CI: 1.11 to 1.29), and heart failure hospitalization (AR: 29.0% vs. 26.4%; RR: 1.10; 95% CI: 1.04 to 1.16). No significant differences were observed for acute ischemic stroke (AR: 4.3% vs. 4.3%; RR: 1.00; 95% CI: 0.85 to 1.18), acute myocardial infarction (AR: 4.6% vs. 4.3%; RR: 1.04; 95% CI: 0.88 to 1.23), or pacemaker implantation (AR: 1.0% vs. 1.3%; RR: 0.74; 95% CI: 0.54 to 1.01).Conclusions: In patients with coexisting atrial fibrillation and heart failure, digoxin was associated with significantly higher risks of all-cause mortality, cardiovascular mortality, and heart failure hospitalization compared to beta-blocker. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

 Dual Versus Single Antiplatelet Therapy After Transcatheter Aortic Valve Implantation for Bioprosthetic Valve Failurehttps://www.jacc.org/doi/10.1016/j.jcin.2025.09.018ABSTRACTBackground: Single antiplatelet therapy (SAPT) is the standard treatment after transcatheter aortic valve intervention (TAVI). However, valve-in-valve transcatheter aortic valve intervention to treat surgical bioprosthesis dysfunction carries an increased thrombotic risk and may benefit from more intensive antithrombotic treatment. Objectives: The aim of this study is to compare the outcomes of patients treated with dual antiplatelet therapy (DAPT) or Single antiplatelet therapy in the first year after valve-in-valve transcatheter aortic valve intervention. Methods: Patients treated with valve-in-valve transcatheter aortic valve intervention at 10 participating centers were included and grouped according to treatment with dual antiplatelet therapy or Single antiplatelet therapy, while those treated with oral anticoagulant therapy were excluded.Both clinical and echocardiographic outcomes were analyzed at one-year follow up. A propensity score was developed, then inverse probability of treatment weighting was applied in hazard ratios (HR) estimation, to account for confounders. Results: A total of 278 patients were included. No differencebetween groups was observed for major adverse cardiac and cerebrovascular events (HR 0.499, 95% confidence interval [CI] 0.182-1.371, P=0.178), major bleedings (HR 0.776, 95% CI 0.172-3.504, P=0.741) and death (HR 0.907, 95% CI 0.272-3.022, P=0.874). Less strokes were observed in patients treated with dual antiplatelet therapy (HR 0.093, 95% CI 0.010-0.831, P=0.033). Additionally, there was no significant difference in moderate or severe structural valve deterioration (1.9% vs 6.0%, P=0.161). Conclusions:Dual antiplatelet therapy after valve-in-valve transcatheter aortic valve intervention may be associated with a lower one-year incidence of stroke, while no significant difference was observed for other major ischemic and bleeding outcomes or for premature valve deterioration.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

1-Month Versus 12-Month Dual Antiplatelet Therapy for Patients with Chronic Total Occlusion After Successful Percutaneous Coronary InterventionDrugs Aging . 2025 Oct;42(10):975-985. doi:10.1007/s40266-025-01235-z. AbstractPurpose: Compared with long-term dual antiplatelet therapy (DAPT, aspirin with clopidogrel or ticagrelor), short-termDAPT followed by single antiplatelet therapy (SAPT, clopidogrel or ticagrelor) has demonstrated superiority in reducing bleeding risk while maintaining non-inferior in cardiovascular benefits in coronary heart disease (CHD) aftersuccessful percutaneous coronary intervention (PCI). However, no prospective study has explored the benefits of this short-term regimen on patients with chronic total occlusion (CTO) undergoing PCI.Methods: Consecutive patients who underwentsuccessful elective CTO-PCI were prospectively enrolled from April 2019 to May 2021. After receiving 1-month DAPT, all patients were divided into two groups: SAPT group (followed by clopidogrel or ticagrelor monotherapy) and DAPT group(continued with dual antiplatelet therapy). Detailed baseline characteristics, angiographic and procedural details, and 1-year follow-up data were collected. The endpoints were major adverse cardiovascular events (MACE) and bleeding.Results: A total of 701 patients who underwentsuccessful CTO-PCI were enrolled, among whom 330 patients (47.1%) received DAPT and 371 patients (52.9%) received SAPT (clopidogrel or ticagrelor) after 1-month DAPT. Compared with patients receiving DAPT, patients in the SAPT (clopidogrel or ticagrelor) group had a lower rate of previous stroke, fewerleft anterior descending coronary artery (LAD) lesions and contrast volume, and fewer lesions per patient, but longer lesion length (P < 0.05). The incidence of major adverse cardiovascular events (14.5% versus 15.4%; p = 0.742) was not significantly different between the two groups. The DAPT group showed a higher incidence of minor bleeding (BARC types 1 or 2; 12.7% versus 2.3%, p < 0.001) than SAPT (clopidogrel or ticagrelor), while no difference was found for major bleeding (BARC types 3 or 5; 1.2% versus 2.3%, p = 0.261).Conclusions: Compared with standard 12-month dualantiplatelet therapy, 1-month dual antiplatelet therapy followed by clopidogrel or ticagrelor monotherapy resulted in lower bleeding risks and similar cardiovascular benefits in chronic total occlusion - percutaneous coronary intervention patients.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Drug Utilization Patterns and Adherenceto Guideline-Directed Therapy in Acute Myocardial Infarction: A ProspectiveObservational StudyInternational Journal of Life Sciences, Biotechnology andPharma Research Vol. 14, No. 10, October 2025 DOI:10.69605/ijlbpr_14.10.2025.11ABSTRACT Background: Acute myocardial infarction (AMI) is aleading cause of morbidity and mortality worldwide. Effective pharmacotherapy plays a crucial role in secondary prevention and improving clinical outcomes. This study evaluates drug utilization patterns in Acute myocardial infarction patients,adherence to guideline-recommended therapies, and factors influencing medication adherence. Methods: A prospective observational study was conducted on 100 Acute myocardial infarction patients. Demographic data, comorbidities, Killip class, left ventricular ejection fraction (LVEF), and drug utilization were analyzed. Adherence to guideline-recommended therapies, including dual antiplatelet therapy (DAPT), beta-blockers, ACE inhibitors/ARBs, statins, and SGLT2 inhibitors, was assessed based on the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines. Results: The study included 100 patients (mean age: 54.27 ± 13.51 years), with 82% males. Most (81%) were Killip class I, indicating mild heart failure. Hypertension (34%) and diabetes (24%) were common, while 58% reported tobaccouse. LVEF was <30% in 18% of patients. Thrombolysis was performed in 95%, predominantly with streptokinase (94%). DAPT adherence was high (98%), with ticagrelor (58%) being the most prescribed. Beta-blockers were used in 62%, andACE inhibitors/ARBs in 44%. PCI was performed in 67%, primarily for Left Anterior Descending  lesions. AWMI was the most common MI type (45%). Adherence to ACC/AHA guidelines was high for antiplatelets (98%) and statins(96%), but suboptimal for betablockers (62%) and ACE inhibitors/ARBs (44%). Older patients had lower adherence to guideline-directed therapies.Conclusion: The study demonstrates high adherence toantiplatelets and statins but suboptimal beta-blocker and ACE inhibitor/ARB use. Streptokinase was the preferred thrombolytic. Targeted interventions are needed to improve adherence, especially in older patients, to optimize Acutemyocardial infarction management and outcomes.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

The use of beta-blockers for heart failure with reduced ejection fraction in the era of SGLT2 inhibitors - are westill afraid to up-titrate?Heart Vessels . 2025 Sep;40(9):797-804.doi: 10.1007/s00380-025-02525-7.AbstractBeta-blockers are one of the four major pillars of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). The therapy has presented the best effects when up-titrated to evidence-based target doses. Despite their proven benefits, physicians have traditionally shown reluctance to up-titrate beta-blockersbecause of their negative inotropic and chronotropic effects. The effects of newly introduced sodium-glucose cotransporter 2 inhibitors (SGLT2I) in treating heart failure with reduced ejection fraction might open more room for adequate beta-blockers up-titration. The goal of this study was to evaluate the up-titration practice, and impact of target doses of beta-blockers in patients with heart failure with reduced ejection fraction receiving SGLT2I. This is aprospective cohort study involving patients with heart failure with reduced ejection fraction receiving SGLT2I therapy. Baseline use and dosing to the evidence-based targets were examined. We compared the groups of patientsreceiving maximally titrated beta-blockers versus incompletely titrated. Primary outcome was composite of (1) rehospitalization or revisit to emergency unit due to the heart failure; (2) all-cause death and major adverse cardiacevents (MACE). Secondary outcomes were heart rate at rest, left ventricular ejection fraction, NT-proBNP, and NYHA status at 6 and 12 months of follow-up. Study endpoints were documented via telephone interviews, regular outpatientfollow-up, or by electronic hospital records. This study included a total of 458 patients with median follow-up time of 365 (186-502) days. A total of 122 (26.6%) patients hadbeta-blockers maximally up-titrated. The results show that adherence to maximal target doses of β-blocker therapy significantly reduces hazard of death or major adverse cardiac events comparing to not using maximal doses of β-blocker (factor 0.43). Hazard reduction was not statistically significant for composite of rehospitalization or revisit to emergency unit due to HF. Maximal doses of beta-blockers did not result in a significant decrease in resting heart rate. Our real-world data have highlighted the prevalence of incomplete titration of beta-blockers. Although it has been shown that evidence-based target dosing of beta-blockersreduces death and major adverse cardiac events, there is still room for improvement with up-titrating beta-blockers in eligible patients.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Angiotensin receptor-neprilysin inhibitors and mortality among patients with heart failure with reducedejection fractionhttps://doi.org/10.1016/j.amjcard.2025.08.063AbstractBackgroundWhile trial evidence supports the benefit of angiotensin receptor-neprilysin inhibitor (ARNI) therapy in heart failurewith reduced ejection fraction (HFrEF), its effectiveness in routine clinical practice is less explored. This study investigated the relative and absolute effectiveness of ARNI in patients with heart failure with reduced ejectionfraction.MethodsThis nationwide Danish database study included patients with left ventricular ejection fraction (LVEF) ≤40%,2018–2023. Using a prevalent new user design, 2,446 ARNI initiators were matched 1:2 to 4,892 users of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) based on propensity scores, age, LVEF,and NT-proBNP. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular mortality and hospitalization.ResultsThere were 279 deaths among ARNI initiators(5.6/100 person-years) and 533 among ACE-I/ARB users (6.7/100 person-years), yielding a hazard ratio (HR) of 0.85 (95% CI, 0.74–0.98) for all-cause mortality. A significant interaction was observed for recent hospitalization (p=0.04),with ARNI yielding a lower hazard ratio in this group. hazard ratios were otherwise consistent across age, sex, left ventricular ejection fraction, NT-proBNP, NYHA class, ischemic heart disease, chronic kidney disease, and type2 diabetes. The largest absolute mortality reductions were seen in subgroups with recent hospitalization, NYHA class III–IV, and severely elevated NT-proBNP. ARNI was also associated with a lower risk of cardiovascular death (HR, 0.81; 95% CI, 0.65–0.99), but not with other secondary outcomes.ConclusionsIn this study, ARNI was associated with a 15% reduction in all-cause mortality vs ACE-I/ARB. Patients with advanced orsymptomatic heart failure appeared to experience the greatest absolute benefit.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Comparison between clopidogrel and ticagrelor in CYP2C19 loss-of-function alleles coronary artery disease andstroke patients: a meta-analysisEur J Clin Pharmacol. 2025 Sep;81(9):1241-1256.AbstractBackground: It is suggested that in patientswith coronary artery diseases (CAD) and stroke, the use of ticagrelor and aspirin may perform better than clopidogrel and aspirin regarding the risk of thrombosis/embolism, including recurrent myocardial infarction (MI) andcardiovascular death, especially in those carrying CYP2C19 loss-of-function (LOF) alleles. Therefore, we conducted the present systematic review and meta-analysis to investigate the effect of clopidogrel and ticagrelor in coronaryartery diseases and stroke patients with CYP2C19 LOF alleles (poor metabolizers of clopidogrel).Methods: We performed the current systematicreview and meta-analysis by searching for all eligible publications on PubMed, Web of Science, and Scopus from inception to November 2024. A search strategyemploying three primary keywords in conjunction with their corresponding Medical Subject Headings (MeSH) terms: "Ticagrelor" AND "Clopidogrel" AND"CYP2C19" (PROSPERO ID CRD420251050533). We implemented the odds ratio (OR) as an effect estimate for the dichotomous variables. The analysis was done at 95% confidence intervals (CI), and the p-value was significant if it was less than or equal to 0.05.Results: Using clopidogrel was associated withan increased risk of thrombosis/embolism compared with ticagrelor, showing odds ratio = 1.78 (95%CI, 1.08,2.95; p = 0.02). Also, clopidogrel led to an increased risk of stroke, whether when used in stroke or coronary artery diseases patients with CYP2C19 LOF alleles, compared with ticagrelor, with an overall odds ratio = 1.43 (95%CI, 1.23, 1.66; p < 0.00001) and a higher rate of MI with odds ratio = 1.53 (95%CI, 1.22, 1.92; p = 0.0003). No significant difference was observed between the two groups (clopidogrel andticagrelor) in stroke or coronary artery diseases patients with odds ratio = 0.98 (95%CI, 0.79, 1.22; p = 0.87). Also, no significant difference was observed between bothgroups regarding the risk of minor bleeding in stroke or coronary artery diseases patients with odds ratio = 0.66 (95%CI, 0.42, 1.05; p = 0.08) and any types of bleeding (major or minor bleeding) with overall odds ratio = 0.81 (95%CI, 0.54, 1.21; p = 0.3) and I2 = 88%, p < 0.00001.Conclusion: The meta-analysis of the selected articles indicated a preference for ticagrelor over clopidogrel in patients with stroke or coronary artery diseases possessing CYP2C19 LOF alleles. The reduced incidence of thrombosis/embolism and associated events, such as strokeand MI, was noted in individuals administered ticagrelor in comparison to those receiving clopidogrel. Bleeding remains a concern with ticagrelor; however, current studies indicate its safety since there are no significant changes in therisk of minor and major bleeding and ICH compared to clopidogrel.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysisof randomised controlled trialsLancet. 2025 Sep 13;406(10508):1128-1137.AbstractBackground: The effects of β-blocker therapy on clinicaloutcomes in patients with myocardial infarction and mildly reduced (40-49%) left ventricular ejection fraction (LVEF) are largely unknown. Four recently conducted randomised trials tested the efficacy of β blockers after a recent myocardial infarction in patients without reduced left ventricular ejectionfraction (LVEF ≥40%). However, none were individually powered to assess these effects in the subgroup of patients with mildly reduced left ventricular ejection fraction. We aimed to assess the efficacy of β blockers in patientswith myocardial infarction and mildly reduced left ventricular ejection fraction during the index hospitalisation. Methods: We conducted an individual patient-levelmeta-analysis of patients with mildly reduced left ventricular ejection fraction and no history or signs of heart failure from four recent clinical trials. These studies were included because they were randomised controlled trials testing long-term effects (median follow-up >1 year) of oral β-blocker therapy in patients who recently had a myocardial infarction(randomisation within 14 days) and had mildly reduced left ventricular ejection fraction. No further studies were found in a systematic review (Jan 1, 2020 to June 26, 2025).A one-stage, fixed-effects, Cox proportional hazards regression model was used to assess the treatment effect of β blockers on the predefined primary composite endpoint of all-cause death, new myocardial infarction, or heartfailure. All endpoints were independently adjudicated. This meta-analysis was registered with PROSPERO (CRD420251023480). Findings: 1885 patients with myocardial infarction andmildly reduced left ventricular ejection fraction were included in the meta-analysis: 979 from the REBOOT trial, 422 from the BETAMI trial, 430 from the DANBLOCK trial, and 54 from the CAPITAL-RCT trial. Overall, 991 patientswere assigned to β blockers and 894 to control (no β blockers). The primary composite endpoint occurred in 106 patients (32·6 events per 1000 patient-years) in theβ-blocker group and 129 patients (43·0 per 1000 patient-years) in the no β-blocker group (hazard ratio 0·75 [95% CI 0·58-0·97]; p=0·031). No heterogeneity between thetrials (trial-by-treatment pinteraction=0·95) or between countries of enrolment was observed (pinteraction=0·98). Interpretation: In patients with acute myocardial infarctionwith mildly reduced left ventricular ejection fraction without history or clinical signs of heart failure, β-blocker therapy was associated with a reduction in the composite of all-cause death, new myocardial infarction, or heart failure. These results extend the known benefits of these agents inpatients with myocardial infarction with reduced left ventricular ejection fraction to the subgroup with mildly reduced left ventricular ejection fraction.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

ST-elevation myocardial infarction and air pollution: relationship between hourly air pollution and cardiovascular risk factorsJ Cardiovasc Med (Hagerstown). 2025 Aug 1;26(8):412-419. AbstractObjective: Air pollution contributes to cardiovascular diseases through oxidative stress, inflammation, autonomicnervous system imbalance, and direct particle translocation. This study examines the relationship between air pollution parameters and risk factors in patients presenting with (STEMI). Methods: This prospective, cross-sectional studyincluded ST-elevation myocardial infarction patients aged at least 18 years in a tertiary ST-elevation myocardial infarction hospital. Demographics, comorbidities, seasonal variations, comorbidities, vital signs, hourly air pollution and weather parameters on admission, hospital length of stay, treatment modalities, and outcomes were recorded. Results: Among 1413 patients, 75.1% were men. The median age of female patients [65 (IQR: 58-73)] was significantly higher that of than males [55 (IQR: 50-66), P < 0.001].Median air quality index (AQI) [53 (IQR: 37-55)] and particulate matter (PM2.5) levels [18 (IQR: 11-27)] on admission were above Environmental Protection Agency limits. Patients with prior coronary artery disease (P = 0.037)and female patients (P = 0.018) had significantly lower PM10 exposure. PM2.5 levels were significantly higher in patients aged >75 years [20.5 (IQR: 13-29)] than in youngerpatients [18 (IQR: 11-27), P = 0.022]. Those recommended for coronary artery bypass grafting had lower sulfur dioxide levels [6 (IQR: 4-9) vs. 8 (IQR: 5-13), P = 0.003]. Conclusion: When air quality index and particulatematter 2.5 levels exceed EPA limits, they may interact with cardiovascular risk factors such as age, sex, and comorbidities, contributing to the development ofST-elevation myocardial infarction. Elderly individuals, women, and those with a history of cardiovascular disease may be more susceptible to the adverse effects of air pollution.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

SGLT2 inhibitor with and without ALDosterone AntagonIst for heart failure with preserved ejection fraction:Design paperESC Heart Fail. 2025 Aug;12(4):3134-3144. doi: 10.1002/ehf2.15294 AbstractBackground: Sodium glucose co-transporter 2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists(MRA) reduce heart failure (HF) events in patients with heart failure and mildly reduced or preserved ejection fraction (HFmr/pEF). The randomized comparison of Sodium glucose co-transporter 2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists (MRA)combination versus SGLT2i or MRA alone requires further testing in heart failure and mildly reduced or preserved ejection fraction. Aim: To compare the efficacy (NT-proBNP change as primary outcome) and safety (potassium, creatinine, and blood pressure changes) of dapagliflozin/spironolactone combination versus dapagliflozin alone (primary comparison) and spironolactone alone (exploratory comparison). Methods: SOGALDI-PEF (SOdium-Glucose cotransporter 2 inhibitor, ALDosterone AntagonIst, or both for heart failure with preserved ejection fraction; NCT05676684), a proof-of-concept investigator-initiated two-centre randomized cross-over trial comparing three arms (dapagliflozin, spironolactone, or both) for three periods of 12 weeks each intercalated by a wash-out period of 4 weeks. After two independent trials demonstrating efficacy of SGLT2i in heart failure and mildly reduced or preserved ejection fraction, amid-trial protocol amendment dropped the spironolactone alone sequence and reduced the wash-out period to 1 week. A sample size of 108 patients was estimated to provide 80% power, at a 0.05 alfa level, to detect a 0.15 LogNT-proBNPdifference between the spironolactone/dapagliflozin combination and dapagliflozin alone sequence. Results: SOGALDI-PEF included 108 patients with a median age of 76 years, 57% women, 42% with atrial fibrillation, 46% with type 2 diabetes, 33% having an eGFR below 60 mL/min/1.73m2, and 93% having an ejection fraction ≥ 50%. The median serum potassium was 4.3 mmol/L, and the median NT-proBNP was 764 pg/mL. Most patients were treated with renin-angiotensin blockers (68%), beta-blockers(70%) and loop diuretics (69%). Compared to other heart failure and mildly reduced or preserved ejection fraction trials, SOGALDI-PEF patients were older, were more frequently women, had a high prevalence of atrial fibrillation, and had more often a preserved ejection fraction. Conclusions: SOGALDI-PEF will be the first trial in heart failure and mildly reduced or preserved ejection fraction to test the combination of dapagliflozin/spironolactone vsdapagliflozin alone in a randomized manner. SOGALDI-PEF will provide information on the potential efficacy and safety of concomitant administration of spironolactone with dapagliflozin vs dapagliflozin alone in an elderly population with heart failure and mildly reduced or preserved ejection fraction.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AβYSS trialEur Heart J 2025 Aug 1;46(29):2894-2902. doi: 10.1093/eurheartj/ehaf170.AbstractBackground and aims: This study aims to report theeffects of β-blocker interruption on blood pressure (BP) and heart rate (HR) in the AβYSS trial where patients were randomized to interruption or continuation of β-blocker treatment after a myocardial infarction (MI). Methods: Changes in heart rate and blood pressurefrom baseline to post-randomization are reported using linear mixed repeated model, in the 3698 patients of the AβYSS trial with a median follow-up of 3.0 years. Additionally, changes in heart rate and blood pressure and the impact on the primary endpoint (death, MI, stroke, hospitalization for cardiovascular reason) in the pre-specified subgroups of patients with or without history of hypertension were assessed using linear mixed repeated and adjusted Cox proportional hazards model, respectively. Results: β-blocker interruption was associated withsignificant increase {least square mean difference [95% confidence interval (CI)]} in systolic BP [+3.7 (2.6, 4.8) mmHg, P <.001], diastolic BP [+3.3 (2.6, 4.0) mmHg, P < .001], and resting heart rate [+10 [9, 11) b.p.m., P < .001] at 6 months that persisted over the duration of follow-up despite an increase in antihypertensive drugs in the β-blocker interruptiongroup. The effects were observed in both hypertensive (43% of the population) and non-hypertensive patients. Hypertensive patients were at higher risk of events (25.8% vs. 19.2%) as compared with patients without hypertension (adjusted hazard ratio 1.18, 95% CI 1.01-1.36, P = .03). Patients with hypertension had a particularly marked increase in the primary endpoint (risk difference 5.02%, 0.72%-9.32%, P = .014) when randomized to β-blocker interruption.Conclusions: Interruption of β-blocker treatment after an uncomplicated myocardial infarction led to a sustained increase in blood pressure and heart rate with potentially deleterious effects on outcomes, especially in patients with history of hypertension.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

1-Month Versus 12-Month Dual Antiplatelet Therapy for Patients with Chronic Total Occlusion After Successful Percutaneous Coronary InterventionDrugs Aging. 2025 Aug 2. doi: 10.1007/s40266-025-01235z. AbstractPurpose: Compared with long-term dual antiplatelet therapy (DAPT, aspirin with clopidogrel or ticagrelor), short-term DAPT followed by single antiplatelet therapy (SAPT, clopidogrel or ticagrelor) has demonstrated superiority in reducing bleeding risk while maintaining non-inferior in cardiovascular benefits in coronary heart disease (CHD) aftersuccessful percutaneous coronary intervention (PCI). However, no prospective study has explored the benefits of this short-term regimen on patients with chronic total occlusion (CTO) undergoing Percutaneous Coronary Intervention. Methods: Consecutive patients who underwent successful elective chronic total occlusion Percutaneous CoronaryIntervention were prospectively enrolled from April 2019 to May 2021. After receiving 1-month DAPT, all patients were divided into two groups: SAPT group (followed by clopidogrel or ticagrelor monotherapy) and DAPT group (continued with dual antiplatelet therapy). Detailed baseline characteristics, angiographic and procedural details, and 1-year follow-up data were collected. The endpoints were major adverse cardiovascular events (MACE) and bleeding. Results: A total of 701 patients who underwent successful chronic total occlusion Percutaneous Coronary Interventionwere enrolled, among whom 330 patients (47.1%) received DAPT and 371 patients (52.9%) received SAPT (clopidogrel or ticagrelor) after 1-month DAPT. Compared with patients receiving DAPT, patients in the SAPT (clopidogrel or ticagrelor) group had a lower rate of previous stroke, fewer left anterior descending coronary artery (LAD) lesions and contrast volume, and fewer lesions per patient, but longer lesion length (P < 0.05). The incidence of MACE (14.5% versus 15.4%; p = 0.742) was not significantly different between the two groups. The DAPT group showed a higher incidence of minor bleeding (BARC types 1 or 2; 12.7% versus 2.3%, p < 0.001) than SAPT (clopidogrel or ticagrelor), while no difference was found for major bleeding (BARC types 3 or 5; 1.2% versus 2.3%, p = 0.261). Conclusions: Compared with standard 12-month DAPT, 1-month DAPT followed by clopidogrel or ticagrelor monotherapy resulted in lower bleeding risks and similar cardiovascular benefits in chronic total occlusion Percutaneous Coronary Intervention patients.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Effects of moderate physical trainingprogram in post-myocardial infarction patients with arterial hypertensionEur J Transl Myol. 2025 Jul 10. doi: 10.4081/ejtm.2025.13943 AbstractThe clinical effectiveness of physical training in a cardiac rehabilitation program (CRP) was assessed in hypertensive(AH), post-myocardial infarction (MI) patients. 206 patients were randomized into a physically trained group (PhTG, n=102) and an untrained, control group (CG, n=104). All patients received standard drug therapy. physically trained group patients performed mild callisthenic exercises and moderately intensive bicycle exercise three times/week for one year. Compared to control patients, physically trained group patients had significant changes in exercise capacity (duration +38%, p<0.001; total work +63.6%, p<0.001); rate-pressure product (-8.2%, p<0.01); left ventricular ejectionfraction (+7.6%, p<0.001); left ventricular stroke volume (+5.1%, p<0.01). Resting BP decreased in physically trained group patients (systolic BP, -3.1%, p<0.05; diastolic BP, -3.5%, p<0.001), but increased in control group patients (systolic BP, +3.1%, p<0.05; diastolic BP +3.4%, p<0.05). physically trained group patients had fewer myocardial ischemic episodes, including painless ischemia during exercise, fewer anginaattacks, less nitroglycerin consumption, improved quality of life, fewer cardiovascular events (-50%, p<0.05), and days of absence from work (-43.2%, p <0.05). Thus, supplementing a cardiac rehabilitation program with moderate exercise improved Blood Pressure, work capacity, cardiac function, and quality of life in hypertensive, post-myocardialinfarction patients. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website. 

Combined effects of clonal hematopoiesis of intermediate potential and P2Y12 inhibitors on outcomes of patients with ST-segment elevation myocardial infarction: A prospective studyhttps://doi.org/10.1016/j.phrs.2025.107852 AbstractClonal hematopoiesis of intermediate potential (CHIP) is a prominent risk factor for atherosclerosis, but effectivemedications for Clonal hematopoiesis of intermediate potential -associated risk are still lacking. This study aimed to assess prognostic impacts of P2Y12 inhibitors in the context of Clonal hematopoiesis of intermediate potential with aprospective cohort of 1332 patients of ST-segment elevation myocardial infarction (STEMI). Using targeted deep sequencing, Clonal hematopoiesis of intermediate potential was defined by any Clonal hematopoiesis of intermediatepotential -gene mutations with variant allele frequency (VAF) > 2%. Patients were stratified into four groups according to Clonal hematopoiesis of intermediate potential status and the prescribed types of P2Y12 inhibitors (ticagrelor and clopidogrel). The primary outcome was major adversecardiovascular events (MACE), a composite of death, recurrent MI, re-hospitalization due to heart failure and ischemic stroke. During a median follow-up of 1458 days, Clonal hematopoiesis of intermediate potential patientsreceiving ticagrelor exhibited lower risk of major adverse cardiovascular events (hazard ratio [HR]: 0.42, 95% confidence interval [CI]: 0.20–0.88, P = 0.022), followed bynon- Clonal hematopoiesis of intermediate potential patients on clopidogrel (HR: 0.60, 95% CI: 0.41–0.88, P =0.010) and ticagrelor (HR: 0.66, 95% CI: 0.44–0.99, P = 0.044), as compared to Clonal hematopoiesis of intermediate potential patients on clopidogrel, with significantinteractions detected between ticagrelor and Clonal hematopoiesis of intermediate potential (P interaction =0.015, relative excess risk due to interaction: -1.53, 95% CI: -4.91– -0.66). In sum, Clonal hematopoiesis of intermediate potential and P2Y12 inhibitors jointly affected outcomes of STEMI patients, and ticagrelor was associated to greater risk reduction in the presence of Clonal hematopoiesis of intermediate potential. These findings would promote more personalized antiplatelet medications for patients with ST-segment elevation myocardial infarction.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Early β-Blocker Use and Clinical Outcomesin Acute Myocardial Injury: A Retrospective Cohort StudyAm J Med. 2025 Jul;138(7):1090-1098.e6.AbstractBackground: Acute myocardial injury is defined by elevated cardiac troponin levels with a rising and/or falling pattern, and is associated with increased mortality risk compared topatients without myocardial injury. The role of β-blockers in patients with acute myocardial injury remains unclear.Methods: This multicenter, retrospective cohort study used data from the Tianjin Health and Medical Data Platform to assess the impact of early β-blocker use on 1-year all-causemortality and major adverse cardiovascular events (MACE) in acute myocardial injury patients, employing a new user and target trial emulation design. Propensity score matching was applied, and Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI).Results: After propensity score matching, a total of 25,966 participants were included: 8667 to the β-blockergroup and 17,299 to the non-β-blocker group. A total of 4113 deaths (15.8%) and 5795 major adverse cardiovascular events (22.3%) occurred. Compared with nonusers, β-blocker was associated with the reduced risk of all-cause mortality(HR: 0.89, 95% CI: 0.83-0.95) and major adverse cardiovascular events (HR: 0.90, 95% CI: 0.85-0.95).In the subgroup analysis, β-blockers were associated with a significantly reduced risk of mortality in patients without stroke (HR 0.85, 95% CI: 0.78-0.93), while no significant association was observed in patients with stroke (HR 1.04, 95% CI: 0.93-1.16).Conclusions: Early use of β-blockers is associated with the reduced risk of 1-year mortality in patients with acute myocardial injury. To more accurately assess the therapeuticeffects, prospective trials are necessary, and these data provide key research directions for future trials.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

A Retrospective Cohort Study on Long-TermOutcomes of Ticagrelor Versus Clopidogrel After Retrograde Percutaneous Coronary Intervention for Chronic Total OcclusionAm J Cardiovasc Drugs. 2025 Jul 12. doi:10.1007/s40256-025-00750-z.AbstractBackground: Chronic total occlusion (CTO) affects 15-25% of patients undergoing coronary angiography, and successful percutaneous coronary intervention (PCI) can improve ischemia, angina symptoms, and overall quality of life. However, Chronic total occlusion - percutaneous coronary intervention is a complex procedure with higher risks of acute thrombosis, restenosis, and long-term thrombosis due to factors such as longer lesion length, calcification, and the need for more stents. Dual antiplatelet therapy (DAPT) is essential after percutaneous coronary intervention, but theoptimal regimen for Chronic total occlusion, particularly in patients with chronic coronary syndrome, remains under debate. Although more potent P2Y12 inhibitors such as ticagrelor may offer benefits in some cases, recent studieshave shown mixed results.Objective: This study aimed to assess the effect of potent Dual antiplatelet therapy on long-term outcomes in patients with Chronic total occlusion undergoing retrograde percutaneous coronary intervention.Method: We conducted a retrospective analysis of836 consecutive patients who underwent elective retrograde Chronic total occlusion - percutaneous coronary intervention at a single center between January 2011 and April 2023. We compared patient and lesion characteristics,procedural details and results, and long-term outcomes between patients who received ticagrelor and those who received clopidogrel after retrograde Chronic total occlusion - percutaneous coronary intervention.Result: Clinical follow-up was available in 767 (91.2%) patients, with a median follow-up of 1041 days (range 531-1511). The risk of major adverse cardiovascular events was significantly lower in patients receiving ticagrelor than in those receiving clopidogrel (8.8% vs. 18.5%, p = 0.005),primarily due to reductions in all-cause mortality (1.9% vs. 8.1%, p = 0.009) and cardiac death (0.6% vs. 5.8%, p =0.012).Conclusion: Dual antiplatelet therapy with ticagrelor may represent a safe and efficient management strategy for patients undergoing retrograde Chronic total occlusion - percutaneous coronary intervention.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Antiplatelet and Anticoagulant Therapy in the 2025 ACC/AHA Guideline for Acute Coronary Syndromes: KeyRecommendationsJACC. 2025 Jun, 85 (22) 2074–2078 The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for theManagement of Patients With Acute Coronary Syndromes (ACS), published in this issue of JACC, replaces the prior U.S. guidelines on the management of ST-segment and non–ST-segment elevation ACS. The new guideline provides anexcellent evidence-based framework for diagnosis and management of type I ACS (ie, in the setting of atherothrombosis). This Guideline Commentary highlightsthe key recommendations related to antithrombotic therapy, compares the 2025 guideline with prior American College of Cardiology (ACC)/American Heart Association (AHA) and European Society of Cardiology (ESC) recommendations, and offers reflections on recent changes and opportunities for further clarification. With respect to antiplatelet therapy, early initiation ofaspirin and an oral P2Y12 receptor inhibitor remain Class 1 recommendations. The new guideline recommends either ticagrelor or prasugrel (Class 1, without distinction between the two) as the preferred P2Y12 inhibitor in ST-segmentelevation myocardial infarction (STEMI) or non–ST-segment elevation myocardial infarction (NSTEMI). If these agents are contraindicated, not tolerated, unaffordable, or unavailable, clopidogrel is recommended. The initiation of oral P2Y12 inhibitors before transfer to the catheterization laboratory isrecommended if there is an expected delay of >24 hours (Class 2b). In patients undergoing percutaneous coronary intervention (PCI) who have not received a P2Y12 inhibitor, intravenous cangrelor may be reasonable (Class 2b).The recommendations for the duration of dual antiplatelet therapy (DAPT) following ACS are more nuanced: The guideline recommends a default DAPT duration of 1 year after ACS for patients without high bleeding risk (Class 1),but where bleeding risk is a concern, it recommends ticagrelor monotherapy 1 month after PCI (Class 1) .Clopidogrel-based DAPT is recommended for patientswith STEMI who receive fibrinolytic therapy. In patients with NSTEMI who undergo medical therapy alone, the guideline gives a Class 1 recommendation for aspirin and ticagrelor. In conclusion, the 2025 ACC/AHA guideline for diagnosing and managing ACS provides thoughtful, practical, and actionable recommendations for antithrombotic therapy. When paired with available resources and individualcharacteristics and values of patients, they can help clinical practice and medical practitioners until further data emerges. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy,validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, whichyou should exercise in evaluating the information on this website.

Pragmatic Use of Ticagrelor: ImprovingOutcomes in Medical Management of Acute Coronary Syndrome (PracTiCal India Study)Journal of Indian College of Cardiology ():10.4103/jicc.jicc_73_24, June 05, 2025. | DOI: 10.4103/jicc.jicc_73_24AbstractBackground: The utilization of ticagrelor in the medical management ofacute coronary syndrome (ACS) has been extensively explored in interventions such as percutaneous coronary intervention. However, its use in acute coronarysyndrome without intervention remains inadequately explored. The PracTiCal India Study was initiated to address this gap, aiming to optimize ticagrelor’s application in medical management in treating various cardiovascularconditions, particularly acute coronary syndrome.Methods: This questionnaire-based survey was conducted amongcardiologists in India. The questionnaire consisted of eight questions specifically designed to collect data on the most effective and efficient methods for managing acute coronary syndrome, with a focus on the optimal utilization of ticagrelor. The survey results were subsequently discussed in a round table meeting by a panel of experts.Results: A total of 103 cardiologists completed the survey. Among theparticipants, 70.9% preferred ticagrelor for not reperfused ST-segment elevation myocardial infarction (STEMI) and 58.3% of participants chose it for nonrevascularized non-STEMI (NSTEMI). The participants commonly consideredmultiple stents (76.7%), a high risk of stent thrombosis (74.8%), and a history of previous revascularization (63.1%) as the most significant factors for initiating ticagrelor. The most common factors limiting the effective use of ticagrelor were bleeding risk (63.1%) and cost (52.4%). In addition, 43.7%preferred transitioning ACS patients to ticagrelor without reperfusion after using a different P2Y12 inhibitor.Conclusion: The study highlights ticagrelor as the preferred P2Y12inhibitor for both not reperfused STEMI and NSTEMI cases, reflecting its widespread acceptance among cardiologists. The decision to employ ticagrelor is primarily influenced by stent-related complications and the patient’s comorbidity profile. However, the practical application of ticagrelor is often hindered by concerns regarding hemorrhagic complications and the cost of therapy, particularly in scenarios involving patients who have not undergonerevascularization procedures.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy,validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, whichyou should exercise in evaluating the information on this website. 

Exploring the Impact of Beta-Blockers Post-Acute Myocardial Infarction in Patients with Preserved Ejection Fraction: A Meta-AnalysisJ. Clin. Med. 2025, 14(11), 3969; https://doi.org/10.3390/jcm14113969 AbstractBackground/Objectives: Previous research has establishedthat beta-blockers significantly reduce all-cause mortality, cardiovascular mortality, and recurrent acute myocardial infarction (AMI) in patients with left ventricular dysfunction following AMI. However, their efficacy in patientswith preserved left ventricular ejection fraction (LVEF) who undergo timely reperfusion and revascularization while receiving evidence-based medical management remains inconclusive. To address this uncertainty, we conducted asystematic review and meta-analysis to synthesize the available evidence on the impact of beta-blocker therapy in patients with acute myocardial infarction andpreserved left ventricular ejection fraction. Methods: A comprehensive literature search was conductedacross PubMed, the Web of Science, and Scopus from their inception until November 2024. The search strategy incorporated three primary keywords and their corresponding Medical Subject Headings (MeSH) terms: “preserved”, “myocardial infarction”, and “beta-blocker”. Data analysis was performed using Review Manager 5.4 software. A random-effects model was applied to account forthe study’s heterogeneity, while a fixed-effects model was utilized for homogeneous outcomes. Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated for dichotomous outcomes, with a 95% confidence interval (CI) and a significance threshold of p < 0.05. Results: Beta-blocker therapy was significantly associatedwith a reduction in all-cause mortality compared to non-use, with an OR of 0.73 (95% CI: 0.61–0.88, p = 0.001) and an HR of 0.78 (95% CI: 0.67–0.91, p = 0.002). Similarly, beta-blockeradministration was linked to a lower risk of cardiovascular mortality, demonstrating an OR of 0.76 (95%CI: 0.68–0.84, p < 0.00001) and an HR of 0.76 (95% CI: 0.59–0.99, p = 0.04). Furthermore, beta-blocker use was significantly correlated with a decreased risk of majoradverse cardiovascular events (MACEs) compared to non-use, with an OR of 0.84 (95% CI: 0.75–0.95, p = 0.004)and an HR of 0.84 (95% CI: 0.71–0.99, p = 0.04). Conclusions: The current meta-analysis suggestsa potential beneficial association between beta-blocker use and outcomes in patients with acute myocardial infarction and preserved left ventricular ejection fraction, including lower rates of all-cause mortality, cardiovascularmortality, and MACEs; however, these findings should be interpreted with caution due to the observational nature of most included studies. Therefore, further randomized controlled trials (RCTs) are needed to confirm thesefindings, particularly in distinguishing outcomes among patients with and without heart failure.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy,validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website 

The 2025 Guideline for the Management of Patients With Acute Coronary Syndromes: Asian Perspectivehttps://www.jacc.org/doi/full/10.1016/j.jacc.2025.04.011The 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for theManagement of Patients with Acute Coronary Syndromes introduces key updates that may influence global clinical practice. Given Asia’s immense population and regional diversity, assessing how these U.S.-based guidelines translate into real-world application is essential.Although grounded in robust clinical trial evidence, their relevance in Asia varies due to differences in demographics, access to treatment, health care infrastructure, and cultural context. This paper explores how these updatesintersect with regional realities, focusing on 4 key areas: 1) antithrombotic strategies; 2) lipid-lowering therapy; 3) multivessel revascularization; and 4) mechanical circulatory support in cardiogenic shock.In South Asia, ACS management is shaped by a high burden of cardiometabolic risk, earlier disease onset, and major socioeconomic status (SES) disparities. One-thirdof patients receive care in urban tertiary centers, but most rely on under-resourced hospitals in smaller towns. Evidence-based practices are more common in high- socioeconomic status settings; elsewhere, cost and practicality drive care decisions.1. Antithrombotic therapy is mostly dictated by affordability. Clopidogrel remains the dominant P2Y12 inhibitor. Ticagrelor is increasingly used in high-socioeconomic status urban areas, supported by local production, but is rare in rural settings and Pakistan. Prasugrel is used in <10% of patients, due to bleeding risk in those with low body weight. DAPT typically lasts 12 months; shorter courses are reserved for high bleeding risk.2. The Lipid Association of India recommends one of the world’s most aggressive lipid-lowering strategies, using moderate- or high-intensity statins plus ezetimibe to achieve LDL-C targets of <50 mg/dL for very high risk and <30 mg/dL for extreme risk individuals, based on atheroscleroticcardiovascular disease and/or multiple high-risk features upon ACS presentation. If <20% additional LDL-C reduction is needed, bempedoic acid or bile acid sequestrants may be used; if >20%, a PCSK9i is preferred. PCSK9i and inclisiran remain largely unaffordable, though use has grown over the past year among higher socioeconomic groups, guided by the 2024 Indian Consensus Statement. Lipoprotein(a) testing is recommended at least once in all adults beginning at age 18 years.3. Revascularization strategies depend on available infrastructure. In urban high- socioeconomic status settings, primary PCI with radial access is preferred, with staged PCIfor nonculprit lesions. In rural areas, fibrinolysis—typically tenecteplase or streptokinase—remains the primary treatment due to limited PCI access.4. Mechanical circulatory support availability is minimal.microaxial flow pumps are present in select tertiary centers but are rarely used due to cost and training requirements. Intra-aortic balloon pump use is the mainstay. Venoarterial extracorporeal membrane oxygenation is availableonly in specialized centers, with limited use due to high cost, low expertise, and delayed presentation.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website

Effect of Body Mass Index in Patients With Cardiogenic Shock Requiring Microaxial Flow PumpJACC: Asia. May 04, 2025. Epublished DOI:10.1016/j.jacasi.2025.03.003AbstractBackgroundThe impact of obesity on mortality in patients with cardiogenic shock (CS) requiring microaxial flow pumps (mAFP) remains undetermined. ObjectivesThis study investigated the effect of body mass index (BMI) on mortality in CS patients treated with microaxial flow pumps MethodsData from 3,636 consecutive CS patients treated with Impella microaxial flow pumps in the J-PVAD (Japanese Registry for Percutaneous Ventricular Assist Device) nationwide prospective registry in Japan between February 2020 and December 2022 were analyzed. Patients werestratified into 5 BMI categories: underweight (<18.5 kg/m2),normal weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2), obesity (25.0-29.9 kg/m2), and severe obesity (≥30.0 kg/m2). Multivariate Cox regression analysis assessed the relationship between BMI and 30-day mortality. ResultsCrude 30-day mortality increased incrementally with higher BMI categories. Adjusted HRs for 30-day mortality(normal weight as reference) were 0.71 (95% CI [CI]: 0.56-0.90; P = 0.005) for underweight, 1.03 (95%CI: 0.88-1.21; P = 0.681) for overweight, 1.37 (95% CI: 1.19-1.57; P < 0.001) for obesity, and 2.00 (95% CI: 1.66-2.41; P < 0.001) for severe obesity. Patients in the underweight and severe obesity groups experienced a higher incidence of bleeding after percutaneous coronary intervention under microaxial flow pumps, whereas hemolysis increased withhigher BMI categories. Bleeding and hemolysis were associated with mortality only in patients who were underweight. ConclusionsHigher BMI was associated with increased mortality in CS patients treated with microaxial flow pumps. Although patients who were underweight demonstrated overall favorable survival outcomes, bleeding and hemolysis contributed to mortality in this group. Further research isneeded to explore whether a BMI-based approach can improve clinical outcomes. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

The Impact of Preoperative P2Y12 Inhibitors on Short- and Long-Term Outcomes Following Percutaneous CoronaryInterventionDOI: 10.1016/j.jscai.2025.103226 ExternalLink BackgroundThe preoperative usage of P2Y12 inhibitors primarily aim to reduce thrombotic complications for percutaneous coronary intervention (PCI), however, there is limited data on how these medications impact rates of adverse outcomes post- percutaneous coronary intervention. MethodsWe conducted a single-center observationalstudy to evaluate outcomes of percutaneous coronary intervention with or without preoperative P2Y12 inhibitor usage at our high-burden, urban percutaneouscoronary intervention center. Multivariable logistic regression analysis was employed to evaluate clinical outcomes between cohorts, adjusting for demographic and clinical covariates. ResultsAfter adjustments, our study included 2,222 patients who underwent percutaneous coronary intervention. After 30 days, patients preoperatively administered P2Y12 inhibitors had significantly lower rates of reinterventions in any lesion (p=0.001). After 6 months and 1 year, patients administered P2Y12 inhibitors had significantly lower rates of all-causemortality (p=0.002 and p=0.017). There were no significant differences in outcomes post- percutaneous coronary intervention for mortality (all-cause or cardiovascular), recurrent acute coronary syndrome, congestive heart failure readmission, cardiac arrest, reintervention, or cerebrovascular accident among either group 1 year post- percutaneous coronary intervention (p>0.05). ConclusionsWhile P2Y12 inhibitors are indicated post- percutaneouscoronary intervention to prevent stent thrombosis, there is limited data on how preprocedural administration affects post- percutaneous coronary intervention outcomes.Our study underscores the importance of these medications in reducing rates of short-term lesion reintervention and long-term mortality.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.  

Incidence and Risk Factors of De Novo Postpartum Hypertension: Understanding Links to Long-Term Cardiovascular RiskJACC Adv. 2025 Jun, 4 (6_Part_1) 101756 AbstractBackgroundIndividuals developing hypertensive disorders of pregnancy face a 2- to 5-fold risk of long-term cardiovascular disease. Limited data exist on de novo postpartum hypertension (dnPPHTN), where those normotensive during pregnancy develop hypertension immediately postpartum.Under-recognition of de novo postpartum hypertension can lead to severe morbidity due to delayed or absent treatment and missed opportunities for mitigating long-term cardiovascular disease risk. ObjectivesThe aim of the study was to estimate theincidence of de novo postpartum hypertension and identify demographic and clinical risk factors for its development. MethodsThis retrospective cohort study analyzed 506 postpartum individuals delivering at a tertiary care institution over 1month. Participants were classified as: 1) normotensive; or 2) de novo postpartum hypertension, defined as systolic blood pressure (BP) ≥140 mm Hg and/or diastolic BP ≥90 mm Hg on at least 2 occasions up to 6 weeks postpartumafter a normotensive pregnancy. We excluded those with prepregnancy or antepartum hypertensive disorders. Demographic and clinical characteristics were compared using adjusted logistic regression models. ResultsOf 389 included participants, 35 (9.0%) developed de novo postpartum hypertension. Of these, 5.7% had pregestationaldiabetes compared to 0.6% of normotensive individuals (P = 0.042; adjusted OR: 11.3; 95% CI: 1.8-73.1). Early prenatal diastolic BP was higher in the de novo postpartum hypertension group (72.2 vs 68.4 mm Hg, P =0.008), though this difference did not persist after adjustment. Medication-dependent gestational diabetes mellitus (ie, A2GDM) was associated with de novo postpartum hypertension (adjusted OR: 6.1; 95% CI: 1.2-30.1). ConclusionsPregestational diabetes and Medication-dependentgestational diabetes mellitus are associated with de novo postpartum hypertension. Closer follow-up for BP monitoring postpartum and more urgent transitions of care for ongoing medical management may reduce long-termcardiovascular risk.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Aspirin vs Clopidogrel vs Ticagrelor Monotherapy Compared to 12 Months of DAPT Following PCI; A Systematic Review and Meta-AnalysisDOI: 10.1016/j.jscai.2025.103158 ExternalLink BackgroundShort-term Dual Antiplatelet Therapy (DAPT) may reduce the risk of bleeding after Percutaneous Coronary Intervention (PCI) as compared to the standard 12 months of Dual Antiplatelet Therapy . However, it may not provide the same benefits against stent thrombosis and ischemic events. We aim to analyse the various recent Randomized Controlled trials (RCTs) to find the ideal drug among Aspirin or one of the PGY12 Inhibitors and time of initiation for monotherapy following Percutaneous Coronary Intervention with the lowest risk of adverse outcomes as compared to long term Dual Antiplatelet Therapy. MethodsRandomized Controlled trials comparing monotherapy with Ticagrelor, Aspirin or Clopidogrel to Dual Antiplatelet Therapy in adults undergoing Percutaneous Coronary Intervention were selected. The primary outcome was defined as Major adverse Cardiac and Cerebral events (MACCE) which is a composite of all cause death, myocardial infarction, stroke or clinically driven revascularization. The secondary outcome was clinically relevant bleeding. ResultsDrug Based analysis : short term Dual Antiplatelet Therapy was associated with a lower probability of MACCE (RR 0.90,95% CI 0.85, 0.96, p = 0.002) and Bleeding Risk (RR 0.66, 95% CI 0.55, 0.80, p < 0.0001). Ticagrelor was associated with the lowest risk for both MACCE and Bleeding. Duration based analysis : switching to monotherapy at 1 month or lesspresented a slightly higher bleeding risk but a lower risk of MACCE as compared to switching at 3 months. However both strategies had a lower risk for MACCE (0.91, 95% CI 0.85,0.98, p= 0.01) and bleeding (RR 0.67, 95% CI 0.54, 0.83, p = 0.0002) as compared to 12 months of Dual Antiplatelet Therapy. ConclusionsShort term Dual Antiplatelet Therapy is superior to12 months of Dual Antiplatelet Therapy, with Ticagrelor being thesafest drug started either at 1 or 3 months depending on the clinical situation.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Does Timing of Coronary Artery Bypass Grafting after ST-Elevation Myocardial Infarction Impact Early- and Long-Term Outcomes?DOI: 10.1055/s-0044-1787851 AbstractBackground: The optimal timing of surgicalrevascularization after ST-elevation myocardial infarction (STEMI) is controversial, with some suggesting higher mortality rates in patients undergoing early surgery. The aim of the study is to determine the effect of the timing of surgical revascularization on 30-day mortality and long-termoutcomes in these patients.Methods: Retrospective single-center analysis ofpatients with ST-elevation myocardial infarction undergoing coronary artery bypass grafting (CABG) between January 2008 and December 2019 at our institution. The cohort was split into three groups based on time from symptomonset until surgical revascularization (Group 1: <12 hours, Group 2: 12-72 hours, Group 3: >72 hours). Statistical analyses were performed with and without patients in cardiogenic shock. Primary outcomes were 30-day mortality and10-year survival.Results: During the study period, 437 consecutive patients underwent surgical revascularization in the setting ofSTEMI. The mean age was 67.0 years, 96 (22.0%) patients were female, and 281 (64.3%) patients underwent off-pump CABG. The overall 30-day mortality includingpatients with cardiogenic shock was 12.8%. The 30-day mortality was 16.1, 13.9, and 9.3% in Groups 1, 2, and 3 (p = 0.31), whereas 10-year survival was 48.5, 57.3,and 54.9% (log-rank: p =0.40). After exclusion of patients in cardiogenic shock, there was no difference between the three groups in 30-day and 10-year mortality. Timing ofsurgery had no influence on early- and long-term survival.Conclusion: In patients with ST-elevationmyocardial infarction, early surgical revascularization achieved similar early- and long-term survival rates compared with a delayed surgical revascularizationstrategy. Hence, when indicated, an early coronary artery bypass grafting strategy has no disadvantages in comparison to a delayed strategy. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Rationale and Design of the TADCLOT Trial: A Double Blind Randomized Controlled Trial Comparing Twice a DayClopidogrel vs. Ticagrelor in Reducing Major Cardiac Events in Patients with Acute STEMI Undergoing Primary Percutaneous Coronary InterventionDOI: 10.1016/j.ahj.2025.03.021 AbstractBackground: Ticagrelor has been proven superior toclopidogrel in reducing adverse cardiovascular events in patients with acute coronary syndrome (ACS), yet economic factors often favor clopidogrel in real-world clinical practice. Although double dose clopidogrel has shownpotential benefits over once-daily regimens, its direct comparison with ticagrelor in ST-elevation myocardial infarction (STEMI) patients remains unexplored.Methods and design: Twice a Day Clopidogrel vs.Ticagrelor in Reducing Major Cardiac Events in Patients with Acute STEMI Undergoing Primary PCI (TADCLOT) trial is a double-blind, randomized controlled trial conducted at the National Institute of Cardiovascular Diseases (NICVD),Karachi, Pakistan. It is designed as a superiority trial to evaluate the efficacy and safety of ticagrelor over twice-daily clopidogrel in reducing major adverse cardiac events (MACE) in STEMI patients undergoing primary percutaneous coronary intervention (PCI). Following successful PCI for STEMI, and when the patient is deemed suitable for discharge, patients are randomized 1:1 to receive either ticagrelor (180 mg loading dose followed by 90 mg BID for30 days) or clopidogrel (600 mg loading dose followed by 75 mg BID for 30 days). The primary endpoint is the rate of major adverse cardiac events (MACE), a composite of death, myocardial infarction, stent thrombosis, target lesionrevascularization, or stroke at 30 days following randomization. Secondary endpoints include the individual components of MACE, bleeding complications, and drug discontinuation due to adverse events. Enrollment has reached 88%, with 2,200 patients planned to complete the trial.Implications: The TADCLOT trial will provide crucialinsights into the comparative efficacy of ticagrelor versus twice-daily clopidogrel in reducing early stent thrombosis and improving outcomes in STEMI patients undergoing primary PCI. The trial will particularly contributevaluable insights for post-PCI care, considering both the economic and genetic context of the high risk South Asian population.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

In-hospital use of beta-blockers for critically ill patients with acute heart failure: Whether and when to initiateDOI: 10.1016/j.jclinane.2025.111824 AbstractBackground: The use of beta-blockers during hospitalization for acute heart failure (AHF) remains controversial. This study aimed to investigate whether beta-blocker use isassociated with a reduced risk of mortality in critically ill patients with AHF and to determine the optimal timing for initiating beta-blocker therapy. Methods: Data from critically ill patients with AHF in the MIMIC-IV version 2.2 database were analyzed.Baseline characteristics, laboratory tests, comorbidities, vital signs, and medication usage at admission and during hospitalization were collected to performinverse probability of treatment weighting (IPTW). IPTW-weighted logistic regression models were then used to examine the relationship between beta-blocker use and mortality. Results: In the IPTW-weighted regression model, patients who newly started beta-blockers or continued theiruse had a lower risk of in-hospital mortality compared to those not treated with beta-blockers (oddsratio [OR]: 0.45; 95 % confidence interval [CI]: 0.34 to 0.61, and OR: 0.53; 95 % CI: 0.41 to 0.69, respectively). Conversely, those who had beta-blockers withdrawn showed a higher risk of in-hospital mortality (OR: 2.59; 95 % CI: 1.63 to4.10). Among beta-blocker users, compared to patients treated before admission and who received their first dose within 48 h of admission, those whowere not treated before admission but started after 48 h had a similar mortality risk (OR: 0.82; 95 % CI: 0.60 to 1.11; P = 0.202). However, patients previously treated with beta-blockers who initiated therapy after 48 h and those not treated before admission but started within 48 h had a lower risk of in-hospital mortality (OR: 0.44; 95 % CI: 0.30 to 0.64; P < 0.001, and OR: 0.65; 95 % CI: 0.48 to 0.86; P = 0.003,respectively). Conclusion: The use of beta-blockers during hospitalization for AHF is associated with a reduced risk of in-hospital mortality, and withdrawal was associated with an increased risk of mortality. Initiating beta-blockers within 48 h for beta-blocker-naïve patients and after 48 h for those previously treated with beta-blockers before admission may further decrease mortality risk. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

1.  Dual antiplatelet therapy is recommended for patients with acute coronary syndromes (ACS). Ticagrelor or prasugrel is recommended in preference to clopidogrel in patients with ACS who are undergoing percutaneous coronary intervention (PCI). In patients with non–ST-segment elevation ACS who are scheduled for an invasive strategy with timing of angiography to be >24 hours, upstream treatment with clopidogrel or ticagrelor may be considered to reduce major adverse cardiovascular events.2. Dual antiplatelet therapy with aspirin and an oral P2Y12 inhibitor is indicated for at least 12 months as the default strategy in patients with ACS who are not at high bleeding risk. Several strategies are available to reduce bleeding risk in patients with ACS who have undergone PCI  and require antiplatelet therapy: (a) in patients at risk for gastrointestinalbleeding, a proton pump inhibitor is recommended; (b) in patients who have tolerated dual antiplatelet therapy with ticagrelor, transition to ticagrelor monotherapy is recommended ≥1 month after PCI; or (c) in patients who require long-term anticoagulation, aspirin discontinuation is recommended 1 to 4 weeks after PCI with continued use of a P2Y12 inhibitor (preferably clopidogrel).3.High-intensity statin therapy is recommended for all patients with ACS, and with the option to initiate concurrent ezetimibe. A nonstatin lipid-lowering agent (eg, ezetimibe,evolocumab, alirocumab, inclisiran, bempedoic acid) is recommended for patients already on maximally tolerated statin who have a low-density lipoprotein cholesterol level of ≥70 mg/dL (1.8 mmol/L). It is reasonable in this high-risk population to further intensify lipid-lowering therapy if the low-density lipoprotein cholesterol level is 55 to <70 mg/dL (1.4 to <1.8 mmol/L) and patient is already on a maximally tolerated statin.4.In patients with non–ST-segment elevation ACS who are at intermediate or high risk of ischemic events, an invasive approach with the intent to proceed with revascularization is recommended during hospitalization to reduce major adverse cardiovascular events. In patients with non–ST-segment elevation ACS who are at low risk of ischemic events, a routine invasive or selective invasive approachwith further risk stratification is recommended to help identify those who may require revascularization and to reduce major adverse cardiovascular events.5. Two procedural strategies are recommended in patients with ACS who are undergoing PCI: (a) radial approach is preferred over femoral approach in patients withACS undergoing PCI to reduce bleeding, vascular complications, and death; and (b) intracoronary imaging is recommended to guide PCI in patients with ACS withcomplex coronary lesions.6. A strategy of complete revascularization is recommended in patients with ST-segment elevation myocardial infarction or non–ST-segment elevation ACS. The choice of revascularization method (ie, coronary artery bypass graft surgery versus multivessel PCI) in non–ST-segment elevation ACS and multivessel disease should be based on the complexity of the coronary artery disease and comorbidconditions. PCI of significant nonculprit stenoses for patients with ST-segment elevation myocardial infarction can be performed in a single procedure or staged with some preference toward performing multivessel PCI in a singleprocedure. In patients with ACS and cardiogenic shock, emergency revascularization of the culprit vessel is indicated; however, routine PCI of non–infarct-related arteries at the time of PCI is not recommended.7. Red blood cell transfusion to maintain a hemoglobin of 10 g/dL may be reasonable in patients with ACS and acute or chronic anemia who are not actively bleeding.

Impact of Metabolic Syndrome on Clinical Profile and Prognosis in Patients with Acute ST-Elevation MyocardialInfarction: a Cross-Sectional Studyhttps://link.springer.com/article/10.1007/s42399-025-01822-6AbstractMetabolic syndrome (MS) has gained attention as a newly discovered risk factor for coronary artery disease (CAD).Studies have demonstrated that individuals with MS have a higher risk for coronary artery disease (CAD), and the risk is higher in females compared to males. Patients with metabolic syndrome have a higher incidence of ST-elevationmyocardial infarction (STEMI), making it a significant risk factor that has to be well-treated for successful secondary prevention. The study’s objective is to determine the frequency of MS in patients with acute STEMI according to the new “obesity-centric” IDF definition and to compare the clinical outcomes of acute STEMI patients with and without MS. A total of 132 consecutive patients with acute STEMI were analyzed, and 100 patients were included. MS wasidentified using criteria based on the “International Diabetes Federation 2005.” The frequency of metabolic syndrome in patients with STEMI was 46%. The frequency was greater in females (53.2%) than in males (43.2%). Patients whohad MS had poor clinical outcomes when compared to patients without MS, including mortality. Mortality due to STEMI in patients with MS was 15.2%, whereas in patients without MS was just 2% (p < 0.05). In addition to being a significant risk factor for cardiovascular disease, metabolic syndrome can also be a strong predictor of the severity and immediate prognosis of the condition.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website. 

Assessing the application of American Heart Association (AHA) guidelines in the management of heart failure withreduced ejection fractionhttps://link.springer.com/article/10.1186/s43044-025-00629-zHeart failure (HF) is a significant global health issue. Appropriate and timely treatment at target doses significantly reduces mortality and enhances quality of life. However, studies indicate suboptimal pharmacotherapy among patients. This study aims to assess the medical treatment of patients with heart failure and reduced ejection fraction (HFrEF) and their adherence to the American Heart Association (AHA) guidelines. The study was designed as a cross-sectional analysis in the cardiac departmentof Razi Hospital in Birjand from March 20, 2020, to March 11, 2023, focusing on patients with left ventricular ejection fraction less than or equal to 40%. Data were extracted from patients’ medical records. Medications were classifiedaccording to the four-pillar therapy recommended by the American Heart Association, including β-blockers, Angiotensin receptor-neprilysin inhibitor, angiotensin-converting enzyme inhibitors/ARBs, SGLT2, and MRAs. Patients were grouped based on their treatment regimens. The percentage of achieved target doses for each medication was categorized as follows: 0–25%, 25–50%, 50–99%, and 100%. Statistical analysis was conducted using SPSS version 22. ResultsThe study included patients with a mean ageof 66 ± 13.7 years, of whom 278 (69%) were male. The mean ejection fraction was 26.8 ± 9.6%, and the most prevalent comorbidity was coronary artery disease (CAD) observed in 68.0% of patients. The in-hospital mortality rate was 5%. Theresults revealed that only 20% were on quadruple therapy, while 10% received none of the recommended medications. The prescription rates for key medications were as follows: β-blockers 76.4%, ACE inhibitors/ARBs 71.6%, MRA 63.3%, SGLT2I 33.5%, and ARNI 0%. Notably, 94.8% of prescribed SGLT2I doses met the target dose, while 84.4% of β-blocker prescriptions and 61.8% of ACEI/ARB prescriptions werebelow 75% of the target dose. ConclusionThe findings reveal significant gaps in the prescription of essential therapies, including MRAs and ARNIs, which arecrucial for managing myocardial dysfunction. Addressing these gaps underscores the necessity for ongoing education and training for healthcare providers in heart failure management.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

The “Silent Enemy” Called Renal Artery Stenosis: A Mini-Review:J. Vasc. Dis. 2025, 4(1), 10; https://doi.org/10.3390/jvd4010010Renal artery stenosis (RAS) is a vascular condition characterized by narrowing of one or both renal arteries, leading to reduced blood flow to the kidneys, activation of the renin–angiotensin–aldosterone system (RAAS), and subsequent renovascular hypertension. Overactivation of the same cascade potentiates the production of angiotensin II, which induces systemic vasoconstriction, increases sodium and water retention via aldosterone, and activates the sympathetic nervous system. Angiotensin II is also implicated in endothelial dysfunction, oxidative stress,and chronic inflammation, thus impairing vascular remodeling and arterial stiffness, all of which serve to accelerate cardiovascular complications, suchas left ventricular hypertrophy, heart failure, and myocardial infarction. Renal artery stenosis is usually due in at least 90% of cases to atherosclerosis, which typically affects older people with diabetes and smoking as risk factors.There are two types of Renal artery stenosis: unilateral and bilateral. Bilateral Renal artery stenosis is commonly associated with flash pulmonary edema, a life-threatening emergency condition in which alveolar space floodingcan occur within minutes. Renal artery stenosis typically remains asymptomatic until the late stage with complications of hypertension, ischemic nephropathy,or chronic kidney disease. FMD tends to create structural abnormalities of the artery, whereas atherosclerosis causes plaque formation and endothelial dysfunction of the artery. Epidemiological surveys have revealed that theprevalence of Renal artery stenosis ranges from 4% to 53% and is especially high among patients with hypertension, cardiovascular disease, or CKD. Diagnosis is based on clinical suspicion and supported by imaging studies, including Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography. Early detection also relies on certain laboratory biomarkers, especially in identifying high-risk patients. These markers wouldinclude increased plasma renin activity, elevated aldosterone-renin ratio, and inflammatory markers, including C-reactive protein and endothelin-1. Treatmentwould also involve pharmacological approaches, including the renin–angiotensin–aldosterone system inhibitors, beta-blockers, and statins, and interventional treatments, including angioplasty and stenting in patientswith severe forms of the disease. However, the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) Trial showed that most patients would likelyrequire medical therapy, and that intervention should be reserved for those with uncontrolled hypertension, progressive renal dysfunction, or recurrent episodes of pulmonary edema. Other emerging therapies include drug-eluting balloons, bioresorbable stents, and gene-editing techniques, all of which have shown great promise in the few studies that have been conducted, although further evaluation is needed. Despite these advances, there are still gaps in knowledge regarding patient stratification, biomarker validation, and the development of personalized treatment strategies. This article reviews thecomplexities of the renin–angiotensin–aldosterone system and its systemic impact on cardiovascular and renal health. Future research can therefore focus on improving early diagnosis, optimizing patient selection for intervention,and developing new therapies to slow disease progression and mitigate complications. 

Early β-Blocker Use and Clinical Outcomes in Acute Myocardial Injury: A Retrospective Cohort Studyhttps://doi.org/10.1016/j.amjmed.2025.02.029AbstractBackgroundAcute myocardial injury is defined by elevated cardiactroponin (cTn) levels with a rising and/or falling pattern, and is associated with increased mortality risk compared to patients without myocardial injury. The role of β-blockers in patients with acute myocardial injury remains unclear.MethodsThis multicenter, retrospective cohort study used data fromthe Tianjin Health and Medical Data Platform to assess the impact of early β-blocker use on 1-year all-cause mortality and major adverse cardiovascular events (MACE) in acute myocardial injury patients, employing a new user andtarget trial emulation design. Propensity score matching (PSM) was applied, and Cox regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI).ResultsAfter PSM, a total of 25,966 participants were included:8,667 to the β-blocker group and 17,299 to the non-β-blocker group. A total of 3,487 deaths (13.5%) and 5,795 MACE (22.3%) occurred. Compared with non-users,β-blocker was associated with the reduced risk of all-cause mortality (HR: 0.89, 95% CI: 0.83-0.95) and MACE (HR: 0.90, 95% CI: 0.85-0.95). In the subgroup analysis, β-blockers were associated with a significantly reduced risk of mortality in patients without stroke (HR 0.85, 95% CI: 0.78–0.93),while no significant association was observed in patients with stroke (HR 1.04, 95% CI: 0.93–1.16).ConclusionsEarly use of β-blockers is associated with the reduced riskof 1-year mortality in patients with acute myocardial injury. To more accurately assess the therapeutic effects, prospective trials are necessary, and these data provide key research directions for future trials. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Impact of controlled stepwise reperfusion during primary percutaneous coronary intervention on patients with ST-elevation myocardial infarction AbstractObjective:The aim of this study is to examine the impact of controlled stepwise reperfusion by modulating pre-dilation balloonpressure during primary percutaneous coronary interventions (PPCI) in patients with ST-elevation myocardial infarction (STEMI). Methods:Consecutive ST-elevation myocardial infarction patients requiring primary percutaneous coronary interventions withthrombolysis in myocardial infarction (TIMI) flow grades 0 or 1, were randomly divided into an experimental group and a control group. For the control group, the pre-dilation balloon was removed immediately after achieving antegradeperfusion beyond the lesion. The experimental group underwent stepwise reperfusion, with the balloon pressure being gradually reduced. Baseline data, intra/post-procedural primary percutaneous coronary interventions data, 3-month left ventricular ejection fraction (LVEF), and major adverse cardiac events (MACE) were documented and compared between the two groups. Results:The control group experienced more severe symptoms during the procedure (p = 0.034), higher post-procedural corrected TIMI frame counts (p = 0.047), more significant hemodynamic changes (p = 0.031), and increased rates of ventricular tachycardia/ventricular fibrillation (p = 0.035). Additionally, they had a higher total number of arrhythmias (p = 0.017), a lower 90-min ST segment resolution rate (p = 0.045), and elevated cTNI levels one week after the procedure (p = 0.047). Three months later, the control group demonstrated a lower LVEF compared to the experimental group (p = 0.048) and a trend towards more drug-treated arrhythmias (p = 0.073). No differences were observedin other statistical results.Conclusion:In patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary interventions, controlled stepwise reperfusion by adjusting the pre-dilation balloon pressure effectively reduces myocardial ischemia-reperfusion injury, improves myocardial perfusion,and supports the recovery of cardiac function.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

Triglyceride glucose-waist circumference as a predictor of mortality and subtypes of cardiovascular disease: asystematic review and meta-analysisDOI https://doi.org/10.1186/s13098-025-01616-9AbstractBackgroundThe significant burden of cardiovascular diseases underscores the necessity for identifying novel predictive markers that can forecast both cardiovascular diseases and mortality. In recent years, Triglycerideglucose -obesity-related parameters have gained special attention in thisregard. This study aimed to assess the association between Triglyceride glucose -waist circumference (TyG-WC) and cardiovascular diseases and mortality. MethodsA comprehensive search was performed in databases including PubMed, Scopus, and Web of Science from their inception until October 6, 2024. The key outcomes of interest included all-cause mortality, cardiovascular mortality, cardiovascular diseases, myocardialinfarction, stroke, coronary artery diseases, peripheral artery diseases, and heart failure. The pooled risk ratio (RR) with corresponding 95% confidence intervals (CI) was calculated. Meta-analysis was carried out using StataMP 14.0. ResultsA total of 17 studies were included in the analysis. The number of participants ranged between 2,224 and 95,342. The meta-analysis revealed that Triglyceride glucose -waist circumference is significantly associated with an increased risk of all-cause mortality, cardiovascular mortality, cardiovascular diseases, myocardial infarction,stroke, coronary artery diseases, and peripheral artery diseases. However, only one study addressed the relationship between Triglyceride glucose -waist circumference and heart failure with a positive correlation. ConclusionThis study indicates that Triglyceride glucose -waist circumference could serve as a promising predictor ofcardiovascular diseases, along with cardiovascular and all-cause mortality. Given its accessibility, Triglyceride glucose -waist circumference may be a practical tool for screening purposes.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.