Drug therapy articles within Nature Reviews Cardiology

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  • Comment |

    Novel cardiovascular therapeutics have the potential to improve health outcomes, but financial toxicity from high out-of-pocket costs can limit the reach of these medications and worsen existing health disparities. Understanding the phenomenon of financial toxicity in treating cardiovascular disease is crucial to achieving health equity.

    • Alexander H. Gunn
    •  & Akshay Pendyal

  • Review Article |

    In this Review, Lam and colleagues evaluate the current literature on sex-related differences in treatment responses in patients with heart failure and highlight potential approaches for tailored therapies and the need for sex-specific evaluation of treatment efficacy and safety in future research.

    • Janice Y. Chyou
    • , Hailun Qin
    •  & Carolyn S. P. Lam

  • Clinical Outlook |

    Atrial fibrillation is the most common sustained arrhythmia and imposes a substantial burden on patients and health-care providers. Clinical evidence suggests that antiarrhythmic therapy to restore and maintain sinus rhythm (rhythm control) can reduce adverse cardiovascular outcomes in patients with new-onset atrial fibrillation. As a result, a paradigm shift towards rhythm control over rate control therapy is emerging, increasing the clinical need for effective and safe antiarrhythmic drugs.

    • Felix Wiedmann
    •  & Constanze Schmidt

  • Review Article |

    In this Review, Sarraju and Nissen summarize the clinical trial evidence for coronary atherosclerotic plaque stabilization and regression with plasma LDL-cholesterol-lowering therapy and other treatments. Invasive and non-invasive imaging modalities used to assess plaque burden and composition are discussed.

    • Ashish Sarraju
    •  & Steven E. Nissen

  • Clinical Outlook |

    The risk of stroke in patients with atrial high-rate episodes (AHREs) depends on age, comorbidities and AHRE burden. Two randomized clinical trials on the use of oral anticoagulant therapy for stroke prevention in older patients with short and rare AHREs have reported conflicting findings on the efficacy of oral anticoagulation in this patient population, although both trials report a significantly increased risk of major bleeding with oral anticoagulation.

    • Tatjana Potpara
    •  & Carina Blomstrom-Lundqvist

  • Research Highlight |

    Treatment with the glucagon-like peptide 1 receptor agonist semaglutide, administered subcutaneously at a dose of 2.4 mg once per week, reduces the risk of major cardiovascular events by 20% compared with placebo in patients who are overweight or obese and with pre-existing cardiovascular disease but without diabetes mellitus, according to findings from the SELECT trial.

    • Irene Fernández-Ruiz

  • Research Highlight |

    Data from the ARIES-HM3 trial show that excluding aspirin from the antithrombotic regimen in patients with advanced heart failure and a left ventricular assist device reduces the number of bleeding events and does not increase the risk of thromboembolism.

    • Gregory B. Lim

  • Research Highlight |

    In patients with heart failure (HF) with preserved ejection fraction and obesity, treatment with the glucagon-like peptide 1 receptor agonist semaglutide (2.4 mg) leads to large reductions in HF-related symptoms and physical limitations, improves exercise function and decreases body weight compared with placebo, according to the STEP-HFpEF trial.

    • Irene Fernández-Ruiz

  • Clinical Outlook |

    Novel non-steroidal mineralocorticoid receptor antagonists (MRAs) have improved pharmacological properties compared with steroidal MRAs. Among the non-steroidal MRAs, finerenone has been approved for patients with chronic kidney disease who have diabetes mellitus and has demonstrated favourable safety and promising early results in patients with heart failure.

    • Gerasimos Filippatos
    •  & Dimitrios Farmakis

  • Research Highlight |

    In the multicentre, randomized, placebo-controlled RAPID trial, use of symptom-prompted, self-administered, intranasally delivered etripamil was safe and superior to placebo for the conversion of paroxysmal superventricular tachycardia to sinus rhythm.

    • Karina Huynh

  • Evidence-based Guidelines |

    Familial hypercholesterolaemia (FH) is a preventable cause of premature coronary artery disease and death. This guidance article from the International Atherosclerosis Society provides a comprehensive overview of FH care that includes recommendations on the detection and management of patients with FH, as well as strategies to maximize implementation.

    • Gerald F. Watts
    • , Samuel S. Gidding
    •  & Raul D. Santos

  • Research Highlight |

    In a diverse population of patients with heart failure with mildly reduced or preserved ejection fraction stabilized after a recent worsening heart failure event, treatment with sacubitril–valsartan induces greater reductions in plasma NT-proBNP levels and is associated with clinical benefit compared with valsartan alone, despite a higher rate of symptomatic hypotension.

    • Irene Fernández-Ruiz

  • Review Article |

    In this Review, the authors discuss current treatment regimens for lowering plasma LDL cholesterol levels to reduce the risk of cardiovascular disease, highlight treatment gaps and challenges, as well as describe opportunities raised by novel available therapies and potential future therapeutic approaches.

    • Julia Brandts
    •  & Kausik K. Ray

  • Clinical Outlook |

    Factor XIa inhibitors are being tested in clinical trials, with the assumption that these agents are as effective as direct oral anticoagulants but cause fewer bleeding events. Findings from phase II trials of direct inhibitors of factor XIa for the prevention of first-ever and recurrent ischaemic stroke or recurrent major coronary artery events suggest fewer bleeding events but with uncertainty about efficacy.

    • Bruna Gigante
    •  & Hugo ten Cate

  • Review Article |

    In this Review, Gawaz and colleagues discuss the pathophysiological role of platelets in acute myocardial ischaemia, vascular inflammation and atherosclerotic progression, summarize the current clinical concepts in antiplatelet therapy and describe novel therapeutic targets for antiplatelet drugs that are currently in development.

    • Meinrad Gawaz
    • , Tobias Geisler
    •  & Oliver Borst

  • Review Article |

    Glucagon-like peptide 1 (GLP1) receptor agonists reduce the rate of major adverse cardiovascular events in people with type 2 diabetes mellitus. In this Review, Ussher and Drucker discuss the possible mechanisms of cardiovascular benefit of GLP1 receptor agonists and highlight the novel GLP1-based multi-agonists currently in development.

    • John R. Ussher
    •  & Daniel J. Drucker

  • Research Highlight |

    MK-0616, an oral inhibitor of PCSK9, safely and effectively lowers plasma levels of LDL cholesterol in a dose-dependent manner in patients with hypercholesterolaemia.

    • Gregory B. Lim

  • Research Highlight |

    Findings from the STELLAR trial show that the addition of sotatercept to background therapy in patients with pulmonary arterial hypertension significantly improved exercise capacity compared with placebo.

    • Karina Huynh

  • Review Article |

    In this Review, Packer summarizes the latest advances in our understanding of the mechanisms that underlie the benefits of sodium–glucose cotransporter 2 (SGLT2) inhibitors in heart failure, identifies specific pathways that are likely to mediate a direct effect of SGLT2 inhibitors on cardiomyocytes and proposes a novel conceptual framework that explains the findings from experimental studies and clinical trials.

    • Milton Packer

  • Comment |

    While there is understandable excitement about the development of new cardiovascular drugs, an unmet and equally important need is to perform new clinical trials of old drugs, including to determine their longer-term effects and if and when they should be discontinued after years of use. New trials of old drugs can inform clinical practice and are much needed.

    • Christopher B. Granger
    • , Stuart J. Pocock
    •  & Bernard J. Gersh

  • Research Highlight |

    According to the TIME trial, patients can take standard antihypertensive medications either in the morning or in the evening, because the timing of therapy has no significant effect on major cardiovascular outcomes.

    • Gregory B. Lim

  • Research Highlight |

    Cold shock domain-containing protein E1 (CSDE1) has been identified as a novel post-transcriptional regulator of LDL receptor levels in the liver.

    • Gregory B. Lim

  • Research Highlight |

    In the SECURE trial, a polypill containing aspirin, ramipril and atorvastatin taken within 6 months after myocardial infarction reduces the risk of major adverse cardiovascular events compared with usual care.

    • Karina Huynh

  • Research Highlight |

    In patients with heart failure (HF) with mildly reduced or preserved ejection fraction, the SGLT2 inhibitor dapagliflozin reduces the risk of worsening HF or cardiovascular death by 18%, reduces total HF events and cardiovascular deaths by 23% and improves HF symptoms, according to findings from the DELIVER trial.

    • Irene Fernández-Ruiz

  • Clinical Outlook |

    More than 50% of patients with chronic heart failure present with iron deficiency, which is associated with reduced quality of life and worse prognosis. Intravenous iron supplementation therapy has been shown to improve clinical outcomes in these patients.

    • Pedro Moliner
    •  & Josep Comin-Colet

  • Clinical Outlook |

    The totality of evidence from large-scale, randomized, controlled clinical trials and mechanistic studies in the laboratory has provided six crucial lessons about the emerging role of SGLT2 inhibitors to prevent the onset of heart failure in patients at high risk and slow the progression of heart failure in patients with established disease.

    • Milton Packer

  • Review Article |

    The evolution of stent design has reduced the incidence of stent thrombosis, meaning that the duration of dual antiplatelet therapy after percutaneous coronary intervention (PCI) might be shortened. In this Review, the authors describe the current evidence base and ongoing clinical trials into the use of P2Y12 inhibitor monotherapy after PCI.

    • Davide Capodanno
    • , Usman Baber
    •  & Dominick J. Angiolillo

  • Research Highlight |

    The results of two early-phase trials of novel lipid-lowering agents targeting ANGPTL3 and lipoprotein(a) might help to combat the residual risk of cardiovascular events in patients treated with statins and/or PCSK9 inhibitors to lower LDL-cholesterol levels.

    • Gregory B. Lim

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