Category: Cardiovascular Disease

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Digoxin Benefits Heart Failure Patients, Study Shows

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Right side heart failure. Credit: Scientific Animations CC4.0

Analyses supporting the use of digitalis glycosides in patients with heart failure were presented in a Late-Breaking Science session at Heart Failure 2026, [1–3] the annual congress of the Heart Failure Association of the European Society of Cardiology.

Investigations from researchers at University Medical Center Groningen, Netherlands, evaluated the effects of the digitalis glycosides, digoxin and digitoxin, in patients with heart failure (HF) and reduced or mildly reduced left ventricular ejection fraction (HF(m)rEF). 

“Digoxin is the oldest drug in cardiovascular medicine, but there has been uncertainty about its value in HF(m)rEF management,” explained Principal Investigator, Professor Dirk van Veldhuisen. “In the DIG trial, published in 1997, digoxin had a neutral effect on the primary endpoint of mortality, but a 28% reduction in heart failure hospitalisations (a secondary endpoint) was observed. Later analyses from DIG showed that lower serum digoxin levels were associated with a favourable effect, while higher digoxin levels worsened prognosis. [4] We conducted the DECISION trial to investigate whether low-dose digoxin has positive effects on cardiovascular outcomes in patients with HF(m)rEF receiving contemporary guideline-recommended treatments.”[1]

The double-blind DECISION trial was conducted at 43 sites in the Netherlands (NCT03783429). Patients with symptomatic mild-to-moderate HF(m)rEF (left ventricular ejection fraction <50%). were randomised to low-dose digoxin or placebo, with a target serum digoxin concentration of 0.5–0.9 ng/mL.  Both patients with sinus rhythm and atrial fibrillation were enrolled. The primary outcome was a composite of total worsening HF events (defined as total hospitalisations or total urgent hospital visits for worsening HF) and cardiovascular mortality. A total of 1001 patients were randomised. The mean age of the participants was 73 years, 28% were women, and 29% had atrial fibrillation.

Low-dose digoxin did not significantly reduce the primary outcome. Over a median follow-up of 36.5 months, 238 primary-outcome events occurred in 131 of 500 patients in the digoxin group, while 291 primary-outcome events occurred in 152 of 501 patients in the placebo group (rate ratio [RR] 0.81; 95% confidence interval [CI] 0.61 to 1.07; p=0.133). Although not statistically significant, the total number of worsening HF events was lower in the digoxin group than in the placebo group (RR 0.76; 95% CI 0.54 to 1.05). Cardiovascular mortality was similar with digoxin and placebo (hazard ratio [HR] 0.93; 95% CI 0.69 to 1.26). Low-dose digoxin was generally well tolerated and safe.

Last year, results were published from the DIGIT-HF trial, which studied another digitalis glycoside, digitoxin, in patients with advanced HF and reduced ejection fraction. [5] Treatment with digitoxin led to a lower risk of death from any cause or hospital admission for worsening HF.

A second presentation at Heart Failure 2026, by Associate Professor Kevin Damman, demonstrated positive overall benefits with digoxin/digitoxin in a meta-analysis of the DECISION, DIGIT-HF and DIG trials. [2] Across 9,013 patients, digitalis glycoside treatment reduced the risk of the primary endpoint of time to cardiovascular death or first worsening HF event compared with placebo (HR 0.85; 95% CI 0.80 to 0.90; p<0.001). This reduction was mostly attributable to the effect on time to the first worsening HF event (HR 0.75; 95% CI 0.69 to 0.81; p<0.001). There was no statistically significant heterogeneity by trial, treatment period or type of digitalis glycoside. In addition, the effect was not attenuated in patients who were already receiving full guideline-directed HF treatment. 

A third presentation, by Professor Peter van der Meer, found that digoxin withdrawal was associated with clinical deterioration. [3] This was a prespecified blinded analysis that followed patients who stopped taking study medication at the end of the DECISION trial, and were subsequently followed for another 6 weeks. Across 587 patients, there were more cardiovascular deaths and HF events in patients after withdrawal of digoxin than after placebo withdrawal (RR 7.37; 95% CI 1.56 to 34.88; p=0.012). 

Summing up the evidence, Professor van Veldhuisen concluded, “In patients with HF(m)rEF, low-dose digitalis glycosides seem to be an effective additional medical treatment option, which are cheap, safe and easy to use. The totality of the evidence supports the role of low-dose digoxin in the contemporary management of HF, with caution warranted when it is stopped.”

References

[1] ‘Low-dose digoxin in heart failure’ presented during the Hottest trials (2) session on 10 May at 13:15 to 14:15 in Room 3, with simultaneous publication in Nature Medicine: https://doi.org/10.1038/s41591-026-04406-6.


[2] ‘DECISION/DIGIT-HF/DIG study level meta analysis’ presented during the Hottest trials (2) session on 10 May at 13:15 to 14:15 in Room 3.


[3] ‘Blinded withdrawal of digoxin or placebo’ presented during the Hottest trials (2) session on 10 May at 13:15 to 14:15 in Room 3. 


[4] Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336:525−533.


[5] Bavendiek U, Großhennig A, Schwab J, et al. Digitoxin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2025;393:1155–1165.

Source: European Society of Cardiology

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Cause of Bicuspid Aortic Valve Revealed in Genetic Study

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New clues from genetic research may help explain what causes the most common heart defect present at birth. Researchers in Sweden have identified rare DNA changes during foetal development that can lead to a condition known as bicuspid aortic valve (BAV).

Pelin Sahlén

Publishing in Nature Communications, a team of researchers from KTH Royal Institute of Technology and Karolinska Institutet identified nearly 30 times more potential genes linked to BAV than previously known. The aortic valve has three cusps; a bicuspid aortic valve is a valve with only two cusps.

The study offers a clearer picture of how heart valves form, says Pelin Sahlén, an associate professor at KTH Royal Institute of Technology whose former student Artemy Zhigulev led the study as his PhD project.

“These findings expand our understanding of the genetic complexity of BAV and raise hope for new ways to improve how genetic risk is assessed,” Sahlén says.

People born with BAV often go on to develop complications, such as a narrowing of the valve or enlargement of the aorta. More than half will undergo surgery at some point in their lives.

But the underlying causes have long remained unclear. Earlier research showed a small number of cases are caused by changes in genes that contain the instructions for making proteins – the molecules that carry out most of the work in a cell. This explained only about 10% of all cases, says the study’s co-author Hanna Björck, associate professor at Karolinska Institutet.

“Most patients had no known genetic cause,” she says.

The new study shifted attention to a different part of the DNA – the regulatory regions of the genome that act like switches, turning important genes on or off during early development. The researchers studied tissues close to heart valves from eight people with BAV and eight people with normal valves.

Rather than focus on genes themselves, Sahlén says they used a technique called HiCap, for targeted 3D genome mapping to examine how the DNA is arranged inside the cell and how regulatory regions connect to key developmental genes.

They found that rare mutations in the regulatory parts of DNA are likely to play a major role in causing BAV. Each patient in the study had different mutations, but many of these mutations disrupted the same important genes that shape the aortic valve in the foetus, Zhigulev says.

“This suggests that even though the mutations vary, they interfere with the same developmental processes,” he says.

One of the surprising discoveries is that adult tissues retain traces of what went wrong during foetal development, Sahlén says. Harmful changes that happened before birth can be detected decades later. The finding indicates adult tissue samples can be used to study problems that originally occurred in the early stages of life.

By David Callahan

Source: KTH Royal Institute of Technology

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A New Explanation for the Rise in Heart Disease Risk After Menopause

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A new study points to gene regulation as a key factor in post-menopausal cardiovascular risk

Photo by Anthony Shkraba on Pexels

Scientists at Virginia Tech say that the increased risk of cardiovascular disease after menopause may stem not only from declining hormone levels, but also from how those changes influence gene activity.

In a new paper published in the journal Cells, researchers examine growing evidence that declining oestrogen levels can alter epigenetics, the system that controls when genes turn on and off. These changes may help explain why rates of heart disease, diabetes, and other metabolic conditions rise sharply in women after menopause.

In addition, the study identifies a potential link between oestrogen loss, changes in gene regulation, and cardiovascular health. The epigenome, the full set of chemical modifications that regulate gene activity without altering DNA, has been studied extensively in breast cancer, but far less is known about how these mechanisms operate in the heart and cardiovascular system, according to  Sumita Mishra, senior author of the study and assistant professor at the Fralin Biomedical Research Institute at VTC.

The findings suggest that oestrogen-related gene regulation pathways, long studied in cancer biology, may also play an important role in cardiometabolic health. Heart disease is the leading cause of death for women, and risk increases during and after the menopause transition, according to the National Heart, Lung, and Blood Institute.

“For years, we’ve focused on oestrogen loss as the primary driver of increased heart disease risk after menopause,” Mishra said. “What’s becoming clear is that the story is more complex. By reframing menopause-related health risks around gene regulation, this work points to new directions for future treatments that may extend beyond hormone therapy to more directly target these regulatory pathways.”

In addition, genetic predisposition and environmental factors, such as diet, exercise, and metabolic disease, likely interact with these pathways to shape cardiovascular risk after menopause, beyond what hormone replacement alone can address.

Rather than identifying a single new mechanism, the results of the study offer a new way of understanding the problem by connecting hormone loss to longer-term changes in how the body regulates interconnected systems involved in cardiovascular and metabolic health.

The study also highlights that many existing interventions used to manage cardiometabolic disease in postmenopausal women, including lipid-lowering therapies, glucose-lowering agents such as GLP-1 receptor agonists and SGLT2 inhibitors, and lifestyle interventions such as diet and exercise, may intersect with gene regulatory pathways influenced by oestrogen.

Emerging evidence suggests that these strategies can modulate metabolic and inflammatory signalling networks and, in some cases, the way DNA is packaged and regulated, helping to link current therapies to menopause-associated biological changes.

The researchers also highlight a gap in current knowledge, noting that much of the mechanistic evidence comes from laboratory and preclinical studies, and that more research in humans is needed to understand how these processes unfold over time.

Looking ahead, ongoing studies in the Mishra laboratory will focus on understanding how metabolic and gene-regulatory pathways are integrated in cardiometabolic disease, including in postmenopausal health. 

The new study also aligns with ongoing research in the Mishra laboratory focused on heart failure with preserved ejection fraction (HFpEF), a form of heart disease that disproportionately affects women and becomes more prevalent after menopause. HFpEF is closely linked to obesity and metabolic dysfunction and remains a major unmet clinical challenge.

In related work published in Hypertension, the Mishra team investigated how oestrogen-dependent signaling pathways in the heart and vasculature are altered after menopause, contributing to changes in vascular function and metabolic regulation. 

Together, these findings emphasise a broader research focus on how hormonal signalling interacts with molecular pathways that govern cardiometabolic health in postmenopausal women. This growing body of work may help guide the development of more targeted strategies to prevent and treat cardiovascular disease in this population.

Mishra is a member of the Center for Exercise Medicine Research and the Center for Vascular and Heart Research at the Fralin Biomedical Research Institute. She is also an assistant professor in the Department of Human Nutrition, Foods, and Exercise in the College of Agriculture and Life Sciences.

By John Pastor

Source: Virginia Tech

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Ablation Superior to Drugs in Treating Persistent AFib

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Large international clinical trials show an innovative procedure outperforms drugs for advanced atrial fibrillation

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A minimally invasive heart procedure may be a better first-line treatment than medication for people living with advanced forms of atrial fibrillation (AFib), according to a major international clinical trial led by researchers at the UBC Faculty of Medicine.

For decades, most patients with AFib have been treated with medications first. Procedures like catheter ablation – a minimally invasive technique used to correct faulty electrical signalling in the heart – have typically been reserved for patients whose symptoms persist despite drug therapy. While recent research has suggested ablation may be a more effective initial treatment for early-stage disease, it has also been unclear whether this is true for patients with more advanced disease, who tend to be older, have more underlying health conditions and face higher risks overall.

Published in The New England Journal of Medicine, the new study shows starting with ablation can lead to better outcomes for patients with advanced forms of AFib.

“Traditionally, we’ve taken a stepwise approach, starting with medications and moving to procedures later,” said Dr Jason Andrade, clinical professor at UBC’s faculty of medicine and investigator at the Centre for Cardiovascular Innovation. “What this trial shows is that, even in patients with more advanced AFib, earlier intervention with ablation can provide substantial benefits and better control of the disease.”

A different way to treat the heart

The study focused on patients with persistent AFib, a more serious form in which the abnormal rhythm lasts longer and is more difficult to treat.

Researchers randomly assigned patients to receive either catheter ablation as their initial treatment or standard anti-arrhythmic drug therapy.

During catheter ablation, physicians guide thin, flexible tubes through blood vessels into the heart. Once in place, they eliminate the areas of heart tissue responsible for triggering and sustaining the abnormal electrical signals.

In this study, researchers used a newer technique called pulsed field ablation, which delivers short bursts of electrical energy to precisely target heart tissue.

“You can think of it as resetting the heart’s electrical system,” said Dr. Andrade. “Instead of using heat or freezing, this approach uses carefully controlled pulses to interrupt abnormal signals while minimising damage to surrounding tissue.”

After one year, patients who underwent ablation were significantly more likely to remain free of abnormal heart rhythms than those who started with medication. The overall risk of serious adverse events was similar between the two groups.

“Patients with more advanced atrial fibrillation are inherently more complex,” said Dr Andrade. “Even in this higher-risk group, starting with ablation can offer better control of the condition.”

A decade of reshaping global care

The findings build on more than a decade of research led by Dr Andrade and his team that has helped transform how AFib is treated worldwide.

Earlier landmark trials from this group demonstrated that catheter ablation could be used as a first-line treatment in patients with early-stage AFib. In addition, these studies were the first to demonstrate that catheter ablation was a disease-modifying therapy, significantly slowing the progression of the disease.

Those discoveries helped shift clinical practice globally, with physicians increasingly offering ablation earlier in a patient’s care.

Together, the program of research has redefined how AFib can be treated across its full course, from early to more advanced stages, giving patients and clinicians clearer guidance on when to consider ablation.

“Our goal is to give patients and clinicians the evidence they need to make the best decision for each individual,” said Dr Andrade. “This study fills an important gap for a group of patients where the answer hasn’t been clear.”

Source: The University of British Columbia

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Genetic Study in Indians Finds New Pathways Involved in Cardiometabolic Disease

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Study of 3000 Punjabi Sikhs may yield new targets for treating Type 2 diabetes and other disorders

Photo by Sangharsh Lohakare on Unsplash

A study conducted in an Indian population has identified new molecular pathways that contribute to cardiovascular disease, which had not been reported previously in studies of Europeans. Dharambir Sanghera of the University of Oklahoma Health Sciences Center, US, led the new study, which was published April 23rd in the open access journal PLOS Medicine.

Worldwide, rates of cardiometabolic disease, which includes obesity, Type 2 diabetes and heart disease, are on the rise, and South Asian people living abroad appear to be especially susceptible. Previous studies have looked for genes that influence the levels of various breakdown products of lipids in the blood and their connection to different diseases, but most of this research has been conducted in people of European ancestry.

In the new study, researchers looked at how genetics influenced the levels of 516 lipid metabolites in the blood of 3000 Punjabi Sikh individuals, in an effort to better understand how these genetic pathways contribute to disease in different ethnic groups. They compared their findings to previous results from more than 1 million Europeans and 15 000 individuals with Indian ancestry. The team identified new genetic pathways that link specific lipid metabolites to disease. Notably, they confirmed that one metabolite, LPC O-16:0, which is known to be involved with immune cell signaling and inflammation, influences Type 2 diabetes risk. They also identified a genetic variant that may protect Indians from developing heart disease by modulating levels of the metabolite PC 38:4.

These findings offer new insights into the diverse molecular origins of cardiometabolic disease and provide potential pathways to be explored for designing innovative therapies. The researchers conclude that including more non-European participants in this type of research would help in identifying distinct disease subtypes linked to different genetic pathways. These advances would likely be beneficial in clinical practice by enabling more personalised therapies and preventive strategies for people from different backgrounds.

The authors add, “This study reveals new genetic pathways and lipid markers that contribute to type 2 diabetes and heart disease, specifically emphasising how immune system signaling affects metabolic health. By identifying unique genetic signatures in Asian Indians, the research advocates for ancestry-specific medical approaches to address chronic immuno-vascular conditions in cardiometabolic disease.”

Provided by PLOS

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Benefits of Physical Activity May Outweigh Risks for Kids with Cardiomyopathy, ICDs

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With proper assessment and monitoring, the risk of serious heart events during physical activity may be lower than previously believed for children and adolescents with certain heart conditions, according to a new American Heart Association scientific statement

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Physical activity in children and teenagers with cardiomyopathy (conditions that affect the heart muscle’s structure and function, impairing its ability to pump or fill effectively), as well as children with implantable cardioverter-defibrillators (ICDs) may be safer than previous research suggested, according to a new scientific statement from the American Heart Association, published today in the Association’s flagship peer-reviewed journal Circulation.

While physical activity and exercise are essential for childhood development and long-term health, they have been traditionally discouraged among children and adolescents with cardiomyopathies and ICDs (implantable devices that detect life-threatening abnormal heart rhythms and deliver electrical shocks) due to concerns that they could worsen heart function or lead to sudden cardiac death.

“While safety is always paramount, halting all physical activity among children with cardiomyopathy or ICDs has at times led to unintended consequences. The latest research indicates that restricting children’s movement can negatively affect their heart health, physical fitness levels, mental well-being and social development, and quality of life,” said Jonathan B. Edelson, MD, MSCE, chair of the scientific statement writing group, an associate professor of paediatrics and medical director of the sports cardiology program and heart transplant and ventricular assist device programs in the division of cardiology at Children’s Hospital of Philadelphia.

What do parents and caregivers need to know?

Ensuring safe participation in physical activity requires thoughtful, individualized planning and ongoing collaboration among clinicians, families and patients.

  • Personalised approach: Tailored risk assessments based on diagnosis, risk profile, genetic profile and clinical evaluations are critical to better guide decisions about prescribing physical activity for children with different types of cardiomyopathies. Various diagnostic screening tools, such as echocardiograms, cardiac imaging and exercise stress tests, can be used to assess symptoms at rest and with activity. Genetic testing and family screening can also be helpful to assess individual risk.
  • Shared decision-making: Clinicians, families and (when developmentally appropriate) children or adolescents with cardiomyopathy and/or ICDs can work together to balance a patient’s risk, patient- and family-tailored goals and values. It is important for clinicians to disclose when risk evidence is based on adult data.
  • Close follow-up and reassessment: Ongoing monitoring is important to track potential shifts in risk, assess if symptoms progress and evaluate if heart function improves or deteriorates. The recommendations for safe physical activity must evolve as the child grows, activities change and the disease progresses.


Close follow-up and reassessment: Ongoing monitoring is important to track potential shifts in risk, assess if symptoms progress and evaluate if heart function improves or deteriorates. The recommendations for safe physical activity must evolve as the child grows, activities change and the disease progresses.

What types of activities can be considered?

The new scientific statement aims to shift from adopting a one-size-fits-all approach to physical activity limitations to considering ways for youth with heart conditions or an ICD to safely participate in physical activities – from low-intensity daily activities to high-intensity training and sports in select cases – after a detailed individualised risk assessment.

Light-to-moderate intensity exercise (such as walking, light cycling or swimming) may be appropriate to maintain physical fitness, social development and quality of life, with regular monitoring of their condition. Structured physical activity, such as fitness classes, strength training, running, biking, hiking or organised sports programs, may be reasonable for some children and adolescents with heart conditions. For some carefully selected paediatric patients with certain cardiomyopathies, participation in physical activity including competitive sports may be reasonable after expert assessment and shared decision-making discussion about the risks and benefits. Emergency action plans, including AED (automated external defibrillator) access and bystanders trained in CPR, are essential during organised sports. Additional guidance for specific types of cardiomyopathies are detailed in the manuscript.

“Children with cardiomyopathy should not automatically be sidelined from participating in physical activity, including recreational or competitive sports,” Edelson said. “Most children should be physically active – with individualised evaluation, monitoring and planning. Physical activity is important for their long-term health, physical and social development.”

The statement notes more research is needed about childhood cardiomyopathies because most of the findings in the statement are based on observational studies in adults; therefore, findings should be applied cautiously to a paediatric population. In addition, outstanding questions remain, such as how moderate or vigorous exercise may affect the long-term progression and how risk varies across different types of cardiomyopathies.

Source: American Heart Association

Categories : Cardiovascular Disease NeurologyTags :

Combo Pill Shown to Cut Risk of Recurrent Stroke by 39%

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Haemorrhagic stroke. Credit: Scientific Animations CC4.0

Treatment with GMRx2, a single pill combination of three low-dose blood pressure medicines, significantly reduced the risk of another stroke in patients with intracerebral haemorrhage and high blood pressure. Results from the TRIDENT randomised controlled trial, led by The George Institute for Global Health, are published in The New England Journal of Medicine.

Professor Craig Anderson, Principal Investigator and Senior Professorial Fellow at The George Institute, said, “Lowering blood pressure is the only proven method to prevent another stroke, yet achieving good blood pressure control is a real challenge. One big issue is that the number and doses of antihypertensive medications are not increased when needed and doctors and patients struggle with complex pill regimens.

“Our study showed that GMRx2, a once-daily triple combination pill, cut the risk of another stroke by 39%. These findings could translate to important treatment benefits for the millions of people affected by intracerebral haemorrhage worldwide who face a high risk of having another one.”

The international study involved 1670 patients who had experienced intracerebral haemorrhage and had systolic blood pressure (SBP) of 130–160 mmHg. They received GMRx2, a single pill combination containing telmisartan 20mg, amlodipine 2.5mg, and indapamide 1.25mg, or a placebo, alongside standard care.

During an average period of follow-up of three years, stroke occurred in 4.6% of patients receiving GMRx2 compared to 7.4% in the placebo group. This equated to a 39% lower risk of recurrent stroke. Overall, the results showed one stroke was prevented for every 35 patients treated with GMRx2.

The GMRx2 group achieved better blood pressure control, with mean SBP levels 9mmHg lower than the placebo group. Patients treated with GMRx2 also experienced reduced rates of major cardiovascular events (non-fatal stroke, non-fatal heart attack and cardiovascular death) by 33% versus placebo. Serious adverse events were comparable between the treatment and placebo groups, affecting 23.8% and 26.8% of patients, respectively. Concerns of fatigue, dizziness and falls were infrequent and occurred similarly between the GMRx2 and placebo groups.

Almost 17 million people worldwide have experienced intracerebral haemorrhage, and there are over three million new cases each year. Among patients who survive this type of stroke, approximately one quarter will later die from recurrent stroke or cardiovascular disease. The condition disproportionately affects people in low- and middle-income countries (LMICs), where there is often poorer control of high blood pressure. Intracerebral haemorrhage is one of the most dangerous types of strokes, occurring at almost twice the rate in LMICs compared to high-income countries.

Professor Jeyaraj Pandian, President of the World Stroke Organization, said, “TRIDENT is a major advance in showing the enormous benefits of effective blood pressure control after an intracerebral haemorrhage, and a simple and effective strategy in which this can be achieved, with relevance to patients all over the world.”

Professor Anderson added, “These study results have the potential to mark a real shift in how we manage blood pressure following a stroke. This single-pill triple combination helped patients reach target blood pressure levels.

“We hope GMRx2 is approved for this indication by regulatory authorities throughout the world, and if so that it is widely used as an effective approach with the potential to improve the outcome for patients affected by intracerebral haemorrhage, and also ischaemic stroke, across the globe.”

Source: The George Institute for Global Public Health

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AI Model Predicts How CPAP Affects Cardiovascular Risk in Obstructive Sleep Apnoea

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Mount Sinai researchers have created an analytic tool using machine learning that can predict cardiovascular disease risk in millions of patients with obstructive sleep apnoea, according to findings recently published in Nature Communications Medicine.  

The team said their study is the first to provide estimates of whether continuous positive airway pressure (CPAP), a widely used therapy for obstructive sleep apnoea, will increase or decrease an individual’s cardiovascular risk. It highlights the potential for precision medicine and varied approaches to tailor clinical care and reduce cardiovascular disease risk in vulnerable patients. 

Obstructive sleep apnoea is a common, serious condition in which breathing repeatedly stops and starts during sleep. It is associated with elevated risks for cardiovascular disease, including stroke and heart disease. CPAP, which provides a continuous stream of pressurised air through a mask and helps eliminate breathing disturbances during sleep, remains the most effective treatment for sleep apnoea. However, prior large studies have not shown that CPAP lowers risks for cardiovascular disease in patients with this disease.  

The Mount Sinai researchers used a machine learning algorithm to create an analysis model that predicts how CPAP could affect an individual’s cardiovascular health – estimating each patient’s likeliness of benefit or harm from the therapy, based on their sleep and health information.  

“Our findings represent a significant advancement in personalised medicine, moving away from a one-size-fits-all strategy in the treatment of obstructive sleep apnoea,” said co-corresponding author Neomi A. Shah, MD, MPH, MSc, ATSF, Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine) and Artificial Intelligence and Human Health, and System Vice Chair of Faculty Affairs for the Department of Medicine at Icahn School of Medicine at Mount Sinai. “This underscores the value of new data-driven approaches like our model to assist clinicians in making informed decisions about CPAP treatment recommendations, enhancing personalised care to meet the individual needs of every patient.” 

The Mount Sinai team analysed data from the Sleep Apnea Cardiovascular Endpoints (SAVE) trial, the largest clinical cohort evaluating CPAP for cardiovascular disease prevention with more than 2,600 participants from 89 sites in seven countries, to estimate individualised treatment effect scores. They considered more than 100 predictors from sleep and health information to establish 23 key baseline features, such as prior medical conditions and smoking status, in their analysis model.  

The researchers found that treatment response significantly varied across the cohort. The model identified a subgroup who were expected to have improved cardiovascular risk with CPAP treatment; participants in this subgroup who were randomly assigned to receive the therapy experienced a 100-fold improvement in future cardiac risk compared with patients from this subgroup on usual care. Conversely, those in a subgroup predicted to be harmed by the therapy experienced a greater than 100-fold increase in cardiovascular disease outcomes, including recurrent strokes and heart attacks, when receiving CPAP compared with usual care.  

“These results demonstrate the power of machine learning for prediction of treatment effects in an era of precision medicine; however, such models require careful validation to prove their utility in clinical practice,” said co-primary author Oren Cohen, MD, Assistant Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine) at the Icahn School of Medicine. 

“Artificial intelligence in medicine must move beyond pattern recognition to causal reasoning,” said co-corresponding author Mayte Suarez-Farinas, PhD, Co-Director for the Division of Biostatistics and Data Science, and Professor of Population Health Science and Policy, and Artificial Intelligence and Human Health, at the Icahn School of Medicine. “By estimating individualised treatment effects over time using randomised clinical trial data, we move predictive AI toward decision-support tools grounded in causality and capable of informing real-world treatment decisions and improving outcomes.”  

Source: Mount Sinai

Categories : Cancer Cardiovascular DiseaseTags :

New Study Finds Common Blood Pressure Drug Boosts Cancer Treatment

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Credit: Pixabay CC0

Dartmouth Cancer Center (DCC) researchers have discovered that an existing, widely used blood pressure medication may help improve the effectiveness of certain cancer treatments – potentially expanding their use to many more patients and reducing toxicities.

In a new study led by clinician-scientist Tyler J. Curiel, MD, MPH, FACP, investigators found that the FDA-approved blood pressure drug telmisartan can significantly enhance the cancer-killing activity of the targeted cancer therapy olaparib.

“This study shows that a common, safe, convenient, tolerable, and inexpensive once-daily pill may significantly improve how well an important class of cancer therapies works,” said Curiel.

Exploiting cancer’s weakness

PARP inhibitor drugs, such as olaparib, work by exploiting weaknesses in how some cancer cells repair damaged DNA. PARP inhibitors are particularly effective in tumours with certain gene mutations. However, many tumours lack these mutations, limiting the number of patients who can benefit from these drugs. Cancers can also eventually develop resistance to PARP inhibitors.

In early studies, Curiel’s team discovered that when combined with olaparib, telmisartan can make tumours more vulnerable to PARP inhibitors, even when the tumours lack the gene mutations that usually make this type of drug effective.

The combination also stimulated an immune response within the tumour. Specifically, the combination of the two drugs fuelled the production of a type of molecule that helps the immune system recognize and attack cancer.

“This immune activation appears to be a key reason the combination works so well,” Curiel said.

Unique among blood pressure drugs

Telmisartan belongs to a class of medications called “angiotensin II receptor blockers” (ARBs), commonly prescribed to treat hypertension, or high blood pressure. But the DCC study found that the cancer-treatment-enhancing effects were unique to telmisartan among all of the ARBs tested.

Telmisartan also reduced levels of a protein inside tumour cells that cancers use to evade immune attack – further increasing its therapeutic potential.

“This study was about PARP inhibitors,” Curiel said. “But we also have a lot of evidence that telmisartan makes certain other chemotherapies and immunotherapies more effective through related mechanisms. Its potential could therefore extend to many other types of cancers and treatments.”

Bench to bedside: clinical trials

Telmisartan’s widespread use and high tolerability, even in people without high blood pressure, make it ideal for clinical use. Curiel’s team is already using the combination strategy in patients through two ongoing clinical trials at DCC.

One trial is for men with metastatic, castration-resistant prostate cancer. The first patient enrolled in the study experienced what Curiel described as an exceptional response to treatment. The second trial is in platinum-resistant ovarian cancer, which just enrolled its first patient.

“We are encouraged by what we are seeing so far,” Curiel said. “We have multiple trials in development to determine whether this approach can help more patients benefit from more effective cancer treatments.”

Source: Dartmouth Cancer Center

Categories : Cardiovascular Disease Lab Tests and ImagingTags :

Dual Imaging Identifies Cause of Heart Attack in Patients Without Blocked Arteries

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International study supports combining advanced imaging to guide diagnosis and care 

Photo by Joice Kelly on Unsplash

When Ashley Perlow felt a sharp pain shoot across her chest and into both wrists, she didn’t think it could be a heart attack. She was 36, a new mom, and otherwise healthy.

At the hospital, blood tests showed signs of a heart attack, but her arteries appeared normal.

Now, new research led by clinicians and researchers at NYU Grossman School of Medicine shows that in cases like hers, using two complementary heart imaging tests can identify the underlying cause of these heart attacks in most patients without coronary artery narrowing, helping guide diagnosis and medical treatment in a condition that often leaves patients without clear answers. The study is among the largest and most comprehensive to examine MINOCA, or myocardial infarction with non-obstructive coronary arteries, a condition that accounts for 6 to 15% of heart attacks and is about three times more common in women than men.

“When arteries are not badly blocked, it can be unclear what caused the event,” said Harmony R. Reynolds, MD, lead author and director of the Cardiovascular Clinical Research Center in the Leon H. Charney Division of Cardiology at NYU Langone Health. “What we show is that in most cases, we can find the underlying explanation, and most often it is a true heart attack. Our results support the need to do specialised imaging in all patients with MINOCA, because we could not reliably predict who will have specific imaging findings.”

The findings come from the Heart Attack Research Program (HARP), a large international, prospective study. The latest results were presented by Dr Reynolds as featured clinical research at the American College of Cardiology’s 2026 Annual Scientific Session and simultaneously published March 28 in Circulation.

Dr Reynolds and the team found that combining coronary optical coherence tomography (OCT) and a cardiac magnetic resonance imaging (MRI) identified the underlying cause of the heart event in 79 percent of study participants.

How Advanced Diagnostic Imaging Reveals the Cause

To better understand these cases in both women and men, researchers enrolled 336 patients across 28 international sites in the Unites States, Canada, and the United Kingdom. The median age of participants was 58 years, including 270 women and 66 men.

Using coronary OCT and cardiac MRI, researchers identified underlying causes, assessed how often each test provided a diagnosis, and examined differences between sexes.

During coronary OCT, a thin catheter is placed inside the coronary arteries to capture high-resolution images of the artery wall, helping detect plaque buildup or blood clots that may not appear on a standard angiogram. Cardiac MRI provides detailed images of the heart muscle, showing where damage has occurred and whether it is related to reduced blood flow, inflammation, or another cause.

Using both imaging techniques together, researchers identified a likely cause in 79% of patients.

Most (59%) had a typical heart attack mechanism related to reduced blood flow from plaque buildup, artery spasm or blood clotting, while 20% (67 patients) had conditions that mimic a heart attack, such as myocarditis, takotsubo syndrome, or other cardiomyopathies. These nonischaemic conditions require different treatment approaches than traditional heart attacks.

The new research builds on earlier work by Dr Reynolds and colleagues, published in 2020 in Circulation, that demonstrated the value of using the same imaging methods in a smaller group of women. The current study expands those findings to a larger, more diverse international population.

Implications for Patient Care

The findings provide important support for current clinical guidelines, which recommend additional imaging in these patients but have largely been based on expert consensus rather than large-scale data. The results also highlight the limitations of standard angiography, which shows blood flow but cannot detect problems within the artery wall or subtle heart muscle injuries.

The combination of OCT and cardiac MRI provided a significantly higher diagnostic yield than either test alone. The study also found that doctors cannot reliably predict which patients will benefit from one imaging test versus another based on symptoms, blood tests, or initial findings. Even patients with relatively low levels of cardiac biomarkers frequently had detectable heart damage on imaging.

“We had hoped to be able to tailor testing to individual patients,” said Dr Reynolds. “Instead, we found that comprehensive imaging is often necessary to get the full answer.”

Although MINOCA occurs more frequently in women, researchers found no significant differences in the underlying causes between women and men once the condition developed. This suggests that the disease process itself is similar once it occurs.

For Perlow, that clarity was critical. After months of unanswered questions, she was referred to Dr Reynolds at NYU Langone, where further evaluation and testing helped officially diagnose her condition as MINOCA and guide her care.

Source: NYU Langone Heath