30-Second Takeaway
- Lower blood pressure in isolated diastolic hypertension; benefit parallels other phenotypes without clear diastolic J-curve.
- In acute heart failure, add-on diuretics aid decongestion, while in-hospital SGLT2 inhibitors uniquely improve outcomes and renal safety.
- Early aspirin withdrawal after PCI appears harmful in STEMI but reasonable in NSTE-ACS when using potent P2Y12 monotherapy.
Week ending December 13, 2025
Refining cardiovascular therapy: who to treat, how aggressively, and with which modality
BP lowering in isolated diastolic hypertension confers similar cardiovascular protection as in other patients
This individual patient data meta-analysis pooled 51 RCTs including 358,325 participants, of whom 4.4% had isolated diastolic hypertension (IDH). IDH was defined as systolic BP <130 mmHg with diastolic BP ≥80 mmHg at baseline. A 5 mmHg systolic BP reduction reduced major cardiovascular events similarly in IDH and non-IDH (HR 0.91 vs 0.90; no interaction). Treatment benefit did not attenuate across baseline diastolic BP strata, even when diastolic BP was <60 mmHg.
Combination diuretics in acute HF improve decongestion; SGLT2 inhibitors uniquely improve outcomes
This meta-analysis of 11 RCTs (7,517 acute HF patients) evaluated various combination diuretic strategies versus loop diuretics alone. Combination therapy did not reduce all-cause mortality or HF events but increased weight loss, urinary output, and diuretic efficiency. SGLT2 inhibitors given during hospitalization reduced HF events (RR 0.66) and worsening renal function (RR 0.69). SGLT2 inhibitor use was also associated with improved all-cause mortality and HF outcomes compared with standard diuretic escalation.
Very early aspirin withdrawal after PCI harms STEMI but appears acceptable in NSTE-ACS
This NEO-MINDSET substudy randomized 3,410 ACS patients post-PCI to potent P2Y12 monotherapy within 4 days versus 12 months of DAPT. Among 2,119 STEMI patients, early aspirin withdrawal increased the 1-year ischemic composite (8.2% vs 5.2%; HR 1.60; 95% CI 1.14-2.24). Among 1,291 NSTE-ACS patients, ischemic events were similar between monotherapy and DAPT (5.1% vs 6.0%; HR 0.84; 95% CI 0.53-1.35; interaction p=0.030). Bleeding (BARC 2-5) was lower with monotherapy in both STEMI and NSTE-ACS, without heterogeneity by presentation.
CMR extracellular volume quantitatively stages ATTR cardiomyopathy and predicts mortality
This CMR study included 1,541 individuals across the ATTR spectrum, from TTR-variant carriers to overt ATTR cardiomyopathy. Extracellular volume (ECV) <30% excluded, and ≥40% confirmed, cardiac involvement; 30%-39% indicated early myocardial infiltration. Over a median 2.8 years, 40% died, and ECV independently predicted mortality (HR 1.22 per 10% increase; 95% CI 1.10-1.34). Stratifying ECV into none, mild, moderate, moderate-to-severe, and severe showed a monotonic increase in mortality risk.
References
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Additional Reads
Optional additional studies from this edition.