Differential Impact of Metoprolol Formulations on Heart Failure Outcomes: A Multi-center Study
https://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.
Methods
In 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.
Results
Baseline 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.
Conclusions
Metoprolol 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.
Beta-Blockers after Myocardial Infarction in Patients without Heart Failure
N Engl J Med . 2025 Nov 13;393(19):1901-1911. doi: 10.1056/NEJMoa2505985
Abstract
Background: 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.
Efficacy and safety of ticagrelor versus clopidogrel in acute myocardial infarction-associated cardiogenic shock: apropensity score-matched analysis
https://doi.org/10.1093/eurheartj/ehaf784.2070
Abstract
Background
Cardiogenic 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.
Methods
We 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.
Results
A 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).
Conclusions
In 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.
Prognostic Implications of Heart Failure Rehospitalization in Adults with CHD & Clinical Benefits of Medical Therapy
https://doi.org/10.1016/j.ijcchd.2025.100640
ABSTRACT
Background
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.
Methods
We 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.
Results
Of 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.
Conclusions
Among 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.
Dual Versus Single Antiplatelet Therapy After Transcatheter Aortic Valve Implantation for Bioprosthetic Valve Failure
https://www.jacc.org/doi/10.1016/j.jcin.2025.09.018
ABSTRACT
Background: 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.
Drug Utilization Patterns and Adherenceto Guideline-Directed Therapy in Acute Myocardial Infarction: A ProspectiveObservational Study
International Journal of Life Sciences, Biotechnology andPharma Research Vol. 14, No. 10, October 2025 DOI:10.69605/ijlbpr_14.10.2025.11
ABSTRACT
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.
1-Month Versus 12-Month Dual Antiplatelet Therapy for Patients with Chronic Total Occlusion After Successful Percutaneous Coronary Intervention
Drugs Aging . 2025 Oct;42(10):975-985. doi:10.1007/s40266-025-01235-z.
Abstract
Purpose: 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.
Impact of digoxin versus beta-blocker in patients withcoexistent atrial fibrillation and heart failure: a target trial emulation
BMC Med . 2025 Oct 21;23(1):575. doi: 10.1186/s12916-025-04408-0.
Abstract
Background: 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.
Comparison between clopidogrel and ticagrelor in CYP2C19 loss-of-function alleles coronary artery disease andstroke patients: a meta-analysis
Eur J Clin Pharmacol. 2025 Sep;81(9):1241-1256.
Abstract
Background: 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.
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.
Abstract
Beta-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.
β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysisof randomised controlled trials
Lancet. 2025 Sep 13;406(10508):1128-1137.
Abstract
Background: 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.
Angiotensin receptor-neprilysin inhibitors and mortality among patients with heart failure with reducedejection fraction
https://doi.org/10.1016/j.amjcard.2025.08.063
Abstract
Background
While 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.
Methods
This 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.
Results
There 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.
Conclusions
In 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.
Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AβYSS trial
Eur Heart J 2025 Aug 1;46(29):2894-2902. doi: 10.1093/eurheartj/ehaf170.
Abstract
Background 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.
ST-elevation myocardial infarction and air pollution: relationship between hourly air pollution and cardiovascular risk factors
J Cardiovasc Med (Hagerstown). 2025 Aug 1;26(8):412-419.
Abstract
Objective: 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.
1-Month Versus 12-Month Dual Antiplatelet Therapy for Patients with Chronic Total Occlusion After Successful Percutaneous Coronary Intervention
Drugs Aging. 2025 Aug 2. doi: 10.1007/s40266-025-01235z.
Abstract
Purpose: 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.
SGLT2 inhibitor with and without ALDosterone AntagonIst for heart failure with preserved ejection fraction:Design paper
ESC Heart Fail. 2025 Aug;12(4):3134-3144. doi: 10.1002/ehf2.15294
Abstract
Background: 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.
Combined effects of clonal hematopoiesis of intermediate potential and P2Y12 inhibitors on outcomes of patients with ST-segment elevation myocardial infarction: A prospective study
https://doi.org/10.1016/j.phrs.2025.107852
Abstract
Clonal 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 Study
Am J Med. 2025 Jul;138(7):1090-1098.e6.
Abstract
Background: 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 Occlusion
Am J Cardiovasc Drugs. 2025 Jul 12. doi:10.1007/s40256-025-00750-z.
Abstract
Background: 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.
Effects of moderate physical trainingprogram in post-myocardial infarction patients with arterial hypertension
Eur J Transl Myol. 2025 Jul 10. doi: 10.4081/ejtm.2025.13943
Abstract
The 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.