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Background The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to reduce biomarkers of cardiovascular disease. We aimed to characterize the time course of change in biomarkers of cardiac injury (high‐sensitivity cardiac troponin I), cardiac strain (NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide]), and inflammation (hs‐CRP [high‐sensitivity C‐reactive protein]) while consuming the DASH diet. Methods and Results The DASH‐Sodium trial was a randomized controlled trial of 412 adults with elevated blood pressure or hypertension. Participants were randomly assigned to 12 weeks of the DASH diet or a typical American diet. Energy intake was adjusted to maintain body weight. Measurements of high‐sensitivity cardiac troponin I, NT‐proBNP, and hs‐CRP were performed in stored serum specimens, collected at baseline and ≈4, 8, and 12 weeks after randomization. In both the control diet and DASH diet, levels of NT‐proBNP decreased; however, there was no difference between diets (P‐trend compared with control=0.22). On the DASH diet versus control, levels of high‐sensitivity cardiac troponin I decreased progressively during follow‐up (P‐trend compared with control=0.025), but a statistically significant between‐diet difference in change from baseline levels was not observed until week 12 (% difference, 17.78% [95% CI, −29.51% to −4.09%]). A similar pattern was evident for hs‐CRP (P‐trend compared with control=0.01; % difference at week 12, 19.97% [95% CI, −31.94% to −5.89%]). Conclusions In comparison with a typical American diet, the DASH diet reduced high‐sensitivity cardiac troponin I and hs‐CRP progressively over 12 weeks. These results suggest that the DASH diet has cumulative benefits over time on biomarkers of subclinical cardiac injury and inflammation. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00000608.

Background Diltiazem, a moderate cytochrome P450 3A4 isozyme/P‐glycoprotein inhibitor, may potentiate the bleeding risk of direct oral anticoagulants (DOACs) through pharmacokinetic interactions. We evaluated the association between concomitant use of diltiazem with DOACs and bleeding among patients with atrial fibrillation, across varying degrees of kidney function. Methods and Results We identified 4544 patients with atrial fibrillation who were initiated on rivaroxaban (n=1583), apixaban (n=2373), or dabigatran (n=588), between 2010 and 2019 in Geisinger Health, with a mean age of 72 years and an estimated glomerular filtration rate of 70 mL/min per 1.73 m2. At the time of DOAC initiation, 15% patients were taking diltiazem and an additional 5% were initiated on diltiazem during follow‐up. Among DOAC users, using diltiazem concurrently (versus DOAC alone) was associated with an increased risk of any bleeding‐related hospitalization (unadjusted risk difference, 2.4; 95% CI, 0.6–4.2 events per 100 person‐years; adjusted hazard ratio, 1.56, 95% CI, 1.15–2.12), as well as major bleeding (unadjusted risk difference, 1.4 [95% CI, 0.1–2.6 events per 100 person‐years]; adjusted hazard ratio, 1.84 [95% CI, 1.18–2.85]). Increased risk of any/major bleeding with diltiazem was observed in both patients with and without CKD (estimated glomerular filtration rate

BackgroundConcerns about hyperkalemia limit the use of angiotensin‐converting enzyme inhibitors (ACE‐I) and angiotensin receptor blockers (ARBs), but guidelines conflict regarding potassium‐monitoring protocols. We quantified hyperkalemia monitoring and risks after ACE‐I/ARB initiation and developed and validated a hyperkalemia susceptibility score. Methods and ResultsWe evaluated 69 426 new users of ACE‐I/ARB therapy in the Stockholm Creatinine Measurements (SCREAM) project with medication initiation from January 1, 2007 to December 31, 2010, and follow‐up for 1 year thereafter. Three fourths (76%) of SCREAM patients had potassium checked within the first year. Potassium >5 and >5.5 mmol/L occurred in 5.6% and 1.7%, respectively. As a comparison, we propensity‐matched new ACE‐I/ARB users to 20 186 new β‐blocker users in SCREAM: 64% had potassium checked. The occurrence of elevated potassium levels was similar between new β‐blocker and ACE‐I/ARB users without kidney disease; only at estimated glomerular filtration rate 60 mL/min per 1.73 m2, but rates were much higher with lower estimated glomerular filtration rate. Use of the hyperkalemia susceptibility score may help guide laboratory monitoring and prescribing strategies.

BackgroundAs part of its 2020 Impact Goals, the American Heart Association developed the Life's Simple 7 metric for cardiovascular health promotion. The relationship between the Life's Simple 7 metric and incident chronic kidney disease (CKD) is unknown. Methods and ResultsWe estimated the association between Life's Simple 7 and incident CKD in 14 832 Atherosclerosis Risk in Communities study participants. Ideal levels of Life's Simple 7 health factors were the following: nonsmoker or quit >1 year ago; body mass index