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Sienna Goren,1,* Nermeen Kidwai,1,* Wilbert S Aronow,2 Gregg M Lanier2 1New York Medical College, Valhalla, NY, USA; 2Departments of Medicine and Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA*These authors contributed equally to this workCorrespondence: Wilbert S Aronow, Department of Cardiology, Westchester Medical Center, and Professor of Medicine, New York Medical College, Macy Pavilion, Room 141, Valhalla, NY, 10595, USA, Tel +1 914 493 5311, Fax +1 914 235 6274, Email Wilbert.Aronow@wmchealth.orgAbstract: Pulmonary arterial hypertension (PAH) is a rare and potentially fatal condition characterized by progressive increases in blood pressure in the arteries of the lungs. Oral selexipag, approved by the Food and Drug Administration (FDA) in 2015 for the treatment of PAH, targets prostacyclin receptors on pulmonary arterial vascular smooth muscle and endothelial cells to improve blood flow through the lungs and reduce pulmonary vascular resistance. Oral selexipag is effective, but may be discontinued due to factors like side effects, emergency conditions, or inability to take oral medication, potentially leading to severe adverse events, such as rebound pulmonary hypertension and right heart failure. To address treatment interruptions, intravenous (IV) selexipag was introduced as an alternative for patients who are temporarily unable to take oral medications. IV selexipag bypasses hepatic metabolism, requiring a 12.5% higher dose compared to the oral form to achieve similar therapeutic effects. It is administered via IV infusion twice daily over 80 minutes, typically for short-term use. However, caution is needed when prescribing selexipag to patients with hepatic or renal issues, and it is contraindicated with strong CYP2C8 inhibitors. A Phase III clinical trial confirmed that switching between oral and IV selexipag was safe, with comparable efficacy and tolerability, though it was limited by small sample size and short duration. Given the risks of treatment interruption and the complexity of managing PAH, this review provides essential insights into the practical use of IV selexipag as a bridging therapy. Furthermore, it calls for larger clinical trials to refine dosing strategies, explore long-term outcomes, and identify patient populations most likely to benefit from IV selexipag.Plain Language Summary: Pulmonary arterial hypertension (PAH) is a rare and dangerous condition that causes high blood pressure in the arteries of the lungs, leading to right heart failure and potentially death. Selexipag is a medication used to treat patients with PAH by widening the blood vessels in the lungs. However, some patients may not be able to take oral selexipag as prescribed, which can worsen their condition. In 2021, an intravenous (IV) form of selexipag was approved as a temporary alternative for these patients. This review examines available literature to provide background and practical instruction for providers prescribing IV selexipag.Unlike oral selexipag, which is processed by enzymes in the liver, the IV form bypasses liver metabolism and enters the bloodstream directly. As a result, the IV dose is typically 12.5% higher than the oral dose to achieve the same therapeutic effects. IV selexipag is administered twice daily through an infusion lasting about 80 minutes and is intended for temporary use. Healthcare providers should use caution when prescribing selexipag to patients with liver or kidney issues. Additionally, selexipag should not be used with medications that block CYP enzymes. A phase III clinical trial reports that common side effects of the IV form of selexipag include headaches and irritation at the injection site. While IV selexipag is considered safe and effective for short-term use, larger studies are needed to better understand how to manage transitions between oral and IV forms.Keywords: prostacyclin, right heart failure, treatment interruption, intravenous selexipag, IP agonist

Diabetic individuals of reproductive age face higher risks of poor pregnancy outcomes and abnormal fetal development. Approximately 4.5% of women of reproductive age have diabetes, with non-Hispanic Black women having the highest prevalence of 15%. Research on the impact of paternal diabetes on offspring cardiac anomalies is limited, but it may interact with metabolic syndrome to increase long-term health risks. Infants of diabetic parents are more likely to develop cyanotic and acyanotic heart defects, hypertrophic cardiomyopathy, and subsequently other cardiovascular issues. Fetal hyperinsulinemia, caused by maternal hyperglycemia, contributes to these conditions through oxidative stress, impaired heart development, and cardiac remodeling. Long-term risks include diabetes, arrhythmias, pulmonary hypertension, heart failure, and early-onset cardiovascular disease. Treatment options are limited, often requiring surgery for severe conditions. Prevention focuses on tight glycemic control, a balanced diet, avoiding teratogens (nicotine, alcohol, or drugs), and using technology like continuous glucose monitors and insulin pumps, along with pregnancy screening and monitoring protocols. Understanding the effects of parental diabetes on offspring's cardiac health is crucial for early intervention, prevention, and improved maternal-fetal care, ultimately reducing the burden of congenital heart defects and long-term cardiovascular complications., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Approximately 5-10% of patients with hypertension have secondary hypertension. We describe a case of secondary hypertension from bilateral renal artery stenosis (RAS): "Pickering syndrome." This is a case of hypertension secondary to bilateral RAS which provides an opportunity to review secondary hypertension with a specific focus on RAS, in terms of when to consider work up, causes of secondary hypertension, diagnostic testing, and treatment.

Background: National heart failure guidelines recommend quadruple therapy with renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors for patients with heart failure with reduced ejection fraction (HFrEF), most of whom also receive loop diuretics. However, the guidelines are less clear about the safe approaches to discontinuing older drugs whose decreasing or residual benefit is less well understood. The objective of this study was to examine whether digoxin can be safely discontinued in patients with HFrEF receiving beta-blockers., Methods: In OPTIMIZE-HF, of 2477 patients with HFrEF (EF ≤45%) receiving beta-blockers and digoxin, digoxin was discontinued in 450 patients. We assembled a propensity score-matched cohort of 433 pairs of patients in which digoxin continuation vs. discontinuation groups were balanced on 51 baseline characteristics. Using the same approach, from 992 patients not on beta-blockers, we assembled a matched cohort of 198 pairs of patients also balanced on 51 baseline characteristics. Hazard ratios (HRs) and 95% CIs for 1-year outcomes were estimated., Results: Among patients receiving beta-blockers, digoxin discontinuation had no association with the combined endpoint of heart failure readmission or death (HR, 1.01; 95% CI, 0.85-1.19), heart failure readmission (HR, 1.03; 95% CI, 0.85-1.25) or death (HR, 0.91; 95% CI, 0.72-1.14). Respective HRs (95% CIs) among patients not receiving beta-blockers were 1.60 (1.25-2.04), 1.62 (1.18-2.22) and 1.43 (1.08-1.89)., Conclusions: Digoxin can be discontinued without increasing the risk of adverse outcomes in patients with HFrEF receiving beta-blockers. Future studies need to examine the residual benefit of older heart failure drugs to ensure their safe discontinuation in patients with HFrEF receiving newer guideline-directed medical therapy., (Published by Elsevier Inc.)

The 2021 Percutaneous Coronary Intervention guidelines completed by American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions provide a set of guidelines regarding revascularization strategies. With emphasis on equity of care, multidisciplinary heart team use, revascularization for acute coronary syndrome, and stable ischemic heart disease, the guidelines create a thorough framework with recommendations regarding therapeutic strategies. In this comprehensive review, our aim is to summarize the 2021 revascularization guidelines and analyze key points regarding each recommendation., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Resistant hypertension (RH) is the state of uncontrolled blood pressure in the face of ostensibly optimal pharmacological intervention. It accounts for roughly one in six cases of hypertension, and is associated with more severe morbidity and mortality outcomes than is non-RH. The prevalence of RH implies a currently unmanaged pathology, which may involve the potent vasoconstrictor endothelin. Several endothelin receptor antagonists are currently marketed for pulmonary arterial hypertension, but none so far has been marketed for RH. Aprocitentan is currently in development, an endothelin receptor antagonist that effectively produces clinically significant and sustained decreases in systolic and diastolic blood pressure in the setting of RH., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Thrombi in the left atrial appendage (LAA) are an important cause of systemic thromboembolism in patients with atrial fibrillation. The gold standard for the diagnosis of LAA thrombi is a transesophageal echocardiogram, although cardiac multidetector computed tomography, intracardiac echocardiogram, and cardiac magnetic resonance imaging are alternative diagnostic imaging modalities. When an LAA thrombus is diagnosed, effective anticoagulation is recommended for at least 3 weeks or until thrombus resolution is confirmed on repeat transesophageal echocardiogram. Recent prospective research shows the efficacy of nonvitamin K oral anticoagulants in the treatment of LAA thrombus, which offers a promising alternative to vitamin K antagonists. As an alternative approach, left atrial aspiration thrombectomy has been described in case reports, though there is limited evidence comparing its efficacy to anticoagulation alone., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Atrial fibrillation (AF) is the most common arrhythmia in the United States and the most common cause of embolic cerebrovascular events, with the majority of these thrombi originating in the left atrial appendage. The left atrial appendage (LAA) has separate developmental, ultrastructural, and physiological characteristics from the left atrium. Although LAA anatomy is highly variable, it can be categorized into 4 types: cactus, cauliflower, chicken wing, and windsock. The cauliflower type is associated with higher stroke risk in patients with nonvalvular AF. Although the cornerstone of therapy to prevent embolic strokes from AF has been anticoagulation with thrombin inhibitors, a large group of patients are unable to tolerate anticoagulation due to bleeding. This has led to the development and advancement of multiple surgical and percutaneous LAA closure devices to prevent embolic cerebrovascular accidents without the need for anticoagulation. In this article, we discuss the outcomes of major studies that utilized surgical LAA occlusion and its effectiveness. Furthermore, we summarize nonsurgical methods of LAA closure and future directions regarding LAA closure., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Mitral regurgitation (MR) is a prevalent valvular heart disease with significant morbidity, particularly in aging populations. Management strategies for MR have evolved from traditional open-heart surgery to innovative transcatheter approaches, addressing the limitations of surgical repair in high-risk patients. Transcatheter edge-to-edge repair, exemplified by devices such as MitraClip and PASCAL, has shown efficacy in reducing MR severity, improving functional capacity, and decreasing heart failure hospitalizations in selected patients. Advances in annuloplasty and chordal repair offer minimally invasive options with promising early outcomes. Transcatheter mitral valve replacement represents the frontier of MR treatment, addressing anatomical complexities unsuitable for repair, though complications such as left ventricular outflow tract obstruction persist. Emerging data from clinical trials underscore the importance of patient selection and a multidisciplinary heart team approach. In this review, each modality is discussed concerning its indications, procedural techniques, outcomes, and associated challenges. It highlights the transformative potential of transcatheter mitral valve interventions while emphasizing the need for ongoing innovation and research to optimize outcomes and expand therapeutic options for patients with severe MR., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Hypertensive disorders in pregnancy (HDPs) are a leading cause of maternal and fetal morbidity and mortality worldwide. The pathophysiology is complex and still poorly understood but thought to involve a combination of maternal modifiable and nonmodifiable risk factors and placental changes with resultant end-organ dysfunction. Treatment of HDP involves a combination of lifestyle modification and pharmacotherapy, with differing treatment thresholds across organizations. HDP can increase maternal risk for future cardiovascular disease and has shown disparities in racial prevalence and outcomes. Additional efforts are needed to minimize the risk for future cardiovascular disease and improve racial disparities in patients facing HDP., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Congenital heart disease (CHD) affects approximately 0.5-1% of the population, with advancements in cardiovascular care enabling 97% of these individuals to survive to adulthood. Pregnancy in women with CHD presents with unique challenges due to increased hemodynamic demands and associated risks. This review provides a comprehensive analysis of maternal outcomes in women with CHD, focusing on the physiological changes during pregnancy, classification of CHD types, and their specific consequences. The review highlights significant complications within this population, such as arrhythmias, heart failure, thromboembolic events, and aortic dissection, emphasizing the need for multidisciplinary management and individualized care. Despite considerable advancements, gaps in research persist, particularly in neonatal risk prediction and long-term maternal outcomes. Future directions prioritize the refinement of risk stratification models and leveraging emerging technologies to enhance care for this complex population., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Orthotopic liver transplant (OLT) medicine is a constantly evolving field, especially with the demographics of individuals with advanced liver disease drastically changing. OLT candidates are now older, and there is an increase of nonalcoholic steatohepatitis cirrhosis due to the epidemic of obesity, which has also resulted in an increase in cardiac comorbidities in this population. The pathophysiology of liver cirrhosis creates many complexities during the pre- and postoperative management of OLT. We discuss the role of screening for common co-existent cardiovascular comorbidities, including coronary artery disease, congestive heart failure, arrhythmias, and portopulmonary hypertension, as well as challenges in the standardization of pre-liver transplant cardiovascular care., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

The consumption of artificial sweeteners has significantly increased globally, particularly as a substitute for sugar for the management of conditions such as diabetes and obesity, which are significant risk factors for cardiovascular disease. Despite their widespread use, the health impacts of artificial sweeteners remain contentious. Research has suggested that certain sweeteners may contribute to systemic inflammation, endothelial dysfunction, and disruptions in gut microbiota, potentially altering glucose metabolism and exacerbating metabolic conditions such as diabetes and obesity. However, other studies highlight potential benefits, such as weight control and improved glucose tolerance. Still, the long-term safety of artificial sweeteners, particularly with chronic consumption, remains uncertain. This literature review explores the cardiovascular risks associated with various artificial sweeteners, focusing on the 6 US Food and Drug Administration-approved nonnutritive sweeteners, aspartame, sucralose, saccharin, acesulfame K, cyclamate, and neotame, as well as nutritive sweeteners such as polyols (erythritol, xylitol, sorbitol, and maltitol). Ongoing research, including in vitro, animal, and clinical studies, aims to clarify the long-term cardiovascular and metabolic implications of artificial sweeteners and assess the safety of their widespread use across diverse populations., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Aging is a multifaceted biological process characterized by progressive physiological decline and increased susceptibility to diseases. Central to this process are molecular and cellular changes that contribute to hallmark features of aging, including mitochondrial dysfunction, genomic instability, telomere attrition, and cellular senescence. Emerging research highlights the role of nutrient deficiencies in accelerating aging, bringing dietary supplements such as taurine and berberine into focus. Taurine, a sulfur-containing amino acid, plays a critical role in cellular protection, osmoregulation, and antioxidant defense, with evidence linking its deficiency to cellular senescence, mitochondrial dysfunction, and stem cell exhaustion. Berberine, an isoquinoline alkaloid, exerts antiaging effects by modulating key signaling pathways, including adenosine monophosphate-activated protein kinase/mechanistic target of rapamycin and sirtuin 1, and promoting mitohormesis. This review explores the mechanisms by which taurine and berberine mitigate aging processes, highlighting their effects on cellular metabolism, stress response, and longevity. Animal studies demonstrate their potential to enhance health span and lifespan although human clinical trials remain limited. Future research should focus on elucidating their molecular pathways, evaluating their combined effects with other interventions such as caloric restriction, and optimizing dosage for clinical applications. Taurine and berberine represent promising therapeutic candidates for addressing fundamental aspects of aging and advancing strategies for healthy aging and lifespan extension., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Background: According to current clinical practice guidelines, ambulatory blood pressure measurement (ABPM) is recommended to confirm diagnoses of hypertension. It remains unclear as to which method is superior in predicting mortality outcomes., Methods: Prospective observational studies, comparing ABPM with clinical blood pressure measurements (CBPM), were included with outcomes of the study being all-cause and cardiovascular mortality., Results: Nine studies with a total of 23,140 participants were included. Each 10-mmHg increase in 24-hour mean systolic blood pressure (SBP) was linked to a higher risk of all-cause mortality (HR: 1.13, 95% CI: 1.09-1.18), while clinic blood pressure measurement (CBPM) was not a significant predictor (HR: 1.02, 95% CI: 0.90-1.13). Nighttime SBP increases of 10 mmHg were associated with a higher all-cause mortality risk than daytime SBP (HR: 1.16, 95% CI: 1.11-1.21 versus HR: 1.08, 95% CI: 1.05-1.12). For cardiovascular mortality, a 10 mmHg increase in SBP yielded an HR of 1.21 (95% CI: 1.16-1.27) for 24-hour ABPM compared to 1.08 (95% CI: 1.04-1.11) for CBPM. Similarly, for a 5 mmHg increase in diastolic blood pressure (DBP), the HR was 1.14 (95% CI: 1.07-1.20) for 24-hour ABPM versus 1.04 (95% CI: 1.01-1.07) for clinical DBP, highlighting 24-hour monitoring as a stronger predictor for cardiovascular mortality., Conclusion: The findings of this study support the superiority of ABPM measurements in predicting both all-cause and cardiovascular mortality., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Sickle cell trait was once considered to benign hereditary condition, besides the association of renal medullary carcinoma, affecting red blood cells. The inherited disorder creates several health issues under various conditions, such as dehydration, hypoxia, or extreme physical exertion. Healthcare professionals and patients with the disorder should understand the importance of vascular complications in sickle cell traits. This article emphasizes the pathophysiology, epidemiology, and molecular basis of the sickle cell trait, which involves virtually every organ system and involves vascular endothelial dysfunction, cerebral vasculopathy, renal complications, cardiopulmonary manifestations, and splenic issues. Techniques of prevention and management strategies for quality-of-life improvement in the case of sickle cell trait are presented., Competing Interests: Disclosures: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Right ventricular myocardial infarction (RVMI) is a significant and distinct form of acute myocardial infarction associated with considerable morbidity and mortality. It occurs most commonly due to proximal right coronary artery obstruction, often in conjunction with inferior myocardial infarction. RVMI poses unique diagnostic and therapeutic challenges due to the anatomical and functional differences between the right and left ventricles. Key clinical manifestations include symptoms of right-sided heart failure, such as hypotension, jugular venous distention, and peripheral edema. The pathophysiology of RVMI involves impaired right ventricular (RV) function, decreased cardiac output, and poor hemodynamic stability, often leading to cardiogenic shock. Diagnostic tools, including 12-lead electrocardiography, echocardiography, cardiac magnetic resonance imaging, and coronary angiography, play crucial roles in detecting RVMI and determining its severity. Treatment strategies focus on early revascularization through primary percutaneous coronary intervention or thrombolysis, maintaining adequate RV preload, and managing arrhythmias and hemodynamic instability. In severe cases, mechanical circulatory support, such as intra-aortic balloon pumps and extracorporeal membrane oxygenation, may be required. Despite advancements in imaging and therapeutic approaches, RVMI remains a complex condition that demands timely and specialized management to improve patient outcomes. Further research is needed to refine diagnostic and treatment strategies and to reduce the high mortality rates associated with this condition., Competing Interests: Disclosures: The authors have no conflicts of interest to report., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Coronary artery calcification is an impediment to percutaneous coronary interventions by obstructing the device pathway or stent deployment. To facilitate percutaneous coronary intervention in such complex lesions, high-pressure balloon dilations, atherectomy procedures, and specialty balloons are used but they all come with considerable limitations and periprocedural complications like dissection and perforation. To surpass these disadvantages, intravascular lithotripsy was introduced which acts by delivering high-pressure pulsatile sonic waves circumferentially thereby destroying the calcium deposits. It is a safe and effective treatment modality in treating severe coronary artery calcification and facilitating stent delivery with minimal complications., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by proliferative remodeling and obliterative narrowing of the pulmonary vasculature. While outcomes have improved with existing treatments targeting 3 main pathways, there remains a critical need for novel therapies that address different and novel mechanisms of PAH. Sotatercept, recently Food and Drug Administration (FDA) approved, is a groundbreaking fusion protein that binds to activin and growth differentiation factors, rebalancing antiproliferative and pro-proliferative signals to reverse remodeling in both the pulmonary vasculature and the right ventricle. This review highlights current evidence exploring the safety and efficacy of sotatercept in the 2 landmark trials, phase 2 Pulmonary Arterial Hypertension and Sotatercept Trial and Research and phase 3 Sotatercept Treatment in Expansion of Long-term Learning and Assessment in PAH trial, which were instrumental in securing FDA approval for adult PAH patients with WHO functional class II or III symptoms already receiving background pulmonary hypertension therapy. Overall, sotatercept represents a landmark advancement in PAH treatment, offering hope for patients and the potential to delay or avoid lung transplantation. Importantly, this marks the beginning of an era of targeted therapies aimed at reverse remodeling in PAH while improving outcomes., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) play a vital role in managing and preventing cardiovascular disease, particularly in elderly populations who face elevated risks for atherosclerosis and related conditions. This review delves into the mechanisms of statin action, emphasizing their impact on low-density lipoprotein cholesterol levels, anti-inflammatory properties, and potential genetic factors influencing efficacy and drug tolerability. Consideration is given to statin intolerance and management strategies, drug interactions, and guidelines for primary and secondary prevention of cardiovascular events. Patient-centered care and shared decision-making are highlighted as essential for effective therapy in elderly patients. This review also addresses the importance of personalized approaches in the context of genetic markers such as SLCO1B1 polymorphisms, optimizing patient outcomes and minimizing adverse effects. Finally, emerging areas of research are discussed, underscoring the need for further studies on the cognitive impact of statins and newer lipid-lowering agents. This analysis serves to inform clinical practice by balancing statins' cardiovascular benefits against potential risks, aiming for a tailored approach in managing elderly patients with cardiovascular concerns., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

The incidence of left ventricular (LV) thrombus following acute myocardial infarction has declined significantly due to recent advancements in reperfusion and antithrombotic therapies. The development of LV thrombus depends on Virchow's triad: endothelial injury following myocardial infarction, blood stasis from LV dysfunction, and hypercoagulability. Diagnostic modalities for LV thrombus include transthoracic echocardiography and late gadolinium enhancement cardiac magnetic resonance imaging. Anticoagulation with direct oral anticoagulants or vitamin K antagonists for 3 months following initial diagnosis of LV thrombus remains the treatment of choice for LV thrombus. However, further evidence is needed to demonstrate the noninferiority of direct oral anticoagulants compared with vitamin K antagonists for the prevention of thromboembolic events., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Out-of-hospital cardiac arrest has a high mortality rate. Unlike ST-elevation myocardial infarction, the results of performing early coronary angiography (CAG) in non-ST-elevation myocardial infarction patients are controversial. This study aimed to compare early and nonearly CAG in this population, in addition to the identification of differences between randomized controlled trials (RCTs) and observational studies conducted in this regard. A systematic search in PubMed, Embase, and Cochrane library was performed to identify the relevant studies. Random-effect meta-analysis was done to calculate the pooled effect size of early versus nonearly CAG outcomes in all studies in addition to each of the RCT and observational subgroups of the studies. The relative risk ratio (RR), along with its 95% confidence interval (CI), was used as a measure of difference. A total of 16 studies including 5234 cases were included in our analyses. Compared with observational cohorts, RCT studies had patients with higher baseline comorbidities (older age, hypertension, diabetes, and coronary artery disease). Random-effect analysis revealed a lower rate of in-hospital mortality in the early-CAG group (RR, 0.79; 95% CI, 0.65-0.97; P = 0.02); however, RCT studies did not find a statistical difference in this outcome (RR, 1.01; 95% CI, 0.83-1.23; P = 0.91). Moreover, mid-term mortality rates were lower in the early-CAG group (RR, 0.87; 95% CI, 0.78-0.98; P = 0.02), mostly due to observational studies. There was no significant difference between the groups in other efficacy and safety outcomes. Although early CAG was associated with lower in-hospital and mid-term mortality in overall analyses, no such difference was confirmed by the results obtained from RCTs. Current evidence from RCTs may not be representative of real-world patients and should be interpreted within its limitation., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Marijuana is now one of the most widely used substances in the United States that has been rising in prevalence given increasing legalization and recreational and medical usage. Despite its widespread use, there have been increasing concerns regarding the cardiovascular safety of marijuana. Recent studies have found a link between marijuana use and the development of cardiovascular disease. Most notably, marijuana has been found to be associated with various cardiac complications, including atherosclerosis, myocardial infarction, stroke, cardiomyopathy, arrhythmia, and arteritis. Given these growing concerns, this article seeks to examine the effects and significance of marijuana on cardiovascular health., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Aortopathies can be congenital or acquired. Aortic atherosclerosis, abdominal aortic aneurysm, and degenerative aortic stenosis are some of the major manifestations of acquired aortopathy. Dyslipidemia, an imbalance of plasma lipid levels, is strongly associated with common aortopathies. A relationship between abdominal aortic aneurysm, degenerative aortic stenosis, and dyslipidemia has been identified in the literature but finding effective preventive strategies has been challenging. Nevertheless, lipid-lowering therapy remains a mainstay of both treatment and prevention. In patients with aortic atheroma, statins were found to be protective through the review of this study. There is currently no place for statins in the treatment or prevention of disease progression in patients with calcific aortic stenosis. Their low cost, widespread availability, and strong safety profile tip the risk-to-benefit ratio toward statins for abdominal aortic aneurysms but more research is needed. A review of proprotein convertase subtilisin/kexin type 9 inhibitors may yield similar benefits for all aortopathy patients; however, those results are not yet available., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Cardiogenic shock (CS) is a life-threatening medical condition that requires prompt recognition and treatment. The use of standardized CS criteria, such as the Society for Cardiovascular Angiography and Interventions criteria, can categorize patients and guide therapeutic strategies. Temporary mechanical circulatory support (MCS) devices have become valuable tools in the treatment of CS, as they can provide cardiovascular support as a bridge to recovery, cardiac surgery, or advanced therapies such as cardiac transplant or durable ventricular assist devices. The use of MCS should be tailored to each individual patient, focused on a stepwise escalation of circulatory support to support both end-organ perfusion and myocardial recovery. As newer MCS devices reduce myocardial oxygen demand without increasing ischemia, the possibility of recovery is optimized. In this review, we discuss the different modalities of MCS focusing on the mechanism of support and the advantages and disadvantages of each device., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Cardiovascular disease is a major cause of morbidity and mortality worldwide in patients with type 2 diabetes. Type 2 diabetes confers an elevated risk of developing heart failure and atherosclerotic cardiovascular disease. Until recently, there have been limited options to prevent and reduce the cardiovascular complications of type 2 diabetes. However, recent therapeutic advances have led to the adoption of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in cardiovascular management. Though SGLT2i were originally used for antihyperglycemic treatment, a series of landmark trials found that SGLT2i may confer cardio-protective effects in patients with heart failure and atherosclerotic cardiovascular disease, particularly a reduction in cardiovascular mortality and hospitalizations for heart failure. The cardiovascular benefits of SGLT2i were similarly demonstrated in patients with and without type 2 diabetes. Though previous trials found SGLT2i to be cardio-protective in heart failure with reduced ejection fraction, recent trials demonstrated that SGLT2i may also provide cardiovascular benefits in heart failure with mildly reduced and preserved ejection fraction. These advances have led SGLT2i to become an instrumental component of cardiovascular therapy., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)