Daily Cardiology Research Analysis

AIMS: Regular heavy alcohol consumption may lead to the development of alcohol-related cardiomyopathy and symptomatic heart failure (HF) later in life. However, the dose-response relationship between alcohol consumption and risk for incident HF, and whether these associations vary by sex and type of alcoholic beverage remains unclear. METHODS AND RESULTS: A total of 407 014 participants (52% women, age 56 years) from the UK Biobank who completed alcohol-related questionnaires and without a history of HF at baseline were included in the study. Competing-risk model and cubic spline regression analyses were used to calculate hazard ratios of the association between alcohol consumption and incident HF in men and women. The associations were adjusted for an extensive set of potential confounders. During a median follow-up of 12 years, 11 735 (34% women) cases of incident HF were identified. Total alcohol consumption was higher in men than in women (median consumption: 16 vs. 8 drinks/week, p < 0.001). A J-shaped association was observed between total alcohol consumption and incident HF in both men and women. Drinking alcohol <28 units/week was associated with a lower risk for developing HF, with a ~20% maximum risk reduction at 14 units/week in men and 7 units/week in women, independent of common confounders. Similar trends were observed in wine consumption. However, the risk of incident HF increases with beer consumption, particularly in women (p for sex interaction = 0.002). Consuming 7-14 units/week of beer was associated with a 29% increased risk of incident HF in women. CONCLUSION: Alcohol consumption was higher among men compared with women. Although low to moderate total alcohol consumption appears to be associated with a reduced risk of developed HF, beer drinkers, particularly women, were at higher risk of developed HF.

AIMS: Methods of non-invasive remote patient monitoring (RPM) for heart failure (HF) remain diverse. Understanding factors that influence the effectiveness of RPM on HF-related and all-cause hospitalizations, mortality, and emergency department visits is crucial for developing successful RPM interventions. This meta-analysis aims to synthesize and compare existing literature on RPM components that impact HF-related and all-cause hospitalizations, mortality and emergency department visits in HF patients. METHODS AND RESULTS: A systematic search of electronic databases (PubMed, EMBASE, CENTRAL) identified randomized controlled trials from January 2012 to June 2023, comparing non-invasive RPM interventions for HF with usual care. A random-effects meta-analysis assessed outcomes, and additional analyses identified effective RPM components. A total of 41 studies with 16 312 patients (mean follow-up: 9.88 ± 6.37 months) were included. RPM was associated with lower mortality risk (pooled odds ratio [OR] 0.81 95% confidence interval [CI] 0.69-0.95; I CONCLUSION: This meta-analysis confirms the efficacy of RPM in reducing HF-related hospitalizations and mortality. Effective components include self-management, education modules, and video communication. However, heterogeneity among interventions challenges the overall evaluation. Modernizing RPM with advanced technologies like non-invasive sensors, artificial intelligence, and cardiac telerehabilitation could enhance its potential.

IMPORTANCE: Disease characteristics of genetically mediated coronary artery disease (CAD) on coronary angiography and the association of genomic risk with outcomes after coronary angiography are not well understood. OBJECTIVE: To assess the angiographic characteristics and risk of post-coronary angiography outcomes of patients with genomic drivers of CAD: familial hypercholesterolemia (FH), high polygenic risk score (PRS), and clonal hematopoiesis of indeterminate potential (CHIP). DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 3518 Mass General Brigham Biobank participants with genomic information who underwent coronary angiography was conducted between July 18, 2000, and August 1, 2023. EXPOSURES: The presence of a genomic risk factor of CAD, defined as FH variant, high CAD PRS, or CHIP driver variation. MAIN OUTCOMES AND MEASURES: Coronary artery disease presentation (stable or acute), angiographic CAD characteristics (severity and burden), angiographic outcomes (repeat angiogram, revascularization, and in-stent restenosis), and clinical outcomes (heart failure and all-cause mortality). RESULTS: Among 3518 participants (2467 [70.1%] male; median age, 64.0 [IQR, 55.0-72.0] years), 1509 (42.9%) had at least 1 genomic driver of CAD (26 FH, 1191 high CAD PRS, and 466 CHIP) that was associated with the presentation of acute coronary syndromes (adjusted odds ratio, 2.67; 95% CI, 2.19-3.26) and with the presence, burden, and severity of angiographic CAD. This association was driven by FH and CAD PRS. One SD of CAD PRS was associated with a 12.51-point higher Gensini score. During 9 years of follow-up, there was an increased risk among FH carriers for a repeat angiogram (adjusted hazard ratio [AHR], 1.70; 95% CI, 1.02-2.83), and revascularization (AHR, 1.97; 95% CI, 1.02-3.80), and among people with high CAD PRS (repeat angiogram: AHR, 1.79; 95% CI, 1.45-2.22; revascularization: AHR, 1.85; 95% CI, 1.37-2.50; and in-stent restenosis: AHR, 3.89; 95% CI, 2.16-7.01). CHIP carriers had no significant increase in angiographic outcomes but were at higher risk of heart failure (AHR, 1.58; 95% CI, 1.04-2.40) and all-cause mortality (AHR, 1.78; 95% CI, 1.47-2.16). CONCLUSIONS AND RELEVANCE: The findings of this study suggest that germline monogenic and polygenic risk are associated with acute coronary syndromes presentation, severity and burden of atherosclerosis, and risk of repeat angiogram, revascularization, and in-stent restenosis. CHIP variant status is associated with incident heart failure and mortality after coronary angiography.