Daily Cardiology Research Analysis
Analyzed 83 papers and selected 3 impactful papers.
Summary
Three studies stand out today: an IPD meta-analysis in Lancet shows finerenone reduces CKD progression, heart failure hospitalization, cardiovascular and all-cause death across diverse CKD etiologies. A large target-trial emulation supports intensive BP targets <130/80 mmHg in uncomplicated hypertension without excess serious adverse events. An OCT-based study introduces residual lipid burden as a pancoronary imaging biomarker predicting 5-year non-culprit MACE beyond TCFA.
Research Themes
- Cardiorenal therapeutics across CKD etiologies
- Hypertension management using real-world causal inference
- Coronary plaque characterization with intracoronary OCT
Selected Articles
1. Efficacy and safety of finerenone in patients with chronic kidney disease: an individual participant data pooled analysis (INFINITY).
Across 14,574 CKD participants from three randomized, double-blind trials, finerenone reduced CKD progression (including kidney failure), heart failure hospitalization, cardiovascular death, and all-cause mortality. Benefits were observed across diverse CKD etiologies and across glycemia, eGFR, and albuminuria strata.
Impact: This IPD meta-analysis elevates finerenone to a foundational therapy in CKD by demonstrating consistent kidney and cardiovascular protection across etiologies, including mortality benefit.
Clinical Implications: Consider finerenone on top of standard of care (e.g., ACEi/ARB and SGLT2 inhibitors when appropriate) in CKD patients to reduce HF hospitalization, cardiovascular and all-cause mortality, and slow CKD progression across a wide range of eGFR and albuminuria.
Key Findings
- Finerenone reduced kidney disease progression (kidney failure or sustained ≥57% eGFR decline) across pooled trials.
- Finerenone lowered heart failure hospitalization and cardiovascular death, and reduced all-cause mortality.
- Efficacy and safety were consistent across CKD etiologies and across glycemia, eGFR, and albuminuria strata.
Methodological Strengths
- Individual participant data meta-analysis of randomized, double-blind, placebo-controlled trials with harmonized endpoints
- Large sample size (n=14,574) enabling robust subgroup analyses across CKD etiologies and risk strata
Limitations
- Heterogeneity across trials and evolving background therapies may influence effect estimates
- Industry-funded program; detailed safety profiles by rare adverse events not provided in abstract
Future Directions: Define optimal sequencing and combination with ACEi/ARB and SGLT2 inhibitors, evaluate efficacy in underrepresented CKD etiologies, and assess long-term safety in broader real-world cohorts.
BACKGROUND: Overactivation of the mineralocorticoid receptor is a common pathway for chronic kidney disease (CKD) progression across multiple disease aetiologies. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, has shown kidney and cardiovascular benefits in CKD due to type 2 diabetes, but its efficacy and safety across disease aetiologies, and levels of glycaemia, estimated glomerular filtration rate (eGFR), and albuminuria have not been evaluated. The aim of this study was to evaluate the efficacy and safety of finerenone across the spectrum of CKD. METHODS: We conducted an individual participant data meta-analysis of three randomised, double-blind, placebo-controlled trials of finerenone in patients with CKD: FIDELIO-DKD (NCT02540993; Sept 17, 2015, to April 14, 2020), FIGARO-DKD (NCT02545049; Sept 17, 2015, to Feb 2, 2021), and FIND-CKD (NCT05047263; Sept 21, 2021, to Feb 2, 2026). We used Cox regression models to evaluate relative effects on kidney and cardiovascular outcomes. The main kidney outcome was kidney failure or sustained 57% or more decline in eGFR; the main cardiovascular outcome was hospitalisation for heart failure or cardiovascular death. This study was registered with PROSPERO, CRD420251269149. FINDINGS: Across the three trials enrolling 14 574 participants, the mean age was 63·7 years (SD 10·6), 4467 (30·7%) were female, 10 107 (69·3%) were male, mean eGFR was 56·4 mL/min per 1·73 m INTERPRETATION: In the studied populations with CKD, finerenone reduced the risk of CKD progression, including kidney failure alone, and reduced heart failure hospitalisation, cardiovascular death, and all-cause death. These findings support finerenone as a foundational therapy for CKD across a broad range of disease aetiologies and levels of glycaemia, eGFR, and albuminuria. FUNDING: Bayer.
2. Optimal blood pressure target in patients with uncomplicated hypertension: a target trial emulation study.
In a territory-wide target-trial emulation including 118,271 adults with uncomplicated hypertension, targeting BP <130/80 mmHg reduced hypertension-related complications and all-cause mortality compared with standard targets, without a significant increase in serious adverse events. These real-world data support guideline adoption of intensive targets in primary care.
Impact: Provides robust real-world causal inference confirming the benefit and safety of intensive BP targets in primary care, addressing a major evidence-to-practice gap.
Clinical Implications: Adopt a BP target <130/80 mmHg for adults with uncomplicated hypertension in primary care when tolerated, with systems to monitor safety and adherence.
Key Findings
- Targeting BP <130/80 mmHg reduced hypertension-related complications compared with 130–140/80–90 mmHg.
- All-cause mortality was lower with intensive targets, without significant increases in serious adverse events.
- Findings derived from a territory-wide public healthcare database using a target-trial emulation on 118,271 patients.
Methodological Strengths
- Target-trial emulation approach enhances causal inference from observational data
- Very large sample size from a territory-wide integrated healthcare database
Limitations
- Observational design remains susceptible to residual confounding and measurement biases
- Follow-up duration and detailed safety phenotypes are not specified in the abstract
Future Directions: Extend emulations to high-risk subgroups (elderly, CKD, diabetes), incorporate device-based out-of-office BP, and test pragmatic implementation strategies for intensive targets.
The limited real-world evidence on the clinical benefits of intensive blood pressure (BP) management demonstrated in randomised controlled trials has led to its poor adoption in primary care settings. Here we conducted a target trial emulation study on 118,271 patients with uncomplicated hypertension to evaluate the effectiveness and safety managed by intensive (below 130/80 mmHg) compared to standard (130-140/80-90 mmHg) BP targets using a territory-wide public healthcare database in Hong Kong. Patients in the intensive blood pressure target group were observed to incur a lower risk of hypertension related complications and all-cause mortality with no significant increased risk of the serious adverse events reported. The findings of this study provide evidence on the clinical benefits of an intensive BP management in real-world settings, supporting the adoption of a BP target of less than 130/80 mmHg in clinical guidelines for the treatment of adult patients with hypertension in primary care.
3. Long-term prognostic value of residual lipid burden in acute myocardial infarction.
In 1,312 AMI patients undergoing three-vessel intracoronary OCT, a higher OCT-derived residual lipid burden across all non-culprit lesions was associated with pancoronary plaque vulnerability and independently predicted 5-year non-culprit lesion-related MACE (adjusted HR 3.84), beyond non-culprit TCFA. Most events were ischemia-driven revascularizations.
Impact: Introduces a pancoronary, imaging-based risk metric that outperforms focal TCFA for long-term non-culprit risk after AMI, potentially informing secondary prevention strategies.
Clinical Implications: In AMI survivors, integrating OCT-derived residual lipid burden may refine risk stratification beyond focal vulnerability and support more intensive lipid-lowering and surveillance for patients with high pancoronary lipid burden.
Key Findings
- High residual lipid burden was associated with greater multivessel disease, non-culprit plaque rupture, and TCFA (53.8% vs 11.0%; all p<0.001).
- High RLB independently predicted 5-year non-culprit lesion-related MACE (8.4% vs 2.6%; adjusted HR 3.84, 95% CI 1.98–7.45), mostly ischemia-driven revascularizations.
- When modeled with non-culprit TCFA, RLB remained predictive (p=0.002) whereas TCFA lost significance (p=0.079); as a continuous metric, AUC was 0.63; findings were consistent in both sexes.
Methodological Strengths
- Three-vessel intracoronary OCT enabling comprehensive pancoronary lipid assessment
- Median 4.1-year follow-up with multivariable adjustment and sex-stratified analyses
Limitations
- Observational design in patients selected for three-vessel OCT may introduce selection bias
- Event discrimination as a continuous metric was modest (AUC 0.63), and most endpoints were revascularizations rather than hard events
Future Directions: Prospective validation of RLB-guided therapy escalation, integration with systemic lipid biomarkers and plaque mechanics, and randomized strategies targeting high-RLB patients.
BACKGROUND AND AIMS: To examine the clinical significance and prognostic value of total coronary artery non-culprit residual lipid burden (RLB) after percutaneous coronary intervention in acute myocardial infarction (AMI) patients. METHODS: A total of 1312 AMI patients who underwent three-vessel optical coherence tomography (OCT) were divided into low RLB group (n = 656) and high RLB group (n = 656) based on median value of OCT-derived RLB (total lipid index of all non-culprit lesions). Patients were followed for up to 5 years (median 4.1 years). Major adverse cardiovascular events (MACE) were recorded. RESULTS: The high RLB group had more frequent multi-vessel disease, non-culprit plaque rupture, thin-cap fibroatheroma (TCFA: 53.8% vs. 11.0%), and other vulnerable plaque features (all p < 0.001) than the low RLB group. After adjusting for clinical risk factors, a high RLB independently predicted non-culprit plaque rupture, TCFA, and vulnerable plaque features. Patients with a high RLB had a significantly greater incidence of 5-year non-culprit lesion-related MACE (8.4% vs. 2.6%, adjusted HR: 3.84, 95%CI: 1.98-7.45) than patients with a low RLB; most events were ischemia-driven revascularization. When a high RLB and non-culprit TCFA were simultaneously added to the model, a high RLB remained predictive (p = 0.002), but non-culprit TCFA was no longer predictive (p = 0.079). When used as a continuous variable, the prognostic value of RLB was attenuated (AUC = 0.63). Moreover, the association of RLB with plaque vulnerability and outcomes was observed in both sexes. CONCLUSIONS: OCT-derived RLB was associated with pancoronary plaque characteristics in AMI patients. A high RLB predicted 5-year adverse events independent of TCFA.