Colchicine has been shown to mitigate inflammation and reduce adverse cardiovascular events. However, evidence from clinical trials has been mixed regarding its efficacy in cardiovascular prevention among patients undergoing cardiac surgery. We aimed to evaluate the association between colchicine use and cardiovascular outcomes in patients undergoing cardiac surgery. We conducted a systematic literature search on various electronic databases for relevant studies from their inception until July 15, 2025. Randomized controlled trials (RCTs) with two arms—one with colchicine as an intervention and the other with placebo—in patients undergoing cardiac surgery were included. Risk ratios (RRs) and weighted mean differences (WMDs), along with 95
Hypertension is the leading modifiable cardiovascular risk factor, yet long-term adherence to antihypertensive therapy remains suboptimal. RNA-based approaches targeting hepatic angiotensinogen (AGT) have emerged as an attractive strategy for upstream renin–angiotensin–aldosterone system suppression and warrant a timely, focused review of the field. PubMed/MEDLINE, ClinicalTrials.gov and the most relevant scientific and academic databases were searched up to February 2026 to draft a narrative review of peer-reviewed clinical trials, pivotal translational studies, contemporary hypertension guidelines, and official regulatory documents relevant to innovative antihypertensive treatments, such as antisense AGT suppression (zilebesiran), endothelin antagonism (aprocitentan), and aldosterone-synthase inhibition (baxdrostat). Zilebesiran demonstrated durable blood-pressure lowering in monotherapy (KARDIA-1: placebo-adjusted ambulatory systolic blood pressure (BP) − 16.7 mmHg at month 3) and as add-on therapy (KARDIA-2: greatest effect with indapamide background). KARDIA-3 extended evaluation to a higher-risk, heavily medicated population, in which the primary endpoint was not met. The ongoing ZENITH outcomes trial will determine whether AGT silencing reduces hard cardiovascular end-points. Aprocitentan reduced office and ambulatory systolic BP in resistant hypertension (PRECISION trial) and has received regulatory approval in the USA, EU, and UK, with specific monitoring requirements for fluid retention and hematological effects. Baxdrostat demonstrated selective aldosterone-synthase inhibition with meaningful BP reductions across two phase II trials. RNA interference targeting AGT represents one of the most advanced disease-modifying platforms in hypertension, alongside the already-approved endothelin antagonism and the emerging aldosterone synthase inhibition strategy. The available evidence supports cautious optimism and continued translational investment, but not premature adoption into routine practice.
Lipoprotein(a) [Lp(a)] is a genetically determined, low-density lipoprotein-like particle that has emerged as an important and independent contributor to atherosclerotic cardiovascular disease and calcific aortic valve stenosis. Elevated Lp(a) concentrations, defined as approximately 125 nmol/L (≥ 50 mg/dL) by most consensus thresholds, affect an estimated 20
Zilebesiran is an investigational RNA interference therapeutic that lowers blood pressure by silencing hepatic angiotensinogen, thereby offering sustained antihypertensive activity with infrequent dosing in selected ambulatory populations. This profile is attractive for long-term blood pressure control, but it also raises an unresolved clinical question: how should acute illness be managed when upstream renin–angiotensin system suppression cannot be rapidly attenuated? In this Current Opinion, we place that question in perspective using available trial data, cardiorenal physiology, and acute-care literature. Early-phase studies established that zilebesiran produces sustained angiotensinogen suppression and blood pressure reduction, while also showing that the antihypertensive response is modulated by dietary sodium intake and background renin–angiotensin–aldosterone system blockade. Phase 2 studies then confirmed antihypertensive efficacy in clinically stable outpatient populations, and KARDIA-3 extended evaluation to patients with uncontrolled hypertension and established or high cardiovascular risk receiving multiple antihypertensive agents; however, the study did not meet its prespecified multiplicity-adjusted threshold for statistical significance at month 3. The concern is not that harm has been demonstrated, but that prolonged angiotensinogen silencing may reduce short-term therapeutic flexibility during sepsis, perioperative stress, acute heart failure, marked volume depletion, or hyperkalemia—settings in which clinicians often rely on temporary adjustment of oral renin–angiotensin–aldosterone system inhibitors. Early reversal strategies are conceptually important, but current approaches appear better suited to planned de-escalation than emergency rescue. Future work should define vulnerable phenotypes, clarify whether acute-care pathways require protocol adaptation, and determine how reversibility can be operationalized as phase 3 development advances.
Physical inactivity causes a significant burden from cardiovascular disease worldwide. As sedentary behaviours become increasingly prevalent, there is a growing imperative to explore practical strategies to mitigate cardiovascular risk. This systematic review and meta-analysis aimed to evaluate the association between physical activity in the form of stair climbing and cardiovascular risk. A systematic search of the PubMed and Embase databases was conducted from inception until 8 April 2025. Randomised controlled trials or observational studies including stair climbing as a variable were included. The outcomes of interest were cardiovascular mortality and incidence of cardiovascular disease including myocardial infarction, ischaemic stroke and heart failure. Statistical analyses were conducted using the Review Manager (RevMan) software. The database search yielded 1873 studies, out of which, nine studies with 480,479 patients were included in the analysis. The pooled analysis of five studies and 455,619 patients revealed that stair climbing was associated with a significant reduction in cardiovascular mortality (relative risk [RR] 0.61, 95
