Cardiac rehabilitation (CR) is a structured, multidisciplinary secondary-prevention intervention combining supervised exercise training, risk-factor modification, psychosocial support, and patient education. Decades of trial and registry data establish CR as one of the highest-value interventions available to patients recovering from acute myocardial infarction (AMI), with associations to reduced mortality, fewer reinfarctions, fewer hospital readmissions, improved left ventricular function, and better quality of life. This review synthesizes contemporary evidence on the physiological, clinical, and psychosocial impact of CR after AMI; examines how program timing, intensity, and delivery model (center-based, home-based, hybrid, and digital) shape outcomes; and reviews the substantial gap between guideline recommendations and real-world referral and participation rates. Despite a Class I guideline recommendation and consistent evidence of benefit, fewer than one-third of eligible patients in the United States complete a CR program, with pronounced disparities by sex, race, income, and geography. Closing this implementation gap - through systematic referral, flexible delivery models, and quality-indicator-driven auditing - represents one of the largest remaining opportunities to improve outcomes after AMI.
AIMS:This study compares the outcomes of adult patients with acutely decompensated heart failure(ADHF) treated with intravenous(IV) diuretics in an inpatient setting versus outpatient management in heart failure specialist nurse delivered, consultant-led ambulatory acute heart failure unit(AHFU). METHODS & RESULTS:A single-centre retrospective observational cohort study of 3713 patients with acute HF was conducted from January 2016 to December 2022. Hospitalised patients treated for ADHF with IV diuretics(Standard Care-SC, n = 2483) were compared to those treated with bolus IV diuretics in an outpatient specialist AHFU(n = 1230). Propensity score matching(PSM) was used to adjust for baseline differences across 11 covariates, resulting in two evenly matched cohorts of 1,227 patients in each arm. Before PSM, significant differences were observed between the SC and AHFU cohorts. The SC cohort was older(mean age 76.8 vs 75.0; p ≤ 0.001), had a higher clinical risk score(GWTG 43.35±11.38 vs. 42.37±12.02; p = 0.016), greater frailty(CFS 5.23±1.14 vs. 5.16±1.01;p = 0.007), elevated NTproBNP levels, higher ejection fraction(43.35%±11.38 vs. 42.37%±12.02; p = 0.016), and a higher prevalence of comorbidities(CCI 7.44±1.87 vs. 7.3 ± 1.73; p = 0.021). After matching, the cohorts were comparable across all covariates. The AHFU group showed significantly lower readmission rates at 30 days(16.5% vs. 24.1%,p < 0.001) and 1 year(25.2% vs. 30.8%,p = 0.004) compared to the SC group. The AHFU group had lower 30-day mortality(10.1% vs.13.5%, p = 0.009), but there was no significant difference in 1-year mortality(10.9% vs.10.8%,p=>0.999) was seen. CONCLUSION:Our propensity score-matched analysis demonstrates that HF specialist nurse-delivered, consultant-led AHFU care can improve 30-day mortality and readmission rates, as well as 1-year readmission outcomes. This model may serve as an alternative to hospitalisation for suitable patients.
OBJECTIVE:Given the significant role of self-care in managing heart failure, this study aimed to validate the Turkish version of the European Heart Failure Self-Care Behavior Scale Caregiver Version, focusing on the contributions of caregivers. DESIGN:This was a cross-sectional, methodological study. METHODS:This study assessed the contributions of caregivers to patients with heart failure, with 150 participants at a university hospital's cardiology clinic between January and May 2022. Confirmatory factor analysis was employed to verify construct validity using exploratory factor analysis (EFA). Cronbach's alpha was used to assess the reliability, internal consistency, and test-retest reliability of the data. The intraclass correlation coefficient (ICC) was used to estimate the reliability of the results. RESULTS:Factor analysis revealed that the construct comprised two factors, each with nine items. The factor loadings ranged from 0.61 to 0.87, accounting for 61.60% of the total variance. The fit indices were CFI=0.989, AGFI=0.961, and χ2/df 1.286, p<0.001, and RMSEA=0.044. The determination was made that the scale demonstrated acceptable model fit indices. CONCLUSION/IMPLICATION:The analysis identified two primary factors with strong factor loadings, explaining over 60% of the variance, indicating the scale's robust construct validity for assessing caregivers' contributions to heart failure self-care.
Heart failure (HF) remains a leading cause of global mortality. Remote ischemic conditioning (RIC), a non-invasive technique involving brief episodes of non-lethal limb ischemia and reperfusion, has been investigated as a potential cardioprotective and vascular-conditioning strategy, but its role in chronic HF remains uncertain. This review evaluated the effect of RIC on cardiac biomarkers, coronary microcirculation, left ventricular function, hemodynamics, functional capacity, safety, and clinical outcomes in adults with chronic HF irrespective of etiology. PubMed, Embase, CENTRAL, Web of Science, Scopus, and CINAHL were searched from inception through August 2026 without language restrictions; ClinicalTrials.gov, WHO ICTRP, conference literature, and citation searching were also examined. After deduplication, 966 records were screened. Eight completed studies with outcome data were identified, including seven independent studies with peer-reviewed full-text reports and one abstract-only study, encompassing 215 patients with HF. Small studies reported numerical reductions in BNP/NT-proBNP and selected favorable microvascular, hemodynamic, and ventricular-function findings; however, objective exercise-capacity outcomes were predominantly neutral, and no eligible study was adequately powered to assess mortality or HF hospitalization. The evidence base is limited by small samples, heterogeneous RIC protocols, methodological limitations, risk of bias, and reliance on surrogate endpoints. RIC remains investigational, and larger sham-controlled multicenter trials using contemporary guideline-directed medical therapy and patient-important outcomes are required.
BACKGROUND:Risk stratification in elderly patients with heart failure (HF) remains challenging. Conventional risk models often fail to capture physiologic vulnerability, limiting personalized care. The Clinical Frailty Scale (CFS), a simple bedside measure of frailty, has not been systematically evaluated for its prognostic value in elderly HF populations. METHODS:We performed a systematic review of MEDLINE, Scopus, ScienceDirect, and Cochrane databases through June 2026, including studies evaluating the prognostic value of the CFS in patients with HF. Multivariable-adjusted hazard ratios (HRs) for allcause mortality, HF hospitalization, and the composite outcome of all-cause mortality/HF hospitalization were pooled using a random-effects inverse-variance model in RevMan 5.4. RESULTS:Five studies including 2,682 elderly HF patients were included in the quantitative synthesis (mean age 81.2 years; 45.4% male; mean LVEF 53.7%). Among studies reporting phenotype, approximately 75% had preserved or mildly reduced EF. Higher CFS scores were associated with statistically significant increases in the risk of all-cause mortality (HR 2.39; 95% CI 1.72-3.32; p < 0.001; I²=45%), HF hospitalization (HR 1.52; 95% CI 1.18-1.95; p = 0.001; I²=0%), and composite outcome (HR 1.75; 95% CI 1.41-2.16; <;0.001; I²=0%). Leave-one-out sensitivity analysis confirmed robust allcause mortality associations; exclusion of one study reduced heterogeneity to 0% (HR 2.02; 95% CI 1.56-2.63; p < 0.001; I²=0%). These associations were derived from multivariable-adjusted models accounting for age, sex, LVEF, and comorbidities. CONCLUSIONS:Frailty assessed by the Clinical Frailty Scale is associated with increased mortality and HF rehospitalization, with more than a two-fold increase in all-cause mortality independent of conventional risk factors.
BACKGROUND:Iron deficiency is common in patients undergoing cardiac surgery and is associated with adverse perioperative outcomes. However, its systematic assessment and treatment remain inconsistently implemented in clinical practice. METHODS:We performed a prespecified sub-analysis of a multinational electronic survey conducted by the Interamerican Society of Cardiology between January and August 2025. The analysis included 551 cardiologists and evaluated perceived relevance, self-reported clinical practices, and professional and institutional factors associated with the implementation of routine preoperative iron deficiency screening and frequent intravenous iron use. Two multivariable logistic regression models were constructed to identify independent determinants of implementation. RESULTS:The median age of respondents was 41 years, and 62% were male. Although 87% considered preoperative iron deficiency management highly relevant, only 48% reported routine iron status assessment and 41% reported frequent intravenous iron use. Institutional protocols were independently associated with routine iron deficiency screening (OR 2.59, 95% CI 1.60-4.23), whereas fewer than five years of professional experience and practice at high-volume surgical centers were associated with lower odds of routine screening. Frequent intravenous iron use was independently associated with routine iron deficiency screening (OR 3.49, 95% CI 2.22-5.54), routine access to intravenous iron (OR 2.48, 95% CI 1.56-3.99), and institutional protocols (OR 2.06, 95% CI 1.26-3.40). CONCLUSIONS:Despite high perceived clinical relevance, substantial gaps persist in the implementation of iron deficiency management before cardiac surgery. Institutional protocols, systematic screening, and access to intravenous iron appear to be key determinants of clinical adoption.
BACKGROUND:Myocardial fibrosis on cardiovascular magnetic resonance (CMR), assessed by late gadolinium enhancement (LGE) and parametric mapping, is an established predictor of adverse events in cardiomyopathy. We assessed whether artificial intelligence (AI) quantification of fibrosis adds independent prognostic value. METHODS:We searched six databases, a clinical-trials register, and a preprint server from inception to 13 June 2026. Eligible studies used AI to generate a fibrosis marker in adults with ischemic or nonischemic cardiomyopathy, with covariate-adjusted outcomes over ≥12 months. Risk of bias was assessed using PROBAST, PROBAST+AI, and QUIPS. Fewer than three comparable studies precluded meta-analysis; certainty was rated using GRADE. RESULTS:Of 448 records (381 after de-duplication), 18 full texts were reviewed and two included, one peer-reviewed and one preprint. In an ischemic-cardiomyopathy registry (Ghanbari et al.; n = 216 analytic, 26 events), AI-derived dense LGE scar predicted arrhythmic events (univariable hazard ratio [HR] 2.35, 95% CI 1.33-4.15), and AI-derived but not manual scar improved discrimination beyond guideline criteria (area under the curve 0.63 to 0.68; p = 0.02). In a nonischemic dilated-cardiomyopathy preprint (Kim et al.; n = 347, 119 events), automated extracellular volume ≥30% predicted cardiovascular death or heart-failure hospitalization (adjusted HR 2.00, 95% CI 1.32-3.03). Both were at high risk of bias, with data-derived thresholds and no external validation. CONCLUSIONS:Across only two studies, AI-derived fibrosis was independently associated with adverse cardiovascular events, but its added value over manual quantification remains unproven. Certainty was very low. The evidence base is sparse and not yet ready for clinical use.
Device-detected atrial high-rate episodes and subclinical atrial fibrillation occupy an intermediate state between an electronic signal and clinically documented atrial fibrillation. ARTESiA showed that apixaban reduced stroke or systemic embolism compared with aspirin while increasing major bleeding. NOAH-AFNET 6 found no significant reduction in its broader composite of cardiovascular death, stroke, or systemic embolism with edoxaban and more death or major bleeding. Together, the trials indicate a low untreated stroke rate near 1% per year, reduced ischemic stroke with direct oral anticoagulation, and increased major bleeding. Treatment depends on absolute risk, outcome severity, and competing harm rather than a binary reading of statistical significance. This narrative review distinguishes randomized evidence, formal guideline recommendations, the 2026 American College of Cardiology Scientific Statement, and the authors' proposed framework, integrating diagnostic certainty, device source, episode characteristics and trajectory, prior stroke or transient ischemic attack, vascular and atrial substrate, bleeding susceptibility, and patient priorities. After rhythm confirmation, higher thromboembolic risk—including subgroup evidence after prior stroke or transient ischemic attack—may favor consideration of anticoagulation when bleeding risk is acceptable; uncertain signals, isolated short episodes, lower clinical risk, or substantial competing harm may favor continued surveillance. The six-minute trial eligibility criterion, episode duration, and device type are not independently validated universal treatment triggers, and no universally validated burden threshold exists. The proposed staged net-clinical-benefit framework is conceptual and hypothesis-generating, has not been prospectively or externally validated, and is not intended as a universal prescriptive treatment algorithm.
Drawing from the world of science fiction allows for a creative approach to illustrate important health topics. We have known for some time that addressing the chronic disease crisis at its root cause, cardiovascular disease being a primary component of this crisis, is optimal - the root cause being the primordial prevention of unhealthy lifestyle behaviors from ever taking hold, well before risk factors for chronic disease have the opportunity to manifest. Changing health trajectory at this level would transform health from the population to individual level. If only there was a time machine to trajectory engineer health and bend the curve of chronic disease at its root. This essay provides a valuable health lesson by taking a fresh look at one of the best science fiction movies ever made - Back to the Future.
BACKGROUND:The triglyceride-glucose (TyG) index, a simple laboratory marker of insulin resistance, has been associated with cardiometabolic risk. OBJECTIVES:The purpose of this study was to evaluate whether baseline TyG predicts long-term major adverse cardiovascular events (MACE) in patients with type 2 diabetes (T2DM) without clinical coronary artery disease (CAD), independent of traditional risk factors and coronary artery calcium scoring (CACS). METHODS:We conducted a retrospective analysis of a prospectively recruited cohort of 735 patients with T2DM, aged 55-74 years (48% women), enrolled between 2006 and 2008. All participants had at least one additional cardiovascular risk factor, no history or symptoms of CAD, and underwent computed tomography for CACS assessment. Multivariate Cox proportional hazards models were used to investigate the association of baseline TyG with the occurrence of myocardial infarction, stroke, or all-cause death, adjusting for demographic factors, diabetes severity, and CACS. RESULTS:Over a median follow-up of 16.4 years, 327 patients experienced a first MACE. Compared with patients with TyG <50th percentile (<9.26), multivariable-adjusted hazard ratios (95% CI) were 1.62 (1.30-2.03), 1.84 (1.43-2.38), and 2.09 (1.48-2.94) for TyG ≥50th (≥9.26), >75th (>9.68), and ≥90th (>10.16) percentiles, respectively. The association remained significant after additional adjustment for diabetes severity and CACS. In a combined TyG-CACS model, MACE incidence progressively increased from 1.29 (TyG <9.26; CACS=0) to 5.33 (TyG >9.68; CACS ≥100) events per 100 patient-years. CONCLUSIONS:In a cohort without known CAD, baseline TyG independently predicts long-term MACE in T2DM. This simple, widely available metabolic marker may enhance cardiovascular risk stratification and MACE primary prevention strategies.
Cardio-oncology patients may face complex treatment regimens due to the concurrent existence of cancer and cardiovascular disease, leading to a considerable polypharmacy burden. This significantly increases the prospect of drug-drug interactions (DDIs) and gene-drug interactions. The majority of these interactions arise from comparable pharmacokinetic and pharmacological pathways associated with drug transporters and cytochrome P450 enzymes. The significance of pharmacogenomics in tailored treatment strategies are emphasised by the fact that genetic variability enhances individual differences in drug response, safety, and efficacy. This narrative review focus on the effects of key genetic polymorphisms (e.g., DPYD, CYP2C19, and CYP2C9) on the metabolism and efficacy of commonly prescribed anticancer and cardiovascular medications such as fluoropyrimidines, clopidogrel, and warfarin. In addition it explore the role of pharmacogenomic variants on drug-drug interactions within the field of cardio-oncology. The study ultimately emphasizes the necessity of precision medicine in India to address the genetic diversity and underrepresentation in global genomic databases. The absence of pharmacogenomic testing, infrastructural deficiencies, financial constraints, and insufficient clinical integration hinder the widespread use of this technology in India. The Genome India Project and other national initiatives establish the foundation for pharmacogenomic-guided therapy. Utilizing genetic data, together with artificial intelligence-based predictive tools, for clinical decision-making may enhance medication safety and yield optimal outcomes in Indian cardio-oncology patients.
BACKGROUND AND OBJECTIVES:Cardiovascular risk factors originating in childhood and adolescence may persist into adulthood and increase cardiovascular morbidity and mortality. Arterial stiffness, measured by pulse wave velocity (PWV), and impaired cardiac autonomic modulation (CAM) are early indicators of cardiovascular dysfunction, yet their relationship during growth is not fully understood. The potential role of moderate-to-vigorous physical activity (MVPA) in this association also remains unclear. This study examined whether MVPA influences the association between PWV and CAM in children and adolescents. METHODS:This cross-sectional study included 111 participants (mean age 10.5 years; 49 girls). PWV was assessed using the Arteris AOP device. CAM was evaluated through heart rate variability indices (SDNN, RMSSD, LF, HF, SD1, SD2). MVPA was measured using the Actigraph GT3-X accelerometer. Associations between PWV and CAM were analyzed using quantile regression adjusted for sex, age, and body mass index (Model 1), with additional adjustment for MVPA (Model 2). RESULTS:PWV was inversely associated with RMSSD (β = -15.77; 95% CI: -31.15 to -0.40; p = 0.045) and SD1 (β = -13.15; 95% CI: -23.81 to -2.84; p = 0.033). After adjustment for MVPA, these associations were attenuated: PWV-RMSSD remained borderline significant (β = -14.08; 95% CI: -28.11 to -0.24; p = 0.049), while PWV-SD1 was no longer significant (p = 0.055). No associations were observed for SDNN, LF, HF, or SD2. CONCLUSION:Higher PWV was associated with lower parasympathetic modulation in youth, but this relationship was attenuated after accounting for MVPA. These findings suggest that physical activity may partially mitigate the adverse effects of arterial stiffness on autonomic function during early life.
Heart failure with preserved ejection fraction (HFpEF) is increasingly driven by obesity and cardiometabolic dysfunction. In this phenotype, the dominant biology extends beyond congestion alone and includes visceral and epicardial adiposity, systemic inflammation, impaired myocardial energetics, endothelial dysfunction, and exertional elevation in filling pressures. We performed a PRISMA-compliant systematic review with structured narrative evidence synthesis to evaluate pharmacological therapy in obesity-driven HFpEF, searching PubMed/MEDLINE, Scopus, Web of Science Core Collection, ClinicalTrials.gov, and WHO ICTRP through December 2025. Eighteen reports were included in the final qualitative synthesis. The available evidence supports sodium-glucose cotransporter 2 inhibitors as the pharmacological foundation because they provide the most mature outcome data across the preserved ejection fraction spectrum. Semaglutide improves symptoms, physical limitations, exercise capacity, and body weight in dedicated obesity-related HFpEF trials, whereas tirzepatide extends this signal by improving clinical status and reducing worsening heart failure events. Finerenone broadens the therapeutic platform in HF with mildly reduced or preserved ejection fraction, although obesity-specific data remain indirect. Conventional neurohormonal therapies retain a selective role, but they are not the principal biological match for this phenotype. Obesity-driven HFpEF should therefore be managed as a cardiometabolic syndrome with heart failure expression, using a phenotype-based sequence that links diagnosis, decongestion, SGLT2 inhibition, obesity-directed therapy, and selective adjunctive intensification.
Control of cardiovascular risk factors remains suboptimal worldwide, despite advances in pharmacologic therapies and evidence-based guidelines. Key modifiable determinants such as hypertension, diabetes, dyslipidemia, and smoking are still poorly managed, with fewer than half of patients achieving recommended targets in most registries, largely due to clinical inertia, limited adherence, and health system barriers. Beyond these classical determinants, non-biological barriers such as therapeutic inertia and limited treatment adherence continue to widen the gap between guideline recommendations and real-world practice. Addressing psychosocial factors is therefore essential for effective cardiovascular prevention. This review synthesizes current evidence, quantifies the treatment gaps across conventional and nonconventional risk factors, and highlights opportunities for integrated, patient-centered strategies to reduce residual cardiovascular risk.
BACKGROUND:Acute heart failure (AHF) carries substantial in-hospital mortality, yet prognostic data from sub-Saharan Africa, and particularly from Mauritania, are virtually absent. We aimed to identify independent predictors of in-hospital mortality at the only dedicated cardiology centre in Mauritania. METHODS:The MATURE registry prospectively enrolled consecutive adults hospitalised for AHF at the Centre National de Cardiologie, Nouakchott, between 1 January and 31 May 2024. Because deaths were few, a pre-specified parsimonious multivariable logistic-regression strategy avoided overfitting; discrimination was assessed by the area under the receiver-operating-characteristic curve (AUC) and calibration by the Hosmer-Lemeshow test. RESULTS:Of 307 patients (median age 61 years [IQR 51-70]; 64.8% male), in-hospital mortality was 5.5% (n = 17). Non-survivors had lower systolic blood pressure (100 vs 120 mmHg, p = 0.001), higher heart rate (114 vs 95 bpm, p = 0.001) and higher creatinine (14 vs 10 mg/L, p = 0.002); cardiogenic shock (23.5% vs 3.4%, p = 0.005) and intensive-care admission (70.6% vs 35.9%, p = 0.008) were more frequent. In the final model, systolic blood pressure (adjusted OR 0.96 per mmHg, 95% CI 0.94-0.99, p = 0.002) and serum creatinine (adjusted OR 1.02 per mg/L, 95% CI 1.00-1.03, p = 0.030) were independent predictors. Discrimination was moderate (AUC 0.75) and calibration acceptable (p = 0.31). CONCLUSIONS:In this first Mauritanian AHF cohort, in-hospital mortality was comparable to international registries. Low systolic blood pressure and renal dysfunction were the strongest independent predictors of death, offering simple bedside risk stratification where advanced diagnostics are unavailable.
BACKGROUND:Left atrial appendage occlusion (LAAO) reduces thromboembolic risk in patients with atrial fibrillation (AF) who have contraindications to oral anticoagulation (OAC). LAAO can be performed surgically (S-LAAO) or percutaneously (pLAAO), but direct comparative evidence remains limited. METHODS:We conducted a contemporary narrative review of evidence for S-LAAO and pLAAO, emphasizing randomized controlled trials (RCTs) and systematic reviews (SRs), with and without meta-analyses. A focused PubMed/MEDLINE search evaluated procedural safety, thromboembolic outcomes, and completeness of LAA exclusion. Preprocedural, intraprocedural, and postprocedural imaging evidence was additionally assessed using guidelines, expert consensus statements, observational studies, and emerging clinical trials. RESULTS:RCTs and SRs support both S-LAAO and pLAAO for reducing thromboembolic events. S-LAAO reduces stroke and systemic embolism when performed during concomitant cardiac surgery, with the strongest evidence from LAAOS III. Evidence for isolated S-LAAO, including epicardial AtriClip closure, remains limited. pLAAO has been evaluated in multiple RCTs and SRs and has demonstrated noninferiority to OAC in selected populations. Incomplete LAA exclusion remains a concern with both approaches, manifesting as residual stumps after surgical closure and peri-device leaks after percutaneous implantation. TEE and cardiac CT remain key imaging modalities, while ICE, CMR, and DSA/fluoroscopy-guided techniques are increasingly investigated. CONCLUSION:Both S-LAAO and pLAAO effectively reduce thromboembolic risk; however, evidence does not establish superiority of one approach. Evidence is substantially greater for pLAAO, whereas S-LAAO is primarily studied during concomitant cardiac surgery. Direct comparative studies are needed. Future research should address residual LAA patency, postprocedural antithrombotic therapy, and emerging imaging strategies.
AIMS:Although disease-modifying therapies have changed the management of transthyretin amyloid cardiomyopathy (ATTR-CM), supportive heart failure care remains crucial. Patients with ATTR-CM were excluded or underrepresented in randomized trials of sodium-glucose cotransporter-2 inhibitors (SGLT2i), leaving their role in this population uncertain. We performed a systematic review and stratified meta-analysis evaluating their efficacy, safety, and tolerability. METHODS AND RESULTS:PubMed/MEDLINE, Scopus, and the Cochrane Library/CENTRAL were searched up to 1 May 2026. The primary endpoint was ATTR-specific HR-based all-cause mortality. For studies enrolling both ATTR and AL amyloidosis, only separable ATTR subcohort estimates were extracted for the primary synthesis; AL estimates were excluded. Risk of bias was assessed using ROBINS-I and certainty of evidence using GRADE. Eighteen studies were included, comprising 12,039 SGLT2i-treated patients and 12,016 comparator patients across all analytic domains, although possible database overlap should be considered. The primary ATTR-specific HR-based synthesis showed an association between SGLT2i therapy and lower all-cause mortality (HR 0.65, 95% CI 0.56-0.76; I²=37.5%; 8 studies). HF-related events were directionally favourable but non-definitive (HR 0.73, 95% CI 0.50-1.06; I²=73.2%; 5 studies). Composite mortality/HF-related outcomes were associated with a lower risk (HR 0.69, 95% CI 0.55-0.85; I²=3.1%; 3 studies). Arrhythmic outcomes were only exploratory. SGLT2i therapy appeared well tolerated, with low pooled rates of definite discontinuation (6.9%), genitourinary events (4.7%), and AKI/renal adverse events (2.3%). CONCLUSION:Current non-randomized ATTR-specific evidence suggests that SGLT2i therapy in ATTR-CM/ATTR-HF is associated with lower all-cause mortality and acceptable safety and tolerability. Certainty remains low because of observational design, endpoint heterogeneity, heterogeneous background disease-modifying therapy, potential database overlap, and lack of patient-level amyloidosis subtype/stage stratification. Dedicated randomized trials are needed.
BACKGROUND:The Dietary Approaches to Stop Hypertension (DASH) diet is widely recommended for blood pressure control; however, its comparative effectiveness relative to other structured dietary interventions remains uncertain. OBJECTIVE:To evaluate the comparative effectiveness of the DASH diet versus alternative dietary interventions on blood pressure and cardiometabolic outcomes in adults. METHODS:A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA guidelines. Multiple databases were searched from inception to February 2026. Eligible studies included adults with elevated blood pressure or hypertension comparing the DASH diet with other dietary interventions or usual care. Continuous outcomes were pooled using random-effects models and expressed as mean differences (MD) or standardized mean differences (SMD). Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was evaluated using the GRADE approach. RESULTS:A total of 22 randomized controlled trials were included in the qualitative synthesis, of which 10 were included in the meta-analysis. The DASH diet did not demonstrate a statistically significant advantage over comparator diets in reducing systolic blood pressure (MD = 1.30; 95% CI: -1.54 to 4.14) or diastolic blood pressure (MD = 0.21; 95% CI: -3.72 to 4.14), with substantial heterogeneity observed across studies. Significant effects were identified for selected cardiometabolic outcomes, including reductions in urinary sodium excretion (MD = -32.89; 95% CI: -62.76 to -3.01), LDL cholesterol (MD = -8.59; 95% CI: -14.64 to -2.54), and glycated hemoglobin (HbA1c) (MD = -0.49; 95% CI: -0.52 to -0.46), as well as an increase in urinary potassium excretion (MD = 11.76; 95% CI: 4.08 to 19.44). The certainty of evidence ranged from moderate to very low across outcomes. CONCLUSIONS:The DASH diet was not superior to other dietary interventions in reducing blood pressure; however, it demonstrated consistent benefits in selected cardiometabolic parameters. Given the overall low certainty of evidence and substantial heterogeneity, these findings should be interpreted cautiously. Future research should focus on well-designed trials with standardized outcomes and longer follow-up to clarify comparative effectiveness.
