Background: Inflammation plays a key role in atrial fibrillation (AF) pathogenesis. The empirical dietary inflammatory potential (EDIP) score predicts circulating inflammatory biomarkers and adverse cardiac outcomes, but its association with incident AF is unclear. This study aimed to examine the relationship between EDIP score and AF risk. Methods: Participants from the Atherosclerosis Risk in Communities (ARIC) free of baseline AF who completed a validated food frequency questionnaire were included. Correlation of EDIP with inflammatory biomarkers (factor VIII, fibrinogen, von Willebrand factor, and C-reactive protein) was examined at baseline. Incident AF was ascertained using electrocardiograms, hospital records, and death certificates. Cox proportional hazards models estimated hazard ratios of AF across EDIP quantiles and per SD increase, adjusting for sociodemographic and cardiovascular risk factors. Results: Among 8,277 participants (54.1 years old, 51.3% women, 80% white), higher EDIP score correlated with circulating inflammatory biomarkers at baseline. Over a median 24.2 years of follow-up, 1,453 had incident AF (incident rate 8.6 per 1,000 person-years). Compared with the most anti-inflammatory diet (EDIP Q1), the most pro-inflammatory diet (EDIP Q5) was associated with increased AF risk (HR 1.21; 95% CI 1.03?1.43). Sex-stratified analyses showed a stronger association in men (HR 1.43; 95% CI 1.14?1.79), while no significant association was observed in women. Conclusions: Pro-inflammatory dietary patterns are independently associated with higher AF risk in a middle-aged cohort. These findings would support incorporating dietary inflammatory load into AF risk stratification. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement this research did not receive any external funds. The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute (NHLBI) contracts (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I). The authors thank the staff and participants of the ARIC study for their important contributions. This manuscript was prepared using a limited access dataset obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) and does not necessarily reflect the opinions or views of the ARIC study investigators or the NHLBI. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: this manuscript used public access dataset. No further IRB approval needed as data was daintified as the time of usage. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data used in this study were obtained from the National Heart, Lung, and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC). The datasets used for this analysis are available under the ARIC BioLINCC accession number HLB00020025a. Researchers may request access to these data directly through the BioLINCC website.

Background Coronary artery calcification (CAC) and mitral annular calcification (MAC) reflect cardiovascular aging and systemic atherosclerosis and have each been associated with the risk of atrial fibrillation (AF). Objective To examine the joint associations of CAC and MAC with incident AF in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods CAC and MAC were assessed using cardiac computed tomography and quantified by Agatston scoring. Participants were categorized into four groups: no CAC and no MAC (reference), CAC present without MAC, MAC present without CAC, both CAC and MAC present. Incident AF was identified through hospitalization records and Medicare claims. Multivariable-adjusted Cox proportional hazards models examined the association between CAC/MAC categories and incident AF. Improvement in AF risk prediction with the addition of CAC and MAC to Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE-AF) risk score was assessed using Harrell's C-statistic. Results Among 6588 participants (mean age 62 ​± ​10 years; 53% female) free of baseline AF, 1306 incident AF events occurred over a median follow-up of 16.5 years. Participants with both CAC and MAC present had the highest risk of AF. Compared with the reference group, CAC present without MAC, MAC present without CAC, and both CAC and MAC present were associated with 39%, 74%, and 96% higher risks of incident AF, respectively. Addition of CAC and MAC improved discrimination of the CHARGE-AF model (C-statistic 0.746 to 0.754; p ​< ​0.01). Conclusions CAC and MAC were jointly associated with incident AF, and their inclusion in a risk score improved AF risk prediction.

BACKGROUND:Ketone bodies (KB) are endogenous energy sources synthesized by the liver in response to metabolic stress. Their associations with atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and mortality and their potential beneficial or harmful effects have yet to be determined. This study aimed to examine the association between KB and incident cardiovascular outcomes and mortality in a large general population cohort free from ASCVD and HF at baseline. METHODS:This analysis included 90 987 participants (mean age 56.4 ± 8.1 years; 54.7% women) from the UK Biobank without prevalent ASCVD or HF. KB were measured by nuclear magnetic resonance spectroscopy. The primary outcomes were ASCVD, HF, and all-cause death. Secondary outcomes were myocardial infarction, ischemic stroke, peripheral artery disease, and CVD death. All outcomes were defined based on International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes. Multivariable-adjusted Cox proportional hazards models examined the association of total KB with incident cardiovascular outcomes and mortality. RESULTS:At a median follow-up of 13.4 years, higher levels of total KB (per 10-fold increase) were associated with a greater risk of incident ASCVD, HF, and all-cause mortality (hazard ratio [HR], 1.31 [95% CI, 1.18-1.46], 1.44 [95% CI, 1.24-1.6]7, and 1.51 [95% CI, 1.38-1.66]), respectively. Participants also demonstrated a 37% (95% CI, 11%-69%) increased risk of stroke and 69% (95% CI, 43%-100%) increased risk of CVDdeath. There was no significant association between KB and incident myocardial infarction. CONCLUSIONS:Elevation in endogenous KB in a population free from CVD at baseline is associated with an increased risk of ASCVD, HF, stroke, and mortality.

Background: The Atherogenic Index of Plasma (AIP), a novel biomarker of lipid metabolism, is linked to adverse cardiovascular disease (CVD) outcomes. Subclinical myocardial injury (SCMI) may precede clinically evident CVD. We examined the association between AIP and SCMI, and their combined impact on CVD mortality in the general population. Methods: We analyzed 7,093 participants without CVD from the Third National Health and Nutrition Examination Survey. AIP was calculated as the logarithmic ratio of triglycerides to HDL cholesterol. Participants were stratified into low or high AIP groups based on the median AIP value (0.958). SCMI was defined by a Cardiac Infarction/Injury Score (CIIS) ≥10 from 12-lead electrocardiograms. Four groups were created based on AIP and SCMI status. CVD mortality data were obtained from the National Death Index. Multivariable logistic regression models assessed the cross-sectional association between AIP and SCMI, while Cox proportional hazards models examined the relationship between different AIP/SCMI groups and CVD mortality. Results: At baseline, 1,861 participants had SCMI, and 3,533 had high AIP. In the cross-sectional analysis, adjusted for socio-demographics and CVD risk factors, high AIP was significantly associated with increased odds of SCMI [OR (95% CI): 1.20 (1.07–1.35)]. Compared to participants with low AIP and absent SCMI, those with SCMI, irrespective of AIP level, had a significantly higher risk of CVD mortality in multivariable Cox proportional hazard models. However, high AIP without SCMI was not associated with CVD mortality (AIP/SCMI interaction p-value = 0.477) (Table) . Conclusions: In a CVD-free general population, high AIP was associated with an increased risk of SCMI. While SCMI was linked to a higher risk of CVD mortality regardless of AIP levels, high AIP was only associated with CVD mortality when SCMI was present. These findings suggest that the reported adverse outcomes linked to high AIP may be driven by the development of SCMI.

Background: Lung cancer screening with low-dose computed tomography (LDCT) may uncover incidental findings (IFs) unrelated to lung cancer. There may be potential benefits from identifying clinically significant IFs that warrant intervention and potential harms related to identifying IFs that are not clinically significant but may result in additional evaluation, clinician effort, patient anxiety, complications, and excess cost. Objectives: To identify knowledge and research gaps and develop and prioritize research questions to address the approach to and management of IFs. Methods: We convened a multidisciplinary panel to review the available literature on IFs detected in lung cancer screening LDCT examinations, focusing on variability and standardizing reporting, management of IFs, and evaluation of the benefits and harms of IFs, particularly cardiovascular-related IFs. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in 1) reporting of IFs, 2) management of IFs, and 3) identifying and reporting coronary artery calcification found on lung cancer screening LDCT. Finally, we present the panel's initial 36 research questions and the final 20 prioritized questions. Conclusions: This statement provides a prioritized research agenda to further efforts focused on evaluating, managing, and increasing awareness of IFs in lung cancer screening.

BACKGROUND:Coronary artery calcium scoring (CACS) by computed tomography could enhance risk assessment and decision making for preventive medication in patients with diabetes. We performed a microsimulation study to compare costs and health outcomes of guideline-based periodic cardiovascular risk assessment with and without CACS. METHODS:We modeled various US guideline-based preventive approaches based on periodically assessed 10-year risk by pooled cohort equations with and without CACS. We predicted cumulative costs and quality-adjusted life years (QALYs) until age 100 years from the US health care sector perspective in MESA (Multi-Ethnic Study of Atherosclerosis) participants aged 45 to 84 years with diabetes (n=853), who were weighted to represent the US general patient population. Probabilistic and deterministic sensitivity analyses were performed to address uncertainty. RESULTS:Initiating high-intensity statins regardless of risk and low-dose aspirin if 10-year risk ≥10% led to the largest QALY gains with incremental cost-effectiveness ratios of $35 000 to $40 000/QALY. When omitting such universal approaches, allocating high-intensity statins and low-dose aspirin if CACS ≥100 led to incremental cost-effectiveness ratios around $50 000/QALY. Ranking of strategies by cost-effectiveness was generally robust against parameter uncertainty. The incremental cost-effectiveness ratio of the CACS ≥100 strategy fell below $50 000/QALY if the fee of CACS fell below $75 or when statin continuation was assumed to significantly improve with nonzero CAC scores. CONCLUSIONS:Broadening the use of high-intensity statins and low-dose aspirin in patients aged 45 to 84 years with diabetes can be considered cost-effective. If broad-scale use of intensive preventive treatment is either not feasible or not desired, then CACS may be cost-effective in refining preventive treatment decisions.

AIMS:To assess associations between out-of-pocket (OOP) expenditures and adherence to glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) among low-income Medicare beneficiaries with diabetes. MATERIALS AND METHODS:We analysed Medicare Current Beneficiary Survey two-year longitudinal data (2016-2021) on beneficiaries with diabetes using GLP-1RAs (N = 168; weighted = 2 187 500) or SGLT2i (N = 139; weighted = 1 741 910) in year one (baseline). Among these, N = 97 (weighted = 1 117 637) GLP-1RA and N = 73 (weighted = 785 301) SGLT2i users had an income below 200% of the Federal Poverty Level (low-income). Survey-weighted generalized Poisson regression assessed the association between baseline cumulative OOP drug expenses and year two adherence, defined as proportion of days covered (PDC). We repeated analyses in participants with higher income and using dual (Medicare/Medicaid) enrolment as a proxy for full coverage in low income. RESULTS:Year-two PDC was 65.2% (95% CI: 57.9%-72.6%) for low-income GLP-1RA users and 65.4% (95% CI: 58.3%-72.5%) for low-income SGLT2i users. We did not observe a significant association between OOP costs (mean: $253; range: $0-$4699) and adherence in low-income GLP-1RA users. For low-income SGLT2i users, higher OOP costs (mean: $204; $0-$2649) were associated with lower adherence: adjusted adherence ratio 0.959 (95% CI: 0.932-0.987) per $100 increase. Dual Medicare-Medicaid coverage was associated with increased adherence: adjusted adherence ratio 1.580 (95% CI: 1.061-2.352). For high-income GLP-1RA users, higher OOP expenditures were associated with increased adherence in the highest income range. CONCLUSIONS:OOP costs for GLP-1RAs and SGLT2i are substantial, potentially posing a particular burden for low-income Medicare beneficiaries. Policy changes may reduce this burden, although adherence improvements appear limited to beneficiaries using SGLT2i.

Background/Objectives : Hypertension is linked to slower walking pace and cognitive decline, but the ability of slow gait to predict dementia in older adults with hypertension is unclear. This study examined whether slow baseline gait predicts future cognitive impairment in older adults with hypertension enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition in Decreased Hypertension (MIND) study. Methods : SPRINTMIND randomized adults ≥50 years of age with hypertension to intensive (target systolic blood pressure <120 mmHg) or standard (<140 mmHg) blood pressure control. Baseline gait speed was measured in participants ≥75 years of age. We defined slow gait as speed ≤0.8 m/s. Outcomes were probable dementia (pD), mild cognitive impairment (MCI), and composite pD or MCI. Results : Among 2,351 participants, 33.3% had slow baseline gait. Over median 4-year follow-up, the slow gait group had higher rates of incident pD (13.5% vs 6.4%), MCI (19.4% vs 11.9%), and pD or MCI (29.2% vs 16.3%) compared with normal gait. Adjusted Cox regression models revealed that slow gait was associated with a 1.85-fold higher risk of pD (95% confidence interval [1.37, 2.50], p < .001), 1.52-fold higher risk of MCI (95% confidence interval [1.20, 1.93], p = .001), and 1.61-fold higher risk of pD or MCI (95% confidence interval [1.32, 1.97], p < .001). Intensive blood pressure control did not significantly affect cognitive outcomes in either gait group. Conclusion : Slow gait speed predicts increased cognitive decline risk among older adults with hypertension. Significance/Implications : Gait speed assessment can identify older adults with hypertension at higher risk of cognitive decline, allowing earlier intervention to potentially delay progression.

Background: The relationship between self-rated health (SRH) and cardiovascular events in individuals with hypertension, but without diabetes mellitus, is understudied. Methods: We performed a post hoc analysis of data from SPRINT (Systolic Blood Pressure Intervention Trial). SRH was categorized into excellent, very good, good and fair/poor. Using multivariable Cox regression, we estimated hazard ratios and 95% confidence intervals (CIs) for the association of SRH with both all-cause mortality and a composite of cardiovascular events (the primary outcome), which was defined to include myocardial infarction (MI), other acute coronary syndromes, stroke, acute decompensated heart failure, and cardiovascular death. Results: We included 9319 SPRINT participants (aged 67.9 ± 9 years, 35.6% women) with a median follow-up of 3.8 years. Compared with SRH of excellent, the risk [hazard ratio (95% CI)] of the primary outcome associated with very good, good, and fair/poor SRH was 1.11(0.78–1.56), 1.45 (1.03–2.05), and 1.87(1.28–2.75), respectively. Similarly, compared with SRH of excellent, the risk of all-cause mortality [hazard ratio (95% CI)] associated with very good, good, and fair/poor SRH was 1.13 (0.73–1.76), 1.72 (1.12–2.64), and 2.11 (1.32–3.38), respectively. Less favorable SRH (LF-SRH) was also associated with a higher risk of each component of the primary outcome and serious adverse events (SAE). Conclusion: Among individuals with hypertension, SRH is independently associated with the risk of incident cardiovascular events, all-cause mortality, and SAE. Our study suggest that guidelines should consider the potential significance of including SRH in the clinical history of patients with hypertension.

BACKGROUND:Current prevalence estimates of heart failure (HF) are primarily based on self-report or HF hospitalizations. There is an unmet need to define the prevalence and pathogenesis of early symptomatic HF, which may be undiagnosed and precedes HF hospitalization. METHODS:The MESA (Multi-Ethnic Study of Atherosclerosis) Early HF study was conducted during MESA exam 6 to determine the prevalence of early HF and investigate the transition from risk factors to early HF in a diverse population-based cohort of older adults. Between 2016 and 2018, 3285 MESA participants from 6 field centers underwent comprehensive speckle-tracking echocardiography with passive leg raise maneuver, Kansas City Cardiomyopathy Questionnaire, 6-minute walk test, arterial stiffness assessment, and proteomics (including NT-proBNP [N-terminal pro-B-type natriuretic peptide]). RESULTS:Median age was 73 (25th-75th percentile 67-81) years, 53.2% were female, 25.6% were Black, 12.8% were Chinese, and 40.0% were White. The prevalence of HF risk factors was high: hypertension, 61.9%; former or current smoking, 53.7%; obesity 34.8%; diabetes; 24.7%; and chronic kidney disease; 22%. Overt cardiovascular disease, which ranged from 2.1% (HF) to 13.6% (atrial fibrillation), was less common. Of the 3285 participants, 96% underwent proteomics, 94% Kansas City Cardiomyopathy Questionnaire, 93% speckle-tracking echocardiography with passive leg raise, 82% arterial stiffness exam, and 77% 6-minute walk test. Feasibility of resting speckle-tracking echocardiography (87%-99% across cardiac chambers) and passive leg raise Doppler/speckle-tracking echocardiography (>84%) measurements was high. A total of 120 unique echocardiographic indices were measured. CONCLUSIONS:The MESA Early HF study is a key resource for cardiovascular researchers who are interested in improving the epidemiological and phenotypic characterization of early HF. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005487.

Background Prior research suggests clinical effects of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) and sodium‐glucose cotransporter‐2 inhibitors (SGLT2is) are mediated by changes in glycated hemoglobin, body weight, systolic blood pressure, hematocrit, and urine albumin‐creatinine ratio. We aimed to confirm these findings using a meta‐analytic approach. Methods and Results We updated a systematic review of 9 GLP‐1RA and 13 SGLT2i trials and summarized longitudinal mediator data. We obtained hazard ratios (HRs) for cardiovascular, renal, and mortality outcomes. We performed linear mixed‐effects modeling of LogHRs versus changes in potential mediators and investigated differences in meta‐regression associations among drug classes using interaction terms. HRs generally became more protective with greater glycated hemoglobin reduction among GLP‐1RA trials, with average HR improvements of 20% to 30%, reaching statistical significance for major adverse cardiovascular events (ΔHR, 23%; P=0.02). Among SGLT2i trials, associations with HRs were not significant and differed from GLP1‐RA trials for major adverse cardiovascular events (Pinteraction=0.04). HRs for major adverse cardiovascular events, myocardial infarction, and stroke became less efficacious (ΔHR, −15% to −34%), with more weight loss for SGLT2i but not for GLP‐1RA trials (ΔHR, 4%−7%; Pinteraction<0.05). Among 5 SGLT2i trials with available data, HRs for stroke became less efficacious with larger increases in hematocrit (ΔHR, 123%; P=0.09). No changes in HRs by systolic blood pressure (ΔHR, −11% to 9%) and urine albumin‐creatinine ratio (ΔHR, −1% to 4%) were found for any outcome. Conclusions We confirmed increased efficacy findings for major adverse cardiovascular events with reduction in glycated hemoglobin for GLP1‐RAs. Further research is needed on the potential loss of cardiovascular benefits with increased weight loss and hematocrit for SGLT2i.

AIM:To assess the efficacy of aspirin use for primary prevention of cardiovascular disease (CVD) with incident atherosclerotic CVD and mortality in high-risk type 2 diabetes. METHODS:In this post hoc analysis, we included participants in the ACCORD trial without CVD at baseline. The association between aspirin use and the primary outcome (a composite of nonfatal myocardial infarction, nonfatal stroke or cardiovascular [CV] death) and all-cause mortality was evaluated using Cox proportional hazard analysis adjusting for demographics, CV risk factors and comorbidities. RESULTS:Eligible participants (n = 6330) were aged 62.8 ± 5.9 years at baseline, 43.8% of the participants were female, and 3026 (47.8%) used aspirin. Over a median (interquartile range) follow-up of 4.9 (4.1-5.7) years, the number (%) of primary outcome and all-cause mortality events in those who used aspirin (vs. those who did not), was 196 (6.5) versus 229 (6.9) and 146 (4.8) versus 147 (4.5), respectively. The adjusted hazard ratios (95% confidence interval) associated with aspirin use for the primary outcome and all-cause mortality were 0.94 (0.77-1.14) and 1.08 (0.85-1.36), respectively. CONCLUSION:In high-risk individuals with type 2 diabetes, the use of aspirin for primary prevention was not associated with a decreased risk of incident CVD or all-cause mortality.

European Journal of Heart FailureEarly View Invited Editorial Multimorbidity in the era of increasing life expectancy and aging population Nikhil Patel, Nikhil Patel Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USASearch for more papers by this authorJoseph Yeboah, Corresponding Author Joseph Yeboah [email protected] Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA Corresponding author. Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA. Tel. +1 336 716-7015, Fax +1 336 716-9188, Email: [email protected]Search for more papers by this author Nikhil Patel, Nikhil Patel Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USASearch for more papers by this authorJoseph Yeboah, Corresponding Author Joseph Yeboah [email protected] Division of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA Corresponding author. Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA. Tel. +1 336 716-7015, Fax +1 336 716-9188, Email: [email protected]Search for more papers by this author First published: 11 April 2024 https://doi.org/10.1002/ejhf.3243 The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology. doi: 10.1002/ejhf.3112. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. 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BACKGROUND: Sarcopenia and hypertension are independently associated with worse cardiovascular disease (CVD) risk and survival. While individuals with sarcopenia may benefit from intensive blood pressure (BP) control, the increased vulnerability of this population raises concerns for potential harm. This study aimed to evaluate clinical and safety outcomes with intensive (target <120 mm Hg) versus standard (<140 mm Hg) systolic BP targets in older hypertensive adults with sarcopenia compared with nonsarcopenic counterparts in the SPRINT (Systolic Blood Pressure Intervention Trial). METHODS: Sarcopenia was defined using surrogates of the lowest sex-stratified median of the sarcopenia index (serum creatinine/cystatin C×100) for muscle wasting and gait speed ≤0.8 m/s for muscle weakness. Outcomes included CVD events, all-cause mortality, and serious adverse events. RESULTS: Of 2571 SPRINT participants with sarcopenia index and gait speed data available (aged ≥75 years), 502 (19.5%) met the criteria for sarcopenia, which was associated with higher risks of CVD events (adjusted hazard ratio, 1.49 [95% CI, 1.15–1.94]; P =0.003) and all-cause mortality (adjusted hazard ratio, 1.46 [95% CI, 1.09–1.94]; P =0.010). In participants with sarcopenia, intensive (versus standard) BP control nearly halved the risk of CVD events (adjusted hazard ratio, 0.57 [95% CI, 0.36–0.88]; P =0.012) without increasing serious adverse events. Similar risk reduction was seen for all-cause mortality in participants with sarcopenia (adjusted hazard ratio, 0.66 [95% CI, 0.41–1.08]; P =0.102), but the effect was only significant in those without chronic kidney disease. CONCLUSIONS: Older hypertensive adults with sarcopenia randomized to intensive BP control experienced a lower risk of CVD without increased adverse events compared with standard BP control. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01206062.