Cardiovascular disease and chronic kidney disease remain the leading causes of morbidity and mortality in patients with type 2 diabetes, even when conventional risk factors are well managed. Two drug classes have emerged over the past decade that reduce these risks through mechanisms that are largely independent of glucose lowering effect: sodium-glucose cotransporter 2 inhibitors and nonsteroidal mineralocorticoid receptor antagonists. Empagliflozin demonstrated reductions in cardiovascular mortality, heart failure hospitalization, and kidney disease progression in the EMPA-REG OUTCOME trial and was subsequently shown to benefit patients with heart failure across the ejection fraction spectrum in the EMPEROR trials. Finerenone, the first nonsteroidal mineralocorticoid receptor antagonist with phase III cardiorenal outcome data, reduced both cardiovascular and kidney composite endpoints in the FIDELIO-DKD and FIGARO-DKD trials, effects that were confirmed and strengthened in the pooled FIDELITY analysis of over 13,000 patients. These 2 agents target distinct pathophysiological pathways. Sodium-glucose cotransporter 2 inhibition acts primarily through hemodynamic and tubuloglomerular mechanisms, whereas finerenone addresses mineralocorticoid receptor driven inflammation and fibrosis in cardiac and renal tissue. The CONFIDENCE trial, published in 2025, was the first prospective study to test their combination; finerenone plus empagliflozin reduced urinary albumin.

Background: Despite being a pillar of heart failure (HF) management, the guideline-directed initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2is) may be challenging due to the barrier of associated urinary tract infections (UTIs). Although there is a known risk, it remains unclear whether UTI incidence differs between patients with and without a prior history of UTIs. Methods: This study aimed to evaluate the risk-benefit profile of initiating an SGLT2i in patients with a history of UTIs. This retrospective, single-center healthcare system cohort analysis included adult patients hospitalized and taking an SGLT2i between 1 January 2020, and 31 August 2024. The included patients were divided into two cohorts: patients with and without a history of UTI pre-SGLT2i (described in this study as UTI-naive). Patients with urogenital structural abnormalities, indwelling catheters, or high-risk profiles were excluded. The primary outcome was the incidence of UTIs post-SGLT2i initiation. Secondary outcomes included the number of UTIs within 30, 60, and 90 days after starting an SGLT2i. Results: A total of 280 patients were evaluated for this study, of which 250 were included for analysis. Of those, 197 were UTI-naive, and 53 had a history of UTI pre-SGLT2i use. The most utilized SGLT2i was empagliflozin (75.6%). Amongst the cohorts, 20.4% of the UTI-naive patients developed a UTI post-SGLT2i versus 30.2% in patients with a historical UTI (p = 0.13). Conclusions: There was no significant difference in UTIs developed up to 90 days post-SGLT2i initiation, regardless of previous infections, suggesting that a history of UTI should not be a barrier to differing first-line therapy.

Background:Non-obstructive hypertrophic cardiomyopathy (nHCM) remains a therapeutic challenge, with limited pharmacological options beyond symptomatic management. Mavacamten, a selective allosteric cardiac myosin inhibitor, has shown benefit in obstructive HCM, but its role in nHCM is uncertain. Methods:A systematic search of PubMed, Embase, CENTRAL, and ClinicalTrials.gov was conducted up to November 2025 for placebo-controlled randomized controlled trials (RCTs) enrolling patients with nHCM. Outcomes included Kansas City Cardiomyopathy Questionnaire (KCCQ) score, peak oxygen consumption (pVO2), New York Heart Association (NYHA) functional class, and treatment-emergent adverse events (TEAEs). Pooled mean differences (MDs) and risk ratios (RRs) were estimated using random- or fixed-effects models based on heterogeneity. Results:Two RCTs (n = 639) met inclusion criteria. Mavacamten showed a nonsignificant improvement in KCCQ (MD: 2.12; 95% CI: -0.98 to 5.22; I2 = 0%) and peak oxygen consumption (MD: 0.36 mL/kg/min; 95% CI: -0.20 to 0.92; I2 = 0%). No significant difference was observed in NYHA class improvement (RR: 1.15; 95% CI: 0.93 to 1.43; I2 = 0%). TEAE incidence was similar between groups (RR: 1.11; 95% CI: 0.34 to 3.58; I2 = 40.8%). Atrial fibrillation occurred more frequently with mavacamten (RR: 1.41; 95% CI: 1.28 to 1.56), whereas palpitations and dizziness did not differ significantly. Conclusions:Mavacamten does not significantly enhance symptoms, functional capacity, or health status in nHCM, though safety is comparable to placebo. Ongoing monitoring for arrhythmias and reduced ejection fraction is essential. Larger, longer-term studies are needed to clarify its role in this population.

Purpose Cardiogenic shock (ICD-10 R57.0) is a life-threatening condition with significant mortality. Despite advancements in critical care and mechanical circulatory support, disparities in cardiogenic shock-related mortality persist. This study examines variations in mortality across demographic, geographic, temporal, and healthcare access factors in the United States over two decades. Methods A retrospective analysis of cardiogenic shock-related deaths from 1999 to 2020 was conducted using the CDC WONDER database. Crude and age-adjusted mortality rates (AAMR) per 100,000 population were analyzed and stratified by state, urbanization level, sex, race, age group, and place of death. Geographic, racial, and healthcare disparities were assessed. Results A total of 11,732 cardiogenic shock-related deaths were identified. Mortality increased with age, peaking at 2.2 per 100,000 in individuals aged 85+ years. Geographic disparities were evident, with Alabama exhibiting the highest age-adjusted mortality rate (1.0 per 100,000) and Arizona the lowest (0.0 per 100,000), suggesting variations in healthcare access and management. Rural areas (Micropolitan & NonCore) had higher mortality rates compared to Large Central Metro areas. Males had slightly higher mortality than females. Racial disparities were observed, with Black individuals having an elevated age-adjusted rate (0.3 per 100,000) compared to White individuals (0.2 per 100,000). Mortality increased over time, rising from 516 deaths in 1999 to 990 deaths in 2020, with crude rates increasing from 0.2 to 0.3 per 100,000. The majority of deaths occurred in hospitals (75.2%), while 6.9% occurred at home, 5.6% in nursing homes, and 0.7% in hospice facilities, highlighting disparities in end-of-life care access. Conclusions Significant disparities in cardiogenic shock-related mortality exist across demographic and healthcare access factors. Older individuals, Black populations, rural residents, and those in specific geographic regions bear a disproportionate burden. The predominance of hospital deaths indicates advanced disease presentation at the time of care. Targeted public health initiatives, improved early detection, and enhanced critical care access are essential to reducing these disparities and improving outcomes. Clinical Implications Understanding these disparities can guide healthcare policy, resource allocation, and interventions to mitigate inequities in cardiogenic shock-related mortality. Efforts aimed at expanding rural healthcare services, addressing racial disparities, and improving early recognition and intervention strategies may help reduce the mortality burden.

Background: Essential hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality. The COVID-19 pandemic introduced major disruptions in chronic disease care, but its impact on hypertension-specific mortality at the population level remains underexplored. Methods: We used the CDC WONDER Multiple Cause of Death database to extract mortality data for essential hypertension (ICD-10 I10) from 2016–2023. We compared pre-COVID (2016–2019) and post-COVID (2020–2023) periods. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated using bridged-race census estimates and stratified by sex, race/ethnicity, age group, state, urbanization, year, and place of death. Results: There were 89,835 deaths pre-COVID and 107,425 deaths post-COVID, with the national AAMR increasing from 5.61 to 6.44 per 100,000. Increases were observed across all demographics: male AAMR rose from 5.74 to 6.76 and female from 5.34 to 5.97. Black individuals had the highest AAMR in both periods (9.20 to 10.66), while White individuals had the lowest (5.24 to 6.03). Adults ≥65 accounted for the majority of deaths; among them, the 65–74 group rose from 13.1 to 16.2 and the 75–84 group from 32.7 to 36.4. Geographically, Mississippi and West Virginia had the highest AAMRs in both eras, while Colorado and Utah consistently had the lowest. Urban-rural differences persisted, with Non-Core areas experiencing the highest AAMR post-COVID (6.16 to 6.95). Notably, the proportion of deaths occurring at home increased from 37.3% to 43.4%, while inpatient deaths remained stable around 16%, indicating a shift toward out-of-hospital deaths. Conclusion: Essential hypertension mortality increased following the COVID-19 pandemic, with widening disparities by sex and race and a marked shift toward out-of-hospital deaths. These findings highlight the urgent need to strengthen outpatient hypertension management and community health strategies, especially in vulnerable populations.