Heart failure with mildly reduced or preserved ejection fraction (HFpEF) accounts for over half of heart failure cases, with obesity playing a key role. Residual risk remains high despite available therapies. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown potential cardiometabolic benefits, but their role in HFpEF remains unclear. A systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating GLP-1RAs in HFpEF was conducted. Studies evaluating GLP-1RA in combination with glucose-dependent insulinotropic polypeptide (GIP) were also included. The analyzed outcomes included cardiovascular (CV) death, worsening heart failure (HF) events, and their composite. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Six RCTs with 8,788 patients were included. GLP-1RAs significantly reduced the composite outcome of CV death or worsening HF events (HR: 0.68 [0.51-0.89], p = 0.006, I² = 47%) as well as worsening HF events alone (HR: 0.56 [0.38-0.82], p = 0.003, I² = 51%). No significant reduction was observed for CV death alone (HR: 0.86 [0.67-1.12], p = 0.27, I² = 0%). GLP-1RAs reduce worsening HF events and the composite of CV death or worsening HF in HFpEF, particularly in patients with obesity or diabetes. These findings support their role as a promising therapy requiring further HFpEF-focused trials.

Background: Hypertension is a major public health concern and a key risk factor for acute myocardial infarction (AMI), significantly contributing to cardiovascular mortality. Despite advancements in management and treatment, trends in associated mortality remain underexplored.Objective: This study examines U.S. national trends in hypertension‐ and AMI‐associated mortality from 2000 to 2023, focusing on demographics and regions.Methods: Age‐adjusted mortality rates (AAMRs) per 100,000 for adults aged ≥ 25 with hypertension and AMI were extracted from the CDC WONDER database. Annual percent changes (APCs) and average APCs (AAPCs) with 95% confidence intervals (CIs) were calculated, stratified by year, sex, race/ethnicity, age, urbanization, and Census region.Results: From 2000 to 2023, 933,024 hypertension‐ and AMI‐related deaths were recorded. Overall, AAMR declined from 19.84 per 100,000 in 2000 to 16.26 in 2023 (AAPC: −0.93%, 95% CI: −1.18% to −0.76%). However, a sharp rise in mortality occurred between 2018 and 2021, coinciding with the COVID‐19 pandemic. Stratified analyses revealed persistently higher mortality rates among menmen, non‐Hispanic BlackBlack individuals, and residents of the Southern and rural U.S. regions. Younger adults showed an increasing AAMR trend, indicating a growing burden of hypertension and AMI‐associated disease.Conclusion: While long‐term mortality trends show a decline, recent years have seen a rise, particularly among high‐risk groups. Targeted public health interventions addressing hypertension management, cardiovascular risk reduction, and healthcare disparities are essential to mitigate the ongoing burden of hypertension and AMI mortality in the U.S.

Sex‐based differences in the efficacy of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) on cardiovascular, renal, and cerebrovascular outcomes remain unclear. This systematic review and meta‐analysis evaluated sex‐specific effects of GLP‐1RAs in patients with type 2 diabetes mellitus and related comorbidities. Randomised controlled trials and secondary analyses comparing GLP‐1RAs with placebo and reporting sex‐stratified data were included. Outcomes assessed included composite kidney outcomes, 3‐point major adverse cardiovascular events (MACE: cardiovascular death, non‐fatal myocardial infarction, or non‐fatal stroke), individual components of MACE, and hospitalization for heart failure (HHF). Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using random‐effects models. Eleven trials comprising 85,273 patients (43, 339 receiving GLP‐1RAs; 41, 934 placebo) were analysed. GLP‐1RAs significantly reduced the risk of composite kidney outcomes by 20% in males (HR: 0.80; 95% CI: 0.69–0.92) and 31% in females (HR: 0.69; 95% CI: 0.54–0.87), with no significant sex interaction ( p = 0.31). The risk of 3‐point MACE was reduced by 14% in males (HR: 0.86; 95% CI: 0.79–0.93) and 18% in females (HR: 0.82; 95% CI: 0.75–0.90; p = 0.47). Stroke risk decreased by 21% in males and 25% in females. No significant sex‐based differences were observed for cardiovascular death, myocardial infarction, or HHF. GLP‐1RAs reduce the risk of major cardiovascular, kidney, and cerebrovascular outcomes in both sexes, with consistent benefits across men and women. While variations between sexes were observed in certain outcomes, these differences did not reach statistical significance for interaction. Future trials should improve female representation and explore sex‐specific effects further.

Introduction: Vascular intestinal disorders (VID), including mesenteric ischemia, ischemic colitis, and intestinal angiodysplasia, have a global incidence of 8.11/100 000/year and a mortality of 1.26/100 000/year (15.5% death rate), rising from ~1% to ~3% in childhood to ~50% after 95 years. In the US, the incidence of acute vascular insufficiency of the intestine (AVII) is rising, warranting detailed trend analysis.Methods: CDC WONDER death certificates (1999–2020) for adults > 25 years were analyzed using ICD‐10 code N55. Age‐adjusted mortality rates (AAMRs) per 100 000 were stratified by year, sex, race/ethnicity, and region. Joinpoint Regression (v5.2.0) calculated annual percent changes (APCs); significance was defined as p < 0.05.Results: Overall AAMR declined from 9.35 (1999) to 5.81 (2020). Women had higher AAMRs (7.63; 95% CI: 7.6–7.66) than men (6.5; 95% CI: 6.49–6.56). By race/ethnicity, AAMRs were highest in NH American Indian (7.89; 95% CI: 7.57–8.21), NH Black (7.84; 95% CI: 7.75–7.9), NH White (7.25; 95% CI: 7.22–7.28), Hispanic (5.91; 95% CI: 5.83–6), and NH Asian (3.59; 95% CI: 3.5–3.68). Micropolitan areas had higher AAMRs (7.92) than metropolitan (6.99). Regional AAMRs were highest in the Midwest (7.7; 95% CI: 7.65–7.75), followed by South (7.17; 95% CI: 7.13–7.21), West (7.02; 95% CI: 6.96–7.07), and Northeast (6.85; 95% CI: 6.79–6.9). Kentucky had the highest state AAMR (9.67; 95% CI: 9.43–9.9), Hawaii the lowest (4.59; 95% CI: 4.31–4.87). Oklahoma, Rhode Island, Tennessee, West Virginia, and Wyoming ranked in the top 90th percentile.Conclusion: Despite an overall decline, VID mortality remains high among women, NH American Indians, rural areas, and the Midwest—underscoring the need for targeted interventions.

Background: Atrial fibrillation (AF) and dementia are increasingly prevalent in aging US populations. Their association raises public health concerns, emphasizing the need to understand mortality trends in older adults. This study examines AF and dementia‐related mortality trends from 2000 to 2020.Methods: Using the CDC WONDER Multiple Cause of Death database, we analyzed death certificates for individuals aged 65 and older, reporting age‐adjusted mortality rates (AAMRs) per 100 000 persons. Trends were assessed through annual percent change (APC) analysis via Joinpoint regression, with stratifications by sex, race/ethnicity, urbanization, and Census regions.Results: A total of 400 103 AF and dementia‐related deaths were recorded between 2000 and 2020. The AAMR increased markedly from 25.4 in 2000 to 70.4 in 2020. The overall AAMR showed a steady increase from 2000 to 2018 (APC: +4.2%; 95% CI: 2.5–5.5), with a sharper rise from 2018 to 2020 (APC: +9.5%; 95% CI: 4.5–12.2; p < 0.001). Mortality rates were comparable between men (AAMR: 44.4) and women (AAMR: 43.9). NH White individuals exhibited the highest AAMR (47.0), followed by NH Black (26.6), Hispanic (23.1), and NH Asian/Pacific Islander (18.0) populations. Nonmetropolitan areas had higher AAMRs (48.1) compared to metropolitan areas (43.5). Regionally, the Western US recorded the highest AAMR at 48.2, while state‐level disparities showed a nearly threefold difference between the top 90th and bottom 10th percentiles.Conclusion: Rising AF and dementia‐related mortality rates among older adults highlight a need for targeted screening and intervention, particularly for high‐risk demographics and underserved regions.