🔥New in #EHJCVP🔥 In this analysis by Warnberg et al., including >12,000 patients with newly diagnosed heart failure, eplerenone was associated with lower all-cause mortality, less kidney function decline, and less mild hyperkalaemia compared with spironolactone. Interestingly, the apparent increase in HF hospitalization was attenuated when death was considered as a competing risk. ‼️Strengths: new-user design, long-term follow-up, individual-level laboratory data, multiple sensitivity analyses, and a negative-control outcome. 🚨But these findings require careful interpretation. This remains an observational comparison between markedly different populations: patients receiving eplerenone were younger, had better kidney function and differed substantially in background HF therapy. ❗️Moreover, LVEF was unavailable and the mortality association was attenuated and no longer significant in the subgroup enriched for HFrEF. Therefore, not evidence of superiority, but certainly a signal worth investigating. 💊An interesting contribution to the ongoing question: are spironolactone and eplerenone really interchangeable in HF? 🔗 doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @Massimi78530343 @doreen_sy @OtiliaTica1 @ESC_Journals @escardio

Indeed. The EHJ CVP is a treasure trove of such insightful information Pop right over to read it right here:

🔥New in #EHJCVP🔥 Fontan circulation is not just fixed piping, it is re-engineering. What happens to the PK of drugs following the Fontan procedure? ❗️Suppressed liver enzymes →reduced firstpass ❗️Enteropathy related protein-loss and hypoalbuminuria → increased free fraction of highly-protein bound drugs ❗️Reduced cardiac output → reduced volume of distribution of hydrophilic drugs + diminishes renal perfusion ❗️Reduced muscle mass → creatinine-based glomerular function estimation overestimates true renal function 💊Anticoagulants, antiarrhythmics, neurohormonal antagonists and pulmonary vasodilators are amongst those affected. Piqued? Read the review doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @Massimi78530343 @doreen_sy @OtiliaTica1 @ESC_Journals @escardio

🫀📢Call for Papers #EHJCVP Advancing cardiovascular pharmacotherapy through scientific excellence Building on the vision outlined by our Editor-in-Chief, Prof. @BiancaRoccaTwt , EHJ-CVP welcomes high-quality submissions advancing the science and clinical practice of cardiovascular drug therapy💊 🔬 We particularly encourage research addressing: 🔹 Drug development and clinical pharmacology 🔹 Drug efficacy, effectiveness and safety 🔹 Optimization of pharmacological treatments across cardiovascular diseases 🔹 Methodological excellence, research integrity and critical appraisal 🔹 Translation of pharmacological evidence into clinical practice 🎯 From innovative pharmacological research to better clinical decisions, the mission is to promote rigorous evidence that may improve cardiovascular care 🔥Have exciting research to share? We look forward to receiving your work 🔗academic.oup.com/ehjcvp/page… @Massimi78530343 @OtiliaTica1 @doreen_sy @ESC_Journals @escardio @ESC_Lavinia

🫀New in #EHJCVP Statin adherence among patients with hypertension in Swedish primary health care: a QregPV cohort study using explainable machine learning 📖Johan Sandslätt, Tobias Andersson and colleagues examined 2-year statin adherence in 30 497 patients with hypertension who started a statin in Swedish primary care between 2012 and 2015. Mean proportion of days covered was 73.2%, and only 60.2% reached adequate adherence (PDC above 80%). Adherence differed by indication: 54.0% in primary prevention, 61.3% in diabetes without cardiovascular disease and 65.5% in secondary prevention. ®️Using XGBoost with SHAP values, followed by multilevel regression, the five most important baseline characteristics were dispensed antithrombotic therapy (OR 1.38, 95% CI 1.26 to 1.50), the primary health care centre itself (MOR 1.16, 95% CI 1.12 to 1.20), age per 10-year increase (OR 1.14, 95% CI 1.12 to 1.17), initiation with atorvastatin rather than simvastatin (OR 1.33, 95% Cl 1.24 to 1.44) and birth outside Sweden (OR 0.73 to 0.78). Anxiety was also linked to lower adherence (OR 0.80, 95% CI 0.76 to 0.85). As a retrospective register-based cohort, the study measures dispensing rather than intake and the associations are not causal. Its novelty lies in applying explainable machine learning to a full regional primary care population, and in showing that the health care centre itself contributes to adherence variation that points to targets for intervention at both patient and provider level, particularly in primary prevention where adherence was lowest. 🔗 doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @Massimi78530343 @doreen_sy @OtiliaTica1 @escardio @ESC_Journals

🫀 From #EHJ to #EHJCVP about the new editor-in-chief @BiancaRoccaTwt A profile by #judithozkan in the #EHJ introduces our Editor-in-Chief, Bianca Rocca, Professor of Pharmacology at LUM University. Trained in haematology in Rome and in translational pharmacology at the University of Pennsylvania and the Wistar Institute, she names Carlo Patrono, Garret A. FitzGerald and Valerio De Stefano as her three formative mentors, and antithrombotic drugs, haemostasis, precision cardiovascular pharmacology, clinical research methodology and ethics in science as her core interests. She joined the #EHJCVP editorial board shortly after the journal launched in 2014, has been involved with the ESC Working Group on Cardiovascular Pharmacotherapy since 2008, where she is now Chairperson Elect, and took up the Editor-in-Chief role in early 2026. Her stated priorities: building trust through transparency, integrity and methodological rigour; empowering diversity and gender balance among authors, reviewers and editors; promoting method-focused articles; and exploring digital tools, with open access widening who can read the journal. Read the profile: doi.org/10.1093/eurheartj/eh… #EHJCVP

📣🫀 New in #EHJCVP What happens to anticoagulation strategy for cancer-associated thrombosis after discontinuation of blinded study treatment and prior to unblinding in a clinical trial? This interesting analysis by Isabelle Mahè, Celine Chapelle and collegues, from the API-CAT trial provides a snapshot of the dilemma on anticoagulation decisions in daily practice. After study-treatment discontinuation, among 1,458 trial participants, anticoagulation was stopped in 13.6% and continued in 86.4%, largely with DOACs. Yet dosing choices were highly variable: 62.7% received full-dose anticoagulation and 36.9% a reduced dose. ‼️Importantly, treatment decisions were only weakly related to patient or cancer characteristics, but varied according to timing of discontinuation, physician specialty and country. The study therefore captures a true "therapeutic grey zone" in extended anticoagulation for cancer-associated VTE-just before the API-CAT results provided evidence supporting reduced-dose apixaban. At the same time, it raises important unanswered questions: Which patients can safely discontinue anticoagulation after the initial treatment period? What drives the substantial differences across countries and specialities? How much of this variability reflects local practice patterns rather than patient risk? A glimpse into how clinicians navigate uncertainty when evidence is still evolving 🔗 doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @Massimi78530343 @doreen_sy @OtiliaTica1

📣📣📣New in #EHJCVP 🫀Beyond API-CAT: who should continue anticoagulation, and for how long? API-CAT showed that reduced-dose apixaban preserves efficacy while reducing bleeding during extended anticoagulation for cancer-associated thrombosis. Yet, while it answers how intensely we should anticoagulate, two key questions remain: who should continue treatment and for how long? In this Viewpoint, Marcello Di Nisio and Tzu-Fei Wang argues that extended anticoagulation should be a dynamic process of benefit-risk reassessment, adapting to cancer status, bleeding risk, prognosis and patients' preferences. The future may lie not only in safer doses, but in the right treatment, for the right patient, for the right duration. 🔗 doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @Massimi78530343 @OtiliaTica1 @doreen_sy

🫀 New in #EHJCVP When randomization is not enough: divergent β-blocker trials and the illusion of universal causality @elmir1omerovic , @BjornRedfors and colleagues ask why two rigorous trials of β-blockers after myocardial infarction without reduced ejection fraction reached opposite conclusions. REBOOT, with 8505 patients in Spain and Italy, found no significant benefit. BETAMI-DANBLOCK, with 5574 patients in Norway and Denmark, reported a reduction in its composite endpoint (HR 0.85, 95% CI 0.75 to 0.98), driven mainly by fewer non-fatal infarctions. The authors resist the prevailing explanation based on ejection fraction. In BETAMI-DANBLOCK, 85% of participants had preserved EF, whilst the EF 40 to 49% subgroup now put forward as the therapeutic target was itself not significant (HR 0.82, 95% CI 0.65 to 1.02). Drawing on Cartwright and Pearl, they argue that β-blockers have a stable causal capacity, but that its clinical expression depends on the causal environment: CYP2D6 pharmacogenomics, the agents used (metoprolol versus bisoprolol), cultures of care and rehabilitation intensity, and climate and circadian stressors. These mechanisms are offered as prespecifiable, testable hypotheses, and the authors are explicit that they carry no confirmatory weight. They conclude that both trials can be right, each within its causal environment and that β-blockers after MI are conditionally effective rather than universally beneficial or futile 📜Guidelines should evolve cautiously and registry-based phase 4 trials with CYP2D6 genotyping, rehabilitation intensity scoring and geographic and seasonal covariables should test where the benefit is real🪧 🔗doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @Massimi78530343 @OtiliaTica1 @doreen_sy @escardio @ESC_Journals

📢 The September issue of #EHJCVP is out! 
🧠 Rethinking evidence and methodology from randomized trials
🩸 Extended anticoagulation in cancer-associated thrombosis
🤖 Statin adherence & machine learning
❤️ Hydroxychloroquine-associated electrical abnormalities and cardiomyopathy 
🫀 Pharmacokinetics in Fontan circulation From trial methodology to everyday pharmacotherapy Explore the new issue👇 🔗 academic.oup.com/ehjcvp/issu… @escardio @ESC_Journals

🫀 New in #EHJCVP Universal evidence and contextual pharmacotherapy In her editorial, Editor-in-Chief @BiancaRoccaTwt draws the thread through this issue: context, broadly defined, shapes every stage of cardiovascular pharmacotherapy, from how evidence is generated and interpreted to how drugs are prescribed, taken and tolerated. 🗒️Two methodology pieces open the issue. A Current Opinion examines the divergent β-blocker trials after myocardial infarction, REBOOT and BETAMI-DANBLOCK, and introduces the concept of the causal environment. A companion Viewpoint responds with a GRADE-based framework for judging when inconsistency between trials should change decisions. Two papers then turn to cancer-associated thrombosis after API-CAT: an Original Article reports how trial investigators decided on anticoagulation after extended treatment, and a Viewpoint sets out the questions that remain on who should continue, for how long, and at what dose. The issue also includes an Original Article using explainable machine learning in the Swedish QregPV cohort to study statin adherence in patients with hypertension, a translational study combining a clinical cohort with experiments in human iPSC-derived cardiomyocytes to characterise hydroxychloroquine-associated electrical abnormalities and cardiomyopathy, and a Review of pharmacokinetics in the Fontan circulation. It closes with a correspondence exchange on bleeding risk assessment and anticoagulation in post-operative atrial fibrillation after coronary surgery, and a letter on accountability in Cardiovascular-Kidney-Metabolic syndrome care. 🔗doi.org/10.1093/ehjcvp/pvag0… @Massimi78530343 @doreen_sy @OtiliaTica1 @escardio @ESC_Journals

🫀 New in #EHJCVP 🌎🌏🌍May the universal truth rest in peace and us with her? On how to understand inconsistency in and among pharmacological trials Maura Marcucci, Holger J. Schünemann and Federico Germini ask how to read the divergent β-blocker trials after myocardial infarction without reduced ejection fraction: REBOOT found no cardiovascular benefit, whilst BETAMI-DANBLOCK found benefit. ⏩Their answer draws on the GRADE framework. Inconsistency matters when treatment effects differ enough to warrant different decisions for subgroups of patients, and that judgement rests on absolute effects measured against decision thresholds, rather than on statistical heterogeneity alone. They give a worked example. With a baseline risk of 2.4 events per 100 patient-years for the composite of death, MI or heart failure, the BETAMI hazard ratio of 0.79 translates into an absolute risk difference of minus 0.5 events per 100 patient-years. If the threshold for at least a small effect is set at 1 event per 100 patient-years, this estimate sits below it, in line with the neutral trials. The authors advocate a multi-domain approach that separates absolute from relative treatment effects and weighs the risk of inconsistency alongside imprecision, indirectness and the other sources of uncertainty, always with the appropriate subgroup PICO question in mind. 🔗doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @Massimi78530343 @OtiliaTica1 @doreen_sy

🫀New in #EHJCVP Should urate-lowering therapy be used to reduce cardiovascular risk beyond gout? In this issue of EHJ–Cardiovascular Pharmacotherapy, @FedericaFogacci, Claudio Borghi et al. examine the role of serum uric acid and urate-lowering therapy across the cardio–renal–metabolic continuum. Elevated serum uric acid is associated with hypertension, coronary artery disease, heart failure, stroke, chronic kidney disease, and mortality. Mendelian randomization studies also suggest a modest causal contribution to blood pressure, coronary disease, and advanced kidney disease. However, clinical trials have not consistently shown fewer cardiovascular events when urate-lowering therapy is added to guideline-directed treatment in asymptomatic hyperuricaemia, stable ischaemic heart disease, chronic heart failure, or chronic kidney disease. The evidence therefore does not support routine urate-lowering therapy solely for cardiovascular prevention in asymptomatic hyperuricaemia. Treatment should remain focused on gout and symptomatic hyperuricaemia, while future phenotype-guided approaches may help identify patients most likely to benefit. 🔗doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @OtiliaTica1 @doreen_sy @ESC_Journals @escardio

🫀New in #EHJCVP 💊Should lipid-lowering therapy be routinely initiated in patients with established heart failure? In this issue, Drexel, @AgewallStefan and colleagues examine the complex relationship between dyslipidaemia, atherosclerosis, and heart failure-and the role of lipid-lowering therapy across different stages and phenotypes of the disease. Although statins modestly reduce the incidence of heart failure in individuals without heart failure at baseline, dedicated outcome studies of rosuvastatin and alirocumab have not demonstrated a clear clinical benefit in patients with established heart failure. Importantly, there is no evidence that lipid-lowering therapies are harmful in heart failure. They should be continued when another established indication exists, particularly atherosclerotic cardiovascular disease. However, current evidence does not support their routine initiation solely for heart failure in the absence of another indication. 📃The review highlights the importance of timing and atiology: early lipid lowering may help prevent ischaemic heart failure by interrupting the progression from dyslipidaemia to atherosclerosis and coronary artery disease, whereas benefit may be more limited in advanced or non-ischaemic heart failure 🔗 doi.org/10.1093/ehjcvp/pvag0… @BiancaRoccaTwt @Massimi78530343 @OtiliaTica1 @doreen_sy

🫀 The ESC Working Group on Cardiovascular Pharmacotherapy and the Editorial Board of the #EHJCVP warmly congratulate @LindeCecilia on becoming President of the ESC @escardio We look forward to supporting her efforts to advance and implement cardiovascular science, education and patient care across our Community @BiancaRoccaTwt