The United States is facing a demographic shift as the population of older adults grows rapidly, with the proportion of Americans ≥65 years of age projected to double by 2060. This aging trend will have far-reaching effects on health care systems, especially because aging is a primary risk factor for cardiovascular disease. Age-related cardiovascular changes, such as increased arterial stiffness, endothelial dysfunction, and reduced elasticity, increase the risk for hypertension, atherosclerosis, and other risk factors. Older adults often experience additional complications, including obesity, diabetes, and metabolic diseases, further increasing their cardiovascular risk. Every year, >720 000 Americans experience myocardial infarction or coronary artery disease-related deaths, with older adults disproportionately affected. Individuals ≥75 years of age account for 30% to 40% of all acute coronary syndrome hospitalizations, often presenting with complex coronary disease and associated geriatric syndromes, such as frailty, cognitive impairment, and multimorbidity, complicating revascularization strategies. American College of Cardiology/American Heart Association guidelines for coronary revascularization primarily focus on younger populations, leaving substantial gaps for older adults with geriatric complexities. This scientific statement highlights the need for individualized approaches that consider geriatric syndromes, patient preferences, cognitive function, and life expectancy. This scientific statement outlines key aims: to review age-related cardiovascular changes and geriatric syndromes, provide pragmatic revascularization strategies, and advocate for shared decision-making. Addressing these knowledge gaps is essential for optimizing cardiovascular care for older adults, ensuring that treatment aligns with patient goals and accounts for the unique risks they face.

Missing data in clinical trials remains an ongoing concern. With the expansion of data privacy efforts and the consequent inability to contact trial participants for follow-up, the magnitude and reasons of missing data in clinical trials have shifted. The impact of missing data on a clinical trial results largely depends on the reason why the data are missing. When data are missing at random, the influence on the study's conclusions may be minimal. In contrast, when data are missing not at random, the integrity of the trial results can be compromised. For example, if participants are lost to follow-up or withdraw consent due to adverse reactions or side effects like bleeding, then the remaining participants may disproportionately represent those who can tolerate the therapy or are less frail, leading to biased conclusions regarding the drug's safety and efficacy, a phenomenon referred to as differential censoring. The best strategy is to minimize missing data from the outset of the trial, which includes designing an informed consent form that sets the expectation that and the alternate methods by which outcomes will be tracked even if the participant elects to discontinue study treatment. Likewise, rather than waiting until the end of the study, missing data should be continually and proactively minimized during the trial by offering patients more convenient and infrequent visit strategies or follow-up through relatives or other health care professionals as needed. Also, it is critical to characterize the basis for data missingness so that its impact on trial interpretation can be better assessed. This article provides a roadmap to successfully implement all of these strategies to minimize missing data.

Right heart catheterization plays a pivotal role in the preprocedural evaluation of patients considered for transcatheter tricuspid valve edge-to-edge repair. This study aimed to explore the potential impact of hemodynamic parameters obtained through right heart catheterization on patient-centered outcomes.

The clinical effects of sacubitril-valsartan, an angiotensin receptor-neprilysin inhibitor, on anthracycline-induced cardiotoxicity remain unknown. Experimental evidence suggests cardioprotective properties. This study evaluated the efficacy of sacubitril-valsartan in reducing cardiotoxicity in patients with increased cardiac troponin I concentrations during anthracycline chemotherapy.

The rapid advancement of genomic and precision medicine has expanded the role of genetics and genomics in the diagnosis, risk stratification, and management of cardiovascular diseases. With the decreasing cost and increasing accessibility of genetic testing, its clinical utility continues to expand, necessitating updated policies to ensure equitable access, appropriate regulatory oversight, and ethical data stewardship. This policy statement by the American Heart Association provides a framework addressing key policy areas, including equitable implementation of genetic testing, the impact of federal regulations, data privacy concerns, reimbursement for genetic counseling services, and the integration of emerging technologies such as artificial intelligence in cardiovascular genomics into clinical practice. This policy statement underscores the importance of strategic investments in biobanking and genomic research across all populations to enhance variant interpretation and to improve risk prediction models. In addition, it highlights the evolving landscape of pharmacogenomics, polygenic risk scores, and precision public health approaches to cardiovascular disease prevention. By advocating for a multidisciplinary approach that bridges scientific innovation, clinical application, and policy development, this policy statement aims to optimize the benefits of genetic and genomic testing while mitigating disparities and ethical challenges in its implementation.

Background: The Lead EvaluAtion for Defibrillation and Reliability (LEADR) trial evaluated the small-diameter (4.7Fr), lumenless, integrated bipolar OmniaSecure defibrillation lead. The trial exceeded primary safety and efficacy objective thresholds, demonstrating favorable efficacy at implant and a low rate of complications. Three-year term outcomes of the LEADR trial assessing the OmniaSecure lead are reported here. Methods: The LEADR trial is a prospective, multicenter, single-arm clinical trial. Patients with an indication for de novo ICD/CRT-D were implanted with the OmniaSecure lead in standard right ventricle (RV) locations and followed at prespecified intervals. The lead was evaluated for safety, efficacy, and reliability through final follow-up. Results: There were 643/657 patients (97.9%) successfully implanted with the OmniaSecure lead with a mean follow-up of 32.4 ± 9.1 months (26% female, 61.9 ± 12.9 years). Pacing capture threshold, pacing impedance, and R-wave amplitudes remained stable throughout. There was a 96.5% freedom from major study lead-related complications at 3 years. At 3 years, 22.3% of patients received appropriate therapies, i.e., shock and/or anti-tachycardia pacing (ATP), with a 75.4% ATP efficacy. Inappropriate shock rate was 2.7% and 5.9% at 1 and 3 years, respectively. Conclusions: The final results of the LEADR trial demonstrated 3-year term safety, efficacy, and reliability of the OmniaSecure lead, emphasizing the potential utility of this lead in a wide variety of patients.

The role of cardiac magnetic resonance (CMR) quantification of tricuspid regurgitation (TR) to identify high-risk patients with TR remains poorly defined. The aim of this study was to assess the prognostic relevance of TR quantification and of its consequences by CMR in a large real-world cohort.

Cardiorespiratory fitness is an integrative measure of cardiometabolic health and predictor of survival, yet little is known about its molecular underpinnings. Small molecule metabolites and lipids are increasingly recognized as exercise-stimulated signaling molecules and candidate molecular transducers of cardiorespiratory fitness.

Transthyretin amyloidosis with cardiomyopathy (ATTR-CM) is a progressive disease caused by the deposition of transthyretin as amyloid in the myocardium. Current therapies may slow disease progression but do not clear existing deposits. Coramitug is a humanized monoclonal antibody that targets misfolded transthyretin, designed to promote clearance of transthyretin amyloid through antibody-mediated phagocytosis.

The high-dose inactivated influenza vaccine (HD-IIV) has demonstrated superior protection against a range of hospitalization endpoints versus standard-dose inactivated influenza vaccine (SD-IIV), but its effectiveness against specific cardiovascular (CV) outcomes and in those with pre-existing CV disease (CVD) is not well elucidated.