This Week in Cardiology — Aug 17, 2026

Welcome to This Week in Cardiology. This week we're covering 10 notable papers spanning risk stratification with biomarkers and body measurements, imaging to guide decisions in chest pain and cardiomyopathy, and therapeutics ranging from finerenone in heart failure to anticoagulation in dementia and platelet storage in cardiac surgery. Let's dive in.

Let's start with risk stratification, where two papers converge on natriuretic peptides. In the Annals of Internal Medicine, Cai and colleagues analysed more than 8,400 community-dwelling older adults from the ASPREE trial and its observational extension, all free of cardiovascular disease, with NT-proBNP measured at enrolment and again at year three. They classified participants by what they call heart stress status — age-specific NT-proBNP elevation — into persistently free of heart stress, remission, incident, or sustained. Over a median eight years of follow-up, participants who developed heart stress or had it persistently carried roughly six to seven-and-a-half percentage points higher absolute risk of cardiovascular events and of death by year eight compared with those who stayed free of it. The clinically interesting group were those whose NT-proBNP came back down: their absolute risks looked essentially the same as people who never had elevation at all. This is observational, in a predominantly White cohort, and it cannot tell us that lowering NT-proBNP causes lower risk — but it does argue that a single measurement is a snapshot, and that repeating it a few years later reclassifies people meaningfully. Complementing this, Heart published work from Tomasdottir and colleagues on more than 3,100 patients with atrial fibrillation who were NOT anticoagulated, drawn from two aspirin-randomised trials. Being in atrial fibrillation on the baseline electrocardiogram was the single strongest clinical correlate of NT-proBNP, with concentrations about four times higher than in sinus rhythm. Despite that, the prognostic signal held regardless of rhythm: patients in the third quartile of NT-proBNP had roughly double the risk of ischaemic stroke, heart failure hospitalisation, cardiovascular death, and all-cause death compared with the lowest quartile. So you can interpret an elevated NT-proBNP in atrial fibrillation as prognostically meaningful even though the rhythm itself inflates the number.

Staying with risk, the Journal of the American College of Cardiology published a large analysis from the Cross-Cohort Collaboration, led by Dardari and colleagues, of roughly 259,000 people across 15 cohorts followed for a median of 20 years, asking whether waist circumference and waist-to-hip ratio add anything to body mass index across nine cardiovascular outcomes [7]. Discordance was common: among people classified as overweight, about 40 percent had a high waist measurement, and among people with obesity, nearly half of them had a low waist-to-hip ratio. In people of normal weight or overweight, a clinically high waist circumference or waist-to-hip ratio carried 15 to 50 percent greater risk for most outcomes. Among those with obesity, a low waist circumference was not associated with significantly different risk than normal-weight peers — with the exception of all-cause mortality, where risk was actually lower. Notably, the sex pattern differed: women with obesity but a low waist-to-hip ratio still carried significantly elevated risk for all outcomes, unlike men. The population attributable risk from elevated central adiposity ran from 13 to 49 percent, highest for heart failure and atrial fibrillation. The practical message is simple and cheap: put a tape measure in the room.

On to imaging. Heart published the CONCRETE cluster-randomised trial from Koopman and colleagues, which randomised 101 Dutch general practices to give general practitioners direct access to coronary artery calcium scoring versus standard care for patients with stable chest pain [4]. The primary outcome — a practice-level increase in cardiovascular risk management registrations over two years — was flatly negative, essentially no difference between arms. But at the patient level, among 583 patients, calcium score access cut cardiologist referrals by about 47 percent in relative terms, from 80 percent down to 43 percent, and roughly doubled enrolment in preventive risk management. Detection of obstructive disease was not significantly different. Referral probability tracked the score, from about 8 percent for a score of zero up to 94 percent for scores of 400 or more, and no patient with a zero score had obstructive disease. So calcium scoring worked as a gatekeeper for low-likelihood patients without missing disease — but don't expect it to change practice-level prevention metrics on its own. From the European Heart Journal, Larsen and colleagues screened just over 10,000 asymptomatic Danish adults over 40 with coronary computed tomography angiography. Across every decade of life, and whether or not risk factors were present, women had less subclinical atherosclerosis than men. Obstructive subclinical disease was strongly prognostic in both sexes — a roughly fourfold higher hazard of myocardial infarction in women and twelvefold in men — though the test for sex interaction was not significant, so the apparent difference in magnitude should be read cautiously. Also in the imaging space, JAMA Cardiology published a retrospective post hoc analysis by Razvi and colleagues of cardiac magnetic resonance in just 43 United Kingdom participants from the HELIOS-B trial of vutrisiran in transthyretin amyloid cardiomyopathy [2]. None were on background tafamidis. Vutrisiran was associated with substantially better biventricular ejection fractions and stroke volumes, lower left ventricular mass, and a reduction in extracellular volume of about six and a half percent, the marker of amyloid load. At three years, two of nine vutrisiran patients showed amyloid regression versus none on placebo, while five of eight placebo patients progressed versus one of nine on treatment. The effect sizes are eye-catching but the numbers are tiny, single-centre, and post hoc — treat this as mechanistic support for gene-silencing therapy, not a new endpoint.

Turning to therapeutics. In the European Journal of Heart Failure, Ostrominski and colleagues report a pre-specified FINEARTS-HF analysis of apparent treatment-resistant hypertension in heart failure with mildly reduced or preserved ejection fraction [1]. Among 6,001 participants, roughly one in eight met criteria for apparent resistant hypertension. Finerenone lowered systolic blood pressure to a similar degree across all blood pressure categories, and the relative benefit on the primary composite of cardiovascular death and total heart failure events, as well as on health status, was consistent regardless of hypertension category, with no signal that safety differed. Practically, resistant hypertension is not a reason to withhold finerenone in this population, and it may be a reason to reach for it. The European Heart Journal also published a Swedish nationwide study by Zhu and colleagues linking the dementia registry to over 7,300 patients with incident Alzheimer's disease and pre-existing atrial fibrillation [8]. Compared with no anticoagulation, direct oral anticoagulant users had modestly slower cognitive decline — about 0.23 Mini-Mental State Examination points per year — plus about a 19 percent lower mortality, a third lower rate of stroke or systemic embolism, fewer fractures, and no excess major bleeding. Warfarin reduced mortality and stroke too, but with about a 31 percent higher rate of major bleeding. This is observational and confounding by indication is a real concern, but it argues against the reflex of stopping anticoagulation when dementia is diagnosed. Finally, JAMA published the CHIPS randomised trial from Spinella and colleagues, in which nearly 1,000 actively bleeding pediatric and adult cardiac surgery patients across 27 sites in the United States and Australia were randomised to cold-stored platelets kept up to 21 days versus room-temperature platelets kept up to seven days [3]. Cold-stored platelets were noninferior on the haemostatic efficacy score at every storage duration, with chest tube output at 24 hours statistically indistinguishable and no differences in thrombosis, respiratory or renal outcomes, or mortality — with the one exception of higher reexploration rates in the cold-stored group, which deserves scrutiny. If confirmed operationally, this could substantially reduce platelet wastage and extend availability. And rounding out the week, Circulation published the Pediatric Pulmonary Hypertension International Risk Score from Griffiths and colleagues, a machine-learning model built on 345 registry patients using 16 selected predictors, which achieved an area under the curve of 0.90 in internal testing and 0.76 to 0.77 in Dutch and Spanish external validation, with negative predictive values above 90 percent — useful mainly for confidently identifying low-risk children over the next year.

If you only have time for one paper this week, make it the FINEARTS-HF resistant hypertension analysis in the European Journal of Heart Failure [1]. It answers a question that comes up in clinic every week — whether difficult-to-control blood pressure changes how you use finerenone in preserved ejection fraction heart failure — and the answer is clean and immediately actionable.

Here are the key takeaways from this week in Cardiology. First, NT-proBNP deserves to be tracked over time, not measured once: older adults whose elevation resolves look like those who never had it, and in atrial fibrillation an elevated value predicts events regardless of the rhythm at the time. Second, measure the waist — central adiposity reclassifies cardiovascular risk in a large fraction of people whose body mass index says otherwise, particularly for heart failure and atrial fibrillation. Third, coronary calcium scoring in primary care safely halved cardiology referrals for low-likelihood chest pain, but did not move practice-level prevention metrics. Fourth, finerenone works consistently in preserved and mildly reduced ejection fraction heart failure, including in the one in eight patients with apparent treatment-resistant hypertension. Fifth, don't reflexively deprescribe anticoagulation at an Alzheimer's diagnosis; the Swedish data favour direct oral anticoagulants over warfarin or nothing. And finally, cold-stored platelets out to 21 days held up against room-temperature platelets in bleeding cardiac surgery patients, with a note of caution about reexploration.

That's your roundup for This Week in Cardiology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.