Ibrahim Mortada

Background: Evidence comparing intermediate‐term outcomes of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in patients with concomitant heart failure and chronic kidney disease remains limited. Methods: Using the TriNetX Global Collaborative Network, we conducted a retrospective study of adults with heart failure and chronic kidney disease undergoing TAVI or SAVR between January 2020 and December 2025. We excluded patients with redo procedures, history of endocarditis, prior heart transplant, ventricular assist device placement, or concomitant valve surgery. The primary outcome was all‐cause death. Secondary outcomes included acute myocardial infarction, ischemic stroke, acute kidney injury, and all‐cause hospitalization. Outcomes were assessed over 2 years of follow‐up using Cox proportional hazards models. Results: Before matching, 9575 patients underwent TAVI and 1233 underwent SAVR. Propensity score matching across 21 covariates balanced demographics, comorbidities, medications, and laboratory values, yielding 1034 matched patients in each cohort. During follow‐up, TAVI was associated with a higher mortality rate (hazard ratio [HR], 1.56 [95% CI, 1.21–2.01]) and lower risk of acute kidney injury (HR, 0.69 [95% CI, 0.60–0.80]) compared with SAVR. Risks of acute myocardial infarction (HR, 1.12 [95% CI, 0.87–1.44]), ischemic stroke (HR, 1.11 [95% CI, 0.85–1.45]), and all‐cause hospitalization (HR, 0.90 [95% CI, 0.81–1.00]) were similar. Sensitivity analyses across alternative modeling strategies yielded directionally consistent results. Conclusions: In this contemporary‐era cohort of patients with heart failure and chronic kidney disease, SAVR was associated with a lower mortality rate, whereas TAVI was associated with less acute kidney injury. These findings suggest important trade‐offs between procedural strategies in high‐risk cardiorenal populations.

Cardiovascular disease is a significant cause of on-duty death among firefighters and a primary source of morbidity in law enforcement officers. The American Heart Association’s Life’s Essential 8 (LE8) offers a standardized cardiovascular health phenotype across diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure. Published first-responder studies generally report individual LE8 components rather than composite scores. This narrative review synthesizes evidence for the eight components across both professions and evaluates five domains not directly measured by LE8: structural and occupational conditions, psychological health, sex-specific and reproductive context, functional reserve and occupational readiness, and occupational cardiovascular toxicity. Evidence is strongest for obesity, hypertension, fitness, sleep disruption, and psychological distress. Firefighter studies also document subclinical atherosclerosis and acute vascular effects of fire suppression, whereas law enforcement studies identify substantial cardiometabolic risk, frequent sleep disorders, and stress-related vulnerability. Evidence in women remains limited, so sex-specific conclusions should be treated as assessment and research priorities rather than established occupation-specific causal pathways. LE8 provides a useful starting point for assessing cardiovascular health in first responders, but occupational factors should also be considered. Prospective studies are needed to determine whether adding these occupational factors improves risk assessment or prevention beyond LE8 alone.

Background: Type 2 diabetes mellitus (T2DM) increases the risk of cardiovascular and neurocognitive complications. GLP-1 receptor agonists (GLP-1 RAs) and SGLT2 inhibitors (SGLT2is) have pleiotropic effects beyond glycemic control, but comparative long-term data on dementia, cardiovascular events, and mortality in older adults are limited. Methods: This retrospective cohort study used the TriNetX US Collaborative Network. Adults ≥60 years with T2DM on metformin plus either GLP-1 RAs or SGLT2is (n=56,211 per cohort after matching, 2014–2020) were propensity-score matched on demographic and clinical characteristics. Five-year outcomes included incident Alzheimer’s disease, vascular dementia, other dementia, dementia-related medication use, NSTEMI, STEMI, and all-cause mortality. Results: After propensity-score matching, GLP-1 RA use was associated with higher risks of Alzheimer’s disease (RR 1.33, 95% CI 1.18–1.48), vascular dementia (RR 1.56, 95% CI 1.39–1.76), other dementia (RR 1.33, 95% CI 1.21–1.47), dementia-related medication initiation, and all-cause mortality (RR 1.11, 95% CI 1.08–1.15) compared with SGLT2is. NSTEMI and STEMI risks did not differ significantly between groups. Conclusions: In older adults with T2DM, SGLT2is were associated with lower risks of dementia, dementia-related medication use, and all-cause mortality compared with GLP-1 RAs in propensity-score matched cohorts. These observational findings are hypothesis-generating and should be confirmed in prospective studies.

Background: Sex-related differences are well recognized in heart failure with preserved ejection fraction (HFpEF), but real-world data describing clinical outcomes by sex among patients with obesity and HFpEF treated with tirzepatide remain limited. Objectives: To compare observed hospitalization, cardiovascular, and gastrointestinal outcomes between male and female patients with obesity and HFpEF treated with tirzepatide. Design: Retrospective, propensity score-matched, within-treatment cohort study. Methods: A retrospective study was conducted using TriNetX database which included 110 healthcare organizations. Adults with obesity, HFpEF, and taking tirzepatide between June 1, 2022 and January 1, 2025 were identified. Males and females were balanced using 1:1 propensity score matching (n=1,654 per group). Primary outcome assessed included all-cause hospitalization. Secondary outcomes were all-cause mortality, HF exacerbation, major adverse cardiovascular events (MACE), incident atrial fibrillation, nausea/vomiting and diarrhea. Two prespecified falsification endpoints were used. Results: During 1-year follow-up, males had a lower hazard of all-cause hospitalization compared with females (HR 0.87, 95% CI 0.77–0.98). No significant differences were observed for all-cause mortality (HR 1.73, 95% CI 0.95–3.18), HF exacerbation (HR 1.14, 95% CI 0.90–1.44), MACE (HR 1.28, 95% CI 0.99–1.65), or incident atrial fibrillation (HR 1.21, 95% CI 0.61–2.43). Males experienced lower rates of nausea and vomiting (HR 0.50, 95% CI 0.37–0.67), while diarrhea was similar (HR 0.84, 95% CI 0.59–1.19). Falsification endpoints showed no significant associations. Conclusion: Among tirzepatide-treated patients with obesity and HFpEF, no statistically significant sex-associated differences were detected in major cardiovascular outcomes. Males had a modestly lower observed hazard of hospitalization and fewer coded nausea and vomiting events. Because this was a within-treatment observational comparison without an external comparator, these findings should not be interpreted as evidence of differential tirzepatide effectiveness by sex.

Cardiovascular disease remains the leading cause of line-of-duty mortality among firefighters. Sudden cardiac death occurs disproportionately during emergency operations, particularly fire suppression, suggesting an interaction between occupational stressors and underlying cardiovascular vulnerability. This narrative review integrates epidemiologic, mechanistic, and clinical data from observational studies, systematic reviews, and contemporary cardiovascular guidelines. A structured literature search of PubMed and Google Scholar identified studies addressing cardiovascular disease, sudden cardiac death, occupational stress, and autonomic regulation in firefighters. Autopsy and case–control data indicate that most duty-related sudden cardiac deaths occur in the presence of underlying coronary atherosclerosis. Firefighters exhibit a high prevalence of cardiovascular risk factors, including hypertension (10%–44%), obesity (14%–60%), dyslipidemia (20%–56%), and metabolic syndrome (∼22%); these rates exceed those reported in age-matched general-population samples. Emergency operations are associated with marked sympathetic activation, hemodynamic stress, and circadian perturbation, which may promote plaque destabilization, myocardial ischemia, and ventricular arrhythmia. Additionally, occupational stress and sleep disturbance are linked to autonomic imbalance, potentially increasing arrhythmic susceptibility. Sudden cardiac death in firefighters reflects the interaction between baseline cardiometabolic risk and intermittent high-intensity physiologic stress rather than a distinct occupational disease entity. Early risk identification, guideline-directed therapy, and recognition of occupational stressors are central to cardiovascular risk reduction in this population.

While patients with type 2 diabetes mellitus (T2DM) and heart failure (HF) are frequently prescribed dipeptidyl peptidase-4 inhibitors (DPP-4is), emerging evidence suggests glucagon-like peptide-1 receptor agonists may offer improved outcomes. This study compared the effectiveness of tirzepatide versus DPP-4i in patients with T2DM and HF. Adults with T2DM and HF treated between 2022 and 2025 were included. Cohort A comprised patients receiving tirzepatide, and Cohort B comprised patients receiving DPP-4is. Prespecified subgroup analyses were conducted for HF with reduced ejection fraction (HFrEF) and HF with non-reduced ejection fraction (HFnonrEF). Propensity score matching was performed across demographic, clinical, medication, and laboratory covariates. Outcomes included all-cause mortality, hospitalization, HF exacerbation, and major adverse cardiovascular events (MACE). After matching, 8,956 patients were included in each group. Tirzepatide therapy was associated with a lower hazard of all-cause mortality (HR 0.32, 95% CI 0.25–0.42), hospitalizations (HR 0.53, 95% CI 0.48–0.57), HF exacerbation (HR 0.37, 95% CI 0.33–0.42) and MACE (HR 0.79, 95% CI 0.73–0.84). Sub-group analyses for HFrEF and HFnonrEF demonstrated similar trends. In conclusion, among patients with T2DM and HF, treatment with tirzepatide was associated with markedly lower hazards of mortality, hospitalization, HF exacerbation, and MACE compared to DPP-4 inhibitors.