The "2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults" retires and replaces the "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults."

Ultraprocessed foods and beverages (UPFs) pose a growing public health challenge. Commonly defined by the Nova system, UPFs are industrially processed products made with additives or ingredients not commonly used in home cooking. Although ultraprocessing or extensive processing can lower cost and improve shelf life, convenience, and taste of certain products, high UPF intake is consistently linked to negative health outcomes. Although mechanisms remain unclear, evidence supports food policies that limit UPF intake while avoiding unintended consequences. Identifying high-risk UPF subgroups is essential to balancing nutritional goals with the need for accessible and appealing food options. Most UPFs overlap with foods high in saturated fat, added sugars, and sodium, which are already targets for cardiometabolic risk reduction. Future priorities include uncovering how UPFs specifically affect cardiometabolic health, refining dietary guidance to discourage nutrient-poor UPFs, and clarifying the impact of UPFs with more favorable profiles. This science advisory reviews current evidence on UPFs and their impact on cardiometabolic health and outlines research needs, regulatory reform, and policy changes needed to affect better dietary intake and overall health.

Assessment of left ventricular systolic function is essential for diagnosing and managing cardiac diseases and provides important prognostic information to the treating clinician. However, traditional methods for assessing left ventricular systolic function such as ejection fraction are limited by their reliance on geometric assumptions, subjective reader interpretation, sensitivity to loading conditions and volume, and reflection of a single plane of motion. In addition to interobserver and intraobserver variability and technical confounders, this evaluation is complicated by the complex 3-dimensional organization of the myocardial fibers, which are oriented longitudinally in the subendocardium, transversely in the midmyocardium, and obliquely in the subepicardium. Conversely, 2-dimensional speckle-tracking echocardiography measures left ventricular deformation as myocardial strain in the 3 planes of chamber motion: longitudinal, circumferential, and radial. From a clinical perspective, left ventricular global longitudinal strain offers superior diagnostic and prognostic value across the spectrum of cardiovascular disorders compared with ejection fraction, is highly reproducible, and detects subclinical dysfunction before the ejection fraction declines. Given the expanding clinical utility of speckle-tracking echocardiography and the incremental prognostic and therapeutic value of integrating global longitudinal strain into clinical practice as a potential biomarker, the objectives of this scientific statement are (1) to review the principles and technical aspects of speckle-tracking echocardiography strain imaging; (2) to provide a practical, evidence-based review of the application of speckle-tracking echocardiography in heart failure, cardiomyopathies, ischemic heart disease, valvular disease, and cardio-oncology; (3) to explore the potential utility of speckle-tracking echocardiography in cardiac resynchronization and implantable cardioverter defibrillator therapy; and (4) to outline the future directions of speckle-tracking echocardiography.

Extending cardiovascular disease prevention beyond health care settings is needed to improve population health and to advance health equity. Furthermore, evidence-based practices in community settings leverage assets and strengths (eg, community trust, reach) of organizations and practitioners. Using the Roadmap for Leveraging Implementation Science to Achieve Cardiovascular Health Equity, we conducted a narrative review to determine the scope of studies describing implementation strategies of cardiovascular health evidence-based practices in community settings and to identify bright spots and gaps in what is known about implementing cardiovascular health evidence-based practices in community settings. Evidence for the effect of interventions delivered in community settings to improve cardiovascular health behaviors is emerging in various community settings. Evidence-based practices were identified, selected, and culturally adapted through community engagement, particularly in faith-based and social service/other settings (eg, salons/barbershops). We found several interventions and adaptations aimed at improving outcomes in groups that have historically been excluded by the health care system. The Designing for Dissemination and Sustainability approach supports consideration of contextual factors (eg, alignment of evidence-based practice with the mission, workflow, time, and priorities of the setting) in selecting and adapting evidence-based practices. Development of implementation strategies must engage those who will be asked to implement the intervention and the organization in which it will be implemented. Key research opportunities include high-quality studies that explicitly compare well-specified implementation strategies in various community settings. Taken together, there are bright spots and opportunities for enhanced impact through implementation of evidence-based practices for cardiovascular disease prevention in community settings.

Efforts to enhance risk stratification in patients with coronary artery disease have driven the pursuit of early detection of rupture-prone plaques-before destabilization and the onset of life-threatening thrombosis-giving rise to the concept of the vulnerable plaque (VP). Invasive diagnostic modalities closely mirror histology and provide instrumental information on VP hallmarks and their prognostic significance. However, limited positive predictive value and invasive nature restrict their use for systematic screening. Noninvasive techniques offer broader application potential, but their specificity and resolution remain inferior to those of invasive techniques. A deeper understanding of the complex interplay between traditional ischemic risk factors, anatomic settings, rheological effects and systemic influences contributing to plaque evolution and rupture has refined our approach to identifying and managing VPs. Systemic therapies have been shown to counteract plaque progression and stabilize VPs by thickening the fibrous cap, decreasing atheroma and necrotic core volumes, and reducing inflammation. In parallel, the hypothesis of sealing and passivating VPs by intravascular imaging-guided preventive stenting is gaining support after the promising results of clinical trials and substantial advances in contemporary device performance and biocompatibility. Upcoming evidence will be instrumental in defining the net benefit of novel diagnostic tools and therapeutic strategies for VPs.

Cardiovascular disease remains the leading cause of death worldwide, calling for the development of novel therapeutics. Over the past 3 decades, substantial investments in human genetic research have unveiled the genetic architecture of cardiovascular disease, offering promising novel therapeutic targets. These discoveries have been instrumental in the development of several cardiovascular drug development programs, such as those targeting proprotein convertase subtilisin/kexin type 9, lipoprotein (a), apo C3, and angiopoietin-like 3. Large-scale resources such as population-based biobanks and data repositories, now enable human genetic data to be leveraged at scale and inform not only target selection, but also clinical drug development. This review highlights the transformative potential of human genetics in cardiovascular drug development, focusing on IL (interleukin)-6 signaling as a case study. Specifically, we discuss how IL-6 signaling was pinpointed as a key causal mediator of atherosclerosis by genetic data, shaping the current development landscape for anti-IL-6 therapeutics in cardiovascular disease. Recent genetic studies employing innovative methodologies have provided key insights into prioritizing indications for clinical testing, informing repurposing strategies, optimizing clinical trial design for population selection, and assessing safety signals. Despite this progress, methodological challenges, such as pleiotropic effects of genetic variants, extrapolation of small genetic associations to large interventional effects, and the predominance of European-derived data, highlight the need for careful interpretation. Continued methodological advances, coupled with the emergence of high-throughput omics data and detailed cardiovascular phenotyping, promise unprecedented opportunities to refine drug discovery and development.

The increasing demand for donor hearts presents both a critical challenge and a significant opportunity for innovation in cardiac transplantation. Advancements in immunosuppressive regimens and genetic engineering have reignited recent interest in xenotransplantation. Notably, 2 human patients have received genetically modified pig hearts under expanded-access authorization. They survived for 40 and 60 days, with xenograft failure preceding death in both cases. Concurrently, decedent studies have focused on monitoring the short-term physiological function of genetically modified cardiac xenografts in legally brain-dead recipients, representing a novel experimental paradigm for preclinical testing to help bridge the gap between nonhuman primate studies and clinical trials. These contemporary achievements build on a large body of exploratory efforts in cardiac xenotransplantation in nonhuman primates. Despite significant progress in overcoming hyperacute rejection, adaptive cellular and humoral immunological barriers remain. This review aims to critically evaluate the current advancements in xenotransplantation, to explore ongoing challenges, and to discuss the future potential of this innovative approach in addressing the growing demand for donor organs in cardiac transplantation.

The postacute sequelae of SARS-CoV-2, also known as Long COVID, may affect 10% to 25% of individuals diagnosed with SARS-CoV-2. More than 100 symptoms have been reported among patients with Long COVID, but almost all patients report severe fatigue, orthostatic intolerance, shortness of breath, and reductions in exercise tolerance. Emerging data suggest that cardiovascular deconditioning plays a major role in the development of this syndrome and that reductions in functional capacity among patients with Long COVID are comparable to reductions seen among individuals with cardiovascular deconditioning resulting from bed rest. Concern has been raised about the use of exercise training as part of the management strategy for patients with Long COVID. However, exercise training appropriately tailored to the patient with cardiovascular deconditioning may be an effective strategy to facilitate improvement in symptoms. This American Heart Association scientific statement provides a concise yet comprehensive overview of mechanisms contributing to development of Long COVID and methods by which exercise training may be applied to this unique patient population to alleviate symptoms and improve quality of life. In addition, methods of reintroducing exercise and return to play among athletes affected by COVID-19 are discussed.

Poor diet quality is a leading risk factor for cardiometabolic disease (ie, diabetes and diseases associated with metabolism and inflammation), which is present in about half of American adults. Support has grown for incorporating the provision of healthy food as a complement to or a component of clinical care. Such "Food Is Medicine" programs provide free or subsidized healthy food directly to patients in close coordination with the health care system. In this review, we systematically examined published randomized controlled trials examining Food Is Medicine programs in the United States, categorizing them into different stages of development using the National Institutes of Health Model for Behavioral Intervention Development. This review identified a total of 14 randomized controlled trials of Food Is Medicine interventions in the United States with noncommunicable disease outcomes, more than one-third of which were early-stage smaller-scale trials (stage 1 randomized controlled trials). Broad variations in populations enrolled; intervention design, duration, and intensity; and outcomes precluded many direct comparisons between studies. Randomized controlled trial data were generally consistent with findings in the observational literature, indicating that common Food Is Medicine approaches often positively influence diet quality and food security, which are theorized to be key mediators for clinical outcomes. However, the impact on clinical outcomes was inconsistent and often failed to reach statistical significance. These observations highlight the need for larger, higher-quality Food Is Medicine studies focusing on the measurement of clinical outcomes within well-designed programs and the need for additional randomized controlled trials that more systematically map out the relationship between participation in different types of Food Is Medicine programs and health outcomes.

Intraoperative transesophageal echocardiography is used with increasing frequency in cardiac surgery for monitoring and diagnostic purposes. Recent data have shown the impact of improved outcomes in patients undergoing cardiac surgery and the use of intraoperative transesophageal echocardiography in managing complex surgical decisions. However, specialty society recommendations have not been updated to reflect these trends. This scientific statement reviews the state-of-the-art practice of intraoperative echocardiography, summarizes the association of the use of intraoperative transesophageal echocardiography with enhanced outcomes, and provides specific perioperative and procedural transesophageal echocardiography considerations in the cardiac surgical population.

Alcohol is one of the most commonly consumed substances in the world, exhibiting complex relationships with multiple aspects of cardiovascular health and disease. The majority of the research on the topic is observational and therefore prone to bias and confounding. The available evidence suggests no risk to possible risk reduction when alcohol is consumed in low amounts (such as no more than 1 to 2 drinks a day) in regard to coronary artery disease, stroke, sudden death, and possibly heart failure. The risk associated with consuming 1 to 2 drinks a day on atrial fibrillation remains unknown. More randomized trials of low to moderate alcohol consumption are needed for more definitive conclusions. In stark contrast, heavier alcohol consumption such as binge drinking or consuming on average ≥3 drinks a day is consistently associated with worse outcomes in every cardiovascular disease entity studied. Considering the level of evidence, it remains unknown whether drinking is part of a healthy lifestyle and therefore clinicians should reinforce healthy lifestyle behaviors such as regularly engaging in physical activity, avoiding tobacco use, and maintaining healthy body weight.

The win ratio is a method for analyzing a hierarchical composite outcome. It has been most widely used in randomized clinical trials (RCTs) in cardiovascular disease. We performed a review of cardiovascular RCTs using the win ratio published between January 2022 and July 2024. The aims were to summarize current use and to provide examples to illustrate effective use and communication. We identified 36 eligible RCTs, mainly in heart failure and ischemic heart disease. Intervention was pharmaceutical in 26, a procedure in 7, and treatment strategy in 3 trials. When outcomes were analyzed with both conventional composite end points or hierarchical analysis, the conclusions tended to be similar. The win ratio was often used to combine evidence from event outcomes and quantitative measures together in a hierarchical composite, as was done in 23 RCTs. It was also used to create a clinically more relevant measure in RCTs by recognizing the clinical priorities among event outcomes. Selected example RCTs illustrate how the clarity of win ratio findings can be improved by (1) complementing the win ratio (a relative measure) with the win difference, (2) identifying which components of a hierarchical composite drive the overall results, and (3) clearly prespecifying the outcomes and win ratio analysis to be used. We conclude with a set of recommendations for future use of hierarchical composite outcomes and the win ratio. When used wisely, the win ratio is a valuable tool in the analysis of RCTs.

Cardiac intensive care units are witnessing a demographic shift, characterized by patients with increasingly complex or end-stage cardiovascular disease with a greater burden of concomitant comorbid noncardiovascular disease. Despite technical advances in care that may be offered, many critically ill cardiovascular patients will nevertheless experience significant morbidity and mortality during the acute decompensation, including physical and psychological suffering. Palliative care, with its specialized focus on alleviating suffering, aligns treatments with patient and caregiver values and improves overall care planning. Integrating palliative care into cardiovascular disease management extends the therapeutic approach beyond life-sustaining measures to encompass life-enhancing goals, addressing the physical, emotional, psychosocial, and spiritual needs of critically ill patients. This American Heart Association scientific statement aims to explore the definitions and conceptual framework of palliative care and to suggest strategies to integrate palliative care principles into the management of patients with critical cardiovascular illness.

The "open vein hypothesis" postulates that early thrombus clearance and restoration of venous blood flow may prevent postthrombotic syndrome after proximal deep vein thrombosis. Since its proposal several decades ago, new insights from basic and clinical studies have motivated a re-evaluation and refinement of this hypothesis. According to data from these studies, susceptibility to postthrombotic syndrome occurs as a result of differences in genetic composition, thrombophilic conditions, predilection to inflammation and fibrosis, endogenous fibrinolytic capability, timing of symptom presentation and treatment initiation, and efficacy of antithrombotic therapy. Although initial restoration of an open vein appears to be beneficial for selected patient groups, freedom from postthrombotic syndrome is more likely in the setting of long-term venous patency, reduced recurrent thrombotic episodes, and reduced perithrombotic (eg, vein wall and valve) inflammation. These underlying biological mechanisms need further elucidation, with a long-term goal of personalizing treatment by mapping the individuals' clinical presentation with their underlying risk factors and assessing time-dependent biological processes that occur as a clinical venous thrombosis resolves. This scientific statement (1) highlights historical fundamentals of the open vein hypothesis and then showcases new research insights into the pathophysiological factors driving postthrombotic syndrome; (2) discusses advantages and disadvantages of imaging modalities for deep vein thrombosis used in clinical practice, including the potential to depict thrombus chronicity and status of vein wall injury; (3) proposes measures to develop integrated multidisciplinary care for deep vein thrombosis focused on the reduction of postthrombotic syndrome; and (4) identifies priority areas and questions for further research.

The Get With the Guidelines-Heart Failure program was developed in 2005 with the goal of bringing evidence-based guidelines in heart failure management into widespread clinical practice. The program includes workshops, webinars, tool kits, chart abstraction, performance benchmarking, and achievement awards to drive quality improvement at participating hospitals. Two decades after its inception, the program has grown to include over 600 participating institutions across the United States. Linking registry data to Centers for Medicare and Medicaid Services claims has also allowed for the evaluation of longitudinal outcomes. Get With the Guidelines-Heart Failure has helped improve the quality of care for patients and has contributed substantially to the understanding of clinical science and optimal management of heart failure. This narrative review provides an overview of the indelible impact of the Get With the Guidelines-Heart Failure program on quality heart failure care over the past 20 years and highlights future challenges and directions.

Despite advances in cardiovascular care and improved outcomes, fragmented healthcare systems, nonequitable access to health care, and nonuniform and unbiased collection and access to healthcare data have exacerbated disparities in healthcare provision and further delayed the technological-enabled implementation of precision medicine. Precision medicine relies on a foundation of accurate and valid omics and phenomics that can be harnessed at scale from electronic health records. Big data approaches in noncardiovascular healthcare domains have helped improve efficiency and expedite the development of novel therapeutics; therefore, applying such an approach to cardiovascular precision medicine is an opportunity to further advance the field. Several endeavors, including the American Heart Association Precision Medicine platform and public-private partnerships (such as BigData@Heart in Europe), as well as cloud-based platforms, such as Terra used for the National Institutes of Health All of Us, are attempting to temporally and ontologically harmonize data. This state-of-the-art review summarizes best practices used in cardiovascular genomic and precision medicine and provides recommendations for systems' requirements that could enhance and accelerate the integration of these platforms.

Mitral regurgitation and tricuspid regurgitation are the most common valvular heart diseases in patients with heart failure and have independent prognostic value. Transcatheter interventions are now available for the treatment of valvular heart disease, and their efficacy and safety have been tested in randomized controlled trials. However, evidence is still limited and sometimes inconclusive because several aspects of these trials limit their interpretation or consistency. These include heterogeneity in the pathogenesis and clinical characteristics of patients, the dynamic nature of secondary atrioventricular valve disease severity, the role of heart failure medications and devices, dependency on procedural results and operators' skills, smaller number of patients enrolled and the power to detect differences in trials, and limitations to use patients' reported outcomes with unblinded study protocols. These specific aspects of trials in patients with atrioventricular valve disease are reviewed in this article with a focus on possible solutions to generate further evidence for the efficacy and safety for transcatheter treatments of atrioventricular valve disease in patients with heart failure.

Despite major advances in recent years, the timely detection and prevention of incipient congestion in patients with chronic heart failure remains challenging. Most approaches are either invasive or require the acquisition of additional hardware. Leveraging voice analysis for the purposes of diagnosing, predicting risks, and telemonitoring clinical outcomes of patients with heart failure represents a promising, cost-effective, and convenient alternative compared with hitherto deployed methods. To expand this field, close collaboration of several disciplines of medicine and computer science is an obligatory requirement. The current review aims to lay out the state-of-the-art in this quickly advancing area of research. It elucidates the foundation for voice feature extraction, describes the prospective capabilities of this evolving technology, and outlines the challenges involved in identifying vocal biomarkers both in general and in the context of heart failure.

Cardiovascular disease remains a leading cause of morbidity and mortality in adults despite recent scientific advancements. Although people are living longer lives, there may be an adverse impact on quality of life, necessitating a greater need for palliative care services and support. Palliative care for adults with advanced cardiovascular disease has the potential to significantly improve quality of life for individuals living with cardiovascular disease and their informal care partners. Effective communication, shared decision-making, age-friendly care principles, and advance care planning are vital components of palliative care and support comprehensive and holistic care throughout the advanced cardiovascular disease trajectory and across care settings. Current evidence highlights the benefits of palliative care in managing symptoms, reducing psychological distress, and supporting both people with cardiovascular disease and their care partners. However, significant gaps exist in palliative care research related to non-heart failure populations, care partner outcomes, and palliative care implementation in diverse populations. This scientific statement (1) discusses the application of effective communication, shared decision-making, age-friendly care, and advance care planning in advanced cardiovascular disease palliative care; (2) provides a summary of recent evidence related to palliative care and symptom management, quality of life, spiritual and psychological support, and bereavement support in individuals with advanced cardiovascular disease and their care partners; (3) discusses issues involving diversity, equity, and inclusion in cardiovascular disease palliative care; (4) highlights the ethical and legal concerns surrounding palliative care and implanted cardiac devices; and (5) provides strategies for palliative care engagement in adults with advanced cardiovascular disease for the care team.

The growing morbidity, mortality, and health care costs related to heart failure (HF) underscore the urgent need to prioritize its primary prevention. Whereas a risk-based approach for HF prevention remains in its infancy, several key opportunities exist to actualize this paradigm in clinical practice. First, the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guidelines provided recommendations, for the first time, on the clinical utility of multivariable risk equations to estimate risk of incident HF. Second, the American Heart Association recently developed the PREVENT (Predicting Risk of Cardiovascular Disease Events) equations, which not only enable prediction of incident HF separately, but also include HF in the prediction of total cardiovascular disease. Third, the predominant phenotype of HF risk has emerged as the cardiovascular-kidney-metabolic syndrome. Fourth, the emergence of novel therapies that prevent incident HF (eg, sodium-glucose cotransporter-2 inhibitors) and target multiple cardiovascular-kidney-metabolic axes demonstrate growing potential for risk-based interventions. Whereas the concept of risk-based prevention has been established for decades, it has only been operationalized for atherosclerotic cardiovascular disease prevention to date. Translating these opportunities into a conceptual framework of risk-based primary prevention of HF requires implementation of PREVENT-HF (Predicting Risk of Cardiovascular Disease Events-Heart Failure) equations, targeted use of cardiac biomarkers (eg, natriuretic peptides) and echocardiography for risk reclassification and earlier detection of pre-HF, and definition of therapy-specific risk thresholds that incorporate net benefit and cost-effectiveness. This scientific statement reviews the current evidence for accurate risk prediction, defines strategies for equitable prevention, and proposes potential strategies for the successful implementation of risk-based primary prevention of HF.