We could not assess dosage directly, we evaluated serial heart rate measurement at 6, 12, 24, and 36 months as a surrogate for therapeutic intensity

The gap

Evidence profile

Sourced from the inline gaps and future work and limitations of the source papers, classified as general, spanning 3 journals.

Supporting evidence — 3 representative gaps

• Bisoprolol vs. Carvedilol After Percutaneous Coronary Intervention in Acute Myocardial Infarction With Reduced Left Ventricular Ejection Fraction (2026) · Circulation Journal · doi

  34 Although we could not assess dosage directly, we evalu- ated serial heart rate measurement at 6, 12, 24, and 36 months as a surrogate for therapeutic intensity. Eighth, the study was limited to a 3-year follow-up period, which may be insufficient to fully capture long-term cardiovascular outcomes. Finally, although we used a multicenter registry, the sample size of the matched cohort was insufficient to detect modest differences between the 2 agents. Further large-scale studies with extended follow- up are warranted to better elucidate the long-term associa- 649 tion of β-blocker selection on the prognosis of patients with AMI and reduced LVEF. Further large-scale prospective randomized trials or meta- analyses with extended follow-up are warranted to better elucidate the long-term association of specific β-blocker selection on the prognosis of patients with AMI and reduced LVEF.

  generalinline gaps
  Keywords: follow long term insufficient further large scale extended warranted better elucidate blocker selection prognosis patients
• Failure to achieve LDL-C and HS-CRP targets in post-acute myocardial infarction patients: prevalence and predictors. (2026) · PubMed · doi

  The present findings have direct implications for sec- ondary prevention strategies in post-AMI care. First, the observation that nearly half of Vietnamese patients failed to achieve LDL-C or hs-CRP targets underscores the im- portance of routine monitoring of both lipid and inflamma- tory markers in clinical practice. Second, high-risk groups such as patients with diabetes mellitus or chronic kidney disease warrant more aggressive and tailored therapeutic approaches. Third, the protective association of ACEI/ARB therapy highlights the potential benefit of prioritizing agents with pleiotropic effects that extend beyond blood pressure control. Finally, integration of emerging anti-inflammatory therapies may represent the next step in addressing residual cardiovascular risk and should be considered in future in- terventional trials. Future research should expand upon these findings through larger, multicenter studies across diverse Vietnamese and Southeast Asian populations to confirm external validity. Longitudinal cohort designs are warranted to determine the prognostic significance of persistent hs-CRP elevation in post-AMI patients and to evaluate the impact of dual-target achievement on long-term outcomes. In addition, interven- tional studies exploring anti-inflammatory therapies - such as colchicine, interleukin-1β inhibitors, or other emerging agents - should be prioritized to complement intensive lipid-lowering strategies. Genetic and ethnically tailored approaches may also yield further insight into residual risk mechanisms unique to Asian populations. Ultimately, integra- tion of lipid and inflammatory targets into comprehensive sec- ondary prevention algorithms represents a promising avenue for reducing cardiovascular morbidity and mortality. Figure 1. Prevalence of target failure among post-AMI patients. Figure 2. Graphical abstract illustrating dual target failure (LDL-C and hs-CRP).

  generalfuture work
  Keywords: patients post lipid risk inflammatory target ondary prevention strategies vietnamese targets tailored approaches agents emerging
• Integrated Management Strategies for Hypertension and Diabetes in Cardiovascular Disease Prevention: A Systematic Review (2026) · Cureus · doi

  The principal interpretive constraint of this systematic review is not the absence of evidence but the heterogeneity of the available evidence base. Most included studies were cohort, retrospective, or comparative effectiveness analyses, which provide clinically relevant real-world data but cannot establish causality with the same strength as randomized controlled trials. Observed associations may therefore reflect residual confounding, treatment-selection bias, differences in baseline cardiovascular risk, variation in medication exposure, and inconsistent adjustment for comorbidities or concurrent therapies. Differences in study design, population demographics, comparator groups, follow-up duration, and cardiovascular 2026 Sen et al. Cureus 18(6): e111603. DOI 10.7759/cureus.111603 9 of 12 endpoint definitions also limited direct cross-study comparisons and precluded meta-analysis. Although hypertension was central to the review question, the included studies primarily evaluated glucose- lowering pharmacotherapies, cardiometabolic risk-factor control, and integrated care models. Therefore, class-specific antihypertensive treatment evidence, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, calcium-channel blockers, beta-blockers, and diuretics, was not comprehensively synthesized. This limits the ability of the review to draw conclusions regarding preferred antihypertensive drug classes in patients with coexisting T2DM and hypertension. This review also did not specifically synthesize emerging dual SGLT2 inhibitor/GLP-1 receptor agonist combination therapy evidence or recent cardiorenal outcome trials as separate evidence categories. As a result, conclusions regarding newer cardiometabolic treatment strategies should be interpreted in the context of the included studies and their predefined eligibility criteria. Future updates should incorporate emerging evidence on dual-class cardiometabolic pharmacotherapy, kidney-cardiovascular outcome trials, and contemporary guideline-directed approaches to combined metabolic and blood pressure management. The inclusion of a pilot implementation protocol required separate interpretation. Because the HEARTS- aligned study did not report completed clinical outcomes, it was not used as evidence of cardiovascular risk reduction or clinical effectiveness. Its value lies in illustrating a planned health-system implementation strategy rather than demonstrating patient-level benefit. This distinction is important when interpreting the contribution of system-level care models within the broader synthesis. Future research should move from association-based evidence toward causal and implementation-focused evaluation. Well-designed randomized controlled trials and pragmatic comparative effectiveness studies are needed to clarify the independent and combined effects of glucose-lowering therapies, antihypertensive treatment, blood pressure control, glycemic stability, and lifestyle interventions on cardiovascular endpoints. Longitudinal implementation studies are also needed to determine whether integrated care models such as HEARTS can produce sustained improvements in blood pressure control, glycemic control, medication adherence, cardiovascular events, cost-effectiveness, and patient-reported outcomes across diverse healthcare settings.

  generallimitationsevidence 5/5
  Keywords: evidence cardiovascular review effectiveness trials treatment control implementation included risk cardiometabolic care models antihypertensive blockers

Questions about this gap