Kosin Medical Journal

Original articles

A single-center analysis of guideline-directed medical therapy in patients with heart failure with mildly reduced or preserved ejection fraction according to current heart failure guidelines: Bong-Joon Kim, Suhyun Bae, Soo-Jin Kim, Sung-Il Im, Jung-Ho Heo; Kosin Med J. 2025;40(4):280-289. Published online December 26, 2025; DOI: https://doi.org/10.7180/kmj.25.124

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Background
Recent landmark trials have shown that several pharmacologic therapies improve outcomes in patients with heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF), leading to updates in heart failure (HF) management guidelines. However, real-world adherence to guideline-directed medical therapy (GDMT) in these populations remains uncertain. This study evaluated GDMT prescription patterns in patients with HFmrEF or HFpEF based on the 2022 Korean Heart Failure Society guidelines.
Methods
This single-center observational study included patients newly diagnosed with HF between January and December 2023, identified using International Classification of Diseases codes. Patients without recent echocardiographic or N-terminal pro–brain natriuretic peptide data, those with reduced ejection fraction, or those with end-stage renal disease were excluded. Electronic medical records were reviewed to assess GDMT prescription rates.
Results
Among 615 patients (mean age, 68.9 years; 52.4% female), 568 had HFpEF and 47 had HFmrEF. Common comorbidities included hypertension (75.5%), diabetes mellitus (50.9%), ischemic heart disease (43.7%), and chronic kidney disease (22.6%). Overall prescription rates were 73.3% for renin–angiotensin system inhibitors, 83.7% for beta-blockers, 41.1% for mineralocorticoid receptor antagonists (MRAs), and 42.9% for sodium–glucose cotransporter 2 inhibitors (SGLT2is). SGLT2i use was significantly higher in patients with diabetes than in those without (71.6% vs. 13.2%; p<0.001). Angiotensin receptor–neprilysin inhibitors and MRAs were more frequently prescribed in HFmrEF than HFpEF. Beta-blocker use was lower in patients aged ≥75 years.
Conclusions
A substantial gap persists between guideline recommendations and real-world GDMT use in patients with HFmrEF and HFpEF, particularly for SGLT2is. Multicenter studies are warranted to further characterize and address this treatment gap.

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Bridging the gap between guidelines and real-world practice for heart failure with mildly reduced or preserved ejection fraction
Hidenori Yaku
Kosin Medical Journal.2025; 40(4): 239. CrossRef

Early effects of PCSK9 inhibitors: evolocumab versus alirocumab: Su-Hyun Bae, Bong-Joon Kim, Soo-Jin Kim, Sung-Il Im, Hyun-Su Kim, Jung-Ho Heo; Kosin Med J. 2025;40(1):49-54. Published online March 27, 2025; DOI: https://doi.org/10.7180/kmj.24.145

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Background
The significance of risk modification in patients with acute coronary syndrome (ACS) is well recognized; however, the optimal timing for adminstering PCSK9 inhibitors remains unclear. Additionally, the lipid-lowering efficacy of evolocumab and alirocumab has not been fully established. This study evaluated the lipid-lowering effects of these two PCSK9 inhibitors.
Methods
Patients diagnosed with ACS, including unstable angina, ST-segment elevation myocardial infarction, and non-ST-segment elevation myocardial infarction, who were treated with a PCSK9 inhibitor (evolocumab or alirocumab) during hospitalization for ACS between 2021 and 2023 were retrospectively analyzed. Baseline low-density lipoprotein cholesterol (LDL-C) levels were assessed, and changes in LDL-C levels during the acute and subacute phases after PCSK9 inhibitor administration were compared between the evolocumab and alirocumab groups.
Results
Among 80 patients diagnosed with ACS, 36 received evolocumab, while 44 were treated with alirocumab. The mean baseline LDL-C level was 123 mg/dL in the evolocumab group and 128 mg/dL in the alirocumab group (p=0.456). In the subacute phase, the mean follow-up LDL-C levels were 47.05 mg/dL in the evolocumab group and 49.5 mg/dL in the alirocumab group (p=0.585). The mean percentage reduction in LDL-C levels during the subacute phase was 60.41% in the evolocumab group and 58.51% in the alirocumab group (p=0.431). These differences were not statistically significant.
Conclusions
No significant differences were observed between evolocumab and alirocumab. LDL-C levels exhibited a similar trend, characterized by a rapid decline in the acute phase, followed by a slight rebound in the subacute phase.

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Efficacy and safety of proprotein convertase subtilisin/kexin type 9 inhibitors for adults with familial hypercholesterolemia: A network meta-analysis
Weiwei Ding, Lingyao Sun, Yun Shi, Lei Tian
International Journal of Cardiology Cardiovascular Risk and Prevention.2026; 28: 200568. CrossRef

Synergistic effects of drug and aerobic exercise on endothelial function and epicardial fat thickness in patients with hypertension and dyslipidemia: Eun-Ah Jo, Shan-Shan Wu, Hyung-Rae Han, Jung-Jun Park, Jung-Ho Heo; Kosin Med J. 2025;40(1):31-40. Published online February 17, 2025; DOI: https://doi.org/10.7180/kmj.24.137

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Background
Aerobic exercise training and drug therapy are well-established interventions for the prevention and treatment of hypertension and dyslipidemia. We investigated the synergistic effects of aerobic exercise and olmesartan/rosuvastatin on epicardial fat thickness (EFT) and endothelial function in patients with hypertension and dyslipidemia.
Methods
A sample of 75 participants with hypertension and dyslipidemia was evaluated for multifactorial cardiovascular risk at baseline and at 6 months of intervention according to anthropometric and hemodynamic components, lipid profile, glycemia, brachial artery flow-mediated dilation (FMD), and EFT. After 3 months of drug therapy only, participants were allocated to one of three conditions: treadmill (n=22), exergame (n=29), or control (n=24).
Results
After 12 weeks of drug therapy only, systolic and diastolic blood pressure (3% and 2%, both p<0.05), total cholesterol (6.3%, p<0.01), low-density lipoprotein cholesterol (4.9%, p<0.05), triglycerides (11.1%, p<0.05), fasting blood glucose (10.2%, p<0.01), and glycosylated hemoglobin (3%, p<0.01) were significantly reduced. After 12 weeks of combined aerobic exercise and drug therapy, both the treadmill and exergame groups showed a significant improvement in FMD (both p<0.001) and reduction in EFT (both p<0.001). Systolic and diastolic blood pressures decreased in the treadmill group only (1.9% and 2.7%, respectively, p<0.05).
Conclusions
Incorporating aerobic exercise into drug therapy regimens can yield synergistic effects, particularly in improving endothelial function and reducing EFT, providing a comprehensive approach to managing cardiovascular risk in patients with hypertension and dyslipidemia.

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Heart matters: How glucose‐ and lipid‐modulating drugs remodel epicardial adipose tissue accumulation, inflammatory patterns and browning
Elisabeth Heuboeck, Charnkamal Singh Bhogal, Markus Mandl
Diabetes, Obesity and Metabolism.2026; 28(2): 878. CrossRef

Case report

Disseminated Staphylococcus aureus infection and acute bacterial pericarditis: a case report: Su Hyun Bae, Song-Hyun Lee, Joon-Young Choi, Bong-Joon Kim, Soo-Jin Kim, Sung-Il Im, Hyun-Su Kim, Jung-Ho Heo; Kosin Med J. 2023;38(2):134-137. Published online August 16, 2022; DOI: https://doi.org/10.7180/kmj.22.021

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We experienced a case of disseminated Staphylococcus aureus infection with bacterial pericarditis that progressed to septic shock and multiorgan failure despite pericardiocentesis and surgical removal of the original abscess with intensive antibiotic therapy. We report this case because of the patient’s very rare and remarkable echocardiographic findings and highly turbid pericardial effusion.

Citations

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Case Report: Acute methicillin-sensitive Staphylococcus aureus pericarditis in a diabetic patient
Daniel J. Lim, Richard Lu, Edwin C. Y. Sng, Felix M. Uy, Wei L. Huang, Siang C. Chai, Anthony Yii, Ing X. Soo, Jenn N. Khoo, X. Ruan
Frontiers in Cardiovascular Medicine.2025;[Epub] CrossRef

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