{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T02:19:02Z","timestamp":1793758742328,"version":"4.6.1"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec id=\"ab-hoi260002-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Mounting evidence suggests that renin-independent aldosteronism is common and often underrecognized. Yet, whether aldosteronism across this broader spectrum is associated with incident cardiovascular disease (CVD) has not, to the authors\u2019 knowledge, been comprehensively evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260002-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether aldosterone measures are associated with incident CVD events in community-dwelling older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260002-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This prospective cohort analysis included participants from the Atherosclerosis Risk in Communities (ARIC) study with serum aldosterone and renin levels measured in 2011 to 2013. Longitudinal analyses were conducted in March to September 2025 using Cox regression to assess associations between aldosterone parameters and incident CVD among participants free of heart failure (HF), myocardial infarction (MI), stroke, and potassium-sparing diuretic use at ARIC visit 5 (2011-2013).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260002-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Serum aldosterone level and aldosterone-renin ratio (ARR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260002-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Incident HF hospitalization, atrial fibrillation (AF), ischemic stroke, MI, and a composite of these events plus all-cause death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260002-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3477 individuals free of baseline CVD (mean [SD] age, 74.8\u2009[4.9] years; 2139 female [61.5%]), the median (IQR) aldosterone level was 5.1 (3.0-8.3) ng\/dL (to convert to picomoles per liter, multiply by 27.74), renin activity was 0.78 (0.41-1.90) ng\/mL per hour, and ARR was 5.9 (2.2-12.3) ng\/dL per ng\/mL\/h. Over 9 years of follow-up, higher ARR was associated with the composite outcome (adjusted hazard ratio [aHR], 1.04; 95% CI, 1.01-1.08 per doubling), stroke (aHR, 1.13; 95% CI, 1.02-1.26), and AF (aHR, 1.10; 95% CI, 1.05-1.15) but not with incident HF hospitalization (aHR, 1.02; 95% CI, 0.96-1.07) or MI (aHR, 1.01; 95% CI, 0.92-1.12).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260002-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>The findings of this cohort study underscore a spectrum of primary aldosteronism, in which higher ARR was independently associated with increased risks of AF and ischemic stroke among older adults, supporting the aldosterone pathway as a potential target for CVD prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamacardio.2026.0068","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T16:30:41Z","timestamp":1772641841000},"page":"341","source":"Crossref","is-referenced-by-count":12,"title":["Spectrum of Primary Aldosteronism and Risk of Cardiovascular Outcomes"],"prefix":"10.1001","volume":"11","author":[{"given":"Mats C. H.","family":"Lassen","sequence":"first","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W.","family":"Ostrominski","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian L.","family":"Claggett","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus O.","family":"Wijkman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Department of Health, Medicine and Caring Sciences, Link\u00f6ping University, Norrk\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of North Carolina, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy R.","family":"Van\u2019t Hof","sequence":"additional","affiliation":[{"name":"Cardiovascular Division and Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amil M.","family":"Shah","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tor","family":"Biering-S\u00f8rensen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenifer M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muthiah","family":"Vaduganathan","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"2","key":"hoi260002r1","doi-asserted-by":"publisher","first-page":"4409","DOI":"10.1002\/j.2040-4603.2023.tb00256.x","article-title":"Aldosterone: renal action and physiological effects.","volume":"13","author":"Johnston","year":"2023","journal-title":"Compr Physiol"},{"issue":"7","key":"hoi260002r2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.030142","article-title":"Adverse effects of aldosterone: beyond blood pressure.","volume":"13","author":"Brown","year":"2024","journal-title":"J Am Heart Assoc"},{"issue":"14","key":"hoi260002r3","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1056\/NEJMoa030207","article-title":"Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction.","volume":"348","author":"Pitt","year":"2003","journal-title":"N Engl J Med"},{"issue":"1","key":"hoi260002r4","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMoa1009492","article-title":"Eplerenone in patients with systolic heart failure and mild symptoms.","volume":"364","author":"Zannad","year":"2011","journal-title":"N Engl J Med"},{"issue":"16","key":"hoi260002r5","doi-asserted-by":"publisher","first-page":"1475","DOI":"10.1056\/NEJMoa2407107","article-title":"Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction.","volume":"391","author":"Solomon","year":"2024","journal-title":"N Engl J Med"},{"issue":"23","key":"hoi260002r6","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1056\/NEJMoa2025845","article-title":"Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes.","volume":"383","author":"Bakris","year":"2020","journal-title":"N Engl J Med"},{"issue":"12","key":"hoi260002r7","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1016\/S2213-8587(14)70194-9","article-title":"Antialbuminuric effect of the aldosterone blocker eplerenone in nondiabetic hypertensive patients with albuminuria: a double-blind, randomized, placebo-controlled trial.","volume":"2","author":"Ando","year":"2014","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"10424","key":"hoi260002r8","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/S0140-6736(23)02408-X","article-title":"Efficacy and safety of aldosterone synthase inhibition with and without empagliflozin for chronic kidney disease: a randomised, controlled, phase 2 trial.","volume":"403","author":"Tuttle","year":"2024","journal-title":"Lancet"},{"issue":"8","key":"hoi260002r9","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1001\/jamacardio.2018.2003","article-title":"Incidence of atrial fibrillation and mineralocorticoid receptor activity in patients with medically and surgically treated primary aldosteronism.","volume":"3","author":"Hundemer","year":"2018","journal-title":"JAMA Cardiol"},{"issue":"1","key":"hoi260002r10","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/S2213-8587(17)30367-4","article-title":"Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study.","volume":"6","author":"Hundemer","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"hoi260002r11","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/S2213-8587(17)30319-4","article-title":"Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis.","volume":"6","author":"Monticone","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"hoi260002r12","doi-asserted-by":"publisher","first-page":"10","DOI":"10.7326\/M20-0065","article-title":"The unrecognized prevalence of primary aldosteronism: a cross-sectional study.","volume":"173","author":"Brown","year":"2020","journal-title":"Ann Intern Med"},{"issue":"2","key":"hoi260002r13","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1161\/CIRCULATIONAHA.123.066389","article-title":"Subclinical primary aldosteronism and cardiovascular health: a population-based cohort study.","volume":"149","author":"Hundemer","year":"2024","journal-title":"Circulation"},{"issue":"13","key":"hoi260002r14","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1161\/CIRCULATIONAHA.124.073507","article-title":"Subclinical primary aldosteronism and major adverse cardiovascular events: a longitudinal population-based cohort study.","volume":"152","author":"Goupil","year":"2025","journal-title":"Circulation"},{"issue":"1","key":"hoi260002r15","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1056\/NEJMoa033263","article-title":"Serum aldosterone and the incidence of hypertension in nonhypertensive persons.","volume":"351","author":"Vasan","year":"2004","journal-title":"N Engl J Med"},{"issue":"4","key":"hoi260002r16","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1161\/01.HYP.0000258554.87444.91","article-title":"Clinical and genetic correlates of aldosterone-to-renin ratio and relations to blood pressure in a community sample.","volume":"49","author":"Newton-Cheh","year":"2007","journal-title":"Hypertension"},{"issue":"9","key":"hoi260002r17","doi-asserted-by":"publisher","first-page":"630","DOI":"10.7326\/M17-0882","article-title":"The spectrum of subclinical primary aldosteronism and incident hypertension: a cohort study.","volume":"167","author":"Brown","year":"2017","journal-title":"Ann Intern Med"},{"issue":"24","key":"hoi260002r18","doi-asserted-by":"publisher","first-page":"2355","DOI":"10.1161\/CIRCULATIONAHA.120.050896","article-title":"Association of serum aldosterone and plasma renin activity with ambulatory blood pressure in African Americans: the Jackson Heart Study.","volume":"143","author":"Joseph","year":"2021","journal-title":"Circulation"},{"issue":"1","key":"hoi260002r19","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1161\/HYPERTENSIONAHA.120.15006","article-title":"Serum aldosterone concentration, blood pressure, and coronary artery calcium: the Multi-Ethnic Study of Atherosclerosis.","volume":"76","author":"Inoue","year":"2020","journal-title":"Hypertension"},{"issue":"9","key":"hoi260002r20","doi-asserted-by":"publisher","first-page":"1984","DOI":"10.1161\/HYPERTENSIONAHA.122.19134","article-title":"Cardiac structure and function across the spectrum of aldosteronism: the Atherosclerosis Risk in Communities study.","volume":"79","author":"Brown","year":"2022","journal-title":"Hypertension"},{"issue":"24","key":"hoi260002r21","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.023082","article-title":"Heightened cardiovascular risk in hypertension associated with renin-independent aldosteronism vs renin-dependent aldosteronism: a collaborative study.","volume":"10","author":"Hu","year":"2021","journal-title":"J Am Heart Assoc"},{"issue":"23","key":"hoi260002r22","doi-asserted-by":"publisher","first-page":"2939","DOI":"10.1016\/j.jacc.2021.04.035","article-title":"The ARIC (Atherosclerosis Risk in Communities) study: JACC focus seminar 3\/8.","volume":"77","author":"Wright","year":"2021","journal-title":"J Am Coll Cardiol"},{"issue":"6","key":"hoi260002r23","doi-asserted-by":"publisher","first-page":"1334","DOI":"10.1161\/HYPERTENSIONAHA.120.15026","article-title":"2020 International Society of Hypertension global hypertension practice guidelines.","volume":"75","author":"Unger","year":"2020","journal-title":"Hypertension"},{"issue":"2","key":"hoi260002r24","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1161\/CIRCHEARTFAILURE.111.963199","article-title":"Classification of heart failure in the Atherosclerosis Risk in Communities (ARIC) study: a comparison of diagnostic criteria.","volume":"5","author":"Rosamond","year":"2012","journal-title":"Circ Heart Fail"},{"issue":"13","key":"hoi260002r25","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1056\/NEJM199809243391301","article-title":"Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994.","volume":"339","author":"Rosamond","year":"1998","journal-title":"N Engl J Med"},{"issue":"4","key":"hoi260002r26","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1161\/01.STR.30.4.736","article-title":"Stroke incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort.","volume":"30","author":"Rosamond","year":"1999","journal-title":"Stroke"},{"issue":"21","key":"hoi260002r27","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1161\/CIRCULATIONAHA.114.014145","article-title":"Atrial fibrillation and risk of ST-segment-elevation vs non\u2013ST-segment-elevation myocardial infarction: the Atherosclerosis Risk in Communities (ARIC) study.","volume":"131","author":"Soliman","year":"2015","journal-title":"Circulation"},{"issue":"9","key":"hoi260002r28","doi-asserted-by":"publisher","first-page":"2453","DOI":"10.1210\/clinem\/dgaf284","article-title":"Primary aldosteronism: an endocrine society clinical practice guideline.","volume":"110","author":"Adler","year":"2025","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"hoi260002r29","doi-asserted-by":"publisher","first-page":"1835","DOI":"10.1210\/jc.2016-3867","article-title":"Renin phenotypes characterize vascular disease, autonomous aldosteronism, and mineralocorticoid receptor activity.","volume":"102","author":"Hundemer","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"hoi260002r30","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1161\/HYPERTENSIONAHA.117.10596","article-title":"Adrenalectomy lowers incident atrial fibrillation in primary aldosteronism patients at long term.","volume":"71","author":"Rossi","year":"2018","journal-title":"Hypertension"},{"issue":"12","key":"hoi260002r31","doi-asserted-by":"publisher","first-page":"3758","DOI":"10.1038\/s41591-024-03264-4","article-title":"Finerenone in heart failure and chronic kidney disease with type 2 diabetes: FINE-HEART pooled analysis of cardiovascular, kidney, and mortality outcomes.","volume":"30","author":"Vaduganathan","year":"2024","journal-title":"Nat Med"},{"issue":"2","key":"hoi260002r32","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.jacc.2021.04.079","article-title":"Finerenone reduces new-onset atrial fibrillation in patients with chronic kidney disease and type 2 diabetes.","volume":"78","author":"Filippatos","year":"2021","journal-title":"J Am Coll Cardiol"},{"issue":"18","key":"hoi260002r33","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1016\/j.jacc.2011.11.063","article-title":"Eplerenone and atrial fibrillation in mild systolic heart failure: results from the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization snd Survival Study in Heart Failure) study.","volume":"59","author":"Swedberg","year":"2012","journal-title":"J Am Coll Cardiol"},{"issue":"9","key":"hoi260002r34","doi-asserted-by":"publisher","first-page":"300","DOI":"10.3390\/jcdd9090300","article-title":"Stroke risks in primary aldosteronism with different treatments: a systematic review and meta-analysis.","volume":"9","author":"Qian","year":"2022","journal-title":"J Cardiovasc Dev Dis"},{"issue":"12","key":"hoi260002r35","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002505","article-title":"Aldosterone predicts cardiovascular, renal, and metabolic disease in the general community: a 4-year follow-up.","volume":"4","author":"Buglioni","year":"2015","journal-title":"J Am Heart Assoc"},{"issue":"37","key":"hoi260002r36","doi-asserted-by":"publisher","first-page":"3627","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.","volume":"44","author":"McDonagh","year":"2023","journal-title":"Eur Heart J"},{"issue":"18","key":"hoi260002r37","doi-asserted-by":"publisher","first-page":"e895","DOI":"10.1161\/CIR.0000000000001063","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines.","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"issue":"6","key":"hoi260002r38","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1161\/CIRCULATIONAHA.121.057983","article-title":"Finerenone reduces risk of incident heart failure in patients with chronic kidney disease and type 2 diabetes: analyses from the FIGARO-DKD trial.","volume":"145","author":"Filippatos","year":"2022","journal-title":"Circulation"},{"issue":"20","key":"hoi260002r41","doi-asserted-by":"publisher","first-page":"1636","DOI":"10.1161\/CIR.0000000000001186","article-title":"A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association.","volume":"148","author":"Ndumele","year":"2023","journal-title":"Circulation"},{"issue":"11","key":"hoi260002r42","doi-asserted-by":"publisher","first-page":"4472","DOI":"10.1210\/jc.2007-1088","article-title":"Body mass index predicts aldosterone production in normotensive adults on a high-salt diet.","volume":"92","author":"Bentley-Lewis","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"issue":"7","key":"hoi260002r43","doi-asserted-by":"publisher","first-page":"2566","DOI":"10.1210\/jc.2008-0251","article-title":"Body mass index predicts plasma aldosterone concentrations in overweight-obese primary hypertensive patients.","volume":"93","author":"Rossi","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"hoi260002r44","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/HJH.0000000000002216","article-title":"Renal damage in primary aldosteronism: a systematic review and meta-analysis.","volume":"38","author":"Monticone","year":"2020","journal-title":"J Hypertens"},{"issue":"11","key":"hoi260002r45","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1001\/jamacardio.2023.3241","article-title":"Prevalence and overlap of cardiac, renal, and metabolic conditions in US adults, 1999-2020.","volume":"8","author":"Ostrominski","year":"2023","journal-title":"JAMA Cardiol"},{"issue":"6","key":"hoi260002r46","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1093\/ajh\/hpt276","article-title":"Association of renin and aldosterone with ethnicity and blood pressure: the Multi-Ethnic Study of Atherosclerosis.","volume":"27","author":"Rifkin","year":"2014","journal-title":"Am J Hypertens"},{"issue":"3","key":"hoi260002r47","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1161\/HYPERTENSIONAHA.120.16429","article-title":"Intraindividual variability of aldosterone concentrations in primary aldosteronism: implications for case detection.","volume":"77","author":"Yozamp","year":"2021","journal-title":"Hypertension"},{"key":"hoi260002r39","unstructured":"Phase III study investigating heart failure and cardiovascular death with baxdrostat in combination with dapagliflozin. ClinicalTrials.gov identifier: NCT06677060. Updated December 18, 2025. Accessed January 29, 2026. https:\/\/clinicaltrials.gov\/study\/NCT06677060"},{"key":"hoi260002r40","unstructured":"A study to test vicadrostat (BI 690517) taken together with empagliflozin in people with type 2 diabetes, high blood pressure, and cardiovascular disease. ClinicalTrials.gov identifier: NCT07064473. Updated January 21, 2026. Accessed January 29, 2026. https:\/\/clinicaltrials.gov\/study\/NCT07064473"}],"container-title":["JAMA Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/articlepdf\/2845797\/jamacardiology_lassen_2026_oi_260002_1775567386.7599.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T15:00:53Z","timestamp":1775660453000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/fullarticle\/2845797"}},"subtitle":["The Atherosclerosis Risk in Communities Study"],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":47,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamacardio.2026.0068","relation":{},"ISSN":["2380-6583"],"issn-type":[{"value":"2380-6583","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}