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Article History

Received: 2 January 2026

Accepted: 28 April 2026

First Online: 27 May 2026

Declarations

:

: Kevin Alexander is a consultant to Alexion, Alnylam, Bayer, BridgeBio, Novo Nordisk, and Pfizer. Kevin Alexander is also an Editorial Board member of Cardiology and Therapy . He was not involved in the selection of peer reviewers for the manuscript nor in any of the subsequent editorial decisions. Shun Kohsaka has received investigator-initiated research funding from Novartis and AstraZeneca. Steen Hvitfeldt Poulsen has received consulting fees from BridgeBio; Pfizer, Alnylam, Novo Nordisk, Cytokinetics, Bayer and AstraZeneca. Astrid Terkelsen has received honorarium from Novo Nordisk DK, Sanofi, AstraZeneca, and Alnylam Sweden AB. J. Gustav Smith reports that his employer (Gothenburg University) is paid by AstraZeneca for his involvement in ANTHOLOGY (no personal payment). Johan Sundström reports direct or indirect stock ownership in companies (Sence Research AB, Symptoms Europe AB, MinForskning AB, Anagram kommunikation AB) providing services to companies and authorities in the health sector, including Amgen, AstraZeneca, Bayer, Boehringer, Eli Lilly, Gilead, GSK, Göteborg University, Itrim, Ipsen, Janssen, Karolinska Institutet, LIF, Linköping University, Novo Nordisk, Parexel, Pfizer, Region Stockholm, Region Uppsala, Sanofi, STRAMA, Takeda, TLV, Uppsala University, Vifor Pharma, WeMind. Jason Wright, Arti Gauvri Bhimjiyani, Krister Järbrink † , and Laura Davis are employees of, and hold stock in, AstraZeneca. Lisa Anderson has participated in an advisory board for Alnylam and has received travel support from Abbott and support as a Junior Fellow from Pfizer. Yuya Matsue has received honorarium from Otsuka Pharmaceutical Co., Ltd., EN Otsuka Pharmaceutical Co., Ltd., Novartis Pharma K.K., Ono Pharmaceutical Co., Ltd., AstraZeneca, Nippon Boehringer Ingelheim Co., Ltd., Bayer Yakuhin, Ltd., Kyowa Kirin Co., Ltd., Pfizer Japan Inc., and Alnylam Japan. He has also received collaborative research funding from Otsuka Pharmaceutical Co., Ltd., EN Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Bayer Yakuhin, Ltd., Nippon Boehringer Ingelheim Co., Ltd., AstraZeneca K.K., Roche Diagnostics K.K., Grace Imaging Inc., and Omron Healthcare Co., Ltd. Björn Pilebro has received financial reimbursement for consulting from AstraZeneca and is an investigator in studies sponsored by Akcea Therapeutics, Alnylam Pharmaceuticals, Inc., and Intellia Therapeutics. Krister Järbrink was an employee and shareholder of AstraZeneca at the time of the study but has since changed employment.

: OverTTuRe was performed in accordance with ethical principles that are consistent with the Declaration of Helsinki, International Conference on Harmonization (ICH), Good Clinical Practices (GCPs), Guidelines for Good Pharmacoepidemiology Practices (GPP), and the applicable legislation on noninterventional studies and/or observational studies. Obtaining informed consent from participants was not applicable as this study was solely based on secondary data from the following data sources: Optum’s de-identified Clinformatics ® Data Mart Database (Optum ® CDM) from the United States, Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) from the United Kingdom, Medical Data Vision (MDV) from Japan, CROSS-TRACKS from Denmark, and CELOSIA from Sweden. Ethical approval for the use of CELOSIA data in the OverTTuRe study was granted by the Swedish Ethical Review Authority. CPRD’s Research Data Governance approved the use of CPRD and HES data in the OverTTuRe study. The MDV utilizes anonymized data, which exempts clinical studies from the application of the Japanese Ethical Guidelines for Medical and Biological Research Involving Human Subjects. In this study, MDV anonymized the provided data; therefore, obtaining informed consent was deemed unnecessary. In Denmark, register-based studies require no ethical approval [ ]. Optum ® CDM does not require ethics approval, as the data is de-identified and fully compliant with the Health Insurance Portability and Accountability Act.