European journal of preventive cardiology最新文献

Metabolic and bariatric surgery (MBS) has long been considered the most effective long-term treatment for severe obesity and its associated comorbidities, including type-2 diabetes mellitus, metabolic syndrome, obstructive sleep apnea syndrome, and cardiovascular disease. Beyond weight loss, MBS has been associated with improved glycemic and metabolic control, lower apnea burden, reduced risk of major adverse cardiovascular events, and improved overall survival. In the last few years, the use of safe and effective weight-loss medications has revolutionized the management of patients with obesity, and may in the future influence referral patterns for MBS. Future research is therefore warranted to clarify the integration between MBS and these novel pharmacological opportunities, with the aim of optimizing patient selection and therapeutic pathways. The aim of this narrative review is therefore to describe the role of MBS in contemporary clinical practice, considering the evolving landscape of pharmacological approaches to treat patients with obesity.

Aims: Inclisiran, an siRNA-targeting hepatic PCSK9 mRNA, reduces low-density lipoprotein cholesterol (LDL-C), but its effect on major adverse cardiovascular event (MACE) remains unconfirmed. The SIRIUS in-silico modelling program aimed to predict the efficacy of inclisiran on MACE in virtual patients with atherosclerotic cardiovascular disease (ASCVD).

Methods: The SIRIUS simulation (NCT05974345) used a validated mechanistic model of ASCVD and lipid-lowering therapy (LLT) effects in a virtual population with established ASCVD and LDL-C ≥70 mg/dL. Each virtual patient served as their own control to compare inclisiran versus placebo as an adjunct to high-intensity statin therapy, alone or with ezetimibe over 5 years. The model did not account for non-adherence, recurrent events, or adverse effects.

Results: Among 204 691 virtual patients, inclisiran was predicted to reduce LDL-C by 49.7% versus placebo (from 91.1 to 48.3 mg/dL). Relative to placebo, inclisiran was predicted to lower 5 years risk of 3-point MACE by 25.2% (11.3% vs. 14.9%), myocardial infarction by 34.8% (5.7% vs. 8.6%; HR 0.65), ischaemic stroke by 26% (2.6% vs. 3.4%; HR 0.74), and major adverse limb event by 34.1% (0.5% vs. 0.8%; HR 0.66). A 7.1% relative reduction of cardiovascular death was predicted (4.2% vs. 4.5%; HR 0.93).

Conclusions: SIRIUS is the first in-silico simulation using a knowledge-based mechanistic model to predict the efficacy of LLT on cardiovascular outcomes in ASCVD. These findings offer early model-based prediction of inclisiran's potential cardiovascular benefit ahead of phase 3 outcome trials.

Aims: To assess independent impacts of air and noise pollution and residential green exposure on non-invasively derived coronary obstruction and myocardial ischaemia.

Methods and results: Consecutive patients screened by coronary computed tomography angiography (CCTA) for stable chest pain between 1 January 2019 and 31 December 2020 were included in a registry. Exposure associations between residential PM2.5 (particulate matter <2.5 μm), NO2 (nitric dioxide), major road distance, airport distance, normalized difference vegetation index, obstructive coronary artery disease (OCAD, stenosis ≥50%), and abnormal fractional flow reserve (FFRCT ≤80%) measurements were assessed by propensity score (PS)-adjusted logistic regression. A subgroup analysis was performed according to Framingham low (<10%) and high (>20%) 10-year coronary heart disease risk categories. A total of 2620 patients were enrolled, including 420 (16%) FFRCT analyses. OCAD was reported in 518 (20%) patients and abnormal FFRCT in 276 (11%). People with OCAD lived closer to the airport [10.841 (7.869-19.022) km vs. 12.297 (8.691-22.843) km, P < 0.001). People living closer to the airport had more cardiovascular (CV) and socio-economic risk factors. Distance to airport decreased OCAD risk (OR 0.983, 95% CI 0.974-0.992, per 1 km) in univariable analysis. After PS adjustment, environmental stressors were not significantly associated with OCAD, regardless of risk categories. Only distance to major road decreased abnormal FFRCT risk (OR 0.634, 95% CI 0.421-0.926, per 1 km) in high-risk patients after PS adjustment.

Conclusion: We found no clear environmental associations with CT-derived coronary obstruction or ischaemia. However, airport proximity was linked to OCAD risk via CV and socio-economic factors, while major road proximity was independently associated with myocardial ischaemia in high-CV-risk patients, warranting further investigation.