JAMA cardiology最新文献

Yellowish Nodules on a Man Consuming a Carnivore Diet. 食用食肉动物的人身上有黄色结节。

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology

Pub Date : 2025-01-22 DOI: 10.1001/jamacardio.2024.5209

Konstantinos Marmagkiolis, Jaime Caballero, Cezar Iliescu

引用次数: 0

Supine Blood Pressure and Risk of Cardiovascular Disease and Mortality. 仰卧位血压与心血管疾病和死亡率的风险。

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology

Pub Date : 2025-01-22 DOI: 10.1001/jamacardio.2024.5213

Duc M Giao, Hannah Col, Fredrick Larbi Kwapong, Ruth-Alma Turkson-Ocran, Long H Ngo, Jennifer L Cluett, Lynne Wagenknecht, B Gwen Windham, Elizabeth Selvin, Pamela L Lutsey, Stephen P Juraschek

Importance: Nocturnal hypertension while asleep is associated with substantial increases in risk of cardiovascular disease (CVD) and death. Whether hypertension while supine is a risk factor associated with CVD independent of seated hypertension remains unknown.Objective: To investigate the association between supine hypertension and CVD outcomes and by hypertension treatment status.Design, setting, and participants: This prospective cohort study used data from the Atherosclerosis Risk in Communities (ARIC) study, which was established in 1987 to examine cardiovascular risk factors among middle-aged adults from 4 communities in the US. Supine and seated blood pressure were measured in more than 13 000 middle-aged adults with longitudinal surveillance for CVD over 27 years. Participants with a history of coronary heart disease (CHD), heart failure, or stroke were excluded. Data were analyzed from May 2023 through December 2024.Exposures: Supine hypertension (supine systolic blood pressure ≥130 or diastolic blood pressure ≥80 mm Hg) with and without seated hypertension (seated systolic blood pressure ≥130 or diastolic blood pressure ≥80 mm Hg).Main outcomes and measures: Cox proportional hazard models with adjustment for CVD risk factors were performed to investigate the association of supine hypertension with and without seated hypertension with incident CHD, heart failure, stroke, fatal CHD, and all-cause mortality.Results: Of 11 369 participants without known CVD (6332 female [55.7%] and 5037 male [44.3%]; 2858 Black [25.1%] and 8511 White [74.9%]; mean [SD] age 53.9 [5.7] years]), 16.4% (95% CI, 15.5%-17.2%) of those without seated hypertension had supine hypertension and 73.5% (95% CI, 72.2%-74.8%) of those with seated hypertension had supine hypertension. Supine hypertension was associated with incident CHD (hazard ratio [HR], 1.60; 95% CI, 1.45-1.76), heart failure (HR, 1.83; 95% CI, 1.68-2.01), stroke (HR, 1.86; 95% CI, 1.63-2.13), fatal CHD (HR, 2.18; 95% CI, 1.84-2.59), and all-cause mortality (HR, 1.43; 95% CI, 1.35-1.52) during a median (25th, 75th percentile) follow-up of 25.7 (15.4, 30.4) years, 26.9 (17.6, 30.5) years, 27.6 (18.5, 30.6 years), 28.3 (20.5, 30.7) years, and 28.3 (20.5 years, 30.7) years, respectively. There were no meaningful differences by seated hypertension status. Results were similar by hypertension medication use. Participants with supine hypertension alone had risk associations similar to those of participants with hypertension in both positions and significantly greater than those of participants with seated hypertension alone with the exception of fatal CHD; seated vs supine HRs were 0.72 (95% CI, 0.61-0.85) for CHD, 0.72 (95% CI, 0.60-0.85) for heart failure, 0.66 (95% CI, 0.51-0.86) for stroke, and 0.83 (95% CI, 0.74-0.92) for all-cause mortality.Conclusio

重要性：睡眠时的夜间高血压与心血管疾病（CVD）和死亡风险的大幅增加有关。仰卧时高血压是否独立于坐位高血压与CVD相关的危险因素尚不清楚。目的：探讨仰卧位高血压与心血管疾病结局及高血压治疗状况的关系。设计、环境和参与者：这项前瞻性队列研究使用了社区动脉粥样硬化风险（ARIC）研究的数据，该研究成立于1987年，旨在研究美国4个社区中年人的心血管危险因素。对13000多名中年人进行27年心血管疾病纵向监测，测量仰卧和坐位血压。有冠心病（CHD）、心力衰竭或中风病史的参与者被排除在外。数据分析从2023年5月到2024年12月。暴露：仰卧位高血压（仰卧位收缩压≥130或舒张压≥80mmhg）伴或不伴坐位高血压（坐位收缩压≥130或舒张压≥80mmhg）。主要结局和措施：采用校正CVD危险因素的Cox比例风险模型，研究伴有和不伴有坐位高血压的仰卧位高血压与冠心病、心力衰竭、中风、致死性冠心病和全因死亡率的关系。结果：在11 369名无已知心血管疾病的参与者中，6332名女性[55.7%]，5037名男性[44.3%]；2858黑色[25.1%]和8511白色[74.9%]；平均[SD]年龄53.9[5.7]岁])，非坐位高血压患者中有16.4% （95% CI, 15.5% ~ 17.2%）有仰卧位高血压，有坐位高血压患者中有73.5% （95% CI, 72.2% ~ 74.8%）有仰卧位高血压。仰卧位高血压与冠心病的发生相关(危险比[HR]， 1.60；95% CI, 1.45-1.76)，心力衰竭(HR, 1.83；95% CI, 1.68-2.01)，卒中(HR, 1.86；95% CI, 1.63-2.13)，致死性冠心病(HR, 2.18；95% CI, 1.84-2.59)和全因死亡率(HR, 1.43；95% CI, 1.35-1.52)，中位（第25、75百分位）随访时间分别为25.7（15.4、30.4）年、26.9（17.6、30.5）年、27.6（18.5、30.6）年、28.3（20.5、30.7）年和28.3（20.5、30.7）年。坐位高血压状态无显著性差异。高血压药物使用的结果相似。除致命性冠心病外，单独仰卧位高血压患者的风险关联与两种体位高血压患者相似，且显著高于单独坐位高血压患者；坐位与仰卧位的hr分别为：冠心病0.72 （95% CI, 0.61-0.85）、心力衰竭0.72 （95% CI, 0.60-0.85）、中风0.66 （95% CI, 0.51-0.86）、全因死亡率0.83 （95% CI, 0.74-0.92）。结论和相关性：仰卧位高血压与坐位高血压相比，单独坐位高血压有更高的心血管疾病风险。未来的研究应在夜间高血压的背景下评估仰卧位高血压，并将其作为血压治疗的独立目标。

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引用次数: 0

Clinical Phenotype and Prognosis of Asymptomatic Patients With Transthyretin Cardiac Amyloid Infiltration. 经甲状腺素型心脏淀粉样蛋白浸润无症状患者的临床表型与预后。

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology

Pub Date : 2025-01-22 DOI: 10.1001/jamacardio.2024.5221

Aldostefano Porcari, Yousuf Razvi, Francesco Cappelli, Christian Nitsche, Matteo Serenelli, Simone Longhi, Giulio Sinigiani, Alberto Cipriani, Alberto Aimo, Daniela Tomasoni, Mattia Zampieri, Anna Cantone, Valentina Allegro, Giuseppe Vergaro, Ahmad Masri, Marcus Urey, Adam Ioannou, Aviva Petrie, Navid Noory, Finn Gustafsson, Michael Poledniczek, Michele Emdin, Marco Metra, Gianfranco Sinagra, Ana Martinez-Naharro, Ashutosh D Wechalekar, Helen Lachman, Carol Whelan, Philip N Hawkins, Scott D Solomon, Julian D Gillmore, Marianna Fontana

Importance: Patients with transthyretin (ATTR) cardiac amyloid infiltration are increasingly diagnosed at earlier disease stages with no heart failure (HF) symptoms and a wide range of cardiac amyloid infiltration.Objective: To characterize the clinical phenotype and natural history of asymptomatic patients with ATTR cardiac amyloid infiltration.Design, setting, and participants: This cohort study analyzed data of all patients at 12 international centers for amyloidosis from January 1, 2008, through December 31, 2023. Inclusion criteria were asymptomatic ATTR cardiac amyloid infiltration, defined as an absence of HF history, HF signs and symptoms, diuretic therapy, and plasma cell dyscrasia with evidence of myocardial uptake on bone scintigraphy. If plasma cell dyscrasia was present, histologic confirmation of ATTR amyloid was required.Exposure: Asymptomatic ATTR cardiac amyloid infiltration.Main outcomes and measures: The primary outcomes were all-cause and cardiovascular (CV) mortality. The secondary outcomes were unplanned HF hospitalization, unplanned CV-related hospitalization, and a composite outcome of CV mortality and HF hospitalization.Results: The study comprised 485 patients with asymptomatic ATTR cardiac amyloid infiltration (mean [SD] age, 74.9 [9.9] years, 85.8% male, 112 [23.1%] with hereditary ATTR amyloidosis), with 369 (76.1%) having grade 2 or 3 and 116 (23.9%) having grade 1 cardiac uptake at baseline. Patients with grade 2 or 3 uptake exhibited significantly more cardiac functional and structural abnormalities vs patients with grade 1 uptake. At 3 years, compared with grade 1 uptake, patients with grade 2 or 3 uptake had greater development of HF (54.3% [95% CI, 47.7%-61.3%] vs 23.1% [95% CI, 14.8%-35.1%]), greater outpatient diuretic initiation and N-terminal pro-B-type natriuretic peptide progression (35.0% [95% CI, 28.0%-43.2%] vs 12.4% [95% CI, 6.3%-23.7%]), and greater HF hospitalization (8.7% [95% CI, 5.9%-12.9%] vs 0%) and unplanned CV hospitalization (20.0% [95% CI, 15.7%-25.3%] vs 4.3% [95% CI, 1.6%-11.3%]). Over a median follow-up of 37 months (IQR, 20-64 months), the all-cause death rate was similar between patients with grade 1 vs 2 and 3 uptake; however, those with grade 2 or 3 compared with grade 1 uptake had a significantly higher risk of CV mortality (unadjusted hazard ratio, 5.30; 95% CI, 1.92-14.65).Conclusions and relevance: This study shows that asymptomatic ATTR cardiac amyloid infiltration encompasses a wide spectrum of disease severity, with patients with grade 2 or 3 cardiac uptake experiencing an increased rate of CV events and CV mortality and patients with grade 1 uptake experiencing a lower CV event rate and predominantly non-CV mortality. These findings support the use of disease-modifying treatments in asymptomatic patients with grade

重要性：转甲状腺素（ATTR）心脏淀粉样蛋白浸润的患者越来越多地在疾病早期被诊断出来，没有心力衰竭（HF）症状和广泛的心脏淀粉样蛋白浸润。目的：探讨无症状ATTR心脏淀粉样蛋白浸润患者的临床表型和自然病史。设计、环境和参与者：该队列研究分析了2008年1月1日至2023年12月31日12个国际淀粉样变中心的所有患者的数据。纳入标准为无症状ATTR心脏淀粉样蛋白浸润，定义为无HF病史、HF体征和症状、利尿剂治疗和浆细胞病变，骨显像显示心肌摄取。如果浆细胞病变存在，则需要组织学证实ATTR淀粉样蛋白。暴露：无症状ATTR心脏淀粉样蛋白浸润。主要结局和指标：主要结局为全因死亡率和心血管死亡率。次要结局为非计划的HF住院、非计划的CV相关住院，以及CV死亡率和HF住院的综合结局。结果：该研究纳入485例无症状ATTR心脏淀粉样蛋白浸润患者（平均[SD]年龄74.9[9.9]岁，85.8%为男性，112例[23.1%]为遗传性ATTR淀粉样变性），其中369例（76.1%）为2级或3级，116例（23.9%）基线时为1级心脏摄取。与1级摄取患者相比，2级或3级摄取患者表现出更多的心脏功能和结构异常。3年后，与1级摄取相比，2级或3级摄取的患者更容易发生HF (54.3% [95% CI, 47.7%-61.3%] vs 23.1% [95% CI, 14.8%-35.1%])，门诊利尿起始和n -末端前b型利钠肽进展更大（35.0% [95% CI, 28.0%-43.2%] vs 12.4% [95% CI, 6.3%-23.7%]），更大的HF住院率（8.7% [95% CI, 5.9%-12.9%] vs 0%）和计划外CV住院率（20.0% [95% CI, 15.7%-25.3%] vs 4.3% [95% CI, 1.6%-11.3%]）。中位随访37个月（IQR， 20-64个月），1级与2级和3级摄取患者的全因死亡率相似；然而，与1级服用相比，2级或3级服用的CV死亡率风险明显更高(未经调整的风险比，5.30；95% ci, 1.92-14.65)。结论和相关性：该研究表明，无症状ATTR心脏淀粉样蛋白浸润包括广泛的疾病严重程度，2级或3级心脏摄取的患者CV事件发生率和CV死亡率增加，1级心脏摄取的患者CV事件发生率较低，主要是非CV死亡率。这些发现支持在2级或3级摄取的无症状患者中使用改善疾病的治疗，并强调需要进行大规模研究来评估它们在1级摄取中的作用。

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引用次数: 0

Artificial Intelligence-Guided Lung Ultrasound by Nonexperts. 非专业人士的人工智能引导肺部超声。

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology

Pub Date : 2025-01-15 DOI: 10.1001/jamacardio.2024.4991

Cristiana Baloescu, John Bailitz, Baljash Cheema, Ravi Agarwala, Madeline Jankowski, Onyinyechi Eke, Rachel Liu, Jason Nomura, Lori Stolz, Luna Gargani, Eren Alkan, Tyler Wellman, Nripesh Parajuli, Andrew Marra, Yngvil Thomas, Daven Patel, Evelyn Schraft, James O'Brien, Christopher L Moore, Michael Gottlieb

Importance: Lung ultrasound (LUS) aids in the diagnosis of patients with dyspnea, including those with cardiogenic pulmonary edema, but requires technical proficiency for image acquisition. Previous research has demonstrated the effectiveness of artificial intelligence (AI) in guiding novice users to acquire high-quality cardiac ultrasound images, suggesting its potential for broader use in LUS.

Objective: To evaluate the ability of AI to guide acquisition of diagnostic-quality LUS images by trained health care professionals (THCPs).

Design, setting, and participants: In this multicenter diagnostic validation study conducted between July 2023 and December 2023, participants aged 21 years or older with shortness of breath recruited from 4 clinical sites underwent 2 ultrasound examinations: 1 examination by a THCP operator using Lung Guidance AI and the other by a trained LUS expert without AI. The THCPs (including medical assistants, respiratory therapists, and nurses) underwent standardized AI training for LUS acquisition before participation.

Interventions: Lung Guidance AI software uses deep learning algorithms guiding LUS image acquisition and B-line annotation. Using an 8-zone LUS protocol, the AI software automatically captures images of diagnostic quality.

Main outcomes and measures: The primary end point was the proportion of THCP-acquired examinations of diagnostic quality according to a panel of 5 masked expert LUS readers, who provided remote review and ground truth validation.

Results: The intention-to-treat analysis included 176 participants (81 female participants [46.0%]; mean [SD] age, 63 [14] years; mean [SD] body mass index, 31 [8]). Overall, 98.3% (95% CI, 95.1%-99.4%) of THCP-acquired studies were of diagnostic quality, with no statistically significant difference in quality compared to LUS expert-acquired studies (difference, 1.7%; 95% CI, -1.6% to 5.0%).

Conclusions and relevance: In this multicenter validation study, THCPs with AI assistance achieved LUS images meeting diagnostic standards compared with LUS experts without AI. This technology could extend access to LUS to underserved areas lacking expert personnel.

Trial registration: ClinicalTrials.gov Identifier: NCT05992324.

重要性：肺超声（LUS）有助于诊断呼吸困难患者，包括心源性肺水肿患者，但需要熟练的图像采集技术。先前的研究已经证明了人工智能（AI）在指导新手用户获取高质量心脏超声图像方面的有效性，这表明它在LUS中有更广泛的应用潜力。目的：评价人工智能对训练有素的卫生保健专业人员（THCPs）获取诊断质量LUS图像的指导能力。设计、环境和参与者：在这项于2023年7月至2023年12月进行的多中心诊断验证研究中，从4个临床地点招募的21岁或以上呼吸短促的参与者进行了两次超声检查：一次由THCP操作员使用肺引导AI进行检查，另一次由训练有素的LUS专家进行检查。thcp（包括医疗助理、呼吸治疗师和护士）在参与前接受了标准化的LUS获取人工智能培训。干预措施：Lung Guidance AI软件使用深度学习算法指导LUS图像采集和b线标注。使用8区LUS协议，人工智能软件自动捕获诊断质量的图像。主要结局和措施：主要终点是由5名蒙面专家LUS读者组成的小组提供远程审查和地面真相验证，thcp获得诊断质量检查的比例。结果：意向治疗分析纳入176名受试者(女性81名[46.0%]；平均[SD]年龄63岁；平均[SD]体重指数31[8])。总体而言，98.3% （95% CI, 95.1%-99.4%）的thcp获得性研究具有诊断质量，与LUS专家获得性研究相比，质量无统计学差异(差异，1.7%；95% CI, -1.6% ~ 5.0%)。结论和相关性：在这项多中心验证研究中，与没有人工智能的LUS专家相比，人工智能辅助下的thcp获得了符合诊断标准的LUS图像。这项技术可以将LUS扩展到缺乏专业人员的服务不足的地区。试验注册：ClinicalTrials.gov标识符：NCT05992324。

{"title":"Artificial Intelligence-Guided Lung Ultrasound by Nonexperts.","authors":"Cristiana Baloescu, John Bailitz, Baljash Cheema, Ravi Agarwala, Madeline Jankowski, Onyinyechi Eke, Rachel Liu, Jason Nomura, Lori Stolz, Luna Gargani, Eren Alkan, Tyler Wellman, Nripesh Parajuli, Andrew Marra, Yngvil Thomas, Daven Patel, Evelyn Schraft, James O'Brien, Christopher L Moore, Michael Gottlieb","doi":"10.1001/jamacardio.2024.4991","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.4991","url":null,"abstract":"Importance: Lung ultrasound (LUS) aids in the diagnosis of patients with dyspnea, including those with cardiogenic pulmonary edema, but requires technical proficiency for image acquisition. Previous research has demonstrated the effectiveness of artificial intelligence (AI) in guiding novice users to acquire high-quality cardiac ultrasound images, suggesting its potential for broader use in LUS.Objective: To evaluate the ability of AI to guide acquisition of diagnostic-quality LUS images by trained health care professionals (THCPs).Design, setting, and participants: In this multicenter diagnostic validation study conducted between July 2023 and December 2023, participants aged 21 years or older with shortness of breath recruited from 4 clinical sites underwent 2 ultrasound examinations: 1 examination by a THCP operator using Lung Guidance AI and the other by a trained LUS expert without AI. The THCPs (including medical assistants, respiratory therapists, and nurses) underwent standardized AI training for LUS acquisition before participation.Interventions: Lung Guidance AI software uses deep learning algorithms guiding LUS image acquisition and B-line annotation. Using an 8-zone LUS protocol, the AI software automatically captures images of diagnostic quality.Main outcomes and measures: The primary end point was the proportion of THCP-acquired examinations of diagnostic quality according to a panel of 5 masked expert LUS readers, who provided remote review and ground truth validation.Results: The intention-to-treat analysis included 176 participants (81 female participants [46.0%]; mean [SD] age, 63 [14] years; mean [SD] body mass index, 31 [8]). Overall, 98.3% (95% CI, 95.1%-99.4%) of THCP-acquired studies were of diagnostic quality, with no statistically significant difference in quality compared to LUS expert-acquired studies (difference, 1.7%; 95% CI, -1.6% to 5.0%).Conclusions and relevance: In this multicenter validation study, THCPs with AI assistance achieved LUS images meeting diagnostic standards compared with LUS experts without AI. This technology could extend access to LUS to underserved areas lacking expert personnel.Trial registration: ClinicalTrials.gov Identifier: NCT05992324.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Genetic Predisposition to Low-Density Lipoprotein Cholesterol and Incident Type 2 Diabetes. 低密度脂蛋白胆固醇和2型糖尿病的遗传易感性。

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology

Pub Date : 2025-01-15 DOI: 10.1001/jamacardio.2024.5072

Akshaya Ravi, Satoshi Koyama, So Mi Jemma Cho, Sara Haidermota, Whitney Hornsby, Patrick T Ellinor, Pradeep Natarajan

Importance: Treatment to lower high levels of low-density lipoprotein cholesterol (LDL-C) reduces incident coronary artery disease (CAD) risk but modestly increases the risk for incident type 2 diabetes (T2D). The extent to which genetic factors across the cholesterol spectrum are associated with incident T2D is not well understood.

Objective: To investigate the association of genetic predisposition to increased LDL-C levels with incident T2D risk.

Design, setting, and participants: In this large prospective, population-based cohort study, UK Biobank participants who underwent whole-exome sequencing and genome-wide genotyping were included. Participants were separated into 7 groups with familial hypercholesterolemia (FH), predicted loss of function (pLOF) in APOB or PCSK9 variants, and LDL-C polygenic risk score (PRS) quintiles. Data were collected between 2006 and 2010, with a median follow-up of 13.7 (IQR, 12.9-14.5) years. Data were analyzed from March 1 to November 1, 2024.

Exposures: LDL-C level, LDL-C PRS, FH, or pLOF variant status.

Main outcomes and measures: Cox proportional hazards regression models adjusted for age, sex, genotyping array, lipid-lowering medication use, and the first 10 genetic principal components were fitted to assess the association between LDL-C genetic factors and incident T2D and CAD risks.

Results: Among the 361 082 participants, mean (SD) age was 56.8 (8.0) years, 194 751 (53.9%) were female, and mean (SD) baseline LDL-C level was 138.0 (33.6) mg/dL. During the follow-up period, 22 619 (6.3%) participants developed incident T2D and 17 966 (5.0%) developed incident CAD. The hazard ratio for incident T2D was lowest in the FH group (0.65; 95% CI, 0.54-0.77), while the highest risk was in the pLOF group (1.48; 95% CI, 1.18-1.86). The association between LDL-C PRS and incident T2D was 0.72 (95% CI, 0.66-0.79) for very high LDL-C PRS, 0.87 (95% CI, 0.84-0.90) for high LDL-C PRS, 1.13 (95% CI, 1.09-1.17) for low LDL-C PRS, and 1.26 (95% CI, 1.15-1.38) for very low LDL-C PRS. CAD risk increased directly with the LDL-C PRS.

Conclusions and relevance: In this cohort study, LDL-C and T2D risks were inversely associated across genetic mechanisms for LDL-C variation. Further elucidation of the mechanisms associating low LDL-C risk with increased risk of T2D is warranted.

重要性：降低低密度脂蛋白胆固醇（LDL-C）的治疗降低了冠心病（CAD）的发生风险，但适度增加了2型糖尿病（T2D）的发生风险。在多大程度上，胆固醇谱上的遗传因素与T2D的发生有关尚不清楚。目的：探讨LDL-C水平升高的遗传易感性与T2D发生风险的关系。设计、环境和参与者：在这项大型前瞻性、基于人群的队列研究中，英国生物银行的参与者接受了全外显子组测序和全基因组基因分型。参与者按家族性高胆固醇血症（FH）、APOB或PCSK9变异的预测功能丧失（pLOF）和LDL-C多基因风险评分（PRS）五分位数分为7组。数据收集于2006年至2010年，中位随访时间为13.7年（IQR, 12.9-14.5）年。数据分析时间为2024年3月1日至11月1日。暴露：LDL-C水平，LDL-C PRS， FH或pLOF变异状态。主要结局和测量方法：采用Cox比例风险回归模型，对年龄、性别、基因分型阵列、降脂药物使用和前10个遗传主成分进行校正，以评估LDL-C遗传因素与T2D和CAD事件风险之间的关系。结果：在361 082名参与者中，平均（SD）年龄为56.8（8.0）岁，194 751（53.9%）为女性，平均（SD）基线LDL-C水平为138.0 (33.6)mg/dL。在随访期间，22 619名（6.3%）参与者发生T2D事件，17 966名（5.0%）参与者发生CAD事件。FH组发生T2D的风险比最低(0.65；95% CI, 0.54-0.77)，而pLOF组的风险最高(1.48；95% ci, 1.18-1.86)。LDL-C PRS与T2D事件之间的关联：非常高的LDL-C PRS为0.72 (95% CI, 0.66-0.79)，高的LDL-C PRS为0.87 (95% CI, 0.84-0.90)，低LDL-C PRS为1.13 (95% CI, 1.09-1.17)，极低LDL-C PRS为1.26 （95% CI, 1.15-1.38）。冠心病风险随着LDL-C PRS的升高而直接增加。结论和相关性：在这项队列研究中，LDL-C和T2D风险在LDL-C变异的遗传机制中呈负相关。进一步阐明低LDL-C风险与T2D风险增加相关的机制是有必要的。

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引用次数: 0

Cost-Effectiveness of a Polypill for Cardiovascular Disease Prevention in an Underserved Population 在服务不足人群中预防心血管疾病的一种复方药片的成本效益

IF 24 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology

Pub Date : 2025-01-08 DOI: 10.1001/jamacardio.2024.4812

Ciaran N. Kohli-Lynch, Andrew E. Moran, Dhruv S. Kazi, Kirsten Bibbins-Domingo, Neil Jordan, Dustin French, Yiyi Zhang, Thomas J. Wang, Brandon K. Bellows

ImportanceThe Southern Community Cohort Study (SCCS) Polypill Trial showed that a cardiovascular polypill (a single pill containing a statin and 3 half-standard dose antihypertensive medications) effectively controls cardiovascular disease (CVD) risk factors in a majority Black race and low-income population. The cost-effectiveness of polypill treatment in this population has not been previously studied.ObjectiveTo determine the cost-effectiveness of the cardiovascular polypill.Design, Setting, and ParticipantsA discrete-event simulation version of the well-established CVD policy model simulated clinical and economic outcomes of the SCCS Polypill Trial from a health care sector perspective. A time horizon of 10 years was adopted. Polypill treatment was priced at $463 per year in the base-case analysis. Model input data were derived from the National Health and Nutrition Examination Survey, Medical Expenditure Panel Survey, pooled longitudinal cohort studies, the SCCS Polypill Trial, and published literature. Two cohorts were analyzed: an SCCS Polypill Trial–representative cohort of 100 000 individuals and all trial-eligible non-Hispanic Black US adults. Study parameters and model inputs were varied extensively in 1-way and probabilistic sensitivity analysis.ExposuresPolypill treatment or usual care.Main Outcome and MeasuresPrimary outcomes were direct health care costs (US dollar 2023) and quality-adjusted life-years (QALYs), both discounted 3% annually, and the incremental cost per QALY gained.ResultsIn the trial-representative cohort of 100 000 individuals (mean [SD] age, 56.9 [5.9] years; 61 807 female [61.8%]), polypill treatment was projected to yield a mean of 1190 (95% uncertainty interval, 287-2159) additional QALYs compared with usual care, at a cost of approximately $10 152 000. Hence, polypill treatment was estimated to cost $8560 per QALY gained compared with usual care and was high value (&lt;$50 000 per QALY gained) in 99% of simulations. Polypill treatment was estimated to be high value when priced at $559 or less per year and cost saving when priced at $443 or less per year. In almost all sensitivity analyses, polypill treatment remained high value. In a secondary analysis of 3 602 427 trial-eligible non-Hispanic Black US adults (mean [SD] age, 55.4 [7.6] years; 2 006 597 female [55.7%]), polypill treatment was high value, with an estimated cost of $13 400 per QALY gained.Conclusions and RelevanceResults of this economic evaluation suggest that polypill treatment could be a high value intervention for a low-income, majority Black population with limited access to health care services. It could additionally reduce health disparities.

南方社区队列研究（SCCS）多药片试验表明，一种心血管多药片（一种含有他汀类药物和3种半标准剂量降压药的单片）有效地控制了大多数黑人和低收入人群心血管疾病（CVD）的危险因素。在这一人群中，复方药片治疗的成本效益以前没有研究过。目的探讨心血管复方丸剂的成本-效果。设计、设置和参与者建立的心血管疾病政策模型的离散事件模拟版本从卫生保健部门的角度模拟了SCCS多药片试验的临床和经济结果。采用了10年的时间期限。在基本病例分析中，复方药片治疗的价格为每年463美元。模型输入数据来源于国家健康和营养检查调查、医疗支出小组调查、汇总纵向队列研究、SCCS多药片试验和已发表的文献。对两个队列进行了分析：一个SCCS Polypill试验的10万人代表队列和所有符合试验条件的非西班牙裔美国黑人成年人。在单向和概率敏感性分析中，研究参数和模型输入变化很大。暴露：多利匹治疗或常规护理。主要结局和测量方法主要结局是直接医疗保健成本（2023美元）和质量调整生命年（QALYs），均为每年3%的折扣率，以及每个QALY获得的增量成本。结果在100,000个体的试验代表性队列中(平均[SD]年龄56.9[5.9]岁；61,807名女性[61.8%])，与常规护理相比，预计复方制剂治疗平均可产生1190个（95%不确定区间，287-2159）额外的质量年，费用约为10 152 000美元。因此，与常规护理相比，多药片治疗估计每获得一个质量aly花费8560美元，并且在99%的模拟中是高价值的（每获得一个质量aly 50,000美元）。据估计，在每年559美元或更低的价格下，多药片治疗是高价值的，而在每年443美元或更低的价格下，多药片治疗是节省成本的。在几乎所有的敏感性分析中，多药片治疗仍然是高价值的。在一项对3602427名符合试验条件的非西班牙裔美国黑人成人的二次分析中(平均[SD]年龄55.4[7.6]岁；（2 006 597名女性[55.7%]），复方丸剂治疗价值高，每个QALY的估计成本为13 400美元。结论和相关性本经济评价的结果表明，对于获得医疗保健服务有限的低收入多数黑人人群，多药片治疗可能是一种高价值的干预措施。它还可以减少健康差距。

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引用次数: 0

Aspirin and Hemocompatibility After LVAD Implantation in Patients With Atherosclerotic Vascular Disease: A Secondary Analysis From the ARIES-HM3 Randomized Clinical Trial. 动脉粥样硬化性血管疾病患者LVAD植入后阿司匹林和血液相容性：ARIES-HM3随机临床试验的二次分析

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology

Pub Date : 2025-01-08 DOI: 10.1001/jamacardio.2024.4849

Finn Gustafsson, Nir Uriel, Ivan Netuka, Jason N Katz, Francis D Pagani, Jean M Connors, Ulrich P Jorde, Daniel Zimpfer, Yuriy Pya, Jennifer Conway, Anelechi Anyanwu, Anna Mara Scandroglio, Nasir Sulemanjee, Pavan Atluri, Mary Keebler, Craig H Selzman, Jeffrey D Alexis, Christopher Hayward, John Henderson, Nicholas Dirckx, Carlo Gazzola, Mandeep R Mehra

Importance: The Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure (ARIES-HM3) study demonstrated that aspirin may be safely eliminated from the antithrombotic regimen after HeartMate 3 (HM3 [Abbott Cardiovascular]) left ventricular assist device (LVAD) implantation. This prespecified analysis explored whether conditions requiring aspirin (prior percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], stroke, or peripheral vascular disease [PVD]) would influence outcomes differentially with aspirin avoidance.Objective: To analyze aspirin avoidance on hemocompatibility-related adverse events (HRAEs) at 1 year after implant in patients with a history of CABG, PCI, stroke, or PVD.Design, setting, and participants: This was an international, multicenter, prospective, double-blind, placebo-controlled, randomized clinical trial including patients implanted with a de novo HM3 LVAD across 51 centers. Data analysis was conducted from April to July 2024.Interventions: Patients were randomized in a 1:1 ratio to receive aspirin (100 mg per day) or placebo, in addition to a vitamin K antagonist (VKA) targeted to an international normalized ratio of 2 to 3 in both groups.Main outcomes and measures: Primary end point (assessed for noninferiority) was a composite of survival free of any nonsurgical (>14 days after implant) HRAEs including stroke, pump thrombosis, bleeding, and arterial peripheral thromboembolism at 12 months. Secondary end points included nonsurgical bleeding, stroke, and pump thrombosis events.Results: Among 589 of 628 patients (mean [SD] age, 57.1 [13.7] years; 456 male [77.4%]) who contributed to the primary end point analysis, a history of PCI, CABG, stroke, or PVD was present in 41% (240 of 589 patients). There was no interaction between the presence of an atherosclerotic vascular condition and effect of aspirin compared with placebo (P for interaction= .23). The preset 10% noninferiority margin was not crossed for the studied subgroup of patients. Thrombotic events were rare, with no differences between aspirin and placebo in patients with and without vascular disease (P for interaction = .77). Aspirin treatment was associated with a higher rate of nonsurgical major bleeding events in the group with prior vascular condition history compared with those without aspirin (rate ratio for placebo compared with aspirin, 0.52; 95% CI, 0.35-0.79).Conclusions and relevance: Results of this prespecified analysis of the ARIES-HM3 randomized clinical trial demonstrate that in patients with advanced heart failure who have classical indications for antiplatelet therapy use at the time of LVAD implantation, aspirin avoidance was safe and not associated with increased thrombosis risk. Importantly, elimination of aspirin w

重要性：晚期心力衰竭患者使用左心室辅助装置（ares -HM3）时阿司匹林和血液相容性事件的研究表明，在心脏伴侣3 （HM3[雅培心血管]）左心室辅助装置（LVAD）植入后，阿司匹林可以安全地从抗血栓治疗方案中消除。这项预先指定的分析探讨了是否需要阿司匹林（既往经皮冠状动脉介入治疗[PCI]、冠状动脉旁路移植术[CABG]、中风或周围血管疾病[PVD]）会对避免服用阿司匹林的结果产生不同的影响。目的：分析有冠脉搭桥、PCI、卒中或PVD病史的患者在植入后1年内避免阿司匹林对血液相容性相关不良事件（HRAEs）的影响。设计、环境和参与者：这是一项国际性、多中心、前瞻性、双盲、安慰剂对照、随机临床试验，包括51个中心植入全新HM3左心室辅助器的患者。数据分析时间为2024年4月至7月。干预措施：患者按1:1的比例随机接受阿司匹林（每天100毫克）或安慰剂，此外两组均以2比3的国际标准化比例服用维生素K拮抗剂（VKA）。主要结局和措施：主要终点（非劣效性评估）是12个月无任何非手术（植入物后14天）HRAEs（包括卒中、泵血栓形成、出血和动脉外周血栓栓塞）的综合生存。次要终点包括非手术出血、中风和泵血栓事件。结果：628例患者中，589例患者(平均[SD]年龄57.1[13.7]岁；456名男性[77.4%])参与了主要终点分析，其中41%（589例患者中的240例）存在PCI、CABG、卒中或PVD病史。与安慰剂相比，动脉粥样硬化性血管状况的存在与阿司匹林的效果之间没有相互作用（相互作用的P = 0.23）。研究亚组患者未越过预设的10%非劣效性界限。血栓事件很少见，在有和没有血管疾病的患者中，阿司匹林和安慰剂之间没有差异（相互作用P = 0.77）。与没有服用阿司匹林的患者相比，有既往血管病史的患者接受阿司匹林治疗后非手术性大出血事件发生率更高(安慰剂组与阿司匹林组的比率为0.52；95% ci, 0.35-0.79)。结论和相关性：这项预先指定的ARIES-HM3随机临床试验的分析结果表明，在LVAD植入时具有抗血小板治疗经典适应症的晚期心力衰竭患者中，避免使用阿司匹林是安全的，并且与血栓形成风险增加无关。重要的是，在有PCI、CABG、卒中或PVD病史的患者中，停用阿司匹林不会增加血栓形成，但会减少非手术性出血事件。试验注册：ClinicalTrials.gov标识符：NCT04069156。

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引用次数: 0

Recurrent Chest Pain in a Young Female Patient With Family History of Cancer 有癌症家族史的年轻女性患者复发性胸痛

IF 24 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology

Pub Date : 2025-01-08 DOI: 10.1001/jamacardio.2024.4823

Ushasi Saraswati, Jaideep Singh Bhalla, Allan L. Klein

A female patient presents with chest pain, and echocardiography reveals moderate circumferential pericardial effusion, leading to a diagnosis of acute pericarditis. Initial cardiac magnetic resonance imaging phase-sensitive inversion recovery sequences in the sagittal section depict late gadolinium enhancement on the pericardium and pericardial thickening. What would you do next?

女性患者表现为胸痛，超声心动图显示中度心包积液，诊断为急性心包炎。最初的心脏磁共振成像矢状面相位敏感反转恢复序列显示心包晚期钆增强和心包增厚。接下来你会做什么？

引用次数: 0

Omitting Aspirin in High-Risk Left Ventricular Assist Device Implant. 高危左心室辅助装置植入时忽略阿司匹林。

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology

Pub Date : 2025-01-08 DOI: 10.1001/jamacardio.2024.4861

Nosheen Reza

引用次数: 0

Error in Table. 表中出现错误。

IF 14.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JAMA cardiology

Pub Date : 2025-01-08 DOI: 10.1001/jamacardio.2024.5456

引用次数: 0