Pub Date : 2026-01-21DOI: 10.1001/jamacardio.2025.5249
Pilar Lopez Santi,Federico Fortuni,Jérémy Bernard,Camille Sarrazyn,Aileen P Chua,Steele C Butcher,Maria C Meucci,Jingnan Zhang,Roxana Enache,Edgar Tay,Alice Bergeron,Kai-Hang Yiu,Marie-Annick Clavel,Philippe Pibarot,Jeroen J Bax,Nina Ajmone Marsan
ImportanceLeft ventricular (LV) dilatation is an established prognosticator in aortic regurgitation (AR). Current guidelines recommend aortic valve surgery (AVS) using LV end-systolic diameter index (LVESDi) with a uniform threshold, irrespective of sex. While LV end-systolic volume index (LVESVi) may better characterize LV remodeling, it was only recently included in European guideline recommendations, with a threshold of 45 mL/m2 for both men and women.ObjectiveTo assess sex differences in LV remodeling using linear and volumetric dimensions and their association with outcomes in AR.Design, Setting, and ParticipantsThis was a multicenter cohort study of patients with moderate-severe AR and preserved LV ejection fraction (LVEF) between December 2003 and December 2022, with a median (IQR) follow-up of 7 (4-11) years. The study took place at 5 centers in the Netherlands, Singapore, Hong Kong, Canada, and Romania. Patients with at least moderate-severe AR and preserved LVEF (≥50%) were included. Those with symptoms, acute AR, significant other valvular disease, or prior valve surgery were excluded. Data were analyzed from January to November 2024.ExposureLV dilatation assessed by LVESDi and LVESVi.Main Outcomes and MeasuresAll-cause mortality during medical management and following AVS.ResultsA total of 808 patients (mean [SD] age, 56 [19] years; 488 men and 320 women) were included, 323 of whom underwent AVS. Mean (SD) baseline LVESDi did not differ between sexes (women: 20 [5] mm/m2 vs men: 20 [4] mm/m2; P = .77), whereas men had larger mean (SD) LVESVi (39 [16] mL/m2 vs 31 [15] mL/m2; P < .001). During follow-up under medical management, 74 patients died. Adjusted 6-year survival was lower in women (80% vs 89%; P = .001). Receiver operating characteristic curve analysis identified LVESDi 20 mm/m2 or greater for both sexes, LVESVi 40 mL/m2 or greater for women, and LVESVi 45 mL/m2 or greater for men as thresholds associated with mortality. These cutoffs were validated using age-adjusted cubic splines and remained associated with outcomes after multivariable adjustment, with a differential effect by sex for LVESVi but not for LVESDi. After AVS, survival did not differ by sex (85% women vs 89% men; P = .31). Only preoperative LVESVi was associated with mortality, with a significant sex interaction (HR, 1.03; 95% CI, 1.00-1.06; P = .04).Conclusions and RelevanceIn this study among individuals with moderate-severe AR, similar LVESDi thresholds (20 mm/m2) for both sexes, but lower than currently recommended by guidelines, were independently associated with mortality. In turn, LVESVi thresholds were 40 mL/m2 for women and 45 mL/m2 for men, suggesting the need for sex-specific cutoffs to improve risk stratification.
左室（LV）扩张是主动脉瓣反流（AR）的预后指标。目前的指南推荐主动脉瓣手术（AVS）使用具有统一阈值的左室收缩末期直径指数（LVESDi），而不考虑性别。虽然左室收缩末期容积指数（LVESVi）可以更好地表征左室重构，但直到最近才被纳入欧洲指南建议，男性和女性的阈值均为45 mL/m2。目的利用线性和体积尺寸评估左室重构的性别差异及其与AR结局的关系。设计、环境和参与者：这是一项多中心队列研究，研究对象为2003年12月至2022年12月期间中重度AR患者和保留左室射血分数（LVEF），中位（IQR）随访时间为7（4-11）年。这项研究在荷兰、新加坡、香港、加拿大和罗马尼亚的5个中心进行。包括至少有中重度AR和LVEF保存（≥50%）的患者。排除有症状、急性急性变应性鼻炎、显著其他瓣膜疾病或既往瓣膜手术的患者。数据分析时间为2024年1月至11月。通过LVESDi和LVESVi评估暴露。主要结局和测量方法：医疗管理期间和AVS后的全因死亡率。结果共纳入808例患者（平均[SD]年龄56岁，男性488例，女性320例），其中323例患者行AVS。平均（SD）基线LVESDi在性别之间没有差异(女性：20 [5]mm/m2 vs男性：20 [5]mm/m2； P =。77)，而男性的平均（SD） LVESVi更大（39 [15]mL/m2 vs 31 [15] mL/m2; P < 0.001）。在医疗管理的随访期间，74名患者死亡。女性的调整后6年生存率较低（80% vs 89%; P = 0.001）。受试者工作特征曲线分析确定，男女的LVESDi为20 mm/m2或更高，女性的LVESVi为40 mL/m2或更高，男性的LVESVi为45 mL/m2或更高，这是与死亡率相关的阈值。使用年龄调整三次样条验证了这些截断值，并且在多变量调整后仍然与结果相关，LVESVi的性别差异影响，而LVESDi则没有。AVS后，生存率无性别差异（85%女性vs 89%男性；P = 0.31）。只有术前LVESVi与死亡率相关，且存在显著的性别交互作用（HR, 1.03; 95% CI, 1.00-1.06; P = 0.04）。在本研究中，在中重度AR患者中，男女LVESDi阈值相似（20 mm/m2），但低于目前指南推荐值，与死亡率独立相关。反过来，LVESVi阈值女性为40 mL/m2，男性为45 mL/m2，这表明需要性别特异性的截止值来改善风险分层。
{"title":"Sex Differences in Left Ventricular Remodeling for Risk Stratification of Patients With Aortic Regurgitation.","authors":"Pilar Lopez Santi,Federico Fortuni,Jérémy Bernard,Camille Sarrazyn,Aileen P Chua,Steele C Butcher,Maria C Meucci,Jingnan Zhang,Roxana Enache,Edgar Tay,Alice Bergeron,Kai-Hang Yiu,Marie-Annick Clavel,Philippe Pibarot,Jeroen J Bax,Nina Ajmone Marsan","doi":"10.1001/jamacardio.2025.5249","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.5249","url":null,"abstract":"ImportanceLeft ventricular (LV) dilatation is an established prognosticator in aortic regurgitation (AR). Current guidelines recommend aortic valve surgery (AVS) using LV end-systolic diameter index (LVESDi) with a uniform threshold, irrespective of sex. While LV end-systolic volume index (LVESVi) may better characterize LV remodeling, it was only recently included in European guideline recommendations, with a threshold of 45 mL/m2 for both men and women.ObjectiveTo assess sex differences in LV remodeling using linear and volumetric dimensions and their association with outcomes in AR.Design, Setting, and ParticipantsThis was a multicenter cohort study of patients with moderate-severe AR and preserved LV ejection fraction (LVEF) between December 2003 and December 2022, with a median (IQR) follow-up of 7 (4-11) years. The study took place at 5 centers in the Netherlands, Singapore, Hong Kong, Canada, and Romania. Patients with at least moderate-severe AR and preserved LVEF (≥50%) were included. Those with symptoms, acute AR, significant other valvular disease, or prior valve surgery were excluded. Data were analyzed from January to November 2024.ExposureLV dilatation assessed by LVESDi and LVESVi.Main Outcomes and MeasuresAll-cause mortality during medical management and following AVS.ResultsA total of 808 patients (mean [SD] age, 56 [19] years; 488 men and 320 women) were included, 323 of whom underwent AVS. Mean (SD) baseline LVESDi did not differ between sexes (women: 20 [5] mm/m2 vs men: 20 [4] mm/m2; P = .77), whereas men had larger mean (SD) LVESVi (39 [16] mL/m2 vs 31 [15] mL/m2; P < .001). During follow-up under medical management, 74 patients died. Adjusted 6-year survival was lower in women (80% vs 89%; P = .001). Receiver operating characteristic curve analysis identified LVESDi 20 mm/m2 or greater for both sexes, LVESVi 40 mL/m2 or greater for women, and LVESVi 45 mL/m2 or greater for men as thresholds associated with mortality. These cutoffs were validated using age-adjusted cubic splines and remained associated with outcomes after multivariable adjustment, with a differential effect by sex for LVESVi but not for LVESDi. After AVS, survival did not differ by sex (85% women vs 89% men; P = .31). Only preoperative LVESVi was associated with mortality, with a significant sex interaction (HR, 1.03; 95% CI, 1.00-1.06; P = .04).Conclusions and RelevanceIn this study among individuals with moderate-severe AR, similar LVESDi thresholds (20 mm/m2) for both sexes, but lower than currently recommended by guidelines, were independently associated with mortality. In turn, LVESVi thresholds were 40 mL/m2 for women and 45 mL/m2 for men, suggesting the need for sex-specific cutoffs to improve risk stratification.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"39 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005166","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}
Pub Date : 2026-01-21DOI: 10.1001/jamacardio.2025.5196
Ozan Unlu,David Zelle,Christopher P Cannon,Simin Lee,Marian McPartlin,Samantha Subramaniam,Michela Tucci,Michael Oates,Christian Figueroa,Hunter Nichols,Tabitha V Rutkowski,Alexander J Blood,Benjamin M Scirica,Naomi D L Fisher
ImportanceHome blood pressure monitoring (HBPM) is essential and universally recommended for hypertension management, but patterns of real-world patient engagement with HBPM have not been studied and remain largely unknown.ObjectiveTo evaluate patient engagement with HBPM in a remote hypertension management program.Design, Setting, and ParticipantsThis retrospective cohort study analyzing prospectively collected program data was conducted within a remote hypertension management program at a large academic health care system, Mass General Brigham, in Boston, Massachusetts. Data were collected from from September 2018 to June 2022. Adults with uncontrolled hypertension enrolled in the program were eligible for inclusion. Data analyses were conducted from February to April 2025.InterventionsPatients received free automated HBPM devices, education, and ongoing personalized support from health care navigators via telephone and messaging, with algorithm-guided medication titration.Main Outcomes and MeasuresThe primary outcome was engagement at baseline. Weekly HBPM frequency was categorized as no engagement (0 measurements), low engagement (1-11 measurements/week), intermediate engagement (12-23 measurements/week), and high engagement (24-28 measurements/week).ResultsA total of 3390 patients were enrolled in the remote hypertension program; median (IQR) patient age was 61 (52-69) years, with 1958 (57.8%) female patients. Mean (SD) systolic BP at baseline was 143 (13) mm Hg, and most patients had comorbidities, including 1369 patients (40.4%) with atherosclerotic cardiovascular disease and 996 (29.4%) with diabetes. At baseline, 1107 patients (32.7%) had no engagement, 484 (14.3%) had low engagement, 618 (18.2%) had intermediate engagement, and 1181 (34.8%) had high engagement.Conclusions and RelevanceIn this cohort study of a remote hypertension management program, patient engagement with HBPM was suboptimal despite free devices, education, and personalized support with a navigator. To support optimal HBPM, innovative methods of BP monitoring that are more convenient and less burdensome for patients may enhance engagement and improve hypertension management outcomes.
家庭血压监测（HBPM）是必不可少的，并且被普遍推荐用于高血压管理，但现实世界中患者参与HBPM的模式尚未研究，并且在很大程度上仍然未知。目的评估远程高血压管理项目中HBPM的患者参与情况。设计、环境和参与者本回顾性队列研究分析了前瞻性收集的项目数据，在马萨诸塞州波士顿的大型学术卫生保健系统Mass General Brigham的一个远程高血压管理项目中进行。数据收集时间为2018年9月至2022年6月。参加该项目的高血压未控制的成年人符合入选条件。数据分析时间为2025年2月至4月。干预措施：患者接受了免费的自动HBPM设备、教育和医疗导航员通过电话和短信提供的持续个性化支持，并使用算法指导的药物滴定。主要结果和测量主要结果是基线时的参与度。每周HBPM频率分为无参与度（0次测量）、低参与度（1-11次测量/周）、中等参与度（12-23次测量/周）和高参与度（24-28次测量/周）。结果远程高血压项目共纳入3390例患者；中位（IQR）患者年龄61岁（52 ~ 69岁），女性1958例（57.8%）。基线时平均收缩压（SD）为143 (13)mm Hg，大多数患者有合并症，其中1369例（40.4%）患有动脉粥样硬化性心血管疾病，996例（29.4%）患有糖尿病。基线时，1107例（32.7%）患者无敬业度，484例（14.3%）患者敬业度低，618例（18.2%）患者敬业度中等，1181例（34.8%）患者敬业度高。结论和相关性在这项远程高血压管理项目的队列研究中，尽管有免费设备、教育和导航个性化支持，但患者参与HBPM的效果并不理想。为了支持最佳HBPM，对患者来说更方便、负担更少的创新血压监测方法可能会提高患者的参与度并改善高血压管理结果。
{"title":"Patient Engagement With Home Blood Pressure Monitoring.","authors":"Ozan Unlu,David Zelle,Christopher P Cannon,Simin Lee,Marian McPartlin,Samantha Subramaniam,Michela Tucci,Michael Oates,Christian Figueroa,Hunter Nichols,Tabitha V Rutkowski,Alexander J Blood,Benjamin M Scirica,Naomi D L Fisher","doi":"10.1001/jamacardio.2025.5196","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.5196","url":null,"abstract":"ImportanceHome blood pressure monitoring (HBPM) is essential and universally recommended for hypertension management, but patterns of real-world patient engagement with HBPM have not been studied and remain largely unknown.ObjectiveTo evaluate patient engagement with HBPM in a remote hypertension management program.Design, Setting, and ParticipantsThis retrospective cohort study analyzing prospectively collected program data was conducted within a remote hypertension management program at a large academic health care system, Mass General Brigham, in Boston, Massachusetts. Data were collected from from September 2018 to June 2022. Adults with uncontrolled hypertension enrolled in the program were eligible for inclusion. Data analyses were conducted from February to April 2025.InterventionsPatients received free automated HBPM devices, education, and ongoing personalized support from health care navigators via telephone and messaging, with algorithm-guided medication titration.Main Outcomes and MeasuresThe primary outcome was engagement at baseline. Weekly HBPM frequency was categorized as no engagement (0 measurements), low engagement (1-11 measurements/week), intermediate engagement (12-23 measurements/week), and high engagement (24-28 measurements/week).ResultsA total of 3390 patients were enrolled in the remote hypertension program; median (IQR) patient age was 61 (52-69) years, with 1958 (57.8%) female patients. Mean (SD) systolic BP at baseline was 143 (13) mm Hg, and most patients had comorbidities, including 1369 patients (40.4%) with atherosclerotic cardiovascular disease and 996 (29.4%) with diabetes. At baseline, 1107 patients (32.7%) had no engagement, 484 (14.3%) had low engagement, 618 (18.2%) had intermediate engagement, and 1181 (34.8%) had high engagement.Conclusions and RelevanceIn this cohort study of a remote hypertension management program, patient engagement with HBPM was suboptimal despite free devices, education, and personalized support with a navigator. To support optimal HBPM, innovative methods of BP monitoring that are more convenient and less burdensome for patients may enhance engagement and improve hypertension management outcomes.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"3 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005230","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}
Pub Date : 2026-01-14DOI: 10.1001/jamacardio.2025.4927
Arnaud D Kaze,Stephen P Juraschek,Jordana B Cohen,Siddharth Singh,Chiadi E Ndumele,Christie M Ballantyne,Jarrett D Berry,Justin B Echouffo-Tcheugui
ImportanceIt is unclear whether and the extent to which subclinical myocardial injury or stress coexisting with prediabetes is associated with the risk of heart failure (HF).ObjectiveTo evaluate the joint associations of prediabetes and subclinical myocardial injury or stress with incident HF risk.Design, Setting, and ParticipantsThis post hoc prospective cohort study analyzed data from the Systolic Blood Pressure Intervention Trial (SPRINT). Two analytic samples were used: (1) adults with hypertension without diabetes or prior HF for the baseline biomarkers analysis and (2) participants with biomarker measurements at both baseline and 12 months for the longitudinal biomarkers' change. Prediabetes was defined as a fasting plasma glucose level of 100 to 125 mg/dL. Subclinical myocardial injury was defined as a high-sensitivity cardiac troponin I (hs-cTnI) level of 6 ng/L or higher in men and 4 ng/L or higher in women and subclinical myocardial stress defined as an N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of 125 pg/mL or higher. A 25% or greater increase in any biomarker concentration from baseline to 12 months defined longitudinal change. Data were analyzed between January 1 and May 31, 2025.Main Outcomes and MeasuresThe primary outcome was adjudicated incident HF. Cox proportional hazards models were used to estimate hazard ratios (HRs) for HF across joint categories of prediabetes and biomarker elevation.ResultsOf 8234 participants (mean [SD] age, 68 [9] years; 37.1% women), 3271 (39.7%) had prediabetes, 2942 (35.7%) had subclinical myocardial injury, and 3593 (43.6%) had subclinical myocardial stress. Over a median follow-up of 3.2 years (IQR, 2.8-3.8 years), 122 participants developed HF. Compared with normoglycemia and no myocardial injury, those with both prediabetes and injury had the highest HF risk (HR, 4.20; 95% CI, 2.31-7.63); similar findings were observed for myocardial stress (HR, 5.20; 95% CI, 2.52-10.70). In the longitudinal analysis (median follow-up, 2.3 years [IQR, 1.9-2-8 years]), 7449 participants with both prediabetes and a 25% or greater increase in hs-cTnI or NT-proBNP level had the highest risk of HF (for hs-cTnI: HR, 3.05; 95% CI, 1.58-5.88; for NT-proBNP: HR, 2.39; 95% CI, 1.28-4.46).Conclusions and RelevanceThese findings suggest that among adults with hypertension, prediabetes in combination with subclinical myocardial injury or stress is associated with a significantly elevated risk for HF. These findings support the integration of glycemic status and cardiac biomarkers profiling to improve HF risk stratification and guide prevention.
{"title":"Prediabetes, Subclinical Myocardial Injury or Stress, and Heart Failure Risk for Adults With Hypertension.","authors":"Arnaud D Kaze,Stephen P Juraschek,Jordana B Cohen,Siddharth Singh,Chiadi E Ndumele,Christie M Ballantyne,Jarrett D Berry,Justin B Echouffo-Tcheugui","doi":"10.1001/jamacardio.2025.4927","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4927","url":null,"abstract":"ImportanceIt is unclear whether and the extent to which subclinical myocardial injury or stress coexisting with prediabetes is associated with the risk of heart failure (HF).ObjectiveTo evaluate the joint associations of prediabetes and subclinical myocardial injury or stress with incident HF risk.Design, Setting, and ParticipantsThis post hoc prospective cohort study analyzed data from the Systolic Blood Pressure Intervention Trial (SPRINT). Two analytic samples were used: (1) adults with hypertension without diabetes or prior HF for the baseline biomarkers analysis and (2) participants with biomarker measurements at both baseline and 12 months for the longitudinal biomarkers' change. Prediabetes was defined as a fasting plasma glucose level of 100 to 125 mg/dL. Subclinical myocardial injury was defined as a high-sensitivity cardiac troponin I (hs-cTnI) level of 6 ng/L or higher in men and 4 ng/L or higher in women and subclinical myocardial stress defined as an N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of 125 pg/mL or higher. A 25% or greater increase in any biomarker concentration from baseline to 12 months defined longitudinal change. Data were analyzed between January 1 and May 31, 2025.Main Outcomes and MeasuresThe primary outcome was adjudicated incident HF. Cox proportional hazards models were used to estimate hazard ratios (HRs) for HF across joint categories of prediabetes and biomarker elevation.ResultsOf 8234 participants (mean [SD] age, 68 [9] years; 37.1% women), 3271 (39.7%) had prediabetes, 2942 (35.7%) had subclinical myocardial injury, and 3593 (43.6%) had subclinical myocardial stress. Over a median follow-up of 3.2 years (IQR, 2.8-3.8 years), 122 participants developed HF. Compared with normoglycemia and no myocardial injury, those with both prediabetes and injury had the highest HF risk (HR, 4.20; 95% CI, 2.31-7.63); similar findings were observed for myocardial stress (HR, 5.20; 95% CI, 2.52-10.70). In the longitudinal analysis (median follow-up, 2.3 years [IQR, 1.9-2-8 years]), 7449 participants with both prediabetes and a 25% or greater increase in hs-cTnI or NT-proBNP level had the highest risk of HF (for hs-cTnI: HR, 3.05; 95% CI, 1.58-5.88; for NT-proBNP: HR, 2.39; 95% CI, 1.28-4.46).Conclusions and RelevanceThese findings suggest that among adults with hypertension, prediabetes in combination with subclinical myocardial injury or stress is associated with a significantly elevated risk for HF. These findings support the integration of glycemic status and cardiac biomarkers profiling to improve HF risk stratification and guide prevention.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"54 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961452","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}
Pub Date : 2026-01-08DOI: 10.1001/jamacardio.2025.5645
Dharam J. Kumbhani, Saket Girotra, Huaying Dong, Yang Song, Pratik Manandhar, Ayman Elbadawi, James A. de Lemos, Adnan K. Chhatriwalla, John Carroll, Ralph Brindis, Tsuyoshi Kaneko, Vinod Thourani, Wayne Batchelor, Robert W. Yeh, Sreekanth Vemulapalli
Importance Recent evidence suggests that hospital-level associations between procedural volume and outcomes for transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (MTEER) may be plateauing. Less is known about the operator volumes–outcomes association in the contemporary era. Objective To determine whether an operator-level volume-outcomes association exists for TAVR and MTEER in the contemporary era. Design, Setting, and Participants This cohort study examined data from patients undergoing TAVR or MTEER between January 2020 and December 2023 included in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapies (TVT) Registry, a national all-comers real-world registry. Consecutive patients undergoing TAVR for aortic stenosis or MTEER for mitral regurgitation were included. Data analysis was performed from October 2024 to December 2025. Exposure TAVR or MTEER. Main Outcomes and Measures The primary outcome measures were (1) 30-day all-cause mortality, (2) a 30-day composite outcome, and (3) in-hospital procedural complications following TAVR or MTEER. Data from the STS/ACC TVT Registry were analyzed for patients undergoing TAVR or MTEER between 2020 and 2023. The primary analysis assessed the association between operator volume and 30-day outcomes using a 2-level random-effects logistic regression model. The interaction between operator and hospital volumes and the association between TAVR and MTEER outcomes were also evaluated. Results A total of 358 943 patients underwent TAVR at 827 hospitals (7524 operators; median [IQR] annual volume, 24 [11-47]), and 51 407 patients underwent MTEER at 493 hospitals (2483 operators; median [IQR] annual volume, 12 [7-19]). For TAVR, median (IQR) patient age was 79.0 (73.0-85.0) years, and 152 186 patients (42.4%) were female; for MTEER, median (IQR) patient age was 79.0 (71.0-84.0) years, and 23 402 patients (45.5%) were female. Low-volume operators demonstrated inferior process of care measures compared with high-volume operators. In adjusted analyses, a higher risk of 30-day mortality (odds ratio [OR], 1.13; 95% CI, 1.02-1.26; <jats:italic toggle="yes">P</jats:italic> = .02) and in-hospital complications (OR, 1.09; 95% CI, 1.03-1.16; <jats:italic toggle="yes">P</jats:italic> = .005) was observed for low-volume TAVR operators (&lt;15/y) compared with high-volume operators (&gt;37/y). For MTEER, in-hospital complications (OR, 1.31; 95% CI, 1.11-1.56; <jats:italic toggle="yes">P</jats:italic> = .002) were higher for low-volume operators (&lt;8/y) compared with high-volume operators (&gt;16/y), while 30-day mortality was not different (OR, 1.16; 95% CI, 0.96-1.41; <jats:italic toggle="yes">P</jats:italic> = .12). Associations were consistent across hospital volume strata. Operator-level outcomes for TAVR and MTEER were not correlated. Conclusions and Relevance In this cohort study, results from
最近的证据表明，经导管主动脉瓣置换术（TAVR）和二尖瓣边缘到边缘修复术（MTEER）的手术容量与医院水平的结果之间的关联可能处于稳定状态。在当代，人们对运营商数量与结果之间的关系知之甚少。目的探讨当代TAVR和MTEER是否存在操作者水平的容积-预后相关性。设计、设置和参与者本队列研究检查了2020年1月至2023年12月期间接受TAVR或MTEER的患者的数据，这些数据纳入了胸外科学会(STS)/美国心脏病学会（ACC）经导管瓣膜治疗（TVT）登记处，这是一个全国性的真实世界登记处。连续接受主动脉瓣狭窄TAVR或二尖瓣返流MTEER治疗的患者纳入研究。数据分析时间为2024年10月至2025年12月。曝光TAVR或MTEER。主要结局指标为：(1)30天全因死亡率，(2)30天综合结局，(3)TAVR或MTEER术后的院内手术并发症。STS/ACC TVT登记处的数据分析了2020年至2023年间接受TAVR或MTEER的患者。初步分析使用2水平随机效应logistic回归模型评估了操作者数量与30天预后之间的关系。操作者和医院数量之间的相互作用以及TAVR和MTEER结果之间的关联也被评估。结果827家医院共358 943例TAVR患者（7524人，IQR中位数为24[11-47]），493家医院共51 407例MTEER患者（2483人，IQR中位数为12[7-19]）。TAVR患者中位（IQR）年龄为79.0（73.0 ~ 85.0）岁，女性152186例（42.4%）；MTEER患者的中位（IQR）年龄为79.0（71.0 ~ 84.0）岁，23402例（45.5%）为女性。与高容量操作员相比，低容量操作员表现出较差的护理措施过程。在校正分析中，与大容量TAVR手术者（>37/y）相比，小容量TAVR手术者（<15/y）的30天死亡率（比值比[OR]， 1.13; 95% CI, 1.02-1.26; P = 0.02）和院内并发症（比值比[OR]， 1.09; 95% CI, 1.03-1.16; P = 0.005）更高。对于MTEER，小容量手术（<8/y）的住院并发症（OR, 1.31; 95% CI, 1.11-1.56; P = 0.002）高于大容量手术（>16/y），而30天死亡率无差异（OR, 1.16; 95% CI, 0.96-1.41; P = 0.12）。关联在医院容积层中是一致的。操作者水平的TAVR和MTEER结果不相关。结论和相关性在这项队列研究中，来自美国当代大型注册中心的结果表明，TAVR和MTEER的手术量与患者预后之间存在持续的负相关关系。这些发现可能有助于为旨在确保最佳结果的未来政策提供信息。
{"title":"Contemporary Operator Procedural Volumes and Outcomes for TAVR and MTEER in the US","authors":"Dharam J. Kumbhani, Saket Girotra, Huaying Dong, Yang Song, Pratik Manandhar, Ayman Elbadawi, James A. de Lemos, Adnan K. Chhatriwalla, John Carroll, Ralph Brindis, Tsuyoshi Kaneko, Vinod Thourani, Wayne Batchelor, Robert W. Yeh, Sreekanth Vemulapalli","doi":"10.1001/jamacardio.2025.5645","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.5645","url":null,"abstract":"Importance Recent evidence suggests that hospital-level associations between procedural volume and outcomes for transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (MTEER) may be plateauing. Less is known about the operator volumes–outcomes association in the contemporary era. Objective To determine whether an operator-level volume-outcomes association exists for TAVR and MTEER in the contemporary era. Design, Setting, and Participants This cohort study examined data from patients undergoing TAVR or MTEER between January 2020 and December 2023 included in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapies (TVT) Registry, a national all-comers real-world registry. Consecutive patients undergoing TAVR for aortic stenosis or MTEER for mitral regurgitation were included. Data analysis was performed from October 2024 to December 2025. Exposure TAVR or MTEER. Main Outcomes and Measures The primary outcome measures were (1) 30-day all-cause mortality, (2) a 30-day composite outcome, and (3) in-hospital procedural complications following TAVR or MTEER. Data from the STS/ACC TVT Registry were analyzed for patients undergoing TAVR or MTEER between 2020 and 2023. The primary analysis assessed the association between operator volume and 30-day outcomes using a 2-level random-effects logistic regression model. The interaction between operator and hospital volumes and the association between TAVR and MTEER outcomes were also evaluated. Results A total of 358 943 patients underwent TAVR at 827 hospitals (7524 operators; median [IQR] annual volume, 24 [11-47]), and 51 407 patients underwent MTEER at 493 hospitals (2483 operators; median [IQR] annual volume, 12 [7-19]). For TAVR, median (IQR) patient age was 79.0 (73.0-85.0) years, and 152 186 patients (42.4%) were female; for MTEER, median (IQR) patient age was 79.0 (71.0-84.0) years, and 23 402 patients (45.5%) were female. Low-volume operators demonstrated inferior process of care measures compared with high-volume operators. In adjusted analyses, a higher risk of 30-day mortality (odds ratio [OR], 1.13; 95% CI, 1.02-1.26; <jats:italic toggle=\"yes\">P</jats:italic> = .02) and in-hospital complications (OR, 1.09; 95% CI, 1.03-1.16; <jats:italic toggle=\"yes\">P</jats:italic> = .005) was observed for low-volume TAVR operators (&amp;lt;15/y) compared with high-volume operators (&amp;gt;37/y). For MTEER, in-hospital complications (OR, 1.31; 95% CI, 1.11-1.56; <jats:italic toggle=\"yes\">P</jats:italic> = .002) were higher for low-volume operators (&amp;lt;8/y) compared with high-volume operators (&amp;gt;16/y), while 30-day mortality was not different (OR, 1.16; 95% CI, 0.96-1.41; <jats:italic toggle=\"yes\">P</jats:italic> = .12). Associations were consistent across hospital volume strata. Operator-level outcomes for TAVR and MTEER were not correlated. Conclusions and Relevance In this cohort study, results from","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"1 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919900","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}
Pub Date : 2026-01-07DOI: 10.1001/jamacardio.2025.4869
Neha Hafeez,Brian L Claggett,Anjali T Owens,Adam S Helms,Sara Saberi,Rachel Lampert,John C Stendahl,Euan A Ashley,Victoria N Parikh,Neal K Lakdawala,Jodie Ingles,Iacopo Olivotto,Carolyn Y Ho,Matthew R Taylor,Sadiya S Khan,Sharlene M Day
ImportanceArea-based indicators of social determinants of health (SDOH) are associated with higher risk for acquired heart disease, but their impact on conditions with a strong genetic etiology, such as hypertrophic cardiomyopathy (HCM), is not well understood.ObjectiveTo determine the association of area-based SDOH with clinical outcomes in patients with HCM.Design, Setting, and ParticipantsThis multicenter, prospective cohort study was conducted among US adult patients with HCM from 5 sites in the Sarcomeric Human Cardiomyopathy Registry (a multicenter prospective registry of patients with HCM) who were followed up for a median (IQR) period of 2.15 (0.15-5.82) years. Data were entered from 2015 to March 2024, and data analysis was completed from March 2024 to June 2025.ExposuresPatients' residential addresses were geocoded at the zip code level and linked to the American Communities Survey to estimate area-based (1) median household income and (2) social deprivation index (SDI), which ranges from 0 to 100, with higher scores indicating a more deprived area.Main Outcomes and MeasuresMultivariate models, adjusting for age at diagnosis, body mass index, hypertension, and sex, were used to estimate the independent association of area-based median household income and SDI with heart failure (HF), ventricular arrhythmias (VA), and an overall composite outcome (VA, HF, atrial fibrillation, stroke, and death).ResultsAmong 4431 US adult patients with HCM, median (IQR) age at HCM diagnosis was 51.3 (38.9-61.6) years, and 1862 patients (42.0%) were female. Median (IQR) area-based household income was $80 000 ($60 000-$110 000), and median (IQR) SDI was 25 (10-55). Adjusted hazard ratios comparing the lowest income group to the highest income group were 2.07 (95% CI, 1.77-2.42; P < .001) for HF, 1.31 (95% CI, 0.97-1.78; P = .08) for VA, and 1.52 (95% CI, 1.36-1.69; P < .001) for the overall composite outcome. Adjusted hazard ratios comparing the highest SDI (ie, more deprived) group to the lowest SDI group were 1.48 (95% CI, 1.29-1.70; P < .001) for HF, 1.55 (95% CI, 1.15-2.09; P = .004) for VA, and 1.36 (95% CI, 1.22-1.50; P < .001) for the overall composite outcome.Conclusions and RelevanceIn this multicenter cohort study, residing in an area with lower median household income or worse SDI were each independently associated with adverse clinical outcomes in patients with HCM. These findings suggest that despite the genetically determined nature of HCM, place of residence is associated with patient outcomes.
基于区域的健康社会决定因素指标（SDOH）与获得性心脏病的高风险相关，但它们对肥厚性心肌病（HCM）等具有强烈遗传病因的疾病的影响尚不清楚。目的探讨HCM患者区域性SDOH与临床预后的关系。设计、环境和参与者这项多中心、前瞻性队列研究在美国成年HCM患者中进行，这些患者来自肌性人类心肌病登记处（一个HCM患者的多中心前瞻性登记处）的5个地点，随访的中位（IQR）期为2.15（0.15-5.82）年。数据录入时间为2015年至2024年3月，数据分析时间为2024年3月至2025年6月。患者的居住地址按邮政编码进行地理编码，并与美国社区调查相关联，以估计基于区域的(1)家庭收入中位数和(2)社会剥夺指数（SDI），其范围从0到100，分数越高表明贫困程度越高。主要结局和测量采用多变量模型，调整诊断年龄、体重指数、高血压和性别，用于估计基于地区的家庭收入中位数和SDI与心力衰竭（HF）、室性心律失常（VA）和总体复合结局（VA、HF、房颤、中风和死亡）的独立关联。结果4431例美国成年HCM患者中，HCM诊断时的中位（IQR）年龄为51.3岁（38.9 ~ 61.6）岁，女性1862例（42.0%）。基于地区的家庭收入中位数（IQR）为80 000美元（60 000美元- 110 000美元），SDI中位数（IQR）为25（10-55）。最低收入组与最高收入组的校正风险比为2.07 （95% CI, 1.77-2.42; P < 0.05）。0.001), 1.31 (95% CI, 0.97-1.78；VA为1.52 (95% CI, 1.36-1.69; P <。001)的总体综合结果。最高SDI（即更贫困）组与最低SDI组的校正风险比为1.48 (95% CI, 1.29-1.70; P <。0.001), 1.55 (95% CI, 1.15-2.09；VA为1.36 (95% CI, 1.22-1.50; P <。001)的总体综合结果。结论和相关性在这项多中心队列研究中，居住在家庭收入中位数较低或SDI较差的地区与HCM患者的不良临床结果独立相关。这些发现表明，尽管HCM的性质由基因决定，但居住地与患者的预后有关。
{"title":"Social Determinants of Health and Clinical Outcomes in Hypertrophic Cardiomyopathy.","authors":"Neha Hafeez,Brian L Claggett,Anjali T Owens,Adam S Helms,Sara Saberi,Rachel Lampert,John C Stendahl,Euan A Ashley,Victoria N Parikh,Neal K Lakdawala,Jodie Ingles,Iacopo Olivotto,Carolyn Y Ho,Matthew R Taylor,Sadiya S Khan,Sharlene M Day","doi":"10.1001/jamacardio.2025.4869","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4869","url":null,"abstract":"ImportanceArea-based indicators of social determinants of health (SDOH) are associated with higher risk for acquired heart disease, but their impact on conditions with a strong genetic etiology, such as hypertrophic cardiomyopathy (HCM), is not well understood.ObjectiveTo determine the association of area-based SDOH with clinical outcomes in patients with HCM.Design, Setting, and ParticipantsThis multicenter, prospective cohort study was conducted among US adult patients with HCM from 5 sites in the Sarcomeric Human Cardiomyopathy Registry (a multicenter prospective registry of patients with HCM) who were followed up for a median (IQR) period of 2.15 (0.15-5.82) years. Data were entered from 2015 to March 2024, and data analysis was completed from March 2024 to June 2025.ExposuresPatients' residential addresses were geocoded at the zip code level and linked to the American Communities Survey to estimate area-based (1) median household income and (2) social deprivation index (SDI), which ranges from 0 to 100, with higher scores indicating a more deprived area.Main Outcomes and MeasuresMultivariate models, adjusting for age at diagnosis, body mass index, hypertension, and sex, were used to estimate the independent association of area-based median household income and SDI with heart failure (HF), ventricular arrhythmias (VA), and an overall composite outcome (VA, HF, atrial fibrillation, stroke, and death).ResultsAmong 4431 US adult patients with HCM, median (IQR) age at HCM diagnosis was 51.3 (38.9-61.6) years, and 1862 patients (42.0%) were female. Median (IQR) area-based household income was $80 000 ($60 000-$110 000), and median (IQR) SDI was 25 (10-55). Adjusted hazard ratios comparing the lowest income group to the highest income group were 2.07 (95% CI, 1.77-2.42; P < .001) for HF, 1.31 (95% CI, 0.97-1.78; P = .08) for VA, and 1.52 (95% CI, 1.36-1.69; P < .001) for the overall composite outcome. Adjusted hazard ratios comparing the highest SDI (ie, more deprived) group to the lowest SDI group were 1.48 (95% CI, 1.29-1.70; P < .001) for HF, 1.55 (95% CI, 1.15-2.09; P = .004) for VA, and 1.36 (95% CI, 1.22-1.50; P < .001) for the overall composite outcome.Conclusions and RelevanceIn this multicenter cohort study, residing in an area with lower median household income or worse SDI were each independently associated with adverse clinical outcomes in patients with HCM. These findings suggest that despite the genetically determined nature of HCM, place of residence is associated with patient outcomes.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"3 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907754","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}
ImportanceHomozygous familial hypercholesterolemia (HoFH) is a rare, life-threatening genetic disorder. Patients with HoFH have markedly elevated low-density lipoprotein cholesterol (LDL-C) levels from birth, and their activity of LDL receptor (LDLR) is typically absent or severely impaired. However, efficacy of traditional lipid-regulating agents relies on residual LDLR function. Angiopoietinlike 3 (ANGPTL3)-directed therapies could reduce lipid levels through an LDLR-independent pathway.ObjectiveTo evaluate SHR-1918, a fully human monoclonal antibody targeting ANGPTL3, in adults with HoFH taking stable lipid-lowering therapy.Design, Setting, and ParticipantsThis was a multicenter, single-arm, phase 2 nonrandomized clinical trial conducted at 8 sites in China between December 19, 2023, and April 2, 2024. Included were participants with HoFH taking stable lipid-lowering therapy.InterventionsPatients were given subcutaneous SHR-1918 at 600 mg every 4 weeks for 12 weeks, followed by an 8-week follow-up.Main Outcomes and MeasuresThe primary end point was the percent change in serum LDL-C level from baseline to week 12.ResultsA total of 26 patients (mean [SD] age, 36.1 [12.2] years; 16 female [61.5%]) were included in this analysis. The mean (SD) baseline LDL-C level was 433.59 (173.74) mg/dL. At week 12, the mean percent change in LDL-C level was -59.09% (SD, 11.71%; 95% CI, -63.81% to -54.36%). The reduction was observed throughout the entire 8-week follow-up period. SHR-1918 suggested similar LDL-C reduction across HoFH genotypes, with a percent change from baseline to week 12 of -61.32% for homozygous, -56.40% for compound heterozygous, and -72.21% for double heterozygous. Overall, 16 patients (61.5%) had at least 1 treatment-emergent adverse event, with the most common being proteinuria (4 [15.4%]). Injection site reaction occurred in only 1 patient (3.8%) and included pain and rash or erythema (both grade 1).Conclusions and RelevanceResults show that SHR-1918 was associated with a substantial reduction in LDL-C level and favorable safety profile among patients with HoFH taking stable lipid-lowering therapy.Trial RegistrationClinicalTrials.gov Identifier: NCT06009393.
{"title":"Anti-ANGPTL3 Antibody SHR-1918 for Homozygous Familial Hypercholesterolemia: A Nonrandomized Clinical Trial.","authors":"Daoquan Peng,Lvya Wang,Lin Pi,Yawei Xu,Jiyan Chen,Yanqing Wu,Nan Wang,Xiaoshu Chen,Sheng Qi,Sheng Feng,Gang Cheng,Chao Lv,Min Zhu,Ying Zhu","doi":"10.1001/jamacardio.2025.4878","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.4878","url":null,"abstract":"ImportanceHomozygous familial hypercholesterolemia (HoFH) is a rare, life-threatening genetic disorder. Patients with HoFH have markedly elevated low-density lipoprotein cholesterol (LDL-C) levels from birth, and their activity of LDL receptor (LDLR) is typically absent or severely impaired. However, efficacy of traditional lipid-regulating agents relies on residual LDLR function. Angiopoietinlike 3 (ANGPTL3)-directed therapies could reduce lipid levels through an LDLR-independent pathway.ObjectiveTo evaluate SHR-1918, a fully human monoclonal antibody targeting ANGPTL3, in adults with HoFH taking stable lipid-lowering therapy.Design, Setting, and ParticipantsThis was a multicenter, single-arm, phase 2 nonrandomized clinical trial conducted at 8 sites in China between December 19, 2023, and April 2, 2024. Included were participants with HoFH taking stable lipid-lowering therapy.InterventionsPatients were given subcutaneous SHR-1918 at 600 mg every 4 weeks for 12 weeks, followed by an 8-week follow-up.Main Outcomes and MeasuresThe primary end point was the percent change in serum LDL-C level from baseline to week 12.ResultsA total of 26 patients (mean [SD] age, 36.1 [12.2] years; 16 female [61.5%]) were included in this analysis. The mean (SD) baseline LDL-C level was 433.59 (173.74) mg/dL. At week 12, the mean percent change in LDL-C level was -59.09% (SD, 11.71%; 95% CI, -63.81% to -54.36%). The reduction was observed throughout the entire 8-week follow-up period. SHR-1918 suggested similar LDL-C reduction across HoFH genotypes, with a percent change from baseline to week 12 of -61.32% for homozygous, -56.40% for compound heterozygous, and -72.21% for double heterozygous. Overall, 16 patients (61.5%) had at least 1 treatment-emergent adverse event, with the most common being proteinuria (4 [15.4%]). Injection site reaction occurred in only 1 patient (3.8%) and included pain and rash or erythema (both grade 1).Conclusions and RelevanceResults show that SHR-1918 was associated with a substantial reduction in LDL-C level and favorable safety profile among patients with HoFH taking stable lipid-lowering therapy.Trial RegistrationClinicalTrials.gov Identifier: NCT06009393.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"76 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907755","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}
Pub Date : 2026-01-07DOI: 10.1001/jamacardio.2025.5043
Ask Tybjærg Nordestgaard,Daniel I Chasman,Vinayaga Moorthy,Jordan M Kraaijenhof,Nancy R Cook,I-Min Lee,Julie E Buring,Paul M Ridker
ImportanceElevated lipoprotein(a) predicts high risk of cardiovascular disease among a modest proportion of healthy individuals, an issue that complicates screening guidelines.ObjectiveTo examine spline models, clinical thresholds, and percentiles of baseline lipoprotein(a) levels as 30-year determinants of cardiovascular risk.Design, Setting, and ParticipantsThis cohort study was conducted among female health professionals participating in the Women's Health Study, who were followed up prospectively from 1993 to 2023. Women without cardiovascular disease, cancer, and other major chronic illnesses had blood samples taken at baseline. All individuals with lipoprotein(a) measurements and/or of European ancestry with genotype information for the LPA rs3798220 variation were included. Data analyses were performed from January through April 2025.ExposuresContinuously valued baseline lipoprotein(a), lipoprotein(a) clinical thresholds and percentiles, and LPA rs3798220 genotypes known to predict lipoprotein(a) levels among individuals of European ancestry.Main Outcomes and MeasuresThe primary outcomes were incident major cardiovascular events, coronary heart disease, ischemic stroke, and cardiovascular death. Age- and multivariable-adjusted cause-specific Cox models were used to calculated hazard ratios for the cardiovascular outcomes. The hypothesis was formulated after collection of the data.ResultsA total of 27 748 women with baseline lipoprotein(a) measurements and 23 279 women of European ancestry with rs3798220 genotype information were included (median [IQR] age, 53 [49-60] years), among whom 3707 and 3165 major cardiovascular events, respectively, accrued during a median (IQR) follow-up period of 27.8 (22.8-29.4) years. Among women with lipoprotein(a) measurements, lipoprotein(a) levels above 30 mg/dL or the 75th percentile (31 mg/dL) were associated with increased 30-year risk of major cardiovascular events and coronary heart disease. Levels above 120 mg/dL or the 99th percentile (131 mg/dL) were associated with increased risk of ischemic stroke and cardiovascular death. Multivariable adjusted hazard ratios for levels above 120 mg/dL vs below 10 mg/dL or above the 99th percentile vs below the 50th percentile (11 mg/dL) were 1.54 (95% CI, 1.24-1.92) and 1.74 (95% CI, 1.35-2.25) for major cardiovascular events, 1.80 (95% CI, 1.36-2.37) and 2.06 (95% CI, 1.49-2.84) for coronary heart disease, 1.41 (95% CI, 0.93-2.15) and 1.85 (95% CI, 1.17-2.93) for ischemic stroke, and 1.63 (95% CI, 1.16-2.28) and 1.86 (95% CI, 1.26-2.72) for cardiovascular death, respectively. Among women with genotype information, rs3798220 minor allele carriers had a higher risk of major cardiovascular events.Conclusions and RelevancePer the results of this cohort study, very high lipoprotein(a) levels correlated with increased 30-year risk of cardiovascular disease among healthy women. Screening for elevated lipoprotein(a) in the general population may be warranted.
{"title":"Thirty-Year Risk of Cardiovascular Disease Among Healthy Women According to Clinical Thresholds of Lipoprotein(a).","authors":"Ask Tybjærg Nordestgaard,Daniel I Chasman,Vinayaga Moorthy,Jordan M Kraaijenhof,Nancy R Cook,I-Min Lee,Julie E Buring,Paul M Ridker","doi":"10.1001/jamacardio.2025.5043","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.5043","url":null,"abstract":"ImportanceElevated lipoprotein(a) predicts high risk of cardiovascular disease among a modest proportion of healthy individuals, an issue that complicates screening guidelines.ObjectiveTo examine spline models, clinical thresholds, and percentiles of baseline lipoprotein(a) levels as 30-year determinants of cardiovascular risk.Design, Setting, and ParticipantsThis cohort study was conducted among female health professionals participating in the Women's Health Study, who were followed up prospectively from 1993 to 2023. Women without cardiovascular disease, cancer, and other major chronic illnesses had blood samples taken at baseline. All individuals with lipoprotein(a) measurements and/or of European ancestry with genotype information for the LPA rs3798220 variation were included. Data analyses were performed from January through April 2025.ExposuresContinuously valued baseline lipoprotein(a), lipoprotein(a) clinical thresholds and percentiles, and LPA rs3798220 genotypes known to predict lipoprotein(a) levels among individuals of European ancestry.Main Outcomes and MeasuresThe primary outcomes were incident major cardiovascular events, coronary heart disease, ischemic stroke, and cardiovascular death. Age- and multivariable-adjusted cause-specific Cox models were used to calculated hazard ratios for the cardiovascular outcomes. The hypothesis was formulated after collection of the data.ResultsA total of 27 748 women with baseline lipoprotein(a) measurements and 23 279 women of European ancestry with rs3798220 genotype information were included (median [IQR] age, 53 [49-60] years), among whom 3707 and 3165 major cardiovascular events, respectively, accrued during a median (IQR) follow-up period of 27.8 (22.8-29.4) years. Among women with lipoprotein(a) measurements, lipoprotein(a) levels above 30 mg/dL or the 75th percentile (31 mg/dL) were associated with increased 30-year risk of major cardiovascular events and coronary heart disease. Levels above 120 mg/dL or the 99th percentile (131 mg/dL) were associated with increased risk of ischemic stroke and cardiovascular death. Multivariable adjusted hazard ratios for levels above 120 mg/dL vs below 10 mg/dL or above the 99th percentile vs below the 50th percentile (11 mg/dL) were 1.54 (95% CI, 1.24-1.92) and 1.74 (95% CI, 1.35-2.25) for major cardiovascular events, 1.80 (95% CI, 1.36-2.37) and 2.06 (95% CI, 1.49-2.84) for coronary heart disease, 1.41 (95% CI, 0.93-2.15) and 1.85 (95% CI, 1.17-2.93) for ischemic stroke, and 1.63 (95% CI, 1.16-2.28) and 1.86 (95% CI, 1.26-2.72) for cardiovascular death, respectively. Among women with genotype information, rs3798220 minor allele carriers had a higher risk of major cardiovascular events.Conclusions and RelevancePer the results of this cohort study, very high lipoprotein(a) levels correlated with increased 30-year risk of cardiovascular disease among healthy women. Screening for elevated lipoprotein(a) in the general population may be warranted.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"177 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907796","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}
Pub Date : 2026-01-07DOI: 10.1001/jamacardio.2025.5023
Paul W Armstrong,Christopher B Granger,Kevin R Bainey
{"title":"Transfer of Patients With ST-Elevation MI for Reperfusion-It's About Time.","authors":"Paul W Armstrong,Christopher B Granger,Kevin R Bainey","doi":"10.1001/jamacardio.2025.5023","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.5023","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"42 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907760","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}
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