Pub Date : 2025-02-01DOI: 10.1001/jamacardio.2024.4806
Marko Lucijanic, Eugen Javor, Marko Skelin
{"title":"Sex Differences in the Effectiveness and Safety of Aspirin.","authors":"Marko Lucijanic, Eugen Javor, Marko Skelin","doi":"10.1001/jamacardio.2024.4806","DOIUrl":"10.1001/jamacardio.2024.4806","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"201"},"PeriodicalIF":14.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914420","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 : 2025-02-01DOI: 10.1001/jamacardio.2025.0009
{"title":"Error in Abstract and Results.","authors":"","doi":"10.1001/jamacardio.2025.0009","DOIUrl":"10.1001/jamacardio.2025.0009","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"10 2","pages":"202"},"PeriodicalIF":14.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-29DOI: 10.1001/jamacardio.2024.5281
Catherine Pollak, Andrew Parambath, Samantha Coratti, Laurie Norton, Anthony Girard, Catherine Reitz, Christopher K. Snider, Lin Xu, Zakiya Walker, Aileen John, Mary E. Putt, Kevin G. Volpp, Shivan J. Mehta
ImportanceA comprehensive lipid panel is recommended by guidelines to evaluate atherosclerotic cardiovascular disease risk, but uptake is low.ObjectiveTo evaluate whether direct outreach including bulk orders with and without text messaging increases lipid screening rates.Design, Setting, and ParticipantsPragmatic randomized clinical trial conducted from June 6, 2023, to September 6, 2023, at 2 primary care practices at an academic health system among patients aged 20 to 75 years with at least 1 primary care visit in the past 3 years who were overdue for lipid screening. Data analysis was performed from September 2023 to May 2024.InterventionsEligible patients were randomized in a 1:2:2 ratio to usual care (group 1), direct outreach and bulk orders (group 2), and bulk order outreach with additional text message reminders for scheduling assistance (group 3). In group 3, participants received an initial, follow-up, and reminder text message. Patients with electronic portal accounts were encouraged to schedule through them, while others received laboratory contact information. Any participant inquiries were answered either with automated responses for common questions or with study team support.Main Outcomes and MeasuresProportion of patients who completed a lipid panel within 3 months.ResultsAmong the 1000 participants, the median (IQR) age was 38 (28-55) years; 470 (47.0%) were female; and 22 (2.3%) were Asian, 38 (3.9%) were Black, 32 (3.2%) were Hispanic or Latino, and 862 (88.6%) were White (race and ethnicity were based on self-reported data). At 3 months, a lipid panel was completed by 12 of 202 patients (5.9%; 95% CI, 3.4% to 10.1%) receiving usual care (group 1) vs 62 of 394 patients (15.7%; 95% CI, 12.5% to 19.7%) receiving direct outreach and bulk order (group 2), a difference of 9.8 percentage points (95% CI, 4.6 to 15.0; P = .001). The panel was completed by 73 of 404 patients (18.1%; 95% CI, 14.6% to 22.1%) receiving outreach, bulk order, and text message reminders (group 3), for a difference of 2.4 percentage points (95% CI, −3.1 to 7.8; P = .43) vs outreach with bulk order alone (group 2). At 6 months, there were no significant differences in lipid screening between either group 1 vs group 2 or group 2 vs group 3.Conclusions and RelevanceLipid screening among participants receiving bulk orders and outreach letters increased significantly compared with usual care at 3 months. However, there was no difference at 6 months. More than 80% of patients did not follow through with lipid screening despite the intervention, and there was no additional increase in lipid testing at 3 months among participants receiving bulk ordering and supplemental text messaging.Trial RegistrationClinicalTrials.gov Identifier: NCT05724615
{"title":"Default Bulk Ordering and Text Messaging to Enhance Outreach for Lipid Screening","authors":"Catherine Pollak, Andrew Parambath, Samantha Coratti, Laurie Norton, Anthony Girard, Catherine Reitz, Christopher K. Snider, Lin Xu, Zakiya Walker, Aileen John, Mary E. Putt, Kevin G. Volpp, Shivan J. Mehta","doi":"10.1001/jamacardio.2024.5281","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5281","url":null,"abstract":"ImportanceA comprehensive lipid panel is recommended by guidelines to evaluate atherosclerotic cardiovascular disease risk, but uptake is low.ObjectiveTo evaluate whether direct outreach including bulk orders with and without text messaging increases lipid screening rates.Design, Setting, and ParticipantsPragmatic randomized clinical trial conducted from June 6, 2023, to September 6, 2023, at 2 primary care practices at an academic health system among patients aged 20 to 75 years with at least 1 primary care visit in the past 3 years who were overdue for lipid screening. Data analysis was performed from September 2023 to May 2024.InterventionsEligible patients were randomized in a 1:2:2 ratio to usual care (group 1), direct outreach and bulk orders (group 2), and bulk order outreach with additional text message reminders for scheduling assistance (group 3). In group 3, participants received an initial, follow-up, and reminder text message. Patients with electronic portal accounts were encouraged to schedule through them, while others received laboratory contact information. Any participant inquiries were answered either with automated responses for common questions or with study team support.Main Outcomes and MeasuresProportion of patients who completed a lipid panel within 3 months.ResultsAmong the 1000 participants, the median (IQR) age was 38 (28-55) years; 470 (47.0%) were female; and 22 (2.3%) were Asian, 38 (3.9%) were Black, 32 (3.2%) were Hispanic or Latino, and 862 (88.6%) were White (race and ethnicity were based on self-reported data). At 3 months, a lipid panel was completed by 12 of 202 patients (5.9%; 95% CI, 3.4% to 10.1%) receiving usual care (group 1) vs 62 of 394 patients (15.7%; 95% CI, 12.5% to 19.7%) receiving direct outreach and bulk order (group 2), a difference of 9.8 percentage points (95% CI, 4.6 to 15.0; <jats:italic>P</jats:italic> = .001). The panel was completed by 73 of 404 patients (18.1%; 95% CI, 14.6% to 22.1%) receiving outreach, bulk order, and text message reminders (group 3), for a difference of 2.4 percentage points (95% CI, −3.1 to 7.8; <jats:italic>P</jats:italic> = .43) vs outreach with bulk order alone (group 2). At 6 months, there were no significant differences in lipid screening between either group 1 vs group 2 or group 2 vs group 3.Conclusions and RelevanceLipid screening among participants receiving bulk orders and outreach letters increased significantly compared with usual care at 3 months. However, there was no difference at 6 months. More than 80% of patients did not follow through with lipid screening despite the intervention, and there was no additional increase in lipid testing at 3 months among participants receiving bulk ordering and supplemental text messaging.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT05724615\">NCT05724615</jats:ext-link>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"22 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056293","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 : 2025-01-29DOI: 10.1001/jamacardio.2024.5124
Herry Mapesi, Martin Rohacek, Fiona Vanobberghen, Ravi Gupta, Herieth Ismael Wilson, Blaise Lukau, Alain Amstutz, Aza Lyimo, Josephine Muhairwe, Elizabeth Senkoro, Theonestina Byakuzana, Jacqueline Nkouabi, Geofrey Mbunda, Jamali Siru, Ayesha Tarr, Elsie Ramapepe, Madavida Mphunyane, Johanna Oehri, Valeriya Nemtsova, Xiaohan Yan, Moniek Bresser, Tracy Renée Glass, Daniel Henry Paris, Günther Fink, Winfrid Gingo, Niklaus Daniel Labhardt, Thilo Burkard, Maja Weisser
ImportanceHypertension is the primary cardiovascular risk factor in Africa. Recently revised World Health Organization guidelines recommend starting antihypertensive dual therapy; clinical efficacy and tolerability of low-dose triple combination remain unclear.ObjectivesTo compare the effect of 3 treatment strategies on blood pressure control among persons with untreated hypertension in Africa.Design, Setting, and ParticipantsThis was an open-label, parallel, 3-arm randomized clinical trial to evaluate noninferiority of a strategy starting 2 pills vs full-dose monotherapy with stepped escalation (noninferiority margin 10%) and superiority of starting low-dose 3 pills vs monotherapy allowing for monthly up titration. Recruitment lasted from March 5, 2020, to March 30, 2022. The setting was 2 hospitals in rural Lesotho and Tanzania. Participants included nonpregnant Black African individuals 18 years and older with uncomplicated, untreated hypertension (standardized office blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic).InterventionsParticipants were randomized 2:2:1 to stepped monotherapy (amlodipine, 10 mg, with escalation to add hydrochlorothiazide if needed), 2-pill strategy (amlodipine, 5 mg; losartan, 25 mg), or 3-pill strategy (amlodipine, 2.5 mg; losartan, 12.5 mg; hydrochlorothiazide, 6.25 mg). Drugs were up titrated monthly until reaching the target blood pressure (≤ 130/80 mm Hg for participants aged &lt;65 years; ≤140/90 mm Hg for those aged ≥65 years).Main Outcomes and MeasuresProportion of participants reaching target blood pressure at 12 weeks.ResultsOf 1761 participants screened, 1268 were enrolled (median [IQR] age, 54 [45-65] years; 914 female [72%]), with 505 in the monotherapy cohort, 510 in the 2-pill cohort, and 253 in the 3-pill cohort. In noninferiority analyses, 207 of 370 participants (56%) receiving the 2-pill strategy and 173 of 338 participants (51%) receiving the stepped monotherapy strategy achieved the blood pressure target (adjusted odds ratio [aOR], 1.18; 95% CI, 0.87-1.61), fulfilling noninferiority. In superiority analyses after multiple imputation for missing outcome data, 57% of participants receiving the 3-pill strategy, 55% receiving the 2-pill strategy, and 49% receiving the stepped monotherapy strategy reached the target blood pressure (aOR, 1.24; 95% CI, 0.94-1.63; <jats:italic>P</jats:italic> = .12 and aOR, 1.28; 95% CI, 0.91-1.79; <jats:italic>P</jats:italic> = .16 for the 2-pill and 3-pill vs stepped monotherapy strategies, respectively).Conclusions and RelevanceResults of this randomized clinical trial show that in 2 African settings, for adults with uncomplicated untreated hypertension, a strategy starting a 2-pill low-dose treatment was noninferior to starting stepped monotherapy. Two-pill and 3-pill low-dose strategies were not superior to stepped monotherapy. Wide CIs preclude the ability to rule out potentially clinically important effects of the additional pill strategies for h
{"title":"Treatment Strategies to Control Blood Pressure in People With Hypertension in Tanzania and Lesotho","authors":"Herry Mapesi, Martin Rohacek, Fiona Vanobberghen, Ravi Gupta, Herieth Ismael Wilson, Blaise Lukau, Alain Amstutz, Aza Lyimo, Josephine Muhairwe, Elizabeth Senkoro, Theonestina Byakuzana, Jacqueline Nkouabi, Geofrey Mbunda, Jamali Siru, Ayesha Tarr, Elsie Ramapepe, Madavida Mphunyane, Johanna Oehri, Valeriya Nemtsova, Xiaohan Yan, Moniek Bresser, Tracy Renée Glass, Daniel Henry Paris, Günther Fink, Winfrid Gingo, Niklaus Daniel Labhardt, Thilo Burkard, Maja Weisser","doi":"10.1001/jamacardio.2024.5124","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5124","url":null,"abstract":"ImportanceHypertension is the primary cardiovascular risk factor in Africa. Recently revised World Health Organization guidelines recommend starting antihypertensive dual therapy; clinical efficacy and tolerability of low-dose triple combination remain unclear.ObjectivesTo compare the effect of 3 treatment strategies on blood pressure control among persons with untreated hypertension in Africa.Design, Setting, and ParticipantsThis was an open-label, parallel, 3-arm randomized clinical trial to evaluate noninferiority of a strategy starting 2 pills vs full-dose monotherapy with stepped escalation (noninferiority margin 10%) and superiority of starting low-dose 3 pills vs monotherapy allowing for monthly up titration. Recruitment lasted from March 5, 2020, to March 30, 2022. The setting was 2 hospitals in rural Lesotho and Tanzania. Participants included nonpregnant Black African individuals 18 years and older with uncomplicated, untreated hypertension (standardized office blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic).InterventionsParticipants were randomized 2:2:1 to stepped monotherapy (amlodipine, 10 mg, with escalation to add hydrochlorothiazide if needed), 2-pill strategy (amlodipine, 5 mg; losartan, 25 mg), or 3-pill strategy (amlodipine, 2.5 mg; losartan, 12.5 mg; hydrochlorothiazide, 6.25 mg). Drugs were up titrated monthly until reaching the target blood pressure (≤ 130/80 mm Hg for participants aged &amp;lt;65 years; ≤140/90 mm Hg for those aged ≥65 years).Main Outcomes and MeasuresProportion of participants reaching target blood pressure at 12 weeks.ResultsOf 1761 participants screened, 1268 were enrolled (median [IQR] age, 54 [45-65] years; 914 female [72%]), with 505 in the monotherapy cohort, 510 in the 2-pill cohort, and 253 in the 3-pill cohort. In noninferiority analyses, 207 of 370 participants (56%) receiving the 2-pill strategy and 173 of 338 participants (51%) receiving the stepped monotherapy strategy achieved the blood pressure target (adjusted odds ratio [aOR], 1.18; 95% CI, 0.87-1.61), fulfilling noninferiority. In superiority analyses after multiple imputation for missing outcome data, 57% of participants receiving the 3-pill strategy, 55% receiving the 2-pill strategy, and 49% receiving the stepped monotherapy strategy reached the target blood pressure (aOR, 1.24; 95% CI, 0.94-1.63; <jats:italic>P</jats:italic> = .12 and aOR, 1.28; 95% CI, 0.91-1.79; <jats:italic>P</jats:italic> = .16 for the 2-pill and 3-pill vs stepped monotherapy strategies, respectively).Conclusions and RelevanceResults of this randomized clinical trial show that in 2 African settings, for adults with uncomplicated untreated hypertension, a strategy starting a 2-pill low-dose treatment was noninferior to starting stepped monotherapy. Two-pill and 3-pill low-dose strategies were not superior to stepped monotherapy. Wide CIs preclude the ability to rule out potentially clinically important effects of the additional pill strategies for h","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"1 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056250","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 : 2025-01-29DOI: 10.1001/jamacardio.2024.5278
Erica S Spatz,Jeremy I Schwartz,Thomas R Frieden
{"title":"Blood Pressure Control-Many Paths, 1 Goal.","authors":"Erica S Spatz,Jeremy I Schwartz,Thomas R Frieden","doi":"10.1001/jamacardio.2024.5278","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5278","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"82 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056836","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 : 2025-01-22DOI: 10.1001/jamacardio.2024.5209
Konstantinos Marmagkiolis, Jaime Caballero, Cezar Iliescu
{"title":"Yellowish Nodules on a Man Consuming a Carnivore Diet.","authors":"Konstantinos Marmagkiolis, Jaime Caballero, Cezar Iliescu","doi":"10.1001/jamacardio.2024.5209","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5209","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005147","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 : 2025-01-22DOI: 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
<p><strong>Importance: </strong>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.</p><p><strong>Objective: </strong>To investigate the association between supine hypertension and CVD outcomes and by hypertension treatment status.</p><p><strong>Design, setting, and participants: </strong>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.</p><p><strong>Exposures: </strong>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).</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusio
{"title":"Supine Blood Pressure and Risk of Cardiovascular Disease and Mortality.","authors":"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","doi":"10.1001/jamacardio.2024.5213","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5213","url":null,"abstract":"<p><strong>Importance: </strong>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.</p><p><strong>Objective: </strong>To investigate the association between supine hypertension and CVD outcomes and by hypertension treatment status.</p><p><strong>Design, setting, and participants: </strong>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.</p><p><strong>Exposures: </strong>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).</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusio","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005552","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 : 2025-01-22DOI: 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
<p><strong>Importance: </strong>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.</p><p><strong>Objective: </strong>To characterize the clinical phenotype and natural history of asymptomatic patients with ATTR cardiac amyloid infiltration.</p><p><strong>Design, setting, and participants: </strong>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.</p><p><strong>Exposure: </strong>Asymptomatic ATTR cardiac amyloid infiltration.</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions and relevance: </strong>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。
{"title":"Clinical Phenotype and Prognosis of Asymptomatic Patients With Transthyretin Cardiac Amyloid Infiltration.","authors":"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","doi":"10.1001/jamacardio.2024.5221","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5221","url":null,"abstract":"<p><strong>Importance: </strong>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.</p><p><strong>Objective: </strong>To characterize the clinical phenotype and natural history of asymptomatic patients with ATTR cardiac amyloid infiltration.</p><p><strong>Design, setting, and participants: </strong>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.</p><p><strong>Exposure: </strong>Asymptomatic ATTR cardiac amyloid infiltration.</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions and relevance: </strong>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 ","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005551","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：