Current Cardiovascular Risk Reports最新文献

Purpose of review: Numerous studies have established lipoprotein(a) [Lp(a)] as an independent and modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis (CAVS). As such Lp(a) has become the focus of targeted drug therapy development with the goal of reducing Lp(a) serum concentrations and improving outcomes. This review aims to inform readers on the investigational agents currently in clinical trials and highlight key differences including dosing intervals and routes of administration that may facilitate uptake and retention of a particular potential medication in certain patient populations.

Recent findings: Five investigational agents are currently undergoing various stages of clinical trials for the treatment of elevated Lp(a). Three potential therapies are small interfering RNA (siRNA) molecules and a fourth is an antisense oligonucleotide (ASO) all of which are subcutaneously injected. A fifth agent is a small molecule inhibitor that is orally administered. A sixth agent, a cholesteryl ester transfer protein (CETP) inhibitor that is primarily being studied for LDL-C reduction has shown promise for reducing Lp(a). A seventh agent based on gene-editing is currently in the developmental stage. Results have revealed notable reductions in Lp(a) with favorable tolerability and safety. Phase 3 trials will be crucial in determining the viability of lowering Lp(a) with such therapies and improving cardiovascular outcomes.

Summary: Promising results indicate the potential in the near future to have medications primarily for lowering Lp(a) which has thus far eluded targeted drug therapy. As such advances stand to benefit large segments of the population living with and at risk for ASCVD, future research is vital to validate safety and efficacy in the long-term as well to understand how to optimize uptake and retention among patients with diverse circumstances.

Purpose of review: To identify physical activity-related barriers, facilitators, and preferences among adults with obesity living in rural areas, a scoping review was conducted.

Recent findings: Ten studies conducted in the United States, Australia, Nepal, and Mexico were included. The barriers reported most often were social/physical environment concerns (e.g., lack of resources/social support), as well as finding time. The one study comparing barriers across obesity classes I-III found minimal differences. Th most frequently reported facilitators included fitness trackers and social interaction/being part of a group. In the only study reporting intervention preferences, residents of rural areas preferred web-based delivery, whereas individuals with obesity favored face-to-face delivery.

Summary: When developing physical activity interventions, it is important to consider environmental and psychosocial factors that can hinder or facilitate engagement among rural adults with obesity. More research on preferences is needed to inform future interventions.

Purpose of review: Lipoprotein(a) [Lp(a)], an atherogenic low-density lipoprotein cholesterol (LDL-C)-like molecule, has emerged as an important risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). This review summarizes the evidence supporting Lp(a) as a causal risk factor for ASCVD and calcific aortic valve stenosis (CAVS).

Recent findings: Lp(a) is largely (~ 90%) genetically determined and approximately 20% of the global population has elevated Lp(a). The unique structure of Lp(a) leads to proatherogenic, proinflammatory, and antifibrinolytic properties. Data from epidemiological, genome-wide association, Mendelian randomization, and meta-analyses have shown a clear association between Lp(a) and ASCVD, as well as CAVS. There are emerging data on the association between Lp(a) and ischemic stroke, peripheral arterial disease, and heart failure; however, the associations are not as strong.

Summary: Several lines of evidence support Lp(a) as a causal risk factor for ASCVD and CAVS. The 2024 National Lipid Association guidelines, 2022 European Atherosclerosis Society, and 2021 Canadian Cardiology Society guidelines recommend testing Lp(a) once in all adults to guide primary prevention efforts. Further studies on cardiovascular outcomes with Lp(a) targeted therapies will provide more insight on causal relationship between Lp(a) and cardiovascular disease.

Purpose of the review: Glucagon-like peptide 1 (GLP-1) receptor agonists (RA) have transformed obesity and type 2 diabetes (T2D) management. Tirzepatide, the first dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) RA approved for both conditions, has paved the way for next-generation incretin-based therapies. Among these, triple agonists targeting GLP-1, GIP, and glucagon receptors represent a promising next step. This review outlines the rationale for their development and summarizes clinical trial data, focusing on retatrutide, the most advanced candidate.

Recent findings: Retatrutide is the first triple agonist (acting on GLP-1/GIP/glucagon receptors) with published phase 2 data in people with obesity as well as in people with T2D. Retatrutide achieved up to 24.2% mean weight loss after 48 weeks in individuals with obesity and 16.9% in those with T2D after 36 weeks. In the T2D study, HbA1c improved by 2.2%, with 82% of participants reaching HbA1c ≤ 6.5%. Retatrutide also improved multiple cardiometabolic parameters, including blood pressure, lipids, waist circumference, and liver fat (82% reduction in hepatic steatosis). Gastrointestinal symptoms were the most common side effects; no major safety concerns were observed. A comprehensive phase 3 program is ongoing to evaluate efficacy, safety, and cardiovascular/renal outcomes in people with obesity and/or T2D. Other unimolecular triple agonists and combination regimens involving tirzepatide with additional mono agonists are also in development.

Summary: Retatrutide, a triple agonist now in phase 3 trials, has the potential to become the most effective pharmacological treatment for obesity while also offering substantial benefits in T2D management and other cardiometabolic risk factors.

Purpose of the review: Hypertension remains a major public health concern globally and in the United States with significant racial/ethnic disparities in prevalence, treatment, and control. Despite effective treatments, undiagnosed or uncontrolled hypertension persists, leading to an increased risk of cardiovascular disease and substantial healthcare costs. Addressing hypertension disparities requires a comprehensive approach, integrating clinical interventions with community-based strategies. This review examines the current landscape of clinic-and community-based interventions designed to improve hypertension management and reduce disparities.

Recent findings: Clinic-based approaches highlighted include implementing evidence-based guidelines, using treatment algorithms, promoting self-management, integrating digital health technologies, and incorporating team-based care approaches. Community interventions discussed involve lifestyle modification programs, faith-based initiatives, trusted community spaces, culturally-tailored health education, engaging community health workers, and collaborative care models linking clinics and communities. This review stresses the importance of addressing SDoH, fostering community engagement, and delivering culturally competent care. Strengthening clinic-community linkages, evaluating long-term effectiveness and cost-effectiveness, leveraging technology and innovation, and addressing gaps in research for underrepresented groups are key priorities for advancing health equity in hypertension management.

Summary: To effectively close the widening gap in hypertension disparities, collaborative multi-level efforts integrating clinical excellence and community empowerment are essential to mitigate the disproportionate burden of hypertension among racial/ethnic minority populations.

Purpose of review: The integration of artificial intelligence (AI) in medicine holds promise for transformative advancements aimed at improving healthcare outcomes. Amidst this promise, AI has been envisioned as a tool to detect and mitigate racial and ethnic inequity known to plague current cardiovascular care. However, this enthusiasm is dampened by the recognition that AI itself can harbor and propagate biases, necessitating a careful approach to ensure equity. This review highlights topics in the landscape of AI in cardiology, its role in identifying and addressing healthcare inequities, promoting diversity in research, concerns surrounding its applications, and proposed strategies for fostering equitable utilization.

Recent findings: Artificial intelligence has proven to be a valuable tool for clinicians in diagnosing and mitigating racial and ethnic inequities in cardiology, as well as the promotion of diversity in research. This promise is counterbalanced by the cautionary reality that AI can inadvertently perpetuate existent biases stemming from limited diversity in training data, inherent biases within datasets, and inadequate bias detection and monitoring mechanisms. Recognizing these concerns, experts emphasize the need for rigorous efforts to address these limitations in the development and deployment of AI within medicine.

Summary: Implementing AI in cardiovascular care to identify and address racial and ethnic inequities requires careful design and execution, beginning with meticulous data collection and a thorough review of training datasets. Furthermore, ensuring equitable performance involves rigorous testing and continuous surveillance of algorithms. Lastly, the promotion of diversity in the AI workforce and engagement of stakeholders are crucial to the advancement of equity to ultimately realize the potential for artificial intelligence for cardiovascular health equity.

Purpose of review: Peripheral Artery Disease (PAD), a condition affecting millions of patients, is often underdiagnosed due to a lack of symptoms in the early stages and management can be complex given differences in genetic and phenotypic characteristics. This review aims to provide readers with an update on the utility of machine learning (ML) in the management of PAD.

Recent findings: Recent research leveraging electronic health record (EHR) data and ML algorithms have demonstrated significant advances in the potential use of automated systems, namely artificial intelligence (AI), to accurately identify patients who might benefit from further PAD screening. Additionally, deep learning algorithms can be used on imaging data to assist in PAD diagnosis and automate clinical risk stratification.ML models can predict major adverse cardiovascular events (MACE) and major adverse limb events (MALE) with considerable accuracy, with many studies also demonstrating the ability to more accurately risk stratify patients for deleterious outcomes after surgical intervention. These predictions can assist physicians in developing more patient-centric treatment plans and allow for earlier, more aggressive management of modifiable risk-factors in high-risk patients. The use of proteomic biomarkers in ML models offers a valuable addition to traditional screening and stratification paradigms, though clinical utility may be limited by cost and accessibility.

Summary: The application of AI to the care of PAD patients may enable earlier diagnosis and more accurate risk stratification, leveraging readily available EHR and imaging data, and there is a burgeoning interest in incorporating biological data for further refinement. Thus, the promise of precision PAD care grows closer. Future research should focus on validating these models via real-world integration into clinical practice and prospective evaluation of the impact of this new care paradigm.

Purpose of review: Despite efforts to curtail its impact on medical care, race remains a powerful risk factor for morbidity and mortality following cardiac surgery. While patients from racial and ethnic minority groups are underrepresented in cardiac surgery, they experience a disproportionally elevated number of adverse outcomes following various cardiac surgical procedures. This review provides a summary of existing literature highlighting disparities in coronary artery bypass surgery, valvular surgery, cardiac transplantation, and mechanical circulatory support.

Recent findings: Unfortunately, specific causes of these disparities can be difficult to identify, even in large, multicenter studies, due to the complex relationship between race and post-operative outcomes. Current data suggest that these racial/ethnic disparities can be attributed to a combination of patient, socioeconomic, and hospital setting characteristics.

Summary: Proposed solutions to combat the mechanisms underlying the observed disparate outcomes require deployment of a multidisciplinary team of cardiologists, anesthesiologists, cardiac surgeons, and experts in health care equity and medical ethics. Successful identification of at-risk populations and the implementation of preventive measures are necessary first steps towards dismantling racial/ethnic differences in cardiac surgery outcomes.

Purpose of review: Hypertension (HTN) and obesity are increasing in prevalence and severity in adolescents and have significant implications for long term morbidity and mortality. This review focuses on the diagnosis and management of HTN in adolescents with obesity with an emphasis on co-management of the two conditions.

Recent findings: Recent studies affirm the increasing prevalence of abnormal blood pressures and diagnoses of HTN associated with increased adiposity. Current guidelines recommend routine screening with proper technique for HTN in patients with obesity. Additionally, obesity and HTN related co-occurring medical conditions should be evaluated as there is frequently a bidirectional impact on risk and outcomes. Importantly, advances in adolescent obesity management have subsequently led to positive implications for the management of obesity-related comorbidities such as HTN. The co-management of obesity and HTN is an emerging strategy for treatment and prevention of additional morbidity and mortality as patients progress to adulthood.

Summary: In adolescent patients with obesity, prompt recognition and appropriate diagnosis of HTN as well as related co-occurring conditions are necessary first steps in management. Co-management of obesity and HTN is likely to lead to improved outcomes. While lifestyle interventions serve as the foundation to this management, adjunctive and emerging therapies should be considered to adequately treat both conditions.