Severe infections, particularly those requiring hospitalization, have been widely recognized as potential risk factors for cardiovascular and cerebrovascular diseases. However, the precise relationship remains unclear, particularly regarding how factors such as different time windows, repeated infections, infections caused by various pathogens, and infections involving different organ systems may influence the risk of acute cardiovascular and cerebrovascular events. This study aimed to evaluate the impact of severe infections on the incidence of these acute events by specifically focusing on these factors.
Methods
We conducted a prospective cohort study involving 55,338 participants, with a median follow-up duration of 6.42 years (IQR: 4.56–7.01). Hospitalization events related to infectious diseases and incident cardiovascular and cerebrovascular diseases were identified using passive follow-up methods. Segmented Cox regression analyses were performed to evaluate the effects of various infection-related factors on the risk of acute cardiovascular and cerebrovascular diseases, including different time windows after infection, repeated infections, infections caused by various pathogens, and infections involving different organ systems.
Results
The risk of cardiovascular and cerebrovascular events after severe infection was elevated during the whole follow-up (HR=4.07, 95% CI: 3.62–4.57) and was most significantly elevated in 3 months following severe infection (HR=8.24, 95% CI: 6.16–11.02). Repeated infections were positively correlated with the excess risk of stroke (HR=4.73, 95% CI: 1.75–12.79 for ≥3 infections, p for difference = 0.013). Infections involving different organ systems carried a much higher risk compared to single-system infections (HR= 13.11, 95% CI: 7.3–23.53). Viral infections notably increased the risk of acute ischemic heart disease (HR=4.22, 95% CI: 2.29–7.76).
Conclusion
The study found that severe infections were associated with the elevated risk of cardiovascular and cerebrovascular events. The findings suggest that more attention should be given to preventing and intervening in cardiovascular events among high-risk infection populations.
{"title":"Impact of severe infections on the risk of acute cardiovascular and cerebrovascular diseases: A prospective cohort study","authors":"Siqi Tang , Yonggen Jiang , Yiling Wu , Xuyan Su , Shuo Wang , Ruilin Chen , Genming Zhao , Wanghong Xu , Xing Liu , Ruoxin Zhang , Tiejun Zhang , Xingdong Chen , Yanfeng Jiang , Chen Suo","doi":"10.1016/j.ajpc.2026.101436","DOIUrl":"10.1016/j.ajpc.2026.101436","url":null,"abstract":"<div><h3>Background</h3><div>Severe infections, particularly those requiring hospitalization, have been widely recognized as potential risk factors for cardiovascular and cerebrovascular diseases. However, the precise relationship remains unclear, particularly regarding how factors such as different time windows, repeated infections, infections caused by various pathogens, and infections involving different organ systems may influence the risk of acute cardiovascular and cerebrovascular events. This study aimed to evaluate the impact of severe infections on the incidence of these acute events by specifically focusing on these factors.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study involving 55,338 participants, with a median follow-up duration of 6.42 years (IQR: 4.56–7.01). Hospitalization events related to infectious diseases and incident cardiovascular and cerebrovascular diseases were identified using passive follow-up methods. Segmented Cox regression analyses were performed to evaluate the effects of various infection-related factors on the risk of acute cardiovascular and cerebrovascular diseases, including different time windows after infection, repeated infections, infections caused by various pathogens, and infections involving different organ systems.</div></div><div><h3>Results</h3><div>The risk of cardiovascular and cerebrovascular events after severe infection was elevated during the whole follow-up (HR=4.07, 95% CI: 3.62–4.57) and was most significantly elevated in 3 months following severe infection (HR=8.24, 95% CI: 6.16–11.02). Repeated infections were positively correlated with the excess risk of stroke (HR=4.73, 95% CI: 1.75–12.79 for ≥3 infections, p for difference = 0.013). Infections involving different organ systems carried a much higher risk compared to single-system infections (HR= 13.11, 95% CI: 7.3–23.53). Viral infections notably increased the risk of acute ischemic heart disease (HR=4.22, 95% CI: 2.29–7.76).</div></div><div><h3>Conclusion</h3><div>The study found that severe infections were associated with the elevated risk of cardiovascular and cerebrovascular events. The findings suggest that more attention should be given to preventing and intervening in cardiovascular events among high-risk infection populations.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101436"},"PeriodicalIF":5.9,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-19DOI: 10.1016/j.ajpc.2026.101432
Theresa Boyer , Allison W. Peng , Michael Fang , Timothy Chow , Amelia S. Wallace , Wendy Bennett , Erin D. Michos , Chiadi E. Ndumele , Elizabeth Selvin , Anum S. Minhas
Introduction
Cardiovascular-Kidney-Metabolic (CKM) syndrome provides a framework for early cardiometabolic and kidney dysfunction. While reproductive risk factors are associated with cardiovascular disease, their relationship to CKM syndrome stages remains unclear. We estimated CKM prevalence among reproductive-aged US women and evaluated associations with reproductive risk factors.
Methods
Using the National Health and Nutrition Examination Survey (2013-2020), we included 3,917 non-pregnant women aged 20-49 years. Reproductive risk factors included early menarche (≤10 years), infertility, gestational diabetes, delivery of a large-for-gestational-age neonate, and grand multiparity (≥ 5 births). CKM stages were classified as stage 0 (no risk factors), stage 1 (excess or dysfunctional adiposity), stage 2 (metabolic risk factors or chronic kidney disease), stage 3 (subclinical cardiovascular disease), stage 4 (clinical cardiovascular disease). Adjusted prevalence ratios (aPRs) for CKM stage ≥ 2 were estimated using Poisson regression accounting for sociodemographic and behavioral factors.
Results
Approximately 34.7% (95% CI: 32.3, 37.1) of women reported at least one reproductive risk factor. Overall, 55.1% (95% CI: 52.9, 57.3) were classified as CKM stage ≥ 2. Women with reproductive risk factors were more likely to be in higher CKM stages. Significant associations with CKM stage ≥ 2 were observed for gestational diabetes (aPR, 1.25; 95% CI: 1.13, 1.39) and infertility (aPR, 1.14; 95% CI: 1.04, 1.26).
Conclusion
CKM syndrome is highly prevalent among reproductive-aged women in the US. Histories of gestational diabetes and infertility were associated with higher CKM stages. Incorporating reproductive factors into clinical tools could support targeted prevention of CKM progression and future CVD.
{"title":"Reproductive risk factors and prevalence of cardiovascular-kidney-metabolic syndrome among young women","authors":"Theresa Boyer , Allison W. Peng , Michael Fang , Timothy Chow , Amelia S. Wallace , Wendy Bennett , Erin D. Michos , Chiadi E. Ndumele , Elizabeth Selvin , Anum S. Minhas","doi":"10.1016/j.ajpc.2026.101432","DOIUrl":"10.1016/j.ajpc.2026.101432","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiovascular-Kidney-Metabolic (CKM) syndrome provides a framework for early cardiometabolic and kidney dysfunction. While reproductive risk factors are associated with cardiovascular disease, their relationship to CKM syndrome stages remains unclear. We estimated CKM prevalence among reproductive-aged US women and evaluated associations with reproductive risk factors.</div></div><div><h3>Methods</h3><div>Using the National Health and Nutrition Examination Survey (2013-2020), we included 3,917 non-pregnant women aged 20-49 years. Reproductive risk factors included early menarche (≤10 years), infertility, gestational diabetes, delivery of a large-for-gestational-age neonate, and grand multiparity (≥ 5 births). CKM stages were classified as stage 0 (no risk factors), stage 1 (excess or dysfunctional adiposity), stage 2 (metabolic risk factors or chronic kidney disease), stage 3 (subclinical cardiovascular disease), stage 4 (clinical cardiovascular disease). Adjusted prevalence ratios (aPRs) for CKM stage ≥ 2 were estimated using Poisson regression accounting for sociodemographic and behavioral factors.</div></div><div><h3>Results</h3><div>Approximately 34.7% (95% CI: 32.3, 37.1) of women reported at least one reproductive risk factor. Overall, 55.1% (95% CI: 52.9, 57.3) were classified as CKM stage ≥ 2. Women with reproductive risk factors were more likely to be in higher CKM stages. Significant associations with CKM stage ≥ 2 were observed for gestational diabetes (aPR, 1.25; 95% CI: 1.13, 1.39) and infertility (aPR, 1.14; 95% CI: 1.04, 1.26).</div></div><div><h3>Conclusion</h3><div>CKM syndrome is highly prevalent among reproductive-aged women in the US. Histories of gestational diabetes and infertility were associated with higher CKM stages. Incorporating reproductive factors into clinical tools could support targeted prevention of CKM progression and future CVD.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101432"},"PeriodicalIF":5.9,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.ajpc.2026.101434
Prerna Singh , Michael D. Glidden , Santosh Sirasapalli , Sai Ponnana , Neda Shafiabadi Hassani , Christos P. Kotanidis , Abigail Wilgor , Brittany N. Weber , David L. Wilson , Sanjay Rajagopalan
Background
Immune-mediated inflammatory diseases (IMID) are associated with accelerated atherosclerosis, yet it is unclear whether CT coronary artery calcium scoring (CTCS) captures this excess cardiovascular risk accurately. We hypothesized that in adults undergoing CTCS, IMID modifies the relationship between coronary artery calcium (CAC) score and incident major adverse cardiac events (MACE).
Methods
Among 43,420 individuals in the CLARIFY Registry (University Hospitals Cleveland, 2014–2020) who underwent no-cost CTCS scans, we identified 545 individuals with IMID. After propensity-score matching on age, sex, race, hypertension, diabetes, and smoking status with a 2:1 ratio, 1635 matched individuals were analyzed (545 with IMID and 1090 matched non-IMID controls). CAC was categorized as 0, 1–99, 100–399, ≥400. The primary outcome of 4-point MACE was analyzed over a median 4.2-year follow-up. Cox models tested CAC categories compared to CAC 0, stratified by IMID. Additionally, a log(CAC+1) × IMID interaction term was modeled, to assess whether the risk gradient of CAC differed by IMID status.
Results
Individuals with IMID exhibited over twice the MACE incidence of matched controls (40.8 vs 17.6 per 1000 person-years). Among those with zero CAC, those with IMID had a three-fold higher event rate (21.98 vs 7.18 per 1000 person-years). In controls, MACE risk rose stepwise with CAC, quadrupling from CAC 0 to ≥400 (adjusted HR = 4.74; p < 0.001), whereas in IMID increasing CAC conferred no significant gradient (p = 0.21). The interaction between CAC and IMID was significant (β = –0.27; HR 0.76, 95% CI 0.55–1.00), indicating an attenuated CAC-MACE relationship in IMID.
Conclusion
In IMID, baseline risk is elevated even with zero CAC, with attenuation of the traditional CAC-risk gradient observed in non-IMID controls. These findings suggest that, in IMID (1) a CAC score of zero may not guarantee low cardiovascular risk and (2) CAC has less incremental prognostic value than in the general population.
免疫介导的炎症性疾病（IMID）与动脉粥样硬化加速相关，但目前尚不清楚CT冠状动脉钙评分（CTCS）是否能准确捕获这种额外的心血管风险。我们假设，在接受CTCS的成年人中，IMID改变了冠状动脉钙（CAC）评分与主要不良心脏事件（MACE）之间的关系。方法：在clarity注册中心（克利夫兰大学医院，2014-2020年）接受无成本CTCS扫描的43420名患者中，我们确定了545名IMID患者。在年龄、性别、种族、高血压、糖尿病和吸烟状况按2:1的比例进行倾向评分匹配后，分析了1635名匹配的个体（545名患有IMID， 1090名匹配的非IMID对照）。CAC分为0、1-99、100-399、≥400。在中位4.2年的随访中分析了4点MACE的主要结局。Cox模型比较了CAC与CAC 0的分类，并按IMID分层。此外，建立了一个log（CAC+1） × IMID相互作用项模型，以评估CAC的风险梯度是否因IMID状态而异。结果：IMID患者的MACE发生率是匹配对照组的两倍多（40.8 vs 17.6 / 1000人-年）。在没有CAC的患者中，IMID患者的事件发生率高出3倍（21.98 vs 7.18 / 1000人-年）。在对照组中，MACE风险随着CAC的增加而逐步上升，从CAC 0到≥400增加了四倍（调整后的HR = 4.74; p < 0.001），而在IMID中，CAC增加没有显著的梯度（p = 0.21）。CAC和IMID之间的相互作用显著（β = -0.27; HR 0.76, 95% CI 0.55-1.00），表明IMID中CAC- mace关系减弱。在IMID中，即使CAC为零，基线风险也会升高，而在非IMID对照组中，传统的CAC风险梯度会减弱。这些发现表明，在IMID中(1)CAC评分为零可能不能保证心血管风险低，(2)CAC的增量预后价值低于一般人群。
{"title":"Immune-mediated inflammatory disease and coronary calcium: Elevated baseline risk and attenuated prognostic gradient","authors":"Prerna Singh , Michael D. Glidden , Santosh Sirasapalli , Sai Ponnana , Neda Shafiabadi Hassani , Christos P. Kotanidis , Abigail Wilgor , Brittany N. Weber , David L. Wilson , Sanjay Rajagopalan","doi":"10.1016/j.ajpc.2026.101434","DOIUrl":"10.1016/j.ajpc.2026.101434","url":null,"abstract":"<div><h3>Background</h3><div>Immune-mediated inflammatory diseases (IMID) are associated with accelerated atherosclerosis, yet it is unclear whether CT coronary artery calcium scoring (CTCS) captures this excess cardiovascular risk accurately. We hypothesized that in adults undergoing CTCS, IMID modifies the relationship between coronary artery calcium (CAC) score and incident major adverse cardiac events (MACE).</div></div><div><h3>Methods</h3><div>Among 43,420 individuals in the CLARIFY Registry (University Hospitals Cleveland, 2014–2020) who underwent no-cost CTCS scans, we identified 545 individuals with IMID. After propensity-score matching on age, sex, race, hypertension, diabetes, and smoking status with a 2:1 ratio, 1635 matched individuals were analyzed (545 with IMID and 1090 matched non-IMID controls). CAC was categorized as 0, 1–99, 100–399, ≥400. The primary outcome of 4-point MACE was analyzed over a median 4.2-year follow-up. Cox models tested CAC categories compared to CAC 0, stratified by IMID. Additionally, a log(CAC+1) × IMID interaction term was modeled, to assess whether the risk gradient of CAC differed by IMID status.</div></div><div><h3>Results</h3><div>Individuals with IMID exhibited over twice the MACE incidence of matched controls (40.8 vs 17.6 per 1000 person-years). Among those with zero CAC, those with IMID had a three-fold higher event rate (21.98 vs 7.18 per 1000 person-years). In controls, MACE risk rose stepwise with CAC, quadrupling from CAC 0 to ≥400 (adjusted HR = 4.74; <em>p</em> < 0.001), whereas in IMID increasing CAC conferred no significant gradient (<em>p</em> = 0.21). The interaction between CAC and IMID was significant (β = –0.27; HR 0.76, 95% CI 0.55–1.00), indicating an attenuated CAC-MACE relationship in IMID.</div></div><div><h3>Conclusion</h3><div>In IMID, baseline risk is elevated even with zero CAC, with attenuation of the traditional CAC-risk gradient observed in non-IMID controls. These findings suggest that, in IMID (1) a CAC score of zero may not guarantee low cardiovascular risk and (2) CAC has less incremental prognostic value than in the general population.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101434"},"PeriodicalIF":5.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.ajpc.2026.101433
Miao Huang , Ru Fu , Xiexiong Zhao , Tao Liu , Xiaogang Li , Weihong Jiang
Aims
To investigate the impact of Life's Essential 8 (LE8) on mortality risk and life expectancy in patients with and without cardiometabolic multimorbidity (CMM).
Methods
264,675 participants from UK Biobank were categorized into low, moderate, and high cardiovascular health (CVH) levels based on LE8 score. Baseline disease status was categorized as no cardiometabolic diseases (CMD), single cardiometabolic disease (SCMD), or CMM. The Cox proportional hazards model was used to assess the risk of all-cause mortality, and the flexible parametric survival model was employed to estimate life expectancy.
Results
During a median follow-up of 14.27 years, 20,335 all-cause deaths occurred. For each 10-point increase in LE8 score, the risk of all-cause mortality declined by approximately 20 % whether in groups of CMD-free, SCMD, or CMM. Compared to the CMD-free with high CVH group, the adjusted hazard ratio (HR) of all-cause mortality was 2.86 (95 % CI: 1.79–4.55) for CMM patients with high CVH, and 6.49 (95 % CI: 5.56–7.58) for CMM patients with low CVH. High CVH levels reduced CMM-related mortality risk by 66.12 %. Compared to those with low CVH, residual life expectancy at age 45 of participants with high CVH extended by 11.05 years (95 % CI: 10.97–11.14) in CMD-free group, 8.73 years (95 % CI: 8.56–8.92) in SCMD group, and 8.12 years (95 % CI: 7.59–8.64) in CMM group. Among CVH components, the tobacco/nicotine score had the greatest impact on mortality risk and life expectancy.
Conclusions
Regardless of CMM statuses, higher LE8 scores were consistently associated with lower mortality risk and longer residual life expectancy.
{"title":"Life’s Essential 8 and healthy longevity among people with and without cardiometabolic multimorbidity: A prospective study of UK Biobank","authors":"Miao Huang , Ru Fu , Xiexiong Zhao , Tao Liu , Xiaogang Li , Weihong Jiang","doi":"10.1016/j.ajpc.2026.101433","DOIUrl":"10.1016/j.ajpc.2026.101433","url":null,"abstract":"<div><h3>Aims</h3><div>To investigate the impact of Life's Essential 8 (LE8) on mortality risk and life expectancy in patients with and without cardiometabolic multimorbidity (CMM).</div></div><div><h3>Methods</h3><div>264,675 participants from UK Biobank were categorized into low, moderate, and high cardiovascular health (CVH) levels based on LE8 score. Baseline disease status was categorized as no cardiometabolic diseases (CMD), single cardiometabolic disease (SCMD), or CMM. The Cox proportional hazards model was used to assess the risk of all-cause mortality, and the flexible parametric survival model was employed to estimate life expectancy.</div></div><div><h3>Results</h3><div>During a median follow-up of 14.27 years, 20,335 all-cause deaths occurred. For each 10-point increase in LE8 score, the risk of all-cause mortality declined by approximately 20 % whether in groups of CMD-free, SCMD, or CMM. Compared to the CMD-free with high CVH group, the adjusted hazard ratio (HR) of all-cause mortality was 2.86 (95 % CI: 1.79–4.55) for CMM patients with high CVH, and 6.49 (95 % CI: 5.56–7.58) for CMM patients with low CVH. High CVH levels reduced CMM-related mortality risk by 66.12 %. Compared to those with low CVH, residual life expectancy at age 45 of participants with high CVH extended by 11.05 years (95 % CI: 10.97–11.14) in CMD-free group, 8.73 years (95 % CI: 8.56–8.92) in SCMD group, and 8.12 years (95 % CI: 7.59–8.64) in CMM group. Among CVH components, the tobacco/nicotine score had the greatest impact on mortality risk and life expectancy.</div></div><div><h3>Conclusions</h3><div>Regardless of CMM statuses, higher LE8 scores were consistently associated with lower mortality risk and longer residual life expectancy.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101433"},"PeriodicalIF":5.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.ajpc.2026.101418
Priyansh P. Shah , Romit Bhattacharya
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of type 2 diabetes, obesity and cardiovascular health, yet some patients remain hesitant to start these therapies due to perceptions that they are “new” or unproven. This commentary equips clinicians with practical counseling strategies to reframe the “newness” narrative and address long-term safety concerns. We provide a brief history of GLP-1 from its discovery in the 1980s to nearly two decades of clinical use, underscoring that GLP-1RAs are the product of extensive research rather than experimental novelties. We compare native GLP-1 to newer agents like semaglutide and tirzepatide, highlighting structural modifications that prolong action without fundamentally altering the hormone’s mechanism. Known safety data are summarized emphasizing the predominance of mild, transient gastrointestinal side effects and the lack of evidence for feared risks like cancer along with how to discuss these points. A practical counseling checklist and sample patient-centric language are included to facilitate shared decision-making. In sum, clinicians can confidently reassure patients that GLP-1RAs are well-studied, mechanism-based therapies with millions of patient-years of experience supporting their safety and efficacy.
{"title":"Addressing patient concerns about the ‘newness’ and long-term safety of GLP-1 receptor agonists: A clinician’s guide to counseling","authors":"Priyansh P. Shah , Romit Bhattacharya","doi":"10.1016/j.ajpc.2026.101418","DOIUrl":"10.1016/j.ajpc.2026.101418","url":null,"abstract":"<div><div>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of type 2 diabetes, obesity and cardiovascular health, yet some patients remain hesitant to start these therapies due to perceptions that they are “new” or unproven. This commentary equips clinicians with practical counseling strategies to reframe the “newness” narrative and address long-term safety concerns. We provide a brief history of GLP-1 from its discovery in the 1980s to nearly two decades of clinical use, underscoring that GLP-1RAs are the product of extensive research rather than experimental novelties. We compare native GLP-1 to newer agents like semaglutide and tirzepatide, highlighting structural modifications that prolong action without fundamentally altering the hormone’s mechanism. Known safety data are summarized emphasizing the predominance of mild, transient gastrointestinal side effects and the lack of evidence for feared risks like cancer along with how to discuss these points. A practical counseling checklist and sample patient-centric language are included to facilitate shared decision-making. In sum, clinicians can confidently reassure patients that GLP-1RAs are well-studied, mechanism-based therapies with millions of patient-years of experience supporting their safety and efficacy.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101418"},"PeriodicalIF":5.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.ajpc.2026.101427
Dongjin Nam , Yong-Hwan Jang , So Jung Ryu , Sahil Thakur , Simon Nusinovici , Junseok Park , Moonsu Kim , Sunjin Hwang
{"title":"Artificial intelligence based retinal imaging for cardiovascular risk and statin guidance in retinal vein occlusion","authors":"Dongjin Nam , Yong-Hwan Jang , So Jung Ryu , Sahil Thakur , Simon Nusinovici , Junseok Park , Moonsu Kim , Sunjin Hwang","doi":"10.1016/j.ajpc.2026.101427","DOIUrl":"10.1016/j.ajpc.2026.101427","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101427"},"PeriodicalIF":5.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.ajpc.2026.101422
Alexander R Zheutlin , Alexander Chaitoff , Daniel Addo , Adam P Bress
Background
Accurate self-perception of body weight status is important for patient engagement and effective management of overweight and obesity. We estimated the prevalence of misperceived weight status and lack of clinician counseling among US adults who meet criteria for being overweight or obese.
Methods
Pooled cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) from 2013 through March 2020. Adults aged ≥20 years with measured body mass index (BMI) and self-reported weight status were included. Our primary exposure was BMI categorized as: 1) overweight (25–29.9 kg/m²), 2) class I obesity (30–34.9 kg/m²), 3) class II obesity (35–39.9 kg/m²), or 4) class III obesity (≥40 kg/m²). Sensitivity analysis redefined overweight as 27.0–29.9 kg/m² as well as restricting to those with an elevated BMI and waist circumference (102 cm for men and 88 cm for women). Our primary outcome was the proportion of respondents who did not perceive themselves to be overweight. Secondary outcomes included the proportion reporting a clinician-recommendation to lose weight. We used multivariable survey–weighted Poisson regression (adjusted prevalence ratios [aPRs]) to describe trends over time. We stratified analyses by presence of cardiovascular disease (CVD) and diabetes, separately.
Results
Among 16,124 NHANES participants with BMI ≥25.0 kg/m² (representing approximately 182 million US adults), 20.5% were classified as overweight (25.0–29.9 kg/m²), 14.4% as class I obese (30.0–34.9 kg/m²), 4.8% as class II obese (35.0–39.9 kg/m²), and 3.2% as class III obese (≥40.0 kg/m²). The prevalence of adults who did not perceive themselves as overweight was highest among those classified as overweight (48.0%) and declined with increasing BMI category: 17.5% among those with class I obesity, 6.2% with class II obesity, and 3.1% with class III obesity. In contrast, clinician recommendation to lose weight increased with BMI: 17.2% of those with overweight, 42.6% with class I obesity, 57.4% with class II obesity, and 71.3% with class III obesity reported receiving such advice within the past 12 months.
Conclusions
Nearly one-third of all US adults who are overweight or obese do not perceive themselves to be overweight and a significant portion have not been recommended to lose weight by a clinician. Gaps between patient perceptions about their weight and their weight status reflect a critical opportunity for intervention in preventive care.
{"title":"Self-perceived bodyweight status among adults who are overweight or have obesity, with and without high cardiovascular risk","authors":"Alexander R Zheutlin , Alexander Chaitoff , Daniel Addo , Adam P Bress","doi":"10.1016/j.ajpc.2026.101422","DOIUrl":"10.1016/j.ajpc.2026.101422","url":null,"abstract":"<div><h3>Background</h3><div>Accurate self-perception of body weight status is important for patient engagement and effective management of overweight and obesity. We estimated the prevalence of misperceived weight status and lack of clinician counseling among US adults who meet criteria for being overweight or obese.</div></div><div><h3>Methods</h3><div>Pooled cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) from 2013 through March 2020. Adults aged ≥20 years with measured body mass index (BMI) and self-reported weight status were included. Our primary exposure was BMI categorized as: 1) overweight (25–29.9 kg/m²), 2) class I obesity (30–34.9 kg/m²), 3) class II obesity (35–39.9 kg/m²), or 4) class III obesity (≥40 kg/m²). Sensitivity analysis redefined overweight as 27.0–29.9 kg/m² as well as restricting to those with an elevated BMI and waist circumference (102 cm for men and 88 cm for women). Our primary outcome was the proportion of respondents who did not perceive themselves to be overweight. Secondary outcomes included the proportion reporting a clinician-recommendation to lose weight. We used multivariable survey–weighted Poisson regression (adjusted prevalence ratios [aPRs]) to describe trends over time. We stratified analyses by presence of cardiovascular disease (CVD) and diabetes, separately.</div></div><div><h3>Results</h3><div>Among 16,124 NHANES participants with BMI ≥25.0 kg/m² (representing approximately 182 million US adults), 20.5% were classified as overweight (25.0–29.9 kg/m²), 14.4% as class I obese (30.0–34.9 kg/m²), 4.8% as class II obese (35.0–39.9 kg/m²), and 3.2% as class III obese (≥40.0 kg/m²). The prevalence of adults who did not perceive themselves as overweight was highest among those classified as overweight (48.0%) and declined with increasing BMI category: 17.5% among those with class I obesity, 6.2% with class II obesity, and 3.1% with class III obesity. In contrast, clinician recommendation to lose weight increased with BMI: 17.2% of those with overweight, 42.6% with class I obesity, 57.4% with class II obesity, and 71.3% with class III obesity reported receiving such advice within the past 12 months.</div></div><div><h3>Conclusions</h3><div>Nearly one-third of all US adults who are overweight or obese do not perceive themselves to be overweight and a significant portion have not been recommended to lose weight by a clinician. Gaps between patient perceptions about their weight and their weight status reflect a critical opportunity for intervention in preventive care.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101422"},"PeriodicalIF":5.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.ajpc.2026.101424
Sofia Mongardi , Martino F. Pengo , Carolina Lombardi , Patrizia Steca , Marco Masseroli
Background
Tools like Life’s Simple 7 (LS7) can help estimate the risk of cardiovascular events in healthy subjects. Recently, the Life’s Essential 8 (LE8) was developed, including sleep as an additional variable for a more precise cardiovascular risk estimation. However, it is unclear whether such an increase in complexity is associated with an improvement in the score’s performance. We aimed to test the LS7 and LE8 in a European cohort in order to understand whether adding subjective sleep information could allow a better cardiovascular risk stratification.
Methods
UK Biobank data were used for computing the cardiovascular scores. Sleep duration was evaluated through questionnaires. The cardiovascular outcomes were fatal and non-fatal CVD events. Multivariable-adjusted logistic and Cox proportional hazards models were used to evaluate associations of the different metrics with CVD prevalence and incidence. The c-statistic was used to quantify differences in incident CVD discrimination.
Results
A cohort of 106,724 participants (mean age: 55.9 years, 55% males) included 6,130 prevalent and 11,575 incident CVD events (mean follow-up: 12.9 ± 2.7 years). CVH metrics were categorised into tertiles. LS7- and LE8-based metrics effectively characterised prevalent and incident CVD events. LS7 models had similar C-statistics with (0.705, 95% CI: 0.701–0.709) and without (0.706, 95% CI: 0.702–0.710) sleep data. LE8 without sleep (0.708, 95% CI: 0.704–0.712) outperformed LS7 without sleep by 0.002 (95% CI: 0.001–0.003, p < 0.05). However, standard LE8 with sleep (0.706, 95% CI: 0.702–0.710) showed no significant difference from LS7.
Conclusions
In a European cohort, LS7 and LE8 are useful tools for risk stratification. However, despite the LE8 offering marginally better risk stratification than LS7, the inclusion of subjective sleep did not provide a tangible advantage.
{"title":"Understanding the impact of sleep on cardiovascular risk estimation: comparison of LS7 and LE8 performances in a European population","authors":"Sofia Mongardi , Martino F. Pengo , Carolina Lombardi , Patrizia Steca , Marco Masseroli","doi":"10.1016/j.ajpc.2026.101424","DOIUrl":"10.1016/j.ajpc.2026.101424","url":null,"abstract":"<div><h3>Background</h3><div>Tools like Life’s Simple 7 (LS7) can help estimate the risk of cardiovascular events in healthy subjects. Recently, the Life’s Essential 8 (LE8) was developed, including sleep as an additional variable for a more precise cardiovascular risk estimation. However, it is unclear whether such an increase in complexity is associated with an improvement in the score’s performance. We aimed to test the LS7 and LE8 in a European cohort in order to understand whether adding subjective sleep information could allow a better cardiovascular risk stratification.</div></div><div><h3>Methods</h3><div>UK Biobank data were used for computing the cardiovascular scores. Sleep duration was evaluated through questionnaires. The cardiovascular outcomes were fatal and non-fatal CVD events. Multivariable-adjusted logistic and Cox proportional hazards models were used to evaluate associations of the different metrics with CVD prevalence and incidence. The c-statistic was used to quantify differences in incident CVD discrimination.</div></div><div><h3>Results</h3><div>A cohort of 106,724 participants (mean age: 55.9 years, 55% males) included 6,130 prevalent and 11,575 incident CVD events (mean follow-up: 12.9 ± 2.7 years). CVH metrics were categorised into tertiles. LS7- and LE8-based metrics effectively characterised prevalent and incident CVD events. LS7 models had similar C-statistics with (0.705, 95% CI: 0.701–0.709) and without (0.706, 95% CI: 0.702–0.710) sleep data. LE8 without sleep (0.708, 95% CI: 0.704–0.712) outperformed LS7 without sleep by 0.002 (95% CI: 0.001–0.003, p < 0.05). However, standard LE8 with sleep (0.706, 95% CI: 0.702–0.710) showed no significant difference from LS7.</div></div><div><h3>Conclusions</h3><div>In a European cohort, LS7 and LE8 are useful tools for risk stratification. However, despite the LE8 offering marginally better risk stratification than LS7, the inclusion of subjective sleep did not provide a tangible advantage.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101424"},"PeriodicalIF":5.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.ajpc.2026.101415
Jiaxin Zhong , Yiwei Zhao , Huifen He , Yi Lan , Zixin Cai
<div><h3>Background</h3><div>Metabolic dysfunction–associated steatotic liver disease (MASLD) is associated with atherosclerotic cardiovascular disease (ASCVD), yet the magnitude of cardiovascular risk across various disease labels and the clinical utility of readily available risk-associated markers remains unclear.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, Web of Science, and the Cochrane Library from 1 January 2000 to 30 September 2025. Observational studies, as well as randomized trials contributing baseline cross-sectional observational data, were included. We pooled relative effects for (i) 10-year ASCVD high-risk classification as defined by established risk engines and (ii) incident major adverse cardiovascular events (MACE). Heterogeneity (<em>I²</em> and τ²), small-study effects (funnel plots and Egger’s tests), and leave-one-out sensitivity analyses were assessed. Risk of bias was evaluated using customized Newcastle–Ottawa Scales.</div></div><div><h3>Results</h3><div>Fifty-two studies were included. Compared with non-steatotic comparators, steatotic liver disease was associated with a higher overall cardiovascular burden (pooled relative effect 2.02, 95 % CI 1.90–2.14). When stratified by outcome, pooled effects were 1.91 (95 % CI 1.60–2.29) for predicted 10-year ASCVD high-risk classification and 1.74 (95 % CI 1.43–2.12) for incident MACE. Associations were consistent across disease labels, including nonalcoholic fatty liver disease (NAFLD; 1.98, 95 % CI 1.81–2.16), with higher but less precise estimates observed for nonalcoholic steatohepatitis (NASH; 3.60, 95 % CI 1.16–6.04). Readily available biomarkers may help complement established ASCVD risk scores by refining cardiovascular risk stratification in individuals with MASLD. Several readily available markers were informative for cardiovascular risk: Fatty Liver Index (FLI) ≥60 (hazard ratio [HR] 1.61, 95 % CI 1.12–2.11) and ≥30 (HR 1.39, 95 % CI 1.11–1.66); Fibrosis-4 index (FIB-4) ≥1.30 (HR 2.25, 95 % CI 1.84–2.65); blood pressure ≥130/85 mmHg (HR 2.16, 95 % CI 1.81–2.51); triglyceride–glucose index (TyG) >8.716 (HR 1.40, 95 % CI 1.26–1.54); and type IV collagen 7S ≥5 ng/mL (HR 2.37, 95 % CI 1.45–4.29). Compared with controls, MASLD was also associated with an adverse biomarker profile, including higher high-sensitivity C-reactive protein (hs-CRP) (+1.06 mg/L), homeostasis model assessment of insulin resistance (HOMA-IR) (+1.65), alanine aminotransferase (ALT) (+8.89 U/L), aspartate aminotransferase (AST) (+6.10 U/L), gamma-glutamyl transferase (GGT) (+13.23 U/L), total cholesterol (TC) (+9.05 mg/dL), triglycerides (TG) (+48.33 mg/dL), low-density lipoprotein cholesterol (LDL-C) (+8.46 mg/dL), glycated hemoglobin (HbA1c) (+0.43 %), and lower high-density lipoprotein cholesterol (HDL-C) (−8.41 mg/dL).</div></div><div><h3>Conclusions</h3><div>MASLD is associated with an approximate twofold increased risk of cardiovascular events, but this association varie
背景：代谢功能障碍相关脂肪变性肝病（MASLD）与动脉粥样硬化性心血管疾病（ASCVD）相关，然而各种疾病标记的心血管风险程度和现成的风险相关标志物的临床应用仍不清楚。方法检索PubMed、Embase、Web of Science和Cochrane图书馆2000年1月1日至2025年9月30日的文献。包括观察性研究，以及提供基线横断面观察数据的随机试验。我们汇总了(i) 10年ASCVD高风险分类（由已建立的风险引擎定义）和（ii）主要不良心血管事件（MACE）的相对效应。评估异质性（I²和τ²）、小研究效应（漏斗图和Egger检验）和遗漏敏感性分析。使用定制的纽卡斯尔-渥太华量表评估偏倚风险。结果共纳入52项研究。与非脂肪变性比较者相比，脂肪变性肝病与较高的总体心血管负担相关（合并相对效应2.02,95% CI 1.90-2.14）。当按结果分层时，预测10年ASCVD高危分类的合并效应为1.91 (95% CI 1.60-2.29)，事件MACE的合并效应为1.74 （95% CI 1.43-2.12）。各种疾病标签的相关性是一致的，包括非酒精性脂肪性肝病（NAFLD; 1.98, 95% CI 1.81-2.16），非酒精性脂肪性肝炎（NASH; 3.60, 95% CI 1.16-6.04）的相关性较高，但准确性较低。易于获得的生物标志物可以通过细化MASLD患者的心血管风险分层来帮助补充已建立的ASCVD风险评分。一些现成的标志物对心血管风险有信息：脂肪肝指数(FLI)≥60（危险比[HR] 1.61, 95% CI 1.12-2.11）和≥30（危险比[HR] 1.39, 95% CI 1.11-1.66）；纤维化-4指数(FIB-4)≥1.30 (HR 2.25, 95% CI 1.84-2.65)；血压≥130/85 mmHg (HR 2.16, 95% CI 1.81 ~ 2.51)；甘油三酯-葡萄糖指数（TyG） >8.716 (HR 1.40, 95% CI 1.26-1.54)；IV型胶原7S≥5 ng/mL （HR 2.37, 95% CI 1.45-4.29）。与对照组相比，MASLD还与不良生物标志物相关，包括较高的高敏c -反应蛋白（hs-CRP） （+1.06 mg/L），胰岛素抵抗稳态模型评估（HOMA-IR）（+1.65），丙氨酸转氨酶（ALT） （+8.89 U/L），天冬氨酸转氨酶（AST） （+6.10 U/L）， γ -谷氨酰转移酶（GGT） （+13.23 U/L），总胆固醇（+9.05 mg/dL），甘油三酯（TG） （+48.33 mg/dL），低密度脂蛋白胆固醇（+8.46 mg/dL），糖化血红蛋白（HbA1c）（+ 0.43%）和较低的高密度脂蛋白胆固醇（HDL-C） （- 8.41 mg/dL）。结论：smasld与心血管事件风险增加约两倍相关，但这种关联因人群和临床背景而异。一个简洁实用的小组- fib -4、FLI、血压和甘油三酯-葡萄糖指数，如果有IV型胶原蛋白7S（以及选定情况下的NAFLD-LFS） -可以补充已建立的ASCVD风险评估，并支持在常规MASLD护理中早期、风险指导的预防。
{"title":"Risk-associated and clinically informative biomarkers for cardiovascular risk stratification in metabolic dysfunction–Associated steatotic liver disease","authors":"Jiaxin Zhong , Yiwei Zhao , Huifen He , Yi Lan , Zixin Cai","doi":"10.1016/j.ajpc.2026.101415","DOIUrl":"10.1016/j.ajpc.2026.101415","url":null,"abstract":"<div><h3>Background</h3><div>Metabolic dysfunction–associated steatotic liver disease (MASLD) is associated with atherosclerotic cardiovascular disease (ASCVD), yet the magnitude of cardiovascular risk across various disease labels and the clinical utility of readily available risk-associated markers remains unclear.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, Web of Science, and the Cochrane Library from 1 January 2000 to 30 September 2025. Observational studies, as well as randomized trials contributing baseline cross-sectional observational data, were included. We pooled relative effects for (i) 10-year ASCVD high-risk classification as defined by established risk engines and (ii) incident major adverse cardiovascular events (MACE). Heterogeneity (<em>I²</em> and τ²), small-study effects (funnel plots and Egger’s tests), and leave-one-out sensitivity analyses were assessed. Risk of bias was evaluated using customized Newcastle–Ottawa Scales.</div></div><div><h3>Results</h3><div>Fifty-two studies were included. Compared with non-steatotic comparators, steatotic liver disease was associated with a higher overall cardiovascular burden (pooled relative effect 2.02, 95 % CI 1.90–2.14). When stratified by outcome, pooled effects were 1.91 (95 % CI 1.60–2.29) for predicted 10-year ASCVD high-risk classification and 1.74 (95 % CI 1.43–2.12) for incident MACE. Associations were consistent across disease labels, including nonalcoholic fatty liver disease (NAFLD; 1.98, 95 % CI 1.81–2.16), with higher but less precise estimates observed for nonalcoholic steatohepatitis (NASH; 3.60, 95 % CI 1.16–6.04). Readily available biomarkers may help complement established ASCVD risk scores by refining cardiovascular risk stratification in individuals with MASLD. Several readily available markers were informative for cardiovascular risk: Fatty Liver Index (FLI) ≥60 (hazard ratio [HR] 1.61, 95 % CI 1.12–2.11) and ≥30 (HR 1.39, 95 % CI 1.11–1.66); Fibrosis-4 index (FIB-4) ≥1.30 (HR 2.25, 95 % CI 1.84–2.65); blood pressure ≥130/85 mmHg (HR 2.16, 95 % CI 1.81–2.51); triglyceride–glucose index (TyG) >8.716 (HR 1.40, 95 % CI 1.26–1.54); and type IV collagen 7S ≥5 ng/mL (HR 2.37, 95 % CI 1.45–4.29). Compared with controls, MASLD was also associated with an adverse biomarker profile, including higher high-sensitivity C-reactive protein (hs-CRP) (+1.06 mg/L), homeostasis model assessment of insulin resistance (HOMA-IR) (+1.65), alanine aminotransferase (ALT) (+8.89 U/L), aspartate aminotransferase (AST) (+6.10 U/L), gamma-glutamyl transferase (GGT) (+13.23 U/L), total cholesterol (TC) (+9.05 mg/dL), triglycerides (TG) (+48.33 mg/dL), low-density lipoprotein cholesterol (LDL-C) (+8.46 mg/dL), glycated hemoglobin (HbA1c) (+0.43 %), and lower high-density lipoprotein cholesterol (HDL-C) (−8.41 mg/dL).</div></div><div><h3>Conclusions</h3><div>MASLD is associated with an approximate twofold increased risk of cardiovascular events, but this association varie","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101415"},"PeriodicalIF":5.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-11DOI: 10.1016/j.ajpc.2026.101419
Huiwen Li , Yu Zhang , Yinong Chen , Hong Chen , Chunling Dong , Yiwei Shi , Xiaomao Xu , Ling Zhu , Zhe Cheng , Maoyun Wang , Juhong Shi , Hong Chen , Jun Wan , Shuai Zhang , Dingyi Wang , Yunxia Zhang , Yuzhi Tao , Wanmu Xie , Zhu Zhang , Zhenguo Zhai
Background
The impact of cardiometabolic multimorbidity (CMM), defined as the coexistence of multiple cardiometabolic diseases (CMD), on acute pulmonary embolism (PE) outcomes remains understudied. We investigated the burden of CMM and its association with short-term outcomes, treatment patterns, and potential mediators in PE.
Methods
We analyzed 7284 patients with acute PE from a nationwide multicenter prospective registry. CMM was defined as the presence of ≥2 CMDs (hypertension, diabetes, dyslipidemia, pre-existing cardiovascular disease, or stroke). The primary objective was to evaluate the association between CMM and 30-day all-cause death and bleeding events. Cox regression models were used to estimate hazard ratios (HR). Sensitivity and subgroup analyses confirmed the robustness of findings, while causal mediation analysis explored underlying pathways.
Results
Overall, 54.2% of patients had ≥1 CMD, and 24.8% had CMM. After multivariable adjustment, CMM was independently associated with increased risks of 30-day all-cause death (HR = 1.28, 95% CI 1.02–1.65) and bleeding (HR = 1.45, 95% CI 1.04–2.01), with mortality rising stepwise with increasing CMD burden. In intermediate-high risk PE, the presence of CMM was linked to lower use of reperfusion therapy. Mediation analysis identified body mass index, blood glucose, and renal function markers as partial drivers of these associations.
Conclusion
CMM is prevalent in PE and not only independently increases the risk of 30-day all-cause death and bleeding but also may influence reperfusion treatment choices. Future studies should test adding CMM to risk assessment to improve stratification and decision-making.
背景心脏代谢多病（CMM），定义为多种心脏代谢疾病（CMD）的共存，对急性肺栓塞（PE）结果的影响仍未得到充分研究。我们调查了CMM的负担及其与PE的短期结局、治疗模式和潜在介质的关系。方法我们分析了7284例来自全国多中心前瞻性登记的急性PE患者。CMM被定义为存在≥2个CMDs（高血压、糖尿病、血脂异常、既往心血管疾病或中风）。主要目的是评估CMM与30天全因死亡和出血事件之间的关系。采用Cox回归模型估计风险比（HR）。敏感性和亚组分析证实了研究结果的稳健性，而因果中介分析探索了潜在的途径。结果总体而言，54.2%的患者有≥1个CMD， 24.8%的患者有CMM。多变量调整后，CMM与30天全因死亡（HR = 1.28, 95% CI 1.02-1.65）和出血（HR = 1.45, 95% CI 1.04-2.01）风险增加独立相关，死亡率随CMD负担的增加而逐步上升。在中高风险PE中，CMM的存在与再灌注治疗的低使用率有关。中介分析确定体重指数、血糖和肾功能指标是这些关联的部分驱动因素。结论cmm在PE中普遍存在，不仅独立增加了30天全因死亡和出血的风险，而且可能影响再灌注治疗的选择。未来的研究应尝试将CMM加入风险评估，以改善分层和决策。
{"title":"Cardiometabolic multimorbidity and short-term outcomes in pulmonary embolism: Findings from the CURES Registry-2","authors":"Huiwen Li , Yu Zhang , Yinong Chen , Hong Chen , Chunling Dong , Yiwei Shi , Xiaomao Xu , Ling Zhu , Zhe Cheng , Maoyun Wang , Juhong Shi , Hong Chen , Jun Wan , Shuai Zhang , Dingyi Wang , Yunxia Zhang , Yuzhi Tao , Wanmu Xie , Zhu Zhang , Zhenguo Zhai","doi":"10.1016/j.ajpc.2026.101419","DOIUrl":"10.1016/j.ajpc.2026.101419","url":null,"abstract":"<div><h3>Background</h3><div>The impact of cardiometabolic multimorbidity (CMM), defined as the coexistence of multiple cardiometabolic diseases (CMD), on acute pulmonary embolism (PE) outcomes remains understudied. We investigated the burden of CMM and its association with short-term outcomes, treatment patterns, and potential mediators in PE.</div></div><div><h3>Methods</h3><div>We analyzed 7284 patients with acute PE from a nationwide multicenter prospective registry. CMM was defined as the presence of ≥2 CMDs (hypertension, diabetes, dyslipidemia, pre-existing cardiovascular disease, or stroke). The primary objective was to evaluate the association between CMM and 30-day all-cause death and bleeding events. Cox regression models were used to estimate hazard ratios (HR). Sensitivity and subgroup analyses confirmed the robustness of findings, while causal mediation analysis explored underlying pathways.</div></div><div><h3>Results</h3><div>Overall, 54.2% of patients had ≥1 CMD, and 24.8% had CMM. After multivariable adjustment, CMM was independently associated with increased risks of 30-day all-cause death (HR = 1.28, 95% CI 1.02–1.65) and bleeding (HR = 1.45, 95% CI 1.04–2.01), with mortality rising stepwise with increasing CMD burden. In intermediate-high risk PE, the presence of CMM was linked to lower use of reperfusion therapy. Mediation analysis identified body mass index, blood glucose, and renal function markers as partial drivers of these associations.</div></div><div><h3>Conclusion</h3><div>CMM is prevalent in PE and not only independently increases the risk of 30-day all-cause death and bleeding but also may influence reperfusion treatment choices. Future studies should test adding CMM to risk assessment to improve stratification and decision-making.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101419"},"PeriodicalIF":5.9,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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