American journal of preventive cardiology最新文献

{"title":"Unhealthy alcohol use and risk of coronary heart disease among young and middle-aged adults","authors":"Jamal S. Rana ,&nbsp;Felicia W. Chi ,&nbsp;Isaac Acquah ,&nbsp;Stacy A. Sterling","doi":"10.1016/j.ajpc.2025.100947","DOIUrl":"10.1016/j.ajpc.2025.100947","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the associations between unhealthy alcohol use and risk of coronary heart disease (CHD) among women and men aged 18–65 years.</div></div><div><h3>Methods</h3><div>An observational study in an integrated healthcare system with systematic alcohol screening. We identified 432,265 primary care patients aged 18–65 years who, in 2014–2015, reported weekly alcohol intake levels. Weekly alcohol intake, categorized into below (≤14/week men; ≤7/week women) and above limits (≥15/week men; ≥ 8/week women) per U.S. guidelines, and heavy episodic drinking (HED, ≥5/≥4 drinks any day in past 3 months for men/women, respectively). Main outcome was CHD during 4-year follow-up, based on inpatient ICD diagnoses of myocardial infarction and CHD. Cox proportional hazards models adjusted for age, sex, race/ethnicity, body mass index, physical activity, smoking, hypertension, diabetes, and hyperlipidemia.</div></div><div><h3>Results</h3><div>The cohort comprised 44 % women, mean age (standard deviation) of 43.5 years (±13.1). Weekly alcohol intake above limits was associated with higher prevalence of cardiovascular risk factors, and a 26 %, 19 % and 43 % higher risk on the overall, men- and women-specific risk of CHD after adjusting for these risk factors (hazard ratio [95 % confidence interval] = 1.26[1.13 -1.40], 1.19[1.04–1.35] and 1.43[1.20–1.71], respectively).</div></div><div><h3>Conclusions</h3><div>In a large, real-world, diverse population with a systematic alcohol screening program, having weekly alcohol intake above limits was associated with increased risk of CHD among young and middle-aged men and women. Increased CHD risk due to alcohol intake above limits warrants particular awareness and interventions.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100947"},"PeriodicalIF":4.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143376896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of payer rejections and out-of-pocket costs on patient access to bempedoic acid therapy","authors":"Jimin Hwang ,&nbsp;Eric Peterson ,&nbsp;Anand Gupta ,&nbsp;Evelyn Sarnes ,&nbsp;Kristin Gillard ,&nbsp;Ann Marie Navar","doi":"10.1016/j.ajpc.2025.100940","DOIUrl":"10.1016/j.ajpc.2025.100940","url":null,"abstract":"<div><h3>Background</h3><div>Early uptake of novel cholesterol-lowering therapies was limited by extensive utilization management practices and high cost. Whether similar challenges affected access to bempedoic acid (BA) is unknown.</div></div><div><h3>Methods</h3><div>For all patients prescribed BA from the date of FDA approval (February 2020) through 12/31/2022 identified using nationwide pharmacy transaction data, we assessed whether their first prescription was approved or rejected. Multivariable logistic regression was performed to assess factors associated with approval. Among those approved, prescription fill rates were evaluated by out-of-pocket cost. For those with rejected prescriptions, changes in lipid-lowering therapy after rejection were described.</div></div><div><h3>Results</h3><div>Of 116,176 patients (median age 67 years; 56.6 % women) initially prescribed BA, 80,056 (68.9 %) received approval. Factors associated with approval included: commercial insurance (odds ratio [OR] 1.62 [95 % confidence interval (CI) 1.56, 1.68] vs. government insurance, <em>P</em> &lt; 0.001), cardiology specialty prescriber (OR 1.39 [1.34, 1.44] vs. primary care physicians, <em>P</em> &lt; 0.001), and prescriber volume (OR 1.44 [1.38, 1.51] for fourth [highest] quartile vs. first [lowest] quartile prescribers, <em>P</em> &lt; 0.001). Of those who received approval, 82.4 % (<em>n</em> = 65,969) filled the prescription, while 17.3 % (<em>n</em> = 14,087) abandoned the prescription. Abandonment rates increased with increasing patient OOP costs. Escalation in an alternative lipid-lowering therapy over the subsequent year was observed in 36.2 % and 33.3 % of patients with rejected and abandoned prescriptions, respectively.</div></div><div><h3>Conclusion</h3><div>Nearly half of patients prescribed BA failed to receive therapy due to a combination of payer rejections and prescription abandonment. Arduous utilization management criteria or high OOP costs put patients at high risk for failure of therapy initiation.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100940"},"PeriodicalIF":4.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Composite cardiovascular risk factor control in US adults with diabetes and relation to social determinants of health: The All of Us research program","authors":"Frances Golden,&nbsp;Johnathan Tran,&nbsp;Nathan D. Wong","doi":"10.1016/j.ajpc.2025.100939","DOIUrl":"10.1016/j.ajpc.2025.100939","url":null,"abstract":"<div><h3>Background</h3><div>Data are limited on composite cardiovascular risk factor control in patients with type 2 diabetes mellitus (T2DM). This study aims to identify disparities in cardiovascular risk factor control based on most recent recommendations and relationships to social determinants of health in a large-scale real-world cohort of US adults.</div></div><div><h3>Methods</h3><div>We analyzed data from 88,416 participants with T2DM in the NIH Precision Medicine Initiative <em>All of Us</em> Research Program 2018–2022. We investigated the management of five key cardiovascular risk factors—glycated hemoglobin (HbA1c), LDL cholesterol (LDL-C), body mass index (BMI), blood pressure (BP), and smoking status. Statistical methods included Chi-square tests for categorical comparisons, <em>t</em>-tests for mean differences, and multiple logistic regression to assess the impact of demographic and socioeconomic factors on risk factor control.</div></div><div><h3>Results</h3><div>The study revealed low risk factor control with only 27.7 % of participants achieving recommended levels for three or more risk factors (RFs) and 4.9 % for four or more RFs. Overall, while 81.0% were at target for HbA1c, only 37.9% were at target for BP and 10.4% for LDL-C. Notably, only 1.9 % and 6.9 % were at target for HbA1c, LDL-C, and BP together, based on current and prior recommendations, respectively. Significant disparities were observed across race/ethnicity, sex, and socioeconomic lines with 43.1 % of Asian participants at control for ≥3 RFs compared to 21.1 % of non-Hispanic black participants. In logistic regression analysis, factors such as higher income, higher educational attainment, and health insurance were associated with better RF control, while higher polysocial risk scores linked to poorer control.</div></div><div><h3>Conclusions</h3><div>Despite some progress in managing individual CVD risk factors in T2DM, overall composite risk factor control remains poor, especially among underrepresented and socioeconomically disadvantaged groups. The findings highlight the necessity for integrated healthcare strategies that address both medical and social needs to improve control of CVD risk factors and outcomes in T2DM.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100939"},"PeriodicalIF":4.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of adverse cardiovascular events following spinal cord injury in patients with osteoporosis: Real-world evidence","authors":"Shih-Kai Kao ,&nbsp;Yu-Ting Yu ,&nbsp;Ming-Hsien Tsai","doi":"10.1016/j.ajpc.2025.100938","DOIUrl":"10.1016/j.ajpc.2025.100938","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal cord injury (SCI) is associated with increased cardiovascular risks, and cardiovascular disease (CVD) remains a leading cause of death for individuals with SCI. Osteoporosis, a condition associated with SCI, has been linked to CVD. However, the cardiovascular risk profile of individuals with SCI with osteoporosis remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study by using data from the TriNetX Research Network. We included adults with osteoporosis with or without a diagnosis of SCI between 2015 and 2020: case (SCI group, <em>N =</em> 7,308) and control (non-SCI group, <em>N =</em> 843,235) cohorts. Propensity score matching was performed to balance baseline characteristics between the cohorts (<em>N =</em> 7,296 in each group). A Cox regression model was employed to estimate the hazard ratio (HR) for the primary outcomes: the development of acute myocardial infarction (AMI), atrial fibrillation (AF), or heart failure (HF).</div></div><div><h3>Results</h3><div>Individuals with SCI with osteoporosis have a significantly higher risk of cardiovascular events (HR: 1.15, 95 % confidence interval [CI]: 1.08–1.22)—including AMI (HR: 1.17 95 % CI: 1.02–1.33), AF (HR: 1.14, 95 % CI: 1.04–1.24), and HF (HR: 1.14, 95 % CI: 1.05–1.24)—than do those without SCI. Furthermore, mortality risk is higher in individuals with SCI, particularly those with pathological fracture. Subgroup analyses based on sex and age supported these findings.</div></div><div><h3>Conclusion</h3><div>The complex interplay between SCI, osteoporosis, and cardiovascular health underscores the requirement for comprehensive management strategies for individuals with SCI who also have osteoporosis.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100938"},"PeriodicalIF":4.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143369515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the association of novel Anthropometric and atherogenicity indices with all-cause, cardiovascular and non-cardiovascular mortality in a general population of Iranian adults","authors":"Parisa Hajihashemi ,&nbsp;Noushin Mohammadifard ,&nbsp;Motahare Bateni ,&nbsp;Fahimeh Haghighatdoost ,&nbsp;Maryam Boshtam ,&nbsp;Jamshid Najafian ,&nbsp;Masoumeh Sadeghi ,&nbsp;Niloufar Shabani ,&nbsp;Nizal Sarrafzadegan","doi":"10.1016/j.ajpc.2025.100936","DOIUrl":"10.1016/j.ajpc.2025.100936","url":null,"abstract":"<div><h3>Background</h3><div>The association of novel anthropometrics and novel atherogenicity indices with mortality remains uncertain.</div></div><div><h3>Objective</h3><div>To compare the association of novel anthropometrics and atherogenicity indices with all-cause, cardiovascular (CVD), and non-CVD mortality in Iranian adults.</div></div><div><h3>Methods</h3><div>Utilizing data from Isfahan Cohort Study, 5432 participants aged older than 35 years were enrolled. Three anthropometrics indices including a body shape index (ABSI), body roundness index (BRI) and abdominal volume index (AVI), and three atherogenicity indices including atherogenic index of plasma (AIP), Castelli risk index (CRI) and the cholesterol index (CI) were calculated. Cox proportional hazards regression models were used to explore the association between indices and mortality.</div></div><div><h3>Results</h3><div>After a median follow-up of 11.25 years, the ABSI was independently associated with increased risk of all-cause mortality (HR_Q4 _{vs. Q1} = 1.43, 95 % CI: 1.07, 1.92; P trend = 0.02). A positive, independent association was also observed between CRI-II (HR_Q4 _{vs. Q1} = 1.49, 95 % CI: 0.99, 2.25; P trend = 0.04) and AIP (HR_Q4 _{vs. Q1} = 1.81, 95 % CI: 1.92, 2.27; P trend = 0.01) and CVD mortality. For non-CVD mortality, despite a direct link for ABSI (HR_Q4 _{vs. Q1} = 1.92, 95 % CI: 1.32, 2.80; P trend = 0.001), an inverse association was found for CI (HR_Q4 _{vs. Q1} = 0.68, 95 % CI: 0.49, 0.95; P trend = 0.007).</div></div><div><h3>Conclusion</h3><div>Amongst various investigated anthropometric indices, ABSI was directly related to all-cause and non-CVD mortality. However, atherogenicity indices including CRI-II and AIP could predict the incidence risk of CVD mortality among Iranians. Further studies are warranted to confirm these findings.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100936"},"PeriodicalIF":4.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring the impact of obesity on cardiovascular risk for northern Colorado school children: Healthy hearts and minds program 2013–2023","authors":"Austin M. Pollack ,&nbsp;Tracy L. Nelson ,&nbsp;NaNet A. Jenkins ,&nbsp;Meghan W. Willis ,&nbsp;Paige C. Lueders ,&nbsp;Anna K. Kingman ,&nbsp;Landon D. Hamilton ,&nbsp;Gary J. Luckasen","doi":"10.1016/j.ajpc.2025.100933","DOIUrl":"10.1016/j.ajpc.2025.100933","url":null,"abstract":"<div><div>Obesity is associated with cardiovascular disease (CVD) risk factors in both children and adults and is predictive of poor cardiovascular outcomes. Prevalence of CVD risk factors among children has become more frequent and is often influenced by the family. The purpose of this study was to both cross-sectionally and longitudinally determine the prevalence and changes in CVD risk factors among northern Colorado students.</div><div>Data was collected from August 2013 to May 2023 as part of the UCHealth Healthy Hearts and Minds (HHM) program (51,882 students, 52.4 % female, 71.5 % White). Objective measures of total cholesterol (TChol), high-density lipoprotein cholesterol (HDL), blood pressure, height, and weight were collected. Self-reported familial CVD risk factors from parents/guardians including overweight/obesity were collected.</div><div>CVD risk consistently rises with increasing BMI across grade levels. TChol was higher and HDL was lower as BMI increased, regardless of age or sex.</div><div>Students who maintained a healthy weight in elementary and high school (66.2 % males, 67.6 % females) or moved to a healthy weight after elementary school (7.4 % males, 5.0 % females) had lower CVD risk compared to students who were overweight/obese (17.4 % males, 14.7 % females) at both timepoints. Students with a healthy weight in elementary and high school were less likely to have a family member reporting overweight/obesity (26.5 % and 28.0 %) than students who were overweight in both grade levels (50.5 % and 56.7 %).</div><div>Given the increase in childhood obesity, there is a need for aggressive screening and treatment of obesity and CVD risk in children and their families.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100933"},"PeriodicalIF":4.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond identification of familial hypercholesterolemia: Improving downstream visits and treatments in a large health care system","authors":"Harin Lee ,&nbsp;Tarun Kadaru ,&nbsp;Ruth Schneider ,&nbsp;Taylor Triana ,&nbsp;Carol Tujardon ,&nbsp;Colby Ayers ,&nbsp;Mujeeb Basit ,&nbsp;Zahid Ahmad ,&nbsp;Amit Khera","doi":"10.1016/j.ajpc.2025.100937","DOIUrl":"10.1016/j.ajpc.2025.100937","url":null,"abstract":"<div><h3>Objective</h3><div>Familial Hypercholesterolemia (FH) is underdiagnosed and undertreated. Several electronic health record (EHR) algorithms have been developed to improve identification of patients with FH. The approach to improving downstream processes of care and implementation of appropriate treatment after identification of these individuals is unclear.</div></div><div><h3>Methods</h3><div>Individuals at UT Southwestern Medical Center with an LDL-C ≥ 190mg/dL (<em>n</em> = 8368) ever recorded in the EHR were included in an FH registry. As part of a QI program, random individuals from the registry deemed to possibly have FH were contacted via (1) MyChart message, (2) phone call, (3) letter, and/or (4) InBasket message to their PCP to notify them of the potential FH diagnosis, higher risk of ASCVD events, and offering referral to an FH specialist. Participants were contacted 1–4 times by one of these modalities. Chart extraction of contacted patients was performed to determine the type and frequency of contact and downstream visits and interventions. The composite primary outcome of the study included changes to lipid-lowering medications, family screening for FH, and new chart diagnosis of FH.</div></div><div><h3>Results</h3><div>A total of 242 patients from the FH registry were reviewed of which 108 (mean age 55, 69 % women, highest mean LDL-C 267 ± 47 mg/dL) met the inclusion criteria. A total of 180 patient contact attempts were made (mean 1.7 per patient) with most being by MyChart (48 %) and telephone (41 %). Of those contacted, 35 % had a follow-up visit with a PCP and/or a lipid specialist, and 22 % saw any composite change. Patients whose PCP was contacted were more likely to have adjustments made to their lipid lowering medication(s) (<em>p</em> = 0.016), be diagnosed with FH (<em>p</em> = 0.025), and have a follow-up visit (<em>p</em> = 0.033). A greater number of contacts (2.17 vs 1.52, <em>p</em> &lt; 0.001) was also associated with any composite change in outcome.</div></div><div><h3>Conclusions</h3><div>Approximately 1 in 5 individuals in a large healthcare system who were contacted for a recorded LDL-C ≥ 190 mg/dL had a meaningful improvement in the management of severe hypercholesterolemia and diagnosis of FH. Various process factors were associated with a greater change in clinical care. These data highlight the importance of systematic evaluation to enhance interventions to improve the care of individuals with possible FH.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100937"},"PeriodicalIF":4.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary artery calcium in a 20-year-old South Asian patient - pushing the limits of detecting \"early disease\"","authors":"Erfan Tasdighi ,&nbsp;Charlie Brumley ,&nbsp;Aashna Vajramani ,&nbsp;Michael J Blaha ,&nbsp;Anandita Agarwala","doi":"10.1016/j.ajpc.2025.100935","DOIUrl":"10.1016/j.ajpc.2025.100935","url":null,"abstract":"<div><div>Coronary artery calcium (CAC) assessment has long been reserved for intermediate-risk individuals in mid- to older-adult populations. However, a growing body of evidence supports expanding CAC measurement to younger adults who exhibit multiple risk factors or other risk-enhancing features. We describe a case of a very young, 20-year-old, South Asian man with a CAC score of 15.7 Agatston Units. Despite his age and lack of overt symptoms, his CAC score placed him at the 99th percentile for his age and sex, underscoring the limitations of relying solely on traditional risk algorithms. Early CAC detection in such patients has potential for significant clinical impact, allowing timely implementation of intensive lifestyle modification and the most aggressive possible pharmacotherapy for cardiovascular risk reduction.</div><div>Evidence indicates that even minimal CAC in very young individuals can progress exponentially, markedly increasing the risk of future atherosclerotic cardiovascular disease. Nonetheless, current guidelines do not recommend CAC testing in this population, creating a missed opportunity to detect and intervene in high-risk individuals during early adulthood. These observations underscore the need for more precise risk stratification strategies in select high-risk populations. Incorporating CAC measurements into care for young, high-risk individuals—alongside newer tools such as polygenic risk scores and low-radiation coronary CT angiography—could revolutionize preventive cardiology. Further research is needed to refine the cost-effectiveness and implementation strategies for early CAC measurement, develop more inclusive guidelines, and ensure a specialized workforce capable of delivering comprehensive preventive care.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100935"},"PeriodicalIF":4.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated plasma trimethyllysine is associated with incident atrial fibrillation","authors":"Mads M Svenningsson ,&nbsp;Gard FT Svingen ,&nbsp;Per M Ueland ,&nbsp;Gerhard Sulo ,&nbsp;Espen Ø Bjørnestad ,&nbsp;Eva R Pedersen ,&nbsp;Indu Dhar ,&nbsp;Dennis W. Nilsen ,&nbsp;Ottar Nygård","doi":"10.1016/j.ajpc.2025.100932","DOIUrl":"10.1016/j.ajpc.2025.100932","url":null,"abstract":"<div><h3>Background/Aim</h3><div>Trimethyllysine (TML) is a methylated amino acid, which is linked to epigenetic regulation and can serve as a precursor of trimethylamine-N-oxide (TMAO). TMAO is a microbiota-derived metabolite and a potential risk factor of cardiovascular disease. TML has recently been linked to atherosclerosis, acute myocardial infarction and prevalent atrial fibrillation (AF). However, any association between circulating TML and incident AF has not yet been reported and was the aim of the current study in a large community based cohort.</div></div><div><h3>Methods</h3><div>Information regarding AF was obtained by linking patient data to national health registries. Risk associations were explored by logistic regression. Potential improvements in risk reclassification were calculated by the continuous net reclassification index (NRI˃0) and the Receiver Operating Curve Area Under the Curve (ROC-AUC).</div></div><div><h3>Results</h3><div>At baseline 3117 patients were included. During a median (25th-75th percentile) follow-up of 10.8 (9.4 – 11.2) years, 492 patients (15.8 %) developed AF. Higher plasma TML was associated with incident AF per 1 SD log-transformed TML (OR (95 % CI) 1.30 (1.16–1.46) <em>P</em> &lt; 0.01). Further analyses also showed an increase in NRI&gt;0 (95 % CI) of 0.24 (0.14–0.33) <em>P</em> &lt; 0.001 and ROC-AUC (95 % CI) of 0.013 (0.004–0.022) <em>P</em> = 0.006.</div></div><div><h3>Conclusion</h3><div>TML was associated with, and improved risk classification of, new-onset AF in this large cohort of community dwelling adults. Our results motivate further studies on the association between TML and cardiac arrhythmias.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100932"},"PeriodicalIF":4.3,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers of residual risk and all-cause mortality after acute coronary syndrome.","authors":"Anna Toso ,&nbsp;Mario Leoncini ,&nbsp;Mauro Maioli ,&nbsp;Simona Villani ,&nbsp;Francesco Bellandi","doi":"10.1016/j.ajpc.2025.100934","DOIUrl":"10.1016/j.ajpc.2025.100934","url":null,"abstract":"<div><h3>Background</h3><div>Adverse cardiovascular events often recur after acute coronary syndrome (ACS), despite secondary prevention measures. Residual risk involves various inflammatory, metabolic and renal factors as well as lipid and thrombotic processes. This cohort study investigates the relationship between four risk biomarkers at 1 month after ACS and all-cause death within 3 years in patients treated with early invasive strategy and high-intensity statins from admission.</div></div><div><h3>Methods</h3><div>Levels of residual risk for the biomarkers were: low-density lipoprotein cholesterol (LDL-C) ≥ 70 mg/dl; high-sensitivity C reactive protein (hs-CRP) ≥ 2 mg/l; glycosylated hemoglobin (HbA1c) ≥ 7% in diabetic and ≥ 5.7% in non-diabetic patients; decrease in estimated glomerular filtration rate (eGFR) ≥ 25% compared to baseline. The association between the four biomarkers and all-cause death within 3 years was evaluated with Cox proportional analysis.</div></div><div><h3>Results</h3><div>This study included 1099 patients (68±12 years; 70.3% males). At 1 month the majority of patients had levels of LDL-C, hs-CRP and/or HbA1c above the risk cut-points, and only 7% of cases presented reduced eGFR. Reduced eGFR and hs-CRP ≥ 2 mg/l at 1 month were the sole independent biomarker predictors of 3-year mortality (adjusted hazard ratios 3.03 and 2.66, respectively).</div></div><div><h3>Conclusions</h3><div>In this population on high-intensity statin therapy only hsCRP and eGFR were independently associated with medium-term mortality. Diversification of secondary preventive measures based on routine evaluations of inflammation and kidney function markers, not only LDL-C, could lead to better targeted reduction of residual risk after ACS.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100934"},"PeriodicalIF":4.3,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}