Pub Date : 2026-04-01Epub Date: 2025-12-21DOI: 10.1016/j.ajpc.2025.101390
Jo Kato , Tomohiro Manabe , Fumihiro Yamasawa
Background
Sudden cardiac arrest (SCA) is a rare but catastrophic event that can occur during long-distance road races. Although habitual training mitigates SCA risk, it remains uncertain whether running pace on race day can help identify susceptible individuals.
Methods
We prospectively collected cases of SCA in Japan Association of Athletics Federations (JAAF)-certified full marathons between April 2011 and March 2020. Collapses during or within 1 hour after races that required basic life support were included. Running pace was calculated from the last available split or finish time, and expected completion times were compared with age- and sex-stratified marathon ranking data. Predicted finish time percentiles were evaluated within subgroups defined by calendar year, sex, age group, and location of collapse (race tertile or postfinish).
Results
Among 4.53 million starters in 571 marathons, 74 SCA cases were identified (1.6/100,000). The median age was 52 years, and 93% were men. Over half of the events occurred in the final tertile or immediately postfinish. The median pace was 10 minutes 25 seconds per mile (interquartile range: 9:15–12:13), with an extrapolated finish time of 4 hours 33 minutes, corresponding to the 48th percentile in population rankings. Females and those collapsing in the latter part of the race tended to occupy higher percentile ranks than the general finisher distribution.
Conclusions
Marathon-related SCA occurred at running speeds indistinguishable from the general finisher population, challenging the assumption that less conditioned runners are particularly at risk of SCA.
{"title":"Marathon running pace immediately before sudden cardiac arrest","authors":"Jo Kato , Tomohiro Manabe , Fumihiro Yamasawa","doi":"10.1016/j.ajpc.2025.101390","DOIUrl":"10.1016/j.ajpc.2025.101390","url":null,"abstract":"<div><h3>Background</h3><div>Sudden cardiac arrest (SCA) is a rare but catastrophic event that can occur during long-distance road races. Although habitual training mitigates SCA risk, it remains uncertain whether running pace on race day can help identify susceptible individuals.</div></div><div><h3>Methods</h3><div>We prospectively collected cases of SCA in Japan Association of Athletics Federations (JAAF)-certified full marathons between April 2011 and March 2020. Collapses during or within 1 hour after races that required basic life support were included. Running pace was calculated from the last available split or finish time, and expected completion times were compared with age- and sex-stratified marathon ranking data. Predicted finish time percentiles were evaluated within subgroups defined by calendar year, sex, age group, and location of collapse (race tertile or postfinish).</div></div><div><h3>Results</h3><div>Among 4.53 million starters in 571 marathons, 74 SCA cases were identified (1.6/100,000). The median age was 52 years, and 93% were men. Over half of the events occurred in the final tertile or immediately postfinish. The median pace was 10 minutes 25 seconds per mile (interquartile range: 9:15–12:13), with an extrapolated finish time of 4 hours 33 minutes, corresponding to the 48th percentile in population rankings. Females and those collapsing in the latter part of the race tended to occupy higher percentile ranks than the general finisher distribution.</div></div><div><h3>Conclusions</h3><div>Marathon-related SCA occurred at running speeds indistinguishable from the general finisher population, challenging the assumption that less conditioned runners are particularly at risk of SCA.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101390"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928856","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 : 2026-04-01Epub 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":"2026-04-01","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 : 2026-04-01Epub Date: 2026-01-10DOI: 10.1016/j.ajpc.2026.101414
Bingtao Weng , Haizhen Chen , Han Chen , Ningjian Wang , Hongliang Feng , Kehua Yang , Xiao Tan
Background
Circadian rest–activity rhythm (CRAR) is a modifiable determinant of metabolic and cardiovascular health, yet its role in cardiovascular events and mortality among individuals with cardiovascular–kidney–metabolic (CKM) syndrome remains unclear.
Methods
Accelerometer-derived CRAR parameters were analyzed in two nationally representative cohorts. Primary outcomes included cardiovascular incidence among participants with CKM stages 0–3 and all-cause and cardiovascular mortality among those with stages 1–4. Multinomial logistic and Cox proportional hazards models assessed associations of CRAR with CKM progression and subsequent outcomes. Mediation analyses examined inflammatory biomarkers, and improvements in prediction were evaluated using changes in C-statistics.
Results
Among 74,777 participants, higher relative amplitude (RA) tertiles were associated with slower CKM progression and lower risks of cardiovascular incidence (T2: HR 0.87, 95% CI 0.82–0.93; T3: HR 0.79, 95% CI 0.73–0.85), all-cause mortality (T2: HR 0.70, 95% CI 0.64–0.77; T3: HR 0.60, 95% CI 0.54–0.67), and cardiovascular mortality (T2: HR 0.70, 95% CI 0.57–0.86; T3: HR 0.45, 95% CI 0.34–0.61). Higher intradaily variability (IV) was associated with increased all-cause mortality (T2: HR 1.12, 95% CI 1.02–1.22; T3: HR 1.19, 95% CI 1.08–1.30). Inflammatory biomarkers modestly mediated these associations (1%–5%). Optimal thresholds were RA = 0.87 for cardiovascular incidence, RA = 0.81 and IV = 0.68 for mortality. Adding CRAR to basic models improved prediction of all-cause and cardiovascular mortality (ΔC-statistic = 0.019 and 0.017). Results were validated in an independent cohort of 6046 participants.
Conclusion
Adverse CRAR is associated with CKM progression and elevated risks of cardiovascular events and mortality, highlighting its utility in identifying high-risk individuals and guiding targeted interventions through risk stratification and incremental prediction.
昼夜休息-活动节律（CRAR）是代谢和心血管健康的可改变决定因素，但其在心血管-肾-代谢（CKM）综合征患者心血管事件和死亡率中的作用尚不清楚。方法在两个具有全国代表性的队列中分析加速度计衍生的CRAR参数。主要结局包括0-3期CKM参与者的心血管发病率和1-4期参与者的全因死亡率和心血管死亡率。多项logistic和Cox比例风险模型评估了CRAR与CKM进展和后续结局的关系。中介分析检查炎症生物标志物，并使用c统计量的变化评估预测的改进。结果在74,777名参与者中，较高的相对振幅（RA）分位数与较慢的CKM进展、较低的心血管发病率风险（T2: HR 0.87, 95% CI 0.82-0.93; T3: HR 0.79, 95% CI 0.73-0.85）、全因死亡率（T2: HR 0.70, 95% CI 0.64-0.77; T3: HR 0.60, 95% CI 0.54-0.67）和心血管死亡率（T2: HR 0.70, 95% CI 0.57-0.86; T3: HR 0.45, 95% CI 0.34-0.61）相关。较高的每日变异性（IV）与全因死亡率增加相关（T2: HR 1.12, 95% CI 1.02-1.22; T3: HR 1.19, 95% CI 1.08-1.30）。炎症生物标志物适度介导了这些关联（1%-5%）。最佳阈值为心血管发病率RA = 0.87，死亡率RA = 0.81, IV = 0.68。在基础模型中加入CRAR可改善全因死亡率和心血管死亡率的预测（ΔC-statistic = 0.019和0.017）。结果在6046名参与者的独立队列中得到验证。结论CRAR不良反应与CKM进展、心血管事件和死亡风险升高相关，突出了其在识别高危人群和通过风险分层和增量预测指导有针对性干预方面的作用。
{"title":"Rest-activity rhythms and cardiovascular events in cardiovascular–kidney–metabolic syndrome: evidence from two nationwide cohorts","authors":"Bingtao Weng , Haizhen Chen , Han Chen , Ningjian Wang , Hongliang Feng , Kehua Yang , Xiao Tan","doi":"10.1016/j.ajpc.2026.101414","DOIUrl":"10.1016/j.ajpc.2026.101414","url":null,"abstract":"<div><h3>Background</h3><div>Circadian rest–activity rhythm (CRAR) is a modifiable determinant of metabolic and cardiovascular health, yet its role in cardiovascular events and mortality among individuals with cardiovascular–kidney–metabolic (CKM) syndrome remains unclear.</div></div><div><h3>Methods</h3><div>Accelerometer-derived CRAR parameters were analyzed in two nationally representative cohorts. Primary outcomes included cardiovascular incidence among participants with CKM stages 0–3 and all-cause and cardiovascular mortality among those with stages 1–4. Multinomial logistic and Cox proportional hazards models assessed associations of CRAR with CKM progression and subsequent outcomes. Mediation analyses examined inflammatory biomarkers, and improvements in prediction were evaluated using changes in C-statistics.</div></div><div><h3>Results</h3><div>Among 74,777 participants, higher relative amplitude (RA) tertiles were associated with slower CKM progression and lower risks of cardiovascular incidence (T2: HR 0.87, 95% CI 0.82–0.93; T3: HR 0.79, 95% CI 0.73–0.85), all-cause mortality (T2: HR 0.70, 95% CI 0.64–0.77; T3: HR 0.60, 95% CI 0.54–0.67), and cardiovascular mortality (T2: HR 0.70, 95% CI 0.57–0.86; T3: HR 0.45, 95% CI 0.34–0.61). Higher intradaily variability (IV) was associated with increased all-cause mortality (T2: HR 1.12, 95% CI 1.02–1.22; T3: HR 1.19, 95% CI 1.08–1.30). Inflammatory biomarkers modestly mediated these associations (1%–5%). Optimal thresholds were RA = 0.87 for cardiovascular incidence, RA = 0.81 and IV = 0.68 for mortality. Adding CRAR to basic models improved prediction of all-cause and cardiovascular mortality (ΔC-statistic = 0.019 and 0.017). Results were validated in an independent cohort of 6046 participants.</div></div><div><h3>Conclusion</h3><div>Adverse CRAR is associated with CKM progression and elevated risks of cardiovascular events and mortality, highlighting its utility in identifying high-risk individuals and guiding targeted interventions through risk stratification and incremental prediction.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101414"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980830","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}
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":"2026-04-01","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 : 2026-04-01Epub 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":"2026-04-01","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 : 2026-04-01Epub 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":"2026-04-01","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 : 2026-04-01Epub 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":"2026-04-01","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 : 2026-04-01Epub 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":"2026-04-01","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 : 2026-04-01Epub 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":"2026-04-01","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 : 2026-04-01Epub Date: 2026-01-05DOI: 10.1016/j.ajpc.2026.101412
Abhishek Gami , Siyu Zou , Zeina A. Dardari , Ramzi Dudum , Yejin Mok , Matthew J. Budoff , Pamela L. Lutsey , Candace M. Howard , David Couper , Kunihiro Matsushita , Michael J. Blaha
Introduction
Coronary artery calcium (CAC) scoring is a commonly used tool for cardiovascular disease (CVD) risk assessment and is reported using the Agatston score. However, there has been increasing interest in measures of CAC beyond the Agatston score, including measures capturing the overall distribution of vessel calcification. We assessed the association between 30-year traditional risk factor exposure and the presence of a more diffuse pattern of CAC in older adults aged 75 and older.
Methods
We studied participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent CAC scoring and were free of prior CVD. Time-weighted average exposure to traditional cardiovascular risk factors (over 30 years) was calculated. The CAC diffusivity index was calculated for each participant as 1 - (CAC in most affected vessel/total CAC) to capture distribution of calcification, and associations between traditional risk factors and more diffuse CAC patterns were studied.
Results
In 2201 participants (mean age 80, 61.8% women), time-averaged exposure to systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), ever smoking, male sex, and limited education were independently associated with more diffuse CAC (p < 0.05).
Conclusion
Longitudinal exposure to traditional CVD risk factors including higher SBP, higher LDL-C, lower HDL-C, and smoking was associated with a more diffuse pattern of CAC in a population of adults aged 75 and older.
{"title":"Predictors of diffuse coronary artery calcium phenotype in adults aged ≥ 75: The Atherosclerosis Risk in Communities (ARIC) study","authors":"Abhishek Gami , Siyu Zou , Zeina A. Dardari , Ramzi Dudum , Yejin Mok , Matthew J. Budoff , Pamela L. Lutsey , Candace M. Howard , David Couper , Kunihiro Matsushita , Michael J. Blaha","doi":"10.1016/j.ajpc.2026.101412","DOIUrl":"10.1016/j.ajpc.2026.101412","url":null,"abstract":"<div><h3>Introduction</h3><div>Coronary artery calcium (CAC) scoring is a commonly used tool for cardiovascular disease (CVD) risk assessment and is reported using the Agatston score. However, there has been increasing interest in measures of CAC beyond the Agatston score, including measures capturing the overall distribution of vessel calcification. We assessed the association between 30-year traditional risk factor exposure and the presence of a more diffuse pattern of CAC in older adults aged 75 and older.</div></div><div><h3>Methods</h3><div>We studied participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent CAC scoring and were free of prior CVD. Time-weighted average exposure to traditional cardiovascular risk factors (over 30 years) was calculated. The CAC diffusivity index was calculated for each participant as 1 - (CAC in most affected vessel/total CAC) to capture distribution of calcification, and associations between traditional risk factors and more diffuse CAC patterns were studied.</div></div><div><h3>Results</h3><div>In 2201 participants (mean age 80, 61.8% women), time-averaged exposure to systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), ever smoking, male sex, and limited education were independently associated with more diffuse CAC (<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Longitudinal exposure to traditional CVD risk factors including higher SBP, higher LDL-C, lower HDL-C, and smoking was associated with a more diffuse pattern of CAC in a population of adults aged 75 and older.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101412"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928855","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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