American journal of preventive cardiology最新文献

{"title":"Disparities in statin use following identification of coronary artery calcium","authors":"Charlotte C. Ellberg ,&nbsp;Kavenpreet Bal ,&nbsp;Edward Duran ,&nbsp;Michael H. Criqui ,&nbsp;Michael D. Shapiro ,&nbsp;Harpreet S. Bhatia","doi":"10.1016/j.ajpc.2025.100990","DOIUrl":"10.1016/j.ajpc.2025.100990","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery calcium (CAC) scoring is a useful tool for risk stratification in asymptomatic individuals, and current clinical practice is to utilize statins in individuals with CAC. A growing body of research has aimed to identify and mitigate health disparities and their relation to cardiovascular disease (CVD) risk. Likewise, studies have highlighted social determinants of health (SDOH) that contribute to health disparities in CVD.</div></div><div><h3>Objectives</h3><div>We aimed to evaluate whether disparities exist with regards to statin use after identification of CAC within the Multi-Ethnic Study of Atherosclerosis (MESA).</div></div><div><h3>Methods</h3><div>The associations between race/ethnicity, age, sex, primary language, and an aggregate SDOH score (calculated using previously defined methods) with statin use at short- and long-term follow-up were evaluated in logistic regression models with adjustment for traditional CVD risk factors in individuals with baseline CAC&gt;0 without baseline statin use.</div></div><div><h3>Results</h3><div>In the overall cohort, 3416 participants had CAC = 0, 1794 CAC 1–99, 757 CAC 100–300, and 847 CAC&gt;300 AU Mean age was 62 (10.2) years, 53 % (<em>n</em> = 3601) were women, 38.5 % (<em>n</em> = 2622) were non-Hispanic White, 27.8 % (<em>n</em> = 1892) were non-Hispanic Black, 22.0 % (<em>n</em> = 1892) were Hispanic and 11.8 % (<em>n</em> = 1892) were Chinese. At short-term follow up (median 1.6 years, <em>n</em> = 2665), those with a higher SDOH score (worse burden) (OR 0.39, 95 % CI 0.16–0.91), Hispanic (OR 0.59, 95 % CI 0.40–0.85) and Spanish speaking individuals (OR 0.51, 95 % CI 0.30–0.83) were less likely to report statin use following CAC identification. At long-term follow up (median 9.4 years, <em>n</em> = 2533), Black individuals (OR 0.71, 95 % CI 0.52–0.96), Chinese (OR 0.58, 95 % CI 0.39–0.86) and Chinese speaking individuals (OR 0.50, 95 % CI 0.33–0.76) were also less likely to report statin use following CAC identification, and a trend was noted for SDOH score (OR 0.53, 95 % CI 0.26–1.09).</div></div><div><h3>Conclusions</h3><div>This study identifies disparities in statin use by race/ethnicity, language, and social determinants of health after identification of CAC. While CAC is an effective tool for identifying atherosclerosis in asymptomatic individuals, more equitable use of subsequent therapy is needed.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"22 ","pages":"Article 100990"},"PeriodicalIF":4.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833980","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}

{"title":"Prevalence of American heart association's ¨ Life's Essential 8¨ in a cohort of Latino women","authors":"Paola Varleta ,&nbsp;Mónica Acevedo ,&nbsp;Giovanna Valentino ,&nbsp;Carolina Casas-Cordero ,&nbsp;Amalia Berríos ,&nbsp;Rosario López-Infante","doi":"10.1016/j.ajpc.2025.100988","DOIUrl":"10.1016/j.ajpc.2025.100988","url":null,"abstract":"<div><div>The ideal cardiovascular health (CVH) construct has recently been updated to ¨ Life's Essential 8¨(LE8).</div></div><div><h3>Objective</h3><div>to determine LE8′s prevalence and its association with sociodemographic and socioeconomic determinants in a Latino women cohort in Santiago de Chile.</div></div><div><h3>Methods</h3><div>Cross-sectional study on 619 women between 35 and 70 years old, representing 1.359.509 women (after expansion factors). LE8 was assessed through a survey on demographic and CV risk factors, as well as anthropometric, blood pressure, and biochemical measurements. The overall LE8 score was estimated for all participants, ranging from 0 to 100 (≥80 points, high CVH and &lt; 50 points, low CVH). Besides, the score for each metric was determined. A descriptive analysis was performed with sample weights for the overall sample, and stratified by age, education, family income level and civil status. A regression analysis was performed adjusted by age group, family income and education level to determine the association of sociodemographic variables with LE8 score.</div></div><div><h3>Results</h3><div>The mean overall LE8 score was 62.7 points. Only 11.5 % had a high LE8, while 18.2 % had a low score. The best-accomplished metrics were blood glucose and physical activity (PA); the worst were diet and nicotine exposure. The adjusted regression analysis showed significantly higher scores for younger age (+3.2 points for &lt;45yo, p &lt; 0.05) and higher education level (+5 points, p &lt; 0.01 and +12 points, p = 0.000,1 for high school and tertiary education, respectively). Higher LE8 scores in women with high education level were significantly driven by improvements in 5 metrics (lipids, blood pressure, body mass index, diet and PA).</div></div><div><h3>Conclusion</h3><div>Nearly 1 out of 9 women from Santiago had an ideal LE8 score. Years of education are crucial determinants in the fight to get an ideal CVH.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"22 ","pages":"Article 100988"},"PeriodicalIF":4.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833817","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}

{"title":"Evidence-based SGLT2 inhibitor and GLP-1 receptor agonist use by race in the VA healthcare system","authors":"Demetria M. Bolden ,&nbsp;Vanessa Richardson ,&nbsp;Taufiq Salahuddin ,&nbsp;Kamal Henderson ,&nbsp;Paul L. Hess ,&nbsp;Sridharan Raghavan ,&nbsp;David R. Saxon ,&nbsp;P. Michael Ho ,&nbsp;Stephen W. Waldo ,&nbsp;Gregory G. Schwartz","doi":"10.1016/j.ajpc.2025.100966","DOIUrl":"10.1016/j.ajpc.2025.100966","url":null,"abstract":"<div><h3>Importance</h3><div>Adoption of novel therapeutics often lags for Black versus non-Hispanic White patients. Seminal clinical trials established the cardiovascular efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease. However, it is uncertain whether race influences the evidence-based prescription of these agents.</div></div><div><h3>Objective</h3><div>To determine whether evidence-based prescription of SGLT2i or GLP-1RA differs by Black versus White race in the Veterans Affairs (VA) healthcare system.</div></div><div><h3>Design, Setting, and Participants</h3><div>Retrospective cohort study of US Veterans with T2D and angiographically confirmed coronary artery disease (CAD) at 84 VA medical centers over the period 2015–2023. Data from the VA Clinical Assessment, Reporting, and Tracking Program were used to construct cohorts eligible for SGLT2i or GLP-1RA treatment based on eligibility criteria for the seminal Empagliflozin, Cardiovascular Outcomes, and Mortality in T2D (EMPA-REG OUTCOME) or the Liraglutide Effect and Action in Diabetes (LEADER) trial, respectively. Multivariable logistic regression estimated adjusted odds of trial-concordant SGLT2i or GLP-1RA prescription by race.</div></div><div><h3>Exposures</h3><div>Self-identified race.</div></div><div><h3>Main Outcomes and Measures</h3><div>SGLT2i or GLP-1RA prescription among those with an evidence-based (trial-concordant) indication.</div></div><div><h3>Results</h3><div>Of 63,561 Veterans with T2D and CAD, 3527 Black and 18,668 White patients met criteria for trial-concordant SGLT2i treatment and 2020 Black and 10,103 White patients for GLP1-RA treatment. Trial-concordant prescription of both classes increased over time for both races but reached only 42 % for SGLT2i and 15 % for GLP1-RA in 2023. Black versus White race was not associated with evidence-based SGLT2i prescription (adjusted odds ratio [OR] 0.96, 95 % CI 0.89–1.04, <em>P</em> = 0.32). However, Black Veterans were less likely than White to be provided with a trial-concordant GLP1-RA prescription (adjusted OR 0.85, 95 % CI 0.74–0.98, <em>P</em> = 0.025).</div></div><div><h3>Conclusions and Relevance</h3><div>Among patients with T2D and CAD in the VA healthcare system, evidence-based SGLT2i and GLP1-RA prescription increased over time, but many eligible patients remained untreated. Although SGLT2i prescription did not differ by race, Black versus White Veterans were less likely to receive evidence-based GLP1-RA prescription. Racial disparities in evidence-based cardiovascular drug prescription exist even in a healthcare system with few economic barriers and may be drug class-specific.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"22 ","pages":"Article 100966"},"PeriodicalIF":4.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823693","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}

{"title":"Associations between visceral adipose and renal artery calcification: Results from the multi-ethnic study of atherosclerosis","authors":"Harsimran Bajwa ,&nbsp;Michael Criqui ,&nbsp;Ron Blankstein ,&nbsp;Siddique Abbasi ,&nbsp;Joao Lima ,&nbsp;Jingzhong Ding ,&nbsp;Tara Shrout Allen ,&nbsp;Matthew Allison","doi":"10.1016/j.ajpc.2025.100979","DOIUrl":"10.1016/j.ajpc.2025.100979","url":null,"abstract":"<div><h3>Background</h3><div>Visceral adipose tissue (VAT) has been associated with higher levels of atherosclerosis. Renal artery calcification (RAC) secondary to atherosclerosis has been found to be associated with an increase in all-cause mortality.</div></div><div><h3>Methods</h3><div>1 978 participants underwent CT imaging to measure VAT and RAC. Rate ratio regression was used to estimate prevalence ratios (PRs) for the presence of RAC, while linear regression was used to estimate linear coefficients for the severity of RAC.</div></div><div><h3>Results</h3><div>1 196 participants had complete VAT and RAC measurements. In adjusted models, VAT area was not associated with RAC presence (PR 1.02, 95 % CI 0.89, 1.16, <em>p</em> = 0.80), while greater VAT density was inversely, but not significantly, associated with RAC presence (PR 0.89, 95 % CI 0.78, 1.02, <em>p</em> = 0.10). Among 354 participants with RAC &gt; 0, VAT area was significantly associated with RAC severity (slope 63.32, 95 % CI 11.84, 114.81, <em>p</em> = 0.02), while VAT density was not associated (slope 9.78, 95 % CI -40.87, 60.44, <em>p</em> = 0.71).</div></div><div><h3>Conclusions</h3><div>VAT area and density are not significantly associated with RAC presence, while greater VAT area is significantly associated with RAC severity among those with RAC &gt; 0. Our results are the first describing the relationship between VAT and RAC, and are in contrast to previous literature demonstrating a significant association between VAT and coronary artery calcification.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"22 ","pages":"Article 100979"},"PeriodicalIF":4.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823689","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}

{"title":"Improving outcomes in acute coronary syndrome: A meta-analysis of home-based compared to hospital-based cardiac rehabilitation and usual care","authors":"Eva Marti ,&nbsp;Anggoro Budi Hartopo ,&nbsp;Haryani ,&nbsp;Margareta Hesti Rahayu ,&nbsp;Riris Diana ,&nbsp;Ninik Yunitri","doi":"10.1016/j.ajpc.2025.100982","DOIUrl":"10.1016/j.ajpc.2025.100982","url":null,"abstract":"<div><h3>Aim</h3><div>To assess the effectiveness of home-based cardiac rehabilitation (HBCR) in improving health-related quality of life (HRQoL) and other outcomes in patients with acute coronary syndrome (ACS), compared to hospital-based cardiac rehabilitation (CR) and usual care.</div></div><div><h3>Methods</h3><div>This systematic review followed PRISMA guidelines and included a comprehensive search across MEDLINE, CINAHL, ProQuest, Cochrane Library, Clinical Key, PubMed, Embase, and ClinicalTrials.gov up to June 2023. A total of 19 studies with 2822 participants were included. Eligible RCTs assessed the impact of HBCR on ACS patients, comparing it with hospital-based CR or usual care. The primary outcome was QoL, with secondary outcomes including cardiovascular capacity, cardiovascular disease risk factors, and rehospitalization rates. Statistical analysis was conducted using a random-effects model in R Statistic.</div></div><div><h3>Results</h3><div>HBCR improves QoL compared to all comparators (hospital-based CR and usual care) (SMD 0.17, 95 % CI 0.00 to 0.33). HBCR was equally effective as hospital-based CR in enhancing QoL, peak VO₂, 6-min walk distance (6 MWD), lipid profiles, and blood pressure. Compared to usual care, HBCR significantly improved QoL (SMD 0.29, 95 % CI 0.11 to 0.46) and HDL-cholesterol level (SMD 0.18, 95 % CI 0.02 to 0.34), while reducing triglyceride level more effectively (SMD −0.34, 95 % CI −0.57 to −0.11). However, no significant differences were observed between HBCR and usual care in terms of peak VO₂, rehospitalization rates, LDL-cholesterol, total cholesterol, or blood pressure.</div></div><div><h3>Conclusions</h3><div>HBCR significantly improves QoL and is equally effective as hospital-based CR across all measured outcomes. Compared to usual care, HBCR leads to significant improvements in specific aspects of QoL as a primary outcome, as well as in HDL-cholesterol and triglyceride levels. However, its impact on other outcomes, such as peak VO₂, LDL-cholesterol, total cholesterol, and blood pressure, is not consistently significant.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"22 ","pages":"Article 100982"},"PeriodicalIF":4.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820489","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}

{"title":"Life's Essential 8 cardiovascular health status of 18–69-year-old individuals in France","authors":"Omar Deraz ,&nbsp;Sofiane Kab ,&nbsp;Mathilde Touvier ,&nbsp;Xavier Jouven ,&nbsp;Marcel Goldberg ,&nbsp;Marie Zins ,&nbsp;Jean-Philippe Empana","doi":"10.1016/j.ajpc.2025.100981","DOIUrl":"10.1016/j.ajpc.2025.100981","url":null,"abstract":"<div><h3>Background</h3><div>In 2022, the previously American Heart Association (AHA) life's simple 7 score (range 0 to 14) measuring cardiovascular health (CVH) has been updated by adding sleep health and providing more granularity to the score (range 0 to 100) to measure the so-called Life's Essential 8 (LE8) score. However, the distribution of the LE8 score in nationwide representative US and non-US populations is scarce. The present study quantifies LE8 score distribution and identifies determinants of high CVH (80–100 points) in French adults.</div></div><div><h3>Methods</h3><div>CONSTANCES is a nationwide French cohort study that randomly recruited participants aged 18 to 69 years in 24 participating health examination centers in 21 French “<em>départements</em>” in different regions of France between 2012 and 2019. Design weights for age class, sex, socio economic status, and examination center/region were applied to represent the source population. LE8 score was quantified using inclusion data on eight CVH metrics. The prevalence estimates were age-standardized directly using the 2022 EU 28 population. Mixed effects multivariable linear and logistic regression models identified key LE8 score determinants.</div></div><div><h3>Results</h3><div>The study included 191,335 participants free of prior cardiovascular disease, with an average age of 46.48 years (SD 13.41) and 54 % women, representing 45.17 million individuals aged 18–69 in France. The overall mean LE8 score was 66.11 (68.92 in women vs. 62.79 in men, <em>p</em> = 6.875e⁻⁷), 13.21 %, 76.81 %, and 9.43 % achieved high (≥ 80 points), moderate (50–79 points), and poor (&lt; 50 points) LE8 levels, respectively. Diet had the lowest mean score (41.50), while blood glycemia had the highest mean score (95.50). Mixed effects multivariable regression models identified younger age, womanhood, high educational attainment, self-employment, or managerial positions, not living with a partner, fewer depressive symptoms, lower alcohol consumption, rural residence, less socioeconomic deprivation, and absence of CVD family history as predictors of higher LE8 scores.</div></div><div><h3>Conclusions</h3><div>Only 13.21 % of adults in France achieved a high LE8 score (≥ 80 points), and disparities related to individual and contextual socio-demographic factors and mental health were identified. The findings further underscore the importance of timely implementation of effective and personalized primordial prevention strategies.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"22 ","pages":"Article 100981"},"PeriodicalIF":4.3,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769099","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":"Age and sex differences in the efficacy of early invasive strategy for non-ST-elevation acute coronary syndrome: A comparative analysis in stable patients","authors":"Edina Cenko ,&nbsp;Maria Bergami ,&nbsp;Jinsung Yoon ,&nbsp;Giuseppe Vadalà ,&nbsp;Sasko Kedev ,&nbsp;Jorgo Kostov ,&nbsp;Marija Vavlukis ,&nbsp;Elif Vraynko ,&nbsp;Davor Miličić ,&nbsp;Zorana Vasiljevic ,&nbsp;Marija Zdravkovic ,&nbsp;Alfredo R. Galassi ,&nbsp;Olivia Manfrini ,&nbsp;Raffaele Bugiardini","doi":"10.1016/j.ajpc.2025.100984","DOIUrl":"10.1016/j.ajpc.2025.100984","url":null,"abstract":"<div><h3>Objective</h3><div>Previous works have struggled to clearly define sex-specific outcomes based on initial management in NSTE-ACS patients. We examined if early revascularization (&lt;24 h) versus conservative strategy impacts differently based on sex and age in stable NSTE-ACS patients upon hospital admission.</div></div><div><h3>Methods</h3><div>We identified 8905 patients with diagnosis of non‐ST elevation acute coronary syndromes (NSTE-ACS) in the ISACS-TC database. Patients with cardiac arrest, hemodynamic instability, and serious ventricular arrhythmias were excluded. The final cohort consisted of 7589 patients. The characteristics between groups were adjusted using inverse probability of treatment weighting models. Primary outcome measure was all-cause 30-day mortality. Risk ratios (RRs) with their 95 % CIs were employed.</div></div><div><h3>Results</h3><div>Of the 7589 NSTE-ACS patients identified, 2450 (32.3 %) were women. The data show a notable reduction in mortality for the older women (aged 65 years and older) undergoing early invasive strategy compared to those receiving an initial conservative (3.0 % versus 5.1 %; RR: 0.57; 95 % CI: 0.32 – 0.99) Conversely, younger women did not exhibit a significant association between early invasive strategy and mortality reduction (2.0 % versus 0.9 %; RR: 2.27; 95 % CI: 0.73 – 7.04). For men, age stratification did not markedly alter the observed benefits of an early invasive strategy over a conservative approach in the overall population, with reduced death rates in both older (3.1 % versus 5.7 %; RR: 0.52; 95 % CI: 0.34 – 0.80) and younger age groups (0.8 % versus 1.7 %; RR: 0.46; 95 % CI: 0.22 – 0.94). These age and sex-specific mortality patterns did not significantly change within subgroups stratified by the presence of NSTEMI, or a GRACE risk score&gt;140.</div></div><div><h3>Conclusion</h3><div>Early coronary revascularization is associated with improved 30-day survival in older men and women and younger men who present to hospital in stable conditions after NSTE-ACS. It does not confer a survival advantage in young women. Further studies are needed to more accurately risk-stratify young women to guide treatment strategies.</div></div><div><h3>Registration</h3><div>ClinicalTrials.gov: NCT01218776</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"22 ","pages":"Article 100984"},"PeriodicalIF":4.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791578","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":"Association of cardiovascular-kidney-metabolic syndrome with all-cause and cardiovascular mortality: A prospective cohort study","authors":"Jiangtao Li ,&nbsp;Xiang Wei","doi":"10.1016/j.ajpc.2025.100985","DOIUrl":"10.1016/j.ajpc.2025.100985","url":null,"abstract":"<div><h3>Background</h3><div>Given evidence on the cardiovascular disease (CVD) risk conferred by comorbidity risk factors, the American Heart Association (AHA) recently introduced a novel staging construct, named cardiovascular-kidney-metabolic (CKM) syndrome. This study examined the association of CKM syndrome stages with all-cause and cardiovascular mortality among US adults.</div></div><div><h3>Methods</h3><div>Data were from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 at baseline linked to the 2019 National Death Index records. For each participant, the CKM syndrome was classified into five stages: stage 0 (no CKM risk factors), 1 (excess or dysfunctional adiposity), 2 (metabolic risk factors and chronic kidney disease), 3 (subclinical CVD), or 4 (clinical CVD). The main outcomes were all-cause and cardiovascular mortality.</div></div><div><h3>Results</h3><div>Among 34,809 participants (mean age: 46.7 years; male: 49.2 %), the prevalence of CKM stages 0 to 4 was 13.2 %, 20.8 %, 53.1 %, 5.0 %, and 7.8 %, respectively. During a median follow-up of 8.3 years, compared to participants with CKM stage 0, those with higher stages had increased risks of all-cause mortality (stage 2: HR 1.43, 95 % 1.13–1.80; stage 3, HR 2.75, 95 % CI 2.12–3.57; stage 4, HR 3.02, 95 % CI 2.35–3.89). The corresponding hazard ratios (95 % confidence interval) of cardiovascular mortality risks were 2.96 (1.39–6.30), 7.60 (3.50–16.5), and 10.5 (5.01–22.2). The population-attributable fractions for advanced (stages 3 or 4) vs. CKM syndrome stages (stages 0, 1, or 2) were 25.3 % for all-cause mortality and 45.3 % for cardiovascular mortality.</div></div><div><h3>Conclusion</h3><div>Higher CKM syndrome stages were associated with increased risks of all-cause and cardiovascular mortality. These findings emphasize that primordial and primary prevention efforts on promoting CKM health should be strengthened to reduce mortality risk.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"22 ","pages":"Article 100985"},"PeriodicalIF":4.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769100","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":"LDL cholesterol burden in elderly patients with familial hypercholesterolemia: Insights from real-world data","authors":"Torunn Melnes ,&nbsp;Martin P. Bogsrud ,&nbsp;Jacob J. Christensen ,&nbsp;Amanda Rundblad ,&nbsp;Kjetil Retterstøl ,&nbsp;Ingunn Narverud ,&nbsp;Pål Aukrust ,&nbsp;Bente Halvorsen ,&nbsp;Stine M. Ulven ,&nbsp;Kirsten B. Holven","doi":"10.1016/j.ajpc.2025.100986","DOIUrl":"10.1016/j.ajpc.2025.100986","url":null,"abstract":"<div><h3>Background and aims</h3><div>Familial hypercholesterolemia (FH) is a genetic disorder characterized by elevated low-density lipoprotein cholesterol (LDL-C) and increased risk of premature coronary heart disease (CHD). While current LDL-C levels usually guides therapy, the cumulative exposure to LDL-C (the LDL-C burden) is suggested to offer a more precise estimate of cardiovascular risk in people with FH. Therefore, using real-world data, this study aimed to estimate the LDL-C burden at different ages in elderly FH patients with and without CHD, and to assess the LDL-C burden at CHD onset.</div></div><div><h3>Methods</h3><div>Data was retrospectively collected from the medical records of elderly (&gt;60 years) FH patients at the Lipid Clinic in Oslo. The LDL-C burden (mM-years) was estimated based on repeated LDL-C measurements and information on lipid-lowering medication. Time-weighted average (TWA) LDL-C was calculated as LDL-C burden divided by years.</div></div><div><h3>Results</h3><div>We included 112 FH patients, of which 55 (49 %) had experienced at least one CHD-event, and 58 (52 %) were females. Median age at first and last visit were 50 years and 68 years, respectively, with a median of 9 (range; 2–14) available LDL-C measurements. Subjects with CHD had higher LDL-C burden at all ages tested (45, 50 and 60 years) compared with the non-CHD group (<em>p</em> &lt; 0.01, also after adjusting for sex), and had higher TWA LDL-C before treatment at the Lipid Clinic (<em>p</em> = 0.004), but not during follow-up (<em>p</em> = 0.6). There were no sex differences in LDL-C burden at all ages tested, also after adjusting for CHD (<em>p</em> &gt; 0.1). However, women had higher TWA LDL-C during follow-up at the Lipid Clinic (<em>p</em> = 0.01). Median LDL-C burden at CHD onset was 352 mM-years; numerically lower in women than in men (320 vs. 357 mM-years, respectively. <em>p</em> = 0.1).</div></div><div><h3>Conclusion</h3><div>Elderly FH patients with CHD had higher estimated LDL-C burden compared with FH patients without CHD, due to higher burden <em>prior to treatment</em>, highlighting the importance of early</div><div>detection and treatment.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"22 ","pages":"Article 100986"},"PeriodicalIF":4.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785296","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 microvascular dysfunction and its role in heart failure with preserved ejection fraction for future prevention and treatment","authors":"Rachel M Bond ,&nbsp;Kendra Ivy ,&nbsp;Tre'Cherie Crumbs ,&nbsp;Vikram Purewal ,&nbsp;Samed Obang ,&nbsp;Dan Inder S Sraow","doi":"10.1016/j.ajpc.2025.100983","DOIUrl":"10.1016/j.ajpc.2025.100983","url":null,"abstract":"<div><div>Ischemic heart disease has long been established as the leading cause of heart failure, typically as a result of hemodynamically significant and obstructive coronary anatomy. Since, the role of dysfunctional coronary microvascular pathophysiologic mechanisms have also been associated with the development of congestive heart failure (CHF), most notably heart failure with preserved ejection fraction (HFpEF) although with limited clinical evidence. Conventional cardiometabolic and behavioral risk factors common to HFpEF such as diabetes mellitus (DM), obesity, hypertension, dyslipidemia, smoking, and chronic kidney disease foster a pro-inflammatory environment conducive to endothelial dysfunction and improper regulation of vasoactive substances. The impaired relaxation and increased vasoconstriction of damaged endothelium gives rise to impaired coronary blood flow and episodes of transient ischemia. Such coronary microvascular dysfunction (CMD) has its own implication on cardiovascular pathophysiologic mechanisms beyond symptomatic coronary and myocardial ischemia, and thus its own potential prevention goals and treatment targets for patients with HFpEF, where previous management had been limited. As such, we conducted a literature review to address the current landscape of data which links CMD to HFpEF. Furthermore, we considered the implications of biopsychosocial elements such as race, ethnicity, sex, gender, and the social determinants of health as they relate to the disparate health outcomes of those most at risk for CMD and HFpEF.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"22 ","pages":"Article 100983"},"PeriodicalIF":4.3,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769093","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}