American journal of preventive cardiology最新文献

{"title":"PATIENT JOURNEY AND HEALTHCARE PROFESSIONALS’ PERSPECTIVES OF INFLAMMATION IN ATHEROSCLEROTIC CARDIOVASCULAR DISEASE","authors":"Brittany Weber MD, PhD ,&nbsp;Delilah McCarty PharmD, BCACP, CDCES ,&nbsp;Carey Robar MD ,&nbsp;Udi Fainberg MD ,&nbsp;Marat Fudim MD, MHS ,&nbsp;Katherine Byrne MS ,&nbsp;Ty Gluckman MD, FACC","doi":"10.1016/j.ajpc.2025.101115","DOIUrl":"10.1016/j.ajpc.2025.101115","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>Few surveys have focused on the patient journey in the management of secondary prevention of atherosclerotic cardiovascular disease (ASCVD) or healthcare professionals’ (HCP) perspectives on the role of systemic inflammation in ASCVD.</div></div><div><h3>Methods</h3><div>This 30-minute, self-administered, IRB-exempt, US survey was conducted between June 7 to August 6, 2024. It comprised ASCVD patients (n=200) self-diagnosed with myocardial infarction (n=61), stroke (n=72), or peripheral artery disease (n=67), and HCPs (n=204), including cardiologists, cardiology specialists, and cardiology nurse practitioners or physicians’ assistants.</div></div><div><h3>Results</h3><div>Patient participants were aged 19 to 75 years, 58% male, and primarily White (74%) or Black/African American (18%) and diagnosed with ASCVD 3 months to 5 years earlier. Most common comorbidities in ASCVD patients according to HCPs were hyperlipidemia (60%), hypertension (56%), obesity (44%), and diabetes (38%). According to HCPs, ASCVD patients most often were receiving statins (78%) and antiplatelet therapy (65%). Only 18% of ASCVD patients believed their treatment was working extremely well; 82% reported persistent symptoms, including chest pain (28%), issues walking (28%), or breathing issues and/or cough (26%). Most HCPs (87%) believed that a residual CV risk remained after modifying traditional risk factors in ASCVD. Approximately 66% of HCPs agreed that systemic inflammation is a key underlying cause of ASCVD and not sufficiently addressed by current treatments, and 58% reported being satisfied with current ASCVD treatments. Approximately 30% of cardiologists sampled often or always test for hsCRP, and of those, 79% did so due to the presence or suspicion of an inflammatory comorbidity. Most HCPs (61%) agreed with the statement that IL-1 and IL-6 are not routinely tested in ASCVD patients and are not included in guidelines or considered standard of care.</div></div><div><h3>Conclusions</h3><div>Unmet needs remain, and gaps exist in diagnosing and managing systemic inflammation in ASCVD patients. Most patients reported persistent symptoms and only ∼20% believed their treatment was working well. 66% of HCPs believed systemic inflammation is not sufficiently addressed by current treatments.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101115"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104831","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":"IMPACT OF POST-TRAUMATIC STRESS DISORDER (PTSD) ON PATIENTS WITH CORONARY ARTERY DISEASE (CAD): INSIGHTS FROM THE NATIONAL INPATIENT DATABASE 2021-2022","authors":"Rajat Gupta MD,&nbsp;Gabriel Velez Oquendo MD,&nbsp;Sana Ahmed MD,&nbsp;Yash Garg MD","doi":"10.1016/j.ajpc.2025.101167","DOIUrl":"10.1016/j.ajpc.2025.101167","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD in Special Populations</div></div><div><h3>Background</h3><div>While common modifiable factors for coronary artery disease (CAD) have been well studied, the data on impact of post-traumatic stress disorder (PTSD) on cardiovascular outcomes remains limited. Our study aims to assess the impact of PTSD on the mortality and secondary outcomes in CAD population.</div></div><div><h3>Methods</h3><div>Data was obtained from the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) 2021-2022 database using ICD-10-CM codes to assess the impact of PTSD on mortality and other variables including length of stay in hospital, cardiac arrest, and acute coronary syndrome, in CAD patients. Multivariable logistic regression analysis was applied to analyze the above outcomes.</div></div><div><h3>Results</h3><div>A total of 1,111,533 patients with CAD were identified in the NIS database, of which 12,107 patients had a diagnosis of PTSD. Patients in the PTSD cohort belonged to the 18-34 age group [OR = 22.57, (95% CI: 19.10, 26.68), p &lt; 0.001], predominantly male [OR = 1.27, (95% CI: 1.22, 1.32), p &lt;0.001], and Native Americans [OR = 6.01, (95% CI: 4.54, 7.96), p &lt;0.001]. The presence of PTSD was associated with lower in-hospital mortality [OR = 0.46, (95% CI: 0.41, 0.53), p &lt; 0.001], no change in length of stay [OR = 1.00, (95% CI: 1.00, 1.00), p = 0.995]. Moreover, secondary outcomes including cardiac arrest and acute coronary syndrome decreased odds (p &lt; 0.001 and 0732, respectively) in patients with PTSD.</div></div><div><h3>Conclusions</h3><div>PTSD was associated with early onset CAD (as average age in the PTSD cohort was 18-34 years) compared to average onset of CAD at around 55 years in males. This may indicate increased risk of CAD in patients with PTSD, especially native Americans, however, other confounding social and lifestyle factors need to be studied. It was also interesting to find PTSD associated with CAD had decreased in hospital mortality compared to the control cohort. We do not feel that PTSD is protective in coronary artery disease, but rather the patient cohort with PTSD and CAD had smaller population and possibly increased healthcare utilization over a period of time. However, this will need to be further elucidated in future prospective clinical trials.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101167"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104902","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":"URBAN-RURAL DISPARITIES IN THE PRESCRIPTION OF NOVEL LIPID-LOWERING THERAPIES","authors":"Jimin Hwang MD MPH,&nbsp;Emily Decicco MD,&nbsp;Eric Peterson MD, MPH,&nbsp;Anand Gupta MBBS, MPH,&nbsp;Evelyn Sarnes PharmD, MPH,&nbsp;Ann Marie Navar MD, PhD","doi":"10.1016/j.ajpc.2025.101090","DOIUrl":"10.1016/j.ajpc.2025.101090","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research</div></div><div><h3>Background</h3><div>Rural areas in the U.S. face a disproportionate burden of atherosclerotic cardiovascular disease (ASCVD) and face limited access to specialist care. Because specialists more commonly prescribe novel therapies, this can also impact access to new medications. In this study, we sought to examine rural-urban differences in the presence and characteristics of prescribers of novel lipid lowering therapies (LLT).</div></div><div><h3>Methods</h3><div>This cross-sectional study analyzed pharmacy transaction data from Symphony Health Solutions (2018–2022) for all prescriptions of any lipid lowering therapy. Prescribers were identified from the Symphony database and cross-matched with their National Provider Identifier number. Prescriber address was linked to census tract-level data, which were classified as rural or urban based on Health Resources and Services Administration definitions. At the census-tract level, the presence of prescribers for novel LLTs overall and by prescriber specialty was assessed.</div></div><div><h3>Results</h3><div>Among 85,396 census tracts (20.3% rural), 62.9% had at least one prescriber of LLT, including 66.7% of urban and 59.7% of rural census tracts. Of these with any LLT prescriber, at least one prescriber of novel LLT (PCSK9i or Bempedoic acid) was present in 42.7% of rural census tracks and 36% of urban census tracks. In urban areas, 67.7% of cardiology LLT prescribers and 50.2% of primary care prescribers had prescribed at least one novel LLT. In rural areas, 80.0% of cardiologists and 52.9% of primary care prescribers had prescribed at least one novel LLT. In multivariable modeling, the presence of a cardiologist was associated with greater likelihood of the presence of a prescriber of novel LLT (OR 11.6, 95%CI 10.2–11.6), but there was no difference in the odds of the presence at least one prescriber of novel LLT between urban and rural areas (OR 1.0, 95%CI 0.9–1.0).</div></div><div><h3>Conclusions</h3><div>Specialists and primary care providers in rural areas were more likely to prescribe a novel LLT than those in urban areas. As a result, despite differences in access to specialist care, among census tracts with at least one prescriber of LLT, rural areas were not less likely to have a prescriber of novel LLT.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101090"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104955","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":"HEART SMART: DEVELOPING SURVIVING AND THRIVING WITH HEART DISEASE – A COMPREHENSIVE HEART DISEASE BOOK AND IOS MOBILE APPLICATION FOR CARDIOVASCULAR MONITORING AND EDUCATION","authors":"Fah Sysavanh B.S. (current OMS-II),&nbsp;Ermin Tale B.S. (current OMS-IV),&nbsp;Alicia Purtell B.S. (current OMS-II),&nbsp;William Gao B.S. (current OMS-II),&nbsp;Todd Cohen MD","doi":"10.1016/j.ajpc.2025.101168","DOIUrl":"10.1016/j.ajpc.2025.101168","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research</div></div><div><h3>Background</h3><div>Cardiovascular disease is a leading cause of death worldwide, with professional societies emphasizing risk reduction and health literacy. Evidence-based, comprehensive heart disease books and a user-friendly iOS mobile application can be used to empower patients to learn about and monitor their cardiovascular health. The objective of this project is to develop a comprehensive heart disease book on heart disease prevention and treatment in conjunction with an iOS mobile application to track cardiovascular metrics, while providing interactive educational content for healthcare workers and patients alike.</div></div><div><h3>Methods</h3><div>The book <em>Surviving and Thriving with Heart Disease</em> will expand on <em>A Patient’s Guide to Heart Rhythm Problems</em> (Johns Hopkins University Press), which is narrower in scope and outdated. The authors sought information on preventing and treating heart disease from a world-renowned preventative cardiologist and guest doctors to provide insight on multifactorial management strategies. An accompanying iOS mobile application, developed using the Waterfall method and Native app approach, was built using Xcode software version 15.2, programmed in Swift 5.8.1, and tested on the iPhone 13 Pro Max (iOS 17.6.1) to ensure quality and performance.</div></div><div><h3>Results</h3><div>The expanded book includes updated medical information on treatment strategies, alternative medicine, osteopathy, mindfulness, artificial intelligence, telemedicine, and coping strategies for healthcare workers and patients. It features a “Surviving and Thriving” card, available in the book, mobile application, and Long Island Heart Rhythm Center website, to help patients track key health information (Plan B, Figure 1). The mobile application also offers interactive features: cardiovascular metrics widgets and graphs, a language model for user inquiries, a Framingham Risk score calculator, and educational animations of cardiovascular conditions (Figure 2a and 2b).</div></div><div><h3>Conclusions</h3><div>This book, to be published via Springer Publishing, is an important resource for healthcare workers and patients. It highlights the importance of having a Plan B and provides a way to track important heart-related numbers using the “Surviving and Thriving” card, complemented by a mobile application to improve health literacy. Future developments include integrating the American Heart Association’s <em>Predicting Risk of cardiovascular disease EVENTs</em> model and conducting a longitudinal study on the application’s benefits.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101168"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104987","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":"The long-term prognostic value of the framingham risk scoring in patients with myocardial infarction with nonobstructive coronary arteries","authors":"Hao Zhang ,&nbsp;Sizhuang Huang ,&nbsp;Yanwen Fang ,&nbsp;Side Gao ,&nbsp;Jiansong Yuan ,&nbsp;Mengyue Yu","doi":"10.1016/j.ajpc.2025.101269","DOIUrl":"10.1016/j.ajpc.2025.101269","url":null,"abstract":"<div><h3>Background</h3><div>The Framingham Risk Score for Cardiovascular Disease (FRSCVD), based on the Framingham Heart Study, serves as a foundation for many prediction models. However, its applicability in predicting the long-term prognosis of patients experiencing myocardial infarction with nonobstructive coronary arteries (MINOCA) remains uncertain.</div></div><div><h3>Methods</h3><div>A cohort of 1158 MINOCA patients was enrolled and stratified into three groups based on 10-year FRSCVD risk. The primary endpoint was defined as major adverse cardiovascular events (MACE), which included all-cause mortality, non-fatal myocardial infarction, ischemic stroke, revascularization, and hospitalizations due to unstable angina or heart failure. Cox regression models, Kaplan-Meier survival curves, and receiver-operating characteristic (ROC) curve analyses were conducted.</div></div><div><h3>Results</h3><div>Over the median follow-up of 47.4 months, the incidence of MACE increased significantly in MINOCA patients with higher FRSCVD risk stratification (9.6 % vs. 12.5 % vs. 20.8 %; <em>P</em> &lt; 0.001). Increased FRSCVD was independently associated with a higher risk of MACE after adjustment for relevant risk factors (HR 1.108, 95 % CI: 1.053–1.166, <em>p</em> &lt; 0.001). The Kaplan-Meier curves also demonstrated a higher risk of MACE events in the high-risk FRSCVD group (log-rank <em>P</em> &lt; 0.001). Time-dependent ROC analyses revealed that the area under the curve (AUC) of FRSCVD for predicting distant MACE in MINOCA patients was 0.687 (AUC at 1 year), 0.641 (AUC at 3 years), and 0.610 (AUC at 5 years).</div></div><div><h3>Conclusions</h3><div>FRSCVD demonstrates a significant association with long-term prognosis in MINOCA patients, exhibiting particular predictive value for heart failure progression while serving as a potential tool for early risk stratification.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101269"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144920159","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":"NEW-ONSET AND PRE-EXISTING CARDIOVASCULAR COMORBIDITIES AND SURVIVAL OF LUNG CANCER PATIENTS IN KOREA","authors":"Kui Son CHOI ,&nbsp;Dong-Woo CHOI Ph.D. ,&nbsp;Hye Jin YOON MPH","doi":"10.1016/j.ajpc.2025.101151","DOIUrl":"10.1016/j.ajpc.2025.101151","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD in Special Populations</div></div><div><h3>Background</h3><div>Lung cancer patients exhibit the highest incidence of cardiovascular comorbidities among all cancer types. However, the impact of the timing of cardiovascular disease (CVD) onset on mortality risk in lung cancer patients remains unclear. This study aimed to assess the role of pre-existing and new-onset CVD in survival of patients with non-small cell lung cancer (NSCLC).</div></div><div><h3>Methods</h3><div>3,144 patients with non-small cell lung cancer (NSCLC) who visited the National Cancer Center in Korea (2012-2017) were analyzed. CVD status was categorized into “none”, “pre-existing”, and “new-onset”, defined by hospitalization for myocardial infarction (I21–I23, MI), ischemic stroke (I63, G45, STR), or heart failure (I50, HF) within 1 year before or after NSCLC diagnosis, using the International Classification of Diseases, 10th Revision (ICD-10). Cox regression analysis using landmark approach (1 year landmark period) and A time-dependent Cox regression analysis were performed to confirm the consistency of the results. Furthermore, the pre-existing group was subdivided into “stable pre-existing” (CVD diagnosed only before cancer) and “recurrent” (CVD events recurring after cancer diagnosis) groups.</div></div><div><h3>Results</h3><div>Of 3,144 NSCLC patients (mean age 64.2 years; 36.9% women), 92.8% had no CVD, 3.6% had pre-existing CVD, and 3.7% had new-onset CVD. Mortality was highest in the new-onset group (61.7%), followed by pre-existing (54.5%), and none (47.8%). New-onset CVD was associated with increased mortality risk compared to non-CVD group (adjusted Hazard Ratio [aHR]: 1.90, 95% Confidence Interval [CI]: 1.47-2.45), In contrast, the pre-existing or recurrent CVD groups did not show a significant increase in mortality risk. This pattern was consistent across each CVD component analyzed. Moreover, time-dependent Cox regression analysis produced consistent results, thereby supporting the robustness of the findings. Additionally, the highest mortality risk in the new-onset group occurred at 1 year (aHR: 2.29, 95% CI: 1.65-3.18). Subgroup analysis revealed heterogeneity in mortality risks among women, patients with BMI &lt;25 kg/m², and smokers.</div></div><div><h3>Conclusions</h3><div>Among patients with NSCLC, new-onset CVD was strongly associated with increased mortality, particularly within the first year after diagnosis. These findings highlight the critical importance of early cardiovascular risk detection and proactive management in NSCLC patients, underscoring the need for integrated cardio-oncology approaches.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101151"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104240","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":"EFFECT OF OBICETRAPIB ON NEW ONSET DIABETES IN PATIENTS WITH ELEVATED LDL-C RECEIVING MAXIMALLY TOLERATED STATIN THERAPY: POOLED ANALYSES OF THE BROADWAY AND BROOKLYN TRIALS","authors":"John JP Kastelein MD, PhD ,&nbsp;Kausik K Ray MD MPHil FMedSci ,&nbsp;Michael Szarek PhD ,&nbsp;Adam J Nelson MBBS PhD ,&nbsp;Marc Ditmarsch MD ,&nbsp;Douglas Kling MBA ,&nbsp;Michael H Davidson MD ,&nbsp;Stephen J Nicholls MBBS PhD","doi":"10.1016/j.ajpc.2025.101134","DOIUrl":"10.1016/j.ajpc.2025.101134","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Pharmacologic Therapy</div></div><div><h3>Background</h3><div>Clinical and genetic studies indicate LDL-C lowering cardiovascular benefits proportional to LDL-C degree reduction, not by its mechanism achieved; however, LDL-C lowering effect on glycemic control and new onset diabetes (NoD) vary by intervention. Although genetics predict on-target effect on HMGCoA, NCP1L1 and PCSK9 lowering of NoD risk, this has only been observed in statin trials. Obicetrapib, a cholesteryl ester transfer protein inhibitor (CETPi), reduces LDL-C, Lp(a) and raises apoA1/HDL-C. Metaanalyses of early CETPi trials demonstrated 16% lower NoD risk. Effects of obicetrapib on glycaemia and NoD risk are unknown.</div></div><div><h3>Methods</h3><div>Pooled analysis of BROADWAY and BROOKLYN trials which randomized ASCVD or HeFH patients with elevated LDL-C despite maximally tolerated statins to Obicetrapib 10mg once daily or placebo for 1 year, were conducted. Obicetrapib’s day 84 and 365 HbA1c effects and NoD risk in patients without known baseline diabetic history and glycaemia strata (prediabetes, or normoglycemia), were assessed - adjusted for baseline Hba1c, trial and statin use. An additional updated meta-analysis of NoD risk with CETPi including obicetrapib data was performed, determining whether any observed associations were consistent with prior class-level observations.</div></div><div><h3>Results</h3><div>1848 patients, mean age 63.4, women 38.1%, 89.7% on statin were included with baseline median LDLC, 96 mg/dl (IQR 78-126), HbA1c 5.7% (5.4%-5.9%). Placebo-corrected LDL-C, Lp(a), and HDL-C median changes were -35.3%, -35.6%, and +136.7% (all P &lt; 0.0001. Post-baseline HbA1c was lower with Obicetrapib vs Placebo, p &lt;0.0297), consistent by glycemia stratum (Figure). Treatment HR for NoD was 0.77 (95% CI 0.57-1.04), p=0.09 (Figure) with consistent trends in those within normoglycemia and prediabetes (Figure). The additional updated meta-analysis, including obicetrapib data from 4 prior large RCTS, produced an overall RR for NoD of 0.83 (CI 0.77-0.90), 13.5%, p-value for heterogeneity 0.493, consistent with CETPi overall class effect</div></div><div><h3>Conclusions</h3><div>Obicetrapib reduced HbA1c trending towards lower risk of NoD in prediabetic and normoglycemic patients at baseline. Although obicetrapib led to greater LDL-C reductions than other CETPi, Obicetrapib effects on NoD were consistent with other CETPi. As risk of NoD accrues over time, larger, longer trials are needed to determine full degree of potential protective effects of obicetrapib on NoD risk.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101134"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104491","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":"SAFETY AND EFFICACY OF CHOLESTERYL ESTER TRANSFER PROTEIN INHIBITION: FROM GENETICS TO OUTCOME TRIALS","authors":"John JP Kastelein MD, PhD ,&nbsp;Brian A. Ference MD, Mphil, FMedSci ,&nbsp;Adam J Nelson MBBS, PhD ,&nbsp;Stephen Nicholls MBBS, PhD ,&nbsp;Kausik K Ray MD, Mphil, FMedSci","doi":"10.1016/j.ajpc.2025.101135","DOIUrl":"10.1016/j.ajpc.2025.101135","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>To investigate the associations between HDL-C levels with mortality and cardiovascular (CV) events; the safety of increased HDL-C due to CETP inhibition; and the efficacy of CETP as a target of lipid-altering therapy.</div></div><div><h3>Methods</h3><div>The cumulative rates of major coronary events, CV mortality, and non-CV mortality were compared among participants in the UK Biobank (n∼445,000) who were randomized by nature to different levels of lifetime exposure to HDL-C (Mendelian randomization [MR]) using an instrumental variable genetic score. The cumulative rates of major coronary events among participants randomized by nature to CETP, HMG CoA reductase, and PCSK9 inhibition was compared for the same absolute reduction in apoB among participants in the UK Biobank or CARDloGRAMplusC4D consortium (n=630,070). A Meta-analysis of RCTs adjusted for magnitude and duration of therapy was used to estimate the association between CETP inhibition induced changes in plasma HDL-C and the risk of both all-cause and CV mortality (n=58,412); and between CETP inhibition and the risk of major CV events, CV mortality, and all-cause mortality (n=42,541).</div></div><div><h3>Results</h3><div>There was no compelling unconfounded evidence from observational studies, MR studies, or RCTs that very high plasma HDL-C levels increase risk of all-cause, non-CV, or CV mortality. CETP inhibition is associated with a modestly lower risk of all-cause and CV mortality. There was consistent randomized evidence from MR and RCTs that CETP inhibition reduces risk of major CV events proportional to the achieved reduction in plasma apoB, and by approximately the same amount as statins and PCSK9 inhibitors for the same achieved reduction in apoB.</div></div><div><h3>Conclusions</h3><div>Neither naturally occurring elevated HDL-C or therapeutically increased HDL-C due to CETP inhibition are associated with increased all-cause, CV, or non-CV mortality. ApoB reduction induced by CETP inhibition reduces CV risk by approximately the same degree as reductions induced by statins and PCSK9 inhibitors.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101135"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104495","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":"VICTORION-INITIATE: LOW-DENSITY LIPOPROTEIN CHOLESTEROL GOAL ATTAINMENT AND CUMULATIVE EXPOSURE WITH “INCLISIRAN FIRST” VERSUS USUAL CARE IN PATIENTS WITH ATHEROSCLEROTIC CARDIOVASCULAR DISEASE","authors":"Fatima Rodriguez MD, MPH ,&nbsp;Michael Koren JMD ,&nbsp;Cara East MD ,&nbsp;Yousuf Ali PhD ,&nbsp;Kelly Kleeman ,&nbsp;Samiha Sarwat ,&nbsp;Cheryl Abbas ,&nbsp;Peter Toth MD, PhD","doi":"10.1016/j.ajpc.2025.101130","DOIUrl":"10.1016/j.ajpc.2025.101130","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD /CVD Risk Reduction</div></div><div><h3>Background</h3><div>Rapid and sustained attainment of guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals is critical for patients with atherosclerotic cardiovascular disease (ASCVD). In VICTORION-INITIATE, inclisiran allowed more patients with ASCVD to achieve and sustain LDL-C goals vs current usual care (UC).This study evaluated cumulative LDL-C exposure in the overall population and LDL-C goal attainment and safety in prespecified subgroups receiving an “inclisiran first” implementation strategy (IF; adding inclisiran immediately on failure to achieve LDL-C &lt;70 mg/dL with maximally tolerated statins) compared with UC.</div></div><div><h3>Methods</h3><div>VICTORION-INITIATE was a 330-day, prospective, pragmatically designed trial conducted at 45 sites across 20 states in the United States. Patients were randomized 1:1 (stratified by insurance status) to IF (open-label inclisiran 284 mg at Days 0, 90 and 270 plus UC) or UC alone, (lipid management directed by treating physician’s discretion). Subgroup analysis evaluated LDL-C goal attainment by timing of the most recent ASCVD event (&lt;1 year/≥1 year prior to consent), ASCVD subtype (coronary heart disease [CHD], peripheral arterial disease [PAD], and cerebrovascular disease [CVD]) and statin intolerance. Cumulative LDL-C exposure and safety by subgroup were also evaluated.</div></div><div><h3>Results</h3><div>Of 450 patients randomized to IF or UC, 11.1% and 84.2% had an ASCVD event &lt;1 year or ≥1 year prior to consent, respectively; 91.8%, 18.2% and 14.7% had a history of CHD, CVD or PAD, and 25.8% were statin intolerant. Cumulative exposure to LDL-C to Day 330 was &gt;50% lower with IF vs UC (mean time-adjusted LDL-C: 42.4 mg/dL vs 90.7 mg/dL, (Figure). Significantly more patients on IF achieved LDL-C goals of &lt;70 mg/dL and &lt;55 mg/dL at Day 330 vs UC, irrespective of the subgroups (Table). Across subgroups, the incidence of treatment-emergent adverse events (TEAEs) and serious TEAEs were similar between IF and UC (IF: 52.6%-71.2%, UC: 46.2%-66.0% and IF: 10.7%-28.3%, UC: 11.4%-22.2%, respectively).</div></div><div><h3>Conclusions</h3><div>Patients with ASCVD and LDL-C &gt;70 mg/dL on IF had lower cumulative LDL-C exposure and achieved rapid and sustained LDL-C goals than those on UC, regardless of ASCVD subtype, event timing, and statin intolerance. The safety profile of IF was consistent across subgroups, with no differences in adverse events vs UC.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101130"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104632","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":"EXPLORING THE UTILITY OF A CVD RISK PREDICTING RETINAL AI MODEL IN IDENTIFYING CACS OVER 400 IN PATIENTS WITH AND WITHOUT DIABETES","authors":"Dongjin Nam MD ,&nbsp;Sahil Thakur MBBS, MS, PhD ,&nbsp;A.V. Rukmini MBBS, MD, PhD ,&nbsp;Jaewon Seo BE ,&nbsp;Jungkyung Cho MD ,&nbsp;Junseok Park MD ,&nbsp;Tae Hyun Park MD ,&nbsp;Tyler Hyungtaek Rim MD, MBA, PhD ,&nbsp;Sung Soo Kim MD, PhD ,&nbsp;Chan Joo Lee MD, MM, PhD ,&nbsp;Sungha Park MD, MM, PhD","doi":"10.1016/j.ajpc.2025.101179","DOIUrl":"10.1016/j.ajpc.2025.101179","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>Dr. Noon CVD, a CVD risk prediction model based on retinal-imaging has been shown to estimate probability of coronary artery calcium (CAC). Dr.Noon risk categories (low, moderate, high) have shown performance comparable to conventional CAC risk categories (0, 1-99, ≥100) in predicting 5- year cardiovascular risk. For guiding intensive preventive strategies, CACS ≥400 is considered clinically significant. The current study explored the utility of Dr. Noon CVD to identify CACS ≥400 in patients with and without diabetes mellitus (DM).</div></div><div><h3>Methods</h3><div>This analysis included 1,252 participants from the CMERC-HI cohort classified into six groups based on Dr. Noon CVD risk level (low [&lt;31], moderate [&lt;41], high [41–51], very high [&gt;51]) and DM status. non-DM with low (1a), moderate (2a), high (3a) and very high (4a) risk; and DM with low (1b), moderate (2b), high (3b) and very high (4b) risk. We performed ROC analysis of the Dr. Noon CVD score for predicting CACS ≥400 and compared AUCs by DM status. Prevalence of CACS ≥400 was assessed for each group and logistic regression models calculated odds ratios (ORs), adjusting for cardiovascular risk factors.</div></div><div><h3>Results</h3><div>CACS ≥400 was present in 189 patients (15.1%). AUC was 0.787 (non-DM) and 0.758 (DM) with no significant difference (p=0.4186). Sensitivity and specificity across Dr. Noon CVD risk categories were comparable between DM and non-DM groups. The proportion of patients with CACS ≥400 increased incrementally from Group 1a (0.6%, 1 of 155) to Group 4b (43.0%, 64 of 149). In non-DM patients, both high- and very high-risk groups showed significantly higher odds of CACS ≥400, with clear separation even between high and very high-risk (OR=4.17, p&lt;0.001). In DM patients, only the very high-risk group showed significant elevation vs. high-risk (OR=3.81, p&lt;0.001), while high-risk alone was not distinguishable from lower-risk groups.</div></div><div><h3>Conclusions</h3><div>In addition to identifying 5y-CVD risk, Dr. Noon CVD could also be used to identify patients at increased risk of having a CACS ≥400. Future studies could evaluate the effectiveness of using Dr. Noon CVD when stratified using both Dr. Noon CVD risk category and diabetes status. Further analysis could support its clinical applicability for targeted preventive interventions.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101179"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104862","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}