American journal of preventive cardiology最新文献_第10页

Trends in utilization and cost of triglyceride-lowering therapies among Medicare beneficiaries: An analysis from the Medicare part D database 医疗保险受益人使用甘油三酯降低疗法的趋势和成本：来自医疗保险D部分数据库的分析

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-10-06 DOI: 10.1016/j.ajpc.2025.101318

Kabir Malkani , Ruina Zhang , Navjot Sobti , Krista Zachariah , Jacob Groenendyk , Subhanik Purkayastha , Xiaohan Ying , Danielle Newbury , Diala Steitieh , Sonika Patel , Vinay Kini

Background

Approximately 14 million U.S. adults may benefit from treatment of hypertriglyceridemia to reduce risk of atherosclerotic cardiovascular disease (ASCVD). While the evidence base for treatment of hypertriglyceridemia has significantly changed over time, patterns of utilization and spending on triglyceride-lowering therapies in the U.S. are not well-understood.

Methods

We used the Medicare Part D Prescriber dataset from 2013 to 2021 to identify all generic and brand name formulations of triglyceride-lowering therapies (fibrates, omega-3 acid ethyl esters, and niacin). We assessed annual expenditures and number of beneficiaries, evaluated trends and assessed potential savings to Medicare if generic medications were used in place of brand names.

Results

We identified seventeen oral triglyceride-lowering medications used from 2013–2021. There was a 22 % decline in beneficiaries receiving any triglyceride-lowering therapy and a 32 % reduction in Medicare spending over the study period. For fibrates, overall use declined by 21 % (from 1.6 million to 1.3 million beneficiaries) and spending declined by 67 % (from $735 million to $243 million). For omega-3 acid ethyl esters, overall use increased by 47 % (from 389k to 571k beneficiaries) and spending increased by 101 % (from $461 million to $925 million). For niacin, overall use declined by 87.3 % (from 445k to 56k beneficiaries) and spending declined by 92.9 % (from $431 million to $31 million). When generics became available, expenditure on and number of beneficiaries receiving brand name medications decreased. During the study period, $5.0 billion (41 %) was spent on brand name triglyceride-lowering therapies, and $1.5 billion could have been saved by switching to their respective generic versions when available.

Conclusions

Among Medicare Part D beneficiaries, use and spending on fibrates and niacin declined, while use and spending on omega-3 acid ethyl esters increased. These trends likely reflect changes in the evidence base and guideline recommendations for hypertriglyceridemia treatment. While most beneficiaries received generic medications when available, substantial spending on brand name medications persists, indicating potential missed opportunities for cost savings.

大约1400万美国成年人可能从治疗高甘油三酯血症中获益，以降低动脉粥样硬化性心血管疾病（ASCVD）的风险。虽然治疗高甘油三酯血症的证据基础随着时间的推移发生了显著的变化，但在美国，降低甘油三酯治疗的使用模式和支出还不是很清楚。方法：我们使用2013年至2021年的医疗保险D部分处方者数据集来识别所有通用和品牌名称的甘油三酯降低疗法（贝特酸酯、omega-3酸乙酯和烟酸）。我们评估了年度支出和受益人人数，评估了趋势，并评估了如果使用仿制药代替品牌药，医疗保险的潜在节省。我们确定了2013-2021年期间使用的17种口服甘油三酯降低药物。在研究期间，接受任何甘油三酯降低治疗的受益人减少了22%，医疗保险支出减少了32%。贝特类药物的总体使用减少了21%（从160万受益人减少到130万受益人），支出减少了67%（从7.35亿美元减少到2.43亿美元）。对于omega-3酸乙酯，总体使用量增加了47%（从38.9万受益人增加到57.1万受益人），支出增加了101%（从4.61亿美元增加到9.25亿美元）。对于烟酸，总体使用量下降了87.3%（从44.5万受益人下降到5.6万受益人），支出下降了92.9%（从4.31亿美元下降到3100万美元）。当获得仿制药时，接受品牌药物的支出和受益人人数减少。在研究期间，有50亿美元（41%）花费在降低甘油三酯的品牌疗法上，而如果在可用的情况下改用各自的仿制药，则可以节省15亿美元。结论：在医疗保险D部分受益人中，贝特酸盐和烟酸的使用和支出下降，而omega-3酸乙酯的使用和支出增加。这些趋势可能反映了高甘油三酯血症治疗的证据基础和指南建议的变化。虽然大多数受益人在可获得的情况下接受非专利药物，但在品牌药物上的大量支出仍然存在，这表明可能错过了节省成本的机会。

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引用次数: 0

Associations between artificial sweeteners and cardiovascular disease, stroke, and diabetes: A Mendelian randomization study 人工甜味剂与心血管疾病、中风和糖尿病之间的关系：一项孟德尔随机研究

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-10-06 DOI: 10.1016/j.ajpc.2025.101325

Jinming Fan , Yifei Hu , Junzhu Zhang , Jiawen Chen , Yajun Yuan , Benshuai Yu

Background

Erythritol is a widely used artificial sweetener, yet its long-term impact on cardiometabolic health remains debated. This study aimed to investigate the genetic associations of erythritol with cardiovascular disease (CVD), stroke, and diabetes using a two-sample Mendelian randomization (TSMR) approach.

Methods

We utilized single-nucleotide polymorphisms (SNPs) associated with erythritol levels from genome-wide association studies (GWAS) as instrumental variables (IVs). The primary analysis employed the inverse-variance weighted (IVW) method. Robustness was assessed using multiple sensitivity analyses (including MR-Egger, weighted median, weighted multitude, and simple mode). Heterogeneity test, pleiotropy test, and sensitivity analysis were also conducted to further ensure the accuracy and stability of the research results.

Results

Erythritol showed positive associations with coronary heart disease (CHD) (OR = 1.0020, 95% CI: 1.0007–1.0034, P = 0.0034), myocardial infarction (MI) (OR = 1.0015, 95% CI: 1.0004–1.0026, P = 0.0090), and stroke (OR = 1.0463, 95% CI: 1.0010–1.0937, P = 0.0449) according to the IVW method. There was suggestive evidence of a positive association between erythritol and CHD, MI, and stroke. No significant causal association was observed between erythritol with heart failure (HF) and diabetes.

Conclusions

This TSMR study provides genetic evidence suggesting erythritol is associated with an increased risk of CHD, MI, and stroke, but not with HF or diabetes. Our findings could further clarify the effect of erythritol on CVD, stroke and diabetes, and thus be more beneficial in reducing the risk of disease. Clinical trial number: not applicable.

豆芽糖醇是一种广泛使用的人工甜味剂，但其对心脏代谢健康的长期影响仍存在争议。本研究旨在采用双样本孟德尔随机化（TSMR）方法研究赤藓糖醇与心血管疾病（CVD）、中风和糖尿病的遗传关联。方法利用全基因组关联研究（GWAS）中与赤藓糖醇水平相关的单核苷酸多态性（snp）作为工具变量（IVs）。初步分析采用反方差加权（IVW）方法。采用多重敏感性分析（包括MR-Egger、加权中位数、加权众数和简单模式）评估稳健性。并进行异质性检验、多效性检验和敏感性分析，进一步保证研究结果的准确性和稳定性。结果根据IVW方法，赤四醇与冠心病（CHD）（OR = 1.0020, 95% CI: 1.0007 ~ 1.0034, P = 0.0034）、心肌梗死（MI）（OR = 1.0015, 95% CI: 1.0004 ~ 1.0026, P = 0.0090）、脑卒中（OR = 1.0463, 95% CI: 1.0010 ~ 1.0937, P = 0.0449）呈正相关。有提示证据表明赤藓糖醇与冠心病、心肌梗死和中风呈正相关。赤藓糖醇与心力衰竭（HF）和糖尿病之间没有明显的因果关系。结论：这项TSMR研究提供了遗传学证据，表明赤藓糖醇与冠心病、心肌梗死和中风的风险增加有关，但与心衰或糖尿病无关。我们的研究结果可以进一步阐明赤藓糖醇对心血管疾病、中风和糖尿病的作用，从而更有利于降低疾病的风险。临床试验号：不适用。

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引用次数: 0

Systemic inflammation modulates lipoprotein(a)-associated coronary stenosis in the chronic coronary syndromes 慢性冠状动脉综合征中全身性炎症调节脂蛋白(a)相关冠状动脉狭窄

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-10-05 DOI: 10.1016/j.ajpc.2025.101324

Lu Shen , Wenqing Zhai , Ping Jiang , Feng Liang , Ruonan Li , Dongju Xu , Qingna Zhang , Jing Zhang , Xingyong Tao

Background

Recent researches highlight the interdependence of lipoprotein(a) [Lp(a)] and Lp(a)-associated cardiovascular risk with the background inflammatory burden. This study aimed to investigate whether systemic inflammation modulates Lp(a)-associated coronary stenosis in chronic coronary syndromes (CCS).

Methods

A total of 1513 participants undergoing angiography at a tertiary cardiology center in China were included in our retrospective, cross-sectional study. Participants were categorized into normal, mild, and severe groups based on the Gensini Scores, which quantitatively assess stenosis severity. Multinomial logistic models were calculated according to accompanying systemic inflammation concentration.

Results

Participants with elevated Lp(a) levels had a high coronary stenosis risk: fully adjusted model odds ratios (ORs) [95% confidence intervals (CIs)] for the mild vs. normal and severe vs. normal groups were 1.47 (1.11-1.96) and 1.68 (1.21-2.33). Notably, the strongest Lp(a)-coronary stenosis associations after multi-variable adjustment persisted only in low inflammation concentration [systemic inflammation response index (SIRI) < 0.64)] [mild vs. normal, OR 2.03, 95% CI 1.17-3.54, P = 0.012; severe vs. normal, OR 2.34, 95% CI 1.24-4.44, P = 0.009], with no associations in moderate (0.64 ≤ SIRI < 1.41) and high (SIRI ≥ 1.41) state. Identical analysis across the systemic immune-inflammation index (SII) and neutrophil to lymphocyte ratio (NLR) yielded consistent results.

Conclusions

Elevated Lp(a) correlates with coronary stenosis only in low inflammation concentration. Considering systemic inflammation in personalized Lp(a)-lowering therapies is more conducive for CCS managements.

最近的研究强调了脂蛋白(a) [Lp(a)]和Lp(a)相关的心血管风险与背景炎症负担的相互依赖性。本研究旨在探讨全身性炎症是否会调节慢性冠脉综合征（CCS）中Lp(a)相关的冠状动脉狭窄。方法我们的回顾性横断面研究纳入了1513名在中国三级心脏病中心接受血管造影的参与者。参与者根据Gensini评分分为正常、轻度和重度组，Gensini评分定量评估狭窄的严重程度。根据伴随的全身炎症浓度计算多项logistic模型。结果Lp(a)水平升高的受试者冠脉狭窄风险较高：轻度组与正常组、重度组与正常组的完全调整模型优势比（ORs）[95%置信区间（CIs）]分别为1.47（1.11-1.96）和1.68（1.21-2.33）。值得注意的是，经多变量调整后，Lp(a)与冠状动脉狭窄的相关性仅在低炎症浓度下存在[全身炎症反应指数（SIRI） <； 0.64][轻度vs正常，OR 2.03, 95% CI 1.17-3.54, P = 0.012；重度与正常（OR 2.34, 95% CI 1.24-4.44, P = 0.009），中度（0.64≤SIRI < 1.41）和重度（SIRI≥1.41）状态无关联。对全身免疫炎症指数（SII）和中性粒细胞与淋巴细胞比率（NLR）的相同分析得出了一致的结果。结论仅在低炎症浓度时，Lp(a)升高与冠状动脉狭窄相关。在个体化Lp(a)降低治疗中考虑全身性炎症更有利于CCS的管理。

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引用次数: 0

Global, regional, and national burden of atrial fibrillation and atrial flutter in the working-age population from 1990 to 2021: A systematic analysis based on 2021 global burden of disease data 1990年至2021年工作年龄人口房颤和心房扑动的全球、区域和国家负担：基于2021年全球疾病负担数据的系统分析

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-10-05 DOI: 10.1016/j.ajpc.2025.101322

Chao Yang , Youjin Kong , Xiao Liu , Xingxiao Huang , Qiuliu Sun , Hanxin Wang , Minjun Yu , Beibei Gao , Jinyu Huang

Atrial fibrillation and atrial flutter impose a significant global health burden, particularly among individuals aged 30–64 years. This study analyzed data from the Global Burden of Disease 2021 database to estimate disease burden trends from 1990 to 2021. Key metrics included age-standardized incidence, prevalence, mortality, and disability-adjusted life years rates, stratified by age, sex, and Socio-Demographic Index. The methodologies encompassed descriptive analysis, age-period-cohort modeling, decomposition techniques, and Bayesian forecasting. From 1990 to 2021, age-standardized incidence rates increased by an estimated annual percentage change of 0.14, prevalence rates by 0.20, and disability rates by 0.08, while mortality rates declined by 0.16. By 2021, global incidence reached 47.05 per 100,000 population, prevalence 397.94, mortality 0.49, and disability 48.46. High-SDI regions exhibited the highest burden, with incidence at 61.01 and prevalence at 515.73 per 100,000, whereas low-SDI regions recorded the lowest incidence and prevalence at 35.32 and 282.73, respectively. Males consistently showed higher incidence, prevalence, and disability rates than females, with disease burden peaking in the 60–64 age group. Population growth contributed 52 % to the rise in prevalent cases, surpassing aging and epidemiological factors. Projections to 2050 indicate declines in incidence to 45.18 and prevalence to 387.53 per 100,000, but mortality and disability rates are expected to rise to 0.51 and 49.29. High systolic blood pressure accounted for 13.04 % of disability-adjusted life years globally, with contributions from high body mass index increasing across all SDI quintiles. Health inequalities narrowed between high- and low-SDI countries, with the slope index of inequality decreasing from 21.41 to 15.41 per 100,000 years and the concentration index shifting from 0.04 to -0.02. Critical priorities include optimising screening programmes in high-SDI regions, expanding access to hypertension control and anticoagulant therapy in low-SDI areas, and implementing reasonable monitoring of consumption of highly processed foods high in salt and sugar. Multisectoral strategies integrating real-time burden monitoring, salt-sugar regulation policies, and equitable technology distribution are essential to align with Sustainable Development Goals. This study underscores the necessity of region-specific interventions to mitigate economic productivity losses linked to atrial fibrillation and atrial flutter in the working-age population.

心房颤动和心房扑动造成了重大的全球健康负担，特别是在30-64岁的人群中。本研究分析了来自2021年全球疾病负担数据库的数据，以估计1990年至2021年的疾病负担趋势。关键指标包括按年龄、性别和社会人口指数分层的年龄标准化发病率、患病率、死亡率和残疾调整生命年率。方法包括描述性分析、年龄-时期-队列模型、分解技术和贝叶斯预测。从1990年到2021年，年龄标准化发病率估计每年增加0.14%，流行率增加0.20%，致残率增加0.08%，死亡率下降0.16%。到2021年，全球发病率达到每10万人47.05人，患病率397.94人，死亡率0.49人，致残率48.46人。高sdi地区的发病率和患病率最高，分别为61.01 / 10万和515.73 / 10万，低sdi地区的发病率和患病率最低，分别为35.32 / 10万和282.73 / 10万。男性的发病率、患病率和致残率始终高于女性，疾病负担在60-64岁年龄组达到高峰。人口增长对流行病例的增加贡献了52%，超过了老龄化和流行病学因素。到2050年的预测显示，发病率下降到每10万人45.18人，流行率下降到每10万人387.53人，但死亡率和残疾率预计将上升到0.51人和49.29人。高收缩压占全球残疾调整生命年的13.04%，在所有SDI五分位数中，高体重指数的贡献都在增加。健康不平等在高sdi国家和低sdi国家之间缩小，不平等的斜率指数从每10万年21.41降至15.41，浓度指数从0.04降至-0.02。关键优先事项包括优化高sdi地区的筛查规划，在低sdi地区扩大高血压控制和抗凝治疗的可及性，以及对高盐和高糖高度加工食品的消费实施合理监测。整合实时负担监测、盐糖监管政策和公平技术分配的多部门战略对于实现可持续发展目标至关重要。这项研究强调了有必要采取针对特定区域的干预措施，以减轻与工作年龄人口心房颤动和心房扑动相关的经济生产力损失。

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引用次数: 0

Genetic and measured LDL-C: Differential and interactive effects on cardiovascular and stroke subtypes 遗传和测量LDL-C：对心血管和中风亚型的差异和相互作用影响

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-10-05 DOI: 10.1016/j.ajpc.2025.101323

Yeun Soo Yang , So Young Kim , Hyungwoo Seo , Sunmi Lee , Keum Ji Jung

Background

Low-density lipoprotein cholesterol (LDL-C), a key contributor to coronary artery disease (CAD), increases mortality. While lowering LDL-C is protective, concerns remain that very low levels may increase hemorrhagic stroke risk. This study explored genetic and environmental determinants of LDL-C to understand these relationships.

Methods

This analysis was conducted using the Korean Cancer Prevention Study-II (KCPS-II) with over 150 thousand participants. Using the microarray results from the KCPS-II biobank, a genome-wide association study (GWAS) was performed to identify genetic variations associated with LDL-C. Environmentally determined LDL-C (ELDL-C) was calculated by subtracting genetically determined LDL-C (GLDL-C) from the measured LDL-C (MLDL-C). MLDL-C, GLDL-C, and ELDL-C levels were divided into quintiles, and their associations with cardiovascular diseases were analyzed. BBJ-GWAS summary statistics were used for external validation.

Results

In the final analysis of 136,263 participants, MLDL-C levels were associated with confounding factors, while GLDL-C was independent of these factors. GLDL-C demonstrated a linear association with ASCVD and IHD risk but no increased risk at lower levels for HS. Additionally, the lowest GLDL-C group did not show elevated HS risk in either the KCPS-II or BBJ-based analysis. Notably, even in high genetic risk groups, the risk of cardiovascular disease was reduced when environmentally determined ELDL-C was low.

Conclusion

This study demonstrates that lower LDL-C levels are linearly associated with a reduced atherosclerotic cardiovascular disease risk. Furthermore, low LDL-C was not a risk factor for hemorrhagic stroke. These findings suggest that individuals with genetically high LDL-C can lower their cardiovascular risk through lifestyle modifications.

背景：低密度脂蛋白胆固醇（LDL-C）是冠状动脉疾病（CAD）的一个关键因素，它会增加死亡率。虽然降低LDL-C具有保护作用，但人们仍然担心，过低的LDL-C水平可能会增加出血性中风的风险。本研究探讨了LDL-C的遗传和环境决定因素，以了解这些关系。方法本分析采用韩国癌症预防研究- ii （KCPS-II）进行，参与者超过15万人。利用KCPS-II生物库的微阵列结果，进行了全基因组关联研究（GWAS），以确定与LDL-C相关的遗传变异。环境决定LDL-C （ELDL-C）是通过从测量的LDL-C （MLDL-C）中减去遗传决定LDL-C （GLDL-C）来计算的。将MLDL-C、GLDL-C和ELDL-C水平分为五分位数，并分析其与心血管疾病的相关性。采用BBJ-GWAS汇总统计进行外部验证。结果在136263名参与者的最终分析中，MLDL-C水平与混杂因素相关，而GLDL-C与这些因素无关。GLDL-C与ASCVD和IHD风险呈线性相关，但在HS低水平时没有增加风险。此外，在KCPS-II或基于bbj的分析中，GLDL-C最低的组均未显示HS风险升高。值得注意的是，即使在高遗传风险群体中，当环境决定的ELDL-C较低时，心血管疾病的风险也会降低。结论：低LDL-C水平与动脉粥样硬化性心血管疾病风险降低呈线性相关。此外，低LDL-C并不是出血性中风的危险因素。这些发现表明，具有高LDL-C基因的个体可以通过改变生活方式来降低心血管风险。

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引用次数: 0

Clinical, economic, and health care resource utilization burden of acute myocardial infarction and the role of systemic inflammation in US hospitals: A real-world study 美国医院急性心肌梗死的临床、经济和卫生保健资源利用负担和全身性炎症的作用：一项真实世界的研究

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-10-04 DOI: 10.1016/j.ajpc.2025.101320

Lei Lv , Jeffrey R. Skaar , Carey Robar , Sunday Ikpe , Shanthi Krishnaswami , Zhun Cao , Weilong Li , Michael G. Nanna

Background

Acute myocardial infarction (AMI), a leading cause of death in the US, is associated with significant clinical and economic burden. Systemic inflammation is a risk factor for worse cardiovascular outcomes, but the role of systemic inflammation in patients with AMI is not well established.

Objective

To evaluate clinical, health care resource utilization (HCRU), and economic outcomes in patients with type 1 AMI, and explore results based on systemic inflammation status.

Methods

Data from the Premier Healthcare Database were retrospectively analyzed, including adults with ≥1 inpatient hospitalization for type 1 AMI (using ICD-10-CM codes) from January 1, 2017, to August 31, 2023. Data were analyzed at index and within 30 and 90 days after index discharge. Demographics, clinical and HCRU outcomes, and costs were described for all patients with AMI and compared between those with and without evidence of systemic inflammation. Inflammation status was based on C-reactive protein (CRP) or high-sensitivity C-reactive protein (hsCRP) levels, such that patients with CRP/hsCRP between 2 and 10 mg/L were considered to have evidence of systemic inflammation. Patients with levels <2 mg/L or without CRP/hsCRP test results were considered to have no evidence of systemic inflammation. CRP/hsCRP test results were available in a limited number of patients.

Results

Among patients with AMI (N = 1,078,572), in-hospital mortality was 7.6 % during index hospitalization. The mean index length of stay was 5 days, and average cost of care was $23,648. Readmission rates were 7.9 % and 12.9 % within 30 and 90 days after discharge, respectively. Patients with evidence of systemic inflammation (n = 1673) had higher mortality and longer index stays as well as increased readmission rates compared with patients without evidence of systemic inflammation (n = 1,076,899) (all, P < 0.01).

Conclusion

Patients experiencing AMI, and especially those with evidence of systemic inflammation, experience persistently high risk of mortality, morbidity, recurrence, and large economic burdens. Greater attention is needed to optimize the care of this at-risk population.

背景：急性心肌梗死（AMI）是美国的主要死亡原因之一，与重大的临床和经济负担相关。全身性炎症是心血管预后恶化的危险因素，但全身性炎症在AMI患者中的作用尚不明确。目的评价1型AMI患者的临床、医疗资源利用（HCRU）和经济预后，并探讨基于全身性炎症状态的结果。方法回顾性分析来自Premier Healthcare数据库的数据，包括2017年1月1日至2023年8月31日期间因1型AMI（使用ICD-10-CM代码）住院≥1例的成年人。数据分析在指数和指数排出后30天和90天内的数据。描述了所有AMI患者的人口统计学、临床和HCRU结果和费用，并比较了有和没有全身性炎症证据的患者。炎症状态基于c反应蛋白（CRP）或高敏c反应蛋白（hsCRP）水平，因此CRP/hsCRP在2 - 10mg /L之间的患者被认为有全身性炎症的证据。2 mg/L水平或没有CRP/hsCRP测试结果的患者被认为没有全身性炎症的证据。CRP/hsCRP检测结果在有限数量的患者中可用。结果AMI患者（N = 1,078,572）在指数住院期间的住院死亡率为7.6%。平均指数住院时间为5天，平均护理费用为23,648美元。出院后30天和90天再入院率分别为7.9%和12.9%。有全身性炎症证据的患者（n = 1673）与无全身性炎症证据的患者（n = 1,076,899）相比，死亡率更高，住院时间更长，再入院率也更高（均P <； 0.01）。结论AMI患者，特别是有全身性炎症的患者，死亡率、发病率、复发率持续高，经济负担大。需要更加重视优化对这一高危人群的护理。

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引用次数: 0

Beyond ‘low salt, low fat’: Reimagining nutrition advice in the cardiac discharge summary 超越“低盐、低脂肪”：重新构想心脏放电总结中的营养建议

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-10-04 DOI: 10.1016/j.ajpc.2025.101321

Suvetha Kannappan , Rajendiran Gopalan

Despite strong evidence on the role of nutrition in secondary prevention of cardiovascular diseases, most cardiac discharge advises are generic and vague. This commentary advocates for a paradigm shift in post-discharge dietary counseling, positioning it as a critical, evidence-based tool for secondary prevention. Gathering evidence from global and interventional studies, we discuss the need for specific, prescriptive nutritional advice during discharge when patients are in the most receptive period. This commentary also briefs about the challenges that prevent clinicians from delivering meaningful dietary advice. We propose a multi-level strategy: integrating nutrition and behavior change counseling into medical education and licensing standards; building physician competence through experiential methods like culinary medicine; embedding structured dietary prescriptions into electronic health records; and ensuring consistent discharge summary quality through institutional policies and training. Furthermore, aligning policy reforms—including insurance coverage for nutrition counseling and food-is-medicine initiatives—will be essential to scale these interventions equitably. By redefining the role of nutrition in discharge planning, health systems can improve patient engagement, reduce readmissions, and contribute meaningfully to cardiovascular disease prevention and health system sustainability.

尽管有强有力的证据表明营养在心血管疾病二级预防中的作用，但大多数心脏排泄建议都是笼统和模糊的。这篇评论提倡在出院后饮食咨询中进行范式转变，将其定位为二级预防的关键、循证工具。从全球和干预性研究中收集证据，我们讨论了在出院时患者最易接受的时期提供具体、规范的营养建议的必要性。本评论还简要介绍了阻碍临床医生提供有意义的饮食建议的挑战。我们提出了多层次的策略：将营养和行为改变咨询纳入医学教育和许可标准；通过烹饪医学等体验性方法培养医生的能力；将结构化饮食处方嵌入电子健康记录；通过制度政策和培训确保出院总结质量的一致性。此外，协调政策改革——包括营养咨询和粮食即药物倡议的保险覆盖范围——对于公平地扩大这些干预措施至关重要。通过重新定义营养在出院计划中的作用，卫生系统可以提高患者参与度，减少再入院率，并为心血管疾病预防和卫生系统的可持续性做出有意义的贡献。

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引用次数: 0

Importance of Life’s Essential 8 in predicting short- and long-term incidence of cardiovascular disease: The atherosclerosis risk in communities study 生命要素8在预测心血管疾病短期和长期发病率中的重要性：社区动脉粥样硬化风险研究

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-10-03 DOI: 10.1016/j.ajpc.2025.101315

Renjie Zou , Zheqi Wen , Chenyin Zhang , Zhuoshan Huang , Xiaodong Zhuang , Zhen Wu

Background

As is acknowledged that there is a strong negative association between Life’s Essential 8 (LE8) and the major adverse cardiovascular events (MACE). However, from the perspective of primary prevention of cardiovascular diseases (CVD), it is more valuable to discover the factors to predict the incidence of CVD. We intend to explore the predictive value of LE8 for the short-term and long-term incidence of CVD in the population without CVD at baseline.

Methods

Participants in the ARIC (Atherosclerosis Risk in Communities) study were studied. Logistic regression models estimated the relationship between LE8 and CVD, including coronary heart disease (CHD), atrial fibrillation (AF) and stroke. Cox proportional hazards regression models were employed to assess whether an increase in the LE8 score could reduce the short-term and long-term incidence of CVD.

Results

Among the 8083 participants studied at V2, 332 (4.1%) were diagnosed with CHD, 98 (1.8%) with stroke, and 24 (0.3%) with AF. LE8 was negatively associated with the prevalence of CHD, stroke, but without statistically significant association with AF. After adjusting for other cardiovascular-related risk factors, LE8 was still negatively associated with stroke (OR:0.959; 95%CI, 0.943-0.976; P<0.001). During the short-term follow-up, for each 1-point increase in the LE8 score, the risks of CHD, stroke, and AF decreased by 6.5%, 5.4%, and 5.1% respectively (the hazard ratio values were 0.935, 0.946, and 0.949). Whether LE8 was used as a continuous variable or a categorical variable, the higher the score, the lower the likelihood of developing CHD at the long-term follow-up. Using the ROC curve, the area under the curve (AUC) of LE8 for predicting the 5-year, 15-year, and 25-year incidence of CHD was 0.77, 0.696, and 0.644, respectively.

Conclusions

A higher LE8 score is consistently associated with a lower probability of the incidence of CHD during both short-term and long-term follow-up periods.

众所周知，生命必需8 （LE8）与主要心血管不良事件（MACE）之间存在强烈的负相关。然而，从心血管疾病一级预防的角度来看，发现预测心血管疾病发病率的因素更有价值。我们打算探讨LE8对基线时无CVD人群的短期和长期CVD发病率的预测价值。方法对社区动脉粥样硬化风险（ARIC）研究的参与者进行研究。Logistic回归模型估计LE8与CVD的关系，包括冠心病（CHD）、心房颤动（AF）和脑卒中。采用Cox比例风险回归模型评估LE8评分的升高是否能降低CVD的短期和长期发病率。结果在V2期研究的8083名参与者中，332名（4.1%）被诊断为冠心病，98名（1.8%）被诊断为卒中，24名（0.3%）被诊断为房颤。LE8与冠心病、卒中的患病率呈负相关，但与房颤的相关性无统计学意义。在校正其他心血管相关危险因素后，LE8仍与卒中呈负相关（OR:0.959; 95%CI: 0.943-0.976; P<0.001）。在短期随访中，LE8评分每升高1分，冠心病、脑卒中、房颤发生风险分别降低6.5%、5.4%、5.1%（风险比值分别为0.935、0.946、0.949）。无论是作为连续变量还是分类变量，在长期随访中，LE8得分越高，发生冠心病的可能性越低。ROC曲线显示，LE8预测5年、15年、25年冠心病发病率的曲线下面积（AUC）分别为0.77、0.696、0.644。结论在短期和长期随访期间，LE8评分越高，冠心病发生率越低。

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引用次数: 0

Lipoprotein(a), family history, and incidence of premature ASCVD events in a pooled US cohort 美国队列中脂蛋白(a)、家族史和早发ASCVD事件的发生率

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-10-03 DOI: 10.1016/j.ajpc.2025.101319

Yihang Fan , Wenjun Fan , Xingdi Hu , Michael Y. Tsai , Ron C. Hoogeveen , Matthew J. Budoff , Nathan D. Wong

Background

Lipoprotein(a) [Lp(a)] is an independent, genetic, and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). There are limited data on its impact on premature ASCVD, including in diverse populations and with family history. We examined Lp(a) in relation to premature ASCVD (male aged <55, female aged <65 years) compared to later onset ASCVD, and differences by family history, sex, and race/ethnicity in a large, multi-ethnic U.S. cohort.

Methods

We analyzed data from 27,756 individuals without prior ASCVD at baseline from a pooled cohort consisting of five U.S. prospective studies. Lp(a) levels were stratified by cohort-specific percentiles. Multivariable Cox regression assessed the association of Lp(a) with composite incident premature and non-premature ASCVD events by sex, race, and family history.

Results

Among 5276 ASCVD events over a mean follow-up of 21.1 years, 773 (14.7 %) were premature ASCVD events. A higher proportion of women (65.2% vs. 38.3%) and Black individuals (45.8% vs. 27.7%) were observed in individuals with premature ASCVD compared to those with non-premature ASCVD events. For each 50 mg/dL increase in Lp(a), the risk of premature ASCVD increased by 30 % (HR: 1.30, 95% CI: 1.28–1.51), compared to a 24 % increase for non-premature ASCVD (HR: 1.24 [1.14–1.33]). Compared with Lp(a) levels <50th percentile, Lp(a) levels ≥ 90th percentile had adjusted HRs of 1.39 (1.10–1.75) and 1.39 (1.26–1.54) for premature and non-premature ASCVD events, respectively. We observed a trend for elevated Lp(a) levels predicting premature ASCVD events more strongly in those with a family history of ASCVD and in White individuals.

Conclusion

Elevated Lp(a) is an important predictor of both premature and later onset ASCVD events.

脂蛋白(a) [Lp(a)]是动脉粥样硬化性心血管疾病（ASCVD）的独立、遗传和因果危险因素。关于其对早发ASCVD影响的数据有限，包括在不同人群和有家族史的人群中。我们在美国的一个大型多种族队列中研究了Lp(a)与早发性ASCVD（男性55岁，女性65岁）和晚发性ASCVD的关系，以及家族史、性别和种族/民族的差异。方法：我们分析了来自美国5项前瞻性研究的27,756名无ASCVD患者的基线数据。Lp(a)水平按队列特定百分位数分层。多变量Cox回归通过性别、种族和家族史来评估Lp(a)与复合早发和非早发ASCVD事件的关联。结果在平均21.1年的随访中，5276例ASCVD事件中，773例（14.7%）为过早ASCVD事件。与非早发ASCVD患者相比，早发ASCVD患者中女性（65.2% vs. 38.3%）和黑人（45.8% vs. 27.7%）的比例更高。Lp(a)每增加50 mg/dL，过早ASCVD的风险增加30% (HR: 1.30, 95% CI: 1.28-1.51)，而非过早ASCVD的风险增加24% （HR: 1.24[1.14-1.33]）。与Lp(a)水平和Lp(a)水平第50百分位相比，Lp(a)水平≥90百分位的早产儿和非早产儿ASCVD事件的调整hr分别为1.39（1.10-1.75）和1.39（1.26-1.54）。我们观察到，在有ASCVD家族史的人和白人中，Lp(a)水平升高的趋势更能预测ASCVD的过早发生。结论Lp(a)升高是早发型和晚发型ASCVD事件的重要预测因子。

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引用次数: 0

The association of coronary artery disease by coronary CT angiography & cardiovascular outcomes in Psoriatic disease 银屑病患者冠状动脉CT血管造影与心血管预后的关系

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-10-03 DOI: 10.1016/j.ajpc.2025.101317

Jonathan A. Aun , Daniel M. Huck , Stephanie A. Besser , Arthur Shiyovich , Milena Petranovic , Adam N. Berman , Camila Veronica Blair , Christos P. Kotanidis , Jon Hainer , Dave W. Biery , Nayruti Trivedi , Khaled Abdelrahman , Rhanderson Cardoso , Joseph Merola , Michael Garshick , Brian Ghoshhajra , Sandeep Hegdire , Marcelo Di Carli , Ron Blankstein , Brittany N. Weber

引用次数: 0