Pub Date : 2025-01-13DOI: 10.1016/j.ajpc.2025.100931
Ming-Li Chen , Jin Li , Kruthika R. Iyer , Catherine Tcheandjieu , Shirin Jimenez , Elias Levy Itshak Salfati , Liana C. Del Gobbo , Marcia L Stefanick , Manisha Desai , Xiaonan Xue , Themistocles L Assimes
Background
Premorbid health traits that increase the risk of dying at the time of initial presentation of coronary heart disease (CHD) remain poorly characterized.
Methods
We followed 148,230 post-menopausal participants in the Women's Health Initiative for a median of 13.3 years. We ascertained the first occurrence of CHD and performed a joint Cox multivariate regression to identify premorbid predictors for a fatal rather than a non-fatal incident event.
Results
A total of 10,714 incident CHD events including 513 fatal events accrued during follow up. A five-year increase in age, smoking 5 to 34 cigarettes per day, and a standard deviation (SD) increase in the Cornel voltage product, an electrocardiographic measure highly correlated with left ventricular mass index on echocardiography, each independently increased the relative risk (RR) of dying from one's initial presentation of CHD by 46 % (95 % confidence interval [CI], 35 to 58 %), 30 % (8 to 51 %,), and 17 % (7 to 28 %), respectively. A high level of recreational physical activity (>1200 metabolic equivalent (MET) minutes per week) reduced one's relative risk by 32 % (12 to 49 %). A significant dose-response effect was observed for both physical activity and smoking and the reduction in absolute risk of presenting with fatal CHD associated with a healthy lifestyle was roughly equivalent to the difference in risk observed among women separated in age by approximately 10 years.
Conclusions
Modifiable factors affect a post-menopausal woman's risk of dying from her initial presentation of CHD. Our findings may reduce case-fatality risk of CHD by motivating individuals at risk to adopt and/or adhere to established primary prevention strategies.
{"title":"Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative study","authors":"Ming-Li Chen , Jin Li , Kruthika R. Iyer , Catherine Tcheandjieu , Shirin Jimenez , Elias Levy Itshak Salfati , Liana C. Del Gobbo , Marcia L Stefanick , Manisha Desai , Xiaonan Xue , Themistocles L Assimes","doi":"10.1016/j.ajpc.2025.100931","DOIUrl":"10.1016/j.ajpc.2025.100931","url":null,"abstract":"<div><h3>Background</h3><div>Premorbid health traits that increase the risk of dying at the time of initial presentation of coronary heart disease (CHD) remain poorly characterized.</div></div><div><h3>Methods</h3><div>We followed 148,230 post-menopausal participants in the Women's Health Initiative for a median of 13.3 years. We ascertained the first occurrence of CHD and performed a joint Cox multivariate regression to identify premorbid predictors for a fatal rather than a non-fatal incident event.</div></div><div><h3>Results</h3><div>A total of 10,714 incident CHD events including 513 fatal events accrued during follow up. A five-year increase in age, smoking 5 to 34 cigarettes per day, and a standard deviation (SD) increase in the Cornel voltage product, an electrocardiographic measure highly correlated with left ventricular mass index on echocardiography, each independently increased the relative risk (RR) of dying from one's initial presentation of CHD by 46 % (95 % confidence interval [CI], 35 to 58 %), 30 % (8 to 51 %,), and 17 % (7 to 28 %), respectively. A high level of recreational physical activity (>1200 metabolic equivalent (MET) minutes per week) reduced one's relative risk by 32 % (12 to 49 %). A significant dose-response effect was observed for both physical activity and smoking and the reduction in absolute risk of presenting with fatal CHD associated with a healthy lifestyle was roughly equivalent to the difference in risk observed among women separated in age by approximately 10 years.</div></div><div><h3>Conclusions</h3><div>Modifiable factors affect a post-menopausal woman's risk of dying from her initial presentation of CHD. Our findings may reduce case-fatality risk of CHD by motivating individuals at risk to adopt and/or adhere to established primary prevention strategies.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100931"},"PeriodicalIF":4.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101197","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}
Pub Date : 2025-01-09DOI: 10.1016/j.ajpc.2025.100929
Guadalupe Flores Tomasino , Caroline Park , Kajetan Grodecki , Jolien Geers , Donghee Han , Andrew Lin , Keiichiro Kuronuma , Nipun Manral , Emily Xing , Heidi Gransar , Sebastien Cadet , Alan Rozanski , Piotr J. Slomka , Michelle Williams , Daniel S. Berman , Damini Dey
Background
Ethnic differences in coronary atherosclerosis remain to be fully elucidated. We aimed to assess quantitative plaque characteristics from coronary CT Angiography (CCTA) in relation to ethnicity and cardiovascular risk factors in a multi-ethnic asymptomatic US population.
Methods
This cross-sectional study retrospectively evaluated 388 asymptomatic patients selected from a prospective CCTA registry. A total of 194 patients from ethnic minority groups (Asian, African American, and Hispanic) were matched by age, sex, and cardiovascular risk factors to 194 White patients. Quantitative plaque volumes—including total plaque, non-calcified plaque, low-attenuation non-calcified plaque (<30 Hounsfield Units [HU]), and calcified plaque—were measured using artificial intelligence-enabled software. Pericoronary adipose tissue attenuation (PCAT) was also assessed and reported in Hounsfield Units (HU).
Results
The total study population included 388 patients (age 59.9±11.7 years, 68% male), of which 63% had coronary atherosclerosis with total plaque volumes of 149[IQR 50-438] mm3, driven predominantly by non-calcified plaque (122, IQR 27-369) mm3. Men presented higher volumes of all plaque components compared to women (P<0.05). In multivariable analysis adjusted for cardiovascular risk factors, only African American patients were associated with lower total plaque (β=-89.2, P=0.036), calcified (β=-26.1, P=0.015), and non-calcified plaque volumes (β=-62.7, P=0.022). African American patients were also associated with higher PCAT (β=5.8, P<0.001), along with family history of coronary artery disease (β=2.1, P=0.04).
Conclusions
Our study showed a uniformly high prevalence of atherosclerosis in this asymptomatic cohort, with lower plaque volumes of all sub-components in women. African American patients were associated with lower quantitative plaque volumes (total, non-calcified and calcified) but with higher PCAT compared to White patients; with no significant differences observed among other ethnic minorities.
{"title":"Coronary plaque characteristics quantified by artificial intelligence-enabled plaque analysis: Insights from a multi-ethnic asymptomatic US population","authors":"Guadalupe Flores Tomasino , Caroline Park , Kajetan Grodecki , Jolien Geers , Donghee Han , Andrew Lin , Keiichiro Kuronuma , Nipun Manral , Emily Xing , Heidi Gransar , Sebastien Cadet , Alan Rozanski , Piotr J. Slomka , Michelle Williams , Daniel S. Berman , Damini Dey","doi":"10.1016/j.ajpc.2025.100929","DOIUrl":"10.1016/j.ajpc.2025.100929","url":null,"abstract":"<div><h3>Background</h3><div>Ethnic differences in coronary atherosclerosis remain to be fully elucidated. We aimed to assess quantitative plaque characteristics from coronary CT Angiography (CCTA) in relation to ethnicity and cardiovascular risk factors in a multi-ethnic asymptomatic US population.</div></div><div><h3>Methods</h3><div>This cross-sectional study retrospectively evaluated 388 asymptomatic patients selected from a prospective CCTA registry. A total of 194 patients from ethnic minority groups (Asian, African American, and Hispanic) were matched by age, sex, and cardiovascular risk factors to 194 White patients. Quantitative plaque volumes—including total plaque, non-calcified plaque, low-attenuation non-calcified plaque (<30 Hounsfield Units [HU]), and calcified plaque—were measured using artificial intelligence-enabled software. Pericoronary adipose tissue attenuation (PCAT) was also assessed and reported in Hounsfield Units (HU).</div></div><div><h3>Results</h3><div>The total study population included 388 patients (age 59.9±11.7 years, 68% male), of which 63% had coronary atherosclerosis with total plaque volumes of 149[IQR 50-438] mm<sup>3</sup>, driven predominantly by non-calcified plaque (122, IQR 27-369) mm<sup>3</sup>. Men presented higher volumes of all plaque components compared to women (P<0.05). In multivariable analysis adjusted for cardiovascular risk factors, only African American patients were associated with lower total plaque (β=-89.2, P=0.036), calcified (β=-26.1, P=0.015), and non-calcified plaque volumes (β=-62.7, P=0.022). African American patients were also associated with higher PCAT (β=5.8, P<0.001), along with family history of coronary artery disease (β=2.1, P=0.04).</div></div><div><h3>Conclusions</h3><div>Our study showed a uniformly high prevalence of atherosclerosis in this asymptomatic cohort, with lower plaque volumes of all sub-components in women. African American patients were associated with lower quantitative plaque volumes (total, non-calcified and calcified) but with higher PCAT compared to White patients; with no significant differences observed among other ethnic minorities.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100929"},"PeriodicalIF":4.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082403","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}
Pub Date : 2025-01-09DOI: 10.1016/j.ajpc.2025.100930
James K. Fleming , Renee M. Sullivan , David Alfego , Natalia T. Leach , Tamara J. Richman , Jill Rafalko
Introduction
Familial Hypercholesterolemia (FH) is a primarily autosomal dominant condition characterized by markedly elevated low-density lipoprotein-cholesterol (LDL-c) and an increased risk of atherosclerosis and cardiovascular disease (CVD). Though early identification and treatment are crucial to optimizing outcomes, few laboratory strategies exist to detect FH.
Methods
All lipid tests for total cholesterol (TC) and LDL-c ordered through a large nation-wide network of medical laboratories in the United States (US) from 2018 - 2022 were retrospectively evaluated using a decision tree algorithm based on Simon Broome lipid criteria. If thresholds were met, results were classified as “possible FH” or as “no lipid evidence of FH” if not met.
Results
The review of 121,141,307 lipid panels and associated genetic tests from 58,400,105 patients resulted in 1,843,966 (3.2 %) that were classified as “possible FH”. Overall, the mean TC was higher in females than males, particularly in those ≥16 years. LDL-c in the “no lipid evidence of FH” cohort increased year-over-year; LDL-c was stable or decreased in the “possible FH” cohort. Despite the large number of patients classified with “possible FH”, very few (0.02 %) matched patients had genetic testing.
Conclusion
A laboratory-developed algorithm using Simon Broome lipid criteria can help identify patients who may benefit from additional FH evaluation. While critical, testing hyperlipidemic children for FH is grossly underutilized, as is genetic testing for FH. Diagnostic laboratories are uniquely positioned to bring FH to the attention of clinicians, with the goal of earlier diagnosis, cascade testing, and appropriate treatment.
{"title":"A strategy to increase identification of patients with Familial Hypercholesterolemia: Application of the Simon Broome lipid criteria in a large-scale retrospective analysis","authors":"James K. Fleming , Renee M. Sullivan , David Alfego , Natalia T. Leach , Tamara J. Richman , Jill Rafalko","doi":"10.1016/j.ajpc.2025.100930","DOIUrl":"10.1016/j.ajpc.2025.100930","url":null,"abstract":"<div><h3>Introduction</h3><div>Familial Hypercholesterolemia (FH) is a primarily autosomal dominant condition characterized by markedly elevated low-density lipoprotein-cholesterol (LDL-c) and an increased risk of atherosclerosis and cardiovascular disease (CVD). Though early identification and treatment are crucial to optimizing outcomes, few laboratory strategies exist to detect FH.</div></div><div><h3>Methods</h3><div>All lipid tests for total cholesterol (TC) and LDL-c ordered through a large nation-wide network of medical laboratories in the United States (US) from 2018 - 2022 were retrospectively evaluated using a decision tree algorithm based on Simon Broome lipid criteria. If thresholds were met, results were classified as “possible FH” or as “no lipid evidence of FH” if not met.</div></div><div><h3>Results</h3><div>The review of 121,141,307 lipid panels and associated genetic tests from 58,400,105 patients resulted in 1,843,966 (3.2 %) that were classified as “possible FH”. Overall, the mean TC was higher in females than males, particularly in those ≥16 years. LDL-c in the “no lipid evidence of FH” cohort increased year-over-year; LDL-c was stable or decreased in the “possible FH” cohort. Despite the large number of patients classified with “possible FH”, very few (0.02 %) matched patients had genetic testing.</div></div><div><h3>Conclusion</h3><div>A laboratory-developed algorithm using Simon Broome lipid criteria can help identify patients who may benefit from additional FH evaluation. While critical, testing hyperlipidemic children for FH is grossly underutilized, as is genetic testing for FH. Diagnostic laboratories are uniquely positioned to bring FH to the attention of clinicians, with the goal of earlier diagnosis, cascade testing, and appropriate treatment.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100930"},"PeriodicalIF":4.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082383","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}
Pub Date : 2025-01-08DOI: 10.1016/j.ajpc.2024.100922
Aaron King , Xi Tan , Neil Dhopeshwarkar , Rhonda Bohn , Katherine Dea , Charles E. Leonard , Adam de Havenon
Introduction
Limited data exist on the cardiovascular effectiveness of once-weekly (OW) glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in real-world practice.
Methods
We assessed the OW GLP-1 RA effects on vascular risk factors in adults with type 2 diabetes and atherosclerotic cardiovascular disease using data from a large-scale US electronic health record database (index date = first prescription of OW GLP-1 RA). Exploratory analyses were performed on patients newly initiating OW GLP-1 RAs with semaglutide, OW GLP-1 RAs without semaglutide, and semaglutide. Changes in vascular risk factors were evaluated by comparing mean measures between the 12-month pre- and post-index periods. Analyses were conducted for all three cohorts and subpopulations including stratified by tercile of baseline vascular risk factor value.
Results
In the final cohorts ([1] OW GLP-1 RA including semaglutide: n = 20,084; [2] OW GLP-1 RA excluding semaglutide: n = 16,894; [3] semaglutide: n = 3,435), significant mean reductions (P < 0.001) were observed from baseline to post-index in hemoglobin A1c (%, [1] -1.1; [2] -1.1; [3] -1.2), low-density lipoprotein cholesterol (mg/dL, [1] -6.4; [2] -6.4; [3] -6.9), total cholesterol (mg/dL, [1] -11.0; [2] -11.1; [3] -10.7), triglycerides (mg/dL, [1] -31.8; [2] -31.4; [3] -33.1), systolic blood pressure (mmHg, [1] -1.5; [2] -1.2; [3] -3.1), body weight (kg, [1] -2.7; [2] -2.4; [3] -4.3) and body mass index (kg/m2; [1] -0.9; [2] -0.8; [3] -1.4). Largest reductions were observed in the top tercile.
Conclusion
Our data suggest GLP-1 RAs are associated with significant reductions in key vascular risk factors in real-world practice.
{"title":"Effect of glucagon-like peptide-1 receptor agonists on vascular risk factors among adults with type 2 diabetes and established atherosclerotic cardiovascular disease","authors":"Aaron King , Xi Tan , Neil Dhopeshwarkar , Rhonda Bohn , Katherine Dea , Charles E. Leonard , Adam de Havenon","doi":"10.1016/j.ajpc.2024.100922","DOIUrl":"10.1016/j.ajpc.2024.100922","url":null,"abstract":"<div><h3>Introduction</h3><div>Limited data exist on the cardiovascular effectiveness of once-weekly (OW) glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in real-world practice.</div></div><div><h3>Methods</h3><div>We assessed the OW GLP-1 RA effects on vascular risk factors in adults with type 2 diabetes and atherosclerotic cardiovascular disease using data from a large-scale US electronic health record database (index date = first prescription of OW GLP-1 RA). Exploratory analyses were performed on patients newly initiating OW GLP-1 RAs with semaglutide, OW GLP-1 RAs without semaglutide, and semaglutide. Changes in vascular risk factors were evaluated by comparing mean measures between the 12-month pre- and post-index periods. Analyses were conducted for all three cohorts and subpopulations including stratified by tercile of baseline vascular risk factor value.</div></div><div><h3>Results</h3><div>In the final cohorts ([1] OW GLP-1 RA including semaglutide: <em>n</em> = 20,084; [2] OW GLP-1 RA excluding semaglutide: <em>n</em> = 16,894; [3] semaglutide: <em>n</em> = 3,435), significant mean reductions (<em>P</em> < 0.001) were observed from baseline to post-index in hemoglobin A1c (%, [1] -1.1; [2] -1.1; [3] -1.2), low-density lipoprotein cholesterol (mg/dL, [1] -6.4; [2] -6.4; [3] -6.9), total cholesterol (mg/dL, [1] -11.0; [2] -11.1; [3] -10.7), triglycerides (mg/dL, [1] -31.8; [2] -31.4; [3] -33.1), systolic blood pressure (mmHg, [1] -1.5; [2] -1.2; [3] -3.1), body weight (kg, [1] -2.7; [2] -2.4; [3] -4.3) and body mass index (kg/m<sup>2</sup>; [1] -0.9; [2] -0.8; [3] -1.4). Largest reductions were observed in the top tercile.</div></div><div><h3>Conclusion</h3><div>Our data suggest GLP-1 RAs are associated with significant reductions in key vascular risk factors in real-world practice.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100922"},"PeriodicalIF":4.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082405","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}
Pub Date : 2025-01-02DOI: 10.1016/j.ajpc.2024.100916
Alexander C. Razavi , Omar Dzaye , Miguel Cainzos-Achirica , Zeina Dardari , Marly Van Assen , Arshed A. Quyyumi , Khurram Nasir , J. Jeffrey Carr , Matthew J. Budoff , Roger S. Blumenthal , Paolo Raggi , Carlo N. De Cecco , Laurence S. Sperling , Michael J. Blaha , Seamus P. Whelton
Background
Calcification of the ascending and/or descending thoracic aorta is easily measured via non-contrast cardiac computed tomography (CT), commonly performed for quantification of coronary artery calcium (CAC). We assessed whether thoracic aortic calcium (TAC) further improves long-term cardiovascular disease (CVD) risk stratification beyond CAC alone.
Methods
Cardiac CT was performed among 6,783 asymptomatic Multi-Ethnic Study of Atherosclerosis participants at baseline. Cox proportional hazards regression assessed the association of TAC with incident CVD and all-cause mortality over a median follow-up of 17.7 years, adjusting for CVD risk factors and CAC.
Results
The mean age was 62.1 years old, 53% were female, and 28% had TAC. Over a median follow-up of 17.7 years, 48% of participants with TAC ≥500 experienced CVD and 72% died. Compared to TAC=0, TAC ≥500 was significantly associated with an increased risk of CVD (HR=1.28, 95% CI: 1.06-1.54) and all-cause mortality (HR=1.44, 95% CI: 1.25–1.65), with the strongest association among persons with CAC=0 (CVD HR=1.79, 95% CI: 1.04–3.07; all-cause mortality HR=1.82, 95% CI: 1.29–2.56). The addition of TAC to traditional risk factors and CAC did not improve CVD discrimination (ΔC-statistic=+0.002, p=0.12), but incrementally improved prediction of all-cause mortality (CVD: ΔC-statistic=+0.002, p=0.02).
Conclusions
Participants with TAC ≥500 had a high long-term risk for CVD and all-cause mortality. TAC primarily improved risk stratification among persons with CAC=0.
{"title":"Association of thoracic aortic calcium with incident cardiovascular disease and all-cause mortality across the spectrum of coronary artery calcium burden","authors":"Alexander C. Razavi , Omar Dzaye , Miguel Cainzos-Achirica , Zeina Dardari , Marly Van Assen , Arshed A. Quyyumi , Khurram Nasir , J. Jeffrey Carr , Matthew J. Budoff , Roger S. Blumenthal , Paolo Raggi , Carlo N. De Cecco , Laurence S. Sperling , Michael J. Blaha , Seamus P. Whelton","doi":"10.1016/j.ajpc.2024.100916","DOIUrl":"10.1016/j.ajpc.2024.100916","url":null,"abstract":"<div><h3>Background</h3><div>Calcification of the ascending and/or descending thoracic aorta is easily measured via non-contrast cardiac computed tomography (CT), commonly performed for quantification of coronary artery calcium (CAC). We assessed whether thoracic aortic calcium (TAC) further improves long-term cardiovascular disease (CVD) risk stratification beyond CAC alone.</div></div><div><h3>Methods</h3><div>Cardiac CT was performed among 6,783 asymptomatic Multi-Ethnic Study of Atherosclerosis participants at baseline. Cox proportional hazards regression assessed the association of TAC with incident CVD and all-cause mortality over a median follow-up of 17.7 years, adjusting for CVD risk factors and CAC.</div></div><div><h3>Results</h3><div>The mean age was 62.1 years old, 53% were female, and 28% had TAC. Over a median follow-up of 17.7 years, 48% of participants with TAC ≥500 experienced CVD and 72% died. Compared to TAC=0, TAC ≥500 was significantly associated with an increased risk of CVD (HR=1.28, 95% CI: 1.06-1.54) and all-cause mortality (HR=1.44, 95% CI: 1.25–1.65), with the strongest association among persons with CAC=0 (CVD HR=1.79, 95% CI: 1.04–3.07; all-cause mortality HR=1.82, 95% CI: 1.29–2.56). The addition of TAC to traditional risk factors and CAC did not improve CVD discrimination (ΔC-statistic=+0.002, <em>p</em>=0.12), but incrementally improved prediction of all-cause mortality (CVD: ΔC-statistic=+0.002, <em>p</em>=0.02).</div></div><div><h3>Conclusions</h3><div>Participants with TAC ≥500 had a high long-term risk for CVD and all-cause mortality. TAC primarily improved risk stratification among persons with CAC=0.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100916"},"PeriodicalIF":4.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082387","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}
Pub Date : 2024-12-31DOI: 10.1016/j.ajpc.2024.100927
Huzaifa Ul Haq Ansari , Muhammad Ammar Samad , Eman Mahboob , Eeshal Zulfiqar , Shurjeel Uddin Qazi , Areeba Ahsan , Mushood Ahmed , Faizan Ahmed , Raheel Ahmed , Shafaqat Ali , Mahboob Alam , Jamal S. Rana , Gregg C. Fonarow
Background
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown benefits in improving cardiovascular (CV) outcomes in patients with heart failure (HF) and may mitigate symptom progression in myocardial infarction (MI). However, their effectiveness in patients with type 2 diabetes and MI undergoing percutaneous coronary intervention (PCI) is unclear.
Methods
To identify eligible studies, a comprehensive search of electronic databases, PubMed, Cochrane Library, Scopus and Embase, was conducted from inception until May 2024. Results were presented as risk ratios (RR) and their corresponding 95 % confidence intervals (CIs).
Results
Our analysis included 8 observational studies comprising 24,229 patients. The results indicated that SGLT2i with PCI was associated with a significantly reduced risk of all-cause death (RR=0.61; 95 % CI=0.54 to 0.68), CV death (RR=0.46; 95 % CI=0.22 to 0.94), major adverse cardiovascular events (RR=0.80;95 % CI: 0.66 to 0.96), HF-related hospitalizations (RR=0.63; 95 % CI=0.44 to 0.90), stroke (RR=0.77; 95 % CI: 0.62 to 0.96) and acute kidney injury (RR=0.46; 95 % CI: 0.25 to 0.84) compared to PCI without SGLT2i use. However, the risk of revascularization remained comparable between the groups.
Conclusion
Our study demonstrates that SGLT2i with PCI in patients with type 2 diabetes and MI are associated with improved CV outcomes compared to PCI without SGLT2i use. Randomized controlled trials are required to confirm the improvement in outcomes with SGLT2i therapy combined with PCI in patients with MI and diabetes.
{"title":"Sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and myocardial infarction undergoing percutaneous coronary intervention: A systematic review and meta-analysis","authors":"Huzaifa Ul Haq Ansari , Muhammad Ammar Samad , Eman Mahboob , Eeshal Zulfiqar , Shurjeel Uddin Qazi , Areeba Ahsan , Mushood Ahmed , Faizan Ahmed , Raheel Ahmed , Shafaqat Ali , Mahboob Alam , Jamal S. Rana , Gregg C. Fonarow","doi":"10.1016/j.ajpc.2024.100927","DOIUrl":"10.1016/j.ajpc.2024.100927","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown benefits in improving cardiovascular (CV) outcomes in patients with heart failure (HF) and may mitigate symptom progression in myocardial infarction (MI). However, their effectiveness in patients with type 2 diabetes and MI undergoing percutaneous coronary intervention (PCI) is unclear.</div></div><div><h3>Methods</h3><div>To identify eligible studies, a comprehensive search of electronic databases, PubMed, Cochrane Library, Scopus and Embase, was conducted from inception until May 2024. Results were presented as risk ratios (RR) and their corresponding 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Our analysis included 8 observational studies comprising 24,229 patients. The results indicated that SGLT2i with PCI was associated with a significantly reduced risk of all-cause death (RR=0.61; 95 % CI=0.54 to 0.68), CV death (RR=0.46; 95 % CI=0.22 to 0.94), major adverse cardiovascular events (RR=0.80;95 % CI: 0.66 to 0.96), HF-related hospitalizations (RR=0.63; 95 % CI=0.44 to 0.90), stroke (RR=0.77; 95 % CI: 0.62 to 0.96) and acute kidney injury (RR=0.46; 95 % CI: 0.25 to 0.84) compared to PCI without SGLT2i use. However, the risk of revascularization remained comparable between the groups.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates that SGLT2i with PCI in patients with type 2 diabetes and MI are associated with improved CV outcomes compared to PCI without SGLT2i use. Randomized controlled trials are required to confirm the improvement in outcomes with SGLT2i therapy combined with PCI in patients with MI and diabetes.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100927"},"PeriodicalIF":4.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048777","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}
Pub Date : 2024-12-30DOI: 10.1016/j.ajpc.2024.100926
Yidan Wang , Shan Zhong , Na Sun , Yunfei Wu , Jun Lyu , Minghui Piao , Wenbo Qu , Xueyu Wang , Wenjun Ni , Xia Gu , Tianshu Han , Jinwei Tian
Objective
Cancer survivors have an increased risk of developing coronary artery disease (CAD). We introduce CAD polygenic risk scores (PRS) and examine associations with cancer status on CAD outcomes.
Methods
From the UK Biobank, we identified cancer survivors and CAD outcomes among 464,193 CAD-free participants using linked cancer registries, hospitalizations, and death records. CAD-PRS was categorized as low (lowest tertile), intermediate (tertile 2), and high (highest tertile). Adjusted Cox models assessed the joint and interaction effects of cancer status and CAD-PRS on CAD outcomes.
Results
Over the follow-up (median 11.7 years), 36,332 participants developed CAD. Compared to low CAD-PRS, the hazard ratios (HRs) and 95% confidence intervals (CIs) for CAD was 1.35 (1.31–1.38) for intermediate and 1.86 (1.81–1.91) for high CAD-PRS. The HR (95% CI) for CAD in cancer survivors was 1.16 (1.13–1.19) compared to those without cancer. In the joint effect analysis, compared to participants with low CAD-PRS and no cancer, the HRs (95% CIs) for CAD were 1.37 (1.32–1.41) and 1.90 (1.84–1.96) for intermediate and high CAD-PRS without cancer, respectively. For those with cancer, the HRs (95% CIs) were 1.26 (1.19–1.33), 1.59 (1.51–1.67), and 2.13 (2.03–2.23) for low, intermediate, and high CAD-PRS, respectively. A significant multiplicative interaction (HR: 0.94, 95% CI: 0.91–0.98) was observed between CAD-PRS and cancer status on CAD. Additionally, a significant additive interaction between cancer and high CAD-PRS was found for fatal CAD.
Conclusion
Cancer was associated with a higher risk of CAD and may further increase the risk of CAD related to genetic factors.
{"title":"Cancer, genetic susceptibility and risk of coronary artery disease: A prospective study","authors":"Yidan Wang , Shan Zhong , Na Sun , Yunfei Wu , Jun Lyu , Minghui Piao , Wenbo Qu , Xueyu Wang , Wenjun Ni , Xia Gu , Tianshu Han , Jinwei Tian","doi":"10.1016/j.ajpc.2024.100926","DOIUrl":"10.1016/j.ajpc.2024.100926","url":null,"abstract":"<div><h3>Objective</h3><div>Cancer survivors have an increased risk of developing coronary artery disease (CAD). We introduce CAD polygenic risk scores (PRS) and examine associations with cancer status on CAD outcomes.</div></div><div><h3>Methods</h3><div>From the UK Biobank, we identified cancer survivors and CAD outcomes among 464,193 CAD-free participants using linked cancer registries, hospitalizations, and death records. CAD-PRS was categorized as low (lowest tertile), intermediate (tertile 2), and high (highest tertile). Adjusted Cox models assessed the joint and interaction effects of cancer status and CAD-PRS on CAD outcomes.</div></div><div><h3>Results</h3><div>Over the follow-up (median 11.7 years), 36,332 participants developed CAD. Compared to low CAD-PRS, the hazard ratios (HRs) and 95% confidence intervals (CIs) for CAD was 1.35 (1.31–1.38) for intermediate and 1.86 (1.81–1.91) for high CAD-PRS. The HR (95% CI) for CAD in cancer survivors was 1.16 (1.13–1.19) compared to those without cancer. In the joint effect analysis, compared to participants with low CAD-PRS and no cancer, the HRs (95% CIs) for CAD were 1.37 (1.32–1.41) and 1.90 (1.84–1.96) for intermediate and high CAD-PRS without cancer, respectively. For those with cancer, the HRs (95% CIs) were 1.26 (1.19–1.33), 1.59 (1.51–1.67), and 2.13 (2.03–2.23) for low, intermediate, and high CAD-PRS, respectively. A significant multiplicative interaction (HR: 0.94, 95% CI: 0.91–0.98) was observed between CAD-PRS and cancer status on CAD. Additionally, a significant additive interaction between cancer and high CAD-PRS was found for fatal CAD.</div></div><div><h3>Conclusion</h3><div>Cancer was associated with a higher risk of CAD and may further increase the risk of CAD related to genetic factors.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100926"},"PeriodicalIF":4.3,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101246","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}
Pub Date : 2024-12-24DOI: 10.1016/j.ajpc.2024.100925
Kartik K. Venkatesh , William A. Grobman , Xiaoning Huang , Lynn M. Yee , Janet Catov , Hy Simhan , David M. Haas , Brian Mercer , Uma Reddy , Robert M. Silver , Lisa D. Levine , Judith Chung , George Saade , Philip Greenland , C. Noel Bairey Merz , Becky McNeil , Sadiya S Khan
We examined whether neighborhood-level socioeconomic disadvantage per the Area Deprivation Index (ADI) was associated with maternal cardiovascular health (CVH) in early pregnancy per the American Heart Association Life's Essential 8 (LE8). This is a cross-sectional analysis from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study (nuMoM2b-HHS) cohort. The exposure was the ADI in tertiles (T) from least (T1) to most (T3) socioeconomic disadvantage. The outcome was the LE8 as a continuous score ranging from worst (0) to best (100) composite CVH; and included physical activity, diet quality, tobacco use, sleep quantity, body mass index, blood pressure, glucose, and lipid levels. Among 4,508 nulliparous individuals at a mean maternal age of 27.0 years (SD: 5.6) and at a mean gestational age of 11.4 weeks (SD 1.6), the mean ADI was 48.0 (SD: 30.4) and the mean LE8 was 80.3 (SD: 12.5). Pregnant individuals living in neighborhoods with greater socioeconomic disadvantage had lower mean LE8 scores (i.e., worse CVH) compared with those living in neighborhoods with lesser disadvantage (T1 vs. T2 adjusted mean: 82.6 vs. 80.5; adj. ß:2.08; 95 % CI:3.51, -0.64; and T1 vs. T3 adjusted mean: 82.6 vs. 77.8; adj. ß:4.77; 95 % CI:8.16, -1.38). Neighborhood-level socioeconomic disadvantage was associated with worse maternal CVH in early pregnancy.
根据美国心脏协会生命基本8 (LE8)，我们研究了社区水平的社会经济劣势（区域剥夺指数（ADI））是否与怀孕早期孕产妇心血管健康（CVH）相关。这是一项来自前瞻性未产妊娠结局研究-监测准妈妈心脏健康研究（nuMoM2b-HHS）队列的横断面分析。暴露为从最小（T1）到最大（T3）社会经济劣势的ADI (T)。结果是LE8作为连续评分，从最差(0)到最佳（100）的综合CVH；包括身体活动、饮食质量、烟草使用、睡眠时间、体重指数、血压、血糖和脂质水平。4508例产妇平均年龄为27.0岁（SD: 5.6），平均胎龄为11.4周（SD: 1.6），平均ADI为48.0 (SD: 30.4)，平均LE8为80.3 （SD: 12.5）。与生活在社会经济劣势较小的社区的孕妇相比，生活在社会经济劣势较大的社区的孕妇LE8平均得分较低（即CVH较差）(T1与T2调整后的平均值：82.6 vs 80.5；轮廓分明的ß:2.08;95% ci:3.51, -0.64；T1与T3调整后的平均值：82.6 vs 77.8；轮廓分明的ß:4.77;95% ci:8.16, -1.38)。社区水平的社会经济劣势与妊娠早期母体CVH恶化有关。
{"title":"Association of neighborhood-level socioeconomic disadvantage and Life's Essential 8 in early pregnancy","authors":"Kartik K. Venkatesh , William A. Grobman , Xiaoning Huang , Lynn M. Yee , Janet Catov , Hy Simhan , David M. Haas , Brian Mercer , Uma Reddy , Robert M. Silver , Lisa D. Levine , Judith Chung , George Saade , Philip Greenland , C. Noel Bairey Merz , Becky McNeil , Sadiya S Khan","doi":"10.1016/j.ajpc.2024.100925","DOIUrl":"10.1016/j.ajpc.2024.100925","url":null,"abstract":"<div><div>We examined whether neighborhood-level socioeconomic disadvantage per the Area Deprivation Index (ADI) was associated with maternal cardiovascular health (CVH) in early pregnancy per the American Heart Association Life's Essential 8 (LE8). This is a cross-sectional analysis from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study (nuMoM2b-HHS) cohort. The exposure was the ADI in tertiles (T) from least (T1) to most (T3) socioeconomic disadvantage. The outcome was the LE8 as a continuous score ranging from worst (0) to best (100) composite CVH; and included physical activity, diet quality, tobacco use, sleep quantity, body mass index, blood pressure, glucose, and lipid levels. Among 4,508 nulliparous individuals at a mean maternal age of 27.0 years (SD: 5.6) and at a mean gestational age of 11.4 weeks (SD 1.6), the mean ADI was 48.0 (SD: 30.4) and the mean LE8 was 80.3 (SD: 12.5). Pregnant individuals living in neighborhoods with greater socioeconomic disadvantage had lower mean LE8 scores (i.e., worse CVH) compared with those living in neighborhoods with lesser disadvantage (T1 vs. T2 adjusted mean: 82.6 vs. 80.5; adj. ß:2.08; 95 % CI:3.51, -0.64; and T1 vs. T3 adjusted mean: 82.6 vs. 77.8; adj. ß:4.77; 95 % CI:8.16, -1.38). Neighborhood-level socioeconomic disadvantage was associated with worse maternal CVH in early pregnancy.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100925"},"PeriodicalIF":4.3,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017293","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}
Pub Date : 2024-12-24DOI: 10.1016/j.ajpc.2024.100924
Krunal D. Amin , Aarti Thakkar , Tara Budampati , Sarina Matai , Esra Akkaya , Nishant P. Shah
Sleep is increasingly recognized as a significant contributor to the development of cardiovascular disease (CVD). Recent American Heart Association guidelines incorporate sleep duration into the “Life's Essential Eight” framework of ideal cardiovascular health. This article will review the evidence relating sleep duration, regularity, and quality with all-cause and cardiovascular mortality, cardiometabolic syndrome, and coronary artery disease in adults. Short sleep duration is strongly associated with cardiovascular mortality, cardiometabolic risk factors, and coronary artery disease. Limited studies also suggest a possible U-shaped association, with long sleep duration also associated with greater cardiovascular risk. Sleep regularity has emerged as a strong and independent risk factor for CVD-related mortality, cardiometabolic syndrome, and subclinical atherosclerosis. Less is known about the impact of sleep quality on CVD, though a number of observational studies suggest a possible association with metabolic syndrome and subclinical atherosclerosis. This review provides an update of the literature on the cardiovascular impact of sleep for the everyday clinician and highlights gaps in knowledge that warrant future research.
{"title":"A good night's rest: A contemporary review of sleep and cardiovascular health","authors":"Krunal D. Amin , Aarti Thakkar , Tara Budampati , Sarina Matai , Esra Akkaya , Nishant P. Shah","doi":"10.1016/j.ajpc.2024.100924","DOIUrl":"10.1016/j.ajpc.2024.100924","url":null,"abstract":"<div><div>Sleep is increasingly recognized as a significant contributor to the development of cardiovascular disease (CVD). Recent American Heart Association guidelines incorporate sleep duration into the “Life's Essential Eight” framework of ideal cardiovascular health. This article will review the evidence relating sleep duration, regularity, and quality with all-cause and cardiovascular mortality, cardiometabolic syndrome, and coronary artery disease in adults. Short sleep duration is strongly associated with cardiovascular mortality, cardiometabolic risk factors, and coronary artery disease. Limited studies also suggest a possible U-shaped association, with long sleep duration also associated with greater cardiovascular risk. Sleep regularity has emerged as a strong and independent risk factor for CVD-related mortality, cardiometabolic syndrome, and subclinical atherosclerosis. Less is known about the impact of sleep quality on CVD, though a number of observational studies suggest a possible association with metabolic syndrome and subclinical atherosclerosis. This review provides an update of the literature on the cardiovascular impact of sleep for the everyday clinician and highlights gaps in knowledge that warrant future research.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100924"},"PeriodicalIF":4.3,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11742591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017208","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}
Pub Date : 2024-12-22DOI: 10.1016/j.ajpc.2024.100923
Ester Cánovas Rodríguez , Andrea Kallmeyer , Nieves Tarín , Carmen Cristóbal , Ana Huelmos , Ana María Pello Lázaro , Álvaro Aceña , Carlos Gutiérrez-Landaluce , Óscar González-Lorenzo , Jairo Lumpuy-Castillo , Joaquín Alonso , Lorenzo López-Bescós , Jesús Egido , Óscar Lorenzo , Luis M. Blanco-Colio , José Tuñón
Objective
To quantify the added clinical benefit of a healthy lifestyle following an acute coronary syndrome (ACS). Our study seeks to answer the question: Is adherence to medical therapy sufficient or a healthy lifestyle provides additional improvement?.
Methods
This is a prospective observational multi-center study of 685 ACS patients. At 6 months patients were asked about their post-ACS lifestyle and were given a score (range: 0–7) with the following items: Intake of ≥3 fruits and vegetables/day, ≥2 fish servings/week, ≤7 alcohol beverages/week, feeling stress <once/month, moderate-intense physical activity in leisure time, walking at work, and giving up tobacco. One point was assigned for each of these items. Mean follow-up was 4.89 (2.85–7.70) years.
Results
After adjusting for demographic variables, cardiovascular risk factors, characteristics of the index event, high-sensitivity C-reactive protein (hs-CRP), and drug therapy, multivariate Cox regression showed that the lifestyle SCORE was independently and inversely associated with both the incidence of the primary outcome (ischemic events [any ACS, stroke, or Transient Ischemic Attack] or death) (HR 0.65 (CI95 % 0.44–0.96); p = 0.029) and death (HR 0.41 [95 %CI 0.18–0.91]; p = 0.029). Statin therapy was also independently and inversely associated with the incidence of the primary outcome and death. Kaplan-Meier curves showed a higher event-free survival for both outcomes in patients with SCORE≥4 (healthy lifestyle) than in those with SCORE<4 (unhealthy lifestyle). Additionally, patients with a SCORE≥4 had a significantly greater decrease of total cholesterol and hs-CRP. For each 1-point increase in the score, there was a 35 % reduction in the incidence of the primary outcome (ischemic events or death) and a 59 % reduction in the incidence of death.
Conclusion
Among patients with ACS and similar medical therapy, a healthy lifestyle is an independent and added marker of a lower incidence of new ischemic events and death. It is also associated with a better lipid profile and lower inflammation after the ACS. As the prognosis of ACS has improved over the years due to better therapies; this study shows that lifestyle modifications continue to offer significant benefit at this point in time.
{"title":"Beyond secondary prevention drugs: Added benefit in survival and events of a healthy lifestyle in patients after an acute coronary syndrome","authors":"Ester Cánovas Rodríguez , Andrea Kallmeyer , Nieves Tarín , Carmen Cristóbal , Ana Huelmos , Ana María Pello Lázaro , Álvaro Aceña , Carlos Gutiérrez-Landaluce , Óscar González-Lorenzo , Jairo Lumpuy-Castillo , Joaquín Alonso , Lorenzo López-Bescós , Jesús Egido , Óscar Lorenzo , Luis M. Blanco-Colio , José Tuñón","doi":"10.1016/j.ajpc.2024.100923","DOIUrl":"10.1016/j.ajpc.2024.100923","url":null,"abstract":"<div><h3>Objective</h3><div>To quantify the added clinical benefit of a healthy lifestyle following an acute coronary syndrome (ACS). Our study seeks to answer the question: Is adherence to medical therapy sufficient or a healthy lifestyle provides additional improvement?.</div></div><div><h3>Methods</h3><div>This is a prospective observational multi-center study of 685 ACS patients. At 6 months patients were asked about their post-ACS lifestyle and were given a score (range: 0–7) with the following items: Intake of ≥3 fruits and vegetables/day, ≥2 fish servings/week, ≤7 alcohol beverages/week, feeling stress <once/month, moderate-intense physical activity in leisure time, walking at work, and giving up tobacco. One point was assigned for each of these items. Mean follow-up was 4.89 (2.85–7.70) years.</div></div><div><h3>Results</h3><div>After adjusting for demographic variables, cardiovascular risk factors, characteristics of the index event, high-sensitivity C-reactive protein (hs-CRP), and drug therapy, multivariate Cox regression showed that the lifestyle SCORE was independently and inversely associated with both the incidence of the primary outcome (ischemic events [any ACS, stroke, or Transient Ischemic Attack] or death) (HR 0.65 (CI95 % 0.44–0.96); <em>p</em> = 0.029) and death (HR 0.41 [95 %CI 0.18–0.91]; <em>p</em> = 0.029). Statin therapy was also independently and inversely associated with the incidence of the primary outcome and death. Kaplan-Meier curves showed a higher event-free survival for both outcomes in patients with SCORE≥4 (healthy lifestyle) than in those with SCORE<4 (unhealthy lifestyle). Additionally, patients with a SCORE≥4 had a significantly greater decrease of total cholesterol and hs-CRP. For each 1-point increase in the score, there was a 35 % reduction in the incidence of the primary outcome (ischemic events or death) and a 59 % reduction in the incidence of death.</div></div><div><h3>Conclusion</h3><div>Among patients with ACS and similar medical therapy, a healthy lifestyle is an independent and added marker of a lower incidence of new ischemic events and death. It is also associated with a better lipid profile and lower inflammation after the ACS. As the prognosis of ACS has improved over the years due to better therapies; this study shows that lifestyle modifications continue to offer significant benefit at this point in time.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100923"},"PeriodicalIF":4.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017299","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号