American journal of preventive cardiology最新文献

{"title":"Clinician-level variation in lipid management for secondary prevention of atherosclerotic cardiovascular disease: Opportunities for practice improvement","authors":"Danh Q Nguyen,&nbsp;Jimin Hwang,&nbsp;Anand Rohatgi,&nbsp;Parag H Joshi,&nbsp;Amit Khera,&nbsp;Eric D Peterson,&nbsp;Ann Marie Navar","doi":"10.1016/j.ajpc.2026.101421","DOIUrl":"10.1016/j.ajpc.2026.101421","url":null,"abstract":"<div><h3>Introduction</h3><div>While prior studies have documented suboptimal lipid management and low rates of low-density lipoprotein cholesterol (LDL-C) goal achievement in patients with atherosclerotic cardiovascular disease (ASCVD), the degree of variability in lipid-lowering therapy (LLT) practice patterns between clinicians is less well described.</div></div><div><h3>Methods</h3><div>In this cohort study, we evaluated the use of LLTs and achievement of LDL-C &lt;70 mg/dL among adults with ASCVD (coronary artery disease, peripheral arterial disease, or ischemic cerebrovascular disease) followed by a cardiology physician or advanced practice provider (APP) at a large academic medical center in north Texas from 01/01/22–06/30/24. LLT utilization and LDL-C goal achievement were modeled using mixed-effects logistic regression with clustering at the clinician level, adjusting for patient age, insurance, ASCVD type, and diabetes. We quantified clinician-level variability using the adjusted median odds ratios (aMORs) from these models.</div></div><div><h3>Results</h3><div>Among 9098 patients with ASCVD (median age 71.0 years, 61.6% male, 70.5% White) seen across 77 cardiology clinicians (56 physicians, 21 APPs), 52.8% were on a high-intensity statin, 17.1% were on ezetimibe, 7.8% were on novel LLT (proprotein convertase subtilisin/kexin type 9 monoclonal antibody, inclisiran, or bempedoic acid). Of those with an available lipid panel in the past year (<em>n</em> = 7122), 48.5% achieved an LDL-C &lt;70 mg/dL. Lipid management strategies varied substantially across clinicians. In mixed-effects models adjusting for patient-level factors, significant clinician-level variation was observed in the use of high-intensity statins (aMOR 1.44, 95% CI 1.34–1.59), ezetimibe (aMOR 1.68, 95% CI 1.52–1.91), and novel LLT (aMOR 2.21, 95% CI 1.90–2.68). Variation in achieving LDL-C &lt;70 mg/dL was more modest (aMOR 1.31, 95% CI 1.23–1.42). Sequential adjustment for clinician prescribing patterns explained nearly half of the observed variability in LDL-C goal achievement, reducing the aMOR to 1.16 (95% CI 1.09–1.27).</div></div><div><h3>Conclusion</h3><div>We found suboptimal rates of high-intensity statin and LDL-C control among patients with ASCVD. Even among cardiology clinicians at the same academic medical center, practice patterns varied widely in using LLT and achieving LDL-C goals for secondary prevention. Understanding the reasons for this variability and standardizing lipid management across the specialty may improve quality of care for patients with ASCVD.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101421"},"PeriodicalIF":5.9,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038965","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":"Rest-activity rhythms and cardiovascular events in cardiovascular–kidney–metabolic syndrome: evidence from two nationwide cohorts","authors":"Bingtao Weng ,&nbsp;Haizhen Chen ,&nbsp;Han Chen ,&nbsp;Ningjian Wang ,&nbsp;Hongliang Feng ,&nbsp;Kehua Yang ,&nbsp;Xiao Tan","doi":"10.1016/j.ajpc.2026.101414","DOIUrl":"10.1016/j.ajpc.2026.101414","url":null,"abstract":"<div><h3>Background</h3><div>Circadian rest–activity rhythm (CRAR) is a modifiable determinant of metabolic and cardiovascular health, yet its role in cardiovascular events and mortality among individuals with cardiovascular–kidney–metabolic (CKM) syndrome remains unclear.</div></div><div><h3>Methods</h3><div>Accelerometer-derived CRAR parameters were analyzed in two nationally representative cohorts. Primary outcomes included cardiovascular incidence among participants with CKM stages 0–3 and all-cause and cardiovascular mortality among those with stages 1–4. Multinomial logistic and Cox proportional hazards models assessed associations of CRAR with CKM progression and subsequent outcomes. Mediation analyses examined inflammatory biomarkers, and improvements in prediction were evaluated using changes in C-statistics.</div></div><div><h3>Results</h3><div>Among 74,777 participants, higher relative amplitude (RA) tertiles were associated with slower CKM progression and lower risks of cardiovascular incidence (T2: HR 0.87, 95% CI 0.82–0.93; T3: HR 0.79, 95% CI 0.73–0.85), all-cause mortality (T2: HR 0.70, 95% CI 0.64–0.77; T3: HR 0.60, 95% CI 0.54–0.67), and cardiovascular mortality (T2: HR 0.70, 95% CI 0.57–0.86; T3: HR 0.45, 95% CI 0.34–0.61). Higher intradaily variability (IV) was associated with increased all-cause mortality (T2: HR 1.12, 95% CI 1.02–1.22; T3: HR 1.19, 95% CI 1.08–1.30). Inflammatory biomarkers modestly mediated these associations (1%–5%). Optimal thresholds were RA = 0.87 for cardiovascular incidence, RA = 0.81 and IV = 0.68 for mortality. Adding CRAR to basic models improved prediction of all-cause and cardiovascular mortality (ΔC-statistic = 0.019 and 0.017). Results were validated in an independent cohort of 6046 participants.</div></div><div><h3>Conclusion</h3><div>Adverse CRAR is associated with CKM progression and elevated risks of cardiovascular events and mortality, highlighting its utility in identifying high-risk individuals and guiding targeted interventions through risk stratification and incremental prediction.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101414"},"PeriodicalIF":5.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress in risk assessment and management: Forecasting updates across international cholesterol guidelines","authors":"Alexander C. Razavi ,&nbsp;Mark Sokolsky ,&nbsp;Matthew Belanger ,&nbsp;Cameron Blazoski ,&nbsp;Jared A. Spitz ,&nbsp;Laurence S. Sperling ,&nbsp;Roger S. Blumenthal ,&nbsp;Seamus P. Whelton","doi":"10.1016/j.ajpc.2026.101417","DOIUrl":"10.1016/j.ajpc.2026.101417","url":null,"abstract":"<div><div>In anticipation of updates to cholesterol guidelines globally, evidence since the most recent iteration of recommendations across US and Europe for risk assessment and lipid management are reviewed. ASCVD risk estimation is at the core of determining lipid lowering goals and consideration for therapies. In primary prevention, incorporation of the PREVENT equations will be featured in updated guidelines, which will likely demarcate new, lower risk thresholds compared to the prior Pooled Cohort Equations. Additionally, the use of coronary artery calcium (CAC) improves risk estimation to inform medication allocation and LDL-C goals beyond traditional risk factor risk estimation. To achieve lower LDL-C, many adults will need multiple lipid-lowering medications. For high-risk individuals, combination therapy with low/moderate intensity statin and ezetimibe or bempedoic acid should be considered. Additionally, proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) therapies can be used to attain lower LDL-C in high-risk individuals, including those with clinical ASCVD or a high CAC burden. In very-high risk patients, treatment to LDL-C values as low as &lt;30 mg/dL further reduces ASCVD risk without significant adverse events. Among individuals treated with PSCK9i therapy, those with elevated Lp(a) may have greater ASCVD risk reduction and may be a patient population that is prioritized for PCSK9i until therapies directly targeting Lp(a) are available. An ASCVD risk-based approach should be the foundation for determining LDL-C goals with consideration that multiple lipid-lowering therapies are often necessary for high and very-high risk patients who were treated to very low LDL-C in more recent randomized controlled trials.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101417"},"PeriodicalIF":5.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038962","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":"Utilizing existing test results to improve primary prevention in patients with subclinical coronary atherosclerosis: The USE-IT study","authors":"Mateo Iwanowski ,&nbsp;Carolina C. Pappalettere ,&nbsp;Joan Vime-Jubany ,&nbsp;Alina Velescu ,&nbsp;Lidia Marcos ,&nbsp;Roberto Chalela ,&nbsp;Flavio Zuccarino ,&nbsp;Jose Maria Maiques ,&nbsp;Helena Tizon-Marcos ,&nbsp;Beatriz Vaquerizo-Montilla ,&nbsp;Sonia Ruiz-Bustillo ,&nbsp;Benjamin Casteigt ,&nbsp;Nuria Rodriguez ,&nbsp;Diego Rodriguez-Chiaradia ,&nbsp;Jaume Marrugat ,&nbsp;Miguel Cainzos-Achirica","doi":"10.1016/j.ajpc.2025.101396","DOIUrl":"10.1016/j.ajpc.2025.101396","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Aims&lt;/h3&gt;&lt;div&gt;The systematic referral of patients with incidentally detected subclinical coronary atherosclerosis to a specialized prevention clinic is an innovative strategy in Europe. The USE-IT study aims to assess its impact in terms of 12-month change in low-density lipoprotein cholesterol (LDL-C) levels.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Prospective, non-randomized study (&lt;em&gt;N&lt;/em&gt; = 291). Patients were referred after incidental detection of subclinical coronary atherosclerosis through a clinically indicated cardiac/coronary computed tomography (CT) (29%), invasive coronary angiography (24%), or chest CT (44%). Cardiovascular risk-reduction interventions were implemented following relevant guidelines.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Mean age was 66 years, 43% women. The prevalence of traditional risk factors was high, 38% of the patients had atherosclerosis in ≥3 coronary arteries, 33% had at least one stenosis ≥50% and 60% had an elevated CAC score (≥300 UA). Mean baseline LDL-C levels were 108 mg/dL (SD 37), 16% had LDL-C &lt;70mg/dL, and 6% had LDL-C &lt;55mg/dL. At 12 months there were marked increases in the use of high-intensity statins (28% vs 78%, &lt;em&gt;p&lt;/em&gt; &lt; 0.001) and ezetimibe (7% vs 69%, &lt;em&gt;p&lt;/em&gt; &lt; 0.001). At the end of follow-up, mean LDL-C levels were 61 mg/dL (&lt;em&gt;p&lt;/em&gt; &lt; 0.001), 76% participants had LDL-C &lt;70mg/dL (&lt;em&gt;p&lt;/em&gt; &lt; 0.001), and 49% &lt;55mg/dL (&lt;em&gt;p&lt;/em&gt; &lt; 0.001). Among smokers, 15% of them successfully quit tobacco during follow-up, and obesity prevalence went from 34% to 29% (&lt;em&gt;p&lt;/em&gt; = 0.002).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Systematic referral of patients with incidentally detected subclinical coronary atherosclerosis to a specialized prevention clinic and subsequent guideline-based risk management provides an innovative opportunity to achieve large, guideline-recommended reductions in LDL-C and enhance the management of other risk factors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Lay Summary&lt;/h3&gt;&lt;div&gt;This research study was performed to assess whether a specialized, dedicated cardiovascular prevention clinic could help lower the levels of “bad” cholesterol (LDL-C) and improve the management of other cardiovascular risk factors in people who, despite feeling well, already have fatty plaques building up in their heart’s arteries. Such men and women are at increased risk of heart attacks and strokes, however, so far they had received very limited attention in prevention clinics and primary care settings, particularly when those plaques are identified incidentally. Reducing their levels of bad cholesterol can be very helpful reducing their risk of a subsequent heart attack. Specifically, at twelve months, we observed:&lt;/div&gt;&lt;div&gt;• Large reductions in the levels of bad cholesterol compared to the levels that those same patients had at the beginning of follow-up (i.e., before being referred to the prevention clinic), paired with enhanced use of guideline-recommended lipid-lowering pha","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101396"},"PeriodicalIF":5.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926477","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 evolving burden of ischemic heart disease in China, 1990-2023: Three decades of trends, risk factors, and future challenges","authors":"Changjun Li ,&nbsp;Xinbo Xu ,&nbsp;Heyan Zhang ,&nbsp;Haihang Xu ,&nbsp;Zhaolong Xu ,&nbsp;Qinghua Chang ,&nbsp;JingFu Bao","doi":"10.1016/j.ajpc.2026.101413","DOIUrl":"10.1016/j.ajpc.2026.101413","url":null,"abstract":"<div><h3>Background</h3><div>Ischemic heart disease represent a critical and growing public health challenge in China, against a backdrop of rapid demographic and epidemiological transitions.</div></div><div><h3>Objective</h3><div>This comprehensive analysis aims to analyze the evolving burden, risk factors, and demographic drivers of ischemic heart disease in China from 1990 to 2023 to inform targeted policy and clinical interventions.</div></div><div><h3>Methods</h3><div>Using data from the Global Burden of Disease 2023 study, we systematically examined ischemic heart disease prevalence, mortality, disability-adjusted life years (DALYs), and associated risk factors in China. A Bayesian Age-Period-Cohort model was applied for future predictions.</div></div><div><h3>Results</h3><div>From 1990 to 2023, the absolute number of ischemic heart disease prevalence cases in China increased by 174.95%, deaths by 173.76%, and DALYs by 100.02%. However, age-standardized mortality and DALY rates declined. Significant disparities were observed: males generally bore a higher burden, though females had higher prevalence after age 75 and higher mortality after 80. Decomposition analysis identified population aging as the primary driver, accounting for 124.46% of the increase in DALYs, while epidemiological changes mitigated mortality and DALY rates. High systolic blood pressure was the leading risk factor, followed by lead exposure and high LDL cholesterol. Smoking and dietary risks also contributed substantially. Projections to 2035 suggest an overall decline in total burden but a continued rise in cases among adults aged 60 and older.</div></div><div><h3>Conclusion</h3><div>The findings highlight the urgent need for enhanced, equitable prevention strategies focusing on blood pressure control, environmental health, tobacco regulation, and dietary interventions, alongside integrated, patient-centered care models tailored to the aging population and gender-specific vulnerabilities of ischemic heart disease in China.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101413"},"PeriodicalIF":5.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079317","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":"Quality-of-life and functional outcomes in virtual vs traditional cardiac rehabilitation: A retrospective cohort study","authors":"Sri Nuvvula,&nbsp;Rahul Rege,&nbsp;Sarah Siemers,&nbsp;Jennifer Drummond,&nbsp;Benjamin J. Hirsh,&nbsp;Neil D. Shah","doi":"10.1016/j.ajpc.2026.101411","DOIUrl":"10.1016/j.ajpc.2026.101411","url":null,"abstract":"<div><div>Virtual cardiac rehabilitation (VCR) offers a potential strategy to expand access to cardiac rehabilitation and address participation barriers, including transportation, work obligations, and limited program availability. This retrospective cohort study compared quality-of-life, functional capacity, and other clinical outcomes between patients enrolled in VCR and traditional cardiac rehabilitation (TCR) at a single academic center between June 2022 and August 2024. Outcomes of interest included changes in Dartmouth COOP quality-of-life scores, metabolic equivalents (METs), Patient Health Questionnaire-9 (PHQ-9), Rate Your Plate dietary scores, body mass index (BMI), and systolic and diastolic blood pressure. A total of 171 patients (40 VCR, 131 TCR) were included. VCR participants demonstrated greater improvement in Dartmouth COOP scores (–5.13 ± 4.65vs –3.20 ± 4.34; <em>p</em> &lt; 0.05), whereas TCR participants had comparable improvements in METs (1.93 ± 1.19 vs 0.92 ± 0.85; <em>p</em> = 0.11). No significant differences were observed in PHQ-9, Rate Your Plate scores, BMI, or blood pressure. In exploratory subgroup analyses, female participants in VCR had greater quality-of-life improvement (–6.18 ± 4.85 vs –2.86 ± 3.85; <em>p</em> &lt; 0.05), while TCR participants had greater MET improvement among those with ≥5 mmHg diastolic blood pressure reduction. VCR was associated with quality-of-life improvements comparable to TCR and may offer potential benefits for women, while TCR produced larger functional capacity gains in subgroup analyses. These findings are hypothesis-generating, reflect a single-center predominantly homogenous population, and require confirmation in prospective, randomized studies.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101411"},"PeriodicalIF":5.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926476","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":"Predictors of diffuse coronary artery calcium phenotype in adults aged ≥ 75: The Atherosclerosis Risk in Communities (ARIC) study","authors":"Abhishek Gami ,&nbsp;Siyu Zou ,&nbsp;Zeina A. Dardari ,&nbsp;Ramzi Dudum ,&nbsp;Yejin Mok ,&nbsp;Matthew J. Budoff ,&nbsp;Pamela L. Lutsey ,&nbsp;Candace M. Howard ,&nbsp;David Couper ,&nbsp;Kunihiro Matsushita ,&nbsp;Michael J. Blaha","doi":"10.1016/j.ajpc.2026.101412","DOIUrl":"10.1016/j.ajpc.2026.101412","url":null,"abstract":"<div><h3>Introduction</h3><div>Coronary artery calcium (CAC) scoring is a commonly used tool for cardiovascular disease (CVD) risk assessment and is reported using the Agatston score. However, there has been increasing interest in measures of CAC beyond the Agatston score, including measures capturing the overall distribution of vessel calcification. We assessed the association between 30-year traditional risk factor exposure and the presence of a more diffuse pattern of CAC in older adults aged 75 and older.</div></div><div><h3>Methods</h3><div>We studied participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent CAC scoring and were free of prior CVD. Time-weighted average exposure to traditional cardiovascular risk factors (over 30 years) was calculated. The CAC diffusivity index was calculated for each participant as 1 - (CAC in most affected vessel/total CAC) to capture distribution of calcification, and associations between traditional risk factors and more diffuse CAC patterns were studied.</div></div><div><h3>Results</h3><div>In 2201 participants (mean age 80, 61.8% women), time-averaged exposure to systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), ever smoking, male sex, and limited education were independently associated with more diffuse CAC (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Longitudinal exposure to traditional CVD risk factors including higher SBP, higher LDL-C, lower HDL-C, and smoking was associated with a more diffuse pattern of CAC in a population of adults aged 75 and older.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101412"},"PeriodicalIF":5.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalizing prevention for healthy cardiovascular aging: Geriatric cardiology in the 2024-2025 hypertension and dyslipidemia guidelines","authors":"Aaron L. Troy ,&nbsp;Timothy S. Anderson ,&nbsp;Alexander C. Razavi ,&nbsp;Stacey L. Schott ,&nbsp;Jared A. Spitz ,&nbsp;Roger S. Blumenthal","doi":"10.1016/j.ajpc.2026.101410","DOIUrl":"10.1016/j.ajpc.2026.101410","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101410"},"PeriodicalIF":5.9,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925940","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":"Prediction of cardiovascular disease risk in women and individuals with polycystic ovary syndrome using the American Heart Association PREVENT model: A long-term population-based cohort study","authors":"Parham Heidari ,&nbsp;Ramin Farrokhi ,&nbsp;Faegheh Firouzi ,&nbsp;Yasamin Zivari ,&nbsp;Fereidoun Azizi ,&nbsp;Fahimeh Ramezani Tehrani ,&nbsp;Samira Behboudi-Gandevani","doi":"10.1016/j.ajpc.2026.101408","DOIUrl":"10.1016/j.ajpc.2026.101408","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to assess the performance of the PREVENT risk model, in terms of discrimination and calibration in the overall female sample representative of the Iranian general population, across age groups, and among women with PCOS.</div></div><div><h3>Methods</h3><div>In this population-based prospective study, we used data from phases 3–7 of the Tehran Lipid and Glucose Study (2006–2021). A total of 3983 women aged 30–79 years without baseline CVD and with complete data for the PREVENT risk score were included, of whom 2117 had known PCOS or isolated PCOS phenotypes status. The PREVENT risk model was applied to estimate 10-year CVD risk. The primary outcome was incident CVD, which was defined as a composite of fatal and nonfatal atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF), identified follow-ups. Model discrimination was evaluated using Harrell’s C-statistics and time-dependent AUC, and calibration was assessed by comparing predicted and observed 10-year CVD risks in general female population, by age group, and by PCOS status.</div></div><div><h3>Results</h3><div>Among 3983 women (median follow-up 12.2 years; mean age 47.6 years; mean BMI 28.6 kg/m²), 911 had confirmed PCOS/Isolated-PCOS phenotypes. In the overall population, the PREVENT risk model demonstrated good discrimination (C-statistic 0.84, 95 % CI: 0.82–0.86; AUC 0.80) and satisfactory calibration in lower- and mid-risk deciles, with some underestimation at the highest risk deciles. Discrimination declined with increasing age, performing best in women aged 30–44 years (C-statistic 0.82, AUC 0.83). Stratified by PCOS status, the model maintained good discrimination in women with PCOS/isolated PCOS phenotypes (C-statistic 0.79, AUC 0.81) and non-PCOS/ non-isolated PCOS phenotypes controls (C-statistic 0.85, AUC 0.81), with calibration remaining satisfactory across subgroups, though high-risk quartiles in older women were slightly underestimated.</div></div><div><h3>Conclusions</h3><div>In this long-term, population-based cohort of Iranian women, the PREVENT risk model showed good discrimination and acceptable calibration for predicting 10-year CVD risk in both the general population and women with PCOS/Isolated-PCOS phenotypes. Performance was highest in women under 55 years, with some underestimation of risk in older or high-risk individuals.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101408"},"PeriodicalIF":5.9,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925945","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":"Population estimates, trends, characteristics and prognostic outcomes of cardiovascular-kidney-liver-metabolic health: A population-based study","authors":"Yiming Chen ,&nbsp;Haryo Raden Himan ,&nbsp;Yalkin Yazicioglu ,&nbsp;Rachel Goh ,&nbsp;Yip Han Chin ,&nbsp;Bryan Chong ,&nbsp;Srinithy Nagarajan ,&nbsp;Martin Tze Wah Kueh ,&nbsp;Jiong-Wei Wang ,&nbsp;Mark M Muthiah ,&nbsp;Xin Zhou ,&nbsp;Mark Y Chan ,&nbsp;Anurag Mehta ,&nbsp;Mamas A Mamas ,&nbsp;Muhammad Shahzeb Khan ,&nbsp;Nicholas WS Chew","doi":"10.1016/j.ajpc.2025.101405","DOIUrl":"10.1016/j.ajpc.2025.101405","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular-kidney-liver-metabolic (CKLM) diseases constitute the presence of MASLD, T2D, CKD, obesity and/or CVD, that often co-exist and synergistically increase cardiovascular risk. However, the prevalence, extent and outcomes of the CKLM burden remain poorly understood.</div></div><div><h3>Methods</h3><div>This population-based study utilised National Health and Nutrition Examination Survey (NHANES) 2007–2018 database, examining individuals’ number (0–4) and permutations of CKLM diseases, namely: type 2 diabetes (T2D), obesity, metabolic dysfunction-associated steatotic liver disease (MASLD), chronic kidney disease (CKD). The primary outcome was all-cause mortality. Cox regression models were constructed to evaluate the relationship between CKLM phenotypes and all-cause mortality, adjusting for age, sex, race, socioeconomic status, and physical activity.</div></div><div><h3>Results</h3><div>The weighted cohort represented 97.8 million US adults (mean age 47.7 ± 16.7 years). 54.16% of the cohort had ≥1 CKLM diseases. From 2007 to 2018, the proportion of individuals with ≥2 CKLM diseases increased from 32.4% to 55.6% of the population, with the largest increase in proportion of individuals with 4 diseases. The most common CKLM phenotype was MASLD-obesity (23.0%), followed by MASLD-obesity-T2D (5.1%). The highest mortality rates were observed in individuals with 4 CKLM diseases (21.4%), followed by 3 diseases (12.2%). Cox regression revealed that 4 diseases predicted the highest mortality risk (aHR 2.24, 95%CI: 1.66–3.02, <em>p</em> &lt; 0.001), followed by 3 diseases (aHR 1.52, 95%CI: 1.25–1.85, <em>p</em> &lt; 0.001). The MASLD-T2D-CKD phenotype (aHR 3.13, 95%CI: 1.80–5.42, <em>p</em> &lt; 0.001) and T2D-CKD phenotype (aHR 3.26, 95%CI: 2.33–4.55, <em>p</em> &lt; 0.001) predicted the highest mortality risk.</div></div><div><h3>Conclusions</h3><div>The CKLM multimorbidity burden is rising in the US population. Higher CKLM burden (≥3 CKLM diseases) and CKD-centric phenotypes (MASLD-T2D-CKD or T2D-CKD) independently predict the highest mortality risk.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101405"},"PeriodicalIF":5.9,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925946","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}