American journal of preventive cardiology最新文献

{"title":"Temporal trends in lipoprotein(a) testing among United States veterans from 2014 to 2023","authors":"Sofia E. Gomez ,&nbsp;Adam Furst ,&nbsp;Tania Chen ,&nbsp;Natasha Din ,&nbsp;David J. Maron ,&nbsp;Paul Heidenreich ,&nbsp;Neil Kalwani ,&nbsp;Shriram Nallamshetty ,&nbsp;Jonathan H Ward ,&nbsp;Anthony Lozama ,&nbsp;Alexander Sandhu ,&nbsp;Fatima Rodriguez","doi":"10.1016/j.ajpc.2024.100872","DOIUrl":"10.1016/j.ajpc.2024.100872","url":null,"abstract":"<div><h3>Objective</h3><div>Lipoprotein (a) [Lp(a)] is a causal, genetically-inherited risk amplifier for atherosclerotic cardiovascular disease (ASCVD). Practice guidelines increasingly recommend broad Lp(a) screening among various populations to optimize preventive care. Corresponding changes in testing rates and population-level detection of elevated Lp(a) in recent years has not been well described.</div></div><div><h3>Methods</h3><div>Using Veterans Affairs electronic health record data, we performed a retrospective cohort study evaluating temporal trends in Lp(a) testing and detection of elevated Lp(a) levels (defined as greater than 50 mg/dL) from January 1, 2014 to December 31, 2023 among United States Veterans without prior Lp(a) testing. Testing rates were stratified based on demographic and clinical factors to investigate possible drivers for and disparities in testing: age, sex, race and ethnicity, history of ASCVD, and neighborhood social vulnerability.</div></div><div><h3>Results</h3><div>Lp(a) testing increased nationally from 1 test per 10,000 eligible Veterans (558 tests) in 2014 to 9 tests per 10,000 (4,440 tests) in 2023, while the proportion of elevated Lp(a) levels remained stable. Factors associated with higher likelihood of Lp(a) testing over time were a history of ASCVD, Asian race, and residing in neighborhoods with less social vulnerability.</div></div><div><h3>Conclusion</h3><div>Despite a 9-fold increase in Lp(a) testing among US Veterans over the last decade, the overall testing rate remains extremely low. The steady proportion of Veterans with elevated Lp(a) over time supports the clinical utility of testing expansion. Efforts to increase testing, especially among Veterans living in neighborhoods with high social vulnerability, will be important to reduce emerging disparities as novel therapeutics to target Lp(a) become available.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100872"},"PeriodicalIF":4.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142421531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do clinical decision support tools improve quality of care outcomes in the primary prevention of cardiovascular disease: A systematic review and meta-analysis","authors":"Iva Buzancic ,&nbsp;Harvey Jia Wei Koh ,&nbsp;Caroline Trin ,&nbsp;Caitlin Nash ,&nbsp;Maja Ortner Hadziabdic ,&nbsp;Dora Belec ,&nbsp;Sophia Zoungas ,&nbsp;Ella Zomer ,&nbsp;Lachlan Dalli ,&nbsp;Zanfina Ademi ,&nbsp;Bryan Chua ,&nbsp;Stella Talic","doi":"10.1016/j.ajpc.2024.100855","DOIUrl":"10.1016/j.ajpc.2024.100855","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;To assess the effectiveness of Clinical Decision Support Tools (CDSTs) in enhancing the quality of care outcomes in primary cardiovascular disease (CVD) prevention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A systematic review was undertaken in accordance with PRISMA guidelines, and included searches in Ovid Medline, Ovid Embase, CINAHL, and Scopus. Eligible studies were randomized controlled trials of CDSTs comprising digital notifications in electronic health systems (EHS/EHR) in various primary healthcare settings, published post-2013, in patients with CVD risks and without established CVD. Two reviewers independently assessed risk of bias using the Cochrane RoB-2 tool. Attainment of clinical targets was analysed using a Restricted Maximum Likelihood random effects meta-analysis. Other relevant outcomes were narratively synthesised due to heterogeneity of studies and outcome metrics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Meta-analysis revealed CDSTs showed improvement in systolic (Mean Standardised Difference (MSD)=0.39, 95 %CI=-0.31, -1.10) and diastolic blood pressure target achievement (MSD=0.34, 95 %CI=-0.24, -0.92), but had no significant impact on lipid (MSD=0.01; 95 %CI=-0.10, 0.11) or glucose target attainment (MSD=-0.19, 95 %CI=-0.66, 0.28). The CDSTs with active prompts increased statin initiation and improved patients’ adherence to clinical appointments but had minimal effect on other medications and on enhancing adherence to medication.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;CDSTs were found to be effective in improving blood pressure clinical target attainments. However, the presence of multi-layered barriers affecting the uptake, longer-term use and active engagement from both clinicians and patients may hinder the full potential for achieving other quality of care outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Lay Summary&lt;/h3&gt;&lt;div&gt;The study aimed to evaluate how Clinical Decision Support Tools (CDSTs) impact the quality of care for primary cardiovascular disease (CVD) management. CDSTs are tools designed to support healthcare professionals in delivering the best possible care to patients by providing timely and relevant information at the point of care (ie. digital notifications in electronic health systems). Although CDST are designed to improve the quality of healthcare outcomes, the current evidence of their effectiveness is inconsistent. Therefore, we conducted a systematic review with meta-analysis, to quantify the effectiveness of CDSTs. The eligibility criteria targeted patients with CVD risk factors, but without diagnosed CVD. The meta-analysis found that CDSTs showed improvement in systolic and diastolic blood pressure target achievement but did not significantly impact lipid or glucose target attainment. Specifically, CDSTs showed effectiveness in increasing statin prescribing but not antihypertensives or antidiabetics prescribing. Interventions with CDSTs aimed at increasing screening programmes were effective for pat","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100855"},"PeriodicalIF":4.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing cardiovascular disease in South Asians: A fellow's voice","authors":"Aarti Thakkar","doi":"10.1016/j.ajpc.2024.100727","DOIUrl":"10.1016/j.ajpc.2024.100727","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100727"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666667724000953/pdfft?md5=be6edf74b0d6534d91836f1aaec933c5&pid=1-s2.0-S2666667724000953-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editors’ Message – September 2024","authors":"Nathan D. Wong ,&nbsp;Erin D. Michos","doi":"10.1016/j.ajpc.2024.100729","DOIUrl":"10.1016/j.ajpc.2024.100729","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100729"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666667724000977/pdfft?md5=3f376c5a9407fd5d7279164b804c694b&pid=1-s2.0-S2666667724000977-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142151222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FEASIBILITY OF A HOME-BASED CARDIAC REHABILITATION PROGRAM AMONG ADULTS WITH CARDIOVASCULAR DISEASE: A PILOT STUDY","authors":"Tim Bilbrey EP, MBA","doi":"10.1016/j.ajpc.2024.100770","DOIUrl":"10.1016/j.ajpc.2024.100770","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Rehabilitation</div></div><div><h3>Background</h3><div>Home-based cardiac rehabilitation (HBCR) has the potential to improve access to cardiac rehabilitation for patients recovering from acute cardiovascular disease (CVD). This study aims to assess the feasibility and initial impact of a technology-enabled HBCR program delivered by a multidisciplinary team to patients with CVD.</div></div><div><h3>Methods</h3><div>This prospective, single-arm study used a within-subject design. We recruited patients (age 40+) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, heart failure, etc.). All eligible and enrolled patients referred to the RecoveryPlus.Health (RPH) remote CR clinic in Roanoke, TX between May and August of 2023 were included. The care team provided guideline-concordant CR services to study participants via two modalities: 1) synchronous telehealth exercise training via video conferencing; and 2) asynchronous mHealth virtual coaching app. Baseline survey and electronic health record (EHR) data were used to extract sociodemographic and clinical data. Feasibility was measured by program completion rate and CR service use. Preliminary efficacy was measured by changes in 6-minute walk test (6MWT), resting heart rate, and quality of life (SF-12) before and after the 12-week program. Paired t tests were used to examine the changes in the outcome variables post intervention.</div></div><div><h3>Results</h3><div>A total of 75 patients consented and were enrolled in the study. The average age was 64.2 (SD=10.3, Range: 45-85) and 50.7% were female. The most frequent referring diagnosis was heart failure (49.3%). 62 (82.7%) participants completed the 12-week study. Among those who completed the study, all patients attended the telehealth sessions and 60 (95.2%) used the mHealth App. Post intervention, participants on average improved their 6MWT by 40.0 meters (ES=0.632, 95% CI: 0.356 to 0.877), indicating better cardiorespiratory endurance. The physical and mental summary scores were also improved by 2.7 (ES=0.413) and 2.2 (ES=0.244), respectively. There were no differences in resting heart rate and no serious program-related adverse events were reported.</div></div><div><h3>Conclusions</h3><div>The pilot data showed that the HBCR program was feasible in delivering remote CR care to patients at home. The promising preliminary results suggest that a randomized controlled efficacy trial is warranted.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100770"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MASSIVE AORTIC ATHEROMA AS CAUSE OF ISCHEMIC STROKE","authors":"Mitchell Padkins MD","doi":"10.1016/j.ajpc.2024.100753","DOIUrl":"10.1016/j.ajpc.2024.100753","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Case Presentation</h3><div>A 78-year-old-male was referred for assessment of the etiology of a symptomatic ischemic stroke in the right cerebellum. Vascular imaging including CT angiogram of the head and neck as well as prolonged electrocardiogram monitoring did not reveal a cause of his stroke.</div><div>A transesophageal echocardiogram (TEE) demonstrated no embolic source in the cardiac chambers and no intra-atrial shunt was identified. However, upon inspection of the descending thoracic aorta, a large atheroma was visualized measuring 2 cm in diameter and 0.7 cm thick (Figure). This finding led to a CT to further characterize this lesion. CT demonstrated non-calcified atherosclerotic plaque in the descending thoracic aorta which was determined to be the likely etiology of the stroke.</div><div>The identification of significant atherosclerotic plaque led to aggressive secondary prevention with the addition of aspirin 81 mg and high-intensity statin therapy. The patient's LDL cholesterol decreased from 120 mg/dL prior to the event to 42 mg/dL 12 weeks after initiating high-intensity statin therapy. At 1-year follow-up the patient has had no neurologic events and is tolerating therapy well.</div></div><div><h3>Background</h3><div>After a cerebrovascular accident is diagnosed, testing is warranted to identify the etiology. Unless a known etiology is identified, testing typically includes laboratory studies, prolonged ambulatory cardiac monitoring, imaging of the head and neck vessels, and imaging of the cardiac structures. Cardiac imaging typically begins with a transthoracic echocardiogram (TTE). However, TTE lacks the spatial resolution to identify atheromatous disease in the descending thoracic aorta. Thus, further imaging with TEE is often necessary for imaging the aorta and to rule out an intra-cardiac shunt.</div><div>After the etiology of a stroke is defined, management focuses on aggressive risk factor modification. Recent guidelines recommend initiating high-intensity statin therapy with a goal of reducing LDL to reduce the risk of future sequela related to atherosclerosis. In this case, aggressive antiplatelet and lipid lowering therapy was initiated with a significant reduction in the patient's LDL cholesterol.</div></div><div><h3>Conclusions</h3><div>This case represents a massive descending aortic atheroma, identified on TEE, as the cause of an ischemic stroke that led to aggressive secondary risk factor modification.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100753"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BASELINE CHARACTERISTICS OF PARTICIPANTS ENROLLED IN VICTORION-INCEPTION: A RANDOMIZED STUDY OF INCLISIRAN VS. USUAL CARE IN PATIENTS WITH RECENT HOSPITALIZATION FOR AN ACUTE CORONARY SYNDROME","authors":"Kirk U Knowlton MD","doi":"10.1016/j.ajpc.2024.100756","DOIUrl":"10.1016/j.ajpc.2024.100756","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>Patients with recent acute coronary syndrome (ACS) are at high risk for recurrent atherosclerotic cardiovascular disease (ASCVD) events. Lowering low-density lipoprotein cholesterol (LDL-C) to &lt;70 mg/mL can reduce this risk; thus, lipid-lowering therapy (LLT), including non-statin therapy, should be intensified within 4–6 weeks of ACS. Despite this recommendation, few patients achieve LDL-C &lt;70 mg/dL after an ACS event. When added to maximally tolerated statin therapy, inclisiran lowered LDL-C by an additional ∼50% in patients with ASCVD in prior trials, but those with ACS within 3 months of screening were excluded.</div></div><div><h3>Methods</h3><div>VICTORION-INCEPTION (NCT04873934) is an ongoing, Phase 3b, US, randomized, parallel-group, open-label, multicenter trial in patients with recent ACS. Eligible patients were screened within 5 weeks of hospital discharge and had LDL¬ C ≥70 mg/mL (or non-high-density lipoprotein cholesterol [HDL-C] ≥100 mg/dL) either on statin therapy or with statin intolerance. Patients were randomized 1:1 to inclisiran 284 mg (equivalent to 300 mg inclisiran sodium) on Days 0, 90, and 270 plus usual care or usual care alone (standard of care per treating physician). This interim analysis describes patient demographics and clinical characteristics.</div></div><div><h3>Results</h3><div>Through February 5, 2024, 788 patients were screened across 40 sites, of whom 400 were eligible and randomized: median age 61 years, 29.3% female, 12.3% Black or African American, and 14.3% Hispanic or Latino. The most common index ACS event (93%) was myocardial infarction (MI); 22% of patients had a prior MI. The median time from discharge to randomization was 34 days (Q1–Q3: 26–43). At baseline, median calculated LDL-C was 84.0 mg/dL (Q1–Q3: 71.0–103.0), non-HDL-C was 107.0 mg/dL (Q1–Q3: 93.0–129.0), and 95.5% of patients were receiving LLT (any statin therapy [alone or combination]: 93.3%; any high-intensity statin therapy: 81.3%; combination therapy [statin plus non-statin LLT]: 9.0%). Demographic and baseline characteristics are comparable between treatment arms (Table).</div></div><div><h3>Conclusions</h3><div>VICTORION-INCEPTION evaluates the LDL-C lowering effect of implementing a systematic LDL-C management pathway including inclisiran in patients with a recent ACS. The enrolled study population is reflective of real-world US clinical practice.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100756"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PREDICTORS OF LIPOPROTEIN(A) TESTING ACROSS A NATIONAL COHORT: INSIGHTS FROM THE VETERANS HEALTH ADMINISTRATION","authors":"Tania Chen MBBS, MPH","doi":"10.1016/j.ajpc.2024.100767","DOIUrl":"10.1016/j.ajpc.2024.100767","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] is a genetically determined, independent, causal risk factor for atherosclerotic cardiovascular diseases (ASCVD). Multiple practice guidelines increasingly recommend Lp(a) testing to refine cardiovascular risk assessment. We aimed to evaluate sociodemographic and clinical factors influencing Lp(a) testing in the Veterans Affairs (VA) healthcare system.</div></div><div><h3>Methods</h3><div>We assembled a retrospective cohort using data from the VA electronic health record, Medicare claims, and community care for Veterans having at least one outpatient visit in the VA between July 1, 2020, and June 30, 2023, and at least one prescription filled in 180 days before the date of the last VA outpatient encounter to ensure adequate healthcare system contact. We evaluated patient-level sociodemographic and clinical predictors of Lp(a) testing. Predictors included self-reported race and ethnicity, social vulnerability, the presence and type of ASCVD, and low-density lipoprotein cholesterol (LDL-C) levels. Neighborhood social vulnerability was defined using the CDC's Social Vulnerability Index (SVI) and categorized by quartiles (higher numbers associated with higher vulnerability). Associations between patient characteristics and Lp(a) testing were estimated using generalized estimating equations.</div></div><div><h3>Results</h3><div>Among 5,331,271 Veterans, the median age was 67 years (IQR 52-76) with 10.3% female; 69.6% identified as White, 18.8% Black, 7.4% Hispanic. Less than 1% of eligible Veterans have received Lp(a) testing. Lp(a) was more likely to be tested among Veterans with older age, White race, non-Hispanic ethnicity, living in urban neighborhoods, and those with low SVI (less vulnerable neighborhoods). After multivariable adjustment, Lp(a) testing was more likely among women, Veterans identified as Black or Asian, and those with established ASCVD (Figure). Across 130 VA facilities, Lp(a) testing ranged from 0.01-3.40%. The median Lp(a) level among those tested at VA facilities was 16 mg/dL (IQR 6-53) with 26% of Veterans with ASCVD and 20% of Veterans without ASCVD having Lp(a) levels &gt;50 mg.</div></div><div><h3>Conclusions</h3><div>Lp(a) testing is infrequent in the VA healthcare system, with disparities in testing by sociodemographic and clinical characteristics. About a quarter of those tested had elevated Lp(a) levels. Developing strategies to improve overall Lp(a) testing and reduce existing gaps in testing by sociodemographic factors is critical as targeted therapeutics become available.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100767"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TEMPORAL TRENDS IN LIPOPROTEIN(A) TESTING AMONG UNITED STATES VETERANS FROM 2014-2023","authors":"Sofia E. Gomez MD","doi":"10.1016/j.ajpc.2024.100758","DOIUrl":"10.1016/j.ajpc.2024.100758","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Novel Biomarkers</div></div><div><h3>Background</h3><div>Elevated lipoprotein(a) [Lp(a)] is a genetically-determined, independent, causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Multiple contemporary clinical practice guidelines endorse Lp(a) testing to refine risk stratification for ASCVD and guide clinical decision-making among high-risk patients. Changes in rates of testing and detection of elevated Lp(a) over time have not been well described.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using Veterans Affairs electronic health record data to evaluate temporal trends in Lp(a) testing from January 1, 2014 to December 31, 2023 among United States Veterans. We identified Veterans in each year who had a primary care or cardiology visit, an active medication filled, and no prior Lp(a) testing. We stratified testing rates based on demographic and clinical factors: age, sex, race and ethnicity, history of ASCVD, and neighborhood social vulnerability index (SVI) scores as defined by the Centers for Disease Control. The SVI incorporates variables such as employment, income, crowding, and education, with higher scores suggesting greater vulnerability. We classified elevated Lp(a) levels using three clinically meaningful thresholds: 50 mg/dL, 70 mg/dL and 90 mg/dL.</div></div><div><h3>Results</h3><div>Lp(a) testing increased nationally from 1 test per 10,000 eligible Veterans (558 tests) in 2014 to 9 tests per 10,000 (4,440 tests) in 2023. While testing increased across all groups, prevalent ASCVD was strongly associated with an increase in Lp(a) testing over time (Figure). Rates of testing increased less among those residing in neighborhoods with high social vulnerability compared with low social vulnerability. Rates of testing increased most among Asian Veterans but similarly across other racial and ethnic groups. The percent of elevated tests across clinically meaningful thresholds has remained stable over time.</div></div><div><h3>Conclusions</h3><div>We found a 9-fold increase in Lp(a) testing among US Veterans over the last decade, particularly among those with ASCVD, but the overall rate remains extremely low. The proportion of Veterans with elevated Lp(a) has remained steady, supporting the clinical utility of testing expansion. Efforts to increase testing among Veterans living in neighborhoods with high social vulnerability will be important to reduce emerging disparities as novel therapeutics to target Lp(a) become available.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100758"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PERFORMANCE OF PREVENT AND POOLED COHORT EQUATIONS FOR PREDICTING 10 YEAR ASCVD RISK IN THE UK BIOBANK","authors":"Matthew Ambrosio MS","doi":"10.1016/j.ajpc.2024.100782","DOIUrl":"10.1016/j.ajpc.2024.100782","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>The Pooled Cohort Equations (PCE) were created in 2013 to assess ASCVD risk in primary prevention. In 2023 the American Heart Association published the PREVENT equations to assess the risk of cardiovascular disease, including ASCVD and heart failure, in primary prevention. The comparative performance of PCE and PREVENT for predicting 10-year ASCVD risk has not been evaluated in an external large-scale epidemiologic cohort.</div></div><div><h3>Methods</h3><div>The study population includes participants of the UK Biobank who were free of clinical cardiovascular disease. 10-year ASCVD risk was calculated using the PCE and PREVENT equations, respectively.</div><div>Individuals who died from non-ASCVD events, or were lost to follow-up before 10 years without developing ASCVD were excluded. C-statistics (AUCs) were calculated separately for men and women to evaluate risk discrimination, and correlated delta AUCs were calculated using DeLong's method. Predicted 10-year risks were divided into deciles for each equation and stratified by gender to compare predicted risk versus observed risk within each decile, with a Hosmer-Lemeshow test performed for goodness of fit.</div></div><div><h3>Results</h3><div>The final cohort was 370,885 individuals (mean age 56, 55.3% women, 94.0% white), after excluding 14,604 individuals lost to follow-up before 10 years without developing ASCVD. The observed 10-year ASCVD (95% CI) was 2.4% (2.31%-2.44%) for women and 5.5% (5.45%-5.56%) for men; the median (IQR) PCE predicted 10-year ASCVD risk was 3.6% (1.53%-7.12%) for women and 10.6% (5.33%-17.03%) for men. The median PREVENT predicted 10-year ASCVD risk was 2.9% (1.47%-4.95%) for women and 5.2% (3.02%-7.93%) for men. The C-statistics for PCE were 0.732 (0.7253-0.7389) for women and 0.695 (0.6893-0.7000) for men. In comparison, the C-statistics for PREVENT were 0.732 (0.7249-0.7382) for women and 0.695 (0.6894-0.6998) for men. Delta AUC was -0.0009 (p=0.36) for women and -0.0009 (p=0.21) for men. Figure 1 displays the mean PCE and PREVENT predicted 10-year ASCVD risks compared to observed risks for each decile. The PREVENT equations appear to be better calibrated than the PCE.</div></div><div><h3>Conclusions</h3><div>There is no significant difference in 10-year ASCVD risk discrimination between PCE and PREVENT equations. However, the PREVENT equations appear to be better calibrated at predicting risk compared to the PCE.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100782"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422820","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}