American journal of preventive cardiology最新文献

{"title":"Associations between cardiovascular-kidney-metabolic syndrome staging and risks of all-cause and cardiovascular mortality: a systematic review and meta-analysis","authors":"Huimin Ding ,&nbsp;Liqun Jiang ,&nbsp;Yiqiu Zhao ,&nbsp;Dongjun Lee ,&nbsp;Buongo Chun","doi":"10.1016/j.ajpc.2026.101407","DOIUrl":"10.1016/j.ajpc.2026.101407","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular, kidney, and metabolic disorders are closely interconnected and jointly increase atherosclerotic burden and mortality risk. In 2023, the American Heart Association introduced the cardiovascular–kidney–metabolic (CKM) syndrome as a staged framework to characterize this multisystem risk. However, evidence linking CKM stages to mortality has not yet been quantitatively synthesized.</div></div><div><h3>Methods</h3><div>We conducted a PROSPERO-registered (CRD420251161180) systematic review and meta-analysis following MOOSE and PRISMA guidelines. Four databases (PUBMED,Web of science, Embase, Cochrane library)were searched through August 8, 2025. Cohort studies assessing CKM stages (0–4) and reporting all-cause, cardiovascular disease (CVD), coronary heart disease (CHD), or stroke mortality were synthesized using random-effects models, with subgroup, meta-regression, and sensitivity analyses.</div></div><div><h3>Results</h3><div>9 cohort studies including 10,330,498 participants were analyzed. Mortality risk increased significantly with advancing CKM stages. Compared with Stage 0, Stage 4 was associated with markedly higher risks of all-cause mortality (HR = 3.82, 95% CI: 2.24–6.52), CVD mortality (HR = 6.38, 95% CI: 5.22–7.80), CHD mortality (HR = 9.19, 95% CI: 6.93–12.20), and stroke mortality (HR = 5.48, 95% CI: 4.28–7.02). Meta-regression identified age and educational attainment as significant effect modifiers and sources of heterogeneity. In sex-stratified analyses, all-cause mortality was consistently higher in women across CKM stages, whereas CVD mortality was higher in women at earlier stages but higher in men at later stages. Leave-one-out (LOO) sensitivity analyses and publication bias assessments supported the robustness of these findings.</div></div><div><h3>Conclusions</h3><div>Advancing CKM stages are associated with progressively higher mortality risks, highlighting their value for early risk assessment and targeted prevention.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101407"},"PeriodicalIF":5.9,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925939","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":"History of gestational diabetes, modifiable lifestyle factors, and risk of cardiovascular disease and mortality: a prospective cohort study","authors":"Sidong Li ,&nbsp;Yuxiao Wu ,&nbsp;Yuxiang Yan ,&nbsp;Yang Du ,&nbsp;Shuhan Chen ,&nbsp;Deirdre K. Tobias ,&nbsp;Cuilin Zhang ,&nbsp;Wei Bao","doi":"10.1016/j.ajpc.2025.101406","DOIUrl":"10.1016/j.ajpc.2025.101406","url":null,"abstract":"<div><h3>Background</h3><div>Women with a history of gestational diabetes (GDM) have an increased risk of cardiovascular disease (CVD) throughout their lifetime. It is still unclear whether adhering to a healthy lifestyle can modify the association of GDM with the risk of CVD and mortality.</div></div><div><h3>Methods</h3><div>This study included 125,435 parous women from the UK Biobank prospective cohort. The history of GDM was determined by self-reported diagnosis or hospital admission records. A healthy lifestyle score was defined by incorporating self-reported information on five modifiable risk factors, including smoking, alcohol intake, physical activity, diet, and sleep duration. The primary outcome was a composite of major CVD and all-cause mortality.</div></div><div><h3>Results</h3><div>The mean age was 56.4 ± 7.9 yrs, and 668 participants had a history of GDM. After a median follow-up of 13.6 years, 9371 had major CVD events, and 6750 died. The association between GDM history with the composite of major CVD and all-cause mortality was stronger among women with the least healthy lifestyles (HR, 2.35 [95% CI, 1.72–3.22]) compared to those with moderately healthy (1.31 [0.84–2.06]) or the healthiest lifestyles (1.24 [0.75–2.06]; <em>P</em> = 0.001 for interaction). The relative excess risk due to interaction between GDM history and the least healthy lifestyles was 0.52 (0.27–0.77; <em>P</em> = 0.02). Compared to women with no GDM history and the healthiest lifestyle, those with GDM history and the least healthy lifestyle had a threefold increased risk of the composite outcome (3.00 [2.20–4.10]), while women with GDM history and the healthiest lifestyle did not experience a significantly higher risk (1.19 [0.71–1.97]).</div></div><div><h3>Conclusions</h3><div>Women with a history of GDM did not experience a higher risk of all-cause mortality and major CVD when adhering to a healthy lifestyle in midlife.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101406"},"PeriodicalIF":5.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925943","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":"Inaccurate information regarding cardiovascular disease prevention enabled by generative artificial intelligence","authors":"Astefanos Al-Dalakta ,&nbsp;Bianca Honnekeri ,&nbsp;Fatima Rodriguez ,&nbsp;Luke Laffin ,&nbsp;Vikas Sunder ,&nbsp;Dennis Bruemmer ,&nbsp;Leslie Cho ,&nbsp;Steven E. Nissen ,&nbsp;Ashish Sarraju","doi":"10.1016/j.ajpc.2025.101404","DOIUrl":"10.1016/j.ajpc.2025.101404","url":null,"abstract":"<div><div>Inaccurate information regarding cardiovascular disease (CVD) prevention is prevalent on the internet and may influence medical decisions. Artificial intelligence “bots” are present on the internet and may be used for medical questions. This physician-led experiment evaluated the generation of inaccurate CVD information on two widely used generative artificial intelligence (genAI) models, namely OpenAI o1 and DeepSeek-R1. Performed in February 2025, this experiment was designed to evaluate genAI responses regarding nine commonly relevant CVD prevention topics, including statin therapy, supplements, and LDL cholesterol. Prompts were devised in two “tones”, termed a neutral tone prompt and an inaccuracy tone prompt, the latter of which specifically requested inaccurate information. Two board-certified preventive cardiologists graded responses as appropriate, borderline, or inappropriate based on content and references. For the nine neutral tone prompts, 88.9 % (8/9) of OpenAI o1’s responses and 66.7 % (6/9) of DeepSeek R1’s were graded as appropriate. For the inaccuracy tone prompts, OpenAI o1 produced no appropriate responses (0/9), with 22.2 % (2/9) graded as borderline and 77.8 % (7/9) inappropriate. All of DeepSeek R1’s replies (9/9) were graded as inappropriate. Findings highlight the relative ease with which genAI models can be prompted to produce inaccurate information on CVD prevention topics that are highly relevant to public health. Findings underscore the need for further research and policy interventions to mitigate AI-driven informational risks.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101404"},"PeriodicalIF":5.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926481","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":"Associations of threat- and deprivation-related adverse childhood experiences with risk of cardiovascular disease in later life","authors":"Zi-Mu Chen ,&nbsp;Yan-Bo Zhang ,&nbsp;Sha Sha ,&nbsp;Qinge Zhang ,&nbsp;Zhaohui Su ,&nbsp;Teris Cheung ,&nbsp;Gabor S. Ungvari ,&nbsp;Todd Jackson ,&nbsp;Yu-Tao Xiang ,&nbsp;Yuan Feng","doi":"10.1016/j.ajpc.2025.101403","DOIUrl":"10.1016/j.ajpc.2025.101403","url":null,"abstract":"<div><div>Exposure to adverse childhood experiences (ACEs) has consistent associations with increased long-term risk of cardiovascular disease (CVD). However, links of distinct ACE subtypes and particular ACEs with later-life CVD are insufficiently understood. This longitudinal cohort study initially recruited 20,452 participants from the China Health and Retirement Longitudinal Study and Life History Survey. Follow-up data were obtained from five waves conducted between 2011 and 2020. ACEs were measured with ten items adapted from the Life Stressor Checklist-Revised, a measure that includes five threat-related ACEs and five deprivation-related ACEs. The outcome measure was CVD (including heart disease and stroke) during the follow-up period. Multivariate Cox proportional hazards regression models assessed links of cumulative ACEs, ACE subtypes, and individual ACEs with CVD incidence. Of 13,920 included participants, 8434 (60.6 %) reported exposure to at least one ACE. During the study period of 9 years, 2689 participants (19.3 %) received a clinical diagnosis of CVD, including 2098 (15.1 %) with heart disease and 683 (4.9 %) with stroke. Both threat-related ACEs (hazard ratio [HR], 1.08; 95 % CI, 1.03–1.12) and deprivation-related ACEs (HR, 1.08; 95 % CI, 1.01–1.15) were independently associated with increased risk of CVD, with the strongest association observed for stroke. Findings underscore the importance of considering threat- and deprivation-related ACEs in assessments and targeted intervention studies as potential means of yielding long-term cardioprotective benefits.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101403"},"PeriodicalIF":5.9,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of peripheral artery disease (PAD) on risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes","authors":"James Amamoo ,&nbsp;Lin Xie ,&nbsp;Andrea Steffens ,&nbsp;Erin Buysman ,&nbsp;Caroline Swift ,&nbsp;Sherif Mehanna ,&nbsp;Noelle N. Gronroos ,&nbsp;Marc P. Bonaca","doi":"10.1016/j.ajpc.2025.101397","DOIUrl":"10.1016/j.ajpc.2025.101397","url":null,"abstract":"<div><h3>Background</h3><div>As of 2021, global estimates show that 536.6 million adults aged 20 to 79 years are living with type 2 diabetes (T2D), and the prevalence of T2D is projected to increase to about 783 million individuals by 2045. Peripheral artery disease (PAD), which is caused by atherosclerosis of the extremities (most commonly lower limbs) leading to the narrowing of blood vessels, is a major risk factor for lower extremity amputation and is a common comorbidity of diabetes. Patients with both T2D and PAD often have advanced systemic vascular disease, which may involve other vascular territories, such as the coronary and cerebral arteries. However, PAD is underdiagnosed and underrecognized, particularly at earlier stages of the disease.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used real-world data to characterize the vascular risk profile of patients with T2D with PAD and those with T2D without other evidence of atherosclerotic cardiovascular disease, including irreversible harm events of the heart, limbs, and brain.</div></div><div><h3>Results</h3><div>Patients with T2D and PAD had a higher risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) compared with those without PAD. Ankle-brachial index and duplex ultrasound were the most commonly used assessments during diagnostic evaluation for PAD.</div></div><div><h3>Conclusions</h3><div>Among patients with T2D, presence of PAD was associated with an increased risk of all evaluated outcomes. These findings highlight the significant vascular burden of PAD among patients with T2D.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101397"},"PeriodicalIF":5.9,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926478","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":"Lifes essential 8 score and 10-year cardiovascular outcomes in atrial fibrillation: A UK biobank analysis with simulated lifestyle improvement","authors":"Charlotte J. Fitzhugh ,&nbsp;Helen Jones ,&nbsp;Lawrence Foweather ,&nbsp;Benjamin J.R. Buckley","doi":"10.1016/j.ajpc.2025.101399","DOIUrl":"10.1016/j.ajpc.2025.101399","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) is associated with high risks of mortality and cardiovascular events, yet the prognostic value of comprehensive lifestyle and clinical health metrics remains uncertain.</div></div><div><h3>Objective</h3><div>To investigate whether cardiovascular health (CVH), as measured by the American Heart Association's Life’s Essential 8 (LE8) score, is associated with clinical outcomes in people with AF, and to estimate the impact of simulated improvement in CVH components.</div></div><div><h3>Methods</h3><div>Data were drawn from the UK Biobank, a prospective population-based cohort. Participants with AF were identified using ICD codes. CVH was assessed using a modified LE8 score (range 0–100), derived from smoking status, cholesterol, blood pressure, BMI, HbA1c, physical activity, diet, and sleep. Primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE: ischaemic heart disease, myocardial infarction, stroke, and heart failure). Associations were analysed using Cox models with penalised splines, presented in Kaplan-Meier curves. Population attributable and potential impact fractions were estimated.</div></div><div><h3>Results</h3><div>Among 23,758 individuals with AF and 10-year follow-up, higher CVH scores associated with lower risk of all-cause mortality and MACE in a non-linear, graded pattern. Compared with the lowest quartile, the highest CVH quartile had 39% lower risk of all-cause mortality (HR: 0.61, 95% CI: 0.56–0.67) and 38% lower risk of MACE (HR: 0.62, 95% CI: 0.58–0.67; both <em>p</em> &lt; 0.001). Associations were modified by age and multimorbidity. Simulated improvements in CVH could reduce all-cause mortality by 10% and MACE by 7%, with diet, smoking, blood pressure, and BMI contributing most.</div></div><div><h3>Conclusion</h3><div>Higher LE8 scores were independently associated with lower all-cause mortality and MACE risk in people with AF, supporting the role of lifestyle-based secondary prevention in AF care.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101399"},"PeriodicalIF":5.9,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977334","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":"Trends in lipoprotein(a) testing and impact on clinical care: A contemporary systemwide analysis","authors":"Mahima Mangla ,&nbsp;Tia Bimal ,&nbsp;Ehimare Akhabue ,&nbsp;Xueqi Huang ,&nbsp;Marlys Koschinsky ,&nbsp;Georgeta Vaidean ,&nbsp;James Donnelly ,&nbsp;Tanesh Ayyalu ,&nbsp;Guy Mintz ,&nbsp;Eugenia Gianos","doi":"10.1016/j.ajpc.2025.101402","DOIUrl":"10.1016/j.ajpc.2025.101402","url":null,"abstract":"<div><h3>Aims</h3><div>Elevated lipoprotein(a) [Lp(a)] is an independent, causal risk factor for atherosclerotic cardiovascular disease (ASCVD), yet testing remains low. As our health system has expanded its efforts to increase Lp(a) awareness, we evaluated testing rates and their impact on care.</div></div><div><h3>Methods</h3><div>Lp(a) testing rates were collected through electronic health record queries between 1/1/2022 to 12/31/2024. Baseline demographics, ASCVD status, Lp(a) testing rates by specialty, lipid lowering therapy (LLT) prescriptions and number of cardiology referrals were collected.</div></div><div><h3>Results</h3><div>450,412 outpatients had ≥1 lipid panel order and 3.7 % (<em>N</em> = 16,476) had Lp(a) tested. Of those who had Lp(a) measured, 50.5 % were female and 61.8 % identified as White. Most Lp(a) orders were for patients without established ASCVD (68.9 %). Between 2022–2024, Lp(a) orders increased from 3052 to 8425. Most orders were placed by cardiologists, although their proportion decreased (75.5 % in 2022 vs. 62.9 % in 2024) as orders from other specialties increased. We found 67.0 % of patients with normal Lp(a) (&lt;75 nmol/L) levels, 12.2 % with intermediate risk (75 ≥ Lp(a) &lt; 125 nmol/L), 11.3 % with high risk (125 ≥ Lp(a) &lt; 200 nmol/L) and 9.4 % with very high-risk values (≥200 nmol/L). Across the same Lp(a) categories, LLT initiation/escalation rates were 12.8 %, 17.5 %, 20.2 % and 22.1 %. There was a positive association between LLT initiation/escalation and Lp(a) range (<em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>While Lp(a) testing was low, it increased substantially over time. High risk Lp(a) levels were found irrespective of ASCVD status and were associated with more aggressive treatment. Systematic strategies to increase Lp(a) awareness and testing are warranted to mitigate cardiovascular risk.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101402"},"PeriodicalIF":5.9,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977335","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":"Perimenopause as an obesogenic sensitive period: Contributions to elevated cardiovascular risk","authors":"Margot E. Manning ,&nbsp;Sara L. Stockman ,&nbsp;Markella V. Zanni","doi":"10.1016/j.ajpc.2025.101398","DOIUrl":"10.1016/j.ajpc.2025.101398","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Perimenopause, encompassing the period of progressive menstrual irregularity preceding a woman’s final menstrual cycle and extending 12 months thereafter, is associated with an acceleration in atherosclerotic cardiovascular disease (CVD) risk, attributable in part to redistribution of body fat. During perimenopause, even in the context of minimal-to-modest weight gain, women experience an expansion of visceral adipose tissue. Concomitantly, women often experience a reduction in gluteofemoral subcutaneous adipose tissue. This pattern of fat redistribution is associated with a greater prevalence of CVD risk factors and a higher incidence of CVD events. Here we present a case of disproportionate weight gain and fat redistribution in a woman newly initiating a long-acting injectable antipsychotic medication with mild-to-moderate obesogenic effects during perimenopause.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Presentation&lt;/h3&gt;&lt;div&gt;A 46-year-old woman with schizoaffective disorder and primary hypothyroidism on levothyroxine presented to her endocrinologist with concerns of weight gain. She also reported vasomotor symptoms and oligomenorrhea. For management of schizoaffective disorder, she was engaged in psychiatric counseling and had initiated a monthly, extended-release aripiprazole lauroxil injectable, within the year. On physical examination, her weight had increased by 9.2 kilograms, shifting her to an overweight body mass index. Fat distribution was notably centripetal, but there was no other Cushing’s stigmata. Laboratory evaluation revealed thyroid stimulating hormone within normal limits, an elevated follicle stimulating hormone level, and an undetectable antimullerian hormone level. Human chorionic gonadotropin test was negative, and neither prolactin nor 24-hour urine free cortisol levels were elevated. Ultimately, her psychiatrist discontinued the long-acting aripiprazole therapy while continuing counseling. Greater than two years post medication discontinuation, she has not achieved significant weight loss, despite augmented physical activity and implementation of dietary changes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In a perimenopausal woman, initiation of a medication with mild-to-moderate obesogenic effects potentially precipitated a dramatic weight gain (10x above the potential magnitude described in package insert), and despite medication discontinuation and lifestyle interventions, excess weight was not shed. While the menopausal transition is not typically associated with significant weight gain, the clinical case described suggests that perimenopausal factors may have contributed to medication-induced weight gain, which was predominantly centrally distributed. As metabolic memory in adipocytes can impede meaningful weight loss, this case highlights perimenopause as a critical period of heightened metabolic sensitivity to pharmacologic insult. Clinicians of perimenopausal patients should exercise caution in init","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101398"},"PeriodicalIF":5.9,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915428","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 dominant driver paradigm of cardiometabolic care","authors":"Joel Hernandez Sevillano ,&nbsp;Masih A. Babagoli ,&nbsp;Yitong Chen ,&nbsp;Shelley H. Liu ,&nbsp;Pranav Mellacheruvu ,&nbsp;Janet Johnson ,&nbsp;Borja Ibanez ,&nbsp;Oscar Lorenzo ,&nbsp;Jeffrey I. Mechanick","doi":"10.1016/j.ajpc.2025.101389","DOIUrl":"10.1016/j.ajpc.2025.101389","url":null,"abstract":"<div><h3>Background</h3><div>In cardiometabolic care, the conventional paradigm is based on concurrent and independent management of different drivers (e.g., abnormal adiposity, dysglycemia, and hypertension) that are causally interconnected. Alternatively, epidemiological and mechanistic evidence supports a novel dominant driver paradigm, based on the determination of the earliest causative driver.</div></div><div><h3>Objective</h3><div>To determine the degree of discordance between the conventional paradigm (prevalence distributions of unprocessed cardiometabolic drivers) and the dominant driver paradigm (prevalence distributions of processed dominant drivers).</div></div><div><h3>Methods</h3><div>The cardiometabolic drivers at initial presentation of patients from a preventive cardiology center were retrospectively tabulated and an etiologic dominant driver was determined for each patient. Prevalence differences and agreement measures between the conventional tabulation of drivers and the dominant drivers were ascertained.</div></div><div><h3>Results</h3><div>966 patients were included (mean age, 61.7 ± 16.0; 606 [63.0%] female). The prevalence of abnormal adiposity was similar in both paradigms (67.6% vs 66.5%; <em>p</em> = 0.637). However, the prevalence rates for dysglycemia (64.7% vs 14.5%; <em>p</em> &lt; 0.001), hypertension (87.6% vs 16.0%; <em>p</em> &lt; 0.001), and dyslipidemia (97.2% vs 3%; <em>p</em> &lt; 0.001) were significantly higher in the conventional compared to the dominant driver paradigm. Globally, the two paradigms had only slight agreement (kappa=0.188; <em>p</em> &lt; 0.001). Complications in patients with predisease (overweight body mass index range and prediabetes hemoglobin A1c range) were found in 90% and 91% of presentations, respectively.</div></div><div><h3>Conclusion</h3><div>Clinical targeting of dysglycemia, hypertension, and dyslipidemia would be drastically reduced with a dominant driver paradigm in which abnormal adiposity is the most frequent dominant driver. With the advent of novel and effective pharmacotherapies for the treatment of abnormal adiposity, simplification of cardiometabolic-based chronic disease treatment is possible.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101389"},"PeriodicalIF":5.9,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925944","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":"From image to action: Evaluating the translation of coronary CT angiography findings into cardiovascular prevention in the emergency department","authors":"Pragati Shrestha ,&nbsp;Jaymie R. Meliker ,&nbsp;Adam J. Singer ,&nbsp;Pablo R. Ros ,&nbsp;Lisa Benz Scott","doi":"10.1016/j.ajpc.2025.101394","DOIUrl":"10.1016/j.ajpc.2025.101394","url":null,"abstract":"<div><h3>Background</h3><div>Coronary CT angiography (CCTA) is increasingly used in emergency departments (ED) for chest pain evaluation, but its role in directing preventive therapy at discharge remains unclear.</div></div><div><h3>Objectives</h3><div>We aimed to determine whether CCTA findings were associated with statin initiation at discharge and to identify gaps in preventive care.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study of adult patients (≥18 years) undergoing CCTA for chest pain in the ED of a large academic hospital. CCTA findings were categorized as no CAD, non-obstructive CAD (&lt;50% stenosis), or obstructive CAD (≥50% stenosis). The primary outcome was statin initiation at discharge among statin-naïve patients. Secondary outcomes included cardiology referral and heart disease education. We applied multivariable Firth logistic regression for the primary outcome and modified Poisson regression with robust variance for secondary outcomes.</div></div><div><h3>Results</h3><div>Of 1410 participants (mean age=53.5 ± 10.9 years; 52.8% female), 723 (51.3%) had no CAD and 687 (48.7%) had CAD (69.3% non-obstructive, 30.7% obstructive). In statin-naïve patients (<em>n</em> = 1120), statin initiation rates were 79.7% for obstructive CAD and 9.5% for non-obstructive CAD. Adjusted models showed higher statin initiation with obstructive CAD (OR=97.0, 95% CI: 22.9–410.5) and non-obstructive CAD (OR=18.2, 95% CI: 4.8–69.1) compared with no CAD. Cardiology referral occurred in 96.2% of obstructive and 83.2% of non-obstructive CAD; education was documented in 83.4% and 52.1%, respectively.</div></div><div><h3>Conclusions</h3><div>CCTA findings strongly predict statin initiation at discharge, yet large treatment gaps persist, especially in non-obstructive CAD. Routine ED CCTA provides a missed but actionable opportunity to initiate guideline-based therapy and reduce ASCVD burden.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101394"},"PeriodicalIF":5.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980818","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}