Pub Date : 2024-12-01DOI: 10.1016/j.ajpc.2024.100897
Michael D. Shapiro
{"title":"A vision for the future: ASPC's new educational offerings for 2025","authors":"Michael D. Shapiro","doi":"10.1016/j.ajpc.2024.100897","DOIUrl":"10.1016/j.ajpc.2024.100897","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100897"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744897","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 : 2024-12-01DOI: 10.1016/j.ajpc.2024.100901
Erin D. Michos , Nathan D. Wong
{"title":"Editors’ message – December 2024","authors":"Erin D. Michos , Nathan D. Wong","doi":"10.1016/j.ajpc.2024.100901","DOIUrl":"10.1016/j.ajpc.2024.100901","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100901"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744896","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 : 2024-12-01DOI: 10.1016/j.ajpc.2024.100900
Gregory P. Geba , Ruifeng Chen , Kasturi Talapatra , Taylor Brackin , Kusha A. Mohammadi , Robert Pordy , Garen Manvelian , David J. Maron , Gregory G. Schwartz , Michael Szarek , Ph. Gabriel Steg , Sergio Fazio
Background
Patients with recent acute coronary syndrome (ACS) commonly experience chest pain, which affects quality of life even when not due to recurrence of ACS. This post hoc analysis of ODYSSEY OUTCOMES assessed the effect of alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, on the incidence of chest pain not due to recurrent ACS.
Methods
Patients with recent ACS (n = 18,894) and elevated atherogenic lipoprotein levels despite optimized statin therapy were randomized to subcutaneous alirocumab or matching placebo every 2 weeks. Alirocumab dose was adjusted to target low-density lipoprotein cholesterol (LDL-C) 25–50 mg/dL (0.6–1.3 mmol/L) and to avoid consecutive LDL-C <15 mg/dL (0.39 mmol/L). Non-hospitalized chest pain adverse events and chest pain events requiring hospitalization but negatively adjudicated for recurrent ACS were assessed.
Results
Chest pain not requiring hospitalization was reported as an adverse event in 1490 patients, including 7.5 % and 8.3 % of alirocumab and placebo groups, respectively. Hospitalization for chest pain negatively adjudicated for recurrent ACS occurred in 952 patients, including 4.8 % and 5.3 % of alirocumab and placebo groups, respectively. Adjusting for baseline covariates, alirocumab use was associated with 8.1 % lower risk of chest pain (either non-hospitalized or hospitalized events) versus placebo (HR: 0.919; 95 % CI: 0.845–0.998; P = 0.046); a landmark analysis at 7 months showed a larger, 11.7 % risk reduction (HR: 0.883; 95 % CI: 0.793–0.984; P = 0.024).
Conclusions
Alirocumab use is associated with reduced incidence of chest pain events after ACS, including those not requiring hospitalization and those requiring hospitalization but not adjudicated as recurrent ACS.
{"title":"Alirocumab and chest pain after acute coronary syndrome: An analysis of ODYSSEY OUTCOMES","authors":"Gregory P. Geba , Ruifeng Chen , Kasturi Talapatra , Taylor Brackin , Kusha A. Mohammadi , Robert Pordy , Garen Manvelian , David J. Maron , Gregory G. Schwartz , Michael Szarek , Ph. Gabriel Steg , Sergio Fazio","doi":"10.1016/j.ajpc.2024.100900","DOIUrl":"10.1016/j.ajpc.2024.100900","url":null,"abstract":"<div><h3>Background</h3><div>Patients with recent acute coronary syndrome (ACS) commonly experience chest pain, which affects quality of life even when not due to recurrence of ACS. This post hoc analysis of ODYSSEY OUTCOMES assessed the effect of alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, on the incidence of chest pain not due to recurrent ACS.</div></div><div><h3>Methods</h3><div>Patients with recent ACS (<em>n</em> = 18,894) and elevated atherogenic lipoprotein levels despite optimized statin therapy were randomized to subcutaneous alirocumab or matching placebo every 2 weeks. Alirocumab dose was adjusted to target low-density lipoprotein cholesterol (LDL-C) 25–50 mg/dL (0.6–1.3 mmol/L) and to avoid consecutive LDL-C <15 mg/dL (0.39 mmol/L). Non-hospitalized chest pain adverse events and chest pain events requiring hospitalization but negatively adjudicated for recurrent ACS were assessed.</div></div><div><h3>Results</h3><div>Chest pain not requiring hospitalization was reported as an adverse event in 1490 patients, including 7.5 % and 8.3 % of alirocumab and placebo groups, respectively. Hospitalization for chest pain negatively adjudicated for recurrent ACS occurred in 952 patients, including 4.8 % and 5.3 % of alirocumab and placebo groups, respectively. Adjusting for baseline covariates, alirocumab use was associated with 8.1 % lower risk of chest pain (either non-hospitalized or hospitalized events) versus placebo (HR: 0.919; 95 % CI: 0.845–0.998; <em>P</em> = 0.046); a landmark analysis at 7 months showed a larger, 11.7 % risk reduction (HR: 0.883; 95 % CI: 0.793–0.984; <em>P</em> = 0.024).</div></div><div><h3>Conclusions</h3><div>Alirocumab use is associated with reduced incidence of chest pain events after ACS, including those not requiring hospitalization and those requiring hospitalization but not adjudicated as recurrent ACS.</div></div><div><h3>Trial registration</h3><div>NCT01663402</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100900"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757675","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 : 2024-11-29DOI: 10.1016/j.ajpc.2024.100899
Timo Schmitz , Dennis Freuer , Philip Raake , Jakob Linseisen , Christa Meisinger
Aims
To investigate the association between body mass index (BMI) at acute myocardial infarction (AMI) and all-cause as well as cause-specific long-term mortality.
Methods
The analysis was based on 10,651 hospitalized AMI patients (age 25–84 years) recorded by the population-based Myocardial Infarction Registry Augsburg between 2000 and 2017. The median follow-up time was 6.7 years [IQR: 3.5–10.0)]. Cause-specific mortality was obtained by evaluating the death certificates. In multivariable-adjusted COX regression models using cubic splines for the variable BMI, the association between BMI and cause-specific mortality (all-cause, cardiovascular, ischemic heart diseases, cancer) was investigated. Additionally, a subgroup analysis in three age groups was performed for all-cause mortality.
Results
Overall, there was a statistically significant U-shaped association between BMI at AMI and long-term mortality with the lowest hazard ratios (HR) found for BMI values between 25 and 30 kg/m². For cancer mortality, higher BMI values > 30 kg/m² were not associated with higher mortality. In patients aged <60 years, there was a significant association between BMI values >35 kg/m² and increased all-cause mortality; this association was missing in 60 to 84 years old patients. For all groups and for each specific cause of mortality, lower BMI (<25kg/m²) values were significantly associated with higher mortality.
Conclusions
Overall, a lower BMI – and also a high BMI in patients younger than 60 years - seem to be a risk factors for increased all-cause mortality after AMI. A BMI in a mid-range between 25 and 30 kg/m² is favorable in terms of long-term survival after AMI.
{"title":"Association between BMI and cause-specific long-term mortality in acute myocardial infarction patients","authors":"Timo Schmitz , Dennis Freuer , Philip Raake , Jakob Linseisen , Christa Meisinger","doi":"10.1016/j.ajpc.2024.100899","DOIUrl":"10.1016/j.ajpc.2024.100899","url":null,"abstract":"<div><h3>Aims</h3><div>To investigate the association between body mass index (BMI) at acute myocardial infarction (AMI) and all-cause as well as cause-specific long-term mortality.</div></div><div><h3>Methods</h3><div>The analysis was based on 10,651 hospitalized AMI patients (age 25–84 years) recorded by the population-based Myocardial Infarction Registry Augsburg between 2000 and 2017. The median follow-up time was 6.7 years [IQR: 3.5–10.0)]. Cause-specific mortality was obtained by evaluating the death certificates. In multivariable-adjusted COX regression models using cubic splines for the variable BMI, the association between BMI and cause-specific mortality (all-cause, cardiovascular, ischemic heart diseases, cancer) was investigated. Additionally, a subgroup analysis in three age groups was performed for all-cause mortality.</div></div><div><h3>Results</h3><div>Overall, there was a statistically significant U-shaped association between BMI at AMI and long-term mortality with the lowest hazard ratios (HR) found for BMI values between 25 and 30 kg/m². For cancer mortality, higher BMI values > 30 kg/m² were not associated with higher mortality. In patients aged <60 years, there was a significant association between BMI values >35 kg/m² and increased all-cause mortality; this association was missing in 60 to 84 years old patients. For all groups and for each specific cause of mortality, lower BMI (<25kg/m²) values were significantly associated with higher mortality.</div></div><div><h3>Conclusions</h3><div>Overall, a lower BMI – and also a high BMI in patients younger than 60 years - seem to be a risk factors for increased all-cause mortality after AMI. A BMI in a mid-range between 25 and 30 kg/m² is favorable in terms of long-term survival after AMI.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100899"},"PeriodicalIF":4.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886338","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 : 2024-11-29DOI: 10.1016/j.ajpc.2024.100902
Yan Liu , Yi Gao , Guangcan Yan , Yige Liu , Wei Tian , Yiying Zhang , Shanjie Wang , Bo Yu
Objective
Secondhand smoke (SHS) is a strong but comparatively controllable cardiometabolic risk factor. This study aims to assess the present and future burden of cardiometabolic diseases (CMDs) from SHS exposure.
Methods
Using the Global Burden of Disease (GBD) framework, we examined mortality and disability-adjusted life year (DALY) from CMDs attributable to SHS, by age, sex, and year, including cardiovascular disease [CVD, ischemic heart disease (IHD) and/or stroke], and/or Type 2 Diabetes Mellitus (T2DM) from 1990 to 2019. The predicted death number and age-standardized mortality rate (ASMR) from 2020 to 2040 were estimated by the Bayesian age-period cohort (BAPC) model.
Results
SHS exposure declined until 2016 but stabilized or increased thereafter. From 1990 to 2019, CMD-related deaths and DALYs due to SHS are continuously increasing, particularly in low-middle and middle Sociodemographic Index (SDI) regions. In 2019, a significant proportion of CMD-related deaths and DALYs among females under 65 were attributed to SHS exposure. In females aged 25–29, SHS contributed to 16.12 % and 13.30 % of IHD and T2DM deaths, respectively. Surprisingly, forecasts show that annual deaths from IHD, stroke, and T2DM related to SHS exposure are anticipated to rise over the next 20 years.
Conclusions
SHS exposure has stopped declining in recent years. CMD-related deaths from controlled SHS have increased and are predicted to rise substantially over the next 20 years. Reducing SHS exposure could have major benefits for cardiometabolic health worldwide, especially for women under 65 years in less developed regions.
{"title":"Global disease burden analysis of Cardiometabolic disease attributable to second-hand smoke exposure from 1990 to 2040","authors":"Yan Liu , Yi Gao , Guangcan Yan , Yige Liu , Wei Tian , Yiying Zhang , Shanjie Wang , Bo Yu","doi":"10.1016/j.ajpc.2024.100902","DOIUrl":"10.1016/j.ajpc.2024.100902","url":null,"abstract":"<div><h3>Objective</h3><div>Secondhand smoke (SHS) is a strong but comparatively controllable cardiometabolic risk factor. This study aims to assess the present and future burden of cardiometabolic diseases (CMDs) from SHS exposure.</div></div><div><h3>Methods</h3><div>Using the Global Burden of Disease (GBD) framework, we examined mortality and disability-adjusted life year (DALY) from CMDs attributable to SHS, by age, sex, and year, including cardiovascular disease [CVD, ischemic heart disease (IHD) and/or stroke], and/or Type 2 Diabetes Mellitus (T2DM) from 1990 to 2019. The predicted death number and age-standardized mortality rate (ASMR) from 2020 to 2040 were estimated by the Bayesian age-period cohort (BAPC) model.</div></div><div><h3>Results</h3><div>SHS exposure declined until 2016 but stabilized or increased thereafter. From 1990 to 2019, CMD-related deaths and DALYs due to SHS are continuously increasing, particularly in low-middle and middle Sociodemographic Index (SDI) regions. In 2019, a significant proportion of CMD-related deaths and DALYs among females under 65 were attributed to SHS exposure. In females aged 25–29, SHS contributed to 16.12 % and 13.30 % of IHD and T2DM deaths, respectively. Surprisingly, forecasts show that annual deaths from IHD, stroke, and T2DM related to SHS exposure are anticipated to rise over the next 20 years.</div></div><div><h3>Conclusions</h3><div>SHS exposure has stopped declining in recent years. CMD-related deaths from controlled SHS have increased and are predicted to rise substantially over the next 20 years. Reducing SHS exposure could have major benefits for cardiometabolic health worldwide, especially for women under 65 years in less developed regions.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100902"},"PeriodicalIF":4.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886447","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 : 2024-11-23DOI: 10.1016/j.ajpc.2024.100895
Wael E. Eid , Emma Hatfield Sapp , Callen Conroy , Coby Bessinger , Cassidy L. Moody , Ryan Yadav , Reece Tolliver , Joseph Nolan , Suzanne M. Francis
Background
Lipoprotein(a) [Lp(a)] is a low-density lipoprotein variant with atherogenic, thrombogenic, and pro-inflammatory properties that may have numerous pathologic effects, including dyslipidemia. Screening for Lp(a) is clinically significant, due to its causal role in atherosclerotic cardiovascular disease (ASCVD). Among clinicians, however, there remains a general lack of both clinical awareness of Lp(a) and adequate tools to track Lp(a) testing in patients.
Objective
To study factors affecting Lp(a) screening by: i) determining the effectiveness of messaging providers at a large community health system about Lp(a) screening and measuring the subsequent percentage of Lp(a) tests requested; and ii) by determining the percentage of patients who obtained Lp(a) testing after being advised by the provider.
Methods
From December 2022 through March 2023, messages detailing the need for Lp(a) screening were sent via the Epic EHR™ to providers of patients meeting criteria for Lp(a) testing in advance of scheduled patient appointments. In this prospective study, providers were randomized into 2 groups: those receiving the pre-appointment message (Group 1) and those not receiving the pre-appointment message (Group 2).
Results
Sending pre-appointment messages correlated with more Lp(a) orders (16.6 % v. 4.7 %, P < 0.001) and consequently with more tests performed (10.2 % v. 3.7 %, p < 0.001). Among provider types, nurse practitioners and physician assistants had the highest number of Lp(a) results per order (Z = 16.40, P < 0.001), achieving 30.8–39.1 % more test results, even if they did not receive the pre-appointment message. Distribution of Lp(a) values in patients was 59.7 % ≤ 29 mg/dL; 9.7 % > 29 and < 50mg/dL; and 30.6 % ≥ 50 mg/dL.
Conclusion
Providers who received pre-appointment messages via an EHR were associated with requesting more tests and consequently receiving more Lp(a) results, compared with providers who did not receive messages.
背景：脂蛋白(a) [Lp(a)]是一种低密度脂蛋白变体，具有致动脉粥样硬化、血栓形成和促炎特性，可能具有许多病理效应，包括血脂异常。由于Lp(a)在动脉粥样硬化性心血管疾病（ASCVD）中起因果作用，因此筛查Lp(a)具有重要的临床意义。然而，在临床医生中，仍然普遍缺乏Lp(a)的临床意识和足够的工具来跟踪患者的Lp(a)检测。目的：通过以下方式研究影响Lp(a)筛查的因素：i)确定大型社区卫生系统中Lp(a)筛查的信息提供者的有效性，并测量随后要求进行Lp(a)测试的百分比；ii)确定在提供者建议下接受Lp(a)检测的患者百分比。方法：从2022年12月到2023年3月，详细说明Lp(a)筛查需求的信息通过Epic EHR™发送给符合Lp(a)检测标准的患者的提供者，提前安排患者预约。在这项前瞻性研究中，提供者被随机分为两组：接受预约前信息的（第1组）和未接受预约前信息的（第2组）。结果：发送预约前信息与更多的Lp(a)订单相关（16.6% vs . 4.7%, P < 0.001），因此进行了更多的测试（10.2% vs . 3.7%, P < 0.001）。在提供者类型中，执业护士和医师助理每个订单的Lp(a)结果数量最高（Z = 16.40, P < 0.001），即使他们没有收到预约前信息，也能获得30.8- 39.1%的测试结果。Lp(a)值在患者中的分布为59.7%≤29 mg/dL；9.7% bbb29和< 50mg/dL；≥50mg /dL的占30.6%。结论：与没有收到信息的提供者相比，通过电子病历收到预约前信息的提供者要求更多的检查，从而收到更多的Lp(a)结果。
{"title":"Increasing provider awareness of Lp(a) testing for patients at risk for cardiovascular disease: A comparative study","authors":"Wael E. Eid , Emma Hatfield Sapp , Callen Conroy , Coby Bessinger , Cassidy L. Moody , Ryan Yadav , Reece Tolliver , Joseph Nolan , Suzanne M. Francis","doi":"10.1016/j.ajpc.2024.100895","DOIUrl":"10.1016/j.ajpc.2024.100895","url":null,"abstract":"<div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] is a low-density lipoprotein variant with atherogenic, thrombogenic, and pro-inflammatory properties that may have numerous pathologic effects, including dyslipidemia. Screening for Lp(a) is clinically significant, due to its causal role in atherosclerotic cardiovascular disease (ASCVD). Among clinicians, however, there remains a general lack of both clinical awareness of Lp(a) and adequate tools to track Lp(a) testing in patients.</div></div><div><h3>Objective</h3><div>To study factors affecting Lp(a) screening by: i) determining the effectiveness of messaging providers at a large community health system about Lp(a) screening and measuring the subsequent percentage of Lp(a) tests requested; and ii) by determining the percentage of patients who obtained Lp(a) testing after being advised by the provider.</div></div><div><h3>Methods</h3><div>From December 2022 through March 2023, messages detailing the need for Lp(a) screening were sent via the Epic EHR™ to providers of patients meeting criteria for Lp(a) testing in advance of scheduled patient appointments. In this prospective study, providers were randomized into 2 groups: those receiving the pre-appointment message (Group 1) and those not receiving the pre-appointment message (Group 2).</div></div><div><h3>Results</h3><div>Sending pre-appointment messages correlated with more Lp(a) orders (16.6 % v. 4.7 %, <em>P</em> < 0.001) and consequently with more tests performed (10.2 % v. 3.7 %, <em>p</em> < 0.001). Among provider types, nurse practitioners and physician assistants had the highest number of Lp(a) results per order (<em>Z</em> = 16.40, <em>P</em> < 0.001), achieving 30.8–39.1 % more test results, even if they did not receive the pre-appointment message. Distribution of Lp(a) values in patients was 59.7 % ≤ 29 mg/dL; 9.7 % > 29 and < 50mg/dL; and 30.6 % ≥ 50 mg/dL.</div></div><div><h3>Conclusion</h3><div>Providers who received pre-appointment messages via an EHR were associated with requesting more tests and consequently receiving more Lp(a) results, compared with providers who did not receive messages.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100895"},"PeriodicalIF":4.3,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886541","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 : 2024-11-19DOI: 10.1016/j.ajpc.2024.100892
Emma R. Douma , Tom Roovers , Mirela Habibović , Gert-Jan de Bruijn , Jos A. Bosch , Boris Schmitz , Willem J. Kop , on behalf of the TIMELY consortium
Background
Participation in cardiac rehabilitation (CR) reduces risk of cardiovascular mortality, improves functional capacity and enhances quality of life in patients with coronary artery disease (CAD). eHealth-based CR can increase participation rates, but research into effective components is necessary. The objective of this systematic review was to identify effective behavior change techniques (BCTs) used in eHealth-based CR interventions.
Methods
A search of four databases (CINAHL, PubMed, PsychINFO, and MEDLINE) was conducted until January 10, 2023. Randomized controlled trials investigating eHealth-based interventions for patients with CAD were included. Risk of bias was assessed using the Effective Public Healthcare Practice Project tool. BCTs were coded following the Behavior Change Taxonomy. A best-evidence synthesis was conducted to determine the effectiveness of BCTs, with ratings ranging from A (strong evidence indicating either a positive effect (+) or no effect (-)) to D (no data collected).
Results
A total of 88 studies (25,007 participants) met the eligibility criteria. The interventions in these studies used 31 different BCTs. The most common BCTs were instructions on how to perform the behavior (k = 86), social support (k = 69) and information about health consequences (k = 56). The evidence for action planning was rated as A+ for medication adherence and diet. Conversely, for systematically decreasing the number of prompts/cues sent during an intervention, the evidence was rated as A- for physical activity, medication adherence and smoking cessation. The evidence for feedback on behavior was rated as A+ for medication adherence and A- for smoking cessation.
Conclusions
Action planning is effective as a BCT in eHealth-based CR, whereas reducing prompts/cues is not. Feedback on behavior may, depending on the behavior targeted, exert both positive and no effect, suggesting that BCT-behavior matching is important to optimize effectiveness of eHealth-based CR.
{"title":"Effectiveness of behavior change techniques in eHealth-based cardiac rehabilitation in patients with coronary artery disease: A systematic review","authors":"Emma R. Douma , Tom Roovers , Mirela Habibović , Gert-Jan de Bruijn , Jos A. Bosch , Boris Schmitz , Willem J. Kop , on behalf of the TIMELY consortium","doi":"10.1016/j.ajpc.2024.100892","DOIUrl":"10.1016/j.ajpc.2024.100892","url":null,"abstract":"<div><h3>Background</h3><div>Participation in cardiac rehabilitation (CR) reduces risk of cardiovascular mortality, improves functional capacity and enhances quality of life in patients with coronary artery disease (CAD). eHealth-based CR can increase participation rates, but research into effective components is necessary. The objective of this systematic review was to identify effective behavior change techniques (BCTs) used in eHealth-based CR interventions.</div></div><div><h3>Methods</h3><div>A search of four databases (CINAHL, PubMed, PsychINFO, and MEDLINE) was conducted until January 10, 2023. Randomized controlled trials investigating eHealth-based interventions for patients with CAD were included. Risk of bias was assessed using the Effective Public Healthcare Practice Project tool. BCTs were coded following the Behavior Change Taxonomy. A best-evidence synthesis was conducted to determine the effectiveness of BCTs, with ratings ranging from A (strong evidence indicating either a positive effect (+) or no effect (-)) to D (no data collected).</div></div><div><h3>Results</h3><div>A total of 88 studies (25,007 participants) met the eligibility criteria. The interventions in these studies used 31 different BCTs. The most common BCTs were <em>instructions on how to perform the behavior</em> (k = 86), <em>social support</em> (k = 69) and <em>information about health consequences</em> (k = 56). The evidence for <em>action planning</em> was rated as A+ for medication adherence and diet. Conversely, for systematically decreasing the number of prompts/cues sent during an intervention, the evidence was rated as A- for physical activity, medication adherence and smoking cessation. The evidence for <em>feedback on behavior</em> was rated as A+ for medication adherence and A- for smoking cessation.</div></div><div><h3>Conclusions</h3><div>Action planning is effective as a BCT in eHealth-based CR, whereas reducing prompts/cues is not. <em>Feedback on behavior</em> may, depending on the behavior targeted, exert both positive and no effect, suggesting that BCT-behavior matching is important to optimize effectiveness of eHealth-based CR.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100892"},"PeriodicalIF":4.3,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703725","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}
The role of circulating endothelial progenitor cells (cEPCs) in vascular repair and their association to cardiovascular protection is well established.
Objectives
We examined the effect of proprotein convertase subtilisin kexin type 9 monoclonal antibodies (PCSK9 mAb) on cEPCs in adults with hypercholesterolemia and cardiovascular disease, aiming to establish a pleotropic class effect.
Methods
Non-interventional prospective study in patients with cardiovascular disease treated with either evolocumab or alirocumab. Patients were sampled for cEPCs at baseline, 1- and 3-months following initiation of PCSK9 mAb. cEPCs were assessed using flow cytometry by expression of CD34/CD133 and vascular endothelial growth factor receptor (VEGFR)-2, and functionally by formation of colony forming units (CFUs) and by Mitochondrial Tetrazolium (MTT) assay, indicative of cEPCs viability.
Results
51 patients (median age 67 (IQR 63,74) years;63 % male, median low-density lipoprotein-cholesterol (LDL-C) 125 (102,165) mg/dL) were initiated on PCSK9 mAb therapy (evolocumab n = 22, alirocumab n = 29) for secondary prevention. Following 3-month treatment with PCSK9 mAb, there was an increase in CD34(+)VEGFR-2(+) and CD133(+)VEGFR-2(+) levels (0.50 % [IQR 0.30,1.04] to 1.36 % [0.89, 1.73], p < 0.001 and 0.57 % [0.25,0.88] to 1.18 % [0.74,1.66], p < 0.001, respectively). Functionally, increase in EPCs-CFUs was evident (0.5 [0.0,1.0] to 2.0 [1.5,2.5], p < 0.001) with concomitant increase in MTT (0.11 [0.09,0.15] to 0.17 [0.12,0.21], p < 0.001). Stratifying by PCSK9 mAb, both agents were associated with an increase in cEPCs level and function.
Conclusions
In hypercholesterolemic patients with cardiovascular disease treated with PCSK9 mAb, there is an increase in cEPCs levels and function from baseline levels. These findings, which persist in both evolocumab and alirocumab, might suggest a novel pleiotropic class effect.
{"title":"Circulating Endothelial Progenitor Cells in Patients with Established Cardiovascular Disease Treated with PCSK9 Monoclonal Antibodies","authors":"Chen Gurevitz , Osnat Itzhaki Ben Zadok , Dorit Leshem-Lev , Lital Hodeda , Aviad Rotholz , Ran Kornowski , Alon Eisen","doi":"10.1016/j.ajpc.2024.100896","DOIUrl":"10.1016/j.ajpc.2024.100896","url":null,"abstract":"<div><h3>Background</h3><div>The role of circulating endothelial progenitor cells (cEPCs) in vascular repair and their association to cardiovascular protection is well established.</div></div><div><h3>Objectives</h3><div>We examined the effect of proprotein convertase subtilisin kexin type 9 monoclonal antibodies (PCSK9 mAb) on cEPCs in adults with hypercholesterolemia and cardiovascular disease, aiming to establish a pleotropic class effect.</div></div><div><h3>Methods</h3><div>Non-interventional prospective study in patients with cardiovascular disease treated with either evolocumab or alirocumab. Patients were sampled for cEPCs at baseline, 1- and 3-months following initiation of PCSK9 mAb. cEPCs were assessed using flow cytometry by expression of CD34/CD133 and vascular endothelial growth factor receptor (VEGFR)-2, and functionally by formation of colony forming units (CFUs) and by Mitochondrial Tetrazolium (MTT) assay, indicative of cEPCs viability.</div></div><div><h3>Results</h3><div>51 patients (median age 67 (IQR 63,74) years;63 % male, median low-density lipoprotein-cholesterol (LDL-C) 125 (102,165) mg/dL) were initiated on PCSK9 mAb therapy (evolocumab <em>n</em> = 22, alirocumab <em>n</em> = 29) for secondary prevention. Following 3-month treatment with PCSK9 mAb, there was an increase in CD34<sup>(+)</sup>VEGFR-2<sup>(+)</sup> and CD133<sup>(+)</sup>VEGFR-2<sup>(+)</sup> levels (0.50 % [IQR 0.30,1.04] to 1.36 % [0.89, 1.73], <em>p</em> < 0.001 and 0.57 % [0.25,0.88] to 1.18 % [0.74,1.66], <em>p</em> < 0.001, respectively). Functionally, increase in EPCs-CFUs was evident (0.5 [0.0,1.0] to 2.0 [1.5,2.5], <em>p</em> < 0.001) with concomitant increase in MTT (0.11 [0.09,0.15] to 0.17 [0.12,0.21], <em>p</em> < 0.001). Stratifying by PCSK9 mAb, both agents were associated with an increase in cEPCs level and function.</div></div><div><h3>Conclusions</h3><div>In hypercholesterolemic patients with cardiovascular disease treated with PCSK9 mAb, there is an increase in cEPCs levels and function from baseline levels. These findings, which persist in both evolocumab and alirocumab, might suggest a novel pleiotropic class effect.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100896"},"PeriodicalIF":4.3,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703727","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 : 2024-11-15DOI: 10.1016/j.ajpc.2024.100889
Michael C. Wang , Toluwalase Awoyemi , Norrina B. Allen , Ravi Shah , Matthew Nayor , Yuan Luo , Joao A.C. Lima , Donald M. Lloyd-Jones , Sadiya S. Khan
Objective
To generate data-driven phenogroups of cardiac structure and function based on echocardiographic measures assessed in asymptomatic middle-aged adults free of CVD, and examine associations between these newly defined phenogroups and incident premature cardiovascular disease (CVD).
Methods
Data were analyzed from participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study free of CVD who underwent an echocardiogram at the Year 25 (2010-2011) in-person examination. Continuous echocardiographic measures of left heart structure, left ventricular systolic function (including strain) and diastolic function, right ventricular systolic function, and hemodynamic measures were included in latent class analysis to generate novel phenogroups. Associations between data-driven phenogroups and risk of premature CVD (coronary artery disease, stroke, or heart failure) were estimated using Cox proportional hazards regression adjusted for traditional CVD risk factors.
Results
Among 3361 participants, mean (standard deviation) age was 50.1 (3.6) years, 57% were female, and 46% were non-Hispanic Black. Three overall phenogroups were identified and labeled as: (1) optimal cardiac mechanics (36.2%); (2) suboptimal systolic function (38.2%); and (3) suboptimal diastolic function (25.6%). Over a median 8.9 years of follow-up, 121 premature CVD events occurred. Risk of CVD was higher in the suboptimal diastolic function group (unadjusted hazard ratio [HR] 4.08 [95% CI: 2.48, 6.71] and adjusted HR 1.95 [1.12, 3.40]) compared with the optimal group. The suboptimal systolic function group had a higher unadjusted risk of CVD (1.86 [1.10, 3.15]), which was attenuated after adjustment for CVD risk factors (1.36 [0.79, 2.36]).
Conclusions and relevance
Unbiased, data-driven clustering of echocardiographic measures in middle-aged adults identified distinct patterns of cardiac remodeling that were associated with risk of premature CVD. Premature CVD risk was highest with the pattern of suboptimal diastolic function. This suggests potential utility of a composite echocardiography-based index for prioritizing prevention strategies earlier in the life course.
{"title":"Latent class analysis of cardiac structure and function and association with premature cardiovascular disease: The Coronary Artery Risk Development in Young Adults (CARDIA) study","authors":"Michael C. Wang , Toluwalase Awoyemi , Norrina B. Allen , Ravi Shah , Matthew Nayor , Yuan Luo , Joao A.C. Lima , Donald M. Lloyd-Jones , Sadiya S. Khan","doi":"10.1016/j.ajpc.2024.100889","DOIUrl":"10.1016/j.ajpc.2024.100889","url":null,"abstract":"<div><h3>Objective</h3><div>To generate data-driven phenogroups of cardiac structure and function based on echocardiographic measures assessed in asymptomatic middle-aged adults free of CVD, and examine associations between these newly defined phenogroups and incident premature cardiovascular disease (CVD).</div></div><div><h3>Methods</h3><div>Data were analyzed from participants in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study free of CVD who underwent an echocardiogram at the Year 25 (2010-2011) in-person examination. Continuous echocardiographic measures of left heart structure, left ventricular systolic function (including strain) and diastolic function, right ventricular systolic function, and hemodynamic measures were included in latent class analysis to generate novel phenogroups. Associations between data-driven phenogroups and risk of premature CVD (coronary artery disease, stroke, or heart failure) were estimated using Cox proportional hazards regression adjusted for traditional CVD risk factors.</div></div><div><h3>Results</h3><div>Among 3361 participants, mean (standard deviation) age was 50.1 (3.6) years, 57% were female, and 46% were non-Hispanic Black. Three overall phenogroups were identified and labeled as: (1) optimal cardiac mechanics (36.2%); (2) suboptimal systolic function (38.2%); and (3) suboptimal diastolic function (25.6%). Over a median 8.9 years of follow-up, 121 premature CVD events occurred. Risk of CVD was higher in the suboptimal diastolic function group (unadjusted hazard ratio [HR] 4.08 [95% CI: 2.48, 6.71] and adjusted HR 1.95 [1.12, 3.40]) compared with the optimal group. The suboptimal systolic function group had a higher unadjusted risk of CVD (1.86 [1.10, 3.15]), which was attenuated after adjustment for CVD risk factors (1.36 [0.79, 2.36]).</div></div><div><h3>Conclusions and relevance</h3><div>Unbiased, data-driven clustering of echocardiographic measures in middle-aged adults identified distinct patterns of cardiac remodeling that were associated with risk of premature CVD. Premature CVD risk was highest with the pattern of suboptimal diastolic function. This suggests potential utility of a composite echocardiography-based index for prioritizing prevention strategies earlier in the life course.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100889"},"PeriodicalIF":4.3,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703724","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}
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