Pub Date : 2025-12-22DOI: 10.1016/j.ajpc.2025.101392
Aline F Pedroso , Luisa C C Brant , Antonio L P Ribeiro , Sandhi M Barreto , Roberta C Figueiredo , Rohan Khera
Background
Models predicting ASCVD risk often overestimate risk in diverse populations from low- and middle-income countries (LMICs), limiting their clinical utility and efficiency of resource allocation.
Methods
We evaluated the performance of the PREVENT score in a large, multiethnic, population-based cohort of adults without baseline ASCVD, followed prospectively for adjudicated cardiovascular events. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was evaluated by predicted-to-observed (P/O) risk ratios. We compared PREVENT with the 2019 WHO cardiovascular risk score, a model specifically recalibrated for use in LMICs, and assessed reclassification using the net reclassification index (NRI), scaling the 10-year risk to 5-year estimates using exponential survival transformation. Additionally, we examined how risk reclassification would affect recommendations for preventive therapy.
Results
Among 11,077 participants (age 53.1 ± 8.1 years, 55.3% female), 157 ASCVD events occurred over five years. Discrimination was similar for PREVENT (AUC 0.76, 95 % CI: 0.72–0.80) and WHO (0.75, 95 % CI: 0.71–0.78). PREVENT had better calibration (P/O 1.21 [1.07–1.51] vs. 1.57 [1.31–2.46] for WHO) and improved risk classification (NRI 0.19). This improvement was more pronounced among women (NRI = 0.24) and Black or mixed-race individuals (NRI = 0.28). In adults aged 40–75 with ≥1 cardiovascular risk factor, the PREVENT model appropriately up-classified more individuals who had an event to the group for which there is a recommendation for preventive treatment.
Conclusions
PREVENT demonstrated better alignment between predicted and observed ASCVD risk compared with the WHO score in a large, diverse LMIC cohort. Its higher out-of-the-box calibration may enable more accurate risk stratification and efficient resource allocation in LMICs.
{"title":"Cardiovascular risk stratification without recalibration: A comparative study of the PREVENT and WHO risk scores in a multiethnic Brazilian cohort","authors":"Aline F Pedroso , Luisa C C Brant , Antonio L P Ribeiro , Sandhi M Barreto , Roberta C Figueiredo , Rohan Khera","doi":"10.1016/j.ajpc.2025.101392","DOIUrl":"10.1016/j.ajpc.2025.101392","url":null,"abstract":"<div><h3>Background</h3><div>Models predicting ASCVD risk often overestimate risk in diverse populations from low- and middle-income countries (LMICs), limiting their clinical utility and efficiency of resource allocation.</div></div><div><h3>Methods</h3><div>We evaluated the performance of the PREVENT score in a large, multiethnic, population-based cohort of adults without baseline ASCVD, followed prospectively for adjudicated cardiovascular events. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was evaluated by predicted-to-observed (P/O) risk ratios. We compared PREVENT with the 2019 WHO cardiovascular risk score, a model specifically recalibrated for use in LMICs, and assessed reclassification using the net reclassification index (NRI), scaling the 10-year risk to 5-year estimates using exponential survival transformation. Additionally, we examined how risk reclassification would affect recommendations for preventive therapy.</div></div><div><h3>Results</h3><div>Among 11,077 participants (age 53.1 ± 8.1 years, 55.3% female), 157 ASCVD events occurred over five years. Discrimination was similar for PREVENT (AUC 0.76, 95 % CI: 0.72–0.80) and WHO (0.75, 95 % CI: 0.71–0.78). PREVENT had better calibration (P/O 1.21 [1.07–1.51] vs. 1.57 [1.31–2.46] for WHO) and improved risk classification (NRI 0.19). This improvement was more pronounced among women (NRI = 0.24) and Black or mixed-race individuals (NRI = 0.28). In adults aged 40–75 with ≥1 cardiovascular risk factor, the PREVENT model appropriately up-classified more individuals who had an event to the group for which there is a recommendation for preventive treatment.</div></div><div><h3>Conclusions</h3><div>PREVENT demonstrated better alignment between predicted and observed ASCVD risk compared with the WHO score in a large, diverse LMIC cohort. Its higher out-of-the-box calibration may enable more accurate risk stratification and efficient resource allocation in LMICs.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101392"},"PeriodicalIF":5.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925942","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}
Pub Date : 2025-12-22DOI: 10.1016/j.ajpc.2025.101393
Wenke Cheng , Wenbo Tang , Zhongyan Du , Bi Tang
Background
: Cardiovascular health (CVH), as defined by the American Heart Association's Life’s Essential 8 (LE8) metric, is associated with reduced cardiovascular disease (CVD) risk. However, its quantitative impact on acute myocardial infarction (AMI)—including risk reduction magnitude, onset delays, and population-level preventable burden—remains unclear.
Methods
: In this prospective cohort study, we analysed 122,914 UK Biobank participants aged 40–69 years who were free from CVD at baseline. CVH was evaluated using LE8 metrics, and was categorised as low (<50), moderate (50–79), or high (≥80). Associations between CVH and AMI risk/onset were assessed through multivariable Cox regression, accelerated failure time models, and restricted cubic splines. Mediation analysis evaluated the contributions of inflammatory (hs-CRP, leukocytes, platelets), metabolic (triglycerides, urate), renal function (eGFR), and mental health status (anxiety and depression).
Results
: Over 163.2-month median follow-up, 2892 AMI cases (844 STEMI, 1490 NSTEMI) occurred. Each 1-unit LE8 increase reduced AMI risk by 3 % (HR 0.970, 95 % CI: 0.967–0.973). Moderate and high CVH groups exhibited 41.2 % (HR 0.588, 95 % CI: 0.534–0.648) and 75 % (HR 0.25, 95 % CI: 0.205–0.306) risk reductions versus low CVH, with consistent trends for STEMI/NSTEMI. AMI onset was delayed by 14.5 months in the moderate CVH group and 33.6 months in the high group compared with the low group. The population attributable fraction for AMI was 58.01 % (95 % CI, 57.15 %–58.86 %) when comparing the combined moderate or high CVH group with the low CVH group. Inflammatory/metabolic biomarkers mediated 1.57–8.62 % of the CVH-AMI relationship.
Conclusion
: Higher CVH levels were associated with reduced AMI risk and delayed onset, with inflammatory and metabolic biomarkers partially mediating this relationship. In the low-CVH group, a hypothetical shift to higher CVH levels was associated with a scenario-based population attributable fraction of approximately 60 %, highlighting the potential population impact of improving cardiovascular health.
{"title":"Life’s essential 8 scores and acute myocardial infarction: Associations with risk, onset delay, and scenario-based preventable fraction estimates","authors":"Wenke Cheng , Wenbo Tang , Zhongyan Du , Bi Tang","doi":"10.1016/j.ajpc.2025.101393","DOIUrl":"10.1016/j.ajpc.2025.101393","url":null,"abstract":"<div><h3>Background</h3><div><strong>:</strong> Cardiovascular health (CVH), as defined by the American Heart Association's Life’s Essential 8 (LE8) metric, is associated with reduced cardiovascular disease (CVD) risk. However, its quantitative impact on acute myocardial infarction (AMI)—including risk reduction magnitude, onset delays, and population-level preventable burden—remains unclear.</div></div><div><h3>Methods</h3><div><strong>:</strong> In this prospective cohort study, we analysed 122,914 UK Biobank participants aged 40–69 years who were free from CVD at baseline. CVH was evaluated using LE8 metrics, and was categorised as low (<50), moderate (50–79), or high (≥80). Associations between CVH and AMI risk/onset were assessed through multivariable Cox regression, accelerated failure time models, and restricted cubic splines. Mediation analysis evaluated the contributions of inflammatory (hs-CRP, leukocytes, platelets), metabolic (triglycerides, urate), renal function (eGFR), and mental health status (anxiety and depression).</div></div><div><h3>Results</h3><div><strong>:</strong> Over 163.2-month median follow-up, 2892 AMI cases (844 STEMI, 1490 NSTEMI) occurred. Each 1-unit LE8 increase reduced AMI risk by 3 % (HR 0.970, 95 % CI: 0.967–0.973). Moderate and high CVH groups exhibited 41.2 % (HR 0.588, 95 % CI: 0.534–0.648) and 75 % (HR 0.25, 95 % CI: 0.205–0.306) risk reductions versus low CVH, with consistent trends for STEMI/NSTEMI. AMI onset was delayed by 14.5 months in the moderate CVH group and 33.6 months in the high group compared with the low group. The population attributable fraction for AMI was 58.01 % (95 % CI, 57.15 %–58.86 %) when comparing the combined moderate or high CVH group with the low CVH group. Inflammatory/metabolic biomarkers mediated 1.57–8.62 % of the CVH-AMI relationship.</div></div><div><h3>Conclusion</h3><div><strong>:</strong> Higher CVH levels were associated with reduced AMI risk and delayed onset, with inflammatory and metabolic biomarkers partially mediating this relationship. In the low-CVH group, a hypothetical shift to higher CVH levels was associated with a scenario-based population attributable fraction of approximately 60 %, highlighting the potential population impact of improving cardiovascular health.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101393"},"PeriodicalIF":5.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926492","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}
Pub Date : 2025-12-21DOI: 10.1016/j.ajpc.2025.101390
Jo Kato , Tomohiro Manabe , Fumihiro Yamasawa
Background
Sudden cardiac arrest (SCA) is a rare but catastrophic event that can occur during long-distance road races. Although habitual training mitigates SCA risk, it remains uncertain whether running pace on race day can help identify susceptible individuals.
Methods
We prospectively collected cases of SCA in Japan Association of Athletics Federations (JAAF)-certified full marathons between April 2011 and March 2020. Collapses during or within 1 hour after races that required basic life support were included. Running pace was calculated from the last available split or finish time, and expected completion times were compared with age- and sex-stratified marathon ranking data. Predicted finish time percentiles were evaluated within subgroups defined by calendar year, sex, age group, and location of collapse (race tertile or postfinish).
Results
Among 4.53 million starters in 571 marathons, 74 SCA cases were identified (1.6/100,000). The median age was 52 years, and 93% were men. Over half of the events occurred in the final tertile or immediately postfinish. The median pace was 10 minutes 25 seconds per mile (interquartile range: 9:15–12:13), with an extrapolated finish time of 4 hours 33 minutes, corresponding to the 48th percentile in population rankings. Females and those collapsing in the latter part of the race tended to occupy higher percentile ranks than the general finisher distribution.
Conclusions
Marathon-related SCA occurred at running speeds indistinguishable from the general finisher population, challenging the assumption that less conditioned runners are particularly at risk of SCA.
{"title":"Marathon running pace immediately before sudden cardiac arrest","authors":"Jo Kato , Tomohiro Manabe , Fumihiro Yamasawa","doi":"10.1016/j.ajpc.2025.101390","DOIUrl":"10.1016/j.ajpc.2025.101390","url":null,"abstract":"<div><h3>Background</h3><div>Sudden cardiac arrest (SCA) is a rare but catastrophic event that can occur during long-distance road races. Although habitual training mitigates SCA risk, it remains uncertain whether running pace on race day can help identify susceptible individuals.</div></div><div><h3>Methods</h3><div>We prospectively collected cases of SCA in Japan Association of Athletics Federations (JAAF)-certified full marathons between April 2011 and March 2020. Collapses during or within 1 hour after races that required basic life support were included. Running pace was calculated from the last available split or finish time, and expected completion times were compared with age- and sex-stratified marathon ranking data. Predicted finish time percentiles were evaluated within subgroups defined by calendar year, sex, age group, and location of collapse (race tertile or postfinish).</div></div><div><h3>Results</h3><div>Among 4.53 million starters in 571 marathons, 74 SCA cases were identified (1.6/100,000). The median age was 52 years, and 93% were men. Over half of the events occurred in the final tertile or immediately postfinish. The median pace was 10 minutes 25 seconds per mile (interquartile range: 9:15–12:13), with an extrapolated finish time of 4 hours 33 minutes, corresponding to the 48th percentile in population rankings. Females and those collapsing in the latter part of the race tended to occupy higher percentile ranks than the general finisher distribution.</div></div><div><h3>Conclusions</h3><div>Marathon-related SCA occurred at running speeds indistinguishable from the general finisher population, challenging the assumption that less conditioned runners are particularly at risk of SCA.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101390"},"PeriodicalIF":5.9,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928856","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}
Pub Date : 2025-12-21DOI: 10.1016/j.ajpc.2025.101391
Shichen Jiang , Linjie Li , Yuyang Miao , Geru Aa , Hangkuan Liu , Xiaozhi Chen , Haonan Sun , Yiwen Fang , Pengfei Sun , Xin Zhou , Qiang Zhang
Background
Current evidence regarding the optimal intensity of lipid-lowering therapy (LLT) for post-myocardial infarction (MI) patients aged over 80 years remains insufficient.
Methods
This analysis was performed in patients aged over 80 years following MI, using data from the Tianjin Health and Medical Data Platform. The exposure was intensity of LLT (low-intensity versus moderate- to high-intensity). The primary outcome was all-cause mortality, with secondary outcomes including cardiovascular mortality, recurrent MI and stroke. Multivariable-adjusted Cox model was used to calculated hazard ratio (HR) and 95 % confidence interval (CI). Charlson Comorbidity Index (CCI) score was used to stratify the cohort.
Results
Among the 11,585 patients, 3559 received low-intensity LLT, and 8026 received moderate- to high-intensity LLT, with mortality rates of 29.1 % and 21.4 % respectively during a median follow-up of 3 years. Compared with low-intensity LLT group, moderate- to high-intensity LLT was associated with a statistically significant reduction in all-cause mortality (HR, 0.81 [95 % CI: 0.75–0.88]) and cardiovascular mortality (HR, 0.77 [95 % CI: 0.70–0.86]). The multivariable fractional polynomial interaction analysis revealed that only patients with CCI scores ≤ 4 derived significantly both all-cause mortality and cardiovascular mortality reduction from moderate-to-high-intensity LLT (HR, 0.79 [95 % CI: 0.72–0.87]; HR, 0.74 [95 % CI: 0.65–0.84], respectively).
Conclusion
Among MI patients aged over 80 years, moderate-to-high-intensity LLT significantly reduced mortality risk during 3-year follow-up compared to low-intensity LLT only in patients with CCI scores ≤ 4. Further investigation is required to optimize personalized lipid management through rigorous assessment of LLT benefits versus adverse effects.
{"title":"Low-intensity versus moderate- to high-intensity lipid-lowering therapy after myocardial infarction in patients aged 80 years and older: A retrospective cohort study","authors":"Shichen Jiang , Linjie Li , Yuyang Miao , Geru Aa , Hangkuan Liu , Xiaozhi Chen , Haonan Sun , Yiwen Fang , Pengfei Sun , Xin Zhou , Qiang Zhang","doi":"10.1016/j.ajpc.2025.101391","DOIUrl":"10.1016/j.ajpc.2025.101391","url":null,"abstract":"<div><h3>Background</h3><div>Current evidence regarding the optimal intensity of lipid-lowering therapy (LLT) for post-myocardial infarction (MI) patients aged over 80 years remains insufficient.</div></div><div><h3>Methods</h3><div>This analysis was performed in patients aged over 80 years following MI, using data from the Tianjin Health and Medical Data Platform. The exposure was intensity of LLT (low-intensity versus moderate- to high-intensity). The primary outcome was all-cause mortality, with secondary outcomes including cardiovascular mortality, recurrent MI and stroke. Multivariable-adjusted Cox model was used to calculated hazard ratio (HR) and 95 % confidence interval (CI). Charlson Comorbidity Index (CCI) score was used to stratify the cohort.</div></div><div><h3>Results</h3><div>Among the 11,585 patients, 3559 received low-intensity LLT, and 8026 received moderate- to high-intensity LLT, with mortality rates of 29.1 % and 21.4 % respectively during a median follow-up of 3 years. Compared with low-intensity LLT group, moderate- to high-intensity LLT was associated with a statistically significant reduction in all-cause mortality (HR, 0.81 [95 % CI: 0.75–0.88]) and cardiovascular mortality (HR, 0.77 [95 % CI: 0.70–0.86]). The multivariable fractional polynomial interaction analysis revealed that only patients with CCI scores ≤ 4 derived significantly both all-cause mortality and cardiovascular mortality reduction from moderate-to-high-intensity LLT (HR, 0.79 [95 % CI: 0.72–0.87]; HR, 0.74 [95 % CI: 0.65–0.84], respectively).</div></div><div><h3>Conclusion</h3><div>Among MI patients aged over 80 years, moderate-to-high-intensity LLT significantly reduced mortality risk during 3-year follow-up compared to low-intensity LLT only in patients with CCI scores ≤ 4. Further investigation is required to optimize personalized lipid management through rigorous assessment of LLT benefits versus adverse effects.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101391"},"PeriodicalIF":5.9,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926490","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}
Pub Date : 2025-12-20DOI: 10.1016/j.ajpc.2025.101388
Nathan D. Wong , Yihang Fan , Wenjun Fan , Jonathan H Ward , Belinda Schludi , Xingdi Hu
Background
Data are limited regarding national clinician awareness, testing, and treatment of lipoprotein(a) [Lp(a)]. We conducted a national survey of US clinicians to investigate these issues.
Methods
An internet-based survey of awareness, testing and treatment of Lp(a) was administered by a medical survey company to clinicians who have been in practice ≥5 years in the US or its territories.
Results
2002 clinicians completed the survey: 47 % were primary care, 35 % cardiology, 9 % endocrinology, and 9 % neurology. 28 % were female, 24 % Asian, 4 % Hispanic, and 3 % Black. Awareness: 81 % of respondents agreed Lp(a) is a significant risk driver for cardiovascular disease (CVD). 77 % and 75 % agreed knowing Lp(a) would help in risk stratification and increase patient engagement, respectively. Testing: 41 % of respondents agreed with universal testing of Lp(a). Most agreed Lp(a) should be measured in those with premature (73 %), family history of premature (71 %), or recurrent CVD events (68 %). Treatment: 77 % reported having CVD outcome data were felt to be very important for a new therapy, followed by long-term efficacy/safety data (69 %), real-world data (53 %), magnitude of Lp(a) reduction (21 %), dosing frequency (17 %), and mechanism of action (12 %). Clinicians reported being most likely to consider prescribing Lp(a)-targeted therapy with proven CVD benefit among patients with premature (47 %) or recurrent (51 %) CVD events.
Conclusion
Most clinicians agree knowing the Lp(a) level can improve risk assessment and patient engagement. Patients with premature or recurrent CVD events are most likely to be targeted for Lp(a) testing and for prescribing possible future Lp(a)-targeted therapies.
{"title":"Clinician awareness, testing, and treatment for lipoprotein(a): Results from a large US national survey","authors":"Nathan D. Wong , Yihang Fan , Wenjun Fan , Jonathan H Ward , Belinda Schludi , Xingdi Hu","doi":"10.1016/j.ajpc.2025.101388","DOIUrl":"10.1016/j.ajpc.2025.101388","url":null,"abstract":"<div><h3>Background</h3><div>Data are limited regarding national clinician awareness, testing, and treatment of lipoprotein(a) [Lp(a)]. We conducted a national survey of US clinicians to investigate these issues.</div></div><div><h3>Methods</h3><div>An internet-based survey of awareness, testing and treatment of Lp(a) was administered by a medical survey company to clinicians who have been in practice ≥5 years in the US or its territories.</div></div><div><h3>Results</h3><div>2002 clinicians completed the survey: 47 % were primary care, 35 % cardiology, 9 % endocrinology, and 9 % neurology. 28 % were female, 24 % Asian, 4 % Hispanic, and 3 % Black. <em>Awareness:</em> 81 % of respondents agreed Lp(a) is a significant risk driver for cardiovascular disease (CVD). 77 % and 75 % agreed knowing Lp(a) would help in risk stratification and increase patient engagement, respectively. <em>Testing:</em> 41 % of respondents agreed with universal testing of Lp(a). Most agreed Lp(a) should be measured in those with premature (73 %), family history of premature (71 %), or recurrent CVD events (68 %). <em>Treatment:</em> 77 % reported having CVD outcome data were felt to be very important for a new therapy, followed by long-term efficacy/safety data (69 %), real-world data (53 %), magnitude of Lp(a) reduction (21 %), dosing frequency (17 %), and mechanism of action (12 %). Clinicians reported being most likely to consider prescribing Lp(a)-targeted therapy with proven CVD benefit among patients with premature (47 %) or recurrent (51 %) CVD events.</div></div><div><h3>Conclusion</h3><div>Most clinicians agree knowing the Lp(a) level can improve risk assessment and patient engagement. Patients with premature or recurrent CVD events are most likely to be targeted for Lp(a) testing and for prescribing possible future Lp(a)-targeted therapies.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101388"},"PeriodicalIF":5.9,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926480","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}
Pub Date : 2025-12-19DOI: 10.1016/j.ajpc.2025.101386
Lawrence A. Leiter , Taruja Karmarkar , Lori D. Bash , Jason Exter , Jordana K. Schmier , Sayeli P. Jayade , Kyle C. Roney , Ross J. Simpson Jr , Seth J. Baum
Background and Aims
Improving care of patients with hyperlipidemia requires an understanding of the barriers physicians perceive in prescribing low-density lipoprotein cholesterol (LDL-C)-lowering therapies. This study explores physicians’ perceptions of time and resource burdens, identify perceived patient adherence barriers, and examine factors influencing physicians’ decision-making in LDL-C management.
Methods
This is a non-interventional, cross-sectional, online survey of US-based primary care practitioners (PCP) and cardiologists who recommended or provided lipid-lowering therapy (LLT) to ≥50 adults per month, practiced for ≥2 years, and completed the survey in English. The survey comprised multiple-choice, constant sum, and numerical questions about physician decision-making, patient management, and perceptions of patient attitudes/behaviors regarding LDL-C management. Descriptive univariate analyses were conducted.
Results
200 PCPs and 200 cardiologists completed the survey. Most physicians reported prescribing lipid-lowering therapy (LLT) and that patients declined injectable proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). They attributed this refusal to cost/insurance, fear/discomfort taking injections, and a preference for oral therapies. Physicians viewed patients with a history of ASCVD, with LLT experience, and those with greater understanding of ASCVD risk to have higher LLT adherence compared to those without. Most physicians spent a median of 10 min in shared decision-making conversations, regardless of therapies they prescribed. They reported needing longer to instruct patients during adherence counseling for PCSK9is than for oral therapies.
Conclusions
Our findings suggest patient, clinician, and system barriers may all hinder LDL-C management and adherence. A greater understanding of the association between perceived barriers and real-world behaviors will help optimize lipid management.
{"title":"Optimizing low-density lipoprotein cholesterol (LDL-C) management – a US physician survey of barriers and burdens","authors":"Lawrence A. Leiter , Taruja Karmarkar , Lori D. Bash , Jason Exter , Jordana K. Schmier , Sayeli P. Jayade , Kyle C. Roney , Ross J. Simpson Jr , Seth J. Baum","doi":"10.1016/j.ajpc.2025.101386","DOIUrl":"10.1016/j.ajpc.2025.101386","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Improving care of patients with hyperlipidemia requires an understanding of the barriers physicians perceive in prescribing low-density lipoprotein cholesterol (LDL-C)-lowering therapies. This study explores physicians’ perceptions of time and resource burdens, identify perceived patient adherence barriers, and examine factors influencing physicians’ decision-making in LDL-C management.</div></div><div><h3>Methods</h3><div>This is a non-interventional, cross-sectional, online survey of US-based primary care practitioners (PCP) and cardiologists who recommended or provided lipid-lowering therapy (LLT) to ≥50 adults per month, practiced for ≥2 years, and completed the survey in English. The survey comprised multiple-choice, constant sum, and numerical questions about physician decision-making, patient management, and perceptions of patient attitudes/behaviors regarding LDL-C management. Descriptive univariate analyses were conducted.</div></div><div><h3>Results</h3><div>200 PCPs and 200 cardiologists completed the survey. Most physicians reported prescribing lipid-lowering therapy (LLT) and that patients declined injectable proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). They attributed this refusal to cost/insurance, fear/discomfort taking injections, and a preference for oral therapies. Physicians viewed patients with a history of ASCVD, with LLT experience, and those with greater understanding of ASCVD risk to have higher LLT adherence compared to those without. Most physicians spent a median of 10 min in shared decision-making conversations, regardless of therapies they prescribed. They reported needing longer to instruct patients during adherence counseling for PCSK9is than for oral therapies.</div></div><div><h3>Conclusions</h3><div>Our findings suggest patient, clinician, and system barriers may all hinder LDL-C management and adherence. A greater understanding of the association between perceived barriers and real-world behaviors will help optimize lipid management.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101386"},"PeriodicalIF":5.9,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926479","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}
Pub Date : 2025-12-19DOI: 10.1016/j.ajpc.2025.101387
Michael Miller , Deepak L. Bhatt , Eliot A. Brinton , Terry A. Jacobson , Ph. Gabriel Steg , Steven B. Ketchum , Armando Lira Pineda , Jean-Claude Tardif , Christie M. Ballantyne , REDUCE-IT Investigators*
Background/Introduction
Cardiovascular-kidney-metabolic (CKM) syndrome was recently identified as a cardiometabolic disorder that incorporates chronic kidney disease with the metabolic syndrome (MetS). REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) was an international, double-blind, placebo-controlled trial that randomized hypertriglyceridemic (TG, 150-499 mg/dL) statin-treated patients with established cardiovascular disease (CVD) or diabetes and multiple CVD risk factors to icosapent ethyl (IPE) or placebo (4 grams/day). It is unknown if renal insufficiency added to MetS confers incremental CVD risk in secondary prevention patients without diabetes and if IPE lowers that risk.
Methods
The current study evaluated the secondary prevention patient subgroup with a history of MetSyn, but without diabetes at baseline (n=2860). In the subset of patients with CVD and MetS without diabetes, subjects were divided into the following groups: eGFR < 60 mL/min/1.73 m2 (n=565), eGFR ≥ 60 to < 90 mL/min/1.73 m2 (n=1686), and eGFR ≥ 90 mL/min/1.73 m2 (n=609). Event rates of the primary and secondary trial endpoints were compared in placebo subjects with higher vs lower baseline eGFR, and the effect of IPE on these endpoints was also compared within each of the three subgroups.
Results
In the placebo arm, CKM was associated with increased risk of the primary composite endpoint at eGFR < 90 mL/min/1.73 m2 (Hazard Ratio [HR], 1.44 [95% CI, 1.05, 1.96]; P=0.02) and at eGFR < 60 mL/min/1.73 m2 (HR, 1.87 [95% CI, 1.31, 2.69]; P=0.0005) compared with MetS patients with normal kidney function (eGFR ≥ 90 mL/min/1.73 m2). A similar trend but without statistical significance was observed for eGFR ≥ 60 to < 90 mL/min/1.73 m² (HR, 1.30 [95% CI, 0.94, 1.79]; P=0.11) compared with MetS patients with normal kidney function. In patients with CKM (eGFR < 60 mL/min/1.73 m2) adjusted for age and sex, treatment with IPE compared with placebo was associated with significant reductions in the primary composite endpoint (HR, 0.55 [95% CI, 0.38, 0.78]; P=0.0009) and in the key secondary composite endpoint (HR, 0.52 [95% CI, 0.35,0.79], P= 0.002). Treatment with IPE was associated with an absolute risk reduction of 11.2% and number needed to treat of 9 patients to prevent an initial primary composite endpoint event over the study period.
Conclusions
In this REDUCE-IT analysis of secondary prevention patients without diabetes at baseline, the recently defined CKM syndrome was associated with incremental CVD risk compared with MetS and normal renal function. Treatment with IPE substantially reduced CVD risk in MetS patients with renal insufficiency (i.e., CKM) and CVD.
{"title":"Icosapent ethyl reduces CVD risk in cardiovascular-kidney-metabolic syndrome: REDUCE-IT CKM","authors":"Michael Miller , Deepak L. Bhatt , Eliot A. Brinton , Terry A. Jacobson , Ph. Gabriel Steg , Steven B. Ketchum , Armando Lira Pineda , Jean-Claude Tardif , Christie M. Ballantyne , REDUCE-IT Investigators*","doi":"10.1016/j.ajpc.2025.101387","DOIUrl":"10.1016/j.ajpc.2025.101387","url":null,"abstract":"<div><h3>Background/Introduction</h3><div>Cardiovascular-kidney-metabolic (CKM) syndrome was recently identified as a cardiometabolic disorder that incorporates chronic kidney disease with the metabolic syndrome (MetS). REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) was an international, double-blind, placebo-controlled trial that randomized hypertriglyceridemic (TG, 150-499 mg/dL) statin-treated patients with established cardiovascular disease (CVD) or diabetes and multiple CVD risk factors to icosapent ethyl (IPE) or placebo (4 grams/day). It is unknown if renal insufficiency added to MetS confers incremental CVD risk in secondary prevention patients without diabetes and if IPE lowers that risk.</div></div><div><h3>Methods</h3><div>The current study evaluated the secondary prevention patient subgroup with a history of MetSyn, but without diabetes at baseline (n=2860). In the subset of patients with CVD and MetS without diabetes, subjects were divided into the following groups: eGFR < 60 mL/min/1.73 m<sup>2</sup> (n=565), eGFR ≥ 60 to < 90 mL/min/1.73 m<sup>2</sup> (n=1686), and eGFR ≥ 90 mL/min/1.73 m<sup>2</sup> (n=609). Event rates of the primary and secondary trial endpoints were compared in placebo subjects with higher vs lower baseline eGFR, and the effect of IPE on these endpoints was also compared within each of the three subgroups.</div></div><div><h3>Results</h3><div>In the placebo arm, CKM was associated with increased risk of the primary composite endpoint at eGFR < 90 mL/min/1.73 m<sup>2</sup> (Hazard Ratio [HR], 1.44 [95% CI, 1.05, 1.96]; <em>P=0.02</em>) and at eGFR < 60 mL/min/1.73 m<sup>2</sup> (HR, 1.87 [95% CI, 1.31, 2.69]; <em>P=0.0005</em>) compared with MetS patients with normal kidney function (eGFR ≥ 90 mL/min/1.73 m<sup>2</sup>). A similar trend but without statistical significance was observed for eGFR ≥ 60 to < 90 mL/min/1.73 m² (HR, 1.30 [95% CI, 0.94, 1.79]; <em>P=0.11</em>) compared with MetS patients with normal kidney function. In patients with CKM (eGFR < 60 mL/min/1.73 m<sup>2</sup>) adjusted for age and sex, treatment with IPE compared with placebo was associated with significant reductions in the primary composite endpoint (HR, 0.55 [95% CI, 0.38, 0.78]; <em>P=0.0009</em>) and in the key secondary composite endpoint (HR, 0.52 [95% CI, 0.35,0.79], <em>P</em>= <em>0.002</em>). Treatment with IPE was associated with an absolute risk reduction of 11.2% and number needed to treat of 9 patients to prevent an initial primary composite endpoint event over the study period.</div></div><div><h3>Conclusions</h3><div>In this REDUCE-IT analysis of secondary prevention patients without diabetes at baseline, the recently defined CKM syndrome was associated with incremental CVD risk compared with MetS and normal renal function. Treatment with IPE substantially reduced CVD risk in MetS patients with renal insufficiency (i.e., CKM) and CVD.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101387"},"PeriodicalIF":5.9,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926491","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}
Pub Date : 2025-12-18DOI: 10.1016/j.ajpc.2025.101385
Yuan-Yuan Kang , Jin Zhang , Yi Chen , Jian-Zhong Xu , Ji-Guang Wang
To our knowledge, this was the first report of a female with a history of chronic hypertension and preeclampsia who successfully delivered a second child following renal denervation (RDN). After the procedure and titration of antihypertensive medication, her ambulatory and clinic blood pressure levels improved significantly. Notably, her second entire pregnancy was sustained with reduced ambulatory blood pressure and an absence of proteinuria. This case suggests that RDN may represent a potentially feasible and effective therapeutic option for women with poor uncontrolled hypertension taking three kinds of antihypertensive drugs who wish to conceive and achieve a successful pregnancy.
{"title":"Renal denervation for successful pregnancy in a patient with chronic hypertension and history of preeclampsia: A case report","authors":"Yuan-Yuan Kang , Jin Zhang , Yi Chen , Jian-Zhong Xu , Ji-Guang Wang","doi":"10.1016/j.ajpc.2025.101385","DOIUrl":"10.1016/j.ajpc.2025.101385","url":null,"abstract":"<div><div>To our knowledge, this was the first report of a female with a history of chronic hypertension and preeclampsia who successfully delivered a second child following renal denervation (RDN). After the procedure and titration of antihypertensive medication, her ambulatory and clinic blood pressure levels improved significantly. Notably, her second entire pregnancy was sustained with reduced ambulatory blood pressure and an absence of proteinuria. This case suggests that RDN may represent a potentially feasible and effective therapeutic option for women with poor uncontrolled hypertension taking three kinds of antihypertensive drugs who wish to conceive and achieve a successful pregnancy.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101385"},"PeriodicalIF":5.9,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925941","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}
Pub Date : 2025-12-12DOI: 10.1016/j.ajpc.2025.101379
Xiang Li , Tong Xia , Paul Landsbergis , Imelda Wong , Jian Li
Background
Shift work is a known risk factor for cardiometabolic diseases (CMD), including cardiovascular diseases (CVD) and diabetes. However, limited evidence exists on the long-term prognosis of individuals already diagnosed with CMD, particularly regarding mortality outcomes following continued exposure to shift work. This study aimed to investigate the prospective association between shift work and mortality outcomes, including all-cause, CMD, and CVD mortality, among U.S. workers with CMD.
Methods
The data of 2010 and 2015 National Health Interview Survey (NHIS) were linked to mortality records from the National Death Index through December 31, 2019. A total of 9,622 workers with CMD were included. Shift work exposure was self-reported usual work schedules and categorized as shift versus regular daytime work. Cox proportional hazards models were performed, with adjustment for baseline demographic information, socioeconomic status, and occupational characteristics.
Results
At baseline, 25.7 % (2,470) reported shift work. During follow-up period, 308 deaths in the non-shift work group (100 CMD deaths and 90 CVD deaths) and 129 deaths in the shift work group (50 CMD deaths and 43 CVD deaths) were documented. Shift work was associated with a higher risk of all-cause mortality (HR=1.28, 95 % CI=1.02, 1.62), CMD mortality (HR=1.57, 95 % CI=1.01, 2.42), and CVD mortality (HR=1.61, 95 % CI=1.02, 2.53), adjusting for baseline covariates.
Conclusions
Among U.S. workers with CMD, shift work was associated with substantially higher risks of all-cause and cause-specific mortality, highlighting the need to consider occupational exposures in clinical care and workplace policies to support secondary prevention for workers with CMD.
{"title":"Long-term prognosis of cardiometabolic diseases among U.S. workers: The contribution of shift work to mortality","authors":"Xiang Li , Tong Xia , Paul Landsbergis , Imelda Wong , Jian Li","doi":"10.1016/j.ajpc.2025.101379","DOIUrl":"10.1016/j.ajpc.2025.101379","url":null,"abstract":"<div><h3>Background</h3><div>Shift work is a known risk factor for cardiometabolic diseases (CMD), including cardiovascular diseases (CVD) and diabetes. However, limited evidence exists on the long-term prognosis of individuals already diagnosed with CMD, particularly regarding mortality outcomes following continued exposure to shift work. This study aimed to investigate the prospective association between shift work and mortality outcomes, including all-cause, CMD, and CVD mortality, among U.S. workers with CMD.</div></div><div><h3>Methods</h3><div>The data of 2010 and 2015 National Health Interview Survey (NHIS) were linked to mortality records from the National Death Index through December 31, 2019. A total of 9,622 workers with CMD were included. Shift work exposure was self-reported usual work schedules and categorized as shift versus regular daytime work. Cox proportional hazards models were performed, with adjustment for baseline demographic information, socioeconomic status, and occupational characteristics.</div></div><div><h3>Results</h3><div>At baseline, 25.7 % (2,470) reported shift work. During follow-up period, 308 deaths in the non-shift work group (100 CMD deaths and 90 CVD deaths) and 129 deaths in the shift work group (50 CMD deaths and 43 CVD deaths) were documented. Shift work was associated with a higher risk of all-cause mortality (HR=1.28, 95 % CI=1.02, 1.62), CMD mortality (HR=1.57, 95 % CI=1.01, 2.42), and CVD mortality (HR=1.61, 95 % CI=1.02, 2.53), adjusting for baseline covariates.</div></div><div><h3>Conclusions</h3><div>Among U.S. workers with CMD, shift work was associated with substantially higher risks of all-cause and cause-specific mortality, highlighting the need to consider occupational exposures in clinical care and workplace policies to support secondary prevention for workers with CMD.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101379"},"PeriodicalIF":5.9,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791035","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}
Pub Date : 2025-12-11DOI: 10.1016/j.ajpc.2025.101383
Ziang Zuo , Quanlin Yang , Yongxin Sun , Ben Huang
Ischemic heart disease (IHD) remains the leading cause of global mortality. Apart from traditional risk factors like hypertension and dyslipidemia, ambient temperature extremes—both cold and heat—have increasingly been recognized as important but underexplored contributors to IHD burden, with the impact of climate change necessitating a deeper understanding of temperature-related cardiovascular risks. Here we performed a cross-sectional analysis of Global Burden of Disease 2021 data stratified by region, sex, age, and Socio-Demographic Index (SDI) aiming to demonstrating the burden of temperature extremes-related IHD. Temporal trends were quantified using estimated annual percentage change (EAPC), inequalities were assessed via the slope index and concentration index, and autoregressive integrated moving average models were used to project burden through 2050. In 2021, cold-related IHD accounted for 505,300 deaths and 9.96 million disability-adjusted life years (DALYs) worldwide. Cold-related mortality and DALYs declined since 1990 (EAPC = −1.73), whereas heat-related IHD—although smaller in absolute terms—rose over time (EAPC = 1.68). High-SDI regions experienced the largest reductions in cold-related IHD, while low-SDI regions exhibited the steepest increases in heat-related burden. Age- and sex-specific patterns differed: in males both cold- and heat-related burdens peaked at 60–69 years; in females cold-related burden peaked at 80–84 years and heat-related burden at 65–69 years. Projections suggest a continued decline in cold-related IHD but a rising heat-related burden. These findings underscore the need for climate-sensitive public health strategies to mitigate temperature-related cardiovascular risk, particularly in less developed regions.
{"title":"Global burden of ischemic heart disease attributable to temperature extremes in adults aged 40 years and older: Trends, inequalities, and projections (1990–2050)","authors":"Ziang Zuo , Quanlin Yang , Yongxin Sun , Ben Huang","doi":"10.1016/j.ajpc.2025.101383","DOIUrl":"10.1016/j.ajpc.2025.101383","url":null,"abstract":"<div><div>Ischemic heart disease (IHD) remains the leading cause of global mortality. Apart from traditional risk factors like hypertension and dyslipidemia, ambient temperature extremes—both cold and heat—have increasingly been recognized as important but underexplored contributors to IHD burden, with the impact of climate change necessitating a deeper understanding of temperature-related cardiovascular risks. Here we performed a cross-sectional analysis of Global Burden of Disease 2021 data stratified by region, sex, age, and Socio-Demographic Index (SDI) aiming to demonstrating the burden of temperature extremes-related IHD. Temporal trends were quantified using estimated annual percentage change (EAPC), inequalities were assessed via the slope index and concentration index, and autoregressive integrated moving average models were used to project burden through 2050. In 2021, cold-related IHD accounted for 505,300 deaths and 9.96 million disability-adjusted life years (DALYs) worldwide. Cold-related mortality and DALYs declined since 1990 (EAPC = −1.73), whereas heat-related IHD—although smaller in absolute terms—rose over time (EAPC = 1.68). High-SDI regions experienced the largest reductions in cold-related IHD, while low-SDI regions exhibited the steepest increases in heat-related burden. Age- and sex-specific patterns differed: in males both cold- and heat-related burdens peaked at 60–69 years; in females cold-related burden peaked at 80–84 years and heat-related burden at 65–69 years. Projections suggest a continued decline in cold-related IHD but a rising heat-related burden. These findings underscore the need for climate-sensitive public health strategies to mitigate temperature-related cardiovascular risk, particularly in less developed regions.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101383"},"PeriodicalIF":5.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791032","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}
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