American journal of preventive cardiology最新文献_第5页

Association of self-rated health and risk of incident atrial fibrillation: Findings from three cohorts 自评健康与房颤发生风险的关系：来自三个队列的研究结果

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-11 DOI: 10.1016/j.ajpc.2025.101378

Parveen K Garg , Aniqa Alam , Harpreet S Bhatia , Jens Horn , Vegard Malmo , Jan Pal Loennechen , Scott Mu , Randi Foraker , Elizabeth Selvin , Imre Janszky , Susan R. Heckbert , Alvaro Alonso

Background

Self-rated health (SRH) is easy to obtain and is known to be a good predictor for mortality and several comorbidities, including cardiovascular disease, but its relation to atrial fibrillation (AF) is largely unknown. We determined the association of SRH with risk of developing AF.

Methods

We conducted a pooled cohort analysis of participants in the Atherosclerosis Risk in Communities Study (ARIC) (n = 10,255; mean age, 63 years), the Trøndelag Health Study (HUNT-3 Study) (n = 43,668, mean age, 53 years), and the Multi-Ethnic Study of Atherosclerosis Study (MESA) (n = 5037, mean age, 66 years) cohorts to examine the association of SRH with risk of atrial fibrillation (AF). We categorized SRH as “poor or fair”, “good”, or “very good or excellent”. Incident AF was identified via visit electrocardiograms, hospital discharge codes, or Medicare claims. We used Cox regression to quantify the association of baseline SRH category and AF risk in each cohort. Models were adjusted for demographics, body mass index, tobacco use, alcohol, diabetes, hypertension, cholesterol, cardiovascular disease, and physical activity. We pooled the hazard ratios (HR) and 95 % CIs using a fixed-effects model.

Results

Over a mean of 16±6, 9 ± 2, and 10±4 years of follow-up, 2340 (22.8 %), 1525 (3.5 %), and 879 (17.4 %) incident AF events occurred in ARIC, HUNT-3, and MESA respectively. Lower SRH categories were associated with higher AF risk in each cohort and in the pooled analysis: HR 1.11 (95 % CI 1.02 to 1.20) for good SRH; and 1.40 (95 % CI, 1.26 to1.55) for fair or poor SRH compared to very good or excellent SRH.

Conclusions

Worse SRH was independently associated with a higher risk of developing AF. SRH is an easily obtainable metric and may help to additionally identify individuals at higher risk for AF.

自评健康（SRH）很容易获得，并且已知是死亡率和几种合并症（包括心血管疾病）的良好预测指标，但其与心房颤动（AF）的关系在很大程度上是未知的。我们对社区动脉粥样硬化风险研究（ARIC）（n = 10,255，平均年龄63岁）、Trøndelag健康研究（HUNT-3研究）（n = 43,668，平均年龄53岁）和多种族动脉粥样硬化研究（MESA）（n = 5037，平均年龄66岁）的参与者进行了汇总队列分析，以研究SRH与房颤（AF）风险的关系。我们将SRH分为“差或一般”、“好”、“非常好或优秀”。通过就诊心电图、出院代码或医疗保险索赔确定事件房颤。我们使用Cox回归来量化每个队列中基线SRH类别与房颤风险的关联。模型根据人口统计、体重指数、吸烟、饮酒、糖尿病、高血压、胆固醇、心血管疾病和身体活动进行了调整。我们使用固定效应模型汇总了风险比（HR）和95% ci。结果在平均16±6年、9±2年和10±4年的随访中，ARIC、HUNT-3和MESA组分别发生2340例（22.8%）、1525例（3.5%）和879例（17.4%）AF事件。在每个队列和合并分析中，较低的SRH类别与较高的房颤风险相关：良好SRH的HR为1.11 (95% CI 1.02至1.20)；与非常好或优秀的SRH相比，一般或较差的SRH为1.40 （95% CI， 1.26至1.55）。结论：较差的SRH与发生房颤的高风险独立相关。SRH是一种容易获得的指标，可能有助于额外识别房颤高风险个体。

{"title":"Association of self-rated health and risk of incident atrial fibrillation: Findings from three cohorts","authors":"Parveen K Garg , Aniqa Alam , Harpreet S Bhatia , Jens Horn , Vegard Malmo , Jan Pal Loennechen , Scott Mu , Randi Foraker , Elizabeth Selvin , Imre Janszky , Susan R. Heckbert , Alvaro Alonso","doi":"10.1016/j.ajpc.2025.101378","DOIUrl":"10.1016/j.ajpc.2025.101378","url":null,"abstract":"<div><h3>Background</h3><div>Self-rated health (SRH) is easy to obtain and is known to be a good predictor for mortality and several comorbidities, including cardiovascular disease, but its relation to atrial fibrillation (AF) is largely unknown. We determined the association of SRH with risk of developing AF.</div></div><div><h3>Methods</h3><div>We conducted a pooled cohort analysis of participants in the Atherosclerosis Risk in Communities Study (ARIC) (<em>n</em> = 10,255; mean age, 63 years), the Trøndelag Health Study (HUNT-3 Study) (<em>n</em> = 43,668, mean age, 53 years), and the Multi-Ethnic Study of Atherosclerosis Study (MESA) (<em>n</em> = 5037, mean age, 66 years) cohorts to examine the association of SRH with risk of atrial fibrillation (AF). We categorized SRH as “poor or fair”, “good”, or “very good or excellent”. Incident AF was identified via visit electrocardiograms, hospital discharge codes, or Medicare claims. We used Cox regression to quantify the association of baseline SRH category and AF risk in each cohort. Models were adjusted for demographics, body mass index, tobacco use, alcohol, diabetes, hypertension, cholesterol, cardiovascular disease, and physical activity. We pooled the hazard ratios (HR) and 95 % CIs using a fixed-effects model.</div></div><div><h3>Results</h3><div>Over a mean of 16±6, 9 ± 2, and 10±4 years of follow-up, 2340 (22.8 %), 1525 (3.5 %), and 879 (17.4 %) incident AF events occurred in ARIC, HUNT-3, and MESA respectively. Lower SRH categories were associated with higher AF risk in each cohort and in the pooled analysis: HR 1.11 (95 % CI 1.02 to 1.20) for good SRH; and 1.40 (95 % CI, 1.26 to1.55) for fair or poor SRH compared to very good or excellent SRH.</div></div><div><h3>Conclusions</h3><div>Worse SRH was independently associated with a higher risk of developing AF. SRH is an easily obtainable metric and may help to additionally identify individuals at higher risk for AF.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101378"},"PeriodicalIF":5.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791029","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}

引用次数: 0

Social determinants of health, life’s essential 8 metrics, and cardiovascular morbidity and mortality: a nationwide cohort study 健康的社会决定因素，生命的基本指标，心血管发病率和死亡率：一项全国性队列研究

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-11 DOI: 10.1016/j.ajpc.2025.101382

Yunan Xu , Xiangjun Zhang , Yan Xue , Wan Shen , Xuebing Leng , Quanhong Chen , Xiannen Pan , Feng Huang , Hao Chen

Background

Life's Essential 8 (LE8) provides a framework to assess and improve cardiovascular health, ultimately reducing cardiovascular disease (CVD) risk. However, the role of LE8 metrics in addressing CVD disparities associated with social determinants of health (SDoH) remains unclear.

Methods

This cohort study employed the National Health and Nutrition Examination Survey (2005–2018) data. Logistic regression models, Cox proportional hazard models, and multiple mediation analysis were used to assess the associations of the SDoH score with CVD morbidity (self-reported diagnosis of congestive heart failure, coronary heart disease, angina pectoris, myocardial infarction, and stroke), CVD mortality, and mortality (mortality data were derived from the NHANES Public-Use Linked Mortality File), as well as the contributions of LE8 metrics to the associations.

Results

The top four reported unfavorable SDoH were low education level (21.5%), income-to-poverty ratio <3 (17.5%), no private health insurance (13.0%), and unemployment (11.5%). Unfavorable SDoH exposure was associated with higher CVD morbidity [odds ratio (OR) and 95% confidence interval (CI): 2.36 (2.18, 2.55) and CVD mortality [hazard ratio (HR) and 95%CI: 2.70 (2.24, 3.24)]. LE8 metrics accounted for approximately 30.4% (95%CI: 26.2%, 34.7%), 23.0% (95%CI: 19.3%, 28.3%), and 24.0% (95%CI: 20.6%, 28.8%) of the association between SDoH and CVD morbidity, CVD mortality, and all-cause mortality, respectively, with nicotine exposure, physical activity, and sleep health being the main LE8 contributors. Differences in the distribution of SDoH components, as well as the contribution of LE8 to the association between SDoH and CVD risk were observed across race/ethnicity groups.

Conclusions

Our findings highlight the effectiveness for public health interventions targeting SDoH to improve LE8 metrics and ultimately reducing CVD morbidity and mortality. Future research should also explore the impact of non-LE8 factors and racial/ethnic differences in developing comprehensive CVD prevention strategies among U.S. adults.

生命必需8 （LE8）提供了一个评估和改善心血管健康的框架，最终降低心血管疾病（CVD）风险。然而，LE8指标在解决与健康社会决定因素（SDoH）相关的心血管疾病差异中的作用仍不清楚。方法采用2005-2018年全国健康与营养调查数据进行队列研究。采用Logistic回归模型、Cox比例风险模型和多重调节分析来评估SDoH评分与CVD发病率（自述诊断为充血性心力衰竭、冠心病、心绞痛、心肌梗死和卒中）、CVD死亡率和死亡率（死亡率数据来自NHANES公共使用相关死亡率文件）的相关性，以及LE8指标对相关性的贡献。结果受教育程度低（21.5%）、收入贫困比（17.5%）、无私人医疗保险（13.0%）和失业（11.5%）是影响健康的前4个因素。不良的SDoH暴露与较高的CVD发病率[优势比（OR）和95%可信区间（CI）： 2.36(2.18, 2.55)]和CVD死亡率[危险比（HR）和95%可信区间：2.70(2.24,3.24)]相关。LE8指标分别约占SDoH与CVD发病率、CVD死亡率和全因死亡率之间相关性的30.4% （95%CI: 26.2%, 34.7%）、23.0% （95%CI: 19.3%, 28.3%）和24.0% (95%CI: 20.6%, 28.8%)，其中尼古丁暴露、身体活动和睡眠健康是主要的LE8因素。SDoH成分分布的差异，以及LE8对SDoH和心血管疾病风险之间关联的贡献，在不同种族/民族群体中被观察到。结论我们的研究结果强调了针对SDoH的公共卫生干预措施在改善LE8指标并最终降低CVD发病率和死亡率方面的有效性。未来的研究还应探讨非le8因素和种族/民族差异对制定美国成年人心血管疾病综合预防策略的影响。

{"title":"Social determinants of health, life’s essential 8 metrics, and cardiovascular morbidity and mortality: a nationwide cohort study","authors":"Yunan Xu , Xiangjun Zhang , Yan Xue , Wan Shen , Xuebing Leng , Quanhong Chen , Xiannen Pan , Feng Huang , Hao Chen","doi":"10.1016/j.ajpc.2025.101382","DOIUrl":"10.1016/j.ajpc.2025.101382","url":null,"abstract":"<div><h3>Background</h3><div>Life's Essential 8 (LE8) provides a framework to assess and improve cardiovascular health, ultimately reducing cardiovascular disease (CVD) risk. However, the role of LE8 metrics in addressing CVD disparities associated with social determinants of health (SDoH) remains unclear.</div></div><div><h3>Methods</h3><div>This cohort study employed the National Health and Nutrition Examination Survey (2005–2018) data. Logistic regression models, Cox proportional hazard models, and multiple mediation analysis were used to assess the associations of the SDoH score with CVD morbidity (self-reported diagnosis of congestive heart failure, coronary heart disease, angina pectoris, myocardial infarction, and stroke), CVD mortality, and mortality (mortality data were derived from the NHANES Public-Use Linked Mortality File), as well as the contributions of LE8 metrics to the associations.</div></div><div><h3>Results</h3><div>The top four reported unfavorable SDoH were low education level (21.5%), income-to-poverty ratio <3 (17.5%), no private health insurance (13.0%), and unemployment (11.5%). Unfavorable SDoH exposure was associated with higher CVD morbidity [odds ratio (OR) and 95% confidence interval (CI): 2.36 (2.18, 2.55) and CVD mortality [hazard ratio (HR) and 95%CI: 2.70 (2.24, 3.24)]. LE8 metrics accounted for approximately 30.4% (95%CI: 26.2%, 34.7%), 23.0% (95%CI: 19.3%, 28.3%), and 24.0% (95%CI: 20.6%, 28.8%) of the association between SDoH and CVD morbidity, CVD mortality, and all-cause mortality, respectively, with nicotine exposure, physical activity, and sleep health being the main LE8 contributors. Differences in the distribution of SDoH components, as well as the contribution of LE8 to the association between SDoH and CVD risk were observed across race/ethnicity groups.</div></div><div><h3>Conclusions</h3><div>Our findings highlight the effectiveness for public health interventions targeting SDoH to improve LE8 metrics and ultimately reducing CVD morbidity and mortality. Future research should also explore the impact of non-LE8 factors and racial/ethnic differences in developing comprehensive CVD prevention strategies among U.S. adults.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101382"},"PeriodicalIF":5.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791033","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}

引用次数: 0

Bundled measurement of LDL-cholesterol, lipoprotein(a), and high sensitivity C-reactive protein across the spectrum of cardiovascular risk ldl -胆固醇、脂蛋白(a)和高灵敏度c反应蛋白在心血管风险谱上的捆绑测量

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-11 DOI: 10.1016/j.ajpc.2025.101384

Alexander C. Razavi , Aaron L. Troy , Laurence S. Sperling , Roger S. Blumenthal

In the era of the Predicting Risk of Cardiovascular Disease (CVD) EVENTs (PREVENT) equations, recalibrating definitions for low, borderline, intermediate, and high risk will be of primary importance. Similarly, the cardiovascular-kidney-metabolic construct calls for more robust assessment of residual risk among individuals with clinical CVD. Recent observational studies demonstrate long-term prognostic value of LDL-cholesterol, lipoprotein(a) [Lp(a)], and high-sensitivity C-reactive protein (hsCRP) for the prediction of CVD. These findings support prior randomized clinical trial data demonstrating a benefit of primary prevention statin therapy for individuals with elevated hsCRP, and that elevated Lp(a) and hsCRP are associated with residual CVD risk in those with clinical CVD and well-controlled LDL-C. Overall, such evidence supports universal measurement of LDL-C, Lp(a), and, for most patients, hsCRP across the spectrum of CVD to facilitate earlier lifestyle guidance and more precise allocation of preventive pharmacotherapies.

在预测心血管疾病（CVD）事件风险（prevention）方程的时代，重新校准低、临界、中等和高风险的定义将是至关重要的。同样，心血管-肾脏-代谢结构要求对临床CVD患者的剩余风险进行更有力的评估。最近的观察性研究表明，ldl -胆固醇、脂蛋白(a) [Lp(a)]和高敏c反应蛋白（hsCRP）在预测心血管疾病方面具有长期预后价值。这些发现支持了先前的随机临床试验数据，表明他汀类药物一级预防治疗对hsCRP升高的个体有益，并且在临床CVD和LDL-C控制良好的患者中，Lp(a)和hsCRP升高与剩余CVD风险相关。总的来说，这些证据支持普遍测量LDL-C， Lp(a)，对于大多数CVD患者，hsCRP，以促进早期生活方式指导和更精确地分配预防性药物治疗。

{"title":"Bundled measurement of LDL-cholesterol, lipoprotein(a), and high sensitivity C-reactive protein across the spectrum of cardiovascular risk","authors":"Alexander C. Razavi , Aaron L. Troy , Laurence S. Sperling , Roger S. Blumenthal","doi":"10.1016/j.ajpc.2025.101384","DOIUrl":"10.1016/j.ajpc.2025.101384","url":null,"abstract":"<div><div>In the era of the Predicting Risk of Cardiovascular Disease (CVD) EVENTs (PREVENT) equations, recalibrating definitions for low, borderline, intermediate, and high risk will be of primary importance. Similarly, the cardiovascular-kidney-metabolic construct calls for more robust assessment of residual risk among individuals with clinical CVD. Recent observational studies demonstrate long-term prognostic value of LDL-cholesterol, lipoprotein(a) [Lp(a)], and high-sensitivity C-reactive protein (hsCRP) for the prediction of CVD. These findings support prior randomized clinical trial data demonstrating a benefit of primary prevention statin therapy for individuals with elevated hsCRP, and that elevated Lp(a) and hsCRP are associated with residual CVD risk in those with clinical CVD and well-controlled LDL-C. Overall, such evidence supports universal measurement of LDL-C, Lp(a), and, for most patients, hsCRP across the spectrum of CVD to facilitate earlier lifestyle guidance and more precise allocation of preventive pharmacotherapies.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101384"},"PeriodicalIF":5.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791164","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}

引用次数: 0

Synergistic effects of genetic susceptibility and air pollution on cardiovascular disease 遗传易感性与空气污染对心血管疾病的协同效应

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-11 DOI: 10.1016/j.ajpc.2025.101381

Yun-Jiu Cheng , Li-Juan Liu , Su-Hua Wu , Li-Chun Wang , Hai Deng , Hui-Qiang Wei , Wei-Dong Lin , Xian-Hong Fang , Yi-Jian Liao , Shu-Lin Wu , Yu-Mei Xue , Yue-Dong Ma , Yang Wu

Background

Although both genetic susceptibility and air pollution are established risk factors for cardiovascular disease (CVD), evidence for their interaction, particularly on the additive scale, remains limited and inconclusive. We aimed to investigate the individual and joint effects of long-term exposure to air pollutants and polygenic risk on incident CVD.

Methods

In a prospective cohort of 460,572 participants from the UK Biobank, we estimated hazard ratios (HRs) for CVD associated with particulate matter (PM_2.5 and PM₁₀), nitrogen dioxide (NO₂), and nitrogen oxides (NO_X) using Cox models. A polygenic risk score (PRS) for CVD was constructed, and additive and multiplicative interactions between PRS and air pollution were assessed.

Results

Over a median follow-up of 11.92 years, 48,690 incident CVD cases occurred. Both a higher genetic risk and increased air pollution exposure were independently associated with elevated CVD risk. Notably, a significant synergistic effect was observed. Compared to participants with low genetic risk and low pollution exposure, those with high genetic risk and high exposure faced the greatest hazard, with HRs of 1.76 (1.68–1.84) for PM_2.5, 1.74 (1.66–1.83) for PM₁₀, 1.82 (1.73–1.91) for NO₂, and 1.81 (1.73–1.90) for NO_x. These associations persisted at concentrations below WHO air quality guidelines and were robust across a series of sensitivity analyses.

Conclusions

Our findings call for a reevaluation of air quality standards and indicate that genetic profiling could identify subpopulations that would derive the greatest benefit from air pollution mitigation strategies.

虽然遗传易感性和空气污染都是心血管疾病（CVD）的既定危险因素，但它们相互作用的证据，特别是在累加性尺度上，仍然有限且不确定。我们的目的是调查长期暴露于空气污染物和多基因风险对心血管疾病的个体和联合影响。方法在一项来自UK Biobank的460,572名参与者的前瞻性队列研究中，我们使用Cox模型估计了与颗粒物（PM2.5和PM10）、二氧化氮（NO2）和氮氧化物（NOX）相关的心血管疾病风险比（hr）。构建了心血管疾病多基因风险评分（PRS），并评估了PRS与空气污染之间的加性和乘性相互作用。结果中位随访11.92年，共发生48,690例心血管疾病。较高的遗传风险和增加的空气污染暴露都与心血管疾病风险升高独立相关。值得注意的是，观察到显著的协同效应。与低遗传风险和低污染暴露的参与者相比，高遗传风险和高暴露的参与者面临的危害最大，PM2.5的hr为1.76 (1.68-1.84)，PM10的hr为1.74 (1.66-1.83)，NO2的hr为1.82 (1.73-1.91)，NOx的hr为1.81（1.73-1.90）。在低于世卫组织空气质量指南的浓度下，这些关联仍然存在，并且在一系列敏感性分析中表现强劲。研究结果呼吁对空气质量标准进行重新评估，并表明基因图谱可以确定从空气污染缓解策略中获益最大的亚群。

{"title":"Synergistic effects of genetic susceptibility and air pollution on cardiovascular disease","authors":"Yun-Jiu Cheng , Li-Juan Liu , Su-Hua Wu , Li-Chun Wang , Hai Deng , Hui-Qiang Wei , Wei-Dong Lin , Xian-Hong Fang , Yi-Jian Liao , Shu-Lin Wu , Yu-Mei Xue , Yue-Dong Ma , Yang Wu","doi":"10.1016/j.ajpc.2025.101381","DOIUrl":"10.1016/j.ajpc.2025.101381","url":null,"abstract":"<div><h3>Background</h3><div>Although both genetic susceptibility and air pollution are established risk factors for cardiovascular disease (CVD), evidence for their interaction, particularly on the additive scale, remains limited and inconclusive. We aimed to investigate the individual and joint effects of long-term exposure to air pollutants and polygenic risk on incident CVD.</div></div><div><h3>Methods</h3><div>In a prospective cohort of 460,572 participants from the UK Biobank, we estimated hazard ratios (HRs) for CVD associated with particulate matter (PM<sub>2.5</sub> and PM<sub>10</sub>), nitrogen dioxide (NO<sub>2</sub>), and nitrogen oxides (NO<em><sub>X</sub></em>) using Cox models. A polygenic risk score (PRS) for CVD was constructed, and additive and multiplicative interactions between PRS and air pollution were assessed.</div></div><div><h3>Results</h3><div>Over a median follow-up of 11.92 years, 48,690 incident CVD cases occurred. Both a higher genetic risk and increased air pollution exposure were independently associated with elevated CVD risk. Notably, a significant synergistic effect was observed. Compared to participants with low genetic risk and low pollution exposure, those with high genetic risk and high exposure faced the greatest hazard, with HRs of 1.76 (1.68–1.84) for PM<sub>2.5</sub>, 1.74 (1.66–1.83) for PM<sub>10</sub>, 1.82 (1.73–1.91) for NO<sub>2</sub>, and 1.81 (1.73–1.90) for NO<em><sub>x</sub></em>. These associations persisted at concentrations below WHO air quality guidelines and were robust across a series of sensitivity analyses.</div></div><div><h3>Conclusions</h3><div>Our findings call for a reevaluation of air quality standards and indicate that genetic profiling could identify subpopulations that would derive the greatest benefit from air pollution mitigation strategies.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101381"},"PeriodicalIF":5.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791086","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}

引用次数: 0

Chronic kidney disease screening to reduce cardiovascular risk: a call to action 慢性肾脏疾病筛查降低心血管风险：行动呼吁

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-11 DOI: 10.1016/j.ajpc.2025.101380

Erin D. Michos , David Cherney , Pam Kushner

Chronic kidney disease (CKD) has a high global prevalence, affecting around 1 in 7 adults in the United States; however, most adults with CKD are unaware that they have the condition. Diagnosis and treatment of CKD is essential due to the associated increased morbidity and mortality, including increased risk of cardiovascular disease (CVD) and heart failure. Importantly, people with CKD are more likely to die from CVD than progress to end-stage kidney disease. Dual evaluation of estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) is essential to determine the level of risk and to guide appropriate treatment. Although abnormalities in both eGFR and UACR can be modifiable risk factors for CKD progression and adverse CV outcomes, there is evidence of underuse of this dual screening for CKD. However, for patients with diagnosed CKD, striking reductions in cardiorenal risk may be achieved by combining appropriate evidence-based therapies. Current approaches to management of CKD involve the use of multiple therapies that target different pathological pathways to reduce cardiorenal risk. Therefore, we raise a call to action to improve the standard of care for early diagnosis and management of CKD, to minimize the risk of disease progression and complications, reduce CV risk, and ultimately improve patient outcomes. Alongside primary care clinicians, cardiologists can also lead the way for preventive efforts and implementation of guideline-directed therapies that can reduce the risk of both CKD progression and adverse CV outcomes.

慢性肾脏疾病（CKD）具有很高的全球患病率，在美国影响约七分之一的成年人；然而，大多数患有慢性肾病的成年人都不知道自己患有这种疾病。由于相关的发病率和死亡率增加，包括心血管疾病（CVD）和心力衰竭的风险增加，CKD的诊断和治疗是必不可少的。重要的是，CKD患者更有可能死于心血管疾病，而不是进展为终末期肾脏疾病。双重评估肾小球滤过率（eGFR）和尿白蛋白-肌酐比（UACR）对于确定风险水平和指导适当的治疗是必不可少的。尽管eGFR和UACR的异常可能是CKD进展和不良CV结果的可改变的危险因素，但有证据表明这种双重筛查对CKD的使用不足。然而，对于诊断为CKD的患者，通过结合适当的循证治疗，可以显著降低心肾风险。目前CKD的治疗方法包括使用针对不同病理途径的多种治疗方法来降低心肾风险。因此，我们呼吁采取行动，提高CKD早期诊断和管理的护理标准，以尽量减少疾病进展和并发症的风险，降低心血管风险，最终改善患者的预后。与初级保健临床医生一起，心脏病专家也可以引导预防工作和指导治疗的实施，从而降低CKD进展和不良心血管结果的风险。

{"title":"Chronic kidney disease screening to reduce cardiovascular risk: a call to action","authors":"Erin D. Michos , David Cherney , Pam Kushner","doi":"10.1016/j.ajpc.2025.101380","DOIUrl":"10.1016/j.ajpc.2025.101380","url":null,"abstract":"<div><div>Chronic kidney disease (CKD) has a high global prevalence, affecting around 1 in 7 adults in the United States; however, most adults with CKD are unaware that they have the condition. Diagnosis and treatment of CKD is essential due to the associated increased morbidity and mortality, including increased risk of cardiovascular disease (CVD) and heart failure. Importantly, people with CKD are more likely to die from CVD than progress to end-stage kidney disease. Dual evaluation of estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) is essential to determine the level of risk and to guide appropriate treatment. Although abnormalities in both eGFR and UACR can be modifiable risk factors for CKD progression and adverse CV outcomes, there is evidence of underuse of this dual screening for CKD. However, for patients with diagnosed CKD, striking reductions in cardiorenal risk may be achieved by combining appropriate evidence-based therapies. Current approaches to management of CKD involve the use of multiple therapies that target different pathological pathways to reduce cardiorenal risk. Therefore, we raise a call to action to improve the standard of care for early diagnosis and management of CKD, to minimize the risk of disease progression and complications, reduce CV risk, and ultimately improve patient outcomes. Alongside primary care clinicians, cardiologists can also lead the way for preventive efforts and implementation of guideline-directed therapies that can reduce the risk of both CKD progression and adverse CV outcomes.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101380"},"PeriodicalIF":5.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926018","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}

引用次数: 0

Sex-specific cardiovascular risk prediction using AI-derived epicardial adipose tissue measurements on CT calcium scoring exams 基于ai的心外膜脂肪组织测量在CT钙评分检查中的性别特异性心血管风险预测

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-08 DOI: 10.1016/j.ajpc.2025.101367

Prerna Singh , Tao Hu , Ammar Hoori , Sadeer Al-Kindi , David L. Wilson , Sanjay Rajagopalan

Background

The Agatston CAC score from CT-calcium scoring (CTCS) is a standard guideline recommended measure for cardiovascular risk assessment that quantifies calcified plaque burden. However, many studies have reported lower discrimination of CTCS in females. Embedded epicardial adipose tissue (EAT) features have previously been shown to improve prediction of calcium scoring, and we hypothesized that it may provide incremental prognostic information in females. In this study, we evaluate whether integrating epicardial “fat-omics” with CAC score improves major adverse cardiac events (MACE) prediction from CTCS in females and assess the added value of sex-specific modeling.

Methods

40,851 individuals undergoing CTCS for primary prevention (CLARIFY Registry, NCT04075162) were analyzed. MACE was defined as myocardial infarction, stroke, revascularization, or mortality. A validated deep learning model segmented EAT, and 211 “fat-omics” features were extracted. Cox models were trained using CAC score, CAC with fat-omics (EAT-CAC), and sex-specific EAT-CAC models trained. Performance was evaluated on a held-out test set (20 %) using C-index, calibration, and decision curves.

Results

The cohort had a mean age of 59.2 years, with 49.4 % females, and 1017 MACE events (2.49 %) over a mean follow-up of 1.7 years. On the test set (N = 8169), CAC had lower discrimination in females (C-index: 0.671) than males (0.769). EAT-CAC improved performance in females (0.691, p < 0.01 vs. CAC), with further improvement using the female-specific model (0.714, p < 0.0001 vs. CAC). No significant changes were observed in males. EAT-CAC models demonstrated good calibration, improved net benefit, and remained independently predictive after comorbidity adjustment (HR = 2.96, p < 0.001).

Conclusions

Sex-specific risk models incorporating epicardial fat-omics from CTCS improve risk prediction in females and equity in cardiovascular risk assessment.

背景：ct -钙评分（CTCS）中的Agatston CAC评分是一种标准指南推荐的心血管风险评估指标，可量化钙化斑块负担。然而，许多研究报道CTCS在女性中的歧视程度较低。嵌入的心外膜脂肪组织（EAT）特征先前已被证明可以改善钙评分的预测，我们假设它可能为女性提供增量预后信息。在这项研究中，我们评估了将心外膜“脂肪组学”与CAC评分相结合是否能改善女性CTCS对主要不良心脏事件（MACE）的预测，并评估了性别特异性建模的附加价值。方法对40,851例接受CTCS进行一级预防的个体（clarity Registry, NCT04075162）进行分析。MACE定义为心肌梗死、卒中、血运重建术或死亡。经过验证的深度学习模型对EAT进行了分割，并提取了211个“脂肪组学”特征。Cox模型使用CAC评分、CAC与脂肪组学（EAT-CAC）和性别特异性的EAT-CAC模型进行训练。使用C-index、校准和决策曲线在hold -out测试集（20%）上评估性能。结果该队列的平均年龄为59.2岁，女性占49.4%，在平均1.7年的随访期间发生1017例MACE事件（2.49%）。在检验集（N = 8169）上，女性对CAC的歧视程度（C-index: 0.671）低于男性（0.769）。EAT-CAC提高了女性的表现（0.691,p < 0.01，与CAC相比），使用女性特异性模型进一步改善（0.714,p < 0.0001，与CAC相比）。在男性中没有观察到明显的变化。EAT-CAC模型显示了良好的校准，提高了净效益，并且在合并症调整后仍保持独立预测（HR = 2.96, p < 0.001）。结论结合CTCS心外膜脂肪组学的性别特异性风险模型提高了女性的风险预测和心血管风险评估的公平性。

{"title":"Sex-specific cardiovascular risk prediction using AI-derived epicardial adipose tissue measurements on CT calcium scoring exams","authors":"Prerna Singh , Tao Hu , Ammar Hoori , Sadeer Al-Kindi , David L. Wilson , Sanjay Rajagopalan","doi":"10.1016/j.ajpc.2025.101367","DOIUrl":"10.1016/j.ajpc.2025.101367","url":null,"abstract":"<div><h3>Background</h3><div>The Agatston CAC score from CT-calcium scoring (CTCS) is a standard guideline recommended measure for cardiovascular risk assessment that quantifies calcified plaque burden. However, many studies have reported lower discrimination of CTCS in females. Embedded epicardial adipose tissue (EAT) features have previously been shown to improve prediction of calcium scoring, and we hypothesized that it may provide incremental prognostic information in females. In this study, we evaluate whether integrating epicardial “fat-omics” with CAC score improves major adverse cardiac events (MACE) prediction from CTCS in females and assess the added value of sex-specific modeling.</div></div><div><h3>Methods</h3><div>40,851 individuals undergoing CTCS for primary prevention (CLARIFY Registry, NCT04075162) were analyzed. MACE was defined as myocardial infarction, stroke, revascularization, or mortality. A validated deep learning model segmented EAT, and 211 “fat-omics” features were extracted. Cox models were trained using CAC score, CAC with fat-omics (EAT-CAC), and sex-specific EAT-CAC models trained. Performance was evaluated on a held-out test set (20 %) using C-index, calibration, and decision curves.</div></div><div><h3>Results</h3><div>The cohort had a mean age of 59.2 years, with 49.4 % females, and 1017 MACE events (2.49 %) over a mean follow-up of 1.7 years. On the test set (<em>N</em> = 8169), CAC had lower discrimination in females (C-index: 0.671) than males (0.769). EAT-CAC improved performance in females (0.691, <em>p</em> < 0.01 vs. CAC), with further improvement using the female-specific model (0.714, <em>p</em> < 0.0001 vs. CAC). No significant changes were observed in males. EAT-CAC models demonstrated good calibration, improved net benefit, and remained independently predictive after comorbidity adjustment (HR = 2.96, p < 0.001).</div></div><div><h3>Conclusions</h3><div>Sex-specific risk models incorporating epicardial fat-omics from CTCS improve risk prediction in females and equity in cardiovascular risk assessment.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101367"},"PeriodicalIF":5.9,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791030","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}

引用次数: 0

Cardiovascular-kidney-metabolic syndrome stages and increased risk of all-cause and cause-specific mortality in UK Biobank 英国生物银行的心血管肾脏代谢综合征分期和全因和病因特异性死亡率风险增加

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-08 DOI: 10.1016/j.ajpc.2025.101369

Tingting Xu , Jin Wei , Ming Xu , Huiqin Li , Silu Chen , Hongsheng Ji , Junyi Xin , Yan Gao , Mulong Du

Background

Cardiovascular–kidney–metabolic (CKM) syndrome poses a critical challenge for public health. However, its association with mortality risk remain inadequately characterized.

Methods

282,952 participants at baseline from the UK Biobank were monitored until November 12, 2021. Cox regression analyses evaluated the associations between CKM stages and the risk of all-cause and cause-specific mortality, including cardiovascular diseases (CVD), cancer, respiratory diseases, and digestive system diseases.

Results

Over a median follow-up of 12.7 years, 16,834 deaths occurred, including 15.8% from CVD, 50.3% from cancer, 6.0% from respiratory diseases, 3.6% from digestive system diseases, and 24.3% from other causes. The risk of all-cause, cancer, CVD, respiratory, and digestive mortality increased with advancing CKM stages (P < 0.001). Compared with Stage 0, the hazard ratios (HR) in Stage 4 were 2.34 (95% confidence interval [CI]: 2.11–2.58) for all-cause mortality, 10.15 (95% CI: 6.92–14.89) for CVD mortality, and 1.41 (95% CI: 1.23–1.62) for cancer mortality. Furthermore, younger adults (aged ≤ 60 years; P_interaction < 0.001) had stronger associations with all-cause, CVD, cancer, and respiratory events. Significant associations were observed between current smoking and cancer mortality (P_interaction < 0.001), and between previous smoking and all-cause and CVD mortality (P_interaction < 0.001).

Conclusions

CKM stages are strongly associated with increased all-cause and cause-specific mortality. Early identification and intervention in CKM syndrome patients could be crucial for reducing premature mortality and improving public health.

背景：心血管-肾代谢综合征（CKM）对公众健康构成了严峻的挑战。然而，其与死亡风险的关系仍然没有得到充分的描述。方法：对来自英国生物银行（UK Biobank）的282952名基线参与者进行监测，直至2021年11月12日。Cox回归分析评估了CKM分期与全因和特定原因死亡风险之间的关系，包括心血管疾病（CVD）、癌症、呼吸系统疾病和消化系统疾病。结果在12.7年的中位随访中，共发生16834例死亡，其中心血管疾病15.8%，癌症50.3%，呼吸系统疾病6.0%，消化系统疾病3.6%，其他原因24.3%。全因、癌症、心血管疾病、呼吸和消化系统死亡率的风险随着CKM分期的进展而增加（P < 0.001）。与0期相比，4期全因死亡率的风险比（HR）为2.34(95%可信区间[CI]: 2.11-2.58)，心血管疾病死亡率的风险比为10.15 (95% CI: 6.92-14.89)，癌症死亡率的风险比为1.41 （95% CI: 1.23-1.62）。此外，年轻人（年龄≤60岁；p < 0.001）与全因、心血管疾病、癌症和呼吸事件有更强的相关性。目前吸烟与癌症死亡率之间存在显著相关性（p - interaction < 0.001），以前吸烟与全因死亡率和心血管疾病死亡率之间存在显著相关性（p - interaction < 0.001）。结论sckm分期与全因和病因特异性死亡率增高密切相关。CKM综合征患者的早期识别和干预对于降低过早死亡率和改善公众健康至关重要。

{"title":"Cardiovascular-kidney-metabolic syndrome stages and increased risk of all-cause and cause-specific mortality in UK Biobank","authors":"Tingting Xu , Jin Wei , Ming Xu , Huiqin Li , Silu Chen , Hongsheng Ji , Junyi Xin , Yan Gao , Mulong Du","doi":"10.1016/j.ajpc.2025.101369","DOIUrl":"10.1016/j.ajpc.2025.101369","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular–kidney–metabolic (CKM) syndrome poses a critical challenge for public health. However, its association with mortality risk remain inadequately characterized.</div></div><div><h3>Methods</h3><div>282,952 participants at baseline from the UK Biobank were monitored until November 12, 2021. Cox regression analyses evaluated the associations between CKM stages and the risk of all-cause and cause-specific mortality, including cardiovascular diseases (CVD), cancer, respiratory diseases, and digestive system diseases.</div></div><div><h3>Results</h3><div>Over a median follow-up of 12.7 years, 16,834 deaths occurred, including 15.8% from CVD, 50.3% from cancer, 6.0% from respiratory diseases, 3.6% from digestive system diseases, and 24.3% from other causes. The risk of all-cause, cancer, CVD, respiratory, and digestive mortality increased with advancing CKM stages (<em>P</em> < 0.001). Compared with Stage 0, the hazard ratios (HR) in Stage 4 were 2.34 (95% confidence interval [CI]: 2.11–2.58) for all-cause mortality, 10.15 (95% CI: 6.92–14.89) for CVD mortality, and 1.41 (95% CI: 1.23–1.62) for cancer mortality. Furthermore, younger adults (aged ≤ 60 years; <em>P</em><sub>interaction</sub> < 0.001) had stronger associations with all-cause, CVD, cancer, and respiratory events. Significant associations were observed between current smoking and cancer mortality (<em>P</em><sub>interaction</sub> < 0.001), and between previous smoking and all-cause and CVD mortality (<em>P</em><sub>interaction</sub> < 0.001).</div></div><div><h3>Conclusions</h3><div>CKM stages are strongly associated with increased all-cause and cause-specific mortality. Early identification and intervention in CKM syndrome patients could be crucial for reducing premature mortality and improving public health.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101369"},"PeriodicalIF":5.9,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791031","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}

引用次数: 0

Association of PREVENT risk model with body fat distribution and subclinical left ventricular dysfunction 预防风险模型与体脂分布和亚临床左心室功能障碍的关系

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-08 DOI: 10.1016/j.ajpc.2025.101368

Kazutoshi Hirose , Koki Nakanishi , Masao Daimon , Naoko Sawada , Satoshi Konoma , Satomi Kobayashi , Hikari Seki , Yuriko Yoshida , Megumi Hirokawa , Tomoko Nakao , Hiroyuki Morita , Marco R. Di Tullio , Shunichi Homma , Makoto Kurano , Norihiko Takeda

Background

Recently developed Predicting Risk of cardiovascular disease EVENTs (PREVENT) risk model has shown excellent performance for cardiovascular risk stratification, but its relationship with body fat distribution and left ventricular (LV) mechanics is unknown.

Methods

We investigated 517 participants free of overt cardiac disease who underwent an extensive cardiovascular health examination. The PREVENT risk score was calculated in each participant, and the study population was categorized into three groups based on the tertiles of the risk score. Body fat distribution was assessed using computed tomography and quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. All participants also underwent two-dimensional transthoracic echocardiography, and LV global longitudinal strain (LVGLS) was obtained with speckle-tracking analysis. Univariable and multivariable logistic regression models were constructed to investigate the association between the PREVENT risk model and abnormal LVGLS (<17.0 % for male and <18.0 % for female) adjusting for the clinically relevant covariates.

Results

Individuals with high PREVENT score had the largest VFA (160.0 [109.7–194.4] cm²), followed by intermediate and low score groups (138.6 [92.0–176.4] cm² and 89.4 [50.6–123.9] cm², p < 0.001), while SFA was comparable among the three groups (p = 0.480). LVGLS was significantly lower with increasing PREVENT risk score (20.4 ± 3.3 % vs. 18.9 ± 2.8 % vs. 18.1 ± 2.7 %, p < 0.001). Multivariable logistic regression analysis showed that the PREVENT risk score carried an independent risk for abnormal LVGLS (adjusted odds ratio per 1 % increase 1.06, p = 0.006).

Conclusion

The PREVENT risk model was associated with abdominal visceral fat accumulation and subclinical LV dysfunction.

最近开发的预测心血管疾病事件风险（prevention）模型在心血管风险分层方面表现优异，但其与体脂分布和左心室（LV）力学的关系尚不清楚。方法我们调查了517名无明显心脏疾病的参与者，他们接受了广泛的心血管健康检查。计算每个参与者的预防风险评分，并根据风险评分的分位数将研究人群分为三组。使用计算机断层扫描评估体脂分布，并定量评估脐水平的内脏脂肪面积（VFA）和皮下脂肪面积（SFA）。所有参与者还接受了二维经胸超声心动图，并通过斑点跟踪分析获得左室整体纵向应变（LVGLS）。构建单变量和多变量logistic回归模型，探讨预防风险模型与LVGLS异常（男性17.0%，女性18.0%）之间的相关性，并对临床相关协变量进行校正。结果预防得分高的个体VFA最大（160.0 [109.7-194.4]cm2），中低分组次之（138.6 [92.0-176.4]cm2和89.4 [50.6-123.9]cm2, p < 0.001），三组间SFA具有可比性（p = 0.480）。LVGLS随着prevention风险评分的增加而显著降低（20.4±3.3% vs. 18.9±2.8% vs. 18.1±2.7%,p < 0.001）。多变量logistic回归分析显示，prevention风险评分存在LVGLS异常的独立风险（校正优势比每增加1%为1.06,p = 0.006）。结论预防风险模型与腹部内脏脂肪堆积和亚临床左室功能障碍有关。

{"title":"Association of PREVENT risk model with body fat distribution and subclinical left ventricular dysfunction","authors":"Kazutoshi Hirose , Koki Nakanishi , Masao Daimon , Naoko Sawada , Satoshi Konoma , Satomi Kobayashi , Hikari Seki , Yuriko Yoshida , Megumi Hirokawa , Tomoko Nakao , Hiroyuki Morita , Marco R. Di Tullio , Shunichi Homma , Makoto Kurano , Norihiko Takeda","doi":"10.1016/j.ajpc.2025.101368","DOIUrl":"10.1016/j.ajpc.2025.101368","url":null,"abstract":"<div><h3>Background</h3><div>Recently developed Predicting Risk of cardiovascular disease EVENTs (PREVENT) risk model has shown excellent performance for cardiovascular risk stratification, but its relationship with body fat distribution and left ventricular (LV) mechanics is unknown.</div></div><div><h3>Methods</h3><div>We investigated 517 participants free of overt cardiac disease who underwent an extensive cardiovascular health examination. The PREVENT risk score was calculated in each participant, and the study population was categorized into three groups based on the tertiles of the risk score. Body fat distribution was assessed using computed tomography and quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. All participants also underwent two-dimensional transthoracic echocardiography, and LV global longitudinal strain (LVGLS) was obtained with speckle-tracking analysis. Univariable and multivariable logistic regression models were constructed to investigate the association between the PREVENT risk model and abnormal LVGLS (<17.0 % for male and <18.0 % for female) adjusting for the clinically relevant covariates.</div></div><div><h3>Results</h3><div>Individuals with high PREVENT score had the largest VFA (160.0 [109.7–194.4] cm<sup>2</sup>), followed by intermediate and low score groups (138.6 [92.0–176.4] cm<sup>2</sup> and 89.4 [50.6–123.9] cm<sup>2</sup>, <em>p</em> < 0.001), while SFA was comparable among the three groups (<em>p</em> = 0.480). LVGLS was significantly lower with increasing PREVENT risk score (20.4 ± 3.3 % vs. 18.9 ± 2.8 % vs. 18.1 ± 2.7 %, <em>p</em> < 0.001). Multivariable logistic regression analysis showed that the PREVENT risk score carried an independent risk for abnormal LVGLS (adjusted odds ratio per 1 % increase 1.06, <em>p</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>The PREVENT risk model was associated with abdominal visceral fat accumulation and subclinical LV dysfunction.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101368"},"PeriodicalIF":5.9,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791034","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}

引用次数: 0

The risk of cardiovascular death in systemic immune-mediated diseases: A systematic review and meta-analysis 系统性免疫介导疾病的心血管死亡风险：一项系统综述和荟萃分析

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-07 DOI: 10.1016/j.ajpc.2025.101366

Stefano Figliozzi , Thanakorn Rojanathagoon , Spyridoula Karogianni , Lorenzo Cambini , Marco Bernardi , Cristina Panico , Fabrizio Ricci , Maria De Santis , Antonio Cannatà , Marinos Kallikourdis , Sebastiano Sciarretta , Giulio Stefanini , Mamas A Mamas , Gianluigi Condorelli , Pierre F Sabouret , Georgios Georgiopoulos

Aims

To perform a systematic review and meta-analysis assessing the association between systemic immune-mediated diseases (SIDs) and cardiovascular death.

Methods

A systematic search of PubMed, Cochrane Library, and ClinicalTrials.gov was performed from inception through September 28, 2024. Effect measures for cardiovascular death were extracted for overall SIDs and for individual subtypes. Pre-specified sensitivity analyses and meta-regression by age, sex, and follow-up duration were conducted. The study followed MOOSE guidelines (PROSPERO-ID: CRD420251033612).

Results

From 76,531 records, 39 observational studies comprising 171,748 patients were included. SIDs were associated with higher cardiovascular mortality (HR 1.26; 95 % CI 1.09–1.47; p = 0.002), consistent across sensitivity analyses. Female sex significantly modified the association, whereas age and follow-up duration did not. Among SIDs subtypes, only rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and granulomatosis with polyangiitis (GPA) retained a significant association with increased cardiovascular mortality. Of 1410 adjudicated cardiovascular deaths, 1292 (91.6 %) were due to acute coronary syndrome (ACS). The pooled risk of cardiovascular death from ACS was increased by 34 % (HR 1.34; 95 % CI 1.05–1.72; p = 0.019). Heterogeneity across studies was high (I² = 95 %).

Conclusions

SIDs were associated with an increased risk of cardiovascular death. The strongest associations were observed in SLE, GPA, RA, and among females. Although causality could not be inferred due to the observational nature and the heterogeneous cohorts of available studies, these findings underscore the need for improved risk stratification in these high-risk groups.

目的对系统性免疫介导性疾病（SIDs）与心血管死亡之间的关系进行系统回顾和荟萃分析。方法系统检索PubMed、Cochrane Library和ClinicalTrials.gov网站，检索时间为2024年9月28日。提取了总体SIDs和单个亚型的心血管死亡效应测量。按年龄、性别和随访时间进行预先指定的敏感性分析和meta回归。该研究遵循了MOOSE指南（PROSPERO-ID: CRD420251033612）。结果从76,531份记录中，纳入了39项观察性研究，包括171,748名患者。小岛屿发育障碍与较高的心血管死亡率相关（HR 1.26; 95% CI 1.09-1.47; p = 0.002），在敏感性分析中是一致的。女性性别显著改变了这种关联，而年龄和随访时间则没有。在SIDs亚型中，只有类风湿性关节炎（RA）、系统性红斑狼疮（SLE）和肉芽肿病合并多血管炎（GPA）与心血管死亡率增加有显著关联。在1410例心血管死亡中，1292例（91.6%）死于急性冠脉综合征（ACS）。ACS导致心血管死亡的总风险增加了34% （HR 1.34; 95% CI 1.05-1.72; p = 0.019）。研究间的异质性很高（I2 = 95%）。结论ssid与心血管死亡风险增加相关。在SLE、GPA、RA和女性中观察到最强的相关性。虽然由于观察性质和现有研究的异质性队列，无法推断因果关系，但这些发现强调了在这些高危人群中改进风险分层的必要性。

{"title":"The risk of cardiovascular death in systemic immune-mediated diseases: A systematic review and meta-analysis","authors":"Stefano Figliozzi , Thanakorn Rojanathagoon , Spyridoula Karogianni , Lorenzo Cambini , Marco Bernardi , Cristina Panico , Fabrizio Ricci , Maria De Santis , Antonio Cannatà , Marinos Kallikourdis , Sebastiano Sciarretta , Giulio Stefanini , Mamas A Mamas , Gianluigi Condorelli , Pierre F Sabouret , Georgios Georgiopoulos","doi":"10.1016/j.ajpc.2025.101366","DOIUrl":"10.1016/j.ajpc.2025.101366","url":null,"abstract":"<div><h3>Aims</h3><div>To perform a systematic review and meta-analysis assessing the association between systemic immune-mediated diseases (SIDs) and cardiovascular death.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Cochrane Library, and ClinicalTrials.gov was performed from inception through September 28, 2024. Effect measures for cardiovascular death were extracted for overall SIDs and for individual subtypes. Pre-specified sensitivity analyses and meta-regression by age, sex, and follow-up duration were conducted. The study followed MOOSE guidelines (PROSPERO-ID: CRD420251033612).</div></div><div><h3>Results</h3><div>From 76,531 records, 39 observational studies comprising 171,748 patients were included. SIDs were associated with higher cardiovascular mortality (HR 1.26; 95 % CI 1.09–1.47; <em>p</em> = 0.002), consistent across sensitivity analyses. Female sex significantly modified the association, whereas age and follow-up duration did not. Among SIDs subtypes, only rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and granulomatosis with polyangiitis (GPA) retained a significant association with increased cardiovascular mortality. Of 1410 adjudicated cardiovascular deaths, 1292 (91.6 %) were due to acute coronary syndrome (ACS). The pooled risk of cardiovascular death from ACS was increased by 34 % (HR 1.34; 95 % CI 1.05–1.72; <em>p</em> = 0.019). Heterogeneity across studies was high (I<sup>2</sup> = 95 %).</div></div><div><h3>Conclusions</h3><div>SIDs were associated with an increased risk of cardiovascular death. The strongest associations were observed in SLE, GPA, RA, and among females. Although causality could not be inferred due to the observational nature and the heterogeneous cohorts of available studies, these findings underscore the need for improved risk stratification in these high-risk groups.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101366"},"PeriodicalIF":5.9,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738310","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}

引用次数: 0

Inspecting the association between metabolic obese phenotypes and heart failure subtypes risk 检查代谢性肥胖表型与心力衰竭亚型风险之间的关系

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-06 DOI: 10.1016/j.ajpc.2025.101365

Jiancheng Zhang , Bin Dong , Jiayong Li , Yu Ning , Yilong Wang , Jiale Huang , Wengen Zhu , Zhe Zhen , Weihao Liang , Fangfei Wei , Peisen Huang , Chen Chen , Min Ye , Yugang Dong , Chen Liu , Yuzhong Wu , Ruicong Xue

Aim

Obesity and metabolic unhealth don’t always co-exist. The relation between phenotypes derived from metabolic obese status and heart failure (HF) subtypes categorized by left ventricular ejection fraction (LVEF) is unclear. We aimed to investigate the association between metabolic obese phenotypes and future HF subtypes risk.

Objectives

A total of 9791 participants from the ARIC study were classified into phenotypes based on obese and metabolic status: metabolically healthy non-obesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy non-obesity (MUNO) and metabolically unhealthy obesity (MUO).

Methods

Cox regression models were applied to explore the relationship between metabolic obese phenotypes and risk of HF with preserved ejection fraction (HFpEF, LVEF ≥ 50 %) and HF with reduced or mid-range ejection fraction (HFrEF/HFmrEF, LVEF < 50 %) in total population and subgroups. Associations between phenotypes transition over time and HF subtypes risk were further analyzed.

Results

Compared with MHNO participants, HFpEF risk was increased in MHO (hazard ratio and 95 % confidence interval, 1.77 [1.39–2.26]), MUNO (1.59 [1.27–1.99]) and MUO (2.77 [2.25–3.40]), while HFrEF/HFmrEF risk were higher in MUNO (1.61 [1.27–2.04]) and MUO (2.19 [1.74–2.75]) participants. Subgroup analyses revealed that the associations between metabolic obese phenotypes and HF subtypes risk were more predominant in participants < 55 years old and female. Persistent MHO, MUNO or MUO were associated with increased HFpEF risk and almost any transition to MUO resulted in increased risk of all HF subtypes.

Conclusions

MUNO and MUO were associated with all HF subtypes risk, while MHO was only associated with future HFpEF rather than HFrEF/HFmrEF.

肥胖和代谢不健康并不总是共存的。代谢性肥胖的表型与左心室射血分数（LVEF）分类的心力衰竭（HF）亚型之间的关系尚不清楚。我们的目的是研究代谢性肥胖表型与未来HF亚型风险之间的关系。来自ARIC研究的9791名参与者根据肥胖和代谢状态分为代谢健康非肥胖（MHNO）、代谢健康肥胖（MHO）、代谢不健康非肥胖（MUNO）和代谢不健康肥胖（MUO）。方法应用scox回归模型探讨代谢肥胖表型与总人群和亚组中保持射血分数的HF （HFpEF, LVEF≥50%）和降低或中等射血分数的HF （HFrEF/HFmrEF, LVEF < 50%）发生风险的关系。进一步分析了表型随时间变化与HF亚型风险之间的关系。结果与MHNO组相比，MHO组HFpEF风险增加（风险比和95%可信区间分别为1.77[1.39 ~ 2.26]）、MUNO组（1.59[1.27 ~ 1.99]）和MUO组（2.77[2.25 ~ 3.40]），而MUNO组（1.61[1.27 ~ 2.04]）和MUO组（2.19 [1.74 ~ 2.75]）HFrEF/HFmrEF风险更高。亚组分析显示，代谢性肥胖表型与HF亚型风险之间的关联在55岁和女性参与者中更为突出。持续性MHO、MUO或MUO与HFpEF风险增加相关，几乎任何向MUO的转变都会导致所有HF亚型的风险增加。结论smuno和MUO与所有HF亚型风险相关，而MHO仅与未来HFpEF相关，而与HFrEF/HFmrEF无关。

{"title":"Inspecting the association between metabolic obese phenotypes and heart failure subtypes risk","authors":"Jiancheng Zhang , Bin Dong , Jiayong Li , Yu Ning , Yilong Wang , Jiale Huang , Wengen Zhu , Zhe Zhen , Weihao Liang , Fangfei Wei , Peisen Huang , Chen Chen , Min Ye , Yugang Dong , Chen Liu , Yuzhong Wu , Ruicong Xue","doi":"10.1016/j.ajpc.2025.101365","DOIUrl":"10.1016/j.ajpc.2025.101365","url":null,"abstract":"<div><h3>Aim</h3><div>Obesity and metabolic unhealth don’t always co-exist. The relation between phenotypes derived from metabolic obese status and heart failure (HF) subtypes categorized by left ventricular ejection fraction (LVEF) is unclear. We aimed to investigate the association between metabolic obese phenotypes and future HF subtypes risk.</div></div><div><h3>Objectives</h3><div>A total of 9791 participants from the ARIC study were classified into phenotypes based on obese and metabolic status: metabolically healthy non-obesity (MHNO), metabolically healthy obesity (MHO), metabolically unhealthy non-obesity (MUNO) and metabolically unhealthy obesity (MUO).</div></div><div><h3>Methods</h3><div>Cox regression models were applied to explore the relationship between metabolic obese phenotypes and risk of HF with preserved ejection fraction (HFpEF, LVEF ≥ 50 %) and HF with reduced or mid-range ejection fraction (HFrEF/HFmrEF, LVEF < 50 %) in total population and subgroups. Associations between phenotypes transition over time and HF subtypes risk were further analyzed.</div></div><div><h3>Results</h3><div>Compared with MHNO participants, HFpEF risk was increased in MHO (hazard ratio and 95 % confidence interval, 1.77 [1.39–2.26]), MUNO (1.59 [1.27–1.99]) and MUO (2.77 [2.25–3.40]), while HFrEF/HFmrEF risk were higher in MUNO (1.61 [1.27–2.04]) and MUO (2.19 [1.74–2.75]) participants. Subgroup analyses revealed that the associations between metabolic obese phenotypes and HF subtypes risk were more predominant in participants < 55 years old and female. Persistent MHO, MUNO or MUO were associated with increased HFpEF risk and almost any transition to MUO resulted in increased risk of all HF subtypes.</div></div><div><h3>Conclusions</h3><div>MUNO and MUO were associated with all HF subtypes risk, while MHO was only associated with future HFpEF rather than HFrEF/HFmrEF.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101365"},"PeriodicalIF":5.9,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738309","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}

引用次数: 0