American journal of preventive cardiology最新文献

英文中文

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 : 2026-03-01 Epub 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。

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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 : 2026-03-01 Epub 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。

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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 : 2026-03-01 Epub 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。

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引用次数: 0

Long-term prognosis of cardiometabolic diseases among U.S. workers: The contribution of shift work to mortality 美国工人心脏代谢疾病的长期预后：轮班工作对死亡率的贡献

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2026-03-01 Epub Date: 2025-12-12 DOI: 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.

轮班工作是已知的心血管代谢疾病（CMD）的危险因素，包括心血管疾病（CVD）和糖尿病。然而，关于已经诊断为CMD的个体的长期预后的证据有限，特别是关于继续暴露于轮班工作后的死亡率结果。本研究旨在调查轮班工作与美国CMD患者死亡率（包括全因、CMD和CVD死亡率）之间的前瞻性关联。方法将2010年和2015年全国健康访谈调查（NHIS）的数据与截至2019年12月31日的全国死亡指数（National Death Index）的死亡记录相关联。共包括9,622名患有CMD的工人。轮班工作暴露是自我报告的日常工作时间表，并被归类为轮班与常规白天工作。采用Cox比例风险模型，对基线人口统计信息、社会经济地位和职业特征进行调整。结果基线时，25.7%（2470人）报告轮班工作。在随访期间，记录了非轮班工作组308例死亡（100例CMD死亡和90例CVD死亡）和轮班工作组129例死亡（50例CMD死亡和43例CVD死亡）。轮班工作与全因死亡率（HR=1.28, 95% CI=1.02, 1.62）、CMD死亡率（HR=1.57, 95% CI=1.01, 2.42）和CVD死亡率（HR=1.61, 95% CI=1.02, 2.53）的高风险相关，并对基线协变量进行了调整。结论：在美国患有CMD的工人中，轮班工作与全因和特定原因死亡的风险显著升高有关，这突出了在临床护理和工作场所政策中考虑职业暴露的必要性，以支持CMD工人的二级预防。

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引用次数: 0

Personalizing prevention for healthy cardiovascular aging: Geriatric cardiology in the 2024-2025 hypertension and dyslipidemia guidelines 健康心血管衰老的个体化预防：2024-2025年高血压和血脂异常指南中的老年心脏病学

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2026-02-01 Epub Date: 2026-01-03 DOI: 10.1016/j.ajpc.2026.101410

Aaron L. Troy , Timothy S. Anderson , Alexander C. Razavi , Stacey L. Schott , Jared A. Spitz , Roger S. Blumenthal

引用次数: 0

Baseline characteristics and response to evinacumab in females and males with homozygous familial hypercholesterolemia in the ELIPSE OLE study ELIPSE OLE研究中纯合子家族性高胆固醇血症女性和男性患者对依维那单抗的基线特征和反应

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2026-02-01 Epub Date: 2026-01-19 DOI: 10.1016/j.ajpc.2025.101395

Diane Brisson , Albert Wiegman , Alpana Waldron , Pinay Kainth , Frederick J Raal , Daniel Gaudet

Aim

Evinacumab is an ANGPTL-3 inhibitor developed for the treatment of homozygous familial hypercholesterolemia (HoFH), a rare condition characterized by extremely elevated LDL-cholesterol (LDL-C) levels and premature atherosclerotic cardiovascular disease. Despite important sex-related disparities in lipid metabolism, females are still underrepresented in trials, limiting the generalizability of results. With 116 patients, of which 49 % were females, the ELIPSE-OLE study has the largest cohort of HoFH females involved in a clinical trial. The aim of this analysis was to compare response to evinacumab in females and males in the ELIPSE OLE study.

Methods

This study is a post hoc exploratory analysis of data on 57 females and 59 males, aged ≥12 years and on stable background lipid-lowering therapy (LLT) from ELIPSE OLE. Patients received evinacumab 15 mg/kg intravenously every 4 weeks. The primary efficacy endpoint was the reduction in LDL-C concentration from baseline to week-24.

Results

Baseline LDL-C [mean (SD)] tended to be higher in females aged 18 to <50 than males: 8.4(5.4) vs 6.4(3.5) mmol/L. Following treatment with evinacumab, the percent decrease in LDL-C reached at week-24 was 44 % in the overall cohort and was sustained over time. Evinacumab significantly decreased LDL-C in both sexes, regardless of age and background LLT. There was a trend, although not significant, toward higher relative precent decrease of LDL-C among females.

Conclusion

In a study where half of the participants were females, evinacumab led to substantial LDL-C reduction in HoFH patients of both sexes, regardless of genotype or background LLT.

目的：Evinacumab是一种ANGPTL-3抑制剂，用于治疗纯合子家族性高胆固醇血症（HoFH），这是一种罕见的疾病，其特征是ldl -胆固醇（LDL-C）水平极高和过早动脉粥样硬化性心血管疾病。尽管脂质代谢存在重要的性别差异，但女性在试验中的代表性仍然不足，限制了结果的普遍性。有116例患者，其中49%为女性，elisse - ole研究是参与临床试验的最大的HoFH女性队列。本分析的目的是比较elisse OLE研究中女性和男性对evinacumab的反应。方法：本研究是对57名女性和59名男性的事后探索性分析，年龄≥12岁，接受ELIPSE OLE稳定背景降脂治疗（LLT）。患者每4周静脉注射evinacumab 15mg /kg。主要疗效终点是LDL-C浓度从基线到第24周的降低。结果：基线LDL-C[平均（SD）]在18岁至18岁的女性中趋于较高。结论：在一项一半参与者为女性的研究中，evinacumab导致男女HoFH患者的LDL-C大幅降低，无论基因型或背景LLT如何。

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引用次数: 0

Lowering barriers Not the bar: Redefining the role of American Journal of Preventive Cardiology in the next era 降低障碍而不是门槛：重新定义美国预防心脏病学杂志在下一个时代的角色。

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2026-02-01 Epub Date: 2026-01-24 DOI: 10.1016/j.ajpc.2026.101450

Khurram Nasir

引用次数: 0

The new Dietary Guidelines for Americans: When national nutritional policy outpaces the evidence 新的美国人膳食指南：当国家营养政策超越了证据。

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2026-02-01 Epub Date: 2026-02-23 DOI: 10.1016/j.ajpc.2026.101440

Martha Gulati , Danielle Belardo , Robert J. Ostfeld , American Society for Preventive Cardiology Nutrition Committee

引用次数: 0

Lipoprotein(a) epidemiology and role in secondary and primary-and-a-half cardiovascular prevention: From subclinical atherosclerosis to coronary events 脂蛋白(a)流行病学及其在二级和一级半心血管预防中的作用：从亚临床动脉粥样硬化到冠状动脉事件。

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2026-02-01 Epub Date: 2026-01-23 DOI: 10.1016/j.ajpc.2026.101416

Mateo Iwanowski , Sonia Ruiz-Bustillo , Joan Vime-Jubany , Flavio Zuccarino , Diego Álvaro Perez Zerpa , Laura Jimenez-Mayorga , Sara Rodriguez , Nuria Rodriguez , Paula Cabero , Consol Ivern , Badosa Marce Neus , Beatriz Vaquerizo-Montilla , Miguel Cainzos-Achirica

Introduction

Lipoprotein(a) (Lp[a]) is an independent risk factor for atherosclerotic cardiovascular events and aortic stenosis. In Spain, the prevalence of elevated Lp(a) and its clinical impact remain poorly defined.

Methods

We conducted a cross-sectional study including two cohorts: patients discharged after a non-fatal acute coronary syndrome (secondary prevention), and asymptomatic patients with subclinical atherosclerosis (“1.5 prevention”). The prevalence of elevated Lp(a) levels was assessed in both groups. Associations with multivessel coronary artery disease (secondary prevention) and with a coronary artery calcium (CAC) score ≥300 AU (1.5 prevention) were analyzed.

Results

A total of 1043 patients were included (788 secondary prevention). Median Lp(a) levels were 61 nmol/L in secondary prevention and 29 nmol/L in the 1.5 prevention cohort. In secondary prevention, 36.8%, 33.6%, 29.2%, and 24.5% had Lp(a) ≥125, ≥150, ≥175, and ≥ 200nmol/L, respectively; in the 1.5 prevention cohort the corresponding proportions were 27.5%, 24.3%, 17.6%, and 14.1%. In secondary prevention, Lp(a) ≥175 nmol/L was associated with multivessel disease after multivariable adjustment for age, sex, LDLc, and statin treatment (OR 1.45, 95% CI: 1.04–2.01; p = 0.027). In 1.5 prevention, Lp(a) ≥175 nmol/L showed a prevalence of CAC ≥300 AU of 86%. Elevated Lp(a) (≥175 nmol/L) was associated with CAC ≥300 AU (OR 4.47, 95% CI 1.39–20.07; p = 0.023), although this association lost significance after multivariable adjustment.

Conclusions

Elevated Lp(a) levels are common in both populations and correlate with greater atherosclerotic burden. These findings support the systematic assessment of Lp(a) to guide preventive strategies across both patient populations.

简介：脂蛋白(a) （Lp[a]）是动脉粥样硬化性心血管事件和主动脉狭窄的独立危险因素。在西班牙，Lp(a)升高的患病率及其临床影响仍不明确。方法：我们进行了一项横断面研究，包括两个队列：非致死性急性冠状动脉综合征（二级预防）后出院的患者，以及无症状的亚临床动脉粥样硬化（“1.5预防”）患者。评估两组患者Lp(a)水平升高的发生率。分析与多支冠状动脉疾病（二级预防）和冠状动脉钙（CAC）评分≥300 AU（1.5预防）的相关性。结果：共纳入1043例患者，其中二级预防788例。中位Lp(a)水平在二级预防组为61 nmol/L，在1.5预防组为29 nmol/L。在二级预防中，Lp(a)≥125、≥150、≥175和≥200nmol/L分别为36.8%、33.6%、29.2%和24.5%；在1.5预防组中，相应比例分别为27.5%、24.3%、17.6%和14.1%。在二级预防中，经年龄、性别、低密度脂蛋白和他汀类药物治疗等多变量调整后，Lp(a)≥175 nmol/L与多血管疾病相关（OR 1.45, 95% CI: 1.04-2.01; p = 0.027）。在1.5预防中，Lp(a)≥175 nmol/L表明CAC≥300 AU的患病率为86%。升高的Lp(a)（≥175 nmol/L）与CAC≥300 AU相关（OR 4.47, 95% CI 1.39-20.07; p = 0.023），尽管在多变量调整后这种关联失去了显著性。结论：Lp(a)水平升高在两种人群中都很常见，并且与更大的动脉粥样硬化负担相关。这些发现支持对Lp(a)进行系统评估，以指导两种患者群体的预防策略。

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引用次数: 0

Integrating financial risk into cardiometabolic prevention: From price transparency to patient-level insights into diabetes-related spending 将财务风险纳入心脏代谢预防：从价格透明度到糖尿病相关支出的患者层面洞察。

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2026-02-01 Epub Date: 2026-01-22 DOI: 10.1016/j.ajpc.2026.101444

Pauline Pearcy , Khurram Nasir , Elias Mossialos

引用次数: 0

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