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

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。

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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 : 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

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。

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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。

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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 : 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

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。

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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。

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引用次数: 0

Impact of patient phenotype on the relationship between accelerometer-derived physical activity and cardiovascular events in atrial fibrillation 心房颤动患者表型对加速度计衍生的体力活动与心血管事件之间关系的影响

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-05 DOI: 10.1016/j.ajpc.2025.101362

Maxime Boidin , Benjamin JR Buckley , Gregory YH Lip , Dick HJ Thijssen

Aims

Atrial fibrillation (AF) is a heterogeneous condition with varying comorbidity profiles, yet current physical activity guidelines do not differentiate between AF phenotypes. We examined the association between objectively measured moderate-to-vigorous physical activity (MVPA) and major adverse cardiovascular events (MACE) across different AF phenotypes.

Methods

In a prospective cohort of 4858 adults with AF (mean age 63, 37 % female) from the UK Biobank, wrist-worn accelerometry quantified MVPA. Hierarchical clustering classified individuals into 'high' and 'low' risk clusters based on comorbidities. Activity patterns were also described by rhythm control treatment status. Cox-proportional hazards models assessed the association between MVPA and MACE across clusters, while Poisson regression identified notable MVPA thresholds.

Results

The 'high-risk' cluster (n = 2583) experienced more MACE (HR: 3.81, 95 %CI: 3.19–4.55, p < 0.001) than the 'low-risk' cluster (n = 2275). Greater MVPA was associated with lower MACE incidence in both clusters. In the 'low risk' cluster, those with median MVPA of 187 min/week had lower MACE incidence (HR 0.39, 95 %CI 0.22–0.70, p = 0.001) than the reference group (median 56 min/week). In the 'high risk' cluster, those with median MVPA of 167 min/week had lower MACE incidence (HR 0.57, 95 %CI 0.44–0.74, p < 0.001) than their reference group (median 42 min/week). Poisson models identified 35 and 103 min/week as notable thresholds (IRRs: 0.35 and 0.31, respectively; both p < 0.001). Among patients undergoing rhythm control (n = 1354), higher MVPA was associated with lower MACE incidence (HR 0.42, 95 %CI 0.26–0.66, p < 0.001).

Conclusion

In this AF cohort, higher MVPA was associated with lower MACE incidence across different risk phenotypes and treatment statuses.

心房颤动（AF）是一种异质性疾病，具有不同的合并症，但目前的身体活动指南并未区分AF表型。我们研究了客观测量的中高强度身体活动（MVPA）与不同AF表型的主要不良心血管事件（MACE）之间的关系。方法在来自英国生物银行的4858名成年房颤患者（平均年龄63岁，37%为女性）的前瞻性队列中，腕带加速度计量化了MVPA。分层聚类将个体根据合并症分为“高”和“低”风险群。节律控制治疗状态也描述了活动模式。cox比例风险模型评估了MVPA和MACE之间的关联，而泊松回归确定了显著的MVPA阈值。结果“高风险”组（n = 2583）比“低风险”组（n = 2275）经历了更多的MACE （HR: 3.81, 95% CI: 3.19-4.55, p < 0.001）。在两组患者中，MVPA越大，MACE发生率越低。在“低风险”组中，MVPA中位数为187分钟/周的患者MACE发生率低于对照组（中位数为56分钟/周）（HR 0.39, 95% CI 0.22-0.70, p = 0.001）。在“高风险”组中，MVPA中位数为167分钟/周的患者MACE发生率低于对照组（中位数为42分钟/周）（HR 0.57, 95% CI 0.44-0.74, p < 0.001）。泊松模型确定35和103分钟/周为显著阈值（irs分别为0.35和0.31;p < 0.001）。在接受心律控制的患者中（n = 1354），较高的MVPA与较低的MACE发生率相关（HR 0.42, 95% CI 0.26-0.66, p < 0.001）。结论：在该房颤队列中，不同风险表型和治疗状态下，MVPA较高与MACE发生率较低相关。

{"title":"Impact of patient phenotype on the relationship between accelerometer-derived physical activity and cardiovascular events in atrial fibrillation","authors":"Maxime Boidin , Benjamin JR Buckley , Gregory YH Lip , Dick HJ Thijssen","doi":"10.1016/j.ajpc.2025.101362","DOIUrl":"10.1016/j.ajpc.2025.101362","url":null,"abstract":"<div><h3>Aims</h3><div>Atrial fibrillation (AF) is a heterogeneous condition with varying comorbidity profiles, yet current physical activity guidelines do not differentiate between AF phenotypes. We examined the association between objectively measured moderate-to-vigorous physical activity (MVPA) and major adverse cardiovascular events (MACE) across different AF phenotypes.</div></div><div><h3>Methods</h3><div>In a prospective cohort of 4858 adults with AF (mean age 63, 37 % female) from the UK Biobank, wrist-worn accelerometry quantified MVPA. Hierarchical clustering classified individuals into 'high' and 'low' risk clusters based on comorbidities. Activity patterns were also described by rhythm control treatment status. Cox-proportional hazards models assessed the association between MVPA and MACE across clusters, while Poisson regression identified notable MVPA thresholds.</div></div><div><h3>Results</h3><div>The 'high-risk' cluster (<em>n</em> = 2583) experienced more MACE (HR: 3.81, 95 %CI: 3.19–4.55, <em>p</em> < 0.001) than the 'low-risk' cluster (<em>n</em> = 2275). Greater MVPA was associated with lower MACE incidence in both clusters. In the 'low risk' cluster, those with median MVPA of 187 min/week had lower MACE incidence (HR 0.39, 95 %CI 0.22–0.70, <em>p</em> = 0.001) than the reference group (median 56 min/week). In the 'high risk' cluster, those with median MVPA of 167 min/week had lower MACE incidence (HR 0.57, 95 %CI 0.44–0.74, <em>p</em> < 0.001) than their reference group (median 42 min/week). Poisson models identified 35 and 103 min/week as notable thresholds (IRRs: 0.35 and 0.31, respectively; both <em>p</em> < 0.001). Among patients undergoing rhythm control (<em>n</em> = 1354), higher MVPA was associated with lower MACE incidence (HR 0.42, 95 %CI 0.26–0.66, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>In this AF cohort, higher MVPA was associated with lower MACE incidence across different risk phenotypes and treatment statuses.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"25 ","pages":"Article 101362"},"PeriodicalIF":5.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738311","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

Temporal patterns of triglyceride testing and test results among adults with severe or extreme hypertriglyceridemia in US clinical practice 美国临床实践中严重或极端高甘油三酯血症成人甘油三酯测试的时间模式和测试结果

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.ajpc.2025.101356

Asia Sikora Kessler , Seth J. Baum , Emily Kutrieb , Montserrat Vera Llonch , Hongsheng Wu , Derek Weycker , Jonathan L. Respress , Daniel E. Soffer

Severe hypertriglyceridemia (sHTG; triglyceride [TG] 500-879 mg/dL) and extreme hypertriglyceridemia (eHTG; TG ≥880 mg/dL), are risk-enhancing factors for atherosclerotic cardiovascular disease and acute pancreatitis, yet little is known about routine TG monitoring. This study characterized real-world frequency and patterns of TG testing and results among adults with sHTG/eHTG. Among 1.8 M adults, first observed TG was 500-879 for 0.7% and ≥880 for 0.2%. During mean follow-up of 27 months, 38% of patients with first TG 500-879 or ≥880 had one test, and among those with ≥2 tests, mean interval between first/second tests was ≥244 days. Among patients with first TG 500-879 and ≥3 tests, second TG was ≥500 for 26% and all three TGs were ≥500 for 11%. Among patients with first TG ≥880 and ≥3 tests, second TG was ≥500 for 46% and all three TGs were ≥500 for 30%. Findings suggest that follow-up TG testing is suboptimal, and TG results are persistently high for many patients with sHTG/eHTG.

严重高甘油三酯血症（sHTG；甘油三酯[TG] 500-879 mg/dL）和极端高甘油三酯血症（eHTG; TG≥880 mg/dL）是动脉粥样硬化性心血管疾病和急性胰腺炎的危险增强因素，但对常规TG监测知之甚少。本研究描述了真实世界中sHTG/eHTG成人患者TG检测的频率和模式以及结果。在180万成年人中，首次观察到的TG为500-879(0.7%),≥880（0.2%）。在平均27个月的随访中，38%的首次TG 500-879或≥880的患者进行了一次检测，在≥2次检测的患者中，第一次/第二次检测的平均间隔时间≥244天。在首次TG 500-879且≥3次试验的患者中，26%的患者第二次TG≥500,11%的患者三次TG均≥500。在首次TG≥880和≥3次试验的患者中，46%的患者第二次TG≥500,30%的患者三次TG均≥500。研究结果表明，后续TG检测并不理想，许多sHTG/eHTG患者的TG结果持续较高。

{"title":"Temporal patterns of triglyceride testing and test results among adults with severe or extreme hypertriglyceridemia in US clinical practice","authors":"Asia Sikora Kessler , Seth J. Baum , Emily Kutrieb , Montserrat Vera Llonch , Hongsheng Wu , Derek Weycker , Jonathan L. Respress , Daniel E. Soffer","doi":"10.1016/j.ajpc.2025.101356","DOIUrl":"10.1016/j.ajpc.2025.101356","url":null,"abstract":"<div><div>Severe hypertriglyceridemia (sHTG; triglyceride [TG] 500-879 mg/dL) and extreme hypertriglyceridemia (eHTG; TG ≥880 mg/dL), are risk-enhancing factors for atherosclerotic cardiovascular disease and acute pancreatitis, yet little is known about routine TG monitoring. This study characterized real-world frequency and patterns of TG testing and results among adults with sHTG/eHTG. Among 1.8 M adults, first observed TG was 500-879 for 0.7% and ≥880 for 0.2%. During mean follow-up of 27 months, 38% of patients with first TG 500-879 or ≥880 had one test, and among those with ≥2 tests, mean interval between first/second tests was ≥244 days. Among patients with first TG 500-879 and ≥3 tests, second TG was ≥500 for 26% and all three TGs were ≥500 for 11%. Among patients with first TG ≥880 and ≥3 tests, second TG was ≥500 for 46% and all three TGs were ≥500 for 30%. Findings suggest that follow-up TG testing is suboptimal, and TG results are persistently high for many patients with sHTG/eHTG.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"24 ","pages":"Article 101356"},"PeriodicalIF":5.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617655","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

Nonlinear association between glycemic markers and incident cardio‑renal‑metabolic multimorbidity: two decades of follow‑up in the Tehran Lipid and Glucose Study 血糖指标与心肾代谢多病之间的非线性关联：德黑兰脂质和葡萄糖研究的二十年随访

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-01 DOI: 10.1016/j.ajpc.2025.101353

Navid Ebrahimi , Soroush Masrouri , Seyed Saeed Tamehri Zadeh , Maryam Tohidi , Fereidoun Azizi , Farzad Hadaegh

Objective

To investigate the association between glycemic markers and the incidence of cardio-renal-metabolic multimorbidity (CRMM) in initially disease-free individuals.

Methods

We used multivariable Cox proportional hazards models to evaluate associations between fasting plasma glucose (FPG), 2-hour post-load glucose (2hPG), serum insulin, and homeostatic model assessment of insulin resistance (HOMA-IR) with incident CRMM, defined as the coexistence of ≥ 2 of cardiovascular disease (CVD) (including coronary heart disease, stroke, or cardiovascular death), type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD) among individuals initially free of these conditions.

Results

During a median follow-up of 15.3 years (IQR: 11.9–16.4), among 5734 participants (3097 women), 340 (5.9 %) developed CRMM. The most frequent combination among those with incident CRMM was CVD and T2DM (49.1 %), followed by CKD and T2DM (19.7 %), CVD and CKD (18.5 %), and all three conditions (12.6 %). Hazard ratios (HRs) of incident CRMM associated with each 1-standard deviation (SD) increase in FPG, 2hPG, insulin (natural log), and HOMA-IR (natural log) were 1.48 (95 % CI: 1.34–1.64), 1.47 (1.32–1.63), 1.10 (0.91 –1.32), and 1.22 (1.01–1.47), respectively. Prediabetes, defined by either ADA or WHO criteria, was significantly associated with increased CRMM risk. Nonlinear threshold analyses indicated that the risk of CRMM increased significantly above an FPG threshold of 90.92 mg/dL and a 2hPG threshold of 109.92 mg/dL.

Conclusions

Glycemic levels below the ADA-defined prediabetes thresholds for both FPG and 2hPG were associated with higher risks of CRMM, suggesting that glucose ranges below the current cut-offs conceal considerable risk and may warrant earlier preventive action.

目的探讨血糖指标与初始无疾病人群心肾代谢多病（CRMM）发生率的关系。方法采用多变量Cox比例风险模型评估空腹血糖（FPG）、负荷后2小时血糖（2hPG）、血清胰岛素和胰岛素抵抗的稳态模型评估（HOMA-IR）与CRMM事件之间的关系。CRMM事件定义为同时存在≥2例心血管疾病（CVD）（包括冠心病、中风或心血管性死亡）、2型糖尿病（T2DM）、和慢性肾脏疾病（CKD）。结果在15.3年的中位随访期间（IQR: 11.9-16.4），在5734名参与者（3097名女性）中，340名（5.9%）发生CRMM。在发生CRMM的患者中，最常见的合并是CVD和T2DM(49.1%)，其次是CKD和T2DM (19.7%)， CVD和CKD(18.5%)，以及所有三种情况（12.6%）。与FPG、2hPG、胰岛素（自然对数）和HOMA-IR（自然对数）每增加1个标准差（SD）相关的CRMM事件的危险比（hr）分别为1.48 （95% CI: 1.34-1.64）、1.47（1.32-1.63）、1.10（0.91 -1.32）和1.22（1.01-1.47）。根据ADA或WHO标准定义的前驱糖尿病与CRMM风险增加显著相关。非线性阈值分析表明，在FPG阈值90.92 mg/dL和2hPG阈值109.92 mg/dL以上，CRMM的风险显著增加。结论：血糖水平低于ada定义的FPG和2hPG的糖尿病前期阈值与CRMM的高风险相关，表明血糖水平低于当前临界值隐藏了相当大的风险，可能需要早期采取预防措施。

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引用次数: 0