Pub Date : 2024-11-14DOI: 10.1016/j.ajpc.2024.100894
Renee Fogelberg , Kelly C. Young-Wolff , Jaya Nadella , Mehreen Khan , Yi-Fen Irene Chen , Jamal S. Rana
Objective
To describe Kaiser Permanente Northern California's (KPNC) systematic implementation of universal tobacco screening, evidence-based interventions, and performance measures to achieve long-term smoking cessation success.
Methods
We outline seven key components of KPNC's tobacco screening and intervention program that contributed to a significant decline in smoking prevalence. We also report changes in the prevalence of current smokers within KPNC from 2014 to 2023 using linear regression analyses.
Results
Key factors driving the success of the tobacco cessation program included risk-based screening algorithms, alert prompts for at-risk patients, system-wide medical champions, performance tracking, virtual coaching, widespread messaging, and comprehensive medication management. Implementing this multifaceted approach across all facilities was associated with a significant reduction in smoking prevalence, from 8.6% in 2014 to 5.8% in 2023 (p < 0.0001).
Conclusion
Our comprehensive, system-wide approach resulted in substantial public health gains and highlights the potential of similar preventive strategies as healthcare systems transition toward value-based care.
{"title":"300,000 quitters and counting; A systematic approach to tobacco cessation","authors":"Renee Fogelberg , Kelly C. Young-Wolff , Jaya Nadella , Mehreen Khan , Yi-Fen Irene Chen , Jamal S. Rana","doi":"10.1016/j.ajpc.2024.100894","DOIUrl":"10.1016/j.ajpc.2024.100894","url":null,"abstract":"<div><h3>Objective</h3><div>To describe Kaiser Permanente Northern California's (KPNC) systematic implementation of universal tobacco screening, evidence-based interventions, and performance measures to achieve long-term smoking cessation success.</div></div><div><h3>Methods</h3><div>We outline seven key components of KPNC's tobacco screening and intervention program that contributed to a significant decline in smoking prevalence. We also report changes in the prevalence of current smokers within KPNC from 2014 to 2023 using linear regression analyses.</div></div><div><h3>Results</h3><div>Key factors driving the success of the tobacco cessation program included risk-based screening algorithms, alert prompts for at-risk patients, system-wide medical champions, performance tracking, virtual coaching, widespread messaging, and comprehensive medication management. Implementing this multifaceted approach across all facilities was associated with a significant reduction in smoking prevalence, from 8.6% in 2014 to 5.8% in 2023 (p < 0.0001).</div></div><div><h3>Conclusion</h3><div>Our comprehensive, system-wide approach resulted in substantial public health gains and highlights the potential of similar preventive strategies as healthcare systems transition toward value-based care.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100894"},"PeriodicalIF":4.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142702833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-14DOI: 10.1016/j.ajpc.2024.100893
G.J. Jerome , C.L. Lilly
Background: A better understanding of cardiovascular disease (CVD), and cardiovascular health (CVH) among adults with disabilities is needed to address disability related health disparities. Methods: This study analyzed National Health and Nutrition Examination Survey (NHANES) questionnaires, medical examinations, and 24-hour dietary recall data from 2013–2018 for adults age 20–79 years with and without self-reported disability. CVD was dichotomous based on self-report and CVH was assessed using American Heart Association Life's Essential 8 (LE8) comprised of four health behaviors (diet, physical activity, nicotine exposure, and sleep health) and four health factors (body mass index, blood lipids, blood glucose, and blood pressure) with higher scores indicating better CVH. Analyses incorporated the complex multistage NHANES sampling design. Results: The study included 1,300 adults with self-reported CVD and 13,656 adults who were CVD free. Separate weighted logistic regressions for age groups of 20–39, 40–59, and 60–79 years indicated adults with a disability had higher odds of CVD compared to those who were disability free (ORadj (95 %CI) 8.0(4.6–14.1), 5.8(4.3–8.0), 2.5(1.9–3.3) respectively). Among those who were CVD free, CVH was lower for those with a disability compared to those without a disability for the total LE8 score (meanadj(SE) 56.9(0.5) vs. 65.7(0.3), p < .001) and all eight LE8 metrics (p ≤ 0.004). Conclusion: These results are aligned with the call to action to improve health and wellness of persons with disabilities which should include wellness programming for health behaviors such as diet, physical activity, sleep health, and nicotine cessation.
{"title":"Association of cardiovascular disease and cardiovascular health with disability status in a nationally representative sample of US adults","authors":"G.J. Jerome , C.L. Lilly","doi":"10.1016/j.ajpc.2024.100893","DOIUrl":"10.1016/j.ajpc.2024.100893","url":null,"abstract":"<div><div>Background: A better understanding of cardiovascular disease (CVD), and cardiovascular health (CVH) among adults with disabilities is needed to address disability related health disparities. Methods: This study analyzed National Health and Nutrition Examination Survey (NHANES) questionnaires, medical examinations, and 24-hour dietary recall data from 2013–2018 for adults age 20–79 years with and without self-reported disability. CVD was dichotomous based on self-report and CVH was assessed using American Heart Association Life's Essential 8 (LE8) comprised of four health behaviors (diet, physical activity, nicotine exposure, and sleep health) and four health factors (body mass index, blood lipids, blood glucose, and blood pressure) with higher scores indicating better CVH. Analyses incorporated the complex multistage NHANES sampling design. Results: The study included 1,300 adults with self-reported CVD and 13,656 adults who were CVD free. Separate weighted logistic regressions for age groups of 20–39, 40–59, and 60–79 years indicated adults with a disability had higher odds of CVD compared to those who were disability free (OR<sub>adj</sub> (95 %CI) 8.0(4.6–14.1), 5.8(4.3–8.0), 2.5(1.9–3.3) respectively). Among those who were CVD free, CVH was lower for those with a disability compared to those without a disability for the total LE8 score (mean<sub>adj</sub>(SE) 56.9(0.5) vs. 65.7(0.3), <em>p <</em> .001) and all eight LE8 metrics (<em>p ≤</em> 0.004). Conclusion: These results are aligned with the call to action to improve health and wellness of persons with disabilities which should include wellness programming for health behaviors such as diet, physical activity, sleep health, and nicotine cessation.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100893"},"PeriodicalIF":4.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-07DOI: 10.1016/j.ajpc.2024.100890
Shoa L. Clarke , Blake Thomson
Objective
Guidelines for statin therapy emphasize treatment of adults ages 40–75 years, with less guidance for the treatment of younger adults, ages 20–39 years. Only two class 1 recommendations for statin apply to younger adults: 1) secondary prevention and 2) severe hypercholesterolemia (LDL-C ≥ 190 mg/dL). The implementation of guidelines within this age group has not been well studied.
Methods & Results
Here, we use data from the National Health and Nutrition Examination Survey (2013–2020) to estimate statin eligibility and use among US younger adults. Based on this nationally representative sample, we extrapolate that approximately 923,000 younger adults had a history of atherosclerotic cardiovascular disease, but only ∼24 % were on statin. Among younger adults in the primary prevention group, we extrapolate that at least 1.09 million had severe hypercholesterolemia. To expand on this analysis, we calculated untreated LDL-C values for individuals on statin using two methods, and we estimate that only ∼11–20 % of younger adults with severe hypercholesterolemia were on statin. Lastly, among untreated younger adults with a class 1 indication for statin, fewer than 25 % reported that a doctor or healthcare provider had recommended cholesterol medication.
Conclusion
The implementation of class 1 recommendations for statin treatment in younger adults is poor. While efforts to improve risk prediction in the young have recently received significant attention, our results indicate that identifying high risk younger adults is insufficient. We must also improve guideline-recommended treatment in this age group.
{"title":"Guideline recommended statin eligibility and use among U.S. adults ages 20 to 39 years","authors":"Shoa L. Clarke , Blake Thomson","doi":"10.1016/j.ajpc.2024.100890","DOIUrl":"10.1016/j.ajpc.2024.100890","url":null,"abstract":"<div><h3>Objective</h3><div>Guidelines for statin therapy emphasize treatment of adults ages 40–75 years, with less guidance for the treatment of younger adults, ages 20–39 years. Only two class 1 recommendations for statin apply to younger adults: 1) secondary prevention and 2) severe hypercholesterolemia (LDL-C ≥ 190 mg/dL). The implementation of guidelines within this age group has not been well studied.</div></div><div><h3>Methods & Results</h3><div>Here, we use data from the National Health and Nutrition Examination Survey (2013–2020) to estimate statin eligibility and use among US younger adults. Based on this nationally representative sample, we extrapolate that approximately 923,000 younger adults had a history of atherosclerotic cardiovascular disease, but only ∼24 % were on statin. Among younger adults in the primary prevention group, we extrapolate that at least 1.09 million had severe hypercholesterolemia. To expand on this analysis, we calculated untreated LDL-C values for individuals on statin using two methods, and we estimate that only ∼11–20 % of younger adults with severe hypercholesterolemia were on statin. Lastly, among untreated younger adults with a class 1 indication for statin, fewer than 25 % reported that a doctor or healthcare provider had recommended cholesterol medication.</div></div><div><h3>Conclusion</h3><div>The implementation of class 1 recommendations for statin treatment in younger adults is poor. While efforts to improve risk prediction in the young have recently received significant attention, our results indicate that identifying high risk younger adults is insufficient. We must also improve guideline-recommended treatment in this age group.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100890"},"PeriodicalIF":4.3,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142662457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1016/j.ajpc.2024.100885
Pablo Corral , María Gabriela Matta , Carlos Aguilar-Salinas , Roopa Mehta , Gabriela Berg , Massimiliano Ruscica , Laura Schreier
Lipoprotein (a) [Lp(a)] is a lipoprotein with multiple deleterious characteristics and is a recognized cardiovascular (CV) risk factor. The pro-atherogenic, pro-thrombotic, and pro-inflammatory features of Lp(a) are associated not only with atherosclerotic vascular disease but also with aortic valve calcification and all-cause mortality. One of the most interesting aspects of Lp(a) is that its level is determined by genetics in more than 90% of cases, with lifestyle habits having very little influence. Therefore, the recommendation is to test it, at least, once in a lifetime. Contrary to previous beliefs, evidence in recent decades has shown that women have the same or even greater CV risk than men of the same age, attributed to female sex hormones. Different stages of a woman's life can impact on Lp(a) levels, from newborn to menopause, including other critical moments such as menarche and pregnancy. The main objective of this review is to describe and analyze the effect of different specific periods of a woman's life on Lp(a) levels and the potential clinical relevance on their CV risk.
{"title":"Lipoprotein(a) throughout life in women","authors":"Pablo Corral , María Gabriela Matta , Carlos Aguilar-Salinas , Roopa Mehta , Gabriela Berg , Massimiliano Ruscica , Laura Schreier","doi":"10.1016/j.ajpc.2024.100885","DOIUrl":"10.1016/j.ajpc.2024.100885","url":null,"abstract":"<div><div>Lipoprotein (a) [Lp(a)] is a lipoprotein with multiple deleterious characteristics and is a recognized cardiovascular (CV) risk factor. The pro-atherogenic, pro-thrombotic, and pro-inflammatory features of Lp(a) are associated not only with atherosclerotic vascular disease but also with aortic valve calcification and all-cause mortality. One of the most interesting aspects of Lp(a) is that its level is determined by genetics in more than 90% of cases, with lifestyle habits having very little influence. Therefore, the recommendation is to test it, at least, once in a lifetime. Contrary to previous beliefs, evidence in recent decades has shown that women have the same or even greater CV risk than men of the same age, attributed to female sex hormones. Different stages of a woman's life can impact on Lp(a) levels, from newborn to menopause, including other critical moments such as menarche and pregnancy. The main objective of this review is to describe and analyze the effect of different specific periods of a woman's life on Lp(a) levels and the potential clinical relevance on their CV risk.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100885"},"PeriodicalIF":4.3,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142662456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.ajpc.2024.100888
Elizabeth A. Kobe , Aarti Thakkar , Sarina Matai , Esra Akkaya , Neha J. Pagidipati , Robert W. McGarrah , Gerald S. Bloomfield , Nishant P. Shah
Effective antiretroviral therapy (ART) is now nearly ubiquitous. However, the survival benefits conferred with ART contribute to an aging human immunodeficiency virus (HIV) population and increased risk of chronic diseases, like atherosclerotic cardiovascular disease (ASCVD). Furthermore, HIV is a known risk enhancer of ASCVD and acknowledged as such in the current 2018 AHA/ACC Blood Cholesterol guidelines [1]. This makes cardiovascular risk factor identification and modification among people living with HIV (PLWH) of increasing importance to prevent cardiovascular events. In this review, we aim to summarize the epidemiology and pathogenesis of how HIV is linked to atherogenesis and to discuss cardiometabolic risk factor modification specific to PLWH, covering obesity, hypertension, insulin resistance, metabolic dysfunction-associated steatotic liver disease, and dyslipidemia.
{"title":"Optimizing cardiometabolic risk in people living with human immunodeficiency virus: A deep dive into an important risk enhancer","authors":"Elizabeth A. Kobe , Aarti Thakkar , Sarina Matai , Esra Akkaya , Neha J. Pagidipati , Robert W. McGarrah , Gerald S. Bloomfield , Nishant P. Shah","doi":"10.1016/j.ajpc.2024.100888","DOIUrl":"10.1016/j.ajpc.2024.100888","url":null,"abstract":"<div><div>Effective antiretroviral therapy (ART) is now nearly ubiquitous. However, the survival benefits conferred with ART contribute to an aging human immunodeficiency virus (HIV) population and increased risk of chronic diseases, like atherosclerotic cardiovascular disease (ASCVD). Furthermore, HIV is a known risk enhancer of ASCVD and acknowledged as such in the current 2018 AHA/ACC Blood Cholesterol guidelines [1]. This makes cardiovascular risk factor identification and modification among people living with HIV (PLWH) of increasing importance to prevent cardiovascular events. In this review, we aim to summarize the epidemiology and pathogenesis of how HIV is linked to atherogenesis and to discuss cardiometabolic risk factor modification specific to PLWH, covering obesity, hypertension, insulin resistance, metabolic dysfunction-associated steatotic liver disease, and dyslipidemia.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100888"},"PeriodicalIF":4.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess i) the epidemiology of cardiodiabesity, ii) its association with healthcare resource utilization and cost of care, as well as iii) provide recommendations for its management.
Methods
A cohort study of insured adults with early-stage and/or active cardiodiabesity from January 2019 to December 2021 identified through a longitudinal, and de-identified medical and pharmacy claims database was conducted. All patients were followed for one year through December 2022. Conditions include cardiovascular disease, prediabetes, Type 2 diabetes (T2D), chronic kidney disease (CKD), overweight and/or obesity. Rates of progression from early-stage cardiodiabesity to active cardiodiabesity and/or advanced cardiodiabesity with complications; frequency of emergency department, inpatient and outpatient visits; as well as total cost of care over one year were analyzed.
Results
A total of 3,273,813 and 1,628,407 patients had at least one of the comorbid conditions for early-stage and active cardiodiabesity, respectively. Among those with all early-stage cardiodiabesity conditions, 27.4 % progressed to active cardiodiabesity, while 88.4 % of those with all active cardiodiabesity conditions progressed to complications within one year. Predictors of progression from early-stage to active cardiodiabesity were hypertension (OR: 2.31, 95 % CI: 2.29–2.33, p < 0.001), hyperlipidemia (OR: 1.77, 95 % CI: 1.76–1.79, p < 0.001), CKD stages 1 and 2 (OR: 1.74, 95 % CI: 1.69–1.79, p < 0.001), prediabetes (OR: 1.64, 95 % CI: 1.63–1.66, p < 0.001) and living in areas with very high social needs (OR: 1.25, 95 % CI: 1.23–1.26, p < 0.001). Significant predictors of progression from active cardiodiabesity to complications were T2D (OR: 1.88, 95 % CI: 1.81–1.96, p < 0.001), CVD (OR: 1.47, 95 % CI: 1.44–1.51, p < 0.001), CKD stages 3 and 4 (OR: 1.37, 95 % CI: 1.34–1.41, p < 0.001) and obesity (OR: 1.29, 95 % CI: 1.26–1.32, p < 0.001). Average total cost of care increased significantly among those who progressed from one disease phase to the next (p < 0.05).
Conclusions
Cardiodiabesity is deadly and rapidly progressive with substantial economic burden on the healthcare system. However, it is preventable. Innovative approaches to better understand the holistic impact of cardiodiabesity on total cost of care, early intervention or management to halt disease progression and promote equity, as well as decrease resource utilization are needed.
{"title":"Cardiodiabesity: Epidemiology, resource and economic impact","authors":"Duy Do, Tiffany Lee, Calie Santana, Angela Inneh, Urvashi Patel","doi":"10.1016/j.ajpc.2024.100887","DOIUrl":"10.1016/j.ajpc.2024.100887","url":null,"abstract":"<div><h3>Objective</h3><div>To assess i) the epidemiology of cardiodiabesity, ii) its association with healthcare resource utilization and cost of care, as well as iii) provide recommendations for its management.</div></div><div><h3>Methods</h3><div>A cohort study of insured adults with early-stage and/or active cardiodiabesity from January 2019 to December 2021 identified through a longitudinal, and de-identified medical and pharmacy claims database was conducted. All patients were followed for one year through December 2022. Conditions include cardiovascular disease, prediabetes, Type 2 diabetes (T2D), chronic kidney disease (CKD), overweight and/or obesity. Rates of progression from early-stage cardiodiabesity to active cardiodiabesity and/or advanced cardiodiabesity with complications; frequency of emergency department, inpatient and outpatient visits; as well as total cost of care over one year were analyzed.</div></div><div><h3>Results</h3><div>A total of 3,273,813 and 1,628,407 patients had at least one of the comorbid conditions for early-stage and active cardiodiabesity, respectively. Among those with all early-stage cardiodiabesity conditions, 27.4 % progressed to active cardiodiabesity, while 88.4 % of those with all active cardiodiabesity conditions progressed to complications within one year. Predictors of progression from early-stage to active cardiodiabesity were hypertension (OR: 2.31, 95 % CI: 2.29–2.33, <em>p</em> < 0.001), hyperlipidemia (OR: 1.77, 95 % CI: 1.76–1.79, <em>p</em> < 0.001), CKD stages 1 and 2 (OR: 1.74, 95 % CI: 1.69–1.79, <em>p</em> < 0.001), prediabetes (OR: 1.64, 95 % CI: 1.63–1.66, <em>p</em> < 0.001) and living in areas with very high social needs (OR: 1.25, 95 % CI: 1.23–1.26, <em>p</em> < 0.001). Significant predictors of progression from active cardiodiabesity to complications were T2D (OR: 1.88, 95 % CI: 1.81–1.96, <em>p</em> < 0.001), CVD (OR: 1.47, 95 % CI: 1.44–1.51, <em>p</em> < 0.001), CKD stages 3 and 4 (OR: 1.37, 95 % CI: 1.34–1.41, <em>p</em> < 0.001) and obesity (OR: 1.29, 95 % CI: 1.26–1.32, <em>p</em> < 0.001). Average total cost of care increased significantly among those who progressed from one disease phase to the next (p < 0.05).</div></div><div><h3>Conclusions</h3><div>Cardiodiabesity is deadly and rapidly progressive with substantial economic burden on the healthcare system. However, it is preventable. Innovative approaches to better understand the holistic impact of cardiodiabesity on total cost of care, early intervention or management to halt disease progression and promote equity, as well as decrease resource utilization are needed.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100887"},"PeriodicalIF":4.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142662458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.ajpc.2024.100886
Matteo Manzato , Jeffery W. Meeusen , Leslie J. Donato , Allan S. Jaffe , Vlad C. Vasile
Objective
Lipoprotein(a) [Lp(a)] has been associated with Atherosclerotic Cardiovascular Disease (ASCVD). Approximately 20 % of the population has elevated Lp(a). Despite its well-recognized role in ASCVD, universal screening remains controversial. The aim of our study is to investigate laboratory testing patterns for Lp(a) in subjects screened with a standard lipid panel at a large tertiary referring US institution.
Methods
Data were retrospectively collected at Mayo Clinic from the Mayo Data Explorer (MDE). Subjects were included if they had a lipid panel measured between May 1, 2022, and April 30, 2023. Demographic data, Lp(a) measurements, statins and aspirin prescription and ASCVD events which occurred at any time in the life of a subject were recorded along with respective dates. The cumulative number of Lp(a) laboratory test orders were also tallied from 1994 to 2023 independently of the lipid panel requests.
Results
Between May 1, 2022, and April 30, 2023, 257,225 subjects had a lipid panel ordered. Of these, only 386 (0.15 %) had Lp(a) tested within 1 year of the lipid panel, while 2406 (0.94 %) had Lp(a) tested at any time. Lp(a) was tested more frequently in males (67 %) and in subjects who developed Myocardial Infarction (MI) at any time (12 %). Following Lp(a) results, there was no significant change in statin or aspirin prescription associated with Lp(a) levels. Secondary prevention was the main setting for ordering Lp(a) testing, and there was no change in this trend throughout the years.
Conclusions
Testing rates for Lp(a) in the general population are low and the main setting remains secondary prevention. Women are less tested than men. When Lp(a) is found to be elevated, often times there is no change in patient management to mitigate the ASCVD risk.
{"title":"Lipoprotein (a) testing patterns among subjects with a measured lipid panel: The Mayo Clinic experience","authors":"Matteo Manzato , Jeffery W. Meeusen , Leslie J. Donato , Allan S. Jaffe , Vlad C. Vasile","doi":"10.1016/j.ajpc.2024.100886","DOIUrl":"10.1016/j.ajpc.2024.100886","url":null,"abstract":"<div><h3>Objective</h3><div>Lipoprotein(a) [Lp(a)] has been associated with Atherosclerotic Cardiovascular Disease (ASCVD). Approximately 20 % of the population has elevated Lp(a). Despite its well-recognized role in ASCVD, universal screening remains controversial. The aim of our study is to investigate laboratory testing patterns for Lp(a) in subjects screened with a standard lipid panel at a large tertiary referring US institution.</div></div><div><h3>Methods</h3><div>Data were retrospectively collected at Mayo Clinic from the Mayo Data Explorer (MDE). Subjects were included if they had a lipid panel measured between May 1, 2022, and April 30, 2023. Demographic data, Lp(a) measurements, statins and aspirin prescription and ASCVD events which occurred at any time in the life of a subject were recorded along with respective dates. The cumulative number of Lp(a) laboratory test orders were also tallied from 1994 to 2023 independently of the lipid panel requests.</div></div><div><h3>Results</h3><div>Between May 1, 2022, and April 30, 2023, 257,225 subjects had a lipid panel ordered. Of these, only 386 (0.15 %) had Lp(a) tested within 1 year of the lipid panel, while 2406 (0.94 %) had Lp(a) tested at any time. Lp(a) was tested more frequently in males (67 %) and in subjects who developed Myocardial Infarction (MI) at any time (12 %). Following Lp(a) results, there was no significant change in statin or aspirin prescription associated with Lp(a) levels. Secondary prevention was the main setting for ordering Lp(a) testing, and there was no change in this trend throughout the years.</div></div><div><h3>Conclusions</h3><div>Testing rates for Lp(a) in the general population are low and the main setting remains secondary prevention. Women are less tested than men. When Lp(a) is found to be elevated, often times there is no change in patient management to mitigate the ASCVD risk.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100886"},"PeriodicalIF":4.3,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-12DOI: 10.1016/j.ajpc.2024.100869
Shih-Ming Chuang , Sung-Chen Liu , Ming-Nan Chien , Chun-Chuan Lee , Yuan-Teh Lee , Kuo-Liong Chien
Cardiovascular diseases (CVD) remain a leading cause of global mortality, with atherosclerosis and inflammation playing pivotal roles in their development. The neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-HDL cholesterol ratio (NHR) have emerged as potential biomarkers for assessing CVD risk. In this community-based cohort study conducted in Taiwan, involving 3278 participants, we investigated the associations between NHR, NLR, and the risks of CVD and all-cause mortality. Our findings revealed that both NHR and NLR were effective in identifying individuals at high risk for CVD. However, when assessing their joint effect, NHR alone demonstrated a stronger predictive value for CVD prognosis than NLR or the combination of both markers. Furthermore, NLR alone showed potential as a predictor of all-cause mortality when compared with NHR alone or in combination with NLR and NHR. These findings underscore the complex interplay between inflammation and lipid metabolism in the pathogenesis of CVD. While NHR shows promise as a cost-effective tool for CVD risk assessment, NLR emerges potential as a prognostic marker for mortality. Further research is warranted to explore the dynamic changes in these markers and their implications for clinical practice.
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Pub Date : 2024-10-10DOI: 10.1016/j.ajpc.2024.100884
Pashupati P. Mishra , Binisha H. Mishra , Leo-Pekka Lyytikäinen , Sirkka Goebeler , Mika Martiskainen , Emma Hakamaa , Marcus E. Kleber , Graciela E. Delgado , Winfried März , Mika Kähönen , Pekka J. Karhunen , Terho Lehtimäki
Aim
The modest added predictive value of the existing genetic risk scores (GRSs) for coronary artery disease (CAD) could be partly due to missing genetic components, hidden in the genetic architecture of intermediate phenotypes such as coronary artery calcification (CAC). In this study, we investigated the predictive ability of CAC GRS for CAD.
Materials and methods
We investigated the association of CAC GRSs with CAD and coronary calcification among the participants in the Ludwigshafen Risk and Cardiovascular Health study (LURIC) (n = 2742), the Tampere Vascular Study (TVS) (n = 133), and the Tampere Sudden Death Study (TSDS) (n = 660) using summary data from the largest multi-ancestry GWAS meta-analysis of CAC to date. Added predictive value of the CAC GRS over the traditional CVD risk factors as well as metaGRS, a GRS for CAD constructed with 1.7 million genetic variants, was tested with standard train–test machine learning approach using the LURIC data, which had the largest sample size.
Results
CAC GRS was significantly associated with CAD in LURIC (OR=1.41, 95 % CI [1.28–1.55]), TVS (OR=1.79, 95 % CI [1.05–3.21]) as well as in TSDS (OR=4.20, 95 % CI [1.74–10.52]). CAC GRS showed strong association with calcification areas in left (OR=1.78, 95 % CI [1.16–2.74]) and right (OR=1.71, 95 % CI [1.98–2.67]) coronary arteries. There was statistically significant added predictive value of the CAC GRS for CAD over the used traditional CVD risk factors (AUC 0.734 vs 0.717, p-value = 0.02). Furthermore, CAC GRS improved the prediction accuracy for CAD when combined with metaGRS.
Conclusions
This study showed that CAC GRS is a new risk marker for CAD in three European cohorts, with added predictive value over the traditional CVD risk factors.
目的现有遗传风险评分（GRSs）对冠状动脉疾病（CAD）的预测价值不高，部分原因可能是隐藏在冠状动脉钙化（CAC）等中间表型的遗传结构中的遗传成分缺失。在这项研究中，我们调查了 CAC GRS 对 CAD 的预测能力。材料与方法我们利用迄今为止最大的 CAC 多宗族 GWAS meta 分析的汇总数据，调查了路德维希港风险与心血管健康研究（LURIC）（n = 2742）、坦佩雷血管研究（TVS）（n = 133）和坦佩雷猝死研究（TSDS）（n = 660）参与者的 CAC GRS 与 CAD 和冠状动脉钙化的关联。利用样本量最大的 LURIC 数据，采用标准的训练-测试机器学习方法，测试了 CAC GRS 相对于传统心血管疾病风险因素以及元 GRS（用 170 万个基因变异构建的 CAD GRS）的预测价值。结果在 LURIC（OR=1.41，95 % CI [1.28-1.55]）、TVS（OR=1.79，95 % CI [1.05-3.21]）和 TSDS（OR=4.20，95 % CI [1.74-10.52]）中，CAC GRS 与 CAD 显著相关。CAC GRS 显示与左冠状动脉（OR=1.78，95 % CI [1.16-2.74]）和右冠状动脉（OR=1.71，95 % CI [1.98-2.67]）的钙化面积密切相关。与使用的传统心血管疾病风险因素相比，CAC GRS 对 CAD 的预测值有明显的统计学意义（AUC 0.734 vs 0.717，p 值 = 0.02）。结论这项研究表明，在三个欧洲队列中，CAC GRS 是一种新的心血管疾病风险标志物，与传统的心血管疾病风险因素相比，具有更高的预测价值。
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