American journal of preventive cardiology最新文献

{"title":"EDIBLE OIL T2 PROFILES PROVIDE INSIGHTS INTO HUMAN ADIPOSE TISSUE FLUIDITY","authors":"Shayan E. Pourjavaheri BS","doi":"10.1016/j.ajpc.2024.100812","DOIUrl":"10.1016/j.ajpc.2024.100812","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Novel Biomarkers</div></div><div><h3>Background</h3><div>Dietary fatty acid profiles have been linked to cardiovascular risk. The fatty acid profile of human adipose tissue (AT) mirrors dietary intake and hepatic de novo lipogenesis. In turn, lipogenesis is amplified by insulin resistance, another risk factor for cardiovascular disease. Thus, AT fluidity is a potential biomarker of cardiometabolic health and disease risk. To assess the fluidity and fatty acid composition of human AT non-invasively, our laboratory developed a patented device that measures the transverse relaxation times (T₂) of the human fingertip. <strong>Hypothesis</strong>: Biologically relevant edible oils of varying fatty acid composition show a linear association between T₂ and triacylglycerol (TAG) fluidity.</div></div><div><h3>Methods</h3><div>Lipid ¹H T₂ relaxation decay curves for edible oil samples were recorded at 37°C using a 0.47T Bruker mq20 benchtop magnetic resonance relaxometer operating at 20 MHz. The decay curves were deconvoluted into 3-component T₂ profiles using a discrete inverse Laplace transform (XPFit, Alango Ltd.). Macroscopic fluidity (1/viscosity) was measured at 37°C using a ViscoLab 5000 viscometer.</div></div><div><h3>Results</h3><div>Each T₂ profile contained 3 peaks assigned to distinct mobility domains within each TAG molecule. For Peak 1, the mean T₂ values in msec increased with cis-double content: 275.3 (olive oil, high oleic acid), 373.2 (safflower oil, high linoleic), 388.0 (cod liver oil, mixed composition), 459.7 (flaxseed oil, high alpha-linolenic), 488.6 (fish oil 2, moderate eicosapentaenoic, EPA, and docosahexaenoic, DHA) and 691.5 (fish oil 3, high EPA and DHA). Across this series of edible oils, the T₂ values were linearly associated with fluidity (R²= 0.83) and the average number of cis-double bonds per TAG molecule (R²= 0.95), p&lt;0.001 (Figure 1). Similar linear associations were observed for Peaks 2 and 3.</div></div><div><h3>Conclusions</h3><div>The fluidity and cis-double bond content of biologically relevant TAGs can be monitored non-invasively using benchtop magnetic resonance. These results provide a framework for interpreting non-invasive adipose tissue T₂ measurements in the living human finger.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100812"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422917","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}

{"title":"INITIATING PATIENTS ON GLP-1/COMBINED GLP-1 AND GIP AGONISTS: A QUALITY IMPROVEMENT PROJECT","authors":"Shreya Srivastava MD, MPH","doi":"10.1016/j.ajpc.2024.100813","DOIUrl":"10.1016/j.ajpc.2024.100813","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Diabetes</div></div><div><h3>Background</h3><div>Both glucagon-like-peptide-1 (GLP-1) and combined GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonist medications have shown efficacy on weight loss, diabetes mellitus, and some with cardiovascular mortality benefits as seen with Semaglutide in the SELECT trial. However, these medications are prescribed at low rates despite the large number of patients who medically qualify.</div></div><div><h3>Methods</h3><div>Patients who met criteria for prescription of GLP-1 and GLP-1/GIP agonist medications based on qualifying body mass index (BMI) and comorbid conditions were identified at the resident clinic of the Northwell Health Medical Subspecialities Clinic. A random sample of 500 of these patients underwent intervention. Chart review was performed to identify patients not presently prescribed the medication, and providers were notified via secure message. One year after pilot intervention, data was extracted from the electronic medical record regarding medication use, insurance, BMI, demographic factors, comorbid conditions, and laboratory values. Multivariate logistic regression analysis was conducted with adjustment for the above listed covariates.</div></div><div><h3>Results</h3><div>Of the 500 randomly sampled patients, 43 were excluded due to missing key data. Of the remaining 457 patients, 32% were initiated on GLP-1 or GLP-1/GIP agonist medications (Table 1). Regression analyses revealed that patients with BMI greater than 35 had 2.79 and 5.88 larger odds, respectively, compared to those with BMI 30-35 and 27-30, of being started on the medication (95% CI 1.62 – 4.80, 3.04 – 11.38). Additionally, patients on metformin had 2.6 times greater odds of being started on the medication (95% CI 1.61 – 4.33). For every 1% increase in Hemoglobin A1c there was a 1.79 times greater odds of prescription (95% CI 1.45-2.19).</div></div><div><h3>Conclusions</h3><div>Our study demonstrates that there is a significant proportion of patients with BMI less than 35 who qualify and may benefit from the use GLP-1 or GLP-1/GIP agonist medications. Providers should be aware of under-prescribing in this population in addition to those who have well-controlled diabetes.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100813"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422918","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}

{"title":"HEARTFELT DECISIONS: DEVELOPMENT OF PATIENT DECISION AIDS FOR AN ACADEMIC PREVENTIVE CARDIOLOGY CLINIC","authors":"Justin Joy PharmD, BCCP","doi":"10.1016/j.ajpc.2024.100802","DOIUrl":"10.1016/j.ajpc.2024.100802","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research</div></div><div><h3>Background</h3><div>The AHA scientific statement on shared decision making (SDM) recommends tools such as patient decision aids (PtDA) to support patients in their cardiovascular decisions. PtDAs can be used for patients indicated for additional therapy including PCSK9 inhibitors (PCSK9i). Collaboration between our health-system specialty pharmacy and the preventive cardiology clinic allows for the integration of cost-related information and patient comprehension of risk/benefit analysis into the PtDA while also utilizing the skills of a Clinical Pharmacy Specialist.</div></div><div><h3>Methods</h3><div>A focus group of pharmacists and cardiologists convened over several meetings to define the scope and target audience of the PtDA, overall design, and information for inclusion. A preliminary needs assessment was conducted via a survey distributed to multidisciplinary team members of physicians, nurses, and clinical pharmacists. Future steps will involve semi-structured interviews to gather patient feedback and implementing a pilot test with patients already established on PCSK9i therapy. We will evaluate the impact of PtDA through knowledge transfer questions, SURE (Sure of myself, Understand information, Risk-benefit ratio, and Encouragement) questions, and how various elements of the PtDA contributed to patients’ decision-making process.</div></div><div><h3>Results</h3><div>Feedback from the cardiologist focus group and multidisciplinary survey highlighted the need for decision aids in this treatment decision and generated suggestions for the format and delivery of the PtDA. As part of the initial prototypes, we have included evidence-based estimates on the benefits of PCSK9i, the degree of risk reduction, side effects, and medication costs (Figure). Cost is expressed as patient's copay at the health-system specialty pharmacy both before and after financial assistance has been applied, where applicable. Three Likert Scale questions have been included to help clarify each patients’ values and preferences. Alternative therapeutic options discussed include ezetimibe, bempedoic acid, and/or re-challenging a statin with patients with statin associated side effects.</div></div><div><h3>Conclusions</h3><div>Through collaborative efforts, we've developed an initial PtDA prototype to facilitate SDM for patients considering PCSK9i.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100802"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422968","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}

{"title":"EMPOWERING BUFFALO: IMPROVING HYPERTENSION THROUGH FREE BLOOD PRESSURE MONITOR LOANING AND SHARED DECISION-MAKING","authors":"Mingma Sherpa DO","doi":"10.1016/j.ajpc.2024.100819","DOIUrl":"10.1016/j.ajpc.2024.100819","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Therapeutic Area&lt;/h3&gt;&lt;div&gt;Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Hypertension is a serious health concern that can lead to heart disease and other complications. Despite the availability of proven methods for managing hypertension, recent data shows that blood pressure (BP) control in the US is declining. This highlights a gap between expert recommendations and real-world practice. To address this issue, our initiative focuses on serving underserved communities, specifically those the Hertel Elmwood Clinic serves. By loaning out blood pressure cuffs ( through AHA grants) and utilizing self-measured blood pressure monitoring, we aim to manage hypertension remotely. This approach has significant implications for empowering patients, improving outcomes, promoting continuity of care, and building resilience within care communities that cater to vulnerable populations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A cohort of 83 individuals diagnosed with hypertension were equipped with BP monitors to track their blood pressure. Patient charts were examined to gather demographic data and office BP readings for 1-3 months pre- and post-monitor distribution. Furthermore, a phone survey with 24 questions was administered to a subset of patients to assess their engagement and satisfaction levels. Responses were measured using a Likert scale and binary answers. The results were analyzed using descriptive statistics and paired t-tests.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;After conducting a thorough analysis of the data chart, the participants who received a blood pressure cuff and shared decision-making witnessed a remarkable reduction in their systolic BP by 11.7 mm Hg (P&lt;0.05, 5.15 to 7.54) and diastolic BP by 4.25 mm Hg (P&lt;0.05, 3.88 to 4.93). The participants comprised 66% females, with an average participant age of 61. The race distribution was 70% African American, 20% Caucasian, and 10% unreported. Most participants (90%) reported feeling empowered in their healthcare and other benefits.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In conclusion, the data presented in this study provides compelling evidence that delivering free BP monitors or BP machines covered by insurance to clinic patients is a highly effective strategy for improving health outcomes and patient engagement. The results demonstrate that removing cost barriers can significantly impact in-office BP reduction, BP monitoring, and patient satisfaction. This program benefits patients and healthcare providers by improving patient engagement and overall satisfaction. The success of this initiative highlights the importance of exploring and implementing novel approaches to healthcare that prioritize patient-centered care and address the financial and logistical barriers that can hinder effective hypertension management. Further research is needed to confirm the generalizability of these findings","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100819"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422706","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}

{"title":"TRIGLYCERIDE-TO-HIGH-DENSITY-LIPOPROTEIN RATIO HAS LIMITED DIAGNOSTIC ACCURACY FOR DETECTING EARLY INSULIN RESISTANCE","authors":"Caleb Park BSA","doi":"10.1016/j.ajpc.2024.100764","DOIUrl":"10.1016/j.ajpc.2024.100764","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Diabetes</div></div><div><h3>Background</h3><div>Type 2 diabetes mellitus (T2DM) and its complications pose a significant global health challenge, affecting 537 million individuals worldwide. Early identification of insulin resistance (IR) is crucial for managing the risk and preventing T2DM. Existing literature supports the use of the triglyceride-to-high-density lipoprotein ratio (TG/HDL) as a practical marker of IR and a component of metabolic syndrome (MetS). However, the compensatory hyperinsulinemia that precedes MetS and prediabetes may suppress this ratio and mask hidden IR. Hypothesis: For individuals with early metabolic imbalance (EMI), TG/HDL lacks the diagnostic power to detect compensated insulin resistance.</div></div><div><h3>Methods</h3><div>Leveraging data from the 2015-2018 U.S. National Health &amp; Nutrition Examination Survey, we assigned each study participant to one of four groups: (1) healthy balanced metabolism, (2) EMI (includes early IR), (3) prediabetes and/or dyslipidemia and (4) T2DM and/or cardiovascular disease (CVD). The homeostatic model assessment of insulin resistance v.2 (HOMA2-IR) was the reference standard, with the median of groups 1 and 2 serving as the cut point. Population-weighted receiver operating characteristic (ROC) curves were used to assess predictive accuracy, measured by area-under-the-curve (AUC) with the 95% confidence interval (CI).</div></div><div><h3>Results</h3><div>ROC analysis 1 included all 4 groups: AUC=0.720 (95% CI: 0.701, 0.739). Analysis 2 included only groups 1-3: AUC=0.704 (95% CI: 0.683, 0.726). Analysis 3 included only groups 1 and 2: AUC=0.663 (95% CI: 0.621, 0.704).</div></div><div><h3>Conclusions</h3><div>This study highlights the limited diagnostic accuracy of TG/HDL ratio as a marker of insulin resistance for individuals with early metabolic imbalance. This condition includes compensated insulin resistance in the absence of prediabetes, MetS, T2DM and CVD. More effective markers are needed to screen for EMI, a hidden risk factor for T2DM and CVD.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100764"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422729","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}

{"title":"UTILIZATION OF PET/CT IN BREAST CANCER PATIENTS FOR SCREENING OF CARDIOVASCULAR DISEASE USING INCIDENTAL CORONARY CALCIUM: A SINGLE CENTER EXPERIENCE","authors":"Carlos Vergara-Sanchez MD","doi":"10.1016/j.ajpc.2024.100737","DOIUrl":"10.1016/j.ajpc.2024.100737","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>Breast cancer has been associated with increased cardiovascular events and mortality. Strategies to improve primary prevention in this population are needed. PET/CT is an opportunity to have an initial screening for presence of atherosclerosis.</div></div><div><h3>Methods</h3><div>We collected data from one institution from 2009-2021 of female patients with a first time diagnosis of breast cancer, undergoing PET/CT for cancer staging. We reviewed the primary images looking for presence or absence of coronary calcium and the scoped the official reports to assess if coronary calcium was reported. We registered variables including age, race, arterial age, hypertension, BMI, reporting of calcium score by radiologist, use of statin, LDL. Dichotomous variables are expressed in frequencies and percentage. For continuous variables we used mean and standard deviation.</div></div><div><h3>Results</h3><div>A total of 276 patients were identified. Mean age is 55 years old. Coronary calcium was present in 68 patients(24%). In those patients, the finding was mentioned for 5 patients(7.35%) in the radiologic report, mean LDL was 114 mg/dl, mean arterial age was 68 years old. Within the patients with coronary calcium, 27 patients had a calcium score &gt;100 A, the highest calcium score was 3,747.9 A, only 12 patients from this subset were in lipid lowering therapy. 208 patients did not have coronary calcification, absence of coronary calcifications was mentioned in only 10 patients; mean LDL was 105 mg/dL.</div></div><div><h3>Conclusions</h3><div>There is an under-reporting of coronary calcium burden in patients undergoing PET/CT for cancer staging which represents a missed opportunity for stronger primary prevention strategies in this population of patients with higher cardiovascular risk. Awareness of incidental findings of coronary atherosclerosis has the potential of improving cardiovascular outcomes.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100737"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422742","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}

{"title":"OBICETRAPIB TARGETS ALL ATHEROGENIC LIPOPROTEINS BEYOND LDL-C","authors":"Michael Davidson MD","doi":"10.1016/j.ajpc.2024.100752","DOIUrl":"10.1016/j.ajpc.2024.100752","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Kidney Disease</div></div><div><h3>Background</h3><div>Despite reductions in low-density lipoprotein cholesterol (LDL-C) with statin and non-statin lipid-lowering therapies, a large proportion of cardiovascular disease (CVD) risk remains. An investigation of 8 large CV outcome trials with statins demonstrated, on average, a relative risk reduction of 25%, leaving the majority of risk unaddressed. Residual risk is due in part to lipid components beyond LDL-C, such as LDL particle (-P) concentration, small dense (sd)LDL-C, and lipoprotein(a) [Lp(a)]. Obicetrapib is a cholesteryl ester transfer protein inhibitor under investigation for reducing atherogenic lipoproteins and CVD events.</div></div><div><h3>Methods</h3><div>ROSE1 (n=120) and ROSE2 (n=119) were phase II trials of obicetrapib on top of high-intensity statins for 8 or 12 weeks and TA-8995-203 (n=102) was a phase II trial of obicetrapib on top of atorvastatin 10/20 mg or rosuvastatin 5/10 mg for 8 weeks in Japanese participants. All trials enrolled men and women without CVD who had LDL-C &gt;70 mg/dL; all included a treatment arm of obicetrapib 10 mg monotherapy. Additionally, ROSE2 combined obicetrapib 10 mg with ezetimibe 10 mg. A complete lipid profile and apolipoprotein (Apo) B were measured in all trials. Additionally, Lp(a) was measured in ROSE1 and ROSE2, and sdLDL-C and nuclear magnetic resonance-assessed lipoprotein subfractions were analyzed in ROSE2.</div></div><div><h3>Results</h3><div>In addition to significantly lowering LDL-C by up to 50.8%, Apo B by up to 29.8%, and non-HDL-C by up to 44.4%, in ROSE2 obicetrapib 10 mg monotherapy compared to placebo significantly decreased total LDL-P, small LDL-P, and sdLDL-C by 54.8%, 92.7%, and 30.9%, respectively. A pooled analysis of Lp(a) demonstrated a placebo-corrected reduction of 57.1%. Obicetrapib plus ezetimibe also significantly reduced total LDL-P (-72.1%), small LDL-P (-95.4%), and sdLDL-C (-44.4%), beyond its significant effects on LDL-C (-63.4%), non-HDL-C (-55.6%), and Apo B (-34.4%). Obicetrapib had an adverse event profile similar to placebo, and it was nearly completely eliminated from circulation within 4 weeks after dosing.</div></div><div><h3>Conclusions</h3><div>By reducing atherogenic lipoproteins beyond LDL-C, obicetrapib monotherapy on top of statins and in combination with ezetimibe represents a promising therapy to address residual lipoprotein-related risk for CVD on top of currently available LDL-C-lowering therapies.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100752"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422751","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}

{"title":"PROGNOSTIC VALUE OF LIPOPROTEIN(A) FOR MAJOR ADVERSE CARDIOVASCULAR EVENTS IN RELATION TO C-REACTIVE PROTEIN - A SYSTEMATIC REVIEW AND META-ANALYSIS","authors":"Pamela L. Alebna MD, MPH","doi":"10.1016/j.ajpc.2024.100783","DOIUrl":"10.1016/j.ajpc.2024.100783","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Existing evidence supports an increased risk of Major Adverse Cardiovascular Events (MACE) with elevated lipoprotein(a) (Lp(a)) regardless of high sensitivity C-reactive protein (hs-CRP) levels. However, some studies have presented divergent results between primary and secondary prevention populations. A meta-analysis could yield a more definitive estimation of the joint influence of these biomarkers on MACE risk.</div></div><div><h3>Methods</h3><div>We performed a systematic review of studies evaluating the risk of MACE with elevated Lp(a) and hs-CRP (PROSPERO CRD4202345109). The primary outcome was the pooled hazard ratio (HR) of the association between Lp(a) and MACE among individuals with low (&lt;2mg/L) and high (≥2 mg/L) hs-CRP levels. We performed a subgroup analysis in primary and secondary prevention populations. A random effects model was used given the wide heterogeneity in studies.</div></div><div><h3>Results</h3><div>A total of seven studies were identified in the systematic review and included in the meta-analysis. The overall pooled sample comprised 558,914 individuals. The mean proportion of females was 37% and the weighted mean age for the entire cohort was 58.9 years. In individuals with elevated Lp(a), the risk of MACE was significantly increased across both low and high hs-CRP groups, with pooled hazard ratios (HR) of 1.24 (95% CI: 1.10–1.41) and 1.33 (95% CI: 1.19–1.49), respectively. In the primary prevention population, the pooled HR for low and high hs-CRP groups was 1.33 (95% CI: 1.06–1.66) and 1.43 (95% CI: 1.13–1.82), respectively, with a nonsignificant subgroup difference (P=0.65). The corresponding HR for the secondary prevention population was 1.10 (95% CI: 1.03–1.18) and 1.31 (95% CI: 1.09–1.57), respectively, with a non-significant subgroup difference (P=0.34) (Figure).</div></div><div><h3>Conclusions</h3><div>Our analysis confirms that elevated Lp(a) significantly elevates MACE risk across varying hs-CRP levels, underlining its relevance in both primary and secondary prevention cohorts.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100783"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422821","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}

{"title":"GAINING POUNDS AND APPETITE: STATIN'S DOUBLE-EDGED EFFECT ON PRIMARY PREVENTION","authors":"Alyssa Zaidi MD","doi":"10.1016/j.ajpc.2024.100749","DOIUrl":"10.1016/j.ajpc.2024.100749","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Case Presentation</h3><div>A 66-year-old female with hyperlipidemia was referred to cardiology due to a family history of coronary artery disease (CAD). Prior to her initial visit, she had a total cholesterol (TC) 264 mg/dL, triglycerides (TG) 89 mg/dL, high-density lipoprotein (HDL) 76mg/dL, and low-density lipoprotein (LDL) 173 mg/dL; her lipoprotein (a) was 314.4 nmol/L. She had undergone Commuted Tomography (CT) Coronary Artery Calcium Score (CACS) testing and had an Agatston calcium score of 5.6 (57th percentile). Her weight was 66 kg with a BMI of 25.7 kg/m2. She was initiated on pravastatin 20 mg and her LDL improved to 70 mg/dL, however she began to note weight gain. She was switched to rosuvastatin 20 mg and noted a profound lack of satiety, with a further 4kg total weight gain since statin initiation seven months prior, while her LDL improved to 44 mg/dL. She was switched to evolocumab, and her lack of satiety improved immediately. She lost 3 kg within three months of stopping her statin.</div></div><div><h3>Background</h3><div>Dyslipidemia is a primary risk factor for atherosclerotic cardiovascular disease, and a target of preventative cardiology. Prior studies have shown that statin users may adopt a less heart-healthy diet while on a statin, due to a belief of being protected from bad outcomes, ultimately resulting in more weight gain. However, even in those making favorable lifestyle choices, statins may be a hindrance to their goals of weight loss though a leptin-mediated impairment of satiety.</div></div><div><h3>Conclusions</h3><div>Anecdotal evidence has demonstrated weight gain as a frequent side effect of statin use. This case illustrates a clear temporal relationship between statin use and weight gain, primarily mediated by a lack of satiety. While statins may address one element of primary prevention, in some patients, they may contribute to another, and alternative agents should be used. Further studies are needed to better understand the mechanism behind this effect.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100749"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422826","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}

{"title":"A 5-YEAR TREND OF NON-ALCOHOLIC LIVER CIRRHOSIS AND CARDIOGENIC SHOCK IN HEART FAILURE PATIENTS","authors":"Jamal Perry MD","doi":"10.1016/j.ajpc.2024.100814","DOIUrl":"10.1016/j.ajpc.2024.100814","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Heart Failure</div></div><div><h3>Background</h3><div>In heart failure (HF) patients, the intersection of non-alcoholic liver cirrhosis (NALC) and cardiogenic shock poses significant clinical challenges. Understanding the trends of these complications is essential for improving patient outcomes. This study examines the trend of NALC and its progression to cardiogenic shock among HF patients over a five-year period.</div></div><div><h3>Methods</h3><div>Data from the National Inpatient Sample (2016-2020) were analyzed to identify HF patients with NALC using ICD-10 codes. Trends were assessed using the Cochran-Armitage test for trend analysis and multivariable logistic regression to adjust for confounding factors. The year 2016 was the reference year for comparing data trends up to 2020. Outcomes are presented as odds ratios (ORs) with 95% confidence intervals (CIs) and p-values.</div></div><div><h3>Results</h3><div>Out of 1,372,419 HF patients, 26,435 (1.9%) had NALC, with 1,180 (4.5%) experiencing cardiogenic shock with a mean age of 65 and predominantly male 59.3%. The rate of NALC among HF patients was 1.7% in 2016. By 2017, it increased to 2.0% (OR 1.2, 95% CI 1.20–1.31, p&lt;0.001), 2.2% in 2018 (OR 1.3, 95% CI 1.17–1.42, p&lt;0.001), 2.4% in 2019 (OR 1.5, 95% CI 1.31–1.60, p&lt;0.001), and 2.7% in 2020 (OR 1.6, 95% CI 1.47–1.79, p&lt;0.001), indicating an upward trend (trend p&lt;0.001). Cardiogenic shock rates in patients with NALC were 3.53% in 2016, increasing to 4.32% in 2017 (OR 1.2, 95% CI 0.83–1.83, p=0.3) compared to 3.1% in patients without NALC, 4.73% in 2018 (OR 1.3, 95% CI 0.85–2.1, p=0.2) compared to 4.5%, 6.93% in 2019 (OR 1.5, 95% CI 1.37–3.02, p&lt;0.001) compared to 5.6%, and 6.60% in 2020 (OR 1.6, 95% CI 1.25–2.88, p=0.003) compared to 6.4%, showing an increase trend (trend p&lt;0.001). Overall, Cardiogenic shock OR was 1.5 (95% CI 1.31–1.70, p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>The study highlights the increasing trend of NALC and a concurrent increase in the rate of cardiogenic shock among patients with HF. This underscores the importance of vigilant monitoring and targeted intervention in effectively managing the HF population.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100814"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422829","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}