American journal of preventive cardiology最新文献_第9页

Importance of Life’s Essential 8 in predicting short- and long-term incidence of cardiovascular disease: The atherosclerosis risk in communities study 生命要素8在预测心血管疾病短期和长期发病率中的重要性：社区动脉粥样硬化风险研究

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-01 Epub Date: 2025-10-03 DOI: 10.1016/j.ajpc.2025.101315

Renjie Zou , Zheqi Wen , Chenyin Zhang , Zhuoshan Huang , Xiaodong Zhuang , Zhen Wu

Background

As is acknowledged that there is a strong negative association between Life’s Essential 8 (LE8) and the major adverse cardiovascular events (MACE). However, from the perspective of primary prevention of cardiovascular diseases (CVD), it is more valuable to discover the factors to predict the incidence of CVD. We intend to explore the predictive value of LE8 for the short-term and long-term incidence of CVD in the population without CVD at baseline.

Methods

Participants in the ARIC (Atherosclerosis Risk in Communities) study were studied. Logistic regression models estimated the relationship between LE8 and CVD, including coronary heart disease (CHD), atrial fibrillation (AF) and stroke. Cox proportional hazards regression models were employed to assess whether an increase in the LE8 score could reduce the short-term and long-term incidence of CVD.

Results

Among the 8083 participants studied at V2, 332 (4.1%) were diagnosed with CHD, 98 (1.8%) with stroke, and 24 (0.3%) with AF. LE8 was negatively associated with the prevalence of CHD, stroke, but without statistically significant association with AF. After adjusting for other cardiovascular-related risk factors, LE8 was still negatively associated with stroke (OR:0.959; 95%CI, 0.943-0.976; P<0.001). During the short-term follow-up, for each 1-point increase in the LE8 score, the risks of CHD, stroke, and AF decreased by 6.5%, 5.4%, and 5.1% respectively (the hazard ratio values were 0.935, 0.946, and 0.949). Whether LE8 was used as a continuous variable or a categorical variable, the higher the score, the lower the likelihood of developing CHD at the long-term follow-up. Using the ROC curve, the area under the curve (AUC) of LE8 for predicting the 5-year, 15-year, and 25-year incidence of CHD was 0.77, 0.696, and 0.644, respectively.

Conclusions

A higher LE8 score is consistently associated with a lower probability of the incidence of CHD during both short-term and long-term follow-up periods.

众所周知，生命必需8 （LE8）与主要心血管不良事件（MACE）之间存在强烈的负相关。然而，从心血管疾病一级预防的角度来看，发现预测心血管疾病发病率的因素更有价值。我们打算探讨LE8对基线时无CVD人群的短期和长期CVD发病率的预测价值。方法对社区动脉粥样硬化风险（ARIC）研究的参与者进行研究。Logistic回归模型估计LE8与CVD的关系，包括冠心病（CHD）、心房颤动（AF）和脑卒中。采用Cox比例风险回归模型评估LE8评分的升高是否能降低CVD的短期和长期发病率。结果在V2期研究的8083名参与者中，332名（4.1%）被诊断为冠心病，98名（1.8%）被诊断为卒中，24名（0.3%）被诊断为房颤。LE8与冠心病、卒中的患病率呈负相关，但与房颤的相关性无统计学意义。在校正其他心血管相关危险因素后，LE8仍与卒中呈负相关（OR:0.959; 95%CI: 0.943-0.976; P<0.001）。在短期随访中，LE8评分每升高1分，冠心病、脑卒中、房颤发生风险分别降低6.5%、5.4%、5.1%（风险比值分别为0.935、0.946、0.949）。无论是作为连续变量还是分类变量，在长期随访中，LE8得分越高，发生冠心病的可能性越低。ROC曲线显示，LE8预测5年、15年、25年冠心病发病率的曲线下面积（AUC）分别为0.77、0.696、0.644。结论在短期和长期随访期间，LE8评分越高，冠心病发生率越低。

{"title":"Importance of Life’s Essential 8 in predicting short- and long-term incidence of cardiovascular disease: The atherosclerosis risk in communities study","authors":"Renjie Zou , Zheqi Wen , Chenyin Zhang , Zhuoshan Huang , Xiaodong Zhuang , Zhen Wu","doi":"10.1016/j.ajpc.2025.101315","DOIUrl":"10.1016/j.ajpc.2025.101315","url":null,"abstract":"<div><h3>Background</h3><div>As is acknowledged that there is a strong negative association between Life’s Essential 8 (LE8) and the major adverse cardiovascular events (MACE). However, from the perspective of primary prevention of cardiovascular diseases (CVD), it is more valuable to discover the factors to predict the incidence of CVD. We intend to explore the predictive value of LE8 for the short-term and long-term incidence of CVD in the population without CVD at baseline.</div></div><div><h3>Methods</h3><div>Participants in the ARIC (Atherosclerosis Risk in Communities) study were studied. Logistic regression models estimated the relationship between LE8 and CVD, including coronary heart disease (CHD), atrial fibrillation (AF) and stroke. Cox proportional hazards regression models were employed to assess whether an increase in the LE8 score could reduce the short-term and long-term incidence of CVD.</div></div><div><h3>Results</h3><div>Among the 8083 participants studied at V2, 332 (4.1%) were diagnosed with CHD, 98 (1.8%) with stroke, and 24 (0.3%) with AF. LE8 was negatively associated with the prevalence of CHD, stroke, but without statistically significant association with AF. After adjusting for other cardiovascular-related risk factors, LE8 was still negatively associated with stroke (OR:0.959; 95%CI, 0.943-0.976; P<0.001). During the short-term follow-up, for each 1-point increase in the LE8 score, the risks of CHD, stroke, and AF decreased by 6.5%, 5.4%, and 5.1% respectively (the hazard ratio values were 0.935, 0.946, and 0.949). Whether LE8 was used as a continuous variable or a categorical variable, the higher the score, the lower the likelihood of developing CHD at the long-term follow-up. Using the ROC curve, the area under the curve (AUC) of LE8 for predicting the 5-year, 15-year, and 25-year incidence of CHD was 0.77, 0.696, and 0.644, respectively.</div></div><div><h3>Conclusions</h3><div>A higher LE8 score is consistently associated with a lower probability of the incidence of CHD during both short-term and long-term follow-up periods.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"24 ","pages":"Article 101315"},"PeriodicalIF":5.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268327","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

AJPC family heart summit special issue: guest editor overview / message AJPC家心峰会特刊：特邀编辑概述/留言

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-01 Epub Date: 2025-10-13 DOI: 10.1016/j.ajpc.2025.101331

Laurence S. Sperling , Martha Gulati

引用次数: 0

Efficacy and safety of obicetrapib in patients with dyslipidemia: An updated meta-analysis of randomized controlled trials obicetrapib对血脂异常患者的疗效和安全性：一项随机对照试验的最新荟萃分析

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-01 Epub Date: 2025-09-17 DOI: 10.1016/j.ajpc.2025.101303

Beatriz Araújo , Giang Son Arrighini , Flávia Queiroga , Ensieh Sadat Mansouri , André Rivera , Wellgner Fernandes Oliveira Amador , Ivo Queiroz , Maria Antônia Costa Cruz Akabane , Leo N Consoli , Milene Vitória Sampaio Sobral , Lucas M. Barbosa , Luciana Gioli-Pereira , Erin D. Michos

Introduction

Obicetrapib is a novel cholesteryl ester transfer protein (CETP) inhibitor with promising lipid-lowering effects. While earlier CETP inhibitors have shown inconsistent cardiovascular outcomes and safety concerns, the efficacy and safety of obicetrapib remain under active investigation.

Methods

We systematically searched PubMed, Embase, and Cochrane Central databases for randomized controlled trials (RCTs) comparing obicetrapib versus placebo in adults with dyslipidemia or at high cardiovascular risk. We pooled mean differences (MDs) with 95 % confidence intervals (CI) with a random effects model. We used R software version 4.4.2 for statistical analysis.

Results

We included 7 RCTs comprising 3381 participants, of whom 2151 (63 %) received obicetrapib. The mean age was 64.3 years, and 36 % were women. Compared with placebo, obicetrapib significantly reduced mean LDL-C (MD: -37.21 %; 95 % CI: -41.53 to -32.90; p < 0.01; I²=64 %), lipoprotein(a) (MD: -37.16 %; 95 % CI: -43.63 to -30.70; p < 0.01, I²=48 %), apolipoprotein B (MD: -24.65 %; 95 % CI: -28.71 to -20.59; p < 0.01; I²=83 %), non-HDL-C (MD: -31.90 %; 95 % CI: -34.81 to -28.99; p < 0.01; I²=0 %), and triglyceride levels (MD: -7.21 %; 95 % CI: -11.13 to -3.30; p < 0.01; I²=0 %). Interestingly, obicetrapib also reduced the incidence of new-onset diabetes (RR: 0.88; 95 % CI: 0.80 to 0.97; p = 0.01; I²=0 %). In contrast, obicetrapib significantly increased HDL-C (MD: 142.17 %; 95 % CI: 117.56 to 166.78; p < 0.01; I²=98.3 %), total cholesterol (MD: 11.94 %; 95 % CI: 5.61 to 18.28; p = 0.01; I²=91 %), and apolipoprotein A1 concentrations (MD: 52.76 %; 95 % CI: 41.87 to 63.66; p < 0.01; I²=94 %). There were no significant differences in adverse events.

Conclusion

Among patients with dyslipidemia and/or high cardiovascular risk, obicetrapib significantly reduces LDL-C, lipoprotein(a), apolipoprotein B, and non-HDL-C. No significant differences were observed in adverse events, supporting the favorable safety profile of obicetrapib.

obicetrapib是一种新型的胆固醇酯转移蛋白（CETP）抑制剂，具有良好的降脂效果。虽然早期的CETP抑制剂显示出不一致的心血管结局和安全性问题，但obicetrapib的有效性和安全性仍在积极研究中。方法：我们系统地检索PubMed、Embase和Cochrane Central数据库，以比较obicetrapib和安慰剂在成人血脂异常或心血管高危人群中的疗效的随机对照试验（rct）。我们用随机效应模型汇总了95%置信区间（CI）的平均差异（MDs）。我们使用R软件4.4.2版本进行统计分析。我们纳入了7项随机对照试验，包括3381名受试者，其中2151名（63%）接受了obicetrapib。平均年龄64.3岁，女性占36%。与安慰剂相比,obicetrapib显著降低意味着低密度(MD: -37.21%; 95%置信区间:-41.53 - -32.90;p & lt; 0.01; I2 = 64%)、脂蛋白(a) (MD: -37.16%; 95%置信区间:-43.63 - -30.70;p & lt; 0.01, I2 = 48%)、载脂蛋白B (MD: -24.65%; 95%置信区间:-28.71 - -20.59;p & lt; 0.01;我²= 83%),non-HDL-C (MD: -31.90%; 95%置信区间:-34.81 - -28.99;p & lt; 0.01; I2 = 0%),和甘油三酸酯水平(MD: -7.21%; 95%置信区间:-11.13 - -3.30;p & lt; 0.01; I2 = 0%)。有趣的是，obicetrapib也降低了新发糖尿病的发病率（RR: 0.88; 95% CI: 0.80 ~ 0.97; p = 0.01; I²= 0%）。相反，obicetrapib显著增加HDL-C （MD: 142.17%; 95% CI: 117.56 ~ 166.78; p < 0.01; I2= 98.3%）、总胆固醇（MD: 11.94%; 95% CI: 5.61 ~ 18.28; p = 0.01; I2= 91%）和载脂蛋白A1浓度（MD: 52.76%; 95% CI: 41.87 ~ 63.66; p < 0.01; I²= 94%）。两组不良事件发生率无显著差异。结论在血脂异常和/或心血管高危患者中，obicetrapib可显著降低LDL-C、脂蛋白(a)、载脂蛋白B和非hdl - c。在不良事件方面没有观察到显著差异，支持obictrapib良好的安全性。

{"title":"Efficacy and safety of obicetrapib in patients with dyslipidemia: An updated meta-analysis of randomized controlled trials","authors":"Beatriz Araújo , Giang Son Arrighini , Flávia Queiroga , Ensieh Sadat Mansouri , André Rivera , Wellgner Fernandes Oliveira Amador , Ivo Queiroz , Maria Antônia Costa Cruz Akabane , Leo N Consoli , Milene Vitória Sampaio Sobral , Lucas M. Barbosa , Luciana Gioli-Pereira , Erin D. Michos","doi":"10.1016/j.ajpc.2025.101303","DOIUrl":"10.1016/j.ajpc.2025.101303","url":null,"abstract":"<div><h3>Introduction</h3><div>Obicetrapib is a novel cholesteryl ester transfer protein (CETP) inhibitor with promising lipid-lowering effects. While earlier CETP inhibitors have shown inconsistent cardiovascular outcomes and safety concerns, the efficacy and safety of obicetrapib remain under active investigation.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, and Cochrane Central databases for randomized controlled trials (RCTs) comparing obicetrapib versus placebo in adults with dyslipidemia or at high cardiovascular risk. We pooled mean differences (MDs) with 95 % confidence intervals (CI) with a random effects model. We used R software version 4.4.2 for statistical analysis.</div></div><div><h3>Results</h3><div>We included 7 RCTs comprising 3381 participants, of whom 2151 (63 %) received obicetrapib. The mean age was 64.3 years, and 36 % were women. Compared with placebo, obicetrapib significantly reduced mean LDL-C (MD: -37.21 %; 95 % CI: -41.53 to -32.90; <em>p</em> < 0.01; I<sup>2</sup>=64 %), lipoprotein(a) (MD: -37.16 %; 95 % CI: -43.63 to -30.70; <em>p</em> < 0.01, I<sup>2</sup>=48 %), apolipoprotein B (MD: -24.65 %; 95 % CI: -28.71 to -20.59; <em>p</em> < 0.01; I²=83 %), non-HDL-C (MD: -31.90 %; 95 % CI: -34.81 to -28.99; <em>p</em> < 0.01; I<sup>2</sup>=0 %), and triglyceride levels (MD: -7.21 %; 95 % CI: -11.13 to -3.30; <em>p</em> < 0.01; I<sup>2</sup>=0 %). Interestingly, obicetrapib also reduced the incidence of new-onset diabetes (RR: 0.88; 95 % CI: 0.80 to 0.97; <em>p</em> = 0.01; I²=0 %). In contrast, obicetrapib significantly increased HDL-C (MD: 142.17 %; 95 % CI: 117.56 to 166.78; <em>p</em> < 0.01; I<sup>2</sup>=98.3 %), total cholesterol (MD: 11.94 %; 95 % CI: 5.61 to 18.28; <em>p</em> = 0.01; I<sup>2</sup>=91 %), and apolipoprotein A1 concentrations (MD: 52.76 %; 95 % CI: 41.87 to 63.66; <em>p</em> < 0.01; I²=94 %). There were no significant differences in adverse events.</div></div><div><h3>Conclusion</h3><div>Among patients with dyslipidemia and/or high cardiovascular risk, obicetrapib significantly reduces LDL-C, lipoprotein(a), apolipoprotein B, and non-HDL-C. No significant differences were observed in adverse events, supporting the favorable safety profile of obicetrapib.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"24 ","pages":"Article 101303"},"PeriodicalIF":5.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221564","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

Erectile dysfunction and cardiovascular-kidney-metabolic syndrome: Insights from the all of us research program 勃起功能障碍和心血管-肾脏-代谢综合征：来自我们所有研究项目的见解

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-01 Epub Date: 2025-10-12 DOI: 10.1016/j.ajpc.2025.101332

Cameron M. Blazoski , Zhiqi Yao , Tobias S. Kohler , Martin M. Miner , John Erhabor , Michael J. Blaha

Introduction

Erectile dysfunction (ED) is associated with cardiovascular disease (CVD) risk factors and is a potential indicator for future CVD events, but ED’s association with cardiovascular-kidney-metabolic (CKM) syndrome has not been systematically studied.

Methods

This study used data from the All of Us Research Program covering 2017 to 2023. The primary exposure was prevalence of electronic health record-diagnosed ED with cross-sectional analyses measuring the association between prevalent ED and prevalent CKM conditions. In participants without CKM conditions at baseline, we performed survival analyses to evaluate the association between prevalent ED and the development of future CKM conditions with a follow up period ranging from a median of 2.1–4.0 years.

Results

Of the 97,475 male participants in this study, 5,575 (5.7 %) had a documented baseline ED diagnosis. The highest prevalence by race was white individuals (7.2 %) and by age range was 75–80 (12.7 %). Participants with ED versus those without ED had a higher rate of CKM conditions including diabetes mellitus (T2DM) (19.3 % vs 7.3 %), hypertension (HTN) (47.6 % vs 18.8 %), chronic kidney disease (CKD) (10.3 % vs 2.8 %), heart failure (HF) (5.7 % vs 2.0 %), atherosclerotic cardiovascular disease (ASCVD) (3.0 % vs 1.3 %), and atrial fibrillation (AF) (7.3 % vs 2.5 %). Baseline prevalent ED was associated with higher risks of developing CKM conditions of CKD, HF, AF, ASCVD, and HTN but not the development of T2DM.

Conclusion

A diagnosis of ED was significantly associated with both the prevalence and future development of cardiovascular and metabolic conditions, suggesting that ED assessment should be incorporated into routine cardiometabolic risk evaluation.

勃起功能障碍（ED）与心血管疾病（CVD）危险因素相关，是未来CVD事件的潜在指标，但ED与心血管肾代谢（CKM）综合征的关系尚未系统研究。本研究使用了2017年至2023年“我们所有人研究计划”的数据。主要暴露是电子健康记录诊断的ED的流行，并通过横断面分析测量流行ED与流行CKM状况之间的关联。在基线时无CKM条件的参与者中，我们进行了生存分析，以评估流行ED与未来CKM条件发展之间的关系，随访时间中位数为2.1-4.0年。结果在这项研究的97475名男性参与者中，5575名（5.7%）有记录的ED基线诊断。按种族划分的患病率最高的是白人（7.2%），按年龄划分的患病率最高的是75-80岁（12.7%）。与没有ED的参与者相比，ED患者的CKM疾病发生率更高，包括糖尿病（T2DM）（19.3%对7.3%）、高血压（HTN）（47.6%对18.8%）、慢性肾病（CKD）（10.3%对2.8%）、心力衰竭（HF）（5.7%对2.0%）、动脉粥样硬化性心血管疾病（ASCVD）（3.0%对1.3%）和心房颤动（AF）（7.3%对2.5%）。基线流行ED与发生CKD、HF、AF、ASCVD和HTN等CKM状况的高风险相关，但与发生T2DM无关。结论ED的诊断与心血管和代谢疾病的患病率及未来发展均有显著相关性，提示ED评估应纳入常规心脏代谢风险评估。

{"title":"Erectile dysfunction and cardiovascular-kidney-metabolic syndrome: Insights from the all of us research program","authors":"Cameron M. Blazoski , Zhiqi Yao , Tobias S. Kohler , Martin M. Miner , John Erhabor , Michael J. Blaha","doi":"10.1016/j.ajpc.2025.101332","DOIUrl":"10.1016/j.ajpc.2025.101332","url":null,"abstract":"<div><h3>Introduction</h3><div>Erectile dysfunction (ED) is associated with cardiovascular disease (CVD) risk factors and is a potential indicator for future CVD events, but ED’s association with cardiovascular-kidney-metabolic (CKM) syndrome has not been systematically studied.</div></div><div><h3>Methods</h3><div>This study used data from the <em>All of Us</em> Research Program covering 2017 to 2023. The primary exposure was prevalence of electronic health record-diagnosed ED with cross-sectional analyses measuring the association between prevalent ED and prevalent CKM conditions. In participants without CKM conditions at baseline, we performed survival analyses to evaluate the association between prevalent ED and the development of future CKM conditions with a follow up period ranging from a median of 2.1–4.0 years.</div></div><div><h3>Results</h3><div>Of the 97,475 male participants in this study, 5,575 (5.7 %) had a documented baseline ED diagnosis. The highest prevalence by race was white individuals (7.2 %) and by age range was 75–80 (12.7 %). Participants with ED versus those without ED had a higher rate of CKM conditions including diabetes mellitus (T2DM) (19.3 % vs 7.3 %), hypertension (HTN) (47.6 % vs 18.8 %), chronic kidney disease (CKD) (10.3 % vs 2.8 %), heart failure (HF) (5.7 % vs 2.0 %), atherosclerotic cardiovascular disease (ASCVD) (3.0 % vs 1.3 %), and atrial fibrillation (AF) (7.3 % vs 2.5 %). Baseline prevalent ED was associated with higher risks of developing CKM conditions of CKD, HF, AF, ASCVD, and HTN but not the development of T2DM.</div></div><div><h3>Conclusion</h3><div>A diagnosis of ED was significantly associated with both the prevalence and future development of cardiovascular and metabolic conditions, suggesting that ED assessment should be incorporated into routine cardiometabolic risk evaluation.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"24 ","pages":"Article 101332"},"PeriodicalIF":5.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465798","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

Over-the-counter access to combined oral contraceptives for individuals with hypertension: an expert review 高血压患者非处方获得联合口服避孕药：专家综述

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-01 Epub Date: 2025-10-10 DOI: 10.1016/j.ajpc.2025.101328

Kate Grindlay , Katherine Key , Raegan McDonald-Mosley , Melissa Kottke , Dázon Dixon Diallo , Martha Gulati , Daniel Grossman

Efforts are underway to move a combined oral contraceptive over the counter in the United States. However, hypertension is an important contraindication and questions exist regarding how users should screen for it in an over-the-counter setting. An expert panel convened in April 2022 to review the literature related to hypertension and an over-the-counter switch for combined oral contraceptives and vote on a set of blood pressure screening recommendations for future over-the-counter combined oral contraceptives. Research indicates that people can accurately self-screen for contraindications to combined oral contraceptives using simple checklists, and the absolute risk of adverse events is low among people with hypertension who use combined oral contraceptives and must be balanced against substantially higher risks of pregnancy as well as benefits of increased contraceptive access. Based on these data, the panel concluded that 1) individuals who have not had their blood pressure checked in the last year or do not know their blood pressure should be advised in product labeling to get it checked prior to purchase; 2) blood pressure documentation should not be required to purchase over-the-counter combined oral contraceptives, provided over-the-counter switch behavioral studies demonstrate individuals can correctly self-screen for use; and 3) blood pressure screening should be made more accessible and affordable. Over-the-counter combined oral contraceptives may increase access to the most commonly used reversible contraceptive method. They may also provide an opportunity for enhanced education and awareness of hypertension and preventive cardiovascular screenings among people of reproductive age, particularly young people and people of color.

美国正在努力将一种复方口服避孕药推向非处方。然而，高血压是一个重要的禁忌症，存在关于使用者如何在非处方环境中筛查高血压的问题。一个专家小组于2022年4月召开会议，审查与高血压和非处方联合口服避孕药转换相关的文献，并就未来非处方联合口服避孕药的一套血压筛查建议进行投票。研究表明，人们可以使用简单的检查表准确地自我筛选联合口服避孕药的禁忌症，并且在使用联合口服避孕药的高血压患者中，不良事件的绝对风险很低，必须与怀孕风险大幅增加以及增加获得避孕药具的好处相平衡。根据这些数据，专家组得出结论：1)在过去一年中没有测量过血压的人，或者不知道自己的血压的人，应该在产品标签上被建议在购买前进行测量；2)购买非处方联合口服避孕药不应要求血压记录，前提是非处方切换行为研究表明个体能够正确地自我筛查使用；3)血压筛查应该更容易获得和负担得起。非处方联合口服避孕药可能增加获得最常用的可逆避孕方法的机会。它们还可以为育龄人群，特别是年轻人和有色人种，提供机会，加强对高血压和预防性心血管筛查的教育和认识。

{"title":"Over-the-counter access to combined oral contraceptives for individuals with hypertension: an expert review","authors":"Kate Grindlay , Katherine Key , Raegan McDonald-Mosley , Melissa Kottke , Dázon Dixon Diallo , Martha Gulati , Daniel Grossman","doi":"10.1016/j.ajpc.2025.101328","DOIUrl":"10.1016/j.ajpc.2025.101328","url":null,"abstract":"<div><div>Efforts are underway to move a combined oral contraceptive over the counter in the United States. However, hypertension is an important contraindication and questions exist regarding how users should screen for it in an over-the-counter setting. An expert panel convened in April 2022 to review the literature related to hypertension and an over-the-counter switch for combined oral contraceptives and vote on a set of blood pressure screening recommendations for future over-the-counter combined oral contraceptives. Research indicates that people can accurately self-screen for contraindications to combined oral contraceptives using simple checklists, and the absolute risk of adverse events is low among people with hypertension who use combined oral contraceptives and must be balanced against substantially higher risks of pregnancy as well as benefits of increased contraceptive access. Based on these data, the panel concluded that 1) individuals who have not had their blood pressure checked in the last year or do not know their blood pressure should be advised in product labeling to get it checked prior to purchase; 2) blood pressure documentation should not be required to purchase over-the-counter combined oral contraceptives, provided over-the-counter switch behavioral studies demonstrate individuals can correctly self-screen for use; and 3) blood pressure screening should be made more accessible and affordable. Over-the-counter combined oral contraceptives may increase access to the most commonly used reversible contraceptive method. They may also provide an opportunity for enhanced education and awareness of hypertension and preventive cardiovascular screenings among people of reproductive age, particularly young people and people of color.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"24 ","pages":"Article 101328"},"PeriodicalIF":5.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324905","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 Epub Date: 2025-11-20 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

Cardiovascular disease risk estimates using the new PREVENT Equation: The good, bad, and the ugly 心血管疾病的风险估计使用新的预防方程式：好的，坏的和丑陋的

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-01 Epub Date: 2025-09-11 DOI: 10.1016/j.ajpc.2025.101288

Pooja V. Selvam , Rahul Sharma , Peter Ganz , Roger S. Blumenthal , Martha Gulati

引用次数: 0

Association between proprotein convertase subtilisin/kexin type 9 targeted therapies and the risk of arrhythmias: a meta-analysis of randomized controlled trials 蛋白转化酶枯草杆菌素/kexin 9型靶向治疗与心律失常风险之间的关系：随机对照试验的荟萃分析

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-01 Epub Date: 2025-09-21 DOI: 10.1016/j.ajpc.2025.101311

Vikash Jaiswal , Aman Goyal , Novonil Deb , Nishat Shama , Vivek Mittal , Kripa Rajak , Anupam Halder , Sulochana Khadka , Tushar Kumar , Raheel Ahmed , Ibadete Bytyçi , Maciej Banach , Lipid and Blood Pressure Meta-Analysis Collaboration (LBPMC) Group

Background

Proprotein convertase subtilisin/kexin type 9 (PCSK9) targeted therapies effectively lower low-density lipoprotein cholesterol (LDL-C) and circulating PCSK9 levels. However, their effect on the risk of arrhythmias remains uncertain, and this meta-analysis aims to investigate the association.

Methods

We performed a systematic literature search on all electronic databases for relevant randomized controlled trials (RCTs) from inception until 16th August 2024. Primary clinical endpoint was atrial fibrillation (AFib), while the secondary endpoints were atrial flutter (AFL), ventricular fibrillation (VF), ventricular tachycardia (VT), supraventricular tachycardia (SVT), sudden cardiac death (SCD), cardiac arrest and atrioventricular blocks.

Results

28 RCTs with 95,520 patients were finally included in the analysis. The mean age of the group treated with PCSK9 inhibitors was similar to the control group (60.13 years vs. 60.06 years). At mean follow-up of 1.6 years the PCSK9i group had similar risk of AFib (OR, 0.88; 95 %CI: 0.75–1.03, p = 0.11), AFL (OR, 1.04; 95 %CI: 0.70–1.54, p = 0.84), VT (OR, 0.80; 95 %CI: 0.58–1.11, p = 0.18), VF (OR, 0.77;95 %CI: 0.40–1.47, p = 0.43) and SVT (OR, 0.94; 95 %CI: 0.56–1.58, p = 0.82) compared to control group. Similarly, the SCD (OR, 0.91; 95 %CI: 0.62–1.32, p = 0.61), and AV block (OR, 0.72; 95 %CI: 0.34–1.52, p = 0.39) did not differ between the groups.

Conclusion

This meta-analysis did not find a significant association between PCSK9i and arrhythmias.

背景：蛋白转化酶枯草杆菌素/凯斯蛋白9型（PCSK9）靶向治疗可有效降低低密度脂蛋白胆固醇（LDL-C）和循环PCSK9水平。然而，它们对心律失常风险的影响仍不确定，本荟萃分析旨在调查其相关性。方法系统检索自启动至2024年8月16日所有电子数据库中相关随机对照试验（rct）的文献。主要临床终点为心房颤动（AFib），次要终点为心房扑动（AFL）、心室颤动（VF）、室性心动过速（VT）、室上心动过速（SVT）、心源性猝死（SCD）、心脏骤停和房室传导阻滞。结果共纳入28项随机对照试验，共95,520例患者。PCSK9抑制剂治疗组的平均年龄与对照组相似（60.13岁vs. 60.06岁）。在平均1.6年的随访中，PCSK9i组与对照组相比，AFib （OR, 0.88; 95% CI: 0.75-1.03, p = 0.11）、AFL （OR, 1.04; 95% CI: 0.70-1.54, p = 0.84）、VT （OR, 0.80; 95% CI: 0.58-1.11, p = 0.18）、VF （OR, 0.77; 95% CI: 0.40-1.47, p = 0.43）和SVT （OR, 0.94; 95% CI: 0.56-1.58, p = 0.82）的风险相似。同样，SCD （OR, 0.91; 95% CI: 0.62-1.32, p = 0.61）和AV阻滞（OR, 0.72; 95% CI: 0.34-1.52, p = 0.39）组间无差异。结论本荟萃分析未发现PCSK9i与心律失常之间存在显著关联。

{"title":"Association between proprotein convertase subtilisin/kexin type 9 targeted therapies and the risk of arrhythmias: a meta-analysis of randomized controlled trials","authors":"Vikash Jaiswal , Aman Goyal , Novonil Deb , Nishat Shama , Vivek Mittal , Kripa Rajak , Anupam Halder , Sulochana Khadka , Tushar Kumar , Raheel Ahmed , Ibadete Bytyçi , Maciej Banach , Lipid and Blood Pressure Meta-Analysis Collaboration (LBPMC) Group","doi":"10.1016/j.ajpc.2025.101311","DOIUrl":"10.1016/j.ajpc.2025.101311","url":null,"abstract":"<div><h3>Background</h3><div>Proprotein convertase subtilisin/kexin type 9 (PCSK9) targeted therapies effectively lower low-density lipoprotein cholesterol (LDL-C) and circulating PCSK9 levels. However, their effect on the risk of arrhythmias remains uncertain, and this meta-analysis aims to investigate the association.</div></div><div><h3>Methods</h3><div>We performed a systematic literature search on all electronic databases for relevant randomized controlled trials (RCTs) from inception until 16th August 2024. Primary clinical endpoint was atrial fibrillation (AFib), while the secondary endpoints were atrial flutter (AFL), ventricular fibrillation (VF), ventricular tachycardia (VT), supraventricular tachycardia (SVT), sudden cardiac death (SCD), cardiac arrest and atrioventricular blocks.</div></div><div><h3>Results</h3><div>28 RCTs with 95,520 patients were finally included in the analysis. The mean age of the group treated with PCSK9 inhibitors was similar to the control group (60.13 years vs. 60.06 years). At mean follow-up of 1.6 years the PCSK9i group had similar risk of AFib (OR, 0.88; 95 %CI: 0.75–1.03, <em>p</em> = 0.11), AFL (OR, 1.04; 95 %CI: 0.70–1.54, <em>p</em> = 0.84), VT (OR, 0.80; 95 %CI: 0.58–1.11, <em>p</em> = 0.18), VF (OR, 0.77;95 %CI: 0.40–1.47, <em>p</em> = 0.43) and SVT (OR, 0.94; 95 %CI: 0.56–1.58, <em>p</em> = 0.82) compared to control group. Similarly, the SCD (OR, 0.91; 95 %CI: 0.62–1.32, <em>p</em> = 0.61), and AV block (OR, 0.72; 95 %CI: 0.34–1.52, <em>p</em> = 0.39) did not differ between the groups.</div></div><div><h3>Conclusion</h3><div>This meta-analysis did not find a significant association between PCSK9i and arrhythmias.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"24 ","pages":"Article 101311"},"PeriodicalIF":5.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221727","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 Epub Date: 2025-11-19 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。

{"title":"Nonlinear association between glycemic markers and incident cardio‑renal‑metabolic multimorbidity: two decades of follow‑up in the Tehran Lipid and Glucose Study","authors":"Navid Ebrahimi , Soroush Masrouri , Seyed Saeed Tamehri Zadeh , Maryam Tohidi , Fereidoun Azizi , Farzad Hadaegh","doi":"10.1016/j.ajpc.2025.101353","DOIUrl":"10.1016/j.ajpc.2025.101353","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between glycemic markers and the incidence of cardio-renal-metabolic multimorbidity (CRMM) in initially disease-free individuals.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"24 ","pages":"Article 101353"},"PeriodicalIF":5.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618247","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

Genetic and measured LDL-C: Differential and interactive effects on cardiovascular and stroke subtypes 遗传和测量LDL-C：对心血管和中风亚型的差异和相互作用影响

IF 5.9 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology

Pub Date : 2025-12-01 Epub Date: 2025-10-05 DOI: 10.1016/j.ajpc.2025.101323

Yeun Soo Yang , So Young Kim , Hyungwoo Seo , Sunmi Lee , Keum Ji Jung

Background

Low-density lipoprotein cholesterol (LDL-C), a key contributor to coronary artery disease (CAD), increases mortality. While lowering LDL-C is protective, concerns remain that very low levels may increase hemorrhagic stroke risk. This study explored genetic and environmental determinants of LDL-C to understand these relationships.

Methods

This analysis was conducted using the Korean Cancer Prevention Study-II (KCPS-II) with over 150 thousand participants. Using the microarray results from the KCPS-II biobank, a genome-wide association study (GWAS) was performed to identify genetic variations associated with LDL-C. Environmentally determined LDL-C (ELDL-C) was calculated by subtracting genetically determined LDL-C (GLDL-C) from the measured LDL-C (MLDL-C). MLDL-C, GLDL-C, and ELDL-C levels were divided into quintiles, and their associations with cardiovascular diseases were analyzed. BBJ-GWAS summary statistics were used for external validation.

Results

In the final analysis of 136,263 participants, MLDL-C levels were associated with confounding factors, while GLDL-C was independent of these factors. GLDL-C demonstrated a linear association with ASCVD and IHD risk but no increased risk at lower levels for HS. Additionally, the lowest GLDL-C group did not show elevated HS risk in either the KCPS-II or BBJ-based analysis. Notably, even in high genetic risk groups, the risk of cardiovascular disease was reduced when environmentally determined ELDL-C was low.

Conclusion

This study demonstrates that lower LDL-C levels are linearly associated with a reduced atherosclerotic cardiovascular disease risk. Furthermore, low LDL-C was not a risk factor for hemorrhagic stroke. These findings suggest that individuals with genetically high LDL-C can lower their cardiovascular risk through lifestyle modifications.

背景：低密度脂蛋白胆固醇（LDL-C）是冠状动脉疾病（CAD）的一个关键因素，它会增加死亡率。虽然降低LDL-C具有保护作用，但人们仍然担心，过低的LDL-C水平可能会增加出血性中风的风险。本研究探讨了LDL-C的遗传和环境决定因素，以了解这些关系。方法本分析采用韩国癌症预防研究- ii （KCPS-II）进行，参与者超过15万人。利用KCPS-II生物库的微阵列结果，进行了全基因组关联研究（GWAS），以确定与LDL-C相关的遗传变异。环境决定LDL-C （ELDL-C）是通过从测量的LDL-C （MLDL-C）中减去遗传决定LDL-C （GLDL-C）来计算的。将MLDL-C、GLDL-C和ELDL-C水平分为五分位数，并分析其与心血管疾病的相关性。采用BBJ-GWAS汇总统计进行外部验证。结果在136263名参与者的最终分析中，MLDL-C水平与混杂因素相关，而GLDL-C与这些因素无关。GLDL-C与ASCVD和IHD风险呈线性相关，但在HS低水平时没有增加风险。此外，在KCPS-II或基于bbj的分析中，GLDL-C最低的组均未显示HS风险升高。值得注意的是，即使在高遗传风险群体中，当环境决定的ELDL-C较低时，心血管疾病的风险也会降低。结论：低LDL-C水平与动脉粥样硬化性心血管疾病风险降低呈线性相关。此外，低LDL-C并不是出血性中风的危险因素。这些发现表明，具有高LDL-C基因的个体可以通过改变生活方式来降低心血管风险。

{"title":"Genetic and measured LDL-C: Differential and interactive effects on cardiovascular and stroke subtypes","authors":"Yeun Soo Yang , So Young Kim , Hyungwoo Seo , Sunmi Lee , Keum Ji Jung","doi":"10.1016/j.ajpc.2025.101323","DOIUrl":"10.1016/j.ajpc.2025.101323","url":null,"abstract":"<div><h3>Background</h3><div>Low-density lipoprotein cholesterol (LDL-C), a key contributor to coronary artery disease (CAD), increases mortality. While lowering LDL-C is protective, concerns remain that very low levels may increase hemorrhagic stroke risk. This study explored genetic and environmental determinants of LDL-C to understand these relationships.</div></div><div><h3>Methods</h3><div>This analysis was conducted using the Korean Cancer Prevention Study-II (KCPS-II) with over 150 thousand participants. Using the microarray results from the KCPS-II biobank, a genome-wide association study (GWAS) was performed to identify genetic variations associated with LDL-C. Environmentally determined LDL-C (ELDL-C) was calculated by subtracting genetically determined LDL-C (GLDL-C) from the measured LDL-C (MLDL-C). MLDL-C, GLDL-C, and ELDL-C levels were divided into quintiles, and their associations with cardiovascular diseases were analyzed. BBJ-GWAS summary statistics were used for external validation.</div></div><div><h3>Results</h3><div>In the final analysis of 136,263 participants, MLDL-C levels were associated with confounding factors, while GLDL-C was independent of these factors. GLDL-C demonstrated a linear association with ASCVD and IHD risk but no increased risk at lower levels for HS. Additionally, the lowest GLDL-C group did not show elevated HS risk in either the KCPS-II or BBJ-based analysis. Notably, even in high genetic risk groups, the risk of cardiovascular disease was reduced when environmentally determined ELDL-C was low.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that lower LDL-C levels are linearly associated with a reduced atherosclerotic cardiovascular disease risk. Furthermore, low LDL-C was not a risk factor for hemorrhagic stroke. These findings suggest that individuals with genetically high LDL-C can lower their cardiovascular risk through lifestyle modifications.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"24 ","pages":"Article 101323"},"PeriodicalIF":5.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362936","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