JAMA cardiology最新文献

{"title":"Trajectory of Cardiovascular Health Across Childhood and Adolescence","authors":"Izzuddin M. Aris, Sheryl L. Rifas-Shiman, Wei Perng, Li Yi, Sarah D. de Ferranti, Marie-France Hivert, Emily Oken","doi":"10.1001/jamacardio.2024.4022","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.4022","url":null,"abstract":"ImportanceThe American Heart Association put forth the Life’s Essential 8 construct to assess cardiovascular health (CVH) based on 8 behavioral and health factors. Few studies have characterized the natural history of CVH in early life or identified its sociodemographic determinants.ObjectiveTo characterize CVH trajectories across childhood and adolescence and identify associations with sociodemographic variables.Design, Setting, and ParticipantsThis study used data from the Project Viva prebirth cohort, an ongoing prospective prebirth cohort study conducted in a large multispecialty group practice in eastern Massachusetts among women who were pregnant and enrolled from April 1999 to November 2002. Participant inclusion required 3 or more CVH metrics in early childhood (median [range] age, 3.2 [2.8-6.2] years) or 4 metrics or more in midchildhood (median [range] age, 7.7 [6.6-10.9] years), early adolescence (median [range] age, 13.0 [11.9-16.6] years), or late adolescence (median [range] age, 17.5 [15.4-20.1] years). Of 2218 live births in the original cohort, 1523 were included in the present analysis. Data were analyzed from June to December 2023.ExposuresChild sex, race, and ethnicity; maternal education; and household income.Main Outcomes and MeasuresCVH score (0-100 points) from early childhood to late adolescence, calculated as the unweighted average of all available CVH metrics at each life stage.ResultsAmong 1523 children, 782 (51.4%) were male; 53 (3.5%) were non-Hispanic Asian, 231 (15.2%) were non-Hispanic Black, 988 (65.0%) were non-Hispanic White, and 175 (11.5%) were non-Hispanic other. The mean (SD) CVH score was 82.6 (8.6) in early childhood, 84.1 (8.3) in midchildhood, 82.0 (9.8) in early adolescence, and 73.8 (11.5) in late adolescence. The estimated mean (SD) age of inflection when CVH score declined was 10.1 (0.7) years for male children and 10.0 (0.6) years for female children; the decline in CVH was associated with health behaviors rather than health factors. Male children (vs female children) had faster CVH score gain before the inflection (β, 0.79 points/year; 95% CI, 0.67 to 0.91) and faster CVH score decline after the inflection (β, −0.33 points/year; 95% CI, −0.44 to −0.22). Non-Hispanic Black children (β, 0.32 years; 95% CI, 0.20 to 0.43) and children of other non-Hispanic races (β, 0.16 years; 95% CI, 0.05 to 0.28) children had later timing of inflection compared with non-Hispanic White children. Children of mothers without (vs with) a college degree or with household income $70 000 per year or less (vs greater than $70 000/year) exhibited lower CVH trajectory throughout childhood. Children of mothers with some college education (vs a college degree) had later timing of inflection (β, 0.16 years; 95% CI, 0.07 to 0.26) and slower CVH score gain before the inflection (β, −0.24 points/year; 95% CI, −0.40 to −0.08).ConclusionsThis study provides insight into the trajectory of CVH early in life, which may contribute to CVH","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"24 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potassium Nitrate in Heart Failure With Preserved Ejection Fraction","authors":"Payman Zamani, Sanjiv J. Shah, Jordana B. Cohen, Manyun Zhao, Wei Yang, Jessica L. Afable, Maria Caturla, Hannah Maynard, Bianca Pourmussa, Cassandra Demastus, Ipsita Mohanty, Michelle Menon Miyake, Srinath Adusumalli, Kenneth B. Margulies, Stuart B. Prenner, David C. Poole, Neil Wilson, Ravinder Reddy, Raymond R. Townsend, Harry Ischiropoulos, Thomas P. Cappola, Julio A. Chirinos","doi":"10.1001/jamacardio.2024.4417","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.4417","url":null,"abstract":"ImportanceNitric oxide deficiency may contribute to exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF). Prior pilot studies have shown improvements in exercise tolerance with single-dose and short-term inorganic nitrate administration.ObjectiveTo assess the impact of chronic inorganic nitrate administration on exercise tolerance in a larger trial of participants with HFpEF.Design, Setting, and ParticipantsThis multicenter randomized double-blinded crossover trial was conducted at the University of Pennsylvania, the Philadelphia Veterans Affairs Medical Center, and Northwestern University between October 2016 and July 2022. Participants included patients with symptomatic (New York Heart Association class II/III) HFpEF who had objective signs of elevated left ventricular filling pressures. Image quantification, physiological data modeling and biochemical measurements, unblinding, and statistical analyses were completed in 2024.InterventionPotassium nitrate (KNO<jats:sub>3</jats:sub>) (6 mmol 3 times daily) vs equimolar doses of potassium chloride (KCl) for 6 weeks, each with a 1-week washout in between.MAIN OUTCOMES AND MEASURESThe coprimary end points included peak oxygen uptake and total work performed during a maximal effort incremental cardiopulmonary exercise test. Secondary end points included the exercise systemic vasodilatory reserve (ie, reduction in systemic vascular resistance with exercise) and quality of life assessed using the Kansas City Cardiomyopathy Questionnaire.ResultsEighty-four participants were enrolled. Median age was 68 years and 58 participants were women (69.0%). Most participants had NYHA class II disease (69%) with a mean 6-minute walk distance of 335.5 (SD, 97.3) m. Seventy-seven participants received the KNO<jats:sub>3</jats:sub> intervention and 74 received the KCl intervention. KNO<jats:sub>3</jats:sub> increased trough levels of serum nitric oxide metabolites after 6 weeks (KNO<jats:sub>3</jats:sub>, 418.4 [SD, 26.9] uM vs KCl, 40.1 [SD, 28.3] uM; <jats:italic>P</jats:italic> &amp;amp;lt; .001). KNO<jats:sub>3</jats:sub> did not improve peak oxygen uptake (KNO<jats:sub>3</jats:sub>, 10.23 [SD, 0.43] mL/min/kg vs KCl, 10.17 [SD, 0.43] mL/min/kg; <jats:italic>P</jats:italic> = .73) or total work performed (KNO<jats:sub>3</jats:sub>, 25.9 [SD, 3.65] kilojoules vs KCl, 23.63 [SD, 3.63] kilojoules; <jats:italic>P</jats:italic> = .29). KNO<jats:sub>3</jats:sub> nitrate did not improve the vasodilatory reserve or quality of life, though it was well-tolerated.Conclusions and RelevanceIn this study, potassium nitrate did not improve aerobic capacity, total work, or quality of life in participants with HFpEF.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT02840799\">NCT02840799</jats:ext-link>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"52 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chest Pain in a Middle-Aged Man","authors":"Qinghua Chang, Zhaolong Xu, Renguang Liu","doi":"10.1001/jamacardio.2024.4440","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.4440","url":null,"abstract":"A man in his mid-50s presented with chest pain lasting 30 minutes. The initial electrocardiogram showed type A preexcitation syndrome, with obvious ST-segment depression in leads V3 through V5 and positive delta wave. What would you do next?","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"24 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142841878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing Declines in Cardiovascular Health From Childhood: Never Too Early for Heart Health.","authors":"Natalie A Cameron, Norrina B Allen","doi":"10.1001/jamacardio.2024.4019","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.4019","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pitavastatin, Procollagen Pathways, and Plaque Stabilization in Patients With HIV: A Secondary Analysis of the REPRIEVE Randomized Clinical Trial.","authors":"Márton Kolossváry, Samuel R Schnittman, Markella V Zanni, Kathleen V Fitch, Carl J Fichtenbaum, Judith A Aberg, Gerald S Bloomfield, Carlos D Malvestutto, Judith Currier, Marissa R Diggs, Christopher deFilippi, Allison Ross Eckard, Adrian Curran, Murat Centinbas, Ruslan Sadreyev, Borek Foldyna, Thomas Mayrhofer, Julia Karady, Jana Taron, Sara McCallum, Michael T Lu, Heather J Ribaudo, Pamela S Douglas, Steven K Grinspoon","doi":"10.1001/jamacardio.2024.4115","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.4115","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;In a mechanistic substudy of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) randomized clinical trial, pitavastatin reduced noncalcified plaque (NCP) volume, but specific protein and gene pathways contributing to changes in coronary plaque remain unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To use targeted discovery proteomics and transcriptomics approaches to interrogate biological pathways beyond low-density lipoprotein cholesterol (LDL-C), relating statin outcomes to reduce NCP volume and promote plaque stabilization among people with HIV (PWH).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a post hoc analysis of the double-blind, placebo-controlled, REPRIEVE randomized clinical trial. Participants underwent coronary computed tomography angiography (CTA), plasma protein analysis, and transcriptomic analysis at baseline and 2-year follow-up. The trial enrolled PWH from April 2015 to February 2018 at 31 US research sites. PWH without known cardiovascular diseases taking antiretroviral therapy and with low to moderate 10-year cardiovascular risk were eligible. Data analyses were conducted from October 2023 to February 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Oral pitavastatin calcium, 4 mg per day.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Relative change in plasma proteomics, transcriptomics, and noncalcified plaque volume among those receiving treatment vs placebo.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 558 individuals (mean [SD] age, 51 [6] years; 455 male [82%]) included in the proteomics assessment, 272 (48.7%) received pitavastatin and 286 (51.3%) received placebo. After adjusting for false discovery rates, pitavastatin increased abundance of procollagen C-endopeptidase enhancer 1 (PCOLCE), neuropilin 1 (NRP-1), major histocompatibility complex class I polypeptide-related sequence A (MIC-A) and B (MIC-B), and decreased abundance of tissue factor pathway inhibitor (TFPI), tumor necrosis factor ligand superfamily member 10 (TRAIL), angiopoietin-related protein 3 (ANGPTL3), and mannose-binding protein C (MBL2). Among these proteins, the association of pitavastatin with PCOLCE (a rate-limiting enzyme of collagen deposition) was greatest, with an effect size of 24.3% (95% CI, 18.0%-30.8%; P &lt; .001). In a transcriptomic analysis, individual collagen genes and collagen gene sets showed increased expression. Among the 195 individuals with plaque at baseline (88 [45.1%] taking pitavastatin, 107 [54.9%] taking placebo), changes in NCP volume were most strongly associated with changes in PCOLCE (%change NCP volume/log2-fold change = -31.9%; 95% CI, -42.9% to -18.7%; P &lt; .001), independent of changes in LDL-C level. Increases in PCOLCE related most strongly to change in the fibro-fatty (&lt;130 Hounsfield units) component of NCP (%change fibro-fatty volume/log2-fold change = -38.5%; 95% CI, -58.1% to -9.7%; P = .01) with a directionally opposite, although nonsignificant, incre","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiotensin Receptor-Neprilysin Inhibitor Prescribing Patterns in Patients Hospitalized for Heart Failure.","authors":"Pratyaksh K Srivastava, Alexandra M Klomhaus, Stephen J Greene, Paul Heidenreich, Sabra C Lewsey, Clyde W Yancy, Gregg C Fonarow","doi":"10.1001/jamacardio.2024.3815","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.3815","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Angiotensin receptor-neprilysin inhibition (ARNI) improves mortality among patients with heart failure with reduced ejection fraction (HFrEF), ie, those with an EF of 40% or less.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe national longitudinal trends in ARNI prescribing patterns among hospitalized patients with HFrEF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Using data from the Get With The Guidelines-Heart Failure (GWTG-HF) registry, hospitalized patients with HFrEF at 614 participating hospitals were identified. Rates of ARNI, angiotensin converting enzyme inhibitor (ACEI), and angiotensin II receptor blocker (ARB) prescription at discharge were evaluated across 3 time periods. Adjusted logistic regression and piecewise logistic regression were used to evaluate the impact of publication dates on ARNI prescription rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;ARNI prescribing patterns in hospitalized patients with HFrEF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Rates of ARNI, ACEI, and ARB prescription at discharge were evaluated across 3 time periods as follows: (1) period 1 included the US Food and Drug Administration (FDA) approval of sacubitril-valsartan to the day before the PIONEER-HF (Comparison of Sacubitril-Valsartan vs Enalapril on Effect on N-Terminal Pro-Brain Natriuretic Peptide in Patients Stabilized From an Acute Heart Failure Episode) trial publication (July 7, 2015-November 10, 2018); (2) period 2 included the day of the PIONEER-HF trial publication to the day before publication of the 2021 Update to the 2017 Consensus for Optimization of Heart Failure Treatment (November 11, 2018-January 10, 2021); and (3) period 3 included the day of the 2021 update publication to the last available data at the time of analysis (January 11, 2021-December 31, 2022).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 114 333 hospitalized patients (mean [IQR] age, 67.0 [57.0-78.0] years; 74 765 male [65.4%]) were included in this study. Rates of ARNI prescribed at discharge increased from 1.1% (27 of 2451) during July 7, 2015, to September 30, 2015, to 55.4% (1957 of 3536) during October 1, 2022, to December 31, 2022. ACEI or ARB prescription at discharge fell from 88.3% (2612 of 2957) to 45.9% (2033 of 4434) over the same period, whereas ACEI, ARB, or ARNI prescription increased from 71.1% (2639 of 3713) to 84.7% (3990 of 4711). In adjusted logistic regression models, compared with period 1, patients discharged during period 2 and period 3 were found to have a 3.81-fold (95% CI, 3.65-3.98) and 9.15-fold (95% CI, 8.79-9.52) increased odds of ARNI prescription at discharge, and a 0.46 (95% CI, 0.45-0.48) and 0.25 (95% CI, 0.24-0.26) decreased odds of ACEI or ARB prescription at discharge.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Results of this cross-sectional study reveal that in the 7 years after FDA drug approval of sacubitril-valsartan, rates of ARNI or ACEI, ARB, or ARNI prescription ","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Vitro, but Not Yet In Vivo.","authors":"Victoria R Bradford","doi":"10.1001/jamacardio.2024.4363","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.4363","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspirin for Secondary Prevention of Atherosclerosis-Evidence or Dogma?","authors":"John G F Cleland","doi":"10.1001/jamacardio.2024.4335","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.4335","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transthyretin Tetramer Destabilization and Increased Mortality in the General Population.","authors":"Mette Christoffersen, Anders Møller Greve, Louise Stig Hornstrup, Ruth Frikke-Schmidt, Børge Grønne Nordestgaard, Anne Tybjærg-Hansen","doi":"10.1001/jamacardio.2024.4102","DOIUrl":"10.1001/jamacardio.2024.4102","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Transthyretin tetramer destabilization is the rate-limiting step in the development of transthyretin cardiac amyloidosis, an underrecognized contributor to mortality in older adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To test the hypothesis that transthyretin tetramer destabilization is associated with all-cause and cardiovascular mortality in the general population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this cohort study including individuals aged 20 to 80 years, genetic data were analyzed from 2 similar prospective studies of the Danish general population, the Copenhagen City Heart Study (CCHS) and the Copenhagen General Population Study (CGPS). Observational data from a subsample of the same studies where transthyretin was measured consecutively were also analyzed. In both studies, individuals were followed up from the examination date (1991-1994 in CCHS and 2003-2015 in CGPS) until death or the end of follow-up in December 2018. Data were analyzed from November 1, 2023, to August 15, 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Missense variants in TTR associated with increasing transthyretin tetramer destabilization in primary genetic analyses, and plasma transthyretin level in secondary observational analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;All-cause and cardiovascular mortality identified from the national Danish Civil Registration System and the national Danish Register of Causes of Death.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 102 204 individuals (median [IQR] age, 57 [47-66] years; 56 445 [55%] female) were included. Median follow-up was 10 years (range, &lt;1-27 years). In genetic analyses, p.T139M, a transthyretin tetramer stabilizing variant that is more stable than noncarriers' tetramer stability, was used as the reference. For noncarriers who have intermediate tetramer stability and for heterozygotes for amyloidogenic variants (p.V142I, p.H110N, and p.D119N) who have the lowest tetramer stability, respective hazard ratios (HRs) were 1.37 (95% CI, 1.06-1.77) and 1.65 (95% CI, 0.95-2.88) for all-cause mortality (P for trend = .01), and 1.63 (95% CI, 0.92-2.89) and 2.23 (95% CI, 0.78-6.34) for cardiovascular mortality (P for trend = .06). Furthermore, compared with p.T139M, plasma transthyretin decreased stepwise by TTR genotype: -18% for noncarriers and -29% for heterozygotes for amyloidogenic variants (p.V142I, p.H110N, p.D119N; P for trend &lt; .001). Therefore, genetically determined, increasingly lower plasma transthyretin could be considered a surrogate marker for transthyretin tetramer destabilization. Observationally, among 19 619 individuals, noncarriers with plasma transthyretin concentrations less than 20 mg/dL vs 20 to 40 mg/dL had HRs of 1.12 (95% CI, 1.02-1.23) for all-cause mortality and 1.16 (95% CI, 0.97-1.39) for cardiovascular mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Transthyretin tetramer destabilization was associated with all-c","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Figure.","authors":"","doi":"10.1001/jamacardio.2024.4925","DOIUrl":"10.1001/jamacardio.2024.4925","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}