JAMA cardiology最新文献

{"title":"Location of LMNA Variants and Clinical Outcomes in Cardiomyopathy.","authors":"Ashwin Bhaskaran,Rabah Ben Yaou,Adam S Helms,Abdallah Fayssoil,Pascale Richard,Tanya Stojkovic,Frédéric Anselme,Fabien Labombarda,Cathy Chikhaoui,Annachiara De Sandre-Giovannoli,Isabelle Jeru,France Leturcq,Corinne Vigouroux,Mohamed Dembele,Perry Elliott,Konstantinos Savvatis,Katja Zeppenfeld,Hassina Bouguerra,Philippe Charron,Saurabh Kumar,Gisèle Bonne,Karim Wahbi,Neal K Lakdawala","doi":"10.1001/jamacardio.2025.2069","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2069","url":null,"abstract":"ImportancePrior studies have suggested that patients with nonmissense (ie, truncating) variants causing LMNA cardiomyopathy have worse arrhythmic outcomes compared to those with missense variants. However, the effect of the spatial distribution of missense and truncating variants on clinical outcomes remains poorly understood.ObjectiveTo determine the association of the spatial distribution of missense and truncating LMNA variants with cardiac outcomes.Design, Setting, and ParticipantsThis multicenter, retrospective, observational cohort study used data from an international registry (from January 2013 on) and data derived from tertiary cardiomyopathy centers (January 2000 and June 2017). Patients with likely pathogenic/pathogenic LMNA variants and no prior malignant ventricular arrhythmia (VA) were eligible for inclusion. Data analysis was completed from March 2022 to March 2025.Main Outcomes and MeasuresThe primary outcome of time to VA was defined as sudden cardiac death, appropriate implantable cardioverter-defibrillator therapy, or other manifestations of hemodynamically unstable VA. The secondary composite outcome of advanced heart failure was defined as nonsudden cardiac death, implantation of a left ventricular assist device, or cardiac transplant. Outcomes were stratified by type of variant (missense or truncating), affected transcript position (head, rod, or tail), and location on the LMNA gene.ResultsA total of 718 patients were included, among whom mean (SD) age was 41.1 (14.3) years, 381 patients (53.1%) were female, and mean (SD) baseline left ventricular ejection fraction was 55.8% (13.3%). Over a median follow-up of 4.2 years, 223 patients experienced the primary outcome of malignant VA and 109 experienced the secondary outcome of advanced heart failure. Patients with truncating variants had a higher risk of VA (hazard ratio [HR], 1.72; 95% CI, 1.19-2.48; P = .004) but no difference in advanced heart failure (HR, 0.94; 95% CI, 0.64-1.40; P = .77) compared with patients with missense variants. There were no significant differences in the primary and secondary outcomes when stratifying truncating variants by location on the LMNA gene or transcript position. In contrast, on multivariable analysis, missense variants affecting the tail domain of LMNA (HR, 0.35; 95% CI, 0.16-0.78; P = .02) and located in exons 7 through 12 (HR, 0.39; 95% CI, 0.17-0.89; P = .035) were associated with a significantly lower risk of the primary outcome of malignant VA.Conclusions and RelevanceIn this retrospective cohort study, truncating LMNA variants were associated with worse arrhythmic outcomes independent of variant position, whereas missense variants affecting the tail domain and located in exons 7 through 12 had better arrhythmic and heart failure outcomes. Understanding the mechanisms underlying these differences may have future therapeutic implications.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"23 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533344","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":"Supine Blood Pressure and Cardiovascular Risk-Reply.","authors":"Duc M Giao,Stephen P Juraschek","doi":"10.1001/jamacardio.2025.1933","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1933","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"69 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533499","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":"Supine Blood Pressure and Cardiovascular Risk.","authors":"Janis M Nolde,Marcio Galindo Kiuchi,Markus P Schlaich","doi":"10.1001/jamacardio.2025.1930","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1930","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"150 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533501","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":"User Trust in Artificial Intelligence-Guided Lung Ultrasound-Reply.","authors":"Cristiana Baloescu,John Bailitz,Michael Gottlieb","doi":"10.1001/jamacardio.2025.2056","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2056","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"78 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533503","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":"User Trust in Artificial Intelligence-Guided Lung Ultrasound.","authors":"Rohan G Reddy,David A Danford,Shelby Kutty","doi":"10.1001/jamacardio.2025.2053","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.2053","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"33 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533502","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":"Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial.","authors":"Nina Rieckmann, Konrad Neumann, Pál Maurovich-Horvat, Klaus F Kofoed, Theodora Benedek, Maria Bosserdt, Patrick Donnelly, José Rodriguez-Palomares, Andrejs Erglis, Cyril Štechovský, Gintare Šakalyte, Nada Cemerlic Adic, Matthias Gutberlet, Ignacio Diez, Gershan Davis, Elke Zimmermann, Cezary Kepka, Radosav Vidakovic, Marco Francone, Malgorzata Ilnicka-Suckiel, Fabian Plank, Juhani Knuuti, Rita Faria, Stephen Schröder, Colin Berry, Luca Saba, Balazs Ruzsics, Christine Kubiak, Kristian Schultz Hansen, Jacqueline Müller-Nordhorn, Bela Merkely, Andreas D Knudsen, Imre Benedek, Clare Orr, Filipa Xavier Valente, Ligita Zvaigzne, Vojtech Suchánek, Laura Zajanckauskiene, Filip Adic, Michael Woinke, Darragh Waters, Iñigo Lecumberri, Erica Thwaite, Michael Laule, Mariusz Kruk, Aleksandar N Neskovic, Lucia Ilaria Birtolo, Donata Kusmierz, Gudrun Feuchtner, Mikko Pietilä, Vasco Gama Ribeiro, Tanja Drosch, Christian Delles, Gildo Matta, Michael Fisher, Bálint Szilveszter, Linnea Larsen, Mihaela Ratiu, Stephanie Kelly, Bruno Garcia Del Blanco, Zsófia D Drobni, Birgit Jurlander, Susan Regan, Hug Cuéllar Calabria, Melinda Boussoussou, Thomas Engstrøm, Roxana Hodas, Adriane E Napp, Robert Haase, Sarah Feger, Mahmoud M A Mohamed, Henryk Dreger, Matthias Rief, Viktoria Wieske, Melanie Estrella, Florian Michallek, Daniel B Mark, Peter Martus, Jonathan D Dodd, Harold C Sox, Lina M Serna-Higuita, Marc Dewey","doi":"10.1001/jamacardio.2025.0992","DOIUrl":"10.1001/jamacardio.2025.0992","url":null,"abstract":"<p><strong>Importance: </strong>The effect of computed tomography (CT) vs invasive coronary angiography (ICA) on health status outcomes is unknown.</p><p><strong>Objective: </strong>To evaluate CT and ICA first-test strategies on quality of life (QOL) and angina.</p><p><strong>Design, setting, and participants: </strong>The Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial, conducted between October 2015 and April 2019 in 26 European centers, followed up patients with stable chest pain and intermediate probability of coronary artery disease for a median 3.5 years. Data analysis was from December 2023 to July 2024.</p><p><strong>Interventions: </strong>Random assignment to CT or ICA.</p><p><strong>Main outcomes and measures: </strong>Patient-reported Euro QOL 5-dimensions descriptive system (EQ-5D-3L) visual analog scale (EQ-5D-3L-VAS) and 12-item Short Form Health Survey (SF-12) physical component score (SF-12-PCS) were primary prespecified QOL outcomes. Angina was the primary prespecified chest pain outcome. The EQ-5D-3L-VAS, summary index (EQ-5D-3L-SI), mental component summary (SF-12-MCS), and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-A) and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-D) were also evaluated.</p><p><strong>Results: </strong>Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 1735 (96.0%) in the CT group and 1671 (95.3%) in the ICA group completed at least 1 health status assessment during 3.5 years of follow-up. Health status outcomes were similar between groups, with significant improvements in all QOL outcomes (eg, mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = 4.0; 95% CI, 3.1-4.9; P < .001; ICA = 4.6; 95% CI, 3.6-5.6; P =.002), except HADS-D, which improved only in the CT group (mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = -0.2; 95% CI, -0.4 to 0; P = .04; ICA = -0.2; 95% CI, -0.4 to 0; P = .12). Female patients had worse baseline and follow-up QOL than male patients (eg, baseline EQ-5D-3L-VAS difference between men and women = 5.2; 95% CI, 4.0-6.3; P <.001 and at 3.5 years = 3.1; 95% CI, 1.9-4.4; P < .001) but showed greater improvements in EQ-5D-3L-VAS (-1.9; 95% CI, -3.4 to -0.5; P = .009), SF-12-PCS (-1.4; -2.1 to -0.7; P < .001), and HADS-A (0.3; 0-0.7; P = .04). Angina outcomes were comparable between groups at 3.5 years, with similar 1-year rates in the CT group but higher rates in female than male patients in the ICA group (10.2% vs 6.2%; P = .007).</p><p><strong>Conclusions and relevance: </strong>Results of this secondary analysis of the DISCHARGE randomized clinical trial reveal that there was no significant difference in QOL or chest pain outcomes with CT vs ICA at 3.5 years. Female patients had worse health status than male patients at baseline and follow-up, and CT or ICA did not affect these differences.</p><p><strong>Trial registra","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"728-739"},"PeriodicalIF":14.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967139","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":"Mining the Electronic Medical Record for Hypertension Treatment-Hope or Hype?","authors":"Sadiya S Khan","doi":"10.1001/jamacardio.2025.0842","DOIUrl":"10.1001/jamacardio.2025.0842","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"695"},"PeriodicalIF":14.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752788","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":"Prepregnancy Cardiovascular Health, Gestational Diabetes, and Coronary Artery Calcium.","authors":"Natalie A Cameron,Lucia C Petito,Laura A Colangelo,Erica P Gunderson,Janet M Catov,William A Grobman,Jamal S Rana,James G Terry,Donald M Lloyd-Jones,Norrina B Allen,Sadiya S Khan","doi":"10.1001/jamacardio.2025.1887","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1887","url":null,"abstract":"ImportancePoor cardiovascular health (CVH) and gestational diabetes (GD) are each associated with higher risk for cardiovascular disease (CVD). Individuals with poor CVH also have a higher risk of GD, but it remains unclear if GD mediates the association between prepregnancy CVH and CVD.ObjectiveTo examine whether GD is a mediator or marker of the association between prepregnancy CVH and midlife subclinical CVD.Design, Setting, and ParticipantsThis prospective, population-based cohort study was nested within the CARDIA (Coronary Artery Risk Development in Young Adults) study, which included self-identified Black and White women with up to 35 years of follow-up. This study was conducted at 4 US centers among women with at least 1 singleton birth from baseline through 15-year follow-up, available prepregnancy CVH data, available CAC data from 15- to 25-year follow-up, and no prepregnancy diabetes. Data for this study were collected from 1985 to 2010 and analyzed from 2021 to 2024.ExposurePrepregnancy CVH, quantified using the American Heart Association's Life's Simple 7 (score 0-14) and stratified as low or moderate (0-10) and high (11-14) based on a median split.Main Outcomes and MeasuresThe primary outcome was CAC, quantified via computed tomography scans. Odds ratios (ORs) were calculated for GD and incident CAC greater than 0 among people with low or moderate CVH compared with high prepregnancy CVH adjusted for age, race, education, and parity. Causal mediation analyses estimated the proportion of the association between prepregnancy CVH and incident CAC mediated through GD.ResultsOf 1052 included women, mean (SD) age was 28.6 (4.5) years; 501 individuals (47.6%) self-identified as Black, and 551 individuals (52.4%) self-identified as White. Women with lower (worse) compared with high (better) prepregnancy CVH were more likely to have a pregnancy complicated by GD (8.8% vs 6.3%; adjusted OR, 1.8; 95% CI, 1.1-3.0) and were more likely to develop CAC (28.2% vs 19.2%; adjusted OR, 1.7; 95% CI, 1.2-2.5). GD mediated 6% (95% CI, 0%-22%) of the association between prepregnancy CVH and incident CAC.Conclusions and RelevanceIn this cohort study, less favorable prepregnancy CVH was associated with subclinical CVD in midlife, but only a small proportion of this association was mediated through GD. This suggests that GD predominantly represents a marker of prepregnancy CVH and emphasizes the importance of improving CVH early in the life course prior to pregnancy.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"16 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478804","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":"Performance of the American Heart Association's PREVENT Equations Among Disaggregated Racial and Ethnic Subgroups.","authors":"Xiaowei Yan,Adrian M Bacong,Qiwen Huang,Hannah Husby,Ramzi Dudum,Powell Jose,Latha Palaniappan,Fatima Rodriguez","doi":"10.1001/jamacardio.2025.1865","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1865","url":null,"abstract":"ImportanceIn the original validation, the Predicting Risk of Cardiovascular Disease (CVD) Events (PREVENT) equations demonstrated good discrimination and calibration among racial and ethnic groups, but the model performance among Asian and Hispanic disaggregated subgroups has not been previously described.ObjectiveTo assess the performance of the PREVENT equations by race and ethnicity, including disaggregated Asian and Hispanic subgroups.Design, Setting, and ParticipantsThis was an electronic health record-based retrospective cohort study of primary care patients aged 30 to 79 years across Sutter Health, a large integrated health system in Northern California, from January 2010 to September 2023. Patients who had at least 2 primary care visits during the study period were eligible for the study (1 484 582). Those outside of the study age range, with prior CVD events in the washout period, missing key predictors, or having at least 1 predictor out of the allowed normal range for the American Heart Association's PREVENT equations, were excluded, leaving a study population of 361 778.ExposureEligible patients had complete baseline data required for the PREVENT equations, including non-high-density lipoprotein cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, body mass index, estimated glomerular filtration rate (or creatinine), diabetes, and current smoking status, and were free from CVD at baseline.Main Outcomes and MeasuresThe primary outcomes were CVD events, identified using International Classification of Diseases, Ninth and Tenth Revisions, codes described in the PREVENT derivation.ResultsAmong 361 778 patients who met the inclusion criteria, mean (SD) age was 54.6 (12.2) years; 191 151 (53%) were female; and 81 424 (22%) were non-Hispanic Asian and 40 897 (11%) were Hispanic. Over a mean (SD) follow-up of 8.1 (3.2) years, there were 22 648 (6.3%) CVD events. The C statistic for total CVD was 0.83 (95% CI, 0.82-0.84) for the Asian population and 0.80 (95% CI, 0.79-0.81) for the Hispanic population. The calibration slopes were 0.84 (95% CI, 0.78-0.90) and 1.02 (95% CI, 0.94-1.10) for Asian and Hispanic patients, respectively. Within the Asian population, C statistics for total CVD among disaggregated Asian subgroups ranged from 0.79 (95% CI, 0.77-0.81) in Filipino patients to 0.85 (95% CI, 0.83-0.87) in Asian Indian patients. The calibration slope for total CVD was less than 1 for all Asian subgroups except Asian Indian. Among disaggregated Hispanic subgroups, the C statistics were similar and between 0.80 and 0.82 for total CVD, and the calibration slope for total CVD included 1 for all subgroups. There were small differences in the performance of atherosclerotic CVD and heart failure PREVENT equations among racial and ethnic groups and subgroups.Conclusions and RelevanceThe PREVENT equations appropriately predicted risk in contemporary diverse Asian and Hispanic subgroups with modest variation in performance across ","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"69 1 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478802","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":"Preoperative Cardiovascular Risk and Postoperative Outcomes by Renin-Angiotensin System Inhibitor Use: A Secondary Analysis of a Randomized Clinical Trial.","authors":"Justine Tang,Romain Pirracchio,Bernard Cholley,Alexandre Joosten,Julien Birckener,Jeremy Falcone,Hélène Charbonneau,Amélie Delaporte,David Chen,Etienne Gayat,Matthieu Legrand","doi":"10.1001/jamacardio.2025.1920","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.1920","url":null,"abstract":"ImportanceThe STOP-or-NOT randomized clinical trial compared the outcomes of continuing vs discontinuing renin-angiotensin system inhibitors (RASi) prior to major noncardiac surgery and found no difference in the postoperative risk of death or major complications, but it remains unclear whether preoperative cardiovascular risk stratification influences the response to this intervention. This post hoc analysis explores whether preoperative cardiovascular risk stratification affects the outcomes in patients who continue vs discontinue RASi use before major surgery.ObjectiveTo evaluate whether preoperative cardiovascular risk stratification affects the strategy of RASi management before major noncardiac surgery.Design, Setting, and ParticipantsThis is a post hoc analysis of the multicenter STOP-or-NOT randomized clinical trial, conducted across 40 hospitals in France between January 2018 and April 2023, with follow-up for 28 days postoperatively. Data analysis was performed from September 2024 to January 2025. The participants were patients who had been treated with RASi for at least 3 months and were scheduled for major noncardiac surgery.InterventionPatients were randomized to either continue RASi until the day of surgery or to discontinue RASi 48 hours prior to surgery.Main Outcomes and MeasuresThe primary outcome was a composite of all-cause mortality and major postoperative complications. Secondary outcomes were major adverse cardiovascular events and acute kidney injury. Cardiovascular risk stratification was assessed with the Revised Cardiac Risk Index (RCRI), American University of Beirut (AUB)-HAS2 Cardiovascular Risk Index, and systolic blood pressure prior to randomization.ResultsAmong the 2222 patients (median [IQR] age, 68 [61-73] years; 771 [35%] female), 1107 were randomized to RASi continuation and 1115 were randomized to RASi discontinuation. Using the RCRI, 592 patients were categorized as low risk (0 points), 1095 as intermediate-low risk (1 point), 418 as intermediate-high risk (2 points), and 117 as high risk (≥3 points). Using the AUB-HAS2 Cardiac Risk Index, 1049 patients were categorized as low risk (0 points), 727 as intermediate-low risk (1 point), 333 as intermediate-high risk (2 points), and 113 as high risk (≥3 points). A total of 2132 patients were split into 4 quartiles of preoperative systolic blood pressure. The risk of postoperative complications and major adverse cardiovascular events varied with RCRI score. However, a strategy of RASi continuation vs discontinuation was not associated with a higher risk of postoperative complications.ConclusionsThis study found that preoperative cardiovascular risk did not affect patient outcomes with respect to the strategy of continuing vs discontinuing RASi before major noncardiac surgery, suggesting that the decision to continue or discontinue RASi should not be influenced by a patient's preoperative cardiovascular risk assessment.Trial RegistrationClinicalTrials.gov Identifie","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"17 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478803","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}