JAMA cardiology最新文献

{"title":"Novel Controlled Metabolic Accelerator for Obesity-Related HFpEF","authors":"Ambarish Pandey, Gregory D. Lewis, Barry A. Borlaug, Sanjiv J. Shah, Andrew J. Sauer, Sheldon Litwin, Kavita Sharma, Diane K. Jorkasky, Elizabeth A. Tarka, Shaharyar M. Khan, Dalane W. Kitzman","doi":"10.1001/jamacardio.2025.0103","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0103","url":null,"abstract":"ImportanceExcess body fat plays a pivotal role in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). HU6 is a novel, controlled metabolic accelerator that enhances mitochondrial uncoupling resulting in increased metabolism and fat-specific weight loss.ObjectiveTo assess efficacy and safety of HU6 in reducing body weight, improving peak volume of oxygen consumption (VO<jats:sub>2</jats:sub>) and body composition among patients with obesity-related HFpEF.Design, Setting, and ParticipantsThe Exploratory Phase 2A, Double-Blind, Placebo-Controlled Dose Escalation Study of Safety, Tolerability, Pharmacodynamics, and Pharmacokinetics of HU6 for Subjects With Obese HFpEF (HuMAIN-HFpEF) trial was a multicenter, dose-escalation randomized clinical trial among patients with chronic stable HFpEF and obesity. Data were analyzed from July to October 2024.InterventionHU6 treatment for 19 weeks, starting at 150 mg per day and potentially up titrated to 450 mg per day based on safety and tolerability vs placebo.Main Outcomes and MeasuresThe primary end point was change in body weight.ResultsOf 66 participants randomized (mean [SD] age, 64.5 [12] years; 38 female [58%]; mean [SD] weight, 110.9 [22.4] kg), 56 completed the trial. HU6 (vs placebo) significantly decreased weight (between-group difference, −2.86 kg; 95% CI, −4.68 to −1.04 kg; <jats:italic>P</jats:italic> = .003), total fat mass (between-group difference, −2.96 kg; 95% CI, −4.50 to −1.42 kg; <jats:italic>P</jats:italic> &amp;amp;lt; .001), and percentage visceral fat (between-group difference,−1.3%; 95% CI, −2.1 to −0.5%; <jats:italic>P</jats:italic> = .003), with no significant loss of muscle mass. There were no statistically significant changes in peak VO<jats:sub>2</jats:sub>, 6-minute walk distance, Kansas City Cardiomyopathy Questionnaire score, high-sensitivity C-reactive protein level, N-terminal pro–brain natriuretic peptide level, or diastolic function. Serious adverse events were noted in 5 participants (4 in the HU6 group; 1 in the placebo group), including 1 death, all judged unrelated to treatment.Conclusions and RelevanceAmong patients with obesity-related HFpEF, treatment with HU6 for 19 weeks led to modest but statistically significant weight loss without significant changes in peak VO<jats:sub>2</jats:sub>. Larger trials of longer duration are warranted to determine whether longer-term administration of HU6 can improve exercise function, quality of life, and cardiovascular outcomes in this increasingly common disorder.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/NCT05284617\">NCT05284617</jats:ext-link>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"23 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599610","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":"Food Insecurity and Incident Cardiovascular Disease Among Black and White US Individuals, 2000-2020","authors":"Jenny Jia, Mercedes R. Carnethon, Mandy Wong, Cora E. Lewis, Pamela J. Schreiner, Namratha R. Kandula","doi":"10.1001/jamacardio.2025.0109","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0109","url":null,"abstract":"ImportanceFood insecurity is associated with prevalent cardiovascular disease (CVD), but studies have been limited to cross-sectional data.ObjectivesTo study whether food insecurity is associated with incident CVD and to determine whether this association varies by sex, education, or race.Design, Setting, and ParticipantsThis prospective cohort study was conducted among US adults without preexisting CVD participating in the CARDIA (Coronary Artery Risk Development in Young Adults) study from 2000 to August 31, 2020. Data analysis was conducted from December 2022 to April 2024.ExposureFood insecurity, defined as endorsing limitations in household food variety and/or food quantity, assessed in the period 2000-2001.Main Outcomes and MeasuresThe primary outcome was CVD events, consisting of fatal and nonfatal coronary heart disease, heart failure, stroke, transient ischemic attack, or peripheral arterial disease, identified annually through August 31, 2020.ResultsOf 3616 total participating adults, mean (SD) age was 40.1 (3.6) years, and 2027 participants (56%) were female. Of 3616 participants, 1696 (47%) self-reported Black race and 529 participants (15%) had food insecurity at baseline. Individuals with food insecurity were more likely to self-identify as Black and report lower educational attainment. The mean (SD) follow-up period was 18.8 (3.4) years, during which 255 CVD events occurred: 57 events (11%) in food-insecure participants and 198 events (6%) in food-secure participants over the study period. After adjusting for age, sex, and field center, food insecurity was associated with incident CVD (adjusted hazard ratio [aHR], 1.90; 95% CI, 1.41-2.56). The association persisted (aHR, 1.47; 95% CI, 1.08-2.01) after further adjustment for the socioeconomic factors of education, marital status, and usual source of medical care.Conclusions and RelevanceIn this prospective cohort study among participants in the CARDIA study, food insecurity was associated with incident CVD even after adjustment for socioeconomic factors, suggesting that food insecurity may be an important social deprivation measure in clinical assessment of CVD risk. Whether interventions to reduce food insecurity programs can potentially alleviate CVD should be further studied.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"8 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599343","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":"Importance of Age and Sex in Carotid Artery Plaque Detection and Cardiovascular Disease Risk.","authors":"Matthew C Tattersall, Spencer L Hansen, Robyn L McClelland, Claudia E Korcarz, Kristin M Hansen, Wendy S Post, Michael D Shapiro, James H Stein","doi":"10.1001/jamacardio.2024.5702","DOIUrl":"10.1001/jamacardio.2024.5702","url":null,"abstract":"<p><strong>Importance: </strong>Carotid artery plaque (CAP) is commonly encountered in clinical practice. Presence of CAP predicts future atherosclerotic cardiovascular disease (ASCVD) events; however, CAP prevalence increases with age, and it is unknown how age and sex affect the association of CAP presence and ASCVD risk.</p><p><strong>Objectives: </strong>To describe CAP prevalence by age, sex, race, and ethnicity in a multiethnic population and to investigate whether the impact of CAP detection on relative ASCVD risk declines with age and differs by sex.</p><p><strong>Design, setting, and participants: </strong>This cohort study examines participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Adults aged 45 to 84 years who were free of clinical ASCVD at recruitment (2000-2002) were included, and follow-up for ASCVD events was conducted through December 2019. Data analysis was performed from July 2023 to April 2024.</p><p><strong>Exposure: </strong>Presence of CAP.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was ASCVD events (coronary heart disease events, stroke, and ASCVD death). Prevalence of CAP by age, sex, race, and ethnicity was calculated. Cox proportional hazards models with age interaction terms were used to investigate associations of CAP and incident ASCVD events across sexes.</p><p><strong>Results: </strong>Among 6814 adults in the MESA cohort, 5689 participants had complete data and were included in this analysis. Among these 5689 participants, mean (SD) age was 62.0 (10.2) years, and 3002 participants (53%) were female. The cohort included 1551 Black participants (27%), 687 Chinese participants (12%), 1276 Hispanic participants (22%), and 2165 White participants (38%). In total, participants experienced 1043 ASCVD events over a median (IQR) period of 17.6 (10.5-18.4) years. Prevalence of CAP differed by age, sex, race, and ethnicity, ranging from 15% in Chinese women younger than 50 years to 95% in non-Hispanic White men aged 80 to 84 years. CAP independently predicted ASCVD events (hazard ratio, 1.38; 95% CI, 1.20-1.58; P < .001). The strength of this association was stronger among younger participants (≤60 years) vs older (>60 years) (P for interaction = .01), especially among women (P for interaction = .005) vs men (P for interaction = .66). CAP detection in younger individuals conferred higher relative ASCVD risk than in older participants, who had higher absolute risk regardless of CAP.</p><p><strong>Conclusions and relevance: </strong>CAP becomes very common with increasing age among individuals without clinical ASCVD, and the association of CAP with incident ASCVD events was strongest in younger ages, especially among women. These data can help guide ASCVD risk assessment in younger adults and provide perspective when CAP is detected on clinical imaging studies in older adults.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556881","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":"Valsartan and Cardiac Remodeling in Early-Stage Hypertrophic Cardiomyopathy: The VANISH Randomized Clinical Trial Cardiac Magnetic Resonance Substudy.","authors":"John W Ostrominski, Brian L Claggett, Michael Jerosch-Herold, Anna Axelsson Raja, Sharlene M Day, Mark W Russell, Kenneth Zahka, Alexandre C Pereira, Steven D Colan, Anne M Murphy, Charles Canter, Richard G Bach, Matthew T Wheeler, Joseph W Rossano, Anjali T Owens, Luisa Mestroni, Matthew R G Taylor, Amit R Patel, Ivan Wilmot, Jonathan H Soslow, Jason R Becker, Neal K Lakdawala, Henning Bundgaard, Jose D Vargas, Carolyn Y Ho","doi":"10.1001/jamacardio.2024.5677","DOIUrl":"10.1001/jamacardio.2024.5677","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Valsartan has been shown to attenuate phenotypic progression among individuals with early-stage sarcomeric hypertrophic cardiomyopathy (HCM). Myocardial tissue characterization by cardiac magnetic resonance (CMR) imaging may enhance mechanistic insights, but whether valsartan influences these parameters remains uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the treatment effects of valsartan on myocardial structure, function, and tissue parameters in early-stage sarcomeric HCM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This prespecified CMR substudy of the VANISH (Valsartan for Attenuating Disease Evolution in Early Sarcomeric Hypertrophic Cardiomyopathy) randomized clinical trial evaluated treatment effects of valsartan vs placebo on myocardial structure, function, and tissue parameters and was conducted from April 2014 through July 2019 at 17 international sites. Individuals aged 8 to 45 years with early-stage HCM aged between 8 and 45 years and with no or minimal symptoms were eligible for inclusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;Treatment with placebo or valsartan (80 mg per day for children weighing &lt;35 kg, 160 mg per day for children weighing ≥35 kg, or 320 mg per day for adults aged 18 years or older).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was mean change in CMR parameters between baseline and year 2, including indexed extracellular volume (iECV), indexed intracellular volume (iICV), and late gadolinium enhancement (LGE). Mean between-group differences in CMR parameters between baseline and year 2 were evaluated using multivariable mixed-effects linear regression models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 137 of 178 VANISH participants (77.0%) underwent CMR imaging at baseline and year 2. Among these participants, mean (SD) age was 23 (10) years, and 51 participants (37.2%) were female. Baseline characteristics and CMR parameters were well balanced between treatment groups. Higher LGE, iECV, and iICV at baseline were associated with higher cardiac biomarker levels and more pronounced cardiac remodeling. Between baseline and year 2, valsartan appeared to increase left ventricular (LV) end-diastolic volume index (mean difference [MD], 3.3 mL/m2; 95% CI, 0.4-6.2; P = .03), suggesting treatment benefit, but did not significantly impact LV mass index (MD, -2.9 g/m2; 95% CI, -6.1 to 0.2; P = .07) or LV ejection fraction. Similarly, valsartan appeared to reduce decline in right ventricular volumes. Valsartan appeared to significantly reduce iICV progression (MD, -5.0 mL/m2; 95% CI, -9.7 to -0.4; P = .03), but did not impact iECV (MD, 0.0 mL/m2; 95% CI, -1.4 to 1.3; P = .95) or LGE progression (MD, 0.5%; 95% CI, -0.4 to 1.3; P = .30).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;These findings enhance mechanistic insights into the effect of valsartan in early-stage HCM, showing potential benefits on biventricular remodeling and myocardial ","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556885","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":"Finerenone for Heart Failure and Risk Estimated by the PREDICT-HFpEF Model: A Secondary Analysis of FINEARTS-HF.","authors":"Kirsty McDowell, Kieran F Docherty, Ross T Campbell, Alasdair D Henderson, Pardeep S Jhund, Brian L Claggett, Akshay S Desai, James Lay-Flurrie, Lucas Hofmeister, Andrea Scalise, Carolyn S P Lam, Mark C Petrie, Morten Schou, Michele Senni, Sanjiv J Shah, Jacob A Udell, Faiez Zannad, Bertram Pitt, Muthiah Vaduganathan, Scott D Solomon, John J V McMurray","doi":"10.1001/jamacardio.2025.0025","DOIUrl":"10.1001/jamacardio.2025.0025","url":null,"abstract":"<p><strong>Importance: </strong>Patients with heart failure (HF) and mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF) have a spectrum of risk, and the effect of therapies may vary by risk.</p><p><strong>Objectives: </strong>To validate the Prognostic Models for Mortality and Morbidity in HFpEF (PREDICT-HFpEF) in the phase 3 randomized clinical trial Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) and to evaluate the effect of finerenone, compared with placebo, across the spectrum of risk in these patients.</p><p><strong>Design, setting, and participants: </strong>The FINEARTS-HF trial was conducted across 653 sites in 37 countries. Participants were adults 40 years and older with symptomatic HF and left ventricular EF of 40% or greater randomized between September 2020 and January 2023.</p><p><strong>Intervention: </strong>Finerenone (titrated to 20 mg or 40 mg) or placebo.</p><p><strong>Main outcomes and measures: </strong>The 3 PREDICT-HFpEF risk scores for the composite outcome of cardiovascular death or HF hospitalization, cardiovascular death, and all-cause death, respectively, were calculated. Predicted risk was compared with observed outcomes. Model performance was assessed using the Harrell C statistic. The rates of the predicted outcomes (plus the composite of cardiovascular death and worsening HF events, which was the primary end point in the trial) were examined according to quintiles of risk score, as was the effect of finerenone according to risk quintiles.</p><p><strong>Results: </strong>A total of 6001 patients (mean [SD] age, 72 [9.6] years; 3269 male [54.5%]) were randomized in the FINEARTS-HF trial. The C statistics for cardiovascular death or HF hospitalization, cardiovascular death, and all-cause death at 2 years were 0.71 (95% CI, 0.69-0.72), 0.68 (95% CI, 0.66-0.71), and 0.69 (95% CI, 0.67-0.71), respectively. The risk of the composite outcomes was approximately 8- to 10-fold higher in those in the highest compared with the lowest risk quintile. The relative risk reduction with finerenone compared with placebo was consistent across the spectrum of risk for all outcomes examined (eg, interaction P value for primary outcome = .24).</p><p><strong>Conclusions and relevance: </strong>Results of the FINEARTS-HF randomized clinical trial demonstrate that the PREDICT-HFpEF models performed well in terms of calibration and discrimination. Baseline risk did not modify the benefit of finerenone.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04435626.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556818","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":"Coronary Artery Calcium Testing-Too Early, Too Late, Too Often.","authors":"Alexander R Zheutlin, Anuj K Chokshi, John T Wilkins, Neil J Stone","doi":"10.1001/jamacardio.2024.5644","DOIUrl":"https://doi.org/10.1001/jamacardio.2024.5644","url":null,"abstract":"<p><strong>Importance: </strong>Traditional risk factors, enhancing factors, and risk scores help clinicians assess atherosclerotic cardiovascular disease (ASCVD) risk for primary prevention. The latest cholesterol guidelines suggest measuring coronary artery calcium (CAC) score by computed tomography (CT) in those at intermediate risk when there is uncertainty about statin initiation for primary prevention. CAC testing can improve both risk estimation and adherence to cardiovascular risk-reducing behaviors.</p><p><strong>Observations: </strong>As measuring CAC score has become more widely available, this article focuses on 3 situations where CAC testing may be omitted or deferred until a time when CAC testing can provide clinically useful information. Three clinical scenarios to facilitate the clinician-patient risk discussion are as follows: (1) when CAC testing is too early, (2) when CAC testing is too late, and (3) when CAC testing is repeated too often. The timing of CAC testing sits within the decision point of lipid-lowering therapy use. High-risk young adults may face an elevated lifetime risk of cardiovascular disease despite a CAC level of 0, whereas older adults may not see an expected benefit over a short time horizon or may already be taking lipid-lowering therapy, rendering a CAC score less valuable. Integrating a CAC score into the decision to initiate lipid-lowering therapy requires understanding of a patient's risk factors, including age, as well as the natural history of atherosclerosis and related events.</p><p><strong>Conclusions and relevance: </strong>These clinical scenarios reflect when consideration of CAC score is of use and when it is not. Although CAC testing is becoming more widely available and sought after by clinicians and patients alike, it is only as useful as the clinical context. Understanding when assessing CAC score is too early to effectively rule out risk, too late to influence decisions, or too often to yield clinically relevant information provides important insights that optimize the clinical utility of this potentially valuable prognostic tool.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556856","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":"Filling the Evidence Gaps Toward a Coronary Artery Calcium-Guided Primary Prevention Strategy.","authors":"Michael J Blaha","doi":"10.1001/jamacardio.2025.0410","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0410","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567102","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":"Simultaneous or Rapid Initiation of Combination Therapy for Heart Failure With Preserved Ejection Fraction.","authors":"Stephen J Greene, Javed Butler, Gregg C Fonarow","doi":"10.1001/jamacardio.2025.0038","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0038","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556883","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":"Yellowish Nodules on a Man Consuming a Carnivore Diet.","authors":"Konstantinos Marmagkiolis, Jaime Caballero, Cezar Iliescu","doi":"10.1001/jamacardio.2024.5209","DOIUrl":"10.1001/jamacardio.2024.5209","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"297"},"PeriodicalIF":14.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005147","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":"Artificial Intelligence-Enhanced Electrocardiography for Prediction of Incident Hypertension.","authors":"Arunashis Sau, Joseph Barker, Libor Pastika, Ewa Sieliwonczyk, Konstantinos Patlatzoglou, Kathryn A McGurk, Nicholas S Peters, Declan P O'Regan, James S Ware, Daniel B Kramer, Jonathan W Waks, Fu Siong Ng","doi":"10.1001/jamacardio.2024.4796","DOIUrl":"10.1001/jamacardio.2024.4796","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Hypertension underpins significant global morbidity and mortality. Early lifestyle intervention and treatment are effective in reducing adverse outcomes. Artificial intelligence-enhanced electrocardiography (AI-ECG) has been shown to identify a broad spectrum of subclinical disease and may be useful for predicting incident hypertension.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To develop an AI-ECG risk estimator (AIRE) to predict incident hypertension (AIRE-HTN) and stratify risk for hypertension-associated adverse outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This was a development and external validation prognostic cohort study conducted at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, a secondary care setting. External validation was conducted in the UK Biobank (UKB), a UK-based volunteer cohort. AIRE-HTN was trained and tested to predict incident hypertension using routinely collected ECGs from patients at BIDMC between 2014 and 2023. The algorithm was then evaluated to risk stratify patients for hypertension- associated adverse outcomes and externally validated on UKB data between 2014 and 2022 for both incident hypertension and risk stratification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;AIRE-HTN, which uses a residual convolutional neural network architecture with a discrete-time survival loss function, was trained to predict incident hypertension.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;AIRE-HTN was trained on 1 163 401 ECGs from 189 539 patients (mean [SD] age, 57.7 [18.7] years; 98 747 female [52.1%]) at BIDMC. A total of 19 423 BIDMC patients composed the test set and were evaluated for incident hypertension. From the UKB, AIRE-HTN was tested on 65 610 ECGs from same number of participants (mean [SD] age, 65.4 [7.9] years; 33 785 female [51.5%]). A total of 35 806 UKB patients were evaluated for incident hypertension. AIRE-HTN predicted incident hypertension (BIDMC: n = 6446 [33%] events; C index, 0.70; 95% CI, 0.69-0.71; UKB: n = 1532 [4%] events; C index, 0.70; 95% CI, 0.69-0.71). Performance was maintained in individuals without left ventricular hypertrophy and those with normal ECGs (C indices, 0.67-0.72). AIRE-HTN was significantly additive to existing clinical risk factors in predicting incident hypertension (continuous net reclassification index, BIDMC: 0.44; 95% CI, 0.33-0.53; UKB: 0.32; 95% CI, 0.23-0.37). In adjusted Cox models, AIRE-HTN score was an independent predictor of cardiovascular death (hazard ratio [HR] per standard deviation, 2.24; 95% CI, 1.67-3.00) and stratified risk for heart failure (HR, 2.60; 95% CI, 2.22-3.04), myocardial infarction (HR, 3.13; 95% CI, 2.55-3.83), ischemic stroke (HR, 1.23; 95% CI, 1.11-1.37), and chronic kidney disease (HR, 1.89; 95% CI, 1.68-2.12), beyond traditional risk factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Results suggest that AIRE-HTN, an AI-ECG model, can predict incident hypertension and i","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"214-223"},"PeriodicalIF":14.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914832","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}