JAMA cardiology最新文献

{"title":"Intracoronary Structural-Molecular Imaging for Multitargeted Characterization of High-Risk Plaque: First-in-Human OCT-FLIm.","authors":"Sunwon Kim,Hyeong Soo Nam,Dong Oh Kang,Jeongmoo Han,Hyokee Kim,Joon Woo Song,Eun Jin Park,Ryeong Hyun Kim,Hyun Jung Kim,Jin Hyuk Kim,Sunki Lee,Young Su Kim,Pyoungjae Park,Man-Jong Baik,Hongki Yoo,Jin Won Kim","doi":"10.1001/jamacardio.2025.0928","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0928","url":null,"abstract":"ImportanceFluorescence lifetime imaging (FLIm) is a molecular imaging technique used to visualize the biochemical composition of atherosclerosis. Novel dual-modal imaging using optical coherence tomography (OCT)-FLIm has the potential to provide both microstructural and biocompositional information on coronary plaques; however, it needs validation for clinical application.ObjectiveTo investigate the clinical feasibility and safety of OCT-FLIm for characterizing plaque compositions in patients with coronary artery disease (CAD) undergoing revascularization therapy.Design, Setting, and ParticipantsA prospective, open-label, single-center diagnostic feasibility study involving 40 patients with significant CAD requiring coronary revascularization. This first-in-human clinical study of the novel intracoronary OCT-FLIm imaging was conducted between February and August 2022. The analyses were performed from August 2022 to July 2023.InterventionsAn OCT-FLIm system with 2.6-F catheters was constructed. All patients underwent OCT-FLIm for target/culprit and nontarget/nonculprit lesions during coronary revascularization. Intravascular ultrasound imaging was performed for comparison.Main Outcomes and MeasuresThe primary outcome was to assess the FLIm-derived molecular readouts of prespecified plaque compositions. The secondary outcome was the feasibility of OCT-FLIm in determining target/culprit plaque compositions across different subsets of atherosclerotic disease activity: (1) acute coronary syndrome (ACS) vs chronic stable angina (CSA) and (2) angiographic rapid disease progression vs nonprogressive controls.ResultsWe prospectively enrolled 40 patients (mean [SD] age, 63.1 [8.1] years; 32 men [80.0%]), of whom 20 presented with ACS and 20 with CSA. OCT provided the structural features of plaques, and FLIm characterized the molecular signatures of atheroma compositions, including macrophages, healed plaques, superficial calcification, and fibrosis, in a reproducible manner. Fluorescence lifetime (FL) values of the plaque compositions correlated with findings from prior autopsy studies. Plaque inflammation was significantly greater in patients with ACS than those with CSA. The mean (SD) of inflammation-FL was 7.59 (0.96) nanoseconds for patients with ACS vs 6.46 (0.87) nanoseconds for patients with CSA (P < .001). The healed plaque phenotype was more prominently distributed in the segments of rapid disease progression than in nonprogressive controls. The mean (SD) healed plaque-FL was 5.31 (0.20) nanoseconds for the rapidly progressive lesions vs 4.81 (0.30) nanoseconds for the rapidly nonprogressive lesions (P < .001). All patients underwent OCT-FLIm safely without adverse clinical events.Conclusions and RelevanceThis diagnostic feasibility study found that an OCT-FLIm structural-molecular intracoronary imaging is clinically feasible and safe for the comprehensive characterization of human atheromas, supporting its potential role in the diagnosis and biol","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"26 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915148","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":"487-491"},"PeriodicalIF":14.8,"publicationDate":"2025-05-01","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":"Encouraging Pharmacist Referrals for Evidence-Based Statin Initiation: Two Cluster Randomized Clinical Trials.","authors":"Alexander C Fanaroff, Qian Huang, Kayla Clark, Laurie A Norton, Wendell E Kellum, Dwight Eichelberger, John C Wood, Zachary Bricker, Andrea G Dooley Wood, Greta Kemmer, Jennifer I Smith, Srinath Adusumalli, Mary E Putt, Kevin G Volpp","doi":"10.1001/jamacardio.2025.0244","DOIUrl":"10.1001/jamacardio.2025.0244","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Despite statins' benefit in preventing major adverse cardiovascular events, most patients with an indication for statin therapy are not appropriately treated. Clinicians' limited time and lack of systematic efforts to address preventive care likely contribute to gaps in statin prescribing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the effect on statin prescribing of 2 interventions to refer appropriate patients to a pharmacist for lipid management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;These 2 pragmatic cluster randomized clinical trials were conducted among 12 total primary care practices in a community health system. Trial 1 was a delayed-intervention design of a visit-based intervention with randomization at the clinician level in a single clinic, and trial 2 was a parallel-arm trial of an asynchronous intervention with randomization at the clinic level in 11 clinics. Patients who were assigned to a primary care clinician at a participating practice, had an indication for a high-intensity or moderate-intensity statin, and were either not prescribed a statin or prescribed an inappropriately low statin dose were eligible for inclusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Trial 1 tested an interruptive electronic health record alert that appeared during eligible patients' visits and facilitated referral to a pharmacist, while trial 2 tested an order for pharmacist referral placed by the study team for cosignature by the primary care clinician without regard to the timing of a clinic visit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome and measure: &lt;/strong&gt;The primary outcome was the proportion of patients prescribed a statin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 1412 patients were enrolled in trial 1 and 1950 in trial 2. Across both trials, mean (SD) patient age was 65.6 (9.9) years, and 1485 patients (44.2%) were female. Mean (SD) baseline 10-year risk of major cardiovascular events was 17.9% (9.4). In trial 1, the interruptive alert was not associated with a significant increase in statin prescriptions compared with usual care (15.6% vs 11.6%; unadjusted absolute difference, 3.9 percentage points; 95% CI, -0.4 to 8.3). In trial 2, semiautomated pharmacist referrals were associated with an increase in statin prescriptions by 16 percentage points compared with usual care (31.6% vs 15.2%; unadjusted absolute difference, 16.4 percentage points; 95% CI, 12.7-20.1).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In these 2 cluster randomized clinical trials, visit-based interruptive alerts were not associated with a significant increase in statin prescribing compared with usual care, whereas a strategy of asynchronous semiautomated referral for pharmacist comanagement was associated with a substantial increase. This strategy of asynchronous semiautomated referrals for pharmacist involvement in lipid management could be a scalable and effective approach to increasing statin prescribing for patients at hig","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"473-481"},"PeriodicalIF":14.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709812","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":"Hypertensive Disorders of Pregnancy and Long-Term Risk of Dilated Cardiomyopathy.","authors":"Upasana Tayal, Constantinos Kallis, Georgie M Massen, Nora Rossberg, Emily L Graul, Jennifer K Quint","doi":"10.1001/jamacardio.2025.0328","DOIUrl":"10.1001/jamacardio.2025.0328","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The impact of hypertensive disorders of pregnancy on developing dilated cardiomyopathy is unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine whether hypertensive disorders of pregnancy are associated with long-term risk of dilated cardiomyopathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This population-based cohort study performed in England used the following linked electronic health records databases: Clinical Practice Research Datalink (CPRD) Pregnancy Register, CPRD Aurum (primary care), Hospital Episode Statistics Admitted Patient Care, and Office for National Statistics mortality data. Participants included an exposed cohort of 14 083 patients in their first pregnancy with hypertensive disorders of pregnancy (index date observed: January 1997 to December 2018; followed up until July 2023) and unexposed cohort of 70 415 with normotensive pregnancies randomly sampled from the Pregnancy Register (5:1 ratio).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Hypertensive disorder of pregnancy (preeclampsia, gestational hypertension).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Cox proportional hazards models were fitted to estimate hazard ratios (HRs) of developing dilated cardiomyopathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The cohort included 14 083 individuals with a hypertensive disease of pregnancy during their first pregnancy and 70 415 individuals with normotensive first pregnancies. A first-time pregnancy complicated by a hypertensive disorder of pregnancy, compared with a normotensive first-time pregnancy, was associated with a 93% higher risk of developing dilated cardiomyopathy (adjusted HR, 1.93 [95% CI, 1.33-2.81]; P = .001; adjusted for maternal age). Dilated cardiomyopathy developed a median (IQR) of 5.1 (0.7-10.6) years post partum in those with HDP and 10.6 (4.2-15.8) years post partum in those with normotensive first pregnancies. The association remained significant after adjusting for maternal age, birth year, gestational diabetes, postpregnancy diabetes, postpregnancy hypertension, total parity, ethnicity, and socioeconomic status (adjusted HR, 1.55 [95% CI, 1.04-2.31]; P = .03). There was a dose response; there was a higher risk of DCM in those with preeclampsia (adjusted HR, 1.85 [95% CI, 1.24-2.76]; P = .002) and severe preeclampsia (adjusted HR, 4.29 [95% CI, 2.32-7.96]; P &lt; .001). Maternal age (adjusted HR per year of age, 1.06 [95% CI, 1.03-1.08]; P &lt; .001) and postpartum incident hypertension (adjusted HR, 1.68 [95% CI, 1.16-2.42]; P = .006) were independently associated with the development of DCM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Patients with hypertensive disorders of pregnancy had a greater risk of developing dilated cardiomyopathy. Older maternal age and postpartum hypertension were associated with higher risk of dilated cardiomyopathy after a hypertensive disorder of pregnancy. These findings support long-term clinical vigilance of patients with a history of hypertensive","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"498-502"},"PeriodicalIF":14.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763620","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":"Progressive Kidney Dysfunction After Left Atrial Appendage Closure.","authors":"Shuaishuai Yuan, Chao Tao, Peijun Li","doi":"10.1001/jamacardio.2025.0258","DOIUrl":"10.1001/jamacardio.2025.0258","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"512"},"PeriodicalIF":14.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811347","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":"Adverse Pregnancy Outcomes and N-Terminal Pro-Brain Natriuretic Peptide Levels 2 to 7 Years After Delivery: The nuMoM2b Heart Health Study.","authors":"Priya M Freaney, Xiaoning Huang, Lucia C Petito, William A Grobman, Janet Catov, Alisse Hauspurg, C Noel Bairey Merz, Natalie Bello, Jin Kyung Kim, Abbi Lane, David M Haas, Lisa D Levine, Rebecca B McNeil, Eliza Miller, George Saade, Lauren Theilen, Lynn M Yee, Jasmina Varagic, Brian Mercer, Uma Reddy, Donald M Lloyd-Jones, Philip Greenland, Sadiya S Khan","doi":"10.1001/jamacardio.2025.0325","DOIUrl":"10.1001/jamacardio.2025.0325","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"514-516"},"PeriodicalIF":14.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763500","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":"Peak Oxygen Uptake vs Ventilatory Efficiency.","authors":"Jiawei Du, Jinghua Hou","doi":"10.1001/jamacardio.2025.0216","DOIUrl":"10.1001/jamacardio.2025.0216","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"516-517"},"PeriodicalIF":14.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657095","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":"Long-Term Aspirin vs Clopidogrel After Coronary Stenting by Bleeding Risk and Procedural Complexity.","authors":"Jeehoon Kang, Jaewook Chung, Kyung Woo Park, Jang-Whan Bae, Huijin Lee, Doyeon Hwang, Han-Mo Yang, Kyoo-Rok Han, Keon-Woong Moon, Ung Kim, Moo-Yong Rhee, Doo-Il Kim, Song-Yi Kim, Sung-Yun Lee, Seung Uk Lee, Sang-Wook Kim, Seok Yeon Kim, Jung-Kyu Han, Eun-Seok Shin, Bon-Kwon Koo, Hyo-Soo Kim","doi":"10.1001/jamacardio.2024.4030","DOIUrl":"10.1001/jamacardio.2024.4030","url":null,"abstract":"<p><strong>Importance: </strong>Antiplatelet monotherapy in the chronic maintenance period for patients with high bleeding risk (HBR) and those who have undergone complex percutaneous coronary intervention (PCI) has not yet been explored.</p><p><strong>Objective: </strong>To compare clopidogrel vs aspirin monotherapy in patients with HBR and/or PCI complexity.</p><p><strong>Design, setting, and participants: </strong>This post hoc analysis of the multicenter HOST-EXAM Extended study, an open-label trial conducted across 37 sites in South Korea, enrolled patients from 2014 to 2018 with up to 5.9 years of follow-up. The analysis was conducted from February to November 2023. Patients who maintained dual antiplatelet therapy (DAPT) event-free for 6 to 18 months following PCI were included.</p><p><strong>Interventions: </strong>Patients were randomized to receive either clopidogrel or aspirin in a 1:1 ratio. Those with sufficient data to assess HBR or complex PCI were analyzed.</p><p><strong>Main outcomes and measures: </strong>Coprimary end points were thrombotic composite end point (cardiovascular death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and definite/probable stent thrombosis) and any bleeding (Bleeding Academic Research Consortium type 2 to 5).</p><p><strong>Results: </strong>Of 3974 patients included (mean [SD] age, 63.4 [10.7] years; 2976 male [74.9%]), 866 had HBR (21.8%), and 849 underwent complex PCI (21.4%). Clopidogrel as compared with aspirin was associated with lower rates of thrombotic and bleeding events regardless of HBR and/or PCI complexity. For the thrombotic composite end point, the hazard ratio (HR) was 0.75 (95% CI, 0.53-1.04) among HBR vs 0.62 (95% CI, 0.48-0.80) among patients without HBR (P for interaction = 0.38) and 0.49 (95% CI, 0.32-0.77) among patients with complex PCI vs 0.74 (95% CI, 0.59-0.92) among patients with noncomplex PCI (P for interaction = 0.12). The reduction in bleeding by clopidogrel compared with aspirin was consistent among both patients with HBR (HR, 0.82; 95% CI, 0.56-1.21) and patients without HBR (HR, 0.58; 95% CI, 0.40-0.85; P for interaction = 0.20) and among patients undergoing complex PCI (HR, 0.79; 95% CI, 0.47-1.33) vs noncomplex PCI (HR, 0.68; 95% CI, 0.50-0.93; P for interaction = 0.62).</p><p><strong>Conclusions and relevance: </strong>In this study, in patients who experienced PCI and were event-free during 6 to 18 months of DAPT, the beneficial impact of clopidogrel monotherapy over aspirin monotherapy was consistent, regardless of bleeding risk and/or PCI complexity.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02044250.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"427-436"},"PeriodicalIF":14.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12079284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728666","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":"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":"503-509"},"PeriodicalIF":14.8,"publicationDate":"2025-05-01","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":"10.1001/jamacardio.2025.0410","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"411-413"},"PeriodicalIF":14.8,"publicationDate":"2025-05-01","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}