Journal of the American College of Cardiology最新文献

{"title":"Impact of Obicetrapib on Major Adverse Cardiovascular Events in High-Risk Patients: A Pooled Analysis.","authors":"Stephen J Nicholls, Adam J Nelson, Kausik K Ray, Christie M Ballantyne, Marc Ditmarsch, Douglas Kling, Andrew Hsieh, Michael Szarek, John J Kastelein, Michael H Davidson","doi":"10.1016/j.jacc.2025.07.056","DOIUrl":"10.1016/j.jacc.2025.07.056","url":null,"abstract":"<p><strong>Background: </strong>The cholesteryl ester transfer protein inhibitor obicetrapib decreases levels of atherogenic lipids and raises high-density lipoprotein cholesterol (HDL-C).</p><p><strong>Objectives: </strong>In this study, we sought to determine the effect of obicetrapib on cardiovascular events.</p><p><strong>Methods: </strong>The effects of 10 mg obicetrapib and placebo daily on major adverse cardiovascular event (MACE) rates were investigated in a pooled analysis of 354 patients with heterozygous familial hypercholesterolemia (HeFH) and 2,530 patients with atherosclerotic cardiovascular disease (ASCVD) over 365 days. The association between on-treatment lipids and MACE were also investigated.</p><p><strong>Results: </strong>The cohort (mean age 66 years, 36% female, ASCVD 82%, HeFH 27%, diabetes 35%) had median baseline levels of low-density lipoprotein cholesterol (LDL-C) 92 mg/dL, HDL-C 48 mg/dL, apolipoprotein B (ApoB) 88 mg/dL, non-HDL-C 116 mg/dL, and lipoprotein(a) (Lp(a)) 40.5 nmol/L. Obicetrapib produced greater reductions in LDL-C (-34.0 vs -4.0 mg/dL, -37.8% vs -4.6%), ApoB (-19.0 vs -3.0 mg/dL, -21.7% vs -3.6%), non-HDL-C (-36.0 vs -4.0 mg/dL, -32.4% vs -3.7%), and Lp(a) (-9.8 vs 0 nmol/L, -32.5% vs 0%) and increased HDL-C (+68.0 vs +1.0 mg/dL, +140.0% vs +1.5%). The rate of coronary heart disease death, myocardial infarction, ischemic stroke, or coronary revascularization was lower with obicetrapib (3.9% vs 5.0%; HR: 0.77; 95% CI: 0.54-1.11; P = 0.16), with a risk reduction in the second 6 months (HR: 0.60; 95% CI: 0.37-0.99; P = 0.04). The rate of coronary heart disease death, myocardial infarction, or coronary revascularization was lower with obicetrapib (3.2% vs 4.7%; HR: 0.68; 95% CI: 0.46-1.00; P = 0.048), with a risk reduction in the second 6 months (HR: 0.45; 95% CI: 0.26-0.77; P = 0.003). Achieved levels of LDL-C (P = 0.003), ApoB (P = 0.007), non-HDL-C (P = 0.01), Lp(a) (P = 0.003), and HDL-C (P = 0.0001) were associated with event rates.</p><p><strong>Conclusions: </strong>Obicetrapib treatment associated with a reduction in coronary events, evident beyond 6 months of treatment.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1046-1056"},"PeriodicalIF":22.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958432","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":"Event Reduction With Obicetrapib: A Word of Caution.","authors":"Vera Bittner","doi":"10.1016/j.jacc.2025.08.031","DOIUrl":"10.1016/j.jacc.2025.08.031","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1059-1060"},"PeriodicalIF":22.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958872","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":"Obicetrapib and Cardiovascular Events: A Promising Signal in Need of Confirmation.","authors":"Harlan M Krumholz, Neha J Pagidipati","doi":"10.1016/j.jacc.2025.08.016","DOIUrl":"10.1016/j.jacc.2025.08.016","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1057-1058"},"PeriodicalIF":22.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958648","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":"Central Adiposity or Hypertension: Which Drives Heart Failure With a Preserved Ejection Fraction?","authors":"Milton Packer, Javed Butler, Carolyn S P Lam, Faiez Zannad, Muthiah Vaduganathan, Barry A Borlaug","doi":"10.1016/j.jacc.2025.08.036","DOIUrl":"10.1016/j.jacc.2025.08.036","url":null,"abstract":"<p><p>The 2 most prevalent risk factors for the development of heart failure and a preserved ejection fraction (HFpEF) are hypertension and obesity, but their relative importance in driving the evolution and progression of HFpEF has not been critically evaluated. The role of excess adiposity in HFpEF has been substantially underappreciated, largely because of reliance on body mass index (rather than waist-to-height ratio) to identify an expanded fat mass and on a meaningful elevation of natriuretic peptides to identify HFpEF. In the general population, changes in central obesity and visceral adiposity are observed years before HFpEF becomes clinically manifest, and central obesity is present in >80% to 90% of patients with established HFpEF, with the degree of adiposity being strongly related to the hemodynamic and clinical severity of HFpEF. Therapeutic amelioration of excess adiposity by bariatric surgery or incretin-based drugs appears to have substantial effects on the evolution and progression of HFpEF, with reported reductions of 40% to 60% in the risk of heart failure hospitalizations. Hypertension also increases the risk of heart failure, but in Mendelian randomization studies, HFpEF is more strongly linked to obesity than to hypertension. Furthermore, the available evidence from clinical trials does not support a consistent link between blood pressure lowering and a reduced risk of HFpEF, particularly in patients with coexisting obesity. Although a history of hypertension is exceptionally prevalent among patients with established HFpEF, in trials of patients with established HFpEF, drugs that lowered systolic blood pressure by 3 to 7 mm Hg yielded a heart failure event risk reduction of only 5% to 18%. Furthermore, the magnitude of the observed benefit on heart failure events was not related to the elevation of baseline systolic blood pressure or the magnitude of the drug-related decreases in blood pressure. Adiposity causes hypertension, and if excess adiposity is not alleviated, blood pressure lowering with many antihypertensive drugs may not be able to alleviate left ventricular systolic and diastolic and vascular stiffness. Taken together, the totality of evidence suggests that-in the current era-central adiposity appears to be more important than hypertension as a determinant of the evolution and progression of HFpEF.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199867","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 Automation of Echocardiographic Measurements.","authors":"Yuki Sahashi, Hirotaka Ieki, Victoria Yuan, Matthew Christensen, Milos Vukadinovic, Christina Binder-Rodriguez, Justin Rhee, James Y Zou, Bryan He, Paul Cheng, David Ouyang","doi":"10.1016/j.jacc.2025.07.053","DOIUrl":"10.1016/j.jacc.2025.07.053","url":null,"abstract":"<p><strong>Background: </strong>Accurate measurement of echocardiographic parameters is crucial for the diagnosis of cardiovascular disease and tracking of change over time; however, manual assessment requires time-consuming effort and can be imprecise. Artificial intelligence has the potential to reduce clinician burden by automating the time-intensive task of comprehensive measurement of echocardiographic parameters.</p><p><strong>Objectives: </strong>The purpose of this study was to develop and validate open-sourced deep learning semantic segmentation models for the automated measurement of 18 anatomic and Doppler measurements in echocardiography.</p><p><strong>Methods: </strong>We trained models for the automated measurement of echocardiography parameters using data sets between 2011 and 2023 from Cedars-Sinai Medical Center (CSMC). The outputs of segmentation models were compared with sonographer measurements from temporal split data from CSMC and an external data set from Stanford Healthcare (SHC) to access accuracy and precision.</p><p><strong>Results: </strong>We used 877,983 echocardiographic measurements from 155,215 studies from CSMC to develop EchoNet-Measurements, an open-source deep learning model for echocardiographic annotation. The models demonstrated high accuracy when compared with sonographer measurements from held-out data from CSMC and an independent external validation data set from SHC. Measurements across all 9 B-mode and 9 Doppler measurements had high accuracy (mean coverage probability of 0.796 and 0.839 and mean relative difference of 0.120 and 0.096 on held-out test set from CSMC and external data set from SHC, respectively). When evaluated end-to-end on 2,103 temporally distinct studies at CSMC, EchoNet-Measurements had similar reasonable performance (mean coverage probability 0.803 and mean relative difference of 0.108). Performance was consistent across patient characteristics including age, sex, and atrial fibrillation, obesity status, and machine vendors.</p><p><strong>Conclusions: </strong>EchoNet-Measurements achieves high accuracy in automated echocardiographic quantification and potential for assisting the clinicians in the echocardiography workflow. This open-source model provides the foundation for future developments in artificial intelligence applied to echocardiography.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"964-978"},"PeriodicalIF":22.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008328","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":"Seeing Is Believing: Intelligence Is Artificial, Responsibility Is Not.","authors":"Timothy J Poterucha, Pierre Elias, Platon Lukyanenko, Joshua Mayourian","doi":"10.1016/j.jacc.2025.08.029","DOIUrl":"10.1016/j.jacc.2025.08.029","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"979-981"},"PeriodicalIF":22.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008331","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":"Honoring a Cricket Star's International Legacy: Reducing Preventable Cardiac Deaths With Better Care Delivery.","authors":"Jason H Wasfy","doi":"10.1016/j.jacc.2025.07.028","DOIUrl":"10.1016/j.jacc.2025.07.028","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"962-963"},"PeriodicalIF":22.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855680","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":"Reimagining Cardiovascular Screening: Leveraging Detection for Population Health Impact.","authors":"Adam N Berman, Amrita Mukhopadhyay, Saul B Blecker, Leora I Horwitz","doi":"10.1016/j.jacc.2025.07.047","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.07.047","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 13","pages":"959-961"},"PeriodicalIF":22.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137994","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":"Reappraisal of Evidentiary Support for Transcatheter Aortic Valve Implantation for Low-Risk Aortic Stenosis: Insights From Midterm Results of the PARTNER 3 and Evolut LR Trials.","authors":"Sanjay Kaul","doi":"10.1016/j.jacc.2025.06.019","DOIUrl":"10.1016/j.jacc.2025.06.019","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1002-1005"},"PeriodicalIF":22.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958624","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":"Pop-Up Cardiovascular Screening Within Community Pharmacies and an International Sporting Event.","authors":"Sean Tan, Adam J Nelson, Rahul G Muthalaly, Nitesh Nerlekar, Noel Duncan, Helen P Nolan, Stephen J Nicholls","doi":"10.1016/j.jacc.2025.07.020","DOIUrl":"10.1016/j.jacc.2025.07.020","url":null,"abstract":"<p><strong>Background: </strong>Atherosclerotic cardiovascular disease is a leading cause of mortality and morbidity. However, screening for cardiovascular risk at a population level remains challenging due to variable uptake and compliance.</p><p><strong>Objectives: </strong>This study investigated an opportunistic pop-up approach to community screening for cardiovascular risk and the differences in captured populations according to screening station location and day and time of screening.</p><p><strong>Methods: </strong>This prospective observational study was conducted over a 7-week period using a participant-operated health station that recorded demographic characteristics, lifestyle factors, medical history, and engagement with health care. Stations were placed in 311 community pharmacies and a stadium during an international sporting event. The primary outcome was prevalence of an uncontrolled cardiovascular risk factor, defined as elevated blood pressure readings, elevated body mass index, or active smoking.</p><p><strong>Results: </strong>A total of 76,085 participants were screened: 68,345 (89.8%) participants at pharmacies and 7,740 (10.2%) at the sporting event. There were 34,430 (45.3%) participants aged ≥45 years, and 39,957 (52.5%) were male. A total of 52,453 (68.9%) participants met the primary outcome: 37.2% had elevated blood pressure readings, 60.5% elevated body mass index, and 12.1% were smokers. Higher rates of the primary outcome were observed at the sporting event compared with pharmacies. Among community pharmacy participants, increased rates of uncontrolled cardiovascular risk factors were observed in rural pharmacy locations and during weekday and daytime screening.</p><p><strong>Conclusions: </strong>Uncontrolled cardiovascular risk factors were prevalent during opportunistic pop-up community screening, with higher rates observed at the sporting event, rural pharmacies, and during weekday and daytime screening.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"950-958"},"PeriodicalIF":22.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855681","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}