Journal of the American College of Cardiology最新文献

{"title":"Clinical Considerations for the Care of the Tactical Athlete With Cardiovascular Abnormalities: A Scientific Statement From the American College of Cardiology and the American Heart Association.","authors":"Elizabeth H Dineen, Mark C Haigney, Benjamin D Levine, Michael J Ackerman, Aaron L Baggish, Travis C Batts, Alan C Braverman, Eugene H Chung, Geoffrey J Cole, William K Cornwell, Eddie Davenport, Peter N Dean, Harry C Dietz, Alexander Eastman, Marc Alaric Franzos, J Sawalla Guseh, Travis E Harrell, Edward A Hulten, Cynthia A James, Jonathan H Kim, Rachel J Lampert, Matthew W Martinez, Joseph W May, Francis G O'Connor, Bradley J Petek, Ankit B Shah, Denise L Smith, Paul D Thompson, Meagan M Wasfy, James A Watts, Julie A Brothers, Nisha Charkoudian, Sharlene M Day, Michael S Emery, N A Mark Estes, Antonio B Fernandez, Melissa Givens, Samuel O Jones, Stefanos N Kales, Mark S Link, James E Locke, Martin Maron, Silvana Molossi, Andrew R Morgan, Caroline Murphy, Matthew Needleman, James Pawelczyk, Dermot M Phelan, Keri M Shafer, Wanpen Vongpatanasin, Clyde W Yancy, Wojciech Zareba","doi":"10.1016/j.jacc.2026.07.003","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.07.003","url":null,"abstract":"<p><strong>Aim: </strong>The American College of Cardiology/American Heart Association Scientific Statement, \"Clinical Considerations for the Care of the Tactical Athlete With Cardiovascular Abnormalities,\" was written to provide guidance and education for clinicians caring for the tactical athlete (ie, firefighters, law enforcement officers, military) with cardiovascular disease or risk for cardiovascular disease, and for the organizations overseeing the care and wellness of these athletes. The considerations are shaped by the interaction between occupational demands and fit for full duty assessments, including risk discussions about how a cardiovascular event in a tactical athlete could impact teammates' well-being, community safety, and overall mission success.</p><p><strong>Methods: </strong>This scientific statement is organized into 11 sections focused on cardiovascular disease processes and other topics that are relevant when considering the potential risks and benefits of performing tasks specific to the tactical athlete. Task forces, comprised of experts in tactical athlete domains, sports cardiology, and the respective topics covered, were assigned to each section, and specific \"Clinical Considerations Tables\" for clinicians to reference were prepared. Comprehensive literature reviews and an emphasis on tactical athlete-focused data, as available, were integral in the writing of all clinical considerations presented. The framework mirrors that of the recently published, \"Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology.\"</p><p><strong>Structure: </strong>The specific sections in this document include: Section 1: Tactical Tasks Classification; Section 2: The Tactical Athlete Preparticipation Cardiac Evaluation; Section 3: Ethical and Legal Aspects of Tactical Clinical Management; Section 4: Genetic Cardiomyopathies; Section 5: Myocarditis and Other Acquired Cardiac Conditions; Section 6: Congenital Heart Disease; Section 7: Aortopathy, Bicuspid Aortic Valve, and Spontaneous Coronary Artery Dissection; Section 8: Syncope, SCA, Arrhythmias, and Devices; Section 9: Cardiac Channelopathies; Section 10: Older Tactical Athlete; Section 11: Environmental Exposures, PED/S, and Additional Cardiac Conditions and Considerations. Each section provides a summary detailing the rationale for key clinical considerations and the respective Clinical Considerations Table(s).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887938","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":"Air Pollution-Induced Cardiovascular Disease: Moving From Mechanisms to Decisive Action.","authors":"Robert D Brook, Sanjay Rajagopalan","doi":"10.1016/j.jacc.2026.03.156","DOIUrl":"10.1016/j.jacc.2026.03.156","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"948-950"},"PeriodicalIF":22.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973397","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":"Heat Plus Fire: A Compound Hazard Threatening Cardiovascular Health.","authors":"Lingzhi Chu","doi":"10.1016/j.jacc.2026.06.016","DOIUrl":"10.1016/j.jacc.2026.06.016","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"978-979"},"PeriodicalIF":22.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620209","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":"Chronic PM_2.5 Exposure Is Associated With Invasively Assessed Coronary Endothelial Dysfunction.","authors":"Matteo Manzato, Parvin Kalhor, Kai Nogami, Alessia Pinna, Rocco A Montone, Lilach O Lerman, Amir Lerman","doi":"10.1016/j.jacc.2026.03.155","DOIUrl":"10.1016/j.jacc.2026.03.155","url":null,"abstract":"<p><strong>Background: </strong>Coronary endothelial dysfunction (ED) represents an early stage of coronary artery disease (CAD). Several factors may induce ED. Air pollution, more specifically particulate matter <2.5 μm (PM_2.5), has emerged as a major nontraditional cardiovascular risk factor contributing to early vascular injury, but its impact on coronary ED remains poorly defined.</p><p><strong>Objectives: </strong>In this study, we sought to identify an association between chronic PM_2.5 exposure and epicardial endothelial dysfunction (EED) determined by means of invasive coronary vasoreactivity testing, the criterion standard technique to assess EED.</p><p><strong>Methods: </strong>This observational study included prospectively enrolled patients with angina and nonobstructive CAD who underwent coronary reactivity testing at Mayo Clinic from 2000 to 2023. Residential addresses at the time of testing were geocoded to derive monthly PM_2.5 exposure at a 0.01° × 0.01° spatial resolution, averaged over the 2 years preceding testing. EED was defined as percentage change of less than -20% in coronary artery diameter in response to acetylcholine infusion. Associations between continuous PM_2.5 and EED were assessed according to a generalized propensity score with a gamma-distributed model to derive stabilized inverse probability weights, applied in multivariable logistic regression.</p><p><strong>Results: </strong>A total of 1,485 patients with a median age of 51.7 years (Q1-Q3: 42.7-60.1 years) were included in the analysis. Individuals exposed to PM_2.5 above environmental protection agency standards (9 μg/m³) were younger and had less cardiovascular comorbidities, although they had worse lipid profiles. In weighted multivariable logistic regression, each 1 μg/m³ increase in PM_2.5 was associated with increased odds of EED (OR: 1.078; 95% CI: 1.021-1.139; P = 0.007), adjusted for age, sex, body mass index, and cardiovascular comorbidities.</p><p><strong>Conclusions: </strong>Chronic PM_2.5 exposure is associated with epicardial coronary ED, suggesting a potential biological link between PM_2.5 and CAD.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"937-947"},"PeriodicalIF":22.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973442","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 Exposure to PM_2.5 Constituents and Coronary Heart Disease Risk in China.","authors":"Wenhao Wang, Hanrui Liu, Qian Li, Yan Dou, Keyong Huang, Fangchao Liu, Jianxin Li, Shufeng Chen, Zhouxin Yin, Yun Hang, Chong Shen, Xueli Yang, Jichun Chen, Xiaoqing Liu, Jie Cao, Ling Yu, Fanghong Lu, Xianping Wu, Xingbo Mo, Dongsheng Hu, Jianfeng Huang, Joshua S Fu, Stefanie Ebelt, Alvaro Alonso, Howard H Chang, Xiangfeng Lu, Fengchao Liang, Dongfeng Gu, Yang Liu","doi":"10.1016/j.jacc.2026.05.030","DOIUrl":"10.1016/j.jacc.2026.05.030","url":null,"abstract":"<p><strong>Background: </strong>In China, the associations between long-term fine particulate matter with aerodynamic diameter ≤2.5 μm (PM_2.5) exposure and coronary heart disease appear to differ from those reported in high-income countries, thus potentially reflecting differences in PM_2.5 composition. However, constituent-specific evidence from national cohort studies remains limited.</p><p><strong>Objectives: </strong>This study aimed to investigate the associations of long-term exposure to PM_2.5 constituents with the incidence and mortality risks of coronary heart disease and its subtype, acute myocardial infarction (AMI).</p><p><strong>Methods: </strong>This nationwide prospective cohort study was conducted in 101,906 adults from the China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) Project who were free of cardiovascular disease at baseline. Participants were followed up from 2003 to 2019. Annual residential exposures to PM_2.5 constituents, including elemental carbon (EC), organic carbon (OC), nitrate, and sulfate, were estimated using validated satellite-based machine learning models. Cox proportional hazards models with time-varying exposures were used to estimate HRs and 95% CIs per IQR increase, adjusted for major demographic, behavioral, and clinical covariates.</p><p><strong>Results: </strong>During a median follow-up of 11.08 years (1,230,732 person-years), 3,500 incident cases of coronary heart disease, including 1,771 AMI events, and 1,321 coronary heart disease deaths, including 808 AMI deaths, were recorded. Per IQR increase in EC, OC, nitrate, and sulfate exposure, HRs for coronary heart disease incidence were 1.10 (95% CI: 1.01-1.19), 1.60 (95% CI: 1.31-1.95), 1.43 (95% CI: 1.06-1.95), and 0.93 (95% CI: 0.82-1.06), respectively. Similar positive associations for EC, OC, and nitrate were observed for coronary heart disease mortality and AMI outcomes, whereas the health impacts of sulfate were weaker and less consistent across outcomes. Concentration-response curves indicated an overall increasing coronary heart disease risk for OC, EC, and nitrate exposure with a plateau or slight attenuation in the higher exposure range of EC and OC, whereas sulfate exposure showed nonlinear associations without a sustained increase in risk.</p><p><strong>Conclusions: </strong>Long-term exposure to specific PM_2.5 constituents was associated with increased risks of coronary heart disease and AMI, thus highlighting the need for constituent-specific air pollution control beyond PM_2.5 mass.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"997-1009"},"PeriodicalIF":22.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447702","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":"Environment and the Heart: Measuring the Health Impact of Environmental Risks and Making It Matter.","authors":"Katrin Burkart, Michael Brauer, Gregory A Roth","doi":"10.1016/j.jacc.2026.05.016","DOIUrl":"10.1016/j.jacc.2026.05.016","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1033-1036"},"PeriodicalIF":22.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405081","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":"Compound Exposure to Extreme Heat and Substantial Landscape Fire-Sourced Air Pollution on Cardiovascular Mortality.","authors":"Bo Wen, Yao Wu, Eric Lavigne, Micheline Coelho, Rongbin Xu, Gongbo Chen, Pei Yu, Yanming Liu, Wenhua Yu, Tingting Ye, Wenzhong Huang, Zhengyu Yang, Yiwen Zhang, Zhihu Xu, Shuang Zhou, Ke Ju, Paulo Saldiva, Patricia Matus, Wissanupong Kliengchuay, Kraichat Tantrakarnapa, Shanshan Li, Yuming Guo","doi":"10.1016/j.jacc.2026.06.005","DOIUrl":"10.1016/j.jacc.2026.06.005","url":null,"abstract":"<p><strong>Background: </strong>Climate change is increasing the frequency and co-occurrence of extreme heat and landscape fire-sourced air pollution; yet, evidence on their combined cardiovascular impacts remains limited.</p><p><strong>Objectives: </strong>The purpose of this study was to examine whether compound exposure to heat waves and substantial fire-sourced air pollution (SFAP) is associated with excess cardiovascular disease (CVD) mortality risk beyond single-hazard exposure and assess potential additive interactions.</p><p><strong>Methods: </strong>We conducted a multicountry time-series study across 6 countries, analyzing national representative daily CVD mortality data in relation to heat waves, SFAP, and their co-occurrence. Each day was classified into mutually exclusive exposure states: no hazard, heat wave-only, SFAP-only, and compound exposure. We estimated relative risks (RRs) using quasi-Poisson regression and evaluated additive interaction using the relative excess risk due to interaction (RERI), attributable proportion, and synergy index.</p><p><strong>Results: </strong>Based on 5.9 million CVD death records, compound exposure was associated with an 11.5% increase in cardiovascular mortality (RR: 1.115; 95% CI: 1.100-1.130), exceeding risks for heat wave-only (RR: 1.083; 95% CI: 1.074-1.091) and SFAP-only exposure (RR: 1.014; 95% CI: 1.008-1.021). Modest positive additive interaction was observed (RERI: 0.018; 95% CI: 0.002-0.035), corresponding to 1.598% (95% CI: 0.181%-3.129%) of cardiovascular mortality during compound exposure days. The largest additive interaction was observed for heart failure (HF) mortality, for which compound exposure was associated with an RR of 1.245 (95% CI: 1.191-1.301), with 7.731% (95% CI: 3.293%-12.488%) of HF deaths during compound exposure days attributable to additive interaction (RERI: 0.096; 95% CI: 0.040-0.161). Smaller but positive interaction effects were also observed for ischemic heart disease and stroke. Interaction magnitude varied across countries, with the largest effects observed in Australia. Results were consistent across alternative buffering windows and heat wave definitions, although the magnitude of the estimated effects attenuated modestly with wider buffers.</p><p><strong>Conclusions: </strong>Compound exposure to heat waves and SFAP was associated with higher cardiovascular mortality than single exposures, with stronger additive interaction signals for HF. These findings indicate that treating heat waves and landscape fire smoke as independent hazards may underestimate short-term cardiovascular mortality risk.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"965-977"},"PeriodicalIF":22.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620614","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":"Constituent-Specific PM_2.5 and Cardiovascular Risk: From Mass to Mixture.","authors":"Ying Hu, Xin Meng, Kai Chen","doi":"10.1016/j.jacc.2026.06.014","DOIUrl":"10.1016/j.jacc.2026.06.014","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1013-1015"},"PeriodicalIF":22.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549662","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":"Short-Term PM_2.5 Exposure and Cardiovascular Mortality: A Global Exposure-Response Analysis to Inform Alert Thresholds.","authors":"Yongkang Yang, Jianyu Deng, Peng Zhou, Pengfei Li, Tianjia Guan, Tao Xue, Tong Zhu","doi":"10.1016/j.jacc.2025.11.055","DOIUrl":"10.1016/j.jacc.2025.11.055","url":null,"abstract":"<p><strong>Background: </strong>Short-term exposure to ambient fine particulate matter (PM_2.5) is an established risk factor for cardiovascular morbidity and mortality. However, existing air pollution alert systems are inefficient in protecting general populations, partly because of a lack of precise understanding of the nonlinear exposure-response relationship between PM_2.5 and cardiovascular mortality.</p><p><strong>Objectives: </strong>The aim of this study was to construct a globally representative nonlinear exposure-response function for short-term PM_2.5 exposure and cardiovascular mortality through a systematic meta-analysis of published global literature. On the basis of this function, the goal was to identify an optimal public health alert threshold that balances health protection benefits with societal disruption.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of 100 epidemiologic studies (comprising 123 effect estimates) up to May 2025 was conducted. An innovative 3-stage meta-regression model, combining spline functions and structural causal modeling theory, was used to estimate the nonlinear curve. On the basis of this curve, and integrated with global gridded data on PM_2.5 concentrations, population, and baseline mortality, the cardiovascular mortality burden attributable to PM_2.5 from 2000 to 2023 was quantified, and a receiver-operating characteristic-like curve analysis was used to determine the optimal alert value.</p><p><strong>Results: </strong>The meta-analysis confirmed that for every 10 μg/m³ increase in short-term PM_2.5 concentration, the pooled risk ratio for cardiovascular mortality was 1.0090 (95% CI: 1.0074-1.0106). The constructed exposure-response curve exhibited a supralinear pattern: the marginal risk was high at low concentrations, flattened at moderate concentrations (∼75-150 μg/m³), and rose sharply again above 150 μg/m³. In 2023, the global number of cardiovascular deaths attributable to PM_2.5 pollution episodes (exceeding the World Health Organization's first-stage interim target of 75 μg/m³) was estimated at 59,399 (95% CI: 38,126-82,413). The optimal alert value was estimated as 136 μg/m³ (95% CI: 129-148), which could prevent 73.2% (95% CI: 71.8%-76.6%) of attributable deaths while affecting only 32% of at-risk person-days.</p><p><strong>Conclusions: </strong>A significant nonlinear relationship exists between short-term PM_2.5 exposure and cardiovascular mortality. The optimal alert value identified in this study provides critical evidence for developing more scientific, efficient, and health-oriented air pollution warning systems, thereby maximizing public health benefits while minimizing social disruption.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"914-930"},"PeriodicalIF":22.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146219954","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":"From Observation to Anticipation in a Changing Climate: Building a Climate-Cardiovascular Early Warning System.","authors":"Tiantian Li, Qinghua Sun, Yirong Liu, Chaodong Long","doi":"10.1016/j.jacc.2026.07.020","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.07.020","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"88 9","pages":"1030-1032"},"PeriodicalIF":22.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874193","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}