Journal of the American Heart Association最新文献

{"title":"Childhood Family Income and Adult Cardiovascular Health: Indirect Effects Through Childhood Neighborhood Socioeconomic Advantages and Disadvantages in a Prospective Sample of Young Men.","authors":"Emily J Jones, Portia Miller, Brianna N Natale, Tess Dupree, Sydney Damon, Anna L Marsland, Daniel S Shaw, Elizabeth Votruba-Drzal","doi":"10.1161/JAHA.124.037871","DOIUrl":"https://doi.org/10.1161/JAHA.124.037871","url":null,"abstract":"<p><strong>Background: </strong>Childhood family income may impact men's cardiovascular health (CVH), partly through exposure to neighborhood advantages and disadvantages experienced across childhood.</p><p><strong>Methods and results: </strong>One hundred thirty-one boys (52.7% Black or bi/multiracial) born into low-income households in an urban environment were followed throughout childhood and completed a health assessment in adulthood. Childhood family income and home addresses were collected when participants were ages 1.5 to 17 years (13 waves). Annual income was averaged across waves to calculate mean childhood family income. Addresses were geocoded and linked with Census data to estimate neighborhood socioeconomic advantage and disadvantage at the Census-tract level and averaged across waves to estimate cumulative childhood neighborhood advantage and disadvantage. At age 32 years, participants underwent a physiological assessment, and CVH was estimated using Life's Essential 8 metrics: body mass index, blood pressure, cholesterol, glycated hemoglobin, sleep, smoking, and physical activity (diet not available). The Hayes' MEDCURVE macro was used to estimate indirect effects of childhood family income on adult CVH through neighborhood socioeconomic advantage and disadvantage across childhood. Higher childhood family income was associated with better CVH among men through greater exposure to childhood neighborhood advantage. Greater childhood family income was also protective for men's CVH through reduced exposure to childhood neighborhood disadvantage; however, the indirect effect through neighborhood disadvantage varied by childhood income and was the most robust among men raised in relatively higher-income households throughout childhood.</p><p><strong>Conclusions: </strong>Improving socioeconomic neighborhood conditions may have the potential to benefit adult CVH among racially diverse boys born into low-income urban environments.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037871"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804737","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":"Early Initiation of Sodium-Glucose Cotransporter 2 Inhibitors in Acute Heart Failure: A Systematic Review and Meta-Analysis.","authors":"Miloud Cherbi, Olivier Lairez, Guillaume Baudry, Paul Gautier, François Roubille, Clément Delmas","doi":"10.1161/JAHA.124.039105","DOIUrl":"https://doi.org/10.1161/JAHA.124.039105","url":null,"abstract":"<p><strong>Background: </strong>Observational studies and small randomized controlled trials have suggested the benefits of early introduction of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in acute heart failure (AHF). However, current evidence on their efficacy and safety in this clinical setting remains limited.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis to assess efficacy/safety of early use of SGLT2is in AHF. PUBMED/EMBASE/Cochrane were searched from inception to May 31, 2024, for randomized controlled trials evaluating outcomes of SGLT2i early initiation in patients with AHF. Efficacy outcomes were all-cause death and heart failure rehospitalizations. Safety outcomes included acute kidney injury, ketoacidosis, urinary tract infections, hypotension, and hypoglycemia. Early initiation was defined as performed before or shortly after discharge (within 3 days). A sensitivity analysis was conducted, including only patients with initiation before discharge.</p><p><strong>Results: </strong>Seven randomized controlled trials that enrolled 2320 patients were included. Early use of SGLT2is was associated with a significant reduction in all-cause death (odds ratio, 0.71 [95% CI, 0.55-0.92; 95% PI, 0.55-0.98]) and HF rehospitalizations (odds ratio, 0.73 [95% CI, 0.57-0.94; 95% PI, 0.58-0.93]), even after adjusting for follow-up duration. SGLT2i initiation before discharge yielded consistent results for efficacy outcomes. Safety outcomes could not be usefully determined because of a low events rate resulting in wide CIs. The impact of diabetic status remains basically unknown due to the small number of available randomized controlled trials investigating this population.</p><p><strong>Conclusions: </strong>Early introduction of SGLT2is in AHF improves all-cause death and rehospitalization rates, can be performed before discharge, and should be offered to most patients with AHF.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039105"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804682","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":"Impact of Social Determinants of Health on Outcomes of Nontraumatic Subarachnoid Hemorrhage.","authors":"Daniela Renedo, Cyprien A Rivier, Andrew Koo, Santiago Clocchiatti-Tuozzo, Shufan Huo, Nanthiya Sujijantarat, Victor M Torres-Lopez, Ryan M Hebert, Lee Schwamm, Adam de Havenon, Murat Gunel, Charles C Matouk, Guido J Falcone, Kevin N Sheth","doi":"10.1161/JAHA.124.037199","DOIUrl":"https://doi.org/10.1161/JAHA.124.037199","url":null,"abstract":"<p><strong>Background: </strong>Nontraumatic subarachnoid hemorrhage (SAH) presents a significant health burden, yet the influence of social determinants of health on outcomes remains unclear. This study examines the impact of social determinants of health on outcomes of patients with SAH.</p><p><strong>Methods and results: </strong>We conducted a retrospective analysis of prospectively collected data from the GWTG (Get With The Guidelines)-Stroke registry, including patients with SAH across the United States from 2012 to 2021. The role of the Social Deprivation Index (SDI) and adjusted gross income, stratified into tertiles, were assessed. Outcomes included in-hospital death, length of stay, and discharge disposition (good: home/rehabilitation; poor: long-term facility/hospice/death). Covariates included demographics, medical history, vascular risk factors, and SAH severity. Multivariable regressions were used to estimate associations, presenting odds ratios (ORs) and relative risks. Our study comprised 108 090 patients with nontraumatic SAH (mean age, 59.76 years; 61.3% women). The average length of stay was 12.04 days, 55.6% had good discharge disposition, and the overall mortality rate was 15.5%. Analyses showed that a high Social Deprivation Index was associated with reduced odds of a good discharge (unadjusted OR, 0.90 [95% CI, 0.87-0.92]; adjusted OR, 0.87 [95% CI, 0.82-0.92]), while higher adjusted gross income correlated with decreased death (unadjusted OR, 0.94 [95% CI, 0.90-0.97]; adjusted OR, 0.90 [95% CI, 0.83-0.96]). A high Social Deprivation Index was significantly associated with longer length of stay (unadjusted relative risk, 1.06 [95% CI, 1.07-1.26]; adjusted relative risk, 1.03 [95% CI, 1.01-1.13]).</p><p><strong>Conclusions: </strong>Social determinants of health shape outcomes for patients with SAH, with a clear gradient of impact across socioeconomic levels.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037199"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804683","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":"Disabling Neurologic Deficits and Antiplatelet Therapy in Acute Minor Stroke.","authors":"Chong Han, Ming Yang, Yuesong Pan, Hao Li, Liping Liu, Xia Meng, Yilong Wang, Yongjun Wang","doi":"10.1161/JAHA.122.029734","DOIUrl":"https://doi.org/10.1161/JAHA.122.029734","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the clinical outcome among patients with minor stroke, both with and without disabling neurologic deficits (DNDs). It sought to investigate the efficacy of antiplatelet therapy using clopidogrel-aspirin versus aspirin alone within the framework of the CHANCE (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) trial.</p><p><strong>Methods and results: </strong>We enrolled 3725 patients with minor stroke from the CHANCE trial. Patients were divided into 2 groups: those with DNDs and those without, based on the presence or absence of DND, as determined by the baseline National Institutes of Health Stroke Scale score. The interaction between the treatment effects of antiplatelet therapy in patients with or without DNDs was analyzed using the Cox proportional hazards regression model. Of all enrolled patients, 1918 (51.5%) had DNDs, and 1807 (48.5%) did not. Patients with DNDs exhibited a higher risk of stroke recurrence at 90 days compared with those without (11.9% versus 8.5%; <i>P</i>=0.008). Dual antiplatelet therapy with clopidogrel and aspirin was associated with a reduced risk of recurrent stroke compared with the mono antiplatelet therapy in both patients with DND and patients without DNDs (adjusted hazard ratios, 0.74 [95% CI, 0.57-0.96] and 0.64 [95% CI, 0.46-0.88], respectively). There was no significant interaction between DNDs and antiplatelet therapy in reducing stroke recurrence (interaction <i>P</i>=0.634).</p><p><strong>Conclusions: </strong>DNDs appear to correlate with an elevated risk of recurrent stroke in patients with minor stroke. Dual antiplatelet therapy demonstrates superiority over aspirin alone in reducing the risk of subsequent stroke events within 90 days in patients, regardless of the presence of DNDs.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique Identifier: NCT00979589.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e029734"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804742","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":"Spontaneous Coronary Artery Dissection and a Family History of Aortic Dissection: A Genetic Association Study.","authors":"Lucy McGrath-Cadell, Stephanie Hesselson, Ingrid Tarr, Emma M Rath, Michael Troup, Yunkai Gao, Keerat Junday, Monique Bax, Siiri E Iismaa, Nicholas Collins, David W M Muller, Jason C Kovacic, Eleni Giannoulatou, Robert M Graham","doi":"10.1161/JAHA.124.037921","DOIUrl":"https://doi.org/10.1161/JAHA.124.037921","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome or sudden cardiac death, primarily affecting relatively young women (median age, 51 years) without typical cardiovascular risk factors. SCAD has a genetic component, with genome-wide association studies identifying multiple risk loci. Thoracic aortic dissection (type A) shares some genetic overlap with SCAD, suggesting potential common predispositions.</p><p><strong>Methods: </strong>We performed genetic screening or whole-genome sequencing of 17 patients with SCAD (94% women) with a first- or second-degree relative (89% men) affected by aortic dissection (AD). We assessed rare variants in candidate genes and genome-wide using the American College of Medical Genetics and Genomics criteria. Polygenic risk scores were calculated to assess genetic risk for SCAD, fibromuscular dysplasia, AD, and abdominal aortic aneurysm in patients with SCAD, relatives with AD, and controls.</p><p><strong>Results: </strong>Whole-genome sequencing identified pathogenic or likely pathogenic variants in <i>SMAD3</i>, <i>CBS</i>, and <i>COL3A1</i> in 3 SCAD cases. Additionally, 4 variants of uncertain significance were found in candidate genes. Polygenic risk scores for SCAD were significantly associated with increased odds of SCAD in probands versus controls (odds ratio, 1.79 [95% CI, 1.08-2.99]; <i>P</i>=0.024).</p><p><strong>Conclusions: </strong>Our study supports a complex genetic landscape underlying SCAD, implicating rare monogenic pathogenic variants and polygenic risk. We identified pathogenic variants in patients with SCAD with a family history of AD, highlighting potential genetic links between these vascular disorders. The findings underscore the importance of genetic screening in patients with SCAD with a history of AD to identify individuals at risk and guide preventive strategies.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037921"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804658","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":"Mediation of Time-Related Blood Pressure Variability on Intensive Blood Pressure Lowering and Functional Outcomes Post Endovascular Therapy: A Post Hoc Analysis of the OPTIMAL-BP Trial.","authors":"Jun Young Chang, Jae Young Park, Jeong Yun Song, Jun Sang Yoo, Kyu Bong Lee, Jae Wook Jung, Ji Sung Lee, Young Dae Kim, Byung Moon Kim, Bang-Hoon Cho, Seong Hwan Ahn, Sung-Il Sohn, Tae-Jin Song, Yoonkyung Chang, Kwon-Duk Seo, Sukyoon Lee, Jang-Hyun Baek, Han-Jin Cho, Dong Hoon Shin, Jinkwon Kim, Kyung-Yul Lee, Yang-Ha Hwang, Chi Kyung Kim, Jae Guk Kim, Sun U Kwon, Oh Young Bang, Ji Hoe Heo, Hyo Suk Nam","doi":"10.1161/JAHA.124.039723","DOIUrl":"https://doi.org/10.1161/JAHA.124.039723","url":null,"abstract":"<p><strong>Background: </strong>We investigated whether the association between blood pressure (BP) management in patients with successful reperfusion following endovascular therapy (EVT) and functional outcomes is mediated by BP variability parameters.</p><p><strong>Methods and results: </strong>This is a post hoc analysis of the OPTIMAL-BP (Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control) trial, conducted at 19 centers in South Korea. The primary outcome was the 90-day functional outcome, assessed using the modified Rankin Scale. Multivariable logistic regression analysis was conducted for the association between BP variability and outcomes including 90-day modified Rankin Scale score, symptomatic intracranial hemorrhage, and final infarction volume. Mediation analysis was performed to evaluate the causal inference whether the relationship between intensive BP management and the 90-day modified Rankin Scale scoreis mediated by 24-hour BP variability parameters (time rate [TR], SD, coefficient of variation, and variability independent of the mean). Among various BP variability parameters, higher TR was associated with an unfavorable ordinal shift of the 90-day modified Rankin Scale score (adjusted odds ratio [aOR], 1.17 [95% CI, 1.04-1.32], <i>P</i>=0.007) and an increase in final infarction volume (<math><semantics><mrow><mi>β</mi></mrow><annotation>$$ beta $$</annotation></semantics></math> coefficient, 21.24 [95% CI, 3.99-38.48], <i>P</i>=0.016), but did not increase the risk of symptomatic intracranial hemorrhage. TR fully mediated the association between intensive BP management and functional outcomes. The proportion of the association explained by TR was 40.93%.</p><p><strong>Conclusions: </strong>TR mediated the relationship between intensive BP management and poor functional outcome in successfully reperfused patients with ischemic stroke by contributing to an increase in infarct volume. Efforts to modulate TR after EVT may be helpful in improving clinical outcomes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039723"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804686","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":"Prognostic Value of Strain by Tissue Tracking Cardiac Magnetic Resonance in Myocardial Infarction With Nonobstructive Coronary Arteries.","authors":"Lei Chen, Bowen Qiu, Fuad A Abdu, Lu Liu, Wen Zhang, Chunyue Wang, Jiasuer Alifu, Penglong Qi, Wenliang Che, Yuan Lu","doi":"10.1161/JAHA.124.039395","DOIUrl":"https://doi.org/10.1161/JAHA.124.039395","url":null,"abstract":"<p><strong>Background: </strong>Strain assessed by cardiac magnetic resonance (CMR) is a key prognostic indicator in myocardial infarction. However, the strain characteristics and prognostic value in myocardial infarction with nonobstructive coronary arteries (MINOCA) with different causes are unclear. This study aims to describe left atrial (LA) and left ventricular strain in patients with MINOCA and evaluate their predictive value for major adverse cardiovascular events (MACEs) in \"true MINOCA\" cases.</p><p><strong>Methods and results: </strong>This single-center retrospective study included patients suspected of myocardial infarction who completed CMR during hospitalization. CMR images were used to obtain LA and left ventricular strain via CMR feature tracking. True MINOCA was defined by evidence of ischemia or infarction on CMR. MACEs included all-cause death, recurrent myocardial infarction, stroke, heart failure, atrial fibrillation, and angina pectoris. This study included 386 patients, with a median time from admission to CMR of 4 days. LA and left ventricular strains varied by pathogenesis, with the lowest strain in patients with cardiomyopathy. For patients with true MINOCA, Cox regression showed that global longitudinal strain (hazard ratio [HR], 0.90 [95% CI, 0.82-0.99]; <i>P</i>=0.022) and LA reservoir strain (HR, 0.95 [95% CI, 0.91-0.99]; <i>P</i>=0.014) were independently associated with MACEs. Kaplan-Meier analysis indicated that patients with LA reservoir strain ≤21.25% or global longitudinal strain ≤16.4% had a significantly higher MACE risk (<i>P</i><0.001). Integrating global longitudinal strain and LA reservoir strain improved MACE prediction.</p><p><strong>Conclusions: </strong>LA and left ventricular strains vary among MINOCA pathogeneses. In true MINOCA patients, global longitudinal strain and LA reservoir strains independently predict MACE risk. Integrating these strains enhances MACE prediction.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique Identifier: NCT06502899.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039395"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804689","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":"Prolonged Venous Transit as a Superior Predictor of Functional Outcomes in Successfully Reperfused Large Vessel Occlusions: Comparative Analysis With Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio.","authors":"Janet Mei, Hamza Adel Salim, Dhairya A Lakhani, Aneri Balar, Vaibhav Vagal, Manisha Koneru, Dylan Wolman, Risheng Xu, Victor Urrutia, Elisabeth Breese Marsh, Benjamin Pulli, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z Hyson, Mona Shahriari, Adam A Dmytriw, Adrien Guenego, Gregory W Albers, Hanzhang Lu, Kambiz Nael, Argye E Hillis, Rafael Llinas, Max Wintermark, Tobias D Faizy, Jeremy J Heit, Vivek Yedavalli","doi":"10.1161/JAHA.124.039924","DOIUrl":"https://doi.org/10.1161/JAHA.124.039924","url":null,"abstract":"<p><strong>Background: </strong>Collateral status plays a crucial role in outcomes after acute ischemic stroke due to large vessel occlusion. Tissue-level collaterals and venous outflow are key components following mechanical thrombectomy. This study evaluates the predictive performance of prolonged venous transit (PVT), cerebral blood volume index, and hypoperfusion intensity ratio in determining 90-day functional outcomes.</p><p><strong>Methods and results: </strong>We retrospectively analyzed patients with acute ischemic stroke due to large vessel occlusion with successful mechanical thrombectomy (modified Treatment in Cerebral Infarction score 2b, 2c, or 3). PVT+ was defined as <i>T</i>_max ≥10 seconds in the superior sagittal sinus or torcula. Favorable hypoperfusion intensity ratio was <0.4, and cerebral blood volume index was ≥0.8. We assessed their predictive value using logistic regression and receiver operating characteristic analysis. Among 119 patients (median age: 71 years, 59.7% female), 37 (30.3%) were PVT+. Favorable 90-day modified Rankin Scale score (≤2) was achieved in 53.8%. PVT- had a sensitivity of 84.4%, outperforming cerebral blood volume index (75.0%) and hypoperfusion intensity ratio (54.7%). Combining PVT with CBV index or hypoperfusion intensity ratio improved predictive accuracy (area under the curve: 0.716-0.727; all <i>P</i><0.05).</p><p><strong>Conclusions: </strong>PVT is a superior predictor of 90-day functional outcomes compared with cerebral blood volume index and hypoperfusion intensity ratio, emphasizing the role of venous outflow in collateral assessment and stroke prognosis.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039924"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804651","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":"Cardiovascular Health Trajectories and Prevalent Metabolic Dysfunction-Associated Steatotic Liver Disease in Midlife: The CARDIA Study.","authors":"Seong W Park, Hongyan Ning, Mercedes R Carnethon, Lisa B VanWagner","doi":"10.1161/JAHA.124.037948","DOIUrl":"https://doi.org/10.1161/JAHA.124.037948","url":null,"abstract":"<p><strong>Background: </strong>Metabolic-dysfunction associated steatotic liver disease (MASLD) is associated with prevalent cardiovascular disease. More favorable cardiovascular health (CVH) profiles are associated with a lower prevalence of MASLD in cross-sectional studies. The relationship between long-term CVH patterns and MASLD prevalence in midlife remains unknown.</p><p><strong>Methods and results: </strong>Participants (aged 18-30 years at baseline) of the CARDIA (Coronary Artery Risk Development in Young Adults) study who had individual CVH components measured at 7 examinations over 20 years and liver fat assessed by noncontrast computed tomography at year 25 follow-up were included. CVH score was defined using published American Heart Association definitions. Group-based trajectory modeling was used to identify CVH trajectories. MASLD was defined as liver attenuation of ≤51 Hounsfield units with at least 1 metabolic risk factor after excluding other causes of liver fat. Logistic regression was used to examine associations of CVH trajectory groups and MASLD prevalence. At baseline, 39% of 2529 participants had high and 5% had low CVH, respectively. MASLD prevalence at year 25 was 23% (n=587). Five distinct CVH trajectories were identified. Between the 2 groups that started at similar CVH scores, those whose CVH declined over time had a higher prevalence of MASLD at year 25 (7.0% in high-stable versus 23.0% high-decreasing; 24.4% in moderate-stable versus 35.7% in moderate-decreasing). Lower and decreasing trajectories were associated with higher year-25 MASLD prevalence compared with the high-stable trajectory.</p><p><strong>Conclusions: </strong>Achieving and maintaining high CVH scores starting in young adulthood lowers the risk of prevalent MASLD in midlife.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037948"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804732","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":"Subclinical Atherosclerosis Risk Can Be Predicted in Female Patients With Systemic Lupus Erythematosus Using Metabolomic Signatures: An Observational Study.","authors":"Laurel Woodridge, Maria G Tektonidou, George A Robinson, Junjie Peng, Leda Coelewij, Lucia Martin-Gutierrez, Elvira Chocano Navarro, Maura Griffin, Andrew Nicolaides, Coziana Ciurtin, Anisur Rahman, Inés Pineda Torra, Elizabeth C Jury","doi":"10.1161/JAHA.124.036507","DOIUrl":"https://doi.org/10.1161/JAHA.124.036507","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is a leading cause of death in women with systemic lupus erythematosus (SLE) due to accelerated atherosclerosis that is not predicted by established CVD risk scores. This study aimed to develop, validate, and test a female-focused predictive atherosclerosis risk signature based on serum metabolites in patients with SLE.</p><p><strong>Methods and results: </strong>Female patients with SLE were assessed for the presence (SLE-P; n=18) or absence (SLE-NP; n=26) of subclinical atherosclerosis using vascular ultrasound for carotid/femoral intima-media thickness. CVD risk was assessed using QRISK3 (which includes SLE diagnosis as a risk factor) and Framingham Risk Score. Serum metabolomics (n≥250) was performed and analyzed using machine learning pipelines. Despite having subclinical atherosclerosis, 44.8% to 100% of patients with SLE-P had low CVD risk according to QRISK3/Framlingham Risk Score scores. Using a lipid-focused metabolomic analysis, an improved atherosclerosis risk predictive signature was developed comprising 35 metabolites/5 clinical traits that classified patients with SLE-P and outperformed CVD risk assessment tools, lipid profiles measured in routine care, and clinical features alone. This \"atherosclerosis risk signature\" was validated in a second adult female SLE cohort (n=98) that predicted plaque status with moderate accuracy (area under the receiver operating characteristic curve, 0.79). The signature was then refined into a 5-feature subclinical plaque-predictive score that not only stratified the combined SLE-P/SLE-NP cohorts (n=142; area under the receiver operating characteristic curve, 0.84) but also predicted 3-year atherosclerosis progression in female postpubertal patients with juvenile-onset SLE (n=36; area under the receiver operating characteristic curve, 0.79). Finally, the 5-feature score identified distinct high and low subclinical atherosclerosis risk subgroups in a \"real-world\" setting of unscanned adult patients with SLE (n=38).</p><p><strong>Conclusions: </strong>This atherosclerosis risk score could improve CVD risk assessment/management in female patients with SLE across age. Validation in non-SLE and healthy cohorts could further substantiate these findings.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036507"},"PeriodicalIF":5.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804660","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}