Journal of the American Heart Association最新文献

{"title":"Association Between Short-Term Change in Quality of Life and Clinical Outcomes: A Post Hoc Analysis of the ISCHEMIA Trial.","authors":"Tulio Caldonazo, Jessica Kim, Rachel Heise, Mohamed Rahouma, Lamia Harik, Bjorn Redfors, Sigrid Sandner, Torsten Doenst, Mario F L Gaudino","doi":"10.1161/JAHA.124.038250","DOIUrl":"10.1161/JAHA.124.038250","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038250"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722529","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":"Nationwide Trends in Stroke Among Patients Undergoing Hemodialysis by Sex and Race: An Analysis From the US Renal Database.","authors":"Zafar Ali, Wan-Chi Chan, Edward F Ellerbeck, Reem A Mustafa, Jinxiang Hu, Kamal Gupta","doi":"10.1161/JAHA.124.036468","DOIUrl":"10.1161/JAHA.124.036468","url":null,"abstract":"<p><strong>Background: </strong>The risk of ischemic stroke hospitalization in patients with end-stage kidney disease has declined over time, but data are limited, especially for hemorrhagic stroke trends. Race- and sex-based differences have not been well studied.</p><p><strong>Methods and results: </strong>We conducted a retrospective cohort study using the US Renal Data System to examine the incidence of stroke among incident patients undergoing hemodialysis from 2006 to 2016. We identified 391 195 new patients undergoing hemodialysis (mean age, 70.1 years; 44.8% women) between 2006 and 2016. The incidence of any stroke per 100 000 patients decreased from 2746 cases at 1 year and 6823 cases at 3 years during 2006 to 2009 to 1983 cases at 1 year and 5162 cases at 3 years in 2014 to 2016 (<i>P</i><0.001). Women had higher stroke incidence than men (<i>P</i><0.001). White adults had higher incidence compared with Black adults, Hispanic adults, and Other (Native American participants and those whose racial and ethnic identification did not align with the classifications) race (<i>P</i><0.001). The risk decreased over the study period for both sexes and races, except \"Other\" race. Hemorrhagic stroke incidence was 409 cases at 1 year and 1125 at 3 years per 100 000. No sex difference was observed at 1 year, but women had higher 3-year rates (<i>P</i>=0.005). Black and Hispanic adults had higher 3-year hemorrhagic stroke rates than White adults (<i>P</i><0.001). Decreases occurred only for women, Black adults, and Hispanic adults at 1 year.</p><p><strong>Conclusions: </strong>While the overall risk of stroke remains high after hemodialysis initiation, significant reductions in stroke risk have occurred over the past decade across sexes and racial groups.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036468"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711939","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":"Carotid Intima-Media Thickness, Carotid Distensibility, and Incident Heart Failure in Older Men: The British Regional Heart Study.","authors":"Atinuke Akinmolayan, A Olia Papacosta, Lucy T Lennon, Elizabeth A Ellins, Julian P J Halcox, Peter H Whincup, S Goya Wannamethee","doi":"10.1161/JAHA.124.037167","DOIUrl":"10.1161/JAHA.124.037167","url":null,"abstract":"<p><strong>Background: </strong>Carotid intima-media thickness (CIMT) and carotid distensibility are markers of arterial change; however, little is known of the association with incident heart failure (HF). We aimed to assess this.</p><p><strong>Methods: </strong>This was a longitudinal analysis of data from the British Regional Heart Study, a prospective cohort study. A total of 1631 men aged 71 to 92 years, without a diagnosis of HF at baseline, were included. Between 2010 and 2012, participants completed a questionnaire, underwent a physical examination, and provided a fasting blood sample. CIMT and carotid artery distension were measured, and carotid distensibility was calculated. Cox proportional hazards modeling was used to assess the multivariate-adjusted hazard ratios (HRs) of incident HF by quartiles of CIMT and distensibility, excluding men with prevalent myocardial infarction.</p><p><strong>Results: </strong>The values used in the analysis were adjusted for age, social class, smoking, physical activity, alcohol status, body mass index, use of statins and antihypertensives, prevalent diabetes and stroke, pulse pressure, and presence of atrial arrhythmias. Lower carotid distensibility (bottom quartile) and higher CIMT (top quartile) were associated with increased risk of incident HF (HR, 2.55 [95% CI, 1.24-5.24]; <i>P</i>=0.01; and HR, 2.20 [95% CI, 1.14-4.23]; <i>P</i>=0.02, respectively). CIMT but not carotid distensibility was associated with incident myocardial infarction. The association between carotid distensibility and incident HF persisted after adjustment for incident myocardial infarction and CIMT (HR, 2.53 [95% CI, 1.23-5.22]; <i>P</i>=0.01); however, the association between CIMT and incident HF was attenuated after this adjustment (HR, 1.64 [95% CI, 0.84-3.21]; <i>P</i>=0.15).</p><p><strong>Conclusions: </strong>Lower carotid distensibility and higher CIMT were associated with an increased risk of incident HF, despite adjustment for incident myocardial infarction.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037167"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674899","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":"Timing and Adherence Matter for Sodium-Glucose Cotransporter-2 Inhibitors in Heart Failure.","authors":"Mehmet Birhan Yilmaz, Ahmet Celik, Anil Sahin, Tugce Colluoglu, Dilek Ural, Arzu Kanik, Naim Ata, Mustafa Mahir Ulgu, Şuayip Birinci","doi":"10.1161/JAHA.124.037035","DOIUrl":"10.1161/JAHA.124.037035","url":null,"abstract":"<p><strong>Background: </strong>It is imperative to maintain the use of sodium-glucose cotransporter-2 inhibitors (SGLT-2is) in patients with diabetes both after the index diagnosis of heart failure (HF) and even prior to the index diagnosis of HF. We aimed to investigate whether timing of SGLT-2 is before the index diagnosis of HF, and second, adherence to SGLT-2is in the form of the proportion of days covered metric matter in patients with HF and diabetes.</p><p><strong>Methods and results: </strong>All-cause death up to 7 years were evaluated in HF with diabetes from the subgroup analysis of TRends-HF (TRends in Heart Failure in Türkiye). Patients with HF and diabetes, who were prescribed an SGLT-2i either before or after the index diagnosis of HF were identified, categorized according to duration of exposure before the index HF diagnosis and according to proportion of days covered after the index diagnosis of HF, and compared with nonusers. There were 1 229 833 patients with HF and diabetes in the cohort. A total of 247 987 were on an SGLT-2i and had available timing data, and 14.06% had SGLT-2i on board before the index HF diagnosis. Median duration of SGLT-2i exposure before the index HF diagnosis was 417 days. Prognosis was the best among patients with diabetes who were prescribed an SGLT-2i before the index diagnosis of HF with an exposure more than median duration. Of note, among patients who were prescribed an SGLT-2i after the index HF diagnosis; there was a numerically graded increase in all-cause mortality rate such that a >10% decrease in SGLT-2i proportion of days covered was associated with a 59% increase in all-cause death (hazard ratio, 1.21-2.09).</p><p><strong>Conclusions: </strong>Regardless of time or adherence, SGLT-2is offer a remarkable all-cause death benefit to patients with HF and diabetes. SGLT-2is' all-cause death benefit for patients with HF and diabetes was greatest when it was prescribed before the HF index diagnosis. Poor adherence to SGLT-2is was associated with worsening survival in patients with HF and diabetes following the diagnosis of index HF.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037035"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674906","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 DNA-Methylation Age Acceleration on Long-Term Mortality Among US Adults With Cardiovascular-Kidney-Metabolic Syndrome.","authors":"Shuang Wu, Jun Zhu, Siqi Lyu, Juan Wang, Xinghui Shao, Han Zhang, Ziyi Zhong, Hongyu Liu, Lihui Zheng, Yang Chen","doi":"10.1161/JAHA.124.039751","DOIUrl":"10.1161/JAHA.124.039751","url":null,"abstract":"<p><strong>Background: </strong>The association between DNA methylation age acceleration (DNAmAA) and cardiovascular-kidney-metabolic (CKM) syndrome stages and long-term mortality in the population with CKM syndrome remains unclear.</p><p><strong>Methods and results: </strong>This cohort study included 1889 participants from the National Health and Nutrition Examination Survey (1999-2002) with CKM stages and DNA methylation age data. DNAmAA was calculated as residuals from the regression of DNA methylation age on chronological age. The primary outcome was all-cause mortality, with cardiovascular and noncardiovascular mortality as secondary outcomes. Proportional odds models assessed the associations between DNAmAAs and CKM stages, and Cox proportional hazards regression models estimated the associations between DNAmAAs and mortality. Significant associations were found between DNAmAAs and advanced CKM stages, particularly for GrimAge2Mort acceleration (GrimAA) (odds ratio [OR], 1.547 [95% CI, 1.316-1.819]). Over an average follow-up of 14 years, 1015 deaths occurred. Each 5-unit increase in GrimAA was associated with a 50% increase in all-cause mortality (95% CI, 1.39-1.63), a 77% increase in cardiovascular mortality (95% CI, 1.46-2.15), and a 42% increase in noncardiovascular mortality (95% CI, 1.27-1.59). With the lowest GrimAA tertile as a reference, the highest GrimAA tertile showed hazard ratios of 1.95 (95% CI, 1.56-2.45) for all-cause mortality, 3.06 (95% CI, 2.13-4.40) for cardiovascular mortality, and 1.65 (95% CI, 1.20-2.29) for noncardiovascular mortality. Mediation analysis indicated that GrimAA mediates the association between various exposures (including physical activity, Healthy Eating Index-2015 score, hemoglobin A1c, etc.) and mortality.</p><p><strong>Conclusions: </strong>GrimAA may serve as a valuable biomarker for assessing CKM stages and mortality risk in individuals with CKM syndrome, thereby informing personalized management strategies.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039751"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674917","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":"Associations Between Social Determinants of Health, Allostatic Load, and Anthracycline Cardiotoxicity in a Diverse Patient Population.","authors":"Lili Zhang, Justin Song, Waqas Hanif, Rachel Clark, Magued Haroun, Mrunalini Dandamudi, Patricia Guia Simoza, Leandro Slipczuk, Mario J Garcia, Min Pu, Carlos A Gongora, Tomas G Neilan, Della F Makower, Earle C Chambers, Carlos J Rodriguez","doi":"10.1161/JAHA.124.036649","DOIUrl":"10.1161/JAHA.124.036649","url":null,"abstract":"<p><strong>Background: </strong>Allostatic load (AL) is a measurement of physiological burden of chronic stress, operationalized using a composite score derived from biomarkers from multiple physiologic systems. The relationship between AL and anthracycline cardiotoxicity is unclear.</p><p><strong>Methods and results: </strong>We included consecutive adult patients who underwent anthracycline-based chemotherapy from 2016 to 2019 for any type of cancer. Patients with preexisting heart failure and lack of AL score measures were excluded from the analysis. A composite AL score was calculated using 9 biomarkers tested before initiating chemotherapy. The end point was the development of cardiotoxicity (defined as clinical heart failure or drop in left ventricular ejection fraction≥10% to <50%). A total of 718 patients were included in the analysis (29% Non-Hispanic White, 31% Non-Hispanic Black, 40% Hispanic). The mean AL score was 2.4±1.4 and it was significantly higher in Non-Hispanic Black and Hispanic patients compared with Non-Hispanic White patients (2.5±1.3 in Non-Hispanic Black versus 2.4±1.3 in Hispanic versus 2.1±1.5 in Non-Hispanic White, <i>P</i>=0.031). In patients who developed cardiotoxicity, AL score was significantly higher than patients without cardiotoxicity (2.7±1.4 versus 2.3±1.3, <i>P</i>=0.006). AL score was independently associated with incident anthracycline cardiotoxicity after adjusting for race and ethnicity, age, sex, cardiovascular risk factors, anthracycline dose, baseline left ventricular ejection fraction, cancer type, and cancer metastasis (hazard ratio 1.20 per 1 AL score increase [95% CI, 1.02-1.43], <i>P</i>=0.033). AL score remained significantly associated with anthracycline cardiotoxicity after additional adjustment of social determinants of health.</p><p><strong>Conclusions: </strong>AL score can be a potential important prognostic marker in the prediction of cardiotoxicity in patients with cancer undergoing cardiotoxic treatment independent of social determinants of health.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036649"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722532","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":"Multimorbidity Patterns and In-Hospital Outcomes in Chinese Young Women (Aged <55 Years) Presenting with ST-Segment-Elevation Myocardial Infarction.","authors":"Geru A, Liang Zhao, Wennan Liu, Pengfei Sun, Linjie Li, Bin Sun, Piao Li, Yongle Li, Xin Zhou, Qing Yang","doi":"10.1161/JAHA.124.034124","DOIUrl":"10.1161/JAHA.124.034124","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence highlights an increasing incidence of myocardial infarction in young women. Identifying clinical multimorbidity patterns in this population may improve therapeutic strategies and clinical care.</p><p><strong>Methods and results: </strong>We identified multimorbidity patterns in 9570 young women with ST-segment-elevation myocardial infarction (median age, 50 years [range, 47.0-53.0 years]) admitted to the China Chest Pain Center Database between 2016 and 2021. Hierarchical clustering of 15 medical conditions was performed to derive multimorbidity patterns. The primary outcome was a composite of in-hospital adverse events. Associations between multimorbidity patterns and outcomes were evaluated using multivariable-adjusted logistic regression models. Among 9570 patients, 50% (n=4789) had multimorbidity. Six multimorbidity patterns were identified, including 4 specific patterns: (1) pattern 1, cerebrovascular cluster (histories of cerebrovascular disease and hypertension); (2) pattern 2, traditional cardiovascular disease risk factors cluster (histories of hyperlipidemia, obesity, and diabetes, and family history of cardiovascular disease and smoking); (3) pattern 3, coronary-heart failure cluster (histories of heart failure, coronary artery disease, peripheral arterial disease, and thyroid dysfunction); and (4) pattern 4, anemia-renal dysfunction cluster (histories of atrial fibrillation, anemia, chronic kidney disease, and peptic ulcer). Compared with patients without multimorbidity, those with pattern 1 (odds ratio [OR], 2.29 [95% CI, 1.49-3.52]), pattern 2 (OR, 1.52 [95% CI, 1.24-1.86]), and pattern 4 (OR, 2.25 [95% CI, 1.10-4.61]) exhibited higher risks for composite outcomes.</p><p><strong>Conclusions: </strong>Specific multimorbidity patterns in young women with ST-segment-elevation myocardial infarction were associated with distinct in-hospital outcomes in a nationwide registry, providing proof-of-concept evidence to guide future therapeutic approaches.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e034124"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733213","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":"Alterations in Liver Perfusion in Adults With Fontan Circulation as Assessed by Dual Cholate Clearance.","authors":"Yuli Y Kim, Annique Nyman, Yuan-Shung Huang, Alexis Z Tomlinson, Michael P McRae, Greg T Everson, Sumeet Vaikunth, Benjamin Rosenthal, Jack Rychik, Maarouf A Hoteit","doi":"10.1161/JAHA.124.039479","DOIUrl":"10.1161/JAHA.124.039479","url":null,"abstract":"<p><strong>Background: </strong>Fontan circulation (FC) in complex congenital heart disease is characterized by altered hemodynamics and associated with Fontan-associated liver disease. Patients with FC may exhibit abnormalities in cholate clearance due to abnormal perfusion. We aimed to compare cholate clearance in adults with FC to healthy controls and explore associations between cholate clearance and clinical features.</p><p><strong>Methods and results: </strong>This is a prospective cohort study of patients with FC ≥18 years of age between 2019 and 2022. Systemic and portal hepatic clearance of cholate was assessed using a dual cholate clearance assay (HepQuant Shunt), measuring systemic and portal hepatic filtration rates (HFRs). Systemic HFR/portal HFR ratio (SHUNT%) was calculated. Participants with FC and healthy controls were compared using the Fisher exact test and Wilcoxon test. Univariable regression and multivariable analyses determined associations with clinical variables. There were 35 participants with FC (54% women; median age 29.0 years [interquartile range, 24.0-36.0], 91% White) and 26 controls. In addition to lower platelet counts and higher aspartate aminotransferase to platelet ratio index, and Fibrosis-4 indices, FC participants had lower systemic HFR and portal HFR. SHUNT% was comparable with controls but ranged from 8% to 76%, with 8 (23%) having SHUNT% >30%. In those with FC, increase in SHUNT% was associated with elevated Fontan pressure, higher aortopulmonary collateral flow, decreased oxygen saturation, elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, thrombocytopenia, and Fibrosis-4 ≥1.45.</p><p><strong>Conclusions: </strong>Cholate clearance, as defined by systemic and portal HFR, is impaired in those with FC. Features of worse Fontan physiology correlate with higher SHUNT%, supporting the hypothesis that hemodynamic derangements play a role in progression of Fontan-associated liver disease.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03726229.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039479"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674822","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":"Social Vulnerability and Long-Term Cardiovascular Outcomes After COVID-19 Hospitalization: An Analysis of the American Heart Association COVID-19 Registry Linked With Medicare Claims Data.","authors":"Reza Fakhraei, Yang Song, Dhruv S Kazi, Rishi K Wadhera, James A de Lemos, Sandeep R Das, David A Morrow, Issa J Dahabreh, Christine M Rutan, Kathie Thomas, Robert W Yeh","doi":"10.1161/JAHA.124.038073","DOIUrl":"10.1161/JAHA.124.038073","url":null,"abstract":"<p><strong>Background: </strong>Patients hospitalized with COVID-19 from socioeconomically vulnerable communities are at risk for in-hospital cardiovascular events. However, the association of socioeconomic vulnerability and outcomes after hospitalization is uncertain.</p><p><strong>Methods and results: </strong>American Heart Association COVID-19 Cardiovascular Disease Registry hospitalizations between March 1, 2020, and June 30, 2022, linked with Medicare fee-for-service claims, were analyzed. We used Centers for Disease Control and Prevention's Social Vulnerability Index to ascertain county-level and Medicare-Medicaid dual eligibility to ascertain patient-level social vulnerability. We evaluated the association between social vulnerability and a composite of myocardial infarction, stroke, heart failure, venous thromboembolism, cardiogenic shock, cardiac arrest, and death, following discharge, using Cox regression models. The study included 8565 patients (mean age 78 years, 50% female, 16% Black, 4% Hispanic, 25% dual eligible, 34% residing in the most vulnerable counties). Patients residing in the most vulnerable counties, and dual eligible patients, were more likely to be female, Black or Hispanic, and have increased comorbidities. A total of 3783 (52%) patients experienced a composite outcome. We found no association between the most vulnerable, compared with least vulnerable, counties and cardiovascular events (hazard ratio [HR], 0.97 [95% CI, 0.87-1.07]). Dual eligibility, compared with nondual eligibility, was associated with increased cardiovascular events (HR, 1.28 [95% CI, 1.19-1.37]), which was attenuated after adjusting for comorbidities (HR, 0.97 [95% CI, 0.89-1.04]).</p><p><strong>Conclusions: </strong>Among survivors of COVID-19 hospitalization, patient-level social vulnerability was associated with cardiovascular events, explained by increased comorbidities. County-level social vulnerability was not observed to be a risk for postdischarge events. Findings suggest targeting public health efforts toward dual eligible patients to mitigate poor outcomes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038073"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674891","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":"Life Course Approach for Managing Familial Hypercholesterolemia.","authors":"Samuel S Gidding, Dirk J Blom, Brian McCrindle, Uma Ramaswami, Raul D Santos, Gerald F Watts, Albert Wiegman","doi":"10.1161/JAHA.124.038458","DOIUrl":"10.1161/JAHA.124.038458","url":null,"abstract":"<p><p>Treatment of familial hypercholesterolemia is directed toward the moment of the medical encounter. However, risk for heart disease as a consequence of having familial hypercholesterolemia is related to lifelong exposure to elevated low-density lipoprotein cholesterol, rather than low-density lipoprotein cholesterol level at a specific time point. The purpose of this review is to reassess contemporary research on treatment of familial hypercholesterolemia and current evidence-based guidelines, to present an approach that emphasizes treatment across the life course, and to recognize the importance of family experiences to care. To accomplish this, we review the changing treatment needs that emerge across the life course, from birth through childhood, adolescence, young adulthood, peripregnancy, middle age, and late in life. Special attention is paid to improving adherence to treatment, the potential role of monitoring atherosclerosis in a lifelong model of care, and medical issues related to care transitions: from pediatric to internal medicine care, peripregnancy, after a cardiac event, and care after age 70 years in the absence of a cardiac event. Novel considerations related to treatment of homozygous familial hypercholesterolemia are discussed. The summary identifies research gaps that need to be closed to move from the current point-of-care model to one that considers treatment over the life course.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038458"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674921","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}