Journal of the American Heart Association最新文献

{"title":"Race and Ethnicity in Heart Failure Trials: Time to Update Recommended Categories for Global Relevance.","authors":"Mingming Yang, Toru Kondo, Pooja Dewan, Akshay S Desai, Antonio S Sibulo, Carolyn S P Lam, Chern-En Chiang, Efrain A Gomez, Felipe A Martinez, Jorge Thierer, Jose C Nicolau, Jose F Kerr Saraiva, Masafumi Kitakaze, Milton Packer, Muthiah Vaduganathan, Pham Nguyen Vinh, William T Abraham, Pardeep S Jhund, Scott D Solomon, John J V McMurray","doi":"10.1161/JAHA.124.037810","DOIUrl":"10.1161/JAHA.124.037810","url":null,"abstract":"<p><strong>Background: </strong>The collection of race and ethnicity data in clinical trials using standardized categories is recommended by the US Food and Drug Administration, although this is primarily for domestic reasons. The applicability and understanding of the categories in multinational trials are uncertain.</p><p><strong>Methods: </strong>We analyzed patient-level data from 13 major heart failure trials, examining race and ethnicity data recorded by country, as recommended by the Food and Drug Administration: \"American Indian or Alaska Native,\" \"Asian,\" \"Black or African American,\" \"Native Hawaiian or Other Pacific Islander,\" and \"White\" for race and \"Hispanic or Latino\" as a minimum for ethnicity (with an expanded list of ethnicities available).</p><p><strong>Results: </strong>Of the 54 087 patients studied, approximately 32.3% were women. In the United States, 77% of patients were reported to be of White race and 19% of Black race with very few assigned to another race category (1% Asian, 0.7% Native American, 0.2% Native Hawaiian or other Pacific islander, and 1.4% \"other\"). In Europe, race was almost uniformly reported as White, and a similar racial homogeneity was reported in Asia (Asian race). Conversely, in Latin America, 8.9% of patients were described as \"American Indian or Alaska Native,\" with a very high proportion in specific countries (eg, 36% in Guatemala and 21% in Mexico). In the United States, 6.2% of participants were reported to have Hispanic/Latino ethnicity but most patients in Latin America were reported to have this ethnicity; conversely, few patients had this ethnicity reported outside the Americas, including in Spain and Portugal. Among patients designated as Asian race, specific ethnicities (eg, Indian, Japanese etc) almost completely overlapped with the country of origin.</p><p><strong>Conclusions: </strong>This study highlights the challenges of applying standardized race and, particularly, ethnicity categories in global clinical trials. A multistakeholder approach is needed to improve the collection of race and ethnicity data in clinical trials.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037810"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267925","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":"Association of Shift Work and Lifestyle With Aortic Aneurysm Incidence: A Large Prospective Cohort Study in the UK Biobank.","authors":"Xinyi Liu, Xiaoyang Zhang, Chen Gong, Haiou Hu, Zhiyu Qiao, Chengnan Li, Yipeng Ge, Junming Zhu","doi":"10.1161/JAHA.124.040481","DOIUrl":"10.1161/JAHA.124.040481","url":null,"abstract":"<p><strong>Background: </strong>Shift work is associated with various health problems, but its impact on aortic aneurysm (AA) is unclear. The role of lifestyle factors in this regard is also less clear. This study aimed to explore the combined effects of shift work and lifestyle on AA risk.</p><p><strong>Methods: </strong>A total of 213971 employed or self-employed participants from the UK Biobank were included in the study. Employment and lifestyle information was collected. Cox proportional hazards regression models were applied to assess the association between shift work and AA. Restricted cubic spline functions, mediation, interaction, and joint analyses were used to further explore the relationship between unhealthy lifestyle, shift work, and AA risk.</p><p><strong>Results: </strong>Among 213 971 participants, 1035 developed AA during a mean follow-up of 14.9 years. In fully adjusted models, shift work was associated with a significantly higher risk of AA (hazard ratio [HR], 1.24 [95% CI, 1.06-1.46]), with frequent shift workers showing an elevated risk (HR, 1.27 [95% CI, 1.03-1.57]). A dose-dependent relationship was observed between the unhealthy lifestyle score and the risk of AA, with the risk of AA increasing as the unhealthy lifestyle score increased. The joint effect of shift work and unhealthy lifestyle showed a significant association, particularly among shift workers with 4 to 5 unhealthy lifestyle factors (HR, 2.26 [95% CI, 1.63-3.14]).</p><p><strong>Conclusions: </strong>In this cohort study, we found that shift work was significantly associated with an increased risk of AA. Additionally, unhealthy lifestyles, particularly smoking, may play a crucial role in this association. These findings underscore the need for targeted prevention strategies, especially for shift workers with unhealthy lifestyle factors.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040481"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217584","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":"Surgical, Hybrid, or Delayed Surgical Stage 1: Single-Ventricle Palliation Pathway Utilization and Outcome Trends.","authors":"Michael Kuntz, Steven Staffa, Eleonore Valencia, Aditya Kaza, Viviane G Nasr","doi":"10.1161/JAHA.124.039616","DOIUrl":"10.1161/JAHA.124.039616","url":null,"abstract":"<p><strong>Background: </strong>Pathways for single-ventricle palliation include traditional neonatal surgical stage 1 palliation (SP), hybrid stage 1 palliation (HP; pulmonary artery flow restriction with ductal stenting), and delayed surgical stage 1 palliation (DSP), preceded by pulmonary artery flow restriction and prostaglandins. Findings from studies aiming to determine the optimal pathway are conflicting. We aimed to describe current pathway utilization and outcomes.</p><p><strong>Methods: </strong>Using the Pediatric Health Information System between January 2016 and August 2023, we identified 1872 patients who underwent single-ventricle palliation (1573 SP, 123 DSP, and 176 HP).</p><p><strong>Results: </strong>Prematurity or low birth weight (<2.5 kg) were most common for DSP (52.9%) compared with SP (15.3%) and HP (36.4%) (<i>P</i><0.001). Comorbid conditions were most common for DSP. Case selection varied based on hospital volume; centers in the lowest volume quintile performed relatively more HP and DSP. In-hospital mortality and index hospitalization transplant were highest among HP (25.6%, 8.5%) compared with DSP (13.8%, 0.8%) and SP (11.3%, 0.9%) (<i>P</i><0.001). Hospital and intensive care unit length of stay were highest for DSP (both <i>P</i><0.001). Patients born prematurely or with low birth weight showed the highest in-hospital mortality for HP (35.9%) compared with DSP (16.9%) and SP (19.9%) (<i>P</i>=0.012); postprocedure length of stay was longest for DSP (<i>P</i>=0.026). The costs per day did not vary.</p><p><strong>Conclusions: </strong>DSP was used for patients with a higher rate of prematurity, lower birth weight, and more noncardiac comorbid conditions. HP, however, was associated with higher in-hospital mortality and index hospitalization transplant. Further study to determine the potential benefit of DSP for high-risk patients is warranted.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039616"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227646","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 Disease Attributable to High Systolic Blood Pressure in Younger Adults Requires Greater Attention: Insights from the Global Burden of Disease Study 2021.","authors":"Fanqi Li, Jiasong Li, Siyuan Tan, Gaoming Zeng, Jiayi Zhu, Jiabao Zhou, Zixi Zhang, Qiuzhen Lin, Na Liu, Qiming Liu","doi":"10.1161/JAHA.125.041964","DOIUrl":"10.1161/JAHA.125.041964","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) represents the most significant global burden among all diseases. High systolic blood pressure (HBP) is the most prevalent risk factor for CVD. This study aims to investigate the global burden of CVDs attributable to high systolic blood pressure (HBP-CVD) and to assess the effectiveness of disease control across different age groups.</p><p><strong>Methods: </strong>The burden was assessed by analyzing the numbers, age-standardized rates of deaths, and disability-adjusted life-years, alongside the corresponding estimated annual percentage change, stratified by age, sex, sociodemographic index, and geographical regions.</p><p><strong>Results: </strong>From 1990 to 2021, the age-standardized rates of death and disability-adjusted life-years declined, with estimated annual percentage changes of -1.45 and -1.36, respectively. However, owing to the growth in population, the current burden of HBP-CVD is increasing. The age-period-cohort model suggests that the alleviation of disease burden is more pronounced in populations ≥50 years of age, with the lowest point occurring around 70 years of age. The age-stratified estimated annual percentage change further substantiates this issue, revealing that disease control efforts are least effective in the 15 to 49 years of age group, compared with the 50 to 69 and 70+ years of age groups. Overall, health inequities in HBP-CVD are decreasing, yet they persist. More importantly, health inequities in the 15 to 49 years of age group have exacerbated from 1990 to 2021.</p><p><strong>Conclusions: </strong>The burden of HBP-CVD remains severe, and disease control was least effective in the 15 to 49 years of age group compared with the 50 to 69 and 70+ years of age groups. Urgent adjustments to health care policies are imperative.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041964"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267849","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":"Choroidal Vascular Volume, White Matter Hyperintensity, and Their Interaction With Cognitive Function in Aging Adults.","authors":"Youjie Wang, Ruilin Wang, Hang Wang, Le Cao, Chen Ye, Junfeng Liu, Bo Wu, William Robert Kwapong, Wendan Tao","doi":"10.1161/JAHA.124.039369","DOIUrl":"10.1161/JAHA.124.039369","url":null,"abstract":"<p><strong>Background: </strong>Reports have proposed the retinal choroid as a potential biomarker for dementia and cerebral age-related disorders. However, the clinical use of the choroid as a surrogate marker remains underexplored. This study investigated the associations among choroidal perfusion, white matter hyperintensity (WMH), and cognitive function.</p><p><strong>Methods: </strong>WMH severity (volume and shape features) and choroidal characteristics, including choroidal vascular volume, choroidal vascularity index, and choriocapillaris flow density, were automatically quantified in aging adults. Partial Spearman correlation was used to examine the relationship between choroidal and WMH metrics. General linear models were used to examine the associations of choroidal metrics and WMH characteristics with cognitive performance, as well as to explore potential interaction effects, whereas generalized estimating equations were applied to account for within-subject correlations in eye-specific data.</p><p><strong>Results: </strong>A total of 197 participants were included in the study. Choroidal vascular volume and choroidal vascular index were inversely correlated with total and periventricular WMH volumes. Irregular WMH shape and reduced choroidal vascular volume were both associated with poorer memory performance. A significant interaction was found between choroidal perfusion and periventricular WMH shape on memory, suggesting that the relationship between WMH features and memory function may be more pronounced in individuals with lower choroidal perfusion.</p><p><strong>Conclusions: </strong>The severity of WMH and the status of choroidal perfusion may jointly reflect memory performance, suggesting ischemia as a potential shared mechanism. Future research is warranted to assess the clinical usefulness of WMH and choroidal metrics in predicting cognitive decline.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039369"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267850","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":"Selection by Noncontrast Computed Tomography With or Without Computed Tomography Angiography Versus Computed Tomography Perfusion for Endovascular Therapy in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.","authors":"Yang Zhang, Yang Zhao, Bowen Deng, Simiao Wu, Raul G Nogueira, Mohamad Abdalkader, Simon Nagel, Patrik Michel, Zhongming Qiu, Qingwu Yang, Zhongrong Miao, Xiaochuan Huo, Dapeng Sun, Amrou Sarraj, Bruce C V Campbell, Chuansheng Zhao, Wenhuo Chen, Tingyu Yi, Wei Bian, Thanh N Nguyen, Yi Sui, Haiyuan Wang","doi":"10.1161/JAHA.124.038173","DOIUrl":"10.1161/JAHA.124.038173","url":null,"abstract":"<p><strong>Background: </strong>The effect of imaging selection on endovascular therapy for acute ischemic stroke remains debated. We compared the efficacy and safety of imaging modalities using computed tomography perfusion with using noncontrast computed tomography (NCCT)±computed tomography angiography.</p><p><strong>Methods: </strong>Studies from PubMed, Embase, and Cochrane Library up to March 1, 2024, were analyzed. Sixteen studies (12 199 patients) assessed functional independence (modified Rankin Scale score of 0-2 at 90 days) using odds ratios (ORs). This study was registered with the International Prospective Register of Systematic Reviews (CRD42024519554).</p><p><strong>Results: </strong>No significant differences were observed in functional independence (OR, 1.09 [95% CI, 0.98-1.21]), modified Rankin Scale score of 0 to 1 (OR, 1.07 [95% CI, 0.88-1.29]), 0 to 3 (OR, 1.04 [95% CI, 0.92-1.18]), thrombolysis in cerebral infarction 2b to 3 (OR, 1.08 [95% CI, 0.95-1.22]), symptomatic intracranial hemorrhage (OR, 0.87 [95% CI, 0.74-1.04]), and any intracranial hemorrhage (OR, 0.95 [95% CI, 0.80-1.12]) between the computed tomography perfusion and NCCT group. There was a significantly lower odds of death during follow-up in the computed tomography perfusion group compared with the NCCT group (OR, 0.78 [95% CI, 0.70-0.88]). Comparison of modified Rankin Scale score of 0 to 2 significantly favored NCCT selection for patients with large cores (<i>P</i>_interaction=0.05). Risk of bias assessment using the Cochrane risk assessment tool revealed concerns in 1 randomized control trial, while observational and post hoc studies assessed with Risk of Bias in Nonrandomized Studies of Interventions I showed moderate (2 studies), serious (11 studies), and critical (2 studies) risk of bias.</p><p><strong>Conclusions: </strong>These findings indicate that patients undergoing endovascular therapy selected with computed tomography perfusion had a similar functional prognosis compared with those selected with NCCT but had lower odds of death during follow-up. NCCT-defined large-core patients had better functional outcomes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038173"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267926","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":"What Every Cardiologist Should Know About Contraception and Reproductive Planning in 2025.","authors":"Leslie Cho, Joan E Briller, Haywood L Brown, Daniela R Crousillat, Deirdre J Mattina, Amy A Sarma, Nandita S Scott, Jyoti Sharma, Rachel Sinkey, Stephanie Teal, Kathryn J Lindley","doi":"10.1161/JAHA.124.041885","DOIUrl":"10.1161/JAHA.124.041885","url":null,"abstract":"<p><p>Recent studies have shown that maternal mortality continues to increase for all racial and ethnic groups in the United States. The recent changes in reproductive legal policies combined with unacceptably high morbidity and mortality rates have made it crucial for every cardiologist to understand and engage with reproductive planning. The risk of cardiovascular complications during pregnancy is prohibitively high for patients in the modified World Health Organization Risk Class IV with maternal cardiovascular event rates of >40%, and pregnancy is not recommended. It is critical that cardiologists partner with primary care providers, Obstetrics and Gynecology, Complex Family Planning subspecialist, Maternal-Fetal Medicine specialists, Anesthesia, and Pharmacist and Nursing to implement available contraception strategies and understand termination options that can be offered to these high-risk patients. The aim of this article is to review risks and advantages of available contraception and pregnancy termination options as it pertains to these high-risk cardiac patients.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041885"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267927","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":"Exploring Facilitators and Barriers of Medically Tailored Meal Interventions for Patients Hospitalized With Acute Heart Failure: A Qualitative Study.","authors":"Ihab Hassanieh, Sang Gune K Yoo, Jing Li, Virginia McKay, Mark D Huffman","doi":"10.1161/JAHA.124.038438","DOIUrl":"10.1161/JAHA.124.038438","url":null,"abstract":"<p><strong>Background: </strong>Acute heart failure (AHF) is associated with high rehospitalization, morbidity, and mortality rates. Implementing medically tailored meal (MTM) interventions may help to optimize nutrition and improve outcomes for patients with AHF. This study aimed to explore facilitators and barriers to implementing an MTM intervention in a tertiary hospital.</p><p><strong>Methods: </strong>From August 2023 to October 2023, we conducted semistructured interviews with health care workers and patients with AHF at Barnes Jewish Hospital in Saint Louis, Missouri. The study used the updated Consolidated Framework for Implementation Research 2.0 to assess 5 domains: MTM characteristics, inner and outer settings, individual characteristics, and implementation process. Audio files were transcribed, and data were analyzed using inductive and deductive approaches.</p><p><strong>Results: </strong>The sample (n=30) consisted of health care workers, including cardiologists (n=5), hospitalists (n=3), nurse practitioners (n=3) and dietitians (n=4), and patients hospitalized for AHF (n=15). Participants identified facilitators including perceived trust in MTM recommendations from providers, potential for improved health outcomes, necessity for dietary compliance, and availability of multidisciplinary teams for implementation. Barriers included the need for further research on MTM efficacy, logistical complexities of MTM implementation, implementation costs, limited funding, and lack of electronic medical record integration. Patient participants had limited knowledge about MTM interventions and highlighted the importance in choosing their prescribed meal options.</p><p><strong>Conclusions: </strong>This study identified facilitators and barriers to implementing an MTM intervention for patients with AHF in a tertiary hospital. Addressing these barriers with contextually relevant strategies could enhance the successful implementation of MTM programs.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038438"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303592","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":"New Imaging Modality in Craniocervical Artery Dissections: Photon Counting Computed Tomography Angiography.","authors":"Zafer Keser, Helena K Xeros, Grace E Thompson, Ahmed O El Sadaney, John C Benson, Ajay A Madhavan, Giuseppe Lanzino, Felix E Diehn","doi":"10.1161/JAHA.125.041628","DOIUrl":"10.1161/JAHA.125.041628","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041628"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303595","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":"Narcolepsy Is Associated With Subclinical Cardiovascular Disease as Early as Childhood: A Big Data Analysis.","authors":"Christopher N Kaufmann, Munaza Riaz, Haesuk Park, Wei-Hsuan Lo-Ciganic, Debbie Wilson, Emerson M Wickwire, Atul Malhotra, Rakesh Bhattacharjee","doi":"10.1161/JAHA.124.039899","DOIUrl":"10.1161/JAHA.124.039899","url":null,"abstract":"<p><strong>Background: </strong>Narcolepsy is linked to adverse cardiovascular disease (CVD) outcomes, but few studies have examined its associations with subclinical CVD, including in children. We assessed the relationship between narcolepsy and subclinical CVD outcomes, including hypertension, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis.</p><p><strong>Methods and results: </strong>We conducted a retrospective cohort study using MarketScan Commercial and Medicare Supplemental databases from January 1, 2005 to December 31, 2021. Patients included N=22 293 diagnosed with narcolepsy (NT1 and NT2) and N=63 709 propensity-score-matched without. Patients with narcolepsy were identified as those with ≥2 outpatient insurance claims for narcolepsy (type 1 or type 2) within a 1-year interval with 1 claim being nondiagnostic. Main outcomes were diagnosis of hypertension, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis following index date, as well as a composite measure for CVD and major adverse cardiovascular events. Compared with propensity-score-matched patients without narcolepsy, patients with narcolepsy had an increased risk for hypertension (hazard ratio [HR], 1.40 [95% CI, 1.34-1.47]), hyperlipidemia (HR, 1.41 [95% CI, 1.35-1.47]), diabetes (HR, 1.50 [95% CI, 1.38-1.64), nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (HR, 1.48 [95% CI, 1.28-1.73]), CVD composite (HR,1.61 [95% CI, 1.35-1.47]), and major adverse cardiovascular events (HR,1.69 [95% CI, 1.43-2.00]). Results remained significant following adjustment for narcolepsy medications including stimulants, wake-promoting agents, and oxybates. Results stratified by age groups showed similar findings, including heightened risk for those <25 years old.</p><p><strong>Conclusions: </strong>Narcolepsy is associated with greater risk of subclinical CVD even in patients as early as childhood. Detection of these outcomes early in the course of narcolepsy could help reduce the burden of adverse cardiovascular events later in life.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039899"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025757","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}