Journal of the American Heart Association最新文献

{"title":"Long-Term Outcomes of Peripheral Artery Disease in Veterans: Analysis of the Peripheral Artery Disease Long-Term Survival Study (PEARLS).","authors":"Saket Girotra, Qiang Li, Mary Vaughan-Sarrazin, Brian C Lund, Mohammad Al-Garadi, Joshua A Beckman, Rohit Nathani, Richard M Hoffman, Paul S Chan, Subhash Banerjee, Shirling Tsai, Dharam J Kumbhani, Nicole Minniefield-Young, Kim G Smolderen, Shipra Arya, Cathy Nguyen, Michael E Matheny, Glenn T Gobbel","doi":"10.1161/JAHA.124.038403","DOIUrl":"10.1161/JAHA.124.038403","url":null,"abstract":"<p><strong>Background: </strong>Contemporary research in peripheral artery disease (PAD) remains limited due to lack of a national registry and low accuracy of diagnosis codes to identify patients with PAD.</p><p><strong>Methods: </strong>Leveraging a novel natural language processing system that identifies PAD with high accuracy using ankle-brachial index and toe-brachial index values, we created a registry of 103 748 patients with new-onset PAD in the Veterans Health Administration. Study end points include mortality, cardiovascular events (hospitalization for acute myocardial infarction or stroke) and limb events (hospitalization for critical limb ischemia or major amputation) and were identified using Veterans Affairs and non-Veterans Affairs encounters.</p><p><strong>Results: </strong>The mean age was 70.6 years; 97.3% were male, and 18.5% self-identified as Black. The mean ankle-brachial index value was 0.78 (SD: 0.26) and the mean toe-brachial index value was 0.51 (SD: 0.19). A majority of patients were current (27.1%) or former (30.0%) smokers. Prevalence of hypertension (86.6%), heart failure (22.7%), diabetes (54.8%), chronic kidney disease (23.6%), and chronic obstructive pulmonary disease (35.4%) was high. At 1 year, 9.4% of patients had died. The 1-year incidence of cardiovascular events was 5.6 per 100 patient-years and limb events was 7.0 per 100 patient-years.</p><p><strong>Conclusions: </strong>We have successfully launched a registry of >100 000 patients with a new diagnosis of PAD in the Veterans Health Administration, the largest integrated health system in the United States. The incidence of death and clinical events in our cohort is high. Ongoing studies will yield important insights regarding improving care and outcomes in this high-risk group.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038403"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674923","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":"Combining Ventricular Fibrillation Features With Defibrillation Waveform Parameters Improves the Ability to Predict Shock Outcomes in a Rabbit Model of Cardiac Arrest.","authors":"Yushun Gong, Jianjie Wang, Jingru Li, Liang Wei, Yongqin Li","doi":"10.1161/JAHA.124.039527","DOIUrl":"10.1161/JAHA.124.039527","url":null,"abstract":"<p><strong>Background: </strong>Quantitative ventricular fibrillation (VF) analysis has the potential to optimize defibrillation by predicting shock outcomes, but its performance remains unsatisfactory. This study investigated whether combining VF features with defibrillation parameters could enhance the ability of shock outcome prediction.</p><p><strong>Methods: </strong>VF was electrically induced and left untreated for 30 to 180 seconds in 55 New Zealand rabbits. A defibrillatory shock was applied with 1 of 9 biphasic waveforms with different tilts and durations. A 4-step up-and-down protocol was used to maintain the success rate near 50% for each waveform. Ten features and 10 parameters were obtained from the recorded VF and defibrillation waveforms. Logistic regression and a convolutional neural network were used to combine VF features with defibrillation parameters.</p><p><strong>Results: </strong>The area under the curve value for the combination of a single VF feature and a single defibrillation parameter (0.725 [95% CI, 0.676-0.775] versus 0.644 [95% CI, 0.589-0.699]; <i>P</i>=0.002) was significantly greater than that for the optimal VF feature. The area under the curve value for the combination of multiple VF features and multiple defibrillation parameters (0.752 [95% CI, 0.704-0.800] versus 0.657 [95% CI, 0.602-0.712]; <i>P</i><0.001) was significantly greater than that the combination of multiple VF features. The area under the curve for the combination of the raw VF waveform and raw defibrillation waveform (0.781 [95% CI, 0.734-0.828] versus 0.685 [95% CI, 0.632-0.738]; <i>P</i>=0.007) was significantly greater than that for the raw VF waveform.</p><p><strong>Conclusions: </strong>In this animal model, combining VF features with defibrillation parameters greatly enhanced the ability of shock outcome prediction, whether it was based on extracted features/parameters or directly using raw waveforms with machine learning methods.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039527"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722565","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":"Thoracic Aortic Aneurysm Growth Rates and Predicting Factors: A Systematic Review and Meta-Analysis.","authors":"Matthew Henry, Carlos A Campello Jorge, Pieter A J van Bakel, Heather A Knauer, Mark MacEachern, Joost A van Herwaarden, Gisela Teixidó-Tura, Arturo Evangelista, Richmond W Jeremy, C A Figueroa, Himanshu J Patel, Marion Hofmann Bowman, Kim Eagle, Nicholas S Burris","doi":"10.1161/JAHA.124.038821","DOIUrl":"10.1161/JAHA.124.038821","url":null,"abstract":"<p><strong>Background: </strong>Thoracic aortic aneurysm (TAA) is an indolent, potentially fatal disease, which progresses at variable rates that are influenced by pathogenesis and patient characteristics. We conducted a systematic review and meta-analysis to synthesize the current evidence on growth rate (GR) and predictive factors among patients with syndromic and nonsyndromic heritable thoracic aortic disease, bicuspid aortic valve, and sporadic TAA.</p><p><strong>Methods and results: </strong>Online databases were searched for studies that reported aortic growth on adult patients with asymptomatic TAA. Pooled GRs were calculated for 3 different TAA groups: syndromic heritable thoracic aortic disease, bicuspid aortic valve, and sporadic TAA. The search yielded 6297 studies, of which 85 were included in the systematic review, and 55 in the meta-analysis of growth rate (10 syndromic heritable thoracic aortic disease, 31 bicuspid aortic valve, and 34 sporadic subgroups). Mean observed TAA GR was 0.25 mm/y (95% CI, -0.18 to 0.68) in Turner syndrome, 0.45 mm/y (95% CI, 0.00-0.90) in Marfan syndrome, and 0.81 mm/y (95% CI, -0.46 to 2.08) in Loeys-Dietz syndrome. The mean observed GR in patients with bicuspid aortic valve before aortic valve surgery was 0.37 mm/y (95% CI, 0.29-0.46), compared with 0.18 mm/y (95% CI, 0.14-0.33) in postsurgical studies. Mean observed GR in sporadic ascending TAA was 0.33 mm/y (95% CI, 0.13-0.52) and 2.71 mm/y (95% CI, 0.53-4.88) in descending TAA.</p><p><strong>Conclusions: </strong>Considering all pathogeneses, ascending TAAs typically grow at 0.25 to 1 mm/y, and thus annual surveillance is likely too frequent to detect growth in most patients. Studies vary widely in populations, methodology, and outcomes, with few high-quality longitudinal studies and no predictors of aortic GR.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038821"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722601","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":"Racial and Ethnic Disparities in Cardiotoxicity in Patients With Cancer Treated With Anthracyclines.","authors":"Lili Zhang, Justin Song, Waqas Hanif, Rachel Clark, Magued Haroun, Caroline McNaughton, Leandro Slipczuk, Mario J Garcia, Min Pu, Carlos A Gongora, Tomas G Neilan, Della Makower, Charles B Hall, Earle C Chambers, Carlos J Rodriguez","doi":"10.1161/JAHA.124.037780","DOIUrl":"10.1161/JAHA.124.037780","url":null,"abstract":"<p><strong>Background: </strong>Cardiotoxicity in patients with cancer treated with anthracyclines is associated with increased morbidity and mortality. We aimed to examine the incidence of and risk factors for cardiotoxicity in a racially and ethnically diverse cohort with cancer treated with anthracyclines.</p><p><strong>Methods: </strong>We included consecutive adult patients who underwent anthracycline-based chemotherapy from 2016 to 2019 for any type of cancer. The end point was the development of cardiotoxicity (defined as clinical heart failure or drop in left ventricular ejection fraction ≥10% to ≤50%).</p><p><strong>Results: </strong>A total of 743 individuals were included (28.0% Non-Hispanic [NH] White, 30.5% NH Black, 38.5% Hispanic, 3.0% Asian). Hypertension, diabetes, hyperlipidemia, obesity, and low socioeconomic status were more common in NH Black and Hispanic individuals. During a median follow-up of 21 months, 98 individuals (13.2%) developed cardiotoxicity. The incidence of cardiotoxicity was significantly higher in NH Black (16.3%), Hispanic (14.7%) and Asian (18.2%) individuals than in NH White (7.2%) individuals (<i>P</i>=0.024). After adjusting for cardiovascular risk factors, socioeconomic status score, anthracycline dose, baseline left ventricular ejection fraction, and cancer type, being NH Black (hazard ratio [HR], 2.62 [95% CI, 1.23-5.56]) or Hispanic (HR, 2.37 [95% CI, 1.11-5.07]) was independently associated with a higher risk of cardiotoxicity. NH Black and Hispanic individuals had a greater decline in left ventricular ejection fraction compared with NH White and Asian counterparts. The associations between baseline characteristics and incident cardiotoxicity were similar across different racial and ethnic groups.</p><p><strong>Conclusions: </strong>In a large retrospective multiracial and ethnic cohort treated with anthracyclines, NH Black, Hispanic, and Asian individuals had an increased risk of cardiotoxicity compared with their NH White counterparts.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037780"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658941","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":"Burden of Multimorbidity in Young Women With ST-Segment-Elevation Myocardial Infarction.","authors":"Linh Tran, Anum Minhas","doi":"10.1161/JAHA.125.041397","DOIUrl":"10.1161/JAHA.125.041397","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041397"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722542","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":"Evidence of Declining Mortality Trends for Hypertrophic Cardiomyopathy in the United States and the Impact of the COVID-19 Pandemic.","authors":"Ahmed Sayed, Barry J Maron, Ethan J Rowin, Martin S Maron","doi":"10.1161/JAHA.124.037047","DOIUrl":"10.1161/JAHA.124.037047","url":null,"abstract":"<p><strong>Background: </strong>Dedicated hypertrophic cardiomyopathy (HCM) center cohorts have reported reductions in HCM-related deaths, likely due to the introduction of contemporary treatments. Similar declining HCM mortality rates are reported in the general US population over 2 decades (1999-2019), but the impact of the COVID-19 pandemic on HCM has not been assessed.</p><p><strong>Methods and results: </strong>Age-adjusted mortality rates based on death certificates from 1999 to 2022 were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research. HCM-related mortality trends were compared with non-HCM cardiovascular deaths and all-cause deaths. Excess HCM-related deaths were estimated during the 2020 to 2022 COVID-19 pandemic. From 1999 to 2019, HCM-related age-adjusted mortality rates declined progressively, reaching a cumulative 53% (95% CI, 50%-56%) reduction in 2019, exceeding declines in non-HCM cardiovascular disease (25%) and all-cause deaths (18%). Declines were evident among all age groups but were most substantial among patients aged 15 to 24 years (62%; 95% CI, 47%-73%) and 25 to 44 years (62% [95% CI, 56%-68%]) but less so in patients aged ≥65 years. During the COVID-19 pandemic, HCM-related deaths <i>increased</i> by 31% (95% CI, 23%-40%), exceeding increases in non-HCM cardiovascular and all-cause deaths. During the pandemic, 5462 HCM-related deaths were observed compared with 4770 expected deaths on the basis of the preceding period, resulting in a 692 estimated excess HCM-related deaths (95% CI, 554-830).</p><p><strong>Conclusions: </strong>Based on an analysis of death certificates, the marked decline in HCM-related deaths of >50% achieved in the US general population during the 2 decades from 1999 to 2019 was substantially reversed (by 29%) during the subsequent 3-year COVID-19 pandemic.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037047"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711962","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":"In-Hospital Outcomes in Patients With Acute Myocardial Infarction and No Standard Modifiable Cardiovascular Risk Factors Across Varying Body Mass Index: Findings From the CCC-ACS Project.","authors":"Yuxiu Yang, Zaiqiang Liu, Fei Gao, Xiaoteng Ma, Jing Liu, Zhijian Wang","doi":"10.1161/JAHA.124.037651","DOIUrl":"10.1161/JAHA.124.037651","url":null,"abstract":"<p><strong>Background: </strong>Individuals who present with acute myocardial infarction in the absence of standard modifiable cardiovascular risk factors (ie, SMuRF-less) seem to have a significantly increased risk of mortality; however, it remains unclear whether the \"SMuRF paradox\" would be influenced by patients' baseline body mass index (BMI) status.</p><p><strong>Methods: </strong>Using data from the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project from November 2014 to July 2019, we analyzed patients with acute myocardial infarction with and without SMuRFs and categorized their BMI as underweight (<18.5 kg/m²), normal weight (18.5-24 kg/m²), overweight (24-28 kg/m²), and obese (>28 kg/m²). The primary outcome was in-hospital all-cause mortality. Multivariable logistic regression models were used to estimate BMI-stratified associations between SMuRF-less status and outcomes.</p><p><strong>Results: </strong>The study included 44 538 patients with first-presentation acute myocardial infarction, of whom 4454 were SMuRF-less. The incidence of SMuRF-lessness declined from 16.2% to 6.5% as BMI increased by category, and it prevailed more frequently among women and older people regardless of their BMI status. Patients who were SMuRF-less had a significant increase in in-hospital mortality than patients with ≥1 SMuRF (adjusted odds ratio [OR], 1.750 [95% CI, 1.057-2.896], <i>P</i><0.001). The highest mortality rate was observed in the group who were SMuRF-less and underweight (3.5%). Considering patients with ≥1 SMuRF and obesity as the reference group, the group who were SMuRF-less underweight exhibited the highest increase in mortality (adjusted OR, 3.854 [95% CI, 2.130-6.973], <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Among patients with first-presentation acute myocardial infarction, compared with those with ≥1 SMuRF, patients who were SMuRF-less have a significantly higher risk of in-hospital mortality, especially in those underweight, whereas in-hospital survival was the most favorable among patients with ≥1 SMuRF and obesity.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT0230661.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037651"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711981","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":"Cerebral Embolic Protection Devices in Transcatheter Aortic Valve Implantation: Meta-Analysis With Trial Sequential Analysis.","authors":"Nav Warraich, Michel Pompeu Sá, Xander Jacquemyn, Toshiki Kuno, Derek Serna-Gallegos, Ibrahim Sultan","doi":"10.1161/JAHA.124.038869","DOIUrl":"10.1161/JAHA.124.038869","url":null,"abstract":"<p><strong>Background: </strong>We aimed to reevaluate randomized controlled trial data on outcomes of cerebral embolic protection device use during transcatheter aortic valve implantation. A conventional meta-analysis followed by trial sequential analysis was conducted to evaluate the strength of the current evidence.</p><p><strong>Methods and results: </strong>Databases were searched for randomized controlled trials. Primary outcomes included all stroke, disabling stroke, and all-cause mortality. Conventional study-level meta-analysis was performed using random-effects modeling. Trial sequential analysis was conducted to generate adjusted significance boundaries, futility boundaries, and the required information size considering a type I error of 5% and a power of 90%. Seven trials were included with a total of 4031 patients, of whom 2171 were treated with a device and 1860 were not. Conventional meta-analysis showed no significant difference in all stroke (relative risk [RR], 0.85 [95% CI, 0.61-1.18]; <i>P</i>=0.339) and disabling stroke (RR, 0.59 [95% CI, 0.30-1.13]; <i>P</i>=0.113) with device use. The trial sequential analysis determined an absence of evidence for all stroke (required information size of 71 650 [5.6%]) and disabling stroke (required information size of 337 256 [1.2%]). Conventional meta-analysis determined no significant difference in all-cause mortality (RR, 1.03 [95% CI, 0.49-2.17]; <i>P</i>=0.928) with device use. The trial sequential analysis determined that the futility boundary was reached (required information size of 5772 [69.3%]).</p><p><strong>Conclusions: </strong>There are insufficient randomized controlled trial data on cerebral embolic protection device use to provide conclusive meta-analytic findings for stroke outcomes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038869"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674836","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":"Genomic Exploration of Essential Hypertension in African-Brazilian Quilombo Populations: A Comprehensive Approach With Pedigree Analysis and Family-Based Association Studies.","authors":"Vinicius Magalhães Borges, Andrea R V R Horimoto, Ellen Marie Wijsman, Lilian Kimura, Kelly Nunes, Alejandro Q Nato, Regina Célia Mingroni-Netto","doi":"10.1161/JAHA.124.036193","DOIUrl":"10.1161/JAHA.124.036193","url":null,"abstract":"<p><strong>Background: </strong>Essential hypertension (EH) is a global health issue. Despite extensive research, much of EH heritability remains unexplained. We investigated the genetic basis of EH in African-derived individuals from partially isolated quilombo populations in Vale do Ribeira (São Paulo, Brazil).</p><p><strong>Methods and results: </strong>Samples from 431 individuals (167 affected, 261 unaffected, 3 unknown) were genotyped using a 650 000 single-nucleotide polymorphism array. Estimated global ancestry proportions were 47% African, 36% European, and 16% Native American. We constructed 6 pedigrees using additional data from 673 individuals and created 3 nonoverlapping single-nucleotide polymorphism subpanels. We phased haplotypes and performed local ancestry analysis to account for admixture. Genome-wide linkage analysis and fine-mapping via family-based association studies were conducted, prioritizing EH-associated genes through a systematic approach involving databases like PubMed, ClinVar, and GWAS (Genome-Wide Association Studies) Catalog. Linkage analysis identified 22 regions of interest with logarithm of the odds scores ranging from 1.45 to 3.03, encompassing 2363 genes. Fine-mapping (family-based association studies) identified 60 EH-related candidate genes and 117 suggestive/significant variants. Among these, 14 genes, including <i>PHGDH</i>, <i>S100A10</i>, <i>MFN2</i>, and <i>RYR2</i>, were strongly related to hypertension harboring 29 suggestive/significant single-nucleotide polymorphisms.</p><p><strong>Conclusions: </strong>Through a complementary approach combining admixture-adjusted Genome-wide linkage analysis based on Markov chain Monte Carlo methods, family-based association studies on known and imputed data, and gene prioritizing, new loci, variants, and candidate genes were identified. These findings provide targets for future research, replication in other populations, facilitate personalized treatments, and improve public health toward African-derived underrepresented populations. Limitations include restricted single-nucleotide polymorphism coverage, self-reported pedigree data, and lack of available EH genomic studies on admixed populations for independent validation, despite the performed genetic correlation analyses using summary statistics.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036193"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674845","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":"Stressor-Evoked Brain Activity, Cardiovascular Reactivity, and Subclinical Atherosclerosis in Midlife Adults.","authors":"Javier Rasero, Timohy D Verstynen, Caitlin M DuPont, Thomas E Kraynak, Emma Barinas-Mitchell, Mark R Scudder, Thomas W Kamarck, Amy I Sentis, Regina L Leckie, Peter J Gianaros","doi":"10.1161/JAHA.124.034908","DOIUrl":"https://doi.org/10.1161/JAHA.124.034908","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular responses to psychological stressors have been separately associated with preclinical atherosclerosis and hemodynamic brain activity patterns across different studies and cohorts; however, what has not been established is whether cardiovascular stress responses reliably link indicators of stressor-evoked brain activity and preclinical atherosclerosis that have been measured in the same individuals. Accordingly, the present study used cross-validation and predictive modeling to test for the first time whether stressor-evoked systolic blood pressure responses statistically mediated the association between concurrently measured brain activity and a vascular marker of preclinical atherosclerosis in the carotid arteries.</p><p><strong>Methods and results: </strong>Six hundred twenty-four midlife adults (aged 28-56 years, 54.97% women) from 2 different cohorts underwent 2 information-conflict functional magnetic resonance imaging tasks, with concurrent systolic blood pressure measures collected. Carotid artery intima-media thickness was measured by ultrasonography. A mediation framework that included harmonization, cross-validation, and penalized principal component regression was then used. Brain areas where functional magnetic resonance imaging activity exhibited reliable direct and indirect effects were identified through bootstrapping. Sensitivity analysis further tested the robustness of findings after accounting for prevailing levels of cardiovascular disease risk and brain imaging data quality. Task-averaged patterns of functional magnetic resonance imaging activity across distributed brain areas exhibited a generalizable association with carotid artery intima-media thickness, which was reliably mediated by an area under the curve measure of aggregate systolic blood pressure reactivity. Importantly, this effect held in sensitivity analyses. Implicated brain areas in this mediation included the ventromedial prefrontal cortex, anterior cingulate cortex, insula, and amygdala.</p><p><strong>Conclusions: </strong>These novel findings support a link between stressor-evoked brain activity and preclinical atherosclerosis, which is accounted for by individual differences in corresponding levels of stressor-evoked cardiovascular reactivity.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e034908"},"PeriodicalIF":5.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755722","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}