Journal of the American Heart Association最新文献

{"title":"Blood Pressure and Late Pregnancy Circulating miRNAs in the MADRES Study.","authors":"Elizabeth C Anderson, Meghan E Muse, Zhongzheng Niu, Helen B Foley, Joshua J Levy, Megan E Romano, Jiang Gui, Jessica L Bentz, Shohreh F Farzan, Theresa M Bastain, Carmen J Marsit, Carrie V Breton, Caitlin G Howe","doi":"10.1161/JAHA.124.040416","DOIUrl":"10.1161/JAHA.124.040416","url":null,"abstract":"<p><strong>Background: </strong>Circulating extracellular and vesicle particle (EVP) miRNAs have been associated with cardiovascular risk and adverse birth outcomes. Hypertensive disorders of pregnancy (HDP) increase risk for adverse birth outcomes and future cardiovascular outcomes in mothers and children and have been associated with altered maternal circulating EVP miRNA levels during pregnancy. Whether these relationships exist for elevated blood pressure (BP) in the subclinical range is unknown. We investigated associations between (1) hypertensive disorders of pregnancy and (2) maternal BP trajectories, including in the subclinical range, and circulating EVP miRNA levels during pregnancy in the MADRES (Maternal and Developmental Risks From Environmental and Social Stressors) Study (n=372).</p><p><strong>Methods: </strong>Latent class trajectory modeling was used to identify trajectories from BP measures abstracted from medical records. The NanoString nCounter platform was used to quantify 798 miRNAs extracted from maternal blood (median gestational age: 31.6 weeks). Covariate-adjusted regression models assessed associations between each hypertensive disorders of pregnancy subtype or BP trajectory and levels of each miRNA.</p><p><strong>Results: </strong>Three BP trajectories were identified: Low, Moderate, and High. Chronic hypertension was associated with higher levels of miR-1185-2-3p (<i>P</i>_{false discovery rate}<0.05), a placenta-specific miRNA linked to arterial stiffness and preterm delivery. Many placenta-expressed miRNAs previously associated with a longer gestational duration in the same cohort were lower among participants with elevated BP (<i>P</i><0.05). Target genes of BP-associated EVP miRNAs were overrepresented in pathways involved in vascular inflammation, oxidative stress, endothelial dysfunction, and placental function.</p><p><strong>Conclusions: </strong>Circulating levels of placenta-expressed EVP miRNAs previously implicated in adverse birth and cardiovascular outcomes are sensitive to elevated maternal BP during pregnancy, including in the subclinical range.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040416"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267848","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":"Evaluating the Prevalence of Optimal Neurodevelopmental Outcome at 2 Years in Children Previously on Ventricular Assist Device Support.","authors":"Shannon Oliver, Jennifer Conway, Holger Buchholz, Darren H Freed, Mohammed Al-Aklalbi, De Villiers Jonker, Ari R Joffe, Nastaran Hajizadeh Bastani, Irina Dinu, Simon Urschel, Tara Pidborochynski, Joseph Atallah, Charlene M T Robertson","doi":"10.1161/JAHA.125.041384","DOIUrl":"10.1161/JAHA.125.041384","url":null,"abstract":"<p><strong>Background: </strong>Literature reporting neurodevelopmental outcomes for patients who undergo ventricular assist device (VAD) therapy is limited to posttransplant cohorts. This study aims to determine the prevalence of optimal neurodevelopmental outcome and factors associated with nonoptimal outcome in patients implanted with a VAD at ≤15 months of age.</p><p><strong>Methods: </strong>Patients followed by the Complex Pediatric Therapies Follow-Up Program were included in a prospective-inception cohort study if born between January 2006 and December 2022 and implanted with a VAD at ≤15 months of age. A modified optimal neurodevelopmental outcome was defined as scores of ≥80 on the Bayley Scales of Infant and Toddler Development and on the Adaptive Behavior Assessment System, and in the absence of cerebral palsy, permanent hearing loss, visual impairment, or seizure disorder. Firth multiple regression analysis was used to determine independent factors associated with nonoptimal outcome.</p><p><strong>Results: </strong>A total of 56 patients underwent VAD implant at ≤15 months with neurodevelopmental assessments available for 39/40 patients who survived to 2 years. The mean age of VAD implant was 5.45 (SD 3.99) months, 69.2% were male, and 38.5% had congenital heart disease. Optimal neurodevelopmental outcome was seen in 25.6% of patients. Neurological insult (OR, 12.34 [95% CI, 1.29-1660.36], <i>P</i>=0.026) was the only independent factor identified associated with nonoptimal outcome.</p><p><strong>Conclusions: </strong>Optimal outcome was demonstrated in one quarter of patients who had a VAD at ≤15 months of age and underwent neurodevelopmental testing at 2 years of age. A potentially modifiable factor of neurological insult was demonstrated as being independently associated with nonoptimal outcome.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041384"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303590","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":"Prevalence and Management of Multiple Valvular Heart Disease in Patients Undergoing Transcatheter Aortic Valve Replacement: A Multicenter Study on the Impact of Staged Valvular Interventions on Outcomes.","authors":"Baravan Al-Kassou, Jannik Kapplinghaus, Caroline Meckelburg, Jasmin Shamekhi, Adem Aksoy, Hendrik Wienemann, Lara Al-Kassou, Andreas Zietzer, Atsushi Sugiura, Vedat Tiyerili, Clemens Eckel, Johanna Vogelhuber, Marcel Weber, Tobias Zeus, Matti Adam, Helge Möllmann, Mohamed Abdel-Wahab, Holger Thiele, Stephan Baldus, Malte Kelm, Farhad Bakhtiary, Georg Nickenig, Sebastian Zimmer","doi":"10.1161/JAHA.124.040150","DOIUrl":"10.1161/JAHA.124.040150","url":null,"abstract":"<p><strong>Background: </strong>Multiple valvular heart disease correlates with poor outcomes following transcatheter aortic valve replacement. Previous studies have focused on mitral regurgitation (MR) or tricuspid regurgitation (TR) individually, without comparing their long-term effects. The impact of staged transcatheter edge-to-edge repair (TEER) remains unclear. We aimed to assess the prevalence and effects of severe multiple valvular heart disease (sMVHD) and evaluate the impact of staged TEER on outcomes.</p><p><strong>Methods: </strong>Patients were recruited from 4 transcatheter aortic valve replacement centers. The primary cohort included 2823 patients to evaluate the prevalence of sMVHD. All patients were screened for additional valvular interventions; those undergoing TEER for severe MR (n=147) or TR (n=59) were included.</p><p><strong>Results: </strong>Concomitant sMVHD was observed in 369 patients, with 208 having severe MR and 161 having severe TR. The 1-year mortality rate was higher in patients with sMVHD compared with the overall cohort (9.0 versus 5.2 per 100 person-years; <i>P</i><0.01). Severe TR was associated with the highest 1-year mortality rate, followed by severe MR and no or mild multiple valvular heart disease (13.3 versus 6.4 versus 3.9 per 100 person-years; <i>P</i><0.01). This difference persisted over 5 years (<i>P</i><0.01). Patients undergoing staged TEER showed a reduced 1-year mortality rate compared with conservative management (4.1 versus 12.1 per 100 person-years; <i>P</i><0.001). This trend continued over 5 years (<i>P</i><0.001). Severe TR was independently associated with an increased mortality rate (hazard ratio, 1.79 [95% CI, 1.17-2.74]; <i>P</i><0.01).</p><p><strong>Conclusions: </strong>Persistent sMVHD was associated with an increased mortality rate following transcatheter aortic valve replacement, with severe TR posing a higher risk than severe MR. Staged TEER was associated with improved outcomes and warrants consideration in sMVHD.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040150"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227643","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":"Extreme Heat and Arrhythmia in Patients With Implanted Devices.","authors":"Barrak Alahmad, Taofik Oyekunle, Claire Strohmeyer, Anderson P Rudke, Petros Koutrakis, Theofanie Mela","doi":"10.1161/JAHA.124.040352","DOIUrl":"10.1161/JAHA.124.040352","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmia, particularly atrial fibrillation, is on the rise globally. While increased surveillance, aging populations, and other risk factors partially explain this rise, emerging risks such as extreme heat from climate change are underexplored.</p><p><strong>Methods: </strong>We used Product Surveillance Registry by Medtronic (2016-2023) in the United States to examine patients with implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator devices. We identified first arrhythmic episodes (atrial tachycardia/fibrillation [AT/AF] or ventricular tachycardia/fibrillation) recorded by devices. Events were matched to ambient temperatures from local weather stations. We used a case-crossover design where each arrhythmia event hour was matched with multiple control hours from the same patient, within the same day of week, month, and year. Conditional logistic models were then pooled across all climate zones in the United States to obtain nonlinear dose-response between temperature and arrhythmia.</p><p><strong>Results: </strong>Our analysis included 3079 individuals across 103 cities. Fewer AT/AF and ventricular tachycardia/fibrillation events occurred during early morning hours (1 am-8 am) compared with daytime hours (9 am-4 pm) (<i>P</i> <0.001). AT/AF episodes were also fewer on weekends compared with weekdays (<i>P</i> <0.001). We found a significant dose-response relationship between high outdoor temperatures and AT/AF events. Relative to an optimal temperature (19 °C), odds ratios for AT/AF events increased substantially at temperatures of 39 °C (odds ratio, 2.41 [95% CI, 1.37-4.25]), 40 °C (odds ratio, 2.60 [95% CI, 1.38-4.89]), and 41 °C (odds ratio, 2.81 [95% CI, 1.40-5.63]). No significant association between temperature and ventricular tachycardia/ ventricular fibrillation was observed. Lagged temperature exposures did not change the results.</p><p><strong>Conclusions: </strong>Extreme hot outdoor temperatures were significantly associated with higher odds of AF episodes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040352"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227642","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":"Effect of Time Delay on Reperfusion After Tenecteplase in an Extended Time Window: Analysis From the CHABLIS-T Trials.","authors":"Lan Hong, Juehua Zhu, Zhijiao He, Xinru Wang, Siyuan Li, Xinyu Liu, Yifeng Ling, Lumeng Yang, Qi Fang, Qiang Dong, Xin Cheng","doi":"10.1161/JAHA.124.040994","DOIUrl":"10.1161/JAHA.124.040994","url":null,"abstract":"<p><strong>Background: </strong>The association between time and reperfusion in an extended time window remains unexplored. This study aimed to investigate whether time delay was associated with reduced odds of reperfusion in patients with acute ischemic stroke treated with tenecteplase in the 4.5- to 24-hour time window, in the CHABLIS-T (Chinese Acute Tissue-Based Imaging Selection for Lysis in Stroke-Tenecteplase) trials.</p><p><strong>Methods: </strong>Patients from the CHABLIS-T and CHABLIS-T II trials treated with tenecteplase were included. Major reperfusion was assessed via follow-up perfusion imaging or digital subtraction angiography. Time intervals from symptom onset/last known well to hospital arrival/administration of tenecteplase were analyzed as continuous and categorical variables in multivariable logistic regression models. Subgroup analysis examined the consistency of the association across different patient characteristics.</p><p><strong>Results: </strong>Sixty-seven patients achieved postthrombolytic major reperfusion among the 199 patients included. Longer onset-to-arrival time was associated with lower odds of major reperfusion (continuous: odds ratio [OR], 0.98 per 10 minutes, <i>P</i>=0.004; categorical: OR, 0.45, <i>P</i>=0.003). Similarly, prolonged onset-to-thrombolysis time was associated with decreased probability of reperfusion (continuous variable: OR, 0.98 per 10 minutes, <i>P</i>=0.01; categorical variable: OR, 0.48, <i>P</i>=0.002). The analysis of time from last known well drew similar results. Subgroup analysis revealed that patients with nonatherosclerotic stroke were more susceptible to time delay.</p><p><strong>Conclusions: </strong>Time delay was associated with reduced postthrombolytic reperfusion odds in patients with stroke treated with tenecteplase, especially in nonatherosclerotic cases. Prompt reperfusion remains essential, even in patients with benign perfusion profiles in an extended time window.</p><p><strong>Registration: </strong>URL: https://clinicalTrials.gov; URL: CHABLIS-T NCT04086147; CHABLIS-T II NCT04516993.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040994"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267921","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 Left Ventricular Diastolic Pressure Changes on Clinical Outcomes After Transcatheter Aortic Valve Replacement.","authors":"Jiwon Seo, Ah-Ram Kim, Iksung Cho, Chi Young Shim, Geu-Ru Hong, Eui-Young Choi, Se-Joong Rim, Young-Guk Ko, Myeong-Ki Hong, Jae-Kwan Song, Jong-Won Ha","doi":"10.1161/JAHA.124.039372","DOIUrl":"10.1161/JAHA.124.039372","url":null,"abstract":"<p><p>Changes in left ventricular (LV) diastolic pressure after transcatheter aortic valve replacement (TAVR) or their relationship with subsequent outcomes remain poorly clarified. Accordingly, we aimed to assess the changes in invasively measured LV diastolic pressure and their relationship with long-term outcomes in patients undergoing TAVR.</p><p><strong>Methods: </strong>In total, 509 patients with severe aortic stenosis who underwent TAVR at 3 tertiary centers were retrospectively included and divided into 2 groups according to changes in LV pre-A pressure after TAVR: Group 1, with no change or decrease in pre-A pressure, and Group 2, presenting an increase in pre-A pressure after TAVR. The primary outcome was a composite of all-cause death and rehospitalization for heart failure.</p><p><strong>Results: </strong>Group 1 included 39% (n=198) patients, and Group 2 had 61% (n=311) patients. More patients in Group 2 had diabetes, chronic kidney disease, and a larger aortic valve area than in Group 1. During the follow-up period (median, 28 months), 122 primary outcomes were recorded. In Kaplan-Meier analysis, the cumulative incidence of the primary outcome and all-cause death was significantly lower in Group 1 than in Group 2. In multivariable Cox hazard models, Group 1 was independently associated with a favorable primary outcome (hazard ratio, 0.52 [95% CI, 0.34-0.80]; <i>P</i>=0.003).</p><p><strong>Conclusions: </strong>Increase in LV pre-A pressure after TAVR is common, and no change or decrease in LV pre-A pressure after TAVR is independently associated with favorable outcomes. Changes in LV pre-A pressure can help identify patient subsets who will maximally benefit from TAVR.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039372"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144353","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":"Comparing 3 Evidence-Based Strategies to Reduce Cardiovascular Disease Burden: An Individual-Based Cardiometabolic Policy Simulation.","authors":"Sylvia Lutze, Steve Bachmeier, Alison Bowman, Nicole DeCleene, Hussain Jafari, Matthew Kappel, Caroline Kinuthia, Paulina Lindstedt, Megan Lindstrom, Rajan Mudambi, Christian Razo, Kjell Swedin, Abraham Flaxman, Gregory Roth","doi":"10.1161/JAHA.124.039204","DOIUrl":"10.1161/JAHA.124.039204","url":null,"abstract":"<p><strong>Background: </strong>Understanding the real-world impact of clinical trials that change risk factors is important for health policy. We developed a microsimulation that estimates the population-level benefits in each US state of cardiometabolic interventions.</p><p><strong>Methods: </strong>We designed a state-specific agent-based simulation model with 51 million in silico individuals and estimated results for 2023 to 2040. Input data reflected current cardiometabolic health and the effects of interventions and risk factors. We constructed 3 health policy intervention scenarios based on randomized controlled trials proven to improve cardiometabolic population health: improved access to fixed-dose combination antihypertensive medication, a pharmacist-led intervention with phone-based reminders to increase adherence to statin and antihypertensive medications at the time they are initiated, and a community-based lifestyle and behavior intervention designed to prevent diabetes. Outcomes included CVD events, deaths, and disability-adjusted life years (DALYs).</p><p><strong>Results: </strong>Our simulation included a representative population of the United States, accurate at the age, sex, and state level. By 2040, the fixed-dose combination intervention was estimated to have prevented 776 000 (95% uncertainty interval, 578 000-956 000) CVD DALYs and 44 600 (95% uncertainty interval, 32 700-55 600) deaths annually. The pharmacist-led intervention prevented 170 000 (95% uncertainty interval, 129 000-208 000) CVD DALYs, and the community-based intervention prevented 152 000 (95% uncertainty interval, 128 000-173 000) CVD DALYs.</p><p><strong>Conclusions: </strong>A fixed-dose combination of antihypertensives could prevent 1.2% of total CVD DALYs, with smaller benefits from adherence and lifestyle-focused programs. Impact of interventions varied by state. Providing accurate population-level estimates can help local health policy decision-makers implement the most impactful interventions.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039204"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121422","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":"App-Recorded Daily Step Counts, Sex Differences, and Risk of Cardiovascular Outcomes Among Middle-Aged Population.","authors":"Yasuaki Takeji, Akihiro Nomura, Hayato Tada, Soichiro Usui, Kenji Sakata, Takahiro Tabuchi, Masayuki Takamura","doi":"10.1161/JAHA.124.040402","DOIUrl":"10.1161/JAHA.124.040402","url":null,"abstract":"<p><strong>Background: </strong>Limited data are available on sex-specific associations between daily step counts and cardiovascular events in middle-aged adults.</p><p><strong>Methods: </strong>This study used the KenCoM Healthcare Database to evaluate sex-specific differences in cardiovascular event risk associated with daily step counts (DSC). The database incorporates DSC data from the KenCoM smartphone app, along with health checkup records and Japanese health insurance claims data. We recruited and enrolled participants using the KenCoM app, registering them in our database between January 2016 and September 2021. The primary outcome was the 5-year cumulative incidence of composite cardiovascular events, including myocardial infarction, stroke, angina pectoris, heart failure, and atrial fibrillation. We compared event rates across quintiles of DSC. The quintiles were defined as follows: Group 1 (<4000 steps/d), Group 2 (4000-5999 steps/d), Group 3 (6000-7999 steps/d), Group 4 (8000-9999 steps/d), and Group 5 (≥10 000 steps/d).</p><p><strong>Results: </strong>This study included 73 975 participants (55 612 men and 18 363 women) with a mean age of 44.1±10.1 years. The adjusted risk of 5-year cardiovascular events was significantly lower in Group 5 compared with Group 1 in the entire cohort (adjusted hazard ratio, 0.87 [95% CI, 0.77-0.98]; <i>P</i>=0.02). Sex-specific analysis showed that the adjusted risk of cardiovascular events was significantly lower in Group 5 compared with Group 1 in men (adjusted hazard ratio, 0.82 [95% CI, 0.72-0.94]; <i>P</i>=0.004), but this effect was not observed in women.</p><p><strong>Conclusions: </strong>The highest DSC was associated with a lower risk of cardiovascular events compared with the lowest DSC in men, but not in women, within a middle-aged population.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040402"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129461","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":"Expanding the Role of Drug-Coated Balloons in Contemporary Percutaneous Coronary Intervention: Start of the Next Revolution or Just One More Weapon in a Growing Arsenal?","authors":"Sandeep Nathan","doi":"10.1161/JAHA.125.042448","DOIUrl":"10.1161/JAHA.125.042448","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042448"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175779","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":"Lipoprotein(a) and Heart Failure Among Black and White Participants in Atherosclerosis Risk in Communities Study, Framingham Offspring Study, and Multi-Ethnic Study of Atherosclerosis: The Pooling Project.","authors":"Sarah Nomura, Weihua Guan, Yixin Zhang, Geoffrey H Tison, Hiroaki Ikezaki, Margaret R Diffenderfer, Ching-Ti Liu, Ron C Hoogeveen, Christie M Ballantyne, Ernst J Schaefer, Michael Y Tsai","doi":"10.1161/JAHA.124.038608","DOIUrl":"10.1161/JAHA.124.038608","url":null,"abstract":"<p><strong>Background: </strong>This study investigated Lp(a) (lipoprotein(a)) levels with heart failure (HF) incidence overall and ejection fraction (EF) subtypes among Black and White participants in a pooled analysis of MESA (Multi-Ethnic Study of Atherosclerosis), FOS (Framingham Offspring Study), and ARIC (Atherosclerosis Risk in Communities Study).</p><p><strong>Methods: </strong>This study was conducted among 16 771 White and Black participants in ARIC (N=10 347), MESA (N=4150), and FOS (N=2274). Baseline was time of Lp(a) measurement (ARIC Visit 4: 1996-1998; MESA Visit 1: 2000-2002; FOS Cycle 6: 1995-1998). HF with reduced EF (HFrEF) was defined as EF <50% and ≥50% as HF with preserved EF (HFpEF). Cox proportional hazards regression was used to evaluate associations between Lp(a) (log-transformed continuous, dichotomized at ≥30 mg/dL and ≥50 mg/dL, and quartiles) and HF (overall, HFpEF, HFrEF) in the overall population and stratified by race. Analyses were replicated excluding prior history of myocardial infarction.</p><p><strong>Results: </strong>There were 2759 HF cases (HFpEF N=859; HFrEF N=649; EF unknown N=1251) through 2019. Among White participants, Lp(a) ≥50 mg/dL was associated with HF risk overall (hazard ratio [HR], 1.19 [95% CI, 1.07-1.34]) and by EF subtype (HFpEF HR, 1.32 [95% CI, 1.08-1.59]; HFrEF HR, 1.33 [95% CI, 1.05-1.67]). Among Black participants, Lp(a) ≥50 mg/dL was not associated with HF risk overall (HR, 0.93 [95% CI, 0.78-1.11]) or by EF subtype (HFpEF HR, 0.97 [95% CI, 0.69-1.35]; HFrEF HR, 0.89 [95% CI, 0.63-1.26]). Associations were no longer significant after excluding prior myocardial infarction.</p><p><strong>Conclusions: </strong>Elevated Lp(a) levels are associated with HF risk among White, but not Black individuals, and associations appears to be mostly mediated by a history of myocardial infarction.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038608"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143148","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}