Journal of the American Heart Association最新文献

{"title":"Two-Year Changes in Remnant Cholesterol and Stroke Risk in the Chinese Population: A Prospective Cohort Study.","authors":"Dan Wang, Zifei Zhang, Yijun Zhang, Shuohua Chen, Nan Qu, Haibin Li, Yongkang Sun, Xue Tian, Xinsheng Han, Shouling Wu, Anxin Wang","doi":"10.1161/JAHA.124.038559","DOIUrl":"10.1161/JAHA.124.038559","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have shown that elevated remnant cholesterol (RC) was associated with stroke risk. There is insufficient evidence on the relationship between 2-year changes in RC and stroke risk in the general population. Our aim was to explore the relationship between 2-year changes in RC and the risks of stroke and its subtypes in the general population.</p><p><strong>Methods: </strong>The study included 62 443 individuals who were free of stroke from the Kailuan Study. Two-year changes in RC was defined as the difference between the RC in 2008 and that in 2006. Multivariable-adjusted Cox proportion models were used to examine the associations between 2-year changes in RC with the risks of stroke and its subtypes.</p><p><strong>Results: </strong>During a median follow-up period of 10.30 years, 3780 (6.38%) stroke events occurred. The changes in RC were positively associated with the risk of stroke, after adjustment for multiple potential confounders. The hazard ratio (HR) for the Q4 group versus the Q1 group was 1.14 (95%, CI, 1.02-1.28) for stroke, and 1.18 (95% CI, 1.04-1.32) for ischemic stroke. The risks of stroke were higher in the RC increased group than the RC nonincreased group. The HR was 1.12 (95% CI, 1.04-1.20) for stroke, and 1.15 (95% CI, 1.07-1.24) for ischemic stroke.</p><p><strong>Conclusions: </strong>Substantial changes in RC are associated with increased risks of stroke in the general population. Monitoring long-term changes in RC may assist with the early identification of individuals at high risk of stroke.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038559"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121377","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 Between Endothelial Alterations, Cardiac Function, and Outcomes From Health to Heart Failure: Insight From the STANISLAS, MEDIA-DHF, and BIOSTAT-CHF Cohorts.","authors":"Jeremy Lagrange, Mohammad Jahangiri, Guillaume Baudry, Nathalie Mercier, Luca Monzo, Zohra Lamiral, Kévin Duarte, Jozine M Ter Maaten, Faiez Zannad, Adriaan A Voors, Nicolas Girerd","doi":"10.1161/JAHA.124.040179","DOIUrl":"10.1161/JAHA.124.040179","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) is a multifaceted syndrome, likely stemming from comorbidity-induced inflammation resulting in endothelial dysfunction. Endothelial glycocalyx degradation's role in the development and prognosis of HFpEF remains largely unexplored. Our study aimed at exploring the association between glycocalyx degradation and diastolic dysfunction and determining whether glycocalyx degradation can predict clinical outcomes in patients with HFpEF.</p><p><strong>Methods: </strong>Perlecan and thrombomodulin concentrations were assessed in individuals deemed healthy (STANISLAS [Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux (Annual Noninvasive Temporary Monitoring of the Health of Insured Lorrainers)] cohort, n=1705) and patients with HFpEF (MEDIA-DHF [Metabolic Road to Diastolic Heart Failure], n=460 and BIOSTAT-CHF [Biology Study to Tailored Treatment in Chronic Heart Failure], n=556) to evaluate endothelial glycocalyx degradation.</p><p><strong>Results: </strong>In patients with HFpEF, perlecan but not thrombomodulin was increased compared with controls (<i>P</i><0.0001 versus <i>P</i>=0.73). In adjusted analysis, perlecan was associated with peak early mitral inflow velocity/peak early diastolic mitral annular velocity ratio and thrombomodulin with peak early diastolic mitral annular velocity in control individuals, whereas perlecan and thrombomodulin were associated with peak early mitral inflow velocity/peak early diastolic mitral annular velocity and left atrial volume index in patients with HFpEF (all <i>P</i><0.03). Perlecan was significantly associated with cardiovascular hospitalization and death in the MEDIA-DHF (adjusted hazard ratio [HR] for highest tertile versus first tertile, 2.44 [95% CI, 1.11-5.34]; <i>P</i>=0.026) and BIOSTAT-CHF cohorts (adjusted HR, 2.12 [95% CI, 1.49-3.03]; <i>P</i><0.0001). Thrombomodulin was associated with a worse outcome in BIOSTAT-CHF (<i>P</i>=0.004) but not in MEDIA-DHF.</p><p><strong>Conclusions: </strong>Higher circulating levels of the endothelial glycocalyx degradation biomarkers like perlecan and, to a lesser extent, thrombomodulin are associated with features of diastolic dysfunction in population and HFpEF settings and predict poor outcome in patients with HFpEF. These results suggest that glycocalyx degradation may be an early step in the pathological processes leading to HFpEF and gain further prognostic value in later stages (ie, overt HFpEF).</p><p><strong>Registration: </strong>URL: https://clinicaltrials.gov/; Unique identifiers: NCT01391442, https://clinicaltrials.gov/study/NCT01391442?cond=stanislas&rank=1; NCT02446327; URL: https://cordis.europa.eu; BIOSTAT-CHF ID: 242209.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040179"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175773","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 Ambient Air Pollution With Invasive Pulmonary Hemodynamics and Long-Term Outcomes in Patients With Pulmonary Arterial Hypertension.","authors":"Sicheng Zhang, Luyang Gao, Sicong Li, Manqing Luo, Qunying Xi, Ping Lin, Zhihui Zhao, Qing Zhao, Xiaoxu Xie, Qin Luo, Yansong Guo, Zhihong Liu","doi":"10.1161/JAHA.124.039343","DOIUrl":"10.1161/JAHA.124.039343","url":null,"abstract":"<p><strong>Background: </strong>Although the impact of ambient air pollution on mortality in cardiovascular and pulmonary diseases is well documented, its specific link to pulmonary arterial hypertension remains unclear. This study investigated the association between ambient particulate matter (PM) exposure and all-cause death or lung transplantation, as well as pulmonary hemodynamics in patients with pulmonary arterial hypertension.</p><p><strong>Methods: </strong>This retrospective cohort study included 1327 participants with pulmonary arterial hypertension who underwent right heart catheterization (RHC). Ambient PM_2.5 and PM₁₀ levels were estimated using the China High Air Pollutants data set, with a 3-year average exposure before diagnosis as the primary exposure metric. All-cause death or lung transplantation was the primary end point. Cox proportional hazard models assessed the association between PM exposure and primary outcomes, and generalized linear models evaluated pulmonary hemodynamics. Mediation analysis explored potential mediating factors.</p><p><strong>Results: </strong>The median age of the participants was 33.0 years, with 73.2% being women. Median PM_2.5 and PM₁₀ levels were 58.0 [43.6-76.1] and 103.0 [80.4-129.3] μg/m³, respectively. Over a median follow-up of 3.1 years, 149 patients died or underwent lung transplantation. Each 10 μg/m³ increase in PM_2.5 and PM₁₀ was associated with a 14.5% and 7.9% increased risk of primary outcomes, respectively. PM exposure was linked to worsened pulmonary hemodynamics, such as pulmonary vascular resistance and cardiac index. Mediation analysis suggested lipid metabolism, uric acid, and lymphocytes may partially mediate these effects.</p><p><strong>Conclusions: </strong>Long-term PM_2.5 and PM₁₀ exposure is not only associated with increased risk of death or lung transplantation in patients with pulmonary arterial hypertension but also affects disease severity and pulmonary hemodynamics.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039343"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121483","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":"Cost-Effectiveness Analysis of Surgical Strategies Versus Medical Management for Rheumatic Heart Disease in Rwanda.","authors":"Vongai Mlambo, Songnan Wang, Maurice Musoni, Hannah Rando, Lambert Ingabire, Ceeya Patton-Bolman, Gloria Mukeshimana, Evariste Ntaganda, Ralph Bolman, Eran Bendavid, Yihan Lin","doi":"10.1161/JAHA.124.038365","DOIUrl":"10.1161/JAHA.124.038365","url":null,"abstract":"<p><strong>Background: </strong>One-third of the global rheumatic heart disease burden lies in sub-Saharan Africa, where 17% of patients with severe rheumatic heart disease die within 3 years without valve surgery. Surgery is often considered uneconomical, although this assumption is not grounded in cost-effectiveness analyses.</p><p><strong>Methods: </strong>We evaluated the cost-effectiveness of mechanical valve replacement, bioprosthetic valve replacement, and valve repair compared with medical management for patients with severe rheumatic heart disease in Rwanda. Using a Markov model, we simulated disease progression, incorporating transition probabilities from a meta-analysis of regional observational studies. Costs were calculated using microcosting, and health effects were measured in disability-adjusted life-years (DALYs). Cost-effectiveness was defined by a willingness-to-pay threshold of United States dollars (USD) $2307 per DALY, which is 3 times Rwanda's gross domestic product per capita. A 3% discount rate for costs and DALYs was applied.</p><p><strong>Results: </strong>Surgical strategies extended life expectancy from 7 to 11 to 13 years. Mechanical and bioprosthetic valve replacements were cost-effective compared with medical management. Mechanical valve replacement was most efficient, averting 5.64 discounted DALYs for a lifetime discounted cost of USD $10 539.34, with an incremental cost-effectiveness ratio of USD $1704 per DALY. Bioprosthetic valve replacement averted 5.27 discounted DALYs but incurred higher costs (USD $10 873.06). Valve repair only averted 3.30 DALYs despite being least expensive (USD $8790.19). Repair became the most efficient surgical strategy if valve degeneration rates dropped <3.7% annually.</p><p><strong>Conclusions: </strong>Mechanical valve replacement is the most efficient surgical strategy for severe rheumatic heart disease in sub-Saharan Africa, challenging assumptions that surgery is uneconomical. Reducing surgery costs and optimizing anticoagulation could further enhance cost-effectiveness.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038365"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144372","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":"Smooth Muscle Cell-Derived Fibronectin Promotes an Atheroprotective Smooth Muscle Cell Phenotype Associated With Altered NO-cGMP Signaling.","authors":"Susanne Feil, Maria T K Zaldivia, Jacek Kiesel, Malte Roessing, Andreas Peter, Daniel Morales-Cano, Jacob F Bentzon, Moritz Lehners, Robert Feil","doi":"10.1161/JAHA.124.040395","DOIUrl":"10.1161/JAHA.124.040395","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease due to atherosclerosis is the leading cause of death worldwide. Recent studies revealed an important role of smooth muscle cell (SMC) phenotypic switching in atherogenesis. How the extracellular matrix affects SMC phenotype in atherosclerotic lesions is not well understood. Fibronectin (Fn1) is an abundant component of the extracellular matrix in plaques and has been linked to coronary artery disease risk in humans.</p><p><strong>Methods: </strong>We used mouse genetics combined with single-cell analyses, cell lineage tracing, and immunostaining of murine and human atherosclerotic lesions.</p><p><strong>Results: </strong>Genetic ablation of SMC-derived Fn1 in mice led to a decrease of alpha smooth muscle actin-positive cells in atherosclerotic lesions and a reduced collagen content in the fibrous cap indicative of decreased plaque stability. Plaques lacking SMC-derived Fn1 contained more modulated SMCs with relatively low collagen expression. Interestingly, a subset of the modulated SMCs showed high expression of NO-sensitive guanylyl cyclase (NO-GC). NO-GC is a major cGMP generator in SMCs and like Fn1 has been implicated in coronary artery disease. Fn1 knockout SMCs showed increased cell growth and activity of the NO-cGMP pathway. Expression of Fn1 and NO-GC was also detected in modulated SMCs of human atherosclerotic lesions.</p><p><strong>Conclusions: </strong>SMC-derived Fn1 promotes plaque stability through suppression of SMC phenotypes with low alpha smooth muscle actin and collagen expression. This atheroprotective effect might be mediated, at least in part, by a crosstalk between Fn1 and the NO-cGMP axis in SMCs. Our study identifies a mechanistic link between 2 coronary artery disease risk genes, Fn1 and NO-GC, which explains how the extracellular matrix regulates SMC phenotype and plaque stability.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040395"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175723","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":"Differential Characteristics and Outcomes of Urgent/Emergent Versus Elective Aortic Valve Replacement.","authors":"Joseph E Ebinger, Aakriti Gupta, Tzu Yu Huang, Marcella A Kelley, Christin Thompson, Maria Platanis, Susan Cheng","doi":"10.1161/JAHA.125.041148","DOIUrl":"10.1161/JAHA.125.041148","url":null,"abstract":"<p><strong>Background: </strong>Despite the slowly progressive nature of aortic stenosis, a proportion of aortic valve replacements (AVRs) still occur on an urgent/emergent basis. We sought to characterize the predictors, outcomes, and potential opportunities to prevent urgent/emergent AVRs.</p><p><strong>Methods: </strong>We analyzed Medicare data to identify patients undergoing AVRs from 2017 to 2022. We used multivariable regression to identify factors associated with nonelective AVRs; we also examined the association of nonelective AVRs with clinical outcomes and health care costs.</p><p><strong>Results: </strong>In total, 15 305 patients (16% urgent/emergent) underwent AVR during the study period. Compared with patients undergoing elective AVRs, those receiving urgent/emergent AVRs were more frequently of Black race or Hispanic ethnicity, and less likely to have received a diagnosis of aortic stenosis, despite 91.7% having seen a cardiologist or primary care provider in the prior year. In multivariable-adjusted analyses, dual Medicare-Medicaid enrollment, male sex, and recent heart failure hospitalization were associated with increased risk for urgent/emergent AVR; conversely, recent aortic stenosis diagnosis and cardiologist visit were associated with lower odds of urgent/emergent AVR. In turn, urgent/emergent compared with elective AVR increased risk for in-hospital death, intensive care unit admission, and discharge to a facility versus home, in addition to longer lengths of stay and higher health care costs.</p><p><strong>Conclusions: </strong>Urgent/emergent AVR occurs more frequently among Black, Hispanic, and dual Medicare-Medicaid-eligible patients. Nonelective AVR is also associated with worse hospital outcomes as well as greater health care costs. Importantly, variable timing in diagnosis of aortic stenosis appears to be a key determinant; thus, augmented screening efforts may improve outcomes and reduce disparities.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041148"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175777","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 Lipoprotein(a) With Major Adverse Limb Events and All-Cause Mortality Following Revascularization for Chronic Limb-Threatening Ischemia: A Substudy of the BEST-CLI Trial.","authors":"Alexander E Sullivan, Shi Huang, Suman Kundu, Victoria E Thomas, Daniel G Clair, Aaron W Aday, Matthew T Menard, Alik Farber, Kenneth Rosenfield, Jonathan D Newman, Jeffrey S Berger, Quinn S Wells, Matthew S Freiberg, MacRae F Linton, Joshua A Beckman","doi":"10.1161/JAHA.125.041177","DOIUrl":"10.1161/JAHA.125.041177","url":null,"abstract":"<p><strong>Background: </strong>The BEST-CLI (Best Endovascular Versus Best Surgical Therapy in Patients With Critical Limb Ischemia) trial tested the optimal initial revascularization strategy in patients with chronic limb-threatening ischemia. Little is known about the prognostic relevance of Lp(a) (lipoprotein[a]) and its modification by renal function in patients with chronic limb-threatening ischemia. We investigated the relationship between Lp(a) and prespecified cardiovascular outcomes.</p><p><strong>Methods: </strong>A subgroup of patients from the BEST-CLI trial (as part of the TIDE [The Impact of Diabetes on Revascularization] study) underwent blinded, core-laboratory assessment of Lp(a) levels and were included in this analysis. The primary end point was major adverse limb events or death from any cause. Secondary end points were the components of the primary end point, major amputation, major reintervention, and major adverse cardiac events (myocardial infarction, ischemic stroke, or death from any cause). The association of Lp(a) with end points was assessed using Cox proportional hazard models adjusting for traditional risk factors and then also for renal function and statin use, which increase Lp(a) levels.</p><p><strong>Results: </strong>A total of 189 patients (median [interquartile range] age 67.3 [61.6-74.1] years) were included and followed for a median of 2.1 (1.2-2.9) years. Median Lp(a) for the total study population was 27.3 (10.4-65.8) mg/dL, and 62 (32.8%) patients had elevated values (≥50 mg/dL). The 1-year event rate of the primary outcome was 33.3 (95% CI, 23.7-42.8) per 100 person-years. There was no association between Lp(a) and the primary outcome (hazard ratio [HR], 1.00 [95% CI, 0.99-1.00]; <i>P</i>=0.186). In secondary analyses controlling for renal function, elevated Lp(a) was associated with increased risk for all-cause death (HR, 1.03 [95% CI, 1.01-1.05]; <i>P</i>=0.009). Results were similar regardless of peripheral revascularization strategy.</p><p><strong>Conclusions: </strong>Elevated Lp(a) level was not associated with major adverse limb events or death but was associated with all-cause death after controlling for renal function. Lp(a) may be an important therapeutic target in the patient population with high-risk chronic limb-threatening ischemia.</p><p><strong>Registration: </strong>https://clinicaltrials.gov/study/NCT03085524; Unique identifier: NCT03085524.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041177"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121485","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":"Heterogeneous Exercise Responses to High-Intensity Interval Training Are Associated With Varied Long-Term Cardiovascular Outcomes in Patients With Heart Failure: A 15-Year Follow-Up.","authors":"Tieh-Cheng Fu, Shu-Chun Huang, Shin-Sheng Yuan, Chao-Hung Wang, Jong-Shyan Wang, Wen-Chung Tsai, Wen-Jin Cherng, Yu-Chiau Shyu, Chih-Chin Hsu","doi":"10.1161/JAHA.124.040330","DOIUrl":"10.1161/JAHA.124.040330","url":null,"abstract":"<p><strong>Background: </strong>This study investigated exercise response heterogeneity and its mediating role in survival for patients with heart failure.</p><p><strong>Methods and results: </strong>We conducted a retrospective cohort study by examining the registry satabase in 3 institutes from 2009 to 2024. All 182 included patients with heart failure completed 36 sessions of high-intensity interval training (HIIT) at alternating intensities of 80% and 40% peak oxygen consumption (<math><semantics><mrow><mover><mtext>V</mtext><mo>˙</mo></mover></mrow></semantics></math>_o_2peak). Based on the improvement of <math><semantics><mrow><mover><mtext>V</mtext><mo>˙</mo></mover></mrow></semantics></math>o_2peak (Δ<math><semantics><mrow><mover><mtext>V</mtext><mo>˙</mo></mover></mrow></semantics></math>o_2peak=post-HIIT <math><semantics><mrow><mover><mtext>V</mtext><mo>˙</mo></mover></mrow></semantics></math>o_2peak-baseline <math><semantics><mrow><mover><mtext>V</mtext><mo>˙</mo></mover></mrow></semantics></math>o_2peak), they were classified as responders (Δ<math><semantics><mrow><mover><mtext>V</mtext><mo>˙</mo></mover></mrow></semantics></math>o_2peak>0) or nonresponders (Δ<math><semantics><mrow><mover><mtext>V</mtext><mo>˙</mo></mover></mrow></semantics></math>o_2peak ≤0). The end points were the long-term survivals and readmissions for them. The prevalence of nonresponders was 21% (39/182). Responders (n=143) showed significant improvement of oxygen uptake efficiency slope, arteriovenous oxygen difference and skeletal muscle mass after HIIT. The above physiological adaptations in responders were significantly greater than in nonresponders. The 14-year cardiovascular event-free survival was significantly better in responders (91.3%) than nonresponders (76.8%). Higher <math><semantics><mrow><mover><mtext>V</mtext><mo>˙</mo></mover></mrow></semantics></math>o_2peak was a protective factor for cardiovascular death (adjusted hazard ratio [aHR], 0.411 [95% CI, 0.172-0.985]; <i>P</i>=0.046). Male sex (aHR, 0.320 [95% CI, 0.136-0.757]; <i>P</i>=0.009) and higher oxygen uptake efficiency slope (aHR, 0.995 [95% CI, 0.992-0.998]; <i>P</i>=0.005) were protective factors against cardiovascular readmissions. Causal mediation analysis revealed that <math><semantics><mrow><mover><mtext>V</mtext><mo>˙</mo></mover></mrow></semantics></math>o_2peak mediated the association between HIIT and all-cause death, while heart rate reserve mediated HIIT effects on cardiovascular readmissions.</p><p><strong>Conclusions: </strong>The longitudinal study has identified different physiological adaptations to HIIT in patients with heart failure. Improvement of cardiorespiratory fitness appears to be the dominant factor in reduction of the cardiovascular event for patients with heart failure.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040330"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175787","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 Differences in Sodium Sources and Sodium Reduction Behaviors Among US Adults: NHANES 2017 to 2020 Prepandemic.","authors":"Jessica Cheng, Anne N Thorndike, Stella Yi","doi":"10.1161/JAHA.124.037997","DOIUrl":"10.1161/JAHA.124.037997","url":null,"abstract":"<p><strong>Background: </strong>Nearly all US adults exceed sodium recommendations, which increases cardiovascular risk. Understanding racial and ethnic differences in sodium sources and behaviors could lead to nuanced public health messaging, dietary interventions, and clinical guidance to achieve population-level sodium reduction more equitably.</p><p><strong>Methods and results: </strong>Using National Health and Nutrition Examination Survey (NHANES) 2017 to 2020 prepandemic data, racial and ethnic differences in sodium sources and sodium-related behaviors (eg, salt use at the table and in food preparation, doctor advice to reduce sodium, attempts to reduce sodium, and label reading) were assessed using weighted chi-square. Given the nutrient database's assumption that rice is salted may be inappropriate for some ethnic groups, we conducted a secondary analysis altering this assumption. Pizza, soup, and chicken were top sources of sodium across racial and ethnic groups. For Asian American adults, 4 top sources were unique (eg, soy-based condiments). Black adults reported the highest rates of reducing sodium (67% versus 44% among White adults) and receiving physician sodium reduction advice (35% versus 18% among Asian American adults). Asian American adults were the most likely to frequently use salt during food preparation (66% versus Other Race adults 32%) but reported not using salt at the table (39% versus 18% among Mexican American adults). Assuming rice is unsalted reduces Asian American sodium intake estimates by ~325 mg/day.</p><p><strong>Conclusions: </strong>To equitably address sodium intake, culturally appropriate advice on sources of sodium and salt usage may be needed, particularly for Asian American adults.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037997"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175795","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":"Iron Deficiency Is Associated With Impaired Myocardial Reperfusion in ST-Segment-Elevation Myocardial Infarction: Influence of the Definition Used.","authors":"José A Barrabés, Javier Inserte, Laura Castellote, Irene Buera, Laia Milà, Antonia Sambola, Aitor Uribarri, Maria Vidal, David Aluja, Sara Delgado-Tomás, Pablo E Tobías-Castillo, Maria Calvo-Barceló, Andrea Guala, José F Rodríguez-Palomares, Bruno García Del Blanco, David Beneítez, Ignacio Ferreira-González","doi":"10.1161/JAHA.124.040845","DOIUrl":"10.1161/JAHA.124.040845","url":null,"abstract":"<p><strong>Background: </strong>The role of iron deficiency (ID) in ST-segment-elevation myocardial infarction (STEMI) remains unclear. This study aimed to assess whether ID is associated with impaired myocardial reperfusion in STEMI and whether this association is affected by ID definition.</p><p><strong>Methods: </strong>We included 942 consecutive patients with STEMI successfully treated with primary percutaneous coronary intervention. ID was defined either as recommended by international guidelines or, alternatively, as ferritin <100 ng/mL, transferrin saturation <20%, or serum iron ≤13 μmol/L. In 595 patients, serum soluble transferrin receptor levels were measured. Impaired myocardial reperfusion was defined as lack of ST-segment resolution ≥50% 60 to 90 minutes after percutaneous coronary intervention.</p><p><strong>Results: </strong>ID prevalence varied across these definitions. Impaired reperfusion was present in 12.7% of patients without ID and 41.0% of those with ID defined by transferrin saturation <20% (<i>P</i><0.001). This association was less pronounced for serum iron ≤13 μmol/L, weaker for guideline criteria, and absent for high (≥1.59 mg/L) soluble transferrin receptor levels or low ferritin. Transferrin saturation <20%, but not ferritin-based criteria, was associated with poorer clinical course and left ventricular function and higher in-hospital mortality and remained an independent predictor of impaired reperfusion after adjusting for baseline predictors and anemia.</p><p><strong>Conclusions: </strong>ID defined by transferrin saturation <20% is strongly related to impaired ST resolution and predicts a worse in-hospital outcome in patients with STEMI treated with primary percutaneous coronary intervention. The association of other ID criteria with myocardial reperfusion or with the clinical course is weaker or absent. The potential preventive or therapeutic strategies targeting ID in STEMI warrant further investigation.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040845"},"PeriodicalIF":5.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121312","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}