American journal of preventive cardiology最新文献

{"title":"Marathon running pace immediately before sudden cardiac arrest","authors":"Jo Kato ,&nbsp;Tomohiro Manabe ,&nbsp;Fumihiro Yamasawa","doi":"10.1016/j.ajpc.2025.101390","DOIUrl":"10.1016/j.ajpc.2025.101390","url":null,"abstract":"<div><h3>Background</h3><div>Sudden cardiac arrest (SCA) is a rare but catastrophic event that can occur during long-distance road races. Although habitual training mitigates SCA risk, it remains uncertain whether running pace on race day can help identify susceptible individuals.</div></div><div><h3>Methods</h3><div>We prospectively collected cases of SCA in Japan Association of Athletics Federations (JAAF)-certified full marathons between April 2011 and March 2020. Collapses during or within 1 hour after races that required basic life support were included. Running pace was calculated from the last available split or finish time, and expected completion times were compared with age- and sex-stratified marathon ranking data. Predicted finish time percentiles were evaluated within subgroups defined by calendar year, sex, age group, and location of collapse (race tertile or postfinish).</div></div><div><h3>Results</h3><div>Among 4.53 million starters in 571 marathons, 74 SCA cases were identified (1.6/100,000). The median age was 52 years, and 93% were men. Over half of the events occurred in the final tertile or immediately postfinish. The median pace was 10 minutes 25 seconds per mile (interquartile range: 9:15–12:13), with an extrapolated finish time of 4 hours 33 minutes, corresponding to the 48th percentile in population rankings. Females and those collapsing in the latter part of the race tended to occupy higher percentile ranks than the general finisher distribution.</div></div><div><h3>Conclusions</h3><div>Marathon-related SCA occurred at running speeds indistinguishable from the general finisher population, challenging the assumption that less conditioned runners are particularly at risk of SCA.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101390"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune-mediated inflammatory disease and coronary calcium: Elevated baseline risk and attenuated prognostic gradient","authors":"Prerna Singh ,&nbsp;Michael D. Glidden ,&nbsp;Santosh Sirasapalli ,&nbsp;Sai Ponnana ,&nbsp;Neda Shafiabadi Hassani ,&nbsp;Christos P. Kotanidis ,&nbsp;Abigail Wilgor ,&nbsp;Brittany N. Weber ,&nbsp;David L. Wilson ,&nbsp;Sanjay Rajagopalan","doi":"10.1016/j.ajpc.2026.101434","DOIUrl":"10.1016/j.ajpc.2026.101434","url":null,"abstract":"<div><h3>Background</h3><div>Immune-mediated inflammatory diseases (IMID) are associated with accelerated atherosclerosis, yet it is unclear whether CT coronary artery calcium scoring (CTCS) captures this excess cardiovascular risk accurately. We hypothesized that in adults undergoing CTCS, IMID modifies the relationship between coronary artery calcium (CAC) score and incident major adverse cardiac events (MACE).</div></div><div><h3>Methods</h3><div>Among 43,420 individuals in the CLARIFY Registry (University Hospitals Cleveland, 2014–2020) who underwent no-cost CTCS scans, we identified 545 individuals with IMID. After propensity-score matching on age, sex, race, hypertension, diabetes, and smoking status with a 2:1 ratio, 1635 matched individuals were analyzed (545 with IMID and 1090 matched non-IMID controls). CAC was categorized as 0, 1–99, 100–399, ≥400. The primary outcome of 4-point MACE was analyzed over a median 4.2-year follow-up. Cox models tested CAC categories compared to CAC 0, stratified by IMID. Additionally, a log(CAC+1) × IMID interaction term was modeled, to assess whether the risk gradient of CAC differed by IMID status.</div></div><div><h3>Results</h3><div>Individuals with IMID exhibited over twice the MACE incidence of matched controls (40.8 vs 17.6 per 1000 person-years). Among those with zero CAC, those with IMID had a three-fold higher event rate (21.98 vs 7.18 per 1000 person-years). In controls, MACE risk rose stepwise with CAC, quadrupling from CAC 0 to ≥400 (adjusted HR = 4.74; <em>p</em> &lt; 0.001), whereas in IMID increasing CAC conferred no significant gradient (<em>p</em> = 0.21). The interaction between CAC and IMID was significant (β = –0.27; HR 0.76, 95% CI 0.55–1.00), indicating an attenuated CAC-MACE relationship in IMID.</div></div><div><h3>Conclusion</h3><div>In IMID, baseline risk is elevated even with zero CAC, with attenuation of the traditional CAC-risk gradient observed in non-IMID controls. These findings suggest that, in IMID (1) a CAC score of zero may not guarantee low cardiovascular risk and (2) CAC has less incremental prognostic value than in the general population.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101434"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rest-activity rhythms and cardiovascular events in cardiovascular–kidney–metabolic syndrome: evidence from two nationwide cohorts","authors":"Bingtao Weng ,&nbsp;Haizhen Chen ,&nbsp;Han Chen ,&nbsp;Ningjian Wang ,&nbsp;Hongliang Feng ,&nbsp;Kehua Yang ,&nbsp;Xiao Tan","doi":"10.1016/j.ajpc.2026.101414","DOIUrl":"10.1016/j.ajpc.2026.101414","url":null,"abstract":"<div><h3>Background</h3><div>Circadian rest–activity rhythm (CRAR) is a modifiable determinant of metabolic and cardiovascular health, yet its role in cardiovascular events and mortality among individuals with cardiovascular–kidney–metabolic (CKM) syndrome remains unclear.</div></div><div><h3>Methods</h3><div>Accelerometer-derived CRAR parameters were analyzed in two nationally representative cohorts. Primary outcomes included cardiovascular incidence among participants with CKM stages 0–3 and all-cause and cardiovascular mortality among those with stages 1–4. Multinomial logistic and Cox proportional hazards models assessed associations of CRAR with CKM progression and subsequent outcomes. Mediation analyses examined inflammatory biomarkers, and improvements in prediction were evaluated using changes in C-statistics.</div></div><div><h3>Results</h3><div>Among 74,777 participants, higher relative amplitude (RA) tertiles were associated with slower CKM progression and lower risks of cardiovascular incidence (T2: HR 0.87, 95% CI 0.82–0.93; T3: HR 0.79, 95% CI 0.73–0.85), all-cause mortality (T2: HR 0.70, 95% CI 0.64–0.77; T3: HR 0.60, 95% CI 0.54–0.67), and cardiovascular mortality (T2: HR 0.70, 95% CI 0.57–0.86; T3: HR 0.45, 95% CI 0.34–0.61). Higher intradaily variability (IV) was associated with increased all-cause mortality (T2: HR 1.12, 95% CI 1.02–1.22; T3: HR 1.19, 95% CI 1.08–1.30). Inflammatory biomarkers modestly mediated these associations (1%–5%). Optimal thresholds were RA = 0.87 for cardiovascular incidence, RA = 0.81 and IV = 0.68 for mortality. Adding CRAR to basic models improved prediction of all-cause and cardiovascular mortality (ΔC-statistic = 0.019 and 0.017). Results were validated in an independent cohort of 6046 participants.</div></div><div><h3>Conclusion</h3><div>Adverse CRAR is associated with CKM progression and elevated risks of cardiovascular events and mortality, highlighting its utility in identifying high-risk individuals and guiding targeted interventions through risk stratification and incremental prediction.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101414"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The emerging role of CETP inhibition in the prevention of Alzheimer's disease","authors":"Michael H Davidson ,&nbsp;Andrew Hsieh ,&nbsp;Mathijs de Kleer ,&nbsp;Michael S. Szarek ,&nbsp;Philip Scheltens ,&nbsp;Everard Vijverberg ,&nbsp;Adam Johnson ,&nbsp;Marc Ditmarsch ,&nbsp;John J.P. Kastelein","doi":"10.1016/j.ajpc.2026.101442","DOIUrl":"10.1016/j.ajpc.2026.101442","url":null,"abstract":"<div><div>We recently showed that patients with atherosclerotic cardiovascular disease (ASCVD) carry a substantial but largely unrecognized burden of early Alzheimer's disease (AD) pathology. In the BROADWAY pivotal phase 3 lipid-lowering trial, nearly half of participants with high-risk ASCVD had plasma p-tau217 concentrations above thresholds associated with preclinical AD, yet none had undergone evaluation for cognitive impairment. In this population, apolipoprotein E ε4 (APOE4) carriers were disproportionately represented among those with the highest p-tau217 levels. These findings expose a critical gap between cardiovascular care and dementia prevention and raise the question whether interventions targeting shared pathophysiology could address both conditions simultaneously.</div><div>Cholesteryl ester transfer protein (CETP) inhibition has emerged as a candidate for this dual role. In BROADWAY, obicetrapib reduced p-tau217 progression across the study population, with effects most pronounced in APOE4 carriers. In fact, treatment differences favoring obicetrapib were observed across all measured AD biomarkers in high-risk subgroups, including neurofilament light chain, glial fibrillary acidic protein, and the amyloid-beta (Aβ) 42:40 ratio. Unlike approaches that target downstream pathology, such as amyloid plaques already deposited in the brain or the inflammatory consequences of established disease, CETP inhibition may address the upstream processes involved in initiating the pathological cascade: lipid dysregulation, cholesterol ester accumulation in glial cells, impaired cholesterol efflux, lipid peroxidation, oxysterol formation, and deficient antioxidant transport.</div><div>This review examines the biological rationale linking APOE4 status to disordered lipid metabolism in both peripheral and central compartments, the genetic and epidemiological evidence supporting CETP as a therapeutic target, the mechanisms through which CETP inhibition might confer neuroprotection, and the clinical data suggesting obicetrapib as the first oral agent associated with favorable changes in AD biomarkers across both amyloid and tau axes in individuals at high genetic risk for the development of AD.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101442"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147702755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in unawareness of cardiovascular disease risk factors among racial & ethnic groups in the United States","authors":"Ramzi Ibrahim ,&nbsp;Kamal Awad ,&nbsp;Abdelrahman Hafez ,&nbsp;Hoang Nhat Pham ,&nbsp;Min Choon Tan ,&nbsp;Mohammed Salih ,&nbsp;Justin Z Lee ,&nbsp;Dan Sorajja ,&nbsp;Luis R Scott ,&nbsp;Chadi Ayoub ,&nbsp;Reza Arsanjani","doi":"10.1016/j.ajpc.2026.101456","DOIUrl":"10.1016/j.ajpc.2026.101456","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101456"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147702795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of severe infections on the risk of acute cardiovascular and cerebrovascular diseases: A prospective cohort study","authors":"Siqi Tang ,&nbsp;Yonggen Jiang ,&nbsp;Yiling Wu ,&nbsp;Xuyan Su ,&nbsp;Shuo Wang ,&nbsp;Ruilin Chen ,&nbsp;Genming Zhao ,&nbsp;Wanghong Xu ,&nbsp;Xing Liu ,&nbsp;Ruoxin Zhang ,&nbsp;Tiejun Zhang ,&nbsp;Xingdong Chen ,&nbsp;Yanfeng Jiang ,&nbsp;Chen Suo","doi":"10.1016/j.ajpc.2026.101436","DOIUrl":"10.1016/j.ajpc.2026.101436","url":null,"abstract":"<div><h3>Background</h3><div>Severe infections, particularly those requiring hospitalization, have been widely recognized as potential risk factors for cardiovascular and cerebrovascular diseases. However, the precise relationship remains unclear, particularly regarding how factors such as different time windows, repeated infections, infections caused by various pathogens, and infections involving different organ systems may influence the risk of acute cardiovascular and cerebrovascular events. This study aimed to evaluate the impact of severe infections on the incidence of these acute events by specifically focusing on these factors.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study involving 55,338 participants, with a median follow-up duration of 6.42 years (IQR: 4.56–7.01). Hospitalization events related to infectious diseases and incident cardiovascular and cerebrovascular diseases were identified using passive follow-up methods. Segmented Cox regression analyses were performed to evaluate the effects of various infection-related factors on the risk of acute cardiovascular and cerebrovascular diseases, including different time windows after infection, repeated infections, infections caused by various pathogens, and infections involving different organ systems.</div></div><div><h3>Results</h3><div>The risk of cardiovascular and cerebrovascular events after severe infection was elevated during the whole follow-up (HR=4.07, 95% CI: 3.62–4.57) and was most significantly elevated in 3 months following severe infection (HR=8.24, 95% CI: 6.16–11.02). Repeated infections were positively correlated with the excess risk of stroke (HR=4.73, 95% CI: 1.75–12.79 for ≥3 infections, p for difference = 0.013). Infections involving different organ systems carried a much higher risk compared to single-system infections (HR= 13.11, 95% CI: 7.3–23.53). Viral infections notably increased the risk of acute ischemic heart disease (HR=4.22, 95% CI: 2.29–7.76).</div></div><div><h3>Conclusion</h3><div>The study found that severe infections were associated with the elevated risk of cardiovascular and cerebrovascular events. The findings suggest that more attention should be given to preventing and intervening in cardiovascular events among high-risk infection populations.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101436"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in cardiovascular health based on Life’s Essential 8 among Korean adults, 2007–2023","authors":"Dasom Son ,&nbsp;Yeeun Seo ,&nbsp;Kyoung Hwa Ha ,&nbsp;Hyeok-Hee Lee ,&nbsp;Hyeon Chang Kim ,&nbsp;Hokyou Lee","doi":"10.1016/j.ajpc.2026.101448","DOIUrl":"10.1016/j.ajpc.2026.101448","url":null,"abstract":"<div><h3>Background</h3><div>In 2022, the American Heart Association introduced Life’s Essential 8 (LE8), an updated framework for assessing cardiovascular health (CVH). This study examined trends in overall LE8 CVH and individual metric scores from 2007 to 2023 in the Korean adult population.</div></div><div><h3>Methods</h3><div>We conducted a serial, cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (KNHANES; waves 4–9), adults aged ≥20 years. CVH was assessed using LE8 metrics, each scored range of 0–100. The overall score was calculated as the mean of the eight metrics and categorized as low (0-&lt;50), moderate (50-&lt;80), or high (80–100).</div></div><div><h3>Results</h3><div>There were 76,255 participants, representing 35,494,751 adults. The mean (95% CI) CVH score declined from 68.5 (68.1–68.9) in 2007–2009 to 65.9 (65.5–66.2) in 2016–2018, and returned to 68.5 (68.1–69.0) in 2022–2023. In the most recent period, women had higher mean scores than men (72.8 [95% CI: 72.2–73.3] vs. 64.3 [95% CI: 63.7–64.8]), and adults aged 20–39 years scored higher than those aged ≥70 years (72.5 [95% CI: 72.0–73.1] vs. 64.5 [95% CI: 63.9–65.1]). Trends varied by individual metrics. Sleep health and blood glucose scores remained high. Nicotine exposure, body mass index, blood lipids, and blood pressure scores remained moderate. Diet and physical activity scores remained low. These patterns also differed by sex and age.</div></div><div><h3>Conclusions</h3><div>Over the 17 years, CVH in Korean adults remained in the moderate range, with a decline through 2018 and full recovery by 2022–2023. Differences by age and sex underscore the need for tailored prevention strategies.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101448"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147702760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Very low-grade albuminuria is linked to arterial stiffness in a population-based cohort","authors":"Victor Walendy ,&nbsp;Michael Gekle ,&nbsp;Claudia Grossmann ,&nbsp;Alexander Kluttig ,&nbsp;Frank Bernhard Kraus ,&nbsp;Beatrice Ludwig-Kraus ,&nbsp;Rafael Mikolajczyk ,&nbsp;Thomas Schmid ,&nbsp;Oliver Thews ,&nbsp;Andreas Wienke ,&nbsp;Melanie Zinkhan ,&nbsp;Matthias Girndt","doi":"10.1016/j.ajpc.2026.101495","DOIUrl":"10.1016/j.ajpc.2026.101495","url":null,"abstract":"<div><h3>Background</h3><div>Albuminuria even at low levels and increased arterial stiffness are associated with higher cardiovascular risk. Very low-grade albuminuria (VLGA; urinary albumin–creatinine ratio [uACR] &lt;30 mg/g) has been linked to adverse outcomes, but its association with arterial stiffness in the general population, particularly among individuals without major cardiometabolic disease, remains uncertain.</div></div><div><h3>Methods</h3><div>We analyzed data from 7613 participants of the German National Cohort (NAKO) with available uACR and brachial–ankle pulse wave velocity (PWV[ba]) measurements. Multivariable linear regression was used to assess the association between log₁₀-transformed uACR and PWV(ba), adjusting for age, sex, systolic blood pressure, obesity indices, LDL-cholesterol, HbA1c, and estimated glomerular filtration rate (eGFR). A low-risk subgroup excluded participants with arterial hypertension or diabetes mellitus.</div></div><div><h3>Results</h3><div>Among included participants, 49.6 % were female and 7100 (93.3 %) had uACR &lt;30 mg/g. In the full cohort, a 10-fold higher uACR was associated with higher PWV(ba) by 0.10 m/s (95 % CI 0.03–0.17). Similar associations were observed in the VLGA subgroup (0.16 m/s; 95 % CI 0.07–0.25). In the low-risk VLGA subgroup (<em>n</em> = 4308), uACR remained positively associated with PWV(ba) (0.18 m/s per 10-fold higher uACR; 95 % CI 0.08–0.28).</div></div><div><h3>Conclusion</h3><div>Higher uACR was consistently associated with greater arterial stiffness across the full cohort and among individuals with very low-grade albuminuria, including those without arterial hypertension or diabetes mellitus.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101495"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147702762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validating clinical risk scores in contemporary populations using CCTA","authors":"Miguel Cainzos-Achirica","doi":"10.1016/j.ajpc.2026.101483","DOIUrl":"10.1016/j.ajpc.2026.101483","url":null,"abstract":"<div><div>None.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101483"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147702792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediabetes, obesity and risk for incident atherosclerotic cardiovascular disease: A large-scale contemporary cohort study","authors":"Jamal S. Rana ,&nbsp;Edward D. Shin ,&nbsp;Holly Finertie ,&nbsp;Natasha Chowdhury ,&nbsp;Julie A. Schmittdiel","doi":"10.1016/j.ajpc.2026.101468","DOIUrl":"10.1016/j.ajpc.2026.101468","url":null,"abstract":"<div><h3>Background</h3><div>Prediabetes is a highly prevalent metabolic state associated with the development of type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD). Early identification and management of prediabetes and obesity are critical to mitigate this risk, particularly in younger adults. However, contemporary large-scale data on the interplay of prediabetes, obesity, and cardiovascular outcomes across the adult lifespan remains limited.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adults aged 18–90 years old within Kaiser Permanente Northern California (KPNC) from 2015–2018, excluding those with a prior history of diabetes or ASCVD. Individuals with prediabetes (HbA1c 5.7–6.4% or fasting glucose 100–125 mg/dL) were compared with those with normoglycemia. Obesity was classified based on body mass index (BMI) ≥ 30kg/m² at baseline. The primary outcome was incident ASCVD, a composite of myocardial infarction, stroke, or revascularization procedures. Outcomes were tracked over 5 years and analyzed using multivariable Cox proportional hazards models, adjusted for demographic and clinical covariates and stratified by age group.</div></div><div><h3>Results</h3><div>The final cohort comprised 1358,882 individuals (mean age of 52.5 years; 55.8% women) of whom 688,575 (50.7%) had prediabetes at baseline. In the cohort19.2% had both prediabetes and obesity, 31.5% had prediabetes without obesity, 12.2% did not have prediabetes but had obesity, and 37.1% had neither. Over a mean follow-up period of 4.1 years, prediabetes was independently associated with a 21% increased risk of ASCVD after full adjustment (Hazard Ratio [HR] 1.21; 95% CI, 1.18–1.25). This association was strongest among younger adults (ages 18–34: HR 1.54; 95% CI, 1.18–2.02). Fully adjusted, HRs for 5-year ASCVD risk were 1.32 (95% CI 1.28–1.37) for individuals with prediabetes and obesity, and 1.22 (95% CI 1.18–1.26) for those with prediabetes without obesity, compared to the reference group without prediabetes or obesity.</div></div><div><h3>Conclusion</h3><div>In a large, contemporary cohort study, prediabetes was independently associated with a significantly increased 5-year risk of ASCVD. The relative risk was most pronounced among young adults and those with obesity. These findings underscore a critical window for implementing targeted strategies to mitigate cardiovascular risk early during metabolic dysregulation.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101468"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147706768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}