American journal of preventive cardiology最新文献

{"title":"ASSOCIATION BETWEEN DIETARY QUALITY AND SUBCLINICAL MYOCARDIAL INJURY IN NHANES III STUDY","authors":"Juliana H. Namutebi MD, MS","doi":"10.1016/j.ajpc.2024.100790","DOIUrl":"10.1016/j.ajpc.2024.100790","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD /CVD Risk Reduction</div></div><div><h3>Background</h3><div>Adherence to a high-quality diet is linked to a lower risk of clinical cardiovascular disease (CVD), however, the relationship between dietary quality and subclinical myocardial injury (SCMI) on electrocardiogram (ECG) is understudied.</div></div><div><h3>Methods</h3><div>This analysis included 6580 participants without CVD who underwent ECG in the Third United States National Health and Nutrition Examination Survey (NHANES III) conducted between 1988 and 1994. Relying on 24-hour dietary recall interviews, Dietary quality was assessed using the Healthy Eating Index (HEI). We excluded participants with missing ECG data or HEI scores. The HEI scores (ranging 0-100), were calculated, with a higher score indicating better diet quality. The overall HEI score comprised scores for the consumption of grains, fruits, vegetables, meats, dairy, total fat, saturated fat, cholesterol, sodium, and dietary variety. Participants were classified into tertiles based on both their overall HEI scores and the scores of each of the 10 individual HEI components. Tertile 3 denoted the highest HEI score, while tertile 1 represented the lowest. SCMI was defined as a cardiac infarction/injury score ≥10 on ECG. The cross‐sectional relationship between HEI scores and SCMI was assessed using multivariate logistic regression models.</div></div><div><h3>Results</h3><div>The prevalence of SCMI in tertile 3, tertile 2 and tertile 1 was 543 (24.7%), 570 (26.0%) and 609 (27.8%), respectively (p value = 0.063). When compared to participants in tertile 3, those in tertile 1 had a 1.29-fold higher odds of SCMI. Similarly, among the individual dietary quality components, participants in tertile 1, compared to those in tertile 3, had 1.19-fold higher odds of SCMI for fruit intake, 1.15-fold higher odds for fat intake, and 1.22-fold higher odds for dietary variety (Table).</div></div><div><h3>Conclusions</h3><div>In the NHANES III study, there was a significant association between low HEI scores and higher odds of SCMI. These results underscore the potential benefit of maintaining a high-quality dietary intake in preventing subclinical CVD.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100790"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPROVEMENT IN HEART FAILURE NAVIGATOR CONSULTATION - A QUALITY IMPROVEMENT INITIATIVE","authors":"Parnia Abolhassan Choubdar MD","doi":"10.1016/j.ajpc.2024.100791","DOIUrl":"10.1016/j.ajpc.2024.100791","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Heart Failure</div></div><div><h3>Background</h3><div>Heart failure (HF) has the highest 30-day rehospitalization rate among medical and surgical conditions. Data shows that HF patients who suffer from a 30-day readmission have worse prognosis at 6-month follow-up. Implementing educational interventions to improve outcome of adherence in HF patients has shown to reduce readmission rates by &gt;15%. Although the means to implement such educational interventions are available, this resource appears grossly underutilized. Preliminary analysis showed that &lt; 15% of patients admitted to advanced heart care with an ICD 10 diagnosis of acute heart failure exacerbation currently to receive an order for HF Navigator consultation.</div></div><div><h3>Methods</h3><div>The number of heart failure navigator consults placed on the advanced heart care unit in relation to primary diagnosis of acute heart failure exacerbation was measured. The baseline, measured over several weeks prior to implementation of intervention, was measured to be &lt;15%. Plan-Do-Study-Act (PDSA) Cycles were run. The cycles entailed: 1st Provider reeducation that ANY HF admission warrants HF Navigator consultation, 2nd Implementation of a widget making it accessible to follow up if consultation happened, 3rd order set for HF was enforced , which entailed the heart failure navigator order, 4th Distribution of reminder posters, post it's, and emails, 5th Distribution of questionnaire evaluating the main cause of lack of adherence to orders, serving as reminder to utilize the order, 6th educational meeting with the HF Navigator. 7th Information technology guided interventions are currently pending.</div></div><div><h3>Results</h3><div>The following number of orders for heart failure navigator consultation were noted after each PDSA cycle:1st 16%, 2nd 16%, 3rd 33 %, 4th 39 %, 5th 26%, 6th 50% (Figure 1).</div></div><div><h3>Conclusions</h3><div>Sustained and relevant change requires ongoing education, and improved workflow with utilization of order sets, which equal integrated clinical pathways. Ultimately, information technology support is needed to implement reflex orders, and clinical pathway tools, based on diagnosis, to ensure evidence based healthcare and optimal patient care. Advancements in electronic medical record systems with application of clinical pathways will improve human error and in the long-term safe patient suffering and hospital dollars.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100791"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EVALUATING TOUR006 IN PARTICIPANTS WITH CHRONIC KIDNEY DISEASE AND ELEVATED HS-CRP: RATIONALE AND DESIGN OF THE TRANQUILITY PHASE 2 STUDY","authors":"Emil DeGoma MD","doi":"10.1016/j.ajpc.2024.100778","DOIUrl":"10.1016/j.ajpc.2024.100778","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Pharmacologic Therapy</div></div><div><h3>Background</h3><div>Subgroups of patients with atherosclerotic cardiovascular disease (ASCVD) remain at very high risk of major adverse cardiovascular and limb events despite lifestyle modification and intensive pharmacological management including antiplatelet drugs, antihypertensive therapy, and LDL-lowering medications. Converging evidence from human genetic studies, prospective cohort studies, and mechanistic studies as well as results of canakinumab and colchicine cardiovascular outcome trials support the therapeutic potential of IL-6 pathway inhibition to lower the risk of ASCVD independent of traditional risk factors. TOUR006 is a fully human, high-affinity monoclonal antibody against the IL-6 cytokine. In prior Phase 1/2 studies, TOUR006 administered to patients with high-grade inflammatory autoimmune diseases such as rheumatoid arthritis, Crohn's disease, and systemic lupus erythematosus achieved rapid and durable reductions in C-reactive protein (CRP), the key downstream pharmacodynamic (PD) biomarker of IL-6 activity, as assessed by the high-sensitivity (hs) assay. A pharmacokinetic (PK)/PD model was developed from these data, and simulations in virtual patients showed significant reductions in hs-CRP with both monthly and quarterly dosing of TOUR006. The objective of this Phase 2 study is to characterize the hs-CRP-lowering effect, safety, tolerability, and PK of TOUR006 in patients with chronic kidney disease (CKD) and elevated hs-CRP. The CKD population was selected for this trial because of the high prevalence of elevated hs-CRP as well as evidence supporting a significant role of IL-6 pathway activation in driving ASCVD risk among patients with CKD.</div></div><div><h3>Methods</h3><div>TRANQUILITY is a Phase 2, randomized, double-blind, placebo-controlled, multicenter, US-based trial enrolling approximately 120 patients with CKD stage 3 or 4 and hs-CRP≥2 and &lt;15 mg/L. Participants will be stratified by CKD stage and randomized to subcutaneous TOUR006 50 mg quarterly, 25 mg quarterly, 15 mg monthly, or placebo (Figure). The primary PD endpoint is change in hs-CRP; additional biomarkers include IL-6, lipoprotein(a), oxidized LDL, and fibrinogen. Treatment and follow-up periods are 180 days and 185 days, respectively.</div></div><div><h3>Conclusions</h3><div>TRANQUILITY, an ongoing trial with anticipated primary completion in May 2025, will assess the safety, tolerability, PK, and hs-CRP-lowering effect of TOUR006 and inform the dosing regimen and design of future Phase 3 cardiovascular studies in high-risk patients.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100778"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASPCCongress2025_SaveTheDate","authors":"","doi":"10.1016/S2666-6677(24)00232-0","DOIUrl":"10.1016/S2666-6677(24)00232-0","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100864"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666667724002320/pdfft?md5=b07b8bf38d93949043f6742d5932f78a&pid=1-s2.0-S2666667724002320-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ANGIOGRAPHIC FINDINGS IN SYMPTOMATIC PATIENTS WITH EVIDENCE OF ISCHEMIA BY PET/CT PERFUSION IMAGING BUT WITH ZERO CORONARY ARTERY CALCIUM","authors":"Leslie Iverson PA-C","doi":"10.1016/j.ajpc.2024.100817","DOIUrl":"10.1016/j.ajpc.2024.100817","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>Coronary artery calcium (CAC) is a strong, incremental predictor of coronary artery disease (CAD) risk. In contrast, the absence of CAC portends a low but not zero risk, which has been ascribed to non-calcified, “soft” plaques. However, other pathologies in CAC=0 patients (pts) are possible, including spontaneous coronary artery dissection, microvascular disease, coronary anomalies, etc. We sought to determine the spectrum and frequency of angiographic findings in symptomatic pts with ischemia on stress PET/CT who had zero CAC.</div></div><div><h3>Methods</h3><div>The Intermountain nuclear medicine and hospital electronic medical record databases were searched for CAC=0 pts undergoing stress positron emission tomography (PET/CT) between 2/1/2014 and 7/1/2022. We defined PET abnormality with ischemic burden (IB) &gt;=10% as definite, IB &gt;0&lt;10% as equivocal, and IB=0 as normal. We defined severe and moderate CAD as &gt;=70% and 50-69% stenosis, respectively. Pts were followed for coronary interventions and major adverse cardiovascular events (MACE) over 1.1 +/- 0.9 y.</div></div><div><h3>Results</h3><div>Of 59,639 total PET/CT studies, 4284 (7.2%) had CAC=0 and no prior history of CAD. Of these, 28 with adequate quality PET (0.65%) had IB &gt;=10% (NPV 99.3%). Table 1 summarizes demographics across IB categories. Coronary angiography (n=21) or coronary CT angiography (n=5) was performed within &lt;90 days in 25 (89%) of IB&gt;=10% pts (Table 2). Severe CAD was present in 11, moderate in 1, mild in 4, and none in 9. Thus, 14 (56%) with positive PET (IB&gt;=10%) of 25 angiographic cases were not explained by severe CAD, suggesting possible microvascular dysfunction. Revascularization was indicated in only 10 (PCI in 6, CABG in 4) of the 28 IB&gt;=10% pts (35.7% of IB&gt;=10%, 0.23% of CAC=0 pts); follow-up MACE occurred in 2 (7%) with IB&gt;=10% (repeat revascularizations) vs 1.6% of others (p=NS).</div></div><div><h3>Conclusions</h3><div>In this large stress PET/CT experience, IB &gt;=10% in pts with CAC=0 was rare. The majority were not explained by obstructive CAD. However, given the rare possibility of severe CAD or other pathologies, such as microvascular angina, a zero CAC score should be interpreted in the context of clinical judgement in deciding whether to proceed with additional testing such as stress PET.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100817"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PIECING THE PUZZLE TOGETHER WHEN FAMILY HISTORY IS UNKNOWN: EARLY DIAGNOSIS AND MANAGEMENT OF A PATIENT WITH FAMILIAL HYPERCHOLESTEROLEMIA","authors":"Lavanya Garnepudi MD","doi":"10.1016/j.ajpc.2024.100755","DOIUrl":"10.1016/j.ajpc.2024.100755","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Case Presentation</h3><div>A 43-year-old male presented to our primary care clinic to establish care. He was in his usual state of health, endorsed a balanced diet and daily exercise. His family history was unknown as he was adopted. Vital signs were normal, and the physical exam was unremarkable. A routine lipid profile revealed a total cholesterol level of 391 mg/dL, LDL-C level of 251 md/dL, HDL-C level of 57 mg/dL, and triglyceride level of 56 mg/dL. Given abnormally elevated LDL-C levels in a patient who otherwise had no known risk factors, an FH screening panel was ordered. The patient was also started on 40 mg atorvastatin daily and referred to the lipid clinic where he was diagnosed with FH using the Dutch Lipid Clinic Diagnostic Criteria (5 points: LDL- C between 250- 325 mg/dL+ 8 points: functional genetic mutation).</div></div><div><h3>Background</h3><div>Familial Hypercholesterolemia (FH) is a genetic disease that contributes to an increased risk for coronary artery disease, MI, and sudden cardiac death. Although awareness surrounding FH is increasing, this condition remains underdiagnosed and undertreated. In most countries, less than 20% of prevalent cases are diagnosed, and even less patients are aware of their condition, often not until after the first ASCVD event. Literature shows that underdiagnosis is multifactorial, including lack of awareness of the disorder, a lack of international consensus on which diagnostic criteria is superior, and minimal comfort with treating patients with intensive therapy.</div></div><div><h3>Conclusions</h3><div>Family health history is crucial to disease prevention though physicians often lack time and patients can lack information (as in this case). Genetic testing is the future of preventive medicine but remains underutilized in the primary care setting3. There has historically been uncertainty surrounding insurance coverage of genetic testing and the financial implications for patients. Collaborative efforts among primary care providers, genetics departments, lipid clinics, and insurers are essential to recognize the full potential of genetic testing while ensuring equitable access and affordability to all patients. This case highlights the importance of early identification, treatment, and referral of FH patients who would otherwise be missed given their asymptomatic status and unknown family history.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100755"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TARGETING CUTANEOUS IMMUNE RESPONSES FOR CARDIOVASCULAR DISEASE PREVENTION AND THERAPY","authors":"Kelly Frasier DO, MS","doi":"10.1016/j.ajpc.2024.100742","DOIUrl":"10.1016/j.ajpc.2024.100742","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Therapeutic Area&lt;/h3&gt;&lt;div&gt;Other&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The intricate interplay between the skin immune system and cardiovascular health has emerged as a compelling area of investigation with profound implications for preventive and therapeutic strategies in cardiovascular diseases (CVDs). While traditional risk factors such as hypertension and dyslipidemia have long been recognized as contributors to CVD development, recent literature underscores the pivotal role of immune-mediated mechanisms, particularly those involving the skin, in cardiovascular pathophysiology. This review aims to analyze the current understanding of how cutaneous immune modulation influences cardiovascular health, exploring potential therapeutic interventions and highlighting avenues for future research. By furthering our understanding of the complex relationship between the skin immune system and CVDs, this review seeks to bridge the gap between dermatology and cardiology, offering insights that could revolutionize approaches to CVD prevention and therapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This literature review systematically examined existing research on the interplay between the skin immune system and cardiovascular health to study potential preventive and therapeutic strategies for cardiovascular diseases (CVDs). Relevant articles were identified through comprehensive searches of electronic databases including PubMed and Google Scholar, using keywords such as \"skin immune system,\" \"cardiovascular health,\" \"atherosclerosis,\" \"psoriasis,\" \"atopic dermatitis,\" and \"immunomodulatory therapy.\" Articles published in peer-reviewed journals up to the present date were included, with a focus on original research articles, review papers, and meta-analyses. Additionally, reference lists of retrieved articles were manually searched to identify additional relevant studies. Data extraction involved summarizing key findings related to the role of cutaneous immune modulation in cardiovascular pathophysiology, potential mechanisms linking skin immunity to CVD risk, therapeutic interventions targeting the skin immune system, and areas for future research. The synthesis of findings was organized thematically to provide a comprehensive overview of the current understanding of the topic.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The review revealed a substantial body of literature highlighting the intricate relationship between the skin immune system and cardiovascular health. Studies consistently demonstrated the involvement of immune-mediated mechanisms in the pathogenesis of cardiovascular diseases, with particular emphasis on inflammation and immune cell activation. Notably, inflammatory pathways within the vessel wall, driven by cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), were implicated in endothelial dysfunction and atherosclerosis development. Moreover, the skin immune system was found to play a significant role in mod","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100742"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COMPARISON OF AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH AUTONOMIC DYSFUNCTION VS PATIENTS WITHOUT AUTONOMIC DYSFUNCTION","authors":"Megan Bach DO","doi":"10.1016/j.ajpc.2024.100784","DOIUrl":"10.1016/j.ajpc.2024.100784","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research</div></div><div><h3>Background</h3><div>Blood pressure (BP) patterns in patients with autonomic dysfunction (AD), particularly those with postural orthostatic tachycardia syndrome (POTS), remain an area of limited understanding. Utility in ambulatory blood pressure monitoring (ABPM) among patients with various forms of AD compared to patients without a diagnosis of AD remains unknown.</div></div><div><h3>Methods</h3><div>Patients referred for ABPM between 1/2019 and 7/2023 for a diagnosis AD with POTS, AD / Orthostatic Intolerance (OI) without POTS, or no AD were reviewed. Patient characteristics and ABPM data were analyzed. Statistical analysis was completed through test of trends. The primary outcome was to compare the incidence of uncontrolled 24-hour BP between patients with AD with POTS to those with AD/OI but without POTS and to those without AD. As a secondary outcome, nocturnal dipping status was assessed.</div></div><div><h3>Results</h3><div>A total of 243 patients were assessed and 62 (25.5%) had a diagnosis of AD, of which 37 (15.2%) had a diagnosis of POTS. Patients with POTS were predominantly female, younger, and of white ethnicity (Table). ABPM data revealed that 81% of patients with POTS and 73% of patients without AD maintained controlled BP over 24 hours, in contrast to just 24% of those with AD/OI but without POTS (p &lt; 0.001). The mean 24-hour SBP for patients with AD with POTS (117.7 mmHg) and patients without AD (131.3 mmHg) were within normal values, in contrast to the 137.1 mmHg observed in those with AD/OI without POTS (p &lt; 0.001). Abnormal dipping status was prevalent in 51% of the AD with POTS cohort, 68% of the AD/OI without POTS cohort, and 56% of the without AD cohort. Nocturnal non-dipping was prevalent in 46% of the AD with POTS cohort, 36% of the AD/OI without POTS cohort, and 37% of the without AD cohort.</div></div><div><h3>Conclusions</h3><div>Most patients with AD with POTS, and those without AD, demonstrate normal 24-hour BP readings on ABPM. However, ABPM detected a high incidence of uncontrolled 24-hr BP readings in patients with AD or Orthostatic Intolerance without POTS, prompting discussion of valuable utility of this test in this cohort.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100784"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AWARENESS AND REFERRAL RATES OF CARDIAC REHABILITATION AMONG INTERNAL MEDICINE RESIDENTS IN A COMMUNITY SETTING: A MULTICENTER ANALYSIS","authors":"Harsha Sai Sreemantula MD","doi":"10.1016/j.ajpc.2024.100774","DOIUrl":"10.1016/j.ajpc.2024.100774","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Rehabilitation</div></div><div><h3>Background</h3><div>In the United States, The Centers for Medicare &amp; Medicaid Services and most insurers authorize coverage for Cardiac Rehabilitation (CR) services for patients with stable chronic HF with LVEF ≤35% and NYHA functional class II to IV symptoms despite six weeks of treatment with optimal HF therapy. CR has a Class 1 Recommendation in the current American College of Cardiology/American Heart Association guideline for managing HF. Community hospitals deal with most of the above two indications, and little data exists about the referral processes in such places.</div></div><div><h3>Methods</h3><div>A questionnaire regarding cardiac rehabilitation, inquiring about internal medicine residents' awareness of indications, components, outcomes, and referral practices, was sent to 5 different community-based institutions. The information was collected anonymously and later analyzed in statistical software.</div></div><div><h3>Results</h3><div>Out of 136 residents, there was more or less equal distribution among the 3 PGY years, with the majority responding of having a cardiac catheterization lab and acknowledging recurrent heart failure admissions to their institutions. Varied responses were received regarding cardiac rehab availability at respective institutions. Surprisingly, despite somewhat adequate knowledge regarding cardiac rehabilitation's indications, components, and outcomes, only 28.68 % acknowledged routine CR referral. Referral rates increased with increasing training years. Further trends are seen in Table 1, Table 2, and Table 3.</div></div><div><h3>Conclusions</h3><div>Despite numerous studies highlighting the importance of physician referrals for cardiac rehabilitation enrollment, there is limited data on internal medicine residents' knowledge and referral practices. This is pivotal as they often manage a significant portion of patients with acute coronary syndromes and heart failure exacerbations in a community setting. Further research is needed to uncover disparities and improve cardiac rehabilitation utilization in community-based healthcare settings.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100774"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PEGOZAFERMIN DEMONSTRATED ROBUST HISTOLOGIC IMPROVEMENT AND BENEFIT IN HEPATIC AND METABOLIC BIOMARKERS IN A 48-WEEK MULTI-CENTER, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED PHASE 2B TRIAL (ENLIVEN)","authors":"Cynthia L. Hartsfield PhD","doi":"10.1016/j.ajpc.2024.100807","DOIUrl":"10.1016/j.ajpc.2024.100807","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Pharmacologic Therapy</div></div><div><h3>Background</h3><div>Metabolic dysfunction-associated steatohepatitis (MASH) is often associated with metabolic disorders such as obesity, metabolic syndrome, and/or diabetes. FGF21 analogs such as pegozafermin (PGZ) have direct effects on liver fibrosis as well as additional hepatic and extrahepatic benefits in patients with MASH. The Phase 2b ENLIVEN trial evaluated the efficacy and safety of PGZ given weekly (QW) or every two-weeks (Q2W) versus placebo in MASH patients with biopsy-proven F2/F3 fibrosis. The primary histology endpoints were assessed at week 24, followed by a 24-week blinded extension for a total of 48 weeks.</div></div><div><h3>Methods</h3><div>Patients were randomized to PGZ 15mg QW, 30mg QW, or 44mg Q2W or placebo for 24-weeks (histology-based primary endpoints). During the 24-week extension, patients continued their assigned treatment except for a subset of placebo patients who were re-randomized to receive PGZ 30mg QW. The full analysis set includes F2/F3 patients with NAFLD activity score (NAS) ≥4 at baseline (n=192).</div></div><div><h3>Results</h3><div>Both primary histological endpoints considered as reasonably likely surrogates of clinical outcome benefit - at least one stage of fibrosis improvement without worsening of MASH and MASH resolution without worsening of fibrosis - were achieved by a significantly higher proportion of patients treated with PGZ 30mg QW or 44 mg Q2W than placebo. PGZ treatment also improved liver fat content (MRI-PDFF), biomarkers of fibrosis (VCTE, ELF, PRO-C3) and liver injury (ALT, AST) as well as lipids and HgA1c at both 24 weeks and week 48. PGZ was generally safe and well tolerated with the most common treatment emergent adverse events (TEAEs) being mild/moderate nausea and diarrhea. No deaths occurred; six early terminations for TEAEs including one drug-related serious AE occurred.</div></div><div><h3>Conclusions</h3><div>Treatment with PGZ in MASH patients with F2/F3 fibrosis led to highly significant fibrosis regression and MASH resolution and to robust and sustained improvements in non-invasive biomarkers of liver fat and inflammation, fibrosis, and metabolic markers, with a favorable safety and tolerability profile. PGZ is the first therapy to achieve fibrosis regression and MASH resolution with a Q2W dosing regimen. The confirmatory Phase 3 program in MASH was recently initiated.</div><div>Please note that ENLIVEN 28-week data were presented at EASL 2023 and ENLIVEN 48-week data are accepted as an oral presentation for EASL 2024. This is the first abstract to include both data sets.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100807"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}