American journal of preventive cardiology最新文献

{"title":"PERSISTENT ATRIAL FIBRILLATION AFTER CATHETER ABLATION IN HUMAN IMMUNODEFICIENCY VIRUS TYPE‐1 POSITIVE PATIENTS","authors":"Sophia Navajas MD","doi":"10.1016/j.ajpc.2024.100805","DOIUrl":"10.1016/j.ajpc.2024.100805","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Other: Electrophysiology</div></div><div><h3>Case Presentation</h3><div>A 35-year-old African-American male with medical history of HIV-1 infection on 800 mg Darunavir, 150 mg Cobicistat, 200 mg Emtricitabine, and 10 mg Tenofovir Alafenamide presented with the complain of palpitations and sweating. He reported resting tachycardia, 120-140 beats per minute, from his smartwatch. Upon arrival, 12-lead electrocardiogram showed atrial flutter with variable A-V block. Patient's troponin I was <0.01 ng/ml. Subsequently, he underwent transesophageal echocardiogram and was successfully cardioverted to sinus rhythm with one dose of 200 joules of synchronized cardioversion. After multidisciplinary management, patient was discharged on Sotalol 80 mg twice a day and Dabigatran 150 mg twice a day. 45 days after initial presentation, patient underwent successful outpatient atrial flutter ablation. 65 days status post ablation, he again presented and was admitted due to atrial fibrillation with premature ventricular complexes. Currently, patient remains on rate control with anticoagulation treatment and frequent outpatient surveillance. Since the last incidence, no inpatient hospitalizations have been reported.</div></div><div><h3>Background</h3><div>Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. It is due to abnormal electrical activity within the atria of the heart, causing them to fibrillate. This arrhythmia may be paroxysmal (less than seven days) or persistent (more than seven days) (1). Researcher studies have found that Human Immunodeficiency Virus (HIV)-positive patients had an incidence of 18.2 AF diagnoses per thousand person-years, compared to 8.9 in patients without HIV (2). Non-pulmonary vein triggers are highly prevalent in HIV-positive AF patients and the mid- and long-term arrhythmia recurrence was observed to be mostly driven by those triggers (3). We present a patient who represents part of the growing study population of young HIV-1 positive male associated with arrhythmia recurrence.</div></div><div><h3>Conclusions</h3><div>The prothrombotic nature of HIV infection is well-documented (4). It is believed that HIV-1 infection elevates stroke risk via systemic mechanisms such as low-grade inflammation and heightened oxidative stress, or through direct cardiac toxicity potentially leading to AF (5). A key consideration in the treatment of atrial fibrillation in patients with HIV‐1 who are in combination antiretroviral therapy (ART), is the significant impact these drugs have on liver enzymes like CYP2C9 and CYP3A4 (6). These enzymes are crucial for metabolizing numerous medications, including various oral anticoagulants (6). Given this, there is a strong likelihood of interactions between vitamin K antagonists and ART, particularly with protease inhibitors (PIs) or non‐nucleoside reverse transcriptase inhibitors (NNRTIs) (7).</div><div>Additionally, ART regimens containing PIs with or","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100805"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422971","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":"EVALUATION OF WEIGHT REDUCTION AND METABOLIC PARAMETERS IN HIV COHORT UNDERGOING TREATMENT WITH GLP-1 RECEPTOR AGONISTS AT A LARGE PUBLIC NYC/HHC+ HOSPITAL IN NEW YORK CITY","authors":"Natalia Nazarenko MD","doi":"10.1016/j.ajpc.2024.100788","DOIUrl":"10.1016/j.ajpc.2024.100788","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Obesity</div></div><div><h3>Background</h3><div>Individuals living with HIV who undergo prolonged combined antiretroviral therapy (cART) may experience weight gain as a potential side effect. Many of these individuals are prescribed GLP-1 receptor agonists (RA), which are recognized for their ability to reduce weight. However, there is uncertainty regarding whether cART could serve as a confounding factor, potentially influencing the effectiveness of GLP-1 RA treatment and impeding the attainment of desired outcomes.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted, reviewing electronic medical records of 239 HIV-positive patients on GLP-1 RA. After applying criteria, 180 patients were analyzed, all on GLP-1 RA for at least 12 weeks. Multivariate logistic regression was used, assessing weight loss, BMI, HbA1c change, and association between weight loss and cART.</div></div><div><h3>Results</h3><div>Out of 180 participants, 51.67% were male and 48.33% were female, with a mean age of 58.2 (SD +/- 11.09). 82% of participants had diabetes mellitus II type (DMT2). The mean duration of GLP-1 RA treatment was 25.38 months (SD +/- 18.5). Semaglutide was used by 50.5%, liraglutide by 4%, and dulaglutide by 45.5%. Weight gain was observed in 29.4%, weight loss under 5 kg in 34.4%, 5-10 kg loss in 15%, and over 10 kg loss in 21.11%. Mean weight reduction was 2.5 kg (SD +/- 12.5), HbA1c reduction was 1.03% (SD +/- 2.3), and BMI reduction was 0.76 (SD +/- 12.4). No significant association was found between GLP duration and weight reduction. Dolutegravir/Lamivudine showed less weight reduction compared to other cART regimens (OR=0.36, CI 0.13 – 0.97, p=0.044).</div></div><div><h3>Conclusions</h3><div>We observed expected positive outcomes linked to GLP-1 RA use, leading to improvements in the metabolic profiles of individuals living with HIV on cART. Further analysis is needed to investigate the relationship between weight and improvements in metabolic parameters with different cART regimens. Additionally, it's important to examine potential sex and racial disparities in response to GLP-1 RA therapy among people living with HIV on cART.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100788"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422705","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":"LIPOPROTEIN(A) AND APOLIPOPROTEIN B ARE RELATED TO AORTIC STENOSIS: RESULTS FROM THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL) AND ECHOCARDIOGRAPHIC STUDY OF LATINOS (ECHO-SOL)","authors":"Akhil Avunoori Chandra MD","doi":"10.1016/j.ajpc.2024.100823","DOIUrl":"10.1016/j.ajpc.2024.100823","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Heart Failure</div></div><div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] and Apolipoprotein B [apoB] have been previously studied as risk factors of calcific aortic valve disease primarily among non-Hispanic/Latino populations. However, the association between apoB and calcific aortic stenosis (AS) is not as well known.</div></div><div><h3>Methods</h3><div>Data from 8,564 community-dwelling Hispanics/Latinos with echocardiograms performed at Visit 2 (HCHS/SOL, 2014-2017 and Echo-SOL, 2015-2018) were analyzed. These participants had Lp(a) levels (nmol/L) and apoB levels (mg/dL) measured at HCHS/SOL Visit 1 (2008 to 2011). Pearson correlation coefficient (r), linear and logistic regression models were used to study the association of Lp(a) and apoB with the following outcomes: 1. Aortic valve peak velocity (AVPV), cm/s; 2. Aortic valve peak pressure gradient (AVPPG), mmHg, and 3. Aortic stenosis, defined as AVPV ≥ 300 cm/s for moderate or severe AS. AVPV ≤ 100 cm/s was considered normal and used as a reference value for AS. Lp(a) and apoB were modeled as continuous variables. Sampling weights and surveys methods were used to account for HCHS/SOL complex design.</div></div><div><h3>Results</h3><div>Overall, the mean (SE) age was 58.4 (0.2) years, and 53.6% were female. Their baseline median IQR (Q1-Q3) Lp(a) and apoB levels were 22.5 (8.1-66.6) nmol/L and 105.1 (88.7-122.9) mg/dL, respectively. HCHS/SOL overall baseline median IQR (Q1-Q3) Lp(a) was 19.7 (7.3-60.6) nmol/L and apoB was 96.7 (79.4-116.0) mg/dL, respectively. Table 1: Higher baseline Lp(a) levels were significantly associated with worsened AVPV and AVPPG at Visit 2. Higher apoB levels were associated with worsened AVPV and AVPPG. Compared to normal AVPV values, using 10-unit increments, increasing Lp(a) levels were associated with increased risk of moderate or severe AS (ORLp(a) 1.10 (95% CI, 1.06-1.14), p&lt;0.0001); and increasing apoB levels were associated with mild AS or Aortic Sclerosis (ORapoB1.032 (95% CI, 1.002-1.063), p&lt;0.04).</div></div><div><h3>Conclusions</h3><div>Lp(a) and apoB are significantly associated with AVPV and AVPPG and are significant predictors of AS; suggesting these markers may be potentially modifiable risk factors for calcific aortic valvular disease among Hispanic/Latinos.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100823"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422708","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":"UNEXPLAINED LOW VOLTAGE PRECORDIAL QRS ON ECG IN ASYMPTOMATIC SUBJECTS SHOULD NOT BE DISMISSED WITHOUT FURTHER INVESTIGATION FOR ABNORMAL CARDIOVASCULAR RISK BIOMARKERS SUCH AS BNP, CRP, MICROALBUMIN AND/OR EPICARDIAL FAT VOLUME","authors":"Mahfouz El Shahawy MD, MS","doi":"10.1016/j.ajpc.2024.100773","DOIUrl":"10.1016/j.ajpc.2024.100773","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Novel Biomarkers</div></div><div><h3>Background</h3><div>Low voltage QRS in precordial leads in asymptomatic subjects has been reported to be associated with increased epicardial fat volume which is a novel cardiovascular risk marker.</div><div>Purpose of this study is to examine the prevalence of abnormal cardiovascular risk biomarkers such as BNP, CRP and/or microalbumin in asymptomatic subjects with low voltage QRS complexes in precordial leads on ECG and elevated epicardial fat volume.</div></div><div><h3>Methods</h3><div>330 asymptomatic obese subjects were screened for cardiovascular risk assessment using the Early Cardiovascular Disease Risk Scoring System (ESCVDRS) known as Rasmussen Risk Score (RRS), previously reported. The ESCVDRS includes 7 vascular and 3 cardiac tests. Among the additional test, CRP, proBNP, microalbumin were also measured. Coronary calcium score and epicardial fat volume was measured utilizing cardiac CT Siemens Somatom Definition Dual source CT scanner 64x2. Out of the 330 subjects, 55 subjects with average age 68, also underwent measurement of epicardial fat volume on CT utilizing same and similar forms definition 64 x 2. Waist circumference was also measured. The 55 subjects were divided in 2 groups: Group A, 33 subject with cardio-obesity and low precordial QRS voltage on ECG; Group B, 22 subjects with normal epicardial fat volume and normal ECG.</div></div><div><h3>Results</h3><div>Results are shown in the table below. As seen, Group A had a significant abnormal biomarker, including BNP, CRP and microalbumin as compared with Group B.</div></div><div><h3>Conclusions</h3><div><ul><li><span>(1)</span><span><div>Unexplained low voltage QRS in precordial leads in asymptomatic subjects should not be dismissed as normal without further evaluation for cardiovascular biomarkers to rule out significant early subclinical cardiovascular disease risk.</div></span></li><li><span>(2)</span><span><div>Low Precordial QRS voltage on ECG in the absence of other known causes may be indicative of excess epicardial fat volume which is significant CV disease risk marker and must be treated.</div></span></li></ul></div><div>1 ounce of early cardiovascular disease prevention is better than pounds of late treatment.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100773"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423102","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":"BENEATH THE SURFACE: EXPLORING A CASE OF LEFT CIRCUMFLEX ARTERY DISSECTION","authors":"Menon Tushar MD","doi":"10.1016/j.ajpc.2024.100820","DOIUrl":"10.1016/j.ajpc.2024.100820","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Other: Non Atherosclerotic Acute Coronary Syndromes ( Spontaneous Coronary Artery Disease)</div></div><div><h3>Case Presentation</h3><div>A 53-year-old woman with a history of hypertension was initially discharged after an NSTEMI and left heart cath showing spontaneous coronary artery dissection (SCAD) in the left circumflex artery. She returned to the ER three days later with chest pain. Despite initial plans for discharge with aggressive BP management using a nitro drip, her rising troponin levels necessitated overnight observation. Further cardiac cath revealed extensive SCAD (originating in the distal left main, extending into the circumflex, and terminating in the left PDA, as well as the obtuse marginal branch), worsening from the last angiogram done a week ago, likely due to uncontrolled hypertension. She was admitted to the ICU for 48 hours for heparin therapy and strict BP control, and was later discharged with instructions for close outpatient cardiology follow-up.</div></div><div><h3>Background</h3><div>SCAD emerges as an increasingly acknowledged etiology behind non-atherosclerotic acute coronary syndromes. SCAD is implicated in 0.1% to 0.4% of all acute coronary syndrome (ACS) occurrences and is re-sponsible for about 25% of ACS instances in women under 50 and less commonly in men ( less than 15% of instances affect men). Risk factors include female sex, pregnancy, fibromuscular dysplasia, and associations with genetic connective tissue disorders such as Marfan and Ehlers-Danlos syndromes. It most commonly occurs in the LAD artery. In 46 to 61% of instances, the diagonal and septal branches are also in-volved; 15 to 45% of cases involve the circumflex, ramus, and marginal branches. Affecting several coronary branches is uncommon, but may occur in 9 to 23% of patients. Diagnosis predominantly relies on coronary angiography, which identifies the false lumen and intramural hematoma resulting from intimal disruption and vasa vasorum bleeding. Treatment is primarily medical for cases without progression, hemodynamic instability, or significant myocardial involvement, utilizing aspirin, plavix, ACE inhibitors, beta blockers, and heparin. Refractory cases may necessitate interventional strategies like stenting, angioplasty, coronary artery bypass grafting (CABG), or percutaneous transluminal coronary angioplasty). Reoccurrence from HTN occurs in 10 to 30% of patients.</div></div><div><h3>Conclusions</h3><div>SCAD is becoming recognized as the cause of acute myocardial infarction, particularly in young female patients with low cardiovascular risks.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100820"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423108","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":"EXAMINING URBAN AND RURAL PHARMACY AVAILABILITY IN MINNESOTA FROM 2009 TO 2020","authors":"Katy Lehenbauer MD, MPH","doi":"10.1016/j.ajpc.2024.100821","DOIUrl":"10.1016/j.ajpc.2024.100821","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD in Special Populations</div></div><div><h3>Background</h3><div>Cardiovascular disease (CVD) is the leading cause of death in the United States. Controlling CVD risk factors is key to treatment and prevention. However, medication adherence is difficult when pharmacies are difficult to access. This study aims to characterize pharmacy access by geographic region in Minnesota from 2009 to 2020.</div></div><div><h3>Methods</h3><div>Pharmacy lists for 2009 and 2020 were obtained from the Minnesota Board of Pharmacy. Pharmacies were geocoded and labeled with a rural-urban community area (RUCA) code. Geographic areas were divided into 3 RUCA areas: urban, large rural city/town, small/isolated rural town. Each pharmacy was designated as a chain, supermarket-based, independent, or associated with a health system. We evaluated pharmacy hours, count and density for each geographic area by year, and the proportion of pharmacy types in all geographic locations.</div></div><div><h3>Results</h3><div>A total of 1,010 pharmacies were open in 2009 and 916 pharmacies in 2020. Pharmacy density (n/100,000 resident) decreased over time for all geographic areas: urban from 17.0 to 13.9, large rural from 24.1 to 21.1, and small rural from 25.6 to 24.2. Pharmacy types also changed over time. While chain pharmacies accounted for nearly half of pharmacies in both 2009 and 2020, independent pharmacies decreased over time in all regions (Figure 1). Supermarket and health system pharmacies represented a stable or increasing share of all pharmacies although the absolute number of pharmacies decreased everywhere except in small rural towns.</div><div>Supermarket pharmacies had the best access; &gt;95% were open after 6pm and had open hours on the weekend. Chain pharmacies had similarly high accessibility in the urban regions, but were less accessible in large rural city (65% extended hours, 87% open weekends) and small town (23% extended hours, 66% open weekends) regions (Table 1). Independent pharmacies tended to be open on weekends, but were less likely to have extended hours.</div></div><div><h3>Conclusions</h3><div>Pharmacy access decreased across the state of Minnesota from 2009 to 2020, especially for independent pharmacies. Residents of less populated areas had fewer options for pharmacy use outside of regular business hours.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100821"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423109","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":"ASSOCIATION BETWEEN RURALITY AND SUBCLINICAL MYOCARDIAL INJURY","authors":"Santul Bapat MD","doi":"10.1016/j.ajpc.2024.100760","DOIUrl":"10.1016/j.ajpc.2024.100760","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Living in a rural setting has been linked to cardiovascular disease (CVD) morbidity and mortality. However, the association between rurality and subclinical myocardial injury (SC-MI) has not previously been studied.</div></div><div><h3>Methods</h3><div>This cross-sectional analysis was restricted to adult participants without baseline CVD (myocardial infarction, heart failure, or stroke), who underwent 12-lead electrocardiogram (ECG) recording in the Third National Health and Nutritional Examination Survey (NHANES III), 1988 to 1994. Rurality classification was based on the U.S Department of Agriculture (USDA) rural-urban continuum codes. SC-MI was defined as a cardiac infarction/injury score ≥10 on ECG. Using multivariate logistic regression, we examined the association between rurality and SC-MI.</div></div><div><h3>Results</h3><div>This analysis included 6,805 (age 59.1±13.4 years, 52.3% female, 49.8% White) participants, of whom 3,666 (53.9%) lived in rural areas. Compared to participants living in urban areas, those living in rural areas had a higher prevalence of SC-MI (28.6% vs. 23.4%; p-value &lt;0.0001). In the multivariable logistic regression model, rural residence, relative to urban residency, was associated with 21% (p&lt;0.001) higher odds of SC-MI (Table). These associations were consistent in subgroups stratified by demographics and CVD risk factors.</div></div><div><h3>Conclusions</h3><div>Those living in rural areas had a higher likelihood of subclinical myocardial injury suggesting that rurality is not only associated with clinical CVD, but also subclinical forms of the disease.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100760"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422754","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":"SEX-BASED DIFFERENCES IN AORTIC VALVE CALCIUM AND THE RISK FOR AORTIC STENOSIS","authors":"Natalie Marrero MD","doi":"10.1016/j.ajpc.2024.100734","DOIUrl":"10.1016/j.ajpc.2024.100734","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Novel Biomarkers</div></div><div><h3>Background</h3><div>Aortic valve calcification (AVC) is the primary underlying process leading to aortic stenosis (AS). In general, women have lower AVC scores compared to men of the same age and the AVC score threshold for severe AS is lower for women. It remains unknown if the long-term risk of AS differs between sexes with similar AVC scores. We aimed to assess the association between AVC and the risk for clinically significant AS stratified by sex using the Multi-Ethnic Study of Atherosclerosis (MESA).</div></div><div><h3>Methods</h3><div>We included 6,812 MESA participants free of cardiovascular disease with AVC measured at Visit 1 using non-contrast cardiac CT. AVC was examined as a continuous (logarithmically transformed, ln (AVC+1)) and categorical variable (0, 1-99, 100-299, ≥300 AU). Incident long-term AS was adjudicated using standard clinical criteria with a median follow up of 16 years. The primary outcome was incident moderate or severe AS. The association between AVC and AS was examined by calculating absolute event rates per 1,000 person-years, and multivariable adjusted Cox Proportional hazards regression.</div></div><div><h3>Results</h3><div>Among those with AVC &gt;0, women were older (71.7 years vs. 69.8 years, p = 0.01) and generally had a higher risk factor burden. There were 65 cases of incident AS for women and 75 for men. There was a similar absolute event rate for incident AS for women and men across the AVC categories. AVC as a continuous variable was strongly associated with an increased risk for incident aortic stenosis for both women (HR 1.91, 95% CI 1.68-2.16) and men (HR 2.13, 95% CI 1.88-2.41). There was no interaction between AVC, as a continuous variable, and sex (p = 0.31) for the association with AS. The adjusted hazard for severe AS was similar across AVC categories for women and men with HR estimates 134.9 (95% CI 45.1-403.9) for women with AVC ≥300 and 132.8 (95% CI 6.2-274.9) for men with AVC ≥300 (Table 1).</div></div><div><h3>Conclusions</h3><div>The association of AVC with the long-term risk for incident AS was similar for women versus men. These findings further emphasize the utility of AVC as a prognostic marker for incident AS.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100734"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422818","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":"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}