American journal of preventive cardiology最新文献

{"title":"USE OF GLP-1 RECEPTOR AGONISTS AND/OR SGLT-2 INHIBITORS AMONG PATIENTS WITH PERIPHERAL ARTERY DISEASE BEFORE AND AFTER REVASCULARIZATION IN A SINGLE-CENTER COHORT","authors":"","doi":"10.1016/j.ajpc.2024.100762","DOIUrl":"10.1016/j.ajpc.2024.100762","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Peripheral Artery Disease</div></div><div><h3>Background</h3><div>Diabetes mellitus (DM) is a major risk factor for peripheral artery disease (PAD). Patients with both PAD and DM have an increased risk of major adverse atherosclerotic events. GLP-1 RA and SGLT-2i are recommended to improve major adverse cardiac events among patients with atherosclerotic disease. Despite this, optimal treatment remains an unmet need.</div></div><div><h3>Methods</h3><div>The cohort included patients who have undergone their index limb revascularization for PAD between 01/01/2021 and 12/31/2022 at a major urban safety net hospital. The cohort was created using ICD-10 and CPT codes. The cohort was created using ICD-10 and CPT codes. GLP-1 RA and SGLT-2i prescriptions and HbA1c were abstracted at baseline (prior to index revascularization) and at 1 year post discharge.</div></div><div><h3>Results</h3><div>The final cohort included 311 patients with 36% female, 49% Hispanic, 36% Black, and was 63 ± 10 years old. Furthermore, 58% were either on Medicaid or a hospital-specific subsidized health plan. History of hypertension, hyperlipidemia, and type 2 diabetes were seen in 98%, 93%, and 79% of patients, respectively. Of the 288 patients with A1c prior or during revascularization, median was 7.55% and 45% (129/288) had HA1C &lt; 7%. Only 176 (57%) patients had HA1C check within 1 year of revascularization with median 7.33% and 44% (77/176) with HA1C &lt; 7%. Looking at diabetes medications, the number of patients on GLP-1 RA increased from 27 (9%) to 53 (17%). The number of patients on SGLT-2i increased from 55 (18%) to 82 (26%), and that of metformin increased from 172 (55%) to 191 (61%).</div></div><div><h3>Conclusions</h3><div>In a large safety net hospital with high rates of comorbid diabetes and peripheral artery disease, only 176 (57%) patients had repeat HA1C within 1 year of revascularization. Despite an increase in metformin, GLP-1 RA, SGLT-2i use, the glycemic control remained poor with only 1 in 4 patients with documented to be at HbA1c &lt;7% at 1 year. These findings highlight an important care gap, and revascularization as an important opportunity for medical optimization. Clinician education and EHR (electronic health record) interventions could be leveraged to improve outcomes in this population.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422714","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":"BODY WEIGHT, LIPOPROTEIN (A), AND INCIDENT CARDIOVASCULAR DISEASE IN THE UK BIOBANK","authors":"","doi":"10.1016/j.ajpc.2024.100739","DOIUrl":"10.1016/j.ajpc.2024.100739","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Elevated lipoprotein (a) (Lp[a]) is a recognized risk factor for atherosclerotic cardiovascular disease (ASCVD). However, there is a scarcity of research investigating its impact on ASCVD risk across different body weight categories.</div></div><div><h3>Methods</h3><div>The UK Biobank is a large prospective observational study across the United Kingdom. The analysis included individuals without prior cardiovascular disease (CVD) during the baseline period (2006-2010). Those with a baseline body mass index (BMI) below 18.5 kg/m² were excluded. Data were retrieved and analyzed between November-December 2023. ASCVD was defined as a composite of peripheral arterial disease, coronary artery disease, myocardial infarction, ischemic stroke, and cardiovascular mortality based on the International Classification of Diseases (ICD) 9 and ICD 10 codes. Normal weight was defined as BMI 18.5-24.9, overweight as BMI 25.0-29.9, and obese as BMI ≥30. The study cohort was stratified into six (6) groups as follows: Group 1: Normal weight with Lp(a) &lt;50mg/dL, Group 2: Normal weight with Lp(a) ≥ 50mg/dL, Group 3: Overweight with Lp(a) &lt;50mg/dL, Group 4: Overweight with Lp(a) ≥ 50mg/dL, Group 5: Obese with Lp(a) &lt;50mg/dL, and Obese with Lp(a) ≥ 50mg/dL. Using the multivariable Fine-Gray sub distribution hazards regression with the competing risk of all non-CVD death, we estimated the hazard ratios (HR) for incident ASCVD in the six groups.</div></div><div><h3>Results</h3><div>Of the 358,762 individuals included in the study, 55.1% were women; mean (SD) age was 56.3 (±8.1) years. During a median follow-up period of 13.7 years, 29,295 (8.2%) ASCVD events occurred. Compared to the reference group (normal weight, Lp(a) &lt;50mg/dL), Lp(a) ≥ 50mg/dL was associated with increased adjusted hazard ratios (95% CI) for incident ASCVD of 1.14 (1.08–1.20), 1.07 (1.02–1.11), and 1.09 (1.04–1.15) among those with normal weight, overweight, and obese, respectively. However, in the absence of Lp(a) ≥ 50mg/dL, higher BMI categories were associated with a reduced risk of ASCVD (Table).</div></div><div><h3>Conclusions</h3><div>These findings show that elevated Lp(a) is associated with an increased risk of ASCVD across all body weight categories, emphasizing the potent and independent role of Lp(a) as a cardiovascular risk factor.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422744","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":"NAVIGATING THE CHALLENGES OF TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR): A CASE STUDY","authors":"","doi":"10.1016/j.ajpc.2024.100748","DOIUrl":"10.1016/j.ajpc.2024.100748","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Other: CV Surgery</div></div><div><h3>Case Presentation</h3><div>A 66-year-old man presented with severe symptomatic bicuspid aortic stenosis and New York Heart Association class III chronic diastolic congestive heart failure. Despite being evaluated by the heart team and considering surgical aortic valve replacement, he opted for TAVR. During his procedure, severe annular and leaflet calcification complicated the valve deployment, leading to valve migration and necessitated emergent retrieval and repositioning. Post-procedure, the patient developed hypotension and tamponade physiology, prompting emergent pericardiocentesis. Subsequently, an acute type A aortic dissection was discovered, mandating open aortic valve replacement with ascending aortic graft.</div></div><div><h3>Background</h3><div>The decision-making process in TAVR involves weighing individual patient factors against procedural risks, underscoring the need for shared decision-making and comprehensive preoperative evaluation.</div><div>The significant challenge posed by severe valve calcification, which resulted in valve migration, emphasizes the importance of intraoperative imaging for real-time visualization during transcatheter aortic valve replacement (TAVR) procedures. These imaging modalities, such as transesophageal echocardiography (TEE) or intravascular ultrasound (IVUS), enable precise assessment of anatomical structures and guide the deployment of the valve with optimal positioning. Additionally, skilled intervention is essential in navigating procedural complexities encountered during TAVR. Experienced interventionalists, as in this case, possess the expertise to address challenges promptly, such as managing calcified anatomy or addressing complications like valve migration.</div><div>The development of cardiac tamponade highlights the necessity for vigilant post-procedural monitoring and prompt intervention. Timely recognition and management of complications is critical in optimizing patient outcomes. Furthermore, the discovery of an acute type A aortic dissection emphasizes the potential for catastrophic events in TAVR recipients. This case highlights the importance of maintaining a high index of suspicion for procedural complications and the readiness to escalate to open surgical intervention when necessary.</div></div><div><h3>Conclusions</h3><div>Transcatheter aortic valve replacement (TAVR) has emerged as a viable option for select patients with severe aortic stenosis, particularly those deemed too high risk for surgical intervention. However TAVR it is not without complications, as demonstrated in our case of a 66-year-old man who underwent TAVR but encountered significant perioperative and postoperative complications.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422720","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":"ERECTILE DYSFUNCTION REVERSED AFTER ADOPTION OF A WHOLE FOOD PLANT-BASED DIET","authors":"","doi":"10.1016/j.ajpc.2024.100772","DOIUrl":"10.1016/j.ajpc.2024.100772","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Other: Erectile Dysfunction</div></div><div><h3>Case Presentation</h3><div>Mr. C is a 52-year-old with cardiovascular disease who presented to our Cardiac Wellness Program at Montefiore on February 2024.</div><div>Since at least 2019, he reported not having morning erections and having worsening erectile function. He was not on medications associated with erectile dysfunction (ED).</div><div>In January 2021, he had a drug-eluting stent placed in his left anterior descending artery for stable angina.</div><div>He has hyperlipidemia for which he has been on statin since the age of 28. He has no known history of myocardial infarction, diabetes, stroke, hypothyroidism, hypogonadism, heart failure, smoking, or illicit drug use. He has never used medications to treat ED.</div><div>He exercised regularly since June 2021.</div><div>Blood pressure was 110/72, pulse 79, BMI 28kg/m². Physical exam was unremarkable.</div><div>He had been eating “healthfully” from 2011 until April 2022. From Sunday until Friday night his diet consisted of salads, beans, mushrooms, whole grains, soups, plant-based shakes, and processed vegan snack foods. From Friday night until Sunday he would consume “high volumes” of cheese, meats, and highly processed foods.</div><div>In April 2022, he started a whole-food plant-based diet (WFPB). About three months later, he noticed improvements in his erectile function.</div><div>In July of 2023, he heard that eating more green leafy vegetables may increase nitric oxide production, so he increased his daily servings (each serving was a handful) of greens from 3 to 6. His erectile function normalized within months.</div><div>He was given the International Index of Erectile Function-5 questionnaire, a validated measure of erectile function and answered as if he were at the following time points:</div><div>1/2021: Directly before stent placement: 9 (Moderate ED)</div><div>3/2022: Directly before beginning a WFPB diet: 9 (Moderate ED)</div><div>6/2023: Directly before beginning 6 daily servings of greens: 20 (Mild ED)</div><div>2/2024: 25 (Normal sexual function)</div></div><div><h3>Background</h3><div>Erectile dysfunction is the “canary in the coal mine” for coronary disease (CAD) as ED typically presents 3-5 years before CAD. Vascular ED shares the same risk factors as CAD.</div></div><div><h3>Conclusions</h3><div>To our knowledge, this is the first reported case of ED resolving after the adoption of a WFPB diet.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423101","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 FAMILY INCOME, SUBCLINICAL MYOCARDIAL INJURY, AND CARDIOVASCULAR MORTALITY IN THE GENERAL POPULATION","authors":"","doi":"10.1016/j.ajpc.2024.100736","DOIUrl":"10.1016/j.ajpc.2024.100736","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Both low family income and subclinical myocardial injury (SCMI) are risk factors for cardiovascular disease (CVD) mortality. However, the impact of their joint association on CVD mortality is unclear. Therefore, we sought to examine the joint associations of family income and SCMI with CVD mortality.</div></div><div><h3>Methods</h3><div>This analysis from the third National Health and Nutrition Examination Survey (NHANES-III) included 6,805 participants (age 59.1±13.4 years, 52.3% women, and 49.8% White) free of CVD at baseline. Family income was assessed using the poverty-to-income ratio (PIR) and categorized into low (PIR&lt;1), middle (PIR=1-4), and high (PIR&gt;4) income. A validated ECG-based cardiac infarction injury score (CIIS) ≥10 was considered positive for SCMI. CVD mortality was determined using the National Death Index. Cox-proportional hazard analysis was used to evaluate the associations of family income and SCMI, separately and jointly, with CVD mortality.</div></div><div><h3>Results</h3><div>A total of 1,782 individuals (26.2%) had SCMI at baseline. During a median follow-up of 18.2 years, 856 (12.6%) events of CVD mortality occurred. In separate multivariable Cox models, SCMI (vs. no SCMI) and middle- and low-income (vs. high-income) were each associated with a higher risk of CVD mortality [HR(95%CI): 1.34(1.16–1.54), 1.44(1.16–1.78), and 1.59(1.22–2.07), respectively]. Compared to high-income participants without SCMI, those with low-income and SCMI had the highest risk of CVD mortality (Table).</div></div><div><h3>Conclusions</h3><div>Lower family income and SCMI are associated with CVD mortality, and their concomitant presence is associated with the highest risk. Family income and SCMI may help in the individualized assessment of CVD risk.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422741","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":"Real-world impact of transitioning from one lipoprotein(a) assay to another in a clinical setting","authors":"","doi":"10.1016/j.ajpc.2024.100726","DOIUrl":"10.1016/j.ajpc.2024.100726","url":null,"abstract":"<div><h3>Background and aims</h3><p>Different lipoprotein(a) [Lp(a)] assays may affect risk stratification of individuals and thus clinical decision-making. We aimed to investigate how transitioning between Lp(a) assays at a large central laboratory affected the proportion of individuals with Lp(a) result above clinical thresholds.</p></div><div><h3>Methods</h3><p>We studied nationwide clinical laboratory data including 185,493 unique individuals (47.7 % women) aged 18-50 years with 272,463 Lp(a) measurements using Roche (2000-2009) and Siemens Lp(a) assay (2009-2019).</p></div><div><h3>Results</h3><p>While the majority of individuals (66-75 %) had low levels of Lp(a) (&lt;30 mg/dL) independent of the assay used, the Roche assay detected 20 % more individuals with Lp(a) &gt;50 mg/dL, 40 % more individuals with Lp(a) &gt;100 mg/dL and 80 % more individuals with Lp(a) &gt; 180 mg/dL than the currently used Siemens assay, likely due to calibration differences.</p></div><div><h3>Conclusion</h3><p>Transitioning from one Lp(a) immunoassay to another had significant impact on Lp(a) results, particularly in individuals approaching clinically relevant Lp(a) thresholds.</p></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666667724000941/pdfft?md5=b4e82c85b1837ad5e8bce9d75dcc8758&pid=1-s2.0-S2666667724000941-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094832","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":"FACTORS IMPACTING PHYSICIAN WELL-BEING FOR PREVENTION OF BURNOUT","authors":"","doi":"10.1016/j.ajpc.2024.100825","DOIUrl":"10.1016/j.ajpc.2024.100825","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>Physician burnout is an ongoing epidemic and can lead to increased depression and suicide risk. Burnout occurs in physicians of all ages, but residents and fellows are at increased risk. Approximately five resident physicians per year commit suicide. This has profound implications, as early-career burnout may predict a greater risk for physicians to leave healthcare or turn to self-medication. Individuals with positive psychological health exhibit a reduced risk of cardiovascular disease, whereas prolonged experiences of depression, anxiety, and chronic stress may predispose individuals to adverse cardiovascular events. The ACGME emphasizes the importance of well-being by adding “Physician Well-Being” to its core initiatives. In this study, we aim to highlight initiatives which can be undertaken to improve physician wellbeing.</div></div><div><h3>Methods</h3><div>This study was designed to incorporate feedback from 6 residency and fellowship programs in USA. These programs were selected based on innovative wellness initiatives. Residents and fellows were surveyed for their feedback on the impact of these initiatives on their wellbeing and mental health.</div></div><div><h3>Results</h3><div>Having mental health days in addition to paid time off and sick leave had a highly positive impact on the physicians’ well-being with around 88.6 % of the responses recording the same. Similar results were seen with the availability of fresh and healthy free food for physicians. Majority of the responses indicated that wellness meetings through online platforms had no impact at all on physician wellbeing while wellness events like parties and get togethers had a moderately positive impact on physician wellbeing. Having in-house entertainment like music, TV and radio in the resident/ fellow lounge was also found to have a moderately positive impact on most physicians.</div></div><div><h3>Conclusions</h3><div>The findings help us understand the changes that can be implemented for resident wellness. Further research on a grander scale is warranted to evaluate individual-level, program-wide, and institutional interventions help prevent resident and fellow physician burnout.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422710","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":"PCSK9 INHIBITORS IN PERIPHERAL ARTERY DISEASE: REVIEW OF EFFICACY, SAFETY, AND OUTCOMES","authors":"","doi":"10.1016/j.ajpc.2024.100800","DOIUrl":"10.1016/j.ajpc.2024.100800","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Peripheral Artery Disease</div></div><div><h3>Background</h3><div>Peripheral artery disease (PAD) is a debilitating condition characterized by atherosclerosis in the peripheral arteries, affecting approximately 200 million people worldwide. Current treatment options for PAD, such as statins, have limitations in terms of efficacy and tolerability. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have shown promise in reducing cardiovascular events in hypercholesterolemic patients. This review focuses on the efficacy, safety, and clinical outcomes of PCSK9 inhibitors in PAD based on recent trials and literature.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted using PubMed to identify relevant trials and studies evaluating PCSK9 inhibitors in PAD patients. Key trials including FOURIER and ODYSSEY were analyzed for efficacy in reducing LDL cholesterol levels and cardiovascular events, including myocardial infarction, stroke, coronary revascularization, and major adverse limb events. Safety data was compiled from multiple trials. Cost-effectiveness studies were also reviewed.</div></div><div><h3>Results</h3><div>The FOURIER trial demonstrated that evolocumab significantly reduced LDL cholesterol by 59% (p&lt;0.001) and the risk of cardiovascular events (HR 0.85; 95% CI, 0.79 to 0.92; p&lt;0.001) in PAD patients at 48 weeks. The ODYSSEY trial showed similar LDL reductions of 55% at 4 months and 63% at 48 months with alirocumab. Injection site reactions were the most common adverse event in safety evaluations (evolocumab 2.1% vs placebo 1.6%). Despite high costs (incremental cost-effectiveness ratios &gt;$500,000 per QALY in some analyses), PCSK9 inhibitors may be cost-effective in specific high-risk populations.</div></div><div><h3>Conclusions</h3><div>PCSK9 inhibitors demonstrate significant efficacy in lowering LDL cholesterol and reducing cardiovascular events in PAD patients, with a favorable safety profile. However, cost remains a barrier to widespread utilization. Current PAD treatment guidelines do not yet incorporate PCSK9 inhibitors. Further research is needed on long-term outcomes, cost-effectiveness, and the role of PCSK9 inhibitors in the context of current PAD management. PCSK9 inhibitors represent a promising therapeutic option for select high-risk PAD patients not at goal with statins alone.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422966","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":"THE HEALERS: A PATIENT, COMMUNITY, AND STAKEHOLDER ADVISORY BOARD FOCUS GROUP SERIES TO REFINE A NOVEL VIRTUAL-WORLD CARDIAC REHABILITATION INTERVENTION AND CLINICAL TRIAL","authors":"","doi":"10.1016/j.ajpc.2024.100796","DOIUrl":"10.1016/j.ajpc.2024.100796","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Therapeutic Area&lt;/h3&gt;&lt;div&gt;Rehabilitation&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Cardiac rehabilitation (CR) is a widely underutilized secondary cardiovascular disease prevention strategy, due to a variety of barriers to participation that disproportionately impact women, racial and ethnic minority groups, and patients with low socioeconomic status. Destination Cardiac Rehab, a virtual world-based CR (VWCR) program was designed by our team in collaboration with patients and community members to mitigate the barriers to CR participation. Prior proof-of-concept and pilot studies demonstrated feasibility and acceptability of this novel intervention and a trend toward improvement in cardiovascular health behaviors. In anticipation of a randomized-controlled trial planned to further validate the intervention as an alternative to tradition center-based CR, utilizing a community engaged research (CER) approach, a patient/community/stakeholder-advisory board (PCS-AB), self-coined, the HEALERS was created to inform iterative refinements to the VWCR intervention, and the trial recruitment/retention plans to better meet patients’ needs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Patients who previously completed CR, patients who enrolled but did not complete CR, CR eligible patients, and representatives from key stakeholder/advocacy groups were recruited to the PCS-AB from six academic medical centers. Following recruitment of a diverse group, the HEALERS participated in five 90-minute virtual focus group sessions to provide feedback on various aspects of the VWCR intervention and the recruitment/retention plans. Feedback was analyzed to identify major themes to inform revisions to the trial protocol. Illustrative quotes were selected to represent each theme.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Twenty-two members were recruited with diverse sociodemographic and personal/professional backgrounds (mean age 59 years, 50% female). Emerging themes were identified and classified into subgroups. Regarding trial recruitment, members recommended effective communication strategies, suggestions for the recruitment video, and expansion of recruitment settings. The HEALERS emphasized the importance of feeling safe during exercise and social support in designing an effective VWCR intervention. They also provided recommendations to optimize various components of the CR sessions and the VWCR platform. Lastly, they identified reminder messages, tangible incentives, and garnering positive relationships with the CR staff as important retention tools.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;A diverse PCS-AB was convened to better understand the community needs and improve Destination Cardiac Rehab in meeting patient needs in anticipation of an upcoming RCT. The HEALERS offered valuable insights that informed actionable changes to the RCT protocol. They also expressed concerns inherent to a VW intervention and potential solutions to mitigate their concerns. The PCS-AB will","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423024","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":"PLASMA WATER T2 IMPROVES WITH LIFESTYLE MODIFICATION: NEW PREDICTIONS FROM LINEAR MIXED EFFECTS MODELS","authors":"","doi":"10.1016/j.ajpc.2024.100808","DOIUrl":"10.1016/j.ajpc.2024.100808","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Novel Biomarkers</div></div><div><h3>Background</h3><div>Plasma and serum water T2 are global markers of metabolic health. In an ancillary study of the PREMIER randomized controlled trial, we measured T2 values for 4,578 biobanked plasma and serum samples. The parent study recruited and randomized 810 participants into 3 treatment arms: advice-only (TX1), comprehensive lifestyle intervention (TX2), and comprehensive plus DASH: dietary approaches to stop hypertension (TX3). Health and fitness were measured at 0 (baseline), 6- and 18-months post-intervention. Here, we developed new linear mixed effects models to assess the plasma water T2 response for biomarker validation. The models incorporate adjustments appropriate for a repeated measures study design to minimize confounding and bias. <strong>Hypothesis</strong>: Plasma water T2 increases (improves) in response to the PREMIER lifestyle interventions.</div></div><div><h3>Methods</h3><div>Linear mixed-effects modeling was performed using Stata 18.0. The primary outcome was change from baseline in plasma water T2 at 18 months for each treatment arm, evaluated using pairwise marginal comparisons.</div></div><div><h3>Results</h3><div>Model 1 incorporated baseline plasma water T2, visit (months), and treatment group as fixed effects. Subject ID nested into cohort were random effects. After 18 months, plasma water T2 increased by 25.3 msec in TX1 (p=0.0240), 12.1 msec in TX2 (p=0.2815), and 23.5 msec in TX3 (p=0.0362). Model 2 incorporated additional covariates: baseline plasma water T2, baseline LDL, plasma total protein, fasting insulin, fitness, BMI-Race interaction, visit (months), treatment group, and the interaction between visit in months &amp; treatment as fixed effects. Subject ID nested into cohort, varying by time, served as random effects for Model 2. After 18 months, plasma water T2 increased by 35.2 msec in TX1 (p=0.0003), 27.8 msec in TX2 (p=0.0049), and 30.0 msec in TX3 (p=0.0028). Similar but smaller increases were observed after 6 months: 17.0 msec in TX1 (p=0.0142), 14.3 msec in TX2 (p=0.0459) and 15.3 msec in TX3 (p=0.0364). The time trajectories for Model 2 are plotted in Figure 1.</div></div><div><h3>Conclusions</h3><div>Model 2 demonstrated substantial increases (improvements) in plasma water T2 after 6 and 18 months for each treatment group. These results validate plasma water T2 as a practical biomarker for monitoring global improvement in cardiometabolic health following lifestyle modification.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422913","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}