American journal of preventive cardiology最新文献

{"title":"PROGRESSIVE CORONARY ARTERY DISEASE, ELEVATED LP (A) REQUIRING LIPID APHERESIS","authors":"Susan Alideeb MD","doi":"10.1016/j.ajpc.2024.100793","DOIUrl":"10.1016/j.ajpc.2024.100793","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD /CVD Risk Reduction</div></div><div><h3>Case Presentation</h3><div>This is a 55-year-old female with a medical history of familial hypercholesterolemia, elevated lipoprotein (a) (Lp (a)), diabetes mellitus, myocardial infarction 2020, coronary artery disease with multiple percutaneous coronary intervention and status post coronary artery bypass surgery 2022, status post coronary brachytherapy for re-stenosis 2022, re-stenosis in 2023. The patient is on Rosuvastatin 40 mg, Ezetimibe 10mg, and Evolocumab 140 mg. Due to progressive coronary disease despite good medical therapy, the patient was referred for lipid apheresis (LA).</div></div><div><h3>Background</h3><div>This case demonstrates the accelerated effect of atherosclerosis mitigated by Lp(a). This patient developed progressive coronary artery disease (CAD), despite a low-density lipoprotein (LDL) of 85 mg/dl. Lp(a) is associated with increased risks of CAD, stroke, thrombosis, and aortic stenosis, particularly when greater than 125 nmol/L. Lp(a) has a pro-inflammatory effect, prothrombotic effect, and pro-atherosclerotic. Structurally similar to tissue plasminogen activator, which interferes with the natural pathways of thrombolysis. Currently, LA is the only treatment indicated for elevated Lp(a) in the setting of CAD and elevated cholesterol. The 2018 Cholesterol Guidelines state Lp(a) is a cardiovascular-enhancing risk feature. Evolocumab and Inclisiran can reduce Lp(a) up to 30 % but are not indicated as treatments. The European guidelines recommend LA for patients with elevated Lp(a) levels &gt; 60 mg/dl, and progressive atherosclerotic cardiovascular disease despite risk factors well controlled. LA can lower Lp(a) by 60 % and LDL up to 70 %.</div></div><div><h3>Conclusions</h3><div>LA should be regarded as a principal therapeutic option with elevated Lp(a) &gt;125nnmol/l in patients with progressive CAD despite maximal lipid-lowering therapy, aiming to achieve an LDL &lt; 70 mg/dl and reduce Lp(a) &gt; 60 % to mitigate other cardiovascular risk outcomes. A 70 % risk reduction in major adverse cardiovascular events in the first year of treatment was reported by the German Lipid Apheresis Registry. Lp(a) treatment options Pelacarsen and Olpasiran will not be available in the near future. These agents may change the need to do LA. This patient with progressive CAD, multiple interventions with very high Lp(a) benefitted from LA with greater than 80 % reduction in Lp(a) levels. Rise in Lp(a) bi-weekly, will require weekly treatments.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100793"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423110","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) ELEVATIONS COMMON, BUT NOT HIGHER IN GENOTYPE POSITIVE FAMILIAL HYPERCHOLESTEROLEMIA VERSUS GENOTYPE NEGATIVE INDIVIDUALS WITH HYPERLIPIDEMIA, IN PATIENTS REFERRED TO A DEDICATED CARDIOVASCULAR GENETIC COUNSELING CLINIC","authors":"Bailey A Kamp MS","doi":"10.1016/j.ajpc.2024.100768","DOIUrl":"10.1016/j.ajpc.2024.100768","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] is an apob100 containing lipoprotein with athero- and thrombogenic potential with a global population prevalence estimated at 20%. Previous research has presented conflicting data on whether individuals with genotype positive (Gene+) familial hypercholesterolemia (FH) are more likely to have elevated Lp(a) (≥50 mg/dL) vs genotype negative (Gene-) individuals.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of a 200 individual cohort of patients referred to be seen by the Intermountain Medical Center Cardiovascular Genetic Counseling clinic from 2018 to 2024 who had Lp(a) measurements (mg/dL) and underwent full gene sequencing and deletion/duplication analysis of the APOB, LDLR, LDLRAP1, and PCSK9 genes using next-generation sequencing technologies. The Lp(a) measurements were compared between 56 gene+ individuals and 144 gene- individuals.</div></div><div><h3>Results</h3><div>Of the 56 gene+ individuals, 21 had an Lp(a) ≥50 mg/dL (37.5%). Of the 144 gene- individuals, 61 had an Lp(a) ≥50 mg/dL (42.4%). Using Pearson's Chi-Squared Test, we calculated the chi-square value of 0.53.</div></div><div><h3>Conclusions</h3><div>The prevalence of elevated Lp(a) was nearly double (37.5% and 42.4%) than is estimated in the general population. However, the difference in proportion of patients with elevated Lp(a) between gene+ and gene- patients was not statistically significant. These findings reaffirm the importance of screening for elevated Lp(a) in all patients, regardless of genotype status.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100768"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422732","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":"PATIENT EDUCATION FOR CORONARY ARTERY DISEASE PREVENTION: A LITERATURE REVIEW","authors":"Hannah Hart MD","doi":"10.1016/j.ajpc.2024.100810","DOIUrl":"10.1016/j.ajpc.2024.100810","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>Coronary Artery Disease (CAD) is the most common manifestation of cardiovascular disease (CVD) related morbidity and mortality. Although billions of dollars have been spent on diagnostic and therapeutic innovations over the last two decades, it remains the number one cause of morbidity and mortality. Guidelines now explicitly recommend doctors to provide educational resources to optimize heart health. In this study, we perform a comprehensive review of the literature involving patient education-based interventions intended to prevent CAD. We hypothesize that media-based education on CAD may improve clinical outcomes compared to more traditional forms of education.</div></div><div><h3>Methods</h3><div>We conducted a review of the currently published manuscripts dating up to July 2023 using PubMed and Google Scholar. The search phrases used were “Patient Education,” “Educational Intervention,” and “Coronary Artery Disease Prevention”. The results were sorted by title and date. We compiled data from these studies with information about demographics, type of intervention, and results of the interventions. We discuss our major findings from the review as well as the limitations and future studies that may arise because of our findings.</div></div><div><h3>Results</h3><div>Eight studies were included in the review. The studies consisted of a variety of interventions such as video-based, phone call-based, smartphone-based, or pamphlet-based. Most patient education-based interventions regarding CAD lead to significant changes in behavior, knowledge, or in some cases, significant improvement in clinical outcomes. Overall, this did not depend on the specific type of intervention, nor the specific setting. When comparing the media-based interventions to the more traditional text-based or usual care groups, there was a trend toward more significant improvement in knowledge about CAD as well as improvement in modifiable risk factors such as BMI, blood pressure, or cholesterol.</div></div><div><h3>Conclusions</h3><div>Patient education is an important and effective means of not only improving patient quality of life, but also clinical outcomes. This review demonstrates that patient education may have significant implications to improve the individual and societal burden of CAD. With advancements in technology and a greater role of digital and social media in society, video-based interventions will be essential to invest in to advance the field of preventive cardiology.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100810"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422915","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":"ST ELEVATIONS DURING LEFT ATRIAL APPENDAGE OCCLUSION (LAAO) SECONDARY TO WATCHMAN DEVICE COMPRESSION OF THE LEFT CIRCUMFLEX (LCX) ARTERY: A CASE REPORT","authors":"Lorelle Sun MS","doi":"10.1016/j.ajpc.2024.100799","DOIUrl":"10.1016/j.ajpc.2024.100799","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Ischemic Stroke</div></div><div><h3>Case Presentation</h3><div>A 67-year-old male, with paroxysmal atrial fibrillation (AF), CHADS-VASc 3, and HAS-BLED 3, was admitted for elective WATCHMAN left atrial appendage occlusion (LAAO). Following transesophageal echocardiography (TEE) measurements of the left atrial appendage (LAA), the 24-mm WATCHMAN FLX was selected given manufacturer recommendation of 10-27% compression rate. During the procedure, initial device deployment was successful with appropriate position, compression, and closure in setting of a prominent pectinate ridge. However, within minutes, blood pressure dropped, and electrocardiogram (ECG) showed nonsustained ventricular tachycardia and inferolateral ST elevations. Device compression was 18-23% and shoulder was 0-20%; there was no flow around the device. In the 90° TEE view, device edge to left circumflex (LCx) artery measured 2.4 mm. Upon device recapture, hemodynamic and ECG abnormalities resolved quickly. There was no evidence of air embolism or left atrial thrombus. Given mechanical compression of LCx by a properly sized and positioned device, a decision was made to discontinue the procedure. Postoperative ECG and imaging showed no acute changes. Patient remained asymptomatic and hemodynamically stable upon discharge.</div></div><div><h3>Background</h3><div>Reducing stroke risk is paramount in patients with AF, though chronic anticoagulation confers a major bleeding risk. Research has consistently highlighted the comparable efficacy of percutaneous LAAOs to oral anticoagulation in preventing stroke among nonvalvular AF patients. WATCHMAN LAAOs have increased in prevalence since its approval by the Food and Drug Administration in 2015. Despite their relative safety, a rare yet critical complication involves compression of the LCx coronary artery.</div></div><div><h3>Conclusions</h3><div>This represents the second reported case of LCx coronary artery compression by a WATCHMAN, resulting in hemodynamic instability and acute ST elevations that resolved with device removal. This complication warrants vigilance as recognition should lead to device withdrawal. Further investigation into patient specific risk factors is warranted to stratify risk prior to device implantation. Individual differences, such as preexisting coronary artery disease and proximity of left coronary artery and its branches to LAA should be considered. While current guidelines recommend sizing devices up for over-compression to minimize peri-device leaks, our case highlights that even within recommended compression ratios, mechanical coronary artery compression remains a risk.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100799"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422965","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":"ASPC_2025FellowsJournalAd_082124","authors":"","doi":"10.1016/S2666-6677(24)00234-4","DOIUrl":"10.1016/S2666-6677(24)00234-4","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100866"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666667724002344/pdfft?md5=8009b79c4acaf85266e28713eba78ff7&pid=1-s2.0-S2666667724002344-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270755","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":"Robert J Ostfeld MD, MSc","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":"19 ","pages":"Article 100772"},"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":"NAVIGATING THE CHALLENGES OF TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR): A CASE STUDY","authors":"Tushar Menon MD","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":"19 ","pages":"Article 100748"},"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":"ASSOCIATION BETWEEN FAMILY INCOME, SUBCLINICAL MYOCARDIAL INJURY, AND CARDIOVASCULAR MORTALITY IN THE GENERAL POPULATION","authors":"Sneha Chebrolu MD","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":"19 ","pages":"Article 100736"},"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":"BODY WEIGHT, LIPOPROTEIN (A), AND INCIDENT CARDIOVASCULAR DISEASE IN THE UK BIOBANK","authors":"Richard Kazibwe MD, MS","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":"19 ","pages":"Article 100739"},"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":"BEYOND DIAGNOSIS: PROGNOSTIC UTILITY OF B-NATRIURETIC PEPTIDE IN PREGNANT PATIENTS PRESENTING TO ARKANSAS’ HIGH-RISK CARDIO-OBSTETRICS PROGRAM","authors":"Landon Bruich BS","doi":"10.1016/j.ajpc.2024.100816","DOIUrl":"10.1016/j.ajpc.2024.100816","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>B-natriuretic peptide (BNP) is used as a screening biomarker for patients in cardio-obstetric programs. In nonpregnant females, obesity falsely lowers BNP, but its accuracy in the obese pregnant population is less known. We studied the diagnostic and prognostic utility of BNP in a predominantly obese, high-risk obstetric population in Arkansas.</div></div><div><h3>Methods</h3><div>We established a retrospective registry of pregnant patients who had undergone a BNP and echocardiographic assessment (within 30 days of each other) at the University of Arkansas Medical Center between January 1, 1995, to October 30, 2022. We assessed the relationship between BNP levels and left ventricular ejection fraction (LVEF) using Pearson correlation coefficients. We used receiver operating curves to identify an optimal BNP cutoff for predicting a reduced LVEF (&lt;50%), and cox regression analysis to determine a prognostic cutoff value. A p-value of &lt;0.05 indicated statistical significance. Analyses are performed using MedCalc software (Ostend, Belgium).</div></div><div><h3>Results</h3><div>We studied a total of n=315 pregnant patients with a median ±SD age of 29.8 years old (25-34) and BMI of 34 kg/m2 (34-41). In patients with a BMI of ≥ 35, there was no correlation between BNP and LVEF [-0.05 (-0.21 to 0.09, P = 0.47)] (Figure 1b). Of all variables examined, only LVEF of &lt;50% was predictive of maternal mortality with a 95% confidence interval of 1.1 to 25.1 and a P value of 0.04. Significant cutoff values for BMI and BNP are listed in Figure 1c-d.</div></div><div><h3>Conclusions</h3><div>BNP based screening in high-risk obstetric patients requires consideration of BMI in interpretation of test, paralleling the effect obesity has on BNP in a non-pregnant population. In conclusion, we recommend considering an echocardiography in obese, pregnant patients with a clinical suspicion of new or worsening heart failure, regardless of BNP level.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100816"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422831","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}