American journal of preventive cardiology最新文献

{"title":"SEX DIFFERENCES IN MYOCARDIAL INFARCTION RISK AMONG INDIVIDUALS WITH HIGH LIPOPROTEIN(A): A META-ANALYSIS","authors":"Sneha Annie Sebastian MD ,&nbsp;Inderbir Padda MD, MPH","doi":"10.1016/j.ajpc.2025.101147","DOIUrl":"10.1016/j.ajpc.2025.101147","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] is a well-established causal risk factor for cardiovascular morbidity and mortality. Despite this, little is known about how sex influences the risk of myocardial infarction (MI) in individuals with high Lp(a) levels.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search of multiple databases up to March 25, 2025. Statistical analysis was performed using RevMan 5.4, applying a random-effects model to pool dichotomous outcomes as risk ratios (RR) with corresponding 95% confidence intervals (CI). The degree of heterogeneity among studies was assessed using Higgins I2 statistic. High Lp(a) levels were defined as median levels of ≥30 mg/dL. The protocol for this study has been submitted to PROSPERO for registration (CRD 1022715).</div></div><div><h3>Results</h3><div>Our final analysis included 14 observational studies examining the influence of sex on Lp(a) levels and the risk of MI, with a total of 66,124 patients (46% females), an average age of 57 years, and an average follow-up period of 7.6 years. The narrative synthesis of the included studies indicated a positive association between elevated Lp(a) levels and an increased risk of MI in both females and males. However, the pooled analysis showed no statistically significant difference in the risk of MI between females and males with high Lp(a) levels, with an RR of 1.01 (95% CI: 0.77–1.31; p = 0.96; I2 = 98%), and high heterogeneity was observed. Additionally, some studies reported a significant increase in Lp(a) levels in women after the age of 50.</div></div><div><h3>Conclusions</h3><div>Our analysis found no sex-based difference in the risk of MI associated with high Lp(a) levels. However, further studies are needed to explore sex-specific thresholds in the clinical evaluation of cardiovascular disease risk based on Lp(a) levels, which could improve personalized cardiovascular risk assessment.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101147"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LDL-C AND POLYGENIC RISK FOR CORONARY HEART DISEASE RISK ASSESSMENT","authors":"Jamal Rana MD, PhD ,&nbsp;Meng Lu MS ,&nbsp;Roberto Elosua MD, PhD ,&nbsp;Martha Gulati MD, MSc ,&nbsp;Nathan D. Wong PhD, MPH ,&nbsp;Carlos Iribarren MD, MPH, PhD","doi":"10.1016/j.ajpc.2025.101101","DOIUrl":"10.1016/j.ajpc.2025.101101","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>Elevated concentrations of LDL-cholesterol (LDL-C) are a major independent modifiable risk factor for coronary heart disease (CHD). However, the joint consideration of LDL-C and background polygenic risk in assessing risk remains unclear.</div></div><div><h3>Methods</h3><div>We utilized data from a subset of the Genetic Epidemiology Resource in Adult Health and Aging (GERA) Multi-Ethnic cohort (n=47,576) who were without diabetes and not taking cholesterol lowering medication at baseline in 2007-2008. We stratified the cohort into three groups of CHD genetic risk (low=quintile 1; intermediate=quintiles 2, 3 and 4; and high=quintile 5) using a 12-SNP Polygenic Risk Score (PRS) for CHD (CARDIO inCode-Score, GENinCode Plc). Incident CHD consisted of primary in-patient codes for angina pectoris, myocardial infarction, revascularization procedures or CHD death through 12/31/2022 (n=1,678); mean follow-up was 13.8 years. Age-adjusted CHD rates per 10,000 person-years were estimated using Poisson regression (accounting for death and health plan disenrollment) according to polygenic risk and LDL-C level. Hazard ratios and 95% confidence intervals for 1 standard deviation (SD) increment of LDL-C in each PRS group were obtain using Cox regression adjusting for 10 principal components of ancestry plus traditional risk factors. We tested for formal interaction LDL-C*PRS as continuous variables in the fully adjusted model.</div></div><div><h3>Results</h3><div>Mean ± SD age = 58.1 ± 10.3 years; 62% female; 18% non-European ancestry. There were nonstatistically significant associations between LDL-C and incident CHD among low polygenic risk individuals, although individuals with severe hypercholesterolemia (≥190 mg/dL) in this group had a markedly elevated HR (2.3; p=0.06) (Table and forest plot). In the intermediate polygenic risk group, there was a steady increased risk of CHD as LDL-C increased, with markedly higher HR (&gt;2.0) starting at 160 mg/dL. In the high polygenic risk group, HR of CHD began to increase markedly starting at LDL-C of 130 mg/dL, and the combination of both high polygenic risk and severe hypercholesterolemia (LDL-C &gt; 190 mg/dL) was associated with a HR of 3.6.</div></div><div><h3>Conclusions</h3><div>These results have important clinical implications for lipid management in asymptomatic populations and support a more aggressive management and primary prevention for individuals with high polygenic risk.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101101"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACUTE CORONARY SYNDROME AND INFLAMMATORY BOWEL DISEASE: A 20-YEAR NATIONAL DATABASE STUDY ON CARDIOVASCULAR RISK AND INSIGHT INTO PREVENTION","authors":"Alexander Hurtado MD,&nbsp;Walter Rossi MD,&nbsp;Reniell X. Iñiguez MD","doi":"10.1016/j.ajpc.2025.101109","DOIUrl":"10.1016/j.ajpc.2025.101109","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD in Special Populations</div></div><div><h3>Background</h3><div>Patients with inflammatory bowel disease (IBD) are at an increased risk of developing acute coronary syndrome (ACS). This elevated risk is thought to stem from chronic systemic inflammation coupled with traditional risk factors for cardiovascular disease (CVD). Despite this recognized association, limited data exists on the impact of inflammation control and classic CVD preventive strategies in IBD.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of a national database (TriNetX, LLC), accessed on February 19, 2025, encompassing electronic health records from 64 hospital systems and over 100 million patients across the United States between January 1, 2005, and January 1, 2025. Patients with IBD were compared to propensity-matched adult controls (matched for age, sex, hypertension, type 2 diabetes, dyslipidemia, tobacco use, alcohol abuse, and overweight/obesity) using 1:1 greedy nearest neighbor matching. Primary analysis compared the prevalence, odds ratio, and Cox proportional hazards regression for ACS in patients with IBD compared to propensity-matched controls. Subset analyses examined comorbidities, cardiovascular medication use, and IBD-specific immunomodulatory therapies in IBD patients with and without ACS.</div></div><div><h3>Results</h3><div>Among 185,881 IBD patients and 7,873,639 propensity-matched controls, the unweighted ACS prevalence was 10.6% vs. 6.6% (OR 1.68, 95% CI [1.65-1.71], p&lt;0.001). The presence of IBD was independently associated with a greater risk of ACS over time (HR 1.33, 95% CI [1.311.35], p&lt;0.001). Subset analyses yielded 19,775 patients with IBD who had ACS and 166,106 patients with IBD who did not have ACS. Between these two groups, the use of common immunomodulators was associated with a lower risk of ACS (OR 0.16, 95% CI [0.15-0.17], p &lt;0.001). Traditional CVD risk factors remained prevalent among IBD patients, with no significant risk reduction observed with conventional cardiovascular medications; however, optimal dosing and degree of risk factor control could not be assessed.</div></div><div><h3>Conclusions</h3><div>From 2005 to 2025, ACS prevalence remained higher in IBD patients, mirroring prior studies. Our findings highlight the complex interplay between chronic systemic inflammation and classic CVD risk factors in driving ACS risk among IBD patients. While immunomodulatory therapy appears to be protective against CVD, comprehensive and aggressive strategies to manage traditional CVD risk factors remain essential.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101109"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 RECEPTOR AGONISTS AND CARDIOVASCULAR OUTCOMES IN PATIENTS WITH CORONARY PLAQUE: A REAL-WORLD PROPENSITY-MATCHED ANALYSIS","authors":"Osman Yousafzai MD,&nbsp;Frank Annie PHD FACC,&nbsp;Sarah Rinehart MD FACC","doi":"10.1016/j.ajpc.2025.101169","DOIUrl":"10.1016/j.ajpc.2025.101169","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>Atherosclerotic plaque burden remains a major driver of cardiovascular events in patients with coronary artery disease. Glucagon-like peptide-1 (GLP-1) receptor agonists have shown potential cardiovascular benefits, but their impact on patients with established plaque remains under investigation. This study assesses the effect of GLP-1 therapy in patients with confirmed coronary plaque.</div></div><div><h3>Methods</h3><div>Using TriNetX, a federated electronic medical record network from January 1, 2022 to December 31, 2024, we identified two propensity-matched cohorts with documented coronary plaque: those who received GLP-1 analogues (n=24,648) and those who did not (n=24,648). Inclusion required both imaging consistent with plaque (e.g., coronary CTA, angiography, calcium scoring) and diagnostic codes for atherosclerosis. Outcomes analyzed over 1-year follow-up included major adverse cardiovascular events (MACE), myocardial infarction (MI), inpatient hospitalizations, and lipid panel values (LDL, total cholesterol, non-HDL, triglycerides).</div></div><div><h3>Results</h3><div>Compared to controls, GLP-1 users had significantly lower risks of:</div><div>• <strong>MACE</strong> (34.3% vs. 41.9%; OR 0.725, 95% CI 0.699–0.751, p&lt;0.001)</div><div>• <strong>Myocardial infarction</strong> (13.9% vs. 20.8%; OR 0.615, 95% CI 0.586–0.644, p&lt;0.001)</div><div>• <strong>Inpatient visits</strong> (22.8% vs. 28.7%; OR 0.731, 95% CI 0.702–0.761, p&lt;0.001)</div><div>Survival analysis demonstrated higher 1-year event-free survival in the GLP-1 group across all outcomes. GLP-1 users also had modestly improved lipid profiles, including lower LDL (70.8 vs. 73.6 mg/dL), total cholesterol (142.8 vs. 145.8 mg/dL), and non-HDL cholesterol (98.3 vs. 99.9 mg/dL). Although triglycerides remained higher in the GLP-1 group at 1 year (149.8 vs. 139.4 mg/dL), they showed a greater improvement from baseline, with a decrease of 14.2 mg/dL compared to a 5.4 mg/dL increase in the non-GLP-1 group.</div></div><div><h3>Conclusions</h3><div>Among patients with confirmed coronary plaque, GLP-1 therapy is associated with substantial reductions in adverse cardiovascular outcomes and improvements in lipid parameters. These findings support the cardiovascular protective role of GLP-1 analogues in high-risk atherosclerotic populations.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101169"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CURRENT CANNABIS USE IS ASSOCIATED WITH INCREASED INDEXES OF DIASTOLIC DYSFUNCTION IN ADULTS: A RETROSPECTIVE ANALYSIS","authors":"Rahul Almeida B.S. Candidate in Biology ,&nbsp;Yigit Unlu (Co-first author), M.D. ,&nbsp;Mina Navabzadeh PharmD. ,&nbsp;Jing Cheng M.D., MS, Ph.D. ,&nbsp;Lam Tran B.A. ,&nbsp;Matthew Springer Ph.D. ,&nbsp;Leila Mohammadi M.D., Ph.D.","doi":"10.1016/j.ajpc.2025.101175","DOIUrl":"10.1016/j.ajpc.2025.101175","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Although the effects of tobacco use on cardiac function are well documented, less is known about cannabis use and its impact on systolic and diastolic function parameters as measured by echocardiography. In a retrospective study, we evaluated the relationship between cannabis use and cardiac functional parameters (systolic and diastolic) that have predictive value in future heart failure (HF) related morbidity and mortality.</div></div><div><h3>Methods</h3><div>We screened patients who underwent echocardiography imaging at UCSF Medical Center between March 2018 and May 2024 who also had questionnaire data available for cannabis use (smoking and edibles; n=189 [101 F, 88 M], mean±SD for age: 65.9±11.7). Cardiac function parameters considered were both systolic (left ventricular ejection fraction (LVEF)) and diastolic (left atrial volume index (LAVI), left ventricular end diastolic volume index (LVEDVI), and left ventricular internal diameter in diastole (LVIDd)). Categorical differences in cardiac function parameters between users (n=87), non-users (n=60), and prior users (n=42) were quantified in a generalized linear model and expressed as beta coefficient (ß) ± SEM after adjustments for age, sex, and brain natriuretic peptide (BNP). p&lt;0.05 was considered significant.</div></div><div><h3>Results</h3><div>Cannabis use was associated with a higher LVEDVI (ß=12.9±4.7, p=0.007) and LVIDd (ß=0.47±0.19, p=0.01) compared to non-users. Cannabis use was not a significant determinant of LVEF or LAVI (both p&gt;0.05). However, there was a trend of an association between cannabis use and a higher LAVI score in women (ß=22.1±11.4, p=0.06) that was not observed in men (p=0.28). Similar results were obtained when the analysis was adjusted for patient age, sex, BNP, tobacco use status, and LVEF (for diastolic function parameters). Prior use (those that have reported to have ever used cannabis) was not a significant determinant of any of the measures of systolic or diastolic function.</div></div><div><h3>Conclusions</h3><div>Current cannabis use is associated with higher LVEDVI and LVIDd, and not with differences in LVEF. Cannabis use is not associated with LAVI score in men, but our results are suggestive of a potential association in women. Our findings point to a relationship between cannabis use and subclinical cardiac alterations that can inform preventive cardiovascular interventions for at-risk populations.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101175"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"QUANTIFYING THE POTENTIAL IMPACT OF MATERNAL CARDIOVASCULAR HEALTH ON PREVENTION OF ADVERSE PREGNANCY OUTCOMES","authors":"Jaclyn D. Borrowman PhD ,&nbsp;Xiaoning Huang PhD ,&nbsp;Amanda M. Perak MD, MS ,&nbsp;Sadiya S. Khan MD, MSc ,&nbsp;Alexa Freedman PhD (Senior author) ,&nbsp;George R. Saade ,&nbsp;Janet M. Catov PhD, MS ,&nbsp;Philip Greenland ,&nbsp;Sherrine A. Ibrahim MD ,&nbsp;Lauren Theilen MD, MS ,&nbsp;C. Noel Bairey Merz MD ,&nbsp;Lisa D. Levine MD, MSCE ,&nbsp;Lynn M Yee MD","doi":"10.1016/j.ajpc.2025.101165","DOIUrl":"10.1016/j.ajpc.2025.101165","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>More favorable maternal cardiovascular health (CVH) is associated with lower risk of adverse pregnancy outcomes (APOs). However, estimates of the potential impact of improving maternal CVH on the burden of APOs are not available. We sought to estimate the proportion of APOs that could be prevented if the population distribution of maternal CVH was improved.</div></div><div><h3>Methods</h3><div>Pregnant participants aged ≥ 18 years enrolled in the Nulliparous Pregnancy Outcomes Study (nuMoM2b) without pre-pregnancy hypertension or diabetes were included in analyses. First trimester CVH was assessed using six-factors from the Life’s Essential 8 framework (physical activity, diet, sleep, nicotine use, body mass index, and blood pressure). CVH was scored from 0-100 with higher scores representing better CVH. APOs included new-onset hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), and preterm birth (&lt;37 weeks gestation, PTB). The primary outcome was incidence of any APO and secondary outcomes included each APO separately. Logistic regression models assessed the association of early pregnancy CVH and APOs. Impact fractions were calculated to estimate the proportion of APOs that could be prevented if maternal CVH was improved for those with the lowest CVH scores. A priori selected covariates of study site, maternal age, insurance type, and depressive symptoms at baseline were included in analyses.</div></div><div><h3>Results</h3><div>Among the 8927 pregnant participants included, 25.3% experiencing an APO. A lower total CVH score was associated with a significantly higher risk of the composite APO outcome. An estimated 12% of APOs would be prevented if a hypothetical intervention shifted all participants with a CVH score &lt;50 to a score of 50 (5.8% of participants). Moreover, a dose-response relationship was observed with 15% and 40% of APOs estimated to prevented if a hypothetical intervention shifted participants with a CVH score &lt;80 to 80 points (51.4% of participants) or shifted everyone to 100 points (96.6% of participants), respectively (<strong>Figure 1</strong>). Similar findings were observed for each APO type.</div></div><div><h3>Conclusions</h3><div>In this cohort of nulliparous pregnant individuals, estimated potential benefits of improving maternal CVH to reduce APOs are considerable. Determining efficacious and equitable strategies to improve CVH pre-pregnancy or early pregnancy period are needed.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101165"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"META-ANALYSIS OF IMPACT OF STATINS ON RENAL FUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 3 AND 4","authors":"Deepak Vedamurthy MD,&nbsp;Usman Sagheer MD,&nbsp;Kyari Sumayin Ngamdu MD,&nbsp;Mahima Tyagi MD,&nbsp;Dinesh Kalra MD","doi":"10.1016/j.ajpc.2025.101122","DOIUrl":"10.1016/j.ajpc.2025.101122","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Kidney Disease</div></div><div><h3>Background</h3><div>Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death in CKD patients. CKD patients have highly atherogenic dyslipidemia characterized by small, dense LDL particles. Statins remain the foundation of therapy for reducing the enhanced ASCVD risk. Due to concerns regarding futility, competing risks, and polypharmacy in very advanced CKD patients, lipid-lowering therapy is often underutilized in this high-risk population. We performed a systematic review to study the impact of statins on the estimated glomerular filtration rate (eGFR) in patients with CKD stages 3 to 4 at baseline.</div></div><div><h3>Methods</h3><div>We screened articles in PubMed and Cochrane Library, published in the English language between 01/01/1990 and 01/01/2024. We included randomized clinical trials enrolling patients with moderate to severe CKD, who were treated with a statin medication as the main intervention, had a follow-up duration of at least 12 months, and reported an eGFR at the beginning and the conclusion of the study. The mean annual change in eGFR was the primary outcome of interest. A random-effects model was used to assess the impact of statin treatment compared to the control on the annual change in eGFR.</div></div><div><h3>Results</h3><div>1941 studies were initially identified. 13 RCTs, comprising 14,393 individuals on statin therapy, were finally included. 6 studies were evaluated statins in primary ASCVD prevention, 6 evaluated statins in secondary ASCVD prevention. In many included studies, the risk of bias was deemed to be low. The average follow-up ranged from 12 months to 6 years. The pairwise meta-analysis revealed that statin use slowed the rate of eGFR decline by 0.24 mL/min/1.73 m2 per year (p = 0.0003) more compared to controls. Eggerʼs test showed no evidence of publication bias (p = 0.13).</div></div><div><h3>Conclusion</h3><div>Statin therapy in patients with CKD stages 3 &amp; 4 had a beneficial, albeit small, effect on renal function by reducing the rate of decline in eGFR over time. Thus, statins can be safely used in this high-risk population. Future, larger studies should evaluate the potential benefit of apoB lowering drugs on renal function in moderate to advanced CKD and the potential interaction of other renoprotective drugs in this population.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101122"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TARGETING ELEVATED LIPOPROTEIN (A) WITH PCSK9 INHIBITORS: A NEW FRONTIER IN CARDIOVASCULAR RISK REDUCTION: AN UMBRELLA REVIEW","authors":"Raaj pawan Kumar lingamgunta Mbbs student ,&nbsp;Dr. Krishna prasad (Assistant professor) ,&nbsp;Dr. kolli Naga Saritha (Senior lecturer statistics)","doi":"10.1016/j.ajpc.2025.101157","DOIUrl":"10.1016/j.ajpc.2025.101157","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD /CVD Risk Reduction</div></div><div><h3>Background</h3><div>Elevated Lipoprotein(a), a genetically inherited risk factor, is independently associated with increased cardiovascular risk. It remains underdiagnosed and undertreated in clinical practice, posing an unmet need in cardiovascular prevention. Unlike LDL-Cholestrol, lipoprotein(a) levels are not significantly influenced by diet or conventional lipid-lowering therapies such as statins. Recent studies suggest that Proprotein Convertase Subtilisin Kexin9 (PCSK9) inhibitors, initially developed for LDL-C reduction, may also reduce lipoprotein(a), offering dual benefits for patients with elevated lipoproteins(a) levels and high cardiovascular risk.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was performed in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library, covering 2014 to 2024. Eleven systematic reviews and meta-analyses, comprising 253,311 participants, were selected based on predefined inclusion criteria. Cardiovascular risk reduction (hazard ratios) and Lp(a) reduction percentages were synthesized into standardized mean percentage change metrics. Data extraction and synthesis were performed independently by three reviewers. Participants aged 18 to 65 were studied from international centers and exhibited diverse cardiovascular risk profiles, Population characteristics were analyzed using pooled clinical trial data from different phases.</div></div><div><h3>Results</h3><div>Lp(a) reduction was analyzed in 11 studies with 253,311 participants. The mean reduction was 25.08% (95% CI:21.94%-28.21%), with reductions ranging from 10.91% to 30.60%. Sensitivity analysis confirmed a stabilized reduction of 26.5%. There was significant heterogeneity (I2 = 99.9%) and potential publication bias (Egger’s test, p = 0.001). Cardiovascular risk reduction was assessed in seven studies, yielding a pooled Hazard Ratio (HR) of 0.85 (95% CI: 0.75- 0.96, P = 0.008), representing a 15% reduction in Atherosclerotic Cardiovascular Disease (ASCVD) risk. Moderate heterogeneity (I2 = 72%) and possible publication bias (p=0.042) were noted.</div></div><div><h3>Conclusions</h3><div>PCSK9 inhibitors demonstrate a dual role, effectively decreasing both LDL-C and lipoprotein(a), which has a significant role in the primary prevention of cardiovascular events. By focusing on Lp(a) that is genetically raised, these drugs may help reduce the residual cardiovascular risk that is unmet by conventional lipid-lowering interventions. Yet, because of the heterogeneity and probable publication bias, many large and focused trials are needed to validate the data, optimize these interventions, and define clinical recommendations for Lp(a) treatment.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101157"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OPTIMIZING FAMILIAL HYPERCHOLESTEROLEMIA MANAGEMENT: EARLY FINDINGS FROM THE ATLANTIC LIPID LOWERING TREATMENT OPTIMIZATION PROGRAM (ALLTOP)","authors":"Jeffrey N. Feldman MD ,&nbsp;Robert D. Fishberg MD, FACC ,&nbsp;Deatrah Dubose APN ,&nbsp;Lise Cooper DMH ,&nbsp;Anjali Kakwani PharmD ,&nbsp;Cassidy Maggio PharmD","doi":"10.1016/j.ajpc.2025.101121","DOIUrl":"10.1016/j.ajpc.2025.101121","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>Despite established guidelines, lipid management in high-risk ASCVD patients remains suboptimal. This prospective, multicenter study, IRB-approved study evaluates the impact of supportive care focused on LDL-C management in high-risk ASCVD patients over two years and will eventually enroll 250 patients. These early findings represent the first 19 patients who have reached their first 6-month milestone for follow-up LDL-C levels. Using the EHR, a dedicated nurse practitioner (NP), clinical pharmacists, and primary care partnerships, we identify high-risk patients and target an LDL-C &lt;100 mg/dL in six months. We assess LDL-C goal achievement based on 2022 ACC guidelines over 24–96 weeks, with patients as their own controls. Our goal is to develop a model for primary and secondary prevention that integrates guidelines for treatment at the practice level that has the potential to improve outcomes. For instance, higher LDL-C post-PCI increases adverse events, emphasizing targeted control. Lipid clinics using EHRs identified undiagnosed FH cases and improved therapy. EHR alerts only modestly boosted lipid-lowering therapies (LLT), requiring further adherence strategies. A multidisciplinary care model showed superior LDL-C reductions.</div></div><div><h3>Methods</h3><div>Participants were identified via the EHR and other databases, such FeelBetter, clinician referrals, and ClinicalTrials.gov and must have an LDL-C ≥160. Supportive care includes a dedicated NP providing weekly education and follow-up, in-person or virtually. Clinical pharmacists review medication therapy problems (MTPs), including barriers to medication access and adherence. Additional support includes genetic testing, social services, and specialist referrals.</div></div><div><h3>Results</h3><div>Among the 19 participants with six-month follow-up lab values, 14 (74%) reduced their LDL-C levels an average of 48 points. Seven of the 14 (50%) achieved LDL-C &lt;100, with three (21%) achieving an LDL-C &lt;70. Clinical pharmacist reviews identified 20 MTPs, including barriers to medication adherence, dose adjustments, and the need for additional LLTs. Sixteen participants completed genetic testing, with one identified as having a heterozygous familial hypercholesterolemia (HeFH)-related gene variant, necessitating follow-up and cascade testing, and lifestyle modifications.</div></div><div><h3>Conclusions</h3><div>Preliminary evidence from the ALLTOP study supports the effectiveness of a structured, multidisciplinary model for optimizing hypercholesterolemia and HeFH management.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101121"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DEMOGRAPHICS AND OUTCOMES OF PATIENTS WITH TAKOTSUBO SYNDROME AND RHEUMATOID ARTHRITIS","authors":"Karla Inestroza M.D.","doi":"10.1016/j.ajpc.2025.101137","DOIUrl":"10.1016/j.ajpc.2025.101137","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD in Special Populations</div></div><div><h3>Background</h3><div>Takotsubo syndrome (TS) features transient left ventricular apical dysfunction. Physical or emotional stress is the most common cause of TS. The exact pathophysiological mechanism of TS remains unclear, and some hypotheses include myocardial edema and inflammation, coronary vasospasm, microcirculatory dysfunction, catecholamine surge, and sympathetic overdrive as possible mechanisms. While the potential link between rheumatological conditions and TS is suspected, there is a general lack of descriptions of the clinical implications of this association.</div></div><div><h3>Methods</h3><div>The US National Inpatient Database was queried from 2011 to 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. We identified patients admitted with TS who had a coronary angiogram. We then excluded those who underwent coronary percutaneous coronary intervention (PCI), coronary artery bypass graft (CAGB) or had a diagnosis of myocarditis. We compared baseline characteristics and in-hospital outcomes of patients with TS with vs. without rheumatoid arthritis (RA).</div></div><div><h3>Results</h3><div>We identified 126,475 patients with TS, of which 4,001 (3.2%) had concomitant RA.</div><div>Patients with TS and RA were older (68.7 vs. 66.6 years, p ≤0.001), more likely to be of female sex (95.7% vs. 88%, p ≤0.001), and white in race (85.1% vs. 82.8%, p ≤0.001) compared to patients without RA. Those with RA had more anxiety (22.4% vs. 20.1%, p ≤0.001), major depressive disorder (20.3% vs. 17%, p ≤0.001) prior history of bariatric surgery (2.5% vs. 1.5%, p ≤0.001), cirrhosis (2.2% vs. 1.4%, p ≤0.001), pulmonary hypertension (8.1% vs. 5.7%, p ≤0.001), and obstructive sleep apnea (7.9% vs. 5.3%, p ≤0.001) compared to patients without RA.</div><div>Regarding in-hospital outcomes, after adjusting for age, sex, and race, there was no difference in all-cause mortality within groups (1.6% vs. 2%, p =0.09).</div><div>However, those with RA were more likely to have complications like heart failure (42.3% vs. 39%, p &lt;0.001, 1.1 [1.05-1.2]), sepsis 6.9% vs. 5%, p &lt;0.001, 1.5 [1.3-1.7]), and supraventricular tachycardia (3.1% vs. 2.1%, p &lt;0.001, 1.5 [1.3-1.8]). They were less likely to have a cardiac arrest, cardiogenic shock, or ventricular fibrillation, and required less cardioversion compared to patients without RA.</div></div><div><h3>Conclusions</h3><div>The prognosis of TS in patients with RA appears to be similar to that of patients without RA. Due to the nature of this study, we could not stratify according to disease severity or disease duration in patients with RA, which have been reported to influence comorbidities and long-term patient outcomes significantly.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101137"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}