American journal of preventive cardiology最新文献

{"title":"Vegetarian dietary patterns and cardiovascular risk factors and disease prevention: An umbrella review of systematic reviews","authors":"Matthew J. Landry ,&nbsp;Katelyn E. Senkus ,&nbsp;A Reed Mangels ,&nbsp;Nanci S. Guest ,&nbsp;Roman Pawlak ,&nbsp;Sudha Raj ,&nbsp;Deepa Handu ,&nbsp;Mary Rozga","doi":"10.1016/j.ajpc.2024.100868","DOIUrl":"10.1016/j.ajpc.2024.100868","url":null,"abstract":"<div><h3>Background</h3><div>Diet significantly influences the risk of developing cardiovascular disease (CVD), the leading cause of death in the United States. As vegetarian dietary patterns are increasingly being included within clinical practice guidelines, there is a need to review the most recent evidence regarding if and how these dietary patterns mitigate CVD risk.</div></div><div><h3>Objective</h3><div>This umbrella review of systematic reviews compared the relationships between vegetarian, vegan and non-vegetarian dietary patterns and CVD health outcomes and risk factors among presumably healthy adults (≥18 years) in the general population.</div></div><div><h3>Methods</h3><div>MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, Food Science Source and SportsDiscus databases were searched for systematic reviews (SRs) published from 2018 until March 2024. Eligible SRs and meta-analyses examined relationships between vegetarian or vegan diets and CVD risk factors and disease outcomes compared to non-vegetarian diets. SRs were screened in duplicate, and SR quality was assessed with AMSTAR2. The overall certainty of evidence (COE) was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) method.</div></div><div><h3>Results</h3><div>There were 758 articles identified in the databases’ search and 21 SRs met inclusion criteria. SRs targeting the general population had primarily observational evidence. Vegetarian, including vegan, dietary patterns were associated with reduced risk for CVD incidence [Relative Risk: 0.85 (0.79, 0.92)] and CVD mortality [Hazard Ratio: 0.92 (0.85, 0.99)] compared to non-vegetarian diets. Vegan dietary patterns were associated with reductions in CVD risk factors including blood pressure [systolic mean difference (95 % CI): -2.56 mmHg (-4.66, -0.445)], low-density lipoprotein cholesterol [-0.49 mmol/l (-0.62, -0.36)], and body mass index [-1.72 kg/m² (-2.30, -1.16)] compared to non-vegetarian dietary patterns, as well as c-reactive protein concentrations in a novel meta-analysis [-0.55 mg/l (-1.07, -0.03)].</div></div><div><h3>Conclusion</h3><div>Practitioners can consider recommending vegetarian dietary patterns to reduce cardiometabolic risk factors and risk of CVD incidence and mortality.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100868"},"PeriodicalIF":4.3,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142421450","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":"Effects of vitamin D supplementation on cardiac biomarkers: Results from the STURDY trial","authors":"Katharine W Rainer ,&nbsp;William Earle ,&nbsp;Erin D Michos ,&nbsp;Edgar R Miller 3rd ,&nbsp;Amal A Wanigatunga ,&nbsp;Heather Rebuck ,&nbsp;Robert Christensen ,&nbsp;Jennifer A Schrack ,&nbsp;Christine M Mitchell ,&nbsp;Rita R Kalyani ,&nbsp;Lawrence J Appel ,&nbsp;Stephen P Juraschek","doi":"10.1016/j.ajpc.2024.100871","DOIUrl":"10.1016/j.ajpc.2024.100871","url":null,"abstract":"<div><h3>Objectives</h3><div>In observational studies, older adults with low serum vitamin D levels are at higher risk of cardiovascular disease (CVD), but randomized trials have failed to demonstrate reduction in CVD risk from vitamin D supplementation, possibly because the doses of vitamin D supplements tested were too low. Our objective was to determine if higher doses of vitamin D supplementation reduce high-sensitivity cardiac troponin (hs-cTnI) and N-terminal pro-b-type natriuretic peptide (NT-proBNP), markers of subclinical CVD.</div></div><div><h3>Methods</h3><div>The Study to Understand Fall Reduction and Vitamin D in You (STURDY) was a double-blind, randomized, response-adaptive trial that tested the effects of 4 doses of vitamin D3 supplementation (200, 1000, 2000, 4000 IU/day) on fall risk among older adults with low serum 25-hydroxyvitamin D concentrations (10–29 ng/mL). Hs-cTnI and NT-proBNP levels were measured at baseline, 3-, 12-, and 24-month follow-up visits. For this ancillary study, we used data from the original trial and compared participants by treatment group: low-dose (200 IU/day) or high-dose (1000+ IU/day). The effects of vitamin D dose on biomarkers were assessed via mixed effects tobit models.</div></div><div><h3>Results</h3><div>Among 688 participants (mean age of 76.5) hs-cTnI increased in both the low- and high-dose groups by 5.2 % and 7.0 %, respectively; likewise, NT-proBNP increased by 11.3 % and 9.3 %, respectively. Compared to the low-dose, high-dose vitamin D supplementation did not affect hs-cTnI (1.6 %-difference; 95 % CI: -5.3, 8.9) or NT-proBNP (-1.8 %-difference; 95 % CI: -9.3, 6.3).</div></div><div><h3>Conclusions</h3><div>Compared to low-dose vitamin D supplementation, doses ≥1,000 IU/ day did not affect markers of subclinical CVD in older adults with low serum vitamin D levels.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100871"},"PeriodicalIF":4.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432750","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":"Psychological and socio-economic correlates of cardiovascular health among young adults in Puerto Rico","authors":"Milagros C. Rosal ,&nbsp;Israel Almodóvar-Rivera ,&nbsp;Sharina D. Person ,&nbsp;Andrea López-Cepero ,&nbsp;Catarina I. Kiefe ,&nbsp;Katherine L. Tucker ,&nbsp;Maria Uribe-Jerez ,&nbsp;José Rodríguez-Orengo ,&nbsp;Cynthia M. Pérez","doi":"10.1016/j.ajpc.2024.100875","DOIUrl":"10.1016/j.ajpc.2024.100875","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to determine the relationship between socioeconomic and psychological factors and overall cardiovascular health (CVH), as defined by the American Heart Association's Life's Essential 8 (LE8), among young adults in Puerto Rico.</div></div><div><h3>Methods</h3><div>Participants were 2156 young adults, between the ages of 18–29 years, enrolled in the PR-OUTLOOK study. The analysis included survey, laboratory, and physical measurement data collected from September 2020 to November 2023. Assessed socioeconomic indicators included food insecurity, housing instability, economic insecurity, and subjective social standing. Evaluated psychological factors comprised symptoms of depression, anxiety, post-traumatic stress, and overall perceived stress. LE8 scores were calculated and classified as suboptimal (poor/intermediate range) vs. ideal CVH. Logistic regression models estimated associations between each socioeconomic and psychological measure and suboptimal CVH, and dominance analysis assessed the importance of each measure.</div></div><div><h3>Results</h3><div>Participants' mean age was 22.6 (SD = 3.1), 60.9 % were female, about one-third (34.2 %) had high school education or less, and over one-third had public or no health insurance (38.4 %). Participants reporting socioeconomic adversity (i.e., high food insecurity, housing instability and economic insecurity, and low subjective social standing) and elevated psychological symptoms (i.e., symptoms of anxiety, depression, post-traumatic stress, and overall perceived stress) had lower CVH scores. However, in the adjusted analysis, only lower subjective social standing (OR = 1.38, 95 % CI = 1.13–1.69) and elevated symptoms of anxiety (OR = 1.63, 95 % CI = 1.25–2.13) and depression (OR = 1.30, 95 % CI = 1.03–1.65) emerged as the primary contributors to suboptimal CVH (vs. ideal).</div></div><div><h3>Conclusion</h3><div>Efforts to preserve and enhance CVH among young Puerto Ricans on the island should target these factors.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100875"},"PeriodicalIF":4.3,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327394","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":"Temporal trends in lipoprotein(a) testing among United States veterans from 2014 to 2023","authors":"Sofia E. Gomez ,&nbsp;Adam Furst ,&nbsp;Tania Chen ,&nbsp;Natasha Din ,&nbsp;David J. Maron ,&nbsp;Paul Heidenreich ,&nbsp;Neil Kalwani ,&nbsp;Shriram Nallamshetty ,&nbsp;Jonathan H Ward ,&nbsp;Anthony Lozama ,&nbsp;Alexander Sandhu ,&nbsp;Fatima Rodriguez","doi":"10.1016/j.ajpc.2024.100872","DOIUrl":"10.1016/j.ajpc.2024.100872","url":null,"abstract":"<div><h3>Objective</h3><div>Lipoprotein (a) [Lp(a)] is a causal, genetically-inherited risk amplifier for atherosclerotic cardiovascular disease (ASCVD). Practice guidelines increasingly recommend broad Lp(a) screening among various populations to optimize preventive care. Corresponding changes in testing rates and population-level detection of elevated Lp(a) in recent years has not been well described.</div></div><div><h3>Methods</h3><div>Using Veterans Affairs electronic health record data, we performed a retrospective cohort study evaluating temporal trends in Lp(a) testing and detection of elevated Lp(a) levels (defined as greater than 50 mg/dL) from January 1, 2014 to December 31, 2023 among United States Veterans without prior Lp(a) testing. Testing rates were stratified based on demographic and clinical factors to investigate possible drivers for and disparities in testing: age, sex, race and ethnicity, history of ASCVD, and neighborhood social vulnerability.</div></div><div><h3>Results</h3><div>Lp(a) testing increased nationally from 1 test per 10,000 eligible Veterans (558 tests) in 2014 to 9 tests per 10,000 (4,440 tests) in 2023, while the proportion of elevated Lp(a) levels remained stable. Factors associated with higher likelihood of Lp(a) testing over time were a history of ASCVD, Asian race, and residing in neighborhoods with less social vulnerability.</div></div><div><h3>Conclusion</h3><div>Despite a 9-fold increase in Lp(a) testing among US Veterans over the last decade, the overall testing rate remains extremely low. The steady proportion of Veterans with elevated Lp(a) over time supports the clinical utility of testing expansion. Efforts to increase testing, especially among Veterans living in neighborhoods with high social vulnerability, will be important to reduce emerging disparities as novel therapeutics to target Lp(a) become available.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100872"},"PeriodicalIF":4.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142421531","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":"Do clinical decision support tools improve quality of care outcomes in the primary prevention of cardiovascular disease: A systematic review and meta-analysis","authors":"Iva Buzancic ,&nbsp;Harvey Jia Wei Koh ,&nbsp;Caroline Trin ,&nbsp;Caitlin Nash ,&nbsp;Maja Ortner Hadziabdic ,&nbsp;Dora Belec ,&nbsp;Sophia Zoungas ,&nbsp;Ella Zomer ,&nbsp;Lachlan Dalli ,&nbsp;Zanfina Ademi ,&nbsp;Bryan Chua ,&nbsp;Stella Talic","doi":"10.1016/j.ajpc.2024.100855","DOIUrl":"10.1016/j.ajpc.2024.100855","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;To assess the effectiveness of Clinical Decision Support Tools (CDSTs) in enhancing the quality of care outcomes in primary cardiovascular disease (CVD) prevention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A systematic review was undertaken in accordance with PRISMA guidelines, and included searches in Ovid Medline, Ovid Embase, CINAHL, and Scopus. Eligible studies were randomized controlled trials of CDSTs comprising digital notifications in electronic health systems (EHS/EHR) in various primary healthcare settings, published post-2013, in patients with CVD risks and without established CVD. Two reviewers independently assessed risk of bias using the Cochrane RoB-2 tool. Attainment of clinical targets was analysed using a Restricted Maximum Likelihood random effects meta-analysis. Other relevant outcomes were narratively synthesised due to heterogeneity of studies and outcome metrics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Meta-analysis revealed CDSTs showed improvement in systolic (Mean Standardised Difference (MSD)=0.39, 95 %CI=-0.31, -1.10) and diastolic blood pressure target achievement (MSD=0.34, 95 %CI=-0.24, -0.92), but had no significant impact on lipid (MSD=0.01; 95 %CI=-0.10, 0.11) or glucose target attainment (MSD=-0.19, 95 %CI=-0.66, 0.28). The CDSTs with active prompts increased statin initiation and improved patients’ adherence to clinical appointments but had minimal effect on other medications and on enhancing adherence to medication.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;CDSTs were found to be effective in improving blood pressure clinical target attainments. However, the presence of multi-layered barriers affecting the uptake, longer-term use and active engagement from both clinicians and patients may hinder the full potential for achieving other quality of care outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Lay Summary&lt;/h3&gt;&lt;div&gt;The study aimed to evaluate how Clinical Decision Support Tools (CDSTs) impact the quality of care for primary cardiovascular disease (CVD) management. CDSTs are tools designed to support healthcare professionals in delivering the best possible care to patients by providing timely and relevant information at the point of care (ie. digital notifications in electronic health systems). Although CDST are designed to improve the quality of healthcare outcomes, the current evidence of their effectiveness is inconsistent. Therefore, we conducted a systematic review with meta-analysis, to quantify the effectiveness of CDSTs. The eligibility criteria targeted patients with CVD risk factors, but without diagnosed CVD. The meta-analysis found that CDSTs showed improvement in systolic and diastolic blood pressure target achievement but did not significantly impact lipid or glucose target attainment. Specifically, CDSTs showed effectiveness in increasing statin prescribing but not antihypertensives or antidiabetics prescribing. Interventions with CDSTs aimed at increasing screening programmes were effective for pat","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"20 ","pages":"Article 100855"},"PeriodicalIF":4.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327395","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":"Addressing cardiovascular disease in South Asians: A fellow's voice","authors":"Aarti Thakkar","doi":"10.1016/j.ajpc.2024.100727","DOIUrl":"10.1016/j.ajpc.2024.100727","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100727"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666667724000953/pdfft?md5=be6edf74b0d6534d91836f1aaec933c5&pid=1-s2.0-S2666667724000953-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117759","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":"Editors’ Message – September 2024","authors":"Nathan D. Wong ,&nbsp;Erin D. Michos","doi":"10.1016/j.ajpc.2024.100729","DOIUrl":"10.1016/j.ajpc.2024.100729","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100729"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666667724000977/pdfft?md5=3f376c5a9407fd5d7279164b804c694b&pid=1-s2.0-S2666667724000977-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142151222","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":"FEASIBILITY OF A HOME-BASED CARDIAC REHABILITATION PROGRAM AMONG ADULTS WITH CARDIOVASCULAR DISEASE: A PILOT STUDY","authors":"Tim Bilbrey EP, MBA","doi":"10.1016/j.ajpc.2024.100770","DOIUrl":"10.1016/j.ajpc.2024.100770","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Rehabilitation</div></div><div><h3>Background</h3><div>Home-based cardiac rehabilitation (HBCR) has the potential to improve access to cardiac rehabilitation for patients recovering from acute cardiovascular disease (CVD). This study aims to assess the feasibility and initial impact of a technology-enabled HBCR program delivered by a multidisciplinary team to patients with CVD.</div></div><div><h3>Methods</h3><div>This prospective, single-arm study used a within-subject design. We recruited patients (age 40+) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, heart failure, etc.). All eligible and enrolled patients referred to the RecoveryPlus.Health (RPH) remote CR clinic in Roanoke, TX between May and August of 2023 were included. The care team provided guideline-concordant CR services to study participants via two modalities: 1) synchronous telehealth exercise training via video conferencing; and 2) asynchronous mHealth virtual coaching app. Baseline survey and electronic health record (EHR) data were used to extract sociodemographic and clinical data. Feasibility was measured by program completion rate and CR service use. Preliminary efficacy was measured by changes in 6-minute walk test (6MWT), resting heart rate, and quality of life (SF-12) before and after the 12-week program. Paired t tests were used to examine the changes in the outcome variables post intervention.</div></div><div><h3>Results</h3><div>A total of 75 patients consented and were enrolled in the study. The average age was 64.2 (SD=10.3, Range: 45-85) and 50.7% were female. The most frequent referring diagnosis was heart failure (49.3%). 62 (82.7%) participants completed the 12-week study. Among those who completed the study, all patients attended the telehealth sessions and 60 (95.2%) used the mHealth App. Post intervention, participants on average improved their 6MWT by 40.0 meters (ES=0.632, 95% CI: 0.356 to 0.877), indicating better cardiorespiratory endurance. The physical and mental summary scores were also improved by 2.7 (ES=0.413) and 2.2 (ES=0.244), respectively. There were no differences in resting heart rate and no serious program-related adverse events were reported.</div></div><div><h3>Conclusions</h3><div>The pilot data showed that the HBCR program was feasible in delivering remote CR care to patients at home. The promising preliminary results suggest that a randomized controlled efficacy trial is warranted.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100770"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422703","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":"MASSIVE AORTIC ATHEROMA AS CAUSE OF ISCHEMIC STROKE","authors":"Mitchell Padkins MD","doi":"10.1016/j.ajpc.2024.100753","DOIUrl":"10.1016/j.ajpc.2024.100753","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Case Presentation</h3><div>A 78-year-old-male was referred for assessment of the etiology of a symptomatic ischemic stroke in the right cerebellum. Vascular imaging including CT angiogram of the head and neck as well as prolonged electrocardiogram monitoring did not reveal a cause of his stroke.</div><div>A transesophageal echocardiogram (TEE) demonstrated no embolic source in the cardiac chambers and no intra-atrial shunt was identified. However, upon inspection of the descending thoracic aorta, a large atheroma was visualized measuring 2 cm in diameter and 0.7 cm thick (Figure). This finding led to a CT to further characterize this lesion. CT demonstrated non-calcified atherosclerotic plaque in the descending thoracic aorta which was determined to be the likely etiology of the stroke.</div><div>The identification of significant atherosclerotic plaque led to aggressive secondary prevention with the addition of aspirin 81 mg and high-intensity statin therapy. The patient's LDL cholesterol decreased from 120 mg/dL prior to the event to 42 mg/dL 12 weeks after initiating high-intensity statin therapy. At 1-year follow-up the patient has had no neurologic events and is tolerating therapy well.</div></div><div><h3>Background</h3><div>After a cerebrovascular accident is diagnosed, testing is warranted to identify the etiology. Unless a known etiology is identified, testing typically includes laboratory studies, prolonged ambulatory cardiac monitoring, imaging of the head and neck vessels, and imaging of the cardiac structures. Cardiac imaging typically begins with a transthoracic echocardiogram (TTE). However, TTE lacks the spatial resolution to identify atheromatous disease in the descending thoracic aorta. Thus, further imaging with TEE is often necessary for imaging the aorta and to rule out an intra-cardiac shunt.</div><div>After the etiology of a stroke is defined, management focuses on aggressive risk factor modification. Recent guidelines recommend initiating high-intensity statin therapy with a goal of reducing LDL to reduce the risk of future sequela related to atherosclerosis. In this case, aggressive antiplatelet and lipid lowering therapy was initiated with a significant reduction in the patient's LDL cholesterol.</div></div><div><h3>Conclusions</h3><div>This case represents a massive descending aortic atheroma, identified on TEE, as the cause of an ischemic stroke that led to aggressive secondary risk factor modification.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100753"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422716","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":"BASELINE CHARACTERISTICS OF PARTICIPANTS ENROLLED IN VICTORION-INCEPTION: A RANDOMIZED STUDY OF INCLISIRAN VS. USUAL CARE IN PATIENTS WITH RECENT HOSPITALIZATION FOR AN ACUTE CORONARY SYNDROME","authors":"Kirk U Knowlton MD","doi":"10.1016/j.ajpc.2024.100756","DOIUrl":"10.1016/j.ajpc.2024.100756","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>Patients with recent acute coronary syndrome (ACS) are at high risk for recurrent atherosclerotic cardiovascular disease (ASCVD) events. Lowering low-density lipoprotein cholesterol (LDL-C) to &lt;70 mg/mL can reduce this risk; thus, lipid-lowering therapy (LLT), including non-statin therapy, should be intensified within 4–6 weeks of ACS. Despite this recommendation, few patients achieve LDL-C &lt;70 mg/dL after an ACS event. When added to maximally tolerated statin therapy, inclisiran lowered LDL-C by an additional ∼50% in patients with ASCVD in prior trials, but those with ACS within 3 months of screening were excluded.</div></div><div><h3>Methods</h3><div>VICTORION-INCEPTION (NCT04873934) is an ongoing, Phase 3b, US, randomized, parallel-group, open-label, multicenter trial in patients with recent ACS. Eligible patients were screened within 5 weeks of hospital discharge and had LDL¬ C ≥70 mg/mL (or non-high-density lipoprotein cholesterol [HDL-C] ≥100 mg/dL) either on statin therapy or with statin intolerance. Patients were randomized 1:1 to inclisiran 284 mg (equivalent to 300 mg inclisiran sodium) on Days 0, 90, and 270 plus usual care or usual care alone (standard of care per treating physician). This interim analysis describes patient demographics and clinical characteristics.</div></div><div><h3>Results</h3><div>Through February 5, 2024, 788 patients were screened across 40 sites, of whom 400 were eligible and randomized: median age 61 years, 29.3% female, 12.3% Black or African American, and 14.3% Hispanic or Latino. The most common index ACS event (93%) was myocardial infarction (MI); 22% of patients had a prior MI. The median time from discharge to randomization was 34 days (Q1–Q3: 26–43). At baseline, median calculated LDL-C was 84.0 mg/dL (Q1–Q3: 71.0–103.0), non-HDL-C was 107.0 mg/dL (Q1–Q3: 93.0–129.0), and 95.5% of patients were receiving LLT (any statin therapy [alone or combination]: 93.3%; any high-intensity statin therapy: 81.3%; combination therapy [statin plus non-statin LLT]: 9.0%). Demographic and baseline characteristics are comparable between treatment arms (Table).</div></div><div><h3>Conclusions</h3><div>VICTORION-INCEPTION evaluates the LDL-C lowering effect of implementing a systematic LDL-C management pathway including inclisiran in patients with a recent ACS. The enrolled study population is reflective of real-world US clinical practice.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100756"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422728","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}