American journal of preventive cardiology最新文献

{"title":"PREDICTORS OF LIPOPROTEIN(A) TESTING ACROSS A NATIONAL COHORT: INSIGHTS FROM THE VETERANS HEALTH ADMINISTRATION","authors":"Tania Chen MBBS, MPH","doi":"10.1016/j.ajpc.2024.100767","DOIUrl":"10.1016/j.ajpc.2024.100767","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 a genetically determined, independent, causal risk factor for atherosclerotic cardiovascular diseases (ASCVD). Multiple practice guidelines increasingly recommend Lp(a) testing to refine cardiovascular risk assessment. We aimed to evaluate sociodemographic and clinical factors influencing Lp(a) testing in the Veterans Affairs (VA) healthcare system.</div></div><div><h3>Methods</h3><div>We assembled a retrospective cohort using data from the VA electronic health record, Medicare claims, and community care for Veterans having at least one outpatient visit in the VA between July 1, 2020, and June 30, 2023, and at least one prescription filled in 180 days before the date of the last VA outpatient encounter to ensure adequate healthcare system contact. We evaluated patient-level sociodemographic and clinical predictors of Lp(a) testing. Predictors included self-reported race and ethnicity, social vulnerability, the presence and type of ASCVD, and low-density lipoprotein cholesterol (LDL-C) levels. Neighborhood social vulnerability was defined using the CDC's Social Vulnerability Index (SVI) and categorized by quartiles (higher numbers associated with higher vulnerability). Associations between patient characteristics and Lp(a) testing were estimated using generalized estimating equations.</div></div><div><h3>Results</h3><div>Among 5,331,271 Veterans, the median age was 67 years (IQR 52-76) with 10.3% female; 69.6% identified as White, 18.8% Black, 7.4% Hispanic. Less than 1% of eligible Veterans have received Lp(a) testing. Lp(a) was more likely to be tested among Veterans with older age, White race, non-Hispanic ethnicity, living in urban neighborhoods, and those with low SVI (less vulnerable neighborhoods). After multivariable adjustment, Lp(a) testing was more likely among women, Veterans identified as Black or Asian, and those with established ASCVD (Figure). Across 130 VA facilities, Lp(a) testing ranged from 0.01-3.40%. The median Lp(a) level among those tested at VA facilities was 16 mg/dL (IQR 6-53) with 26% of Veterans with ASCVD and 20% of Veterans without ASCVD having Lp(a) levels &gt;50 mg.</div></div><div><h3>Conclusions</h3><div>Lp(a) testing is infrequent in the VA healthcare system, with disparities in testing by sociodemographic and clinical characteristics. About a quarter of those tested had elevated Lp(a) levels. Developing strategies to improve overall Lp(a) testing and reduce existing gaps in testing by sociodemographic factors is critical as targeted therapeutics become available.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100767"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422731","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 2014-2023","authors":"Sofia E. Gomez MD","doi":"10.1016/j.ajpc.2024.100758","DOIUrl":"10.1016/j.ajpc.2024.100758","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Novel Biomarkers</div></div><div><h3>Background</h3><div>Elevated lipoprotein(a) [Lp(a)] is a genetically-determined, independent, causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Multiple contemporary clinical practice guidelines endorse Lp(a) testing to refine risk stratification for ASCVD and guide clinical decision-making among high-risk patients. Changes in rates of testing and detection of elevated Lp(a) over time have not been well described.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using Veterans Affairs electronic health record data to evaluate temporal trends in Lp(a) testing from January 1, 2014 to December 31, 2023 among United States Veterans. We identified Veterans in each year who had a primary care or cardiology visit, an active medication filled, and no prior Lp(a) testing. We stratified testing rates based on demographic and clinical factors: age, sex, race and ethnicity, history of ASCVD, and neighborhood social vulnerability index (SVI) scores as defined by the Centers for Disease Control. The SVI incorporates variables such as employment, income, crowding, and education, with higher scores suggesting greater vulnerability. We classified elevated Lp(a) levels using three clinically meaningful thresholds: 50 mg/dL, 70 mg/dL and 90 mg/dL.</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 testing increased across all groups, prevalent ASCVD was strongly associated with an increase in Lp(a) testing over time (Figure). Rates of testing increased less among those residing in neighborhoods with high social vulnerability compared with low social vulnerability. Rates of testing increased most among Asian Veterans but similarly across other racial and ethnic groups. The percent of elevated tests across clinically meaningful thresholds has remained stable over time.</div></div><div><h3>Conclusions</h3><div>We found a 9-fold increase in Lp(a) testing among US Veterans over the last decade, particularly among those with ASCVD, but the overall rate remains extremely low. The proportion of Veterans with elevated Lp(a) has remained steady, supporting the clinical utility of testing expansion. Efforts to increase testing 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":"19 ","pages":"Article 100758"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422753","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":"PERFORMANCE OF PREVENT AND POOLED COHORT EQUATIONS FOR PREDICTING 10 YEAR ASCVD RISK IN THE UK BIOBANK","authors":"Matthew Ambrosio MS","doi":"10.1016/j.ajpc.2024.100782","DOIUrl":"10.1016/j.ajpc.2024.100782","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>The Pooled Cohort Equations (PCE) were created in 2013 to assess ASCVD risk in primary prevention. In 2023 the American Heart Association published the PREVENT equations to assess the risk of cardiovascular disease, including ASCVD and heart failure, in primary prevention. The comparative performance of PCE and PREVENT for predicting 10-year ASCVD risk has not been evaluated in an external large-scale epidemiologic cohort.</div></div><div><h3>Methods</h3><div>The study population includes participants of the UK Biobank who were free of clinical cardiovascular disease. 10-year ASCVD risk was calculated using the PCE and PREVENT equations, respectively.</div><div>Individuals who died from non-ASCVD events, or were lost to follow-up before 10 years without developing ASCVD were excluded. C-statistics (AUCs) were calculated separately for men and women to evaluate risk discrimination, and correlated delta AUCs were calculated using DeLong's method. Predicted 10-year risks were divided into deciles for each equation and stratified by gender to compare predicted risk versus observed risk within each decile, with a Hosmer-Lemeshow test performed for goodness of fit.</div></div><div><h3>Results</h3><div>The final cohort was 370,885 individuals (mean age 56, 55.3% women, 94.0% white), after excluding 14,604 individuals lost to follow-up before 10 years without developing ASCVD. The observed 10-year ASCVD (95% CI) was 2.4% (2.31%-2.44%) for women and 5.5% (5.45%-5.56%) for men; the median (IQR) PCE predicted 10-year ASCVD risk was 3.6% (1.53%-7.12%) for women and 10.6% (5.33%-17.03%) for men. The median PREVENT predicted 10-year ASCVD risk was 2.9% (1.47%-4.95%) for women and 5.2% (3.02%-7.93%) for men. The C-statistics for PCE were 0.732 (0.7253-0.7389) for women and 0.695 (0.6893-0.7000) for men. In comparison, the C-statistics for PREVENT were 0.732 (0.7249-0.7382) for women and 0.695 (0.6894-0.6998) for men. Delta AUC was -0.0009 (p=0.36) for women and -0.0009 (p=0.21) for men. Figure 1 displays the mean PCE and PREVENT predicted 10-year ASCVD risks compared to observed risks for each decile. The PREVENT equations appear to be better calibrated than the PCE.</div></div><div><h3>Conclusions</h3><div>There is no significant difference in 10-year ASCVD risk discrimination between PCE and PREVENT equations. However, the PREVENT equations appear to be better calibrated at predicting risk compared to the PCE.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100782"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422820","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":"IMPACT OF CARDIOMETABOLIC DISORDERS ON THE DIAGNOSIS OF METABOLIC ASSOCIATED FATTY LIVER DISEASE (MAFLD) AMONG HOSPITALIZED PATIENTS: A 5-YEAR RETROSPECTIVE STUDY OF NIS DATABASE BETWEEN 2016-2020.","authors":"Adedeji Adenusi MD, MPH","doi":"10.1016/j.ajpc.2024.100785","DOIUrl":"10.1016/j.ajpc.2024.100785","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Cardiometabolic disorders are health conditions that are associated with increased risk for cardiovascular events and sudden cardiac death in the US. However, only a few studies explored these health conditions on the increasing trend of MAFLD. This study aims to explore the impact of cardiometabolic disorders among patients diagnosed with MAFLD in US hospitals.</div></div><div><h3>Methods</h3><div>We used the NIS data of 2016-2020 period for this cross-sectional study. Our main outcome was MAFLD while predictors were cardiometabolic syndrome (hypertension, diabetes, CKD, dyslipidemia, obesity) with co-variates (race, age, sex). We did descriptive analysis, bivariate and multivariate logistic regressions to identify potential predictors associated with MAFLD.</div></div><div><h3>Results</h3><div>A total of 252,254,979 hospitalized patients were analyzed of which 112,375 patients were hospitalized with principal diagnosis of MAFLD/NAFLD. MAFLD were predominantly diagnosed in females (61.3%), individuals over 45 years (89.4%), white (78.4%), those with obesity (66.2%), without dyslipidemia (55.1%), with metabolic syndrome (98.8%), hypertension (66.2%), diabetes (80.4%) and chronic kidney disease (67.7%). Patients with obesity were two-fold likely to be diagnosed with MAFLD compared to patients with normal BMI. (aOR= 2.319 [95%CI 2.223-2.419], p&lt;.0001). Conversely patients with dyslipidemia were less likely to be diagnosed with MAFLD than those without dyslipidemia. (0.903 [0.870-0.936], p&lt;.0001). Patients with metabolic syndrome were four-fold likely to be diagnosed with MAFLD compared with non-metabolic syndrome patients. (4.353 [3.583-5.289], p&lt;.0001). Patients with hypertension had a marginal likelihood to be diagnosed with MAFLD compared to non-hypertensive patients. (1.044 [1.003-1.086], p=0.0348). Patients with diabetes or CKD were two-fold likely to be diagnosed with MAFLD compared with non-diabetic and non-CKD patients respectively. (2.439 [2.345-2.536], p&lt;.0001), (2.305 [2.206-2.409], p&lt;.0001). Patient of Hispanic descent were more likely to have MAFLD compared with patients of white descents. (1.169 [1.082-1.264], p&lt;.0001), while patients from black and Asian descent were less likely to have MAFLD respectively. (0.235 [0.219-0.251], p&lt;.0001), (0.651 [0.585-0.724], p&lt;.0001)</div></div><div><h3>Conclusions</h3><div>The results of this study contribute to the body of knowledge on the risk and pattern of MAFLD among patients with cardiometabolic disorders, emphasizing the complex interplay between sociodemographic and clinical factors. This further informs lifestyle modification, early detection and treatment of cardiometabolic disorders as preventive strategy for MAFLD.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100785"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422823","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":"VENTRICULAR FIBRILLATION ARREST IN AN ELDERLY FEMALE DUE TO AMIODARONE-INDUCED ACQUIRED LONG-QT SYNDROME","authors":"Mingma Sherpa DO","doi":"10.1016/j.ajpc.2024.100787","DOIUrl":"10.1016/j.ajpc.2024.100787","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Pharmacologic Therapy</div></div><div><h3>Case Presentation</h3><div>We report the case of a 77-year-old female who presents after a LifeVest defibrillator shock. She had initially presented a month prior with new-onset heart failure and atrial fibrillation with rapid ventricular response. She was diagnosed with tachycardia-mediated cardiomyopathy. After three unsuccessful attempts at cardioversion, she was started on oral amiodarone 400mg twice a day. On discharge, she was prescribed oral amiodarone 200mg daily, along with entresto, metoprolol succinate, and empagliflozin.</div><div>She returned a month later after a shock at home. LifeVest interrogation demonstrated polymorphic ventricular tachycardia (VT)/ventricular fibrillation (VF) with prolonged QTc of 712 msec before VT/VF. Laboratory evaluation on admission within normal limits. Initial EKG showed sinus bradycardia with QTc 630 milliseconds (ms). The patient experienced recurrent TdP, requiring defibrillation three additional times while in the emergency department. Cardiac catheterization showed non-obstructive CAD. Amiodarone was held with improvement in her QTc to 398 ms. She was switched to mexiletine 150 mg TID, remained in sinus rhythm, and was discharged with a dual chamber pacemaker and defibrillator for secondary prevention.</div></div><div><h3>Background</h3><div>Due to age-related electrophysiological and structural changes, elderly individuals face an elevated risk of acquired long-QT syndrome (LQTS). Females are at a higher risk than males, with a 1-3% incidence of amiodarone-induced Torsades de Pointes (TdP). Older women taking amiodarone are especially susceptible to proarrhythmic effects, including QT interval prolongation, which can potentially lead to clinical complications.</div></div><div><h3>Conclusions</h3><div>Amiodarone is frequently utilized to treat atrial fibrillation refractory to cardioversion. However, current guidelines are based on studies conducted mainly on middle-aged men with minimal inclusion of women, especially older women, with a lack of sex-specific analysis and reporting. Women are prone to adverse drug reactions, and these reactions may be more severe due to doses that do not consider body weight differences. This can result in higher plasma levels and potential overdosage in women compared to men. Personalizing treatment by identifying sex differences in dosing, efficacy, and safety of cardiovascular drugs may help reduce the rate of adverse effects.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100787"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422825","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":"\"HIGH AND INFLAMED\" A CURIOUS CASE OF CANNABIS-INDUCED RECURRENT MYOPERICARDITIS","authors":"Sophia Navajas MD","doi":"10.1016/j.ajpc.2024.100751","DOIUrl":"10.1016/j.ajpc.2024.100751","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Case Presentation</h3><div>A 27-year-old male with a history of presumed viral myopericarditis in 2021 presented with chest pain. He was found to have elevated troponin but coronary angiography was normal. On an echocardiogram, he was found to have a moderately thickened pericardium without effusion and a preserved LV systolic function. He was treated with indomethacin, prednisone, and colchicine however his symptoms recurred in 2023. An electrocardiogram (EKG) showed ST-segment elevation in I and aVL, with mild elevation across septal leads V2-V4. Troponin is 1.86, CPK of 206, and CRP of 5.5. A repeat echocardiogram revealed LVEF 55% Without pericardial effusion and no wall motion abnormalities. The patient clinically improved and was discharged on indomethacin 50 mg q8h to decrease dose by 25 mg per week, colchicine 0.6 mg bid for six weeks, and prednisone 40 mg for weeks with gradual taper.</div></div><div><h3>Background</h3><div>The United Nations estimated that around 192 million individuals aged 15 to 64 were using cannabis as of 2016(1). Over time, there has been a global trend towards decriminalizing and legalizing recreational cannabis (1). While the immediate impact of cannabis on heart rate is known to occur within 10 to 30 minutes of consumption (2), its long-term effects on cardiovascular health remain less understood due to regulatory constraints (3).</div><div>Emerging research suggests a potential connection between prolonged cannabis use and increased risk of cardiovascular diseases, although the precise mechanisms are not fully elucidated (4,5). Conditions like pericarditis and myocarditis, both heart inflammations, share similar symptoms and are diagnosed based on clinical observations, lab tests, and imaging.</div></div><div><h3>Conclusions</h3><div>Marijuana use has been linked to severe cardiovascular complications, such as myopericarditis. Therefore, healthcare professionals should maintain a high index of suspicion and routinely inquire about marijuana consumption in patients presenting with chest pain. Moreover, there is an apparent demand for further research to ascertain the most efficacious treatment modalities for myopericarditis induced by marijuana usage.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100751"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EVALUATION OF WEIGHT REDUCTION AND METABOLIC PARAMETERS IN HIV COHORT UNDERGOING TREATMENT WITH GLP-1 RECEPTOR AGONISTS AT A LARGE PUBLIC NYC/HHC+ HOSPITAL IN NEW YORK CITY","authors":"Natalia Nazarenko MD","doi":"10.1016/j.ajpc.2024.100788","DOIUrl":"10.1016/j.ajpc.2024.100788","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Obesity</div></div><div><h3>Background</h3><div>Individuals living with HIV who undergo prolonged combined antiretroviral therapy (cART) may experience weight gain as a potential side effect. Many of these individuals are prescribed GLP-1 receptor agonists (RA), which are recognized for their ability to reduce weight. However, there is uncertainty regarding whether cART could serve as a confounding factor, potentially influencing the effectiveness of GLP-1 RA treatment and impeding the attainment of desired outcomes.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted, reviewing electronic medical records of 239 HIV-positive patients on GLP-1 RA. After applying criteria, 180 patients were analyzed, all on GLP-1 RA for at least 12 weeks. Multivariate logistic regression was used, assessing weight loss, BMI, HbA1c change, and association between weight loss and cART.</div></div><div><h3>Results</h3><div>Out of 180 participants, 51.67% were male and 48.33% were female, with a mean age of 58.2 (SD +/- 11.09). 82% of participants had diabetes mellitus II type (DMT2). The mean duration of GLP-1 RA treatment was 25.38 months (SD +/- 18.5). Semaglutide was used by 50.5%, liraglutide by 4%, and dulaglutide by 45.5%. Weight gain was observed in 29.4%, weight loss under 5 kg in 34.4%, 5-10 kg loss in 15%, and over 10 kg loss in 21.11%. Mean weight reduction was 2.5 kg (SD +/- 12.5), HbA1c reduction was 1.03% (SD +/- 2.3), and BMI reduction was 0.76 (SD +/- 12.4). No significant association was found between GLP duration and weight reduction. Dolutegravir/Lamivudine showed less weight reduction compared to other cART regimens (OR=0.36, CI 0.13 – 0.97, p=0.044).</div></div><div><h3>Conclusions</h3><div>We observed expected positive outcomes linked to GLP-1 RA use, leading to improvements in the metabolic profiles of individuals living with HIV on cART. Further analysis is needed to investigate the relationship between weight and improvements in metabolic parameters with different cART regimens. Additionally, it's important to examine potential sex and racial disparities in response to GLP-1 RA therapy among people living with HIV on cART.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100788"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotyping lipid profiles in type 2 diabetes: Risk association and outcomes from the Cardiovascular Health Study","authors":"David Bleich ,&nbsp;Mary L. Biggs ,&nbsp;Julius M. Gardin ,&nbsp;Mary Lyles ,&nbsp;David S. Siscovick ,&nbsp;Kenneth J. Mukamal","doi":"10.1016/j.ajpc.2024.100725","DOIUrl":"10.1016/j.ajpc.2024.100725","url":null,"abstract":"<div><h3>Aims</h3><p>To determine whether discrete lipid profiles (refer to as lipid phenotyping) can be used to stratify cardiovascular risk in individuals with type 2 diabetes.</p></div><div><h3>Methods and results</h3><p>Cardiovascular Health Study participants with diabetes and fasting lipid profiles at baseline (<em>n</em> = 866) were categorized separately by level of LDL cholesterol and HDL-C/Triglyceride (Tg) profiles (low Tg/high HDL-C; high Tg/low HDL-C; high Tg only or low HDL-C only). We performed Cox multivariate regression analysis to assess the risk of CVD mortality, incident myocardial infarction (MI), heart failure (HF), stroke, and composite MACE (MI, HF, stroke, and CVD mortality) associated with each lipid category. We also calculated risk estimates for MACE using lipid measures as continuous variables. In the fully adjusted model, the high triglyceride plus low HDL-C cholesterol phenotype demonstrated risk that was at least as high as the highest LDL-C sub-group phenotype for CVD mortality (Hazard ratio {HR} 1.58 vs 1.48), MI (HR 1.53 vs 1.58), HF (HR 1.47 vs 1.20), stroke (HR 2.02 vs 1.43), and MACE (HR 1.58 vs 1.38). When modeled continuously, the HR per SD for MACE was 1.12 (<em>p</em> = 0.03) for LDL-C and 1.19–1.20 (<em>p</em> &lt; 0.001) for triglycerides or remnant cholesterol.</p></div><div><h3>Conclusions</h3><p>Participants with the high triglyceride/low HDL-C phenotype had equivalent or higher CVD risk than those with the high LDL-C phenotype. Further studies are necessary to determine whether lipid phenotyping accounts for the substantial CVD risk not explained by LDL cholesterol among individuals with type 2 diabetes.</p></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100725"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266666772400093X/pdfft?md5=34ecc037be6eeb164d07124684c133f3&pid=1-s2.0-S266666772400093X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094638","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":"EARLY METABOLIC IMBALANCE IN YOUNG ADULTS HAS VARIABLE IMPACT ON 35-YEAR MORTALITY RISK","authors":"Teresa J. Yoon BS","doi":"10.1016/j.ajpc.2024.100827","DOIUrl":"10.1016/j.ajpc.2024.100827","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Early metabolic imbalance (EMI) is a hidden condition characterized by compensated insulin resistance, often accompanied by oxidative stress, subclinical inflammation, and hypoxia. Individuals with EMI have fasting glucose, triglycerides, hemoglobin A1c, and high-density lipoprotein cholesterol (HDL-C) values all within normal limits. Thus, EMI is undetected in routine screening for diabetes and cardiovascular risk. Previously, we reported that EMI is an independent risk factor for type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (CVD). <strong>Hypothesis:</strong> EMI in young adults increases the 35-year mortality risk compared with healthy, balanced metabolism.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study. The parent study began in 1985, enrolling 5,113 young adults ages 18-30, with study visits every five years for 35 years. For this retrospective analysis, the baseline exclusion criteria were fasting hyperglycemia, hypertriglyceridemia, low HDL-C, pregnancy, diabetes, or CVD; n=3,292. Cox proportional hazards regression analysis was performed using Stata 18.0 (StataCorp). The primary exposure variable was EMI, measured as the upper and lower halves of baseline homeostatic model assessment of insulin resistance v.2 (HOMA2-IR). The baseline covariates included other known causes of death. The primary outcome was time-to-incident mortality or censor. Mortality risk was measured as a Cox hazard ratio (HR) with 95% confidence interval (CI) and p-value. Each model met the assumption of proportional hazards.</div></div><div><h3>Results</h3><div>Over the 35-year follow-up period, 280 individuals died for a cumulative incidence of 8.5%. Cox Model 1 incorporated categorical HOMA2-IR (high/low) at baseline. Model 2 included the interaction between HOMA2-IR, sex, and race as a categorical variable (Table 1). Model 3 included the interaction variable from Model 2, along with other causes of death as covariates. As seen in Table 1, the Cox hazard ratios for EMI were modified by sex and race.</div></div><div><h3>Conclusions</h3><div>For young adults in CARDIA, EMI had a variable impact on 35-year mortality. The risk was modified by sex and race, even after adjusting for known risk factors. Further analysis is warranted.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100827"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423106","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":"FIRST PRESENTATION OF CARDIOVASCULAR DISEASE IN PREVIOUSLY HEALTHY INDIVIDUALS: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS","authors":"Jonathan Kermanshahchi BA","doi":"10.1016/j.ajpc.2024.100746","DOIUrl":"10.1016/j.ajpc.2024.100746","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>The initial presentation of atherosclerotic cardiovascular disease (ASCVD) may be a severe, sometimes fatal outcome, and there is need for improved understanding and identification of ASCVD in asymptomatic individuals.</div></div><div><h3>Methods</h3><div>Using data from 6,779 participants the Multi-Ethnic Study of Atherosclerosis (MESA) without known cardiovascular disease, we evaluated the association between traditional risk factors and coronary artery calcium (CAC) with first ASCVD event (angina, stroke, myocardial infarction [MI], or death/resuscitated cardiac arrest [RCA]) in cox proportional hazards models.</div></div><div><h3>Results</h3><div>Overall, 1037 participants (15.3%) experienced a first ASCVD event over median follow-up of 15.8 years. The most common first presentation was death/RCA (27.7%). Those with CAC&gt;0 were significantly more likely to present with angina than those with CAC=0 (26.% vs 13.0%, overall p&lt;0.001). Black (35.6%) and Chinese (28.7%) individuals were more likely to present with death/RCA than White individuals (24.8%, overall p=0.011) and Black (25.7%) and Hispanic (29.3%) individuals were more likely to present with stroke than White (21.7%, p&lt;0.001 overall) individuals. Women were more likely to present with death/RCA than men (29.8 vs 26.3%, overall p&lt;0.001). Age, systolic blood pressure, diabetes, and smoking were significantly associated with a first presentation of death/RCA, while female sex and HDL-C were inversely associated. CAC (ln-transformed) was also significantly associated with first presentation of death/RCA (HR 1.15, 95% CI 1.10-1.22) and improved risk prediction when added to the Pooled Cohort Equations (continuous NRI 0.6081, 95% CI 0.4971-0.7141).</div></div><div><h3>Conclusions</h3><div>In previously asymptomatic individuals, the most common initial presentation of ASCVD was death/resuscitated cardiac arrest. In addition to traditional risk factors, CAC was associated with an initial presentation of death/RCA, and improved risk prediction for death/RCA when added to traditional risk factors. These findings suggest CAC scoring may help to identify individuals at risk for death or resuscitated cardiac arrest as a first presentation of ASCVD.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100746"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422718","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}