American journal of preventive cardiology最新文献

{"title":"Beyond identification of familial hypercholesterolemia: Improving downstream visits and treatments in a large health care system","authors":"Harin Lee ,&nbsp;Tarun Kadaru ,&nbsp;Ruth Schneider ,&nbsp;Taylor Triana ,&nbsp;Carol Tujardon ,&nbsp;Colby Ayers ,&nbsp;Mujeeb Basit ,&nbsp;Zahid Ahmad ,&nbsp;Amit Khera","doi":"10.1016/j.ajpc.2025.100937","DOIUrl":"10.1016/j.ajpc.2025.100937","url":null,"abstract":"<div><h3>Objective</h3><div>Familial Hypercholesterolemia (FH) is underdiagnosed and undertreated. Several electronic health record (EHR) algorithms have been developed to improve identification of patients with FH. The approach to improving downstream processes of care and implementation of appropriate treatment after identification of these individuals is unclear.</div></div><div><h3>Methods</h3><div>Individuals at UT Southwestern Medical Center with an LDL-C ≥ 190mg/dL (<em>n</em> = 8368) ever recorded in the EHR were included in an FH registry. As part of a QI program, random individuals from the registry deemed to possibly have FH were contacted via (1) MyChart message, (2) phone call, (3) letter, and/or (4) InBasket message to their PCP to notify them of the potential FH diagnosis, higher risk of ASCVD events, and offering referral to an FH specialist. Participants were contacted 1–4 times by one of these modalities. Chart extraction of contacted patients was performed to determine the type and frequency of contact and downstream visits and interventions. The composite primary outcome of the study included changes to lipid-lowering medications, family screening for FH, and new chart diagnosis of FH.</div></div><div><h3>Results</h3><div>A total of 242 patients from the FH registry were reviewed of which 108 (mean age 55, 69 % women, highest mean LDL-C 267 ± 47 mg/dL) met the inclusion criteria. A total of 180 patient contact attempts were made (mean 1.7 per patient) with most being by MyChart (48 %) and telephone (41 %). Of those contacted, 35 % had a follow-up visit with a PCP and/or a lipid specialist, and 22 % saw any composite change. Patients whose PCP was contacted were more likely to have adjustments made to their lipid lowering medication(s) (<em>p</em> = 0.016), be diagnosed with FH (<em>p</em> = 0.025), and have a follow-up visit (<em>p</em> = 0.033). A greater number of contacts (2.17 vs 1.52, <em>p</em> &lt; 0.001) was also associated with any composite change in outcome.</div></div><div><h3>Conclusions</h3><div>Approximately 1 in 5 individuals in a large healthcare system who were contacted for a recorded LDL-C ≥ 190 mg/dL had a meaningful improvement in the management of severe hypercholesterolemia and diagnosis of FH. Various process factors were associated with a greater change in clinical care. These data highlight the importance of systematic evaluation to enhance interventions to improve the care of individuals with possible FH.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100937"},"PeriodicalIF":4.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349630","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":"Coronary artery calcium in a 20-year-old South Asian patient - pushing the limits of detecting \"early disease\"","authors":"Erfan Tasdighi ,&nbsp;Charlie Brumley ,&nbsp;Aashna Vajramani ,&nbsp;Michael J Blaha ,&nbsp;Anandita Agarwala","doi":"10.1016/j.ajpc.2025.100935","DOIUrl":"10.1016/j.ajpc.2025.100935","url":null,"abstract":"<div><div>Coronary artery calcium (CAC) assessment has long been reserved for intermediate-risk individuals in mid- to older-adult populations. However, a growing body of evidence supports expanding CAC measurement to younger adults who exhibit multiple risk factors or other risk-enhancing features. We describe a case of a very young, 20-year-old, South Asian man with a CAC score of 15.7 Agatston Units. Despite his age and lack of overt symptoms, his CAC score placed him at the 99th percentile for his age and sex, underscoring the limitations of relying solely on traditional risk algorithms. Early CAC detection in such patients has potential for significant clinical impact, allowing timely implementation of intensive lifestyle modification and the most aggressive possible pharmacotherapy for cardiovascular risk reduction.</div><div>Evidence indicates that even minimal CAC in very young individuals can progress exponentially, markedly increasing the risk of future atherosclerotic cardiovascular disease. Nonetheless, current guidelines do not recommend CAC testing in this population, creating a missed opportunity to detect and intervene in high-risk individuals during early adulthood. These observations underscore the need for more precise risk stratification strategies in select high-risk populations. Incorporating CAC measurements into care for young, high-risk individuals—alongside newer tools such as polygenic risk scores and low-radiation coronary CT angiography—could revolutionize preventive cardiology. Further research is needed to refine the cost-effectiveness and implementation strategies for early CAC measurement, develop more inclusive guidelines, and ensure a specialized workforce capable of delivering comprehensive preventive care.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100935"},"PeriodicalIF":4.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101168","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":"Elevated plasma trimethyllysine is associated with incident atrial fibrillation","authors":"Mads M Svenningsson ,&nbsp;Gard FT Svingen ,&nbsp;Per M Ueland ,&nbsp;Gerhard Sulo ,&nbsp;Espen Ø Bjørnestad ,&nbsp;Eva R Pedersen ,&nbsp;Indu Dhar ,&nbsp;Dennis W. Nilsen ,&nbsp;Ottar Nygård","doi":"10.1016/j.ajpc.2025.100932","DOIUrl":"10.1016/j.ajpc.2025.100932","url":null,"abstract":"<div><h3>Background/Aim</h3><div>Trimethyllysine (TML) is a methylated amino acid, which is linked to epigenetic regulation and can serve as a precursor of trimethylamine-N-oxide (TMAO). TMAO is a microbiota-derived metabolite and a potential risk factor of cardiovascular disease. TML has recently been linked to atherosclerosis, acute myocardial infarction and prevalent atrial fibrillation (AF). However, any association between circulating TML and incident AF has not yet been reported and was the aim of the current study in a large community based cohort.</div></div><div><h3>Methods</h3><div>Information regarding AF was obtained by linking patient data to national health registries. Risk associations were explored by logistic regression. Potential improvements in risk reclassification were calculated by the continuous net reclassification index (NRI˃0) and the Receiver Operating Curve Area Under the Curve (ROC-AUC).</div></div><div><h3>Results</h3><div>At baseline 3117 patients were included. During a median (25th-75th percentile) follow-up of 10.8 (9.4 – 11.2) years, 492 patients (15.8 %) developed AF. Higher plasma TML was associated with incident AF per 1 SD log-transformed TML (OR (95 % CI) 1.30 (1.16–1.46) <em>P</em> &lt; 0.01). Further analyses also showed an increase in NRI&gt;0 (95 % CI) of 0.24 (0.14–0.33) <em>P</em> &lt; 0.001 and ROC-AUC (95 % CI) of 0.013 (0.004–0.022) <em>P</em> = 0.006.</div></div><div><h3>Conclusion</h3><div>TML was associated with, and improved risk classification of, new-onset AF in this large cohort of community dwelling adults. Our results motivate further studies on the association between TML and cardiac arrhythmias.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100932"},"PeriodicalIF":4.3,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101198","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":"Biomarkers of residual risk and all-cause mortality after acute coronary syndrome.","authors":"Anna Toso ,&nbsp;Mario Leoncini ,&nbsp;Mauro Maioli ,&nbsp;Simona Villani ,&nbsp;Francesco Bellandi","doi":"10.1016/j.ajpc.2025.100934","DOIUrl":"10.1016/j.ajpc.2025.100934","url":null,"abstract":"<div><h3>Background</h3><div>Adverse cardiovascular events often recur after acute coronary syndrome (ACS), despite secondary prevention measures. Residual risk involves various inflammatory, metabolic and renal factors as well as lipid and thrombotic processes. This cohort study investigates the relationship between four risk biomarkers at 1 month after ACS and all-cause death within 3 years in patients treated with early invasive strategy and high-intensity statins from admission.</div></div><div><h3>Methods</h3><div>Levels of residual risk for the biomarkers were: low-density lipoprotein cholesterol (LDL-C) ≥ 70 mg/dl; high-sensitivity C reactive protein (hs-CRP) ≥ 2 mg/l; glycosylated hemoglobin (HbA1c) ≥ 7% in diabetic and ≥ 5.7% in non-diabetic patients; decrease in estimated glomerular filtration rate (eGFR) ≥ 25% compared to baseline. The association between the four biomarkers and all-cause death within 3 years was evaluated with Cox proportional analysis.</div></div><div><h3>Results</h3><div>This study included 1099 patients (68±12 years; 70.3% males). At 1 month the majority of patients had levels of LDL-C, hs-CRP and/or HbA1c above the risk cut-points, and only 7% of cases presented reduced eGFR. Reduced eGFR and hs-CRP ≥ 2 mg/l at 1 month were the sole independent biomarker predictors of 3-year mortality (adjusted hazard ratios 3.03 and 2.66, respectively).</div></div><div><h3>Conclusions</h3><div>In this population on high-intensity statin therapy only hsCRP and eGFR were independently associated with medium-term mortality. Diversification of secondary preventive measures based on routine evaluations of inflammation and kidney function markers, not only LDL-C, could lead to better targeted reduction of residual risk after ACS.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100934"},"PeriodicalIF":4.3,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082388","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":"Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative study","authors":"Ming-Li Chen ,&nbsp;Jin Li ,&nbsp;Kruthika R. Iyer ,&nbsp;Catherine Tcheandjieu ,&nbsp;Shirin Jimenez ,&nbsp;Elias Levy Itshak Salfati ,&nbsp;Liana C. Del Gobbo ,&nbsp;Marcia L Stefanick ,&nbsp;Manisha Desai ,&nbsp;Xiaonan Xue ,&nbsp;Themistocles L Assimes","doi":"10.1016/j.ajpc.2025.100931","DOIUrl":"10.1016/j.ajpc.2025.100931","url":null,"abstract":"<div><h3>Background</h3><div>Premorbid health traits that increase the risk of dying at the time of initial presentation of coronary heart disease (CHD) remain poorly characterized.</div></div><div><h3>Methods</h3><div>We followed 148,230 post-menopausal participants in the Women's Health Initiative for a median of 13.3 years. We ascertained the first occurrence of CHD and performed a joint Cox multivariate regression to identify premorbid predictors for a fatal rather than a non-fatal incident event.</div></div><div><h3>Results</h3><div>A total of 10,714 incident CHD events including 513 fatal events accrued during follow up. A five-year increase in age, smoking 5 to 34 cigarettes per day, and a standard deviation (SD) increase in the Cornel voltage product, an electrocardiographic measure highly correlated with left ventricular mass index on echocardiography, each independently increased the relative risk (RR) of dying from one's initial presentation of CHD by 46 % (95 % confidence interval [CI], 35 to 58 %), 30 % (8 to 51 %,), and 17 % (7 to 28 %), respectively. A high level of recreational physical activity (&gt;1200 metabolic equivalent (MET) minutes per week) reduced one's relative risk by 32 % (12 to 49 %). A significant dose-response effect was observed for both physical activity and smoking and the reduction in absolute risk of presenting with fatal CHD associated with a healthy lifestyle was roughly equivalent to the difference in risk observed among women separated in age by approximately 10 years.</div></div><div><h3>Conclusions</h3><div>Modifiable factors affect a post-menopausal woman's risk of dying from her initial presentation of CHD. Our findings may reduce case-fatality risk of CHD by motivating individuals at risk to adopt and/or adhere to established primary prevention strategies.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100931"},"PeriodicalIF":4.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101197","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":"Coronary plaque characteristics quantified by artificial intelligence-enabled plaque analysis: Insights from a multi-ethnic asymptomatic US population","authors":"Guadalupe Flores Tomasino ,&nbsp;Caroline Park ,&nbsp;Kajetan Grodecki ,&nbsp;Jolien Geers ,&nbsp;Donghee Han ,&nbsp;Andrew Lin ,&nbsp;Keiichiro Kuronuma ,&nbsp;Nipun Manral ,&nbsp;Emily Xing ,&nbsp;Heidi Gransar ,&nbsp;Sebastien Cadet ,&nbsp;Alan Rozanski ,&nbsp;Piotr J. Slomka ,&nbsp;Michelle Williams ,&nbsp;Daniel S. Berman ,&nbsp;Damini Dey","doi":"10.1016/j.ajpc.2025.100929","DOIUrl":"10.1016/j.ajpc.2025.100929","url":null,"abstract":"<div><h3>Background</h3><div>Ethnic differences in coronary atherosclerosis remain to be fully elucidated. We aimed to assess quantitative plaque characteristics from coronary CT Angiography (CCTA) in relation to ethnicity and cardiovascular risk factors in a multi-ethnic asymptomatic US population.</div></div><div><h3>Methods</h3><div>This cross-sectional study retrospectively evaluated 388 asymptomatic patients selected from a prospective CCTA registry. A total of 194 patients from ethnic minority groups (Asian, African American, and Hispanic) were matched by age, sex, and cardiovascular risk factors to 194 White patients. Quantitative plaque volumes—including total plaque, non-calcified plaque, low-attenuation non-calcified plaque (&lt;30 Hounsfield Units [HU]), and calcified plaque—were measured using artificial intelligence-enabled software. Pericoronary adipose tissue attenuation (PCAT) was also assessed and reported in Hounsfield Units (HU).</div></div><div><h3>Results</h3><div>The total study population included 388 patients (age 59.9±11.7 years, 68% male), of which 63% had coronary atherosclerosis with total plaque volumes of 149[IQR 50-438] mm³, driven predominantly by non-calcified plaque (122, IQR 27-369) mm³. Men presented higher volumes of all plaque components compared to women (P&lt;0.05). In multivariable analysis adjusted for cardiovascular risk factors, only African American patients were associated with lower total plaque (β=-89.2, P=0.036), calcified (β=-26.1, P=0.015), and non-calcified plaque volumes (β=-62.7, P=0.022). African American patients were also associated with higher PCAT (β=5.8, P&lt;0.001), along with family history of coronary artery disease (β=2.1, P=0.04).</div></div><div><h3>Conclusions</h3><div>Our study showed a uniformly high prevalence of atherosclerosis in this asymptomatic cohort, with lower plaque volumes of all sub-components in women. African American patients were associated with lower quantitative plaque volumes (total, non-calcified and calcified) but with higher PCAT compared to White patients; with no significant differences observed among other ethnic minorities.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100929"},"PeriodicalIF":4.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082403","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":"A strategy to increase identification of patients with Familial Hypercholesterolemia: Application of the Simon Broome lipid criteria in a large-scale retrospective analysis","authors":"James K. Fleming ,&nbsp;Renee M. Sullivan ,&nbsp;David Alfego ,&nbsp;Natalia T. Leach ,&nbsp;Tamara J. Richman ,&nbsp;Jill Rafalko","doi":"10.1016/j.ajpc.2025.100930","DOIUrl":"10.1016/j.ajpc.2025.100930","url":null,"abstract":"<div><h3>Introduction</h3><div>Familial Hypercholesterolemia (FH) is a primarily autosomal dominant condition characterized by markedly elevated low-density lipoprotein-cholesterol (LDL-c) and an increased risk of atherosclerosis and cardiovascular disease (CVD). Though early identification and treatment are crucial to optimizing outcomes, few laboratory strategies exist to detect FH.</div></div><div><h3>Methods</h3><div>All lipid tests for total cholesterol (TC) and LDL-c ordered through a large nation-wide network of medical laboratories in the United States (US) from 2018 - 2022 were retrospectively evaluated using a decision tree algorithm based on Simon Broome lipid criteria. If thresholds were met, results were classified as “possible FH” or as “no lipid evidence of FH” if not met.</div></div><div><h3>Results</h3><div>The review of 121,141,307 lipid panels and associated genetic tests from 58,400,105 patients resulted in 1,843,966 (3.2 %) that were classified as “possible FH”. Overall, the mean TC was higher in females than males, particularly in those ≥16 years. LDL-c in the “no lipid evidence of FH” cohort increased year-over-year; LDL-c was stable or decreased in the “possible FH” cohort. Despite the large number of patients classified with “possible FH”, very few (0.02 %) matched patients had genetic testing.</div></div><div><h3>Conclusion</h3><div>A laboratory-developed algorithm using Simon Broome lipid criteria can help identify patients who may benefit from additional FH evaluation. While critical, testing hyperlipidemic children for FH is grossly underutilized, as is genetic testing for FH. Diagnostic laboratories are uniquely positioned to bring FH to the attention of clinicians, with the goal of earlier diagnosis, cascade testing, and appropriate treatment.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100930"},"PeriodicalIF":4.3,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082383","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":"Effect of glucagon-like peptide-1 receptor agonists on vascular risk factors among adults with type 2 diabetes and established atherosclerotic cardiovascular disease","authors":"Aaron King ,&nbsp;Xi Tan ,&nbsp;Neil Dhopeshwarkar ,&nbsp;Rhonda Bohn ,&nbsp;Katherine Dea ,&nbsp;Charles E. Leonard ,&nbsp;Adam de Havenon","doi":"10.1016/j.ajpc.2024.100922","DOIUrl":"10.1016/j.ajpc.2024.100922","url":null,"abstract":"<div><h3>Introduction</h3><div>Limited data exist on the cardiovascular effectiveness of once-weekly (OW) glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in real-world practice.</div></div><div><h3>Methods</h3><div>We assessed the OW GLP-1 RA effects on vascular risk factors in adults with type 2 diabetes and atherosclerotic cardiovascular disease using data from a large-scale US electronic health record database (index date = first prescription of OW GLP-1 RA). Exploratory analyses were performed on patients newly initiating OW GLP-1 RAs with semaglutide, OW GLP-1 RAs without semaglutide, and semaglutide. Changes in vascular risk factors were evaluated by comparing mean measures between the 12-month pre- and post-index periods. Analyses were conducted for all three cohorts and subpopulations including stratified by tercile of baseline vascular risk factor value.</div></div><div><h3>Results</h3><div>In the final cohorts ([1] OW GLP-1 RA including semaglutide: <em>n</em> = 20,084; [2] OW GLP-1 RA excluding semaglutide: <em>n</em> = 16,894; [3] semaglutide: <em>n</em> = 3,435), significant mean reductions (<em>P</em> &lt; 0.001) were observed from baseline to post-index in hemoglobin A1c (%, [1] -1.1; [2] -1.1; [3] -1.2), low-density lipoprotein cholesterol (mg/dL, [1] -6.4; [2] -6.4; [3] -6.9), total cholesterol (mg/dL, [1] -11.0; [2] -11.1; [3] -10.7), triglycerides (mg/dL, [1] -31.8; [2] -31.4; [3] -33.1), systolic blood pressure (mmHg, [1] -1.5; [2] -1.2; [3] -3.1), body weight (kg, [1] -2.7; [2] -2.4; [3] -4.3) and body mass index (kg/m²; [1] -0.9; [2] -0.8; [3] -1.4). Largest reductions were observed in the top tercile.</div></div><div><h3>Conclusion</h3><div>Our data suggest GLP-1 RAs are associated with significant reductions in key vascular risk factors in real-world practice.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100922"},"PeriodicalIF":4.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of thoracic aortic calcium with incident cardiovascular disease and all-cause mortality across the spectrum of coronary artery calcium burden","authors":"Alexander C. Razavi ,&nbsp;Omar Dzaye ,&nbsp;Miguel Cainzos-Achirica ,&nbsp;Zeina Dardari ,&nbsp;Marly Van Assen ,&nbsp;Arshed A. Quyyumi ,&nbsp;Khurram Nasir ,&nbsp;J. Jeffrey Carr ,&nbsp;Matthew J. Budoff ,&nbsp;Roger S. Blumenthal ,&nbsp;Paolo Raggi ,&nbsp;Carlo N. De Cecco ,&nbsp;Laurence S. Sperling ,&nbsp;Michael J. Blaha ,&nbsp;Seamus P. Whelton","doi":"10.1016/j.ajpc.2024.100916","DOIUrl":"10.1016/j.ajpc.2024.100916","url":null,"abstract":"<div><h3>Background</h3><div>Calcification of the ascending and/or descending thoracic aorta is easily measured via non-contrast cardiac computed tomography (CT), commonly performed for quantification of coronary artery calcium (CAC). We assessed whether thoracic aortic calcium (TAC) further improves long-term cardiovascular disease (CVD) risk stratification beyond CAC alone.</div></div><div><h3>Methods</h3><div>Cardiac CT was performed among 6,783 asymptomatic Multi-Ethnic Study of Atherosclerosis participants at baseline. Cox proportional hazards regression assessed the association of TAC with incident CVD and all-cause mortality over a median follow-up of 17.7 years, adjusting for CVD risk factors and CAC.</div></div><div><h3>Results</h3><div>The mean age was 62.1 years old, 53% were female, and 28% had TAC. Over a median follow-up of 17.7 years, 48% of participants with TAC ≥500 experienced CVD and 72% died. Compared to TAC=0, TAC ≥500 was significantly associated with an increased risk of CVD (HR=1.28, 95% CI: 1.06-1.54) and all-cause mortality (HR=1.44, 95% CI: 1.25–1.65), with the strongest association among persons with CAC=0 (CVD HR=1.79, 95% CI: 1.04–3.07; all-cause mortality HR=1.82, 95% CI: 1.29–2.56). The addition of TAC to traditional risk factors and CAC did not improve CVD discrimination (ΔC-statistic=+0.002, <em>p</em>=0.12), but incrementally improved prediction of all-cause mortality (CVD: ΔC-statistic=+0.002, <em>p</em>=0.02).</div></div><div><h3>Conclusions</h3><div>Participants with TAC ≥500 had a high long-term risk for CVD and all-cause mortality. TAC primarily improved risk stratification among persons with CAC=0.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100916"},"PeriodicalIF":4.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082387","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":"Sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and myocardial infarction undergoing percutaneous coronary intervention: A systematic review and meta-analysis","authors":"Huzaifa Ul Haq Ansari ,&nbsp;Muhammad Ammar Samad ,&nbsp;Eman Mahboob ,&nbsp;Eeshal Zulfiqar ,&nbsp;Shurjeel Uddin Qazi ,&nbsp;Areeba Ahsan ,&nbsp;Mushood Ahmed ,&nbsp;Faizan Ahmed ,&nbsp;Raheel Ahmed ,&nbsp;Shafaqat Ali ,&nbsp;Mahboob Alam ,&nbsp;Jamal S. Rana ,&nbsp;Gregg C. Fonarow","doi":"10.1016/j.ajpc.2024.100927","DOIUrl":"10.1016/j.ajpc.2024.100927","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown benefits in improving cardiovascular (CV) outcomes in patients with heart failure (HF) and may mitigate symptom progression in myocardial infarction (MI). However, their effectiveness in patients with type 2 diabetes and MI undergoing percutaneous coronary intervention (PCI) is unclear.</div></div><div><h3>Methods</h3><div>To identify eligible studies, a comprehensive search of electronic databases, PubMed, Cochrane Library, Scopus and Embase, was conducted from inception until May 2024. Results were presented as risk ratios (RR) and their corresponding 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Our analysis included 8 observational studies comprising 24,229 patients. The results indicated that SGLT2i with PCI was associated with a significantly reduced risk of all-cause death (RR=0.61; 95 % CI=0.54 to 0.68), CV death (RR=0.46; 95 % CI=0.22 to 0.94), major adverse cardiovascular events (RR=0.80;95 % CI: 0.66 to 0.96), HF-related hospitalizations (RR=0.63; 95 % CI=0.44 to 0.90), stroke (RR=0.77; 95 % CI: 0.62 to 0.96) and acute kidney injury (RR=0.46; 95 % CI: 0.25 to 0.84) compared to PCI without SGLT2i use. However, the risk of revascularization remained comparable between the groups.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates that SGLT2i with PCI in patients with type 2 diabetes and MI are associated with improved CV outcomes compared to PCI without SGLT2i use. Randomized controlled trials are required to confirm the improvement in outcomes with SGLT2i therapy combined with PCI in patients with MI and diabetes.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"21 ","pages":"Article 100927"},"PeriodicalIF":4.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11757226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048777","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}