American journal of preventive cardiology最新文献

{"title":"Health disparities; is there progress?","authors":"Clyde W. Yancy ,&nbsp;Heather M. Johnson","doi":"10.1016/j.ajpc.2025.101079","DOIUrl":"10.1016/j.ajpc.2025.101079","url":null,"abstract":"<div><div>The contemporary history of health disparities dates to 1984 with the release of the Heckler Report. The differences in outcomes as a function of race were declared striking and not in keeping with the excellence of American Medicine and with a subsequent call to action that would eliminate health disparities. Forty years later, the gaps have widened. Root causes include economic disparity, social determinants of health and elements of bias, both implicit and explicit. Reframing the challenge and noting the extent to which disparities persist across multiple cohorts is the new call to action.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"24 ","pages":"Article 101079"},"PeriodicalIF":5.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State-of-the-art review: The value of leveraging evidence and data (LEAD) in pediatric screening for familial hypercholesterolemia","authors":"Jonathan N Flyer ,&nbsp;Tomáš Freiberger ,&nbsp;Adam L Ware ,&nbsp;Amy L Peterson","doi":"10.1016/j.ajpc.2025.101262","DOIUrl":"10.1016/j.ajpc.2025.101262","url":null,"abstract":"<div><div>Familial hypercholesterolemia (FH) is a common genetic disorder of lipid metabolism resulting in lifelong elevated levels of low-density lipoprotein cholesterol and early atherosclerotic cardiovascular disease. Although FH can be identified at young ages, it remains frequently undetected, underdiagnosed, and undertreated in the United States and around the world. Despite compelling data to support screening for FH in children, and universal lipid screening guidelines endorsed by the National Heart, Lung and Blood Institute and the American Academy of Pediatrics, screening practices in the United States remain controversial and suboptimal. The Family Heart Foundation launched its LEAD (Leverage Evidence and Data) Pediatric Initiative at the 2024 Family Heart Foundation 10th Annual Global Summit to help understand testing barriers, propose innovative solutions, and integrate improvement science to measure outcomes. Presentations highlighted common challenges with pediatric lipid screening and demonstrated creative process solutions to improve screening prevalence for children. This state-of-the-art review discusses common barriers to pediatric lipid screening, identifies process solutions, and explores innovative practices to increase the frequency of universal pediatric lipid screening.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101262"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144931965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GENETICALLY PREDICTED BLOOD PRESSURE AND RISK OF INCIDENT HYPERTENSION AT 2 TO 7 YEARS POSTPARTUM","authors":"Jan Hemeryck Bsc ,&nbsp;Greenland Philip MD, FAHA, FACC, FESC, FRCP (hon.) ,&nbsp;Vandergrift Nathan PhD ,&nbsp;Grobman William MD, MBA ,&nbsp;Khan Sadiya MD, MSc ,&nbsp;Levine Lisa MD, MSCE ,&nbsp;Carrie Rouse MD ,&nbsp;Janet Catov PHD, MS ,&nbsp;Lauren Theilen MD, MScI ,&nbsp;Bairey-Merz C Noel MD, MACC, FAHA, FESC ,&nbsp;Yee Linn MD, MPH ,&nbsp;Chung Judith MD ,&nbsp;Ezzat Daniel Bsc ,&nbsp;Saade George MD ,&nbsp;Honigberg Michael MD, MPP","doi":"10.1016/j.ajpc.2025.101153","DOIUrl":"10.1016/j.ajpc.2025.101153","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCD/CVD in Women</div></div><div><h3>Background</h3><div>Pregnancy represents a “stress test” that can unmask heightened risk of early onset maternal cardiovascular disease. Hypertensive disorders of pregnancy (HDP; preeclampsia/eclampsia and gestational hypertension) are associated with earlier development of chronic hypertension, which represents a key mediator for future cardiovascular disease. Whether genetic risk for high blood pressure (BP) can stratify risk of new-onset hypertension after pregnancy, beyond other factors such as HDP history and clinical characteristics, is unclear.</div></div><div><h3>Methods</h3><div>The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) is a prospective observational cohort that enrolled nulliparous individuals with singleton pregnancies between 2010-2013 at eight U.S. clinical centers. The present analysis included genotyped uMoM2b participants without pre-gestational chronic hypertension who completed a follow-up assessment at 2-7 years postpartum. Genetic BP risk was calculated using a genome-wide polygenic score and categorized as low (bottom quintile), intermediate (quintiles 2-4) or high (top quintile). The primary outcome was development of stage 1+ hypertension (≥130/80 mmHg or use of antihypertensive medication). Logistic regression tested the association of genetic risk with development of hypertension, adjusted for sociodemographic factors, pre-pregnancy diabetes, first-trimester BP, postpartum body mass index (BMI) and HDP history in the index pregnancy. Key secondary analyses were stratified by HDP history.</div></div><div><h3>Results</h3><div>Among 3,009 participants (mean age 30.8 years, 13.3% with prior HDP), 576 (19.1%) had developed hypertension by 2-7 (mean 3.2) years after delivery. Genetic risk was independently associated with incident hypertension (high vs. low genetic risk: adjusted odds ratio [aOR], 1.58 [95% CI, 1.16-2.15]; P=0.004) and higher follow-up (systolic [+2.90 mmHg; P&lt;0.001] and diastolic BP [+2.72 mmHg; P&lt;0.001]). In stratified analyses, high vs. low genetic risk was associated with incident hypertension in those without prior HDP (aOR 1.82 [95% CI 1.29-2.57]; P&lt;0.001) but not in those with prior HDP (aOR 0.88 [95% CI 0.42-1.81]; P=0.75; Pinteraction = 0.09).</div></div><div><h3>Conclusions</h3><div>Higher BP genetic risk was independently associated with higher risk of developing incident hypertension 2-7 years after delivery in nulliparous individuals with singleton pregnancies but appeared less informative in those with prior HDP, who have higher absolute risk for progression to chronic hypertension.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101153"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPACT OF THE CHOLESTERYL ESTER TRANSFER PROTEIN INHIBITOR, OBICETRAPIB, ON LIPOPROTEIN(A) LEVELS: POOLED DATA FROM PHASE 3 CLINICAL TRIALS","authors":"Andrew Hsieh PharmD ,&nbsp;Stephen J. Nicholls MBBS, PhD ,&nbsp;Kausik K. Ray MD MPHil FMedSci ,&nbsp;Michael Szarek PhD ,&nbsp;Marc Ditmarsch MD ,&nbsp;Douglas Kling MBA ,&nbsp;Adam J. Nelson MBBS, PhD ,&nbsp;Michael Davidson MD ,&nbsp;John JP Kastelein MD, PhD","doi":"10.1016/j.ajpc.2025.101155","DOIUrl":"10.1016/j.ajpc.2025.101155","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Pharmacologic Therapy</div></div><div><h3>Background</h3><div>Increasing evidence implicates lipoprotein(a) [Lp(a)] in atherosclerotic cardiovascular disease (ASCVD) causality, stimulating efforts to develop Lp(a) lowering therapies. While all ASCVD patients require low-density lipoprotein cholesterol (LDL-C) lowering, 50% have Lp(a) levels greater than 50 nmol/L, likely to promote residual risk. Therapies lowering LDL-C and Lp(a) have cardiovascular benefit potential since both are independent risk factors. The highly selective cholesteryl ester transfer protein (CETP) inhibitor, obicetrapib, reduced LDL-C by up to 51%, and raised high-density lipoprotein cholesterol (HDL-C) up to 165% in early trials. Obicetrapib’s impact on Lp(a) levels remains to be fully elucidated.</div></div><div><h3>Methods</h3><div>To investigate obicetrapib’s Lp(a) changes in patients greater than 50 nmol/L at baseline, a pooled analysis was conducted within (1) BROADWAY (obicetrapib and placebo in heterozygous familial hypercholesterolemia (HeFH) or ASCVD patients), (2) BROOKLYN (obicetrapib and placebo in HeFH patients) and (3) TANDEM (fixed dose combination of obicetrapib, ezetimibe, obicetrapib/ezetimibe and placebo in patients with or at high risk of ASCVD) clinical trials. Median differences in placebo-adjusted percentage and absolute LDL-C and Lp(a) changes from baseline to day 84 were determined by Hodges-Lehman analyses.</div></div><div><h3>Results</h3><div>Patients (n=2538) had median LDL-C baseline levels of 92 mg/dL and Lp(a) of 42.7 nmol/L. Obicetrapib produced LDL-C placebo-adjusted reductions by 37.4% and 35.0 mg/dL. Correlation between absolute changes in apoB and LDL-C was r=0.88, however, correlation between absolute change in apoB and Lp(a) was r=0.18. In patients with baseline Lp(a) levels ³50 but below 150 nmol/L, obicetrapib produced 44.8% Lp(a) placebo-adjusted percent reductions and 37.4 nmol/L absolute reductions in Lp(a). While patients with baseline Lp(a) ³150 nmol/L demonstrated lower percentage reduction in Lp(a) with obicetrapib than those with baseline levels between 50 and 150 nmol/L, absolute reduction in Lp(a) was similar in both groups (-33.1 vs. -37.4 nmol/L). (Table).</div></div><div><h3>Conclusions</h3><div>Obicetrapib reduced both LDL-C and Lp(a). Absolute reduction in Lp(a) was similar in patients with mildly elevated Lp(a) levels, who are unlikely to qualify for administration of RNA targeted Lp(a) lowering agents. Combined effects of obicetrapib on both LDL-C and Lp(a) have potential to be an effective approach to lowering cardiovascular risk and is undergoing evaluation in a large cardiovascular outcomes trial.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101155"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FROM BENCH TO BEDSIDE: INVESTIGATING SGLT2 INHIBITORS AS A NOVEL STRATEGY AGAINST CHEMOTHERAPY-INDUCED CARDIOMYOPATHY","authors":"Rade R. Jibawi Rivera BS ,&nbsp;Faris Muaref BS ,&nbsp;Sulaiman Paika BS ,&nbsp;Dr. Kiran C. Patel ,&nbsp;Christopher Gondi PhD","doi":"10.1016/j.ajpc.2025.101142","DOIUrl":"10.1016/j.ajpc.2025.101142","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Therapeutic Area&lt;/h3&gt;&lt;div&gt;Pharmacologic Therapy&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Anthracyclines are essential components of chemotherapeutic regimens for a broad spectrum of malignancies, yet their utility is constrained by cumulative, dose-dependent cardiotoxicity, often culminating in non-ischemic cardiomyopathy and heart failure. The pathogenesis involves oxidative stress, mitochondrial dysfunction, and topoisomerase IIβ–mediated DNA damage in cardiomyocytes. While ACE inhibitors and angiotensin receptor blockers (ARBs) have demonstrated modest cardioprotective effects, the efficacy of newer heart failure therapies remains underexplored. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, endorsed as Class I therapy for heart failure with reduced ejection fraction (HFrEF) per 2022 AHA/ACC/HFSA guidelines, have shown robust cardioprotective effects in large cardiovascular outcomes trials. However, their potential to prevent or attenuate anthracycline-induced cardiotoxicity has not been systematically evaluated. This study aimed to assess preclinical and clinical evidence supporting their use in anthracycline-exposed populations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A systematic review was conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches of major medical databases and clinical trial registries were performed through March 2025. Eligible studies investigated SGLT2 inhibitors, beta-blockers, or ACE inhibitors in adult patients receiving anthracycline-based chemotherapy or in animal models replicating this exposure. Primary outcomes included changes in left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), and incidence of heart failure. Studies involving pre-existing heart failure or non-anthracyclinerelated cardiotoxicity were excluded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Preclinical studies (n=4) consistently demonstrated that SGLT2 inhibitors mitigated cardiomyocyte injury, fibrosis, and oxidative stress, preserving cardiac function in anthracycline-exposed models. In one study, LVEF was significantly higher in animals treated with SGLT2 inhibitors (61.3% ± 11%) versus controls (49.2% ± 8%, p = 0.007). Additional studies corroborated reduced histopathological damage and improved myocardial performance. No clinical trials to date have specifically assessed SGLT2 inhibitors in oncology populations. Nevertheless, major cardiovascular trials (e.g., EMPA-REG OUTCOME, DECLARE-TIMI 58) have demonstrated substantial reductions in heart failure events among non-cancer cohorts. In contrast, ACE inhibitors and beta-blockers have shown variable efficacy during chemotherapy, with inconsistent findings across studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;SGLT2 inhibitors exhibit consistent cardioprotective effects in preclinical models of anthracycline cardiotoxicity and possess well-established efficacy in broader cardiovascular populations. These findings underscore the critical need for ","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101142"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PALISADE: PLOZASIRAN DECREASES THE RISK OF ACUTE PANCREATITIS AND MAY IMPROVE QUALITY OF LIFE IN FAMILIAL CHYLOMICRONEMIA SYNDROME","authors":"Gerald F Watts MD PhD ,&nbsp;Robert A Hegele MD ,&nbsp;Robert S Rosenson MD ,&nbsp;Ira J Goldberg MD ,&nbsp;Antonio Gallo MD PhD ,&nbsp;Ann Mertens MD PhD ,&nbsp;Alexis Baass MD ,&nbsp;Ran Fu PhD ,&nbsp;Ma’an Muhsin MD ,&nbsp;Jennifer Hellawell MD ,&nbsp;Nicholas J Leeper MD ,&nbsp;Daniel Gaudet MD PhD","doi":"10.1016/j.ajpc.2025.101140","DOIUrl":"10.1016/j.ajpc.2025.101140","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD /CVD Risk Reduction</div></div><div><h3>Background</h3><div>FCS causes life-threatening Acute Pancreatitis (AP) and may be due to genetic defects in the enzyme lipoprotein lipase (LPL) which impair the circulatory clearance of chylomicrons (CMs) and triglycerides (TGs). Other clinical manifestations collectively impair QoL. Plozasiran is a siRNA that reduces hepatic apolipoprotein (apo) C-III, thereby effectively lowering extremely high TGs. We describe effects of plozasiran on AP outcomes and QoL in patients with FCS.</div></div><div><h3>Methods</h3><div>PALISADE was a Phase 3 double blind, placebo-controlled trial of 75 adults with FCS (59% were genetically confirmed) on best standard-of-care. Patients were randomized to quarterly dosed plozasiran (25 or 50 mg SC) or placebo for 12 months. TG lowering was the primary endpoint and adjudicated rates of AP were a key (alpha-controlled) secondary endpoint. Qualitative patient reported outcomes on composite measures of QoL, EORTC-QLQ-C30, PAN-26 and EQ-5D-5L were exploratory.</div></div><div><h3>Results</h3><div>Plozasiran lowered median TG levels from &gt;2000 to 544 mg/dL at 12 months (p&lt;0.001), independent of a confirmed FCS genotype. All key secondary endpoints (previously reported) showed significant benefits of plozasiran. Nine AP episodes in 7 patients were positively adjudicated: patients receiving plozasiran achieved an 83% reduction in the risk of developing AP versus placebo, (p&lt;0.03). Placebo patients with AP transitioned to open label treatment, limiting the ability to assess cumulative events. Plozasiran was well-tolerated. Severe and serious events were less common with Plozasiran than placebo.</div><div>AP severity differed: 6 severe and 1 moderate event occurred on placebo vs 1 moderate and 1 mild event on Plozasiran. Placebo patients spent 47 days in the hospital vs 10 days with Plozasiran. More patients in placebo experienced abdominal pain leading to AP.</div><div>Absolute changes in various domain scores of the selected patient reported outcomes correlated with improvements. Most symptom domains improved in the QoL assessments, some with clinically meaningful scores &gt; -10 points, i.e. significant improvements in appetite loss, -15.9, insomnia, -16.8 (p&lt;0.05, both). Functional domain scores improved, some with clinically meaningful scores &gt; +10 points, i.e. improvements in role function, +14.8 and emotional function, +11.8 (p&lt;0.05, both), and health care satisfaction, +14.7. Clinically meaningful improvements were shown for appetite loss, insomnia, cognitive functioning, emotional functioning, and role functioning in the plozasiran treated subjects compared to placebo (nominal p-values of &lt;0.05).</div></div><div><h3>Conclusions</h3><div>Plozasiran significantly reduced TG and AP while improving QoL in the PALISADE trial.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101140"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BENEFITS OF CARDIAC REHABILITATION FOR SECONDARY PREVENTION IN HEART FAILURE: A LITERATURE REVIEW","authors":"Ifunanyachukwu Okwuosa M.D.","doi":"10.1016/j.ajpc.2025.101118","DOIUrl":"10.1016/j.ajpc.2025.101118","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Heart Failure</div></div><div><h3>Background</h3><div>Approximately 6.7 million adults in the U.S. have a diagnosis of heart failure, with a projected prevalence of 11.4 million by 2050. These individuals experience a significant decrease in quality of life and frequent hospitalizations for acute cardiac decompensation. There is also an evident economic burden on the healthcare system due to these high rates of hospitalizations. Cardiac rehabilitation, a multidisciplinary intervention, is well-established for post-coronary revascularization procedures but remains underutilized for heart failure patients. This review evaluates its benefits based on recent U.S. based randomized controlled trials (RCTs).</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted on PubMed to identify relevant RCTs carried out in the US and published in English between January 2020 to February 2025. The search strategy included keywords: “cardiac rehabilitation”, “exercise”, “physical activity”, “heart failure”, “HFrEF”, “HFpEF”, “congestive heart failure”, “chronic heart failure”, and “CHF”. Only studies involving adult patients (≥ 18 years of age) were included. Six studies, which directly measured the effects of cardiac rehab on patients with heart failure, were selected for this literature review.</div></div><div><h3>Results</h3><div>Cardiac rehabilitation significantly improved exercise capacity, peak VO2, leg strength, and quality of life compared to usual care. Reductions in arterial stiffness, myocardial stiffness, and left ventricular mass were observed. Interventions lasted 12 weeks to 1 year, with high-intensity and resistance exercises yielding better outcomes than moderate-intensity workouts. However, no significant difference was found in 6-month rehospitalization or mortality rates.</div></div><div><h3>Conclusions</h3><div>Cardiac rehabilitation enhances exercise tolerance and quality of life in heart failure patients, though mortality and hospitalization rates remain unchanged. Future research should explore its direct economic impact on both patients and the healthcare system and the effectiveness of cardiac rehabilitation across different stages of heart failure. Integrating cardiac rehab referrals into post-discharge and outpatient workflow may optimize heart failure patient outcomes.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101118"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GENDER AFFECTS CARE AND PROGNOSIS IN ACUTE CORONARY SYNDROME","authors":"Csaba Sari CsS ,&nbsp;Christian M. Heesch CMH ,&nbsp;Peter Andreka PA","doi":"10.1016/j.ajpc.2025.101092","DOIUrl":"10.1016/j.ajpc.2025.101092","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCD/CVD in Women</div></div><div><h3>Background</h3><div>This study evaluates possible differences in prognosis in acute coronary syndrome (ACS) based on gender of the patient, analyzing data from the National Myocardial Infarction Register in Hungary. The data include 76,153 ACS patients followed over five years. The study evaluates all-cause mortality, risk factors, and treatment outcomes. All cause mortality was assessed at 30 days, 1 year, and 5 years.</div></div><div><h3>Methods</h3><div>The data set analyzed is the result of mandatory reporting of data on patients presenting with ACS to hospitals in Hungary, in effect from January 2014 on forward. Data on 155,000 encounters involving over 130,000 patients were collected by September 2022. The current study comprises a retrospective analysis of all cases reported to the registry from its date of inception (January 1st, 2014) to 2019. The primary outcome measured was all-cause mortality.</div></div><div><h3>Results</h3><div>The analyzed patient cohort had a median age of 67.4 years, 60% of patients entered were males. Key patient characteristics included a 34% prevalence of diabetes and an 18% history of previous ACS, 44% of the patients presented with ST elevation myocardial infarction (STEMI) during their initial admission, and 77% were admitted directly to hospitals with percutaneous coronary intervention (PCI) capability. There was a 12.1% short-term (30 day), a 21.5% mid-term (one year), and a 37% long-term (five year) all-causemortality rate across the cohort. Both short- term and long-term mortality rates were influenced significantly by age, diabetes, and whether the patient’s ACS presentation was caused by a STEMI versus a non ST elevation myocardial infarction (NSTEMI). Women presented with a less favourable cardiovascular risk profile, characterized by higher rates of diabetes, hypertension, and older age. Men had a higher incidence of prior cardiac interventions, they notably received more timely treatment compared to women, and they were more likely to undergo PCI. Further, women experienced higher rates of complications during treatment and they were less likely to receive guideline consistent drug therapy at discharge.</div></div><div><h3>Conclusions</h3><div>Our results demonstrate gender-related disparities in key parameters relating to presentation, triaging, and treatment modality chosen in patients presenting with ACS. Physiological gender related patient differences alone cannot explain these disparities. We believe that unconscious bias and knowledge deficits regarding the more diverse and atypical presentation patterns of female ACS patients likely affect decision makers at all levels (patients themselves, physicians, and allied health professionals). Such unconscious bias and knowledge deficits should be the target of educational campaigns directed at the public and at health care professionals.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101092"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PROGNOSTIC VALUE OF HIGH-SENSITIVITY C-REACTIVE PROTEIN (HS-CRP) IN PREDICTING FUTURE CARDIOVASCULAR EVENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS","authors":"Moiuz Chaudhri MD ,&nbsp;Ahmed Al Mahrizi BS ,&nbsp;Barira Haroon BS ,&nbsp;Michael Acevedo BS ,&nbsp;Arjun Ramachandran BS ,&nbsp;Laith Rahabneh MD ,&nbsp;Ambica Nair MD ,&nbsp;Christian Kaunzinger MD ,&nbsp;Arthur Okere MD","doi":"10.1016/j.ajpc.2025.101166","DOIUrl":"10.1016/j.ajpc.2025.101166","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>Inflammation plays a central role in atherosclerosis and cardiovascular events. High-sensitivity C-reactive protein (hs-CRP), a ubiquitous biomarker of systemic inflammation, has come to the attention of preventive cardiologists for its ability to enhance cardiovascular risk prediction beyond established risk factors. But its prognostic significance in heterogeneous populations and study designs is uncertain. To fill this gap, we performed a systematic review and meta-analysis to investigate association between a high hs-CRP level and subsequently increased risk for future cardiovascular events in adults.</div></div><div><h3>Methods</h3><div>This study adhered to the PRISMA 2020 statement and was registered in PROSPERO (CRD42025638183). A systematic search of studies from 2013 to 2023 yielded 3,644 articles; after 248 duplicates were removed, data were extracted from full-text reviews of 30. Four studies (n=6816) met inclusion criteria for quantitative analysis. We included studies that reported odds ratios (OR) with confidence intervals (CIs) for the association between elevated hs-CRP and cardiovascular events. We performed a random-effects meta-analysis to derive pooled effect estimates.</div></div><div><h3>Results</h3><div>They included four studies with 6,816 subjects. Elevated hs-CRP levels predicted subsequent cardiovascular events (OR: 1.99, 95% CI: 1.36–2.94, p = 0.0004). Moderate heterogeneity was found (I² = 66.1%, p = 0.0315). The individual study ORs ranged from 1.50 to 4.50 and were all statistically significant. Outcomes were asymptomatic carotid stenosis, aortic atherosclerosis, ischemic stroke, and restenosis after coronary angioplasty.</div></div><div><h3>Conclusions</h3><div>High hs-CRP is an independent risk factor for cardiovascular events, with those affected being almost twice as likely to suffer them. These findings solidify its role as an adjunct biomarker in preventive cardiology. Larger and more homogenous studies are needed to improve the risk prediction models including inflammation, as the traits of inflammation may vary in different populations.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101166"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ENHANCING CDC AND EPA HEATRISK AND AIR QUALITY RISK RECOMMENDATIONS: A NARRATIVE REVIEW AND ACTION ALGORITHM FOR CARDIAC PATIENTS","authors":"Elizabeth Beveridge BS ,&nbsp;Jose Ramon Medina Inojosa M.D, MSc ,&nbsp;Rebecca Philipsborn M.D, MPA ,&nbsp;Zachary T. Martin PhD ,&nbsp;Riya Goel B.S ,&nbsp;Laurence Sperling M.D.","doi":"10.1016/j.ajpc.2025.101145","DOIUrl":"10.1016/j.ajpc.2025.101145","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>Cardiovascular disease (CVD) remains the leading cause of mortality worldwide. As its prevalence continues to rise, so does the severity of climate change. The increasing number of days with extreme heat and poor air quality exacerbates cardiovascular outcomes, particularly for individuals with preexisting CVD. While the Centers for Disease Control and Prevention (CDC) and Environmental Protection Agency (EPA) recommend using HeatRisk and the Air Quality Index (AQI) to assess environmental safety, no specific guidelines exist for patients with preexisting CVD, despite their heightened risk. This narrative review addresses this gap by summarizing current data and evaluating how HeatRisk and AQI should be applied to this vulnerable population.</div></div><div><h3>Methods</h3><div>A literature review was conducted using PubMed and snowballing, focusing on studies published between 2000 and 2025 that examined physiological effects of heat and poor air quality on cardiovascular outcomes. Risk factors, including pregnancy, obesity, geography, and socioeconomic status, were considered, along with existing guidelines from the CDC, EPA, and National Weather Service.</div></div><div><h3>Results</h3><div>Extreme heat and poor air quality were linked to increased mortality and morbidity in patients with a history of heart failure, ischemic heart disease, stroke, or myocardial infarction. High-risk subgroups identified included women, older adults, residents of warmer climates, individuals with preexisting arrythmias, individuals taking certain medications, pregnant individuals, and those from lower socioeconomic backgrounds. Furthermore, extreme heat and poor air quality exacerbated cardiometabolic risk factors such as hypertension, insulin resistance, and atherosclerosis.</div></div><div><h3>Conclusions</h3><div>Physicians should educate patients with CVD about the risks associated with extreme heat and poor air quality. Based on this literature review, individuals with ischemic heart disease, heart failure, a history of past stroke or myocardial infarction, or a calculated risk score greater than three should take precautions when the HeatRisk reaches Level 1 (Yellow) and/or the AQI is ≥ 50 (Figure 1). Individuals with a calculated risk score of one or two should consider precautions when HeatRisk reaches Level 2 (Orange) and/or AQI is ≥ 100 (Figure 1).</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101145"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}