American journal of preventive cardiology最新文献

{"title":"BENEATH THE SURFACE: EXPLORING A CASE OF LEFT CIRCUMFLEX ARTERY DISSECTION","authors":"","doi":"10.1016/j.ajpc.2024.100820","DOIUrl":"10.1016/j.ajpc.2024.100820","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Other: Non Atherosclerotic Acute Coronary Syndromes ( Spontaneous Coronary Artery Disease)</div></div><div><h3>Case Presentation</h3><div>A 53-year-old woman with a history of hypertension was initially discharged after an NSTEMI and left heart cath showing spontaneous coronary artery dissection (SCAD) in the left circumflex artery. She returned to the ER three days later with chest pain. Despite initial plans for discharge with aggressive BP management using a nitro drip, her rising troponin levels necessitated overnight observation. Further cardiac cath revealed extensive SCAD (originating in the distal left main, extending into the circumflex, and terminating in the left PDA, as well as the obtuse marginal branch), worsening from the last angiogram done a week ago, likely due to uncontrolled hypertension. She was admitted to the ICU for 48 hours for heparin therapy and strict BP control, and was later discharged with instructions for close outpatient cardiology follow-up.</div></div><div><h3>Background</h3><div>SCAD emerges as an increasingly acknowledged etiology behind non-atherosclerotic acute coronary syndromes. SCAD is implicated in 0.1% to 0.4% of all acute coronary syndrome (ACS) occurrences and is re-sponsible for about 25% of ACS instances in women under 50 and less commonly in men ( less than 15% of instances affect men). Risk factors include female sex, pregnancy, fibromuscular dysplasia, and associations with genetic connective tissue disorders such as Marfan and Ehlers-Danlos syndromes. It most commonly occurs in the LAD artery. In 46 to 61% of instances, the diagonal and septal branches are also in-volved; 15 to 45% of cases involve the circumflex, ramus, and marginal branches. Affecting several coronary branches is uncommon, but may occur in 9 to 23% of patients. Diagnosis predominantly relies on coronary angiography, which identifies the false lumen and intramural hematoma resulting from intimal disruption and vasa vasorum bleeding. Treatment is primarily medical for cases without progression, hemodynamic instability, or significant myocardial involvement, utilizing aspirin, plavix, ACE inhibitors, beta blockers, and heparin. Refractory cases may necessitate interventional strategies like stenting, angioplasty, coronary artery bypass grafting (CABG), or percutaneous transluminal coronary angioplasty). Reoccurrence from HTN occurs in 10 to 30% of patients.</div></div><div><h3>Conclusions</h3><div>SCAD is becoming recognized as the cause of acute myocardial infarction, particularly in young female patients with low cardiovascular risks.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423108","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":"LIPOPROTEIN(A) AND APOLIPOPROTEIN B ARE RELATED TO AORTIC STENOSIS: RESULTS FROM THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL) AND ECHOCARDIOGRAPHIC STUDY OF LATINOS (ECHO-SOL)","authors":"","doi":"10.1016/j.ajpc.2024.100823","DOIUrl":"10.1016/j.ajpc.2024.100823","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Heart Failure</div></div><div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] and Apolipoprotein B [apoB] have been previously studied as risk factors of calcific aortic valve disease primarily among non-Hispanic/Latino populations. However, the association between apoB and calcific aortic stenosis (AS) is not as well known.</div></div><div><h3>Methods</h3><div>Data from 8,564 community-dwelling Hispanics/Latinos with echocardiograms performed at Visit 2 (HCHS/SOL, 2014-2017 and Echo-SOL, 2015-2018) were analyzed. These participants had Lp(a) levels (nmol/L) and apoB levels (mg/dL) measured at HCHS/SOL Visit 1 (2008 to 2011). Pearson correlation coefficient (r), linear and logistic regression models were used to study the association of Lp(a) and apoB with the following outcomes: 1. Aortic valve peak velocity (AVPV), cm/s; 2. Aortic valve peak pressure gradient (AVPPG), mmHg, and 3. Aortic stenosis, defined as AVPV ≥ 300 cm/s for moderate or severe AS. AVPV ≤ 100 cm/s was considered normal and used as a reference value for AS. Lp(a) and apoB were modeled as continuous variables. Sampling weights and surveys methods were used to account for HCHS/SOL complex design.</div></div><div><h3>Results</h3><div>Overall, the mean (SE) age was 58.4 (0.2) years, and 53.6% were female. Their baseline median IQR (Q1-Q3) Lp(a) and apoB levels were 22.5 (8.1-66.6) nmol/L and 105.1 (88.7-122.9) mg/dL, respectively. HCHS/SOL overall baseline median IQR (Q1-Q3) Lp(a) was 19.7 (7.3-60.6) nmol/L and apoB was 96.7 (79.4-116.0) mg/dL, respectively. Table 1: Higher baseline Lp(a) levels were significantly associated with worsened AVPV and AVPPG at Visit 2. Higher apoB levels were associated with worsened AVPV and AVPPG. Compared to normal AVPV values, using 10-unit increments, increasing Lp(a) levels were associated with increased risk of moderate or severe AS (ORLp(a) 1.10 (95% CI, 1.06-1.14), p&lt;0.0001); and increasing apoB levels were associated with mild AS or Aortic Sclerosis (ORapoB1.032 (95% CI, 1.002-1.063), p&lt;0.04).</div></div><div><h3>Conclusions</h3><div>Lp(a) and apoB are significantly associated with AVPV and AVPPG and are significant predictors of AS; suggesting these markers may be potentially modifiable risk factors for calcific aortic valvular disease among Hispanic/Latinos.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422708","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 BETWEEN DIETARY QUALITY AND SUBCLINICAL MYOCARDIAL INJURY IN NHANES III STUDY","authors":"","doi":"10.1016/j.ajpc.2024.100790","DOIUrl":"10.1016/j.ajpc.2024.100790","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD /CVD Risk Reduction</div></div><div><h3>Background</h3><div>Adherence to a high-quality diet is linked to a lower risk of clinical cardiovascular disease (CVD), however, the relationship between dietary quality and subclinical myocardial injury (SCMI) on electrocardiogram (ECG) is understudied.</div></div><div><h3>Methods</h3><div>This analysis included 6580 participants without CVD who underwent ECG in the Third United States National Health and Nutrition Examination Survey (NHANES III) conducted between 1988 and 1994. Relying on 24-hour dietary recall interviews, Dietary quality was assessed using the Healthy Eating Index (HEI). We excluded participants with missing ECG data or HEI scores. The HEI scores (ranging 0-100), were calculated, with a higher score indicating better diet quality. The overall HEI score comprised scores for the consumption of grains, fruits, vegetables, meats, dairy, total fat, saturated fat, cholesterol, sodium, and dietary variety. Participants were classified into tertiles based on both their overall HEI scores and the scores of each of the 10 individual HEI components. Tertile 3 denoted the highest HEI score, while tertile 1 represented the lowest. SCMI was defined as a cardiac infarction/injury score ≥10 on ECG. The cross‐sectional relationship between HEI scores and SCMI was assessed using multivariate logistic regression models.</div></div><div><h3>Results</h3><div>The prevalence of SCMI in tertile 3, tertile 2 and tertile 1 was 543 (24.7%), 570 (26.0%) and 609 (27.8%), respectively (p value = 0.063). When compared to participants in tertile 3, those in tertile 1 had a 1.29-fold higher odds of SCMI. Similarly, among the individual dietary quality components, participants in tertile 1, compared to those in tertile 3, had 1.19-fold higher odds of SCMI for fruit intake, 1.15-fold higher odds for fat intake, and 1.22-fold higher odds for dietary variety (Table).</div></div><div><h3>Conclusions</h3><div>In the NHANES III study, there was a significant association between low HEI scores and higher odds of SCMI. These results underscore the potential benefit of maintaining a high-quality dietary intake in preventing subclinical CVD.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422836","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 BETWEEN RURALITY AND SUBCLINICAL MYOCARDIAL INJURY","authors":"","doi":"10.1016/j.ajpc.2024.100760","DOIUrl":"10.1016/j.ajpc.2024.100760","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Living in a rural setting has been linked to cardiovascular disease (CVD) morbidity and mortality. However, the association between rurality and subclinical myocardial injury (SC-MI) has not previously been studied.</div></div><div><h3>Methods</h3><div>This cross-sectional analysis was restricted to adult participants without baseline CVD (myocardial infarction, heart failure, or stroke), who underwent 12-lead electrocardiogram (ECG) recording in the Third National Health and Nutritional Examination Survey (NHANES III), 1988 to 1994. Rurality classification was based on the U.S Department of Agriculture (USDA) rural-urban continuum codes. SC-MI was defined as a cardiac infarction/injury score ≥10 on ECG. Using multivariate logistic regression, we examined the association between rurality and SC-MI.</div></div><div><h3>Results</h3><div>This analysis included 6,805 (age 59.1±13.4 years, 52.3% female, 49.8% White) participants, of whom 3,666 (53.9%) lived in rural areas. Compared to participants living in urban areas, those living in rural areas had a higher prevalence of SC-MI (28.6% vs. 23.4%; p-value &lt;0.0001). In the multivariable logistic regression model, rural residence, relative to urban residency, was associated with 21% (p&lt;0.001) higher odds of SC-MI (Table). These associations were consistent in subgroups stratified by demographics and CVD risk factors.</div></div><div><h3>Conclusions</h3><div>Those living in rural areas had a higher likelihood of subclinical myocardial injury suggesting that rurality is not only associated with clinical CVD, but also subclinical forms of the disease.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422754","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":"UNEXPLAINED LOW VOLTAGE PRECORDIAL QRS ON ECG IN ASYMPTOMATIC SUBJECTS SHOULD NOT BE DISMISSED WITHOUT FURTHER INVESTIGATION FOR ABNORMAL CARDIOVASCULAR RISK BIOMARKERS SUCH AS BNP, CRP, MICROALBUMIN AND/OR EPICARDIAL FAT VOLUME","authors":"","doi":"10.1016/j.ajpc.2024.100773","DOIUrl":"10.1016/j.ajpc.2024.100773","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Novel Biomarkers</div></div><div><h3>Background</h3><div>Low voltage QRS in precordial leads in asymptomatic subjects has been reported to be associated with increased epicardial fat volume which is a novel cardiovascular risk marker.</div><div>Purpose of this study is to examine the prevalence of abnormal cardiovascular risk biomarkers such as BNP, CRP and/or microalbumin in asymptomatic subjects with low voltage QRS complexes in precordial leads on ECG and elevated epicardial fat volume.</div></div><div><h3>Methods</h3><div>330 asymptomatic obese subjects were screened for cardiovascular risk assessment using the Early Cardiovascular Disease Risk Scoring System (ESCVDRS) known as Rasmussen Risk Score (RRS), previously reported. The ESCVDRS includes 7 vascular and 3 cardiac tests. Among the additional test, CRP, proBNP, microalbumin were also measured. Coronary calcium score and epicardial fat volume was measured utilizing cardiac CT Siemens Somatom Definition Dual source CT scanner 64x2. Out of the 330 subjects, 55 subjects with average age 68, also underwent measurement of epicardial fat volume on CT utilizing same and similar forms definition 64 x 2. Waist circumference was also measured. The 55 subjects were divided in 2 groups: Group A, 33 subject with cardio-obesity and low precordial QRS voltage on ECG; Group B, 22 subjects with normal epicardial fat volume and normal ECG.</div></div><div><h3>Results</h3><div>Results are shown in the table below. As seen, Group A had a significant abnormal biomarker, including BNP, CRP and microalbumin as compared with Group B.</div></div><div><h3>Conclusions</h3><div><ul><li><span>(1)</span><span><div>Unexplained low voltage QRS in precordial leads in asymptomatic subjects should not be dismissed as normal without further evaluation for cardiovascular biomarkers to rule out significant early subclinical cardiovascular disease risk.</div></span></li><li><span>(2)</span><span><div>Low Precordial QRS voltage on ECG in the absence of other known causes may be indicative of excess epicardial fat volume which is significant CV disease risk marker and must be treated.</div></span></li></ul></div><div>1 ounce of early cardiovascular disease prevention is better than pounds of late treatment.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423102","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":"ASPCCongress2025_SaveTheDate","authors":"","doi":"10.1016/S2666-6677(24)00232-0","DOIUrl":"10.1016/S2666-6677(24)00232-0","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666667724002320/pdfft?md5=b07b8bf38d93949043f6742d5932f78a&pid=1-s2.0-S2666667724002320-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270754","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":"COMPARISON OF AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH AUTONOMIC DYSFUNCTION VS PATIENTS WITHOUT AUTONOMIC DYSFUNCTION","authors":"","doi":"10.1016/j.ajpc.2024.100784","DOIUrl":"10.1016/j.ajpc.2024.100784","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research</div></div><div><h3>Background</h3><div>Blood pressure (BP) patterns in patients with autonomic dysfunction (AD), particularly those with postural orthostatic tachycardia syndrome (POTS), remain an area of limited understanding. Utility in ambulatory blood pressure monitoring (ABPM) among patients with various forms of AD compared to patients without a diagnosis of AD remains unknown.</div></div><div><h3>Methods</h3><div>Patients referred for ABPM between 1/2019 and 7/2023 for a diagnosis AD with POTS, AD / Orthostatic Intolerance (OI) without POTS, or no AD were reviewed. Patient characteristics and ABPM data were analyzed. Statistical analysis was completed through test of trends. The primary outcome was to compare the incidence of uncontrolled 24-hour BP between patients with AD with POTS to those with AD/OI but without POTS and to those without AD. As a secondary outcome, nocturnal dipping status was assessed.</div></div><div><h3>Results</h3><div>A total of 243 patients were assessed and 62 (25.5%) had a diagnosis of AD, of which 37 (15.2%) had a diagnosis of POTS. Patients with POTS were predominantly female, younger, and of white ethnicity (Table). ABPM data revealed that 81% of patients with POTS and 73% of patients without AD maintained controlled BP over 24 hours, in contrast to just 24% of those with AD/OI but without POTS (p &lt; 0.001). The mean 24-hour SBP for patients with AD with POTS (117.7 mmHg) and patients without AD (131.3 mmHg) were within normal values, in contrast to the 137.1 mmHg observed in those with AD/OI without POTS (p &lt; 0.001). Abnormal dipping status was prevalent in 51% of the AD with POTS cohort, 68% of the AD/OI without POTS cohort, and 56% of the without AD cohort. Nocturnal non-dipping was prevalent in 46% of the AD with POTS cohort, 36% of the AD/OI without POTS cohort, and 37% of the without AD cohort.</div></div><div><h3>Conclusions</h3><div>Most patients with AD with POTS, and those without AD, demonstrate normal 24-hour BP readings on ABPM. However, ABPM detected a high incidence of uncontrolled 24-hr BP readings in patients with AD or Orthostatic Intolerance without POTS, prompting discussion of valuable utility of this test in this cohort.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422822","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":"ANGIOGRAPHIC FINDINGS IN SYMPTOMATIC PATIENTS WITH EVIDENCE OF ISCHEMIA BY PET/CT PERFUSION IMAGING BUT WITH ZERO CORONARY ARTERY CALCIUM","authors":"","doi":"10.1016/j.ajpc.2024.100817","DOIUrl":"10.1016/j.ajpc.2024.100817","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>Coronary artery calcium (CAC) is a strong, incremental predictor of coronary artery disease (CAD) risk. In contrast, the absence of CAC portends a low but not zero risk, which has been ascribed to non-calcified, “soft” plaques. However, other pathologies in CAC=0 patients (pts) are possible, including spontaneous coronary artery dissection, microvascular disease, coronary anomalies, etc. We sought to determine the spectrum and frequency of angiographic findings in symptomatic pts with ischemia on stress PET/CT who had zero CAC.</div></div><div><h3>Methods</h3><div>The Intermountain nuclear medicine and hospital electronic medical record databases were searched for CAC=0 pts undergoing stress positron emission tomography (PET/CT) between 2/1/2014 and 7/1/2022. We defined PET abnormality with ischemic burden (IB) &gt;=10% as definite, IB &gt;0&lt;10% as equivocal, and IB=0 as normal. We defined severe and moderate CAD as &gt;=70% and 50-69% stenosis, respectively. Pts were followed for coronary interventions and major adverse cardiovascular events (MACE) over 1.1 +/- 0.9 y.</div></div><div><h3>Results</h3><div>Of 59,639 total PET/CT studies, 4284 (7.2%) had CAC=0 and no prior history of CAD. Of these, 28 with adequate quality PET (0.65%) had IB &gt;=10% (NPV 99.3%). Table 1 summarizes demographics across IB categories. Coronary angiography (n=21) or coronary CT angiography (n=5) was performed within &lt;90 days in 25 (89%) of IB&gt;=10% pts (Table 2). Severe CAD was present in 11, moderate in 1, mild in 4, and none in 9. Thus, 14 (56%) with positive PET (IB&gt;=10%) of 25 angiographic cases were not explained by severe CAD, suggesting possible microvascular dysfunction. Revascularization was indicated in only 10 (PCI in 6, CABG in 4) of the 28 IB&gt;=10% pts (35.7% of IB&gt;=10%, 0.23% of CAC=0 pts); follow-up MACE occurred in 2 (7%) with IB&gt;=10% (repeat revascularizations) vs 1.6% of others (p=NS).</div></div><div><h3>Conclusions</h3><div>In this large stress PET/CT experience, IB &gt;=10% in pts with CAC=0 was rare. The majority were not explained by obstructive CAD. However, given the rare possibility of severe CAD or other pathologies, such as microvascular angina, a zero CAC score should be interpreted in the context of clinical judgement in deciding whether to proceed with additional testing such as stress PET.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423111","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":"AWARENESS AND REFERRAL RATES OF CARDIAC REHABILITATION AMONG INTERNAL MEDICINE RESIDENTS IN A COMMUNITY SETTING: A MULTICENTER ANALYSIS","authors":"","doi":"10.1016/j.ajpc.2024.100774","DOIUrl":"10.1016/j.ajpc.2024.100774","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Rehabilitation</div></div><div><h3>Background</h3><div>In the United States, The Centers for Medicare &amp; Medicaid Services and most insurers authorize coverage for Cardiac Rehabilitation (CR) services for patients with stable chronic HF with LVEF ≤35% and NYHA functional class II to IV symptoms despite six weeks of treatment with optimal HF therapy. CR has a Class 1 Recommendation in the current American College of Cardiology/American Heart Association guideline for managing HF. Community hospitals deal with most of the above two indications, and little data exists about the referral processes in such places.</div></div><div><h3>Methods</h3><div>A questionnaire regarding cardiac rehabilitation, inquiring about internal medicine residents' awareness of indications, components, outcomes, and referral practices, was sent to 5 different community-based institutions. The information was collected anonymously and later analyzed in statistical software.</div></div><div><h3>Results</h3><div>Out of 136 residents, there was more or less equal distribution among the 3 PGY years, with the majority responding of having a cardiac catheterization lab and acknowledging recurrent heart failure admissions to their institutions. Varied responses were received regarding cardiac rehab availability at respective institutions. Surprisingly, despite somewhat adequate knowledge regarding cardiac rehabilitation's indications, components, and outcomes, only 28.68 % acknowledged routine CR referral. Referral rates increased with increasing training years. Further trends are seen in Table 1, Table 2, and Table 3.</div></div><div><h3>Conclusions</h3><div>Despite numerous studies highlighting the importance of physician referrals for cardiac rehabilitation enrollment, there is limited data on internal medicine residents' knowledge and referral practices. This is pivotal as they often manage a significant portion of patients with acute coronary syndromes and heart failure exacerbations in a community setting. Further research is needed to uncover disparities and improve cardiac rehabilitation utilization in community-based healthcare settings.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422903","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":"PEGOZAFERMIN DEMONSTRATED ROBUST HISTOLOGIC IMPROVEMENT AND BENEFIT IN HEPATIC AND METABOLIC BIOMARKERS IN A 48-WEEK MULTI-CENTER, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED PHASE 2B TRIAL (ENLIVEN)","authors":"","doi":"10.1016/j.ajpc.2024.100807","DOIUrl":"10.1016/j.ajpc.2024.100807","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Pharmacologic Therapy</div></div><div><h3>Background</h3><div>Metabolic dysfunction-associated steatohepatitis (MASH) is often associated with metabolic disorders such as obesity, metabolic syndrome, and/or diabetes. FGF21 analogs such as pegozafermin (PGZ) have direct effects on liver fibrosis as well as additional hepatic and extrahepatic benefits in patients with MASH. The Phase 2b ENLIVEN trial evaluated the efficacy and safety of PGZ given weekly (QW) or every two-weeks (Q2W) versus placebo in MASH patients with biopsy-proven F2/F3 fibrosis. The primary histology endpoints were assessed at week 24, followed by a 24-week blinded extension for a total of 48 weeks.</div></div><div><h3>Methods</h3><div>Patients were randomized to PGZ 15mg QW, 30mg QW, or 44mg Q2W or placebo for 24-weeks (histology-based primary endpoints). During the 24-week extension, patients continued their assigned treatment except for a subset of placebo patients who were re-randomized to receive PGZ 30mg QW. The full analysis set includes F2/F3 patients with NAFLD activity score (NAS) ≥4 at baseline (n=192).</div></div><div><h3>Results</h3><div>Both primary histological endpoints considered as reasonably likely surrogates of clinical outcome benefit - at least one stage of fibrosis improvement without worsening of MASH and MASH resolution without worsening of fibrosis - were achieved by a significantly higher proportion of patients treated with PGZ 30mg QW or 44 mg Q2W than placebo. PGZ treatment also improved liver fat content (MRI-PDFF), biomarkers of fibrosis (VCTE, ELF, PRO-C3) and liver injury (ALT, AST) as well as lipids and HgA1c at both 24 weeks and week 48. PGZ was generally safe and well tolerated with the most common treatment emergent adverse events (TEAEs) being mild/moderate nausea and diarrhea. No deaths occurred; six early terminations for TEAEs including one drug-related serious AE occurred.</div></div><div><h3>Conclusions</h3><div>Treatment with PGZ in MASH patients with F2/F3 fibrosis led to highly significant fibrosis regression and MASH resolution and to robust and sustained improvements in non-invasive biomarkers of liver fat and inflammation, fibrosis, and metabolic markers, with a favorable safety and tolerability profile. PGZ is the first therapy to achieve fibrosis regression and MASH resolution with a Q2W dosing regimen. The confirmatory Phase 3 program in MASH was recently initiated.</div><div>Please note that ENLIVEN 28-week data were presented at EASL 2023 and ENLIVEN 48-week data are accepted as an oral presentation for EASL 2024. This is the first abstract to include both data sets.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":null,"pages":null},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422912","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}