American journal of preventive cardiology最新文献

{"title":"BENEATH THE SURFACE: EXPLORING A CASE OF LEFT CIRCUMFLEX ARTERY DISSECTION","authors":"Menon Tushar MD","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":"19 ","pages":"Article 100820"},"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":"EXAMINING URBAN AND RURAL PHARMACY AVAILABILITY IN MINNESOTA FROM 2009 TO 2020","authors":"Katy Lehenbauer MD, MPH","doi":"10.1016/j.ajpc.2024.100821","DOIUrl":"10.1016/j.ajpc.2024.100821","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD in Special Populations</div></div><div><h3>Background</h3><div>Cardiovascular disease (CVD) is the leading cause of death in the United States. Controlling CVD risk factors is key to treatment and prevention. However, medication adherence is difficult when pharmacies are difficult to access. This study aims to characterize pharmacy access by geographic region in Minnesota from 2009 to 2020.</div></div><div><h3>Methods</h3><div>Pharmacy lists for 2009 and 2020 were obtained from the Minnesota Board of Pharmacy. Pharmacies were geocoded and labeled with a rural-urban community area (RUCA) code. Geographic areas were divided into 3 RUCA areas: urban, large rural city/town, small/isolated rural town. Each pharmacy was designated as a chain, supermarket-based, independent, or associated with a health system. We evaluated pharmacy hours, count and density for each geographic area by year, and the proportion of pharmacy types in all geographic locations.</div></div><div><h3>Results</h3><div>A total of 1,010 pharmacies were open in 2009 and 916 pharmacies in 2020. Pharmacy density (n/100,000 resident) decreased over time for all geographic areas: urban from 17.0 to 13.9, large rural from 24.1 to 21.1, and small rural from 25.6 to 24.2. Pharmacy types also changed over time. While chain pharmacies accounted for nearly half of pharmacies in both 2009 and 2020, independent pharmacies decreased over time in all regions (Figure 1). Supermarket and health system pharmacies represented a stable or increasing share of all pharmacies although the absolute number of pharmacies decreased everywhere except in small rural towns.</div><div>Supermarket pharmacies had the best access; &gt;95% were open after 6pm and had open hours on the weekend. Chain pharmacies had similarly high accessibility in the urban regions, but were less accessible in large rural city (65% extended hours, 87% open weekends) and small town (23% extended hours, 66% open weekends) regions (Table 1). Independent pharmacies tended to be open on weekends, but were less likely to have extended hours.</div></div><div><h3>Conclusions</h3><div>Pharmacy access decreased across the state of Minnesota from 2009 to 2020, especially for independent pharmacies. Residents of less populated areas had fewer options for pharmacy use outside of regular business hours.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100821"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142423109","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":"Santul Bapat MD","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":"19 ","pages":"Article 100760"},"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":"SEX-BASED DIFFERENCES IN AORTIC VALVE CALCIUM AND THE RISK FOR AORTIC STENOSIS","authors":"Natalie Marrero MD","doi":"10.1016/j.ajpc.2024.100734","DOIUrl":"10.1016/j.ajpc.2024.100734","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Novel Biomarkers</div></div><div><h3>Background</h3><div>Aortic valve calcification (AVC) is the primary underlying process leading to aortic stenosis (AS). In general, women have lower AVC scores compared to men of the same age and the AVC score threshold for severe AS is lower for women. It remains unknown if the long-term risk of AS differs between sexes with similar AVC scores. We aimed to assess the association between AVC and the risk for clinically significant AS stratified by sex using the Multi-Ethnic Study of Atherosclerosis (MESA).</div></div><div><h3>Methods</h3><div>We included 6,812 MESA participants free of cardiovascular disease with AVC measured at Visit 1 using non-contrast cardiac CT. AVC was examined as a continuous (logarithmically transformed, ln (AVC+1)) and categorical variable (0, 1-99, 100-299, ≥300 AU). Incident long-term AS was adjudicated using standard clinical criteria with a median follow up of 16 years. The primary outcome was incident moderate or severe AS. The association between AVC and AS was examined by calculating absolute event rates per 1,000 person-years, and multivariable adjusted Cox Proportional hazards regression.</div></div><div><h3>Results</h3><div>Among those with AVC &gt;0, women were older (71.7 years vs. 69.8 years, p = 0.01) and generally had a higher risk factor burden. There were 65 cases of incident AS for women and 75 for men. There was a similar absolute event rate for incident AS for women and men across the AVC categories. AVC as a continuous variable was strongly associated with an increased risk for incident aortic stenosis for both women (HR 1.91, 95% CI 1.68-2.16) and men (HR 2.13, 95% CI 1.88-2.41). There was no interaction between AVC, as a continuous variable, and sex (p = 0.31) for the association with AS. The adjusted hazard for severe AS was similar across AVC categories for women and men with HR estimates 134.9 (95% CI 45.1-403.9) for women with AVC ≥300 and 132.8 (95% CI 6.2-274.9) for men with AVC ≥300 (Table 1).</div></div><div><h3>Conclusions</h3><div>The association of AVC with the long-term risk for incident AS was similar for women versus men. These findings further emphasize the utility of AVC as a prognostic marker for incident AS.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100734"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422818","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":"Juliana H. Namutebi MD, MS","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":"19 ","pages":"Article 100790"},"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":"IMPROVEMENT IN HEART FAILURE NAVIGATOR CONSULTATION - A QUALITY IMPROVEMENT INITIATIVE","authors":"Parnia Abolhassan Choubdar MD","doi":"10.1016/j.ajpc.2024.100791","DOIUrl":"10.1016/j.ajpc.2024.100791","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Heart Failure</div></div><div><h3>Background</h3><div>Heart failure (HF) has the highest 30-day rehospitalization rate among medical and surgical conditions. Data shows that HF patients who suffer from a 30-day readmission have worse prognosis at 6-month follow-up. Implementing educational interventions to improve outcome of adherence in HF patients has shown to reduce readmission rates by &gt;15%. Although the means to implement such educational interventions are available, this resource appears grossly underutilized. Preliminary analysis showed that &lt; 15% of patients admitted to advanced heart care with an ICD 10 diagnosis of acute heart failure exacerbation currently to receive an order for HF Navigator consultation.</div></div><div><h3>Methods</h3><div>The number of heart failure navigator consults placed on the advanced heart care unit in relation to primary diagnosis of acute heart failure exacerbation was measured. The baseline, measured over several weeks prior to implementation of intervention, was measured to be &lt;15%. Plan-Do-Study-Act (PDSA) Cycles were run. The cycles entailed: 1st Provider reeducation that ANY HF admission warrants HF Navigator consultation, 2nd Implementation of a widget making it accessible to follow up if consultation happened, 3rd order set for HF was enforced , which entailed the heart failure navigator order, 4th Distribution of reminder posters, post it's, and emails, 5th Distribution of questionnaire evaluating the main cause of lack of adherence to orders, serving as reminder to utilize the order, 6th educational meeting with the HF Navigator. 7th Information technology guided interventions are currently pending.</div></div><div><h3>Results</h3><div>The following number of orders for heart failure navigator consultation were noted after each PDSA cycle:1st 16%, 2nd 16%, 3rd 33 %, 4th 39 %, 5th 26%, 6th 50% (Figure 1).</div></div><div><h3>Conclusions</h3><div>Sustained and relevant change requires ongoing education, and improved workflow with utilization of order sets, which equal integrated clinical pathways. Ultimately, information technology support is needed to implement reflex orders, and clinical pathway tools, based on diagnosis, to ensure evidence based healthcare and optimal patient care. Advancements in electronic medical record systems with application of clinical pathways will improve human error and in the long-term safe patient suffering and hospital dollars.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100791"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422837","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":"EVALUATING TOUR006 IN PARTICIPANTS WITH CHRONIC KIDNEY DISEASE AND ELEVATED HS-CRP: RATIONALE AND DESIGN OF THE TRANQUILITY PHASE 2 STUDY","authors":"Emil DeGoma MD","doi":"10.1016/j.ajpc.2024.100778","DOIUrl":"10.1016/j.ajpc.2024.100778","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Pharmacologic Therapy</div></div><div><h3>Background</h3><div>Subgroups of patients with atherosclerotic cardiovascular disease (ASCVD) remain at very high risk of major adverse cardiovascular and limb events despite lifestyle modification and intensive pharmacological management including antiplatelet drugs, antihypertensive therapy, and LDL-lowering medications. Converging evidence from human genetic studies, prospective cohort studies, and mechanistic studies as well as results of canakinumab and colchicine cardiovascular outcome trials support the therapeutic potential of IL-6 pathway inhibition to lower the risk of ASCVD independent of traditional risk factors. TOUR006 is a fully human, high-affinity monoclonal antibody against the IL-6 cytokine. In prior Phase 1/2 studies, TOUR006 administered to patients with high-grade inflammatory autoimmune diseases such as rheumatoid arthritis, Crohn's disease, and systemic lupus erythematosus achieved rapid and durable reductions in C-reactive protein (CRP), the key downstream pharmacodynamic (PD) biomarker of IL-6 activity, as assessed by the high-sensitivity (hs) assay. A pharmacokinetic (PK)/PD model was developed from these data, and simulations in virtual patients showed significant reductions in hs-CRP with both monthly and quarterly dosing of TOUR006. The objective of this Phase 2 study is to characterize the hs-CRP-lowering effect, safety, tolerability, and PK of TOUR006 in patients with chronic kidney disease (CKD) and elevated hs-CRP. The CKD population was selected for this trial because of the high prevalence of elevated hs-CRP as well as evidence supporting a significant role of IL-6 pathway activation in driving ASCVD risk among patients with CKD.</div></div><div><h3>Methods</h3><div>TRANQUILITY is a Phase 2, randomized, double-blind, placebo-controlled, multicenter, US-based trial enrolling approximately 120 patients with CKD stage 3 or 4 and hs-CRP≥2 and &lt;15 mg/L. Participants will be stratified by CKD stage and randomized to subcutaneous TOUR006 50 mg quarterly, 25 mg quarterly, 15 mg monthly, or placebo (Figure). The primary PD endpoint is change in hs-CRP; additional biomarkers include IL-6, lipoprotein(a), oxidized LDL, and fibrinogen. Treatment and follow-up periods are 180 days and 185 days, respectively.</div></div><div><h3>Conclusions</h3><div>TRANQUILITY, an ongoing trial with anticipated primary completion in May 2025, will assess the safety, tolerability, PK, and hs-CRP-lowering effect of TOUR006 and inform the dosing regimen and design of future Phase 3 cardiovascular studies in high-risk patients.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100778"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422907","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":"19 ","pages":"Article 100864"},"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":"ANGIOGRAPHIC FINDINGS IN SYMPTOMATIC PATIENTS WITH EVIDENCE OF ISCHEMIA BY PET/CT PERFUSION IMAGING BUT WITH ZERO CORONARY ARTERY CALCIUM","authors":"Leslie Iverson PA-C","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":"19 ","pages":"Article 100817"},"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":"PIECING THE PUZZLE TOGETHER WHEN FAMILY HISTORY IS UNKNOWN: EARLY DIAGNOSIS AND MANAGEMENT OF A PATIENT WITH FAMILIAL HYPERCHOLESTEROLEMIA","authors":"Lavanya Garnepudi MD","doi":"10.1016/j.ajpc.2024.100755","DOIUrl":"10.1016/j.ajpc.2024.100755","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Case Presentation</h3><div>A 43-year-old male presented to our primary care clinic to establish care. He was in his usual state of health, endorsed a balanced diet and daily exercise. His family history was unknown as he was adopted. Vital signs were normal, and the physical exam was unremarkable. A routine lipid profile revealed a total cholesterol level of 391 mg/dL, LDL-C level of 251 md/dL, HDL-C level of 57 mg/dL, and triglyceride level of 56 mg/dL. Given abnormally elevated LDL-C levels in a patient who otherwise had no known risk factors, an FH screening panel was ordered. The patient was also started on 40 mg atorvastatin daily and referred to the lipid clinic where he was diagnosed with FH using the Dutch Lipid Clinic Diagnostic Criteria (5 points: LDL- C between 250- 325 mg/dL+ 8 points: functional genetic mutation).</div></div><div><h3>Background</h3><div>Familial Hypercholesterolemia (FH) is a genetic disease that contributes to an increased risk for coronary artery disease, MI, and sudden cardiac death. Although awareness surrounding FH is increasing, this condition remains underdiagnosed and undertreated. In most countries, less than 20% of prevalent cases are diagnosed, and even less patients are aware of their condition, often not until after the first ASCVD event. Literature shows that underdiagnosis is multifactorial, including lack of awareness of the disorder, a lack of international consensus on which diagnostic criteria is superior, and minimal comfort with treating patients with intensive therapy.</div></div><div><h3>Conclusions</h3><div>Family health history is crucial to disease prevention though physicians often lack time and patients can lack information (as in this case). Genetic testing is the future of preventive medicine but remains underutilized in the primary care setting3. There has historically been uncertainty surrounding insurance coverage of genetic testing and the financial implications for patients. Collaborative efforts among primary care providers, genetics departments, lipid clinics, and insurers are essential to recognize the full potential of genetic testing while ensuring equitable access and affordability to all patients. This case highlights the importance of early identification, treatment, and referral of FH patients who would otherwise be missed given their asymptomatic status and unknown family history.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"19 ","pages":"Article 100755"},"PeriodicalIF":4.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142422727","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}