American journal of preventive cardiology最新文献

{"title":"EFFECT OF OBICETRAPIB ON NEW ONSET DIABETES IN PATIENTS WITH ELEVATED LDL-C RECEIVING MAXIMALLY TOLERATED STATIN THERAPY: POOLED ANALYSES OF THE BROADWAY AND BROOKLYN TRIALS","authors":"John JP Kastelein MD, PhD ,&nbsp;Kausik K Ray MD MPHil FMedSci ,&nbsp;Michael Szarek PhD ,&nbsp;Adam J Nelson MBBS PhD ,&nbsp;Marc Ditmarsch MD ,&nbsp;Douglas Kling MBA ,&nbsp;Michael H Davidson MD ,&nbsp;Stephen J Nicholls MBBS PhD","doi":"10.1016/j.ajpc.2025.101134","DOIUrl":"10.1016/j.ajpc.2025.101134","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Pharmacologic Therapy</div></div><div><h3>Background</h3><div>Clinical and genetic studies indicate LDL-C lowering cardiovascular benefits proportional to LDL-C degree reduction, not by its mechanism achieved; however, LDL-C lowering effect on glycemic control and new onset diabetes (NoD) vary by intervention. Although genetics predict on-target effect on HMGCoA, NCP1L1 and PCSK9 lowering of NoD risk, this has only been observed in statin trials. Obicetrapib, a cholesteryl ester transfer protein inhibitor (CETPi), reduces LDL-C, Lp(a) and raises apoA1/HDL-C. Metaanalyses of early CETPi trials demonstrated 16% lower NoD risk. Effects of obicetrapib on glycaemia and NoD risk are unknown.</div></div><div><h3>Methods</h3><div>Pooled analysis of BROADWAY and BROOKLYN trials which randomized ASCVD or HeFH patients with elevated LDL-C despite maximally tolerated statins to Obicetrapib 10mg once daily or placebo for 1 year, were conducted. Obicetrapib’s day 84 and 365 HbA1c effects and NoD risk in patients without known baseline diabetic history and glycaemia strata (prediabetes, or normoglycemia), were assessed - adjusted for baseline Hba1c, trial and statin use. An additional updated meta-analysis of NoD risk with CETPi including obicetrapib data was performed, determining whether any observed associations were consistent with prior class-level observations.</div></div><div><h3>Results</h3><div>1848 patients, mean age 63.4, women 38.1%, 89.7% on statin were included with baseline median LDLC, 96 mg/dl (IQR 78-126), HbA1c 5.7% (5.4%-5.9%). Placebo-corrected LDL-C, Lp(a), and HDL-C median changes were -35.3%, -35.6%, and +136.7% (all P &lt; 0.0001. Post-baseline HbA1c was lower with Obicetrapib vs Placebo, p &lt;0.0297), consistent by glycemia stratum (Figure). Treatment HR for NoD was 0.77 (95% CI 0.57-1.04), p=0.09 (Figure) with consistent trends in those within normoglycemia and prediabetes (Figure). The additional updated meta-analysis, including obicetrapib data from 4 prior large RCTS, produced an overall RR for NoD of 0.83 (CI 0.77-0.90), 13.5%, p-value for heterogeneity 0.493, consistent with CETPi overall class effect</div></div><div><h3>Conclusions</h3><div>Obicetrapib reduced HbA1c trending towards lower risk of NoD in prediabetic and normoglycemic patients at baseline. Although obicetrapib led to greater LDL-C reductions than other CETPi, Obicetrapib effects on NoD were consistent with other CETPi. As risk of NoD accrues over time, larger, longer trials are needed to determine full degree of potential protective effects of obicetrapib on NoD risk.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101134"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104491","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":"SAFETY AND EFFICACY OF CHOLESTERYL ESTER TRANSFER PROTEIN INHIBITION: FROM GENETICS TO OUTCOME TRIALS","authors":"John JP Kastelein MD, PhD ,&nbsp;Brian A. Ference MD, Mphil, FMedSci ,&nbsp;Adam J Nelson MBBS, PhD ,&nbsp;Stephen Nicholls MBBS, PhD ,&nbsp;Kausik K Ray MD, Mphil, FMedSci","doi":"10.1016/j.ajpc.2025.101135","DOIUrl":"10.1016/j.ajpc.2025.101135","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>To investigate the associations between HDL-C levels with mortality and cardiovascular (CV) events; the safety of increased HDL-C due to CETP inhibition; and the efficacy of CETP as a target of lipid-altering therapy.</div></div><div><h3>Methods</h3><div>The cumulative rates of major coronary events, CV mortality, and non-CV mortality were compared among participants in the UK Biobank (n∼445,000) who were randomized by nature to different levels of lifetime exposure to HDL-C (Mendelian randomization [MR]) using an instrumental variable genetic score. The cumulative rates of major coronary events among participants randomized by nature to CETP, HMG CoA reductase, and PCSK9 inhibition was compared for the same absolute reduction in apoB among participants in the UK Biobank or CARDloGRAMplusC4D consortium (n=630,070). A Meta-analysis of RCTs adjusted for magnitude and duration of therapy was used to estimate the association between CETP inhibition induced changes in plasma HDL-C and the risk of both all-cause and CV mortality (n=58,412); and between CETP inhibition and the risk of major CV events, CV mortality, and all-cause mortality (n=42,541).</div></div><div><h3>Results</h3><div>There was no compelling unconfounded evidence from observational studies, MR studies, or RCTs that very high plasma HDL-C levels increase risk of all-cause, non-CV, or CV mortality. CETP inhibition is associated with a modestly lower risk of all-cause and CV mortality. There was consistent randomized evidence from MR and RCTs that CETP inhibition reduces risk of major CV events proportional to the achieved reduction in plasma apoB, and by approximately the same amount as statins and PCSK9 inhibitors for the same achieved reduction in apoB.</div></div><div><h3>Conclusions</h3><div>Neither naturally occurring elevated HDL-C or therapeutically increased HDL-C due to CETP inhibition are associated with increased all-cause, CV, or non-CV mortality. ApoB reduction induced by CETP inhibition reduces CV risk by approximately the same degree as reductions induced by statins and PCSK9 inhibitors.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101135"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104495","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":"VICTORION-INITIATE: LOW-DENSITY LIPOPROTEIN CHOLESTEROL GOAL ATTAINMENT AND CUMULATIVE EXPOSURE WITH “INCLISIRAN FIRST” VERSUS USUAL CARE IN PATIENTS WITH ATHEROSCLEROTIC CARDIOVASCULAR DISEASE","authors":"Fatima Rodriguez MD, MPH ,&nbsp;Michael Koren JMD ,&nbsp;Cara East MD ,&nbsp;Yousuf Ali PhD ,&nbsp;Kelly Kleeman ,&nbsp;Samiha Sarwat ,&nbsp;Cheryl Abbas ,&nbsp;Peter Toth MD, PhD","doi":"10.1016/j.ajpc.2025.101130","DOIUrl":"10.1016/j.ajpc.2025.101130","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD /CVD Risk Reduction</div></div><div><h3>Background</h3><div>Rapid and sustained attainment of guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals is critical for patients with atherosclerotic cardiovascular disease (ASCVD). In VICTORION-INITIATE, inclisiran allowed more patients with ASCVD to achieve and sustain LDL-C goals vs current usual care (UC).This study evaluated cumulative LDL-C exposure in the overall population and LDL-C goal attainment and safety in prespecified subgroups receiving an “inclisiran first” implementation strategy (IF; adding inclisiran immediately on failure to achieve LDL-C &lt;70 mg/dL with maximally tolerated statins) compared with UC.</div></div><div><h3>Methods</h3><div>VICTORION-INITIATE was a 330-day, prospective, pragmatically designed trial conducted at 45 sites across 20 states in the United States. Patients were randomized 1:1 (stratified by insurance status) to IF (open-label inclisiran 284 mg at Days 0, 90 and 270 plus UC) or UC alone, (lipid management directed by treating physician’s discretion). Subgroup analysis evaluated LDL-C goal attainment by timing of the most recent ASCVD event (&lt;1 year/≥1 year prior to consent), ASCVD subtype (coronary heart disease [CHD], peripheral arterial disease [PAD], and cerebrovascular disease [CVD]) and statin intolerance. Cumulative LDL-C exposure and safety by subgroup were also evaluated.</div></div><div><h3>Results</h3><div>Of 450 patients randomized to IF or UC, 11.1% and 84.2% had an ASCVD event &lt;1 year or ≥1 year prior to consent, respectively; 91.8%, 18.2% and 14.7% had a history of CHD, CVD or PAD, and 25.8% were statin intolerant. Cumulative exposure to LDL-C to Day 330 was &gt;50% lower with IF vs UC (mean time-adjusted LDL-C: 42.4 mg/dL vs 90.7 mg/dL, (Figure). Significantly more patients on IF achieved LDL-C goals of &lt;70 mg/dL and &lt;55 mg/dL at Day 330 vs UC, irrespective of the subgroups (Table). Across subgroups, the incidence of treatment-emergent adverse events (TEAEs) and serious TEAEs were similar between IF and UC (IF: 52.6%-71.2%, UC: 46.2%-66.0% and IF: 10.7%-28.3%, UC: 11.4%-22.2%, respectively).</div></div><div><h3>Conclusions</h3><div>Patients with ASCVD and LDL-C &gt;70 mg/dL on IF had lower cumulative LDL-C exposure and achieved rapid and sustained LDL-C goals than those on UC, regardless of ASCVD subtype, event timing, and statin intolerance. The safety profile of IF was consistent across subgroups, with no differences in adverse events vs UC.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101130"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104632","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":"EXPLORING THE UTILITY OF A CVD RISK PREDICTING RETINAL AI MODEL IN IDENTIFYING CACS OVER 400 IN PATIENTS WITH AND WITHOUT DIABETES","authors":"Dongjin Nam MD ,&nbsp;Sahil Thakur MBBS, MS, PhD ,&nbsp;A.V. Rukmini MBBS, MD, PhD ,&nbsp;Jaewon Seo BE ,&nbsp;Jungkyung Cho MD ,&nbsp;Junseok Park MD ,&nbsp;Tae Hyun Park MD ,&nbsp;Tyler Hyungtaek Rim MD, MBA, PhD ,&nbsp;Sung Soo Kim MD, PhD ,&nbsp;Chan Joo Lee MD, MM, PhD ,&nbsp;Sungha Park MD, MM, PhD","doi":"10.1016/j.ajpc.2025.101179","DOIUrl":"10.1016/j.ajpc.2025.101179","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>Dr. Noon CVD, a CVD risk prediction model based on retinal-imaging has been shown to estimate probability of coronary artery calcium (CAC). Dr.Noon risk categories (low, moderate, high) have shown performance comparable to conventional CAC risk categories (0, 1-99, ≥100) in predicting 5- year cardiovascular risk. For guiding intensive preventive strategies, CACS ≥400 is considered clinically significant. The current study explored the utility of Dr. Noon CVD to identify CACS ≥400 in patients with and without diabetes mellitus (DM).</div></div><div><h3>Methods</h3><div>This analysis included 1,252 participants from the CMERC-HI cohort classified into six groups based on Dr. Noon CVD risk level (low [&lt;31], moderate [&lt;41], high [41–51], very high [&gt;51]) and DM status. non-DM with low (1a), moderate (2a), high (3a) and very high (4a) risk; and DM with low (1b), moderate (2b), high (3b) and very high (4b) risk. We performed ROC analysis of the Dr. Noon CVD score for predicting CACS ≥400 and compared AUCs by DM status. Prevalence of CACS ≥400 was assessed for each group and logistic regression models calculated odds ratios (ORs), adjusting for cardiovascular risk factors.</div></div><div><h3>Results</h3><div>CACS ≥400 was present in 189 patients (15.1%). AUC was 0.787 (non-DM) and 0.758 (DM) with no significant difference (p=0.4186). Sensitivity and specificity across Dr. Noon CVD risk categories were comparable between DM and non-DM groups. The proportion of patients with CACS ≥400 increased incrementally from Group 1a (0.6%, 1 of 155) to Group 4b (43.0%, 64 of 149). In non-DM patients, both high- and very high-risk groups showed significantly higher odds of CACS ≥400, with clear separation even between high and very high-risk (OR=4.17, p&lt;0.001). In DM patients, only the very high-risk group showed significant elevation vs. high-risk (OR=3.81, p&lt;0.001), while high-risk alone was not distinguishable from lower-risk groups.</div></div><div><h3>Conclusions</h3><div>In addition to identifying 5y-CVD risk, Dr. Noon CVD could also be used to identify patients at increased risk of having a CACS ≥400. Future studies could evaluate the effectiveness of using Dr. Noon CVD when stratified using both Dr. Noon CVD risk category and diabetes status. Further analysis could support its clinical applicability for targeted preventive interventions.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101179"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104862","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":"MICROPLASTICS. A NEW RISK FACTOR FOR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE","authors":"Sri Vaishnavi Umesh M.B.B.S","doi":"10.1016/j.ajpc.2025.101110","DOIUrl":"10.1016/j.ajpc.2025.101110","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Therapeutic Area&lt;/h3&gt;&lt;div&gt;ASCVD/CVD Risk Factors&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Plastics are a part of our day-to-day lives. Once plastic disintegrates, it generates microplastics, which are invisible to the human eye. So far, there is evidence that microplastics have been found in tissues of plants, animals, and human beings, but their role in the causality of diseases is not yet uncovered. Atherosclerosis results from inflammation and fat deposition in the arteries that lead to plaque formation. This research aims to determine whether atherosclerosis could be brought about by or worsened by microplastics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Extensive search was performed across multiple databases, including PubMed, Scopus, Medline, and Embase. Keywords like 'MICROPLASTICS\", \"MICROPLASTICS AND ATHEROSCLEROSIS\", \"ATHEROSCLEROSIS\", \"NANOPLASTICS\", \"NANOPLASTICS AND ATHEROSCLEROSIS\", \"MICROPLASTICS AND INFLAMMATION\", \"MICROPLASTICS AND ENDOTHELIAL DYSFUNCTION”, etc. were used to search. Articles were chosen based on their relevancy and recency. After an extensive search, 58 articles passed the criteria and were chosen to be a part of the study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;1.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Microplastics are ubiquitous, and they enter the body by three major routes - inhalation, ingestion and direct skin contact.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;2.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Microplastics affect the pathogenesis of atherosclerosis:&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;a.&lt;/span&gt;&lt;span&gt;&lt;div&gt;They induce lipid accumulation in the cytoplasm, predisposing to foam cell formation. Microplastics and nanoplastics up-regulate the scavenger receptor - MARCO- causing LDL accumulation and worsening inflammation.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;b.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Microplastics up-regulate ICAM-1, VCAM -1, TNF-α expression, causing enhanced adherence, transendothelial migration of inflammatory cells, and inflammation.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;c.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Microplastics cause phenotype switching of vascular smooth muscle cells, which is a key pathological event in the formation of an atheroma.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;li&gt;&lt;span&gt;d.&lt;/span&gt;&lt;span&gt;&lt;div&gt;Microplastics accumulate in the formed atheroma plaque and harbour a worse fate as compared to plaques without microplastics.&lt;/div&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Microplastics enter the body via three major routes- food, air, or by skin contact. In the cardiovascular system, they are known to cause free radical damage and cardiac fibrosis. Specific to atherogenesis, they affect every step. They predispose to dyslipidemia, they cause endothelial dysfunction and inflammation, and they additionally create a procoagulant environment. microplastics cause vascular smooth muscle cells phenotype switching and are shown to accumulate in the plaque and accelerate its growth. With the given information, one can infer that microplastic exposure has a detrimental effect on cardiovascular health","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101110"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104818","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":"PARTICIPATION IN A COMPREHENSIVE CARDIAC REHABILITATION PROGRAM IMPROVES MID- AND LONG-TERM PROGNOSIS IN SURVIVORS OF ACUTE CORONARY SYNDROME","authors":"Csaba Sari CsS ,&nbsp;Christian M. Heesch CMH ,&nbsp;Peter Andreka PA","doi":"10.1016/j.ajpc.2025.101091","DOIUrl":"10.1016/j.ajpc.2025.101091","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>Cardiovascular disease is the leading cause of death in developed nations. While survival rates of myocardial infarction have improved in the last decades due to cost-intensive technical and organizational advances, efforts to improve prognosis through secondary prevention measures are often neglected. This study evaluates the effects of participation in a comprehensive cardiac rehabilitation program (CCR) on survival in patients presenting with acute coronary syndrome (ACS).</div></div><div><h3>Methods</h3><div>In Hungary, as of January 2014, by mandate data pertaining to patients suffering from ACS are entered into the National Myocardial Infarction Register (the Register), which by now stores data on 155,000 ACS events of more than 130,000 patients. Retrospective analysis was performed on the data of the Register.</div></div><div><h3>Results</h3><div>We examined data on 76,153 ACS cases that occurred from 2014 to 2019. For the purposes of this study, we focused on early survivors, and 66905 patients were included in our analysis (alive after 30 days of the index event). The main potentially modifiable protective factors, analyzed by binary regression model, were percutaneous coronary intervention (PCI), direct admission to a PCI capable hospital and participation in a comprehensive cardiac rehabilitation program. In Hungary, such programs include supervised physical exercise as well as patient education on smoking cessation, dietary changes, and medication compliance Our study showed that participation in CCR programs was associated with a 42% reduction in 1-year mortality for patients with ST-elevation myocardial infarction (STEMI) and improved long-term survival rates across various patient subgroups. Despite its efficacy, the participation rate in CCR was low, with only 21% of eligible patients completing such programs. The lowest rate of CCR participation was in non-ST-elevation myocardiac infarction (NSTEMI) patients that did not undergo PCI, a group that also exhibited the highest mortality rates. Factors predicting lower participation rates were older age, male gender, NSTEMI presentation, and lack of percutaneous coronary intervention (PCI).</div></div><div><h3>Conclusions</h3><div>This study shows a significant survival benefit of participation in a comprehensive cardiac rehabilitation program in early survivors of ACS. This finding was contrasted by a very low participation rate in this highly effective and cost-effective intervention. Increasing awareness of CCR’s benefits both amongst patients and providers, as well as increasing access to and availability of CCR should significantly improve survival rates following ACS.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101091"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104944","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":"PROACTIVE CARDIOVASCULAR PROTECTION ALONG THE CARDIAC CONTINUUM: UNDERSTANDING RISK TO OPTIMIZE PREVENTION","authors":"Margaret Harris PhD, CHCP,&nbsp;Ann Carothers,&nbsp;Fred Stange DO","doi":"10.1016/j.ajpc.2025.101104","DOIUrl":"10.1016/j.ajpc.2025.101104","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide. Understanding the cardiac risk continuum and leveraging advanced risk assessment techniques are crucial for optimizing primary prevention strategies. This educational program aimed to enhance healthcare providers’ (HCPs) knowledge and competence in cardiovascular risk assessment and prevention. The objective of this study was to evaluate the impact of an online continuing medical education (CME) program on improving the knowledge, competence, and confidence of cardiologists and primary care physicians (PCPs) in identifying and mitigating cardiovascular risk along the cardiac continuum. Post-education assessments demonstrated significant improvements in knowledge and competence:<ul><li><span>•</span><span><div><strong>Cardiac Risk Continuum Awareness:</strong> 21% of cardiologists and 22% of PCPs improved their understanding of the progression from primary to secondary prevention (P &lt; .001).</div></span></li><li><span>•</span><span><div><strong>Image-Guided Cardiovascular Risk Assessment:</strong> 13% of cardiologists and 17% of PCPs improved their understanding of the role of image-guided cardiovascular risk techniques in the primary prevention setting (P &lt; .001).</div></span></li><li><span>•</span><span><div><strong>Competence in Risk-Based Treatment Decisions:</strong> 13% of cardiologists and 15% of PCPs improved their ability to integrate risk stratification tools into treatment planning (P &lt; .001).</div></span></li><li><span>•</span><span><div><strong>Confidence Gains:</strong> Post-education, 41% of cardiologists and 21% of PCPs reported feeling “mostly” or “very confident” in tailoring primary prevention strategies.</div></span></li></ul></div></div><div><h3>Conclusions</h3><div>The CME program significantly enhanced clinicians' knowledge and confidence in cardiovascular risk assessment and prevention. These findings underscore the value of targeted education in improving evidence-based clinical decision-making for primary cardiovascular prevention. Continued educational efforts are recommended to bridge gaps in practice and optimize patient outcomes.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101104"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104958","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":"QUALITY AND READABILITY OF CHATGPT IN ANSWERING PATIENTS’ PREVENTIVE CARDIOLOGY QUESTIONS: A PILOT STUDY","authors":"Prem Patel MD ,&nbsp;Allison Bigeh DO ,&nbsp;Benjamin Romer MD ,&nbsp;Shantanu Dev BS ,&nbsp;Samar Binkheder PhD ,&nbsp;Lang Li PhD ,&nbsp;Weidan Cao PhD ,&nbsp;M. Wesley Milks MD","doi":"10.1016/j.ajpc.2025.101170","DOIUrl":"10.1016/j.ajpc.2025.101170","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Other</div></div><div><h3>Background</h3><div>As artificial intelligence (AI) becomes increasingly integrated into healthcare, ChatGPT has emerged as a promising tool for patient education. However, research on its suitability for preventive cardiology remains limited. With patients increasingly relying on online health information, it is essential that content is both scientifically accurate and accessible to individuals of all health literacy levels. This study evaluates the quality and readability of ChatGPT’s responses to common questions on lifestyle modification, women’s cardiovascular health, and cholesterol management.</div></div><div><h3>Methods</h3><div>Twenty-six questions (8 on lifestyle modifications, 8 on women’s cardiovascular health, and 10 on cholesterol management) were queried using the GPT-4 model. Responses were independently evaluated by three board-certified preventive cardiologists, referencing the latest national cardiovascular guidelines. Quality was assessed using a 5-point Likert scale for correctness, comprehensiveness, conciseness, and comprehensibility, previously employed in medical AI research. Readability was analyzed using the Flesch-Kincaid Grade Level and other standardized readability metrics.</div></div><div><h3>Results</h3><div>ChatGPT provided adequate responses to 88.4% (23/26) of questions, with mean (SE) scores of 3.71 ± 0.20 for correctness, 4.06 ± 0.14 for conciseness, 4.06 ± 0.13 for comprehensiveness, and 4.40 ± 0.10 for comprehensibility. The highest-scoring topic was lifestyle modification (84.4%), followed by cholesterol management (81.2%) and women’s cardiovascular health (77.8%). Among inadequate responses, key limitations included overstating the risks of low LDL cholesterol and exaggerating the benefits of estrogen replacement therapy (ERT) for postmenopausal CVD risk reduction. ChatGPT also provided unsupported recommendations regarding dietary supplements for CVD prevention. Readability analysis revealed responses at a 13th-grade level, exceeding the recommended 6th-grade level for patient education.</div></div><div><h3>Conclusions</h3><div>ChatGPT’s responses were generally suitable for topics such as heart-healthy diets, exercise, weight management, epidemiology and clinical presentation of CVD in women, postmenopausal CVD risk, cholesterol-lowering therapy, statin-associated side effects, and Lp(a) risk stratification. However, inaccuracies persisted in dietary supplementation, ERT, and very low LDL levels. Enhancements in AI training are needed to improve accuracy in these areas. Additionally, the high readability level limits accessibility for the general public, underscoring the need for optimization to ensure clear and reliable patient education.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101170"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104989","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":"Metabolic syndrome and the risk of incident heart failure: a prospective cohort study","authors":"Hongye Wei ,&nbsp;Ziyi Qiu ,&nbsp;Ziting Gao ,&nbsp;Yajing Wei ,&nbsp;Jun Xiao ,&nbsp;Wuqing Huang","doi":"10.1016/j.ajpc.2025.101279","DOIUrl":"10.1016/j.ajpc.2025.101279","url":null,"abstract":"<div><div>Aim: Previous studies have reported the link between metabolic syndrome (MetS) and multiple cardiovascular diseases. This study aimed to comprehensively investigate the role of MetS in the risk of developing HF.</div><div>Methods: This is a prospective cohort study based on UK Biobank. The components of MetS included increased blood pressure (P), central obesity (W), elevated blood glucose (G), reduced HDL cholesterol (H) and increased triglycerides (T); the cumulative burden of MetS components was defined as the sum of the presence of altered MetS components; and specific clusters of MetS components was defined as different combinations of the altered components. The outcome was incident heart failure. Cox proportional‐hazards models were used to generate the estimates.</div><div>Results: Over a median follow-up for 13.2 years, 11,875 cases of incident HF occurred. As compared to individuals without altered component of MetS, the adjusted HRs gradually increased from 1.54, 1.64, 1.86, 2.18 to 2.62 across groups with 1–5 altered components, respectively. Increased blood pressure conferred a greater risk of HF than other components after adjustment, while increased triglycerides showed a protective effect, resulting in the highest risk observed in the clusters of PGHW (adjusted HR = 3.17, 95 % CI = 2.70–3.72), followed by PGHTW, PGW, PGH, and PGTW. These observed associations were almost stronger in younger adults than older participants, or in females than males.</div><div>Conclusion: Cumulative burden of MetS was associated with higher incidence of HF, while which varied by different clusters.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101279"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026474","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 DISPARITIES IN DEPRESSION AND ITS ASSOCIATION WITH CARDIOMETABOLIC RISK FACTORS AMONG YOUNG ADULTS IN A LOW-MIDDLE INCOME COUNTRY: A CROSS-SECTIONAL STUDY","authors":"Siraj Ahmad ,&nbsp;Saad bin Zafar ,&nbsp;Muhammad Shahid ,&nbsp;Aysha Almas","doi":"10.1016/j.ajpc.2025.101143","DOIUrl":"10.1016/j.ajpc.2025.101143","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Depression is a leading cause of disability globally, with higher burdens in low-middle income countries (LMICs) like Pakistan. Emerging evidence links depression to cardiometabolic diseases, but data from primary care settings in Pakistan remain limited. This study assessed the burden of depression and its association with gender and cardiometabolic risk factors among young adults in Karachi, Pakistan.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted from September 2022 to February 2023 at five primary care clinics affiliated with Aga Khan University. Adults aged 18 - 50 years (men) and 18 - 60 years (women) with at least one atherosclerotic cardiovascular disease (ASCVD) risk factor were included. A total of 614 participants were enrolled via non-probability consecutive sampling. Depression was assessed using the PHQ-9, with scores ≥10 indicating depression. Cardiometabolic risk factors included hypertension, diabetes, dyslipidemia, obesity (BMI and waist circumference), and smoking. Physical activity (IPAQ) and socioeconomic status (WAMI index) were recorded. Multivariable logistic regression was used to assess associations between gender and depression.</div></div><div><h3>Results</h3><div>Among 614 participants (mean age: 41.9 ± 9.2 years), 373 (60.7%) were women. Depression was present in 18.2% overall, significantly higher in women (22.2%) than men (12.0%) (p=0.001). Adjusted analysis showed women had 2.6 times higher odds of depression (OR: 2.645; 95% CI: 1.478–4.733). Dyslipidemia (84.7%), obesity (90.6%), and hypertension (49.7%) were common, but these were not associated with depression. An inverse relationship was found between depression and obesity by BMI (p=0.001), though not by waist circumference. Depressed participants had lower physical activity (p=0.027) and WAMI scores (p=0.007). Smoking was more prevalent among those with depression (21.4% vs. 12.2%, p=0.014), though not significant after adjustment.</div></div><div><h3>Conclusions</h3><div>Depression is highly prevalent among young adults in Karachi, with women disproportionately affected. The lack of association with cardiometabolic risk factors contrasts with global literature, possibly due to cultural perceptions of obesity. These findings underscore the need for gender-sensitive mental health interventions in primary care. While traditional cardiometabolic risks were not independently associated with depression, links with lower physical activity, socioeconomic status, and smoking highlight the need for integrated mental and physical health strategies in primary care.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"23 ","pages":"Article 101143"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104361","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}