American journal of preventive cardiology最新文献

{"title":"GAINING POUNDS AND APPETITE: STATIN'S DOUBLE-EDGED EFFECT ON PRIMARY PREVENTION","authors":"","doi":"10.1016/j.ajpc.2024.100749","DOIUrl":"10.1016/j.ajpc.2024.100749","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Case Presentation</h3><div>A 66-year-old female with hyperlipidemia was referred to cardiology due to a family history of coronary artery disease (CAD). Prior to her initial visit, she had a total cholesterol (TC) 264 mg/dL, triglycerides (TG) 89 mg/dL, high-density lipoprotein (HDL) 76mg/dL, and low-density lipoprotein (LDL) 173 mg/dL; her lipoprotein (a) was 314.4 nmol/L. She had undergone Commuted Tomography (CT) Coronary Artery Calcium Score (CACS) testing and had an Agatston calcium score of 5.6 (57th percentile). Her weight was 66 kg with a BMI of 25.7 kg/m2. She was initiated on pravastatin 20 mg and her LDL improved to 70 mg/dL, however she began to note weight gain. She was switched to rosuvastatin 20 mg and noted a profound lack of satiety, with a further 4kg total weight gain since statin initiation seven months prior, while her LDL improved to 44 mg/dL. She was switched to evolocumab, and her lack of satiety improved immediately. She lost 3 kg within three months of stopping her statin.</div></div><div><h3>Background</h3><div>Dyslipidemia is a primary risk factor for atherosclerotic cardiovascular disease, and a target of preventative cardiology. Prior studies have shown that statin users may adopt a less heart-healthy diet while on a statin, due to a belief of being protected from bad outcomes, ultimately resulting in more weight gain. However, even in those making favorable lifestyle choices, statins may be a hindrance to their goals of weight loss though a leptin-mediated impairment of satiety.</div></div><div><h3>Conclusions</h3><div>Anecdotal evidence has demonstrated weight gain as a frequent side effect of statin use. This case illustrates a clear temporal relationship between statin use and weight gain, primarily mediated by a lack of satiety. While statins may address one element of primary prevention, in some patients, they may contribute to another, and alternative agents should be used. Further studies are needed to better understand the mechanism behind this effect.</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":"142422826","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":"TRIGLYCERIDE-TO-HIGH-DENSITY-LIPOPROTEIN RATIO HAS LIMITED DIAGNOSTIC ACCURACY FOR DETECTING EARLY INSULIN RESISTANCE","authors":"","doi":"10.1016/j.ajpc.2024.100764","DOIUrl":"10.1016/j.ajpc.2024.100764","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Diabetes</div></div><div><h3>Background</h3><div>Type 2 diabetes mellitus (T2DM) and its complications pose a significant global health challenge, affecting 537 million individuals worldwide. Early identification of insulin resistance (IR) is crucial for managing the risk and preventing T2DM. Existing literature supports the use of the triglyceride-to-high-density lipoprotein ratio (TG/HDL) as a practical marker of IR and a component of metabolic syndrome (MetS). However, the compensatory hyperinsulinemia that precedes MetS and prediabetes may suppress this ratio and mask hidden IR. Hypothesis: For individuals with early metabolic imbalance (EMI), TG/HDL lacks the diagnostic power to detect compensated insulin resistance.</div></div><div><h3>Methods</h3><div>Leveraging data from the 2015-2018 U.S. National Health &amp; Nutrition Examination Survey, we assigned each study participant to one of four groups: (1) healthy balanced metabolism, (2) EMI (includes early IR), (3) prediabetes and/or dyslipidemia and (4) T2DM and/or cardiovascular disease (CVD). The homeostatic model assessment of insulin resistance v.2 (HOMA2-IR) was the reference standard, with the median of groups 1 and 2 serving as the cut point. Population-weighted receiver operating characteristic (ROC) curves were used to assess predictive accuracy, measured by area-under-the-curve (AUC) with the 95% confidence interval (CI).</div></div><div><h3>Results</h3><div>ROC analysis 1 included all 4 groups: AUC=0.720 (95% CI: 0.701, 0.739). Analysis 2 included only groups 1-3: AUC=0.704 (95% CI: 0.683, 0.726). Analysis 3 included only groups 1 and 2: AUC=0.663 (95% CI: 0.621, 0.704).</div></div><div><h3>Conclusions</h3><div>This study highlights the limited diagnostic accuracy of TG/HDL ratio as a marker of insulin resistance for individuals with early metabolic imbalance. This condition includes compensated insulin resistance in the absence of prediabetes, MetS, T2DM and CVD. More effective markers are needed to screen for EMI, a hidden risk factor for T2DM and 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":"142422729","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":"EMPOWERING BUFFALO: IMPROVING HYPERTENSION THROUGH FREE BLOOD PRESSURE MONITOR LOANING AND SHARED DECISION-MAKING","authors":"","doi":"10.1016/j.ajpc.2024.100819","DOIUrl":"10.1016/j.ajpc.2024.100819","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Therapeutic Area&lt;/h3&gt;&lt;div&gt;Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Hypertension is a serious health concern that can lead to heart disease and other complications. Despite the availability of proven methods for managing hypertension, recent data shows that blood pressure (BP) control in the US is declining. This highlights a gap between expert recommendations and real-world practice. To address this issue, our initiative focuses on serving underserved communities, specifically those the Hertel Elmwood Clinic serves. By loaning out blood pressure cuffs ( through AHA grants) and utilizing self-measured blood pressure monitoring, we aim to manage hypertension remotely. This approach has significant implications for empowering patients, improving outcomes, promoting continuity of care, and building resilience within care communities that cater to vulnerable populations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A cohort of 83 individuals diagnosed with hypertension were equipped with BP monitors to track their blood pressure. Patient charts were examined to gather demographic data and office BP readings for 1-3 months pre- and post-monitor distribution. Furthermore, a phone survey with 24 questions was administered to a subset of patients to assess their engagement and satisfaction levels. Responses were measured using a Likert scale and binary answers. The results were analyzed using descriptive statistics and paired t-tests.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;After conducting a thorough analysis of the data chart, the participants who received a blood pressure cuff and shared decision-making witnessed a remarkable reduction in their systolic BP by 11.7 mm Hg (P&lt;0.05, 5.15 to 7.54) and diastolic BP by 4.25 mm Hg (P&lt;0.05, 3.88 to 4.93). The participants comprised 66% females, with an average participant age of 61. The race distribution was 70% African American, 20% Caucasian, and 10% unreported. Most participants (90%) reported feeling empowered in their healthcare and other benefits.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In conclusion, the data presented in this study provides compelling evidence that delivering free BP monitors or BP machines covered by insurance to clinic patients is a highly effective strategy for improving health outcomes and patient engagement. The results demonstrate that removing cost barriers can significantly impact in-office BP reduction, BP monitoring, and patient satisfaction. This program benefits patients and healthcare providers by improving patient engagement and overall satisfaction. The success of this initiative highlights the importance of exploring and implementing novel approaches to healthcare that prioritize patient-centered care and address the financial and logistical barriers that can hinder effective hypertension management. Further research is needed to confirm the generalizability of these findings","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":"142422706","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":"PROGNOSTIC VALUE OF LIPOPROTEIN(A) FOR MAJOR ADVERSE CARDIOVASCULAR EVENTS IN RELATION TO C-REACTIVE PROTEIN - A SYSTEMATIC REVIEW AND META-ANALYSIS","authors":"","doi":"10.1016/j.ajpc.2024.100783","DOIUrl":"10.1016/j.ajpc.2024.100783","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Existing evidence supports an increased risk of Major Adverse Cardiovascular Events (MACE) with elevated lipoprotein(a) (Lp(a)) regardless of high sensitivity C-reactive protein (hs-CRP) levels. However, some studies have presented divergent results between primary and secondary prevention populations. A meta-analysis could yield a more definitive estimation of the joint influence of these biomarkers on MACE risk.</div></div><div><h3>Methods</h3><div>We performed a systematic review of studies evaluating the risk of MACE with elevated Lp(a) and hs-CRP (PROSPERO CRD4202345109). The primary outcome was the pooled hazard ratio (HR) of the association between Lp(a) and MACE among individuals with low (&lt;2mg/L) and high (≥2 mg/L) hs-CRP levels. We performed a subgroup analysis in primary and secondary prevention populations. A random effects model was used given the wide heterogeneity in studies.</div></div><div><h3>Results</h3><div>A total of seven studies were identified in the systematic review and included in the meta-analysis. The overall pooled sample comprised 558,914 individuals. The mean proportion of females was 37% and the weighted mean age for the entire cohort was 58.9 years. In individuals with elevated Lp(a), the risk of MACE was significantly increased across both low and high hs-CRP groups, with pooled hazard ratios (HR) of 1.24 (95% CI: 1.10–1.41) and 1.33 (95% CI: 1.19–1.49), respectively. In the primary prevention population, the pooled HR for low and high hs-CRP groups was 1.33 (95% CI: 1.06–1.66) and 1.43 (95% CI: 1.13–1.82), respectively, with a nonsignificant subgroup difference (P=0.65). The corresponding HR for the secondary prevention population was 1.10 (95% CI: 1.03–1.18) and 1.31 (95% CI: 1.09–1.57), respectively, with a non-significant subgroup difference (P=0.34) (Figure).</div></div><div><h3>Conclusions</h3><div>Our analysis confirms that elevated Lp(a) significantly elevates MACE risk across varying hs-CRP levels, underlining its relevance in both primary and secondary prevention cohorts.</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":"142422821","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":"IMPROVING COMMUNICATION OF 30-YEAR CARDIOVASCULAR DISEASE RISK ESTIMATES: AGE- AND SEX-STANDARDIZED PERCENTILES","authors":"","doi":"10.1016/j.ajpc.2024.100818","DOIUrl":"10.1016/j.ajpc.2024.100818","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>American Heart Association/American College of Cardiology primary prevention guidelines recommend estimation of 30-year cardiovascular disease (CVD) risk to guide clinician-patient discussions in younger adults. While the novel AHA PREVENT equations included 30-year risk models, interpretation of these risk estimates is challenging for both clinicians and patients. Standardized risk percentiles based on the U.S. population may provide a useful and accessible tool to optimize risk communication.</div></div><div><h3>Methods</h3><div>Using data from the 2011 to 2018 National Health and Nutrition Examination Surveys (NHANES) in U.S. adults aged 30-59 years, we estimated the population-level distribution of 30-year risk for CVD (which includes atherosclerotic CVD [ASCVD] and heart failure [HF]) using the AHA PREVENT equations. We calculated the 30-year risk corresponding to percentile ranks and generated age- and sex-specific standardized risk percentiles for CVD, ASCVD, and HF.</div></div><div><h3>Results</h3><div>Among 9,204 participants, representing approximately 109 million US adults, 34% were 30-39 years old, 31% were 40-49 years old, and 35% were 50-59 years old. The population-level distribution of 30-year risk for CVD, ASCVD, and HF was significantly higher in older age strata and in males compared with females (Figure). Among females, the 30-year absolute risk for CVD that represented the 75^th percentile (i.e., only 25% of age- and sex-matched peers would have higher risk) was 6% for 30 to 39- year-olds, 16% for 40 to 49-year-olds, and 29% for 50 to 59-year-olds. Among males, the 30-year absolute risk for CVD that represented the 75th percentile was 11% for 30 to 39-year-olds, 23% for 40 to 49-year-olds, and 33% for 50 to 59-year-olds. Similar patterns were observed for percentile distributions in 30-year risk estimates for ASCVD and HF.</div></div><div><h3>Conclusions</h3><div>Translation of PREVENT-based 30-year CVD, ASCVD, and HF risk estimates into age- and sex-standardized percentiles may offer a useful tool for clinicians and patients to interpret risk.</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":"142422834","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":"Remembering Dr. George L. Bakris: A pillar of cardiorenal medicine and mentorship","authors":"","doi":"10.1016/j.ajpc.2024.100728","DOIUrl":"10.1016/j.ajpc.2024.100728","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/S2666667724000965/pdfft?md5=b6ff057968abcc37597f0ebb5c8b56c9&pid=1-s2.0-S2666667724000965-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239142","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":"PATIENT EDUCATION FOR CORONARY ARTERY DISEASE PREVENTION: A LITERATURE REVIEW","authors":"","doi":"10.1016/j.ajpc.2024.100810","DOIUrl":"10.1016/j.ajpc.2024.100810","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>Coronary Artery Disease (CAD) is the most common manifestation of cardiovascular disease (CVD) related morbidity and mortality. Although billions of dollars have been spent on diagnostic and therapeutic innovations over the last two decades, it remains the number one cause of morbidity and mortality. Guidelines now explicitly recommend doctors to provide educational resources to optimize heart health. In this study, we perform a comprehensive review of the literature involving patient education-based interventions intended to prevent CAD. We hypothesize that media-based education on CAD may improve clinical outcomes compared to more traditional forms of education.</div></div><div><h3>Methods</h3><div>We conducted a review of the currently published manuscripts dating up to July 2023 using PubMed and Google Scholar. The search phrases used were “Patient Education,” “Educational Intervention,” and “Coronary Artery Disease Prevention”. The results were sorted by title and date. We compiled data from these studies with information about demographics, type of intervention, and results of the interventions. We discuss our major findings from the review as well as the limitations and future studies that may arise because of our findings.</div></div><div><h3>Results</h3><div>Eight studies were included in the review. The studies consisted of a variety of interventions such as video-based, phone call-based, smartphone-based, or pamphlet-based. Most patient education-based interventions regarding CAD lead to significant changes in behavior, knowledge, or in some cases, significant improvement in clinical outcomes. Overall, this did not depend on the specific type of intervention, nor the specific setting. When comparing the media-based interventions to the more traditional text-based or usual care groups, there was a trend toward more significant improvement in knowledge about CAD as well as improvement in modifiable risk factors such as BMI, blood pressure, or cholesterol.</div></div><div><h3>Conclusions</h3><div>Patient education is an important and effective means of not only improving patient quality of life, but also clinical outcomes. This review demonstrates that patient education may have significant implications to improve the individual and societal burden of CAD. With advancements in technology and a greater role of digital and social media in society, video-based interventions will be essential to invest in to advance the field of preventive cardiology.</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":"142422915","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":"ST ELEVATIONS DURING LEFT ATRIAL APPENDAGE OCCLUSION (LAAO) SECONDARY TO WATCHMAN DEVICE COMPRESSION OF THE LEFT CIRCUMFLEX (LCX) ARTERY: A CASE REPORT","authors":"","doi":"10.1016/j.ajpc.2024.100799","DOIUrl":"10.1016/j.ajpc.2024.100799","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Ischemic Stroke</div></div><div><h3>Case Presentation</h3><div>A 67-year-old male, with paroxysmal atrial fibrillation (AF), CHADS-VASc 3, and HAS-BLED 3, was admitted for elective WATCHMAN left atrial appendage occlusion (LAAO). Following transesophageal echocardiography (TEE) measurements of the left atrial appendage (LAA), the 24-mm WATCHMAN FLX was selected given manufacturer recommendation of 10-27% compression rate. During the procedure, initial device deployment was successful with appropriate position, compression, and closure in setting of a prominent pectinate ridge. However, within minutes, blood pressure dropped, and electrocardiogram (ECG) showed nonsustained ventricular tachycardia and inferolateral ST elevations. Device compression was 18-23% and shoulder was 0-20%; there was no flow around the device. In the 90° TEE view, device edge to left circumflex (LCx) artery measured 2.4 mm. Upon device recapture, hemodynamic and ECG abnormalities resolved quickly. There was no evidence of air embolism or left atrial thrombus. Given mechanical compression of LCx by a properly sized and positioned device, a decision was made to discontinue the procedure. Postoperative ECG and imaging showed no acute changes. Patient remained asymptomatic and hemodynamically stable upon discharge.</div></div><div><h3>Background</h3><div>Reducing stroke risk is paramount in patients with AF, though chronic anticoagulation confers a major bleeding risk. Research has consistently highlighted the comparable efficacy of percutaneous LAAOs to oral anticoagulation in preventing stroke among nonvalvular AF patients. WATCHMAN LAAOs have increased in prevalence since its approval by the Food and Drug Administration in 2015. Despite their relative safety, a rare yet critical complication involves compression of the LCx coronary artery.</div></div><div><h3>Conclusions</h3><div>This represents the second reported case of LCx coronary artery compression by a WATCHMAN, resulting in hemodynamic instability and acute ST elevations that resolved with device removal. This complication warrants vigilance as recognition should lead to device withdrawal. Further investigation into patient specific risk factors is warranted to stratify risk prior to device implantation. Individual differences, such as preexisting coronary artery disease and proximity of left coronary artery and its branches to LAA should be considered. While current guidelines recommend sizing devices up for over-compression to minimize peri-device leaks, our case highlights that even within recommended compression ratios, mechanical coronary artery compression remains a risk.</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":"142422965","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 PEAK METABOLIC WORKLOAD (METS) AND CARDIOVASCULAR MORBIDITY IN A LOW SOCIOECONOMIC POPULATION: A RETROSPECTIVE STUDY","authors":"","doi":"10.1016/j.ajpc.2024.100731","DOIUrl":"10.1016/j.ajpc.2024.100731","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>CVD Prevention – Primary and Secondary</div></div><div><h3>Background</h3><div>The non-linear correlation between peak metabolic workload and cardiovascular disease incidence is under scrutiny in this study, particularly within the low socioeconomic residents of South Bronx.</div></div><div><h3>Methods</h3><div>A retrospective examination of 190 patients subjected to cardiac graded treadmill stress testing and MET level evaluation between January 2007 and July 2023 was performed. Patients with incomplete testing, known heart disease, prior strokes, peripheral artery disease, severe systemic conditions, and pregnancy were excluded. Participants were segregated into low (&lt;5), moderate (5-8), and high (&gt;8) MET groups. The primary outcome was cardiovascular morbidity incidence. Data analysis was controlled for age, sex, cardiac disease family history, BMI, smoking, and DM, HTN, and HLD histories.</div></div><div><h3>Results</h3><div>Of the 190 participants, (47.9% females, 52.1% males, mean age 53 ± 14) 20 (11%) had at least one CV morbidity during the study period. Adjusted models demonstrated that patients with MET &gt;5 had 0.14 lower odds of a cardiovascular event than MET 5-8 patients (OR 0.86; 95% CI 0.20-3.82), whereas METS &gt;8 patients had 1.8 times higher odds (OR 1.8, CI 95% 0.51-6.46).</div></div><div><h3>Conclusions</h3><div>Among the low-income population, our findings challenge previous studies, suggesting a linear relationship between higher METs and increased cardiovascular events. This warrants further investigation to validate our findings.</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":"142422712","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":"PROGRESSIVE CORONARY ARTERY DISEASE, ELEVATED LP (A) REQUIRING LIPID APHERESIS","authors":"","doi":"10.1016/j.ajpc.2024.100793","DOIUrl":"10.1016/j.ajpc.2024.100793","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD /CVD Risk Reduction</div></div><div><h3>Case Presentation</h3><div>This is a 55-year-old female with a medical history of familial hypercholesterolemia, elevated lipoprotein (a) (Lp (a)), diabetes mellitus, myocardial infarction 2020, coronary artery disease with multiple percutaneous coronary intervention and status post coronary artery bypass surgery 2022, status post coronary brachytherapy for re-stenosis 2022, re-stenosis in 2023. The patient is on Rosuvastatin 40 mg, Ezetimibe 10mg, and Evolocumab 140 mg. Due to progressive coronary disease despite good medical therapy, the patient was referred for lipid apheresis (LA).</div></div><div><h3>Background</h3><div>This case demonstrates the accelerated effect of atherosclerosis mitigated by Lp(a). This patient developed progressive coronary artery disease (CAD), despite a low-density lipoprotein (LDL) of 85 mg/dl. Lp(a) is associated with increased risks of CAD, stroke, thrombosis, and aortic stenosis, particularly when greater than 125 nmol/L. Lp(a) has a pro-inflammatory effect, prothrombotic effect, and pro-atherosclerotic. Structurally similar to tissue plasminogen activator, which interferes with the natural pathways of thrombolysis. Currently, LA is the only treatment indicated for elevated Lp(a) in the setting of CAD and elevated cholesterol. The 2018 Cholesterol Guidelines state Lp(a) is a cardiovascular-enhancing risk feature. Evolocumab and Inclisiran can reduce Lp(a) up to 30 % but are not indicated as treatments. The European guidelines recommend LA for patients with elevated Lp(a) levels &gt; 60 mg/dl, and progressive atherosclerotic cardiovascular disease despite risk factors well controlled. LA can lower Lp(a) by 60 % and LDL up to 70 %.</div></div><div><h3>Conclusions</h3><div>LA should be regarded as a principal therapeutic option with elevated Lp(a) &gt;125nnmol/l in patients with progressive CAD despite maximal lipid-lowering therapy, aiming to achieve an LDL &lt; 70 mg/dl and reduce Lp(a) &gt; 60 % to mitigate other cardiovascular risk outcomes. A 70 % risk reduction in major adverse cardiovascular events in the first year of treatment was reported by the German Lipid Apheresis Registry. Lp(a) treatment options Pelacarsen and Olpasiran will not be available in the near future. These agents may change the need to do LA. This patient with progressive CAD, multiple interventions with very high Lp(a) benefitted from LA with greater than 80 % reduction in Lp(a) levels. Rise in Lp(a) bi-weekly, will require weekly treatments.</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":"142423110","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}