American journal of preventive cardiology最新文献

{"title":"Social determinants of health and cardiovascular health across female life stages: Reproductive and midlife women in the National Health Interview Survey","authors":"Bede N. Nriagu , Shiwani Mahajan , Yaa Adoma Kwapong , Samuel A. Ayedun , Huzaifa Faizan , Muhammad Khalid Tahir , Faith E. Metlock , Lily Dastmalchi , Zulqarnain Javed , Garima Sharma","doi":"10.1016/j.ajpc.2026.101552","DOIUrl":"10.1016/j.ajpc.2026.101552","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"27 ","pages":"Article 101552"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the mindfulness-based blood pressure reduction (MB-BP) program on cardiovascular health: A randomized clinical trial","authors":"Fan Wu ,&nbsp;LaPrincess C. Brewer ,&nbsp;Vinicius V. Neves ,&nbsp;Matthew M. Scarpaci ,&nbsp;Frances B. Saadeh ,&nbsp;Jeffrey A. Proulx ,&nbsp;Eric B. Loucks","doi":"10.1016/j.ajpc.2026.101584","DOIUrl":"10.1016/j.ajpc.2026.101584","url":null,"abstract":"<div><h3>Background</h3><div>Mindfulness-based interventions may improve cardiovascular health (CVH) by supporting behavioral change across multiple risk factors. This study evaluated the impact of Mindfulness-Based Blood Pressure Reduction (MB-BP), a mindfulness program targeting hypertension-related behaviors, on CVH using the American Heart Association’s Life’s Essential 8 framework.</div></div><div><h3>Methods</h3><div>This secondary analysis of parallel-group, phase 2 randomized clinical trial evaluated the effects of MB-BP on CVH in 201 participants with elevated office BP (≥120/80 mmHg). The MB-BP group (n=101) received an 8-week program focused on mindfulness training and education targeting diet, physical activity, medication adherence, alcohol use, and stress, whereas the control group (n=100) received enhanced usual care. CVH was assessed using available Life’s Essential 8 components: systolic blood pressure, body mass index (BMI), diet (DASH adherence), physical activity, smoking, and sleep duration. Generalized estimating equations evaluated intervention effects through six months.</div></div><div><h3>Results</h3><div>At six months follow-up, MB-BP participants significantly improved composite CVH scores compared to controls (standardized mean difference: 0.144; 95% CI: 0.023, 0.266). MB-BP influenced most CVH components in healthier directions at trend levels, with the strongest responses for physical activity (47.9 MET min/week; 95% CI: -16.5, 112.3), sleep (0.34 hours/night; 95% CI: -0.10, 0.78), systolic blood pressure (-4.95 mmHg; 95% CI: -10.34, 0.44) and DASH diet score (0.27, 95% CI: -0.15, 0.69).</div></div><div><h3>Conclusions</h3><div>MB-BP led to modest but clinically relevant improvements in CVH, driven by multiple Life’s Essential 8 components. These findings suggest that MB-BP may be an effective behavioral intervention to support CVH and reduce risk for cardiovascular disease.</div><div><strong>ClinicalTrials.gov Preregistration Identifiers:</strong> NCT03256890, NCT03859076</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"27 ","pages":"Article 101584"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195686","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":"Maternal pre-pregnancy BMI, gestational weight gain, and the cardiovascular stress response in the adolescent offspring","authors":"Arwen S.J. Kamphuis ,&nbsp;Alexander Hirsch ,&nbsp;Ricardo P.J. Budde ,&nbsp;Arno A.W. Roest ,&nbsp;Vincent W.V. Jaddoe ,&nbsp;Romy Gaillard","doi":"10.1016/j.ajpc.2026.101606","DOIUrl":"10.1016/j.ajpc.2026.101606","url":null,"abstract":"<div><h3>Background</h3><div>Maternal pre-pregnancy overweight and excessive gestational weight gain (GWG) are important risk factors for cardiovascular disorders in offspring. Underlying mechanisms remain unclear, but may involve structural and functional cardiovascular developmental adaptions. To detect subtle cardiovascular adaptations not present at rest, exercise testing can be used. We examined the associations of maternal pre-pregnancy BMI and GWG with the cardiovascular stress response in adolescent offspring.</div></div><div><h3>Methods</h3><div>Among 180 mother-adolescent-pairs from a population-based prospective cohort from early-pregnancy onwards, we obtained maternal pre-pregnancy BMI and GWG by physical measurements and questionnaires. At 16 years, offspring performed an isometric handgrip exercise with continuous heart rate and blood pressure (BP) monitoring and cardiovascular MRI.</div></div><div><h3>Results</h3><div>Maternal pre-pregnancy overweight was associated with higher adolescent peak systolic BP (compared to maternal normal weight: difference: 0.45SDS, 95% confidence interval:0.12–0.78 SDS), but not with systolic BP at rest or recovery. This association was also present across-the-full-range of maternal pre-pregnancy BMI and not explained by birth characteristics or adolescent BMI. No differences were observed in heart rate or diastolic BP response to exercise by maternal pre-pregnancy BMI across-the-full-range, in clinical categories or by GWG. Higher GWG across-the-full-range, but not maternal pre-pregnancy BMI or excessive GWG, was associated with higher left ventricular stroke volume, ejection fraction, and cardiac index during stress (all p-values&lt;0.05). These associations were not explained by birth characteristics or adolescent BMI.</div></div><div><h3>Conclusions</h3><div>Higher maternal pre-pregnancy BMI and GWG across-the-full-range are associated with higher systolic BP at peak exercise and an altered cardiac response to exercise in adolescent offspring, respectively. Optimizing maternal weight before and during pregnancy may aid in prevention of cardiovascular risk development in offspring.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"27 ","pages":"Article 101606"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195688","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":"Body mass index and waist-hip ratio – Risk factors for aortic valve disease: The atherosclerosis risk in communities (ARIC) study","authors":"Chunxiao Zhang ,&nbsp;Ethan Moser ,&nbsp;Anne Eaton ,&nbsp;Jeremy Van’t Hof ,&nbsp;Weihong Tang ,&nbsp;Amil Shah ,&nbsp;Aaron R. Folsom ,&nbsp;Lin Yee Chen","doi":"10.1016/j.ajpc.2026.101600","DOIUrl":"10.1016/j.ajpc.2026.101600","url":null,"abstract":"<div><h3>Background</h3><div>Elevated body mass index (BMI) has been associated with increased risk of aortic valve stenosis (AS) in observational and Mendelian randomization studies; however, its association, and that of waist-hip ratio (WHR), with aortic valve insufficiency (AI) remains unclear. We investigated the association of BMI and WHR with incident aortic valve disease (AVD) in the ARIC Study.</div></div><div><h3>Methods</h3><div>We analyzed ARIC participants with echocardiograms at Visits 5 (2011–13) and 7 (2018–19). BMI and WHR were assessed at Visit 5. Incident AVD between Visits 5 and 7 was categorized as aortic valve sclerosis, AI without stenosis, and AS. Multinomial regression models were employed.</div></div><div><h3>Results</h3><div>Among 1931 participants (mean age of 73.5 ± 4.2 years, 59.7% female, and 23.2% Black), 572 (29.6%) developed AVD (345 aortic valve sclerosis, 159 AI, and 68 AS). Higher BMI was associated with a greater incidence of aortic valve sclerosis (OR: 1.29 per 1-SD (5.08 kg/m2), 95% CI: 1.13–1.48) and AS (OR: 1.28, 95% CI: 1.00–1.63), but not AI (OR: 0.93, 95% CI: 0.75–1.14). Higher WHR was associated with an increased risk of incident aortic valve sclerosis (OR: 1.17 per 1-SD (0.079), 95% CI: 1.00–1.35), AS (OR: 1.44, 95% CI: 1.11–1.85), and also AI (OR: 1.24, 95% CI: 1.01–1.53).</div></div><div><h3>Conclusions</h3><div>Higher BMI is a risk factor for incident aortic valve sclerosis and AS, but not AI. Greater WHR is a risk factor not only for incident aortic valve sclerosis and AS, but also for incident AI. Avoiding abdominal obesity may prevent non-rheumatic AVD in older adults.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"27 ","pages":"Article 101600"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195690","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":"Effects of anti-inflammatory agents on cardiovascular outcomes: A systematic review and meta-analysis of randomised controlled trials","authors":"A Perkovic ,&nbsp;ER Webster ,&nbsp;PM Ridker ,&nbsp;KR Tuttle ,&nbsp;V Perkovic ,&nbsp;BL Neuen","doi":"10.1016/j.ajpc.2026.101642","DOIUrl":"10.1016/j.ajpc.2026.101642","url":null,"abstract":"<div><h3>Background</h3><div>Inflammation is causally implicated in the development and progression of atherosclerotic cardiovascular disease, but clinical trials of anti-inflammatory therapies have yielded inconsistent effects on cardiovascular outcomes.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis to evaluate the cardiovascular efficacy and safety of a broad range of anti-inflammatory agents. Medline, Embase and Cochrane databases were searched from inception to 08 October 2024 for randomised controlled trials evaluating the effect of anti-inflammatory therapies on a primary cardiovascular outcome with at least 100 patient-years follow-up per treatment arm. Trial level meta-analysis was performed using a random effects model. The primary outcome was major adverse cardiovascular events (MACE); other outcomes included myocardial infarction, stroke, heart failure, serious adverse events, infection, and malignancy.</div></div><div><h3>Results</h3><div>Thirteen trials enrolling 82,208 participants were included. The effect of anti-inflammatory agents on MACE varied by drug class (P-heterogeneity=0.049), driven primarily by benefits observed with colchicine (RR 0.76; 95 % CI 0.65–0.90; moderate certainty) and canakinumab (RR 0.88; 95 % CI 0.79–0.97; moderate certainty), with no benefit observed for other agents. Among colchicine trials, heterogeneity was identified (P-heterogeneity=0.003), and subgroup analyses suggested greater benefit in coronary artery disease and/or recent myocardial infarction trials (P-heterogeneity=0.068). Safety outcomes also varied by drug class, with significant heterogeneity in serious adverse events (P-heterogeneity=0.005), largely attributable to methotrexate, and some evidence of heterogeneity for infection (P-heterogeneity=0.076) and malignancy (P-heterogeneity=0.077).</div></div><div><h3>Conclusion</h3><div>Some anti-inflammatory agents may reduce the risk of cardiovascular outcomes, but their effects appear to vary substantially across drug classes, with important differences in both efficacy and safety. These findings underscore the need for rigorous evaluation of new anti-inflammatory therapeutics to ascertain benefits and harms across different populations and therapeutic indications.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"27 ","pages":"Article 101642"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195780","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":"The changing identity of preventive cardiology: from risk factors to risk phenotypes","authors":"Michael D. Shapiro","doi":"10.1016/j.ajpc.2026.101660","DOIUrl":"10.1016/j.ajpc.2026.101660","url":null,"abstract":"","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"27 ","pages":"Article 101660"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148196005","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":"Improving the clinical diagnosis of familial hypercholesterolemia among patients attending diabetes and cardiology clinics","authors":"Salman M. Toor ,&nbsp;Ralph K. Akyea ,&nbsp;Shaban Mohammed ,&nbsp;Moza S.H. Al Hail ,&nbsp;Ayman El-Menyar ,&nbsp;Mohammed Gomaa ,&nbsp;Amin Jayyousi ,&nbsp;Jassim M. Al Suwaidi ,&nbsp;Nadeem Qureshi ,&nbsp;Omar M.E. Albagha","doi":"10.1016/j.ajpc.2026.101431","DOIUrl":"10.1016/j.ajpc.2026.101431","url":null,"abstract":"<div><h3>Background and aims</h3><div>Familial Hypercholesterolemia (FH) is a common autosomal dominant disorder that remains largely underdiagnosed globally (&lt;10 %). Suspected FH cases are commonly identified using the Dutch Lipid Clinic (DLCN) and Simon Broome (SB) criteria, while the FH case ascertainment tool (FAMCAT) has been recently developed as a predictive algorithm for improving FH detection. Qatar has a high FH prevalence (1 in 125) in the general population. We determined FH prevalence and compared clinical presentation among Qatari patients with diabetes and heart disease, and between sexes.</div></div><div><h3>Methods</h3><div>We applied the DLCN and SB criteria, and FAMCAT algorithm on data captured from a clinical cohort of native Qatari subjects (<em>n</em> = 501), recruited from two hospital-based clinics: diabetes and cardiology.</div></div><div><h3>Results</h3><div>DLCN criteria stratified 12.6 % (95 % CI [10.0, 15.8]) as definite and 21.8 % [18.4, 25.6] as probable FH cases. SB classified 4.8 % [3.2, 7.0] as definite and 17.2 % [14.1, 20.7] as possible FH, while FAMCAT identified 35.5 % [31.5, 39.8] as suspected FH cases. DLCN showed a higher incidence of definite/probable FH in the diabetes clinic, while SB and FAMCAT identified similar proportion of definite/suspected FH cases between clinics. The three tools showed similar FH stratification between sexes.</div></div><div><h3>Conclusions</h3><div>The prevalence of likely FH cases among diabetes and cardiology patients in Qatar was estimated at ∼1 in 3–4 patients, depending on the diagnostic criteria. Applying FH case-finding tools in hyperlipidemia patients can enhance detection rates and help mitigate FH-related morbidity and mortality through timely intervention.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"27 ","pages":"Article 101431"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148196099","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":"AI-CVD-HF: A heart failure risk prediction model based on coronary artery calcium scans compared with PREVENT-HF","authors":"Seyed Reza Mirjalili ,&nbsp;Kyle Atlas ,&nbsp;Anthony P. Reeves ,&nbsp;Chenyu Zhang ,&nbsp;Jakob Wasserthal ,&nbsp;Amir Azimi ,&nbsp;Ali Hashemi ,&nbsp;Mohammadhossein Mozafarybazargany ,&nbsp;Amir Ghaffari Jolfayi ,&nbsp;Thomas Atlas ,&nbsp;Claudia I. Henschke ,&nbsp;David F. Yankelevitz ,&nbsp;Javier J. Zulueta ,&nbsp;Wenjun Fan ,&nbsp;Jeffrey I. Mechanick ,&nbsp;Andrea D. Branch ,&nbsp;Zahi Fayad ,&nbsp;Michael V. McConnell ,&nbsp;Jamal S. Rana ,&nbsp;Rozemarijn Vliegenthart ,&nbsp;Morteza Naghavi","doi":"10.1016/j.ajpc.2026.101464","DOIUrl":"10.1016/j.ajpc.2026.101464","url":null,"abstract":"<div><h3>Background</h3><div>The AI-CVD initiative seeks to extract actionable information from coronary artery calcium (CAC) scans beyond the CAC score. We aimed to develop a heart failure (HF) prediction model, AI-CVD-HF, based on AI-derived features from non-contrast CAC scans, and compare it with PREVENT-HF.</div></div><div><h3>Method</h3><div>AI features from CAC scans of 6743 asymptomatic participants in the Multi-Ethnic Study of Atherosclerosis (MESA) and Framingham Heart Study–Offspring (FHS-O) (mean age 62.3 ± 10.1; 47.2% male; median follow-up 17.1 years; 429 HF events) were analyzed. Features were selected using random forest and modeled with random survival forest. Performance was assessed against the base PREVENT-HF using 5-fold cross-validation for area under the receiver-operating-characteristic curve (AUC), area under the precision-recall curve (AUPRC), net-benefit, and calibration. External validation experiment was conducted to assess generalizability.</div></div><div><h3>Results</h3><div>Selected features for AI-CVD-HF model included AI-CAC score, left-to-right ventricular volume ratio, left atrial volume, left ventricular mass, visceral fat volume, skeletal muscle mean density, thoracic aortic calcification, age and sex. The 10-year AUC of AI-CVD-HF was 0.83 (95% CI:0.81–0.85), compared with PREVENT-HF (0.79, 95% CI:0.75–0.83; <em>p</em> = 0.01) and also demonstrated 32% higher AUPRC (0.25[95% CI:0.11–0.39] vs 0.19[95% CI:0.07–0.31]; <em>p</em> = 0.049), and consistent performance across age, sex, and race/ethnicity. Calibration metrics favored AI-CVD-HF over PREVENT-HF (Brier score [0.0356 vs 0.0383], slope [1.02 vs 1.20]). External validation showed performance and calibration consistent with internal validation.</div></div><div><h3>Conclusions</h3><div>AI-CVD-HF, using AI-derived features from CAC scans, demonstrated more favorable discrimination and calibration than PREVENT-HF for HF prediction, extending the utility of CAC scans beyond coronary artery disease risk assessment.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"27 ","pages":"Article 101464"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148196101","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":"Marathon running pace immediately before sudden cardiac arrest","authors":"Jo Kato ,&nbsp;Tomohiro Manabe ,&nbsp;Fumihiro Yamasawa","doi":"10.1016/j.ajpc.2025.101390","DOIUrl":"10.1016/j.ajpc.2025.101390","url":null,"abstract":"<div><h3>Background</h3><div>Sudden cardiac arrest (SCA) is a rare but catastrophic event that can occur during long-distance road races. Although habitual training mitigates SCA risk, it remains uncertain whether running pace on race day can help identify susceptible individuals.</div></div><div><h3>Methods</h3><div>We prospectively collected cases of SCA in Japan Association of Athletics Federations (JAAF)-certified full marathons between April 2011 and March 2020. Collapses during or within 1 hour after races that required basic life support were included. Running pace was calculated from the last available split or finish time, and expected completion times were compared with age- and sex-stratified marathon ranking data. Predicted finish time percentiles were evaluated within subgroups defined by calendar year, sex, age group, and location of collapse (race tertile or postfinish).</div></div><div><h3>Results</h3><div>Among 4.53 million starters in 571 marathons, 74 SCA cases were identified (1.6/100,000). The median age was 52 years, and 93% were men. Over half of the events occurred in the final tertile or immediately postfinish. The median pace was 10 minutes 25 seconds per mile (interquartile range: 9:15–12:13), with an extrapolated finish time of 4 hours 33 minutes, corresponding to the 48th percentile in population rankings. Females and those collapsing in the latter part of the race tended to occupy higher percentile ranks than the general finisher distribution.</div></div><div><h3>Conclusions</h3><div>Marathon-related SCA occurred at running speeds indistinguishable from the general finisher population, challenging the assumption that less conditioned runners are particularly at risk of SCA.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101390"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928856","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":"Immune-mediated inflammatory disease and coronary calcium: Elevated baseline risk and attenuated prognostic gradient","authors":"Prerna Singh ,&nbsp;Michael D. Glidden ,&nbsp;Santosh Sirasapalli ,&nbsp;Sai Ponnana ,&nbsp;Neda Shafiabadi Hassani ,&nbsp;Christos P. Kotanidis ,&nbsp;Abigail Wilgor ,&nbsp;Brittany N. Weber ,&nbsp;David L. Wilson ,&nbsp;Sanjay Rajagopalan","doi":"10.1016/j.ajpc.2026.101434","DOIUrl":"10.1016/j.ajpc.2026.101434","url":null,"abstract":"<div><h3>Background</h3><div>Immune-mediated inflammatory diseases (IMID) are associated with accelerated atherosclerosis, yet it is unclear whether CT coronary artery calcium scoring (CTCS) captures this excess cardiovascular risk accurately. We hypothesized that in adults undergoing CTCS, IMID modifies the relationship between coronary artery calcium (CAC) score and incident major adverse cardiac events (MACE).</div></div><div><h3>Methods</h3><div>Among 43,420 individuals in the CLARIFY Registry (University Hospitals Cleveland, 2014–2020) who underwent no-cost CTCS scans, we identified 545 individuals with IMID. After propensity-score matching on age, sex, race, hypertension, diabetes, and smoking status with a 2:1 ratio, 1635 matched individuals were analyzed (545 with IMID and 1090 matched non-IMID controls). CAC was categorized as 0, 1–99, 100–399, ≥400. The primary outcome of 4-point MACE was analyzed over a median 4.2-year follow-up. Cox models tested CAC categories compared to CAC 0, stratified by IMID. Additionally, a log(CAC+1) × IMID interaction term was modeled, to assess whether the risk gradient of CAC differed by IMID status.</div></div><div><h3>Results</h3><div>Individuals with IMID exhibited over twice the MACE incidence of matched controls (40.8 vs 17.6 per 1000 person-years). Among those with zero CAC, those with IMID had a three-fold higher event rate (21.98 vs 7.18 per 1000 person-years). In controls, MACE risk rose stepwise with CAC, quadrupling from CAC 0 to ≥400 (adjusted HR = 4.74; <em>p</em> &lt; 0.001), whereas in IMID increasing CAC conferred no significant gradient (<em>p</em> = 0.21). The interaction between CAC and IMID was significant (β = –0.27; HR 0.76, 95% CI 0.55–1.00), indicating an attenuated CAC-MACE relationship in IMID.</div></div><div><h3>Conclusion</h3><div>In IMID, baseline risk is elevated even with zero CAC, with attenuation of the traditional CAC-risk gradient observed in non-IMID controls. These findings suggest that, in IMID (1) a CAC score of zero may not guarantee low cardiovascular risk and (2) CAC has less incremental prognostic value than in the general population.</div></div>","PeriodicalId":72173,"journal":{"name":"American journal of preventive cardiology","volume":"26 ","pages":"Article 101434"},"PeriodicalIF":5.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146079318","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}