American journal of preventive cardiology最新文献

{"title":"LIPOPROTEIN(A) ELEVATIONS COMMON, BUT NOT HIGHER IN GENOTYPE POSITIVE FAMILIAL HYPERCHOLESTEROLEMIA VERSUS GENOTYPE NEGATIVE INDIVIDUALS WITH HYPERLIPIDEMIA, IN PATIENTS REFERRED TO A DEDICATED CARDIOVASCULAR GENETIC COUNSELING CLINIC","authors":"","doi":"10.1016/j.ajpc.2024.100768","DOIUrl":"10.1016/j.ajpc.2024.100768","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] is an apob100 containing lipoprotein with athero- and thrombogenic potential with a global population prevalence estimated at 20%. Previous research has presented conflicting data on whether individuals with genotype positive (Gene+) familial hypercholesterolemia (FH) are more likely to have elevated Lp(a) (≥50 mg/dL) vs genotype negative (Gene-) individuals.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of a 200 individual cohort of patients referred to be seen by the Intermountain Medical Center Cardiovascular Genetic Counseling clinic from 2018 to 2024 who had Lp(a) measurements (mg/dL) and underwent full gene sequencing and deletion/duplication analysis of the APOB, LDLR, LDLRAP1, and PCSK9 genes using next-generation sequencing technologies. The Lp(a) measurements were compared between 56 gene+ individuals and 144 gene- individuals.</div></div><div><h3>Results</h3><div>Of the 56 gene+ individuals, 21 had an Lp(a) ≥50 mg/dL (37.5%). Of the 144 gene- individuals, 61 had an Lp(a) ≥50 mg/dL (42.4%). Using Pearson's Chi-Squared Test, we calculated the chi-square value of 0.53.</div></div><div><h3>Conclusions</h3><div>The prevalence of elevated Lp(a) was nearly double (37.5% and 42.4%) than is estimated in the general population. However, the difference in proportion of patients with elevated Lp(a) between gene+ and gene- patients was not statistically significant. These findings reaffirm the importance of screening for elevated Lp(a) in all patients, regardless of genotype status.</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":"142422732","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":"PROVIDER-LEVEL VARIATION IN NOVEL CARDIOVASCULAR MEDICATION PRESCRIPTION AMONG PATIENTS HOSPITALIZED FOR HEART FAILURE AND CORONARY ARTERY DISEASE IN THE VETERANS AFFAIRS SYSTEM","authors":"","doi":"10.1016/j.ajpc.2024.100828","DOIUrl":"10.1016/j.ajpc.2024.100828","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research</div></div><div><h3>Background</h3><div>Novel therapies such as angiotensin receptor-neprilysin inhibitors (ARNI), sodium-glucose cotransporter-2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have well-established benefit for patients with heart failure (HF) and coronary artery disease (CAD), but use remains low. We aimed to characterize provider-level variation in the use of these medications in the Veterans Health Administration (VA).</div></div><div><h3>Methods</h3><div>Using VA health record and administrative data, two patient cohorts were retrospectively identified with hospitalization from 2017-2023 for either HF or CAD with concurrent Type 2 diabetes (T2D). Provider-level data for use of ARNI and SGLT2i for HF and SGTL2i or GLP-1 RA for CAD+T2D were assessed, including at hospital admission, discharge, or within 6 months of discharge. Providers were considered users if they had an outpatient visit with a patient who had a filled prescription for a given medication within 6 months of discharge, regardless of when or by whom the prescription was written. Providers with above-median utilization for all 3 classes were considered high utilizers. Histograms and adjusted median odds ratios were used to characterize provider-level variability in prevalent use of novel medications by medical subspecialty.</div></div><div><h3>Results</h3><div>The HF and CAD+T2D cohorts included 83,849 and 71,678 unique patients, respectively, with 14,645 providers. Distributions of providers by prevalent use of each respective medication class are shown by medical subspecialty in the Figure. Mean prevalent use over the study period ranged from 17-44% for a given specialty and medication class. Most providers had &lt;50% use of each medication class, though there were smaller numbers of providers with near-100% prevalent use of novel medications. Endocrinology and cardiology had the highest proportions of high utilizers (44% and 39%, respectively, compared with 24% and 15% for primary care and nephrology). Adjusted median odds ratios across all providers over the full study period were 1.7 and 1.8 for ARNI and SGLT2i in the HF cohort and 1.8 in the CAD+T2D cohort.</div></div><div><h3>Conclusions</h3><div>Cardiologists and endocrinologists were mostly likely to use novel cardiovascular medications, but there was substantial provider-level variation across all prescribing subspecialities. Further research is needed to identify implementation strategies to improve uptake among all providers.</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":"142423107","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":"COMORBIDITIES AND PROCEDURAL OUTCOMES IN STEMI PATIENTS WITH AND WITHOUT A HISTORY OF DRUG ABUSE","authors":"","doi":"10.1016/j.ajpc.2024.100794","DOIUrl":"10.1016/j.ajpc.2024.100794","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Factors</div></div><div><h3>Background</h3><div>Patients with a history of drug abuse are at increased risk for cardiovascular events, including ST-segment elevation myocardial infarction (STEMI). However, the prevalence of comorbidities and procedural outcomes in this population remain understudied. This study aimed to compare the prevalence of comorbidities and procedural outcomes in STEMI patients with and without a history of drug abuse.</div></div><div><h3>Methods</h3><div>A total of 180,265 patients diagnosed with STEMI in 2020 with NIS data using SPSS were included in this registry study. Patients were categorized into two groups: those with a history of drug abuse (n=8,843; 4.9%) and those without (n=171,422; 95.1%). The prevalence of comorbidities, including congestive heart failure, diabetes, and renal failure, was compared between the two groups using odds ratios (OR) and 95% confidence intervals (CI). Procedural outcomes, such as percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG), were also analyzed.</div></div><div><h3>Results</h3><div>Drug users had a higher prevalence of congestive heart failure (69% vs. 62%) and renal failure (31% vs. 39%) compared to non-drug users. However, diabetes was less prevalent among drug users (14% vs. 43%). Non-drug users with congestive heart failure had higher odds of mortality (OR 1.353, 95% CI: 1.301-1.408) compared to those without, while drug users had lower odds (OR 0.724, 95% CI: 0.581-0.902). No significant differences in mortality odds were observed for diabetes in either group. Non-drug users with renal failure had higher odds of mortality (OR 1.266, 95% CI: 1.218-1.314), while drug users exhibited no significant change. Among patients undergoing procedures, non-drug users had higher rates of single-vessel PCI (0.436% vs. 0.339%), double-vessel PCI (0.080% vs. 0.034%), and single-vessel CABG (0.046% vs. 0.034%) compared to drug users.</div></div><div><h3>Conclusions</h3><div>This study highlights the differences in comorbidities and procedural outcomes between STEMI patients with and without a history of drug abuse. Drug users had a higher prevalence of congestive heart failure and renal failure but a lower prevalence of diabetes compared to non-drug users. Non-drug users with congestive heart failure and renal failure had higher odds of mortality, while drug users had lower or no significant change in mortality odds. Non-drug users also had higher rates of PCI and CABG procedures compared to drug users. These findings emphasize the need for tailored management strategies considering the unique comorbidity profiles and procedural outcomes in STEMI patients with a history of drug abuse.</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":"142423023","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":"INCIDENTAL CORONARY ARTERY CALCIUM REPORTING ON CHEST CT SCANS USING NATURAL LANGUAGE PROCESSING: INSIGHTS FROM VETERANS HEALTH ADMINISTRATION","authors":"","doi":"10.1016/j.ajpc.2024.100763","DOIUrl":"10.1016/j.ajpc.2024.100763","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 the strongest predictor of cardiovascular events. CAC can be identified on non-cardiac chest CTs, but reporting is inconsistent. We developed a natural language processing (NLP) algorithm to identify incidental CAC reporting on non-gated chest CT reports and described patterns in CAC reporting across the Veterans Health Administration (VHA).</div></div><div><h3>Methods</h3><div>We identified non-cardiac CT scan reports across the VHA between 2006-2024. We developed an NLP algorithm by creating Regex rules to detect mentions of CAC (none, mild, moderate, severe, or unclassified). We manually annotated 1,060 reports as the gold standard for algorithm development. We iteratively refined an NLP algorithm based on accuracy with the development scans. We validated the algorithm's performance on an independent sample of 1,000 scans and applied the algorithm to all non-cardiac chest CTs in the VHA over the study period. We described the frequency of CAC reporting over time in addition to facility-level variation.</div></div><div><h3>Results</h3><div>Across 1,000 validation reports, the algorithm had a sensitivity of 99% and a positive predictive value (PPV) of 94% for CAC being mentioned in the CT report. Among reports in which CAC was mentioned, the algorithm had a 99% sensitivity and 97% PPV for correctly noting the presence of CAC. The algorithm had a 96% accuracy for correctly detecting the reported CAC severity.</div><div>There were 6,825,889 non-cardiac chest CTs between January 2006 and March 2024 in the VHA. The presence or absence of CAC was described in 2,519,296 reports (37%). CAC reporting was highest among lung cancer screening CTs (49%). CAC reporting increased over time (Table). In 2023, reporting ranged from 0% to 63% across 128 VA facilities.</div><div>Among CTs that reported CAC presence or absence, CAC was described as present on 2,425,416 reports (96%). Among CTs that reported CAC presence, CAC severity was unclassified in 56%, mild in 16%, moderate in 13%, and severe in 15% of scans.</div></div><div><h3>Conclusions</h3><div>CAC is not reported on a majority of non-cardiac chest CTs in a large national cohort, but reporting is increasing over time. Strategies to improve CAC reporting or leverage emerging automated CAC detection algorithms are needed.</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":"142422715","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":"CARDIAC INPATIENTS ARE HIGHLY INTERESTED IN VIRTUAL CARDIAC REHABILITATION","authors":"","doi":"10.1016/j.ajpc.2024.100797","DOIUrl":"10.1016/j.ajpc.2024.100797","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Rehabilitation</div></div><div><h3>Background</h3><div>Cardiac rehabilitation (CR) improves cardiovascular health and decreases hospital readmissions; unfortunately, it is widely underused by patients. Digital health interventions offer a potential solution to increase participation in CR. However, patients’ interest and concerns regarding virtual CR have not been fully explored.</div></div><div><h3>Methods</h3><div>A Qualtrics survey was administered to cardiac inpatients in the progressive cardiac care unit at Johns Hopkins Hospital from 2020-2024. This study included English-speaking patients, &gt;18 years of age who met medical eligibility for CR. One-way ANOVA, Chi-square, and Fisher's Exact test were used to assess differences in interest in engaging in virtual CR by age, sex, and race, respectively.</div></div><div><h3>Results</h3><div>A total of 150 cardiac inpatients were included: age 64 ± 13 years, 62% (93/150) male, 57% (85/150) White, and 41% (61/150) completing a 4-year degree or higher. 93% (139/150) of patients reported owning a smartphone. The patients reported that their primary barriers to CR participation were traveling to the CR center (49%, 73/150), costs/insurance coverage (29%, 44/150), and a tight schedule (28%, 42/150). Notably, the majority of patients (71%, 107/150) expressed interest in engaging in virtual CR. Interest in virtual CR did not differ by age (p=0.35) or sex (p=0.49); however, Black (90%, 46/51) and Asian (83%, 5/6) adults reported being more interested in virtual CR than White (61%, 52/85) adults (p&lt;0.001). While 39% of patients (58/150) felt less safe exercising at home compared to a supervised center, 83% (48/58) of these patients reported they would feel more confident exercising at home if able to communicate by phone with specialized staff during training sessions. Additionally, 39% (58/150) of patients expressed concerns about decreased motivation training alone at home; however, 52% (30/58) of these patients felt group calls with other patients could enhance engagement.</div></div><div><h3>Conclusions</h3><div>Virtual CR may advance health equity by overcoming traditional barriers to participation, with the majority of patients, especially Black and Asian adults, expressing interest. High prevalence of smartphone ownership suggests this may be feasible. Virtual CR efforts should focus on addressing safety concerns and enhancing motivation via direct communication with staff and other patients.</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":"142423025","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":"ASPC_2025FellowsJournalAd_082124","authors":"","doi":"10.1016/S2666-6677(24)00234-4","DOIUrl":"10.1016/S2666-6677(24)00234-4","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/S2666667724002344/pdfft?md5=8009b79c4acaf85266e28713eba78ff7&pid=1-s2.0-S2666667724002344-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270755","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":"Gender disparities in utilization of statins for low density lipoprotein management across the spectrum of atherosclerotic cardiovascular disease: Insights from the houston methodist cardiovascular disease learning health system registry","authors":"","doi":"10.1016/j.ajpc.2024.100722","DOIUrl":"10.1016/j.ajpc.2024.100722","url":null,"abstract":"<div><h3>Introduction</h3><p>Lower statin utilization is reported among women compared to men, however large-scale studies evaluating gender disparities in LDL-C management in individuals with ASCVD and its subtypes remain limited, particularly across age and racial/ethnic subgroups. In this study, we address this knowledge gap using data from a large US healthcare system.</p></div><div><h3>Methods</h3><p>All adult patients with established ASCVD in the Houston Methodist Learning Health System Registry during 2016–2022 were included. Statin use and dose were extracted from the database. The association between gender and statin utilization was evaluated using multivariate logistic regression analyses in patients with ASCVD overall, across ASCVD subtypes, and by age, racial/ethnic subgroups, and socioeconomic risk factors.</p></div><div><h3>Results</h3><p>A total of 97,819 patients with prevalent ASCVD were included. Women with ASCVD had lower utilization of any statin (64.3% vs 72.6 %; <em>p</em> &lt; 0.001) and high-intensity statin (29.8% vs 42.5 % <em>p</em> &lt; 0.001) compared with men. In fully adjusted models, women had 40 % lower odds of any (adjusted odds ratio [aOR]:0.58, 95 % CI 0.57–0.60) and high-intensity statin use (aOR:0.59, 0.57–0.61) relative to men. Women were also less likely to have guideline-recommended LDL-C &lt; 70 mg/dL (30.2% vs 42.7 %; <em>p</em> &lt; 0.01). These differences persisted across age, racial/ethnic and socioeconomic subgroups.</p></div><div><h3>Conclusion</h3><p>Significant gender disparities exist in contemporary lipid management among patients with ASCVD, with women being less likely to receive any and high-intensity statin and achieving guideline defined LDL-C goal compared with men across age and racial/ethnic subgroups. These disparities underscore the need to further understand potential socioeconomic drivers of the observed lower statin uptake in women.</p></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":"https://www.sciencedirect.com/science/article/pii/S2666667724000904/pdfft?md5=674aa6502f57471edab59be01f1075ce&pid=1-s2.0-S2666667724000904-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094636","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":"BEYOND DIAGNOSIS: PROGNOSTIC UTILITY OF B-NATRIURETIC PEPTIDE IN PREGNANT PATIENTS PRESENTING TO ARKANSAS’ HIGH-RISK CARDIO-OBSTETRICS PROGRAM","authors":"","doi":"10.1016/j.ajpc.2024.100816","DOIUrl":"10.1016/j.ajpc.2024.100816","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD Risk Assessment</div></div><div><h3>Background</h3><div>B-natriuretic peptide (BNP) is used as a screening biomarker for patients in cardio-obstetric programs. In nonpregnant females, obesity falsely lowers BNP, but its accuracy in the obese pregnant population is less known. We studied the diagnostic and prognostic utility of BNP in a predominantly obese, high-risk obstetric population in Arkansas.</div></div><div><h3>Methods</h3><div>We established a retrospective registry of pregnant patients who had undergone a BNP and echocardiographic assessment (within 30 days of each other) at the University of Arkansas Medical Center between January 1, 1995, to October 30, 2022. We assessed the relationship between BNP levels and left ventricular ejection fraction (LVEF) using Pearson correlation coefficients. We used receiver operating curves to identify an optimal BNP cutoff for predicting a reduced LVEF (&lt;50%), and cox regression analysis to determine a prognostic cutoff value. A p-value of &lt;0.05 indicated statistical significance. Analyses are performed using MedCalc software (Ostend, Belgium).</div></div><div><h3>Results</h3><div>We studied a total of n=315 pregnant patients with a median ±SD age of 29.8 years old (25-34) and BMI of 34 kg/m2 (34-41). In patients with a BMI of ≥ 35, there was no correlation between BNP and LVEF [-0.05 (-0.21 to 0.09, P = 0.47)] (Figure 1b). Of all variables examined, only LVEF of &lt;50% was predictive of maternal mortality with a 95% confidence interval of 1.1 to 25.1 and a P value of 0.04. Significant cutoff values for BMI and BNP are listed in Figure 1c-d.</div></div><div><h3>Conclusions</h3><div>BNP based screening in high-risk obstetric patients requires consideration of BMI in interpretation of test, paralleling the effect obesity has on BNP in a non-pregnant population. In conclusion, we recommend considering an echocardiography in obese, pregnant patients with a clinical suspicion of new or worsening heart failure, regardless of BNP level.</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":"142422831","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":"COMPARING THE INCIDENCE AND RISK FACTORS ASSOCIATED WITH CORONARY ARTERY DISEASE IN PATIENTS RECEIVING BRUTON'S TYROSINE KINASE INHIBITORS","authors":"","doi":"10.1016/j.ajpc.2024.100775","DOIUrl":"10.1016/j.ajpc.2024.100775","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>ASCVD/CVD in Special Populations</div></div><div><h3>Background</h3><div>Bruton's tyrosine kinase inhibitors (BTKi) have increased risk of cardiotoxicity including atrial fibrillation and hypertension. However, little data exists on the incidence and risk factors associated with coronary artery disease (CAD) for patients on BTKi.</div></div><div><h3>Methods</h3><div>This was a retrospective single-center study of patients with hematologic malignancies from 2014-2024 on ibrutinib, acalabrutinib, or zanubrutinib. Patients meeting the following criteria were included: age &gt;65 years, BTKi usage &gt;28 days, and CAD. We measured demographics as well as characteristics of CAD including diagnosis modality, obstructive vs non-obstructive disease, revascularization approach (if any), and medical treatment. Categorical variables were analyzed via chi-squared tests at a significance level of 0.05.</div></div><div><h3>Results</h3><div>Of 534 screened patients, 69 met inclusion criteria. Average age was 76, and 19% were female. Overall prevalence of CAD ranged from 7-15% among the selected BTKi's, with no statistical difference in the prevalence (p=0.24) or incidence of CAD (p=0.69). In sub-group analysis of ibrutinib, hyperlipidemia was associated with new-onset CAD (p=0.04). Only 80% of patients were receiving a statin, with no significant difference between the different BTKi's (p=0.59). Patients on ibrutinib were less likely to be on aspirin compared to those on acalabrutinib (32% vs 63%; p=0.02).</div></div><div><h3>Conclusions</h3><div>Patients with CAD and hematologic malignancies receiving BTKi's appear to tolerate these therapies without excess coronary disease. A prior diagnosis of CAD may not limit BTKi use when indicated. Due to the small sample size, further research is needed to confirm 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":"142422902","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":"TYPE 1 KOUNIS SYNDROME: ALLERGIC VASOSPASTIC CARDIAC EVENT TRIGGERED BY CIPROFLOXACIN","authors":"","doi":"10.1016/j.ajpc.2024.100765","DOIUrl":"10.1016/j.ajpc.2024.100765","url":null,"abstract":"<div><h3>Therapeutic Area</h3><div>Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research</div></div><div><h3>Case Presentation</h3><div>A 30-year-old male was brought to ED with sudden onset chest pain, diaphoresis, and lightheadedness, accompanied by itching, confusion, and collapse. Symptoms developed shortly after he took oral ciprofloxacin, which was prescribed by his physician because of a two-day history of flu-like symptoms. He denied any significant medical or family history of heart disease. He denied smoking, alcohol, or substance abuse.</div><div>On evaluation, he was diaphoretic and tachypneic with blood pressure of 90/60 mmHg, heart rate of 58/minute, and oxygen saturation of 85%. The cardiovascular examination was unremarkable.</div><div>Initial EKG showed ST-segment elevation in leads II, III, and aVF, suggestive of inferior wall myocardial infarction (1a). Urgent coronary angiography revealed normal coronary arteries with no significant thrombosis or stenosis (1b). Laboratory evaluations revealed elevated levels of troponin I (4.9 ng/ml) and creatine kinase MB (47 IU/L). He was managed with sublingual nitroglycerine, methylprednisolone, and intramuscular injection of epinephrine. Allergic work-up revealed elevated serum tryptase level (17/ng/ml). Over the subsequent hours, his condition improved. Repeat EKG showed sinus rhythm and resolution of ST-segment elevation (1c). Bedside echocardiography revealed no obvious segmental wall motion abnormalities. He remained hemodynamically stable throughout his admission, and he was advised to avoid fluoroquinolone antibiotics in future.</div></div><div><h3>Background</h3><div>Kounis syndrome (KS), also known as allergic myocardial infarction, is a rare but potentially life-threatening condition characterized by acute coronary syndrome secondary to allergic reactions. Patients may present with normal coronary arteries (type I), established coronary artery disease (type II), or in-stent thrombosis or restenosis (type III). KS is most frequently triggered by medication and ciprofloxacin-induced KS-1 is rarely reported. We report a case of KS-1 triggered by ciprofloxacin.</div></div><div><h3>Conclusions</h3><div>Ciprofloxacin is generally a well-tolerated drug and life-threatening hypersensitivity reactions are rare. To our knowledge, only four cases of ciprofloxacin-induced KS have been reported. Recognition of drug-induced allergic reactions as a potential trigger of acute coronary events is crucial for timely diagnosis and management. KS-1 should be included in the differential diagnosis of the acute coronary event with no coronary artery lesion, especially in patients with no previous cardiac history and recent ingestion of fluoroquinolones.</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":"142422704","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}