JACC advances最新文献

{"title":"Utility of Skin Patch Testing to Investigate Cardiac Implant-Related Hypersensitivity","authors":"Madeline K. Mahowald MD , John Z. Nan MD , Ahmed El Shaer MBBS , Alejandra N. Chavez-Ponce MD , Julio C. Sartori-Valinotti MD , Dawn MR. Davis MD , Mohamad Alkhouli MD","doi":"10.1016/j.jacadv.2025.101911","DOIUrl":"10.1016/j.jacadv.2025.101911","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 8","pages":"Article 101911"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535081","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":"Persistent Imbalance","authors":"Alaina K. Kipps MD, MS ,&nbsp;Audrey C. Marshall MD, MPH ,&nbsp;Neha Bansal MD ,&nbsp;Holly Bauser-Heaton MD, PhD ,&nbsp;Nadine Choueiter MD ,&nbsp;Devyani Chowdhury MD, MHA ,&nbsp;Aarti Dalal DO ,&nbsp;Molly Ehrlich BS ,&nbsp;Lindsay R. Freud MD ,&nbsp;Supriya S. Jain MD ,&nbsp;Pei-Ni Jone MD ,&nbsp;Kristin Laraja MD ,&nbsp;Dalia Lopez-Colon PhD ,&nbsp;Sonal T. Owens MD ,&nbsp;Christina Ronai MD MSEd ,&nbsp;Ritu Sachdeva MBBS ,&nbsp;Corey Stiver MD ,&nbsp;Nicole Sutton MD ,&nbsp;Terrie Vasilopoulos PhD ,&nbsp;Jennifer Co-Vu MD","doi":"10.1016/j.jacadv.2025.101878","DOIUrl":"10.1016/j.jacadv.2025.101878","url":null,"abstract":"<div><h3>Background</h3><div>Despite recent gender parity of physicians entering pediatric cardiology, representation of women leaders lags their male colleagues.</div></div><div><h3>Objectives</h3><div>We sought to better understand the variation in women in leadership roles in pediatric cardiology.</div></div><div><h3>Methods</h3><div>The gender of physicians in 16 prespecified leadership positions was collected by survey between July 2022 and January 2023 from pediatric cardiology programs with &gt;5 cardiologists in North America. We analyzed the association of women leaders with center size (based on surgical volume), geographic region, presence of categorical fellowship program, and gender of division chief and department chair.</div></div><div><h3>Results</h3><div>Across 99 centers, a median of 13 (Q1-Q3: 10-15) roles/center were identified. Women held 36.8% of all leadership roles and 35.1% of cardiology-specific roles. Only 13% of pediatric cardiology chiefs were women. Their programs had more women in subsection leadership roles than male-led centers (47% vs 36%, <em>P</em> = 0.028). A minority of leadership posts were shared among 2 physicians, yet more women than men shared their roles (5.4% women vs 2.5% men, <em>P</em> = 0.010). More men than women have dual leadership positions (15.1% men vs 9.9% women, <em>P</em> = 0.012). We found no association of center size, geographic region, presence of fellowship program, or gender of department chair with percent women leadership.</div></div><div><h3>Conclusions</h3><div>Women hold fewer leadership positions across most subsections of pediatric cardiology programs, with more equitable distribution at centers led by women division chiefs. Women are more likely to share a leadership position with another cardiologist and less likely than men to hold more than 1 leadership post concurrently.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101878"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686491","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":"Clinical Status and Reintervention in Neonates With Symptomatic Tetralogy of Fallot","authors":"Jeffery J. Meadows MD, MSCI ,&nbsp;Yun Zhang PhD ,&nbsp;Christopher J. Petit MD ,&nbsp;Bryan H. Goldstein MD ,&nbsp;Courtney E. McCracken PhD ,&nbsp;Asaad Beshish MD ,&nbsp;George T. Nicholson MD ,&nbsp;Mark A. Law MD ,&nbsp;Jeffrey D. Zampi MD ,&nbsp;Shabana Shahanavaz MD ,&nbsp;Paul J. Chai MD ,&nbsp;Jennifer C. Romano MD ,&nbsp;Sarosh P. Batlivala MD, MSCI ,&nbsp;Shiraz A. Maskatia MD ,&nbsp;Ivor B. Asztalos MD, MSCE ,&nbsp;Hala Q. Khan BS ,&nbsp;Alicia M. Kamsheh MD, MSCE ,&nbsp;Steven J. Healan MD, MSCI ,&nbsp;Justin D. Smith MD ,&nbsp;R. Allen Ligon MD ,&nbsp;Athar M. Qureshi MD","doi":"10.1016/j.jacadv.2025.101919","DOIUrl":"10.1016/j.jacadv.2025.101919","url":null,"abstract":"<div><h3>Background</h3><div>In symptomatic neonates with tetralogy of Fallot (sTOF), the initial treatment strategy significantly affects early outcomes, but its long-term impact remains less well defined.</div></div><div><h3>Objectives</h3><div>The aim of the study was to compare primary (PR) vs staged repair (SR) in sTOF with respect to reintervention (RI) rates and types, clinical and echocardiographic outcomes, and medication use.</div></div><div><h3>Methods</h3><div>Neonates with sTOF undergoing PR or SR and with &gt;1 year of follow-up after complete repair were included. The primary outcome was cumulative RI incidence; secondary outcomes included mortality and late echocardiographic and clinical findings. Propensity scoring adjusted for baseline differences. Landmark analysis assessed RI risk at yearly intervals following complete repair.</div></div><div><h3>Results</h3><div>Of 441 neonates, 182 (41%) underwent PR, and 259 (59%) underwent SR. Groups differed in gestational age, intubation, and 22q11 status. Median follow-up postrepair was 5.26 (2.91, 8.21) years. RI burden was high in both groups, with a small, consistent but nonsignificant advantage to PR. The type of RI varied over time. PR was associated with greater pulmonary insufficiency and larger pulmonary arteries. RV pressure was ≤half systemic in 80%; 10% had ≥moderate tricuspid regurgitation, without between-group difference. Elevated RV pressure was associated with ≥moderate tricuspid regurgitation.</div></div><div><h3>Conclusions</h3><div>Among sTOF survivors beyond the early perioperative period, late RI burden and residual hemodynamic lesions are common and largely unrelated to initial strategy. PR is associated with increased pulmonary insufficiency and pulmonary artery size.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101919"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686490","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":"Clinical and Engagement Results of a Nationwide Comprehensive Remote Patient Care Hypertension Program","authors":"David I. Feldman MD, MPH ,&nbsp;Spencer Reynolds MBA ,&nbsp;Luis Valor BBA ,&nbsp;Sarine Babikian PhD ,&nbsp;Theodore Feldman MD ,&nbsp;Randall Curnow MD, MBA ,&nbsp;Brian D. Stein MD, MS ,&nbsp;Christopher Frost MD, MHM ,&nbsp;Sowmya Viswanathan MD, MBA, MHCM ,&nbsp;Jeffrey Galles DO ,&nbsp;Lynn T. Simon MD, MBA ,&nbsp;Eve Cunningham MD, MBA ,&nbsp;Marat Fudim MD, MHS","doi":"10.1016/j.jacadv.2025.101892","DOIUrl":"10.1016/j.jacadv.2025.101892","url":null,"abstract":"<div><h3>Background</h3><div>Traditional methods for treating hypertension have been ineffective. Remote patient care (RPC) can transform how we provide longitudinal care for patients with hypertension.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to determine whether an RPC hypertension program can provide a scalable solution for optimizing hypertension management, especially among rural/underserved patients.</div></div><div><h3>Methods</h3><div>A technology-enabled RPC provider enrolled patients into an RPC hypertension program from February 2022 to June 2024. Using vitals automatically transmitted from a cellular-enabled blood pressure (BP) cuff and scheduled visits, clinicians leveraged technology-enabled clinical protocols to drive engagement and improve hypertension control. Mean reduction in BP and percentage of individuals at BP goal were evaluated using a paired <em>t</em>-test and McNemar's test, respectively.</div></div><div><h3>Results</h3><div>A total of 23,638 patients were enrolled (mean [SD] age 73(9), 60.0% female, 56.9% rural/underserved) with a baseline BP of 140/81 mm Hg. The mean (SD) reduction in BP was 7/5 (14/8) mm Hg (<em>P</em> &lt; 0.001) after a follow-up of 30 (24) weeks, with a greater reduction in individuals with a higher baseline BP. Clinical engagement was high (75% and 57% of patients still measuring vitals at 6 and 12 months, respectively) with 11,834,837 vitals measured, 177,620 clinical encounters and 118,792 phone calls completed, and 117,457 high-acuity clinical alerts resolved. There was a 70% relative increase in the number of patients at goal BP at follow-up (36.6% vs 21.5%; <em>P</em> &lt; 0.001). Results among rural/underserved patients were similar.</div></div><div><h3>Conclusions</h3><div>A nationwide RPC hypertension program can drive high patient engagement and facilitate clinical encounters at scale, resulting in reduced BP levels and more patients achieving BP goals across the United States.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101892"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686488","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":"Risk-Stratified Prognostic Implications of Contrast-Associated Acute Kidney Injury After Percutaneous Coronary Intervention","authors":"Takahiro Suzuki MD, MPH ,&nbsp;Shun Kohsaka MD ,&nbsp;John A. Spertus MD, MPH ,&nbsp;Satoshi Shoji MD, PhD ,&nbsp;Yasuyuki Shiraishi MD, PhD ,&nbsp;Nobuhiro Ikemura MD, PhD ,&nbsp;Ryo Nakamaru MD, PhD ,&nbsp;Takanori Ohata MD ,&nbsp;Masaki Kodaira MD, PhD ,&nbsp;Ikuko Ueda PhD ,&nbsp;Shigetaka Noma MD, PhD ,&nbsp;Yohei Numasawa MD, PhD ,&nbsp;Masaki Ieda MD, PhD","doi":"10.1016/j.jacadv.2025.101899","DOIUrl":"10.1016/j.jacadv.2025.101899","url":null,"abstract":"<div><h3>Background</h3><div>The clinical importance of contrast-associated acute kidney injury (CA-AKI), the most common complication after percutaneous coronary intervention (PCI), is debated.</div></div><div><h3>Objectives</h3><div>We aimed to assess the association between CA-AKI and long-term outcomes, overall and across the National Cardiovascular Data Registry (NCDR) AKI risk categories.</div></div><div><h3>Methods</h3><div>We analyzed patients undergoing PCI between September 2008 and October 2021 from a Japanese registry aligned with the NCDR and categorized them by the NCDR AKI risk score tertiles (low-risk [&lt;4.9%], intermediate-risk [4.9%-6.7%], and high-risk [≥6.7%]) groups. CA-AKI was defined as a 0.3 mg/dL increase or 50% increase in creatinine or the initiation of dialysis. Cox regression analyses assessed the association between CA-AKI and 2-year major adverse cardiovascular events (MACE; all-cause mortality, acute coronary syndrome, heart failure hospitalization, or stroke), and interactions were tested to examine whether preprocedural risk modified the association of CA-AKI with outcomes.</div></div><div><h3>Results</h3><div>Of 7,916 patients, 723 (9.1%) developed CA-AKI; its incidence for low-risk, intermediate-risk, and high-risk groups was 2.3%, 7.3%, and 17.9%, respectively. CA-AKI was associated with an increased risk of MACE (adjusted HR [aHR]: 1.64; 95% CI: 1.37-1.97). The interaction between AKI risk profile and MACE was not significant (<em>P</em> interaction = 0.14), and a consistent association of CA-AKI and MACE across risk categories was observed (high-risk, aHR: 1.60; 95% CI: 1.30-1.98; intermediate, aHR: 1.64; 95% CI: 1.10-2.44; and low, aHR: 2.84; 95% CI: 1.43-5.65, respectively).</div></div><div><h3>Conclusions</h3><div>CA-AKI was associated with long-term outcomes across all AKI risk profiles in PCI patients, underscoring the importance of interventions to reduce periprocedural CA-AKI.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101899"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686628","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":"Electrocardiographic Findings Among Major League Soccer Athletes","authors":"Robyn E. Bryde MD ,&nbsp;Marybeth F. Soutar MS ,&nbsp;Aakash A. Bavishi MD ,&nbsp;Jonathan H. Kim MD ,&nbsp;Eugene Chung MD ,&nbsp;John A. Gallucci MD ,&nbsp;Joan Street ,&nbsp;Holly Silvers PT ,&nbsp;Margot Putukian MD ,&nbsp;Matthew W. Martinez MD","doi":"10.1016/j.jacadv.2025.101886","DOIUrl":"10.1016/j.jacadv.2025.101886","url":null,"abstract":"<div><h3>Background</h3><div>Major League Soccer (MLS) is composed of an ethnically diverse athlete population for which electrocardiogram (ECG) analysis has not been previously reported.</div></div><div><h3>Objectives</h3><div>This paper evaluated MLS player ECGs and characterized ECGs as having normal, borderline, and/or abnormal ECG findings based on the international criteria. Echocardiographic data were analyzed when history, physical, or ECG findings were abnormal.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study of MLS players from 2017 to 2020.</div></div><div><h3>Results</h3><div>A total of 706 athletes were included in this study. Athletes were predominantly Caucasian 346 (49%), followed by Black, 85 (26%), and Hispanic, 175 (25%). The mean (SD) age was 24.5 (4.3) years with an age range of 15 to 37 years. The most common abnormal ECG finding was T wave inversion (TWI) (total percent of TWI). Black athletes had a greater proportion of ECGs with any isolated TWI, with 11.9%, compared to Caucasian (5.2%, <em>P</em> = 0.005) and Hispanic (5.7%, <em>P</em> = 0.040) athletes. Subgroup analysis of those with abnormal TWI revealed mostly structurally normal hearts. The most common borderline finding was left axis deviation, with Black athletes having a statistically greater proportion of left axis deviation when compared to Caucasian athletes (3.8% vs 1.2%, <em>P</em> = 0.043). Training-related ECG changes are highly prevalent among professional male soccer players regardless of race.</div></div><div><h3>Conclusions</h3><div>The most common ECG abnormality and borderline finding per international criteria are TWI and left atrial enlargement, respectively. Both were more prevalent in Black athletes. Echocardiography did not reveal underlying cardiovascular disease during follow-up even in the presence of abnormal ECG findings.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101886"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686489","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":"Cholesterol Levels and Cardiovascular Outcomes Following Statin Initiation for Primary Prevention","authors":"Wade Thompson PharmD PhD ,&nbsp;Irene Jeong MSc ,&nbsp;Shalane Basque MSc ,&nbsp;Husam Abdel-Qadir MD PhD ,&nbsp;Peter C. Austin PhD ,&nbsp;Dennis T. Ko MD MSc ,&nbsp;Ida Famiyeh BScPhm MSc ,&nbsp;Anna Chu MHSc ,&nbsp;Jiming Fang PhD ,&nbsp;Ayodele Odutayo MD DPhil ,&nbsp;Cynthia A. Jackevicius BScPhm, PharmD MSc ,&nbsp;Lucas C. Godoy MD PhD ,&nbsp;Douglas S. Lee MD PhD ,&nbsp;Todd J. Anderson MD ,&nbsp;Jacob A. Udell MD MPH","doi":"10.1016/j.jacadv.2025.101864","DOIUrl":"10.1016/j.jacadv.2025.101864","url":null,"abstract":"<div><h3>Background</h3><div>Non-high-density lipoprotein cholesterol (HDL-C) is increasingly incorporated into guidelines along with low-density lipoprotein cholesterol (LDL-C) to guide lipid-lowering therapy decisions.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to examine patterns of LDL-C and non-HDL-C levels after statin initiation for primary prevention and their association with incident cardiovascular events.</div></div><div><h3>Methods</h3><div>This was a population-based cohort study in Ontario, Canada, among persons aged ≥66 years starting a statin for primary prevention between January 1, 2012, and December 31, 2019. We identified those with a lipid panel in the 1-year after starting a statin and categorized individuals based on LDL-C and non-HDL-C thresholds for intensification in the 2021 Canadian Cardiovascular Society dyslipidemia guidelines. We stratified by diabetes/chronic kidney disease (CKD) status. The primary outcome was the composite of all-cause mortality or cardiovascular events, with follow-up to December 31, 2020. We used a Cox proportional hazards model for analysis.</div></div><div><h3>Results</h3><div>Our cohort comprised 125,013 people. The median follow-up was 2.5 years. Compared with those meeting both LDL-C and non-HDL-C thresholds, being above both thresholds was associated with an increased rate of the primary outcome for people without diabetes/CKD (HR: 1.10; 95% CI: 1.05-1.15) and for those with diabetes/CKD (HR: 1.16; 95% CI: 1.09-1.23). Being below the LDL-C threshold but above non-HDL-C threshold was associated with an increased rate of the primary outcome for people with diabetes/CKD (HR: 1.16; 95% CI: 1.03-1.30).</div></div><div><h3>Conclusions</h3><div>These findings support the residual risk associated with incompletely controlled LDL-C or non-HDL-C levels after statin initiation for primary prevention.</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101864"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686627","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":"Criteria From General Population to Special Field till Individual","authors":"Tianxiang Gu,&nbsp;Yang Yu","doi":"10.1016/j.jacadv.2025.101840","DOIUrl":"10.1016/j.jacadv.2025.101840","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101840"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686493","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 Impact of Diagnostic Code and Inclusion Period on Clinical Outcomes in ATTR Cardiomyopathy","authors":"Pei-Lun Lee MD ,&nbsp;Kuan-Yu Chi MD ,&nbsp;Yu-Shiuan Lin MD ,&nbsp;Dimitrios Varrias MD ,&nbsp;Snehal R. Patel MD","doi":"10.1016/j.jacadv.2025.101918","DOIUrl":"10.1016/j.jacadv.2025.101918","url":null,"abstract":"","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101918"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686495","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":"Longitudinal Data From the KETO-CTA Study","authors":"Adrian Soto-Mota MD, PhD ,&nbsp;Nicholas G. Norwitz PhD ,&nbsp;Venkat S. Manubolu MD ,&nbsp;April Kinninger MPH ,&nbsp;Thomas R. Wood BM BCh, PhD ,&nbsp;James Earls MD ,&nbsp;David Feldman AA ,&nbsp;Matthew Budoff MD","doi":"10.1016/j.jacadv.2025.101686","DOIUrl":"10.1016/j.jacadv.2025.101686","url":null,"abstract":"<div><h3>Background</h3><div>Changes in low-density lipoprotein cholesterol (LDL-C) among people following a ketogenic diet (KD) are heterogeneous. Prior work has identified an inverse association between body mass index and change in LDL-C. However, the cardiovascular disease risk implications of these lipid changes remain unknown.</div></div><div><h3>Objectives</h3><div>The aim of the study was to examine the association between plaque progression and its predicting factors.</div></div><div><h3>Methods</h3><div>A total of 100 individuals exhibiting KD-induced LDL-C ≥190 mg/dL, high-density lipoprotein cholesterol ≥60 mg/dL, and triglycerides ≤80 mg/dL were followed for 1 year using coronary artery calcium and coronary computed tomography angiography. Plaque progression predictors were assessed with linear regression and Bayes factors. Diet adherence and baseline cardiovascular disease risk sensitivity analyses were performed.</div></div><div><h3>Results</h3><div>High apolipoprotein B (ApoB) (median 178 mg/dL, Q1-Q3: 149-214 mg/dL) and LDL-C (median 237 mg/dL, Q1-Q3: 202-308 mg/dL) with low total plaque score (TPS) (median 0, Q1-Q3: 0-2.25) were observed at baseline. The median change in NCPV was 18.9 mm³ (IQR: 9.3-47.0 mm³) and the median change in PAV was 0.8% (IQR: 0.3%-1.7%). Neither change in ApoB (median 3 mg/dL, Q1-Q3: −17 to 35 mg/dL), baseline ApoB, nor total LDL-C exposure (median 1,302 days, Q1-Q3: 984-1,754 days) were associated with the change in noncalcified plaque volume (NCPV) or TPS. Bayesian inference calculations were between 6 and 10 times more supportive of the null hypothesis (no association between ApoB and plaque progression) than of the alternative hypothesis. All baseline plaque metrics (coronary artery calcium, NCPV, total plaque score, and percent atheroma volume) were strongly associated with the change in NCPV.</div></div><div><h3>Conclusions</h3><div>In lean metabolically healthy people on KD, neither total exposure nor changes in baseline levels of ApoB and LDL-C were associated with changes in plaque. Conversely, baseline plaque was associated with plaque progression, supporting the notion that, in this population, plaque predicts plaque but ApoB does not. (Diet-induced Elevations in LDL-C and Progression of Atherosclerosis [Keto-CTA]; <span><span>NCT05733325</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":73527,"journal":{"name":"JACC advances","volume":"4 7","pages":"Article 101686"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796877","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}