2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Research progress in myocardial function and diseases related to muscarinic acetylcholine receptor (Review)

Muscarinic acetylcholine (ACh) receptors (also known as M receptors) are widely distributed in all organs and tissues of the body, mainly playing a role in cholinergic nerve conduction. There are five known subtypes of muscarinic ACh receptors, but their pharmacological mechanisms of action on myocardial function have remained to be clearly defined. Functional myocardial diseases and myocardial injuries, such as arrhythmia, myocardial ischemia, myocarditis and myocardial fibrosis, may be affected by muscarinic ACh receptors. This article reviews the research progress of the regulation of myocardial function by muscarinic ACh receptors and related diseases, with the aim of developing better strategies and providing references for further revealing and clarifying the signal transduction and mechanisms of muscarinic ACh receptors in cardiomyocytes, and finding potential myocardial protective drugs that act on muscarinic ACh receptors.

Dietary sodium reduction lowers 10-year atherosclerotic cardiovascular disease risk score: Results from the DASH-sodium trial

Background

The Dietary Approaches to Stop Hypertension (DASH) diet lowers estimated 10-year ASCVD (atherosclerotic cardiovascular disease) risk. The effects of dietary sodium reduction on ASCVD risk are uncertain. This study aims to evaluate the impact of sodium reduction, alone and combined with the DASH diet, on 10-year ASCVD risk scores.

Methods

The DASH-Sodium trial randomized adults with elevated blood pressure (average systolic blood pressure of 120 to 159 mm Hg and average diastolic blood pressure of 80 to 95 mm Hg) to the DASH diet or typical American diet. Within each arm, individuals consumed 3 different levels of sodium in random order: low, medium, and high. Each period lasted 30 days. Pooled cohort equation-estimated 10-year ASCVD risk scores were calculated at baseline and at the end of each feeding period. The primary outcomes of interest were the absolute and relative differences in 10-year ASCVD risk scores from baseline.

Results

Among the 412 participants (mean age 48 ± 10 years; 57 % female, 57 % Black), sodium reduction decreased ASCVD risk scores in both dietary arms. Compared to high sodium intake, low sodium intake changed ASCVD risk by -9.4 % (95 % CI -11.7, -7.0). When compared to a typical American diet, the DASH diet changed 10-year ASCVD by -5.3 % (95 % CI -9.3, -1.2). Compared to a high sodium-control diet, the combination of both low sodium intake with DASH changed ASCVD risk by -14.1 % (95 % CI -18.6, -9.3).

Conclusions

Sodium reduction and the DASH diet both independently reduced 10-year ASCVD risk scores. Moreover, the combined impact was additive. These findings support dietary sodium reduction in addition to the DASH diet for ASCVD prevention.

Opportunistic Identification of Coronary Artery Calcium and Valve/Vascular Calcifications on Chest X-Ray: Improvements With Single-Exposure Dual-Energy Imaging

Purpose: To evaluate whether single-exposure, dual-energy chest X-ray (DEX) improves visualization of coronary artery calcium (CAC) and valve/vascular calcifications compared to conventional X-ray. Materials and Methods: Sixty-one bone-marrow transplant patients (22- 79 years; median 61; IQR 15; w/m, 24/37), underwent single-exposure dual-energy X-ray (Reveal 35C, KA imaging) in pa and lateral projection, followed by a standard-of-care chest CT. Two DEX pairs (pa/lateral) were calculated: a composite image (COMP) and a bone image with soft-tissue subtraction (BI). The COMP pair was reviewed by 2 chest radiologists, assessing the presence/absence of CAC and valve/vascular calcifications on a confidence scale from -2 (confidently not present) to 2 (confidently present). Subsequently, the BI pair was revealed, and readers reevaluated both pairs (COMP and BI) jointly using the identical scale. CTCAC scores were categorized according to the CAC-DRS (0-3) and served as standard of reference, valve/vascular calcifications were categorized on CT as present or absent. Results: For detecting CAC on DEX in any CAC-DRS category (1-3), in category 2-3, in category 3, and for valve/vascular calcifications, the ROC-AUC (combined for both readers) for COMP images was 0.74 (CI: 0.64-0.84), 0.81 (CI: 0.68-0.94), 0.84 (CI: 0.69-0.98), and 0.90 (CI: 0.83-0.99), and for the BI images 0.91 (CI: 0.83-0.98), 0.94 (CI: 0.86- 1.00), 0.89 (CI: 0.77-1.00), and 0.98 (CI: 0.96-1.00), with P = .0003, P = .044, P = .42, and P = .55, respectively. The Intraclass-Correlation-Coefficient (ICC) for CAC on COMP/BI was 0.973/0.954, and for valve/vascular calcifications 0.971/0.965. Conclusion: Single-exposure, dual-energy acquisition improves diagnostic confidence for coronary artery calcium and valve/vascular calcification identification on chest X-rays.

Exosomes derived from baicalin‑pretreated mesenchymal stem cells mitigate atherosclerosis by regulating the SIRT1/NF‑κB signaling pathway

Atherosclerosis (AS) is a disease with high global incidence and mortality rates. Currently, the treatment of AS in clinical practice carries a high risk of adverse effects and toxic side effects. The pretreatment of mesenchymal stem cells (MSCs) with drugs may enhance the bioactivity of MSC‑derived exosomes (MSC‑exos), which could be a promising candidate for inhibiting the progression of AS. The aim of the present study was to investigate the ability of exos derived from baicalin‑preconditioned MSCs (Ba‑exos) to exhibit an inhibitory effect on AS progression and to explore the potential molecular mechanisms. Exos were isolated from untreated MSCs and MSCs pretreated with Ba, and were characterized using transmission electron microscopy, nanoparticle tracking analysis and western blotting. Subsequently, Cell Counting Kit‑8 and Transwell assays, reverse transcription‑quantitative PCR, immunofluorescence, western blotting and ELISA were used to evaluate the effects of Ba‑exos on AS, and the possible molecular mechanisms. Oil Red O and Masson staining were used to assess AS pathological tissue in a high‑fat diet‑induced mouse model of AS. Notably, MSC‑exos and Ba‑exos were successfully isolated. Compared with MSC‑exos, Ba‑exos demonstrated superior inhibitory effects on the viability and migration, and the levels of inflammatory factors in oxidized low‑density lipoprotein (ox‑LDL)‑induced vascular smooth muscle cells (VSMCs). Additionally, compared with MSC‑exos, Ba‑exos significantly inhibited NF‑κB activation by upregulating sirtuin 1 (SIRT1), thereby suppressing inflammation in ox‑LDL‑induced VSMCs to a greater extent. In mice with high‑fat diet‑induced AS, Ba‑exos exhibited the ability to inhibit AS plaque formation and to alleviate AS progression by reducing the levels of inflammatory factors compared with MSC‑exos; however, the difference was not significant. In conclusion, Ba‑exos may serve as a potential strategy for treating AS by regulating the SIRT1/NF‑κB signaling pathway to suppress inflammation.

Cardiac Self-Efficacy Improvement in a Digital Heart Health Program: Secondary Analysis From a Feasibility and Acceptability Pilot Study

Background

Lifestyle modification programs play a critical role in preventing and managing cardiovascular disease (CVD). A key aim of many programs is improving patients' self-efficacy. In-person lifestyle modification programs can enhance self-efficacy in managing CVD risk, also known as cardiac self-efficacy (CSE). However, such programs are typically staffing and resource intensive. Digital lifestyle modification programs may offer a scalable and accessible way to improve CSE, but this has not been shown in prior research.

Objective

This study examined changes in CSE among individuals using a digital lifestyle modification program for cardiovascular health. Evaluation of improvement in CSE was a secondary goal of a feasibility and acceptability pilot study of a digital program for Heart Health.

Methods

Participants were individuals with elevated risk for CVD who enrolled in a 90-day pilot study that involved mobile app-based, artificial intelligence-powered health coaching and educational lessons focused on behaviors that promote cardiovascular health. Participants completed the 9-item CSE Scale at baseline and in month 2. Changes in confidence in participants' ability to manage their cardiovascular health were assessed.

Results

The sample included 273 (n=207, 61.2% female; mean age 59.3, SD 10.1 years) participants who submitted a complete CSE Scale at baseline and in month 2. The total CSE Scale score increased by 12.9% (P<.001) from baseline to month 2. Additionally, there were significant increases in mean score on each of the 9 individual CSE Scale items (all P<.001), with the largest increases in confidence "in knowing when to call or visit the doctor for your heart disease" (17% increase; P<.001), "in knowing how much physical activity is good for you" (16.3% increase; P<.001), and "that you can get regular aerobic exercise" (19% increase; P<.001).

Conclusions

The present analyses indicate that participants in a digital lifestyle modification program for cardiovascular health showed significant improvements in CSE within 2 months. This work adds to the growing literature examining ways to improve health-related self-efficacy and scalable access to programs for prevention and management of CVD.

Disparities in cardiovascular disease outcomes and economic burdens among minorities in southeastern Virginia

BACKGROUND

Cardiovascular diseases are the leading cause of mortality in the United States, presenting significant public health challenges and financial burdens, particularly in Southeastern Virginia, where African American and Hispanic (AA&H) populations are disproportionately affected.

METHODS

This retrospective observational study analyzed data from 30,855 hospital discharges of AA&H patients across Southeastern Virginia from 2016 to 2020, focusing on individuals aged 18 to 85 with cardiovascular diseases. Utilizing the Virginia Health Information database, we examined demographic information, clinical data, and healthcare utilization patterns through hypothesis tests and regression models to explore associations between these variables and the economic impacts of cardiovascular diseases.

RESULTS

Heart failure and shock (47.2% of discharges) and cardiac arrhythmia and conduction disorders (12.3%) were the most prevalent cardiovascular conditions. Female patients incurred significantly higher charges than males across conditions (7.1% higher in heart failure, p < 0.0001; 8.8% higher in chest pain, p < 0.01). Younger patients (< 65 years) faced 8.5% higher charges for cardiac arrhythmia with procedures (p < 0.0001) and 5.2% higher charges for circulatory disorders (p < 0.05). Year of discharge consistently predicted increasing costs (standardized coefficient 0.816 for acute myocardial infarction, p < 0.0001). The presence of fluid and electrolyte disorders was associated with significantly higher charges across conditions (standardized coefficient 0.042 for heart failure, p < 0.0001; 0.051 for acute myocardial infarction, p < 0.0001).

DISCUSSION

The findings highlight the complex interplay between demographic characteristics and healthcare costs among AA&H populations, underscoring the need for targeted interventions. The significant economic impact observed calls for culturally competent healthcare strategies that can mitigate high costs and improve health outcomes. However, the retrospective, administrative nature of the data limits establishing causality, with potential misclassification of some conditions.

CONCLUSION

This study provides crucial insights into cardiovascular disease management's demographic and economic dimensions among AA&H populations in Southeastern Virginia. By identifying key factors contributing to healthcare disparities, the research supports the development of tailored interventions aimed at reducing the burden of cardiovascular diseases, thereby improving overall health equity and reducing economic strains on the healthcare system.

Dose-dependent effects of omega-3 polyunsaturated fatty acids on C-reactive protein concentrations in cardiometabolic disorders: a dose-response meta-analysis of randomized clinical trials

BACKGROUND

Based on current knowledge, omega-3 fatty acids help to reduce the concentration of C-reactive protein (CRP). However, the dose-response effect and the strength of this effect are not entirely clear.

METHODS

We systematically searched and screened databases to include eligible studies. This study incorporates a random effect, as well as dose-response meta-analyses using a restricted cubic spline model.

RESULTS

Forty randomized clinical trials were analyzed. Results demonstrated significant non-linear dose-response efficacy in the reduction of CRP concentration in patients with cardiovascular disease, metabolic syndrome, and hypertension up to 1200 mg/day of EPA and DHA. In addition, there was a linear decrease in CRP concentration in the dyslipidemia population. The meta-analysis results did not show any significant reduction of CRP in overweight and obese participants, and the dose-response analysis failed to show any apparent reduction. In type 2 diabetes, pooling the results revealed a significant reduction in CRP; however, the combination of EPA and DHA failed to show significant dose-response efficacy in changing CRP concentration.

CONCLUSION

1200 mg/day of EPA and DHA may help to reduce CRP concentration in patients with cardiometabolic disorders. This reduction is clinically significant, and thus intervention with omega-3 fatty acids should be considered for this population.

Effects of Combining Coronary Calcium Score With Treatment on Plaque Progression in Familial Coronary Artery Disease: A Randomized Clinical Trial

Importance

Coronary artery calcium (CAC) scoring provides prognostic information, especially in patients at intermediate risk for coronary artery disease (CAD). However, the benefit of combining CAC score with a primary prevention strategy has not been tested in a randomized trial.

Objective

To assess whether combining the CAC score with a prevention strategy can be used to limit plaque progression in intermediate-risk patients with a family history of premature CAD.

Design, Setting, and Participants

Prospective, randomized, open-blinded end point clinical trial in 7 hospitals across Australia (between 2013 and 2020; the last date of follow-up was June 5, 2021). Asymptomatic people aged 40 to 70 years with a first-degree relative with CAD onset at younger than 60 years old or second-degree relative with onset at younger than 50 years old were recruited from the community.

Interventions

Intermediate-risk participants underwent CAC scoring. Those with a CAC score greater than 0 but less than 400 underwent coronary computed tomography angiography (CCTA) and were randomized to CAC score-informed prevention or usual care.

Main Outcomes and Measures

Follow-up CCTA was obtained at 3 years, with plaque volume measured by an independent core laboratory. The primary outcome was total plaque volume, with further analysis for calcified and noncalcified plaque volume.

Results

This study included 365 participants (mean [SD] age, 58 [6] years; 57.5% male); 179 in the CAC score-informed and 186 in the usual care groups. Compared with usual care, the CAC score-informed group showed a sustained reduction in total (mean [SD], -3 [31] mg/dL vs -56 [38] mg/dL; P < .001) and LDL (mean [SD], -2 [31] vs -51 [36] mg/dL; P < .001) cholesterol levels at 3 years, which was associated with a reduction in pooled cohort equation risk calculation (mean [SD], 2.1% [2.9%] vs 0.5% [2.9%]; P < .001). Plaque progression was greater in usual care than CAC score-informed participants for total plaque volume (mean [SD], 24.9 [37.7] mm3 vs 15.4 [30.9] mm3; P = .009), noncalcified plaque volume (mean [SD], 15.7 [32.2] mm3 vs 5.6 [28.5] mm3; P = .002), and fibrofatty and necrotic core plaque volume (mean [SD], 4.5 [25.8] mm3 vs -0.8 [12.6] mm3; P = .02). These plaque volume changes were independent of other risk factors including baseline plaque volume, blood pressure, and lipid profile.

Conclusions and Relevance

The combination of CAC score with a primary prevention strategy in intermediate-risk patients with a family history of CAD was associated with reduction of atherogenic lipids and slower plaque progression compared with usual care. These data support the use of CAC score to assist intensive preventive strategies in intermediate-risk patients.

Trial Registration

anzctr.org.au Identifier: ACTRN12614001294640.

High-Volume Physical Activity and Clinical Coronary Artery Disease Outcomes: Findings From the Cooper Center Longitudinal Study

BACKGROUND

High-volume physical activity (PA) is associated with a higher prevalence of subclinical coronary artery disease (CAD). However, the clinical significance of subclinical CAD among high-volume exercisers remains incompletely understood, and the dose-response relationship between high-volume PA and clinical CAD events remains uncertain.

METHODS

Individual participant data from the Cooper Center Longitudinal Study (1987-2018) were linked to Medicare claims files. PA volume was determined by self-report and categorized as <500, 500 to 1499, 1500 to 2999, and ≥3000 metabolic equivalent of task (MET)-minutes per week. Subclinical CAD (coronary artery calcium [CAC]) was measured by cardiac computed tomography. All other risk factors were measured in the standard fashion. Composite CAD events (acute myocardial infarction and revascularization) and all-cause mortality were determined from Medicare claims files. A multivariable-adjusted proportional hazards illness-death model with random shared frailty was used to estimate the association between PA volume, CAC, and both clinical CAD and death. Heterogeneity in the association between CAC and clinical CAD across levels of PA was determined with multiplicative interaction terms.

RESULTS

We included 26 724 participants (54 years of age; 28% women). Mean exercise volume was 1130 MET-minutes per week, with 1997 (7.5%) reporting ≥3000 MET-minutes per week. After a mean follow-up of 20.5 years, we observed 811 acute myocardial infarction events, 1636 composite CAD events, and 2857 deaths without CAD. Compared with individuals exercising <500 MET-minutes per week, the lowest risk for acute myocardial infarction occurred among individuals with intermediate PA volumes (500-1499 MET-minutes per week: hazard ratio [HR], 0.77 [95% CI, 0.65-0.91]; 1500-2499 MET-minutes per week: HR, 0.78 [95% CI, 0.63-0.95]). There was no association between high-volume PA (>3000 MET-minutesw per week) and risk for acute myocardial infarction (HR, 0.95 [95% CI, 0.72-1.25]). In contrast, the lowest risk for death was observed among the high-volume PA group (HR, 0.71 [95% CI, 0.60-0.83]). CAC (on log scale) was associated with a higher risk for composite CAD across all PA categories, including among the high-volume PA subgroup (HR, 1.29 [95% CI, 1.16-1.44]; P<0.001; Pinteraction= 0.969).

CONCLUSIONS

Compared with low-volume PA, high-volume PA was associated with a lower risk for all-cause mortality but a similar risk for clinical CAD. CAC was associated with an increased risk for clinical CAD regardless of the volume of PA.

Effects of probiotic supplementation on blood lipids ın hypercholesterolemic obese patients: a randomized, double-blind, placebo-controlled pilot trial

Introduction

Objective: this trial aimed to determine the effects of probiotic supplementation on weight loss and lipid profiles in hypercholesterolemic obese patients. Methods: ın this pilot randomized, double-blind, placebo-controlled trial, hypercholesterolemic obese patients (BMI = 30.0-35.0 kg/m2) were randomly divided into 2 groups to receive either probiotic capsules (n = 12) or a matching placebo (n = 12) groups. The patients in the probiotic group took capsules 2 times a day that contained Enterococcus faecium, Lactobacillus plantarum, Streptococcus thermophiles, Bifidobacterium lactis, Lactobacillus acidophilus, Bifidobacterium longum (1.5 × 109 CFU/g) for 8 weeks. All patients adhered to a medical nutrition therapy that aimed for a weight loss of 0.5 to 1 kg per week. Anthropometric measurements and body composition were taken at baseline and were monitored every week throughout the study. Blood lipids were assessed at baseline and after the 8-week intervention. Results: after the 8-week dietary intervention, both probiotic and placebo groups showed significant decreased in total cholesterol (-36.50 ± 19.27 vs -25.91 ± 19.25, mg/dl), LDL-C (-(31.75 ± 18.11 vs -31.91 ± 31.00 mg/dl) and TG (-31.83 ± 67.37 vs -28.25 ± 59.09), respectively (p < 0.05). Body weight, BMI, body fat ratio, and waist circumference also significantly decreased after the dietary intervention in both groups (p < 0.05). Overall, no significant difference was found neither in the reductions of total cholesterol, LDL-C, TG concentrations nor the anthropometric indices between the probiotic and placebo groups (p > 0.05). Conclusions: the results of our study demonstrated that the administration of probiotic supplements for 8 weeks in obese subjects with hypercholesterolemia had favorable effects on lipid profiles, although there was no beneficial effect compared to the control group. These results indicate that anthropometric indices significantly decreased in response to adherence to the low-calorie diet recommended by dietitians in both the groups. However, conducting more trails with large sample size and longer follow-up time is necessary.

Healthcare providers' awareness and management of cardiovascular risks in women with hypertensive disorders of pregnancy and gestational diabetes

INTRODUCTION

Cardiovascular disease (CVD) is the leading cause of death and the mortality rate and prognosis of CVD in women are worse compared to men. Adverse Pregnancy Outcomes (APOs) are frequently overlooked sex-specific risk factors for CVD and affect up to one in five pregnant women. This study evaluated healthcare providers'(HCPs) awareness of the long-term cardiovascular risk associated with gestational diabetes mellitus and hypertensive disorders of pregnancy.

METHODS

A cross-sectional survey was conducted in Austria between March and August 2022 to assess HCPs' knowledge, follow-up recommendations, and counseling regarding cardiovascular risk following APOs. The respondents were divided into general medicine, Obstetrics and Gynecology (O&G), general internal medicine, and cardiology.

RESULTS

Of the 175 responses, 20% (n = 35) were from general medicine, 39% (n = 68) from O&G, 39% (n = 69) from general internal medicine and cardiology, and 2% (n = 3) from other specialties. Although most respondents were aware of increased CVD risk following APOs, significant knowledge gaps were identified, particularly concerning the prevalence and timing of CVD onset after APOs. Over 50% do not counsel women with APOs on cardiovascular risk reduction strategies and approximately half do not counsel on the risk of recurrence of APOs. Less than 20% provide women with written follow-up information. Differences in expertise were observed among specialties, with O&G demonstrating the highest level of knowledge.

CONCLUSION

This study identified knowledge gaps among HCPs in postpartum care for women with APOs highlighting the importance of standardized follow-up programs and the need for targeted education for HCPs.

Effectiveness of proprotein convertase subtilisin/kexin type 9 inhibitors in managing hypercholesterolemia post-statin-associated immune-mediated necrotizing myopathy: report of five cases and literature review

Immune-mediated necrotizing myopathy (IMNM), a type of inflammatory myopathy, is associated with anti-SRP or anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR) antibodies, with statin use potentially inducing statin-associated IMNM (SAIMNM) due to HMGCR targeting. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors may offer a safer alternative for lipid-lowering in these patients. This study aims to describe the clinical characteristics of SAIMNM patients and evaluate the safety of PCSK9 inhibitors after myositis onset. We present the clinical characteristics of five SAIMNM patients and evaluate the safety of PCSK9 inhibitors in these cases. Additionally, we conducted a literature review using four different databases (Medline/PubMed, Scopus, Cochrane and DOAJ) to summarize the available data on IMNM. While numerous articles discussed statin-induced myositis, we selected only those studies that addressed the treatment of dyslipidemia after the management of IMNM. All five patients were women, with four having a history of statin use. One statin-naïve patient was positive for anti-SRP antibodies, while the others had anti-HMGCR antibodies. After a mean follow-up of 18.2 months, creatine phosphokinase (CPK) levels dropped from 1028.6 IU/L to 135 IU/L, and LDL cholesterol levels decreased from 206.2 mg/dL to 87.2 mg/dL. All patients were treated with steroids (with a gradual dosage reduction), and four of the five received second line immunosuppressive therapy, such as intravenous immunoglobulin, methotrexate, azathioprine, and mycophenolate mofetil. No disease recurrence occurred after starting PCSK9 inhibitors. A review of seven studies (15 patients) showed a mean CPK of 1531.9 IU/L. 40% received steroids and another immunosuppressant. Statin rechallenge caused relapse in two cases, but PCSK9 inhibitors were well tolerated, with only one patient needing additional immunosuppression. Additionally, ezetimibe and bempedoic acid were used successfully in some patients. Finally, lipid levels appeared to be lower after treatment with PCSK9 inhibitors. Administration of PCSK9 inhibitors appears to be an effective and safe option for the treatment of dyslipidaemia in patients with IMNM.

Elevated high-sensitivity C-reactive protein and dyslipidaemia in type 2 diabetes mellitus: implications for cardiovascular risk prediction in Nigerian patients

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with type 2 diabetes mellitus (T2DM). Inflammation, marked by elevated high-sensitivity C-reactive protein (hs-CRP) levels, and dyslipidaemia, are critical contributors to atherosclerosis and cardiovascular risk. In Nigeria, where T2DM prevalence is rising, there is a need for more comprehensive risk prediction tools, incorporating both traditional and newer biomarkers such as hs-CRP. This study aimed to investigate the association between elevated hs-CRP levels and dyslipidaemia in Nigerian patients with T2DM and to explore the potential implications for cardiovascular risk prediction.

METHODS

A hospital-based cross-sectional study was conducted among 150 T2DM patients and 150 age-matched controls. Data on socio-demographics, medical history, clinical characteristics, and laboratory parameters, including lipid profiles and hs-CRP levels, were collected. The relationship between hs-CRP levels and lipid parameters was assessed using Pearson's correlation coefficient and independent t-tests.

RESULTS

T2DM patients exhibited significantly higher hs-CRP levels (2.2 ± 1.8 mg/L vs. 1.2 ± 1.0 mg/L, p < 0.001), dyslipidaemia (p < 0.001), and blood pressure (SPB- 127.6 ± 12.4 mmHg, DBP- 77.6 ± 6.6 mmHg vs. SBP- 119.6 ± 10.8 mmHg, DBP- 72.1 ± 8.0 mmHg; p = 0.001) compared to controls. However, no significant correlation was found between hs-CRP levels and lipid parameters.

CONCLUSION

Although no direct association was found between elevated hs-CRP levels and dyslipidaemia, hs-CRP remains an important marker of cardiovascular risk possibly through non-lipid pathways, such as inflammation-driven endothelial dysfunction. Further research is needed to evaluate its potential role in refining cardiovascular risk assessment in the Nigerian T2DM population.

CLINICAL TRIAL NUMBER

Not applicable.

Cardiovascular diseases and depression: A meta-analysis and Mendelian randomization analysis

Depression is a common psychiatric symptom among patients with cardiovascular disease (CVD), adversely affecting their health. Despite the identification of various contributing factors, the precise mechanisms linking CVD and depression remain elusive. This study conducted a meta-analysis to investigate the association between CVD and depression. Furthermore, a bidirectional Mendelian randomization (MR) analysis was undertaken to clarify the causal relationship between the two conditions. The meta-analysis included 39 studies, encompassing 63,444 patients with CVD, 12,308 of whom were diagnosed with depression. The results revealed a significant association between CVD and depression or anxiety, with an estimated overall prevalence of depression in CVD patients of 20.8%. Subgroup analyses showed that the prevalence of depression in patients with coronary artery disease and heart failure was 19.8 and 24.7%, respectively. According to a random-effects model, depressive symptoms were linked to an increase in unadjusted all-cause mortality compared with non-depressed patients. The MR analysis, employing the inverse-variance weighted method as the primary tool for causality assessment, identified significant associations between various CVD types and depression or anxiety phenotypes. These findings underscore the significant relationship between CVD and depression or anxiety, leading to an elevated risk of all-cause mortality. Moreover, the MR analysis provides the first genetically-informed evidence suggesting that depression plays a critical role in the development and progression of certain CVD subtypes. This emphasizes the need for addressing depressive symptoms in CVD patients to prevent or reduce adverse cardiovascular outcomes.

Using Genomics to Develop Personalized Cardiovascular Treatments

Advances in genomic technologies have significantly enhanced our understanding of both monogenic and polygenic etiologies of cardiovascular disease. In this review, we explore how the utilization of genomic information is bringing personalized medicine approaches to the forefront of cardiovascular disease management. We discuss how genomic data can resolve diagnostic uncertainty, support cascade screening, and inform treatment strategies. The role that genome-wide association studies have had in identifying thousands of risk variants for polygenic cardiovascular diseases, and how these insights, harnessed through the development of polygenic risk scores, could advance personalized risk prediction beyond traditional clinical algorithms. We detail how pharmacogenomics approaches leverage genotype information to guide drug selection and mitigate adverse events. Finally, we present the paradigm-shifting approach of gene therapy, which holds the promise of being a curative intervention for cardiovascular conditions.

Patient Portals and Shared Decision-Making in US Adults With or at Risk of Cardiovascular Diseases: A Cross-Sectional Study

BACKGROUND

Patient portals are secure online platforms that have shown potential to facilitate shared decision-making (SDM) in cardiovascular disease risk reduction. However, the role of health care providers (HCPs) in offering patient portals within the context of SDM remains poorly understood. This study aimed to examine the relationship between patient portal access offered by HCPs and patient engagement in SDM among adults with or at risk of cardiovascular disease in the United States (US).

METHODS

This population-based cross-sectional study included a nationally representative sample of US adults from the 2022 Health Information National Trends Survey. We performed weighted multivariable logistic regression analyses to examine the association between patient portal access offered by HCPs and patient engagement in SDM.

RESULTS

The study included a representative sample of 4234 adults with or at risk of cardiovascular disease. The mean age of the participants was 48.5 years (SD, 17.1), with 50.6% female and 62.8% White. Adults who were offered access to patient portals by HCPs (adjusted odds ratio, 2.11 [95% CI, 1.34-3.32]) and encouraged to use them (adjusted odds ratio, 1.68 [95% CI, 1.15-2.45]) were more likely to engage in SDM than their counterparts, adjusting for covariates. The extent of this association varied by demographics and social determinants of health.

CONCLUSIONS

Offering access to patient portals and encouragement to use them by HCPs was associated with high SDM among US adults with or at risk of cardiovascular disease. Future research is needed to explore the possible causal relationship between patient portal use and access and patient engagement in SDM.

Risk-Based Primary Prevention of Heart Failure: A Scientific Statement From the American Heart Association

The growing morbidity, mortality, and health care costs related to heart failure (HF) underscore the urgent need to prioritize its primary prevention. Whereas a risk-based approach for HF prevention remains in its infancy, several key opportunities exist to actualize this paradigm in clinical practice. First, the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guidelines provided recommendations, for the first time, on the clinical utility of multivariable risk equations to estimate risk of incident HF. Second, the American Heart Association recently developed the PREVENT (Predicting Risk of Cardiovascular Disease Events) equations, which not only enable prediction of incident HF separately, but also include HF in the prediction of total cardiovascular disease. Third, the predominant phenotype of HF risk has emerged as the cardiovascular-kidney-metabolic syndrome. Fourth, the emergence of novel therapies that prevent incident HF (eg, sodium-glucose cotransporter-2 inhibitors) and target multiple cardiovascular-kidney-metabolic axes demonstrate growing potential for risk-based interventions. Whereas the concept of risk-based prevention has been established for decades, it has only been operationalized for atherosclerotic cardiovascular disease prevention to date. Translating these opportunities into a conceptual framework of risk-based primary prevention of HF requires implementation of PREVENT-HF (Predicting Risk of Cardiovascular Disease Events-Heart Failure) equations, targeted use of cardiac biomarkers (eg, natriuretic peptides) and echocardiography for risk reclassification and earlier detection of pre-HF, and definition of therapy-specific risk thresholds that incorporate net benefit and cost-effectiveness. This scientific statement reviews the current evidence for accurate risk prediction, defines strategies for equitable prevention, and proposes potential strategies for the successful implementation of risk-based primary prevention of HF.

Community-Based and Public Health Initiatives Drive Cardiovascular Disease Prevention: A State-of-the-Art Review

BACKGROUND

Because of the massive global healthcare burden that cardiovascular diseases (CVD) present, it is critical that effective, highly scalable prevention strategies be identified and implemented to meet this unique health challenge.

PURPOSE

The purpose of this review is to analyze and synthesize current research initiatives for CVD prevention at both community-based and practice-based levels.

CONCLUSIONS

This state-of-the-art review article highlights successful intervention strategies and their outcomes, explores the implications for population-based practice, and discusses the importance of long-term behavior change in achieving sustained CVD prevention. The article also discusses the need for building community capacity through engagement and collaboration and advocates for culturally appropriate dissemination strategies to ensure equitable access to new technologies and interventions in CVD prevention.

CLINICAL IMPLICATIONS

This review suggests that clinicians and researchers should integrate evidence-based, community-engaged, and culturally tailored strategies into practice and future research to promote long-term behavior change and equitable CVD prevention.

Association of Accelerometer-Derived Physical Activity Pattern With the Risks of All-Cause, Cardiovascular Disease, and Cancer Death

BACKGROUND

Current guidelines suggest engaging in a minimum of 150 minutes of moderate to vigorous physical activity (MVPA) each week to support overall health. However, the effect of concentrated versus evenly distributed physical activity (PA) on health outcomes remains uncertain. This study aims to investigate the associations of "weekend warrior" pattern, where most MVPA is completed in 1 to 2 days, and a more evenly spread MVPA pattern with mortality risk.

METHODS

Data from the UK Biobank were used, with participants having a full week of device-measured PA data from 2013 to 2015. Three MVPA patterns were defined: inactive, active weekend warrior, and active regular. The relationships between PA patterns and mortality risk were investigated using the Cox proportional hazards model.

RESULTS

During an 8.1-year median follow-up, 3965 adults died from all causes, including 667 from cardiovascular disease and 1780 from cancer. Both the active weekend warrior group (all-cause death: hazard ratio [HR], 0.68 [95% CI, 0.64-0.74]; cardiovascular disease death: HR, 0.69 [95% CI, 0.58-0.83]; cancer death: HR, 0.79 [95% CI, 0.71-0.89]) and the active regular group (all-cause death: HR, 0.74 [95% CI, 0.68-0.81]; cardiovascular disease death: HR, 0.76 [95% CI, 0.61-0.94]; cancer death: HR, 0.87 [95% CI, 0.76-0.99]) demonstrated a lower mortality risk compared with the inactive group after following the recommended 150 minutes of MVPA per week. Furthermore, there was no discernible difference in the mortality risk between the active regular group and the active weekend warrior group.

CONCLUSIONS

Engaging in PA concentrated within 1 to 2 days was related with a similar reduction in mortality risk as more evenly spread activity. Our findings are particularly significant for individuals who find it challenging to engage in regular PA due to time constraints.

Feasibility of an Individualized Exercise Training Program for Children with Hypertrophic Cardiomyopathy

Limited data exist to guide exercise participation in pediatric hypertrophic cardiomyopathy (HCM) patients. Exercise is traditionally restricted in this population, despite research in adults with HCM demonstrating exercise-associated cardiovascular and psychological benefit. This pilot study seeks to assesses the safety and feasibility of a moderate-intensity exercise program in children with HCM to guide future study design. Eight subjects ages 8-18 with HCM were recruited from the outpatient cardiology clinic at a large tertiary care referral center. All subjects were NYHA Class I (n = 4) or II (n = 4) and median septal wall thickness was 2.3 cm [IQR 1.4, 2.5]. The intervention included a 16-week exercise program, consisting of three 30-min aerobic and two strength sessions per week. A target heart rate zone was established using a baseline cardiopulmonary exercise test (CPET). A FitBit device was used to titrate activity to this zone during sessions. Self-reported adherence ranged from 1.25 to 96.25%. At baseline, cardiorespiratory fitness, assessed by CPET, and Health Related Quality of Life (HRQoL), assessed using two validated instruments, were reduced compared to peers. All subjects (n = 4) who completed the intervention improved in exercise performance and HRQoL measures. Ambulatory rhythm monitoring did not reveal any intervention-related arrhythmias, and there were no cardiac adverse events. This pilot study shows the promise of a potential benefit of an interventional exercise program in children with HCM. Future work should aim to improve retention, and more fully assess the safety and impact of exercise in pediatric HCM.

Video Clips of the Dietary Approaches to Stop Hypertension Diet on YouTube: A Social Media Content Analysis

BACKGROUND

YouTube is among the most highly used internet video sharing platforms worldwide.

OBJECTIVE

The aim in this study was to conduct a social media content analysis of Dietary Approaches to Stop Hypertension (DASH) diet videos on YouTube.

METHODS

Specific search parameters were input into YouTube, and 101 videos were evaluated for quality and viewer exposure/engagement metrics independently by 3 content experts using the DISCERN instrument, a 16-item instrument designed to assess quality, reliability, and dependability of an online source. Scores were aggregated for analysis.

RESULTS

The majority (n = 69, 68.3%) of the videos were categorized as educational and came from a nonprofit source (n = 35, 34.7%). Although multiple speakers were the most frequent speaker type (n = 30, 29.7%), influencers/actors, dietitians, and healthcare providers were relatively equally distributed across the category (25.7%, 22.8%, and 21.8% respectively). Correlation analysis evaluating video's views, comments, and likes indicates that these video metrics are not correlated with video quality. However, the length of video was moderately and positively associated (P = .01) with the 4 DISCERN parameters of quality.

CONCLUSION

Study findings suggest that videos on DASH diet offered via YouTube could potentially be an inexpensive venue to promote healthful dietary practices and educate clients. Existing YouTube content on DASH diet demonstrates significant variability in quality ratings based on DISCERN. Providers should direct individuals to engage with high-quality educational DASH diet videos on YouTube that are created with qualified health professionals and are shared by reputable institutions.

Translation of genomics into routine cardiological practice: insights from a European Society of Cardiology Cardiovascular Round Table

Cardiovascular diseases (CVD) remain the leading cause of death globally and there is an urgent need for innovative approaches to treatment. One emerging avenue is genetic therapies, which hold particular promise for diseases with a monogenic basis. Gene silencing techniques using antisense oligonucleotides or ribonucleic acid interference strategies are currently at the forefront of genetic therapies in CVD, with several ribonucleic acid-targeted therapies already approved for the treatment of conditions such as familial hypercholesterolaemia and transthyretin amyloidosis. For diseases caused by loss-of-function genetic variants, there is growing interest in gene therapy, applying either gene replacement strategies using adeno-associated virus vectors or gene editing strategies using tools such as the clustered regularly interspaced short palindromic repeats and clustered regularly interspaced short palindromic repeats-associated protein-9 system. Preclinical studies have highlighted the potential of this technology in CVD and promising data are beginning to emerge from early-phase clinical trials. During a European Society of Cardiology Cardiovascular Round Table workshop, the challenges of translating these novel therapeutic strategies to the routine cardiology clinic were discussed. Several key priorities were identified, including the need for disease-specific preclinical models, precision diagnostics, adequately powered clinical trials with meaningful endpoints, and enhanced education of healthcare professionals and patients. The Cardiovascular Round Table also considered the role of polygenic risk scores in risk stratification and how these can potentially be implemented in clinical practice.

Leveraging Patients' Interest in Lifestyle Medicine: A Growth Opportunity for Providers and the Health Care System

Background: Lifestyle medicine, including whole-food, plant-based eating, is an evidence-based approach to reducing chronic disease risks. Despite its alignment with recommendations from major medical societies, lifestyle medicine is not emphasized in medical education. Health care providers' level of exposure to lifestyle medicine may facilitate or obstruct patients' ability to make healthy lifestyle changes and reduce their chronic disease risk. Materials and Methods: We analyzed transcripts of focus groups from participants (n = 17) in a pilot plant-based lifestyle medicine program. The program itself was situated in a large public health care system and had demonstrated efficacy in improving cardiometabolic outcomes. Our thematic analysis evaluated quotations citing interactions with providers not affiliated with the program. Results: We found participants cited discordant patient-provider perspectives around patient decisions to pursue lifestyle and, specifically, regarding the benefits of lifestyle in treating lifestyle-related chronic illness. Conclusion: Our findings demonstrate that patients could have missed an opportunity to incur the benefits of lifestyle medicine had they not pursued the program despite the perception of their providers' opposition. These hypothesis-generating findings suggest the need to build providers' awareness of and exposure to lifestyle medicine to facilitate patient engagement in evidence-based lifestyle behavior change programs.

When accurate prediction models yield harmful self-fulfilling prophecies

Prediction models are popular in medical research and practice. Many expect that by predicting patient-specific outcomes, these models have the potential to inform treatment decisions, and they are frequently lauded as instruments for personalized, data-driven healthcare. We show, however, that using prediction models for decision-making can lead to harm, even when the predictions exhibit good discrimination after deployment. These models are harmful self-fulfilling prophecies: their deployment harms a group of patients, but the worse outcome of these patients does not diminish the discrimination of the model. Our main result is a formal characterization of a set of such prediction models. Next, we show that models that are well calibrated before and after deployment are useless for decision-making, as they make no change in the data distribution. These results call for a reconsideration of standard practices for validation and deployment of prediction models that are used in medical decisions.

Modern therapy of patients with lupus erythematosus must include appropriate management of their heightened rates of atherosclerotic cardiovascular events: a literature update

Atherosclerotic cardiovascular disease (ASCVD) remains the biggest killer of patients with lupus erythematosus (LE) and the general non-autoimmune population. In this literature update on LE and ASCVD, we focused on published work since our earlier review article, meaning from 2021 to the present, with an emphasis on cutaneous LE. Several themes emerged. First, new work shows that patients with lupus still exhibit a high burden of conventional risk factors for ASCVD events. Second, recent studies continue to implicate possible effects of lupus disease activity to worsen rates of ASCVD events beyond predictions from conventional risk factors. Third, new work on estimating the risk of future ASCVD events in patients with lupus supports arterial-wall imaging, inclusion of lupus-specific factors, estimators of ASCVD event risk that take lupus status into account and considering lupus as a diabetes equivalent or even as a diabetes-plus-smoking equivalent in this context. Technologies for arterial-wall imaging continue to improve and will likely play an increasing role in ASCVD assessment and management. Fourth, purported cardiovascular benefits from certain disease-modifying antirheumatic drugs such as antimalarials have become less clear. Fifth, earlier treatment of atherosclerosis, which is a lifelong disease, can be accomplished with diet, exercise, smoking cessation and new classes of safe and effective medications for lipid-lowering and blood pressure control. Benefits on subclinical arterial disease by imaging and on ASCVD events have been reported, supporting the concept that ASCVD is eminently manageable in this autoimmune condition. Sixth, despite the heightened risk for ASCVD events in patients with lupus, available therapeutic approaches remain unused or underused and, accordingly, event rates remain high.Raising awareness among patients and healthcare providers about ASCVD assessment and management in patients with LE is essential. Greater vigilance is needed to prevent ASCVD events in patients with lupus by addressing dyslipidaemias, hypertension, smoking, obesity and physical inactivity.

Cardioprotective Glucose-Lowering Agents and Dementia Risk: A Systematic Review and Meta-Analysis

Importance

Although diabetes is a risk factor for dementia, the effect of glucose-lowering therapy for prevention of incident dementia is uncertain.

Objective

To determine whether cardioprotective glucose-lowering therapy (sodium-glucose cotransporter-2 inhibitors [SGLT2is], glucagon-like peptide-1 receptor agonists [GLP-1RAs], metformin, and pioglitazone), compared with controls, was associated with a reduction in risk of dementia or cognitive impairment, and among primary dementia subtypes.

Data Sources

The PubMed and Embase databases were searched for studies published from inception of the database to July 11, 2024.

Study Selection

Randomized clinical trials comparing cardioprotective glucose-lowering therapy with controls that reported dementia or change in cognitive scores. Cardioprotective glucose-lowering therapies were defined as drug classes recommended by guidelines for reduction of cardiovascular events, based on evidence from phase III randomized clinical trials. Inclusion criteria were assessed independently and inconsistencies were resolved by consensus.

Data Extraction and Synthesis

Data were screened and extracted independently by 2 authors adhering to the PRISMA guidelines in August 2024. Random-effects meta-analysis models were used to estimate a pooled treatment effect.

Main Outcomes and Measures

The primary outcome measure was dementia or cognitive impairment. The secondary outcomes were primary dementia subtypes, including vascular and Alzheimer dementia, and change in cognitive scores.

Results

Twenty-six randomized clinical trials were eligible for inclusion (N = 164 531 participants), of which 23 trials (n = 160 191 participants) reported the incidence of dementia or cognitive impairment, including 12 trials evaluating SGLT2is, 10 trials evaluating GLP-1RAs, and 1 trial evaluating pioglitazone (no trials of metformin were identified). The mean (SD) age of trial participants was 64.4 (3.5) years and 57 470 (34.9%) were women. Overall, cardioprotective glucose-lowering therapy was not significantly associated with a reduction in cognitive impairment or dementia (odds ratio [OR], 0.83 [95% CI, 0.60-1.14]). Among drug classes, GLP-1RAs were associated with a statistically significant reduction in dementia (OR, 0.55 [95% CI, 0.35-0.86]), but not SGLT2is (OR, 1.20 [95% CI, 0.67-2.17]; P value for heterogeneity = .04).

Conclusions and Relevance

While cardioprotective glucose-lowering therapies were not associated with an overall reduction in all-cause dementia, this meta-analysis of randomized clinical trials found that glucose lowering with GLP-1RAs was associated with a statistically significant reduction in all-cause dementia.

Mendelian-based urolithiasis risk concerning fish consumption and fish oil supplement

The link between fish consumption and urolithiasis risk has been observed in previous observational studies, yet a definitive causal relationship remains uncertain. We acquired data regarding fish consumption, fish oil supplementation, and urolithiasis from publicly available large-scale genome-wide association studies (GWAS). Urolithiasis data were sourced from the FinnGen consortium, comprising 5347 cases and 213,445 controls. Information on fish consumption and fish oil supplementation was extracted from the UK Biobank, encompassing 460,443 samples for oily fish consumption, 460,880 samples for non-oily fish consumption, and 461,384 samples for fish oil intake. We conducted 2-sample Mendelian randomization (MR) analyses employing random effects inverse variance weighting, weighted median, and MR-Egger methods, respectively. Additionally, a sensitivity analysis was executed. Our study revealed a heightened risk of urolithiasis associated with non-oily fish consumption (odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.04-3.03; P = .03), whereas no causal link was found between oily fish consumption and urolithiasis (OR = 0.92, 95% CI: 0.60-1.40; P = .69). Conversely, fish oil supplementation was linked to a diminished urolithiasis risk (OR: 0.02, 95% CI: 0-0.30; P = .005). Furthermore, our sensitivity analysis yielded no evidence of heterogeneity or pleiotropy in our MR analysis. In summary, our study, utilizing genetic data, suggests that non-oily fish consumption may increase the risk of urolithiasis formation, while fish oil supplementation may mitigate this risk.

Alpha-lipoic acid on intermediate disease markers in overweight or obese adults: a systematic review and meta-analysis

OBJECTIVES

To evaluate the associations between alpha-lipoic acid (ALA) intake and intermediate disease markers in overweight or obese adults.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, EMBASE, Medline, APA PsycINFO, SocINDEX, CINAHL, SSRN, SocArXiv, PsyArXiv, medRxiv, and Google Scholar (from inception to October 2024).

ELIGIBILITY CRITERIA

This study included English-language randomised controlled trials (RCTs) on adults (body mass index ≥25 kg/m²) to assess the impact of ALA on intermediate disease markers. Studies lacking outcome data, duplicates or inaccessible full texts were excluded.

DATA EXTRACTION AND SYNTHESIS

Paired reviewers independently extracted the data. We used frequentist meta-analysis to summarise the evidence, employing the DerSimonian and Laird estimator to account for heterogeneity across study designs, settings and measurement methods. Heterogeneity was assessed via the I² statistic with CIs and τ² values. The risk of bias was independently assessed by two reviewers according to the Cochrane Handbook, covering domains such as randomisation, blinding and data completeness. Publication bias was assessed using Begg's test, while funnel plots and Egger's test were applied to outcomes with 10 or more studies.

RESULTS

This meta-analysis included 11 RCTs from an initial screening of 431 studies, encompassing a total of 704 adults. The meta-analysis results revealed no significant associations were detected between ALA supplementation and changes in intermediate disease markers, including triglyceride (TG) (standardised mean difference (SMD): -0.08, 95% CI: -0.24 to 0.09, p=0.36, I²=0.00%, τ²=0.00), total cholesterol (TC) (SMD: 0.08, 95% CI: -0.55 to 0.71, p=0.80, I²=87.50%, τ²=0.52), high-density lipoprotein cholesterol (HDL-C) (SMD: -0.05, 95% CI: -0.22 to 0.11, p=0.52, I²=0.00%, τ²=0.00), low-density lipoprotein cholesterol (LDL-C) (SMD: -0.13, 95% CI: -0.40 to 0.15, p=0.37, I²=0.00%, τ²=0.00), homeostasis model assessment of insulin resistance (HOMA-IR) (SMD: -0.23, 95% CI: -0.60 to 0.15, p=0.23, I²=26.20%, τ²=0.05) and fasting blood glucose (FBS) (SMD: 0.13, 95% CI: -0.16 to 0.41, p=0.39, I²=29.40%, τ²=0.04). According to the Grading of Recommendations Assessment, Development and Evaluation bias assessment approach, eight studies were rated as having low bias (grade A), and three studies were rated as having moderate bias (grade B). Begg's test indicated no evidence of publication bias.

CONCLUSIONS

No significant associations were detected between ALA intake and intermediate disease markers, including TG, TC, HDL-C, LDL-C, HOMA-IR and FBS levels, in overweight or obese adults. Further research is needed to explore the potential associations of ALA, especially in high-risk populations with metabolic disorders, by employing longer intervention durations, higher dosages and optimised formulations.

PROSPERO REGISTRATION NUMBER

CRD42023450239.

Cardiovascular Effects of Antiseizure Medications for Epilepsy

Antiseizure medications (ASMs) are the primary treatment for epilepsy. However, adverse cardiac effects of ASMs can occur, related to their effects on lipid metabolism, raising ischemic heart disease risk; or specific actions on cardiac ion channels, increasing cardiac arrhythmia risk. Select ASMs, particularly enzyme inducers used at higher doses or for longer durations, can adversely affect lipids or cause metabolic changes, and thereby increase the risk for ischemic heart disease. These metabolic and potentially proarrhythmic actions may contribute to the increased cardiovascular morbidity and mortality that occur in epilepsy. Many ASMs block sodium channels or affect the QT interval, which can lead to proarrhythmia, particularly when used in combination with other medications or given to vulnerable populations. While ASMs are rarely reported to cause cardiac arrhythmias directly, population data raise concerns that cardiac arrhythmias and sudden cardiac death may be more common in epilepsy, and that sodium channel blocking ASMs in particular, might contribute. It is also possible that some cases of sudden cardiac death could be misclassified as sudden unexpected death in epilepsy (SUDEP), leading to an underestimation of the cardiovascular risk in this population. Cardiovascular risk factors, such as smoking and a sedentary lifestyle, are also associated with epilepsy, and should also be addressed. This summary is a narrative review of the literature, clarifies which ASMs tend to have more cardiovascular effects, and provides practical suggestions for medication management and monitoring from neurology and cardiology perspectives.

Prognostic circulatory signature metabolites of stable versus unstable angina: an application of NMR spectroscopy

In spite of the ongoing efforts to probe the metabolic signatures of stable (SA) from unstable (UA) angina, it is concerning that to date there are no clinically validated circulatory biochemical signatures against the intrinsic anatomical changes that are screened by invasive coronary angiography. Hence, the aim of this study is to generate precise biochemical fingerprints using filtered serum-based metabolomics and high-throughput nuclear magnetic resonance (NMR) spectroscopy to accurately distinguish the metabolic signatures of patients suffering with SA or UA angina. The study includes 118 filtered serum samples from patients suffering from UA (n = 50) and SA (n = 68). High-resolution NMR spectroscopy was used to assess the metabolic remodeling in these cohorts. Subsequently, principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS-DA), and artificial neural network (ANN) analysis were adapted to engender a precise prediction model. Analysis of the receiver operating characteristic (ROC) curve was conducted to determine the clinical usefulness of metabolic markers. The outcome revealed that the metabolic profile for the underlying disease is characterized by altered metabolite levels in UA relative to SA. Creatinine, 3-OH butyrate, and aspartate level could differentiate 100% of UA from SA with 100% sensitivity and specificity. To monitor and determine UA from patients with SA, 1H NMR-based filtered serum metabolic profiling seems to be a promising, less invasive, and faster investigative approach.NEW & NOTEWORTHY There are no metabolic signatures present to identify unstable from stable angina. Coronary angiography identifies anatomical changes after the event of unstable angina, but NMR-based metabolomics identifies unstable from stable angina within 4 h. Creatinine, 3-OH butyrate, and aspartate were able to segregate unstable from stable angina.

Resource Efficient Screening for Primary Prevention of Coronary Heart Disease: A Proof-of-Concept Test in the MESA Cohort

BACKGROUND

The best use of cardiac imaging to guide preventive coronary heart disease (CHD) treatment is debated. Current guidelines recommend the pooled cohort equation, followed by computed tomography for coronary artery calcification (CAC) assessment. We evaluated if this approach could be simplified using a self-report risk algorithm instead of the pooled cohort equation.

METHODS

A gradient boosting machine model was trained on self-reported factors to calculate the probability of a high CAC score (≥100). This model was part of a self-report-based CHD preventive strategy with 3 steps: (1) calculate the probability of having a high CAC; (2) perform computed tomography for high-risk individuals; and (3) assign treatment eligibility with lipid-lowering therapy if CAC score exceeds a designated threshold. This strategy was tested using data from the MESA (Multi-Ethnic Study of Atherosclerosis) cohort (n=4564) and compared with guidelines recommending CAC scanning for intermediate-risk individuals (pooled cohort equation, 7.5% to <20%) by evaluating CHD events over 10-year follow-up in the group defined as treatment eligible by either strategy.

RESULTS

The pooled cohort equation identified 33% of the MESA population as eligible for a CAC scan and 19% as treatment eligible, capturing 48% of all CHD events (103 of 216). The self-report strategy identified 56% of CHD events (120 of 216; P=0.02) with the same number of CAC scans and treatments but required health care visits for only 33% of the population.

CONCLUSIONS

A self-report screening strategy, combined with CAC scoring, is more resource efficient and better discriminates high-risk individuals suitable for lipid-lowering therapy compared with current guidelines.

2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

AIM

The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."

METHODS

A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

STRUCTURE

Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Exploring the impact of graded alcohol use on atherogenic lipid profiles among Latinos with underlying chronic liver disease

BACKGROUND

Alcohol use and hepatitis C virus (HCV) often coexist and are associated with cardiovascular disease. One of the underlying drivers is dyslipidemia. We assessed lipid and lipoprotein levels and the relationship between alcohol use and atherogenic lipid profiles, specifically small dense low-density lipoprotein cholesterol (sdLDL-C), in Latinos with and without HCV.

METHODS

From June 1, 2002, to January 1, 2016, 150 Latino adults underwent demographic, clinical, metabolic, lipid/lipoprotein, and genetic evaluations. Linear regression (adjusted for age, sex, and recent alcohol use) assessed factors associated with sdLDL-C.

RESULTS

Participant characteristics were as follows: median age 44 years, 64% male, 39% HCV+, and alcohol use in the last 12 months was 19% heavy and 47% moderate. Ancestries were as follows: 52% European, 40% Native American (NA), and 4.3% African. 29% had non-CC PNPLA3, 89% non-CC TM6SF2, and 73% non-CC IL-28b genotypes. High-density lipoprotein (HDL) cholesterol, HDL-3, apolipoprotein A-1, and lipoprotein-associated phospholipase A2 levels differed by alcohol use groups (p < 0.05). On multivariable analysis, female sex (est. -6.08, p < 0.001), HCV+ status (est. -8.49, p < 0.001), and heavy alcohol use (vs. none) (est. -4.32, p = 0.03) were associated with lower, while NA ancestry (est. 0.92; p = 0.01) and adipose tissue insulin resistance (est. 3.30, p < 0.001) were associated with higher sdLDL-C levels. The positive association between NA ancestry and sdLDL-C was dampened by the presence of a non-CC IL28b genotype (interaction est. -1.95, p = 0.01).

CONCLUSIONS

In this Latino cohort, ancestry and metabolic dysfunction, independent of alcohol use and HCV, were associated with atherogenic risk. In addition to HCV treatment in this population, cardiometabolic health should be optimized.

A Clinical Retrospective Study on the Combined Use of Monocyte-to-Lymphocyte Ratio and Triglyceride-Glucose Index to Predict the Severity of Coronary Artery Disease

Background

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality. Traditional risk models based on factors like age, hypertension, and lipid levels are limited in individualized prediction, especially for high-risk populations. This study evaluates the independent and combined predictive value of the monocyte-to-lymphocyte ratio (MLR) and triglyceride-glucose (TyG) index for assessing CAD severity.

Methods

In this single-center, retrospective study, 678 patients who underwent coronary angiography (CAG) between January 2022 and June 2024 were included. Eligible patients were aged ≥ 40 years with suspected or confirmed CAD. Clinical data and laboratory values were extracted from electronic records. MLR was calculated as the monocyte-to-lymphocyte ratio, and TyG index was derived from fasting triglycerides and glucose. CAD severity was categorized by SYNTAX scores into no CAD, mild, moderate, and severe CAD. Statistical analyses included Spearman correlation, multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis to assess the diagnostic accuracy of MLR and TyG index.

Results

Of the 678 patients, 67.1% had CAD. Both MLR and TyG index were significantly associated with CAD severity, with MLR showing a stronger correlation with SYNTAX scores. Multivariate analysis confirmed MLR (odds ratio (OR) = 2.15) and TyG index (OR = 1.75) as independent predictors of CAD. The combined MLR-TyG model achieved an area under the curve (AUC) of 0.804, surpassing the predictive value of each marker alone. Subgroup analysis indicated high predictive accuracy in diabetic and hypertensive patients.

Conclusions

MLR and TyG index independently and jointly predict CAD severity, with the combined model enhancing diagnostic accuracy. Reflecting both inflammatory and metabolic dysfunction, this dual-marker approach offers a practical tool for CAD risk stratification, particularly in high-risk populations. Further multicenter studies are needed to validate these findings and examine additional biomarker combinations to refine CAD risk models.

Comorbidity in Midlife and Cancer Outcomes

Importance

Comorbidities in midlife are common but how these conditions are associated with cancer outcomes is poorly understood.

Objective

To investigate the association between different comorbidities and risk of incident cancer and cancer mortality.

Design, Setting, and Participants

This cohort study is a secondary analysis of the prospective Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial conducted at 10 PLCO screening centers across the US. Participants included adults aged 55 to 74 years without a history of cancer enrolled between 1993 and 2001. Statistical analysis was performed from June 2023 to December 2024.

Exposures

Self-reported history of 12 comorbid conditions classified into 5 distinct classifications guided by World Health Organization categorization.

Main Outcome and Measures

Outcomes included risk of all cancers combined, risk of 19 individual cancer types, and cancer mortality. Multivariable Cox proportional hazards models were used to estimate the association between comorbidity classifications and cancer outcomes.

Results

Among 128 999 participants included in the analysis, 330 (0.3%) were American Indian, 5414 (4.2%) were Asian or Pacific Islander, 6704 (5.2%) were non-Hispanic Black, and 114 073 (88.4%) were non-Hispanic White; 64 171 (49.7%) were male; and the median (IQR) age was 62 (58-66) years. After a median (IQR) follow-up of 20 (19-22) years, the risk of any incident cancer was significantly higher for individuals with a history of respiratory (hazard ratio [HR], 1.07 [95% CI, 1.02-1.12]) and cardiovascular conditions (HR, 1.02 [95% CI, 1.00-1.05]). History of each comorbid condition evaluated was significantly associated with incidence of at least 1 cancer type. The strongest association was between history of liver conditions and risk of liver cancer (HR, 5.57 [95% CI, 4.03-7.71]), whereas metabolic conditions (obesity or type 2 diabetes) were significantly associated with higher risk of 9 cancer types and lower risk of 4 cancer types. Respiratory (HR, 1.19 [95% CI, 1.11-1.28]), cardiovascular (HR, 1.08 [95% CI, 1.04-1.13]), and metabolic (HR, 1.09 [95% CI, 1.05-1.14]) conditions were positively associated with a higher hazard of cancer death.

Conclusions and Relevance

In this cohort study of 128 999 adults without a history of cancer, comorbidities in midlife were associated with the overall risk of cancer and more strongly associated with risk of multiple individual cancer types, with the direction of association differing across cancer types. These results may inform clinical management of patients at risk for cancer.

A Mediterranean-Style Diet with Lean Beef Lowers Blood Pressure and Improves Vascular Function: Secondary Outcomes from a Randomized Crossover Trial

Background

The Mediterranean (MED) dietary pattern improves cardiovascular disease (CVD) risk factors. Increased central systolic blood pressure and arterial stiffness are independent predictors of CVD. The effect of a MED diet on these measures of vascular health has not been investigated.

Objectives

The aim was to evaluate the effects of a MED diet incorporating 0.5 oz./d (MED0.5), 2.5 oz./d (MED2.5) and 5.5 oz./d (MED5.5) of lean beef compared with an Average American diet (AAD) on vascular health [brachial and central blood pressure, pulse wave velocity (PWV), and augmentation index].

Methods

A multicenter, 4-period randomized, crossover, controlled-feeding study was conducted at Penn State University and USDA, Beltsville. In random sequence order, participants consumed each test diet for 4 wk. Vascular outcomes were assessed at baseline and the end of each diet period. Linear mixed models were used for analyses.

Results

Between-diet differences were observed for peripheral and central blood pressure as well as PWV (P < 0.05). PWV was lower following MED0.5 [-0.24 m/s; 95% confidence interval (CI): -0.44, -0.04] and MED2.5 (-0.27 m/s; 95% CI: -0.47, -0.07) compared with the AAD; PWV was nominally lower after the MED5.5 compared with the AAD (-0.20 m/s; 95% CI: -0.40, 0.003; P = 0.055). Central systolic blood pressure was lower following the MED0.5 (-3.24 mmHg; 95% CI: -5.22, -1.27) and MED2.5 (-2.93 mmHg; 95% CI: -4.91, -0.96) compared with the AAD. A similar pattern was observed for central diastolic pressure. Brachial systolic and diastolic pressure were lower following all 3 MED diets compared with the AAD (P < 0.05).

Conclusions

Compared with an AAD, MED diets containing 0.5 and 2.5 oz./d of lean beef improved brachial and central systolic and diastolic blood pressure and arterial stiffness. Our findings suggest that a MED diet with ≤5.5 oz./d of lean beef does not adversely affect vascular function.This trial was registered at clinicaltrials.gov as NCT02723617.

Accelerometer-derived physical activity patterns and incident type 2 diabetes: a prospective cohort study

BACKGROUND

Emerging evidence suggests a significant relationship between the duration of physical activity (PA) and the incidence of type 2 diabetes (T2D). However, the association between the "weekend warrior" (WW) pattern-characterized by concentrated moderate-to-vigorous PA (MVPA) over one to two days-and T2D remains unclear.

METHODS

This prospective cohort study aims to utilize device-measured PA data to investigate the associations between PA patterns and T2D. Individuals were divided into three MVPA patterns on the basis of WHO guidelines: inactive (< 150 min), active WW (≥ 150 min with ≥ 50% of total MVPA achieved in one to two days), and active regular (≥ 150 min but not active WW). These patterns were also evaluated using sample percentile thresholds. The relationships between PA patterns and the risk of T2D were analysed employing Cox proportional hazards models.

RESULTS

A total of 1972 participants developed T2D over a 7.9-year median follow-up period. In the fully adjusted model, both active patterns demonstrated comparable reductions in the risk of developing T2D (active WW: hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.58-0.71; active regular: 0.56, 0.49-0.64). Moreover, the risk of T2D exhibited a progressive decline as the duration of MVPA increased across both active patterns.

CONCLUSIONS

Engaging in MVPA for one or two days per week provides comparable protective benefits against the incidence of T2D as more evenly distributed PA. Additionally, exceeding the current guidelines may confer even greater advantages.

Discordance of 10- and 30-Year Predicted Risk for Cardiovascular Disease in US Adults

This study examines the distribution of 10- and 30-year cardiovascular disease risk estimates among US adults.

Contribution of Body Composition Measures to the Increased Left Ventricular Mass Index in Young Adult Black and White Females

Objective: We aimed to determine the contribution of various types of body composition measures to the increased left ventricular mass index (LVMI) in young adult females. Methods: Data from the National Growth and Health Study (NGHS), including dual-energy x-ray absorptiometry (DEXA), magnetic resonance imaging (MRI), and echocardiogram, were analyzed (N = 589, 54.8% Black, mean age: 24.9 ± 0.7 years). Logistic and linear regressions were conducted to assess for the contribution of fat mass (FM) and fat-free mass (FFM) by DEXA and subcutaneous abdominal adipose tissue (SAT) mass and visceral adipose tissue (VAT) volume by MRI in relation to the increased LVMI or left ventricular hypertrophy (LVH; LVMI ≥ 38.6 g/m2.7). Results: FM (β ± SE: 0.025 ± 0.002, p < 0.01, adjusted R 2 = 0.313), FFM (0.059 ± 0.003, p < 0.01, adjusted R 2 = 0.374), SAT (0.054 ± 0.005, p < 0.01, adjusted R 2 = 0.291), and VAT (0.194 ± 0.019, p < 0.01, adjusted R 2 = 0.256) were each significantly associated with the increased LVMI, with FFM having the greatest association. Black race was associated with the increased LVMI in models involving individual fat mass types (0.055 ± 0.020, p < 0.01 for FM; 0.054 ± 0.021, p = 0.01 for SAT; 0.119 ± 0.021, p < 0.01 for VAT). In logistic models considering all mass types, FFM (OR [95% CI]: 1.62 [1.46-1.79], p < 0.01) and systolic blood pressure (SBP) (1.04 [1.01-1.07], p < 0.01) were significant contributors to LVH (area under the receiver-operator characteristic curve 0.847), and only FFM was a significant contributor in the corresponding linear regression (β ± SE: 0.059 ± 0.003, p < 0.01, adjusted R 2 = 0.374). Conclusions: FFM had the greatest association with LVH and LVMI, confirming previously published data. Through the use of MRI, we found that neither subtype of abdominal fat mass (SAT and VAT) better explained the variance in LVMI than FFM.

Associations between clinical AUDIT-C screens and HDL cholesterol are observed across primary care patient subgroups

BACKGROUND

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a validated, scaled marker of past-year alcohol consumption that is increasingly used in population-based screening and research. Like other screening questionnaires, AUDIT-C scores are influenced by patient and system factors affecting self-report. High-density lipoprotein (HDL) cholesterol increases with alcohol consumption and is routinely measured in primary care. Researchers using AUDIT-C scores as an outcome could potentially use HDL as a population-level check on the performance of alcohol screening, for example, to assess the extent to which changes in AUDIT-C scores after an intervention reflect changes in drinking or changes in self-report. However, the association between AUDIT-C scores and HDL has only been evaluated in limited populations.

METHODS

Cross-sectional associations between AUDIT-C scores and HDL were examined in 290,091 Kaiser Permanente Washington primary care patients who had HDL measured as part of clinical care in the 365 days before or 14 days after routine screening with the AUDIT-C. Linear regression models examined the association between AUDIT-C scores and HDL and explored effect modification by sociodemographic and clinical characteristics.

RESULTS

AUDIT-C scores were positively associated with HDL, including for subgroups defined by age, sex, race, ethnicity, geographically estimated socioeconomic status, presence of cardiovascular disease, history of alcohol or drug treatment, tobacco use, receipt of lipid-lowering medications, and, for female patients, receipt of oral estrogen or progestin medications. Effect modification analyses showed that most sociodemographic and clinical characteristics modified the association between AUDIT-C and HDL.

CONCLUSIONS

The association between AUDIT-C and HDL is present in a range of sociodemographic and clinical subgroups. However, effect modification by sociodemographic and clinical characteristics may limit the use of that association in assessing the validity of alcohol screening scores across heterogeneous populations.

Interactive Effects of Weight Recording Frequency and the Volume of Chat Communication With Health Care Professionals on Weight Loss in mHealth Interventions for Noncommunicable Diseases: Retrospective Observational Study

Background

Mobile health (mHealth) apps are increasingly used for health promotion, particularly for managing noncommunicable diseases (NCDs) through behavior modification. Understanding the factors associated with successful weight loss in such interventions can improve program effectiveness.

Objective

This study examined factors influencing weight change and the relationship between weight recording frequency and chat volume with health care professionals on weight loss in individuals with obesity and NCDs.

Methods

The participants had obesity (BMI ≥25 kg/m²) and were diagnosed with NCDs (eg, hypertension, diabetes, dyslipidemia). The program included 12 telephone consultations with health care professionals. Only participants who completed the full 6-month program, including all 12 telephone consultations, and provided an end-of-study weight were included in the analysis. The primary outcome was the rate of weight change, defined as the percentage change in weight from the initial period (first 14 days) to the final period (2 weeks before the last consultation), relative to the initial weight. The key independent variables were proportion of days with weight recording and chat communication volume (total messages exchanged). An interaction term between these variables was included to assess moderation effects in the regression analysis. The volume of communication was measured as the total number of messages exchanged, with each message, regardless of who sent it, being counted as 1 interaction. Health care staffs were instructed to send a single scheduled chat message per week following each biweekly phone consultation. These scheduled messages primarily included personalized feedback, reminders, and motivational support. In addition, providers responded to participant-initiated messages at any time during the program. Furthermore, 1 professional responded to each participant. Hierarchical multiple regression and simple slope analyses were conducted to identify relationships and interactions among these variables.

Results

The final analysis of this study included 2423 participants. Significant negative associations were found between the rate of weight change and baseline BMI (β=-.10; P<.001), proportion of days with weight recording (β=-.017; P<.001), and communication volume (β=-.193; P<.001). The interaction between proportion of days with weight recording and chat frequency also showed a significantly negative effect on weight change (β=-.01; P<.001). Simple slope analysis showed that when the proportion of days with weight recording was +1 SD above the mean, frequent chats were associated with greater weight reduction (slope=-0.60; P<.001), whereas no significant effect was observed at -1 SD (slope=-0.01; P=.94).

Conclusions

The findings suggest that both the proportion of days with weight recording and communication volume independently and interactively influence weight change in individuals with obesity and NCDs.

Treatment of endothelial cell dysfunction in atherosclerosis: a new perspective integrating traditional and modern approaches

Atherosclerosis (AS), a prime causative factor in cardiovascular disease, originates from endothelial cell dysfunction (ECD). Comprising a vital part of the vascular endothelium, endothelial cells play a crucial role in maintaining vascular homeostasis, optimizing redox balance, and regulating inflammatory responses. More evidence shows that ECD not only serves as an early harbinger of AS but also exhibits a strong association with disease progression. In recent years, the treatment strategies for ECD have been continuously evolving, encompassing interventions ranging from lifestyle modifications to traditional pharmacotherapy aimed at reducing risk factors, which also have demonstrated the ability to improve endothelial cell function. Additionally, novel strategies such as promising biotherapy and gene therapy have drawn attention. These methods have demonstrated enormous potential and promising prospects in improving endothelial function and reversing AS. However, it is essential to remain cognizant that the current treatments still present significant challenges regarding therapeutic efficacy, long-term safety, and ethical issues. This article aims to provide a systematic review of these treatment methods, analyze the mechanisms and efficacy of various therapeutic strategies, with the goal of offering insights and guidance for clinical practice, and further advancing the prevention and treatment of cardiovascular diseases.

Encouraging Pharmacist Referrals for Evidence-Based Statin Initiation: Two Cluster Randomized Clinical Trials

Importance

Despite statins' benefit in preventing major adverse cardiovascular events, most patients with an indication for statin therapy are not appropriately treated. Clinicians' limited time and lack of systematic efforts to address preventive care likely contribute to gaps in statin prescribing.

Objective

To determine the effect on statin prescribing of 2 interventions to refer appropriate patients to a pharmacist for lipid management.

Design, Setting, and Participants

These 2 pragmatic cluster randomized clinical trials were conducted among 12 total primary care practices in a community health system. Trial 1 was a delayed-intervention design of a visit-based intervention with randomization at the clinician level in a single clinic, and trial 2 was a parallel-arm trial of an asynchronous intervention with randomization at the clinic level in 11 clinics. Patients who were assigned to a primary care clinician at a participating practice, had an indication for a high-intensity or moderate-intensity statin, and were either not prescribed a statin or prescribed an inappropriately low statin dose were eligible for inclusion.

Intervention

Trial 1 tested an interruptive electronic health record alert that appeared during eligible patients' visits and facilitated referral to a pharmacist, while trial 2 tested an order for pharmacist referral placed by the study team for cosignature by the primary care clinician without regard to the timing of a clinic visit.

Main Outcome and Measure

The primary outcome was the proportion of patients prescribed a statin.

Results

Overall, 1412 patients were enrolled in trial 1 and 1950 in trial 2. Across both trials, mean (SD) patient age was 65.6 (9.9) years, and 1485 patients (44.2%) were female. Mean (SD) baseline 10-year risk of major cardiovascular events was 17.9% (9.4). In trial 1, the interruptive alert was not associated with a significant increase in statin prescriptions compared with usual care (15.6% vs 11.6%; unadjusted absolute difference, 3.9 percentage points; 95% CI, -0.4 to 8.3). In trial 2, semiautomated pharmacist referrals were associated with an increase in statin prescriptions by 16 percentage points compared with usual care (31.6% vs 15.2%; unadjusted absolute difference, 16.4 percentage points; 95% CI, 12.7-20.1).

Conclusions and Relevance

In these 2 cluster randomized clinical trials, visit-based interruptive alerts were not associated with a significant increase in statin prescribing compared with usual care, whereas a strategy of asynchronous semiautomated referral for pharmacist comanagement was associated with a substantial increase. This strategy of asynchronous semiautomated referrals for pharmacist involvement in lipid management could be a scalable and effective approach to increasing statin prescribing for patients at high risk.

Trial Registration

ClinicalTrials.gov Identifier: NCT05537064.

Cardiovascular Health in the Transition From Adolescence to Emerging Adulthood: A Scientific Statement From the American Heart Association

Cardiovascular disease remains a leading cause of death in the United States, with an alarming rise in the proportion of young adults experiencing cardiovascular events. Many adolescents enter adulthood with significant cardiovascular disease risk factors. This scientific statement addresses the critical need for cardiovascular health promotion during emerging adulthood, a transitional stage between the ages of 18 and 25 or 29 years of age. We discuss the significance of social determinants of health and the interplay between individual-level risk factors and developmental changes, including shifts in substance use, social connections, and emotional well-being. We conclude by outlining strategies for optimizing cardiovascular health promotion and disease prevention, underscoring the importance of primordial prevention, early intervention, and tailored approaches to address the unique needs of emerging adults. Addressing these multifaceted factors is crucial for mitigating the burden of cardiovascular disease risk factors among emerging adults and promoting long-term cardiovascular well-being.

[Clinical application of cardiac computed tomography : Current recommendations]

Cardiac computed tomography (CT) is suitable for use in patients with a low to intermediate pretest probability for risk stratification and for a clear exclusion of coronary heart disease. Furthermore, in addition to a purely anatomical depiction of coronary stenosis it enables the morphological assessment of the underlying plaques and a functional assessment of the hemodynamic relevance. The clinical value of cardiac CT is taken into account in the guidelines of the European Society of Cardiology (ESC) on chronic coronary syndrome with a class 1 recommendation. Cardiac CT therefore has an essential gatekeeper function with respect to the indications for coronary interventions. In the field of structural heart diseases cardiac CT is a core element in the preprocedural planning of heart valve interventions and is the first choice procedure in the postinterventional assessment of unclear findings. Therefore, for interventional heart valve replacement CT-based planning is nowadays the established standard in the clinical diagnostics.

Effects of a cardioprotective nutritional program on apolipoproteins and lipids in secondary cardiovascular disease prevention

OBJECTIVE

This study aimed to evaluate the impact of the Brazilian Cardioprotective Nutrition Program (BALANCE Program) on the plasma levels of various apolipoproteins (A-I, A-II, B, C-II, C-III, and E) and lipid biomarkers over a three-year follow-up period in individuals undergoing secondary cardiovascular prevention.

SUBJECTS AND METHODS

This exploratory analysis included 276 patients aged 45 years or older with a history of cardiovascular disease within the preceding decade. Participants were randomly assigned to one of two groups and monitored over three years: the BALANCE Program group (intervention group; n = 123) and the control (conventional nutritional advice; n = 153). Assessments of clinical and lifestyle data, anthropometry, food intake, plasma apolipoproteins, and lipid profiles were conducted at baseline and at the 3-year follow-up. Intervention adherence was measured utilizing the BALANCE dietary index.

RESULTS

By the end of the follow-up period, adherence was significantly higher in the intervention group (mean difference BALANCE-control [95% CI]: 2.09 points [-0.19; 4.37]), mainly due to increased consumption of fruits, vegetables, legumes, and low-fat dairy products. There were no significant differences in plasma apolipoprotein levels between the groups throughout the study. Nevertheless, significant reductions were observed in the total cholesterol and non-HDL cholesterol levels in the BALANCE group compared to the control group (mean difference intervention-control [95% CI]: -9.95 mg/dL [-18.5; -1.39] and -8.86 mg/dL [-17.53; -0.2], respectively).

CONCLUSION

Following three years of intervention, despite higher adherence to the BALANCE Program, there were no significant changes in plasma apolipoprotein concentrations or overall lipid biomarkers.

Serum ferritin associated with atherogenic lipid profiles in a high-altitude living general population

Background

Serum ferritin (SF) levels are associated with metabolic syndrome and dyslipidemia. However, the association between SF and atherogenic lipid profiles in high-altitude living populations remains unclear.

Methods

In 2021, a cross-sectional study was conducted on adult Tajik individuals residing in Tashkurgan Tajik Autonomous County (average altitude 3,100 meters). Demographic information and anthropometric measurements were collected in local clinics. Fasting blood samples were analyzed using a Beckman AU-680 Automatic Biochemical analyzer at the biochemical laboratory of Fuwai Hospital. Univariate linear regression analyses were used to explore the association between SF and atherogenic lipid levels. Subgroup analysis was used based on gender and different high-sensitivity C-reactive protein (hs-CRP) and serum amyloid A (SAA) levels. The association between higher SF quartiles and different kinds of dyslipidemia were analyzed by logistic regression.

Results

There were 1,703 participants in total, among which 866 (50.9%) being men. The mean ages of male and female participants were similar (41.50 vs. 42.38 years; P = 0.224). SF levels were significantly correlated with total cholesterol (TC) (Beta = 0.225, P < 0.001), low-density lipoprotein cholesterol (LDL-C) (Beta = 0.197, P < 0.001), high-density lipoprotein cholesterol (HDL-C) (Beta = -0.218, P < 0.001), triglycerides (TG) (Beta = 0.332, P < 0.001), and small dense LDL-C (sdLDL-C) (Beta = 0.316, P < 0.001), with the exception of lipoprotein (a) (Lp(a)) (Beta = 0.018, P = 0.475). SF was significantly correlated with LDL-C and HDL-C in women, and correlated with TC, TG, and sdLDL-C levels in both men and women in different inflammatory conditions. Elevated SF levels was significantly correlated with high TC (OR: 1.413, 95% CI [1.010-1.978]), high TG (OR: 1.602, 95% CI [1.299-1.976]), and high sdLDL-C (OR: 1.631, 95% CI [1.370-1.942]) in men and high TC (OR: 1.461, 95% CI [1.061-2.014]), high LDL-C (OR: 2.104, 95% CI [1.481-2.990]), low HDL-C (OR: 1.447, 95% CI [1.195-1.752]), high TG (OR: 2.106, 95% CI [1.454-3.050]), and high sdLDL-C (OR: 2.000, 95% CI [1.589-2.516]) in women. After adjusting for potential confounders, elevated SF levels continue to be correlated with high TG in male (OR: 1.382, 95% CI [1.100-1.737]) and female (OR: 1.677, 95% CI [1.070-2.628]) participants. In both young and middle-aged subgroups, the associations between SF and TG, TC, HDL-C, LDL-C, and sdLDL-C were still significant.

Conclusions

SF was closely related to atherogenic lipid profiles, especially with regard to TG in high-altitude populations. This association cannot be attributed to its role as an inflammation marker.

Long-term aspirin use influences the probability of distant metastases and operability in patients with pancreatic ductal adenocarcinoma: a single-center retrospective study

Background

Aspirin, a non-steroidal anti-inflammatory drug and platelet inhibitor, has been shown to reduce cancer incidence, lower metastatic rates and improve survival in certain cancer types. However, data on the effect of aspirin on prognosis in pancreatic ductal adenocarcinoma (PDAC) are limited. Therefore, we conducted a retrospective, single-center study to evaluate the impact of aspirin use on disease characteristics and survival in PDAC patients.

Materials and methods

The study analyzed data from all consecutively treated PDAC patients over a 6-year period. Operability, Tumor-Node-Metastasis (TNM) stage, and survival endpoints were compared between patients who had used aspirin for 2 or more years prior to their diagnosis (ASA ≥ 2) and those who did not (ASA 0).

Results

A total of 182 patients were included. In the ASA ≥ 2 group, significantly fewer patients had metastatic disease at diagnosis, and a significantly larger proportion presented in the operable stages, compared to the ASA 0 group. No significant differences were observed between the two groups in the T or N stages, overall survival, disease-free survival, or time to progression-free survival.

Conclusions

Although long-term aspirin use did not influence survival endpoints, it was associated with a significantly lower probability of demonstrable distant metastases at diagnosis and a higher rate of resectable disease. This finding warrants further research to explore new therapeutic approaches for the treatment of PDAC.