Background Suboptimal cholesterol management in patients with coronary artery disease (CAD) may contribute to future cardiovascular events and increased health care utilization and costs. Objectives The objectives of the study was to assess lipid-lowering medication use and low-density lipoprotein cholesterol (LDL-C) levels in adults with CAD hospitalized for acute coronary events. Methods We analyzed adults ≥18 years of age with CAD hospitalized for myocardial infarction or unstable angina in 2023 to 2024 in the Get With The Guidelines-CAD registry. Evidence-based lipid-lowering medication was defined as statin therapy. A secondary composite definition was use of statins, ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors. LDL-C thresholds examined were <70 mg/dL (primary), <100 mg/dL, and <55 mg/dL (secondary). Results Among 34,003 patients (mean age 68 years, 71% male, 73% White), 68.4% were using a statin at admission, whereas 71.1% were using statins, ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors. Among 23,558 patients with documented LDL-C at admission, 42.6% had LDL-C <70 mg/dL, including 50.2% and 25.4% of those using and not using statins, respectively (adjusted prevalence ratio [aPR] associated with statin use: 1.96; 95% CI: 1.84-2.08). Women were less likely than men to have LDL-C <70 mg/dL (aPR: 0.85; 95% CI: 0.81-0.85 and 0.79; 95% CI: 0.70-0.89 among those using and not using statins, respectively). Black patients using statins were less likely to have an LDL-C <70 mg/dL than their White counterparts (aPR: 0.70; 95% CI: 0.65-0.75). In secondary analyses, 67.7% and 25.4% of patients had an LDL-C <100 mg/dL and <55 mg/dL, respectively. Conclusions Targeted quality improvement initiatives are needed to address gaps in ambulatory cholesterol management.
Background Heart failure (HF) with preserved ejection fraction (HFpEF) is highly prevalent among adults with type 2 diabetes (T2D) but often remains undiagnosed. The HFpEF-ABA score (based on age, body-mass index and atrial fibrillation) has demonstrated excellent diagnosis performance in patients with unexplained dyspnea but lacks validation for opportunistic screening of HFpEF. Objectives We aimed to evaluate the diagnostic and prognostic utility of the HFpEF-ABA score in outpatients with T2D. Methods We analyzed 1,125 outpatients with T2D from the prospective, multicenter DIABET-IC cohort. HFpEF diagnosis was based on the European Society of Cardiology guidelines criteria and confirmed by a cardiologist. We evaluated the diagnostic performance of HFpEF-ABA score and its association with 3-year all-cause death, HF hospitalization, and their composite. Results HFpEF was confirmed in 190 participants (16.9%). The HFpEF-ABA score yielded an area under the receiver operating characteristic curve of 0.75 (95% CI: 0.71-0.79). Over 3 years, 61 deaths and 23 HF hospitalizations occurred. Per 10-percentage-point increase in HFpEF probability, the risk increased for all-cause death (HR: 1.34; 95% CI: 1.17-1.54), HF hospitalization (HR: 1.16; 95% CI: 0.94-1.43), and the composite endpoint (HR: 1.28; 95% CI: 1.14-1.44). Scores ≥75% identified patients at higher risk of death (HR: 2.40; 95% CI: 1.45-3.97), HF hospitalization (HR: 2.51; 95% CI: 1.10-5.72), and the composite (HR: 2.41; 95% CI: 1.55-3.73). Conclusions In ambulatory adults with T2D, the HFpEF-ABA score showed moderate diagnostic discrimination for HFpEF and was associated with adverse clinical outcomes at follow-up.
BACKGROUND:Electronic cigarette use, vaping, is common among young adults. The cardiovascular (CV) risk remains unknown. OBJECTIVES:This study evaluated the association of long-term vaping with markers of CV risk in young adults. METHODS:We recruited 372 CV disease-free participants aged 18 to 49 years into 4 groups: vaping/never smoking, vaping/former smoking, vaping/current smoking (dual use), or never vaping/never smoking and measured systolic and diastolic blood pressure (SBP/DBP), endothelial function (Framingham reactive hyperemia index), and coronary artery calcification (CAC) (spatially weighted CAC score). We used multivariable-adjusted linear and log-linear regression to model associations of vaping with markers of CV risk. RESULTS:The median (Q1-Q3) age was 26 (21-33) years, and 50.5% were males. The median (Q1-Q3) years of vaping was 4 (2-6) years. After adjustment for age, gender, education, and body mass index, least squares mean differences (95% CI) for SBP/DBP in mm Hg were 4.79 (1.83-7.75)/2.88 (0.54-5.21), 1.60 (-1.65 to 4.85)/1.44 (-1.12 to 4.00), 1.10 (-1.86 to 4.06)/1.48 (-0.86 to 3.82), respectively, comparing vaping/never smoking, vaping/former smoking, and dual use to never vaping/never smoking. The corresponding least squares mean differences (95% CI) of SBP/DBP for greater than 100 vs fewer than 36 e-cigarette puffs/day were 4.84 (0.94-8.74)/3.57 (0.74-6.41) mm Hg. There was no association between vaping categories and Framingham reactive hyperemia index. For spatially weighted CAC score, there was an inverse association for the 3 vaping categories vs never vaping/never smoking. CONCLUSIONS:Long-term vaping in young adults was associated with higher blood pressure, with evidence of a dose-response by vaping intensity. Vaping alone or vaping plus smoking provided no risk reduction for hypertension compared to never vaping or smoking.
Background Hypertensive disorders of pregnancy (HDP) increase the risk of future cardiovascular events. Objectives The objective of the study was to examine the association between lifestyle factors and premature (<50 years) cardiovascular (pCV) events in women with and without HDP. Methods Data from young parous women in the Australian Longitudinal Study on Women’s Health 1973-1978 cohort were linked with medical records. Time-varying Cox proportional hazards models were used to assess whether lifestyle factors were associated with pCV in those with and without HDP. Outcomes of pCV included stroke, ischemic heart disease, valvular heart disease, cardiomyopathy, select arrhythmias, valvular heart disease, pulmonary embolism, and deep vein thrombosis. Results Among 10,368 parous women (median follow-up: 16.5 years), 14.4% (1,493/10,368) had HDP and 4.3% (448/10,310) experienced a pCV event. HDP (adjusted HR [aHR]: 1.74; 95% CI: 1.32-2.31), obesity (aHR: 1.60; 95% CI: 1.19-2.15), and high saturated-fat intake (>319 g/day) (aHR: 1.67; 95% CI: 1.11-2.53) were associated with an increased risk of pCV. Breastfeeding (>16 months) (aHR: 0.66; 95% CI: 0.49-0.89) and high protein intake (>90 g/day) (aHR: 0.65; 95% CI: 0.43-0.96) were associated with a lower risk of pCV. The association between smoking, the Australian Recommended Food Score diet, and glycemic index with pCV events differed in women with and without HDP. Conclusions This study found that a HDP diagnosis was associated with pCV. Obesity and high saturated-fat intake were associated with increased pCV, whereas breastfeeding and high protein intake were associated with lower pCV. The impact of some risk factors on the development of pCV differs between women with and without HDP. These findings highlight the importance of prevention management in women with HDP.
Background Percutaneous coronary intervention (PCI) is a widely available procedure for managing patients with and without acute myocardial infarction (AMI). Although age is a strong predictor of outcomes after PCI, contemporary data in patients with very advanced age are limited. Objectives The objectives of the study was to delineate the current practice patterns and clinical outcomes of PCI across septuagenarians, octogenarians, and nonagenarians. Methods The Japanese PCI is a nationwide registry covering most of the PCI procedures performed within the country. PCI procedures between 2019 and 2024 were included. Patients were divided into four age categories: 20 to 69, 70 to 79, 80 to 89, and 90 to 99 years, and further grouped according to the indications (AMI vs non-AMI). The trends and patterns of PCI procedures, in-hospital mortality, and complications across the age groups were assessed. Results A total of 1,454,940 PCI procedures, with 387,454 (26.6%) and 1,067,486 (73.4%) for AMI and non-AMI, were analyzed. During the study period, the mean age has consistently increased from 71.0 to 72.1 years in the entire study population. Nonagenarians accounted for 3.9% and 1.7% in the AMI and non-AMI cohorts in 2019 and 5.0% and 2.4% in 2024. In both cohorts, the higher age categories were associated with increased risks of in-hospital mortality and complications. Conclusions Our nationwide study demonstrated a consistent year-on-year increase in the age of patients undergoing PCI without reaching a plateau. Advanced age was strongly associated with poor outcomes, particularly in nonagenarians, reinforcing the need for shared decision-making in PCI in the oldest-old population.
Background: Cognitive decline has been reported after coronary artery revascularization, but whether it reflects procedure-specific effects or the burden of underlying vascular disease remains uncertain. Objectives: To determine whether incident dementia risk differs according to coronary revascularization strategy among older adults with acute coronary syndrome (ACS). Methods: We conducted a longitudinal cohort study among adults aged ≥65 years hospitalized for ACS between 2010 and 2020 (n = 25,176). Patients underwent percutaneous coronary intervention (n = 8,043), coronary artery bypass grafting (n = 797), or received no revascularization (n = 16,336). A second comparator cohort included patients with stable coronary artery disease (CAD) without revascularization (n = 154,299). The primary outcome was incident dementia identified using validated International Classification of Diseases codes after a 1-year washout. Propensity-matched analyses used Cox models accounting for the competing risk of death. Results: Revascularized patients were younger (74.8 ± 6.9 vs 77.1 ± 8.2 years), more often male (66.2% vs 54.0%), and had lower Elixhauser multimorbidity scores (4.6 ± 2.8 vs 5.4 ± 3.0, all P < 0.001). Over a median 4.8 years of follow-up, 9.0% of ACS patients developed dementia. Revascularization was not associated with increased dementia risk compared with ACS without revascularization (sub-hazard ratio: 1.05; 95% CI: 0.95-1.17) or stable CAD. Dementia risk was also similar between percutaneous coronary intervention and coronary artery bypass grafting. Conclusions: We found that among older adults with ACS, coronary revascularization was not statistically significantly associated with increased dementia risk compared with no revascularization or stable CAD. These findings reflect the hypothesis that the majority of dementia risk is potentially driven more by cumulative vascular and systemic factors than by procedure-specific neurotoxicity.
Regular intensive training induces structural, functional, and electrical cardiac adaptations collectively known as the athlete's heart. Many electrocardiogram (ECG) findings in athletes, including sinus bradycardia, early repolarization, and increased QRS voltages, reflect benign physiological adaptation. However, some patterns overlap with features of cardiomyopathy and may pose diagnostic challenges. This state-of-the-art review examines sport-specific ECG patterns and how different training modalities influence cardiac electrical remodeling and its clinical interpretation. Endurance athletes typically exhibit changes related to chronic volume loading, such as sinus bradycardia, early repolarization, and high QRS voltages. Strength athletes more often demonstrate ECG features consistent with pressure overload, including increased QRS voltages and relatively higher resting heart rates. Mixed-sport athletes show intermediate characteristics reflecting combined dynamic and static demands. Although most findings are benign, abnormalities such as lateral, inferolateral, or anterolateral T-wave inversion warrant further evaluation. Integrating sport-specific patterns with contemporary athlete-specific ECG criteria improves diagnostic accuracy and helps identify athletes requiring additional investigation.
BACKGROUND:Low-density lipoprotein cholesterol (LDL-C), among other lipids, is a strong causal and modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD). However, lipid-lowering therapy (LLT) is underutilized and many patients do not reach LDL-C goals. OBJECTIVES:This study aimed to evaluate patient preferences for LLT attributes to inform shared decision-making and improve treatment adoption and adherence. METHODS:Adults ≥40 years with elevated LDL-C and a recommendation for LLT completed a cross-sectional, web-based survey assessing treatment experiences and preferences. A discrete choice experiment elicited preferences across 7 attributes: LDL-C reduction, stroke risk, heart attack risk, revascularization risk, new-onset diabetes, musculoskeletal pain, and regimen/mode of administration. Survey responses were analyzed using univariate and bivariate methods. Preference weights (PW) and relative importance were estimated using hierarchical Bayesian modeling. RESULTS:Among 508 participants (mean age: 62.8 ± 11.4 years), 49.0% had prior ASCVD, 55.3% were female, and 43.9% were current or former smokers. Participants prioritized immediate and tangible treatment features over long-term benefits. Mode of administration was the most influential attribute (relative importance = 25.9). A once-daily oral pill was most preferred (PW = 1.75), followed by a daily pill plus a second oral pill before breakfast (PW = 0.17), whereas regimens including biweekly injections were least preferred (PW = -1.13). Higher perceived ASCVD risk was associated with greater emphasis on cardiovascular risk reduction and less emphasis on regimen. CONCLUSIONS:Mode of administration is a key driver of LLT preferences. Incorporating patient preferences into shared decision-making may improve adherence and implementation of guideline-directed therapy.
Background Despite growing evidence of sex-specific differences in cardiovascular (CV) disease, sex-specific prevention strategies are lacking. Objectives This study aims to examine CV risk factors according to age and sex in a German working population. Methods In collaboration with ias PREVENT, a provider of medical checkups for employees of German companies, a data set of 40,704 checkups was evaluated. The cohort was stratified by sex and age into 6 groups: women and men <45 years, between 45 and 55 years, and >55 years, respectively. The study analyzed the distribution of CV risk factors with a focus on sex-specific differences. Results The average age of the cohort was 49 years (25% women). The cohort exhibited overall low burden of CV risk factors. The prevalence of hypertension, elevated low-density lipoprotein, and diabetes was 18.4%, 39.5%, and 5.3% in women compared to 30.7%, 58.7%, and 5.7% in men. In the group ages 45 to 55 years old, a higher proportion of women than men smoked. Obesity prevalence was higher in women than in men starting at the age of 50. Diabetes prevalence was higher in women than men under 45 but reversed in men above 55 years. Conclusions The study underscores the need for sex- and age-specific CV prevention in the working environment. Participants demonstrated escalating CV risk, particularly with increasing age (45-55 years). This highlights the need for targeted measures for this age group, including the menopausal phase in women.
Background Patients with palpitations and dizziness are typically monitored using ambulatory electrocardiographic (ECG) monitoring including Holter monitors and extended continuous ECG monitors. The KardiaMobile 6L (KM6L), a portable medical-grade ECG recorder, enables patients to initiate 6-lead ECG recordings during symptoms when needed. Objectives This study aimed to assess the comparative effectiveness in detecting clinically significant arrhythmias between ambulatory ECG monitoring modalities and 30-day use of KM6L. Methods Patients with palpitations or other arrhythmic symptoms who were referred to for standard ambulatory monitoring (either 24- or 48-hour Holter or ambulatory ECG patch) were asked to perform 1-minute, 6-lead ECG recordings with the KM6L device during symptomatic episodes over a 30-day period. Clinically significant arrhythmias were defined as atrial fibrillation/flutter, second/third-degree atrioventricular block, wide complex tachycardia, supraventricular tachycardia >100 bpm, pauses >3 seconds, or sinus tachycardia >130 bpm. Detection rates between KM6L and standard monitoring were compared using McNemar test. Results We enrolled 350 (40%, n = 140 with 24/48-hour Holter) patients who recorded 6,251 KM6L recordings (median 15 per patient). Significant arrhythmias were detected in 66 patients (18.9%) using either ambulatory ECG monitoring or KM6L. Ambulatory ECG monitoring modalities identified arrhythmias in 27 patients (7.7%), whereas KM6L detected arrhythmias in 52 patients (14.9%) (P < 0.001). Importantly, 39 arrhythmia episodes (11.1%) were detected exclusively by KM6L (P = 0.0008), most commonly atrial fibrillation (n = 23). Conclusions These findings demonstrate that patient-initiated, symptom-triggered ECG monitoring substantially enhances arrhythmia detection compared with traditional short-duration monitoring.
BACKGROUND:Macrophages are key drivers of coronary artery plaque development and can be detected via optical coherence tomography as circumferential regions. However, the association between macrophage arc and plaque vulnerability remains unclear. OBJECTIVES:The objective of the study was to evaluate the correlation between macrophage arc and vulnerable plaques. METHODS:This multicenter, retrospective study enrolled consecutive patients with coronary artery disease who underwent optical coherence tomography (January 2017-April 2023). Macrophage arc was evaluated using maximum arc, mean arc, and mean arc score (MAS) in the target vessel. The mean arc and MAS were calculated as the total detectable macrophage arc or score of each frame, divided by imaged vessel segment length (mm). Furthermore, the association between macrophage arc, plaque vulnerability, and acute myocardial infarction (AMI) at admission was investigated. RESULTS:Overall, 1,129 patients (1,278 vessels; 1,525 vulnerable plaques) were enrolled. The macrophage arc was significantly increased in cases of plaque rupture (PR), thin-cap fibroatheroma (TCFA), and AMI cases (P < 0.0001). Both the mean arc and MAS were markedly higher in regions adjacent to PR or TCFA compared with the entire segment (P < 0.0001). Multivariate analyses demonstrated that maximum arc, mean arc, and MAS were correlated with PR, TCFA, and AMI. Receiver operating characteristic analysis identified optimal cutoff values-maximum arc ≥156.5°, mean arc ≥78.89°/mm, and MAS ≥2.34-each significantly associated with PR, TCFA, and AMI, respectively (all P < 0.001). CONCLUSIONS:Macrophage arcs are associated with plaque vulnerability and AMI. Further external validation and prospective studies are needed to confirm these observations.
BACKGROUND:Right ventricular dysfunction (RVD) is common in cardiogenic shock and associated with poor outcomes. However, early RVD trajectories after initiation of percutaneous ventricular assist device (PVAD) support and their prognostic implications remain unclear. OBJECTIVES:The objectives of the study was to characterize the trajectory of hemodynamic RVD (hRVD) during the first 24 hours after PVAD initiation and evaluate its association with outcomes. METHODS:This study included patients with cardiogenic shock treated with PVAD from the UNLOADERS-PVAD registry. RVD was hemodynamically defined by an elevated right atrial pressure ≥15 mm Hg and/or a low pulmonary artery pulsatility index <0.9. Hemodynamic assessments were performed pre-PVAD, early post-PVAD, and 24 h post-PVAD. The primary endpoint was a composite of all-cause mortality or reintroduction of mechanical circulatory support after PVAD discontinuation within 30 days. RESULTS:Among 463 patients with available data, hRVD was present in 52% (63/121) pre-PVAD, decreased to 48% (211/443) early post-PVAD, and further to 39% (169/436) at 24 h post-PVAD. hRVD trajectories were heterogeneous, with improvement predominating over deterioration. The median follow-up from PVAD implantation was 27 (12-30) days. Persistent or worsening hRVD at 24 h post-PVAD was associated with a higher risk of the primary endpoint. Elevated right atrial pressure was associated with adverse outcomes only at 24 h post-PVAD, whereas low pulmonary artery pulsatility index was consistently associated with adverse outcomes across all time points. CONCLUSIONS:In patients with cardiogenic shock supported by PVAD, the early trajectory of hRVD provides prognostic information. Persistent or worsening hRVD at 24 hours identifies high-risk patients and may guide timely escalation of right-heart-targeted therapies. (UNLOADERS-PVAD [Unloading and Heart Recovery with Advanced Mechanical Circulatory Support: Optimal Management of Percutaneous Ventricular Assist Device] UMIN000052966).
