Background Despite guideline recommendations for optimal medical therapy (OMT) for ischemic heart disease (IHD), sex disparities in pharmacologic treatment remain poorly characterized in recent years. Objectives The objective of the study was to examine sex differences in the use and trends of guideline-recommended OMT among adults with IHD in the United States from 2011 to 2020. Methods We performed a serial cross-sectional analysis using nationally representative data from the 2011 to 2020 National Health and Nutrition Examination Survey. Adults aged ≥18 years with self-reported IHD were included. OMT was defined as the use of antiplatelets, statins, β-blockers, and renin-angiotensin-aldosterone system inhibitors (RAASi). We examined differences in medication use by sex and evaluated temporal trends stratified by age (<50 vs ≥ 50 years), adjusting for sociodemographic and clinical factors. Results Among 1,905 adults with IHD (40.6% women; mean age 65.4 years), women were significantly less likely than men to receive antiplatelets (68.0% vs 77.7%), statins (57.2% vs 73.9%), RAASi (45.6% vs 59.0%), and OMT combinations including all 4 medications (17.5% vs 32.5%). These differences remained after multivariable adjustment, particularly for statins (adjusted OR: 0.62; 95% CI: 0.40-0.96) and RAASi (adjusted OR: 0.56; 95% CI: 0.38-0.84). Sex disparities were most pronounced among adults under 50 years, with slower increases in OMT uptake over time among women. Conclusions From 2011 to 2020, women, particularly younger women, remained less likely than men to receive guideline-directed OMT for self-reported IHD. These findings underscore the need for policy and practice interventions to improve equitable treatment in cardiovascular disease.

This JAMA Clinical Guidelines Synopsis summarizes the 2026 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on management of dyslipidemia.

OBJECTIVES:Black women may be particularly vulnerable to negative shame experiences, shaped by racism and sexism. Yet, the breadth of research that examines shame experiences from Black women's perspective is limited. This study sought to describe the sociocultural context in which Black women experience shame in America. METHOD:Forty Black women (Mage = 41 years) across the United States participated in a narrative study. A thematic analysis focused on understanding shame cues in participant narratives. RESULTS:One major theme of racialized shame experience was revealed. Sociocultural contexts of these experiences were identified including Black women's state of invisibility; experiences in the workplace and academia; treatment related to skin color, hair, and body; and romantic relationship expectations. CONCLUSIONS:These findings warrant further attention to the consequence of Black women's shame experiences. Implications for addressing shame and well-being for Black women are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The objective of this study was to determine whether exposure to structural racism-related state laws is associated with cardiovascular health among a racially and ethnically diverse sample of US adults. Data were from the Database of Structural Racism-Related State Laws and the Behavioral Risk Factor Surveillance System (BRFSS). The sample included 958 019 BRFSS 2011 and 2013 respondents aged 18 years or older from all 50 US states. The exposure was a summary index of 22 state laws related to the criminal legal system, economics and labor, education, health care, housing, immigration, and political participation. The outcome was the American Heart Association's Life's Simple 7 (LS7), a summary index of 7 cardiovascular health indicators. Linear regression models included fixed effects for year and state to control for time trends and unmeasured, time-invariant, state-level contextual factors. In the full sample, a 1 SD increase in the structural racism state legal index was associated with a 0.06-unit decrease in the LS7 (b = -0.06; 95% CI, -0.09 to 0.02; P = .001), controlling for individual- and state-level covariates. Contrary to expectations, stratified models revealed no statistically significant differences by race and ethnicity in the association between the structural racism state legal index and the LS7.

Background:Despite guideline recommendations for optimal medical therapy (OMT) in the secondary prevention of ischemic heart disease (IHD)-including antiplatelets, statins, renin-angiotensin-aldosterone system inhibitors (RAASi), and β-blockers-substantial sex disparities in OMT utilization persist. The extent to which national efforts have mitigated these disparities in contemporary cohorts remains unclear. Methods:We analyzed data from the 2011-2020 National Health and Nutrition Examination Survey (NHANES) cycles, identifying adults with self-reported IHD (defined as a history of myocardial infarction or coronary heart disease). OMT use in the preceding 30 days was assessed based on participant report and verified through medication containers when available. We evaluated trends in individual drug classes and common combinations, stratified by sex. Results:Among 1,905 adults (mean age 65.4 years; 40.6% women), women had significantly lower rates of OMT use compared to men, including antiplatelets (68.0% vs 77.7%), statins (57.2% vs 73.9%), RAASi (45.6% vs 59.0%), and β-blockers (51.2% vs 61.1%). Women were also less likely to use guideline-recommended combinations such as aspirin plus statins (47.4% vs 64.1%) and all four OMT classes (17.5% vs 32.5%). After adjustment for sociodemographic and clinical factors, women remained less likely to use antiplatelets (OR 0.71; 95% CI, 0.52-0.94), statins (OR 0.62; 95% CI, 0.40-0.96), and RAASi (OR 0.56; 95% CI, 0.38-0.84), while β-blocker use did not differ significantly. These sex-based disparities were consistent across all survey cycles from 2011 to 2020. Conclusion:In this nationally representative study, women with IHD were significantly less likely than men to receive guideline-directed OMT, with persistent disparities over the past decade. These findings underscore the need for targeted strategies to close the sex gap in cardiovascular prevention.

BACKGROUND:Systems-level approaches can promote equitable hypertension outcomes. Remote patient monitoring (RPM) is a patient-centered hypertension solution, but successful implementation strategies require further exploration. OBJECTIVES:This study was designed to determine social and institutional factors of RPM utilization at an academic medical center. METHODS:We used a mixed methods study design. Using logistic regression, we retrospectively assessed the relation of sociodemographic variables with RPM engagement, achievement of normotension, and maintenance of normotension at 180 days post-RPM. We completed Cox regression and Kaplan-Meier analyses to investigate the association of level of engagement and achieving normotension outcome. To augment the quantitative analysis, we concurrently interviewed RPM staff members to assess systems-level themes of RPM program implementation. The interviews were recorded, transcribed, and inductively coded using a validated implementation framework. RESULTS:We analyzed 1744 RPM program participants (mean age 63.1 years, 64.7% female, 82.6% Black) between May 2022 and August 2024. Patients with higher RPM engagement were older than those with lower engagement (65.6 years vs 62.3 years). The high engagement group differed by race, with more Black individuals in the high engagement group. High engagement (OR: 2.06; 95% CI: 1.51-2.84; P < 0.001) was associated with likelihood of normotension and had a shorter time to normotension (HR: 2.52; 95% CI: 2.14-2.98; P < 0.001). Ten key staff provided important insights of barriers and facilitators of RPM implementation that converged with statistical analyses. CONCLUSIONS:An RPM program successfully improved blood pressure care, especially among patients with higher program engagement. These findings reveal opportunities for achieving equitable hypertension outcomes.

Introduction Molecular alterations in the PI3K/AKT and Ras/Raf/MEK/ERK pathways are frequently observed in patients with endometrial cancers. However, mTOR inhibitors, such as temsirolimus, have modest clinical benefits. In addition to inducing metabolic changes in cells, metformin activates AMPK, which in turn inhibits the mTOR pathway. In this phase 1 clinical trial we hypothesized that combining metformin with temsirolimus would potentiate the antitumor activity against advanced or recurrent endometrial cancer. Methods The dose-expansion cohort used a Simon Minimax two-stage design. The objectives of the endometrial cancer expansion cohort were to evaluate the clinical tumor response, as indicated by the objective response and clinical benefit rates, as well as an ongoing safety assessment of the combination treatment. Results Forty patients were enrolled in this study. The most common treatment-related adverse events (reported in 32 patients) were hypertriglyceridemia (n = 14), diarrhea (n = 13), mucositis (n = 13), anorexia (n = 12), and anemia (n = 10). The grade 3 adverse events were 2 instances each of anemia and thrombocytopenia and 1 instance each of mucositis, fatigue, weight loss, hypokalemia, hypophosphatemia, and increased aspartate aminotransferase and alanine transaminase levels. Among the 33 patients evaluable for response, objective response was seen in two (6 %; both partial responses), and 13 (39 %) patients had stable disease, including 11 for ≥4 months, representing a clinical benefit rate of 39 %. Conclusions The results of this single-center clinical trial showed that, in patients with advanced or recurrent endometrial cancer, metformin can be safely added to temsirolimus providing limited response without added safety concerns.Clinical trial registration number: NCT01529593.

BACKGROUND:Few studies have examined the impact of neighborhood-level factors on outcomes for patients with heart failure with reduced ejection fraction (HFrEF). OBJECTIVES:The purpose of this study was to understand the impact of neighborhood factors on readmission and mortality risk hospitalized patients with HFrEF. METHODS:We analyzed data from the Hopeful Heart Trial that evaluated the impact of blended collaborative care for treating HFrEF and depression among patients discharged from 8 Pittsburgh-area hospitals from March 2014 to October 2017. Using patients' home address at discharge to determine neighborhood Walk Score (WS; 0-100 scale) and Area Deprivation Index (ADI; 0-100), we examined the incidence of 12-month all-cause and cardiovascular-related hospital readmissions and vital status up to 5 years postdischarge through June 2022 using multivariable-adjusted Cox proportional hazards models. RESULTS:Hopeful Heart enrolled 756 people with HFrEF (baseline mean age 64.0, 44% female, 73% White race, 28% ± 9.1% mean left ventricular ejection fraction, mean 9-Item Patient Health Questionnaire score 12 ± 5.7, median WS 69 (IQR: 49-88), and median ADI 12 (IQR: 10-15) and followed them for a median of 57.7 months (IQR: 25.0-68.4). Individuals from the least walkable neighborhoods experienced greater 12-month all-cause mortality (HR: 1.70 [95% CI: 1.11-2.61]; P = 0.016), while those from the most deprived neighborhoods had higher 12-month cardiovascular-related hospital readmission (HR: 1.39 [95% CI: 1.09-1.78]; P = 0.008). Neither WS nor ADI predicted 12-month all-cause readmission and cardiovascular-related mortality or 5-year all-cause mortality. CONCLUSIONS:Among recently hospitalized HFrEF patients, neighborhood factors affect 12-month rehospitalization and mortality risk but not 5-year mortality. (Blended Collaborative Care for Heart Failure and Co-Morbid Depression; NCT02044211).

BACKGROUND:Unmet social and caregiving needs can make caregiving for a person with dementia more difficult. Although national policy encourages adoption of systematic screening for health-related social risks (HRSRs) in clinical settings, the accuracy of these risk-based screening tools for detecting unmet social needs is unknown. METHODS:We used baseline data from dementia caregivers (N = 343) enrolled in a randomized controlled trial evaluating CommunityRx-Dementia, a social care intervention conducted on Chicago's South Side. We assessed caregivers' (1) unmet social and caregiving needs by querying need for 14 resource types and (2) HRSRs using the Center for Medicare & Medicaid Services (CMS) Accountable Health Communities (AHC) screening tool. Using unmet social needs as the reference, we examined the sensitivity of the AHC tool to detect food, housing, and transportation needs. Analyses were stratified by gender. RESULTS:Most caregivers were women (78%), non-Hispanic (96%), Black (81%), partnered (58%) and had an annual household income ≥$50K (64%). Unmet social and caregiving needs were similarly prevalent among women and men caregivers (87% had ≥1 need, 43% had ≥5 needs). HRSRs were also prevalent. The most common HRSR was lack of social support (45%). Housing instability, difficulty with utilities and having any HRSRs were significantly more prevalent among women (all p < 0.05). The AHC screener had low sensitivity for detecting unmet food (39%, 95% confidence interval [CI]: 27%-53%), housing (42%, 95% CI: 31%-53%), and transportation (22%, 95% CI: 14%-31%) needs. Sensitivity did not differ by gender for food (41% for women and 30% for men, p = 0.72) or housing (44% for women and 29% for men, p = 0.37) needs. For transportation needs, sensitivity was 27% for women versus 0% for men (p = 0.01). CONCLUSIONS:Men and women caregivers have high rates of unmet social needs that are often missed by the CMS-recommended risk-based screening method. Findings indicate a role for need-based screening in implementing social care.

Importance:Racial disparities in cardiovascular health, including sudden cardiac death (SCD), exist among both the general and athlete populations. Among competitive athletes, disparities in health outcomes potentially influenced by social determinants of health (SDOH) and structural racism remain inadequately understood. This narrative review centers on race in sports cardiology, addressing racial disparities in SCD risk, false-positive cardiac screening rates among athletes, and the prevalence of left ventricular hypertrophy, and encourages a reexamination of race-based practices in sports cardiology, such as the interpretation of screening 12-lead electrocardiogram findings. Observations:Drawing from an array of sources, including epidemiological data and broader medical literature, this narrative review discusses racial disparities in sports cardiology and calls for a paradigm shift in approach that encompasses 3 key principles: race-conscious awareness, clinical inclusivity, and research-driven refinement of clinical practice. These proposed principles call for a shift away from race-based assumptions towards individualized, health-focused care in sports cardiology. This shift would include fostering awareness of sociopolitical constructs, diversifying the medical team workforce, and conducting diverse, evidence-based research to better understand disparities and address inequities in sports cardiology care. Conclusions and Relevance:In sports cardiology, inadequate consideration of the impact of structural racism and SDOH on racial disparities in health outcomes among athletes has resulted in potential biases in current normative standards and in the clinical approach to the cardiovascular care of athletes. An evidence-based approach to successfully address disparities requires pivoting from outdated race-based practices to a race-conscious framework to better understand and improve health care outcomes for diverse athletic populations.

134 Background: Somatic BRCA1/2 mutations in BRCA-associated cancers increase therapeutic sensitivity to platinum-based chemotherapies and PARP inhibitors, but the implications of BRCA mutations in non- BRCA-associated cancers such as CRC is unknown and hypothesized to be shaped by tumor lineage. We thus conducted a retrospective analysis of outcomes with platinum-based chemotherapy and PARP inhibition in pts with CRC, where the estimated prevalence of BRCA1/2 alterations is 3-4%. Methods: Pts with blood or tissue next generation sequencing (NGS) positive for a somatic BRCA1/2 variant and a diagnosis of CRC were identified from a single institution database. The pathogenicity of each mutation was annotated using public genomic databases (e.g. ClinVar). Pt characteristics were compared using Fisher’s exact test. Log-rank test was used for comparison of survival distribution among groups. Results: 8,258 NGS reports with a BRCA1/2 alteration from 1760 cancer pts were identified of which 189 (11%) had a diagnosis of CRC. 54/189 CRC pts (29%) had ≥1 pathogenic BRCA1/2 variant, 19 pts (10%) had ≥1 benign variant, and 134 pts (69%) had 1 ≥ variant of unknown significance (VUS); 26 pts (14%) had more than one BRCA1/2 variant. Pts with ≥1 pathogenic mutation (n=54) were more likely to have an inactivating DNA polymerase epsilon (POLE) mutation versus pts with only benign/VUS BRCA1/2 variants (n=135) (20% vs 6%, p=0.004) while prevalence of microsatellite instability (MSI-H) (19% vs 13%, p=0.37) and Ras/Raf (53% vs 53%, p=1.00) were similar between groups. Median progression free survival (PFS) among 115 CRC pts (unselected for BRCA1/2 pathogenicity) who received an oxaliplatin-based regimen for advanced disease in the 1 st line (n=52) was similar to the median PFS among pts who received an irinotecan-based regimen (n=63) (7.0 mths vs 7.0 mths, p=0.48). Median PFS with an oxaliplatin-based regimen in the 1 st line among 52 pts with pathogenic BRCA1/2 variants (n=13) was 5.1 mths vs 7.4 mths among pts with benign/VUS BRCA1/2 variants (n=39) (p=0.398). There were no significant differences in median PFS among pts with a pathogenic vs benign/VUS BRCA1/2 variants when the analysis was restricted to pts with BRCA1/2 variants identified in tissue (p=0.76) and to pts without co-occurring driver mutations (Ras/Raf, MSI-H, and/or POLE) (p=0.1). Overall survival in patients with advanced disease was similar between pts with a pathogenic (n=52) vs benign/VUS (n=122) BRCA variants (37.1 mths vs 45.1 mths, p=0.14). 6 pts (4 with pathogenic BRCA1/2 and 3 with VUS) received a PARP inhibitor after a median of 3 lines of treatment and the best response was disease progression in 6 pts (100%). Conclusions: In the context of CRC, somatic BRCA1/2 mutations frequently co-occur with pathogenic POLE mutations, but do not appear to confer therapeutic benefit to platinum-based chemotherapy and PARP inhibitors.

BACKGROUND:It is unknown whether predelivery cardiology care is associated with future risk of major adverse cardiovascular events (MACE) in preeclampsia/eclampsia (PrE/E). We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1 year post-delivery for Black and White patients with PrE/E. METHODS:Using Optum's de-identified Clinformatics Data Mart Database, we identified Black and White patients with PrE/E who had a delivery between 2008 and 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Regression models were used to assess the hazard of MACE by cardiology care for each race. Separate hazards were calculated for the first 14 days and the remainder of the year. RESULTS:Among 29 336 patients (83.4% White patients, 16.6% Black patients, 99.5% commercially insured, mean age: 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White patients, 13.0% Black patients). Black patients had higher incidence of MACE than White patients at 1 year post-delivery (2.7% versus 1.4%) with the majority within 14 days of delivery (Black patients: 58.7%; White patients: 67.8%). After adjusting for age and comorbidities, receipt of cardiology care was associated with a lower hazard of MACE for White patients within 14 days after delivery (hazard ratio, 0.31 [95% CI, 0.21-0.46]; P<0.001) but not Black patients (hazard ratio, 1.00 [95% CI, 0.60-1.67]; P=0.999). The effect of the interaction between race and cardiology care was significant in the first 14 days (P<0.001) but not the remainder of the year (P=0.56). CONCLUSIONS:Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. Cardiology care was associated with a lower hazard of MACE only for White patients during the first 14 days after delivery.

A virtual tour of the Personalized Cancer Therapy website (www.personalizedcancertherapy.org).