Attaining LDL-cholesterol target post major coronary event: Care gap, associated factors and clinical outcomes.

Lp(a) (lipoprotein[a]) is a risk factor for coronary heart disease. Whether baseline Lp(a) identifies higher-risk patients who derive more benefit from evolocumab is not established in a population without previous myocardial infarction (MI) or stroke. From June 2019 to November 2021, the VESALIUS-CV trial (Effect of Evolocumab in Patients at High Cardiovascular Risk Without Prior Myocardial Infarctions or Stroke) enrolled patients with qualifying atherosclerosis or high-risk diabetes without previous MI or stroke and randomized them to evolocumab or placebo (median follow-up 4.6 years). In a prespecified analysis, Lp(a) was assessed at baseline in 7557 patients. Cox models were used to assess the adjusted risk of cardiovascular events by baseline Lp(a) in the placebo arm, and the efficacy of evolocumab by baseline Lp(a). The primary outcome of interest was the composite of major coronary events (coronary heart disease death, MI, or urgent coronary revascularization). Median age was 66 [interquartile range, 60-71] years, and 42.8% were women; median Lp(a) was 28 [interquartile range, 9-132] nmol/L. Higher baseline Lp(a) was associated with an increased risk of major coronary events (adjusted hazard ratio [HRadjusted] per 100 nmol/L increase in Lp(a), 1.15 [95% CI, 1.05-1.26]; P=0.004), particularly for MI (HRadjusted, 1.23 [95% CI, 1.10-1.38]; P<0.001). There was no association between Lp(a) and ischemic stroke (HRadjusted, 1.00 [95% CI, 0.84-1.19]; P=0.99). After 48 weeks, evolocumab reduced LDL-C (low-density lipoprotein cholesterol) by 66.8 mg/dL and Lp(a) by 38.0 nmol/L in patients with baseline Lp(a) >105 nmol/L versus 61.1 mg/dL and 6.0 nmol/L in those with baseline Lp(a) ≤105 nmol/L. The relative reductions in the rate of major coronary events were 41% (HR, 0.59 [95% CI, 0.41-0.83]) in those with Lp(a) >105 nmol/L compared with 35% (HR, 0.65 [95% CI, 0.51-0.82]) in those below (P-interaction=0.45 for Lp[a] modeled as continuous variable). The corresponding absolute reductions were 3.7% versus 2.5% (P-interaction=0.09), corresponding to a number needed to treat of 28 versus 40 to prevent 1 major coronary event at 5 years. In patients with atherosclerosis or high-risk diabetes but without previous MI or stroke, Lp(a) was independently associated with an increased risk of major coronary events but not ischemic stroke. Evolocumab reduced the relative risk of major coronary events to a similar degree irrespective of baseline Lp(a), with a numerically greater absolute risk reduction in patients with elevated Lp(a). URL: https://www.clinicaltrials.gov; Unique identifier: NCT03872401.

IntroductionRadiation-induced heart injury (RIHI) remains an important concern in left-sided postmastectomy radiotherapy (PMRT), particularly when internal mammary lymph nodes (IMLNs) are included in the target volume. Helical tomotherapy (HT) provides excellent target conformity for complex targets, but cardiac sparing remains challenging. This study evaluated whether dose-gradient function (DGF)-guided optimization could further reduce cardiac exposure in left-sided breast cancer patients treated with HT after modified radical mastectomy.MethodsTwenty-six female patients with left-sided breast cancer who underwent PMRT were retrospectively included. Initial HT plan was generated and evaluated using DGF, which quantifies dose falloff outside the target volume. The patient with the minimum DGF curve area () was used as the internal benchmarking and was not re-optimized. The remaining 25 patients underwent DGF-guided re-optimization. Mean heart dose (MHD), cardiac dose-volume indices, left anterior descending coronary artery (LAD) dose, and the model-based relative risk increase (RRI) of major coronary events, were compared between the original and optimized plans.ResultsDGF-guided re-optimization significantly reduced cardiac dose parameters while maintaining target coverage and overall plan quality. MHD decreased from 6.190 ± 0.384 Gy to 5.322 ± 0.332 Gy (P < 0.001), and cardiac decreased from 43.084 ± 4.807% to 29.260 ± 4.453% (P < 0.001), with significant reductions in , , and (all P < 0.05). LAD decreased from 86.150 ± 8.152% to 81.240 ± 9.100% (P < 0.001), and LAD mean dose decreased from 18.786 ± 2.661 Gy to 18.230 ± 2.691 Gy (P < 0.001). Greater cardiac dose reduction was observed in the IMLNs irradiation group. The estimated relative risk increase decreased from 45.803 ± 2.839% to 39.383 ± 2.459% (P < 0.001).ConclusionDGF-guided optimization may improve HT plan quality for left-sided PMRT and achieve additional reductions in cardiac dose and model-based cardiac risk estimates, particularly in cases requiring IMLNs irradiation.

We aimed to investigate the potential role of polygenic risk in early-onset coronary artery disease (CAD) and recurrence of major adverse coronary events (MACE) in patients with low prevalence of traditional cardiovascular risk factors (CVRFs). This was a prospective study enrolling a cohort of patients with early-onset CAD (<50 years) despite no/few traditional CVRFs. Baseline CAD risk was calculated according to Systematic Coronary Risk Evaluation 2 (SCORE2). The CAD-polygenic risk score (PGS) developed by Khera et al. was computed for the patients and compared with a local control population of unselected individuals. MACE were collected at long term follow-up. We enrolled 42 patients [81% males; median age 44 years, interquartile range (IQR) 40-46] presenting with early-onset CAD from 2014 to 2021. The majority of them (72%) had ≤1 modifiable CVRF with a 3.9% mean risk of developing CV event at 10 years. The control population consisted of 1408 individuals (51% males; median age 39 years, IQR 29-49). We found a significant positive shift in CAD-PGS distribution among early-CAD patients compared with controls (P value < 0.0001). Over a median follow-up of 104 months, 40.5% of patients experienced a new MACE, with an annual incidence rate of 8 (IQR 5-13) per 100 persons/year. In patients with early-onset CAD despite low clinical risk score, we found CAD-PGS values significantly higher than in the general population and a high rate of recurrence of MACE. These findings highlight the potential of PGS in refining CAD risk stratification, properly tailoring prevention strategies.

BackgroundIn recent years, the impact of lipoprotein(a) (Lp(a)) on the prognosis of coronary heart disease has been increasingly recognized. Lp(a) is an independent risk factor for cardiovascular disease, and studies have shown that homocysteine (HCY) may influence the association between Lp(a) and the risk of recurrent cardiovascular events. This study investigates the association between Lp(a) levels and recurrent cardiovascular events in patients with varying HCY concentrations.MethodsWe conducted a 36-month follow-up on 530 patients with coronary heart disease and divided them into low-Lp(a) and high-Lp(a) groups based on Lp(a) levels. The incidence rates of major adverse cardiovascular events (MACE) and acute coronary events (ACE) were compared between the two groups. The association between elevated Lp(a) and cardiovascular risk in different subgroups(based on HCY concentration) was analyzed using Kaplan-Meier curves and Cox proportional hazards models.ResultsElevated Lp(a) remained a significant risk factor for both MACE (HR = 2.07, 95% CI = 1.37–3.12, P = 0.001) and ACE (HR = 2.83, 95% CI = 1.67–4.81, P = 0.001) overall. In subgroup analyses, elevated Lp(a) in patients with moderate-to-high HCY levels constituted a high-risk cohort for MACE and ACE occurrence (HR = 1.87, 95% CI = 1.01–3.46, P = 0.046;HR = 2.85, 95% CI = 1.32–6.18, P = 0.008). Among those with low HCY levels, elevated Lp(a) showed no association with either MACE or ACE (P > 0.05).ConclusionWhen HCY is elevated, patients with increased Lp(a) experience amplified risk of recurrent cardiovascular events. This association shifts when HCY is at low levels. Future efforts should emphasize combined assessment of Lp(a) and HCY and explore targeted intervention strategies to reduce residual cardiovascular risk.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12872-026-05847-0.

The residual recurrence risk after atrial fibrillation (AF)-related stroke is high despite anticoagulation, thereby necessitating new therapies. The importance of inflammation in AF is increasingly recognized. However, patients with AF-related stroke were excluded from recent trials of anti-inflammatory therapies. It is uncertain whether associations between IL-6/high-sensitivity C-reactive protein (hsCRP) and poststroke recurrence are modified by AF status. In this study, we aimed to analyze the association between IL-6/hsCRP and recurrence according to AF history. We leveraged individual participant data from studies identified by systematic review. We analyzed associations between IL-6/hsCRP and recurrent stroke/major adverse cardiovascular events (MACEs) (defined as fatal or nonfatal recurrent stroke or major coronary events) using multivariable Cox regression analyses (conditional logistic regression for 1 study) adjusted for age, sex, index event, cardiovascular risk factors, and medication use, stratified by AF status. Data from 11 prospective studies with 10,080 patients (2,134 with AF, mean age 70 years, 59.3% male) were included. During 21,080 person-years of follow-up, 1,677 patients had MACEs and 1,342 had recurrent stroke. Inflammatory markers were higher in patients with AF, irrespective of stroke severity and timing of measurement, with elevated levels persisting well beyond the acute phase. hsCRP was associated with recurrent MACEs in patients with AF (adjusted risk ratio [aRR] 1.14, 95% CI 1.04-1.25, per loge-unit increase) and without AF (aRR 1.08, 1.03-1.13) (Pinteraction 0.30). There were similar associations on per-quarter analysis in patients with AF (aRR 1.51, 1.04-2.18) and without AF (aRR 1.32, 1.10-1.59) (Q4 vs Q1). No association was observed between hsCRP and recurrent stroke in either group. For IL-6, there was no evidence of interaction according to AF status for MACEs (Pinteraction 0.57) or recurrent stroke (Pinteraction 0.82). The aRR per loge unit for MACE was 1.17 (1.07-1.27) in patients without AF and 1.10 (0.91-1.34) in those with AF. The corresponding aRR for recurrent stroke was 1.15 (1.05-1.25) and 1.12 (0.91-1.37) in patients without and with AF, respectively. These data highlight the importance of inflammatory mechanisms in vascular recurrence irrespective of AF, provide rationale for the inclusion of patients with AF in trials of anti-inflammatory therapy, and support a selection approach in future trials based on elevated inflammatory marker levels, rather than stroke etiology alone.

Background and objectives The risk-treatment paradox (RTP) has not been studied in very high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). We aimed to describe the cohort of very high-risk NSTE-ACS patients, analyse the impact of RTP on outcomes, and identify subgroups of patients who derive the greatest benefit from immediate invasive coronary angiography (ICA). Methods This retrospective analysis included 340 patients diagnosed with NSTE-ACS who met at least one of the established criteria for very high risk at admission. RTP was defined as any management tactic other than emergency (<2 h) ICA. Ongoing myocardial ischaemia (OMI) was defined as a combination of ongoing or recurrent chest pain and/or dyspnoea, along with at least one additional established very high-risk criterion. Results RTP was identified in 213 cases (62.6%). There was no adverse effect of RTP on in-hospital mortality [14% vs. 10% in the RTP group, P = 0.34, odds ratio (OR) 0.708; 95% confidence interval (CI) 0.36-1.37] or on the incidence of long-term major adverse coronary events (MACE). An independent predictor of adverse outcomes was evidence of OMI at hospital admission. Signs of OMI were observed in 168 patients (49.4%). In this subgroup, failure to perform emergency invasive coronary angiography was associated with a higher incidence of MACE during the three-year follow up (29% vs. 47.5% in the RTP group, P=0.02, OR 2.2; 95% CI 1.0-4.5). Interpretations and conclusions There was no significant effect of risk-treatment paradox on outcomes in very high-risk patients. Patients with signs of ongoing myocardial ischaemia benefit most from undergoing emergency invasive coronary angiography with the intention of performing percutaneous coronary intervention within two hours.

United States Veterans who served in Vietnam, the Korean Demilitarized Zone, or Thailand Air Force bases from 1962 to 1971 were likely exposed to Agent Orange, as approximately 107 million pounds of the chemical were sprayed in the areas where the fighting occurred. Agent Orange was an herbicide used by the United States military to kill the jungle, foliage, tall grasses, bushes, and weeds. Agent Orange contained 2,3,7,8-tetrachlorodibenzo-p-dioxin, the most toxic form of dioxin, which has been associated with multiple disease processes and cardiac issues. An original quantitative descriptive, retrospective cohort, secondary data analysis study was conducted utilizing data collected by the Veterans Health Administration (VHA) via the Cardiovascular Assessment, Reporting, and Tracking System for Cath Labs and the Computerized Patient Record System. A new and innovative Structured Query Language report was created for data mining. Statistical tests included Chi-square tests, two-sample t-tests, prevalence, logistic regression, and odds ratios. A secondary analysis was conducted to assess for confounders, associations, and differences. Veterans exposed to Agent Orange status post (s/p) percutaneous coronary intervention (PCI) have significantly higher body mass index (P ≤ .01), with a higher percentage of obesity (45.4% vs. 41.0%) and severe obesity (7.0% vs. 6.1%). There is a higher prevalence of those exposed to Agent Orange in the white (85% vs. 79.3%, P ≤ .01) and non-Hispanic/Latino (93.9% vs. 92.9%, P ≤ .01) male population. There is a higher prevalence of hypertension (91.3% vs. 90.7%, P = .03), hyperlipidemia (91.7% vs. 90.1%, P ≤ .01), and diabetes (53.5% vs. 49.8%, P ≤ .01) in those exposed vs. non-exposed. Lastly, there is a higher prevalence (1.8% vs. 1.5%) and fully adjusted odds 1.22 (95%CI: 1.08, 1.37; P = .0011) of coronary artery bypass graft surgery (CABG). Veterans exposed to Agent Orange are high-risk cardiovascular patients with a higher prevalence and odds of CABG s/p PCI. The increased prevalence of hypertension, hyperlipidemia, obesity, severe obesity, and diabetes in Veterans exposed to Agent Orange s/p PCI suggests that Agent Orange may contribute to the development of these disease processes. Strengths include the quality and longevity of the data collected, the Promise to Address Comprehensive Toxics (PACT) Act supporting Agent Orange research, and the advanced age of the Veterans increases the likelihood of cardiovascular disease. Weaknesses include the inability to quantify and confirm Agent Orange exposure, the inability to determine causation, and the VHA registrar's office could have erroneously assigned the Agent Orange disability flag by not verifying the service location. This study impacts the care of the Veterans s/p PCI; providers should assess the comorbidities, coronary artery disease progression, number of vessels affected, tortuosity of the cardiac vessels, location of the coronary artery lesion(s), size of the lesion(s), and the number of stents needed to determine if repeat PCI is the preferred treatment over CABG. Future studies should include the newly categorized Veterans exposed to Agent Orange from the PACT Act screenings, the CABG outcomes, the characteristics of the coronary lesions, the type of stent(s), and the medications prescribed at the time of the original PCI.

Introduction: Breast cancer remains the most frequently diagnosed malignancy among women worldwide, with approximately 2 million new cases annually. Radiotherapy (RT) significantly reduces local recurrence and breast cancer related mortality; however, incidental irradiation of cardiac sub-structures can lead to radiation-induced heart disease (RIHD). Despite substantial advances in treatment planning and dose optimization, a considerable proportion of patients remain at risk of cardiac toxicity. Current evidence suggests a linear relationship between mean heart dose (MHD) and cardiac events, with an excess relative risk of approximately 4–7% per Gy increase in MHD. This narrative review aims to establish evidence regarding dose-response relationships, cardiac substructure sensitivity, modern heart-sparing techniques, early detection strategies, and the balance between oncologic benefit and cardiovascular risk in breast cancer radiotherapy. Methodology: A comprehensive literature search was conducted from January 2015 to September 2025 using the Cochrane Library, PubMed Central, and Google Scholar. Studies involving breast cancer patients treated with adjuvant radiotherapy to the breast/chest wall with or without regional nodal irradiation and reporting cardiac outcomes were included. Over 250 records were identified; after removal of duplicates and screening, 31 relevant studies were incorporated. Landmark randomized trials, meta-analyses, dosimetric studies, and prospective imaging-based investigations were narratively analyzed. The narrative review was synthesized across four domains: epidemiology and risk magnitude, dose-response relationships and substructure dosimetry, impact of modern RT techniques, and early cardiac injury detection and risk stratification. Results: A consistent linear dose-response relationship between MHD and major coronary events was observed, with an excess MHD of approximately 7.4% per Gy. Radiotherapy was associated with a 6.4% increase in 10-year cardiovascular event risk. Randomized trial data by Taylor et al. demonstrated an excess relative risk of 0.04 per Gy for cardiac mortality. Meta-analytic evidence showed that left-sided RT significantly increased the risk of coronary heart disease (RR 1.29) and cardiac death (RR 1.22) compared with right-sided RT. Cardiac substructures, particularly the left anterior descending artery (LAD) and left ventricle (LV), appeared more predictive of ischemic risk than whole-heart dose alone. Dosimetric studies demonstrated that deep inspiration breath-hold (DIBH) reduced LAD maximum and mean doses by 31.7% and 28.1%, respectively, compared with free-breathing plans (p ≤ 0.001), supporting its routine clinical implementation. Advanced techniques such as VMAT achieved acceptable target coverage while facilitating cardiac dose reduction as compared to 3D-CRT. Although RT provides an absolute survival benefit of approximately 4–5% against breast cancer mortality, it is associated with a modest increase in cardiovascular mortality of about 0.2–0.3%, underscoring the importance of individualized risk–benefit assessment. Advanced echocardiographic techniques, including strain imaging, demonstrated early subclinical myocardial dysfunction within six months of RT, highlighting opportunities for early intervention. Conclusion: This review provides an insight into the current prevalence of radiotherapy induced cardiotoxicity in breast cancer patients and most commonly used approaches to possibly alleviate the adverse effects of radiation. Despite clear evidence linking radiation induced cardiotoxicity, a clear consensus on dose constraints, radiotherapy volumes for cardiac sparing is required. Cardio-oncology, as an emerging multidisciplinary field might serve as a bridge in the current gaps of researches on cardio-protection and cardiotoxicity.

Elevated plasma concentration of lipoprotein(a) is a highly prevalent, independent, and causal risk factor for the development of numerous cardiovascular diseases. This review summarizes the key clinical evidence for elevated lipoprotein(a) as a risk factor for atherosclerotic cardiovascular disease, aortic stenosis, and abdominal aortic aneurysm. These data are specifically linked to ongoing developments in understanding the pathophysiological mechanisms of lipoprotein(a) in these contexts. Highly potent lipoprotein(a)-lowering therapies are being studied in cardiovascular outcomes trials for their ability to prevent major adverse coronary events and aortic stenosis progression, potentially ushering in a new era of clinical management of lipoprotein(a).

ABSTRACTObjectiveTo evaluate the incremental value of non‐gated chest CT coronary artery calcium score in enhancing GRACE score prediction of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).MethodsA retrospective cohort study was conducted on 324 ACS patients undergoing PCI and non‐gated chest CT. Patients were divided into MACE (n = 100) and non‐MACE (n = 224) groups with a median follow‐up of 18.7 months. The predictive performance of the GRACE score, Agatston score, and combined clinical composite model was evaluated using receiver operating characteristic (ROC) curves and survival analysis based on optimal cutoff values.ResultsModel 3 (GRACE + CACS) demonstrated AUC values of 0.798 and 0.827 in the training and testing cohorts, respectively, significantly outperforming Model 1 (GRACE) (training AUC = 0.702; testing AUC = 0.758). Model 4, incorporating clinical features, demonstrated optimal predictive performance (training set AUC = 0.806; testing set AUC = 0.857). The AUC differences were statistically significant (p < 0.05). Survival curves revealed the highest MACE incidence (94.4%, p < 0.01) in the high‐risk combined Ga1 group (GRACE ≥ 140 and Agatston ≥ 400).ConclusionThe non‐gated chest CT coronary calcification score significantly enhances the predictive value of the GRACE score for major adverse coronary events (MACE) after coronary intervention. When combined with clinical indicators, the predictive power is further improved. Sensitivity analysis confirms the robustness of this finding, providing a reliable tool for clinical risk stratification.

The causal and mediated relationships between major depressive disorder (MDD), post-traumatic stress disorder (PTSD), anxiety disorders and premature mortality: Evidence from genome-wide association study.

Human milk contains numerous natural bioactive components that are closely associated with cardiovascular health. However, previous studies investigating the association between breastfed as a baby and the risk of cardiovascular disease (CVD) have yielded conflicting results. We conducted a 2-sample Mendelian randomization (MR) analysis to estimate the causal association between breastfed as a baby and 6 CVD using GWAS data. Multivariate MR and mediation analysis was used to investigate the mediating effects. Additionally, sensitivity analyses was applied to validate the results. The results showed a casual association between breastfed as a baby and lower risk of major coronary heart disease event (CHD; odds ratio = 0.194, 95% CI: 0.066-0.574). However, no significant associations were found between breastfed as a baby and venous thromboembolism, stroke, all-cause heart failure, atrial fibrillation and flutter, and type 2 diabetes. Mediation analysis showed that high-density lipoprotein (HDL) mediated the causal relationship between breastfed as a baby and CHD, and the proportion of mediating effect was 6.61%. This study demonstrated that breastfeeding in infancy can reduce the risk of CHD, and the lipid component HDL may be an important bioactive substance through which breast milk exerts its protective effects.

The relationship between childhood obesity and cardiovascular and cerebrovascular diseases (CCVD) remains ambiguous. This study aims to explore the causal relationship between childhood obesity and CCVD utilizing the two-sample Mendelian randomization (MR) method. Furthermore, the study investigates the prognostic implications of obesity on CCVD, utilizing insights derived from the Global Burden of Disease (GBD) study 2021. This study utilized pooled data on childhood obesity from the genome-wide association study (GWAS) available in the IEU Open GWAS database, alongside data on 20 types of CCVD from the GWAS in the 2024 Finngen database for analysis. The inverse variance weighted (IVW) method was served as the primary analysis method, while MR-Egger regression, weighted median, simple mode and weighted mode were employed as supplementary analyses to explore the causal relationship between childhood obesity and CCVD in adulthood. Cochran’s Q test, MR-Egger intercept test, and leave-one-out test were performed to access the robustness of the results. Simultaneously, summary data on childhood obesity from GWAS in the EGG database were utilized to replicate the analysis to verify the robustness of the results. Additionally, the latest data from the 2021 GBD study were employed to analyze the prognostic correlation between obesity and CCVD. IVW analysis finds positive causal relationship between childhood obesity and risk of coronary atherosclerosis, cardiovascular diseases, hard cardiovascular diseases, ischemic heart disease, angina pectoris, unstable angina pectoris, myocardial infarction, heart failure, major coronary heart disease event, cardiac arrhythmias, atrial fibrillation and flutter, coronary revascularization (ANGIO or CABG), coronary angioplasty, coronary artery bypass grafting, stroke, and embolic stroke (all P < 0.05). These causal relationships remained significant after correcting for the false discovery rate (all P < 0.05). Steiger directional test confirmed that the direction of the effect of childhood obesity on CCVD was correct (all P < 0.001). No causal relationship was identified between childhood obesity and cardiac arrest, stroke (excluding SAH), subarachnoid haemorrhage, and intracerebral haemorrhage (all P>0.05). MR-Egger intercept test and leave-one-out test suggested that the research results are robust. The replication analysis corroborated the consistent findings, thereby further confirming the robustness of the results. The findings of GBD study showed that obesity was an important risk factor for deaths and DALYs in patients with CCVD. This study revealed the positive causal relationship between childhood obesity and various CCVD. Obesity was identified as a risk factor for contributing to adverse prognostic outcomes in CCVD patients. This highlights the need for clinicians to prioritize evidence-based strategies in the management of childhood obesity to prevent the onset and adverse progression of CCVD in adulthood.

Background and Objectives: The present study evaluates documentation and control of cardiovascular risk factors (RFs) in patients with coronary heart disease (CHD) during routine outpatient visits at a single tertiary center in western Romania and places these findings in descriptive context relative to SURF-CHD reports from Europe. Materials and Methods: We have enrolled 136 consecutive patients between 18 and 80 years old with coronary artery disease attending routine outpatient clinic check-ups between May 2019 and July 2020. All patients had been diagnosed with acute coronary syndrome or stable angina pectoris and had been treated either by PCI or CABG. Comparisons with SURF-CHD were primarily descriptive due to non-harmonized denominators and lack of patient-level data; inferential testing was limited to variables with clear n/N in both cohorts. Results: Most patients (81%) were males with a mean age of 61.7 years. 93.4% of the patients had undergone PCI, and 4.4% had coronary artery bypass graft (CABG). Regarding risk factors, 25% were current smokers, while 50% were former smokers and the mean BMI value was 29.9 (±6.07). While most patients (80.1%) revealed no previous history of dyslipidemia, 62.5% had no previous history of arterial hypertension, and 84.6% had no previous history of diabetes mellitus. Mean LDL cholesterol levels after a major coronary event remained 93.55 (±43.52) mg/dL, mean HbA1c levels were 7.86 (±1.40)%, while mean systolic blood pressure was 129 (±14.9) mmHg. Conclusions: In this single-center audit, several modifiable RFs remained suboptimally controlled despite established CHD. These results should not be generalized nationally; rather, they highlight center-level opportunities for improving secondary prevention and underscore the need for multicenter, nationally representative registries in Romania.

Cardiovascular risks of ibuprofen versus naproxen: a target trial emulation

Relationship between coronary artery calcium score and plaque vulnerability by coronary CT angiography in non-obstructive coronary artery disease

Background: Atherosclerotic cardiovascular disease (ASCVD) most often manifests initially with a myocardial infarction or stroke. While the aetiology of atherosclerosis and benefits of risk factor (lipids and blood pressure) management are well established, less is known about the effectiveness of ASCVD risk assessment and management in the period leading up to such events. Aims: To identify patients with a major coronary or cerebrovascular event at first presentation of ASCVD between 2010-23 and assess identification and management of ASCVD risk in the year preceding the event. Methods: We conducted a retrospective, population-level,observational study using linked anonymised health record data amongst 102,148 patients with a fatal or non-fatal major coronary or cerebrovascular event at first ASCVD diagnosisin Wales (UK). Trends in the documentation of QRISK 10-year risk score, management of LDL-C and blood pressure(BP), and prescription of lipid lowering therapy (LLT) were identified in the year preceding presentation. Results: Documentation of LDL-C in the year prior to presentation increased from 27.8% to 38.5% between 2010-23, of which the proportion with a level of &lt;1.8 mmol/L increased from 4.5% to 9.5% (Figure 1A). Prescription of LLT increased from 26.0% to 33.8% between 2010-23, with an increase in the prescribing of high-intensity statin from 2.0% to 6.7% (Figure 1B). Documentation of BP decreased from 55.2% to 49.8% between 2010-23, and achievement of systolic and diastolic BP &lt;140&amp;90 mmHg increased, thoughonly from 26.5% to 27.4% (Figure 1C). Documentation of QRISK score within 5-years prior to presentation increased from 16.1% to 27.7% between 2014-23, of which 28.1% scored &gt;20% in 2023 (Figure 1D). Among patients with a recorded QRISK of &gt;20%, only 19.1% were prescribed LLTin 2014, increasing to 27.5% in 2023 (Figure 1E). Conclusions: Although management of lipids has improved over time in the primary prevention setting, the effectiveness of control of patient's risk factors remains suboptimal at a population level. The majority of patients suffering MI or stroke as their initial presentation of CVD do not have their BP or lipids tested (or controlled when tested) in the year preceding initial presentation with these acute vascular events.Improvements are required in identification of those at risk and management of modifiable risk factors to meet guideline-recommended standards of care at the population level.

IntroductionHigh-intensity statin therapy is recommended as a first-line strategy for lowering low-density lipoprotein cholesterol (LDL-C) levels in patients with acute myocardial infarction (AMI). A combination of moderate-intensity statin and ezetimibe at an equivalent dose to high-intensity statin may achieve similar LDL-C reduction with fewer side effects. This study evaluates the long-term efficacy and safety of this approach, initiated following AMI, compared with high-intensity statin monotherapy.Methods and analysisThe ROSUZET-AMI trial is a multicentre, prospective, open-label, randomised, non-inferiority trial. Patients with AMI who underwent percutaneous coronary intervention were randomised 1:1 to receive either moderate-intensity statin with ezetimibe (rosuvastatin 5 mg with ezetimibe 10 mg) or high-intensity statin monotherapy (rosuvastatin 20 mg). The primary endpoint is the composite of cardiovascular death, major coronary events (non-fatal myocardial infarction, documented unstable angina requiring hospitalisation and all coronary revascularisation events occurring at least 30 days after randomisation), or non-fatal stroke.Ethics and disseminationEthics approval for this study was obtained from the Institutional Review Board of Seoul St. Mary’s Hospital (No. 2020-0424-0003). Informed consent is obtained from every participant before randomisation. The results of this study will be submitted for publication in international peer-reviewed journals, and the key findings will be presented at international scientific conferences.Trial registration numberNCT04499859.

Coronary artery disease (CAD) polygenic risk scores (PRS) enhance risk stratification, but it is unknown whether the degree varies across the spectrum of atherosclerotic cardiovascular disease (ASCVD). We compared the association of a CAD PRS and coronary events in patients with ASCVD and a prior ischemic event, ASCVD without event, and without overt ASCVD. Genotyped patients from 6 multinational cardiovascular trials were categorized into low (bottom 20%), intermediate (middle 60%), and high (top 20%) genetic risk using a genome-wide CAD PRS, then grouped by ASCVD status. The primary endpoint was any major coronary event, a composite of death from coronary disease, myocardial infarction, or coronary revascularization. 59,905 participants (mean age, 66 years; 71% male) were included; 47,456 (79%) had established ASCVD. Compared with low genetic risk, major coronary events were more frequent in high (HR, 2.06; 95%CI, 1.88-2.24; p<0.001) and intermediate (HR, 1.57; 95%CI, 1.45-1.70; p<0.001) genetic risk. Genetic risk was more strongly associated with major coronary events in patients without overt ASCVD (HR between high vs. low genetic risk, 4.63) than patients with ASCVD without (HR, 1.73) or with an ischemic event (HR, 1.63) (Pinteraction<0.001). Absolute risk difference between high and low genetic risk was comparable across ASCVD categories (5.0-7.0% difference at 3 years). A CAD PRS was associated with incident major coronary events in all ASCVD categories. Although genetics provided the strongest relative association in patients without established ASCVD, the absolute risk gradient was comparable for patients with and without ASCVD.