Primary Prevention Research Articles

Low agreement among guidelines for primary prevention ICD recommendations in hypertrophic cardiomyopathy: Short title: Differing ICD recommendations in HCM

Sudden cardiac death (SCD) risk stratification and primary prevention implantable cardioverter-defibrillator (ICD) recommendations are based on differing strategies for hypertrophic cardiomyopathy (HCM). This study aimed to evaluate the impact of the 2023 European Society of Cardiology (ESC) guidelines on the 2014 ESC and the 2024 American Heart Association (AHA)/American College of Cardiology (ACC) systems in terms of primary prevention ICD recommendations for HCM. A cohort of 200 patients with HCM in Brazil was assessed for SCD risk profile according to current guidelines. The agreement for primary prevention ICD recommendations was evaluated among different strategies. SCD and appropriate shock were defined as the end points. Among the 200 patients, 63 (31%) received a primary prevention ICD, with 10 (15.8%) receiving appropriate shocks. Low agreement was found among the guidelines (Fleiss' kappa 0.340, 95% confidence interval [CI] 0.286 to 0.395, p <0.001). The European systems showed moderate agreement. The 2024 AHA/ACC algorithm placed 58% of patients in class IIa, whereas only 29% achieved this recommendation with the 2023 ESC model. The end points occurred in 8% of patients over 9.4 ± 6.5 years. The 2014 ESC guidelines had the highest accuracy (77%, 95% CI 71 to 83) and negative predictive value (96%, 95% CI 90 to 98) in detecting patients in class IIa with primary end points. However, all guidelines showed a low positive predictive value. The 2024 AHA/ACC guidelines classified the largest proportion of patients (81%) with the primary end point as class IIa. Low agreement was found among guidelines regarding primary prevention ICD recommendations in HCM, particularly between the 2023 ESC and 2024 AHA/ACC systems.

Magnitude of effect of low dose colchicine, a newly food and drug administration approved treatment for stroke prevention.

As the Food and Drug Administration in June 2023 approved low dose colchicine for primary prevention of stroke and other cardiovascular events, an updated meta-analysis of stroke outcomes in randomized trials would help inform clinical practice.**** METHODS: Systematic, study-level meta-analysis of randomized clinical trials of long-term colchicine in patients with established atherosclerotic cardiovascular disease (ASCVD, preponderantly primary prevention for stroke) or following non-cardioembolic ischemic stroke/transient ischemic attack (secondary prevention). Heterogeneity was assessed with the I2 statistic and Cochrane's Q and potential bias assessed with the Risk of Bias 2.0 scale. Six randomized control trials met selection criteria, enrolling 14,987 patients (7495 colchicine, 7492 placebo), with median follow-up 26.3 months. Colchicine dosage in all trials was 0.5 mg once-daily. Across all trials, colchicine treatment produced a 28 % relative risk reduction in stroke (1.77 % vs 2.54 %, risk ratio (RR)=0.72, 95 %CI: 0.58-0.89; p = 0.003) and a comparable relative reduction on major adverse cardiovascular events. There was potential heterogeneity by subgroup (pinteraction = 0.06), with a stronger relative reduction for stroke in the five ASCVD trials (RR=0.48, 95 %CI:0.30-0.77; p = 0.003) than the non-cardioembolic ischemic stroke/TIA population (RR=0.80, 95 %CI:0.63-1.02; p = 0.07). Colchicine was associated with a small, non-significant increase in all-cause mortality (RR: 1.09; 95 %Cl: 0.85-1.40, p = 0.49) but not cardiovascular death (RR: 0.92; 95 %Cl: 0.65-1.29, p = 0.61). Low-dose colchicine treatment decreases stroke and major adverse cardiovascular event risk in patients with ASCVD and potentially in patients following a non-cardioembolic ischemic stroke/TIA. Among every 1000 patients treated over 2 years, approximately 6.6 strokes and 24 major adverse cardiovascular events are avoided.

Health networking on cancer in the European Union: a 'green paper' by the EU Joint Action on Networks of Expertise (JANE).

Health networking is in principle a formidable instrument to address many challenges posed by cancer, one of the two most common and most lethal non-communicable chronic diseases. The European Union (EU)'s Beating Cancer Plan foresaw the addition of new health networks to the four already existing European Reference Networks on rare cancers: the Network of Comprehensive Cancer Centres and several networks of expertise (NoEs), which will be shortly deployed on items as complex and poor-prognosis cancers, palliative care, survivorship, personalised primary and secondary prevention, omic technologies, hi-tech medical resources, and cancers in adolescents and young adults. The community of experts of the EU Joint Action, due to build such NoEs, has drafted this 'green paper', incorporating 13 open questions, in an effort to foster discussion on some open questions about health networking on cancer in the EU. These affect highly diverse issues such as the following: how gaps in research into the instrument of health networking may be filled; which items lend themselves more to health networking in the EU; what degree of cooperation and harmonisation should be required of EU member states to best exploit health networking and give rise to European networks of national/regional networks; how the idea of subsidiarity may be best interpreted to support health networking in the context of EU treaties, which basically do not include health; how health networks should be funded and with what degree of cooperation between the EU and national levels; whether EU health networks should be shaped as legal entities or could give rise to secondary legal entities, also with a view to fundraising; how health networks should be best shaped to advance cancer research and how the EU regulatory system should be updated to exploit such impulse to health networks, in view of the EU General Data Protection Regulation and the new EU Health Data Space; how artificial intelligence can be exploited today within health networks and to what extent it will be able to overcome challenges such as the current lack of interoperability of electronic health records and the language barrier across the EU; and how health networks should involve patients and their groups, with regard to their formal role within EU health networks as well as their ability to have a say in items such as production of clinical practice guidelines, the design of investigator-driven clinical trials, EU regulatory decisions on medicines and devices, health service data governance, and identification of unmet needs.

Association of chronic pain with incidence and progression of cardiometabolic multimorbidity in middle-aged and older populations: a multicohort study.

Chronic pain is associated with single cardiometabolic diseases (CMDs). Less is known about the association of chronic pain with the co-occurrence of multiple CMDs, known as cardiometabolic multimorbidity (CMM). This study aims to examine the association between chronic pain and incidence of CMM and if it existed, to what extent chronic pain relates to the progression of specific CMD-related multimorbidity (MM). We pooled individual-level data of 59,134 participants from 4 cohort studies across 18 countries between 2010 and 2020. Participants aged 45 years or older, free of CMDs (diabetes, heart diseases, and stroke), and with self-reported chronic pain status at baseline were included. Multinomial logistic regression was performed on the association of chronic pain with incident CMM and the progression of specific CMD-related MM. One-third (21,204) of participants reported chronic pain at baseline. After 8 to 9 years, 1344 (2.3%) developed CMM. Chronic pain was associated with the onset of each CMD (odds ratio [OR] range 1.12-1.37) and CMM combinations (OR range 1.57-2.09). It is also linked with the increased odds of more CMDs (1, 2, and 3) during the follow-up. For example, OR increased from 1.31 for individuals with one CMD, to 1.57 for those with 2 CMDs, to 2.09 for those with 3 CMDs. Chronic pain was also associated with developing all CMD-related MM (OR range 1.26-1.88). Compared with those with diabetes only, participants with chronic pain were more likely to progress to diabetes and heart diseases, as well as diabetes, heart diseases, and stroke. Chronic pain is associated with incidence and progression of CMM, whose management should be considered in primary and secondary prevention of CMM among middle-aged and older populations.

A biokinetic approach in primary knee osteoarthritis prevention and management-exploring movement profiles and kinetic chain interactions: Current concepts.

Knee osteoarthritis (OA) is a chronic disease characterized by increasing prevalence and significant physical, psychological, and economic burdens. Despite extensive research, the definition, risk factors, and effective cost-efficient treatments for knee OA remain unclear. This article aims to revisit primary knee OA, understanding its etiology, and focusing on prevention and individualized nonoperative treatment modalities. This study reviews various aspects of knee OA, including its global prevalence, economic impact, and current treatment strategies. It explores the role of mechanical loading pathways in the disease's onset, highlighting the importance of considering not only the knee but the entire kinetic chain in diagnosis and treatment. Also, it discusses knee anatomy and biomechanics during functional activities, emphasizing the role of neuromuscular control and the influence of proximal and distal joints on knee health. Current treatments focus mainly on symptom management, with limited success in disease prevention and curative interventions. This review underlines the importance of understanding the biomechanical risk factors contributing to knee OA and the necessity of individualized interventions based on biokinetic profile analysis. Knee OA management and prevention necessitate a paradigm shift from viewing it as a localized knee disease to recognizing related mechanical overloads of the human complex motion system. Identifying individual inductive elements is paramount for effective knee OA prevention, management, and rehabilitation. Future research should endeavor to identify movement profile subgroups to establish an early-stage prognosis and the impact of interventions for each group. LEVEL OF EVIDENCE V: Expert opinion based on nonsystematic review.

Correction to: 2024 Guideline for the Primary Prevention of Stroke: A Guideline From the American Heart Association/American Stroke Association.

Correction to: 2024 Guideline for the Primary Prevention of Stroke: A Guideline From the American Heart Association/American Stroke Association.

Fully automated coronary artery calcium score and risk categorization from chest CT using deep learning and multiorgan segmentation: A validation study from National Lung Screening Trial (NLST).

The National Lung Screening Trial (NLST) has shown that screening with low dose CT in high-risk population was associated with reduction in lung cancer mortality. These patients are also at high risk of coronary artery disease, and we used deep learning model to automatically detect, quantify and perform risk categorisation of coronary artery calcification score (CACS) from non-ECG gated Chest CT scans. Automated calcium quantification was performed using a neural network based on Mask regions with convolutional neural networks (R-CNN) for multiorgan segmentation. Manual evaluation of calcium was carried out using proprietary software. This study used 80 patients to train the segmentation model and randomly selected 1442 patients were used for the validation of the algorithm. We compared the model generated results with Ground Truth. Automatic cardiac and aortic segmentation model worked well (Mean Dice score: 0.91). Cohen's kappa coefficient between the reference actual and the interclass computed predictive categories on the test set is 0.72 (95% CI: 0.61-0.83). Our method correctly classifies the risk group in 78.8% of the cases and classifies the subjects in the same group. F-score is measured as 0.78; 0.71; 0.81; 0.82; 0.92 in calcium score categories 0(CS:0), I (1-99), II (100-400), III (400-1000), IV (>1000), respectively. 79% of the predictive scores lie in the same categories, 20% of the predictive scores are one category up or down, and only 1.2% patients were more than one category off. For the presence/absence of coronary artery calcifications, our deep learning model achieved a sensitivity of 90% and a specificity of 94%. Fully automated model shows good correlation compared with reference standards. Automating the process could improve diagnostic ability, risk categorization, facilitate primary prevention intervention, improve morbidity and mortality, and decrease healthcare costs.

A 20-year population-wide cohort study on association of aspirin and risk of gastrointestinal and non-gastrointestinal cancer.

830 Background: Aspirin has been shown to reduce the risk of various gastrointestinal (GI) and non-GI cancers 1,2 . However, little was known about at what age aspirin should be started for maximal chemoprotective better on GI cancer. Furthermore, the randomised controlled trial on aspirin for primary prevention use in healthy elderly (ASPREE) showed no association between aspirin and cancer incidence despite the limitation of short follow-up duration 3 . The current study aims to investigate the 20-year risk of cancer using aspirin in a territory-wide Hong Kong population cohort. Methods: The study included all aspirin users from 2000 to 2019, and non-aspirin users matched by age and sex at a ratio of 1:2. Enrolled subjects with a history of cancer at enrolment, cancer incidence or death within 6 months were excluded. The incidence of individual GI and non-GI cancer was presented as the primary outcome. Baseline characteristics between aspirin and non-aspirin users were adjusted in the survival analysis by inverse probability of treatment weighting (IPTW). The fine-grey model has been used to address bias from competing risk of death. The sub-distribution hazard ratio was presented for the association of aspirin use and risk of GI and non-GI cancers. Results: The current study included 538,147 aspirin users and 968,378 non-users with a mean age of 64.8 years. A total number of 36,683 cases of GI cancer (2.4%) and 47,196 cases of non-GI cancers (3.1%) were observed. Aspirin was associated with a lower risk of several common individual GI cancers, including colorectal cancer (SHR 0.78, 95% CI 0.76-0.81), liver cancer (SHR 0.67, 95% CI 0.64-0.70), stomach cancer (SHR 0.79, 95% CI 0.75-0.84) and pancreatic cancer (SHR 0.85, 95% CI 0.79-0.91), but not oesophageal cancer. On the other hand, aspirin was associated with a lower risk of prostate cancer (SHR 0.95, 95% CI 0.91-1.00) and breast cancer (SHR 0.76, 95% CI 0.73-0.79), but not lung cancer and kidney cancer. In overall, aspirin was associated with a 24% lower risk of GI cancers (SHR 0.76, 95% CI 0.74-0.78) and a 3% lower risk of non-GI cancers (SHR 0.97, 95% CI 0.95-0.99). Conclusions: Aspirin was associated with a lower risk of most GI cancers, including colorectal cancer, liver cancer, stomach cancer and pancreatic cancer, but not most non-GI cancers. In general, results on the effect of aspirin on GI cancer prevention were consistent with the previously presented 10-year cohort. 1. Bosetti C, Santucci C, Gallus S, Martinetti M, La Vecchia C. Aspirin and the Risk of Colorectal and Other Digestive Tract Cancers: An Updated Meta-analysis through 2019. Ann Oncol. 2020;31(5):558-568. 2. Santucci C, Gallus S, Martinetti M, La Vecchia C, Bosetti C. Aspirin and the risk of nondigestive tract cancers: An updated meta-analysis to 2019. Int J Cancer. 2021;148(6):1372-1382. 3. McNeil JJ, Gibbs P, Orchard SG, et al. Effect of Aspirin on Cancer Incidence and Mortality in Older Adults. J Natl Cancer Inst. 2021;113(3):258-265.

The effect of sarpogrelate compared to aspirin in high- or very-high-risk diabetes for primary prevention

The benefit of aspirin in primary prevention for atherosclerotic cardiovascular diseases (ASCVD) is questionable due to bleeding complications. We analyzed the Korean National Health Insurance data to compare the efficacy and overall bleeding of sarpogrelate, an antiplatelet agent with lower bleeding risk, versus aspirin in high-/very-high-risk diabetic populations without prior ASCVD. The primary endpoint was net adverse clinical events (NACE), defined as a composite of efficacy and overall bleeding. The efficacy was a composite of all-cause death, myocardial infarction (MI) and stroke, whereas overall bleeding included intracranial hemorrhage (ICH) and gastrointestinal (GI) bleeding. A total of 10,778 high-/very-high-risk diabetic patients (9550 on aspirin, 1228 on sarpogrelate) were analyzed. After propensity score matching, sarpogrelate was linked to a lower incidence of NACE (HR:0.71; 95% CI 0.57–0.88), mainly driven by 62% reductions in overall bleeding (0.38; 0.17–0.81), a composite of 64% and 72% lower rate of GI bleeding and ICH, respectively. Additionally, there was no significant differences in MI or stroke between groups. In high- or very-high-risk diabetic patients without ASCVD, sarpogrelate use was associated with net clinical benefit mainly due to the reduction of significant reduction in overall bleeding events.

Performance and Safety of the Extravascular Implantable Cardioverter Defibrillator Through Long-Term Follow-Up: Final Results From the Pivotal Study.

Substernal lead placement of the extravascular implantable cardioverter defibrillator (EV ICD) permits both defibrillation at thresholds similar to those seen with transvenous implantable cardioverter defibrillators and effective anti-tachycardia pacing (ATP) while avoiding the vasculature and associated complications. The global Pivotal study has shown the EV ICD system to be safe and effective through 6 months, but long-term experience has yet to be published. Our aim was to report the performance and safety of the EV ICD system throughout the study. The EV ICD Pivotal study was a prospective, global, single-arm, premarket clinical study. Individuals with a Class I or IIa indication for a single-chamber implantable cardioverter defibrillator per guidelines were enrolled. Freedom from major system- or procedure-related complications and appropriate and inappropriate therapy rates were assessed through 3 years with the Kaplan-Meier method. ATP success was calculated from simple proportions. An implantation was attempted in 316 patients (25.3% female; 53.8±13.1 years of age; 81.6% primary prevention; left ventricular ejection fraction, 38.9±15.4%). Of 299 patients with a successful implantation, 24 experienced 82 spontaneous arrhythmic episodes that were appropriately treated with ATP only (38, 46.3%), shock only (34, 41.5%), or both (10, 12.2%) for a Kaplan-Meier-estimated rate of first any appropriate therapy of 9.2% at 3 years. ATP was successful in 77.1% (37/48) of episodes, and ATP use significantly increased from discharge to last follow-up visit (P<0.0001). Shock therapy was successful in 100% (27/27) of discrete, spontaneous ventricular arrhythmias. The inappropriate shock rates at 1 and 3 years were 9.8% and 17.5%, respectively, with P-wave oversensing the predominant cause. No major intraprocedural complications were reported, and the estimated freedom from system- or procedure-related major complications was 91.9% at 1 year and 89.0% at 3 years. The most common major complications were lead dislodgement (10 events; n=9 patients, 2.8%), postoperative wound or device pocket infection (n=8, 2.5%), and device inappropriate shock delivery (n=4, 1.3%). Twenty-four system revisions were performed as a result of major complications related to the EV ICD system or procedure. From implantation to study completion, the EV ICD Pivotal study demonstrated that a single integrated system with an extravascular lead placed in the substernal space maintains high ATP success, effective defibrillation, and a consistent safety profile. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04060680.

Rationale and design of the HOVON 170 DLBCL-ANTICIPATE trial: preventing anthracycline-induced cardiac dysfunction with dexrazoxane

BackgroundDexrazoxane has been studied for its ability to prevent anthracycline-induced cardiac dysfunction (AICD) in several trials but its use in clinical practice remains limited. This is related to the low to moderate quality of the generated evidence, safety concerns and restricted prescribing indications. Additional randomized trials are needed before this drug can be routinely integrated into cardio-oncology clinical practice.ObjectivesTo describe the rationale and design of the HOVON 170 DLBCL – ANTICIPATE trial. This trial aims to establish the efficacy and safety of dexrazoxane for the primary prevention of AICD in patients diagnosed with Diffuse Large B-Cell Lymphoma (DLBCL) treated with six cycles R-CHOP21 chemo-immunotherapy.MethodsThis is a multicenter, parallel-group, open-label, phase III trial, randomizing 324 patients between either no cardioprotective treatment or dexrazoxane from the first R-CHOP cycle. The primary and co-primary endpoints are the incidence of AICD within 12 months of registration and the percentage of patients with complete metabolic remission at the end-of-treatment PET-CT respectively. The trial is registered at the EU Clinical Trials Register (EU-CT number 2023-505377-32) and ClinicalTrials.gov (NCT06220032).ResultsThe medical research ethics committee approved the trial in May 2024. Recruitment has started in September 2024 and is expected to last for three years.ConclusionsThis trial is poised to contribute crucial evidence concerning the efficacy and safety on the use of dexrazoxane in the primary prevention of AICD. The trial is anticipated to address critical knowledge gaps and offer important insights into the value of dexrazoxane in cardio-oncology practice.

Relationship between cerebral blood flow velocities and sociodemographic characteristics of sickle cell anaemia children aged 2-16 years seen at federal teaching hospital Owerri

Background: Sickle cell anaemia (SCA) is a chronic haemolytic state associated with recurrent blood transfusions, infections and its attendant complications. The study compared the relationship between cerebral artery blood flow velocities (CBFV) and socio-demographic parameters (age, sex, socioeconomic status and age at diagnosis) of male and female SCA children aged 2-16 years seen at Federal Teaching Hospital Owerri, Imo state. Methods: Structured questionnaire were used to obtain relevant bio-sociodemographic information’s from SCA children that attended the sickle cell specialist clinic of the hospital between April and September 2023.Later, Transcranial Doppler ultrasound scan was done for them. Results: A total of 102 subjects were screened within the study period. CBFV decreases with increasing age, 100% of those with abnormal CBFV were aged 2-6 years and 75% females. Majority of children with abnormal CBFV belonged to lower and middle socioeconomic class. Abnormal CBFV was found in 17.6% of subjects Conclusions: The prevalence of abnormal cerebral blood flow velocity in SCA children is 17.6% and majorily in younger age group. Identification of subjects at risk for a CVA helped in primary prevention by prompt therapy institution.

Implantable Cardioverter Defibrillator in Nonischemic Versus Ischemic Cardiomyopathy: Real-World Primary Prevention Study.

The evidence in the primary prevention of sudden cardiac death (SCD) by using implantable cardioverter defibrillators (ICD) in patients with ischemic cardiomyopathy (ICM) is well-established but remains controversial for those with nonischemic cardiomyopathy (NICM). This study evaluates whether prognostic differences exist between ICM and NICM patients after ICD implantation. Patients initially undergoing ICD implantation as primary SCD prevention were retrospectively enrolled from January 2017 to May 2023. Malignant ventricular arrhythmic and/or SCD were set as the primary endpoint, whereas all-cause mortality was the secondary endpoint. Patients were grouped by heart failure etiology (ICM vs. NICM) and then by primary endpoint events occurrence. Outcomes analyses were performed between the NICM and ICM patients. The final cohort had 342 patients, 213 (62.3%) with NICM and 129 (37.7%) with ICM. At a median follow-up of 23.0 (10.7, 33.2) months, 51 patients (14.9%) encountered primary endpoint events. No statistically significant disparities in primary endpoint events (log rank p = 0.413), all-cause death (log rank p = 0.208), cardiovascular mortality (log rank p = 0.218), or appropriate ICD therapy (log rank p = 0.250) between the two groups were indicated by Kaplan-Meier survival analysis. Moreover, the COX-adjusted models further demonstrated the absence of any significant differences between the two groups. In real-world settings, primary prevention of SCD with ICD implantation yields similar outcomes for ICM and NICM patients, including probabilities of SCD and/or malignant ventricular arrhythmias, all-cause mortality, appropriate ICD therapy, and cardiovascular mortality.

Long-term burden of body mass index since childhood and impaired physical performance in midlife.

The impact of long-term burden of body mass index (BMI) since childhood on physical performance in midlife remains unclear. We aimed to investigate the association between cumulative exposure to BMI since childhood and midlife physical performance by using data from the Bogalusa Heart Study (BHS). This longitudinal study consisted of 749 participants (aged 37.6 to 56.7 years at follow-up) who had been examined at least four times during childhood, with 39.3 years of follow-up. BMI in childhood, adulthood, as a cumulative burden of BMI in childhood, or as a cumulative burden from childhood to adulthood were inversely associated with midlife Short Physical Performance Battery (SPPB) scores, 4-m gait speed, and 6-min walking distance. Individuals with higher BMI as adults but not as children did not have lower SPPB scores (OR,1.67; 95% CI, 0.85-3.27), while individuals with consistently high BMI from childhood to adulthood (2.13 1.18-3.82) and individuals with high childhood BMI (2.12 [1.10-4.10]) but low adult BMI had significantly increased risk compared with individuals with low child and low adult BMI. Cumulative burden of BMI from childhood to midlife associated with worse midlife physical performance. Maintaining a healthy body weight throughout life may play a role in preventing or delaying the onset of functional decline. We examined the impact of long-term burden of body mass index (BMI) since childhood on subsequent physical performance in midlife. We found that ①BMI in childhood and cumulative burden of BMI since childhood were associated with poor physical function in midlife; ② Individuals with high childhood BMI but low adult BMI have poor midlife physical performance; ③ Subjects with both high childhood and adulthood BMI have worse midlife physical performance. Our findings have important implications for active monitoring BMI from childhood and turning the focus of functional decline prevention to primary and primordial prevention.

Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.

Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women.

Association Between Liver Fibrosis and Risk of Incident Stroke and Mortality: ALarge Prospective Cohort Study.

There is a well-established relationship between liver conditions and cardiovascular diseases. However, uncertainty persists regarding the contribution of liver fibrosis to major stroke types including ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage at the population level. In this large prospective cohort study, participants without previous stroke or coronary heart disease at baseline from the UK Biobank were included. We identified participants at high probability of advanced liver fibrosis using the Fibrosis-4 index >2.67 or aspartate aminotransferase to platelet ratio index ≥1.0. Multivariable Cox proportional hazard regression analyses were conducted to estimate hazard ratios (HRs) for liver fibrosis with the incidence of major stroke types, stroke-related death, and all-cause death. Among 379 953 participants (mean age, 56.2 [SD, 8.1] years; 44.6% men), 7396 (1.9%) had a Fibrosis-4 index >2.67 at baseline. During a median follow-up of 12.75 (interquartile range, 12.03-13.48) years, 7143 (1.9%) incident stroke cases were documented. Advanced liver fibrosis assessed by the Fibrosis-4 index was associated with an increased risk of ischemic stroke (HR, 1.94 [95% CI, 1.70-2.22]), intracerebral hemorrhage (HR, 2.14 [95% CI, 1.63-2.81]), subarachnoid hemorrhage (HR, 1.90 [95% CI, 1.27-2.84), stroke-related death (HR, 2.20 [95% CI, 1.73-2.80]), and all-cause death (HR, 2.59 [95% CI, 2.46-2.73]). Using the aspartate aminotransferase to platelet ratio index as an alternative score, liver fibrosis was correlated with magnified risk of intracerebral hemorrhage (HR, 3.76 [95% CI, 2.38-5.93]) and subarachnoid hemorrhage (HR, 3.05 [95% CI, 1.51-6.13]) compared with ischemic stroke (HR, 1.58 [95% CI, 1.17-2.14]). Restricted cubic spline analysis showed nonlinear associations of the Fibrosis-4 index and aspartate aminotransferase to platelet ratio index with stroke incidence and all-cause death. Liver fibrosis is associated with increased risk of incident stroke and death among people without previous stroke or cardiovascular events, with particularly greater risk of intracerebral hemorrhage and subarachnoid hemorrhage. Noninvasive indices of liver fibrosis may serve as an easily accessible marker to detect individuals facing elevated risk of stroke and death in the primary prevention settings.

Assessing Primary Prevention Programs for Intimate Partner Violence: A Review of Contemporary Approaches

A systematic review of primary prevention programs for intimate partner violence (IPV) was conducted. Inclusion criteria for studies included publication in a peer-reviewed journal, a representative, community, or clinical sample, written in English, and conducted in the United States. A total of 24 articles were included. All studies included some kind of intervention, such as knowledge and/or behavioral, to change outcomes in IPV perpetration and/or victimization. Of the 24 studies, 16 used experimental designs, with the majority focused on adolescent samples (n= 14). The majority of studies used a group modality. Several prevention programs were adapted for specific subgroups (i.e., refugees) with promising outcomes for preventing IPV. While the majority of research reviewed suggests some reduction in IPV, the field still yields mixed results. Research does point toward the importance of adapting or creating prevention programs specifically for marginalized or vulnerable subgroups. Comparisons to a prior review highlight developments in this body of research over the past 10 years. Recommendations for intervention and policy with future directions for IPV research are discussed.

Triglyceride-glucose index in predicting the risk of new-onset diabetes in the general population aged 45 years and older: a national prospective cohort study

ObjectiveInsulin resistance (IR) is often present in diabetes, which imposes a heavy burden on the prevention and treatment of diabetes. Triglyceride glucose index (TyG) is simple, reliable and reproducible in detecting IR, and has great advantages in predicting the risk of diabetes. The aim of this study was to analyze the potential association between TyG and the risk of diabetes in Chinese middle-aged and older adults using a prospective cohort study design.MethodsThis study used longitudinal data from five waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, 2018, and 2020, involving 5886 participants. We used Cox proportional risk regression modeling to investigate the association between TyG index and the risk of new-onset diabetes, and decision tree analysis to identify high-risk groups for diabetes. Finally, ROC curves were applied in order to construct a predictive model for diabetes.ResultsA total of 1054 (17.9%) participants developed diabetes throughout the 9-year follow-up. Our study utilized a multivariate Cox proportional risk regression model and found a significant correlation between TyG index and diabetes risk. The analysis also revealed a nonlinear relationship between TyG index and diabetes risk.Receiver Operating Characteristic(ROC) curve analysis showed that the Area under the curve(AUC) area of TyG index in predicting the risk of new-onset diabetes was 0.652 (P < 0.05).ConclusionsTyG index can be used as a risk factor for predicting new-onset diabetes in the middle-aged and elderly population in China. In addition, there was a nonlinear relationship between TyG index and diabetes. Improving insulin resistance by regulating glucose and lipid metabolism plays an important role in the primary prevention of diabetes.

Correlation between uterine volume and intrauterine adhesion: a propensity score matching analysis

Objective: To investigate the correlation between uterine volume and intrauterine adhesion (IUA). Methods: From June 2018 to November 2019, totally 7 007 patients who underwent hysteroscopy in outpatient operating rooms of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital were retrospectively analyzed. Patients of reproductive age with IUA without uterine fibroids and adenomyosis were selected as IUA group, and patients of reproductive age without uterine fibroids and adenomyosis without IUA during the same period were selected as the control group. The propensity score matching (PSM) method was used to perform 1∶1 matching for the two groups of patients, matching variables included age, height, weight, body mass index (BMI), gravidity, parity, and number of abortion curettage. Whether there was any difference in uterine volume between the two groups of patients was compared, and whether uterine volume was an influencing factor of IUA was explored. The patients in IUA group were also categorized into mild, moderate and severe to explore whether uterine volume influenced the severity of IUA. Results: (1) After inclusion and exclusion criteria, 351 patients were included in IUA group and 2 986 patients in the control group. With PSM, 327 patients in IUA group and 327 patients in the control group were finally enrolled in this study. There were no statistically significant differences in age, height, weight, BMI, gravidity, parity, and number of abortion curettage between the two groups of patients after matching (all P>0.05). (2) After PSM, there was a significant difference between the uterine volume of IUA group (median: 44.23 cm3) and the uterine volume of the control group (median: 57.20 cm3; P<0.001). (3) Reduced uterine volume (OR=0.961, 95%CI: 0.952-0.970) was an independent risk factor for IUA (P<0.001). (4) Uterine volume had a significant effect on the severity of IUA (P<0.001), the larger the uterine volume (B=-0.030, 95%CI: -0.044 to -0.017), the less severe the IUA. Conclusions: Reduced uterine volume is an independent risk factor for IUA, and uterine volume has a significant effect on the severity of IUA. In patients with small uterine volume size, primary and secondary prevention of IUA should be emphasized.

Looking Back Looking Forward: Parent-Infant Treatment in the Anni Bergman Home-Visiting Project

ABSTRACT In this paper the authors describe the Anni Bergman Parent-Infant Program (ABPIP), with a focus on the development of the Home-Visiting Project (HVP) begun in 2014 in New York City. This primary prevention project provides psychoanalytic, relationship-based clinical intervention to mothers and their infants struggling with multiple stressors caused by poverty, histories of trauma, single parenthood, lack of employment, and limited access to health care and food. The beginnings of the project are described, including the centrality of infant observation as a port of entry into the subsequent dyadic therapy approach. Three clinical vignettes of the first mother-infant pair with whom we worked illustrate the beginnings of the treatment model that we developed. Both authors visited the mother and infant pair on a weekly basis for three years. Thinking and working together helped to create a template for the outreach project, the intervention approach, and informed further plans to expand the project and to include additional therapists and referral sources.