Atherosclerotic Cardiovascular Disease Risk Research Articles

Association of diastolic blood pressure and coronary artery calcium in South Asian American adults.

DBP is associated with atherosclerosis and cardiovascular disease, independent of SBP. However, prior evaluation of the association of DBP with coronary artery calcium (CAC) has not included South Asian adults, a population that is at excess risk of atherosclerotic cardiovascular disease. In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, we evaluated the association of sex-specific DBP tertiles and CAC score at least 100 with robust Poisson regression adjusted for age, sex, SBP, BP medication use, and other cardiovascular risk factors. We examined these associations stratified by antihypertensive medication use, and secondarily the association of baseline DBP tertile with incident CAC at least 100 over median 4.7 years of follow-up. Among 1155 participants (48% women, mean age 57 years), mean (standard deviation) DBP was 74 (10) mmHg, 33% were on antihypertensive medications, and 22% had CAC at least 100. Relative to DBP in tertile 1, DBP in tertiles 2 and 3 was associated with a significantly higher prevalence of CAC at least 100 [adjusted prevalence ratio 1.30 [95% confidence interval (CI) 1.03-1.65] and 1.47 (1.12-1.93), respectively]. These significant associations were primarily observed in participants who were not on antihypertensive medications. Baseline DBP tertile was not associated with incident CAC at least 100. Among South Asian adults in MASALA, DBP in the second or third tertiles vs. tertile 1 were associated with a higher prevalence of CAC at least 100 after adjustment for covariates including SBP. DBP may be an important clinical ASCVD risk factor among South Asian adults.

Disease Risk Score Derivation and Validation in Abu Dhabi, United Arab Emirates: A Retrospective Cohort Study.

Cardiovascular disease risk assessment is a key tool in primary prevention. The ADRS (Abu Dhabi Risk Study) is a retrospective cohort study aiming to develop 10-year risk prediction equations for coronary artery disease (CAD), stroke, and atherosclerotic cardiovascular disease (ASCVD), and validate international risk equations. The 8699 participants were examined in the Abu Dhabi cardiovascular screening program from 2011 to 2013 with a subsequent average follow-up of 9.2 years. They were assessed in 2023 for new CAD, admissions for acute coronary syndrome, or stroke. The validation cohort, 2554 subjects, is from the 2016 to 2017 Abu Dhabi community screening program, with 6.67 years average follow-up. Of 8504 ASCVD-free subjects, 250 experienced new CAD events. ASCVD risk factors in this population were age, sex, smoking, high cholesterol/high-density lipoprotein ratio, and diabetes diagnosis, in addition to low vitamin D level and low glomerular filtration rate. Three ADRS prediction models were derived using Cox regression. The ADRS-CAD had a C statistic of 0.899 (0.882-0.916) compared with 0.828 (0.803-0.852) for the Framingham Risk Score in the same sample. ADRS-stroke had a C statistic of 0.904 (0.865-0.944). The ADRS-ASCVD had a C statistic of 0.898 (0.883-0.913) compared with 0.891 (0.875-0.907) of pooled cohort equations and 0.825 (0.802-0.847) for Framingham Risk Score-cardiovascular disease. Applying our formulas to the validation cohort yielded C statistics of 0.825 (0.803-0.846), 0.799 (0.774-0.824), and 0.761 (0.71-0.813) for ASCVD, CAD, and stroke, respectively. The pooled cohort equations in this cohort had a C statistic for ASCVD of 0.824 (0.802-0.846). This study demonstrates the value of tailoring risk assessments to local populations and health care contexts.

A qualitative study of perceptions of the care pathway for familial hypercholesterolemia: screening, diagnosis, treatment, and family cascade screening

BackgroundFamilial hypercholesterolemia (FH) is an autosomal dominant genetic condition that carries increased risk for premature atherosclerotic cardiovascular disease, cardiovascular events, and death. Due to low uptake of evidence-based practices, up to 80% of FH patients remain undiagnosed and most are undertreated. This project aimed to understand patient and clinician perceptions across the care pathway of evidence-based diagnosis and treatment of FH, to inform implementation strategy design for two clinical trials seeking to increase evidence-based care.MethodsWith input from FH experts, we identified key points along the FH care pathway that might be targeted with broad-scale implementation efforts, including: (a) identification of the need for screening; (b) completion of screening test(s); (c) diagnosis; (d) connection to treatment; and (e) family cascade screening (a process used to identify and screen relatives of individuals diagnosed with FH). Then, we conducted qualitative interviews with patients who had participated in a prior FH quality improvement initiative and with clinicians who treat high cholesterol. We analyzed data using thematic analysis.ResultsWe interviewed 21 patients and 17 clinicians. Patient themes offered insights related to the impact of family history, reactions to a diagnosis of high cholesterol and/or FH, experiences with FH treatment and clinical care, perceptions of tools to diagnose FH, motivations and preferences for FH screening efforts, and reactions to family screening. Clinician themes offered insights into the perceived value of FH screening and diagnosis, current FH-related practice and context, and attitudes toward tools to aid clinical practice. In both sets of interviews, confusion and misconceptions about what makes FH unique and its clinical implications were common, as were concerns about logistics and competing priorities.ConclusionQualitative inquiry generated insights into several modifiable patient and clinician determinants of engagement with evidence-based implementation along the FH care pathway, many of which can be targeted with behavioral economics strategies that simplify complex decisions and by addressing informational and emotional needs. These findings offer actionable insights to inform future implementation research that seeks to close the evidence-to-practice gap in diagnosis and delivery of evidence-based care for FH.

Lipoprotein(a) levels in a population with clinical atherosclerotic cardiovascular disease in the United States: A subanalysis from the Lp(a)HERITAGE study

BackgroundElevated lipoprotein(a) (Lp[a]) is the most common inherited dyslipidemia that is independently and causally associated with increased atherosclerotic cardiovascular disease (ASCVD) risk. However, data from diverse populations with ASCVD are lacking. ObjectiveTo evaluate Lp(a) levels in a diverse, contemporary United States (US) population with ASCVD, stratified by race, ethnicity, and sex. MethodsLp(a)HERITAGE (NCT03887520) was a multicenter study that estimated the prevalence of elevated Lp(a) in adults (18–80 years) with ASCVD. US participants with Lp(a) measured in nmol/L pre- or post-enrollment were included in this subanalysis. This study was descriptive; therefore, no statistical comparisons were made. ResultsOf all US participants, 14% had an Lp(a) measurement pre-enrollment. This subanalysis included 7,679 US participants with Lp(a) measurements in nmol/L (80.5% White; 66.4% male; mean age 63.8 years [standard deviation ± 9.7]). Median Lp(a) was >2.5-fold higher in Black participants (132.0 nmol/L; interquartile range [IQR],57.1–239.6) vs the overall population (52.1 nmol/L; IQR, 15.7–167.8), and higher in females compared with males (69.4 nmol/L; IQR, 20.1–194.7 vs 45.6 nmol/L; IQR,14.0–152.6, respectively). Lp(a) levels ≥125 nmol/L were more prevalent among Black (52.0%) and female (38.9%) participants vs the overall population (33.3%). ConclusionsIn US Lp(a)HERITAGE participants, only 14% had an Lp(a) measurement pre-enrollment, despite having ASCVD. One-third of participants demonstrated Lp(a) levels ≥125 nmol/L, the threshold for high ASCVD risk, which was higher among Black (1/2) and female (2/5) participants, suggesting a greater need for Lp(a) testing in these groups to inform ASCVD risk mitigation.

The associations between exposure to ambient air pollution and coagulation markers and the potential effects of DNA methylation

Previous studies have illustrated the pivotal role of coagulation biomarkers in the link between air pollution and cardiovascular disease (CVD). However, inconsistencies remain in the conclusions, with limited studies conducted in rural areas of China. We conducted a panel study in rural areas of Henan Province, China. Considering the potential effect modifications of atherosclerotic cardiovascular disease (ASCVD) risks, 104 participants were enrolled, comprising two matched groups: 52 with high ASCVD risks and 52 with low ASCVD risks. DNA methylation at CpG sites and coagulation indices were measured for all participants. Linear mixed-effect regression models were used to evaluate the associations between ambient air pollution, coagulation biomarkers, and DNA methylation. We observed that for every 5-day standard deviation (SD) increment of PM2.5 (11.91μg/m³) and PM10 (13.65μg/m³), fibrinogen increased by 7.70% (95%CI: 2.27, 13.12) and 8.50% (95%CI: 2.46, 14.55), respectively. SO2 (6.95μg/m³) was associated with 40.25% (95%CI: 14.83, 65.67) increase in plasminogen activator inhibitor-1 (PAI-1). Decreased methylation at CpG sites was associated with exposure to air pollution. However, DNA methylation did not mediate the association between ambient air pollution and coagulation. Our study revealed the harmful impact of ambient air pollution on coagulation function but found no significant mediation effects of DNA methylation.

Childhood cardiometabolic risk factors associated with the perinatal environment of the maternal-paternal-child triad.

Clustering of cardiometabolic risk factors in childhood significantly increases the risk of atherosclerotic cardiovascular disease later in life. Identification of modifiable parental factors that contribute to offspring cardiometabolic health is critical for the prevention of disease. The objective was to identify factors associated with child cardiometabolic risk factors at age 5 years. Triads from a longitudinal cohort were recalled at 5 years (n = 68). Dietary intake, anthropometrics, physical activity and serum-based risk factors were collected. Best subset selection, linear and logistic regressions were used to identify triad variables associated with increased risk of cardiometabolic risk factor clustering at age 5 years. In this cohort, best subset modelling revealed that increased paternal fat mass, serum low-density lipoproteins and triglycerides, maternal dietary added sugar and being female were associated with increased odds of offspring having two or more cardiometabolic risk factors at age 5 years. Dietary and exercise interventions prior to conception targeting paternal adiposity and dyslipidaemia as well as maternal dietary habits could decrease children's cardiometabolic risk in later life.

Cholesteryl ester transfer protein inhibition: a pathway to reducing risk of morbidity and promoting longevity.

To review the evidence and describe the biological plausibility for the benefits of inhibiting cholesteryl ester transfer protein (CETP) on multiple organ systems through modification of lipoprotein metabolism. Results from observational studies, Mendelian randomization analyses, and randomized clinical trials support the potential of CETP inhibition to reduce atherosclerotic cardiovascular disease (ASCVD) risk through a reduction of apolipoprotein B-containing lipoproteins. In contrast, raising high-density lipoprotein (HDL) particles, as previously hypothesized, did not contribute to ASCVD risk reduction. There is also an expanding body of evidence supporting the benefits of CETP inhibition for safeguarding against other conditions associated with aging, particularly new-onset type 2 diabetes mellitus and dementia, as well as age-related macular degeneration, septicemia, and possibly chronic kidney disease. The latter are likely mediated through improved functionality of the HDL particle, including its role on cholesterol efflux and antioxidative, anti-inflammatory, and antimicrobial activities. At present, there is robust clinical evidence to support the benefits of reducing CETP activity for ASCVD risk reduction, and plausibility exists for the promotion of longevity by reducing risks of several other conditions. An ongoing large clinical trial program of the latest potent CETP inhibitor, obicetrapib, is expected to provide further insight into CETP inhibition as a therapeutic target for these various conditions.

Atherosclerotic cardiovascular disease risk based on SCORE algorithms and reclassification based on preclinical atherosclerotic plaques.

The aim of this study was to determine the efficacy of the number of carotid and common femoral bifurcations with plaque (NBP) detected by ultrasound in reclassifying atherosclerotic cardiovascular disease (ASCVD) risk obtained from SCORE algorithms. Data from the cohort of 1000 individuals free from ASCVD in the Cyprus Epidemiological Study on Atherosclerosis was used. In each predicted ASCVD risk class (low, moderate, high) based on SCORE algorithms and baseline data, the observed 10-year risk of subgroups according to the NBP was used to reclassify participants. There were 222 ASCVD events during a mean follow-up of 15.2±4.9 years. In each predicted risk class, the observed 10-year ASCVD event risk increased progressively in the subgroups across the presence of 1, 2, 3 and 4 bifurcations with plaque (P<0.001); Hazard Ratios (crude and adjusted for conventional risk factors) also increased progressively (P<0.001). There was a correct down classification in 152 and correct up classification in 99 participants. Total correct reclassification improvement was in 251 (25.1%). The results demonstrate that the NBP which is easy to detect is an independent predictor of ASCVD events and can be used to reclassify individuals into a different risk class by improving on the predicted SCORE risk.

Blood Pressure Predicted From Artificial Intelligence Analysis of Retinal Images Correlates With Future Cardiovascular Events

BackgroundHigh systolic blood pressure (SBP) is one of the leading modifiable risk factors for premature cardiovascular death. The retinal vasculature exhibits well-documented adaptations to high SBP and these vascular changes are known to correlate with atherosclerotic cardiovascular disease (ASCVD) events. ObjectivesThe purpose of this study was to determine whether using artificial intelligence (AI) to predict an individual’s SBP from retinal images would more accurately correlate with future ASCVD events compared to measured SBP. Methods95,665 macula-centered retinal images drawn from the 51,778 individuals in the UK Biobank who had not experienced an ASCVD event prior to retinal imaging were used. A deep-learning model was trained to predict an individual’s SBP. The correlation of subsequent ASCVD events with the AI-predicted SBP and the mean of the measured SBP acquired at the time of retinal imaging was determined and compared. ResultsThe overall ASCVD event rate observed was 3.4%. The correlation between SBP and future ASCVD events was significantly higher if the AI-predicted SBP was used compared to the measured SBP: 0.067 v 0.049, P = 0.008. Variability in measured SBP in UK Biobank was present (mean absolute difference = 8.2 mm Hg), which impacted the 10-year ASCVD risk score in 6% of the participants. ConclusionsWith the variability and challenges of real-world SBP measurement, AI analysis of retinal images may provide a more reliable and accurate biomarker for predicting future ASCVD events than traditionally measured SBP.

Pharmacist-led Care in Collaboration with a Cardiovascular Team to Improve the Management of Atherosclerotic Cardiovascular Disease Risk in Hospitalized Patients

Pharmacist-led Care in Collaboration with a Cardiovascular Team to Improve the Management of Atherosclerotic Cardiovascular Disease Risk in Hospitalized Patients

Integrating Metabolomics Domain Knowledge with Explainable Machine Learning in Atherosclerotic Cardiovascular Disease Classification

Metabolomic data often present challenges due to high dimensionality, collinearity, and variability in metabolite concentrations. Machine learning (ML) application in metabolomic analyses is enabling the extraction of meaningful information from complex data. Bringing together domain-specific knowledge from metabolomics with explainable ML methods can refine the predictive performance and interpretability of models used in atherosclerosis research. In this work, we aimed to identify the most impactful metabolites associated with the presence of atherosclerotic cardiovascular disease (ASCVD) in cross-sectional case–control studies using explainable ML methods integrated with metabolomics domain knowledge. For this, a subset from the FLEMENGHO cohort with metabolomic data available was used as the training cohort, including 63 patients with a history of ASCVD and 52 non-smoking controls matched by age, sex, and body mass index from the same population. First, Partial Least Squares Discriminant Analysis (PLS-DA) was applied for dimensionality reduction. The selected metabolites’ correlations were analyzed by considering their chemical categorization. Then, eXtreme Gradient Boosting (XGBoost) was used to identify metabolites that characterize ASCVD. Next, the selected metabolites were evaluated in an external cohort to determine their effectiveness in distinguishing between cases and controls. A total of 56 metabolites were selected for ASCVD discrimination using PLS-DA. The primary identified metabolites’ superclasses included lipids, organic acids, and organic oxygen compounds. Upon integrating these metabolites with the XGBoost model, the classification yielded a test area under the curve (AUC) of 0.75. SHAP analyses ranked cholesterol, 3-methylhistidine, and glucuronic acid among the most impactful features and showed the diversity of metabolites considered for building the ASCVD discriminator. Also using XGBoost, the selected metabolites achieved an AUC of 0.93 in an independent external validation cohort. In conclusion, the combination of different metabolites has the potential to build classifiers for ASCVD. Integrating metabolite categorization within the SHAP analysis further enhanced the interpretability of the model, offering insights into metabolite-specific contributions to ASCVD risk.

Coronary Artery Disease and Major Adverse Cardiovascular Events in People With Hepatic Steatosis at Low Atherosclerotic Cardiovascular Disease Risk.

Hepatic steatosis (HS) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥ 7.5% are associated with increased risk for cardiovascular events. To assess underlying coronary artery disease (CAD) and major adverse cardiovascular event (MACE) among those with and without HS at different ASCVD risk. We evaluated stable chest pain patients receiving coronary computed tomography (CT) in the PROMISE trial. HS and CAD endpoints were defined on coronary CT. MACE was defined as unstable angina, non-fatal myocardial infarction, and all-cause death. Multivariable Cox regression, adjusting for CAD characteristics, assessed the association of HS with MACE for ASCVD < 7.5%. One thousand two hundred and four of 3702 (32.5%) patients were at ASCVD < 7.5% and 20.3% (244/1204) of them had HS. Individuals with HS were younger (54.3 ± 5.2 vs. 55.8 ± 5.2; p < 0.001), more often males (40.2% [98/244] vs. 27.1% [260/960]; p < 0.001), had more risk factors/person (2.06 ± 0.89 vs. 1.93 ± 0.91; p = 0.047). CAD characteristics were similar between HS vs. non-HS patients at ASCVD < 7.5% and ASCVD ≥ 7.5% (all p > 0.05). Patients with HS had greater MACE rate compared to non-HS patients (ASCVD < 7.5%: 3.75%[9/244] vs. 1.5% [14/960]; p = 0.027 and ASCVD ≥ 7.5%: 4.7% [33/696] vs. 3.1% [56/1802]; p = 0.043). In patients without HS, MACE rate was higher in the ASCVD ≥ 7.5% vs. < 7.5% (3.1% [56/1802] vs. 1.5% [14/960]; p = 0.011). In patients with HS, MACE rates were not significantly different between ASCVD ≥ 7.5% vs. < 7.5% (4.7% [33/696] vs. 3.7% [9/244]; p = 0.484). In ASCVD < 7.5%, HS predicted MACE (aHR:2.34, 95%CI:1.01-5.43; p = 0.048), independent of CAD characteristics. Individuals with HS at ASCVD < 7.5% risk had similar CAD characteristics as patients without HS at < 7.5% ASCVD risk, yet experienced comparable MACE rates as those at ASCVD ≥ 7.5%.

The association between triglyceride glucose index and the risk of cardiovascular disease in obstructive sleep apnea

PurposeThe triglyceride glucose (TyG) index is a dependable indicator of insulin resistance (IR), serves as a valuable biomarker for identifying obstructive sleep apnea (OSA) and predicting its comorbidities. Both OSA and the TyG index are significantly related to the incidence and development of cardiovascular disease (CVD). We focus on investigating the relationship between the TyG index and the incidence of CVD risk in OSA.MethodsThe TyG index, homeostatic model assessment of IR (HOMA-IR) index, and polysomnography were assessed in 191 participants with OSA and without pre-existing CVD. To estimate the lifetime CVD risk, we employed the ‘Prediction for Atherosclerotic CVD Risk in China’ equation. The TyG index’s association with CVD risk was scrutinized using multivariable logistic regression models, contrasting it with the HOMA-IR index. We compared the predictive power for high lifetime CVD risk of the TyG index and the HOMA-IR index using receiver-operating characteristic (ROC) curve analysis.ResultsA total of 89 participants had high lifetime CVD risk. In fully adjusted model and additionally adjusted for HOMA-IR index, participants situated within the fifth quantile of the TyG index exhibited an increased lifetime CVD risk, with OR of 4.32 (95% CI, 1.19–15.67). The TyG index demonstrated significant predictive power for high lifetime CVD risk across varying severities of OSA and outperformed the HOMA-IR index, as evidenced by a larger area under the ROC curve.ConclusionThe TyG index, independent of the HOMA-IR index and obesity, was linked to an increased lifetime CVD risk. In predicting cardiovascular outcomes, the TyG index could potentially outperform the HOMA-IR index among individuals with OSA.

Reducing Cardiovascular Risk in HIV: The Unseen Impact of Visceral Fat

While modern antiretroviral therapy (ART) for people with HIV (PWH) increases life expectancy, there is still an increased risk of developing cardiovascular disease (CVD) in this population. As one factor associated with this increased risk is excess visceral abdominal fat (EVAF), the Visceral Adiposity Measurement and Observations Study (VAMOS) aimed to assess the impact of EVAF on CVD risk in PWH taking modern ART. Participants were grouped according to visceral adipose tissue (VAT) surface area &lt;130 cm2 (non-EVAF group) or ≥130 cm2 (EVAF group), quantified by CT scan. Findings presented at IDWeek 2024 revealed significant differences between EVAF and non-EVAF groups in 10-year atherosclerotic CVD (ASCVD) risk score, as well as many of their individual components. VAMOS also showed correlations between increasing VAT surface area and increasing 10-year ASCVD risk score and insulin resistance measures. Accordingly, VAT may represent a targetable factor to reduce ASCVD risk. Also shown was an inverse relationship between growth hormone (GH) levels and VAT surface area. As GH reductions related to obesity are associated with elevated CVD risk, increasing GH levels may consequently reduce ASCVD risk score. Analysis of two Phase III trials of the GH-releasing hormone (GHRH) analogue tesamorelin, which can significantly reduce VAT in PWH, was also presented at IDWeek 2024. A significant overall trend in 10-year ASCVD risk score reduction was shown in tesamorelin-treated participants, around half of which were already taking lipid lowering therapies. This suggests a benefit of targeting and reducing EVAF to further impact ASCVD risk.

Traditional Risk Factors, Optimal Cardiovascular Health, and Elevated Lipoprotein(a).

To assess the association of traditional risk factor burden and Life's Simple 7 (LS7) score with incident atherosclerotic cardiovascular disease (ASCVD) across Lp(a) levels. There were 6,676 participants without clinical ASCVD from the Multi-Ethnic Study of Atherosclerosis who underwent Lp(a) testing and were followed for incident ASCVD events (coronary heart disease and stroke). Low, intermediate, and elevated Lp(a) were defined as <30, 30-49, and >50 mg/dL, respectively. Cox proportional hazards regression assessed the association of traditional risk factors and LS7 score (poor: 0-8, average: 9-10, optimal: 11-14) with incident ASCVD across Lp(a) groups during a median follow-up of 17.7 years, adjusting for demographics and time-varying statin and aspirin therapy. The mean age was 62.1 years, 53% were women, and 61% were non-white. The median Lp(a) was 17 (IQR 8-41) mg/dL, 13% had Lp(a) 30-49 mg/dL, and 20% had Lp(a) >50 mg/dL. Individuals with Lp(a) >50 mg/dL had higher absolute event rates across all LS7 categories. There was no significant interaction between Lp(a) and LS7 score on incident ASCVD (p-interaction=0.60). Compared to a poor LS7 score, optimal LS7 conferred a lower risk for incident ASCVD among individuals with Lp(a) <30 (HR=0.45, 95% CI: 0.28-0.71), Lp(a) 30-49 (HR=0.12, 95% CI: 0.02-0.89), and Lp(a) >50 mg/dL (HR=0.35, 95% CI: 0.13-0.99). Participants without clinical ASCVD who achieved an optimal LS7 score had ASCVD risk reduction regardless of Lp(a) level. These results emphasize the importance of a healthy lifestyle and ASCVD risk factor control among individuals with elevated Lp(a).

PCSK9 Inhibitors: Focus on Evolocumab and Its Impact on Atherosclerosis Progression

This paper investigates the therapeutic use of PCSK9 inhibitors, particularly Evolocumab, as monoclonal antibodies for the treatment of atherosclerosis based on recent literature reviews. PCSK9 is an outstanding example of a breakthrough in medical science, with advancements in understanding its biological function driving substantial progress in atherosclerosis treatment. Atherosclerotic cardiovascular disease (ASCVD) is a leading global cause of mortality, imposing substantial financial burdens on healthcare systems. Elevated low-density lipoprotein cholesterol (LDL-C), a modifiable risk factor, plays a pivotal role in the development of ASCVD. Emerging treatments such as PCSK9 inhibitors are now being introduced to combat this issue, with the goal of reducing ASCVD risk by directly targeting LDL-C levels. This discovery highlighted the potential of monoclonal antibodies to inhibit PCSK9, thereby enhancing LDL-C receptor activity. This breakthrough led to the development of Alirocumab and Evolocumab inhibitors, which typically reduce LDL-C levels by approximately 50%. This research underscores the importance of PCSK9 inhibitors in treating ASCVD, drawing on evidence from various randomized controlled trials such as FOURIER, ODYSSEY OUTCOMES, and VESALIUS-CV. These trials have also shown that PCSK9 inhibitors are effective and safe for the treatment of several cardiovascular disorders. PCSK9 inhibitors are therefore useful in patients who do not reach their target LDL-C levels when on the highest doses of statins or patients with very high cardiovascular risk who cannot tolerate statins at all.

Correlation and Agreement Between the SCORE2 and PREVENT 10-Year Atherosclerotic Cardiovascular Disease Risk Scores: Insights from Coronary Computed Tomography Angiography

Correlation and Agreement Between the SCORE2 and PREVENT 10-Year Atherosclerotic Cardiovascular Disease Risk Scores: Insights from Coronary Computed Tomography Angiography

Characterising the lipid profile of paediatric patients with anomalous aortic origins of a coronary artery.

Lipid levels in paediatric patients with anomalous aortic origin of a coronary artery (AAOCA) have not previously been explored. Patients with CHD have an increased risk of atherosclerotic cardiovascular disease later in life compared to the general population. We aim to characterise the lipid profiles in paediatric patients with AAOCA and explore its relation to diagnosis, race/ethnicity, and exercise. Single institution retrospective cohort of 180 AAOCA paediatric patients (median age 13.7 years interquartile range 9.7-15.6, 66% male). Total cholesterol, HDL, LDL, triglycerides, total cholesterol to HDL ratio, and non-HDL cholesterol were evaluated across race/ethnicity, sex, type of AAOCA, documented ischaemia on imaging, exercise level, and surgery status. Normality of the data distribution for each lipid parameter was evaluated using Kolmogorov-Smirnov testing. Accordingly, Mann-Whitney U and t-tests were used to compare variables. The proportion of abnormal lipid levels by sex and race/ethnicity was calculated. Total cholesterol was elevated in 29%, (51/177) of patients, HDL 37% (64/174), triglycerides 44% (72/165), LDL 16% (28/170), total cholesterol-HDL ratio 29%, (48/163), and non-HDL cholesterol 28% (47/165). Across subgroups categorised on the basis of surgery status, exercise level, AAOCA type, and sex, the mean and median levels for individual lipid parameters were normal. By race/ethnicity, Hispanic patients had significantly higher triglyceride (median 99, interquartile range 71-136.5, p = <0.001) and total cholesterol to HDL ratios (median 3.2, interquartile range 2.7-4.5, p = 0.014) versus non-Hispanic White and Black patients. Two-thirds of patients exercise recreationally. Hispanic patients have significantly elevated triglycerides and total cholesterol to HDL ratios compared to others. Longitudinal follow-up evaluating differences in long-term lipid status in patients with AAOCA and risk for cardiovascular events is warranted.

Predictors of Atherosclerotic Cardiovascular Disease Events in Patients with Metabolic Dysfunction-associated Steatotic Liver Disease.

Objective Metabolic dysfunction-associated steatotic liver disease (MASLD) is a chronic liver disease associated with metabolic comorbidities. However, the risk factors for atherosclerotic cardiovascular disease (ASCVD) in these patients remain unclear. Therefore, this study investigated predictors of ASCVD in patients with MASLD. Methods This single-center retrospective study examined 372 patients with MASLD ≥40 years old with liver biopsies and available Hisayama scores (median follow-up, 7.4 years; range, 0.6-22 years). We compared baseline characteristics, liver histology (stage, lobular inflammation, steatosis, and hepatocellular ballooning), fibrosis-4 (FIB-4) index (<1.3/1.3-2.66/≥2.67), and laboratory data between patients with and without ASCVD. A predictive model for the onset of ASCVD based on the Hisayama score (low/intermediate/high) and ASCVD incidence was evaluated according to the liver fibrosis stage and FIB-4 index. Results ASCVD incidence was 11.1/1,000 person-years, with cumulative incidences of 4.4%, 9.0%, 14%, and 32% at 5, 10, 15, and 20 years, respectively. Regarding the incidence of ASCVD, the liver fibrosis stage and an FIB-4 index ≥2.67 were not significant predictors, but type IV collagen 7S was a significant predictor. The incidence of ASCVD was higher in the intermediate- and high-risk Hisayama score groups than in the low-risk group. In the multivariate Cox proportional hazards model, the Hisayama score and type IV collagen 7S predicted the incidence of ASCVD more accurately than an FIB-4 index ≥2.67. Conclusions The Hisayama score predicted ASCVD risk in patients with MASLD. These findings will help predict and improve the prognosis of MASLD.

High low-density lipoprotein cholesterol levels in people with HIV by individual cardiovascular risk: A retrospective observational study

BackgroundPeople with HIV (PWH) are at increased risk of atherosclerotic cardiovascular disease (ASCVD). Lowering low-density lipoprotein cholesterol (LDL-C) is central of cardiovascular disease prevention. The aim of this study was to assess the prevalence, treatment, and control of high LDL-C levels as assessed on the basis of the ASCVD risk profiles indicated by European Society of Cardiology (ESC) guidelines of a cohort of PWH in order to evaluate the state of LDL-C management in current clinical practice. MethodsWe retrospectively assessed the prevalence, treatment, and control of high LDL-C levels in a cohort of PWH aged ≥40 years who accessed our HIV outpatient clinic between 1 March 2022 and 31 March 2023. Their 10-year ASCVD risk was calculated on the basis of their age and co-morbidities as recommended by guidelines. High LDL-C levels were defined as those above the “step two” target of their specific ASCVD risk category. ResultsAmong the 1404 assessed PWH, who were prevalently male (74.5 %) and Caucasian (85.6 %), and had a median age of 56 years (interquartile range [IQR] 49–61), 295 (21 %) were at very high risk (VHR), 634 (45.2 %) at high-risk (HR), and 348 (24.8 %) not at HR. The overall median LDL-C level was 116 mg/dL (IQR 96–141). Five hundred and sixteen (37 %) were undergoing lipid lowering treatment (LLT), and 650 (46.3 %) failed to achieve any step of their target LDL-C levels. ConclusionsDespite the high prevalence of PWH at VHR/HR for ASCVD, LDL-C levels were poorly controlled and LLT was greatly under used.