Author: admin

MESA, UK Biobank Data: Lp(a) and IL-6 Predict CHD, ASCVD Risk

Lipoprotein a (Lp[a]) and interleukin-6 (IL-6) are independent predictors of coronary heart disease (CHD), defined as myocardial infarction or resuscitated cardiac arrest, and when combined the two biomarkers identified patients at the highest risk of CHD, according to research in two primary prevention cohorts, the Multi-Ethnic Study of Atherosclerosis (MESA) (n=6,514) and the UK Biobank (n=26,574), published in JACC.

The hazard ratios (HRs) for CHD were 1.13 and 1.22 for Lp(a) and IL-6, respectively, in MESA and 1.11 and 1.19 in UK Biobank cohort. Similar results were found for atherosclerotic cardiovascular disease and peripheral vascular disease. The analysis conducted by Harpreet Bhatia, MD, MAS, FACC, et al., found the HRs for CHD for LP(a) plus IL-6 were 1.72 in MESA and 1.39 in the UK Biobank cohort.

“The findings of our study support the potential incorporation of IL-6 in a primary prevention setting in addition to Lp(a); at the minimum, IL-6 may be considered a risk enhancer as it identifies individuals with increased cardiovascular risk independent of traditional risk factors, hsCRP and Lp(a),” write Bhatia and colleagues.

ECV’s Prognostic Ability in ATTR

Extracellular volume (ECV) identified on cardiovascular magnetic resonance (CMR) imaging provides a quantitative framework for staging and therapeutic planning in transthyretin amyloidosis (ATTR) by directly quantifying myocardial amyloid load and defining reproducible thresholds to stratify burden and refine risk prediction, according to findings published in JACC. Study authors Awais Sheikh, MBChB, et al., analyzed all-cause mortality in 1,541 patients undergoing CMR for ATTR, classified as TTR-variant carriers, extra-cardiac ATTR, early stage ATTR-CM or overt ATTR-CM. At a median 2.8-year follow-up, results showed the ECV had a strong prognostic ability with <30% excluded and ≥40% confirmed cardiac involvement, independently predicting mortality across categories: <30% none; 30-39% mild, 40-49% moderate, 50-59% moderate-severe and ≥60% severe (HR, 1.22 per 10% increase; p<0.001). “ECV outperforms traditional staging tools,” write the authors. “These data establish ECV as a quantitative biomarker that bridges clinical practice and trial design, translating amyloid biology into actionable measurement.”

ALLSTAR: Gamification For Breast, Prostate Cancer Survivors

Gamification increased physical activity among Black and Hispanic cancer survivors compared with attention control alone, according to research published in JACC: CardioOncology. The clinical trial randomized 150 Black and Hispanic breast and prostate cancer survivors treated with cardiotoxic therapy and with at least one risk factor for cardiovascular disease (mean age, 64 years; 81% women; 64% Black; 35% Hispanic) to either attention control (n=76) or gamification (n=74), both featuring a wearable device to track daily steps and self-determined daily step goals. Gamification participants were awarded points each week, with points lost if they did not reach their goals. Those who kept most of their points each week were moved up a level, with participants at the highest level receiving a trophy at the end of the intervention.

Results showed that gamification participants had a greater mean daily step average and spent more time on weekly moderate-vigorous physical activity than control in both the 24-week intervention period (+759 steps, p=0.007; +16 minutes, p=0.010) and 12-week follow-up period (+581 steps, p=0.070; +11 minutes, p=0.048). Noting the greater health barriers historically marginalized communities can face within health systems, “by leveraging principles from behavioral economics, including precommitment, status quo bias, the endowment effect, goal gradients, the fresh start effect, and social accountability, the intervention addresses common barriers to behavior change,” write study authors Alexander C. Fanaroff, MD, et al.

FH Clinical, Genetic Signs in CAD Risk Assessment

Clinical and genetic signatures of familial hypercholesterolemia (FH) were useful in determining the risk of coronary artery disease (CAD) among patients with severe hypercholesterolemia, beyond the incorporation of LDL-C alone, according to original research published in JACC: Advances. In the retrospective study, investigators Hayato Tada, MD, et al., evaluated data from 1,273 patients (mean age, 49; 50% women) with LDL-C ≥180 mg/dL. Results showed that at a median follow-up of 12.4 years, 144 CAD events occurred. Patients with either an FH-variant (n=298) or clinical signs of FH (n=199) had a higher risk of developing CAD events (HR, 1.44, p=0.007; HR, 2.27; p<0.001, respectively). Those participants with both FH-variant and clinical signs (n=548) had a five-fold higher risk for CAD (p<0.001) after adjustment for known risk factors and LDL-C year score. “We strongly suggest assessing these clinical and genetic signatures of FH and then treating them differently based on their risk strata,” write the investigators. “These procedures may be reasonable not only for accurate diagnosis but also for personalized medicine.”

Quality Improvement Project: Optimizing Telemetry Use

In a quality improvement project presented in JACC: Case Reports, Hera Jamal, DO, et al., outline a low-cost, resident-led initiative that improved telemetry ordering practice at a tertiary care center. The initiative offered an educational lecture to internal medicine residents and teaching hospitalists regarding AHA best practice guidelines and posted physical reminders near telemetry stations. Results from 156 preintervention admissions and 110 postintervention showed an increase from 61% to 74% on the proportion of appropriate telemetry orders upon admission (p=0.03), although no significant change was observed at 48 hours (38% vs. 39%, p=1.00). Jamal and colleagues write on their initiative: “This is important given the established safety of discontinuing unnecessary telemetry in nonintensive care settings and the burden that continued use places on both patients and healthcare staff.”

Survival in Patients with Advanced Symptoms of oHCM Undergoing Surgical Myectomy

Patients with advanced symptoms of obstructive hypertrophic cardiomyopathy (oHCM) undergoing surgery myectomy (SM) had worse long-term survival compared to those with lesser symptoms – despite earlier time to surgery from initial presentation, according to research published in JACC: Heart Failure. The observational study stratified 3,546 oHCM patients by NYHA class upon initial presentation, and at a mean follow-up of 12 years recorded 698 composite events, including 661 deaths, 11 cardiac transplants and 51 appropriate ICD discharges. Even with time to initial surgery shorter in the higher classes, the number of events grew from Class I (70 events, 19% of patients) to II (232, 16%) to III (396, 23%; p<0.001). “Patients undergoing SM at an earlier symptomatic stage demonstrate superior long-term outcomes, underscoring the importance of timely referral before advanced disease occurs,” write study authors Shada Jadam, MD, et al.

Efficacy of Treadmill Stress Echocardiography in HCM

Treadmill stress echocardiography (TSE) has diagnostic and prognostic value in patients with asymptomatic HCM, according to a study by Sana Sultana, MD, et al., published in JACC: Cardiovascular Imaging. Of 1,299 NYHA Class I asymptomatic HCM patients undergoing TSE, 22% were found to have latent dynamic left ventricular outflow tract obstruction (LVOTO), only observed during the testing. Furthermore, 37% failed to achieve age-sex predicted metabolic equivalents (ASP-METs) ≥85%. At a mean follow-up of 12.1 years, ASP-METs <85%, undetected without TSE, was associated with increased mortality (17% vs. 12%) as well as lower survival rates at one, 10, 15 and 20 years. “The findings challenge the reliability of patient-reported symptom status and underscore the limitations of subjective self-reported assessments in clinical decision-making,” write the authors. “Whenever feasible, it is important to objectively assess functional capacity and record latent dynamic LVOTO using exercise echocardiography.”