Search

Objective: Lipoprotein(a) [Lp(a)] is an atherogenic and prothrombotic lipoprotein associated with atherosclerotic cardiovascular disease (ASCVD). We assessed the association between regular aspirin use and ASCVD mortality among individuals with versus without elevated Lp(a) in a nationally representative US cohort. Methods: Eligible participants were aged 40–70 years without clinical ASCVD, reported on aspirin use, and had Lp(a) measurements from the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994), the only cycle of this nationally representative US cohort to measure Lp(a). Regular aspirin use was defined as taking aspirin ≥30 times in the previous month. Using NHANES III linked mortality records and weighted Cox proportional hazards regression, the association between regular aspirin use and ASCVD mortality was observed in those with and without elevated Lp(a) (≥50 versus

Objective: Current guidelines for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend targeting a low-density lipoprotein cholesterol (LDL-C) of < 70 mg/dL. However, temporal trends and racial/ethnic- and sex-differences in achievement of LDL-C targets are not well described. We assessed trends and racial/ethnic- and sex-differences in achievement of LDL-C < 70 mg/dL using data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008 to 2017-March 2020. Methods: We combined NHANES cycles into 4 periods: 2005–2008, 2009–2012, 2013–2016, and 2017-March 2020 and included participants ≥ 40 years with self-reported ASCVD. We estimated LDL-C < 70 mg/dL prevalence over time and further stratified by sex and race/ethnicity. We used multivariable logistic regression adjusted for social determinants of health and clinical covariates to model LDL-C target attainment. Results: Among 1,826 NHANES participants representing 7,161,221 US adults with self-reported ASCVD (59.6% ≥ 65 years, 56.4% male, 74.8% White), LDL-C target attainment increased from 19.0% (95% CI, 15.3%-23.3%) in 2005–2008 to 26.3% (95% CI, 20.4%-33.1%) in 2017-March 2020 (P = 0.012 for trend). Achievement of LDL-C < 70 mg/dL significantly rose among men from19.5% (95% CI, 15.1%-24.8%) to 29.4% (95% CI, 20.7%-29.9%) without significant change in women (from 18.3% [95% CI, 13.6%-24.2%] to 22.5% [95% CI, 13.0%-35.9%]; P = 0.241 for trend). Improvement in LDL-C target attainment was similar among White, Black, and Hispanic individuals (∼5–7% increase) and was greatest among individuals of other (non-White, Hispanic, or Black) race/ethnicity (23.1% increase). In our multivariable analysis, comorbid diabetes and ages 65–75 and > 75 years were associated with LDL-C target attainment. Conclusion: LDL-C control modestly improved between 2005 and 2008 and 2017-March 2020; however, only ∼1/4 of individuals met guideline-directed LDL-C treatment targets by 2017-March 2020. Women had lower LDL-C control and lesser magnitude of improvement in LDL-C control than men, highlighting a need for targeted interventions to improve lipid-lowering therapy utilization in this population.

Metabolic-dysfunction associated steatotic liver disease (MASLD) affects 1 out of every 3 individuals in the adult population and the disease prevalence is predicted to increase worldwide. Patients with MASLD are also burdened by cardiovascular disease, which is the leading cause of mortality in this population. Complex metabolic derangements such as insulin resistance and atherogenic dyslipidemia affect patients with MASLD. In patients with MASLD, treatment such as pharmacotherapy may be best directed towards improving the adverse concomitant metabolic disorders associated with MASLD, particularly the ones that may contribute to MASLD. Herein, we discuss conventional therapies that target cardiometabolic risk factors which have the potential to improve hepatic injury, and summarize emerging therapies that target hepatic receptors, fibrosis, and fatty acid oxidation in patients with MASLD. Given the relationship between hepatic injury which leads to MASLD, insulin resistance, and ultimately atherogenic dyslipidemia our review uniquely delves into the effects of conventional and emerging therapies for MASLD on plasma lipid parameters.

Therapeutic Area: ASCVD/CVD in Special Populations Background: Association between socioeconomic status and cardiovascular diseases (CVD) is well-documented. Racial disparities in prevalence and outcomes of CVD have also been extensively studied. The intersection of income, race, and CVD is relatively underexplored. Hence, we aimed to study the prevalence of CVD and associated risk factors among different races/ethnicities across different income groups. Methods: This retrospective analysis included data from participants from the National Health and Nutrition Examination Survey from 2005-2018. Adults ≥20 years who identified as non-Hispanic (NH) White, NH Black, or Hispanic (Mexican-American and other Hispanics) were included. Family income to poverty ratio (PIR) was calculated by dividing family (or individual) income by poverty guidelines specific to the survey year and used as a measure of socioeconomic status. The participants were divided into four quartiles based on PIR 3.9 (highest income). Weighted logistic regression was performed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine the association of race/ethnicity and CVD and associated risk factors in each quartile. Models were adjusted for age, sex, race, health insurance, marital status, citizenship status, and level of education and PIR. Results: We included 31,884 unweighted participants that corresponded to 191,307,167 weighted, nationally representative participants. Of these, 8,009 (weighted 16.3%), 7,967 (weighted 19.2%), 7,944 (weighted 26.9%), and 7,964 (weighted 37.5%) participants belonged to 1st, 2nd, 3rd, and 4th quartiles respectively. The proportion of NH-Whites increased with increasing PIR quartiles whereas the proportion of NH-Blacks and Hispanics decreased with increasing PIR quartiles. In adjusted analyses, the prevalence odds of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke decreased in a step-wise manner from 1st to 4th PIR quartile. Overall, NH Blacks had higher prevalence odds of DM, hypertension, obesity, CHF, and stroke compared to NH Whites, whereas NH Whites had higher prevalence odds of CAD and dyslipidemia compared to NH Blacks (Figure 1). The model testing for PIR-race/ethnicity interaction revealed that PIR-race/ethnicity interaction was significant for obesity (P-interaction 0.002) and diabetes mellitus (P-interaction 0.027) (Figure 2). The difference in prevalence odds between NH White adults and NH Black adults was greater for obesity and diabetes mellitus in the highest PIR quartile compared to the lowest PIR quartile. PIR-race/ethnicity interaction for stroke was 0.053 with the difference in prevalence odds between NH White adults and NH Black adults being greater in the higher PIR quartiles compared to the lowest PIR quartile. Conclusions: The difference in prevalence between NH White and NH Black adults was greater for diabetes mellitus, obesity and stroke in the highest PIR quartile compared to the lowest PIR quartile. These data suggest a complex interplay between race/ethnicities and income inequalities resulting in disparities in CVD.

Therapeutic Area: ASCVD/CVD in Special Populations Background: Association between socioeconomic status and cardiovascular diseases (CVD) is well-documented. Racial disparities in prevalence and outcomes of CVD have also been extensively studied. The intersection of income, race, and CVD is relatively underexplored. Hence, we aimed to study the prevalence of CVD and associated risk factors among different races/ethnicities across different income groups. Methods: This retrospective analysis included data from participants from the National Health and Nutrition Examination Survey from 2005-2018. Adults ≥20 years who identified as non-Hispanic (NH) White, NH Black, or Hispanic (Mexican-American and other Hispanics) were included. Family income to poverty ratio (PIR) was calculated by dividing family (or individual) income by poverty guidelines specific to the survey year and used as a measure of socioeconomic status. The participants were divided into four quartiles based on PIR 3.9 (highest income). Weighted logistic regression was performed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine the association of race/ethnicity and CVD and associated risk factors in each quartile. Models were adjusted for age, sex, race, health insurance, marital status, citizenship status, and level of education and PIR. Results: We included 31,884 unweighted participants that corresponded to 191,307,167 weighted, nationally representative participants. Of these, 8,009 (weighted 16.3%), 7,967 (weighted 19.2%), 7,944 (weighted 26.9%), and 7,964 (weighted 37.5%) participants belonged to 1st, 2nd, 3rd, and 4th quartiles respectively. The proportion of NH-Whites increased with increasing PIR quartiles whereas the proportion of NH-Blacks and Hispanics decreased with increasing PIR quartiles. In adjusted analyses, the prevalence odds of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke decreased in a step-wise manner from 1st to 4th PIR quartile. Overall, NH Blacks had higher prevalence odds of DM, hypertension, obesity, CHF, and stroke compared to NH Whites, whereas NH Whites had higher prevalence odds of CAD and dyslipidemia compared to NH Blacks (Figure 1). The model testing for PIR-race/ethnicity interaction revealed that PIR-race/ethnicity interaction was significant for obesity (P-interaction 0.002) and diabetes mellitus (P-interaction 0.027) (Figure 2). The difference in prevalence odds between NH White adults and NH Black adults was greater for obesity and diabetes mellitus in the highest PIR quartile compared to the lowest PIR quartile. PIR-race/ethnicity interaction for stroke was 0.053 with the difference in prevalence odds between NH White adults and NH Black adults being greater in the higher PIR quartiles compared to the lowest PIR quartile. Conclusions: The difference in prevalence between NH White and NH Black adults was greater for diabetes mellitus, obesity and stroke in the highest PIR quartile compared to the lowest PIR quartile. These data suggest a complex interplay between race/ethnicities and income inequalities resulting in disparities in CVD.

Therapeutic Area: Heart Failure Background: Several studies have shown that most patients who are eligible for an Sodium-glucose Cotransporter-2 inhibitor (SGLT2i) are not receiving them and the proportion of prescriptions from cardiologists was very low (

ABSTRACT: The American Society for Preventive Cardiology (ASPC) ''Ten things to know about ten cardiovascular disease risk factors – 2022'' is a summary document regarding cardiovascular disease (CVD) risk factors. This 2022 update provides summary tables of ten things to know about 10 CVD risk factors and builds upon the foundation of prior annual versions of ''Ten things to know about ten cardiovascular disease risk factors” published since 2020. This 2022 version provides the perspective of ASPC members and includes updated sentinel references (i.e., applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful dietary intake, physical inactivity, dyslipidemia, pre-diabetes/diabetes, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis (with smoking as a potential contributor to thrombosis), kidney dysfunction and genetics/familial hypercholesterolemia. Other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the ASPC ''Ten things to know about ten cardiovascular disease risk factors – 2022” to provide a tabular overview of things to know about ten of the most common CVD risk factors applicable to preventive cardiology and provide ready access to applicable guidelines and sentinel reviews.

Untreated hypertension may contribute to increased atherosclerotic cardiovascular disease (ASCVD) risk in South Asians (SA). We assessed HTN prevalence among untreated adults free of baseline ASCVD from the MASALA & MESA studies. The proportion of participants who received discordant recommendations regarding antihypertensive pharmacotherapy use by the 2017-ACC/AHA and JNC7 Guidelines across CAC score categories in each race/ethnic group was calculated. Compared with untreated MESA participants (n = 3896), untreated SA (n = 445) were younger (55±8 versus 59±10 years), had higher DBP (73±10 versus 70±10 mmHg), total cholesterol (199±34 versus 196±34 mg/dL), statin use (16% versus 9%) and CAC=0 prevalence (69% versus 58%), with fewer current smokers (3% versus 15%) and lower 10-year-ASCVD-risk (6.4% versus 9.9%) (all p100 and thus may be better at informing hypertension management in American South Asians.

Cardiovascular disease prevention is a complicated field requiring similar resource allocation and training as any other subspecialty in cardiology. To highlight the increasing need for primordial, primary and secondary cardiovascular disease prevention at a population level, it is necessary to have a clear vision for not only adequate training in the field but also sample career trajectories that today’s fellows-intraining (FIT) and early career (EC) physicians can use as a reference. However due to less centralized training, reduced exposure to the discipline and no clear institutional champions, direct access to “role model” careers in cardiovascular disease prevention may be lacking for today’s generation of trainees. These trends may change with more formalized recognition and more visibility of career trajectories in the field. In the current short report, we propose career pathways in cardiovascular disease prevention that can serve as a board resource roadmap for today’s FIT/EC physicians to design their careers in cardiovascular disease prevention. We explore three types of preventive cardiologists prototypes including; “the researcher”, “the clinician” and “the academic” preventive cardiologist models. These models are based on experiences gained in separate preventive cardiology training fellowships in addition to general cardiology training. Further, with advances in the scientific technologies, we highlight the future trajectory in the field. Preventive cardiology, although currently not the most desired path for FIT/EC physicians to pursue today, has the potential to be seen as the lucrative and essential training field in the future.