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Background: Neighborhood characteristics serve as risk factors for metabolic syndrome (MetS). However, the intermediary factors linking this relationship remain understudied. Thus, we investigated the sex-specific mediating role of C-reactive protein, physical activity (PA), and perceived stress in the associations of perceived neighborhood social environment (PNSE) with MetS severity among Black adults., Methods and Results: This cross-sectional study included 3185 adults (64% women) from exam 1 (2000-2004) of the Jackson Heart Study. MetS severity Z scores were calculated based on the Adult Treatment Panel III criteria formula. PNSE included neighborhood violence, problems, and social cohesion. Men and women were analyzed separately. A bootstrap resampling technique with 95% bias-corrected CI (95% BC CI) was used to evaluate whether C-reactive protein, PA, and perceived stress mediated the association between each PNSE and MetS severity, adjusting for covariates. All PNSE factors were directly related to MetS severity in women but not in men. In women, neighborhood problems were indirectly associated with MetS severity mediated through PA (β=0.02 [95% BC CI, 0.00-0.05]). In men, neighborhood violence, problems, and social cohesion were indirectly associated with MetS severity mediated through PA (β=0.05 [95% BC CI, 0.01-0.10]; β=0.03 [95% BC CI, 0.00-0.06]; and β=-0.04 [95% BC CI, -0.09 to -0.01], respectively). Neither C-reactive protein nor perceived stress mediated such associations in either women or men., Conclusions: All PNSEs (violence, problems, and social cohesion) were directly related to MetS severity in women only. PA mediated the relationship between each PNSE and MetS in a sex-specific manner. Efforts focusing on local conditions are needed to better understand why such disparities exist for at-risk minoritized groups.

In the primary prevention of atherosclerotic cardiovascular disease (ASCVD), a significant portion of high-risk patients have diabetes. Two decades ago, patients with or without cardiovascular disease were identified as having coronary heart disease (CHD) risk equivalents because prospective studies showed that they were at risk for future CHD events equivalent to that of patients with established CHD. Thus, for patients with CHD, cholesterol guidelines recommended that patients with diabetes should be treated routinely with statins. However, recently, the treatment of diabetes has been greatly improved, and the risk for ASCVD has decreased. For this reason, it may be appropriate to re-evaluate the recommendations for routine use of statins in patients with diabetes. One of the major advances in the risk assessment for ASCVD is the introduction of coronary artery calcium measurement. This report will examine the role of coronary artery calcium scanning for the decision to initiate statin therapy in the primary prevention for patients with diabetes., (Copyright © 2022. Published by Elsevier Inc.)

Guidelines support lowering cholesterol to decrease atherosclerotic cardiovascular disease (ASCVD) risk across the entire lifespan with intensive lifestyle intervention, as well as statin and non-statin pharmacotherapy for those at highest risk. Modest improvements in the initiation, use, and adherence to statin therapy in patients with ASCVD have occurred over the past decades. However, studies continue to document a less than desired implementation of guidelines highlighting a substantial and persistent treatment gap. The success of implementation depends on the consideration of a variety of barriers that exist throughout the healthcare delivery system. Further research is needed to comprehensively evaluate these barriers in order to develop appropriate and sustainable interventions to improve guideline implementation., Competing Interests: Declaration of Competing Interest Ewa Dembowski, MD, Isaac Freedman, BS, Scott M. Grundy MD, PhD, declare no conflicts of interest. Neil Stone, MD receives an honorarium from Knowledge to Practice, an educational company without pharmaceutical connection., (Copyright © 2022 Elsevier Inc. All rights reserved.)

There is a need to identify high-risk features that predict early-onset atherosclerotic cardiovascular disease (ASCVD). The authors provide insights to help clinicians identify and address high-risk conditions in the 20- to 39-year age range (young adults). These include tobacco use, elevated blood pressure/hypertension, family history of premature ASCVD, primary severe hypercholesterolemia such as familial hypercholesterolemia, diabetes with diabetes-specific risk-enhancing factors, or the presence of multiple other risk-enhancing factors, including in females, a history of pre-eclampsia or menopause under age 40. The authors update current thinking on lipid risk factors such as triglycerides, non-high-density lipoprotein cholesterol, apolipoprotein B, or lipoprotein (a) that are useful in understanding an individual's long-term ASCVD risk. The authors review emerging strategies, such as coronary artery calcium and polygenic risk scores in this age group, that have potential clinical utility, but whose best use remains uncertain. Finally, the authors discuss both the obstacles and opportunities for addressing prevention in early adulthood., Competing Interests: Funding Support and Author Disclosures Dr Rigotti received support from National Institutes of Health (NIH) grant # R01HL111821; has received grants from NCI, NIDA, and Achieve Life Sciences; has been a consultant for Achieve Life Sciences; and has received royalties from UpToDate. Dr Mora received support from NIH grant # K24HL136852; has received grants from the NIH, outside this work; and has been a consultant for Pfizer and Quest Diagnostics. Dr Khan has received support from American Heart Association grant #19TPA34890060 and the NIH grants P30AG059988 and P30DK092939, outside this work. Dr Navar has received funding for research to her institution from Bristol Myers Squibb, Esperion, Amgen, and Janssen; and has received honoraria and consulting fees from Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, CSL Behring, Esperion, Janssen, Lilly, Sanofi, Regeneron, NovoNordisk, Novartis, The Medicines Company, New Amsterdam, Cerner, 89Bio, and Pfizer. Dr Blaha has received grants from the NIH, the Food and Drug Administration, American Heart Association, Amgen Foundation, Bayer, and Novo Nordisk; and has served on advisory boards for Amgen, Sanofi, Regeneron, Novartis, Novo Nordisk, Bayer, Akcea, Kowa, 89Bio, Kaleido, Inozyme, and Roche. Dr Pencina has received funding outside the work from the nonprofit Doggone Foundation/McGill University Health Centre; has received grants from Regeneron/Sanofi and Amgen to his institution; and has served on an advisory board for Boehringer Ingelheim. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)