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Background: Oral lipid-lowering treatment (LLT) is the standard of care for patients with cardiovascular disease (CVD). However, insufficient treatment intensity and poor adherence can lead to suboptimal treatment benefit, rendering patients at increased risk of CVD., Aims: The objective of this study was to evaluate trends in LLT intensity and adherence in Sweden over time, and their association with major adverse cardiovascular events (MACE) after recent myocardial infarction (MI), and also to assess the impact of transition from secondary to primary care on intensity and adherence., Methods and Results: This retrospective observational cohort study used data from Swedish nationwide patient registers and included patients on LLT after an MI in the years 2010-2016 ( n = 50,298; mean age, 68 years; 69% men). LLT intensity was evaluated over time (overall, for 2010-2013 and for 2014-2016) as the proportion of patients prescribed low-, moderate-, and high-intensity LLT. Adherence was assessed as the proportion of days covered. A combined measure of intensity and adherence was also considered. Differences in treatment patterns and MACE were assessed. Initiation of high-intensity LLT increased over the two time periods studied (2010-2013, 32%; 2014-2016, 91%). Adherence varied by LLT intensity and was highest in patients receiving high-intensity LLT (>80%), especially during the first time period. Little change in treatment intensity or the combined measure of intensity and adherence was observed after transition to primary care. There was a significant association between the combined measure of intensity and adherence and MACE reduction (hazard ratio [95% confidence interval] per 10% increase in the combined measure: 0.84 [0.82-0.86]; P < 0.01)., Conclusion: The proportion of post-MI patients with high LLT intensity and adherence has increased in recent years, with little change after transfer from specialist to primary care. The combination of LLT intensity and adherence is important for preventing future cardiovascular events., Competing Interests: Maria K Svensson and Francesc Sorio were employed by Amgen when the study was conducted. Guillermo Villa is an employee and stockholder of Amgen. Margret Leósdóttir has received honoraria from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, MSD and Sanofi, investigator-initiated research grants from Amgen and Pfizer, and an honorarium from Amgen for work associated with this manuscript. Jonas Banefelt, Maria Lindh, and Alexander Rieem Dun are employed by Quantify Research, a contract research organization that provides consultancy services for the pharmaceutical industry. Anna Norhammar has received honoraria from AstraZeneca, Eli Lilly, Novo Nordisk, MSD, and Boehringer Ingelheim, and an honorarium from Amgen for worktime associated with this manuscript., (© 2022 The Author(s). Published by Upsala Medical Society.)

Objective: To examine the predictive capability of a 1-h vs 2-h postload glucose value for cardiovascular morbidity and mortality., Design: Prospective, population-based cohort study (Malmö Preventive Project) with subject inclusion 1974-1992., Methods: 4934 men without known diabetes and cardiovascular disease, who had blood glucose (BG) measured at 0, 20, 40, 60, 90 and 120 min during an OGTT (30 g glucose per m 2 body surface area), were followed for 27 years. Data on cardiovascular events and death were obtained through national and local registries. Predictive capabilities of fasting BG (FBG) and glucose values obtained during OGTT alone and added to a clinical prediction model comprising traditional cardiovascular risk factors were assessed using Harrell's concordance index (C-index) and integrated discrimination improvement (IDI)., Results: Median age was 48 (25th-75th percentile: 48-49) years and mean FBG 4.6 ± 0.6 mmol/L. FBG and 2-h postload BG did not independently predict cardiovascular events or death. Conversely, 1-h postload BG predicted cardiovascular morbidity and mortality and remained an independent predictor of cardiovascular death (HR: 1.09, 95% CI: 1.01-1.17, P  = 0.02) and all-cause mortality (HR: 1.10, 95% CI: 1.05-1.16, P  < 0.0001) after adjusting for various traditional risk factors. Clinical risk factors with added 1-h postload BG performed better than clinical risk factors alone, in predicting cardiovascular death (likelihood-ratio test, P  = 0.02) and all-cause mortality (likelihood-ratio test, P  = 0.0001; significant IDI, P  = 0.0003)., Conclusion: Among men without known diabetes, addition of 1-h BG, but not FBG or 2-h BG, to clinical risk factors provided incremental prognostic yield for prediction of cardiovascular death and all-cause mortality., (© 2018 European Society of Endocrinology.)

Aims To assess the incremental value of biomarkers, including N-terminal prohormone of brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), growth differentiation factor 15 (GDF-15), and procollagen type 1 N-terminal propeptide (P1NP), in predicting incident cardiovascular events and mortality among asymptomatic individuals from the general population, beyond traditional risk factors, including fasting glucose and renal function (cystatin C), medication use, and echocardiographic measures. Methods and results Prospective population-based cohort study of 1324 subjects without a previous cardiovascular event, who underwent baseline echocardiography and biomarker assessment between 2002 and 2006. The clinical endpoint was the composite of myocardial infarction, invasively treated stable/unstable ischemic heart disease, heart failure, stroke, or all-cause mortality. Predictive capabilities were evaluated using Cox proportional-hazards regression, Harrell's concordance index (C-index), and net reclassification improvement. Median age was 66 (interquartile range: 60-70) years, and 413 (31%) were female. During median 8.6 (interquartile range: 8.1-9.2) follow-up years, 368 (28%) composite events occurred. NT-proBNP, hs-TnT, GDF-15, and IL-6 were significantly associated with outcome, independently of traditional risk factors, medications, and echocardiography ( p < 0.05 for all). Separate addition of NT-proBNP and GDF-15 to traditional risk factors, medications, and echocardiographic measurements provided significant improvements in discriminative ability (NT-proBNP: C-index 0.714 vs. 0.703, p = 0.03; GDF-15: C-index 0.721 vs. 0.703, p = 0.02). Both biomarkers remained significant predictors of outcome upon inclusion in the same model ( p < 0.05 for both). Conclusions NT-proBNP and GDF-15 each enhance prognostication beyond traditional risk factors, glucose levels, renal function, and echocardiography in individuals without known cardiovascular disease.

Aims: To examine whether baseline fasting plasma glucose (FPG) modifies the prognostic role of left ventricular (LV) mass, geometric pattern, and diastolic function, for prediction of cardiovascular morbidity and mortality., Methods: Population-based cohort study comprising of 1047 men and 456 women with preserved ejection fraction, included between 2002 and 2006, who underwent echocardiography based on groups defined by FPG, measured prior to echocardiography. The clinical endpoint was the composite of cardiovascular events and all-cause mortality, assessed through national and local registries. Cox proportional-hazards regression with interaction analysis was used to evaluate the risk associated with FPG and LV structure and function., Results: Median age was 67years, and 31% had impaired fasting glucose, 31% diabetes, 17% LV hypertrophy, and 40% diastolic dysfunction. During a median follow-up duration of 8.3years, 449 composite events occurred. FPG (hazard ratio (HR), 1.09 (95% confidence interval (CI): 1.05-1.13), P<0.001) and several markers of LV structure and function, including LV mass index (HR, 1.10 (95% CI: 1.06-1.15), P<0.001) and E/é (HR, 1.08 (95% CI 1.05-1.10), P<0.001) were associated with an increased risk of events. In the subgroup of 678 individuals without previous cardiovascular disease, who did not receive cardiovascular, anti-diabetic, or lipid-lowering medication, FPG significantly interacted with the association between concentric LV hypertrophy and event risk (P<0.001), and with the association between diastolic dysfunction and event risk (P=0.02), including grade 2 or 3 dysfunction (P=0.04)., Conclusions: Echocardiographic abnormalities were more strongly associated with an adverse prognosis among subjects with impaired fasting glucose or diabetes., (Copyright © 2017 Elsevier B.V. All rights reserved.)