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Enhanced self-measured blood pressure with commercially available connected smartphone apps were not superior to a standard blood pressure cuff for reducing 

 or improving patient satisfaction, according to the results of the BP Home study.

A randomized clinical trial comparing use of standard and enhanced self-measurement approaches in more than 2100 individuals, results of the study demonstrate the mean change in systolic blood pressure during the trial was not significantly different among the study arms, with mean reductions of -10.8 (SD, 18) mmHg and -10.6 (SD, 18) mmHg among the enhance and standard self-measured blood pressure groups, respectively.

“The answer from BP Home is clear: there is no significant benefit from enhanced vs standard SMBP when delivered without additional cointerventions or support. Enhanced SMBP does not provide any additional reduction in BP, and patients would not recommend an enhanced SMBP device to their peers more than a standard device,” wrote investigators.

The PCORnet Blood Pressure Home Monitoring (BP Home) Study was led by investigators from the University of California, San Francisco and the National Patient-Centered Clinical Research Network (PCORnet) who sought to compare use of blood pressure self-monitoring with or without a connected smartphone application for improving systolic blood pressure in patients with uncontrolled hypertension. With enrollment and randomization occurring between from August 3, 2019-December 31, 2020, investigators identified a cohort of 2101 individuals from 23 PCORnet practice sites who reported having uncontrolled blood pressure at their last clinic visit, a desire to lower their blood pressure, and a smartphone.

These individuals were randomized in a 1:1 ratio to blood pressure monitoring with or without an accompanying smartphone application, then followed for 6 months to examine potential changes in systolic blood pressure from the baseline visit to the most recent visit. Investigators noted the difference in reduction of systolic blood pressure was the primary outcome measure for the study and data related to this outcome was extracted from electronic health records. Investigators also pointed out blood pressure cuffs were distributed through the mail and no clinician engagement was undertaken during the study.

The overall patient cohort had a mean age of 58 (SD, 13) years, 43% were male, and 31% were non-Hispanic Black or Hispanic individuals. Art baseline, most reported being comfortable using technology, with a mean comfortability score of 4.1 (SD, 1.1) out of 5.

Upon analysis, results indicated the mean change in systolic blood pressure from baseline to 6 months was -10.8 (SD, 18) mmHg in the group using the smartphone application and -10.6 (SD, 18) mmHg in the standard group (Adjusted difference, -0.19 mmHg [95% CI, -1.83 to 1.44]; 

=.81). In an analysis of secondary outcomes, results suggested difference were mostly null, except for documented attainment of blood pressure control to lower than 140/90 mmHg, which investigators pointed out occurred among 32% in the group leveraging the smartphone application and 29% in the group not using the smartphone application (OR, 1.15 [95% CI, 1.01 to 1.34]). Additionally, investigators highlight most participants reported being very likely to recommend their self-measured blood pressure monitoring device to a friend, with rates of 70% and 69% reported among the enhanced and standard measurement arms of the study.

“The results of this randomized clinical trial provide a definitive answer that BP Home provides a definitive answer to the simple, pragmatic question posed by the patient advisory board: should patients with uncontrolled BP be directed to purchase (or be provided) an enhanced SMBP device, spend the time to download and connect their device to a smartphone application, and learn how to use the application to track and use their SMBP measurements, or should they simply pursue standard SMBP?,” wrote investigators.

Effectiveness of Standard vs Enhanced Self-measurement of Blood Pressure Paired With a Connected Smartphone Application

Articles

Results of the HOME BP study suggest a linked smartphone application combined with standard blood pressure monitoring did not result in superior blood pressure reductions than a standard approach. 

Enhanced Screenings with Smartphone App No Better than Standard Blood Pressure Cuff, Study Shows

The American College of Chest Physicians (CHEST) have released new clinical practice guidance for perioperative management of 

Released on August 11, the guidelines, which include 44 evidence-based recommendations related to perioperative management of antithrombotic therapy, were published with the intent of replacing the organization 2012 guideline on the same topic.

“For perioperative antithrombotic management, it’s very important to have standardized approaches and protocols to limit variability in practice and, in turn, to minimize preventable bleeding and thrombotic events. Until now, guidance for clinicians was available only in piecemeal approach—related to specific clinical areas—whereas the CHEST guidelines provide a ‘one-stop’ comprehensive and definitive compilation of evidence to inform best practices in perioperative anticoagulant and antiplatelet management,” said lead of the guideline writing committee James D. Douketis, MD, a staff physician in Vascular Medicine and General Internal Medicine at St. Joseph’s Healthcare Hamilton, 

. “These guidelines are also practical, providing clinicians with ‘how to’ approaches for managing patients on warfarin, DOACs and antiplatelet drugs who are undergoing a wide array of surgeries and procedures as well as those who may need heparin bridging.”

Composed by Douketis and 13 other members of the multidisciplinary guideline writing committee, the new guidelines answer 43 population, intervention, comparator, and outcome (PICO) questions compared with 11 PICO questions in the 2012 guideline. Within the guideline, the writing panel addresses topics including new recommendations on use of multiple agents new to the market in 2012, but commonly used in 2022, including vitamin K antagonists, antiplatelet drugs, and direct oral anticoagulants (DOACs). The guideline itself is separated into 4 categories breaking down the management of patients into specific groups defined by use of a vitamin K antagonist, use of perioperative heparin bridging, use of a DOAC, and use of an antiplatelet drug.

Based on a review of data centered around the 43 aforementioned PICO questions, recommendations within the guideline were graded high, moderate, low, and very low certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology for clinical practice guidelines. In their release announcing the new guidelines, CHEST highlighted 6 of the recommendations within the guidelines.

In patients receiving VKA therapy for atrial fibrillation who require VKA interruption for an elective surgery/procedure, the guidelines recommend against heparin bridging.(Strong recommendation)

In patients receiving VKA therapy who require a pacemaker or ICD implantation, the guidelines recommend continuation of VKA over VKA interruption and heparin bridging. (Strong recommendation)

In patients receiving VKA therapy for a mechanical heart valve or VTE who require VKA interruption for an elective surgery/procedure, the guidelines suggest against heparin bridging. (Conditional recommendation)

In patients receiving VKA therapy who require VKA interruption for a colonoscopy with anticipated polypectomy, the guidelines suggest against heparin bridging during the period of VKA interruption. (Conditional recommendation)

In patients receiving a DOAC (apixaban, dabigatran, edoxaban, rivaroxaban) who require an elective surgery/procedure, the guidelines suggest stopping the DOAC for 1 to 2 days (1 to 4 days for dabigatran) before the surgery/procedure over apixaban continuation. Postoperatively, the guideline suggest resuming the DOAC about 24 hours after a low/moderate-bleed-risk surgery/procedure and 48-72 hours after a high-bleed-risk surgery/procedure. (Conditional recommendation)

In patients receiving acetylsalicylic acid (ASA) who are undergoing elective noncardiac surgery, the guidelines suggest ASA continuation over ASA interruption. (Conditional recommendation)

The aforementioned release from CHEST noted the guidelines contain separate recommendations on the perioperative management of patients who are undergoing minor procedures, comprising dental, dermatological, ophthalmological, pacemaker/ICD implantation, and gastrointestinal procedures.

Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline

On August 11, the American College of Chest Physicians (CHEST) released 44 new evidence-based recommendations in their new guidelines for perioperative management of antithrombotic therapy, which were published with the intention of replacing the 2012 guidelines on the subject. 

CHEST Releases New Guidance for Perioperative Management of Antithrombotic Therapy

In patients with obstructive sleep apnea, undergoing soft-tissue sleep surgery could contribute to improved inflammatory and cardiometabolic health profiles, according to the result of a new study.

A meta-analysis and systematic review of 26 studies examining the impact of soft-tissue sleep surgery on inflammatory markers in adults with OSA, results of the study suggest undergoing sleep surgery was associated with improvements in C-reactive protein (CRP), glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and interleukin-6 (IL-6).

“Overall, soft-tissue sleep surgery for OSA may be associated with improved cardiometabolic and systemic inflammatory markers. Hence, the findings from this study suggest that the association of sleep surgery with lower levels of inflammatory markers may offer improved outcomes for patients with OSA,” wrote investigators.

Although many had hypothesized the detrimental impact of OSA on cardiometabolic health profiles, it has not been until recently that this impact and potential avenues for mitigation have become a topic of interest for both researchers and clinicians. With this in mind, a team led by investigators representing Singapore General Hospital and Tel Aviv University designed the current study as a systematic review and meta-analysis of data from the Cochrane Embase, and PubMed databases to assess associations between undergoing sleep surgery and proinflammatory markers in patients with OSA.

For the study, investigators sought to identify full-text studies published in English in peer-reviewed journals from inception of the databases to June 14, 2022, that reported preoperative and postoperative levels of serum biomarkers in patients undergoing sleep surgery. Investigators’ initial search yielded 3218 articles. After application of inclusion criteria and exclusion of duplicates, 56 were selected for full-text review and 26 were ultimately identified for inclusion in the investigators’ meta-analyses.

This group of studies included 17 prospective cohort studies and 9 retrospective cohort studies, with a total population of 1187 patients. The overall patient population had a mean age of 42.8 (SD, 11.1) years, 78.5% were men, and the mean follow-up time was 7.3 (SD, 8.2) months. Investigators pointed out the mean BMI was 28.4 (SD, 2.0) kg/m2, mean AHI was 36.0 (SD, 13.8), mean ESS was 11.2 (SD, 2.3), the cumulative sleep time percentage with oxyhemoglobin saturation less than 90% (CT90) was 16.7 (SD, 8.7), and the mean arterial oxygen saturation (SaO2) nadir was 73.3% (SD, 13.2%).

The primary outcome of interest was the preoperative and postoperative levels of multiple serum biomarkers in patients. For the purpose of analysis, meta-analyses of the standardized mean difference (SMD) were conducted in random-effects models and, investigators pointed out, the probability of benefit and number needed to treat were calculated for outcomes that demonstrated a statistically significant effect after sleep surgery to ensure relevance to clinicians and patients.

Results of the investigators’ analyses indicated undergoing soft-tissue sleep surgery was associated with a large decrease in CRP (SMD, -0.377 [95% CI, -0.617 to -0.137), total cholesterol (SMD, -0.267 [95% CI, -0.417 to -0.116), LDL (SMD, -0.201 [95% CI, -0.344 to -0.058), IL-6 (SMD, -1.086 [95% CI, -1.952 to -0.221]), tumor necrosis factor-α (SMD, -0.822 [95% CI, -1.617 to -0.027]), triglyceride (SMD, -0.186 [95% CI, -0.301 to -0.071]), and leptin (SMD, -0.519 [95% CI, -0.954 to -0.083]) in patients with OSA. Meta-regression revealed increased age, greater preoperative CT90, and greater change in CT90 postoperatively were associated with a greater decrease in serum CRP levels. Investigators also highlighted a greater reduction in AHI was associated with a greater reduction in total and LDL cholesterol, while greater reductions in BMI and AHI were also associated with a greater increase in HDL cholesterol.

“In this pairwise meta-analysis of 26 studies, we demonstrated that sleep surgery was associated with a large decrease in serum CRP, total cholesterol, LDL, IL-6, TNF-α, triglyceride, and leptin. This reduction remained across different types of surgeries, geographic regions, follow-up duration, and hs-CRP vs CRP subgroups,” investigators added.

Improved Inflammatory and Cardiometabolic Profile After Soft-Tissue Sleep Surgery for Obstructive Sleep Apnea

JAMA Otolaryngology–Head & Neck Surgery.

A systematic review and meta-analysis provide an overview of the potential improvements in cardiometabolic health profile, including changes in HDL-C, LDL-C, and triglycerides, observed after patients with obstructive sleep apnea have undergone soft-tissue surgery. 

In Obstructive Sleep Apnea, Soft-Tissue Surgery Can Improve Cardiometabolic Health Profile

New research is providing further evidence in support of large-scale use of salt substitutes in public health efforts to mitigate the impact of 

Led by investigators from the landmark Salt Substitute and Stroke Study (SSaSS), results of the systematic review and meta-analysis provide an overview of the apparent reductions in blood pressure observed with use of a salt substitute as well as the impact on overall risk of mortality and mortality from cardiovascular-specific causes.

“Salt substitutes produce consistent blood pressure-lowering effects across geographies and diverse participant subsets. Blood pressure-mediated beneficial effects of salt substitute on clinical outcomes appear likely to be accrued across a broad range of populations without adverse effects,” wrote investigators.

Led by Bruce Neal, MBChB, PhD, of the George Institute for Global Health, who was also the lead investigator of 

 the current study was launched with the intent of providing clinicians with further evidence of the effects of salt substitutes on clinical outcomes in broader population groups. To do so, investigators designed their endeavor as a systematic review and meta-analysis of parallel-group, step-wedge, or cluster randomized controlled trials evaluated the impact of salt substitutes on blood pressure or clinical outcomes.

Through a search of the PubMed, Embase and Cochrane Library databases from inception through August 31, 2021, investigators identified 21 trials encompassing 31,939 participants for inclusion in their analyses. Of the 21 trials identified for inclusion, 19 reported effects on blood pressure and 5 reported effects on clinical outcomes. For the purpose of analysis, meta-analyses and meta-regressions were used to estimate the consistency of findings across trials, geographic locations, and patient subgroups.

Upon analysis, investigators found use of a salt substitute was associated with an overall reduction of systolic blood pressure of -4.61 mmHg (95% CI, -6.07 to -3.12) and of diastolic blood pressure of -1.61 mmHg (95% CI, -2.42 to -0.79), which investigators noted appeared to be consistent regardless of geographical region and across patient subgroups defined by age, sex, history of hypertension, body mass index, baseline blood pressure, baseline 24-hour urinary sodium and baseline 24-hour urinary potassium (all 

for homogeneity >.05). Using meta-regression, investigators found each 10% lower proportion of sodium chloride in the salt substitute was associated with a -0.95 mmHg (95% CI,-1.78 to-0.12; 

=.025) in diastolic blood pressure and a -1.53 mmHg (95% CI, -3.02 to -0.03; 

=.045) greater reduction in systolic blood pressure. In additional analyses, investigators observed clear protective effects of salt substitute use on total mortality (RR, 0.89 [95% CI, 0.85 to 0.94]), cardiovascular mortality (RR, 0.87 [95% CI, 0.81 to 0.94]), and cardiovascular events (RR, 0.89 [95% CI, 0.85 to 0.94]).

“These findings are unlikely to reflect the play of chance and support the adoption of salt substitutes in clinical practice and public health policy as a strategy to reduce dietary sodium intake, increase dietary potassium intake, lower blood pressure and prevent major cardiovascular events,” investigators added.

Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis

A systematic review and meta-analysis from SSaSS investigators provide further insight into the reductions in blood pressure observed with use of a salt substitute, as well as the impact of use on overall risk of mortality and mortality from cardiovascular-specific causes.

Salt Substitutes Linked to Lower Blood Pressure, Reduced Event and Mortality Risk

An analysis of data from the Chronic Renal Insufficiency Cohort (CRIC) is providing clinicians with an overview of the impact of aldosterone levels on risk of worsening 

With a decade of follow-up data suggesting each doubling of aldosterone was linked to an 11% increase in risk of CKD progression, investigators suggest the results provide evidence backing use of the nonsteroidal MRA finerenone (Kerendia) for reducing the risk of CKD progression in these patients.

“These findings are important as they suggest that higher concentrations of aldosterone may play a role in CKD progression and cardiovascular disease in patients with CKD. This study provides evidence for the mechanism by which mineralocorticoid receptor antagonists could delay CKD progression and supports investigating their value in patients without diabetes,” said lead investigator Ashish Verma, MD, assistant professor at Boston University School of Medicine, 

As both fields have advanced in recent years, role of cardiologists and nephrologists become more intertwined. Now, thanks to advances in pharmacological therapies, the intersectionality of cardiovascular and nephrotic conditions has been transformed. With an interest in learning more about how the mechanism of action for MRAs in delaying CKD progression, Verma and a trio of colleagues from Boston-based institutions conducted the current study with the intent of assessing how aldosterone levels may impact CKD progression in patients with or without diabetes.

To do so, investigators designed the present study as an observational cohort analysis of data from 3680 participants aged 21-74 years enrolled within the CRIC study from April 8, 2003-September 3, 2018. Exclusion criteria for the present study included inability to provide written consent, institutionalization, pregnancy, enrollment in other studies, and being classified as New York Heart Association Classes III–IV heart failure, among others.

The primary outcome of interest for the observational cohort analysis was CKD progression, which was defined as a composite of 50% decline in estimated glomerular filtration rate (eGFR) or end-stage kidney disease, whichever occurred first. Investigators pointed out Cox proportion hazard models were used to estimate associations between serum aldosterone levels and CKD outcomes.

The 3680-patient cohort identified for inclusion had a mean age of 58.1 (SD, 11.1) years, 44.7% were female, 46.8% were White, 41.2% were Black, 86% had hypertension, 82% had a history of hypercholesterolemia, and the mean eGFR was 44.3 (SD, 15.0) mL/min/1.73m2. At baseline, higher aldosterone concentrations were associated with a lower eGFR, lower serum potassium, greater urinary potassium, and protein excretion. During a follow-up period lasting a median of 9.6 years, 1412 individuals developed the composite outcome of CKD progression and 1129 individuals developed end-stage kidney disease.

Initial analysis revealed those who developed the composite CKD outcome had a median baseline serum aldosterone concentration that was greater than those who did not develop the composite outcome or were censored for loss to follow-up or death (10.6 vs 9.6 ng/dL; 

 <.001). In adjusted models, results suggested each doubling in serum aldosterone levels was associated with an 11% increase in risk of CKD progression (HR, 1.11 [95% CI, 1.04-1.18]).

In fully adjusted analyses, those in the highest quartile of serum aldosterone had a 45% increased risk of CKD progression (HR, 1.45 [95% CI; 1.22–1.73]) compared to those in the lowest quartile. Investigators highlighted the risk for CKD progression was similar regardless of whether patients had concomitant diabetes (

-interaction=.10). In additional analyses assessing associations of serum aldosterone and all-cause mortality, which included 11.5 years of follow-up data, results indicated those win the highest quartile of serum aldosterone had a 22% greater risk of all-cause mortality (HR, 1.22 [95% CI, 1.02-1.45]) compared to those in the lowest quartile.

“Taken together, these studies suggest that aldosterone levels need to be assessed in all patients at risk for and/or in the presence of cardiorenal disease, especially if they have central obesity and/or resistant hypertension. We now have relatively safe and better-tolerated agents than traditional steroidal agents that can and should be used to reduce cardiorenal risk in these groups of patients,” wrote George Bakris, MD, of the University of Chicago Medicine, in 

Aldosterone in chronic kidney disease and renal outcomes,

An analysis of patient data from the Chronic Renal Insufficiency Cohort Study suggests increased levels of serum aldosterone were associated with an increased risk of chronic kidney disease progression.

Serum Aldosterone Levels Could Predict Chronic Kidney Disease Progression

Preventive cardiology treads a unique line in medicine. A field with perhaps the most tangible impact on public health, but often underappreciated as a cog in public health efforts. 

The cardiovascular disease epidemic raged for decades, and it was not until advances in preventive cardiology, including a new emphasis on cardiovascular risk factors and lifestyle behaviors, that rates of cardiovascular disease began to plateau in the US. Still, most cardiologists will acknowledge there is work to be done in regard to optimizing prevention and prevention strategies among patients.

This aim helped to drive the agenda of the American Society for Preventive Cardiology (ASPC) 2022 Congress on CVD Prevention. At the meeting, which was held from July 29-31 in Louisville, KY, topics of interest included blood pressure, the heart-brain axis, aspirin usage, primordial Prevention, the cost of prevention, and Overcoming Barriers in the Treatment of Diabetes in Clinical Practice, among others. With an interest in learning more about the meeting and trending topics in preventive cardiology, 

 reached out to Peter Toth, MD, director of Preventive Cardiology at CGH Medical Center and former president of the ASPC, for further perspective.

ASPC 2022 Updates with Peter Toth, MD, PhD

While the ASPC program is meticulously planned, were there any items of focus that seemed to be trending among attendees more than others?

I think it's mostly interest in what is practical, what can I take back to my practice to improve patient care. The ASPC is about getting back to basics. It's about making sure that our members have the tools as well as the knowledge to go back and practice state-of-the-art medicine, to make sure they are practicing contemporary medicine, and that their patients are meeting guideline-directed goals or targets. This is extremely important, because we know not only nationwide, but worldwide, risk factor goal attainment rates are very, very, very poor.

The only way to change this really is to do it one patient at a time, you can jump up and down and write more guidelines and you can write more journal articles, but the bottom line is that sometimes people just need to hear it. They need to hear someone explain it and explain it in a way that is clear, concise, and that they can take back to their practice Monday morning and say, "Okay, here's what I need to do in this situation and let's do it".

So, the practical was emphasized. Sure, we have some lectures that are a little bit more technical, but when it comes to providing people with information and best practices currently in diabetes, hyperlipidemia, hypertension, and established atherosclerotic cardiovascular disease, this is all very hands-on clinical stuff and our membership loves this, because they're devoted, committed, and energetic.

Is this a novel approach or has this been the traditional motive for APSC meetings?

Well, it's no secret that if you write a 150- or 200-page guideline, not many are going to read it. They don't have time and they need something more condensed, something very focused and something that they will remember. This is where an organization like the ASPC comes in, because our conferences are very, very clinic focused and I think that's a good thing. As a result of this, you're improving care, you're helping to optimize resource allocation utilization, and you are using technology appropriately. Let's take the case of coronary artery calcium, coronary artery CT angiography, or magnetic resonance imaging, we had a 2-day course, which helped clinicians understand precisely where to position each of these technologies and how best to use them.

As the outgoing president of the ASPC, are there any specific areas or topics in preventive where fulfilling a knowledge gap among cardiologists and care providers could immediately improve care?

First, aspirin. How do you optimize aspirin use because, so often now, people just don't use the aspirin. Well, that's completely inappropriate. Especially, in the secondary prevention setting. In primary prevention, it takes a little bit more judgment when calculating or estimating the patient's risk for the next 10 years. However, to simply remove the benefit that aspirin offers and take it off the table is ludicrous. So, it does take judgment because you have to balance benefit against the risk of bleeding, but I think we're getting better at this, and I think this was discussed thoroughly at the conference.

Next: Blood Pressure. A blood pressure of 138 over 83 is no longer appropriate. The guideline has changed and the needle has changed. We now understand what a crucial risk factor blood pressure is and even being off by 3 over 2 can augment risk.

Lastly: Cholesterol. It is shocking that still only one-third of high-risk patients get their LDL, to their risk stratified goal. We have so many tools available to us now to help patients achieve LDL lowering so there is really no excuse for it. At a conference like ours, we provide very specific instruction on how, when, and where to use specific interventions to augment the benefit of statin therapy or, in the case of patients who are statin intolerant, how best to use other LDL-lowering approaches.

Also, cigarette smoking. My goodness, this is such a crucial risk factor, but it's an addiction and very difficult to break. It is another one of those things that we have to continually emphasize to your patients how important it is to quit smoking and tell them that we'll do whatever it takes to help them do it. It is at the top of the list. Another thing that people don't always talk about is medication adherence. So many patients are given appropriate medication, but they stop them either because they don't understand what the medication is doing or, maybe, their friends told them that the medication is bad for them—the list of reasons is long. Simply speaking with patients at every visit about the importance of adherence and helping them understand what each individual medication is doing to help reduce risk for acute cardiovascular events goes a long way toward improving adherence and compliance.

Editor’s Note: This transcript has been edited for length and clarity.

Peter Toth, MD, PhD, sits down for a Q&A related to updates from the ASPC 2022 meeting and trends topics in preventive cardiology, including aspirin use and blood pressure management.

ASPC 2022 Recap, with Peter Toth, MD, PhD

A patient in their mid-70s presents to the hospital with chest pain since 2 AM that became constant at 5 AM and made him vomit. The pain radiates to the back and is pleuritic, but only mildly so. He denies syncope, palpitations, SOB, leg swelling or pain, fever, cough or other complaints.

Vital signs are normal except for bradycardia. The physical exam is normal except that he is moaning in pain.

An ECG is performed:

Our latest case report from Brady Pregerson, MD, features a patient in their mid-70s presenting to the hospital with chest pain since 2 AM that became constant at 5 AM and made him vomit. Check out the EKG and determine the correct diagnosis!

Cardiology Case Report: Early Morning Chest Pain

Entering menopause before 40 years of age could signal an increased risk of 

 and heart failure, according to the results of a new study of more than 1.4 million women.

Using data from 1,401,175 postmenopausal women within the Korean National Health Insurance Service, investigators found women with a history of premature menopause had a 33% greater 

 and 9% greater risk of atrial fibrillation compared to those without early menopause in adjusted analyses, with further analysis indicating all patients entering menopause prior to 50 years of age had an increased risk of both conditions.

“Women with premature menopause should be aware that they may be more likely to develop heart failure or atrial fibrillation than their peers,” said study author Dr. Ga Eun Nam of Korea University College of Medicine, Seoul, Republic of Korea, in a 

statement from the European Society of Cardiology

. “This may be good motivation to improve lifestyle habits known to be linked with heart disease, such as quitting smoking and exercising.”

To further the existing knowledge base related to early menopause and cardiovascular risk, Eun Nam and a team of colleagues designed the current study with the aim of estimating the associations of premature menopause and age at menopause with risk of heart failure and atrial fibrillation using data from the Korean National Health Insurance Service and multivariable Cox proportional hazard models. From the Korean National Health Insurance Service, investigators identified 1,401,175 postmenopausal women with had undergone health examinations and had full data related to their reproductive histories collected.

Of the 1,401,175 women included in the study, 2% (n=28,111) had a history of premature menopause. The mean age at menopause for those without premature menopause was 50.2±3.7 years compared to 36.7±2.2 years among those with a history of premature menopause. Compared to their counterparts without premature menopause, those with premature menopause were more likely to report having been an ever-smoker (6.0% vs 3.8%; 

 <.001) and less likely to report regular exercise (15.3% vs 18.5%; 

The overall study cohort had a mean follow-up duration of 9.1 years. During this time, 42,699 new cases of heart failure and 44,834 new cases of atrial fibrillation were identified using ICD codes. In multivariable analyses, results indicated women with history of premature menopause had an increased risk of both heart failure (HR, 1.33, [95% CI, 1.26-1.40]; 

<.001) and atrial fibrillation (HR, 1.09 [95% CI, 1.02-1.16]; 

=.008) compared to women without history of premature menopause.

Additional analyses according to age shed further light on the associations between premature menopause and increased risk of both conditions. For heart failure, further analysis indicated those aged 45-49, 40-44, and less than 40 years at menopause had increases in risk for incident heart failure of 11% (HR, 1.11 [95% CI, 1.08-1.13]), 23% (1.23, 1.19−1.28), and 39% (1.39, 1.31−1.47) incident HF, respectively, compared to those who entered menopause at 50 years or later (

 <.001). For atrial fibrillation, those aged 45-49, 40-44, and less than 40 years at menopause had increases in risk for incident atrial fibrillation of a 4% (HR, 1.04 [95% CI, 1.02-1.06), 10% (HR, 1.10 [95% CI, 1.06-1.14]), and 11% (HR, 1.11 [95% CI, 1.04-1.18]), respectively, compared to those who entered menopause at 50 years or later (

“The misconception that heart disease primarily affects men has meant that sex-specific risk factors have been largely ignored. Evidence is accumulating that undergoing menopause before the age of 40 may increase the likelihood of heart disease later in life. Our study indicates that reproductive history should be routinely considered in addition to traditional risk factors such as smoking when evaluating the future likelihood of heart failure and atrial fibrillation.”

Age at menopause and risk of heart failure and atrial fibrillation: a nationwide cohort study

An analysis of more than 1.4 million women with nearly a decade of follow-up data, a new study suggests entering menopause before the age of 40 was associated with a 33% increase in risk of heart failure, but investigators noted an increasing trend in risk was observed for all women entering menopause before 50 years fo age. 

Menopause Before 50 Could Predict Increased Cardiovascular Disease Risk

An analysis of 5-year outcomes data from the PARTNER 1, 2, and S3 trials is providing insight into the prognostic value of early left ventricular ejection fraction (LVEF) improvement among patients with 

 who have undergone transcatheter aortic valve replacement (TAVR).

Results of the study demonstrate those who experienced early improvement in LVEF after TAVR, which investigators noted was observed among 1-in-3 patients who with severe aortic stenosis and LVEF below 50% who underwent TAVR, was associated with lower 5-year all-cause and cardiovascular mortality than their counterparts who did not experience an initial improvement in LVEF after TAVR, but this was only observed among female individuals and not their male counterparts.

“In high- or intermediate-risk patients with symptomatic severe AS and LVEF less than 50% undergoing transfemoral TAVR, 1 in 3 experienced early improvement in LVEF,” wrote investigators. “Prior myocardial infarction, diabetes, cancer, higher baseline LVEF, larger left ventricular end-diastolic diameter, and larger aortic valve area were associated with lower likelihood of early LVEF improvement, whereas higher BMI and higher stroke volume index were associated with increased likelihood of early LVEF improvement after TAVR. Early LVEF improvement after TAVR was associated with lower 5-year all-cause death and cardiac death.”

As the popularity of TAVR procedures continues to increase, priorities for research have begun to shift from the procedure itself to long-term care of patients undergoing TAVR. With this in mind, the current study was conducted by a team of more than 20 investigators representing multiple institutions, including Massachusetts General Hospital, Cleveland Clinic, Duke University School of Medicine, and Baylor University Medical Center, with the intent of examining associations between early LVEF improvement after TAVR and 5-year outcomes.

To do so, the study was designed as an analysis of patient data from high- and intermediate-risk patients with baseline LVEF of less than 50% who underwent transfemoral TAVR who were enrolled in the Placement of Aortic Transcatheter Valves (PARTNER) 1, 2, and S3 trials and registries between July 2007 and April 2015, with analysis occurring from August 2020-May 2021. From these data sources, investigators identified 659 patients for inclusion in their analyses. This cohort was 71% male, had a mean age of 82.4 (SD, 7.7) years, and 89.7% were White.

The primary exposure for the investigators’ analyses was early LVEF improvement. For the purpose of analysis, LVEF improvement was defined as an increase of 10% points or more at 30 days post-TAVR. Investigators noted LVEF improvement was also assessed as a continuous variable. The primary outcome of interest was all-cause mortality at 5 years.

Upon analysis, LVEF improvement within 30 days was identified among 32.8% (n=216) of the 659-patient cohort (mean LVEF, 16.4 [SD, 5.7%]). Additional analyses produced results suggesting a history of myocardial infarction, diabetes, cancer, higher baseline LVEF, larger left ventricular end-diastolic diameter, and larger aortic valve area were independently associated with decreased likelihood of LVEF improvement. Compared to those without early LVEF improvement after TAVR, those with early LVEF improvement had a reduced instance of5-year all-cause death (50.0% [95% CI, 43.3-57.1] vs 58.4% [95% CI, 53.6-63.2]; 

=.04) and cardiac death (29.5% [95% CI, 23.2-37.1] vs 38.1% [95% CI, 33.1-43.6]; 

In multivariable analyses using LVEF improvement as a continuous variable, results indicated early improvement in LVEF was associated with lower 5-year all-cause death (aHR per 5% increase in LVEF, 0.94 [95% CI, 0.88-1.00]; 

=.04) and cardiac death (aHR per 5% increase in LVEF, 0.90 [95% CI, 0.82-0.98]; 

=.02) after TAVR. Investigators pointed out a restricted cubic spline analysis demonstrated a visual inflection point at an LVEF improvement of 10%. Beyond this point, there was a notable decline in all-cause mortality with an increasing degree of LVEF improvement.

Investigators also pointed out there were no statistically differences in rehospitalizations, NYHA functional class, or KCCQ-OS at 5 years between those with early LVEF improvement and those without early LVEF improvement. In a subgroup analysis, results suggested the association between early LVEF improvement and 5-year all-cause mortality was consistent regardless of presence or absence of CAD or prior myocardial infarction.

Investigators noted multiple limitations within their study for clinicians to consider before interpreting results of their efforts. These included listed applicability due to inclusion criteria, limited generalizability because of the use of only SAPIEN, SAPIEN XT, or SAPIEN 3 TAVR bioprostheses, and lack of knowledge related to exact etiology of left ventricular dysfunction.

“Further studies are needed to understand the pathophysiologic mechanism(s) mediating reduced mortality in patients with early LVEF recovery after TAVR,” investigators added.

Association Between Early Left Ventricular Ejection Fraction Improvement After Transcatheter Aortic Valve Replacement and 5-Year Clinical Outcomes

An analysis of data from the PARTNERS trials and registries details associations between early LVEF improvement following TAVR and 5-year outcomes, including risk of all-cause and cardiovascular mortality.

Early LVEF Improvement Signals Lower Risk of 5-Year Mortality Following TAVR

The phase 3 APOLLO-B study examining use patisiran (ONPATTRO) in patients with transthyretin-mediated (ATTR) amyloidosis with cardiomyopathy has met both its primary and first secondary, according to a 

Announced on August 3, the company announced the trial had met its primary endpoint of a statistically significant improvement in 6-minute walk test at 12 months with patisiran compared to placebo therapy and its first secondary endpoint of providing a statistically significant improvement in quality of life at 12 months with patisiran compared to placebo. In their release, the company also noted plans to use data from the study in a supplemental new drug application with the US Food and Drug Administration (FDA) in late 2022.

“We are thrilled that APOLLO-B successfully met all its major objectives, which we believe for the first time validates the hypothesis that TTR silencing by an RNAi therapeutic can be an effective approach for treating the cardiomyopathy of ATTR amyloidosis,” said Pushkal Garg, MD, Chief Medical Officer of Alnylam, in the aforementioned release. “ATTR amyloidosis with cardiomyopathy is an increasingly recognized cause of heart failure, affecting greater than 250,000 patients around the world. These patients have limited treatment options, and disease progression is common. As such, we are encouraged to see the potential of patisiran to improve the functional capacity and quality of life of patients living with this fatal, multi-system disease.”

A phase 3, randomized, double-blind, placebo-controlled trial APOLLO-B was launched in 2019 and conducted at 69 sites in 21 countries with the intent of assessing the efficacy and safety of patisiran in patients with ATTR amyloidosis with cardiomyopathy. The trial enrolled 360 adult patients and randomized them in a 1:1 ratio to receive either 03.mg/kg patisiran or placebo intravenously every 3 weeks over a 12-month double-blind treatment period. At the conclusion of this 12-month period, study protocol requires patients to be switched to patisiran for an open-label extension period.

The primary endpoint of the trial was change in from 6-minute walking test score from baseline to 12 months compared to placebo therapy. Secondary endpoints for the trial included health-related quality of life, which was measured through KCCQ change, and a trio of composite outcomes. These composite outcomes included a composite of all-cause mortality, frequency of cardiovascular events, and change from baseline in 6-minute walking test score, a composite of all-cause mortality and frequency of all-cause hospitalizations and urgent heart failure visits in patients not on tafamidis at baseline, and a composite of all-cause mortality and frequency of all-cause hospitalizations and urgent heart failure visits in the overall study population.

Later in their release, Alnylam Pharmaceuticals highlighted the safety profile of patisiran observed in double-blind treatment period of the trial, including similar frequencies of adverse events (91.2% and 94.4%, respectively) and serious adverse events (33.7% and 35.4%, respectively) among the patisiran and placebo arms of the trial.

“I am delighted by the results of the APOLLO-B study, which suggest the potential for patisiran to be a treatment option for patients with ATTR amyloidosis with cardiomyopathy, assuming favorable regulatory review. In addition, the APOLLO-B data further strengthen our confidence in our Phase 3 HELIOS-B study of vutrisiran in ATTR amyloidosis with cardiomyopathy, which is expected to report out in early 2024,” said Yvonne Greenstreet, MBChB, Chief Executive Officer of Alnylam, in the aforementioned release.

Alnylam Pharmaceuticals noted plans to presented full results of the APOLLO-B study as part of a late-breaking session at the 18th International Symposium on Amyloidosis on September 8, 2022, in Germany. Patisiran is currently approved in the United States and Canada for the treatment of the polyneuropathy of hATTR amyloidosis in adults and is also approved in the European Union, Switzerland, and Brazil for the treatment of hATTR amyloidosis in adults with Stage 1 or Stage 2 polyneuropathy.

Already approved by the FDA for the treatment of the polyneuropathy of hATTR amyloidosis, the August 3rd announcement of APOLLO-B results from Alnylam Pharmaceuticals suggests patisiran (ONPATTRO) could be a safe and efficacious treatment option for patients with ATTR amyloidosis with cardiomyopathy. 

Patisiran Meets Primary Endpoint in APOLLO-B Trial

Much talk is made of climate change and increasing environmental dangers with rising temperatures, increasing pollution, and population explosions around the world. The age-old question of nature versus nurture continues to vex researchers and clinicians alike.

We know very well that both our genetic predisposition and the environment we are exposed to play crucial roles in our health, fitness, and ultimately our demise. Studies show that in 2019, environmental factors were associated with approximately 11.3 million deaths including 5.1 million from cardiovascular disease (CVD).

Michael Hadley, MD, and colleagues at the Icahn School of Medicine at Mount Sinai feel strongly that understanding the relationships between environmental risk factors and health is a critical step towards designing targeted policies and programs to reduce the burden of attributable disease.

While many studies have looked at individual environmental risk factors for disease, the authors sought to develop a spatial environmental model accounting for independent associations between multiple environmental factors and mortality across different socioeconomic populations.

Utilizing data from the Golestan Cohort Study in Iran, Hadley’s group enrolled over 50,000 individuals compiling mortality data along with spatial environmental factors available from public databases including: ambient air pollution, household fuel use and ventilation, socioeconomic environment, proximity to traffic, distance to coronary intervention centers, population density, nighttime light exposure, and land use.

The resulting data collected was illuminating to say the least. The authors showed that populations exposed to high levels of outdoor air pollution were 17 percent more likely to die from CVD and 20 percent more likely to die from any cause when compared to those not exposed to high levels of air pollution.

 Subjects who were exposed to indoor combustion of any kind of biomaterial without proper ventilation were 23% more likely to die from any cause and 36% more likely to die from heart disease.

Those burning kerosene without ventilation were 19 percent more likely to die from CVD and 9 percent more likely to die from any cause.

Those in close proximity to small and large roadways realized a 13% increase in risk for any cause mortality.

With regards to healthcare access, for every six miles subjects lived away from a heart catheterization center the risk of dying from heart disease went up by 2% and all-cause mortality by 1%.

Finally, no significant relationship was found between socioeconomic status, population density, nighttime light, and land usage and an increased risk for death.

“This study advances our understanding of which environmental factors may be most detrimental to cardiovascular health,” Hadley said.

The most powerful contribution of this study comes in the revelation that the total burden of heart disease attributed to indoor and outdoor pollution is equivalent to that attributed to smoking tobacco.

 For perspective, cigarette smoking is the number one modifiable risk factor for cardiovascular disease worldwide.

 The authors of this study suggest that these data can be used to target specific populations based on exposure for interventions tailored to those specific exposures.

“Our work demonstrates how publicly available data can be used to create risk maps for individual communities, even in rural, low-income settings,” Hadley stated. “Eventually, we expect health systems to use similar approaches to create environmental risk maps for the communities they serve. The data can empower physicians to estimate environmental risks posted to their patients and offer individualized recommendations to mitigate risk.”

The information is out there. Data on pollution, air quality, water quality, and distance to critical access hospitals is a matter of public record. Clinicians can use this data to recommend wearing masks for pollution or ventilation improvement when utilizing indoor fuel for heat. There is a reason local weather stations report air quality and smog levels in their daily reports. Our job as clinicians is to make these data available to our patients in real time. Recommending our patients, especially those with preexisting conditions, avoid exposure based on their specific circumstances and location may significantly extend their lives and improve their quality of living.

Hadley MB, Nalini M, Adhikari S, Szymonifka J, Etemadi A, Kamangar F, et al. (2022) Spatial environmental factors predict cardiovascular and all-cause mortality: Results of the SPACE study. PLoS ONE 17(6): e0269650. https://doi.org/10.1371/journal.pone.0269650

Murray CJ, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020; 396(10258):1223–49. https://doi.org/10.1016/S0140-6736 (20)30752-2 PMID: 33069327

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006904/

In his most recent column, Dr. Gregory Weiss provides perspective on a recent Icahn School of Medicine-led study examining the impact of environmental exposures on risk of cardiovascular disease.

Environmental Exposures and Cardiovascular Death, with Gregory Weiss, MD

Patients with gout experiencing a flare-up were at a heightened risk of myocardial infarction and stroke in the 4 months followings the gout flare-up, according to the results of a new study.

A study of 62,574 patients with gout, results demonstrate patients who experienced a gout flare-up had a nearly doubling in risk of a cardiovascular event in the 60 days following the flare-up, with residual risk noted up to 120 days after the initial gout flare-up.

“The results show that among patients with gout, patients who experienced a heart attack or stroke had significantly increased odds of a gout flare during the preceding 120-days compared with patients who did not experience such events. These findings suggest that gout flares are associated with a transient increase in cardiovascular events following flares,” said lead investigator Abhishek Abhishek, PhD, a professor of rheumatology at the University of Nottingham and honorary consultant rheumatologist at the Nottingham University Hospital, 

Using data recorded within the Clinical Practice Research Datalink (CPRD) from 1997-2020, investigators designed a study using a nested case-control study and also a self-controlled case series in which patients served as their own controls. From the CPRD, which is a longitudinal primary care database of EHR data from more than 700 general practices in the UK, investigators identified 96,153 patients with newly diagnosed gout during the period of interest.

The 96,153-patient cohort identified for inclusion had a mean age of 76.5 years, 69.3% were men, and 10,475 had a subsequent cardiovascular event. For the purpose of analysis, the 10,475 patients who experienced a cardiovascular event were matched with 52,099 patients without a cardiovascular event. The self-controlled car series included 1421 patients with atrial least 1 gout flare and at least 1 cardiovascular event after the diagnosis of gout.

Upon analysis, results suggested patients with cardiovascular events had significantly greater odds of experiencing a gout flare within the prior 0 to 60 days (aOR, 1.93 [95% CI, 1.57-2.38]) and within the prior 61-120 days (aOR, 1.57 [95% CI, 1.26-1.96]) compared to those who did not experience a cardiovascular event. This risk was not observed for gout flares occurring within 121-180 days after a gout flare (aOR, 1.06 [95% CI, 0.84-1.34]). In the self-controlled case series, cardiovascular event rates per 1000 person-days were 2.49 (95% CI, 2.16-2.82) 0-60 days within a gout flare, 2.16 (95% CI, 1.85-2.47) 61-120 days after a shout flare, 1.70 (95% CI, 1.42-1.98) 121-180 days after a gout flare, compared to a rate of 1.32 (955 CI, 1.23-1.41) within the 150 days before or the 181-540 days after a gout flare.

Further comparison to the 150 days preceding and 181-540 days after gout flare the differences in observed incidence rate differences for cardiovascular events per 1000 person-days and adjusted condense rate ratios were:

0-60 Days: 1.17 (95% CI, 0.83-1.52) and 1.89 (95% CI, 1.54-2.30)

61-120 Days: 0.84 (95% CI, 0.52-1.17) and 1.64 (95% CI, 1.45-1.86)

121-180 Days: 0.38 (95% CI, 0.09-0.67) and 1.29 (95% CI, 1.02-1.64)

Jeffrey L. Anderson, MD, and Kirk U. Knowlton, MD, both of the Intermountain Heart Institute at Intermountain Healthcare, provided perspective on the real-world implications of the current study for clinical practice.

“The findings of the study by Cipolletta et al should alert clinicians and patients to the increased cardiovascular risk in the weeks beginning after a gout flare and should focus attention on optimizing preventive measures. Patients should be alert to the signs and symptoms of unstable angina, MI, and ischemic stroke so that medical care can be emergently sought,” wrote Anderson and Knowlton. “Clinicians should emphasize the importance of optimizing lifestyle measures and standard risk factor control, including adherence to diet, statins, anti-inflammatory drugs, smoking cessation, diabetic and blood pressure control, and antithrombotic medications as indicated. However, to keep this increased risk in perspective, the incremental risk after a gout flare was small (0.6% over 0-60 days).”

Association Between Gout Flare and Subsequent Cardiovascular Events Among Patients With Gout

A study of more than 60,000 patients with gout provides insight into the apparent increase in risk of cardiovascular events observed in the months immediately following a gout flare. 

Risk of Cardiovascular Event Heightened in Months Following a Gout Flare

An analysis leveraging data from the 2020 US Census Bureau report paints a grim picture related to projected rates of cardiovascular risk factors and disease among the US population by 2060.

Led by a team at Massachusetts General Hospital, results of the study detail projected increases of 18% or more in prevalence of diabetes, cholesterol disorders, hypertension, and obesity as well as 33% increases in the rates of both heart failure and stroke among the US population from 2025 to 2060.

“Our analysis projects that that the prevalence of cardiovascular risk factors and diseases will continue to rise with worrisome trends,” said senior investigator James Januzzi Jr, MD, cardiologist at Massachusetts General Hospital and Hutter Family Professor of Medicine at Harvard Medical School,

. “These striking projections will disproportionately affect racial and ethnic minority populations in the U.S. Understanding these results will hopefully inform future public health policy efforts and allow us to implement prevention and treatment measures in an equitable manner.”

As the US population ages and becomes more diverse, concern has grown over the implications for health systems on a societal level. With an interest in understanding these trends to improve policy planning and public health interventions, Januzzi and a team of colleagues from Massachusetts General Hospital designed the current study with the intent of estimating the prevalence of cardiovascular risk factors and cardiovascular disease according to age, sex, race, and ethnicity using logistic regression models based on NHANES survey data from the 2013-2018 survey cycles and the 2020 US Census report projections for 2025-2060.

The specific risk factors of interest for the investigators’ analyses were diabetes, hypertension, dyslipidemia, and obesity. For the purpose of analysis, cardiovascular disease included ischemic heart disease, myocardial infarction, stroke, and heart failure, all of which were based on self-reported patient data.

In their analyses, investigators found the prevalence of all 4 risk factors was expected to rise among the overall US population from 2025 to 2060. The greatest estimated increase was observed for diabetes mellitus at 39.3% with an estimated 54.6 million individuals impacted by 2060. The rates of hypertension were expected to increase by 27.1% to 162.5 million individuals, the rate of dyslipidemia was expected to increase by 27.6% to 125.7 million individuals, and obesity was expected to increase nay 18.3% to 125.7 million individuals. Investigators pointed out that although the absolute number of individuals with obesity is expected to rise, the overall prevalence is projected to decrease from 39.4% in 2025 to 38.8% in 2060.

Notable increases were observed for cardiovascular disease. Results indicated the estimated prevalence of ischemic heart disease was expected to rise 30.7% from 2025 to 2060 to an estimated 8.8% of the population. Prevalence of heart failure was expected to increase by 33.4% to an estimated 4.0% of the population, stroke was expected to increase by 33.8% to 4.5% of the population, and myocardial infarction was expected to increase by 16.9% to 4.9% of the population.

Investigators called attention to differences in projected change observed in the current study according to race and ethnicity. Specifically, the greatest overall prevalence of risk factors remission was expected to remain among the White population due to overall size, but the White population was expected to experience a gradual decrease in risk factors from 2025 to 2060. Among minority populations, the project prevalence of all risk factors was expected to rise.

“Ultimately, as prevention is imperative to tackle the future burden of cardiovascular disease, the results from this study pose an important challenge,” said lead investigator Reza Mohebi, MD, the Dennis and Marilyn Barry Fellow in Cardiology at Massachusetts General Hospital, in the aforementioned statement. “In order to reduce the burden of cardiovascular disease in the U.S. population, health care policymakers will need to allocate preventive measures and health care resources to the more vulnerable populations we projected to have higher percentage rise in disease.”

In an accompanying editorial published in 

Andreas P. Kalogeropoulos, MD, MPH, PHD, and Javed Butler, MD, MPH, MBA, applauded the efforts of investigators and underlined the importance of the implications brought forth by their analyses.

“Despite that several assumptions underlie these projections, the importance of this work cannot be overestimated,” said Kalogeropoulos, a clinical and outcomes researcher at Stony Brook University Medical Center. “The absolute numbers are staggering and suggest that by year 2060, compared to 2025, the numbers of people, particularly minorities, with CV risk factors are expected to increase dramatically. Unless targeted action is taken, disparities in the burden of cardiovascular disease are only going to be exacerbated over time.”

Cardiovascular Disease Projections in the United States Based on the 2020 Census Estimates

Journal of the American College of Cardiology.

Using data from the 2020 US Census report and recent NHANES survey data, investigators from Massachusetts General Hospital detail expected increases in the prevalence of cardiovascular risk factors and cardiovascular disease among the US population by 2060.

Study Warns of Significant Increases in Diabetes and Cardiovascular Disease by 2060

New research from Duke Health’s AI Health Team suggests newer is not always better, at least when it comes to risk scores for predicting coronary heart disease in young and middle-aged adults.

An analysis of data from a pair of major studies provides insight into the use of a traditional 30-year risk score against a polygenic risk score for predicting coronary heart disease based on risk score across multiple age groups