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Contemporary Cardiology

2022

DOI: 10.1007/978-3-030-98824-1_13

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Inflammatory Diseases and Risk of Atherosclerotic Cardiovascular Disease: A New Focus on Prevention

Renato Quispe¹,

Bibin Varghese²,

³

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Discussion2

Autoimmune Disorders1

Hospitalization Characteristics Of the Study Population1

Introduction1

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Cited by 6 publications

(7 citation statements)

References 95 publications

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“…Current guidelines in the US, similar to those in other countries, recommend that health care practitioners calculate CVD risk scores and use the scores to engage patients in discussions about CVD prevention. Although previous studies of CVD risk scoring interventions have shown improvement in CVD risk factor control, this is the first study of a CVD risk score–focused intervention to demonstrate declines in CVD events …”

Section: Discussionmentioning

confidence: 85%

Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending

Blue,

Kranker,

Markovitz

et al. 2023

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ImportanceThe Million Hearts Model paid health care organizations to assess and reduce cardiovascular disease (CVD) risk. Model effects on long-term outcomes are unknown.ObjectiveTo estimate model effects on first-time myocardial infarctions (MIs) and strokes and Medicare spending over a period up to 5 years.Design, Setting, and ParticipantsThis pragmatic cluster-randomized trial ran from 2017 to 2021, with organizations assigned to a model intervention group or standard care control group. Randomized organizations included 516 US-based primary care and specialty practices, health centers, and hospital-based outpatient clinics participating voluntarily. Of these organizations, 342 entered patients into the study population, which included Medicare fee-for-service beneficiaries aged 40 to 79 years with no previous MI or stroke and with high or medium CVD risk (a 10-year predicted probability of MI or stroke [ie, CVD risk score] ≥15%) in 2017-2018.InterventionOrganizations agreed to perform guideline-concordant care, including routine CVD risk assessment and cardiovascular care management for high-risk patients. The Centers for Medicare &amp; Medicaid Services paid organizations to calculate CVD risk scores for Medicare fee-for-service beneficiaries. CMS further rewarded organizations for reducing risk among high-risk beneficiaries (CVD risk score ≥30%).Main Outcomes and MeasuresOutcomes included first-time CVD events (MIs, strokes, and transient ischemic attacks) identified in Medicare claims, combined first-time CVD events from claims and CVD deaths (coronary heart disease or cerebrovascular disease deaths) identified using the National Death Index, and Medicare Parts A and B spending for CVD events and overall. Outcomes were measured through 2021.ResultsHigh- and medium-risk model intervention beneficiaries (n = 130 578) and standard care control beneficiaries (n = 88 286) were similar in age (median age, 72-73 y), sex (58%-59% men), race (7%-8% Black), and baseline CVD risk score (median, 24%). The probability of a first-time CVD event within 5 years was 0.3 percentage points lower for intervention beneficiaries than control beneficiaries (3.3% relative effect; adjusted hazard ratio [HR], 0.97 [90% CI, 0.93-1.00]; P = .09). The 5-year probability of combined first-time CVD events and CVD deaths was 0.4 percentage points lower in the intervention group (4.2% relative effect; HR, 0.96 [90% CI, 0.93-0.99]; P = .02). Medicare spending for CVD events was similar between the groups (effect estimate, −$1.83 per beneficiary per month [90% CI, −$3.97 to −$0.30]; P = .16), as was overall Medicare spending including model payments (effect estimate, $2.11 per beneficiary per month [90% CI, −$16.66 to $20.89]; P = .85).Conclusions and RelevanceThe Million Hearts Model, which encouraged and paid for CVD risk assessment and reduction, reduced first-time MIs and strokes. Results support guidelines to use risk scores for CVD primary prevention.Trial RegistrationClinicalTrials.gov Identifier: NCT04047147

“…Current guidelines in the US, similar to those in other countries, recommend that health care practitioners calculate CVD risk scores and use the scores to engage patients in discussions about CVD prevention. Although previous studies of CVD risk scoring interventions have shown improvement in CVD risk factor control, this is the first study of a CVD risk score–focused intervention to demonstrate declines in CVD events …”

Section: Discussionmentioning

confidence: 85%

Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending

Blue,

Kranker,

Markovitz

et al. 2023

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ImportanceThe Million Hearts Model paid health care organizations to assess and reduce cardiovascular disease (CVD) risk. Model effects on long-term outcomes are unknown.ObjectiveTo estimate model effects on first-time myocardial infarctions (MIs) and strokes and Medicare spending over a period up to 5 years.Design, Setting, and ParticipantsThis pragmatic cluster-randomized trial ran from 2017 to 2021, with organizations assigned to a model intervention group or standard care control group. Randomized organizations included 516 US-based primary care and specialty practices, health centers, and hospital-based outpatient clinics participating voluntarily. Of these organizations, 342 entered patients into the study population, which included Medicare fee-for-service beneficiaries aged 40 to 79 years with no previous MI or stroke and with high or medium CVD risk (a 10-year predicted probability of MI or stroke [ie, CVD risk score] ≥15%) in 2017-2018.InterventionOrganizations agreed to perform guideline-concordant care, including routine CVD risk assessment and cardiovascular care management for high-risk patients. The Centers for Medicare &amp; Medicaid Services paid organizations to calculate CVD risk scores for Medicare fee-for-service beneficiaries. CMS further rewarded organizations for reducing risk among high-risk beneficiaries (CVD risk score ≥30%).Main Outcomes and MeasuresOutcomes included first-time CVD events (MIs, strokes, and transient ischemic attacks) identified in Medicare claims, combined first-time CVD events from claims and CVD deaths (coronary heart disease or cerebrovascular disease deaths) identified using the National Death Index, and Medicare Parts A and B spending for CVD events and overall. Outcomes were measured through 2021.ResultsHigh- and medium-risk model intervention beneficiaries (n = 130 578) and standard care control beneficiaries (n = 88 286) were similar in age (median age, 72-73 y), sex (58%-59% men), race (7%-8% Black), and baseline CVD risk score (median, 24%). The probability of a first-time CVD event within 5 years was 0.3 percentage points lower for intervention beneficiaries than control beneficiaries (3.3% relative effect; adjusted hazard ratio [HR], 0.97 [90% CI, 0.93-1.00]; P = .09). The 5-year probability of combined first-time CVD events and CVD deaths was 0.4 percentage points lower in the intervention group (4.2% relative effect; HR, 0.96 [90% CI, 0.93-0.99]; P = .02). Medicare spending for CVD events was similar between the groups (effect estimate, −$1.83 per beneficiary per month [90% CI, −$3.97 to −$0.30]; P = .16), as was overall Medicare spending including model payments (effect estimate, $2.11 per beneficiary per month [90% CI, −$16.66 to $20.89]; P = .85).Conclusions and RelevanceThe Million Hearts Model, which encouraged and paid for CVD risk assessment and reduction, reduced first-time MIs and strokes. Results support guidelines to use risk scores for CVD primary prevention.Trial RegistrationClinicalTrials.gov Identifier: NCT04047147

“…Previous literature findings suggest that individuals with SLE have worse obstetric outcomes in terms of preeclampsia and preterm birth. 17 , 18 , 22 Studies 13 , 23 , 24 , 25 , 26 have found that a chronic inflammatory state was associated with increased risk for preeclampsia and long-term CV events. Our study may represent a significant addition to the existing literature because it found that SLE was associated with acute peripartum CV events, an association that was independent of traditional risk factors and preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 63 115 002 weighted hospitalizations for deliveries (median [IQR] age, 28 [24][25][26][27][28][29][30][31][32]…”

Section: Hospitalization Characteristics Of the Study Populationmentioning

confidence: 99%

Analysis of Cardiovascular Complications During Delivery Admissions Among Patients With Systemic Lupus Erythematosus, 2004-2019

¹

,

²

,

³

et al. 2022

JAMA Netw Open

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ImportanceIndividuals with systemic lupus erythematosus (SLE) have an increased risk of pregnancy-related complications. However, data on acute cardiovascular complications during delivery admissions remain limited.ObjectiveTo investigate whether SLE is associated with an increased risk of acute peripartum cardiovascular complications during delivery hospitalization among individuals giving birth.Design, Setting, and ParticipantsThis population-based cross-sectional study was conducted with data from the National Inpatient Sample (2004-2019) by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify delivery hospitalizations among birthing individuals with a diagnosis of SLE. A multivariable logistic regression model was developed to report an adjusted odds ratio (OR) for the association between SLE and acute peripartum cardiovascular complications. Data were analyzed from May 1 through September 1, 2022.ExposureDiagnosed SLE.Main Outcomes and MeasuresPrimary study end points were preeclampsia, peripartum cardiomyopathy, and heart failure. Secondary end points included ischemic and hemorrhagic stroke, pulmonary edema, cardiac arrhythmias, acute kidney injury (AKI), venous thromboembolism (VTE), length of stay, and cost of hospitalization.ResultsA total of 63 115 002 weighted delivery hospitalizations (median [IQR] age, 28 [24-32] years; all were female patients) were identified, of which 77 560 hospitalizations (0.1%) were among individuals with SLE and 63 037 442 hospitalizations (99.9%) were among those without SLE. After adjustment for age, race and ethnicity, comorbidities, insurance, and income level, SLE remained an independent risk factor associated with peripartum cardiovascular complications, including preeclampsia (adjusted OR [aOR], 2.12; 95% CI, 2.07-2.17), peripartum cardiomyopathy (aOR, 4.42; 95% CI, 3.79-5.13), heart failure (aOR, 4.06; 95% CI, 3.61-4.57), cardiac arrhythmias (aOR, 2.06; 95% CI, 1.94-2.21), AKI (aOR, 7.66; 95% CI, 7.06-8.32), stroke (aOR, 4.83; 95% CI, 4.18-5.57), and VTE (aOR, 6.90; 95% CI, 6.11-7.80). For resource use, median (IQR) length of stay (3 [2-4] days vs 2 [2-3] days; P &lt; .001) and cost of hospitalization ($4953 [$3305-$7517] vs $3722 [$2606-$5400]; P &lt; .001) were higher for deliveries among individuals with SLE.Conclusions and RelevanceThis study found that SLE was associated with increased risk of complications, including preeclampsia, peripartum cardiomyopathy, heart failure, arrhythmias, AKI, stroke, and VTE during delivery hospitalization and an increased length and cost of hospitalization.

“…Autoimmune disorders such as SLE and RA and other inflammatory diseases have been associated with a heightened risk for CVD beyond that explained by traditional risk factors [35][36][37], at least 1.5-fold greater than the general population [38]. In a large database of over 22 million UK patients, the risk of incident CVD was 56% higher among those with an autoimmune disease compared to those without [hazard ratio 1.56 ].…”

Section: Autoimmune Disordersmentioning

confidence: 99%

Cardiovascular disease prevention in women – the current state in 2023

Purohit,

Kim,

Michos

2023

Current Opinion in Cardiology

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Purpose of review Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality for women globally. The purpose of this review is to provide an updated overview of CVD prevention in women, focusing on what is currently understood about female-specific or female-predominant CVD risk factors and the importance of tailored strategies for risk assessment and medical interventions. Recent findings Recent studies have demonstrated the need to account for risk factors specific to women in current risk assessment models for CVD, including early menarche, polycystic ovary syndrome, adverse pregnancy outcomes, early menopause, and chronic inflammatory conditions. Incorporation of these findings has led to advancements in sex-specific guidelines, diagnostic tools, and treatment approaches that have led to improvement in the precision of CVD prevention strategies. At-risk women benefit similarly to lipid-lowering and other preventive therapies as men but are less likely to be treated. Summary CVD prevention in women has made substantial progress over the past decade, marked by increasing awareness among clinicians, improved understanding of sex-specific risk-enhancing factors, and incorporation of sex-specific guidelines for management. However, there remain knowledge gaps that warrant ongoing efforts to optimize CVD prevention strategies in women, which will ultimately lead to improved cardiovascular health outcomes.

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