Advancements in risk stratification and management strategies in primary cardiovascular prevention

Barkas, Fotios; Sener, Yusuf Ziya; Golforoush, Pelin Arabacilar; Kheirkhah, Azin; Rodriguez-Sanchez, Elena; Novak, Jan; Apellaniz-Ruiz, Maria; Akyea, Ralph Kwame; Bianconi, Vanessa; Ceasovschih, Alexandr; Chee, Ying Jie; Cherska, Mariia; Chora, Joana Rita; D'Oria, Mario; Demikhova, Nadiia; Kocyigit Burunkaya, Duygu; Rimbert, Antoine; Macchi, Chiara; Rathod, Krishnaraj; Roth, Lynn; Sukhorukov, Vasily; Stoica, Svetlana; Scicali, Roberto; Storozhenko, Tatyana; Uzokov, Jamol; Lupo, Maria Giovanna; van der Vorst, Emiel P.C.; Porsch, Florentina

doi:10.1016/j.atherosclerosis.2024.117579

Cited by 7 publications

(1 citation statement)

References 224 publications

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“…Increased inflammation, insulin resistance, abnormal metabolism of lipids, vascular endothelial dysfunction, and increased blood pressure are considered as the most important underlying mechanisms linking obesity with atherosclerosis [ 6 , 7 ]. Recently, the use of novel approaches in advanced imaging, biomarkers, genetics and artificial intelligence have been proposed as cardiovascular risk stratification strategies rather than just traditional risk factors [ 8 ]. Obesity stems from a condition called adiposopathy, which is characterized by anatomical and functional disturbances in adipose tissue caused by a positive caloric balance in genetically and environmentally vulnerable individuals, which can lead to adverse metabolic, endocrine and immune responses [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

The association between the visceral to subcutaneous abdominal fat ratio and the risk of cardiovascular diseases: a systematic review

Emamat,

Jamshidi,

Farhadi

et al. 2024

BMC Public Health

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Background Cardiovascular diseases (CVDs) are the primary cause of mortality globally. The prevalence of obesity is rising worldwide; there seems to be a significant positive association between obesity and CVDs. The distribution of fat in the abdominal area in the form of visceral (VAT) or subcutaneous adipose tissue (SAT) affects the risk of CVDs. The aim of the present study was to conduct a systematic review of the available literature regarding the association between the VAT-to-SAT ratio and CVDs. Methods A comprehensive search strategy was used to retrieve all human observational studies indexed in PubMed, Scopus and Google Scholar databases/search engines (from Jan 2000 up to Oct 2023). The VAT-to-SAT or SAT-to-VAT ratio was an independent variable and various cardiovascular diseases, including hypertension, atherosclerosis, coronary heart disease, cerebrovascular disease and heart failure, were considered as outcomes of interest. Results Out of 1173 initial studies, 910 papers were screened. Based on the inclusion criteria, 883 papers were excluded. Finally, 27 papers (18 cross-sectional and 9 cohort studies) published between 2010 and 2023 which met the inclusion criteria were reviewed. Conclusions The distribution of abdominal fat seems to be associated with the risk of CVDs; the majority of the evidence suggests that a higher abdominal VAT-to-SAT ratio is associated with the development of CVDs. Therefore, this ratio can be used as a prognostic indicator for CVDs. Trial registration Not applicable.

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Section: Introductionmentioning

confidence: 99%

The association between the visceral to subcutaneous abdominal fat ratio and the risk of cardiovascular diseases: a systematic review

Emamat,

Jamshidi,

Farhadi

et al. 2024

BMC Public Health

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Advancements in the Treatment of Atherosclerosis: From Conventional Therapies to Cutting-Edge Innovations

Liu,

Lu,

Zhang

et al. 2024

ACS Pharmacol. Transl. Sci.

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Atherosclerosis is a leading cause of morbidity and mortality worldwide, driven by a complex interplay of lipid dysregulation, inflammation, and vascular pathology. Despite advancements in understanding the multifactorial nature of atherosclerosis and improvements in clinical management, existing therapies often fall short in reversing the disease, focusing instead on symptom alleviation and risk reduction. This review highlights recent strides in identifying genetic markers, elucidating inflammatory pathways, and understanding environmental contributors to atherosclerosis. It also evaluates the efficacy and limitations of current pharmacological treatments, revascularization techniques, and the impact of these interventions on patient outcomes. Furthermore, we explore innovative therapeutic strategies, including the promising fields of nanomedicine, nucleic acid-based therapies, and immunomodulation, which offer potential for targeted and effective treatment modalities. However, integrating these advances into clinical practice is challenged by regulatory, economic, and logistical barriers. This review synthesizes the latest research and clinical advancements to provide a comprehensive roadmap for future therapeutic strategies and emphasize the critical need for innovative approaches to fundamentally change the course of atherosclerosis management.

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From a genomic risk model to clinical trial implementation in a learning health system: the ProGRESS Study

Vassy,

Dornisch,

Karunamuni

et al. 2024

Preprint

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Background: As healthcare moves from a one-size-fits-all approach towards precision care, individual risk prediction is an important step in disease prevention and early detection. Biobank-linked healthcare systems can generate knowledge about genomic risk and test the impact of implementing that knowledge in care. Risk-stratified prostate cancer screening is one clinical application that might benefit from such an approach. Methods: We developed a clinical translation pipeline for genomics-informed prostate cancer screening in a national healthcare system. We used data from 585,418 male participants of the Veterans Affairs (VA) Million Veteran Program (MVP), among whom 101,920 self-identify as Black/African-American, to develop and validate the Prostate CAncer integrated Risk Evaluation (P-CARE) model, a prostate cancer risk prediction model based on a polygenic score, family history, and genetic principal components. The model was externally validated in data from 18,457 PRACTICAL Consortium participants. A novel blended genome-exome (BGE) platform was used to develop a clinical laboratory assay for both the P-CARE model and rare variants in prostate cancer-associated genes, including additional validation in 74,331 samples from the All of Us Research Program. Results: In overall and ancestry-stratified analyses, the polygenic score of 601 variants was associated with any, metastatic, and fatal prostate cancer in MVP and PRACTICAL. Values of the P-CARE model at ≥80th percentile in the multiancestry cohort overall were associated with hazard ratios (HR) of 2.75 (95% CI 2.66-2.84), 2.78 (95% CI 2.54-2.99), and 2.59 (95% CI 2.22-2.97) for any, metastatic, and fatal prostate cancer in MVP, respectively, compared to the median. When high- and low-risk groups were defined as P-CARE HR>1.5 and HR<0.75 for metastatic prostate cancer, the 220,062 (37.6%) high-risk vs.146,826 (25.1%) low-risk participants in MVP had a 47.9% vs. 14.1%, 9.3% vs. 2.0%, and 3.6% vs. 0.8% cumulative cause-specific incidence of any, metastatic, and fatal prostate cancer by age 90, respectively. The clinical assay and reports are now being implemented in a clinical trial of precision prostate cancer screening in the VA healthcare system (Clinicaltrials.govNCT05926102). Conclusions: A model consisting of a polygenic score, family history, and genetic principal components describes a clinically important gradient of prostate cancer risk in a diverse patient population and demonstrates the potential of learning health systems to implement and evaluate precision health care approaches.

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Advancements in risk stratification and management strategies in primary cardiovascular prevention

Cited by 7 publications

References 224 publications

The association between the visceral to subcutaneous abdominal fat ratio and the risk of cardiovascular diseases: a systematic review

The association between the visceral to subcutaneous abdominal fat ratio and the risk of cardiovascular diseases: a systematic review

Advancements in the Treatment of Atherosclerosis: From Conventional Therapies to Cutting-Edge Innovations

From a genomic risk model to clinical trial implementation in a learning health system: the ProGRESS Study

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