Comparison of Short- and Long-Term Cardiovascular Disease Risk Assessment Tools in US Young Adults.

Background: In 2023, the American Heart Association published the Predicting Risk of Cardiovascular Disease Events (PREVENT) equations for estimating atherosclerotic cardiovascular disease (ASCVD) risk in adults aged 30 to 79 years. We compared PREVENT's performance with existing US guideline recommended models-Pooled Cohort Equations for 10-year ASCVD risk and FHS (Framingham Heart Study) equations for 30-year ASCVD risk-among young adults.

Methods: We analyzed adults aged 20 to 39 years without baseline ASCVD from 2 sources: (1) pooled data from 2 large epidemiologic cohorts (CARDIA [Coronary Artery Risk Development in Young Adults] and FHS, n=7763), and (2) electronic health records from Kaiser Permanente Southern California (n=266 378).

Clinical and Demographic Characteristics Associated With Diabetes Remission in Six Integrated Health Care Systems: A Retrospective Cohort Study.

Objective: To assess the real-world frequency and characteristics associated with type 2 diabetes remission in a large and diverse cohort of U.S. adults.

Lipid-lowering Therapy Utilization, Adherence, and Outcomes Among Adults With and at-Risk for Atherosclerotic Cardiovascular Disease in an Integrated Healthcare Delivery System in Southern California.

Despite their safety and effectiveness, lipid-lowering therapy (LLT) remains underutilized among adults with and at-risk for atherosclerotic cardiovascular disease (ASCVD) in terms of prescriber-guideline concordance and patient adherence. We examined LLT use, adherence, and outcomes among primary and secondary prevention populations. Adults ≥21 years of age in Kaiser Permanente Southern California with a history of ASCVD or intermediate (≥7.

Development and Validation of an Incident Hypertension Risk Prediction Model for Young Adults.

Background: Identifying young adults at high risk of hypertension can improve blood pressure screening recommendations.

Methods: We developed models to predict incident hypertension using diverse contemporary cohorts of young adults aged 18 to 39 years from Kaiser Permanente Southern California (derivation and internal validation) and 3 cohort studies (CARDIA [Coronary Artery Risk Development in Young Adults], FHS [Framingham Heart Study], HCHS/SOL [Hispanic Community Health Study/Study of Latinos]; external validation). Predictors included age, systolic and diastolic blood pressure, body mass index, smoking, social determinants of health, comorbidities, high- and low-density lipoprotein cholesterol, and pregnancy-related hypertensive disorders.

Association of Rate-Control and Antiarrhythmic Medication Use and Risk of Ischemic Stroke and Death in Patients on Dialysis With Atrial Fibrillation.

Background: Incident atrial fibrillation (AF) is common among adults with kidney failure treated with maintenance dialysis and is associated with poor clinical outcomes. Limited data exist informing treatment of AF among patients on dialysis. We aimed to describe the use of rate-control and antiarrhythmic medications for AF among patients on dialysis and associations of these medication use strategies with stroke and all-cause death.

Clinical and socioeconomic factors associated with recurrent atrial fibrillation after catheter ablation or antiarrhythmic drug therapy.

Background: Maintaining sinus rhythm after initiating rhythm control strategies in atrial fibrillation (AF) remains challenging.

Objective: The study sought to investigate risk factors associated with AF recurrence among patients with incident AF who underwent catheter ablation or received antiarrhythmic drugs (AADs).

Methods: We identified adults with incident AF from 2010 to 2017 who underwent catheter ablation or initiated AAD therapy from 2 U.

Blood Pressure Outcomes Following a Home Blood Pressure Monitoring Program in a Large Integrated US Health System.

Background: Home blood pressure telemonitoring (HBPT) can empower patients to participate in their healthcare and reduce office BP. Evidence whether BP control can be sustained following HBPT is scarce. We examined the effects of a HBPT program on BP outcomes.

Trends in Hypertension Prevalence, Awareness, Treatment, and Control Among US Young Adults, 2003-2023.

Background: This study evaluated recent trends in hypertension prevalence and management among US young adults, and assessed disparities by age, sex, or race and ethnicity, as well as potential factors contributing to the age-related disparities.

Methods: Data from 51,291 adults aged ≥18 years in the National Health and Nutrition Examination Survey 2003-2004 to 2021-2023 were analyzed. Stage 1 or 2 hypertension was defined as systolic/diastolic blood pressure (BP) ≥130/80 mmHg or antihypertensive medication use.

Evaluation and Comparison of the PREVENT and Pooled Cohort Equations for 10-Year Atherosclerotic Cardiovascular Risk Prediction.

Background: We compared the atherosclerotic cardiovascular disease (ASCVD) risk prediction performance of the American Heart Association's Predicting Risk of Cardiovascular Disease Events (PREVENT) Base and PREVENT Full equations (includes urine albumin/creatinine ratio, glycated hemoglobin, and social deprivation index) with the pooled cohort equations (PCEs).

Methods: We included adults, aged 40 to 75 years, with no history of ASCVD, diabetes, or statin use in 2009 from Kaiser Permanente Southern California and followed up through 2019. ASCVD was defined as myocardial infarction, fatal coronary heart disease, and fatal and nonfatal ischemic stroke.

SPRINT Treatment Among Adults With Chronic Kidney Disease From 2 Large Health Care Systems.

Importance: It is unclear whether the effects of intensive vs standard blood pressure (BP) targets seen in clinical trials generalize to patients with chronic kidney disease (CKD) encountered in everyday practice due to differences in the distribution of cardiovascular risk factors and coexisting conditions.

Objective: To evaluate whether the beneficial and adverse effects of intensive vs standard BP control observed in the Systolic Blood Pressure Intervention Trial (SPRINT) are transportable to a target population of adults with CKD in clinical practice.

Design, Setting, And Participants: This comparative effectiveness study identified 2 populations with CKD who met the eligibility criteria for SPRINT between January 1 and December 31, 2019, in the Veterans Health Administration (VHA) and Kaiser Permanente of Southern California (KPSC).

Risk-enhancing factors and social determinants of health in risk assessment for atherosclerotic cardiovascular disease.

Background: The Pooled Cohort Equations (PCEs) do not accurately estimate atherosclerotic cardiovascular disease (ASCVD) risk in certain populations. The 2018 AHA/ACC cholesterol guideline identified risk-enhancing factors as a supplement to PCEs-based risk assessment. However, the role of each risk-enhancing factor in ASCVD risk assessment has not been well quantified.

Blood Pressure Reduction and Changes in Antihypertensive Medication Use Among Patients With Hypertension Who Initiated Sodium-Glucose Cotransporter-2 Inhibitors.

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated a blood pressure (BP) reduction benefit despite other indications for use. We evaluated BP changes and antihypertensive medication use pre- and post-SGLT2i initiation among 12 960 patients with treated hypertension and among subgroups with apparent treatment-resistant hypertension (aTRH) and/or proteinuria. Post-SGLT2i initiation, the mean (SD) systolic blood pressure (SBP) was reduced from 133.

Cardiovascular Risk Associated With Social Determinants of Health at Individual and Area Levels.

Importance: The benefit of adding social determinants of health (SDOH) when estimating atherosclerotic cardiovascular disease (ASCVD) risk is unclear.

Objective: To examine the association of SDOH at both individual and area levels with ASCVD risks, and to assess if adding individual- and area-level SDOH to the pooled cohort equations (PCEs) or the Predicting Risk of CVD Events (PREVENT) equations improves the accuracy of risk estimates.

Design, Setting, And Participants: This cohort study included participants data from 4 large US cohort studies.

Association Between Young Adult Characteristics and Blood Pressure Trajectories.

Background: Blood pressure (BP) trajectories from young adulthood through middle age are associated with cardiovascular risk. We examined the associations of hypertension risk factors with BP trajectories among a large diverse sample.

Methods And Results: We analyzed data from young adults, aged 18 to 39 years, with untreated BP <140/90 mm Hg at baseline from Kaiser Permanente Southern California (N=355 324).

Representation of Real-World Adults With Chronic Kidney Disease in Clinical Trials Supporting Blood Pressure Treatment Targets.

Background: Little is known about how well trial participants with chronic kidney disease (CKD) represent real-world adults with CKD. We assessed the population representativeness of clinical trials supporting the 2021 Kidney Disease: Improving Global Outcomes blood pressure (BP) guidelines in real-world adults with CKD.

Methods And Results: Using a cross-sectional analysis, we identified patients with CKD who met the guideline definition of hypertension based on use of antihypertensive medications or sustained systolic BP ≥120 mm Hg in 2019 in the Veterans Affairs and Kaiser Permanente of Southern California.

Hyperaldosteronism Screening and Findings From a Large Diverse Population With Resistant Hypertension Within an Integrated Health System.

Introduction: Hyperaldosteronism (HA) is a common cause of secondary hypertension and may contribute to resistant hypertension (RH). The authors sought to determine and characterize HA screening, positivity rates, and mineralocorticoid receptor antagonist (MRA) use among patients with RH.

Methods: A cross-sectional study was performed within Kaiser Permanente Southern California (7/1/2012-6/30/2017).

Treatment and Control of Hypertension Among Adults With Chronic Kidney Disease, 2011 to 2019.

Background: Hypertension frequently accompanies chronic kidney disease (CKD) as etiology and sequela. We examined contemporary trends in hypertension treatment and control in a national sample of adults with CKD.

Methods: We evaluated 5% cross-sectional samples of adults with CKD between 2011 and 2019 in the Veterans Health Administration.

Validation of ICD-10 hospital discharge diagnosis codes to identify incident and recurrent ischemic stroke from a US integrated healthcare system.

Purpose: This study validated incident and recurrent ischemic stroke identified by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) hospital discharge diagnosis codes.

Methods: Using electronic health records (EHR) of adults (≥18 years) receiving care from Kaiser Permanente Southern California with ICD-10 hospital discharge diagnosis codes of ischemic stroke (I63.x, G46.

Association of Direct Oral Anticoagulation Management Strategies With Clinical Outcomes for Adults With Atrial Fibrillation.

Importance: Anticoagulation management services (AMSs; ie, warfarin clinics) have evolved to include patients treated with direct oral anticoagulants (DOACs), but it is unknown whether DOAC therapy management services improve outcomes for patients with atrial fibrillation (AF).

Objective: To compare outcomes associated with 3 DOAC care models for preventing adverse anticoagulation-related outcomes among patients with AF.

Design, Setting, And Participants: This retrospective cohort study included 44 746 adult patients with a diagnosis of AF who initiated oral anticoagulation (DOAC or warfarin) between August 1, 2016, and December 31, 2019, in 3 Kaiser Permanente (KP) regions.

Effectiveness and safety of Dabigatran 110 mg versus 150 mg for Stroke Prevention in Patients with Atrial Fibrillation at High Bleeding Risk.

Purpose: The effectiveness and tolerability of a reduced dose (110 mg) of dabigatran versus the standard dose (150 mg) were evaluated in subgroups of patients with atrial fibrillation (AF) at high bleeding risk.

Methods: Eligible patients were adults with AF and a creatinine clearance rate ≥30 mL/min who were initiated on treatment with dabigatran (index) between 2016 and 2018. High-bleeding-risk subgroups were identified: (1) age ≥80 years; (2) moderate renal impairment (creatinine clearance rate 30-<50 mL/min); and (3) recent bleeding or a HAS-BLED score of ≥3.