Risk stratification of chest pain in the emergency department using artificial intelligence applied to electrocardiograms.

Background: Despite standardised approaches, subjective assessment and inconsistent diagnostic testing for chest pain in the emergency department (ED) drive costs, disparities and adverse outcomes. Artificial intelligence offers potential to automate and improve risk stratification.

Methods And Results: Using a retrospective cohort of 15 048 patients presenting to the ED of a tertiary care hospital, we trained a neural network classifier ('Chest Pain-AI' or 'CP-AI') to predict a 7-day composite endpoint of major cardiovascular diagnoses including myocardial infarction, pulmonary embolism, aortic dissection and all-cause mortality.

Targeting with Olezarsen in Moderate Hypertriglyceridemia.

Background: Highly effective therapies to reduce triglyceride levels are lacking. Olezarsen is an -acetylgalactosamine-conjugated antisense oligonucleotide that targets the messenger RNA of apolipoprotein C-III, which inhibits triglyceride clearance.

Methods: In this phase 3, international, double-blind, randomized, placebo-controlled trial, we enrolled patients with moderate hypertriglyceridemia (triglyceride level, 150 to 499 mg per deciliter) and elevated cardiovascular risk or with severe hypertriglyceridemia (triglyceride level, ≥500 mg per deciliter) and randomly assigned them in a 1:3 ratio to a 50-mg or 80-mg cohort.

Win ratio aligns with and enhances interpretation of REPRIEVE's primary findings.

We performed a win ratio (WR) analysis of REPRIEVE, a randomized trial of pitavastatin vs placebo for CVD in people with HIV, to assess robustness to event severity. WR aligns with primary findings, and provides insight into pitavastatin protections: persistent advantage over placebo on CV Death, Stroke, and Myocardial Infarction.

Sex-Specific Prognostic Value of Automated Epicardial Adipose Tissue Quantification on Serial Lung Cancer Screening Chest CT.

Aims: Epicardial adipose tissue (EAT) is a metabolically active fat depot associated with coronary atherosclerosis and cardiovascular (CV) risk. While EAT is a known prognostic marker in lung cancer screening, its sex-specific prognostic value remains unclear. This study investigated sex differences in the prognostic utility of serial EAT measurements on low-dose chest CTs.

Survival After Initial Stress Testing vs Anatomic Testing in Suspected Coronary Artery Disease: Long-Term Follow-Up of the PROMISE Randomized Clinical Trial.

Importance: Symptoms suggestive of coronary artery disease (CAD) often require noninvasive testing for diagnostic and prognostic evaluation.

Objective: To determine long-term outcomes in patients randomized to functional (stress) vs anatomic (coronary computed tomographic angiography [CTA]) initial testing.

Design, Setting, And Participants: This study is a 2025 follow-up analysis of mortality of participants in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) randomized clinical trial, which was conducted from 2009 to 2014, using a 2024 National Death Index search.

Frailty, Pitavastatin, and Major Adverse Cardiovascular Events Among People With HIV.

Background: People with HIV (PWH) are at increased risk for atherosclerotic cardiovascular diseases (ASCVDs) and geriatric syndromes, including frailty. REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) demonstrated a 36% reduction in major adverse cardiovascular events (MACE) with pitavastatin vs placebo but the role of statins for ASCVD prevention among frail PWH is not known.

Objectives: The purpose of this study was to evaluate whether frailty is associated with MACE and whether pitavastatin prevents MACE regardless of frailty.

Deep Learning Chest X-Ray Age, Epigenetic Aging Clocks and Associations with Age-Related Subclinical Disease in the Project Baseline Health Study.

Background: Chronological age is an important component of medical risk scores and decision-making. However, there is considerable variability in how individuals age. We recently published an open-source deep learning model to assess biological age from chest radiographs (CXR-Age), which predicts all-cause and cardiovascular mortality better than chronological age.

External Testing of a Deep Learning Model for Lung Cancer Risk from Low-Dose Chest CT.

Background Sybil, an open-source deep learning model that uses low-dose CT (LDCT) for lung cancer prediction, requires rigorous external testing to confirm generalizability. Additionally, its utility in identifying individuals with high risk who never smoked or have light smoking histories remains unanswered. Purpose To externally test Sybil for identifying individuals with high risk for lung cancer within an Asian health checkup cohort.

No evidence of pitavastatin effect on muscle area or density among people with HIV.

Background: Skeletal muscle area (MA) and muscle density (MD) are key determinants of physical function and typically decline with increasing age. Statins have well-known musculoskeletal effects but whether statins impact MA or MD is not well established, especially in the setting of randomized treatment.

Methods: REPRIEVE is a double-blind randomized trial evaluating the effect of pitavastatin for primary prevention of major adverse cardiovascular events in people with HIV (PWH).

An open-source, automated machine learning approach for large-scale image retrieval for thoracic aorta analysis studies.

Objective: To develop an image retrieval pipeline capable of identifying specific series of thoracic aortic computed tomography (CT) scans from a diverse database.

Materials And Methods: An automated image analysis pipeline was developed to select series that show the entire thoracic aorta with arterial phase contrast from within a heterogeneous institutional cohort of 4184 CT scans of the chest.

Results: The automated pipeline identified 3435 (82%) studies from within the database that met criteria.

Aging-related changes in body composition across the lifespan - insights from over 66.000 individuals of a Western European population.

Body composition (adiposity and muscle depots) is strongly associated with cardiometabolic risk. However, using body composition measures for future disease risk prediction is difficult as they may reflect total body size or typical aging rather than poor health. We used data from the UK Biobank (UKB) and the German National Cohort (NAKO) to calculate age-, sex-, and height-specific z-scores for body composition measures (subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), skeletal muscle (SM), SM fat fraction (SMFF), and intramuscular adipose tissue (IMAT)) and describe changes across the lifespan.

Effect of Pitavastatin on Epigenetic Aging Biomarkers in People With HIV: Pilot Substudy of the REPRIEVE Trial.

Background: People with human immunodeficiency virus (HIV, PWH) exhibit increased cardiovascular disease (CVD) risk and accelerated biological aging. REPRIEVE demonstrated that pitavastatin reduced major adverse cardiovascular events (MACE) in antiretroviral therapy (ART)-treated PWH with low-to-moderate traditional cardiovascular risk. It remains unknown whether statin therapy can modulate epigenetic aging in PWH.

Baseline atrial volume indices and major adverse cardiac events following thoracic radiotherapy.

Introduction: Patients receiving thoracic radiotherapy (RT) have an increased risk of major adverse cardiac events (MACE) posttreatment. We utilized machine learning (ML) to discover novel predictors of MACE and validated them on an external cohort.

Methods: This multi-institutional retrospective study included 984 patients [ = 803 non-small cell lung cancer (NSCLC),  = 181 breast cancer] treated with radiotherapy.

Effects of antiretrovirals on major adverse cardiovascular events in the REPRIEVE trial: a longitudinal cohort analysis.

Background: In the REPRIEVE trial of statin therapy in people with HIV, pitavastatin reduced major adverse cardiovascular events (MACE) among those with low-to-moderate risk of cardiovascular disease (CVD). We aimed to investigate associations between former and current use of antiretroviral therapy (ART) on entry into the REPRIEVE trial and the development of MACE.

Methods: This longitudinal cohort analysis was a prespecified secondary analysis of the REPRIEVE trial, a double-blind, placebo-controlled, multicentre, phase 3 randomised trial conducted at 137 sites in 12 countries.

Risks for sudden cardiac and undetermined cause of death among people with HIV in the REPRIEVE primary cardiovascular prevention trial.

Objective: People with HIV (PWH) are at increased risk of sudden cardiac death (SCD) but the mechanisms are unclear limiting prevention efforts. We leveraged the global REPRIEVE trial with carefully adjudicated atherosclerotic cardiovascular disease (ASCVD) outcomes to determine cardiac, behavioral, and HIV-specific risks associated with SCD and assess potential similarities to undetermined deaths (UDD).

Design/methods: REPRIEVE included 7769 PWH with low-to-moderate traditional ASCVD risk without known ASCVD randomized to pitavastatin vs.

Coronary Plaque, Inflammation, Subclinical Myocardial Injury, and Major Adverse Cardiovascular Events in the REPRIEVE Substudy.

Background: In REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV), pitavastatin prevented major adverse cardiovascular events (MACE) and reduced noncalcified coronary plaque (NCP) among people with HIV and low-to-moderate traditional cardiovascular disease (CVD) risk.

Objectives: The purpose of this study was to assess the relationship of coronary plaque, inflammation, and subclinical myocardial injury with MACE.

Methods: A total of 804 REPRIEVE Mechanistic Substudy participants enrolled from April 2015 to February 2018 at 31 U.

Periaortic Fat Attenuation on Nongated Noncontrast Chest CT Images to Assess Changes in Arterial Inflammation: Impact of Atorvastatin.

Background: Imaging markers of atherosclerotic inflammation are needed to enhance cardiovascular risk assessment and evaluate the impact of therapies. We sought to test the hypothesis that treatments impacting arterial inflammation can be evaluated using a simplified measure of periaortic fat attenuation (FA) assessed on noncontrast, nongated computed tomography of the descending thoracic aorta.

Methods: Measurements were performed on F-fluorodeoxyglucose positron emission tomography/computed tomography images from a double-blind, randomized trial conducted between 2008 and 2009 that assessed the impact of statin therapy on arterial inflammation.

Factors Affecting Risk of CVD Events in a Global CVD Prevention Cohort of People with HIV.

Background: PWH face increased risks of major adverse cardiovascular disease (MACE), partially mitigated by statin therapy.

Methods: We characterized factors associated with MACE and MACE subcomponents among a global cohort of PWH in REPRIEVE. Our primary outcome measure was time-to-first primary MACE.

Cardiovascular Hazards of Abacavir- Versus Tenofovir-Containing Antiretroviral Therapies: Insights From an Analysis of the REPRIEVE Trial Cohort.

Background: Prior analyses suggest that the nucleoside reverse transcriptase inhibitor (NRTI) abacavir (ABC), but not tenofovir (TFV), is associated with a 2-fold increase in the hazard of myocardial infarction. the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) is ideally suited to evaluate the role of ABC and the TFV backbones, tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF), in major adverse cardiovascular events (MACE).

Methods: We compared hazard of first MACE among people living with human immunodeficiency virus (HIV) at low-to-moderate cardiovascular risk using ABC (n = 883), TAF (n = 957), and TDF (n = 4274) at entry.

Statin effects on the incidence of major non-cardiovascular disease events among a global cohort of people with HIV: a randomised controlled trial.

Background: Given the pleiotropic effects of statins beyond lipid-lowering, statins might positively impact other, non-cardiovascular diseases (non-CVDs). In this study, we prospectively assessed statin effects on non-CVD events and their incidence among people with HIV globally.

Methods: The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE; ClinicalTrials.

Predicting Respiratory Disease Mortality Risk Using Open-Source AI on Chest Radiographs in an Asian Health Screening Population.

Purpose To assess the prognostic value of an open-source deep learning-based chest radiographs algorithm, CXR-Lung-Risk, for stratifying respiratory disease mortality risk among an Asian health screening population using baseline and follow-up chest radiographs. Materials and Methods This single-center, retrospective study analyzed chest radiographs from individuals who underwent health screenings between January 2004 and June 2018. The CXR-Lung-Risk scores from baseline chest radiographs were externally tested for predicting mortality due to lung disease or lung cancer, using competing risk analysis, with adjustments made for clinical factors.

Air pollution, coronary artery disease, and cardiovascular events: Insights from the PROMISE trial.

Background: Air pollution is associated with mortality and major adverse cardiovascular events (MACE) in the general population. However, little is known about the relationship between air pollution and coronary artery disease (CAD) and how this relates to MACE.

Methods: This study utilized data from the computed tomography (CT) arm of the PROMISE trial investigating symptomatic individuals with suspected CAD.

Olezarsen in patients with hypertriglyceridemia at high cardiovascular risk: Rationale and design of the Essence-TIMI 73b trial.

Background: Elevated triglycerides are an important risk factor for atherosclerosis. However, the magnitude of triglyceride lowering with currently available therapies is modest and the impact of triglyceride-lowering on atherosclerosis remains undefined. Olezarsen is an antisense oligonucleotide (ASO) targeting mRNA for apolipoprotein C-III (apoC-III), an inhibitor of triglyceride clearance.