It is unclear which blood pressure (BP) components in young adulthood determine cardiovascular disease (CVD) by middle age. Yano and coauthors report longitudinal data in 4880 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study (mean age at enrollment, 24.9 years). During 25-year follow-up, 210 CVD events occurred, with twice as many events occurring in black adults. Risk of CVD was associated with systolic BP but not diastolic BP in black participantss but with diastolic BP rather than systolic BP in white participants. This questions the classic view that diastolic BP identifies future CVD events more so than systolic BP in all young adults. In a commentary, Navar and Peterson note that hypertension is likely to represent more than a single disease, modified by race/ethnicity and age.
Prognostic data on coronary artery calcium (CAC) are limited in younger adults. Carr and coauthors studied 3043 participants aged 32 to 46 years in the Coronary Artery Risk Development in Young Adults (CARDIA) study and identified CAC in 309 participants (10.2%). During 12.5-year follow-up, any degree of CAC, even low scores, was associated with CVD events. A selective screening strategy based on CVD risk factors in young adults could reduce the number needed to image to find 1 person with CAC to 2.2. Blankstein and Greenland indicate in an editorial that future studies are needed to better select appropriate candidates for CAC testing, more so in younger than in older individuals.
Evaluating quality of life (QOL) in patients after transcatheter aortic valve replacement is critically important. Arnold and coauthors examined outcomes in patients treated from November 2011 through March 2016 at more than 450 sites in the national Transcatheter Valve Therapy Registry. At 30 days (31 636 patients) and 1 year (7014 patients), surviving patients (median age, 84 years) had large improvements in QOL, measured with the Kansas City Cardiomyopathy Questionnaire. Although QOL results were favorable for most patients, approximately 1 in 3 had a poor outcome. Alexander discusses in a commentary that the ability to anticipate symptoms and QOL after transcatheter aortic valve replacement with more informed selection is central to achieving goals of care.
Invited Commentary and Editor's Note
The phenotypic spectrum of sarcomere mutations in those with hypertrophic cardiomyopathy (HCM) is not fully known. Ho and coauthors conducted a multicenter observational study in the HCMNet network to characterize 136 mutation carriers with and without left ventricular (LV) hypertrophy. Mutation carriers had smaller LV cavities, higher LV wall thickness (WT) to diastolic diameter ratios, and higher LV ejection fractions than gene-negative family controls. Mutation carriers showed a continuous correlation between clinical variables and LVWT but no clear LVWT threshold signifying pathologic transition. Tardiff notes in a commentary that the complexity of sarcomeric HCM will require novel diagnostic and translational approaches and that the present study moves closer to these important goals.
Author Audio Interview
Highlights. JAMA Cardiol. 2017;2(4):349. doi:10.1001/jamacardio.2016.3639