RESUMO
BACKGROUND: Lean metabolic dysfunction-associated steatotic liver disease (MASLD), characterized by a BMI < 25 kg/m² (or < 23 kg/m² in Asians), presents a challenging prognosis compared to non-lean MASLD. This study examines cardiovascular outcomes in both lean and non-lean MASLD cohorts. METHODS: In this meta-analysis, pooled odds ratios (ORs) within 95 % confidence intervals (CIs) were calculated for primary outcomes (cardiovascular mortality and major adverse cardiovascular events [MACE]) and secondary outcomes (cardiovascular disease [CVD], all-cause mortality, hypertension, and dyslipidemia). Studies comparing lean and non-lean MASLD within the same cohorts were analyzed, prioritizing those with larger sample sizes or recent publication dates. RESULTS: Twenty-one studies were identified, encompassing lean MASLD patients (n = 7153; mean age 52.9 ± 7.4; 56 % male) and non-lean MASLD patients (n = 23,514; mean age 53.2 ± 6.8; 63 % male). Lean MASLD exhibited a 50 % increase in cardiovascular mortality odds compared to non-lean MASLD (OR: 1.5, 95 % CI 1.2-1.8; p < 0.0001). MACE odds were 10 % lower in lean MASLD (OR: 0.9, 95 % CI 0.7-1.2; p = 0.7), while CVD odds were 40 % lower (p = 0.01). All-cause mortality showed a 40 % higher odds in lean MASLD versus non-lean MASLD (p = 0.06). Lean MASLD had 30 % lower odds for both hypertension (p = 0.01) and dyslipidemia (p = 0.02) compared to non-lean MASLD. CONCLUSION: Despite a favorable cardiometabolic profile and comparable MACE rates, lean individuals with MASLD face elevated cardiovascular mortality risk.
Assuntos
Doenças Cardiovasculares , Humanos , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/epidemiologia , Índice de Massa Corporal , Magreza/epidemiologia , Magreza/complicações , Morbidade/tendências , Prognóstico , Fatores de RiscoRESUMO
IMPORTANCE: Chicago is one of the most racially segregated cities in the US, with the largest mortality gap between neighborhoods. Computed tomographic coronary artery calcium scoring (CACS) is an excellent risk stratification tool, but costs about $200 out-of-pocket, making it inaccessible to some. OBJECTIVE: To determine whether this ACC/AHA guideline-recommended screening tool is accessible to all populations and neighborhoods, we evaluated the price and availability of CACS in Chicago area hospitals. DESIGN: We used the Illinois Department of Public Health list of area hospitals to inquire about CACS availability and price. We compared these results to US Census Bureau data for each hospital's service area's demographic, ethnic and socioeconomic population characteristics. RESULTS: Out of the 40 hospitals in Chicagoland, 30 offered CACS. The 10 hospitals without CACS were smaller hospitals in zip codes with a higher population density (p â< â0.01), higher poverty rates (22% vs. 13%, p â< â0.01), lower percentage of white population (p â< â0.02), lower frequency of higher education (35% vs. 51%, p â< â0.05), and a trend toward more black residents (p â< â0.10). Life expectancy was greater in areas with CACS available (78 vs. 75 years, p â< â0.05). Even in areas with CACS, there was wide price variation, with higher prices in poorer areas (r â= â0.57, p â< â0.01). The highest vs. lowest quintile of income had higher education, larger white population (80% vs. 14%, p â< â0.0001), and longer life expectancy (81 vs. 72 years, p â< â0.0002), but tended to have a lower price of CACS ($86 vs. $487, p â< â0.08). CONCLUSIONS AND RELEVANCE: CACS is a powerful, evidenced-based clinical tool, but the availability and price vary widely in Chicagoland, and directly correlate with the socioeconomic and health care disparities that are known to exist. Removing these barriers to coronary artery disease screening may be one method to improve the poor cardiovascular outcomes in these areas.
Assuntos
Cálcio , Doença da Artéria Coronariana , Angiografia Coronária/métodos , Doença da Artéria Coronariana/epidemiologia , Vasos Coronários/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Fatores SocioeconômicosRESUMO
Primary mural endocarditis without valvular involvement is rare and most often involves the ventricular endocardium. Left atrial mural endocarditis is an extremely rare subset of infective endocarditis. We describe a case of a young woman with left atrial mural endocarditis without significant structural or valvular heart disease.