Seth S Martin

Johns Hopkins Medicine | JHUSOM · Ciccarone Center for the Prevention of Cardiovascular Disease

BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood...

Background: Hybrid cardiac rehabilitation (HCR) is an emerging approach to increase participation in cardiac rehabilitation, which targets improvements in functional status and broader risk factor modification including lipid management. However, long-term lipid control trends of patients engaging in HCR remain unexplored. Methods: Using data from...

This narrative review aims to equip clinicians with an understanding of how digital health innovations and artificial intelligence can be applied to clinical care pathways for cardiovascular prevention. We describe a case that highlights augmentative AI for the incidental detection of coronary artery calcium, a mobile application to improve patient...

Background The metabolic syndrome phenotype of individuals with obesity is characterized by elevated levels of triglyceride‐rich lipoproteins and remnant particles, which have been shown to be significantly atherogenic. Understanding the association between adipokines, endogenous hormones produced by adipose tissue, and remnant cholesterol (RC) wou...

Background The COVID-19 pandemic prompted rapid expansion of telemedicine to access subspecialty care. However, potential disparities in access to telemedicine in cardiology remain to be fully characterized. Objectives The authors aimed to study whether telemedicine visit modality (video or audio only) differed by sociodemographic characteristics...

Background Prior studies have shown that cardiovascular disease (CVD) can be effectively managed through telehealth. However, there are little national data on the use of telehealth in people with CVD or CVD risk factors. We aimed to determine the prevalence of telehealth visits and visit modality (video versus audio‐only) in people with CVD and CV...

Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have surged in popularity in recent years, with discussions about their on-label and off-label use spilling into the public forum. No study has analyzed online discussions about GLP-1RAs. Objectives The purpose of this study was to analyze perceptions of GLP-1RAs on social media. Met...

Objective Elevated lipoprotein(a) [Lp(a)] is an independent, genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD). We evaluated the frequency of testing for elevated Lp(a) and subsequent management at the Johns Hopkins Hospital, a large academic medical center, over a 5-year period. Methods The Johns Hopkins Hospit...

Purpose of Review To provide the reader with an overview of how smartwatches may be used for arrhythmia detection, diagnosis, and management. Recent Findings Various rhythm-monitoring wearable devices are currently available in the consumer market. Studies are ongoing to evaluate the impact of smartwatches in clinical decision making and cardiovas...

Background Telemedicine expanded during the COVID-19 pandemic, though use differed by age, sex, race or ethnicity, educational attainment, income, and location. It is unclear if high telehealth use or inequities persisted late into the pandemic. Objective This study aims to evaluate the prevalence of, inequities in, and primary reasons for telehea...

Objective Assess the yield of genetic testing for pathogenic variants in ABCG5, ABCG8, LIPA, and APOE in individuals with personal and family histories suggestive of familial hypercholesterolemia. Methods Retrospective review of patients seen in the Advanced Lipid Disorders Clinic at Johns Hopkins Results In the lipid clinic at a single center du...

Background: Digital health technologies are rapidly evolving and transforming the care of diabetes and cardiovascular disease (CVD). Purpose of the review: In this review, we discuss emerging approaches incorporating digital health technologies to improve patient outcomes through a more continuous, accessible, proactive, and patient-centered app...

Background: Normal serum total cholesterol (TC) based on standard lab definitions is typically considered <200 mg/dL. However, normal TC levels do not indicate optimal levels of low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C), the two measures most associated with risk of atherosclerotic cardiovas...

Background: Telehealth use remains high following the COVID-19 pandemic, but patient satisfaction with telehealth care is unclear. Methods: We used cross-sectional data from the Health Information National Trends Survey (HINTS 6). 2,058 English and Spanish-speaking U.S. adults (≥18 years) with a telehealth visit in the 12 months before March-Novemb...

Cumulative exposure to low-density lipoprotein cholesterol (LDL-C) is a key driver of atherosclerotic cardiovascular disease (ASCVD) risk. An armamentarium of therapies to achieve robust and sustained reduction in LDL-C can reduce ASCVD risk. The gold standard for LDL-C assessment is ultracentrifugation but in routine clinical practice LDL-C is usu...

BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood...

Background Cardiac rehabilitation (CR) is an evidence‐based, guideline‐recommended intervention for patients recovering from a cardiac event, surgery or procedure that improves morbidity, mortality, and functional status. CR is traditionally provided in‐center, which limits access and engagement, most notably among underrepresented racial and ethni...

This “Point” contends that now is the time for all laboratories to recognize the importance of more accurately reporting clinically valid lipid results, notably low-density lipoprotein cholesterol (LDL-C). In 2013, one of us (S.S.M.) and colleagues introduced a novel solution (1) that has been robustly validated in numerous studies across varying p...

Although great progress has been made in the diagnostic and treatment options for dyslipidemias, unawareness, underdiagnosis and undertreatment of these disorders remain a significant global health concern. Growth in digital applications and newer models of care provide novel tools to improve the management of chronic conditions such as dyslipidemi...

Dietary supplements augment the nutritional value of everyday food intake and originate from the historical practices of ancient Egyptian (Ebers papyrus), Chinese (Pen Ts’ao by Shen Nung), Indian (Ayurveda), Greek (Hippocrates), and Arabic herbalists. In modern-day medicine, the use of dietary supplements continues to increase in popularity with gr...

Introduction: Strong evidence supports that (1) risk factor modification (RFM), (2) stroke prevention, (3) rhythm and (4) rate control are the four pillars of atrial fibrillation (Afib) management. Critical gaps exist in the clinical implementation of these four pillars. Patients and clinicians have identified lack of patient education as a major c...

Introduction: Racial differences in Lp(a) distributions are well known, with higher levels in Black adults compared to White adults. It is unclear whether the risk implications of higher Lp(a) levels are the same in Black and White adults. Furthermore, the contribution of racial differences in Lp(a) to disparities in ASCVD in the US has not been we...

BACKGROUND: Despite the well-established benefits of cardiac rehabilitation (CR) for secondary prevention of cardiovascular disease, participation remains low due to limited supply and access barriers. We built a hybrid CR program that combines in-person and home-based CR (with smartphone app (Corrie Health), smartwatch, Bluetooth blood pressure mo...

Background Guideline-directed medical therapies (GDMTs) improve quality of life and health outcomes for patients with heart failure (HF). However, GDMT utilization is suboptimal among patients with HF. Objective The aims of this study were to engage key stakeholders in semistructured, virtual human-centered design sessions to identify challenges i...

Purpose of Review We review under-representation of key demographic groups in cardiovascular clinical trials, focusing on lipid-lowering trials. We outline multilevel strategies to recruit and retain diverse populations in cardiovascular trials. Recent Findings Barriers to participation in trials occur at the study, participant, health system, spo...

Introduction To evaluate the relationship between ENDS use and the risk of stroke when compared to non-smokers. Material and methods A comprehensive search was conducted until June 15, 2023. Results 6 studies with 1,024,401 participants were included in our analysis. ENDS use was associated with a significant increased risk of stroke (OR: 1.52; 9...

BACKGROUND Telemedicine expanded during the COVID-19 pandemic, though use differed by age, sex, race or ethnicity, educational attainment, income, and location. It is unclear if high telehealth use or inequities persisted late into the pandemic. OBJECTIVE This study aims to evaluate the prevalence of, inequities in, and primary reasons for telehea...

Background: There is good evidence showing that inactivity and walking minimal steps per day increase the risk of cardiovascular (CV) disease and general ill-health. The optimal number of steps, and their role in health is however still unclear. Therefore, in this meta-analysis, we aimed to evaluate the relationship between step count and all-cause...

Multiple lines of evidence confirm that the cumulative burden of low-density lipoprotein cholesterol (LDL-C) is causally related to the development of atherosclerotic cardiovascular disease (ASCVD). As such, lowering LDL-C is a central tenet in all ASCVD prevention guidelines, which recommend matching the intensity of LDL-C lowering with the absolu...

Background: Alternatives to the Friedewald low-density lipoprotein cholesterol (LDL-C) equation have been proposed. Objective: To compare the accuracy of available LDL-C equations with ultracentrifugation measurement. Methods: We used the second harvest of the Very Large Database of Lipids (VLDbL), which is a population-representative convenience s...

About one out of ten US adults have diabetes mellitus (DM), and this prevalence is estimated to significantly increase in the years to come. Dyslipidemia is highly prevalent among patients with DM and plays a key role in the development of atherosclerosis. Several pathological changes occur at the cellular level in the vascular wall that are not ex...

Diabetes mellitus is associated with high rates of atherosclerosis-related cardiovascular events. Rigorous randomized controlled trials have shown consistently beneficial effects with statin treatment in patients with diabetes mellitus, reducing event rates. The beneficial effects are seen consistently with low-density lipoprotein cholesterol lower...

Cardiac rehabilitation has strong evidence of benefit across many cardiovascular conditions but is underused. Even for those patients who participate in cardiac rehabilitation, there is the potential to better support them in improving behaviors known to promote optimal cardiovascular health and in sustaining those behaviors over time. Digital tech...

Background Homozygous familial hypercholesterolemia (HoFH) is a rare, treatment‐resistant disorder characterized by early‐onset atherosclerotic and aortic valvular cardiovascular disease if left untreated. Contemporary information on HoFH in the United States is lacking, and the extent of underdiagnosis and undertreatment is uncertain. Methods and...

Background The metabolic syndrome phenotype of individuals with obesity is characterized by elevated levels of triglyceride (TG)-rich lipoproteins and remnant particles, which have been shown to be significantly atherogenic. Understanding the association between adipokines, endogenous hormones produced by adipose tissue, and remnant cholesterol (RC...

Background: Disparities in hypertension outcomes persist among Black and Hispanic adults and persons living in poverty in the United States. The "LINKED-BP Program" is a multi-level intervention linking home blood pressure (BP) monitoring with a mobile health application, support from community health workers (CHWs), and BP measurement training at...

The American Heart Association recently published updates to its definition of cardiovascular health (CVH) in its Presidential Advisory called Life's Essential 8. In particular, the update from Life's Simple 7 added a new component of sleep duration and refined definitions of prior components, including measurement of diet, nicotine exposure, blood...

Introduction: Despite overwhelming evidence that guideline-directed medical therapies (GDMT) for heart failure (HF) can reduce mortality and improve quality of life, significant gaps in treatment optimization persist. GDMT initiation and up-titration are especially critical for improving patient outcomes post-hospitalization. Objective: Identify ch...

Background: Hypertension disparities persist in underserved populations in the United States. Presently, few implementation trials have focused on adults with elevated blood pressure (BP) or untreated stage 1 hypertension. To address this scientific gap, we have developed a pragmatic cluster-randomized controlled trial, the “LINKED-BP Program,” a p...

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glu...

Background Depression is a nontraditional risk factor for cardiovascular disease (CVD). Data on the association of depression and poor mental health with CVD and suboptimal cardiovascular health (CVH) among young adults are limited. Methods and Results We used data from 593 616 young adults (aged 18–49 years) from the 2017 to 2020 Behavioral Risk...

Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote del...

Objective Longitudinal trajectories of cardiovascular health (CVH) may reflect vascular risk burden due to prolonged cumulative exposure to non-ideal CVH levels. Identifying individuals who have a higher risk CVH trajectory may facilitate treatment, screening, and prevention. We aimed to characterize 10-year trajectories of CVH and examine the asso...

Background : According to the 2022 American Heart Association Heart Disease and Stroke Statistics, coronary heart disease remains the leading cause of death attributable to cardiovascular disease (CVD). In 2016 only ~1 in 4 Medicare beneficiaries who were eligible for cardiac rehab (CR) participated. We explored the use of cardiovascular biomarkers...

Introduction: The metabolic phenotype of obesity is characterized by high levels of triglyceride (TG)-rich lipoproteins and remnant particles, which are atherogenic. Adipokines are endogenous hormones released from adipose tissue with several metabolic effects. We aimed to assess the association between adipokines and levels of remnant cholesterol...

Background: Cardiac rehabilitation (CR) is an effective program for the secondary prevention of cardiovascular disease. Novel CR delivery methods are needed to increase access in an equitable and cost-effective manner. Herein, we present lessons learned in developing and implementing our hybrid CR program. Methods: We established a 5-step approach...

Introduction: Homozygous familial hypercholesterolemia (HoFH) is an inherited autosomal co-dominant disorder characterized by severely elevated circulating low-density lipoprotein (LDL). Monoclonal antibodies are now a treatment focus. Inhibition of proprotein convertase subtilisin kexin type 9 (PCSK9) increases the number of LDL receptors. Inhibit...

Importance: Clinical hyperthyroidism accelerates bone resorption without compensatory bone formation, reducing bone density and increasing the risk of fracture. The association between subclinical hyperthyroidism and fracture risk is less clear. Objective: To investigate the association of endogenous subclinical thyroid dysfunction and fracture...

Despite the rapid growth of wearables as a consumer technology sector and a growing evidence base supporting their use, they have been slow to be adopted by the health system into clinical care. As regulatory, reimbursement and technical barriers recede, a persistent challenge remains how to make wearable data actionable for clinicians - transformi...

This case report describes a 67-year-old African-American woman with homozygous familial hypercholesterolemia caused by 2 pathogenic variants in the LDLR gene. Initial surgical, pharmacological, and low-density lipoprotein apheresis interventions were insufficient; the addition of proprotein convertase subtilisin-kexin type 9 and angiopoietin-like...

Background: Smartphone ownership and mobile app use are steadily increasing in individuals of diverse racial and ethnic backgrounds living in the United States. Growing adoption of technology creates a perfect opportunity for digital health interventions to increase access to health care. To successfully implement digital health interventions and...

Atherosclerosis is a systemic disease that affects all vascular beds, including coronary, cerebral, and peripheral arteries. With an estimated 236.6 million people living with peripheral artery disease (PAD), its prevalence ranks only behind coronary artery disease (CAD) and ischemic stroke in atherosclerotic diseases (Song et al., Lancet Glob Heal...

Background Mobile health (mHealth) has an emerging role in the prevention of cardiovascular disease. This study evaluated possible inequities in mHealth access in older adults. Methods and Results mHealth access was assessed from 2019 to 2020 in MESA (Multi‐Ethnic Study of Atherosclerosis) telephone surveys of 2796 participants aged 62 to 102 year...

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Machine learning (ML) refers to computational algorithms that iteratively improve their ability to recognize patterns in data. The digitization of our healthcare infrastructure is generating an abundance of data from electronic health records, imaging, wearables, and sensors that can be analyzed by ML algorithms to generate personalized risk assess...

Purpose of Review Internationally, cardiovascular disease (CVD) is the leading cause of death in women. With risk factors for CVD continuing to rise, early identification and management of chronic diseases such as hypertension, diabetes, and obstructive sleep apnea is necessary for prevention. Pregnancy is a natural stress test for women with risk...

Background Documenting trends in risk factors among individuals with cardiovascular disease (CVD) may inform policy and secondary prevention initiatives. Objectives This study aimed to examine 20-year trends in risk profiles among U.S. adults with CVD and any racial/ethnic disparities. Methods In this serial cross-sectional analysis of 6,335 adul...

Background Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a serine protease that is a mediator of the immune response to sepsis. PCSK9 is also highly expressed in pneumocytes and pulmonary endothelial cells. We hypothesized that serum PCSK9 levels would be associated with death and ICU outcomes in patients with ARDS. Methods Using data a...

Launching an academic career in cardiology can be challenging. Mentorship has long been considered a core component in the academic career advancement of trainees across different disciplines and career stages, including cardiovascular disease. But simply having a mentor may not be sufficient to embark on a successful academic journey in cardiology...

Purpose of Review We discuss current controversies in the clinical use of omega-3 fatty acids (FA), primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and examine discrepancies between recent trials. Furthermore, we discuss potential side effects reported in these studies and the role of mixed omega-3 FA dietary supplements and c...

Stagnating COVID-19 vaccination rates and vaccine hesitancy remain a threat to public health. Improved strategies for real-time tracking and estimation of population-level behavior regarding vaccinations are needed. The aim of this study was to evaluate whether online search trends for COIVD-19 and influenza mirror vaccination rates. State-level we...

Background Aspirin is widely administered to prevent cardiovascular disease (CVD). However, appropriate use of aspirin depends on patient understanding of its risks, benefits, and indications, especially where aspirin is available over the counter (OTC). Methods and Results We did a survey of patient‐reported 10‐year cardiovascular risk; aspirin t...