Clinical and genetic landscape of individuals evaluated in a CHIP cardiology clinic: A single-center experience, 2020 to 2025.

Abstract

6593 Background: Despite growing observational data linking clonal hematopoiesis of indeterminate potential (CHIP) to adverse cardiovascular outcomes, the cardiovascular evaluation and management of individuals with clonal hematopoiesis remain undefined. We report the experience of a dedicated CHIP Cardiology Clinic. Methods: We conducted a retrospective review of patients evaluated in the CHIP Cardiology Clinic at the Brigham and Women’s Hospital. Baseline demographics, comorbidities, medication use, and treatment interventions were extracted from the electronic medical record. Results: Fifty-three patients were evaluated between 2020 and 2025, of whom 39 (73.6%) had clonal hematopoiesis (CH), out of which 12 (30.8%) met criteria for CHIP. Among individuals with CH, the most frequently identified mutations were D N M T 3 A (30, 76.9%), T E T 2 (23, 59.0%), and A S X L 1 (6, 15.4%). The mean age was 65.9 years (range 40-81), and 23 (58.9%) were male. Hypertension and dyslipidemia were each present in 23 (59.0%) patients. Existing cardiovascular diseases included coronary artery disease (7, 18.0%) and arrhythmias (3, 7.7%). Following evaluation in the CHIP Clinic, and shared decision-making discussion in view of the dearth of evidence regarding outcome improvement in those with CHIP, lipid-lowering therapies were initiated or increased in 28 (71.8%) patients, with statins initiated or dose escalated in 21 (53.8%) and ezetimibe in 11 (28.2%). Blood pressure medications were initiated or intensified in 5 (12.8%) patients. Ischemic evaluation was performed in 3 (7.7%) patients due to suggestive symptoms. We developed a “patient page” to acquaint the patients and families with CHIP. (https://doi.org/10.1001/jamacardio.2024.3773). Conclusions: In this first longitudinal report from a dedicated CHIP Cardiology Clinic, a substantial proportion of patients harbored somatic mutations associated with elevated cardiovascular risk. Institution of preventive cardiovascular medications, in particular lipid-lowering therapies, was a frequent intervention. These findings support the feasibility of CHIP-focused cardiovascular care but underscore the need for prospective trials to evaluate the impact of targeted preventive strategies in this population.