Journal of atherosclerosis and thrombosis最新文献

Aims: Increased arterial stiffness is associated with the severity of cerebral small-vessel disease (SVD) and may predict incident dementia. This study investigated the predictive value of brachial-ankle pulse wave velocity (ba-PWV) for dementia and cognitive decline.

Methods: Data were obtained from a Japanese cohort of 478 patients who underwent ba-PWV measurement. Magnetic resonance imaging (MRI) was used to evaluate SVD severity. The Mini-Mental State Examination (MMSE) and the Japanese version of the Montreal Cognitive Assessment (MoCA-J) were used to assess the cognitive function. The primary outcome was the incidence of dementia. The secondary outcome was cognitive change during three years of follow-up.

Results: The median age was 71 years old, 61% were men, and the median ba-PWV was 1787 cm/s. Dementia was diagnosed in 23 patients during a mean follow-up of 4.8 years. A Cox proportional hazard regression analysis revealed that the highest quartile (ba-PWV ≥ 2102 cm/s) was associated with a significantly higher risk of dementia than the first to third quartiles (ba-PWV ≤ 2099 cm/s) after adjusting for risk factors, the mean blood pressure, the MoCA-J score, and SVD severity (adjusted HR, 3.40; 95% CI, 1.24-9.34; P=0.018). Longitudinal cognitive changes in 192 patients indicated that ba-PWV was negatively related to changes in the MoCA-J score (r=-0.184, P=0.011). The decline in the MoCA-J score in the highest quartile was greater than that in the first to third quartiles after adjusting for risk factors, SVD severity, and baseline MoCA-J score (P=0.017).

Conclusions: ba-PWV was associated with incident dementia and cognitive decline, independent of age, risk factors, the baseline cognitive function, and the SVD severity.

Atherosclerosis, a major contributor to cardiovascular diseases (CVD), remains a leading cause of global mortality and morbidity. The pathogenesis of atherosclerosis involves a complex interplay of endothelial dysfunction, chronic inflammation, lipid accumulation, and arterial stiffness. Among the various preventive strategies, physical activity has emerged as a highly effective, non-pharmacological intervention. This review examines the preventive effects of different types of exercise-specifically aerobic exercise, resistance training, and combined training-on atherosclerosis development. Drawing on evidence from landmark studies, we explore the underlying mechanisms by which these exercise modalities improve endothelial function, reduce systemic inflammation, and enhance lipid profiles, thereby mitigating the progression of atherosclerosis. Additionally, the review discusses the dose-response relationship between physical activity and cardiovascular health, the differential effects of exercise intensities, and the potential risks associated with high-intensity training. The synergistic benefits of combined aerobic and resistance training are highlighted, particularly in populations with metabolic syndrome or other high-risk conditions. Emerging trends in personalized exercise medicine and the use of wearable technology for monitoring physical activity are also addressed, underscoring the potential for tailored exercise prescriptions to maximize cardiovascular health. By integrating current research findings, this review provides insights into effective exercise strategies for reducing cardiometabolic risk and emphasizes the importance of personalized approaches in exercise interventions.

Aim: This study assessed the predictive value of pericarotid fat density (PFD) on carotid computed tomography angiography (CTA) for recurrent ischemic stroke or transient ischemic attack (TIA).

Methods: In total, 739 patients who underwent CTA between January 2014 and December 2021 were retrospectively included in this study. The PFD was evaluated using carotid CTA. The clinical endpoint was recurrent ischemic stroke or transient ischemic attack (TIA). The association between PFD and the endpoint was examined using Kaplan-Meier and Cox analyses. The combination model was established using significant clinical imaging risk factors and PFD. The predictive performance of the model was assessed using the receiver operating characteristic curve (ROC).

Results: A total of 739 patients (mean age: 64.28±9.44 years old, 496 males) completed a median of 3.31 years of follow-up (interquartile range, 2.11-4.05). During the follow-up period, 166 patients reached the clinical end point. The event-free survival (EFS) rate was lower in the high-PFD group than in the low-PFD group (log-rank P＜0.001). Multivariate Cox analyses showed that the PFD was associated with recurrent stroke or TIA (all P＜0.05). The combination model demonstrated excellent performance in predicting the clinical endpoint (area under the curve = 0.89). In addition, the endpoint event prognostic value was significantly improved by adding the PFD to the baseline model (C-statistic improvement: 0.61-0.84).

Conclusion: CTA-assessed PFD is an independent predictor of recurrent stroke or TIA.

Aim: Previous studies have shown that higher educational levels are associated with slower progression of arterial stiffness; however, evidence from Asian countries is lacking. We aimed to examine the association between educational level and arterial stiffness measured using the cardio-ankle vascular index (CAVI) over time in a sample of Japanese men and women.

Methods: A total of 1381 participants (453 men and 928 women) were included in the present study. Arterial stiffness was measured using the CAVI at baseline (2009-2012) and 5 years later (2014-2018). The educational level was divided into two groups (junior or senior high school vs. junior college, professional school, college, or higher) based on a self-administered questionnaire. A mixed-effects model was used to analyze the association between education and the CAVI at baseline and its change over 5 years. The participants were stratified by sex and age (＜65 vs. ≥ 65 years).

Results: The CAVI at baseline did not differ significantly according to education in any of the four subgroups accorded to age and sex. However, among women of ≥ 65 years of age, the change in the CAVI over 5 years was significantly smaller in the higher education group (p=0.04). No such association was found in women of ＜65 years of age or men.

Conclusions: Education is a factor that affects arterial stiffness in women of ≥ 65 years of age. These results suggest that educational level affects arterial stiffness, depending on sex and age.

Atherosclerotic cardiovascular disease (ASCVD) is a leading global cause of mortality, and recent research has underscored the critical role of lipoproteins in modulating cardiovascular (CV) risk. Elevated low-density lipoprotein cholesterol (LDL-C) levels have been linked to increased CV events, and while numerous trials have confirmed the efficacy of lipid-lowering therapies (LLT), significant gaps remain between recommended LDL-C targets and real-world clinical practice. This review addresses care gaps in LLT, emphasizing the necessity for innovative approaches that extend beyond LDL-C management. It explores combination therapy approaches such as statins combined with ezetimibe or PCSK9 inhibitors, which have shown promise in enhancing LDL-C reduction and improving outcomes in high-risk patients. Additionally, this review discusses new approaches in lipid modification strategies, including bempedoic acid, inclisiran, and drugs that lower Lp(a), highlighting their potential for CV risk reduction. Furthermore, it emphasizes the potential of polygenic risk scores to guide LLT and lifestyle changes despite challenges in implementation and genetic testing ethics. This article discusses the current guidelines and proposes innovative approaches for optimizing lipoprotein management, ultimately contributing to improved patient outcomes in ASCVD prevention.

Aim: We aimed to clarify the degree and factors associated with low-density lipoprotein (LDL)-cholesterol treatment target attainment among patients with heterozygous familial hypercholesterolemia (HeFH) using the Hokuriku-plus FH registry.

Methods: The Hokuriku-plus FH registry (UMIN000038210) was a prospective, observational, multicenter cohort study that enrolled consecutive patients with FH who fulfilled the clinical criteria for FH in Japan from 37 participating hospitals, mostly in the Hokuriku region, from April 2020 to March 2024. This registry collects data on clinical parameters, including lipid levels, physical findings, genetic background, and clinical events. In total, 431 patients were enrolled, and the median followup period was 3.1 years. We assessed the degree and factors associated with LDL-cholesterol treatment target attainment among patients with HeFH using the Hokuriku-plus FH registry.

Results: Among the 431 patients, sufficient data were collected from 386 patients. Logistic regression analysis revealed that male sex (odds ratio [OR] = 2.16, 95% confidence interval [CI]: 1.14-3.18, p＜0.001) and genetic testing (OR = 1.68, 95% CI: 1.10-2.26, p＜0.001) were significantly associated with LDL-cholesterol treatment target attainment. In fact, female patients were less likely to attain LDL-cholesterol treatment target than male patients (24.0% vs. 38.1%, p＜0.001), and patients who did not undergo genetic testing were less likely to attain LDL-cholesterol treatment target than those who underwent genetic testing (24.5% vs. 37.1%, p＜0.001).

Conclusion: Sex bias and masked genetic status are significant barriers to the clinical management of patients with HeFH.

Aims: Several risk-scoring models, including the Fukuoka Stroke Risk Score, Essen Stroke Risk Score, and Stroke Prognosis Instrument II, have been developed to predict recurrent cerebrovascular events in patients with ischemic stroke. As myocardial infarction (MI) and ischemic stroke are both atherosclerotic diseases, these scoring models in the field of cerebrovascular disease may be applicable and useful for risk stratification in patients with acute MI. We therefore evaluated the diagnostic ability and clinical applicability of these stroke risk scores in predicting atherosclerotic events after acute MI.

Methods: This multicenter retrospective study included 2016 patients with acute MI who underwent percutaneous coronary intervention and survived to discharge. The three risk-scoring models were calculated, and their diagnostic ability for major adverse cardiovascular events (MACE) after discharge, a composite of cardiovascular death, recurrent MI, and ischemic stroke, was evaluated.

Results: During the median follow-up of 523 days, 218 (10.8%) patients experienced MACE after discharge. High values for Fukuoka Stroke Risk Score, Essen Stroke Risk Score, and Stroke Prognosis Instrument II were progressively associated with an increased risk of MACE after discharge. Overall, the diagnostic abilities of the three risk scores were similar.

Conclusions: Risk prediction models in the field of ischemic stroke, including the Fukuoka Stroke Risk Score, Essen Stroke Risk Score, and Stroke Prognosis Instrument II, were useful in stratifying MACE risk in patients with acute MI. Risk-scoring models for atherosclerotic cardiovascular disease may be applicable to patient populations with other cardiovascular diseases in different arterial territories.

Aims: Atherogenic dyslipidemia (AD) is regarded as a residual risk of cardiovascular diseases characterized by low high-density lipoprotein cholesterol (HDL-C) and high triglyceride (TG) levels and related to the intracranial stenosis of atheromatous thrombotic brain infarction (ATBI). Further, atherosclerosis is possibly related to another stroke subtype, including cryptogenic stroke (CS). In particular, an aortic complicated lesion (ACL) is a notable embolic source of CS, since recurrence of aortogenic brain embolism is not rare. This study aimed to clarify the underlying association between AD and CS.

Methods: CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for ESUS/CS) had extensive data from CS patients who underwent transesophageal echocardiography (TEE). AD was defined as HDL-C ≤ 40 mg/dl and TG ≥ 150 mg/dl. Based on these criteria, patients were divided into an AD group and a non-AD group to compare the clinical features.

Results: Of 664 CS patients (446 men, 68.7±12.8 years), 68 (10.2%) met the criteria of AD (AD group), and 596 (89.8%) were in the non-AD group. On multiple logistic regression analysis, body mass index (unit OR 1.11, 95%CI 1.04-1.19, p=0.002), diabetes mellitus (OR 2.23, 95%CI 1.28-3.87, p=0.004), ACL in the arch (OR 1.89, 95%CI 1.09-3.31, p=0.025), and deterioration during hospitalization (OR 3.96, 95%CI 1.32-10.68, p=0.009) were independently associated with AD.

Conclusion: AD was not rare in the present CS population. Moreover, AD was crucially related to ACL in CS. Therefore, intensive and pleiotropic lipid-modifying therapy would be efficacious for further treatment of aortogenic brain embolism.

Aim: Patients with type 2 diabetes mellitus (T2D) are prone to develop vascular calcification. Fetuin-A protects against vascular calcification but it increases insulin resistance. T50 calciprotein crystallization (also called serum calcification propensity) is a novel marker of calcification stress. This study examined whether T2D affects T50 and the potential role of fetuin-A in the relationship between T2D and T50.

Methods: This cross-sectional study included 101 individuals with T2D and 101 individuals without diabetes (controls). T50 and fetuin-A levels were measured using the established nephelometric method and an enzyme-linked immunosorbent assay, respectively.

Results: Although fetuin-A levels were higher in the T2D group, T50 was not significantly different between the T2D and control groups. In multivariable-adjusted analyses of the total population, T50 was not independently associated with the presence of T2D, fasting plasma glucose, or HbA1c, whereas T50 was significantly associated with fetuin-A, phosphate, and calcium levels. The association between T50 and fetuin-A was modified by the presence of T2D. A subgroup analysis revealed that the positive association between T50 and fetuin-A was significant but smaller in the T2D group, and that the associations of T50 with serum phosphate and calcium were more evident in the T2D group. Additional analyses showed that T50/fetuin-A ratio was lower in the T2D group and that T50/fetuin-A ratio was inversely correlated with fasting glucose and HbA1c levels.

Conclusions: T2D itself was not significantly associated with T50 but T2D modified the association between T50 and fetuin-A in favor of developing vascular calcification in T2D.