Journal of atherosclerosis and thrombosis最新文献

Aims: While glomerular hyperfiltration (GHF) emerged as a risk factor for cardiovascular disease (CVD), little is known about the association between GHF and blood lipid profile. We aimed to examine the association between GHF and blood lipid parameters in adults with few comorbidities.

Methods: A cross-sectional study was performed on adults undergoing health screening in Osaka, Japan. Adults with a history of heart disease or stroke, those with diabetes mellitus, chronic kidney disease (estimated glomerular filtration rate (eGFR) ＜60 mL/min/1.73m²), or those using lipid-lowering medication were excluded. The outcome was GHF, defined as ＞95^th percentile of eGFR after stratification by age and sex. The exposure was blood lipid parameters, including total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), non-HDL-C, TG/HDL-C ratio, small dense LDL-C (sdLDL-C), and sdLDL-C/LDL-C ratio. Associations between blood lipid parameters and GHF were examined by multiple logistic regression under a Bayesian framework, adjusted for established risk factors of GHF, including body mass index, blood pressure, and lifestyle factors.

Results: Of 17,288 eligible individuals (mean age 50.1±9.9 years; 45.5% women), 853 individuals (4.9%) had GHF. Multiple logistic regression analyses demonstrated an association between a higher sdLDL-C/LDL-C ratio and GHF (odds ratio (OR) = 1.51, 95% credible interval (CrI) 1.21-1.88). LDL-C showed an inverse association with GHF (OR = 0.94, 95% CrI 0.92-0.97).

Conclusion: Our findings demonstrated an independent association between a higher sdLDL-C/LDL-C ratio and GHF. The role of an sdLDL-C/LDL-C ratio in GHF development and CVD risk merits further investigation.

Aim: Achilles tendon xanthomas are a characteristic feature of familial hypercholesterolemia (FH). Achilles tendon thickness (ATT) has been associated with the severity of coronary artery disease (CAD) in FH. However, its relevance in non-FH remains unclear. Therefore, we assessed the relationship between ATT and CAD severity in patients with acute coronary syndrome (ACS) without FH.

Methods: A total of 194 patients (mean age: 69.1±11.9 years) with ACS without FH were retrospectively investigated and divided into two groups: single-vessel disease (SVD) or multivessel disease (MVD). ATT was measured using ultrasonography (US-ATT) and radiography (Xp-ATT). The association between ATT and CAD severity was evaluated.

Results: Of the total, 107 patients (55.2%) had SVD, and 87 (44.8%) had MVD. Mean US-ATT and Xp-ATT values were 5.0±0.6 mm and 6.4±1.2 mm, respectively. ATT was significantly greater in the MVD group than in the SVD group (US-ATT: 5.2 mm vs. 4.8 mm, p＜0.01; Xp-ATT: 6.6 mm vs. 6.1 mm, p = 0.01) and correlated with the SYNTAX score (US-ATT: r = 0.30, p＜0.01; Xp-ATT: r = 0.19, p = 0.02). Multivariable analysis identified US-ATT as an independent predictor of MVD (odds ratio: 2.71; 95% confidence interval: 1.46-5.01; p＜0.01).

Conclusion: In patients with ACS without FH, ATT was significantly associated with CAD severity. This suggests that ATT, particularly US-ATT, may serve as a practical, non-invasive marker for cardiovascular risk stratification.

Aim: Specific Health Checkups (SHCs) and Specific Health Guidance (SHG) were launched in 2008, but the factors related to their effectiveness have not been clarified. We examined the mean reduction in body weight (BW) and waist circumference (WC) of participants eligible for active support under SHG. Body size was considered, as well as the number of support points given during SHG, which indicates the amount of support they received.

Methods: A dataset of participants (aged 40-64) who were eligible for SHG and had SHC results collected between 2011 and 2012 was analyzed (n = 76,565). The mean changes in BW and WC between 2011 and 2012 were compared among participants based on their participation status (did not participate, dropped out, finished) and the number of support points for those who finished. Participants were also stratified by sex and BMI (kg/m²): normal weight, overweight, and obese.

Results: The mean BW change (95% CI) for those who did not participate and finished SHG was -0.45 kg (-0.47, -0.43) and -1.32 kg (-1.39, -1.25) in men, and -0.66 kg (-0.72, -0.60) and -1.68 kg (-1.87, -1.49) in women, respectively. Higher support points and larger body sizes correlated with greater reductions in BW in men (P＜0.001), but the associations were not significant in women. The reduction in WC was greater in women with normal weight than in obese women.

Conclusion: Sex differences were observed in the association between BW/WC reduction and body size or the amount of support given during SHG.

Aim: The relationship between multiple modifiable risk factors (RFs) and coronary plaque development remains unclear. This study investigated the relationship between the cumulative RF burden and coronary inflammation, a key driver of atherosclerosis, and whether this relationship varies according to the status of coronary artery stenosis.

Methods: We analyzed 958 patients who underwent coronary computed tomography angiography. Modifiable RFs included hypertension, diabetes, a body mass index ≥ 30 kg/m ², and current smoking status. Risk factor burden was categorized by the number of risk factors, ranging from none to ≥ 2. Coronary inflammation was quantified by the perivascular fat attenuation index (FAI), defining a high FAI as a value above the 75th percentile (＞-70.2 HU).

Results: Among the patients, 142 had no RFs, 467 had 1 RF, and 349 had ≥ 2 RFs. The median FAI was -76.2HU, and a high FAI was observed in 239 patients. Compared to those with no RFs, the multivariable Poisson regression with robust error variance demonstrated a significant increase in the prevalence of a high FAI among patients with higher RF burdens: 1 RF (relative risk [RR] 1.56; 95% confidence interval [CI], 1.06-2.30) and ≥ 2 RFs (RR 1.71; 95% CI, 1.16-2.52). Similar associations were observed in patients with no or minimal atheroma (＜25%): one RF (RR, 1.65; 95% CI, 1.01-2.68) and ≥ 2 RFs (RR 2.25; 95% CI, 1.38-3.66).

Conclusions: A greater RF burden was associated with increased coronary inflammation in a dose-dependent manner. These findings indicate that RF clustering is associated with higher coronary inflammation even in the absence of significant coronary plaque.

Atherosclerotic cardiovascular disease (ASCVD) is associated with a very high risk of secondary cardiovascular events. Elevated low-density lipoprotein cholesterol (LDL-C) is a major determinant in the progression of ASCVD and in the onset of associated adverse events. Consequently, rigorous control of LDL-C is a cornerstone of secondary prevention strategies, typically achieved through statin therapy, either as monotherapy or in combination with ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors. Recent large-scale clinical trials have demonstrated that intensive LDL-C lowering significantly reduces cardiovascular risk, leading to updated guidelines in the United States and Europe that advocate for more aggressive LDL-C treatment targets for secondary prevention in ASCVD. In this context, a working group established in the Japan Atherosclerosis Society performed a scoping review of LDL-C treatment targets for the secondary prevention of ASCVD. The working group systematically reviewed the available evidence for coronary artery disease (including acute and chronic coronary syndrome), atherothrombotic brain infarction, and peripheral artery disease, all of which are defined as ASCVD. The aim was to assess the evidence-based LDL-C treatment targets for the secondary prevention of defined ASCVD in Japanese patients.

Japan's health checkup system has developed over the last four decades as a principal national strategy for preventing cerebrovascular and cardiovascular diseases (CVD). Early community-based health checkups, implemented under the Health Services for the Elderly Act of 1982, contributed to reductions in CVD mortality and the demand for inpatient care through the improved detection and management of hypertension. As lifestyle-related diseases became increasingly prominent, the government introduced Health Japan 21 and subsequently launched the Specific Health Checkups and Specific Health Guidance (SHC/SHG) program in 2008 to strengthen evidence-based population-wide prevention targeting of visceral obesity and the associated cardiometabolic risks. The SHC program provides standardized assessments, including anthropometric measurements, laboratory testing, medical history, and lifestyle questionnaires. Risk stratification is primarily based on abdominal obesity and the accumulation of metabolic risk factors, which determine individualized health guidance through motivational or intensive support. The SHG program offers structured behavioral interventions delivered by trained health professionals to promote sustainable lifestyle modifications. Growing evidence supports the effectiveness of the SHC/SHG program. Health checkup participation has been associated with lower mortality, and health guidance has demonstrated favorable improvements in obesity indicators, metabolic parameters, and pharmacotherapy initiation. Economic evaluations further suggest that the program is cost effective. However, some limitations remain, including modest long-term effects and insufficient risk identification among non-obese individuals with elevated cardiometabolic risk. Improving the participation rates and refining risk stratification beyond obesity-based criteria are ongoing priorities. Continued research and periodic revision of checkup items are essential for enhancing the program's impact as a nationwide strategy for ASCVD prevention.

Familial hypercholesterolemia (FH) is a highly prevalent genetic disorder that occurs in approximately one in 300 people in the general population. In cases of heterozygous FH, which are encountered frequently, cardiovascular disease, the main complication, typically manifests after adulthood. However, if the diagnosis and treatment begin in childhood, the onset of such complications can be prevented. Therefore, it can be said that the diagnosis and treatment of this disease from childhood is extremely important; even more so in the case of homozygous FH. However, specific indicators for diagnosing FH physical findings such as Achilles tendon thickening and tendon xanthomas rarely manifest in childhood. It is also difficult to obtain detailed medical histories from relatives. Therefore, it is not always easy to make a clinical diagnosis. In this context, since 2022, genetic testing for FH has been covered by national health insurance in Japan, and it can be considered for children as needed. This paper presents the previous research concerning genetic testing for children, its importance and application, as well as the latest findings on universal screening that includes genetic testing. It is expected that the development of pediatric FH management in our country, which has not been particularly proactive until now, will contribute to the suppression of cardiovascular complications in this condition.

Aims: The global distribution of lipoprotein(a) [Lp(a)] levels varies due to racial and ethnic differences. However, the clinical relevance of Lp(a) levels in Japanese patients has not been fully explored.

Methods: We investigated the association of Lp(a) levels, the Suita score, and the presence of high-risk plaque (HRP) as well as that of ≥ 50% stenosis, quantitative plaque volume, and the value of coronary artery calcium score in coronary computed tomographic angiography (CCTA), among 272 Japanese patients (mean age: 65 years) in whom serum Lp(a) levels were measured due to suspected coronary artery disease. HRP was defined as positive remodeling and/or low attenuation. Plaque volume was quantified as the percent plaque volume.

Results: HRP was identified in 33 (12.1%) patients. The prevalence of HRP, ≥ 50% stenosis, and percent plaque volume progressively increased with higher Lp (a) levels and Suita scores. In multivariate analyses, Lp(a) and the Suita score independently predicted HRP when assessed as continuous (p = 0.02, p＜0.001, respectively) or categorical variables (p = 0.005, p = 0.007, respectively). Patients in the highest tertile of Lp(a) and classified as high- or intermediate-risk by the Suita score had the highest HRP risk, whereas those in the lower 2 tertiles and low-risk group had the lowest. Incorporating Lp(a) into the Suita score improved the prediction of HRP beyond the Suita score alone (p = 0.005).

Conclusions: The combinatorial value of assessing Lp(a) levels and Suita score may provide useful insight regarding Japanese patients undergoing CCTA for the prediction of HRP.