Journal of atherosclerosis and thrombosis最新文献

Aims: The phase angle (PhA) derived from a bioelectrical impedance analysis (BIA) is a risk factor for cardiovascular disease (CVD). The present study explored the relationship between PhA and the progression of subclinical atherosclerosis in asymptomatic adults.

Methods: Two cross-sectional studies were performed on 15579 participants who underwent carotid ultrasound testing and a BIA as well as 8228 participants who underwent brachial ankle pulse wave velocity (baPWV) testing and a BIA. We also conducted a longitudinal study in participants without CVD and carotid atherosclerosis (CAS) at baseline who underwent carotid ultrasound ≥ 2 times (n = 2680) or baPWV testing [≥ 2 times] (n = 1775). CAS and the brachial ankle pulse wave velocity (baPWV) were selected as the subclinical atherosclerosis markers.

Results: In the cross-sectional studies, participants with CAS (5.43±0.60° vs. 5.73±0.61°, P＜0.001) or elevated baPWV (5.38±0.62° vs. 5.74±0.59°, P＜0.001) had lower PhA values than controls. Furthermore, the PhA value was independently and inversely correlated with CAS (adjusted odds ratio [OR] = 0.41, 95% confidence interval [CI] 0.37-0.46, P＜0.001) and elevated baPWV (adjusted OR = 0.45, 95% CI 0.39-0.52, P＜0.001). Restricted cubic spline curve analyses indicated dose-response associations of PhA values with subclinical atherosclerosis. In the longitudinal study, high PhA values at baseline decreased the risk of incident CAS (adjusted hazard ratio = 0.44, 95% CI 0.36-0.54, P＜0.001). Multivariate linear regression analyses showed that the PhA was negatively associated with absolute or relative annual changes in baPWV.

Conclusion: The PhA value is significantly associated with the progression of subclinical atherosclerosis, indicating that PhA may serve as a noninvasive marker for monitoring subclinical atherosclerosis in a primary prevention setting.

Aim: The long-term clinical outcomes of endovascular therapy (EVT) for aortoiliac (AI) artery lesions remain unclear. This study aimed to investigate 10-year patency and mortality after AI stent implantation.

Methods: This multicenter retrospective study included 1919 patients (2375 limbs) who underwent AI stent implantation to treat symptomatic peripheral artery disease (PAD) between January 2005 and December 2010. The study outcome was primary patency, which was defined as a treated vessel without restenosis, mortality, and associated factors.

Results: The mean age of the study cohort was 71±9 years. Chronic limb-threatening ischemia (CLTI) accounted for 17.2% of cases, and chronic total occlusion (CTO) was found in 24.6% of cases. During a median follow-up period of 2.9 years (interquartile range: 1.0-6.0 years), 412 patients lost patency, whereas 467 patients died without experiencing loss of patency. At 1, 6, and 10 years post-EVT, respectively, the primary patency rates were estimated to be 92.8%, 79.3%, and 77.2%, and the survival rates were 94.9%, 77.0%, and 63.1%. Female sex, CTO, and the presence of outflow lesions were significantly associated with an increased risk of patency loss after stent implantation (all P＜0.05), whereas age, dialysis-dependent renal failure, heart failure, and CLTI were significantly associated with an increased risk of mortality.

Conclusion: Stent implantation for AI lesions achieved favorable 10-year patency, with patency loss plateauing after six years. No AI lesion characteristic was associated with mortality. These results support the long-term efficacy of EVT in the clinical practice.

Aim: Mounting evidence suggests apolipoprotein E-containing high-density lipoprotein cholesterol (APOE-HDLC) as an indicator of the anti-atherogenic function of HDLC, but data are lacking on whether or not APOE-HDLC is involved in the development of atherosclerosis in humans. This study was performed to explore whether or not APOE-HDLC is associated with atherosclerotic plaque progression in humans.

Methods: Among 823 participants 45 to 74 years old who were free of cardiovascular disease, we assessed nuclear magnetic resonance spectroscopy-measured HDL particle concentrations, APOE-HDLC levels and HDLC levels at baseline, and performed carotid ultrasound measurements in surveys conducted in 2002 and again in 2007 after a 5-year interval. The ratio of APOE-HDLC to total HDLC (APOE-HDLC/HDLC ratio) was calculated to assess the relative proportion of APOE-HDLC in total HDLC, given the strong correlation between them.

Results: The baseline APOE-HDLC/HDLC ratio was significantly associated with the risk of 5-year plaque progression (relative risk [RR] = 0.71; 95% confidence interval [CI] = 0.53-0.95), which is independent of the ratio of HDLC to the HDL particle number (HDLC/P ratio). In particular, participants with an HDLC/P ratio ≥ 44.8 (denoted very high level of cholesterol content per HDLP, a marker of dysfunctional HDL) had a 36% reduced 5-year plaque progression risk (RR = 0.64; 95% CI = 0.43-0.97) if combined with the highest APOE-HDLC/HDLC ratio, as compared with the lowest APOE-HDLC/HDLC ratio.

Conclusions: These results highlight the potential utility of APOE-containing HDL as a candidate emerging biomarker for the anti-atherosclerotic function of HDL particles.

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.