Journal of atherosclerosis and thrombosis最新文献

Aim: Sedentary behavior and physical inactivity increase the risk of cardiometabolic diseases. It is important to evaluate physical activity in daily life and understand the influence of these factors on cardiometabolic diseases in the Japanese population, which tends to have a prolonged sitting time. We examined the association between sedentary behavior and physical inactivity, characterized by extended television (TV) viewing and low step counts, which are easily monitored and modifiable, and cardiometabolic risk factors in the Japanese population.

Methods: This cross-sectional study included 2,531 Japanese adults (1,087 men and 1,444 women) 20-91 years old, randomly selected throughout Japan. TV viewing was assessed using a self-reported questionnaire, and step counts were measured using pedometers. Cardiometabolic risk factors were determined using physical examinations or blood samples. The association between sedentary behavior and physical inactivity with each risk factor was examined using a cross-sectional analysis with multivariate-adjusted logistic regression models.

Results: In both sexes, longer TV viewing positively correlated with low high-density lipoprotein (HDL) cholesterol and high triglycerides (TG). In women, TV viewing time is associated with obesity and increased abdominal circumference (AC). Conversely, in men, lower step counts were positively associated with obesity and increased AC, low HDL cholesterol, and high TG levels.

Conclusions: The association between prolonged TV viewing and cardiometabolic risk factors was more pronounced in women than in men, whereas the influence of lower step counts was stronger in men than in women. These findings contribute to the improvement of cardiovascular health by monitoring and managing individual screen times and step counts in daily life.

Patients with familial hypercholesterolemia (FH) carry an extremely elevated cardiovascular risk because of lifelong exposure to elevated low-density lipoprotein cholesterol (LDL-C). The Japan Atherosclerosis Society (JAS) complies with the clinical guidelines of FH stipulating diagnostic criteria as well as the treatment targets based on their cardiovascular preventive status. These guidelines are expected to improve the FH diagnosis rate and facilitate better LDL-C management, ultimately leading to improved patient outcomes. However, there are no clear instructions on how and when to assess atherosclerosis. In addition, current treatment target goals, especially for adults with heterozygous FH (HeFH) (LDL-C ＜100 mg/dL in primary prevention and LDL-C ＜70 mg/dL in secondary prevention), are sometimes insufficient to fully navigate to prevent cardiovascular events, given that many factors, such as hypertension, diabetes, smoking, lipoprotein (a), cholesterol-year score, coronary artery calcium, and pathogenic mutations are associated with a further increased risk on top of the LDL-C level assessed cross-sectionally. Accordingly, we summarized contemporary strategies for assessing systemic atherosclerosis and treatment options.

Aim: The triglyceride-glucose (TyG) index, a biomarker commonly used to evaluate metabolic health status, can predict unfavorable outcomes. Thus, we aimed to explore evidence regarding the prognostic value of the TyG index in patients with ischemic cardiomyopathy and heart failure with preserved ejection fraction (HFpEF).

Methods: We enrolled 277 consecutive participants with new-onset ischemic cardiomyopathy and HFpEF who underwent coronary artery bypass grafting (CABG). The primary study endpoint was major adverse cardiovascular events (MACEs), defined as cardiac death, acute myocardial infarction, graft failure, and stroke.

Results: During a median follow-up of 43.34 months, 70 patients (25.1%) experienced MACEs. A multivariable Cox regression analysis identified the TyG index as an independent risk factor for MACEs, with a higher baseline TyG index associated with greater risk after adjusting for confounding factors. A restricted cubic spline showed that the TyG index had a linear relationship across the range. The optimal cut-off value of 9.167 for the TyG index demonstrated a sensitivity of 70% and specificity of 84.1%, with an AUC of 0.820 (p＜0.001, 95% CI: 0.762-0.878), thus effectively stratifying participants into lower TyG index (TyG ＜9.167, n = 182) and higher TyG index groups (TyG ≥ 9.167, n = 95), while subgroup analyses confirmed a robust association with MACEs across various populations. Furthermore, the time-dependent area under the curve, calibration curve, and decision curve analyses demonstrated that incorporating the TyG index into the traditional cardiovascular risk factor model significantly enhanced the prediction of MACE risk. Additionally, significant net reclassification improvement (0.335, 95% confidence interval [CI]: 0.136-0.518, p＜0.05) and integrated discrimination improvement (0.178, 95%CI: 0.089-0.270, p＜0.001) were also observed.

Conclusion: The TyG index is a reliable prognostic indicator for MACEs after CABG in patients with ischemic cardiomyopathy and HFpEF and it serves as a valuable complement to traditional cardiovascular risk factors by providing metabolic-related insights.

Pediatric lifestyle disease screening in Japan plays a crucial role in the early detection of obesity, dyslipidemia, hypertension, and type 2 diabetes. However, it is not mandated by national law, instead being conducted independently by local governments, which results in significant regional disparities. While many programs focus only on obese children, this approach risks missing high-risk individuals with normal weight, such as those with familial hypercholesterolemia (FH) or non-obese type 2 diabetes. Regional initiatives in cities such as Fukuoka, Niigata, Kumamoto, and Kitakyushu have demonstrated various effective models, including the use of growth and obesity curves, expanded screening parameters, and school-healthcare collaborations. National surveys show that fewer than 30% of municipalities conduct such screenings, often with limited standardization. Kagawa Prefecture presents a notable example of integrating FH screening with lifestyle checkups to achieve high participation and follow-up rates. To expand and improve its effectiveness, universal screening based on standardized criteria is essential. Efforts should also focus on public education, early intervention, and coordinated systems involving school nurses and teachers, pediatricians and family doctors, local medical associations, educational boards, and municipal health authorities. Universal screening, combined with individualized follow-up and strong community collaboration, can help healthcare providers, educators, and local governments in Japan respond more effectively to the growing prevalence of pediatric obesity and metabolic disorders. This approach also promotes equitable access to preventive care for children.

Aims: Despite strong recommendations for medical consultation, the treatment status and low-density lipoprotein cholesterol (LDL-C) levels at 1-year follow-up of individuals with referral-level LDL-C identified in health checkups remain unclear. We evaluated the treatment status and 1-year LDL-C control among individuals identified in health checkups as requiring early medical consultation due to LDL-C levels of ≥ 180 mg/dL.

Methods: We conducted a nationwide cohort study including health checkup data for individuals aged 20-74 years. We identified 102,049 individuals (median age: 48 years; male: 66.8%) with uncontrolled LDL-C (≥ 180 mg/dL) at baseline, who had no prior lipid-lowering therapy. Poisson regression with robust error variance was used to assess factors associated with uncontrolled LDL-C at 1 year.

Results: Among individuals with LDL-C ≥ 180 mg/dL at baseline, 56,147 (55.0%) visited a medical institution within 3 months of the checkup, and 13,124 (12.9%) were prescribed lipid-lowering medications at 1 year. At 1 year follow-up, 49,260 (48.3%) still had LDL-C ≥ 180 mg/dL. Factors associated with persistent LDL-C ≥ 180 mg/dL at 1 year included obesity (RR: 1.07, [95% CI: 1.06-1.09]), 10 mg/dL increase in LDL-C at baseline (1.11 [1.10-1.11]), smoking (1.05 [1.04-1.07]), alcohol consumption (0.95 [0.94-0.97]), poor sleep quality (1.02 [1.01-1.03]), and skipping breakfast ≥ 3 times per week (1.07 [1.05-1.08]).

Conclusions: Despite being classified as requiring early medical intervention, only half of individuals with LDL-C ≥ 180 mg/dL visited a physician within 3 months, and nearly half continued to have uncontrolled LDL-C at 1 year. Strategies to facilitate timely medical visits and appropriate lipid management in health checkup-identified cases are warranted.

Aim: Frailty, particularly chronic limb-threatening ischemia (CLTI), is a major health concern in patients with peripheral artery disease. CLTI onset can lead to increased frailty and impaired ability to perform daily activities. However, its in-hospital frailty progression in these patients remain poorly defined. This study aims to address this knowledge gap.

Methods: We analyzed 841 CLTI patients (mean age, 75.8 years; 60.2% male) who underwent endovascular therapy (EVT) and were discharged alive from a multicenter registry. Frailty was assessed at admission and discharge using the Clinical Frailty Scale (CFS), categorized as non-frail (1-3), mildly frail (4-5), or advanced frail (6-9). Frailty progression was defined as a transition to a higher frailty category during hospitalization. The predictors of frailty progression during hospitalization were assessed using logistic regression analyses.

Results: Overall, 103 patients (12.2%) experienced frailty progression. Compared to those without progression, these patients had lower left ventricular ejection fraction (LVEF), lower hemoglobin and albumin levels, and more severe wounds. Independent predictors of frailty progression included LVEF ＜40% (odds ratio [OR], 2.02), hemoglobin ＜11 g/dL (OR 1.67), and Wound Grade 3 (OR 2.04). Within 2 years after discharge, the amputation-free survival rate was significantly lower in the progression group than in the non-progression group (42.6% vs. 56.0%; log-rank p = 0.008). The wound healing rate within 2 years after EVT was also significantly lower in the progression group than in the non-progression group (78.2% vs. 88.8%; log-rank p = 0.001).

Conclusions: In-hospital frailty progression was observed in one of the eight patients with CLTI undergoing EVT. Frailty progression was linked to more severe clinical status and worse life and limb outcomes than cases without progression.

Aim: Overproduction of large very low-density lipoprotein1 (VLDL1) is a central abnormality in metabolic dyslipidemia. Excess-triglycerides (Ex-TG), based on the Friedewald equation, is considered to be a marker for TG-rich VLDL, but it remains uncertain whether Ex-TG reflects large VLDL particles.

Methods: We conducted a retrospective sub-analysis of the PROUD48 study, which compared the effects of pemafibrate and omega-3 fatty acids (FAs) on apolipoprotein B48, with data available on VLDL subfractions. Hyperlipidemic patients on statins were treated with pemafibrate (n = 56) or omega-3FAs (n = 56) for 16 weeks. VLDL subfractions: large (L), middle (M), and small (S) were separated using high-performance liquid chromatography. Ex-TG was calculated as plasma TG minus 5 x calculated VLDL-cholesterol (C).Calculated VLDL=total-C minus directly measured LDL-C minus HDL-C.

Results: Pemafibrate and omega-3FAs reduced plasma TG levels by 42% and 27%, respectively; however, a marked reduction in Ex-TG was observed only with omega-3 FAs. Ex-TG was positively correlated with L-VLDL-TG, %L-VLDL-TG, (L-M+S)-VLDL-TG, and L-VLDL-TG/C, while it showed no positive correlation with smaller VLDLs and apoB48. TG exhibited stronger correlations with L-VLDL-related parameters than Ex-TG, but was also positively associated with smaller VLDLs and apoB48. These correlation patterns remained consistent even when examining the relationship between changes in Ex-TG, TG, or apoB48 and corresponding changes in VLDL subfractions using lipid-lowering agents.

Conclusions: The behavior of Ex-TG appears consistent with previous kinetic studies showing that omega-3FAs primarily suppress VLDL1 production, whereas fibrates promote TG removal, suggesting that Ex-TG serves as a surrogate marker for VLDL1 overproduction.

A 79-year-old Chinese man was referred for nephrotic syndrome (proteinuria 4.4 g/day). In blood tests, serum high-density lipoprotein (HDL) cholesterol was undetectable, and the esterified cholesterol to total cholesterol ratio was very low. Lecithin: cholesterol acyltransferase (LCAT) activity was also undetectable. Since he had neither corneal opacity nor pathological mutations in the LCAT gene and anti-LCAT antibodies were detected in serum, a diagnosis of acquired LCAT deficiency was made. Renal biopsy revealed glomerulopathy associated with LCAT deficiency and membranous nephropathy (MN). Since the patient's proteinuria did not improve despite prescribing an angiotensin II receptor blocker (ARB), we suggested the prescription of prednisolone, but he returned to China due to the expiration of his residence visa for Japan. One year after the initial visit, his proteinuria had improved to 0.9 g/day without immunosuppressive therapy. However, his HDL cholesterol level was still low at around 3 mg/dL, indicating a discrepancy between remission of nephrotic syndrome and lack of improvement in lipid levels.Of the 11 patients with acquired LCAT deficiency reported to date, 4 with undetectable LCAT activity and MN on renal biopsy required immunosuppressive therapy to alleviate proteinuria. The present patient was prescribed only an ARB according to his preference, which happened to be consistent with the MN treatment guideline that states, "Wait 6 months for spontaneous remission while using maximal antiproteinuric therapy." The clinical course of acquired LCAT deficiency varies, and further case reports are needed to determine the necessity of immunosuppressive therapy.