Journal of atherosclerosis and thrombosis最新文献

Aims: The safety and efficacy of drug-coated balloon angioplasty (DCBA), compared to plain old balloon angioplasty (POBA) for peripheral artery in-stent restenosis (ISR), have been examined in clinical trials. However, little is known about the pathological response after DCBA for ISR. We compared the intravascular imaging findings and tissue responses of in-stent neointima in iliac arteries after DCBA and POBA using atherosclerotic porcine peripheral arteries.

Methods: Bare metal stents (BMSs) were implanted in the iliac arteries of microminipigs fed high-cholesterol chow. Four weeks after BMS implantation, stented regions were assessed by optical coherence tomography (OCT), followed by either DCBA or POBA. The adherence of the drugs delivered was observed by OCT and angioscopy, performed immediately after DCBA, and then confirmed with scanning electron microscopy. Four weeks after balloon angioplasty, the stented regions were investigated by OCT followed by pathological examination.

Results: Neointimal volume after DCBA was significantly reduced, while that after POBA showed minimal change. Histological assessments revealed decreases in cell number and the α-smooth muscle actin (SMA)-positive area, while the aniline blue-positive area and the alcian blue-positive area in the neointima was increased, after DCBA as compared to after POBA.

Conclusions: The neointima after DCBA in the BMS-implanted region showed fewer smooth muscle cells and more mature extracellular matrix than that after POBA. These results confirmed the clinical benefits of DCBA with ISR for lower extremity arterial disease.

Aim: This study investigated the efficacy and safety of endovascular revascularization for symptomatic non-acute atherosclerotic intracranial LVO.

Methods: For non-acute atherosclerotic intracranial large vessel occlusion (LVO), despite aggressive medical treatment, recurrent ischemic stroke or transient ischemic attack related to the occluded artery still occurs repeatedly. This retrospective cohort study included stroke patients with intracranial LVO who received endovascular treatment (EVT), categorized by successful recanalization and the time interval from symptom onset to revascularization (＜30 days vs. ≥ 30 days). The primary efficacy outcome was stroke recurrence or mortality at the 6-month follow-up.

Results: Of the 264 patients in the study, 229 (87%) had successful recanalization, while 35 (13%) did not. In addition, 139 patients had recanalization times ≤ 30 days, and 125 had recanalization times ＞30 days. The successful recanalization group had a significantly lower rate of stroke recurrence or death during follow-up than the unsuccessful group (9.6% vs. 31.4%, adjusted odds ratio [OR]: 4.98, 95% confidence interval [CI]: 1.86 -13.37; P = 0.001). The group with a recanalization time ≤ 30 days also demonstrated a significantly lower rate of stroke recurrence or death during follow-up than the group with a recanalization time ＞30 days (7.9% vs.17.6%, P = 0.015). In addition, the rate of a favorable prognosis (modified Rankin Scale [mRS] 0-2) during the follow-up period was significantly higher in the successful recanalization group than in the successful recanalization group (71.1% vs. 51.4%, P = 0.021).

Conclusion: These findings suggest that successful recanalization may have therapeutic potential for patients with non-acute intracranial large-vessel occlusion, particularly for those with LVO recanalization lasting ＜30 days, who show more significant benefits than those with longer-lasting recanalization [please check this carefully].

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.