Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017

Central blood pressure profile variability and prognostic impact of transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) is a proven treatment for severe aortic stenosis (AS); however, the effects of TAVI on central blood pressure (CBP) and clinical outcomes remain unclear. We assessed CBP indices before and after TAVI and their prognostic value. Seventy-six patients with severe AS who underwent TAVI were retrospectively evaluated, and CBP was estimated noninvasively 1 day before and after TAVI. The following indices were measured: augmentation index corrected for heart rate (HR) (AIx@HR75), peak pressure of the forward wave (Pf) and backward wave (Pb), time to peak pressure of the forward wave corrected for HR (Tfc) and the backward wave corrected for HR (Tbc), and ejection duration (ED). The primary endpoint was the composite outcome of all-cause mortality and hospitalized heart failure. The median follow-up period was 1135 (844-1404) days. Tfc, Tbc, ED, Pb, and AIx@HR75 decreased despite no significant changes in Pf after TAVI. The univariable Cox proportional hazards model showed that ED 1 day after TAVI was associated with composite outcomes (hazard ratio: 1.02; 95% confidence interval [CI]: 1.01-1.04; P = 0.002). When the patients were divided into two groups by the cutoff value determining composite outcomes by receiver operating characteristic curve analysis, a long ED 1 day after TAVI was significantly associated with composite outcomes by Kaplan-Meier curve analysis (log-rank test, P < 0.001). The multivariable Cox proportional hazards model showed that a long ED 1 day after TAVI was associated with composite outcomes (adjusted hazard ratio: 12.12; 95% CI 2.41-60.81; P = 0.002). In conclusion, a long ED 1 day after TAVI was associated with adverse clinical outcomes.

White Matter Microstructure Alterations in Older Adults With Dyslipidemia Associated With Cognitive and Locomotor Dysfunction Evaluated Using Neurite Orientation Dispersion and Density Imaging

INTRODUCTION

Diffusion tensor imaging (DTI) studies have shown white matter (WM) microstructural alterations in individuals with dyslipidemia; however, DTI indices are not specific to WM pathology. However, neurite orientation dispersion and density imaging (NODDI) provides more specific measurements of WM microstructure. This study aimed to evaluate dyslipidemia-related WM microstructure alterations and their association with cognitive and motor functions using NODDI.

METHODS

The DTI and NODDI metrics were analyzed through tract-based spatial statistics between 24 older adults with dyslipidemia (low-density lipoprotein ≥140 mg/dL, high-density lipoprotein <40 mg/dL, and triglyceride ≥150 mg/dL, or under treatment) and 18 healthy control participants (HCs). Partial correlation tests were performed between diffusion magnetic resonance imaging measures and lipid profiles, cognitive, or locomotor scores in the dyslipidemia and HC groups separately. WM volumetry between HCs and dyslipidemia groups was also assessed. Age, gender, intracranial volume, and years of education were included as covariates in all analyses. A false discovery rate-corrected P value of <0.05 was considered statistically significant.

RESULTS

Individuals with dyslipidemia exhibited a notably reduced neurite density index (NDI) in several WM areas, including the posterior and superior corona radiata, the body, the genu, and the splenium of the corpus callosum, as well as the bilateral anterior and posterior internal capsule, compared with HCs. In the dyslipidemia group, lower NDI was significantly correlated with lower scores on the stand-up test and the Japanese version of the Montreal Cognitive Assessment. No significant differences were found in DTI metrics or WM volumes between dyslipidemia individuals and HCs.

CONCLUSION

Our findings suggest that NODDI can serve as a biomarker for assessing WM microstructural alterations in older adults with dyslipidemia. Particularly, NODDI indicates a lower intra-axonal volume, which may suggest axonal loss associated with dyslipidemia, and correlates with cognitive and locomotor function decline.

Japan-multimodal intervention trial for the prevention of dementia in older people with lifestyle-related diseases: A community-based, 18-month, randomized controlled trial

BackgroundThe prevalence of Alzheimer's disease is increasing in Japan, highlighting the need to establish evidence-based strategies for its prevention.ObjectiveWe aimed to evaluate the effectiveness of a multimodal community-based intervention for Japanese older people with lifestyle-related diseases and to identify challenges in implementing such interventions to prevent dementia in local communities.MethodsAn 18-month randomized controlled trial was conducted among individuals aged 65-85 years with lifestyle-related diseases (hypertension, hyperlipidemia, diabetes, overweight/underweight, smoking), residing in a single apartment complex. Participants were randomly assigned to a multimodal intervention group (group-based physical exercise, nutritional guidance, management of lifestyle-related diseases, and cognitive training) or a control group. The primary outcome was the change in the composite score derived from seven neuropsychological tests. The trial was registered (UMIN000041887: September 24, 2020).ResultsOf 224 screened individuals, 198 were randomized (99 in each group), and 175 (88.4%) completed the 18-month assessment. There was no significant difference between the intervention and control groups in the primary outcome (change in composite test score: 0.25; 95% confidence interval 0.16 to 0.33 versus 0.29; 95% confidence interval 0.20 to 0.38, respectively; p = 0.463). However, a subgroup analysis of participants with mild cognitive impairment showed a significant intervention effect on changes in logical memory, for both immediate (p = 0.041) and delayed recall tasks (p = 0.043).ConclusionsThis multimodal intervention program demonstrated no effectiveness in mitigating cognitive decline. Further research is needed to develop more effective strategies and to better define target populations.

Development and validation of a nomogram for in-stent restenosis within 2 years in patients after iliac or femoral artery stent placement

OBJECTIVE

This study aimed to analyze the risk factors for in-stent restenosis (ISR) within 2 years after iliac or femoral artery stent placement.

METHODS

Clinical data of 237 patients diagnosed with peripheral arterial disease (PAD) and receiving iliac or femoral artery stent placement for the first time in the Third Hospital of Hebei Medical University from January 2015 to December 2022 were analyzed. Patients were randomized into training and validation set (7:3). Logistic regression was used to perform univariate and multivariate analysis on the possible factors of ISR, identify independent risk factors, establish a risk nomogram prediction model, and internally verify the predictability and accuracy of the model.

RESULTS

Binary logistic regression analysis showed that diabetes, hyperlipidemia, hyperfibrinogenemia and below-the-knee run-offs were independent risk factors for ISR within 2 years after iliac or femoral artery stent placement in patients with PAD. Based on these factors, the risk prediction model is established. The c index of the model was 0.856. The results showed that the risk prediction model has good accuracy in predicting ISR within 2 years after iliac or femoral artery stent placement.

CONCLUSIONS

The risk prediction model based on the 4 risk factors of diabetes, hyperlipidemia, hyperfibrinogenemia and below-the-knee run-offs has good predictive performance.

Prevalence of high N-terminal prohormone of brain natriuretic peptide levels and associated factors among community-dwelling older adults aged over 75 years (The SONIC study): a cross-sectional study

OBJECTIVES

Considering the heart failure (HF) pandemic, numerous older adults in the community may exhibit potential cardiac overload or asymptomatic HF without apparent HF diagnosis. This study aimed to examine the distribution of serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels in community-dwelling old age adults aged ≥ 75 years, and to investigate the associated factors for each NT-proBNP classification.

RESULTS

A cross-sectional analysis revealed that 52.0% of 611 participants had NT-proBNP ≥ 125 pg/mL. Multinomial logistic regression analysis showed that female sex, older age (80s and 90s), and uncontrolled high blood pressure were significantly associated with 125 ≤ NT-proBNP < 300 pg/mL, while older age (80s and 90s), coronary artery disease, atrial fibrillation, and renal dysfunction were significantly associated with NT-proBNP ≥ 300 pg/mL. Independent association between higher salt intake and NT-proBNP ≥ 300 pg/mL was also observed. Appropriate management of common HF risk factors, such as uncontrolled high blood pressure and high salt intake, is crucial to prevent the progression of overt HF.

The effectiveness of the current lipid-lowering therapy for refractory dyslipidaemia in patients with coronary artery disease: the price of 'the lower, the better' - results of a survey by Japanese cardiologists

BACKGROUND

Optimal medical therapy plays a critical role in improving the prognosis of patients with coronary artery disease (CAD), particularly through the management of dyslipidaemia. This study investigated treatment practices for patients with dyslipidaemia-complicated CAD (DL-CAD) in Japan, focusing on cases considered refractory to standard management.

RESEARCH DESIGN AND METHODS

A web-based survey was conducted from 10 November 2023 to 1 December 2023 among cardiologists. Responses from 202 participants were analysed and divided into two groups based on the proportion of patients with refractory DL-CAD: <10% (n = 102) and ≥ 10% (n = 100).

RESULTS

There was no significant difference in the use of maximally tolerated statins between groups. However, ezetimibe, EPA, and omega-3-acid ethyl esters were used more frequently in the group with a higher proportion of refractory patients. Logistic regression analysis revealed that the use of ezetimibe was the only factor affecting the proportion of patients with refractory DL-CAD (odds ratio: 1.26, p = 0.0499).

CONCLUSIONS

Japanese cardiologists tend to prescribe ezetimibe in addition to maximally tolerated statin for patients with refractory DL-CAD. Furthermore, they are increasingly targeting elevated triglycerides using polyunsaturated fatty acids as a strategy to reduce residual cardiovascular risk when LDL-C targets are unmet.

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Is an Independent Risk Factor for the Development of Ischemic Heart Disease - A 10-Year Cohort Study

Background

The association of each of the recently classified steatotic liver diseases (SLDs), including metabolic dysfunction-associated SLD (MASLD), MASLD and increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD), with new development of ischemic heart disease (IHD) remains unclear.

Methods and Results

We investigated the associations of various SLDs with the development of IHD during a 10-year follow-up period in 13,815 Japanese individuals without a history of IHD (men/women 8,933/4,882; mean age 48 years) who underwent annual health checkups including an abdominal ultrasound examination. Among the participants, 4,639 (33.6%) subjects were diagnosed as having SLDs, and the proportions of subjects with MASLD, MetALD and ALD were 25.4%, 4.7% and 1.9%, respectively. During the follow-up period, 1,963 (16.2%; men/women 1,374 [17.2%]/589 [14.2%]) subjects had new development of IHD. Multivariable Cox proportional hazard model analysis after adjustment of age, sex, estimated glomerular filtration rate (eGFR), current smoking habit, diabetes, hypertension and dyslipidemia showed that the adjusted risk for new onset of IHD was significantly higher in subjects with MASLD (hazard ratio 1.20 [95% confidence interval 1.01-1.55]; P=0.042) than in those without SLD. Other SLDs were not selected as independent risk factors for the development of IHD.

Conclusions

The presence of MASLD, but not other SLDs, is an independent risk factor for new onset of IHD during a 10-year follow-up period.

Association of Skeletal Muscle Mass with Habitual Exercise, Mealtime and Sleep in Middle-Aged Men: Cross-Sectional Study

Objective: To investigate the cross-sectional association between skeletal muscle mass and lifestyles including exercise, mealtime, and sleep habits in adult men aged under 64. Materials and Methods: A total of 101 Japanese men aged under 64 who underwent "Anti-aging Health Checkups" were enrolled in the study. Cross-sectional analyses were conducted using the subjects' data such as body mass index, skeletal muscle mass index (SMI), and self-reported lifestyle information. The physical activity (PA) value of habitual exercise per week (metabolic equivalent hr/week) was categorized into three groups. Mealtime combination of breakfast and dinner time was categorized into five groups. A multiple regression analysis demonstrated how each PA group has an association with SMI. Moreover, an analysis of covariance was performed to investigate the association between "mealtime combined with PA" and SMI levels by comparison and to investigate the association between "sleep duration or satisfaction combined with PA" and SMI levels, respectively. Results: The subjects with "breakfast before 8 a.m." had a significant positive association between SMI and PA levels; in addition, among the subjects from the "dinner before 8 p.m." group, as the PA level was higher, the SMI level increased. Consequently, the SMI level increased as the PA level was higher among the subjects who had "breakfast before 8 a.m. and dinner before 8 p.m." Furthermore, sufficient sleep such as more than 6 hr and satisfied sleep had positive associations with SMI as PA levels increased. Conclusion: These findings suggest a potential benefit of habitual exercise with breakfast before 8 a.m., dinner before 8 p.m., and sufficient sleep for maintaining skeletal muscle mass among middle-aged men.

Comparison of the effects of pemafibrate and omega-3 fatty acid ethyl on fatty liver index in patients with dyslipidemia treated with statin: a sub-analysis from the PROUD48 study

Background

Fatty liver index (FLI) calculated by using body mass index, waist circumference and levels of triglycerides and γ-glutamyl transpeptidase is a noninvasive biomarker for diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD), which is one of the high-risk conditions of atherosclerotic cardiovascular diseases. To compare the effects of pemafibrate and omega-3 fatty acid ethyl on FLI, we conducted a sub-analysis study of the Pemafibrate Reduction of triglyceride-rich lipoproteins compared with Omega-3 fatty acid ethyl for Unmet needs in Dyslipidemic patients on target to apoB-48 (PROUD48) study.

Methods

57 participants in the pemafibrate 0.4 mg per day treatment group (PEMA, men/women: 37/20, mean 64 years) and 60 participants in the omega-3 fatty acid ethyl 4 g per day treatment group (OMEGA-3, men/women: 35/25, mean 63 years) in the PROUD48 study were included in the present study. Changes in FLI and prevalence of MASLD from baseline to week 16 in PEMA and OMEGA-3 were investigated.

Results

Median FLI was significantly decreased by both PEMA (69.7 to 47.6, P < 0.001) and OMEGA-3 (64.8 to 59.5, P < 0.001). There was a significant difference in change in FLI between PEMA and OMEGA-3 (-18.3 ± 14.1 vs. -5.5 ± 9.4, P < 0.001). The proportions of MASLD estimated by FLI (baseline/week 16) in PEMA and OMEGA-3 were 93.0/68.4% (P = 0.002) and 90.0/85.0% (P = 0.582), respectively.

Conclusions

Pemafibrate is superior to omega-3 fatty acid ethyl in lowering effects of FLI and MASLD in patients with dyslipidemia receiving statin treatment, suggesting that pemafibrate is a beneficial agent for hypertriglyceridemia and reduction of the risk for MASLD.

Aspartate/alanine aminotransferase ratio and development of chronic kidney disease in non-diabetic men and women: a population-based longitudinal study in Kagawa, Japan

BACKGROUND

The relationship between serum aspartate/alanine aminotransferase ratio (AST/ALT) and subsequent development of chronic kidney disease (CKD) in non-diabetic Asian adults has not yet been fully investigated in longitudinal studies.

METHODS

The study included all middle-aged and older non-diabetic Japanese citizens who received health check-ups in Zentsuji, Kagawa, Japan (1998-2023). AST/ALT was classified into three categories: < 1.0 (reference), 1.0- < 1.5, and ≥ 1.5. CKD was defined as an estimated glomerular filtration rate of < 60 mL/min/1.73 m2. The Weibull accelerated failure time model was used to examine the association between AST/ALT categories and subsequent CKD onset because the proportional hazards assumption was violated.

RESULTS

Of 6309 men and 9192 women, 2966 men and 4395 women remained in the final cohort. After a mean follow-up of 7.50 years for men and 8.34 years for women, 33.7% of men and 34.0% of women developed CKD. Women had higher AST/ALT than men. In women, a dose-response relationship was observed, with a 9% shorter survival time to CKD onset for AST/ALT ≥ 1.5 compared with AST/ALT < 1.0. In contrast, men had a shorter survival time to CKD onset by point estimates, but the 95% confidence intervals crossed 1 in all models.

CONCLUSIONS

In this study comparing the risks of CKD development in non-diabetic men and women by AST/ALT levels, a dose-response relationship was only observed in women. Differences in the distribution of AST/ALT by sex may have affected the results. Therefore, in non-diabetic Japanese women, AST/ALT may be used as an indicator of future CKD development.

A prospective study of comparing waist circumference and BMI as predictors for the kidney damage progression

OBJECTIVE

Chronic kidney disease (CKD) is irreversible and linked with various adverse health outcomes and diminished quality of life. Although obesity is recognized as a risk factor for the progression of kidney damage, reliance solely on body mass index (BMI) to measure obesity has been increasingly questioned. The use of other indicators that reflect more on abdominal adiposity like waist circumference (WC) have been proposed. This study aims to determine whether WC can serve as an alternative predictor of kidney damage progression.

METHODS

This prospective study enrolled individuals with normal kidney function during their annual health checkups from April 2016 to March 2019. Data on BMI, WC, WC-related devices, health-related lifestyle, and comorbidities were collected at baseline. WC was categorized using various definitions and analyzed for its association with the risk of kidney damage progression, taking into account BMI categories. The participants were monitored until March 2023 to observe kidney damage progression.

RESULTS

Out of the 4,129 participants, WC showed a higher risk of kidney damage progression in males (HR=1.01-1.39, p-value<0.05). These associations were not observed in females. After adjusting for BMI categories, the associations disappeared. Males in the overweight BMI category, defined as a BMI ≥ 25 kg/m2, showed a significantly increased risk of kidney damage progression (HR = 1.69, p-value < 0.0001).

CONCLUSIONS

The findings indicate that waist circumference significantly affects the progression of kidney damage in males. However, the study also reaffirms BMI as a dependable predictor of kidney damage. It underscores the importance of maintaining normal ranges for both BMI and waist circumference to reduce the risk of progressing kidney damage.

Association between statin use and cataract formation in a retrospective cohort study using Japanese health screening and claims data

In this retrospective cohort study of data (recorded between 1 January 2005 and 31 December 2017) from a commercially available health screening and insurance claims database of the working-age Japanese population, we examined the association of statin use with cataract formation. Using the health screening data, we identified 1,178,560 patients who met the dyslipidaemia criteria; among them, 724,200 patients were enrolled. Based on person-years, the cohort was categorised by statin non-use and new use. Unadjusted, age-sex-adjusted, and multivariate-adjusted hazard ratios (hazard ratios [HRs]; with their 95% confidence intervals [CIs]) were estimated, and intergroup comparisons were undertaken using Cox proportional hazards regression. An increased risk of cataract incidence was associated with statin use (adjusted HR [95% CI]) compared with statin non-use (1.56 [1.43-1.70]). The adjusted HRs [95% CI] for cataract incidence for low- and high-potency statins were 1.48 [1.30-1.70] and 1.61 [1.44-1.79], respectively, whereas those for lipophilic and hydrophilic statins were 1.56 [1.39-1.75] and 1.56 [1.38-1.75], respectively. The adjusted HR for statin use with incidence of cataract was 1.35-1.73, except for fluvastatin and simvastatin. In the middle-aged Japanese working population, statin use was associated with a 1.5- to 1.6-fold higher risk of cataracts.

Effect of PCSK9 inhibitor usage on coronary endothelial dysfunction in patients with hypercholesterolemia after coronary stenting: The CuVIC-2 trial

BACKGROUND

The effects of evolocumab on coronary endothelial dysfunction (CED), a hallmark of atherogenesis, are unknown. The aim of this study was to investigate whether evolocumab, in combination with high-dose statins, could ameliorate CED in patients who underwent coronary stenting.

METHODS

The CuVIC-2 trial was a multicenter randomized controlled trial. CED was defined as intracoronary acetylcholine (ACh)-induced contractile responses with signs of myocardial ischemia. We originally intended to enroll 160 participants but altered the study design due to the COVID-19 pandemic and then recruited 41 participants. The revised primary endpoint was the coronary contraction rate in response to ACh assessed in a core laboratory, ensuring a statistical power of over 80 % using the mixed model for repeated measures.

RESULTS

The evolocumab in combination with high-dose statins with or without ezetimibe (EV + S) group included 19 males and 4 females aged 62 ± 13 years. The high-dose statins with or without ezetimibe (S) group included 13 males and 5 females aged 64 ± 11 years. Compared with the S group, the EV + S group presented a significantly greater decrease in low-density lipoprotein cholesterol at 28 weeks; 83 ± 17 to 20 ± 16 mg/dL (-76 % from the baseline) in the EV + S group and 88 ± 16 to 81 ± 20 mg/dL (-7 % from the baseline) in the S group (p < 0.0001). At 28 weeks, there was no difference between the two groups in terms of the coronary artery constriction rate across all doses [mean difference: 4.8 % (95 % CI: -13.6 to 23.2); p = 0.6].

CONCLUSIONS

Amelioration of CED by evolocumab was not observed in this trial with several limitations.

Serum Lipoprotein(a) Levels and Their Association with Atherosclerotic Cardiovascular Disease in Japan

AIMS

To investigate the distribution of lipoprotein(a) (Lp(a)) and its association with atherosclerotic cardiovascular disease (ASCVD) in Japanese patients at high risk for ASCVD using a health insurance database.

METHODS

Between July 2013 and June 2021, patients eligible for ASCVD prevention according to the 2017 Japan Atherosclerosis Society (JAS) guidelines with documented Lp(a) test results were extracted from the Medical Data Vision claims database and divided into three groups: primary prevention high-risk (Group I), secondary prevention (Group II) and secondary prevention high-risk (Group III). Data on lipid levels, cardiovascular morbidity risk factors and lipid-lowering treatments were extracted.

RESULTS

Of 700,580 patients with documented low-density lipoprotein cholesterol (LDL-C), 2,967 (0.42%) were tested for Lp(a). In 2,170 eligible patients, the median [interquartile range] serum concentration of Lp(a) was 13.9 [7.5-24.6] mg/dL, with 151 patients (7.0%) above the recommended risk threshold of ≥ 50 mg/dL. Lp(a) levels increased with risk across all prevention groups. Being in the highest Lp(a) quintile (Q5) was associated with an increased frequency of ASCVD (28.9% versus 18.9% in the lowest quintile (Q1) for unstable angina; 18.7% versus 10.1% for myocardial infarction; 27.9% versus 17.0% for ischemic stroke). In the secondary prevention groups, the proportion of patients meeting an LDL-C target of ＜70 mg/dL decreased from 30.2% in Q1 to 19.0% in Q5 for Group II and from 32.9% to 16.3% for Group III.

CONCLUSIONS

Despite a high prevalence of Lp(a) ≥ 50mg/dL in Japanese patients at high risk for ASCVD, it found that the Lp(a) testing rate was very low.

Effect of the Xanthine Oxidase Inhibitor Febuxostat on the Cardio-Ankle Vascular Index in Asymptomatic Patients with Hyperuricemia and Liver Dysfunction: A Sub-Analysis of the PRIZE Study

AIMS

The effect of uric acid (UA)-lowering therapy with xanthine oxidoreductase (XOR) inhibitors on the development of cardiovascular disease requires further investigation. This study aimed to evaluate the long-term effects of febuxostat on arterial stiffness, focusing on liver function.

METHODS

The PRIZE study involved random assignment of patients with asymptomatic hyperuricemia to receive either add-on febuxostat treatment (febuxostat group) or non-pharmacological treatment (control group). Of the 514 participants, 23 and 14 patients in the febuxostat and control groups, respectively, underwent assessment of arterial stiffness using the cardio-ankle vascular index (CAVI). The participants in each group were further grouped on the basis of their baseline alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels (above or below the media value or 30 U/L). The primary endpoint was the change in the CAVI from baseline to 12 and 24 months.

RESULTS

Overall, no significant differences were found between the control and febuxostat groups in the least-squares mean estimates of changes in CAVI at 24 months (mean between-group difference, -0.41 [95% CI, -1.05 to 0.23]; p=0.204). However, there were significant differences in participants with higher baseline ALT or AST levels above 30 U/L at 24 months (mean between-group difference, -1.12 [95% CI, -2.23 to -0.01]; p=0.048 for ALT ≥ 30 U/L and -1.08 [95% CI, -2.13 to -0.03]; p=0.044 for AST ≥ 30 U/L).

CONCLUSIONS

Two-year treatment with febuxostat demonstrated a beneficial effect on CAVI in patients with hyperuricemia and liver dysfunction.

Circadian variation in patients with acute heart failure with preserved ejection fraction

BACKGROUND

The circadian system influences the pathophysiology of many cardiovascular diseases; however, circadian variations in patients with heart failure with preserved ejection fraction (HFpEF) are unknown. Thus, this study aimed to compare the clinical characteristics and risk factors for in-hospital mortality between patients with daytime- versus nighttime-onset HFpEF.

METHODS

This multicenter retrospective study included 3875 consecutive patients with acute HFpEF. Daytime and nighttime periods were defined as 6:00-17:59 and 18:00-5:59, respectively. Potential prognostic factors for in-hospital mortality were selected using univariable analyses. Those with P values of <0.10 were used in multivariable logistic regression analyses with forward selection (likelihood ratios) to identify significant prognostic factors.

RESULTS

The incidence of daytime-onset HFpEF was significantly lower but the in-hospital mortality was significantly higher than that of nighttime-onset HFpEF. Independent prognostic factors for in-hospital mortality in patients with daytime-onset HFpEF were age (odds ratio [OR], 1.057) and systolic blood pressure (OR: 0.979). In contrast, age (OR: 1.067), coexisting atrial fibrillation/flutter (OR: 2.023), systolic blood pressure (OR: 0.989), estimated glomerular filtration rate (OR: 0.971), treatment with diuretics (OR: 0.282), and treatment with beta-blockers (OR: 0.514) were independent prognostic factors in patients with nighttime-onset HFpEF.

CONCLUSIONS

The incidence of acute HFpEF exhibits circadian variations, and onset-related differences in clinical characteristics and prognostic factors for in-hospital mortality were identified. These findings may provide new insights for future research and guide individualized patient management strategies.

Characteristics of Patients With Acute Coronary Syndrome and Lipid Management Status Insights From the Optimal Therapy for All Kagoshima Acute Coronary Syndrome (OK-ACS) Registry

BACKGROUND

With aging of the population, atherosclerotic diseases have increased in Japan, with acute coronary syndrome (ACS) a significant cause of morbidity and mortality. In Kagoshima Prefecture, ACS mortality rates exceed the national average, reflecting challenges in lipid management and access to care.

METHODS AND RESULTS

The Optimal Therapy for All Kagoshima Acute Coronary Syndrome (OK-ACS) Registry, initiated in April 2022, enrolled 2,328 ACS patients across Kagoshima. This study evaluated the impact of a standardized lipid management pathway, the "Kagoshima Style," on low-density lipoprotein cholesterol (LDL-C) control and guideline adherence, as well as the regional profile of ACS in Kagoshima. The pathway was implemented at all percutaneous coronary intervention facilities to optimize lipid management and secondary prevention. LDL-C levels decreased significantly (P<0.0001) from admission to discharge and at 3 months (113.3±39.9, 74.6±28.0, and 69.2±25.9 mg/dL, respectively), with no difference according to place of residence. The proportion of patients with LDL-C <70 mg/dL increased from 12% at admission to 59% at 3 months. Maximum tolerated doses of high-intensity statin use increased from 7% at baseline to 9.3% after pathway implementation. Geographic disparities were evident, with patients from isolated islands experiencing delayed treatment access.

CONCLUSIONS

The Kagoshima Style pathway improved lipid management, reducing LDL-C and enhancing guideline adherence. This interim analysis provides insights into lipid management and regional disparities in patients with ACS across Kagoshima prefecture.

Efficacy and Safety of Bempedoic Acid in Japanese Patients With Hypercholesterolemia - A Randomized, Double-Blind, Placebo-Controlled Phase 3 Study (the CLEAR-J Trial)

BACKGROUND

Statins can effectively reduce low-density lipoprotein cholesterol (LDL-C), but additional options are needed for inadequate responses to statins or statin intolerance. Bempedoic acid is a small-molecule oral LDL-C-lowering drug that inhibits ATP citrate lyase, an enzyme 2 steps upstream of 3-hydroxy-3-methylglutaryl coenzyme A reductase in the metabolic pathway for cholesterol synthesis.

METHODS AND RESULTS

The CLEAR-J trial evaluated bempedoic acid 180 mg/day for 12 weeks in Japanese patients with inadequately controlled LDL-C. Percentage changes in LDL-C between baseline and Week 12 (primary endpoint) were -25.25% and -3.46% in the bempedoic acid and placebo groups, respectively, with a significant between-group difference (-21.78%; 95% confidence interval [CI] -26.71%, -16.85%; P<0.001). Changes in secondary endpoints in the bempedoic acid and placebo groups were as follows: non-high-density lipoprotein cholesterol, -20.33% and -2.76%, respectively (between-group difference -17.57%; 95% CI -22.03%, -13.12%); total cholesterol -16.36% and -2.23%, respectively (between-group difference -14.13%; 95% CI -17.79%, -10.47%); and apolipoprotein B -18.10% and -0.67%, respectively (between-group difference -17.43%; 95% CI -21.97%, -12.89%). At 12 weeks, 62.5% of the bempedoic acid group had achieved target LDL-C values. Treatment-emergent adverse events appeared in 3 patients taking bempedoic acid and 2 patients taking placebo.

CONCLUSIONS

This study confirmed the safety and efficacy of bempedoic acid after 12 weeks treatment in Japanese patients with high LDL-C who had inadequate response to statins or statin intolerance.

The Effect of Bauhinia bowkeri Extracts on Hypercholesterolemia: Insights from In Vitro and In Silico Investigations

Despite the many current cholesterol-lowering drugs on the market, the persistent surge of hypercholesterolemic-related complications ignites a fascinating search for the discovery of novel therapeutics. This study aimed at investigating the anti-hypercholesterolemic effect of Bauhinia bowkeri extracts. The plant material was sequentially extracted with n-hexane, dichloromethane (DCM), and 70% ethanol. The phytochemical constituents of the extracts were analyzed through GC-MS and the antioxidant activity of the extracts was screened against a wide range of free radicals (ABTS, DPPH, hydroxyl radical, and nitric oxide). The extracts were also screened for the metal iron chelating and reducing power potential. The enzyme inhibitory activity of the extracts on pancreatic lipase, cholesterol esterase, and HMG-CoA reductase as well as the bile acid binding capacity were evaluated. Among the total of 122 compounds detected in the three extracts, only 7 compounds (E-15-Heptadecenal, Diethyl Phthalate, 9,12,15-Octadecatrienoic acid ethyl ester, (Z,Z) Tetradecane 5-methyl, and Octadecane 5-methyl) were found to be common in all the extracts. The extract displayed a varying degree of efficiency on free radicals with IC50 values ranging from 0.07 mg/mL to 0.41 mg/mL. A concentration-dependent inhibition of pancreatic lipase and cholesterol esterase activities, along with a reduction in the bile-binding capacity exhibited by the extracts, was noted. In silico investigations of some of the phytoconstituent revealed significant inhibition of HMG-CoA reductase, cyclooxygenase, and hormone-sensitive lipase with a binding affinity that ranged between -5.1 and -7.0 kcal/mol. These findings suggest that Bauhinia bowkeri extracts possess potential antioxidant and anti-hypercholesterolemic properties.

Low HDL cholesterol levels in women and hypertriglyceridemia in men: predictors of MASLD onset in individuals without steatosis

BACKGROUND

Individuals with metabolic-associated steatotic liver disease (MASLD) have a worse prognosis compared to patients without steatosis, and its prevalence is increasing. However, detailed risk factors based on obesity and sex remain unclear. We aimed to investigate the impact of cardiometabolic risk factors (CMRFs) on the risk of MASLD in individuals without pre-existing SLD.

METHODS

SLD was diagnosed by ultrasonography. Non-SLD individuals were followed 65,657 person-years. Incidence rates of MASLD were assessed by Kaplan-Meier analysis. Furthermore, independent factors associated with the development of MASLD were identified using Cox regression analysis, stratified by four groups: obese men, non-obese men, obese women, and non-obese women.

RESULTS

The overall incidence rate of MASLD was 39.3/1,000 person-years. The cumulative incidence was highest in obese men, followed by obese women, non-obese men, and non-obese women. Two or more CMRFs increased the risk of MASLD in all groups. Low HDL cholesterol level was the strongest independent risk factor in both obese and non-obese women and hypertriglyceridemia for both obese and non-obese men. The impact of these CMRFs was stronger in non-obese individuals. (HR [95% CI]: women non-obese 1.9 [1.5-2.4], obese 1.4 [1.1-1.8]; men non-obese 2.3 [1.9-2.9], obese 1.5 [1.2-2.0]).

CONCLUSIONS

Multiple CMRFs are important to MASLD development, regardless of sex and obesity. In this Japanese cohort, low HDL cholesterol in women and hypertriglyceridemia in men were the most significant risk factors, especially among the non-obese group. These findings suggest that sex-specific CMRFs may play a role in the development of MASLD.

Preβ1-high-density lipoprotein binds to TG-rich lipoproteins and its release is impaired in the postprandial state among patients with poorly controlled type 2 diabetes

BackgroundAlthough preβ1-high-density lipoprotein (preβ1-HDL) promotes cholesterol efflux, high fasting preβ1-high-density lipoprotein levels after breakfast are reduced in patients with poorly controlled type 2 diabetes.ObjectiveThis study investigated whether preβ1-high-density lipoprotein binds to triglyceride (TG)-rich lipoproteins (TGRLs) in the postprandial state and is released during lipolysis.MethodsWe measured preβ1-high-density lipoprotein concentrations, lecithin-cholesterol acyltransferase (LCAT) activity, and LCAT-dependent preβ1-high-density lipoprotein conversion before and after breakfast in patients with diabetes. We also performed in vitro studies using TGRLs. Preβ1-high-density lipoprotein was quantified by enzyme-linked immunosorbent assay and native two-dimensional gradient gel (N-2D-gel) electrophoresis.ResultsBefore breakfast, the diabetes group had higher preβ1-high-density lipoprotein concentrations than the healthy controls; after breakfast, levels in the two groups were similar. Neither LCAT mass nor the LCAT-dependent preβ1-high-density lipoprotein conversion rate changed after breakfast. Mixing of fasting plasma with chylomicrons or very-low-density lipoprotein (VLDL) reduced the preβ1-high-density lipoprotein level by 15% ± 4% and 45% ± 10%, respectively. N-2D-gel electrophoresis showed that preβ1-high-density lipoprotein was generated by bacteria-derived TG lipase only from postprandial VLDL of patients with type 2 diabetes.ConclusionPreβ1-high-density lipoprotein binds to TGRLs in the postprandial state and is released during lipolysis, implying that postprandial hyperlipidemia impairs reverse cholesterol transport in patients with poorly controlled type 2 diabetes.

Evaluation of the beneficial effects of pemafibrate in hypertriglyceridemia with or without alcohol drinking (PAR-CHAT: PARmodia-CHikushi Anti-dyslipidemia Trial)

Purpose

To examine the efficacy and safety of pemafibrate in outpatients with hypertriglyceridemia, including alcoholic hypertriglyceridemia.

Method

This multicenter, open-label, prospective observational study (C20-07-009) included outpatients with hypertriglyceridemia being treated with pemafibrate who were registered at Fukuoka University Chikushi Hospital or associated clinics. Endpoints were changes in serum triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C), hepatic biomarkers, and other blood values from baseline to 24 weeks and safety. Patients were compared according to alcohol drinking.

Result

From October 2020 to March 2022, 203 patients were registered at 14 facilities. We analyzed 174 patients (mean age, 65.5 years) with baseline fasting TG values who continued pemafibrate for 24 weeks; 55 % drank alcohol, and 35 % were receiving statins. Median fasting TG was 284 mg/dL (IQR, 228-392 mg/dL) at baseline and decreased significantly to 141 mg/dL (IQR, 108-194 mg/dL) at 24 weeks (p < 0.01), independent of alcohol use (non-drinking group, 259 to 134 mg/dL; daily drinking group, 318 to 169 mg/dL; occasional drinking group, 298 to 158 mg/dL; all p < 0.01). Median HDL-C increased significantly from 46 mg/dL (IQR, 39-53 mg/dL) at baseline to 53 mg/dL (IQR, 45-60 mg/dL) at 24 weeks (p < 0.01). Hepatic biomarkers improved significantly at 24 weeks. Low-density lipoprotein cholesterol (LDL-C) increased significantly overall, but not in patients receiving statins. Side effects throughout the study period included dizziness and nausea (1 patient each).

Conclusion

Pemafibrate improves TG, HDL-C, hepatic biomarkers and hypertriglyceridemia regardless of alcohol consumption and is safe. Increase of LDL-C was suppressed in patients treated with statins.

Genetic Evidence for Causal Effects of Circulating Remnant Lipid Profile on Cerebral Hemorrhage and Ischemic Stroke: A Mendelian Randomization Study

BACKGROUND

Mendelian randomization was employed to investigate the impact of circulating lipids, specifically residual lipids, on the risk of susceptibility to cerebral hemorrhage and ischemic stroke.

METHODS

According to the previous studies, we chose 19 circulating lipids, comprising 6 regular lipids and 13 residual lipids, to investigate their potential causal relationship with intracranial hemorrhage and ischemic stroke. The effect estimates were computed utilizing the random-effects inverse-variance-weighted methodology.

RESULTS

The findings revealed negative correlations between high-density lipoprotein cholesterol (HDL-C) and cerebral hemorrhage and large artery stroke. HDL-C, apolipoprotein A1 (Apo A1), TG in very small VLDL, and TG in IDL were found to be negatively correlated with any ischemic stroke. apolipoprotein B (Apo B), triglycerides (TG), low-density lipoprotein cholestrol (LDL-C), L.VLDL-TG, TG in medium VLDL, and TG in small VLDL exhibited positive correlations with large artery stroke. TG in very large HDL and TG in IDL were positively correlated with cardioembolic stroke. No significant causal relationship was observed between circulating lipids, with the exception of HDL-C and cerebral hemorrhage. No causal relationship was identified between any circulating lipids and small vessel stroke. Furthermore, the causal relationships were only found between residual lipids and ischemic stroke.

CONCLUSIONS

This study provides evidence for the beneficial impact of Apo A1 and HDL-C in reducing the risk of ischemic stroke, as well as the protective effect of HDL-C against cerebral hemorrhage. It highlights the detrimental effects of Apo B, TG, and LDL-C in increasing the risk of ischemic stroke, particularly in cases of large artery stroke. Furthermore, the study underscores the heterogeneity and 2-sided effects of the causal relationship between triglyceride-rich lipoproteins and ischemic stroke, offering a promising avenue for the treatment of ischemic stroke.

Assessment of Low-density Lipoprotein Cholesterol Levels and Non-invasive Vascular Health in School-aged Children: A Study in Ogasa District, Shizuoka Prefecture

AIM

The present study assessed low-density lipoprotein cholesterol (LDL-C) levels in school-aged children from the Ogasa District of Shizuoka Prefecture and evaluated the utility of non-invasive vascular tests, namely flow-mediated dilation (FMD) and intima-media thickness (IMT), in pediatric patients with familial hypercholesterolemia (FH).

METHOD

We analyzed the lipid test results of 8,568 students screened for prevention of lifestyle-related diseases and 78 children under 15 years old with cholesterol levels exceeding 220 mg/dL who visited Chutoen General Medical Center. We examined the LDL-C distribution from school-age screenings and conducted FMD and IMT assessments on those meeting the 2022 Pediatric FH Guidelines criteria.

RESULTS

Among the screened students, 186 (2.2%) exhibited LDL-C levels above 140 mg/dL, including 123 fourth-graders (2.8%) and 63 first-year junior high students (1.5%). The mean LDL-C level across all students was 90.0 mg/dL (standard deviation: 21.3 mg/dL), with the 95th percentile at approximately 125.0 mg/dL. Of the 78 children who visited the hospital, 65 met the FH diagnostic criteria. In children ≥ 10 years old, no significant IMT differences were observed between the Definitive and Probable FH groups and the Possible FH group; however, a significant difference in the FMD percentage was noted between these groups (9.9% [8.1%-11.9%] vs. 14.2% [11.6%-16.3%], P=0.003).

CONCLUSIONS

Our findings highlight the LDL-C distribution in FH screening and suggest a potential reduction in FMD in pediatric FH patients ≥ 10 years old. These results emphasize the importance of initiating pharmacological interventions in school-aged children to maintain optimal LDL-C levels for lifelong cardiovascular health.

Prognostic impact of diabetes mellitus on in-hospital mortality in patients with acute myocardial infarction complicating renal dysfunction according to age and sex

BACKGROUND

Patients with acute myocardial infarction (AMI) complicating renal dysfunction (RD) are recognized as being at high risk. Although diabetes mellitus (DM) is a major cause of RD, the prognostic impact of coexisting DM on mortality in patients with AMI complicating RD is ill-defined. This study compared the prognostic impact of coexisting DM in patients with AMI complicating RD according to both age and sex.

METHODS

A multicenter retrospective study was conducted on 2988 consecutive patients with AMI complicating RD (estimated glomerular filtration rate <60 mL/min per 1.73 m2). Multivariable Cox regression analysis was performed to investigate the effects of DM on in-hospital mortality.

RESULTS

Statistically significant interactions between age and DM and between sex and DM for in-hospital mortality were revealed in the entire cohort. Coexisting DM was identified as an independent risk factor for in-hospital mortality (hazard ratio [HR], 2.543) in young (aged <65 years), but not old (aged ≥65 years), patients. DM was identified as an independent risk factor (HR, 1.469) in male, but not female, patients. Kaplan-Meier survival curves showed that DM correlated with significantly low survival rates in patients that were young or male as compared to those who were old or female.

CONCLUSIONS

There were significant differences in the prognostic impact of DM on in-hospital mortality between young and old as well as male and female patients with AMI complicating RD. These results have implications for future research and the management of patients with DM, RD, and AMI comorbidities.

Evaluating the feasibility of a community-adapted multi-domain intervention for dementia prevention in older adults

BackgroundDementia impacts individuals, families, and society, necessitating effective prevention strategies.ObjectiveTo evaluate the feasibility of a community-adapted multi-domain intervention for dementia prevention among older adults in Obu City, Japan and how uncertainties in implementing definitive trials can be reduced.MethodsA 12-month one-arm intervention trial was conducted with 80 community-dwelling older adults aged 65-86 years from two district regions. The multi-domain intervention included physical exercise, nutrition guidance, cognitive training, social participation, and vascular risk management. The primary outcome was the continuation rate, defined as the proportion of participants attending >60% of classes from the initial assessment to 6 months. Secondary outcomes, such as fidelity, acceptability, and appropriateness, were assessed through qualitative and quantitative evaluations. Additionally, health outcomes, including cognitive function and overall lifestyle, were evaluated.ResultsThe study achieved continuation rates of 75% and 76% at 6 and 12 months, respectively, indicating high feasibility. Participants showed high program acceptability (average acceptance score, 4.4 of 5). Fidelity was high regarding content coverage and duration, although the frequency and coverage varied between study sites. Cognitive function remained stable; food-diversity status improved significantly over the study period, though the absence of a control group limits causal interpretation of these changes.ConclusionsThe community-adapted multi-domain intervention for dementia prevention demonstrated high feasibility and acceptability among older adults. Our findings can help reduce uncertainties and support planning future definitive trials to evaluate the effectiveness of community-based dementia-prevention programs.

Atherosclerotic Cardiovascular Disease Risk Prediction Models in China, Japan, and Korea: Implications for East Asians?

The management of atherosclerotic cardiovascular disease (ASCVD) in the United States is currently based upon large epidemiological studies in primarily non-Hispanic White subjects. Although this strategy provides a uniform approach that is simpler to implement, it may result in inappropriately targeting certain Asian populations for treatment based on inaccurate ASCVD risk estimation. In this state-of-the-art review, we detail the similarities and differences in the prevalence of ASCVD and its risk factors among Chinese, Japanese, and Korean people living in the United States and in their native countries. We highlight the limitations of current risk calculators when applied to East Asian immigrants and summarize risk stratification approaches in China, Japan, and Korea. Our review underscores the need to disaggregate registry, cohort, and clinical trial data by East Asian subgroups, to actively engage these populations in research, and to initiate studies to better define ASCVD risk in East Asian people living in the United States.

Burden, risk factors, and projections of ischemic heart disease in China (1990-2021): findings from the 2021 GBD study

Background

Ischemic heart disease (IHD) remains a major public health challenge in China. This study aimed to comprehensively analyze the burden of IHD, its risk factors, and future trends from 1990 to 2021 using the Global Burden of Disease database.

Methods

We assessed IHD trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) stratified by age (greater than 15 years) and gender. Age-standardized rates, average annual percentage changes, and joinpoint regression analyses were used to evaluate temporal trends. Decomposition and frontier analyses were conducted to identify key contributors to the IHD burden, while future projections were generated for the next 15 years.

Results

In 2021, the number of IHD incident cases, prevalent cases, deaths, and DALYs in China were 3.17, 3.25, 3.57, and 2.62 times higher than those in 1990, respectively. Age-standardized mortality rates and age-standardized DALYs rates demonstrated an initial increase, followed by a gradual decline. Males showed higher IHD burden during middle age, while elderly females surpassed males in the later years. Aging, high systolic blood pressure, ambient particulate matter pollution, elevated low-density lipoprotein cholesterol, and smoking were the primary drivers of IHD burden. Future projections suggest a declining incidence and prevalence among males but increasing trends in females, with DALYs expected to rise significantly in the female population.

Conclusions

The burden of IHD in China has evolved significantly over the past three decades, driven by demographic and environmental factors. While prevalence and incidence have risen, mortality and DALYs have shown a recent decline, reflecting shifts in disease patterns. Age and gender disparities are evident, with middle-aged males and elderly females disproportionately affected. Key contributors, such as high blood pressure and pollution, highlight the need for targeted interventions. Gender-specific public health strategies, alongside improved environmental and health policies, are essential to mitigating the future burden of IHD in China.

Association of nocturnal oxygen saturation with coronary artery calcification: cross-sectional evidence from the population-based SESSA study among Japanese men

OBJECTIVE

We investigated the associations of nocturnal oxygen saturation (SpO2) with prevalence of coronary artery calcification (CAC) and its level of burden, and whether the associations differ by obesity and mediate through diabetes mellitus (DM), dyslipidaemia and hypertension.

DESIGN

Observational study.

SETTING

Kusatsu, Shiga.

PARTICIPANTS

We analysed data from 510 Japanese men (aged 46-76 years) with no history of myocardial infarction.

PRIMARY AND SECONDARY OUTCOMES

Mean SpO2, minimum SpO2 and oxygen desaturation index (ODI) were measured using overnight pulse oximetry (primary exposures), while CAC was assessed using CT. Prevalence of CAC (>0) and its burden (CAC 0, >0-100, >100-400 and>400) were evaluated as outcomes. Body mass index≥25.0 kg/m2 defined as obesity.

RESULTS

Mean±SD age was 66.7±7.2 years. The prevalence of CAC was 64.7% (CAC scores>0-100, 31.4%; >100-400, 20.0% and>400, 13.3%). In multivariable binary logistic regression, the OR and 95% CI for the prevalence of CAC were 1.25 (1.02 to 1.53) per 1-SD decrement in mean SpO2 and 1.25 (1.01 to 1.55) per 1-SD increment in ODI. The associations lost their significance while further adjusted for DM and dyslipidaemia. Similar trends were observed for the level of CAC burden in multivariable ordinal logistic regression. Obesity did not show significant interaction with SpO2 on CAC. In mediation analysis, the OR (95% CI) for natural indirect effect; percentage mediated through dyslipidaemia in association of 1-SD decrement in mean SpO2 with prevalence of CAC were 1.06 (1.01 to 1.10); 25.4%. These estimates for mediation through DM and dyslipidaemia for 1-SD increment in ODI in the associations were 1.07 (1.01 to 1.12); 29.6% and 1.04 (1.00 to 1.08); 17.5%, respectively.

CONCLUSIONS

Lower mean SpO2 and higher ODI are associated with CAC among Japanese men, independent of age, lifestyle factors and obesity. The associations became non-significant after adjusting for diabetes and dyslipidaemia, but were mediated through these factors.

Impact of the COVID-19 pandemic on the incidence of cardiometabolic risk factors among workers: results from the Japan Epidemiology Collaboration on Occupational Health study

BACKGROUND

The COVID-19 pandemic and associated restrictions on human activities have greatly changed lifestyles, which might have deteriorated the cardiometabolic profile.

OBJECTIVE

This study aimed to examine the effect of the COVID-19 pandemic on the incidence of cardiometabolic risk factors among Japanese workers in fiscal years (FY) 2020 and 2021 compared with the prepandemic period.

METHOD

This study comprised an average of 71 025 employees in Japan who underwent annual health check-ups for at least two successive years from 2015 to 2021. Annual incidence rates from 2016 to 2021 were assessed for obesity, diabetes, hypertension, dyslipidaemia and metabolic syndrome (MetS). The observed incidence rates in 2020 and 2021 were compared with the predicted incidence based on prepandemic trends (2016 to 2019).

RESULTS

Relative to the prepandemic, the incidence of all the outcomes, except for dyslipidaemia, significantly increased in 2020. Between FY 2016 and 2019, the adjusted mean incidence of obesity, diabetes, hypertension, dyslipidaemia and MetS was 5.0%, 1.4%, 5.3%, 17.4% and 7.6%, respectively. In FY 2020, the adjusted incidence (95% CI) of these outcomes increased to 6.02 (5.80 to 6.24), 1.84 (1.73 to 1.96), 6.62 (6.40 to 6.83), 19.31 (18.83 to 19.78) and 8.51 (8.23 to 8.78), which were higher than the predicted incidence of 5.24 (4.99 to 5.49), 1.54 (1.41 to 1.67), 6.02 (5.76 to 6.27), 18.58 (18.00 to 19.16) and 8.05 (7.71 to 8.38) for 2020, respectively. The incidence returned to the prepandemic levels in FY 2021.

CONCLUSION

Results showed a worsening of the cardiometabolic profile during the initial year of the pandemic, which was reverted in the second year to the levels before the pandemic.

Call for a consensual definition of dyslipidemia in coronary angiography trials

Dyslipidemia is extensively analyzed in clinical trials investigating its role as a risk factor for coronary artery disease (CAD). However, its definition varies vastly among studies, leading to different attributions to the variable dyslipidemia. The objectives of this study are to verify the hypothesis of a lack of a consensual definition of dyslipidemia in coronary angiography studies and to propose a consensual definition of dyslipidemia, considering the influence of each serum lipid parameter on mortality. A systematic search of coronary angiography studies focusing on dyslipidemia was conducted. We listed definitions and their references in the 258 articles the research found. Out of the 258 articles retrieved in the search, 52 studies (20%) provided a definition of dyslipidemia, and 20 (8%) mentioned the source. We identified 39 different definitions. To mitigate misinterpretations of cardiovascular risk factors, we propose the use of the "lipid triad" components to define dyslipidemia: LDL-cholesterol >3.0 mmol/L for primary prevention and >2.6 mmol/L or >1.4 mmol/L for secondary prevention in patients over/under 75 years old, respectively; or HDL-cholesterol <1.3 mmol/L (women) and <1.0 mmol/L (men); or triglycerides >1.7 mmol/L.

The Asia-Pacific Body Mass Index Classification and New-Onset Chronic Kidney Disease in Non-Diabetic Japanese Adults: A Community-Based Longitudinal Study from 1998 to 2023

Background/Objectives: Obesity is a risk factor for chronic kidney disease (CKD) in Asians. The Asia-Pacific body mass index (BMI) classification sets lower obesity cutoffs than the conventional BMI classification for all races, generally reflecting the lower BMIs in Asians. This longitudinal study evaluated the association between BMI, as classified by the Asia-Pacific BMI system, and CKD development in non-diabetic Asian adults. Methods: A population-based longitudinal study (1998-2023) was conducted in non-diabetic Japanese adults (hemoglobin A1c < 6.5%) in Zentsuji City (Kagawa Prefecture, Japan). The generalized gamma model was used to assess the relationship between time-varying BMI categories and CKD development, stratified by sex. CKD was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m2. BMI was calculated as weight (kg) divided by the square of height (m2) and categorized per the Asia-Pacific classification as overweight (23.0-24.9 kg/m2), obesity class I (25.0-29.9 kg/m2), and obesity class II (≥30.0 kg/m2). Results: CKD developed in 34.2% of 3098 men and 34.8% of 4391 women. The mean follow-up times were 7.41 years for men and 8.25 years for women. During follow-up, the BMI distributions for men were 5.0% underweight, 43.3% normal weight, 25.6% overweight, 24.1% obesity class I, and 2.0% obesity class II; those for women were 7.7%, 50.5%, 20.5%, 18.3%, and 2.9%, respectively. Compared with normal weight, obesity class I was associated with a 6% (95% confidence interval [CI]: 2-10%) shorter time to CKD onset in men and 5% (95% CI: 2-7%) in women. In both sexes, obesity class II showed shorter survival times than normal weight by point estimates, although all 95% CIs crossed the null value. Conclusions: Obesity, as classified by the Asia-Pacific BMI system, shortened the time to CKD onset in non-diabetic Asians. The conventional BMI cutoff for obesity (≥30.0 kg/m2) may be too high to identify CKD risk in this population. The findings of this study may be useful for public health professionals in designing interventions to prevent CKD.

A Medical Claims Database Study of Factors Associated with Medication Adherence and Treatment Persistence in Patients Receiving PCSK9 Monoclonal Antibodies

AIM

To investigate medication adherence and treatment persistence in patients receiving proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (mAbs) in Japan.

METHODS

Using an anonymized claims database from January 2015 to December 2021, data on adult patients at high risk for atherosclerotic cardiovascular disease or with a history of coronary artery disease (CAD) who had at least 1 prescription for PCSK9-mAbs were retrieved.

RESULTS

In total, 276 patients were analyzed. The cumulative treatment persistence rate after 1 year was 67.0%. A multivariate analysis revealed that better adherence to oral low-density lipoprotein cholesterol (LDL-C)-lowering therapy in the year before starting PCSK9-mAbs (adjusted odds ratio [OR] 2.16) and a history of CAD for secondary prevention (adjusted OR 2.44) were associated with better adherence to PCSK9-mAbs in the first year. Better adherence to oral LDL-C-lowering therapy in the year before starting PCSK9-mAbs (adjusted OR 2.32) and a history of CAD for secondary prevention (adjusted OR 3.03) were also associated with a lower rate of discontinuation of PCSK9-mAbs. Age, sex, comorbidity, number of tablets taken daily (all medications), and number of hospital or clinic visits in the year prior to starting PCSK9-mAbs did not affect the persistence rate or adherence to PCSK9-mAbs in the multivariate analyses.

CONCLUSION

Better adherence to oral LDL-C-lowering therapy and secondary prevention were identified as factors associated with better medication adherence and treatment persistence in patients receiving PCSK9-mAbs within the first year.

Patient Sex and Physician Gender as Modifiers of Low-density Lipoprotein Cholesterol Control in High-risk Patients of Atherosclerotic Disease: A Cross-sectional Study

Introduction

Inadequate management of low-density lipoprotein (LDL) cholesterol is more common in female patients than in male patients in the context of preventing atherosclerotic cardiovascular disease. Moreover, the effect of physician gender on patient outcomes has been acknowledged. However, to date, no study in Japan has investigated this issue or explored the potential interactions between patient sex and physician gender. This study aimed to assess disparities in achieving LDL cholesterol targets between male and female patients and examine the impact of the patient-physician gender dyad.

Methods

We conducted a cross-sectional study using electronic medical records from an urban Japanese clinic. Patients aged 40-79 years with coronary artery disease, noncardiogenic stroke, or diabetes mellitus were included in the study. The modified Poisson regression model with robust error variance was used, and patients were stratified by sex to evaluate the interaction between patient sex and physician gender.

Results

Among the 714 patients (44.1% women), female patients were less likely to achieve LDL cholesterol targets than male patients (70.7% male vs. 63.9% female). Adjusted analyses revealed that this trend persisted for female patients (adjusted prevalence ratio: 0.86, 95% confidence interval [CI]: 0.77-0.96). A notable interaction between patient sex and physician gender was observed; male patients managed by female physicians had lower LDL cholesterol target achievement than male patients managed by male physicians (adjusted prevalence ratio: 0.74 [95% CI: 0.62-0.88]).

Conclusions

Female patients were less likely to achieve LDL cholesterol targets, and patient-physician gender discordance was associated with poorer lipid management. These findings highlight the need for quality improvement interventions to address the disparity.

Long-term renoprotective effect of luseogliflozin in type 2 diabetes patients: CHikushi Anti-diabetes mellitus Trial-Lusefi (CHAT-Lu)

Several sodium-glucose cotransporter 2 (SGLT2) inhibitors are known to have beneficial effects on renal function in patients with type 2 diabetes. However, the long-term effects of luseogliflozin, an SGLT2 inhibitor, remain uncertain in real-world settings. This multicenter, open-label, prospective observational study evaluated the long-term effects of luseogliflozin on renal function in Japanese patients with type 2 diabetes. Fifty-four outpatients initiated on luseogliflozin at Fukuoka University Chikushi Hospital or associated clinics were enrolled from April 2018 to December 2019, with 46 patients included in the final analysis set. The primary outcome was the change in estimated glomerular filtration rate (eGFR) from baseline to 104 weeks, and secondary outcomes included the change in eGFR at week 52 and changes in body weight and blood and urinary parameters at 52 and 104 weeks. The mean duration of diabetes was 8.1 years. Baseline eGFR was 75.8 ± 17.4 mL/min/1.73m2, and no decline in eGFR was observed from baseline to 104 weeks. Decline in eGFR was suppressed in the two groups stratified by baseline eGFR (< 60 and ≥ 60 mL/min/1.73m2). No changes were noted in urinary albumin excretion rate. Blood glucose, body weight, blood pressure, liver function, and uric acid levels showed significant improvements. There were four adverse events, but no serious adverse events closely related to luseogliflozin treatment. In type 2 diabetes patients, 2-year treatment with luseogliflozin provided beneficial metabolic effects and improved the rate of decline in eGFR, suggesting a renal protective effect.

Emotion suppression differentially moderates the link between stress and cardiovascular disease risk in Japanese and Americans

Background

Cardiovascular disease (CVD) remains a key cause of mortality worldwide. Prior work has found that the association between stress and cardiovascular outcomes is moderated by emotion regulation (ER) and expressive suppression (i.e., emotion inhibition), which is linked with adverse outcomes (i.e., inflammation) in Western (Americans) but not Eastern (Japanese) populations. Existing cultural differences in biological stress responses and suppression use suggest that these factors may have different implications for CV outcomes.

Objective

We address this gap in the literature by examining if ER differentially moderates the relationship between stress and CVD risk between Japanese and American adults.

Method

Participants were from the Midlife in Japan and Midlife in the United States studies and had complete biomarker and psychological data (Japanese: N = 315, M age = 59.22, 149 females; Americans: N = 524, M age = 51.98, 291 females). Stress was indexed using the perceived stress scale. Trait suppression and reappraisal were indexed using the Emotion Regulation Questionnaire. CVD risk was indexed using a composite score of body mass index, C-reactive protein, interleukin-6, systolic blood pressure, and high-density lipoprotein cholesterol ratio.

Results

Adjusting for age, sex, education, tobacco, alcohol, and prescription medication use, linear regressions revealed robust cultural differences among those with high suppression (r = -0.10 [-0.19, -0.01]). Higher stress was linked with higher CVD risk in Americans regardless of the level of reappraisal or suppression (r's > 0.11, p's < 0.07). In contrast, among Japanese with high suppression, higher stress was associated with lower CVD risk (r = -0.09 [-0.23, 0.05]). Higher stress was associated with greater inflammation among Japanese with lower suppression (r = 0.10 [-0.07, 0.28]).

Conclusions

Consistent with prior work, these findings suggest that adaptive ER moderates the association between stress and CVD risk, and that suppression may not be universally 'maladaptive.' Results emphasize the importance of considering cultural context when assessing the impact of emotion suppression on health, which may help explain differences in CVD outcomes between individuals from Eastern and Western populations.

Effects of laparoscopic sleeve gastrectomy on weight loss and metabolic improvement in subjects aged 65 years or older: a subanalysis of J-SMART study

Aim

To investigate the effect of weight loss and metabolic improvement after laparoscopic sleeve gastrectomy (LSG) in older adults aged 65 years or over compared with younger adults in a retrospective analysis.

Methods

The J-SMART study database of 322 Japanese individuals with body mass index (BMI) ≥32 kg/m2 who underwent LSG between 2011 and 2014 at 10 centers accredited by the Japanese Society for Treatment of Obesity were analyzed. The subjects were classified into two groups: ≥65 age group (range, 65-76 years; n = 25) and <65 age group (range, 22-64 years; n = 297). Clinical parameters were compared between the groups.

Results

Baseline data for the ≥65 vs. <65 age groups were: median age 67 years vs. 45 years; weight 92.7 kg vs. 114.4 kg; BMI 40.0 kg/m2 vs. 41.9 kg/m2; and HbA1c 6.8% vs. 6.5%. The ≥65 age group had significantly lower preoperative weight, BMI, estimated glomerular filtration rate, and ABCD score, but higher visceral fat area and prevalence of diabetes, hypertension, and obstructive sleep apnea (OSAS). Weight was significantly reduced in both groups throughout 5 years post-LSG, though total weight loss at 2 years was lower in the ≥65 age group (28.0%) than in the <65 group (30.0%). Remission rates of diabetes, hypertension, OSAS, and joint disorders 2 years after LSG showed no significant differences, except for dyslipidemia.

Conclusion

LSG may be an efficacious option for improving obesity-related health problems in older adults. However, postoperative safety and complications were not evaluated in this study and further research is needed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-024-00767-w.

Case report of familial hypercholesterolemia with internal carotid neck swelling

Familial hypercholesterolemia is a multi-gene disorder affecting 1 in 200-500 individual which is characterized by increased level of total cholesterol and low density lipoprotein (LDL) which deposit cholesterol reach protein leading to xanthomas, corneal arcus and prone to develop risk for atherosclerosis and coronary heart disease. 11 year female, born of consanguineous marriage attended with yellowish patches (Xanthelasma) bilaterally present over upper eyelid, buttock since 5-6 years. In family history younger girl along with both parents has Xanthelasma. In investigations, routine blood, urine and ECG& ECHO was normal except lipid profile of patient and sibling was abnormal. Child was treated with atorvastatin and dietary advice. In follow up after 3 month, child had complained of neck pain and swelling to left side. Then USG neck and Color Doppler showed reduced diastolic flow of left ICA and type two plaques and type 111 plaque in Rt common carotid artery. Anti-platelets was added and referred to cardiologist for coronary angiography which showed LAD - proximal mid distal diffuse plaque, LCX- proximal eccentric plaque. This case highlights the significance of conscious and proactive genetic screening for familial hypercholesterolemia especially in consanguineous marriage, to diagnose, treat and prevent mortality with premature coronary artery disease.

Estimated Proximal Tubule Fluid Phosphate Concentration and Renal Tubular Damage Biomarkers in Early Stages of Chronic Kidney Disease

OBJECTIVE

An increase in proximal tubule fluid phosphate concentration is caused by increased serum fibroblast growth factor-23 (FGF23) levels, which resulted in renal tubular damage in a mouse model of chronic kidney disease (CKD). However, few human studies have supported this concept. This study aimed to explore the association among estimated proximal tubule fluid phosphate concentration (ePTFp), serum FGF23 levels, and renal tubular damage biomarkers in middle-aged and older populations with mild decline in renal function.

METHODS

This cross-sectional study included 218 participants aged ≥45 with CKD stages G2-G4. Anthropometric measurements, blood tests, spot urine biomarkers, renal ultrasonography, cardiovascular assessment, smoking status, and medication usage were obtained in the morning in fasted states. The ePTFp was calculated using serum creatinine, urine phosphate, and creatinine concentrations. Urinary β2-microglobulin (β2-MG) and liver-type fatty acid-binding protein (L-FABP) levels were evaluated to assess renal tubular damage.

RESULTS

PTFp, serum FGF23, urinary β2-MG, and urinary L-FABP levels increased with CKD stage progression (stages G2, G3, and G4). However, serum and urine phosphate concentrations were comparable across the CKD stages. Univariate analysis revealed a stronger correlation of ePTFp with serum FGF23, urinary β2-MG, and urinary L-FABP levels than with the corresponding serum and urine phosphate concentrations. Multivariate analyses demonstrated that increased ePTFp was independently associated with elevated serum FGF23 and urinary β2-MG levels, even after adjusting for potential covariates, including the estimated glomerular filtration rate and urinary albumin-to-creatinine ratio.

CONCLUSIONS

Our results are consistent with the concept in mouse model and suggest that increased ePTFp are associated with increased serum FGF23 levels and renal tubular damage during the early stages of CKD.

Role of ABCA1 in Atherosclerosis: Novel Mutations and Potential Plant-derived Therapies

ATP-binding cassette transporter A1 (ABCA1) is one of the key proteins regulating cholesterol homeostasis and playing a crucial role in atherosclerosis development. ABCA1 regulates the rate-limiting step of reverse cholesterol transport, facilitates the efflux of surplus intracellular cholesterol and phospholipids, and suppresses inflammation through several signalling pathways. At the same time, many mutations and Single Nucleotide Polymorphisms (SNPs) have been identified in the ABCA1 gene, which affects its biological function and is associated with several hereditary diseases (such as familial hypo-alpha-lipoproteinaemia and Tangier disease) and increased risk of cardiovascular diseases (CVDs). This review summarises recently identified mutations and SNPs in their connection to atherosclerosis and associated CVDs. Also, we discuss the recently described application of various plant-derived compounds to modulate ABCA1 expression in different in vitro and in vivo models. Herein, we present a comprehensive overview of the association of ABCA1 mutations and SNPs with CVDs and as a pharmacological target for different natural-derived compounds and highlight the potential application of these phytochemicals for treating atherosclerosis through modulation of ABCA1 expression.

Drugs for dyslipidaemia: the legacy effect of the Scandinavian Simvastatin Survival Study (4S)

Since the discovery of statins and the Scandinavian Simvastatin Survival Study (4S) results three decades ago, remarkable advances have been made in the treatment of dyslipidaemia, a major risk factor for atherosclerotic cardiovascular disease. Safe and effective statins remain the cornerstone of therapeutic approach for this indication, including for children with genetic dyslipidaemia, and are one of the most widely prescribed drugs in the world. However, despite the affordability of generic statins, they remain underutilised worldwide. The use of ezetimibe to further decrease plasma LDL cholesterol and the targeting of other atherogenic lipoproteins, such as triglyceride-rich lipoproteins and lipoprotein(a), are likely to be required to further reduce atherosclerotic cardiovascular disease events. Drugs directed at these lipoproteins, including gene silencing and editing methods that durably suppress the production of proteins, such as PCSK9 and ANGPTL3, open novel therapeutic options to further reduce the development of atherosclerotic cardiovascular disease.

Prediction of Hepatocellular Carcinoma After Hepatitis C Virus Sustained Virologic Response Using a Random Survival Forest Model

PURPOSE

Postsustained virologic response (SVR) screening following clinical guidelines does not address individual risk of hepatocellular carcinoma (HCC). Our aim is to provide tailored screening for patients using machine learning to predict HCC incidence after SVR.

METHODS

Using clinical data from 1,028 SVR patients, we developed an HCC prediction model using a random survival forest (RSF). Model performance was assessed using Harrel's c-index and validated in an independent cohort of 737 SVR patients. Shapley additive explanation (SHAP) facilitated feature quantification, whereas optimal cutoffs were determined using maximally selected rank statistics. We used Kaplan-Meier analysis to compare cumulative HCC incidence between risk groups.

RESULTS

We achieved c-index scores and 95% CIs of 0.90 (0.85 to 0.94) and 0.80 (0.74 to 0.85) in the derivation and validation cohorts, respectively, in a model using platelet count, gamma-glutamyl transpeptidase, sex, age, and ALT. Stratification resulted in four risk groups: low, intermediate, high, and very high. The 5-year cumulative HCC incidence rates and 95% CIs for these groups were as follows: derivation: 0% (0 to 0), 3.8% (0.6 to 6.8), 26.2% (17.2 to 34.3), and 54.2% (20.2 to 73.7), respectively, and validation: 0.7% (0 to 1.6), 7.1% (2.7 to 11.3), 5.2% (0 to 10.8), and 28.6% (0 to 55.3), respectively.

CONCLUSION

The integration of RSF and SHAP enabled accurate HCC risk classification after SVR, which may facilitate individualized HCC screening strategies and more cost-effective care.

Association between subjective walking speed and metabolic diseases in individuals with obesity: a cross-sectional analysis

The association between subjective walking speed and metabolic diseases has received limited attention, particularly in individuals with obesity. We aimed to clarify this association using comprehensive health checkup data of participants with obesity. In total, 8578 individuals with a body mass index ≥ 25.0 kg/m2, 9626 individuals with waist circumference ≥ 85 cm in men and ≥ 90 cm in women, and 6742 individuals who met both criteria of body mass index and waist circumference were included in this cross-sectional analysis. Subjective walking speed was investigated using the question "Is your walking speed faster than the speed of those of your age and sex?" in a health examination questionnaire. Metabolic diseases were defined according to the guidelines for each disease, and modified Poisson regression analyses were performed. In the model adjusted for age and sex, individuals with obesity based on body mass index and fast subjective walking speed showed significantly lower risk of diabetes mellitus (risk ratio [RR] 0.70; 95% CI 0.63-0.77) and dyslipidemia (RR 0.97; 95% CI 0.94-1.00). Similarly, among those with obesity based on waist circumference and both body mass index and waist circumference, fast subjective walking speed showed a significant negative association with hypertension (RR 0.94; 95% CI 0.90-0.97 and RR 0.95; 95% CI 0.92-0.99, respectively), diabetes mellitus (RR 0.70; 95% CI 0.64-0.77 and RR 0.70; 95% CI 0.63-0.77, respectively), and dyslipidemia (RR 0.96; 95% CI 0.94-0.99 and RR 0.96; 95% CI 0.94-0.99, respectively). Thus, among individuals with obesity, the odds of metabolic diseases were lower if their subjective walking speed was fast. This study contributes to earlier prevention of the cascade of diseases that begin with obesity.

Combined effect of histological findings and diabetes mellitus on liver-related events in patients with metabolic dysfunction-associated steatotic liver disease

AIM

Advanced fibrosis has a strong influence on the occurrence of liver-related events in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), while diabetes mellitus (DM), which is often complicated by MASLD, is associated with the progression of MASLD. We stratified patients with MASLD according to the severity of liver pathological findings and the presence of DM, aiming to examine whether these indices could be used to accurately assess the risk of developing liver-related events.

METHODS

A total of 282 patients with liver biopsy-proven MASLD were included. Liver-related events were defined as the occurrence of hepatocellular carcinoma (HCC) and complications of liver cirrhosis, such as ascites, hepatic encephalopathy, Child-Pugh class B and C, as well as treatment-eligible esophageal and gastric varices.

RESULTS

Multivariate analysis adjusted for age, sex, body mass index, alanine aminotransferase, creatinine, hemoglobin A1c, smoking habits, dyslipidemia, hypertension, nonalcoholic fatty liver disease activity score (NAS), or fibrosis stage showed that advanced fibrosis with or without DM was a risk factor for liver-related events. The combined effect of DM and advanced fibrosis increased the risk of HCC onset. However, DM alone or in combination with NAS did not affect the development of liver-related events, including the occurrence of HCC and complications of liver cirrhosis.

CONCLUSIONS

While the assessment of fibrosis in patients with MASLD is important for evaluating the risk of developing liver-related events, combining the assessment of DM may be possible to stratify groups at higher risk of developing HCC.

Relationship between respiratory function assessed by spirometry and mild cognitive impairment among community-dwelling older adults

AIM

Aging is a major cause of cognitive dysfunction. It has also been reported that respiratory function may influence cognitive dysfunction. However, few studies have examined the relationship between cognitive function and respiratory function among community-dwelling older adults. This study aims to determine the relationship between respiratory function, assessed using spirometry, and mild cognitive impairment (MCI) in community-dwelling older adults.

METHODS

This study included 419 participants aged 73 ± 1 years and 348 participants aged 83 ± 1 years from the SONIC cohort study (Septuagenarians Octogenarians Nonagenarians Investigation with Centenarians Study). Respiratory function was evaluated using %Vital Capacity (%VC), Forced Expiratory Volume 1 s (FEV1)/Forced Vital Capacity (FVC), and %Peak Expiratory Flow (%PEF). Airflow-limitation presence and stages were classified using FEV1/FVC. Cognitive function and MCI were assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J).

RESULTS

The MoCA-J score exhibited a declining trend as the airflow-limitation stage increased among study participants in the 83 ± 1 age group. The presence of airflow limitation was associated with MCI in the 83 ± 1 age group. Among the indicators of each respiratory function, low %PEF was found to be associated with an increased rate of MCI. Furthermore, low %VC has also been suggested to be associated with an increased rate of MCI in the 83 ± 1 age female group.

CONCLUSIONS

Advanced airflow-limitation stages may exacerbate cognitive dysfunction in community-dwelling older adults. The presence of airflow limitation and low %VC may also be associated with cognitive dysfunction in older women. Consequently, reduced respiratory function may potentially be associated with MCI in community-dwelling older adults. Geriatr Gerontol Int 2024; 24: 1001-1007.

An In-depth Single-center Retrospective Assessment of In-hospital Outcomes in Acute Myocardial Infarction Patients with and without Diabetes

Objective This study examined variations in in-hospital mortality causes and identified independent mortality predictors among patients with acute myocardial infarction (AMI) with and without diabetes mellitus (DM). Methods We examined factors influencing in-hospital mortality in a single-center retrospective observational study. Separate multivariate analyses were conducted for both groups to identify independent predictors of in-hospital mortality. Patients This study included consecutive patients admitted to Iwate Medical University Hospital between January 2012 and December 2017 with a diagnosis of AMI. Results Of 1,140 patients meeting the AMI criteria (average age: 68.2±12.8 years old, 75% men), 408 (35.8%) had diabetes. The DM group had a 1.87-times higher 30-day mortality rate, a lower prevalence of ST-elevated MI (56.6% vs. 65.3% in non-DM, p=0.004), and more frequent non-cardiac causes of death (32% vs. 14% in non-DM, p=0.046) than the non-DM group. Independent predictors of in-hospital mortality in both groups were cardiogenic shock (CS) [DM: hazard ratio (HR) 6.59, 95% confidence interval (CI) 2.90-14.95; non-DM: HR 4.42, 95% CI 1.99-9.77] and renal dysfunction (DM: HR 5.64, 95% CI 1.59-20.04; non-DM: HR 5.92, 95% CI 1.79-19.53). Among patients with DM, a history of stroke was an additional independent predictor of in-hospital mortality (HR 2.59, 95% CI 1.07-6.31). Conclusion Notable disparities were identified in the causes of death and predictive factors of mortality between these two groups of patients with AMI. To further improve AMI outcomes, individualized management and prioritizing non-cardiac comorbidities during hospitalization may be crucial, particularly in patients with DM.

An 18-month multimodal intervention trial for preventing dementia: J-MINT PRIME Tamba

BACKGROUND

The number of people with dementia is increasing in Japan, and establishing evidence for preventing dementia is necessary.

METHODS

This study was a randomized controlled trial in cognitively normal community-dwelling older adults aged 65 to 85 with diabetes and/or hypertension. Participants were randomly assigned in a 1:1 ratio. The intervention group underwent 90 min of group-based weekly physical exercise, cognitive training, nutritional counseling, and vascular risk management for 18 months. The primary endpoint was the change in a cognitive composite score calculated by averaging the z-scores of seven neuropsychological tests from baseline to 18 months.

RESULTS

We randomly assigned 203 participants to two groups, and 178 (87.7%) completed the 18-month follow-up. There was a significant group difference in the cognitive composite score change at 18 months (mean difference 0.16, 95% confidence interval: 0.04 to 0.27; p = 0.009).

DISCUSSION

An 18-month multimodal intervention for older adults at risk of dementia could improve their cognitive function. The trial was registered in the Clinical Trial Registration System (UMIN000041938).

HIGHLIGHTS

Japan-Multimodal Intervention Trial for Prevention of Dementia (J-MINT) PRIME Tamba was a randomized controlled trial to prevent dementia. We provided a multifactorial intervention based on the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) trial methodology. The primary outcome, the cognitive composite score, improved with our intervention. Executive function/processing speed and memory improved in the intervention group. Intervention adherence was high, and no serious adverse events occurred.

Impact of Low-Dose Prasugrel on Platelet Reactivity in Chronic Phase of Post-Percutaneous Coronary Intervention (CHAPERON): a Prospective Cohort Study

PURPOSE

Asians often face the problems of clopidogrel resistance and East Asian paradox. This study aimed to evaluate the effects of P2Y12 inhibitors, including low-dose prasugrel 2.5 mg, on the P2Y12 reaction unit (PRU) in the chronic phase after percutaneous coronary intervention (PCI).

METHODS

A total of 348 patients were studied. PRU was measured 6-12 months after PCI and subsequently, 6 months later using a P2Y12 assay, respectively. This study evaluated the proportion of bleeding risk (PRU ≤ 85) and ischemic risk (PRU ≥ 239) as primary endpoints, and the prediction of bleeding risk and ischemic risk using multivariable logistic regression analysis.

RESULTS

At baseline, 136 patients (39%) received prasugrel 3.75 mg, 48 patients (14%) received prasugrel 2.5 mg, and 164 patients (47%) received clopidogrel 75 mg. Clopidogrel 75 mg had a significantly higher proportion of ischemic risk within one year after PCI than the other groups, and was an independent predictor for ischemic risk with reference of prasugrel 3.75 mg. In addition, switching from clopidogrel 75 mg to prasugrel 2.5 mg significantly lowered and aggregated the PRU value. Whereas, dose reduction of prasugrel had a significantly lower proportion of bleeding risk over one year after PCI than the continuation of prasugrel 3.75 mg, and was an independent predictor for bleeding risk with reference of continuation of prasugrel 3.75 mg.

CONCLUSIONS

Prasugrel 2.5 mg has a lower ischemic risk and a more stable PRU value compared with clopidogrel treatment. Prasugrel also contributes to a decline in bleeding risk with concomitant dose reduction.

TRIAL REGISTRATION

University Hospital Medical Information Network (UMIN), ID: UMIN000029541, Date: October 16, 2017 ( https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000033395 ).

Handgrip Strength Is Inversely Associated With the Progression of Kidney Damage in a General Japanese Population: A Prospective Cohort Study

Background Handgrip strength is an indicator of muscle function and a predictor of health outcomes. However, only a few studies have examined the association between handgrip strength and the development of kidney damage. This study aimed to investigate the longitudinal association of handgrip strength with kidney damage in a general Japanese population. Methods This prospective cohort study enrolled participants with normal kidney function who attended annual health check-ups in Ibaraki Prefecture, Japan, between April 2016 and March 2020. Clinical information, including data from blood and urine tests, physiological examinations, and handgrip strength tests, was collected at enrollment. Lifestyle information was also collected via a self-administered questionnaire. The study participants were followed up for the progression of kidney damage until March 2023. Relative handgrip strength was calculated by dividing the handgrip strength by the body mass index to adjust for differences in body mass. A Cox proportional hazards model was used to examine the relationship between relative handgrip strength and the progression of kidney damage. Results A total of 4304 participants with normal kidney function were enrolled in this study. During the mean follow-up period of approximately 4 years (SD 1.8 years), 15.4% of the participants developed kidney damage. After adjusting for covariates, higher relative handgrip strength was associated with a lower risk of kidney damage in men (HR = 0.63, 95% CI: 0.43 - 0.90; p = 0.012), but no significant association was observed in women. Conclusions Higher relative handgrip strength is associated with a lower risk of kidney damage in men. This finding highlights the importance of muscle strength in preventing kidney damage.

Association between blood pressure and new onset of chronic kidney disease in non-diabetic Japanese adults: A population-based longitudinal study from 1998 to 2023

BACKGROUND AND AIMS

Hypertension is a risk factor for developing chronic kidney disease (CKD). Studies of adult participants in the USA reported that hypertension increased the risk of developing CKD even in the non-diabetic population. However, studies in non-diabetic populations are limited and additional studies in other races are required. This study aimed to examine the relationship between hypertension and the development of CKD in non-diabetic Asian adults.

METHODS AND RESULTS

In this longitudinal study, non-diabetic Japanese adults who took annual checkups from 1998 to 2023 were included. CKD was defined as <60 mL/min/1.73 m2, and hypertension was classified into four levels according to the guidelines of the American College of Cardiology/American Heart Association. The Weibull accelerated failure time model was selected because the proportional hazards assumption was violated. Of the 7363 (men: 40.3%) people in the final cohort, 2498 (men: 40.1%) developed CKD after a mean follow-up of 7.99 years. Elevated blood pressure (BP) and hypertension stage 2 had a 9% (95% confidence interval [CI]: 1%-16%) and 11% (95% CI: 5%-17%) shorter survival time to CKD onset, respectively, than normal BP. Hypertension stage 1 also had a shorter survival to CKD onset by point estimate, but all 95% CIs crossed 1 in all models.

CONCLUSIONS

In a relatively healthy Asian population without diabetes, controlling BP to an appropriate range reduces the risk of developing CKD.