{"title":"Association of Visceral Fat Accumulation with Endothelial Glycocalyx Degradation in People with and without Type 2 Diabetes: A Retrospective Cross-sectional Study.","authors":"Shoko Miyamoto, Yoshinori Kakutani, Tomoaki Morioka, Yuko Yamazaki, Akinobu Ochi, Shinya Fukumoto, Tetsuo Shoji, Masanori Emoto","doi":"10.5551/jat.65623","DOIUrl":"https://doi.org/10.5551/jat.65623","url":null,"abstract":"<p><strong>Aim: </strong>Serum syndecan-1 (SDC-1) concentration is a biomarker for endothelial glycocalyx (EG) degradation, which is elevated in type 2 diabetes (T2D). EG degradation is an early step in vascular endothelial dysfunction. This study investigated the association between serum SDC-1 concentration and visceral fat accumulation, which is closely related to vascular endothelial dysfunction, in people with and without T2D.</p><p><strong>Methods: </strong>This was a cross-sectional study with two independent groups, one including 219 individuals without diabetes (ND) and the other including 203 individuals with T2D. Visceral fat accumulation was assessed as the visceral fat area (VFA) using computed tomography (CT) in ND or dual bioelectrical impedance analysis (BIA) in T2D. Multivariate analyses were performed for ND and T2D to assess the association between VFA and serum SDC-1 concentrations.</p><p><strong>Results: </strong>The medians of serum SDC-1 concentration were 16.0 ng/mL and 26.5 ng/mL in ND and T2D, respectively. In the univariate analysis, both CT-VFA in the ND group and BIA-VFA in the T2D group were positively correlated with serum SDC-1 concentration. Moreover, the association between VFAs and serum SDC-1 concentration was independent of other covariates in multivariate analysis for each group. However, neither the body mass index nor subcutaneous fat area were associated with serum SDC-1 concentrations in either group.</p><p><strong>Conclusions: </strong>CT-VFA and BIA-VFA were independently associated with serum SDC-1 concentrations. Our findings suggest that visceral fat accumulation is involved in the degradation of EG irrespective of the presence of T2D.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Long-term Clinical Outcomes after Endovascular Treatment by Aortoiliac Artery Stent Implantation.","authors":"Akiko Tanaka, Mitsuyoshi Takahara, Kenji Suzuki, Osamu Iida, Terutoshi Yamaoka, Yoshimitsu Soga","doi":"10.5551/jat.65290","DOIUrl":"https://doi.org/10.5551/jat.65290","url":null,"abstract":"<p><strong>Aim: </strong>The long-term clinical outcomes of endovascular therapy (EVT) for aortoiliac (AI) artery lesions remain unclear. This study aimed to investigate 10-year patency and mortality after AI stent implantation.</p><p><strong>Methods: </strong>This multicenter retrospective study included 1919 patients (2375 limbs) who underwent AI stent implantation to treat symptomatic peripheral artery disease (PAD) between January 2005 and December 2010. The study outcome was primary patency, which was defined as a treated vessel without restenosis, mortality, and associated factors.</p><p><strong>Results: </strong>The mean age of the study cohort was 71±9 years. Chronic limb-threatening ischemia (CLTI) accounted for 17.2% of cases, and chronic total occlusion (CTO) was found in 24.6% of cases. During a median follow-up period of 2.9 years (interquartile range: 1.0-6.0 years), 412 patients lost patency, whereas 467 patients died without experiencing loss of patency. At 1, 6, and 10 years post-EVT, respectively, the primary patency rates were estimated to be 92.8%, 79.3%, and 77.2%, and the survival rates were 94.9%, 77.0%, and 63.1%. Female sex, CTO, and the presence of outflow lesions were significantly associated with an increased risk of patency loss after stent implantation (all P<0.05), whereas age, dialysis-dependent renal failure, heart failure, and CLTI were significantly associated with an increased risk of mortality.</p><p><strong>Conclusion: </strong>Stent implantation for AI lesions achieved favorable 10-year patency, with patency loss plateauing after six years. No AI lesion characteristic was associated with mortality. These results support the long-term efficacy of EVT in the clinical practice.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Taeko Mashima, Emi Oishi, Takanori Honda, Jun Hata, Toshifumi Minohara, Tomoyuki Ohara, Tomohiro Nakao, Takanari Kitazono, Ken Yamaura, Toshiharu Ninomiya
{"title":"QT Interval Prolongation and Dementia in a General Japanese Population: the Hisayama Study.","authors":"Taeko Mashima, Emi Oishi, Takanori Honda, Jun Hata, Toshifumi Minohara, Tomoyuki Ohara, Tomohiro Nakao, Takanari Kitazono, Ken Yamaura, Toshiharu Ninomiya","doi":"10.5551/jat.65686","DOIUrl":"https://doi.org/10.5551/jat.65686","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the association between a prolonged heart rate-corrected QT (QTc) interval on a 12-lead electrocardiogram and the risk of developing dementia and its subtypes using long-term prospective longitudinal data from a Japanese community.</p><p><strong>Methods: </strong>A total of 1,082 residents ≥ 60 years old without dementia were followed up for 24 years. The QT interval was corrected for the heart rate using Bazett's equation. QTc prolongation was defined as QTc ≥ 440 ms, and participants with QTc <440 ms were divided into tertiles. Therefore, QTc interval levels at baseline were divided into 4 ranges: ≤ 401, 402-417, 418-439, and ≥ 440 ms. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) of QTc interval levels on the risk of dementia.</p><p><strong>Results: </strong>During the follow-up period, 475 participants developed all-cause dementia, 146 had vascular dementia (VaD), and 295 had Alzheimer's disease (AD). Compared with the lowest QTc level (≤ 401 ms), the multivariable-adjusted HRs for VaD increased significantly with longer QTc intervals (HR [95% confidence interval] 1.80 [1.05 to 3.08] for 402-417 ms, 1.93 [1.12 to 3.34] for 418-439 ms, and 2.64 [1.49 to 4.68] for ≥ 440 ms; p for trend = 0.01). No significant association was found between QTc interval and the risk of both all-cause dementia and AD.</p><p><strong>Conclusion: </strong>The present findings suggest that QTc prolongation serves as a potential indicator for identifying individuals at a high risk of developing VaD. QTc measurement may assist in the primary prevention of VaD.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mengxing Wang, Shanyu Pu, Aoming Jin, S Claiborne Johnston, Philip M Bath, Qiang Dong, Anding Xu, Hongyi Yan, Xia Meng, Baoshi Yuan, Jing Jing, Jinxi Lin, Yong Jiang, Xuewei Xie, Yuesong Pan, Yongjun Wang
{"title":"Effect of Stroke Severity on Efficacy and Safety of Indobufen versus Aspirin in Patients with Moderate to Severe Stroke: Results from the INSURE Randomized Clinical Trial.","authors":"Mengxing Wang, Shanyu Pu, Aoming Jin, S Claiborne Johnston, Philip M Bath, Qiang Dong, Anding Xu, Hongyi Yan, Xia Meng, Baoshi Yuan, Jing Jing, Jinxi Lin, Yong Jiang, Xuewei Xie, Yuesong Pan, Yongjun Wang","doi":"10.5551/jat.65723","DOIUrl":"https://doi.org/10.5551/jat.65723","url":null,"abstract":"<p><strong>Aims: </strong>Stroke severity may affect the benefits and safety of antiplatelet therapies. We aimed to investigate whether the efficacy and safety of indobufen versus aspirin were affected by stroke severity.</p><p><strong>Methods: </strong>We compared the efficacy and safety of indobufen versus aspirin in patients with NIHSS scores of 4-6, 7-9, and 10-18. The primary efficacy outcome was new stroke (ischemic or hemorrhagic) within 90 days, and the primary safety outcome was moderate or severe bleeding within 90 days. The non-inferiority criteria were set at 1.25 for the upper bounds of the 95% CI of the HR for indobufen versus aspirin based on the statistical analysis of the primary clinical trial.</p><p><strong>Results: </strong>In total, 3921 patients presented with NIHSS scores of 4-6, 998 patients presented with NIHSS scores of 7-9, and 515 patients presented with NIHSS scores of 10-18. The risk of the primary outcome among patients with NIHSS scores of 4-6 was higher in indobufen group than that in aspirin group (HR, 1.62; 95% CI, 1.26 to 2.08). However, indobufen was non-inferior to aspirin in patients with NIHSS scores of 7-9 (HR, 0.66; 95% CI, 0.38 to 1.15; non-inferiority P = 0.01) and NIHSS scores of 10-18 (HR, 0.49; 95% CI, 0.23 to 1.05; non-inferiority P = 0.008), with a significant statistical interaction (P = 0.001). Moderate or severe bleeding risk differences between treatments did not vary with stroke severity.</p><p><strong>Conclusions: </strong>This exploratory analysis indicates that the benefit of indobufen in reducing new strokes within 3 months may vary across stroke severity. The potential non-inferiority of indobufen relative to aspirin in patients with NIHSS scores of ≥ 7, with no significant difference in safety, requires further study.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Serum Desmosterol Level Reflects Hepatic Inflammation Grade in Patients with Biopsy-Confirmed Metabolic Dysfunction-Associated Steatotic Liver Disease.","authors":"Takashi Omatsu, Masahiro Koseki, Kaori Ito, Ayami Saga, Hiroshi Sawabe, Katsunao Tanaka, Hiroyasu Inui, Takeshi Okada, Makoto Nishida, Hirokazu Takahashi, Shinichi Aishima, Yoshihiro Kamada, Hiroshi Yoshida, Yasushi Sakata","doi":"10.5551/jat.65748","DOIUrl":"https://doi.org/10.5551/jat.65748","url":null,"abstract":"<p><strong>Aim: </strong>Desmosterol, a cholesterol precursor, is converted by Δ24-dehydrocholesterol reductase. Hence, desmosterol levels are considered to reflect cholesterol metabolism. This study aimed to evaluate sterols as novel biomarkers of liver condition in Asian moderate obese patients with metabolic dysfunction-associated steatotic liver disease (MASLD).</p><p><strong>Methods: </strong>In total, 218 patients with MASLD who underwent liver biopsy were prospectively enrolled. Liver biopsy samples were evaluated by a well-versed pathologist according to the criteria. The serum sterols of biopsy-proven patients', such as desmosterol, sitosterol, and campesterol, of the patients with biopsy-proven MASLD were analyzed using liquid chromatography-mass spectrometry.</p><p><strong>Results: </strong>Inflammation grade 0/1/2/3 was observed in 8/107/90/12 patients, and fibrosis stage 0/1/2/3/4 was observed in 25/48/64/63/17 patients, respectively. Serum desmosterol levels were significantly different by inflammation grade 0-3 (one-way analysis of variance [ANOVA], p = 0.004), with a beta coefficient of 0.219 (95% confidence interval [CI]: 0.088-0.350, p<0.01). Ordinal logistic regression analysis data on inflammation grade, adjusted for other parameters, showed that desmosterol had an odds ratio of 3.727 (95% CI 1.422-9.901, p<0.005). Although desmosterol levels are influenced by statin treatment, in non-statin-treated patients, serum desmosterol levels remained significantly different by inflammation grade (one-way ANOVA, p = 0.041), and the beta coefficient was 0.233 (95% CI: 0.066-0.400, p<0.01).</p><p><strong>Conclusions: </strong>Serum desmosterol levels indicated the degree of hepatic inflammatory activity in patients with MASLD. Since desmosterol, a ligand of nuclear receptor LXR, reflects hepatic cholesterol metabolism, we hope that our findings will contribute to establishing a novel biomarker to screen the high-risk patients for cardiovascular diseases in MASLD.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Makiko Egawa, Masami Ikeda, Hayato Tada, Mariko Harada-Shiba, Masayuki Yoshida
{"title":"Survey on the Current Status of Perinatal Management among Women with Familial Hypercholesterolemia in Japan.","authors":"Makiko Egawa, Masami Ikeda, Hayato Tada, Mariko Harada-Shiba, Masayuki Yoshida","doi":"10.5551/jat.65668","DOIUrl":"https://doi.org/10.5551/jat.65668","url":null,"abstract":"<p><strong>Aim: </strong>Women with familial hypercholesterolemia (FH) face specific challenges during pregnancy and childbirth, such as treatment restrictions and the absence of guidelines. This study therefore assessed the status of perinatal management and the needs of women with FH.</p><p><strong>Methods: </strong>We contacted 240 board-certified FH specialists, and these physicians screened eligible patients for the survey. Two internet-based surveys were conducted between August 2023 and March 2024: one for physicians and one for women with FH.</p><p><strong>Results: </strong>A total of 72 physicians completed the questionnaires. Fifty-seven percent had managed pregnant women with FH, and 64% reported difficulties, including \"selecting and adjusting treatment options\" and \"the absence of guidelines on pregnancy and childbirth for women with FH.\" Few physicians referred their patients to obstetricians prior to pregnancy. Eighty-three women with FH completed a questionnaire. Among those who had given birth after being diagnosed with FH, the most common problems reported were \"could not be treated,\" \"obstetricians' insufficient knowledge of FH,\" and \"insufficient information about pregnancy and delivery for women with FH.\" Half of these women discontinued treatment for over one year. In addition, 78% of women indicated a need for counseling on pregnancy-related matters.</p><p><strong>Conclusion: </strong>Many physicians have reported challenges in managing pregnant women with FH, and some women have lost years of treatment during pregnancy-related periods. Women with FH should receive advice on planned pregnancy and breastfeeding to balance FH treatment with childbearing and parenting, and obstetricians should actively collaborate with physicians.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Role of Polygenic Risk Score in the General Population: Current Status and Future Prospects.","authors":"Masato Takase, Atsushi Hozawa","doi":"10.5551/jat.RV22039","DOIUrl":"https://doi.org/10.5551/jat.RV22039","url":null,"abstract":"<p><p>Polygenic risk scores (PRSs), constructed from numerous common single nucleotide polymorphisms (SNPs), have emerged as useful tools for predicting future atherosclerotic cardiovascular disease (ASCVD). PRSs have shown independent associations with ASCVD outcomes and are increasingly being considered to enhance risk stratification and guide primary prevention strategies. However, most evidence to date has been derived from populations of European ancestry, and their generalizability to other populations, including East Asians, remains uncertain. This review summarizes the current epidemiological evidence on the association between PRS and ASCVD outcomes, focusing on findings in Japanese cohorts. We discuss the potential of PRS as a clinical decision support tool, its incremental value over traditional risk factors, and its role in the early identification of high-risk individuals. We also highlight the limited number of prospective studies in the Japanese population, where validation and implementation studies are ongoing. Given the growing accessibility of genetic testing and the potential of PRS to complement conventional risk assessments, further large-scale studies are warranted to evaluate its clinical utility across diverse populations. Expanding ancestry-specific biobanks and improving PRS transferability are essential steps toward the equitable implementation of genomic risk prediction in ASCVD prevention.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Triglycerides and the Risk of Atherosclerotic Cardiovascular Events Across Different Risk Categories.","authors":"Hiroyuki Mizuta, Masanobu Ishii, So Ikebe, Yasuhiro Otsuka, Yoshinori Yamanouchi, Taishi Nakamura, Kenichi Tsujita","doi":"10.5551/jat.65334","DOIUrl":"10.5551/jat.65334","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the association between triglyceride levels and major adverse cardiovascular events (MACE) in primary and secondary prevention cohorts.</p><p><strong>Methods: </strong>This retrospective study was conducted with a nationwide health insurance claims database, which included approximately 3.8 million participants with medical checkups between January 2005 and August 2020 in Japan. The participants were classified into primary prevention (n=3,415,522) and secondary prevention (n=29,806) cohorts based on cardiovascular or cerebrovascular disease history. Each participant was categorized as having very low (triglyceride <50 mg/dL), low normal (50-99), high normal (100-149), or hypertriglyceridemia (≥ 150). The primary prevention cohort was further stratified into low-, intermediate-, and high-risk groups according to atherosclerotic cardiovascular diseases risk. Outcome was MACE, including acute myocardial infarction (AMI), unstable angina, ischemic stroke, and cardiac death.</p><p><strong>Results: </strong>Over a mean follow-up of 3.25 years, 0.3% and 2.6% MACE occurred in primary and secondary prevention, respectively. Hypertriglyceridemia was associated with high risk of MACE in the primary prevention, but not in the secondary prevention. A significant interaction was observed between prevention categories and the association of TG levels with MACE in those with TG <150 mg/dL and ischemic stroke in those with TG ≥ 150 mg/dL. The population-attributable fraction for hypertriglyceridemia in primary prevention was 4.1% for MACE. In primary prevention, lower risks of AMI were observed in the lower TG category compared to the current threshold.</p><p><strong>Conclusions: </strong>This study suggests distinct triglyceride thresholds for MACE risk in primary and secondary prevention cohorts, requiring further prospective validation for clinical implementation.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"786-803"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Current Status and Future Aspect of Digital Health Innovation in Stroke Prevention and Management.","authors":"Shinichi Wada, Takashi Okada, Masatoshi Koga, Atsushi Mizuno","doi":"10.5551/jat.RV22036","DOIUrl":"10.5551/jat.RV22036","url":null,"abstract":"<p><p>Digital health innovations (DHI) in medicine have led to remarkable progress in stroke prevention and management worldwide. For example, education regarding the knowledge and awareness of stroke, risk scores for stroke incidence, and wearable devices have been used for primary prevention. Automatic telemedicine and diagnostic imaging have been introduced for the treatment of acute stroke. Rehabilitation using robot-assisted training, virtual reality systems, and other applications has been attempted. Information sharing using the DHI may be expected in secondary prevention. Although these DHI technologies likely assist in stroke prevention and management, their usage remains insufficient, partly because of insufficient evidence. Here, we report the current status and problems associated with the effective and widespread use of DHI in Japan.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"775-782"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Secondary Prevention of Stroke in Patients with Non-Valvular Atrial Fibrillation and Advanced Chronic Kidney Disease.","authors":"Yanzhao Ren, Menglong Miao, Ruopeng Tan, Guiwen Xu, Yang Liu, Xiaomeng Yin","doi":"10.5551/jat.65186","DOIUrl":"10.5551/jat.65186","url":null,"abstract":"<p><strong>Aims: </strong>Evidence supporting the prescription of anticoagulant therapy for patients with atrial fibrillation (AF) with advanced chronic kidney disease (CKD) has been limited, and its clinical application in this context remains controversial.</p><p><strong>Methods: </strong>We identified AF patients with advanced CKD (G4-G5) and a history of stroke who were admitted to the First Affiliated Hospital of Dalian Medical University between January 1, 2011, and June 30, 2023. Patients were classified into warfarin, non-vitamin K antagonist oral anticoagulant (NOAC), antiplatelet therapy, and control (no antithrombotic therapy) groups. We evaluated the benefits and safety of different antithrombotic therapies by comparing the long-term clinical outcome measures, including the incidence of subsequent ischemic stroke events, bleeding, and all-cause death.</p><p><strong>Results: </strong>In total, 570 patients were included. In this cohort, 87 (15.3%) patients had no antithrombotic treatment, 252 (44.2%) received antiplatelet therapy, 105 (18.4%) received warfarin, and 126 (22.1%) received NOAC therapy. Compared with patients without treatment, we found that treatment with anticoagulant therapy significantly decreased the risk of ischemic stroke, but antiplatelet therapy did not. Treatment with anticoagulant therapy was associated with significantly lower mortality than no antithrombotic therapy or antiplatelet therapy , at least within the study period. Furthermore, compared with warfarin treatment, patients treated with NOAC therapy showed a significant decrease in the incidence of bleeding risks.</p><p><strong>Conclusion: </strong>Among AF patients with advanced CKD and prior stroke, receiving anticoagulants resulted in a reduced risk of recurrent ischemic stroke events than no antithrombotic treatment, and lower mortality than no antithrombotic treatment or antiplatelet therapy.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"873-886"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}