Journal of atherosclerosis and thrombosis最新文献

{"title":"It's Time to Measure Lp(a): Recognizing a Neglected Cardiovascular Risk.","authors":"Hayato Tada, Masayuki Takamura","doi":"10.5551/jat.ED307","DOIUrl":"10.5551/jat.ED307","url":null,"abstract":"","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"1135-1136"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868372","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":"Hospital Course and Outcomes After Major Bleeding in Patients on Factor Xa Inhibitors in Japan: A Nationwide Observational Study.","authors":"Shun Kohsaka, Masahiro Yasaka, Mitsuru Hoshino, Ryotaro Ide, Fumitaka Wada, Naru Morita","doi":"10.5551/jat.65869","DOIUrl":"10.5551/jat.65869","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the clinical characteristics, management, and in-hospital outcomes of patients hospitalized with major bleeding while receiving direct factor Xa inhibitors (FXa-I) using a large-scale, nationwide administrative claims database.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed an administrative hospital claims database to identify patients hospitalized with major bleeding while receiving FXa-I between August 2011 and May 2022 (before the launch of andexanet alfa), resulting in 8011 patients (median age, 80.0 years) being eligible for the analysis. The data collected encompassed patient demographics, hospitalization details, bleeding sites, and outcomes of interest, such as in-hospital mortality and the resumption of OACs.</p><p><strong>Results: </strong>The most common bleeding sites were upper gastrointestinal bleeding (GIB; 30.3%), intracranial hemorrhage (ICH; 17.6%), lower GIB (11.7%), and trauma-related bleeding (9.1%). Patients had a median hospital stay of 11.0 days (range, 1-911 days). The overall in-hospital mortality rate was 7.1% (95% CI: 6.6-7.7%). In-hospital mortality rates by bleeding site were 17.8% for ICH, 5.1% for upper GIB, 1.4% for lower GIB, 10.2% for trauma-related bleeding, and 4.1% for other bleeding sites. The most common cause of death was hemorrhage-related (70.1%). OACs were resumed in 67.9% of patients, with a median time to resumption of 3.0 days.</p><p><strong>Conclusion: </strong>In this nationwide study, the in-hospital mortality rate for patients hospitalized for FXa-I-related major bleeding was approximately 7%. Although most patients resumed oral anticoagulant therapy during hospitalization, the significant in-hospital mortality rates observed, especially in cases of ICH, highlight the need for strategies to further improve the outcomes in patients experiencing FXa-I-related complications.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"1157-1179"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981943","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":"Polyunsaturated Fatty Acids and Atrial Fibrillation: Friend or Foe?","authors":"Takeo Sato","doi":"10.5551/jat.ED310","DOIUrl":"10.5551/jat.ED310","url":null,"abstract":"","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"1132-1134"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390883","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":"A Literature Review on the Waist Circumference Criteria for Metabolic Syndrome in Japan: Evidence and Implications for Cardiovascular Risk Stratification.","authors":"Tomoe Uchida, Aya Hirata","doi":"10.5551/jat.ERRV22051","DOIUrl":"10.5551/jat.ERRV22051","url":null,"abstract":"","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"1205"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148663826","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":"The Waist-to-Height Ratio and Incidence of High LDL Cholesterol in Japanese: A Retrospective Cohort Study.","authors":"Takako Fujii, Shintaro Ishida, Makiko Abe, Miki Kawazoe, Toshiki Maeda, Chikara Yoshimura, Yori Inoue, Kazuhiro Tada, Koji Takahashi, Kenji Ito, Kosuke Masutani, Hisatomi Arima","doi":"10.5551/jat.66242","DOIUrl":"https://doi.org/10.5551/jat.66242","url":null,"abstract":"<p><strong>Aim: </strong>Low-density lipoprotein cholesterol (LDL-C) is a major contributor to atherosclerotic cardiovascular disease (CVD). The waist-to-height ratio (WHtR) has been proposed as a practical marker of central obesity; however, evidence linking WHtR with incident high LDL-C levels in Japanese populations remains limited. This study investigated the association between WHtR and future LDL-C elevation in a community-based cohort in Japan.</p><p><strong>Methods: </strong>This retrospective cohort study included 3,934 adults aged 30-74 years without dyslipidemia at baseline from the Iki Epidemiological Study of Atherosclerosis and Chronic Kidney Disease. The participants were followed between 2008 and 2019. WHtR was categorized into sex-specific quartiles. Incident high LDL-C was defined as LDL-C ≥ 3.62 mmol/L or initiation of lipid-lowering therapy. Cox proportional hazards models were used to estimate the hazard ratios (HRs), after adjusting for demographic, lifestyle, and clinical factors.</p><p><strong>Results: </strong>During a mean follow-up period of 5.02 years, 466 females and 424 males developed high LDL-C levels. Among females, the adjusted hazard ratio (HR) (95% confidence interval [CI]) for quartile 4 versus quartile 1 was 1.95 (1.41-2.71; p for trend ＜0.0001). Among males, the corresponding adjusted HR (95% CI) was 1.61 (1.18-2.21; p for trend = 0.001). A higher WHtR was associated with an increased risk of incident high LDL-C in both sexes (trend p＜0.01). A WHtR threshold of approximately 0.5 corresponded to a notable increase in risk.</p><p><strong>Conclusion: </strong>A Higher WHtR was associated with an increased risk of incident high LDL-C. These findings suggest that WHtR may be a useful anthropometric indicator for identifying individuals at risk, although further studies are required.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880545","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":"Current and Future Perspectives of LDL-C Lowering Therapies 2026.","authors":"Hayato Tada, Kenji Sakata, Soichiro Usui, Masayuki Takamura","doi":"10.5551/jat.RV22052","DOIUrl":"10.5551/jat.RV22052","url":null,"abstract":"<p><p>LDL cholesterol (LDL-C) is the central causal factor for atherosclerotic cardiovascular disease (ASCVD), and its reduction is a cornerstone of both primary and secondary prevention. Since the introduction of statins more than three decades ago, LDL-C-lowering therapy has expanded substantially, now encompassing ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9)-targeting agents, bempedoic acid, and other emerging modalities. This expanding therapeutic landscape has improved the feasibility of achieving guideline-recommended LDL-C targets, but it has also increased the complexity of clinical decision making. This review provides a contemporary and practical overview of the LDL-C-lowering strategies, beginning with the initial evaluation of patients with elevated LDL-C, including differentiation between primary and secondary causes and the identification of familial hypercholesterolemia (FH). We summarize the current treatment targets for primary and secondary prevention, highlight the optimal selection and use of statins, and discuss the assessment and management of statin intolerance, including the role of the nocebo effect. Non-statin therapies, including ezetimibe, bile acid sequestrants, PCSK9 inhibitors, inclisiran, and bempedoic acid, are reviewed with an emphasis on their mechanisms, efficacy, and clinical positioning. Advanced therapies for severe dyslipidemia, such as lipoprotein apheresis, lomitapide, and evinacumab, are also discussed in this review. Finally, we outline the future directions, including oral PCSK9 inhibitors, next-generation cholesteryl ester transfer protein (CETP) inhibitors, lipoprotein(a)-lowering agents, and genome-editing approaches. Collectively, these developments offer new opportunities to address unmet clinical needs, particularly in patients with FH, statin intolerance, and residual cardiovascular risk. A comprehensive understanding of these therapies is essential for further reducing the burden of ASCVD in the coming decades.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"1111-1123"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148042485","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":"Cross-Sectional Association of Lipoprotein(a) Levels With Vascular Complications and Related Parameters in a Japanese Type 2 Diabetes Cohort.","authors":"Tsutomu Hirano, Mayumi Uetani, Kento Nakata, Natsuko Suzuki, Ema Aoki, Takeshi Hirashima, Yasuki Ito","doi":"10.5551/jat.66152","DOIUrl":"10.5551/jat.66152","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the association between Lipoprotein(a) (Lp(a)) levels and vascular complications, as well as related parameters, in a cohort of Japanese patients with type 2 diabetes.</p><p><strong>Methods: </strong>This cross-sectional analysis was conducted using data from a cohort of patients with 1465 type 2 diabetes. Lp(a) was measured by a turbidimetric immunoassay. Participants were categorized according to Lp(a) levels: GI (＜30), GII (30-49), and GIII (≥ 50 mg/dL). Small dense low-density lipoprotein (LDL)-cholesterol (sdLDL-C) and LDL-triglycerides were measured using homogeneous assays.</p><p><strong>Results: </strong>The median [interquartile range] plasma Lp(a) concentration was 12.7 [6.1-24.6] mg/dL (21.8 [6-50.5] nmol/L). The prevalence rates for GI, GII, and GIII were 80, 12, and 8%, respectively, while low Lp(a) levels (＜5 mg/dL) were present in 18%. These prevalence rates were comparable to those reported in the general Japanese population. Higher Lp(a) grades were associated with the prevalence of coronary artery disease (CAD), peripheral artery disease including borderline cases, severe diabetic retinopathy, and chronic kidney disease (CKD), but not with stroke. Lp(a) levels were higher in older individuals, female, kidney dysfunction, and statin users, whereas lower levels were observed in those with higher glycemia, current drinkers, and liver dysfunction. Patients with CAD or statin users had lower levels of LDL-C, sdLDL-C, LDL-triglycerides, and apolipoprotein B but higher Lp(a) concentrations compared to the control group.</p><p><strong>Conclusions: </strong>Lp(a) levels were associated with the prevalence of diabetic complications, particularly CKD and CAD. Lp(a) remains relevant associated factor with CAD in cross-sectional studies influenced by ongoing lipid-lowering therapies.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"1180-1193"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981950","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":"Major Bleeding During Factor Xa Inhibitor Therapy: Lessons from the Pre-Andexanet Era in Japan.","authors":"Manabu Minami","doi":"10.5551/jat.ED312","DOIUrl":"10.5551/jat.ED312","url":null,"abstract":"","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"1137-1139"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411976","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":"A Case of Familial Chylomicronemia Syndrome Caused by a Novel Homozygous GPIHBP1 Mutation Successfully Treated with the Selective PPARα Modulator Pemafibrate.","authors":"Tomoko Otsuki, Yumi Chung, Yusuke Kawachi, Shiho Komuku, Masayuki Yamanishi, Toru Takano, Atsuhiro Yamaguchi, Hiroyuki Hanada, Daisaku Masuda, Kazuya Miyashita, Shizuya Yamashita","doi":"10.5551/jat.66218","DOIUrl":"10.5551/jat.66218","url":null,"abstract":"<p><strong>Aim: </strong>Familial chylomicronemia syndrome (FCS) is a rare disorder characterized by the accumulation of chylomicrons in the circulation due to genetic defects or autoantibodies affecting lipoprotein lipase (LPL), the key enzyme responsible for the metabolism of chylomicrons and very-low-density lipoproteins (VLDL), or its associated proteins, including apolipoprotein (apo) C-II, apoA-V, glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1), and lipase maturation factor 1 (LMF1). This condition is associated with markedly elevated serum triglyceride (TG) levels and, in severe cases, recurrent episodes of pancreatitis and eruptive xanthomas. Among these etiologies, genetic deficiency of GPIHBP1 is exceedingly rare. We aimed to clarify the clinical and genetic basis and treatment strategies of a patient with GPIHBP1 deficiency.</p><p><strong>Methods: </strong>A 47-year-old woman with a childhood diagnosis of FCS presented with severe epigastric pain and was admitted to Rinku General Medical Center for emergency management of acute pancreatitis secondary to severe chylomicronemia. She had a history of severe hypertriglyceridemia complicated by pancreatitis during her first pregnancy and extreme hypertriglyceridemia exceeding 6,000 mg/dL during her second pregnancy without the development of pancreatitis. DNA sequence analysis was performed as a clinical diagnostic test and outsourced to KUBIX Inc. (Hakusan, Ishikawa, Japan).</p><p><strong>Results: </strong>Laboratory evaluation revealed marked hypertriglyceridemia (1,262 mg/dL) with a type V hyperlipoproteinemia pattern. Serum preheparin LPL mass was markedly reduced, and circulating GPIHBP1 was undetectable. Genetic analysis identified a novel homozygous frameshift mutation in the GPIHBP1 gene (NM_178172.4:c.20del [p.Val7AlafsTer73]), which has not been previously reported in public databases. No pathogenic variants were detected in other LPL-related genes. Acute pancreatitis improved rapidly with fasting and intravenous fluid therapy. Strict dietary fat restriction, followed by the addition of the selective PPARα modulator pemafibrate, successfully maintained TG levels below 500 mg/dL during follow-up.</p><p><strong>Conclusion: </strong>We report an extremely rare case of FCS caused by a novel homozygous mutation in the GPIHBP1 gene, in which pregnancy served as a major trigger for severe hypertriglyceridemia. Early diagnosis and strict lipid control are essential to prevent recurrent pancreatitis in patients with GPIHBP1 deficiency.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"1194-1204"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271583","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":"Association Between Plasma Omega-3 and Omega-6 Fatty Acid Levels and Atrial Fibrillation: A Large-Scale, Real-World Retrospective Study in Japan.","authors":"Naotake Yanagisawa, Kazutoshi Fujibayashi, Tetsuro Miyazaki, Hiroyuki Daida","doi":"10.5551/jat.66117","DOIUrl":"10.5551/jat.66117","url":null,"abstract":"<p><strong>Aim: </strong>The relationship between omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) and atrial fibrillation (AF) remains unclear. This retrospective study aimed to investigate the association between plasma levels of omega-3 PUFAs (eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA]) and omega-6 PUFAs (arachidonic acid [AA] and dihomo-γ-linolenic acid [DGLA]) and the prevalence of AF.</p><p><strong>Methods: </strong>After excluding patients who were prescribed icosapent ethyl (IPE) or were younger than 40 years, data from 9,178 patients at Juntendo University Hospital with plasma EPA, DHA, AA, and DGLA measurements obtained between April 2017 and January 2021 were analyzed. The plasma PUFA levels were divided into quartiles, with the lowest quartile used as the reference. Multivariable logistic regression and restricted cubic spline analyses were performed to assess the association between the PUFA levels and AF.</p><p><strong>Results: </strong>The median age was 69 years (interquartile range [IQR], 59-77 years), and 60.6% of the participants were male. AF was diagnosed in 908 (9.9%) patients. After adjusting for age, sex, and body mass index (BMI), higher plasma levels of EPA, DHA, EPA+DHA, AA, and DGLA were significantly associated with a lower risk of AF (all P＜0.001). In contrast, no significant associations were observed between the PUFA ratios, including (EPA+DHA)/AA, EPA/AA, DHA/AA, and DGLA/AA, and AF. Restricted cubic spline analyses revealed linear inverse associations for EPA, DHA, EPA+DHA, and AA and AF, whereas a nonlinear association for DGLA and AF was observed.</p><p><strong>Conclusion: </strong>Within the physiological ranges, higher plasma levels of EPA, DHA, EPA+DHA, AA, and DGLA were independently and inversely associated with AF risk. However, extremely high EPA concentrations, achieved through pharmacological interventions, have been suggested to be associated with an increased risk of AF.</p>","PeriodicalId":15128,"journal":{"name":"Journal of atherosclerosis and thrombosis","volume":" ","pages":"1140-1147"},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981894","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}