Journal of the American Heart Association最新文献

{"title":"Challenges in the Choice of Nonstatin Medications for Low-Density Lipoprotein-C Lowering for Cardiovascular Risk Reduction.","authors":"Merle Myerson, Bruce A Warden, Joseph J Saseen, Rodis Paparodis","doi":"10.1161/JAHA.125.044134","DOIUrl":"https://doi.org/10.1161/JAHA.125.044134","url":null,"abstract":"<p><p>Atherosclerotic cardiovascular diseases continue to be a leading cause of death globally. Although statin medications remain the cornerstone of treatment for lowering low-density lipoprotein cholesterol and reducing cardiovascular risk, there is a proportion of patients in whom treatment with statins may not achieve the guideline recommended low-density lipoprotein cholesterol targets despite using maximally tolerated doses, or for various reasons, patients are unable or unwilling to intensify or continue statins. In these instances, use of nonstatin medications like ezetimibe, bempedoic acid, or PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors (alirocumab, evolocumab, inclisiran) in addition to maximally tolerated statin therapy can lead to additional lowering of low-density lipoprotein cholesterol and beneficial reductions in cardiovascular events. This review provides an overview of the evidence supporting the use of nonstatin low-density lipoprotein cholesterol lowering medications for cardiovascular risk reduction and practical considerations for the use of these agents.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e044134"},"PeriodicalIF":5.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Listing for Pediatric Donation After Circulatory Death Heart Transplantation Is Associated With Improved Waitlist Outcomes.","authors":"Michael A Catalano, Max Shin, Omar Toubat, Radhika Rastogi, Halil Beqaj, Amit Iyengar, Benjamin F Smood, Nikia Toomey, Jonathan B Edelson, Joseph W Rossano, Matthew J O'Connor, Humera Ahmed, J William Gaynor, Katsuhide Maeda, Constantine D Mavroudis","doi":"10.1161/JAHA.125.041633","DOIUrl":"https://doi.org/10.1161/JAHA.125.041633","url":null,"abstract":"<p><strong>Background: </strong>Advances in procurement techniques have enabled use of hearts obtained via donation after circulatory death (DCD), expanding the donor pool; however, the impact of DCD heart transplant on outcomes in children is not well described. We aim to characterize waitlist survival and outcomes in pediatric heart transplant candidates listed for donation after brain death (DBD) versus DCD hearts.</p><p><strong>Methods: </strong>The United Network for Organ Sharing database was queried for patients aged <18 years at listing, waitlisted for heart transplant between January 2021 and June 2024. Patients were stratified by listing for DBD exclusively, versus DBD and DCD hearts. Waitlist and posttransplant outcomes were compared using Fine-Gray and Kaplan-Meier analyses.</p><p><strong>Results: </strong>Of 2449 listed patients, 2353 (96.1%) were listed for DBD hearts exclusively, and 96 (3.9%) for DCD hearts as well. DCD recipient candidates had increased rates of cardiopulmonary support and were more likely to be status 1A. Of DCD recipient candidates, 15 (15.6%) received DCD hearts and 50 (52.1%) received DBD hearts. When controlling for status, extracorporeal membrane oxygenation, blood type, region, and year, DCD listing was not associated with likelihood of transplant or waitlist death. Among status 1B/2 patients, DCD listing was associated with increased likelihood of transplant (adjusted subhazard ratio, 2.05 [95% CI, 1.16-3.62]; <i>P</i>=0.01). No patients in the status 1B/2 DCD subgroup died while waitlisted. There were no differences in 1-year posttransplant survival.</p><p><strong>Conclusions: </strong>Among candidates for pediatric heart transplant listed as status 1B/2, patients listed for DCD hearts in addition to DBD hearts have shorter waitlist duration, improved transplant rates, lower waitlist mortality rates, and comparable survival to patients listed for DBD hearts alone.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041633"},"PeriodicalIF":5.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of the American Heart Association PREVENT Cardiovascular Disease Risk Equations in Cancer Survivorship: A NHANES Population-Based Study (2009-2018).","authors":"Mustafa Al-Jarshawi, Ofer Kobo, Dennis T Ko, Harindra C Wijeysundera, M Golam Azam, Victoria Silverwood, Ram Bajpai, Rodrigo Bagur, Mamas A Mamas","doi":"10.1161/JAHA.125.042209","DOIUrl":"https://doi.org/10.1161/JAHA.125.042209","url":null,"abstract":"<p><strong>Background: </strong>The PREVENT (Predicting Risk of CVD Events) equations offer a contemporary tool for estimating long-term cardiovascular risk in the general population. This study evaluates the association of baseline cardiovascular risk, calculated by PREVENT equations, with all-cause and cardiovascular mortality in cancer survivors.</p><p><strong>Methods: </strong>Using 10 years of data from the National Health and Nutrition Examination Survey (NHANES) (2009-2018), we analyzed a nationally representative cohort of US cancer survivors. Associations with outcomes were evaluated using Kaplan-Meier curves and multivariable Cox models.</p><p><strong>Results: </strong>A total of 18 722 334 weighted records (2792 unweighted) were analyzed, recording 4 875 627 all-cause deaths (26%) and 1 025 053 cardiovascular deaths (5.5%) over a median follow-up of 9.8 years; 27.84% of cancer survivors were at high baseline cardiovascular risk with variability in baseline cardiovascular risk across different cancer sites. Colon and prostate cancer survivors had the highest prevalence of high cardiovascular risk (54% and 46%, respectively). When compared with low-risk individuals, those at high cardiovascular risk had a nearly 16-fold higher risk of all-cause mortality (adjusted hazard ratio, 15.60 [95% CI, 8.45-28.82]; <i>P</i> <0.001) and a 13-fold higher risk of cardiovascular mortality (adjusted hazard ratio, 12.71 [95% CI, 3.00-53.73]; <i>P</i> <0.001) up to a decade of follow-up. Each 5% increase in baseline cardiovascular risk was associated with higher risks of all-cause mortality (36%) and cardiovascular mortality (51%) (adjusted hazard ratio, 1.36 [95% CI, 1.30-1.42]; adjusted hazard ratio, 1.51 [95% CI, 1.33-1.72], <i>P</i> <0.001 for both).</p><p><strong>Conclusions: </strong>This study highlights the usefulness of the PREVENT equations for predicting all-cause and cardiovascular mortality in cancer survivors.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042209"},"PeriodicalIF":5.3,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Varying Quantities of Lean Beef as Part of a Mediterranean-Style Dietary Pattern on Gut Microbiota and Plasma, Fecal, and Urinary Metabolites: A Randomized Crossover Controlled Feeding Trial.","authors":"Zachary S DiMattia, Jingcheng Zhao, Fuhua Hao, Sergei Koshkin, Jordan E Bisanz, Andrew D Patterson, Jennifer A Fleming, Penny M Kris-Etherton, Kristina S Petersen","doi":"10.1161/JAHA.125.041063","DOIUrl":"10.1161/JAHA.125.041063","url":null,"abstract":"<p><strong>Background: </strong>Consumption of trimethylamine <i>N</i>-oxide (TMAO) precursors, such as carnitine found in lean beef, raises circulating TMAO concentrations; however, a healthy dietary pattern may attenuate these effects.</p><p><strong>Methods: </strong>This randomized, 4-period crossover, controlled-feeding study investigated the effects of Mediterranean-style (MED) diets (carbohydrate 42%, protein 17%, fat 41%) with 14 (MED0.5; 0.5 oz), 71 (MED2.5; 2.5 oz), and 156 (MED5.5; 5.5 oz) g/day/2000 kcal of lean beef, compared with an average American diet (AAD; carbohydrate 52%, protein 15%, fat 33%; 71 g/day/2000 kcal beef), on gut microbiota composition and plasma, urinary, and fecal metabolites including TMAO and precursor molecules. Thirty generally healthy individuals consumed each diet for 4 weeks with a ≥1-week washout. Fasting blood samples, 24-hour urine samples, and fecal samples were collected at baseline and at the end of each 4-week diet period. Metabolites were measured by proton nuclear magnetic resonance and liquid chromatography/mass spectrometry. Gut microbiota composition was measured using amplicon sequencing of the 16S rRNA gene.</p><p><strong>Results: </strong>The 3 MED diets increased gut microbiota diversity compared with the AAD. Plasma TMAO was higher following the AAD compared with the MED0.5 (mean fold difference, 1.78 [95% CI, 1.05-3.06]) and MED2.5 (2.04 [95% CI, 1.18-3.52]). Urinary TMAO was higher following the AAD compared with the MED0.5 (1.88 [95% CI, 1.19-2.97]), MED2.5 (2.15 [95% CI, 1.37- 3.39]), and MED5.5 (1.76 [95% CI, 1.12-2.77]).</p><p><strong>Conclusions: </strong>Compared with an AAD, inclusion of up to 71 g/day of lean beef in a Mediterranean-style diet increased gut microbiota diversity and lowered TMAO concentrations in healthy adults.</p><p><strong>Registration: </strong>URL: https://clinicaltrials.gov; Unique identifier: NCT02723617.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041063"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gestational Diabetes and Incident Hospitalization for Cardiovascular Disease: A Nationwide French Cohort Study.","authors":"Justin B Echouffo-Tcheugui, Solène Tapia, Sonia Bechraoui-Quantin, Jonathan Cottenet, Emmanuel Simon, Catherine Quantin","doi":"10.1161/JAHA.125.041100","DOIUrl":"10.1161/JAHA.125.041100","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is the leading cause of mortality in women. We investigated the associations between gestational diabetes (GD) and the incidence of various CVD outcomes.</p><p><strong>Methods: </strong>This nationwide population-based cohort study included 1 436 468 parous women in France during 2012 to 2013. We used Cox regression to (1) quantify the association of GD with incident hospitalization for chronic hypertension as well as overall and type-specific CVD, (2) investigate the timing to GD-related CVD onset in the postpartum period, and (3) assess the impact of the recurrence of GD on CVD incidence.</p><p><strong>Results: </strong>Women with a history of GD (n=101 814) had a 97% increased relative risk of chronic hypertension (hazard ratio [HR], 1.97 [95% CI, 1.89-2.06]) and a 31% higher overall CVD risk (HR, 1.31 [95% CI, 1.22-1.41]) compared with those without such history. There were increased risks of specific CVDs associated with GD (versus no GD), including increased coronary heart disease (HR, 1.71 [95% CI, 1. 50-1.94]), heart failure (HR, 1.41 [95% CI, 1.21-1.65]), and stroke (HR, 1.16 [95% CI, 1.06-1.28]) risks. The elevated risk was apparent as early as 1 year postpartum for chronic hypertension and CVD outcomes, and the elevated CVD risk was more pronounced among women with ≥2 pregnancies complicated by GD during the study period than in those with 1 GD episode.</p><p><strong>Conclusions: </strong>GD was associated with increased risks of overall and specific CVD, as well as the risk of incident chronic hypertension. The elevated CVD risk was present early in postpartum and persisted over time, and was higher with repeated GD.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041100"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Performance of Unattended Automated Office Blood Pressure Measurement for Hypertension Screening Among People With and Without HIV.","authors":"Ruth K Lucinde, Megan Willkens, Benson Issarow, Salama Fadhil, Cody Cichowitz, Philip Ayieko, Godfrey Kisigo, Sara Venkatraman, Heiner Grosskurth, Ana C Krieger, Richard B Devereux, Myung Hee Lee, Saidi Kapiga, Robert N Peck, Anthony O Etyang","doi":"10.1161/JAHA.125.043957","DOIUrl":"10.1161/JAHA.125.043957","url":null,"abstract":"<p><strong>Background: </strong>The diagnostic performance of automated office blood pressure (AOBP) in screening for hypertension in people with HIV (PWH) is not known.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of baseline data from PWH and people without HIV (PWoH) from the Mwanza HIV&CVD cohort study. We conducted unattended AOBP and 24-hour ambulatory BP monitoring as recommended by international guidelines. Using average 24-hour BP as the reference standard, we estimated the prevalence of hypertensive diagnostic phenotypes and calculated measures of diagnostic performance at different diagnostic cutoffs in participants.</p><p><strong>Results: </strong>We included 959 participants (50.4% PWH and 49.6% PWoH). Characteristics were similar across participant groups. The median age was 44 years (interquartile range, 38-50 years), and 69.8% were women. Overall prevalence of hypertension, based on average 24-hour ambulatory BP monitoring, was 35.3% using European Society of Hypertension cutoffs and did not differ by HIV infection status. Masked hypertension was present in 25.7% (95% CI, 22.0%-29.8%) of PWH and 26.7% (95% CI, 22.9%-30.8%) of PWoH. The sensitivity of unattended AOBP was 25.7% for PWH (95% CI, 19.3%-33.1%) and 25.7% for PWoH (95% CI, 19.4%-33.0%) with little difference in the area under the receiver-operating curve by HIV infection status. Based on 24-hour BP averages, 24.2% of PWH and 21.6% of PWoH had isolated nocturnal hypertension.</p><p><strong>Conclusions: </strong>More than half of individuals with hypertension on ambulatory BP monitoring, irrespective of their HIV infection status, may be misdiagnosed if unattended AOBP alone is used to screen for hypertension in sub-Saharan Africa.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043957"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial Occlusion in Cryptogenic Stroke Is Not Predictive of Recurrent Ischemic Stroke: A Propensity-Score Matched Analysis of the Cardiac Abnormalities in Stroke Prevention and Risk of Recurrence Study.","authors":"Matthew M Smith, James R Brorson, Elena Badillo Goicoechea, Mary Penckofer, Kelsey Eklund, Christoph Stretz, Christina M Lineback, Farid Khasiyev, Deborah Kerrigan, Skylar Lewis, Hamid Ali, Hassan Aboul-Nour, Adam de Havenon, Collin J Culbertson, Emiliya Melkumova, Dinesh Jillella, Oana M Dumitrascu, Parth Parikh, Charles Doolittle, Ian Yahnke, Anvitha Sathya, Samantha Brown, Jieun Kang, Anna Bowman, Mahan Shahrivari, Cheran Elangovan, Siddharth Sehgal, Kelly L Sloane, Muhammad Alvi, Balaji Krishnaiah, Wayneho Kam, Sachin Kothari, Ahmad Abu Qdais, Mudassir Farooqui, Fadi Nahab, Gustavo Antezana Quintela, Richa Sharma, Neeharika Thottempudi, Simona Nedelcu, Franziska Herpich, Patrick Glover, Dalia Chahien, David S Liebeskind, Guillermo Linares, Jean-Philippe Daniel, Sami Al Kasab, Eesha Singh, Marissa D'Souza, Elizabeth Gaudio, Yasmin Aziz, Shadi Yaghi, Narendra Kala, Monica Sarkar, Eric D Goldstein, Lucia Chen, Russel Van Coevering, Jesse M Thon, Brian Stamm, Sean L Thompson, James E Siegler","doi":"10.1161/JAHA.125.041500","DOIUrl":"10.1161/JAHA.125.041500","url":null,"abstract":"<p><strong>Background: </strong>Intracranial occlusions in embolic stroke of undetermined source are histopathologically similar to cardiac sources of embolism. Whether patients with embolic stroke of undetermined source and intracranial occlusion benefit from anticoagulation is unknown.</p><p><strong>Methods: </strong>A multicenter retrospective cohort of adults with cryptogenic stroke was queried for patients with proximal or medium/distal vessel occlusion. The primary outcome was recurrent ischemic stroke, which was assessed in unadjusted and adjusted Cox proportional hazards models and repeated following 1:1 propensity score matching and biweight kernel density matching.</p><p><strong>Results: </strong>Of the 2328 patients who were followed over a median of 1.31 years (interquartile range, 0.34-2.85), 999 (42.6%) had an intracranial occlusion. When compared with patients without an intracranial occlusion, those with an occlusion had fewer atherosclerotic vascular risk factors, more severe symptoms, and less severe cerebral microvascular disease. The rate of recurrent stroke was similar between patients with versus without an intracranial occlusion (6.8%/year [95% CI, 5.7-8.2] versus 7.0%/year [95% CI 6.0-8.1]; adjusted hazard ratio [HR], 1.09 [95% CI, 0.77-1.55]). There was no association between occlusion and recurrent stroke in the adjusted propensity score matching (HR, 1.01 [95% CI, 0.64-1.59]) or kernel density models (HR, 0.95 [95% CI, 0.62-1.45]). There was no interaction between occlusion and treatment with anticoagulation, sex, age, or high-risk sources of embolism for the primary outcome in the unmatched and matched analyses.</p><p><strong>Conclusions: </strong>Intracranial occlusion in patients with embolic stroke of undetermined source is not associated with a greater risk of recurrence when compared with patients without an intracranial occlusion. There was no difference in rate of recurrent stroke with anticoagulation when stratified by presence or absence of occlusion.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041500"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Latest in Resuscitation Research: Highlights From the 2024 American Heart Association's Resuscitation Science Symposium.","authors":"Gabriela M Galli, Aarthi Kaviyarasu, Sachin Agarwal, Catherine R Counts, Tommaso Scquizzato, Betty Yang, Clark G Owyang, Ryan Coute, Simon Orlob, Lindsay Shepard, Saleem Halablab, James Horowitz, Sarah Perman, Ryan Morgan, Anne Grossestreuer, Jacob Vine, Nicholas Johnson, Luke Andrea, Ari Moskowitz, Benjamin Abella, Cameron Dezfulian, Walid H Farooqi, Felipe Teran","doi":"10.1161/JAHA.125.043181","DOIUrl":"10.1161/JAHA.125.043181","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043181"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Acute Valve Syndrome on Outcomes of Aortic Valve Replacement for Aortic Stenosis.","authors":"Michel Pompeu Sá, Nicolas Brozzi, Jose L Navia","doi":"10.1161/JAHA.125.046270","DOIUrl":"10.1161/JAHA.125.046270","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e046270"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Ezetimibe and Statin Combinations With Recurrent Ischemic Stroke: A Nationwide Study With Dual Design.","authors":"Da Hoon Lee, Yoon-A Park, Seo-A Choi, Jung Sun Kim, Jeong Yee, Hye Sun Gwak","doi":"10.1161/JAHA.124.038873","DOIUrl":"10.1161/JAHA.124.038873","url":null,"abstract":"<p><strong>Background: </strong>Statin is recommended for patients with ischemic stroke (IS) to lower low-density lipoprotein cholesterol. Although combining statin with ezetimibe further reduced low-density lipoprotein cholesterol, its impact on IS recurrence has varied by statin type.</p><p><strong>Methods: </strong>We used 2 study designs-a retrospective cohort and a case-control study-using the Korean Health Insurance Review and Assessment database. Patients hospitalized for IS between July 2017 and July 2021 who were treated with atorvastatin or rosuvastatin were included. The cohort study compared recurrent IS risk between ezetimibe users and nonusers, using 1:1 propensity score matching for baseline characteristics. The case-control study assessed ezetimibe use between recurrent cases with IS and age-, sex-, index year-matched controls. Cox proportional hazards and logistic regression models were used to calculate hazard ratios (HRs) and adjusted HRs (aHRs) for the cohort study, as well as odds ratios (ORs) and adjusted ORs (aORs) for the case-control study. We conducted several sensitivity analyses.</p><p><strong>Results: </strong>Among 26 937 patients with IS (16 215 atorvastatin, 10 722 rosuvastatin), the cohort study showed ezetimibe combined with atorvastatin significantly reduced recurrent IS incidence (aHR, 0.73 [95% CI, 0.55-0.98], <i>P</i>=0.037), whereas rosuvastatin showed no significant difference (aHR, 1.00 [95% CI, 0.80-1.24], <i>P</i>=0.985). The case-control study confirmed ezetimibe's protective effect with atorvastatin (aOR, 0.74 [95% CI, 0.58-0.93], <i>P</i>=0.012) but not with rosuvastatin (aOR, 1.01 [95% CI, 0.83-1.24], <i>P</i>=0.903). Sensitivity analyses supported these findings.</p><p><strong>Conclusions: </strong>Ezetimibe combined with atorvastatin was associated with lower recurrent IS rates compared with atorvastatin alone, whereas its addition to rosuvastatin showed no significant association.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038873"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}