Journal of the American Heart Association最新文献

{"title":"Blood Pressure Postural Changes Variability Is Associated With Lower Cognition: The S.AGES Cohort.","authors":"Mathilde Strumia, Jean-Sébastien Vidal, Philippe Cestac, Brigitte Sallerin, Sandrine Andrieu, Olivier Hanon, Laure Rouch","doi":"10.1161/JAHA.124.039197","DOIUrl":"10.1161/JAHA.124.039197","url":null,"abstract":"<p><strong>Background: </strong>Over the past decade, higher blood pressure (BP) variability and postural changes in BP have been associated with lower cognitive function. However, only one study has investigated the specific association between BP postural changes variability and brain health, showing a greater risk of dementia with higher systolic BP (SBP) postural changes variability. We aimed to investigate the association between BP postural changes variability and cognitive function in community-dwelling older adults.</p><p><strong>Methods: </strong>Participants from the S.AGES (Sujets ÂGES) cohort underwent clinical examinations every 6 months during 3 years. At each clinical visit, an orthostatic SBP ratio was calculated: (seated SBP/standing SBP)×100. A similar method was used to compute an orthostatic diastolic BP ratio. Then, we assessed the visit-to-visit BP postural changes variability according to several indicators including coefficient of variation. Cognition was evaluated annually using the Mini-Mental State Examination. Statistical analyses were performed with linear mixed models.</p><p><strong>Results: </strong>We included 2974 patients (mean age, 78 years). After adjustment for demographics, cardiovascular risk factors and disease, seated SBP/diastolic BP, and BP-lowering treatment, visit-to-visit SBP postural changes variability was significantly associated with lower cognition (per 1-SD increase in coefficient of variation: adjusted β=-0.15 [95% CI, -0.27 to -0.04], <i>P</i>=0.01). Similar results were found with visit-to-visit diastolic BP postural changes variability.</p><p><strong>Conclusions: </strong>Visit-to-visit SBP and diastolic BP postural changes variability were associated with lower cognition. Further studies are needed to assess whether controlling orthostatic BP instability over time could help preserve cognitive function.</p><p><strong>Registration: </strong>URL: https://clinicaltrials.gov; Unique identifier: NCT01065909.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":"14 19","pages":"e039197"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245814","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":"Beyond Rejection: Long-Term Survival Following Heart Transplant.","authors":"Justin C Y Chan, Randal I Goldberg","doi":"10.1161/JAHA.125.045281","DOIUrl":"10.1161/JAHA.125.045281","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e045281"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139518","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":"Thermoneutrality Does Not Affect Angiotensin II-Induced Aortic Aneurysms in Hypercholesterolemic Mice.","authors":"Liyuan Zhu, Bowen Li, Michael K Franklin, Deborah A Howatt, Yuriko Katsumata, Alan Daugherty, Hong S Lu","doi":"10.1161/JAHA.125.043689","DOIUrl":"10.1161/JAHA.125.043689","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043689"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193250","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":"Obesity Adversely Affects Dietary Metabolism: Time to Inform Guidelines?","authors":"Rajeev Gupta, Anshul Yadav","doi":"10.1161/JAHA.125.045359","DOIUrl":"10.1161/JAHA.125.045359","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e045359"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193977","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":"Periprocedural Assessment of Coronary Microcirculatory Function to Predict Clinical Outcomes After Elective Percutaneous Coronary Intervention.","authors":"ChenGuang Li, You Zhou, Danbo Lu, Jiaqi Ma, Chunfeng Dai, Jianying Ma, Yumeng Hu, Jianyi Xu, Jianping Xiang, Zhangwei Chen, Juying Qian, Junbo Ge","doi":"10.1161/JAHA.125.043836","DOIUrl":"10.1161/JAHA.125.043836","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous coronary intervention (PCI) could restore epicardial blood flow through the stent-based angioplasty. However, coronary microcirculatory function also affects clinical outcomes and can be quantified by the angiography-derived index of microcirculatory resistance (angio-IMR). The prognostic significance of periprocedural angio-IMR in patients undergoing elective PCI remains unclear. This study aimed to assess angio-IMR before and after PCI, as well as their association with long-term prognosis.</p><p><strong>Methods: </strong>Data from 1768 patients with stable coronary artery disease undergoing elective PCI were analyzed. The primary end point was major adverse cardiac events (MACE) comprising death and nonfatal myocardial infarction.</p><p><strong>Results: </strong>The median angio-IMR was 11.3 (interquartile range, 7.7-15.0) and 17.0 (interquartile range, 14.1-20.4) before and after PCI (<i>P</i><0.001), respectively. During a median follow-up period of 20 months, MACE occurred in 53 patients (3.0%). Periprocedural angio-IMR changes (Δangio-IMR) exhibited superior predictive power for MACE compared with post-PCI angio-IMR alone. Specifically, Δangio-IMR>10 was independently associated with an increased risk of MACE (adjusted hazard ratio, 2.43 [95% CI, 1.32-4.49]; <i>P</i>=0.004). In comparison with periprocedural myocardial infarction, Δangio-IMR>10 could provide additional prognostic value in predicting MACE (area under the curve, 0.681 versus 0.635, <i>P</i><0.05).</p><p><strong>Conclusions: </strong>Δangio-IMR was a predictor of MACE in patients with stable coronary artery disease undergoing elective PCI. Incorporating Δangio-IMR could enhance the identification of patients at high risk of MACE.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043836"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978606","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":"Associations Between Blood Heavy Metal Concentrations and Hypertensive Disorders of Pregnancy in the Japan Environment and Children's Study.","authors":"Nobuhisa Morimoto, Hitomi Okubo, Shoji F Nakayama","doi":"10.1161/JAHA.125.042183","DOIUrl":"10.1161/JAHA.125.042183","url":null,"abstract":"<p><strong>Background: </strong>Previous studies reported inconsistent associations between blood heavy metal concentrations and the risk of hypertensive disorders of pregnancy (HDP), potentially due to small sample sizes and variations in exposure levels, timing of blood sampling, and confounding factors. We investigated this association in Japanese women, a population with relatively low metal exposure, to provide a unique perspective in a low-exposure setting.</p><p><strong>Methods: </strong>We included 88 670 pregnant women, with a mean age of 31.2±5.1 years, enrolled in the Japan Environment and Children's Study. We examined the associations between concentrations of heavy metals (lead, cadmium, and mercury) in blood collected during the second or third trimester and HDP, using multiple logistic regression under a Bayesian framework, adjusting for potential effects of confounders including parity, body mass index, smoking, and diet quality.</p><p><strong>Results: </strong>The per-woman incidence of HDP was 2703 (3.1%). The median blood concentrations of lead, cadmium, and mercury were 5.86 (interquartile range, 4.72-7.35), 0.664 (interquartile range, 0.496-0.906), and 3.62 (interquartile range, 2.53-5.17) ng/g, respectively. After adjusting for potential confounders, blood lead, cadmium, and mercury concentrations were positively associated with the odds of HDP. The median odds ratios for HDP in the highest vs lowest quartiles of blood metal concentrations were 1.58 (95% credible interval, 1.39-1.77) for lead, 1.30 (95% credible interval, 1.15-1.45) for cadmium, and 1.15 (95% credible interval, 1.03-1.28) for mercury.</p><p><strong>Conclusions: </strong>Higher blood lead, cadmium, and mercury concentrations were associated with HDP in Japanese pregnant women. Our findings suggest that low-dose exposure to these heavy metals is an underrecognized but important risk factor for HDP, highlighting the need to develop measures to reduce heavy metal exposure.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042183"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088082","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":"Associations of Immune Cell Subsets With Coronary Artery Calcium Incidence and Progression in the Multi-Ethnic Study of Atherosclerosis.","authors":"Riddhi D Patel, Petra Buzkova, Sally Huber, Alan Landay, Matthew Budoff, Joshua C Bis, Nels Olson, Stephen Rich, Susan R Heckbert, Ani Manichaikul, James Floyd, Russell P Tracy, Bruce M Psaty, Margaret F Doyle, Colleen M Sitlani, Joseph A C Delaney, Alison E Fohner, Matthew J Feinstein","doi":"10.1161/JAHA.125.042502","DOIUrl":"10.1161/JAHA.125.042502","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on associations of immune cell subsets with longitudinal changes in subclinical coronary artery disease.</p><p><strong>Methods: </strong>In the MESA (Multi-Ethnic Study of Atherosclerosis) study, we used a case-cohort approach to explore associations of 28 immune cell subsets measured at baseline (2000-2002) with longitudinal changes in coronary artery calcium (CAC). We examined incident CAC from examination 2 (2002-2004) through examination 5 (2010-2012) in participants with 0 CAC at baseline using multivariable-adjusted Cox regression. In participants with CAC >0 at baseline, we analyzed changes in CAC through examination 5 using multivariable-adjusted linear mixed models. Because no studies have investigated immune cells and longitudinal CAC changes, analyses were considered exploratory, with <i>P</i><0.05 as the threshold for possible significance.</p><p><strong>Results: </strong>Of 975 participants with immune cells subsets and CAC measurements at baseline, 378 had CAC 0 at baseline (mean age, 58.4; 37.0% men) and 597 had CAC >0 at baseline (mean age, 65.7; 57.6% men). Natural killer cells were associated with higher incident CAC (hazard ratio [HR], 1.26 per SD higher natural killer cell proportion; <i>P</i>=0.03), whereas T helper type cells were associated with lower incident CAC (HR, 0.81; <i>P</i>=0.04). B cells were associated with CAC progression (β=53.1 Agatston units per SD higher B-cell proportion, <i>P</i>=0.04), whereas CD14+CD16+ monocytes (β=-71.6; <i>P</i>=0.03) and T regulatory cells (β=-61.9; <i>P</i>=0.03) were associated with lower CAC progression.</p><p><strong>Conclusions: </strong>Natural killer cells may be associated with incident CAC and T regulatory cells may be associated with attenuated CAC progression, among other findings. These warrant replication and experimental investigation.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042502"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088096","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":"Comparative Mortality in Heart Failure on Guideline-Directed Medical Therapy Versus Malignant Cancer: A Report From a Global Federated Research Network.","authors":"Luca Monzo, Guillaume Baudry, Kevin Duarte, Gema Hernandez, Olivier Denquin, Gianluigi Savarese, Nicolas Girerd","doi":"10.1161/JAHA.125.044046","DOIUrl":"10.1161/JAHA.125.044046","url":null,"abstract":"<p><strong>Background: </strong>Guideline-directed medical therapy (GDMT), including angiotensin receptor-neprilysin inhibitor, angiotensin-converting enzyme inhibitors, beta blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors, has significantly improved outcomes in patients with heart failure with reduced ejection fraction (HFrEF). We examined whether modern GDMT alters the historically observed parity in mortality between HF and cancer.</p><p><strong>Methods: </strong>From the TriNetX Global Collaborative Research Network (2015-2024), we identified 32 125 patients with HFrEF on GDMT (angiotensin receptor-neprilysin inhibitor or angiotensin-converting enzyme inhibitors, mineralocorticoid receptor antagonists, beta blockers, and sodium-glucose cotransporter-2 inhibitors), 403 389 not on full GDMT (not receiving all 4 drugs concurrently), and 2 481 106 with malignant cancers. All-cause mortality was compared between HFrEF and cancer overall and across the most common cancers in men (prostate, colorectal, lung) and women (breast, lung, colorectal) using propensity score matching.</p><p><strong>Results: </strong>Patients with HFrEF on GDMT with angiotensin receptor-neprilysin inhibitors had significantly better survival than patients with cancer (hazard ratio [HR], 0.44 [95% CI, 0.41-0.47]; <i>P</i><0.001). A survival benefit, though less pronounced, was also seen for GDMT with angiotensin-converting enzyme inhibitors instead of angiotensin receptor-neprilysin inhibitor (HR, 0.62 [95% CI, 0.57-0.69]; <i>P</i><0.001). Patients not on GDMT had higher mortality than patients with cancer (HR, 1.15 [95% CI, 1.13-1.17]; <i>P</i><0.001). Among the most common sex-specific cancers, only patients with prostate and breast cancer had better survival than those with HFrEF on GDMT, whereas patients not on GDMT showed worse outcomes across most cancers, except lung cancer.</p><p><strong>Conclusions: </strong>In this large real-world analysis, patients with HFrEF on GDMT showed better survival than those with cancer overall and across most sex-specific cancers. Patients not on GDMT experienced worse outcomes, emphasizing the need to optimize treatment in HFrEF.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e044046"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088116","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":"Enhancing Societal Participation for Stroke Survivors With Cognitive Impairments: A Randomized Controlled Trial.","authors":"Shih-Pin Hsu, Te-Hsun Hung, Yen-Nung Lin, Jiunn-Horng Kang, Der-Sheng Han, Valeria Chiu, Tsan-Hon Liou, Yi-Hsuan Wu, Peng-Sheng Ni, Elizabeth R Skidmore, Feng-Hang Chang","doi":"10.1161/JAHA.125.042295","DOIUrl":"10.1161/JAHA.125.042295","url":null,"abstract":"<p><strong>Background: </strong>Returning to societal participation is an important goal for stroke survivors, but evidence for effective rehabilitation remains inconclusive. This study evaluated the efficacy of participation-focused strategy training in improving poststroke participation among community-dwelling survivors with cognitive impairments.</p><p><strong>Methods: </strong>This multicenter, randomized trial enrolled stroke survivors with executive function impairments between January 2019 and March 2023. Participants received either strategy training (n=96) or an attention-control intervention (n=99) in 12 to 15 sessions over 8 weeks. The primary outcome was the postintervention change in participation across productivity, social, and community domains from the baseline, measured by the Participation Measure-3 Domains, 4 Dimensions. Secondary outcomes included changes in activity performance, self-efficacy, and global cognition from baseline.</p><p><strong>Results: </strong>Eligible 195 participants were included in the intention-to-treat analysis (64 women, 32.8%; median [interquartile range] age: 62 [52-68] years). After adjusting for baseline primary outcome, stroke severity, and dose of regular rehabilitation, the strategy training group showed greater improvements in productivity and social participation compared with the control group (adjusted mean difference between groups [95% CI]: 7.89 [2.61-13.16] (<i>P</i>=0.004) and 0.29 [0.08-0.51] (<i>P</i>=0.009), respectively) from baseline to postintervention. These effects remained without adjustment, but did not persist at 3-month follow-up. No significant between-group differences were observed for any other outcomes.</p><p><strong>Conclusions: </strong>Participation-focused strategy training significantly improved productivity and social participation among enrolled stroke survivors compared with the control intervention postintervention. Further research is warranted to confirm these findings in the oldest survivors and to explore approaches for enhancing the long-term benefits of strategy training.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03792061.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042295"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088159","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":"Racial Disparities in Heart Transplantation: Long-Term Graft Survival and Nonmortality Outcomes.","authors":"Steven Anthony Hamilton, Brian Wayda, Yingjie Weng, Shiqi Zhang, Kiran K Khush","doi":"10.1161/JAHA.124.038892","DOIUrl":"10.1161/JAHA.124.038892","url":null,"abstract":"<p><strong>Background: </strong>Prior studies have reported conflicting evidence on racial disparities in heart transplant outcomes, often focusing only on short-term mortality rates. We assessed longer-term survival and a broader range of post-heart transplant outcomes by race.</p><p><strong>Methods: </strong>We analyzed adult heart transplant recipients from 2017 to 2022 in the SRTR (Scientific Registry for Transplant Recipients), categorizing race as Black, non-Hispanic White, or Other. The primary outcome was graft failure at 1 and 3 years. Secondary outcomes included acute rejection, renal dysfunction, and posttransplant diabetes. χ² tests and Kaplan-Meier/logistic regression analyses were used.</p><p><strong>Results: </strong>Among 15 873 recipients (63% White, 23% Black, 14% Other), Black recipients were more likely female, publicly insured, and less likely to be college educated. They also had higher use of durable ventricular assist devices and intra-aortic balloon pump at transplant. One-year graft survival was similar across groups (91.8% Black versus 91.1% non-Black), but 3-year survival was lower among Black individuals (83.4% versus 85.7%, <i>P</i>=0.006). After adjusting for socioeconomic and clinical factors, Black recipients had a higher risk of graft failure at 3 years (odds ratio, 1.22 [95% CI, 1.07-1.39]). Black patients also experienced higher rates of acute rejection (12.4% versus 10.2%), diabetes (10.8% versus 7.1%), and renal dysfunction progression (40.9% versus 37.1%) at 3 years (<i>P</i><0.05 for all).</p><p><strong>Conclusions: </strong>Racial disparities in heart transplant outcomes persist, particularly in longer-term survival. These disparities may be partially mediated by differences in posttransplant complications such as rejection, renal dysfunction, and diabetes.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038892"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139244","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}