Journal of the American Heart Association最新文献

{"title":"Comparison of Centers for Disease Control and Prevention and Hospital-Based Stroke Mortality Data in Kentucky: The Paul Coverdell National Acute Stroke Program.","authors":"Christopher J McLouth, Aaron D Mullen, Lacy K Shumway, Kari D Moore, Brent L McKune, Larry B Goldstein","doi":"10.1161/JAHA.124.039613","DOIUrl":"10.1161/JAHA.124.039613","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039613"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674839","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":"Patterns and Outcomes of Endovascular Thrombectomy Among Patients Over Age 80 Years: The Florida Stroke Registry.","authors":"Vera Sharashidze, Hao Ying, Hannah E Gardener, Carolina M Gutierrez, Ayham Alkhachroum, Ruijie Yin, Lili Zhou, Gillian Gordon Perue, Angus Jameson, David Z Rose, Nicole B Sur, Victor J Del Brutto, Ricardo Hanel, Brijesh Mehta, Dileep R Yavagal, Tatjana Rundek, Jose G Romano, Negar Asdaghi","doi":"10.1161/JAHA.123.033787","DOIUrl":"10.1161/JAHA.123.033787","url":null,"abstract":"<p><strong>Background: </strong>Older patients (≥80 years of age) were under-represented in randomized trials of endovascular thrombectomy (EVT). In the large Florida Stroke Registry (FSR), we aimed to evaluate the characteristics of the older patients receiving EVT in routine practice and to study the impact of age on EVT outcomes.</p><p><strong>Methods and results: </strong>Data prospectively collected from Get With The Guidelines-Stroke hospitals in the FSR from January 2010 to December 2022 were analyzed for EVT outcomes. Among patients receiving EVT, characteristics associated with age ≥80 years and the impact of age on EVT outcomes of discharge directly to home or acute inpatient rehabilitation, and independent ambulation at discharge were studied using multivariable analysis with generalized estimating equations. Among 20 004 EVT FSR patients (mean age 71±15, 50% women), 29% were ≥80 years of age. In multivariable analysis, older patients with EVT had a similar rate of symptomatic intracerebral hemorrhage and in hospital mortality but were less likely to achieve independent ambulation at discharge (odds ratio [OR]: 0.44 [95% CI, 0.39-0.49]), be discharged directly home (OR: 0.46 [95% CI, 0.42-0.51]) or to a rehabilitation facility (OR: 0.68 [95% CI, 0.61-0.75]).</p><p><strong>Conclusions: </strong>In routine practice, close to 30% of EVT treated stroke patients are over the age of 80 years. Our data shows that EVT is safe in this population; however, age remains an independent predictor of poor discharge outcomes post EVT.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e033787"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712143","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":"Exploring the Link Between C-Reactive Protein Change and Stroke Risk: Insights From a Prospective Cohort Study and Genetic Evidence.","authors":"Yitong Ling, Shiqi Yuan, Hongtao Cheng, Shanyuan Tan, Xiaxuan Huang, Yonglan Tang, Zihong Bai, Rui Li, Li Li, Shuna Li, Liying Huang, Anding Xu, Jun Lyu","doi":"10.1161/JAHA.124.038086","DOIUrl":"10.1161/JAHA.124.038086","url":null,"abstract":"<p><strong>Background: </strong>Previous research on how changes in CRP (C-reactive protein) levels predict stroke risk is limited. This study aimed to examine the association between CRP change and the risk of stroke and its subtypes.</p><p><strong>Methods and results: </strong>Based on the UK Biobank data, we investigated the association between CRP change and the risk of stroke and its subtypes with Cox proportional hazards regression analysis. We further performed genetic analyses including genetic correlation, pairwise genome-wide association study, and polygenic risk score. Our study involved 14 754 participants with a median follow-up time of 10.4 years. After categorizing participants by CRP percentage change and making adjustments for potential confounders, it was observed that those with an elevated percentage of CRP change had a higher risk of any stroke (hazard ratio [HR], 1.44 [95% CI, 1.12-1.85]) and ischemic stroke (HR, 1.65 [95% CI, 1.24-2.18]). After categorization by CRP change types and adjustment for confounders, the group that became high level had a higher any-stroke risk (HR, 1.45 [95% CI, 1.04-2.02]), with the group that remained at a high level facing the greatest risk (HR, 1.74 [95% CI, 1.30-2.33]). Similar trends were observed for ischemic stroke. The group that remained at a high level also had a heightened hemorrhagic stroke risk (HR, 1.91 [95% CI, 1.07-3.44]). Genetic analysis showed a significant genetic correlation between CRP and stroke (r_g, 0.257; r_g_<i>P</i>=2.39E-07). Pairwise genome-wide association study analysis identified 5 shared genomic regions between CRP and stroke. Polygenic risk score analysis showed that participants with high stroke polygenic risk score and elevated or remaining high CRP levels have the highest risk of stroke.</p><p><strong>Conclusions: </strong>Both any stroke and ischemic stroke are related to elevated and remaining high CRP levels, while hemorrhagic stroke is only related to remaining high CRP levels.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038086"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711963","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 Measures of Structural Racism and Receipt of Acute Ischemic Stroke Interventions in the United States.","authors":"Amol M Mehta, Sai P Polineni, Praneet Polineni, Mandip S Dhamoon","doi":"10.1161/JAHA.124.037125","DOIUrl":"10.1161/JAHA.124.037125","url":null,"abstract":"<p><strong>Background: </strong>Structural racism and rural/urban differences in stroke care affect care delivery and outcomes. We explored the interplay among structural racism, urbanity, and intravenous thrombolysis (tissue plasminogen activator) and endovascular thrombectomy (ET).</p><p><strong>Methods and results: </strong>In this retrospective study using complete, deidentified inpatient Medicare data (2016-2019), we identified incident acute ischemic stroke admissions, demographics, and hospital-level variables. Medicare beneficiaries aged ≥65 years with incident acute ischemic stroke admission in large metropolitan and nonurban settings were included. Validated structural racism metrics at the county level and a composite structural racism score that incorporated measures of segregation, housing, employment, education, and income were studied. Among 951 914 patients, rural hospitals demonstrated lower intensive care unit capacity (27.5% versus 88.6%), stroke certification (5.3% versus 38.4%), and rates of tissue plasminogen activator (1.6% versus 12.3%) and ET (<1% versus 3.8%). Large metropolitan areas demonstrated higher levels of income inequality (Gini index -0.15 versus 0.11 SD), and racial segregation (dissimilarity index 0.29 SD higher than the US mean). The composite structural racism score was associated with increased odds of tissue plasminogen activator receipt (odds ratio, 1.47 [95% CI, 1.33-1.63]) and ET (odds ratio, 4.15 [95% CI, 2.98-5.79]). Despite greater access to stroke care in urban areas, a persistent racial disparity remained, with Black patients less likely to receive tissue plasminogen activator (odds ratio, 0.70 [95% CI, 0.68-0.72]) and ET (odds ratio, 0.63 [95% CI, 0.60-0.66]) compared with White patients.</p><p><strong>Conclusions: </strong>We found persistent disparities in stroke care access and outcomes, influenced by structural racism and rural-urban differences. Further research should explore interactions between structural racism, urbanity, and health care delivery to inform effective interventions.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037125"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712175","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":"Exploration of the Interrelationship Between Serum Uric Acid, Gout, and Cardiac, Renal, and Metabolic Conditions in Middle Aged and Older People.","authors":"Yingdong Han, Menghui Yao, He Zhao, Xinxin Han, Hong Di, Tiange Xie, Juan Wu, Yibo Wang, Yun Zhang, Xuejun Zeng","doi":"10.1161/JAHA.124.038723","DOIUrl":"10.1161/JAHA.124.038723","url":null,"abstract":"<p><strong>Background: </strong>Cardiac, renal, and metabolic (CRM) conditions are major causes of morbidity and mortality globally. This study aims to explore the relationship between serum uric acid (SUA), hyperuricemia, gout, and CRM conditions in middle-aged and elderly populations.</p><p><strong>Methods: </strong>Sample 1 included participants from CHARLS (China Health and Retirement Longitudinal Study, n=9341), and Sample 2 from NHANES (National Health and Nutrition Examination Survey, unweighted n=17 913; weighted n=115 646 390). Ordinal logistic regression, Cox regression, and restricted cubic spline analyses were used to assess the relationship between SUA, hyperuricemia, gout, and CRM conditions. A 2-sample Mendelian randomization analysis was conducted to explore causal associations between SUA and CRM conditions.</p><p><strong>Results: </strong>In both samples, SUA, hyperuricemia, and gout were positively correlated with the risk of CRM conditions. Among participants with 3 or ≥1 CRM condition(s), SUA, asymptomatic hyperuricemia, and gout with poorly controlled hyperuricemia showed significant positive associations with all-cause mortality, whereas these associations were not observed in patients with gout with normal SUA levels. The restricted cubic spline analysis revealed a positive relationship between SUA levels and the risk of all-cause mortality in participants with ≥1 CRM condition(s), demonstrating a nonlinear dose-response relationship across both samples (<i>P</i> for nonlinearity <0.05). Mendelian randomization analysis indicated that SUA was causally associated with cardiovascular disease, chronic kidney disease, and diabetes.</p><p><strong>Conclusions: </strong>Hyperuricemia and gout are strong predictors of increased prevalence and mortality of CRM conditions, emphasizing the importance of managing hyperuricemia and gout in these patients.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038723"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722566","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":"Harnessing Large Language Models for Chart Review.","authors":"Dongchu Xu, Jonathan W Cunningham","doi":"10.1161/JAHA.125.041581","DOIUrl":"10.1161/JAHA.125.041581","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041581"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722567","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":"Overall Sleep Quality Is Associated With Advanced Stages in Patients With Cardiovascular-Kidney-Metabolic Syndrome.","authors":"Dingyuan Tu, Jie Sun, Pengru Wang, Qiang Xu, Chaoqun Ma","doi":"10.1161/JAHA.124.038674","DOIUrl":"10.1161/JAHA.124.038674","url":null,"abstract":"<p><strong>Background: </strong>In 2023, the American Heart Association defined the concept of cardiovascular-kidney-metabolic (CKM) syndrome as a health disorder ascribed to connections among obesity, diabetes, chronic kidney disease, and cardiovascular disease. We aim to examine the association between overall sleep quality and advanced CKM syndrome.</p><p><strong>Methods: </strong>This cross-sectional study used data on US adults from the National Health and Nutrition Examination Survey 2015 to 2020. Overall sleep quality was evaluated by summarizing 5 sleep behaviors: sleep duration, trouble sleeping, daytime sleepiness, snoring, and nocturia. CKM syndrome was classified into 5 stages: stage 0, no risk factors; stage 1, excess adiposity; stage 2, metabolic risk factors and kidney disease; stage 3, subclinical cardiovascular disease; and stage 4, clinical cardiovascular disease. CKM syndrome stages 3 and 4 are considered advanced. The association between overall sleep quality and advanced CKM syndrome was assessed using a multivariable weighted logistic regression model.</p><p><strong>Results: </strong>Of the 12 245 adults included in our study, 10 607 participants met the criteria for CKM syndrome (stage ≥1), and 8930 were categorized into nonadvanced CKM syndrome, while 1677 were categorized into advanced CKM syndrome. Compared with patients with CKM syndrome in the low-sleep-quality group, the adjusted odds ratios for advanced CKM syndrome were 0.68 (95% CI, 0.54-0.87) for those in the moderate sleep quality group and 0.55 (95% CI, 0.40-0.75) for those in the high-sleep-quality group, respectively.</p><p><strong>Conclusions: </strong>Patients with CKM syndrome with higher overall sleep quality had a lower likelihood of being in advanced stages.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038674"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702328","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":"Patient Predictors of Combination Therapy as Initial Hypertension Treatment: The AOURP (All of Us Research Program) Registry.","authors":"Jingzhi Kevin Yu, Abigail M Gauen, Rachel Zmora, Lucia C Petito, Abel N Kho, Steven M Smith, Norrina B Allen","doi":"10.1161/JAHA.124.037626","DOIUrl":"10.1161/JAHA.124.037626","url":null,"abstract":"","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037626"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711941","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":"Multi-Omic Insight Into the Molecular Networks in the Pathogenesis of Coronary Artery Disease.","authors":"Qinghua Fang, Hongdan Fan, Qiaoqiao Li, Muzi Zhang, Zhengzhong Zhou, Jianlin Du, Jing Huang","doi":"10.1161/JAHA.124.037203","DOIUrl":"10.1161/JAHA.124.037203","url":null,"abstract":"<p><strong>Background: </strong>Genome-wide association studies have revealed numerous loci associated with coronary artery disease (CAD). However, some potential causal/risk genes remain unidentified, and causal therapies are lacking.</p><p><strong>Methods and results: </strong>We integrated multi-omics data from gene methylation, expression, and protein levels using summary data-based Mendelian randomization and colocalization analysis. Candidate genes were prioritized based on protein-level associations, colocalization probability, and links to methylation and expression. Single-cell RNA sequencing data were used to assess differential expression in the coronary arteries of patients with CAD. <i>TAGLN2</i> (<i>Transgelin 2</i>), <i>APOB</i> (<i>Apolipoprotein B</i>), and <i>GIP</i> (<i>Glucose-dependent insulinotropic polypeptide</i>) were identified as the genes most strongly associated with CAD, with <i>TAGLN2</i> exhibiting the most significant association. Higher methylation levels of <i>TAGLN2</i> at specific Cytosine-phosphate-Guanine sites were negatively correlated with its gene expression and associated with a lower risk of CAD, whereas higher circulating TAGLN2 protein levels were positively associated with CAD risk (odds ratio,1.66 [95% CI, 1.32-2.08). These results suggest distinct regulatory mechanisms for <i>TAGLN2</i>. In contrast, <i>APOB</i> and <i>GIP</i> showed positive associations with CAD risk, whereas <i>DHX58</i> (<i>DExH-box helicase 58</i>) and <i>SWAP70</i> (<i>Switch-associated protein 70</i>) were associated with decreased risk.</p><p><strong>Conclusions: </strong>Our findings provide multi-omics evidence suggesting that <i>TAGLN2</i>, <i>APOB</i>, <i>GIP</i>, <i>DHX58</i>, and <i>SWAP70</i> genes are associated with CAD risk. This work provides novel insights into the molecular mechanisms of CAD and highlights the potential of integrating multi-omics data to uncover potential causal relationships that cannot be fully captured by traditional genome-wide association studies.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e037203"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711938","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":"Development of a Risk Tracking Model for Neurological Deterioration in Ischemic Stroke Based on Blood Pressure Dynamics.","authors":"Jihoon Kang, Maengseok Noh, Juneyoung Lee, Youngjo Lee, Hee-Joon Bae","doi":"10.1161/JAHA.124.036287","DOIUrl":"10.1161/JAHA.124.036287","url":null,"abstract":"<p><strong>Background: </strong>Using the significant link between blood pressure fluctuations and neurological deterioration (ND) in patients with ischemic stroke, this study aims to develop a predictive model capable of tracking ND risk in real time, enabling timely detection of high-risk periods.</p><p><strong>Methods and results: </strong>A total of 3906 consecutive patients with ischemic stroke were recruited. To develop an initial predictive model, we employed a multinomial logistic regression model incorporating clinical parameters. This model estimates the probability of ND occurring within 2 distinct time windows relative to hospital arrival: within the first 12 hours and between 12 and 72 hours. To refine ND risk assessments over time, we subsequently introduced an iterative risk-tracking model that uses continuously updated blood pressure measurements. We endeavored to integrate these models, assessing their combined discriminative capacity and clinical utility, with a particular emphasis on pinpointing time periods of increased ND risk. ND rates were observed at 6.1% within the first 12 hours and 7.3% between 12 and 72 hours, presenting the variation over time. Multinomial logistic models encountered disparities in significant predictors across different time zones. The iterative risk-tracking model was successfully set up to forecast ND within a 12-hour window at every measurement. The integrated models achieved an area under the receiver operating characteristic curve ranging from 0.68 to 0.76 for narrowing down ND risk identification within 12 hours without sacrificing predictive accuracy across diverse patient groups. At 90% and 70% sensitivity settings, the combined model presented slightly higher or comparable specificity and positive predictive values relative to conventional models.</p><p><strong>Conclusions: </strong>This study presents a novel approach for real-time monitoring of ND risk in patients with ischemic stroke, using blood pressure trends to identify critical periods for potential intervention.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e036287"},"PeriodicalIF":5.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711960","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}