Journal of the American Heart Association最新文献

{"title":"Atrial Fibrillation, Heart Failure Phenotypes, and Mortality Risk in the Nationwide START Registry: A Propensity Score Matching Analysis.","authors":"Danilo Menichelli, Emilia Antonucci, Gianluca Gazzaniga, Daniela Poli, Giuseppe Armentaro, Giordano di Carlo, Rossella Marcucci, Paolo Calabrò, Arturo Cesaro, Gualtiero Palareti, Angela Sciacqua, Pasquale Pignatelli, Daniele Pastori","doi":"10.1161/JAHA.125.042586","DOIUrl":"10.1161/JAHA.125.042586","url":null,"abstract":"<p><strong>Background: </strong>Data on atrial fibrillation (AF) and heart failure (HF) with preserved ejection fraction (HFpEF) are scarce. We investigated the association of HFpEF with all-cause mortality in AF.</p><p><strong>Methods: </strong>We included 10 369 patients with AF on oral anticoagulants from the nationwide ongoing START (Survey on Anticoagulated Patients Register) registry. Patients were divided into 3 groups: (1) no HF, (2) HF with reduced EF/HF with mildly reduced EF (EF ≤50%), and HFpEF (EF >50%). Patients with HF should have had a clinical diagnosis or a history of HF hospitalization. The association between HF types and all-cause mortality was investigated by Cox proportional hazards regression analysis to estimate hazard ratio (HR) and 95% CI for each factor. The Fine-Gray model and propensity score matching were used.</p><p><strong>Results: </strong>Mean age was 76.4±9.4 years and 45.8% were women. Overall, 2309 (22.2%) patients had HF, of whom 47.4% had HFpEF. During 720±576 days of follow-up (20 747 patients/year), 727 deaths occurred (3.5 per 100 patient-years). After propensity score matching, both HF with mildly reduced EF/HF with reduced EF and HFpEF were associated with all-cause mortality (HR, 1.33; <i>P</i>=0.037 and HR, 1.49; <i>P</i>=0.004). HFpEF was associated with mortality in men (HR, 1.654; <i>P</i>=0.001) but not in women (HR, 1.243; <i>P</i>=0.175). In HFpEF, age≥75 years (HR, 2.247; <i>P</i>=0.003), chronic respiratory disease (HR, 2.109; <i>P</i><0.001), anemia (HR, 1.482; <i>P</i>=0.035), paroxysmal AF (HR, 0.528; <i>P</i>=0.012), creatinine clearance<30 mL/min (HR, 1.791; <i>P</i>=0.018), direct oral anticoagulants (HR, 0.575; <i>P</i>=0.005), and renin-angiotensin inhibitors (HR, 0.670; <i>P</i>=0.033) were associated with all-cause mortality.</p><p><strong>Conclusions: </strong>HFpEF is frequent in patients with AF and associated with an increased mortality, especially in men. Comorbidities and treatments associated differently with mortality according to HF phenotype.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02219984.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042586"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303589","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":"Imaging-Based Brain Frailty Predicts Unfavorable Outcomes in Acute Ischemic Stroke.","authors":"XiaoQing Cheng, Wu Cai, ChuYan Li, Xi Shen, JiaNan Li, LiJun Huang, JinJing Tang, HuiMin Pang, BaiYan Luo, Ya Liu, Qian Chen, Lulu Xiao, WuSheng Zhu, ZeHong Cao, XiaoYu Liu, LongJiang Zhang, XinDao Yin, ZhiQiang Zhang, Feng Shi, Wei Xing, GuangMing Lu","doi":"10.1161/JAHA.124.039790","DOIUrl":"10.1161/JAHA.124.039790","url":null,"abstract":"<p><strong>Background: </strong>Brain frailty is characterized by imaging biomarkers of chronic cerebrovascular injury. Whether brain frailty improves the prediction of acute ischemic stroke complications and prognosis requires further study.</p><p><strong>Methods: </strong>This multicenter, retrospective study included patients with acute ischemic stroke due to large-vessel occlusion in the anterior circulation. All patients underwent magnetic resonance imaging within 7 days of stroke onset, measuring subcortical and cortical atrophy and white matter hyperintensity as indicators of brain frailty. Multivariable logistic regression analyses and receiver operating characteristic curve analyses were used to assess the association and predictive value of brain frailty with complications and unfavorable clinical outcome (90-day modified Rankin Scale score, 3-6).</p><p><strong>Results: </strong>The study included 1090 patients with a median age of 64 (interquartile range, 55-73) years and a median National Institutes of Health Stroke Scale score of 9 (interquartile range, 4.5-15). Multivariable logistic regression analysis showed that independent risk factors for the unfavorable clinical outcome included: National Institutes of Health Stroke Scale score (odds ratio [OR], 1.09 [95% CI, 1.06-1.11]), blood glucose (OR, 1.18 [95% CI, 1.11-1.26]), infarct volume (OR, 1.43 [95% CI, 1.29-1.60]), subcortical atrophy (OR, 1.16 [95% CI, 1.10-1.23]), severe cortical atrophy (OR, 2.31 [95% CI, 1.04-5.15]), and severe white matter hyperintensity (OR, 3.63 [95% CI, 1.91-6.89]). However, brain frailty was not significantly associated with acute ischemic stroke complications (malignant cerebral edema, parenchymal hemorrhage). Including brain frailty indicators in the model significantly improved its unfavorable clinical outcome predictive power (area under the receiver operating characteristic curve increased from 0.762 to 0.822; <i>P</i><0.001). The results remained stable in subgroup analyses across treatment modalities.</p><p><strong>Conclusions: </strong>Brain frailty was significantly associated with the unfavorable clinical outcome. Brain frailty indicators contributed to the predictive efficacy, regardless of treatment modality.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039790"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303593","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":"DK-Crush or Mini-Crush Stenting for Complex Left Main Bifurcation Lesions: The Multicenter EVOLUTE-CRUSH LM Registry.","authors":"Fatih Uzun, Ahmet Güner, Aykun Hakgör, Elnur Alizade, Mehmet B Karataş, Gökhan Alıcı, Ahmet Y Çizgici, İrfan Şahin, İlker Gül, Hamdi Püşüroğlu, Ahmet Karaduman, Cemalettin Akman, Ali E Ataş, Muhammed F Deniz, Deniz N Tekin, Ebru Serin, Mehmet Kocaağa, Mustafa Yaşan, İlhan I Avcı, Oktay Şenöz, Perihan Varım, Abdullah Doğan, Atakan Dursun, Tuba Unkun, İlyas Çetin, Murat Gökalp, Veysel O Tanık, İbrahim F Aktük, Beytullah Çakal, Kudret Keskin, Ezgi G Güner, Aybüke Şimşek, Muhammet A Ekiz, Seda T Üzel, Çağdaş Bulus, Koray Çiloğlu, Muhammed M Göksu, Ali N Çalık, Bilal Boztosun","doi":"10.1161/JAHA.124.040166","DOIUrl":"10.1161/JAHA.124.040166","url":null,"abstract":"<p><strong>Background: </strong>The comparison of outcomes of mini-crush (MCT) versus double kissing crush (DKC) techniques for complex left main bifurcation (LMB) lesions is still lacking. This investigation aimed to assess the long-term outcomes of patients who underwent MCT or DKC for LMB disease.</p><p><strong>Methods: </strong>From 2014 to 2024, patients who underwent percutaneous coronary intervention for complex LMB lesions were retrospectively collected. The primary end point was major adverse cardiac events as the combination of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization during follow-up. The secondary end point was measured as major adverse cardiovascular and cerebral events including all-cause death, target vessel revascularization, target vessel myocardial infarction, stent thrombosis, and stroke.</p><p><strong>Results: </strong>This large-scale multicenter (n=13) observational study included a total of 531 consecutive patients (men: 405 [76.3%], mean age: 63.16±11.26 years) with complex LMB lesions who underwent percutaneous coronary intervention. The initial revascularization strategy was MCT in 313 (59%) patients and DKC in 218 (41%) patients. The number of balloons used (5.91±1.53 versus 6.72±1.70, <i>P</i><0.001) and procedure time (66.60±24.20 versus 72.97±19.97 minutes, <i>P</i><0.001) were notably lower in the MCT group. In the overall population, the long-term major adverse cardiac events (hazard ratio [HR], 0.704; <i>P</i>=0.169) and major adverse cardiovascular and cerebral events (HR, 0.660; <i>P</i>=0.079) did not differ in individuals with complex LMB lesions treated with MCT and DKC. Other end points were also comparable between the 2 groups.</p><p><strong>Conclusions: </strong>In complex LMB lesions, risk-adjusted major adverse cardiac events and major adverse cardiovascular and cerebral events rates were comparable between both techniques, with a nonsignificant trend favoring DKC at long-term follow-up.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique Identifier: NCT06546748.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040166"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112761","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":"Inpatient Outcomes for Patients With Peripheral Artery Disease Hospitalized for Acute Myocardial Infarction.","authors":"Jason Gusdorf, Kamil F Faridi, Tracy Y Wang, Carlos Mena-Hurtado, Kim G Smolderen, Jennifer A Rymer, Jeptha P Curtis, Shuang Li, Eric A Secemsky","doi":"10.1161/JAHA.124.040526","DOIUrl":"10.1161/JAHA.124.040526","url":null,"abstract":"<p><strong>Background: </strong>Patients with both peripheral artery disease (PAD) and coronary artery disease are at heightened risk for adverse cardiovascular outcomes. Although long-term risk has been well documented, contemporary in-hospital outcomes for patients with PAD presenting with acute myocardial infarction (AMI) are less well characterized.</p><p><strong>Methods: </strong>We analyzed 493 740 AMI hospitalizations from 670 US sites in the NCDR (National Cardiovascular Data Registry) Chest Pain-MI Registry between January 2019 and March 2023. Primary outcomes were in-hospital mortality and major bleeding; secondary end points included cardiac arrest, cardiogenic shock, heart failure, stroke, and new dialysis initiation. Subgroup analyses were conducted by age, sex, race, AMI type, revascularization status, and extent of coronary disease. We used the NCDR validated risk model for multivariable adjustment.</p><p><strong>Results: </strong>PAD was present in 36 274 patients with AMI (7.4%). In-hospital mortality was significantly higher in patients with PAD compared with those without (8.23% versus 4.87%; adjusted odds ratio [aOR], 1.25 [95% CI, 1.19-1.31]). Increased mortality persisted across age groups (<65 years: aOR, 1.42; ≥65 years: aOR, 1.18) and AMI type (non-ST-segment-elevation MI: aOR, 1.14; ST-segment-elevation MI: aOR, 1.46), with significant interactions by both age and AMI type. Among revascularized patients, mortality was elevated in those with PAD (aOR, 1.49). PAD was associated with increased rates of major bleeding (aOR, 1.23), particularly among revascularized patients (aOR, 1.31), as well as cardiac arrest, shock, heart failure, stroke, and new dialysis.</p><p><strong>Conclusions: </strong>PAD was independently associated with markedly worse in-hospital outcomes in AMI, highlighting the need for risk mitigation strategies in this high-risk population.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040526"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267923","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":"Decades of Shifting Trends: Arrhythmia-Related Mortalities in the United States (1968-2021) With 2040 Projections.","authors":"Mohammed Mhanna, Ahmad Al-Abdouh, Ashraf Alzahrani, Ahmad Jabri, Abdulmajeed Al-Harbi, Azizullah Beran, Mahmoud Barbarawi, Shareef Mansour, Paari Dominic","doi":"10.1161/JAHA.124.039615","DOIUrl":"10.1161/JAHA.124.039615","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmias are a significant public health concern, and understanding their evolving patterns is vital for informed health care planning. This study explores trends and disparities in arrhythmia-related mortality rates in the United States from 1968 to 2021, projecting up to 2040.</p><p><strong>Methods: </strong>We examined national death records for cardiovascular deaths linked to arrhythmia among individuals aged 15 to 84 years, using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research. Age-adjusted mortality rates (AAMRs) were calculated, and trends were evaluated. Subgroup analyses were conducted on the basis of arrhythmia subtypes, age, sex, race, and geographic regions. AAMRs for 2040 were projected using Autoregressive Integrated Moving Average forecasting.</p><p><strong>Results: </strong>Overall AAMRs increased from 1968 to 2021, peaking in 1988 before declining, then slightly increasing after 2006. Atrial fibrillation- or flutter-related fatalities surpassed cardiac arrest-related deaths after 2006. Sex disparities decreased, with men maintaining higher crude mortality rates, but the gap narrowed. Younger populations witnessed an upward trend in AAMRs after 2006. Racial disparities persisted, with Black populations experiencing higher AAMRs than White populations.</p><p><strong>Conclusions: </strong>This study provides insights into evolving arrhythmia-related death. While overall AAMRs may stabilize by 2040, the projected rise in atrial fibrillation-related deaths, particularly among younger populations, necessitates further investigation. Additional research is needed to determine whether this trend reflects a true epidemiologic shift or improvements in detection and reporting. Furthermore, identifying underlying risk factors and developing targeted interventions will be crucial in mitigating AF-related death in younger adults. Persistent racial disparities underscore the importance of equitable health care strategies.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039615"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267851","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":"Prenatal Per- and Polyfluoroalkyl Substance Exposures and Longitudinal Blood Pressure Measurements in Children Aged 3 to 18 Years: Findings From a Racially and Ethnically Diverse US Birth Cohort.","authors":"Zeyu Li, Guoying Wang, Xiumei Hong, Tammy M Brady, Colleen Pearson, Jessie P Buckley, Xiaobin Wang, Mingyu Zhang","doi":"10.1161/JAHA.124.039949","DOIUrl":"10.1161/JAHA.124.039949","url":null,"abstract":"<p><strong>Background: </strong>Prenatal per- and polyfluoroalkyl substance (PFAS) exposures may influence offspring blood pressure (BP), but long-term studies in diverse populations remain limited.</p><p><strong>Methods: </strong>Participants were from the Boston Birth Cohort. We measured PFAS in maternal plasma collected 24 to 72 hours after delivery and extracted children's BP from medical records. We calculated age-, sex-, and height-specific BP percentiles and defined elevated BP as systolic/diastolic BP ≥90th percentile (ages 3 to <13 years) or ≥120/80 mm Hg (ages 13 to <18 years). We used adjusted mixed-effects linear and modified Poisson models to examine associations of PFAS with BP percentiles and elevated BP. We used linear spline mixed-effects models to predict BP trajectories at ages 3 to 18 years by PFAS levels.</p><p><strong>Results: </strong>We included 13 404 BP measurements from 1094 children (median follow-up: 12 years [interquartile range, 9-15 years]; 61% Black and 22% Hispanic). Overall, higher perfluorodecanoic acid (PFDeA), perfluorononanoic acid (PFNA), and perfluoroundecanoic acid (PFUnA) were associated with higher systolic BP percentile. The associations differed by child life stage, sex, race and ethnicity. For example, associations of PFDeA with systolic BP percentile were stronger in older (β_3-5y=0.40; β_6-12y=1.06; β_13-18y=2.55), male (β_male=1.51; β_female=0.52), and Black (β_Black=1.75; β_Hispanic=0.45) children. In male children, each doubling of perfluoroheptanesulfonic acid (PFHpS) was associated with a 9% higher risk of elevated BP at ages 6 to 12 years and a 17% higher risk at 13 to 18 years, with no increased risk at 3 to 5 years. PFHpS was associated with a dose-dependent divergence in BP trajectories beginning at age 13 years.</p><p><strong>Conclusions: </strong>Prenatal exposures to certain PFAS were associated with offspring BP, with stronger associations in adolescents, male children, and Black children. Prenatal PFAS exposures may have intergenerational, long-term, and latent hypertensive effects.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039949"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287045","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 Rate-Control and Antiarrhythmic Medication Use and Risk of Ischemic Stroke and Death in Patients on Dialysis With Atrial Fibrillation.","authors":"Benjamin Lidgard, Dongjie X Fan, Leila R Zelnick, Jaejin An, Teresa N Harrison, Ming-Sum Lee, Daniel Singer, Grace H Tabada, Alan S Go, Nisha Bansal","doi":"10.1161/JAHA.124.038511","DOIUrl":"10.1161/JAHA.124.038511","url":null,"abstract":"<p><strong>Background: </strong>Incident atrial fibrillation (AF) is common among adults with kidney failure treated with maintenance dialysis and is associated with poor clinical outcomes. Limited data exist informing treatment of AF among patients on dialysis. We aimed to describe the use of rate-control and antiarrhythmic medications for AF among patients on dialysis and associations of these medication use strategies with stroke and all-cause death.</p><p><strong>Methods: </strong>We evaluated patients on dialysis with incident AF between 2010 and 2017 in the Kaiser Permanente Northern and Southern California integrated health care delivery systems. We characterized time-updated <i>incident</i> receipt of rate-control (β blockers, calcium channel blockers, and digoxin) and antiarrhythmic medications from pharmacy databases. We evaluated associations of these therapies with the composite outcome of ischemic stroke and all-cause death using Cox regression, adjusting for potential confounders.</p><p><strong>Results: </strong>Of 2100 patients, 44.0% were newly prescribed rate-control medications, 4.6% were prescribed antiarrhythmic medications, 8.9% were prescribed both, and 42.9% were prescribed neither within 12 months of newly diagnosed AF. During a median 1.66 (interquartile range, 0.45-3.39) years, we observed 1406 composite events (stroke and death). Time-updated use of antiarrhythmics alone (adjusted hazard ratio [HR], 0.74 [95% CI, 0.57-0.96]) or with rate-control (adjusted HR, 0.72 [95% CI, 0.58-0.90]) was associated with lower stroke or death risk versus neither medication. Use of rate-control medications alone was not significantly associated with the composite outcome.</p><p><strong>Conclusions: </strong>Among patients on dialysis with incident AF, use of antiarrhythmic medications may be associated with lower risk of stroke and death. Future randomized trials are needed to determine the efficacy and safety of antiarrhythmic medications in this high-risk population.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038511"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303588","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 Genetic Variants With Rivaroxaban Pharmacokinetics and Pharmacodynamics and Hemorrhage Risk Factors in Patients With Venous Thromboembolism.","authors":"Hui Li, Xiaoshuang He, Yingyun Guan, Qiuya Lu, Jie Fang, Xiaolan Bian","doi":"10.1161/JAHA.124.040698","DOIUrl":"10.1161/JAHA.124.040698","url":null,"abstract":"<p><strong>Background: </strong>Rivaroxaban is a first-line agent for venous thromboembolism prophylaxis and treatment. However, its pharmacokinetics, pharmacodynamics, and bleeding risk exhibit significant interindividual variability. Known nongenetic factors alone cannot fully explain this variability, and the impact of genetic polymorphisms remains debated.</p><p><strong>Methods: </strong>From December 29, 2021, to May 11, 2023, 310 patients with venous thromboembolism treated with rivaroxaban were enrolled in this observational study from a tertiary hospital in Shanghai, China, based on predefined criteria. We assessed relationships between rivaroxaban concentrations, anti-Factor Xa levels, and coagulation parameters; examined the impact of 12 genes on concentrations and anti-Factor Xa levels; and followed up for at least 3 months to identify bleeding risk factors.</p><p><strong>Results: </strong>Rivaroxaban plasma concentration was significantly related to anti-Factor Xa levels (R²=0.697), activated partial thromboplastin time (R²=0.134), prothrombin time (R²=0.123), and international normalized ratio (R²=0.116). Peak concentrations were associated with <i>cytochrome p450</i><i>3A5</i> (rs776746, <i>P</i>=0.023), <i>sushi domain-containing protein 3</i> ( rs76292544, <i>P</i>=0.034), and <i>ATP-binding cassette subfamily G member 2</i> ( rs1045642, <i>P</i>=0.012); trough concentrations were linked to <i>cytochrome p450</i><i>3A5</i> (rs776746, <i>P</i>=0.045), <i>sushi domain-containing protein 3</i> (rs76292544, <i>P</i>=0.014), and <i>ATP-binding cassette subfamily G member 2</i> (rs2231142, <i>P</i>=0.029); peak anti-Factor Xa levels were associated with <i>aldo-keto reductase family 7 member A3</i> (rs1738023, <i>P</i>=0.022; rs1738025, <i>P</i>=0.035) and <i>ATP-binding cassette subfamily A member 6</i> (rs7212506, <i>P</i>=0.044). However, these genetic associations were not significant after Bonferroni correction. Hemorrhage risk factors were anemia, pulmonary embolism, and the TT genotype of <i>sushi domain-containing protein 3</i> (rs76292544).</p><p><strong>Conclusions: </strong>Pharmacogenetic monitoring and hemorrhage risk assessment may contribute to optimize its efficacy and safety. Larger-scale, global multicenter clinical trials are required to validate the potential gene loci for testing, including <i>cytochrome p450</i><i>3A5</i> (rs776746), <i>sushi domain-containing protein 3</i> (rs76292544), <i>ATP-binding cassette transporter B1</i> (rs1045642), and <i>ATP-binding cassette subfamily G member 2</i> (rs2231124), with particular focus on <i>sushi domain-containing protein 3</i> (rs76292544).</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040698"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227638","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":"Incidence, Predictors, and Outcomes of Complete Angina Relief in Symptomatic Patients in the ISCHEMIA Trial.","authors":"Ayesha Singh, Jack C S Rodman, David L Brown","doi":"10.1161/JAHA.124.040057","DOIUrl":"10.1161/JAHA.124.040057","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic coronary disease experience less angina with revascularization plus optimal medical therapy compared with optimal medical therapy alone. However, patients may prefer to better understand their individual likelihood of complete angina relief associated with each treatment approach before selecting a strategy. We therefore sought to determine the incidence, predictors, and outcomes of complete angina relief in symptomatic patients treated with invasive management using revascularization plus optimal medical therapy or conservative therapy with optimal medical therapy alone in the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial.</p><p><strong>Methods: </strong>Angina was assessed using the Seattle Angina Questionnaire Angina Frequency (AF) score. We analyzed patients in the invasive management treatment arm with angina at baseline (Seattle Angina Questionnaire Angina Frequency <100) who underwent revascularization and all patients in the conservative therapy arm with angina at baseline. The primary outcome was angina status at 12 months defined as a Seattle Angina Questionnaire Angina Frequency=100 (complete angina relief) or Seattle Angina Questionnaire Angina Frequency <100 (persistent angina). The association of angina status with the composite of cardiovascular death/myocardial infarction was assessed at 5 years.</p><p><strong>Results: </strong>Among 1376 patients in the conservative therapy arm with angina at baseline, 50% experienced complete angina relief at 12 months. Independent predictors included older age, male sex, recent angina onset, and less baseline angina. Among 1158 patients who underwent revascularization, 70% achieved complete angina relief. Predictors included younger age, nonsmoking, coronary artery bypass graft, and less baseline angina. Cardiovascular death/myocardial infarction rates at 5 years did not differ between patients with or without complete angina relief.</p><p><strong>Conclusions: </strong>Complete angina relief at 12 months in symptomatic patients with chronic coronary disease was achieved in 70% of patients undergoing revascularization and 50% of patients treated ith conservative therapy and did not influence cardiovascular death/myocardial infarction outcomes.</p><p><strong>Registration: </strong>https://ischemiatrial.org/; ISCHEMIA Trial. Accession Number HLB02742323a.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040057"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235962","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":"Stroke Mortality Risk Factors: Global Trends and Regional Variations (1990-2021).","authors":"Dengpan Song, Dingkang Xu, Kaiyuan Zhang, Yuanhao Lou, Yan Du, Yuan An, Ahmed Badr, Daniele Rigamonti, David Cistola, Dongming Yan, Jun Zhang, Fuyou Guo","doi":"10.1161/JAHA.125.042107","DOIUrl":"10.1161/JAHA.125.042107","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a major global health challenge, affected by many risk factors. This study aimed to analyze the risk factors for death induced by 3 primary stroke subtypes from 1990 to 2021 by using data from the Global Burden of Disease 2021 database.</p><p><strong>Methods: </strong>We examine the risk factors for death induced by 3 stroke subtypes: ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The sociodemographic index (SDI) measures the impact of socioeconomic development on disease burden. Age-standardized death rates and estimated annual percentage changes were calculated to analyze trends.</p><p><strong>Results: </strong>In 2021, the global mortality rates of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were substantial, with age-standardized death rates of 44.18, 39.09, and 4.18 per 100 000 people, respectively. The risk factors for stroke-induced death varied on the basis of region, age, and sex, with stronger impacts observed in low-SDI regions, among older individuals, and among men. Although most of the observed risk factors are decreasing globally, this trend is more pronounced in high-SDI regions. Notably, household air pollution from solid fuels remains a significant issue in low-SDI regions. High systolic blood pressure is the strongest risk factor for all stroke types, with the burden increasing rapidly among older adults. High body mass index and ambient particulate matter pollution are exhibiting increasing age-standardized death rates, particularly in middle- and low-SDI regions.</p><p><strong>Conclusions: </strong>In the future, preventive measures against stroke-induced mortality should focus on low-SDI regions, older individuals, and men. Controlling high blood pressure and improving the environment will greatly reduce the burden of stroke.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042107"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227645","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}