Journal of the American Heart Association最新文献

{"title":"Trimetazidine Is Associated With Ameliorated Stroke Risk in Patients With Both Ischemic Heart Disease and Atrial Fibrillation.","authors":"Yuen-Ting Cheng, Gregory Y H Lip, Bernard M Y Cheung, Kai-Hang Yiu, Hung-Fat Tse, Yap-Hang Chan","doi":"10.1161/JAHA.125.041629","DOIUrl":"10.1161/JAHA.125.041629","url":null,"abstract":"<p><strong>Background: </strong>Myocardial ischemia is closely associated with arrhythmogenesis and prognostication in patients with atrial fibrillation (AF). Trimetazidine ameliorates myocardial ischemia through prioritizing cardiomyocyte metabolism to glucose oxidation. Whether trimetazidine clinically reduces stroke risk in patients with ischemic heart disease and AF was unknown.</p><p><strong>Methods: </strong>We recruited patients with ischemic heart disease from the Hong Kong Clinical Data Analysis and Reporting System between January 1, 1999 and December 31, 2020. Patients with comorbid AF were identified, and those with a history of prior stroke were excluded. Trimetazidine users and nonusers (with long-acting nitrates as the control) were compared for the primary end point of incident ischemic stroke using Cox proportional regression, with and without propensity matching.</p><p><strong>Results: </strong>The primary analysis included 12 527 patients with ischemic heart disease and preexisting AF (mean age, 77.5±10.3 years; 44.6% men), who were further categorized as trimetazidine users (n=960) versus nonusers (n=11 567). Over a follow-up period of 1133 (interquartile range, 442-2454) days, 2160 patients (17.2%) developed new-onset ischemic stroke. Trimetazidine use was independently associated with a lower risk of new-onset ischemic stroke (hazard ratio [HR], 0.55 [95% CI, 0.44-0.68]; <i>P</i><0.001). Propensity score-matched analyses revealed similar findings (adjusted HR, 0.65 [95% CI, 0.52-0.80]; <i>P</i><0.001). Furthermore, trimetazidine was also independently associated with a lower risk of recurrent ischemic stroke (HR, 0.51 [95% CI, 0.37-0.69]; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Treatment with trimetazidine is associated with a lower risk of incident and recurrent stroke in patients with both ischemic heart disease and AF. These findings will need to be confirmed in randomized controlled trials.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041629"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193572","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":"Blood Pressure and Cardiovascular Outcomes in Adults With Diabetes and Chronic Kidney Disease.","authors":"Hyeok-Hee Lee, Jong Hyun Jhee, Eun-Jin Kim, Dasom Son, Hyeon Chang Kim, Daichi Shimbo, Hokyou Lee","doi":"10.1161/JAHA.125.042966","DOIUrl":"10.1161/JAHA.125.042966","url":null,"abstract":"<p><strong>Background: </strong>Current hypertension guidelines recommend intensive blood pressure (BP) targets (eg, <130/80 mm Hg) for patients with diabetes and chronic kidney disease. However, data supporting these recommendations are limited.</p><p><strong>Methods: </strong>From Korean nationwide health screening and claims data, we identified 373 966 adults with both diabetes and chronic kidney disease who (1) underwent a baseline health examination in 2009 to 2013; (2) had ≥3 BP-measuring visits during a 5-year look-back period; and (3) did not have prior cardiovascular disease (CVD). The mean of all BPs measured throughout the look-back period was used for the analysis. The primary outcome was CVD event, defined as a composite of myocardial infarction, stroke, heart failure, or death from CVD.</p><p><strong>Results: </strong>Over a median follow-up of 10.2 years, 40 781 CVD events occurred. When using systolic BP 130 to <140 mm Hg as the reference, multivariable-adjusted hazard ratios (HRs) for CVD event in the systolic BP ≥150, 140 to <150, 120 to <130, and <120 mm Hg groups were 1.34 (95% CI, 1.29-1.39), 1.11 (95% CI, 1.08-1.14), 0.89 (95% CI, 0.87-0.91), and 0.77 (95% CI, 0.74-0.80), respectively. When using diastolic BP 80 to <90 mm Hg as the reference, HRs in the diastolic BP ≥100, 90 to <100, 70 to <80, and <70 mm Hg groups were 1.70 (95% CI, 1.56-1.85), 1.19 (95% CI, 1.15-1.24), 0.88 (95% CI, 0.86-0.90), and 0.83 (95% CI, 0.80-0.87), respectively. Systolic BP <130 mm Hg and diastolic BP <80 mm Hg were each associated with reduced CVD risk in a log-linear pattern.</p><p><strong>Conclusions: </strong>Among patients with diabetes and chronic kidney disease, SBP <130 mm Hg and diastolic BP <80 mm Hg were associated with reduced risk of CVD.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042966"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193807","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":"Long-Term Prognostic Value of the Prognostic Nutritional Index in Patients Undergoing Coronary Artery Bypass Grafting.","authors":"Dong Hyun Gim, Seung Hun Lee, Ji Hyun Cha, Ki Hong Choi, Young Bin Song, Joo Myung Lee, Taek Kyu Park, Joo-Yong Hahn, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Dong Seop Jeong, Su Ryeun Chung, Yang Hyun Cho, Kiick Sung, Wook Sung Kim, Jeong Hoon Yang","doi":"10.1161/JAHA.125.043597","DOIUrl":"10.1161/JAHA.125.043597","url":null,"abstract":"<p><strong>Background: </strong>The Prognostic Nutritional Index (PNI) as an indicator of nutritional and immunological status has been widely applied in various medical conditions. However, its prognostic role in postoperative outcomes after coronary artery bypass grafting has not been fully elucidated. This study investigated the long-term prognostic impact of PNI for patients undergoing coronary artery bypass grafting.</p><p><strong>Methods: </strong>A total of 6626 patients who underwent coronary artery bypass grafting from 2001 to 2017 were analyzed. PNI was calculated as 10×serum albumin (g/dL)+0.005×total lymphocyte count (per mm³).</p><p><strong>Results: </strong>PNI is negatively correlated with age (<i>r</i>=-0.24, <i>P</i><0.001) and positively correlated with body mass index (<i>r</i>=0.13, <i>P</i><0.001). PNI was significantly associated with all-cause mortality during a median follow-up of 10.0 years (hazard ratio [HR], 0.96 [per 1 increase] [95% CI, 0.96-0.97]; <i>P</i><0.001). The low-PNI group (≤47, n=3956) showed a higher incidence of all-cause mortality than those with high PNI (>47, n=2670) (64.8% versus 45.5%; adjusted HR, 1.19 [95% CI, 1.09-1.30]; <i>P</i><0.001). The model including PNI showed better prognostic discrimination for predicting all-cause mortality during long-term follow-up compared with the model with only clinical variables (C index, 0.733 [95% CI, 0.721-0.745] versus 0.763 [95% CI, 0.751-0.774]; integrated discrimination improvement, 0.037 [95% CI, 0.032-0.042]; net reclassification index, 0.334 [95% CI, 0.286-0.383]; <i>P</i><0.001 for each comparison).</p><p><strong>Conclusions: </strong>Perioperative PNI was significantly associated with long-term mortality after coronary artery bypass grafting, and addition of PNI improved risk discrimination beyond conventional clinical models. Further prospective studies are warranted to validate these findings.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e043597"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193953","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":"Disparities in Access to Vascular Stroke Imaging and Carotid Revascularization: A Population Study.","authors":"Harshil Shah, Tina He, Naomi Dyck, Jillian Stang, Dana Nicol, Christiane J McIntosh, Stephen B Wilton, Shelagh B Coutts, Nishita Singh, Michael D Hill, Aravind Ganesh","doi":"10.1161/JAHA.125.043715","DOIUrl":"10.1161/JAHA.125.043715","url":null,"abstract":"<p><strong>Background: </strong>Decisions on imaging with computed tomography angiography, magnetic resonance angiography, and ultrasound in stroke or transient ischemic attack (TIA) may be influenced by factors ranging from location-based resource considerations to patient characteristics. We investigated disparities in vascular imaging utilization and carotid revascularization over 7 years in a Canadian province (Alberta, population: 4.4 million).</p><p><strong>Methods: </strong>We used provincial administrative data encompassing patients presenting to hospital or emergency/urgent-care facilities with TIA or ischemic stroke from April 1, 2016 to March 31, 2023. We related the vascular imaging received to year, age, sex, event diagnosis, comorbidities, distance to a comprehensive stroke center, region, and stroke center type using mixed-effects logistic regressions. We similarly examined disparities in imaging for recurrent events and in receipt of carotid endarterectomy/stenting.</p><p><strong>Results: </strong>Among 47 963 patients (median age, 72, interquartile range, 61-82, 47.6% female) with stroke/TIA, patients who were female, older, and experienced minor stroke/TIA (versus major stroke) had lower odds of receiving computed tomography angiography or any neurovascular imaging, as did those presenting to nonstroke centers or rural sites (eg, 35.8% rural versus 75.3% urban, adjusted odds ratio [any imaging]:0.56, 95% CI, 0.34-0.94). Odds of receiving vascular imaging increased over time, including computed tomography angiography (2016:49.1% versus 2023:79.9%, adjusted odds ratio per-year since 2015 [computed tomography angiography], 1.18 [95% CI, 1.16-1.19]). Female sex and absent neurovascular imaging carried lower odds of carotid revascularization (2.4% female versus 4.4% male, adjusted odds ratio, 0.57 [95% CI, 0.52-0.63]).</p><p><strong>Conclusions: </strong>Despite increasing utilization of neurovascular imaging, patients who are female, older, rural, or with minor stroke/TIA remain less likely to receive neurovascular imaging, with expected implications for receiving carotid revascularization. Female patients are less likely to undergo carotid revascularization even after accounting for receipt of imaging.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"eJAHA2025043715T"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088104","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":"Rationale and Design of the EPISODE Trial: A Randomized Controlled Trial on the Effect of PCSK9 Inhibitors in Calcific Aortic Valve Stenosis.","authors":"Yang Zheng, Qiuxuan Li, Yuxiu Yang, Jingyao Yang, Zaiqiang Liu, Xiaoteng Ma, Zhijian Wang","doi":"10.1161/JAHA.125.042112","DOIUrl":"10.1161/JAHA.125.042112","url":null,"abstract":"<p><strong>Background: </strong>Calcific aortic valve stenosis (CAVS) can lead to cardiac adverse outcomes; however, currently, no effective pharmacological interventions are available to prevent or delay disease progression. Emerging evidence has identified significant associations between CAVS and key biomarkers, including Lp(a) (lipoprotein [a]), low-density lipoprotein cholesterol, and PCSK9 (proprotein convertase subtilisin/kexin type 9). However, robust evidence from randomized controlled trials is still lacking to substantiate these associations.</p><p><strong>Methods: </strong>The EPISODE (Effect of PCSK9 Inhibitors on Calcific Aortic Valve Stenosis) trial is a prospective, evaluator-blinded, randomized controlled trial designed to assess the therapeutic efficacy of PCSK9 inhibitors in patients with CAVS. A total of 160 patients with mild-to-moderate or asymptomatic severe CAVS will be randomly assigned to receive either statin monotherapy or a combination of statins and PCSK9 inhibitors. Participants will undergo follow-up assessments at 3-month intervals for 24 months, including transthoracic ultrasonic cardiogram, computed tomography, and quality-of-life evaluations using the EuroQol-5 Dimension-3 Level questionnaire. The primary end point is the annualized change in peak aortic jet velocity, whereas secondary end points encompass changes in aortic valve area, calcification score, incidence of heart valve surgery, and quality of life. Safety end points include all-cause mortality and cardiovascular events.</p><p><strong>Conclusions: </strong>The trial aims to evaluate the efficacy of PCSK9 inhibitors in modulating disease progression, reducing adverse cardiovascular events, and improving clinical outcomes in patients with CAVS. The anticipated findings are expected to provide critical insights for developing novel therapeutic strategies for early intervention in CAVS.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04968509.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e042112"},"PeriodicalIF":5.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088333","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":"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}