Atherosclerosis最新文献

{"title":"Efficacy and safety of ongericimab in Chinese statin-intolerant patients with primary hypercholesterolemia or mixed dyslipidemia: a randomized, placebo-controlled phase 3 trial","authors":"Chunli Shao ,&nbsp;Shu Zhang ,&nbsp;Zhifeng Cheng ,&nbsp;Keping Yang ,&nbsp;Gaopin Wang ,&nbsp;Xiaoxia Shi ,&nbsp;Haibo Yang ,&nbsp;Yuan Ji ,&nbsp;Hua Li ,&nbsp;Shanchun Zhang ,&nbsp;Jinxia Ma ,&nbsp;Zhaohui Pei ,&nbsp;Yumin Zhang ,&nbsp;Yang Li ,&nbsp;Lipeng Li ,&nbsp;Yang Zheng ,&nbsp;Cong Shao ,&nbsp;Mengqi Zhang ,&nbsp;Yu Hao ,&nbsp;Yi-da Tang","doi":"10.1016/j.atherosclerosis.2025.120408","DOIUrl":"10.1016/j.atherosclerosis.2025.120408","url":null,"abstract":"<div><h3>Background and aims</h3><div>Several protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to significantly reduce low-density lipoprotein cholesterol (LDL-C) levels in statin-intolerant patients, but none have been verified in Chinese patients. This study aimed to evaluate the efficacy and safety of ongericimab, a novel PCSK9 monoclonal antibody, in Chinese statin-intolerant patients with primary hypercholesterolemia or mixed dyslipidemia.</div></div><div><h3>Methods</h3><div>This was a randomized, multicenter, double-blind, placebo-controlled phase 3 study designed to enroll 120 statin-intolerant adult patients. Eligible patients were randomly assigned in a 2:1 ratio to receive ongericimab 150 mg or placebo subcutaneously every 2 weeks for 12 weeks in the double-blind treatment period, followed by 40 weeks of ongericimab treatment during the open-label period. The primary endpoint was a percentage change in LDL-C from baseline to week 12. The key secondary endpoints included percentage change from baseline to week 12 in non-high density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (ApoB), total cholesterol (TC), and lipoprotein(a) [Lp(a)].</div></div><div><h3>Results</h3><div>From February 6, 2023, to September 23, 2024, a total of 139 patients were enrolled. The least-squares (LS) mean difference between ongericimab and placebo groups in LDL-C from baseline to week 12 was −66.2 % (95 % CI: 74.2 %, −58.2 %; p &lt; 0.0001), with reductions sustained up to week 52. Ongericimab also significantly reduced levels of non-HDL-C, ApoB, TC, and Lp(a). The overall incidence of treatment-emergent adverse events was comparable between the ongericimab and placebo groups.</div></div><div><h3>Conclusion</h3><div>Ongericimab significantly reduced LDL-C as well as other atherogenic lipid levels and was well tolerated in Chinese statin-intolerant patients with primary hypercholesterolemia or mixed dyslipidemia.</div></div><div><h3>Clinical trial registration</h3><div><span><span>http://www.clinicaltrials.gov</span><svg><path></path></svg></span>; Unique Identifier: NCT05621070.</div></div>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":"407 ","pages":"Article 120408"},"PeriodicalIF":4.9,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The flu shot and cardiovascular Protection: Rethinking inflammation in ischemic heart disease.","authors":"Ole Fröbert, Ida B Pedersen, Astrid J Hjelholt, Christian Erikstrup, Sara Cajander","doi":"10.1016/j.atherosclerosis.2025.120405","DOIUrl":"https://doi.org/10.1016/j.atherosclerosis.2025.120405","url":null,"abstract":"<p><p>Influenza infection is a well-established trigger of acute cardiovascular events, particularly myocardial infarction, mediated by systemic inflammation, endothelial dysfunction, and thrombosis. In this review, we examine the evidence supporting influenza vaccination as a preventive strategy in cardiovascular disease. Observational studies and randomized trials consistently show reduced cardiovascular event rates among vaccinated individuals, with the most pronounced benefit seen after myocardial infarction. Emerging data suggest that the effects of vaccination extend beyond infection prevention, involving immunomodulatory effects, including regulatory T cell activity, features of trained innate immunity, and mechanisms promoting resolution of inflammation. Unlike conventional anti-inflammatory therapies, vaccination appears to rebalance immune responses without compromising host defence. We also consider an evolutionary perspective, proposing that historical influenza exposure may have contributed to the genetic architecture of atherosclerosis. Taken together, current evidence positions influenza vaccination as a safe, low-cost, and biologically plausible intervention in the prevention of cardiovascular events. However, important questions remain. Whether revaccination during hospitalization provides added benefit in previously immunized individuals, and the potential of high-dose or next-generation vaccine platforms such as mRNA, warrant further study. Dedicated outcome trials conducted outside the influenza season are especially needed to clarify nonspecific cardiovascular benefits. Cardiologists and other stakeholders share a responsibility to implement existing guidelines with the same commitment given to statins and platelet inhibitors.</p>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":" ","pages":"120405"},"PeriodicalIF":4.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic determinants of blood-cell traits and the risk of cardiometabolic Diseases: Triangulating evidence from Mendelian randomization and observational analyses","authors":"Jingxian Huang ,&nbsp;Devendra Meena ,&nbsp;Alexander Smith ,&nbsp;Verena Zuber ,&nbsp;Rui Climaco Pinto ,&nbsp;Marie-Joe Dib ,&nbsp;Ioanna Tzoulaki ,&nbsp;Abbas Dehghan","doi":"10.1016/j.atherosclerosis.2025.120409","DOIUrl":"10.1016/j.atherosclerosis.2025.120409","url":null,"abstract":"<div><h3>Background and aims</h3><div>Blood cell traits (BCTs) are linked to cardiometabolic diseases (CMDs) through mechanisms such as inflammation, thrombosis, endothelial dysfunction, and lipid metabolism. BCTs could serve as readily available, cost-effective biomarkers to enhance CVD risk prediction and, if proven causal, may also emerge as novel therapeutic targets. This study examined the genetic architecture and tested potential causal relations between 29 BCTs and 20 CMDs.</div></div><div><h3>Methods</h3><div>We employed univariable Mendelian randomization (UVMR) using inverse-variance weighting as the primary method, MR-Egger and weighted-median as sensitivity analyses, and MR-PRESSO to detect pleiotropic outliers. Multivariable MR Bayesian Model Averaging (MR-BMA) was applied to prioritize the most likely causal factors. To validate findings, we conducted observational analyses among ∼0.4 million UK Biobank participants.</div></div><div><h3>Results</h3><div>UVMR demonstrated that plateletcrit is associated with cardioembolic stroke (log odds ratio [logOR_UVMR]: 2.63), a finding also prioritized by MR-BMA (marginal inclusion probability (MIP): 0.96) and supported by observational analysis (hazard ratio (HR): 1.11). We found evidence supporting a potential causal association of neutrophils and red cell distribution width with small-vessel stroke (logOR_UVMR: 0.10) and coronary artery disease (logOR_UVMR: 0.06), a finding that was further supported by observational data analyses (HR_{small-vessel stroke}: 1.22; HR_{coronary artery disease}: 1.16). Additionally, higher haemoglobin concentration was linked to lower pulse pressure (<em>θ</em>_UVMR: −0.64), with further support from MR-BMA (MIP: 0.97). Furthermore, reticulocyte indices were associated with both low-density lipoprotein cholesterol (<em>θ</em>_UVMR: 1.22) and total cholesterol (<em>θ</em>_UVMR: 1.06), and it was identified as a top-ranked risk factor for these outcomes in MR-BMA.</div></div><div><h3>Conclusions</h3><div>Our study provides supporting evidence for a potential causal effect of BCTs on CMDs, which might pave the way for novel biomarkers and therapeutic targets for precision medicine approaches.</div></div>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":"407 ","pages":"Article 120409"},"PeriodicalIF":4.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144321118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical profile of familial hypercholesterolemia phenotype in adults attended in primary care in a large healthcare area.","authors":"Teresa Gijón-Conde, José R Banegas, Carolina Ferré Sánchez, Rodrigo Alonso, Pedro Mata","doi":"10.1016/j.atherosclerosis.2025.120400","DOIUrl":"https://doi.org/10.1016/j.atherosclerosis.2025.120400","url":null,"abstract":"<p><strong>Background and aims: </strong>To examine the clinical profile and associated clinical characteristics of heterozygous Familial Hypercholesterolemia clinical phenotype (FH) in adults attended in primary care in a large health area of the Community of Madrid, Spain.</p><p><strong>Methods: </strong>Cross-sectional, multicenter study including 156,082 adults (≥18 years) from 69 health centers with at least one lipid profile between 2018 and 2021, using electronic health records (EHR). Severe hypercholesterolemia (SH) was defined as total cholesterol ≥300 mg/dL or LDL-cholesterol≥220 mg/dL and FH phenotype was defined as LDL-C ≥240 mg/dL (≥90th percentile within our study sample) or ≥160 mg/dL under lipid-lowering therapy (LLT), with triglycerides <200 mg/dL and normal TSH levels. Multivariate logistic regression was used to assess clinical associations.</p><p><strong>Results: </strong>SH was present in 6187 individuals (3.96 %), and FH phenotype in 1600 (1.03 %; mean age 60.7 years; 72.7 % women). Compared with non-FH individuals, those with FH were more often female, on LLT (97.6 % vs. 79.0 %), and had lower prevalence of diabetes, hypertension, and obesity (all p < 0.005). Women with FH were more frequently treated but less often with high/very-high intensity LLT than men (25.3 % vs. 36.6 %; p < 0.001). All treated FH patients had LDL-C >130 mg/dL (vs. 60.4 % in non-FH), with higher levels in men (178.7 vs. 170.9 mg/dL; p = 0.0015). Female sex and LLT were independently associated with FH phenotype, while age, diabetes, hypertension, and obesity were inversely associated (all p < 0.05).</p><p><strong>Conclusions: </strong>FH phenotype was identified in 1.03 %, of primary care patients. Women were more often treated but less likely to receive high-intensity or combined therapy compared to men. LDL-C levels were higher in men and intensive therapy reduced sex differences. LDL-C targets were largely unmet. EHR may aid early identification and improve preventive strategies.</p>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":" ","pages":"120400"},"PeriodicalIF":4.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenylate kinase 4 (AK4) deficiency prevents vascular smooth muscle cell phenotypic switching by regulating mitochondrial dysfunction through AMPKα inactivation.","authors":"Shu-Min Zhang, Hanshen Luo, Zuozhi Li, Mingzhao Du, Jingjie Chen, Ding-Sheng Jiang, Yuying Zhang, Chunping Li, Xuanyue Yang, Xue-Sheng Wang, Ze-Min Fang, Fu-Han Gong, Jianye Yang","doi":"10.1016/j.atherosclerosis.2025.120399","DOIUrl":"https://doi.org/10.1016/j.atherosclerosis.2025.120399","url":null,"abstract":"<p><strong>Background and aims: </strong>Mitochondrial dynamics are key mechanism regulating the conversion of vascular smooth muscle cells (VSMCs) from a contractile to a synthetic phenotype, which is involved in neointima formation and restenosis. However, the underlying mechanisms leading to mitochondrial dysfunction are not fully understood.</p><p><strong>Methods: </strong>Western blot was used to detect the expression of relevant molecules at the protein level. CCK-8, EdU assays, and transwell were used to test cell proliferation and migration capacity. Flow cytometry was used to assess cell cycle and ROS.</p><p><strong>Results: </strong>AK4 was upregulated in 10 % fetal bovine serum (FBS)- and 20 ng/mL platelet-derived growth factor-BB (PDGF-BB)-induced human aortic VSMCs (HASMCs). Knockdown of AK4 suppressed the proliferation and synthetic phenotype of HASMCs, while AK4 overexpression accelerated it. Mechanistically, AK4 interacted with protein kinase AMP-activated catalytic subunit alpha (AMPKα) and promoted the phosphorylation of AMPKα at Thr172, which reduced mitochondrial oxidative damage and improved mitochondrial function. Furthermore, activation of AMPKα by metformin or AICAR (acadesine) reversed the inhibitory effects of AK4 deficiency on HASMC phenotypic switching. Moreover, overexpression of wild-type AMPKα counteracted the effects of AK4 knockdown, whereas mutational inactivation of AMPKα (AMPKα^T172A) was not effective in reversing the effect on HASMCs.</p><p><strong>Conclusions: </strong>Our findings suggest that AK4 is a novel regulator of AMPKα activity and positively regulates VSMC dedifferentiation, proliferation, and migration. Targeted inhibition of AK4 may be a potential approach for the treatment of neointima formation and restenosis.</p>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":" ","pages":"120399"},"PeriodicalIF":4.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive imaging of individual histological carotid plaque characteristics: A diagnostic accuracy meta-analysis.","authors":"David Pakizer, Patrick Taffé, Jiří Kozel, Jolanda Elmers, Janusz Feber, Vincent Dunet, Patrik Michel, David Školoudík, Gaia Sirimarco","doi":"10.1016/j.atherosclerosis.2025.120391","DOIUrl":"https://doi.org/10.1016/j.atherosclerosis.2025.120391","url":null,"abstract":"<p><strong>Background and aims: </strong>Accurately detecting carotid plaque characteristics is crucial for identifying high-risk patients due to risk of cerebrovascular events and complications during revascularizations. Diagnostic accuracy of individual and overall carotid plaque characteristics using computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) compared to histology in patients with symptomatic/asymptomatic carotid plaques was aimed.</p><p><strong>Methods: </strong>After prospective registration on PROSPERO (CRD42022329690), Medline Ovid, Embase, Cochrane Library, and Web of Science were searched without any limitations. QUADAS-2 tool was used to study quality assessment, GRADE framework to assess evidence certainty, and univariate/bivariate random-effect meta-analyses for data analysis.</p><p><strong>Results: </strong>Of 5960 studies screened, 107 were identified, resulting in 253 diagnostic accuracy comparisons of 16 plaque characteristics (28 CT, 120 MRI, and 105 US). CT detected intraplaque hemorrhage (IPH) and lipid-rich necrotic core (LRNC) with good accuracy (86 % [95 %CI 67-95] and 84 % [72-91], respectively) and exhibited very high accuracy for ulceration (92 % [87-95]; 76 % on MRI and 75 % on US) and calcification (90 % [58-98] vs. 89 % [87-91] on MRI). MRI identified LRNC and IPH with good accuracy (86 % [81-89] and 86 % [84-88], respectively), and differentiated between acute/subacute/old IPH (accuracy >87 %). US accurately detected ruptured fibrous cap (85 % [77-91]), comparable to MRI (85 % [79-90]), but demonstrated lower performance for other characteristics. Finally, CT detected overall carotid morphology with 89 % accuracy, followed by MRI (86 %; p = 0.374 to CT), and significantly lower by US (78 %; p < 0.001).</p><p><strong>Conclusion: </strong>CT identified key plaque features, especially ulceration and calcification. MRI provided thorough plaque assessment by detecting all features and differentiating IPH age. For overall morphology, CT and MRI surpassed US accuracy.</p>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":" ","pages":"120391"},"PeriodicalIF":4.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of severe COVID-19 infection on coronary microvascular dysfunction in ANOCA patients: A cross-sectional study","authors":"Ali Aldujeli ,&nbsp;Tsung-Ying Tsai ,&nbsp;Ayman Haq ,&nbsp;Kamile Puipaite ,&nbsp;Rima Braukyliene ,&nbsp;Vacis Tatarunas ,&nbsp;Diana Zaliaduonyte ,&nbsp;Ramunas Unikas ,&nbsp;Mick Renkens ,&nbsp;Pruthvi C. Revaiah ,&nbsp;Kotaro Miyashita ,&nbsp;Akihiro Tobe ,&nbsp;Asahi Oshima ,&nbsp;Faisal Sharif ,&nbsp;Vaiva Lesauskaite ,&nbsp;John A. Spertus ,&nbsp;Scot Garg ,&nbsp;Yoshinobu Onuma ,&nbsp;Emmanouil S. Brilakis ,&nbsp;Patrick W. Serruys","doi":"10.1016/j.atherosclerosis.2025.120389","DOIUrl":"10.1016/j.atherosclerosis.2025.120389","url":null,"abstract":"<div><h3>Background and aims</h3><div>Millions of survivors from severe COVID-19 infection suffer from residual symptoms including anginal chest pain. The pathophysiological mechanisms, particularly the role of coronary microvascular dysfunction (CMD), however, remain elusive. We compared the incidence and endotypes of CMD in patients with angina without obstructive coronary artery disease (ANOCA) between those who had a history of severe COVID-19 infection (COVID group, defined as COVID patients needing supplemental oxygen therapy with SpO2 &lt; 90 % on room air), versus those who didn't (Control group).</div></div><div><h3>Methods</h3><div>This multicentre, prospective cohort study enrolled 117 ANOCA patients (COVID group n = 59, Control group n = 58). All participants underwent exercise stress testing and invasive coronary physiology assessment to measure coronary flow reserve (CFR), and the index of microvascular resistance (IMR). CMD was defined as CFR&lt;2.0 or IMR≥25. Patients also completed the modified Seattle Angina Questionnaire (SAQ-7) after invasive functional assessment.</div></div><div><h3>Results</h3><div>CMD was diagnosed in 42 patients (35.9 %): 47.5 % in the COVID group and 24.1 % in the Control group (<em>p</em> = 0.015). The prevalence of structural CMD was significantly higher in the COVID group (28.8 % vs. 5.2 %, p &lt; 0.001). The median IMR was significantly higher in the COVID versus the Control group (20.00 [15.00, 42.00] vs. 17.00 [12.00, 21.00], <em>p</em> = 0.002) while no significant differences were observed in CFR and FFR. The SAQ-7 summary scores (54.44 vs. 59.44, <em>p</em> = 0.003) and physical limitation and quality-of-life domain scores were all significantly lower in the COVID group.</div></div><div><h3>Conclusions</h3><div>The incidence of CMD, particularly structural CMD, was higher in ANOCA patients with a history of severe COVID-19 infection, suggesting a link between persistent angina and CMD in this population.</div></div>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":"407 ","pages":"Article 120389"},"PeriodicalIF":4.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between SSRI use and cardiovascular outcomes in patients with coronary artery disease and generalized anxiety disorder: A real-world cohort study","authors":"Jheng-Yan Wu ,&nbsp;Hsuan-Yuan Chang ,&nbsp;Chia-Li Kao ,&nbsp;Kuo-Chuan Hung ,&nbsp;Tsung Yu ,&nbsp;Yu-Min Lin","doi":"10.1016/j.atherosclerosis.2025.120390","DOIUrl":"10.1016/j.atherosclerosis.2025.120390","url":null,"abstract":"<div><h3>Background and aims</h3><div>Coronary artery disease (CAD) is a leading cause of cardiovascular mortality, and generalized anxiety disorder (GAD) is highly prevalent among CAD patients, worsening cardiovascular outcomes. While selective serotonin reuptake inhibitors (SSRIs) are first-line treatments for anxiety disorders, their impact on cardiovascular prognosis in patients with CAD and GAD remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized real-world data from the TriNetX database. Patients diagnosed with both CAD and GAD between 2016 and 2025 were included and categorized into SSRI users and non-users. Propensity score matching (PSM) was applied to balance baseline characteristics. The primary outcome was major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and all-cause mortality. Secondary outcomes included individual MACE components and all-cause hospitalization. Hazard ratios (HRs) were estimated using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>After 1:1 PSM, 54,526 SSRIs users and 54,526 non-users were analyzed. SSRIs use was significantly associated with a lower one-year risk of MACE (HR: 0.77, 95 % CI: 0.74–0.81, <em>p</em> &lt; 0.001). Similar protective effects were observed across secondary outcomes and subgroups, such as diabetes mellitus, obesity, dyslipidemia, and nicotine dependence. Landmark analyses confirmed consistent results. Negative control analyses showed no significant differences, minimizing bias.</div></div><div><h3>Conclusion</h3><div>SSRIs use is associated with a lower one-year MACE rate in patients with CAD and GAD. These findings highlight the potential cardiovascular benefits of SSRIs in this population. Further clinical trials are warranted to validate these results and explore long-term effects.</div></div>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":"407 ","pages":"Article 120390"},"PeriodicalIF":4.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential cardiovascular impact of ω-3 fatty acid in patients at high cardiovascular risk in Asians versus non-Asians: Sub-analysis of the strength randomized clinical trial.","authors":"Tom Kai Ming Wang, Stephen J Nicholls, Julie St John, Kathy Wolski, Steven E Nissen","doi":"10.1016/j.atherosclerosis.2025.120228","DOIUrl":"https://doi.org/10.1016/j.atherosclerosis.2025.120228","url":null,"abstract":"<p><strong>Background/aims: </strong>Racial differences in lipid and cardiovascular risk profiles are well-established, including for Asians. We compared cardiovascular treatment effects of ω-3 carboxylic acid (CA) between Asians and non-Asians in this post-hoc analysis of the STRENGTH trial.</p><p><strong>Methods: </strong>The STRENGTH trial was a double-blinded randomized controlled trial of 13,078 high cardiovascular risk patients enrolled at 675 global centers. Efficacy and interactions of ω-3 CA for Asians (n = 1355) and non-Asians (n = 11,723) were assessed. The primary endpoint is a 5-point composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularization, and unstable angina hospitalizations.</p><p><strong>Results: </strong>In Asians, ω-3 CA was associated with significantly reduction in the primary endpoint during 3.6 ± 0.7 years follow-up with 81/698 (Kaplan-Meier estimate (KME): 14.8 %) events in the ω-3 CA group, 103/657 (KME: 20.4 %) events in the corn oil group, hazard ratio (HR) 0.72, 95 %CI 0.54-0.96, p = 0.03. In non-Asians, there was not a significant difference in primary endpoint rates, 704/5841 (KME: 15.6 %) events in the ω-3 CA group, 692/5882 (KME: 15.9 %) events in the corn oil group, HR 1.03 95 %CI 0.93-1.14, p = 0.60. There were significant interactions between race (Asian vs non-Asian) and treatment group for the primary endpoint (p = 0.02) and non-fatal stroke (p = 0.02).</p><p><strong>Conclusion: </strong>In this exploratory analysis from the neutral STRENGTH trial, ω-3 CA was associated with significant reduction in the primary endpoint in Asians but not in non-Asian patients with high cardiovascular risk. Further, ideally randomized, research is necessary to assess these hypothesis-generating findings and elucidate potential mechanisms for beneficial effects of ω-3 CA in Asians.</p>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":" ","pages":"120228"},"PeriodicalIF":4.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjustment of the SMART risk score by bioactive adrenomedullin enables a more accurate prediction of mortality in patients with ASCVD","authors":"Berkan Kurt ,&nbsp;Matthias Rau ,&nbsp;Oliver Hartmann ,&nbsp;Andreas Bergmann ,&nbsp;Martin Reugels ,&nbsp;Susanne Just ,&nbsp;Florian A. Wenzl ,&nbsp;Julia Moellmann ,&nbsp;Jens Spießhöfer ,&nbsp;Andrea Milzi ,&nbsp;Kinan Kneizeh ,&nbsp;Kirsten Thiele ,&nbsp;Mathias Hohl ,&nbsp;Simina-Ramona Selejan ,&nbsp;Emiel P.C. van der Vorst ,&nbsp;Edgar Dahl ,&nbsp;Jörg Schröder ,&nbsp;Thomas F. Lüscher ,&nbsp;Nikolaus Marx ,&nbsp;Michael Lehrke ,&nbsp;Florian Kahles","doi":"10.1016/j.atherosclerosis.2025.120220","DOIUrl":"10.1016/j.atherosclerosis.2025.120220","url":null,"abstract":"<div><h3>Background and aims</h3><div>Bioactive adrenomedullin 1-52 (bio-ADM) is a novel biomarker for the assessment of endothelial function and prediction of adverse outcomes in patients with acute heart failure and cardiogenic shock. The SMART (Second Manifestations of Arterial Disease) risk score is a validated tool for risk assessment in patients with established atherosclerotic cardiovascular disease (ASCVD). Here we assessed whether bio-ADM adds incremental prognostic value to the SMART risk score in stable patients with ASCVD.</div></div><div><h3>Methods</h3><div>Circulating bio-ADM levels were measured in 452 stable patients with ASCVD. Endpoints evaluated were all-cause and cardiovascular mortality; follow up was 3 years.</div></div><div><h3>Results</h3><div>Bio-ADM was higher in non-survivors (n = 45; median 36.8 pg/mL) compared to survivors (n = 407; median 18.3 pg/mL; p &lt; 0.0001). Bio-ADM was found to be a strong predictor for all-cause mortality (Chi²: 44.58; C-index: 0.79) as well as cardiovascular death (Chi²: 33.29; C-index: 0.85) and proved to be superior to other markers including hs-Troponin T (Chi²: 7.77; C-index: 0.73) and eGFR_{CKD-EPI 2021} (Chi²: 25.10; C-index: 0.70). In multivariable analyses adjusting for age, sex, diabetes mellitus, hypertension, smoking, NT-proBNP, and eGFR_{CKD-EPI 2021}, bio-ADM remained independently associated with all-cause mortality (HR: 1.6; 95 % CI: 1.2–2.1; Chi²: 96.17; p &lt; 0.00001; C-index: 0.89) and cardiovascular death (HR: 1.7; 95 % CI: 1.1–2.5; Chi²: 57.71; p &lt; 0.00001; C-index: 0.88). Addition of bio-ADM to the SMART risk score meaningfully improved model performance in predicting mortality (SMART risk score: Chi²: 19.91; p = 0.0001; C-index: 0.69; SMART risk score + bio-ADM: Chi²: 54.51; p &lt; 0.00001; C-index: 0.81).</div></div><div><h3>Conclusions</h3><div>Bio-ADM levels are independently associated with mortality and provide incremental added value on top of the SMART risk score in stable patients with ASCVD.</div></div>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":"406 ","pages":"Article 120220"},"PeriodicalIF":4.9,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}