Randomized Trial for Evaluation in Secondary Prevention Efficacy of Combination Therapy–Statin and Eicosapentaenoic Acid (RESPECT-EPA)

Circulation, Journal Year: 2024, Volume and Issue: 150(6), P. 425 - 434

Published: June 14, 2024

BACKGROUND: Low plasma levels of eicosapentaenoic acid (EPA) are associated with cardiovascular events. This trial aimed to assess the clinical benefits icosapent ethyl in patients coronary artery disease, a low EPA/arachidonic (AA) ratio, and statin treatment. METHODS: In this prospective, multicenter, randomized, open-label, blinded end-point study, stable disease EPA/AA ratio (<0.4) were randomized EPA (1800 administered daily) or control group. The primary end point was composite death, nonfatal myocardial infarction, ischemic stroke, unstable angina pectoris, revascularization. secondary points events included sudden cardiac fatal requiring emergency hospitalization revascularization, RESULTS: Overall, 3884 enrolled at 95 sites Japan. Among them, 2506 had 1249 1257 group, respectively. median 0.243 (interquartile range, 0.180–0.314) 0.235 0.163–0.310) Over period 5 years, occurred 112 1225 (9.1%) 155 1235 (12.6%) respectively (hazard 0.79 [95% CI, 0.62–1.00]; P =0.055). Meanwhile, group significantly lower (81/1225 [6.6%] versus 120/1235 [9.7%] patients; hazard 0.73 0.55–0.97]). Adverse did not differ between groups, but rate new-onset atrial fibrillation higher (3.1% 1.6%; =0.017). CONCLUSIONS: Icosapent treatment resulted numerically risk that reach statistical significance chronic REGISTRATION: URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN000012069.

Language: Английский

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Contemporary use and trends in percutaneous coronary intervention in Japan: an outline of the J-PCI registry

Cardiovascular Intervention and Therapeutics, Journal Year: 2020, Volume and Issue: 35(3), P. 218 - 226

Published: May 21, 2020

Abstract Cardiovascular interventions have achieved a level of excellence, with many outstanding advanced techniques and results. The mission the Japanese Association Intervention Therapeutics (CVIT) is to further our understanding cardiovascular intervention establish its procedural safety. [1] Percutaneous Coronary (J-PCI) registry was established sponsored by CVIT, aims provide basic statistics on performance percutaneous coronary (PCI) in Japan. Today, database has grown become one largest healthcare more than 200,000 cases registered annually from approximately 900 institutions Japan representing over 90% all PCI hospitals nation. Importantly, case registrations J-PCI are essential for interventionalist educating hospital certification. present manuscript aimed summarize history outline definitions various items.

Language: Английский

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Prevention of Cardiovascular Events with Omega-3 Polyunsaturated Fatty Acids and the Mechanism Involved

Journal of Atherosclerosis and Thrombosis, Journal Year: 2019, Volume and Issue: 27(3), P. 183 - 198

Published: Oct. 2, 2019

An epidemiological study of Greenlandic Inuit suggested that fish oil, or omega-3 polyunsaturated fatty acids (PUFA), was important in preventing atherosclerotic disease. After this landmark study, many large-scale studies and meta-analyses have examined the health benefits PUFA as part a acid-rich diet to demonstrate its beneficial roles prevention cardiovascular diseases. Recent research has also focused attention on anti-inflammatory effects specialized pro-resolving mediators. Findings these led development preparations for treatment dyslipidemia, including highly purified eicosapentaenoic acid (EPA)-ethyl ester product (Epadel

Language: Английский

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Role of coronary artery calcium score in the primary prevention of cardiovascular disease

BMJ, Journal Year: 2021, Volume and Issue: unknown, P. n776 - n776

Published: May 4, 2021

Abstract First developed in 1990, the Agatston coronary artery calcium (CAC) score is an international guideline-endorsed decision aid for further risk assessment and personalized management primary prevention of atherosclerotic cardiovascular disease. This review discusses key studies that have informed this 30 year journey, from initial plaque screening paradigm to its current role informing shared making. Special attention paid prognostic value a CAC zero (the so called “power zero”), which, context low estimated thresholds consideration preventive therapy with statins guidelines, may be used de-risk individuals thereby inform safe delay or avoidance certain therapies. We also evaluate recommendations scoring clinical practice guidelines around world, past prevailing barriers use routine patient care. Finally, we discuss emerging approaches field, focus on potential not only allocation aspirin general population, but other risk-reduction therapies special populations, such as diabetes people severe hypercholesterolemia.

Language: Английский

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Diagnosis and Management of Statin Intolerance

Journal of Atherosclerosis and Thrombosis, Journal Year: 2019, Volume and Issue: 26(3), P. 207 - 215

Published: Jan. 18, 2019

Statins are the main treatment for hypercholesterolemia and cornerstone of atherosclerotic cardiovascular disease prevention. Many patients taking statins report muscle-related symptoms, one most important causes statin discontinuation, which is associated with an increased risk events. Therefore, it to identify who truly intolerant avoid unnecessary discontinuation this beneficial treatment. Some studies indicate that not all muscle complaints caused by statins, can tolerate a upon re-challenge, down-titration dose, or switching another statin. In paper, we review definitions intolerance approaches reducing among individuals reporting statin-associated symptoms.

Language: Английский

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Febuxostat does not delay progression of carotid atherosclerosis in patients with asymptomatic hyperuricemia: A randomized, controlled trial

PLoS Medicine, Journal Year: 2020, Volume and Issue: 17(4), P. e1003095 - e1003095

Published: April 22, 2020

An elevated level of serum uric acid (SUA) is associated with an increased risk cardiovascular disease. Pharmacological intervention urate-lowering agents, such as the conventional purine analogue xanthine oxidase (XO) inhibitor, allopurinol, has been used widely for a long period time in clinical practice to reduce SUA levels. Febuxostat, novel non-purine selective inhibitor XO, higher potency inhibition XO activity and greater efficacy than allopurinol. However, evidence regarding effects febuxostat on atherosclerosis lacking. The purpose study was test whether treatment delays carotid intima-media thickness (IMT) progression patients asymptomatic hyperuricemia.The multicenter, prospective, randomized, open-label, blinded-endpoint trial undertaken at 48 sites throughout Japan between May 2014 August 2018. Adults both hyperuricemia (SUA >7.0 mg/dL) maximum IMT common artery (CCA) ≥1.1 mm screening were allocated equally using central web system receive either dose-titrated (10-60 mg daily) or control-arm, non-pharmacological lifestyle modification hyperuricemia, healthy diet exercise therapy. Of 514 enrolled participants, 31 excluded from analysis, remaining 483 people (mean age 69.1 years [standard deviation 10.4 years], female 19.7%) included primary analysis (febuxostat group, 239; control 244), based modified intention-to-treat principal. images recorded by single sonographer each site read treatment-blinded manner analyzer core laboratory. endpoint percentage change baseline 24 months mean CCA, determined covariance allocation adjustment factors (age, gender, history type 2 diabetes, SUA, CCA) covariates. Key secondary endpoints changes other ultrasonographic parameters incidence events. values (± standard deviation) CCA-IMT 0.825 ± 0.173 group 0.832 0.175 between-group difference [febuxostat - control], -0.007 [95% confidence interval (CI) -0.039 0.024 mm; P = 0.65]) baseline; 0.182 0.848 0.176 difference, -0.016 CI -0.051 0.019 0.37]) months. Compared had no significant effect 1.2% -0.6% 3.0%] (n 207) versus 1.4% -0.5% 3.3%] 193); -0.2% -2.3% 1.9%; 0.83]). Febuxostat also parameters. comparable two groups (febuxostat, 7.76 mg/dL 0.98 control, 7.73 1.04 mg/dL; 0.03 -0.15 0.21 0.75]). value significantly lower 4.66 1.27 7.28 -2.62 -2.86 -2.38 < 0.001]). Episodes gout arthritis occurred only (4 [1.6%]). There three deaths seven during follow-up. A limitation design, it not placebo-controlled trial, relatively small sample size short period, Japanese hyperuricemia.In did delay progression, compared care. These findings do support use delaying this population.University Hospital Medical Information Network Clinical Trial Registry UMIN000012911.

Language: Английский

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JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases

Circulation Journal, Journal Year: 2021, Volume and Issue: 85(4), P. 402 - 572

Published: Feb. 15, 2021

Language: Английский

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JCS/JSCVS 2018 Guideline on Revascularization of Stable Coronary Artery Disease

Circulation Journal, Journal Year: 2022, Volume and Issue: 86(3), P. 477 - 588

Published: Jan. 30, 2022

Language: Английский

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Comparison of cardiovascular outcomes between SGLT2 inhibitors in diabetes mellitus

Cardiovascular Diabetology, Journal Year: 2022, Volume and Issue: 21(1)

Published: May 18, 2022

Abstract Background There have been scarce data comparing cardiovascular outcomes between individual sodium-glucose cotransporter-2 (SGLT2) inhibitors. We aimed to compare the subsequent risk SGLT2 Methods analyzed 25,315 patients with diabetes mellitus (DM) newly taking inhibitors (empagliflozin: 5302, dapagliflozin: 4681, canagliflozin: 4411, other inhibitors: 10,921). compared risks of developing heart failure (HF), myocardial infarction (MI), angina pectoris (AP), stroke, and atrial fibrillation (AF) Results Median age was 52 years, 82.5% were men. The median fasting plasma glucose HbA1c levels 149 (Q1-Q3:127–182) mg/dL 7.5 (Q1-Q3:6.9–8.6) %. During a mean follow-up 814 ± 591 days, 855 HF, 143 MI, 815 AP, 340 139 AF events recorded. Compared empagliflozin, not significantly different in dapagliflozin, canagliflozin, SGLT For hazard ratios 1.02 (95% confidence interval [CI] 0.81–1.27), 1.08 CI 0.87–1.35), 0.88 0.73–1.07), respectively. Wald tests showed that there no significant difference among confirmed robustness these results through multitude sensitivity analyses. Conclusion for development comparable This is first study wide-range DM treated using large-scale real-world data.

Language: Английский

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Guidelines for the Diagnosis and Treatment of Pediatric Familial Hypercholesterolemia 2022

Journal of Atherosclerosis and Thrombosis, Journal Year: 2023, Volume and Issue: 30(5), P. 531 - 557

Published: Jan. 19, 2023

As atherosclerosis begins in childhood, early diagnosis and treatment of familial hypercholesterolemia (FH) is considered necessary. The basic pediatric FH (under 15 years age) based on hyper-low-density lipoprotein (LDL) cholesterolemia a family history FH; however, this guideline, to reduce overlooked cases, "probable FH" was established. Once diagnosed with or probable FH, efforts should be made promptly provide lifestyle guidance, including diet. It also important conduct an intrafamilial survey, identify members the same condition. If level LDL-C remains above 180 mg/dL, drug therapy at age 10. first-line statin. Evaluation started using non-invasive techniques, such as ultrasound. management target less than 140 mg/dL. homozygous suspected, consult specialist determine response pharmacotherapy evaluating atherosclerosis. inadequate, initiate apheresis soon possible.

Language: Английский

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