Kashihara K, Nakai M, Koga M
… +6 more, Handa A, Kobayashi S, Usumoto S, Yoshimura S, Toyoda K, Japan Stroke Data Bank Investigators
J Atheroscler Thromb
· 2025 Sep · PMID 40159224
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AIM: To evaluate the risk factors, location, treatment, and outcomes of stroke due to arterial dissection, we examined these characteristics in a substantial, long-standing, nationwide stroke cohort. METHODS: The study p...AIM: To evaluate the risk factors, location, treatment, and outcomes of stroke due to arterial dissection, we examined these characteristics in a substantial, long-standing, nationwide stroke cohort. METHODS: The study participants were patients with acute stroke who were registered in the Japan Stroke Data Bank between January 1999 and December 2020. We focused on patients with stroke caused by extracranial or intracranial artery dissection and examined their clinical characteristics, treatments, and outcomes. In addition, we compared the results between clinical subtypes with and without dissection. RESULTS: Among the 218,799 registered patients with acute stroke, 1,353 (0.62%) were attributed to artery dissection. Of these, 880 patients had ischemic stroke, 16 had intracerebral hemorrhage, and 457 had subarachnoid hemorrhage (SAH). Dissection cases were most prevalent among individuals in their 40s and 50s, with intracranial vertebral artery dissection being the primary cause of ischemic stroke and SAH. Male sex, dyslipidemia, diabetes mellitus, and a history of smoking were associated with a higher likelihood of ischemic stroke than SAH. Unfavorable outcomes, defined as a modified Rankin score ≥ 4 at discharge, were observed in 18.9% of ischemic stroke cases and 42.6% of SAH cases with dissection. Neurological severity and older age at admission are associated with unfavorable outcomes in patients with ischemic stroke and SAH. CONCLUSIONS: Ischemic stroke was the most frequent subtype of stroke in patients with arterial dissection, followed by SAH. Patients with stroke due to dissection were younger than those without. Neurological severity and older age at admission are substantial risk factors for unfavorable stroke outcomes due to artery dissection.
J Atheroscler Thromb
· 2025 Jun · PMID 40139842
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Recombinant tissue plasminogen activator (rt-PA), specifically alteplase, remains the standard treatment for acute cerebral infarction across all stroke subtypes. However, per recent randomized controlled trials (RCTs),...Recombinant tissue plasminogen activator (rt-PA), specifically alteplase, remains the standard treatment for acute cerebral infarction across all stroke subtypes. However, per recent randomized controlled trials (RCTs), individuals with mild cerebral infarction, medical management alone without rt-PA can yield functional outcomes comparable to those achieved with thrombolytic therapy. This has sparked ongoing debate regarding the necessity of rt-PA administration in cases of mild stroke. Nonetheless, certain individuals with mild cerebral infarction derive clear benefits from rt-PA therapy. Therefore, an individualized treatment approach should be prioritized over a uniform thrombolytic strategy in these cases. This review examines the therapeutic efficacy and limitations of rt-PA therapy for mild cerebral infarction, integrating evidence from prior clinical studies with the authors' perspectives.
Yu P, Wu DY, Fan XW
… +6 more, Tian X, Wang AX, Jiang Y, Ma WG, Zhang N, Wang CX
J Atheroscler Thromb
· 2025 Sep · PMID 40074360
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AIM: The American Heart Association (AHA) proposed Life's Essential 8 score (LE8) in 2022 as a new metric for cardiovascular health (CVH). This study investigated the association between the LE8 score and the development...AIM: The American Heart Association (AHA) proposed Life's Essential 8 score (LE8) in 2022 as a new metric for cardiovascular health (CVH). This study investigated the association between the LE8 score and the development of carotid artery plaque. METHODS: Data were drawn from the Asymptomatic Polyvascular Abnormalities Community (APAC) cohort study. In 2010, 1,938 participants without carotid plaques were recruited and followed-up until 2012. LE8 scores ranging from 0 to 100 were categorized as low (0-49), moderate (50-79), and high (80-100), whereas carotid plaques were measured using color Doppler ultrasound. A logistic analysis was used to analyze the association between the LE8 score and carotid plaque. RESULTS: During the 2-year follow up period, 350 (18.1%) patients developed new carotid plaques. The incidence of newly developed carotid plaques decreased from 27.0% in the low-LE8 group to 13.7% in the high-LE8 group (p＜0.001). Adjusted odds ratios (ORs) for plaque development were 0.65 (95% confidence interval [CI], 0.45-0.93) in the moderate-LE8 group and 0.55 (95% CI, 0.34-0.90) in the high-LE8 group compared to the low-LE8 group. Higher LE8 scores were associated with a lower risk of stable and multiple carotid plaques. CONCLUSIONS: An elevated LE8 score was associated with a lower risk of carotid plaque formation as well as plaque stability and quantity. Promoting adherence to optimal CVH levels may be beneficial in reducing the burden of carotid plaques and the risk of cardiovascular disease.
Li W, Zhang J, Han L
… +11 more, Niu H, Zhao W, Meng Y, Yin H, Sun L, Zheng M, Wang W, He X, Zhang X, Song Y, Han J
J Atheroscler Thromb
· 2025 Oct · PMID 40074359
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AIM: This study investigated the efficacy and safety of endovascular revascularization for symptomatic non-acute atherosclerotic intracranial LVO. METHODS: For non-acute atherosclerotic intracranial large vessel occlusio...AIM: This study investigated the efficacy and safety of endovascular revascularization for symptomatic non-acute atherosclerotic intracranial LVO. METHODS: For non-acute atherosclerotic intracranial large vessel occlusion (LVO), despite aggressive medical treatment, recurrent ischemic stroke or transient ischemic attack related to the occluded artery still occurs repeatedly. This retrospective cohort study included stroke patients with intracranial LVO who received endovascular treatment (EVT), categorized by successful recanalization and the time interval from symptom onset to revascularization (＜30 days vs. ≥ 30 days). The primary efficacy outcome was stroke recurrence or mortality at the 6-month follow-up. RESULTS: Of the 264 patients in the study, 229 (87%) had successful recanalization, while 35 (13%) did not. In addition, 139 patients had recanalization times ≤ 30 days, and 125 had recanalization times ＞30 days. The successful recanalization group had a significantly lower rate of stroke recurrence or death during follow-up than the unsuccessful group (9.6% vs. 31.4%, adjusted odds ratio [OR]: 4.98, 95% confidence interval [CI]: 1.86 -13.37; P = 0.001). The group with a recanalization time ≤ 30 days also demonstrated a significantly lower rate of stroke recurrence or death during follow-up than the group with a recanalization time ＞30 days (7.9% vs.17.6%, P = 0.015). In addition, the rate of a favorable prognosis (modified Rankin Scale [mRS] 0-2) during the follow-up period was significantly higher in the successful recanalization group than in the successful recanalization group (71.1% vs. 51.4%, P = 0.021). CONCLUSION: These findings suggest that successful recanalization may have therapeutic potential for patients with non-acute intracranial large-vessel occlusion, particularly for those with LVO recanalization lasting ＜30 days, who show more significant benefits than those with longer-lasting recanalization [please check this carefully].
Golledge J, Venn A, Leicht A
… +4 more, Burton N, Parmenter B, Moxon JV, BIP Investigators
J Atheroscler Thromb
· 2025 Sep · PMID 40044157
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AIMS: This post-hoc analysis from the Behavioural Intervention by allied health professionals to promote Physical activity (BIP) trial examined the relationship between depression and step count and walking capacity over...AIMS: This post-hoc analysis from the Behavioural Intervention by allied health professionals to promote Physical activity (BIP) trial examined the relationship between depression and step count and walking capacity over two years in people with peripheral artery disease (PAD). METHODS: BIP included participants with walking impairment due to PAD followed up at 4, 12 and 24 months to measure step count over 7 days using an accelerometer and six-minute walking distance. The relationships between depression at entry with step count and walking distance during follow-up were assessed using linear mixed effects models. RESULTS: At entry, 29 (14.5%) of the 200 participants had depression being treated with anti-depressant medication. Participants diagnosed with depression were more likely to be female (13 of 29, 44.8%) than those not diagnosed with depression (43 of 171, 25.1%). Over 24 months follow-up, daily step count progressively decreased in participants with depression (mean [SD] 4406 (2266) at entry to 3888 (2555) at 24 months) as compared to no change in participants without depression (mean (SD) 5271 (2526) at entry compared to 5120 (2446) at 24 months), inter-group difference p = 0.010. No significant difference in change in six-minute walking distance over 2 years was found between participants with and those without depression. CONCLUSION: Depression is associated with greater decline in self-regulated walking in patients with PAD. Effective treatments for depression are needed which help promote physical activity in people with PAD.
Yamashita S, Fujita H, Yokota D
… +2 more, Morikawa-Isogai Y, Kitamoto R
J Atheroscler Thromb
· 2025 Aug · PMID 40024737
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AIM: We evaluated the efficacy and safety of bempedoic acid, an ATP-citrate lyase inhibitor, at doses of 60, 120, and 180 mg, administered for 12 weeks in conjunction with ongoing treatments (e.g., statin and/or other li...AIM: We evaluated the efficacy and safety of bempedoic acid, an ATP-citrate lyase inhibitor, at doses of 60, 120, and 180 mg, administered for 12 weeks in conjunction with ongoing treatments (e.g., statin and/or other lipid-modifying therapy) and determined the phase 3 trial dosage in Japanese patients. METHODS: This multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 2b trial included patients with hypercholesterolemia at risk for cardiovascular events and an inadequate response to statins/statin intolerance. The percentage change in low-density lipoprotein cholesterol (LDL-C) from baseline to week 12 was calculated. RESULTS: The bempedoic acid 60 mg, 120 mg, 180 mg, and placebo groups included 47, 46, 48, and 47 patients, respectively; 79% of patients had an inadequate response to statins and 21% had statin intolerance. Relative to placebo (-1.9%), LDL-C reduction from baseline to week 12 was significantly greater in the bempedoic acid treatment groups (least squares mean: 60 mg, -10.6%; 120 mg, -21.9%; 180 mg, -21.3%; p＜0.01 vs. placebo). Patients with an inadequate response and statin intolerance who were treated with bempedoic acid showed improved LDL-C levels by week 12. The incidence of treatment-emergent adverse events was higher in the bempedoic acid-treated groups (60 mg, 57.4%; 120 mg, 54.3%; and 180 mg, 58.3%) than in the placebo group (38.3%). There was no increasing trend with increasing doses. Adverse events related to muscular and hepatic disorders were infrequent, and no new or worsening cases of diabetes were reported. CONCLUSIONS: The efficacy and safety of bempedoic acid in Japanese patients with elevated LDL-C levels were confirmed. The 180 mg dosage of bempedoic acid was found to be appropriate for a Japanese phase 3 trial.
Sasaoka M, Kakino A, Villalobos-Labra R
… +8 more, Yamashita Y, Spaans F, Joshita S, Hosoda H, Uehara T, Chen CH, Davidge ST, Sawamura T
J Atheroscler Thromb
· 2025 Sep · PMID 39993736
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AIM: Adiponectin is an anti-diabetic and anti-atherogenic protein secreted primarily from adipose tissue. Adiponectin and modified LDL (mLDL) form a complex to modulate their biological activity. To elucidate the signifi...AIM: Adiponectin is an anti-diabetic and anti-atherogenic protein secreted primarily from adipose tissue. Adiponectin and modified LDL (mLDL) form a complex to modulate their biological activity. To elucidate the significance of the complex formation, we analyzed its effects on vascular tissue and developed and verified novel quantifying methods for adiponectin. METHODS: To study the significance of the mLDL-adiponectin complex (MAC) formation, we used the wire-myography method on rat mesenteric artery. We developed a method to measure MAC by using LOX-1 as the capture protein and anti-adiponectin antibody for detection. We compared serum MAC levels between hemodialysis patients and control subjects. RESULTS: Administering mLDL alone to rat mesenteric artery impaired endothelium-dependent vasorelaxation, whereas simultaneously administering adiponectin with mLDL protected rat mesenteric artery from the mLDL-induced impairment of vasorelaxation. This finding indicates MAC formation prevents endothelium from mLDL-induced dysfunction in tissue. Using our novel ELISA for MAC, we found that MAC was increasingly detectable depending on the doses of mLDL and adiponectin in vitro. In serum, hemodialysis patients showed a significantly higher ratio of MAC-high patients (higher than the median level of MAC) than did healthy controls. Furthermore, the MAC-high hemodialysis group had lower mLDL activity measured as LOX-1 ligand containing apoB. CONCLUSION: Using our ELISA, we detected MAC in human serum that protected blood vessels from the deleterious effects of oxidized LDL.
J Atheroscler Thromb
· 2025 Sep · PMID 39971287
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AIM: The accumulation of metabolic risk factors, namely high blood pressure, hyperlipidemia, and hyperglycemia, has been associated with cardiovascular diseases. However, little evidence is available on the prognostic si...AIM: The accumulation of metabolic risk factors, namely high blood pressure, hyperlipidemia, and hyperglycemia, has been associated with cardiovascular diseases. However, little evidence is available on the prognostic significance of metabolic risk factor accumulation in nonobese individuals. This study investigated this issue by analyzing prefecture-wide health checkup and health insurance data in Japan. METHODS: We analyzed data from 366,881 adults aged 40-74 years who were enrolled in the National Health Insurance, excluding those who experienced a stroke or coronary artery diseases or required long-term care. Baseline clinical information was obtained from annual health checkup data. Incidences of stroke and coronary artery diseases were obtained from insurance data. RESULTS: In the nonobese population, the hazard ratio for stroke increased linearly with the number of accumulated metabolic risk factors, particularly among those aged ＜65 years men (one factor: 2.21, two factors: 2.60; three factors: 3.93) and women (one factor: 1.49, two factors: 1.57; three factors: 2.27). Similar results were observed in the analysis for coronary artery diseases. After excluding participants receiving medications, the association of metabolic risk factor with stroke remained significant, although its association with coronary artery disease became less significant. In the analysis for each metabolic risk factors, high blood pressure (men: hazard ratio = 2.85; women: hazard ratio = 2.17; P＜0.001), but not hyperlipidemia and hyperglycemia, was associated with stroke in the nonobese population. CONCLUSION: The accumulation of metabolic risk factors needs to be considered a risk factor for cardiovascular diseases even in individuals without obesity.
Matsunaga K, Harada-Shiba M, Yamashita S
… +8 more, Tada H, Uda A, Mori K, Yoshimura M, Inoue S, Kamae I, Yokoyama S, Minamino T
J Atheroscler Thromb
· 2025 Aug · PMID 39956559
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AIM: Screening for familial hypercholesterolemia (FH) is important for reducing the incidence of cardiovascular diseases (CVDs). Cost-effectiveness was evaluated using the Kagawa FH screening model, which is a combinatio...AIM: Screening for familial hypercholesterolemia (FH) is important for reducing the incidence of cardiovascular diseases (CVDs). Cost-effectiveness was evaluated using the Kagawa FH screening model, which is a combination of universal screening (US) in the universal health examination for children 9-10 years old conducted in Kagawa Prefecture, and reverse cascade screening (RCS) of the probands' relatives. METHODS: A lifetime simulation was conducted using mathematical models (decision tree and Markov model) to determine the cost-effectiveness of introducing a series of FH screenings (US in children + RCS in adult relatives). Only screening-related costs and direct medical costs were included, using quality-adjusted life years (QALYs) as an outcome. The costs of statins were estimated using the public health insurance claims database DeSC Healthcare, Inc. The risk of each CVD event was estimated using the same claims data and adjusted for age. We hypothesized that standard statin treatment decreases CVD risk by reducing plasma low-density lipoprotein cholesterol levels. RESULTS: A series of FH screenings (US in children + RCS in adult relatives) was cost-effective compared to no screening, with an incremental cost-effectiveness ratio (ICER) of approximately JPY 150,000 (USD 1,042)/QALY, which was below the willingness-to-pay threshold of JPY 5,000,000 (USD 34,722)/QALY for medical technology in Japan (USD 1 = JPY 144). The ICER for the US without RCS was also acceptable at approximately JPY 2,720,000 (USD 18,889)/QALY. CONCLUSION: The cost-effectiveness analysis revealed that a series of FH screenings (US in children + RCS in adult relatives) based on the Kagawa model was cost-effective.
Ehara K, Tamura Y, Takahashi H
… +9 more, Terashima M, Takahashi M, Tsurumi T, Sugimura H, Otani N, Tomoe T, Kitahara K, Sugiyama T, Yasu T
J Atheroscler Thromb
· 2025 Aug · PMID 39938904
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AIMS: Intermittent claudication is a major barrier to establishing an exercise routine in patients with peripheral artery disease (PAD). This study investigated the preconditioning effects of neuromuscular electrical sti...AIMS: Intermittent claudication is a major barrier to establishing an exercise routine in patients with peripheral artery disease (PAD). This study investigated the preconditioning effects of neuromuscular electrical stimulation (NMES) on walking capacity in patients with PAD and intermittent claudication. Additionally, it aimed to determine the optimal NMES settings and the underlying mechanisms of its effects. METHODS: A total of 15 patients with PAD (Fontaine II) participated in a crossover study. Each patient underwent 10-min sessions of NMES at two frequencies (4 and 20 Hz) and two intensities (moderate and high), plus a sham condition, before treadmill walking tests using the modified Gardner protocol. RESULTS: Pain-free walking distance significantly increased after a single session of 20 Hz high-intensity NMES (259.2±27.5 m; p＜0.05) relative to the sham group (201.9±23.6 m). The maximum walking distance also improved significantly after 4 and 20 Hz high-intensity NMES. The vascular endothelial function, assessed by flow-mediated dilation, was significantly enhanced following 20 Hz moderate- and high-intensity NMES, as well as 4 Hz high-intensity NMES, relative to the sham group. Additionally, lower extremity blood flow, as measured via transcutaneous partial pressure of oxygen, improved significantly in all NMES conditions. However, serum markers such as myeloperoxidase, hepatocyte growth factor, vascular endothelial growth factor, and CD34/CD133 progenitor cell counts did not differ significantly between the NMES and sham groups. CONCLUSION: High-intensity 20 Hz NMES is an effective preconditioning strategy for instantaneously enhancing the walking capacity in patients with PAD, likely due to nitric oxide-mediated vasodilation. These findings suggest that NMES is a promising therapeutic approach for PAD rehabilitation.
Arai H, Yamashita S, Araki E
… +6 more, Yokote K, Tanigawa R, Saito A, Furukawa D, Suganami H, Ishibashi S
J Atheroscler Thromb
· 2025 Aug · PMID 39924184
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AIMS: Long-term safety and efficacy of pemafibrate once-daily extended-release (XR) tablets, taken in morning or evening, were evaluated in dyslipidemic patients with high triglycerides (TG). METHODS: In this multicenter...AIMS: Long-term safety and efficacy of pemafibrate once-daily extended-release (XR) tablets, taken in morning or evening, were evaluated in dyslipidemic patients with high triglycerides (TG). METHODS: In this multicenter, randomized, open-label, parallel-group, phase 3 long-term study, dyslipidemic patients with high TG were randomly assigned to morning or evening administration of XR for 52 weeks. The dose was started at 0.2 mg/day and increased to 0.4 mg/day for patients having fasting serum TG ≥ 150mg/dL during treatment. The primary efficacy endpoint was percent change in fasting serum TG. RESULTS: The study enrolled 121 patients, assigning 61 to morning and 60 to evening administration. The study population included 71.1% males. Mean age was 58.5±11.1 (mean±SD) years, body mass index 27.7±4.3 kg/m, and fasting TG 264.0±109.2 mg/dL. Fasting serum TG decreased significantly from baseline to 52 weeks among patients overall and in the morning and evening groups (-45.7%, -44.8%, and -46.6%, respectively, p＜0.001 vs. baseline). The difference in least-squares mean between the morning and evening groups was 3.0%, not statistically significant. The dose was increased in 82 patients (44 morning and 38 evening), with 57.3% (95%CI 45.9, 68.2) achieving fasting serum TG ＜150 mg/dL. Adverse events occurred in 83.5% and adverse drug reactions in 19.0% but with no notable safety problems. CONCLUSIONS: Long-term, once-daily administration of XR was effective and safe in dyslipidemic patients with high TG. XR provided favorable TG-lowering effects regardless of morning or evening administration, and the XR dose increase proved effective in patients having initially inadequate response.
Higashioka M, Sakata S, Oishi E
… +6 more, Honda T, Shibata M, Hata J, Kitazono T, Osawa H, Ninomiya T
J Atheroscler Thromb
· 2025 Aug · PMID 39909456
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AIMS: To investigate the association between metabolic health status, defined by the combination of metabolic syndrome (MetS) and obesity, and cardiovascular disease (CVD) in a Japanese community. METHODS: A total of 2,8...AIMS: To investigate the association between metabolic health status, defined by the combination of metabolic syndrome (MetS) and obesity, and cardiovascular disease (CVD) in a Japanese community. METHODS: A total of 2,842 participants without prior CVD, aged 40 years or older, were followed up from 2007 until 2017. Participants were classified into 4 metabolic health statuses based on the presence of obesity (body mass index ≥ 25 kg/m) and MetS: metabolically healthy normal weight (MHN) (obesity [-] and MetS [-]), metabolically unhealthy normal weight (MUN) (obesity [-] and MetS [+]), metabolically healthy obesity (MHO) (obesity [+] and MetS [-]), and metabolically unhealthy obesity (MUO) (obesity [+] and MetS [+]). The risk estimates were computed by using a Cox hazard regression analysis. RESULTS: During the follow-up period, 190 participants developed CVD. The MUO group had a 1.94-times greater risk of developing CVD than the MHN group after adjusting for confounders, but no excess risk was observed in the MHO group. Moreover, in 1,595 participants who had undergone a health checkup in 2002, 5 years before baseline, the risk of developing CVD was 2.18-times greater in the group that transitioned from MHO to MUO and 1.75-times higher in the stable MUO group than in the stable MHN group, but was not higher in the stable MHO group. CONCLUSIONS: The present findings suggest that cardiovascular risk increases when metabolic abnormalities are present simultaneously with obesity. In individuals with obesity, it may be important to maintain metabolic health and/or lose weight to prevent CVD.
Xu X, Li W, Liu F
… +12 more, Chen C, Xie H, Wang F, Han X, Zhuang Q, Zhao X, Sun J, Yin Y, Wei P, Chen Y, Yang S, Shen C
J Atheroscler Thromb
· 2025 Aug · PMID 39909455
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AIMS: Previous studies have linked platelet-derived growth factors (PDGFs) and their receptor beta (PDGFRB) genetic variants to coronary artery disease (CAD), but their impact on major adverse cardiovascular events (MACE...AIMS: Previous studies have linked platelet-derived growth factors (PDGFs) and their receptor beta (PDGFRB) genetic variants to coronary artery disease (CAD), but their impact on major adverse cardiovascular events (MACEs) remains unclear. METHODS: A cohort study of 3139 patients with CAD followed up until December 1, 2022 (median 5.42 years), genotyped 13 tagSNPs in PDGFs/PDGFRB pathway genes to establish weighted genetic risk scores (wGRS). Multiple Cox regression models analyzed the association of SNPs and wGRS with MACE outcomes using hazard ratios (HRs) and 95% confidence intervals (CIs). The wGRS improvement on traditional risk factors (TRFs) and the Global Registry of Acute Coronary Events (GRACE) score for MACEs were assessed using the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS: Compared to low MACE-GRS (Q1 of quintile), high MACE-GRS (Q5 of quintile) had an increased risk of MACEs, with an adjusted HRs of 1.441 (P = 0.006). Compared to the TRF prediction model, the addition of MACE-GRS showed an improved discrimination with an NRI of 5.1% (95% CI, 0.7%-9.5%, P＜0.001) and IDI of 0.3% (95% CI, 0.0%-0.6%, P＜0.001). In addition, compared to the TRFs and GRACE score model, the addition of MACE-GRS showed an improved discrimination with an NRI of 5.1% (95% CI, 0.7%-9.6%, P＜0.001) and IDI of 0.3% (95% CI, 0.0%-0.5%, P＜0.001). CONCLUSIONS: Variants in the PDGF-PDGFRB pathway genes contribute to the risk of MACEs after CAD, and the wGRS might be able to serve as a risk predictor of MACEs in addition to TRFs.
Komiyama C, Kuwabara M, Harima A
… +3 more, Kanie T, Yamaguchi T, Kodama T
J Atheroscler Thromb
· 2025 Apr · PMID 39894471
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Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality worldwide, including in Japan, where the aging population intensifies its impact. This review evaluated the potential impa...Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality worldwide, including in Japan, where the aging population intensifies its impact. This review evaluated the potential impact of digital healthcare on the prevention and management of ASCVD, covering both primary and secondary prevention strategies. Digital health tools, such as risk assessment applications remote monitoring, lifestyle modification support, and remote rehabilitation, have shown promise in improving patient engagement, adherence, and outcomes. However, while digital health interventions demonstrate significant benefits, challenges persist, including interoperability issues, privacy concerns, low digital literacy among older adults, and limited health insurance coverage for digital interventions. Through an analysis of recent advancements and case studies, this review demonstrates the need for user-centered design, enhanced regulatory frameworks, and expanded insurance support to facilitate the effective integration of digital health in ASCVD care. Furthermore, emerging technologies such as personalized healthcare modules offer promising directions for tailored and impactful care. Addressing these barriers is critical to unleashing the full potential of digital healthcare to reduce the burden of ASCVD and enhance patient outcomes.
Michikawa T, Nishiwaki Y, Asakura K
… +13 more, Okamura T, Takebayashi T, Hasegawa S, Milojevic A, Minami M, Taguri M, Takeuchi A, Ueda K, Sairenchi T, Yamagishi K, Iso H, Irie F, Nitta H
J Atheroscler Thromb
· 2025 Aug · PMID 39864858
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AIMS: Long-term exposure to fine particulate matter (PM) is causally associated with mortality and cardiovascular disease. However, in terms of cardiovascular cause-specific outcomes, there are fewer studies about stroke...AIMS: Long-term exposure to fine particulate matter (PM) is causally associated with mortality and cardiovascular disease. However, in terms of cardiovascular cause-specific outcomes, there are fewer studies about stroke than about coronary heart disease, particularly in Asia. Furthermore, there remains uncertainty regarding the PM-respiratory disease association. We examined whether long-term exposure to PM is associated with all-cause, cardiovascular and respiratory disease mortality in Japan. METHODS: We used data of 46,974 participants (19,707 men; 27,267 women), who were enrolled in 2009 and followed up until 2019, in a community-based prospective cohort study (the second cohort of the Ibaraki Prefectural Health Study). We estimated PM concentrations using the inverse distance weighing methods based on ambient air monitoring data, and assigned each participant to administrative area level concentrations. A Cox proportional hazard model was applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality. RESULTS: During the average follow-up of 10 years, we confirmed 2,789 all-cause deaths. All outcomes including stroke mortality did not significantly increase as the PM concentration increased. For non-malignant respiratory disease mortality, the multivariable adjusted HR per 1 µg/m increase in the PM concentration was 1.09 (95% CI = 0.97-1.23). CONCLUSIONS: In this population exposed to PM at concentrations of 8.3-13.1 µg/m, there was no evidence that long-term exposure to PM had adverse effects on mortality. Weak evidence of positive association observed for non-malignant respiratory disease mortality needs further studies in other populations.