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Despite the detailed imaging information provided by optical coherence tomography (OCT) during percutaneous coronary intervention (PCI), clinical benefits of this imaging technique in this setting remain uncertain. The aim of the OCCUPI trial was to compare the clinical benefits of OCT-guided versus angiography-guided PCI for complex lesions, assessed as the rate of major adverse cardiac events at 1 year.

Dual antiplatelet therapy (DAPT) for 12 months is the standard of care after coronary stenting in patients with acute coronary syndrome (ACS). The aim of this individual patient-level meta-analysis was to summarise the evidence comparing DAPT de-escalation to ticagrelor monotherapy versus continuing DAPT for 12 months after coronary drug-eluting stent implantation.

IMPORTANCE: Among patients undergoing percutaneous coronary intervention (PCI), it remains unclear whether the treatment efficacy of P2Y12 inhibitor monotherapy after a short course of dual antiplatelet therapy (DAPT) depends on the type of P2Y12 inhibitor. OBJECTIVE: To assess the risks and benefits of ticagrelor monotherapy or clopidogrel monotherapy compared with standard DAPT after PCI. DATA SOURCES: MEDLINE, Embase, TCTMD, and the European Society of Cardiology website were searched from inception to September 10, 2023, without language restriction. STUDY SELECTION: Included studies were randomized clinical trials comparing P2Y12 inhibitor monotherapy with DAPT on adjudicated end points in patients without indication to oral anticoagulation undergoing PCI. DATA EXTRACTION AND SYNTHESIS: Patient-level data provided by each trial were synthesized into a pooled dataset and analyzed using a 1-step mixed-effects model. The study is reported following the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data. MAIN OUTCOMES AND MEASURES: The primary objective was to determine noninferiority of ticagrelor or clopidogrel monotherapy vs DAPT on the composite of death, myocardial infarction (MI), or stroke in the per-protocol analysis with a 1.15 margin for the hazard ratio (HR). Key secondary end points were major bleeding and net adverse clinical events (NACE), including the primary end point and major bleeding. RESULTS: Analyses included 6 randomized trials including 25 960 patients undergoing PCI, of whom 24 394 patients (12 403 patients receiving DAPT; 8292 patients receiving ticagrelor monotherapy; 3654 patients receiving clopidogrel monotherapy; 45 patients receiving prasugrel monotherapy) were retained in the per-protocol analysis. Trials of ticagrelor monotherapy were conducted in Asia, Europe, and North America; trials of clopidogrel monotherapy were all conducted in Asia. Ticagrelor was noninferior to DAPT for the primary end point (HR, 0.89; 95% CI, 0.74-1.06; P for noninferiority = .004), but clopidogrel was not noninferior (HR, 1.37; 95% CI, 1.01-1.87; P for noninferiority > .99), with this finding driven by noncardiovascular death. The risk of major bleeding was lower with both ticagrelor (HR, 0.47; 95% CI, 0.36-0.62; P < .001) and clopidogrel monotherapy (HR, 0.49; 95% CI, 0.30-0.81; P = .006; P for interaction = 0.88). NACE were lower with ticagrelor (HR, 0.74; 95% CI, 0.64-0.86, P < .001) but not with clopidogrel monotherapy (HR, 1.00; 95% CI, 0.78-1.28; P = .99; P for interaction = .04). CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis found that ticagrelor monotherapy was noninferior to DAPT for all-cause death, MI, or stroke and superior for major bleeding and NACE. Clopidogrel monotherapy was similarly associated with reduced bleeding but was not noninferior to DAPT for all-cause death, MI, or stroke, largely because of risk observed in 1 trial that exclusively included East Asian patients and a hazard that was driven by an excess of noncardiovascular death.

IMPORTANCE: High-intensity statin is strongly recommended in patients at very high risk (VHR) of atherosclerotic cardiovascular disease (ASCVD). However, concerns about statin-associated adverse effects result in underuse of this strategy in practice. OBJECTIVE: To evaluate the outcomes of a moderate-intensity statin with ezetimibe combination in VHR and non-VHR patients with ASCVD. DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc analysis of the Randomized Comparison of Efficacy and Safety of Lipid Lowering With Statin Monotherapy vs Statin/Ezetimibe Combination for High-Risk Cardiovascular Disease (RACING) open-label, multicenter, randomized clinical trial. The study was conducted from February 2017 to December 2018 at 26 centers in Korea. Study participants included patients with documented ASCVD. Data were analyzed from April to June 2022. INTERVENTIONS: Patients were randomly assigned to moderate-intensity statin with ezetimibe (rosuvastatin, 10 mg, with ezetimibe, 10 mg) or high-intensity statin monotherapy (rosuvastatin, 20 mg). Patients at VHR for ASCVD were defined according to the 2018 American Heart Association/American College of Cardiology guidelines. MAIN OUTCOMES AND MEASURES: The primary end point was the 3-year outcome of cardiovascular death, coronary or peripheral revascularization, hospitalization of cardiovascular events, or nonfatal stroke. RESULTS: A total of 3780 patients (mean [SD] age, 64 [10] years; 2826 male [75%]) in the RACING trial, 1511 (40.0%) were categorized as VHR, which was associated with a greater occurrence of the primary end point (hazard ratio [HR], 1.42; 95% CI, 1.15-1.75). There was no significant difference in the primary end point between those who received combination therapy and high-intensity statin monotherapy among patients with VHR disease (11.2% vs 11.7%; HR, 0.96; 95% CI, 0.71-1.30) and non-VHR disease (7.7% vs 8.7%; HR, 0.88; 95% CI, 0.66-1.18). The median low-density lipoprotein cholesterol (LDL-C) level was significantly lower in the combination therapy group than in the high-intensity statin group (VHR, 1 year: 57 [47-71] mg/dL vs 65 [53-78] mg/dL; non-VHR, 1 year: 58 mg/dL vs 68 mg/dL; P < .001). Furthermore, in both the VHR and non-VHR groups, combination therapy was associated with a significantly greater mean change in LDL-C level (VHR, 1 year: −19.1 mg/dL vs −10.1 mg/dL; 2 years: −22.3 mg/dL vs −13.0 mg/dL; 3 years: −18.8 mg/dL vs −9.7 mg/dL; non-VHR, 1 year: −23.7 mg/dL vs −12.5 mg/dL; 2 years: −25.2 mg/dL vs −15.1 mg/dL; 3 years: −23.5 mg/dL vs −12.6 mg/dL; all P < .001) and proportion of patients with LDL-C level less than 70 mg/dL (VHR, 1 year: 73% vs 58%; non-VHR, 1 year: 72% vs 53%; P < .001). Discontinuation or dose reduction of the lipid-lowering drug due to intolerance occurred less frequently in the combination therapy group (VHR, 4.6% vs 7.7%; P = .02; non-VHR, 5.0% vs 8.7%; P = .001). CONCLUSIONS AND RELEVANCE: Results suggest that the outcomes of ezetimibe combination observed in the RACING trial were consistent among patients at VHR of ASCVD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03044665

Son escasos los datos sobre la duración y el impacto pronóstico del tratamiento antiagregante plaquetario doble (TAPD) tras una intervención coronaria percutánea (ICP) del tronco coronario izquierdo (TCI) con stentsfarmacoactivos de segunda generación. El objetivo de este estudio es investigar los patrones de prescripción y el efecto pronóstico a largo plazo de la duración del TAPD en pacientes sometidos a ICP del TCI con stentsfarmacoactivos segunda generación.

Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing with the rapid progression of atherosclerosis. Accurate detection by OCT of sequelae from percutaneous coronary interventions that might be missed by angiography could improve clinical outcomes. In addition, OCT has become an essential diagnostic modality for myocardial infarction with non-obstructive coronary arteries. Insight into neoatherosclerosis from OCT could improve our understanding of the mechanisms of very late stent thrombosis. The appropriate use of OCT depends on accurate interpretation and understanding of the clinical significance of OCT findings. In this Review, we summarize the state of the art in cardiac OCT and facilitate the uniform use of this modality in coronary atherosclerosis. Contributions have been made by clinicians and investigators worldwide with extensive experience in OCT, with the aim that this document will serve as a standard reference for future research and clinical application.

OBJECTIVE--Although diabetes increases the risk of cardiovascular disease (CVD) and mortality, the dose-response relationship between fasting glucose levels below those diagnostic of diabetes with cardiovascular events has not been well [...]

OBJECTIVE--The aim of this study was to determine the effect of common adiponectin gene polymorphisms on dietary intervention-mediated changes in adiponectin levels and homeostasis model assessment of insulin resistance (HOMA-IR) [...]

Drug combinations rather than increasing doses of one drug can achieve greater efficacy and lower risks. Thus, as an alternative to high-intensity statin monotherapy, moderate-intensity statin with ezetimibe combination therapy can lower LDL cholesterol concentrations effectively while reducing adverse effects. However, evidence from randomised trials to compare long-term clinical outcomes is needed.

Background: Lipoprotein-associated phospholipase [A.sub.2] (Lp-[PLA.sub.2]) is a lipoprotein-bound enzyme that can release atherogenic isoprostanes from esterified phospholipids and that may be involved in inflammation and atherosclerosis. Objective: This study investigates the association between Lp-[PLA.sub.2] activity and coronary artery disease (CAD) in relation to oxidative stress markers, in particular urinary 8-epi-prostaglandin [F.sub.2[alpha]] (8-epi-[PGF.sub.2[alpha]]). Design: We conducted a case-control study in which the crosssectional relation between Lp-[PLA.sub.2] activity, lipoproteins, and oxidative stress markers was determined in 799 patients with anglographically confirmed CAD and 925 healthy controls. Results: Lp-[PLA.sub.2] activity was significantly (P < 0.001) higher in CAD cases than in controls (32.9 [+ or -] 0.46 and 29.7 [+ or -] 0.42 nmol x [mL.sup.-1] x [min.sup.-1], respectively). Both elevated Lp-[PLA.sub.2] activity and urinary excretion concentrations of 8-epi-[PGF.sub.a[alpha]] were associated with greater CAD risk (P for trend < 0.001). Odds ratios for the upper quartiles of Lp-[PLA.sub.2] activity and 8-epi-[PGF.sub.a[alpha]]. excretion were 2.47 (95% CI: 1.79, 3.40) and 2.19 (1.52, 3.15), respectively, after adjustment for sex, age, BMI, blood pressure, smoking and alcohol consumption status, and LDL and HDL cholesterol. When we examined the additive effect of both markers for CAD risk, the relation between 8-epi-[PGF.sub.a[alpha]] and CAD was weakened above the second quartile of Lp-[PLA.sub.2] activity. Moreover, Lp-[PLA.sub.2] activity was positively correlated with urinary excretion concentrations of 8-epi-[PGF.sub.a[alpha]], in controls (r = 0.277, P < 0.001) and cases (r = 0.202, P < 0.001) and with the tail moment of lymphocyte DNA (r = 0.213, P < 0.001) in controls. Conclusion: This study shows an association of elevated Lp-[PLA.sub.2] activity with CAD risk in relation to oxidant stress and thus supports a proatherogenic role of Lp-[PLA.sub.2].

Background: The adiponectin gene is known to modulate adiponectin concentrations and diabetes mellitus development. Objective: We assessed whether adiponectin gene variants contribute to circulating adiponectin, insulin resistance (IR), or cardiovascular disease risk factors. Design: Nondiabetic subjects [n = 902; [bar.x] [+ or -] SE age: 42.5 [+ or -] 0.53 y; body mass index (BMI; in kg/[m.sup.2]): 24.7 [+ or -] 0.11] were genotyped for 2 single-nucleotide polymorphisms (SNPs), 45T [right arrow] G and 276G [right arrow] T. Results: After adjustment for age, sex, and BMI, subjects with the G allele for the SNP 276 had significantly higher concentrations of triacylglycerol and small dense LDL (sdLDL) and smaller LDL particle size than did T/T subjects. G/G subjects at SNP 276 had significantly lower plasma adiponectin and higher homeostasis model assessment (HOMA) of IR and urinary prostaglandin F2[alpha] than did T/T subjects. In the SNP 45-276 haplotype test, we also observed that subjects with the X/X haplotype had significantly higher plasma adiponectin after adjustment than did TG/TG or TG/X haplotype subjects. In the highest BMI group (BMI [greater than or equal to] 26), T/T subjects had lower HOMA-IR (P = 0.011) and higher plasma adiponectin (P = 0.026) at SNP 276 than did G/G or G/T subjects. These patterns were also seen for adiponectin in haplotype groups. However, no significant genotype effect for SNP 45T [right arrow] G was observed. Conclusions: The 276G [right arrow] T polymorphism of the adiponectin gene modulates circulating adiponectin and IR, particularly in obese states. G allele carriers also have higher oxidative stress, higher sdLDL concentrations, and smaller LDL particle size. Therefore, the presence of the G allele in the adiponectin gene at SNP 276 could be a significant contributor to higher cardiovascular disease risk in Koreans, independent of common environmental factors. KEY WORDS Adiponectin, 267G [right arrow] T, obesity, insulin resistance, cardiovascular disease risk

OBJECTIVE--Despite the popularity of coronary stenting in coronary artery disease (CAD), restenosis remains a challenging clinical problem. This study evaluated the efficacy of rosiglitazone for preventing in-stent restenosis in type [...]

Background: Apolipoprotein A5 plays an important role in modulating triacylglycerol metabolism in experimental animal models. Objective: The objective was to determine associations of the common apolipoprotein A5 gene (APOA5)--1131T [right arrow] C polymorphism with postprandial lipemic response and other cardiovascular disease risk factors in humans. Design: Healthy, nonobese subjects [n = 158; mean ([+ or -] SEM) age: 33.8 [+ or -] 1.2 y; body mass index (in kg/[m.sup.2]): 23.3 [+ or -] 0.3] were subdivided into 3 genotype groups: TT (n = 85), TC (n = 56), and CC (n = 17). We measured fasting and postprandial lipid concentrations, lipid peroxidatiom C-reactive protein concentrations, and DNA damage. Results: Fasting triacylglycerol concentrations in carriers of the C allele were higher (P < 0.05) than in carriers of the TT genotype. No other significant genotype-related differences were observed for any of the other baseline measures. After consumption of a mixed meal, carders of the C allele had significantly greater increases in total chylomicron and VLDL triacylglycerol than did subjects with the IT genotype. Moreover, carriers of the C allele had higher dense LDL, serum C-reactive protein, and urinary 8-epi-prostaglandin [F.sub.2[alpha]] concentrations and more lymphocyte DNA damage. Conversely, we did not find significant genotype-related differences in postprandial glucose, insulin, or free fatty acid measures. Conclusions: Our data confirm the genetic modulation of serum fasting triacylglycerol concentrations by the APOA5 gene polymorphism and extend this observation to postprandial triacylglycerol concentrations and to markers of oxidation and inflammation. The presence of the C allele in the APOA5 promoter region at position 1131 could be a significant factor contributing to higher cardiovascular disease risk in Koreans independently of common environmental factors. KEY WORDS Apolipoprotein A5 gene, postprandial lipid response, cardiovascular disease risk, lipid peroxidation, DNA damage, C-reactive protein

ObjectiveLeft atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to analyse the medical and invasive treatment of patients referred for LAAC in the presence of LAA thrombus.MethodsThis multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively.ResultsIAT was the preferred strategy in 57.9% of patients, with total thrombus resolution observed in 60.3% and 75.3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9.6% and 2.9%, respectively, compared with 3.8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90.5% (96.2% vs 86.3% in direct LAAC and IAT group, respectively, p=0.072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29.3% and device-related thrombosis was found in 12.8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22.5% vs 10.5% in the IAT and direct LAAC group, respectively (p=0.102).ConclusionIn the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (~10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up.

The purpose of this study is to evaluate outcomes using drug-coated balloon (DCB) in comparison with uncoated balloon as adjunctive treatment after atherectomy for femoropopliteal artery lesions.

The objective of the study was to investigate aortic remodeling and clinical outcomes after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (AD) according to timing of the procedure.

The percutaneous access site of transfemoral transcatheter aortic valve implantation (TAVI) procedures is commonly closed using a preclosure technique with suture-type closure devices. We sought to evaluate the predictors and outcomes of percutaneous closure device (PCD) failure during transfemoral TAVI.

Supplemental Digital Content is available in the text.

Intensive statin therapy reduces cardiovascular events in acute coronary syndrome. The data concerning the long-term clinical impacts of statin therapy between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) after drug-eluting stent implantation are limited. We compared the 2-year clinical outcomes between these 2 groups after statin therapy.

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

La intervención coronaria percutánea (ICP) guiada por tomografía de coherencia óptica (OCT) obtiene resultados clínicos comparables a la ICP guiada por ecografía intravascular (IVUS) en pacientes con cardiopatía isquémica estable. Escasean los estudios que comparen los resultados de ICP guiada por OCT con la guiada por IVUS en el infarto agudo de miocardio (IAM). Nuestro objetivo fue comparar los resultados de la ICP guiada por OCT frente a la guiada por IVUS en pacientes con IAM en tiempos de stentsliberadores de fármaco (SLF) de segunda generación.

Smoking is linked with increased risk of cardiovascular events among diabetic patients. Prediabetes is associated with increased risk for microvascular and macrovascular complications. We compared the 2-year clinical outcomes of current smoking between prediabetic and type 2 diabetes mellitus (T2DM) patients with acute myocardial infarction (AMI) after newer-generation drug-eluting stent (DES) implantation.

Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events.These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.

The Editors’ Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.

Currently, there exist limited data on patient outcomes following the use of drug-coated balloons (DCBs) to treat complex femoropopliteal arterial occlusive lesions. The aim of the this study is to investigate the outcomes of patient treated with DCBs and to identify the predictors of restenosis.

ObjectiveTo evaluate cardiovascular (CV) outcomes in outpatients with coronary artery disease (CAD) living alone compared with those living with others.MethodsThe prospeCtive observational LongitudinAl RegIstry oF patients with stable coronarY artery disease (CLARIFY) included outpatients with stable CAD. CLARIFY enrolled participants in 45 countries from November 2009 to July 2010, with 5 years of follow-up. Living arrangement was documented at baseline. The primary outcome was a composite of major adverse cardiovascular events (MACEs) defined as CV death, myocardial infarction (MI) and stroke.ResultsAmong 32 367 patients, 3648 patients were living alone (11.3%). After multivariate adjustment, there were no residual differences in MACE among patients living alone compared with those living with others (HR 1.04, 95% CI 0.92 to 1.18, p=0.52); however, there was significant heterogeneity in the exposure effect by sex (Pinteraction<0.01). Specifically, men living alone were at higher risk for MACE (HR 1.17, 95% CI 1.002 to 1.36, p=0.047) as opposed to women living alone (HR 0.82, 95% CI 0.65 to 1.04, p=0.1), predominantly driven by a heterogeneous effect by sex on MI (Pinteraction=0.006). There was no effect modification for MACE by age group (Pinteraction=0.3), although potential varying effects by age for MI (Pinteraction=0.046) and stroke (Pinteraction=0.05).ConclusionsLiving alone was not associated with an independent increase in MACE, although significant sex-based differences were apparent. Men living alone may have a worse prognosis from CV disease than women; further analyses are needed to elucidate the mechanisms underlying this difference.Trial registration numberISRCTN43070564.

Background As mortality due to cardiovascular disease increases throughout the world, accurate data on risk factors such as hyperlipidemia are required. This is lacking in the Asia-Pacific region.Design The observational Dyslipidemia International Study (DYSIS) II was established to quantify the extent of hyperlipidemia in adults with acute and stable coronary heart disease globally.Methods Patients with stable coronary heart disease or hospitalised with an acute coronary syndrome were enrolled across nine Asia-Pacific countries from July 2013 to October 2014. Lipid-lowering therapy and low-density lipoprotein cholesterol target attainment (<70 mg/dL) were assessed. The acute coronary syndrome cohort was followed up 4 months post-discharge.Results Of the 4592 patients enrolled, 2794 had stable coronary heart disease and 1798 were admitted with an acute coronary syndrome. In the coronary heart disease cohort, the mean low-density lipoprotein cholesterol level was 86.9 mg/dL, with 91.7% using lipid-lowering therapy and 31% achieving low-density lipoprotein cholesterol of less than 70 mg/dL. In the acute coronary syndrome cohort at admission, the corresponding values were 103.2 mg/dL, 63.4% and 23.0%, respectively. Target attainment was significantly higher in lipid-lowering therapy-treated than non-treated patients in each cohort (32.6% vs. 12.9% and 31.1% vs. 9.0%, respectively). Mean atorvastatin-equivalent dosages were low (20 ± 15 and 22 ± 18 mg/day, respectively), with little use of non-statin adjuvants (13.0% and 6.8%, respectively). Low-density lipoprotein cholesterol target attainment had improved by follow-up for the acute coronary syndrome patients, but remained low (41.7%).Conclusions Many patients in Asia at very high risk of recurrent cardiovascular events had a low-density lipoprotein cholesterol level above the recommended target. Although lipid-lowering therapy was common, it was not used to its full potential.

Background: Abnormal body fat distribution and reduced antioxidant status have been shown to be effective markers of risk of cardiovascular disease (CVD). Objective: The objective of this study was to determine the differences in body fat distribution and antioxidant status in healthy men (control subjects) and in men with CVD with or without diabetes. Design: An oral-glucose-tolerance test was performed and CVD patients were subdivided into groups according to the presence or absence of diabetes. Adipose tissue areas were calculated from computed tomography scans made at the L1 and L4 vertebrae. Fasting serum concentrations of lipids, testosterone, insulin-like growth factor I, antioxidants, and plasma homocysteine were determined. Results: There were no significant differences in mean age, body mass index (in kg/[m.sup.2]), or blood pressure between the groups. The visceral fat area at the L1 vertebra was nonsignificantly greater in CVD patients without diabetes than in control subjects, whereas it was significantly greater in CVD patients with diabetes than in control subjects at both the L1 and L4 vertebrae. Both groups of CVD patients had higher plasma concentrations of homocysteine and lower serum insulin-like growth factor I concentrations and superoxide dismutase activities than did control subjects. Serum [Beta]-carotene and lycopene concentrations were lowest in the CVD patients with diabetes. Conclusion: The concurrent presence of CVD and diabetes is associated with a greater negative effect on the risk factors typically associated with significant declines in health status. Am J Clin Nutr 2001;73:68-74. KEY WORDS Visceral fat, antioxidants, diabetes, cardiovascular disease, Korean men

Hay poca información acerca de la estrategia de tratamiento de lesiones en bifurcación en el contexto del infarto agudo de miocardio con elevación del segmento ST (IAMCEST). Este estudio comparó los resultados clínicos entre 2 estrategias de tratamiento, 1 y 2 stents, en estos pacientes con lesiones en bifurcación tratados con intervención coronaria percutánea (ICP) primaria en el contexto del IAMCEST.

La vigente guía de práctica clínica para el tratamiento de la hipercolesterolemia recomienda mantener la terapia intensiva con estatinas de los pacientes tratados con implante de stentfarmacoactivo (SFA). Sin embargo, el tratamiento intensivo con estatinas, una vez estabilizado el paciente, con frecuencia no se lleva a cabo en la práctica clínica tras la revascularización con SFA. Actualmente se desconoce el impacto de mantener esa terapia intensiva con estatinas en estos pacientes estables. Se estudia la reducción de eventos adversos en pacientes clínicamente estables en monoterapia con ácido acetilsalicílico tras el implante de un SFA según la terapia de alta o baja intensidad con estatinas.

PR interval is the period from the onset of P wave to the start of the QRS complex on electrocardiograms. A recent genomewide association study (GWAS) suggested that GAREM1was linked to the PR interval on electrocardiograms. This study was designed to validate this correlation using additional subjects and examined the function of Garem1in a mouse model. We analyzed the association of rs17744182, a variant in the GAREM1locus, with the PR interval in 5646 subjects who were recruited from 2 Korean replication sets, Yangpyeong (n = 2471) and Yonsei (n= 3175), and noted a significant genomewide association by meta-analysis (P= 2.39 × 10−8). To confirm the function of Garem1 in mice, Garem1siRNA was injected into mouse tail veins to reduce the expression of Garem1. Garem1transcript levels declined by 53% in the atrium of the heart (P= 0.029), and Garem1-siRNA injected mice experienced a significant decrease in PR interval (43.27 ms vs. 44.89 ms in control, P= 0.007). We analyzed the expression pattern of Garem1 in the heart by immunohistology and observed specific expression of Garem1 in intracardiac ganglia. Garem1 was expressed in most neurons of the ganglion, including cholinergic and adrenergic cells. We have provided evidence that GAREM1is involved in the PR interval of ECGs. These findings increase our understanding of the regulatory signals of heart rhythm through intracardiac ganglia of the autonomic nervous system and can be used to guide the development of a therapeutic target for heart conditions, such as atrial fibrillation.

ABSTRACTOxidative stress activates macroautophagy/autophagy and contributes to atherogenesis via lipophagic flux, a form of lipid removal by autophagy. However, it is not known exactly how endogenous antioxidant enzymes are involved in lipophagic flux. Here, we demonstrate that the antioxidant PRDX1 (peroxiredoxin 1) has a crucial role in the maintenance of lipophagic flux in macrophages. PRDX1 is more highly expressed than other antioxidant enzymes in monocytes and macrophages. We determined that Prdx1deficiency induced excessive oxidative stress and impaired maintenance of autophagic flux in macrophages. Prdx1-deficient macrophages had higher intracellular cholesterol mass and lower cholesterol efflux compared with wild type. This perturbation in cholesterol homeostasis was due to impaired lipophagic cholesterol hydrolysis caused by excessive oxidative stress, resulting in the inhibition of free cholesterol formation and the reduction of NR1H3 (nuclear receptor subfamily 1, group H, member 3) activity. Notably, impairment of both lipophagic flux and cholesterol efflux was restored by the 2-Cys PRDX-mimics ebselen and gliotoxin. Consistent with this observation, apoe −/−mice transplanted with bone marrow from prdx1−/−apoe−/−mice had increased plaque formation compared with apoe−/−BM-transplanted recipients. This study reveals that PRDX1 is crucial to regulating lipophagic flux and maintaining macrophage cholesterol homeostasis against oxidative stress. We suggest that PRDX1-dependent control of oxidative stress may provide a strategy for treating atherosclerosis and autophagy-related human diseases.

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Hay poca información sobre la utilidad de la ecocardiografía intravascular (IVUS) en el tratamiento de lesiones coronarias largas con stentsfarmacoactivos de segunda generación. Se evaluaron por IVUS los predictores de eventos adversos cardiovasculares mayores (MACE) a los 12 meses del implante de stentsliberadores de everolimus para el tratamiento de lesiones coronarias largas.

Monofilaments such as those consisting of polyamide (PA), polydioxanone (PDS), and poly(vinylidene fluoride) (PVDF), have been commonly used in various industries. However, most are non-biodegradable, which is unfavorable for many biomedical applications. Although biodegradable polymers offer significant benefits, they are still limited by their weak mechanical properties, which is an obstacle for use as a biomaterial that requires high strength. To overcome the current limitations of biodegradable monofilaments, a novel solid-state drawing (SSD) process was designed to significantly improve the mechanical properties of both PA and poly(l-lactic acid) (PLLA) monofilaments in this study. Both PA and PLLA monofilaments exhibited more than two-fold increased tensile strength and a highly reduced thickness using SSD. In X-ray diffraction and scanning electron microscopy analyses, it was determined that SSD could not only promote the α-crystal phase, but also smoothen the surface of PLLA monofilaments. To apply SSD-monofilaments with superior properties to cardiovascular stents, a shaped-annealing (SA) process was designed as the follow-up process after SSD. Using this process, three types of vascular stents could be fabricated, composed of SSD-monofilaments: double-helix, single-spring and double-spring shaped stents. The annealing temperature was optimized at 80 °C to minimize the loss of mechanical and physical properties of SSD-monofilaments for secondary processing. All three types of vascular stents were tested according to ISO 25539-2. Consequently, it was confirmed that spring-shaped stents had good recovery rate values and a high compressive modulus. In conclusion, this study showed significantly improved mechanical properties of both tensile and compressive strength simultaneously and extended the potential for biomedical applications of monofilaments.