Language：Japanese   Publisher：Hypertension Research  

Pulmonary arterial hypertension (PAH) is a rare disease characterized by a progressive increase in pulmonary arterial pressure, leading to right heart failure. In clinical practice, reduced exercise tolerance is commonly observed in patients with PAH. Several studies have identified skeletal muscle abnormalities and muscle weakness as factors contributing to impaired exercise capacity in these patients. Recently, peak expiratory flow rate (PEFR) has been shown to correlate with skeletal muscle mass. Given that PEFR can be easily and noninvasively measured using respiratory function tests, we investigated the relationship between PEFR and prognosis in patients with PAH. We enrolled consecutive untreated patients diagnosed with PAH at Kagoshima University Hospital between July 2005 and July 2024. A total of 85 patients were included and divided into the preserved PEFR group and the reduced PEFR group. There were no significant differences in hemodynamic parameters between the two groups; however, the 6-minute walk distance was significantly shorter (p = 0.0062) in the reduced PEFR group. Kaplan–Meier analysis revealed that the cumulative event-free rate was significantly lower in the reduced PEFR group (Log-rank p = 0.0048). Reduced PEFR was independently associated with poorer outcomes after adjusting for age, plus each of right atrial pressure, cardiac index, and pulmonary vascular resistance. In conclusion, PEFR, a method for measuring skeletal muscle, was associated with poor prognosis in patients with PAH when assessed at the time of diagnosis. PEFR can be easily and repeatedly measured, making it potentially useful for prognostic prediction and exercise rehabilitation in these patients. (Figure presented.)

DOI： 10.1038/s41440-025-02511-6

Scopus

PubMed

Language：English   Publisher：Hypertension Research  

This subgroup analysis of the randomized, open-label, parallel-group EXCITE-HT study explored the antihypertensive efficacy and safety of esaxerenone vs trichlormethiazide in patients with type 2 diabetes mellitus (T2DM), stratified by baseline antihypertensive agent (angiotensin receptor blocker [ARB] or calcium channel blocker [CCB]) and urinary albumin-to-creatinine ratio (UACR; <30 or ≥30 mg/gCr). Using thresholds consistent with those used in the main study to interpret the difference in systolic/diastolic blood pressure (SBP/DBP), the between-group difference in least squares mean change (95% confidence interval [CI]) in morning home SBP/DBP at the end of treatment was −2.5 (−4.8, −0.2)/ − 0.7 (−2.0, 0.6) mmHg. Trends were consistent across all subgroups. The geometric mean UACR significantly decreased from baseline to Week 12 in the overall population, ARB subgroup (except for esaxerenone-treated patients), CCB subgroup, and both UACR subgroups. The overall incidence of serum potassium ≥5.5 mEq/L was 2.5% with esaxerenone and 0.9% with trichlormethiazide, with no cases of serum potassium ≥6.0 mEq/L. In this patient population, esaxerenone had a favorable safety profile, achieved blood pressure lowering similar to trichlormethiazide, and elicited a reduction of kidney damage (based on UACR), regardless of baseline antihypertensive agent or UACR. (Figure presented.)

DOI： 10.1038/s41440-025-02437-z

Scopus

PubMed

Language：Japanese   Publisher：Scientific Reports  

Mitochondrial dynamics-related RNAs during hospitalization for acute heart failure (AHF) were rarely evaluated in various points. In total, 234 patients who visited the emergency room for AHF were retrospectively evaluated. Blood samples were collected within 15 min of admission (day 1), after 48–72 h, and between days 7 and 21. Low miR-140-3p during hospitalization was defined as the level being categorized as Q1 more than once (on days 1, 3 and/or 14), and normal-140-3p during hospitalization as the level never being categorized as Q1. The median miR-140-3p levels were significantly decreased on days 3 and 14 (2.53 [1.06–6.42] and 3.65 [1.41–9.05], respectively) in comparison to the value on day 1 (6.71 [2.66–14.0]). Kaplan–Meier curves indicated that all-cause mortality within 1000 days was significantly higher in the low-miR-140-3p group than in the other-miR-140-3p group on days 1 and 14. Moreover, the survival rate was significantly lower and the rate of HF events was significantly higher in the low-miR-140-3p group than in the normal-miR-140-3p group. The miRNA levels of patients further decreased during treatment for AHF. Low levels of mitochondrial fission-related miRNAs during AHF treatment were independently associated with an increased risk of long-term adverse outcomes.

DOI： 10.1038/s41598-025-23792-4

Scopus

PubMed

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> Although metabolic dysfunction-associated fatty liver disease is typically diagnosed using ultrasonography, the fatty liver index (FLI) offers a simple alternative. Brachial-ankle pulse wave velocity (baPWV) is an established marker of arterial stiffness and a predictor of cardiovascular events. This study investigated the association between FLI and baPWV in a general Japanese population.</p><p><b><i>Methods and Results:</i></b> This cross-sectional study included participants aged ≥18 years, excluding those with atrial fibrillation, lower extremity artery disease, severe aortic stenosis, or missing data. The primary outcome was an elevated baPWV (≥1,800 cm/s). Multivariable logistic regression analysis was performed to assess the association between FLI and elevated baPWV, considering FLI both as a categorical variable (low risk: FLI <30; moderate risk: FLI ≥30 and <60; high risk: FLI ≥60) and as a continuous variable (per 10-unit increase). The analysis included 10,122 individuals (mean age 54.3 years; 55% male). In multivariable-adjusted models, the odds of elevated baPWV were significantly higher in the moderate-risk (odds ratio [OR] 1.47; 95% confidence interval [CI] 1.20–1.79) and high-risk (OR 1.78; 95% CI 1.33–2.38) groups, using the low-risk group as the reference category. Each 10-unit increase in FLI was associated with significantly higher odds of the outcome (OR 1.16; 95% CI 1.10–1.22).</p><p><b><i>Conclusions:</i></b> FLI showed a significant association with arterial stiffness in the general Japanese population.</p>

DOI： 10.1253/circrep.cr-25-0218

PubMed

CiNii Research

Language：English   Publisher：(一社)日本内科学会  

Language：Japanese   Publisher：Hypertension Research  

Mitochondria are dynamic organelles that can change their morphology. The role of these mitochondrial dynamics in cardiomyocytes remains obscure in patients with heart failure (HF). Endomyocardial biopsies were performed consecutively in 127 HF patients, and mitochondrial morphology data were obtained from 111 patients by electron microscopy. The patients were divided into three groups according to mitochondrial area quartiles (fission [Q1, area ≤ 0.119 μm², n = 27], normal [Q2/Q3, 0.120 μm² ≤ area ≤ 0.178 μm², n = 55], and fusion [Q4, area ≥ 0.179 μm², n = 28]). In the fission group, the serum N-terminal pro-brain natriuretic peptide and B-type natriuretic peptide (BNP) levels were significantly higher, and patients with HF and a reduced left ventricular ejection fraction were more common, than in the other groups. A multivariate logistic regression model showed that diabetes mellitus was independently associated with placement in the fission group (odds ratio: 2.835, 95%confidence interval [CI]: 1.037–7.752). A Kaplan–Meier curve analysis showed that the prognosis was significantly poorer in the fission group than in the other groups, and a multivariate Cox regression model revealed fission to be an independent predictor of 1500-day mortality (hazard ratio: 4.365, 95%CI: 1.198–15.909). The circulating levels of miR-140-5p (≥2500) were independently associated with the presence of mitochondrial fission (OR: 3.622, 95%CI: 1.260–10.413). Excessive mitochondrial fission was observed in patients with severe HF status, and was independently associated with adverse outcomes in HF patients. Circulating mitochondrial dynamics-related miRNA levels might be of use in detecting mitochondrial fission in the cardiomyocytes of HF patients. (Figure presented.)

DOI： 10.1038/s41440-025-02338-1

Scopus

PubMed

DOI： 10.1038/s41598-025-19217-x

Language：Japanese   Publisher：Plos One  

Background A prolonged QT interval (QTc) is associated with the development of atrial fibrillation. However, reports linking QTc variability and atrial fibrillation are limited. Purpose To investigate the relationship linking prolongation and variability of QTc with new-onset atrial fibrillation in Japanese adults. Methods This retrospective study analyzed the annual health screening data of 103,304 adults (50,438 males; mean age, 54 years) who did not exhibit atrial fibrillation at baseline between April 2005 and October 2018. The majority of the study population underwent annual health examinations according to Japan’s health welfare policy. We calculated QTc times using the Bazett formula (QTc = QT/√RR). QTc variability is indicated by the gap between the maximum and minimum QTc values. Atrial fibrillation was diagnosed by 12-lead surface electrocardiography. The association between QT prolongation and variability in new-onset atrial fibrillation was ascertained by logistic regression analysis. The strength of the association was further analyzed using multivariable analyses adjusted for sex, age, dyslipidemia, diabetes, hypertension, obesity, estimated glomerular filtration rate, and alcohol consumption. Results During the follow-up (median six years), we recorded 341 (0.3%) new atrial fibrillation cases. Univariable analysis showed a significant association between QTc prolongation and variability with new-onset atrial fibrillation (odds ratio [OR] per 10 ms, 1.08 and 1.15; 95% confidence interval [CI], 1.03–1.13 and 1.07–1.23, respectively; P<0.001). Multivariable analysis suggested increased risk of new-onset atrial fibrillation with QTc prolongation and QT variability (OR per 10 ms, 1.09 and 1.16; 95% CI, 1.04–1.14 and 1.09–1.24, respectively; P<0.001). Conclusion In the general Japanese population, QTc prolongation and large QT variability are risk factors for new-onset atrial fibrillation. QT prolongation and large QT variability during sinus rhythm may be good markers for predicting not only ventricular but also atrial arrhythmias such as atrial fibrillation.

DOI： 10.1371/journal.pone.0333169

Scopus

PubMed

Language：English   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：Journal of Cardiology Cases  

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rapidly progressive fatal cancer-related complication. Diagnosing PTTM is challenging, with most cases diagnosed postmortem. Gastric, breast, and lung cancers are the most common primary tumors associated with PTTM. To the best of our knowledge, this is the first case report of PTTM arising from an endometrial carcinoma. A patient with advanced respiratory failure and pulmonary hypertension was diagnosed with endometrial carcinoma. This case highlights the importance of suspecting PTTM in patients with pulmonary hypertension accompanied by rapidly progressive dyspnea when pulmonary embolism has been excluded. In such cases, identifying the primary cancer is crucial for establishing an appropriate treatment plan. It also emphasizes the importance of investigating systemic cancers, extending beyond the frequently encountered cancers, even in the absence of active cancer. Learning objective: Pulmonary tumor thrombotic microangiopathy (PTTM) is a rapidly fatal complication of cancer. This is the first case report of PTTM arising from an endometrial carcinoma. Clinicians should consider PTTM in patients with respiratory failure and pulmonary hypertension, even in the absence of active cancer. Early investigation for underlying malignancy and prompt pathological evaluation are essential for the rapid diagnosis of PTTM.

DOI： 10.1016/j.jccase.2025.06.013

Scopus

PubMed

DOI： 10.1253/circj.CJ-25-0098

DOI： 10.1007/s40520-025-03189-z

Language：English   Publisher：(一社)日本循環器学会  

Language：English   Publisher：(一社)インターナショナルハートジャーナル刊行会  

Language：English  

DOI： 10.25270/jic/25.00230

PubMed

Language：Japanese   Publisher：Jacc Case Reports  

Background: Transfemoral venous access is the standard for MitraClip procedures, but anatomic variations can hinder device delivery. Case Summary: An 88-year-old man with severe mitral regurgitation underwent MitraClip therapy via the right femoral vein. During the procedure, compression by a calcified right iliac artery caused severe tortuosity of the iliac vein, preventing the advancement of the steerable guide catheter. A buddy wire was introduced through a left femoral crossover approach using a Radifocus guidewire into the right iliac vein, allowing successful catheter advancement and device deployment. Discussion: This case highlights the importance of adaptive strategies to overcome anatomic challenges. The buddy wire technique allows for more controlled catheter manipulation and may have reduced the risk of venous injury. Take-Home Message: The crossover buddy wire technique may be a useful bailout strategy with only minimal additional equipment to facilitate steerable guide catheter delivery in cases of venous compression.

DOI： 10.1016/j.jaccas.2025.104570

Scopus

PubMed

Publisher：南江堂  

DOI： 10.15106/j_naika136_222

CiNii Research

Language：Japanese   Publisher：(株)南江堂  

＜文献概要＞★★★心室中隔欠損(VSD)は最も一般的な先天性心疾患の一つであり,左心系の容量負荷疾患である.★★小欠損VSDでも成人期に有意な短絡となることがあり,また大動脈弁逆流(AR)・感染性心内膜炎などの合併症の原因となる.★★修復術後の予後は良好だが,成人期に至って後に発症する合併症があるため,生涯にわたって定期的な経過観察が必要である.★★★:一般内科診療で必要な内容,★★:総合内科専門医試験レベルの内容,★:専門性の高い内容

Language：Japanese   Publisher：The Japan Geriatric Therapy Society  

<p>【Aim】 The purpose of this study was to clarify the characteristics of medication management among community-dwelling older adults with subjective memory complaints (SMC) and to examine the association between SMC and medication management. 【Methods】 A total of 690 aged 65 years or older in the community cohort study in 2019 participated. Of these, 573 who met the inclusion criteria were analyzed. Participants were divided into two groups according to the presence or absence of SMC, and associations with medication management items were analyzed using Fisher's exact test for categorical variables and the unpaired <i>t</i>-test for continuous variables. In addition, binomial logistic regression analysis was conducted with SMC as the dependent variable and medication management items as the independent variables, adjusted for demographic variables. 【Results】 Among the community-dwelling older adults in this study, 206 were in the healthy group and 367 were in the SMC group. Covariate-adjusted binomial logistic regression analysis showed that "having residual medication" (OR: 1.62, 95% CI: 1.01 to 2.59, p = 0.04) and "depressive symptoms" (OR: 1.48, 95% CI: 1.20 to 1.69, p < 0.001) were significantly associated with SMC. 【Conclusion】 The characteristics of medication management among community-dwelling older adults with SMC were significantly associated with "residual medication". Understanding the presence or absence of residual medications from the SMC stage and taking measures to address the factors that led to residual medications may help reduce the burden of caregivers in managing medications.</p>

DOI： 10.57270/jgts.2024_013_oa

CiNii Research

DOI： 10.1038/s41598-025-11229-x

Language：English   Publisher：(一社)日本循環器学会  

Language：Japanese   Publisher：(一社)日本老年療法学会  

【目的】認知症の前臨床期である主観的記憶障害(SMC)段階からの複雑なIADL評価は重要であるが,SMC段階での服薬管理状況を詳しく調べた報告は希少である。本研究では,SMCを有する地域在住高齢者の服薬管理の具体的な特徴を明らかにすることを目的とした。【方法】本研究は,横断観察研究である。2019年度における地域コホート研究に参加した65歳以上の高齢者690名のうち,除外基準に該当する者を除外した573名を解析対象とした。対象者をSMCの有無で2群に分け,服薬状況調査項目との関連について2群間比較および共変量で調整した二項ロジスティック回帰分析を行った。【結果】対象者のうち,健常群が206名,SMC群が367名であり,共変量調整した二項ロジスティック回帰分析の結果,「残薬あり」(OR:1.62,95%CI:1.01-2.59,p=0.04)と「抑うつ症状」(OR:1.48,95%CI:1.20-1.69,p<0.001)はSMCと有意に関連した。【結論】地域在住高齢者において,SMCの段階から残薬の有無を把握し,服薬管理の早期支援を行うことは,認知機能低下が進行した際に服薬管理の介護負担を軽減し,残薬問題を解消する一助になる可能性がある。(著者抄録)

DOI： 10.1097/MBP.0000000000000767

Language：Japanese   Publisher：American Journal of Cardiology  

Calcified nodules (CNs) are associated with poor prognosis after percutaneous coronary intervention (PCI) and have been reported to occur more frequently in hemodialysis patients. However, their prognosis in hemodialysis patients undergoing PCI has not been fully elucidated. We aimed to investigate the prognosis of hemodialysis patients who underwent PCI for CNs using intravascular ultrasound (IVUS) and/or optical coherence tomography (OCT)/optical frequency domain imaging (OFDI). About 141 hemodialysis patients who underwent PCI between January 2020 and December 2021 were analyzed retrospectively in a single center. CNs are defined as heavily calcified plaques that protruding into lumen in a convex shape. MACE (a composite of cardiovascular death, target lesion related myocardial infarction, and target lesion revascularization) between CNs and Non-CNs at 1 year were compared. In the entire study population, the mean age was 69.3 ± 10.7 years, and 94 (77.0%) were male. At 1 year, the incidence of MACE following PCI was significantly higher in the CNs group (39.2% vs 9.9%, log-rank p <0.001), particularly for cardiovascular death (17.7% vs 4.2%, log-rank p = 0.009). After multivariate analysis adjusting for demographic characteristics, CNs remained independently associated with increased risk of MACE (adjusted hazard ratio: 4.93, 95% confidence interval 2.07 to 11.76; p <0.001). CNs were associated with a higher incidence of MACE and a higher cardiovascular death rate in hemodialysis patients who underwent PCI.

DOI： 10.1016/j.amjcard.2025.03.007

Scopus

PubMed

DOI： 10.1002/hsr2.70900

Publisher：メディカルレビュー社  

DOI： 10.18885/hv.0000001924

CiNii Research

Language：Japanese   Publisher：(一社)日本動脈硬化学会  

Language：Japanese   Publisher：(株)メジカルビュー社  

＜文献概要＞Point　1 肥満による幼少期や若年の高血圧は,成人に移行しやすく,循環器疾患の最大のリスクである。2 交感神経系やレニン・アンジオテンシン・アルドステロン系の活性化が,高血圧発症に関与する。3 仮面高血圧や測定誤差に注意し,家庭血圧測定や適切なカフサイズで診断する必要がある。

Language：Japanese   Publisher：(一社)日本動脈硬化学会  

DOI： 10.1136/bmjopen-2024-097005

DOI： 10.1111/psyg.70046

Language：English   Publisher：Nature Publishing Group  

中高年者における5年間の動脈壁硬化の進展に関わる因子について、上腕-足首脈波伝播速度(baPWV)を指標に検討した。2005～2019年の特定健診者のうち、初回と5(範囲3～7)年後のデータが比較可能で、かつ初回baPWV<1400cm/sの男性3394名および女性2710名を対象とした。多変量解析の結果、5年後baPWV≧1400cm/sの発生と関連する因子は、男性で年齢、BMI、収縮期・拡張期血圧、心拍数、空腹時血糖、トリグリセリド、女性で年齢、収縮期・拡張期血圧、心拍数、喫煙歴であった。これらの因子を用いて、5年後baPWV≧1400cm/sの発生リスクを予測するモデルを構築した。ROC解析による識別能(ROC曲線下面積)は、予測スコアが男性(6因子)で0.68、女性(4因子)で0.71、予測式が男性(7因子)で0.71、女性(5因子)で0.77であった。

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

2021年のTarumizu研究に参加した40歳以上の地域在住中高年者542名(平均69.4±10.4歳、女性60.5%)を対象に横断研究を行い、抑うつ傾向と入浴または温泉浴習慣の関連性を評価した。質問票を用いて入浴および温泉浴の頻度を評価し、入浴習慣については週7回未満と週7回、温泉浴習慣については週1回未満と週1回以上に分類した。抑うつ傾向の評価には15項目の老年期うつ病尺度を用い、スコアが5以上の場合に抑うつ傾向とした。入浴習慣が週7回なのは487名(89.9%)、温泉浴習慣が週1回以上なのは124名(22.9%)で、抑うつ傾向は95名(17.5%)で認められた。抑うつ傾向を認めた中高年では、温泉浴習慣が週1回以上の割合が有意に低かった。年齢、性別、収入が得られる職業、外出頻度、移動問題、喫煙歴、飲酒量を調整した多変量ロジスティック回帰解析において、温泉浴習慣が週1回以上の場合は抑うつ傾向のリスクが有意に低かったが(調整オッズ比0.51)、抑うつ傾向と入浴頻度には有意な関連性は認められなかった。

DOI： 10.1038/s41440-024-02078-8

DOI： 10.1038/s41598-025-95618-2

Publisher：東京医学社  

DOI： 10.24479/kd.0000001845

CiNii Research

Language：English   Publisher：The Japanese Society of Internal Medicine  

<p><b>Objective </b>Optimal medical therapy (OMT) is recommended for the secondary prevention of acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). We investigated the relationship between the OMT prescription rate at hospital discharge and clinical outcomes in patients with AMI who underwent successful PCI. </p><p><b>Methods </b>We enrolled 294 consecutive AMI patients who underwent successful emergency PCI between January 2017 and December 2020. The patients were divided into two groups based on their medications at discharge: OMT, defined as a combination of statins, beta-blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers; and non-OMT, defined as the absence of at least one of the aforementioned agents. The primary outcome measure was major adverse cardiovascular events (MACEs), defined as the composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and heart failure requiring hospitalization. </p><p><b>Results </b>According to prescription data, 186 patients (63.3%) were prescribed OMT at discharge. During a median follow-up period of 957 (591-1,308) days, 45 patients developed MACEs. Kaplan-Meier curves showed a significantly lower incidence of MACE in the OMT group than in the non-OMT group (log-rank p<0.001). In the multivariate analysis, OMT remained independently associated with a reduced risk of MACE (hazard ratio, 0.47; 95% confidence interval: 0.25-0.88; p=0.017). </p><p><b>Conclusions </b>Fundamental OMT at discharge was associated with a reduced risk of MACE in AMI patients after successful PCI. Therefore, OMT may be necessary to improve the clinical outcomes of patients with AMI after discharge. </p>

DOI： 10.2169/internalmedicine.5192-24

PubMed

CiNii Research

DOI： 10.1016/j.amjcard.2025.03.007.

DOI： 10.3390/healthcare13060589

Publisher：南江堂  

DOI： 10.15106/j_naika135_614

CiNii Research

DOI： 10.1038/s41440-025-02149-4

Language：English   Publisher：(一社)日本心臓病学会  

19歳男性。特筆すべき既往はなく、COVID-19ワクチン未接種で2021年5月にCOVID-19に罹患し当院に入院した。当初のCTでは肺動脈や右心に異常所見はなかった。退院後6ヵ月後から呼吸困難が悪化し、失神や下肢浮腫が出現したため2022年1月に当院を受診した。血液検査ではDダイマー高値(3.09pg/mL)を示し、肺シンチグラフィで両肺に多発性欠損を認めた。肺動脈血栓塞栓症と診断し、抗凝固療法を開始した。3ヵ月後のフォローアップ時も呼吸困難が継続していた。6分間歩行距離は335mと短く、心エコーでは右室拡大と右室収縮期圧上昇を認めた。右心カテーテルではPAWP 7mmHg、mPAP 38mmHg、PVR 8.7 WUを、肺シンチグラフィでは換気・血流ミスマッチを、肺動脈造影では両側肺動脈に多数のwebやslit病変を、それぞれ確認した。以上より、慢性血栓塞栓性肺高血圧症(CTEPH)と診断した。リオシグアト導入後、経皮的肺動脈形成術を施行した結果、循環動態は改善した。6分間歩行距離は457mに延伸し、呼吸困難や心電図異常も改善した。

Language：Japanese   Publisher：(株)南江堂  

＜文献概要＞プライマリケアでここまでできる!・二次性高血圧症のスクリーニングはできる限り行う.・具体的かつ最新のエビデンスに基づいた生活指導を行う.・病態に応じた降圧薬の選択が必須である.ここからは専門医に任せよう!・治療抵抗性高血圧症,難治性高血圧症はまず専門医にコンサルテーションをする.・二次性高血圧症のスクリーニング陽性例は積極的に専門医に紹介する.

Language：English   Publisher：Nature Publishing Group  

エサキセレノン(E)の有効性と安全性をトリクロルメチアジド(T)と比較した無作為化試験のデータを用い、年齢による降圧効果の違いについて検討した。対象者を65歳未満と65歳以上に分け、ベースラインから試験終了時までの家庭血圧の変化量を評価した。早朝家庭血圧の最小二乗平均変化量の群間差(95%CI)は、65歳未満で-1.3(-3.3～0.8)/-0.8(-2.1～0.5)mmHg、65歳以上で-3.0(-4.9～-1.2)/-0.5(-1.5～0.5)mmHgであり、いずれも非劣性もしくは優越性マージン(両側95%CI上限<3.9/<2.1もしくは<0mmHg)を満たした。就寝前血圧および外来血圧でも同様の結果が得られた。E群の高カリウム血症発現率に年齢区分による差はなかった。Eは患者の年齢に関わらず、家庭血圧低下効果において、Tに対して非劣性または優越性を示すことが確認された。

Language：Japanese   Publisher：(株)東京医学社  

＜文献概要＞はじめに　アンジオテンシン受容体ネプリライシン阻害薬(angiotensin receptor neprilysin inhibitor:ARNI)は,心血管系の治療において新たな薬剤クラスであり,レニン-アンジオテンシン系(renin-angiotensin system:RAS)とナトリウム利尿ペプチド(natriuretic polypeptide:NP)系という,心血管系の主要な調節機構の両方に作用する。従来,複数の作用機序をもつ薬剤は,異なる薬剤を組み合わせた配合薬であることが一般的であったが,ARNIは,アンジオテンシンII受容体拮抗薬(angiotensin II receptor blocker:ARB)とネプリライシン阻害薬(neprilysin inhibitor:NEPI)を1:1で化学的に結合させた単一の分子構造をもつ点が特徴である。ARBであるバルサルタン(valsartan)とNEPIであるサクビトリル(sacubitril)を化合した薬剤であるサクビトリルバルサルタンは,心不全患者,特に駆出率が低下した患者に対する臨床試験で有効性が示され,第一選択薬として位置づけられている。また,サクビトリルバルサルタンは,従来のRAS阻害薬よりも優れた降圧効果をもつことがエビデンスとして示されている。一方で,ARBは高血圧治療において広く使用されており,これまでの多くの研究から,降圧効果や脳,心臓,腎臓の血管疾患に対する有用性が確立されている。しかし,ARNIを高血圧治療に応用する際には,ARBの作用に加えて,NEP阻害という新たな作用機序がもたらす効果を十分に理解したうえで使用する必要がある。

Language：Japanese   Publisher：Journal of Applied Gerontology  

Older adults who cease driving are more likely to experience psychosomatic decline than those who continue driving. This mixed-methods study was intended to examine differences in psychosomatic functions depending on driving status and lifestyle activities, and factors affecting engagement in additional lifestyle activities after driving cessation. The quantitative analysis included individuals aged 60 and above. Driving status, lifestyle activities, and psychosomatic functions were assessed. For qualitative analysis, semi-structured interviews were conducted with the driving-cessation group to determine the factors affecting involvement in various lifestyle activities after driving cessation. Analysis of covariance was used for quantitative data, while text mining and qualitative inductive analysis were used for qualitative data. Older adults who engaged in more lifestyle activities walked faster than those who engaged in fewer lifestyle activities, even after driving cessation. Actively using local and personal resources may increase engagement in lifestyle activities after driving cessation.

DOI： 10.1177/07334648241277043

Scopus

PubMed

Language：English   Publisher：Nature Publishing Group  

レンバチニブ投与に伴う血圧上昇と転帰の関係について検討した。対象は入院にて本剤の投与を開始した肝細胞癌患者67名(男性82.1%、年齢中央値71歳)である。血圧は入院当日と比較して投与開始翌日には高値となった。入院期間中、37.3%の患者が副作用グレード3(≧160/100mmHg)の高血圧を呈した。収縮期血圧の入院当日値から入院中最大値までの上昇量(ΔSBP)の中央値で患者を高/低群に分けて比較したところ、高群(ΔSBP≧26mmHg)は低群より死亡率が低かった。交絡因子を調整したCoxモデルにおいて、ΔSBP≧26mmHgは死亡のリスク低下と有意な関連を示した。レンバチニブ治療を受ける癌患者において、投与後の血圧上昇は予後を反映する有用な指標となる可能性がある。

DOI： 10.1253/circj.CJ-25-0083

Language：Japanese   Publisher：日本救急医学会-九州地方会  

生コンクリートは建築現場で広く採用され,施工効率や品質向上に寄与しているが,皮膚に刺激性がある.症例は左官業の25歳男性.X日,建築現場で長靴に生コンクリートが流入した.途中2回洗浄したが,皮膚に付着が残存し,汚れた長靴で仕事を継続した.生コンクリート付着から14時間後に帰宅し,靴を脱ぎ入浴後就寝した.X+1日,足の痛みで自宅休養した.X+2日,疼痛増悪し当院へ救急搬送された.両足に付着した生コンクリートが長時間の経過で乾燥固着し,足の一部に潰瘍を伴う化学熱傷を認めた.速やかに洗浄・除去し,壊死組織のデブリードメントを行い,外用剤で保存的に加療し得た.生コンクリートは長時間の皮膚接触でアルカリ熱傷を起こす.生コンクリートの皮膚接触を避けるために防護処置を講じ,付着した場合はできるだけ早く大量の水で洗い流し,十分に除去できない場合には直ちに医療機関を受診し,皮膚の保護を図ることが重要である.(著者抄録)

Language：Japanese   Publisher：The Japanese Society of Cardiovascular Disease Prevention  

<p><b>Objectives:</b> To clarify the association between metabolic syndrome (MetS; Metabolic Syndrome), comorbid physical decline, and mild cognitive impairment (MCI) in community-dwelling older adults.</p><p><b>Methods:</b> A cross-sectional analysis of 554 community-dwelling older adults aged 65 years or older (mean age 73.7±6.2 years, 63.4% women) was conducted using data from the Tarumizu Study 2019. MetS was determined using the criteria of the International Diabetes Federation, and physical function decline was judged as applicable if either or both grip strength (<28 kg for men and <18 kg for women) and usual walking speed (<1.0 m/sec) were below the cutoff values. Based on the presence or absence of MetS and physical decline, patients were operationally classified into four groups: robust group, MetS alone group (MetS group), physical decline alone group (physical decline group), and MetS and physical decline coexisting group (coexisting group). MCI was assessed by the National Center for Geriatrics and Gerontology Functional Assessment Tool (NCGG-FAT) for memory, attention, executive function, and processing speed. Participants were considered to have MCI if they scored 1.5 SD or more below the norm, which takes into account age and education, on any of the tests. Logistic regression analysis was performed with MCI as the dependent variable and the four groups defined by the presence of MetS and physical decline as independent variables, with age, sex, educational history, and number of medications as covariates.</p><p><b>Results:</b> Participants characteristics were 191 (34.5%) in the robust group, 218 (39.4%) in the MetS group, 62 (11.2%) in the physical decline group, and 83 (15.0%) in the coexisting group. Logistic regression analysis showed that, compared with the robust group, the physical decline group (odds ratio: 2.39, 95% confidence interval: 1.17-4.87) and the coexisting group (odds ratio: 2.41, 95% confidence interval: 1.21-4.79) each had a significant association with MCI. On the other hand, the MetS group showed no significant association with MCI compared with the robust group.</p><p><b>Conclusion:</b> The presence of physical functional decline and the coexistence of MetS and physical decline are associated with MCI among community-dwelling older persons.</p>

DOI： 10.11381/jjcdp.60.1_36

CiNii Research

DOI： 10.1038/s41440-024-02057-z

DOI： 10.1038/s41440-025-02149-4

Language：Japanese   Publisher：Hypertension Research  

DOI： 10.1038/s41440-024-02073-z

Scopus

PubMed

Language：Japanese   Publisher：Hypertension Research  

This prespecified subanalysis of the multicenter, randomized, open-label, parallel-group EXCITE-HT study aimed to examine the non-inferiority of esaxerenone to trichlormethiazide as a second-line antihypertensive agent according to the basal antihypertensive agent used (angiotensin receptor blocker [ARB] or calcium channel blocker [CCB]). The primary endpoint, change in morning home systolic/diastolic blood pressure (SBP/DBP) from baseline to end of treatment was similar between the two groups (intergroup difference in least squares mean change [95% confidence interval]: −1.3 [−3.8, 1.3]/−0.2 [−1.6, 1.3] mmHg for ARB; −2.7 [−4.2, −1.2]/−0.8 [−1.7, 0.1] mmHg for CCB). The respective incidences of serum potassium levels <3.5 mEq/L and ≥5.5 mEq/L in the ARB subgroup were 3.4% and 4.2% for esaxerenone and 7.9% and 0% for trichlormethiazide; in the CCB subgroup, they were 2.8% and 0.6% for esaxerenone and 13.9% and 1.2% for trichlormethiazide, respectively. The incidence of uric acid level ≥7.0 mg/dL was numerically higher in the trichlormethiazide group than the esaxerenone group in both the ARB and CCB subgroups. The non-inferiority of esaxerenone to trichlormethiazide in lowering morning home BP was demonstrated regardless of whether the basal antihypertensive agent was an ARB or CCB. Esaxerenone with a CCB showed superiority to trichlormethiazide in lowering SBP, without any new safety concerns. Serum potassium levels tended to be higher when esaxerenone was combined with an ARB than with a CCB, but this can be mitigated if administered according to the package insert. (Figure presented.)

DOI： 10.1038/s41440-024-01887-1

Scopus

PubMed

Language：English   Publisher：Nature Publishing Group  

アンジオテンシン受容体拮抗薬(ARB)またはカルシウムチャネル遮断薬(CCB)で治療中の患者に対するセカンドラインの降圧薬として、エサキセレノン(ESA)とトリクロルメチアジド(TRI)の効果を比較した。ARB治療中およびCCB治療中のいずれでも、早朝家庭収縮期/拡張期血圧(SBP/DBP)に関してESA群とTRI群の効果は同程度であった。ARB治療中では血清K濃度<3.5mEq/Lおよび≧5.5mEq/Lの頻度がそれぞれESA群で3.4%および4.2%、TRI群で7.9%および0%で、CCB治療中ではそれぞれESA群で2.8%および0.6%、TRI群では13.9%および1.2%であった。ARB治療中およびCCB治療中のいずれでも尿酸≧7.0mg/dLの頻度はESA群よりTRI群で高かった。ベース薬剤がARBとCCBのいずれでも早朝家庭血圧の低下効果について、TRIに対するESAの非劣性が示された。CCBへのESA併用はSBP低下効果においてTRIより優れ、新たな安全性の問題はみられなかった。

Language：English   Publisher：Nature Publishing Group  

運動の血圧(BP)低下効果を調べた無作為化対照試験4357件のアンブレラレビューおよびメタ解析を行った。ランダム効果モデルメタ解析により複数の試験を統合した効果量を推定した。運動は健常者の収縮期BP(SBP)を有意に低下させ、高血圧を含む生活習慣病患者でも同様であったが、心血管疾患患者では低下させなかった。地域に関して、オセアニアではSBP低下がみられず、アジアでは心血管疾患患者でもSBPが低下した。以上より、どんなタイプの運動でも健常者および生活習慣病患者のBPを低下させるが、心血管疾患患者のBPは低下させず、地域により運動の効果が異なると結論した。

Language：Japanese   Publisher：(一社)日本循環器病予防学会  

【目的】地域在住高齢者を対象にメタボリックシンドローム(MetS;Metabolic Syndrome)および身体機能低下の併存と軽度認知機能障害(MCI;Mild Cognitive Impairment)の関連を検討することを目的とした。【方法】垂水研究2019に参加した65歳以上の地域在住高齢者554名(平均年齢73.7±6.2歳、女性63.4%)のデータを横断的に分析した。MetSは国際糖尿病連合の基準を用いて判定した。身体機能は握力(男性<28kg、女性<18kg)および通常歩行速度(<1.0m/秒)で評価し、いずれか、または両方がカットオフ値未満であれば、身体機能低下ありと判定した。MetSおよび身体機能低下の有無から,健常群、MetS単独群(Mets群)、身体機能低下単独群(身体機能低下群)、MetSおよび身体機能低下併存群(併存群)の4群に分類した。認知機能は、National Center for Geriatrics and Gerontology Functional Assessment Tool(NCGG-FAT)により記憶力、注意機能、遂行機能、情報処理速度を評価し、いずれかの領域で年齢と教育歴を考慮した参照値より1.5SD以上の低下を認めた者をMCIの該当と判定した。MCIの有無を従属変数、MetSおよび身体機能低下の有無で定義された4群を独立変数とし、年齢、性別、教育歴、服薬数を共変量としたロジスティック回帰分析を実施した。【結果】健常群が191名(34.5%)、MetS群が218名(39.4%)、身体機能低下群が62名(11.2%)、併存群が83名(15.0%)であった。ロジスティック回帰分析の結果、健常群と比較し、身体機能低下群(オッズ比:2.39、95%信頼区間:1.17-4.87)、併存群(オッズ比:2.41、95%信頼区間:1.21-4.79)のそれぞれがMCIと有意な関連を認めた。一方、MetS単独群では健常群と比較したMCIと有意な関連を認めなかった。【結論】地域在住高齢者において身体機能低下を有すること、およびMetSと身体機能低下が併存していることはMCIを有することと関連することが示唆された。(著者抄録)

Language：English   Publisher：Nature Publishing Group  

18歳以上の高血圧患者を対象とする外来、家庭および自由行動下の血圧(BP)に対する運動と非運動の影響を比較した無作為化対照試験の84件のメタ解析を行った。ランダム効果モデルメタ解析により複数の試験を統合した効果量を推定した。サブグループ解析で運動タイプ(有酸素運動、動的レジスタンス運動、等尺性レジスタンス運動、複合運動)によるアウトカムの差を検討した。すべての運動は収縮期BP(SBP)および拡張期BP(DBP)を非運動と比べて有意に低下させた。BP低下の程度について運動タイプ間に有意差はなかった。以上の結果から、運動介入はBPを低下させ、レジスタンス運動は有酸素運動と同等の抗高血圧効果を示すと考えられた。

DOI： 10.20685/kenkouigaku.33.4_528

DOI： 10.1038/s41598-025-86497-8

Language：Japanese   Publisher：日本健康医学会  

鹿児島県垂水市で行われた地域コホート研究(垂水研究2021年度)に参加した551名のうち,65歳以上の198名をHbA1cが≧5.6%の糖尿病予備群(103名)とHbA1cが<5.6%の正常群(95名)の2群に分け,Body Mass Index(BMI),収縮期血圧,血清トリグリセリド(TG),HDLコレステロール(HDL-C),LDLコレステロール,総座位時間,10分以上の座位持続時間,中等度以上の活動時間(MVPA)を比較した。座位時間は,ActiGraphを用いて客観的に測定した。糖尿病予備群は,正常群と比較してBMI(p=0.001),TG(p=0.020),10分以上の座位持続時間(p=0.003)が有意に高値を示し,HDL-Cは有意に低値を示した(p=0.002)。糖尿病予備群/正常群という群分けを従属変数,10分以上の座位持続時間,年齢,性別,BMI,HDL-C,TG,MVPAを独立変数としたロジスティック回帰分析を行い,糖尿病予備群に対するオッズ比(OR)を算出したところ,10分以上の座位持続時間(OR,1.01;95%CI:1.01-1.02;p=0.012)とBMI(OR,1.12;95%CI:1.02-1.23;p=0.022)が有意な関連を示した。(著者抄録)

Language：Japanese   Publisher：Journal of Clinical Hypertension  

Angiotensin II receptor blockers (ARBs) and calcium channel blockers (CCBs) are commonly prescribed as first- and second-line treatments for older Japanese patients with hypertension. However, due to age-related decline in renin activity, the effectiveness of ARBs may decrease. This highlights the need for other antihypertensive agents to be used in combination with CCBs to replace ARBs for more effective blood pressure (BP) control. The ESCORT-HT study is a multicenter, randomized, controlled, open-label, parallel-group study with a 4-week run-in period and 12-week treatment period. This study aims to evaluate the efficacy of esaxerenone as a second-line treatment for hypertension and to determine whether its BP-lowering effect is noninferior to that of ARBs in older patients with uncontrolled hypertension on CCB monotherapy. The safety profiles of esaxerenone and ARBs will also be evaluated. Patients will be randomly assigned in a 1:1 ratio to receive either esaxerenone or an ARB. The primary efficacy endpoint will be the change from baseline in morning home systolic BP at the end of the treatment period. The BP-lowering effect of esaxerenone will be considered noninferior to that of ARBs if the upper limit of the two-sided 95% confidence interval (CI) for the difference in systolic BP change between esaxerenone and ARB is <3.8 mmHg, and will be considered superior if the upper limit of the two-sided 95% CI is <0. The findings may elucidate the possible benefits of earlier use of mineralocorticoid receptor blockers in combination with CCBs in older patients with essential hypertension.

DOI： 10.1111/jch.14947

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PubMed

Language：Japanese   Publisher：(一社)日本成人先天性心疾患学会  

Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

2015年1月～2022年2月に単一施設で血管内治療(EVT)を行った下肢動脈疾患(LEAD)患者284例を対象に、低栄養-炎症-アテローム性動脈硬化(MIA)因子の予後的影響を後ろ向きに評価した。MIA因子は、Geriatric Nutritional Risk Index 92未満、高感度C反応性タンパク0.1mg/dL以上、冠動脈血行再建術・ラクナまたはアテローム血栓性脳梗塞の既往とした。62例(22%)が死亡し、72例(25%)で主要有害心血管・脳血管イベント(MACCE;全死亡、非致死的心筋梗塞、脳卒中)を認めた。44例(16%)が3つ全てのMIA(3-MIA)因子を有していた。追跡期間は平均737日であった。多変量Cox比例ハザード回帰分析において、3-MIA因子は全死亡およびMACCEと有意に関連した(ハザード比、95%CIはそれぞれ3.46、1.89～6.34、2.91、1.62～5.22)。Kaplan-Meier法において、複数のMIA因子を有する患者および包括的高度慢性下肢虚血患者では、全死亡およびMACCEの発生率が有意に高かった。EVT後のLEAD患者において、MIA因子の併存は全死亡およびMACCEの独立したリスク因子であることが示された。

Language：Japanese   Publisher：Clinical Gerontologist  

Objectives: Participating in religious activities benefits older adults’ mental health; however, the effects of grave visitation, a significant religious practice in Japan, on older adults’ mental health remain unclear. Therefore, this study examined the relationship between grave visitation frequency and depressive symptoms. Methods: A prospective cohort study of 273 community-dwelling older adults in Japan was conducted with baseline (2018) and follow-up (2022) assessments. Participants were categorized by visitation frequency: more or less than once a week. Changes in visitation frequency were classified as continued high, decreased, continued low, or increased. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS-15). Multivariable linear regressions were used to examine the association between visitation and depressive symptoms. Results: Lower visitation at baseline was associated with worse GDS-15 scores in the follow-up. Those with decreased or continued low visitation had significantly worse depressive symptoms. After adjusting for baseline GDS-15 scores and covariates, the decreased group had significantly worse depressive symptoms than the continued high group. Conclusions: The findings indicate that changes in grave visitation frequency are significantly associated with depressive symptoms. Clinical Implications: Supporting older adults’ access to grave visitation through transportation or community programs may help maintain their well-being and emotional health.

DOI： 10.1080/07317115.2025.2538105

Scopus

PubMed

Language：Japanese   Publisher：Hypertension Research  

It is currently unknown whether baseline N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, a marker of pressure-related cardiac stress, affect the efficacy and safety of esaxerenone vs trichlormethiazide. This exploratory subanalysis of the EXCITE-HT study aimed to compare the antihypertensive efficacy and safety of esaxerenone vs trichlormethiazide in Japanese patients with uncontrolled essential hypertension stratified by baseline NT-proBNP. EXCITE-HT was a randomized, open-label, parallel-group study. In this subanalysis, patients were divided into low and high NT-proBNP subgroups based on their baseline levels (<125 pg/mL and ≥125 pg/mL, respectively). The low NT-proBNP subgroup included 188 and 212 patients and the high NT-proBNP subgroup included 49 and 41 patients in the esaxerenone and trichlormethiazide groups, respectively. A significant decrease in morning home systolic/diastolic blood pressure (SBP/DBP; the primary endpoint) was observed from baseline to the end of treatment in both NT-proBNP subgroups. In the low NT-proBNP subgroup, esaxerenone was superior to trichlormethiazide in lowering SBP and non-inferior in lowering DBP. Non-inferiority could not be confirmed in the high NT-proBNP subgroup. The geometric mean urinary albumin-to-creatinine ratio significantly decreased from baseline to Week 12 in all subgroups (all P < 0.001 vs baseline). No cases of serum potassium level ≥6.0 mEq/L were reported. These findings suggest that esaxerenone is efficacious across a wide range of baseline NT-proBNP levels, while also supporting its favorable safety profile. (Figure presented.)

DOI： 10.1038/s41440-025-02412-8

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PubMed

DOI： 10.1536/ihj.25-050

Language：English   Publisher：The Editorial Committee of Annals of Vascular Diseases  

<p>Diffusion-weighted whole-body imaging with background body signal suppression has been used to diagnose fever of unknown origin. An 86-year-old man who underwent bile duct jejunostomy for bile duct cancer presented with fever (body temperature, 40°C). <i>Escherichia coli</i> was detected in blood cultures. Diffusion-weighted whole-body imaging with background body signal suppression revealed accumulation in the aortic arch. Therefore, infectious aortitis secondary to retrograde cholangitis was diagnosed. The patient was treated with antibiotics, and the aortic arch accumulation disappeared. Diffusion-weighted whole-body imaging with background body signal suppression is a useful modality for diagnosing vasculitis and assessing treatment effectiveness.</p>

DOI： 10.3400/avd.cr.25-00030

PubMed

CiNii Research

Language：English   Publisher：「Annals of Vascular Diseases」編集事務局  

Language：Japanese   Publisher：Clinical Gerontologist  

Objectives: To examine whether satisfaction with meaningful activities (MA) is associated with self-rated sleep quality and sleep duration among community-dwelling older adults. Methods: Data were drawn from 833 individuals aged ≥65 years who participated in a health survey between 2018 and 2019 in Japan. Sleep quality (good, moderate, or poor) and duration (< 6, 6–8, or ≥8 h) were assessed through a questionnaire. Participants selected the MA they considered most meaningful from a list of 95 activities in the Aid for Decision-Making in Occupation Choice, and their satisfaction with these MA were measured. Results: Ordinal logistic regression analysis, with sleep quality or duration as the dependent variable and satisfaction with MA as the independent variable, showed that higher satisfaction with MA was significantly associated with lower odds of poor sleep quality (OR: 0.84, 95% CI: 0.72–0.97, p =.03), but not with sleep duration. However, the association was not significant in sensitivity analyses that reversed the model. Conclusions: Satisfaction with MA may be associated with better sleep quality in older adults. Clinical Implications: Evaluating and enhancing satisfaction with MA may help identify older adults at risk of poor sleep quality, indicating that MA may be useful in supporting sleep.

DOI： 10.1080/07317115.2025.2597956

Scopus

PubMed

Language：Japanese   Publisher：Mental Health Religion and Culture  

This cross-sectional observational study aimed to clarify the relationship between satisfaction with grave visitation and depressive symptoms among Japanese older adults. We analysed older adults who participated in a community health survey (n = 1025). Participants selected meaningful activities from the 95-item Aid for Decision-Making in Occupation Choice and rated their satisfaction on a five-point scale. Depression symptoms were assessed using the 15-item Geriatric Depression Scale. Grave visitation ranked fourth among all activities and was the most frequently chosen social activity. Higher satisfaction with grave visitation was associated with a significantly lower prevalence of depression, particularly in the hopelessness dimension. After adjusting for potential covariates in a Poisson regression analysis, satisfaction with grave visitation was significantly related to depression symptoms (prevalence ratio,.58; 95% confidence interval,.35–.96). Discussing beliefs about the deceased and ancestors and helping to increase satisfaction with grave visitation may help alleviate depressive symptoms.

DOI： 10.1080/13674676.2025.2516583

Scopus

Language：Japanese   Publisher：Jacc Case Reports  

Images: Intravascular imaging (optical coherence tomography and intravascular ultrasound) demonstrating coronary pseudoaneurysm and stent disruption. Case Summary: A 65-year-old man undergoing hemodialysis for diabetic nephropathy developed methicillin-resistant Staphylococcus aureus infective endocarditis complicated by coronary pseudoaneurysm and stent disruption, resulting in cardiac tamponade. Intravascular imaging confirmed the complete destruction of the arterial wall. Emergency covered stent implantation and pericardiocentesis stabilized the patient, followed by a multidisciplinary treatment approach, including prolonged antibiotics and surgical source control, leading to survival. Take-Home Message: Timely imaging-guided diagnosis and a stepwise multidisciplinary strategy were lifesaving in this extremely rare and complex case.

DOI： 10.1016/j.jaccas.2025.106337

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PubMed

Language：Japanese   Publisher：Aging and Mental Health  

Objectives: This two-wave longitudinal study examined whether changes in satisfaction with meaningful activities (MA) were associated with subsequent subjective memory complaints (SMC) among community-dwelling older adults between 2019 and 2021. Method: Health surveys were conducted among local people at two time points: baseline (2019, before the COVID-19 pandemic) and follow-up (2021, during the pandemic). The participants were 275 community-dwelling older adults aged ≥65 years without cognitive decline at baseline. Satisfaction with MA was assessed using the Aid for Decision-Making in Occupation Choice and categorized as maintained/improved or decreased at follow-up. SMC was measured using four items developed by Tsutsumimoto and quantified according to the total number of complaints. Results: Older adults who maintained or improved satisfaction with MA showed no significant increase in SMC (p = 0.30), whereas those who demonstrated decreased satisfaction experienced a significant increase in SMC (p = 0.02). In the generalized linear mixed-effects model adjusted for covariates, a significant association was observed between decreased satisfaction with MA and increased SMC scores (β = 0.32, 95% CI = 0.09–0.55, p < 0.01). Conclusion: Maintaining and improving satisfaction with MA may be associated with a reduced risk of SMC increase in older adults.

DOI： 10.1080/13607863.2025.2570823

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PubMed

Language：Japanese   Publisher：Heart and Vessels  

This study aimed to investigate the association between the modified Japanese Version of High Bleeding Risk (J-HBR) criteria and the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria with clinical outcomes in patients with lower extremity artery disease (LEAD) undergoing endovascular treatment (EVT). We enrolled 305 consecutive patients with LEAD who underwent EVT. Each modified J-HBR and ARC-HBR score was calculated by assigning 1 and 0.5 points to each major and minor criterion, respectively. Coronary artery disease was included as a major criterion in the modified J-HBR criteria, replacing peripheral vascular disease. The cut-off values for ARC-HBR and modified J-HBR scores were determined using the survival classification and regression tree (CART) model to predict all-cause mortality. A novel bleeding risk score associated with major bleeding events was developed from this dataset, with its cut-off determined by the CART model. The primary outcome was all-cause mortality; the secondary outcome was major bleeding events defined as Bleeding Academic Research Consortium type 3 or 5 following EVT. We also compared the discriminatory ability of the modified J-HBR, ARC-HBR, and novel bleeding risk scores. During a median follow-up of 1085 (435–1951) days, 116 patients died and 36 had major bleeding events. The CART model classified patients into low (modified J-HBR < 2, ARC-HBR < 1, novel bleeding risk 0), intermediate (modified J-HBR 2–2.5, ARC-HBR 1–1.5, novel bleeding risk 1), and high (modified J-HBR ≥ 3, ARC-HBR ≥ 2, novel bleeding risk ≥ 2) risk groups. Kaplan–Meier curves demonstrated a significant increase in mortality with higher modified J-HBR and ARC-HBR scores (log-rank p < 0.001) and in major bleeding events with higher novel bleeding risk scores (log-rank p < 0.001). Time-dependent receiver operating characteristic analysis for 1- and 3-year all-cause mortality showed modified J-HBR had a higher area under the curve (AUC) than ARC-HBR at 1 year (0.72 vs. 0.66, p = 0.040) and 3 years (0.66 vs. 0.61, p = 0.024). The novel bleeding risk score tended to have a higher AUC for predicting major bleeding events at 1 year than modified J-HBR (0.77 vs. 0.69, p = 0.068) and ARC-HBR (0.77 vs. 0.67, p = 0.067). The modified J-HBR and ARC-HBR scores effectively stratified the mortality risk, whereas the novel bleeding risk score effectively stratified bleeding risk in patients with LEAD undergoing EVT. The modified J-HBR score demonstrated superior discriminative ability in predicting mid- and long-term mortality compared to the ARC-HBR score.

DOI： 10.1007/s00380-025-02629-0

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PubMed

CiNii Research

DOI： 10.1038/s41440-024-02045-3

Language：English   Publisher：(一社)日本心臓病学会  

カテーテルアブレーション(CA)後の医原性心房中隔欠損(iASD)の発症率と予測因子を検討した。2005年5月～2018年6月に当院で心房細動(AF)に対して初回CAを施行された639例(男性489例、女性150例、平均60.2±10.7歳)を対象に後ろ向き研究を行った。全例に対して術前経食道心エコー(プレTEE)、術前経胸部心エコー(プレTTE)、術後TTE(ポストTTE)を実施し、CAから6ヵ月後のiASDの発症率を評価した。プレTTEにおける平均左房径(LAD)は41.0±6.5mm、平均左室駆出率(LVEF)は64.6±10.3%、左室拡張末期径は30.1±5.8mmであり、高周波CAを行った453例のうち複雑性分裂心房電位(CFAE)アブレーションが258例、CFAEアブレーション+肺静脈隔離術(PVI)が109例、PVI単独が86例、クライオアブレーションが44例であった。ポストTTEでのiASDの検出率は59.6%(497例中296例)、6ヵ月後TTEでは4.6%(23例)であり、年齢、BMI、AFのタイプ、BNP値、プレTTE上のLAD、左房容積、LVEF、右室収縮期圧(RVSP)に関してiASD群と非iASD群との間に有意差はなかった。一方、iASDの発症率は高周波アブレーション群が3.3%、クライオアブレーション群が18.2%とクライオアブレーション群の方が有意に高く、高周波アブレーション群では2シース法の方が1シース法よりiASDの発症率が有意に高値を示していた。単変量解析ではiASD発症の有意な関連因子としてシース径、単一穿刺における2シースの使用が抽出された。

Language：English   Publisher：シュプリンガー・ジャパン(株)  

経皮的冠動脈インターベンション(PCI)を受けた安定型冠動脈疾患(CAD)患者における学術研究コンソーシアム高出血リスクスコア(ARC-HBR)と臨床アウトカムとの関連について検討した。2017年1月～2020年12月にPCIを施行された安定型CAD患者328例をARC-HBRスコア1点未満の低値群143例(男性119例、女性24例、平均65.1±8.7歳)、1～2点の中等値群97例(男性66例、女性31例、平均72.4±9.5歳)、2点以上の高値群88例(男性67例、女性21例、平均75.7±9.5歳)に分類し、主要評価項目は全死亡、非致死性心筋梗塞、非致死性脳卒中の複合としての主要心血管有害事象(MACE)の発症とした。観察期間中央値983日においてMACEの発症を44例に認め、17例に大出血イベント、11例に虚血性イベントがみられた。Kaplan-Meier曲線解析では、ARC-HBRスコアが増すのに伴い主要評価項目の発症率は高くなっており、このうち約75%が全死亡であり、非心血管死が2/3を占めていた。Cox比例ハザード回帰モデルを用いた多変量解析では、ARC-HBRスコア2点以上と1～2点が主要評価項目の発症と有意に関連していた。時間依存性ROC曲線解析では、ARC-HBRのAUCはThrombolysis in Myocardial Infarction Risk Score for Secondary Prevention(TRS2°P)より有意に高く、Coronary Revascularization Demonstrating Outcome Study in Kyoto(CREDO-Kyoto)血栓症リスクスコアとほぼ同等であった。ARC-HBRスコアはPCI施行患者にみられるMACE発症の層別化に有用と考えられた。

DOI： 10.1038/s41440-024-01998-9

DOI： 10.1038/s41440-024-01974-3

Language：English  

DOI： 10.7759/cureus.73433

PubMed

DOI： 10.1007/s12928-024-01058-6

DOI： 10.1016/j.jacl.2024.09.013

DOI： 10.1016/j.jacl.2024.09.013

Language：English  

DOI： 10.1097/MCA.0000000000001428

PubMed

Language：Japanese   Publisher：Journal of Cardiology  

Background: We hypothesized that the beneficial effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on diastolic function might depend on baseline left ventricular (LV) systolic function. Methods: To investigate the effects of SGLT2 inhibitors on LV diastolic function in patients with type 2 diabetes mellitus (T2DM), we conducted a post-hoc sub-study of the PROTECT trial, stratifying the data according to LV ejection fraction (LVEF) at baseline. After excluding patients without echocardiographic data at baseline or 24 months into the PROTECT trial, 31 and 38 patients with T2DM from the full analysis dataset of the PROTECT trial who received ipragliflozin or no SGLT2 inhibitor (control), respectively, were included. The primary endpoint was a comparison of the changes in echocardiographic parameters and N-terminal pro-brain natriuretic peptide levels from baseline to 24 months between the two groups stratified according to baseline LVEF. Results: Differences in diastolic functional parameters (e' and E/e') were noted between the two groups. Among the subgroups defined according to median LVEF values, those with higher LVEF (≥60 %) who received ipragliflozin appeared to have a higher e' and lower E/e' than did those who received the standard of care with no SGLT2 inhibitor, indicating longitudinal improvements between baseline and follow up (p = 0.001 and 0.016, respectively). Conclusions: Ipragliflozin generally improved LV diastolic function in patients with type 2 diabetes, the extent of this improvement might appear to vary with LV systolic function.

DOI： 10.1016/j.jjcc.2024.02.002

Scopus

PubMed

Language：English   Publisher：(一社)日本心臓病学会  

日本の39施設の2型糖尿病患者を対象にPROTECT試験のサブ解析として、左室拡張機能に対するイプラグリフロジンの効果をベースラインの左室駆出率(LVEF)で層別化して検討した。ベースラインおよび24ヵ月後の心エコー検査データが得られなかった患者を除外後、イプラグリフロジン群31例、対照群38例について解析した。24ヵ月後の拡張機能パラメータ(e'、E/e')の変化について、ベースラインのLVEFが中央値(60%)以上の患者においては、イプラグリフロジン群は対照群に比べてe'が有意に高値で、E/e'が有意に低値であったが、ベースラインのLVEFが中央値未満の患者では、e'およびE/e'に有意な群間差を認めなかった。2型糖尿病患者において、イプラグリフロジンは全般的に左室拡張機能を改善したが、改善の程度は左室収縮機能によって異なると考えられた。

Language：Japanese   Publisher：大道学館出版部  

Language：Japanese   Publisher：(一社)日本老年医学会  

Language：Japanese   Publisher：(一社)日本老年医学会  

Language：Japanese   Publisher：(一社)日本老年医学会  

DOI： 10.1177/0733464824127704

DOI： 10.7759/cureus.68605

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：English   Publisher：Nature Publishing Group  

アンジオテンシンII受容体拮抗薬またはカルシウム拮抗薬で降圧不十分な日本人本態性高血圧患者のセカンドライン治療としてのエサキセレノンとトリクロルメチアジドの有効性および安全性を評価するため、12週間の多施設共同無作為化オープンラベル並行群間比較試験(EXCITE-HT試験)を行った。Full analysis setはエサキセレノン群295例(平均65.2±11.5歳)、トリクロルメチアジド群290例(平均64.7±12.1歳)であった。治療終了時における早朝家庭血圧の変化量の最小二乗平均の群間差は収縮期血圧で-2.2mmHg(95%CI -3.6～-0.8mmHg)、拡張期血圧で-0.6mmHg(-1.4～0.2mmHg)であり、両側95%信頼区間の上限がそれぞれ3.9mmHg、2.1mmHgより小さかったことから、エサキセレノンのトリクロルメチアジドに対する非劣性が示された。安全性について新たな懸念は認めなかった。

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：大道学館出版部  

DOI： 10.33290/jtvt.oa.24-0001

Language：Japanese   Publisher：Hypertension Research  

The EXCITE-HT study aimed to evaluate the efficacy and safety of esaxerenone versus thiazide diuretics (trichlormethiazide) as second-line treatment for Japanese patients with uncontrolled essential hypertension. This was a 12-week, multicenter, randomized, open-label, parallel-group study. The non-inferiority of esaxerenone to trichlormethiazide was confirmed if the upper limit of the two-sided 95% confidence interval (CI) for the difference in systolic blood pressure (SBP)/diastolic blood pressure (DBP) change between groups was below 3.9/2.1 mmHg. A total of 295 and 290 patients were included in the esaxerenone and trichlormethiazide groups, respectively. The non-inferiority of esaxerenone to trichlormethiazide was demonstrated: least squares mean change differences in morning home SBP/DBP at end of treatment (EOT) were −2.2 (95% CI, −3.6, −0.8) mmHg for SBP/−0.6 (−1.4, 0.2) mmHg for DBP. Morning home, bedtime home, and office BP significantly decreased (all p < 0.001) from baseline to EOT in both groups. The urinary albumin-to-creatinine ratio and N-terminal pro-brain natriuretic peptide level decreased from baseline to Week 12 in both groups, with no notable intergroup difference. Serum potassium elevations occurred more frequently with esaxerenone, while serum potassium reductions occurred more with trichlormethiazide. Uric acid elevations were observed in both groups, but more frequently with trichlormethiazide than esaxerenone. No cases of gout occurred in this study. Reductions in estimated glomerular filtration rate were similarly observed in both groups. EXCITE-HT is the first randomized controlled study to demonstrate evidence that esaxerenone is non-inferior to trichlormethiazide as second-line treatment for Japanese patients with uncontrolled essential hypertension, with no new safety concerns. (Figure presented.).

DOI： 10.1038/s41440-024-01762-z

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PubMed

DOI： 10.4235/agmr.24.0080

Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

Language：Japanese   Publisher：Japanese Journal of Radiology  

Objectives: To investigate the usefulness of machine learning (ML) models using pretreatment ¹⁸F-FDG-PET-based radiomic features for predicting adverse clinical events (ACEs) in patients with cardiac sarcoidosis (CS). Materials and methods: This retrospective study included 47 patients with CS who underwent ¹⁸F-FDG-PET/CT scan before treatment. The lesions were assigned to the training (n = 38) and testing (n = 9) cohorts. In total, 49 ¹⁸F-FDG-PET-based radiomic features and the visibility of right ventricle ¹⁸F-FDG uptake were used to predict ACEs using seven different ML algorithms (namely, decision tree, random forest [RF], neural network, k-nearest neighbors, Naïve Bayes, logistic regression, and support vector machine [SVM]) with tenfold cross-validation and the synthetic minority over-sampling technique. The ML models were constructed using the top four features ranked by the decrease in Gini impurity. The AUCs and accuracies were used to compare predictive performances. Results: Patients who developed ACEs presented with a significantly higher surface area and gray level run length matrix run length non-uniformity (GLRLM_RLNU), and lower neighborhood gray-tone difference matrix_coarseness and sphericity than those without ACEs (each, p < 0.05). In the training cohort, all seven ML algorithms had a good classification performance with AUC values of > 0.80 (range: 0.841–0.944). In the testing cohort, the RF algorithm had the highest AUC and accuracy (88.9% [8/9]) with a similar classification performance between training and testing cohorts (AUC: 0.945 vs 0.889). GLRLM_RLNU was the most important feature of the modeling process of this RF algorithm. Conclusion: ML analyses using ¹⁸F-FDG-PET-based radiomic features may be useful for predicting ACEs in patients with CS.

DOI： 10.1007/s11604-024-01546-y

Scopus

PubMed

Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

Language：English   Publisher：(公社)日本医学放射線学会  

心サルコイドーシス(CS)患者の臨床有害事象(ACE)の予測に、治療前18F-FDG-PET画像を用いた機械学習(ML)モデルが有用か検討した。MLモデルは7種類のMLアルゴリズムとジニ不純度の低下により最上位となった4つの特徴量を用いて構築した。治療前に18F-FDG-PET/CTが撮像されたCS患者47例(男性9例、女性38例、年齢39～81歳)を対象に、トレーニングコホート38例とテストコホート9例に分けて比較した。その結果、ACE発症患者では非発症患者に比べ、表面積とgray level run length matrix run length non-uniformityでは有意に大きかった一方、neighborhood gray-tone difference matrix_coarsenessおよび球形度は有意に小さかった。また、トレーニングコホートでは全てのMLアルゴリズムが良好な分類性能を示し、テストコホートではrandom forestアルゴリズムで、最も大きなROC曲線下面積と最も高い正確度が得られた。以上より、18F-FDG-PET画像をベースとしたラジオミクス特徴量によるML解析は、CS患者においてACEの予測に有用と判断された。

Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

DOI： 10.14283/jpad.2024.117

Language：English   Publisher：The Japanese Coronary Association  

The importance of optimal medical therapy for chronic coronary syndrome was demonstrated in the COURAGE and ISCHEMIA trials. Hypertension is an important risk factor for atherosclerotic disease; however, it has not garnered as much attention as low-density lipoprotein cholesterol in coronary artery diseases. Blood pressure contributes significantly to the development of atherosclerosis, an underlying pathological mechanism of chronic coronary syndrome. This is due to shear stress, which causes endothelial dysfunction and angiotensin II-induced intimal smooth muscle cell proliferation. Although the renin-angiotensin system plays an important role in atherosclerosis, the strong expression of angiotensin-converting enzyme in macrophages and angiotensin II type 1 receptors in smooth muscle cells suggests that this pathway may be involved in different local pathologies. Furthermore, an imbalance between myocardial oxygen demand and supply contributes to chronic coronary syndromes. An elevated systolic blood pressure also has a significant impact on increased myocardial oxygen consumption. Therefore, adequate blood pressure reduction is important to prevent the development of chronic coronary syndrome. Percutaneous coronary intervention, which significantly contributes to the treatment of chronic coronary syndrome, requires aggressive antithrombotic therapy. Although antithrombotic therapy has significantly increased the success rate, it is also associated with an increase in the incidence of serious adverse bleeding events. A bleeding with antithrombotic therapy study conducted in Japan reported that a robust antihypertensive regimen could reduce the incidence of intracranial hemorrhaging. Percutaneous coronary intervention for chronic coronary syndrome is an elective procedure that should be performed only after adequate blood pressure reduction has been achieved.

DOI： 10.7793/jcad.30.24-00007

CiNii Research

DOI： 10.1016/j.jjcc.2024.06.007

DOI： 10.1177/07334648241261885

DOI： 10.31083/j.rcm2506218

DOI： 10.1007/s00380-024-02428-z

Language：English   Publisher：Japan Atherosclerosis Society  

DOI： 10.5551/jat.gl2022

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PubMed

CiNii Research

Language：Japanese   Publisher：Journal of Cardiology  

Background: Currently, pulmonary hypertension-targeted therapy has been shown to improve the survival of patients with pulmonary artery hypertension (PAH). However, the importance of early diagnosis has not been investigated. Therefore, this study aimed to investigate whether a delayed diagnosis of PAH is associated with its prognosis. Methods and results: A total of 66 consecutive untreated patients were diagnosed with PAH from January 2008 to December 2021 at the Kagoshima University Hospital. The time from symptom onset to diagnosis correlated with brain natriuretic peptide levels (p < 0.001), right ventricle (RV) Tei index (p < 0.001), and the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio (p = 0.003). These findings suggest that in patients with PAH, RV function declines with increasing time from symptom onset to diagnosis. Furthermore, older patients with PAH appeared to have a longer time from symptom onset to diagnosis. Next, patients were divided into delayed diagnosis (>3 months) and early diagnosis (≤3 months) groups based on the time from symptom onset to diagnosis. Patients were categorized into three groups according to the European Society of Cardiology (or the European Respiratory Society) risk stratification guidelines. Patients diagnosed with PAH within 3 months of symptom onset were significantly in the low- or intermediate-risk groups (p < 0.001). A Kaplan-Meier analysis revealed that the cumulative event-free rate was significantly lower (p < 0.01) in the delayed diagnosis group than in the early diagnosis group. A delayed diagnosis was significantly associated with a worse outcome than an early diagnosis, after adjusting for different sets of confounding factors. Conclusions: A delayed PAH diagnosis is associated with a poor prognosis. Early diagnosis of PAH may lead to a low-risk treatment. Furthermore, older patients need more careful screening for PAH.

DOI： 10.1016/j.jjcc.2023.08.004

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PubMed

Language：English   Publisher：(一社)日本動脈硬化学会  

Language：English   Publisher：(一社)日本心臓病学会  

肺動脈性肺高血圧症(PAH)の診断遅延が予後と関連するかについて検討するため、2008年1月～2021年12月に当院でPAHと診断された未治療患者を後ろ向きに調べた。患者をリスク層別化基準に従って低、中、高リスクの3群に分類した。全患者は診断後に至適薬物治療を受けた。追跡期間中の全死因死亡とPAHによる再入院を評価した。患者66例(平均54±15歳、女性87.9%)を解析した。症状発症から診断までの時間は、脳ナトリウム利尿ペプチド値(p<0.001)、右室Tei index(p<0.001)、三尖弁輪の収縮期変動/収縮期肺動脈圧比(p=0.003)と相関し、症状発症から診断までの時間の増加に伴い右室機能が低下することが示唆された。症状発症から診断までの時間と年齢にも弱い相関が認められた。症状発症から診断までの時間が3ヵ月超であった患者(診断遅延群)と3ヵ月以下であった患者(早期診断群)では、リスク層別化に有意差がみられ(p<0.001)、高リスク群は診断遅延群の12%、早期診断群の34%であった。カプランマイヤー解析で、診断遅延群の累積無イベント率は早期診断群より有意に低かった(p<0.01)。交絡因子調整後、診断遅延は予後不良と有意に関連した。以上より、PAHの診断遅延は予後不良につながり、特に高齢患者ではより慎重なPAHのスクリーニングが必要と考えられた。

Language：English   Publisher：(一社)日本内科学会  

日本の健康診断データセットを用いて、血清尿酸(SUA)値と腎機能低下の関連を多変量ロジスティック回帰分析で検討した。2001年から2018年までに健診を受けた227,672例(男性46.1%)を対象に、SUA値で5群に分類し、第2群を基準とした。尿酸値には性差があるため、分析はすべて男女別に行った。男性は平均年齢55.9歳、平均SUA値5.9mgdL、平均eGFR値80.0mL/min/1.73m2、女性は平均年齢57.3歳、平均SUA値4.5mgdL、平均eGFR値81.2mL/min/1.73m2で、男女とも9.4%が腎機能低下(eGFR値60.0mL/min/1.73m2)を有していた。多変量解析において、男女ともに、SUA値が高い第3～5群だけでなく、第1群においても腎機能低下の有病率は有意に高かった。以上より、男女ともSUA値と腎機能低下の有病率はJ字型の関連を示し、高尿酸血症だけではなく低尿酸血症も腎機能低下のリスクと関連することが示唆された。

DOI： 10.1536/ihj.23-553

Language：English   Publisher：Nature Publishing Group  

禁煙後の体重増加が高血圧発症に与える影響について検討した。定期健診者から禁煙者856名を抽出し、禁煙1年後の体重増加量により中央値1.8kg未満の軽度増加(L)群と中央値以上の高度増加(H)群に分け、禁煙6年後の体重および血圧の変化を比較した。ベースライン時の体重は群間で差がなかったが、禁煙6年後はH群で高値を示した(P<0.01)。H群はL群に比べて禁煙6年後のベースラインからの血圧上昇が大きかった(P<0.001)。降圧薬処方率と高血圧の頻度には差がなかった。重回帰分析の結果、高度体重増加は禁煙後の血圧変化の影響因子であった。禁煙者は、背景因子を一致させた喫煙継続者(854名)と比較して、ベースラインから6年後までの体重増加と血圧上昇が大きかった(各P<0.001)。以上より、禁煙後の体重増加は血圧上昇につながる可能性があり、禁煙希望者に対する減量指導の有用性が示唆された。

Language：English   Publisher：(一社)インターナショナルハートジャーナル刊行会  

経皮的冠動脈インターベンション(PCI)を施行した急性冠症候群患者54例を対象に、歯周病に対する基本的な口腔ケアが血管内皮機能に及ぼす影響を検討した。全例で入院時(ベースライン)に血流依存性血管拡張反応(FMD)およびニトログリセリン誘発性内皮非依存性血管拡張反応(NMD)を測定し、PCIから8ヵ月後(フォローアップ)に血管内皮機能検査を再施行した。歯周病および口腔ケアの指標として歯周ポケットの深さ(PPD)、プロービング時の出血(BOP)、磨き残した汚れの割合であるプラークコントロールレコード(PCR)、地域歯周疾患指数(CPI)を評価した。重度歯周病は24例で認め、平均PCRは48.9%であった。患者をPPDが6mm以上でCPIがcode 4の重度歯周病群24例(男性79.1%、平均64.1±8.9歳)と上記以外の非重度歯周病群30例(男性80%、平均64.6±12.8歳)に分類した。ベースラインのFMDに有意な群間差はなかったが、フォローアップ時のFMDは重度群の方が非重度群より有意に低かった。

Language：English   Publisher：Nature Publishing Group  

血清尿酸値(UA)と高血圧発症の関連について、2種類の血圧基準を用いて検討した。対象は健診時血圧が140/90未満の21443名(男性39.8%、集団1)と130/80未満の15245名(同36.5%、集団2)である。5年後の高血圧症有病率(各基準値を超過した者の割合)は、集団1で男性16.3%、女性10.9%、集団2で男性29.7%、女性21.4%であった。多変量解析の結果、全体として、UA(四分位)および高尿酸血症(有無)は5年後の高血圧症と有意に関連した。性別では、UAは男性でのみ高血圧症と関連し、第4四分位群におけるオッズ比は集団1で1.36、集団2で1.31であった(各P<0.01)。高尿酸血症と高血圧症の有意な関連は、集団1では男性(オッズ比1.23、P=0.02)、集団2では女性(1.57、P<0.01)でのみ維持された。UAと高血圧発症の関連には性差があると考えられた。

DOI： 10.1038/s41598-024-60219-y

DOI： 10.4235/agmr.23.0218

Language：English   Publisher：Nature Publishing Group  

定期健診データを用い、ベースラインのBMI、腹囲、Body Roundness Index(BRI)、A Body Shape Index(ABSI)と5年後の高血圧の関連を、男女別および年代別に検討した。健診受診者41902名のうち7622名(18.2%)が5年後までに高血圧を発症した。多変量解析の結果、男女とも全年代(30歳代～60歳代)において、BMI、腹囲、BRIは高血圧発症と有意に関連し、そのオッズ比はいずれも男性より女性で、高年代より低年代で高かった。ABSIについては40代と50代の男性でのみ関連がみられた。非肥満者(BMI<25)の腹囲とBRIは高血圧と関連したが、肥満者ではいずれの指標も関連を示さなかった。ROC解析による曲線下面積は、BMI 0.56～0.80、腹囲0.56～0.77、BRI 0.57～0.77、ABSI 0.51～0.54であり、高血圧の予測におけるABSIの有用性は低いと思われた。

Language：Japanese   Publisher：(株)日本臨床社  

Language：Japanese   Publisher：(公社)日本超音波医学会  

Language：Japanese   Publisher：Japan Heart Foundation  

DOI： 10.11281/shinzo.56.273

CiNii Research

Language：English   Publisher：(一社)日本循環器学会  

Language：English   Publisher：(一社)日本循環器学会  

Language：English   Publisher：(一社)日本循環器学会  

Language：English   Publisher：(一社)日本循環器学会  

Language：English   Publisher：(一社)日本循環器学会  

Language：Japanese   Publisher：(公財)日本心臓財団  

背景・目的:本研究の目的は,脳性ナトリウム利尿ペプチド(brain natriuretic peptide;BNP)や心房性ナトリウム利尿ペプチド(human atrial natriuretic peptide;hANP)などの血液学的指標と心エコー指標との間で,その後のドライウエイト(Dry Weight;DW)減量の予測因子としての有用性に関して比較検討することである.方法:2018年6月から2019年5月の1年間に当院腎臓内科で維持透析を行っている患者のうち,循環器科へ心エコー評価依頼のあった55例に関して,その後のDWの低下の有無により「DW低下あり」群と「DW低下なし」群の2群間に分類し,両群間で血液学的評価(BNPおよびhANP)と心エコーの各指標に関して後ろ向きに比較検討した.結果:血液学的指標に関して,「DW低下あり」群と「DW低下なし」群の2群間でBNP(pg/mL)とhANP(pg/mL)は有意差を認めなかった(414.6[101.4-685.7]vs 185.5[32.5-213.3],p=0.12;162.1[82.25-222.5]vs 113.5[36.1-110.5],p=0.32).一方で,心エコー指標(E:early diastolic filling velocity,A:atrial filling velocity,E':peak early diastolic velocity of the mitral annulus,RVSP:right ventricle systolic pressure)において,「DW低下あり」群は「DW低下なし」群に比較して,有意にE/A,E/E' septal,E/E' lateral,RVSP(mmHg)が高値であった(0.85±0.06 vs 0.67±0.03,p=0.01;24.6±2.1 vs 14.1±1.0,p<0.0001;15.2±1.4 vs 9.9±0.6,p=0.001;39.0±2.5 vs 26.6±1.1,p<0.0001).心エコー評価後のDW低下の有無に関するロジスティック解析(単変量)では,E/A(OR81.2,95%CI[2.227-5312],p=0.0157),E/E'septal(OR1.23,95%CI[1.087-1.477],p=0.0002),E/E' lateral(OR1.26,95%CI[1.083-1.529],p=0.0025),RVSP(OR1.25,95%CI[1.107-1.470],p<0.0001)が有意であった.多変量解析ではRVSPのみが有意であった(OR1.17,95%CI[1.009-1.445],p=0.0366).考察:維持透析患者において心エコー指標はその後のDW低下の予測因子となり得ることが示唆された.(著者抄録)

Language：Japanese   Publisher：(一社)日本病院総合診療医学会  

DOI： 10.1159/000536653

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1413208009

CiNii Research

Publisher：メディカルレビュー社  

DOI： 10.18885/hv.0000001494

CiNii Research

Language：Japanese   Publisher：(株)メジカルビュー社  

＜文献概要＞Point　1 利尿薬の種類と作用機序について理解する。2 HFpEFに対する治療として,「うっ血」や「高血圧」への介入が重要である。3 降圧利尿薬はHFpEFの治療薬として期待できる。

Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞ポイント　・夜間頻尿・多尿は畜尿障害だけではなく,夜間尿産生が亢進することによって発症することもある.・尿産生亢進には高血圧によりナトリウム(Na)利尿と心不全による水利尿がある.・尿産生亢進による夜間頻尿のうち,高血圧はサイアザイド系降圧利尿薬でNa排泄を促し,心不全はループ利尿薬で水分排泄を促すことで改善しうる.

Language：Japanese   Publisher：(株)日本臨床社  

DOI： 10.1038/s41440-023-01549-8

Language：Japanese   Publisher：Hypertension Research  

Although previous reports have shown that sodium-glucose cotransporter-2 (SGLT2) inhibitors have a blood pressure (BP) lowering effect, relevant long-term data is limited. This study aimed to evaluate the effect of the SGLT2 inhibitor ipragliflozin on BP, and associations between BP reduction and changes in cardiometabolic variables in diabetic patients. This was a sub-analysis of the PROTECT trial, a multicenter, randomized, open-label study to assess if ipragliflozin delays carotid atherosclerosis in patients with type 2 diabetes. Participants were randomized to ipragliflozin and control groups. The primary endpoint of the present sub-analysis was the trajectory of systolic BP over 24 months. Correlations between systolic BP changes and cardiometabolic variables were also evaluated. A total of 232 eligible participants with well-balanced baseline characteristics were included in each study group. Throughout the 24-month study period, mean systolic BP was lower in the ipragliflozin group. At 24 months, a between-group difference (ipragliflozin minus control) in mean systolic BP change from baseline was −3.6 mmHg (95% confidence interval, −6.2 to −1.0 mmHg), and the reduction in systolic BP in the ipragliflozin group was consistent across subgroups examined. Changes in systolic BP significantly correlated with those in body mass index in the ipragliflozin group, while no significant correlations with other cardiometabolic variables tested were observed. In conclusion, ipragliflozin treatment was associated with BP reduction throughout the 24-month follow-up period as compared to control treatment. BP reduction correlated with weight loss, which might be one of the mechanisms for the BP lowering effect of SGLT2 inhibitors. (Figure presented.)

DOI： 10.1038/s41440-023-01494-6

Scopus

Language：English   Publisher：Nature Publishing Group  

インスリン抵抗性の指標であるトリグリセリド・グルコース指数(TyG)と慢性腎臓病(CKD)発症の関連について高血圧のサブタイプ別に検討した。年次健診を複数回受診した中年男性32818名を、血圧140/90mmHgをカットオフ値として孤立性拡張期高血圧(IDH、6.72%)、孤立性収縮期高血圧(ISH、7.06%)、収縮期・拡張期高血圧(SDH、10.05%)、正常血圧(76.17%)に群別した。追跡期間中央値6.78年で232名(10.51%)がCKDを発症した。TyGの1単位増加あたりのハザード比は、SDH(1.40、95%CI 1.19～1.64)>ISH(1.36、1.12～1.64)>IDH(1.31、1.06～1.62)>正常血圧(1.18、1.09～1.28)の順に高かった。中年男性のTyG高値は、高血圧の有無や分類にかかわらず、将来のCKD発症と関連することが示唆された。

Language：Japanese   Publisher：(一社)日本成人先天性心疾患学会  

Language：English   Publisher：Nature Publishing Group  

血圧日間変動と排便状況の関連について検討した。対象はコホート登録時と1年後に家庭血圧を月8日以上測定できた地域住民184名(女性110名、平均71±8歳)である。血圧の日間変動性の指標として1ヵ月間の家庭収縮期血圧の変動係数(CV)を算出した。毎日の排便の有無を自記式質問票で確認し、有りの場合を排便状況良好、無しの場合を不良とした。平均CV値は登録時5.93%、1年後5.88%であった。1年後にCVが上昇したのは89名で、その割合は排便状況良好群(61/145名、42%)に比べ、不良群(28/39名、72%)で高かった(P=0.001)。1年後のCV上昇を目的変数、年齢、性、排便状況、服薬状況(降圧剤、下剤、整腸剤)、登録時のCVを独立変数とする多変量回帰分析において、排便状況不良はCV上昇と独立した関連を示した(オッズ比3.81、95%CI 1.64～8.87、P=0.0019)。

Language：English   Publisher：(一社)日本循環器学会  

経皮的冠動脈インターベンション(PCI)施行患者を対象に、日本版高出血リスクスコア(J-HBR)、Academic Research Consortium for High Bleeding Risk(ARC-HBR)、Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy(PRECISE-DAPT)の大出血イベント識別能を比較した。本研究は単一施設後ろ向き観察研究であり、2017年1月～2020年12月に当院でPCIが施行された冠動脈疾患(CAD)の連続患者646例(男性76.8%、平均68.8±11.4歳)を組み入れた。J-HBR、ARC-HBR、PRECISE-DAPTの各スコアによると、それぞれ428例(66.3%)、319例(49.4%)、282例(43.7%)が高出血リスクであった。追跡期間中(中央値974日)、44例が大出血イベントを経験した。J-HBR、ARC-HBR、PRECISE-DAPT各スコアの大出血イベントに対する時間依存型ROC曲線を用いた曲線下面積(AUC)は、それぞれ30日以内で0.84、0.82、0.83、2年以内で0.86、0.83、0.80であった。AUC値は三つの出血リスクスコア間で有意差はなかった。短期・中期の大出血イベントに対して、J-HBRはARC-HBRおよびPRECISE-DAPTと同程度の識別能を有していることが示された。

Language：Japanese   Publisher：体液・代謝管理研究会  

症例は60歳代男性で、商業施設内のトイレで倒れているところを店員に発見され、当院へ救急搬送となった。救急隊接触時、意識レベルJCS III-200、心拍数156回/分、血圧146/135mmHg、呼吸数30回/分、SpO2 70%とショックバイタルで、便失禁があった。顔には黒褐色の嘔吐物が付着していた。酸素投与が開始され、来院時は意識レベルJCS II-10まで回復していたが、末梢冷感著明、眼瞼結膜は蒼白であった。動脈血ガス分析で代謝性アシドーシスと高度貧血を認め、ベッドサイドエコーでは肝周囲、左腎周囲、膀胱周囲、腸管周囲に腹水を認めた。大量輸液、炭酸ナトリウム投与、緊急輸血依頼を行い、ショック状態が持続していたため気管挿管し、人工呼吸器管理とした。胃前庭部からの持続的な出血と消化管狭窄を原因とした通過障害に伴う食事摂取量減少による循環血液量減少性ショックと判断し、意識レベルの改善後、Refeeding症候群の可能性を考慮して、栄養は200kcal/日の極少量から開始した。その後、経静脈的にリン、マグネシウム、カリウムの補正を開始したが、QT延長からTorsade de Pointes(TdP)が出現し電気的除細動を要した。一時ペーシングでTdPの抑制を行いつつ、電解質補正は継続し、その後不整脈の再発はなかった。意識レベル改善後に本人に聴取した結果、6年前から車中泊で生活しており、3ヵ月前から胃部不快感が強く食事摂取が困難となり、ほとんど水分のみで生活していたとのことであった。

CiNii Research

Language：English   Publisher：(一社)日本経カテーテル心臓弁治療学会  

経カテーテル大動脈弁留置術植込み術(TAVI)は、症候性重度大動脈弁狭窄症を有する高齢患者や高リスク外科患者の主要な治療法である。本研究では、当施設で広く使用されている最小サイズのバルーン拡張型経カテーテル心臓弁(THV)であるSAPIEN 3 20mmの安全性と有効性を後ろ向きに評価した。2017年6月～2022年10月に単施設でSAPIEN 3によるTAVIを受けた患者456例を、20mm THV群56例(女性98.2%、平均84.6±5.0歳)、23mm THV群254例(女性82.3%、平均85.5±4.3歳)、26/29mm THV群146例(女性25.3%、平均84.5±4.7歳)に分け、短期成績、有害事象、新規ペースメーカー植込み(PMI)、弁周囲漏出(PVL)、人工臓器患者不適合(PPM)、30日死亡率、2年死亡率を比較した。その結果、20mm THV群では新規PMIや中等度以上のPVLは観察されなかったが、中等度PPMの発生率は他群より有意に高かった。2年全死亡率には有意差が認められなかった。結論として、20mm THVの短期転帰は概ね良好であり、中等度PPMの増加は見られたものの、長期予後への影響は限定的である可能性が示唆された。

DOI： 10.1038/s41440-023-01535-0

DOI： 10.1253/circrep.CR-23-0087

DOI： 10.1136/bmjophth-2023-001456

Language：English  

DOI： 10.1097/MCA.0000000000001286

Language：Japanese   Publisher：Scientific Reports  

Hyperuricemia is reportedly associated with the progression of carotid intima-media thickness (IMT), a surrogate of cardiovascular risks and events. However, factors associated with carotid IMT progression in patients with asymptomatic hyperuricemia are largely unknown. In this post-hoc analysis of the multicenter, randomized PRIZE study, we analyzed data from a total of 326 patients who underwent carotid ultrasonography in a blind manner at baseline and 24 months to evaluate carotid IMT. Mean and maximum IMT at the common carotid artery (CCA) were measured at a central core laboratory. Factors related to the absolute change in mean and maximum IMT from baseline to 24 months were explored. Overall, the adjusted mean [0.0032 (− 0.0214 to 0.0278) mm] and maximum [0.0011 (− 0.0327 to 0.0351) mm] CCA-IMT increased numerically from baseline to 24 months. Multivariable analysis identified higher body mass index, history of atherosclerotic cardiovascular disease (ASCVD), and lower mean CCA-IMT at baseline as significant factors associated with the increase in mean CCA-IMT. In addition, older age and lower mean CCA-IMT at baseline were significant factors for an increased absolute change in the maximum CCA-IMT at 24 months. The present sub-analysis of the PRIZE study showed higher body mass index, history of ASCVD, and older age as significant factors associated with CCA-IMT progression in patients with asymptomatic hyperuricemia. These factors may be considered when identifying the possible risk of atherosclerotic progression in this specific patient population of hyperuricemia. Trial registration: UMIN000012911 and UMIN000041322.

DOI： 10.1038/s41598-023-37183-0

Scopus

Language：Japanese   Publisher：(公社)日本医師会  

Language：Japanese   Publisher：(公社)日本医師会  

Language：Japanese   Publisher：Scientific Reports  

Chronic kidney disease (CKD) is a risk factor for end-stage renal disease and contributes to increased risk of cardiovascular disease morbidity and mortality. We aimed to develop a risk prediction score and equation for future CKD using health checkup data. This study included 58,423 Japanese participants aged 30–69 years, who were randomly assigned to derivation and validation cohorts at a ratio of 2:1. The predictors were anthropometric indices, life style, and blood sampling data. In derivation cohort, we performed multivariable logistic regression analysis and obtained the standardized beta coefficient of each factor that was significantly associated with new-onset CKD and assigned scores to each factor. We created a score and an equation to predict CKD after 5 years and applied them to validation cohort to assess their reproducibility. The risk score ranged 0–16, consisting of age, sex, hypertension, dyslipidemia, diabetes, hyperuricemia, and estimated glomerular filtration rate (eGFR), with area under the curve (AUC) of 0.78 for the derivation cohort and 0.79 for the validation cohort. The CKD incidence gradually and constantly increased as the score increased from ≤ 6 to ≥ 14. The equation consisted of the seven indices described above, with AUC of 0.88 for the derivation cohort and 0.89 for the validation cohort. We developed a risk score and equation to predict CKD incidence after 5 years in Japanese population under 70 years of age. These models had reasonably high predictivity, and their reproducibility was confirmed through internal validation.

DOI： 10.1038/s41598-023-32279-z

Scopus

PubMed

DOI： 10.1038/s41440-023-01507-4

DOI： 10.1038/s41440-023-01505-6

Publisher：メディカルレビュー社  

DOI： 10.18885/hv.0000001383

CiNii Research

Language：Japanese   Publisher：(株)メジカルビュー社  

＜文献概要＞レニン・アンジオテンシン・アルドステロン(RAA)系阻害薬であるアンジオテンシン変換酵素(ACE)阻害薬やアンジオテンシンII受容体阻害薬(ARB)は,降圧薬や心不全治療,心筋梗塞後のリモデリング抑制,慢性腎臓病の蛋白尿抑制など幅広く使われているが,両者の違いや使い分けがあまり明確ではない。一方で,レニン阻害薬はエビデンス不足などからあまり使われていないことが問題である。本稿ではこれらの薬剤の有効的な使用法について言及したい。

Language：Japanese   Publisher：(NPO)日本心臓リハビリテーション学会  

【はじめに】重症心不全患者において周期性呼吸変動を認めることがあり,この現象は骨格筋の機能低下と交感神経活性異常による換気障害で生じる.今回,高度僧帽弁閉鎖不全症に対する手術介入後に周期性呼吸変動が改善した1例を経験したので報告する.【症例紹介】74歳,男性.拡張型心筋症に機能性高度僧帽弁閉鎖不全症を合併し,難治性心不全をきたし,僧帽弁形成術を施行した.手術前の心肺運動負荷試験で酸素脈,最高酸素摂取量の低下,二酸化炭素換気効率の上昇,周期性呼吸変動を認めた.僧帽弁形成術後,高度逆流は軽度まで改善し,リハビリも併用することで酸素脈,最高酸素摂取量の上昇,二酸化炭素換気効率およびBNP値の低下,両握力の改善を認め,周期性呼吸変動は消失した.【結論】僧帽弁逆流に対する手術介入と早期リハビリテーションにより血行動態の改善が得られ,周期性呼吸変動の消失につながったものと考えられた.(著者抄録)

Language：Japanese   Publisher：The Japan Geriatrics Society  

DOI： 10.3143/geriatrics.60.448

PubMed

CiNii Research

DOI： 10.2169/internalmedicine.2474-23

DOI： 10.1186/s12872-023-03547-7

Language：English   Publisher：(一社)日本心臓病学会  

症例は74歳女性で、重度の僧帽弁閉鎖不全を伴う僧帽弁逸脱の既往があった。微熱と下肢の紫斑を繰り返すため市中病院に入院となり、入院中に右手のしびれと脱力が出現し、MRIで左側頭葉と頭頂葉に多発性梗塞病変が認められた。MRI血管造影では右中大脳動脈に小動脈瘤を認め、心エコー検査で僧帽弁に15mm大の疣贅がみられた。血液培養でグラム陽性連鎖球菌が検出され、感染性心内膜炎との診断で当院に転院となった。入院時の胸部X線検査で軽度の肺うっ血がみられ、経食道心エコーでは腱索断裂による僧帽弁後尖(P2)の脱出を認めた。P2の疣贅と重度の僧帽弁逆流も検出された。バンコマイシンとメロペネムの投与を開始し、MRIで出血性梗塞が確認されたため、数週間の保存的治療を行った。最終的には血液培養でAbiotrophia defectivaのコロニーの存在が確認された。入院8日目に真菌性動脈瘤破裂によって突然死亡した。

Language：Japanese   Publisher：Journal of Invasive Cardiology  

DOI： 10.25270/jic/23.00180

Scopus

PubMed

Language：Japanese   Publisher：Journal of Cardiology Cases  

A 74-year-old woman with a history of mitral valve prolapse with mitral regurgitation was transferred to our hospital due to infective endocarditis. Blood culture revealed Abiotrophia defectiva which is known as a nutritional variant streptococcus. Transesophageal echocardiography revealed posterior leaflet (P2) prolapse due to rupture of tendon chordae with severe mitral regurgitation and vegetation on posterior leaflet. Magnetic resonance imaging (MRI) revealed multiple infarction lesions in left temporal lobe and parietal lobe and mycotic aneurysm formation of right middle cerebral artery. Because A. defectiva cannot be cultured on non-supplemented media, their prevalence may be underreported. Learning objective: A number of causative microorganisms of infective endocarditis have been identified. Streptococci and staphylococci account for 80 % of cases of infective endocarditis. Abiotrophia defectiva does not grow in ordinary growth media and its prevalence may be underreported. It is important to know A. defectiva causes infective endocarditis with mycotic aneurysm formation.

DOI： 10.1016/j.jccase.2023.06.002

Scopus

PubMed

Language：Japanese   Publisher：(一社)日本老年医学会  

Language：Japanese   Publisher：(一社)日本脈管学会  

Language：Japanese   Publisher：(一社)日本老年医学会  

症例は認知症のある92歳独居男性.右中下葉肺炎のため3ヵ月間で3度入院した.入院時は毎回揮発油様の体臭と尿臭があり数日で消失していた.3度目の入院の際に灯油に漬けられた柿が自宅にあることが判明し,慢性的な灯油の摂取や誤嚥により肺炎が反復したと考えられた.灯油による肺障害は小児の誤飲や成人の自殺企図で問題になることが多いが,認知症患者においては日常的な摂取が隠れている可能性がある.(著者抄録)

Language：English   Publisher：シュプリンガー・ジャパン(株)  

待機的経皮的冠動脈インターベンション(PCI)を施行された65歳以上の安定狭心症患者239例を対象に、術前のフレイルが長期転帰に影響するかどうか検討した。患者を、臨床フレイルスケール(CFS)が5点以上のフレイル群38例(男性68.4%、平均79.5±7.5歳)と5点未満の非フレイル群201例(男性74.6%、平均74.0±6.6歳)に分類した。主要評価項目は全死亡、非致死性心筋梗塞、脳卒中、入院を要する心不全を合わせた主要心血管イベント(MACE)およびBARC出血基準タイプ3またはタイプ5の出血イベントとした。患者背景はフレイル群の方が高齢で、心不全、脳卒中、末梢動脈疾患の既往が多かった。平均追跡期間は962日で、MACEは46例、出血イベントは10例で発生した。Kaplan-Meier曲線でMACEの発生率はフレイル群の方が有意に高かった(P<0.001)。多変量解析の結果、術前のCFSが5点以上はMACE発生を予測する独立因子であった(HR 4.27、95%CI 1.86～9.80、P<0.001)。さらに出血イベントの累積発生率もフレイル群の方が有意に高かった(P=0.001)。

DOI： 10.1038/s41440-023-01435-3

DOI： 10.1016/j.jacasi.2023.07.006

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：Journal of Clinical Hypertension  

The next-generation mineralocorticoid receptor blocker (MRB) esaxerenone has favorable antihypertensive effects in patients who do not respond to treatment with first-line antihypertensive agents and may be beneficial as a second-line treatment. However, MRBs are currently considered a fourth-line treatment as there is no clinical evidence comparing the efficacy of esaxerenone with other classes of antihypertensive agents. The multicenter, randomized, open-label, parallel-group EXCITE-HT study will evaluate the efficacy and safety of esaxerenone as a second-line agent in the treatment of Japanese patients with uncontrolled essential hypertension. After a 4-week run-in period, patients will receive either esaxerenone or trichlormethiazide for 12 weeks per the package insert and the Japanese Society of Hypertension Guidelines for the Management of Hypertension. At Weeks 4 and 8, the dose of esaxerenone or trichlormethiazide may be increased. Blood pressure (home [morning and bedtime] and office), serum biomarkers, and urinary biomarkers will be measured. The primary efficacy endpoint is the change from baseline in morning home systolic blood pressure/diastolic blood pressure to the end of treatment. The EXCITE-HT study is expected to validate the non-inferiority of esaxerenone to trichlormethiazide and provide the first evidence for the early use of esaxerenone as a second-line agent in the treatment of Japanese patients with uncontrolled essential hypertension instead of its current use as a fourth-line agent.

DOI： 10.1111/jch.14705

Scopus

PubMed

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(NPO)日本高血圧学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：English   Publisher：(一社)日本心臓病学会  

症例は55歳男性で、6年前に胸腺腫瘍、3年前に肺腫瘍と膵腫瘍の手術を受けて、病理学的に神経内分泌腫瘍(NET)と診断されていた。今回、定期検診時の心電図で深い陰性T波が認められ、心エコーで左心尖部の腫瘍が明らかになった。胸痛はなく、血液検査で軽度貧血が認めれ、乳酸脱水素酵素、脳性ナトリウム利尿ペプチド、Dダイマーが上昇していた。2年8ヵ月前に膵全摘術を受けていたことから膵性糖尿病であった。CEA、CA19-9、S-1L2Rなどの腫瘍マーカーは上昇していなかった。オクトレオスキャンでは心尖部に集積が認められ、造影CTでも左室心尖部に造影腫瘤が認められた。脊椎、肋骨、肩甲骨に複数の骨転移が認められ、外科的生検の結果、いずれもNET転移と診断した。心臓のKi-67指数は16%で、G2 NETと一致した。週1回のストレプトゾトシン療法が開始し、1年後には造影CTで心臓腫瘍の増大は認められず、病勢安定と判定された。2年後も心電図所見に変化はなく、心エコーでも腫瘍の増大は認められなかった。

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Publisher：東京医学社  

DOI： 10.24479/kd.0000000841

CiNii Research

DOI： 10.1007/s11739-023-03385-7

Publisher：The Japanese Society of Internal Medicine  

DOI： 10.2169/internalmedicine.1004-22

PubMed

DOI： 10.1016/j.jjcc.2023.01.006

PubMed

Language：Japanese   Publisher：Journal of Cardiology Cases  

Pulmonary artery hypertension associated with human immunodeficiency virus infection (PAH-HIV) is known to be caused by HIV infection. Antiretroviral therapy and PAH-specific drugs improve the prognosis of patients with PAH-HIV, but the pathophysiology of PAH-HIV remains unclear. We report a case of PAH-HIV treated with upfront combination therapy including subcutaneous injection of treprostinil. One year after treatment initiation, the patient's PAH improved significantly. However, it worsened over time due to reduced efficacy of subcutaneous injection of treprostinil. Learning objective: The etiology and pathophysiology of pulmonary artery hypertension associated with human immunodeficiency virus infection (PAH-HIV) remain unclear, and there are few case reports of PAH-HIV in Japan because the HIV prevalence is low. We encountered a case of PAH-HIV in which the efficacy of subcutaneous treprostinil injection was attenuated. It was unclear whether the reduced efficacy was associated with the pathophysiology of PAH-HIV. When PAH control deteriorates, early alteration of medication choice and administration route is important.

DOI： 10.1016/j.jccase.2023.04.008

Scopus

PubMed

Language：Japanese   Publisher：(一社)日本心血管インターベンション治療学会  

Language：English   Publisher：Nature Publishing Group  

Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

Language：Japanese   Publisher：(株)東京医学社  

Language：Japanese   Publisher：(株)日本臨床社  

Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

Language：English   Publisher：(一社)日本心臓病学会  

心肺停止後に自己心拍再開(ROSC)を果たした患者の予測因子と30日死亡率を評価し、その結果を利用することで臨床パラメータから30日死亡率を算出する計算式を構築して、その性能を調べた。導出コホートは1病院で、検証コホートはそれとは異なる2病院で後ろ向きに組み入れた。どの患者も2015年4月～2022年3月に入院した18歳以上のROSC後症例とした。導出コホートでは死亡の転帰を辿った116名と生存例78名を比較した。30日死亡率と関連していた因子は、性別、年齢、心肺停止時の目撃者の存在、バイスタンダーによる心肺蘇生、急性心筋梗塞による心肺停止、瞳孔径、Glasgow Coma Scaleスコア、対光反射の存在、動脈血または静脈血のpH、乳酸濃度、初回の心室細動、心肺停止時間、であった。このうち7因子を使用し、死亡確率を推定するロジスティック回帰式を導出した。この式で算出された推定死亡確率のカットオフ値を54.5%に定めた場合、その感度は86.2%、特異度は80.8%、精度は84.5%となった。検証モデルではこれらの3値は同順で81.8、85.7、82.5%となった。このように、ROSC後の心肺停止患者では、簡単な臨床パラメータを使用して30日死亡率を算出できる可能性が示された。

Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

Language：English   Publisher：(一社)日本心臓病学会  

症例は41歳男性。単純ヘルペスウイルス網膜炎の発症後に後天性免疫不全症候群と診断された。その後、右眼の視力低下と左眼の重度視力障害を経験し、高活性抗レトロウイルス療法によりHIV-RNA量はコントロールされていた。心エコー検査で右心肥大と三尖弁逆流圧較差(TRPG)が認められ、右心カテーテル検査の所見から肺高血圧症が考えられたため、HIV関連肺動脈性肺高血圧症(PAH)と診断した。抗レトロウイルス療法をドルテグラビルナトリウム、アバカビル硫酸塩、ラミブジンに変更した。マシテンタンとタダラフィルの経口投与によって症状は軽減したが、労作時呼吸困難が再び出現した。トレプロスチニル皮下投与を開始したところ、症状と血行動態は改善した。PAHの診断から3年後、タダラフィルをリオシグアトに変更し、トレプロスチニルを増量した。しかし、診断から5年後に心エコーでTRPG悪化が認められたため入院した。トレプロスチニルを増量しても頭痛や吐き気などの副作用が認められなくなったことから、トレプロスチニルの効果が不十分であることが疑われた。トレプロスチニルを静脈内投与に切り替えたところ、直ちに顔面紅潮、頭痛、嘔気などの副作用が出現し、1週間後に血行動態は改善した。

Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Heart Journal Association  

<p>Arterial stiffness has been reported to cause left atrial (LA) remodeling due to increased left ventricular filling pressure, resulting in atrial fibrillation (AF). This study aimed to evaluate the association between LA reverse remodeling (LARR) after AF ablation and cardio-ankle vascular index (CAVI), an indicator of arterial stiffness.</p><p>This study included 333 patients with AF (171 with paroxysmal AF and 162 with nonparoxysmal AF) and LA enlargement (LA volume index ≥ 34 mL/m²) who underwent AF ablation between December 2008 and July 2021. CAVI was evaluated preoperatively during AF (<i>n</i> = 155, 46.5%) or sinus rhythm (<i>n</i> = 178, 53.5%). Participants were divided into groups with LARR (<i>n</i> = 133, 39.9%) and without LARR (<i>n</i> = 200, 60.1%) according to whether the degree of decrease in LA volume index on transthoracic echocardiography 6 months after ablation was ≥ 15% or < 15%, respectively.</p><p>Sinus rhythm was maintained in 168 (50.5%) patients within 3-6 months after the index procedure. Univariate analysis revealed that preoperative CAVI (7.80 ± 1.22 versus 8.57 ± 1.09, <i>P</i> < 0.001) was significantly lower, and the maintenance of sinus rhythm (61.6% versus 43.0%, <i>P</i> = 0.0011) was higher in the group with LARR. Multivariate logistic regression analysis revealed that preoperative CAVI was independently associated with LARR (odds ratio, 0.60, 95% confidence interval, 0.46-0.78, <i>P</i> < 0.001).</p><p>In patients with AF and LA enlargement, CAVI is independently associated with LA reverse remodeling after catheter ablation.</p>

DOI： 10.1536/ihj.23-072

Scopus

PubMed

CiNii Research

Language：Japanese   Publisher：(株)日本臨床社  

Language：English   Publisher：(一社)インターナショナルハートジャーナル刊行会  

カテーテルアブレーションを施行した左房拡大を示す心房細動(AF)患者を対象に、術前の心臓足首血管指数(CAVI)がアブレーション後の左房リバースリモデリング(LARR)と関連するかどうか検討した。対象は左房容積係数が34mL/m2以上のAF患者333例で、171例が発作性AF、162例が非発作性AFであった。アブレーション施行から6ヵ月後に経胸壁心エコー検査を実施し、左房容積係数が15%以上減少した症例をLARRと定義した。患者をLARR陽性群133例(男性74.4%、平均60.1±9.3歳)と陰性群200例(男性71.0%、平均64.6±8.8歳)の2群に分類した。術前のCAVIはLARR陽性群(7.80±1.22)の方が陰性群(8.57±1.09)より有意に低かった(P<0.001)。洞調律を維持した患者は陽性群(61.6%)の方が陰性群(43.0%)より有意に多かった(P<0.001)。重回帰ロジスティック分析で術前のCAVIはアブレーション後のLARRを予測する独立因子であった(OR 0.60、95%CI 0.46～0.78、P<0.001)。

Language：Japanese   Publisher：Japan Health & Research Institute  

<p><b>【Background】</b></p><p>The purpose of the study was to examine the association between bathing habits and objectively assessed sleep or arterial stiffness.</p><p><b>【Methods】</b></p><p>Study 1 included 202 old adults aged 65 years or older, and Study 2 included 524 participants with CAVI (Cardio-Ankle Vascular Index) in Tarumizu Study 2021. Bathing habits were investigated by questionnaire, and objective sleep was assessed by wearing an ActiGraph for one week.</p><p><b>【Results】</b></p><p>In Study 1, there was no significant association between bathing habits (frequency of bathing at home or in hot springs, frequency of hot springs, and communication in hot springs) and sleep duration or sleep efficiency in old adults. In Study 2, CAVI value of the daily bathed group (n=472) was significantly lower than that of the non-daily bathed group (n=52) (8.6±1.1 vs. 9.3±1.4, p=0.002). There was no significant difference in CAVI values between the bathing hot spring at least once a week (n=124) and not (n=400).</p><p><b>【Conclusion】</b></p><p>No significant association was found between bathing habits and objectively assessed sleep duration or sleep efficiency in old persons. In a community-based cohort that included younger adults, the daily bathed group had lower arterial stiffness than the non-daily bathed group.</p>

DOI： 10.32279/jjhr.202344j02

CiNii Research

Language：Japanese   Publisher：(一社)日本集中治療医学会  

Language：English  

DOI： 10.7759/cureus.40837

PubMed

Language：Japanese   Publisher：(一社)日本集中治療医学会  

Language：Japanese   Publisher：(一財)日本健康開発財団  

背景・目的 研究の目的は、入浴習慣と客観的に評価した睡眠との関連、および動脈硬化との関連を検討することである。方法 研究1は、2021年度に開催された垂水市在住者の健康チェック(垂水研究2021年)に参加した65歳以上の高齢者202人、研究2は、垂水研究2021年の全参加者のうち、血管硬化度の指標であるCAVI(Cardio-Ankle Vascular Index)を解析できた524人を対象者とした。入浴習慣は質問票により調査し、客観的睡眠評価は、アクチグラムを1週間装着して評価した。結果 研究1:65歳以上の高齢者において、入浴習慣(自宅や温泉の入浴頻度、温泉の利用頻度、温泉でのコミュニケーション)とアクチグラフを用いて客観的に評価した睡眠時間や睡眠効率との関連を検討したが、有意な関連は認めなかった。研究2:自宅や温泉で毎日入浴する群(472人)のCAVI値は8.6±1.1であり、毎日入浴しない群(52人)のCAVI値9.3±1.4と比較して有意に低値を示した(p=0.002)。週1回以上温泉に行く群(124人)と週1回以上温泉に行かない群(400人)のCAVI値に有意差は認めなかった。結論 65歳以上の高齢者において、入浴習慣と客観的に評価した睡眠時間や睡眠効率との有意な関連は認めなかった。若年者も含めた地域在住コホートにおいて、自宅や温泉に毎日入浴する群は血管硬化度が低いことが示唆された。(著者抄録)

Language：English   Publisher：(一社)日本心臓病学会  

経皮的冠動脈インターベンション(PCI)を緊急施行した急性冠症候群(ACS)患者を対象に、出血リスクの評価目的で使用されているAcademic Research Consortium for High Bleeding Risk(ARC-HBR)基準のスコアと、PCI後の臨床成績との関連性を評価した。2017～2020年に当院で緊急PCIを施行し成功したACSの連続患者を後方視的に調査し、338名(男性78.4%、平均67.6±12.4歳)を解析対象とした。観察期間の中央値は864日で、この間に70名が主要有害心血管イベント(MACE)(全死因死亡、非致死性心筋梗塞、非致死性脳卒中の複合)を発症した。ベースラインデータから算出したARC-HBRスコアによって本集団を3層に分類しカプラン・マイヤー解析を施行した結果、MACEの累積発症率は、ARC-HBRスコアが段階的に上がるにつれ有意に上昇していることが明らかになった(log-rank p<0.001)。こうした結果から、ACS患者ではARC-HBRスコアは緊急PCI施行後のMACEリスク増大の独立関連因子になっていたと結論された。さらに受信者動作特性(ROC)曲線解析を行った結果から、緊急PCI施行後2年以内のMACE発症予測に関するARC-HBRスコアの診断能は、CADILLACリスクスコアと同程度であることも明らかになった。

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12933-023-01856-x

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PubMed

Language：Japanese   Publisher：International Journal of Cardiology  

Background: Carotid plaque is a well-known prognostic factor for cardiovascular diseases. It is unclear which risk factors are associated with the transformation of carotid plaque over time. In this longitudinal study, we examined the risk factors related to carotid plaque progression. Methods: We enrolled 738 men without medication (mean age: 55 ± 10 years) who underwent the first and second health examinations. We measured carotid plaque thickness (PT) at three points of the right and left carotid artery. Plaque score (PS) was calculated by summing all the PTs. We divided the PS into three groups: None-group (PS <1.1), Early-group (1.1 ≤ PS <5.1), and Advanced-group (PS ≥5.1). We analyzed the relationship between PS progression and parameters such as age, body mass index, systolic blood pressure (SBP), fasting blood sugar, low-density lipoprotein cholesterol (LDL-C), and smoking and exercise habits. Results: In multivariable logistic regression analysis, age and SBP were independent factors for PS progression from none to early stages (age, OR 1.07, p = 0.002; SBP, 10 mmHg, OR 1.27, p = 0.041). Age, follow-up period and LDL-C were independently associated factors for PS progression from early to advanced stages (age, OR 1.08,p < 0.001; follow-up period OR1.19, p = 0.041; LDL-C, 10 mg/dL, OR 1.10, p = 0.049). Conclusions: SBP was independently associated with the progress of early atherosclerosis, while LDL-C was independently associated with the progression of advanced atherosclerosis in the general population. Further studies are needed to assess whether early control of SBP and LDL-C levels can reduce the occurrence of future cardiovascular events.

DOI： 10.1016/j.ijcard.2023.02.037

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PubMed

Language：Japanese   Publisher：(株)ライフメディコム  

高血圧は脳心血管病の最大のリスク因子のひとつであるが,コントロール状況は良好であるとは言えない.人口がさほど多くない鹿児島県の2つの都市で,一点集中型の重症化高血圧ゼロ!教室in垂水と全都市包括型の高血圧ゼロの街枕崎の2つの高血圧ゼロのまちづくりを行っているので紹介したい.重症化高血圧ゼロ!教室では年間約7mmHgの血圧低下を認めるという直接的な改善を得られ,これが口コミで近隣住民に広がることを期待している.高血圧ゼロの街枕崎では市内至るところに血圧計を設置して自由に血圧を測ってもらうなどの試みをして一定の効果が得られたが,新型コロナウイルス感染症の拡大により大幅な軌道修正を必要とした.高校生へのアプローチや家庭血圧測定などwithコロナの対応をすることで,さらに充実した高血圧ゼロのまちづくりを行っていきたいと考えている.(著者抄録)

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

垂水研究に参加した高齢者を対象として、墓参りと抑うつ症状およびアパシーとの関連を調べた。評価項目は高齢者うつ尺度、墓参りに関する項目(墓参りの有無、頻度、移動時間、移動手段、供花)などとした。高齢者を墓参状況により、頻繁群240名(週1回以上、平均74.9±6.4歳、女性170名)、不定期群346名(週1回未満、平均73.8±6.4歳、女性195名)、非墓参群52名(墓参せず、平均74.6±7.1歳、女性32名)に分けて検討した。その結果、非墓参群は墓参群と比較して、アパシー有病率が有意に高かった。潜在的共変量調整後のポアソン回帰分析の結果、非墓参群はアパシーと有意に関連していた。以上のように、高齢者において墓参りをしないこととアパシーには有意な関連があることが示された。

Language：English   Publisher：(一社)日本動脈硬化学会  

一般日本人における上腕-足関節脈波伝播速度(baPWV)とSuitaスコアまたはFraminghamリスクスコアの関連を評価し、心血管リスクの男女別および年齢別のbaPWVカットオフ値を検討した。日本の単一施設で健康診断を行った25602名(男性14539名、女性11063名)の大規模データを用いて横断研究を行った。男女ともに、SuitaスコアはFraminghamリスクスコアよりもbaPWVとの関連性が良好であった。ROC曲線解析において、Suitaスコアを用いて推定した中等リスク～高リスク群についてのbaPWVカットオフ値は、男性では40歳代1350cm/s、50歳代1430cm/s、60歳代1520cm/s、70歳代1880cm/s、女性では40歳代1350cm/s、50歳代1430cm/s、60歳代1570cm/s、70歳代1800cm/sであった。

Language：English   Publisher：Japan Medical Association / The Japanese Associaiton of Medical Sciences  

<p><b>Introduction:</b> Blood gas analysis is an important test for making quick and important clinical decisions, and it is recommended that a dedicated syringe that contains heparin be used to measure blood gas. We hypothesized that a plastic syringe could be used as a less-expensive substitute for a dedicated syringe, given that the test is performed immediately after collection.</p><p><b>Methods:</b> This single-center, prospective, observational study involved patients admitted to the Kanoya Medical Center (Kagoshima, Japan) between July 2020 and March 2021, who were requiring blood gas analysis using a dedicated syringe under arterial line (A-line) monitoring. There were no exclusion criteria. Two samples were collected from each patient using a dedicated syringe, and one sample was collected using a plastic syringe. To determine clinical substitutability, Bland-Altman analysis was performed.</p><p><b>Results:</b> A total of 60 samples from 20 consecutive patients were collected and assayed. The mean patient age was 72 years, and 75% patients were men. The 95% limit of agreement for pH, PCO₂, PO₂, Na, K, Ca, and SO₂ were similar for both dedicated and plastic syringes. HCO₃ and BE were significantly higher in the samples taken with plastic syringes, whereas Hb and Ht could not be measured accurately with any syringe.</p><p><b>Conclusions:</b> The use of plastic syringes in place of dedicated syringes is generally considered acceptable for most items considering that measurement is performed within 3 min of collection, and the cost of medical materials may be reduced. Regardless of the type of syringe, caution should be exercised in interpreting the results of measuring Hb and Ht using a blood gas analyzer.</p>

DOI： 10.31662/jmaj.2022-0186

PubMed

CiNii Research

Language：Japanese   Publisher：(有)科学評論社  

Language：English   Publisher：(公社)日本医師会  

血液ガス分析に用いられるプラスチックシリンジの有用性を検討した。2020年7月～2021年3月の間に当院で動脈ライン(Aライン)モニタリング下に専用シリンジを用いて血液ガス分析を行った20例(男性15例、女性5例、平均72±14.5歳)の60サンプルを対象に単施設前向き観察研究を実施した。各患者から専用シリンジによる2サンプル、プラスチックシリンジによる1サンプルを採取し、臨床的代替可能性を評価した。pH、二酸化炭素分圧、酸素分圧、ナトリウム、カリウム、カルシウム、酸素飽和度の95%一致限界は専用シリンジ使用時とプラスチックシリンジ使用時にほぼ差は認められず、重炭酸と過剰塩基はプラスチックシリンジ使用時の方が有意に高値を示していた。ヘモグロビン値とヘマトクリット値はいずれのシリンジを用いた場合でも精度の高い測定は困難であった。プラスチックシリンジは専用シリンジの代用として利用可能であり、医療コストの削減につながるものと思われた。

Language：English   Publisher：(公社)日本医学放射線学会  

2018年4月～2021年8月までの期間内に、術前に[123I]-メタヨードベンジルグアニジン(MIBG)投与によるプラナー画像撮像とSPECT/CT検査を受け、心エコー検査も施行された褐色細胞腫患者18例(男性11例、女性7例、年齢28～76歳)を調査対象とした。後向きに検討した結果、肉眼的には6例は心筋の[123I]-MIBG集積が正常であったが、12例には心筋への[123I]-MIBG集積低下が認められた。また、心筋の[123I]-MIBG集積が正常な患者と集積が低下した患者では拡張機能不全の発症率に有意差が認められ、集積が低下した患者12例中9例には左室拡張機能不全が認められた。さらに、左室拡張機能不全が認められた9例の心筋のSUVmaxは心機能が正常な9例に比べ有意に低く、心筋のSUVmaxは中隔のe'と正相関を示し、中隔のE/e'とは負の相関性が示された。以上より、心筋[123I]-MIBG SUVmaxは、褐色細胞腫患者の心機能特性の評価に有用と考えられた。

DOI： 10.1016/j.jamda.2023.03.010

Language：Japanese   Publisher：The Japanese Society of Internal Medicine  

DOI： 10.2169/naika.112.332

CiNii Research

Language：Japanese   Publisher：(一社)日本内科学会  

Language：English   Publisher：(一社)日本心臓病学会  

症例は68歳男性で、気腫合併肺線維症による肺性心を有していた。今回、労作時呼吸困難のため来院した。急性心不全の診断で入院となり、カテコールアミンとフロセミド治療で状態は改善した。約2週間後に退院し、在宅酸素療法を開始し、その後当院にてタダラフィル、エナラプリル等の内服療法を行っていた。退院後の安定期(31日間)、心不全増悪前(発症直前2週間)、心不全増悪による入院期間を含む7ヵ月間、週に2回心音と心電図を記録して、心音バイオマーカー(CAB)として定量化を行い、CABの変化と心不全による入院との関係性を調査した。入院に至る心不全増悪が始まる直前の増悪前期間中に、おそらく右心からのものと思われる第3心音(S3)強度の可聴不能な変化が観察された。第4心音(S4)強度の値は、安定期および増悪前には高値であったが、入院中に著しく低下した。S3およびS4を含むCABが右心不全増悪と治療により変化することから、増悪徴候の早期検出に有用であることが示唆された。

DOI： 10.1111/psyg.12945

Language：English   Publisher：(一社)日本循環器学会  

Dダイマー≧1.5μg/mL、年齢≧60歳、女性、グルココルチコイド治療継続中、深部静脈血栓症(DVT)高リスク癌、および長時間の不動状態をスコア化したKagoshima-DVTスコア(KDS)を用いて、初回化学療法を受けた消化器癌患者250名(男性158名、女性92名、年齢中央値67歳)の癌関連血栓症(CAT)リスクを評価した。患者はKDSにより低リスク120名(48%)、中リスク97名(38.8%)および高リスク(13.2%)に層別された。61名(27.1%)がCATを発症した。低リスク群の19名(17.6%)、中リスク群の30名(35.3%)および高リスク群の12名(36.4%)がCATを発症した。1年以内のCAT発症の時間依存性ROC曲線下面積は、CATリスク評価モデルであるKhoranaスコア(0.494)と比べてKDS(0.653)で大きかった。CATリスク評価においてKDSはKhoranaスコアより優れていると考えられた。

Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> Cancer-associated thrombosis (CAT) is a common complication of cancer and has received increasing attention; the Khorana Risk Score (KRS) is a recommended but insufficient risk assessment model for CAT. We propose a novel Kagoshima-DVT score (KDS) to predict preoperative deep vein thrombosis (DVT). This scoring method scores D-dimer ≥1.5 μg/mL, age ≥60 years, female sex, ongoing glucocorticoids, cancer with high risk of DVT, and prolonged immobility. The purpose of this study was to compare the performance of the KDS and KRS in predicting CAT in patients with gastrointestinal cancer.</p><p><b><i>Methods and Results:</i></b> In all, 250 patients without a history of thrombosis who received their first chemotherapy for gastrointestinal cancer were divided into low- (48.0%), intermediate- (38.8%), and high-risk (13.2%) groups for CAT development by the KDS. The patients’ median age was 67 years and 63.2% were men. In all, 61 (27.1%) patients developed CAT (17.6%, 35.3%, and 36.4% of patients in the low-, intermediate, and high-risk groups, respectively; log-rank P=0.006). The area under the time-dependent receiver operating characteristic curve for CAT occurrence within 1 year was larger for the KDS than KRS (0.653 vs. 0.494).</p><p><b><i>Conclusions:</i></b> A high KDS at the start of first chemotherapy is a risk indicator for CAT development during chemotherapy. Moreover, the KDS is more useful than the KRS in predicting CAT risk.</p>

DOI： 10.1253/circrep.cr-22-0112

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria have been used to identify high-risk patients undergoing percutaneous coronary intervention (PCI) in current clinical practice. This study aimed to evaluate the association between the number of ARC-HBR criteria and clinical outcomes in patients with acute coronary syndrome (ACS) after an emergent PCI. METHODS: We assessed 338 consecutive patients with ACS who underwent successful emergent PCI between January 2017 and December 2020. The ARC-HBR score was calculated by assigning 1 point to each major criterion and 0.5 points to each minor criterion. The patients were classified into low (ARC-HBR score<1), intermediate (1≤ARC-HBR score<2), and high (ARC-HBR score≥2) bleeding risk groups. We investigated the association between the ARC-HBR score and major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, non-fatal myocardial infarction, and non-fatal stroke. We also compared the diagnostic ability of the ARC-HBR score and Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) risk score. RESULTS: The mean age of the patients was 67.6±12.4years, and 78.4% were men. During the median follow-up of 864 (557-1309) days, 70 patients developed MACEs. Kaplan-Meier curves showed that the cumulative incidence of MACE was significantly higher as the ARC-HBR score increased in a stepwise manner (log-rank p<0.001). There were no significant differences in the area under the receiver operating characteristic curve (AUC) for predicting MACE within two years after an emergent PCI between the ARC-HBR and CADILLAC risk scores (AUC: 0.763 vs. 0.777). CONCLUSIONS: ARC-HBR score was independently associated with an increased risk of MACE in patients with ACS after an emergent PCI. Moreover, it had a similar diagnostic ability for predicting MACE within two years compared to the CADILLAC risk score.

DOI： 10.1016/j.jjcc.2023.01.003

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PubMed

Language：Japanese   Publisher：(株)日本臨床社  

Language：Japanese   Publisher：大道学館出版部  

Language：Japanese   Publisher：Journal of Cardiology Cases  

A 55-year-old male underwent surgery for thymus gland tumors six years previously, and for lung and pancreas tumors three years previously, which were pathologically diagnosed as neuroendocrine tumors (NETs). During routine medical checkups, a giant negative T-wave was observed on the electrocardiogram. Echocardiography revealed a tumor at the apex. A surgical biopsy was performed; the tumor was diagnosed as a cardiac metastasis of NETs, and chemotherapy was initiated. Two years later, echocardiography confirmed that the tumor had not increased in size. A 2-year follow-up of NETs cardiac metastasis is rare; we therefore report this case. Learning objective: Neuroendocrine tumors are considered slowly progressing tumors, but despite the presence of cardiac metastasis, accurate diagnosis and appropriate treatment have allowed the patient to survive the disease for more than two years.

DOI： 10.1016/j.jccase.2023.05.002

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PubMed

Language：Japanese   Publisher：Heart and Vessels  

There are few reports on the long-term clinical outcome after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) complicated with frailty. This novel study investigated the association between pre-PCI frailty and long-term clinical outcomes in elderly patients aged 65 years or older with stable CAD who underwent elective PCI. We assessed 239 consecutive patients aged 65 years or older with stable CAD who underwent successful elective PCI at Kagoshima City Hospital between January 1st, 2017 and December 31st, 2020. Frailty was retrospectively assessed using the Canadian Study and Aging Clinical Frailty Scale (CFS). Based on the pre-PCI CFS, patients were divided into two groups: the non-frail (CFS < 5) and the frail (CFS ≥ 5) group. We investigated the association between pre-PCI CFS and major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure requiring hospitalization. Additionally, we assessed the association between pre-PCI CFS and major bleeding events defined as Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. The mean age was 74.8 ± 7.0 years, and 73.6% were men. According to the pre-PCI frailty assessment, 38 (15.9%) and 201 (84.1%) were classified as frail and non-frail groups, respectively. During a median follow-up of 962 (607–1284) days, 46 patients developed MACEs and 10 patients developed major bleeding events. Kaplan–Meier curves showed a significantly higher incidence of MACE in the frail group compared to those in the non-frail group (Log-rank p < 0.001). Even in multivariate analysis, pre-PCI frailty (CFS ≥ 5) was independently associated with MACE (HR 4.27, 95% CI 1.86–9.80, p-value: < 0.001). Additionally, the cumulative incidence of major bleeding events was significantly higher in the frail group than in the non-frail group (Log-rank p = 0.001). Pre-PCI frailty was an independent risk factor for MACE and bleeding events in elderly patients with stable CAD who underwent elective PCI.

DOI： 10.1007/s00380-023-02276-3

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PubMed

Language：Japanese   Publisher：Plos One  

Background Predicting metabolic syndrome (MetS) is important for identifying high-risk cardiovascular disease individuals and providing preventive interventions. We aimed to develop and validate an equation and a simple MetS score according to the Japanese MetS criteria. Methods In total, 54,198 participants (age, 54.5±10.1 years; men, 46.0%), with baseline and 5-year follow-up data were randomly assigned to 'Derivation' and 'Validation' cohorts (ratio: 2:1). Multivariate logistic regression analysis was performed in derivation cohort and scores were assigned to factors corresponding to β-coefficients. We evaluated predictive ability of the scores using area under the curve (AUC), then applied them to validation cohort to assess reproducibility. Results The primary model ranged 0-27 points had an AUC of 0.81 (sensitivity: 0.81, specificity: 0.81, cut-off score: 14), and consisted of age, sex, blood pressure (BP), body mass index (BMI), serum lipids, glucose measurements, tobacco smoking, and alcohol consumption. The simplified model (excluding blood tests) ranged 0-17 points with an AUC of 0.78 (sensitivity: 0.83, specificity: 0.77, cut-off score: 15) and included: age, sex, systolic BP, diastolic BP, BMI, tobacco smoking, and alcohol consumption. We classified individuals with a score <15 and ≥15 points as low- and high-risk MetS, respectively. Furthermore, the equation model generated an AUC of 0.85 (sensitivity: 0.86, specificity: 0.55). Analysis of the validation and derivation cohorts yielded similar results. Conclusion We developed a primary score, an equation model, and a simple score. The simple score is convenient, well-validated with acceptable discrimination, and could be used for early detection of MetS in high-risk individuals. Copyright:

DOI： 10.1371/journal.pone.0284139

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PubMed

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Atherosclerosis Society  

<p> <b>Aim:</b> This study aims to investigate the association of the Cardio-Ankle Vascular Index (CAVI) with self-reported sleep duration and sleep quality in community-dwelling older adults aged ≥ 65 years.</p><p><b>Methods:</b> The Tarumizu Study was a cohort of community-based health checkups conducted in the Tarumizu City, Japan, in 2018 and 2019. In total, 997 participants aged ≥ 65 years (median age, 74 years) were examined. We obtained the average sleep duration and sleep quality using self-reported questionnaires and classified them into three separate groups according to sleep duration (＜6 h, 6–8 h, and ≥ 8 h) and sleep quality (good, medium, and poor). The arterial stiffness was measured using the CAVI.</p><p><b>Results:</b> As per our findings, the CAVI was significantly higher in the ≥ 8 h sleep group (CAVI=9.6±1.3) than in the ＜6 h (CAVI=9.1±1.1) or 6–8 h (CAVI=9.1±1.2) groups (<i>p</i>＜0.001). After adjustment for age, sex, systolic blood pressure, current smoking status, body mass index, frequency of exercise, educational background, frailty, sleep medication, sleep quality, and nap duration, multivariable regression analysis demonstrated that the CAVI was significantly higher in the ≥ 8 h group than in the 6–8 h group (<i>p</i>=0.016). In contrast, multivariable regression analysis showed that there was no significant association between sleep quality and CAVI.</p><p><b>Conclusions:</b> A significant association was noted between long sleep duration (≥ 8 h) and elevated CAVI in community-dwelling older adults aged ≥ 65 years. We, therefore, suggest that long sleep duration, not sleep quality, is correlated with arterial stiffness in older adults.</p>

DOI： 10.5551/jat.63594

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PubMed

CiNii Research

Language：Japanese   Publisher：日本予防理学療法学会  

<p>【はじめに、目的】</p><p>サルコペニアは転倒や死亡のリスクを増大させる要因であり、サルコペニアの危険因子のひとつには糖尿病が挙げられる。血糖値が糖尿病の基準には満たないが、正常より高い状態は前糖尿病と分類され、前糖尿病は糖尿病へ進行するリスクが高い。サルコペニアの割合はHbA1c値に比例して増加すると報告されており、前糖尿病の段階からサルコペニアの診断基準である筋量、筋力、身体機能が低下している可能性がある。これらを検討することは早期から機能低下を把握する上で重要である。本研究では、地域在住高齢者における前糖尿病および糖尿病と筋量、筋力、身体機能の関係を検討した。</p><p>【方法】</p><p>地域コホート研究（垂水研究2019）に参加した地域在住高齢者687名のうち、脳卒中、認知症の既往、要介護認定者を除く609名（平均74.0±6.3歳、女性62.1%）を対象とした。基礎情報として、年齢、性別、内服数、糖尿病の病歴を聴取した。四肢骨格筋指数（生体電気インピーダンス法）、握力、5回椅子立ち上がりテスト、HbA1c値を測定した。HbA1c値が5.7%未満を非糖尿病群、5.7～6.4%を前糖尿病群とし、6.5%以上または糖尿病の既往がある者を糖尿病群と分類した。四肢骨格筋指数は男性7.0kg/m ²未満、女性5.7kg/m ²未満を筋量低下、握力は男性28kg未満、女性18kg未満を筋力低下とした。また、5回椅子立ち上がりテストは12秒以上を身体機能低下とした。筋量低下、筋力低下、身体機能低下のそれぞれを従属変数とし、糖尿病分類（非糖尿病群、前糖尿病群、糖尿病群）を独立変数としたロジスティック回帰分析を行った。共変量は年齢、性別、多剤併用の有無および筋量低下の有無、筋力低下の有無または身体機能低下の有無とした。</p><p>【結果】</p><p>前糖尿病および糖尿病を有する者の割合はそれぞれ25.0%、15.1% であった。各群における筋量低下の割合は、非糖尿病群40.5%、前糖尿病群33.6%、糖尿病群23.9%であった。筋力低下の割合は、非糖尿病群20.3%、前糖尿病群25.7％、糖尿病群32.6%であった。また、身体機能低下の割合は、非糖尿病群6.6%、前糖尿病群7.9%、糖尿病群14.1%であった。非糖尿病群と比較して前糖尿病群では筋力低下のオッズ比が1.70（95%信頼区間：1.02-2.82）と有意に高かった。非糖尿病群と比較して糖尿病群では筋量低下のオッズ比が0.37（95%信頼区間：0.20-0.69）と有意に低かった。また、糖尿病群では筋力低下のオッズ比が2.10（95%信頼区間：1.15-3.85）、身体機能低下のオッズ比が2.28（95%信頼区間：1.00-5.17）と有意に高かった。</p><p>【結論】</p><p>非糖尿病の者と比較して、前糖尿病を有する者では筋力が低下しており、糖尿病を有する者では筋量は保持しているが、筋力および身体機能が低下していることが示唆された。筋力低下や身体機能低下は将来の日常生活動作能力の低下に影響するため、前糖尿病や糖尿病を有する者は早期から運動介入を検討することが必要だろう。</p><p>【倫理的配慮、説明と同意】</p><p>本研究は鹿児島大学疫学研究等倫理委員会の承認（170351疫）を得て実施した。ヘルシンキ宣言に基づき、対象者には研究内容について口頭と書面にて説明をし、同意を得た。</p>

DOI： 10.57304/jsptpsuppl.1.suppl.no.1.0_6

CiNii Research

Language：Japanese   Publisher：Hypertension Research  

Hypertension is a risk factor for atherosclerosis. Achieving the therapeutic target value of blood pressure (BP) prevents the onset of cardiovascular events; however, it is not clear how antihypertensive drug use and BP control status relate to arterial stiffness. The purpose of this study is to investigate the relationship between BP control status with or without antihypertensive drugs and arterial stiffness. Nine hundred eighty individuals (mean age: 68 ± 11 years) who participated in a community-based cohort study were enrolled. Arterial stiffness was evaluated using the cardio-ankle vascular index (CAVI). Higher BP was defined as a systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. Participants were divided into four groups: normal, non higher BP without antihypertensive drugs (n = 421); untreated, higher BP without antihypertensive drugs (n = 174); good control, non higher BP with antihypertensive drugs (n = 209); and poor control, higher BP with antihypertensive drugs (n = 176). In multivariable logistic analysis adjusted for age, sex, dyslipidemia and diabetes mellitus medication use, obesity, smoking, alcohol drinking, and heart rate at the CAVI measurement for a high CAVI—using a borderline cutoff value of 8.0—the other three groups were significantly associated with a high CAVI when compared with the normal group. By contrast, multivariable logistic analysis of a high CAVI using an abnormal cutoff value of 9.0 demonstrated that the poor control and untreated groups were significantly associated with a high CAVI, whereas the good control group was not. In conclusion, even with antihypertensive drugs, poor BP control is independently associated with a high CAVI.

DOI： 10.1038/s41440-022-01039-3

Scopus

PubMed

Language：Japanese   Publisher：BMC Cardiovascular Disorders  

Background: Malnutrition affects the prognosis of cardiovascular disease. Acute myocardial infarction (AMI) has been a major cause of death around the world. Thus, we investigated the impact of malnutrition as defined by Geriatric Nutritional Risk Index (GNRI) on mortality in AMI patients. Methods: In 268 consecutive AMI patients who underwent percutaneous coronary intervention (PCI), associations between all-cause death and baseline characteristics including malnutrition (GNRI < 92.0) and Global Registry of Acute Coronary Events (GRACE) risk score were assessed. Results: Thirty-three patients died after PCI. Mortality was higher in the 51 malnourished patients than in the 217 non-malnourished patients, both within 1 month after PCI (p < 0.001) and beyond 1 month after PCI (p = 0.017). Multivariate Cox proportional hazards regression modelling using age, left ventricular ejection fraction and GRACE risk score showed malnutrition correlated significantly with all-cause death within 1 month after PCI (hazard ratio [HR] 7.04; 95% confidence interval [CI] 2.30–21.51; p < 0.001) and beyond 1 month after PCI (HR 3.10; 95% CI 1.70–8.96; p = 0.037). There were no significant differences in area under the receiver-operating characteristic (ROC) curve between GRACE risk score and GNRI for predicting all-cause death within 1 month after PCI (0.90 vs. 0.81; p = 0.074) or beyond 1 month after PCI (0.69 vs. 0.71; p = 0.87). Calibration plots comparing actual and predicted mortality confirmed that GNRI (p = 0.006) was more predictive of outcome than GRACE risk score (p = 0.85) beyond 1 month after PCI. Furthermore, comparison of p-value for interaction of malnutrition and GRACE risk score for all-cause death within 1 month after PCI, beyond 1 month after PCI, and the full follow-up period after PCI were p = 0.62, p = 0.64 and p = 0.38, respectively. Conclusions: GNRI may have a potential for predicting the mortality in AMI patients especially in beyond 1 month after PCI, separate from GRACE risk score. Assessment of nutritional status may help stratify the risk of AMI mortality.

DOI： 10.1186/s12872-021-02448-x

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PubMed

Language：English   Publisher：Nature Publishing Group  

垂水市で行われた地域住民を対象とするコホート研究に参加した980名を対象に、降圧薬を用いた場合と用いない場合の血圧コントロール状況と動脈スティフネスとの関連性を評価した。動脈スティフネスの評価には心臓足首血管指数(CAVI)を用いた。高血圧の定義は、収縮期血圧140mmHg以上または拡張期血圧90mmHg以上とした。未治療コントロール良好群421名(平均64±11歳)、未治療コントロール不良群174名(平均67±11歳)、治療コントロール良好群209名(平均73±9歳)、治療コントロール不良群176名(平均73±9歳)に分類した。CAVI評価時の年齢、性別、脂質異常症治療薬使用、糖尿病治療薬使用、肥満、喫煙、飲酒、心拍数を調整後、CAVI高値のカットオフ値を8.0とした場合は未治療コントロール良好群に比べて他の3群でCAVIが有意に高値であり、カットオフ値を9.0とした場合は治療コントロール不良群と未治療コントロール不良群でCAVIが有意に高値であった。降圧薬治療を行っても、血圧コントロール不良はCAVI高値と独立して関連することが示された。

Language：English   Publisher：(一社)日本動脈硬化学会  

65歳以上の地域住民を対象に、心臓足首血管指数(CAVI)と自己報告による睡眠の時間・質の関連性を横断的に調査した。2018～2019年に健康診断を受けた鹿児島県垂水市の高齢者コホート(垂水研究)から、65歳以上の997名(女性622名、年齢中央値74歳)を解析に組み入れた。睡眠時間で3群に分類した。その結果、睡眠時間が8時間以上であった長睡眠群は110名(女性56名、年齢中央値77歳)、6～8時間の中睡眠群は438名(女性269名、年齢中央値74歳)、6時間未満の短睡眠群は449名(女性297名、年齢中央値73歳)であった。この3群で平均CAVIを比較すると、長睡眠群では9.6±1.3となり、中睡眠群(9.1±1.2)または短睡眠群(9.1±1.1)よりも有意に高かった(P<0.001)。各種の因子(年齢、性別、収縮期血圧、現喫煙状態、BMI、運動頻度、学歴、フレイル、睡眠薬、睡眠の質、昼寝時間)で調整を行った多変量回帰分析の結果、長睡眠群のCAVIは中睡眠群よりも有意に高い(p=0.016)ことが証明された。こうした結果とは対照的に、睡眠の質とCAVIの有意な関連性は示されなかった。本解析結果から、高齢者では睡眠時間が長いことが動脈硬化度と相関し、睡眠の質は相関しないことが示唆された。

Language：Japanese   Publisher：International Journal of Environmental Research and Public Health  

Patients with heart disease are more likely to experience social frailty due to physical inactivity, which may affect meaningful activities such as hobbies. This study aimed to investigate (1) the association between heart disease and social frailty in community-dwelling older adults and (2) the characteristics of meaningful activities in community-dwelling older adults with heart disease. Data from 630 older adults who participated in a community-based health survey were obtained, including clinical history, meaningful activities, social frailty and psychosomatic functions. Participants were divided into two groups: those with heart disease (n = 79) and those without (n = 551), and comparisons were made. Social frailty was observed in 23.7% of participants with heart disease, and logistic regression revealed significant associations with heart disease and social frailty after adjusting for potential covariates (OR, 1.97; 95% CI, 1.06 3.67; p = 0.032). Participants with heart disease did not differ significantly in terms of satisfaction or performance; their frequency of engagement in meaningful activities was significantly lower than without heart disease (p = 0.041). These results suggest that heart disease and social frailty are associated in community-dwelling older adults, and that this demographic is inclined to engage in meaningful activities less frequently.

DOI： 10.3390/ijerph192215167

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PubMed

Language：Japanese   Publisher：Journal of Cardiology Cases  

Portopulmonary hypertension (POPH) is a condition defined by the development of pulmonary arterial hypertension (PAH) that is associated with liver disease or portal hypertension. Untreated POPH has a poor prognosis. POPH can be treated with PAH-targeted therapy and can sometimes resolve with liver transplantation (LT); however, poorly controlled POPH can preclude LT owing to an increased peri-operative risk. We report a case of POPH that was diagnosed as an unknown atrial septal defect during PAH-targeted therapy. As observed in our case, the same patient may have several causes of PAH. It is important to confirm an unknown shunt disease using echocardiography during PAH-targeted therapy. Learning objective: It is difficult to detect unknown shunt disease in patients who are diagnosed with pulmonary arterial hypertension (PAH) owing to other causes. We report a case of portopulmonary hypertension that was diagnosed as an unknown atrial septal defect during PAH-targeted therapy. This report highlights the same patient may have several causes of PAH. It is important to confirm an unknown shunt disease using echocardiography during PAH-targeted therapy.

DOI： 10.1016/j.jccase.2022.08.003

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PubMed

Language：English   Publisher：(一社)日本心臓病学会  

症例は51歳女性で、呼吸困難を主訴に近医を受診し、経胸壁心エコー検査で肺高血圧を指摘された。精査と加療を目的に当院へ紹介された。B型肝炎ウイルス感染による非代償性肝硬変の既往があった。受診時の心エコー検査で右室拡大を認め、推定右室収縮期圧は68mmHgであった。腹部CTで著明に拡張した上腸間膜静脈と脾腫を認めた。肺血流シンチグラフィーで肺血栓塞栓の所見はなかった。右心カテーテル検査で肺動脈圧は収縮期が68mmHg、拡張期が23mmHg、平均圧が41mmHg、心係数は5.49L/min/m2であった。門脈圧亢進症による門脈肺高血圧症と診断し、マシテンタンの投与を開始し、2ヵ月後にタダラフィルに切り替えた。4ヵ月後の心エコー検査で以前は見られなかったシャント血流が検出された。肺動脈圧は収縮期43mmHg、拡張期16mmHg、平均26mmHgに低下し、右房酸素飽和度は87.1%に上昇した。心房中隔欠損症と診断し、Amplatzer閉鎖栓を用いた経カテーテル閉鎖術を施行した。1年後に肝性脳症に対して肝移植が施行され、3年後の肺動脈圧は収縮期23mmHg、拡張期10mmHg、平均15mmHgであった。

Language：Japanese   Publisher：Journal of Clinical Medicine  

Bone and muscle mass loss are known to occur simultaneously. The alpha-actinin three (ACTN3) genotype has been shown to potentially affect bone and muscle mass. In this study, we investigated the association between the ACTN3 genotype and bone and muscle mass loss in community-dwelling adults aged ≥ 60 years. This study was a cross-sectional analysis of data from 295 participants who participated in a community health checkup. The ACTN3 genotypes were classified as RR, RX, or XX types. Bone mass loss was defined as a calcaneal speed of sound T-score of <−1.32 and <−1.37, and muscle mass loss was defined as an appendicular skeletal muscle index of <7.0 kg/m² and <5.7 kg/m² in men and women, respectively. The percentages of XX, RX, and RR in the combined bone and muscle mass loss group were 33.8%, 30.8%, and 16.7%, respectively, with a significantly higher trend for XX. Multinomial logistic regression analysis showed that XX had an odds ratio of 3.00 (95% confidence interval 1.05–8.54) of being in the combined bone and muscle mass loss group compared to the RR group (covariates: age, sex, grip strength, and medications). The ACTN3 genotype of XX is associated with a higher rate of comorbid bone and muscle mass loss. Therefore, ACTN3 genotyping should be considered for preventing combined bone and muscle mass loss.

DOI： 10.3390/jcm11206172

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PubMed

Language：Japanese   Publisher：(一社)日本救急医学会  

Language：Japanese   Publisher：Psychogeriatrics  

Background: Frailty is a multidimensional condition characterised by reduced physical and psychological resilience. Older adults also frequently demonstrate apathy, suggesting that it shares similar neuro-physiological pathways with frailty. This cross-sectional study aimed to investigate the association between apathy and frailty as defined by a comprehensive assessment. Methods: We analyzed 882 older adults (mean age: 74.4 ± 6.4 years; 62.1% female) who participated in a community-based health check survey (Tarumizu Study). Apathy was measured by the Geriatric Depression Scale-3A, a three-item subset of the Geriatric Depression Scale-15, and frailty by the Kihon Checklist of physical, psychological, functional, and social status. Associations were examined by multinomial logistic regression with frailty status (robust, pre-frailty, frailty) as the dependent variable, apathy as the independent variable, and sociodemographic factors, medications, cognitive function, functional capacity, and mood symptoms as potential confounders. Results: Apathy was observed in 23.7% of individuals, and logistic regression revealed significant associations with both pre-frailty and frailty after confounder adjustment (pre-frailty: odds ratio (OR) 1.80, 95% CI 1.22–2.64; frailty: OR 3.24, 95% CI 1.63–6.42). Participants with apathy also exhibited greater deficits in the Kihon Checklist subdomains instrumental activities of daily living (P = 0.022), physical function (P < 0.001), oral function (P < 0.001), and cognitive function (P = 0.001). Conclusions: Our findings underscore the importance of comprehensive frailty assessment and demonstrate that apathy can have pervasive deleterious effects on geriatric health.

DOI： 10.1111/psyg.12867

Scopus

PubMed

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

地域在住高齢者におけるアパシーとフレイルとの横断的な関連について検討した。健康診断調査(垂水調査)に参加した地域在住高齢者882名(平均74.4±6.4歳、女性62.1%)を対象とした。アパシーはGeriatric Depression Scale-3Aで評価し、フレイルは基本チェックリスト(下位尺度;日常生活関連動作、運動器機能、低栄養状態、口腔機能、閉じこもり、認知機能)で評価した。その結果、209名(23.7%)でアパシーが認められた。交絡因子調整後の多項ロジスティック回帰分析の結果、アパシーはプレフレイルおよびフレイルと有意に関連していた。アパシーを有する高齢者では有さない高齢者と比較して、基本チェックリストの日常生活関連動作、運動器機能、口腔機能、認知機能に問題を呈する割合が有意に高かった。以上から、包括的なフレイル評価の重要性が示され、アパシーは老年期の健康に広範かつ有害な影響を及ぼす可能性が示唆された。

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(有)科学評論社  

Language：Japanese   Publisher：日本肺高血圧・肺循環学会・日本小児肺循環研究会  

Language：English   Publisher：(一社)日本農村医学会  

症例は56歳女性で、統合失調症のため入院しており、摂食量が不安定であったため点滴を受け、心電図のモニタリングも行われていた。入院24日目に異常心電図を発見され、当心臓科へ診察依頼された。自覚症状はみられなかった。心エコー法では、たこつぼ心筋症に合致する心臓形態が観察された。患者の精神状態のため冠動脈造影法による検査は行えなかったが、その他の検査で網羅的に評価した結果から、たこつぼ心筋症と診断した。発見された心尖部血栓に対する抗凝固療法の他には治療は行わず、患者へは安静を保つよう指導した上で経過観察を続けた。入院18日目に施行した心エコー法では心尖部肥大型心筋症(APH)例に似た心臓形態が示された。この時点でも自覚症状は無く、心不全の徴候もみられなかった。肥大型心筋症例に適用するのと同様の方法にて2Dスペックルトラッキング心エコー法を実施した。その発症早期の所見では、心尖部の円周方向ストレイン(CS)は内層、中層、外層の全てで低下していた。しかし、APH様形態が観察された回復期においては、心尖部内層のCSは急速に回復していた。

Publisher：Japan Atherosclerosis Society  

<p> <b>Aim:</b> In this study, we aim to examine the clinical meaning of low-density lipoprotein cholesterol (LDL-C) ＜70 mg/dL as assessed by Friedewald equation [LDL-C (F)] and Martin method [LDL-C (M)] and non-high-density lipoprotein cholesterol (HDL-C) ＜100 mg/dL on the occurrence of new lesions among Japanese patients with stable angina who underwent percutaneous coronary intervention (PCI) and were prescribed with strong statins.</p><p><b>Methods:</b> Among the 537 consecutive stable angina patients who had underwent PCI and had been prescribed with strong statins, the association between the occurrence of new lesions with myocardial ischemia at the 9-month follow-up coronary angiography and ≤ 2 years after PCI and baseline characteristics were assessed.</p><p><b>Results:</b> New lesions appeared 9 months and ≤ 2 years after PCI in 31 and 90 patients, respectively. Multivariate logistic regression analysis revealed diabetes mellitus (DM) was significantly associated with the occurrence of new lesions ≤ 2 years after PCI [odds ratio (OR) 1.71, 95 % confidence interval (CI) 1.06–2.83, <i>p</i>=0.031], and only non-HDL-C ≥ 100 mg/dL was associated with the occurrence of new lesions both at 9 months and ≤ 2 years after PCI [OR 1.80, 95 % CI 1.10–3.00, <i>p</i>=0.021 and OR 1.85, 95 % CI 1.13–3.07, <i>p</i>=0.016].</p><p><b>Conclusions:</b> Non-HDL-C ≥ 100 mg/dL was determined to be the independent risk factor for the occurrence of new lesions 9 months and ≤ 2 years after PCI among stable angina patients with strong statins. Residual risk after PCI should be considered by assessing not only DM but also non-HDL-C beyond the scope of LDL-C-lowering therapy with strong statins.</p>

DOI： 10.5551/jat.62908

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PubMed

CiNii Research

Language：Japanese   Publisher：The Japan Geriatric Therapy Society  

<p>【Aim】 This study aimed to examine the association between car accident history and fall history among community-dwelling older drivers.【Methods】 A cross-sectional analysis was conducted on 602 older drivers (mean age: 72.8 ± 5.6 years, women: 50.0%) who participated in the regional cohort study (Tarumizu Research 2018, 2019) and were driving at 65 years or older. For car accident history, we listened to their accident history for the past two years and classified it into “accident history” and “no accident history.” The fall history was classified into “with fall history” and “no fall history” based on the presence or absence of falls in the past year. In the statistical analysis, a binomial logistic regression analysis was performed with accident history as the dependent variable, fall history as the independent variable, and age and sex as the covariates.【Results】 It was found that 5.6% of the subjects had a history of car accidents, and 13.0% had a history of falls. Among those with a history of car accidents, a significantly higher percentage of people had a history of falls than among those with no history of car accidents (<i>p</i> = 0.003). The logistic regression analysis showed that having a history of falls was significantly associated with having a history of car accidents (odds ratio: 3.12, 95% confidence interval: 1.42–6.85, <i>p</i> = 0.004).【Conclusions】 The results suggested an association between a history of car accidents and a history of falls among community-dwelling older drivers.</p>

DOI： 10.57270/jgts.2022_007

CiNii Research

Language：English   Publisher：(一社)日本心臓病学会  

初回化学療法を施行した消化管癌患者260例(男性165例、女性95例)を対象に、静脈血栓塞栓症の発症リスクを評価するKhoranaリスクスコア(KRS)と死亡率の関連を後ろ向きに検討した。静脈血栓塞栓症の既往患者は除外した。患者をKRSに基づき低リスク群122例(男性62.3%、年齢中央値67歳)、中等度リスク群114例(男性64.9%、年齢中央値69歳)、高リスク群24例(男性62.5%、年齢中央値65歳)の3群に分類した。主要評価項目は総死亡および腫瘍関連静脈血栓症の発生とした。追跡期間中に腫瘍関連静脈血栓症は61例で発生した。発生率は低リスク群31例(23.3%)、中等度リスク群4例(31.1%)、高リスク群4例(17.4%)の間に有意差はなかった(P=0.4)。死亡は84例で、総死亡率は全体で37.9%であった。総死亡率は低リスク群30例(27.5%)、中等度リスク群41例(44.6%)に比べて高リスク群13例(58.2%)で有意に高かった(P=0.002)。多変量解析で交絡因子を調整した後もKRSは総死亡と有意に関連した(HR:2.83、95%CI:1.37～5.83、P=0.005)。

Language：English   Publisher：(一社)日本動脈硬化学会  

ストロングスタチンを服用している安定狭心症患者537例(男性392例、女性145例)を対象に、non-HDLコレステロール(non-HDL-C)が経皮的冠動脈インターベンション(PCI)後の新たな冠動脈狭窄病変を予測するかどうかについて検討した。予測能をFridewald式およびMartin式で推算したLDLコレステロール(LDL-C)値と比較した。追跡期間は2年で、新たな狭窄病変(NL)は90例で検出された。患者をNL群90例(男性74%、年齢中央値66歳)と非NL群447例(男性73%、年齢中央値70歳)の2群に分類した。患者背景はNL群の方が若年で、糖尿病が有意に多かった。Fridewald(F)式およびMartin式による推算LDL-C値が70mg/dL以上、non-HDL-Cが100mg/dL以上の患者はNL群の方が多かった。単変量解析で糖尿病、F式とMartin式の推算LDL-C値が70mg/dL以上、non-HDL-Cが100mg/dL以上が新たな病変と有意に関連した。多変量解析では糖尿病、およびnon-HDL-Cが100mg/dL以上(OR:1.85、P=0.016)が新たな病変を予測する独立因子であった。

Language：Japanese   Publisher：(一社)日本老年療法学会  

地域在住高齢者ドライバーにおける自動車事故歴と転倒歴の関連性について検討した。地域コホート研究(垂水研究2018または2019)に参加した地域在住高齢者1029名のうち、調査時点で自動車運転免許を保有しており自動車運転をしている602名(女性50.0%、平均72.8±5.6歳)を対象とした。過去2年間の自動車事故経験者(事故歴あり)は34名(女性55.9%、平均72.7±4.9歳)、事故歴なしは568名(女性49.6%、平均72.9±5.7歳)であった。過去1年間の転倒経験者は78名(13.0%)であった。事故歴あり群は事故歴なし群に比べ転倒歴を有する割合が有意に高かった。事故歴とその他の変数(年齢、性別、多剤併用、運転頻度、運転距離、GDS-15、身体機能低下、MCI)の関係については群間での有意な差は認められなかった。二項ロジスティック回帰分析では、転倒歴を有することは事故歴を有することと有意な関連を認めた。

Language：English   Publisher：(一社)日本心臓病学会  

深部静脈血栓症(DVT)が疑われる外来および入院患者973例(男性490例、女性483例)を対象に、術前にDVTを予測する検査前確率スコアを作成し、その妥当性を検証した。全例で超音波検査(全下肢静脈エコー)を実施した。いずれの症例も術前のDダイマー値は1μg/mL以上であった。患者を、予測スコアを作成するための導出群651例(女性51%、平均67.6±13.9歳)と妥当性を検証するための検証群322例(女性49%、平均67.6±13.9歳)に分類した。検査前確率スコアはDダイマー値が1.5μg/mL以上に2点、60歳以上、女性、糖質コルチコイドの使用、長期の運動制限、DVTリスクの高い悪性腫瘍にそれぞれ1点を加算して、0～2点を低リスク、3～4点を中等度リスク、5点以上を高リスクとした。検査前確率スコアのROC曲線下面積(AUC)は導出群で0.72、検証群で0.70であった。導出群でDVTの診断率は低リスク群(7%)、中等度リスク群(23%)に比べて高リスク群(47%)で有意に高かった。同様に検証群もそれぞれ6%、22%、50%と高リスク群で有意に高かった(いずれもP<0.0001)。

Publisher：International Heart Journal Association  

<p>This study aimed to determine independent factors for developing postoperative hypertension using 4 biomarkers in patients receiving oral and maxillofacial surgery under general anesthesia. Brain natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity myocardial troponin T (hs-TnT), and high-sensitivity myocardial troponin I (hs-TnI) were measured and preoperative echocardiograms were examined. Episodes of systolic blood pressure (SBP) ≥ 170 mmHg or diastolic blood pressure ≥ 100 mmHg within 1 week after surgery were considered postoperative hypertension. We analyzed 213 (130 men; 83 women) patients, who were divided into a postoperative hypertension group (HT group, <i>n</i> = 32) and a normal group (N group, <i>n</i> = 181). The HT group showed a higher LVMI (113.5 versus 100.1), higher E/e' of the lateral wall (9.1 versus 7.7), and higher BNP (39.2 versus 22.9 pg/mL), NT-proBNP (400.1 versus 143.9 pg/mL), and hs-TnT (15.6 versus 10.3 ng/L) concentrations compared to the N group. NT-proBNP and hs-TnT concentrations positively associated with E/e', but BNP and hs-TnI did not. NT-proBNP (AUC = 0.64, cutoff value: 117.0 pg/mL) and hs-TnT (AUC = 0.61, cutoff value: 11.0 ng/L) concentrations were effective for discriminating E/e' ≥ 12. Multivariate logistic regression analyses showed that risk factors responsible for developing postoperative hypertension were NT-proBNP and hs-TnT using biomarkers and E/e' as independent variables, and NT-proBNP and SBP at admission using biomarkers and SBP at admission as independent variables. These findings suggest that NT-proBNP and hs-TnT concentrations, and SBP at admission, are useful to predict postoperative hypertension after minor to moderate surgery, and that left ventricular filling pressure is a primary factor associated with postoperative hypertension.</p>

DOI： 10.1536/ihj.22-074

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Language：Japanese   Publisher：Frontiers in Cardiovascular Medicine  

The heart is dependent on ATP production in mitochondria, which is closely associated with cardiovascular disease because of the oxidative stress produced by mitochondria. Mitochondria are highly dynamic organelles that constantly change their morphology to elongated (fusion) or small and spherical (fission). These mitochondrial dynamics are regulated by various small GTPases, Drp1, Fis1, Mitofusin, and Opa1. Mitochondrial fission and fusion are essential to maintain a balance between mitochondrial biogenesis and mitochondrial turnover. Recent studies have demonstrated that mitochondrial dynamics play a crucial role in the development of cardiovascular diseases and senescence. Disruptions in mitochondrial dynamics affect mitochondrial dysfunction and cardiomyocyte survival leading to cardiac ischemia/reperfusion injury, cardiomyopathy, and heart failure. Mitochondrial dynamics and reactive oxygen species production have been associated with endothelial dysfunction, which in turn causes the development of atherosclerosis, hypertension, and even pulmonary hypertension, including pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Here, we review the association between cardiovascular diseases and mitochondrial dynamics, which may represent a potential therapeutic target.

DOI： 10.3389/fcvm.2022.905072

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PubMed

Language：Japanese   Publisher：Archives of Gerontology and Geriatrics  

Objectives: This cross-sectional study investigates the associations among satisfaction with meaningful activities, and social frailty in community-dwelling Japanese older adults. Methods: We analyzed data from 596 older adults (mean age 74.2 ± 6.4 years, female 63.6%) who participated in the Tarumizu Study 2019, a community-based health survey. Participants selected meaningful activities from 95 activities using the Aid for Decision-Making in Occupation Choice (ADOC) tool. Satisfaction was evaluated from 1 to 5, and those who were assigned a rating of 4 or 5 were operationally classified as the high satisfaction group (n = 487), with others occupying the low satisfaction group (n = 109). Both groups were evaluated based on the ADOC, social frailty (Makizako's five items), physical function, depressive symptoms, cognitive function, and higher-level competence. Results: Of the 596 participants, 18.7% showed prevalence of social frailty. The low satisfaction group had a significantly higher prevalence of social frailty (low satisfaction 28.4% vs. high satisfaction 16.4%, P = 0.004) and depressive symptoms (low satisfaction 30.3% vs. high satisfaction 17.9%, P<0.01), and poor higher-level competence (P = 0.026) than the high satisfaction group. Logistic regression analysis showed that social frailty (Odds Ratio 1.78, 95% Confidence Interval 1.068–2.990, P = 0.027) was significantly associated with satisfaction with meaningful activity after adjusting for covariates. We found no significant differences in categories of meaningful activities between the low and high satisfaction groups (P = 0.549). Conclusions: This study suggested that social frailty was associated with satisfaction with meaningful activities, regardless of the degree or category of satisfaction.

DOI： 10.1016/j.archger.2022.104665

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Language：Japanese   Publishing type：Research paper (scientific journal)  

BACKGROUND: Venous thromboembolism is a serious perioperative complication. We developed a new pre-test probability score for predicting deep vein thrombosis (DVT) before surgery. METHODS: Whole leg ultrasonography was performed on 973 inpatients and outpatients with suspected DVT based on a preoperative D-dimer cut-off value of ≥ 1 μg/ml. We allocated two-thirds (n = 651) of the study participants to a derivation cohort and one-third (n = 322) to a validation cohort. The pre-test probability model was developed from the derivation cohort data. RESULTS: The pre-test probability model for DVT assigned 2 points to D-dimer ≥ 1.5 μg/mL and 1 point each to age ≥ 60 years, female sex, ongoing glucocorticoid therapy, prolonged immobility, and cancer with high risk of DVT. The area under the curve of the pre-test probability score was 0.72 and 0.70 in the derivation and validation cohorts, respectively. The rates of DVT according to pre-test probability scores in the derivation and validation cohorts were 7% and 6% in the low (score = 0-2), 23% and 22% in the intermediate (score = 3-4), and 47% and 50% in the high probability group (score ≥ 5), respectively (p < 0.0001). CONCLUSIONS: The pre-test probability score (Kagoshima-DVT score) was helpful in detecting preoperative DVT in both inpatients and outpatients. We identified low probability group to reduce whole-leg ultrasonography and high probability group to detect more DVT before surgery.

DOI： 10.1016/j.jjcc.2021.11.025

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PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)  

Objective: Vinegar has been reported to have a hypotensive effect. We aimed to investigate the relationship between the consumption of vinegar-based side dishes and blood pressure. Research methods & procedures: This cross-sectional study included 746 individuals (257 men and 489 women) aged ≥40 years from Tarumizu, Kagoshima, Japan. Nutrient intake was estimated based on the brief-type self-administered diet history questionnaire. The intake frequency of vinegar-based side dishes (Sunomono and pickles) was determined using a self-administered diet history questionnaire. Participants who did not consume vinegar-based side dishes for a month were defined as having no Sunomono or pickle eating habit. Blood pressure was categorized into four groups according to the Japanese Society of Hypertension Guidelines for the Management of Hypertension. The association between the intake of vinegar-based side dishes and blood pressure categories was analyzed using ordinal logistic regression analysis adjusted for age, body mass index, smoking history, excessive alcohol intake, living situation, energy intake, protein intake, sodium intake, potassium intake, and seaweed intake. Results: Approximately 13.6% men and 6.1% women had no Sunomono eating habits. In men, eating Sunomono, but not pickles, was significantly related to blood pressure categories (estimate, -0.702; 95% CI, -1.122 to -0.310), whereas more frequent consumption of Sunomono did not show an improvement in the blood pressure category. The relationship between eating Sunomono and blood pressure categories was not recognized in women. Conclusion: This was the first study assessing the association between consumption of vinegar-based side dishes and blood pressure categories. We highlighted the effect of Sunomono consumption on blood pressure categories in men. Consumption of Sunomono may improve blood pressure in men.

DOI： 10.1016/j.heliyon.2022.e09505

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Language：Japanese   Publisher：Journal of Cardiology  

Background: The Khorana risk score (KRS) has been recommended for predicting the incidence of cancer-associated thrombosis (CAT). However, it has been reported KRS was not useful in predicting CAT, but rather in predicting death by setting high scores for the primary tumor site or a low prevalence of severe obesity. Methods: A total of 260 consecutive patients with no history of thrombosis and who started initial chemotherapy for gastrointestinal cancer from January 2017 to December 2018 at our hospital were divided into three groups according to KRS; they were observed until December 2019 [122 patients (46.9%) in the low-risk group, 114 patients (43.8%) in the intermediate-risk group, and 24 patients (9.2%) in the high-risk group]. The incidence of CAT and all-cause death were compared among the three groups. Results: The median age of the patients was 67 years; 63.5% were men. CAT was observed in 61 patients (26.1%); 84 patients (37.9%) died during the observation period. The incidence rate of CAT was similar among the three groups (log-rank p = 0.4); but all-cause death showed a significant difference among the three groups (high-risk group: 58.2%, intermediate-risk group: 44.6%, low-risk group: 27.5%, log-rank p = 0.002). In the multivariate analysis, the high-risk KRS group remained at increased risk for all-cause death (HR, 2.83; 95% CI, 1.37–5.83; p = 0.005), but not with CAT. Conclusions: The KRS at the start of chemotherapy for gastrointestinal cancer is not effective in predicting CAT, but it is effective in predicting prognosis in patients with gastrointestinal cancer.

DOI： 10.1016/j.jjcc.2021.11.024

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PubMed

Language：English   Publisher：(一社)インターナショナルハートジャーナル刊行会  

全身麻酔による歯科口腔外科手術を施行した患者213例を対象に、術後高血圧症の関連因子について検討した。術後1週間以内に収縮期血圧が170mmHg以上または拡張期血圧が100mmHg以上を呈した症例を術後高血圧と定義した。術後高血圧は32例で認めた。患者を術後高血圧の陽性群32例(男性19例、女性13例、平均74.6±10.6歳)と陰性群181例(男性111例、女性70例、平均70.9±11.4歳)に分類した。左室心筋重量係数は術後高血圧群(113.5±31.3)の方が陰性群(100.1±24.6)より有意に高く(P=0.0072)、E/e'も術後高血圧群の方が有意に高かった。脳性ナトリウム利尿ペプチド(BNP)、NT-proBNP、高感度心筋トロポニンT(hs-TnT)は術後高血圧群の方が有意に高く、NT-proBNPおよびhs-TnTはE/e'と正に相関した。多重ロジスティック回帰分析でNT-proBNP(OR:1.0020、P=0.0496)、hs-TnT(OR:1.0658、P=0.0472)、入院時の収縮期血圧(OR:1.0348、P=0.0026)が術後高血圧の有意な関連因子であった。

Language：Japanese   Publishing type：Research paper (scientific journal)  

To treat older patients with hypertension, it is important to detect cognitive impairment at an early stage because of its potential influence on treatment efficacy and functional prognosis. In this study, we aimed to identify the incidence and determinants of cognitive impairment in hypertensive patients aged 65 years and above who visited our outpatient clinic and were not previously diagnosed with cognitive impairment. Among 312 patients with hypertension, we found that 35% (n = 109) and 7.7% (n = 24) had cognitive impairment and dementia, respectively, as defined by the Mini-Mental State Examination (≤27 or ≤23, respectively). Patients with cognitive impairment were older, had lower levels of education, and had lower instrumental activities of daily living (IADL) scores than those without cognitive impairment. Multiple regression analysis revealed that age and IADL were associated with cognitive impairment in patients with hypertension. Regarding the treatment of hypertension, the office and home blood pressure levels, number of antihypertensive medications prescribed, and proportion of the use of each antihypertensive drug was equivalent between patients with and without cognitive impairment. Finally, patients with unrecognized cognitive impairment showed distinct clinical characteristics, including high antihypertensive medication burden and preserved IADL, when compared to hypertensive patients in the different cohorts of definitive mild cognitive impairment of a similar age. These findings suggest that older hypertensive patients are at a high risk of masked cognitive decline, even if they are functionally independent.

DOI： 10.1038/s41440-022-00861-z

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Language：Japanese   Publisher：Hypertension Research  

Atherosclerosis and arterial stiffness are phenotypes of atherosclerotic vascular damage. Atherosclerosis originates from endothelial vascular damage and forms focal morphological lesions; arterial stiffness originates from diffuse medial-layer damage in the arterial tree. Thus, the two phenomena reflect different facets of atherosclerotic vascular damage, and they both gradually progress. We conducted a subanalysis to compare the long-term effects of febuxostat on atherosclerosis and arterial stiffness in the PRIZE study (a multicenter, prospective, randomized, open-label, blinded-endpoint clinical trial to examine the effect of febuxostat on carotid atherosclerosis). Among 514 study participants, arterial stiffness parameters (brachial-ankle pulse wave velocity or cardio-ankle vascular index) were obtained at baseline, 12 months, and 24 months in 100 subjects. Among them, 48 subjects were allocated to the control group (i.e., nonpharmacological lifestyle modification for hyperuricemia), and 52 subjects were allocated to the febuxostat treatment group. While the decrease in serum uric acid was greater in the febuxostat group than in the control group, the adjusted percentage decrease in arterial stiffness parameters at month 24 was greater in the febuxostat group than in the control group, with a mean between-group difference (febuxostat − control) of −5.099% (95% confidence interval (CI) −10.009% to −0.188%, p = 0.042). Thus, long-term treatment with febuxostat may exert beneficial effects on arterial stiffness without improving carotid atherosclerosis. A long-term study to examine the effect of febuxostat on cardiovascular outcomes related to increased arterial stiffness is warranted.

DOI： 10.1038/s41440-022-00857-9

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PubMed

Language：English   Publisher：Nature Publishing Group  

PRIZE試験は、頸動脈アテローム硬化に対するフェブキソスタット(Feb)の効果について検討した多施設共同前向き無作為化非盲検エンドポイント臨床試験である。今回、PRIZE試験のサブ解析を実施し、アテローム硬化および動脈壁硬化に対するFebの長期効果を比較した。Feb群52例(中央値66.55歳)と対照群48例(中央値71.00歳)を対象とした。評価項目は、ベースライン時、12ヵ月時、24ヵ月時の動脈壁硬化パラメータ(上腕・足首間脈波伝播速度または心臓足首血管指数)、総頸動脈中膜内膜複合体厚などとした。その結果、Feb群では対照群と比較して血清尿酸値の減少が大きかった。しかし、24ヵ月時点での動脈壁硬化パラメータの調整済み減少率は、対照群と比較してFeb群で大きかった(平均群間差、Feb-対照、p=0.042)。平均総頸動脈中膜内膜複合体厚のベースラインから24ヵ月までの変化率に両群間で差は認められなかった。以上から、Feb長期投与は頸動脈アテローム硬化を改善することなく、動脈壁硬化に有益な効果を発揮する可能性が示された。

Language：English   Publisher：Nature Publishing Group  

当院外来を受診した65歳以上の高血圧症患者のうち、過去に認知障害と診断されていない患者312例を対象に、認知機能障害の発生率とその決定要因について検討した。評価項目は患者背景、ミニメンタルステート検査、手段的日常生活動作(IADL)などとした。認知機能障害の高血圧患者109例(男性54例、平均79.0±6.5歳)、非認知機能障害の高血圧患者203例(男性95例、平均75.0±5.4歳)を対象とした。その結果、認知機能障害の高血圧患者は、非認知機能障害の高血圧患者と比較して、高齢で、教育水準が低く、IADLスコアが低かった。重回帰分析の結果、年齢およびIADLが高血圧患者の認知障害と関連していることが示された。両群間で診察室血圧および家庭血圧、降圧剤処方数、各降圧剤の使用割合は同程度であった。また、本試験に参加した認知機能障害の高血圧患者とORANGEレジストリに登録されたMCIを有する高血圧患者を比較した。その結果、本試験に参加した認知機能障害の高血圧患者はORANGEレジストリ患者と比較して降圧剤処方数が多く、重度の高血圧であることが示された。ORANGEレジストリ患者では本試験の患者と比較してIADL障害を有していることが示された。以上から、高血圧高齢患者は、たとえ機能的に自立していたとしても、隠れた認知機能低下リスクが高いことが示唆された。

Language：Japanese   Publisher：Hypertension Research  

Hypertension is a risk factor for cardiovascular disease. We developed a simple scoring method for predicting future hypertension using health checkup data. A total of 41,902 participants aged 30–69 years without baseline hypertension who underwent annual health checkups (mean age, 52.3 ± 10.2 years; male, 47.7%) were included. They were randomly assigned to derivation (n = 27,935) and validation cohorts (n = 13,967) at a ratio of 2:1. In the derivation cohort, we performed multivariable logistic regression analysis and assigned scores to each factor significantly associated with 5-year hypertension. We evaluated the predictive ability of the scores using area under the curve (AUC) analysis and then applied them to the validation cohort to assess their validity. The score including items requiring blood sampling ranged from 0 to 14 and included seven indicators (age, body mass index, blood pressure, current smoking, family history of hypertension, diabetes, and hyperuricemia). The score not including items requiring blood sampling ranged from 0 to 12 and included five indicators (the above indicators, except diabetes and hyperuricemia). The score not including items requiring blood sampling was better; blood sampling did not improve diagnostic ability. The AUC of the score not including items requiring blood sampling was 0.76, with a sensitivity and specificity of 0.82 and 0.60, respectively, for scores ≥6 points. The incidence of hypertension gradually and constantly increased (from 0.9 to 49.6%) as the score increased from 0 to ≥10. Analysis in the validation cohort yielded similar results. We developed a simple and useful clinical prediction model to predict the 5-year incidence of hypertension among a general Japanese population. The model had reasonably high predictive ability and reproducibility.

DOI： 10.1038/s41440-021-00831-x

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Language：English   Publisher：Nature Publishing Group  

大規模健康診断データを用いて、5年高血圧発症リスクを予測するためスコアリング法の開発を試みた。ベースライン時点で高血圧を有さなかった年次健康診断受診者41902例(男性47.7%、平均52.3±10.2歳)を対象とした。受診者をderivationコホート27935例、validationコホート13967例に無作為にわけて検討した。採血を要するリスクスコア(0～14点;年齢、BMI、血圧、現在の喫煙状況、高血圧の家族歴、糖尿病、高尿酸血症の有無)、採血不要のリスクスコア(0～12点;糖尿病および高尿酸血症を除く上記因子)を作成した。その結果、採血不要スコアのAUCは0.76であり、6点以上では感度、特異度はそれぞれ0.82、0.60であり、採血を要するスコアとほぼ同じであった。高血圧発症率はスコアが高くなるにつれて上昇していた(0～10点以上)。validationコホートでの解析でも同様の結果が得られた。以上から、本モデルの高い予測能および再現性が示された。

Language：Japanese   Publisher：(一社)日本理学療法学会連合  

【目的】地域在住高齢者における骨量・筋量低下と身体活動との関連性を明らかにすることを目的とした。【方法】地域コホート研究(垂水研究2018)に参加した地域在住高齢者173名を分析対象とした。骨量低下は%YAMが70%以下とし,筋量低下は四肢骨格筋指数がサルコペニアの基準より低いものとした。身体活動量は3軸加速度計を用いて,座位行動時間延長,中高強度身体活動時間低下,歩数低下の有無に分類した。骨量・筋量をもとに正常群,骨量低下群,筋量低下群,骨量・筋量低下群の4群に分類し,基本情報および身体活動を比較した。【結果】骨量・筋量低下群は正常群と比べて中高強度身体活動時間が有意に減少していた(オッズ比3.29,p<0.05,共変量:年齢(5歳階級),性別,歩行速度低下,うつ傾向)。【結論】骨量・筋量低下を併存している高齢者は,中高強度身体活動時間が減少していることが示唆された。(著者抄録)

Language：Japanese   Publisher：Japanese Society of physical therapy for prevention  

<p><b>Objective:</b> This study aimed to examine the correlation of sarcopenia with orthopedic disorders, history of falls, and polypharmacy among community-dwelling older adults.</p><p><b>Methods:</b> Data from 905 older adults who participated in community-based health check-up were analyzed. Participants were asked to provide their history of orthopedic disorders, number of prescription medicines, and experience of fall during the past year. Sarcopenia was assessed based on the AWGS2019 criteria.</p><p><b>Results:</b> The prevalence rate of sarcopenia was 18.3 % (n = 166). Although participants with osteoporosis showed a higher prevalence rate, there were no associations of sarcopenia with osteoarthritis and spinal disease. In the logistic regression analyses, there was no significant association between orthopedic disorders and sarcopenia, whereas history of falls (odds ratio = 1.65) and polypharmacy (≥6) (odds ratio = 1.56) were significantly associated with sarcopenia.</p><p><b>Conclusions:</b> A higher prevalence rate of sarcopenia was observed in older adults with osteoporosis. However, there was no significant association found between sarcopenia and orthopedic disorders, including osteoporosis in the multivariate analysis, whereas history of falls and polypharmacy were determined as associated factors with sarcopenia among community-dwelling older adults.</p>

DOI： 10.57304/jptp.1.0_19

CiNii Research

Language：Japanese   Publisher：Japanese Society of Community-based Comprehensive Physical Therapy  

Objective: The purpose of this study was to determine the relationship between the measured mass of the calcaneus bone and the number of stairs used by community-dwelling older adults. Methods: Data obtained from 169 older adults who participated in a community-based health-check survey (Tarumizu Study 2018) were analyzed. Bone mass was measured using the speed of sound of the calcaneal bone and the obtained values were considered to be low when the percentage of the %YAM of the SOS was ≤ 70%. The frequency of stair usage was classified into two groups: 0 and 1 or more times per day at home, and three sub-groups comprising of: 0–2, 3–7, and 8 or more times per week outside home. Results: The results of logistic regression analysis, in which the dependent variable was the presence or absence of bone loss, and the independent variable was the number of stairs used, showed no significant association with the number of stairs used at home. The number of times the stairs were used outside home was set at 0–2 times as a reference, and bone loss was significantly reduced by 8 times or more (odds ratio 0.32, 95% confidence interval 0.11 –0.97, p = 0.045, covariates: age, gender, ASMI, grip strength, walking speed). Conclusion: It was suggested that the frequent use of stairs outside the home may aid in suppressing bone loss. It could be concluded that the use of stairs in activities including going out may affect bone mass as the frequency of stair usage in the house is not relevant.

DOI： 10.57351/jjccpt.1.0_18

CiNii Research

Publisher：Current Problems in Cardiology  

Nutritional status is an important factor affecting prognosis of cardiovascular diseases. We compared major cardiovascular and cerebrovascular events (MACCE) between the malnutrition (geriatric nutritional risk index <92) and non-malnutrition (geriatric nutritional risk index ≥92) groups in 500 stable coronary artery disease patients undergoing percutaneous coronary intervention and evaluated coronary calcification by intravascular ultrasound. Incidences of all-cause death and MACCE differed between the malnutrition and non-malnutrition groups (22% vs 5%, P < 0.001 and 24% vs 6%, P < 0.001). In multivariate Cox proportional hazards regression, malnutrition significantly correlated with all-cause death (P = 0.006) and MACCE (P = 0.010). The proportion of moderate/severe calcification differed between the malnutrition (64%) and non-malnutrition groups (33%, P < 0.001). Multivariate logistic analysis identified age (P < 0.001), malnutrition (P = 0.048), and hemodialysis (P < 0.001) as significantly related to moderate/severe calcification. Malnutrition was an independent risk factor for all-cause death and MACCE in coronary artery disease patients after percutaneous coronary intervention and was associated with moderately/severely calcified lesions.

DOI： 10.1016/j.cpcardiol.2022.101185

Scopus

PubMed

Language：Japanese   Publisher：Archives of Gerontology and Geriatrics  

Objectives: The purpose of this cross-sectional study was to examine the association between cognitive frailty (CF) and higher-level competence among community-dwelling older adults. Methods: Data from 871 older adults (aged ≥ 65 years, mean age 74.3 years, 61.5% women) who had participated in a community-based health check survey (Tarumizu Study 2018-2019) were analyzed. CF was defined as comorbid physical frailty and mild cognitive impairment (MCI). We defined physical frailty as either slow walking speed or poor grip strength. MCI was defined as values below the age- and education-adjusted reference threshold in several tests. Participants were categorized into four groups: robust, physical frailty, MCI, and CF. Higher-level competence was assessed using the Japan Science and Technology Agency Index of Competence (JST-IC). The JST-IC consists of 16 items and four subscales (technology usage, information practice, life management and social engagement). The bottom 20–30% score of the JST-IC and each subscale corresponded to poor higher-level competence. Results: The prevalence of CF was 14.4%. Multivariate logistic regression analysis showed that, CF was significantly associated with poor higher-level competence (odds ratio 1.92, 95% confidence interval 1.18–3.13) after adjusting for covariates. Using a similar analysis to assess the JST-IC subscales, CF was associated with limitations on technology usage (odds ratio 2.29, 95% confidence interval 1.36–3.85) and low social engagement (odds ratio 1.62, 95% confidence interval 1.00–2.61). Conclusions: This study suggests that CF is associated with poor higher-level competence, especially limitations on technology usage and low social engagement.

DOI： 10.1016/j.archger.2021.104589

Scopus

PubMed

Language：Japanese   Publisher：Archives of Gerontology and Geriatrics  

Objectives: This cross-sectional study aimed to clarify the association between physical and social frailty, cognitive impairment, and meaningful activity in older adults. Methods: Data were obtained from 747 older adults (mean age, 74.7 ± 6.2 years; women, 63.9%) who participated in a community-based health check survey (Tarumizu Study 2018). Physical frailty, cognitive impairment, and social frailty were evaluated using the Fried phenotype model (exhibiting one or more of the criteria, including having a pre-frailty status); computerized cognitive test including memory, attention, executive functions, and processing speed (having a score below an age-education adjusted reference threshold in one or more domains); and Makizako's 5 items (exhibiting one or more of the criteria, including having a pre-frailty status), respectively. Participants selected meaningful activities from the 95 activities included in the Aid for Decision-Making in Occupation Choice, after which their satisfaction and performance were evaluated. Meaningful activities were categorized into physical activity, cognitive activity, social activity, and other daily activity. Results: The physical frailty group was significantly less likely to choose physical activity over other activities (p < 0.05). The cognitive impairment group was significantly less likely to choose cognitive activity over other activities (p < 0.01). The multi-domain frailty group (including cognitive impairment) was significantly less likely to choose social activity over other activities (p < 0.05). No significant differences in satisfaction and performance were observed according to frailty status. Conclusions: Our findings indicated that physical and social frailty and cognitive impairment may affect participation in meaningful activities corresponding to these domains.

DOI： 10.1016/j.archger.2021.104616

Scopus

PubMed

Language：Japanese   Publisher：The Japan Geriatric Therapy Society  

<p>【Aim】 This study aimed to determine the modifiable risk factors related to mild cognitive impairment (MCI) and associations between combinations of those factors and MCI in community-dwelling older adults.【Methods】 This cross-sectional study included a total of 578 community-dwelling older adults (aged ≥ 65 years) who had undergone health checkups and were divided into MCI (n = 289) and non-MCI (n = 289) groups. Non-MCI participants were selected through propensity score matching to balance age and gender. The modifiable factors related with MCI were determined and categorized based on those combinations using a decision tree analysis.【Results】 Weakness (grip strength < 28 kg for men, < 18 kg for women), poor sleep quality, and social inactivity (non-participate in regional events) were determined as and categorized based on combinations of those factors. The lowest prevalence rate of MCI was in the non-weakness and non-poor sleep quality group (37.7%) and the highest was in the weakness and social inactivity group (82.0%).【Conclusions】 The combinational status that maintained muscle strength and better sleep quality could be associated with a lower risk of cognitive deficits. However, older adults with weakness and social inactivity would have a greater risk of MCI. Maintenance of muscle strength, sleep quality, and social activity may be helpful in preventing cognitive decline among community-dwelling older adults. When any of those factors decline, the other factors should be maintained for cognitive health.</p>

DOI： 10.57270/jgts.2022_006

CiNii Research

DOI： 10.1038/s41440-021-00818-8

Language：Japanese   Publisher：(一社)日本予防理学療法学会  

【目的】地域在住高齢者における運動器疾患,転倒歴および多剤併用とサルコペニアとの関連性を調べることを目的とした。【方法】地域コホート研究に参加した高齢者905名を対象とし,運動器疾患の有無,1日の服薬数,過去1年間での転倒歴を聴取した。サルコペニアはAWGS2019の基準で判定した。【結果】全対象者のうちの166名(18.3%)がサルコペニアに該当した。骨粗鬆症を有する者ではサルコペニアの該当者が有意に多かったが,脊椎疾患および変形性関節症とサルコペニアとの関連は認められなかった。ロジスティック回帰分析の結果,運動器疾患とサルコペニアの関連は確認されず,多剤併用(6剤以上)(オッズ比1.56)および転倒歴(オッズ比1.65)がサルコペニアと有意に関連していた。【結論】骨粗鬆症を有する高齢者ではサルコペニアに該当する者の割合が高かったものの,多変量解析においてはサルコペニアと運動器疾患との関連性は認められず,多剤併用および転倒歴がサルコペニアと関連する要因として抽出された。(著者抄録)

Language：English   Publisher：Nature Publishing Group  

鹿児島県の地域健診受診者315名(女性201名、平均70±9歳)を対象に、血圧変動と臓器機能の関連について検討した。1ヵ月間(連日、起床後1時間以内)の家庭血圧値の変動係数(CV)四分位群間で心機能(脳性ナトリウム利尿ペプチド前駆体N端フラグメント(NT-proBNP)と高感度トロポニンT)、肝機能(Fib4 index)、腎機能(推算糸球体濾過量;eGFR)を比較した。多変量ロジスティック回帰分析の結果、収縮期血圧CV高位群ほどeGFR低値(<60mL/min/1.73m2)、Fib4 index高値(>2.67)、NT-proBNP高値(>70pg/mL[中央値])のオッズ比が高かった。高感度トロポニンT高値(>0.007ng/mL[中央値])との関連は全群で認められなかった。拡張期血圧CV高位群はNT-proBNP高値のオッズ比が高く、最高四分位群はFib4 index高値のオッズ比も高かったが、eGFR低値および高感度トロポニンT高値との関連はみられなかった。以上から、家庭血圧の日間変動は心臓、肝臓、腎臓のバイオマーカーと独立して関連していることが示された。

Language：Japanese   Publisher：(一社)日本老年療法学会  

地域在住高齢者の軽度認知障害(Mild Cognitive Impairment:MCI)に関連する可変因子を探索し、それらの組み合わせによるMCIとの関連を傾向スコア・マッチング法を用いて検討することを目的に、地域コホート研究の参加者で年齢と性別でマッチングされた65歳以上の高齢者578名(MCI群289名[平均年齢76.4±6.4歳]、非MCI群289名[平均年齢75.9±6.5歳])を対象に、身体機能評価(握力、通常歩行速度)および質問紙による生活状況の調査を行った。決定木分析の結果、握力低下(男性28kg未満、女性18kg未満)、睡眠の質の低下、社会参加(地域の祭りや行事などへの参加)の有無の組み合わせによりグループが形成され、MCIの割合は握力低下なし+睡眠の質の低下なし群(グループI)で最も低く(37.7%)、握力低下あり+地域行事の参加なしの群(グループIV)で最も高かった(82.0%)。

Language：Japanese   Publisher：(一社)日本地域理学療法学会  

【目的】本研究は,地域在住高齢者における踵骨の骨量と階段使用頻度との関連性を調べることを目的とした.【方法】地域コホート研究(垂水研究2018)に参加した高齢者169名を横断的に分析した.骨量は%YAMが70%以下を骨量低下とした.階段使用頻度について,自宅内階段は1日0回と1回以上の2群,自宅外階段は週0～2回・3～7回・8回以上の3群に分類した.【結果】従属変数を骨量低下の有無,独立変数を階段使用頻度としたロジスティック回帰分析の結果,自宅内の階段使用頻度に有意な関連は認められなかったものの,自宅外の階段使用頻度0～2回を参照とし,8回以上では有意に骨量低下が減少した(オッズ比0.32,95%信頼区間0.11-0.97,p=0.045,共変量:年齢,性別,ASMI,握力,歩行速度).【結論】自宅外での階段の使用頻度が多いと骨量低下の抑制に有用となり得る可能性が示唆された.自宅内の階段使用頻度は関連しておらず,外出を含めた階段の使用が骨量に影響を与えている可能性がある.(著者抄録)

Publisher：Vascular  

Objective: The Wound, Ischemia, and foot Infection (WIfI) clinical stage has been thought to have a prognostic value in Chronic limb-threatening ischemia (CLTI) patients, and frailty and nutritional status appear to represent pivotal factor affecting prognosis among CLTI patients. The purpose of this study was to examine clinical factors (including frailty and nutritional status) relevant to WIfI clinical stage. Methods: This retrospective study investigated 200 consecutive CLTI patients. We individually assessed WIfI clinical stage, frailty according to the Clinical Frailty Scale (CFS) score, and malnutrition according to Geriatric Nutritional Risk Index (GNRI). We then compared mortality after endovascular intervention between a WIfI stage 1, 2 group and a stage 3, 4 group, and investigated associations between baseline characteristics (including CFS and GNRI) and WIfI clinical stage. Results: Among 200 patients, 123 patients (62%) showed WIfI stage 1 or 2, and the remaining 77 patients (38%) had WIfI stage 3 or 4. CFS score was significantly higher in the WIfI stage 3, 4 group [median 6.0, interquartile range (IQR) 5.5–7.0] compared with the WIfI stage 1, 2 group (median 5.0, IQR 4.0–6.0, p < 0.001), and GNRI was significantly lower in the WIfI stage 3, 4 group (median 88, IQR 80–97) than in the WIfI stage 1, 2 (median 103, IQR 94–111, p < 0.001). Forty patients (20%) died after endovascular intervention. Incidences of all-cause and cardiac deaths were higher in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group (27% vs. 15%, p = 0.047 and 12% vs. 3%, p = 0.040, respectively). Kaplan–Meier analysis showed a significantly lower survival rate in the WIfI stage 3, 4 group than in the WIfI stage 1, 2 group (p = 0.002 by log-rank test). Multivariate logistic regression analysis using relevant factors from univariate analysis showed CFS score [odds ratio (OR) 2.06, 95% confidence interval (CI) 1.41–3.13, p < 0.001), diabetes mellitus (OR 3.17, 95%CI 1.17–8.61, p = 0.023) and GNRI (OR 0.93, 95%CI 0.89–0.97, p = 0.002) significantly associated with WIfI stage 3 or 4. In addition, multivariate ordinal logistic regression analysis for WIfI clinical stage showed CFS score (OR 1.43, 95%CI 1.09–1.89, p = 0.011), diabetes mellitus (OR 1.77, 95%CI 1.26–2.54, p < 0.001), and high-sensitivity C-reactive protein (OR 1.14, 95%CI 1.02–1.28, p = 0.041) were positively associated with WIfI clinical stage, and GNRI correlated negatively with WIfI clinical stage (OR 0.95, 95%CI 0.91–0.97, p < 0.001). Conclusions: These results indicate that CLTI patients with high WIfI clinical stage may be more frail and malnourished, and be associated with poor prognosis after endovascular intervention.

DOI： 10.1177/17085381221076943

Scopus

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b>Body mass index (BMI) and the waist-to-height ratio (WHtR) are widely used anthropometric indices of obesity to predict cardiovascular risks. However, the usefulness of combining WHtR and BMI values to predict hypertension risk by sex has not been well elucidated.</p><p><b><i>Methods and Results:</i></b>This cohort study enrolled 45,921 participants (mean [±SD] age 53.8±10.5 years; 47.0% men) without hypertension from among those undergoing annual health checkups. Participants were divided into 4 categories based on median BMI and WHtR values, and the 5-year incidence of hypertension was assessed for both sexes using logistic regression analysis. Mean (±SD) BMI and WHtR values were 23.5±3.1 kg/m²and 0.50±0.05, respectively, in men and 22.4±3.3 kg/m²and 0.53±0.06, respectively, in women. Among the women, those with high BMI and low WHtR had an increased risk of hypertension compared with those with low BMI and low WHtR (odds ratio [OR] 1.37, P<0.001); however, the same result was not found in men (OR 1.14, P=0.080). In both sexes, the incidence of hypertension was higher among participants with low BMI and high WHtR than among those with low BMI and low WHtR (men: OR 1.26, P<0.001; women: OR 1.15, P=0.048).</p><p><b><i>Conclusions:</i></b>Using WHtR and BMI together provides a better hypertension risk assessment. Among men, those with a high BMI had no increased hypertension risk when WHtR was low.</p>

DOI： 10.1253/circrep.cr-21-0139

PubMed

CiNii Research

Publisher：Heart and Vessels  

DOI： 10.1007/s00380-021-01891-2

Scopus

PubMed

Language：Japanese   Publisher：Hypertension Research  

Hyperuricemia is related to an increased risk of cardiovascular events from a meta-analysis and antihyperuricemia agents may influence to cardiac function. We evaluated the effect of febuxostat on echocardiographic parameters of diastolic function in patients with asymptomatic hyperuricemia as a prespecified endpoint in the subanalysis of the PRIZE study. Patients in the PRIZE study were assigned randomly to either add-on febuxostat treatment group or control group with only appropriate lifestyle modification. Of the 514 patients in the overall study, 65 patients (31 in the febuxostat group and 34 in the control group) who had complete follow-up echocardiographic data of the ratio of peak early diastolic transmitral flow velocity (E) to peak early diastolic mitral annular velocity (e′) at baseline and after 12 and 24 months were included. The primary endpoint was a comparison of the changes in the E/e′ between the two groups from baseline to 24 months. Interestingly, e′ was slightly decreased in the control group compared with in the febuxostat group (treatment p = 0.068, time, p = 0.337, treatment × Time, p = 0.217). As a result, there were significant increases in E/e′ (treatment p = 0.045, time, p = 0.177, treatment × time, p = 0.137) after 24 months in the control group compared with the febuxostat group. There was no significant difference in the serum levels of N-terminal-pro brain natriuretic peptide and high-sensitive troponin I between the two groups during the study period. In conclusions, additional febuxostat treatment in patients with asymptomatic hyperuricemia for 24 months might have a potential of preventable effects on the impaired diastolic dysfunction.

DOI： 10.1038/s41440-021-00752-9

Scopus

Language：English   Publisher：(一社)日本循環器学会  

日本人一般集団の健康診断データを解析し、BMIと腹囲・身長比(WHtR)の組み合わせによって男女の高血圧リスクを評価できるか調べた。2008年10月1日～2019年3月31日に健康診断を受診した30～70歳の45921名(男性21570名、女性24351名、平均53.8±10.5歳)のデータを後ろ向きに解析した。BMIおよびWHtRの中央値を用いて受診者を4群に分類し、高血圧の5年発症率を男女別に評価した。平均BMIと平均WHtRは男性ではそれぞれ23.5±3.1kg/m2と0.50±0.05、女性では22.4±3.3kg/m2と0.53±0.06であった。ロジスティック回帰分析の結果、女性では高BMIと低WHtRの受診者は低BMIおよび低WHtRの受診者と比較して高血圧リスクが高かったが、男性では高BMIと低WHtRの受診者は高血圧発症リスクが増加しなかった。男女とも低BMIで高WHtRの受診者の方が低BMIで低WHtRの受診者よりも高血圧の発症率が高いことが示された。

Language：Japanese   Publisher：(一社)日本成人先天性心疾患学会  

Language：Japanese   Publisher：(一社)日本成人先天性心疾患学会  

Language：Japanese   Publisher：(一社)日本成人先天性心疾患学会  

Language：English   Publisher：シュプリンガー・ジャパン(株)  

カテーテルアブレーション(CA)を施行した心房細動患者501例(男性378例、女性123例)を対象に、赤血球粒度分布幅(RDW)がCA後の転帰を予測するかどうかを検討した。心房細動患者の内訳は、発作性が239例、持続性が196例、永続性が66例であった。重度の貧血、腎機能低下、悪性腫瘍、血液疾患の既往患者は除外した。3ヵ月のブランキング期間後に心房細動の再発は107例で発生した(再発群)。患者を再発群107例(男性69.2%、平均64.6±10.2歳)と非再発群394例(男性77.2%、平均63.2±10.2歳)の2群に分類した。CA施行前の平均RDWは13.5%で、有意な群間差はなかった。再発群のRDWはベースライン(13.55%)とCA後(13.60%)で変化はなかったが、非再発群では術前(13.64%)に比べて術後(13.37%)に有意に低下した(P<0.001)。Cox比例ハザードモデルによる多変量解析の結果、CA後のRDW低下は心房細動再発の有無を予測する独立因子であった(HR:2.00、95%CI:1.42～2.76、P<0.001)。

Publisher：THE JAPANESE ASSOCIATION OF RURAL MEDICINE  

<p><b>Objective:</b> Few cases of Takotsubo cardiomyopathy with apical hypertrophic cardiomyopathy (APH)-like morphological changes during the recovery process have been reported.</p><p><b>Patient:</b> A 56-year-old woman diagnosed with Takotsubo cardiomyopathy showed a morphology similar to that of APH during recovery. We examined this patient using 2D speckle-tracking echocardiography based on the method used for hypertrophic cardiomyopathy, which suggested that the circumferential strain (CS) of the middle wall indicated myocardial function of the left ventricle, and the CS of the inner wall was associated with left ventricular chamber function.</p><p><b>Results:</b> We measured the CS of the endocardial, middle, and epicardial layers and found that the apical inner layer CS (CSinner), middle layer CS, and outer layer CS were all decreased at the onset. CSinner showed a strong tendency to recover on echocardiography performed when APH-like morphology was observed.</p><p><b>Conclusion:</b> The morphology of the apex in our case likely contributed to the maintenance of chamber function.</p>

DOI： 10.2185/jrm.2021-050

PubMed

Language：Japanese   Publisher：Japanese Society of Physical Therapy  

<p><b>Objective</b>: The purpose of this study was to examine the relationship between low bone mass, low muscle mass, and physical activity in community-dwelling older adults.</p><p><b>Methods</b>: Data obtained from 173 older adults who participated in a community-based health-check survey (Tarumizu Study 2018) were analyzed. Bone mass was measured using the speed of sound (SOS) of the calcaneal bone and was considered low when the percentage of the %YAM of the SOS was ≤70%. Muscle mass was assessed based on the criteria for sarcopenia by the AWGS. Physical activity was measured using an accelerometer to determine whether there was an increase in sedentary activity time, a decrease in MVPA time, and a decrease in step count Classified. The groups were classified into healthy (normal bone and muscle masses), low bone mass (only bone mass decreased), low muscle mass (only muscle mass decreased), and low bone/muscle mass groups (both bone and muscle masses decreased).</p><p><b>Results</b>: As a result of logistic regression analysis, MVPA time was significantly decreased in the bone loss and muscle loss groups compared with the normal group (odds ratio, 3.29; p<0.05; covariates: age [5 years], sex, depression tendency, and decreased walking speed).</p><p><b>Conclusion</b>: This study indicated that MVPA levels were lower in the older adults who had lower bone and muscle masses.</p>

DOI： 10.15063/rigaku.12150

CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)  

The purpose of this cross-sectional study was to analyse the differences in meaningful activities and psychosomatic function depending on the driving status of community-dwelling older adults. Data from 594 older adults were obtained, including activities meaningful to individuals and psychosomatic functions, such as grip strength, depression, cognitive function, and ability of activity. Participants were divided into active driving (n = 549) and after driving cessation (n = 45) groups. In addition, the active driving group was operationally divided into three groups: high-frequency group (n = 387), medium group (n = 119), and infrequent group (n = 42). In the after driving cessation group, grip strength, and Japan Science and Technology Agency Index of Competence scores were significantly lower. Furthermore, the proportion of apathy and physical and social frailty was significantly higher in the after driving cessation group. Regarding meaningful activity, domestic life scores in the after driving cessation group were significantly higher than those of the active driving group. Decreased driving frequency in the active driving group was associated with weak muscle strength, lack of interest, and low activity. This study demonstrated that meaningful activity differed based on the driving status. Hence, we should support the activities of older adults who are considering driving cessation.

DOI： 10.3390/ijerph182413270

Scopus

PubMed

Language：English   Publisher：(一社)日本不整脈心電学会  

心房細動(AF)に対してカテーテルアブレーション(CA)を実施した患者446例(男性370例、女性76例、平均64±10歳)を対象に、1周の通電で肺静脈隔離の成功(First pass isolation)が転帰に及ぼす影響を検討した。対象は接触力(contact force)を指標として肺静脈隔離術を実施した薬剤抵抗性AF患者で、発作性AFは191例、持続性AFは175例、永続性AFは80例であった。患者を左右肺静脈のいずれかでFirst pass isolationに成功したFPI群383例(男性82%、平均64±11歳)と非FPI群63例(男性87%、平均63±9歳)の2群に分類した。患者背景は非FPI群でBMIが有意に高かった。CA治療後2年におけるAF再発回避率はFPI群(75%)の方が非FPI群(59%)より有意に高かった(P=0.032)。Cox比例ハザードモデルを使った多変量解析により、交絡因子で調整したところ、FPIの不達成はアブレーション治療後のAF再発を予測する独立因子であった(HR:1.65、95%CI:1.07～2.55、P=0.02)。

Language：Japanese   Publisher：Nutrients  

Few studies have investigated the relationship between nutritional status and comprehensive assessment of oral hypofunction, especially protein intake-related sarcopenia. Thus, we explored these relationships in a large-scale cross-sectional cohort study using the seven-item evaluation for oral hypofunction and Diet History Questionnaire for nutritional assessment. We used the data from 1004 individuals who participated in the 2019 health survey of the residents of Tarumizu City, Kagoshima Prefecture, Japan for analysis. We found that individuals with oral hypofunction were significantly older with a lower skeletal muscle index. Although there were few foods that had a sig-nificant difference between the groups with and without oral hypofunction, the consumption of beans and meats was significantly lower in women and men in the oral hypofunction group, respectively. According to the lower limit of the tentative dietary goal defined in Japan, comprehensive evaluation of oral hypofunction was significantly and independently associated with protein intake in both men and women (odds ratio, 1.70; 95% confidence interval, 1.21–2.35). In conclusion, we found that oral hypofunction was associated with targeted protein intake for sarcopenia and frailty prevention in middle-aged and older community-dwelling adults. Comprehensive evaluation of oral function with intervention in cases of hypofunction could inform clinicians to better prevent sarcopenia.

DOI： 10.3390/nu13124377

Scopus

PubMed

Language：Japanese   Publisher：(株)ライフメディコム  

高血圧は、圧負荷の増大により心肥大や心筋間質の線維化といった心筋リモデリングをきたし、冠動脈内皮障害を引き起こす。左室内圧の上昇に伴い左房圧も上昇し、心房拡大につながり心房細動の発症リスクとなる。また、糖尿病や脂質異常症、肥満といった生活習慣病も加わると、虚血性心疾患のリスクにもなる。最終的に、高血圧により引き起こされた心肥大や心房細動、虚血性心疾患などにより、心不全の発症につながる。早期の治療介入により、それらの発症を抑制できることが報告されているが、多剤併用にもかかわらず降圧目標値に到達できない治療抵抗性高血圧の患者が存在する。治療抵抗性高血圧患者は、コントロールされた高血圧患者と比較し、持続的な高血圧に伴う臓器障害をきたす可能性が高い。近年、ミネラルコルチコイド受容体(MR)拮抗薬や腎交感神経デナベーションの有用性が報告され、適切な降圧薬の選択や腎交感神経デナベーションによる適切な血圧コントロールにより臓器合併症の予防や進展抑制が期待できる。(著者抄録)

Language：Japanese   Publisher：シュプリンガー・ジャパン(株)  

2008年4月～2016年3月の間に健康診断を2回以上受診した参加者67379名(男性49.8%、平均54.3±10.0歳)を対象に、腹部肥満と新規発症心房細動(AF)との関係を後ろ向きに検討した。参加者の腹囲に基づいて過大腹囲群と正常腹囲群に分けた。全体および男女別に腹部肥満と新規発症心房細動との関連の強度を判定した。過大腹囲群は男性16329名、女性6539名であった。経過観察期間中央値は5年で、280例で新規発症AFが記録された。単変量解析では過大腹囲は男性では新規発症AFと有意に関連したが、女性では関連しなかった。多変量解析では男性で過大腹囲が新規発症AFと有意に関連したが、女性では関連しなかった。腹部肥満は男性では新規発症AFのリスクの増加と関連していた。

Language：Japanese   Publisher：BMC Cardiovascular Disorders  

Background: Pericardiocentesis is frequently performed when fluid needs to be removed from the pericardial sac, for both therapeutic and diagnostic purposes, however, it can still be a high-risk procedure in inexperienced hands and/or an emergent setting. Case presentation: A 78-year-old male made an emergency call complaining of the back pain. When the ambulance crew arrived at his home, he was in a state of shock due to cardiac tamponade diagnosed by portable echocardiography. The pericardiocentesis was performed using a puncture needle on site, and the patient was immediately transferred to our hospital by helicopter. Contrast-enhanced computed tomography showed a small protrusion of contrast media on the inferior wall of the left ventricle, suggesting cardiac rupture due to acute myocardial infarction. Emergency coronary angiography was then performed, which confirmed occlusion of the posterior descending branch of the left circumflex coronary artery. In addition, extravasation of contrast medium due to coronary artery perforation was observed in the acute marginal branch of the right coronary artery. We considered that coronary artery perforation had occurred as a complication of the pericardial puncture. We therefore performed transcatheter coil embolization of the perforated branch, and angiography confirmed immediate vessel sealing and hemostasis. After the procedure, the patient made steady progress without a further increase in pericardial effusion, and was discharged on the 50th day after admission. Conclusions: When performing pericardial drainage, it is important that the physician recognizes the correct procedure and complications of pericardiocentesis, and endeavors to minimize the occurrence of serious complications. As with the patient presented, coil embolization is an effective treatment for distal coronary artery perforation caused by pericardiocentesis.

DOI： 10.1186/s12872-021-01875-0

Scopus

PubMed

Language：Japanese   Publisher：BMC Cardiovascular Disorders  

Background: Stable coronary artery disease (CAD) patients with myocardial damage have a poor prognosis compared to those without myocardial damage. Recently, malnutrition has been reported to affect the prognosis of cardiovascular diseases. However, the effects of malnutrition on prognosis of CAD patients with myocardial damage remains uncertain. We investigated the effects of malnutrition on prognosis of CAD patients with myocardial damage who received percutaneous coronary intervention (PCI). Methods: Subjects comprised 241 stable CAD patients with myocardial damage due to myocardial ischemia or infraction. Patients underwent successful revascularization for the culprit lesion by PCI using second-generation drug-eluting stents and intravascular ultrasound. The geriatric nutritional risk index (GNRI), which is widely used as a simple method for screening nutritional status using body mass index and serum albumin, was used to assess nutritional status. Associations between major cardiovascular and cerebrovascular events (MACCE) and patient characteristics were assessed. Results: Mean GNRI was 100 ± 13, and there were 55 malnourished patients (23%; GNRI < 92) and 186 non-malnourished patients (77%). MACCE occurred within 3 years after PCI in 42 cases (17%), including 34 deaths (14%), and the malnourished group showed a higher rate of MACCE (38%) compared with the non-malnourished group (11%, p < 0.001). Univariate Cox proportional hazards analyses showed that MACCE was associated with age [hazard ratio (HR), 1.04; 95% confidence interval (CI), 1.04–1.07; p = 0.004], prior heart failure (HR 2.35; 95% CI 1.10–5.01; p = 0.027), high-sensitivity C-reactive protein (HR 1.08; 95% CI 1.03–1.11; p < 0.001), hemodialysis (HR 2.63; 95% CI 1.51–4.58; p < 0.001) and malnutrition (HR 3.69; 95% CI 2.11–6.42; p < 0.001). Multivariate Cox proportional hazards analysis revealed hemodialysis (HR 2.17; 95% CI 1.19–3.93; p = 0.011) and malnutrition (HR 2.30; 95% CI 1.13–4.67; p = 0.020) as significantly associated with MACCE. Furthermore, Cox proportional hazards models using malnutrition and hemodialysis revealed that patients with malnutrition and hemodialysis were at greater risk of MACCE after PCI than patients with neither malnutrition nor hemodialysis (HR 6.91; 95% CI 3.29–14.54; p < 0.001). Conclusions: In CAD patients with myocardial damage, malnutrition (GNRI < 92) represents an independent risk factor for MACCE. Assessment of nutritional status may help stratify the risk of cardiovascular events and encourage improvements in nutritional status.

DOI： 10.1186/s12872-021-02296-9

Scopus

PubMed

Publisher：Circ Rep  

DOI： 10.1253/circrep.CR-21-0139.

Language：English   Publisher：Frontiers in Cardiovascular Medicine  

Lectin-like oxidized low-density lipoprotein (ox-LDL) causes vascular senescence and atherosclerosis. It has been reported that ox-LDL scavenger receptor-1 (LOX-1) is associated with the angiotensin II type 1 receptor (AT1R). While mitochondria play a crucial role in the development of vascular senescence and atherosclerosis, they also undergo quality control through mitochondrial dynamics and autophagy. The aim of this study was to investigate (1) whether LOX-1 associates with AT1R, (2) if this regulates mitochondrial quality control, and (3) whether AT1R inhibition using Candesartan might ameliorate ox-LDL-induced vascular senescence. We performed in vitro and in vivo experiments using vascular smooth muscle cells (VSMCs), and C57BL/6 and apolipoprotein E-deficient (ApoE KO) mice. Administration of oxidized low-density lipoprotein (ox-LDL) to VSMCs induced mitochondrial dysfunction and cellular senescence accompanied by excessive mitochondrial fission, due to the activation of fission factor Drp1, which was derived from the activation of the Raf/MEK/ERK pathway. Administration of either Drp1 inhibitor, mdivi-1, or AT1R blocker candesartan attenuated these alterations. Electron microscopy and immunohistochemistry of the co-localization of LAMP2 with TOMM20 signal showed that AT1R inhibition also increased mitochondrial autophagy, but this was not affected by Atg7 deficiency. Conversely, AT1R inhibition increased the co-localization of LAMP2 with Rab9 signal. Moreover, AT1R inhibition-induced mitochondrial autophagy was abolished by Rab9 deficiency, suggesting that AT1R signaling modulated mitochondrial autophagy derived from Rab9-dependent alternative autophagy. Inhibition of the Raf/MEK/ERK pathway also decreased the excessive mitochondrial fission, and Rab9-dependent mitochondrial autophagy, suggesting that AT1R signaling followed the Raf/MEK/ERK axis modulated both mitochondrial dynamics and autophagy. The degree of mitochondrial dysfunction, reactive oxygen species production, vascular senescence, atherosclerosis, and the number of fragmented mitochondria accompanied by Drp1 activation were all higher in ApoE KO mice than in C57BL/6 mice. These detrimental alterations were successfully restored, and mitochondrial autophagy was upregulated with the administration of candesartan to ApoE KO mice. The association of LOX-1 with AT1R was found to play a crucial role in regulating mitochondrial quality control, as cellular/vascular senescence is induced by ox-LDL, and AT1R inhibition improves the adverse effects of ox-LDL.

DOI： 10.3389/fcvm.2021.788655

Scopus

PubMed

Language：Japanese   Publisher：Elsevier BV  

DOI： 10.1016/j.jaccas.2021.08.003

Scopus

PubMed

Language：Japanese   Publisher：(有)科学評論社  

Language：English  

DOI： 10.1186/s12872-021-02296-9.

Language：Japanese   Publisher：(有)科学評論社  

Language：Japanese   Publisher：大道学館出版部  

DOI： 10.1002/joa3.12629

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：Japanese   Publisher：(一社)日本心臓病学会  

Language：English   Publisher：Nature Publishing Group  

血清尿酸値と血圧異常との関連について検討するため、2001～2015年に厚生連病院で定期健康診断を受けた者のデータを解析した。血清尿酸値(mg/dL)が2.0以下の者を低尿酸血症群(LUA群)とし、それ以外の者を血清尿酸値の四分位毎に4群に分けた(SUA1群:2.1～4.0、SUA2群:4.1～5.0、SUA3群:5.1～6.0、SUA4群:6.1以上)。各群の高血圧(130/80mmHg以上または降圧薬の使用)および高血圧症(140/90mmHg以上または降圧薬の使用)の有病率を算出し、血圧異常の割合が最も低い群と比較した各群の調整オッズ比を求めた。定期健康診断を受けた236221名(男性107146名、平均56.0±15.0歳)のデータを解析した。高血圧の有病率は、LUA群、SUA1群～SUA4群でそれぞれ49.0、44.6、52.3、58.6、65.3%であり、高血圧症の有病率はそれぞれ31.0、27.4、33.5、38.7、43.8%であった。SUA1群と比較して、LUA群およびSUA2群～SUA4群の高血圧と高血圧症のオッズ比は有意に高かった。本研究にて、血清尿酸値は血圧異常の有病率と有意に関連し、その関連はJ字型曲線であることが示された。

Publisher：(株)東京医学社  

DOI： 10.24479/j00714.2022002710

CiNii Research

Language：Japanese   Publisher：(株)東京医学社  

Language：Japanese   Publisher：Journal of Invasive Cardiology  

Scopus

Language：English   Publisher：(一社)日本心臓病学会  

ミトコンドリアダイナミクスに関連するmiRNAが肺動脈性肺高血圧症(PAH)、慢性血栓塞栓性肺高血圧症(CTEPH)に及ぼす影響について検討した。2016年10月～2019年1月に右心カテーテル検査を施行した患者のうち、PH(PAH 12例、CTEPH 22例)と診断された34例を対象、左心疾患と診断された30例を対照とした。ミトコンドリアダイナミクスに関連する循環miRNAであるmiR-140-3pおよびmiR-485-5pは異なる特徴を示し、臨床PAHとCTEPHにおける血行動態の変化を制御する上で重要な役割を果たしている可能性のあることが示唆された。

Language：Japanese   Publisher：Japan Heart Foundation  

DOI： 10.11281/shinzo.53.728

CiNii Research

Language：English   Publisher：Frontiers in Aging Neuroscience  

DOI： 10.3389/fnagi.2021.680341

Scopus

PubMed

Publisher：Journal of Cardiology  

DOI： 10.1016/j.jjcc.2021.03.008

Scopus

PubMed

Publisher：International Journal of Geriatric Psychiatry  

DOI： 10.1002/gps.5544

Scopus

PubMed

Language：Japanese   Publisher：(公財)日本心臓財団  

急性心膜炎を起こす疾患として、感染性や特発性など様々な疾患があるが、膠原病による急性心膜炎は比較的稀とされている。今回、シェーグレン症候群に伴う急性心膜炎を呈し、心タンポナーデとなった症例を経験した。71歳の女性で既往に悪性疾患・甲状腺疾患があった。発熱・呼吸苦を契機とした全身精査で心嚢液の貯留を認めた。起坐呼吸となり、心タンポナーデと判断したが、心嚢液が左室後方に貯留しており、穿刺が困難であった。シェーグレン症候群の既往もあり、SS-A抗体が高値であったことからステロイドを投与したところ著効し、開始2日後には心嚢液はほぼ消失した。経過が典型的でない急性心膜炎の症例では、シェーグレン症候群などの膠原病性心嚢液貯留も考慮すべきことを示唆する症例と考えられた。(著者抄録)

Language：Japanese   Publisher：大道学館出版部  

Language：English   Publisher：シュプリンガー・ジャパン(株)  

心房細動アブレーション後に認められる、心房細動再発と全心房伝導時間(PA-TDI duration)との関連について検討した。対象患者は、発作性心房細動に対し高周波アブレーションが施行された患者209例と心房細動再発に対し2回目のアブレーションが施行された患者75例とした。心房の電気的リモデリングを表す体表面心電図上のP波始点から、遠位側冠動脈洞(CS)の心房電位までの時間(PA-CSd duration)、右房の電気的リモデリングを表すP波始点から、近位CS心房電位までの時間(PA-CSp duration)と左房の電気的リモデリングを反映する、近位から遠位CSまでの伝導時間(CSp-CSd duration)を調査した。また、左房の構造的リモデリングマーカーとしては、左房容積係数(LAVI)を測定した。その結果、PA-TDI durationはPA-CSd durationと正相関が認められ、心房細動再発患者では、2回目アブレーションのPA-TDI duration、PA-CSd durationおよびCSp-CSd durationが1回目に比べ有意に長かったが、1回目と2回目のアブレーションのLAVIとPA-CSp durationでは有意差はみられなかった。以上より、発作性心房細動患者に対する心房細動アブレーション後のPA-TDI duration延長は、左房の電気的リモデリング進行と考えられることから、アブレーション後の心房細動再発予測に有用と判断された。

Language：English   Publisher：シュプリンガー・ジャパン(株)  

頸動脈内膜中膜肥厚(IMT)、頸部プラーク、上腕-足首脈波伝播速度(baPWV)などの心血管疾患(CVD)に対する非侵襲的および予測マーカーと、肥満、喫煙、血圧上昇、空腹時血糖値低下(IFG)、脂質異常症(DL)などの伝統的危険因子との関連における性差を調べた。2001年4月～2015年3月に健康診断を実施した被験者3888名(女性743名、平均61±9歳、男性3145名、平均56±11歳)を評価した。高IMT、高頸部プラークスコア(PS)、高baPWVは各性別の中央値で定義した。各パラメーターとアテローム動脈硬化危険因子との関連を解析した。両性とも年齢で補正した多変量ロジスティック回帰分析では血圧上昇のみが高IMT、高PS、高baPWVに対する一般的な危険因子であった。男性ではIFG、DLが高IMT、高PS、高baPWVの一般的危険因子で、肥満が高IMT、喫煙が高IMTと高PSに対する追加の危険因子であった。女性では肥満、DL、IFGが高IMT、高PS、高baPWVに対する追加の危険因子であった。

Language：Japanese   Publisher：一般社団法人 日本サルコペニア・フレイル学会  

<p> <b>［目　的］</b> </p><p>地域在住高齢女性における骨粗鬆症と身体・認知・社会的フレイルとの関係を明らかにする。</p><p> <b>［方　法］</b> </p><p>地域での健康チェックに参加した高齢女性265名を分析対象とした。骨粗鬆症の有無，身体・認知・社会的フレイルを評価し，身体・社会的フレイルに関しては，プレフレイルとフレイルを合わせてプレフレイル以上とした。骨粗鬆症を従属変数とし，身体的プレフレイル以上，認知的フレイル，社会的プレフレイル以上を独立変数としたロジスティック回帰分析を行い，さらに前期・後期高齢女性に分けてオッズ比を算出した。</p><p> <b>［結　果］</b> </p><p>年齢，内服数，教育歴，BMI，関節リウマチの有無，呼吸器疾患の有無で傾向スコアを算出し，傾向スコアで調整したロジスティック回帰分析の結果，後期高齢女性において骨粗鬆症と社会的プレフレイル以上が関連していた（オッズ比3.14，95％ CI1.25-7.93，p＝0.02）。</p><p> <b>［結　論］</b> </p><p>地域在住後期高齢女性において，社会的フレイルは骨粗鬆症のリスクを高める可能性がある。</p>

DOI： 10.69303/jjasf.5.1_96

CiNii Research

Language：Japanese   Publisher：Japan Heart Foundation  

DOI： 10.11281/shinzo.53.623

CiNii Research

Publisher：(株)南山堂  

DOI： 10.15104/j01461.2021231225

CiNii Research

Language：Japanese   Publisher：(株)南山堂  

＜Key Points＞◎蓄尿障害・排尿障害が除外された後には尿産生亢進を考慮に入れる必要がある。食塩摂取過多の食塩感受性高血圧では夜間Naを排泄するために尿産生亢進して夜間頻尿となる。◎うっ血性心不全では、夜間臥位による静脈還流上昇を緩和するために尿産生亢進して夜間頻尿となる。◎高血圧ではサイアザイド利尿薬による昼間の塩分排泄、心不全ではループ利尿薬による昼間の体液量調節が夜間頻尿治療として重要である。(著者抄録)

Language：Japanese   Publisher：(一社)日本サルコペニア・フレイル学会  

[目的]地域在住高齢者における社会参加とサルコペニアとの関連を明らかにすることを目的とした。[方法]地域コホート研究(垂水研究2018)に参加した65歳以上の地域在住高齢者859名のうち、脳卒中等の既往歴のない751名を分析対象とした。Asian Working Group for Sarcopenia2019に基づいてサルコペニアの有無、またJST版活動能力指標の社会参加に関する4項目より社会参加の状況を評価した。[結果]サルコペニアを有する者では、社会参加得点が有意に低値であった(p<0.001)。従属変数をサルコペニアの有無、独立変数を社会参加得点としたロジスティック回帰分析の結果、社会参加とサルコペニアに有意な関連を認めた(オッズ比0.83、95%信頼区間0.71-0.97)(共変量:年齢、性別、教育歴、服薬数、転倒歴、運動習慣、うつ傾向、認知機能)。[結論]地域在住高齢者の社会参加状況はサルコペニアと関連することが示唆された。(著者抄録)

Language：Japanese   Publisher：(公財)日本心臓財団  

症例は74歳の男性。20XX年3月から喉のつかえを自覚し5月に近医で上部消化管内視鏡検査を受け、食道がんを疑われ紹介となった。PET-CTを含めた精査の結果、胸部中部食道がん(臨床stage II:T3、N0、M0)および膀胱がんと診断された。食道がんは手術適応であり、6月に術前化学療法としてFP療法(5-FU+シスプラチン)を2コース受けた。FP療法施行時は末梢挿入式中心静脈カテーテルを留置し、有害事象なく行えた。7月に近医泌尿器科で経尿道的膀胱腫瘍切除術を施行され、膀胱がんとの重複がんと診断された。FP療法の効果判定目的で8月に胸腹部造影CTを施行した。食道がんの縮小を認めるも、右肺動脈本幹に血栓を認めたため入院し、ヘパリン持続点滴とリバーロキサバン強化療法を開始した。入院時より認めていた肉眼的血尿が増悪し、第8病日の採血で血色素量が入院時から4g/dL低下したため、リバーロキサバンをエドキサバンへ変更し、体重減少にあわせて低用量(30mg)使用した。肉眼的血尿は消失し、輸血を行うことなく貧血の改善を認め、退院後に食道がん切除術を施行できた。当院におけるFP療法後のがん関連静脈血栓症を含めて考察する。(著者抄録)

Language：Japanese   Publisher：(一社)日本サルコペニア・フレイル学会  

[目的]地域在住高齢女性における骨粗鬆症と身体・認知・社会的フレイルとの関係を明らかにする。[方法]地域での健康チェックに参加した高齢女性265名を分析対象とした。骨粗鬆症の有無、身体・認知・社会的フレイルを評価し、身体・社会的フレイルに関しては、プレフレイルとフレイルを合わせてプレフレイル以上とした。骨粗鬆症を従属変数とし、身体的プレフレイル以上、認知的フレイル、社会的プレフレイル以上を独立変数としたロジスティック回帰分析を行い、さらに前期・後期高齢女性に分けてオッズ比を算出した。[結果]年齢、内服数、教育歴、BMI、関節リウマチの有無、呼吸器疾患の有無で傾向スコアを算出し、傾向スコアで調整したロジスティック回帰分析の結果、後期高齢女性において骨粗鬆症と社会的プレフレイル以上が関連していた(オッズ比3.14、95%CI1.25-7.93、p=0.02)。[結論]地域在住後期高齢女性において、社会的フレイルは骨粗鬆症のリスクを高める可能性がある。(著者抄録)

Language：Japanese   Publisher：Heart and Vessels  

DOI： 10.1007/s00380-021-01880-5

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Language：Japanese   Publisher：日本肺高血圧・肺循環学会・日本小児肺循環研究会  

DOI： 10.1253/circj.CJ-20-1127.

Language：English   Publisher：The Japanese Circulation Society  

DOI： 10.1253/circj.cj-20-1127

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CiNii Research

Language：Japanese   Publishing type：Research paper (scientific journal)  

Oral hypofunction is a new concept that addresses the oral function of older adults. Few studies have investigated the relationship between oral hypofunction and general health conditions such as frailty, sarcopenia, and mild cognitive impairment. This paper explores these relationships in a large-scale, cross-sectional cohort study. The relationships of oral hypofunction with frailty, sarcopenia, and mild cognitive impairment were examined using data from 832 individuals who participated in the 2018 health survey of the residents of Tarumizu City, Kagoshima Prefecture, Japan. Individuals with frailty, sarcopenia, and mild cognitive impairment had significantly higher rates of oral hypofunction. Frailty was independently associated with deterioration of the swallowing function (odds ratio 2.56; 95% confidence interval, 1.26-5.20), and mild cognitive impairment was independently associated with reduced occlusal force (odds ratio 1.48; 95% confidence interval, 1.05-2.08) and decreased tongue pressure (odds ratio 1.77; 95% confidence interval, 1.28-2.43). There was no independent association found between sarcopenia and oral function. In conclusion, early intervention for related factors such as deterioration of the swallowing function in frailty, reduced occlusal force, and decreased tongue pressure in mild cognitive impairment could lead to the prevention of general hypofunction in older adults.

DOI： 10.3390/jcm10081626

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Background The risk of cardiovascular disease is known to increase after menopause. Mitochondria, which undergo quality control via mitochondrial autophagy, play a crucial role in the regulation of cellular senescence. The aim of this study was to investigate whether the effect of estrogen-mediated protection from senescence on arteries is attributed to the induction of mitochondrial autophagy. Methods and Results We used human umbilical vein cells, vascular smooth muscle cells, and 12-week-old female C57BL/6 mice. The administration of 17β-estradiol (E2) to cells inhibited cellular senescence and mitochondrial dysfunction. Furthermore, E2 increased mitochondrial autophagy, maintaining mitochondrial function, and retarding cellular senescence. Of note, E2 did not modulate LC3 (light chain 3), and ATG7 (autophagy related 7) deficiency did not suppress mitochondrial autophagy in E2-treated cells. Conversely, E2 increased the colocalization of Rab9 with LAMP2 (lysosomal-associated membrane protein 2) signals. The E2-mediated effects on mitochondrial autophagy were abolished by the knockdown of either Ulk1 or Rab9. These results suggest that E2-mediated mitochondrial autophagy is associated with Rab9-dependent alternative autophagy. E2 upregulated SIRT1 (sirtuin 1) and activated LKB1 (liver kinase B1), AMPK (adenosine monophosphate-activated protein kinase), and Ulk1, indicating that the effect of E2 on the induction of Rab9-dependent alternative autophagy is mediated by the SIRT1/LKB1/AMPK/Ulk1 pathway. Compared with the sham-operated mice, ovariectomized mice showed reduced mitochondrial autophagy and accelerated mitochondrial dysfunction and arterial senescence; these detrimental alterations were successfully rescued by the administration of E2. Conclusions We showed that E2-induced mitochondrial autophagy plays a crucial role in the delay of vascular senescence. The Rab9-dependent alternative autophagy is behind E2-induced mitochondrial autophagy.

DOI： 10.1161/JAHA.120.019310

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Language：English   Publishing type：Research paper (scientific journal)  

Blood pressure (BP) is influenced by various factors, and it is known that temperature and BP have a negative relationship. However, few reports have examined the relationship between BP and temperature throughout the day in the same participant over time. Therefore, this study aimed to investigate the relationship between BP and temperature in the morning and evening in the same participants during a time period of ~1 year. In total, 401 participants, who participated in a community-based health checkup survey in Tarumizu, Japan, were enrolled. Five participants were excluded due to missing data. All participants measured their BP and the room temperature at home using a blood pressure monitor (HEM-9700T, OMRON Healthcare, Kyoto, Japan). The mean systolic BP (SBP) and diastolic BP (DBP) in the morning were significantly higher than the mean of the measurements taken in the evening (SBP: morning vs. evening 128 ± 15 mmHg vs. 122 ± 14 mmHg, P < 0.0001; DBP: morning vs. evening 77 ± 10 mmHg vs. 72 ± 8 mmHg, P < 0.0001). Using a linear mixed model with participants as a random effect, SBP and DBP were significantly associated with temperature in both the morning and evening. In the morning, in almost every month except July, a significant association between SBP and temperature was observed. However, there was a significant relationship between evening BP and temperature in all months. In conclusion, BP was significantly related to temperature in both the morning and evening during the year-long study. Furthermore, BP and temperature were significantly associated in all months except morning measurements in July.

DOI： 10.1038/s41440-020-00564-3

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Language：Japanese   Publisher：Journal of Interventional Cardiac Electrophysiology  

Background: The safety and efficacy of periprocedural use of direct oral anticoagulants (DOACs) for atrial fibrillation (AF) remain unclear. We compared the incidence of asymptomatic cerebral micro-thromboembolism and hemopericardium following AF ablation among patients receiving edoxaban, rivaroxaban, and warfarin and between normal- and low-dose use of edoxaban and rivaroxaban. Methods: This prospective randomized study included 170 consecutive AF patients. Patients taking DOACs upon admission to our hospital were randomly assigned to an edoxaban group or to a rivaroxaban group. Warfarin was continued in patients receiving warfarin at admission. All patients underwent AF ablation, and cerebral MRI was performed to evaluate asymptomatic cerebral micro-thromboembolism the day after the procedure. Results: Sixty-one patients were assigned to edoxaban and 63 to rivaroxaban. Warfarin was continued in 46 patients. Although asymptomatic cerebral micro-thromboembolism was detected in 25 patients (16.3%), there were no significant differences among the groups. Hemopericardium occurred in 2 patients (one each in the rivaroxaban and warfarin groups). The incidence of asymptomatic cerebral micro-thromboembolism was higher in the low-dose group (9 patients, 25.7%) than in the normal-dose group (8 patients, 10.0%) for patients prescribed either edoxaban or rivaroxaban (p < 0.05). The proportion of males (88.0%, 69.5%, p < 0.05), history of prior AF ablation (64.0%, 42.2%, p < 0.05), and hypertension (68.0%, 46.1%, p < 0.05) were significantly higher in patients with cerebral thromboembolism. Conclusions: The incidence of asymptomatic cerebral micro-thromboembolism and hemopericardium in AF ablation was similar among patients using edoxaban, rivaroxaban, and warfarin. However, low doses of DOACs may increase the risk of asymptomatic stroke.

DOI： 10.1007/s10840-020-00732-y

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Language：Japanese   Publisher：(有)科学評論社  

Language：Japanese   Publisher：大道学館出版部  

Language：English   Publisher：(一社)日本心臓病学会  

心房細動アブレーション治療が予定されている非弁膜症性心房細動患者975例(男性710例、女性265例、平均63.7±10.3歳)を対象に、抗凝固療法の長期的な有効性と安全性を検討した。対象はアブレーション治療前にリバーロキサバンまたはワルファリンを3週間以上服用したJACREレジストリの登録患者で、患者を服薬に応じてリバーロキサバン群823例とワルファリン群152例の2群に分類した。全体の平均CHADS2スコアは1.0±1.0点、CHA2DS2-VAScスコアは1.9±1.5点であった。患者背景はワルファリン群の方が高齢で、持続性および慢性心房細動が多く、貧血の既往が多かった。追跡期間中に496例(50.9%)が抗凝固療法を継続した。平均追跡期間は29.8±12.0ヵ月で、血栓塞栓症は3例、出血性脳梗塞は5例、大出血は9例で発生した。年間発生率は、それぞれ0.13%、0.22%、0.40%であった。カテーテルアブレーション治療後の血栓塞栓症および重大出血を合わせた複合イベントの発生率に有意な群間差はなかった。心血管イベントの発生率はワルファリン群の方が有意に高かった(P=0.011)。

Language：English   Publisher：(一社)日本循環器学会  

Language：English   Publisher：Nature Publishing Group  

朝夕に自宅で測定した血圧と、同時に記録した室温との関係性を調査した。地域健康診断を受診した参加者395名(男性136名、女性259名、平均71±8歳)を被験者とし、血圧モニターを使用して自宅で血圧と室温を測定した。平均収縮期血圧(SBP)と拡張期血圧(DBP)は、それぞれ139±18mmHgと80±11mmHgで、191名が降圧薬を使用していた。朝のSBPとDBPは、夕方の平均測定値の平均よりも有意に高かった。変量効果としての家庭血圧と室温との関連を検討した線形混合モデルでは、SBPとDBPは朝夕両方の気温と有意に関連していた。7月以外の月の朝においてSBPと気温の間に有意な関連が観察されたが、夕方の血圧と気温の間には全ての月で有意な関連がみられた。血圧は、1年間の研究期間中、朝夕の両方で気温と有意に関連していた。また気温は7月の朝の血圧測定値を除き、全ての月で血圧に有意に影響していた。

Publisher：Journal of Cardiology  

DOI： 10.1016/j.jjcc.2020.09.001

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Language：Japanese   Publisher：鹿児島大学医学部保健学科  

地域コホート研究(垂水研究2018)のデータを用いて、地域在住高齢者における社会的フレイルとうつ傾向との関連について横断観察研究を行った。対象は研究に対する同意が得られた65歳以上の地域在住高齢者859名であった。最終的に社会的フレイルの有無および高齢者用うつ尺度短縮版(GDS15)、その他基本属性に欠損のない812名(男性304名、女性508名、平均年齢74.8歳)を有効回答とし分析対象とした。対象者のうち社会的フレイルを有する者は112名(13.8%)であった。社会的フレイルを有する者は社会的フレイルを有しない者と比較し、高齢で、GDS15の点数は高く、歩行速度、握力が低下していた。社会的フレイルを有する者でうつ傾向のある者は37名(33.0%)で、社会的フレイルを有さない者でうつ傾向のある者90名(12.9%)と比較して有意に高い割合であった。ロジスティック回帰分析の結果からも社会的フレイルはうつ傾向と関連していることが示された。

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Language：English   Publisher：(一社)日本循環器学会  

ドネペジルを服用しているアルツハイマー病患者57例(男性21例、女性36例、平均84.6±5.8歳)を対象に、ドネペジルがQT延長に及ぼす影響を検討した。心房細動または心臓手術の既往を有する患者と透析患者は除外した。性別と年齢をマッチさせたドネペジル以外の内科療法を受ける患者57例(男性21例、女性36例、平均84.1±6.3歳)を対照群として比較した。患者背景は同等で、QT延長を引き起こす可能性のある薬剤または併存症に有意な群間差はなかった。補正QT間隔(QTc)はドネペジル群(0.443±0.032秒)の方が対照群(0.426±0.02秒)より有意に延長していた。QTc延長を認める患者の割合もドネペジル群(30%)の方が対照群(9%)より有意に高かった。ドネペジル群でQTc間隔はベースラインに比べてドネペジル服用後に有意に延長した。重回帰分析でドネペジルの服用、血中カリウム濃度、推算糸球体濾過量がQTc延長と有意に関連していた。

Publisher：一般社団法人 日本循環器学会  

DOI： 10.1253/circrep.CR-20-0115

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CiNii Research

Publisher：Scientific Reports  

DOI： 10.1038/s41598-021-82217-0

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Language：Japanese   Publisher：European Heart Journal Case Reports  

Background Axillary artery injury secondary to proximal humerus fracture is a rare but serious complication. The management of this injury has traditionally involved surgical treatment. Case summary A 66-year-old female with gait disturbance slipped and fell off her wheelchair at home. She presented to a local hospital with right shoulder pain and was subsequently urgently transferred to our hospital by helicopter because of suspicion of axillary artery injury. Computed tomography angiography revealed disruption of the right axillary artery. We decided to perform endovascular treatment instead of surgical treatment for axillary artery injury. However, since endovascular treatment via the right femoral artery was impossible, we performed bidirectional (right femoral and right brachial artery approaches) endovascular treatment. We expanded the occluded lesion using a 3.5 mm × 40 mm sized balloon and placed a 5.0 mm × 50 mm stent graft (Gore^VR Viabahn^VR ) across the lesion. The final subclavian injection confirmed that distal flow to the brachial artery was preserved and that there was no leakage of contrast medium from the axillary artery. Discussion We performed endovascular treatment for axillary artery injury secondary to proximal humerus fracture. Although surgical repair is typically performed for this kind of injury, our experience suggests that endovascular treatment might be an option in patients with axillary artery injury.

DOI： 10.1093/ehjcr/ytaa526

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Language：Japanese   Publisher：(一社)日本心血管インターベンション治療学会  

Language：English   Publisher：(公社)日本栄養・食糧学会  

高齢者815名(女性515名、平均74.9歳)を対象に、栄養素摂取状況とプレフレイル(疲労感、動作緩慢、虚弱、活動量低下、または体重減少のいずれか一つ以上の存在)との関係について検討した。男性の52%および女性の54%がプレフレイルに該当した。男性では栄養素摂取状況とプレフレイルの間に有意な関連はみられなかった。女性の場合、健常群と比較して、プレフレイル群はビタミンKとB群(B1、B2、葉酸、パントテン酸)、リン、カリウム、カルシウム、マグネシウム、鉄、亜鉛、銅の摂取量が有意に少なかった。このうちプレフレイルに関連する有意な変数として抽出されたのはマグネシウムのみであった。マグネシウム摂取量の四分位別にみた女性のプレフレイルの調整オッズ比(95%信頼区間)は、第1分位を基準として、第2分位が0.52(0.29～0.92,p=0.024)、第3分位が0.51(0.28～0.95,p=0.033)、第4分位が0.38(0.19～0.74,p=0.005)であった。以上から、高齢日本人女性において、マグネシウムはプレフレイル予防に重要な栄養素であると考えられた。

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1413207099

CiNii Research

Publisher：Healthcare (Switzerland)  

DOI： 10.3390/healthcare9010032

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Publisher：株式会社　医学書院  

DOI： 10.11477/mf.1438200439

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Publisher：株式会社　医学書院  

DOI： 10.11477/mf.1438200452

CiNii Research

Publisher：Coronary Artery Disease  

DOI： 10.1097/MCA.0000000000000945

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞Point　・加齢に伴い心不全患者は増加するが,高齢心不全患者は,多臓器障害や認知症,サルコペニアやフレイルの合併といった医学的な問題だけでなく,独居や老老介護といった社会的問題も抱えている.・高齢心不全患者に対する加療は難渋することが多いが,急性期病院から慢性期病院,かかりつけ医,在宅診療まで多職種によるチーム医療を継続的に行うことが重要である.

Publisher：Heart and Vessels  

DOI： 10.1007/s00380-021-01775-5

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Center for Academic Publications Japan  

<p>We examined the association between nutrient intake and prefrailty. Data from 815 older people (63% women) who participated in a community-based health check survey (Tarumizu Study) were analyzed. Prefrailty were defined using five parameters (exhaustion, slowness, weakness, low physical activity, and weight loss). Participants with one or more components were considered to belong to the prefrailty group. Nutrition intake was estimated from a validated brief-type self-administered diet history questionnaire. Among the participants, 154 men (52%) and 278 women (54%) were found to be in a status of prefrailty. In men, there were no significant associations between nutrient intake and prefrailty. In women, carbohydrate intake was slightly higher in prefrailty group. Vitamins K, B₁, B₂, folic acid, pantothenic acid, phosphorus, potassium, calcium, magnesium, iron, zinc, and copper intake was significantly lower in the prefrailty group. Among the nutrients, magnesium was identified as a significant covariate of prefrailty using a stepwise regression method. In women adjusted ORs (95%CI, <i>p</i> value) for prefrailty in the first, second, third, and fourth quartiles of magnesium intake were 1.00 (reference), 0.52 (0.29–0.92, 0.024), 0.51 (0.28–0.95, 0.033), and 0.38 (0.19–0.74, 0.005), respectively, by multivariate logistic regression analysis (variates: age, body mass index, energy intake, supplement use, osteoporosis, magnesium, and protein intake). Protein intake did not related to prefrailty. Protein intake might be sufficient to prevent prefrailty in the present study. We propose magnesium to be an important micronutrient that prevents prefrailty in community-dwelling older Japanese women.</p>

DOI： 10.3177/jnsv.67.39

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Language：Japanese   Publisher：Journal of Medical Ultrasonics  

DOI： 10.1007/s10396-021-01090-6

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Language：Japanese   Publisher：Hypertension Research  

DOI： 10.1038/s41440-021-00691-5

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Language：Japanese   Publisher：日本理学療法士協会（現 一般社団法人日本理学療法学会連合）  

DOI： 10.14900/cjpt.48s1.e-71_1

CiNii Research

Language：Japanese   Publisher：日本理学療法士協会（現 一般社団法人日本理学療法学会連合）  

DOI： 10.14900/cjpt.48s1.e-108_1

CiNii Research

Language：Japanese   Publisher：日本理学療法士協会（現 一般社団法人日本理学療法学会連合）  

DOI： 10.14900/cjpt.48s1.e-69_2

CiNii Research

Language：Japanese   Publisher：(株)ライフ・サイエンス  

Language：Japanese   Publisher：(株)北隆館  

動脈硬化とは「動脈の血管が硬くなって弾力性が失われた状態」を指す。加齢や脂質異常症、糖尿病、高血圧などの生活習慣病や、喫煙などが原因となるが、近年この動脈硬化とオートファジーとの関連が明らかになってきている。加齢にともなうオートファジーの低下と血管内皮機能障害との関係や、プラークや線維性被膜の形成に関与する平滑筋細胞とオートファジーとの関係など、血管を構成する血管内皮細胞や平滑筋細胞におけるオートファジーの役割について様々な報告がある。また動脈硬化の形成・進展に重要な役割を果たすマクロファージを主とした炎症細胞や、エネルギー産生の場であると同時に酸化ストレスの産生場でもあるミトコンドリアに関しても、やはりオートファジーとの関係が明らかになってきた。とりわけミトコンドリアに関しては障害を負うと酸化ストレスの産生の面で動脈硬化を惹起するが、こうした障害を負ったミトコンドリアを選択的にオートファジーにより除去する機構いわゆるマイトファジーの存在が明らかとなった。今後動脈硬化性疾患とオートファジーとの関係に対するさらなる病態生理的解析と治療介入方法の発展が大いに期待される。(著者抄録)

Language：Japanese   Publisher：医歯薬出版(株)  

Language：Japanese   Publisher：(公社)日本超音波医学会  

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：The Japanese Circulation Society  

<p>The elderly population is increasing because of increasing life expectancy, and the prevalence of frailty increases with age. Frailty commonly coexists with cardiovascular diseases (CVDs), such as coronary artery disease (CAD), heart failure (HF), aortic stenosis (AS), and atrial fibrillation (AF). Frail patients who undergo revascularization for CAD have higher complication rates; those with HF have a high prevalence of poor outcomes, and those with AF are vulnerable to increased stroke incidence. Moreover, frailty and asymptomatic severe AS were independent factors for mortality. The presence of frailty can lead to poor clinical outcomes, and frailty has been identified as a risk factor for mortality. Thus, the identification of frail patients who are at higher risks of disability and adverse clinical outcomes is important. In this review, the relationship between frailty and CVD is appraised and optimal treatments for frail patients are discussed.</p>

DOI： 10.1253/circj.cj-20-0594

Scopus

PubMed

CiNii Research

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b>Angiotensin II receptor blockers (ARBs) are widely used for the management of hypertension in Japan; however, comparative efficacy data within the ARB drug class remain limited.</p><p><b><i>Methods and Results:</i></b>This systematic literature review identified randomized controlled trials (RCT) indexed in PubMed and Ichushi in Japanese patients with hypertension receiving ARB monotherapy (azilsartan, candesartan cilexetil, irbesartan, losartan potassium, olmesartan medoxomil, telmisartan, valsartan) in at least 1 arm. Of 763 RCTs identified, 77 met the eligibility criteria; of which, 37 reported mean change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) from baseline in the office setting and were used to construct the network. A fixed-effects model (FEM) showed the effect of each drug vs. the reference, azilsartan. Using the FEM, the mean (95% credible interval) change from baseline in SBP/DBP for candesartan cilexetil, irbesartan, losartan potassium, olmesartan medoxomil, telmisartan, and valsartan was 3.8 (2.9–4.8)/2.6 (2.0–3.1), 4.8 (2.0–7.5)/3.7 (1.8–5.6), 3.0 (0.8–5.1)/1.9 (0.5–3.3), 3.2 (1.2–5.1)/2.7 (1.3–4.1), 3.2 (0.8–5.6)/2.0 (0.3–3.6), and 3.1 (1.1–5.1)/2.4 (1.1–3.8) mmHg, respectively.</p><p><b><i>Conclusions:</i></b>The results of this meta-analysis provide evidence that azilsartan has a more favorable efficacy profile than the other ARBs in reducing SBP and DBP.</p>

DOI： 10.1253/circrep.cr-20-0076

PubMed

CiNii Research

Language：Japanese  

Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected more than seven million people worldwide, contributing to 0.4 million deaths as of June 2020. The fact that the virus uses angiotensin-converting enzyme (ACE)-2 as the cell entry receptor and that hypertension as well as cardiovascular disorders frequently coexist with COVID-19 have generated considerable discussion on the management of patients with hypertension. In addition, the COVID-19 pandemic necessitates the development of and adaptation to a "New Normal" lifestyle, which will have a profound impact not only on communicable diseases but also on noncommunicable diseases, including hypertension. Summarizing what is known and what requires further investigation in this field may help to address the challenges we face. In the present review, we critically evaluate the existing evidence for the epidemiological association between COVID-19 and hypertension. We also summarize the current knowledge regarding the pathophysiology of SARS-CoV-2 infection with an emphasis on ACE2, the cardiovascular system, and the kidney. Finally, we review evidence on the use of antihypertensive medication, namely, ACE inhibitors and angiotensin receptor blockers, in patients with COVID-19.

DOI： 10.1038/s41440-020-0515-0

Scopus

PubMed

Language：Japanese   Publisher：(株)メディカルレビュー社  

Language：Japanese   Publisher：(株)メディカルレビュー社  

＜文献概要＞はじめに　高血圧は,動脈硬化性疾患である脳卒中,心筋梗塞や大動脈解離のみならず,認知症,心不全や慢性腎臓病の発症に及ぼす影響は大きく,降圧療法によりリスクを低減することができる。わが国では75歳以上の後期高齢者人口が全体の10%を占めており,さらに高齢者高血圧の有病率は非常に高くなってきている。本稿では,2019年に改訂した「高血圧治療ガイドライン(JSH2019)」を踏まえ,高齢者の動脈硬化予防のための高齢者高血圧管理について概説する。

Language：Japanese   Publisher：(一社)日本老年医学会  

Language：English   Publisher：(一社)日本循環器学会  

日本で承認されているアンジオテンシンII受容体拮抗薬(ARB)の相対的有効性を評価するため、プラセボ対照/比較無作為化試験(RCT)の文献を対象とするネットワークメタアナリシス(NMA)を実施した。PubMedおよび医中誌を用いて、ARB単独療法を受けた原発性高血圧症患者のRCTで、1995年1月1日～2018年8月31日に発表された文献を検索した。固定効果モデル(FEM)と変量効果モデルを用いてNMAを実施した。同定したRCT 763件のうち77件が適格基準に合致した。そのうち37件がベースラインからの収縮期血圧(SBP)と拡張期血圧(DBP)の平均変化を報告していた。FEMでは参照値としてのアジルサルタンと比較した各薬剤の作用を示した。SBP/DBPにおけるベースラインからの平均変化は、カンデサルタンシレキセチルが3.8/2.6mmHg、イルベサルタンが4.8/3.7mmHg、ロサルタンカリウムが3.0/1.9mmHg、オルメサルタンメドキソミルが3.2/2.7mmHg、テルミサルタンが3.2/2.0mmHg、バルサルタンが3.1/2.4mmHgであった。アジルサルタンは、SBPとDBPの低下において他のARBよりも優れた有効性を示した。