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Background : To prevent hypoxic-ischemic brain damage in patients with post-cardiac arrest syndrome (PCAS), international guidelines have emphasized performing targeted temperature management (TTM). However, the most optimal targeted core temperature and cooling duration reached no consensus to date. This study aimed to clarify the optimal targeted core temperature and cooling duration, selected according to the time interval from collapse to return of spontaneous circulation (ROSC) in patients with PCAS due to cardiac etiology. Methods : Between 2014 and 2020, the targeted core temperature was 34 °C or 35 °C, and the cooling duration was 24 h. If the time interval from collapse to ROSC was within 20 min, we performed the 35 °C targeted core temperature (Group A), and, if not, we performed the 34 °C targeted core temperature (Group B). Between 2009 and 2013, the targeted core temperature was 34 °C, and the cooling duration was 24 or 48 h. If the interval was within 20 min, we performed the 24 h cooling duration (Group C), and, if not, we performed the 48 h cooling duration (Group D). Results : The favorable neurological outcome rates at 30 days following cardiac arrest were 45.7% and 45.5% in Groups A + B and C + D, respectively ( p = 0.977). In patients with ROSC within 20 min, the favorable neurological outcome rates at 30 days following cardiac arrest were 75.6% and 86.4% in Groups A and C, respectively ( p = 0.315). In patients with ROSC ≥ 21 min, the favorable neurological outcome rates at 30 days following cardiac arrest were 29.3% and 18.2% in Groups B and D, respectively ( p = 0.233). Conclusions : Selecting the optimal target core temperature and the cooling duration for TTM, according to the time interval from collapse to ROSC, may be helpful in patients with PCAS due to cardiac etiology.

Habitual fish consumption and a healthy lifestyle are associated with lower atherosclerotic CVD (ASCVD) risk. Mildly elevated bilirubin, an end product of Hb metabolism, may be associated with anti-inflammatory effects, suppressing ASCVD risk. No data exist on the relationship between fish consumption, total serum bilirubin (TSB) and inflammation in clinical settings. We conducted a cross-sectional study between April 2019 and March 2020 in a cohort of 8292 participants (average age, 46·7 (sd 12·9) years and 58·9 % men) with no history of ASCVD and TSB concentrations < 2·0 mg/dl. Multiple stepwise regression analysis showed Hb concentrations were a solid positive determinant of TSB concentrations ( β = 0·302, P < 0·0001). Fish consumption ( β = 0·025, P = 0·019) and aerobic exercise ( β = 0·021, P = 0·043) were statistically weak but significantly positive determinants of TSB concentrations. Cigarette smoking negatively affected TSB concentrations ( β = −0·104, P < 0·0001). Moreover, with increasing fish consumption, the proportion of participants with a habit of cigarette smoking decreased, and that of participants who engaged in aerobic exercises increased ( P < 0·0001 for both). Furthermore, as TSB concentrations increased, the leukocyte counts and C-reactive protein concentrations decreased ( P < 0·0001 for both). In conclusion, despite the lesser relevance given to TSB concentrations than Hb concentrations, higher fish consumption and healthier lifestyle behaviours related to fish consumption habits may be additively or synergistically associated with higher TSB concentrations and anti-inflammatory activity, leading to attenuated ASCVD risk. Further investigations are needed to clarify the causal relationships between these factors.

Background: High fish consumption may be involved in lowering inflammation, resulting in the suppression of atherosclerotic cardiovascular disease (ASCVD) development. The monocyte/high-density lipoprotein cholesterol (HDL-C) ratio (MHR) is reported as a novel inflammatory marker of the development of atherosclerosis. We investigated the relationship between fish consumption, MHR, and lifestyle behaviors and explored the foundation of risk stratification of ASCVD using serum HDL-C, MHR, and fish consumption., Methods: We conducted a cross-sectional study among 6841 adults at the Health Planning Center of Nihon University Hospital between April 2019 and March 2020. We calculated the amount of fish consumption based on Japan's National Nutrition Survey results., Results: The median (interquartile range) fish consumption was 111.4 (67.2/169.2) g per week. As fish consumption increased, MHR decreased significantly (p < 0.0001). Multivariate linear regression analysis identified increased fish consumption as an independent negative determinant of a decreased MHR (β = -0.050, p < 0.0001). Additionally, healthier lifestyle behaviors (sleep duration and cigarette smoking habit) were also significantly associated with MHR (β = -0.025, p = 0.027 and β = 0.146, p < 0.0001, respectively). Furthermore, risk stratification of ASCVD could be developed by combining the HDL-C level and fish consumption with the MHR, indicating that even with similar HDL-C levels, higher MHR and lower fish consumption are associated with a higher risk of ASCVD. Multi-logistic regression analysis with the MHR quartile as an independent variable also showed that the increase in quartile was associated with the exacerbation of visceral obesity and glucose/lipid markers., Conclusions: A higher fish consumption may be associated with a lower MHR as well as healthier lifestyle behaviors. Moreover, we proposed the concept of risk stratification through relationships with MHR, HDL-C, and fish consumption to reduce ASCVD risk. Further studies are required to dissect the causal relationships between these results., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest to declare., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: We hypothesized that the addition of eicosapentaenoic acid (EPA) to ongoing statin therapy could change the particle heterogeneity of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) particles, even in stable coronary artery disease (CAD) patients., Methods: We assigned CAD patients already receiving statin therapy to one of two groups: an EPA group (1800 mg/day; n = 30) and a control group (n = 30). A gel permeation high-performance liquid chromatography method was used to measure the particle concentration and number of lipoprotein subclasses., Results: In the EPA group, significant decreases of both the concentration and number of medium LDL (p = 0.0002 and 0.0001), small LDL (p = 0.0004 and 0.0005) and very small LDL (p = 0.0005 and 0.002) particles were observed. Conversely, the concentration and number of large HDL particles increased significantly (p = 0.024 and 0.048). The concentration of very large HDL particles also increased significantly (p = 0.028). Furthermore, significant correlations between the variables that showed significant changes in the LDL and HDL particle subclasses, and the EPA/arachidonic acid (AA) ratio were found. No other significant associations of lipoprotein particle heterogeneity with the serum EPA/AA ratio were noted in either the control group or the EPA group. Interestingly, univariate and multivariate regression analyses revealed that increased serum lecithin-cholesterol acyltransferase activity, a key enzyme of HDL cholesterol efflux, was a predictor for increased above-mentioned HDL particles subclasses., Conclusions: Administration of EPA might alter both LDL and HDL particle heterogeneity, causing decreased concentration and number of smaller LDL particles and increased concentration and number of larger HDL particles. Furthermore, addition of EPA to ongoing statin therapy appears to be capable of increasing the EPA/AA ratio, which might have an anti-atherosclerotic effect on lipoprotein particle heterogeneity, even in stable CAD patients with well-controlled serum lipid levels., Clinical Trial Registration: UMIN (http://www.umin.ac.jp/) Study ID: UMIN000010452., (Copyright © 2020. Published by Elsevier Ltd.)

Few data exist regarding the association of plasma arginine vasopressin (AVP) and noradrenaline (NA) levels with subsequent cardiac events in acute decompensated heart failure (ADHF) patients. We measured plasma AVP and NA levels in ADHF patients on admission. In the follow-up (median: 487 days) of 291 patients, 41 cardiac events (cardiac death or re-hospitalization due to HF) were documented. The plasma AVP (26.4 versus 15.5 pg/mL, P = 0.014) and plasma NA (2347 versus 1524 pg/mL, P = 0.007) levels in the cardiac events group were significantly higher than those in the non-cardiac events group. The multivariable hazard ratios (HR) (95% confidence intervals [CI]) in the first tertile (1T) versus the third tertile (3T) of plasma AVP and NA levels were 2.97 (1.06-8.32) and 3.34 (1.21-9.26) for cardiac events, respectively. Group High (3T of combined AVP and NA) had a significantly higher incidence of cardiac events than Group Low (1T of combined groups) (HR: 3.50, 95% CI: 1.17-10.42, P = 0.017). Similarly, the relative risk ratio of cardiac events according to this stratification was more than that of plasma AVP or NA level alone (3.51, 2.65, and 2.95). Higher levels of plasma AVP and NA measured on admission may be associated with the incidence of cardiac events. Combined evaluation of these two parameters may be useful for assessing the prognosis of ADHF survivors.

Background: The low-density lipoprotein cholesterol/apolipoprotein B (LDL-C/apoB) ratio has conventionally been used as an index of the LDL-particle size. Smaller LDL-particle size is associated with triglyceride (TG) metabolism disorders, often leading to atherogenesis. We investigated the association between the LDL-C/apoB ratio and TG metabolism in coronary artery disease (CAD) patients with diabetes mellitus (DM)., Methods: In the cross-sectional study, the LDL-C/apoB ratio, which provides an estimate of the LDL-particle size, was calculated in 684 consecutive patients with one additional risk factor. The patients were classified into 4 groups based on the presence or absence of CAD and DM, as follows: CAD (-) DM (-) group, n = 416; CAD (-) DM (+) group, n = 118; CAD (+) DM (-) group, n = 90; CAD (+) DM (+) group, n = 60., Results: A multi-logistic regression analysis after adjustments for coronary risk factors revealed that the CAD (+) DM (+) condition was an independent predictor of the smallest LDL-C/apoB ratio among the four groups. Furthermore, multivariate regression analyses identified elevated TG-rich lipoprotein (TRL)-related markers (TG, very-LDL fraction, remnant-like particle cholesterol, apolipoprotein C-II, and apolipoprotein C-III) as being independently predictive of a smaller LDL-particle size in both the overall subject population and a subset of patients with a serum LDL-C level < 100 mg/dL. In the 445 patients followed up for at least 6 months, multi-logistic regression analyses identified increased levels of TRL-related markers as being independently predictive of a decreased LDL-C/apoB ratio, which is indicative of smaller LDL-particle size., Conclusions: The association between disorders of TG metabolism and LDL heterogeneity may account for the risk of CAD in patients with DM. Combined evaluation of TRL-related markers and the LDL-C/apoB ratio may be of increasing importance in the risk stratification of CAD patients with DM. Further studies are needed to investigate the useful clinical indices and outcomes of these patients. Clinical Trial Registration UMIN (http://www.umin.ac.jp/) Study ID: UMIN000028029 retrospectively registered 1 July 2017.