ies have reported conflicting results. 12, 13 In Japanese patients with AF, the J-RHYTHM registry concluded that female sex was not an independent risk factor for thromboembolic events and that male sex was a risk factor for major bleeding and all-cause death. 14 In addition, they validated that the 'CHA2DS2-VA score', excluding female sex, was performed similarly for risk stratification for thromboembolic events. 15 However, a Taiwanese study indicated that females had a higher rate of ischemic stroke than males among patients with AF who were not taking anticoagulants and aged <65 years. 16 In a Chinese AF A trial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of ischemic stroke and death. 1,2 Previous studies have indicated sex-related differences in the clinical characteristics and outcomes of AF patients. 3-6 Female sex is considered an increased risk for thromboembolism in patients with AF, albeit with an age-dependency (being relevant at age ≥65 or with other risk factors) and is included in the CHA2DS2-VASc score for stroke risk stratification. 7-10 A recent Swedish study also demonstrated that female AF patients aged ≥75 years are at higher risk of ischemic stroke, 11 but other stud- Background: Female sex is considered a risk factor for thromboembolism in patients with atrial fibrillation (AF), and is included in the risk stratification scheme, CHA2DS2-VASc score. The purpose of the present study was to investigate the clinical outcomes of female Japanese AF patients.
Aims Atrial fibrillation (AF) increases the risk of thromboembolism, such as ischaemic stroke or systemic embolism (SE). The aim of this study was to investigate the relationship between left ventricular relative wall thickness (RWT) and the risk of thromboembolism in patients with non-valvular AF. Methods and results The Fushimi AF Registry is a community-based prospective survey of the patients with AF in Japan. Analyses were performed on 3067 non-valvular AF patients, in which RWT values determined by transthoracic echocardiography were available at the baseline. The high-RWT group (RWT above the median) was more often female, older, and had higher systolic blood pressure, CHADS2 and CHA2DS2-VASc scores, as compared with low-RWT group. During the median follow-up period of 1309 days, there was a higher incidence of ischaemic stroke/SE in the high-RWT group [unadjusted hazard ratio (HR), 1.91; 95% confidence interval (CI), 1.42–2.59]. On multivariate Cox regression analysis, including the components of CHA2DS2-VASc score, left atrial diameter, oral anticoagulant prescription at baseline, and type of AF, high RWT was independently associated with ischaemic stroke/SE (adjusted HR, 1.81; 95% CI, 1.34–2.47). Stratified analysis demonstrated no significant interaction for any subgroups. In Kaplan–Meier analysis, ordinal RWT quartiles stratified the incidence of ischaemic stroke/SE. Finally, addition of RWT to CHA2DS2-VASc score increased the performance of risk stratification for the incidence of stroke/SE. Conclusion Relative wall thickness was independently associated with ischaemic stroke/SE among Japanese patients with non-valvular AF, suggesting the importance of left ventricular morphology in contributing to adverse outcomes, particularly thromboembolism.
Introduction: Various types of skin lesions with pruritus have been reported in participants of Asian clinical trials on sodium-glucose cotransporter-2 (SGLT2) inhibitors. The aim of this study was to determine whether the diuretic effect of a SGLT2 inhibitor could modify skin hydration status in patients with type 2 diabetes mellitus. Methods: A prospective, short-term, open-label, two-parallel-arm, pilot study was conducted. Eligible patients were assigned to either a SGLT2 inhibitor (50 mg ipragliflozin once daily) group or to a dipeptidyl peptidase-4 inhibitor (50 mg sitagliptin once daily) group (control). The biophysical characteristics of the skin were measured and blood chemistry tests were run in all participants 1 day prior to medication initiation (pre-treatment values) and 14 days thereafter (post-treatment values). Results: Fourteen patients were enrolled in the study, of whom eight were in the ipragliflozin group and six in the sitagliptin group. Compared to the pre-treatment values, the glycated hemoglobin (HbA1c) levels were slightly but significantly reduced in the ipragliflozin group (p = 0.02), but the changes in HbA1c from the pre-treatment to post-treatment time points did not significantly differ between the two treatment groups. Serum 3-hydroxy butyrate levels were significantly higher in the ipragliflozin group than in the sitagliptin group (p \ 0.02). Neither electrical capacitance nor electrical conductance of the stratum corneum (SC), parameters that reflect skin water content, was reduced by 14 days of ipragliflozin treatment; similarly, no changes in these parameters were found in the sitagliptin control group. There was also no difference in the changes in water barrier function of the SC between the two treatment groups. There was a significant linear correlation (p \ 0.01) in skin water content at pre-treatment and that 14 days after treatment with each drug, respectively. Conclusion: Ipragliflozin treatment for 14 days did not significantly affect the skin hydration status in patients with well-controlled type 2
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