苅尾 七臣

Prasugrel reduces the recurrence of atherosclerotic cardiovascular disease and restenosis after percutaneous coronary intervention (PCI). However, its actual dosage in Japan has not been well studied. This study aimed to compare different prasugrel doses after PCI using retrospective data from the Clinical Deep Data Accumulation System (CLIDAS) database. A retrospective observational study was conducted using the CLIDAS-PCI database with a 2-year follow-up after PCI. There were 2,869 and 52 patients in the 3.75- and 2.5 mg groups, respectively. The 2.5 mg group was comprised of significantly more female, older, shorter, and lower-body-weight patients and included more patients with a history of coronary artery bypass grafting, stroke, peripheral arterial disease, or active malignancy than the 3.75 mg group. Concomitant medications included antiplatelets, anticoagulants, and statins. Laboratory data showed substantially lower hemoglobin and platelet counts in the 2.5 mg group. Most patients weighed < 50 kg; however, fewer had an estimated glomerular filtration rate < 30 mL/min/1.73 m². Major adverse cardio- and cerebrovascular events were similar between groups. The 2.5 mg group had more non-fatal strokes and major bleeding associated with antithrombotic therapy. In Japan, prasugrel 2.5 mg should be considered to reduce major bleeding in patients with low body weight, older adults, women, those receiving concomitant antithrombotic therapy, and those with low platelet counts.

Chronic kidney disease (CKD) is a major risk factor for cardiovascular events, and controlling blood pressure (BP) is essential for reducing this risk in CKD patients. Although office BP is the standard for BP control in CKD, home BP monitoring more precisely predicts cardiovascular outcomes, especially across Kidney Disease: Improving Global Outcomes (KDIGO) risk categories. This study evaluated the differential impact of office and home BP control on cardiovascular event rates across KDIGO risk levels. Data from 4264 participants in the Japan Morning Surge-Home Blood Pressure study were analyzed. Participants were stratified by KDIGO risk and classified by BP control using office (<140/90 mmHg) and home (<135/85 mmHg) thresholds. The primary outcome was a composite of cardiovascular events, including myocardial infarction, stroke, heart failure hospitalization, and cardiovascular death. Cox proportional hazards models evaluated associations between BP control and cardiovascular risk within KDIGO strata. Over a median 6.2-year follow-up, 262 cardiovascular events occurred. In the high/very high KDIGO group, controlled home BP was associated with a lower event rate (10.3 vs. 31.8 per 1000 person-years; HR = 0.38, 95% CI 0.20-0.70; P < 0.001). The interaction between home BP and KDIGO risk was significant (P = 0.024). Office BP control showed no significant association with cardiovascular outcomes. Subgroup analysis revealed that morning and evening home BP control predicted reduced cardiovascular risk in high-risk individuals. Home BP control, not office BP control, was associated with reduced cardiovascular risk, especially in individuals with high KDIGO risk. These findings support integrating home BP monitoring into CKD-related hypertension care.