{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:33:12Z","timestamp":1759969992065,"version":"build-2065373602"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,10,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Myocardial ischemia is closely associated with arrhythmogenesis and prognostication in patients with atrial fibrillation (AF). Trimetazidine ameliorates myocardial ischemia through prioritizing cardiomyocyte metabolism to glucose oxidation. Whether trimetazidine clinically reduces stroke risk in patients with ischemic heart disease and AF was unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">We recruited patients with ischemic heart disease from the Hong Kong Clinical Data Analysis and Reporting System between January 1, 1999 and December 31, 2020. Patients with comorbid AF were identified, and those with a history of prior stroke were excluded. Trimetazidine users and nonusers (with long\u2010acting nitrates as the control) were compared for the primary end point of incident ischemic stroke using Cox proportional regression, with and without propensity matching.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The primary analysis included 12\u2009527 patients with ischemic heart disease and preexisting AF (mean age, 77.5\u00b110.3\u2009years; 44.6% men), who were further categorized as trimetazidine users (n=960) versus nonusers (n=11\u2009567). Over a follow\u2010up period of 1133 (interquartile range, 442\u20132454) days, 2160 patients (17.2%) developed new\u2010onset ischemic stroke. Trimetazidine use was independently associated with a lower risk of new\u2010onset ischemic stroke (hazard ratio [HR], 0.55 [95% CI, 0.44\u20130.68];\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001). Propensity score\u2013matched analyses revealed similar findings (adjusted HR, 0.65 [95% CI, 0.52\u20130.80];\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001). Furthermore, trimetazidine was also independently associated with a lower risk of recurrent ischemic stroke (HR, 0.51 [95% CI, 0.37\u20130.69];\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Treatment with trimetazidine is associated with a lower risk of incident and recurrent stroke in patients with both ischemic heart disease and AF. These findings will need to be confirmed in randomized controlled trials.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.125.041629","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T10:33:28Z","timestamp":1759228408000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Trimetazidine Is Associated With Ameliorated Stroke Risk in Patients With Both Ischemic Heart Disease and Atrial Fibrillation"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8277-5218","authenticated-orcid":false,"given":"Yuen\u2010Ting","family":"Cheng","sequence":"first","affiliation":[{"name":"The University of Hong Kong","place":["Hong Kong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool John Moores University and Liverpool Heart and Chest Hospital","place":["Liverpool, UK"]},{"name":"Aalborg University","place":["Aalborg, Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9106-7363","authenticated-orcid":false,"given":"Bernard M. Y.","family":"Cheung","sequence":"additional","affiliation":[{"name":"The University of Hong Kong","place":["Hong Kong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2145-3108","authenticated-orcid":false,"given":"Kai\u2010Hang","family":"Yiu","sequence":"additional","affiliation":[{"name":"The University of Hong Kong","place":["Hong Kong, China"]},{"name":"Shenzhen Hong Kong University Hospital","place":["Shenzhen, China"]},{"name":"The University of Hong Kong","place":["Hong Kong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9578-7808","authenticated-orcid":false,"given":"Hung\u2010Fat","family":"Tse","sequence":"additional","affiliation":[{"name":"The University of Hong Kong","place":["Hong Kong, China"]},{"name":"Shenzhen Hong Kong University Hospital","place":["Shenzhen, China"]},{"name":"The University of Hong Kong","place":["Hong Kong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5384-8468","authenticated-orcid":false,"given":"Yap\u2010Hang","family":"Chan","sequence":"additional","affiliation":[{"name":"The University of Hong Kong","place":["Hong Kong, China"]},{"name":"The University of Hong Kong","place":["Hong Kong, China"]},{"name":"The University of Hong Kong","place":["Hong Kong, China"]},{"name":"Cambridge University Hospitals NHS Foundation Trust\/University of Cambridge","place":["Cambridge, UK"]},{"name":"Royal Papworth Hospital, Cambridge Biomedical Campus","place":["Cambridge, 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