Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

External validation of CLOTS-AF score in patients with atrial fibrillation undergoing transesophageal echocardiography

BACKGROUND

Predicting thromboembolic events caused by left atrial appendage thrombosis (LAAT) is crucial since it is the most concerning complication of nonvalvular atrial fibrillation (NVAF).

OBJECTIVE

The objective of this study was to establish the predictive effectiveness of a novel scoring system known as the CLOTS-AF score in identifying the existence of thrombus using transesophageal echocardiography (TEE) in patients with NVAF and to compare it with the CHA2DS2-VASc score.

METHODS

This study was conducted retrospectively with 668 NVAF patients who underwent TEE in a single centre. The patients were categorized into two categories based on the presence or absence of LAAT on TEE. The CLOTS-AF score was computed for all patients, which was then compared to the CHA2DS2-VASc score.

RESULTS

Thrombus was detected in the left atrial appendage (LAA) of 114 (17%) individuals. The study revealed that the thrombus (+) group had substantially higher CHA2DS2-VASc scores and CLOTS-AF scores (3 (2-4); 4 (3-6), p < .001), respectively. Furthermore, the CLOTS-AF score was shown to be a better predictor of LAAT than the CHA2DS2-VASc score (AUC: 0.70 vs. AUC: 0.61, p < .001).

CONCLUSIONS

This study could validate the CLOTS-AF score in an external cohort by demonstrating its significant predictive power and underscoring its vital role in clinical practice.

The effects of initiating a 24-hour fast with a low versus a high carbohydrate shake on glycemic control in older adults: a randomized crossover study

PURPOSE

This study measured the impact of macronutrient composition of a pre-fast meal on time-to-ketosis and other metabolic indicators of glycemic control during a 24-hr fast within a population of older, sedentary, overweight adults.

METHODS

Twenty-four adults who were over the age of 50, sedentary (< 150 min of weekly exercise), and overweight (BMI ≥ 27) participated in a randomized crossover study. Each of these inclusion criteria have been shown to increase the risk for the development of chronic diseases. Participants began each 24-hr fast with either a high carbohydrate/low fat/moderate protein (HC/LF) or an isocaloric low carbohydrate/high fat/moderate protein (LC/HF) shake. Metabolic indicators included subcutaneous glucose readings every 15 min throughout the study, capillary beta-hydroxybutyrate (BHB), and plasma concentrations of insulin, glucagon, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP). Measurements of these hormones took place at 0, 1, 24, and 48 h, and BHB measurements took place at 0, 1, 4, 8, 12 and 24 h.

RESULTS

Glucose levels were higher in the HC/LF group 15 min to 2.25 h after fast initiation (p < 0.05 for all). There was a significant condition by time interaction for BHB (F = 3.84, p < 0.01). Nutritional ketosis (BHB ≥ 0.5 mmol/L) was reached on average by 12 h in the LC/HF condition but was not reached at any point during the fast on average in the HC/LF condition. An hour after consuming the LC/HF shake insulin was 41.9% lower (t = 6.13, p < 0.01), glucagon 23.6% higher (t = -4.72, p < 0.01), GLP-1 26.8% higher (t = -5.16, p < 0.01), and GIP 34.4% higher (t = -3.41, p < 0.01) compared to the HC/LF shake.

CONCLUSION

A low carbohydrate pre-fast meal can reduce time-to-ketosis in older, sedentary, overweight adults. Those looking to improve glycemic control through fasting or time-restricted eating interventions may consider the macronutrient composition of their pre-fast meal to improve its efficacy.

TOTUM-854 Human Circulating Bioactives Preserve Endothelial Cell Function

Background: TOTUM-854 is a patented plant extract blend characterized by its components that have previously been described for their potential health benefits in limiting hypertension onset. However, most of the literature data remain descriptive regarding the mode of action at the cellular level, especially in humans, and further investigations are required for optimized therapeutic strategies. Methods: We first demonstrated in an L-NAME mouse model that TOTUM-854 supports the prevention of hypertension in vitro and in vivo. Then, we designed an ex vivo clinical innovative approach considering the circulating metabolites produced by the digestive tract upon TOTUM-854 ingestion in humans. Human serum was collected in healthy volunteers before and after the acute intake of 3.71 g of TOTUM-854. The bioavailability of circulating metabolites was confirmed and characterized by UPLC-MS. Human serum containing TOTUM-854-derived metabolites was further processed for incubation with human endothelial cells (HUVECs), in the absence or presence of palmitate (200 µM). Results: HUVEC protection against lipotoxicity was characterized by (1) decreased ACE-1 activity (-32% p < 0.0001); (2) the inhibition of oxidative stress with decreased ROS (-12% observed by DCFDA and DHE fluorescent microscopy) and decreased Nox2 gene expression (-6.7 fold change vs. palmitate, p < 0.01); and (3) the inhibition of an inflammatory response, with a decrease in IL-1β release (-37% compared to palmitate, p < 0.001) and decreased MCP-1 and VCAM-1 gene expression (-93% p < 0.001 and -77% p < 0.001, respectively). Conclusions: Overall, this study provides insightful data regarding the protective role of TOTUM-854 in human endothelial cells. Using an innovative clinical ex vivo approach, our data support the role of TOTUM-854 circulating metabolites in vascular protection in humans.

The relationship between comorbidities, physical inactivity, kinesiophobia and physical performance in hypertensive individuals: a cross-sectional study

BACKGROUND

Hypertension is a prevalent chronic condition accompanied by comorbidities that negatively affect health outcomes. Comorbid conditions in hypertensive individuals may contribute to increased physical inactivity, heightened levels of kinesiophobia, and diminished physical performance. This study aimed to investigate the relationships among Charlson Comorbidity Index (CCI). scores, kinesiophobia, physical activity levels, and physical performance in hypertensive individuals.

METHODS

A cross-sectional study included 186 hypertensive participants aged ≥ 40 years. CCI was utilized to assess comorbidities, and physical activity levels were evaluated with the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Kinesiophobia was measured using the Tampa Kinesiophobia Scale (TKS)., and physical performance was evaluated through the 30-Second Sit-to-Stand Test (STS-30). and the Five Times Sit-to-Stand Test (FT-STS). Spearman correlation analysis was performed to assess relationships among variables.

RESULTS

The majority of participants (88.7%) exhibited kinesiophobia, and 93.5% were physically inactive. A significant but positive weak correlation were found between CCI and TKS (r = 0.239, p = 0.002). A significant but weak negative correlation were observed between CCI and STS-30 (r=-0.264, p = 0.001), while a weak positive correlation was observed CCI and FT-STS (r = 0.227, p = 0.005) among inactive individuals. A weak negative correlation was also found between IPAQ-SF and CCI in inactive participants (r=-0.184, p = 0.020). No significant correlations were found in active individuals. The effect sizes for these correlations ranged from moderate to small, suggesting a meaningful, but limited, impact of comorbidities on physical inactivity and kinesiophobia.

CONCLUSIONS

Comorbidities (CCI) were significantly associated with kinesiophobia and physical performance in inactive hypertensive individuals. These findings highlight the need for patient-centered targeted interventions addressing comorbidities to enhance physical activity, management kinesiophobia and improve physical performance in this population.

Impact of Lifestyle Modifications Along With Pharmacological Treatment of Heart Failure: A Narrative Review

Heart failure (HF) remains a leading cause of morbidity and mortality worldwide. While pharmacological therapy is foundational, lifestyle modifications are increasingly recognised for their complementary role. This narrative review explores the synergistic effects of lifestyle interventions, combined with pharmacological treatment, in HF management. A literature search (2000-2025) was conducted using PubMed, Scopus, Cochrane, and Google Scholar, to identify studies on integrative approaches to HF care. Lifestyle changes, such as dietary modification, exercise, weight management, smoking and alcohol cessation, and psychosocial support, enhance the efficacy of standard therapies, improve quality of life, and reduce hospitalisations. Integration with medications, like renin-angiotensin-aldosterone system (RAAS) inhibitors, beta-blockers, and sodium-glucose cotransporter-2 (SGLT2) inhibitors, shows improved neurohormonal balance, reduced inflammation, better endothelial function, and delayed cardiac remodelling. However, socioeconomic and cultural barriers challenge real-world implementation. Combining lifestyle interventions with pharmacotherapy provides a holistic, patient-centred strategy for HF management. Future efforts should focus on personalised care, multidisciplinary teams, and policy support, to improve adherence and outcomes.

Treatment options for heart failure in individuals with overweight or obesity: a review

Obesity and heart failure are interlaced global epidemics, each contributing to significant morbidity and mortality. Obesity is not only a risk-factor for heart failure, but also complicates its management, by distinctive pathophysiological mechanisms and cumulative comorbidities, requiring tailored treatment plan. To present current treatment options for heart failure in individuals with overweight/obesity, emphasizing available pharmacological therapies, non-pharmacological strategies, and the management of related comorbidities. We conducted a comprehensive literature review regarding the results of heart failure treatments in individuals with overweight/obesity, including cornerstone interventions as well as emerging therapeutic options. Specific drug classes, including angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors, have demonstrated consistent efficacy in heart failure irrespective of body mass index, while diuretics remain a key for fluid management. Glucagon-like peptide-1 receptor agonists have shown promising results in improving relevant outcomes and warrant further research. Non-pharmacological approaches, including weight-loss strategies and lifestyle modifications, have shown to improve symptoms, exercise tolerance and quality of life. Managing heart failure in individuals with overweight/obesity requires a multidisciplinary, individualized approach integrating pharmacological and non-pharmacological options. Emerging therapies and preventive strategies arise to address the unique challenges in this population and provide improved outcomes.

Trends in Salt Consumption and Reduction Practices in Vietnam During 2015-2021: Analyzing Urinary Sodium Levels Among 18-69 Aged Populations

Objectives

This study investigates changes in salt intake and reduction practices among Vietnamese adults (ages 18-69), focusing on high-risk groups for non-communicable diseases (NCDs) like hypertension, diabetes, and elevated BMI.

Methods

Participants aged 18-69 from the 2015 and 2020 STEPs surveys provided data on the spot urine test. Average daily salt intake was calculated using the Intersalt Southern European equation. The prevalence of excessive salt intake was assessed, along with subgroup analyses based on demographic factors and NCD risk.

Results

Average salt intake decreased significantly from 9.42 g/day in 2015 to 8.07 g/day in 2020 (p < 0.01), with the most substantial decline among younger individuals. The percentage exceeding the global average of 10.78 g/day dropped from 24.88% to 8.31%. High-risk groups, including those with hypertension and diabetes, consumed more salt but also showed reductions. Awareness of salt reduction advice remained low, with only 60.9% of the general population informed.

Conclusion

While progress has been made in reducing salt intake, ongoing public health initiatives are essential to meet recommended levels, especially for high-risk populations.

Drug Discovery and Development for Heart Failure Using Multi-Omics Approaches

Heart failure (HF) is a complex, heterogeneous syndrome with rising prevalence and high morbidity and mortality. The pathophysiology and diverse etiologies of HF present significant challenges for developing effective therapies. Omics technologies-including genomics, proteomics, transcriptomics, metabolomics, and epigenomics-have reshaped our understanding of HF at the molecular level, uncovering new biomarkers and potential therapeutic targets. Omics also enable insights into individualized treatment responses, the risks of adverse drug effects, and patient stratification for clinical trials. This review explores how multi-omics can enhance heart failure drug discovery and development across all stages of the therapeutic pipeline: (1) target selection and lead identification, (2) preclinical studies, and (3) clinical trials. By integrating omics approaches throughout the drug development process, we can accelerate the discovery of more effective and personalized therapies for heart failure.

The Close Link Between Obesity and Cardiovascular Disease: Current Insights and Remaining Challenges

Obesity is a global public health crisis, contributing to chronic disease development and poor prognosis. A large body of evidence consistently demonstrates that increased adiposity leads to many cardiovascular diseases (CVDs) and complications, such as coronary artery disease, heart failure, and arrhythmias, via direct and indirect mechanisms. Therefore, weight management is crucial to reduce and prevent cardiovascular risk. The recent emergence of glucose-like peptide-1 receptor agonists shows remarkable weight reduction and cardiovascular prevention. Despite the clear benefits, controversies and challenges on obesity-related CVD remain. This review aims to provide a comprehensive understanding of obesity-related CVD and explore current remaining tasks.

Leveraging pharmacovigilance data to predict population-scale toxicity profiles of checkpoint inhibitor immunotherapy

Immune checkpoint inhibitor (ICI) therapies have made considerable advances in cancer immunotherapy, but the complex and diverse spectrum of ICI-induced toxicities poses substantial challenges to treatment outcomes and computational analysis. Here we introduce DySPred, a dynamic graph convolutional network-based deep learning framework, to map and predict the toxicity profiles of ICIs at the population level by leveraging large-scale real-world pharmacovigilance data. DySPred accurately predicts toxicity risks across diverse demographic cohorts and cancer types, demonstrating resilience in small-sample scenarios and revealing toxicity trends over time. Furthermore, DySPred consistently aligns the toxicity-safety profiles of small-molecule antineoplastic agents with their drug-induced transcriptional alterations. Our study provides a versatile methodology for population-level profiling of ICI-induced toxicities, enabling proactive toxicity monitoring and timely tailoring of treatment and intervention strategies in the advancement of cancer immunotherapy.

Reducing heart failure events via individualized patient education program in patients with reduced ejection fraction

BACKGROUND

Disease management programs for heart failure (HF) often include various strategies such as medication management and lifestyle modifications, and are known to improve clinical outcomes.

OBJECTIVES

To evaluate the effectiveness of an individualized patient education program (IPEP) specifically designed for patients with reduced ejection fraction (HFrEF) on clinical outcomes.

METHODS

In our prospective interventional study involving 164 patients, participants were divided into control (CG) and intervention (IG) groups. The IG received the IPEP facilitated by the academic pharmacist, while both the IG and the CG continued to receive standard care from the healthcare team without any differences in the care provided. Self-care practices, medication adherence, quality of life, and clinical outcomes were assessed at both the 6th and 12th months. Statistical analysis included Chi-square tests, Kaplan-Meier survival plots, and Multivariable Cox proportional regression analysis. Data analysis was conducted using JAMOVI and R software.

RESULTS

The demographic and clinical characteristics of sample population were largely homogeneous in both the groups. The unadjusted 1-year rehospitalization (RH) rate was significantly lower in the IG at 33 % compared to 48 % in the CG, with a hazard ratio of 0.55 (95 % CI: 0.34-0.90, p = 0.018). Kaplan-Meier survival analysis depicts a higher RH rate for HFrEF participants over time, with a significant difference observed between CG and IG (log-rank P = 0.017). Notable disparities in self-care practices emerged & at the 6th and 12th-month assessments medication adherence & QoL were significantly improved in the IG (p ≤ 0.001).

CONCLUSION

IPEP led by an academic pharmacist resulted in improved self-care practices, enhanced quality of life, and reduced one-year rehospitalization rates.

Results of cardiovascular testing among pregnant and postpartum persons undergoing standardized cardiovascular risk assessment

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States, accounting for one in three pregnancy-related deaths. A standardized CVD Risk Assessment can guide clinicians in identifying patients at risk for CVD.

OBJECTIVE

The objective of this study was to evaluate whether a standardized CVD risk assessment yields more abnormal findings on follow-up CVD testing among pregnant and postpartum patients compared to assessments based on clinician judgment alone.

STUDY DESIGN

A retrospective chart review was performed across three geographically and ethnically diverse hospital networks that had implemented the CVD Risk Assessment algorithm. The analysis included a total of 31,232 pregnant and postpartum patients who had presented for obstetric care visit from September 2020 to August 2024. We calculated the proportion of patients with abnormal composite brain natriuretic peptide (BNP), electrocardiogram (EKG), and/or echocardiogram test results by risk assessment group, and a two Proportion Z-Test was conducted to compare proportions. We then calculated the odds of having abnormal tests for each risk assessment group.

RESULTS

Standardized CVD risk assessment yielded more abnormal composite test results than clinician judgment alone (6.9% vs. 4.2%; p<.0001). There was a greater proportion of abnormal test results among the risk-positive than the risk-negative group (23.4% vs. 6.6%; P<.0001). Patients assessed for CVD had 1.69 times the odds of having an abnormal test than those tested based on clinician judgment alone (P<.0001). Risk-positive patients had 4.31 times the odds of having an abnormal test than risk-negative patients (P<.0001).

CONCLUSION

Implementing a standardized CVD Risk Assessment algorithm may enhance the detection of cardiovascular disease in pregnant and postpartum patients with previously unknown CVD or at risk of developing CVD, providing a valuable tool that complements clinician judgment for improved perinatal outcomes.

Triterpenoids from ilicis rotundae cortex ameliorate hyperlipidemia by affecting bile acids-hepatointestinal FXR axis

BACKGROUND

Hyperlipidemia is a lipid metabolism disorder that, in severe cases, can lead to conditions such as hypertension, coronary heart disease, and cirrhosis. Previous studies have identified Ilicis Rotundae Cortex (IRC) crude extract as having the potential to regulate blood lipids. However, whether the triterpenoids therein are the principal agents responsible for hypolipidemic effects and their specific mechanisms of action remain unexplored. This study aimed to investigate the effects of total triterpenoids (TT) extract derived from IRC on hyperlipidemia and to elucidate their potential mechanisms.

METHODS

TT extract was first prepared and characterized to assess their hypolipidemic activity in cell models. A hyperlipidemia mouse model was established by using C57BL/6 J mice fed a high-fat, high-sugar, and high-cholesterol diet for 8 weeks. TT extract was administered as a prophylactic intervention for 4 weeks to evaluate its impact on blood lipid levels, liver lipid metabolism, and liver function. Based on progressive analysis, this study integrated serum non-targeted metabolomics analysis strategy and bile acids-targeted metabolomics analysis strategy. It was combined with modern molecular biology techniques to reveal the mechanism by which TT extract ameliorated the symptoms of hyperlipidemia through a cascade approach.

RESULTS

TT extract treatment significantly reduced lipid levels in hyperlipidemic mice. Notably, TT extract down-regulated bile acid levels, particularly bile acids as FXR antagonists such as T-β-MCA, β-MCA, TUDCA, and UDCA. This effect is likely mediated through alterations in the hepatic FXR-SHP and ileal FXR-FGF15 signaling pathways. TT extract administration led to decreased expression of CYP7A1 and CYP7B1, resulting in reduced bile acid levels in vivo. Additionally, FXR expression was upregulated in both the liver and ileum, potentially activating FGF15 in the ileum, which in turn transmits signals to the liver and modulates SHP and BSEP expression. These changes contribute to the regulation of bile acid synthesis, metabolism, and excretion. In vitro experiments also demonstrated that TT extract influenced the protein expression of FXR and FGF19.

CONCLUSION

Our findings demonstrate that TT extract from IRC has hypolipidemic effects. This study is the first to reveal the mechanism by which TT extract improves hyperlipidemia from the perspective of the hepatic-intestinal axis and bile acid metabolism. Its underlying mechanism is related to activating the intestinal FXR-FGF15/19 signaling pathway, which transmits signals to the liver, thereby affecting the hepatic FXR-SHP signaling pathway. This results in improved bile acid metabolism, ultimately reducing hepatic injury and ileal inflammation to exert hypolipidemic effects.

Obesity: Recent Advances and Future Perspectives

As reported in the World Obesity Atlas 2024 by the World Obesity Federation, the projections for 2035 suggest that more than 1 [...].

Lactiplantibacillus plantarum TCCC11824 exerts hypolipidemic and anti-obesity effects through regulation of NF-κB-HMGCR pathway and gut microbiota in mice and clinical patients

A strong association exists between the high-fat diet (HFD) and the incidence of obesity, hyperlipidemia and cardiovascular disease, affecting an increasing number of individuals. More and more research has shown that probiotics and gut microbiota play important roles in dietary absorption, metabolism, and general health of the host. This aim of this study was to evaluate the therapeutic effects and the underlying mechanisms of Lactiplantibacillus plantarum TCCC11824 (CGMCC 8198) on hyperlipidemia and obesity in mice and humans. First, there was a dose-dependent improvement in HFD-induced hyperlipidemia and obesity in mice that had been treated with L. plantarum TCCC11824 for 5 wk, thus restoring the balance of the gut microbiota. Furthermore, it showed that cell lysate of L. plantarum TCCC11824 could directly exhibit protective effects on the hepatocyte steatosis induced by oleic acid, and regulate the expression of HMGCR by inhibiting the NF-κB pathway. Importantly, L.plantarum TCCC11824 ameliorated the expression of indicators of hyperlipidemia and inhibited the synthesis of SCFAs (short-chain fatty acids), as shown by blood and fecal tests in hyperlipidemic patients. In summary, L. plantarum TCCC11824 exerts anti-hyperlipidemic and anti-obesity effects through the regulation of HMGCR via NF-κB and modulating gut microbiota, indicating its potential as a dietary supplement for the treatment of hyperlipidemia and obesity.

Lipotoxicity Induces Cardiomyocyte Ferroptosis via Activating the STING Pathway

Objective: Lipotoxicity is a well-established contributor to cardiomyocyte death and heart damage, with ferroptosis being identified as a crucial death mode in cardiomyocyte disease. This study aims to explore the potential role and mechanism of ferroptosis in lipotoxicity-induced myocardial injury. Methods: Eight-week high-fat diet (HFD) Sprague-Dawley rat and H9c2 cardiomyocytes treated with palmitic acid (PA) were established for an in vivo and in vitro lipotoxic model. Ferrostatin-1 (Fer-1) and liproxstatin-1 (Lip-1) were used to inhibit ferroptosis. Myocardial-specific stimulator of interferon genes (STING) knockdown rat (Stingmyo-KD) with HFD was further introduced. Rat cardiac structure and function, cell viability, the level of lipid peroxidation, malondialdehyde (MDA), glutathione (GSH), mitochondrial function, ferroptosis-related proteins, and STING pathway-related proteins in H9c2 cells/myocardium were detected. Results: HFD rats with a ferroptosis inhibitor showed improved cardiac structure and function, reduced lipid peroxidation, and restored GSH, which was further confirmed in H9c2 cell. The time-dependent activation of the STING pathway following PA stimulation was observed. Knockdown of the expression of STING could reduce PA-induced cell death, lipid peroxidation, and MDA levels while restoring the GSH. In addition, both HFD Stingmyo-KD rats and HFD rats with systematic inhibition by the STING inhibitor exhibited mitigating lipotoxicity-induced myocardial ferroptosis and reducing myocardial injury. Innovation and Conclusion: These findings suggest that lipotoxicity can induce ferroptosis in cardiomyocytes through the activation of the STING pathway, providing new targets and strategies for the treatment of lipotoxicity cardiomyopathy. Antioxid. Redox Signal. 42, 184-198.

RNA binding proteins: Mechanistic considerations and perspectives in controlling cardiovascular diseases

Cardiovascular diseases (CVDs) are becoming serious disease that endangering human health due to the increasing morbidity and mortality, and many molecular targets are involved in this complex pathologic process. Recently, RNA-binding proteins (RBPs) have received potential attention as a promising targets for preventing CVDs, including myocardial hypertrophy, dilated cardiomyopathy (DCM), myocardial fibrosis, and pulmonary hypertension (PH). As important regulators of RNA metabolism, RBPs play important roles in all steps of the gene expression cascade,and affect the occurrence and development of various diseases. In this review, we discuss the regulatory role of RBPs on various CVDs at the post transcriptional modification level based on current research. We also highlight the existing and potential RNA-based therapeutics that could impact future CVD treatments.

Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments

Background

Diabetes-related cognitive impairment is increasingly recognized as a significant complication, profoundly impacting patients' quality of life. This review aims to examine the pathophysiological mechanisms, clinical manifestations, risk factors, assessment and diagnosis, management strategies, and future research directions of cognitive impairment in diabetes.

Methodology

A comprehensive literature search was conducted using PubMed, Medline, and other medical databases to identify, review, and evaluate published articles on cognitive impairment in diabetes. The search focused on studies examining pathophysiology, clinical presentations, risk factors, diagnostic approaches, and management strategies.

Results

The review of current literature revealed that chronic hyperglycemia, insulin resistance, and vascular factors are major contributing factors to cognitive deficits in diabetes. Clinical manifestations include impairments in attention, memory, executive function, visuospatial abilities, and language. Risk factors encompass disease duration, glycemic control, presence of complications, age, education level, and comorbidities. Assessment tools include cognitive screening instruments, neuropsychological testing, and neuroimaging techniques. Management strategies involve glycemic control optimization, lifestyle modifications, cognitive training, and pharmacological interventions.

Conclusion

This review highlights the significant prevalence and impact of cognitive impairment in diabetes, resulting from complex metabolic and vascular disturbances. Early detection and multifaceted interventions are crucial for preserving cognitive function and improving patient outcomes. Future research should focus on neuroprotective strategies, biomarker identification, and personalized approaches. Collaborative efforts between clinicians and researchers are essential to effectively address this growing healthcare challenge and enhance the quality of life for individuals with diabetes-related cognitive impairment.

Association Between Serum Albumin and the Length of Hospital Stay Among Patients With Acute Heart Failure

Introduction: Albumin plays a vital role in improving osmotic pressure and hemodynamics. A lower serum albumin level may cause pulmonary congestion and edema and contribute to myocardial dysfunction, diuresis resistance, and fluid retention in acute heart failure. Hypothesis: We hypothesized that AHF patients with normal serum albumin have shorter hospital stays. Methods: Using Electronic Medical Records, patients admitted from May 2020 through May 2021 aged >18, ICD-10, and positive Framingham Heart Failure Diagnostic Criteria were included. We excluded patients without albumin records and eGFRs less than 30 mL/min/1.73 m2. Prolonged hospitalization was defined as >8 days of hospitalization. Results: During index emergency department visits, patients were symptomatic (New York Heart Association), aged median of 70 years (Interquartile range (IQR) 18), 59% (n = 103) were male, predominantly White (73%, n = 128), and had a high Charleston Comorbidity index score [5, IQR (4-7)]. Nearly one-fourth (23%, n = 41) of the patients had <3.5 g/dL albumin levels. The median length of hospital stay was eight days (IQR of 11). Comparing differences between lengths of hospital stays (<8 vs. >8 days), there was different serum albumin (3.9 + 0.48 vs. 3.6 + 0.53, p < .001) and left ventricular ejection fraction (45% (range 26-63) versus 30% (range 24-48), p = .004). An increased serum albumin decreased prolonged hospitalization (odds ratio (OR), 0.28; 95% confidence interval (CI), 0.14-0.55, p = <0.001). Patients in the lower albumin group had higher NT-proBNP (median: 8521 (range 2025-9134) versus 5147 (range 2966-14,795) pg/ml, p = .007) and delay in administering intravenous diuretics (391 (167-964) minutes versus 271 (range 157-533) minutes, p = .02). Conclusion: Hypoalbuminemia is strongly associated with prolonged hospitalization. Timely and effective diuretic therapy may reduce hospital stay durations, particularly with albumin supplementation.

Systolic blood pressure, a predictor of mortality and life expectancy following heart failure hospitalization, 2010-2023

BACKGROUND

Optimal systolic blood pressure (SBP) targets for the treatment of hospitalized acute decompensated heart failure (ADHF) patients are not known.

OBJECTIVES

To investigate the association between SBP <130 mmHg at discharge or within 30 days and all-cause mortality or years of life lost (YLL) after ADHF hospitalization.

METHODS

We analyzed medical records of 14,611 adults who survived ADHF hospitalization at 17 hospitals (2010-2022) with follow-up until May 2023. Sensitivity analysis included 10,515 patients with post-discharge SBP measured within 30 days.

RESULTS

Mortality rates at 30 days, 180 days, 1 year, and 3 years were higher in patients with discharge SBP <130 mmHg (6.9 %, 21.1 %, 29.1 %, and 45.1 %) vs. SBP ≥130 mmHg (4.8 %, 16.0 %, 23.6 %, and 40.3 %). Hazard ratios (HR) for mortality were consistently higher in patients with discharge SBP <130 at 1.30 (95 % CI, 1.11-1.52), 1.45 (95 % CI, 1.33-1.58), 1.40 (95 % CI, 1.30-1.51), 1.31 (95 % CI, 1.23-1.38) at these intervals. The average YLL per deceased individual was 1-2 years greater in the discharge SBP <130 group (incidence rate ratios, 1.004 to 1.230). Restricted cubic spline analysis showed that HR for mortality shifted toward better outcomes at discharge SBP ≥130 Sensitivity analysis supported these findings.

CONCLUSION

In hospitalized ADHF patients, SBP <130 mmHg at discharge or within 30 days post-discharge was linked to higher mortality and YLL, while SBP ≥130 mmHg or improvement to ≥130 mmHg post-discharge led to better short and long-term outcomes. Further research is needed to understand the mechanisms and benefits of SBP optimization.

The Effect of Activity Tracking Apps on Physical Activity and Glycemic Control in People with Prediabetes Compared to Normoglycemic Individuals: A Pilot Study

Introduction-Aim: Adopting a lifestyle that incorporates regular physical activity confers substantial benefits to both physical and mental health and is recommended for prediabetic individuals. The aim of this study is to investigate the impact of activity tracking apps on increasing physical activity and its effect on glycemic control in people with prediabetes.

MATERIALS AND METHODS

This pilot study included 37 participants, 18 in the prediabetic group and 19 in the normoglycemic group matched for age and gender (mean age 53 years, 40% males). Participants used the Google Fit app for 3 months. The number of daily steps was recorded via the app, and blood and urine tests as well as body fat measurements were conducted before and following 3 months of app use. The co-primary outcome was the change in steps, and the change in HbA1c in both groups. Secondary outcomes were the change in fasting plasma glucose (FPG) (main secondary outcome), as well as lipid parameters, body mass index, visceral fat, and kidney function indices among the two groups.

RESULTS

Both groups increased the daily step count following the app intervention, without any statistically significant difference when we compared the steps change between the two groups. We found a statistically significant difference between HbA1c levels in favor of the prediabetic compared to the normoglycemic group [mean difference (MD) 0.16, 95%CI 0.04, 0.28, p-value 0.01)], following the 3-month intervention. Additionally, there was a statistically significant difference between FPG levels in favor of the prediabetic compared to the normoglycemic group (MD 9.06, 95%CI 4.16, 13.96, p-value 0.001).

CONCLUSIONS

The present study suggests that the use of activity tracking apps, combined with tailored activity goals and monthly supportive phone calls, may contribute to improved glycemic control among individuals with prediabetes.

Chronic exercise improves renal AT1 and ETB receptor functions via modulating GRK4 expression in obese Zucker rats

BACKGROUND

Physical activity has profound benefits on health, especially in patients with cardiovascular and metabolic disease. Exercise training can reduce oxidative stress, improve renal function, and thus lower blood pressure. However, the effect of exercise training on angiotensin II type 1 receptors (AT1R) and endothelin subtype B receptors (ETBR)-mediated diuresis and natriuresis in obese Zucker rats is unclear.

METHODS

Lean and obese Zucker rats were exercised or placed on a nonmoving treadmill for 8 weeks. Blood pressure was measured by tail-cuff plethysmography, and functions of AT1R and ETBR in the kidney were measured by natriuresis, respectively.

RESULTS

Our data showed that exercise training improved glucose and lipid metabolism, renal function and sodium excretion in obese Zucker rats, accompanied by decreased oxidative stress and GRK4 expression in obese Zucker rats. Moreover, exercise training reduced the Candesartan-induced an increase in diuresis and natriuresis and increased ETBR agonists (BQ3020)-mediated diuresis and natriuresis in obese Zucker rats, which were associated with decreased renal AT1R expression and ETBR phosphorylation levels.

CONCLUSIONS

The results demonstrate that exercise training lowers blood pressure via improving renal AT1R and ETBR function through modulating GRK4 expression in Obese Zucker Rats and provides potentially effective targets for obesity-related hypertension.

Differential impact of TyG and TyG-BMI indices on short- and long-term mortality in critically ill ischemic stroke patients

BACKGROUND

Ischemic stroke is a major contributor to global morbidity and mortality, particularly in critically ill patients in intensive care units (ICUs). While advances in stroke management have improved outcomes, predicting mortality remains challenging due to the involvement of complex metabolic and cardiovascular factors. The triglyceride-glucose (TyG) index, a marker for insulin resistance, has gained attention for its potential to predict adverse outcomes in stroke patients. Furthermore, the TyG-BMI index, which combines TyG with body mass index (BMI), may offer a more comprehensive measure by accounting for obesity-related metabolic burden. However, the comparative impact of these indices on short- and long-term mortality among critically ill ischemic stroke patients remains unclear.

METHODS

This retrospective cohort study analyzed data from the Medical Information Mart for Intensive Care IV (MIMIC-IV 3.0) database, including 1,334 critically ill ischemic stroke patients. The patients were divided into four groups based on TyG and TyG-BMI quartiles, respectively. Cox proportional hazards models were employed to assess the association of these indices with 30-day, 90-day, 180-day, and 1-year all-cause mortality (ACM). Kaplan-Meier survival analysis was used to compare survival rates across different index levels. We utilized restricted cubic splines (RCS) to examine the association between the TyG, TyG-BMI index and the specified outcomes. Furthermore, TyG and TyG-BMI index were utilized to establish logistic regression models for mortality across different time periods, and corresponding Receiver Operating Characteristic (ROC) curves were generated.

RESULTS

Kaplan-Meier survival analysis show that Higher TyG levels were associated with significantly increased mortality risk at all time points, with patients in the highest TyG quartile exhibiting the greatest risk. Conversely, patients having a lower TyG-BMI level faced a heightened risk of long-term ACM. The RCS analysis results demonstrated that the TyG index did not exhibit a statistically significant nonlinear relationship with mortality across all time points. However, a significant nonlinear relationship was observed between the TyG index and long-term mortality. From the ROC curve, it can be observed that TyG performs better in predicting short-term mortality. Conversely, TyG-BMI demonstrates superior performance in predicting long-term mortality. The analysis revealed that while the TyG index alone is a strong predictor of mortality, the TyG-BMI index enhances the ability to predict long-term outcomes.

CONCLUSION

This finding suggests both the TyG and TyG-BMI indices serve as valuable predictors of mortality in critically ill ischemic stroke patients. However, significant differences were observed across the various follow-up periods. Based on the distinct characteristics of these two indicators, future research should focus on the selective integration of TyG and TyG-BMI indices into clinical risk assessment models, tailored to the metabolic profiles of ischemic stroke patients in the ICU. This approach could enhance the precision of mortality risk stratification and optimize patient management strategies.

Maximal Fat Oxidation During Exercise in Healthy Individuals: Lack of Genetic Association with the FTO rs9939609 Polymorphism

Background/Objectives: Previous studies suggest that there is a genetically determined component of fat oxidation at rest and during exercise. To date, the FTO gene has been proposed as a candidate gene to affect fat oxidation during exercise because of the association of the "at-risk" A allele with different obesity-related factors such as increased body fat, higher appetite and elevated insulin and triglyceride levels. The A allele of the FTO gene may also be linked to obesity through a reduced capacity for fat oxidation during exercise, a topic that remains largely underexplored in the current literature. The aim of this study was to analyze the association between the FTO rs9939609 polymorphism with the rate of fat oxidation during exercise and metabolic syndrome criteria in healthy participants. Methods: A total of 80 healthy participants (41 men and 39 women) underwent comprehensive assessments, including measurements of anthropometric variables, blood pressure and blood measures of fasting glucose, triglycerides, low- and high-density lipoprotein cholesterol (LDL-c and HDL-c), insulin, interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations. Additionally, the Homeostatic Model Assessment (HOMA-IR) was used to evaluate insulin resistance. Peak oxygen uptake (VO2peak) and maximal fat oxidation rate (MFO) were also measured during an incremental cycling test. FTO rs9939609 genotyping (TT, AT, AA) was performed using genomic DNA samples obtained from a buccal swab and measured with PCR. Results: There were 32 participants (40.0%) with the TT genotype; 31 (38.8%) with the AT genotype; and 17 (21.2%) with the AA genotype. Age, body characteristics, VO2peak, blood pressure and blood variables were similar across all three genotypes. However, serum insulin concentration and HOMA-IR were associated with the FTO rs9939609 genotype with higher values in AA with respect to AT and TT participants (p < 0.050). Still, MFO was similar in TT, AT and AA participants (0.35 ± 0.13, 0.37 ± 0.11, 0.33 ± 0.11 g/min, p = 0.702). In the dominant model, there was no statistical difference between TT and A allele carriers. However, the recessive model revealed that AA participants had higher values of body mass, body mass index, blood insulin concentration and HOMA-IR than T allele carriers (p < 0.050), with no differences in MFO. Conclusions: In our sample of healthy individuals, the FTO rs9939609 polymorphism was associated with several phenotypes associated with obesity and insulin resistance, particularly under the AA vs. T allele/recessive model. However, the FTO rs9939609 polymorphism was not associated with MFO during exercise as fat oxidation was similar across genotypes. This suggests that reduced fat oxidation during exercise is unlikely to be a cause of the obesogenic influence of the FTO AA genotype. Clinically, these findings suggest that the obesogenic effects of the FTO AA genotype are unlikely driven by impaired fat oxidation during exercise. Instead, attention should focus on mechanisms like appetite regulation and energy intake. Moreover, exercise interventions may still effectively mitigate obesity risk, as AA individuals retain normal fat oxidation capacity during exercise.

Managing the work of living with heart failure: a qualitative study using the cumulative complexity model from Southeastern Minnesota

OBJECTIVE

Patients with heart failure (HF) perform a variety of self-care activities to control symptoms and minimise the risk of HF decompensations. The objective of this study was to understand how patients build capacity and manage the work of living with HF.

DESIGN

A qualitative study using semi-structured telephone interviews. The interview guide was informed by the Cumulative Complexity Model, a conceptual framework that focuses on a patient's workload and their capacity to manage that work. Interview transcripts were analysed using a mixed inductive and deductive coding approach with organisation into larger thematic categories.

SETTING

Southeastern Minnesota USA (11 counties) with capture of data from local community healthcare providers under the auspices of the Rochester Epidemiology Project.

PARTICIPANTS

Intentional sampling of local patients with HF (n=24, median age 69.5 years, 54% women, 63% rural, 54% preserved ejection fraction) who reported high treatment burden and/ or poor health status on a questionnaire.

RESULTS

Three major themes emerged: using capacity to manage workload, disruptions resulting in workload exceeding capacity and regaining workload-capacity balance. Participants described routinising the daily tasks associated with living with HF to minimise the associated burden and identified disruptions to their routines, including hospitalisations, emergency room visits, worsening health status and changes in healthcare access. To accommodate disruptions and regain workload-capacity balance, participants decreased workload and/or transferred tasks to others to maximise capacity.

CONCLUSIONS

Participants with HF described managing patient workload in times of stable health, but they sometimes struggled to accommodate disruptions and worsening health status. These findings can inform the design of interventions to minimise workload, maximise capacity and improve quality of life for patients with HF.

Effectiveness of Interventions to Disease Management Programs of Patients with Heart Failure: A Systematic Review and Meta-Analysis

Heart failure (HF) prevalence is rising due to population aging and increasing risk factor incidence, thereby posing a significant global public health challenge. Disease management programs (DMPs) play a crucial role in managing HF and optimizing postevent health outcomes. Through a systematic review and meta-analysis, this study aimed to evaluate the effectiveness of DMPs following an HF event. Five electronic databases-Embase, PubMed, Web of Science, Scopus, and CINAHL-were searched for relevant studies published before December 2023. Studies with randomized controlled trials evaluating DMPs versus placebo for patients after an HF event were selected. Twelve articles were included in the meta-analysis, with a total of 3844 patients. The intervention group showed clinically significant improvement in exercise capacity [mean difference (95% confidence interval), 53.33 (43.40-67.26); P < 0.00001]; physical activity [-5.76 (-8.86 to -2.66); P = 0.0003]; emotional well-being [-2.32 (-4.39 to -0.25); P = 0.03]; and quality of life [-9.13 (-16.79 to -1.48); P = 0.02) compared with the control group. Furthermore, the control group showed significantly higher hospital admissions (P = 0.0002); readmissions (P = 0.00001); and mortality due to HF causes (P = 0.003) than the intervention group. DMPs have a positive effect on patients who have experienced an HF event by improving exercise capacity, physical activity, emotional well-being, and quality of life and reducing hospital admissions, readmissions, and mortality due to HF causes.

Exogenous Ketones in Cardiovascular Disease and Diabetes: From Bench to Bedside

Ketone bodies are molecules produced from fatty acids in the liver that act as energy carriers to peripheral tissues when glucose levels are low. Carbohydrate- and calorie-restricted diets, known to increase the levels of circulating ketone bodies, have attracted significant attention in recent years due to their potential health benefits in several diseases. Specifically, increasing ketones through dietary modulation has been reported to be beneficial for cardiovascular health and to improve glucose homeostasis and insulin resistance. Interestingly, although excessive production of ketones may lead to life-threatening ketoacidosis in diabetic patients, mounting evidence suggests that modest levels of ketones play adaptive and beneficial roles in pancreatic beta cells, although the exact mechanisms are still unknown. Of note, Sodium-Glucose Transporter 2 (SGLT2) inhibitors have been shown to increase the levels of beta-hydroxybutyrate (BHB), the most abundant ketone circulating in the human body, which may play a pivotal role in mediating some of their protective effects in cardiovascular health and diabetes. This systematic review provides a comprehensive overview of the scientific literature and presents an analysis of the effects of ketone bodies on cardiovascular pathophysiology and pancreatic beta cell function. The evidence from both preclinical and clinical studies indicates that exogenous ketones may have significant beneficial effects on both cardiomyocytes and pancreatic beta cells, making them intriguing candidates for potential cardioprotective therapies and to preserve beta cell function in patients with diabetes.

The NLRP3-inflammasome inhibitor MCC950 improves cardiac function in a HFpEF mouse model

Heart failure with preserved ejection fraction (HFpEF) is posing a significant medical challenge due to its growing prevalence, high hospitalization rates and limited response to current treatment options. Accumulating evidence suggests that a comorbidity-driven systemic pro-inflammatory state, including activation of the NLRP3 inflammasome, contributes to the pathogenesis of HFpEF. This study aimed to investigate the potential cardiac protective effects of the selective NLRP3 inhibitor MCC950, in a mouse model of HFpEF. HFpEF was obtained in 18-22 months old female mice using high-fat diet (HFD) and angiotensin II (AngII) infusion. Mice developed HFpEF and comorbidities such as obesity, type 2 diabetes, and hypertension. MCC950 was added to HFD and groups were treated for four weeks until the study endpoint. MCC950 treatment resulted in lower plasma IL-18 levels (-47.3 %), illustrating target engagement. First, we observed that MCC950 treatment improved left ventricular function, demonstrated by enhanced global longitudinal strain (GLS, 3.9 %, P<0.01) and reverse peak longitudinal strain (RPLSR, +46.8 %, P<0.05). Second, MCC950 reduced cardiac hypertrophy (cardiomyocyte size -19.5 %, P<0.001) and fibrosis (-32.5 %, P<0.05), accompanied by lower expression of pro-fibrotic genes. Finally, MCC950 treatment reduced macrophage infiltration in left ventricular tissue and attenuated macrophage accumulation in visceral adipose tissue, even more as compared to caloric restriction. Overall, this suggests that NLRP3 inhibition could be a promising treatment for HFpEF patients with a pro-inflammatory profile, potentially improving heart function, systemic inflammation, and metabolic parameters.

Trends in cancer and heart failure related mortality in adult US population: A CDC WONDER database analysis from 1999 to 2020

BACKGROUND

With the advent of novel chemotherapy, survival of patients with cancer has improved. However, people with cancer have an increased risk of heart failure (HF). Conversely, HF-related mortality may undermine survival among people with cancer. We aim to analyze the trends of mortality in people with HF and cancer in the adult US population.

METHODS

We conducted an examination of death certificates sourced from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database, from the years 1999 to 2020. Mortality in adults with HF and cancer was assessed. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change were reported.

RESULTS

Between 1999 and 2020, 621,783 deaths occurred from HF in people with cancer. The AAMR declined from 16.4 in 1999 to 11.9 in 2017, after which an increase to 14.5 was observed in 2020. Men had consistently higher overall AAMR as compared to women (men = 18.1 vs women = 9.9). Similar AAMR was observed between non-Hispanic (NH) Blacks/African Americans (13.9) and NH Whites (13.3), with lower in American Indian/Alaska Native (9.6) and Hispanics (7.4). Asian/Pacific Islanders reported the lowest AAMR (5.7). The Midwestern region reported the highest AAMR (14.8). We observed the highest AAMR amongst the older population (61.4).

CONCLUSION

The mortality rates of people with HF and cancer are increasing in the adult U.S.

POPULATION

This underscores the need for increased screening, aggressive management, and subsequent surveillance of people at risk or with manifested HF in people with cancer.

TFEB signaling promotes autophagic degradation of NLRP3 to attenuate neuroinflammation in diabetic encephalopathy

Diabetic encephalopathy (DE), a neurological complication of diabetes mellitus, has an unclear etiology. Shreds of evidence show that the nucleotide-binding oligomerization domain-like receptor family protein 3 (NLRP3) inflammasome-induced neuroinflammation and transcription factor EB (TFEB)-mediated autophagy impairment may take part in DE development. The cross talk between these two pathways and their contribution to DE remains to be explored. A mouse model of type 2 diabetes mellitus (T2DM) exhibiting cognitive dysfunction was created, along with high-glucose (HG) cultured BV2 cells. Following, 3-methyladenine (3-MA) and rapamycin were used to modulate autophagy. To evaluate the potential therapeutic benefits of TFEB in DE, we overexpressed and knocked down TFEB in both mice and cells. Autophagy impairment and NLRP3 inflammasome activation were noticed in T2DM mice and HG-cultured BV2 cells. The inflammatory response caused by NLRP3 inflammasome activation was decreased by rapamycin-induced autophagy enhancement, while 3-MA treatment further deteriorated it. Nuclear translocation and expression of TFEB were hampered in HG-cultured BV2 cells and T2DM mice. Exogenous TFEB overexpression boosted NLRP3 degradation via autophagy, which in turn alleviated microglial activation as well as ameliorated cognitive deficits and neuronal damage. In addition, TFEB knockdown exacerbated neuroinflammation by decreasing autophagy-mediated NLRP3 degradation. Our findings have unraveled the pathogenesis of a previously underappreciated disease, implying that the activation of NLRP3 inflammasome and impairment of autophagy in microglia are significant etiological factors in the DE. The TFEB-mediated autophagy pathway can reduce neuroinflammation by enhancing NLRP3 degradation. This could potentially serve as a viable and innovative treatment approach for DE.NEW & NOTEWORTHY This article delves into the intricate connections between inflammation, autophagy, diabetes, and neurodegeneration, with a particular focus on a disease that is not yet fully understood-diabetic encephalopathy (DE). TFEB emerges as a pivotal regulator in balancing autophagy and inflammation in DE. Our findings highlight the crucial function of the TFEB-mediated autophagy pathway in mitigating inflammatory damage in DE, suggesting a new treatment strategy.

Metabolic Conditions and Organ Dysfunctions Risk Factors for Gastrointestinal Cancer in Hypertensive Patients: A Case-Control Study in China

Background

The associations of metabolic conditions, chronic organ dysfunctions and acidic food consumption with the risk of gastrointestinal cancer are unknown among individuals with primary hypertension. We sought to identify risk factors for gastrointestinal cancer in this population.

Methods

We conducted a case-control study among individuals who had primary hypertension and were later diagnosed with a type of gastrointestinal cancer, and those who had primary hypertension and were not diagnosed with gastrointestinal cancer at a local hospital from January 2020 to January 2024. We compared sociodemographic, lifestyle, dietary, and medical characteristics between the groups using data extracted from electronic medical records. Univariate and multivariate logistic regression were used to find associations with risk factors.

Results

We identified 125 cases of gastrointestinal cancer and 544 controls who were cancer-free. There were significant associations between overall gastrointestinal cancer and hyperlipidemia (OR, 3.37; 95% CI, 1.98-5.72), diabetes mellitus (OR, 2.58; 95% CI, 1.64-4.07), chronic renal failure (OR, 2.45; 95% CI, 1.43-4.20), alcohol consumption (OR, 2.35; 95% CI, 1.49-3.70), heart failure (OR, 2.13; 95% CI, 1.36-3.33), and higher-grade hypertension (OR, 1.97; 95% CI, 1.41-2.74).

Conclusion

In this retrospective study of patients who had primary hypertension, we identified several comorbid conditions as indicators for gastrointestinal cancer, including hyperlipidemia, diabetes mellitus, chronic renal failure, alcohol consumption, heart failure, and higher-grade hypertension.

Predictive modeling of preoperative acute heart failure in older adults with hypertension: a dual perspective of SHAP values and interaction analysis

BACKGROUND

In older adults with hypertension, hip fractures accompanied by preoperative acute heart failure significantly elevate surgical risks and adverse outcomes, necessitating timely identification and management to improve patient outcomes.

RESEARCH OBJECTIVE

This study aims to enhance the early recognition of acute heart failure in older hypertensive adults prior to hip fracture surgery by developing a predictive model using logistic regression (LR) and machine learning methods, optimizing preoperative assessment and management.

METHODS

Employing a retrospective study design, we analyzed hypertensive older adults who underwent hip fracture surgery at Hebei Medical University Third Hospital from January 2018 to December 2022. Predictive models were constructed using LASSO regression and multivariable logistic regression, evaluated via nomogram charts. Five additional machine learning methods were utilized, with variable importance assessed using SHAP values and the impact of key variables evaluated through multivariate correlation analysis and interaction effects.

RESULTS

The study included 1,370 patients. LASSO regression selected 18 key variables, including sex, age, coronary heart disease, pulmonary infection, ventricular arrhythmias, acute myocardial infarction, and anemia. The logistic regression model demonstrated robust performance with an AUC of 0.753. Although other models outperformed it in sensitivity and F1 score, logistic regression's discriminative ability was significant for clinical decision-making. The Gradient Boosting Machine model, notable for a sensitivity of 95.2%, indicated substantial capability in identifying patients at risk, crucial for reducing missed diagnoses.

CONCLUSION

We developed and compared efficacy of predictive models using logistic regression and machine learning, interpreting them with SHAP values and analyzing key variable interactions. This offers a scientific basis for assessing preoperative heart failure risk in older adults with hypertension and hip fractures, providing significant guidance for individualized treatment strategies and underscoring the value of applying machine learning in clinical settings.

Isoxanthohumol improves hepatic lipid metabolism via regulating the AMPK/PPARα and PI3K/AKT signaling pathways in hyperlipidemic mice

Hyperlipidemia presents a significant global healthcare challenge, necessitating innovative therapeutic strategies for more effective outcomes. Recent studies have highlighted the beneficial impact of moderate beer intake on metabolic diseases. The purpose of this research is to explore the possible molecular mechanisms of isoxanthohumol (IXN), the major hop flavonoid in beer, in the treatment of hyperlipidemia. The mice model of acute hyperlipidemia was constructed by intraperitoneal injection of Triton WR-1339. The therapeutic effect of IXN was assessed by biochemical and histological analyses. Furthermore, comprehensive data mining across various public databases was conducted to identify underlying therapeutic targets of IXN on hyperlipidemia. A protein-protein interaction network was constructed to pinpoint hub targets, and subsequent GO and KEGG enrichment analyses were used to elucidate underlying biological functions. Molecular docking was utilized to validate the binding affinity between hub targets and IXN. Western blotting analysis further verified the protein expression of potential IXN targets. IXN administration significantly improved blood lipid and hepatic lipid levels, alongside increased SOD activity and decreased MDA content in hyperlipidemia mice. Histological analyses, including H&E and Oil Red O staining, showed the improvement of hepatic steatosis with IXN treatment. At the molecular level, IXN significantly increased protein levels of p-AMPK, PPARα, p-PI3K, and p-AKT. IXN activates AMPK/PPARα and PI3K/AKT signaling pathways, leading to reduction in lipid accumulation and oxidative stress, and ultimately ameliorating hyperlipidemia.

Efferocytosis in atherosclerosis

Cardiovascular disease is the leading cause of death worldwide, and it commonly results from atherosclerotic plaque progression. One of the increasingly recognized drivers of atherosclerosis is dysfunctional efferocytosis, a homeostatic mechanism responsible for the clearance of dead cells and the resolution of inflammation. In atherosclerosis, the capacity of phagocytes to participate in efferocytosis is hampered, leading to the accumulation of apoptotic and necrotic tissue within the plaque, which results in enlargement of the necrotic core, increased luminal stenosis and plaque inflammation, and predisposition to plaque rupture or erosion. In this Review, we describe the different forms of programmed cell death that can occur in the atherosclerotic plaque and highlight the efferocytic machinery that is normally implicated in cardiovascular physiology. We then discuss the mechanisms by which efferocytosis fails in atherosclerosis and other cardiovascular and cardiometabolic diseases, including myocardial infarction and diabetes mellitus, and discuss therapeutic approaches that might reverse this pathological process.

Exploring cultural, social, and biological factors influencing obesity onset in two racial-ethnic groups in Quibdó, Colombia

Obesity rates in Colombia are increasing, with variations among racial and ethnic groups. Studies on adult obesity often address socio-economic status, gender, and education but neglect racial-ethnic influences, notably in areas like Quibdó. Therefore, based on the theory of triadic influence, we conducted a qualitative study to identify biobehavioural, social, and cultural phenomena that, from the perspectives of the participants, influence the onset of obesity in Afro-Colombian and indigenous in Quibdó in 2022. The stratification variables were race, ethnicity (Afro-Colombian and Indigenous), and educational level (secondary or higher). Based on a literature review of qualitative studies that commonly explored food culture, nutritional status, and physical activity in analysing obesity within racial and ethnic populations, we incorporated these categories into our research methodology through semi-structured interviews. A framework analysis was used as a qualitative methodology to organise and analyse the collected data. We conducted 21 semi-structured interviews, 13 with the Afro-Colombian population and eight with indigenous inhabitants. The results indicate that cultural beliefs, forced displacement/migration, and alterations in public order have resulted in changes in food security, food culture, and physical activity practices, affecting the onset of obesity. Notably, distinctions in cultural beliefs regarding food culture and health as factors influencing obesity were observed between Afro-Colombians and the Indigenous populations; however, educational differences within the same racial ethnic group were not predominant. Findings indicate obesity is influenced by cultural, social, and biobehavioural factors, especially in regions with racial-ethnic communities facing complex conditions, necessitating targeted racial-ethnic public health policies.

Saturation association between serum 25-hydroxyvitamin D levels and mortality in elderly people with hyperlipidemia: a population-based study from the NHANES (2001-2016)

Background

25-hydroxyvitamin D is the body's main storage form of vitamin D and is internationally recognized as the best indicator of vitamin D status in the human body. There is a scarcity of research investigating the interrelationship between serum 25-hydroxyvitamin D (25(OH)D) levels and mortality among elderly individuals with hyperlipidemia. To address this knowledge gap, we examined the association between serum 25(OH)D levels and mortality in an older hyperlipidemic population from NHANES, while controlling for other influential factors. The study sought to elucidate the correlation between serum 25(OH)D levels and mortality about all-cause mortality, cardiovascular disease (CVD), malignant neoplasms, and mortality from other causes.

Methods

The data from NHANES 2001-2016, including 9,271 participants were analyzed to examine the association between serum 25(OH)D levels and mortality. The interrelationship was illustrated using Kaplan-Meier curves and restricted cubic splines, while the Cox proportional hazards model was utilized to estimate the multifactor adjusted hazard ratio (HR).

Results

This study included 9,271 participants (43.28% male) with an average age of 69.58 years, and the average duration of participant follow-up was 88.37 months. Kaplan-Meier curves demonstrated that lower serum 25(OH)D levels were associated with increased risks of all-cause mortality, cardiovascular mortality, malignant neoplasm mortality, and mortality from other causes. This negative association was further confirmed by the Cox proportional hazards models. Additionally, restricted cubic splines not only revealed this negative association but also highlighted the saturated serum 25(OH)D levels. Moreover, subgroup analyses indicated that the inverse correlation between serum 25(OH)D levels and all-cause mortality was more pronounced in the non-obese and smoking population. And the inverse correlation with mortality from other causes was even stronger in the non-obese population.

Conclusions

In the elderly population with hyperlipidemia, 25(OH)D serum levels were negatively correlated with both cause-specific mortality and all-cause mortality. Moreover, there was a threshold effect in this negative association.

Blood-based biomemristor for hyperglycemia and hyperlipidemia monitoring

Thanks to its structural characteristics and signal patterns similar to those of human brain synapses, memristors are widely believed to be applicable for neuromorphic computing. However, to our knowledge, memristors have not been effectively applied in the biomedical field, especially in disease diagnosis and health monitoring. In this work, a blood-based biomemristor was prepared for in vitro detection of hyperglycemia and hyperlipidemia. It was found that the device exhibits excellent resistance switching (RS) behavior at lower voltage biases. Through mechanism analysis, it has been confirmed that the RS behavior is driven by Ohmic conduction and ion rearrangement. Furthermore, the hyperglycemia and hyperlipidemia detection devices were constructed for the first time based on memristor logic circuits, and circuit simulations were conducted. These results confirm the feasibility of blood-based biomemristors in detecting hyperglycemia and hyperlipidemia, providing new prospects for the important application of memristors in the biomedical field.

An Integrated Pathophysiological and Clinical Perspective of the Synergistic Effects of Obesity, Hypertension, and Hyperlipidemia on Cardiovascular Health: A Systematic Review

This review paper explores the synergistic effects of obesity, hypertension (HTN), and hyperlipidemia on cardiovascular health by integrating pathophysiological and clinical perspectives. Obesity, characterized by excessive body fat, HTN, defined by elevated blood pressure, and hyperlipidemia, indicated by high blood lipid levels, are globally prevalent conditions that significantly increase the risk of cardiovascular diseases (CVDs). The interplay between these conditions exacerbates cardiovascular risk through mechanisms such as chronic inflammation, insulin resistance, endothelial dysfunction, arterial stiffness, and atherogenesis. This review synthesizes epidemiological evidence and highlights the prevalence and co-occurrence of these conditions, with an emphasis on their combined impact on cardiovascular health. The literature search encompassed various databases, and data extraction included key study characteristics and outcomes. The findings underscore the importance of integrated management strategies, involving lifestyle interventions, pharmacological treatments, and regular monitoring, to mitigate the heightened cardiovascular risk posed by these conditions. In addition, the various public health implications are addressed, advocating for community-based interventions and policy changes. Future research directions may include exploring novel therapeutic approaches, personalized medicine strategies, and longitudinal studies to enhance the understanding and management of the synergistic effects of obesity, HTN, and hyperlipidemia on cardiovascular health.

Translational Research and Clinical Application of Traditional Chinese Medicine in Cardiovascular Diseases

Luobing theory is based on the principles of traditional Chinese medicine (TCM) and focuses on the regulation of blood circulation. The translation of Luobing theory into clinical practice has shown promising results in the treatment of cardiovascular diseases (CVDs). Studies have reported the benefits of using Luobing theory in the treatment of metabolic syndrome, atherosclerosis, arrhythmia, and heart failure. This review article provides an overview of the evidence-based application of TCM Luobing theory in the treatment of CVDs. It also highlights the challenges and opportunities of translating TCM into clinical practice and provides valuable insights for future CVD research.

The Construction and Meaning of Race Within Hypertension Guidelines: A Systematic Scoping Review

BACKGROUND

Professional society guidelines are evidence-based recommendations intended to promote standardized care and improve health outcomes. Amid increased recognition of the role racism plays in shaping inequitable healthcare delivery, many researchers and practitioners have critiqued existing guidelines, particularly those that include race-based recommendations. Critiques highlight how racism influences the evidence that guidelines are based on and its interpretation. However, few have used a systematic methodology to examine race-based recommendations. This review examines hypertension guidelines, a condition affecting nearly half of all adults in the United States (US), to understand how guidelines reference and develop recommendations related to race.

METHODS

A systematic scoping review of all professional guidelines on the management of essential hypertension published between 1977 and 2022 to examine the use and meaning of race categories.

RESULTS

Of the 37 guidelines that met the inclusion criteria, we identified a total of 990 mentions of race categories. Black and African/African American were the predominant race categories referred to in guidelines (n = 409). Guideline authors used race in five key domains: describing the prevalence or etiology of hypertension; characterizing prior hypertension studies; describing hypertension interventions; social risk and social determinants of health; the complexity of race. Guideline authors largely used race categories as biological rather than social constructions. None of the guidelines discussed racism and the role it plays in perpetuating hypertension inequities.

DISCUSSION

Hypertension guidelines largely refer to race as a distinct and natural category rather than confront the longstanding history of racism within and beyond the medical system. Normalizing race as a biological rather than social construct fails to address racism as a key determinant driving inequities in cardiovascular health. These changes are necessary to produce meaningful structural solutions that advance equity in hypertension education, research, and care delivery.

Empowering self-care through patient education in heart failure patients: A multimodal approach comprising of P-PILs, videos, and personalized advice

BACKGROUND

Heart failure (HF) patients, in developing countries like India, have limited access to information regarding their health/disease state. To identify patient problems and patient expectations through focused group discussions (FGD) and develop a multimodal educational tool consisting of a pictogram-based patient information leaflet (P-PIL), HF video, and personalized counseling (PC) for HF patients.

MATERIALS AND METHODS

Based on the results of the FGD with stakeholders, we developed, validated, and tested educational tools such as P-PIL and HF videos and personalized counseling for enhancing patient education.

RESULTS

FGD identified major patient-related barriers, and we developed and validated P-PIL and HF videos. Ninety heart failure patients participated in user testing knowledge assessment. The mean scores in knowledge significantly increased from 39.37 to 85.18 (P < 0.001), with 95% of patients favoring P-PIL for its layout design and content. P-PIL, HF videos, and personalized counseling together enhanced patient awareness and self-care, indicating positive healthcare outcomes in HF.

CONCLUSION

A well-developed and validated PIL can be reinforced by videos and personalized counseling and enhancing knowledge levels in HF patients which eventually translates to better outcomes.

Medioresinol from Eucommiae cortex improves myocardial infarction-induced heart failure through activation of the PI3K/AKT/mTOR pathway: A network analysis and experimental study

OBJECTIVE

This study aims to systematically analyze the potential active components of Eucommiae cortex in the treatment of post- myocardial infarction heart failure through network analysis and molecular docking methods. In vitro experiments were conducted to verify that medioresinol, a component of Eucommiae cortex, improves oxygen-glucose deprivation-induced cell failure through its anti-inflammatory and antioxidant capacities.

METHODS

Potential active components of Eucommiae cortex were screened using specific data. The targets of these components were predicted using Swiss Institute of Bioinformatics database and TargetNet, and key targets were identified by intersecting with the disease targets of myocardial infarction and heart failure. Protein-Protein Interaction analysis was performed on the key targets to screen for core targets. Genomics Institute of the Novartis Research Foundation and Human Protein Atlas were used to identify myocardial highly expressed targets. Kyoto Encyclopedia of Genes and Genomes and Gene Ontology enrichment analyses were conducted using the Database for Annotation, Visualization, and Integrated Discovery. Molecular docking was performed for the final components and target proteins. In vitro experiments were carried out using H9c2 cells subjected to oxygen and glucose deprivation conditions to validate the effects of the screened potential active components.

RESULTS

Network analysis revealed that Eucommiae cortex might exert its effects through the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR), hypoxia-inducible factor 1, and Janus kinase/signal transducer and activator of transcription pathways, which are crucial for myocardial contraction, vascular tone regulation, inflammatory response, and oxidative stress. Molecular docking indicated stable binding of the selected compounds to PI3K, AKT, and mTOR. Medioresinol was selected for further study and shown to significantly improve oxidative stress and inflammatory response in myocardial ischemia-hypoxia model cells by activating the PI3K/AKT/mTOR pathway.

CONCLUSION

This study confirms the role of the PI3K/AKT/mTOR pathway in the cardiovascular protective effects of Eucommiae cortex and provides evidence at the cellular level. Medioresinol demonstrated potential therapeutic effects on myocardial infarction induced heart failure by reducing oxidative stress and inflammatory responses. These findings offer a theoretical basis for the application of Eucommiae cortex in the treatment of heart failure and support the development of new therapeutic drugs for cardiovascular diseases. Future research should further validate these effects in animal models and explore the overall efficacy of Eucommiae cortex.

Associations between body fat anthropometric indices and mortality among individuals with metabolic syndrome

BACKGROUND

The distribution of body fat and metabolic health may contribute to the onset of metabolic syndrome (MetS), but the associations between body fat anthropometric indices (AIs) and mortality in individuals with MetS remain unclear.

METHODS

Participants aged 18 years or older with MetS were recruited from the NHANES 1999-2018. The body fat anthropometric indices included the a body shape index (ABSI), body roundness index (BRI), cardiometabolic index (CMI), visceral adiposity index (VAI), waist triglyceride index (WTI), lipid accumulation product (LAP), atherogenic index of plasma (AIP), and triglyceride‒glucose (TyG) index. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) criteria. Mortality data were obtained from the National Death Index through December 31, 2019.

RESULTS

Data were collected from 8,379 individuals with MetS, with a median follow-up of 8.5 years, of whom 1,698 died from all causes and 568 from the CCD. The random survival forest (RSF) analysis indicated that the ABSI had the strongest predictive power for both all-cause mortality and CCD mortality among the eight body fat AIs. After adjusting for multiple variables, the ABSI was found to be linearly and positively associated with all-cause and CCD mortality in individuals with MetS. Participants in the highest quartile of ABSI had an increased risk of all-cause (HR = 1.773 [1.419-2.215]) and CCD (HR = 1.735 [1.267-2.375]) mortality compared with those in the lowest quartile. Furthermore, the ABSI predicted areas under the curve (AUCs) of 0.735, 0.723, 0.718, and 0.725 for all-cause mortality at 3, 5, 10, and 15 years, respectively, and 0.774, 0.758, 0.725, and 0.715 for CCD mortality, respectively.

CONCLUSION

Among eight body fat AIs, the ABSI exhibited the strongest predictive power for mortality in individuals with MetS. Higher ABSI values significantly increased all-cause mortality and CCD mortality in participants with MetS.

Associations between metabolic overweight/obesity phenotypes and mortality risk among patients with chronic heart failure

Background

Metabolic disorders and overweight or obesity are highly prevalent and intricately linked in patients with chronic heart failure (CHF). However, it remains unclear whether there is an interactive effect between these conditions and the prognosis of heart failure, and whether such an interaction is influenced by stratification based on age and sex.

Methods

A total of 4,955 patients with CHF were enrolled in this study. Metabolic status was assessed according to the presence or absence of metabolic syndrome (MetS). BMI categories included normal weight and overweight or obesity (BMI < 24, ≥ 24 kg/m2). Patients were divided into four phenotypes according to their metabolic status and BMI: metabolically healthy with normal weight (MHNW), metabolically unhealthy with normal weight (MUNW), metabolically healthy with overweight or obesity (MHO), and metabolically unhealthy with overweight or obesity (MUO). The incidence of primary outcomes, including all-cause and cardiovascular (CV) death, was recorded.

Results

During a mean follow-up of 3.14 years, a total of 1,388 (28.0%) all-cause deaths and 815 (16.4%) CV deaths were documented. Compared to patients with the MHNW phenotype, those with the MUNW (adjusted hazard ratio [aHR], 1.66; 95% confidence interval [CI], 1.38-2.00) or MUO (aHR, 1.42 [95% CI, 1.24-1.63]) phenotypes had a greater risk of all-cause death, and those with the MHO phenotype (aHR, 0.61 [95% CI, 0.51-0.72]) had a lower risk of all-cause death. Moreover, the above phenomenon existed mainly among males and elderly females (aged ≥ 60 years). In nonelderly females (aged < 60 years), the detrimental effects of MetS were lower (aHR, 1.05 [95% CI, 0.63-1.75] among MUNW group and aHR, 0.52 [95% CI, 0.34-0.80] among MUO group), whereas the protective effects of having overweight or obesity persisted irrespective of metabolic status (aHR, 0.43 [95% CI, 0.26-0.69] among MHO group and aHR, 0.52 [95% CI, 0.34-0.80] among MUO group). Similar results were obtained in the Cox proportional risk analysis of the metabolic overweight/obesity phenotypes and CV death.

Conclusions

In male and elderly female patients with CHF, the detrimental effects of MetS outweighed the protective benefits of having overweight or obesity. Conversely, in nonelderly females, the protective effects of having overweight or obesity were significantly greater than the adverse impacts of MetS.

Relationship between body mass index and clinical events in patients with atrial fibrillation undergoing percutaneous coronary intervention

BACKGROUND

It is still unclear whether body mass index (BMI) affects bleeding and cardiovascular events in patients requiring oral anticoagulants (OAC) for atrial fibrillation (AF) and antiplatelet agents after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). The aim of this study was to evaluate the relationship between BMI and clinical events in patients who underwent PCI under OAC therapy for AF.

METHOD

This was a multicenter, observational cohort study conducted at 15 institutions in Japan. AF patients who underwent PCI with drug-eluting stents for CAD were retrospectively and prospectively included. Patients were divided into the Group 1 (BMI <21.3 kg/m2) and the Group 2 (BMI ≥21.3 kg/m2) according to the first-quartile value of BMI. The primary endpoint was net adverse clinical events (NACE), a composite of major adverse cardiovascular events (MACE) and major bleeding events within one year after index PCI procedure.

RESULTS

In the 720 patients, 180 patients (25.0%) had BMI value <21.3 kg/m2. While the rates of NACE and MACE were significantly higher in the Group 1 than the counterpart (21.1% vs. 11.9%, p = 0.003 and 17.2% vs. 8.9%, p = 0.004), that of major bleeding did not differ significantly between the 2 groups (5.6% vs. 4.3%, p = 0.54). The cumulative rate of NACE and MACE was significantly higher in the Group 1 than the Group 2 (both log-rank p = 0.002), although that of major bleeding events was equivalent between the 2 groups (log-rank p = 0.41). In multivariable Cox regression analyses, while BMI value <21.3 kg/m2 was not associated with major bleeding events, that cut-off value was an independent predictor for increased NACE and MACE.

CONCLUSIONS

Among the patients undergoing PCI for CAD and requiring OAC for AF, BMI value was a useful indicator to predict major adverse clinical events.

The association between joint Serum Neurofilament Light Chain and type 2 diabetes with all-cause and cardiovascular mortality in US adults: a longitudinal study of NHANES

BACKGROUND

In the past, there has been a clear conclusion regarding the sole impact of serum neurofilament light chain (sNfL) levels or type 2 diabetes mellitus (DM) on the risk of death. However, the combined effect of sNfL levels and type 2 DM on all-cause and cardiovascular mortality is still uncertain.

METHODS

This study was a prospective cohort study based on data from the National Health and Nutrition Examination Survey (NHANES). The sNfL levels were measured through immunological methods using blood samples collected during the survey. The diagnosis of diabetes was based on rigorous criteria, and participants' mortality data were followed up until December 31, 2019. Firstly, we separately examined the effects of sNfL and type 2 DM on all-cause and cardiovascular mortality, and finally studied the comprehensive impact of the combination of sNfL and type 2 DM on the risk of mortality. Cumulative Kaplan-Meier curves, multivariate logistic regression and sensitivity analysis were incorporated throughout the entire study.

RESULTS

Participants in the highest quartile of sNfL were observed. Multivariable COX regression model showed that increased sNfL levels and type 2 DM were respectively associated with an increased risk of all-cause and cardiovascular mortality. Furthermore, elevated sNfL levels were significantly associated with an increased risk of all-cause mortality and cardiovascular mortality after adjustment for confounding factors. When considering both elevated sNfL levels and type 2 DM, individuals had a significantly increased risk of mortality. Sensitivity analysis confirmed the robustness of the findings.

CONCLUSIONS

These results suggest that elevated levels of sNfL and type 2 DM are associated with an increased risk of all-cause and cardiovascular mortality, and that participants with increased sNfL levels associated with type 2 DM have higher all-cause mortality and cardiovascular mortality.

Clerodendranthus spicatus (Thunb.) Water Extracts Reduce Lipid Accumulation and Oxidative Stress in the Caenorhabditis elegans

Clerodendranthus spicatus (Thunb.) (Kidney tea) is a very distinctive ethnic herbal medicine in China. Its leaves are widely used as a healthy tea. Many previous studies have demonstrated its various longevity-promoting effects; however, the safety and specific health-promoting effects of Clerodendranthus spicatus (C. spicatus) as a dietary supplement remain unclear. In order to understand the effect of C. spicatus on the longevity of Caenorhabditis elegans (C. elegans), we evaluated its role in C. elegans; C. spicatus water extracts (CSw) were analyzed for the major components and the effects on C. elegans were investigated from physiological and biochemical to molecular levels; CSw contain significant phenolic components (primarily rosmarinic acid and eugenolinic acid) and flavonoids (primarily quercetin and isorhamnetin) and can increase the lifespan of C. elegans. Further investigations showed that CSw modulate stress resistance and lipid metabolism through influencing DAF-16/FoxO (DAF-16), Heat shock factor 1 (HSF-1), and Nuclear Hormone Receptor-49 (NHR-49) signalling pathways; CSw can improve the antioxidant and hypolipidemic activity of C. elegans and prolong the lifespan of C. elegans (with the best effect at low concentrations). Therefore, the recommended daily use of C. spicatus should be considered when consuming it as a healthy tea on a daily basis.

Anti-obesity medications in the management of heart failure with preserved ejection fraction: available evidence and next STEPS

Obesity is associated with an increased risk of incident heart failure with preserved ejection fraction (HFpEF) and, among patients with existing heart failure, is associated with worse quality of life, higher symptom burden, and more HF hospitalizations. Anti-obesity medication (AOM) semaglutide has been shown to be efficacious at both causing intentional weight loss and improving HF symptom burden, with some evidence to suggest that HF clinical events may also be reduced. Additional ongoing trials of AOM in patients with cardiovascular disease, including HFpEF, will further improve insight into the potential role of managing obesity to improve HF status among patients with HFpEF and obesity.

Anti-Obesity Medications in Patients With Heart Failure: Current Evidence and Practical Guidance

Obesity is a significant risk factor for heart failure (HF) development, particularly HF with preserved ejection fraction and as a result, many patients with HF also have obesity. There is growing clinical interest in optimizing strategies for the management of obesity in patients with HF across the spectrums of both ejection fraction and disease severity. The emergence of anti-obesity medications with cardiovascular outcomes benefits, principally glucagon-like peptide-1 receptor agonists, has made it possible to study the impact of anti-obesity medications for patients with baseline cardiovascular conditions, including HF. However, clinical trials data supporting the safety and efficacy of treating obesity in patients with HF is currently limited to patients with HF with preserved ejection fraction, but do confirm safety and weight loss efficacy in this patient population as well as improvements in HF functional status, biomarkers of inflammation and HF stability. Here, we review the current data available surrounding the management of obesity for patients with HF, including the limitations of this evidence and ongoing areas for investigation, summarize the next phase of emerging anti-obesity medications and provide practical clinical advice for the multidisciplinary management of patients with both HF and obesity.

Intentional weight loss in overweight and obese patients with heart failure: A systematic review

AIMS

Approximately 30-49% of heart failure (HF) patients are living with obesity. The recommended body mass index (BMI) for the general population is 18.5-24.9 kg/m2. The obesity paradox suggests that HF patients with obesity (HFpwO) have a better prognosis compared to normal BMI. Guideline recommendations on ideal BMI for HFpwO are limited. This systematic review aims to examine the evidence base for intentional weight loss in HFpwO on the following parameters: mortality, hospitalization, symptoms, quality of life (QOL), effects on left ventricular ejection fraction (LVEF) and adverse events.

METHODS AND RESULTS

A total of 22 studies were identified: lifestyle intervention (n = 9), pharmacotherapy (n = 3), bariatric surgery (n = 10). Mortality and hospitalization, symptoms, QOL, and LVEF were reported in 8, 15 and 14 studies, respectively. All studies had moderate to high risk of bias except one randomized controlled trial (RCT) which evaluated semaglutide in HF with preserved ejection fraction (HFpEF) patients. Semaglutide resulted in weight loss with improvement in QOL. Lifestyle intervention led to weight loss, minimal adverse events, and improvement in symptoms in both HF with reduced ejection fraction (HFrEF) and HFpEF patients. In six observational studies, bariatric surgery in HFrEF patients achieved weight loss and improvement in LVEF safely in most patients but some patients developed worsening HF perioperatively.

CONCLUSION

There is a need for high-quality adequately powered RCTs on intentional weight loss in HFpwO with survival and hospitalization outcomes. All forms of weight loss intervention studied in this review were likely to result in significant weight loss, improved symptoms and QOL. Careful monitoring is required due to an increase in certain adverse events. [Correction added on 11 September 2024, after first online publication: The sub-headings 'Aims', 'Methods and results' and 'Conclusion' have been added in this version.].