Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association

Home-based heat therapy lowers blood pressure and improves endothelial function in older adults

Advancing age is associated with vascular dysfunction and hypertension, both of which increase cardiovascular event risk. Heat therapy has emerged as a novel intervention to improve cardiovascular health in various populations. Therefore, we tested the hypothesis that home-based lower body heat therapy would reduce blood pressure and improve endothelium-dependent vasodilation in older adults. Ambulatory blood pressure monitoring was performed in 19 older adults (67 ± 7 yr) before and after 8 wk of a sham intervention or heat therapy. Endothelium-dependent vasodilation of the superficial femoral artery was assessed via flow-mediated dilation. Participants were provided with a pair of tube-lined pants connected to a portable water circulator to perform the home-based sessions. Water temperature was set to 31°C for sham and 51°C for heat therapy, resulting in target skin temperatures of ∼33°C and ∼40°C, respectively. Participants were instructed to wear the pants 4 days/wk for 60 min each session. Adherence was 100% for both groups. Heat therapy reduced ambulatory daytime systolic blood pressure by Δ -5 ± 8 mmHg, but was unchanged for the sham group (Δ 1 ± 6 mmHg; P = 0.04). Likewise, heat therapy increased flow-mediated dilation (P = 0.02), whereas there was no change across time for the sham group (P = 0.5). These results combined with a strong adherence rate suggest that home-based lower body heat therapy could be an alternative nonpharmacological intervention to reduce blood pressure and improve vascular function, ultimately reducing long-term cardiovascular event risk in older adults.NEW & NOTEWORTHY Advancing age is associated with vascular dysfunction and hypertension, both of which increase cardiovascular event risk. This study determined that 8 wk of home-based lower body heat therapy reduced ambulatory daytime systolic blood pressure and increased flow-mediated dilation of the superficial femoral artery, outcomes not observed in the sham group. These improvements, coupled with 100% adherence among participants, suggest that home-based heat therapy is a pragmatic and effective strategy for improving cardiovascular health in older adults.

Epigenomics and transcriptomics association study of blood pressure and incident diagnosis of hypertension in twins

Hypertension is the most frequent health-related condition worldwide and is a primary risk factor for renal and cardiovascular diseases. However, the underlying molecular mechanisms are still poorly understood. To uncover these mechanisms, multi-omics studies have significant potential, but such studies are challenged by genetic and environmental confounding - an issue that can be effectively reduced by studying intra-pair differences in twins. Here, we coupled data on hypertension diagnoses from the nationwide Danish Patient Registry to a study population of 740 twins for whom genome-wide DNA methylation and gene expression data were available together with measurements of systolic and diastolic blood pressure. We investigated five phenotypes: incident hypertension cases, systolic blood pressure, diastolic blood pressure, hypertension (140/90 mmHg), and hypertension (130/80 mmHg). Statistical analyses were performed using Cox (incident cases) or linear (remaining) regression analyses at both the individual-level and twin pair-level. Significant genes (p < 0.05) at both levels and in both types of biological data were investigated by bioinformatic analyses, including gene set enrichment analysis and interaction network analysis. Overall, most of the identified pathways related to the immune system, particularly inflammation, and biology of vascular smooth muscle cell. Of specific genes, lysine methyltransferase 2 A (KMT2A) was found to be central for incident hypertension, ataxia-telangiectasia mutated (ATM) for systolic blood pressure, and beta-actin (ACTB) for diastolic blood pressure. Noteworthy, lysine methyltransferase 2A (KMT2A) was also identified in the systolic and diastolic blood pressure analyses. Here, we present novel biomarkers for hypertension. This study design is surprisingly rare in the field of hypertension. We identified biological pathways related to vascular smooth muscle cells and the immune system, particular inflammation, to be associated with hypertension and blood pressure. Of specific genes, we identified KMT2A (lysine methyltransferase 2A) to be central for blood pressure and hypertension development. ACTB beta-actin, ATM ataxiatelangiectasia mutated, BP blood pressure, EWAS epigenome-wide association studies, KMT2A lysine methyltransferase 2A, LMER linear mixed effect regression, LR linear regression, TWAS transcriptome-wide association studies.

A Microfluidics-Based Multiplex SERS Immunoassay Device for Analysis of Acute Ischemic Stroke Biomarkers

Sensitive and accurate methods for early detection of acute ischemic stroke (AIS) are essential for timely treatment and prognostic assessment of patients. In this study, we report a microfluidics-based ultrasensitive surface-enhanced Raman scattering (SERS) immunoassay device for the quantitative determination of multiplex biomarkers in AIS. By preparing 5,5'-dithiobis-2-nitrobenzoic acid (DTNB) antibody-modified gold nanoparticles (AuNPs) on SERS devices as SERS probes, the biomarkers in whole blood of AIS were accurately captured and further visualized for SERS signal intensity quantitative analysis of six biomarkers in the blood samples. It is worth mentioning that the limit of detection (LOD) of the method can reach the level of fg/mL, with excellent sensitivity and selectivity. Meanwhile, the analytical comparison with ELISA method showed that the detection results of both methods were consistent, which verified the feasibility of the assembled device. The SERS immunoassay device detection provides a powerful strategy for the prediction, early diagnosis and dynamic monitoring of prognosis of AIS with a wide range of clinical practice prospects.

The Influence of Metabolic and Bariatric Surgery on Cardiovascular Health in Women: A Comprehensive Study

BACKGROUND

Cardiovascular disease (CVD) is the main cause of death in patients with obesity. Bariatric surgery has been shown to promote substantial reduction in carotid intima-media thickness (C-IMT).

AIM

To comprehensively determine the influence of metabolic and bariatric surgery (MBS) on cardiovascular health in women.

METHODS

A total of 24 female patients with a body mass index (BMI) > 35 kg/m2 underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one anastomosis gastric bypass (OAGB), a prospective cohort study in women. C-IMT were evaluated at baseline and 24 months post-MBS.

RESULTS

The results showed a significant reduction in BMI, weight, and C-IMT on the right side 24 months post-MBS (p < 0.001 for BMI and weight and p = 0.004 for C-IMT). There were also significant differences in fasting blood sugar (FBS), triglycerides (TG), total cholesterol, and low-density lipoprotein (LDL) levels. However, high-density lipoprotein (HDL) levels did not show a significant change.

CONCLUSION

The study underscores the potential of MBS in mitigating cardiovascular risk among women with obesity. However, further research is needed to fully understand the impact of MBS on various parameters. The findings highlight the importance of personalized and gender-specific approaches in the management of obesity and related disease.

Prevalence and clustering of modifiable cardiovascular disease risk factors among elderly adults in Yuexiu district, Guangzhou City, China: a cross sectional study

BACKGROUND

Cardiovascular disease has a high prevalence and mortality rate, which are mainly due to the aging population and the high prevalence and clustering of modifiable cardiovascular risk factors (CRFs); however, studies on the aging Chinese population are limited. The study aimed to investigate the prevalence and clustering of CRFs among the elderly population to provide evidence for the overall planning of medical resources and disease management.

METHODS

In this cross-sectional study, 41,517 participants aged ≥ 65 years were recruited from January 2020 to April 2021 in the Yuexiu district, Guangzhou city, China. Sociodemographic and health examination data were collected.

RESULTS

Among the 41,517 participants, 42.2% were male. The prevalence rates of hypertension, diabetes, dyslipidemia, overweight/obesity, and smoking were 87.1%, 33.3%, 47.6%, 45.5%, and 7.6%, respectively. Participants with ≥ 1, ≥2, and ≥ 3 CFRs accounted for 96.3%, 75.0%, and 38.7% of the study population, respectively. After adjusting for sex, education level, marital status, and physical activity level, older age and drinking were independent risk factors for CRF clustering.

CONCLUSIONS

Excluding smoking, there is a high prevalence of CRFs in the elderly population of Southern China, especially hypertension. In addition, the clustering of CRFs was high. In the future, a healthy lifestyle should be promoted in the elderly, and the prevention and management of CRFs should be optimized according to the prevalence and cluster characteristics.

An update on the role and mechanisms of periodontitis in cardiovascular diseases

Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Despite extensive studies into the causes and therapies for CVDs, their incidence and prevalence continue to increase. Periodontitis is a multifactorial, chronic inflammatory disease related to systemic health. Current research suggests that periodontitis may be an unconventional risk factor for CVDs and it may increase the risk of CVDs such as atherosclerosis, coronary heart disease, myocardial infarction, hypertension, heart failure as well as cardiomyopathy. For all these reasons, it is quite plausible that prevention of periodontitis has an impact on the onset or progression of CVDs. Therefore, in this review, we investigated the association between periodontitis caused by oral microorganisms and different CVDs. In addition, we discuss the various mechanisms by which periodontitis contributes to the onset and progression of CVDs. Our review aims to raise global awareness of periodontitis, particularly its role in CVDs, provide a basis for the prevention and treatment of CVDs and offer potential therapeutic targets.

Sensing the Future of Thrombosis Management: Integrating Vessel-on-a-Chip Models, Advanced Biosensors, and AI-Driven Digital Twins

Thrombotic events, such as strokes and deep vein thrombosis, remain a significant global health burden, with traditional diagnostic methods often failing to capture the complex, patient-specific nuances of thrombosis risk. This Perspective explores the revolutionary potential of microengineered vessel-on-chip platforms in thrombosis research and personalized medicine. We discuss the evolution from basic microfluidic channels to advanced 3D-printed, patient-specific models that accurately replicate complex vascular geometries, incorporating all elements of Virchow's triad. Integrating these platforms with cutting-edge sensing technologies, including wearable ultrasonic devices and electrochemical biosensors, enables real-time monitoring of thrombosis-related parameters. Crucially, we highlight the transformative role of artificial intelligence and digital twin technology in leveraging vast patient-specific data collected from these models. This integration allows for the development of predictive algorithms and personalized digital twins, offering unprecedented thrombosis risk assessment, treatment optimization, and drug screening capabilities. The clinical relevance and validation of these models are examined, showcasing their potential to predict thrombotic events and guide personalized treatment strategies. While challenges in scalability, standardization, and regulatory approval persist, the convergence of vessel-on-chip platforms, advanced sensing, and AI-driven digital twins promises to revolutionize thrombosis management. This approach paves the way for a new era of precision cardiovascular care, offering noninvasive, predictive, and personalized strategies for thrombosis prevention and treatment, ultimately improving patient outcomes and reducing the global burden of cardiovascular diseases.

Association between remnant cholesterol and arterial stiffness: Evidence from NHANES 1999-2018

BACKGROUND AND AIM

Remnant cholesterol (RC), an emerging cardiovascular risk factor, has garnered increasing attention in atherosclerotic cardiovascular disease (ASCVD) research, though its relationship with arterial stiffness remains incompletely understood. This study investigated the association between RC and estimated pulse wave velocity (ePWV), a reliable marker of arterial stiffness, with the goal of enhancing our understanding of RC's role in cardiovascular risk assessment.

METHODS AND RESULTS

This study utilized the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018, including 12,505 participants aged 20 years and above. Weighted linear regression, restricted cubic splines (RCS), and subgroup analyses were used to explore the association between RC levels and ePWV. Analysis revealed a significant positive association between RC levels and ePWV, with participants in the highest RC quintile (Q5) exhibiting substantially elevated ePWV compared to those in the lowest quintile (Q1). Notably, RCS analysis demonstrated a non-linear relationship characterized by a saturation effect (p-nonlinear <0.05). Subgroup analyses indicated stronger associations among specific demographic groups, including individuals under 40 years, females, non-Hispanic whites, and those above the poverty level (all interaction p < 0.05). Furthermore, mediation analysis found that various inflammatory markers such as neutrophil count (NEU), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR) played a mediating role in this association.

CONCLUSION

Increased arterial stiffness is associated with higher RC levels, demonstrating a saturation effect at elevated concentrations. This association is partially mediated by NLR, MLR, and NEU, and was stronger among younger, females, non-Hispanic whites, and non-impoverished individuals.

Fish consumption is inversely associated with stroke in Korean adults: the Korea National Health and Nutrition Examination Survey, 2013 to 2021

There is growing evidence supporting a potential role of fish consumption in relation to stroke risk. Several studies have examined the association between fish consumption and stroke risk in various populations, but none have been conducted in Koreans. We hypothesized that there may also be an inverse association between fish consumption and stroke risk in Korean adults. Therefore, we conducted a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey, 2013 to 2021. A total of 30,143 adults aged 19 to 64 years were included in the analysis. Fish consumption was assessed using a 24-hour dietary recall, and the subjects were categorized into four groups based on their total fish consumption (0, 0≤ to <1/2, 1/2≤ to <1, ≥1 serving/d). Stroke status was assessed using questionnaires. Multivariable logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for physician-diagnosed stroke. After adjusting for covariates, high fish consumption was associated with 46% lower odds of stroke in Korean adults compared with no fish consumption (OR 0.54; 95% CI, 0.31-0.94, P for trend = .041). A similar inverse association was found in male adults (OR 0.47; 95% CI, 0.23-0.97, P for trend = .042), and an inverse association between moderate fish consumption and stroke risk was found in female adults (OR 0.22; 95% CI, 0.06-0.78). Our findings suggest that high fish consumption is associated with lower odds of stroke in Korean adults, particularly in men, and moderate fish consumption was associated with lower odds of stroke in women.

Glucagon-like peptide 1 receptor agonists and cancer risk: advancing precision medicine through mechanistic understanding and clinical evidence

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as a primary first-line treatment for type 2 diabetes. This has raised concerns about their impact on cancer risk, spurring extensive research. This review systematically examines the varied effects of GLP-1RAs on the risk of different types of tumors, including overall cancer risk and specific cancers such as thyroid, pancreatic, reproductive system, liver, and colorectal cancers. The potential biological mechanisms underlying their influence on cancer risk are complex, involving metabolic regulation, direct antitumor effects, immune modulation, and epigenetic changes. A systematic comparison with other antidiabetic agents reveals notable differences in their influence on cancer risk across drug classes. Additionally, critical factors that shape the relationship between GLP-1RAs and cancer risk are thoroughly analyzed, including patient demographics, comorbidities, treatment regimens, and lifestyle factors, offering essential insights for developing individualized treatment protocols. Despite significant research progress, critical gaps remain. Future research should prioritize elucidating the molecular mechanisms behind the antitumor effects, refining individualized treatment strategies, investigating early tumor prevention applications, assessing potential benefits for non-diabetic populations, advancing the development of novel therapies, establishing robust safety monitoring frameworks, and building precision medicine decision-making platforms. These efforts aim to establish novel roles for GLP-1RAs in cancer prevention. and treatment, thereby advancing the progress of precision medicine.

Association of Extracoronary Calcification and Incident Heart Failure in the Multiethnic Study of Atherosclerosis (MESA)

BACKGROUND

Extracoronary calcification (ECC) is a prevalent cardiovascular risk factor.

OBJECTIVES

The aim of this study was to examine the association between ECC and heart failure (HF), including heart failure with preserved ejection fraction (HFpEF).

METHODS

MESA (Multi-Ethnic Study of Atherosclerosis) participants with computed tomographic imaging at baseline for calcification of the aortic valve, aortic root, mitral valve, and thoracic aorta were included. ECC score was calculated by rescaling Agatston scores from 0 to 1 for each ECC site and summing the rescaled scores. Multivariable Cox proportional hazards regression was performed to examine the association between ECC quartiles and incident HF.

RESULTS

Of all MESA participants, 3,617 (53.1%) and 3,192 (46.9%) had ECC scores of 0 and >0, respectively. During a mean follow-up period of 12.9 ± 4.2 years, 358 HF events were observed, 179 HF with reduced ejection fraction and 135 HFpEF. After controlling for demographics and risk factors, the highest ECC quartile (compared with the lowest quartile) had 1.7-fold greater hazard of incident HF (adjusted HR: 1.72 [95% CI: 1.16-2.55]; P = 0.007), though this was attenuated to borderline significance after additional adjustment for coronary artery calcification. In contrast for HFpEF, the highest ECC quartile (compared with the lowest quartile) remained independently and statistically significantly associated with 3-fold greater hazard of incident HFpEF (adjusted HR: 3.09 [95% CI: 1.45-6.60]; P = 0.003) after full adjustment, including for coronary artery calcification.

CONCLUSIONS

ECC is associated with increased risk for HF, in particular HFpEF. If this finding is confirmed in other studies, ECC could help improve traditional risk factor estimation and clinical risk assessments for HF and HFpEF.

Convergence of COVID-19 and recurrent stroke: In-hospital mortality risks explored

This editorial comments on the article by Desai et al, which investigates the impact of coronavirus disease 2019 (COVID-19) on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample. The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients, particularly among middle-aged individuals, males, and ethnic minorities. This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups. The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.

The Role of Cardiac Magnetic Resonance in Characterizing Atrial Cardiomyopathy and Guiding Substrate Ablation in Atrial Fibrillation: A Narrative Review

Cardiac magnetic resonance imaging (MRI) is increasingly recognized as a promising tool for tissue characterization in atrial fibrillation (AF), providing detailed insights into anatomy, fibrosis, and scarring. While MRI cannot directly guide ablation lesions, its ability to identify arrhythmogenic substrates could improve patient stratification and procedural planning. Despite these theoretical advantages, the clinical utility of MRI in guiding substrate-based ablation strategies remains a matter of debate. Methods: Our review evaluates the current evidence supporting the integration of MRI into the workflow of AF ablation. Specifically, we examine findings from randomized trials and prospective studies that have investigated the predictive value of MRI-derived fibrosis quantification for procedural outcomes and arrhythmia recurrence. We aim to assess whether MRI can enhance the personalization of ablation strategies and predict treatment success. Challenges such as variability in imaging protocols, lack of standardization in fibrosis quantification, and limited large-scale validation are also addressed. This review provides a comprehensive overview of the current status and potential of MRI in the evolving field of AF ablation.

Genetic and pharmacological targeting of Snail inhibits atherosclerosis by relieving intraplaque endothelium dysfunction and associated inflammation

The intraplaque endothelium dysfunction and associated inflammation contribute to the progression of atherosclerosis. We previously show that zinc-finger transcription factor Snail is predominantly expressed in embryonic vascular endothelial cells (ECs), and deletion of Snail in ECs induces severe defects in vascular development and thus causes embryonic lethality. Snail is essentially absent at postnatal stage, and inducible deletion of Snail in ECs has no impact on physiological angiogenesis in postnatally developing or adult mice. In this study we investigated whether Snail was reactivated in vascular ECs during pathologically angiogenic process (e.g. the formation of atherosclerotic plaque) or could play a functional role in atherosclerosis progression. We showed that the expression levels of Snail were significantly elevated in ECs of human and mouse atherosclerotic plaques, and associated with the disease severity. In the accelerated and canonical mouse models of atherosclerosis, tamoxifen-inducible, EC-specific Snail deletion significantly reduced intraplaque endothelial dysfunction, inflammation and lipid uptake accompanied by enhanced plaque stability. By conducting scRNA-sequencing in ECs of ApoE-/-SnailiΔEC versus ApoE-/-Snailfl/fl arterial vessels, we demonstrated that Snail deletion significantly decreased histone acetylation on Ccl5 and Cxcl10 promoters, thereby decreased CCL5/CXCL10-driven vascular damage and inflammation. Administration with recombinant CXCL10 protein (2 μg/kg, i.v., once per week for three weeks) efficiently restored atherosclerosis in EC-specific Snail-deleted mice. Finally, we developed an orally bioavailable small-molecule Snail inhibitor LFW273 that displayed potent anti-atherosclerotic effects in mice. These results reveal Snail as a promising therapeutic target in atherosclerotic disease.

External validation of the HEART, HEAR, and HET scores for prediction of major adverse cardiac events in adult patients with acute chest pain

BACKGROUND AND IMPORTANCE

In the cohort of patients presenting to the emergency department (ED) with acute chest pain differentiating between those at high risk of major adverse cardiac event (MACE), and those who can safely be discharged, remains a challenge. The history, ECG, age, risk factors, troponin (HEART) score, as well as several abridged versions [history, ECG, age, risk factors (HEAR), history, ECG, troponin (HET)]. are commonly used for this purpose. As with many clinical risk scores, they might be useful, but often lack proper validation. We aimed to externally validate the HEART, HEAR, and HET scores in the setting of a high-volume tertiary care ED in a healthcare system without gatekeeping functions and thus a low-risk population. We further aimed to compare the prognostic performance (discrimination and calibration) of the scores to each other.

DESIGN

External validation study.

SETTINGS AND PARTICIPANTS

On the basis of a-priori sample size calculations, we prospectively included consecutive adult patients presenting to the ED with acute chest pain.

OUTCOME MEASURES AND ANALYSIS

We assessed overall model performance, discrimination, and calibration of all scores, analyzed reclassification from the HEART score and performed decision curve analysis.

MAIN RESULTS

A total of 3273 patients were included, 383 (12%) suffered MACE within 30 days. Classification differed significantly between scores (HEART: 810; 25% low risk; HET: 55; 2%; HEAR: 195; 6%), as did overall performance (area under the curve: 0.85, 0.80, and 0.79, respectively; P < 0.001). HEART score misclassified 7/810 patients (0.9%; 95% confidence interval: 0.4-1.8%) with MACE as low risk, HET 2/55 (3.6%, 0.9-13.8%), and HEAR 0/195, whereas 2087 (72%), 2837 (98%), and 2695 (93%) patients without MACE were erroneously not classified as low risk.

CONCLUSION

The abridged scores fell short of their results in derivation studies, identifying only very few low-risk patients, and showing inferior model performance compared with the original HEART score. Instead of developing new scores, existing scores should be recalibrated to local population characteristics, as needed.

Natural flavonoids from herbs and nutraceuticals as ferroptosis inhibitors in central nervous system diseases: current preclinical evidence and future perspectives

Flavonoids are a class of important polyphenolic compounds, renowned for their antioxidant properties. However, recent studies have uncovered an additional function of these natural flavonoids: their ability to inhibit ferroptosis. Ferroptosis is a key mechanism driving cell death in central nervous system (CNS) diseases, including both acute injuries and chronic neurodegenerative disorders, characterized by iron overload-induced lipid peroxidation and dysfunction of the antioxidant defense system. This review discusses the therapeutic potential of natural flavonoids from herbs and nutraceuticals as ferroptosis inhibitors in CNS diseases, focusing on their molecular mechanisms, summarizing findings from preclinical animal models, and providing insights for clinical translation. We specifically highlight natural flavonoids such as Baicalin, Baicalein, Chrysin, Vitexin, Galangin, Quercetin, Isoquercetin, Eriodictyol, Proanthocyanidin, (-)-epigallocatechin-3-gallate, Dihydromyricetin, Soybean Isoflavones, Calycosin, Icariside II, and Safflower Yellow, which have shown promising results in animal models of acute CNS injuries, including ischemic stroke, cerebral ischemia-reperfusion injury, intracerebral hemorrhage, subarachnoid hemorrhage, traumatic brain injury, and spinal cord injury. Among these, Baicalin and its precursor Baicalein stand out due to extensive research and favorable outcomes in acute injury models. Mechanistically, these flavonoids not only regulate the Nrf2/ARE pathway and activate GPX4/GSH-related antioxidant pathways but also modulate iron metabolism proteins, thereby alleviating iron overload and inhibiting ferroptosis. While flavonoids show promise as ferroptosis inhibitors for CNS diseases, especially in acute injury settings, further studies are needed to evaluate their efficacy, safety, pharmacokinetics, and blood-brain barrier penetration for clinical application.

Sex difference in genetic risk in the prevalence of atrial fibrillation

BACKGROUND

Early detection and management of atrial fibrillation (AF) are crucial. Combined models incorporating genetic risks and clinical risks have been developed to improve predictive ability. Although sex differences have been reported in many aspects of AF, sex differences in genetic risk have not been studied.

OBJECTIVE

The purpose of this study was to assess the sex difference in the effect of polygenic risk score for AF (AF-PRS) on AF prevalence using cross-sectional data from the Tohoku Medical Megabank Project Community-Based Cohort Study in Japan.

METHODS

AF-PRS and Cohorts for Heart and Aging Research in Genomic Epidemiology Atrial Fibrillation (CHARGE-AF) score were used for genetic AF risks and clinical AF risks, respectively. Sex differences in the association of AF-PRS with the prevalence of AF were evaluated.

RESULTS

Among 16,853 participants (mean age 63.4 years; 5182, 30.7% men), the prevalence of AF was 255 (4.9%) in men and 130 (1.1%) in women. In the group with high AF-PRS and high CHARGE-AF score, the odds ratio for AF was highest in men and women (8.2 in men and 9.4 in women), compared with that in the group with low AF-PRS and low CHARGE-AF score. Integrating AF-PRS into the CHARGE-AF score significantly enhanced the area under the receiver operating characteristic curve for AF in men (from 0.639 to 0.749) but not in women (from 0.710 to 0.733).

CONCLUSION

Our study is the first to show a sex difference in the association of AF-PRS and AF prevalence. AF-PRS is more closely associated with the prevalence of AF in men than in women.

The effects of wine consumption and lipid profile: A systematic review and meta-analysis of clinical trials

BACKGROUND AND OBJECTIVE

The aim of this study was to analyze the effects of wine consumption on the lipid profile, distinguishing between triglycerides, total cholesterol, LDL, HDL and fibrinogen.

METHODS

We examined the MEDLINE (via PubMed), Scopus, Cochrane, and Web of Science databases to conduct this systematic review and meta-analysis. PROSPERO has already recorded this study under registration number CRD42023396666.

RESULTS

Thirty-three studies were included in this systematic review, and 29 were included in the meta-analysis. The pooled ES for the effect of red wine consumption on the different lipid profile parameters was significant only for the effect of red wine on the LDL parameter in the prepost studies (-0.29 (95% CI -0.54, -0.05)). The pooled ES for the effect of white wine in prepost studies and clinical trials for the effect of wine consumption on the different parameters did not show any significant results.

CONCLUSION

This systematic review and meta-analysis revealed that wine consumption has an effect on reducing LDL and has no effect on total cholesterol, HDL, triglycerides, or fibrinogen. This research revealed that the duration of the intervention affects triglyceride and total cholesterol levels, indicating that longer interventions are more effective for these two parameters.

REGISTRATION ID

CRD42023396666 (PROSPERO). URL REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=396666.

Profiling X chromosome genes expression relevant to sex dimorphism in stroke: insights from transcriptomics landscape analysis

Introduction

Although age is the most important non-modifiable risk factor for cerebral stroke, it is also apparent that females commonly exhibit longer lifespan and better outcome after stroke compared to the age-matched males. A critical event after stroke is the peripheral infiltration of immune cells across damaged blood-brain barrier, which induces inflammatory and immune responses within the brain parenchyma and consequently worsen brain injury. These events are also dependent on age and display a sex different pattern. Theoretically, X chromosome-encoded differential expression genes (DEGs) may explain differences between the sexes. However, the expression and regulation of these DEGs after stroke have not been studied in detail.

Methods

We conducted three datasets of human blood cells, mice brain, mice microglia and T cells that were previously published, and analyzed the contribution of gender, age and stroke insult on the X chromosome-encoded DEGs.

Results

The main findings were (i) compared to age, the stroke/hypoxia was a more potent factor in eliciting the DEGs. Particularly, older stroke patients exhibited more changes compared to young stroke group. (ii) After a stroke, the DEGs was diversely influenced by sex, age and cell types being studied. Particularly, either aging or gender led to more striking changes in brain-infiltrating T cells than in the resident immune cells.

Discussion

These findings highlight the complex interplay between sex, age, and immune responses in mediating stroke incidence and outcome. Investigation of the identified X chromosome-encoded genes in brain-infiltrating T cells deserves high priority, as they may play more important roles in explaining gender-related differences in stroke and brain injury.

Relationships Matter: Exploring the Impact of Patients' Familial, Community, and Provider Relationships on Hypertension Management

BACKGROUND

Nearly half of US adults have hypertension, with blood pressure (BP) uncontrolled in over two-thirds of cases. Significant disparities exist in BP control, particularly for Southern and rural-dwelling Americans.

OBJECTIVE

To examine the impact of patients' relationships with families, communities, and providers on BP control efforts.

DESIGN

Semi-structured interviews explored patient and provider experiences managing hypertension and controlling BP.

PARTICIPANTS

Twenty-nine providers and 25 patients with hypertension were recruited from 13 high- and low-performing primary care clinics (assessed via hypertension control rates) and one cardiology clinic across two health systems in North Carolina and Kansas.

APPROACH

A health equity framework-shaped interview guide and codebook development. Inductive and deductive coding methodologies were employed, with thematic analysis used to organize emergent themes.

KEY RESULTS

Patients frequently discussed the prevalence of hypertension within their families, with some detailing feelings of inevitability and/or linking their cardiovascular outcomes to family histories. Cultural expectations were often mentioned, with families' and communities' normative behaviors sometimes creating barriers to hypertension management. Southern and/or rural culture (e.g., diet) may pose unique challenges, as some providers cited patients' resistance to deviate from regional norms. The importance of tailoring hypertension care to patients' unique circumstances was often cited and linked with increased trust and patient activation, with the utilization of culturally appropriate, patient-facing resources being identified as a best practice. While providers in high-performing clinics more consistently discussed approaches to tailoring care and using culturally appropriate materials, providers in low-performing clinics more often referenced time constraints limiting personalized care and having non-inclusive resources.

CONCLUSION

Effective hypertension management may be impacted by patients' relationships, both external (e.g., family, community) and internal (e.g., providers) to healthcare. Future research should explore strategies for tailoring culturally appropriate hypertension care to patients, specifically identifying ways to overcome structural barriers that can hinder clinics' utilization.

Comparison of Cryoballoon and Ablation Index-Guided Radiofrequency Ablation in Paroxysmal Atrial Fibrillation

Background: Atrial fibrillation is the most common sustained arrhythmia worldwide. Pulmonary vein isolation (PVI) is the most effective catheter ablation technique for treating paroxysmal atrial fibrillation (pAF). Common ablation methods include point-by-point radiofrequency (RF) ablation and single-shot techniques such as cryoballoon ablation (CB). This single-center, prospective study aimed to compare the efficacy of ablation index-guided RF ablation (AI-RF) and CB in patients with symptomatic, antiarrhythmic-resistant pAF. Methods: A total of 154 patients undergoing initial PVI were divided into two groups (CB: 51, AI-RF: 103), based on the operators' decision. Procedural data (total procedure time, fluoroscopy time, radiation dose, complication rate) and recurrence rates were analyzed over a 12-month follow-up period. Results: The CB group had a significantly shorter total procedure time compared to the AI-RF group (64 [57; 74.8] minutes vs. 92 [76; 119] minutes; p < 0.001). However, the CB group experienced higher fluoroscopy times (559 [395; 868] seconds vs. 167 [126; 224] seconds; p < 0.001) and a greater fluoroscopy dose (21.8 [11.7; 40.1] mGy vs. 7.65 [5.21; 14.5] mGy; p < 0.001). Recurrence rates were similar during both the blanking period (11.7% vs. 10.7%; p = 0.84) and the 12-month follow-up period (22.7% vs. 13.4%; p = 0.22). No major complications were reported during this study. Conclusions: In this single-center study, there were no significant differences in long-term recurrence or complication rates between the CB and AI-RF groups for patients with antiarrhythmic-refractory, symptomatic pAF. While the CB group benefited from a significantly shorter procedure time, it required a higher fluoroscopy dose and a longer fluoroscopy time.

Clonal Hematopoiesis of Indeterminate Potential and Atrial Fibrillation: Insights into Pathophysiology and Clinical Implications

Clonal hematopoiesis of indeterminate potential (CHIP) has emerged as a novel risk factor for cardiovascular diseases. CHIP is characterized by the expansion of hematopoietic stem cell clones harboring somatic mutations in genes such as TET2, DNMT3A, and ASXL1, which are implicated in inflammation, atrial remodeling, and hypercoagulability. These mutations foster a pro-inflammatory and pro-thrombotic environment conducive to arrhythmogenesis, thereby linking CHIP to the development and progression of atrial fibrillation (AF). Mechanistic insights indicate that CHIP contributes to atrial fibrosis, disrupts calcium signaling, and exacerbates oxidative stress, all of which heighten susceptibility to AF. Clinical studies, including epidemiological and Mendelian randomization analyses, further support the association between CHIP and an increased risk of both incident and progressive AF, with specific mutations such as TET2 and ASXL1 identified as significant contributors. Additionally, CHIP has been linked to adverse outcomes in AF, including elevated rates of heart failure, thromboembolism, and mortality. Understanding CHIP's role in AF pathophysiology offers opportunities for the development of precision medicine approaches, providing novel avenues for early intervention and targeted AF treatment. This review synthesizes current mechanistic and clinical evidence on the role of CHIP in AF, emphasizes its potential as a biomarker for risk stratification, and explores emerging therapeutic strategies targeting CHIP-associated pathways.

Different antithrombotic strategies after left atrial appendage closure with the LACbes occluder: protocol of the DAAL trial

INTRODUCTION

The purpose of this study is to evaluate the safety and efficacy of two different antithrombotic strategies, dual antiplatelet therapy (DAPT, aspirin and ticagrelor) and direct oral anticoagulant (DOAC, rivaroxaban), after left atrial appendage closure (LAAC) using the LACbes occluder.

METHODS AND ANALYSIS

This study is a prospective, randomised, controlled and multicentre clinical trial that will compare the clinical efficacy of antiplatelet and anticoagulation therapy after LAAC with the LACbes occluder. It is planned to enrol 296 subjects with non-valvular atrial fibrillation (NVAF) who complete transcatheter closure of the left atrial appendage successfully. All subjects who pass the screening process and sign informed consent forms will be randomised in a 1:1 ratio to the DAPT group (aspirin 100 mg/day and ticagrelor 90 mg two times a day) or the DOAC group (rivaroxaban 15 mg/day). Baseline data within 24 hours after the operation and follow-up information at 3, 6 and 12 months will be recorded to investigate the difference in the incidence of device-related thrombosis, clinical thrombotic events, bleeding and other adverse events.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the Ethics Committee of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Approval number SH9H-2022-T426-1). The protocol (Version: V1, 20230105) has also been submitted and approved by the institutional ethics committee at each participating centre. Results are expected in 2025 and will be disseminated through peer-reviewed journals and presentations at national and international conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2100046712.

TRIAL REGISTRATION NAME

Different antithrombotic strategies after left atrial appendage closure with the LACbes occluder.

Flavonoid intake, inflammation, and atherosclerotic cardiovascular disease risk in U.S. adults: a cross-sectional study

BACKGROUND

This study aimed to investigate the relationship between the dietary intake of total flavonoids and their six subclasses and the risk of atherosclerotic cardiovascular disease (ASCVD) in adults, and to evaluate the potential mediating effect of inflammation in this association.

METHODS

Cross-sectional data from 3841 individuals participating in the National Health and Nutrition Examination Survey 2017-2018 were included in the analysis. Flavonoid intake was assessed using a 2-day dietary recall method, and ASCVD status was determined by extracting relevant information from the medical condition questionnaire. To determine the relationship between flavonoid intake and ASCVD risk, we employed logistic regression, subgroup, mediation, and restricted cubic spline analyses.

RESULTS

Intake of flavan-3-ols, flavones, flavonols, and total flavonoids was negatively correlated with ASCVD risk. Subgroup analysis revealed that the association between flavonoid intake and ASCVD risk exhibits sex-specific differences, with the relationship being more pronounced among women. The significant associations between increased flavonoid intake and reduced ASCVD risk were observed in smokers, non-alcohol consumers, physically inactive individuals, those with hypertension. A nonlinear relationship was observed between the intake of total flavonoids, flavan-3-ols and flavonols and ASCVD risk. Additionally, high-sensitivity C-reactive protein (hs-CRP) and the neutrophil-to-lymphocyte ratio (NLR), inflammatory markers relevant to ASCVD, were found to mediate the association between flavonoid intake and ASCVD risk. Flavonoids demonstrated a dose‒response relationship with reductions in the levels of hs-CRP and the NLR.

CONCLUSIONS

This study indicates the inverse association between flavonoid intake, particularly flavan-3-ols, flavones, and flavonols, and the risk of ASCVD. It highlights the mediating role of CRP and NLR in this relationship. Furthermore, the study emphasizes the importance of considering lifestyle factors and sex when evaluating the cardiovascular benefits of flavonoids.

Prediction of Recurrence of Atrial Fibrillation After Radiofrequency Ablation by Frailty

BACKGROUND

Previous studies have shown that frailty increases the risk of new-onset atrial fibrillation (AF). However, little is known about the association between frailty and the recurrence of AF after radiofrequency ablation. The objective of this study was to investigate the association between frailty and the recurrence in patients with AF who had undergone radiofrequency ablation.

METHODS AND RESULTS

A total of 450 patients >50 years of age with symptomatic drug-refractory AF who had undergone catheter ablation for the first time were retrospectively enrolled. Frailty status was evaluated by the 11-factor modified frailty index and 5-factor modified frailty index. Recurrence was defined as any documented atrial tachyarrhythmia lasting >30 seconds after a 3-month blanking period without any antiarrhythmic drugs during postablation follow-up. Patients in the frail group were older, and had a higher CHA2DS2-VASc score, HAS-BLED score, left atrial diameter, and a higher proportion of comorbidities than those in the nonfrail group. Circumferential pulmonary vein isolation was successfully done in all of the patients. During a median follow-up of 12 months, recurrence was recorded in 98 (21.8%) patients (paroxysmal AF, 20.6%; persistent AF, 23.2%). The Kaplan-Meier analysis showed that the survival rate of freedom from atrial tachyarrhythmias in the frail group was lower than that in nonfrail groups (log-rank P<0.001, 11-factor modified frailty index 31.3% versus 82.4%, 5-factor modified frailty index 44.9% versus 87.5%). After adjustment of additional risk factors in multivariable Cox analysis, 11-factor modified frailty index (hazard ratio [HR], 5.72 [95% CI, 3.79-8.64]; P<0.001) or 5-factor modified frailty index (HR, 5.62 [95% CI, 3.68-8.59]; P<0.001) was significantly associated with atrial tachyarrhythmia recurrence. The results remain significant in the subgroup analyses of different AF types, age groups, and sex. No significant differences of major complications were observed between the frail and nonfrail groups.

CONCLUSIONS

In patients with AF who had undergone catheter ablation, frail patients had around a 6-fold risk of recurrence as compared with the nonfrail patients. Frailty index may be a novel risk factor of recurrent AF.

Effectiveness of community-based intervention using PATCH on disease perception, empowerment, and self-care in hypertension: a community trial protocol

BACKGROUND

Hypertension plays a significant role in the global burden of cardiovascular diseases. The planned approach to community health (PATCH), as a community-based framework, highlights community participation in decision-making. This study aimed to determine the effectiveness of a community-based intervention using the PATCH on disease perception, empowerment, self-care behaviors, and blood pressure in patients with hypertension.

METHODS

This study will be a parallel randomized community trial. Twelve comprehensive rural health service centers (CRHSCs) are randomly selected as clusters. A total sample size of 428 individuals (214 in the intervention group and 214 in the control group) with hypertension covered by CRHSCs will be selected through cluster random sampling. The PATCH framework, developed by the Centers for Disease Control, will be employed to organize the community and empower it to address the issue in the intervention group. The control group will receive only the routine programs provided by the health system. Three months after the intervention, the outcome of hypertension perception will be assessed via the Disease Perception Questionnaire developed by Kamran et al., and empowerment will be measured via the Perceived Control Scale designed by Israel. Six months after the intervention, self-care behaviors will be evaluated through the Self-Care Behavior Assessment Questionnaire created by Han et al., and blood pressure will be assessed using a standard sphygmomanometer. Data analysis will be conducted via SPSS software version 20, which applies univariate and multivariate linear regression tests.

DISCUSSION

The protocol aligns with health policies in the domain of noncommunicable diseases, emphasizing sustainable and participatory approaches. If proven effective, the findings can be utilized in educational programs and policymaking efforts, paving the way for the broader implementation of community-based interventions. Moreover, this framework can empower social groups to take an active role in combating noncommunicable diseases, and if effective, its application could yield long-term health benefits for individuals and communities.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT), IRCT20231213060354N1. Registered on December 24, 2023. https://irct.behdasht.gov.ir/trial/74453.

The Mitochondria-Targeted Peptide Therapeutic Elamipretide Improves Cardiac and Skeletal Muscle Function During Aging Without Detectable Changes in Tissue Epigenetic or Transcriptomic Age

Aging-related decreases in cardiac and skeletal muscle function are strongly associated with various comorbidities. Elamipretide (ELAM), a novel mitochondria-targeted peptide, has demonstrated broad therapeutic efficacy in ameliorating disease conditions associated with mitochondrial dysfunction across both clinical and pre-clinical models. Herein, we investigated the impact of 8-week ELAM treatment on pre- and post-measures of C57BL/6J mice frailty, skeletal muscle, and cardiac muscle function, coupled with post-treatment assessments of biological age and affected molecular pathways. We found that health status, as measured by frailty index, cardiac strain, diastolic function, and skeletal muscle force, is significantly diminished with age, with skeletal muscle force changing in a sex-dependent manner. Conversely, ELAM mitigated frailty accumulation and was able to partially reverse these declines, as evidenced by treatment-induced increases in cardiac strain and muscle fatigue resistance. Despite these improvements, we did not detect statistically significant changes in gene expression or DNA methylation profiles indicative of molecular reorganization or reduced biological age in most ELAM-treated groups. However, pathway analyses revealed that ELAM treatment showed pro-longevity shifts in gene expression, such as upregulation of genes involved in fatty acid metabolism, mitochondrial translation, and oxidative phosphorylation, and downregulation of inflammation. Together, these results indicate that ELAM treatment is effective at mitigating signs of sarcopenia and cardiac dysfunction in an aging mouse model, but that these functional improvements occur independently of detectable changes in epigenetic and transcriptomic age. Thus, some age-related changes in function may be uncoupled from changes in molecular biological age.

Non-high density lipoprotein cholesterol/high density lipoprotein cholesterol is L-shaped associated with all-cause mortality and U-shaped with cardiovascular mortality in hypertensive patients

Background

Patients with hypertension may have better survival rates when their lipid metabolism is in balance. The relationship between the novel composite lipid metric, NHHR, and all-cause and cardiovascular mortality in hypertensive patients remains unknown and warrants further investigation.

Methods

We analyzed data from 5,561 hypertensive participants in the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. To determine the optimal NHHR cutoff point, we employed a maximum selection statistics approach. Participants were subsequently divided into groups for multivariate weighted Cox regression analysis. The association between NHHR and mortality risk was examined using restricted cubic splines (RCS). To investigate possible variations among different populations, subgroup analysis and interaction tests were carried out. The predictive capability of NHHR for survival outcomes was evaluated using time-dependent receiver operating characteristic (ROC) curves.

Results

Over a median follow-up period of 93 months, patients with hypertension exhibited an all-cause mortality rate of 21.78% and a cardiovascular mortality rate of 7.32%. A markedly elevated risk of cardiovascular death was associated with NHHR levels below 1.66 (HR 1.76; 95% CI 1.31-2.38; P < 0.001), as well as an increased risk of all-cause mortality (HR 1.58; 95% CI 1.31-1.91; P < 0.001). The RCS analysis revealed a U-shaped relationship with cardiovascular mortality (P = 0.0083) and an L-shaped correlation with all-cause mortality (P < 0.0001). Areas under the curve (AUC) for cardiovascular mortality were 0.97, 0.76, and 0.87, and for all-cause mortality were 0.76, 0.84, and 0.80 for the 3-year, 5-year, and 10-year survival periods.

Conclusions

The findings indicate that lower NHHR is associated with an increased risk of both cardiovascular and all-cause mortality, highlighting the critical need for comprehensive lipid management in the clinical management of hypertension. These results suggest that NHHR could serve as a valuable tool for identifying high-risk individuals for mortality, and should be incorporated into routine risk stratification assessments for hypertensive patients. This could more effectively improve patient prognosis and guide personalized treatment strategies.

Qualitative study of patients' and clinicians' experiences of an educational intervention for warfarin therapy control in atrial fibrillation in Thailand

OBJECTIVES

We aimed to understand the (1) perspectives of patients with atrial fibrilation (AF) regarding their experience and implementation of The SAMe-TT2R2 score-guided approach in anticoagulant-nave Thai patients with atrial fibrillation (TREATS-AF) educational intervention for warfarin therapy control, including views on cultural transferability to the Thai context, and (2) healthcare professionals' (HCPs) experience of implementing the intervention.

DESIGN

Qualitative research study.

SETTING

Three university hospitals and four tertiary care hospitals in Thailand.

PARTICIPANTS

13 newly diagnosed patients with AF and 13 HCPs delivering the TREATS-AF intervention, an intensive structured educational programme.

METHODS

Semistructured interviews. Patient participants were interviewed at two time points: 4 weeks and 6 months after intervention delivery. HCPs were interviewed when they had at least 6 months experience of intervention delivery. A thematic analysis of content was informed by the framework analytical approach.

RESULTS

13 patients and 13 HCPs were interviewed; most were female (73.3% of patients and all HCPs). Mean age was 70 (68-76) and 40 (38-42.5) years for patients and HCPs, respectively. There were four categories related to the experience of the TREATS-AF intervention: (1) key experiences of the educational sessions, (2) core perceptions of the educational materials provided, (3) suggestions for improving the educational materials and session, and (4) behavioural change and self-management influenced by the TREATS-AF intervention.

CONCLUSIONS

The TREATS-AF intervention assisted interviewees who were newly diagnosed with AF in preparing themselves with the necessary knowledge and skills to manage their condition. They stated that it increased their confidence in self-management.For implementation, regionalised Thai-related food and beverages, patients' literacy and family support should be considered, and infrastructure support for widespread use in healthcare settings would be required.

TRIAL REGISTERATION NUMBER

TCTR20180711003.

Global, regional, and national epidemiology of ischemic heart disease among individuals aged 55 and above from 1990 to 2021: a cross-sectional study

BACKGROUND

The findings of the 2021 Global Burden of Disease (GBD) study can offer valuable insights for the development of screening and prevention strategies targeting ischemic heart disease (IHD). We aim to investigate trends in IHD incidence, mortality, and disability-adjusted life years (DALYs), while exploring associated risk factors for IHD-associated death from 1990 to 2021.

METHODS

The cross-sectional study utilized data from the GBD 2021, covering 204 countries and regions. The analysis included individuals aged 55 and above. We analyzed the trends in IHD incidence, all cause and cause-specific deaths, DALYs, and corresponding estimated annual percentage changes (EAPCs) from 1990 to 2021. These indicators were further stratified by geographical region, country, age group, gender, and sociodemographic index (SDI).

RESULTS

The global incidence rate, mortality rate, and DALYs rate for individuals aged 55 and above with IHD have shown a decreasing trend. However, the number of incident cases, death cases, and DALYs has been increasing from 1990 to 2021. Both the high-middle and high SDI regions exhibit a significant decline in these rates from 1990 to 2021. However, the low SDI, low-middle SDI, and middle SDI regions show less noticeable changes. The region with low-middle SDI experiences the largest increase in mortality rate (EAPC: 0.38; 95%CI, 0.33-0.44) and DALYs rate (EAPC: 0.17; 95%CI, 0.12-0.22). The region with middle SDI experiences the largest increase in incidence rate (EAPC: 0.37; 95%CI, 0.27-0.46). Regionally, East Asia exhibits the greatest increase in incidence rate (EAPC: 0.94; 95% CI, 0.79-1.10), mortality rate (EAPC: 1.68; 95% CI, 1.40-1.94), and DALYs rate (EAPC: 0.94; 95% CI, 0.69-1.20). Among the 12 risk factors associated with mortality from IHD, high systolic blood pressure, dietary risks, high low-density lipoprotein (LDL) cholesterol levels, and air pollution are identified as the primary contributors to global mortality.

CONCLUSIONS

This study reveals that in high SDI regions, the incidence, mortality, and DALYs rate of IHD are declining. Conversely, in low to middle SDI regions, the disease burden of IHD is increasing. It highlights global inequality in IHD burden. Recommendations include early screening, risk management, and strengthening primary care, especially in middle and low SDI regions. Countries should also invest in environmental governance and air pollution control. Future research should focus on evaluating the effects of health policies in different countries, exploring the impact of socio-economic and cultural factors on the burden of IHD, and developing big data-based prediction models to optimize resource allocation and intervention strategies.

Extracellular vesicles lay the ground for neuronal plasticity by restoring mitochondrial function, cell metabolism and immune balance

Extracellular vesicles (EVs) convey complex signals between cells that can be used to promote neuronal plasticity and neurological recovery in brain disease models. These EV signals are multimodal and context-dependent, making them unique therapeutic principles. This review analyzes how EVs released from various cell sources control neuronal metabolic function, neuronal survival and plasticity. Preferential sites of EV communication in the brain are interfaces between pre- and postsynaptic neurons at synapses, between astrocytes and neurons at plasma membranes or tripartite synapses, between oligodendrocytes and neurons at axons, between microglial cells/macrophages and neurons, and between cerebral microvascular cells and neurons. At each of these interfaces, EVs support mitochondrial function and cell metabolism under physiological conditions and orchestrate neuronal survival and plasticity in response to brain injury. In the injured brain, the promotion of neuronal survival and plasticity by EVs is tightly linked with EV actions on mitochondrial function, cell metabolism, oxidative stress and immune responses. Via the stabilization of cell metabolism and immune balance, neuronal plasticity responses are activated and functional neurological recovery is induced. As such, EV lay the ground for neuronal plasticity.

Overview of MitoQ on prevention and management of cardiometabolic diseases: a scoping review

Background

The exploration of mitochondrial-targeted antioxidants represented a burgeoning field of research with significant implications for cardiometabolic diseases (CMD). The studies reviewed in this scoping analysis collectively highlighted the effect of MitoQ on prevention and management of CMD and underlying mechanisms were discussed, mainly including cardiovascular diseases (CVDs), liver health and others.

Methods

This scoping review aimed to synthesize current research on the health impacts of MitoQ on CMD, focusing primarily on human-based clinical trials. While the primary focus was on human trials, in vivo and in vitro studies were referenced as supplementary material to provide a broader understanding of MitoQ's mechanisms and potential effects.

Results

This scoping review had synthesized the findings that collectively contributed to the understanding of mitochondrial-targeted antioxidants and their role in CMD.

Conclusion

The synthesis of these findings illustrated a broad spectrum of benefits ranging from enhanced insulin secretion to improved lipid profiles and mitochondrial function, yet the path to clinical application required further investigation on appropriate doses and populations.

Magnetically Labeled iPSC-Derived Extracellular Vesicles Enable MRI/MPI-Guided Regenerative Therapy for Myocardial Infarction

Stem cell-derived extracellular vesicles (EVs) offer a promising cell-free approach for cardiovascular regenerative medicine. In this study, we developed magnetically labeled induced pluripotent stem cell-derived EVs (magneto-iPSC-EVs) encapsulated with superparamagnetic iron oxide (SPIO) nanoparticles for image-guided regenerative treatment of myocardial infarction, in which EVs that can be detected by both magnetic resonance imaging (MRI) and magnetic particle imaging (MPI). iPSC-EVs were isolated, characterized per MISEV2023 guidelines, and loaded with SuperSPIO20 nanoparticles using optimized electroporation conditions (300 V, 2 × 10 ms pulses), achieving a high loading efficiency of 1.77 ng Fe/106 EVs. In vitro results show that magneto-iPSC-EVs can be sensitively detected by MPI and MRI, with a detectability of approximately 107 EVs. In a mouse myocardial ischemia-reperfusion model, intramyocardially injected magneto-iPSC-EVs (2 × 109) were imaged non-invasively by in vivo MPI for 7 days and ex vivo MRI, with the presence of magneto-iPSC-EVs confirmed by Prussian blue staining. Therapeutically, both native and magneto- iPSC-EVs significantly improved cardiac function, with a 37.3% increase in left ventricular ejection fraction and 61.0% reduction in scar size. This study highlights the potential of magneto-iPSC-EVs as a cell-free approach for cardiovascular regenerative medicine, offering both non-invasive imaging capabilities and therapeutic benefits for myocardial repair.

Beyond the gut: Unraveling the multifaceted influence of microbiome on cardiovascular health

Cardiovascular disease is one of the leading causes of death worldwide. Even while receiving adequate pharmacological treatment for their hypertension, people are nonetheless at greater risk for cardiovascular disease. There is growing evidence that the gut microbiota may have major positive and negative effects on blood pressure and illnesses related with it as more study into this topic is conducted. Trimethylamine n-oxide (TMAO) and short-chain fatty acids (SCFA) are two major by-products of the gut microbiota. TMAO is involved in the formation of other coronary artery diseases, including atherosclerosis and hypertension, while SCFAs play an important role in controlling blood pressure. Numerous investigations have confirmed the established link between dietary salt intake and hypertension. Reducing sodium in the diet is linked to lower rates of cardiovascular disease morbidity and mortality as well as lower rates of blood pressure and hypertension. In both human and animal research, high salt diets increase local and systemic tissue inflammation and compromise gut architecture. Given that the gut microbiota constantly interacts with the immune system and is required for the correct maturation of immune cells, it is scientifically conceivable that it mediates the inflammatory response. This review highlights the therapeutic possibilities for focusing on intestinal microbiomes as well as the potential functions of the gut microbiota and its metabolites in the development of hypertension.

The long-term impact of hypertriglyceridemia-waist phenotype on major adverse cardiovascular events in elderly patients with OSA

INTRODUCTION

The hypertriglyceridemia-waist (HTGW) phenotype is a prevalent risk factor for cardiovascular diseases and obstructive sleep apnea (OSA). However, the impactof the HTGW phenotype on the simultaneous occurrence of OSA and cardiovascular diseases remains unexplored. This study aimed to determine whether the HTGW phenotype elevates the incidence of major adverse cardiovascular events (MACE) in patients with OSA, such as hospitalization for unstable angina and heart failure, myocardial infarction, and cardiovascular death, in patients with OSA.

METHODS

A total of 1,290 patients with OSA were recruited from six hospitals for follow-up. According to the Chinese population criteria recommended by the International Diabetes Federation, the patients were divided into four groups: normal triglyceride waist circumference (NTNW) phenotype, pure high triglyceride (HTNW) phenotype, pure high waist circumference (NTGW) phenotype, and HTGW phenotype. The prognosis for MACE was evaluated using Cox proportional hazards analysis. The prognosis of MACE was evaluated using Cox proportional hazards analysis.

RESULTS

207 (17.9%) developed an HTGW phenotype. After a median of 42 months of follow-up, 119 (10.3%) experienced MACE. Cox proportional hazards analysis revealed that patients exhibiting the HTGW phenotype had a 1.963-fold higher risk of developing MACE than patients with the NTNW phenotype (P = 0.012). These results remained significant after adjusting for confounders, and a 2.186-fold increased risk of MACE was found in patients with NTGW phenotype (P = 0.012). Subgroup analyses revealed an increased risk of MACE in OSA patients with HTGW phenotype and NTGW phenotype that were older than or equal to 70 years, male, and had moderate-to-severe OSA (all P-values < 0.05).

CONCLUSION

The HTGW and NTGW phenotypes significantly increase MACE risk among elderly patients with OSA.

Time trends in coronary heart disease mortality attributed to outdoor PM2.5 in China: an age-period-cohort analysis using the Global Burden of Disease Study 2019

Background

In China, coronary heart disease (CHD) is a significant public health issue affecting the population's health. Evidence suggests that outdoor PM2.5 is a crucial environmental risk factor for CHD mortality. This study aims to provide scientific evidence for the prevention and treatment of CHD by analyzing the trend of CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019.

Methods

Data were obtained from the Global Burden of Disease Study (GBD) 2019. CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019 was extracted from the GBD Data tool. We used an age-period-cohort (APC) model based on the intrinsic estimator (IE) algorithm to decompose the age, period, and cohort effects related to CHD mortality attributed to outdoor PM2.5.

Results

From 1994 to 2019, the crude mortality rates (CMRs) and age-standardized mortality rates (ASMRs) of CHD attributed to outdoor PM2.5 in China showed an overall upward trend. The APC model analysis showed that the relative risk of CHD mortality attributed to outdoor PM2.5 increased exponentially with age, reaching 89.284 (95% CI: 48.669, 163.793) in the 90-95 age group. The period effect increased monotonically, with a relative risk of 3.699 (95% CI: 3.639, 3.760) in 2019. The cohort effect decreased monotonically, with the lowest relative risk of CHD mortality attributed to outdoor PM2.5 in residents born between 1990 and 1994, at 0.135 (95% CI: 0.031, 0.588).

Conclusion

The older adult, a high-risk population, should receive more attention. In the future, continuous efforts should be made to strengthen environmental air pollution control and implement targeted health interventions to reduce the impact of outdoor PM2.5 on CHD mortality.

Sodium nitrate regulates senescence accompanied by aortic atherosclerosis in ApoE-/- mice through the miR-34a/FGF-21 axis

Introduction

Increasing evidence indicates that cellular senescence is a significant risk factor for atherosclerosis (AS).

Methods

In the present study, we used an apolipoprotein E knockout (ApoE-/-) mouse model to address the effect of sodium nitrate on senescence accompanied by atherosclerosis. After sodium nitrate intervention, the degree of AS pathological and cellular senescence changes was evaluated in mouse aortic. At the same time, an H2O2-induced human arterial endothelial cell (HAoEC) senescence model was established to verify the role of miR-34a in AS-associated senescence.

Results

We observed that sodium nitrate decreased the Oil Red O-positive area, reduced the serum cholesterol (CHO) and triglyceride (TG) concentrations, and relieved inflammatory reactions in ApoE-/- mice. Moreover, the SA-β-Gal-positive area, the expression of cell cycle regulation-related genes and miR-34a in the aorta decreased after sodium nitrate treatment. Furthermore, sodium nitrate upregulated the expression of FGF21 by inhibiting the expression of miR-34a, thereby rescuing the senescent phenotype of HAoECs. These results suggested that sodium nitrate could rescue the endothelial cell senescence phenotype and alleviate aortic atherosclerosis in ApoE-/- mice by regulating the miR-34a/FGF21 axis.

Discussion

These findings might lead to the introduction of a new therapy for senescence-related diseases in the future.

Menopause-related changes in vascular signaling by sex hormones

Cardiovascular disease (CVD), such as hypertension and coronary artery disease, involves pathological changes in vascular signaling, function, and structure. Vascular signaling is regulated by multiple intrinsic and extrinsic factors that influence endothelial cells, vascular smooth muscle, and extracellular matrix. Vascular function is also influenced by environmental factors including diet, exercise, and stress, as well as genetic background, sex differences, and age. CVD is more common in adult men and postmenopausal women than in premenopausal women. Specifically, women during menopausal transition, with declining ovarian function and production of estrogen (E2) and progesterone, show marked increase in the incidence of CVD and associated vascular dysfunction. Mechanistic research suggests that E2 and E2 receptor signaling have beneficial effects on vascular function including vasodilation, decreased blood pressure, and cardiovascular protection. Also, the tangible benefits of E2 supplementation in improving menopausal symptoms have prompted clinical trials of menopausal hormone therapy (MHT) in CVD, but the results have been inconsistent. The inadequate benefits of MHT in CVD could be attributed to the E2 type, dose, formulation, route, timing, and duration as well as menopausal changes in E2/E2 receptor vascular signaling. Other factors that could affect the responsiveness to MHT are the integrated hormonal milieu including gonadotropins, progesterone, and testosterone, vascular health status, preexisting cardiovascular conditions, and menopause-related dysfunction in the renal, gastrointestinal, endocrine, immune, and nervous systems. Further analysis of these factors should enhance our understanding of menopause-related changes in vascular signaling by sex hormones and provide better guidance for management of CVD in postmenopausal women. SIGNIFICANCE STATEMENT: Cardiovascular disease is more common in adult men and postmenopausal women than premenopausal women. Earlier observations of vascular benefits of menopausal hormone therapy did not materialize in randomized clinical trials. Further examination of the cardiovascular effects of sex hormones in different formulations and regimens, and the menopausal changes in vascular signaling would help to adjust the menopausal hormone therapy protocols in order to enhance their effectiveness in reducing the risk and the management of cardiovascular disease in postmenopausal women.

Systematic Evaluation of the Impact of a Wide Range of Dietary Habits on Myocardial Infarction: A Two-Sample Mendelian Randomization Analysis

BACKGROUND

Myocardial infarction is a cardiovascular disease that significantly contributes to global morbidity and disability. Given the significant role of diet in the pathogenesis and prevention of cardiovascular diseases, this study rigorously investigates the causal relationship between dietary habits and myocardial infarction.

METHODS AND RESULTS

This study used large-scale genome-wide association studies with pooled UK Biobank data to explore associations between 9 dietary categories (83 types) and myocardial infarction. A 2-sample Mendelian randomization approach was applied to assess these associations, while multivariate Mendelian randomization and mediation analyses investigated the role of lipids in mediating the effects of diet on myocardial infarction. Univariate Mendelian analyses revealed genetic associations among 9 categories of dietary habits (83 types) and myocardial infarction. Notably, robust evidence indicates the "tablespoons of cooked vegetables per day" as the most significant risk factor for myocardial infarction development. "Coffee consumption(cups per day)" and "frequency of adding salt to food" were also identified as supplementary risk factors. In contrast, "overall alcohol intake" showed a protective effect, potentially by increasing high-density lipoprotein cholesterol (4.48% mediation) and reducing triglycerides (6.24% mediation). Cereal category, particularly "cereal consumption (bowls per week)" was associated with reduced myocardial infarction risk, contributing by raising high-density lipoprotein cholesterol (3.69% mediation) and lowering total cholesterol (8.33% mediation). Additionally, "overall cheese consumption" was also protective against myocardial infarction.

CONCLUSIONS

Our findings elucidate the influence of dietary habits on myocardial infarction, showing underlying genetic mechanisms and emphasizing the regulatory role of lipids as an intermediate.

Edaravone dextranol alleviates ferroptosis, Cuproptosis, and blood-brain barrier damage after acute cerebral infarction

Edaravone dextrose (EDB) is a commonly used clinical treatment for cerebral infarction due to its anti-inflammatory and free radical scavenging properties. However, its potential additional neuroprotective mechanisms need to be further investigated. In this study, we evaluated the effects of EDB on ferroptosis, cuproptosis, and blood-brain barrier (BBB) disruption after cerebral infarction in vivo and in vitro by constructing a mouse middle cerebral artery occlusion (MCAO) model, and an oxygen-glucose deprivation/reperfusion (OGD/R) model of neurons and brain microvascular endothelium. Our results showed that EDB treatment improved neurological impairment and brain histopathology in MCAO mice. EDB treatment significantly alleviated ferroptosis and cuproptosis in MCAO mice and OGD/R models of neuronal, in vitro and in vivo, the protective pathway of ferroptosis SLC7A11/GPX4 was detected to be activated and the cuproptosis-promoting protein SLC31A1 and FDX1 were down-regulated. We also found that EDB treatment ameliorated BBB damage in MCAO mice. The endothelial cell protective pathway PDGFRβ/PI3K/AKT activation was also detected in MCAO mice and OGD/R models of endothelial cells after EDB treatment. In conclusion, our study demonstrated that EDB has a good ameliorating effect on ferroptosis, cuproptosis, and BBB damage after cerebral infarction, which provides more evidence for the clinical application of EDB and provides new theories and directions for the study of the mechanism of EDB.

Clinicoeconomic burden among heart failure patients with severely reduced ejection fraction after hospital admission: HF-RESTORE

BACKGROUND

An estimated two-thirds of heart failure (HF) patients with reduced ejection fraction (HFrEF) hospitalized in the United States have a severely reduced left ventricular ejection fraction (LVEF <30%). Few studies have categorized patients according to their severity of left ventricular dysfunction beyond an LVEF of <30%.

METHODS AND RESULTS

Intermountain Health patients (≥18 years) with a primary HF diagnosis, more than or equal to 1 inpatient hospitalization with a primary discharge diagnosis of HF, a documented LVEF of <30%, and a B-type natriuretic peptide >100 pg/mL within 1 year of hospitalization were studied. Patients were stratified by LVEF levels (≤15%, 16-25%, and 26-29%) and evaluated for death, HF hospitalization, healthcare resource utilization, and medical costs. Overall, 2184 patients (mean age 64.2 ± 15.5 years, 72.5% male) were stratified by LVEF [≤15%, n = 468 (21.4%); 16-25%, n = 1399 (64.1%); and 26-29%, n = 317 (14.5%)]. Lower LVEF was associated with younger age, male sex, and fewer comorbidities. Although 1-year mortality differed significantly between LVEF stratifications, which remained after adjustment by risk factors [vs. LVEF 26-29% (referent): ≤15%, hazard ratio (HR) = 1.92, P < 0.0001; and 16-25%, HR = 1.42, P = 0.01], mortality was similar by 3 years. HF hospitalizations at 1 and 3 years were similar among LVEF groups. Total HF costs-driven by increased HF outpatient costs-were significantly higher among LVEF of ≤15%.

CONCLUSION

Patients with an LVEF of ≤15% had a modestly increased risk of 1-year mortality, as well as significantly higher total HF costs. Patients with HFrEF and a severely reduced LVEF continue to face an increased clinicoeconomic burden, and novel therapies to treat this unmet medical need are warranted.

Lipoprotein(a), high-sensitivity c-reactive protein, homocysteine and cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis

Background and aims

Elevated lipoprotein(a) [Lp(a)], high-sensitivity C-Reactive Protein (hs-CRP), and total homocysteine (tHcy) are associated with atherosclerotic cardiovascular disease (ASCVD) risk. This study investigated the individual and joint associations of Lp(a), hs-CRP and tHcy with coronary heart disease (CHD) and stroke.

Methods

This study was conducted in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort (2000-2017) (CHD analytic N = 6,676; stroke analytic N = 6,674 men and women). Associations between Lp(a) (<50 vs. ≥50 mg/dL), hs-CRP (<2 vs. ≥2 mg/L) and tHcy (<12 vs. ≥12 µmol/L) and CHD and stroke incidence were evaluated individually and jointly using Cox proportional hazards regression.

Results

Individually, elevated tHcy was associated with CHD and stroke incidence, Lp(a) with CHD only and hs-CRP with stroke only. In combined analyses, CHD risk was higher when multiple biomarkers were elevated [hs-CRP+Lp(a), hazard ratio (HR)=1.39, 95 % confidence interval (CI): 1.06, 1.82; hs-CRP+ tHcy, HR = 1.34, 95 % CI: 1.02, 1.75; Lp(a)+ tHcy HR = 1.58, 95 % CI: 1.08, 2.30; hs-CRP+Lp(a)+ tHcy HR = 2.02, 95 % CI: 1.26, 3.24]. Stroke risk was elevated when hs-CRP and either Lp(a) (HR = 1.51, 95 % CI: 1.02, 2.23) or tHcy (HR = 2.10, 95 % CI: 1.44, 3.06) was also high, when all three biomarkers were elevated (HR = 2.99, 95 % CI: 1.61, 5.58), or when hs-CRP and tHcy (HR = 1.79, 95 % CI: 1.16, 2.76) were both high.

Conclusions

Risk of ASCVD was highest with concomitant elevation of tHcy, hs-CRP and Lp(a). Inclusion of tHcy and consideration of biomarker combination rather than individual biomarker levels may help better identify individuals at greatest risk for ASCVD events.

Current Real-World Status of Off-Label Under- and Over-Dose of Direct Oral Anticoagulants After Atrial Fibrillation Ablation

BACKGROUND

Off-label under- and overdosing of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) is not uncommon in real-world practice.

OBJECTIVE

This study aimed to identify efficacy and safety of off-label DOACs dose after AF ablation.

METHODS

The RYOUMA registry was a prospective multicenter study of Japanese patients who underwent AF ablation between 2017 and 2018. DOAC prescriptions were categorized into on-label standard dose, on-label reduced dose, off-label underdose, and off-label overdose.

RESULTS

The proportion of off-label doses among patients after AF ablation varied depending on the type of DOAC, ranging from 13.5% to 34.9%. Of 2821 patients, 366 (13.0%) were prescribed an off-label underdose and exhibited significantly higher CHADS2, CHA2DS2-VASc, CHA2DS2-VA, HELT-E2S2, and HAS-BLED scores, age, concomitant use of antiplatelets, and lower weight when compared to the on-label standard dose (n = 1809). While the incidence of ischemic stroke after 1 year of off-label underdose was notably low (0.28%), the rate of major bleeding was relatively high (1.7%). Off-label overdose was prescribed to 134 patients (4.8%), who showed a significantly higher incidence of major bleeding (3.0%) compared to on-label standard dose (0.91%; p = 0.02). The off-label overdose group did not have any particular background and its thromboembolic risk was, conversely, low. The most likely cause of off-label overdose was clinicians potentially overlooking dose criteria, including advanced age, low body weight, and low creatinine clearance.

CONCLUSIONS

In patients after AF ablation, off-label DOAC overdose was infrequent, but significantly associated with higher incidence of major bleeding during the remote period after AF ablation.

TRIAL REGISTRATION

The study was registered as UMIN000026092 (University Hospital Medical Information Network-Clinical Trial Registry).

Antithrombotic therapy in patients with atrial high-rate episodes (AHREs): Current evidence and open questions

With the increasing use of cardiac electronic implantable devices in recent years, the identification of asymptomatic atrial arrhythmias, including atrial high-rate episodes (AHREs) and device-detected subclinical atrial fibrillation (SCAF), has become common in clinical practice. AHREs have potentially important clinical implications because they are considered precursors of atrial fibrillation (AF). Although to a lesser extent than clinical AF, both AHREs and device-detected SCAF are associated with thromboembolic events, however routine use of anticoagulants in these conditions is not recommended. In addition, patients with AHREs are at increased risk of cardiovascular events, including myocardial infarction, heart failure, and cardiovascular hospitalization. The relationship between stroke and AHREs and the potential benefit of anticoagulant therapy in this setting is the subject of ongoing debate. In this review, we aimed to appraise the available evidence and current gaps in the risk stratification and management of patients with AHREs/device-detected SCAF.

Sedentary behavior modified the association between depression and risk of all-cause deaths in hypertensive population

OBJECTIVE

The pathogenic mechanism of depression involves chronic inflammation, which can be affected by sedentary behavior. This study aimed to determine whether sedentary behavior modified the association between depression and risk of death in the hypertensive population.

METHODS

Data from the National Health and Nutrition Examination Survey (2007-2018) was analyzed. Depression was assessed through the Health Questionnaire-9, and sedentary behavior was evaluated using self-reported sitting hours in a day. Deaths were ascertained through the National Death Index until 31 December 2019. The interaction effect was evaluated through multivariable Cox regression analysis.

RESULTS

Eight thousand one hundred and twenty-four patients with hypertension were involved in the study. During a median follow-up of 7.3 years, we confirmed 1384 all-cause and 373 cardiovascular deaths. Separate analyses revealed that both depression and sitting for 6 h per day or more were correlated with increased risks of all-cause and cardiovascular deaths. Of note, we found that sitting time modified the link between depression and the risk of all-cause death (P for interaction: 0.02). Compared with the nondepression group, the depression group was correlated with an elevated risk of all-cause death among participants with sitting time of more than 6 h/day [hazard ratio 1.52, 95% confidence interval (CI) 1.22-1.91, P < 0.001], but not among participants with sitting time of less than 6 h/day (hazard ratio 0.95, 95% CI 0.65-1.39, P = 0.76).

CONCLUSION

Sedentary behavior modified the link between depression and the risk of all-cause death. Reducing sedentary time might attenuate the detrimental effects of depression on survival in the hypertensive population.

Sudden cardiac arrest prediction via deep learning electrocardiogram analysis

Aims

Sudden cardiac arrest (SCA) is a commonly fatal event that often occurs without prior indications. To improve outcomes and enable preventative strategies, the electrocardiogram (ECG) in conjunction with deep learning was explored as a potential screening tool.

Methods and results

A publicly available data set containing 10 s of 12-lead ECGs from individuals who did and did not have an SCA, information about time from ECG to arrest, and age and sex was utilized for analysis to individually predict SCA or not using deep convolution neural network models. The base model that included age and sex, ECGs within 1 day prior to arrest, and data sampled from windows of 720 ms around the R-waves from 221 individuals with SCA and 1046 controls had an area under the receiver operating characteristic curve of 0.77. With sensitivity set at 95%, base model specificity was 31%, which is not clinically applicable. Gradient-weighted class activation mapping showed that the model mostly relied on the QRS complex to make predictions. However, models with ECGs recorded between 1 day to 1 month and 1 month to 1 year prior to arrest demonstrated predictive capabilities.

Conclusion

Deep learning models processing ECG data are a promising means of screening for SCA, and this method explains differences in SCAs due to age and sex. Model performance improved when ECGs were nearer in time to SCAs, although ECG data up to a year prior had predictive value. Sudden cardiac arrest prediction was more dependent upon QRS complex data compared to other ECG segments.

The relationship between continuation of exercise habit for three years and endothelial function in patients with hypertension

The aim of this study was to evaluate the relationship between continuation of exercise habit for a long period and endothelial function assessed by flow-mediated vasodilation (FMD) in patients with hypertension. This study was a multicenter retrospective observational study. A total of 639 patients with hypertension were enrolled in this study. The subjects were divided into two groups based on information on exercise habit: a regular exercise group and a non-regular exercise group (control group). The regular exercise group was defined as patients who had an exercise habit during a 3-year follow-up period. There was no significant difference in FMD at baseline between the regular exercise group and control group. The change in FMD examined by the Wilcoxon signed rank test was significantly larger in the regular exercise group than in the control group (0.4 (-1.4, 2.0) % vs. -0.1 (-2.2, 1.4) %, p = 0.008). After adjustment for confounding factors for FMD, the odds ratio for increase in FMD was significantly larger in the regular exercise group than in the control groups. (OR: 1.59, 95% CI: 1.14-2.21, p = 0.006) A cubic spline curve revealed that even subjects with regular exercise who had a mean exercise intensity of less than 20 Mets・hour/week a had higher odds ratio for increase in endothelial function compared to the control group. These findings suggest that patients with hypertension who engage in regular exercise exhibited better endothelial function compared to those who do not exercise. Clinical Trial Registry Information: http://www.umin.ac.jp (UMIN000012951).

The HET (history, electrocardiogram, and troponin) score has low efficacy and negative predictive value in a multisite U.S. cohort study

INTRODUCTION

The History, Electrocardiogram, and Troponin (HET) score is a simplified alternative to the HEART score for risk stratifying emergency department (ED) patients with chest pain. This study evaluates the safety and efficacy of the HET score for 30-day cardiac death or myocardial infarction (MI).

METHODS

We conducted a secondary analysis of the STOP-CP multisite cohort study. Risk score components were determined prospectively by the treating provider. Patients were classified into low-, intermediate-, and high-risk strata based on HEART and HET scores. Negative predictive value (NPV) was calculated for the primary safety outcome of cardiac death or MI at 30 days. Consistent with prior studies, the commonly accepted threshold of NPV ≥ 99 % was used to define safety. Efficacy was the proportion of patients classified as low risk. NPV and efficacy were compared between HET and HEART scores using generalized score statistic and McNemar's test, respectively.

RESULTS

Among 1460 patients, 46.3 % (676/1460) were women and the mean age was 57.6 ± 12.8 years. Cardiac death or MI at 30 days occurred in 12.7 % (186/1460). Among patients with a low-risk HET score, 1.4 % (4/286) experienced 30-day cardiac death or MI, while 2.2 % (12/534) of patients with a low-risk HEART score had 30-day cardiac death or MI. This yielded a NPV for 30-day of 98.6 % (95 % CI 96.5-99.6 %) for the HET score vs 97.8 % (95 % CI 96.1-98.8 %) for the HEART score (p = 0.29).Efficacy of the HET score was 19.6 % (286/1460, 95 % CI 17.6-21.6 %) vs 36.6 % (534/1460, 95 % CI 34.1-39.1 %) for the HEART score (p < 0.001).

CONCLUSION

In a multisite US cohort study, neither the HET score nor the HEART score achieved a safe NPV. The HET score had significantly lower efficacy than the HEART score.

TRIAL REGISTRATION

High-Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification (STOP-CP; ClinicalTrials.gov: NCT02984436; https://clinicaltrials.gov/ct2/show/NCT02984436).