Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association

The relationship between dietary inflammatory index in adults and coronary heart disease: from NHANES 1999-2018

Background

Previous studies have shown that pro-inflammatory diets increase the risk of coronary heart disease (CHD) and all-cause mortality. The dietary inflammatory index (DII) is a quantitative measure of dietary inflammation, and its accuracy has been validated by several studies.

Methods

This study included 43,842 participants aged ≥18 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. The data of CHD was obtained through a questionnaire survey, and the DII was calculated using 24-h dietary recall data. Generalized linear models and logistic regression were used to determine the mediation factors, and subgroup analyses were conducted to evaluate the interaction between DII and CHD. Mean decrease in Gini (MDG) was used to determine the importance of individual dietary components.

Results

The age of the participants was 49.81 ± 18.10 years, with 20,793 (47.4%) being male. A total of 1,892 (4.3%) participants were diagnosed with CHD, and the median DII score was 1.33 (0.11, 2.40). After adjusting for potential confounders, logistic regression analysis revealed that DII independently associated with CHD [OR: 1.049 (1.012-1.087), p = 0.008]. Triglyceride-glucose index, visceral adiposity index, body mass index, waist-to-height ratio, high-density lipoprotein, and glomerular filtration rate (all p < 0.05) may mediate the relationship between DII and CHD. Subgroup analyses showed that DII was more sensitive in participants aged <75 years (p < 0.001), females (p = 0.028), those with low cholesterol levels (p = 0.004), and individuals with low Framingham risk scores (p = 0.005). MDG analysis indicated that carbohydrate, vitamin C and iron intake have the greatest impact on CHD.

Conclusion

This study suggests that various metabolic and lipid indicators play a mediating role in the relationship between DII and CHD. DII may have a greater adverse impact on traditional low-risk CHD populations.

Medicaid Expansion Among Nonelderly Adults and Cardiovascular Disease: Efficiency Vs. Equity

Policy Points Evidence suggests Medicaid expansion has improved cardiovascular disease (CVD) outcomes, especially among those of lower socioeconomic status. However, less is known about the cost-effectiveness of Medicaid in achieving these outcomes and reducing CVD disparities. We found that Medicaid expansion resulted in a reduction in CVD incidence, suggesting that it was cost-effective in reducing CVD outcomes and equity enhancing but with a high degree of uncertainty. Policymakers will need to trade-off among a number of different factors in consideration of the value of Medicaid including health (especially in treating the chronically ill), financial protection, reduced uncompensated care, and health disparities.

CONTEXT

Evidence suggests Medicaid expansion has improved cardiovascular disease (CVD) outcomes, especially among those of lower socioeconomic status. However, less is known about the cost-effectiveness of Medicaid in achieving these outcomes and reducing CVD disparities. We use distributional cost-effectiveness analysis methods to examine the efficiency and equitability of Medicaid expansion in reducing CVD outcomes.

METHODS

A Monte Carlo Markov-chain microsimulation model was developed to examine lifetime changes in CVD outcomes and disparities as a result of expansion and the associated cost and quality-of-life impacts.

FINDINGS

Medicaid expansion was associated with a reduction of 11 myocardial infarctions, eight strokes, and four CVD deaths per 100,000 person-years compared with no expansion. The largest reductions occurred for those with lower income and education, and those of Black and Hispanic race/ethnicity. We found that the benefits of expansion generally balanced out the costs while redistributing health from higher to lower income groups. In probabilistic sensitivity analysis, we found-using a health opportunity cost threshold of $150,000-that Medicaid expansion was cost-effective in reducing CVD outcomes 53% of the time and both cost-effective (efficient) and equity enhancing 26% to 29% of the time.

CONCLUSIONS

Medicaid expansion resulted in a reduction in CVD incidence, suggesting that it was both cost-effective and equity enhancing in reducing CVD outcomes but with a high degree of uncertainty.

The effects of eccentric cycling on vascular reactivity

Purpose

Eccentric cycling has gained attention as a novel exercise modality that increases muscle performance at lower metabolic demand, which could enhance cardiovascular rehabilitation. However, endothelial function response to eccentric cycling (ECC) has yielded contradictory results. Therefore, the purpose of this study was to determine the effect of 30 min of moderate-intensity cycling ECC on endothelial function.

Methods

A total of 15 (9 females, 6 males) young, apparently healthy participants were recruited for two laboratory visits. First, a maximum oxygen consumption (VO2max) and blood lactate (BLa) threshold were measured to determine moderate workload intensity, followed by a familiarization stage on an ECC ergometer. During the second visit, a 30-min of moderate ECC was performed 72 h after the first visit. Endothelial function was measured via Flow-Mediated Dilation (FMD) pre- and post-exercise bout. FMD was calculated following traditional recommendations and adjusting for exercise-induced endothelial shear stress (ESS), utilizing the same pre-exercise baseline artery diameter for post-exercise FMD calculations.

Results

There was a significant increase in endothelial function (p = 0.037) when adjusting pre-exercise baseline diameter to adjust for ESS, but when utilizing the traditional method no change in endothelial function was observed.

Conclusion

30-min of moderate ECC showed a significant improvement in endothelial function when accounting for exercise-induced ESS. These results support the use of the pre-exercise baseline diameter when calculating post-exercise FMD to avoid the exercise-induced ESS or muscle metabolites effects on post-exercise artery diameter.

A Novel Hidden Protein p-414aa Encoded by circSETD2(14,15) Inhibits Vascular Remodeling

BACKGROUND

Phenotypic switching of vascular smooth muscle cells (VSMCs), leading to neointimal hyperplasia, is a fundamental cause of vascular remodeling diseases such as atherosclerosis and hypertension. Novel hidden proteins encoded by circular RNAs play crucial roles in disease progression, yet their involvement in vascular remodeling diseases has not been comprehensively studied. This study identifies a novel protein derived from a circular RNA in VSMCs and demonstrates its potential role in regulating vascular remodeling.

METHODS

Cell proliferation assays were performed to investigate the effects of circSETD2(14,15) on VSMC proliferation. Techniques such as vector construction, immunoprecipitation-mass spectrometry, and dual-luciferase reporter gene were used to confirm that circSETD2(14,15) encoded a novel protein, p-414aa. The interaction between p-414aa and HuR (human antigen R) was validated with techniques such as coimmunoprecipitation, mass spectrometry, and proximity ligation assay. Through experiments including RNA sequencing and RNA immunoprecipitation, the interaction between HuR and C-FOS (C-Fos proto-oncogene) mRNA was revealed. The role of p-414aa in neointimal hyperplasia was assessed with a carotid artery ligation model in male mice.

RESULTS

Overexpression of circSETD2(14,15) inhibits VSMC phenotypic switching. The novel protein p-414aa, encoded by circSETD2(14,15), interacts with HuR to reduce C-FOS mRNA stability, thereby suppressing VSMC proliferation and ultimately inhibiting neointimal hyperplasia in male mice.

CONCLUSIONS

We uncover a novel hidden protein derived from circSETD2(14,15), called p-414aa, that inhibits vascular remodeling. CircSETD2(14,15) and p-414aa may serve as potential therapeutic targets for vascular remodeling diseases.

Inter- and Intrahospital Price Variation for Common Cardiovascular Admission Diagnoses, Diagnostic Tests, and Therapeutic Procedures

BACKGROUND

The 2021 Price Transparency Rule was implemented to increase market competition, facilitate price shopping, and reduce prices and health care costs. We sought to measure inter- and intrahospital variation in prices, measure price variation across payer types, and identify hospital characteristics associated with increased commercial prices for 16 common cardiovascular admission diagnoses, diagnostic tests, and therapeutic procedures.

METHODS AND RESULTS

Prices were obtained from Turquoise Health, a platform that aggregates hospital prices from publicly available machine-readable files, for each diagnosis, test, and procedure based on Current Procedural Terminology (CPT) and Medicare Severity Diagnosis Related Group (DRG) codes. Hospital characteristics were identified using Dartmouth Atlas data. Inter- and intrahospital price variations were measured using ratios. Multivariate linear mixed-effects models were fit to determine the association between hospital characteristics and hospital-level median commercial negotiated rates. We evaluated 1 020 349 unique rates across all diagnoses, tests, and procedures. The median (interquartile range) ratio of maximum to minimum commercial prices within hospitals ranged from 1.71 (1.14-2.53) for syncope and collapse to 3.1 (2.06-4.58) for cardiac valve surgery. Many hospital referral regions had 90th percentile commercial prices 2 to 3 times larger than 10th percentile commercial prices. Nonprofit status and high hospital market concentration were associated with increased commercial prices across all diagnoses, tests, and procedures.

CONCLUSIONS

There is significant price variation for common cardiovascular admission diagnoses, tests, and procedures across and within hospitals as well as across payer types. Increased hospital market concentration is associated with increased commercial prices, so efforts to improve market competition alongside improving transparency compliance are warranted.

Outer radial glia promotes white matter regeneration after neonatal brain injury

The developing gyrencephalic brain contains a large population of neural stem cells in the ventricular zone and outer subventricular zone (OSVZ), the latter populated by outer radial glia (oRG). The role of oRG during postnatal development is not well understood. We show that oRG cells increase proliferative capacity and contribute to oligodendrocyte precursor cell (OPC) production following brain injury in human infants and neonatal piglets, whose brains resemble the human brain in structure and development. RNA sequencing revealed oRG-specific transcriptional responses to injury in piglets and showed that the activating transcription factor 5 (ATF5) pathway positively regulates oRG proliferation. Intranasal activation of ATF5 using salubrinal enhanced OSVZ-derived oligodendrogenesis in the injured periventricular white matter and improved functional recovery. These results reveal a key role for postnatal oRG in brain injury recovery and identify ATF5 as a potential therapeutic target for treating white matter injury in infants.

Bioinformatics Approach to Investigating the Immuno-Inflammatory Mechanisms of Periodontitis in the Progression of Atherosclerosis

Unstable atherosclerotic plaques are a major cause of acute cardiovascular events and ischemic stroke. Clinical studies have suggested a link between periodontitis and atherosclerotic plaque progression, but the underlying mechanisms remain unclear. To investigate this, transcriptomic datasets related to periodontitis and atherosclerosis were downloaded from Gene Expression Omnibus. A weighted gene co-expression network analysis was used to identify gene modules associated with periodontitis, and the Limma R package identified differentially expressed genes (DEGs) between unstable and stable plaques. Overlapping genes were defined as periodontitis-related DEGs, followed by functional enrichment analysis and protein-protein interaction network construction. Machine learning methods were used to identify biomarkers for unstable plaques related to periodontitis, which were validated using external datasets. Immune infiltration and single-cell analyses were performed to explore the relationship between biomarkers and immune cells. A total of 161 periodontitis-related DEGs were identified, with the pathway analysis showing associations with immune regulation and collagen matrix degradation. HCK, NCKAP1L, and WAS were identified as biomarkers for unstable plaques, demonstrating a high diagnostic value (AUC: 0.9884, 95% CI: 0.9641-1). Immune infiltration analysis revealed an increase in macrophages within unstable plaques. Single-cell analysis showed HCK expression in macrophages and dendritic cells, while NCKAP1L and WAS were expressed in macrophages, dendritic cells, NK cells, and T cells. Consensus clustering identified three expression patterns within unstable plaques. Our findings were validated in atherosclerotic mouse models with periodontitis. This study provides insights into how periodontitis contributes to plaque instability, supporting diagnosis and intervention in patients with periodontitis.

Emergency medicine updates: Cardiac arrest medications

INTRODUCTION

Cardiac arrest is a serious condition frequently managed in the emergency department (ED). Medications are a component of cardiac arrest management.

OBJECTIVE

This paper evaluates key evidence-based updates concerning medications used for patients in cardiac arrest.

DISCUSSION

Several medications have been evaluated for use in cardiac arrest. Routes of administration may include intravenous (IV) and intraosseous (IO). IV administration is recommended, though if an attempt at IV access is unsuccessful, IO access can be utilized. Epinephrine is a core component of guidelines, which recommend 1 mg in those with shockable rhythms if initial CPR and defibrillation are unsuccessful, while in nonshockable rhythms, guidelines recommend that epinephrine 1 mg be administered as soon as feasible. While epinephrine may improve rates of ROSC, it is not associated with improved survival with a favorable neurologic outcome. Evidence suggests the combination of vasopressin, steroids, and epinephrine may improve ROSC among those with in-hospital cardiac arrest, but there is no improvement in survival to discharge and survival with a favorable neurologic outcome. Antiarrhythmics (e.g., amiodarone, lidocaine, procainamide) likely do not improve short-term or long-term survival or neurologic outcomes, though guidelines state that amiodarone may be used in those with cardiac arrest and refractory pulseless ventricular tachycardia (pVT)/ventricular fibrillation (VF). Calcium and sodium bicarbonate should not be routinely administered in those with cardiac arrest. Beta-blockers may be considered in those with shock-resistant pVT/VF.

CONCLUSIONS

An understanding of literature updates concerning medication use in cardiac can improve the ED care of these patients.

Association of salt added to food with risk of cardiovascular diseases: A 2-sample Mendelian randomization study

Salt added to food is believed to potentially influence the risk of cardiovascular diseases (CVD), however, more evidence needs further verification. Here, we conducted a 2-sample Mendelian randomization (MR) study to systematically investigate the associations of salt added to food with 11 types of cardiovascular diseases in the general population. The primary MR analysis adopts the inverse-variance weighting (IVW) method, complemented by ancillary analyses utilizing IVW (fixed effects), weighted medium, maximum likelihood, and penalized weighted median methodologies. The main pleiotropy of genetic variation and sensitivity analysis were correspondingly applied to test the reliability of the results, and the MR-Egger test are the core evaluation methods. Notably, genetically predicted salt added to food demonstrates causal associations with vein thromboembolism (IVW odds ratio [OR]: 1.0084, 95% confidence interval [CI]: 1.0024-1.0143, P = .0056), atrial fibrillation and flutter (IVW OR: 1.3176, 95% CI: 1.0154-1.7098, P = .0380), ischemic stroke (IVW OR: 1.1852, 95% CI: 1.0092-1.3918, P = .0383) and peripheral artery disease (IVW OR: 1.0040, 95% CI: 1.0015-1.0065, P = .0016). These findings provide valuable insights that may guide the development of targeted prevention strategies and interventions focused on dietary habits in the context of cardiovascular diseases.

Pro: All Cardiac Arrest Patients Should Be Transferred To a Cardiac Arrest Center

Out-of-hospital cardiac arrest (OHCA) is characterized by a high prevalence and is burdened by significant mortality and morbidity. While underlying atherosclerotic coronary artery disease accounts for the majority of the cases in the Western world owing to lifestyle and dietary customs, several other conditions and diseases can lead to OHCA. Although patient survival rates have doubled over the past 3 decades, only marginal improvements in terms of overall survival and neurologic outcomes have been observed over the last decade. A growing body of evidence suggests that regional differences in OHCA outcomes may be attributable to differences in hospital infrastructure and healthcare provider expertise, thus contributing to increased awareness of the importance of cardiac arrest centers (CACs). CACs are centers of excellence for post-cardiac arrest care, which provide dedicated, continuous access to specialized multidisciplinary facilities and expert physicians (eg, emergency department, cardiac intensive care unit, coronary angiography laboratory, rehabilitation departments), ultimately seeking to optimize patient management and improve their survival rates and functional outcomes. Here we provide an overview of the complex management of OHCA patients and outline evidence-based benefits that can result from the treatment of OHCA patients in dedicated CACs.

Aberrant neuronal excitation promotes neuroinflammation in the primary motor cortex of ischemic stroke mice

Current treatments for ischemic stroke aim to achieve rapid reperfusion with intravenous thrombolysis and/or endovascular thrombectomy, which have proven to attenuate disability. Despite the significant progress in reperfusion therapies, functional recovery remains inconsistent, primarily due to ongoing neuronal excitotoxicity and neuroinflammation. In this study we investigated the relationship between neuronal activity and neuroinflammation in an ischemic mouse model using chemogenetic techniques. MCAO cerebral ischemia model was established in mice; in vitro oxygen-glucose deprivation/reoxygenation (OGD/R) was established in PC12 neurons. By measuring c-Fos expression, we showed that MCAO caused the activation of both excitatory and inhibitory neurons within the M1 primary motor cortex, which subsequently induced reactive activation of local microglia through the secretion of unique neuronal extracellular vesicles (EVs). Chemogenetic inhibition of abnormal neuronal activity in stroke-affected cortical neurons reversed microglia activation and reduced neuronal apoptosis. By analyzing the miRNAs in EVs from the ischemic M1 cortex, we found that miR-128-3p was significantly downregulated in ischemia-challenged neurons and their EVs, leading to neuronal injury and proinflammatory polarization of microglia. Intravenous injection of miR-128-3p mimics significantly improved neuronal survival, reduced neuroinflammation accompanied by better functional recovery after ischemic stroke. In summary, stroke-induced abnormal neuronal activity reduces miR-128-3p levels in ischemic neurons and EVs, leading to increased microglia activation and neuronal injury after a stroke. The study highlights that inhibiting abnormal neuronal activity or delivering miR-128-3p-enriched EVs as novel methods for stroke treatment.

Gender-specific associations between sleep stages and cardiovascular risk factors

STUDY OBJECTIVES

Sleep characteristics are associated with cardiovascular disease (CVD) risk and both sleep and CVD risk vary by gender. Our objective was to examine associations between polysomnographic sleep characteristics and CVD risk after excluding moderate-severe sleep apnea, and whether gender modifies these associations.

METHODS

This was a cross-sectional study with at-home polysomnography in adults in Brazil (n = 1102 participants with apnea-hypopnea index (AHI) <15 events/hour). Primary exposures were N3, REM, wake after sleep onset (WASO), arousal index, and AHI, and outcomes were blood pressure (BP) and lipid levels.

RESULTS

Associations between sleep and BP varied by gender. In women, more N3 was associated with lower systolic BP (-0.40 mmHg per 10 minutes, 95% CI: -0.71, -0.09), lower diastolic BP (-0.29 mmHg per 10 minutes, 95% CI: -0.50, -0.07), and lower odds of hypertension (OR 0.94, 95% CI: 0.89, 0.98). In men, more WASO was associated with higher systolic BP (0.41 mmHg per 10 minutes, 95% CI: 0.08, 0.74) and higher odds of hypertension (OR 1.07, 95% CI: 1.01, 1.14). No interactions by gender were observed for lipids. More WASO was associated with lower total cholesterol (-0.71 per 10 minutes, 95% CI: -1.37, -0.05). Higher AHI was associated with higher total cholesterol (+0.97 per event/hour, 95% CI: 0.24, 1.70) and higher LDL (+0.84 per event/hour, 95% CI: 0.04, 1.64).

CONCLUSIONS

N3 is more strongly associated with BP in women, which is consistent with other studies demonstrating gender differences in BP control and CVD risk and adds a novel risk factor. Longitudinal and interventional studies are required to determine whether changes in N3 result in BP changes.

The influence of FADS genetic variation and omega-3 fatty acid deficiency on cardiometabolic disease risk in a Mexican American population

Background

Latinos, the largest racial/ethnic minority group in the United States, have high rates of cardiometabolic diseases, hypothesized due in part to genetic variation in the fatty acid desaturase (FADS) cluster that is associated with reduced omega-3 (n-3) highly unsaturated fatty acid (HUFA) biosynthesis. This study examined how variations in FADS and other HUFA pathway-related genes (ELOVL5 and ELOVL2) impact cardiometabolic disease risk factors in Latinos of Mexican Ancestry (LMA).

Results

This study analyzed 493 self-identified LMA from the Arizona Insulin Resistance registry (AIR) and found a marked enrichment in FADS alleles linked the ancestral haplotype (AH) compared to European Americans. LMA individuals with two AH alleles produced markedly lower levels of n-6 and n-3 HUFAs. However, this was more pronounced with the n-3 HUFAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), where the n-6 arachidonic acid (ARA) to EPA and DHA ratios were 30:1 and 5:1, respectively, and circulating EPA levels were reduced to <5 ng/mL. Importantly, genetic variations in both FADS and ELOVL2/5 regions also were strongly associated with several cardiometabolic disease (CMD) markers, with the presence of two FADS AH alleles corresponding to a 45, 33, and 41% increase in fasting insulin, triglyceride levels and HOMA-IR, respectively.

Conclusion

This study reveals the potential impact of genetically influenced HUFA regulation and n-3 HUFA deficiency on cardiometabolic disease risk within LMA. These insights provide a strong rationale for future studies and clinical trials that focus on n-3 HUFA supplementation to mitigate CMD disparities in LMA populations.

Huang-Lian-Jie-Du decoction inhibits CD4+ T cell infiltration into CNS in MCAO rats by regulating BBB

BACKGROUND

Stroke, especially ischemic stroke (IS), represents a major global health challenge due to its high incidence, disability, mortality, recurrence, and economic impact. The limited therapeutic window for thrombolysis underscores the need for new treatments. The blood-brain barrier (BBB), which protects the brain, becomes compromised following ischemia-reperfusion injury, allowing peripheral immune cell infiltration and subsequent neuroinflammation. Huang-Lian-Jie-Du Decoction (HLJDT), a traditional formula with significant neuroprotective effects demonstrated in preliminary studies and literature reviews, has not yet been fully explored for its potential to inhibit peripheral immune cell infiltration through BBB protection.

PURPOSE

This study aims to: (1) Evaluate the efficacy of HLJDT in treating MCAO. (2) Observe the regulatory effect of HLJDT on the infiltration of CD4+ T cells into the central nervous system. (3) Investigate the effect of HLJDT on the Wnt/β-Catenin Signaling Pathway.

METHODS

A focal MCAO reperfusion model will be used to evaluate HLJDT's effects on neurological function (Zea Longa and Garcia scores), infarction volume (TTC staining), and pathological changes (HE and NISSL staining). Immune-inflammatory responses will be assessed using ELISA for cytokines, flow cytometry for T lymphocyte distribution, and immunofluorescence staining for CD4+ T cell infiltration. The interaction of T cell antigens (LFA-1) and endothelial adhesion molecules (ICAM-1) will be studied with ELISA and immunofluorescence. BBB protection will be evaluated with Evans blue staining and transmission electron microscopy. Mechanisms of T cell infiltration will be examined using transmission electron microscopy and Western blotting (WB) for key proteins. Additionally, the impact of HLJDT on the Wnt/β-catenin pathway will be assessed with WB.

RESULTS

HLJDT significantly improves neurological scores, reduces infarction volume, and mitigates pathological damage. It balances CD4+ T cell responses by inhibiting pro-inflammatory cytokines and enhancing anti-inflammatory ones, reducing CD4+ T cell CNS infiltration. HLJDT inhibits LFA-1/ICAM-1 interactions. It can also inhibit CD4+ T cell infiltration by repairing paracellular and transcellular structures of the BBB, with the Wnt/β-catenin signaling pathway playing a key role in this process.

CONCLUSION

We have innovatively demonstrated for the first time that HLJDT can regulate the balance between peripheral and central immune inflammation. It inhibits LFA-1/ICAM-1-mediated cell adhesion and, by modulating the Wnt/β-catenin pathway, improves the paracellular and transcellular structures of the blood-brain barrier, thereby suppressing CD4+ T cell infiltration and providing multifaceted protective effects for MCAO rats.

Cardiac Repair and Regeneration via Advanced Technology: Narrative Literature Review

BACKGROUND

Cardiovascular diseases (CVDs) are the leading cause of death globally, and almost one-half of all adults in the United States have at least one form of heart disease. This review focused on advanced technologies, genetic variables in CVD, and biomaterials used for organ-independent cardiovascular repair systems.

OBJECTIVE

A variety of implantable and wearable devices, including biosensor-equipped cardiovascular stents and biocompatible cardiac patches, have been developed and evaluated. The incorporation of those strategies will hold a bright future in the management of CVD in advanced clinical practice.

METHODS

This study employed widely used academic search systems, such as Google Scholar, PubMed, and Web of Science. Recent progress in diagnostic and treatment methods against CVD, as described in the content, are extensively examined. The innovative bioengineering, gene delivery, cell biology, and artificial intelligence-based technologies that will continuously revolutionize biomedical devices for cardiovascular repair and regeneration are also discussed. The novel, balanced, contemporary, query-based method adapted in this manuscript defined the extent to which an updated literature review could efficiently provide research on the evidence-based, comprehensive applicability of cardiovascular devices for clinical treatment against CVD.

RESULTS

Advanced technologies along with artificial intelligence-based telehealth will be essential to create efficient implantable biomedical devices, including cardiovascular stents. The proper statistical approaches along with results from clinical studies including model-based risk probability prediction from genetic and physiological variables are integral for monitoring and treatment of CVD risk.

CONCLUSIONS

To overcome the current obstacles in cardiac repair and regeneration and achieve successful therapeutic applications, future interdisciplinary collaborative work is essential. Novel cardiovascular devices and their targeted treatments will accomplish enhanced health care delivery and improved therapeutic efficacy against CVD. As the review articles contain comprehensive sources for state-of-the-art evidence for clinicians, these high-quality reviews will serve as a first outline of the updated progress on cardiovascular devices before undertaking clinical studies.

Electrocardiogram-based machine learning for risk stratification of patients with suspected acute coronary syndrome

BACKGROUND AND AIMS

The importance of risk stratification in patients with chest pain extends beyond diagnosis and immediate treatment. This study sought to evaluate the prognostic value of electrocardiogram feature-based machine learning models to risk-stratify all-cause mortality in those with chest pain.

METHODS

This was a prospective observational cohort study of consecutive, non-traumatic patients with chest pain. All-cause death was ascertained from multiple sources, including the CDC National Death Index registry. Six machine learning models were trained for survival analysis using 73 morphological electrocardiogram features (80% training with 10-fold cross-validation and 20% testing), followed by a variational Bayesian Gaussian mixture model to define distinct risk groups. The resulting classification performance was compared against the HEART score.

RESULTS

The derivation cohort included 4015 patients (age 59 ± 16 years, 47% women). The mortality rate was 20.3% after a median follow-up period of 3.05 years (interquartile range 1.75-5.32). Extra Survival Trees outperformed other forecasting models, and the derived risk groups successfully classified patients into low-, moderate-, and high-risk groups (log-rank test statistic = 121.14, P < .001). This model outperformed the HEART score, reducing the rate of missed events by >90% with a negative predictive value and sensitivity of 93.4% and 85.9%, compared to 89.0% and 75.0%, respectively. In an independent external testing cohort (N = 3095, age 59 ± 15 years, 44% women, 30-day mortality 3.5%), patients in the moderate [odds ratio 3.62 (1.35-9.74)] and high [odds ratio 6.12 (2.38-15.75)] risk groups had significantly higher odds of mortality compared to those in the low-risk group.

CONCLUSIONS

The externally validated machine learning-based model, exclusively utilizing features from the 12-lead electrocardiogram, outperformed the HEART score in stratifying the mortality risk of patients with acute chest pain. This may have the potential to impact the precision of care delivery and the allocation of resources to those at highest risk of adverse events.

Temporal mRNA Expression of Purinergic P2 Receptors in the Brain Following Cerebral Ischemia and Reperfusion: Similarities and Distinct Variations Between Rats and Mice

Purinergic P2 receptors are crucial in energy utilization and cellular signaling, making them key targets for stroke therapies. This study examines the temporal mRNA expression of all P2 receptors in rats and mice. Both species exhibited a common subset of P2X and P2Y receptors with elevated expression following cerebral ischemia and reperfusion (I/R), highlighting conserved mechanisms across these species. The receptors with upregulated expression in both species were P2X3, P2X4, P2X7, P2Y2, and P2Y6. While these similarities were observed, notable differences in receptor expression emerged between rats and mice. Rats exhibited a broader receptor profile, with five additional receptors (P2X1, P2Y1, P2Y12, P2Y13, and P2Y14) significantly upregulated compared to only two receptors (P2X2 and P2Y4) in mice, highlighting species-specific regulation of receptor expression distinct from the shared receptors. Following cerebral I/R, P2Y12 was the most upregulated receptor in rats, while P2Y2 was the most upregulated in mice. These findings reveal both conserved and species-specific changes in P2 receptor expression following cerebral I/R. Targeting purinergic receptors, particularly those conserved and upregulated in response to stroke, may represent a promising therapeutic approach.

Ultrasound assessment of the association between left atrial remodeling and fibrosis in patients with valvular atrial fibrillation: a clinical investigation

BACKGROUND

Advanced heart failure in patients with valvular atrial fibrillation (VAF) poses a significant threat to human health. Noninvasive assessment of left atrial remodeling in various pathological conditions is instrumental in guiding clinical treatment decisions, evaluating efficacy, and predicting prognosis.

METHODS

The study enrolled 63 patients diagnosed with mitral stenosis (MS), among whom 44 presented concomitant atrial fibrillation (AF) and 19 had sinus rhythm. Left atrial volume and functional parameters were evaluated using real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI) techniques, while left atrial stiffness index (LASI) was calculated accordingly. During surgery, left atrial myocardial specimens were obtained to determine the CVF through histopathological evaluation, reflecting the extent of left atrial myocardial fibrosis. Comparative analysis was conducted between the AF group and the control group regarding left atrial volume, functional parameters, LASI, as well as their correlation with CVF.

RESULTS

(1) Patients with MS combined with AF exhibit larger left atrial volume, decreased strain at all stages, reduced function, and increased stiffness of the left atrium compared to patients in sinus rhythm. (2) LASI was positively correlated with CVF in both the control and AF groups, exhibiting the highest correlation coefficient (p < 0.05).

CONCLUSION

The application of RT-3DE, 2D-STI, and LASI enables effective evaluation of left atrial structure and function changes in patients with VAF. LASI provides a more accurate indication of the extent of myocardial fibrosis.

CLINICAL TRIAL NUMBER

Not applicable.

Blood pressure management in reperfused ischemic stroke

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of intensive systolic blood pressure management (target less than 160 mmHg) versus conventional management (target less than 180 mmHg) in people undergoing ischemic stroke reperfusion via systemic thrombolysis or endovascular thrombectomy.

Interpreting clinical outcomes using different strut thickness in coronary artery disease: insights from vascular imaging analysis

Background

Coronary artery disease is a global health concern that necessitates treatments, such as percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Recent advancements in biodegradable polymer-coated DES have improved long-term outcomes by reducing neointimal hyperplasia. Superior long-term outcomes in patients with ultrathin-strut sirolimus-eluting Orsiro stent (BP-SES) compared with those with thick-strut biolimus-eluting BioMatrix stent (BP-BES) have been shown. This study aimed to explore the mechanisms underlying these differences by using quantitative coronary angiography (QCA) and optical coherence tomography (OCT).

Methods

This sub-analysis of the BIODEGRADE trial, a prospective, randomized, multi-center study, compared BP-SES and BP-BES in patients who underwent PCI between July 2014 and September 2017. Patients with positive stress test results, ischemic symptoms, or those who consented to routine follow-up angiography were included. QCA and OCT were used to evaluate the lumen diameter, cross-sectional areas and stent apposition or coverage. OCT images were analyzed at 1 mm intervals within 5 mm proximal and distal to the stented segment.

Results

Of the 2,341 patients, 689 underwent follow-up angiography between 18- and 36-months post-PCI, and 929 stents were analyzed via QCA. OCT images of 61 participants were available. The BP-SES group exhibited a significantly larger minimal lumen diameter and reduced late lumen loss compared to the BP-BES group (0.34 ± 0.45 mm vs. 0.42 ± 0.44 mm, P = 0.005). OCT analysis showed significantly less neointimal hyperplasia in the BP-SES group (0.04 ± 0.4 mm2 vs. 0.64 ± 0.54 mm2, P < 0.001), with no significant differences in stent strut coverage or inflammation markers, than in the BP-BES group.

Conclusions

QCA and OCT analyses revealed less neointimal growth with BP-SES than with BP-BES, without delayed healing or increased inflammation. These findings underscore the importance of stent design characteristics and suggest that thinner struts may enhance clinical success by reducing restenosis and improving long-term vessel patency.

Clinical Trial Registration

https://clinicaltrials.gov/study/NCT02299011 (NCT02299011).

Transcriptional, proteomic and metabolic drivers of cardiac regeneration

Following injury, many organs are capable of rapid regeneration of necrotic tissue to regain normal function. In contrast, the damaged heart typically replaces tissue with a collagen-rich scar, due to the limited regenerative capacity of its functional contractile cardiomyocytes (CMs). However, this regenerative capacity varies dramatically during development and between species. Furthermore, studies have shown that cardiac regeneration can be enhanced to return contractile function to the damaged heart following myocardial infarction (MI). In this review, we outline the proliferative capacity of CMs in utero, postnatally and in adulthood. We also describe the regenerative capacity of the heart following MI injury. Finally, we focus on the various therapeutic strategies that aim to augment cardiac regeneration in preclinical animal models. These include altering transcripts, microRNAs, extracellular matrix proteins and inducing metabolic rewiring. Together, these therapies aim to return function to the damaged heart and potentially improve the lives of the millions of heart failure patients currently suffering worldwide.

Short-term outpatient follow-up of vericiguat treatment in patients hospitalized for heart failure

Background

Vericiguat-a novel oral soluble guanylate cyclase stimulator-was developed for the treatment of chronic heart failure (HF). Although the value of vericiguat therapy in chronic HF has been gradually recognized, its safety and efficacy in the acute phase of HF remain elusive.

Methods

100 patients with acute HF receiving vericiguat therapy at the China-Japan Union Hospital of Jilin University between September 2022 and June 2023 were retrospectively analyzed. An external control was built from real-world data of acute HF subjects contemporaneously hospitalized in the same hospital using a propensity score matching (PSM) method.

Results

After a median follow-up of 68 days, 80 patients completed at least one outpatient follow-up or had an endpoint event and cardiovascular death occurred in 6 patients. We matched 75 external control patients for this purpose. In single-arm study, overall, although systolic blood pressure (SBP) decreased significantly before and after treatment, there was little change in SBP in the SBP low group (baseline SBP less than 120mmHg) (from 109 mmHg to 105 mmHg, p = 0.109). Estimated glomerular filtration rate (eGFR) and serum potassium did not change significantly (p = 0.521 and 0.070, respectively). However, compared with the renal function normal group, eGFR showed a slower downward trend in the renal insufficiency group (p = 0.025). After using the PSM method, significant improvements in left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide were seen in both groups before and after treatment. There was no significant difference between the two groups. However, the downward trend in eGFR was even less significant in the vericiguat group, with significant differences between the two groups (p = 0.024).

Conclusions

Vericiguat is feasible in acute HF, even in patients with hypotension and renal dysfunction. At the same time, vericiguat may have a potential renoprotective effect, which warrants further exploration.

E3 ubiquitin ligase RNF128 promotes Lys63-linked polyubiquitination on SRB1 in macrophages and aggravates atherosclerosis

Macrophage-derived foam cell formation is the hallmark of atherosclerotic plaques prominently attributed to excessive lipid uptake and metabolic disorders. As a classic membrane-localized ubiquitin ligase, the role of RNF128 in atherosclerosis remains unknown. We discover that RNF128 is specifically expressed in macrophages of the lipid core based on single-cell RNA sequencing data and persistent hyperlipidemia induces the high expression of RNF128 in macrophages. RNF128 ablation in macrophages ameliorates atherosclerosis in both male and female mice under the background of ApoE and LDLR deficiency. Mechanistically, RNF128 directly binds to scavenger receptor B1 (SRB1), preventing its degradation through the lysosomal system and promoting oxidized low-density lipoprotein (oxLDL)-induced foam cell formation and inflammatory response in macrophages. In addition, RNF128 catalyzes Lys63-linked polyubiquitination on the cytoplasmic C-terminus of the SRB1 at lysine 478, which promotes the endosome SRB1 recycling to the cell membrane with the assistance of Rab11, instead of entering the lysosome for degradation.

Guideline for the Use of Natriuretic Peptides in the Early Diagnosis and Management of Heart Failure in Primary Care (Joint Consensus Report by the Eurasian Society of Heart Failure and the Turkish Association of Family Medicine)

Heart failure (HF) is a complex clinical condition associated with significant morbidity and mortality. Early diagnosis and effective management at the primary care level are essential for improving patient outcomes and reducing the burden on the healthcare systems. The Eurasian Society of HF and the Turkish Association of Family Medicine developed a guideline that underscores the critical role of natriuretic peptides (NPs) in the early detection, diagnosis, and management of HF. NPs, particularly the N-terminal pro-B-type NP, are a reliable biomarker for identifying HF, guiding treatment decisions, and monitoring disease progression. This guideline emphasizes the importance of measuring the levels of these peptides in primary care so as to detect individuals at risk, confirm the diagnosis of HF in symptomatic patients, and evaluate the treatment response. The recommended thresholds for NP levels account for variations arising from factors such as age, gender, and the presence of other health conditions. B-type natriuretic peptides (BNP) levels ≥ 35 pg/ml or N-terminus-proBNP levels ≥ 125 pg/ml are used to confirm the likelihood of HF in symptomatic patients, enabling timely diagnosis and appropriate intervention. Incorporating NP testing into routine clinical practice enables timely referrals and ensures appropriate management at all stages of HF. Beyond diagnosis, the measurement of NPs provides valuable information about treatment effectiveness and prognosis, allowing clinicians to individualize the treatment. By integrating NP testing into primary care, healthcare providers can facilitate early detection, optimize treatment strategies, and improve the quality of life for patients with or at risk of HF. Thus, this guideline highlights the essential role of primary care physicians in addressing the growing challenges of HF through the effective and evidence-based use of NPs.

Intronic SYNE1 Gene Novel Variant Associated with Myocardial Infarction in Young People with a Family History of Premature Atherosclerosis: A Case-Control Study in the Polish Population

Premature myocardial infarction (MI) risk factors, including genetic ones, are crucial for an individual risk stratification. The aim of this study was to investigate the role of genetic variants in young patients with MI and a family history of premature atherosclerosis (FHpa). The studied group consisted of 70 patients aged 26-49 (mean 43.1, SD ± 4.3; 17 women, 53 men), with MI and with FHpa. The targeted enrichment library was prepared and analyzed using the Next-Generation Sequencing method. The results of sequencing were compared to data from the reference control population, consisting of 597 people with no history of MI (418 women, 179 men) aged 18-83 (mean 40.5, SD ± 12.4), using Propensity Score Matching. SYNE1 gene variant NM_182961.4:c.20396+22A>G occurs with a significantly higher incidence in the studied group compared to the control population (OR 4.80 95%CI 1.43-14.45; p = 0.005) as a whole and when matched by age and gender (OR 9.31 95%CI 1.64-95.41; p = 0.004). There were no statistically significant differences in the incidence of variants related to familial hypercholesterolemia (LDLR NM_001195800.2:c.667G>A, PCSK9 NM_182961.4:c.658-36G>A NM_174936.3:c.658-36G>A, and APOB NM_000384.3:c.12382G>A) between both cohorts. A novel variant of the SYNE1 gene is associated with MI in young patients with FHpa.

Valvular calcification in chronic kidney disease: new insights from recent clinical and preclinical studies

Valvular calcification, developing either in the mitral or the aortic valve, is highly prevalent in patients suffering from chronic kidney disease (CKD), in whom their presence correlates with higher cardiovascular and all-cause mortality risk. To date, the exact mechanisms that promote heart valve calcification remain unclear, and none of the treatments tested so far have shown efficacy in preventing valvular fibrocalcific remodelling. It is therefore essential to improve our understanding of the mechanisms involved in the pathological process if we are to find new, effective therapies. The purpose of this review is to (i) summarize our current knowledge of the mechanisms by which CKD and related therapies affect valvular cell activity, (ii) present the latest therapeutic targets identified in preclinical studies, and (iii) discuss the most recent clinical trials evaluating the efficacy of therapies aimed at preventing valvular calcification in CKD.

Oxygen-ozone therapy for myocardial ischemic stroke and cardiovascular disorders

Cardiovascular diseases (CVDs) represent a major concern for human health worldwide. Emergencies in this field include wide repertories of studies dealing primarily with CVD prevention. In addition to dietary habits and lifestyles, medical knowledge is fully needed to improve public educational programs toward cardiovascular risk factors and to enrich the endowment of pharmaceutical options and therapies to address CVDs, particularly for ischemic damage due to an impairment in the endothelial-myocardial relationship. Because ozone is a stimulator of the endothelial nitric oxide synthase/nitric oxide pathway, ozone therapy has been widely demonstrated to have the ability to counteract endothelial-cardiac disorders, providing a novel straightforward opportunity to reduce the impact of CVDs, including atrial fibrillation. In this review, we attempt to establish a state-of-the-art method for the use of ozone in CVD, suggesting that future remarks be addressed to provide fundamental insights into this issue. The purpose of this study was to highlight the role of ozone in the adjunctive medical treatment of cardiovascular pathologies such as acute myocardial infarction due to ischemic disorders.

Effects of a physical therapist-driven individualized hybrid model of the exercise component of cardiac rehabilitation on patient outcomes: a prospective single group, time-series design

PURPOSE

The aim of this prospective single group, time-series study was to determine the feasibility, adherence, and effectiveness of an individualized physical therapist (PT)-driven hybrid model of the exercise component of cardiac rehabilitation (CR) that uses a novel intensity-recovery progression protocol (IRPP) and cardiac testing template (CTT) to assess achieved heart rate (HR) intensity, HR recovery, and intensity-recovery total to guide treatment.

METHODS

Assessment of a questionnaire, treadmill 6-min walk (6MW), 1-min sit-to-stand (1STS), 1-min step, and 1-min agility square tests were assessed on 100 participants. Compared to traditional CR the 36-visit 1:1 hybrid model was individualized using the IRPP program and CTT.

RESULTS

Adherence was 35% (timely) and 44% (overall) completion. The per-protocol analysis (PPA) and intent-to-treat (ITT) analysis suggest significant improvement in objective assessments baseline to visit 15 (PPA = 11 of 14) (ITT = 13 of 14), baseline to visit 30 (PPA = 12 of 14) (ITT = 12 of 14) and visit 15 to visit 30 (PPA = 9 of 14) (ITT = 10 of 14). Improvement beyond the minimal clinically important difference (MCID) was 94.3% in the 6MW and 91.4% in the 1STS.

CONCLUSIONS

The PT-driven IRPP program was feasible in terms of adherence and safety, showing significant improvement in a majority of assessments. Analysis of HR using the CTT may help clinical decision making for progression in CR.

Accelerated development of cardiovascular risk factors mediates risk for major adverse cardiovascular events in posttraumatic stress disorder

BACKGROUND

Individuals with posttraumatic stress disorder (PTSD) have high rates of cardiovascular disease (CVD) and increased cardiometabolic CVD risk factors (CVDRFs, e.g., hypertension, hyperlipidemia, or diabetes mellitus). Nevertheless, it remains unknown whether PTSD accelerates CVDRF development and how that impacts the development of major adverse cardiovascular events (MACE) in a broad population. Furthermore, the underlying mechanisms remain incompletely characterized.

OBJECTIVE

We hypothesized that 1) PTSD accelerates CVDRF development, 2) accelerated CVDRF development mediates the PTSD-MACE relationship, and 3) accelerated CVDRF development is partially explained by alterations in neural, autonomic, and inflammatory intermediaries (e.g., stress-associated neural activity [SNA], ventromedial prefrontal cortex [vmPFC] activity, heart rate variability [HRV], and C-reactive protein [CRP]).

METHODS

Subjects (N = 84,343) in the Mass General Brigham Biobank were studied over 10 years. PTSD, CVDRFs, and MACE were identified by diagnostic codes. From participants with available clinical data, neural, autonomic, and inflammatory mediators (e.g., SNA, vmPFC, HRV, and CRP) were assessed.

RESULTS

PTSD independently predicted incident CVDRFs (hazard ratio [95 % confidence interval] = (1.432 [1.287, 1.592], p < 0.001) and associated with the accelerated development of a new CVDRF by ∼ 4 months versus those without PTSD. The development of new CVDRFs predicted incident MACE (1.736 [1.652, 1.823, p < 0.001) and mediated the link between PTSD and MACE (p < 0.05) by up to 36.4 %. Additionally, lower vmPFC activity, lower HRV, and higher CRP were associated with the development of CVDRFs. HRV and CRP significantly mediated the PTSD-CVDRF link.

CONCLUSIONS

The PTSD-MACE link was partially explained by the accelerated development of CVDRFs. Alterations in neural, autonomic, and inflammatory intermediaries contributed to this association. These findings suggest that greater clinical attention to CVDRFs in individuals with PTSD may attenuate MACE risk.

Mitochondrial quality control: Biochemical mechanism of cardiovascular disease

Mitochondria play a key role in the regulation of energy homeostasis and ATP production in cardiac cells. Mitochondrial dysfunction can trigger several pathological events that contribute to the development and progression of cardiovascular diseases. These mechanisms include the induction of oxidative stress, dysregulation of intracellular calcium cycling, activation of the apoptotic pathway, and alteration of lipid metabolism. This review focuses on the role of mitochondria in intracellular signaling associated with cardiovascular diseases, emphasizing the contributions of reactive oxygen species production and mitochondrial dynamics. Indeed, mitochondrial dysfunction has been implicated in every aspect of cardiovascular disease and is currently being evaluated as a potential target for therapeutic interventions. To treat cardiovascular diseases and improve overall heart health, it is important to better understand these biochemical systems. These findings allow the achievement of targeted therapies and preventive measures. Therefore, this review investigates different studies that demonstrate how changes in mitochondrial dynamics like fusion, fission, and mitophagy contribute to the development or worsening of disorders related to heart diseases by summarizing current research on their role.

Acute Coronary Syndromes in Women: A Narrative Review of Sex-Specific Characteristics

Acute coronary syndromes (ACSs) encompass a spectrum of life-threatening cardiovascular conditions, including unstable angina (UA) and myocardial infarction. While significant progress has been made in the understanding and management of ACS over the years, it has become increasingly evident that sex-based differences play a pivotal role in the pathophysiology, presentation, and outcomes of these conditions. Despite this recognition, the majority of clinical research in the field has historically focused on male populations, leading to a significant knowledge gap in understanding the unique aspects of ACS in women. This review article aims to comprehensively explore and synthesize the current body of literature concerning the sex-specific characteristics of ACS, shedding light on the epidemiology, risk factors, clinical presentation, diagnostic challenges, treatment strategies, and prognosis in women. By elucidating the distinct aspects of ACS in women, this review intends to foster greater awareness and improved clinical management, ultimately contributing to enhanced cardiovascular care for female patients.

Protective effects of α-Pinene against carbon tetrachloride-induced cardiac injury in Wistar rats: modulation of antioxidant and inflammatory responses

The escalating global burden of cardiovascular diseases is a growing concern. Numerous research studies have established that plant-derived polyphenols, including α-pinene-a monocyclic monoterpene found in various plant essential oils-have significant effects on key cardiovascular mechanisms. These effects are mediated through their influence on antioxidant systems, cellular signaling pathways, and gene transcription processes. This study investigated the protective effects of α-pinene against cardiac damage caused by carbon tetrachloride (CCl4) in Wistar rats. Rats were divided into four groups: a control group receiving saline, a disease control group-administered CCl4 (1 mL/kg body weight, intraperitoneally), and two treatment groups receiving α-pinene orally at doses of 50 mg/kg and 100 mg/kg body weight alongside CCl4, to assess its dose-dependent effects. We conducted comprehensive evaluations, including assessments of serum and cardiac toxicity biomarkers, inflammatory mediators, antioxidant defense mechanisms, lipid peroxidation levels, lipid profiles, and histopathological analyses. CCl4 exposure resulted in notable increases in free fatty acids (FFA), total cholesterol (TC), triglycerides (TG), phospholipids (PL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) levels, and a decrease in high-density lipoprotein (HDL) levels. Treatment with α-pinene at 100 mg/kg effectively counteracted these lipid profile changes. CCl4 also caused lipid oxidation and a reduction in antioxidant activities, which were restored to normal levels with α-pinene treatment at 100 mg/kg body weight. Moreover, an upsurge in inflammatory markers (interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and high-sensitivity C-reactive protein (Hs-CRP)) and cardiac toxicity biomarkers (creatine kinase (CK), and creatine kinase-myocardial band (CK-MB) and troponin) induced by CCl4 intoxication was reversed by α-pinene. Histopathological studies further validated these findings. The study concludes that α-pinene, administered at a dosage of 100 mg/kg body weight, effectively alleviates cardiac injury induced by CCl4. The data suggest that α-pinene exerts its protective effects through modulation of various signaling pathways involved in CCl4-induced cardiac toxicity.

Bioengineering Strategies for Treating Neointimal Hyperplasia in Peripheral Vasculature: Innovations and Challenges

Neointimal hyperplasia, a pathological response to arterial interventions or injury, often leads to restenosis and recurrent narrowing or occlusion, particularly in the peripheral vasculature. Its prevalence and negative impact on the long-term success of vascular interventions have driven extensive research aimed at better understanding the condition and developing effective therapies. This review provides a comprehensive overview of emerging bioengineering strategies for treating neointimal hyperplasia in peripheral vessels. These approaches include novel therapeutics and cell-based technologies designed to promote re-endothelialization, modulate vascular smooth muscle cell (VSMC) phenotype, reduce inflammation, scavenge reactive oxygen species (ROS), and enhance biomechanical compatibility between grafts and native vessels. Furthermore, advanced therapeutic delivery modalities are highlighted for their potential to achieve targeted, localized treatment at injury sites. This review also explores underrepresented therapeutic targets beyond traditional approaches, offering new opportunities for intervention. The multifaceted examination underscores the challenge of neointimal hyperplasia and presents a promising roadmap toward more effective treatments, ultimately aiming to improve patient outcomes after vascular interventions.

A novel hybrid ViT-LSTM model with explainable AI for brain stroke detection and classification in CT images: A case study of Rajshahi region

Computed tomography (CT) scans play a key role in the diagnosis of stroke, a leading cause of morbidity and mortality worldwide. However, interpreting these scans is often challenging, necessitating automated solutions for timely and accurate diagnosis. This research proposed a novel hybrid model that integrates a Vision Transformer (ViT) and a Long Short Term Memory (LSTM) to accurately detect and classify stroke characteristics using CT images. The ViT identifies essential features from CT images, while LSTM processes sequential information generated by the ViT, adept at capturing crucial temporal dependencies for understanding patterns and context in sequential data. Moreover, our approach addresses class imbalance issues in stroke datasets by utilizing advanced strategies to improve model robustness. To ensure clinical relevance, Explainable Artificial Intelligence (XAI) methods, including attention maps, SHAP, and LIME, were incorporated to provide reliable and interpretable predictions. The proposed model was evaluated using the primary BrSCTHD-2023 dataset, collected from Rajshahi Medical College Hospital, achieving top accuracies of 73.80%, 91.61%, 93.50%, and 94.55% with the SGD, RMSProp, Adam, and AdamW optimizers, respectively. To further validate and generalize the model, it was also tested on the Kaggle brain stroke dataset, where it achieved an impressive accuracy of 96.61%. The proposed ViT-LSTM model significantly outperformed traditional CNNs and ViT models, demonstrating superior diagnostic performance and generalizability. This study advances automated stroke diagnosis by combining deep learning innovations, domain expertise, and enhanced interpretability to support clinical decision-making, providing reliable diagnostic solutions.

Hypertensive pregnancy disorder, an under-recognized women specific risk factor for heart failure?

During pregnancy, the maternal cardiovascular (CV) system undergoes major haemodynamic alterations ensuring adequate placental perfusion and a healthy pregnancy course. Hypertensive disorders of pregnancy (HDP) occur in almost 10% of gestations and preeclampsia, a more severe form, in 3-4%. Women with HDP demonstrated impaired myocardial function, biventricular chamber dysfunction and adverse biventricular remodelling. Shortly after delivery, women who experienced HDP express increased risk of classic CV risk factors such as hypertension, renal disease, abnormal lipid profile, and diabetes. Within the first two decades following a HDP, women experience increased rates of heart failure, chronic hypertension, ischaemic heart and cerebral disease. The mechanism underlying the relationship between HDP in younger women and CV disease later in life could be explained by sharing pre-pregnancy CV risk factors or due to a direct impact of HDP on the maternal CV system conferring a state of increased susceptibility to future metabolic or haemodynamic insults. Racial disparities in CV risk and social determinants of health also play an important role in their remote CV risk. Although there is general agreement that women who suffered from HDP should undertake early CV screening to allow appropriate prevention and timely treatment, a screening and intervention protocol has not been standardized due to limited available evidence. In this review, we discuss why women with hypertensive pregnancy may be disproportionately affected by heart failure with preserved ejection fraction and how cardiac remodelling during or after pregnancy may influence its development.

Allograft inflammatory Factor-1 induces the dedifferentiation of Vascular Smooth Muscle cells into a macrophage-like phenotype both in vivo and in vitro

Atherosclerosis, a chronic lipid-driven vascular inflammatory disease involving multiple cell types, is the primary cause of cardiovascular disease-related morbidity and mortality. Allograft inflammatory factor 1 (AIF-1) contributes to atherosclerosis development by affecting vascular smooth muscle cells (VSMCs). Increasing research indicates that VSMCs are pivotal in atherosclerosis progression, particularly in macrophage-like phenotypic switching, though the mechanism of AIF-1 VSMCs phenotypic switching is not well understood. This study aims to correlate AIF-1 expression with atherosclerosis development and VSMCs phenotypic switching. AIF-1 was expressed in the atherosclerotic plaques of patients with carotid artery narrowing and atherosclerosis mice. AIF-1 was expressed in ox-LDL treated VSMCs and promoted the apoptosis of VSMCs. AIF-1 significantly influenced macrophage-like VSMC numbers through the AIF-1/NF-κB pathway, enhancing lipid uptake and TNF-α and IL-6 secretion. This study showed increased AIF-1 expression in atherosclerotic plaques in both patients with carotid stenosis and an atherosclerosis animal model. AIF-1 facilitated VSMC dedifferentiation into macrophage-like cells, enhancing lipid uptake and inflammatory factor release through the AIF-1/NF-κB pathway.

Proteomic analysis reveals QiShenYiQi Pills ameliorates ischemia-induced heart failure through inhibition of mitochondrial fission

BACKGROUND

QiShenYiQi Pills (QSYQ) has widely used in clinical treatment of cardiovascular diseases; however, the exact mechanism behind its effectiveness still requires further investigation.

PURPOSE

The purpose of the study was to explore the potential mechanism of QSYQ in the treatment of ischemic heart failure from the perspective of proteomics.

METHODS

In vivo, to observe QSYQ actions on the progression of ischemia-induced heart failure, cardiac function and remodeling was analyzed. The heart tissues of mice were used for Tandem Mass Tag (TMT)-based proteomic analysis. Cardiomyocytes were prepared and subjected to oxygen-glucose deprivation injury. QSYQ effects on differential proteins expressions, mitochondrial fission and mitochondrial function were assayed.

RESULTS

QSYQ treatment preserved cardiac function, limited cardiac fibrosis and alleviated cardiomyocyte hypertrophy in post-myocardial ischemia mice. Proteomic analysis revealed that QSYQ-responsive proteins were mainly involved in mitochondrial fission, including mitochondrial calcium uniporter (MCU), membrane associated ring-CH-type finger 5 (MARCHF5), and mitochondrial fission process 1 (MTFP1). Protein-protein interaction analysis revealed that MCU, MARCHF5 and MTFP1 commonly interacted with dynamin-related protein 1 (DRP1). Knockdown of MCU, MARCHF5, or MTFP1 attenuated excessive mitochondrial fission in cardiomyocytes through regulating DRP1 phosphorylation and its mitochondrial translocation. QSYQ decreased the phosphorylation of DRP1 at Ser616 and enhanced its inhibitory phosphorylation at Ser637, as well as mitigating the mitochondrial recruitment and oligomerization of DRP1, through downregulation of these three differential proteins. As a result, QSYQ alleviated aberrant mitochondrial fission, ameliorated mitochondrial dysfunction, and protected cardiomyocytes from ischemic injury.

CONCLUSION

The novelty lies in the proteomics-based investigation of the mechanism of QSYQ, uncovering that QSYQ mitigated ischemia-induced heart failure by suppressing MCU/MARCHF5/MTFP1-DRP1-driven mitochondrial fission.

Cardiomyocytic FoxP3 Attenuates Expression of β Isoform of Myosin Heavy Chain During Cardiac Hypertrophy and Effects of Triptolide

Cardiac hypertrophy, a maladaptive response to chronic stress, progresses to heart failure through mechanisms requiring deeper exploration. While forkhead helix transcription factor P3 (FoxP3) is well-known as a key regulator in CD4+ T cells, its role in cardiomyocytes remains unclear. Here, by using isoproterenol (ISO)-induced cardiac hypertrophy models (40 mg/kg daily for in vivo study and 10 μmol/L for in vitro study), we revealed the protective role of FoxP3 in cardiac hypertrophy. Though modulating FoxP3 expression using siRNA or plasmid in cardiomyocytes, we found that FoxP3 knockdown exacerbated ISO-induced hypertrophic responses, while overexpression of FoxP3 attenuated hypertrophic effects. The protective function of cardiomyocytic FoxP3 in vivo was further confirmed by infection of adeno-associated virus. Mechanically, the cardiomyocytic FoxP3 decreased the expression of nuclear factor of activated T cells c3 (NFATc3), a key regulator of hypertrophy-related genes, to suppress hypertrophy-related genes, including atrial natriuretic peptide, brain natriuretic peptide and β-myosin heavy chain (β-MHC), and thus ameliorate hypertrophic responses. Besides, the immunoprecipitation and immunofluorescence determination showed that FoxP3 could interact with NFATc3 in the nucleus to form a transcription complex, thereby regulating the transcription activity of NFATc3. Chromatin immunoprecipitation (ChIP) and electrophoretic mobility shift assays (EMSAs) revealed the specific binding sequences of FoxP3 in the β-MHC promoter region, with binding occupancy reduced by ISO, suggesting that FoxP3 could interact with NFATc3 to down-regulate the β-MHC expression. Importantly, we identified triptolide (TP), a bioactive natural product, as a potent inducer of FoxP3 expression. Both in vivo (10 μg/kg daily) and in vitro (10 μmol/L) studies demonstrated that TP significantly reversed cardiac hypertrophy by upregulating FoxP3 expression, thereby inhibiting NFATc3-mediated β-MHC transcription. These findings highlight cardiomyocytic FoxP3 as a novel protective factor, elucidating its underlying mechanisms and demonstrating the therapeutic potential of TP in this process.

Integration of Palliative Care into Heart Failure Care: Consensus-Based Recommendations from the Heart Failure Society of America

Heart failure (HF) is characterized by significant symptoms, compromised quality of life, frequent hospital admissions, and high mortality rates; palliative care (PC) is, therefore, highly relevant for patients with HF and their clinicians. Multiple guidelines and consensus statements recommend the provision of PC alongside HF management. However, few resources exist to guide the integration of PC into HF care, for both primary PC (provided by HF clinicians in the course of HF care) and specialty PC (provided by PC specialists). Through this consensus statement, the Heart Failure Society of America aims to provide a contemporary, practical guide for clinicians and institutions about how PC should be operationalized in the context of comprehensive HF care. Key components of high-quality, integrated HF-PC are described, with a focus on clinical and operational considerations for providing primary and specialty PC, quality measurement and value demonstration, reimbursement and incentive concerns, and the provision of hospice care.

Salvianolic acid B drives gluconeogenesis and peroxisomal redox remodeling in cardiac ischemia/reperfusion injury: A metabolism regulation by metabolite signal crosstalk

Cardiac metabolism relies on glycogen conversion by glycolysis. Glycolysis intersects fatty acid oxidation and often directs a signal crosstalk between redox metabolites. Myocardium with ischemia/reperfusion significantly diverts from normal metabolism. Prospectively, peroxisome lies central to metabolism and redox changes, but mechanisms underlying in ischemia/reperfusion remain undefined. This work aims at investigating the potential effects and mechanisms of Salvianolic acid B (Sal B) in cardioprotection through metabolic remodeling. Following experiments, we found that Sal B is absorbed in blood and rat hearts and its cardiac absorption prevents ischemia/reperfusion injury. Sal B cardioprotection relates to gluconeogenesis activation and peroxisomal redox remodeling. Gluconeogenesis compensates glycogen synthesis through upregulating pyruvate carboxylase (PC) and phosphoenolpyruvate carboxykinase. Gluconeogenic PC activity drives peroxisomal Pex2/Pex3 expressions and promotes the proliferation of peroxisome. Peroxisome quality control is enhanced with Pex5/Pex14/Pex13/Pex2 transcriptions. Nono, a non-POU domain-containing octamer-binding protein, promotes upregulation of gluconeogenic PC and peroxisomal gene transcripts through transcriptionally splicing their pre-RNAs at octamer duplex. Nono also controls the expression of SARM1/PARP1/sirtuin1 for catalyzing nicotinamide adenine dinucleotide (NAD+) consumption, leading to endurable redox capacities of peroxisome. Peroxisomal redox remodeling alters reactive oxygen species (ROS) and NAD+ contents, following which NAD+ affects cardiac accumulation of physiologically harmful glucocorticoid. In the tests of Sal B combinational treatments, results indicate ROS upregulation whereas NAD+ downregulation with glucocorticoid, ROS scavenging and glucocorticoid elimination with NAD+ precursor, and NAD+ promotion with ROS scavenger, respectively. This metabolite signal crosstalk alternatively antagonizes/agonizes Sal B cardioprotective functions on electrocardiographic output and infarction. Taken together, we reported a cardiac metabolism regulation with Sal B, capable of preventing myocardium from ischemia/reperfusion injury. The metabolite signal crosstalk was achieved by coupling reaction cascades between gluconeogenesis and peroxisomal redox remodeling.

Epigenetic Clock Analysis for National Institutes of Health Stroke Scale in Patients With Ischemic Stroke

AIM

Strokes are the second most common cause of mortality and disability worldwide. Ischemic strokes account for the main part of strokes. Recently, the epigenetic changes that occur during biological aging through DNA methylation have gained attention. The National Institutes of Health Stroke Scale (NIHSS) scores measure physical and cognitive function. We hypothesized that there are associations between acute changes in the NIHSS score and biological aging in patients with ischemic stroke. We conducted epigenetic clock analyses to investigate the association between the difference in NIHSS (dNIHSS) and epigenetic clock in patients with ischemic stroke.

METHODS

We used two publicly available DNA methylation data sets from Caucasian patients with ischemic stroke in Spain. The discovery data set consists of 59 patients with ischemic stroke, and the replication dataset consists of 62. Acceleration of several epigenetic clocks (HorvathAge, HannumAge, SkinBloodAge, PhenoAge, GrimAge, GrimAge2, DNA methylation-based telomere length, and DunedinPACE), GrimAge components, and GrimAge2 components was analyzed with standard multiple regression analyses with dNIHSS. We obtained information on dNIHSS between discharge and baseline for each patient. We integrated these results from the two data sets using meta-analyses.

RESULTS

There was no significant association in the epigenetic age acceleration. The predictive value of only Cystatin C showed a significant association with dNIHSS in the GrimAge components.

CONCLUSIONS

We could not find a significant association between the severity during the acute phase of ischemic stroke and epigenetic clocks. We may be able to find different findings with a larger sample size and longitudinal data such as NIHSS scores at fixed intervals.

Assessment of heart and lung morphology in a single case during cardiopulmonary resuscitation: A virtual simulation

Background

Basic science research in cardiopulmonary resuscitation (CPR) is limited by challenges in obtaining haemodynamic data from models that simulate physiological processes. In this study, we assessed the morphology of the heart and lungs and calculated the ejection fractions of cardiac chambers during CPR using a virtual simulation.

Methods

A finite element model of a complete thorax, including internal organs, thoracic rib cage, spine, musculature, and a generic material representing soft tissues, was constructed from magentic resonance images of a man. Twelve chest compression simulations were performed with forces ranging from F = 50 to 600 N. During compression, lung and heart volumes were assessed, and the ejection fraction of each cardiac chamber was calculated.

Results

In our numerical simulations a compression depth of 5.06 cm was reached with a force of 450 N. At this depth, the right and left ventricular ejection fractions were 34.0% and 14.4%, respectively, while the right and left atrial ejection fractions were 22.1% and 24.2%, respectively. The cross-sectional area of the outflow tract decreased by 27.5% and 15.6% in the right and left ventricles, respectively. Lung volumes decreased by 193 cm3 and 169 cm3 in the right and left lungs, respectively, representing 11.2% of the total lung volume.

Conclusion

The right ventricle exhibited the highest ejection fraction among the cardiac chambers, and the left atrium showed a higher ejection fraction than the left ventricle during CPR.

High-risk characteristics of recurrent ischemic stroke after intensive medical management for 6-month follow-up: a histogram study on vessel wall MRI

OBJECTIVE

Intensive medical management has been recommended for ischemic stroke of intracranial atherosclerosis (ICAS), but 9.4-15% probability of recurrent stroke remains an inevitable reality. The characteristics of high-risk intracranial plaque that contribute to stroke recurrence after intensive therapy are unclear.

METHODS

The patients of acute ischemic stroke due to ICAS from two centers were prospectively analyzed, who underwent the 3D high-resolution head and neck vessel wall magnetic resonance imaging (hr-VW-MRI) at baseline and received intensive medical management within 90 days. The morphological features, such as minimal lumen area (MLA), and histogram parameters including entropy were assessed based on hr-VW-MR images. The recurrence of ischemic events after 6 months was defined as hyperintensity on diffusion-weighted images in the ipsilateral vascular territory. Cox regression analysis was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for recurrent events.

RESULTS

A total of 222 patients (age 59.5 ± 12.1; males 153) were finally included, and 38 had recurrent stroke after 6 months. After adjusting the age and gender, Cox regression demonstrated that smoking (HR = 4.321; 95% CI, 1.838-10.161; p = 0.001), taking exercise (HR = 0.409; 95% CI, 0.198-0.843; p = 0.015), blood pressure management (HR = 0.180; 95% CI, 0.073-0.443; p = 0.001), MLA (HR = 0.771; 95% CI, 0.625-0.951; p = 0.015) and entropy (HR = 0.274; 95% CI, 0.130-0.576; p = 0.001) were significant predictors of recurrent ischemic stroke. However, the area under curve value of MRI parameters was significantly higher than that of traditional clinical factors (0.86 vs 0.79; p = 0.01).

CONCLUSIONS

The plaque characteristics based on hr-VW-MRI may provide complementary values over traditional clinical features in predicting ischemic recurrence for ICAS.

KEY POINTS

Question The study addresses recurrent ischemic stroke in intracranial atherosclerosis patients, identifying high-risk plaque features that contribute to recurrence despite intensive medical management. Findings Plaque features on high-resolution vessel wall magnetic resonance imaging (hr-VW-MRI), such as minimal lumen area and entropy, improve prediction of stroke recurrence over clinical factors. Clinical relevance This two-center prospective study improves patient care by using hr-VW-MRI and histogram factors like entropy to better predict stroke recurrence, allowing for more personalized treatment strategies and potentially reducing ischemic events in patients with intracranial atherosclerosis.

Effectiveness of acupuncture on glycolipid metabolism in patients with coronary heart disease: A systematic review and meta-analysis

OBJECTIVE

Disorders of glycolipid metabolism are important pathogenic factors leading to coronary artery disease, and there is no safe and effective comprehensive treatment, while acupuncture has a certain efficacy in heart disease and disorders of glycolipid metabolism. To assess the effects of acupuncture on glycolipid metabolism in patients with coronary heart disease, we conducted a systematic review and meta-analysis.

METHODS

From the time of library construction to August 18, 2023, Searches were conducted in eight databases, with no language restriction. Only RCTs that included acupuncture as a sole or secondary effect on glucose-lipid metabolism in coronary heart disease were included.Our primary outcome indicators were Low-density lipoprotein cholesterol(LDL-C), Hemoglobin A1c(HbA1c). Our analyses were conducted in strict accordance with the PRISMA statement, and the researchers used the Cochrane Handbook for literature screening and data extraction, the "Risk of Bias" tool (ROB.2) for assessing risk of bias, and RevMan (version 5.3) for meta-analysis of outcome metrics, and the GRADE criteria for assessing quality of evidence. Assessing the quality of acupuncture literature using the Standards for reporting interventions in clinical trials of acupuncture.

RESULTS

Our analysis included 18 eligible RCTs (N = 1346 participants). For the primary outcome metrics, acupuncture combined with standard treatment was effective in reducing LDL-C (SMD =-0.56; 95 % CI, -0.75 to -0.38; P < 0.00001), and HbA1c (MD = -1.15; 95 % CI, -1.73 to -0.58; P < 0.0001). For secondary outcome measures, combination therapy improved TC (SMD = -0.97; 95 % CI, -1.44 to -0.51; P < 0.0001), TG (MD = -0.39; 95 % CI, -0.58 to -0.20; P < 0.0001), hs-CRP (MD = -0.98; 95 % CI, -1.43 to -0.52; P <0.0001), 2hPG (MD = -1.45; 95 % CI, -1.74 to -1.16; P < 0.00001), and ORR (RR, 1.27; 95 % CI, 1.19-1.36; P < 0.00001) levels more than standard therapy alone.However, the combination therapy did not prevail in lowering HDL-C (MD = 0.11; 95 % CI, 0.07-0.14; P < 0.00001) compared with standard therapy alone. Meanwhile heterogeneity analysis showed that After coronary heart disease intervention, acupuncture was able to reduce TC (SMD = -0.85; 95 % CI, -1.37 to -0.33; P = 0.001), TG (MD = -0.14; 95 % CI, -0.24 to -0.04; P = 0.004) levels, but did not dominate in lowering LDL-C.

CONCLUSIONS

Acupuncture effectively regulates glycolipid metabolism in coronary artery disease, serving as an adjuvant treatment. It may aid post-PCI healing via lipid metabolism regulation, but rigorous, large-scale, long-term RCTs are needed for validation.

Association of Calf Circumference, Hand Grip Strength, and Physical Performance With Serious Adverse Events in Individuals With Subacute Stroke Hospitalized for Rehabilitation: An Observational Study

OBJECTIVE

To determine whether calf circumference, hand grip strength, and physical performance are linked to the incidence of serious adverse events (SAEs) in patients with subacute stroke.

DESIGN

Retrospective cohort study.

SETTING

Single rehabilitation hospital.

PARTICIPANTS

Patients with stroke admitted for rehabilitation hospital.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

The incidence of SAEs, such as death, cardiovascular events including recurrent stroke, and conditions requiring transfer to another hospital for specialized care or immediate treatment for an acute illness during hospitalization.

RESULTS

A total of 341 patients (median age: 74y) participated in this study, with 232 patients (68%) exhibiting low-physical performance. In the adjusted model, low-physical performance was significantly associated with SAEs (hazard ratio [HR], 3.01; 95% confidence interval [CI], 1.04-8.68; P=.042). However, low calf circumference (HR, 1.60; 95% CI, 0.76-3.38; P=.219) and low hand grip strength (HR, 0.98; 95% CI, 0.39-2.42; P=.960) did not show an independent association.

CONCLUSIONS

Low-physical performance was independently associated with the occurrence of SAEs during hospitalization for rehabilitation in patients with subacute stroke.

IL-1β enhances susceptibility to atrial fibrillation in mice by acting through resident macrophages and promoting caspase-1 expression

Atrial fibrillation (AF) is more prevalent in patients with elevated interleukin (IL)-1β levels. Here we show that daily administration of IL-1β for 15 days sensitizes mice to AF, leading to fibrosis, accumulation of β-pleated sheet proteins in the left atrium, and systemic inflammation, resembling the pathophysiological changes observed in patients with AF. IL-1β administration creates a positive feedback loop, dependent on the IL-1 receptor (IL-1R) activity in cardiac resident macrophages. This results in increased caspase-1 maturation in the left atrium and elevated Il1b and Casp1 transcription in atrial macrophages. IL-1β treatment accelerated action potential and Ca2+ restitution in the left atrium, leading to action-potential shortening. This, along with increased caspase-1 maturation and IL-1R signaling, was essential for inducing AF. Lack of IL-1R in macrophages, but not cardiomyocytes, prevented IL-1β-induced AF sensitivity. By depleting recruited macrophages or deleting IL-1R specifically in cardiac resident macrophages, we further demonstrate that IL-1β/IL-1R signaling in these resident macrophages is responsible for increased AF susceptibility. These findings offer insights into the therapeutic potential of targeting IL-1β/IL-1R signaling in patients with AF and emphasize the importance of recognizing different underlying causes in this patient group.

Omega-3 index improves upon the pooled cohort equation in predicting risk for CVD

BACKGROUND

Accurate predictive tools are crucial for identifying patients at increased risk for atherosclerotic cardiovascular disease (ASCVD). The Pooled Cohort Equation (PCE) is commonly used to predict 10-year risk for ASCVD, but its accuracy remains imperfect.

OBJECTIVE

This study examined the extent to which the omega-3 index (O3I; the proportion of eicosapentaenoic acid+docosahexaenoic acid in erythrocyte membranes) improved the predictive capability of PCE.

METHODS

The O3I was determined in 2550 participants without ASCVD at baseline from Framingham Offspring Cohort. The extent to which the O3I added to the PCE score was assessed using area under the curve (AUC). We also estimated how much the O3I added predictive power to each standard risk factor (blood pressure, diabetes, smoking, total and high-density lipoprotein cholesterol [HDL-C]) individually when added to the basic age+sex+race model. Mean follow-up was 9.1 years.

RESULTS

The AUC predicting 10-year ASCVD events using PCE was 0.689. It increased to 0.698 (P < .05) upon addition of the O3I. The AUC additions to the basic model were 0.028 (blood pressure, HDL-C), 0.020 (diabetes), 0.012 (O3I), 0.006 (cholesterol), and 0.004 (smoking); all but smoking were significant (P < .05). Also, the O3I significantly (P < .05) improved the predictive ability of each of these risk factors when analyzed separately.

CONCLUSION

The O3I improved the PCE prediction, suggesting that it captures risk beyond standard factors. Thus, the O3I may help in ASCVD risk stratification. Further research is needed to extend these findings into more diverse cohorts and to explore the integration of O3I into other existing ASCVD risk assessment tools.