Prognostic Significance of Time Between Balloon and Peak CK-MB in AMI Patients Undergoing Primary PCI

BACKGROUND

Peak creatine kinase-MB (CK-MB) level is an established predictor of clinical outcomes following acute myocardial infarction (AMI). However, the significance of the duration between balloon inflation and peak CK-MB level (BP time) after primary percutaneous coronary intervention (PCI) remains underexplored in terms of prognostic impact.

OBJECTIVES

This study aimed to elucidate the relationship between BP time and prognostic outcomes in patients with AMI.

METHODS

In this multicenter observational study, 935 AMI patients who underwent primary PCI and achieved TIMI flow grade 3 on final angiography were included. CK-MB levels were measured systematically at admission and at 3-hour intervals post-PCI. Based on a BP time threshold of 553 minutes, patients were categorized into 2 groups: the long BP-time group (n = 183) and the short BP-time group (n = 752).

RESULTS

The mean age of the patients was 67 years, with a median BP time of 334 minutes (Q1-Q3: 248-491 minutes). The long BP-time group exhibited a higher prevalence of male patients and a history of prior PCI. Cardiovascular mortality was significantly greater in the long BP-time group (log-rank test: P = 0.002). Multivariable Cox regression analysis indicated that a prolonged BP time was independently associated with increased cardiovascular mortality (HR: 2.63; 95% CI: 1.19-5.78).

CONCLUSIONS

Our findings reveal a significant association between BP time and 1-year cardiovascular mortality in patients with AMI. As a readily assessable parameter, BP time can be a valuable tool for early mortality risk stratification in patients post-primary PCI. (Prognostic Implications of Time between Balloon to Peak Creatinine Kinase-MB in patients with Acute Myocardial Infarction Undergoing Primary PCI: Multicenter Cohort Study; UMIN000049942).

Lipid Control and Social Determinants: Their Association With LDL and Non-HDL Cholesterol Goals in Older Adults-A Population-Based Study

BACKGROUND

Social determinants of health (SDH) significantly influence cardiovascular outcomes; however, their role in achieving lipid profile goals in older adults remains underexplored. This study aimed to evaluate the association between SDH and nonachievement of LDL cholesterol (LDL-C) and non-HDL cholesterol (non-HDL-C) targets in Colombian adults aged ≥ 60 years.

METHODS

A cross-sectional analysis was conducted using data from 1270 participants in the SABE Colombia 2015 study. Logistic regression was applied to estimate odds ratios (ORs) for not achieving LDL-C and non-HDL-C goals on the basis of the Framingham, ASCVD 2013, and SCORE2 models.

RESULTS

Non achieving LDL-C goals were associated with female sex, lack of affiliation with the health system and physical inactivity. Physical inactivity was associated with noncompliance on non-HDL-C goals, among others.

CONCLUSIONS

SDH are strongly associated with poor lipid control. Addressing modifiable SDHs could enhance cardiovascular risk management in older adults.

Mitochondria‑derived peptides: Promising microproteins in cardiovascular diseases (Review)

Mitochondria‑derived peptides (MDPs) are a unique class of peptides encoded by short open reading frames in mitochondrial DNA, including the mitochondrial open reading frame of the 12S ribosomal RNA type‑c (MOTS‑c). Recent studies suggest that MDPs offer therapeutic benefits in various diseases, including neurodegenerative disorders and types of cancer, due to their ability to increase cellular resilience. Mitochondrial dysfunction is a key factor in the onset and progression of cardiovascular diseases (CVDs), such as atherosclerosis and heart failure, as it disrupts energy metabolism, increases oxidative stress and promotes inflammation. MDPs such as humanin and MOTS‑c have emerged as important regulators of mitochondrial health, as they show protective effects against these processes. Recent studies have shown that MDPs can restore mitochondrial function, reduce oxidative damage and alleviate inflammation, thus counteracting the pathological mechanisms that drive CVDs. Therefore, MDPs hold promise as therapeutic agents that are capable of slowing, stopping, or even reversing CVD progression and their use presents a promising strategy for future treatments. However, the clinical application of MDPs remains challenging due to their low bioavailability, poor stability and high synthesis costs. Thus, it is necessary to improve drug delivery systems to enhance the bioavailability of MDPs. Moreover, integrating basic research with clinical trials is essential to bridge the gap between experimental findings and clinical applications.

Patterns and predictors of statin therapy after ischemic stroke and TIA: insights from the LIPYDS multicenter study

BACKGROUND

Patients with ischemic stroke (IS) or TIA face an elevated cardiovascular risk, warranting intensive lipid-lowering therapy. Despite recommendations, adherence to guidelines is suboptimal, leading to frequent undertreatment. This study aims to evaluate the statin use after IS and TIA.

METHODS

LIPYDS is a multicenter, observational, retrospective study including ≥ 18-year-old patients discharged after IS/TIA from 19 Italian centers in 2021. Multivariable logistic regression analysis was used to determine (1) the association between statin prescription (Any-statin versus No-statin), type (High-Intensity-statin versus Other-statin [Moderate/Low-Intensity]) with stroke etiology (TOAST), (2) clinical variables independently associated with statin prescription in the entire cohort and within TOAST categories.

RESULTS

We included 3,740 patients (median age 75 [IQR 64-82]; median LDL-C 104 [IQR 79-131]). At discharge, 1,971 (52.7%) received a High-intensity-statin, 800 (21.4%) Other-statin, 969 (25.9%) No-statin therapy. Among patients not on statin therapy before the event (N = 2686 [71.8%]), 50.1% initiated High-intensity-statin (78.2% of those with Large-Artery-Atherosclerosis, 60.8% Small-Vessel-Disease, 34.7% Cardioembolic, 47.4% Undetermined etiology); in 33% the decision to abstain from initiating statin therapy persisted. Large-Artery-Atherosclerosis showed the strongest association with Any-statin (aOR 3.07 [95%CI 2.39-3.95], p < 0.001) and High-intensity-statin (aOR 4.51 [95%CI 3.39-6.00], p < 0.001), while Cardioembolic stroke showed an inverse association (respectively, aOR 0.36 [95%CI 0.31-0.43], p < 0.001 and aOR 0.52 [95%CI 0.44-0.62], p < 0.001). Stepwise regression highlighted LDL-C and previous statin therapy as consistent predictors of statin at discharge. Older patients and women were less likely to be on a high-intensity formulation.

CONCLUSION

Statins, especially at high-intensity, are under-prescribed after IS and TIA, with older patients, women and those with non-atherosclerotic strokes being the most affected.

Post-discharge pharmacotherapy in people with atrial fibrillation hospitalized for acute myocardial infarction: an Australian cohort study 2018-22

BACKGROUND

Dual antiplatelet therapy with P2Y12 inhibitors (P2Y12i) and aspirin following acute myocardial infarction (AMI) prevents future ischaemic events. People with atrial fibrillation (AF) also require oral anticoagulants (OAC), increasing bleeding risk. Guidelines recommend post-discharge prescribing of direct OAC with clopidogrel and discontinuation of P2Y12i after 12 months, but little is known about use in clinical practice.

AIM

To describe post-discharge use of OACs and P2Y12i in people with AF and a history of OAC use hospitalized for AMI.

METHODS AND RESULTS

We identified 1330 people hospitalized for AMI with a diagnosis of AF and history of OAC use in New South Wales, Australia, July 2018-June 2020. We identified three aspects of post-discharge antithrombotic medicine use with possible safety implications: (1) not being dispensed OACs; (2) dispensing OAC and P2Y12i combinations associated with increased bleeding (involving warfarin, ticagrelor, or prasugrel); and (3) P2Y12i use longer than 12 months.After discharge, 74.3% of people were dispensed an OAC, 45.4% were dispensed a P2Y12i, and 35.8% were dispensed both. People with comorbid heart failure or cancer were less likely to receive OACs. Only 11.2% of people who dispensed both an OAC and P2Y12i received combinations associated with increased bleeding; this was more common among people with chronic kidney disease or prior warfarin or statin use. A total of 44.6% of people dispensed both medicines continued P2Y12i for over 12 months; this was more common in people who received a revascularization or lived in areas of social disadvantage.

CONCLUSION

We identified potential gaps in pharmacotherapy, including underuse of recommended therapies at discharge, use of combinations associated with increased bleeding, and P2Y12i use beyond 12 months. Prescribing vigilance across both hospital and community care is required.

External aortic annuloplasty with a dedicated expansible ring improves outcomes in remodeling root repair compared with homemade Dacron ring

OBJECTIVES

In remodeling valve-sparing root replacement with external annuloplasty, we compare long-term outcomes of a calibrated expansible extra-aortic ring with a homemade Dacron ring.

METHODS

All patients (2003-2020) operated for root aneurysm with/without aortic insufficiency (AI) were included. The standardized CAVIAAR (conservation aortique valvulaire dans les insuffisances aortiques et anévrysmes de la racine-Valve sparing in aortic insufficiencies and root aneurysms) technique was root remodeling and external annuloplasty ring with the EXTRA-AORTIC Ring or homemade Dacron ring.

RESULTS

Among 486 patients (age 52.3 ± 14.0 years) operated for root aneurysm, 375 (repair rate: 77.1%) underwent root remodeling with annuloplasty (extra-aortic ring, n = 289, vs Dacron ring, n = 86). At 10 years (median follow-up, 4.08 years' interquartile range, 1.95-7.61), unmatched and matched analysis showed that patients with extra-aortic ring had greater survival, similar to the general population (93.3% vs 79.9%, P = .097), lower reoperation incidence (2.0% vs 9.7%, P = .0098), and lower AI grade >2 recurrence (1.9% vs 11.2%, P = .0042), compared with patients with a Dacron ring. Mixed-effect model showed that with extra-aortic ring annuloplasty, annular dilation over time (P = .0033) was prevented and, compared with the homemade Dacron ring, root expansibility was better preserved (3.22% vs 2.12%, P = .002) and mean transvalvular gradient was lower (6.58 mm Hg vs 7.94 mm Hg, P = .001). Tricuspid and bicuspid valves with extra-aortic ring had similar reoperation (4.3% vs 0.85%, P = .65) and AI grade >2 incidence (2.7% vs 1.2%, P = .61), expansibility (P = .29), and diameter (P = .47), whereas mean transvalvular gradient was lower for tricuspid valves (5.58 mm Hg vs 7.60 mm Hg, P = .004).

CONCLUSIONS

Valve-sparing root remodeling with calibrated expansible extra-aortic ring annuloplasty improves the outcomes of reoperation and recurrent AI compared with a homemade Dacron ring. It prevents dilation and maintains physiological root dynamics for durable valve repair.

High-Resolution Maps of Left Atrial Displacements and Strains Estimated With 3D Cine MRI Using Online Learning Neural Networks

The functional analysis of the left atrium (LA) is important for evaluating cardiac health and understanding diseases like atrial fibrillation. Cine MRI is ideally placed for the detailed 3D characterization of LA motion and deformation but is lacking appropriate acquisition and analysis tools. Here, we propose tools for the Analysis of Left Atrial Displacements and DeformatIons using online learning neural Networks (Aladdin) and present a technical feasibility study on how Aladdin can characterize 3D LA function globally and regionally. Aladdin includes an online segmentation and image registration network, and a strain calculation pipeline tailored to the LA. We create maps of LA Displacement Vector Field (DVF) magnitude and LA principal strain values from images of 10 healthy volunteers and 8 patients with cardiovascular disease (CVD), of which 2 had large left ventricular ejection fraction (LVEF) impairment. We additionally create an atlas of these biomarkers using the data from the healthy volunteers. Results showed that Aladdin can accurately track the LA wall across the cardiac cycle and characterize its motion and deformation. Global LA function markers assessed with Aladdin agree well with estimates from 2D Cine MRI. A more marked active contraction phase was observed in the healthy cohort, while the CVD $\text {LVEF}_{\downarrow } $ group showed overall reduced LA function. Aladdin is uniquely able to identify LA regions with abnormal deformation metrics that may indicate focal pathology. We expect Aladdin to have important clinical applications as it can non-invasively characterize atrial pathophysiology. All source code and data are available at: https://github.com/cgalaz01/aladdin_cmr_la.

Association between remnant cholesterol and chronic kidney disease: Systematic review and meta-analysis

BACKGROUND AND AIMS

Adequate lipid control has emerged as a key factor in the prevention and management of chronic kidney disease (CKD). Remnant cholesterol (RC), a lipoprotein with an established association with cardiovascular risk, has been investigated in the context of CKD. Given the conflicting results from recent studies, we performed this meta-analysis to summarize the existing evidence on the association between RC and CKD.

METHODS

Medline, Cochrane Library and Scopus were searched until 16 September 2024. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using random-effects meta-analyses. We set as primary end-point of interest the association between RC and CKD.

RESULTS

Twelve studies (4 139 674 participants) were included. Participants with RC values in the highest quantile had significantly greater odds of CKD compared to those in the lowest quantile (Odds Ratio [OR] = 1.46, 95% confidence interval [CI] = 1.26-1.68). In a sensitivity analysis confined to subjects with type 2 diabetes (T2D), those in the higher RC quantile also exhibited significantly increased odds of CKD compared to those in the lowest quantile (OR = 1.46, 95% CI = 1.20-1.78). A significant inverse association was observed between RC and estimated glomerular filtration rate (Mean Difference [MD] = -1.43 mL/min/1.73 m2 for each 1 mmol/L increase in RC, 95% CI = [-2.67, -0.19]). Additionally, individuals with T2D-related CKD had a 24% increased risk of progression to end-stage renal disease for each 1 standard deviation increase in RC (Hazard Ratio [HR] = 1.24, 95% CI = 1.04-1.47).

CONCLUSIONS

RC is directly associated with higher risk for CKD. Beyond traditional lipid markers, greater emphasis should be placed on RC levels in individuals with or at risk for CKD.

Lower total cholesterol and HDL-C levels are associated with increased risk of Behçet's disease in a prospective nationwide Korean study

This study explores the relationship between Behçet's disease (BD) and serum lipid levels, focusing on a large cohort to understand the correlation between lipid profile variations and BD. Utilizing data from the Korean National Healthcare Insurance Service, it encompasses 9,914,049 individuals who participated in health screenings in 2009. The research identifies patients diagnosed with BD during a follow-up period and analyzes their lipid profiles, categorized into quartiles of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG). The study calculates adjusted hazard ratios (aHR) considering age, gender, smoking history, alcohol consumption, exercise habits, income, body mass index, hypertension, and diabetes, to evaluate the impact of lipid concentrations on BD development. Results show a significant increase in BD incidence among those with lower TC and HDL-C levels (aHR for lowest vs. highest TC quartile: 1.57, 95% CI 1.40-1.76, p < 0.0001; aHR for lowest vs. highest HDL-C quartile: 1.66, 95% CI 1.48-1.86, p < 0.0001), while LDL-C and TG levels did not exhibit a statistically significant association with BD risk. Additionally, the risk of BD does not escalate in the low HDL group using lipid-lowering agents (aHR: 1.33, 95% CI 0.93-1.90, p = 0.8496). The study concludes that lower TC and HDL-C levels are associated with an increased risk of developing BD.

The Role of Artificial Intelligence in Providing Real-Time Guidance During Interventional Cardiology Procedures: A Narrative Review

Integrating artificial intelligence (AI) in interventional cardiology revolutionizes procedural guidance, particularly in high-stakes environments such as angioplasty and stent placement. In this narrative review we explore the role of AI in providing real-time decision support, enhancing precision, and improving patient outcomes during these complex procedures. AI algorithms can identify critical anatomical features, predict complications, and optimize stent positioning with unprecedented accuracy by analyzing data from imaging modalities like intravascular ultrasound and optical coherence tomography. The findings of this narrative review, from which we have reviewed more than 150 studies across multiple databases, highlight the necessity of continued research and development to utilize AI to its full potential in enhancing the efficacy and safety of interventional procedures. In this review we highlight AI's current advancements, challenges, and potential in real-time interventional cardiology procedures, emphasizing its transformative impact on clinical practice and patient care.

Lipoprotein(a) Concentration and Cardiovascular Disease in a Group of Patients With Familial Hypercholesterolemia-A Lipid Clinic Experience

BACKGROUND

High Lp(a) concentrations are linked to an increased risk of cardiovascular disease (CVD). However, more evidence is needed to assess the association of Lp(a) with CVD in different vascular beds.

HYPOTHESIS

The aim was to assess the prevalence of increased Lp(a) levels and the association between Lp(a) levels and CVD in hypercholesterolemic patients.

METHODS

We examined 220 patients (110 women) with suspicion of FH. The mean (SD) age was 49.1 (15.02) years, LDL-C 3.49 (1.75) mmol/L, and the median (IR) Lp(a) concentration 0.15 (0.53) g/L.

RESULTS

CVD was present in 24.5%, coronary artery disease (CAD) in 21.4% of the examined individuals. Patients with CVD and patients with CAD had higher Lp(a) levels than patients without these diseases (p = 0.0403 and p = 0.0063, respectively); however, after adjustment for age and sex, only the difference in Lp(a) concentrations between persons with and without CAD remained significant. In total, 42.3% of patients who underwent carotid ultrasound examination had carotid plaques. We did not observe differences in Lp(a) levels between patients with or without plaques or correlations between Lp(a) and carotid IMT. In total, 28.3% of patients had Lp(a) concentrations in the high (> 0.5 g/dL), and 9.9% in the moderate-risk category (0.3-0.5 g/L). We observed an association between Lp(a) risk categories and the presence of CVD (p = 0.003) and CAD (p = 0.0004) but not with the presence of carotid plaques.

CONCLUSIONS

We found a high prevalence of increased Lp(a) levels in a group of hyperlipidemic persons and strong associations of Lp(a) risk categories with CAD but not with carotid atherosclerosis.

STAT3 expression is reduced in cardiac pericytes in HFpEF and its loss reduces cellular adhesion and induces pericyte senescence

Heart failure with preserved ejection fraction (HFpEF) accounts for half of heart failure cases and is characterised by reduced pericyte coverage. While the contributions of other cardiac cell types to HFpEF are well-studied, the role of pericytes remains less understood. Using murine single-nucleus RNA-sequencing to study cardiac pericytes in HFpEF, we identified reduced STAT3 expression as a hallmark of HFpEF pericytes. Mechanistic studies in vitro revealed that STAT3 deletion induces cellular senescence and impairs pericyte adhesion, recapitulating HFpEF-like characteristics. These findings suggest that STAT3 is crucial for maintaining pericyte homeostasis and highlight its reduction as a potential driver of pericyte loss, a defining feature of HFpEF.

Adherence to periprocedural antithrombotic treatment recommendations and its prognostic impact in patients with high ischemic and hemorrhagic risk

INTRODUCTION AND OBJECTIVES

To analyze the clinical impact of the inappropriate use of antithrombotic treatment in patients with high ischemic or hemorrhagic risk during the periprocedural/perisurgical period in Spain.

METHODS

Prospective multicenter observational registry of patients receiving antiplatelet and/or anticoagulant therapy who required an intervention. The incidence of 30-day events was compared based on the peri-intervention management of antithrombotic treatment and the patients' risk classification (high vs. moderate-to-low risk). The primary endpoint was a composite of death, cardiovascular ischemic events, or bleeding events classified as BARC 2 or higher.

RESULTS

A total of 1152 patients were analyzed. Of these, 1.9% had both high ischemic and hemorrhagic risks (A);10.8% had high ischemic risk and low-to-moderate hemorrhagic risk (B); 12% had high hemorrhagic risk and low-to-moderate ischemic risk (C); and 75.3% had both low-to-moderate risks (D). The prevalence of inappropriate treatment was higher in the subgroup with high hemorrhagic risk and low-to-moderate ischemic risk (C) (62.6% vs 40.9% in subgroup A; P<.05; 40.3% in subgroup B; P<.001; and 39.8% in subgroup D; P<.05). The incidence of the composite endpoint was higher in the subgroups with high ischemic and hemorrhagic risks (22.7%) and high ischemic and low-to-moderate hemorrhagic risks (20.9%), compared with 3.6% in subgroup C (P<.05) and 5.7% in subgroup D (P<.001). Among patients with inappropriate treatment, the incidence of the composite endpoint was significantly higher in subgroups with high ischemic and hemorrhagic risks (44.4% vs 7.7%; P=.043) and high ischemic and low-to-moderate hemorrhagic risks (30% vs 14.8%; P=.042).

CONCLUSIONS

The prevalence of inappropriate periprocedural/perisurgical treatment was higher in patients with high hemorrhagic risk and low-to-moderate ischemic risk. The incidence of events was higher in patients with high ischemic risk, with inadequate antithrombotic management being associated with a higher event rate in these groups.

Use of emulsifying plant protein hydrolysates from winery, whiskey and brewery by-products for the development of echium oil delivery emulsions

This study investigates the production of plant protein hydrolysates from defatted grape seed flour and barley spent grains, by-products of wine, beer and whiskey industries, using limited hydrolysis with subtilisin or trypsin. The hydrolysates were characterized by protein content, molecular weight, antioxidant capacity, interfacial adsorption, dilatational rheology, and interfacial conformational changes using synchrotron radiation circular dichroism. Physical and oxidative stability of 5 % echium oil-in-water emulsions (pH 7), stabilized by the hydrolysates, were studied during seven days of storage. The trypsin-derived hydrolysate from brewers' spent grains resulted in the most physically stable emulsion due to enhanced interfacial adsorption and higher dilatational modulus. Alternatively, the trypsin-treated grape seed flour hydrolysate provided the emulsion with the highest oxidative stability, aligning with its superior in vitro antioxidant capacity. These results show the potential of wine and brewery industry side streams as a sustainable source of plant-based emulsifiers with application in omega-3 delivery systems.

Metabolic dysfunction-associated steatotic liver disease is a risk factor for gallstones: A multicenter cohort study

AIM

Gallstone formation is associated with metabolic dysfunction. Recently, new definitions of steatotic liver disease (SLD) have been proposed, including metabolic dysfunction-associated SLD (MASLD) and moderate alcohol intake (MetALD). We investigated the effects of MASLD/MetALD on gallstone formation.

METHODS

This multicenter observational cohort study enrolled 8766 consecutive health-check examinees who underwent abdominal ultrasonography between 2008 and 2021 (total observation period 39,105.9 person-years). All patients were classified into non-SLD, MASLD, or MetALD groups. The effect of MASLD on gallstone development was evaluated using multivariate Cox regression analysis.

RESULTS

Age, male sex, and MASLD were identified as independent risk factors for gallstone development. MASLD was associated with a significantly higher risk of developing gallstones than non-SLD (hazard ratio [HR] 1.7112; 95% confidence interval [CI] 1.4294-2.0486; p < 0.0001) and MetALD (HR 1.3516, 95% CI 1.0130-1.8033, p = 0.0406). However, the risk of MetALD did not significantly differ between the SLD and non-SLD groups. Hypertension was the only significant independent cardiometabolic risk factor for gallstone development in the MASLD group (HR 1.4350, 95% CI 1.0545-1.9528; p = 0.0216). Random forest analysis and directed acyclic graphs identified hypertension as the most important direct factor affecting gallstone development in patients with MASLD.

CONCLUSIONS

MASLD was an independent risk factor for gallstone development, whereas MetALD presented a similar risk as non-SLD. Moderate alcohol consumption may reduce the risk of gallstone formation in patients with MASLD. Hypertension may be the most significant cardiometabolic risk factor for gallstone development in patients with MASLD.

Serum malondialdehyde levels at admission as a predictor of inhospital mortality in patients with acute coronary syndrome

INTRODUCTION AND OBJECTIVE

Malondialdehyde (MDA) is a predictive marker of cardiovascular events in patients with stable angina pectoris. However, there is limited information available regarding this marker in patients with acute coronary syndrome (ACS). The aim of the study was to explore the association of MDA levels with inhospital mortality among patients with ACS.

MATERIALS AND METHODS

The study sample consisted of 556 ACS patients. The leftover plasma samples collected in EDTA vials for troponin T estimation within 24 h of chest pain were used for analysis. Blood samples were collected into tubes for MDA, nitric oxide (NO), inducible nitric oxide synthase (i-NOS), endothelial nitric oxide synthase (e-NOS), total sialic acid (TSA), NT-proBNP, ANP, homocysteine, and cardiac troponin I (cTnI). The blood samples were centrifuged (4000 g , 4 °C) for 10 min, and the obtained serum then kept at -25 °C until the analyses were carried out. The relationship between these markers and inhospital mortality of ACS patients was investigated.

RESULTS

Univariate logistic regression analysis revealed significant correlations among sex, age, creatine, MDA, NT-proBNP, ANP, homocysteine, cTnI, NO, e-NOS, i-NOS, and TSA. Further analysis of these variables using the multivariate logistic regression analysis indicated that age, creatine, MDA, and NT-proBNP were independent predictors. Optimal MDA cutoff value of >33.1 predicted inhospital mortality with 85% sensitivity and 88.17% specificity [AUC: 0.905 (95% CI: 0.878-0.928, P  < 0.001)].

CONCLUSION

We demonstrated that MDA levels were elevated in cases of inhospital mortality among ACS patients and the optimal MDA cutoff value of >33.1 predicted inhospital mortality with 85% sensitivity and 88.17% specificity.

Risk of Incident Type 2 Diabetes and Prediabetes in Patients With Direct Acting Antiviral-Induced Cure of Hepatitis C Virus Infection

BACKGROUND

Data regarding the risk of incident type 2 diabetes (T2D) and prediabetes among patients with hepatitis C virus (HCV) achieving direct-acting antivirals (DAAs)-induced sustained virologic response (SVR12) remains limited.

METHODS

A total of 1079 patients, including 589 with normoglycemia and 490 with prediabetes, who underwent biannual fasting glucose and glycosylated haemoglobin (HbA1c) assessment for a median post-SVR12 follow-up of 5.5 years, were enrolled. We reported the crude (cIRs) and age-standardised incidence rates (ASIRs) of T2D and prediabetes. Factors associated with incident T2D and prediabetes were assessed using the Cox proportional hazards models.

RESULTS

The cIRs of T2D and prediabetes were 1.18 and 8.99 per 100 person-years of follow-up (PYFU), respectively. Additionally, the ASIRs of T2D and prediabetes were 1.09 (95% CI: 0.76-1.53) and 8.47 (95% CI: 7.23-9.90) per 100 PYFU. Prediabetes (adjusted hazard ratio [aHR]: 4.71; 95% confidence interval (CI): 2.55-8.70, p < 0.001), body mass index (BMI) per kg/m2 increase (aHR: 1.17; 95% CI: 1.09-1.26, p < 0.001) and liver stiffness measurement (LSM) per kPa increase (aHR: 1.05; 95% CI: 1.02-1.09, p = 0.001) were associated with a higher risk of incident T2D. Age per year increase (aHR: 1.02; 95% CI: 1.01-1.03, p < 0.001) was associated with a higher risk of incident prediabetes.

CONCLUSION

The incidence rates of T2D and prediabetes remain substantial among patients after HCV eradication. Lifestyle modification, drug therapy and regular monitoring of glycemic status are crucial for patients at risk of developing T2D and prediabetes following HCV clearance.

Escalating Lipid Therapy After Achieving LDL-C <70 mg/dL With Moderate-Intensity Statins in High-Risk Patients

BACKGROUND AND OBJECTIVES

Guidelines recommend target levels of low-density lipoprotein cholesterol (LDL-C) and intensive lipid-lowering therapy (LLT) in high-risk patients. However, the value of escalating LLT when the LDL-C targets are achieved with moderate-intensity statins is unknown. We aimed to evaluate the benefits of LLT escalation in this population.

METHODS

In this retrospective propensity score-matched study, we screened data from two university hospitals between 2006 and 2021. Of the 54,069 patients with atherosclerotic cardiovascular disease (ASCVD), 3,205 who achieved LDL-C levels <70 mg/dL with moderate-intensity statins were included. After 1:3 matching, 1,315 patients (339 with LLT escalation and 976 without) were ultimately examined. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE)1 (cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke) and all-cause death.

RESULTS

During a median follow-up of 5.7 years, the MACCE1 rate was not significantly lower in the escalation group than in the non-escalation group (9.8 and 14.3/1,000 person-years, respectively; hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.43-1.09; p=0.11). Kaplan-Meier curves showed similar results (log-rank p=0.11). The risk of all-cause death did not differ between the groups. MACCE2 rate, which additionally includes coronary/peripheral revascularization, was lower in the escalation group (24.5 and 35.4/1,000 person-years, respectively; HR, 0.70; 95% CI, 0.52-0.94; p=0.017).

CONCLUSIONS

LLT escalation did not significantly lower hard cardiovascular outcomes and all-cause death in patients with ASCVD achieving LDL-C levels <70 mg/dL with moderate-intensity statins. However, it had benefit in reducing revascularization rates in this population.

Unraveling the link between cholesterol and immune system in cancer: From biological mechanistic insights to clinical evidence. A narrative review

Cholesterol and its metabolism seem to be involved not only in cancer progression but also in immune cells activity. In this comprehensive review, we summarize preclinical, translational, and clinical evidence regarding the crucial role of cholesterol and its metabolism in regulating the immune response against cancer cells, shedding light on the multifaceted mechanisms by which cholesterol influences immune cell function and anti-tumor immunity. By synthesizing findings from preclinical studies, we have elucidated the impact of cholesterol on immune cell activation, differentiation, and effector functions. These investigations have revealed that cholesterol metabolism plays a pivotal role in shaping the immune response, with alterations in cholesterol levels directly impacting immune cell behavior and anti-tumor activity. All the steps related to cholesterol metabolism, including its de-novo synthesis, its influx and efflux mechanisms, as well as its metabolites, have a distinct impact on immune cells function and activity, which, if altered, might influence tumor progression. In addition, we have reviewed clinical studies investigating the role of circulating cholesterol on outcomes of patients with advanced tumors treated with immune checkpoint inhibitors, highlighting again in a clinical scenario the correlation between cholesterol and the immune system. Overall, our review emphasizes the importance of cholesterol and its metabolism in orchestrating the immune response against cancer cells. Herein we have provided a comprehensive overview of this emerging field by illustrating the intricate interplay between cholesterol and immune system.

Cost-Effectiveness Analysis of Inclisiran for the Treatment of Primary Hypercholesterolemia or Mixed Dyslipidemia in Singapore

OBJECTIVES

This analysis evaluated the cost-effectiveness of inclisiran plus standard of care (SoC; comprising statins, ezetimibe, and fenofibrate) in primary hypercholesterolemia or mixed dyslipidemia from a Singapore healthcare system perspective. Inclisiran + SoC was separately compared with SoC, alirocumab + SoC, and evolocumab + SoC.

METHODS

A lifetime Markov model in the United Kingdom (UK) was adapted to the Singapore setting. The modeled population (comprising 4 separate subpopulations: "primary prevention heterozygous familial hypercholesterolemia [HeFH]," "secondary prevention HeFH," "atherosclerotic cardiovascular disease [ASCVD]," "primary prevention with elevated risk") and efficacy of inclisiran were informed by the ORION-9, ORION-10, and ORION-11 trials. Comparative efficacies of inclisiran versus comparators were informed by a network meta-analysis. Baseline cardiovascular event risks were obtained from a large UK real-world data set and the Netherlands, and UK-based utilities were applied. Baseline population characteristics, distribution of patients in the ASCVD subpopulation, and costs were sourced from local clinicians and published literature. A willingness-to-pay threshold of S$45 000/quality-adjusted life-year (QALY) was selected.

RESULTS

Across all subpopulations, inclisiran + SoC resulted in higher QALYs and total costs than SoC (incremental cost-effectiveness ratios, S$35 658-163 896/QALY) and dominated evolocumab + SoC and alirocumab + SoC. At the selected threshold, inclisiran + SoC is cost-effective among patients with ASCVD and secondary prevention HeFH. The deterministic sensitivity analysis found that the model was most sensitive to inclisiran's acquisition cost and efficacy and rate ratios translating reductions in low-density lipoprotein cholesterol levels to the risk of cardiovascular death.

CONCLUSIONS

Compared with SoC, evolocumab + SoC, and alirocumab + SoC, inclisiran + SoC is cost-effective in patients with primary hypercholesterolemia or mixed dyslipidemia in Singapore at the selected threshold.

Diagnostic value of cardiac magnetic resonance imaging-based left atrial strain analysis for identifying cardiac diseases with overlapping phyotype

BACKGROUND

The main objective of this study was to compare diagnostic accuracies of cardiac magnetic resonance (CMR)-based left atrial (LA) volumetry and function, including LA strain analysis, for the detection of myocardial impairments in diseases of different etiologies such as hypertensive heart disease, Fabry disease and acute myocarditis.

METHODS

Healthy volunteers (HV, n = 50) and patients with cardiomyopathies (n = 140), including patients with hypertensive heart disease (n = 40), Fabry disease (n = 49), and acute myocarditis (n = 51), underwent CMR at 3 T. Atrial volume and strain analysis based on long-axis cine acquisition was performed using a commercially available post-processing software.

RESULTS

Patients exhibited impaired LA reservoir (28.60 ± 9.91 % vs. 41.27 ± 7.54 %), conduit (17.35 ± 7.72 % vs. 26.89 ± 5.25 %) and booster strain (11.30 ± 4.52 % vs. 14.61 ± 4.15 %) parameters compared to HV (all p < 0.001). In contrast, the volumetric values showed no significant difference between patients and HV (p > 0.05). Passive and total emptying fractions were significantly lower in patients (p < 0.001), while active emptying fraction did not differ (p > 0.05). Superior diagnostic accuracy for the LA reservoir strain demonstrated improved prognostic performance comparing to LA volumetric and functional parameters (area under the curve [AUC] 0.85 vs. e.g. passive emptying fraction AUC 0.78, p < 0.05).

CONCLUSION

LA strain parameters effectively distinguish patients with cardiac diseases presenting overlapping phenotypes from HV and outperform volumetric and traditional functional assessments of the LA.

PCSK9 and its relationship with HMGB1, TLR4, and TNFα in non-statin and statin-treated coronary artery disease patients

Despite statin use in coronary artery disease (CAD), significant risk remains, potentially due to increased proprotein convertase subtilisin/kexin-type 9 (PCSK9) production, which raises LDL-C levels and induces inflammation. The exact relationship between PCSK9, inflammatory markers like TNFα, TLR4, CRP, and HMGB1, and monocyte subsets is poorly understood. This study aimed to explore these relationships in non-statin and statin-taking CAD patients. This case-control study included 91 controls and 91 stable CAD patients, divided into no-statin (NS, n = 25), low-dose statin (LDS, n = 25), and high-dose statin (HDS, n = 41) groups. Serum levels of LDL-C, CRP, PCSK9, TLR4, HMGB1, and TNFα were measured. Monocyte subsets were classified using flow cytometry into classical monocytes (CM), intermediate monocytes (IM), and non-classical monocytes (NCM). CAD patients showed elevated PCSK9, LDL-C, and inflammatory markers compared to controls. Statin groups (LDS, HDS) had lower LDL-C and inflammatory markers but higher PCSK9 than the NS group, with the HDS group showing the lowest LDL-C and inflammatory markers but the highest PCSK9. In the NS group, PCSK9 positively correlated with inflammatory markers (HMGB1, TNFα, TLR4, CRP) and monocyte subsets (IM%, NCM%). In the total statin group (LDS + HDS), PCSK9 negatively correlated with HMGB1, TLR4, and NCM%, for each, respectively, and positively with CM%. Multivariable linear regression showed significant associations between PCSK9 and HMGB1, NCM%, and IM% in the NS group, and HMGB1, NCM%, and TLR4 in the total statin group. In conclusion, we recommend combining PCSK9 inhibitors with statins in high-risk CAD patients. This may enhance statin efficacy, reduce LDL-C, and inhibit the TLR4/NF-кB inflammatory pathway, decreasing atherosclerotic inflammation.

Lipoprotein(a) in youth and childhood as a marker of cardiovascular risk stratification: a meta-analysis

BACKGROUND AND AIMS

Lipoprotein(a) [Lp(a)] is recognized as a risk factor for atherosclerotic cardiovascular diseases (ASCVD), yet its impact during childhood and youth remains understudied. This study aims to evaluate the role of Lp(a) as an independent risk factor for premature ASCVD among young patients.

METHODS

PubMed, Scopus, and CINAHL Complete databases were systematically searched from inception to 12 December 2023 for adjusted observational studies examining the impact of Lp(a) in young patients. Premature coronary artery disease (CAD) and premature arterial stroke were designed as primary endpoints, while the association with family history of premature CAD and familial hypercholesterolemia were secondary endpoints.

RESULTS

Fourteen studies, encompassing 9923 patients, were included in the analysis. Nine studies assessed Lp(a) as an independent risk factor for premature CAD. Meta-analysis revealed Lp(a) to be significantly associated with premature CAD [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01-1.13, P  = 0.02]. Four studies revealed that the high levels of Lp(a) were associated with a more than two-fold increased risk of arterial stroke (OR 2.51; 95% CI 1.51-4.16, P  = 0.004). However, insufficient studies were retrieved to perform a metanalysis for the secondary endpoints.

CONCLUSION

Findings from adjusted observational studies suggest that Lp(a) serves as a risk factor for premature CAD and for arterial stroke in the youngest population.

Increased epicardial adipose tissue is associated with left atrial mechanical dysfunction in patients with heart failure with mildly reduced and preserved ejection fraction

INTRODUCTION

Heart failure (HF) with mildly reduced and preserved ejection fraction (HFmrEF/HFpEF) is often accompanied by atrial dysfunction. It has been suggested that specific ectopic fat depots, such as epicardial adipose tissue (EAT), may directly influence the myocardial cells and, therefore, be involved in the pathophysiology of atrial mechanical dysfunction. In this study, we aimed to investigate the association between EAT and left atrial (LA) mechanical dysfunction.

METHODS AND RESULTS

In total, 82 patients with symptomatic HF and left ventricular ejection fraction > 40% were prospectively enrolled. All patients underwent CMR while in sinus rhythm. LA mechanical dysfunction was defined as the presence of LA end-systolic volume index > 52 mL/m2 and LA reservoir strain < 23%. EAT volume was indexed for body surface area. Mean age was 69 ± 10 years, 42 (51%) were women and mean body mass index (BMI) was 29 ± 6 kg/m2. Mean LVEF was 55 ± 9% and 34 (41%) patients had LA mechanical dysfunction. In patients with LA mechanical dysfunction, the EAT volume was significantly higher than in patients without LA mechanical dysfunction (90 vs 105 mL/m2, p = 0.02) while BMI was similar. In multivariable logistic regression analyses, increased EAT remained significantly associated with LA mechanical dysfunction (OR 1.31, 95% CI 1.03-1.66, p = 0.03).

CONCLUSION

Increased EAT was associated with LA mechanical dysfunction in patients with HFmrEF and HFpEF. Further research is needed to elucidate the exact mechanisms that underlie this association.

Impact of Home-Based Cardiac Rehabilitation on Physical Function, Outcomes, and Costs

PURPOSE

Cardiac rehabilitation (CR) improves health outcomes in patients with cardiovascular disease (CVD), but referral, participation, and completion rates are low. Home-based CR (HBCR) is a proposed solution, but studies on its efficacy are limited. We report our experience from a Veterans Affairs HBCR program on physical function, costs, and outcomes overlapping with the coronavirus disease-2019 (COVID-19) pandemic.

METHODS

A 12-week HBCR program included case-managed individualized exercise and risk management. Six functional tests were conducted remotely, safety was monitored, and quality of life and costs were quantified. A composite outcome (death, myocardial infarction, stroke, and cardiac-related hospitalization) was compared between 70 HBCR participants, 131 patients referred to Community Care, and 71 patients undergoing usual care (no CR) over a mean follow-up of 2.5 ± 0.90 years.

RESULTS

Among HBCR participants, there were significant improvements in right and left leg balance (145 and 56%, respectively, P < .001), 30-second chair stand (47%, P < .001), 2-minute step performance (41%, P < .001), right and left 30-second arm curl (31 and 30%, respectively, P < .001), 50-foot walk test (20%, P = .002), 8-foot up and go test (28%, P < .001), and steps/day (82%, P < .001). Composite events were lower among patients in the HBCR group versus those referred to Community Care ( P = .002). Health care costs were significantly lower among patients in the HBCR group compared to those in Community Care ($2101 vs $3289/subject, P < .001).

CONCLUSIONS

A HBCR program that included a broad spectrum of patients with CVD and multiple co-morbidities, performed largely during the COVID-19 pandemic, resulted in significant functional and outcome benefits and reduced costs.

Statin Use in Special Populations for the Prevention of Cardiovascular Disease in Adults

PURPOSE OF REVIEW

Outcome benefits for HMG-CoA reductase inhibitor (statin) use in the prevention of atherosclerotic cardiovascular disease (ASCVD) are well established and yet, statins remain underutilized with only half of eligible individuals receiving them among certain vulnerable populations. This review critically examines available data to provide a summary of the current evidence for statin use in select populations.

RECENT FINDINGS

Lipid management can be more complex in patients with chronic kidney disease (CKD), organ transplants, metabolic dysfunction associated with steatotic liver disease (MASLD), and human immunodeficiency virus (HIV). Statins are generally safe and effective to reduce the burden of ASCVD among these highly heterogeneous groups of patients and should be considered with careful attention to their concomitant disease state. Herein, we focus on appropriate statin use in these challenging to treat conditions, their relationship with increased ASCVD risk, and approaches to statin use for ASCVD risk reduction. Although further research is needed to define optimal therapy in select high risk groups for ASCVD prevention, statins are proven to be clinically efficacious, safe, and cost-effective for ASCVD prevention, warranting greater efforts to increase their use.

Statin use in HIV: European AIDS Clinical Society guidance for the primary prevention of cardiovascular disease

Atherosclerotic cardiovascular disease (ASCVD) is an important comorbidity in people ageing with HIV. Over-representation of classic risk factors such as smoking, and other factors such as HIV infection and its therapy, which are exclusive to people with HIV, are responsible for the increased risk of developing ASCVD. The tools to estimate risk, including Systematic Coronary Risk Evaluation 2 (SCORE2), generally underestimate risk in people with HIV. The Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study showed that pitavastatin among people with HIV with low-to-moderate ASCVD risk significantly reduced the incidence of major adverse cardiovascular events. Following these results, the European AIDS Clinical Society recommends the use of moderate-intensity statins for people with HIV with a SCORE2 value between 5% and less than 10%, or ≥2·5% if older than 50 years with no additional listed risk factors. Moderate-intensity statins can be considered in people with HIV aged 40 years and over with a SCORE2 <5%. Although the REPRIEVE study findings are expected to have a major effect on clinical care, implementation could be hampered by the absence of adequate guidance or access to statins, concerns about tolerability and potential drug interactions, and difficulties in maintaining adherence. These key recommendations from the European AIDS Clinical Society aim to provide support in this remit.

Low-Density Lipoprotein Cholesterol Levels and Bleeding Risk in Venous Thromboembolism

This case-control study evaluates low-density lipoprotein cholesterol levels and bleeding risk during anticoagulation in patients with acute venous thromboembolism.

Sodium zirconium cyclosilicate for MRAs optimization in HFrEF: lessons learned from the REALIZE-K trial

Mineralocorticoid receptor antagonists (MRAs) are a cornerstone of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF), offering significant benefits in reducing mortality and hospitalizations. However, their use is often constrained by the risk of hyperkalemia, particularly in patients with chronic kidney disease. Patiromer and sodium zirconium cyclosilicate (SZC), two novel potassium binders, have emerged as highly effective and safe tools for managing hyperkalemia and enabling the optimization of MRA therapy. This mini-review critically examines the findings of the recently published REALIZE-K (Randomized Withdrawal Trial Evaluating Sodium Zirconium Cyclosilicate for the Management of Hyperkalemia in Patients With Symptomatic Heart Failure With Reduced Ejection Fraction and Receiving Spironolactone) trial, placing it within the broader context of current evidence on potassium binders and their potential role in mitigating hyperkalemia to optimize MRA treatment. Moreover, it explores other significant barriers to MRA optimization, including clinician concerns over the risk of hyperkalemia, a consistent and pervasive issue that often leads to treatment inertia. By addressing both physiological and psychological barriers, this review aims to provide a comprehensive understanding of how to enhance MRA utilization and potentially improve clinical outcomes in patients with HFrEF.

Emergency Department Triage Accuracy and Delays in Care for High-Risk Conditions

Importance

Emergency department (ED) triage may impact timeliness of care for high-risk conditions.

Objective

To determine the association of ED undertriage with delays in care for patients with subarachnoid hemorrhage (SAH), aortic dissection (AD), and ST-elevation myocardial infarction (STEMI).

Design, Setting, and Participants

This retrospective cohort study included adult ED patients diagnosed with SAH, AD, or STEMI from January 1, 2016, to December 31, 2020, from a multicenter, community-based health care delivery system. Data analysis were completed in March 2023 to October 2024.

Exposure

Undertriage vs correct triage, defined by operational measures of mistriage.

Main Outcomes and Measures

Using a lognormal distribution, the outcomes of interest for patients with SAH and AD were adjusted median time to noncontrast computed tomography (CT) (head CT for patients with SAH, chest CT for patients with AD), antihypertensive medication orders (SAH), and β-blocker orders (AD), and ED length of stay (LOS). For patients with STEMI, outcomes of interest were adjusted median time to electrocardiogram (ECG) and troponin orders.

Results

A total of 5929 patients (median [IQR] age, 63.0 [54.0 to 73.0] years; 3876 [65.4%] male) were identified, including 915 with SAH, 480 with AD, and 4534 with STEMI. There were 1129 Asian patients (19.0%), 553 Black patients (9.3%), 889 Hispanic patients (15.0%), and 2906 non-Hispanic White patients (49.0%). Overall, 2175 patients (36.7%) were undertriaged. For patients with SAH, the lognormal estimate for delay in time to head CT was 0.2 (95% CI, 0.0-0.3), or a delay of 2.4 minutes, and for antihypertensive orders, the lognormal estimate was 4.8 (95% CI, 3.6-5.9), or a delay of 33.3 minutes; the lognormal estimate for ED LOS was 0.1 (95% CI, 0.0-0.1), or 7.7 minutes longer. For patients with AD, the lognormal estimate for delays were 0.2 (95% CI, 0.0-0.4), or 8.9 minutes, for chest CT and 0.5 (95% CI, 0.2-0.7), or 17.6 minutes, for β-blocker orders, and ED LOS was 0.2 (95% CI, 0.1-0.3), or 64 minutes longer. For patients with STEMI, differences in time to ECG and troponin orders were not statistically significant, at less than 1 minute, comparing correctly and undertriaged patients.

Conclusions and Relevance

In this cohort study of patients diagnosed with SAH, AD, or STEMI, ED undertriage was associated with small but significant delays in key diagnostic and therapeutic orders for patients with SAH and AD but not for patients with STEMI.

Impact of the Killip class of heart failure on treatment times and intrahospital mortality among STEMI patients

AIMS

While timely reperfusion is known to reduce mortality, the extent to which the severity of heart failure, as classified by the Killip system, influences treatment delays remains unclear. Our study aims to address the existing gap in evidence regarding the relationship between Killip classification at presentation and treatment times in ST-elevation myocardial infarction (STEMI) patients.

METHODS

We conducted a correlative analysis using data from patients treated in our hospital and enrolled in the FITT-STEMI Register from 2009 to 2022. We focused on the relation of treatment times allocating patients into the four Killip classes and used an ANOVA test (significance level: P  < 0.05). Killip class and intrahospital mortality were studied via binary logistic regression.

RESULTS

In total, 1264 patients were identified. Door-to-balloon time among Killip I patients was 54 (±35) min (mean ± SD) and 53 (±26) min among Killip II and prolonged up to 77.5 (±46) min for class III and 79.7 (±45) min for class IV (overall P -value < 0.001). This remained statistically significant even after the exclusion of patients with out-of-hospital cardiac arrest (OHCA) (overall P -value: <0.001).Post hoc analysis showed a significant difference between Killip II and III classes for both all-comers ( P  = 0.014) as well as after the exclusion of OHCA patients ( P  = 0.012).Intrahospital mortality increased from <5% for classes I and II up to 10.3% for class III and 35.4% for class IV.

CONCLUSION

The severity of heart failure among STEMI patients significantly affects the duration of treatment times. Patients presenting with Killip class III and IV demonstrate high intrahospital mortality rates.

Association between atherogenic index of plasma and peripheral arterial disease

Background: Growing body of evidence suggests that the atherogenic dyslipidemia phenotype is a precursor to Peripheral Arterial Disease (PAD). Nonetheless, there is limited research regarding the association between Atherogenic Index of Plasma (AIP) and PAD which utilized a community population-based database in the United States. We sought to fill this knowledge gap. Methods: A total of 3,517 participants from the National Health and Nutrition Examination Survey 1999-2004 cycles were enrolled in our study. AIP was calculated as log10 (triglycerides/high-density lipoprotein cholesterol). Logistic regression models were adopted to reveal the relationship of AIP and PAD. Additionally, stratified and interaction analyses were also undertaken to see if the relationship was stable in different subgroups. Results: Participants in the higher tertile of AIP tended to have higher prevalence of PAD. A positive correlation was identified between AIP increase and PAD after fully multivariate adjustment (OR=1.30, 95% CI: 1.06-1.59). The multivariable-adjusted OR and 95% CI of the highest AIP tertile compared with the lowest tertile was 1.50 (1.07-2.1). Subgroup analysis demonstrated that the positive association between AIP and PAD was persistent across population subgroups. Conclusions: Our findings demonstrate a positive association between AIP and the incidence of PAD among adults in American adults. Specifically, 1 unit increase in AIP led to a 30% greater risk of PAD.

Impact of diabetes on epicardial reperfusion and mortality in a contemporary STEMI population undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry

BACKGROUND AND AIM

Diabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic.

METHODS AND RESULTS

The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020. Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints were postprocedural TIMI 0-2 flow and 30-day mortality. Our population is represented by 16083 STEMI patients. A total of 3812 (23,7 %) patients suffered from diabetes. They were older, more often males as compared to non-diabetes. Diabetic patients were less often active smokers and had less often a positive family history of CAD, but they were more often affected by hypertension and hypercholesterolemia, with higher prevalence of previous STEMI and previous CABG. Diabetic patients had longer ischemia time, had more often anterior MI, cardiogenic shock, rescue PCI and multivessel disease. They had less often out-of-hospital cardiac arrest and in-stent thrombosis, received more often a mechanical support, received less often a coronary stent and DES. Diabetes was associated with a significantly impaired postprocedural TIMI flow (TIMI 0-2: 9.8 % vs 7.2 %, adjusted OR [95 % CI] = 1.17 [1.02-1.38], p = 0.024) and higher mortality (in-hospital: 9.1 % vs 4.8 %, Adjusted OR [95 % CI] = 1.70 [1.43-2.02], p < 0.001; 30-day mortality: 10.8 % vs 6 %, Adjusted HR [95 % CI] = 1.46 [1.26-1.68], p < 0.001) as compared to non-diabetes, particularly during the pandemic.

CONCLUSIONS

Our study showed that in a contemporary STEMI population undergoing PPCI, diabetes is significantly associated with impaired epicardial reperfusion that translates into higher in-hospital and 30-day mortality, particularly during the pandemic.

Therapeutic inertia in lipid management among Polish adults with type 1 diabetes - results from the cross-sectional PARADISE T1DM study

BACKGROUND AND AIMS

Adults with Type 1 diabetes (T1DM) have increased cardiovascular risk. Most of the Polish general population fails to meet lipid goals. Recent data on the effectiveness of dyslipidemia treatment in T1DM population is lacking. We aimed to investigate which part of adults with T1DM met the dyslipidemia treatment goals according to the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) 2016 and 2019 guidelines.

METHODS AND RESULTS

We recruited adult people with T1DM, for whom a cross-sectional assessment of disease progression was performed. Anthropometric measurements and a basic panel of laboratory tests were conducted for each person. We assessed cardiovascular risk and lipid goals according to the ESC/EAS dyslipidemia guidelines from 2016 to 2019. Among the n = 233 participants, only 34.3 % met the lipid goal according to the 2016 guidelines, while for the 2019 guidelines, merely 13.3 %. Only 12.8 % of individuals with very high cardiovascular risk met the LDL cholesterol goals according to ESC/AES 2016, and 4.9 % when ESC/EAS 2019 guidelines were considered. The median difference between the LDL cholesterol value and the target value was 18.0 (-16.0 to 49.0) mg/dl [20.4 % (-19.8 %-41.2 %)], when considering the 2016 ESC/EAS guidelines, whereas for the 2019 guidelines, it was 36.0 (11.0-60.0) mg/dl [36.3 % (13.9 %-48.0 %)].

CONCLUSION

Therapeutic inertia results in the failure to meet the lipid goals according to the ESC/EAS guidelines for 2016 and 2019 in most Polish adults with T1DM. Many adults with T1DM may require intensification of lipid-lowering interventions.

The Impact of Cardiometabolic Index on Cardiovascular Disease Risk Among Diabetic Patients: Evidence From Two National Cohorts

BACKGROUND

This study investigates the relationship between the Cardiometabolic Index (CMI) and cardiovascular disease (CVD) risk in diabetic populations using data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS). Understanding the predictive role of CMI in assessing CVD risk is essential for enhancing preventive strategies in diabetic patients.

METHODS

A cross-sectional analysis was conducted on diabetic participants from NHANES (2005-2018) and CHARLS (2011). CMI was calculated based on the waist-to-height ratio and the triglyceride-to-HDL-C ratio. Multivariable logistic regression models and restricted cubic spline analyses were utilised to evaluate the associations between CMI and CVD risk, adjusting for demographic and clinical covariates.

RESULTS

In the NHANES cohort (n = 2044), a higher CMI was significantly associated with an increased risk of CVD after adjusting for confounding factors (OR = 2.01, p = 0.0074). Similarly, in the CHARLS cohort (n = 3964), a higher CMI was linked to an elevated CVD risk (OR = 1.45, p = 0.009). Subgroup analyses demonstrated consistent results across various age, gender and health status subgroups. The restricted cubic spline analysis revealed significant non-linear trends between CMI and CVD risk in both cohorts (p < 0.05).

CONCLUSION

CMI is a robust and independent predictor of CVD risk among diabetic individuals across different populations. These findings highlight the potential clinical value of incorporating CMI into routine assessments to identify high-risk diabetic patients. Future longitudinal studies are needed to further validate these findings and explore the underlying mechanisms.

Effects of the Mediterranean diet on the secondary prevention of cardiovascular diseases: a systematic review of randomised controlled trials

This systematic review aimed to summarise the current knowledge regarding the effects of the Mediterranean diet (MD) on the secondary prevention of cardiovascular diseases (CVDs). A systematic search was done on Web of Sciences, PubMed, Scopus, and Google Scholar databases until January 2025. The majority of the included studies (15 of 16 RCTs) supported the role of MD following in the secondary prevention of CVDs. According to the RCT results, the patients in the MD group had lower cardiovascular deaths, non-fatal myocardial infarction, and other events. They also had healthier lipid profiles and blood fatty acids, higher flow-mediated dilation and endothelial progenitor cell levels, and lower endothelial progenitor cells compared to a low-fat diet. However, both MD and control (low-fat diet) groups promoted similar decreases in blood pressure and body mass index. The findings of this review suggested that adherence to the MD could be beneficial in the secondary prevention of CVD.

Spanish Working Group in Crohn's Disease and Ulcerative Colitis (GETECCU) position paper on cardiovascular disease in patients with inflammatory bowel disease

Cardiovascular diseases (CVD) are the leading cause of death worldwide. Therefore, it is essential to understand their relationship and prevalence in different diseases that may present specific risk factors for them. The objective of this document is to analyze the specific prevalence of CVD in patients with inflammatory bowel disease (IBD), describing the presence of classical and non-classical cardiovascular risk factors in these patients. Additionally, we will detail the pathophysiology of atherosclerosis in this patient group and the different methods used to assess cardiovascular risk, including the use of risk calculators in clinical practice and different ways to assess subclinical atherosclerosis and endothelial dysfunction. Furthermore, we will describe the potential influence of medication used for managing patients with IBD on cardiovascular risk, as well as the potential influence of commonly used drugs for managing CVD on the course of IBD. The document provides comments and evidence-based recommendations based on available evidence and expert opinion. An interdisciplinary group of gastroenterologists specialized in IBD management, along with a consulting cardiologist for this type of patients, participated in the development of these recommendations by the Spanish Group of Work on Crohn's Disease and Ulcerative Colitis (GETECCU).

A New Benchmark for Modern Management of Valvular Heart Disease: The Whole-Life Cycle Management System

Valvular heart disease (VHD) is rapidly increasing in prevalence worldwide, affecting millions and significantly impacting global health care systems. Despite notable advancements in understanding VHD progression, perioperative management, imaging techniques, and transcatheter therapies over the past 2 decades, the condition has not received the attention it deserves from the public and policymakers. Many patients with VHD in low- and middle-income countries continue to experience low detection, intervention, and follow-up rates. Systematic care for elderly patients and those with severe comorbidities, as well as postoperative patients, remains insufficient, leading to higher mortality and morbidity rates. This review focuses on the deficiencies in VHD treatment within the Chinese health care system and discusses the modern management program, known as the whole-life cycle management system, that has been implemented to enhance the survival prognosis of VHD patients.

Culprit vessel revascularization prior to complete angiography as a strategy to minimize delays in primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

The rapid restoration of blood flow in patients with acute myocardial infarction with ST elevation through percutaneous coronary intervention (PCI) is crucial for the survival of this population. Attempts to decrease the time from diagnosis of ST-segment elevation myocardial infarction (STEMI) to arrival at the catheterization laboratory have been extensively investigated. However, strategies during the procedure aiming to reduce the time to reperfusion are lacking. We conducted a meta-analysis to evaluate culprit vessel revascularization prior to complete angiography as a strategy to minimize delays in primary PCI for patients with STEMI. We searched PubMed, Embase, and Cochrane Central. Outcomes: vascular access-to-balloon, door-to-balloon, and first medical contact-to-balloon times; death, reinfarction in 30 days, Bleeding Academic Research Consortium ≥3 type, coronary artery bypass grafting referral, and left ventricular ejection fraction %. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I2 statistics. We included 2050 patients from six studies, of which two were randomized controlled trials and four were observational studies. Culprit vessel revascularization prior to complete angiography was associated with a statistically significant decrease of times: vascular access-to-balloon time (mean difference -6.79 min; 95% CI: -8.00 to -5.58; P  < 0.01; I2  = 82%) and door-to-balloon time (mean difference -9.02 min; 95% CI: -12.83 to -5.22; P  < 0.01; I2  = 93%). In this meta-analysis, performing PCI on the culprit lesion prior to complete coronary angiography led to significantly shorter reperfusion times, with no discernible differences in complication rates.

Long-term fasting induces a remodelling of fatty acid composition in erythrocyte membranes

INTRODUCTION

Long-term fasting (LF) activates an adaptative response to switch metabolic fuels from food glucose to lipids stored in adipose tissues. The increase in free fatty acid (FFA) oxidation during fasting triggers health benefits. We questioned if the changes in lipid metabolism during LF could affect lipids in cell membranes in humans. We thus analysed the FA composition in erythrocyte membranes (EM) during 12.6 ± 3.5 days of LF and 1 month after food reintroduction.

METHODS

A total of 98 subjects out of three single-arm interventional studies underwent a medical supervised long-term fasting (12.6 ± 3.5 days) programme. The distribution pattern of 26 FA as well as the HS-Omega-3 Index were assessed in the EM using gas chromatography.

RESULTS

Eighteen of 26 FA showed significant changes. Within the group of saturated FA, myristic (14:0) and stearic acid (18:0) decreased while palmitic (16:0) and arachid acid (20:0) increased. While most monounsaturated FA increased, trans fatty acids decreased or remained unchanged. Within the polyunsaturated FA, arachidonic (20:4n6) and docosahexaenoic (22:6n3) acid increased, while linoleic (18:2n6), alpha-linolenic (18:3n3) and eicosapentaenoic acid (20:5n3) decreased. Consequently, the HS-Omega-3 Index increased. 11 out of the 18 FA with significant changes returned to baseline levels 1 month afterwards. Levels of linoleic and alpha-linolenic acid increased over baseline levels.

CONCLUSIONS

Long-term fasting triggers changes in the FA composition of EM.

Ambient low-level benzene, genetic factors, and heart failure incidence among urban adults

Ambient benzene, a representative volatile organic compound (VOC) primarily resulting from rapid industrialization and urbanization, is also of great concern as an urban air toxic. The global benzene market is experiencing steady growth, driven by its use in industrial manufacturing. Currently, population epidemiological evidence about the effects of ambient benzene on heart failure (HF) incidence is still inadequate, especially at low levels of long-term exposure. Leveraging data from 277,585 urban residents in the UK Biobank, the study utilized Cox regression models adjusted for potential confounders to evaluate the association between low-concentration benzene exposure and HF risk. The investigation also assessed potential interactions between genetic predisposition and ambient benzene by applying relative excess risk due to interaction (RERI) metrics and interaction significance testing. Furthermore, the effect of ambient benzene on cardiac functional parameters was estimated using multiple linear regression models. This study demonstrated that per interquartile range increment of ambient benzene was related to the elevated HF risk (hazard ratios = 1.22, 95 % confidence interval (CI): 1.07-1.39] from the time-dependent Cox model. An additive interaction between ambient benzene and genetic risk was observed (RERI = 0.18, 95 % CI: 0.01-0.36). Ambient benzene exposure demonstrated significant correlations with modifications in cardiac functional parameters, such as ventricular end-diastolic and end-systolic volumes. Prolonged exposure to low-concentration ambient benzene may elevate the likelihood of developing HF, which provides the necessary evidence for the systematic risk assessment of ambient benzene and promotes the formulation and updating of air quality guidelines worldwide.

Persistent gaps in the implementation of lipid-lowering therapy in patients with established atherosclerotic cardiovascular disease: A French nationwide study

BACKGROUND

According to international guidelines, lowering LDL-cholesterol is the cornerstone of atherosclerotic cardiovascular disease (ASCVD) prevention. However, observational studies have identified current gaps in the implementation of lipid-lowering therapy (LLT). This whole-population study aimed to evaluate the prevalence and determinants of LLT use in ASCVD patients.

METHODS

Using the national health data system, all French adults with established ASCVD between 2012 and 2021 were identified using specific ICD-10 and/or procedure codes. LLT use was defined as ≥1 dispensing in the last quarter of 2021. Logistic regression was used to identify factors associated with the absence of LLT use.

FINDINGS

In 2021, 2,206,305 individuals (4.89 % among 45,082,270 adults) had established ASCVD (mean age: 72.2 years; 36.9 % women), including 56.1 % with coronary artery disease, 40.4 % with cerebrovascular disease, and 14.5 % with revascularized peripheral artery disease (PAD). Among the 2,056,354 patients alive on 31st December 2021, 32.5 % did not receive any LLT, while 64.8 % received a statin (27.0 % a high-intensity statin), 13.0 % a combination of statin and ezetimibe, and 0.25 % a PCSK9 inhibitor. The absence of LLT use was significantly associated with female sex (adjusted odds ratio [aOR]:1.42, 95 %CI, 1.41-1.43); lowest/highest ages: < 50 years (aOR (/65-74 years): 2.23, 95 %CI 2.20-2.27) and ≥ 85 years (aOR: 2.10, 95 %CI 2.08-2.13); and stroke and PAD, compared to myocardial infarction (aOR: 2.21, 95 %CI 2.19-2.23 and 1.88, 95 %CI 1.86-1.91, respectively).

INTERPRETATION

In real life, one-third of French ASCVD patients was not regularly treated with LLT, highlighting the urgent need to develop implementation strategies for lipid management.

Association of lipoprotein(a) and diabetes in primary prevention of coronary heart disease: The Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND AND AIMS

Lipoprotein(a) [Lp(a)] and diabetes are both independently associated with cardiovascular disease. Studies demonstrate that elevated Lp(a) is associated with increased incidence of cardiovascular disease in those with and without diabetes. However, it is unclear if Lp(a) modifies the association of diabetes and coronary heart disease (CHD) in primary prevention.

METHODS

The present analysis included 6668 participants from the Multi-Ethnic Study of Atherosclerosis, a community-based cohort without clinical cardiovascular disease at baseline. Participants were categorized as follows: group 1: Lp(a) < 50 mg/dL without diabetes, group 2: Lp(a) ≥50 mg/dL without diabetes, group 3: Lp(a) < 50 mg/dL with diabetes, and group 4: Lp(a) ≥50 mg/dL with diabetes. Survival analysis using Kaplan-Meier and multivariable Cox proportional hazard models were performed to assess the relationship between Lp(a), diabetes, and time to incident CHD.

RESULTS

In a fully adjusted model, log[Lp(a)] and diabetes were both independently associated with CHD (HR: 1.10; 95 % CI: 1.01, 1.20) and (HR:1.65; 95 % CI: 1.31, 2.06), respectively. There was a significant multiplicative interaction between logLp(a) and diabetes (p = 0.033). Compared to the reference group (Lp(a) < 50 mg/dL without diabetes), in a fully adjusted model, those with Lp(a) ≥50 mg/dL without diabetes (group 2) had increased risk of CHD (HR: 1.29; 95 % CI: 1.00, 1.65). Similarly, individuals with Lp(a) < 50 mg/dL with diabetes (group 3) also had greater risk of CHD (HR: 1.52; 95 % CI: 1.16, 1.98). The highest risk for CHD were in those with Lp(a) ≥50 mg/dL with diabetes (group 4) (HR: 2.57; 95 % CI: 1.77, 3.72).

CONCLUSION

The results of this analysis suggest that Lp(a) may modify the association between diabetes and CHD or that diabetes may modify the association between Lp(a) and CHD in those without cardiovascular disease at baseline. Further research is needed to clarify underlying mechanisms between Lp(a), diabetes, and CHD.

Hypertensive women with dyspnea exhibit an unfavorable central blood pressure response to exercise

Limited exercise tolerance and dyspnea in patients with uncomplicated hypertension may pose a diagnostic challenge, particularly when blood pressure is normal and assessment results do not support a diagnosis of heart failure. The purpose of this study was to assess the differences in central blood pressure (cBP) response to exercise between females with hypertension and good exercise tolerance (non-dyspneic females, nDFs; n = 27) and those with dyspnea on exertion (dyspneic females, DFs; n = 25). We also investigated the relations of cBP and its dynamics with peak oxygen consumption (peak VO2) and peak heart rate (peak HR) assessed by cardiopulmonary exercise test (CPET) and peak cardiac output (peak CO) assessed by impedance cardiography. Fifty-two females (mean age 54.5 ± 8.2 years) underwent applanation tonometry during CPET to assess the augmentation index (AIx), cBP, and central pulse pressure (cPP) before exercise (REST), at minute 3-rd of exercise (Ex), and at minutes: 1-st (R1) and 4-th of post-exercise rest (R2). In comparison with nDFs, DFs showed significantly higher cPP_Ex, AIx_Ex, and AIx_R1. The two subgroups showed no differences in cPP or Alx values either before exercise or at R2. In comparison with nDFs, the DFs had a less pronounced change in AIx values during post-exercise rest. There were negative correlations between peak HR and: AIx_R1, AIx_R2, change in AIx (R1-R2), between peak VO2 and: AIx_R1, AIx_R1-R2; between peak CO and: AIx_R1, AIx_R2, AIx_R1-R2. DFs presented a different cBP response to exercise than nDFs. Assessing cBP via applanation tonometry may prove useful in identifying hemodynamic abnormalities associated with limited exercise tolerance.

Reducing sedentary behavior improves depressive symptoms among patients with heart failure enrolled in a home-based mobile health app cardiac rehabilitation

BACKGROUND

Depressive symptoms are common, worsening heart failure (HF) progression and reducing quality of life. While supervised structured exercise training is effective for managing depressive symptoms, it often demands a substantial time commitment or intensive activity that may discourage participation.

OBJECTIVE

Evaluate the impacts of reducing sedentary time with short bouts of light physical activities or greater intensity levels on depressive symptoms after HF patients' enrollment in a home-based intervention.

METHODS

A total of 127 HF patients participated in an experimental two-group design, randomly allocated to either delayed or immediate decreasing sedentary time intervention. The immediate group started the intervention immediately, while the delayed group began after the first group finished their intervention. The 8-week intervention, guided by the Theory of Planned Behavior, focused on interrupting 30 min of sedentary behavior with short bouts of light- or greater intensity physical activities. Demographic and clinical variables were collected at baseline. Depressive symptoms were assessed at baseline, pre-intervention, and post-intervention. Physical activity (daily steps) was monitored daily during the study period using the Samsung mobile health app.

RESULTS

Both groups demonstrated reduced sedentary time during the intervention, with improvements in HF symptom burden. Repeated measures analysis of variance revealed a significant reduction in depressive symptoms in both groups post-intervention, with a greater reduction seen in the immediate group before the delayed group began the intervention.

CONCLUSION

The study highlights the effectiveness of interrupting sedentary behavior with light- or greater intensity activities in managing depressive symptoms among HF patients. The home-based intervention, facilitated by mobile technology, provides a feasible and accessible approach to improving mental well-being.

CLINICAL RELEVANCE

The findings support the broader implementation of home-based interventions addressing sedentary time reduction as a valuable strategy for enhancing the mental health of HF patients, particularly those facing challenges with traditional rehabilitation programs or intense exercise.

Physical activity, health, and life satisfaction: Four panel studies demonstrate reciprocal effects

We examined the between-person correlations and within-person reciprocal effects of physical activity, long-standing health issues, self-rated health, and life satisfaction across four panels using random intercept cross-lagged panel models. Data were analyzed from the Household, Income and Labour Dynamics in Australia Survey (HILDA, N = 32,913, 21 waves, 1-year intervals), the German Socio-Economic Panel (SOEP, N = 83,844, 14 waves, 2-year intervals), the Dutch Longitudinal Internet Studies for the Social Sciences Panel (LISS, N = 14,778, 11 waves, 1-year intervals), and the United Kingdom Household Longitudinal Study (UKHLS, N = 50,032, 4 waves, 2-year intervals). The analysis of the first two panels focused on moderate-to-vigorous physical activity and sports participation in leisure time, whereas the latter two examined physical activity intensities (light, moderate, and vigorous). Across all panels, physical activity and its intensities were positively correlated with long-standing health issues, self-rated health, and life satisfaction. Within-person analyses revealed primarily positive bidirectional effects between physical activity and self-rated health and between physical activity and life satisfaction, with self-rated health effects more pronounced at higher physical activity intensities and life satisfaction at lower intensities. Effects between physical activity and long-standing health issues were less consistent, appearing mainly for moderate-to-vigorous physical activity intensities in 1-year intervals. Physical activity intensities had different effects on self-rated health and life satisfaction, and the effects were bidirectional in nature. These results suggest that physical activity interventions should be tailored to intensity: Light activity may enhance more effective life satisfaction, while higher intensities better support health. The existing bidirectional effects may further trigger an upward spiral, reinforcing improvements in both health and well-being.

Remission of Statin-associated Autoimmune Necrotizing Myopathy With Sequential Immunotherapy: A Well-studied Patient

Statins are a group of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors aimed at reducing cholesterol synthesis. Since their discovery in 1970, their use has exponentially increased, becoming a regular preventive treatment for cardiovascular diseases. Among their most common adverse effects are myopathies, with the most severe being autoimmune necrotizing myopathy. We present a case of a woman in her 70s, with high cardiovascular-risk comorbid conditions, including autoimmune hypothyroidism, type 2 diabetes, arterial hypertension, and dyslipidemia. After 5 years on atorvastatin, she developed proximal limb weakness and elevated creatine kinase and creatine kinase-MB levels. A muscle biopsy showed autoimmune necrotizing myopathy and blood work confirmed positive 3-hydroxy-3-methylglutaryl coenzyme A reductase antibodies. Based on these findings, a diagnosis of statin-associated autoimmune necrotizing myopathy was made. In this case, treatment with intravenous immunoglobulin and rituximab resulted in complete remission.