Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

Body Composition Risk Assessment of All-Cause Mortality in Patients With Coronary Artery Disease Completing Cardiac Rehabilitation

BACKGROUND

Obesity, measured by body mass index, is a risk factor for cardiovascular disease. However, the role of body composition, including body fat percentage and lean body mass (LBM), in cardiovascular outcomes has not been well studied in patients with coronary artery disease (CAD). This study aims to evaluate the association of body composition with cardiovascular outcomes and all-cause mortality in patients with CAD.

METHODS AND RESULTS

Body composition was obtained via bioelectrical impedance analysis from 1291 patients with CAD before starting cardiac rehabilitation. Patients were divided into quintiles by body composition and analyzed in total and after sex stratification. All-cause mortality and a composite of major adverse cardiovascular events, including acute coronary syndrome, coronary revascularization, heart failure hospitalization, and stroke, were primary study outcomes. In the total cohort adjusted analyses, body mass index, body fat percentage, and LBM were not predictors of all-cause mortality or major adverse cardiovascular events. In sex-stratified analyses, among women, the third LBM quintile was associated with decreased risk of all-cause mortality compared with the lowest LBM quintile (adjusted hazard ratio, 0.07 [95% CI, 0.01-0.57]; P=0.01). No other body composition variables were associated with all-cause mortality or major adverse cardiovascular events in either sex.

CONCLUSIONS

In women with CAD, moderate LBM was associated with lower mortality when compared with low LBM, whereas body fat percentage and body mass index were not associated with mortality or major adverse cardiovascular events in either sex. Future research studying the implications of changes in body composition on outcomes in men and women with CAD is warranted.

Clinical Performance of an N-Terminal Pro-B-Type Natriuretic Peptide Assay in Acute Heart Failure Diagnosis

BACKGROUND

We evaluated the Vitros® Immunodiagnostic Products N-terminal pro B-type natriuretic peptide (NT-proBNP) II assay for aiding in diagnosis of heart failure (HF) in patients with acute dyspnea.

METHODS

Serum concentrations of NT-proBNP were measured in patient samples from 20 emergency departments across the United States. Study endpoints included sensitivity, specificity, likelihood ratios, and predictive values for diagnosis of acute HF according to age-stratified cutoffs (450, 900, and 1800 pg/mL), and a rule-out age-independent cutoff (300 pg/mL). Additional measures were area under the curve (AUC) for receiver operating characteristic (ROC) curves. Results were also interpreted in patient subgroups with relevant comorbidities, and gray zone/intermediate assay values.

RESULTS

Of 2200 patients, 1095 (49.8%) were diagnosed with HF by clinical adjudication. Sensitivity and specificity for Vitros NT-proBNP II ranged from 84.0% to 92.1%, and 81.4% to 86.5%, respectively, within and across age groups, and positive predictive values were 80.4% to 85.7%. Using the rule-out cutoff, the negative predictive value was 97.9%, with a negative likelihood ratio of 0.02. In subgroups with comorbidities potentially affecting NT-proBNP concentrations, sensitivities ranged from 82.6% to 89.5%, and AUCs for ROC curves were 0.899 to 0.915.

CONCLUSIONS

The Vitros NT-proBNP II assay demonstrated excellent clinical performance using age-stratified cutoffs along with other clinical information for supporting diagnosis of HF, and can rule out HF with a high negative predictive value using the age-independent cutoff. The assay retained utility in patient subgroups with conditions that influence NT-proBNP concentration, and for those with gray zone results.

CLINICALTRIALS.GOV REGISTRATION NUMBER

NCT03548909.

Unravelling the trajectory of frailty and its influencing factors in elderly patients with coronary heart disease after percutaneous coronary intervention: protocol for a cohort study in China

INTRODUCTION

Frailty is an important factor affecting the short-term and long-term outcomes of elderly patients with coronary heart disease (CHD) after surgery. Most previous studies only assessed frailty before surgery or at discharge, and there was limited tracking of the occurrence and progression of frailty during hospitalisation and after surgery. This paper describes the trends and influencing factors of frailty in elderly patients with CHD before and 6 months after percutaneous coronary intervention (PCI).

METHOD AND ANALYSIS

The frailty study is an observational, prospective cohort study aiming to recruit patients with CHD over 60 years of age who intend to undergo PCI. This study aims to investigate the evolving trends in frailty among elderly patients who have undergone PCI in the 6 months following hospital discharge. Additionally, the influence of cognitive, behavioural, psychosocial, physiological and biological factors on the trajectory of frailty changes in this population was explored based on the International Classification of Functioning, Disability and Health. There will be 11 data collection points, within 48 hours after admission, at hospital discharge and then monthly for the first 6 months, followed by assessments at 12, 24 and 36 months postdischarge. A general estimation equation will be used to analyse the overall trend of frailty. Growth mixture modelling and latent class growth modelling will both be used to identify distinct frailty trajectories. Univariate and logistic regression analyses will be used to identify predictors of trajectories. The Cox proportional hazard regression model will be employed to explore the relationship between the changing trend of different types of frailty within 6 months after discharge and survival status at 36 months.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Ethics Committee of Guangzhou First People's Hospital (K-2023-136-01). All findings will be disseminated through publication in peer-reviewed scientific journals and presentation at conferences and stakeholder organisation events.

Minimally Invasive Syringe-Injectable Hydrogel with Angiogenic Factors for Ischemic Stroke Treatment

Ischemic stroke (IS) accounts for most stroke incidents and causes intractable damage to brain tissue. This condition manifests as diverse aftereffects, such as motor impairment, emotional disturbances, and dementia. However, a fundamental approach to curing IS remains unclear. This study proposes a novel approach for treating IS by employing minimally invasive and injectable jammed gelatin-norbornene nanofibrous hydrogels (GNF) infused with growth factors (GFs). The developed GNF/GF hydrogels are administered to the motor cortex of a rat IS model to evaluate their therapeutic effects on IS-induced motor dysfunction. GNFs mimic a natural fibrous extracellular matrix architecture and can be precisely injected into a targeted brain area. The syringe-injectable jammed nanofibrous hydrogel system increased angiogenesis, inflammation, and sensorimotor function in the IS-affected brain. For clinical applications, the biocompatible GNF hydrogel has the potential to efficiently load disease-specific drugs, enabling targeted therapy for treating a wide range of neurological diseases.

Racial and ethnic disparities in post-acute care service utilization after stroke

Evidence examining disparities in post-acute care (PAC) utilization among various racial and ethnic groups after stroke and the influence of social determinants of health (SDOH) in these decisions is lacking. Thus, we searched the literature from January 2000 to November 2023 regarding PAC among individuals after stroke through: 1) Pubmed, 2) Scopus, 3) Web of Science, 4) Embase, and 5) CINAHL. We found 14 studies. Black individuals were more likely than White individuals to be discharged home with home health (HH) and skilled nursing facilities (SNF). Hispanic individuals were more likely than White individuals to be discharged home with HH, but less likely to be discharged to institutions. Lower socioeconomic status, Medicaid insurance, urban residence, area PAC supply and hospital characteristics were associated with increased institutional discharges among racial and ethnic minority individuals. Future policy should improve access to appropriate PAC commensurate with an individual's medical/social complexity.

Navigating the Future of Elderly Healthcare: A Comprehensive Analysis of Aging Populations and Mortality Trends Using National Inpatient Sample (NIS) Data (2010-2024)

The rapid growth of the elderly population in high-income countries, particularly the United States, is reshaping healthcare systems and exacerbating the burden of age-related diseases. By 2060, the U.S. population aged 65 years and older is projected to nearly double, with the oldest cohort (85+) tripling in size. This demographic shift is contributing to rising mortality rates due to chronic conditions such as Alzheimer's disease, cardiovascular diseases, frailty, and multi-morbidity. Utilizing data from the National Inpatient Sample (NIS) from 2010 to 2024, this review examines key trends in mortality, hospital utilization, and the healthcare system's capacity to manage these shifts. We identify the leading causes of death, hospital admission patterns, and the increasing demand for long-term care. The paper further explores the policy implications of these trends, highlighting the need for integrated care models, geriatric specialization, and preventive healthcare strategies to address the growing demands of an aging population. By providing a comprehensive analysis of these issues, this article aims to inform healthcare policy, improve care delivery for the elderly, and promote further research in geriatric healthcare.

Physical Activity, Sedentary Behaviour, and Cardiovascular Disease Risk Factors in Canadians Living With and Without Cardiovascular Disease

BACKGROUND

Our aim was to describe and compare the proportion of adult Canadians living with and without cardiovascular disease (CVD) and meeting the physical activity (PA) and sedentary behaviour (SB) recommendations of the Canadian 24-Hour Movement Guidelines using accelerometer and self-reported measures.

METHODS

Using adult (18-79 years of age) accelerometer data (Actical, worn during waking hours for 7 consecutive days) as well as chronic condition, sociodemographic, recreational screen time, and PA questions from 3 combined cycles of the Canadian Health Measures Survey, we compared the PA, SB, and CVD risk factors of adults living with and without CVD.

RESULTS

A total of 7035 Canadian adults who reported living with (n = 363) and without (n = 6672) CVD were included. Few adults living with CVD were meeting the PA (29%) and SB (15%) recommendations. CVD status was not significantly associated with the likelihood of meeting the PA or screen time recommendations, but adults living with CVD had a lower likelihood of meeting the sedentary time recommendation when compared with adults without CVD (adjusted odds ratio = 0.49; 95% confidence interval, 0.30-0.82). Adults, primarily men, living with rather than without CVD engaged in less light- and moderate-intensity PA.

CONCLUSIONS

The PA and SB of Canadian adults living with and without CVD are significantly different. Adults living with CVD had a lower likelihood of meeting the sedentary time recommendation, and adults living with CVD, primarily men, engaged in less light- and moderate-intensity PA. The identification of these movement behaviour targets may assist in allocating resources to sedentary individuals with the greatest need of PA.

Type A Aortic Dissection Following Abdominal Solid Organ Transplantation: Population-Level Outcomes in the United States

BACKGROUND

This study aims to analyze the patient characteristics, clinical outcomes, and contemporary trends concerning type A aortic dissection (TAAD) in previous recipients of abdominal solid organ transplantation (ASOT) in the United States.

METHODS

The National Inpatient Sample was queried to identify all patients aged ≥18 with TAAD and a history of ASOT (TAAD-ASOT) between 2002 and 2015Q3 using ICD-9 diagnosis and procedure codes. Baseline characteristics and in-hospital outcomes were compared between TAAD-ASOT patients and TAAD patients without a history of ASOT (TAAD-non-ASOT).

RESULTS

We identified a weighted total of 71 061 TAAD patients. Among them, 346 (0.49%) were ASOT recipients; of these, 318 (91.9%) were kidney transplant recipients, and 28 (8.1%) were liver transplant recipients. There is an increasing trend in the incidence of TAAD among ASOT recipients over the study period (p-trend < 0.001). Compared to TAAD-non-ASOT patients, TAAD-ASOT patients were younger (54.7 vs. 60.7 years, p < 0.001), less likely to be White (53.8% vs. 69.1%, p = 0.008), and associated with a higher Charlson Comorbidity Index (3.79 vs. 2.26, p < 0.001). TAAD-ASOT patients also exhibited significantly higher in-hospital mortality (27.4% vs. 17.8%, p = 0.03) and a greater risk of renal complications (53.5% vs. 29.7%, p < 0.001). Multivariable analysis indicated that a history of ASOT was independently associated with an increased in-hospital mortality rate in TAAD patients (adjusted odds ratio = 1.83, 95% CI = 1.01-3.31, p = 0.04).

CONCLUSIONS

TAAD-ASOT patients were younger but presented a higher comorbidity burden, an elevated in-hospital mortality rate, and an increased risk of postoperative complications compared to TAAD-non-ASOT patients. The rising incidence and unfavorable outcomes emphasize the need for future preventative measures and enhancements in surgical outcomes.

Pre-arrest atrial fibrillation and neurological recovery after cardiac arrest among hospitalized patients: A retrospective cohort study

BACKGROUND

New-onset atrial fibrillation (AF) is associated with an increased risk of stroke in hospitalized patients with severe sepsis. Post-cardiac arrest patients experience conditions similar to sepsis. This study investigated whether pre-arrest AF is associated with poor neurological recovery following in-hospital cardiac arrest (IHCA).

METHODS

This single-centre retrospective study included patients experiencing IHCA between 2005 and 2020. Pre-arrest electrocardiograms (ECGs) were reviewed, including twelve-lead ECGs and ECG strips. New-onset AF was defined as AF absent on electronic health records (EHRs, including admission diagnosis, past medical history and hospitalization notes) but present on pre-arrest ECG. Without considering EHRs, AF-presence was defined as AF present on pre-arrest ECG.

RESULTS

A total of 2466 patients were included, including 93 (3.8%) with new-onset AF and 131 (5.3%) with evidence of AF on pre-arrest ECG. The median age was 67.6 (interquartile range [IQR]: 22.3) years and the median CHA₂DS₂-VASc score was 3.0 (IQR: 3.0). A total of 405 (16.4%) patients survived to hospital discharge, with 228 (9.2%) patients achieving favourable neurological recovery. Multivariable logistic regression analysis indicated that both new-onset AF (odds ratio [OR]: .34, 95% confidence interval [CI]: .12-.94, p-value: .04) and AF-presence (OR: .35, 95% CI: .15-.85, p-value: .02) were inversely associated with favourable neurological recovery in the primary and sensitivity analyses, respectively.

CONCLUSIONS

Pre-arrest AF is a significant risk factor for poor neurological recovery following IHCA. Further research is needed to understand the underlying mechanisms, which could inform the development of strategies to improve outcomes in this patient subgroup.

Deprescribing strategies in older patients with heart failure

Older patients with heart failure are particularly vulnerable due to a wide range of associated comorbidities, disability, and frailty. This population often receives multiple prescriptions, increasing the risk of adverse drug reactions, non-adherence, and drug interactions. Deprescribing, which involves reducing the number of medications to the lowest clinically reasonable limit, has the potential to decrease the risk of drug interactions and enhance patients' quality of life. Moreover, simplifying medication regimens may improve adherence to essential heart failure therapies. This scientific review aims to comprehensively examine deprescribing strategies in older patients with heart failure. It explores the rationale, challenges, benefits, and potential approaches to optimizing medication regimens in this vulnerable population. Furthermore, the review suggests a practical, step-by-step approach for performing deprescribing in older patients with heart failure.

In Utero Nano-Titanium Dioxide Exposure Results in Sexually Dimorphic Weight Gain and Cardiovascular Function in Offspring

Engineered nanomaterials (ENM) are capable of crossing the placental barrier and accumulating in fetal tissue. Specifically, the ENM nano-titanium dioxide (nano-TiO2), has been shown to accumulate in placental and fetal tissue, resulting in decreased birthweight in pups. Additionally, nano-TiO2 is an established cardiac toxicant and regulator of glucose homeostasis, and exposure in utero may lead to serious maladaptive responses in cardiac development and overall metabolism. The current study examines weight gain and cardiac function in male and female Sprague-Dawley rats exposed to 12 mg/m3 nano-TiO2 or filtered air for 6 non-consecutive days in utero between gestational days 12-19. These animals were randomly assigned to receive a grain-based or high-fat diet (60%) between postnatal weeks 12-24 to examine the propensity for weight gain and cardiac response as adults. Our results show a sexually dimorphic response to weight gain with male rats gaining more weight after high-fat diet following in utero nano-TiO2 exposure, and female rats gaining less weight on the high-fat diet respective of exposure. Male rats exposed to nano-TiO2 in utero had reduced ejection fraction prior to diet when compared to air controls. Female rats subjected to in utero nano-TiO2 exposure showed a significant decrease in cardiac output following 12 weeks of high-fat diet. Development of cardiovascular impairments and ultimately cardiac dysfunction and disease following in utero exposures highlights the need for occupational and environmental monitoring of nanoparticulate exposure.

The role of hospital performance on race and ethnicity outcome disparities for US non-traumatic out-of-hospital cardiac arrests

BACKGROUND

Factors contributing to worse outcomes for out-of-hospital cardiac arrests (OHCA) from minoritized communities are poorly understood. We sought to evaluate the impact of receiving hospital performance on OHCA outcome disparities.

METHODS

We performed a retrospective cohort study of non-traumatic OHCAs from the National Cardiac Arrest Registry to Enhance Survival from 2013 to 2022 that survived hospital admission. We created cohorts based on census-tract race/ethnicity: >50% White, >50% Black, and >50% Hispanic/Latino. We stratified hospitals into performance quartiles based on hospital good neurologic outcome rates. We evaluated the association between race/ethnicity and care at better-performing hospitals. Using hierarchical modeling, we compared models evaluating the association between community race/ethnicity and outcomes, ignoring and adjusting for receiving hospital.

RESULTS

We included 202,117 OHCAs. Compared to White, OHCAs from Black (OR 0.12[0.12-0.13]) and Hispanic/Latino (OR 0.21[0.20-0.21]) communities had lower odds of care at higher-performing hospitals, but care at higher-performing hospitals improved outcomes for all groups: White - OR 1.43[1.41-1.44]), Black - OR 1.54[1.50-1.59]), Hispanic/Latino - 1.51[1.46-1.56]. Ignoring receiving hospital, outcomes were worse for OHCAs from Black (aOR 0.56[0.54-0.58]) and Hispanic/Latino (aOR 0.63[0.61-0.66]) communities. Although adjusting for bystander cardiopulmonary resuscitation did not change results, adjusting for hospital performance quartile improved outcome odds (Black - aOR 0.80[0.76-0.84]; Hispanic/Latino - aOR 0.82[0.78-0.86]). Adjusting for receiving hospital random effect also improved outcome odds (Black - aOR 0.84[0.81-0.87]; Hispanic Latino - aOR 0.86[0.83-0.90]).

CONCLUSIONS

OHCAs from Black and Hispanic/Latino communities received care at high-performing hospitals less often, and adjusting for receiving hospital significantly diminished OHCA outcome disparities.

Analysis of the haemodynamic changes caused by surgical and transcatheter aortic valve replacements by means fluid-structure interaction simulations

Aortic valve replacements, both surgical and transcatheter, are nowadays widely employed treatments. Although clinically effective, these procedures are correlated with potentially severe clinical complications which can be associated with the non-physiological haemodynamics that they establish. In this work, the fluid dynamics changes produced by surgical and transcatheter aortic valve replacements are analysed and compared with an ideal healthy native valve configuration, employing advanced fluid-structure interaction (FSI) simulations. The aim of the study is to investigate how existing treatments may affect the aortic valve function, and giving indications about how to improve current therapies. Simulations were performed using the commercial software LS-DYNA, where the FSI strategy is based on the coupling of a Lagrangian approach for the structures and a Eulerian approach for the fluid, whilst the coupling between the two domains is reached through a hybrid arbitrary-Lagrangian-Eulerian algorithm. Idealised geometries are used for the aortic root and leaflets. The aortic wall was modelled as linear elastic material, whilst leaflets were modelled as hyperelastic incompressible, using an Ogden's constitutive model. A combination of physiological flow velocity and pressure differences are applied as boundary conditions to model realistically the whole cardiac cycle. Results are analysed throughout the cardiac cycle in terms of leaflets kinematics, flow dynamics, pressure and valve performance parameters. Globally, surgical valves presented worse performance than transcatheter counterparts (reduced effective orifice area, increased transvalvular pressure drop and increased opening and closing times). The clinical parameters of transcatheter devices were improved and closer to those of the healthy native valve, although the vortical activity within the Valsalva's sinuses was substantially altered. Here, the presence of the partition obstructed the washing out, resulting in higher degree of blood stasis and potential blood damage. The implantation of prosthetic devices produces major haemodynamic changes which alters the valve dynamics and leads to diminished performance. Currently, the design of these substitutes is not optimised to mimic realistic native conditions, particularly in terms of valve opening behaviour. Although transcatheter devices provide systolic performance similar to that estimated for the healthy native aortic model, none of the prosthetic solutions appeared to be able to fully restore healthy physiological conditions.

Effectiveness and safety of exercise training and rehabilitation in elderly patients after heart valve intervention: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To investigate the effectiveness and safety of exercise rehabilitation in older adults undergoing intervention for heart valve disease.

METHOD

PubMed, Embase, Cochrane Library, CINAHL, Ovid Medline, SPORTDiscus, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang were systematically searched until January 2024. Risk-of-bias assessments were performed using the Cochrane risk-of-bias tool. A meta-analysis of the following indexes was performed using RevMan 5.4 software.

RESULTS

Nine trials involving 631 patients were ultimately included. Exercise rehabilitation significantly reduced the risk of adverse events, increased the 6-minute walk distance, improved the physical component of quality of life, and shortened the length of postoperative hospitalization. However, exercise rehabilitation did not affect all-cause mortality, left heart ejection fraction, or peak oxygen uptake.

CONCLUSIONS

Exercise rehabilitation may enhance exercise capacity, reduce the incidence of adverse events, and shorten the length of postoperative hospitalization in older adults undergoing intervention for heart valve disease.

Association of Preoperative Functional Status With Short-Term Major Adverse Outcomes After Cardiac Surgery

Introduction Cardiac surgery plays a crucial role in treating a wide range of cardiovascular conditions, offering life-saving interventions for patients with diseases such as coronary artery disease, heart valve disorders, and heart failure. However, these procedures are not without significant risks, including complications such as stroke, acute kidney injury, respiratory failure, and infections. It is important to not only recognize the potential complications associated with these procedures but also identify high-risk patients early in the treatment process. With the aging population and the increasing burden of comorbidities, a growing number of patients are likely to present with suboptimal functional status prior to cardiac surgery. By incorporating functional status into preoperative evaluations, healthcare providers can improve patient selection, enhance perioperative care, and improve outcomes in this high-risk patient population. Therefore, this study aims to investigate whether preoperative dependent functional status is associated with an increased risk of postoperative major adverse outcomes in patients undergoing cardiac surgery. Methods We performed a retrospective cohort analysis on adult cardiac surgery patients based on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2011-2021 database. We compared a primary composite outcome consisting of post-surgery outcomes between independent and partially/totally dependent patients. The primary outcome was defined as experiencing any of the following adverse events: superficial incisional/deep incisional/organ space surgical site infection, death within 30 days post-operation, stroke/cerebral vascular accident (CVA), cardiac arrest requiring cardiopulmonary resuscitation (CPR), myocardial infarction, pulmonary embolism (PE), deep vein thrombosis (DVT)/thrombophlebitis, progressive renal insufficiency, ventilator use for more than 48 hours post-operation, unplanned intubation or reoperation, sepsis, septic shock, and pneumonia. Confounding variables were age, gender, race, emergency case, comorbidities, and baseline laboratory markers. We used multivariable logistic regression analysis to obtain adjusted odds ratio (OR) and 95% confidence intervals (CIs). Results Of the 42,917 patients included in the study, 30.6% were female and 69.4% were male, with 46.5% of the group being 65-79 years old. The prevalence of dependent status was 2.6%. Compared to independent patients, those who were dependent had a higher incidence of the primary outcome (35.68% vs. 20.93%), yielding a crude OR of 2.09 (95% CI 1.85-2.37). The association remained significant: OR of 1.21 (95% CI 1.04-1.41) after adjustment for age, gender, race, body mass index (BMI), emergency case, and other comorbidities such as diabetes, hypertension, heart failure, preoperative blood transfusion or sepsis, and laboratory markers. Conclusion Patients with preoperative dependent functional status were found to have a significantly greater risk of complications after cardiac surgery, even after adjusting for demographics, comorbidities, laboratory markers, and perioperative characteristics. Further investigation is needed to explore the development and clinical application of a predictive tool that includes functional status, which could help identify high-risk patients and facilitate timely interventions such as prehabilitation programs to enhance functional capacity.

Targeting intracellular autophagic process for the treatment of post-stroke ischemia/reperfusion injury

Cerebral ischemia/reperfusion (I/R) injury is an important pathophysiological condition of ischemic stroke that involves a variety of physiological and pathological cell death pathways, including autophagy, apoptosis, necroptosis, and phagoptosis, among which autophagy is the most studied. We have reviewed studies published in the past 5 years regarding the association between autophagy and cerebral I/R injury. To the best of our knowledge, this is the first review article summarizing potential candidates targeting autophagic pathways in the treatment of I/R injury post ischemic stroke. The findings of this review may help to better understand the pathogenesis and mechanisms of I/R events and bridge the gap between basic and translational research that may lead to the development of novel therapeutic approaches for I/R injury.

Comparative effectiveness and safety of direct oral anticoagulants and warfarin in atrial fibrillation patients with dementia

INTRODUCTION

Developing an effective stroke prevention strategy is crucial for elderly atrial fibrillation (AF) patients with dementia. This is due to the limited and inconsistent evidence available on this topic. In this nationwide, population-based cohort study, we aim to compare the effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in AF patients with dementia.

PATIENTS AND METHODS

We identified AF patients with dementia, aged 50 years or older, from Taiwan's National Health Insurance Research Database between 2010 and 2019. The primary outcome was a composite of hospitalizations due to ischemic stroke, acute myocardial infarction, intracranial hemorrhage, or major bleeding, as well as all-cause mortality. We used 1:1 propensity score matching and Cox proportional hazard models to adjust for confounding factors when comparing outcomes between warfarin and DOAC (apixaban, dabigatran, edoxaban, or rivaroxaban) users or warfarin and each individual DOAC.

RESULTS

There were 2952 patients in the DOAC-warfarin matched cohort. The apixaban-, dabigatran-, edoxaban-, and rivaroxaban-warfarin matched cohorts had 2346, 2554, 1684, and 2938 patients, respectively. The DOAC group, when compared to warfarin, was associated with a lower risk of both the composite outcome (hazard ratio (HR), 0.81; 95% confidence interval (CI) 0.69-0.95) and ischemic stroke (HR 0.65; 95% CI 0.48-0.87). Apixaban (HR 0.79; 95% CI 0.66-0.94), dabigatran (HR 0.64; 95% CI 0.53-0.77), and rivaroxaban (HR 0.82; 95% CI 0.70-0.97) were also associated with a lower risk of the composite outcome.

DISCUSSION AND CONCLUSION

Compared to warfarin, DOACs, whether as a group or apixaban, dabigatran, or rivaroxaban individually, were associated with a reduced risk of the composite outcome in elderly patients with concurrent AF and dementia.

Curcumin attenuates myocardial ischemia‑reperfusion‑induced autophagy‑dependent ferroptosis via Sirt1/AKT/FoxO3a signaling

Curcumin (Cur) effectively attenuates myocardial ischemia/reperfusion injury (MIRI). MIRI has a complex mechanism and is associated with autophagy‑dependent ferroptosis. Therefore, the present study aimed to determine whether autophagy‑dependent ferroptosis occurs in MIRI and assess the mechanism of Cur in attenuating MIRI. The study was conducted on a Sprague‑Dawley rat MIRI model and H9c2 cell anoxia/reoxygenation (A/R) injury model. The effect of Cur pretreatment on A/R or MIRI induced autophagy‑dependent ferroptosis and its molecular mechanism were investigated. Protein expression, lysosomal, reactive oxygen species, Fe2+, oxidative systems, mitochondrial function, subcellular localization of molecules, and cardiac function assays will be employed. Cur decreased MIRI; improved myocardial histopathology; increased cardiomyocyte viability; inhibited ferroptosis, apoptosis and autophagy; reduced infarct size and maintained cardiac function. MIRI decreased silent information regulator 1 (Sirt1), decreased AKT and forkhead box O3A (FoxO3a) phosphorylation, leading to FoxO3a entry into the nucleus to activate translation of autophagy‑related genes and inducing ferroptosis, apoptosis and autophagy. However, Cur pretreatment activated AKT and FoxO3a phosphorylation via Sirt1, thereby transporting FoxO3a out of the nucleus, reducing autophagy‑related gene translation and attenuating MIRI‑induced ferroptosis, apoptosis and autophagy. Of note, the silencing of Sirt1 and administration of triciribine (an AKT inhibitor) both eliminated the protective effect of Cur. Thus, Cur maintained cardiomyocyte function by inhibiting autophagy‑dependent ferroptosis via Sirt1/AKT/FoxO3a signaling.

Age-Dependent Relationship of Physical Inactivity With Incident Cardiovascular Disease: Analysis of a Large Japanese Cohort

BACKGROUND

There have been limited studies examining age-dependent associations between physical inactivity and cardiovascular disease (CVD). We aimed to clarify the age-dependent relationship of physical inactivity with incident CVD.

METHODS

We analyzed 1,097,424 participants, aged 18 to 105 years, without histories of CVD, enrolled in the DeSC database (median age, 63 years; 46.4% men). We categorized participants into the following 4 groups based on age: ≤ 44 years (n = 203,835); 45 to 64 years (n = 403,619); 65 to 79 years (n = 437,236); and ≥ 80 years (n = 52,734). We used 3 physical inactivity components gained from the self-reported questionnaire during a health checkup. The outcomes were composite CVD events including myocardial infarction, stroke, heart failure, and each CVD event.

RESULTS

During a mean follow-up of 3.2 ± 1.9 years, 81,649 CVD events were observed. The hazard ratios of 3 physical inactivity components for CVD events increased with age category (P for interaction < 0.001). For example, the hazard ratio (95% confidence interval) of physical inactivity defined as not doing light sweaty exercise for 30 minutes at least twice a week for incident CVD in the groups aged ≤ 44 years, 45 to 64 years, 65 to 79 years, and ≥ 80 years were 0.97 (0.88-1.05), 1.08 (1.05-1.12), 1.12 (1.10-1.15), and 1.17 (1.12-1.21), respectively (P for interaction < 0.001). This association was consistent across subtypes of CVD including heart failure, myocardial infarction, and stroke.

CONCLUSIONS

The association of physical inactivity with a higher risk of developing CVD increased with age. Preventive efforts for physical activity optimization may be more valuable in older people.

Predicting Mortality in Patients Hospitalized With Acute Myocardial Infarction: From the National Cardiovascular Data Registry

BACKGROUND

In-hospital mortality risk prediction is an important tool for benchmarking quality and patient prognostication. Given changes in patient characteristics and treatments over time, a contemporary risk model for patients with acute myocardial infarction (MI) is needed.

METHODS

Data from 313 825 acute MI hospitalizations between January 2019 and December 2020 for adults aged ≥18 years at 784 sites in the National Cardiovascular Data Registry Chest Pain-MI Registry were used to develop a risk-standardized model to predict in-hospital mortality. The sample was randomly divided into 70% development (n=220 014) and 30% validation (n=93 811) samples, and 23 separate registry-based patient characteristics at presentation were considered for model inclusion using stepwise logistic regression with 1000 bootstrapped samples. A simplified risk score was also developed for individual risk stratification.

RESULTS

The mean age of the study cohort was 65.3 (SD 13.1) years, and 33.6% were women. The overall in-hospital mortality rate was 5.0% (n=15 822 deaths). The final model included 14 variables, with out-of-hospital cardiac arrest, cardiogenic shock, and ST-segment elevation MI as the strongest independent predictors of mortality. The model also included age, comorbidities (dyslipidemia, diabetes, prior percutaneous coronary intervention, cerebrovascular disease, and peripheral artery disease), heart failure on admission, heart rate, systolic blood pressure, glomerular filtration rate, and hemoglobin. The model demonstrated excellent discrimination (C-statistic, 0.868 [95% CI 0.865-0.871]) and good calibration, with similar performance across subgroups based on MI type, periods before and during the COVID-19 pandemic, and hospital volume. The simplified risk score included values from 0 to 25, with mortality risk ranging from 0.3% with a score of 0 to 1 up to 49.4% with a score >11.

CONCLUSIONS

This contemporary risk model accurately predicts in-hospital mortality for patients with acute MI and can be used for risk standardization across hospitals and at the bedside for patient prognostication.

Stroke Incidence and High-Sensitivity C-Reactive Protein Among African Americans: The Jackson Heart Study

Background

Strokes are a leading cause of death and disability among African Americans in the United States. Biological markers to predict stroke remain elusive; thus, our objective was to investigate whether inflammation, as measured by high-sensitivity C-reactive protein (hs-CRP), was associated with stroke incidence among African Americans enrolled in the Jackson Heart Study (JHS).

Methods

Baseline hs-CRP levels were categorized in quintiles: quintile 1 (0.0084 mg/L); quintile 2 (0.0085-0.0189 mg/L); quintile 3 (0.0190-0.036 mg/L); quintile 4 (0.037-0.0675 mg/L); quintile 5 (≥0.0676 mg/L). Nonfatal stroke incidence was ascertained from passive community surveillance through annual phone calls and adjudicated via hospital records. At baseline, stroke risk factors/covariates were compared across quintiles using a one-way analysis of variance and a chi-square test. The association between baseline hs-CRP levels and stroke incidence was determined using a Cox regression analysis to estimate hazard ratios (HRs) and 95% confidence intervals (CI).

Results

In the unadjusted model, hs-CRP levels in quintile 2 (HR, 1.48; 95% CI, 0.96-2.29), quintile 3 (HR, 1.44; 95% CI, 0.93-2.24), and quintile 4 (HR, 1.09; 95% CI, 0.68-1.74) were not associated with stroke incidence when compared with quintile 1 (reference). However, individuals within quintile 5 (HR, 1.78; 95% CI, 1.17-2.72) exhibited a significantly increased risk for stroke compared with those in the reference quintile. This risk persisted after adjusting for stroke risk factors (demographics, anthropometrics, health condition covariates, health behavioral risk factors, and cardiovascular disease history) for quintile 5 (HR, 1.87; 95% CI, 1.17-2.98) compared with reference quintile 1.

Conclusions

An increased and independent risk of nonfatal stroke appears at the highest quintile of hs-CRP values (≥0.0676 mg/L) among JHS participants.

Comparison of Traditional and Intensive Cardiac Rehabilitation on Dietary Behavior and Clinical Risk Factor Outcomes: Secondary Analysis Research

PURPOSE

The objective of this study was to assess differences in dietary behavior and clinical risk factor outcomes and explore predictors of change among patients participating in traditional and Pritikin intensive cardiac rehabilitation (CR).

METHODS

This secondary analysis of cardiac registry data from 2015 to 2021 included patients participating in traditional CR (n = 420) or Pritikin intensive CR (n = 1005) at a single hospital site. Dietary behavior outcomes included the Rate Your Plate measure, while clinical risk factor outcomes included fasting lipids, blood pressure, anthropometrics, functional outcomes, and psychosocial assessment. Analysis of covariance examined a difference in Rate Your Plate scores between CR groups. Multivariate analysis of covariance was used to determine differences in clinical risk factor variables between CR groups. Predictors of change in dietary behavior and clinical risk factors were determined through multiple bivariate linear regression models within each CR group.

RESULTS

Both CR programs led to significant improvements though more change was observed among Pritikin intensive CR participants in dietary behavior, anthropometrics, and fasting lipids. Status as a current or recent smoker was not a significant predictor of dietary behavior. Male sex, status as a current or recent smoker, beta-blockers, and angiotensin-converting enzyme inhibitors prescribed were not significant predictors of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or non-high-density lipoprotein cholesterol for traditional and Pritikin intensive CR groups. There were not significant predictors of blood pressure, body mass, or waist circumference.

CONCLUSION

Although participation in either CR program yielded cardiometabolic benefits, Pritikin intensive CR patients exhibited significantly greater improvements in dietary behavior and clinical risk factors.

Impact of Conventional Stroke Risk Factors on Early- and Late-Onset Ischemic Stroke: A Mendelian Randomization Study

BACKGROUND

Stroke incidence is decreasing in older ages but increasing in young adults. These divergent trends are at least partially attributable not only to diverging trends in stroke risk factors but may also be due to differences in the impact of stroke risk factors at different ages. To address this latter possibility, we used Mendelian randomization to assess differences in the association of stroke risk factors between early-onset ischemic stroke ([EOS]; onset 18-59 years) and late-onset ischemic stroke ([LOS]; onset ≥60 years).

METHODS

We identified genetic variants from the GWAS Catalog for use as instrumental variables to proxy conventional stroke risk factors and then estimated the effects of these variants on risk factors in younger and older individuals in the UK Biobank. We then used these estimates to estimate the causal effects of stroke risk factors on EOS (n=6728 cases) and LOS (n=9272) cases from SiGN (Stroke Genetic Network) and the EOSC (Early-Onset Stroke Consortium). Lastly, we compared odds ratios between EOS and LOS, stratified by TOAST (Trial of ORG 10172 in Acute Stroke Treatment) subtypes, to determine if differences between estimates could be attributed to differences in stroke subtype distributions.

RESULTS

EOS was associated with higher levels of body mass index, blood pressure, type 2 diabetes, and lower levels of HDL (high-density lipoprotein) cholesterol (all P≤0.002), whereas LOS was associated with higher levels of systolic blood pressure (P=0.0001). The causal effect of body mass index on stroke was significantly stronger for EOS than for LOS (odds ratio, 1.26 versus 1.03; P=0.008). After the subtype-stratified analysis, the difference in causal effect sizes between EOS and LOS for body mass index diminished and was no longer significant.

CONCLUSIONS

These results support a causal relationship between body mass index, blood pressure, type 2 diabetes, and HDL cholesterol levels with EOS and blood pressure levels in LOS. Interventions that target these traits may reduce stroke risk.

Optimism mitigated impacts of pre-operative depression and anxiety on post-operative distress in cardiac patients

Both anxiety and depression are comorbid mortality risks in middle-aged and older patients with heart diseases. Open-heart surgery (OHS), a life-altering procedure, can induce psychological distress that impedes postoperative recovery. Extensive research has shown the health benefit of optimism, an indicator of hope-a Character Strength in positive psychology. It predicts low mortality in cardiovascular disease-the number one killer of all Americans. Few studies, however, have explored whether that optimism mitigates the negative impact of preoperative depression and anxiety on postoperative general psychological distress. This interdisciplinary clinical study evaluated a hypothetical model of these relationships prior to and 1 month following OHS in 311 U.S. patients using a three-wave survey. Structural equation modeling (SEM) was performed to predict post-OHS general psychological distress. Optimism was indicated by two subscales in the Life Orientation Test (LOT). Based on the definition, general psychological distress was indicated by low symptom levels of somatization, depression, and anxiety as measured by the SCL-90 subscales. The final solution demonstrated a good fit. Optimism alleviates the negative effects of preoperative depression and anxiety, as indicators of poor mental health, on postoperative distress. Both older age and female gender were positively and directly associated with higher levels of post-OHS symptoms. The finding supports the beneficial role of optimism in mitigating the damage of poor mental health in the postoperative outcome of cardiac patients. The desirable function of character strength hope suggests that health providers should be attentive to and enhance inner strength for reducing the distress of cardiac patients in the postoperative recovery month.

Prevalence of Aspirin or Clopidogrel Pharmacological Resistance in Ischemic Stroke: A Step Toward Precision Medicine

BACKGROUND AND OBJECTIVES

Currently, there is not sufficient data regarding the prevalence of resistance or inadequate platelet function inhibition with the use of antiplatelet therapy in patients with noncardioembolic stroke. This study was designed to evaluate the prevalence of antiplatelet inactivity to aspirin and clopidogrel in the setting of chronic use and presentation with primary or recurrent stroke.

METHODS

Patients who were taking aspirin, clopidogrel, or both at the time of presentation for stroke were selected in this study. Those with confirmed stroke on MRI or clinically determined TIA and age > 18 years were included. A standard laboratory test, VerifyNow aspirin or P2Y12 assay, was utilized to assess the responsiveness to the platelet inhibitors. A total of 158 patients were identified, 52 presenting with primary stroke and 106 with recurrent stroke. Data were analyzed using chi-squared or Fisher's exact as well as t-test analysis.

RESULTS

Of the primary stroke population, 4% of patients demonstrated resistance to aspirin and 30% to clopidogrel. Of the patients presenting with recurrent stroke, 13% demonstrated resistance to aspirin and 38% to clopidogrel. The data also suggest increased resistance to aspirin and clopidogrel in Caucasians compared to minorities, with 11% versus 8% in regard to aspirin and 33% versus 17% to clopidogrel. Additionally, this study demonstrated 17% resistance to aspirin in males compared to 4% in females and 13% in males compared to 36% in females, respectively, regarding resistance to clopidogrel. No difference in inactivity to either aspirin or clopidogrel was detected between patients with stroke mechanisms of small or large vessel disease.

CONCLUSIONS

The present result demonstrated that a sizeable portion of the population has inefficacious activity in the setting of specific antiplatelet agents. Additionally, sex and ethnicity differences in responsiveness to aspirin or clopidogrel have been noted. Determining a patient's response to medications could provide opportunities to individualize treatment and better prevent future strokes. Further studies of a larger scale are indeed needed to apply this information to pursue individualized treatment.

Semi-autonomous drone delivering automated external defibrillators for real out-of-hospital cardiac arrest: A Danish feasibility study

AIM

To assess the feasibility and safety of drone-delivered automated external defibrillators (AEDs) in real out-of-hospital cardiac arrests (OHCAs) in Denmark, addressing the critical need for timely defibrillation in OHCAs.

METHODS

In this prospective clinical study in Aalborg, Denmark, an AED-carrying drone was dispatched for suspected OHCAs, from June 2022 to April 2023. The drone was stationed in an urban area (maximum flight-radius 6 km, covering 110,000 inhabitants) within designated airspace not requiring preflight approval from air-traffic control. Upon OHCA-suspicion, the emergency medical dispatcher activated the drone, which autonomously took off and flew beyond-visual-line-of-sight to the OHCA-location. On-site, a remote drone pilot (stationed cross-border) winched down the AED near the patient's location. Flights were restricted to dry weather, mean windspeeds < 8 m/s, and 8 am to 10 pm.

RESULTS

Of 76 suspected OHCAs, 27 occurred during non-operating hours (nighttime). Of the remaining 49 OHCAs, 16 (33%) were eligible for drone take-off, all of which resulted in successful AED-delivery, without any adverse events. Weather caused 14 cancellations (29%), technical issues (dispatch centre, drone, or hangar problems) 13 (27%), and closed airspace 6 (12%). The median drone response time from activation to AED-delivery was 04:47 min (IQR 03:45-05:27), and the corresponding ambulance response time was 03:25 min (IQR 02:43-04:14). No drone-delivered AEDs were attached.

CONCLUSION

This study demonstrates the safety and feasibility of drone-delivered AEDs to real OHCAs. Improved time to AED delivery was limited due to swift ambulance service, highlighting the importance of strategic AED drone placement.

Redox imbalance driven epigenetic reprogramming and cardiovascular dysfunctions: phytocompounds for prospective epidrugs

BACKGROUND

Cardiovascular diseases (CVDs) are the major contributor to global mortality and are gaining incremental attention following the COVID-19 outbreak. Epigenetic events such as DNA methylation, histone modifications, and non-coding RNAs have a significant impact on the incidence and onset of CVDs. Altered redox status is one of the major causative factors that regulate epigenetic pathways linked to CVDs. Various bioactive phytocompounds used in alternative therapies including Traditional Chinese Medicines (TCM) regulate redox balance and epigenetic phenomena linked to CVDs. Phytocompound-based medications are in the limelight for the development of cost-effective drugs with the least side effects, which will have immense therapeutic applications.

PURPOSE

This review comprehends certain risk factors associated with CVDs and triggered by oxidative stress-driven epigenetic remodelling. Further, it critically evaluates the pharmacological efficacy of phytocompounds as inhibitors of HAT/HDAC and DNMTs as well as miRNAs regulator that lowers the incidence of CVDs, aiming for new candidates as prospective epidrugs.

METHODS

PRISMA flow approach has been adopted for systematic literature review. Different Journals, computational databases, search engines such as Google Scholar, PubMed, Science Direct, Scopus, and ResearchGate were used to collect online information for literature survey. Statistical information collected from the World Health Organization (WHO) site (https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)) and the American Heart Association of Heart Disease and Stroke reported the international and national status of CVDs.

RESULTS

The meta-analysis of various studies is elucidated in the literature, shedding light on major risk factors such as socioeconomic parameters, which contribute highly to redox imbalance, epigenetic modulations, and CVDs. Going forward, redox imbalance driven epigenetic regulations include changes in DNA methylation status, histone modifications and non-coding RNAs expression pattern which further regulates global as well as promoter modification of various transcription factors leading to the onset of CVDs. Further, the role of various bioactive compounds used in herbal medicine, including TCM for redox regulation and epigenetic modifications are discussed. Pharmacological safety doses and different phases of clinical trials of these phytocompounds are elaborated on, which shed light on the acceptance of these phytocompounds as prospective drugs.

CONCLUSION

This review suggests a strong linkage between therapeutic and preventive measures against CVDs by targeting redox imbalance-driven epigenetic reprogramming using phytocompounds as prospective epidrugs. Future in-depth research is required to evaluate the possible molecular mechanisms behind the phytocompound-mediated epigenetic reprogramming and oxidative stress management during CVD progression.

Potential benefits of hormone replacement therapy on cardiovascular and kidney outcomes in postmenopausal women with chronic kidney disease

BACKGROUND

Hormone replacement therapy (HRT) is recommended for alleviating vasomotor symptoms or preventing bone loss in postmenopausal women. This study aimed to investigate the impact of hormone replacement therapy on major adverse cardiovascular events, kidney failure, and mortality in women with chronic kidney disease (CKD).

METHODS

This population-based cohort study analyzed data from the National Cancer Screening Program and the national health examination of South Korea. Data on postmenopausal women were extracted from the 2009 National Cancer Screening Program. Among these postmenopausal women, those with CKD without kidney replacement therapy were selected through a national health examination from 2009 to 2013. The study outcomes were the risks of major adverse cardiovascular events, kidney failure, and all-cause mortality according to hormone replacement therapy.

RESULTS

A total of 768,279 postmenopausal women with CKD were enrolled in this study; of these women, 13.8% (N = 106,052) had a history of hormone replacement therapy. The user and non-user groups differed with respect to baseline characteristics, with the latter being older and having risk factors for cardiovascular disease. After adjustment for confounding factors, the group exposed to hormone replacement therapy showed lower risks of major adverse cardiovascular events, kidney failure, and all-cause mortality.

CONCLUSIONS

This study suggests the potential benefits of hormone replacement therapy in postmenopausal women with CKD and highlighted its potential advantages for cardiovascular and kidney outcomes.

Trajectory of Cognitive Function After Incident Heart Failure

BACKGROUND

The magnitude of cognitive changes after incident heart failure (HF) is unclear. We assessed whether incident HF is associated with changes in cognition after accounting for pre-HF cognitive trajectories and known determinants of cognition.

METHODS

This pooled cohort study included adults without HF, stroke, or dementia from 6 US population-based studies from 1971 to 2019. Linear mixed-effects models estimated cognitive change with incident HF diagnosis and the rate of cognitive change over the years after HF, controlling for pre-HF cognitive trajectories and participant factors. Outcomes included change in global cognition (primary outcome), executive function, and memory (secondary outcomes). Cognitive outcomes were standardized to a t score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition.

RESULTS

We included 29 614 adults (mean [SD] age was 61 [10] years, 55% female, 70% White). During a median follow-up of 6.6 (Q1-Q3, 5.0-19.8) years, 1407 (5%) adults received an incident diagnosis of HF. Incident HF diagnosis was associated with initial decreases in global cognition (-1.1 points [95% CI, -1.4 to -0.8]) and executive function (-0.6 points [95% CI, -1.0 to -0.3]). Larger decreases in global cognition after HF were seen with older age, female sex, and White race. Participants with incident HF diagnosis demonstrated faster and long-term declines in global cognition (-0.1 points per year [95% CI, -0.2 to -0.1]) and executive function (-0.2 points per year [95% CI, -0.2 to -0.1]). The change in memory with incident HF diagnosis was not statistically significant but showed a similar trend with an initial decline of -0.5 points (95% CI, -1.4 to +0.3) and a slope of -0.1 points per year (95% CI, -0.3 to 0.0).

CONCLUSIONS

In this pooled cohort study, incident HF diagnosis was associated with initial decreases in global cognition and executive function and faster, persistent declines in these domains at follow-up.

Promoting self-care and improving quality of life in cardiovascular disease patients: The role of pharmacist-led interventions in community pharmacies

BACKGROUND

Community pharmacists are underutilized in assisting patients with cardiovascular diseases within pharmacy settings. Monitoring and controlling cardiovascular risks could prevent deaths globally and save public health expenses. The aim of this study is to verify how self-care can impact the quality of life of patients with cardiovascular diseases.

METHODS

A quasi-experimental study lasting 12 months was designed, involving pharmacist intervention. The intervention provided to patients involved personalized guidance tailored to their activation level. This included recommendations for lifestyle changes aimed at improving their quality of life, as assessed using research tools. Key biochemical variables, such as cholesterol levels, cardiovascular risk scores, blood pressure, and patient activation, were measured alongside the patients' perceived quality of life.

RESULTS

Activation level increased significantly after 12 months (from 2.81 ± 1.02 to 3.25 ± 0.78; p = 0.09), and quality of life by 9.9 points out of 100 (p = 0.02). In terms of total cholesterol levels, a decrease was observed between the beginning and the end of the study of 18.7 mg/dL (p = 0.04) and in diastolic pressure by 21.1 mm Hg (p = 0.02). In addition, there is a protective factor against cholesterol increase in those patients with a high activation level (PAM level above 3; RR = 0.273; 95%CI = 0.104-0.716), and with an improvement in quality of life (β = 0.761; p = 0.011); and a lower diastolic pressure when activation was higher (β = -0.351; p = 0.025).

CONCLUSION

Community pharmacists have an impact on improving self-care behaviors among patients with cardiovascular diseases. Community pharmacists, through their proactive involvement and tailored care approaches, are identified as key agents in chronic disease management, empowering patients towards healthier outcomes in the face of ongoing health challenges.

Racial and regional disparities in the risk of noncommunicable disease between sub-Saharan black and European white patients

OBJECTIVES

Greater vulnerability of Black vs. White individuals to cardiovascular disease (CVD) and chronic kidney disease (CKD) is well charted in the United States, but studies involving sub-Saharan blacks are scarce.

METHODS

Baseline data (2021-2024) were collected in 168 sub-Saharan Blacks and 93 European Whites in an ongoing clinical trial (NCT04299529), using standardized patient selection criteria. Data included clinical and biochemical risk factors, ECG and echocardiographic traits, Framingham CVD risk, CKD grades (KDIGO 2024), self-assessed symptoms (WHO questionnaire), and urinary proteomic profiles predictive of left ventricular dysfunction (LVD) and CKD, HF1, and CKD273, respectively. Racial comparisons rested on unadjusted and multivariable-adjusted analyses.

RESULTS

Despite being younger (60.4 vs. 68.3 years), blacks had a worse risk profile, as evidenced by higher diabetes prevalence, higher BMI, faster heart rate, unfavourable serum cholesterol fractions, lower estimated glomerular filtration rate, microalbuminuria, and sedentary lifestyle. This resulted in blacks having higher 10-year CVD risk, higher heart age (index of vascular ageing with chronological age as reference), and a worse CKD grades. In both races, CKD273 increased with CKD grade, but CKD273 and HF1 were not different by race. These observations were robust in subgroup and adjusted analyses.

CONCLUSION

This study did not differentiate host (genetic, molecular, and pathogenic) from environmental drivers of disease. Nonetheless, the findings call for a multipronged and comprehensive implementation of innovative health policies in sub-Saharan countries. Education, research, empowerment of stakeholders, and international learned societies connecting experts from a wide array of disciplines should vigorously sustain this effort.

The role of NRF2 function and regulation in atherosclerosis: an update

Atherosclerosis, a chronic inflammatory disease of the arteries, remains a leading cause of cardiovascular morbidity and mortality worldwide. This review examines the molecular mechanisms underlying NRF2 role in atherosclerosis, focusing on the recently defined intricate interplay between autophagy, the nuclear factor erythroid 2-related factor 2 (NRF2) pathway, microRNAs (miRNAs), and genes regulating NRF2 with atheroprotective effects. The NRF2/autophagy axis emerges as a critical regulator of cellular responses to oxidative stress and inflammation in atherosclerosis, with key players including Heat Shock Protein 90 (HSP90), Neuropeptide Y (NPY), and Glutaredoxin 2 (GLRX2). MiRNAs are identified as potent regulators of gene expression in atherosclerosis, impacting NRF2 signalling and disease susceptibility. Additionally, genes such as Prenyl diphosphate synthase subunit 2 (PDSS2), Sulfiredoxin1 (Srxn1), and Isocitrate dehydrogenase 1 (IDH1) are implicated in NRF2-dependent atheroprotective pathways. Future research directions include elucidating the complex interactions between these molecular pathways, evaluating novel therapeutic targets in preclinical and clinical settings, and addressing challenges related to drug delivery and patient heterogeneity. Despite limitations, this review underscores the potential for targeted interventions aimed at modulating NRF2/autophagy signalling and miRNA regulatory networks to mitigate atherosclerosis progression and improve cardiovascular outcomes.

Implementing an Educational Model for Cardiac Arrest Patients During Interfacility Transfers

Background Out-of-hospital cardiac arrest (OHCA) is a significant health concern in the United States, particularly in rural areas where patient care often depends on interfacility transfers (IFTs) to tertiary medical centers. In Maine, OHCA outcomes vary widely across regions, with no standardized education or protocols for the IFT of these patients. A key step toward improving care for this population is providing emergency medical service (EMS) personnel with education on essential aspects of post-return of spontaneous circulation (ROSC) management. To address this need, we developed a pilot virtual curriculum focused on post-ROSC care during IFT. The curriculum was designed to be virtual due to restrictions on in-person didactics at the time of implementation during the COVID-19 pandemic. This study aims to evaluate the feasibility of implementing a virtual curriculum that can be easily distributed. Additionally, we seek to analyze pre- and post-survey data from EMS personnel to assess changes in confidence, anxiety, and knowledge related to post-ROSC care. Methods Two local EMS departments, which handle the majority of IFTs for our institution, were invited to participate in the virtual educational model. The model consisted of a 27-minute recorded session divided into sections and distributed via an online platform in collaboration with Maine EMS. To assess the impact of the curriculum, EMS personnel completed electronic surveys administered through REDCap. A pre-survey was conducted before the curriculum, followed by a post-survey after its completion. The survey included questions measured on a 5-point Likert scale, covering confidence in resuscitation (five questions), anxiety during resuscitation (six questions), knowledge about post-ROSC care (eight questions), and attitudes toward the curriculum (three questions). Data analysis was performed using the Wilcoxon paired signed rank test to evaluate changes across these variables. Results A total of 18 EMS personnel participated in the curriculum (18/24; 75%), with all 18 completing the pre-survey and 10 completing the post-survey. Among those who completed both surveys, 70% agreed or strongly agreed that the IFT curriculum would improve patient care. Regarding knowledge of post-ROSC care, participants showed a mean improvement of +2.125 correct answers across the eight knowledge-based questions, with an average post-survey score of 6/8 (75%). However, there were no significant changes in confidence, skill, or anxiety levels, as indicated by a p-value of >0.9. Conclusions This pilot curriculum demonstrated the feasibility of delivering and completing a virtual educational model for EMS personnel on a topic not currently covered by Maine's state protocols or existing educational programs. Pre-post survey results indicated some improvement in participants; knowledge of post-ROSC care, and 70% believed the curriculum would enhance patient care. Future efforts are underway to integrate this content as a permanent component of local EMS education, given the significant role of ROSC management during IFTs.

Defining Thresholds for Meaningful Health Status Changes Following Transfemoral Carotid Artery Stenting

BACKGROUND

Evaluating health status changes following transfemoral carotid artery stenting (TF-CAS) is essential for assessing procedural success, but meaningful clinical changes are unknown. We aimed to determine minimal clinically important differences (MCIDs) and quantify health status improvement or worsening rates after TF-CAS using the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) registry data.

METHODS

The SAPPHIRE registry included patients undergoing TF-CAS from 2010 to 2014 for both symptomatic and asymptomatic carotid stenosis. Baseline and 30-day health status were assessed using the SF-36 (2010-2012) for mental and physical component scores (MCS and PCS) and the EQ-5D (2012-2014) for 3 L Index and Visual Analog Scale (VAS) scores. For each score, we calculated the 30-day distribution-based MCID (0.5*standard deviations of baseline health status) by symptom status and the overall cohort (symptom-weighted MCIDs). The changes were then categorized as improved, deteriorated, or unchanged based on these MCIDs.

RESULTS

Health status was assessed using the EQ-5D in 3930 patients and the SF-36 in 3018 patients (27.7% and 30.5% symptomatic, respectively). The MCIDs by symptom status were close, hence weighted MCIDs of 0.09 (Index), 11.00 (VAS), 4.70 (PCS), and 5.40 (MCS) were established. Across all subscales, 21.2%-26.1% of patients improved, 10.5%-16.7% worsened, and 57.2%-66.1% unchanged.

CONCLUSIONS

We established thresholds for meaningful health status changes after TF-CAS using common generic instruments. At 30 days after TF-CAS, 70%-80% of patients no change or worsened, while 20%-30% improved. Carotid artery disease-specific instrument would provide better insights into of TF-CAS effects on health status.

Inhibition of circALPK2 enhances proliferation and therapeutic potential of human pluripotent stem cell-derived cardiomyocytes in myocardial infarction

BACKGROUND

Understanding the mechanisms regulating human cardiomyocyte proliferation holds significant promise for developing effective therapies to enhance cardiac regeneration and repair. This study investigates the role of circALPK2, a circular RNA derived from the back-splicing of the 4th exon of alpha protein kinase 2 (ALPK2), in regulating cardiomyocyte proliferation and its therapeutic efficacy in myocardial infarction (MI) treatment.

METHODS

Human embryonic stem cell-derived cardiomyocytes (hESC-CMs) were used to assess the expression and function ofcircALPK2. Lentiviral shRNA-mediated knockdown of circALPK2 was performed in hESC-CMs, followed by RNA sequencing to identify targeted genes and biological processes. The proliferative capacity of wild-type and circALPK2 knockdown hESC-CMs was evaluated using CCK-8 assay, EdU staining and RT-qPCR analysis of cell cycle-related genes. Dual luciferase assays were conducted to validate the predicted miRNA targets and their downstream effects. For in vivo evaluation, MI mice were injected with either wild-type or circALPK2 knockdown hESC-CMs, and the therapeutic potential was assessed by echocardiographic and histological analyses.

RESULTS

We identified circALPK2 as a negative regulator of cell proliferation in hESC-CMs. CircALPK2 was abundantly expressed in hESC-CMs. Knockdown of circALPK2 significantly enhanced cell proliferation in hESC-CMs, as demonstrated by CCK-8 assays (p < 0.001) and EdU staining (p < 0.001), and accelerated the expression of cell cycle-related genes, including CCNA2(p < 0.05) and CDK1 (p < 0.01). Furthermore, circALPK2 was found to function as a sponge to inhibit miR-9 activity, while miR-9 mimics significantly boosted the proliferative capacity of hESC-CMs. Glycogen synthase kinase 3β (GSK3B), a key inhibitor of WNT signaling, was identified as a direct target of miR-9, mediating the regulation of cardiomyocyte proliferation. Importantly, circALPK2 knockdown improved the myocardial repair potential of hESC-CMs when injected into infarcted mouse hearts, as indicated by improved left ventricular ejection fraction (p < 0.01) and fractional shortening (p < 0.05).

CONCLUSIONS

Our study identifies the circALPK2/miR-9/GSK3B axis as a novel target for promoting cardiomyocyte proliferation and enhancing cardiac regeneration.

Extracellular vesicles in atherosclerosis: Current and forthcoming impact

Atherosclerosis is the main pathogenic substrate for cardiovascular diseases (CVDs). Initially categorized as a passive cholesterol storage disease, nowadays, it is considered an active process, identifying inflammation among the key players for its initiation and progression. Despite these advances, patients with CVDs are still at high risk of thrombotic events and death, urging to deepen into the molecular mechanisms underlying atherogenesis, and to identify novel diagnosis and prognosis biomarkers for their stratification. In this context, extracellular vesicles (EVs) have been postulated as an alternative in search of novel biomarkers in atherosclerotic diseases, as well as to investigate the crosstalk between the cells participating in the processes leading to arterial remodelling. EVs are nanosized lipidic particles released by most cell types in physiological and pathological conditions, that enclose lipids, proteins, and nucleic acids from parental cells reflecting their activation status. First considered cellular waste disposal systems, at present, EVs have been recognized as active effectors in a myriad of cellular processes, and as potential diagnosis and prognosis biomarkers also in CVDs. This review summarizes the role of EVs as potential biomarkers of CVDs, and their involvement into the processes leading to atherosclerosis.

Prevalence and Risk Factors of Stroke in Patients with Nonvalvular Atrial Fibrillation: A Case-Control Study

OBJECTIVE

To analyze the prevalence and influencing factors of stroke in patients with nonvalvular atrial fibrillation (SIPWNVAF), and to provide a reference basis for the prevention and control of stroke.

METHODS

Data were obtained from the China National Stroke Screening Survey. From January 2016 to December 2023, a total of 15,471 permanent residents aged ≥40 years in Yinchuan were screened. Patients with nonvalvular atrial fibrillation who had their first stroke were selected as the stroke group (86 patients), and patients with nonvalvular atrial fibrillation who had never had a stroke as the control group (477 patients).

RESULTS

In 563 residents, the crude prevalence of SIPWNVAF was 15.28%, and the standardized prevalence was 9.33%. The multivariable logistic regression analysis revealed that age (odds ratio [OR]: 1.42; 95% confidence interval [CI]: 1.17-1.71), smoking (OR: 2.10; 95% CI: 1.46-3.01), drinking (OR: 2.00; 95% CI: 1.28-3.13), lack of exercise (OR: 2.18; 95% CI: 1.18-4.03), family history of stroke (OR: 4.39; 95% CI: 1.82-10.57), hypertension (OR: 1.94; 95% CI: 1.03-3.63), diabetes (OR: 3.10; 95% CI: 1.37-7.05), dyslipidemia (OR: 2.15; 95% CI: 1.16-3.99), homocysteine ≥15 μmol/L (OR: 2.13; 95% CI: 1.14-3.97), and carotid atherosclerosis (OR: 2.86; 95% CI: 1.53-5.37) were independent risk factors, but educational level (OR: 0.31; 95% CI: 0.17-0.58) was a protective factor for SIPWNVAF.

CONCLUSIONS

The stroke group is significantly more burdened by other independent common risk factors for stroke.

Blood pressure control among Veterans with high cardiovascular disease risk

Objective

Blood pressure (BP) control reduces risk of cardiovascular disease (CVD), the major cause of disability and mortality among the nine million U.S. Veterans receiving care in Veterans Affairs (VA) medical centers. This study examined BP control, defined as a systolic BP < 130 mmHg and diastolic BP < 80 mmHg, among U.S. Veterans with hypertension at high risk for primary or secondary CVD events.

Methods

We utilized data from the VA Informatics and Computing Infrastructure Corporate Data Warehouse on primary care visits within the eight Great Lakes VA medical centers for Veterans with at least one visit between January 1, 2019, and February 28, 2020 and a documented visit within the 12 months prior to study initiation date. Analyses focused on Veterans with diagnosed hypertension and one or more of the following: age ≥65 years, and/or diagnosis of CVD, diabetes mellitus (DM) or chronic kidney disease (CKD). BP control was based on the last recorded BP measurement during the study period.

Results

The mean age of 83,633 Veterans with hypertension was 71.6 years (10.4) years, 96.4 % were male and race/ethnicity was reported as non-Hispanic White in 74.8 %, non-Hispanic Black or African American in 18.4 %, non-Hispanic Asian in 0.3 %, Alaskan Indian or Pacific Islander in 2.6 % and Hispanic in 2.5 %. Mean SBP and DBP based on vital signs at the last clinic visit were 130.8 mmHg (standard deviation [SD] 11.6) and 73.7 mmHg (SD 8.8), respectively. Overall, BP was controlled to < 130/80 mmHg in 38.7 % (95 % Confidence Interval [CI] 38.4, 39.1) and <140/90 mmHg in 76.9 % (95 % CI 76.7, 77.2). Among subgroups, BP was controlled to < 130/80 mmHg in 39.8 % (95 % CI 39.4, 40.2) of the Veterans aged ≥65 years, 45.3 % (95 % CI 44.7, 45.9) with CVD, 39.8 % (95 % CI 39.2, 40.3) with DM, 42.8 % (95 % CI 41.9, 43.6) with CKD and 47.1 % (95 % CI 45.5, 48.6) with CVD +DM +CKD. In contrast, BP control <140/90 mmHg was noted in over 75 % of Veterans within all subgroups.

Conclusion

In this group of Veterans with hypertension and high risk for CVD events, less than half had BP controlled to < 130/80 mmHg. Future studies should investigate strategies to improve BP control such as team-based care with home BP monitoring, education of clinicians on hypertension management, and increased utilization of automated office BP.

ADAMTS7, a target in atherosclerosis, cooperates with its homolog ADAMTS12 to protect against myxomatous valve degeneration

The physiological roles of the metalloprotease-proteoglycan ADAMTS7, a drug target in atherosclerosis and vascular restenosis, and its homolog ADAMTS12, are undefined in the cardiovascular system. The objective of the present work was to investigate their roles in mice with genetic inactivation of both proteases and in relation to the resulting valve defects, to define their proteolytic activities in the matrisome. Here, we demonstrate that Adamts7 and Adamts12 are co-expressed in heart valves and each buffers inactivation of the other by compensatory upregulation. Leaflets of Adamts7 -/-;Adamts12 -/- aortic valves, but not the respective single mutants, were abnormally shaped at birth, with progressively severe disorganization and enlargement occurring thereafter. Doppler echocardiography showed that Adamts7 -/-;Adamts12 -/- mice had stenotic and regurgitant aortic valves. We investigated ADAMTS7 and ADAMTS12 substrates relevant to the valve matrisome in secretome libraries from Adamts7 -/-;Adamts12 -/- cells using the N-terminomics technique Terminal Amine Isotopic Labeling of Substrates (TAILS). Although ADAMTS7 and ADAMTS12 shared several extracellular matrix (ECM) substrates, cleavage sites and sequence preference for each protease were distinct. Adamts7 -/-;Adamts12 -/- valve leaflets showed accumulation of several of the identified ECM substrates, including periostin, a matricellular protein crucial for cardiac valve homeostasis. We conclude that the myxomatous degeneration in Adamts7 -/-;Adamts12 -/- valve leaflets reflects a complex disturbance of ECM proteostasis with accumulation of multiple ADAMTS7 and ADAMTS12 ECM substrates, and perturbation of regulatory pathways with roots in ECM, such as TGFβ signaling, which was increased in the mutant valves.

Measuring intra-arrest transport in out-of-hospital cardiac arrest: A methodological study of registry-compatible definitions

INTRODUCTION

For out-of-hospital cardiac arrest (OHCA) with refractory arrest, transport to hospital with ongoing cardiopulmonary resuscitation (CPR)-"intra-arrest transport (IAT)"-is a treatment option, however it may reduce resuscitation quality. Unfortunately, international registries do not measure IAT directly, but other variables may be used to estimate IAT. We compared three indirect definitions to a direct measurement of IAT.

METHODS

We included advanced life support-treated adult non-traumatic OHCA from a large metropolitan emergency medical services network (2021-2023). We reviewed prehospital records and cardiac monitor files to identify IAT, defined as CPR in progress at time of transport. We compared this to three indirect definitions, including transport prior to: (1) "Any ROSC"; (2)"Sustained ROSC" (≥20 min or present at ED); or, (3) "Post-ROSC Vitals" (1st blood pressure/12-lead ECG.) RESULTS: Of 1,269 cases, the median age was 71 years (IQR: 60-81), 523 (41%) were female, 128 (10%) had initial shockable rhythms, 336 (26%) achieved ROSC on scene and were transported (75 of 200 [38%] with available data experienced rearrest on scene). Overall, 472 (37%, 95% CI: 34-40%) received IAT (direct definition). Indirect definitions of "Any ROSC", "Sustained ROSC", and "Post-ROSC Vitals" demonstrated sensitivity and specificities of 78.0%/100.0%, 98.5%/97.0%, and 82.4%/97.6%, respectively.

CONCLUSION

Compared to a direct measurement of IAT, the indirect definition using "Any ROSC" demonstrated the lowest sensitivity; however, the definition using "Sustained ROSC" showed the highest sensitivity and specificity. These indirect definitions may support estimation of IAT within future research and quality initiatives.

Cardiovascular disease lipids and lipoproteins biomarker standardization

Cardiovascular disease (CVD) is the leading cause of mortality in the United States and globally. This review describes changes in CVD lipid and lipoprotein biomarker measurements that occurred in line with the evolution of clinical practice guidelines for CVD risk assessment and treatment. It also discusses the level of comparability of these biomarker measurements in clinical practice. Comparable and reliable measurements are achieved through assay standardization, which not only depends on correct test calibration but also on factors such as analytical sensitivity, selectivity, susceptibility to factors that can affect the analytical measurement process, and the stability of the test system over time. The current status of standardization for traditional and newer CVD biomarkers is discussed, as are approaches to setting and achieving standardization goals for low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglycerides (TG), lipoprotein(a) (Lp(a)), apolipoproteins (apo) A-I and B, and non-HDL-C. Appropriate levels of standardization for blood lipids are maintained by the Centers for Disease Control and Prevention's (CDC) CVD Biomarkers Standardization Program (CDC CVD BSP) using the analytical performance goals recommended by the National Cholesterol Education Program. The level of measurement agreement that can be achieved is dependent on the characteristics of the analytes and differences in measurement principles between reference measurement procedures and clinical assays. The technical and analytical limitations observed with traditional blood lipids are not observed with apolipoproteins. Additionally, apoB and Lp(a) may more accurately capture CVD risk and residual CVD risk, respectively, than traditional lipids, thus prompting current guidelines to recommend apolipoprotein measurements. This review further discusses CDC's approach to standardization and describes the analytical performance of traditional blood lipids and apoA-I and B observed over the past 11 years. The reference systems for apoA-I and B, previously maintained by a single laboratory, no longer exist, thus requiring the creation of new systems, which is currently underway. This situation emphasizes the importance of a collaborative network of laboratories, such as CDC's Cholesterol Reference Methods Laboratory Network (CRMLN), to ensure standardization sustainability. CDC is supporting the International Federation of Clinical Chemistry and Laboratory Medicine's (IFCC) work to establish such a network for lipoproteins. Ensuring comparability and reliability of CVD biomarker measurements through standardization remains critical for the effective implementation of clinical practice guidelines and for improving patient care. Utilizing experience gained over three decades, CDC CVD BSP will continue to improve the standardization of traditional and emerging CVD biomarkers together with stakeholders.

Therapeutic Options for Disabling Acute Ischemic Stroke

Ischemic stroke affects up to 3% of the US population and is the leading cause of disability nationwide. This article outlines the evidence to support the use of intravenous thrombolytic, including tenecteplase, in the setting of acute ischemic stroke, along with thrombectomy for up to 24 hours, even in those patients with a large ischemic core and in those with an acute basilar artery occlusion. A clinical case of a patient with large ischemic core who received thrombectomy is included, along with images.

Targeted temperature management at 33 versus 36 degrees after out-of-hospital cardiac arrest: A follow-up study

Aim

Targeted temperature management (TTM) is commonly used in the setting of out-of-hospital cardiac arrest (OHCA) to improve survival and functional outcomes. However, real-world evidence of effects and optimal temperature are limited. To help address this, we examined associations between TTM and neurologically-intact survival after non-traumatic OHCA across changing institutional TTM temperature goals.

Methods

We performed a single-site, retrospective, cohort study of adults with non-traumatic OHCA who arrived comatose to the emergency department and received TTM from 2010 to 2020. Primary exposure was TTM goal temperature. Institutional goal temperature changed from 33 °C (TTM33-1) to 36 °C (TTM36) in 2014 and back to 33 °C (TTM33-2) in 2017. The primary outcome was neurologically-intact survival at discharge, defined as Cerebral Performance Category score of 1 or 2. Secondary outcomes included survival to hospital discharge and care processes. Multivariable logistic regression analysis evaluated association between TTM goal and neurological outcome.

Results

Of 1,469 OCHA patients meeting inclusion criteria, 800 (54%) received TTM. TTM was initiated more frequently during TTM33-1 (60%) than TTM36 (52%) or TTM33-2 (52%). After adjustment for demographic and cardiac arrest characteristics, there was no significant association between TTM goal temperature of 33 °C and neurologically-intact survival, versus 36 °C (adjusted odds ratio 1.10, 95% confidence interval 0.76, 1.60).

Conclusion

TTM goal temperature was not significantly associated with neurologically-intact survival of adult OHCA patients who arrived comatose to the emergency department.

Stroke incidence, trends, and geographic disparities in Ghana: An analysis of nationwide health facility records

OBJECTIVES

Despite the increasing burden of stroke and its effects in sub-Saharan Africa, there is a paucity of empirical studies on the burden of stroke and its risk factors to help guide targeted interventions in the region. This study examines the incidence, trends and some factors associated with stroke cases in Ghana.

STUDY DESIGN

Retrospective analysis of observational routinely collected data.

METHODS

Empirical data of confirmed stroke cases from all government-affiliated healthcare facilities were extracted from the District Health Information Management Systems of the Ghana Health Service spanning 2016-2021. Variables include stroke case counts by sex, age group and location. Cartographic geospatial mapping of stroke case density and negative binomial regressions were employed to assess trends and factors associated with stroke.

RESULTS

Stroke cases increased by more than two-fold in just six years (from 10,732 to 23,009). The rates for people 35-59years (IRR = 5.06, 95% CI: 4.04-6.63) and those above 60 years (IRR = 6.29, 95% CI: 5.01-7.88) were 5 and 6 times higher compared with 0-35year old. The rate of stroke in the year 2021 was 61 % higher than in 2016 (IRR = 1.61, 95% CI: 1.18-2.21). People in the northern savannah ecological zone had 77 % lower rate of stroke compared with those in the coastal zone of Ghana (IRR = 0.23, 95% CI: 0.18-0.30).

CONCLUSIONS

The incidence of stroke in Ghana is rising across all age groups, sexes and locations with a trajectory of early onset within the life course. There is an urgent need for the implementation of public health interventions for early detection, prevention and management of stroke cases in the country.

Coronary plaque characteristics quantified by artificial intelligence-enabled plaque analysis: Insights from a multi-ethnic asymptomatic US population

Background

Ethnic differences in coronary atherosclerosis remain to be fully elucidated. We aimed to assess quantitative plaque characteristics from coronary CT Angiography (CCTA) in relation to ethnicity and cardiovascular risk factors in a multi-ethnic asymptomatic US population.

Methods

This cross-sectional study retrospectively evaluated 388 asymptomatic patients selected from a prospective CCTA registry. A total of 194 patients from ethnic minority groups (Asian, African American, and Hispanic) were matched by age, sex, and cardiovascular risk factors to 194 White patients. Quantitative plaque volumes-including total plaque, non-calcified plaque, low-attenuation non-calcified plaque (<30 Hounsfield Units [HU]), and calcified plaque-were measured using artificial intelligence-enabled software. Pericoronary adipose tissue attenuation (PCAT) was also assessed and reported in Hounsfield Units (HU).

Results

The total study population included 388 patients (age 59.9±11.7 years, 68% male), of which 63% had coronary atherosclerosis with total plaque volumes of 149[IQR 50-438] mm3, driven predominantly by non-calcified plaque (122, IQR 27-369) mm3. Men presented higher volumes of all plaque components compared to women (P<0.05). In multivariable analysis adjusted for cardiovascular risk factors, only African American patients were associated with lower total plaque (β=-89.2, P=0.036), calcified (β=-26.1, P=0.015), and non-calcified plaque volumes (β=-62.7, P=0.022). African American patients were also associated with higher PCAT (β=5.8, P<0.001), along with family history of coronary artery disease (β=2.1, P=0.04).

Conclusions

Our study showed a uniformly high prevalence of atherosclerosis in this asymptomatic cohort, with lower plaque volumes of all sub-components in women. African American patients were associated with lower quantitative plaque volumes (total, non-calcified and calcified) but with higher PCAT compared to White patients; with no significant differences observed among other ethnic minorities.

Temporal trends of presumed cardiac origin out-of-hospital cardiac arrest incidence in Guangzhou, southern China: A 10-year consecutive analysis

Background

Despite the rising disease mortality rates, there is a dearth of studies on the incidence and trends of out-of-hospital cardiac arrests (OHCA) in China. This study aims to investigate the incidence and temporal trends of presumed cardiac origin OHCA in Guangzhou, Southern China, from 2011 to 2020.

Methods and results

In this population-based retrospective cohort study, pre-hospital data from the Guangzhou Emergency Medical Service (GZ-EMS) from 2011 to 2020 were analyzed. Crude incidence rates and age-standardized incidence rates (ASIRs) were calculated respectively. ASIRs were calculated using the 2000 national census population as the standard population. The Joinpoint software was used to calculate the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) in the incidence of OHCA over the study period. From 2011 to 2020, 44,375 EMS-assessed OHCAs of presumed cardiac origin were recorded. Overall, the crude incidence rate of OHCA was 53.1 per 100,000 on average. AAPC was 7.0% (95% CI: 4.3%-9.8%). Age-standardized incidence rate(ASIR) was 38.4 per 100,000 on average, with an average annual increase of 4.8% (95% CI: 2.4%-7.3%). The crude and ASIR of OHCA increased in men, while the ASIR changed more moderately in women. The age group of ≥80 years had the highest rate of increase. The 20-29 and 70-79 age groups also demonstrated notable increases.

Conclusions

From 2011 to 2020, Guangzhou experienced a notable upward trend in both crude and ASIR of OHCA, with significant variations observed across gender and age demographics. This trend calls for a deeper investigation into the underlying factors.

Case for Establishing a National Stroke Activation Fee in the United States: Learning From Trauma Centers

There is a large burden of stroke in the United States, and extensive systems of care have been established to address it. The resources devoted to stroke centers are analogous to those of trauma centers, both sharing many strict requirements for certification, clinical preparedness, quality improvement, data management, and reporting. However, trauma programs partly defray these costs through a trauma activation billing code, a billable fee that is charged for activation of the trauma team under strict criteria. There are potential benefits to establishing an analogous national stroke code activation fee. Although a billable stroke code activation fee may increase financial burden on patients, this may be counterbalanced by the significant potential for individual and societal benefits. Providing additional financial support for stroke systems of care may improve acute stroke treatment, reduce stroke burden and poststroke disability, and reduce inequality by broadening the reach of stroke systems of care to disadvantaged communities. Further evaluation of the costs and benefits of implementing a stroke code activation fee based on that currently used by trauma centers is needed.

Toxic stress is associated with cardiovascular disease among younger but not older women in the United States: Results from the research goes red registry

Introduction

Psychosocial stress may be an under-recognized risk factor for cardiovascular disease among younger women (ages 35-54 years).

Methods

Data was obtained from the Research Goes Red Registry, initiated in 2019, and included women from the United States. Women self-reported diagnoses of cardiovascular disease and experiences of toxic stress defined as a significant life-defining stressful activity over a prolonged period unaccompanied by sufficient social resources. Logistic regression models were used to estimate odds ratios between toxic stress and cardiovascular disease and differences by age (< 55 versus ≥ 55 years of age) using an interaction term.

Results

The analytic dataset included 1346 women. The mean age of women was 47.8 (SD: 12.6), 71 % were less than 55 years of age, 83 % were Non-Hispanic White, 59 % indicated that they had experienced toxic stress, and 12 % had cardiovascular disease. In final multivariable models, there were significant differences in the association between toxic stress and cardiovascular disease by age group (toxic stress-by-age interaction = 0.0412) such that toxic stress was only significantly associated with an increased odds of cardiovascular disease among women < 55 years of age (OR: 1.79; 95 % CI: 1.03, 3.11) but not older women ≥ 55 years of age (OR: 0.82; 95 % CI: 0.49, 1.39).

Conclusion

Toxic stress was associated with an increased odds of cardiovascular disease among younger, but not older women in this cross-sectional study. Stress may be an under-recognized risk factor for cardiovascular disease, especially among younger women who may benefit from interventions to mitigate and prevent stress.