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

Expression patterns and clinical value of key m6A RNA modification regulators in smoking patients with coronary artery disease

Even though N6-methyladenosine (m6A) RNA modifications are increasingly being implicated in human disease, their mechanisms are not fully understood in smokers with coronary artery disease (CAD). Thirty m6A-related regulators' expression (MRRE) in CAD individuals (smokers and non-smokers) were analyzed from GEO. Support Vector Machine, random forest, and nomogram models were constructed to assess its clinical value. Consensus clustering, principal component analysis, and ssGSEA were used to construct a full picture of m6A-related regulators in smokers with CAD. Oxygen-glucose deprivation (OGD) and qRT-PCR were used to validate hypoxia's effect on MRRE. A comparison between smokers with CAD and controls revealed lower expression levels of RBM15B, YTHDC2, and ZC3H13. Based on three key MRREs, all models showed good clinical value, and smokers with CAD were divided into two distinct molecular subgroups. The correlations were found between key MRRE and the degree of immune infiltration. Three key MRREs in HUVECs and FMC84 mouse cardiomyocytes were reduced in the OGD group. Through hypoxia, smoking might reduce the expression levels of RBM15B, YTHDC2, and ZC3H13 in smokers with CAD. Our findings provide an important theoretical basis for the treatment of smokers with CAD.

Advancing Myocardial Infarction Treatment: Harnessing Multi-Layered Recellularized Cardiac Patches with Fetal Myocardial Scaffolds and Acellular Amniotic Membrane

PURPOSE

Myocardial infarction (MI) is a leading cause of irreversible functional cardiac tissue loss, requiring novel regenerative strategies. This study assessed the potential therapeutic efficacy of recellularized cardiac patches, incorporating fetal myocardial scaffolds with rat fetal cardiomyocytes and acellular human amniotic membrane, in adult Wistar rat models of MI.

METHODS

Decellularized myocardial tissue was obtained from 14 to 16 week-old human fetuses that had been aborted. Chemical detergents (0.1% EDTA and 0.2% sodium dodecyl sulfate) were used to prepare the fetal extracellular matrix (ECM), which was characterized for bio-scaffold microstructure and biocompatibility via scanning electron microscopy (SEM) and MTT assay, respectively. Neonatal cardiomyocytes were extracted from the ventricles of one-day-old Wistar rats' littermates and characterized through immunostaining against Connexin-43 and α-smooth muscle actin. The isolated cells were seeded onto decellularized tissues and covered with decellularized amniotic membrane. Sixteen healthy adult Wistar rats were systematically allocated to control and MI groups. MI was induced via arterial ligation. Fourteen days post-operation, the MI group was received the engineered patches. Following a two-week post-implantation period, the animals were euthanized, and the hearts were harvested for the graft evaluation.

RESULTS

Histological analysis, DAPI staining, and ultra-structural examination corroborated the successful depletion of cellular elements, while maintaining the integrity of the fetal ECM and architecture. Subsequent histological and immunohistochemichal (IHC) evaluations confirmed effective cardiomyocyte seeding on the scaffolds. The application of these engineered patches in MI models resulted in increased angiogenesis, reduced fibrosis, and restricted scar tissue formation, with the implanted cardiomyocytes remaining viable at graft sites, indicating prospective in vivo cell viability.

CONCLUSIONS

This study suggests that multi-layered recellularized cardiac patches are a promising surgical intervention for myocardial infarction, showcasing significant potential by promoting angiogenesis, mitigating fibrosis, and minimizing scar tissue formation in MI models. These features are pivotal for enhancing the therapeutic outcomes in MI patients, focusing on the restoration of the myocardial structure and function post-infarction.

Early identification of vascular access site complications and frequent heart rate and blood pressure monitoring after cardiac catheterization: A scoping review

BACKGROUND

Nurses perform frequent heart rate (HR) and blood pressure (BP) monitoring, a widespread and longstanding practice, after cardiac catheterization (CC) to identify vascular access site complications for femoral and radial arterial approach in adult patients.

OBJECTIVE

The objective of this scoping review was to answer two questions: (1) how does the available evidence support frequent HR and BP monitoring after CC via femoral and radial approach in adult patients and (2) how does this practice prompt bedside nurses in identifying the procedure's major vascular access site complications, including bleeding, hematoma, and pseudoanurysm?

METHOD

Following the scoping review approach, literature search was conducted (PubMed, CINAHL, Google Scholar) by two co-authors and medical librarian. We reviewed, evaluated, and analyzed the evidence from twenty articles.

RESULTS

The reviewed medical and nursing literature revealed findings challenging the present practice. Out of fifteen research studies, five found frequent HR and BP monitoring after CC to be uninformative while the remaining ten did not report frequent vital signs. Two research articles reported that vascular complications after CC were discovered by RNs directly assessing the access site or by the patients themselves, unrelated to HR and BP. Five non-research articles were included, which all recommended frequent HR and BP monitoring.

CONCLUSIONS

Frequent HR and BP assessment during the recovery period is not supported by empirical research despite being consistently recommended by nursing guidelines and expert opinion articles. Current evidence supports frequent vascular access site assessments and patient education.

Percutaneous left atrial appendage closure using a modified single-operator-technician approach under deep sedation: A single-center experience

Background

Historically, percutaneous transcatheter left atrial appendage closure (LAAC) has been performed under general anesthesia (GA) with transesophageal echocardiographic images obtained by a noninvasive cardiologist and usually requires an overnight hospital stay. Alternatively, we present our single-center experience performing LAACs under deep sedation (DS), employing an echocardiographic technician instead of a noninvasive cardiologist, and expediting same-day discharge. Mid- to long-term outcomes were also evaluated with follow-up imaging at a 45-day visit.

Objective

The purpose of this study was to demonstrate the safety, feasibility, and outcomes of our single-operator-technician LAAC approach.

Methods

A total of 150 patients, with elevated CHA2DS2-VASc scores (a mean of 4 points), underwent transesophageal echocardiography-guided LAAC using the WATCHMAN FLX (Boston Scientific, Marlborough, MA) device under DS.

Results

The mean age of patients was 78 years. Seventy-six (51%) were men. One hundred forty-seven patients (98%) had the LAAC device successfully implanted, and 145 (97%) were discharged on the same day. Nine patients (6%) required conversion from DS to GA. Only 5 patients (4%) had complications during the procedure. None of the patients died or had complications from DS. During the 45-day follow-up visit, one patient had a significant peridevice leak (maximum diameter ≥ 5 mm) and another patient had device-related thrombosis.

Conclusion

Our novel single-operator-technician approach under DS is safe and feasible. Implementing protocols to simplify the traditional 2-operator approach under GA by using DS and an echocardiography technician as well as incorporating same-day discharge could make LAACs more widely available and potentially reduce procedural costs.

Sex-related differences in demographics, diagnosis and management of patients with chronic coronary syndromes

AIMS

The impact of sex-related factors on current clinical management and outcomes of chronic coronary syndromes (CCS) are unclear.

METHODS

All patients belonging to the prospective, nationwide START registry were included. Their baseline characteristics, diagnostic workup, revascularization strategy, pharmacological treatment and 1-year clinical outcomes were compared with respect to sex overall and in age tertiles.

RESULTS

A total of 5070 consecutive patients were included. Most patients were males (80.1%). As expected, the prevalence of females increased with age. Distribution of risk factors and history of cardiovascular disease were different depending on sex, as well as diagnostic workup, with lower use of exercise stress testing in women (25.1% vs. 36.7%, P < 0.0001). The use of coronary angiography was similar in the two groups. Women had lower rates of multivessel coronary artery disease (CAD) (33.0% vs. 40.6% P < 0.0001) and higher rates of nonobstructive CAD (18.3% vs. 11.3%, P < 0.0001). Rates of myocardial revascularization were similar, but women were more likely to receive percutaneous coronary intervention than men (84.3% vs. 77.8%, P < 0.0001) and less likely to receive surgical/hybrid revascularization (10.0% vs. 15.1%, P < 0.0001). At 12-month follow-up, no differences were observed for the combined endpoint of all-cause mortality, re-hospitalization for myocardial infarction, heart failure, stroke or myocardial revascularization between males and females; however, a significantly worse perceived quality of life was observed in women.

CONCLUSIONS

In a large nationwide cohort of patients with CCS, clinical outcomes were not different depending on sex. However, several differences in the diagnostic work-up, treatment strategies and quality of life were found between sexes.

Simultaneously blocking ANGPTL3 and CD47 prevents the progression of atherosclerosis through regulating lipid metabolism, macrophagic efferocytosis and lipid peroxidation

Atherosclerosis (AS) ultimately cause major adverse cardiovascular events (MACEs). While traditional strategies by lipid-reducing have reduced MACEs, many patients continue to face significant risks. It might attribute to the upregulation of CD47 expression in AS lesions, that mediated anti-efferocytosis of macrophages. Therefore, we propose simultaneously blocking ANGPTL3, a vital regulator of lipid metabolism, and CD47 might be a potential approach for AS therapy. Firstly, we investigate the role of a novel anti-ANGPTL3 nanobody-Fc (FD03) in AS. We found that FD03 treatment significantly decreased circulating lipids, plaque size, and lipid deposition in apoE-/- mice compared to control Ab, but there was a twofold increase in plaque formation in comparison to baseline. However, immunofluorescence indicated the upregulation of CD47 expression in the plaques even after FD03 treatment compared to normal vascular tissue. Next, a bifunctional protein containing signal regulatory protein alpha (SIRPα) and FD03 (SIRPαD1-FD03) was constructed to block CD47 and ANGPTL3 concurrently, which had high purity, robust stability, and high affinity to CD47 and ANGPTL3 with biological activity in vitro. Furthermore, SIRPαD1-FD03 fusion protein exhibited the enhanced therapeutic effect on AS compared with SIRPαD1-Fc or FD03, regressing plaque contents and the necrotic core equal to baseline. Mechanistically, SIRPαD1-FD03 reduced serum lipids, augmented the efferocytosis rate and macrophage M2 polarization, and decreased the reactive oxygen species (ROS) and lipid peroxidation level in atherosclerotic plaques. Collectively, our project suggests an effective approach for AS by simultaneously blocking ANGPTL3 and CD47 to regulate lipid metabolism, macrophage activity and lipid peroxidation.

Implication of knowledge, lifestyle and self-efficacy in the prevention of cardiovascular diseases' risk factors among the urban elderly

Background: Cardiovascular disease (CVD) is preventable by effectively managing its risk factors. Such risk factors (smoking, unhealthy eating habits, sedentary lifestyles, etc.) are judged to reflect an individual's self-efficacy, lifestyle modification, and CVD knowledge. Objectives: To evaluate the relationship between lifestyle practices, self-efficacy, and knowledge of CVDs risk factors among the elderly. Methods: A descriptive cross-sectional study was conducted on 424 randomly individuals whose age is ≥60 years. A questionnaire-based survey was administered on the self-efficacy rate, lifestyle practices, and respondents' knowledge of CVDs risk factors. Respondents with a score of ≤50%, 51%-74.99%, and ≥75% were classified as having low, medium, or high self-efficacy. Similarly, the same score was used to classify poor, fair, or good lifestyle; and low, average, or high knowledge. Data were analysed using Statistical Package for Social Sciences, while association among variables was determined using chi-square. Results: Few respondents were involved in physical exercise (1.7%), cigarette smoking (4.5%), regular soft drinks (18.2%), and alcohol consumption (13.2%). Many respondents used excess salt during cooking (92.7%) or ate outside their homes (64.6%). 58.5%, 30.0%, and 11.6% of the respondents had fair, good, and poor lifestyle practices. 11.3%, 58.7%, and 30.0% had low, medium, and high self-efficacy scores. A total of 45.3%, 35.4%, and 19.3% had low, average, and high knowledge. Knowledge and self-efficacy scores were significantly different (P  =  0.001). Conclusion: High self-efficacy and its significant relationship with knowledge could mean that CVD risk factors can be checked if the elderly have a proper lifestyle, positive attitudes, and nutrition education.

Characterizing apparent treatment resistant hypertension in the United States: insights from the All of Us Research Program

BACKGROUND

Hypertension (HTN) remains a significant public health concern and the primary modifiable risk factor for cardiovascular disease, which is the leading cause of death in the United States. We applied our validated HTN computable phenotypes within the All of Us Research Program to uncover prevalence and characteristics of HTN and apparent treatment-resistant hypertension (aTRH) in United States.

METHODS

Within the All of Us Researcher Workbench, we built a retrospective cohort (January 1, 2008-July 1, 2023), identifying all adults with available age data, at least one blood pressure (BP) measurement, prescribed at least one antihypertensive medication, and with at least one SNOMED "Essential hypertension" diagnosis code.

RESULTS

We identified 99 461 participants with HTN who met the eligibility criteria. Following the application of our computable phenotypes, an overall population of 81 462 were further categorized to aTRH (14.4%), stable-controlled HTN (SCH) (39.5%), and Other HTN (46.1%). Compared to participants with SCH, participants with aTRH were older, more likely to be of Black or African American race, had higher levels of social deprivation, and a heightened prevalence of comorbidities such as hyperlipidemia and diabetes. Heart failure, chronic kidney disease, and diabetes were the comorbidities most strongly associated with aTRH. β-blockers were the most prescribed antihypertensive medication. At index date, the overall BP control rate was 62%.

DISCUSSION AND CONCLUSION

All of Us provides a unique opportunity to characterize HTN in the United States. Consistent findings from this study with our prior research highlight the interoperability of our computable phenotypes.

Associations between AHA's Life's Essential 8 and cognition in midlife and older adults

INTRODUCTION

This study evaluated the associations between Life's Essential 8 (LE8) and cognitive performance, and compared the strength of the relationships of Life's Simple 7 (LS7) and LE8 to cognition in midlife and older adults.

METHODS

Participants (N = 1539) were from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Cross-sectional multivariable regression examined the associations between LE8 and cognition. Secondary analyses compared model performance between LE8 and LS7 measures on cognition from the same available sample.

RESULTS

Higher LE8 scores were associated with better global cognitive performance, working memory, and attention. The LS7 model outperformed the LE8 model on global cognitive performance, but the LE8 model outperformed the LS7 model for the working memory domain.

DISCUSSION

Better cardiovascular health (CVH) was associated with better cognitive performance among US middle-aged and older adults. However, the association between CVH and specific cognitive domains varies when using LE8 versus LS7.

HIGHLIGHTS

Cardiovascular health (CVH) is associated with cognitive performance. Life's Essential 8 (LE8) is a new construct to quantify CVH. Associations between LE8 and cognition were assessed. Higher LE8 was associated with better global cognitive performance. Higher LE8 was also associated with better working memory and attention.

Advances in the study of exosomes in cardiovascular diseases

BACKGROUND

Cardiovascular disease (CVD) has been the leading cause of death worldwide for many years. In recent years, exosomes have gained extensive attention in the cardiovascular system due to their excellent biocompatibility. Studies have extensively researched miRNAs in exosomes and found that they play critical roles in various physiological and pathological processes in the cardiovascular system. These processes include promoting or inhibiting inflammatory responses, promoting angiogenesis, participating in cell proliferation and migration, and promoting pathological progression such as fibrosis.

AIM OF REVIEW

This systematic review examines the role of exosomes in various cardiovascular diseases such as atherosclerosis, myocardial infarction, ischemia-reperfusion injury, heart failure and cardiomyopathy. It also presents the latest treatment and prevention methods utilizing exosomes. The study aims to provide new insights and approaches for preventing and treating cardiovascular diseases by exploring the relationship between exosomes and these conditions. Furthermore, the review emphasizes the potential clinical use of exosomes as biomarkers for diagnosing cardiovascular diseases.

KEY SCIENTIFIC CONCEPTS OF REVIEW

Exosomes are nanoscale vesicles surrounded by lipid bilayers that are secreted by most cells in the body. They are heterogeneous, varying in size and composition, with a diameter typically ranging from 40 to 160 nm. Exosomes serve as a means of information communication between cells, carrying various biologically active substances, including lipids, proteins, and small RNAs such as miRNAs and lncRNAs. As a result, they participate in both physiological and pathological processes within the body.

Trends and disparities in age, sex, ethnoracial background, and urbanization status in adult mortality due to thoracic aortic aneurysm: a retrospective nationwide study in the United States

INTRODUCTION

Thoracic aortic aneurysms (TAA) are a significant health concern, with the true prevalence likely underestimated due to undiagnosed cases. Outcomes in TAA are influenced by factors like age, sex, and comorbidities such as hypertension. This study examines mortality trends and disparities associated with TAA in US adults.

METHODOLOGY

This study analyzed death certificates from 1999 to 2020 using the CDC WONDER Database to identify TAA-related deaths in individuals aged 25 and older using ICD-10 codes I71.1 and I71.2. Age-adjusted mortality rates (AAMRs) per 1 000 000 and annual percent changes (APCs) were calculated and stratified by year, sex, age group, race/ethnicity, region, and urbanization status.

RESULTS

Between 1999 and 2020, 47 136 TAA-related deaths were reported among US adults. The AAMR decreased from 16.2 to 8.2 per 1 000 000, with a significant decline from 1999 to 2013 (APC: -5.00; 95% CI: -5.54 to -4.54; P<0.001). Older adults had the highest AAMRs at 44.6 per 1 000 000. Men had higher AAMRs than women (11.2 vs. 9). AAMRs were highest among non-Hispanic (NH) Black (11), followed by NH White (10.3), NH Asian or Pacific Islander (9.5), NH American Indian or Alaska Native (7.8), and Hispanic (5.2) populations. Nonmetropolitan areas had higher AAMRs than metropolitan areas (11 vs. 9.8).

CONCLUSIONS

The analysis showed a significant decline in TAA mortality since 1999, with recent stabilization. However, disparities persist, with higher AAMRs among men, older adults, NH Black adults, and nonmetropolitan residents, highlighting the need for targeted and equitable interventions.

Outcomes of extracorporeal life support in hypothermic cardiac arrest: Revisiting ELSO guidelines

AIM OF THE STUDY

Predictive factors for poor outcomes in hypothermic cardiac arrest (HCA) differ from those in normothermic out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the outcomes of extracorporeal life support (ECLS) in HCA patients who may not be considered eligible based on the guidelines set by the Extracorporeal Life Support Organization (ELSO).

METHODS

A retrospective multicentre study included 127 HCA patients, divided into two groups: those meeting the ELSO eligibility criteria for ECLS, and those with at least one of the following ELSO exclusion criteria: age over 70 years, unwitnessed cardiac arrest, or asystole.

RESULTS

Among the 62 patients who met the ELSO criteria, 38 (61 %) survived to hospital discharge, with 34 (89 %) achieving a favourable neurological outcomes. Of the 65 patients who received ECLS despite not meeting ELSO criteria, 24 (37 %) survived to discharge, with 20 (83 %) demonstrating a favourable neurological outcomes. In patients not meeting one or two ELSO criteria, survival rates were 18 of 47 (38 %) and 6 of 16 (38 %) respectively, with 83 % of survivors in both groups achieving favourable neurological outcomes. The two patients who failed to meet all three ELSO criteria did not survive.

CONCLUSION

Qualification of patients with hypothermic cardiac arrest for ECLS rewarming should not be strictly based on guidelines for normothermic cardiac arrest, as this may result in not initiating potentially life-saving treatment for patients who could have favourable prognoses for survival with good neurological outcomes.

Fitness age outperforms body mass index in differentiating aging patterns and health risk profiles of healthy adults aged 51-80 years

Physical fitness has been extensively shown to strongly associate with general health status and major health risks. Here we tested the ability of a novel estimate of fitness age (FitAge) to differentiate aging trajectories.This study aimed at (1) testing the ability of FitAge to differentiate aging patterns among decelerated, normal, and accelerated agers in selected health domains, (2) estimating the risk for developing major health issues depending on the aging trajectory, and (3) comparing FitAge to body mass index (BMI) categorization in differentiating healthy from unhealthy aging patterns.A total of 176 volunteers participated in this cross-sectional study. Participants underwent clinical screening and a comprehensive assessment of body composition, nutritional and health-related status, cognitive functioning, and haematochemical analyses with routine tests, oxidative stress, and inflammation markers. Scores for major health risks were also computed.FitAge outperformed BMI in estimating major health risk scores and was able to differentiate decelerated from normal and accelerated agers for health risk profile and several physiological domains. Body composition, immune system activation, and inflammation markers emerged as those variables flagging the largest differences between decelerated and accelerated aging patterns.The novel estimate of biological aging can accurately differentiate both in women and men decelerated from accelerated agers in almost all the domains scrutinized. Overall, decelerated aging is linked to positively oriented features which associate with reduced risk of developing major health issues.The present findings have potential relevance and practical implications to identify individuals at higher risk of accelerated aging according to their FitAge estimated via simple and cost-effective motor tests.

Is Anyone Ready to Save a Life? An Examination of Cardiac Emergency Preparedness in Schools

BACKGROUND

This study explored the cardiac emergency preparedness of school employees in Illinois, as well as their attitudes toward cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training.

METHODS

One thousand two hundred seventy-six school employees completed an online survey regarding their school's cardiac emergency preparedness, as well as their access to CPR/AED training, confidence and willingness to perform CPR/AED, and attitudes toward CPR policies and mandates.

RESULTS

In total, results from 1273 school employees were analyzed. School employees in Illinois are not prepared to respond to a cardiac emergency, but desire training, plans, and drills. Demographic analyses revealed statistically significant differences in cardiac emergency preparedness between individuals of different personal and school characteristics.

CONCLUSIONS

School employees in Illinois are not prepared to respond to a cardiac emergency. To increase preparedness for cardiac emergencies at school, schools should implement CPR/AED training for all employees, cardiac emergency response plans, and cardiac emergency response drills.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Policies should be implemented at the state and local level to support cardiac emergency preparedness in schools, including mandated CPR/AED training for all school employees, cardiac emergency response plans for every building, and required cardiac emergency response drills.

Changes in polyunsaturated fatty acids are linked to metabolic syndrome in climacteric syndrome patients

OBJECTIVE

This study explored the association between ω-6 to ω-3 polyunsaturated fatty acids (PUFAs) and metabolic syndrome in women experiencing climacteric syndrome.

METHODS

The study involved 186 female participants and utilized surveys, anthropometric measurements (waist circumference, height, BMI, waist-to-height ratio), blood pressure assessments, and blood samples for lipid profile, glucose, insulin, HbA1c analysis. Serum PUFAs levels were analyzed using gas chromatography-mass spectrometry.

RESULTS

The study found significantly higher measurements of waist circumference, waist-to-height ratio, systolic and diastolic blood pressure in postmenopausal women with metabolic syndrome compared to the control group. In addition, the metabolic syndrome group showed significantly higher levels of fasting blood glucose, triglycerides, low-density lipoprotein cholesterol, HbA1c, insulin, triglyceride to high-density lipoprotein ratio, and total cholesterol to high-density lipoprotein ratio. Furthermore, the study also identified significant differences among premenopausal women, postmenopausal women with metabolic syndrome, and postmenopausal women without metabolic syndrome in terms of omega-3 alpha-linolenic acid, omega-3 docosahexaenoic acid, omega-6 arachidonic acid, and omega-6 to omega-3 ratio.

CONCLUSIONS

We observed that high ω-6 arachidonic acid and ω-6/ω-3 ratio and low ω-3 ALA and ω-3 DHA were associated with high TG and WHtR. High TG and WHtR levels in postmenopausal women are associated with increased risk of Mets.

Unraveling the complex interplay between abnormal hemorheology and shape asymmetry in flow through stenotic arteries

BACKGROUND AND OBJECTIVE

Stenosis or narrowing of arteries due to the buildup of plaque is a common occurrence in atherosclerosis and coronary artery disease (CAD), limiting blood flow to the heart and posing substantial cardiovascular risk. While the role of geometric irregularities in arterial stenosis is well-documented, the complex interplay between the abnormal hemorheology and asymmetric shape in flow characteristics remains unexplored.

METHODS

This study investigates the influence of varying hematocrit (Hct) levels, often caused by conditions such as diabetes and anemia, on flow patterns in an idealized eccentric stenotic artery using computational fluid dynamics simulations. We consider three physiological levels of Hct, 25%, 45%, and 65%, representing anemia, healthy, and diabetic conditions, respectively. The numerical simulations are performed for different combinations of shape eccentricity and blood rheological parameters, and hemodynamic indicators such as wall shear stress (WSS), oscillatory shear index (OSI), are relative residence time (RRT) are calculated to assess the arterial health.

RESULTS

Our results reveal the significant influence of Hct level on stenosis progression. CAD patients with anemia are exposed to lower WSS and higher OSI, which may increase the propensity for plaque progression and rupture. However, for CAD patients with high Hct level - as is often the case in diabetes - the WSS at the minimal lumen area increases rapidly, which may also lead to plaque rupture and cause adverse events such as heart attacks. These disturbances promote endothelial dysfunction, inflammation, and thrombus formation, thereby intensifying cardiovascular risk.

CONCLUSIONS

Our findings underscore the significance of incorporating hemorheological parameters, such as Hct, into computational models for accurate assessment of flow dynamics. We envision that insights gained from this study will inform the development of tailored treatment strategies and interventions in CAD patients with common comorbidities such as diabetes and anemia, thus mitigating the adverse effects of abnormal hemorheology and reducing the ever-growing burden of cardiovascular diseases.

Rutin ameliorates HCD-induced cholesterol metabolism disorder in zebrafish larvae revealed by transcriptome and metabolome analysis

Changes in modern lifestyles have led to an increase in obesity rates. Excessive lipid accumulation leads to abnormal cholesterol metabolism, and maintaining a balanced cholesterol metabolism is essential for the normal functioning of cells and the body. Rutin belongs to the group of flavonoids with hypolipidemic, anti-inflammatory and antioxidant effects. The aim of this study was to investigate the role of rutin in cholesterol metabolism disorders induced by a high cholesterol diet in zebrafish larvae. The trial was divided into five groups: Normal diet (ND), 5 % high cholesterol diet (HCD), 5 % high cholesterol diet with 80 μg/g ezetimibe diet (EZE), 5 % high cholesterol diet with 5 % rutin diet (RL-HCD), and 5 % high cholesterol diet with 10 % rutin diet (RH-HCD). Zebrafish larvae at 5 dpf were randomly divided into five groups and continuously fed different diets for 10 days, after 10 days zebrafish samples were collected for subsequent experiments. Body length, body width, oil red O, and Nile red staining were measured to detect biochemical indexes, analyze inflammatory response and lipid accumulation. Vascular endothelial injury was assessed by stereofluorescence microscopy and ELISA. In order to study the protective effect of rutin in zebrafish with cholesterol metabolism disorder induced by HCD, RNA-seq and LC-MS/MS nontargeted metabolomics were employed. The results indicate that HCD led to an increase in the body length and width of zebrafish. The HCD group induced an increase in body length and width, lipid accumulation, and exacerbated inflammation. Additionally, vascular damage and abnormal expression of endothelial cell markers were observed. Rutin lowered lipid levels in zebrafish fed an HCD, reduced inflammation, and protected endothelial cells. The RNA-seq and metabolomic analysis combined demonstrated that rutin effectively ameliorates the disorder of cholesterol metabolism in vivo by reducing cholesterol synthesis and promoting cholesterol transport.

Association between vitamin A intake and depression among patients with heart failure

AIMS

We aim to investigate the association between vitamin A intake and depression among patients with heart failure (HF).

METHODS AND RESULTS

In this cross-sectional study, data of HF patients were extracted from the National Health and Nutrition Examination Survey (NHANES) 2007-2020. The independent variable was vitamin A intake, and the dependent variable was depression. Weighted univariate and multivariate logistic regression models were performed to explore the association of vitamin A intake with depression in HF patients. A total of 999 HF patients were included, with a mean age of 66.19 (0.51) years, and 566 (52.49%) were male. And 197 patients have depression. Vitamin A intake ≥731.38 mcg was associated with lower incidence of depression [odds ratio (OR) = 0.37; 95% confidence interval (CI): 0.18-0.76] in HF patients. Similarly, the relationship between high vitamin A intake and lower odds of depression were also observed in subgroups of those aged >65 years (OR = 0.16; 95% CI: 0.04-0.55), males (OR = 0.35; 95% CI: 0.14-0.86), without hypertension (OR = 0.25; 95% CI: 0.11-0.58), without diabetes (OR = 0.30; 95% CI: 0.11-0.78), with hyperlipidaemia (OR = 0.23; 95% CI: 0.09-0.64), and with chronic kidney disease (CKD) (OR = 0.32; 95% CI: 0.13-0.80).

CONCLUSIONS

High vitamin A intake was associated with lower odds of depression in HF patients. Appropriate vitamin A supplementation may have potential benefit to the prevention of depression in HF patients. Additional prospective large-scale studies are required to confirm whether or not vitamin A could lead to decrease in depression symptoms.

Partial coverage adhesive augmented sternal fixation and stabilization: A biomechanical analysis

Adhesive-augmented sternal fixation (AASF) has been investigated as an alternative to the clinical standard of cerclage wires; however, previous studies have focused on a full adhesive layer across the sternal midline, which acts as a barrier to bone healing. This study used a human cadaveric model to investigate if partial coverage AASF used in combination with wired fixation could provide adequate stability. Median sternotomies were performed on fifteen human cadaveric sterna. Three groups (n = 5) with varying adhesive coverage (50 %, 62.5 %, 75 %) of the sternal midline and traditional wiring were investigated. Cyclic lateral distraction loading of 10 N to 100 N was applied at 50 N/s. Every 30 cycles, the maximum load was increased by 100 N to a maximum of 500 N. Displacement was measured using transducers spanning the transection line at the manubrium, body, and xiphoid. Mean maximum total displacement (MMTD) for all groups was significantly below 2 mm (p < 0.001) with 1.49 mm ± 0.82 mm, 0.97 mm ± 0. 55 mm, and 0.67 mm ± 0.65 mm in the 50 %, 62.5 %, and 75 % groups respectively. MMTD in the 50 % group was significantly greater than MMTD in the 62.5 % and 75 % groups. AASF improved stability as coverage of the sternal surface with adhesive increased. Partial coverage of the sternal midline with adhesive may provide similar rigidity to a full layer while enabling earlier sternal ossification at the transection line compared to wiring alone.

Rule-based natural language processing to examine variation in worsening heart failure hospitalizations by age, sex, race and ethnicity, and left ventricular ejection fraction

BACKGROUND

Prior studies characterizing worsening heart failure events (WHFE) have been limited in using structured healthcare data from hospitalizations, and with little exploration of sociodemographic variation. The current study examined the impact of incorporating unstructured data to identify WHFE, describing age-, sex-, race and ethnicity-, and left ventricular ejection fraction (LVEF)-specific rates.

METHODS

Adult members of Kaiser Permanente Southern California (KPSC) with a HF diagnosis between 2014 and 2018 were followed through 2019 to identify hospitalized WHFE. The main outcome was hospitalizations with a principal or secondary HF discharge diagnosis meeting rule-based Natural Language Processing (NLP) criteria for WHFE. In comparison, we examined hospitalizations with a principal discharge diagnosis of HF. Age-, sex-, and race and ethnicity-adjusted rates per 100 person-years (PY) were calculated among age, sex, race and ethnicity (non-Hispanic (NH) Asian/Pacific Islander [API], Hispanic, NH Black, NH White) and LVEF subgroups.

RESULTS

Among 44,863 adults with HF, 10,560 (23.5%) had an NLP-defined, hospitalized WHFE. Adjusted rates (per 100 PY) of WHFE using NLP were higher compared to rates based only on HF principal discharge diagnosis codes (12.7 and 9.3, respectively), and this followed similar patterns among subgroups, with the highest rates among adults ≥75 years (16.3 and 11.2), men (13.2 and 9.7), and NH Black (16.9 and 14.3) and Hispanic adults (15.3 and 11.4), and adults with reduced LVEF (16.2 and 14.0). Using NLP disproportionately increased the perceived burden of WHFE among API and adults with mid-range and preserved LVEF.

CONCLUSION

Rule-based NLP improved the capture of hospitalized WHFE above principal discharge diagnosis codes alone. Applying standardized consensus definitions to EHR data may improve understanding of the burden of WHFE and promote optimal care overall and in specific sociodemographic groups.

Multifunctional Porous Soft Composites for Bimodal Wearable Cardiac Monitors

Wearable heart monitors are crucial for early diagnosis and treatment of heart diseases in non-clinical settings. However, their long-term applications require skin-interfaced materials that are ultrasoft, breathable, antibacterial, and possess robust, enduring on-skin adherence-features that remain elusive. Here, we have developed multifunctional porous soft composites that meet all these criteria for skin-interfaced bimodal cardiac monitoring. The composite consists of a bilayer structure featuring phase-separated porous elastomer and slot-die-coated biogel. The porous elastomer ensures ultrasoftness, breathability, ease of handling, and mechanical integrity, while the biogel enables long-term on-skin adherence. Additionally, we incorporated ε-polylysine in the biogel to offer antibacterial properties. Also, the conductive biogel embedded with silver nanowires was developed for use in electrocardiogram sensors to reduce contact impedance and ensure high-fidelity recordings. Furthermore, we assembled a bimodal wearable cardiac monitoring system that demonstrates high-fidelity recordings of both cardiac electrical (electrocardiogram) and mechanical (seismocardiogram) signals over a 14-day testing period.

Effectiveness of Protection Motivation Theory on clinical factors, behavior change, and cardiovascular disease: An integrative review

Objective

To identify and synthesize the primary evidence on the effectiveness of Protection Motivation Theory on and cardiovascular disease and diseases that are risk factors for cardiovascular disease.

Method

An integrative review was conducted using the Whittemore and Knafl method (2005).

Results

Eleven articles met the inclusion and quality assessment criteria. The integration of evidence was abundant in three themes 1) Physical activity 2) Weight and Body Mass Index, and 3) Food consumption and each theme having the same six sub-themes of self-efficacy, response-efficacy, response cost, severity, vulnerability and reward. No studies have addressed all clinical factors and behavioral changes associated with cardiovascular disease.

Conclusion

Due to the limited literature on the effectiveness of Protection Motivation Theory on behavioral changes in patients with cardiovascular diseases, generalizations and practice recommendations are limited. Further research is required to evaluate the effectiveness of this theory in patient outcomes.

Ablation of CCDC8 provides cardioprotection against cardiomyocyte apoptosis via TNF signaling pathway in myocardial ischemia reperfusion injury

AIMS

Myocardial ischemia-reperfusion (I/R) injury induces significant apoptosis and reactive oxygen species (ROS) accumulation in cardiomyocytes. Coiled-coil domain-containing 8 (CCDC8), recently identified as an interacting protein of p53, acts as a cofactor in p53-mediated apoptosis. However, its role in myocardial I/R injury remains unclear.

MATERIALS AND METHODS

We first assessed CCDC8 levels in patients with left ventricular failure (LVF) and in both in vivo and in vitro models of myocardial I/R injury. Next, we used adenovirus 9 (AAV9) to overexpress CCDC8 and small interfering RNA (siRNA) to investigate the role of CCDC8 in myocardial I/R injury. mRNA sequencing and KEGG pathway analysis were performed to identify CCDC8-regulated genes. In vitro experiments were conducted to examine the effects of CCDC8 silencing on TNF-α-induced apoptosis.

KEY FINDINGS

CCDC8 expression was elevated in the left ventricle of LVF patients and in the cardiomyocytes of mice subjected to myocardial I/R injury. Overexpression of CCDC8 in cardiomyocytes via AAV9 exacerbated cardiac dysfunction caused by myocardial I/R injury, while silencing CCDC8 suppressed apoptosis and ROS production in H9c2 cells under hypoxia-reoxygenation (H/R) conditions. mRNA sequencing and KEGG analysis indicated that CCDC8 regulates genes related to cardiac contractility and the TNF signaling pathway. Additionally, CCDC8 silencing reversed TNF-α-induced cardiomyocyte apoptosis in vitro.

SIGNIFICANCE

This study identifies CCDC8 as a key mediator of cardiomyocyte apoptosis via the TNF signaling pathway in myocardial I/R injury. These findings suggest that targeting CCDC8 could be a potential therapeutic strategy for mitigating cardiac dysfunction in myocardial I/R injury.

Navigating stroke care: Geospatial assessment of regional stroke center accessibility: Geospatial Assessment of Stroke Centers

INTRODUCTION

Reducing time between stroke onset and hospital intervention is crucial for positive outcomes in stroke patients. While EMS utilization decreases time to intervention, many US regions are not within timely proximity to an advanced-care-capable stroke center (ASC), defined as a comprehensive or thrombectomy-capable center. This study aims to utilize geographic methodology to identify regions in Wisconsin with both high stroke mortality and low physical accessibility to certified stroke centers (SCs), particularly ASCs.

METHODS

Geocoded mortality records for stroke death between 2015 and 2020 were accessed from the Wisconsin Department of Health Services. Indirectly age-standardized mortality ratios (SMRs) were estimated continuously across Wisconsin using adaptive spatial filtering and mortality records at the census block group level; the surface was then averaged by census tract for tract level SMRs. Addresses for SC locations within Wisconsin and bordering states were collected, and drive times from Wisconsin census tract centroids to the nearest SC subtypes were estimated. Drive times and mortality ratios were evaluated at the tract level alongside Rural-Urban Commuting Area (RUCA) codes. Spatial error regression modeling was used to determine RUCA classifications with the highest stroke risk independent of accessibility to stroke centers.

RESULTS

Approximately 50%, 68%, and 78% of Wisconsin residents resided within 30, 45, and 60 minutes of an ASC, respectively. Median drive time from census tract centroids to the nearest ASC were highest for rural tracts (M=90 minutes, IQR=68-115) compared to small-town (M=82 minutes, IQR=49-113), micropolitan (M=53 minutes, IQR=43-77), and metropolitan tracts (M=19 minutes, IQR=11-35; p<0.001). Clusters of high stroke SMRs were found in urban centers as well as rural areas irrespective of county declinations. Spatial regression modeling suggested small-town census tracts had the highest SMR irrespective of physical accessibility to care and spatial correlation. In small-town census tracts >45 minutes from the nearest ASC, the median stroke SMR was 1.12 (IQR=0.94-1.40) with 226,000 residents and 150 stroke deaths per year.

CONCLUSION

Small-town areas are associated with both long drive distance to ASC locations and high stroke mortality. Geographical analyses reveal apparent stroke care deserts and may inform strategic allocation of emergency medicine resources and coverage.

Utilization of inpatient palliative care services in cardiac arrest complicating acute pulmonary embolism

Introduction

The role of palliative care services in patients with cardiac arrest complicating acute pulmonary embolism has been infrequently studied.

Methods

All adult admissions with pulmonary embolism complicating cardiac arrest were identified using the National Inpatient Sample (2016-2020). The primary outcome of interest was the utilization of palliative care services. Secondary outcomes included predictors of palliative care utilization and its association of with in-hospital mortality, do-not-resuscitate status, discharge disposition, length of stay, and total hospital charges. Multivariable regression analysis was used to adjust for confounding.

Results

Between 01/01/2016 and 12/31/2020, of the 7,320 admissions with pulmonary embolism complicating cardiac arrest, 1229 (16.8 %) received palliative care services. Admissions receiving palliative care were on average older (68.1 ± 0.9 vs. 63.2 ± 0.4 years) and with higher baseline comorbidity (Elixhauser index 6.3 ± 0.1 vs 5.6 ± 0.6) (all p < 0.001). Additionally, this cohort had higher rates of non-cardiac organ failure (respiratory, renal, hepatic, and neurological) and invasive mechanical ventilation (all p < 0.05). Catheter-directed therapy was used less frequently in the cohort receiving palliative care, (2.8 % vs 7.9 %; p < 0.001) whereas the rates of systemic thrombolysis, mechanical and surgical thrombectomy were comparable. The cohort receiving palliative care services had higher in-hospital mortality (85.7 % vs. 69.1 %; adjusted odds ratio 2.20 [95 % CI 1.41-3.42]; p < 0.001). This cohort also had higher rates of do-not-resuscitate status and fewer discharges to home, but comparable hospitalization costs and length of hospital stay.

Conclusions

Palliative care services are used in only 16.8 % of admissions with cardiac arrest complicating pulmonary embolism with significant differences in the populations, suggestive of selective consultation.

Predictors of left atrial appendage thrombus in atrial fibrillation patients undergoing cardioversion

BACKGROUND

Atrial fibrillation and atrial flutter represent the most prevalent clinically significant cardiac arrhythmias. While the CHA2DS2-VASc score is commonly used to inform anticoagulation therapy decisions for patients with these conditions, its predictive power is limited. Therefore, we sought to improve risk prediction for left atrial appendage thrombus (LAAT), a known risk factor for stroke in these patients.

METHODS

We developed and validated an explainable machine learning model using the eXtreme Gradient Boosting algorithm with 5 × 5 nested cross-validation. The primary outcome was to predict the probability of LAAT in patients with atrial fibrillation and atrial flutter who underwent transesophageal echocardiogram prior to cardioversion. Our algorithm used 37 demographic, comorbid, and transthoracic echocardiographic variables.

RESULTS

A total of 795 patients were included in our analysis. LAAT was present in 11.3% of the patients. The average age of patients was 63.3 years and 34.7% were women. Patients with LAAT had significantly lower left ventricular ejection fraction (29.9% vs 43.5%; p < 0.001), lower E' lateral velocity (5.7 cm vs. 7.9 cm; p < 0.001) and higher E/A ratio (2.6 vs 1.8; p = 0.002). Our machine learning model achieved a high AUC of 0.79, with a high specificity of 0.82, and modest sensitivity of 0.57. Left ventricular ejection fraction was the most important variable in predicting LAAT. Patients were split into 10 buckets based on the percentile of their predicted probability of having thrombus. The lower the percentile (e.g., 10%), the lower the probability of having thrombus. Using a cutoff point of 0.16 which includes 10.0% of the patients, we can rule out thrombus with 100% confidence.

CONCLUSION

Using machine learning, we refined the predictive power of predicting LAAT and explained the model. These results show promise in providing better guidance for anticoagulation therapy and cardioversion in AF and AFL patients.

Fasting plasma glucose level and in-hospital cardiac arrest in patients with acute coronary syndrome: findings from the CCC-ACS project

BACKGROUND

The prognosis of patients with coronary artery disease is adversely affected by elevated fasting plasma glucose (FPG) levels. However, the relationship between FPG levels and in-hospital cardiac arrest (IHCA) remains unclear.

OBJECTIVES

The objective of this study was to investigate the association between FPG levels and IHCA in patients diagnosed with acute coronary syndrome (ACS).

METHODS

Data from a total of 31,726 ACS patients fitted with inclusion and exclusion criteria across 241 hospitals in the Improving Care for Cardiovascular Disease in China-ACS project from November 2014 to July 2019 were collected. Different logistic regression models were utilized to examine the associations of FPG levels with IHCA. Sensitivity analyses were then conducted to assess the robustness of the findings. Marginal effect analyses were also employed to evaluate the impact of different therapies.

RESULTS

A total of 335 cases of IHCA and 293 in-hospital mortality were recorded throughout the study. A non-linear relationship between FPG levels and IHCA was identified after adjusting for the covariates. Specifically, a significant association was found between elevated FPG levels (≥6.1 mmol/L) and an increased risk of IHCA. These findings remained consistent across different subgroup analyses including both the diabetic and non-diabetic patients. Additionally, the marginal effect analyses revealed that percutaneous coronary intervention could lower the high FPG-related risk.

CONCLUSIONS

The study findings showed a positive correlation between FPG levels and a higher incidence of IHCA, irrespective of the presence of diabetes.

Acute nicotine exposure attenuates neurological deficits, ischemic injury and brain inflammatory responses and restores hippocampal long-term potentiation in ischemic stroke followed by lipopolysaccharide-induced sepsis-like state

Ischemic stroke is followed by an increased susceptibility to bacterial infections, which exacerbate histological stroke outcome, neurological deficits and memory impairment due to increased neuroinflammation and neurotransmitter dysfunction. Pharmacological activation of nicotinic acetylcholine receptors was suggested to mitigate brain inflammatory responses in ischemic stroke. The functional responses associated with nicotinic acetylcholine receptor activation were unknown. In this study, male NMRI mice subjected to transient intraluminal middle cerebral artery occlusion (MCAO) were intraperitoneally exposed to vehicle treatment or Escherichia coli lipopolysaccharide (LPS; 4 mg/kg)-induced sepsis-like state 24 h post-MCAO, followed by intraperitoneal administration of vehicle or nicotine (0.5 mg/kg) 30 min later. Over 96 h, rectal temperature, neurological deficits, spontaneous locomotor activity, working memory, ischemic injury, synaptic plasticity, and brain inflammatory responses were evaluated by temperature measurement, behavioral analysis, infarct volumetry, electrophysiological recordings, and polymerase-chain reaction analysis. LPS-induced sepsis induced hypothermia, increased general and focal neurological deficits, reduced spontaneous exploration behavior, reduced working memory, and increased infarct volume post-MCAO. Additional treatment with nicotine attenuated LPS-induced hypothermia, reduced neurological deficits, restored exploration behavior, restored working memory, and reduced infarct volume. Local field potential recordings revealed that LPS-induced sepsis decreased long-term potentiation (LTP) in the dentate gyrus post-MCAO, whereas concomitant nicotine exposure restored LTP in the contralateral dentate gyrus. LPS-induced sepsis increased microglial/ macrophage Iba-1 mRNA and astrocytic GFAP mRNA levels post-MCAO, whereas add-on nicotine treatment reduced astrocytic GFAP mRNA. Taken together, these findings indicate that acute nicotine exposure enhances functional stroke recovery. Future studies will have to evaluate the effects of (1) chronic nicotine exposure, a clinically relevant vascular risk factor, and (2) the cessation of nicotine exposure, which is widely recommended post-stroke, but might have detrimental effects in the early stroke recovery phase.

Prediction of metabolic syndrome following a first pregnancy

BACKGROUND

The prevalence of metabolic syndrome is rapidly increasing in the United States. We hypothesized that prediction models using data obtained during pregnancy can accurately predict the future development of metabolic syndrome.

OBJECTIVE

This study aimed to develop machine learning models to predict the development of metabolic syndrome using factors ascertained in nulliparous pregnant individuals.

STUDY DESIGN

This was a secondary analysis of a prospective cohort study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study [nuMoM2b-HHS]). Data were collected from October 2010 to October 2020, and analyzed from July 2023 to October 2023. Participants had in-person visits 2 to 7 years after their first delivery. The primary outcome was metabolic syndrome, defined by the National Cholesterol Education Program Adult Treatment Panel III criteria, which was measured within 2 to 7 years after delivery. A total of 127 variables that were obtained during pregnancy were evaluated. The data set was randomly split into a training set (70%) and a test set (30%). We developed a random forest model and a lasso regression model using variables obtained during pregnancy. We compared the area under the receiver operating characteristic curve for both models. Using the model with the better area under the receiver operating characteristic curve, we developed models that included fewer variables based on SHAP (SHapley Additive exPlanations) values and compared them with the original model. The final model chosen would have fewer variables and noninferior areas under the receiver operating characteristic curve.

RESULTS

A total of 4225 individuals met the inclusion criteria; the mean (standard deviation) age was 27.0 (5.6) years. Of these, 754 (17.8%) developed metabolic syndrome. The area under the receiver operating characteristic curve of the random forest model was 0.878 (95% confidence interval, 0.846-0.909), which was higher than the 0.850 of the lasso model (95% confidence interval, 0.811-0.888; P<.001). Therefore, random forest models using fewer variables were developed. The random forest model with the top 3 variables (high-density lipoprotein, insulin, and high-sensitivity C-reactive protein) was chosen as the final model because it had the area under the receiver operating characteristic curve of 0.867 (95% confidence interval, 0.839-0.895), which was not inferior to the original model (P=.08). The area under the receiver operating characteristic curve of the final model in the test set was 0.847 (95% confidence interval, 0.821-0.873). An online application of the final model was developed (https://kawakita.shinyapps.io/metabolic/).

CONCLUSION

We developed a model that can accurately predict the development of metabolic syndrome in 2 to 7 years after delivery.

Association between dietary niacin intake and abdominal aortic calcification among the US adults: the NHANES 2013-2014

Background

Abdominal aortic calcification (AAC) serves as a reliable predictor of future cardiovascular incidents. This study investigated the association between dietary niacin intake and AAC in US adults.

Methods

In this study, we conducted a cross-sectional study of 2,238 individuals aged 40 years and older using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. AAC was evaluated using the Kauppila scoring system through dual-energy X-ray absorptiometry. Daily niacin intake was calculated by averaging the two dietary recalls and classified in tertiles for analysis. In this study, multiple regression analyses and smoothed curve fitting were used to examine the relationship between dietary niacin intake and AAC, subgroup analyses and interaction tests were used to assess the stability of this relationship across different segments of the population, and forest plots were used to present the results. In addition, we validated the predictive performance of dietary niacin intake on the risk of severe AAC through Receiver Operating Characteristic (ROC) curve analysis.

Results

Among 2,238 participants aged >40 years, the results showed that the higher dietary niacin intake group was associated with lower AAC score (β = -0.02, 95% CI: -0.04 - -0.01), and a lower risk of severe AAC (OR = 0.97, 95% CI: 0.96-0.99). In the fully adjusted model, the higher tertile group was associated with lower AAC score (β = -0.37, 95% CI: -0.73 - -0.02; P for trend = 0.0461) and a lower risk of severe AAC (OR = 0.60, 95% CI: 0.38-0.93; P for trend = 0.0234). The relationship between dietary niacin intake and AAC differed significantly between diabetic and non-diabetic population. The ROC curve analysis revealed that the area under the curve (AUC) for predicting severe AAC risk based on dietary niacin intake was 0.862, indicating good predictive performance.

Conclusion

Higher dietary niacin intake group was associated with lower AAC score and a lower risk of severe AAC. Our findings suggest that dietary niacin intake has the potential to offer benefits in preventing AAC in the general population.

Revealing the molecular links between coronary heart disease and cognitive impairment: the role of aging-related genes and therapeutic potential of stellate ganglion block

Coronary heart disease (CHD) and cognitive impairment frequently co-occur in aging populations, yet the molecular mechanisms linking these conditions remain unclear. This study aims to elucidate the roles of key aging-related genes (ARGs), specifically FKBP5 and DDIT3, in the pathophysiology of CHD and cognitive impairment, and to evaluate the therapeutic potential of stellate ganglion block (SGB). Using single-cell RNA sequencing (scRNA-seq) and bulk RNA sequencing (bulk RNA-seq) data, we identified FKBP5 and DDIT3 as pivotal genes upregulated in both conditions. Experimental findings show that SGB effectively modulates these ARG-related pathways through autonomic regulation, specifically suppressing estrogen and NF-κB signaling pathways, thereby reducing the expression of pro-inflammatory cytokines such as SRC, MMP2, FKBP5, IRAK1, and MYD88, while upregulating the vasodilation-related gene NOS3. This modulation improved endothelial and cardiac function and enhanced cerebral blood flow (CBF), leading to cognitive improvement. Behavioral assessments, including novel object recognition (NOR) and Morris water maze (MWM) tests, demonstrated that SGB-treated rats outperformed untreated MI rats, with significant cognitive recovery over time. Further support from laser Doppler flowmetry (LDF) and electroencephalogram (EEG) analyses revealed increased left frontal blood flow and stabilized neural activity, indicating a favorable neurophysiological environment for cognitive rehabilitation. Our findings suggest that left stellate ganglion block (LSGB) provides both cardiac and cognitive benefits through targeted gene modulation, establishing its therapeutic potential for addressing the intersecting pathologies of CHD and cognitive impairment.

Effect of high-intensity intermittent rehabilitation training on physical function, gut microbiome and metabolite after percutaneous coronary intervention in patients with coronary heart disease

Background

Postoperative rehabilitation exercise training after percutaneous coronary intervention (PCI) is crucial for coronary heart disease (CHD) patients in restoring health and preventing recurrence, including high-intensity interval training (HIIT). However, the impact of HIIT on cardiopulmonary function, gut microbiome and metabolite remains underexplored.

Methods

This study included 60 patients with CHD who underwent percutaneous coronary intervention (PCI). Participants were divided into two groups: 33 in the moderate-intensity continuous training (MCT) group and 27 in the high-intensity interval training (HIIT) group. We assessed difference between two training in cardiopulmonary function, 6-minute walk test (6MWT) performance, biochemical indicators, plasma metabolites, and gut microbiome feature at baseline and after 3 months training. Furthermore, we analyzed 6MWT association to gut microbiome and metabolites with group differences.

Results

The 6MWT showed significantly greater improvement in the HIIT group compared to the MCT group (P = 0.0024). Both groups showed reductions in low-density lipoprotein (LDL) levels and increases in peak oxygen uptake (VO2 peak) after training, but the HIIT group demonstrated a larger effect size in these measures. Moreover, subgroup analysis revealed that patients with a history of myocardial infarction (MI) in the HIIT group experienced a more substantial increase in VO2 peak compared to the MCT group (P = 0.04). In addition, we identified 29 gut microbial species and 30 plasma metabolites that were differentially enriched between the two groups, with some showing a significant impact on 6MWT performance.

Conclusions

High-intensity interval training significantly improves 6MWT performance and exercise tolerance in cardiac rehabilitation patients, particularly enhancing VO2 peak in those with a history of MI. HIIT also appears to modulate the gut microbiome, increasing the abundance of Clostridiales and decreasing traumatic acid content, which may contribute to the observed improvements in exercise tolerance.

Dietary patterns and premature coronary artery disease: result from the Iran premature coronary artery disease (IPAD) study

BACKGROUND

Premature coronary artery disease (PCAD) is one of the major health concerns leading to considerable death and disabilities. This study aimed to evaluate the relationship of dietary patterns with risk of PCAD.

METHODS

Iran premature coronary diseases (IPAD) is a case-control study consists of 3159 participants. Obstructive CAD in ≥ 75% of at least one coronary artery or ≥ 50% in the left main artery based on coronary angiography in women under 70 and men under 60 years old was considered PCAD. The habitual dietary intake of participants was collected using a semi-quantitative validated food frequency questionnaire (SFFQ). Principal Component Analysis (PCA) was used to extract dietary patterns.

RESULTS

Three main dietary patterns including healthy, Western and high-fat, high-sugar were identified. Patients categorized in the last tertile of the healthy dietary pattern had a decreased risk of PCAD (OR = 0.77, 95% CI: 0.64-0.93), while those in the top tertile of Western (OR = 2.38, 95 CI:1.97-2.86) and High-fat simple carbohydrate (HFSC) (OR = 3.10, 95% CI:2.57-3.75) diets had increased risk of PCAD.

CONCLUSIONS

A healthy dietary pattern was significantly related to a decreased risk of PCAD presence, whereas Western and HFSC diets were connected to a higher risk of PCAD.

Nomogram model for screening the risk of frailty in older adult atrial fibrillation patients: a cross-sectional study

Background

Frailty is common in atrial fibrillation (AF) patients, but the specific risk factors contributing to frailty need further investigation. There is an urgent need for a risk prediction model to identify individuals at high risk of frailty.

Aims and objectives

This cross-sectional study aims to explore the multiple risk factors of frailty in older adult patients with AF and then construct a nomogram model to predict frailty risk.

Methods

We recruited 337 hospitalized patients over the age of 60 (average age: 69, 53.1% male) with AF between November 2021 and August 2022. Data collected included patient demographics, disease characteristics, sleep patterns, mental health status, and frailty measures. We used LASSO and ordinal regression to identify independent risk factors. These factors were then incorporated into a nomogram model to predict frailty risk. The model's performance was assessed using the concordance index (C-index) and calibration curves.

Results

Among the AF patients, 23.1% were classified as frail and 52.2% as pre-frail. Six risk factors were identified: age, gender, history of coronary heart disease, number of chronic conditions, sleep disruption, and mental health status. The internal validation C-index was 0.821 (95% CI: 0.778-0.864; bias-corrected C-index: 0.795), and the external validation C-index was 0.819 (95% CI: 0.762-0.876; bias-corrected C-index: 0.819), demonstrating strong discriminative ability. Calibration charts for both internal and external validations closely matched the ideal curve, indicating robust predictive performance.

Conclusion

The nomogram developed in this study is a promising and practical tool for assessing frailty risk in AF patients, aiding clinicians in identifying those at high risk.

Relevance to clinical practice

This study demonstrates the utility of a comprehensive predictive model based on frailty risk factors in AF patients, offering clinicians a practical tool for personalized risk assessment and management strategies.

Implementation of a cardiovascular toolkit in primary care increased women Veterans' engagement in behavior change programs: results from a non-randomized stepped wedge trial

Background

Cardiovascular (CV) disease is the leading cause of death among U.S. women, yet women have a limited understanding of their CV-related morbidity and mortality risks. Provider-, system-, and patient-level barriers point to a need for multi-level evidence-based strategies to facilitate CV risk reduction. Guided by the Replicating Effective Programs framework and complexity theory, we implemented a CV Toolkit in primary care clinics for women Veterans. The objective was to evaluate the effect of implementation of CV toolkit on participation in behavior change programs that target CV risk reduction.

Methods

In partnership with the Veterans Health Administration (VA) Office of Women's Health and National Center for Health Promotion and Disease Prevention, we developed and implemented a CV Toolkit at five geographically diverse VA sites between March 2017-March 2020. Using a non-randomized stepped wedge design, we evaluated the effect of the implementation of toolkit on participation in the VA MOVE! weight management program, and on participation in health promotion and disease prevention (HPDP) programs (coaching, facilitated groups, etc.) and/or complementary integrative health (CIH) programs (yoga, meditation, etc.). We utilized a three-level (patient, site, time) non-linear fixed effect model with stratification by age (65 and older versus younger). Patient participation, utilization, and demographics were extracted from VA administrative data for all women with at least one primary care visit at a participating site from December 2016-March 2020 (n = 6009).

Results

Women were on average 45 years old; 38% were white, 31% Black, 17% Hispanic; and over a third had CV risk factors and/or mental health diagnoses. For women 65 years and older (n = 540), active toolkit implementation resulted in increased odds of MOVE! participation (OR = 1.09; 95% CI:1.030-1.152) compared to when the toolkit was not active either within or between sites. Women younger than 65 (n = 5469) had increased odds of using HPDP/CIH programs during active toolkit implementation (OR = 1.01; 95% CI:1.002-1.022).

Conclusions

Active implementation of the CV Toolkit intervention was significantly associated with increasing participation in behavior change programs. Variation in program participation by age suggests that the diversity of behavior change programs available to women Veterans may facilitate participation across the lifespan.

Trial registration

Clinical Trials.gov, NCT02991534. Registered 12-09-2016, https://clinicaltrials.gov/study/NCT02991534?cond=NCT02991534&rank=1.

Overview of evidence-based research on acupuncture for stroke treatment using magnetic resonance imaging technology

Background

Stroke is a neurological condition characterized by high rates of disability and mortality. Magnetic resonance imaging (MRI) is widely used to examine the mechanisms of acupuncture in stroke treatment.

Purpose

This review provides neuroimaging evidence for the efficacy of acupuncture in treating stroke using MRI.

Method

We conducted a comprehensive search of databases, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Data, Chinese BioMedical Literature Database (CBM), and Chonqing VIP (CQVIP), from inception to April 2024. Relevant neuroimaging studies on acupuncture for stroke were included, and the research findings were presented through charts and textual analyses.

Results

A total of 158 studies were included, and the overall methodological quality of the included studies was moderate to high. The results were divided into three categories: basic characteristics, clinical characteristics, and quality assessment of the included literature.

Conclusion

We elucidated the neural mechanisms underlying the effects of acupuncture on stroke; however, the evidence remains preliminary. There is a need for large-scale, well-designed, multimodal neuroimaging trials. This review represents the first active use of an evidence map to systematically review and illustrate the current state of neuroimaging research on the acupuncture treatment of stroke, thereby providing a valuable reference for future research.

Revascularization after minimally invasive coronary artery bypass grafting in 566 patients: Is it a problem?

OBJECTIVES

Minimally invasive coronary artery bypass grafting (MICS CABG) allows visualization and revascularization of all myocardial territories through a small anterolateral thoracotomy, with or without cardiopulmonary bypass. It is increasing in popularity as a safe and effective alternative to sternotomy CABG. In this study, we examined the correlates and long-term outcomes of repeat revascularization (RR) in patients who undergo MICS CABG.

METHODS

We prospectively followed all patients on an annual or semiannual basis who had undergone MICS CABG surgery over a 17-year period at a single institution. Cumulative incidence of RR was calculated accounting for competing risk of mortality. Kaplan-Meier curves were compared with log-rank test for survival and freedom from cardiac death at 12-years for both groups. Multivariable Cox proportional hazard models were performed to identify variables associated with RR and its impact on long-term survival.

RESULTS

Clinical follow-up was complete for 100% of patients (N = 566) at a mean of 7.0 ± 4.4 years. Forty-nine (8.7%) patients required RR after their MICS CABG, for a cumulative incidence at 12 years of 14.8 ± 2.5%. The most common indication was progression of native coronary disease in 23 (46.9% of RR) patients. Perioperative transfusion was the only variable associated with RR (hazard ratio, 5.0; 95% confidence interval, 2.4-10.3). When we compared patients who had RR with those who did not, there was no significant difference in late survival (92.1 ± 4.5% vs 80.3 ± 3.0%; P = .18).

CONCLUSIONS

Among 566 patients who underwent MICS CABG over a 17-year period, RR was an infrequent event affecting 8.7% of patients, with no negative impact on long-term survival.

Inhibition of endothelial-to-mesenchymal transition in a large animal preclinical arteriovenous fistula model leads to improved remodelling and reduced stenosis

AIMS

Vein grafts are used for many indications, including bypass graft surgery and arteriovenous fistula (AVF) formation. However, patency following vein grafting or AVF formation is suboptimal for various reasons, including thrombosis, neointimal hyperplasia, and adverse remodelling. Recently, endothelial-to-mesenchymal transition (EndMT) was found to contribute to neointimal hyperplasia in mouse vein grafts. We aimed to evaluate the clinical potential of inhibiting EndMT and developed the first dedicated preclinical model to study the efficacy of local EndMT inhibition immediately prior to AVF creation.

METHODS AND RESULTS

We first undertook pilot studies to optimize the creation of a femoral AVF in pigs and verify that EndMT contributes to neointimal formation. We then developed a method to achieve local in vivo SMAD3 knockdown by dwelling a lentiviral construct containing SMAD3 shRNA in the femoral vein prior to AVF creation. Next, in Phase 1, six pigs were randomized to SMAD3 knockdown or control lentivirus to evaluate the effectiveness of SMAD3 knockdown and EndMT inhibition 8 days after AVF creation. In Phase 2, 16 pigs were randomized to SMAD3 knockdown or control lentivirus and were evaluated to assess longer-term effects on AVF diameter, patency, and related measures at 30 days after AVF creation. In Phase 1, compared with controls, SMAD3 knockdown achieved a 75% reduction in the proportion of CD31+ endothelial cells co-expressing SMAD3 (P < 0.001) and also a significant reduction in the extent of EndMT (P < 0.05). In Phase 2, compared with controls, SMAD3 knockdown was associated with an increase in the minimum diameter of the venous limb of the AVF (1.56 ± 1.66 vs. 4.26 ± 1.71 mm, P < 0.01) and a reduced degree of stenosis (P < 0.01). Consistent with this, neointimal thickness was reduced in the SMAD3 knockdown group (0.88 ± 0.51 vs. 0.45 ± 0.19 mm, P < 0.05). Furthermore, endothelial integrity (the proportion of luminal cells expressing endothelial markers) was improved in the SMAD3 knockdown group (P < 0.05).

CONCLUSION

EndMT inhibition in a preclinical AVF model by local SMAD3 knockdown using gene therapy led to reduced neointimal hyperplasia, increased endothelialization, and a reduction in the degree of AVF stenosis. This provides important proof of concept to pursue this approach as a clinical strategy to improve the patency of AVFs and other vein grafts.

Prevalence and risk factors of mortality among heart failure patients in low resource setting hospitals: a multicenter prospective observational study

Background

Heart failure is a significant worldwide health problem that leads to mortality. Therefore, this study aimed to evaluate treatment outcomes and associated factors of heart failure patients who were admitted to hospitals in the southwest of Ethiopia.

Methods and participants

A multicenter prospective observational study was conducted from 1 February to 1 August 2021. Drug therapy problems were assessed as per the Cipolle, Strands, and Morley drug therapy problems classification method. The drug therapy was registered by using the drug-related problem registration format. The results of logistic regression analysis was interpreted as crude odds ratio and adjusted odds ratio (AOR) at 95% confidence interval (CI) to determine the association between dependent and independent variables.

Results

In our study settings, a total of 205 (85.1%) heart failure patients showed improvement and 36 (14.9%) died at hospital discharge. Being ≥65 years (AOR = 7.14, 95% CI: 2.04-.25.01, P = 0.002), a previous hospitalization (AOR = 6.20, 95% CI: 1.81-21.21, P = 0.004), and the presence of medication-related problems (AOR = 3.65, 95% CI: 1.13-11.73, P = 0.03) were the predictors of mortality.

Conclusion

The prevalence of in-hospital mortality among heart failure patients was found to be high. Previous hospitalization, older age, and the presence of drug therapy problems were the predictors of mortality among heart failure patients. Therefore, proper attention should be given to the management of elderly and re-admitted heart failure patients in addition to their regular care. In addition, hospitals should implement clinical pharmacy services to address any drug-related problems.

Decomposition of Heart Failure Prevalence and Mortality Among Older Adults in the United States: Medicare-Based Partitioning Analysis

Background

Heart failure (HF) is a challenging clinical and public health problem characterized by high prevalence and mortality among US older adults, along with a recent decline in HF prevalence and increase in mortality. The changes of prevalence can be decomposed into pre-existing disease prevalence, disease incidence, and respective survival, while the changes of mortality can be decomposed into mortality in the general population independent from HF, pre-existing HF prevalence, incidence, and respective survival. These epidemiological components may contribute differently to the changes in prevalence and mortality.

Objective

We aimed to investigate and compare the relative contributions of epidemiologic determinants in HF prevalence and mortality trends.

Methods

This study was a secondary data analysis of 5% of Medicare claims data for 1992-2017 in the United States. Medicare is a federal health insurance program for older adults aged 65+ years as well as people with specific disabilities and end-stage renal disease. Age-adjusted prevalence and incidence-based mortality (IBM; all-cause mortality that occurred in patients with HF) were partitioned into their respective epidemiologic determinants using the partitioning analysis approach.

Results

The age-adjusted HF prevalence (1/100 person-years) increased from 11 in 1994 to 14.6 in 2005, followed by a decline to 12.6 in 2017, and the age-adjusted HF IBM (1/100,000) increased from 2220.8 in 1994 to 2563.7 in 2000, then declined to 2075.9 in 2016, followed by an increase to 2094.7 in 2017. The HF incidence (1/1000 person-years) declined from 29.4 in 1992 to 19.9 in 2017. The 1-, 3-, and 5-year survival trend showed declines in recent years. Partitioning of HF prevalence showed three phases: (1) decelerated increasing prevalence (1994-2006), (2) accelerated declining prevalence (2007-2014), and (3) decelerated declining prevalence (2015-2017). During the whole period, the decreasing HF incidence contributed to the declines in prevalence, overpowering prevalence increases contributed from survival. Likewise, partitioning of HF IBM showed three phases: (1) decelerated increasing mortality (1994-2001), (2) accelerated declining mortality (2002-2012), and (3) decelerated declining mortality (2013-2017). The decreasing HF incidence in 1994-2017 and increasing survival in 2002-2006 contributed to the declines in mortality, while the decreasing survival in 2007-2017 contributed to the mortality increase.

Conclusions

Decade-long declines in HF prevalence and mortality mainly reflected decreasing incidence, while the most recent increase of mortality was predominantly due to the declining survival. If current trends persist, HF prevalence and mortality are forecasted to grow substantially in the next decade. Prevention strategies should continue the prevention of HF risk factors as well as improvement of treatment and management of HF after diagnosis.

Plasma metabolomic characteristics of atrial fibrillation patients with spontaneous echo contrast

BACKGROUND

The spontaneous echo contrast (SEC) in patients with atrial fibrillation (AF) indicates a prethrombic state that ultimately progresses into thrombus formation. A comprehensive understanding of specific plasma metabolomics characteristics may protect AF patients from thrombus, particularly in the early stage.

OBJECTIVES

Through the investigation of metabolic pathways, we endeavor to uncover the metabolomic characteristics associated with SEC states, and to examine the differential metabolites by which may exert their influence on thrombotic states.

METHODS

Patients with AF were enrolled, and the participants were divided into three groups based on the results of the echocardiogram: non-SEC, low-SEC and high-SEC group. Samples were collected and subjected to non-targeted metabolomics analysis. The analytical process included data quality control, metabolite difference analysis, component analysis, Kegg cluster analysis, etc. RESULTS: Our metabolic phenotype revealed a clear differential metabolic pattern between the SEC and non-SEC. Specifically, we identified 35 and 142 significantly differential metabolites in venous and atrial plasma, respectively, suggesting that SEC may be involved in pervasive metabolic dysregulation and that the degree of metabolic dysregulation in atrial plasma is more severe than that in venous blood.

CONCLUSION

Patients with SEC have a significantly different metabolic pattern compared to those without SEC. Our work promoted the understanding of mechanism of the occurrence and development of SEC, facilitated the screening of the target metabolites for its therapeutic intervention, and provided evidence for the prevention and treatment of SEC or thrombosis in AF. Our work also provided new directions for subsequent research in related fields. In conclusion, our study not only provides a theoretical basis for understanding the occurrence and development of SEC in AF, but also provides recommendations for the daily diet of AF patients with SEC, such as a balanced intake of essential amino acids, avoiding excessive intake of benzoic acid, and intake of appropriate inositol.

CLINICAL TRIAL NUMBER

Not applicable.

Machine learning based clinical prediction model for 1-year mortality in Sepsis patients with atrial fibrillation

Background

Atrial fibrillation (AF) emerges as a pivotal risk determinant for unfavorable outcomes in septic patients. Despite its recognized role, the enduring impact of AF on sepsis prognosis remains ambiguous. This investigation seeks to elucidate the connection between AF and both short and long-term outcomes in sepsis patients. Additionally, it aims to formulate a prognostic model for 1-year mortality utilizing pertinent clinical variables.

Methods

A retrospective analysis encompassed sepsis patients admitted to Beth Israel Deacon Medical Center's intensive care unit. The evaluation encompassed the prevalence of AF and its influence on hospitalization duration, stays in the Intensive Care Unit (ICU), and mortality rates at distinct intervals. Propensity score matching was implemented to mitigate confounding factors. Machine learning techniques, including the Least Absolute Selection and Shrinkage Operator (LASSO) regression and random forest, were deployed for model development.

Results

AF exhibited a correlation with heightened mortality rates at 7 days, 28 days, and 1 year. The resultant predictive model demonstrated superior efficacy compared to prevailing clinical critical illness scores in forecasting mortality risk. Crucial predictors in the model included variables such as RDW, weight, age, BUN, lactate, temperature, MCHC, MBP, ALP, and hemoglobin.

Conclusions

AF emerges as a substantial peril for adverse outcomes in sepsis patients. The risk model, encompassing pertinent clinical variables, outperformed existing clinical critical illness scores in mortality prediction. This model furnishes valuable insights for risk stratification, augmenting prognostic precision in sepsis patients with concomitant AF.

Primary prevention of cardiovascular diseases among women in a South Asian population: a descriptive study of modifiable risk factors

OBJECTIVE

The aim of this study was the assessment of modifiable risk factors of cardiovascular diseases (CVD) among women versus men at a newly developed preventive cardiology clinic of a large tertiary care cardiac centre in Pakistan.

DESIGN

Observational study.

SETTING

Tertiary care cardiac hospital in Karachi, Pakistan.

PARTICIPANTS

Data for this study were obtained retrospectively from a prospectively collected ongoing registry. We have included all female and male individuals who have presented or were referred to our clinic for primary prevention. All the participants had no history of ischaemic heart disease.

OUTCOME MEASURE

In this study, we evaluated the CVD risk factors, estimated risk of CVD, and glycaemic and cholesterol control at baseline and at subsequent follow-ups for high-risk patients.

RESULTS

A total of 535 patients, 314 females, were included with a mean age of 48.3±12.5 years. At baseline, 57.9% (128) of men versus 73.2% (230) of women (p<0.001) were known cases of hypertension (HTN); 18.1% (40) vs 26.8% (84) (p=0.019) were diabetic; 40.5% (89) vs 9.2% (29) (p<0.001) were tobacco users; 26.0% (56) vs 3.2% (10) (p<0.001) were smokers; and 26.9% (57) vs 50.5% (153) had BMI ≥30 kg/m2, respectively.Baseline atherosclerotic cardiovascular disease (ASCVD) risk score was available for 348 (65%), 61.5% (136) of men versus 67.5% (212) of women. The median ASCVD risk score was 6.8% (2.8%-16.1%) vs 2.25% (1%-5.1%) (p<0.001 for men and women, respectively). The ASCVD risk score was ≥20% (high risk) for 22.1% (30) vs 1.9% (4), while the ASCVD risk score was <5% (low risk) for 40.4% (55) vs 74.1% (157) of men and women, respectively.A repeat ASCVD assessment at a median follow-up of 49.5 (7.0-231) days was available for 259 (48.4%) patients, 26.2% (58) of men vs 64% (201) of women, respectively. The median follow-up ASCVD score was 6.55% (2.8%-15.4%) vs 2.1% (0.9%-4.8%) (p<0.001 with ≥20% (high risk) in 19% (11) vs 2% (4) and <5% (low risk) in 34.5% (20) vs 77.1% (155) of men and women, respectively).

CONCLUSIONS

There is a high prevalence of modifiable risk factors for atherosclerotic CVD such as HTN, diabetes and obesity in women as compared with men, but interestingly, ASCVD risk score at the baseline as well as at the follow-up is high in men versus women. Some other non-modifiable risk factors like age, gender and blood lipid profile may also contribute to this difference between the high prevalence of risk factors and low ASCVD risk score in women. With appropriate follow-up and proper counselling, the looming CVD can be better prevented in this population. A dedicated preventive cardiology clinic for the identification of high-risk women and systematic follow-up is needed to predict their actual CVD risk.

TRIAL REGISTRATION

NCT06503341.

Network analysis of anxiety and depressive symptoms among patients with heart failure

BACKGROUND

Anxiety and depressive symptoms are common among patients with heart failure (HF). Physical limitations, lifestyle changes, and uncertainties related to HF can result in the development or exacerbating of anxiety and depressive symptoms. However, the central and bridge symptoms of anxiety and depressive symptoms network among patients with HF remain unclear. Network analysis is a statistical method that can discover and visualize complex relationships between multiple variables. This study aimed to establish a network of anxiety and depressive symptoms and identify the central and bridge symptoms in this network among patients with HF.

METHODS

This study employed a cross-sectional study design and convenience sampling to recruit patients with HF. This study followed the Helsinki Declaration and was approved by the Research Ethics Committee of Hospital. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9) were administered to evaluate anxiety and depressive symptoms among patients with HF, respectively. Network analysis of anxiety and depressive symptoms was performed using R.

RESULTS

In the anxiety and depressive symptoms network, PHQ2 (feeling down, depressed, or hopeless), PHQ7 (inability to concentrate), and GAD4 (difficulty relaxing) were the most central symptoms. Anxiety and depressive symptoms were linked by PHQ2 (feeling down, depressed, or hopeless), GAD6 (becoming easily annoyed or impatient), GAD5 (unable to sit still because of anxiety), GAD7 (feeling afraid that something terrible is about to happen), and PHQ6 (feeling bad or like a failure, or disappointing oneself or family).

CONCLUSIONS

This study identified the central and bridge symptoms in a network of anxiety and depressive symptoms. Targeting these symptoms can contribute to interventions for patients with HF at risk of-or suffering from-anxiety and depressive symptoms, which can be effective in reducing the comorbidity of anxiety and depression.

STING orchestrates microglia polarization via interaction with LC3 in autophagy after ischemia

Autophagy has both protective and pathogenetic effects on injury caused by cerebral ischemia/reperfusion (I/R). Our previous research has indicated that stimulator of interferon genes (STING) could orchestrate microglia polarization following middle cerebral artery occlusion. However, it remains largely unexplored whether STING balances microglial polarization by regulating autophagy in brain I/R injury. Here, STING was observed to show an up-regulation in the microglia from mice subjected to experimental ischemic stroke. Strikingly, the deletion of STING led to the significant skewness of microglia activated by ischemia from a pro- to anti-inflammatory state and substantially alleviated ischemia-induced infarction and neuronal injury. In addition, STING-null mice can restore long-term neurobehavioral function. Then, the crosstalk between neuroinflammation and microglia autophagy was analyzed. The differential activity of autophagy in wild-type and STING-knockout (KO) mice or primary microglia was largely reversed when STING was restored in microglia. Irritating autophagy by rapamycin skewed the anti‑inflammatory state induced by STING-KO to a pro‑inflammatory state in microglia. Furthermore, microtubule-associated protein light-chain-3 (LC3) was identified as the key factor in the STING regulation of autophagy by glutathione-S-transferase (GST) pull-down analysis. Mechanically, STING can directly interact with LC3 through the STING transmembrane domain (1-139aa). Herein, current data determine the pivotal role of autophagy, specifically via LC3 protein, in the regulation of microglial phenotypic transformation by STING. These findings may provide a possible treatment target for delaying the progression of ischemic stroke.

Ciprofol versus propofol for anesthesia induction in cardiac surgery: a randomized double-blind controlled clinical trial

BACKGROUND

Ciprofol, a novel intravenous general anesthetic with a chemical structure similar to propofol, exhibits significantly enhanced potency. It offers a rapid onset, reduced incidence of injection pain, and has comparable effects on heart rate and blood pressure to propofol. However, clinical data on its use for anesthesia induction in cardiac surgery remain limited.

METHODS

Seventy-eight patients undergoing coronary artery bypass grafting or valve replacement surgery were randomly assigned to receive either ciprofol (N = 40) or propofol (N = 38) for anesthesia induction. Variables recorded included changes in mean arterial pressure and heart rate during anesthesia, alterations in the oxygenation index and lactic acid concentration before and 10 min after anesthesia induction, and the incidence of adverse events such as bradycardia, hypotension, and injection pain.

RESULTS

The incidence of anesthesia-induced injection pain was significantly lower in the ciprofol group compared to the propofol group (3% vs. 18%, P < 0.05). The incidence of other adverse events was similar between the groups. No significant differences in hemodynamics or oxygenation index were observed during anesthesia induction between ciprofol and propofol.

CONCLUSIONS

Ciprofol demonstrated a significantly lower incidence of injection pain compared to propofol, potentially improving patient comfort during anesthesia induction. Additionally, ciprofol showed comparable circulatory stability to propofol during anesthesia induction in cardiac surgery, suggesting it may be a suitable alternative to propofol for this application.

TRIAL REGISTRATION

The trial was registered at the ClinicalTrials.gov on 03/10/2024 (NCT06312345).

Nose-to-brain delivery of stem cells in stroke: the role of extracellular vesicles

Stem cell transplantation offers a promising therapy that can be administered days, weeks, or months after a stroke. We recognize 2 major mitigating factors that remain unresolved in cell therapy for stroke, notably: (1) well-defined donor stem cells and (2) mechanism of action. To this end, we advance the use of ProtheraCytes, a population of non-adherent CD34+ cells derived from human peripheral blood and umbilical cord blood, which have been processed under good manufacturing practice, with testing completed in a phase 2 clinical trial in post-acute myocardial infarction (NCT02669810). We also reveal a novel mechanism whereby ProtheraCytes secrete growth factors and extracellular vesicles (EVs) that are associated with angiogenesis and vasculogenesis. Our recent data revealed that intranasal transplantation of ProtheraCytes at 3 days after experimentally induced stroke in adult rats reduced stroke-induced behavioral deficits and histological damage up to 28 days post-stroke. Moreover, we detected upregulation of human CD63+ EVs in the ischemic brains of stroke animals that were transplanted with ProtheraCytes, which correlated with increased levels of DCX-labeled neurogenesis and VEGFR1-associated angiogenesis and vasculogenesis, as well as reduced Iba1-marked inflammation. Altogether, these findings overcome key laboratory-to-clinic translational hurdles, namely the identification of well-characterized, clinical grade ProtheraCytes and the elucidation of a potential CD63+ EV-mediated regenerative mechanism of action. We envision that additional translational studies will guide the development of clinical trials for intranasal ProtheraCytes allografts in stroke patients, with CD63 serving as a critical biomarker.

Predictive markers of early endothelial dysregulation in type-1 diabetes: a meta-analysis

BACKGROUND

This study identifies a new set of salient risk factors that may trigger danger signals of vascular dysregulation in T1D. Vascular abnormalities and impairment of CVD is a major adverse effect of T1D, particularly affecting children, adolescents and young adults.

METHODS

The patients of T1D were compared with the healthy control (HC) for the risk factors of vascular dysregulation in published studies from year 2013 to 2023. The PubMed, Web of Science and Google Scholar databases were searched from 1/1/2013 to 1/9/2023. The risk of bias was assessed with the Cochrane (ROBINS-I ) tool, relevant to clinical subjects. A random effects model was followed and analysed by RevMan 5.4 and GraphPad Prism software.

RESULTS

80 relevant case-control studies having 7492 T1D patients and 5293 HC were included. The age and sex-matched HC consisted of persons free of disease and not under any medication while clinical subjects of < 40 years were included. 28 risk factors were grouped into six primary outcome models, all of which favoured the T1D synonymous with a high risk of CVD.

CONCLUSION

Our findings have strong implications for improving the quality of life and health economics related to vascular disease in T1D. HbA1c% is the most effective biomarker, followed by FBG, LDL-c, AI%, sICAM-1, and FMD% which could be evaluated with a simple blood test or non-invasive techniques. These may serve dual purposes as biomarkers of rapid diagnosis that could offer prospective tailor-made therapeutics for T1D. (Protocol registered at https://www.crd.york.ac.uk/prospero/CRD42022384636 ).