Use of oral anticoagulant drugs is associated with carotid intraplaque hemorrhage in atherosclerosis patients: a meta-analysis

Prevalence and burden of HBV-HIV co-morbidity: a global systematic review and meta-analysis

Introduction

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). Because of the shared modes of transmission, co-infections of HBV are common among people living with Human Immunodeficiency Virus (HIV) infection. While the use of antiretroviral therapy (ART) has significantly improved the life expectancy of HIV patients, hepatitis viral co-infections have become increasingly important. Particularly, HBV infection remains under-diagnosed and under-reported, despite its highly infectious nature. Therefore, this review was aimed at understanding the burden of hepatitis B disease among adults living with HIV receiving ART.

Methods

Using pertinent search terms, all research found in Google Scholar, HINARI, EMBAS, Scopus, and PubMed was located. Data were extracted following the evaluation of the evidence using the Joanna Briggs Institute's cross-sectional and cohort study methodologies.

Result

A total of 18 groups involving 71,411 adults with HBV-HIV were selected for the study. Of those, 10.21% with 95% CI (5.06, 15.36) and 11.05% with 95% CI (2.78, 19.32) of HBV-HIV adults worldwide had an overall prevalence of HBV, with an I2 value of 0.0% (p-value = 0.729) and an I2 value of 0.0% (p-value = 0.818) from cross-sectional and cohort studies, respectively.

Conclusion

The global prevalence of people living with HBV-HIV is high, which poses a serious risk to public health. The review can clearly show the current pooled prevalence of HIV-HBV in the world, which may be helpful for policymakers because a large number of recent studies were included in it. Thus, it is strongly advised to broaden the current preventive and control program's purview and implement new, sensitive screening, testing, and treatment techniques. To raise community awareness, it would also be preferable to revamp the current prevention and control program and establish target-specific task forces at various health facility levels.

Platelet biology and function: plaque erosion vs. rupture

The leading cause of heart disease in developed countries is coronary atherosclerosis, which is not simply a result of ageing but a chronic inflammatory process that can lead to acute clinical events upon atherosclerotic plaque rupture or erosion and arterial thrombus formation. The composition and location of atherosclerotic plaques determine the phenotype of the lesion and whether it is more likely to rupture or to erode. Although plaque rupture and erosion both initiate platelet activation on the exposed vascular surface, the contribution of platelets to thrombus formation differs between the two phenotypes. In this review, plaque phenotype is discussed in relation to thrombus composition, and an overview of important mediators (haemodynamics, matrix components, and soluble factors) in plaque-induced platelet activation is given. As thrombus formation on disrupted plaques does not necessarily result in complete vessel occlusion, plaque healing can occur. Therefore, the latest findings on plaque healing and the potential role of platelets in this process are summarized. Finally, the clinical need for more effective antithrombotic agents is highlighted.

The anti-atherosclerotic effects of natural polysaccharides: from phenomena to the main mechanisms of action

Polysaccharides (PSs) of plant origin have a variety of biological activities, anti-atherosclerotic including, but their use in atherosclerosis therapy is hindered by insufficient knowledge on the cellular and molecular mechanisms of action. In this review, the influence of several natural PSs on the function of macrophages, viral activity, and macrophage cholesterol metabolism has been discussed considering the tight interplay between these aspects in the pathogenesis of atherosclerosis. The anti-atherosclerotic activities of natural PSs related to other mechanisms have been also explored. Directions for further research of anti-atherosclerotic effects of natural PSs have been outlined, the most promising of which can be nutrigenomic studies.

Lower dose direct oral anticoagulants and improved survival: A combined analysis in patients with established atherosclerosis

BACKGROUND

Antithrombotic/anticoagulation effects of direct oral anticoagulants (DOACs) are dose-dependent. However, recent observations suggest that administering lower dose DOACs may better protect against all-cause mortality. We investigated whether, in patients with established atherosclerosis, DOAC dose selection would affect the risk of all-cause mortality.

METHODS

We performed a structured literature research for controlled trials allowing random assignment to a lower dose DOAC, a higher dose DOAC, or control therapy in patients with established atherosclerosis. Pooled risk ratios (RRs) of all-cause mortality in lower and higher dose DOACs versus control therapy were estimated using a random-effect model.

RESULTS

Atherosclerosis manifested as acute coronary syndrome (n=17,220), stable coronary (CAD) and/or peripheral artery disease (PAD) (n=27,395) or CAD associated with atrial fibrillation (n=4,510). Antithrombotic doses of rivaroxaban (2.5 mg or 5.0 mg BID) or dabigatran (50 mg, 75 mg, 110 mg, or 150 mg, BID) were tested in three trials versus single or dual antiplatelet control therapy, whereas anticoagulation doses of edoxaban (30 mg or 60 OD) were tested versus warfarin in one trial. Compared to control, patients receiving lower dose (RR 0.80, 95% CI 0.73-0.89, p<0.0001, I²=0%), but not those receiving higher dose DOACs (RR 0.95, 95% CI 0.87-1.05, p=0.3074, I²=0%), had a significant reduction of all-cause mortality. Benefit from lower dose DOACs remained after sensitivity analysis or direct comparison with higher dose DOACs (RR 0.84, 95% CI 0.76-0.93, p=0.0009, I²=0%).

CONCLUSIONS

Within antithrombotic/anticoagulation regimens of DOAC administration, selection of lower dose appears to protect from all-cause mortality in patients with established atherosclerosis.

Normalized wall index, intraplaque hemorrhage and ulceration of carotid plaques correlate with the severity of ischemic stroke

BACKGROUND AND AIMS

Carotid atherosclerosis is considered an important cause of ischemic stroke. Tthis study aimed to explore the relationship between plaque features and the severity of stroke, and to identify plaque risk factors for the assessment of the severity of ischemic stroke.

METHODS

Symptomatic patients with carotid atherosclerotic plaques were prospectively recruited and underwent high-resolution vessel wall magnetic resonance imaging (VW-MRI). Two trained MRI readers independently identified intraplaque hemorrhage (IPH), calcification (CA), surface CA, deep CA, and ulceration. They measured and calculated the maximum vessel diameter (Max VD), maximum wall thickness (Max WT), total vessel area, lumen area, normalized wall index (NWI), plaque volume, IPH volume, IPH proportion, CA volume, and CA proportion. Patients were divided into two groups according to their National Institutes of Health Stroke Scale (NIHSS) scores (NIHSS ≤1 vs. NIHSS >1). Clinical characteristics and carotid plaque features were compared using the Mann-Whitney U test or Chi-square test as appropriate. Odds ratio (OR) and corresponding 95% confidence interval (CI) of plaque features to distinguish patients with NIHSS >1 were calculated. Spearman's rank correlations or Pearson correlations were determined for plaque features and NIHSS scores.

RESULTS

Of the 97 included patients, 34 (35.05%) with NIHSS >1 had significantly greater NWI (p < 0.05), larger IPH volume (p < 0.01), and greater IPH proportion (p < 0.01), and higher prevalence of IPH (OR, 5.654; 95%CI, 2.272-14.070; p < 0.01) and ulceration (OR, 2.891; 95%CI, 1.090-7.667; p = 0.033) than patients with NIHSS ≤1. Max WT (r = 0.24, p = 0.018), NWI (r = 0.22, p = 0.032), IPH (r = 0.27, p = 0.007), IPH volume (r = 0.35, p < 0.01), IPH proportion (r = 0.28, p = 0.005), and ulceration (r = 0.35, p < 0.01) had positive correlations with NIHSS scores.

CONCLUSIONS

NWI, IPH, and ulceration of carotid atherosclerotic plaque based on high-resolution VW-MRI may be useful indicators for assessing the severity of ischemic stroke in patients with atherosclerosis. NIHSS score is related to max WT, NWI, IPH, IPH volume, IPH proportion, and ulceration.