Hypertension and Dyslipidemia: the Two Partners in Endothelium-Related Crime

Coronary Microvascular Disease Early After Myocardial Infarction: Diagnostic Approach and Prognostic Value-A Narrative Review

Coronary microvascular disease (CMVD) is not an uncommon complication after acute myocardial infarction (AMI), independent of prompt revascularization. It is a serious yet underdiagnosed disease that has a major impact on patient outcomes. Even when the infarct-related artery is successfully revascularized, a significant percentage of patients still have compromised microvascular circulation, which is linked to higher cardiovascular mortality and hospitalization for heart failure. The well-known invasive methods, such as the index of microvascular resistance (IMR) and the coronary flow reserve (CFR), have been considered as gold standards. However, they are constrained by their hazards and complexity. Non-invasive techniques, such as echocardiography Doppler for CFR assessment, positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), and some other techniques provide alternatives, but their accessibility, cost and implementation during the peri-AMI period raise obstacles to their wider use. This review highlights both invasive and non-invasive modalities as it examines the diagnostic methods and prognostic significance of CMVD development early after AMI. Enhancing long-term results in this high-risk population requires a thorough understanding of pathophysiology and a commitment to larger diagnostic and prognostic studies for CMVD.

Hypertension Types and Associated Cardiovascular Risk Factors in Lithuanians Aged 50-54 Years

Background: Hypertension is one of the most common cardiovascular risk factors worldwide. Additionally, epidemiological studies show a worryingly high prevalence of treatment-resistant hypertension. Especially concerning is the frequent co-occurrence of other cardiovascular risk factors, including dyslipidaemia, smoking, and diabetes mellitus. Objectives: The aim of this study is to investigate the prevalence of arterial hypertension and other cardiovascular risk factors in patients aged 50-54 years. Methods: A retrospective study was conducted on patients participating in the Lithuanian High Cardiovascular Risk Primary Prevention Programme. Data were collected from self-report questionnaires, laboratory tests, and clinical assessment. Hypertension was confirmed if systolic blood pressure was ≥140 mmHg and/or diastolic blood pressure was ≥90 mmHg or the patient had been previously diagnosed. Results: In total, 49155 patients-32018 (62.4%) women and 17137 (37.6%) men-were enrolled in this study. A total of 24549 (49.9%) patients were diagnosed with arterial hypertension. The prevalence of non-resistant primary hypertension was 45.9%, while the prevalence of resistant primary hypertension was 4.1%. The prevalence of dyslipidaemia was 92.79% in the non-resistant primary arterial hypertension group and was 94.59% in the resistant primary arterial hypertension group. The prevalence of smoking was higher in the non-resistant primary arterial hypertension group compared to patients with resistant hypertension (22.43% and 17.09%, respectively). A total of 23.06% of patients with resistant primary arterial hypertension had diabetes mellitus. Conclusions: The prevalence of primary arterial hypertension in middle-aged Lithuanians was high, reaching almost 50% in both sexes. Patients tended to have many cardiovascular risk factors simultaneously, with dyslipidaemia being the most common (prevalence > 90%).

Remnant cholesterol inflammatory index and its association with all-cause and cause-specific mortality in middle-aged and elderly populations: evidence from US and Chinese national population surveys

BACKGROUND

The remnant cholesterol inflammatory index (RCII) is a novel metric that combines remnant cholesterol and high-sensitivity C-reactive protein, reflecting the metabolic and inflammatory risk. This study investigates the association between RCII and long-term risks of all-cause and cause-specific mortality in middle-aged and elderly populations in the US and China.

METHOD

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS), including 7,565 and 12,932 participants aged 45 years and older, respectively. The participants were categorized into quartiles based on natural log-transformed RCII (lnRCII) values. Kaplan-Meier survival analysis, Cox proportional hazards models, restricted cubic splines (RCS) and mediation analysis were used to examine the relationship between lnRCII and mortality outcomes, adjusting for potential covariates.

RESULT

The mean age of the participants was 59.90 ± 10.44 years (NHANES) and 58.64 ± 9.78 years (CHARLS), with 53.28% and 52.50% female, respectively. Kaplan-Meier survival analysis showed that higher lnRCII quartiles (≥ 0.79 in NHANES, ≥ -0.13 in CHARLS) were significantly associated with increased all-cause mortality risk (p < 0.001). Each standard deviation (SD) increase in lnRCII corresponded to a higher risk of all-cause mortality, and the hazard ratios (HRs) and 95% confidence interval (CI) were 1.29 (95% CI: 1.21-1.36) in NHANES and 1.26 (95% CI: 1.15-1.38) in CHARLS. In NHANES, lnRCII was also associated with elevated risks of cardiovascular mortality (HR = 1.21, 95% CI: 1.08-1.35) and cancer mortality (HR = 1.30, 95% CI: 1.09-1.55). RCS analysis indicated a J-shaped relationship between lnRCII and both all-cause and cardiovascular mortality, and a linear association with cancer mortality. Mediation analysis showed that systolic blood pressure and fasting plasma glucose partially mediated these associations. Subgroup analyses suggested a stronger association between lnRCII and all-cause mortality in middle-aged US participants (p for interaction = 0.010).

CONCLUSIONS

Elevated RCII levels are significantly associated with increased all-cause mortality risk middle-aged and elderly populations in both the US and China. In the US population, RCII is also associated with increased risks of cardiovascular and cancer mortality. By integrating metabolic and inflammatory risk factors, RCII may serve as a valuable tool for mortality risk stratification and clinical decision-making.

Association Between Carotid Plaque Characteristics and High-risk Coronary Plaque: A Virtual Histology Intravascular Ultrasound Study

This retrospective study aimed to investigate the association between carotid artery plaque characteristics evaluated by virtual histology intravascular ultrasound (VH-IVUS) and high-risk coronary plaques determined by coronary computed tomography angiography (CCTA) among patients (n = 72) who underwent carotid artery stenting (CAS). VH-IVUS examination was performed during CAS and CCTA examination before CAS. Logistic regression models were used to explore the association between carotid plaque characteristics and high-risk coronary plaque. Of 72 patients, 46 (63.9%) were diagnosed as having high-risk coronary plaques. The necrotic core (NC) area, NC percentage, dense calcium (DC) area, and symptomatic carotid artery stenosis were significantly associated with high-risk coronary plaques (all P < .05). Isolated upper-NC area, and upper-NC area combined with upper-DC area were associated with high-risk coronary plaques. Compared with the lower-NC area and lower-DC area groups, participants with upper-NC area and upper-NC area had 12.53 times higher odds ratio of having high-risk coronary plaques. This study showed that the NC area, NC percentage, DC area and symptomatic carotid artery stenosis were associated with high-risk coronary plaques. Participants with both upper-NC area and upper-DC area might have a higher risk of high-risk coronary plaques.

Association between TG/HDL-C and hypertension in Chinese middle-aged and older adults: findings from CHARLS

BACKGROUND

The triacylglycerol to high-density lipoprotein cholesterol ratio (TG/HDL-C) has been recognized as one of the risk factors for cardiovascular diseases, insulin resistance and metabolic syndrome. We aimed to investigate the relationship between TG/HDL-C and hypertension in a Chinese middle-aged and elderly population.

METHODS

We used data from the CHARLS database 2011-2018 to explore the relationship between TG/HDL-C and hypertension through cross-sectional and longitudinal studies. Hypertension was identified by self-report or taking anti-hypertensive medications. Participants aged below 45, or with missing data on TG/HDL-C or hypertension record, or taking lipid-lowering medication were excluded. Participants were divided into three or two groups based on triplets TG/HDL-C and median TG/HDL-C in cross-sectional and longitudinal analysis. Multivariate logistic regression analysis, subgroup analysis, and restricted cubic splines were used in statistics.

RESULTS

In the cross-sectional analysis, a total of 12,824 participants were included, after adjusting for potential confounders, there was a significant association between higher TG/HDL-C and increased prevalence of hypertension (OR = 1.86, 95% CI: 1.65-2.09, p < 0.001), systolic blood pressure (SBP) above 140 mmHg (OR = 1.37, 95% CI: 1.25-1.50, p < 0.0001), diastolic blood pressure (DBP) above 90 mmHg (OR = 1.47, 95% CI: 1.29-1.67, p < 0.0001), and pulse pressure (PP) above 60 mmHg (OR = 1.17, 95% CI: 1.07-1.29, p < 0.0011). The longitudinal analysis included 7909 participants, there was a significant association between higher TG/HDL-C and increased incidence of hypertension (OR = 1.51, 95% CI: 1.32-1.73,p < 0.001). Restricted cubic splines show nonlinear relationship between TG/HDL-C and hypertension.

CONCLUSION

These results demonstrated significant positive association between TG/HDL-C and the prevalence & incidence of hypertension, in a nationwide representative middle-aged and elderly population in China.

Higher Food and Lifestyle Oxidative Balance Scores Decreases the Risk of Hypertension in Chinese Adults: A Population-Based Cross-Sectional Study

Oxidative stress plays an important role in the development of hypertension (HTN). A population-based cross-sectional study was conducted in Fujian province of China. The construction of FoodL-OBS relied on diet and lifestyle components, which included four food and six lifestyle factors. Multivariable-adjusted logistic regression was performed to investigate the association between FoodL-OBS and the risk of HTN. A subgroup analysis was also conducted. Restricted cubic spline (RCS) regression was used to elucidate the dose-response relationship between FoodL-OBS and the risk of HTN. A total of 9578 participants were included, 3271 of whom suffered from HTN. The results of multivariable logistic regression analysis showed that the HTN risk decreased by 14% for each FoodL-OBS unit added [OR: 0.86 (0.84, 0.88), p < 0.01]. Compared with participants with the lowest levels of Food-L-OBS, those with the highest quartile were less likely to have HTN [0.43 (0.37, 0.50)]. Further stratified analysis showed that Food-L-OBS was negatively associated with the risk of HTN, which was statistically significant in participants in subgroups of ≤60 years, female, and no-dyslipidemia. The results of RCS showed a linear negative correlation between Food-L-OBS and HTN in men, but not in women. In conclusion, FoodL-OBS was negatively associated with HTN, and a healthy lifestyle and antioxidant-rich diet may be useful for preventing HTN.

The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and pulmonary function: evidence from NHANES 2007-2012

Background

This research aims to explore the potential association between lung function and the ratio of non-high-density lipoprotein cholesterol (NHL) to high-density lipoprotein cholesterol (NHHR). Previous research has shown that lipid metabolism imbalance is closely linked to cardiovascular disease, however, there is a lack of information regarding its impact on lung function.

Methods

This research used information from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2007 to 2012, including a large-scale sample of 9,498 adults aged 20 years and older. A cross-sectional study employing multivariable regression models was aimed at examining the relevance between NHHR and indicators of lung function (FEV1, FVC, and FEV1/FVC). Adjustments were made for a wide range of confounding factors, encompassing race, gender, age, BMI, smoking status, physical activity, diabetes, alcohol consumption, and education level. Data analysis included categorizing NHHR into quartiles and using trend tests to evaluate dose-response relationships between NHHR quartiles and lung function. Sensitivity analyses were conducted by excluding participants with asthma and COPD to ensure the reliability of the results.

Results

The results manifested a significant correlation between decreased FEV1 and FVC values and elevated NHHR, most notably within the highest quartile of NHHR (Q4), where the association was most pronounced. Additionally, trend test results indicated a significant linear negative correlation between NHHR and both FEV1 and FVC. However, the correlation between FEV1/FVC and NHHR showed a nonlinear U-shaped pattern. Suggesting differential impacts of NHHR on various lung function indicators. The findings' robustness was shown by sensitivity analysis, which revealed that even after omitting people with asthma and COPD, the negative correlation between NHHR and FEV1 and FVC remained significant.

Conclusion

This research emphasizes the significance of tracking lipid levels in evaluating respiratory health and offers early evidence in favor of NHHR as a probable biomarker for respiratory function. Further longitudinal research has occasion to prove the causal relationship between NHHR and lung function and to explore its underlying biological mechanisms.

2024 consensus document of the Italian Society of Arterial Hypertension (SIIA) and the Italian Society of Cardiovascular Prevention (SIPREC): update on LDL cholesterol lowering in patients with arterial hypertension

Hypertension and hypercholesterolemia often occur in the same individuals, increasing the risk of major cardiovascular (CV) outcomes, including myocardial infarction, stroke, CV death, as well as other CV complications. Concomitant management of these condition now represent a crucial step to reduce individual global CV risk and improve CV disease prevention in daily clinical practice. Given the high prevalence of hypertension and hypercholesterolemia in general population and their impact on health status, several pharmacological options are currently available to achieve the recommended therapeutic targets. These drugs, mostly including statins, ezetimibe, bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors and inclisiran, can be used either in monotherapies or in combination therapies, with different clinical indications, therapeutic efficacy and tolerability profile. Decision among different drug classes and dosages, as well as choice between monotherapy or combination therapy (fixed or free), largely depend on individual global CV risk profile and therapeutic targets of low-density lipoprotein (LDL) cholesterol levels to be achieved under pharmacological therapy. The present consensus document represents an update of the previous document published on 2022 and endorsed by the Italian Society of Hypertension (SIIA) and the Italian Society of Cardiovascular Prevention (SIPREC). Here we propose a novel paradigm for the treatment of the patients with hypertension and hypercholesterolemia at high or very high cardiovascular risk. In addition, the pharmacological properties, and the clinical efficacy of novel agents recently approved for a tailored therapy of hypercholesterolemia in patients with atherosclerotic CV disease, including PCSK9 inhibitors and bempedoic acid, will be summarized.

Two-Week Low-Salt Diet Improves Acetylcholine-Induced Microvascular Dilation in Biologically Naïve Psoriasis Patients

Background/Objectives: Patients with psoriasis exhibit endothelial dysfunction (EDy), which increases their cardiovascular risk. Excessive salt intake impairs endothelium-dependent vascular reactivity. However, research on EDy in psoriasis has focused primarily on larger vessels, leaving skin microcirculation unexplored. This study aimed to investigate the effects of a low-salt diet (LS diet, ~3.75 g/day) on microvascular reactivity in patients with chronic plaque psoriasis. Methods: Laser Doppler flowmetry was used to assess skin microcirculation blood flow in response to vascular occlusion (postocclusive reactive hyperemia, PORH), acetylcholine (acetylcholine-induced dilation, AChID), sodium nitroprusside (SNP-induced dilation, SNPID), and local heating (local thermal hyperemia, LTH). Blood and 24 h urine samples were collected for biochemical and inflammatory parameters and dietary adherence monitoring. Results: The results showed significant reductions in systolic (p = 0.021) and mean arterial blood pressure (p = 0.007) after the LS diet. AChID increased by 16% (p = 0.029) regardless of blood pressure changes, especially in normolipemic, normotensive patients without excess visceral fat. Importantly, significant sex differences were observed, with significant improvement in endothelial function observed only in women (p = 0.031 vs. p = 0.477). PORH did not change significantly; however, a Fourier transformation analysis revealed that the endothelial component of the PORH was significantly improved following the LS diet protocol. The duration of psoriasis negatively correlated with changes in AChID (R = -0.46, p = 0.036) and LTH (R = -0.45, p = 0.041) after the LS diet, indicating that prolonged low-grade inflammation reduced endothelial function reversibility. Additionally, lower triglyceride, uric acid, and BMI levels were significant predictors of better endothelial function improvement following the LS diet. Conclusions: This study supports the beneficial effect of the early introduction of an LS diet in the treatment protocols for patients with psoriasis.

Cardiovascular Risk Factors in Middle-Aged Lithuanian Men: A Comparative Study of an Apparently Resistant Hypertension Group

Background/Objectives: Hypertension (HTN) is a significant risk factor for cardiovascular disease (CVD), and a subset of patients exhibits apparently resistant hypertension (aRHTN), where blood pressure remains inadequately controlled despite treatment. This study aims to assess the prevalence of cardiovascular risk factors in middle-aged Lithuanian men with HTN and aRHTN, as well as to evaluate the effectiveness of hypertension management in these groups. Methods: Data from 52,012 men participating in the Lithuanian High Cardiovascular Risk Programme (LitHiR) between 2009 and 2019 were analysed. Participants were categorised into two groups: treated hypertension (HTN) and apparent resistant hypertension (aRHTN). Despite treatment, the aRHTN group included those who failed to achieve their target blood pressure. The prevalence of cardiovascular risk factors (dyslipidaemia, diabetes, metabolic syndrome, obesity, physical inactivity, and an unbalanced diet) was compared between the groups. Results: The overall prevalence of HTN was 47%, with 9.9% of treated hypertensive men having aRHTN. Dyslipidemia was both groups' most prevalent risk factor (94.1% in HTN vs. 95.5% in aRHTN, p < 0.001). Men with aRHTN exhibited higher rates of diabetes (25.9% vs. 18.5%, p < 0.001), metabolic syndrome (75.3% vs. 66.3%, p < 0.001), and left ventricular hypertrophy (59.4% vs. 43.1%, p < 0.001). Treatment success was significantly lower in the aRHTN group (7.57% vs. 28.4%, p < 0.001). Conclusions: Hypertension affects almost half of the studied population, with 10% of treated hypertensives exhibiting aRHTN. The aRHTN group had a higher number of additional cardiovascular risk factors and lower treatment success rates. Improved management of cardiovascular risk factors is crucial, especially in the aRHTN population, to reduce the burden of CVD.

Urinary neonicotinoid exposure and its association with hypertension and dyslipidemia among the elderly: A cross-sectional study in Shenzhen, China

In recent years, neonicotinoids (NEOs) as a new type of insecticide have been increasingly used worldwide, causing significant impacts on human health. This study collected urine samples from 1147 elderly individuals (including 714 in the control group and 433 in the hypertension group) in Shenzhen, China, and detected the concentrations of six types of NEOs and four metabolites of NEOs (mNEOs). The aim of this study is to investigate the association between NEOs exposure and hypertension and dyslipidemia. After measurement, we find that the lowest detection rate (DR) among NEOs is imidacloprid (IMI), at only 39.3%. The NEO with the highest urine median concentration is dinotefuran (DIN) (1.31 μg/L), while the mNEO with the highest median concentration is DM-ACE (2.74 μg/L). Through univariate analysis, we found that DM-THM may promote the development of hypertension, while logistic regression indicated that IMI-OF could be a risk factor for hypertension. As prototypes of these two metabolites, thiamethoxam (THM) and IMI may also be risk factors for hypertension. Linear regression analysis revealed a negative correlation between the concentration of thiamethoxam (THD) and low-density lipoprotein (LDL) level, while DIN was positively correlated with triglyceride (TG) level and negatively correlated with high-density lipoprotein (HDL) level. Mediation effect analysis showed that THD may influence the risk of hypertension in the elderly by affecting LDL level. Based on this study, we believe that exposure to NEOs may increase the risk of hypertension in the elderly population.

The link between the atherogenic index of plasma and the risk of hypertension: Analysis from NHANES 2017-2020

BACKGROUND

The atherogenic index of plasma (AIP) is a newly identified metabolic marker for atherosclerosis. However, there are inconsistent conclusions regarding the relationship between AIP and hypertension.

METHODS

The study subjects were sourced from the National Health and Nutrition Examination Survey (NHANES) database from 2017 to 2020. Logistic regression analyses were employed to explore the correlation between AIP and hypertension. The value of AIP in predicting hypertension was assessed using ROC curves, and their nonlinear relationship was described using restricted cubic splines (RCS). Subgroup analyses, interactions, and sensitivity analyses were also conducted.

RESULTS

The study included 7,067 participants who were sourced from the NHANES database. There were 2723 participants diagnosed hypertension. We observed a notable correlation between AIP and hypertension (OR:1.89, 95%CI: 1.11-3.22, P = 0.019). ROC curve showed AIP had a good predictive value for the onset of hypertension, with the AUC of 0.652 (95% CI:0.639-0.664, p<0.001). RCS found that there existed a nonlinear association between AIP and the incidence of hypertension (p<0.001). Even after excluding individuals under the age of 40 years old, the results still indicate a strong association between AIP and hypertension.

CONCLUSIONS

AIP may serve as an early biological marker for identifying hypertension, facilitating early screening of susceptible populations.

Endothelial Dysfunction in Acute Myocardial Infarction: A Complex Association With Sleep Health, Traditional Cardiovascular Risk Factors and Prognostic Markers

BACKGROUND

Endothelial function (EndFx) is a core component of cardiovascular (CV) health and cardioprotection following acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).

HYPOTHESIS

AMI patients experience endothelial dysfunction (EndDys), associated with traditional CV risk factors and sleep patterns. EndFx may also predict short and mid-term outcomes.

METHODS

EndFx was assessed in 63 patients (56.2 ± 7.6 years) using the Endothelium Quality Index (EQI). Sleep quality and quantity were evaluated using objective (actigraphy) and subjective (Pittsburgh Sleep Quality Index questionnaire) measures. Cardiorespiratory fitness was quantified through the 6-min walking test. Cardiac function was assessed using the left ventricular ejection fraction.

RESULTS

Following AMI, patients tended to experience EndDys (EQI = 1.4 ± 0.7). A severe EndDys was observed in 23.8% of patients (n = 15), while a mild EndDys was present in 63.49% (n = 40). Furthermore, EndDys was significantly associated with traditional CV risk factors (i.e., low physical activity level [12.8%], age [-4.2%], and smoking [-0.7%]) (R2 adjusted = 0.50, p < 0.001). Patients with EndDys had poor sleep quality (p = 0.001) and sleep efficiency (p = 0.016) compared to healthy persons. Patients with severe EndDys exhibited lower cardiorespiratory fitness compared to those with healthy EndFx (p = 0.017). Furthermore, during a follow-up period (nearly 4 months) following PCI, major adverse cardiac events were observed in four patients with severe EndDys.

CONCLUSIONS

Our results emphasize the importance of adequate sleep and an active lifestyle, notably physical activity practice, as modifiable elements to enhance EndFx, which is regarded as a predictive tool following AMI. However, other factors remain to be elucidated as predictors of CV risk.

TRIAL REGISTRATION

The study protocol was registered in the Pan African Clinical Trial Registry under the trial ID: PACTR202208834230748.

Mediating Effects of Serum Lipids and Physical Activity on Hypertension Management of Urban Elderly Residents in China

Background/Objectives: Investigating the importance and potential causal effects of serum lipid biomarkers in the management of hypertension is vital, as these factors positively impact the prevention and control of cardiovascular disease (CVD). Methods: We surveyed 3373 urban residents using longitudinal data from the CHARLS database, collected between 2015 and 2020. Pearson correlation methods were employed to explore the relationships among the numerical variables. A logistic regression model was utilized to identify the risk factors for hypertension. The dose-effect relationship between serum lipids and BP was assessed using restricted cubic splines (RCS). Additionally, piecewise structural equation modeling (PiecewiseSEM) was conducted to further elucidate the direct and indirect pathways involving individual body indices, serum lipids, and PA on BP responses at different levels of physical activity (PA). Results: The four serum lipids showed significant differences between hypertensive and non-hypertensive residents (p < 0.05). All lipids, except for HDL cholesterol, demonstrated extremely significant positive correlations with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p < 0.001). All serum lipid variables were significantly associated with the incidence of hypertension. Specifically, triglycerides (bl_tg), HDL (bl_hdl), and low-density lipoprotein LDL cholesterol were identified as significant risk factors, with odds ratios (ORs) of 1.56 (95% CI: 1.33-1.85, p < 0.001), 1.16 (95% CI: 1.02-1.33, p < 0.05), and 1.62 (95% CI: 1.23-2.15, p < 0.001), respectively. Conversely, cholesterol (bl_cho) was a protective factor for hypertension, with an OR of 0.60 (95% CI: 0.42-0.82, p < 0.01). PA showed weak relationships with blood pressure (BP); however, PA levels had significant effects, particularly at low PA levels. The four serum lipids had the most mediating effect on BP, especially under low PA level conditions, while PA exhibited a partly weak mediating effect on BP, particularly under high PA level conditions. Conclusions: Serum lipids have significant nonlinear relationships with BP and PA levels exert different influences on BP. The significant mediating effects of serum lipids and the weak mediating effects of PA on individual body indices related to SBP and DBP demonstrate significant differences across varying levels of PA, highlighting the importance of low PA levels in hypertension management. This study could provide valuable recommendations and guidance in these areas.

Association of cardiorenal biomarkers with mortality in metabolic syndrome patients: A prospective cohort study from NHANES

Objectives

Approximately 20%-25% of the global adult population is affected by metabolic syndrome (MetS), highlighting its status as a major public health concern. This study aims to investigate the predictive value of cardiorenal biomarkers on mortality among patients with MetS, thus optimizing treatment strategies.

Methods

Utilizing data from the National Health and Nutrition Examination Survey (NHANES) cycles between 1999 and 2004, we conducted a prospective cohort study involving 2369 participants diagnosed with MetS. We evaluated the association of cardiac and renal biomarkers with all-cause and cardiovascular disease (CVD) mortality, employing weighted Cox proportional hazards models. Furthermore, machine learning models were used to predict mortality outcomes based on these biomarkers.

Results

Among 2369 participants in the study cohort, over a median follow-up period of 17.1 years, 774 (32.67%) participants died, including 260 (10.98%) from CVD. The highest quartiles of cardiac biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP]) and renal biomarkers (beta-2 microglobulin, [β2M]) were significantly associated with increased risks of all-cause mortality (hazard ratios [HRs] ranging from 1.94 to 2.06) and CVD mortality (HRs up to 2.86), after adjusting for confounders. Additionally, a U-shaped association was observed between high-sensitivity cardiac troponin T (Hs-cTnT), creatinine (Cr), and all-cause mortality in patients with MetS. Machine learning analyses identified Hs-cTnT, NT-proBNP, and β2M as important predictors of mortality, with the CatBoost model showing superior performance (area under the curve [AUC] = 0.904).

Conclusion

Cardiac and renal biomarkers are significant predictors of mortality in MetS patients, with Hs-cTnT, NT-proBNP, and β2M emerging as crucial indicators. Further research is needed to explore intervention strategies targeting these biomarkers to improve clinical outcomes.

Antihypertensive Potential of Pistacia lentiscus var. Chia: Molecular Insights and Therapeutic Implications

Background: Hypertension poses a significant global health burden and is associated with cardiovascular morbidity. Chios mastic gum (CMG), derived from Pistacia lentiscus var. Chia, shows potential as a phytotherapeutic agent, due to its multifaceted beneficial effects. However, its anti-hypertensive effects and vascular, circulatory, and renal-related dysfunction, have not been thoroughly investigated. Herein, we aimed to explore the antihypertensive potential of CMG, focusing on vascular and renal endothelium, in vivo. Methods: Two models of hypertension in male rats, induced by Angiotensin II and Deoxycorticosterone acetate (DOCA)-high-salt administration, were utilized. CMG was administered at 220 mg/kg daily for four weeks after hypertension onset and blood pressure was measured non-invasively. Whole blood RNA sequencing, metabolomics, real-time PCR, and Western blot analyses of kidney and aorta tissues were additionally performed. Results: CMG significantly lowered systolic, diastolic, and mean blood pressure in both models. RNA sequencing revealed that CMG modulated immunity in the Angiotensin II model and metabolism in the DOCA-HS model. CMG downregulated genes related to oxidative stress and endothelial dysfunction and upregulated endothelial markers such as Vegfa. Metabolomic analysis indicated improved endothelial homeostasis via lysophosphatidylinositol upregulation. Conclusions: CMG emerges as a potent natural antihypertensive therapy, demonstrating beneficial effects on blood pressure and renal endothelial function.

Construction and Validation of a Predictive Model for Coronary Artery Disease Using Extreme Gradient Boosting

Purpose

Early recognition of coronary artery disease (CAD) could delay its progress and significantly reduce mortality. Sensitive, specific, cost-efficient and non-invasive indicators for assessing individual CAD risk in community population screening are urgently needed.

Patients and Methods

3112 patients with CAD and 3182 controls were recruited from three clinical centers in China, and differences in baseline and clinical characteristics were compared. For the discovery cohort, the least absolute shrinkage and selection operator (LASSO) regression was used to identify significant features and four machine learning algorithms (logistic regression, support vector machine (SVM), random forest (RF) and extreme gradient boosting (XGBoost)) were applied to construct models for CAD risk assessment, the receiver operating characteristics (ROC) curve and precision-recall (PR) curve were conducted to evaluate their predictive accuracy. The optimal model was interpreted by Shapley additive explanations (SHAP) analysis and assessed by the ROC curve, calibration curve, and decision curve analysis (DCA) and validated by two external cohorts.

Results

Using LASSO filtration, all included variables were considered to be statistically significant. Four machine learning models were constructed based on these features and the results of ROC and PR curve implied that the XGBoost model exhibited the highest predictive performance, which yielded a high area of ROC curve (AUC) of 0.988 (95% CI: 0.986-0.991) to distinguish CAD patients from controls with a sensitivity of 94.6% and a specificity of 94.6%. The calibration curve showed that the predicted results were in good agreement with actual observations, and DCA exhibited a better net benefit across a wide range of threshold probabilities. External validation of the model also exhibited favorable discriminatory performance, with an AUC, sensitivity, and specificity of 0.953 (95% CI: 0.945-0.960), 89.9%, and 87.1% in the validation cohort, and 0.935 (95% CI: 0.915-0.955), 82.0%, and 90.3% in the replication cohort.

Conclusion

Our model is highly informative for clinical practice and will be conducive to primary prevention and tailoring the precise management for CAD patients.

Association of atherosclerosis indices, serum uric acid to high-density lipoprotein cholesterol ratio and triglycerides-glucose index with hypertension: A gender-disaggregated analysis

This study assessed the association between atherosclerosis indices, serum uric acid to high-density lipoprotein cholesterol ratio (UHR) and triglyceride-glucose (TyG) index and the prevalence of hypertension among MASHAD cohort participants. In this cross-sectional study, the participants were divided into hypertensive and non-hypertensive subjects. The atherosclerosis indices, UHR and TyG index of the two groups were compared. Logistic regression analyses were used to determine the associations of these indices with hypertension in both sex. Receiver operating characteristic (ROC) curve analysis was used to establish the cut-off values for differentiating hypertensive from non-hypertensive subjects. p-values < .05 were considered statistically significant. Data related to 9675 subjects (3035 hypertensive and 6640 non-hypertensive) were analyzed. The mean values of atherosclerosis indices, UHR and TyG index were significantly higher (p < .001) in the hypertensives compared to non-hypertensives. After adjustment for potential confounders, among men, the TyG index (OR = 1.360; 95% CI: 1.210-1.530; p < .001) remained an independent factor for hypertension. Among women, atherogenic index of plasma (OR = 1.005; 95% CI: 1.002-1.007; p < .001), UHR (OR = 1.043; 95% CI: 1.026-1.060; p < .001) and TyG index (OR = 1.519; 95% CI: 1.376-1.677; p < .001) remained independent factors for hypertension. ROC curve analysis revealed that compare to the other indices, TyG index had a better predictive value for hypertension in both sex, especially in women.

The Vascular Function of Resistance Arteries Depends on NADPH Oxidase 4 and Is Exacerbated by Perivascular Adipose Tissue

The NADPH oxidase NOX4 that releases H2O2 can mediate vasoprotective mechanisms under pathophysiological conditions in conductive arteries. However, the role of NOX4 in resistance arteries and in perivascular adipose tissue is not well understood. We hypothesized that NOX4 is of functional importance in resistance arteries and perivascular adipose tissue under dyslipidemia conditions. We detected elevated NOX4 expression in murine and human vessels under dyslipidemia. Diminishing Nox4 under these conditions led to endothelial dysfunction in resistance arteries. The mesenteric arteries of Nox4-/-/Ldlr-/- mice revealed decreased eNos mRNA expression. Inhibition of eNOS in those vessels did not affect vascular function, while in Ldlr-/- mice endothelial function was significantly altered. Anticontractile properties of perivascular adipose tissue at resistance arteries were diminished in Nox4-/-/Ldlr-/- compared with Ldlr-/- mice. In addition, the presence of perivascular adipose tissue further worsened endothelial dysfunction in mesenteric arteries under dyslipidemia conditions. Perivascular adipose tissue from mesenteric arteries revealed a higher expression of markers of white adipocytes compared to markers of beige/brown adipocytes. Among those white adipocyte markers, leptin was significantly less expressed in perivascular adipose tissue from Nox4-/-/Ldlr-/- mice compared with Ldlr-/- mice. Furthermore, in human perivascular adipose tissue with a profound pattern of white adipocyte marker genes, we detected a correlation of NOX4 and LEP expression. In addition, incubating arterial vessels with leptin induced nitrite release, indicating increased eNOS activity. In humans, a higher expression of leptin in perivascular adipose tissue correlated with eNOS expression in the corresponding left internal mammary artery. In conclusion, vascular function of resistance arteries was dependent on Nox4-derived H2O2, especially under dyslipidemia conditions. Perivascular adipose tissue of the mesenteric arteries with white adipose tissue characteristics further aggravated endothelial function through reduced leptin-eNOS signaling.

Prevalence, characteristics, and risk factors of venous thromboembolism in patients with brain tumor undergoing craniotomy: a meta-analysis

BACKGROUND

Brain tumor patients undergoing craniotomy are significantly associated with the development of venous thromboembolism (VTE), while the contributing factors remains controversial. Our study aimed to investigate the prevalence and risk factors for VTE in postoperational brain tumor patients.

METHODS

We searched the PubMed, Embase, Web of Science, Medline, and Cochrane Library databases from their inception to July 2023. Article selection, data extraction, and study quality assessment were performed independently by two reviewers. Publication bias was assessed using Egger's and Begg's tests. Stata 15.0 software was used for data analysis.

RESULTS

A total of 25 studies were considered, with a total of 49,620 brain tumor individuals. The pooled prevalence of VTE during hospitalization in postoperational brain tumor patients was 9% [95% CI: (0.08, 0.10)]. Moreover, our results demonstrated that patients with VTE were older than those without VTE [mean difference [MD] = 8.14, 95% CI: (4.97, 11.30)]. The following variables were significantly associated with VTE: prior history of VTE [OR = 7.81, 95% CI: (3.62, 16.88)], congestive heart failure [OR = 2.33, 95% CI: (1.08-5.05)], diabetes [OR = 1.87, 95% CI: (1.12-3.10)], hypertension [OR = 1.27, 95% CI: (1.07-1.50)], steroid use [OR = 1.63, 95% CI: (1.41, 1.88)], high white blood cells counts [MD = 0.32, 95% CI: (0.01, 0.63)], and high fibrinogen levels [MD = 0.19, 95% CI: (0.08, 0.30)].

CONCLUSION

This meta-analysis identified risk factors for postoperational VTE in patients with brain tumor, which can serve as a theoretical foundation for medical staff to manage and treat VTE.

TRIAL REGISTRATION

CRD42023357459.

The effects of raspberry consumption on lipid profile and blood pressure in adults: A systematic review and meta-analysis

Research into the effects of raspberry on blood pressure and lipid profiles is inconclusive. This meta-analysis was aimed to determine whether raspberry has beneficial effects in clinical practice and to what extent these effects are associated with blood pressure and lipid profiles. A systematic literature search up to September 2023 was completed in PubMed/Medline, Scopus, and Web of Science, to identify eligible RCTs. Heterogeneity tests of the selected trials were performed using the I 2 statistic. Random effects models were evaluated based on the heterogeneity tests, and pooled data were determined as weighted mean differences with a 95% confidence interval. Eleven randomized controlled trials (with 13 arms) were eligible for this meta-analysis. Our findings revealed that Raspberry consumption had no significant effects on the blood pressure and lipid profile markers, including systolic blood pressure (SBP) (WMD, -0.37 mm Hg; 95%CI: -2.19 to 1.44; p = .68), diastolic blood pressure (DBP) (WMD, -2.14 mm Hg; 95%CI: -4.27 to 0.00; p = .05), total cholesterol (TC) (WMD, -6.83 mg/dL; 95%CI: -15.11 to 1.44; p = .10), triglycerides (TG) (WMD, -5.19 mg/dL: 95%CI: -11.76 to 1.37; p = .12), low-density lipoprotein-cholesterol (LDL-C) (WMD, -5.19 mg/dL; 95%CI: -11.58 to 1.18; p = .11), and high-density lipoprotein-cholesterol (HDL-C) (WMD, 0.82 mg/dL; 95%CI: -1.67 to 3.32; p = .51), compared to control groups. Subgroup analysis showed that raspberry consumption significantly decreased total cholesterol and LDL-C levels in people with elevated TC levels, metabolic syndrome, and andropause symptoms, as well as those older than 35, while the consumption of raspberries led to a significant increase in HDL-C levels in females, obese, under 35, and healthy individuals. Raspberry can improve lipid profile and blood pressure, but it is important to keep in mind that further research is necessary to fully understand the exact mechanism of action and a definite conclusion in this regard.