Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015

Cardiac Troponin I Biosensors: Innovations in Real-Time Diagnosis of Cardiovascular Diseases

Cardiac troponin I (cTnI) is a crucial biological macromolecule found in the contractile apparatus of cardiac myocytes, exclusively expressed in cardiomyocytes. It is released into the bloodstream upon cardiac tissue injury, serving as a vital biomarker for the early detection of various heart diseases. Despite advancements in cTnI diagnostics and cardiovascular disease (CVD) detection, there is an ongoing need for more effective early diagnostic methods and innovative approaches. Current CVD diagnosis often relies on clinical signs and symptoms, supplemented by molecular imaging (MI) or biomarkers associated with CVD. However, challenges remain regarding the reliability, specificity and accuracy of analyses for myocardial infarction, particularly in its early stages. Emerging nanomaterial systems present promising solutions for enhancing diagnostic tools due to their unique physical and chemical properties. Various nanomaterials, such as gold nanoparticles, carbon nanotubes, quantum dots, lipids and polymer nanoparticles, are paving new pathways for cardiac disease detection. The advancements in nanomaterial science offer exciting opportunities for cardiac screening. This article provides a comprehensive overview of these advancements, categorizing research efforts focused on both optical and electrochemical platforms, thereby contributing to the evolution of cardiac screening methodologies and addressing the critical need for reliable early diagnostic solutions.

The burden and trend prediction of ischemic heart disease associated with lead exposure: Insights from the Global Burden of Disease study 2021

AIM

The purpose of this study was to quantify the global burden of ischemic heart disease associated with lead exposure, utilizing data from the Global Burden of Disease (GBD) Study, 2021.

METHODS

Data on the burden of ischemic heart disease (IHD) associated with lead exposure were compiled globally from 1990 to 2021. These data were further stratified by dimensions including gender, age, GBD regions, and countries. Utilizing the Joinpoint regression model, we analyzed long-term trends in the burden of IHD disease associated with lead exposure and derived estimated annual percentage changes (EAPC). For future projections, we used an ARIMA model to predict potential trends in the burden of IHD disease associated with lead exposure over the next decade.

RESULTS

The study's findings reveal that in 2021, there were 590,370 deaths attributed to IHD (95% UI (Uncertainty interval (UI) is derived from the Bayesian school of statistical analysis used in the GBD studies. Unlike the frequency school of thought, which constructs confidence intervals (CI), the Bayesian school of thought views probability as a measure of confidence in an event, and in this approach the actual mean is viewed as a random variable dependent on the data and prior knowledge, with UI indicating that there is a specific probability (e.g., 95%) that the actual mean will fall within the interval.): -83,778 to 1,233,628) and 11,854,661 disability-adjusted life years (DALYs) (95% UI: -1,668,553 to 24,791,275) globally due to lead exposure, reflecting an increasing and then stabilizing trend from 1990 to 2021. Comparative analysis across study regions indicated a higher disease burden for IHD in regions with lower Socio-Demographic Index (SDI) values, contrasting with the lower burden in regions with higher SDI values. Furthermore, IHD mortality and DALYs peak in the 70-80 age cohort, with males exhibiting higher rates compared to females. Decadal projections indicate a downward trend in IHD mortality and DALYs for regions with higher SDI, in contrast to an anticipated upward trend in regions with lower SDI.

CONCLUSION

The global burden of ischemic heart disease associated with lead exposure is increasing, particularly in regions with low SDI values and within the elderly population. Considering the profound threat posed by lead exposure to the global burden of IHD, there is an imperative to consistently reinforce and execute robust prevention strategies to mitigate environmental lead exposure.

Association of epicardial fat volume with the severity of coronary artery disease: a preliminary study on risk prediction of obstructive coronary heart disease

BACKGROUND

We aimed to explore the correlation between epicardial fat volume (EFV) and the severity of coronary atherosclerotic artery disease (CAD), evaluate the predictive value of EFV for obstructive CAD, and provide prediction for the selection of clinical treatment schemes for CAD.

METHODS

A total of 203 patients undergoing chest computed tomography (CT) and Coronary Artery Angiography (CAG) were included in this retrospective study. The severity of coronary stenosis and SYNTAX score were evaluated by CAG images. There were 141 patients in obstructive CAD group which was defined as coronary stenosis severity ≥ 70% and 62 patients in non obstructive CAD group.

RESULTS

Multivariate logistic regression analysis showed that after adjusting for confounding factors, EFV (OR, 1.008; 95% CI, 1.000-1.016; p = 0.039) was an independent risk factor for obstructive CAD. Spearman correlation analysis showed a significant positive correlation between EFV and SYNTAX score, as well as the number of coronary lesions (r = 0.157, p = 0.026; r = 0.231, p = 0.002). The EFV of males was significantly higher than that of females (p < 0.001). EFV was significantly positively correlated with intrathoracic fat volume (IFV) (p < 0.001).

CONCLUSIONS

EFV maybe an independent risk factor for obstructive CAD. Quantitative measurement of EFV by QCT can predict the severity of CAD. EFV was significantly correlated with IFV, but not with BMI.

CLINICAL TRIAL NUMBER

Not applicable.

SIRT3 Represses Vascular Remodeling via Reducing Mitochondrial Ac-CoA Accumulation in Vascular Smooth Muscle Cells

BACKGROUND

Vascular remodeling characterized by vascular smooth muscle cell (VSMC) phenotypic switching is a key pathological process leading to numerous cardiovascular diseases, often accompanied by a decrease in mitochondrial oxidative phosphorylation. However, whether VSMC mitochondrial homeostasis plays a central role in vascular remodeling remains elusive. In this study, we investigated the role of SIRT3 (sirtuin 3), a deacetylase that maintains mitochondrial homeostasis, in vascular remodeling.

METHODS

We established a VSMC-specific SIRT3 knockout mouse and a VSMC-specific SIRT3 overexpression mouse. Mice were infused with Ang II (angiotensin II) to establish the conventional abdominal aortic aneurysm model and underwent carotid artery ligation to establish the neointima formation model to investigate the role of SIRT3 in vascular remodeling. In vitro, quiescent-state VSMCs were stimulated with PDGF-BB (platelet-derived growth factor type BB) to investigate the direct role of SIRT3 in VSMC phenotypic switching, and the detailed mechanisms were investigated.

RESULTS

The expression and activity of SIRT3 were decreased in the aortas from mice with Ang II-induced abdominal aortic aneurysm or ligation-induced neointima formation. VSMC-specific knockout of SIRT3 exacerbated vascular remodeling, whereas overexpression or activation of SIRT3 in VSMCs displayed therapeutic effect. Moreover, the reduction of SIRT3 was shown to increase the expression level of KLF4, an important transcription factor that orchestrates VSMC phenotypic switching. Mechanistically, SIRT3 repression caused mitochondrial Ac-CoA (acetyl coenzyme A) accumulation that increased acetylated histone 3 lysine 27 levels in the KLF4 gene promoter region. Blockage of mitochondrial Ac-CoA transporting into the cytoplasm by inhibiting ACLY (ATP-citrate lyase) also inhibited VSMC phenotypic switching and thus attenuated vascular remodeling even when SIRT3 was knocked down.

CONCLUSIONS

This study provides evidence that mitochondrial dysfunction induced by SIRT3 inhibition is a major factor leading to VSMC phenotypic switching and vascular remodeling. Restoration of mitochondrial function and inhibition of mitochondrial Ac-CoA accumulation by activation of SIRT3 may help to treat remodeling-related cardiovascular damage.

Global Burden of Cardiovascular Disease Attributable to Sugar-Sweetened Beverages in Middle-Aged Adults: An Age-Period-Cohort Modelling Study

BACKGROUND

Cardiovascular disease (CVD) presents a significant burden among middle-aged adults (aged 35-64). Diet high in sugar-sweetened beverages is a notable CVD risk factor.

METHODS

Using Global Burden of Disease data from 1990 to 2019, age-standardized rates (ASRs) and average annual percentage change of ASRs were used to describe this burden and its changing trend.

RESULTS

In 2019, global CVD-related ASR (per 100 000) of deaths attributable to sugar-sweetened beverages in middle-aged adults reached 1.91 (95% uncertainty interval [UI], 1.07-2.63) compared with 2.75 (95% UI, 1.76-3.59) in 1990. The global ASR of disability-adjusted life years (DALYs) reached 69.71 in 2019 (95% UI, 38.38-96.36) compared with 97.98 (95% UI, 62.29-128.39) in 1990. Men had more than twice the deaths and DALYs as women. Low and low-middle sociodemographic index regions exhibited a higher burden of DALYs and deaths. In 2019, India and China had the highest numbers of deaths and DALYs and the Solomon Islands and Afghanistan recorded the highest ASRs of deaths and DALYs. A negative linear correlation was observed between sociodemographic index and ASRs of deaths (R=-0.10, P=0.010) and DALYs (R=-0.09, P=0.031) across 21 Global Burden of Disease regions. An inequalities analysis indicated that DALYs due to CVD were disproportionately higher in countries with lower sociodemographic index in 2019 (concentration index of inequality=-0.05 [95% CI, -0.1 to -0.01]).

CONCLUSIONS

Globally, sugar-sweetened beverages have contributed to a substantial increase in DALYs and deaths related to CVD in middle-aged adults over the past 30 years, especially among men and in low sociodemographic index countries.

Cardiovascular disease in adolescents and young adults in Mexico: Secondary analysis of the 2021 global burden of disease study

BACKGROUND AND AIMS

To analyse the burden of young-onset cardiovascular disease (CVD) in Mexico for the years 1990 and 2021, as well as trends from 1990 to 2021, and to evaluate its association with the sociodemographic index (SDI) and the Healthcare Access and Quality Index (HAQI).

METHODS

A secondary analysis of data from the Global Burden of Disease (GBD) study was conducted, stratified by sex, age groups, states, and CVD subcauses. Metrics included mortality, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY).

RESULTS

There was an increase in age-standardized young-onset CVD DALY rates in men and a decrease in women. The leading causes of young-onset CVD deaths were ischemic heart disease, and stroke. Males showed a higher burden for all CVD causes, except for rheumatic heart disease and pulmonary arterial hypertension. The burden of premature mortality was higher in men, while disability was more pronounced in women. Complex associations were observed between SDI, HAQI, and CVD burden, highlighting a heterogeneous situation among Mexican states.

CONCLUSIONS

Recognizing the unique cardiovascular profiles of young men and women and effectively engaging them in healthcare systems may lead to targeted interventions that reduce risk factors, improve health outcomes, and further decrease the burden of young-onset CVD in Mexico.

Serum midkine level and its association with subclinical coronary artery calcification and carotid atherosclerosis in chronic kidney disease

BACKGROUND

There are no studies investigating the role of midkine (MK) in vascular calcification (VC) or vascular disease associated with chronic kidney disease (CKD). This study assessed serum MK level and investigated its relationship with carotid atherosclerosis and coronary artery calcification (CAC) in non-dialysis CKD.

METHODS

The study comprised 80 controls and 185 adult patients with CKD at stages 3-5 who were free of cardiovascular diseases. Acute renal failure, chronic hemodialysis, severe liver disease, inflammatory states, anticoagulation therapy and cancer were excluded. The patients were classified based on presence of CAC score into severe and mild to moderate CAC groups. They were also divided into atherosclerotic and non-atherosclerotic groups based on carotid atherosclerosis. CBC, kidney function tests, lipid profile, intact parathyroid hormone (iPTH), and phosphorus were assessed. Serum levels of MK, tumor necrosis factor- α (TNF- α), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) were quantitatively tested using ELISA. Cardiac CT scan was done to calculate CAC score. Carotid ultrasonography was used to evaluate carotid intima media thickness (CIMT) and identify plaques.

RESULTS

All CKD categories, including CKD-3, CKD-4, and CKD-5, showed higher rates of carotid plaques (p = 0.007, p < 0.001, and p < 0.001, respectively), higher levels of MK (p < 0.001 for each), and higher CAC scores (p < 0.001 for each) as CKD worsened. Compared to mild to moderate CAC patients, severe CAC patients showed increased CIMT (p < 0.001) and raised serum levels of MK (p < 0.001), TNF-α (p = 0.001), IL-6 (p = 0.002), hs-CRP (p = 0.003), iPTH (p = 0.02), phosphorus (p < 0.001), total cholesterol (TC), and low density lipoprotein-cholesterol (LDL-C). Multivariate linear regression revealed that CAC was reliably predicted by MK (p = 0.008) and serum creatinine (p = 0.001). Carotid atherosclerotic patients had higher serum levels of MK, TNF-α, IL-6, hs-CRP, iPTH, phosphorus, TC, total triglycerides and LDL-C (p < 0.001 for each). Multivariate logistic regression showed that serum MK (p = 0.001), serum creatinine (p = 0.005), age (p < 0.001), iPTH (p = 0.007), and IL-6 (p = 0.024) were significant predictors of carotid atherosclerosis.

CONCLUSIONS

As CKD worsened, MK levels, carotid atherosclerosis and CAC increased. Serum MK was a reliable biomarker for asymptomatic carotid atherosclerosis and CAC in non-dialysis CKD, allowing prompt early diagnosis to avert cardiovascular morbidity and death in the future.

TRIAL REGISTRATION

The trial number was 1138 and its registration was approved by the hospital's Research Ethics Committee in 4/2024.

The burden of common neurological disorders in Asia: insights from the Global Burden of Disease Study (1990-2021)

BACKGROUND

Neurological disorders represent a significant global health issue, leading to severe cognitive impairments and being a major cause of premature mortality and disability. This study aims to utilize data from the Global Burden of Disease (GBD) research website to assess the burden of neurological disorders in the Asian region and its individual countries and territory from 1990 to 2021, with the goal of providing reference for global efforts and decision-making in the prevention, treatment, and management of neurological disorders.

METHODS

Based on the Global Burden of Disease data, this study assessed the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of 13 neurological disorders in the Asian region from 1990 to 2021. The epidemiological characteristics of neurological disorders across these Asian regions were analyzed. Joinpoint regression analysis was employed to assess the temporal patterns of the burden of neurological disorders, and the average annual percent change (AAPC) was calculated to determine the overall trend throughout the study period.

RESULTS

In 2021, stroke, migraine, and Alzheimer's disease and other dementias emerged as the primary contributors to neurological burden in Asia, with stroke accounting for 112.87 million disability-adjusted life years (DALYs), followed by migraine (25.4 million) and Alzheimer's disease and other dementias (20.0 million). Stroke was also the leading cause of neurological mortality (5.03 million deaths), trailed by Alzheimer's disease and other dementias (1.0 million). Stroke, migraine, and tension-type headache had the highest prevalence rates among neurological disorders, with 57.3 million, 683.5 million, and 1130.2 million. Temporal trends from 1990 to 2021 revealed a significant decline in age-standardized DALY rates for stroke (estimated annual percentage change [EAPC]: - 1.65%), though absolute DALYs increased (EAPC: 0.06%). In contrast, Alzheimer's disease and other dementias exhibited rising age-standardized (EAPC: 0.14%) and absolute DALYs (EAPC: 2.8%), while infectious neurological diseases (e.g., meningitis, tetanus) demonstrated marked reductions in burden. Sex-specific disparities were evident, with males experiencing a higher total DALY burden (84.8 million vs. 77.05 million), driven by stroke and Parkinson's disease, whereas Alzheimer's disease and other dementias and migraine disproportionately affected females. Geographically, stroke dominated Southeast Asia (67.6% of regional DALYs), while migraine contributed most substantially to West Asia (16%). Nationally, stroke ranked as the leading cause of neurological DALYs in most Asian countries, contrasting with migraine in Israel, Kuwait, Qatar, and the United Arab Emirates. Longitudinal analyses highlighted accelerated declines in stroke DALYs post- 2004 but escalating burdens for Alzheimer's disease and other dementias after 2019, reflecting divergent epidemiological trajectories.

CONCLUSIONS

In 2021, the burden of neurological disorders in Asia remained substantial, with stroke, migraine, and Alzheimer's disease and other dementias being the top three contributors to DALYs. The study also revealed significant differences in the burden of neurological disorders across various subregions and countries in Asia, highlighting the need for enhanced international collaboration, sharing of best practices, provision of technical support, and optimization of healthcare resource allocation.

Combining Experimental Validation and Network Pharmacology to Reveal the Action Mechanism of Panax Notoginseng-Radix Salviae on Atherosclerosis

Purpose

Few studies have evaluated the mechanisms of the specific efficacy of Panax notoginseng-Radix Salviae couplet medicines (PN-RS) in the treatment of atherosclerosis (AS). This study aims to explore the potential bioactive ingredients and molecular mechanisms of PN-RS in the treatment of AS.

Materials and Methods

C57BL/6J mice were fed a common diet as the control group. ApoE-/- mice were randomly divided into the model, PN-RS treatment (0.75 mgPN+3.75 mgRS/g/day via gavage), and positive drug groups (rosuvastatin, 1.25 mg/kg/day via gavage). After two months of drugs intervention, H&E and Masson staining, the serum lipid concentration and atherosclerotic index were conducted to verify the PN-RS efficacy. Network pharmacology analysis was carried out to identify the pathways and targets of PN-RS. The signaling pathway-related targets and cytokines were tested via enzyme-linked immunosorbent assay (ELISA), Western blotting and real-time polymerase chain reaction (PCR).

Results

Network pharmacology analysis identified the JAK2-STAT3 signaling pathway as a key pathway through which PN-RS exerts its therapeutic effects. Results from animal experiments demonstrated that PN-RS significantly reduced the atherosclerotic lesion area and decreased serum levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and atherogenic index (AI). Mechanistic studies further revealed that PN-RS inhibited the JAK2-STAT3 signaling pathway and reduced the concentrations of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), and monocyte chemoattractant protein-1 (MCP-1).

Conclusion

These findings suggest that PN-RS could be a promising treatment for atherosclerosis, applicable across diverse populations. Future research should investigate its efficacy in various demographic groups and in combination with other therapies.

The m7G methylation modification: An emerging player of cardiovascular diseases

Cardiovascular diseases severely endanger human health and are closely associated with epigenetic dysregulation. N7-methylguanosine (m7G), one of the common epigenetic modifications, is present in many different types of RNA molecules and has attracted significant attention due to its impact on various physiological and pathological processes. Recent studies have demonstrated that m7G methylation plays an important role in the occurrence and development of multiple cardiovascular diseases. Application of small molecule inhibitors to target m7G modification mediated by methyltransferase-like protein 1 (METTL1) has shown potentiality in the treatment of cardiovascular diseases. In this review, we summarize the basic knowledge about m7G modification and discuss its role and therapeutic potential in diverse cardiovascular diseases, aiming to provide a theoretical foundation for future research and therapeutic intervention.

Usefulness of the CDC/AAP and the EFP/AAP Criteria to Detect Subclinical Atherosclerosis in Subjects with Diabetes and Severe Periodontal Disease

Background/Objectives: Periodontitis is an inflammatory disease associated with many systemic disorders such as diabetes and cardiovascular disease. The aim was to evaluate the usefulness of the CDC/AAP and the EFP/AAP criteria to detect subclinical atherosclerosis in subjects with diabetes and severe periodontal disease. Methods: This was a cross-sectional study. Atheroma plaque was evaluated by high-resolution carotid and femoral ultrasonography. A dental examination protocol was implemented by a trained periodontist. A full-mouth periodontal clinical examination was carried out at six sites by automated computerized Florida Probe Periodontal Probing. Periodontal disease was defined by CDC/AAP and EFP/AAP criteria. Results: In total, 98 patients were included (60.2% women), of which 50% had diabetes. Subjects with diabetes showed a high prevalence of severe cases of periodontal disease. Both criteria were useful to detect the presence of atheroma plaque only in the presence of diabetes. However, the CDC/AAP criteria had higher correlation with atheroma plaques than EFP/AAP criteria (r = 0.522 vs. r = 0.369, p < 0.001). Conclusions: The CDC/AAP and the EFP/AAP criteria are a useful tool to identify subclinical atherosclerosis in subjects with severe periodontal disease and diabetes. These results show the potential role of the oral healthcare team in the dental office for the identification of subjects with diabetes at risk of developing cardiovascular disease.

The 14-year cumulative genetic high blood pressure and risk of type 2 diabetes in Korean: observational and Mendelian randomization evidence

This study aims to evaluate the causal association of blood pressure (BP) with type 2 diabetes (T2D) and assess the cumulative effect of genetic predisposition of high BP or glycemic for future clinical in Korea. To assess the bidirectional causal association between fasting blood sugar (FBS) and systolic blood pressure (SBP) in the large biobank, five MR methods (a 2-stage least squares (2SLS) regression, inverse-variance weighted (IVW), 2 median-based (simple and weighted) and MR-Egger) were applied using the weighted genetic risk score (wGRS). A bidirectional causality was found in all five methods, and there was no horizontal pleiotropy. Using the 2SLS regression method, genetically determined 10 mm/Hg elevation of SBP caused an increased 0.63 mmol/L FBS (p < 0.0001). Men had a particularly strong bidirectional causal relationship. Distinct predicted trajectories based on genetically determined SBP and FBS levels were identified using group-based trajectory modeling (GBTM). To assess the risk of subsequent hypertension or T2D in each trajectory, the Cox proportional hazard model, and adjusted covariates (including wGRS) were conducted. An uncontrol predicted SBP pattern (fluctuated plot) had a higher risk of subsequence T2D than a control-predicted pattern (HR: 1.25, 95% CI: 1.00-1.58). In the Korean middle-aged, it was significantly demonstrated that there is a bidirectional causality between high BP and T2D, which is different from previous studies in Europe. Specially, cumulative high blood pressure predisposition by the genetic variants may affect to risk of T2D incidence. Prevention of high BP must be followed in lifespan.

Comorbidities and the management of hypertensive heart disease in a low-resource setting: a cross-sectional study

Background

Low-and middle-income countries account for over 80% of the global burden of cardiovascular disease (CVD). The Sub-Saharan African region is the most affected by CVD. Hypertensive Heart Disease (HHD) is a common complication of hypertension which is prevalent in the Democratic Republic of Congo (DRC). Our study aimed to identify the comorbidities associated with and the management of HHD in the DRC.

Materials and methods

This cross-sectional analysis was done at a 200-bed tertiary hospital in Kinshasa, DRC from January to December 2019. Data were collected retrospectively from patient records and missing values were generated by multiple imputations and the pooled values were used for data analysis. Bivariate and multiple correlation regression were used and odds ratios were generated.

Results

34 (56.7%) of the 60 patients were male. The mean age was 63.2 ± 9.7 years, the mean BMI was 25.5 ± 5.0 kg/m2, and 90.0% of patients were unemployed. Patients had dyslipidemia (43.3%), stroke (31.7%), and diabetes (10.0%). Mean serum creatinine (1.4 ± 0.1 mg/dL), HDL (56.7 ± 18.4 mg/dL), LDL (119.3 ± 30.5 mg/dL), and median urea (24.0, IQR: 63.5 mg/dL) levels were abnormal. HDL was a predictor of high blood pressure (P < 0.01). 83.3% of patients took statins, 78.3% took ACE inhibitors, and 70.0% took aspirin.

Conclusion

Congolese HHD patients have multiple comorbidities. Efforts should be focused on increasing access to care through early diagnosis, early referral, and low-resource appropriate management.

How do environmental and operational factors impact particulate matter dynamics in building construction? - Insights from real-time sensing

Construction activities are major contributors to particulate matter (PM) pollution, posing significant risks to workers and nearby populations. However, PM mitigation strategies in the complex nature of construction environments remain underexplored, with limited understanding of how environmental and operational factors jointly influence PM dynamics in real-world settings. This study employs high-resolution real-time monitoring to investigate PM1, PM2.5, and PM10 interactions within an active construction site, focusing on the roles of environmental and operational drivers. Over 28,000 measurements were collected from construction zones, complemented by external reference points. The findings reveal that smaller particles (PM1 and PM2.5) serve as critical intermediaries influencing larger particles (PM10). PM10 concentrations peaked at 1763.37 μg/m3, far exceeding regulatory thresholds. Temperature influenced PM10 primarily through its effect on PM2.5 (57 %), while construction scenarios had 72 % of their impact on PM10 mediated via PM2.5. Distinct PM relationships emerged based on activity types and worker proximity to sensors, with hazardous PM levels persisting in 81.61 % of low-activity periods, highlighting the risks of residual exposure even without active construction. This study underscores the importance of on-site, multi-indicator monitoring systems to capture dynamic PM variations and identify high-risk scenarios. By providing a detailed understanding of PM interactions in active construction settings, these findings offer a robust foundation for developing targeted mitigation strategies and advancing air quality management in construction environments.

LIFU-unlocked endogenous H2S generation for enhancing atherosclerosis-specific gas-enzymatic therapy

Atherosclerotic plaques, which are characterized by endothelial oxidative stress, lipid metabolism disorders and persistent inflammation, can induce serious cardiovascular diseases. However, the pharmacotherapies currently used to treat atherosclerosis (AS), such as lipid-lowering and antithrombotic drugs, can regulate only a single pathological feature of AS, and there is still a dearth of integrated platforms for the multifaceted regulation of AS progression. Herein, we developed a synergistic combination of endogenous H2S gas therapy with a multienzyme-like nanozyme (named LyP-1Lip@HS) for the treatment of AS. The high affinity of the LyP-1 peptide for macrophages and foam cells within plaques allows LyP-1Lip@HS to actively target atherosclerotic lesions. After cavitation was induced by low-intensity focused ultrasound (LIFU), the lipid membrane of LyP-1Lip@HS was disrupted, thereby "unlocking" the enzyme-like activity of hollow mesoporous Prussian blue (HMPB) and facilitating the release of the endogenous H2S donor S-allyl-L-cysteine (SAC). Notably, H2S endogenously generated by enzymatic catalysis plays multiple roles, upregulating the ATP-binding cassette transporter A1 in foam cells to increase lipid efflux and promote the conversion of M1 macrophages to M2 macrophages. Moreover, the high level of reactive oxygen species in the inflammatory microenvironment of the plaque was mitigated. Overall, LyP-1Lip@HS provides a specific and controlled treatment to prevent oxidative stress, inflammation and lipid metabolism disorders, making it a candidate for AS treatment.

Hyperactive mTORC1/4EBP1 signaling dysregulates proteostasis and accelerates cardiac aging

The mechanistic target of rapamycin complex 1 (mTORC1) has a major impact on aging by regulation of proteostasis. It is well established that mTORC1 signaling is hyperactivated with aging and age-related diseases. Previous studies have shown that partial inhibition of mTOR signaling by rapamycin reverses age-related deteriorations in cardiac function and structure in old mice. However, the downstream signaling pathways involved in this protection against cardiac aging have not been established. mTORC1 phosphorylates 4E-binding protein 1 (4EBP1) to promote the initiation of cap-dependent translation. The objective of this project is to examine the role of the mTORC1/4EBP1 axis in age-related cardiac dysfunction. We used a whole-body 4EBP1 KO mouse model, which mimics a hyperactive mTORC1/4EBP1/eIF4E axis, to investigate the effects of hyperactive mTORC1/4EBP1 axis in cardiac aging. Echocardiographic measurements of middle-aged 4EBP1 KO mice show impaired diastolic function and myocardial performance compared to age-matched WT mice and these parameters are at similar levels as old WT mice, suggesting that 4EBP1 KO mice experience accelerated cardiac aging. Old 4EBP1 KO mice show further decline in systolic and diastolic function compared to middle-aged counterparts and have worse systolic and diastolic function than age-matched WT mice. Gene expression levels of heart failure markers are not different between 4EBP1 KO and WT hearts. However, ribosomal biogenesis and protein ubiquitination are significantly increased in 4EBP1 KO hearts when compared to WT controls, suggesting dysregulated proteostasis in 4EBP1 KO hearts. Together, these results show that a hyperactive mTORC1/4EBP1 axis accelerates cardiac aging, potentially by dysregulating proteostasis.

Dysregulated cholesterol uptake and efflux of bone marrow-derived α-SMA+ macrophages contribute to atherosclerotic plaque formation

Macrophages play differential roles in the pathogenesis of atherosclerosis due to their different phenotypes. Although α-SMA+ macrophages have been found to present in bone marrow and atherosclerotic plaques, their role in atherosclerosis remains unclear. By performing partial carotid ligation (PCL) on monocyte/macrophage lineage-tracked mice, we observed bone marrow-derived α-SMA+ macrophages in the subendothelium and atherosclerotic plaques under disturbed flow conditions. The functional role of α-SMA+ macrophages in atherosclerotic plaque formation was examined using macrophage-specific Acta2 knockout (Acta2MKO) mice generated by crossing Acta2f/f transgenic mice with LysM-Cre mice. The size of the aortic plaques was 77.43% smaller in Acta2MKO mice than in Acta2f/f mice following adeno-associated virus-mutant PCSK9 injection and high-fat diet (HFD) feeding for 12 weeks. A significant reduction in lipid deposition, macrophage infiltration and the α-SMA+ area was observed in the aortic roots of Acta2MKO mice compared with Acta2f/f mice. Mechanistically, using Acta2-overexpressing Raw264.7 cells (Acta2hi cells) and bone marrow-derived macrophages (BMDMs) from Acta2MKO mice (Acta2MKO BMDMs), we showed that macrophage α-SMA increased the expression of the scavenger receptor SR-A, induced Ox-LDL binding and uptake, and reduced the level of the cholesterol transporter ABCA1, potentially via the AKT pathway. Together, our results indicate that bone marrow-derived α-SMA+ macrophages contribute to atherosclerotic plaque formation due to dysregulated cholesterol uptake and efflux, providing potential targets for the prevention and treatment of atherosclerosis.

Associations between short-term exposure to fine particulate matter with ischemic stroke mortality and the role of green space: a time-series study in Zibo, China

Background

Previous studies on associations between short-term exposure to fine particulate matter (PM2.5) and ischemic stroke (IS) mortality reported inconclusive results. Additionally, whether and how PM2.5 and green space interact to precipitate IS deaths remains unclear. We aimed to examine the impacts of short-term exposure to PM2.5 on IS mortality and the role of green space in the association.

Methods

We collected data on daily IS deaths, daily PM2.5 concentrations, and monthly normalized difference vegetation index (NDVI) in Zibo City from 2015 to 2019. Generalised additive models were adopted to investigate the short-term impacts of PM2.5 on IS mortality, and subgroup analyses were used to examine effect modification by population characteristics. Stratified analyses by green space levels and joint effect model were conducted to test the interactions of PM2.5 and green space on IS mortality.

Results

A total of 10 799 IS deaths were included in our study. Exposure to PM2.5 was associated with an increased risk of IS mortality, with odds ratios (ORs) of 1.0263 (95% confidence interval (CI) = 1.0017, 1.0516) for each interquartile range (IQR) increase in PM2.5 on lag0 and 1.0317 (95% CI = 1.0016, 1.0627) on lag01. The links between PM2.5 and IS mortality were not significantly different across genders, ages, or PM2.5 zones. Furthermore, our results showed that the effects of PM2.5 on IS mortality were higher in low levels of green space. Specifically, for each IQR increase in PM2.5, the ORs (95% CIs) of IS death in the low level and the high level of NDVI were 1.0287 (95% CI = 1.0019, 1.0563) and 0.9934 (95% CI = 0.9296, 1.0615), respectively. In addition, PM2.5 and NDVI exhibited significant interactive effects on IS mortality, with relative excess odds due to interaction (REOI) of greater than 0.

Conclusions

Our findings showed that PM2.5 was significantly associated with increasing odds of IS mortality. Furthermore, there were synergetic impacts between PM2.5 and lack of greenness on IS mortality. Our results suggest that expanding green spaces, such as increasing park coverage and street greening, along with regulating industrial emissions to reduce PM2.5 levels, can help prevent premature deaths from IS.

Immunotherapy and vaccine-based approaches for atherosclerosis prevention: a systematic review study

INTRODUCTION

Cardiovascular disease is a major global health issue, and atherosclerosis is a leading cause of cardiovascular conditions. Traditional approaches for managing atherosclerosis have limitations, creating a need for alternative preventive strategies such as vaccines.

METHODS

The authors conducted a systematic review following Cochrane Handbook and PRISMA guidelines. They searched multiple databases for studies on preventive vaccines against atherosclerosis, including clinical trials and experimental models. The search period was from 1950 to August 2024.

RESULTS

After screening and evaluation, 47 studies were included in the systematic review. The studies investigated various vaccine candidates and immunization strategies. Vaccination goals involve targeting proteins that are found in higher quantities in individuals with atherosclerosis, such as oxidized low-density lipoprotein (LDL), apolipoprotein B-100, proprotein convertase subtilisin/kexin type-9 serine protease (PCSK9), cholesteryl ester transfer protein (CETP), and heat shock proteins HSP60 and HSP65. The review highlights the potential of vaccines in preventing atherosclerosis by targeting specific antigens, modulating lipoprotein metabolism, and enhancing immune responses. Promising approaches included PCSK9 inhibitors, virus-like particle (VLP)-based vaccines, and gene-editing techniques. Monoclonal antibodies like alirocumab, designed to inhibit PCSK9, were also effective in reducing LDL cholesterol levels.

CONCLUSION

This systematic review provides insights into the progress, challenges, and future directions of preventive vaccine research against atherosclerosis. The findings support the development of effective vaccines to complement existing preventive strategies and reduce the global burden of cardiovascular diseases.

CLINICAL TRIAL NUMBER

It is not applicable.

Rural-urban disparities in mortality of patients with acute myocardial infarction and heart failure: a systematic review and meta-analysis

AIMS

Patients with cardiac disease living in rural areas may face significant challenges in accessing care, and studies suggest that living in rural areas may be associated with worse outcomes. However, it is unclear whether rural-urban disparities have an impact on mortality in patients presenting with acute myocardial infarction (AMI) and heart failure (HF). This meta-analysis aimed to assess differences in mortality between rural and urban patients presenting with AMI and HF.

METHODS AND RESULTS

A systematic search of the literature was performed using PubMed, Embase, MEDLINE, and CENTRAL for all studies published until 16 January 2024. A grey literature search was also performed using a manual web search. The following inclusion criteria were applied: (i) studies must compare rural patients to urban patients presenting to hospital with AMI or HF, and (ii) studies must report on mortality. The primary outcome was all-cause mortality. Comprehensive data were extracted including study design, patient characteristics (sex, age, and comorbidities), sample size, follow-up period, and outcomes. Odds ratios (ORs) were pooled with fixed-effects model. A subgroup analysis was performed to investigate causes for heterogeneity in which studies were separated based on in-hospital mortality, post-discharge mortality, and region of origin including North America, Europe, Asia, and Australia. In total, 37 studies were included (29 retrospective studies, 4 cross-sectional studies, and 4 prospective cohort studies) in our meta-analysis: 24 studies for AMI, 11 studies for HF, and 2 studies for both AMI and HF. This included a total of 21 107 886 patients with AMI (2 230 264 of which were in rural regions) and 18 434 270 patients with HF (2 655 469 of which were in rural regions). Rural patients with AMI had similar age (mean age 69.8 ± 5.7; vs. 67.5 ± 5.1) and were more likely to be female (43.2% vs. 38.5%) compared to urban patients. Rural patients with HF had similar age (mean age 77.1 ± 4.4 vs. 76.5 ± 4.2) and were more likely to be female (56.4% vs. 49.5%) compared to urban patients. The range of follow-up for the AMI cohort was 0 days to 24 months, and the range of follow-up for the HF cohort was 0 days to 24 months. Compared with urban patients, rural patients with AMI had higher mortality rate at follow-up [15.5% vs. 13.4%; OR 1.18, 95% confidence interval (CI), 1.13-1.24; I2 = 97%]. Compared with urban patients, rural patients with HF had higher mortality rate at follow-up (12.3% vs. 11.6%; OR 1.11, 95% CI, 1.11-1.12; I2 = 98%).

CONCLUSION

To our knowledge, this is the first systematic review and meta-analysis assessing mortality differences between rural and urban patients presenting with AMI and HF. We found that patients living in rural areas had an increased risk of mortality when compared to patients in urban areas. Clinical and policy efforts are required to reduce these disparities.

LAY SUMMARY

A total of 37 studies were included in our meta-analysis, involving over 39.5 million patients, and found higher mortality rates in rural patients with AMI and HF compared to those in urban areas. Clinical and policy efforts should focus on improving access to care and outcomes to reduce disparities between rural and urban areas.

Association between exposure to volatile organic compounds and atherogenic index of plasma in NHANES 2011-2018

Volatile organic compounds (VOCs) are prevalent in daily life, yet the relationship between VOCs exposure and the atherogenic index of plasma (AIP) remains inadequately explored, especially in populations with high levels of exposure. This study aims to investigate the non-linear association between VOCs exposure and AIP in the U.S. adult population. Data from the National Health and Nutrition Examination Survey (NHANES) collected between 2011 and 2018 were analyzed. A range of statistical techniques, including Spearman's correlation analysis, weighted quantile sum (WQS), multivariate logistic regression, restricted cubic splines (RCS), stratified threshold models, and bayesian kernel machine regression (BKMR), were systematically employed to assess the relationship between high-dose VOCs exposure and AIP in U.S. adults. The study included 6,027 participants, with an average age of 37 (18-59), and 50.46% were male. Of these, 3,011 had elevated AIP levels. The Mann-Whitney U test compared VOCs exposure across quartiles (Q1-Q4). Spearman models revealed strong joint exposure effects between VOCs like IPMA3 and HMPMA (ρ = 0.97). WQS regression showed a positive association between VOCs and total cholesterol (TC) (β = 5.45, 95% CI = 5.42-5.58, P = 0.04) and high-density lipoprotein cholesterol (HDL-C) (β = 1.07, 95% CI = 1.03-1.10, P = 0.02). After adjusting for confounders, logistic regression revealed that VOCs such as 3-4MHA, 34DMA, AAMA, ATCA, CYMA, HEMA, and SBMA were linked to higher AIP. RCS analysis indicated a nonlinear association between VOCs and AIP. Stratified modeling found that ATCA was significantly and positively associated with AIP (OR = 1.60, 95% CI = 1.20-2.14, p < 0.01), and that when ATCA levels exceeded 128.60 ng/mL, there was a 60% increased risk of elevated AIP. Higher urinary VOCs levels, particularly ATCA, are significantly associated with increased AIP, offering new insights into the potential link between VOCs exposure and cardiovascular disease.

Unlocking the Potential of MicroRNA Expression: Biomarkers for Platelet Reactivity and Coronary Artery Disease

Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, with platelet reactivity playing a central role in its pathogenesis. Recent research has identified microRNAs (miRNAs; miRs) as potential biomarkers for CAD, due to their ability to regulate platelet function and reactivity. This review focuses on four key miRNAs-miR-223, miR-126, miR-21, and miR-150-known to influence platelet reactivity and their implications in CAD. miR-223, which is highly expressed in platelets, has shown associations with CAD and myocardial infarction, while miR-126 has been linked to thrombus formation and vascular health. Additionally, miR-21 and miR-150 have also emerged as important players, with roles in platelet reactivity and cardiovascular outcomes. However, despite their potential, the use of miRNAs as clinical biomarkers faces several challenges, including variability in reported results across studies. These inconsistencies often arise from differences in sample material, preanalytical conditions, and normalization strategies. Furthermore, the influence of antiplatelet therapy on miRNA expression adds another layer of complexity, making it difficult to determine whether observed changes in miRNA levels are due to disease states or therapeutic interventions. This review therefore highlights the need for standardization in miRNA research to enhance the reliability of findings. By addressing these methodological challenges, miRNAs could become powerful tools in personalized medicine, aiding in the development of tailored therapeutic strategies for CAD patients and ultimately improving clinical outcomes.

Recent Progress in Developing Extracellular Vesicles as Nanovehicles to Deliver Carbohydrate-Based Therapeutics and Vaccines

Cell-derived, nanoscale extracellular vesicles (EVs) have emerged as promising tools in diagnostic, therapeutic, and vaccine applications. Their unique properties including the capability to encapsulate diverse molecular cargo as well as the versatility in surface functionalization make them ideal candidates for safe and effective vehicles to deliver a range of biomolecules including gene editing cassettes, therapeutic proteins, glycans, and glycoconjugate vaccines. In this review, we discuss recent advances in the development of EVs derived from mammalian and bacterial cells for use in a delivery of carbohydrate-based protein therapeutics and vaccines. We highlight key innovations in EVs' molecular design, characterization, and deployment for treating diseases including Alzheimer's disease, infectious diseases, and cancers. We discuss challenges for their clinical translation and provide perspectives for future development of EVs within biopharmaceutical research and the clinical translation landscape.

Establishment and validation of post-PCI nomogram in elderly patients with acute coronary syndromes

Objective

The objective of this study was to create and validate a clinical prediction model for the incidence of major adverse cardiovascular events (MACE) within one year after percutaneous coronary intervention (PCI) in elderly patients diagnosed with acute coronary syndromes (ACS).

Methods

The study will use 70% of the 738 patients for model training and the remaining 30% for model validation. The feature recursive elimination algorithm (RFE) and the least absolute shrinkage selection operator (LASSO) regression technique will be used to identify the best combination of features. We compare the clinical prediction model we constructed with GRACE in terms of discrimination, calibration, recall, and clinical impact.

Results

We used the RFE and LASSO regression technique to select 8 key variables from 44 candidates for our predictive model. The predictive model was found to have a good fit based on the Hosmer-Lemeshow test results (χ 2 = 6.245). Additionally, the Brier score of the clinical prediction model was 0.1502, confirming its accuracy. When comparing our clinical prediction model to the widely used GRACE scoring system, the results showed that our model had slightly better predictive efficacy for the dataset involved in this study. The NRI was 0.6166, NRI + was 0.2262, NRI- was 0.3904, and IDI was 0.1272, with a P value of <0.001. The validation set's AUC was 0.787, indicating the prediction model has high differentiation and discriminative ability.

Conclusion

This model assists in the early identification of the risk of MACE within one year after PCI for ACS in elderly patients.

Time trends in coronary heart disease mortality attributed to outdoor PM2.5 in China: an age-period-cohort analysis using the Global Burden of Disease Study 2019

Background

In China, coronary heart disease (CHD) is a significant public health issue affecting the population's health. Evidence suggests that outdoor PM2.5 is a crucial environmental risk factor for CHD mortality. This study aims to provide scientific evidence for the prevention and treatment of CHD by analyzing the trend of CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019.

Methods

Data were obtained from the Global Burden of Disease Study (GBD) 2019. CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019 was extracted from the GBD Data tool. We used an age-period-cohort (APC) model based on the intrinsic estimator (IE) algorithm to decompose the age, period, and cohort effects related to CHD mortality attributed to outdoor PM2.5.

Results

From 1994 to 2019, the crude mortality rates (CMRs) and age-standardized mortality rates (ASMRs) of CHD attributed to outdoor PM2.5 in China showed an overall upward trend. The APC model analysis showed that the relative risk of CHD mortality attributed to outdoor PM2.5 increased exponentially with age, reaching 89.284 (95% CI: 48.669, 163.793) in the 90-95 age group. The period effect increased monotonically, with a relative risk of 3.699 (95% CI: 3.639, 3.760) in 2019. The cohort effect decreased monotonically, with the lowest relative risk of CHD mortality attributed to outdoor PM2.5 in residents born between 1990 and 1994, at 0.135 (95% CI: 0.031, 0.588).

Conclusion

The older adult, a high-risk population, should receive more attention. In the future, continuous efforts should be made to strengthen environmental air pollution control and implement targeted health interventions to reduce the impact of outdoor PM2.5 on CHD mortality.

Advances and Prospects in Using Induced Pluripotent Stem Cells for 3D Bioprinting in Cardiac Tissue Engineering

Background

Cardiovascular diseases remain one of the leading causes of death worldwide. Given the limited self-repair capacity of cardiac tissue, cardiac tissue engineering (CTE) aims to develop strategies and materials for repairing or replacing damaged cardiac tissue by combining biology, medicine, and engineering. Indeed, CTE has made significant strides since the discovery of induced pluripotent stem cells (iPSCs) in 2006, including creating cardiac patches, organoids, and chip models derived from iPSCs, thus offering new strategies for treating cardiac diseases.

Methods

A systematic search for relevant literature published between 2003 and 2024 was conducted in the PubMed and Web of Science databases using "Cardiac Tissue Engineering", "3D Bioprinting", "Scaffold in Tissue Engineering", "Induced Pluripotent Stem Cells", and "iPSCs" as keywords.

Results

This systematic search using the abovementioned keywords identified relevant articles for inclusion in this review. The resulting literature indicated that CTE can offer innovative solutions for treating cardiac diseases when integrated with three-dimensional (3D) bioprinting and iPSC technology.

Conclusions

Despite notable advances in the field of CTE, multiple challenges remain relating to 3D-bioprinted cardiac tissues. These include maintaining long-term cell viability, achieving precise cell distribution, tissue vascularization, material selection, and cost-effectiveness. Therefore, further research is needed to optimize printing techniques, develop more advanced bio-inks, explore larger-scale tissue constructs, and ensure the biosafety and functional fidelity of engineered cardiac tissues. Subsequently, future research efforts should focus on these areas to facilitate the clinical translation of CTE. Moreover, additional long-term animal models and preclinical studies should be conducted to ensure the biosafety and functionality of engineered cardiac tissues, thereby creating novel possibilities for treating patients with heart diseases.

Usefulness of Arterial Stiffness as an Integrated Marker of Cardiovascular Risk

We analyzed the usefulness of the carotid-femoral pulse wave velocity (cfPWV) as an integrated marker for hypertension (HTN)-mediated organ damage (HMOD) and cardiovascular (CV) risk in a cohort with repeated measurements. A total of 1031 patients, 80% of whom had HTN, underwent cfPWV determinations by SphygmoCor. An HMOD score was developed, including microalbuminuria, left ventricular hypertrophy (LVH), intima-media thickness (IMT), and carotid plaques. CV complications included atrial fibrillation (AF), heart failure (HF), stroke, ischemic heart disease (IHD), peripheral artery disease (PAD), or CV death. Survival curves based on Cox regression adjusted for age and systolic blood pressure (SBP), along with Harrell's C statistic, were assessed. There was a trend toward higher cfPWV across categories of the HMOD score. Significant correlations were found among different AS parameters and blood pressure (BP) levels. Age and SBP were highly correlated with cfPWV. Among the 174 patients with at least two cfPWV measurements, there were 12 CV complications over a follow-up period of 2.4 years. The first and second cfPWV measurements, as well as the delta values, were significantly higher in those with CV complications, with most patients experiencing an increase in PWV during follow-up of ≥ 1 m/s. Survival curves significantly differed among tertiles of PWV and the delta, particularly for the second PWV determination, which also showed the highest predictive value (Harrell's C = 0.86). The optimal threshold to predict complications was 9.10 m/s. Our findings suggest that cfPWV represents a promising integrated marker of HMOD, potentially serving as a surrogate endpoint for CV risk.

From physiology to pathology: Emerging roles of GPER in cardiovascular disease

Cardiovascular diseases (CVDs) are among the leading causes of death globally and pose a significant threat to public health. Factors such as prolonged high cholesterol levels, diabetes, smoking, unhealthy diet, and genetic predisposition could contribute to the occurrence and development of CVDs. Common CVDs include hypertension (HTN), atherosclerosis (AS), myocardial infarction (MI), myocardial ischemia-reperfusion injury (MIRI), heart failure (HF) and arrhythmia. Estrogen is recognized for its cardiovascular protective effects, resulting in lower incidence and mortality rates of CVDs in premenopausal women compared to men. The G protein-coupled estrogen receptor (GPER), a G protein-coupled receptor with a seven-transmembrane structure, exhibits unique structural characteristics and widespread tissue distribution. GPER activates intracellular signaling pathways through its interaction with G proteins, mediating estrogen's biological effects and participating in the regulation of cardiovascular function, metabolic balance, and nervous system. Although recent research has highlighted the significant role of GPER in the cardiovascular system, its specific mechanisms remain unclear. Therefore, this review summarizes the latest research on GPER in CVDs, including its fundamental characteristics, physiological functions in the cardiovascular system, and its roles and potential therapeutic applications in common CVDs such as HTN, AS, MI, MIRI, HF and arrhythmia. Exploring GPER's positive effects on cardiovascular health will provide new strategies and research directions for the treatment of CVDs.

Effectiveness of chain of survival for out-of-hospital-cardiac-arrest (OHCA) in resource limited countries: A systematic review

Aim

Given the critical disparities in survival for out-of-hospital-cardiac-arrest (OHCA) in resource limited countries and the lack of context-specific evidence to guide resuscitation practices, we aimed to systematically evaluate the effectiveness of the chain of survival components including bystander response, emergency medical services (EMS) response, advanced life support, and post-resuscitation care on outcomes such as return of spontaneous circulation, survival to admission, survival to hospital discharge, and neurological outcomes in these settings.

Methods

This systematic review, following PRISMA guidelines, included observational and interventional studies on OHCA management from low, lower-middle, and upper-middle-income countries, published in English (2004-2023). PubMed, Embase, CINAHL, and Cochrane Library were searched using predefined terms. Two reviewers independently screened studies, extracted data using the Utstein template, and resolved conflicts with a third reviewer. Data included pre-hospital, patient, and post-resuscitation care factors, as well as short and long-term outcomes. Descriptive analysis and narrative synthesis were conducted, with return of spontaneous circulation (ROSC) rates compared across income groups using t-tests.

Results

Sixteen (16) eligible studies were included. No study was found from low-income countries. ROSC rates ranged from 0.7% to 44%, survival to discharge from 0.6% to 14.1%, and good neurological outcomes (CPC 1-2) from 0.6% to 53.8%. While upper-middle-income countries showed slightly higher ROSC rates, differences were not statistically significant. Risk of bias was moderate to high due to selection bias, inadequate confounding control, and inconsistent reporting. These findings emphasize the need for standardized reporting and further research to improve outcomes in resource limited countries.

Conclusion

This review highlights low survival rates for OHCA in resource limited countries, with significant variability and gaps in evidence. Strengthening EMS systems, adopting context-specific strategies, and standardizing reporting are critical to improving outcomes.

Advances in Technology Promote Patient-Centered Care in Cardiac Rehabilitation

Patient-centered health care (PCC) is a framework of clinical care focused on the patient's individual health care needs. In particular, it emphasizes the development of a partnership between the patient, physician, and healthcare workers to actively involve and empower the patient in their health care decisions. Additionally, PCC goals include ensuring access to care, emotional support, engaging patient support systems, physical comfort, and continuity of care. Technology also provides a platform to engage patients and their families in their care and can be a useful tool to gauge their level of interest, knowledge, and motivations to adequately educate them on the many factors that contribute to their disease, including diet, exercise, medication adherence, psychological support, and early symptom detection. In this article, we summarize the importance of technology in promoting PCC in cardiac rehabilitation and the impact technology may have on the different aspects of patient and physician relationships. Modern technological devices including smartphones, tablets, wearables, and other internet-enabled devices have been shown to help patient-staff communication, cater to patients' individual needs, increase access to health care, and implement aspects of PCC domains.

Role of sirtuin 1 in depression‑induced coronary heart disease: Molecular pathways and therapeutic potential (Review)

Depression and coronary heart disease (CHD) are two interconnected diseases that profoundly impact global health. Depression is both a complex psychiatric disorder and an established risk factor for CHD. Sirtuin 1 (SIRT1) is an enzyme that requires the cofactor nicotinamide adenine dinucleotide (NAD+) to perform its deacetylation function, and its involvement is crucial in reducing cardiovascular risks that are associated with depression. SIRT1 exerts its cardioprotective effects via modulating oxidative stress, inflammation and metabolic processes, all of which are central to the pathogenesis of CHD in individuals with depression. Through influencing these pathways, SIRT1 helps to reduce endothelial dysfunction, prevent the formation of atherosclerotic plaques and stabilize existing plaques, thereby decreasing the overall risk of CHD. The present review underscores the important role of SIRT1 in serving as a therapeutic intervention molecule for tackling cardiovascular complications stemming from depression. Furthermore, it highlights the need for further studies to clarify how SIRT1 influences both depression and CHD at the molecular level. The ultimate goal of this research will be to translate these findings into practical clinical intervention strategies.

Distinct metabolites in atherosclerosis based on metabolomics: A systematic review and meta-analysis primarily in Chinese population

AIMS

Atherosclerosis is a life-threatening disease that develops when a plaque builds up inside an artery and progresses silently. Identifying the early pathological changes and the biomarkers of atherosclerosis deserves attention. We aimed to systematically study and integrate the various metabolites of atherosclerosis in the level of disease to provide more evidences to support early prevention and treatment of atherosclerosis.

DATA SYNTHESIS

The protocol was registered with PROPSERO (CRD42023441845). We searched 14,985 records via EMBASE, PubMed, Web of Science, WanFang data, VIP data, and CNKI databases. The collected metabolites were for qualitative and quantitative meta-analysis. The I2 statistic estimated heterogeneity, with over 50 % considered to adopt the random-effects model. A total of 49 articles were included in the meta-analysis. We finally integrated 83 and 16 metabolites presented more than two times in inclusion studies, respectively in blood (plasma and serum) and urine. Among them, the level of citric acid (SMD = -10.35 [95%CI -15.03, -5.67], p < 0.001), lactic acid (SMD = 6.32 [95%CI 0.12, 12.52], p < 0.001) and TMAO (SMD = 1.40 [95%CI 0.27, 2.53], p < 0.001) had significant differences between atherosclerosis and controls. And we observed blood stasis syndrome of atherosclerosis patients present arterial ischemia and energy disorder obviously.

CONCLUSIONS

The study provides an in-depth understanding of the roles of metabolites on atherosclerosis progression and prediction primarily in Chinese population, which contributing to development of prevention and therapeutic potential in the future.

The journey of the cardiovascular polypill from its conception to the WHO List of Essential Medicines

Cardiovascular disease (CVD) has achieved pandemic proportions and is currently the leading cause of death worldwide. Barriers to optimal secondary cardiovascular prevention include lack of access to chronic treatment as well as low adherence in those who receive these treatments. The polypill represents a simple, cost-effective, scalable strategy to improve access and adherence to medication and effectively bridge the current gap in secondary prevention of CVD. Here, we review the epidemiological need for such a strategy as well as the most notable clinical evidence reported in the past decade supporting the clinical use of the polypill. Furthermore, we discuss the barriers inherent to the acceptance and use of the polypill for secondary prevention of CVD compared to the uptake of other polypills for the treatment of communicable diseases where fixed-dose combinations have become accepted as the cornerstone of treatment for other global pandemics such as HIV.

Impact of snowfall on emergency medical system and mortality in patients with acute coronary syndrome

Acute coronary syndrome (ACS) requires rapid transportation by the emergency medical system (EMS). In snowy areas, traffic conditions may delay EMS transport times and increase mortality rate of ACS. However, there is a paucity of systemic data showing how snowfall affects the EMS and mortality in patients with ACS. This study aimed to investigate the impact of snowfall on the EMS transport times and in-hospital death in patients with ACS. We examined 2387 consecutive ACS patients who were transported via EMS to hospitals participating in the Sapporo City ACS network between April 2013 and April 2023. The patients were divided into two groups based on their arrival on either a snowy day (n = 612, 26%) or a non-snowy day (n = 1775, 74%), as determined by historical weather records from the Japan Meteorological Agency for the Sapporo area. The median age was 68 years, 1754 (74.6%) patients were male. Patients in the snowy day group had longer median time from an EMS call to hospital than those in the non-snowy day group (33 min [IQR 26-40] vs. 29 min [IQR 24-36], P < 0.001). Quantity of snowfall was associated with a delayed time from EMS call to hospital. The proportion of in-hospital death was higher in the snowy day group compared to the non-snowy day group (7.3% vs. 4.6%, P = 0.011). Multivariable logistic regression analysis showed that the snowfall was independently associated with higher incidence of in-hospital death (odds ratio 1.57, 95% confidence interval 1.00-2.47, P = 0.048). In conclusion, snowfall had a significant impact on the EMS and mortality in patients with ACS in an urban city in Japan.

Immersive virtual reality reduces depression, anxiety and stress in patients with cardiovascular diseases undergoing cardiac rehabilitation: A systematic review with meta-analysis

BACKGROUND

Current literature suggests that immersive virtual reality (IVR) could be an efficacious therapeutic approach for patients with cardiovascular diseases (CVD) undergoing cardiac rehabilitation program (CRP). However, this has only been affirmed in individual studies and is yet to be confirmed by a systematic review.

OBJECTIVES

To determine the efficacy of IVR interventions on depression, anxiety, and stress symptoms in patients with CVD.

METHODS

A meta-analysis was performed in line with PRISMA guidelines following a literature search between inception and June 2024 in PubMed, SCOPUS, WOS, CINAHL and PEDro for retrieving randomized controlled trials (RCTs) that compared the efficacy of IVR versus conventional CRPs on depression, anxiety and stress in patients with CVD. The PEDro scale was used to evaluate the methodological quality of the studies. Pooled effects were calculated using the Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI), or mean difference (MD) if studies used the same measure.

RESULTS

Eight RCTs, providing data from 510 patients with CVD (63.8±5.4 years, 60% men), were included. The methodological quality was moderate (M=5.1±1 points). A large rehabilitative effect of IVR was found for reducing depression (SMD=-0.54; 95% CI -0.77 to -0.31; p<0.001), anxiety (SMD=-0.43; 95% CI -0.74 to -0.12; p=0.006) and stress (MD=-14.96; 95% CI -20.1 to -9.8; p<0.001). The findings suggest that combine IVR and CRP is the most appropriate approach for reducing depression, anxiety and stress.

CONCLUSION

IVR, especially when combined with a traditional CRP, reduces depression, anxiety and stress in patients with CVD.

Sex-Specific Vulnerabilities to Subclinical Vascular Brain Injury in Early Late-Life: The Framingham Heart Study

OBJECTIVE

Subclinical vascular brain injury is an increasingly recognized risk factor for stroke and dementia. Despite well-established sex differences in vascular risk and disease prevalence, the impact of sex on drivers of subclinical vascular brain injury remains unclear, presenting a barrier to developing sex-specific prevention guidelines. We aimed to establish the extent to which sex moderates associations between vascular risk factors and magnetic resonance imaging (MRI) measures of subclinical brain injury in stroke-free older adults.

METHODS

We leveraged cross-sectional data from 1,579 stroke- and dementia-free Framingham Heart Study Offspring participants at exam 8 (age 65.7 ± 8.8 years, 53% women). Vascular risks were assessed using components of the Framingham Stroke Risk Profile (FSRP) and diastolic blood pressure (DBP). White matter hyperintensity volume (WMH), total cerebral brain volume (TBV), and covert brain infarcts were quantified using MRI. We examined whether vascular risk factors were associated with MRI measures across the combined cohort, and then determined whether sex modified these associations.

RESULTS

Higher FSRP and specifically systolic blood pressure (SBP) were associated with greater WMH. These associations were stronger in women and remained after adjusting for menopause age and hormone therapy use. By contrast, diabetes and lower DBP were associated with smaller TBV primarily in men. The DBP-atrophy relationship was only observed in men with declining DBP or prior hypertension.

INTERPRETATION

Our findings highlight differential vulnerability to the impact of vascular risk factors on white matter health in women and global atrophy in men, supporting the development of sex-specific guidelines to better preserve vascular brain health in aging. ANN NEUROL 2025;97:460-469.

Trends in atherosclerotic heart disease-related mortality among U.S. adults aged 35 and older: A 22-year analysis

Background

Atherosclerotic heart disease (ASHD) remains a leading cause of mortality worldwide, especially among older adults. Understanding the long-term mortality trends in ASHD can guide public health strategies and address demographic disparities.

Methods

Mortality data for individuals aged 35 years and older were extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMR) per 100,000 persons were calculated and stratified by year, gender, race, urbanization, and place of death. The trends were assessed using the annual percent change (APC) and average annual percent change (AAPC) with 95 % confidence intervals (CI) calculated through Joinpoint regression analysis.

Results

From 1999 to 2020, 7,638,608 ASHD-related deaths were recorded. The overall AAMR declined from 291.08 in 1999 to 170.07 in 2020, with an AAPC of -2.70 % (95 % CI: 2.96 to -2.54). However, an abrupt rise was observed from 2018 to 2020 (APC: 4.55; 95 % CI: 0.77 to 6.75). Males reported higher AAMR than females (Males: 271.9 vs. Females: 151.9). Non-Hispanic (NH) White individuals had the highest AAMR (209.38), followed by NH Black (202.47), NH American Indian (176.12), Hispanic (158.1), and NH Asian (113.7) populations. Nonmetropolitan areas reported the highest AAMR (214.77), while medium metropolitan areas reported the lowest (195.41). The majority of deaths occurred in medical facilities (42.81 %), followed by decedent's homes (25.67 %), and nursing homes (24.79 %).

Conclusion

Despite a long-term decline in ASHD-related mortality, the recent increase from 2018 to 2020 requires further study. Gender and racial disparities persist, highlighting the need for targeted public health efforts to reduce these inequities.

Prediction of cardiovascular risk: validation of a non-laboratory and a laboratory-based score in a Brazilian community-based cohort of the PURE study

Background

Risk scores are essential tools for implementing cardiovascular disease (CVD) prevention. Validating risk scores considering regional diversities and disparities is critical for reducing the burden of CVD on global morbidity and mortality. We aimed to validate two cardiovascular risk scores (laboratory and non-laboratory-based) to predict major adverse cardiovascular events in the Brazilian cohort of the PURE study.

Methods

We validated two risk scores derived from the INTERHEART study, the non-laboratory INTERHEART risk score (NL-IHRS) and the laboratory fasting cholesterol INTERHEART risk score (FC-IHRS) using data from 4623 (urban areas) and 1415 (rural areas) participants without CVD in the Brazilian cohort of the PURE study enrolled in 2004 and 2005 and followed up to September 2021. The endpoint was major cardiovascular events (MACE), defined as the composite of myocardial infarction, stroke, heart failure, or death from cardiovascular causes. We evaluated the model performance of IHRS through c-statistic and calibration methods.

Findings

After a mean follow-up of 8.8 years (range, 0.28-15.1 years), there were 312 cardiovascular events, corresponding to an incidence rate of 0.58% per year (0.56% per year in urban versus 0.64% per year in rural areas). For the NL-IHRS, the c-statistic was 0.69 (95% confidence interval, CI, 0.66-0.72) in the overall cohort, 0.68 (95% CI, 0.64-0.72) in the urban cohort, and 0.72 (95% CI, 0.66-0.78) in the rural cohort. C-statistic values for the recalibrated FC-IHRS were 0.71 (95% CI, 0.67-0.74), 0.71 (95% CI, 0.67-0.75), and 0.70 (95% CI, 0.64-0.76) in the overall, urban, and rural cohorts, respectively.

Interpretation

In this Brazilian community-based prospective cohort, both NL-IHRS and FC-IHRS-based models performed with reasonable discriminative accuracy on the risk estimation of long-term risk of major CVD. A non-laboratory-based CVD risk score may be instrumental in Brazilian communities with limited access to medical resources.

Funding

Population Health Research Institute, Novartis Biociências S.A.

Knowledge, attitude, and practice regarding cardiovascular diseases in Saudi Arabia: A cross-sectional study

Cardiovascular diseases (CVDs) are the primary contributors to mortality and morbidity on a global scale. The aim of this study is to examine knowledge, attitude and practices of the general public regarding CVDs in Saudi Arabia. This is a cross-sectional survey study that was conducted in Saudi Arabia to examine KAP of the general public regarding CVDs between January and February 2024. There were 605 participants in total enrolled in this study. The mean knowledge score for the study participants was 7.1 (2.5) out of 11 (64.5%); which indicates moderate level of knowledge of CVD. A considerable proportion of participants (61.5%) report engaging in vigorous physical activity for a minimum of 30 minutes per day throughout the week, including activities like running, lifting large loads, or drilling. In terms of knowledge, there is no significant difference between males and females across gender categories (odds ratio = 0.92, P = .603). Within the age group category, those between the ages of 24 and 30 (odds ratio = 0.44, P < .001) and 31 and 40 (odds ratio = 0.39, P < .001) demonstrate noticeably diminished probabilities of possessing superior knowledge in comparison to those between the ages of 18 and 23. In relation to marital status, the odds of possessing superior knowledge are considerably lower for married individuals (odds ratio = 0.43, P < .001), divorced individuals (odds ratio = 0.39, P = .003), and widowed individuals (odds ratio = 0.11, P = .004) in comparison to singles. The survey found moderate level of awareness of cardiovascular diseases and strong recognition of preventive measures including physical activity and a healthy diet. There are gaps in CVD symptom knowledge. Participants are typically favorable about CVD prevention and willing to adopt healthy lifestyles. Decision-making recommendations include targeted teaching efforts on symptom awareness, physical activity, and healthy diets. Further research is needed to determine how educational interventions improve knowledge across demographic groups. Longitudinal studies could also evaluate lifestyle treatments for CVD risk reduction.

Association of GGT and hs-CRP with hypertension across different glycemic states in Saudi adults: A cross-sectional study

Introduction

Atherosclerosis, hypertension, and diabetes (DM) is preceded by inflammation and endothelial dysfunction. Early detection of these risk factors is expected to improve prognosis. We aimed to examine the association between gamma-glutamyl transferase (GGT) and highly sensitive C-reactive protein (hs-CRP) with hypertension (HTN) in the presence and absence of dysglycaemia among Saudi adults not previously diagnosed with DM.Methods: adults were recruited randomly from public healthcare centres in Jeddah. Demographic information, blood pressure, and anthropometric measurements were taken. Fasting blood samples were drawn to measure glucose, glycated haemoglobin, lipid profile, hs-CRP, and GGT. Blood was drawn again following a 1-h oral glucose tolerance test, and plasma glucose was measured.

Results

Mean GGT and hs-CRP were higher in people with HTN and dysglycaemia than those without both (P < 0.001). In people with HTN, those with intermediate hyperglycaemia (pre-DM) had significantly higher means of GGT and hs-CRP compared with those without (P < 0.001 and 0.013, respectively). In people with pre-DM, those with HTN had significantly higher means of GGT than those without (P = 0.008), but the increase in mean hs-CRP was not statistically significant. Mean GGT was higher in people with DM compared to means of those with pre-DM and HTN (P = 0.04).

Conclusion

An association between higher serum levels of hs-CRP and GGT and dysglycaemia exists, especially in hypertensive people. Monitoring both biomarkers in dysglycaemic people, especially if they have elevated blood pressure, is recommended to initiate therapeutic interventions.

Ten-year atherosclerotic cardiovascular disease risk score in post-menopausal women with low bone mineral density

BACKGROUND

Reports on the association between cardiovascular disease (CVD) risk and bone mineral density (BMD) remain inconsistent and hence more population-based studies on this subject are needed.

AIMS

This cross-sectional study aimed to evaluate the association between bone mineral density (BMD) at the lumbar spine (L1-L4) and femoral neck (right and left) with 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores in Saudi postmenopausal women.

METHODS

A cohort of 1,450 postmenopausal women with risk factors for bone loss were analyzed using the data from the Chair for Biomarkers of Chronic Diseases (CBCD) Osteoporosis database. BMD at the lumbar spine and femoral neck was assessed using dual-energy X-ray absorptiometry (DXA). Anthropometric and biochemical parameters, including fasting glucose and lipid profiles, were measured. ASCVD risk scores were calculated using the ASCVD Risk Estimator Plus tool. BMD tertiles were analyzed for their association with ASCVD risk.

RESULTS

Women with osteoporosis had significantly lower BMI, waist and hip circumferences, and metabolic dysfunction markers compared to those with normal BMD. Significant negative correlations were observed between ASCVD risk scores and BMD at femoral neck sites in women with osteopenia and osteoporosis. Multivariate logistic regression indicated that women in the lowest BMD tertiles had significantly higher odds of intermediate to high ASCVD risk scores, with adjusted odds ratios of 1.90 for the lumbar spine, 2.19 for the right femoral neck, and 2.04 for the left femoral neck.

CONCLUSIONS

The study identified significant associations between lower BMD at the lumbar spine and femoral neck sites and elevated 10-year ASCVD risk scores in postmenopausal women, particularly among those with osteopenia and osteoporosis. These findings demonstrate the importance of assessing cardiovascular risk in women with low BMD to enable early prevention and management strategies.

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

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

Global burden and national health inequity of ischemic heart disease attributed to kidney dysfunction from 1990 to 2021: Findings from the global burden of disease study 2021

BACKGROUND AND AIMS

To estimate the global disease burden and cross-national inequalities in the distribution of ischemic heart disease attributable to kidney dysfunction (KI-IHD) from 1990 to 2021.

METHODS

The estimates for age-standardized death rates (ASDR) and age-standardized disability-adjusted life-years rates (ASDAR) of KI-IHD were obtained from the Global Burden of Disease Study (GBD) 2021. Data for gross domestic product (GDP) and GDP growth rates were extracted from World Bank database. The average annual percent change (AAPC) was calculated to analyze temporal trends of ASDR and ASDAR by Joinpoint regression model. Slope index of inequality and concentration index were generated to quantify the cross-national socioeconomic inequality of KI-IHD burden.

RESULTS

From 1990 to 2021, the ASDR and ASDAR of KI-IHD has shown downward trend globally; with AAPC values of -1.384 % and -1.204 %. The ASDR and ASDAR of KI-IHD was higher in males than females, with increasing age, the burden gradually increased. The concentration index showed 0.02 (95%CI: 0.02, 0.06) in 1990 and -0.11 (95%CI: 0.15, -0.07) in 2021. The slope index of inequality showed that an excess of 170 ASDR per 100,000 existed between countries with the lowest and the highest SDI in 1990, however, in 2021, the results are reversed, a reduction of 159 per 100,000. GDP growth rate and GDP per capita might be associated with the health inequality of KI-IHD.

CONCLUSION

The burden of KI-IHD has decreased in almost 70 % of countries over the past three decades. Disproportional distribution of health inequalities was concentrated in poor countries.

VasCog Screen test: sensitive in detecting cognitive impairment in patients who had a stroke or with heart failure

INTRODUCTION

Vascular diseases, such as stroke and heart failure (HF), are associated with cognitive decline. Vascular cognitive impairment (CI) is commonly found in patients who had a stroke and with HF, ranging from mild CI to dementia. Early detection of CI is crucial for effective management and rehabilitation. This study aimed to develop the VasCog Screen test, a screening tool to detect CI in patients who had a stroke and with HF.

METHOD

427 patients who had a stroke and with HF were assessed using cognitive measures including Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and a formal neuropsychological battery. The short-MoCA was derived and combined with Symbol Digit Modalities Test (SDMT) to create the VasCog Screen. The discriminatory ability of different tests for CI was compared, establishing optimal cut-off points. Variants of short-MoCA including the SDMT were also evaluated.

RESULTS

Similar prevalence rates of CI were found in stroke and HF cohorts. The most prevalent neuropsychological impairment was visuomotor speed, followed by visual memory and visuoconstruction. More than half of the patients were found to have CI. The VasCog Screen outperformed MMSE, MoCA and short-MoCA in detecting CI. The addition of SDMT to variants of the short-MoCA increased diagnostic accuracy.

CONCLUSION

The VasCog Screen test offers a cognitive screening tool, which is sensitive to cognitive deficits characteristically found in patients who had a stroke and with HF. It was found to have good sensitivity, specificity and classification accuracy. It is easy to administer in busy clinics, enabling early detection of CI and facilitating appropriate interventions.

Effect of Homoarginine on Coronary Artery Complexity and Atherosclerotic Burden in Patients with STEMI

Objective: Homoarginine is a cationic amino acid derived from lysine. Evidence indicates that low-circulating homoarginine concentration is a risk factor for cardiovascular disease and all-cause mortality. A reduction in homoarginine concentrations has been observed in patients with ischemic heart disease, ischemic stroke, ischemic heart disease, and heart failure. The SYNTAX score (SS), an angiographic scoring system, defines the grade and complexity of coronary artery disease (CAD). The objective of this study was to evaluate the relationship between homoarginine level and the severity of CAD according to the SYNTAX score in patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 67 subjects were enrolled into the study with the diagnosis of STEMI of those who underwent coronary angiography. STEMI patients were divided into two groups: low-medium SYNTAX score ≤ 14 (35 patients) and high SYNTAX score > 14 (32 patients). Results: Within the high SS group, serum homoarginine levels were markedly lower (2 ± 0.9 vs. 1.3 ± 0.7; p = 0.001). Homoarginine levels and SS showed a significant negative correlation in entire study cohort In multivariate regression analysis, serum homoarginine levels along with serum urea levels were significantly associated with having higher SS (OR 1.073 p = 0.049 and OR 0.346, p = 0.012, respectively). Conclusions: In conclusion, the diminished plasma homoarginine level emerges as an independent predictor of high atherosclerotic burden among STEMI patients. To the best of our knowledge, this is the first study to demonstrate the relationship between homoarginine and coronary artery complexity.

Application of Nanomaterials in Early Imaging and Advanced Treatment of Atherosclerosis

Atherosclerosis (AS) is a serious disease that poses a significant threat to the global population. In this review, we analyze the development of AS from multiple perspectives, aiming to elucidate its molecular mechanisms. We also focus on imaging techniques and therapeutic approaches, highlighting the crucial role of nanomaterials in both imaging and therapy for AS. By leveraging their compatibility and targeting capabilities, nanomaterials can be integrated with traditional medical imaging and therapeutic agents to achieve targeted drug delivery, controlled release, and precise localization and imaging of atherosclerotic plaques.

Artificial intelligence applied to electrocardiogram to rule out acute myocardial infarction: the ROMIAE multicentre study

BACKGROUND AND AIMS

Emerging evidence supports artificial intelligence-enhanced electrocardiogram (AI-ECG) for detecting acute myocardial infarction (AMI), but real-world validation is needed. The aim of this study was to evaluate the performance of AI-ECG in detecting AMI in the emergency department (ED).

METHODS

The Rule-Out acute Myocardial Infarction using Artificial intelligence Electrocardiogram analysis (ROMIAE) study is a prospective cohort study conducted in the Republic of Korea from March 2022 to October 2023, involving 18 university-level teaching hospitals. Adult patients presenting to the ED within 24 h of symptom onset concerning for AMI were assessed. Exposure included AI-ECG score, HEART score, GRACE 2.0 score, high-sensitivity troponin level, and Physician AMI score. The primary outcome was diagnosis of AMI during index admission, and the secondary outcome was 30 day major adverse cardiovascular event (MACE).

RESULTS

The study population comprised 8493 adults, of whom 1586 (18.6%) were diagnosed with AMI. The area under the receiver operating characteristic curve for AI-ECG was 0.878 (95% CI, 0.868-0.888), comparable with the HEART score (0.877; 95% CI, 0.869-0.886) and superior to the GRACE 2.0 score, high-sensitivity troponin level, and Physician AMI score. For predicting 30 day MACE, AI-ECG (area under the receiver operating characteristic, 0.866; 95% CI, 0.856-0.877) performed comparably with the HEART score (0.858; 95% CI, 0.848-0.868). The integration of the AI-ECG improved risk stratification and AMI discrimination, with a net reclassification improvement of 19.6% (95% CI, 17.38-21.89) and a C-index of 0.926 (95% CI, 0.919-0.933), compared with the HEART score alone.

CONCLUSIONS

In this multicentre prospective study, the AI-ECG demonstrated diagnostic accuracy and predictive power for AMI and 30 day MACE, which was similar to or better than that of traditional risk stratification methods and ED physicians.

QbD-steered HPTLC approach for concurrent estimation of six co-administered COVID-19 and cardiovascular drugs in different matrices: greenness appraisal

Many COVID-19 sufferers have a history of cardiovascular illnesses, which makes them more likely to develop severe COVID-19. Such patients were advised by experts to prioritize drug therapies based on their doctor's commendations to avoid exacerbating their basic illnesses. Therefore, developing an analytical methodology for the concurrent estimation of medications prescribed for co-treating cardiovascular and COVID-19 illnesses is becoming critical in both bioavailability hubs and QC units. Herein, an inventive, rapid, and affordable HPTLC approach was developed, and its conditions were optimized employing the full factorial design approach for the concurrent estimation of aspirin, atorvastatin, atenolol, losartan, remdesivir, and favipiravir as co-administered medications, either with salicylic acid or not. Using the desirability function, the experimental design approach could forecast the best eluent system for optimal resolution results. On HPTLC-silica plates, the above-mentioned medications were separated utilizing an eluent system of ethyl acetate, methylene chloride, methanol, and ammonia (6:4:4:1 by volume), and their spots were detected at 232 nm. The proposed methodology was evaluated following ICH prerequisites and applied successfully to the medications' dosage forms, human plasma, and buffered dissolution media with superb recovery proportions and no intrusiveness from formulations' additives or plasma matrices. Five metrics were employed to appraise the suggested technique's greenness: AGREE, eco-scale, Raynie and Driver, GAPI, and NEMI. The sensitivity, large sample capacity, and short run duration (15 min) of the proposed methodology confirm its appositeness for regular estimation of the above-mentioned medications.

Severe left main coronary artery disease and STEMI in a 19-year-old without traditional risk factors: A rare case of premature coronary artery disease

Premature coronary artery disease (CAD) is defined by the early onset of significant atherosclerotic narrowing of the coronary arteries, generally occurring before age 55 in men and 60 in women. This condition is an increasing concern in cardiovascular medicine due to its impact on younger populations, resulting in greater morbidity, diminished quality of life, and a substantial economic burden. Common risk factors include dyslipidemia, hypertension, diabetes, smoking, obesity, and genetic predispositions such as familial hyperlipidemia. This case report describes a 19-year-old male with no known cardiovascular risk factors who presented with an ST-segment elevation myocardial infarction and ventricular tachycardia caused by left main coronary artery disease including the left anterior descending artery and the left circumflex artery. Despite lacking common risk factors, he underwent successful coronary artery bypass grafting with two grafts.