Micronutrient Supplementation to Reduce Cardiovascular Risk

Dietary supplementation of male mice with inorganic, organic or nanoparticle selenium preparations: evidence supporting a putative gut-thyroid-male fertility axis

Selenium (Se) is linked to physiological homeostasis. Male mice (n = 8/group) were fed control (AIN93G) or diets enriched in sodium selenite (NaSe, 5.6 ppm), methylselenocysteine (Met, 4.7 ppm), diphenyl diselenide (DPDS, 14.2 ppm), or nanoselenium (NanoSe, 2.7 ppm); dietary Se ascertained by inductively-coupled plasma mass spectrometry. At 4 weeks testes, sperm, thyroids, blood and stool were collected to assess histoarchitecture, circulating hormones (thyroxine, T4; triiodothyronine, T3; thyroid stimulating hormone, TSH) and gut microbiome (16S rRNAV3-V4 amplicon sequencing). Supplemented NaSe, Met, and NanoSe increased plasma testosterone and testis glutathione peroxidases (GPx-1/4) while testicular superoxide dismutase and catalase increased slightly in the NanoSe group indicating a selective antioxidant response. Overall, NanoSe and NaSe enhanced male reproductive factors. All thyroids isolated from Se-supplemented mice contained marginal vacuoles and a lower follicle area vs control. Nano-Se enhanced thyroidiodothyronine deiodinase-1 (DIO1) expression however, thyroid GPx-1/4 remained unchanged. Supplemented NaSe and DPDSl increased plasma T3/T4 ratio, while plasma TSH was unchanged. Microbiome analyses showed that NanoSe was most efficacious in altering composition (judged by α-diversity, Shannon index and taxon richness) while the NaSe diet showed the greatest overall change in α-diversity. Dietary Se supplementation, particularly encapsulated NanoSe, may improve male fertility factors by enhancing the gut-thyroid-fertility axis.

Calbindin 2 as a Novel Biomarker and Therapeutic Target for Abdominal Aortic Aneurysm: Integrative Analysis of Human Proteomes and Genetics

BACKGROUND

Abdominal aortic aneurysm (AAA) is a clinical life-threatening issue. No pharmacological treatments are currently approved for the prevention and treatment of AAA. Therefore, identifying novel biomarkers and therapeutic targets is crucial for improving AAA management and outcomes.

METHODS

To identify plasma proteins with potential causal effects on AAA, we integrated genetic evidence from proteome-wide Mendelian randomization, genetic correlation, and colocalization analysis. The role of identified proteins in AAA was further explored through the phenome-wide association study and mediation analysis. Multiomics data analysis, including bulk RNA sequencing, single-cell/single-nucleus RNA sequencing, and spatial transcriptomics, was employed to characterize the expression patterns of these proteins. Experimental validation was performed using an AAA model in apolipoprotein E-deficient mice infused with angiotensin II. Druggability analysis was conducted to identify drug candidates, which were tested in preclinical mouse models.

RESULTS

CALB2 (calbindin 2) was identified as having a causal effect on AAA and may influence the progression of AAA through the regulation of lipid metabolism. Multiomics analysis revealed that CALB2 is predominantly expressed in the mesothelial cells of adipose tissues. Inhibition of CALB2 in an AAA mouse model alleviated AAA progression. Druggability analysis identified lenalidomide and genistein as potential therapeutic candidates, and experiments confirmed their efficacy in preventing AAA development.

CONCLUSIONS

This study identifies CALB2 as being associated with an increased risk of AAA and suggests that i might be a novel biomarker and therapeutic molecule for AAA management. Lenalidomide and genistein hold promising potential as treatments for patients with AAA.

Trends in Coenzyme Q10 Supplement Use and Associations With All-Cause and Cardiovascular Mortality: A Population-Based Cohort Study

Coenzyme Q10 (CoQ10) is a fat-soluble nutrient, which has antioxidant and anti-inflammatory properties. However, there is insufficient evidence on its daily use and the association with mortality. We aimed to evaluate the trends of CoQ10 supplement use among US noninstitutionalized adults and explore its associations with all-cause and CVD mortality. A prospective cohort study used data from the National Health and Nutrition Examination Survey (1999-2018). The association of CoQ10 supplementation with mortality was assessed with Cox proportional hazard models. The overall reported prevalence of CoQ10 supplement use increased from 1.2% (95% CI 0.7%-1.8%) in 1999-2000 to 4.6% (95% CI 3.4%-6.1%) in 2017-2018 (linear p  =  0.002). During an average of 9.8 years of follow-up, 5237 deaths were identified, including 1428 deaths due to CVD. In the multivariable model, CoQ10 supplement use was not associated with all-cause mortality (HR 1.00, 95% CI 0.77-1.30, p = 0.996) and CVD mortality (HR 1.30, 95% CI 0.89-1.90, p = 0.170). Subgroup analyses suggested that the use of CoQ10 supplements was associated with a higher all-cause mortality in obese participants (HR 1.45, 95% CI 1.01-2.08, p for interaction = 0.013). Although the prevalence of CoQ10 supplement use experienced continuous growth from 1999 to 2018 in the general adults of NHANES, CoQ10 supplementation was not associated with all-cause and CVD mortality.

One nanoparticle delivers two different neuroprotective amino acids into ischemic brain and protects against neuronal death in rat cerebral ischemia injury

Previous studies have proven that glycine and proline are neuroprotective but have very low permeability through the blood-brain barrier (BBB), which is a major barrier to the application of these neuroprotective amino acids in the therapy of brain injury. In this study, we aimed to develop a therapeutic strategy by which one chitosan nanoparticle could deliver two different neuroprotective amino acids, glycine and proline, into the rat ischemic brain to confer neuroprotection in a rat model of cerebral ischemia-reperfusion (I/R) injury. Using the ion cross-linking method, we developed a preparation in which one chitosan nanoparticle was simultaneously loaded with glycine and proline (AA-NPs). We evaluated the therapeutic potential of AA-NPs in both cell and animal models of cerebral ischemic stroke. We found that the levels of glycine and proline were decreased in the brain tissues of I/R rats. AA-NPs delivered both glycine and proline into the ischemic brain and reduced ischemic neuronal death in both in vitro and in vivo. These results indicated that the dual delivery of glycine and proline via AA-NPs mediated neuroprotective effects, as evidenced by the reduction of neuronal death in both cellular and animal models of ischemic stroke. AA-NPs provide an efficient and potential delivery strategy by which multiple neuroprotective amino acids can be transported into the ischemic brain simultaneously for the treatment of ischemic stroke.

Ablation of Mouse Selenium-Binding Protein 1 and 2 Elevates LDL by Disruption of Cholesterol Efflux and Lipid Metabolism

Selenium-binding protein 1 (SeBP1) is an anticancer factor that affects lipid metabolism in mouse kidneys via the peroxisome proliferator-activated receptor-alpha (PPARA) pathway. However, its physiological role in the liver is difficult to explain because of the presence of the highly homologous selenium-binding protein 2 (SeBP2). To investigate the role of these proteins in the liver, we generated SeBP1 and SeBP2 double-knockout mice (SeBP1/2-DK). SeBP1/2 deletion did not significantly alter the mice phenotypic compared to that of the wild-type strain. Then, we identified the genes involved in hepatic lipid metabolism. The double knockout did not affect fatty acid and cholesterol synthesis, but inhibited fatty acid oxidation and cholesterol efflux. Furthermore, transfection of HepG2 cells with human selenium-binding protein 1 (hSeBP1) positively regulated PPARA and the genes controlled by it. Overexpression of hSeBP1 reduced the levels of non-esterified fatty acids in the culture medium. The serum levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were significantly different among the three groups. In summary, we elucidated the potential signaling pathways of SeBP1 and SeBP2 in fatty acid oxidation and hepatic cholesterol efflux. Our findings provide insights relevant for developing new strategies to prevent and treat lipid metabolism disorders.

Nonprescription Magnesium Supplement Use and Risk of Heart Failure in Patients With Diabetes: A Target Trial Emulation

BACKGROUND

Both diabetes and low magnesium-containing food intake may increase the risk of heart failure (HF). However, the effect of nonprescription magnesium supplements on the risk of HF or major adverse cardiac events in patients with diabetes is unknown.

METHODS AND RESULTS

Using a target-trial-emulation approach, we assembled a national cohort of 94 239 veterans ≥40 years with diabetes, without prior HF or magnesium use, who received ambulatory care in the US veterans-health care system documented by electronic clinic notes between January 1, 2006 and December 31, 2020. A natural language processing approach was used to detect self-reported magnesium-supplement use from clinic notes, n=17 619 were identified as users versus n=76 620 as nonusers. Using inverse probability treatment weighting, we constructed a cohort balanced in 88 baseline characteristics between users and nonusers. The primary outcome was incident HF. Secondary outcomes were major adverse cardiac events (myocardial infarction, stroke, HF hospitalization, or death). Hazard ratios (HRs) associated with magnesium-supplement use and outcomes were estimated in the inverse probability treatment weighting weighted cohort using Cox regression. The inverse probability treatment weighting weighted cohort had a mean age of 67.4±10.3 years; 18.4% were Black, and 5.1% were women. The mean duration of magnesium-supplement use was 3.5±3.1 (interquartile range, 1.1-5.1) years. Incident HF occurred in 8.0% of users and 9.7% of nonusers of magnesium supplements (HR, 0.94 [95% CI, 0.89-0.99]). Magnesium-supplement use was also associated with a reduced risk of major adverse cardiac events (HR, 0.94 [95% CI, 0.90-0.97]).

CONCLUSIONS

Long-term nonprescription magnesium supplement use was associated with a lower risk of incident HF and major adverse cardiac events in patients with diabetes. These findings should be replicated in randomized controlled trials.

Dietary zinc intake and 10-year atherosclerotic cardiovascular disease risk in diabetes mellitus patients: evidence from NHANES database

OBJECTIVE

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in diabetes mellitus (DM) patients. Oxidative stress and inflammation are important pathological mechanisms affecting the occurrence and development of ASCVD in DM patients. Dietary zinc acts a key role in anti-oxidation, anti-inflammation and blood glucose regulation. This study purposes to explore the relationship between dietary zinc intake and 10-year ASCVD in DM patients.

METHODS

Based on the National Health and Nutrition Examination Survey (NHANES) 2007-2018, the 10-year risk of ASCVD was assessed using the 2018 ACC/AHA guidelines & pooled cohort equations model. The total dietary zinc intake was calculated through 24-h dietary recall. Weighted univariable, multivariate logistic regression and restricted cubic splines (RCS) were performed to evaluate the association between dietary zinc intake and 10-year risk of ASCVD among patients with DM. Stratified analysis based on the history of hypertension, dyslipidemia and hypoglycemic agent's treatment were further evaluated these associations.

RESULTS

Finally, we included 3,053 DM patients, of which 1,245 (40.78%) had high risk of 10-year ASCVD. We found higher dietary zinc intake was related to lower 10-year ASCVD risk among patients with DM (OR = 0.77, 95%CI: 0.61-0.99, P = 0.044), especially in patients with hypertension (OR = 0.53, 95%CI: 0.36-0.80), dyslipidemia (OR = 0.74, 95%CI: 0.58-0.95, P = 0.019), and hypoglycemic agent's treatment (OR = 0.71, 95%CI: 0.54-0.93, P = 0.016).

CONCLUSION

Sufficient dietary zinc intake has potential benefits for cardiovascular health among patients with DM. Further large-scale and well-designed prospective study are needed to further explore these associations.

Folate Biomarkers, Folate Intake, and Risk of Death From All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

CONTEXT

Existing evidence on the relation between folate intake and biomarkers with mortality risk is controversial.

OBJECTIVE

Previous cohort studies were examined regarding folate intake and biomarkers in relation to risk of all-cause, cardiovascular disease- (CVD), and cancer-related mortality through a systematic review and meta-analysis.

DATA SOURCES

A systematic search was performed of the PubMed, Scopus, and ISI Web of Science databases up to July 2023.

DATA EXTRACTION

Prospective cohort studies examining the association of folate biomarkers (in serum, plasma, red blood cells) and intake with risk of all-cause, CVD-, and cancer-related mortality were considered. A random-effects model was applied to combine study-specific risk estimates. Dose-response relations were assessed by 1-stage weighted mixed-effects meta-analysis.

DATA ANALYSIS

A total of 25 cohorts with 423 304 participants, 36 558 all-cause, 12 662 CVD-, and 2426 cancer-related deaths were included. No significant association was observed between the highest levels of folate biomarkers and all-cause mortality risk (hazard ratio [HR], 0.91; 95% CI, 0.77-1.06; n = 17; I2 = 89.4%; P < .001), CVD-related mortality risk (HR, 0.97; 95% CI, 0.87-1.06; n = 11; I2 = 0.0%; P = .57), and cancer-related mortality risk (HR, 0.85; 95% CI, 0.69-1.05; n = 6; I2 = 57.8%; P = .04) compared with the lowest. Furthermore, each 10 nmol/L increase was marginally related to a 12% reduced all-cause mortality risk but not to CVD- and cancer-related mortality risk. A significant inverse association was found between highest intake of dietary folate and the lowest, and risk of all-cause (HR, 0.87; 95% CI, 0.78-0.96; n = 3; I2 = 63.6%; P = .06) and CVD (HR, 0.77; 95% CI, 0.57-0.93; n = 4; I2 = 80.2%; P = .002) mortality.

CONCLUSIONS

This meta-analysis revealed a significant inverse relation between dietary folate intake and risk of all-cause and CVD mortality. Such an association was not found in the case of folate biomarkers. Further prospective studies are warranted to confirm these findings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023401700.

The pharmacology of vitamin C

Ascorbic acid, the reduced form of vitamin C, is a ubiquitous small carbohydrate. Despite decades of focused research, new metabolic functions of this universal electron donor are still being discovered and add to the complexity of our view of vitamin C in human health. Although praised as an unsurpassed water-soluble antioxidant in plasma and cells, the most interesting functions of vitamin C seem to be its roles as specific electron donor in numerous biological reactions ranging from the well-known hydroxylation of proline to cofactor for the epigenetic master regulators ten-eleven translocation enzymes and Jumonji domain-containing histone-lysine demethylases. Some of these functions may have important implications for disease prevention and treatment and have spiked renewed interest in, eg, vitamin C's potential in cancer therapy. Moreover, some fundamental pharmacokinetic properties of vitamin C remain to be established including if other mechanisms than passive diffusion governs the efflux of ascorbate anions from the cell. Taken together, there still seems to be much to learn about the pharmacology of vitamin C and its role in health and disease. This review explores new avenues of vitamin C and integrates our present knowledge of its pharmacology. SIGNIFICANCE STATEMENT: Vitamin C is involved in multiple biological reactions of which most are essential to human health. Hundreds of millions of people are considered deficient in vitamin C according to accepted guidelines, but little is known about the long-term consequences. Although the complexity of vitamin C's physiology and pharmacology has been widely disregarded in clinical studies for decades, it seems clear that a deeper understanding of particularly its pharmacology holds the key to unravel and possibly exploit the potential of vitamin C in disease prevention and therapy.

Association of eating out of home and type 2 diabetes mellitus in Chinese urban workers: A nationwide study

Background

The prevalence of type 2 diabetes mellitus (T2DM) has been rapidly growing in Chinese populations in recent decades, and the shift in eating habits is a key contributing factor to this increase. Eating out of home (EOH) is one of the major shifts in eating habits during this period. However, the influence of EOH on the incidence of T2DM among Chinese urban workers is unknown.

Methods

The cross-sectional study involved an analysis of 13,904 urban workers recruited from 11 health examination centers in the major cities of China to explore the relationship between EOH and T2DM between 2013 September and 2016 March.

Results

Average weekly EOH frequency ≥10 times was positively associated with increased incidence of T2DM in the sampled population (OR: 1.31 [1.11-1.54], p < 0.01), most notably in participants ≤45 years old (OR: 1.41[1.11-1.80], p < 0.01]) and in males (OR:1.26 [1.06-1.51], p < 0.01). An EOH frequency of 5 times/week appears as a threshold for a significant increase in the odds of T2DM. Weekly EOH frequency ≥5 times was associated with increased odds of T2DM in a dose-response manner in the total population and almost all subgroups (p overall association < 0.05 and p nonlinearity ≤ 0.05).

Conclusion

This study showed that a frequency of EOH (≥5 times/week) was associated with a frequency-dependent increase in the odds of T2DM urban workers in China. More nutrition promotion is needed to improve the eating behavior of Chinese urban workers to reduce T2DM risk.

Association of serum folate concentrations with the mortality of cancer: a prospective cohort study

BACKGROUND

The association between serum folate concentrations and the mortality of cancer remains unclear. We aim to investigate the association of serum folate concentrations with all-cause and cause-specific mortality among American adults with cancer.

METHODS

This cohort study included 4535 patients with cancer from National Health and Nutrition Examination Survey (NHANES) 1999 to 2016 and NHANES III (1988-1994). Death outcomes were ascertained by linkage to National Death Index records through 31 December 2019. Cox proportional hazards model and two-piecewise Cox proportional hazards model were used to calculate hazard ratios and 95% confidence intervals for the associations between folate concentrations and the risk of mortality.

RESULTS

During a median follow-up of 37,792 person-years, there were 1998 all-cause deaths and 616 cancer deaths. Non-linear and L-shaped associations were observed between serum folate concentrations and the risk of all-cause and cancer mortality among patients with cancer. Notably, the mortality rates reached a plateau at 23.7 ng/mL for all-cause mortality and 23.57 ng/mL for cancer mortality. When folate levels fell below these thresholds, the risk of all-cause and cancer mortality decreased by approximately 2.1% (HR 0.979; 95% CI 0.969-0.989) and 3.6% (HR 0.964; 95% CI 0.948-0.981), respectively, with each unit increase in the folate concentration up to the thresholds.

CONCLUSION

Our study reveals that low serum folate concentrations are linked to an elevated risk of cancer mortality among individuals with cancer within a certain range and supplementation of folate in cancer patients to achieve specific serum folate level threshold (23.7 ng/mL) might reduce the risk of cancer mortality.

Vitamin E ameliorates blood cholesterol level and alters gut microbiota composition: A randomized controlled trial

BACKGROUND AND AIMS

Antioxidants, including vitamin E (VE) and grape seed extract (GSE), as anti-aging supplementation have been widely used to improve human health. The gut microbiota plays a crucial role in health and affects the treatment effect of various interventions. However, the role of gut microbiota in VE remains unclear. This study aimed to assess the longitudinal impact of VE treatment on body health and the gut microbiota.

METHODS AND RESULTS

A randomized controlled trial was conducted with 90 healthy individuals. The participants were randomly assigned to three groups: a treatment group receiving VE, another antioxidant treatment group receiving GSE, and a control group receiving a placebo. We found that VE ameliorated blood cholesterol levels by reducing the levels of low-density lipoprotein cholesterol (LDL-C) in healthy volunteers. After the intervention, there was an increase in the relative abundance of short-chain fatty acid (SCFA)-producing bacteria and bile acid metabolizers. Specifically, the abundances of Lachnospira sp. and Faecalibacterium spp. increased in the VE. Interestingly, the gut microbiota of poor responders harbored a greater proportion of disease-associated bacterial species.

CONCLUSIONS

VE could promote health by lowering LDL-C, partly and indirectly by affecting gut bacteria with the ability to produce SCFAs or metabolize bile acids.

REGISTRATION NUMBER FOR CLINICAL TRIALS

The clinical trial was registered on August 28, 2021. Registration number was ChiCTR2100050567 (https://www.chictr.org.cn).

Network pharmacology to unveil the blood components and mechanisms of Tongmai Yangxin Pills in treating elderly coronary heart disease

Background

Tongmai Yangxin Pills (TMYXP) is a well-known traditional Chinese medicine compound to treat coronary heart disease (CHD). Aging is a key immutable independent risk factor for CHD. Currently, there are few gene expression profiles of patients treated with traditional Chinese medicine (TCM) or TCM compound. However, the chemical composition and underlying mechanisms of TMYXP against elderly CHD need to be elucidated.

Objective

Exploring the mechanism of TMYXP in treating elderly CHD based on human gene expression profiles, and find the key pharmacodynamic ingredients of TMYXP in treating elderly CHD based on plasma pharmacochemistry and network pharmacology.

Methods

A strength of this study is the use of network pharmacology analysis of gene expression profiles in elderly CHD patients before and after TMYXP treatment. This study focused on peripheral blood mononuclear cell samples from 6 elderly patients with CHD over 60 years old (GSE142008). A total of 40 blood components of TMYXP identified by UPLC/Q-TOF-MS method in the plasma of SD rats. Then, we collected literature-validated TMYXP blood component targets for further network pharmacology analysis.

Results

All blood components of TMYXP exhibited non-toxic properties. By retrieving validated TMYXP blood components's targets, 15 blood components correspond to a total of 4,789 targets. Genistein, emodin, isoliquiritigenin, glycyrrhizic acid, gallic acid, verbascoside, calycosin, rhein, formononetin and ephedrine were the most potential anti-CHD blood components in TMYXP. The above 10 key blood components of TMYXP mainly regulate hub genes CASP3, TGFB1, PTGS2, CXCL8, FAS and JAK2, mediating multiple mechanisms to treat elderly CHD. TMYXP exerts anti-CHD effects on the TNF signaling pathway, PI3K-Akt signaling pathway, p53 signaling pathway, MAPK signaling pathway, lipid and atherosclerosis, NOD-like receptor signaling pathway, diabetic cardiomyopathy and cytokine-cytokine receptor interaction. We further used molecular docking technology to verify the direct interaction of TMYXP blood components with its hub target for treating elderly CHD.

Conclusion

This study builds a bridge connecting TMYXP blood components and its confirmed clinical efficacy, identifies a series of anti-CHD lead compounds, and analyzes their possible mechanisms for treating CHD. The research strategy of this study has the potential to promote the modernization and transformation of TCM and promote the drug development.

Association between fat-soluble vitamin co-exposure patterns and blood pressure in people with hypertension: a cross-sectional study

Background

Existing epidemiological studies investigated the association between a single vitamin and hypertension. However, the potential relationship between the level of circulating multivitamins and blood pressure has not been explored. We aimed to investigate the association between multiple fat-soluble vitamin levels and blood pressure.

Methods

A total of 2052 participants with essential hypertension were sampled nationwide. The plasma concentrations of fat-soluble vitamins (A, E, D, and K) were assessed using liquid chromatography coupled with the mass spectrometry method. Participants were categorized into different co-exposure patterns using the unsupervised K-means clustering method. The multiple linear regression model was used for subsequent analyses.

Results

Participants were classified into two co-exposure patterns of fat-soluble vitamins. The levels of vitamins were relatively low in pattern 1, compared to pattern 2. Participants in pattern 2 had no significantly different blood pressure levels compared to pattern 1. However, the plasma 25-hydroxyvitamin D3 (VD3) levels were negatively associated with SBP (logarithmic 10 transformed) (β = -0.002, 95% CI: -0.004, 0); participants in the fourth α-tocopherol quartile had mean SBP levels that were 1.02% (95% CI: 0.43, 1.61%) greater than those in the lowest quartile (p for trend <0.01). In addition, no significant relationships were found between plasma VA/VK concentrations and blood pressure.

Discussion

Although no significant association between fat-soluble vitamin co-exposure patterns and blood pressure was found, further analyses could imply that plasma α-tocopherol levels may offset the potential protective effect of plasma VD3 on blood pressure among hypertensive adults. This provided a novel perspective for exploring the joint effects of fat-soluble vitamins on blood pressure. Further studies are warranted to better understand the implications.

Clinical Importance of Protein Intake in Hospitalized Elderly Patients With Heart Failure

Background

The relationship between protein intake and the long-term prognosis of elderly patients with heart failure remains poorly understood. We investigated the association between predischarge protein intake and long-term prognosis in hospitalized elderly patients with heart failure.

Methods and Results

A single-center, retrospective analysis of hospitalized patients aged ≥65 years with heart failure and reduced ejection fraction was conducted. Protein intake was evaluated by nutritionists based on visual measurements of the percentage of dietary intake obtained for 7 days before discharge by a nurse. A cutoff of 1.2 g/kg/day protein intake was used to compare the incidence of a composite endpoint, including all-cause mortality and heart failure rehospitalization within 1 year. Among the 100 patients (median age 79 years; 47% male), 56% had low protein intake (<1.2 g/kg/day). Patients with low protein intake had a significantly higher rate of composite endpoints than those with high protein intake (50% vs. 20%; log-rank test P=0.03). Multivariable Cox proportional hazards model revealed that low protein intake was independently associated with long-term prognosis with a hazard ratio of 2.73 and a 95% confidence interval of 1.10-6.80 (P=0.03).

Conclusions

Low protein intake in the predischarge phase was associated with long-term prognosis in hospitalized elderly patients with heart failure and reduced ejection fraction.

Association Between Serum Folate Concentrations and 10-Year Stroke Risk in a Prospective Community Cohort: Mediation and Interaction Analyses

The relationship between folate concentrations and stroke risk remains unestablished, and the mediation effect of homocysteine (Hcy) and interaction effect of methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism has yet to be investigated. This cohort study involved 4903 subjects derived from a Chinese community population. The association between folate and first stroke was examined in Cox proportional hazard regression models. The mediation analyses involving Hcy and the undiscovered modification of the MTHFR C677T genotype were assessed. The mean (SD) age of subjects was 56.7 (8.8) years old, and 37.0% were male. A total of 407 strokes, 375 ischemic strokes and 47 hemorrhagic strokes occurred during the mean (SD) follow-up of 9.3 (1.8) years. The participants in the highest folate quartile (≥8.2 ng/mL) exhibited a lower stroke risk compared to those in the lowest quartile (hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.50-0.93, p = 0.017; p for trend = 0.009). Hcy significantly mediated 14.51% of the relationship between folate and stroke in the fully adjusted model. Only in individuals with the MTHFR 677CC genotype but not CT/TT genotype was folate adversely correlated with stroke (HR: 0.88, 95% CI: 0.79-0.97, p for interaction = 0.026) and ischemic stroke (HR: 0.88, 95% CI: 0.80-0.98, p for interaction = 0.035). Insufficient folate concentrations were associated with a heightened 10-year stroke risk, in which Hcy concentrations played a crucial mediating role. MTHFR C677T gene polymorphism could potentially modify the folate-stroke relationship.

The Influence of Berry-Derived Polyphenol Supplementation on Exercise-Induced Oxidative Stress and Cardiovascular Health in Physically Active Individuals

Numerous studies have documented that high-intensity or prolonged exercise is associated with increased oxidative stress and modification of antioxidant status. Polyphenol-rich dietary supplements seem to be the compounds that can upregulate the endogenous antioxidant defense system and consequently prevent muscle damage, support recovery. As berry fruits are at the top of the list of the richest polyphenol food sources, supplements containing berries have become the subject of interest in the context of counteracting exercise-induced oxidative stress and the development of cardiovascular diseases. The purpose of this review is to summarize current knowledge on the effects of berry-derived polyphenol supplementation on exercise-induced oxidative stress and cardiovascular health in physically active individuals. Based on the available literature, blackcurrant supplementation, with its richest version being New Zealand blackcurrant extract, is the most commonly explored berry fruit, followed by chokeberries and blueberries. Although several studies have documented the significant and beneficial influence of berry-derived supplements on redox status and cardiovascular response, some inconsistencies remain. The presented findings should be interpreted with caution due the limited number of available studies, particularly with the participation of physically active individuals. Further research is needed to reveal more comprehensive and accurate data concerning the impact of berry-derived supplements on exercise-induced outcomes taking into account the type of supplement, time of administration, and dosage.

The Effect of Antioxidant Polyphenol Supplementation on Cardiometabolic Risk Factors: A Systematic Review and Meta-Analysis

Background: Polyphenol is considered to exert a favorable impact on cardiovascular health. Methods: To summarize the role of polyphenol antioxidant supplements in cardiovascular disease, we searched for randomized controlled trials up to 10th November 2024 that reported estimates of the effects of polyphenol antioxidant supplements on cardiometabolic risk factors. Results: Of the 17,126 participants in the 281 studies, weighted mean differences [95% confidence intervals] were derived for the intervention condition utilizing random effects modeling. Our results suggest that multiple polyphenol supplements improved cardiovascular risk markers in the overall population. For example, catechin supplementation decreased systolic (-1.56 [-2.75, -0.37] mmHg) and diastolic blood pressure (-0.95 [-1.69, -0.20] mmHg), anthocyanin supplementation improved multiple blood lipid profiles, and curcumin supplementation benefited indicators of glucose metabolism. Conclusions: Our meta-analysis provides comprehensive evidence that antioxidant polyphenol supplementation can have beneficial effects on various cardiometabolic risk factors in the general population. The observed improvements in blood pressure, lipid profile, and glycemic status support the potential role of these supplements in cardiovascular health promotion. However, the heterogeneity among studies indicates that more research is needed to fully understand the optimal use of different polyphenols. Future research should concentrate on conducting a greater number of well-designed randomized controlled trials over extended periods of time to evaluate the long-term impact on cardiovascular endpoints and to ascertain the optimal doses and durations of antioxidant polyphenol supplementation. Furthermore, additional research is required to gain a deeper understanding of the underlying mechanisms responsible for these cardioprotective effects.

Genetic insights into the effect of trace elements on cardiovascular diseases: multi-omics Mendelian randomization combined with linkage disequilibrium score regression analysis

Objective

Epidemiological evidence indicates that trace elements are significantly associated with cardiovascular health. However, its causality and underlying mechanisms remain unclear. Therefore, this study aimed to investigate the causal relationship between trace elements and cardiovascular disease, as well as their potential mechanism of action.

Method

Two-sample Mendelian randomization (MR) analyses along with mediated and multivariate MR analyses were employed. These analyses utilized 13 trace elements as exposure variables and 20 cardiovascular diseases as outcome variables, with 4907 circulating plasma proteins, 1400 serum metabolites, 731 immune cell phenotypes, and 473 intestinal flora as potential mediators. The Bayesian weighted MR method was used to validate the MR results, and linkage disequilibrium score regression (LDSC) was applied to explore the genetic correlation between trace elements and cardiovascular disease.

Result

Our findings indicated a positive or negative causal relationship between genetically predicted trace elements and cardiovascular disease. An analysis using the Bayesian weighted MR method demonstrated that our causal inference results were reliable. The results of the mediated MR analyses indicate that potassium may reduce the risk of ischemic heart disease by influencing the expression of the plasma proteins BDH2 and C1R. Vitamin B12 may increase the risk of coronary atherosclerosis and cardiovascular death by reducing the levels of VPS29 and PSME1 proteins, while vitamin C may mitigate the risk of cardiac arrest by inhibiting the expression of the TPST2 protein. In addition, potassium can reduce the risk of ischemic heart disease by lowering 4-methoxyphenyl sulfate levels. None of the instrumental variables exhibited pleiotropy in the MR analysis. A sensitivity analysis using the leave-one-out method further confirmed the robustness of our findings. LDSC results indicated a genetic correlation between multiple trace elements and various cardiovascular diseases.

Conclusion

This study uncovered the true causal relationship between trace elements and cardiovascular disease risk using genetic methods, and revealed the significant mediating role of specific plasma proteins and metabolites in this relationship.

2024 Guideline for the Primary Prevention of Stroke: A Guideline From the American Heart Association/American Stroke Association

AIM

The "2024 Guideline for the Primary Prevention of Stroke" replaces the 2014 "Guidelines for the Primary Prevention of Stroke." This updated guideline is intended to be a resource for clinicians to use to guide various prevention strategies for individuals with no history of stroke.

METHODS

A comprehensive search for literature published since the 2014 guideline; derived from research involving human participants published in English; and indexed in MEDLINE, PubMed, Cochrane Library, and other selected and relevant databases was conducted between May and November 2023. Other documents on related subject matter previously published by the American Heart Association were also reviewed.

STRUCTURE

Ischemic and hemorrhagic strokes lead to significant disability but, most important, are preventable. The 2024 primary prevention of stroke guideline provides recommendations based on current evidence for strategies to prevent stroke throughout the life span. These recommendations align with the American Heart Association's Life's Essential 8 for optimizing cardiovascular and brain health, in addition to preventing incident stroke. We also have added sex-specific recommendations for screening and prevention of stroke, which are new compared with the 2014 guideline. Many recommendations for similar risk factor prevention were updated, new topics were reviewed, and recommendations were created when supported by sufficient-quality published data.

Cardiac Urea Cycle Activation by Time-Restricted Feeding Protects Against Pressure Overload-Induced Heart Failure

Heart failure is a leading cause of mortality worldwide, necessitating the development of novel therapeutic and lifestyle interventions. Recent studies highlight a potential role of time-restricted feeding (TRF) in the prevention and treatment of cardiac diseases. Here, it is found that TRF protected against heart failure at different stages in mice. Metabolomic profiling revealed that TRF upregulated most circulating amino acids, and amino acid supplementation protected against heart failure. In contrast, TRF showed a mild effect on cardiac amino acid profile, but increased cardiac amino acid utilization and activated the cardiac urea cycle through upregulating argininosuccinate lyase (ASL) expression. Cardiac-specific ASL knockout abolished the cardioprotective effects afforded by TRF. Circulating amino acids also protected against heart failure through activation of the urea cycle. Additionally, TRF upregulated cardiac ASL expression through transcription factor Yin Yang 1, and urea cycle-derived NO contributes to TRF-afforded cardioprotection. Furthermore, arteriovenous gradients of circulating metabolites across the human hearts were measured, and found that amino acid utilization and urea cycle activity were impaired in patients with decreased cardiac function. These results suggest that TRF is a promising intervention for heart failure, and highlight the importance of urea cycle in regulation of cardiac function.

Association between folate deficiency and hypertension: evidence from an observational and Mendelian randomization study

AIMS

Although folate intake might affect hypertension risk, evidence about the risk of hypertension according to an individual's folate deficiency status is scarce. Therefore, we aimed to investigate the relationship between folate deficiency and hypertension, and their causal associations.

METHODS AND RESULTS

A cross-sectional and prospective cohort study were performed in the UK Biobank (UKB) to investigate the associations between folate deficiency and hypertension prevalence and incidence, using logistic regression and Cox proportional hazard regression, respectively. Subsequently, we conducted one-sample Mendelian randomization (MR) with individual-level data from the UKB to further validate their causal associations. Finally, two-sample MR analyses were applied using summary-level data to further assess the causal relationships of serum folate with blood pressure (BP) and hypertension. In a total of up to 219,089 participants free of hypertension at enrollment, 17,670 participants developed hypertension after a median 12.8 years of follow-up. Compared with participants without folate deficiency, those with folate deficiency had a higher risk of hypertension (HR=1.42, 95% CI=1.24-1.63). One-sample MR analysis in the UKB provided supportive evidence for a causal effect of folate deficiency on hypertension risk (OR for the highest quantile=1.07, 95% CI=1.04-1.10, Ptrend<0.001). Furthermore, two-sample MR also supported a protective effect of higher levels of serum folate on BP (For systolic BP: β =-2.313, 95% CI=-3.532, -1.094; for diastolic BP: β = -1.648, 95% CI= -3.085, -0.211) and hypertension (β =-0.049, 95% CI=-0.069, -0.029).

CONCLUSIONS

Observational and genetically determined folate deficiency were associated with hypertension, suggesting that folate deficiency might be a causal risk factor for hypertension.

The Hypothesis of Trace Elements Involvement in the Coronary Arteries Atherosclerotic Plaques' Location

Background: Coronary artery disease (CAD) is a chronic inflammatory disease with multiple well-known risk factors. Although epidemiological studies report improvements in classical CAD risk-factor control, except for diabetes and obesity, cardiovascular diseases remain the leading causes of morbidity and mortality in the current population. The question regarding the atherosclerotic plaque location in particular arteries remains unanswered. Research on novel possible aspects that could help to properly understand atherosclerosis pathophysiology is essential. This study was based on a body trace-elements analysis, measured in scalp hair samples, as possible co-factors of various enzymes that may be crucial for CAD development. Methods: A total of 133 consecutive male patients with a median age of 71 (65-75) years, who presented with anginal symptoms of CCS class 2.0 (0.3) without previous heart-related interventions, were included in the analysis. The results of the cine-angiography were compared with the demographical, clinical, and laboratory results, followed by scalp-hair trace analysis. The possible predictors for coronary disease locations in the left descending artery (LAD), the circumflex artery (Cx), and the right coronary artery (RCA) were the subjects of this study. Results: Statistically significant differences in the scalp-hair trace elements concentration between the CAD and normal angiogram groups were noticed for magnesium (p = 0.003), calcium (p < 0.001), chromium (p = 0.011), and copper (p = 0.043). The multivariable analysis for epicardial atherosclerotic disease revealed the co-existence of diabetes mellitus (OR: 2.94, 95% CI: 1.27-6.79, p = 0.012) as a possible causative factor for the LAD location. The multivariable analysis for the atherosclerosis location in the Cx artery presented scalp-hair magnesium as a possible predictive factor (OR: 0.98, 95% CI: 0.96-1.00, p = 0.024). The multivariable model for the RCA location of atherosclerotic plaque indicated scalp-hair Zn concentration (0.99, 95% CI: 0.98-1.00, p = 0.002) and serum HDL (OR: 0.61, 95% CI: 0.04-0.09, p = 0.016). Conclusions: Possible hypothetical distinctive pathomechanisms, in particular, coronary artery involvement, in atherosclerosis processes are presented in the male group. Diabetes mellitus was found to be the primary factor for left descending artery disease. The low scalp-hair magnesium concentration was found to be a possible risk factor involved in the circumflex artery atherosclerotic plaque location. The inverse relation between serum high-density lipoprotein, the scalp hair zinc concentration, and right coronary disease was noticed.

Integrated metabolomic and transcriptomic analysis reveals the effects and mechanisms of Jinqi Jiangtang tablets on type 2 diabetes

BACKGROUND

Type 2 diabetes (T2DM) is one of the major metabolic diseases and poses a serious challenge to human life and global economic development. Jinqi Jiangtang Tablets (JQJT) is effective in ameliorating the effects of T2DM, but the mechanism of JQJT is unclear.

PURPOSE

This study integrated metabolomics and transcriptomics to reveal the mechanism by which JQJT improves T2DM.

METHODS

The T2DM mouse model was established, and the effects of JQJT on improving T2DM were evaluated by determining the levels of blood lipids, fasting blood glucose (FBG), insulin metabolism and hepatic lipid accumulation in mice after JQJT administration for 8 weeks. Serum metabolites were detected using ultra-performance liquid chromatography/quadrupole time-of-flight-tandem mass spectrometry (UPLC-Q-TOF-MS) technology, and mouse liver differential genes were detected using transcriptomic technology. Correlation analysis was used to extract metabolites and RNA with correlations, and potential pathways were enriched and constructed using the common pathway analysis function of MetaboAnalyst 5.0. Finally, the expression of key target proteins and genes was verified by Western blot (WB) and Polymerase Chain Reaction (PCR) to further elucidate the mechanism by which JQJT improves T2DM.

RESULTS

JQJT reduced FBG and lipid levels, improved insulin resistance (IR) and hepatic lipoatrophy in mice. A total of 35 differentially abundant metabolites were identified by metabolomics, and 328 differential genes were detected by transcriptomics. The integrated metabolomics and transcriptomics results suggested that JQJT may ameliorate T2DM mainly by regulating glucose and lipid metabolic pathways. WB and PCR results showed that JQJT regulates the insulin signaling pathway, involved in fatty acid metabolism, glycogen synthesis and catabolism.

CONCLUSIONS

JQJT improved IR in T2DM mice by regulating the insulin signaling pathway, improving glycogen synthesis and glycolysis, and increasing hepatic triglyceride and fatty acid metabolism.

Circulating amino acid signature features urea cycle alterations associated with coronary artery disease

Coronary artery disease (CAD) remains a leading cause of death worldwide and imposes a substantial socioeconomic burden on healthcare. Improving risk stratification in clinical practice could help to combat this burden. As amino acids are biologically active metabolites whose involvement in CAD remains largely unknown, this study investigated associations between circulating amino acid levels and CAD phenotypes. A high-coverage quantitative liquid chromatography-mass spectrometry approach was applied to acquire the serum amino acids profile of age- and sex-coarsened-matched patients with CAD (n = 46, 66.9 years, 74.7% male) and healthy individuals (n = 120, 67.4 years, 74.7% male) from the COmPLETE study. Multiple linear regressions were performed to investigate associations between amino acid levels and (a) the health status (CAD vs. healthy), (b) the number of affected coronary arteries, or (c) the left ventricular ejection fraction. Regressions were adjusted for age, sex, daily physical activity, sampling, and fasting time. Urea cycle amino acids (ornithine, citrulline, homocitrulline, aspartate, and arginine) were significantly and negatively associated with CAD, the number of affected coronary arteries, and the left ventricular ejection fraction. Lysine, histidine, and the glutamine/glutamate ratio were also significantly and negatively associated with the CAD phenotypes. Overall, patients with CAD displayed lower levels of urea cycle amino acids, highlighting a potential role for urea cycle amino acid profiling in cardiovascular risk stratification.Trial registrationThe study was registered on https://www.clinicaltrials.gov (NCT03986892) on June 5, 2019.

Nitric Oxide Signaling and Regulation in the Cardiovascular System: Recent Advances

Nitric oxide (NO) from endothelial NO synthase importantly contributes to vascular homeostasis. Reduced NO production or increased scavenging during disease conditions with oxidative stress contribute to endothelial dysfunction and NO deficiency. In addition to the classical enzymatic NO synthases (NOS) system, NO can also be generated via the nitrate-nitrite-NO pathway. Dietary and pharmacological approaches aimed at increasing NO bioactivity, especially in the cardiovascular system, have been the focus of much research since the discovery of this small gaseous signaling molecule. Despite wide appreciation of the biological role of NOS/NO signaling, questions still remain about the chemical nature of NOS-derived bioactivity. Recent studies show that NO-like bioactivity can be efficiently transduced by mobile NO-ferroheme species, which can transfer between proteins, partition into a hydrophobic phase, and directly activate the soluble guanylyl cyclase-cGMP-protein kinase G pathway without intermediacy of free NO. Moreover, interaction between red blood cells and the endothelium in the regulation of vascular NO homeostasis have gained much attention, especially in conditions with cardiometabolic disease. In this review we discuss both classical and nonclassical pathways for NO generation in the cardiovascular system and how these can be modulated for therapeutic purposes. SIGNIFICANCE STATEMENT: After four decades of intensive research, questions persist about the transduction and control of nitric oxide (NO) synthase bioactivity. Here we discuss NO signaling in cardiovascular health and disease, highlighting new findings, such as the important role of red blood cells in cardiovascular NO homeostasis. Nonclassical signaling modes, like the nitrate-nitrite-NO pathway, and therapeutic opportunities related to the NO system are discussed. Existing and potential pharmacological treatments/strategies, as well as dietary components influencing NO generation and signaling are covered.

The impacts of diet on cardiac performance under changing environments

Natural and anthropogenic stressors are dramatically altering environments, impacting key animal physiological traits, including cardiac performance. Animals require energy and nutrients from their diet to support cardiac performance and plasticity; however, the nutritional landscape is changing in response to environmental perturbations. Diet quantity, quality and options vary in space and time across heterogeneous environments, over the lifetime of an organism and in response to environmental stressors. Variation in dietary energy and nutrients (e.g. lipids, amino acids, vitamins, minerals) impact the heart's structure and performance, and thus whole-animal resilience to environmental change. Notably, many animals can alter their diet in response to environmental cues, depending on the context. Yet, most studies feed animals ad libitum using a fixed diet, thus underestimating the role of food in impacting cardiac performance and resilience. By applying an ecological lens to the study of cardiac plasticity, this Commentary aims to further our understanding of cardiac function in the context of environmental change.

Exploring the diagnostic and immune infiltration roles of disulfidptosis related genes in pulmonary hypertension

BACKGROUND

Pulmonary hypertension (PH) is marked by elevated pulmonary artery pressures due to various causes, impacting right heart function and survival. Disulfidptosis, a newly recognized cell death mechanism, may play a role in PH, but its associated genes (DiGs) are not well understood in this context. This study aims to define the diagnostic relevance of DiGs in PH.

METHODS

Using GSE11726 data, we analyzed DiGs and their immune characteristics to identify core genes influencing PH progression. Various machine learning models, including RF, SVM, GLM, and XGB, were compared to determine the most effective diagnostic model. Validation used datasets GSE57345 and GSE48166. Additionally, a CeRNA network was established, and a hypoxia-induced PH rat model was used for experimental validation with Western blot analysis.

RESULTS

12 DiGs significantly associated with PH were identified. The XGB model excelled in diagnostic accuracy (AUC = 0.958), identifying core genes DSTN, NDUFS1, RPN1, TLN1, and MYH10. Validation datasets confirmed the model's effectiveness. A CeRNA network involving these genes, 40 miRNAs, and 115 lncRNAs was constructed. Drug prediction suggested therapeutic potential for folic acid, supported by strong molecular docking results. Experimental validation in a rat model aligned with these findings.

CONCLUSION

We uncovered the distinct expression patterns of DiGs in PH, identified core genes utilizing an XGB machine-learning model, and established a CeRNA network. Drugs targeting the core genes were predicted and subjected to molecular docking. Experimental validation was also conducted for these core genes.

The Association of Dietary Micronutrient Intake and Systemic Inflammation among Patients with Type 2 Diabetes: A Cross-Sectional Study

Inflammation contributes to the pathogenesis of type 2 diabetes (T2DM). This study sought to document how the systemic biomarkers of inflammation varied based on food choices among patients with T2DM. This cross-sectional study enrolled ambulatory patients with T2DM. Demographic and clinical information was collected. Five drops of fingerstick blood were collected using an absorbent paper device (HemaSpot HFR). C-reactive protein (CRP), serum amyloid A protein (SAA), and fibrinogen were measured using a Luminex assay. Patient-generated 7-day food diaries were analyzed using a validated food processor software. Data were analyzed by Pearson's correlation tests, linear regression and logistic regression with the significance level set at 0.05. Among the 71 participants, 43 (60.6%) were females. The average age and duration of T2DM were 64.1 ± 10.3 and 15.8 ± 9.1 years, respectively. In a simple linear regression run with selected micronutrients, iron [F (1, 53) = 5.319, p < 0.05, adj. R2 = 0.074] significantly predicted plasma CRP. This significance was lost with multiple linear regressions including age, gender, BMI, T2DM duration, T2DM complications, glycohemoglobin A1c (HbA1c) and other micronutrients. The average intake of most micronutrients by the participants was below the recommended daily intake. A higher intake of iron-rich foods was associated with higher levels of systemic inflammation in a simple linear regression model, but the association was not present after adjusting for patient factors like age, gender, BMI and T2DM-related variables. This relationship needs to be explored further given the key role of inflammation in the pathogenesis of T2DM and its associated complications.

The Efficacy of Vitamins in the Prevention and Treatment of Cardiovascular Disease

Vitamins are known to affect the regulation of several biochemical and metabolic pathways that influence cellular function. Adequate amounts of both hydrophilic and lipophilic vitamins are required for maintaining normal cardiac and vascular function, but their deficiencies can contribute to cardiovascular abnormalities. In this regard, a deficiency in the lipophilic vitamins, such as vitamins A, D, and E, as well as in the hydrophilic vitamins, such as vitamin C and B, has been associated with suboptimal cardiovascular function, whereas additional intakes have been suggested to reduce the risk of atherosclerosis, hypertension, ischemic heart disease, arrhythmias, and heart failure. Here, we have attempted to describe the association between low vitamin status and cardiovascular disease, and to offer a discussion on the efficacy of vitamins. While there are inconsistencies in the impact of a deficiency in vitamins on the development of cardiovascular disease and the benefits associated with supplementation, this review proposes that specific vitamins may contribute to the prevention of cardiovascular disease in individuals at risk rather than serve as an adjunct therapy.

Association between composite dietary antioxidant index and stroke among individuals with diabetes

BACKGROUND

Recent research has underscored the potentially protective role of dietary antioxidants against chronic conditions, such as cardiovascular diseases and stroke. The composite dietary antioxidant index (CDAI), which reflects the overall intake of key dietary antioxidants, has been identified as a crucial metric for exploring this relationship. Although previous research has shown a negative correlation between CDAI levels and stroke risk in prediabetic individuals, there remains a substantial gap in understanding this association among individuals with dia-betes, who are at an inherently greater risk for cerebrovascular events.

AIM

To investigate the association between CDAI and stroke risk in individuals with diabetes.

METHODS

Using a cross-sectional study design, this investigation analyzed data from the National Health and Nutrition Examination Survey spanning from 2003 to 2018 that included 6735 participants aged over 20 years with diabetes. The CDAI was calculated from 24-h dietary recalls to assess intake of key antioxidants: Vitamins A, C, and E; carotenoids; selenium; and zinc. Multivariate logistic regression and restricted cubic spline analysis were used to rigorously examine the relationship between CDAI and stroke risk.

RESULTS

The participant cohort, with an average age of 59.5 years and a slight male majority, reflected the broader demographic characteristics of individuals with diabetes. The analysis revealed a strong inverse relationship between CDAI levels and stroke risk. Remarkably, those in the highest quintile of CDAI demonstrated a 43% lower prevalence of stroke compared to those in the lowest quintile, even after adjustments for various confounders. This finding not only highlights the negative association between CDAI and stroke risk but also underscores the significant potential of antioxidant-rich diets in reducing stroke prevalence among patients with diabetes.

CONCLUSION

Our findings suggested that CDAI was inversely associated with stroke prevalence among patients with diabetes. These results suggest incorporating antioxidant-rich foods into dietary regimens as a potential strategy for stroke prevention.

Associations of Diet and Lifestyle with Mortality and Stroke: The China Cardiometabolic Disease and Cancer Cohort (4C) Study

OBJECTIVE

This study aimed to examine the individual and combined associations between dietary habits and lifestyle factors concerning all-cause mortality and stroke in Chinese adults.

METHOD

We conducted a nationwide, multicenter, prospective cohort study involving 10,008 participants, gathering baseline data on lifestyle, metabolic status, dietary habits, and living behaviors. Subsequently, a 10-year follow-up was performed, resulting in the inclusion of 7,612 participants in this study. We employed Spearman correlation analysis, restricted cubic spline regression, and Cox regression analysis to evaluate the connections between outcome events, dietary habits, and lifestyle.

RESULT

For each additional serving of pulses consumed per week, there was a slight decrease in the risk of all-cause mortality (HR: 0.91, 95% CI: 0.83-0.99). The hazard ratios for stroke were 2.24 (1.48, 3.37) for current smokers, in comparison to individuals who had never smoked. Appropriate intake of specific dietary factors and certain lifestyle habits were associated with reduced stroke: fruit drinks at 0.51 (0.34, 0.87), and animal viscera at 0.58 (0.32, 1.04). Weekly consumption of at least 21 servings of vegetables (0.72, 0.53-0.98), 0-1 serving of fried food (0.58, 0.38-0.90), and at least 1 serving of carbonated beverages (0.51, 0.28-0.92) was associated with a reduced risk of stroke.

CONCLUSION

Smoking was found to be linked to an increased risk of stroke. A higher intake of fruit drinks and animal viscera was associated with a reduced risk of stroke. In contrast, a higher intake of beans was associated with a decreased risk of overall mortality. Consuming an appropriate amount of vegetables, fried foods, and carbonated drinks was found to potentially lower the risk of stroke. Collectively, these findings underscore the importance of developing tailored dietary interventions conducive to the Chinese populace's health.

Cardiometabolic Risk Factors Associated with Magnesium and Vitamin D Nutrients during Pregnancy-A Narrative Review

This narrative review comprehensively explores the cardiometabolic implications of two vital nutrients, magnesium and vitamin D, during gestation. Magnesium, a key regulator of vascular tone, glucose metabolism, and insulin sensitivity, plays a crucial role in mitigating gestational hypertension and diabetes, a point this review underscores. Conversely, vitamin D, critical for immune response and calcium level maintenance, is linked to gestational diabetes and hypertensive disorders of pregnancy. The authors aim to enhance comprehension of the complex interaction between these nutrients and cardiometabolic function in pregnancy, knowledge that is pivotal for optimizing maternal-fetal outcomes. The mother's health during pregnancy significantly influences the long-term development of the fetus. Recognizing the impact of these nutrient deficiencies on the physiology of cardiometabolic cycles underscores the importance of adequate nutritional support during pregnancy. It also emphasizes the pressing need for future research and targeted interventions to alleviate the burden of pregnancy complications, highlighting the crucial role of healthcare professionals, researchers, and policy makers in obstetrics and gynecology in this endeavor.

The Role of Antioxidants in the Therapy of Cardiovascular Diseases-A Literature Review

Antioxidants are endogenous and exogenous substances with the ability to inhibit oxidation processes by interacting with reactive oxygen species (ROS). ROS, in turn, are small, highly reactive substances capable of oxidizing a wide range of molecules in the human body, including nucleic acids, proteins, lipids, carbohydrates, and even small inorganic compounds. The overproduction of ROS leads to oxidative stress, which constitutes a significant factor contributing to the development of disease, not only markedly diminishing the quality of life but also representing the most common cause of death in developed countries, namely, cardiovascular disease (CVD). The aim of this review is to demonstrate the effect of selected antioxidants, such as coenzyme Q10 (CoQ10), flavonoids, carotenoids, and resveratrol, as well as to introduce new antioxidant therapies utilizing miRNA and nanoparticles, in reducing the incidence and progression of CVD. In addition, new antioxidant therapies in the context of the aforementioned diseases will be considered. This review emphasizes the pleiotropic effects and benefits stemming from the presence of the mentioned substances in the organism, leading to an overall reduction in cardiovascular risk, including coronary heart disease, dyslipidaemia, hypertension, atherosclerosis, and myocardial hypertrophy.

Effects of high-quality protein supplementation on cardiovascular risk factors in individuals with metabolic diseases: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Uncertainties still existed about the effect of high-quality protein supplementation on cardiovascular disease (CVD) risk factors, although high-quality proteins such as soy and milk proteins have proposed to be beneficial for cardiometabolic health.

METHODS

A systematic search in PubMed, Web of Science, Cochrane Library, Scopus, and Embase was conducted to quantify the impact of high-quality protein on CVD risk factors.

RESULTS

63 RCTs on 4 types of high-quality protein including soy protein, milk protein, whey, and casein were evaluated. Soy protein supplementation decreased systolic blood pressure (SBP, -1.42 [-2.68, -0.17] mmHg), total cholesterol (TC, -0.18 [-0.30, -0.07] mmol/L), and low-density lipoprotein cholesterol (LDL-C, -0.16 [-0.27, -0.05] mmol/L). Milk protein supplementation decreased SBP (-2.30 [-3.45, -1.15] mmHg) and total cholesterol (-0.27 [-0.51, -0.03] mmol/L). Whey supplementation decreased SBP (-2.20 [-3.89, -0.51] mmHg), diastolic blood pressure (DBP, -1.07 [-1.98, -0.16] mmHg), triglycerides (-0.10 [-0.17, -0.03] mmol/L), TC (-0.18 [-0.35, -0.01] mmol/L), LDL-C (-0.09 [-0.16, -0.01] mmol/L) and fasting blood insulin (FBI, -2.02 [-3.75, -0.29] pmol/L). Casein supplementation decreased SBP (-4.10 [-8.05, -0.14] mmHg). In the pooled analysis of four high-quality proteins, differential effects were seen in individuals with different health status. In hypertensive individuals, high-quality proteins decreased both SBP (-2.69 [-3.50, -1.87] mmHg) and DBP (-1.34 [-2.09, -0.60] mmHg). In overweight/obese individuals, high-quality proteins improved SBP (-1.40 [-2.22, -0.59] mmHg), DBP (-2.59 [-3.20, -1.98] mmHg), triglycerides (-0.09 [-0.15, -0.02] mmol/L), TC (-0.14 [-0.22, -0.05] mmol/L), LDL-C (-0.12 [-0.16, -0.07] mmol/L), and HDL-C levels (0.02 [0.01, 0.04] mmol/L). According to the benefits on CVD risks factors, whey ranked top for improving cardiometabolic health in hypertensive or overweight/obese individuals.

CONCLUSION

Our study supports a beneficial role of high-quality protein supplementation to reduce CVD risk factors. Further studies are still warranted to investigate the effects of different high-quality proteins on CVD risks in individuals with cardiometabolic disorders.

Antioxidant Lipid Supplement on Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis

The efficacy of functional lipids with antioxidant properties in reducing cardiovascular risk has not been consistent. Randomized controlled trials (RCTs) reporting estimates for the effects of antioxidant functional lipid supplementations on cardiometabolic risk factors were searched up to 1 May 2024. Overall, antioxidant lipid supplementations, compared with placebo, had favorable effects on systolic blood pressure (lycopene: -1.95 [-3.54, -0.36] mmHg), low-density lipoprotein cholesterol (n6 fatty acid: -0.39 [-0.71, -0.06] mmol/L; astaxanthin: -0.11 [-0.21, -0.01] mmol/L), high-density lipoprotein cholesterol (n3 fatty acid: 0.20 [0.13, 0.27] mmol/L; n6 fatty acid: 0.08 [0.01, 0.14] mmol/L; astaxanthin: 0.13 [0.05, 0.21] mmol/L), total cholesterol (n6 fatty acid: -0.24 [-0.37, -0.11] mmol/L; astaxanthin: -0.22 [-0.32, -0.12] mmol/L; beta-carotene: -0.13 [-0.23, -0.04] mmol/L), triglyceride (n3 fatty acid: -0.37 [-0.47, -0.28] mmol/L; astaxanthin: -0.46 [-0.83, -0.10] mmol/L), and fasting blood insulin (astaxanthin: -2.66 [-3.98, -1.34] pmol/L). The benefits of antioxidant lipid supplementations appeared to be most evident in blood pressure and blood lipids in participants with different cardiometabolic health statuses. Notably, n9 fatty acid increased triglyceride and hemoglobin A1C in the total population, which increases CVD risk. Antioxidant lipid supplementations ameliorate cardiometabolic risk factors, while their effect may depend on type and cardiometabolic health status. Long-term RCTs are needed to corroborate risk-benefit ratios across different antioxidant functional lipid supplementation settings.

Folic acid supplementation for stroke prevention: A systematic review and meta-analysis of 21 randomized clinical trials worldwide

BACKGROUND & AIMS

The AHA/ASA guidelines for primary stroke prevention are almost a decade old. The current recommendation regarding folic acid supplementation is based on only 8 clinical trials, and an additional 13 folate trials have been published since then. This meta-analysis aims to fill in critical evidence gaps by comprehensively evaluating 21 published trials with particular attention given to identifying the true influences through stratification.

METHODS

PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched from inception to April 4, 2023. This study included all randomized controlled trials (RCTs) of folic acid with stroke as one of the reporting endpoints. Relative risks and 95% confidence intervals were used to assess the association between folic acid supplementation and the risk of stroke in a random-effects model.

RESULTS

Results from the 21 pooled RCTs totaling 115,559 participants showed that folic acid supplementation significantly reduced the risk of stroke by 10% (RR 0.90, 95%CI 0.83 to 0.98). Subgroup analyses showed that folic acid efficacy was greater in areas without fortified grain or with partially-fortified grain (RR = 0.83, 95% CI 0.75 to 0.93; RR = 1.04 in areas with grain fortification, P-interaction = 0.003). In this group, folic acid supplementation was most efficacious in those without a history of stroke or myocardial infarction (RR = 0.77, 95% CI 0.68 to 0.86; RR = 0.94 for participants with a history of stroke or myocardial infarction, P-interaction = 0.008). The efficacy of folic acid remained consistent regardless of baseline folate levels, folic acid dosage, baseline vitamin B12 levels, vitamin B12 dosage, homocysteine reduction, intervention duration, and whether folic acid was taken alone or in combination (all P-interaction>0.05). All 21 trials were free of attrition bias and reporting bias, and there was no significant publication bias.

CONCLUSIONS

This is by far the largest meta-analysis of RCTs regarding folic acid supplementation and stroke, demonstrating the overall benefit of folic acid for stroke prevention. Grain fortification and history of stroke or myocardial infarction may be the most important influences on the efficacy of folic acid for stroke prevention.

Association of composite dietary antioxidant index with cardiovascular disease in adults: results from 2011 to 2020 NHANES

BACKGROUND

Oxidative stress is a known pathogenic mechanism in cardiovascular disease (CVD), yet the association between dietary antioxidants and CVD in the general population remains underexplored. This study leverages data from the National Health and Nutrition Examination Survey (NHANES) to investigate the association of a composite dietary antioxidant index with CVD in US adults.

METHODS

Analyzing data from 25,997 adults (2011-2020 NHANES), we employed weighted generalized linear models, subgroup analysis, threshold effect analyses, and sensitivity analysis to assess the association between dietary antioxidants and CVD. Nonlinear associations were explored through a restricted cubic spline, with gender-specific stratification and threshold effect analysis to identify critical inflection points.

RESULTS

Increasing levels of the composite dietary antioxidant index corresponded with decreased CVD prevalence (P < 0.001). In all models, weighted generalized linear models revealed a consistent negative association between CVD prevalence. And in Model 3, Quartile 4 had a 29% lower CVD prevalence than Quartile 1[0.71 (0.59, 0.85), P < 0.001]. Meanwhile, the findings of the unweighted logistic regression model demonstrated stability. Various characteristics such as sex, age, race, PIR, education, BMI, alcohol consumption, hypertension, hyperlipidemia, and diabetes did not influence this inverse association (P for interaction >0.05). Notably a nonlinear association was observed, with a significant inflection point at 3.05 among women.

CONCLUSION

This study demonstrates a strong negative association between the composite dietary antioxidant index and CVD prevalence, suggesting the potential protective role of dietary antioxidants. These findings underscore the need for prospective studies to further understand the impact of oxidative stress on cardiovascular health.

Effect of Coenzyme Q10 on Physical Performance in Older Adults with Statin-Associated Asthenia: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial

Background: Available evidence from randomized clinical trials is contrasting and definitely inconclusive in determining whether or not CoQ10 dietary supplementation is advisable in patients with statin intolerance or poor statin tolerability. Methods: This randomized, double-blind, placebo-controlled clinical study aimed at investigating the effect of chronic dietary supplementation with coenzyme Q10 (CoQ10) phytosome on physical performance in older adults with a ≥3-month history of statin-associated asthenia. The study's participants were randomized to either a placebo or 300 mg daily CoQ10 phytosome (equivalent to 60 mg CoQ10; Ubiqsome®, Indena SpA, Milan, Italy). Asthenia, handgrip strength (HGs), 2-min step test (2MST), and 1-min sit-to-stand (STS) repetitions were assessed at baseline and at 8-week follow-up. Results: After the first 4 weeks of dietary supplementation, individuals taking CoQ10 phytosome showed a greater improvement in asthenia compared to the placebo group (p < 0.05). Even more significantly, at 8-week follow-up, participants receiving CoQ10 showed substantial improvements in asthenia (-30.0 ± 20.0%), HGS (+29.8 ± 3.6%), 2MST (+11.1 ± 1.8%), and 1-min STS repetitions (+36.4 ± 3.9%) compared to both baseline and placebo (p < 0.05). Conclusions: According to our findings, chronic dietary supplementation with CoQ10 phytosome significantly enhances physical performance in older adults with statin-associated asthenia. This could have relevant implications for improving the compliance of older adults with statin treatment.

Associations of dietary selenium intake with the risk of chronic diseases and mortality in US adults

Objective

Selenium is an essential micronutrient and a type of dietary antioxidant. This study aimed to investigate the associations of dietary selenium intake with the risk of human chronic disease [cardiovascular disease (CVD), diabetes mellitus (DM), and cancer] and mortality among US general adults.

Methods

The dietary and demographic data in this study were collected from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. Death outcomes were determined by associating with the National Death Index (NDI) records as of December 31, 2019. Logistic regression analyses were used to investigate the relationship of selenium intake with the risk of CVD, DM, and cancer. The effect of dietary selenium on all-cause and disease-specific mortality was estimated with restricted cubic spline (RCS) curves based on the univariate and multivariate Cox proportional hazard models.

Results

Among the 25,801 participants, dietary selenium intake was divided into quintiles (Q1-Q5). After covariate adjustment, the results showed that the participants with higher quintiles (Q4 and Q5) of selenium intake tended to have a low risk of CVD (OR = 0.97, 95% CI: 0.96, 0.99; OR = 0.98, 95% CI: 0.97, 1.00, respectively). Moreover, the RCS curves showed a significant nonlinear association between selenium intake and the risk of all-cause (with a HR of 0.82, 95% CI: 0.68, 0.99) and DM-specific mortality (with the lowest HR of 0.30; 95% CI, 0.12-0.75). Furthermore, we conducted a subgroup analysis and found a negative correlation between the highest quartile of selenium intake and all-cause mortality among participants aged 50 and above (HR = 0.75, 95% CI: 0.60-0.93, p = 0.009).

Conclusion

Our results indicated that a moderate dietary selenium supplement decreased the risk of CVD and displayed a nonlinear trend in association with the risk of all-cause and DM-specific mortality among US adults. In addition, we found that participants aged 50 and older may benefit from higher selenium intake. However, these findings still need to be confirmed through further mechanism exploration.

Melatonin and Vascular Function

The indolamine hormone melatonin, also known as N-acetyl-5-methoxytrypamine, is frequently associated with circadian rhythm regulation. Light can suppress melatonin secretion, and photoperiod regulates melatonin levels by promoting its production and secretion at night in response to darkness. This hormone is becoming more and more understood for its functions as an immune-modulatory, anti-inflammatory, and antioxidant hormone. Melatonin may have a major effect on several diabetes-related disturbances, such as hormonal imbalances, oxidative stress, sleep disturbances, and mood disorders, according to recent research. This has raised interest in investigating the possible therapeutic advantages of melatonin in the treatment of diabetic complications. In addition, several studies have described that melatonin has been linked to the development of diabetes, cancer, Alzheimer's disease, immune system disorders, and heart diseases. In this review, we will highlight some of the functions of melatonin regarding vascular biology.

Selenium as a Modulator of Redox Reactions in the Prevention and Treatment of Cardiovascular Diseases

Cardiovascular diseases stand as the predominant global cause of mortality, exerting a profound impact on both life expectancy and its quality. Given their immense public health burden, extensive efforts have been dedicated to comprehending the underlying mechanisms and developing strategies for prevention and treatment. Selenium, a crucial participant in redox reactions, emerges as a notable factor in maintaining myocardial cell homeostasis and influencing the progression of cardiovascular disorders. Some disorders, such as Keshan disease, are directly linked with its environmental deficiency. Nevertheless, the precise extent of its impact on the cardiovascular system remains unclear, marked by contradictory findings in the existing literature. High selenium levels have been associated with an increased risk of developing hypertension, while lower concentrations have been linked to heart failure and atrial fibrillation. Although some trials have shown its potential effectiveness in specific groups of patients, large cohort supplementation attempts have generally yielded unsatisfactory outcomes. Consequently, there persists a significant need for further research aimed at delineating specific patient cohorts and groups of diseases that would benefit from selenium supplementation.

LLL 44-4 : Micronutrients in acute disease and critical illness

Micronutrients (MN), i.e. trace elements and vitamins, are essential components of the diet in relatively small amounts in any form of nutrition, with special needs in critically ill patients. Critical illness is characterised by the presence of inflammation and oxidative stress. MNs are tightly involved in antioxidant and immune defences. In addition, some conditions, and treatments result in large losses of biological fluids containing MNs: therefore, acute renal injury requiring renal replacement therapy, acute intestinal failure, and major burns and trauma are at high risk of acute depletion of body stores, and of deficiency. MN requirements are increased above standard DRI. Blood level interpretation is complicated by inflammation: some biomarkers assist the status determination. Due to the acute challenges of critical illness, it of utmost importance to cover the needs to maintain the organism's endogenous immune and antioxidant defences, and capacity to repair tissues. Practical strategies are proposed.

Can Daily Dietary Choices Have a Cardioprotective Effect? Food Compounds in the Prevention and Treatment of Cardiometabolic Diseases

Cardiovascular diseases accompanying metabolic syndrome comprise one of the leading causes of death worldwide. The medical community undertakes attempts to improve treatment options and minimize cardiovascular diseases' numerous consequences and exacerbations. In parallel with pharmacotherapies provided by physicians, nutritionists are developing strategies for diet therapy and prevention based on lifestyle changes, with high success rates. Consumption of specified food compounds included in various products with proven protective properties can be helpful in this regard. Due to the wide possibilities of diet in metabolic health promotion, it seems necessary to systematize information about the metabolically protective and cardioprotective properties of fiber, probiotic bacteria, plant sterols, folic acid, vitamins B12, C, and E, PUFAs, lycopene, polyphenols, arginine, CoQ10, and allicin. The aim of this review was to present the food compounds with potential use in cardiometabolic prevention and diet therapy based on the latest available literature.

Association of composite dietary antioxidant index with mortality in adults with hypertension: evidence from NHANES

Objective

The objective of this study is to assess the correlation between composite dietary antioxidant index (CDAI) with all-cause mortality and cause-specific mortality in adults with hypertension.

Methods

The cohort study comprised adult participants with hypertension from the NHANES database, spanning 9 cycles from 2001 to 2018. Follow-up was conducted until December 31, 2019. Multi-variable Cox regression analysis was utilized to ascertain hazard ratios (HR) and their corresponding 95% confidence intervals, evaluating the relationship between CDAI and the risks of all-cause and cause-specific mortality. To further investigate the association between CDAI and mortality rates in adults with hypertension, Kaplan-Meier survival curves, restricted cubic splines (RCS), subgroup analyses and sensitivity analyses were employed.

Results

The analysis included 16,713 adults with hypertension (mean age 56.93 ± 0.23 years, 8,327 [49.61%] male). During the mean follow-up time 102.11 ± 1.22 months, with 3,908 (18.08%) all-cause mortality occurred, 1,082 (4.84%) cardiovascular mortality and 833 (3.80%) cancer mortality. Compared to the lowest quartile of CDAI, the weighted multivariate hazard ratios of participants in the highest quartile was 0.77 (95% CI, 0.68-0.87) for all-cause mortality, 0.83 (95% CI, 0.67-1.04) for cardiovascular mortality, and 0.64 (95% CI, 0.50-0.82) for cancer mortality. RCS analysis demonstrated a nonlinear association of CDAI with all-cause and cancer mortality, and a linear association between CDAI and cardiovascular mortality. The results were robust in subgroup analyses and sensitivity analyses.

Conclusion

Higher CDAI is associated with reduced all-cause mortality, cardiovascular mortality, and cancer mortality in hypertensive adults. Our findings highlight the importance of an antioxidant diet in improving outcomes in adults with hypertension.

Association between plasma metal exposure and health span in very elderly adults: a prospective cohort study with mixture statistical approach

BACKGROUND

Metals have been linked to a diverse spectrum of age-related diseases; however, the effects of metal exposure on health span remains largely unknown. This cohort study aims to determine the association between plasma metal and health span in elder adults aged ≥ 90 years.

METHODS

The plasma concentrations of seven metals were measured at baseline in 300 elder adults. The end of the health span (EHS) was identified as the occurrence of one of eight major morbidities or mortality events. We used Cox regression to assess hazard ratios (HR). The combined effects of multiple metal mixtures were estimated using grouped-weighted quantile sum (GWQS), quantile g-computation (Q-gcomp), and Bayesian kernel machine regression (BKMR) methods.

RESULTS

The estimated HR for EHS with an inter-quartile range (IQR) increment for selenium (Se) was 0.826 (95% confidence interval [CI]: 0.737-0.926); magnesium (Mg), 0.806 (95% CI: 0.691-0.941); iron (Fe), 0.756 (95% CI: 0.623-0.917), and copper (Cu), 0.856 (95% CI: 0.750-0.976). The P for trend of Se, Mg, and Fe were all < 0.05. In the mixture analyses, Q-gcomp showed a negative correlation with EHS (P = 0.904), with the sum of the negative coefficients being -0.211.

CONCLUSION

Higher plasma Se, Mg, and Fe reduced the risk of premature end of health span, suggesting that essential metal elements played a role in health maintenance in elder adults.

The use of potentially interacting supplement-drug pairs in adults with type 2 diabetes: A large population-based cohort study in the UK Biobank

AIMS

To examine the patterns of use of potentially interacting supplement-drug pairs in adults with type 2 diabetes (T2D) in real-world settings, and to explore the impact of potentially interacting supplement-drug pairs on downstream outcomes.

METHODS

Potentially interacting supplement-drug pairs were identified from four tertiary databases. We categorized the potential pharmacodynamic interactions into different clinical types according to their related outcomes and explored their associations with incident outcomes using Cox models.

RESULTS

26,394 participants with T2D in the UK Biobank were included. Half (48.5 %) were supplement users, of whom 85.0 % were taking potentially interacting supplement-drug pairs. The potential pharmacodynamic interactions were related to various clinical outcomes, including reducing the effects of glucose-lowering drugs (50.7 %), hypotension (49.8 %), bleeding (50.4 %) and hepatotoxicity (34.8 %). Exploratory analyses found that the use of potentially interacting supplement-drug pairs was associated with incident hepatic diseases (hazard ratio = 1.26, 95 % confidence interval 1.10-1.44, P < 0.001).

CONCLUSIONS

Real-world data suggests that most adults with T2D who concurrently used supplements and drugs were on potentially interacting supplement-drug combinations, with the potential of causing adverse outcomes such as incident hepatic diseases. Clinicians should communicate with patients and assess the potential risk of supplement-drug interactions in clinical settings.

The Association of Iron Intake and Hypertension, Does Iron Intake Decrease Blood Pressure?

Previous studies reported that iron may have an indispensable role in the risk of hypertension (HTN). However, the result of the studies on the relationship between iron and risk of HTN is inconsistent. This study aimed to assess the association between the association of dietary iron intake and HTN in the Iranian population. This case-control study was conducted on 4184 people aged 35 to 70, including 1239 people with HTN and 2945 people with normal blood pressure (BP) in Sabzevar, Iran. Dietary intake was assessed using a food frequency questionnaire (FFQ). The Nutritionist IV software was used in terms of the assessment of dietary intake of iron. An inverse association was found between iron intake and HTN (OR = 0.97, CI 95%: 0.94-0.99, P = 0.04). The association remained significant after adjustment for age, gender, smoking, drinking alcohol, calorie intake, and BMI (OR = 0.94, CI 95%: 0.89-0.98, P = 0.01). As a conclusion, iron intake was inversely associated with HTN. Further longitudinal studies on the effect of iron intake on BP are required to confirm this finding.

Effect of six month's treatment with omega-3 acid ethyl esters on long-term outcomes after acute myocardial infarction: The OMEGA-REMODEL randomized clinical trial

BACKGROUND

Omega-3 polyunsaturated fatty acids (O3-FA) have been shown to reduce inflammation and adverse cardiac remodeling after acute myocardial infarction (AMI). However, the impact of O3-FA on long-term clinical outcomes remains uncertain.

AIMS

To investigate the impact of O3-FA on adverse cardiac events in long-term follow up post AMI in a pilot-study.

METHODS

Consecutive patients with AMI were randomized 1:1 to receive 6 months of O3-FA (4 g/daily) or placebo in the prospective, multicenter OMEGA-REMODEL trial. Primary endpoint was a composite of major adverse cardiovascular events (MACE) encompassing all-cause death, heart failure hospitalizations, recurrent acute coronary syndrome, and late coronary artery bypass graft (CABG).

RESULTS

A total of 358 patients (62.8% male; 48.1 ± 16.1 years) were followed for a median of 6.6 (IQR: 5.0-9.1) years. Among those receiving O3-FA (n = 180), MACE occurred in 65 (36.1%) compared to 62 (34.8%) of 178 assigned to placebo. By intention-to-treat analysis, O3-FA treatment assignment did not reduce MACE (HR = 1.014; 95%CI = 0.716-1.436; p = 0.938), or its individual components. However, patients with a positive response to O3-FA treatment (n = 43), defined as an increase in the red blood cell omega-3 index (O3I) ≥5% after 6 months of treatment, had lower annualized MACE rates compared to those without (2.9% (95%CI = 1.2-5.1) vs 7.1% (95%CI = 5.7-8.9); p = 0.001). This treatment benefit persisted after adjustment for baseline characteristics (HRadjusted = 0.460; 95%CI = 0.218-0.970; p = 0.041).

CONCLUSION

In long-term follow-up of the OMEGA-REMODEL randomized trial, O3-FA did not reduce MACE after AMI by intention to treat principle, however, patients who achieved a ≥ 5% increase of O3I subsequent to treatment had favorable outcomes.