Mediation effect of arterial stiffness on ideal cardiovascular health and stroke

Estimated pulse wave velocity is associated with all-cause and cardiovascular mortality in individuals with stroke: A national-based prospective cohort study

Extensive evidence underscores the potential of estimated pulse wave velocity (ePWV) as a robust tool for predicting disease prevalence and mortality. However, its comparative effectiveness in forecasting all-cause and cardiovascular disease (CVD) mortality, particularly among stroke populations, remains inadequately characterized in relation to the traditional Framingham Risk Score (FRS) model. This prospective study included 1202 individuals with stroke from the National Health and Nutrition Examination Survey conducted between 1999 and 2014, with comprehensive follow-up data. Survey-weighted Cox regression models were employed to examine the association between ePWV and the risks of all-cause and CVD mortality. Subgroup analyses were performed to evaluate the stability of ePWV in predicting these outcomes. A generalized additive model was utilized to explore the dose-response relationship between ePWV and mortality risk. Receiver operating characteristic curves were then used to assess and compare the prognostic capabilities of ePWV and FRS models for 10-year all-cause and CVD mortality. After adjustment for relevant covariates, each 1 m/s increase in ePWV was associated with a 44% and 65% increase in all-cause and CVD mortality, respectively. ePWV demonstrated consistent prognostic performance across the majority of stroke subpopulations. Notably, ePWV exhibited a nonlinear relationship with all-cause mortality (P for nonlinearity = .045) while maintaining a linear association with CVD mortality (P for nonlinearity = .293). Furthermore, ePWV outperformed the FRS model in predicting 10-year all-cause (Integrated Discrimination Improvement = 0.061, 95% confidence interval: 0.031-0.095, P = .007) and CVD mortality (95% confidence interval: 0.005-0.083, P = .02). ePWV is an independent risk factor for both all-cause and CVD mortality in individuals with stroke, demonstrating superior predictive value compared to the traditional FRS model for forecasting these outcomes.

Trends in cardiovascular and cerebrovascular health scores in the Kailuan population from 2006 to 2011

BACKGROUND

The American Heart Association defines cardiovascular health in terms of four behaviors (smoking, diet, physical activity, and body weight) and three factors (plasma glucose, cholesterol, and blood pressure). By this definition, the prevalence of ideal cardiovascular health behaviors and factors (ICHBF) is negatively correlated with all-cause mortality and risks of cardiovascular and cerebrovascular diseases and malignancy.

AIM

To investigate the changing trends of cardiovascular and cerebrovascular health scores in the Kailuan study population from 2006 to 2011.

METHODS

The Kailuan population data from three health checkups held in 2006-2007, 2008-2009, and 2010-2011 were analyzed, and the constituent ratios of cardiovascular and cerebrovascular health behaviors and factors at ideal, intermediate, and poor levels were calculated by using Huffman and Capewell method. Simultaneously, the cardiovascular and cerebrovascular health behavior and factor scores were calculated.

RESULTS

From 2006 to 2007, the proportion of people with ideal physical exercise, low salt diet, ideal body mass index, ideal total cholesterol level, no smoking, ideal blood sugar, and ideal blood pressure was 13.12%, 9.34%, 49.17%, 64.20%, 49.27%, 69.99%, and 20.55%, respectively, in men with a health score of 8.46, and 12.00%, 9.13%, 61.60%, 64.28%, 98.19%, 78.90% and 36.92% in women, with a score of 10.02. From 2008 to 2009, the proportion was 16.09%, 14.04%, 51.94%, 65.02%, 40.18%, 66.44%, and 17.04% in men, with a score of 8.18, and 16.860%, 17.360%, 64.010%, 67.433%, 98.220%, 76.370%, and 42.340% in women, with a score of 10.12. From 2010 to 2011, the proportion was 12.22%, 17.65%, 49.40%, 68.33%, 48.17%, 64.67%, and 14.68% in males, having a score of 8.21, while in females, the proportion was 11.83%, 18.09%, 49.40%, 67.85%, 98.82%, 74.52%, and 37.78%, with a score of 9.90.

CONCLUSION

The prevalence of ideal cardiovascular and cerebrovascular health behaviors and factors is low in the Kailuan study population due to inadequate scores of relevant health metrics.

Effects of Ginseng Consumption on Cardiovascular Health Biomarkers in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ginseng, with various pharmacological activities, has received increasing attention to improve cardiovascular health (CVH). Therefore, this meta-analysis synthesized the effect of ginseng consumption on biomarkers of CVH in adults. A systematic search was performed in the databases of PubMed, Scopus, Web of Science, Embase, and the Cochrane Library through July 24, 2023 to screen out English-language randomized controlled trials (RCTs) evaluating the effects of ginseng consumption on body composition, blood pressure, vascular stiffness, lipid metabolism, glucose metabolism, insulin resistance, inflammatory cytokines, and adipocytokines in adults. The weighted mean difference (WMD) and 95% confidence interval (CI) were used to evaluate the overall effect size, and STATA 12.0 was used for comprehensive analysis. Forty-five studies were included in the meta-analysis. Ginseng consumption significantly reduced systolic blood pressure (SBP) (WMD = -2.57 mmHg, 95% CI = -4.99 to -0.14, p = 0.038), total cholesterol (TC) (WMD = -4.40 mg/dL, 95% CI = -8.67 to -0.132, p = 0.043), low density lipoprotein cholesterol (LDL-C) (WMD = -2.81 mg/dL, 95% CI = -4.89 to -0.72, p = 0.008), C-reactive protein (CRP) (WMD = -0.41 mg/L, 95% CI = -0.73 to -0.10, p = 0.010), and interleukin-6 (IL-6) (WMD = -2.82 pg./mL, 95% CI = -4.31 to -1.32, p < 0.001). Subgroup analyses suggested that supplementation with ginseng for less than 12 weeks significantly reduced SBP, but 12 weeks or more improved TC and CRP. Ginseng consumption on SBP, TC, and CRP seemed to be more effective on unhealthy participants. The meta-analysis showed that ginseng consumption might have the potential to improve SBP, TC, LDL-C, CRP, and IL-6. These findings suggest that ginseng is a potential candidate for the maintenance of CVH. However, our results had high heterogeneity. Future high-quality studies are needed to firmly establish the clinical efficacy of ginseng consumption.

Association between cardiovascular health metrics and retinal ageing

The study aims to investigate associations between cardiovascular health (CVH) metrics and retinal ageing indexed by retinal age gap. A total of 26,354 participants from the UK Biobank study with available CVH metrics and qualified retinal imaging were included in the present analysis. CVH included 7 metrics (smoking, physical activity, diet, body mass index [BMI], total cholesterol, blood pressure [BP], blood glucose). These were summarized to classify the overall CVH as poor (0-7), intermediate (8-10) or ideal (11-14). Retinal age gap was defined as the difference between biological age predicted by fundus images and chronological age. Accelerated and non-accelerated retinal ageing was defined if retinal age gap was in the upper or lower 50% quantiles of the study population, respectively. Linear and logistic regression models estimated the association of overall CVH and each metric of CVH with retinal age gap respectively. Our results showed that in the fully adjusted model, each one-unit score increase in overall CVH was negatively associated with retinal age gap (odds ratio [OR] = 0.89, 95% confidence interval [CI]: 0.87-0.92, P < 0.001). Compared with poor overall CVH, people with intermediate and ideal overall CVH had significantly lower retinal age gap (OR = 0.76, 95%CI: 0.67-0.85, P < 0.001; OR = 0.58, 95%CI: 0.50-0.67, P < 0.001). Similar associations were found between overall CVH and accelerated retinal ageing. CVH metrics including smoking, BMI, BP, and blood glucose were also significantly associated with higher retinal age gap. Taken together, we found a significant and inverse dose-response association between CVH metrics and retinal age gap, indicating that maintaining healthy metrics especially smoking, BMI, BP, and blood glucose may be crucial to slow down biological ageing.

Abnormal ankle-brachial index, cardiovascular risk factors and healthy lifestyle factors in hypertensive patients: prospective cohort study from a primary care urban population

Background

Peripheral arterial disease (PAD) and arterial stiffness (AS) may be hypertension-mediated vascular lesions. Both are determined by an abnormal ankle-brachial index (ABI) and are predictors of cardiovascular disease (CVD) and mortality. We assessed the relationship in urban hypertensive patients between an abnormal ABI and an ideal cardiovascular health (CVH) score, plus other healthy factors, with unfavourable outcomes.

Methods

We studied 243 hypertensive patients from a primary care urban population, followed for two years. Clinical data, comorbid conditions, including hypertension-mediated organ damage (HMOD) and hypertension-related comorbidities (HRC), hospitalizations and mortality were also recorded.

Results

A low prevalence of ideal CVH was observed in urban hypertensive patients. The ABI ≤ 0.9 group (n = 16) showed a higher proportion of prior CVD other than PAD, mortality and hospitalizations than the ABI > 1.4 group (n = 41), and a poorer lipid, metabolic and renal profile. An inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes (HMOD, HRC, death or hospitalization) was observed. Chronic kidney disease (CKD) and diabetes were independently associated with an ABI ≤ 0.9. Age, sex, diabetes, CKD, ABI ≤ 0.9 and ideal cholesterol were also associated with outcomes, but not other CVH metrics.

Conclusions

Besides a low prevalence of ideal CVH, an inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes was observed in hypertensive patients from an urban population. Stronger efforts to promote ideal CVH may improve outcomes in this particular population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01837-1.

Thyroid Function Affects the Risk of Post-stroke Depression in Patients With Acute Lacunar Stroke

Objective

This study aimed to investigate whether thyroid function profiles are associated with post-stroke depression (PSD) and evaluate the mediation effect of cerebral small vessel disease (cSVD) on the association of thyroid function profiles and PSD in patients with acute ischemic lacunar stroke.

Methods

In this study, 372 patients with confirmed acute ischemic lacunar stroke within 3 days of onset were consecutively recruited. Serum levels of thyroid hormones and thyroid antibodies were detected on admission. Lacunar infarcts, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces were rated using validated scales. The severity of depression was scored with the 24-item Hamilton Depression Scale in the hospital after a week of stroke onset. Multivariate regression was utilized to analyze the association of thyroid function profiles and PSD. Mediation analysis was employed to evaluate the effect of cSVD on the association of thyroid function profiles and PSD.

Results

A total of 87 (23.4%) participants were diagnosed with depression after stroke. Serum thyroid-stimulating hormone (TSH) levels were significantly higher in patients with PSD than in those without PSD, while free triiodothyronine (FT3) and free thyroxine (FT4) were not significantly different between the two groups. After adjusting for potential confounders, serum TSH levels were positively associated with the risk of PSD (OR = 1.228; 95% CI: 1.053–1.431, p = 0.009). A similar association was also found between the total cSVD burden score and PSD (OR = 2.137; 95% CI: 1.634–2.793, p < 0.001). Further mediation analysis indicated that 26.37% of the association between TSH and PSD was mediated by cSVD.

Conclusions

Serum TSH levels on admission can probably predict depression after acute ischemic lacunar stroke.

Predictive value of novel inflammatory markers platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio in arterial stiffness in patients with diabetes: A propensity score-matched analysis

BACKGROUND

Increased arterial stiffness is common in patients with diabetes, and inflammation is one of the main causes of increased arterial stiffness. Platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR) are novel inflammatory markers that are reproducible, widely available, and easy to measure, and are associated with low costs. This study sought to investigate the predictive value of these novel inflammatory markers in patients with diabetes having arterial stiffness.

METHODS

We retrospectively included inpatients with diabetes mellitus from the Endocrinology Department of the Chengdu Fifth People's Hospital from June 2021 to May 2022 and collected data on their general information, biochemical indicators, and brachial-ankle pulse wave velocity (baPWV). After propensity matching, the risk relationship between PLR, NLR, and MLR and arterial stiffness was assessed in the recruited patients.

RESULTS

A total of 882 hospitalized patients with diabetes were included in this study and categorized into the low baPWV (507 cases) or high baPWV group (375 cases) based on the baPWV. After propensity matching, there were 180 patients in all in the high and low baPWV groups. Univariate and multivariate logistic regression analyses revealed that high PLR, NLR, and MLR were independently associated with an increased risk of arterial stiffness in patients with diabetes. In the receiver operating characteristic curve analysis, the NLR area under the curve (AUC) was 0.7194 (sensitivity = 84.4%, specificity = 51.1%) when distinguishing low baPWV and high baPWV in patients with diabetes, which was higher than that for PLR AUC (0.6477) and MLR AUC (0.6479), and the combined diagnosis for AUC.

CONCLUSIONS

NLR was superior to PLR, and MLR and combined diagnosis have certain predictive values that indicate the increase in arterial stiffness in patients with diabetes. These predictive values can help with the early identification of increased arterial stiffness in patients with diabetes.