Epidemiology of cardiovascular disease in China: current features and implications

Trends of cause-specific cardiovascular disease mortality in China, 2009-2019: a nationwide longitudinal study

BACKGROUND

Cardiovascular disease (CVD) is the top cause of death in China. We aimed to identify trends in cause-specific CVD mortality in a rapidly developing country, thereby providing evidence for CVD prophylaxis.

MATERIALS AND METHODS

Using raw data from the Chinese National Mortality Surveillance (CNMS) system, we assessed the mortalities of all CVD and cause-specific CVD during 2009-2019. Temporal trends of crude mortality rates (CMRs) and age-standardized mortality (ASMRs) of CVD were evaluated using joinpoint regression models. Age-sex-specific CVD mortality rates were predicted by using age-period-cohort Poisson regression model.

RESULTS

A total of 10,608,402 CVD death occurred during 2009-2019, accounting for 49.8% of all-cause of death in China. The three major CVD types [cerebrovascular disease, ischemic heart disease (IHD) and hypertensive disease (HD)] accounted for 94.6% of total CVD deaths. The CMR of all CVD increased [the annual average percentage change (AAPC) = 3.4%, 95% confidence interval (CI) 2.6% to 4.1%] while the ASMR decreased (AAPC = -2.0%, 95% CI -3.5% to -0.6%). Cerebrovascular disease is predicted to be the leading cause of CVD death in men and IHD will be the top cause of CVD death in women over the period 2025-2029.

CONCLUSIONS

Although the ASMR of total CVD decreased, CVD remained the leading cause of death in China. Cerebrovascular disease, IHD and HD were the major three leading causes of CVD-related death. Inflammatory heart disease-associated death increased in the young population. Attention should be paid to premature deaths associated with cerebrovascular disease and rheumatic heart disease among rural residents.

Y-box binding protein 1: A critical target for understanding and treating cardiovascular disease

Cardiovascular diseases (CVDs) remain a significant public health burden, characterized by escalating morbidity and mortality rates and demanding novel therapeutic approaches. Cold shock protein Y-box binding protein 1 (YB-1), a highly conserved RNA/DNA-binding protein, has emerged as a pivotal regulator in various pathophysiological processes, including CVDs. YB-1 exerts pleiotropic functions by modulating gene transcription, pre-mRNA splicing, mRNA translation, and stability. The expression and function of YB-1 are intricately regulated by its subcellular localization, post-translational modifications, upstream regulatory signals. YB-1 plays a multifaceted role in CVDs, influencing inflammation, oxidative stress, cell proliferation, apoptosis, phenotypic switching of smooth muscle cells, and mitochondrial dysfunction. However, the regulation of YB-1 expression and function in CVDs is complex and context-dependent, exhibiting divergent effects even in the same disease across different cell types or at disease stages. This review comprehensively explores the structure, regulation, and functional significance of YB-1 in CVDs. We delve into the transcriptional and translational control mechanisms of YB-1, as well as its post-translational modifications. Furthermore, we elucidate the upstream signaling pathways that influence YB-1 expression, with a particular emphasis on non-coding RNAs and specific upstream molecules. Finally, we systematically examine the role of YB-1 in CVDs, summarizing its expression patterns, regulatory mechanisms, and therapeutic potential as a promising target for novel therapeutic interventions. By providing a comprehensive overview of YB-1's involvement in CVDs, this review aims to stimulate further research and facilitate the development of targeted therapies to improve cardiovascular health.

Guiding precision medicine strategy for intravenous ginsenosides via pharmacokinetic-informed bioinformatic approaches: a study on XueShuanTong

BACKGROUND

Intravenous ginsenosides, derived from Panax species, are widely used in China. XueShuanTong injection, enriched with ginsenosides Rb1 and Rg1, is recommended for unstable angina treatment. Although effective, it may cause adverse effects, especially in patients with renal or hepatic impairment, as these organs are vital in ginsenosides' systemic exposure.

PURPOSE

This investigation aimed to inform precision medicine by employing a physiologically based pharmacokinetic (PBPK) model to evaluate transporter-mediated interactions between both ginsenosides and their systemic exposure in patients with organ impairment, thereby ensuring safety.

METHODS

Interactions between ginsenosides Rb1 and Rg1, mediated by human and rat transporters, were characterized at both cellular and vesicular levels. Their interactions with human organic anion-transporting polypeptide (OATP)1B3 and rat Oatp1b2 were evaluated when administered together or as part of XueShuanTong in both rats and humans. PBPK models incorporating OATP-mediated hepatobiliary excretion were developed to characterize their interactions and pharmacokinetics, providing guidance for precision medicine in these patients.

RESULTS

Ginsenoside Rb1 was demonstrated to inhibit human OATP1B3 (Oatp1b2 in rats)-mediated cellular uptake, significantly increasing exposure levels of ginsenoside Rg1 in rats by impairing hepatobiliary elimination. Mechanistic models effectively replicated the pharmacokinetic profiles and the interactions of ginsenosides Rb1 and Rg1. These validated models revealed that decreases in GFR, hematocrit, hepatic volume, and/or OATP1B3 expression and activity in patients with renal or hepatic impairment significantly increased the systemic exposure levels of both ginsenosides. Moreover, the models provided valuable insights into the mechanism of "albumin-facilitated dissociation" associated with ginsenoside Rb1, an OATP1B3 inhibitor. This understanding is crucial for predicting the risk of drug-drug interactions involving drugs with high plasma protein binding.

CONCLUSIONS

By incorporating these key patient-specific physiological parameters into the models, this investigation provides practical guidance for optimizing dosing strategies and improving the therapeutic efficacy of ginsenoside-containing injections, including XueShuanTong, in patients with complex conditions.

Bivalirudin infusion at standard or low regimen during elective percutaneous coronary intervention in high-risk bleeding patients with acute coronary syndrome: Study protocol for a prospective, single-center, randomized controlled trial

BACKGROUND

Bleeding complications associated with anticoagulant therapy should receive more attention in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), especially in those considered at high-risk bleeding. The recommended dosage of bivalirudin in clinical guidelines may not be appropriate for East Asian populations. We are performing a trial to investigate the efficacy and safety of a low bivalirudin regimen without prolonging infusion in high-risk bleeding patients with ACS undergoing elective PCI.

METHODS

The study is a prospective, open-label, randomized controlled, non-inferiority trial. A total of 2510 patients will be enrolled and randomly (1,1) allocated to either receive the low (80 % of the standard dose) or standard bivalirudin regimen without prolonging the infusion after PCI. The primary endpoint is net adverse clinical events (NACE) at 30 days, which is a composite of major adverse cardiovascular and cerebrovascular events (MACCE, including all-cause death, repeat revascularization, stroke, nonfatal myocardial infarction, and stent thrombosis) and any bleeding events defined by the Bleeding Academic Research Consortium (BARC).

CONCLUSIONS

This proposed study is the first randomized controlled trial to evaluate the efficacy and safety of a low versus standard bivalirudin regimen during elective PCI in high-risk bleeding patients with ACS. The results may help achieve dose optimization for the use of perioperative bivalirudin in high-risk bleeding ACS patients undergoing elective PCI.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2200064363. Registered on October 4, 2022.

Sprayable Reactive Oxygen Species-Responsive Hydrogel Coatings Restore Endothelial Barrier Integrity for Functional Vascular Healing

Drug-coated balloons are advancing in coronary interventional therapy for stenosis but often cause traumatic vascular injury, leading to late-stage restenosis. A critical pathological event in this process is the early disruption of the endothelial barrier integrity, which triggers inflammation and hyperplasia. However, effective therapeutic strategies to promptly restore endothelial integrity are lacking. Here, we identify the elimination of excess reactive oxygen species (ROS) as a key mechanism for reinforcing intercellular tight junctions (TJs) and restoring the endothelial barrier function. We thus propose a sprayable, ROS-responsive hydrogel coating, OA@G-NO/B-EC, for vascular balloons designed to mitigate late-stage restenosis. This hydrogel, precisely fabricated via ultrasonic spraying, comprises a reversible phenylboronic ester-bearing caffeate prodrug (B-EC) and a macromolecular nitric oxide (NO) donor (G-NO), both dynamically self-cross-linked with dopamine-modified oxidized dextran (OA) through Schiff base chemistry. The dual dynamic covalent linkages enable the hydrogel to gradually disintegrate in response to ROS accumulation at lesion sites, providing controlled, on-demand therapeutic action. Sustained release of herbal antioxidant caffeates effectively scavenges ROS, rescuing TJ integrity and attenuating inflammation. This favorable microenvironment further enhances both endogenous NO production and exogenous NO delivery, facilitating endothelial proliferation and migration. Moreover, this hydrogel's robust adhesion to the arterial wall ensures sufficient drug retention and delivery. In vitro and in vivo results, supported by RNA sequencing analysis, strongly demonstrate the hydrogel's enhanced capacity for vascular healing and restenosis prevention. This system holds broad potential for surface engineering across diverse biomedical materials and devices, advancing localized drug delivery.

Trajectories of activities of daily living/ instrumental activities of daily living and the risk of cardiovascular diseases

BACKGROUND AND AIM

Prior research has reported the association between activities of daily living (ADL)/instrumental activities of daily living (IADL) of cardiovascular disease (CVD). We aimed to identify distinctive ADL/IADL trajectories and evaluate their relationship of the risk of CVD.

METHODS AND RESULTS

Our analysis included 7717 participants with four ADL/IADL assessments from the China Health and Retirement Longitudinal Study. Trajectories of ADL/IADL were identified by latent mixture modeling. Cox proportional hazards regression models were used to examine the association of ADL/IADL trajectories with CVD risk (stroke or cardiac events). Three distinct ADL/IADL trajectory groups were identified: maintaining a low ADL/IADL score throughout the follow-up (low-low trajectory); low starting ADL/IADL scores then increasing to mild scores (low-mild trajectory), and mild starting ADL/IADL scores then increasing (mild-increasing trajectory). During a median follow-up of 24 months (23 months-25months), a total of 519 respondents experienced CVD (including 143 stroke and 394 cardiac events). Individuals with low-mild and mild-increasing ADL trajectory were significantly associated with higher risk of CVD, with the corresponding hazard ratios were 1.50(1.24-1.81) and 2.02(1.44-2.84), respectively, compared to the individuals with low-low IADL trajectory. Similarly, individuals with low-mild and mild-increasing IADL trajectory were associated with 29 % (hazard ratios = 1.29, 95 % confidence intervals 1.06-1.58) and 59 % (hazard ratios = 1.59, 95 % confidence intervals 1.13-2.22) increased risk of CVD. Furthermore, Individuals with low-mild and mild-increasing ADL/IADL trajectory also had higher risks of stroke and cardiac events.

CONCLUSION

Individuals with low-mild and mild-increasing ADL/IADL trajectory over time were associated with increased risk of incident CVD.

Association Between the Uric Acid to High-Density Lipoprotein Cholesterol Ratio and Residual Risk for Coronary Artery Disease

Despite advances in anti-atherosclerotic therapies, residual risk persists in coronary artery disease (CAD). The uric acid to high-density lipoprotein cholesterol ratio (UHR), a metabolic-inflammatory marker, may predict residual risk, but its association with plaque progression remains unexplored. This study investigates the impact of UHR on atherosclerotic plaque burden in CAD patients after treatment. In this prospective cohort study, 118 patients with newly diagnosed CAD undergoing percutaneous coronary intervention were stratified into quartiles by baseline UHR. Intravascular ultrasound assessed plaque burden and characteristics at baseline and 12-month follow-up. Logistic regression and restricted cubic spline models evaluated associations between UHR and plaque progression, adjusting for cardiovascular risk factors. At baseline, the highest UHR quartile (UHR-4) exhibited higher rates of plaque rupture (19.6% vs. 0-8.7%, P = 0.002) and microchannels (56.5% vs. 33.3-55.3%, P = 0.031) compared to lower quartiles. Baseline percent atheroma volume (PAV) was greater in UHR-4 (52.73% vs. 51.04-52.09%, P = 0.006). At follow-up, UHR-4 had a 3.2-fold increased risk of plaque burden > 70% (adjusted RR 3.237, 95% CI 1.156-9.063, P = 0.025), with a linear UHR-plaque burden relationship (P = 0.015). No associations were observed between UHR and minimal lumen area or positive remodeling. Elevated UHR is independently associated with high atherosclerotic plaque burden (> 70%) in CAD patients under guideline-directed therapy after adjusting for traditional risk factors. UHR may serve as a complementary biomarker to existing risk scores, guiding targeted therapies to mitigate plaque vulnerability.

Association between phenotypic age and in-hospital outcomes in patients with acute myocardial infarction: A retrospective observational study

Background

Phenotypic age (PhenoAge) has emerged as a superior predictor of age-related morbidity and mortality. This study aimed to assess the associations between PhenoAge and in-hospital outcomes in patients with acute myocardial infarction (AMI).

Methods

2896 AMI patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University from 2019 to 2022 were analyzed in this retrospective study. PhenoAge was calculated by using the phenotypic age calculator, an equation for chronologic age and 9 clinical biomarkers, and Phenotypic Age Accelerate (PhenoAgeAccel) was measured using the residuals of regression PhenoAge on chronological age. Clinical outcomes were defined as in-hospital major adverse cardiovascular events (MACEs), including cardiogenic shock, malignant arrhythmia, acute heart failure, and mechanical complications.

Results

Overall, patients with high PhenoAge had a higher Gensini score and a higher likelihood of receiving supportive care, as well as worse clinical outcomes. The same results were observed in patients with positive PhenoAgeAccel. Moreover, PhenoAge and PhenoAgeAccel were significantly associated with in-hospital MACEs even after adjusting for multiple traditional risk factors. The area under the curve for PhenoAge was 0.714 (P < 0.001), which significantly outperformed chronologic age (AUC: 0.601, P < 0.001) and other cardiovascular risk factors. Re-examination of the ROC curves using different combinations of variables, PhenoAge was also able to significantly improve the predictive value of several models.

Conclusions

PhenoAge is significantly associated with clinical outcomes and reliably predicts in-hospital MACEs. Compared with chronological age, PhenoAge is a better complementary biomarker for predicting the risk of in-hospital adverse cardiovascular events in patients with AMI.

Palmitoylation in cardiovascular diseases: Molecular mechanism and therapeutic potential

Cardiovascular disease is one of the leading causes of mortality worldwide, and involves complex pathophysiological mechanisms that encompass various biological processes and molecular pathways. Post-translational modifications of proteins play crucial roles in the occurrence and progression of cardiovascular diseases, among which palmitoylation is particularly important. Various proteins associated with cardiovascular diseases can be palmitoylated to enhance the hydrophobicity of their molecular subdomains. This lipidation can significantly affect some pathophysiological processes, such as metabolism, inflammation by altering protein stability, localization, and signal transduction. In this review, we narratively summarize recent advances in the palmitoylation of proteins related to cardiovascular diseases and discuss its potential as a therapeutic target.

Metal-Organic Frameworks: Unlocking New Frontiers in Cardiovascular Diagnosis and Therapy

Cardiovascular disease (CVD) is one of the most critical diseases which is the predominant cause of death in the world. Early screening and diagnosis of the disease and effective treatment after diagnosis play an important role in the patient's recovery. Metal-organic frameworks (MOFs), a kind of hybrid ordered micro or meso-porous materials, constructed by metal nodes or clusters with organic ligands, due to their special features like high porosity and specific surface area, open metal sites, or ligand tunability, are widely used in various areas including gas storage, catalysis, sensors, biomedicine. Recently, advances in MOFs are bringing new developments and opportunities for the healthcare industry including the theranostic of CVD. In this review, the applications of MOFs are illustrated in the diagnosis and therapy of CVD, including biomarker detection, imaging, drug delivery systems, therapeutic gas delivery platforms, and nanomedicine. Also, the toxicity and biocompatibility of MOFs are discussed. By providing a comprehensive summary of the role played by MOFs in the diagnosis and treatment of CVDs, it is hoped to promote the future applications of MOFs in disease theranostics, especially in CVDs.

Pharmacological effects of betulinic acid and its protective mechanisms on the cardiovascular system

BACKGROUND

Betulinic acid (BA), a pentacyclic triterpenoid saponin widely found in plants, has attracted attention for its diverse pharmacological activities. Recent studies highlight its cardioprotective potential, promoting its relevance in cardiovascular research.

AIM OF THE REVIEW

This review summarizes BA's physicochemical properties, structure-activity relationships, natural sources, and synthesis strategies. It further discusses its pharmacokinetics and toxicity to evaluate its drug development potential, with emphasis on cardioprotective effects and related signaling pathways.

METHODS

Literature was collected from databases such as PubMed and Web of Science, focusing on studies addressing BA's chemical characteristics, biological activities, pharmacokinetics, and cardiovascular relevance.

RESULTS

BA exerts cardioprotective effects via multiple signaling pathways, including NRF2, NF-κB, MAPK, and NFAT. These contribute to its antioxidant, anti-inflammatory, anti-apoptotic, and anti-proliferative actions, as well as its enhancement of endothelial function through nitric oxide signaling. BA also reduces lipid accumulation. Combined with favorable physicochemical properties and synthetic accessibility, these findings support BA as a promising multifunctional lead compound in cardiovascular pharmacology.

CONCLUSION

BA shows strong potential as a cardioprotective natural compound. Although further research is needed to validate its clinical efficacy and safety, its multi-target actions and structural versatility provide a solid basis for development in cardiovascular drug discovery.

Association between serum uric acid and cardiometabolic syndrome: a cross-sectional study from NHANES 1999-2020

BACKGROUND AND AIMS

The relationship between serum uric acid (SUA) levels and cardiometabolic syndrome (CMS) remains controversial. This study aims to investigate the association between SUA and CMS in a large, nationally representative US population.

METHODS

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020. Logistic regression models were used to evaluate the association between SUA and CMS, while restricted cubic spline analysis explored the dose-response relationship. Subgroup analyses were conducted to examine effect modifications by demographic and socioeconomic factors.

RESULTS

The study included 12,638 participants. After adjusting for multiple confounders, higher SUA levels were significantly associated with increased odds of CMS (OR: 1.37, 95% CI: 1.31-1.42). This association remained consistent across different SUA quartiles, with the highest quartile showing the strongest association (OR: 2.72, 95% CI: 2.34-3.16). Restricted cubic spline analysis revealed a nonlinear dose-response relationship between SUA and CMS. Subgroup analyses showed that the association was stronger in females (OR: 1.78, 95% CI: 1.69-1.87) compared to males (OR: 1.47, 95% CI: 1.41-1.54), and varied across education levels and racial/ethnic groups.

CONCLUSION

Our findings indicate a significant positive association between SUA levels and CMS in the US adult population. This relationship appears to be linear and is influenced by factors such as sex, education level, and race/ethnicity. These results suggest that SUA levels may be a useful marker for CMS assessment and potential intervention strategies.

CLINICAL TRIAL NUMBER

Not applicable.

Mediation effect of body mass index on the association between glycated albumin and 10-year atherosclerotic cardiovascular disease risk in Hunan residents of China: a retrospective cross-sectional study

OBJECTIVES

Glycated albumin (GA) and body mass index (BMI) are associated with the risk of atherosclerotic cardiovascular disease (ASCVD). However, the role of BMI in the association between GA and 10-year ASCVD risk is still not fully understood.

DESIGN

A retrospective cross-sectional study.

SETTING

In this retrospective cross-sectional study, 4646 healthy subjects who received a full health examination at the Health Management Medical Center, Third Xiangya Hospital of Central South University, from 1 January 2022 to 30 December 2023 were initially identified. According to the exclusion criteria, 2107 participants were included in the final analysis.

PARTICIPANTS

The inclusion criteria for this study included (a) age is ≥18 years old and (b) subjects were long-term residents of Hunan province.

PRIMARY AND SECONDARY OUTCOME MEASURES

The 10-year ASCVD risk was evaluated via the China-PAR equation. The link between GA and 10-year ASCVD risk was examined through a multivariable logistic regression model, and the dose-response relationship was demonstrated using the restricted cubic spline. The potential mediation effect of BMI on this association was explored, and the differences in this mediation effect across age and metabolic-associated fatty liver disease (MAFLD) subgroups were analysed.

RESULTS

Elevated GA levels were positively linked to an intensified 10-year ASCVD risk (OR=1.160, 95% CI 1.055 to 1.276). Additionally, BMI was negatively linked to GA and 10-year ASCVD risk. BMI mediated 13.9% of the connection between GA and 10-year ASCVD risk. Specifically, the mediating effect of BMI remained significant in the 40-60-year age subgroup and non-MAFLD subgroup, with mediation ratios of 43.7% and 8.5%, respectively.

CONCLUSIONS

GA is a key predictor of 10-year ASCVD risk, and BMI partially mediates this relationship in healthy populations. Therefore, targeted weight management is recommended to reduce the adverse effect of GA on 10-year ASCVD risk in different populations.

Enhanced prognosis and regional cooperative rescue systems for acute myocardial infarction: insights from chest pain centers in Ningxia, China

Chest Pain Centers (CPC) demonstrated improved outcomes for patients with acute myocardial infarction (AMI) globally. However, the long-term impact of CPC establishment in economically developing areas, such as Ningxia, China, remains unclear. This study aimed to assess the long-term prognosis and efficacy of collaborative regional rescue systems centered on CPC for ST-segment elevation myocardial infarction (STEMI) patients in Ningxia. This retrospective cohort study analyzed 5344 STEMI patients from the Ningxia Myocardial Infarction Registry (2014-2019). Based on CPC establishment, patients were segregated into two groups: pre-CPC (n = 2141) and post-CPC (n = 3203). Kaplan-Meier survival analysis and Cox proportional hazards models were employed to compare the groups and evaluate long-term outcomes, including mortality and major adverse cardiovascular and cerebrovascular events (MACCEs). A total of 5344 acute STEMI patients were included, with 2141 (40.06%) in the pre-CPC group and 3203 (59.94%) in the post-CPC group. In comparison to the pre-CPC group, the post-CPC group exhibited lower all-cause mortality rates at 30 days (4.53% vs. 6.68%, p = 0.001), 1 year (6.24% vs. 9.11%, p = 0.001), and 3 years (8.55% vs. 11.86%, p < 0.001). Additionally, the post-CPC group showed decreased rates of MACCEs at 30 days (7.90% vs. 10.00%, p = 0.008) and 3 years (18.86% vs. 23.12%, p < 0.001). Kaplan-Meier survival analysis yielded similar results. After adjusting for confounding factors using COX multivariable regression, the CPC establishment was found to be a protective factor for all-cause mortality and MACCEs within 30 days (MACCEs: HR = 0.72, 95%CI 0.59-0.88, p = 0.005; all-cause mortality: HR = 0.59, 95%CI 0.46-0.77, p < 0.001), 1 year (MACCEs events: HR = 0.80, 95%CI 0.68-0.94, p = 0.006; all-cause mortality: HR = 0.59, 95%CI 0.44-0.69, p < 0.001), and 3 years (MACCEs: HR = 0.71, 95%CI 0.62-0.81, p < 0.001; all-cause mortality: HR = 0.55, 95%CI 0.46-0.67, p < 0.001). The establishment of Chest Pain Centers and implementation of regional cooperative rescue systems significantly improved the long-term prognosis of STEMI patients in Ningxia. These findings underscore the importance of developing CPC in underdeveloped regions to enhance cardiovascular emergency care and reduce mortality and morbidity associated with acute myocardial infarction.

Urban-rural disparities in fall risk among older Chinese adults: insights from machine learning-based predictive models

Background

Falls among older adults are a significant challenge to global healthy aging. Identifying key factors and differences in fall risks, along with developing predictive models, is essential for differentiated and precise interventions in China's urban and rural older populations.

Methods

The data of 5,876 older adults were obtained from the China Health and Retirement Longitudinal Survey (Waves 2015 and 2018). A total of 87 baseline input variables were considered as candidate features. Predictive models for fall risk over the next 3 years among urban and rural older populations were developed using five machine learning algorithms. Logistic regression analysis was employed to identify key factors influencing falls in these populations.

Results

The fall incidence among older adults was 22.4%, with 23.2% in rural areas and 20.9% in urban areas. Common risk factors across both settings include gender, age, fall history, sleep duration, activities of daily living questionnaire scores, memory status, and chair stand test time. In rural areas, additional risks include being unmarried, having diabetes, heart disease, memory-related medication use, and living in houses built 6-20 years ago. For urban, liver disease, arthritis, physical disabilities, depressive symptoms, weak hand strength, poor relations with children, and digestive medication use are significant risk factors while living in a tidy environment is protective. Random Forest models achieved the highest AUC-ROC and sensitivity in both rural (AUC = 0.732, 95% CI: 0.69-0.78; sensitivity = 0.669) and urban (AUC = 0.734, 95% CI: 0.68-0.79; sensitivity = 0.754) areas. Decision curve analysis confirmed the model's clinical utility across a range of threshold probabilities. Key predictors included prior experience of falling, gender, and chair stand test performance in rural areas, while in urban areas, experience of falling, gender, and age were the most influential features.

Conclusion

The key factors influencing falls among older people differ between urban and rural areas, and the predictive models effectively identify high-risk populations in both settings. This facilitates targeted prevention and precise interventions, supporting healthy aging in China.

Development and internal validation of a depressive symptoms prediction model among the patients with cardiovascular disease who have recovered from SARS-CoV-2 infection in Wuhan, China: a cross-sectional study

BACKGROUND

Middle-aged  and elderly patients with cardiovascular disease (CVD) who have recovered from SARS-CoV-2 infection may experience depressive symptoms due to the physical and psychological impact of the pandemic.

OBJECTIVE

To investigate the prevalence and predictors of depressive symptoms among the middle-aged and elderly with CVD who have recovered from SARS-CoV-2 infection in Wuhan, China, and to develop a prediction model for depressive symptoms.

METHODS

A cross-sectional study was conducted among 462 former SARS-CoV-2 middle-aged and elderly patients with CVD in Jianghan District, Wuhan, China from June 10 to July 25, 2021. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Potential predictors of depressive symptoms were selected by the least absolute shrinkage and selection operator (LASSO) regression. A prediction model was developed by random forest (RF) and logistic regression models and compared by the area under the receiver operating characteristic curve (AUROC). The discrimination, calibration, and practical utility of the prediction model were evaluated by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Bootstrap sampling was used for internal validation.

RESULTS

The prevalence of depressive symptoms among the participants was 35.93%. The prediction model included age, stethalgia after recovery, insomnia after recovery, post-traumatic stress disorder (PTSD), anxiety, fatigue, and perceived social support as predictors. The AUROC of the logistic regression model was 0.909 (95%CI: 0.879 ~ 0.939), indicating good discrimination. The calibration curve showed good calibration. The DCA showed that the prediction model had a net benefit for a wide range of risk thresholds. The internal validation confirmed the stability of the prediction model.

CONCLUSION

Depressive symptoms are common among middle-aged and elderly CVD patients who have recovered from SARS-CoV-2 infection in Wuhan, China. A prediction model with satisfactory performance was developed to estimate the risk of depressive symptoms among this population. Interventions targeting long COVID symptoms and social support should be considered to prevent depressive symptoms in CVD patients.

Association between cardiometabolic index and cardiovascular disease: evidence From the NHANES 2007-2018

Background

Although the cardiometabolic index (CMI) has gained recognition as a new tool for evaluating metabolic health, the relationship between CMI and cardiovascular disease (CVD) remains unclear. This research sought to explore the potential association between CMI and CVD.

Methods

Participants from the 2007-2018 National Health and Nutrition Examination Survey (NHANES) were selected. Multivariable logistic regression analyses and smooth curve fitting were utilized to investigate this relationship, along with subgroup evaluations and interaction analyses.

Results

This study included 12,837 subjects and the prevalence of CVD was 11.83%. After full adjustment, participants presenting with an increase of one unit in Ln-transformed CMI associated a 15% higher odds of CVD prevalence (OR = 1.15, 95% CI: 1.05-1.26). In the fully adjusted model, individuals falling into the highest CMI quartile (Quartile 4) demonstrated substantially 35% higher odds than those in the lowest CMI quartile (Quartile 1) (OR = 1.35, 95% CI: 1.11-1.66). In addition, there was no nonlinear relationship between CMI and CVD in our selected sample. This positive association was not greatly influenced by any of the stratifications.

Conclusions

Among US adults, having higher CMI levels is substantially associated with higher odds of CVD prevalence. This finding suggests that regular monitoring of CMI levels could enable physicians to initiate early interventions, potentially slowing the progression of CVD. However, in order to corroborate our findings, further prospective investigations are still required.

Positive Association Between Ultrasonographic Fatty Liver Indicator and the Severity of Coronary Artery Disease

Background: This study investigates the link between metabolic dysfunction-associated fatty liver disease (MAFLD) and coronary artery disease (CAD) using the ultrasonographic fatty liver indicator (US-FLI) to assess liver steatosis. Methods: A total of 204 patients were included, with hepatic steatosis evaluated through ultrasound characteristics, diagnosing fatty liver when US-FLI was ≥2. CAD severity was determined using the SYNTAX score (SS), categorizing 100 CAD patients into mild (SS ≤ 22) and moderate-severe (MS) (SS ≥ 23) groups. The association between US-FLI and SS in patients with MAFLD was evaluated through the multivariate logistic regression model. A receiver operating characteristic curve was applied to determine the accuracy, sensitivity, and specificity of US-FLI in predicting SS. Results: In the multivariate logistic regression analysis, US-FLI was an independent predictor of the CAD group (OR = 1.194, 95% CI: 1.008-1.414, p = 0.040) and the MS group (OR = 1.262, 95% CI: 1.025-1.553, p = 0.028). In the receiver operating characteristic curve analysis, a US-FLI value of 2 was found to be the optimal threshold point for diagnosing MS CAD patients (AUC = 0.620, 95% CI: 0.509-0.713, p = 0.039), with a sensitivity of 65.22% and a specificity of 55.56%. The diagnostic performance of MS CAD patients significantly improved when US-FLI was combined with type 2 diabetes mellitus (T2DM) (AUC = 0.732, 95% CI: 0.632-0.832, p < 0.001), with a sensitivity of 65.22% and specificity of 77.78%. Conclusions: US-FLI was independently and positively associated with CAD severity. US-FLI combined with T2DM had better diagnostic performance in patients with MS CAD.

Combined assessment of stress hyperglycemia ratio and glycemic variability to predict all-cause mortality in critically ill patients with atherosclerotic cardiovascular diseases across different glucose metabolic states: an observational cohort study with machine learning

BACKGROUND

Stress hyperglycemia ratio (SHR) and glycemic variability (GV) reflect acute glucose elevation and fluctuations, which correlate with adverse outcomes in patients with atherosclerotic cardiovascular disease (ASCVD). However, the prognostic significance of combined SHR-GV evaluation for ASCVD mortality remains unclear. This study examines associations of SHR, GV, and their synergistic effects with mortality in patients with ASCVD across different glucose metabolic states, incorporating machine learning (ML) to identify critical risk factors influencing mortality.

METHODS

Patients with ASCVD were screened in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and stratified into normal glucose regulation (NGR), pre-diabetes mellitus (Pre-DM), and diabetes mellitus (DM) groups based on glucose metabolic status. The primary endpoint was 28-day mortality, with 90-day mortality as the secondary outcome. SHR and GV levels were categorized into tertiles. Associations with mortality were analyzed using Kaplan-Meier(KM) curves, Cox proportional hazards models, restricted cubic splines (RCS), receiver operating characteristic (ROC) curves, landmark analyses, and subgroup analyses. Five ML algorithms were employed for mortality risk prediction, with SHapley Additive exPlanations (SHAP) applied to identify critical predictors.

RESULTS

A total of 2807 patients were included, with a median age of 71 years, and 58.78% were male. Overall, 483 (23.14%) and 608 (29.13%) patients died within 28 and 90 days of ICU admission, respectively. In NGR and Pre-DM subgroups, combined SHR-GV assessment demonstrated superior predictive performance for 28-day mortality versus SHR alone [NGR: AUC 0.688 (0.636-0.739) vs. 0.623 (0.568-0.679), P = 0.028; Pre-DM: 0.712 (0.659-0.764) vs. 0.639 (0.582-0.696), P = 0.102] and GV alone [NGR: 0.688 vs. 0.578 (0.524-0.633), P < 0.001; Pre-DM: 0.712 vs. 0.593 (0.524-0.652), P < 0.001]. Consistent findings were observed for 90-day mortality prediction. However, in the DM subgroup, combined assessment improved prediction only for 90-day mortality vs. SHR alone [AUC 0.578 (0.541-0.616) vs. 0.560 (0.520-0.599), P = 0.027], without significant advantages in other comparisons.

CONCLUSIONS

Combined SHR and GV assessment serves as a critical prognostic tool for ASCVD mortality, providing enhanced predictive accuracy compared to individual metrics, particularly in NGR and Pre-DM patients. This integrated approach could inform personalized glycemic management strategies, potentially improving clinical outcomes.

Disentangling the inverse LDL-C-hemorrhagic stroke association in Chinese adults with hypertension: findings from the Chinese Multi-provincial Cohort Study

Why lower low-density lipoprotein cholesterol (LDL-C) was associated with a decreased atherosclerotic cardiovascular disease (ASCVD) risk but an increased hemorrhagic stroke (HS) risk in hypertensive adults remains unclear. We examined whether the inverse LDL-C-HS association partly arises from its effect on ASCVD. We estimated separable effects of LDL-C on HS outside (ie, separable direct effect) or only through its effect on ASCVD (ie, separable indirect effect) in hypertensive adults from the Chinese Multiprovincial Cohort Study. We quantified such effects using numbers needed to treat (NNT) to prevent or cause an extra HS based on the restricted mean event-free time until a 25-year follow-up. Low-density lipoprotein cholesterol <70 mg/dL was not associated with an increased HS risk compared to LDL-C $\ge$70 mg/dL regarding total and separable direct effects. However, a small separable indirect effect (ie, NNT to harm: 9722 participants) was noted and validated via a series of sensitivity analyses. Moreover, modified effects were observed, particularly among patients 35-49 years, men, and those with SBP $\ge$140 mm Hg. These results suggest the inverse LDL-C-HS association in hypertensive adults is partly due to its effect on ASCVD. A better understanding of such associations would provide more enlightening into stroke prevention.

Comparative Discrimination of Life's Simple 7, Life's Essential 8, and Life's Crucial 9: Evaluating the impact of added complexity on mortality prediction

BACKGROUND

Cardiovascular health (CVH) is a key determinant of mortality, but the comparative effectiveness of different CVH metrics remains uncertain. Life's Simple 7 (LS7) evaluates seven domains: smoking, body mass index, physical activity, total cholesterol, blood pressure, fasting glucose, and diet. Life's Essential 8 (LE8) adds sleep health, while Life's Crucial 9 (LC9) further includes mental health. This study aimed to assess whether the additional components in LE8 and LC9 enhance mortality prediction compared to LS7.

METHODS

Data from 22,382 participants in the NHANES 2005-2018 were analyzed. Cox proportional hazards regression models were used to evaluate the associations between the scores of these metrics and all-cause, cardio-cerebrovascular disease (CCD), and CVD mortality. The predictive performance of each metric was assessed via receiver operating characteristic (ROC) curves and area under the curve (AUC) values.

RESULTS

The participants had a mean age of 45.23 ± 0.23 years, and 51.53% were female. During a median follow-up of 7.75 (4.42-11.08) years, there were 1,483 all-cause deaths, 405 CCD deaths, and 337 CVD deaths. Compared with participants with LS7 scores ≤ 4, those with scores ≥ 11 had a 65% (HR = 0.35 [0.25-0.50]) lower risk of all-cause mortality, a 66% (HR = 0.34 [0.16-0.73]) lower risk of CCD mortality, and a 61% (HR = 0.39 [0.18-0.85]) lower risk of CVD mortality. Similar trends were observed for LE8 and LC9. The AUC for LS7 (0.68 [0.66-0.70]) was slightly greater than that for LE8 (0.67 [0.65-0.69], P = 0.007) and LC9 (0.67 [0.65-0.69], P = 0.019) in predicting all-cause mortality at 5 years; however, the overall predictive performance was nearly identical across all three metrics. Furthermore, the addition of LS7 (AUC = 0.84 [0.82-0.86], P < 0.001), LE8 (AUC = 0.84 [0.82-0.86], P < 0.001), and LC9 (AUC = 0.84 [0.83-0.86], P < 0.001) to the baseline model (AUC = 0.83 [0.82-0.85]) significantly improved all-cause mortality predictions at 5 years; however, the actual gains in predictive performance were marginal.

CONCLUSIONS

LS7, LE8, and LC9 all predict mortality effectively. Given its simpler scoring and fewer components, LS7 demonstrates comparable predictive performance to LE8 and LC9, making it a more practical tool for clinical and public health applications.

Advanced oral breviscapine sustained-release tablets for improved ischemic stroke treatment

This study aimed to address the challenges associated with the low oral bioavailability and the necessity for frequent dosing of breviscapine (BRE), a mainstream drug in the treatment of cardiovascular and cerebrovascular diseases. The poor solubility and permeability of BRE in the gastrointestinal tract were identified as significant barriers to effective drug absorption, thereby impacting therapeutic efficacy and patient compliance. To enhance the gastrointestinal absorption of BRE, particles loaded with BRE were engineered utilizing Cremophor EL (CrEL), an absorption enhancer, in conjunction with mesoporous silica, a biocompatible drug delivery vector, formulating mesoporous silica particles loaded with BRE and CrEL (BRE-CrEL@SiO2). The solubility and mucosal permeability of BRE were ameliorated, facilitating transepithelial transport and improving absorption kinetics. BRE-CrEL@SiO2 were subsequently integrated to prepare sustained-release tablets. The finite element simulation method was utilized in the study of non-planar circular BRE tablet process to ensure tablet quality. The superior bioavailability and therapeutic index of the absorption-promoting sustained-release tablets, compared to commercial tablets, were validated through in vivo pharmacokinetic and pharmacodynamic assessments, while safety was maintained. The oral relative bioavailability of the absorption-enhancing sustained-release tablets was 160.7 % relative to the commercial tablets, demonstrated in Beagle dogs, indicating higher absorption. This innovative formulation represents a significant advancement in improving therapeutic efficacy of ischemic stroke and reducing the treatment burden on patients. The study provides new insights into the development of novel dosage forms for BRE and other drugs with poor solubility and permeability, suggesting a promising approach to enhance their therapeutic effectiveness and improve patient compliance in treatment.

The role of deubiquitinases in cardiovascular diseases: mechanisms and therapeutic implications

Cardiovascular diseases (CVDs) have become the leading cause of death globally, surpassing infectious diseases and other chronic illnesses. The incidence and mortality rates of CVDs are rising worldwide, posing a key challenge in public health. The ubiquitination system is a vast and complex. It is an important post-translational modification that plays a crucial role in various cellular processes. Deubiquitination is catalyzed by deubiquitinases (DUBs), which remove ubiquitin (Ub) from ubiquitinated proteins, thereby reversing the ubiquitination process. DUBs play an important role in many biological processes, such as DNA repair, cell metabolism, differentiation, epigenetic regulation, and protein stability control. They also participate in the regulation of many signaling pathways associated with the development and progression of CVDs. In this review, we primarily focus on the role of DUBs in various key pathological mechanisms of atherosclerosis (AS), such as foam cell formation, vascular remodeling (VR), endothelial-to-mesenchymal transition (End-MT), and clonal hematopoiesis (CH). In the heart, we summarize the involvement of DUBs in diseases and pathological processes, including heart failure (HF), myocardial infarction (MI), myocardial hypertrophy (MH) and ischemia/reperfusion (I/R) injury. Additionally, we also explore the diabetic cardiomyopathy (DCM) and the use of doxorubicin-induced cardiotoxicity in clinical settings. A comprehensive understanding of deubiquitination may provide new insights for the treatment and drug design of CVDs.

Sensing ceramides by CYSLTR2 and P2RY6 to aggravate atherosclerosis

Recent evidence has shown that increased levels of circulating long-chain ceramides predict atherosclerotic cardiovascular disease independently of cholesterol1,2. Although targeting ceramide signalling may provide therapeutic benefits beyond the treatment of hypercholesterolaemia, the underlying mechanism by which circulating ceramides aggravate atherosclerotic cardiovascular disease remains elusive. Here we examine whether circulating long-chain ceramides activate membrane G-protein-coupled receptors to exacerbate atherosclerosis. We perform a systematic screen that combines G-protein-signalling quantification, bioinformatic analysis of G-protein-coupled receptor expression and functional examination of NLRP3 inflammasome activation. The results suggest that CYSLTR2 and P2RY6 are potential endogenous receptors of C16:0 ceramide-induced inflammasome activation in both endothelial cells and macrophages. Inhibition of CYSLTR2 and P2RY6 genetically or pharmacologically alleviates ceramide-induced atherosclerosis aggravation. Moreover, increased ceramide levels correlate with the severity of coronary artery disease in patients with varying degrees of renal impairment. Notably, CYSLTR2 and P2RY6 deficiency mitigates chronic-kidney-disease-aggravated atherosclerosis in mice without affecting cholesterol or ceramide levels. Structural analyses of ceramide-CYSLTR2-Gq complexes reveal that both C16:0 and C20:0 ceramides bind in an inclined channel-like ligand-binding pocket on CYSLTR2. We further reveal an unconventional mechanism underlying ceramide-induced CYSLTR2 activation and the CYSLTR2-Gq interface. Overall, our study provides structural and molecular mechanisms of how long-chain ceramides initiate transmembrane Gq and inflammasome signalling through direct binding to CYSLTR2 and P2RY6 receptors. Therefore, blocking these signals may provide a new therapeutic potential to treat atherosclerosis-related diseases.

The association between the aggregate index of systemic inflammation and cardiovascular risk in peritoneal dialysis patients

BACKGROUND AND AIM

The aggregate index of systemic inflammation (AISI), a novel inflammatory biomarker, is associated with various diseases. However, its association with cardiovascular risk in patients treated with peritoneal dialysis (PD) remains unclear. This study aims to explore the relationship between AISI and cardiovascular risk in this high-risk population, providing new insights for risk stratification and guiding clinical decision-making.

METHODS AND RESULTS

This retrospective study enrolled 316 patients who underwent PD catheter insertion at the Second Affiliated Hospital of Anhui Medical University between January 1, 2010, and July 31, 2022. The optimal cut-off value of AISI for predicting cardiovascular events (CVE) was 213.58 using ROC curve analysis. Based on this cut-off value, patients were classified into high and low AISI groups. During a median follow-up of 39 (22, 66) months, 110 patients (34.8 %) developed CVE, and 37 patients (11.7 %) experienced cardiovascular mortality. Kaplan-Meier curves showed that the cumulative incidence of CVE (P < 0.001) and cardiovascular mortality (P = 0.002) were significantly higher in the high AISI group. After adjusting for potential confounding factors, a higher AISI remained an independent risk factor for both CVE (hazard ratio: 2.052; 95 % CI: 1.330-3.164; P = 0.001) and cardiovascular mortality (hazard ratio: 2.651; 95 % CI: 1.088-6.455; P = 0.032) in patients treated with PD. Subgroup analyses showed no significant interactions between AISI and the subgroup variables (P for interaction >0.05).

CONCLUSIONS

Elevated AISI levels are independently associated with an increased risk of CVE and cardiovascular mortality in patients treated with PD. AISI may have significant implications for clinical practice.

Exposure to polystyrene microplastics with different functional groups: Implications for blood pressure and heart

The association between microplastics (MPs) exposure and cardiovascular disease is largely unknown. It is still unclear what effects MPs exposure have on blood pressure and how it affects the heart. As MPs age, their surfaces undergo modifications that may alter how the MPs interact with cells, which may affect the extent of their toxic effects. Here, we used three different surface functional-group polystyrene microplastics (PS-MPs), and exposed 5-week-old SD rats to them over 42 days. Compared with the control group, the mean blood pressure of the MPs exposed rats increased by 22-40%. Exposure to PS-MPs caused oxidative damage to the heart, and induced cardiomyocyte hypertrophy. More interestingly, MPs modified by functional groups induced enhanced adverse effects than unmodified PS-MPs, with amino-modified PS-MPs exhibiting more significant blood pressure elevation and myocardial hypertrophy. Proteomic analysis of cardiac differential proteins focused on factor XII activation, negative regulation of proteolysis, collectively pointed to the downregulation of kininogen. We demonstrated that MPs exposure induced ERK activation, the down-regulation of bradykinin, and inhibition of the downstream nitric oxide signaling pathway. This study demonstrates the different effects of MPs with different functional groups on blood pressure elevation and myocardial hypertrophy, and sheds light on the mechanisms responsible for microplastic-induced cardiovascular toxicity.

A self-sacrificing anti-inflammatory coating promotes simultaneous cardiovascular repair and reendothelialization of implanted devices

During interventional surgeries of implantable cardiovascular devices in addressing cardiovascular diseases (CVD), the inevitable tissue damage will trigger host inflammation and vascular lumen injury, leading to delayed re-endothelization and intimal hyperplasia. Endowing cardiovascular implants with anti-inflammatory and endothelialization functions is conducive to the target site, offering significant tissue repair and regeneration benefits. Herein, inspired by the snake's molting process, a ShedWise device was developed by using the poly(propylene fumarate) polyurethane (PPFU) as the foundational material, which was clicked with hyperbranched polylysine (HBPL) and followed by conjugation with pro-endothelial functional Arg-Glu-Asp-Val peptide (REDV), and finally coated with a "self-sacrificing" layer having reactive oxygen species (ROS)-scavenging ability and degradability. During the acute inflammation in the initial stage of implantation, the ROS-responsive hyperbranched poly(acrylate-capped thioketone-containing ethylene glycol (HBPAK) coating effectively modulated the level of environmental inflammation and resisted initial protein adsorption, showcasing robust tissue protection. As the coating gradually "sacrificed", the exposed hyperbranched HBPL-REDV layer recruited specifically endothelial cells and promoted surface endothelialization. In a rat vascular injury model, the ShedWise demonstrated remarkable efficiency in reducing vascular restenosis, protecting the injured tissue, and fostering re-endothelization of the target site. This innovative design will introduce a novel strategy for surface engineering of cardiovascular implants and other medical devices.

Association between glucose-to-lymphocyte ratio and long-term mortality among women after coronary artery bypass grafting: filling gaps in female

BACKGROUND

Inflammation plays a pivotal role in the progression of coronary artery disease and increases the risk of mortality in patients undergoing coronary artery bypass grafting (CABG). The glucose-to-lymphocyte ratio (GLR), calculated from serum glucose levels and peripheral lymphocyte counts, is a novel marker of inflammation, but its relationship with outcomes after CABG remains unexplored. The aim of this study was to evaluate the association between GLR and long-term mortality.

METHODS

This retrospective cohort study used data from the Medical Information Mart for Intensive Care (MIMIC) database to examine baseline and outcome data for CABG patients. Participants were stratified into quartiles based on GLR levels, and the Cox proportional hazards model and restricted cubic spline analysis were used to evaluate the association between GLR and mortality.

RESULTS

A total of 592 adult patients (mean age 70.0 ± 10.3 years, mean BMI 30.6 ± 6.8 kg/m2) were included. After multivariable adjustment, patients in the highest quartile of GLR had a hazard ratio (HR) of 3.3 (95% CI: 1.04-10.49; Q4 vs. Q2), while those in the lowest quartile had a HR of 5.62 (95% CI: 1.71-18.48; Q1 vs. Q2). A U-shaped relationship was observed between GLR and risk of death (P for nonlinearity < 0.05), with sensitivity and subgroup analyses supporting these findings.

CONCLUSIONS

GLR was significantly associated with an increased risk of long-term mortality, with both the highest and lowest quartiles demonstrating elevated hazard ratios compared to the second quartile. Assessing GLR may have clinical relevance for predicting mortality risk, providing valuable insights for preventive strategies and patient management.

Association of the body roundness index with new-onset cardiovascular disease in middle-aged and older adults with and without diabetes: evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

Among noncommunicable diseases, cardiovascular disease (CVD) is the leading cause of mortality and morbidity. In China, diabetes is renowned for its high incidence rate, and the body roundness index (BRI) is an emerging indicator for assessing obesity, particularly abdominal obesity. High BRI may lead to new-onset CVD events. However, the relationships between the BRI and new-onset CVD in individuals with or without diabetes remain unclear.

METHODS

Data for this analysis were extracted from the China Health and Retirement Longitudinal Study (CHARLS). Our research utilized a cohort that was meticulously assessed over a period from 2011 to 2018, encompassing a comprehensive follow-up of 17,708 participants. Ultimately, this study focused on a subset of 6,737 individuals aged 45 years or older. Methodological approaches include Cox regression, Kaplan-Meier survival analysis, restricted cubic splines (RCS) analysis, receiver operating characteristic (ROC) curve analysis, subgroup analysis, and mediation analysis to explore the relationships of interest.

RESULTS

This study included 6,737 participants, all of whom were above the age of 45. Our findings revealed that within this demographic group, 1,481 (22.0%) patients experienced new-onset CVD. The Kaplan-Meier survival analysis further revealed that the group characterized by non-diabetes mellitus (Non-DM) had the lowest cumulative incidence of CVD compared with the diabetes mellitus (DM) group. Multivariate Cox regression revealed that in the fully adjusted model (Model 3) (HR = 1.122, 95% CI = 1.080 to 1.167), BRI was associated with the risk of CVD in the Non-DM group during the three-wave follow-up. RCS analysis revealed a positive, linear-like dose‒dependent relationship between BRI and new-onset CVD in Non-DM patients (P = 0.007, P for nonlinearity = 0.938). Smoking could affect the ability of the BRI to predict the incidence rate of CVD in the total population and in the population without diabetes (P interaction = 0.007). Moreover, the mediating effect of the BRI on new-onset CVD among diabetic patients was particularly pronounced in the long term, exceeding 4 years.

CONCLUSIONS

Our findings demonstrate a significant association between the BRI and CVD risk in non-diabetic individuals, with diabetes influencing the incidence and risk of new-onset CVD in middle-aged and elderly Chinese populations through the BRI playing a mediating role. As an obesity indicator, the BRI provides a valuable tool for early detection and intervention of CVD.

CLINICAL TRIAL NUMBER

Not applicable.

LDL-C/HDL-C ratio as a predictor of atherosclerosis in the Japanese population: insights from a cross-sectional study

BACKGROUND

Atherosclerosis is a major contributor to cardiovascular disease, and dyslipidemia, particularly low-density lipoprotein cholesterol (LDL-C)/ high-density lipoprotein cholesterol (HDL-C) ratio, plays a critical role in its pathogenesis. Although extensive research has been conducted in Western populations, the relationship between LDL-C/HDL-C ratio and atherosclerosis in the Japanese population remains underexplored. The aim of this study was to investigate the association between LDL-C/HDL-C ratio and atherosclerosis, as measured by brachial-ankle pulse wave velocity (baPWV), in a Japanese cohort.

METHODS

This secondary analysis used data from a cross-sectional study involving 912 participants. LDL-C/HDL-C ratio was calculated from fasting blood samples and baPWV was used to assess atherosclerosis. Univariate and multivariate analyses were performed to evaluate the association between LDL-C/HDL-C ratio and baPWV, adjusting for age, sex, body mass index (BMI), and other potential confounders. Subgroup analyses were performed to explore variations by demographic and clinical factors.

RESULTS

The mean age of the study population was 51.1 years, and 64.9% were male. Significant differences were observed across LDL-C/HDL-C ratio tertiles for age, sex, BMI, blood pressure, liver enzymes, lipid profiles and lifestyle factors (p < 0.001 for most). Univariate analyses showed strong associations between atherosclerosis and age, sex, BMI, blood pressure, liver function markers, metabolic factors and lifestyle behaviours (p < 0.001 for most). Multivariate linear regression models were used to examine the association between LDL-C/HDL-C ratio and baPWV, adjusting for factors such as age, sex, BMI, and other metabolic variables. Subgroup analyses showed significant associations between LDL-C/HDL-C ratio and baPWV in women (p = 0.036), participants aged < 55 years (p = 0.009), and those with BMI < 25 kg/m² (p = 0.044). No significant interactions were observed between subgroups (p for interaction > 0.05).

CONCLUSIONS

LDL-C/HDL-C ratio is significantly associated with atherosclerosis in the Japanese population, with varying strength in different demographic and clinical subgroups. These findings highlight the importance of LDL-C/HDL-C ratio as a predictor of atherosclerosis and underscore the need for targeted interventions to manage cardiovascular risk in this population.

CLINICAL TRIAL NUMBER

Not applicable.

High Cumulative Non-High-Density Lipoprotein-Cholesterol Concentration Increases the Risk of New-Onset Arterial Stiffness - A Prospective Cohort Study

BACKGROUND

The relationship between cumulative non-high-density lipoprotein-cholesterol (cum-non-HDL-C) and the risk of new-onset arterial stiffness has not been characterized.

METHODS AND RESULTS

A total of 6,852 participants with 3 consecutive measurements of total cholesterol and HDL-C and a baseline brachial-ankle pulse wave velocity (baPWV) <1,400 cm/s during 2010-2011, 2012-2013, and 2014-2015 were included. The cum-non-HDL-C concentrations were determined using time weighting, and the participants were grouped: G1 <130 mg/dL, G2 130-159 mg/dL, G3 160-189 mg/dL, and G4 ≥190 mg/dL. Cox models were used to characterize the relationships between cum-non-HDL-C and arterial stiffness by calculating hazard ratios (HRs) and 95% confidence intervals (CIs). Arterial stiffness (baPWV ≥1,800 cm/s) was present in 327 (4.77%) participants over a median follow-up period of 7.7 (interquartile range 7.2-8.2) years. After adjustment for multiple confounders, G2-4 had adjusted HRs (95% CIs) of 1.12 (0.85, 1.48), 1.45 (1.05, 1.99), and 2.52 (1.69, 3.74), respectively (P=0.0004), vs. G1. The adjusted HRs (95% CIs) for exposures of 2, 4, and 6 years were 1.17 (0.87, 1.58), 1.46 (1.96, 2.01), and 1.67 (1.14, 2.44), respectively (P=0.0029), vs. 0 years. Restricted cubic spline analysis revealed a linear dose-response relationship between cum-non-HDL-C and arterial stiffness risk.

CONCLUSIONS

A high cum-non-HDL-C concentration and prolonged exposure to this increase the risk of arterial stiffness. The monitoring and maintenance of appropriate cum-non-HDL-C may reduce the risk of arterial stiffness.

Pericarpium Trichosanthis Injection Protects Isoproterenol-Induced Acute Myocardial Ischemia via Suppressing Inflammatory Damage and Apoptosis Pathways

This research proposes to systematically investigate the cardioprotective mechanisms of Pericarpium Trichosanthis injection (PTI) against acute myocardial ischemia through an integrated approach combining ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF/MS) constituent profiling, UNIFI database-assisted component identification, network pharmacology-guided target prediction, molecular docking verification, and in vivo experimental validation. The multimodal methodology is designed to comprehensively uncover the therapeutic benefits and molecular pathways underlying this traditional Chinese medicine formulation.

METHODS

UPLC-Q-TOF/MS and the UNIFI database were used in conjunction with a literature review to screen and validate the absorbed components of PTI. Using network pharmacology, we constructed protein-protein interaction (PPI) networks for pinpointing prospective therapeutic targets. In addition, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to identify potential signaling pathways. In vivo experiments were conducted to investigate the mechanisms by which PTI ameliorated isoproterenol-induced myocardial injury in rats. All animal experiments have adhered to ARRIVE guidelines.

RESULTS

UPLC-Q-TOF/MS revealed 11 core active components in PTI. Network pharmacology prioritization identified pseudoaspidin, ciryneol C, cynanoside M, daurinol, and n-butyl-β-D-fructopyranoside as central bioactive constituents within the compound-target interaction network. Topological analysis of the protein interactome highlighted AKT1, EGFR, MMP9, SRC, PTGS2, STAT3, BCL2, CASP3, and MAPK3 as the most interconnected nodes with the highest betweenness centrality. Pathway enrichment analysis established the PI3K/Akt signaling cascade as the principal mechanistic route for PTI's cardioprotective effects. Molecular docking simulations demonstrated high-affinity interactions between characteristic components (e.g., cynanoside M, darutigenol) and pivotal targets including PTGS2, MAPK3, CASP3, and BCL2. In vivo investigations showed PTI treatment markedly attenuated myocardial tissue degeneration and collagen deposition (p < 0.05), normalized electrocardiographic ST-segment deviations, and suppressed pro-inflammatory cytokine production (IL-6, TNF-α). The formulation concurrently reduced circulating levels of cardiac injury indicators (LDH, cTnI) and oxidative stress parameters (ROS, MDA), Regarding apoptosis regulation, PTI reduced Bax, caspase-3, and caspase-9, while elevating Bcl-2 (p < 0.05), effectively inhibiting myocardial cell apoptosis with all therapeutic outcomes reaching statistical significance. These findings highlight PTI's protective effects against myocardial injury through multi-target modulation of inflammation, oxidation, and apoptosis.

CONCLUSIONS

PTI exerts its therapeutic effects in treating acute myocardial ischemia by regulating and suppressing inflammatory responses, and inhibiting cardiomyocyte apoptosis.

Does the psychological risk exposure increase carotid plaque detection among the Chinese midlife population? A latent class and regression analysis

AIMS

The aim of this study was to determine whether the psychological risk exposures increase carotid plaque detection in the Chinese midlife population.

METHODS AND RESULTS

This study utilized baseline data from an ongoing prospective cohort study (One Cardiovascular Health Study). Psychological risk exposure was created by including anxiety symptoms, depressive symptoms, and perceived stress through latent class analysis. The results showed that the average age of the 1301 subjects was 37.01 ± 5.59 and 79.55% were female. The rate of carotid plaque was 4.1%. Psychological risk was categorized into three classes: low (n = 735), medium (n = 472), and high (n = 94). After multiple adjustments in the regression model, individuals categorized in the high psychological risk group exhibited significantly higher probabilities of carotid plaque compared with those in the low psychological risk group (OR: 3.744, 95% CI: 1.568-8.937, P = 0.003). The area under the curve for a composite of age, gender, total cholesterol, total triglyceride, and psychological risk stood at 0.762 (95% CI: 0.703-0.820), surpassing combinations excluding psychological risk (P < 0.05). Comparable outcomes were observed for anxiety symptoms and depressive symptoms, but not for perceived stress.

CONCLUSION

Psychological risk exposure was an independent contributor to carotid plaque detection in the Chinese midlife population. Incorporating psychological risk exposure alongside traditional carotid plaque risk factors may enhance the accuracy of diagnosing carotid plaques. Future research should focus on developing screening strategies and targeted interventions to address psychological risk.

Hypnotic use and the risk of cardiovascular diseases in insomnia patients

AIMS

We aimed to examine the association between hypnotic agents and cardiovascular outcomes in general individuals with insomnia.

METHODS AND RESULTS

In a propensity score matched cohort of UK Biobank (UKB) participants with insomnia, Cox proportional hazard model was used to estimate the association between regular use of hypnotic agents and predetermined cardiovascular outcomes including incident coronary heart diseases (CHD), heart failure (HF), stroke, and cardiovascular death. Inverse probability of treatment weighting, competing risk models, and shared frailty models were further performed during sensitivity analysis. Drug-target Mendelian randomization (MR) analyses were employed for further evaluation of the association between therapeutic targets of hypnotics and cardiovascular diseases. During a median follow-up of 14.3 years, the matched cohort documented a total of 929 CHD cases, 360 HF cases, 262 stroke cases, and 180 cardiovascular deaths. No significant association was detected between Z-meds and CHD, stroke, and cardiovascular mortality. Benzodiazepine use was significantly associated with the increased risk of CHD, HF, and cardiovascular mortality. The inverse probability of treatment weighting, competing risk models, and shared frailty models didn't alter the above associations. Moreover, drug-target MR analyses corroborated the safety of Z-meds in the general population regarding cardiovascular health.

CONCLUSION

Our findings suggested the heterogeneous associations between different categories of hypnotics and incident cardiovascular events in individuals with insomnia. Both observational and genetic evidence raised safety concerns regarding the cardiovascular impact of benzodiazepines. No cardiovascular hazard of Z-meds was discovered in the UKB population with insomnia.

E3 ubiquitin ligase CHIP alleviates H/R-induced myocardial injury by inhibiting pyroptosis

BACKGROUND

Hypoxia/Reoxygenation (H/R) injury to cardiomyocytes has adverse effects on the function, structure and prognosis of the heart. Studies have shown that H/R injury is closely related to pyroptosis. The inflammatory response induced by pyroptosis, leading to the death of cardiomyocytes. However, the specific mechanism of pyroptosis in myocardial H/R injury is not fully understood. In recent years, the important role of CHIP proteins in cardiovascular diseases has gradually attracted attention. Studies have found that CHIP protein can play an important role in the regulation of pyroptosis. However, its role in ameliorating H/R injury in cardiomyocytes has not been fully studied.

METHODS

An in vitro H/R model was constructed, and CHIP was knockdown and overexpression interfered simultaneously. The effect of CHIP on pyroptosis and its reduction of H/R-induced myocardial injury were verified by detection of cell viability, LDH, cell membrane integrity, ROS production, inflammatory factors (NLRP3, Caspase-1, ASC, IL-1β) and β-catenin/HSF1 signaling pathway.

RESULTS

In our study, we verified that the occurrence of oxidative stress and pyroptosis as well as cell damage was significantly increased in cardiomyocytes after H/R stimulation in vitro. After CHIP knockdown, pyroptosis of cardiomyocytes was further aggravated, accompanied by the down-regulation of HSF1/β-catenin signaling axis. These adverse changes were ameliorated after CHIP overexpression.

CONCLUSION

Our study confirmed that CHIP can alleviate H/R-induced myocardial injury by mediating pyroptosis, which may be achieved by regulating HSF1/β-catenin signaling pathway.

Cardiovascular Emergency Hospitalization Risks of PM2.5 Transition Metals: A Time-Stratified Case-Crossover Study

PM2.5 pollution poses significant health risks in urban areas, yet the specific cardiovascular impacts of its hazardous components, especially transition metals, remain insufficiently understood. This study evaluated the associations of PM2.5 components on acute myocardial infarction (AMI) and acute aortic dissections (AAD) emergency hospitalizations (n = 9985) using a time-stratified case-crossover between 2017 and 2023 in Xiamen, China. We collected comprehensive data on daily air pollutants, PM2.5 components (water-soluble ions, carbon components, metals, and other elements), and meteorological variables. Conditional logistic regressions were used to estimate odds ratios (OR) per the interquartile range (IQR) of exposures. Our finding reveals significant short-term associations of exposures to air pollutants and PM2.5 components with increased cardiovascular emergency hospitalizations. The strongest associations were observed between cumulative 3-day lagged (lag 0-3) PM2.5 transition metals including Mn [odds ratio, OR = 1.106 (95% CI: 1.032-1.186)], Fe [OR = 1.078, (95% CI: 1.015-1.145)], V [OR = 1.117 (95% CI: 1.024-1.219)], and Zn [OR = 1.08, (95% CI: 1.005-1.161)] exposure with AMI. These associations were stronger among older (age >65 years), male patients, and during colder seasons. Our study highlights the underexplored subacute cardiovascular risks of PM2.5 transition metals, underscoring the need to integrate them into urban air quality management to promote environmental sustainability.

Effect of enhanced external counterpulsation on the rehabilitation of patients with acute myocardial infarction after drug-coated balloon-based percutaneous coronary intervention

OBJECTIVE

To observe, compare and explore the effect of enhanced extracorporeal counterpulsation (EECP) treatment on cardiac rehabilitation in patients with acute myocardial infarction (AMI) after undergoing percutaneous coronary intervention (PCI) using a drug-coated balloon (DCB).

METHODS

This study was a prospective randomised controlled trial of 60 patients with AMI after undergoing PCI using a DCB. Using a random number table method, the patients were randomly divided into control and rehabilitation groups, with 30 patients in each. The follow-up period was 6 months. Patients in the control group received conventional drug and exercise rehabilitation after undergoing DCB-based PCI; those in the rehabilitation group were also given an EECP-based rehabilitation regimen after 7 days of medication and exercise rehabilitation. The effects of EECP on the rehabilitation of patients with AMI after undergoing DCB-based PCI were evaluated by observing changes in cardiac function before and after treatment in the two groups of patients, including cardiac output (CO), stroke volume (SV), brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and 6-minute walking distance (6MWD).

RESULTS

After 6 months of treatment, the control versus the rehabilitation groups' cardiac function results were as follows: CO (5.00 ± 0.67 vs. 4.64 ± 0.58, P = 0.023), SV (70.53 ± 3.33 vs. 65.57 ± 6.10, P < 0.001), BNP (157.63 ± 15.37 vs. 219.40 ± 16.73, P < 0.001), LVEF (65.57 ± 4.33 vs. 60.10 ± 2.92, P < 0.001) and 6MWD (455.43 ± 39.75 vs. 400.73 ± 36.81, P < 0.001). The patients in the rehabilitation group showed improved cardiac function compared with the control group, with statistically significant differences. Furthermore, the improvement in the New York Heart Association cardiac function grading (P < 0.001) and Canadian Cardiovascular Association angina grading (P < 0.001) in the rehabilitation group were significantly improved compared with the gradings of the control group.

CONCLUSION

Using EECP treatment significantly improved the cardiac function of patients with AMI after undergoing DCB-based PCI and was beneficial for their cardiac rehabilitation.

Retrospective perspectives and future trends in nanomedicine treatment: from single membranes to hybrid membranes

At present, various diseases seriously threaten human life and health, and the development of nanodrug delivery systems has brought about a turnaround for traditional drug treatments, with nanoparticles being precisely targeted to improve bioavailability. Surface modification of nanoparticles can prolong blood circulation time and enhance targeting ability. The application of cell membrane-coated nanoparticles further improves their biocompatibility and active targeting ability, providing new hope for the treatment of various diseases. Various types of cell membrane biomimetic nanoparticles have gradually attracted increasing attention due to their unique advantages. However, the pathological microenvironment of different diseases is complex and varied, and the single-cell membrane has several limitations because a single functional property cannot fully meet the requirements of disease treatment. Hybrid cell membranes integrate the advantages of multiple biological membranes and have become an emerging research hotspot. This review summarizes the application of cell membrane biomimetic nanoparticles in the treatment of various diseases and discusses the advantages, challenges and future development of biomimetic nanoparticles. We propose that the fusion of multiple membranes may be a reasonable trend in the future to provide some ideas and directions for the treatment of various diseases.

Association of social isolation and loneliness with incident cardiovascular diseases: results from a nationally prospective cohorts in China

AIMS

Social isolation and loneliness are associated with increased risk of cardiovascular disease (CVD). Most research examining the effects of social isolation and loneliness on CVD is based in Western countries. This study examined the effects of loneliness and social isolation on cardiovascular disease in China.

METHODS

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS). Social isolation, loneliness and CVD were measured at baseline. The analytical sample size was 6,860 for the analysis of self-reported CVD. Cox proportional-hazard regression adjusted for confounding factors were used to assess the association between baseline isolation, loneliness, and CVD.

RESULTS

Incident CVD was followed-up from 2011 to 2018. During the 7 years of follow-up, we found that loneliness was associated with an increased risk of CVD events (adjusted HR, 1.24; 95% CI, 1.06-1.44). In the moderately isolated group, loneliness was significantly associated with an elevated risk of incident CVD after adjusting for all confounders (adjusted HR, 1.40; 95% CI, 1.13-1.73). Loneliness was significantly associated with an increased risk of incident CVD among female participants (adjusted HR, 1.29; 95% CI, 1.07-1.56).

CONCLUSIONS

Loneliness significantly increased the risk of incident CVD, while social isolation did not exhibit a similar correlation. Our findings suggest that targeted and practical social interventions could improve the accuracy and efficiency of identifying individuals at high risk.

Autophagy: a double-edged sword in ischemia-reperfusion injury

Ischemia-reperfusion (I/R) injury describes the pathological process wherein tissue damage, initially caused by insufficient blood supply (ischemia), is exacerbated upon the restoration of blood flow (reperfusion). This phenomenon can lead to irreversible tissue damage and is commonly observed in contexts such as cardiac surgery and stroke, where blood supply is temporarily obstructed. During ischemic conditions, the anaerobic metabolism of tissues and organs results in compromised enzyme activity. Subsequent reperfusion exacerbates mitochondrial dysfunction, leading to increased oxidative stress and the accumulation of reactive oxygen species (ROS). This cascade ultimately triggers cell death through mechanisms such as autophagy and mitophagy. Autophagy constitutes a crucial catabolic mechanism within eukaryotic cells, facilitating the degradation and recycling of damaged, aged, or superfluous organelles and proteins via the lysosomal pathway. This process is essential for maintaining cellular homeostasis and adapting to diverse stress conditions. As a cellular self-degradation and clearance mechanism, autophagy exhibits a dualistic function: it can confer protection during the initial phases of cellular injury, yet potentially exacerbate damage in the later stages. This paper aims to elucidate the fundamental mechanisms of autophagy in I/R injury, highlighting its dual role in regulation and its effects on both organ-specific and systemic responses. By comprehending the dual mechanisms of autophagy and their implications for organ function, this study seeks to explore the potential for therapeutic interventions through the modulation of autophagy within clinical settings.

Barriers and Facilitators of Cardiac Rehabilitation in a Middle-Income Country: A Qualitative Study from China

BACKGROUND

Although effective and recommended by guidelines worldwide, Cardiac Rehabilitation (CR) remains scarce and underutilized. CR implementation has taken place in middle-income countries, but the progress is influenced by both positive and negative factors that remain underexplored. This study identified the barriers and facilitators of CR in a middle-income country, specifically China.

METHODS

An exploratory qualitative study was conducted using semi-structured interviews.

RESULTS

Fifteen CR stakeholders were interviewed. According to the interviewees, the delivery of CR is impeded due to a lack of resources, a lack of CR professionals, and a lack of coordination between health institutions. The participation of CR is hindered by a lack of awareness, a lack of reimbursement, and a lack of access to CR. However, the interviewees also mentioned facilitating factors, namely, a positive attitude of stakeholders, high motivation of some patients, and policy support.

CONCLUSIONS

More awareness regarding the effectiveness of CR is needed. Implementing CR in secondary and primary health institutions could overcome the barriers regarding travel distance and transportation to faraway hospitals. The CR reimbursement methods are needed to ease the financial burden on patients. Our findings reveal factors that need to be considered by policymakers to deliver CR on a wider scale in China.

Association of intra-individual differences in estimated GFR by creatinine versus cystatin C with incident cardiovascular disease

BACKGROUND AND AIMS

This study investigates the association between intra-individual differences in estimated glomerular filtration rate based on serum creatinine (eGFRscr) and cystatin C (ΔeGFRcysc-scr) and incident CVD.

METHODS AND RESULTS

This study used data from the China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2020. ΔeGFRcysc-scr were determined by subtracting eGFRscr from eGFRcysc. The outcome was the incidence of CVD, including heart diseases, and stroke, obtained through self-reports. Cox proportional hazard regression models were employed to examine the association between ΔeGFRcysc-scr and CVD risks. Restricted cubic spline with three knots at the 10th, 50th, and 90th centiles was conducted to flexibly model the association. During this period, 1187 incident CVD events were documented. After adjusting for covariates, the risk of CVD was reduced by 13.2 % (Hazard ratio [HR] = 0.868; 95 % confidence interval [95 % CI]: 0.818-0.921) for every 15 mL/min/1.73 m2 increase in baseline ΔeGFRcysc-scr. Specifically, individuals in negative-ΔeGFRcysc-scr group (<-15 mL/min/1.73 m2) had a 33.6 % increased risk of CVD events (HR = 1.336; 95 % CI: 1.151-1.551), and positive-ΔeGFRcysc-scr group (≥15 mL/min/1.73 m2) had a 34.5 % decrease risk of CVD events (HR = 0.655; 95 % CI: 0.541-0.794), compared with those in reference group (-15 to 15 mL/min/1.73 m2). These associations remained robust after adjusting for potential confounders or sensitivity analysis.

CONCLUSIONS

Our findings suggest that intra-individual differences in eGFR estimates based on creatinine versus cystatin C are associated with CVD risk in the Chinese population. This highlights the potential value of using both markers for more accurate CVD risk stratification in clinical practice.

Sialyl Lewis X (sLex):Biological functions, synthetic methods and therapeutic implications

Carbohydrates are shown to be crucial to several biological processes. They are essential mediators of cell-cell recognition processes. Among them, Sialyl Lewis X (sLex) is a very significant structure in the human body. It is a critical tetrasaccharide that plays a pivotal role in various biological processes, including cell adhesion, immune response, and cancer metastasis. Known as the blood group antigen, sLex is also referred to as cluster of differentiation 15s (CD15s) or stage-specific embryonic antigen 1 (SSEA-1). sLex is not only a prominent blood group antigen, but also involved in the attraction of sperm to the egg during fertilization, prominently displayed at the terminus of glycolipids on the cell surface. By describing the synthetic methods and biological functions of sLex, this review underscores the importance of sLex in both fundamental and applied sciences and its potential to impact clinical practice.

RIPC improves myocardial injury by promoting mitochondrial protection via the PGC-1α/Nrf2 pathway

Myocardial infarction (MI) is a common condition with high morbidity and mortality rates. Remote ischemic preconditioning (RIPC) activates the endogenous protective mechanisms by promoting ischemic tolerance and mitigating the subsequent damage caused by fatal ischemia. Maintaining mitochondrial function is imperative for the prevention of myocardial ischemia. The current study aims to evaluate the therapeutic effects of RIPC on MI with a focus on the mechanisms involved in mitochondrial function. In our study, patients with MI who underwent coronary angiography were randomly assigned to either the RIPC group (n = 20) or the control group (n = 20). RIPC intervention was administered preoperatively by inflating a blood pressure cuff on the upper arm to 200 mmHg for four cycles of 5 min each, interspersed with 5-min reperfusion intervals. The process alleviated myocardial injury among the participants, accompanied by a significant elevation in the serum concentrations of PGC-1α and Nrf2 levels in the serum. In vitro studies showed that RIPC can protect cardiomyocytes against ischemic injury by preserving the mitochondrial morphology, maintaining mitochondrial membrane integrity, and reducing oxidative stress. In vivo experimental findings illustrated that RIPC mitigated myocardial structural damage in mice by augmenting mitochondrial function, leading to significant cardiac protection, as evidenced by improved cardiac function and reduced infarct size. Moreover, the protective effects of RIPC were abolished upon silencing of PGC-1α. Collectively, the results indicated that RIPC activates the PGC-1α/Nrf2 signaling pathway to rescue cardiomyocytes by maintaining mitochondrial function during ischemic insult, suggesting a promising strategy for preventing cardiac ischemia injury.

Association between triglyceride glucose-body mass index and 365-day mortality in patients with critical coronary heart disease

Objectives

The aim of this study was to analyze the association between TyG-BMI and 365-day mortality in critically ill patients with CHD.

Methods

Patient data were extracted from the MIMIC-IV database. All patients were categorized into 3 groups based on TyG-BMI index: Low TyG-BMI index group, Medium TyG-BMI index group, and High TyG-BMI index group. Outcomes included primary and secondary outcomes, with the primary outcome being 365-day mortality and the secondary outcomes being hospital survival, intensive care unit (ICU) survival, and 28-day, 90-day, and 180-day mortality. The Kaplan-Meier survival curves were used to compare the outcomes of the three groups. The relationship between TyG-BMI index and 365-day mortality was assessed using multivariate Cox proportional risk regression models and restricted cubic spline curves (RCS).

Results

889 critically ill patients with CHD were analyzed. Among them, 600 (67.50%) were male patients with a mean age of 68.37 years and 289 (32.50%) were female patients with a mean age of 73.91 years. Patients with a medium TyG-BMI index had the best 365-day prognostic outcome and the highest survival rate compared with patients in the Low and High TyG-BMI index groups [201 (67.68%) vs. 166 (56.08%), 188 (63.51%); P=0.013]. After fully adjusted modeling analysis, the hazard ratio (HR) for 365-day mortality was found to be 0.71 (95% CI 0.54-0.93, P=0.012) for the Medium TyG-BMI index group. Meanwhile, RCS analysis showed an L-shaped relationship between TyG-BMI index and 365-day mortality.

Conclusions

The TyG-BMI index is significantly associated with 365-day mortality in patients with severe CHD.

The Global Burden of Cardiovascular Disease in Adults: A Mapping Review

BACKGROUND

Cardiovascular diseases (CVDs) persist as formidable contributors to global mortality and pose substantial challenges to public health. Most mortality estimates have been attributed to heart attack and stroke. Despite increased public awareness, the burden of CVDs continues to increase.

OBJECTIVE

This review describes the burden of CVDs and risk factors in adults, according to the World Health Organization's (WHO) defined regions.

METHODS

A mapping review methodology was used. PubMed, Scopus, Wiley, the WHO Global Health Observatory data repository, American Heart Association, National Forum for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, European Commission, Eurostat, European Society of Cardiology, World Heart Federation, and Google Scholar were searched using free text search terms: cardiovascular diseases/CVDs, burden, incidence, prevalence, prevention, and risk factor.

RESULTS

Ischemic heart disease predominated in the Americas, Europe, and Eastern Mediterranean, whereas stroke was more common in Africa, Southeast Asia, and the Western Pacific. Premature deaths occur in populations with low socioeconomic status. Several well-known risk factors are preventable, including hypertension, dyslipidemia, diabetes, air pollution, obesity, smoking, lack of physical activity, and unhealthy dietary intake. Emerging risk factors include excessive or lack of sleep, depression, social isolation, air/noise pollution, and exposure to extreme sunshine, arsenic, lead, cadmium, and copper.

CONCLUSIONS

The burden of CVDs and its risk factors vary greatly according to demographics and geographical region. Addressing CVDs requires multifaceted strategies, including region-specific interventions, addressing socioeconomic inequalities, adopting life-course risk management, strengthening the healthcare workforce, and improving health literacy.

U-shaped association between the glycemic variability and prognosis in hemorrhagic stroke patients: a retrospective cohort study from the MIMIC-IV database

Background

Elevated glycemic variability (GV) is commonly observed in intensive care unit (ICU) patients and has been associated with clinical outcomes. However, the relationship between GV and prognosis in ICU patients with hemorrhagic stroke (HS) remains unclear. This study aims to investigate the association between GV and short- and long-term all-cause mortality.

Methods

Clinical data for hemorrhagic stroke (HS) patients were obtained from the MIMIC-IV 3.1 database. GV was quantified using the coefficient of variation (CV), calculated as the ratio of the standard deviation to the mean blood glucose level. The association between GV and clinical outcomes was analyzed using Cox proportional hazards regression models. Additionally, restricted cubic spline (RCS) curves were employed to examine the nonlinear relationship between GV and short- and long-term all-cause mortality.

Results

A total of 2,240 ICU patients with HS were included in this study. In fully adjusted models, RCS analyses revealed a U-shaped association between the CV and both short- and long-term all-cause mortality (P for nonlinearity < 0.001 for all outcomes). Two-piecewise Cox regression models were subsequently applied to identify CV thresholds. The thresholds for all-cause mortality in ICU, during hospitalization, and at 30, 90, and 180 days were determined to be 0.14, 0.16, 0.155, 0.14, and 0.14, respectively. These findings were consistent in sensitivity and subgroup analyses.

Conclusions

In HS patients, higher GV is associated with an increased risk of both short- and long-term all-cause mortality. Our findings suggest that stabilizing GV may improve the prognosis of HS patients.

The association of telomere length and coronary heart disease: A systematic review and dose-response meta-analysis

AIMS

The association of telomere length (TL) and coronary heart disease (CHD) is still debated, and there is a lack of dose-response meta-analyses on this issue. The aim is therefore to integrate existing evidence on the association between TL and CHD risk and explore the dose-response relationship between them.

DATA SYNTHESIS

PubMed, EMBASE, and Web of Science were searched for relevant studies up to September 2024. Meta-analysis was performed using a random-effects model, with data presented as RRs and 95 % CIs. Restricted cubic splines were used to assess linear and nonlinear associations. Subgroup analysis and meta-regression were performed to explore sources of heterogeneity. Fourteen articles (8 prospective cohort studies, 2 case-cohort studies, 2 case-control studies, and 2 cross-sectional studies) were finally included in the meta-analysis, with a total sample size of 199,562 participants and 25,752 cases. For CHD, the total RR for the highest TL group compared to the lowest TL group was 0.69 (95 % CI: 0.61, 0.78, I2 = 64.5 %). For every 1 kilobase pair (kbp) increase in TL, the CHD risk decreased by 23 % (RR = 0.77, 95 % CI: 0.69, 0.87, I2 = 89.0 %). The nonlinearity test indicated a linear association between TL and CHD risk (Pnon-linearity = 0.930). Sensitivity analyses indicated that the results were robust.

CONCLUSIONS

The meta-analysis showed a linear relationship between TL and CHD. People with low TL may be more likely to develop CHD than those with high TL. The association between the two did not change in a wide range of populations.

Chromofungin mitigates free fatty acids-induced endothelial inflammation via inhibition of NOD-like receptor thermal protein domain-associated protein 3 mediated by adenosine 5'-monophosphate-activated protein kinase

Free fatty acids (FFAs) have emerged as significant risk factors for atherosclerosis (AS). Prolonged exposure to FFAs induces vascular endothelial injury, including inflammatory responses and oxidative stress, which are central events in AS. Chromofungin (CHR), a peptide derived from chromogranin A (CGA), has been implicated in various biological functions. However, its physiological roles in endothelial biology and its involvement in the pathological development of AS have not been previously reported. In the present study, we investigated the underlying mechanisms through which CHR exerts its beneficial effects on FFA-challenged human aortic endothelial cells (HAECs). We found that treatment with CHR ameliorated the FFA-induced reduction in cell viability and increase in lactate dehydrogenase (LDH) release. Additionally, CHR mitigated oxidative stress by reducing mitochondrial reactive oxygen species (ROS) levels and increasing superoxide dismutase (SOD) activity. Furthermore, exposure to FFAs increased NADPH oxidase (NOX) 4 expression at both the mRNA and protein levels, which were attenuated by CHR in a dose-dependent manner. Notably, CHR reduced the levels of nucleotide-binding domain and leucine-rich repeat-containing (NLR) family pyrin domain containing 3 (NLRP3), apoptosis-associated speck-like protein containing a CARD (ASC), and cleaved caspase-1 (p10), key components of the NLRP3 inflammasome complex, as well as interleukin 1β (IL-1β) and interleukin-18 (IL-18) expression. Mechanistically, it was demonstrated that FFAs reduced the phosphorylation of AMP-activated protein kinase (AMPK) and acetyl-CoA carboxylase (ACC), which were rescued by CHR in a dose-dependent manner. Conversely, inhibition of AMPK with its specific inhibitor compound C abolished the protective effects of CHR against FFA-induced activation of the NLRP3 inflammasome in HAECs. Based on these findings, we conclude that CHR may serve as a promising agent for maintaining normal endothelial cell function and treating AS.

Sigma-1 Receptor Specific Biological Functions, Protective Role, and Therapeutic Potential in Cardiovascular Diseases

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, and there is an urgent need for efficient and cost-effective treatments to decrease the risk of CVD. The sigma-1 receptor (S1R) plays a role in the development of cardiac hypertrophy, heart failure, ventricular remodeling, and various other cardiac diseases. Preclinical studies have shown that S1R activation has considerable beneficial effects on the cardiovascular system, and this knowledge might contribute to informing clinical trials associated with the prevention and treatment of CVDs. Therefore, the objective of this review was to investigate the mechanisms of S1R in CVD and how modulation of pathways contributes to cardiovascular protection to facilitate the development of new therapeutic agents targeting the cardiovascular system.