Burden of ischemic heart disease and its attributable risk factors in 204 countries and territories, 1990-2019

Clinical standards in angina and non-obstructive coronary arteries: A clinician and patient consensus statement

Patients with angina and non-obstructive coronary arteries (ANOCA) or myocardial ischaemia with non-obstructive coronary arteries (INOCA) comprise a relatively large subgroup within those with ischaemic heart disease. Advances in the understanding of disease mechanisms, diagnostic tests and multidisciplinary care are improving awareness of the needs of affected individuals. However, practice variations and suboptimal management promulgate the health burden and increase health care resource consumption. Clinical standards represent a limited number of quality statements that describe the care patients should be offered by health professionals and providers for a specific clinical condition or defined clinical pathway in line with current best evidence. Clinical standards should address implementation of this evidence along with education of patients and healthcare professionals, multidisciplinary care networks, and research. In this consensus statement, we highlight contemporary evidence and stakeholder views, including clinicians and patients, to provide an international perspective for developing clinical standards for services involving ANOCA/INOCA patients. A clinical service for ANOCA/INOCA should "consider the whole patient" and provide a multidisciplinary, patient-centred service.

Temporal trend and attributable risk factors of cardiovascular disease burden for adults 55 years and older in 204 countries/territories from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021

AIMS

The ageing global population and overall population growth have significantly increased the burden of cardiovascular diseases (CVDs). This study aims to examine global temporal trends in the incidence, disability-adjusted life years (DALYs), and mortality rates of both overall and type-specific CVDs among adults aged 55 and older from 1990 to 2021, with a focus on identifying changes over time, regional disparities, and the key risk factors contributing to this burden.

METHODS AND RESULTS

We analysed data from the Global Burden of Disease Study 2021, covering 204 countries and territories. Trends in age-standardized rates of incidence, DALY, and mortality for both overall and specific types of CVDs were assessed, alongside the impact of key risk factors. Between 1990 and 2021, global age-standardized incidence, DALY, and mortality rates showed a declining trend, with estimated annual percentage changes of -0.39, -1.30, and -1.11, respectively. However, due to overall population growth and ageing, the absolute number of CVD cases continued to rise. Regions with high-middle socio-demographic index (SDI) exhibited the highest incidence and mortality rates, while high SDI regions saw the greatest declines. Men had higher age-standardized rates of CVD incidence, DALY, and mortality compared with women. The burden increased with age, with the oldest age groups (80+ years) showing the highest rates. High systolic blood pressure was the leading modifiable risk factor, contributing to more than half of the CVD-related DALY globally. Other major risk factors included high LDL cholesterol, smoking, and ambient particulate matter pollution.

CONCLUSION

While age-standardized rates of CVD incidence, DALY, and mortality have declined over the past three decades, the total burden of CVDs continues to rise due to population ageing and growth. These findings highlight the need for targeted prevention strategies in regions with high CVD burden, particularly those with lower socioeconomic status.

Global, regional, and national burden of cardiovascular diseases attributable to metabolic risks across all age groups from 1990 to 2021: an analysis of the 2021 global burden of disease study data

OBJECTIVE

The objective is to evaluate the temporal trends in the burden of cardiovascular diseases attributable to metabolic risk factors from 1990 to 2021 and to project the burden over the subsequent 30 years.

METHODS

A joinpoint regression model was employed to estimate the annual percentage change in cardiovascular disease mortality attributable to metabolic risk factors, utilizing data from the Global Burden of Disease (GBD) 2021. An age-period-cohort analysis was conducted to evaluate the effects of age, period, and cohort. A frontier analysis was employed to investigate the correlation between the prevalence of cardiovascular disease attributable to metabolic risk factors and socio-demographic trends. An autoregressive integrated moving average (ARIMA) model was subsequently constructed to forecast future cardiovascular disease burden.

RESULTS

Between 1990 and 2021, the global age-standardized mortality rate (ASMR) of cardiovascular diseases attributable to metabolic factors exhibited a consistent decline (Average Annual Percent Change (AAPC) = -1.28, 95% CI [-1.42, -1.14], P < 0.01). However, the absolute number of deaths increased from 8.326 million to 13.595 million. The most substantial reduction in ASMR was observed in the High Socio-Demographic Index (SDI) region (AAPC = -2.98, 95% CI [-3.10, -2.86], P < 0.01), whereas the reductions were relatively smaller in the Low-middle SDI and Low SDI regions. The ARIMA model predicts a decline in global cardiovascular disease mortality over the next three decades, with the most pronounced decrease anticipated in the high-middle SDI region and smaller declines expected in the middle SDI and low SDI regions.

CONCLUSION

Notwithstanding a global decline in age-standardized mortality and disability-adjusted life year (DALY) rates, the burden of cardiovascular diseases attributable to metabolic factors remains significant worldwide. Targeted interventions must be implemented without delay, particularly for males and populations in low and middle SDI regions, to mitigate the impact of metabolic factors on public health.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Atmospheric Pollutants, Cardiometabolic Disorders, and Dementia in Trajectory Analysis: A 13-Year Longitudinal Cohort Study

BACKGROUND

First cardiometabolic disorders (FCMDs) and dementia pose a significant burden on aging populations. Investigating the association between atmospheric pollutants and the progression of FCMDs and dementia is crucial.

METHODS

A prospective analysis was conducted on 413 149 participants from the UK Biobank. Atmospheric pollutant concentrations were calculated using land-use regression models. We used a multistate model and calculated the polygenic risk score for dementia to analyze the associations of pollutants on the relevant trajectories from baseline to FCMD, subsequent dementia, and death.

RESULTS

Over 13 years, 65 336 patients with FCMD were identified, with 2584 developing dementia and 10 664 dying. Each interquartile range increase in pollutant concentrations showed the hazard ratios (HRs) of particulate matter with aerodynamic diameter ≤2.5 μm (HR, 1.03 [95% CI, 1.02-1.05]); nitrogen dioxide (HR, 1.04 [95% CI, 1.03-1.05]), and nitrogen oxides (HR, 1.03 [95% CI, 1.02-1.04]) for transitioning from baseline to FCMD; particulate matter with aerodynamic diameter ≤2.5 μm (HR, 1.11 [95% CI, 1.05-1.16]; nitrogen dioxide: HR, 1.12 [95% CI, 1.06-1.18]; and nitrogen oxides (HR, 1.07 [95% CI, 1.03-1.12]) for transitioning from FCMD to dementia, and the association between pollutants and this trajectory remained consistent after adjusting for genetic susceptibility to dementia (particulate matter with aerodynamic diameter ≤2.5 μm: HR, 1.06 [95% CI, 1.04-1.08]; nitrogen dioxide: HR, 1.05 ([95% CI, 1.03-1.07); and nitrogen oxides: HR, 1.05 [95% CI, 1.03-1.06]) for transitioning from baseline to death; and particulate matter with aerodynamic diameter ≤2.5 μm: HR, 1.03 ([95% CI, 1.00-1.05); nitrogen dioxide: HR, 1.05 ([95% CI, 1.02-1.08); nitrogen oxides: HR, 1.04 ([95% CI, 1.01-1.06]) for transitioning from subsequent FCMD to death. Particulate matter with aerodynamic diameter ≤10 μm was only significantly associated with the transition from baseline to FCMD.

CONCLUSIONS

Our study provides the first evidence that atmospheric pollutants are associated with the progression of FCMD and subsequent dementia.

Hearts apart: exploring sex disparity in the global and regional burden of ischemic heart disease; a systematic analysis from the global burden of disease study 1990-2021

BACKGROUND

Worldwide, ischemic heart disease is less prevalent in women than in men, but this gap has narrowed in recent decades. This study aims to evaluate trends and gender differences in the global burden of ischemic heart disease (IHD) across demographics and regions from 1990 to 2021.

METHODS

We utilized the data of the Global Burden of Disease Study from 1990 to 2021. The standard epidemiological measurements, including incidence, prevalence, mortality rates, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), were obtained to estimate the burden of IHD concerning age, sex, and the sociodemographic index, allowing for comparisons over time.

RESULTS

The sex parity ratio (SPR), defined as the ratio of females to males, has increased globally. The SPR of age-standardized prevalence (ASPR) and age-standardized incidence (ASIR) rose from 0.610 to 0.631 in 1990 to 0.653 and 0.670 in 2021, respectively. From 1990 to 2021, the SPRs for ASPR and ASIR of IHD increased across all age groups. However, the SPRs for the age-standardized mortality rate (ASMR) and the age-standardized DALY rates (ASDR) of IHD declined. This decrease in the SPR for both ASMR and ASDR of IHD was observed in most regions of this study.

CONCLUSIONS

While progress has been made in reducing the burden of IHD, the increasing sex disparities in specific regions and age groups emphasize the need for continuous monitoring, adaptive health policies, and sex-specific healthcare practices to ensure equitable health outcomes for all populations.

CLINICAL TRIAL NUMBER

not applicable.

Burden of disease in the Belt and Road countries from 1990 to 2021: analysis of estimates from the Global Burden of Disease 2021

BACKGROUND

As a newly emerging collaborative platform to boost regional growth and prosperity, the Belt and Road Initiative (BRI) has great potential to promote global health development. However, the overall health status of BRI countries remains unclear. We analyzed the health patterns and its geographical distribution in 149 BRI countries from 1990 to 2021.

METHODS

Using the Global Burden of Disease 2021 (GBD 2021) online database, we examined time trends, country and income variations in death rate and disability-adjusted life years (DALY) rate, and compared the trends and projected 2030 values for ten key health-related Sustainable Development Goals (SDGs) indicators among the 149 BRI countries.

RESULTS

The number of deaths and DALYs of BRI countries represented 62.9-66.0% of global deaths and 64.8-66.8% of global DALYs between 1990 and 2021, and both the overall age-standardized death rate and DALY rate continued to be higher in BRI countries than in non-BRI countries throughout the time period studied. Great variations existed across the 149 BRI countries for both level of and changes in age-standardized death rate and DALY rate. The 2030 targets for six health-related SDGs indicators will not be reached in over 70% of BRI countries according to the previous changing speed trajectory.

CONCLUSIONS

Our findings demonstrate that BRI countries face a heavy burden of disease that varies across countries, although health outcomes have improved since 1990. Progress toward 2030 targets for six key health-related SDGs indicators in most BRI countries was slow. These findings support calls for more health collaborations, aid programs, and other health service to reduce health disparities across the BRI countries.

Involvement of Piezo 1 in inhibition of shear-induced platelet activation and arterial thrombosis by ginsenoside Rb1

BACKGROUND AND PURPOSE

Shear-induced platelet activation and aggregation (SIPA) play crucial roles in arterial thrombosis. Piezo1 is a mechanosensitive calcium channel that promotes platelet hyperactivation under pathological high-shear conditions. This study explores the function of platelet Piezo1 in SIPA and arterial thrombosis, and the inhibitory effects and mechanisms of ginsenoside Rb1 on these processes.

EXPERIMENTAL APPROACH

Transgenic mice with platelet-specific Piezo1 deficiency (Piezo1ΔPlt) were used to elucidate the role of platelet Piezo1 in SIPA and arterial thrombosis. A microfluidic channel system was employed to assess platelet aggregation, calcium influx, calpain activity, talin cleavage, integrin αIIbβ3 activation and P-selectin expression under shear flow. Cellular thermal shift assay was used to determine binding between Rb1 and Piezo1. Folts-like model in mice was used to evaluate antithrombotic effects of Rb1.

KEY RESULTS

Piezo1 deficiency in platelets reduced platelet activation and aggregation induced by a high shear rate of 4000 s-1 and attenuated arterial thrombosis induced by Folts-like mouse model. Rb1 inhibited SIPA with an IC50 of 10.8 μM. Rb1 inhibited shear-induced Ca2+-dependent platelet activation and aggregation, as well as thrombus formation in Folts-like model in Piezo1fl/fl mice. Rb1 significantly improved thermal stability of Piezo1 in platelets by binding to Piezo1. Treatment of Piezo1ΔPlt mice with Rb1 did not exhibit further inhibitory effects on SIPA and thrombosis.

CONCLUSION AND IMPLICATIONS

Platelet Piezo1 is essential for SIPA and arterial thrombosis induced by high shear. Rb1 exerted anti-platelet and anti-thrombotic effects at high shear rates via Piezo1 channels, providing a potential candidate as antiplatelet therapeutic agent.

Global, regional and national burden of ischaemic heart disease attributable to high body mass index and low physical activity from 1990 to 2021

AIM

This study aimed to estimate the distribution of and changes in the global burden of ischaemic heart disease (IHD) attributable to high body mass index (BMI) and low physical activity (PA) from 1990 to 2021.

METHODS

Data on deaths, disability-adjusted life years (DALYs) and age-standardized rates for IHD attributable to high BMI and low PA were extracted from the Global Burden of Disease 2021 study. Temporal trends by gender, region and Socio-Demographic Index (SDI) were analysed using joinpoint regression. Decomposition, health inequality analysis and Bayesian model were utilized.

RESULTS

From 1990 to 2021, global DALYs and deaths for IHD attributable to high BMI and low PA nearly doubled, despite a decline in age-standardized DALYs ([average annual percent change (AAPC) = -0.26, 95% uncertainty interval (95% UI): -0.45, -0.07), (AAPC = -1.03, 95% UI:-1.18, -0.88]) and deaths rates ([AAPC = -0.53, 95% UI: -0.72, -0.33], [AAPC = -1.13,95% UI: -1.34, -0.92]), respectively. The burden of IHD due to high BMI was predominantly seen in males, while low PA was more prevalent in females. Significant regional and national variation was observed, with the burden shifting from high SDI regions to middle or low SDI regions. Population growth and aging have exacerbated this burden. Health inequities have shown improvement between 1990 and 2021. Projections for the next 15 years suggest rising global age-standardized DALYs and death rates of IHD attributable to high BMI, while those attributable to low PA may decrease.

CONCLUSIONS

Since 1990, the global and regional impact of IHD attributable to high BMI and low PA remains significant, with disparities by gender, age, region and SDI. Countries should implement effective measures to control BMI and promote PA to reduce the IHD burden.

Global, regional, and national burden and risk factors of ischemic heart disease, 1990-2021: an analysis of the global burden of disease study

Background

With a rapidly growing and aging world population, ischemic heart disease (IHD) remains a major burden. This study aimed to reassess the prevalence trend of IHD from 1990 to 2021 from multiple dimensions to improve the shortcomings of the existing studies and provide a solid scientific basis for policymakers.

Methods

This study extracted data on the prevalence, incidence, mortality, disability-adjusted life years (DALYs), and associated risk factors of IHD from the global burden of disease (GBD) 2021 study. Descriptive, decomposition, and risk factor analyses were used to provide insights into the epidemiologic patterns of IHD from 1990 to 2021 and project the burden of IHD from 2022 to 2045. Potential differences in burden and risk factors based on age, sex, 21 GBD geographic regions, five social development index (SDI) regions, and 204 countries are highlighted.

Results

Globally, the age-standardized prevalence rate (ASPR) of IHD is increasing, while the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (ASDR) are decreasing. ASPR, ASIR, ASMR, and ASDR were highest in the low-middle SDI regions and lowest in the high SDI regions. ASMR and ASDR were highest in Nauru and lowest in Portugal. Men had an overall heavier burden of IHD than women; the 65-69 age group had the largest burden, and those aged >95 years had the highest crude incidence rate. In addition, the burden of IHD was negatively correlated with SDI across regions and countries, while decomposition analyses suggest that the main reasons for the current increase in the burden of IHD are aging and population growth. Risk factors have changed relatively little over the 32 years, with metabolic risk still ranking first. We forecast that the absolute burden of IHD will continue to increase till 2045; however, ASIR, ASMR, and ASDR will gradually decline.

Conclusion

From 1990 to 2021, the global burden of IHD generally increased and varied across regions, sex, and age groups. Due to increasing population growth and aging, there is an urgent need for strategically directed measures to reduce the burden of IHD.

Association between non-high-density lipoprotein to high-density lipoprotein cholesterol ratio and bowel health in U.S. adults: a cross-sectional study

Background

The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a robust predictor of dyslipidemia and cardiovascular disease, strongly linked to the development of various chronic conditions. However, there is a paucity of evidence exploring the relationship between NHHR and bowel health, particularly chronic diarrhea and constipation.

Methods

This cross-sectional study utilized data from the National Health and Nutrition Survey (NHANES) 2005-2010. Sociodemographic, lifestyle, and health status data were collected alongside blood lipid levels. Weighted multivariate logistic regression models assessed the association between NHHR and bowel health. The restricted cubic spline (RCS) method was used to explore their dose-response relationship. Subgroup analyses and sensitivity analyses were conducted to further validate the robustness of our findings.

Results

In our study of 11,268 participants, a significant positive association was identified between elevated NHHR levels and chronic constipation in women, with the highest quartile showing an adjusted OR of 1.57 (95% CI: 1.21-2.03) compared to the lowest quartile. This association was notably stronger among female smokers. Sensitivity analyses excluding individuals with hypercholesterolemia or inflammatory bowel disease confirmed the robustness of the correlation. No significant associations were found in men.

Conclusion

The study findings provide novel evidence of the relationship between NHHR and bowel health in United States women, particularly chronic constipation. However, the cross-sectional design of the study limits our ability to establish causality. Additionally, reliance on self-reported bowel health data may introduce inaccuracies. Further research is needed to explore the mechanisms underlying this association and the impact of lifestyle factors.

Why do patients with ischemic heart disease modify their lifestyle? a qualitative study : Motivations for lifestyle modification after IHD

OBJECTIVE

Ischemic Heart Disease (IHD) is a major cause of death worldwide, particularly in low- to middle-income nations, such as Iran. Lifestyle modification (LSM) (e.g., healthy nutritional patterns, regular physical activity, smoking cessation, and stress management) can prevent the development of IHD. This study aimed to identify the motivations behind LSM in patients with IHD.

RESULTS

This qualitative study employed traditional content analysis and purposive sampling from cardiac rehabilitation (CR) centers in Iran. Data were collected through semi-structured interviews, analyzed using Graneheim and Lundman steps, conducted from October 2023 to September 2024. The participants included 15 IHD patients with LSM experience, one patient's son, and 4 healthcare professionals (nurses, clinical psychologists, cardiologists, and nutritionists). The patients had an average age of 63 years and varied in sex, occupation, education, and marital status. Interviews averaged 69 min, ranging from 50 to 100 min. The analysis revealed a theme of "seeking wise survival," with 10 subcategories and three categories: interest and fear (e.g., family interest, fear of death), comprehensive recommendations, and individual and social benefits (e.g., time and cost savings). The findings of this study provide scientific evidence for HCPs to encourage and educate patients and their families regarding the LSM.

Increased monocytes and their derived indicators are associated with clinical severity of acute heart failure following acute myocardial infarction

Objective

Monocytes play a significant role in the pathophysiology of acute myocardial infarction (AMI). The relationship between monocytes, their derived indicators, and the severity of acute heart failure following AMI remains unclear. Therefore, this study aims to investigate the association of monocytes and their derived indicators with clinical severity of acute heart failure in the patients with AMI.

Methods

In total of 173 patients with AMI were enrolled in this retrospective study. The demographic data and relevant medical histories were obtained. Monocytes and lipid levels were measured. All patients were divided into two groups based on killip classification. Killip class III-IV was defined as acute severe heart failure, while killip class I-II was defined as acute non-severe heart failure.

Results

Monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio were significantly higher in patients with acute severe heart failure compared to those with acute non-severe heart failure (P < 0.05). Multivariate logistic regression analysis showed that monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio were independently associated with acute severe heart failure (P < 0.05). Moreover, monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio were linked to NT-proBNP concentrations (P < 0.05). Receiver-operating characteristic curve analysis showed that monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio could identify acute severe heart failure in patients following AMI to some extent (P < 0.05).

Conclusion

The elevation of monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio correlated with clinical severity of acute heart failure following AMI, and offered potential discriminating value for cardiogenic pulmonary edema and shock following AMI.

Trends and Projections of Burden of Ischemic Heart Disease in China Versus Other G20 Countries: A Comparative Study Based on the 2021 Global Burden of Disease Database

Objective

This study aims to analyse the burden of ischemic heart disease (IHD) in China and other G20 countries from 1990-2021 and predict the burden for the next decade.

Methods

Using data from the Global Burden of Disease (GBD) 2021 study, we evaluated the age-standardised rates (ASRs) of incidence, prevalence, mortality and disability-adjusted life years (DALYs) by estimated annual percentage change (EAPC). The Bayesian age-period-cohort (BAPC) model was used to forecast the incidence, mortality and DALY rates of IHD in China from 2021-2040.

Results

The ASRs of incidence, mortality and DALYs of IHD in China increased with EAPCs of 0.66 (95% CI: 0.50, 0.82), 0.97 (95% CI: 0.63, 1.31) and 0.51 (95% CI: 0.24, 0.78), respectively. Compared with other G20 countries, China was ranked 14th for the ASR of incidence in 1990 and then rose to 7th in 2021. The ASR of prevalence for IHD in China jumped from 8th in 1990 to 5th in 2021, and both the ASR of mortality and DALYs for IHD in China ranked 7th in 2021. The top five risk factors affecting mortality in China in 2021 were high systolic blood pressure, dietary risk, air pollution, high LDL cholesterol and tobacco. Over the next 20 years, the ASR of incidence, mortality and DALYs for IHD will increase continuously in males.

Conclusion

The burden of IHD is expected to increase steadily in China, highlighting the urgency for early monitoring and preventative strategies, particularly focusing on the elderly and male populations.

Carotid intima thickness and elasticity combined with MHR predicting the severity of coronary artery stenosis in patients with premature coronary artery disease

BACKGROUND

Carotid intima thickness (CIT) and hardness coefficient (HC) are sensitive indicators of structural and functional changes in the carotid arteries in the subclinical stage of atherosclerosis. The monocyte to high-density lipoprotein cholesterol ratio (MHR), which is a biomarker of inflammation, has been shown to correlate with cardiovascular disease. The aim of this study was to assess the predictive value of CIT and HC with MHR in determining the severity of coronary artery stenosis in patients with premature coronary artery disease (PCAD).

METHODS

This prospective study included 85 PCAD patients who underwent coronary angiography. Patients were categorized into high-score (42 cases) and low-score (43 cases) groups based on the median Gensini score. Additionally, 41 volunteers matched by body mass index (BMI), age, and gender served as a control group. CIT, carotid media thickness (CMT) and carotid intima-media thickness (CIMT) were measured using a 24 MHz ultra-high frequency ultrasound probe. Diameter (Diam), distance (Dist), pulse wave velocity (PWV), and HC were evaluated through RF-data based quantitative analysis on vessel stiffness. Binary logistic regression identified risk factors influencing the severity of coronary artery stenosis. Receiver operating characteristic curves were plotted to evaluate the diagnostic performance of CIT, HC, and MHR, both individually and in combination, for predicting coronary artery stenosis severity in PCAD patients.

RESULTS

CIT, HC and MHR were significantly higher in the high group than in the low and control groups. CIT (AUC = 0.731, 95%CI: 0.624-0.838, P < 0.001) and HC (AUC = 0.783, 95%CI: 0.683-0.882, P < 0.001) individually demonstrated good diagnostic performance in assessing the severity of coronary artery stenosis, with the combined use of carotid parameters and MHR achieving the highest diagnostic efficacy (AUC = 0.849, 95%CI: 0.770-0.929, P < 0.001).

CONCLUSION

Patients in the high group had elevated CIT, CIT/CMT, and HC compared to those in the low group. Combining CIT and HC with MHR demonstrated high efficacy in predicting coronary artery stenosis severity in PCAD patients.

Global, regional, and national burden of ischemic heart disease attributable to metabolic risks: a systematic analysis of Global Burden of Disease 2021

Background

Ischemic heart disease (IHD) represents the most significant disease burden among all cardiovascular diseases (CVDs). The increasing prevalence of metabolic risks in the 21st century has a profound impact on the disease burden associated with IHD. We analyzed the global, regional, and national burdens of IHD attributable to metabolic risks from 1990 to 2021.

Methods

The data were taken from Global Burden of Disease (GBD) study 2021. Deaths, disability-adjusted life years (DALYs), the average annual percent change (AAPC), age-standardized death rates per 100,000 persons (ASDR) and age-standardized rate per 100,000 persons (ASR) of DALYs ranging from 1990 to 2021, were extracted and stratified according to region, nationality, socio-demographic index (SDI), sex, and age. Additionally, the global future trends were predicted using Nordpred prediction model.

Results

Compared to 1990, in 2021, the number of death and DALYs from metabolic risk-attributed IHD increased globally by 67.35% and 59.91%, respectively; whereas ASDR and ASR of DALYs showed a decreasing trend and the most severe impact was observed in male and elderly populations. In addition, the burden of disease showed an inverted V-shaped relationship with SDI from 1990 to 2021. AAPC showed a significant increase in developing countries and a decrease in developed countries. We also analyzed the effects of different risk factors including metabolic risk factors on IHD in different SDI regions and genders. The prediction of future disease burden showed that the number of death and DALYs will keep rising, while ASDR and ASR of DALYs will maintain a certain downward trend.

Conclusions

The results of this study highlighted the need for screening and intervention for metabolic risk factors in specific regions and populations, this should call for increased collaboration between developing and developed countries to reduce the burden of disease and improve the prognosis of patients with IHD.

Global, Regional, and National Burden of Non-Rheumatic Valvular Heart Diseases in Women: A Systematic Analysis of Global Burden of Disease 1990-2021

Background

The incidence of non-rheumatic valvular heart diseases (NRVHD) has shown an increasing trend. However, most studies have overlooked the impact of gender on the disease. Female patients, as a specific subgroup, have rarely been discussed independently. It is essential to conduct separate epidemiological studies to understand the latest epidemiological data for female NRVHD patients and to raise awareness among researchers and clinicians.

Methods

Data from the Global Burden of Disease (GBD) 2021 database were retrieved to obtain epidemiological data on female NRVHD from both global and regional perspectives, covering 204 countries and territories. Joinpoint regression, age-period-cohort analysis, decomposition, and predictive analyses were employed to further examine the epidemiological data.

Results

The incidence of female NRVHD patients has shown a continuous upward trend and is expected to persist in the future, particularly in regions with high and high-middle Socio-Demographic Index (SDI). However, in low and lower-middle SDI regions, patients experience relatively higher Disability-Adjusted Life Years (DALYs) and Years Lived with Disability (YLDs), with a greater number of heart failure cases attributed to NRVHD. Decomposition analysis indicates that the increase in the incidence of NRVHD and its subtypes is primarily driven by population growth and aging.

Conclusions

With economic development and population aging, female NRVHD remains a significant healthcare burden for countries worldwide. Low- and middle-SDI regions should implement tertiary prevention strategies to address the impending shift in the spectrum of valvular heart diseases. Further clinical research should focus on female patients as a distinct subgroup of NRVHD, exploring the unique aspects of the disease in this population.

Global, regional, and national burdens of ischemic heart disease in the older adults aged 60-89 years: a systematic analysis for the Global Burden of Disease Study 2019

Background

Ischemic heart disease (IHD) places a heavy burden on individual and public health. Nevertheless, comprehensive assessments of the burden of IHD in the elderly are absent. It is imperative to update the burden of IHD in older adults and predict the trends.

Methods

The absolute numbers and age-standardized rates (ASRs) of prevalence, mortality, and disability-adjusted life-years (DALYs) for IHD among people aged 60-89 years from 1990 to 2019 were analyzed based on the Global Burden of Disease Study 2019 (GBD 2019). Joinpoint regression analysis was utilized to evaluate the epidemiologic trend of IHD in the elderly from 1990 to 2019. Bayesian age-period-cohort model was used to predict the burden of IHD among the elderly from 2020 to 2034.

Results

Age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized DALY rate (ASDR), and age-standardized mortality rate (ASMR) of IHD in older adults have declined slightly over the past 30 years. In 2019, the ASPR, ASIR, ASDR, and ASMR among the elderly with IHD were 14,280.53 (95% UI, 12,301.34-16,610.6), 1,445.21 (1,142-1,793.58), 11,225.74 (10,342.09-11,960.64), and 675.24 (614.21-721.75) per 100,000. The burden of IHD was significantly higher in older men than in women during the study period. In terms of socio-demographic index (SDI), countries and territories with lower SDI bore a more severe burden of IHD. The burden of IHD in the elderly varied considerably across countries. Uzbekistan had the largest increase in rates of prevalence, incidence, DALY, and mortality. The projections show a downward trend in DALY and mortality rates for IHD in older adults from 2020 to 2034, but incidence and prevalence will increase.

Conclusion

From 1990 to 2019, the worldwide burden of IHD among the elderly witnessed a decline. The IHD burden varied significantly across countries and territories. Policymakers should rationalize the allocation of health resources and implement effective prevention and treatment strategies to reduce the burden of IHD among the elderly in economically less developed countries and regions.

A global analysis of the burden of ischemic heart disease attributable to diet low in ω-3 fatty acids between 1990 and 2021

AIM

Ischemic heart disease (IHD) is a major contributor to global mortality and disability, imposing a significant health and economic burden on patients and society. Despite existing treatment options including medications and surgeries, their effectiveness remains limited, with issues such as suboptimal treatment outcomes and high recurrence rates. This study aims to investigate the relationship between low dietary intake of ω-3 fatty acids and the burden of IHD, hoping to provide new insights into the prevention and treatment of IHD.

METHOD

Using the Global Burden of Disease (GBD) 2021 dataset, we examined the impact of low ω-3 dietary intake on the burden of ischemic heart disease (IHD) between 1990 and 2021globally, regionally, temporally. The Joinpoint regression model was applied to analyze the trend of IHD burden attributed to low ω-3 dietary intake over time.

RESULTS

In 2021, the global IHD-related Disability-Adjusted Life Years (DALYs) and deaths caused by a low ω-3 diet was 15,511,020(95% UI: 3,098,820 to 25,946,110) and 627,340 (95% UI: 119,540 to 1,082,740), accounting for 8.23% (95% UI: 1.64-13.52%) of all IHD-related DALYs and 6.97% (95% UI: 1.33-11.76%) of all IHD deaths, respectively. From 1990 to 2021, there was a significant upward trend in DALYs and deaths, but age-standardized DALYs and death rates showed a declining trend. Regional analysis indicated that the burden of IHD was highest in South Asia and lowest in High-Income Asia Pacific regions. At the national level, India, China, the United States, and Pakistan had a higher burden of IHD. Furthermore, as the Socio-Demographic Index (SDI) increased, the burden of IHD caused by a low ω-3 diet gradually decreased.

CONCLUSION

This study untangles a significant association between a low ω-3 diet and the burden of IHD, emphasizing the importance of promoting healthy eating habits globally. Future research should further explore the impact of dietary changes on the burden of IHD and develop targeted public health policies to reduce the burden of IHD.

Synergistic Effects of Low-Frequency Ultrasound and Therapeutic Agents on Endothelial and Renal Cells: Emphasis on Cell Functionality, Oxidative Stress, and Inflammatory Markers

Background: Ischemic heart disease remains the leading cause of death worldwide, with coronary microvascular dysfunction (CMD) as a key complication after ST-elevation myocardial infarction (STEMI). Endothelial dysfunction contributes to CMD, impairing vascular tone and increasing inflammation. While angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) aid vascular health, their efficacy may improve with therapeutic ultrasound, which enhances drug delivery and endothelial response. This study explores the combined effects of ultrasound and pharmacological treatment on the ACE axis and inflammation in endothelial and renal cells. Methods: Human umbilical vein endothelial cells (HUVECs) and human renal proximal tubular epithelial cell line RPTEC/TERT1 were treated with captopril, losartan, and dexamethasone, alone or combined with low-frequency ultrasound (LFU). Cell viability and wound-healing assays assessed cellular function, while nitric oxide (NO) and reactive oxygen species (ROS) assays were used to evaluate redox signaling. Gene expression related to the ACE axis, inflammation, and vascular and renal cell function was analyzed via qPCR. Results: Captopril and losartan combined with LFU improved endothelial cell viability, wound healing, and NO production at various concentrations, whereas only losartan with LFU enhanced cell viability and wound healing in renal cells. Dexamethasone with LFU increased ROS levels and had variable effects on RPTEC/TERT1 cell survival. Gene expression analysis showed that LFU alone reduced pro-inflammatory markers VCAM-1, ICAM-1, and PTGS2 in captopril-treated HUVECs and similarly affected CYP4F2 in losartan-treated HUVECs. LFU also decreased PTGS2 expression at higher dexamethasone concentrations. In RPTEC/TERT1 cells, LFU alone did not impact SGLT2 or GGT1 expression, but captopril with LFU downregulated GGT1, and dexamethasone with LFU upregulated SGLT2 at higher concentrations. Conclusions: This study demonstrates that LFU enhances the effects of RAS inhibitors by promoting NO synthesis and reducing oxidative stress, while its combination with dexamethasone may have variable, potentially cytotoxic effects on renal cells. Gene expression patterns suggest LFU's anti-inflammatory potential and its role in modulating drug efficacy.

Global, regional, and national epidemiology of ischemic heart disease among individuals aged 55 and above from 1990 to 2021: a cross-sectional study

BACKGROUND

The findings of the 2021 Global Burden of Disease (GBD) study can offer valuable insights for the development of screening and prevention strategies targeting ischemic heart disease (IHD). We aim to investigate trends in IHD incidence, mortality, and disability-adjusted life years (DALYs), while exploring associated risk factors for IHD-associated death from 1990 to 2021.

METHODS

The cross-sectional study utilized data from the GBD 2021, covering 204 countries and regions. The analysis included individuals aged 55 and above. We analyzed the trends in IHD incidence, all cause and cause-specific deaths, DALYs, and corresponding estimated annual percentage changes (EAPCs) from 1990 to 2021. These indicators were further stratified by geographical region, country, age group, gender, and sociodemographic index (SDI).

RESULTS

The global incidence rate, mortality rate, and DALYs rate for individuals aged 55 and above with IHD have shown a decreasing trend. However, the number of incident cases, death cases, and DALYs has been increasing from 1990 to 2021. Both the high-middle and high SDI regions exhibit a significant decline in these rates from 1990 to 2021. However, the low SDI, low-middle SDI, and middle SDI regions show less noticeable changes. The region with low-middle SDI experiences the largest increase in mortality rate (EAPC: 0.38; 95%CI, 0.33-0.44) and DALYs rate (EAPC: 0.17; 95%CI, 0.12-0.22). The region with middle SDI experiences the largest increase in incidence rate (EAPC: 0.37; 95%CI, 0.27-0.46). Regionally, East Asia exhibits the greatest increase in incidence rate (EAPC: 0.94; 95% CI, 0.79-1.10), mortality rate (EAPC: 1.68; 95% CI, 1.40-1.94), and DALYs rate (EAPC: 0.94; 95% CI, 0.69-1.20). Among the 12 risk factors associated with mortality from IHD, high systolic blood pressure, dietary risks, high low-density lipoprotein (LDL) cholesterol levels, and air pollution are identified as the primary contributors to global mortality.

CONCLUSIONS

This study reveals that in high SDI regions, the incidence, mortality, and DALYs rate of IHD are declining. Conversely, in low to middle SDI regions, the disease burden of IHD is increasing. It highlights global inequality in IHD burden. Recommendations include early screening, risk management, and strengthening primary care, especially in middle and low SDI regions. Countries should also invest in environmental governance and air pollution control. Future research should focus on evaluating the effects of health policies in different countries, exploring the impact of socio-economic and cultural factors on the burden of IHD, and developing big data-based prediction models to optimize resource allocation and intervention strategies.

Rupture mechanics of blood clot fibrin fibers: A coarse-grained model study

Thrombosis, when occurring undesirably, disrupts normal blood flow and poses significant medical challenges. As the skeleton of blood clots, fibrin fibers play a vital role in the formation and fragmentation of blood clots. Thus, studying the deformation and fracture characteristics of fibrin fiber networks is the key factor to solve a series of health problems caused by thrombosis. This study employs a coarse-grained model of fibrin fibers to investigate the rupture dynamics of fibrin fiber networks. We propose a new method for generating biomimetic fibrin fiber networks to simulate their spatial geometry in blood clots. We examine the mechanical characteristics and rupture behaviors of fibrin fiber networks under various conditions, including fiber junction density, fiber tortuosity, fiber strength, and the strain limit of single fiber rupture in both tension and simple shear cases. Our findings indicate that the stress-strain relationship of the fibrin fiber network follows a similar pattern to that of individual fibers, characterized by a shortened entropy stretching phase and an extended transition phase. Fiber junction density, fiber strength, and single fiber rupture limit predominantly influence the stress of the network, while fiber tortuosity governs the strain behavior. The availability of more fibers in shear cases to bear the load results in delayed rupture compared to tension cases. With consideration of different factors of fibrin fibers in networks, this work provides a more realistic description of the mechanical deformation process in fibrin fiber networks, offering new insights into their rupture and failure mechanisms. These findings could inspire novel approaches and methodologies for understanding the fracture of fibrin networks during a surgical thrombectomy.

Effectiveness of acupuncture on glycolipid metabolism in patients with coronary heart disease: A systematic review and meta-analysis

OBJECTIVE

Disorders of glycolipid metabolism are important pathogenic factors leading to coronary artery disease, and there is no safe and effective comprehensive treatment, while acupuncture has a certain efficacy in heart disease and disorders of glycolipid metabolism. To assess the effects of acupuncture on glycolipid metabolism in patients with coronary heart disease, we conducted a systematic review and meta-analysis.

METHODS

From the time of library construction to August 18, 2023, Searches were conducted in eight databases, with no language restriction. Only RCTs that included acupuncture as a sole or secondary effect on glucose-lipid metabolism in coronary heart disease were included.Our primary outcome indicators were Low-density lipoprotein cholesterol(LDL-C), Hemoglobin A1c(HbA1c). Our analyses were conducted in strict accordance with the PRISMA statement, and the researchers used the Cochrane Handbook for literature screening and data extraction, the "Risk of Bias" tool (ROB.2) for assessing risk of bias, and RevMan (version 5.3) for meta-analysis of outcome metrics, and the GRADE criteria for assessing quality of evidence. Assessing the quality of acupuncture literature using the Standards for reporting interventions in clinical trials of acupuncture.

RESULTS

Our analysis included 18 eligible RCTs (N = 1346 participants). For the primary outcome metrics, acupuncture combined with standard treatment was effective in reducing LDL-C (SMD =-0.56; 95 % CI, -0.75 to -0.38; P < 0.00001), and HbA1c (MD = -1.15; 95 % CI, -1.73 to -0.58; P < 0.0001). For secondary outcome measures, combination therapy improved TC (SMD = -0.97; 95 % CI, -1.44 to -0.51; P < 0.0001), TG (MD = -0.39; 95 % CI, -0.58 to -0.20; P < 0.0001), hs-CRP (MD = -0.98; 95 % CI, -1.43 to -0.52; P <0.0001), 2hPG (MD = -1.45; 95 % CI, -1.74 to -1.16; P < 0.00001), and ORR (RR, 1.27; 95 % CI, 1.19-1.36; P < 0.00001) levels more than standard therapy alone.However, the combination therapy did not prevail in lowering HDL-C (MD = 0.11; 95 % CI, 0.07-0.14; P < 0.00001) compared with standard therapy alone. Meanwhile heterogeneity analysis showed that After coronary heart disease intervention, acupuncture was able to reduce TC (SMD = -0.85; 95 % CI, -1.37 to -0.33; P = 0.001), TG (MD = -0.14; 95 % CI, -0.24 to -0.04; P = 0.004) levels, but did not dominate in lowering LDL-C.

CONCLUSIONS

Acupuncture effectively regulates glycolipid metabolism in coronary artery disease, serving as an adjuvant treatment. It may aid post-PCI healing via lipid metabolism regulation, but rigorous, large-scale, long-term RCTs are needed for validation.

Influence of Reader Expertise on Myocardial Infarction Detection: A Comparative Study of Dark-Blood and Bright-Blood Late Gadolinium Enhancement MRI

OBJECTIVES

This study aimed to evaluate the influence of reader training and experience on the detection of (small) myocardial infarctions (MIs) and the assessment of ischemic scar transmurality using dark-blood late gadolinium enhancement (LGE) and bright-blood LGE magnetic resonance imaging. It was hypothesized that dark-blood LGE simplifies the detection of (small) MIs for less experienced readers, compared with bright-blood LGE imaging.

MATERIALS AND METHODS

One hundred patients referred for cardiac magnetic resonance imaging for suspected ischemic scar were retrospectively included. Dark-blood LGE was performed first, followed by bright-blood LGE. Nine clinicians, grouped into three levels based on their training and experience, assessed the LGE images for the presence of MI and ischemic scar transmurality. Their assessment was subsequently compared with a European Association of Cardiovascular Imaging level 3 consultant. Reader confidence was evaluated with a 4-point Likert scale. Multilevel logistic regression was used to compare the 2 LGE methods and assess differences in myocardial infarction detection and transmurality among the 3 experience levels. Wilcoxon signed rank tests were performed to compare the reader confidence between the 2 LGE methods, whereas Friedman omnibus tests were conducted to assess differences in reader confidence among the 3 experience levels.

RESULTS

Dark-blood LGE resulted in increased correct detection of MIs compared with bright-blood LGE for both level 1 (87.3% vs 82.7%, odds ratio [OR]: 1.55 [95% confidence interval (CI): 0.94-2.54], P = 0.083) and level 2 readers (89.7% vs 83.0%, OR: 2.05 [95% CI: 1.20-3.51], P = 0.009). There was no significant difference observed between dark-blood LGE and bright-blood LGE for level 3 readers (88.7% vs 87.0%, OR: 1.20 [95% CI: 0.70-2.06], P = 0.495). Level 2 readers significantly detected more small MIs correctly when using dark-blood LGE compared with bright-blood LGE (66.7% vs 50.8%, OR: 2.40 [95% CI: 1.03-5.60], P = 0.042). All experience levels showed significantly increased confidence in presence of ischemic scar and transmurality with dark-blood LGE.

CONCLUSIONS

Readily available dark-blood LGE can assist less experienced readers in correctly detecting and assessing (small) MIs compared with conventional bright-blood LGE. Regardless of experience level, dark-blood LGE improves reader confidence in assessing the presence and transmurality of MIs.

Global, Regional, and National Burden of Ischemic Heart Disease Attributable to 25 Risk Factors and Their Summary Exposure Value Across 204 Countries With Different Socio-Demographic Index Levels, 1990-2021: A Systematic Fixed-Effects Analysis and Comparative Study

Background

A systematic relational assessment of the global, regional, and national Ischemic heart disease (IHD) burden and its attributable risk factors is essential for developing more targeted prevention and intervention strategies.

Methods

The GBD 2021 comparative risk assessment framework was employed to evaluate stroke burden attributable to environmental, behavioral, metabolic, and dietary risk factors, and a total of 25 risk factors were included. Specifically, we used the joinpoint regression model, decomposition analysis, and systematic fixed-effects analysis to reveal the global, regional, and national burden of IHD attributable to these 25 risk factors and their exposure value across 204 countries and territories with different socio-demographic index (SDI) levels from different perspectives.

Results

Joinpoint regression revealed similar trends in summary exposure value (SEV) and attributable burdens for 25 IHD risk factors. From 1990 to 2021, SEV rankings increased for 12/25 risk factors, decreased for 10/25, and remained unchanged for 3/25. Decomposition analysis indicated that from 1990 to 2021, low SDI countries experienced the most significant increase in IHD burden attributable to 25 risk factors due to population growth, while upper-middle and high SDI countries were most affected by population aging, and high SDI countries demonstrated the greatest reduction in IHD burden attributed to epidemiological changes. Panel data analysis elucidated the impact of SEV, SDI, and quality-of-care index (QCI) on attributable IHD burden.

Conclusion

This study emphasizing the critical role of risk factor control. Tailored interventions and exploration of country-specific factors are crucial for effectively reducing the global IHD burden.

Comparison of magnetocardiography and coronary computed tomographic angiography for detection of coronary artery stenosis and the influence of calcium

OBJECTIVES

This study aimed to compare the diagnostic performance of magnetocardiography (MCG) and coronary computed tomography angiography (CCTA) in detecting coronary artery stenosis in relation to coronary calcification.

METHODS

A total of 587 patients who underwent invasive coronary angiography (ICA) with both CCTA and MCG between September 1, 2022, and August 31, 2023, were included. The patients were divided into three subgroups based on their coronary artery calcium score (CACS), namely less than 100, 100-400, and 400 and above, as determined by the Agatston score. The diagnostic sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (ROC) of MCG, CCTA, and the combined diagnostic model (CCTA + MCG) were compared across all CACS subgroups.

RESULTS

According to ICA, 481 out of 587 patients (81.94%) had ischemia. The area under the ROC curve (AUC) of MCG for detecting ischemia was 0.80, with a sensitivity of 74.64% and specificity of 84.91% for all patients. In the different CACS subgroups, the diagnostic specificity of CCTA notably decreased (78.57% vs 24.13% vs 17.46%), while that of MCG remained stable (92.86% vs 86.21% vs 82.54%). The diagnostic accuracy of MCG and the combined diagnostic model was better than that of CCTA when CACS was ≥ 400 (77.22% vs 67.22% vs 58.89%). The AUC values of MCG, CCTA, and the combined model in the CACS ≥ 400 subgroups were 0.78, 0.49, and 0.71, respectively.

CONCLUSIONS

The diagnostic performance of MCG is less affected by CACS than that of CCTA. MCG and the combined model demonstrate better performance than CCTA alone in detecting coronary artery stenosis, particularly in cases with CACS ≥ 400.

KEY POINTS

Question How does the diagnostic performance of MCG compare with coronary computed tomographic angiography (CCTA) at different levels of calcification scores (CACS)? Findings MCG demonstrated better performance than CCTA in detecting coronary artery stenosis, particularly in patients with high CACS. Clinical relevance MCG or the MCG and CCTA combined model can be used to improve the noninvasive imaging diagnostic performance for detecting coronary artery stenosis and reduce unnecessary ICA, especially for patients with high calcification scores.

Development and Validation of Risk Stratification for Heart Failure After Acute Coronary Syndrome Based on Dynamic S100A8/A9 Levels

BACKGROUND

The early assessment of heart failure (HF) risk in patients with acute coronary syndrome (ACS) can help reduce mortality. S100A8/A9 is not only rapidly released after myocardial ischemia, but is also involved in reperfusion injury, which is an important predictor of HF after ACS. We attempted to construct a reliable HF risk stratification tool for evaluating patients with ACS after reperfusion therapy based on S100A8/A9 dynamic changes.

METHODS AND RESULTS

This prospective study included 3 independent cohorts of patients with ACS who received reperfusion therapy. The discovery cohort was divided into 2 subgroups: the longitudinal subgroup (n=264) with serum S100A8/A9 levels measured at admission and on days 1, 2, 3, and 4 postadmission, respectively, and the 2-point subgroup (n=798) with S100A8/A9 levels measured at admission and on day 1 postadmission, respectively. Validation cohorts 1 (n=1399) and 2 (n=1183) both had S100A8/A9 levels measured on day 1 postadmission. HF events included in-hospital HF events after the initial presentation and long-term HF events after discharge. The median follow-up for the discovery cohort, validation cohort 1, and validation cohort 2 was 4.2, 2.6, and 1.8 years, respectively. In the discovery cohort, S100A8/A9's predictive ability at day 1 surpassed other time points. Through the S100A8/A9-guided risk stratification, patients deemed high risk (>7900 ng/mL) exhibited a higher 1-year HF event rate (46% versus 2%, 38% versus 5%) than patients at low risk (<2100 ng/mL) in both validation cohorts. Among patients without left ventricular dysfunction after ACS, β-blocker therapy correlated with reduced 1-year HF events in intermediate-to- high-risk patients but not in low-risk patients.

CONCLUSIONS

S100A8/A9 levels on day 1 accurately classified patients at varying risks of HF, serving as a robust tool for HF risk prediction and treatment guidance.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03752515.

Chronic Coronary Artery Disease: Wall Disease vs. Lumenopathy

Acute and chronic coronary artery disease (CAD) are interconnected, representing two facets of the same condition. Chronic CAD exhibits a dynamic nature, manifesting as stable or acute ischemia, or both. Myocardial ischemia can be transient and reversible. The genesis of CAD involves diverse anatomical and functional mechanisms, including endothelial dysfunction, arteriolar remodeling, capillary rarefaction, and perivascular fibrosis, though no single factor explains its heterogeneity. Chronic CAD is often stable but may present as symptomatic or asymptomatic (e.g., in diabetes) and affect various coronary compartments (epicardial or microcirculation). This complexity necessitates a reappraisal of our approach, as pathophysiological mechanisms vary and often overlap. A comprehensive exploration of these mechanisms using advanced diagnostic techniques can aid in identifying the dynamic processes underlying CAD. The disease may present as obstructive or non-obstructive, stable or unstable, underscoring its diversity. The primary source of CAD lies in the arterial wall, emphasizing the need for research on its components, such as the endothelium and vascular smooth muscle cells, and factors disrupting arterial homeostasis. Shifting focus from arterial luminal status to the arterial wall can provide insights into the genesis of atheromatous plaques, enabling earlier interventions to prevent their development and progression.

Strategies to Improve Health Care Provider Prescription of and Patient Adherence to Guideline-Recommended Cardiovascular Medications for Atherosclerotic Occlusive Disease: Protocol for Two Systematic Reviews and Meta-Analyses of Randomized Controlled Trials

BACKGROUND

In patients with atherosclerotic occlusive diseases, systematic reviews and meta-analyses of randomized controlled trials (RCTs) report that antiplatelets, statins, and antihypertensives reduce the risk of major adverse cardiac events, need for revascularization procedures, mortality, and health care resource use. However, evidence suggests that these patients are not prescribed these medications adequately or do not adhere to them once prescribed.

OBJECTIVE

We aim to systematically review and meta-analyze RCTs examining the effectiveness of implementation or adherence-supporting strategies for improving health care provider prescription of, or patient adherence to, guideline-recommended cardiovascular medications in patients with atherosclerotic occlusive disease.

METHODS

We designed and reported the protocol according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis-Protocols) statement. We will search MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL from their inception. RCTs examining implementation or adherence-supporting strategies for improving prescription of, or adherence to, guideline-recommended cardiovascular medications in adults with cerebrovascular disease, coronary artery disease, peripheral artery disease, or polyvascular disease (>1 of these diseases) will be included. Two investigators will independently review identified titles/abstracts and full-text studies, extract data, assess the risk of bias (using the Cochrane tool), and classify implementation or adherence-supporting strategies using the refined Cochrane Effective Practice and Organization of Care (EPOC) taxonomy (for strategies aimed at improving prescription) and Behavior Change Wheel (BCW; for adherence-supporting strategies). We will narratively synthesize data describing which implementation or adherence-supporting strategies have been evaluated across RCTs, and their reported effectiveness at improving prescription of, or adherence to, guideline-recommended cardiovascular medications (primary outcomes) and patient-important outcomes and health care resource use (secondary outcomes) within refined EPOC taxonomy levels and BCW interventions and policies. Where limited clinical heterogeneity exists between RCTs, estimates describing the effectiveness of implementation or adherence-supporting strategies within different refined EPOC taxonomy levels and BCW interventions and policies will be pooled using random-effects models. Stratified meta-analyses and meta-regressions will assess if strategy effectiveness varies by recruited patient populations, prescriber types, clinical practice settings, and study design characteristics. GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) will be used to communicate evidence certainty.

RESULTS

The search was completed on June 6, 2023. Database searches and the PubMed "related articles" feature identified 4319 unique citations for title/abstract screening. We are currently screening titles/abstracts.

CONCLUSIONS

These studies will identify which implementation and adherence-supporting strategies are being used (and in which combinations) across RCTs for improving the prescription of, or adherence to, guideline-recommended cardiovascular medications in adults with atherosclerotic occlusive diseases. They will also determine the effectiveness of currently trialed implementation and adherence-supporting strategies, and whether effectiveness varies by patient, prescriber, or clinical practice setting traits.

TRIAL REGISTRATION

PROSPERO CRD42023461317; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461317; PROSPERO CRD42023461299; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461299.

Coronary health index based on immunoglobulin light chains to assess coronary heart disease risk with machine learning: a diagnostic trial

BACKGROUND

Recent studies suggest a connection between immunoglobulin light chains (IgLCs) and coronary heart disease (CHD). However, current diagnostic methods using peripheral blood IgLCs levels or subtype ratios show limited accuracy for CHD, lacking comprehensive assessment and posing challenges in early detection and precise disease severity evaluation. We aim to develop and validate a Coronary Health Index (CHI) incorporating total IgLCs levels and their distribution. Additionally, we aim to evaluate its effectiveness by integrating patient data and using machine learning models through diagnostic trial.

METHODS

The CHI was developed and combined with other clinical data. Nine machine learning models were screened to identify optimal diagnostic performance, with the XGBoost model emerging as the top performer. Performance was assessed based on accuracy, sensitivity, and its ability to identify severe CHD cases characterized by complex lesions (SYNTAX score > 33).

RESULTS

The XGBoost model demonstrated high accuracy and sensitivity in diagnosing CHD, with an area under the curve (AUC) of 0.927. It also accurately identified patients with severe CHD, achieving an AUC of 0.991. An online web tool was introduced for broader external validation, confirming the model's effectiveness.

CONCLUSIONS

Combining the CHI with the XGBoost model offers significant advantages in diagnosing CHD and assessing disease severity. This approach can guide clinical interventions and improve large-scale CHD screening.

Trajectories of Disability and Long-Term Care Utilization After Acute Health Events

Hip fractures, strokes, and heart attacks are common acute health events that can lead to long-term disability, care utilization, and unmet needs. However, such impacts, especially in the long term, are not fully understood. Using data from the Health and Retirement Study, 1992-2018, this study examines the long-term trajectories of individuals suffering such health shocks, comparing with individuals not experiencing health shocks. Hip fracture, stroke, and heart attack are confirmed to have severe implications for disability. In most cases of stroke and heart attack, informal caregivers provide the daily support needed by survivors, whereas following hip fracture, nursing home care is more relevant. These health shocks put individuals on worse trajectories of disability, care utilization, and unmet needs. There is no long-term recovery or convergence with individuals who do not suffer shocks. Unmet need is prevalent, even pre-shock and among individuals who do not experience health shocks, emphasizing the importance of preventative care measures. These findings support policy action to ensure hospitalized individuals, especially those aged 50 and above, receive rehabilitative services and other post-acute care. Furthermore, hospitalization is an event that requires the detection and addressing of unmet care needs beyond the short run.

The gut microbiota and its role in the development of cardiovascular disease

INTRODUCTION

The pathophysiology of cardiovascular diseases encompasses a complex interplay of genetic and environmental risk factors. Even if traditional risk factors are treated to target, there remains a residual risk.

AREAS COVERED

This manuscript reviews the potential role of gut microbiota in the development of cardiovascular disease, and as potential target. A systematic search was conducted until 30 October 2024 on PubMed (MEDLINE), using the MeSH terms [Gut microbiota] + [Dysbiosis] + [Cardiovascular] + [TMAO] + [bile acids] + [short-chain fatty acids].

EXPERT OPINION

The term dysbiosis implies changes in equilibrium, with modifications in the composition and functionality of microbiota and a series of additional factors: reduced diversity and uniformity of microorganisms; reduced short-chain fatty acid-producing bacteria; increased gut permeability; release of metabolites, such as trimethylamine N-oxide, betaine, phenylalanine, tryptophan-kynurenine, phenylacetylglutamine, and lipopolysaccharides; and reduced secondary bile acid excretion, leading to inflammation, oxidative stress, and endothelial dysfunction and facilitating the onset of pathological conditions, including obesity, hypertension, diabetes, atherosclerosis, and heart failure. Attempts to restore gut microbiota balance through different interventions, mainly changes in diet, have been shown to positively affect individual components and metabolites and reduce the risk of cardiovascular disease. In addition, probiotics and prebiotics are potentially useful. Fecal microbiota transplantation is a promising therapy.

Global Burden of Early-Onset Ischemic Heart Disease, 1990 to 2019

BACKGROUND

Early-onset ischemic heart disease (IHD) is a growing burden associated with high disability and death.

OBJECTIVES

This study aimed to estimate the burden of incidence, prevalence, and disability-adjusted life years (DALY) of early-onset IHD from 1990 to 2019.

METHODS

Data on the burden of early-onset IHD (men<55 years, women<65 years), including prevalence, incidence, DALY, and deaths, were collected from the Global Burden of Disease study for 204 countries and territories from 1990 to 2019.

RESULTS

In 2019, early-onset IHD affected 5.34 million (95% uncertainty interval [UI]: 3.96-6.96) individuals globally. This resulted in 58.48 million (95% UI: 52.65-64.69) DALY and 1.44 million (95% UI: 1.29-1.59) deaths. Countries with a middle sociodemographic index (SDI) had the highest incidence cases (1.79 million, 95% UI: 1.32-2.34) and the low-middle SDI countries had the highest age-standardized incidence rate of 179.34 per 100,000 (95% UI: 134.38-231.94). Low-middle SDI countries exhibited the highest age-standardized death rate (57.13 per 100,000, 95% UI: 48.45-66.53) and age-standardized DALY rate (2,309.67 per 100,000, 95% UI: 1962.31-2,693.93). Globally, female incidence cases (2.77 million, 95% UI: 2.04-3.64) surpassed male (2.57 million, 95% UI: 1.92-3.32). The top 2 attributable risk factors were high low-density lipoprotein cholesterol and high systolic blood pressure.

CONCLUSIONS

The global incidence rate of early-onset IHD decreased from 1990 to 2019. The incidence rate was highest in low-middle SDI countries, and the burden of DALY was highest in low-middle SDI countries. The DALY and death rate were higher in men. High low-density lipoprotein cholesterol and high systolic blood pressure were the primary attributors.

Cystatin C as a Biomarker for Identifying High-Risk Patients with Acute Coronary Syndrome: An Observational Study

BackgroundCystatin C is a cysteine protease inhibitor, synthesized by nucleated cells, and released into various body fluids. Lots of studies have reported an association between cystatin C and atherosclerotic cardiovascular disease. However, the association of cystatin C with high-risk patients with acute coronary syndrome(ACS) has not been well studied. In this study, we investigated potential association of cystatin C with high-risk patients with ACS, and assessed whether cystatin C provide discriminating power of clinical risk stratification in patients with ACS.MethodsWe enrolled 219 patients with ACS in the present study. The cystatin C concentration was measured in clinical laboratory. The global registry of acute coronary events (GRACE) scores was calculated to assess risk stratification. The high-risk patients with ACS were defined based on GRACE scores and killip classification.ResultsThe cystatin C levels were significantly higher in high-risk patients compared to non-high-risk patients, both in the overall ACS group and its subtypes, including non-ST elevation ACS (NSTE-ACS) and ST elevation ACS (STE-ACS)(P < 0.05). The receiver operating characteristic (ROC) curve analysis showed that cystatin C had a discriminative performance for identifying high-risk patients across these groups(P < 0.05). After adjusting for potential confounders, multivariate logistic regression confirmed that the elevated cystatin C levels were independently associated with high-risk patients with ACS(P < 0.05).ConclusionsThe cystatin C was obviously elevated in high-risk group in the patients with ACS and its subgroups. Cystatin C appears to be a valuable biomarker for distinguishing and predicting high-risk patients with ACS, suggesting its relevance in clinical risk stratification.

The Interactive and Joint Associations of Ambient PM2.5 and Temperature on the Onset of Acute Coronary Syndrome: Findings from The Chinese Cardiovascular Association (CCA) Database-Chest Pain Center Registry

Environmental factors are important exposures that trigger acute coronary syndrome (ACS) onset. However, the interactive and joint associations of multiple exposures on ACS onset remain unknown. A time-stratified case-crossover study was conducted including 1,292,219 ACS patients who were selected from 1,895 districts/counties across China during 2015-2020. The ACS conditions included ST-segment-elevation myocardial infarction (STEMI), non-ST-segment-elevation myocardial infarction (NSTEMI), and unstable angina (UA). Conditional logistic regression models were applied to estimate the interactive and joint associations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) and temperature (TM) with the ACS onset. The ACS onset risks increased by 0.38% for each 10 μg/m3 increment in PM2.5 concentration, and an inverse U-shaped curve of TM and risk of ACS onset was observed. The associations of PM2.5 with the ACS onset were greater on colder days. The jointly attributable fractions (AF) of PM2.5 and nonoptimal TM was 9.93% in all ACS patients, 10.31% in females, 12.91% in patients aged ≥65 years, 17.54% in NSTEMI patients, and 12.43% in Southern China. This study suggested that joint short-term exposures to ambient PM2.5 and moderate cold TM may substantially increase the onset of ACS. Furthermore, there are synergistic interactions among higher PM2.5 and lower TM peaks on the ACS onset.

Construction and validation of coronary heart disease risk prediction model for general hospitals in Tacheng Prefecture, Xinjiang, China

Objective

To analyze the risk factors for coronary heart disease (CHD) in patients hospitalized in general hospitals in the Tacheng Prefecture, Xinjiang, and to construct and verify the nomogram prediction model for the risk of CHD.

Methods

From June 2022 to June 2023, 489 CHD patients (CHD group) and 520 non-CHD individuals (control group) in Tacheng, Xinjiang, were retrospectively selected. Using a 7:3 ratio, patients were divided into a training group (706 cases) and a validation group (303 cases). General clinical data were compared, and key variables were screened using logistic regression (AIC). A CHD risk nomogram for Tacheng was constructed. Model performance was assessed using ROC AUC, calibration curves, and DCA.

Results

In the training group, non-Han Chinese (OR = 2.93, 95% CI: 2.0-4.3), male (OR = 1.65, 95% CI: 1.0-2.7), alcohol consumption (OR = 1.82, 95% CI: 1.2-2.9), hyperlipidemia (OR = 2.41, 95% CI: 1.7-3.5), smoking (OR = 1.61, 95% CI: 1.0-2.6), diabetes mellitus (OR = 1.62, 95% CI: 1.1-2.4), stroke (OR = 2.39, 95% CI: 1.6-3.7), older age (OR = 1.08, 95% CI: 1.1-1.2), and larger waist circumference (OR = 1.04, 95% CI: 1.0-1.1) were the risk factors for coronary heart disease (all P < 0.05). The area under the curve (AUC) of the work characteristics of the subjects in the training group and the validation group were 0.80 (95% CI: 0.8-0.8) and 0.82 (95% CI: 0.8-0.9), respectively. The Hosmer-Lemeshow test indicated P = 0.325 for the training group and P = 0.130 for the validation group, with calibration curves closely fitting the ideal curve. The predicted values aligned well with actual values, and decision curve analysis results suggest that the model offers a net clinical benefit.

Conclusion

The CHD risk prediction model developed in this study for general hospitals in Tacheng Prefecture, Xinjiang, demonstrates strong predictive performance and serves as a simple, user-friendly, cost-effective tool for medical personnel to identify high-risk groups for CHD.

Evaluation of a Specialist Nurse-Led Post-Coronary Heart Disease Support Program: A Prospective Pre-Post Interventional Study

INTRODUCTION

The impact of multidisciplinary supervised cardiac rehabilitation programs on reducing the risk of having heart problems in the future is well documented. However, little is known about nurse-led post-coronary heart disease (post-CHD).

PURPOSE

Our aim was to evaluate the effectiveness of an educational and counseling-structured nurse-led post-CHD support program by assessing the prediction of psychological, behavioral and dietary variables in relation to adherence to a care plan in a single hospital in Athens (Greece).

METHOD

A prospective follow-up comparative approach in a single group of CHD patients was applied. The structured nurse-led program included eight topics (management of anxiety, physical activity, dietary habits, weight control, smoking cessation, alcohol moderation, family engagement and adherence to a care plan). Participants received tailored nursing interventions focused on psychological and behavioral needs and dietary habits by a CHD-specialized nurse based on patients' medical prescriptions and/or instructions. A modified clinical assessment questionnaire by the European Society of Cardiology was applied to identify pre-post clinical baseline measurements. A nurse-led post-coronary Heart Disease Support Program was evaluated by assessing the predictivity (effect) of specific interventions on adherence to a care plan by employing a logistic regression beta coefficient (Generalized Estimating Equations model).

RESULTS

The sample consisted of 275 patients (66.2% male), with a mean age of 68.5 ± 12.5 years old. CHD patients presented significantly lower anxiety rates (54.27 [1st m] vs. 49.63 [2nd m], p < 0.05). In addition, significant differences were observed between the first and the second measurements of total cholesterol (163.27 [1rst m] vs. 134.44 [2nd m], p < 0.001), BMI (obesity) (33.69 [1rst m] vs. 32.79 [2nd m], p < 0.001), smoking (42.18 [1rst m] vs. 22.55 [2nd m], p < 0.001) and adherence to a care plan (78.90 [1rst m] vs. 89.10 [2nd m], p < 0.001). A Generalized Estimating Equations model revealed that participants with higher levels of anxiety showed significantly lower adherence to a care plan (beta -0.10, p < 0.001) and those with family history of CHD (beta -0.71, p = 0.04) in comparison to those with no CHD history. No significant differences were observed in the predictive variables of smoking (beta 0.08, p = 0.69), alcohol consumption (beta 0.09, p = 0.79) and family engagement (beta -0.11, p = 069) with respect to adherence to a care plan, even after adjusting for age, sex and history of CHD.

CONCLUSION

Our findings indicate that the nurse-led post-CHD support program was found to be partially feasible and effective in our single-group study, emphasizing the need for effective training and retention strategies to enhance the specialization of nurses providing post-CHD care and support.

Incidence trends and specific risk factors of ischemic heart disease and stroke: An ecological analysis based on the Global Burden of Disease 2019

Distribution of risk factors for cardiovascular diseases has been changing globally, which may account for the discrepant temporal trends of ischemic heart disease (IHD) and stroke. To test the hypothesis and identify potential contributing factors, we designed an ecological study based on the GDB-2019 data and extracted age-standardized incidence rates (ASIRs) of IHD and stroke, and summary exposure values (SEVs) of 87 attributable factors. A declining trend was observed for ASIRs of stroke (globally from 181.4 to 150.8/100,000 during 1990 and 2019, with an average annual percentage change of -0.64%) and IHD (globally from 316.4 to 262.4/100,000, with an average annual percentage change of -0.67%). However, the ASIR of IHD increased in Eastern Sub-Saharan Africa, Western Sub-Saharan Africa, East Asia, Central Asia, and Oceania, particularly in Uzbekistan and other 55 countries experiencing rapid socioeconomic translation. Eight factors, i.e. diet high in trans-fatty acids, diet low in calcium, high body-mass index, household air pollution from solid fuels, non-exclusive breastfeeding, occupational ergonomic factors, Vitamin A deficiency, and occupational exposure to particulate matter, gases, and fumes, were reversely associated with the ASIR of IHD and stroke at the country level. Ecological trend analysis also illustrated significant reverse associations of the factors with the ASIRs of IHD and stroke in in Western Sub-Saharan Africa, East Asia, and Oceania, but consistent associations in countries classified by the World Bank income levels. The results indicate the contributions of altered exposures to the eight factors in the discrepant trends of IHD and stroke across regions and countries, and suggest the determinant role of socioeconomic development in covariant of the risk factors with the incidences of IHD and stroke.

High-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio predicts long-term adverse outcomes in patients who underwent percutaneous coronary intervention: A prospective cohort study

High-sensitivity C-reactive protein (hsCRP) to high-density lipoprotein cholesterol (HDL-C) ratio (CHR) is associated with coronary artery disease (CAD), but its predictive value for long-term adverse outcomes in patients with CAD following percutaneous coronary intervention (PCI) remains unexplored and is the subject of this study. Patients with CAD who underwent PCI at the Korea University Guro Hospital-Percutaneous Coronary Intervention (KUGH-PCI) Registry since 2004 were included. Patients were categorized into tertiles according to their CHR. The end points were all-cause mortality (ACM), cardiac mortality (CM) and major adverse cardiac events (MACEs). Kaplan-Meier analysis, multivariate Cox regression, restricted cubic spline (RCS) and sensitivity analyses were performed. A total of 3260 patients were included and divided into Group 1 (CHR <0.830, N = 1089), Group 2 (CHR = 0.830-3.782, N = 1085) and Group 3 (CHR >3.782, N = 1086). Higher CHR tertiles were associated with progressively greater risks of ACM, CM and MACEs (log-rank, p < 0.001). Multivariate Cox regression showed that patients in the highest tertile had greater risks of ACM (HR: 2.127 [1.452-3.117]), CM (HR: 3.575 [1.938-6.593]) and MACEs (HR: 1.337 [1.089-1.641]) than those in the lowest tertile. RCS analyses did not reveal a significant non-linear relationship between CHR and ACM, CM or MACEs. The significant associations remained significant in the sensitivity analyses, RCS analyses with or without extreme values, subgroup analyses and multiple imputations for missing data. Elevated CHR is a novel, independent risk factor for long-term ACM, CM and MACEs in CAD patients following PCI.

Global, regional, and national burden of ischaemic heart disease and its attributable risk factors in youth from 1990 to 2019: a Global Burden of Disease study

OBJECTIVES

The objective of this study was to analyse the global, regional, and national burdens of ischaemic heart disease (IHD) in adults aged 15-49 years and its attributable risk factors from 1990 to 2019.

STUDY DESIGN

Epidemiological study.

METHODS

Data were obtained from the Global Burden of Disease (GBD) Study 2019. The estimated annual percentage change was used to evaluate temporal trends in incidence, deaths, and disability-adjusted life years (DALYs) of youth IHD. We selected IHD-associated risk factors, including five environmental/occupational factors, 16 behavioural risks, and five metabolic factors. We computed the age-standardised rates and percentage of age-standardised DALY rates attributable to these factors of youth IHD.

RESULTS

Globally, there were 2.26 million cases of incidence, 0.63 million deaths, and 30.58 million DALYs in 2019. The age-standardised incidence, death, and DALY rates decreased from 1990 to 2019, whereas the absolute number of incidences, deaths, and DALYs increased significantly. Globally, approximately 94.1% of age-standardised DALY rates from IHD in youths aged 15-49 years are attributable to risk factors listed in the GBD 2019 dataset. The leading global and regional risk factors for youth IHD in 2019 were high low-density lipoprotein cholesterol (68.9%), high systolic blood pressure (51.2%), high body mass index (33.1%), smoking (30.5%), and ambient particulate-matter pollution (25.4%).

CONCLUSIONS

The burden of IHD among young people is still heavy, and metabolic risk factors are the leading drivers of IHD. Therefore, formulating relevant policies to control and treat cardiovascular risk factors is an effective measure to reduce the IHD burden in youth.

Network Pharmacology and Experimental Verification: SanQi-DanShen Treats Coronary Heart Disease by Inhibiting the PI3K/AKT Signaling Pathway

Objective

To employee network pharmacology to predict the components and pathways of SanQi-DanShen (SQDS) in treating coronary heart disease, followed by in vitro experiments to validate the molecular mechanism of SQDS in treating coronary heart disease.

Methods

We sourced the active ingredients and targets of Panax notoginseng and Danshen from the Traditional Chinese Medicine Systems Pharmacology database. Coronary heart disease related genes were retrieved from the OMIM, Genecards, and Therapeutic Target databases. Using Cytoscape 3.7.2 software, we constructed a network diagram illustrating the components and targets of SQDS. The associated targets were then imported into the STRING database to build a protein-protein interaction network. The Metascape database and WeChat software were utilized for Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses. Lastly, we performed molecular docking between the key components and related targets using AutoDock Vina. To validate the potential mechanism of SQDS in treating coronary heart disease, we established an acute coronary heart disease rat model via tail vein injection of pituitrin.

Results

Network pharmacology analysis revealed that 65 active ingredients and 167 targets of SQDS are implicated in the treatment of coronary heart disease. The key targets identified include AKT1, TNF, TP53, IL6, and VEGFA. Notably, the PI3K/AKT signaling pathway emerged as the primary pathway. Furthermore, animal experiments showed that, compared to the model group, SQDS significantly reduced levels of TNF-α, IL-6, Bax, and cardiac troponin I, while increasing Bcl-2 content. It also notably suppressed the expression of p-PI3K and p-AKT, thereby offering protection to myocardial tissue.

Conclusion

Through the integrated approach of network pharmacology and molecular docking, we have established that SQDS exerts a multi-component, multi-target, and multi-pathway synergistic therapeutic effect on coronary heart disease. Its mechanism may involve the inhibition of the PI3K/AKT signaling pathway and the reduction of inflammatory factor expression.

Cardiac comorbidities in McArdle disease: case report and systematic review

INTRODUCTION AND METHODS

Myophosphorylase deficiency, also known as McArdle disease or Glycogen Storage Disease type V (GSD-V), is an autosomal recessive metabolic myopathy that results in impaired glycogen breakdown in skeletal muscle. Despite being labelled as a "pure myopathy," cardiac involvement has been reported in some cases, including various cardiac abnormalities such as electrocardiographic changes, coronary artery disease, and cardiomyopathy. Here, we present a unique case of a 72-year-old man with GSD-V and both mitral valvulopathy and coronary artery disease, prompting a systematic review to explore the existing literature on cardiac comorbidities in McArdle disease.

RESULTS

Our systematic literature revision identified 7 case reports and 1 retrospective cohort study. The case reports described 7 GSD-V patients, averaging 54.3 years in age, mostly male (85.7%). Coronary artery disease was noted in 57.1% of cases, hypertrophic cardiomyopathy in 28.5%, severe aortic stenosis in 14.3%, and genetic dilated cardiomyopathy in one. In the retrospective cohort study, five out of 14 subjects (36%) had coronary artery disease.

DISCUSSION AND CONCLUSION

Despite McArdle disease primarily affecting skeletal muscle, cardiac involvement has been observed, especially coronary artery disease, the frequency of which was moreover found to be higher in McArdle patients than in the background population in a previous study from a European registry. Exaggerated cardiovascular responses during exercise and impaired glycolytic metabolism have been speculated as potential contributors. A comprehensive cardiological screening might be recommended for McArdle disease patients to detect and manage cardiac comorbidities. A multidisciplinary approach is crucial to effectively manage both neurological and cardiac aspects of the disease and improve patient outcomes. Further research is required to establish clearer pathophysiological links between McArdle disease and cardiac manifestations in order to clarify the existing findings.

Cardioprotective Effects of Ursodeoxycholic Acid in Isoprenaline-Induced Myocardial Injury in Rats

Patients suffering from cholelithiasis have an increased risk of developing cardiovascular complications, particularly ischemic myocardial disease. Ursodeoxycholic acid (UDCA), already used in clinical practice for the treatment of cholelithiasis and related conditions, has proven antioxidative, anti-inflammatory, and cytoprotective effects. Therefore, the aim of this study was to investigate the cardioprotective effect of UDCA pre-treatment on isoprenaline-induced myocardial injury in rats. Male Wistar albino rats were randomized into four groups. Animals were pre-treated for 10 days with propylene glycol + saline on days 9 and 10 (control), 10 days with propylene glycol + isoprenaline on days 9 and 10 (I group), 10 days with UDCA + saline on days 9 and 10 (UDCA group), and 10 days with UDCA + isoprenaline on days 9 and 10 (UDCA + I group). UDCA pre-treatment significantly reduced values of high-sensitivity troponin I (hsTnI) and aspartate aminotransferase (AST) cardiac markers (p < 0.001 and p < 0.01, respectively). The value of thiobarbituric acid reactive substances (TBARS) was also decreased in the UDCA + I group compared to the I group (p < 0.001). UDCA also significantly increased glutathione (GSH) levels, while showing a tendency to increase levels of superoxide dismutase (SOD) and catalase (CAT). The level of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) expression, a key regulatory gene of inflammation, was diminished when UDCA was administered. A reduction of cardiac damage was also observed in the UDCA pre-treated group. In conclusion, UDCA pre-treatment showed a cardioprotective effect on isoprenaline-induced myocardial injury in rats, primarily by reducing oxidative stress and inflammation.

A global analysis of the burden of ischemic heart disease attributable to diet low in fiber between 1990 and 2019

AIM

Ischemic heart disease (IHD) represents a major cardiovascular condition heavily influenced by dietary factors. This study endeavors to assess the global, regional, and temporal impact of low-fiber diets on the burden of IHD.

METHOD

Leveraging data from the Global Burden of Disease (GBD) 2019 study, we analyzed the worldwide burden of IHD resulting from diet low in fiber using indices including death and disability-adjusted life years (DALY). This burden was further segmented based on variables including regions and countries. To track the evolution from 1990 to 2019, we utilized the Joinpoint regression model to estimate the temporal trend of IHD burden stemming from low-fiber diets.

RESULTS

In 2019, a total of 348.85 thousand (95%UI: 147.57, 568.31) deaths and 7942.96 thousand (95%UI: 3373.58,12978.29) DALY (95% UI: 707.88, 1818) of IHD were attributed to diet low in fiber globally. These figures correspond to 3.82% of all IHD deaths and 4.36% of total IHD DALYs. The age-standardized death and DALY rates per 100,000 individuals were 4.48 (95% UI: 1.90,7.27) and 97.4(95%UI: 41.44, 158.88) respectively. However, significant regional disparities emerged in these age-standardized rates, with South Asia and Central Asia experiencing the highest rates. Between 1990 and 2019, we observed that most regions displayed a downward trend of the age-standardized DALY and death rate of IHD resulting from low-fiber diets, except for Central Sub-Saharan Africa and Southern Sub-Saharan Africa.

CONCLUSION

Our analysis underscores the substantial toll of IHD associated with low-fiber diets, particularly considering the significant regional variations. Therefore, it is imperative to sustain efforts to implement effective measures aimed at enhancing fiber intake worldwide, particularly in countries with lower socio-demographic indices.

Engineered model of heart tissue repair for exploring fibrotic processes and therapeutic interventions

Advancements in human-engineered heart tissue have enhanced the understanding of cardiac cellular alteration. Nevertheless, a human model simulating pathological remodeling following myocardial infarction for therapeutic development remains essential. Here we develop an engineered model of myocardial repair that replicates the phased remodeling process, including hypoxic stress, fibrosis, and electrophysiological dysfunction. Transcriptomic analysis identifies nine critical signaling pathways related to cellular fate transitions, leading to the evaluation of seventeen modulators for their therapeutic potential in a mini-repair model. A scoring system quantitatively evaluates the restoration of abnormal electrophysiology, demonstrating that the phased combination of TGFβ inhibitor SB431542, Rho kinase inhibitor Y27632, and WNT activator CHIR99021 yields enhanced functional restoration compared to single factor treatments in both engineered and mouse myocardial infarction model. This engineered heart tissue repair model effectively captures the phased remodeling following myocardial infarction, providing a crucial platform for discovering therapeutic targets for ischemic heart disease.

Exploring the predictive values of CRP and lymphocytes in coronary artery disease based on a machine learning and Mendelian randomization

Purpose

To investigate the predictive value of leukocyte subsets and C-reactive protein (CRP) in coronary artery disease (CAD).

Methods

We conducted a Mendelian randomization analysis (MR) on leukocyte subsets, C-reactive protein (CRP) and CAD, incorporating data from 68,624 patients who underwent coronary angiography from 2010 to 2022. After initial screening, clinical data from 46,664 patients were analyzed. Techniques employed included propensity score matching (PSM), logistic regression, lasso regression, and random forest algorithms (RF). Risk factors were assessed, and the sensitivity and specificity of the models were evaluated using receiver operating characteristic (ROC) curves. Additionally, survival analysis was conducted based on a 36-month follow-up period.

Results

The inverse variance weight (IVW) analysis showed that basophil count (OR 0.92, 95% CI: 0.84-1.00, P = 0.048), CRP levels (OR 0.87, 95% CI: 0.73-1.00, P = 0.040), and lymphocyte count (OR 1.10, 95% CI: 1.04-1.16, P = 0.001) are significant risk factors for CAD. Using LASSO regression, logistic regression, and RF analysis, both CRP and lymphocyte counts were consistently identified as risk factors for CAD, prior to and following PSM. The ROC curve analysis indicated that the combination of lymphocyte and CRP levels after PSM achieves a higher diagnostic value (0.85). Survival analysis revealed that high lymphocyte counts and low CRP levels are associated with a decreased risk of Major Adverse Cardiovascular Events (MACE) (P < 0.001). Conversely, a higher CRP level combined with lymphocyte counts correlates with a poorer prognosis.

Conclusion

There is a causal relationship between lymphocytes, CRP and CAD. The combined assessment of CRP and lymphocytes offers diagnostic value for CAD. Furthermore, high CRP levels coupled with low lymphocyte counts are associated with a poor prognosis.

Mortality Rate and Years of Life Lost Due to Ischemic Heart Disease in Southern Iran between 2004 and 2019: A Population-Based Study

BACKGROUND

Cardiovascular diseases (CVDs) account for one-third of all deaths worldwide.

METHODS

In this cross-sectional study, we extracted all death records from the Electronic Death Registration System categorized as ischemic heart disease (IHD) based on age, gender, and the year of death according to ICD-10 for this cross-sectional analysis. The Fars province is situated in southern Iran with a population of about 4 million. An analysis of years of life lost (YLL) resulting from premature death from IHD was conducted using the World Health Organization's 2015 YLL framework. The trend of the YLL rates was investigated using joinpoint regression.

RESULTS

In the Fars province, IHD was the cause of 46969 deaths throughout a 16-year study period, (2004 to 2019). Among these, 26,503 (56.4%) were men. The crude death rates per 100000 population for men and women were 84.2 and 66.5, respectively. The total YLL due to premature death due to IHD, during the 16-year study period, was 287625 in male, 209665 in female. The joinpoint regression showed a declining trend in the YLL rate associated with premature death. Annual Percent Change (APC) was -0.6% (95% CI -6.9 to 6.1, P=0.851) for males and -1.5% (95% CI -5.2 to 2.2, P=0.418) for females.

CONCLUSION

The trends of the standardized mortality rate, YLL, and crude mortality rate held steady throughout a 16-year period. Planning for comprehensive primary and secondary prevention and increasing public knowledge of IHD are necessary.