Sex differences in endothelial function important to vascular health and overall cardiovascular disease risk across the lifespan

Targeting the CD39/CD73 pathway: New insights into cardiac fibrosis and inflammation in female cardiac surgery patients

Women undergoing cardiac surgery suffer from worse outcomes than their male counterparts. The reasons for this disparity are multifactorial, but the loss of the protective effects of estrogen likely plays a role. Estrogen acts on the CD39/CD73 purine pathway, and loss of estrogen effects may contribute to the increased inflammation seen in post-menopausal women. We aimed to compare CD39/CD73 expression and downstream fibrosis, and inflammation in men and women undergoing cardiac surgery and then used an ovariectomy/high fat diet mouse model to approximate women who present for cardiac surgery to test therapeutics. We found decreased CD39 and CD73 in women compared to men, which was associated with increased fibrosis. Apyrase supplementation (a CD39 mimetic) improved ejection fraction and decreased E/e'. Increased CD73 function (via dipyridamole) decreased fibrosis. This study demonstrates the importance of purinergic dysfunction in cardiovascular disease in women and presents two potential therapeutics to improve cardiac health via manipulation of purine pathways.

Thermoneutral-housed rats demonstrate impaired perivascular adipose tissue and vascular crosstalk

OBJECTIVE

Vascular pathology, characterized by impaired vasoreactivity and mitochondrial respiration, differs between the sexes. Housing rats under thermoneutral (TN) conditions causes vascular dysfunction and perturbed metabolism. We hypothesized that thoracic perivascular adipose tissue (tPVAT), a vasoregulatory adipose depot known to have a brown adipose tissue (BAT) phenotype, remodels to a mainly white adipose (WAT) phenotype in rats housed at TN, driving diminished vasoreactivity in a sex-dependent manner.

METHODS

Male and female Wistar rats were housed at either room temperature (RT) or TN. We measured changes in tPVAT morphology, vasoreactivity in vessels with intact tPVAT or transferred to tPVAT of the oppositely-housed animal, vessel stiffness, vessel mitochondrial respiration and cellular signaling.

RESULTS

Remodeling of tPVAT was observed in rats housed at TN; animals in this environment showed tPVAT whitening and displayed diminished aortae vasodilation ( P  < 0.05), different between the sexes. Juxtaposing tPVAT from RT rats onto aortae from TN rats in females corrected vasodilation ( P  < 0.05); this did not occur in males. In aortae of all animals housed at TN, mitochondrial respiration was significantly diminished in lipid substrate experiments ( P  < 0.05), and there was significantly less expression of phosphorylated endothelial nitric oxide synthase (peNOS) ( P  < 0.001).

CONCLUSIONS

These data are consistent with TN-induced remodeling of tPVAT, notably associated with sex-specific blunting of vasoreactivity, diminished mitochondrial respiration, and altered cellular signaling.

Strain- and sex-dependent variability in hepatic microcirculation and liver function in mice

BACKGROUND

The integrity and functionality of the hepatic microcirculation are essential for maintaining liver health, which is influenced by sex and genetic background. Understanding these variations is crucial for addressing disparities in liver disease outcomes.

AIM

To investigate the sexual dimorphism and genetic heterogeneity of liver microcirculatory function in mice.

METHODS

We assessed hepatic microhemodynamics in BALB/c, C57BL/6J, and KM mouse strains using laser Doppler flowmetry and wavelet analysis. We analyzed the serum levels of alanine transaminase, glutamic acid aminotransferase, total bile acid, total protein, alkaline phosphatase, and glucose. Histological and immunohistochemical staining were employed to quantify microvascular density and the expression levels of cluster of differentiation (CD) 31, and estrogen receptor α, and β. Statistical analyses, including the Mantel test and Pearson correlation, were conducted to determine the relationships among hepatic function, microcirculation, and marcocirculation between different sexes and across genetic backgrounds.

RESULTS

We identified sex-based disparities in hepatic microhemodynamics across all strains, with males exhibiting higher microvascular perfusion and erythrocyte concentration, but lower blood velocity. Strain-specific differences were evident, particularly in the endothelial oscillatory characteristics of the erythrocyte concentration. No sex-dependent differences in estrogen receptor expression were observed, while significant variations in CD31 expression and microvascular density were observed. The correlations highlighted relationships between hepatic microhemodynamics and liver function indicators.

CONCLUSION

Our findings indicate the influence of genetic and sex differences on hepatic microcirculation and liver function, highlighting the necessity of incorporating both genetic background and sex into hepatic physiology studies and potential liver disease management strategies.

Transient angiotensin-converting enzyme inhibition confers sex-specific protection against angiotensin II-induced cardiac remodeling

Hypertension increases the prevalence of heart failure to a greater extent in women than men. The fibrotic remodeling of the left ventricle (LV) is a major contributor to increased myocardial stiffness and eventual decrease in cardiac function. Cardiac fibrosis can be prevented in the spontaneously hypertensive rat (SHR) by transient angiotensin-converting enzyme inhibitors (ACEi) in males. Whether transient ACEi also protects against fibrosis in females is not known. In the present study, we evaluated angiotensin II (Ang II)-induced cardiac fibrosis and related signaling in male and female SHR to determine how these responses are altered by prior transient ACEi treatment. Relative changes in blood pressure response to both ACEi and Ang II were similar between sexes, whereas Ang II-induced cardiac hypertrophy was attenuated by prior ACEi in males only. Ang II-induced changes in gene expression for collagens I, III, and IV were attenuated by prior ACEi in males but not females. Despite these sex-specific differences, prior ACEi-attenuated Ang II-induced increases in fibrogenic proteins [phosphorylated SMAD3/SMAD3, periostin, and lysyl oxidase (LOX)] and pro-oxidative proteins (NOX2 and NOX4), as well as hydroxyproline (HYP) content similarly in both sexes. Interestingly, a positive correlation between angiotensin II type 1 (AT1) receptor gene expression and Col1a1 in Ang II-treated males is absent in the female SHRs. The observed sex differences in the protection afforded by prior ACEi suggest altered signaling for collagen deposition that may lead to a greater understanding of the sex-dependent efficacy of antihypertensive drugs.NEW & NOTEWORTHY Here, we determine, for the first time that female spontaneously hypertensive rats are responsive to transient angiotensin-converting enzyme inhibitor (ACEi) treatment. Prior work showed that transient ACEi treatment induced persistent protection against a future stimulus in males. Here, Ang II-induced cardiac fibrosis was attenuated by transient ACEi treatment in both sexes. Notably, the underlying mechanism of action is sex-dependent. Specifically, changes in collagen deposition in male but not female hearts correlate with collagen gene expression.

Sexual Dimorphism in Cardiometabolic Diseases: From Development to Senescence and Therapeutic Approaches

The global incidence and prevalence of cardiometabolic disorders have risen significantly in recent years. Although lifestyle choices in adulthood play a crucial role in the development of these conditions, it is well established that events occurring early in life can have an important effect. Recent research on cardiometabolic diseases has highlighted the influence of sexual dimorphism on risk factors, underlying mechanisms, and response to therapies. In this narrative review, we summarize the current understanding of sexual dimorphism in cardiovascular and metabolic diseases in the general population and within the framework of the Developmental Origins of Health and Disease (DOHaD) concept. We explore key risk factors and mechanisms, including the influence of genetic and epigenetic factors, placental and embryonic development, maternal nutrition, sex hormones, energy metabolism, microbiota, oxidative stress, cell death, inflammation, endothelial dysfunction, circadian rhythm, and lifestyle factors. Finally, we discuss some of the main therapeutic approaches, responses to which may be influenced by sexual dimorphism, such as antihypertensive and cardiovascular treatments, oxidative stress management, nutrition, cell therapies, and hormone replacement therapy.

Menopause-related changes in vascular signaling by sex hormones

Cardiovascular disease (CVD), such as hypertension and coronary artery disease, involves pathological changes in vascular signaling, function, and structure. Vascular signaling is regulated by multiple intrinsic and extrinsic factors that influence endothelial cells, vascular smooth muscle, and extracellular matrix. Vascular function is also influenced by environmental factors including diet, exercise, and stress, as well as genetic background, sex differences, and age. CVD is more common in adult men and postmenopausal women than in premenopausal women. Specifically, women during menopausal transition, with declining ovarian function and production of estrogen (E2) and progesterone, show marked increase in the incidence of CVD and associated vascular dysfunction. Mechanistic research suggests that E2 and E2 receptor signaling have beneficial effects on vascular function including vasodilation, decreased blood pressure, and cardiovascular protection. Also, the tangible benefits of E2 supplementation in improving menopausal symptoms have prompted clinical trials of menopausal hormone therapy (MHT) in CVD, but the results have been inconsistent. The inadequate benefits of MHT in CVD could be attributed to the E2 type, dose, formulation, route, timing, and duration as well as menopausal changes in E2/E2 receptor vascular signaling. Other factors that could affect the responsiveness to MHT are the integrated hormonal milieu including gonadotropins, progesterone, and testosterone, vascular health status, preexisting cardiovascular conditions, and menopause-related dysfunction in the renal, gastrointestinal, endocrine, immune, and nervous systems. Further analysis of these factors should enhance our understanding of menopause-related changes in vascular signaling by sex hormones and provide better guidance for management of CVD in postmenopausal women. SIGNIFICANCE STATEMENT: Cardiovascular disease is more common in adult men and postmenopausal women than premenopausal women. Earlier observations of vascular benefits of menopausal hormone therapy did not materialize in randomized clinical trials. Further examination of the cardiovascular effects of sex hormones in different formulations and regimens, and the menopausal changes in vascular signaling would help to adjust the menopausal hormone therapy protocols in order to enhance their effectiveness in reducing the risk and the management of cardiovascular disease in postmenopausal women.

Estradiol levels are differentially associated with pulse wave velocity in trauma-exposed premenopausal women with and without PTSD

Arterial stiffness is a well-known risk factor for cardiovascular disease. Although estradiol (E2) is known to be cardioprotective, the available data point to a growing cardiovascular disease risk in women before menopause due to posttraumatic stress disorder (PTSD). The present study aimed to investigate the effects of E2 on arterial compliance in trauma-exposed premenopausal women, with and without a clinical diagnosis of PTSD. We hypothesized that E2 will be differentially associated with pulse wave velocity (PWV) in women with PTSD (PTSD+, n = 45) and without PTSD (PTSD-, n = 47). Estradiol and PWV were measured during two separate study visits. Serum E2 levels were measured via the quantitative sandwich enzyme-linked immunoassay technique (ELISA) and log-transformed due to non-normal distribution. Carotid to femoral applanation tonometry was used to measure PWV. Our analyses revealed an overall weak and nonsignificant correlation between E2 and PWV (r = -0.119, P = 0.350). However, when examining each group, we found a negative association between E2 and PWV in PTSD- (r = -0.466, P = 0.004). In contrast, we found an unexpected positive association between E2 levels and PWV in PTSD+ (r = 0.360, P = 0.037). Furthermore, a multiple linear regression revealed that E2 was predictive of PWV in PTSD- only, even after accounting for the phase of the menstrual cycle, age, body mass index, diastolic blood pressure, and PTSD symptom severity (R2 = 0.670, P = 0.005). Interestingly, we also found lower levels of E2 in PTSD+ than PTSD- (1.4 ± 0.4 vs. 1.6 ± 0.4 pg/mL, P = 0.022). These findings suggest that PTSD may inhibit the protective effects of E2 on arterial compliance in women before menopause.NEW & NOTEWORTHY In trauma-exposed premenopausal women, we found that serum estradiol (E2) was a predictor of pulse wave velocity (PWV) only in the absence of a posttraumatic stress disorder (PTSD) diagnosis, even after accounting for the phase of the menstrual cycle, age, body mass index, diastolic blood pressure, and PTSD symptom severity. Moreover, E2 levels were lower in women with PTSD than in those without PTSD. We collected E2 and PWV during two separate visits and controlled for the menstrual cycle phase in our analyses.

Endothelial dysfunction in middle-aged and older men with low testosterone is associated with elevated circulating endothelin-1

Low testosterone in middle-aged/older men contributes to accelerated vascular aging, including endothelial dysfunction. However, the mechanisms by which low testosterone affects endothelial dysfunction are not well understood. We sought to determine whether higher endothelin-1 (ET-1) levels are associated with reduced brachial artery flow-mediated dilation (FMD) in middle-aged/older men with low testosterone. Plasma ET-1 was quantified in 60 men categorized as young (n = 20, age = 30 ± 4 yr, testosterone = 510 ± 63 ng/dL), middle-aged/older with normal testosterone (n = 20, age = 59 ± 6 yr, testosterone = 512 ± 115 ng/dL), or middle-aged/older with low testosterone (n = 20, age = 60 ± 8 yr, testosterone = 265 ± 47 ng/dL). Endothelial function was determined via brachial artery FMD. Venous and arterial endothelial cells were harvested via endovascular biopsy in a subset of participants and stained for ET-1 expression. Middle-aged/older men with normal testosterone exhibited lower brachial artery FMD (5.7 ± 2.2%) compared with young men (7.3 ± 1.3%, P = 0.020), which was exaggerated in middle-aged/older men with low testosterone (4.0 ± 1.8%, P = 0.010 vs. middle-aged/older men with normal testosterone). Plasma ET-1 was not different between young (5.6 ± 0.9 ng/dL) and middle-aged/older men with normal testosterone (6.0 ± 1.4 ng/dL, P = 0.681) but was higher in middle-aged/older men with low testosterone (7.7 ± 2.8 ng/dL) compared with both groups (P < 0.001 vs. young men; P = 0.013 vs. middle-aged/older men with normal testosterone). There was no difference in venous (P = 0.616) or arterial (P = 0.222) endothelial cell ET-1 expression between groups. There was a significant inverse association between plasma ET-1 and FMD (r =-0.371, P = 0.004). These data suggest that the accelerated age-associated reduction in endothelial dysfunction in middle-aged/older men with low testosterone is related to higher circulating ET-1.NEW & NOTEWORTHY Middle-aged/older men with low testosterone have reduced vascular endothelial function compared with young and age-matched men with normal testosterone. In this manuscript, we demonstrate that men with low testosterone have higher plasma endothelin-1, which is associated with worse brachial artery flow-mediated dilation. The source of higher plasma endothelin-1 remains unknown; however, higher circulating endothelin-1 appears to be a mechanism contributing to reduced vascular endothelial function in men with low testosterone.

Vascular access dysfunction incidence among Japanese dialysis patients from NDB Open Data Japan

Vascular access (VA) dysfunction affects the quality of care in end-stage renal disease (ESRD) patients undergoing hemodialysis. However, comprehensive nationwide data in Japan are limited. Therefore, we estimated VA dysfunction and recurrence and examined their associations with sex, age, and regional variation using the National Database Open Data Japan (NDB Open). We conducted a population-based observational study using the NDB Open for fiscal years 2020-2022. We identified ESRD patients who underwent VA-related procedures based on claims codes. We also calculated annual VA dysfunction rates and 3-month recurrence rates. We used multiple regression models, adjusted for sex, age, and the fiscal year, to examine associations; the regional differences were also evaluated. The average annual VA dysfunction rate was 74.0% (standard error [SE], 1.7%), with a 3-month recurrence rate of 16.9% (SE, 0.5%). Females and older patients showed higher rates. Age correlated positively with the VA dysfunction rate (ρ = 0.827-0.941). VA dysfunction rates varied across prefectures. In Japanese ESRD patients, VA dysfunction showed sex- and age-related differences, along with regional variations. These findings may inform future prevention strategies and research utilizing detailed clinical data.

Posttraumatic Stress Disorder Is Associated With Endothelial Dysfunction in Women With HIV

BACKGROUND

HIV induced endothelial dysfunction (ED) contributes to cardiovascular disease (CVD) in women with HIV (WWH). Although psychosocial stress has been implicated in the development of CVD in HIV, its impact on ED in WWH remains unknown.

OBJECTIVES

The authors hypothesized that posttraumatic stress disorder (PTSD) and HIV interact to contribute to ED in WWH.

METHODS

We enrolled 87 women from the Women's Interagency HIV Study in Atlanta, Georgia, who reported previous trauma and completed the PTSD Checklist: Civilian Version (PCL-C), which assesses PTSD symptom severity (PCL-C score) and PTSD status (PCL-C >44). Brachial artery flow-mediated dilation (FMD) was measured to assess endothelial function. The impact of PTSD, HIV, and their interaction on endothelial function was evaluated using linear regression models adjusted for demographics, CVD risk factors, depressive symptoms, and statin use.

RESULTS

Overall, 55 (63.2%) had HIV, 24 (27.5%) had PTSD, and 13 (14.9%) had both. Those with PTSD were more likely to smoke (18 [75%] vs 28 [44.4%], P = 0.02) and have depressive symptoms (14 [58.3%] vs 18 [28.6%], P = 0.02) than those without PTSD. In adjusted models, the HIV-PTSD (severity and status) interaction effect on FMD was significant (P = 0.01). Both PTSD severity (β per 10-point increase: -0.72% [95% CI: -1.22 to -0.21], P = 0.01) and PTSD status (β: -2.51% [95% CI: -4.21 to -0.77], P = 0.01) were independently associated with lower FMD in WWH but not in those without HIV.

CONCLUSIONS

PTSD is independently associated with ED in WWH. Whether treatment for PTSD improves ED and CVD in WWH needs further study.

Getting to the Heart of the Matter: Exploring the Intersection of Cardiovascular Disease, Sex and Race and How Exercise, and Gut Microbiota Influence these Relationships

Cardiovascular disease (CVD) is the leading cause of death worldwide, with physical inactivity being a known contributor to the global rates of CVD incidence. CVD incidence, however, is not uniform with recognized sex differences as well and racial and ethnic differences. Furthermore, gut microbiota have been associated with CVD, sex, and race/ethnicity. Researchers have begun to examine the interplay of these complicated yet interrelated topics. This review will present evidence that CVD (risk and development), and gut microbiota are distinct between the sexes and racial/ethnic groups, which appear to be influenced by acculturation, discrimination, stress, and lifestyle factors like exercise. Furthermore, this review will address the beneficial impacts of exercise on the cardiovascular system and will provide recommendations for future research in the field.

Sex-specific mechanisms in vascular aging: exploring cellular and molecular pathways in the pathogenesis of age-related cardiovascular and cerebrovascular diseases

Aging remains the foremost risk factor for cardiovascular and cerebrovascular diseases, surpassing traditional factors in epidemiological significance. This review elucidates the cellular and molecular mechanisms underlying vascular aging, with an emphasis on sex differences that influence disease progression and clinical outcomes in older adults. We discuss the convergence of aging processes at the macro- and microvascular levels and their contributions to the pathogenesis of vascular diseases. Critical analysis of both preclinical and clinical studies reveals significant sex-specific variations in these mechanisms, which could be pivotal in understanding the disparity in disease morbidity and mortality between sexes. The review highlights key molecular pathways, including oxidative stress, inflammation, and autophagy, and their differential roles in the vascular aging of males and females. We argue that recognizing these sex-specific differences is crucial for developing targeted therapeutic strategies aimed at preventing and managing age-related vascular pathologies. The implications for personalized medicine and potential areas for future research are also explored, emphasizing the need for a nuanced approach to the study and treatment of vascular aging.

Sex-specific responses of central artery stiffness to cold pressor test-mediated sympathetic activation

Considerable attention has been devoted to investigating whether acute activation of the sympathetic nervous system, triggered by daily life stressors, increases central artery stiffness (CAS). Overt sex differences in sympathetic neurovascular transduction lead to distinct cardiovascular responses to sympathoexcitation in men versus women. Our study aimed to determine if the cold pressor test (CPT), chosen to simulate highly painful stressors individuals encounter daily, would induce CAS augmentation in a sex-balanced cohort of young individuals and whether any observed CAS increase would differ between sexes. Twenty-eight participants (14 men, 14 women) provided baseline and CPT measurements of carotid-femoral pulse wave velocity (cf-PWV), mean arterial pressure (MAP), cardiac output (CO), total peripheral resistance (TPR), and heart rate (HR). CPT involved immersing participants' feet in 5 °C ice-water slurry. Data were analyzed using 2-way analysis of variance and post hoc testing, where applicable. CPT significantly increased (p < 0.01) cf-PWV values in our population, with women showing lower collective CAS values compared to men across baseline and CPT conditions. CPT augmented (p < 0.01) MAP, HR, and CO without altering stroke volume (SV), but increased (p = 0.002) TPR only in men. Men collectively exhibited higher (p < 0.01) CO and SV values across baseline and CPT conditions, as well as lower (p < 0.01) TPR values compared to women. These results support the notion that CPT increases CAS in a healthy young population. Despite observed sex differences in peripheral vascular responses to CPT, these variances did not differently impact the central pressor response or central artery stiffening between sexes. Given the well-documented sex differences in cardiovascular risk and incidence, these findings deepen understanding of how cardiocirculatory responses differ between sexes under stress. These findings support sex-specific approaches in cardiovascular medicine and prevention, including tailored coping strategies for managing stress.

Short-term estradiol administration does not restore endothelin-B receptor-mediated vasodilation in postmenopausal women

The endothelin-B receptor (ETBR) mediates vasodilation in young women, an effect that is absent in postmenopausal women. We have previously demonstrated that ETBR-mediated vasodilation is regulated by estradiol (E2) in young women; however, the impact of E2 on ETBR function in postmenopausal women remains unknown. Accordingly, the objective of this study was to test the hypothesis that E2 exposure restores ETBR-mediated dilation in postmenopausal women. Ten healthy postmenopausal women (55 ± 2 yr of age, 5 ± 3 years since menopause) completed the study. E2 was administered by transdermal patch for 7 days (0.1 mg/day, Vivelle-Dot patch). Vasodilation in the cutaneous microcirculation (microvascular endothelial function) was measured via local heating (42°C) using laser Doppler flowmetry combined with intradermal microdialysis perfusions of lactated Ringer's (control) and ETBR antagonist (BQ-788, 300 nM) at baseline and after E2 administration. There was no effect of E2 on ETBR function [hormone × site, F(1,9) = 0.77, P = 0.40]. These data demonstrate that in contrast to findings in premenopausal women, E2 administration does not restore ETBR function in postmenopausal women.NEW & NOTEWORTHY The vascular endothelial endothelin-B receptor (ETBR) mediates vasodilation in premenopausal women, an effect modulated by estradiol. ETBR-mediated vasodilation is lost in postmenopausal women, but the effect of exogenous estradiol administration on ETBR function in postmenopausal women is not known. During estradiol administration, ETBR blockade did not affect cutaneous microvascular vasodilatory response to local heating. We demonstrate that exogenous estradiol administration does not restore ETBR-mediated vasodilation in postmenopausal women.

Vascular health and exercise in females throughout the lifespan: Exploring puberty, pregnancy and menopause

This narrative review highlights the impact of exercise on vascular health in females over the lifespan with an emphasis on puberty, pregnancy and menopause. These events encompass substantial changes in sex hormone levels, particularly oestrogens and progesterone. They are also accompanied by distinct adaptations of the central, peripheral and cerebral vasculature. Regular exercise is an effective mechanism to reduce vascular risk in females of all ages, especially for those at higher risk for vascular disorders. However, there are large variabilities in the vascular adaptations to exercise in females that may be related to circulating sex hormone levels. In addition, exogenous hormones, such as oral contraceptives taken after puberty or hormonal replacement therapy taken to mitigate symptoms of menopause, may interact with exercise-induced changes in vascular function. We highlight how more research is needed to understand the optimal exercise interventions to promote vascular health in females across the lifespan, especially during times of hormonal transition.

Accuracy of nursing diagnoses identified at admission and discharge of patients with decompensated heart failure

PURPOSE

To determine the accuracy of nursing diagnoses at hospital admission and discharge for patients with heart failure (HF).

METHODS

This comparative study examined the documentation in 155 medical records of patients with an admitting diagnosis of HF during August 2018 and July 2019. An audit tool was used to record the diagnoses made by nurses during routine care at the time of admission and discharge. Two researchers (L.S. and A.C.) examined the records and evaluated the documented nursing diagnoses using the Nursing Diagnosis Accuracy Scale version 2. Kappa was used for agreement between them. Patient social and clinical characteristics were described using percentages, absolute frequencies, means, and standard deviations.

FINDINGS

A total of 18 unique nursing diagnoses were identified across the 155 patients. Among the 754 nursing diagnoses recorded, 85% of those identified at admission (n = 644) were deemed highly accurate. At discharge, of the 527 diagnoses recorded, 66% (n = 349) were rated as highly accurate. Excess fluid volume was the most common diagnosis (85% at admission, 49% at discharge). Three risk diagnoses were frequent at both points: risk for infection, risk for falls, and risk for decreased cardiac output. Agreement between evaluators ranged from Κ = 0.234 to 1.00.

CONCLUSIONS

Greater agreement in nursing diagnoses at discharge likely reflects ongoing patient monitoring. Persistent diagnoses at discharge highlight the need for continued nursing care post-discharge.

IMPLICATIONS FOR NURSING PRACTICE

This study encourages nurses to improve clinical evaluation for HF patients from admission to discharge. As key clinical indicators are identified, nurses can improve the accuracy of their diagnoses and plan more effective interventions to achieve positive health outcomes and reduce unnecessary hospitalization.

Association Between Obstructive Sleep Apnea and Hearing Loss Using 2019-2021 Korea National Health and Nutrition Examination Survey Data

Background: The association of hearing loss with obstructive sleep apnea (OSA) has been investigated in several studies, but analyses using large national population-based datasets are lacking. Therefore, we aimed to determine the effect of the severity of OSA on hearing loss using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Methods: We reviewed the KNHANES data from 2019 to 2021, analyzing 7730 subjects aged 40 and older who completed the sleep health survey (STOP-BANG questionnaire, SBQ) and hearing assessment. According to their SBQ scores, subjects were classified into low-, intermediate-, and high-risk OSA groups. Hearing loss was defined as a pure-tone average (PTA) greater than 25 dB at frequencies of 0.5, 1, 2, and 4 kHz in the better ear. In addition, low- and high-frequency hearing loss was defined as PTA >25 dB at 0.5, 1, and 2 kHz and PTA >40 dB at 2, 4, and 8 kHz, respectively. Results: Of a total of 7730 subjects, 4781 (62.4%), 2534 (31.7%), and 415 (5.9%) belonged to the low-, intermediate-, and high-risk groups, respectively. Mean hearing thresholds were significantly higher in the intermediate-, high-, and intermediate/high-risk groups compared to the low-risk group (all P < .001). After adjusting for related variables, logistic regression analyses revealed that hearing loss was not significantly correlated with OSA severity in the male subgroup. However, female subjects with more than an intermediate risk of OSA had a 1.372 times higher risk of hearing loss than those with a low risk of OSA (odds ratio: 1.372, 95% CI: 1.039-1.814). Conclusion: The study found that the risk of hearing loss was significantly related to the severity of OSA in the female subgroup.

Sex-mediated effects of transglutaminase 2 inhibition on endothelial function in human resistance arteries from diabetic and non-diabetic patients

Transglutaminase 2 (TG2) is an enzyme with multiple conformations. In its open conformation, TG2 exhibits transamidase activity linked to fibrosis, arterial remodeling, and endothelial dysfunction, a process enhanced by high glucose in endothelial cells. However, the closed conformation of TG2 contributes to transmembrane signaling and nitric oxide (NO)-dependent vasorelaxation. LDN 27219, a reversible allosteric inhibitor, stabilizes TG2 in its closed conformation. We examined whether pharmacological modulation of TG2 into its closed conformation induces vasorelaxation and enhances endothelium-dependent and independent relaxation in resistance arteries from age-matched diabetic (n = 14) and non-diabetic patients (n = 14) (age 71 (Standard Error of the Mean: ± 2)). Subcutaneous arteries (diameter 133-1013 µm) were isolated from abdominal fat biopsies. TG2 mRNA expression and transamidase activity were assessed via RT-qPCR and 5-biotin(amido)pentylamine (5-BP) incorporation, while vascular reactivity was measured using wire myography. TG2 mRNA was highly expressed without significant differences between the groups and LDN 27219 induced concentration-dependent vasorelaxation in arteries from both groups. Sex-specific analysis revealed that potentiation of acetylcholine-induced vasorelaxation by LDN 27219 was driven by increased TG2 expression in non-diabetic females, whereas no effect was observed in arteries from non-diabetic males. Among diabetic patients, LDN 27219 increased maximal acetylcholine-induced vasorelaxation in males only. LDN 27219 did not affect endothelium-independent relaxation to sodium nitroprusside in either group. In conclusion, TG2 is expressed in human resistance arteries, and LDN 27219 induced vasorelaxation, selectively enhancing ACh relaxation in non-diabetic females, likely owing to increased TG2 expression. This finding underscores the importance of sex differences in TG2 modulation of vasorelaxation.

Prevalence and determinants of ideal cardiovascular health by sex and region-a population-based study in Peru

Introduction

Attaining what the American Heart Association terms Ideal Cardiovascular Health (ICVH) is viewed as an essential objective for preventing cardiovascular diseases (CVD).

Objective

To determine the prevalence of ICVH, stratified by sex and region and its associated factors in the adult population of Peru.

Materials and methods

Analytical cross-sectional study. Data were obtained from the Life Stage Food and Nutrition Surveillance Survey (VIANEV). ICVH can be depicted vis-a-vis the seven metrics of the AHA: blood pressure levels, total cholesterol and glucose levels, smoking status, body mass index, physical activity levels, and dietary intake through the consumption of fruits and vegetables. The variable was categorized as deficient/moderate vs. ideal for regression analysis.

Results

Of the 863 participants examined, findings demonstrated that 38.01% had ICVH. The prevalence is trending lower in correlation with rising age and educational attainment levels and for those inhabitants residing at higher elevations. Likewise, statistically significant variations were observable concerning the prevalence of ICVH contingent on the region of residence and marital status, in particular amongst the feminine inhabitants.

Conclusions

These results demonstrate that the frequency of ICVH in the grown-up inhabitants of Peru is comparatively tiny. Things linked to a lesser frequency of ICVH involve increased age, a higher level of education, living at higher altitudes, and staying married to a woman. These discoveries underscore the need to implement prevention and treatment strategies for CVD distinct for each inhabitant team.

Sex dimorphism in kidney health and disease: mechanistic insights and clinical implication

Sex is a key variable in the regulation of human physiology and pathology. Many diseases disproportionately affect one sex: autoimmune diseases, such as systemic lupus erythematosus, are more common in women but more severe in men, whereas the incidence of other disorders such as gouty arthritis and malignant cancers is higher in men. Besides the pathophysiology, sex may also influence the efficacy of therapeutics; participants in clinical trials are still predominately men, and the side effects of drugs are more common in women than in men. Sex dimorphism is a prominent feature of kidney physiology and function, and consequently affects the predisposition to many adult kidney diseases. These differences subsequently influence the response to immune stimuli, hormones, and therapies. It is highly likely that these responses differ between the sexes. Therefore, it becomes imperative to consider sex differences in translational science from basic science to preclinical research to clinical research and trials. Under-representation of one sex in preclinical animal studies or clinical trials remains an issue and key reported outcomes of such studies ought to be presented separately. Without this, it remains difficult to tailor the management of kidney disease appropriately and effectively. In this review, we provide mechanistic insights into sex differences in rodents and humans, both in kidney health and disease, highlight the importance of considering sex differences in the design of any preclinical animal or clinical study, and propose guidance on how to optimal design and conduct preclinical animal studies in future research.

HucMSCs can alleviate abnormal vasculogenesis induced by high glucose through the MAPK signaling pathway

Vascular complications caused by diabetes mellitus contribute a major threat to increased disability and mortality of diabetic patients, which are characterized by damaged endothelial cells and angiogenesis. Human umbilical cord-derived mesenchymal stem cells (hucMSCs) have been demonstrated to alleviate endothelial cell damage and improve angiogenesis. However, these investigations overlooked the pivotal role of vasculogenesis. In this study, we utilized blood vessel organoids (BVOs) to investigate the impact of high glucose on vasculogenesis and subsequent angiogenesis. We found that BVOs in the vascular lineage induction stage were more sensitive to high glucose and more susceptible to affect endothelial cell differentiation and function. Moreover, hucMSCs can alleviate the high glucose-induced inhibition of endothelial cell differentiation and dysfunction through MAPK signaling pathway downregulation, with the MAPK activator dimethyl fumarate further illustrating the results. Thereby, we demonstrated that high glucose can lead to abnormal vasculogenesis and impact subsequent angiogenesis, and hucMSCs can alleviate this effect.

Incremental Cardiovascular Risk of Menopause in Women with Psoriasis, Psoriatic Arthritis or Spondyloarthritis?

PURPOSE OF THE REVIEW

This narrative review aims to discuss the most recent studies regarding the risk of cardiovascular disease (CVD) in women with psoriasis, psoriatic arthritis (PsA) and spondyloarthritis (SpA). In addition, the potential of menopause to modulate/increase CVD risk in women with these diseases will also be explored. It is of major interest to gain more understanding into this topic because it can have meaningful implications for screening and treatment of CVD risk in these women.

RECENT FINDINGS

Literature shows that psoriasis, PsA, SpA and menopause itself cause higher CVD risks and higher CVD prevalence. This is predominantly explained by the increase of chronic systemic inflammation. No existing literature conclusively demonstrates or studies specifically whether the menopause amplifies this effect caused by psoriasis, PsA, or SpA.

CONCLUSION

Differences in pathophysiology of psoriasis, SpA and PsA versus the menopausal transition could suggest that menopause may increase the risk of CVD. However, the hypothesis that menopause represents an additional CV risk factor in women with psoriasis, PsA and SpA still needs to be thoroughly investigated and more clinical studies are required for further understanding and conclusions.

A long-term high-fat diet induces differential gene expression changes in spatially distinct adipose tissue of male mice

The accumulation of visceral adipose tissue (VAT) is strongly associated with cardiovascular disease and diabetes. In contrast, individuals with increased subcutaneous adipose tissue (SAT) without corresponding increases in VAT are associated with a metabolic healthy obese phenotype. These observations implicate dysfunctional VAT as a driver of disease processes, warranting investigation into obesity-induced alterations of distinct adipose depots. To determine the effects of obesity on adipose gene expression, male mice (n = 4) were fed a high-fat diet to induce obesity or a normal laboratory diet (lean controls) for 12-14 mo. Mesenteric VAT and inguinal SAT were isolated for bulk RNA sequencing. AT from lean controls served as a reference to obesity-induced changes. The long-term high-fat diet induced the expression of 169 and 814 unique genes in SAT and VAT, respectively. SAT from obese mice exhibited 308 differentially expressed genes (164 upregulated and 144 downregulated). VAT from obese mice exhibited 690 differentially expressed genes (262 genes upregulated and 428 downregulated). KEGG pathway and GO analyses revealed that metabolic pathways were upregulated in SAT versus downregulated in VAT while inflammatory signaling was upregulated in VAT. We next determined common genes that were differentially regulated between SAT and VAT in response to obesity and identified four genes that exhibited this profile: elovl6 and kcnj15 were upregulated in SAT/downregulated in VAT while trdn and hspb7 were downregulated in SAT/upregulated in VAT. We propose that these genes in particular should be further pursued to determine their roles in SAT versus VAT with respect to obesity.NEW & NOTEWORTHY A long-term high-fat diet induced the expression of more than 980 unique genes across subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). The high-fat diet also induced the differential expression of nearly 1,000 AT genes. We identified four genes that were oppositely expressed in SAT versus VAT in response to the high-fat diet and propose that these genes in particular may serve as promising targets aimed at resolving VAT dysfunction in obesity.

Cerebral vasomotor reactivity to carbon dioxide using the rebreathe technique: assessment of within-day and between-day repeatability

The cerebral vasodilator response to increased arterial carbon dioxide (CO2) concentration, termed cerebral vasomotor reactivity (CVMR), is used to assess cerebral vascular function. We sought to assess the within-day and between-day repeatability of CVMR to rebreathing-induced hypercapnia. Twelve healthy adults performed a within-day short interval protocol (17 ± 2 min between trials), ten performed a within-day long interval protocol (145 ± 16 min between trials), and seventeen performed a between-day protocol (5 ± 2 days between visits). Repeatability of the slope of the percent change in middle cerebral artery mean blood velocity (%MCAvmean) and cerebral vascular conductance index (%CVCi), to the change in partial pressure of end-tidal CO2 ([Formula: see text]) between the two trials/days was assessed. Within-day short interval, %MCAvmean slope demonstrated fair to excellent repeatability (intraclass correlation, ICC = 0.92 [95% confidence interval 0.72-0.98]; P < 0.001) while %CVCi slope showed more variability (ICC = 0.84 [0.47-0.95]; P = 0.002]). Within-day long interval, %MCAvmean (ICC = 0.95 [0.80-0.99]) and %CVCi (ICC = 0.94 [0.71-0.99]) slopes showed good to excellent and fair to excellent repeatability respectively (P < 0.001 for both). For between-day trials, better repeatability was observed for %CVCi (ICC = 0.85 [0.57-0.95]; P < 0.001) compared with %MCAvmean (ICC = 0.76 [0.33-0.91]; P = 0.004) slope. These findings indicate repeatable within- and between-day CVMR responses to rebreathe-induced hypercapnia. However, a longer interval may be better for within-day repeat trials, particularly for CVCi measures.NEW & NOTEWORTHY The cerebral vasodilator response to increases in arterial carbon dioxide concentration, termed cerebral vasomotor reactivity, provides an index of cerebral vascular function/health. Reduced responses are present in populations with elevated cerebral vascular and neurocognitive disease risk/overt disease. Cerebral vasomotor reactivity is often assessed during rebreathing-induced hypercapnia. This study determined that the day-to-day and between-day variability in this response is repeatable, thereby providing important methodological information to the scientific community.

VascuFit: Aerobic exercise improves endothelial function independent of cardiovascular risk: A randomized-controlled trial

BACKGROUND AND AIMS

Endothelial dysfunction predicts elevated cardiovascular (CV) risk in healthy individuals. Aerobic exercise reduces endothelial dysfunction in part by improving CV risk factors. Yet, this explains less than 50 % of the effect and a direct influence of exercise training on the endothelium is discussed as possible contributor. The VascuFit study applied non-linear periodized aerobic exercise (NLPE) training to assess its multilevel effects on endothelial function including potential epigenetic endothelial modifications by circulating micro-ribonucleic acids (endomiRs).

METHODS

Sedentary adults with elevated CV risk between 40 and 60 years were randomized 2:1 and engaged in an eight-week ergometer-based NLPE training (n = 30) or received standard exercise recommendations (n = 14). Macro-, microvascular, cellular and molecular adaptations were assessed via brachial-arterial flow-mediated dilation (baFMD), static retinal vessel analysis (SVA), flow cytometry, and endomiRs regulating key pathways of endothelial function. Statistics included ANCOVA, Principal Component Analysis (PCA), and regression analyses.

RESULTS

baFMD improved by 2.38 % (CI:0.70-4.06, p = 0.007) independent of CV risk, whereas SVA parameters and circulating endothelial (progenitor) cells did not significantly change in the NLPE group. The mean distance between baseline and follow-up PCA loadings of the endomiR dataset explaining 44.2 % of dataset variability was higher in the NLPE-group compared to the control group (2.71 ± 2.02 vs. 1.65 ± 0.93). However, regression analyses showed no evidence of endomiRs explaining the improvement of baFMD.

CONCLUSIONS

The improvement of macrovascular endothelial function by aerobic exercise training was independent from CV risk factors. Increased heterogeneity among endomiRs did not explain this effect, but suggests an adaptive response to the exercise stimulus on the epigenetic level.

Extragonadal function of follicle-stimulating hormone: Evidence for a role in endothelial physiology and dysfunction

AIMS

Follicle-stimulating hormone (FSH) plays a fundamental role in reproduction stimulating ovarian folliculogenesis, Sertoli cells function and spermatogenesis. However, the recent identification of FSH receptor (FSHR) also in extra-gonadal tissues has suggested that FSH activity may not be limited only to fertility regulation, with conflicting results on the possible role of FSH in endothelial cells. The aim of this study was to investigate FSH role on endothelial function in Human Umbilical Vein Endothelial Cells (HUVECs).

RESULTS

Endothelial Nitric oxide synthase (eNOS) expression, eNOS phosphorylation and Nitric Oxide (NO) production resulted increased after the stimulation of HUVEC with recombinant human FSH (rhFSH) at 3.6x103 ng/ml, with increasing Calcium release from intracellular stores. Furthermore, IP3 production increased after rhFSH stimulation despite PTX treatment and NFAT1 was observed prevalently in nucleus. We observed a statistical difference between untreated cells and cells stimulated with 0.36x103 ng/ml and between cells stimulated with 0.36x103 ng/ml and cells stimulated with 1.8x103 ng/ml at 4 and 8 h by Wound healing assay, respectively. Furthermore, a higher cellular permeability was observed in stimulated cells, with atypical VE-cadherin distribution, as well as filamentous actin.

CONCLUSIONS

Our findings suggest that FSH at high concentrations elicits a signalling that could compromise the endothelial membrane. Indeed, VE-cadherin anomalies may severely affect the endothelial barrier, resulting in an increased membrane permeability. Although NO is an important vasodilatation factor, probably an excessive production could impact on endothelial functionality, partially explaining the increased risk of cardiovascular diseases in menopausal women and men with hypogonadism.

Effects of aerobic exercise on beta-amyloid, insulin resistance, and blood markers in obese middle-aged women

PURPOSE

This research focused on examining how an 8-weeks intervention of high-intensity (HIAE) and moderate-intensity aerobic exercise (MIAE) influenced body composition, β-amyloid (Aβ) levels, metabolic markers (glucose, insulin, and HOMA-IR), and blood lipid profiles (total cholesterol [TC], triglycerides [TG], low-density lipoprotein-cholesterol [LDL-C], and high-density lipoprotein-cholesterol [HDL-C]) in obese middle-aged women.

METHODS

Thirty obese middle-aged women (body mass index [BMI] ≥ 25 kg/m2, body fat ≥ 30%) were randomly divided into three groups: HIAE, MIAE, or control groups (n = 10 per group). The exercise groups performed aerobic exercise three times per week for 8 weeks at an intensity of 80-85% (HIAE) and 60-65% (MIAE) of VO2max. Body composition, Aβ levels, metabolic markers, and blood lipid profiles were measured before and after the intervention. A two-way repeated-measures analysis of variance (ANOVA) was applied to analyze the data and determine interaction effects.

RESULTS

Both the HIAE and MIAE groups showed notable reductions in body weight, body fat percentage, BMI, Aβ, glucose, insulin, HOMA-IR, and all blood lipid variables over time compared to the control group (p < 0.001). Significant time-by-group interaction effects were observed for each variable, with HIAE resulting in greater reductions in TC, TG, and LDL-C, and greater increases in HDL-C. Post hoc analyses showed a substantial rise in HDL-C levels for the HIAE group compared to the control group (p = 0.000), with a trend toward greater increases than in MIAE (p = 0.058).

CONCLUSION

HIAE and MIAE interventions effectively improved metabolic and cognitive health markers in middle-aged women with obesity. These findings emphasize the dose-response effects of exercise intensity, with HIAE offering greater benefits for lipid control and Aβ reduction.

Seasonal variation in vascular function: a systematic review and recommendations for future research

Vascular function serves as a prognostic marker for cardiovascular disease and may exhibit seasonal variations due to lifestyle and environmental factors. Our systematic review aimed to determine whether seasonal variations in vascular function are present. We conducted a search of five databases (MEDLINE via PubMed, CINAHL, Web of Science, Cochrane Library, and Biomed Central) to identify evidence of seasonal variations in vascular function. Studies were eligible for inclusion if they assessed vascular function in adult humans during two or more seasons and were published in English. Of the 20,420 studies screened, 12 were eligible and none were excluded due to bias. Nine studies reported significant seasonal variations in vascular function, whereas three studies found no significant seasonal variations. The seasonality of vascular function remains unclear. However, current literature indicates that vascular dysfunction may exhibit a seasonal pattern, with vascular function reduced in the winter. Seasonal variations in endothelial function necessitate further exploration, particularly concerning factors such as exercise, temperature, light exposure, and air pollution. Future research should adopt standardised protocols, involve diverse and larger populations, employ longitudinal designs to minimise confounding factors, systematically measure and adjust for environmental variables, and accurately assess the impact of seasonal variation on vascular function.

"Behavioural and metabolic risk factors of cardiovascular diseases among post-menopausal women: A cross-sectional study in Itahari sub-metropolitan city of Nepal"

BACKGROUND AND OBJECTIVES

Cardiovascular diseases (CVDs) are main cause of mortality and morbidity among women globally. Menopause, aging and different factors in collaboration leads to increased risk for CVDs among postmenopausal women but study on risk factors of CVDs among postmenopausal women is limited in Nepal. Therefore, we aimed to assess prevalence of behavioural and metabolic risk factors of cardiovascular disease among post-menopausal women.

MATERIALS & METHODS

Community based cross-sectional study was carried among 390 post-menopausal women of the Itahari sub-metropolitan city. Multistage simple random sampling technique was used to collect data. Modified semi structured questionnaire STEP I, STEP II and STEP III was used as data collection tool. SPSS version 11.5 used for data analysis. Chi-square test and logistic regressions were performed at 95% confidence interval to find predictors of raised blood pressure and overweight/obesity.

RESULTS

The mean age of respondents was 63.37 years. The prevalence of current smokers, current alcohol use, less than 5 servings of fruits and vegetables per day, low level of physical activity, overweight/obesity and raised blood pressure was 9.2%, 18.2%, 86.4%, 52.3%, 56.2% and 44.4% respectively. On multivariate analysis strong predictors of overweight obesity were age ≤59 years (AOR: 3.21, CI 1.49-6.89), poor economic status (AOR: 1.764, CI: 1.120-2.779) and low physical activity (AOR: 2.132, CI: 1.350-3.370). Predictors of raised blood pressure were age ≥75 years (AOR: 2.04, CI: 1.01-4.11), unmarried and widow (AOR: 1.815, CI: 1.108-2.971), higher economic status (AOR: 1.752, CI: 1.119-2.740) and smoking (AOR: 4.109, CI: 1.737-9.718).

CONCLUSION

Prevalence of behavioural and metabolic risk factors among postmenopausal women in Itahari sub-metropolitan city were alarmingly high. This calls for an early need of intervention and policies at local, provincial and institutional level to address risk factors of CVDs.

Metabolic Responses to Redox Stress in Vascular Cells

Significance: Redox stress underlies numerous vascular disease mechanisms. Metabolic adaptability is essential for vascular cells to preserve energy and redox homeostasis. Recent Advances: Single-cell technologies and multiomic studies demonstrate significant metabolic heterogeneity among vascular cells in health and disease. Increasing evidence shows that reductive or oxidative stress can induce metabolic reprogramming of vascular cells. A recent example is intracellular L-2-hydroxyglutarate accumulation in response to hypoxic reductive stress, which attenuates the glucose flux through glycolysis and mitochondrial respiration in pulmonary vascular cells and provides protection against further reductive stress. Critical Issues: Regulation of cellular redox homeostasis is highly compartmentalized and complex. Vascular cells rely on multiple metabolic pathways, but the precise connectivity among these pathways and their regulatory mechanisms is only partially defined. There is also a critical need to understand better the cross-regulatory mechanisms between the redox system and metabolic pathways as perturbations in either systems or their cross talk can be detrimental. Future Directions: Future studies are needed to define further how multiple metabolic pathways are wired in vascular cells individually and as a network of closely intertwined processes given that a perturbation in one metabolic compartment often affects others. There also needs to be a comprehensive understanding of how different types of redox perturbations are sensed by and regulate different cellular metabolic pathways with specific attention to subcellular compartmentalization. Lastly, integration of dynamic changes occurring in multiple metabolic pathways and their cross talk with the redox system is an important goal in this multiomics era. Antioxid. Redox Signal. 41,793-817.

Can longer lifespan be associated with gut microbiota involvement in lipid metabolism?

Biological aging is linked to altered body composition and reduced neuroactive steroid hormones like dehydroepiandrosterone sulfate (DHEAS), which can stimulate the GABA signaling pathway via gut microbiota. Our study examined the association of gut microbiota with lifespan in mice through comprehensive analysis of its composition and functional involvement in cholesterol sulfate, a precursor of DHEAS, metabolism. We used 16S rRNA and metagenomic sequencing, followed by metabolic pathway prediction and thin layer chromatography and MALDI-TOF cholesterol sulfate identification. Significant increases in bacteria such as Bacteroides, typical for long-lived and Odoribacter and Colidextribacter, specific for short-lived mice were detected. Furthermore, for males (Rikenella and Alloprevotella) and females (Lactobacillus and Bacteroides), specific bacterial groups emerged as predictors (AUC = 1), highlighting sex-specific patterns. Long-lived mice showed a strong correlation of Bacteroides (0.918) with lipid and steroid hormone metabolism, while a negative correlation of GABAergic synapse with body weight (-0.589). We found that several Bacteroides species harboring the sulfotransferase gene and gene cluster for sulfonate donor synthesis are involved in converting cholesterol to cholesterol sulfate, significantly higher in the feces of long-lived individuals. Overall, we suggest that increased involvement of gut bacteria, mainly Bacteroides spp., in cholesterol sulfate synthesis could ameliorate aging through lipid metabolism.

Functional bias of contractile control in mouse resistance arteries

Constrictor agonists set arterial tone through two coupling processes, one tied to (electromechanical), the other independent (pharmacomechanical) of, membrane potential (VM). This dual arrangement raises an intriguing question: is the contribution of each mechanism (1) fixed and proportionate, or (2) variable and functionally biased. Examination began in mouse mesenteric arteries with a vasomotor assessment to a classic Gq/11 (phenylephrine) or Gq/11/G12/13 (U46619) agonist, in the absence and presence of nifedipine, to separate among the two coupling mechanisms. Each constrictor elicited a concentration response curve that was attenuated and rightward shifted by nifedipine, findings consistent with functional bias. Electromechanical coupling preceded pharmacomechanical, the latter's importance rising with agonist concentration. In this regard, ensuing contractile and phosphorylation (CPI-17 & MYPT1 (T-855 & T-697)) measures revealed phenylephrine-induced pharmacomechanical coupling was tied to protein kinase C (PKC) activity, while that enabled by U46619 to PKC and Rho-kinase. A complete switch to pharmacomechanical coupling arose when agonist superfusion was replaced by pipet application to a small portion of artery. This switch was predicted, a priori, by a computer model of electromechanical control and supported by additional measures of VM and cytosolic Ca2+. We conclude that the coupling mechanisms driving agonist-induced constriction are variable and functionally biased, their relative importance set in accordance with agonist concentration and manner of application. These findings have important implications to hemodynamic control in health and disease, including hypertension and arterial vasospasm.

Higher Adherence to the Mediterranean Diet Is Associated with a Lower Risk of Steatotic, Alcohol-Related, and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Retrospective Analysis

BACKGROUND AND AIMS

Metabolic liver disease is associated with obesity, insulin resistance, cardiovascular disease, and metabolic disorders. A Mediterranean diet (MD), known for its anti-inflammatory and antioxidant properties, is effective in managing various chronic diseases, including liver diseases. This study aimed to explore the influence of adherence to the MD on the risk of chronic metabolic diseases, including steatotic liver disease (SLD), metabolic dysfunction-associated steatotic liver disease (MASLD), and alcohol-related liver diseases (ALDs).

METHODS

This retrospective cohort study analyzed 5395 individuals from a single center between 2020 and 2022, grouped by adherence to the MD using the Korean Mediterranean Diet Adherence Score (K-MEDAS). MASLD score, ALD, and cardiovascular risk factors were also assessed. Statistical analyses were performed using 1:1 exact matching and multiple regression to compare the less adherent (K-MEDAS 0-7) and highly adherent (K-MEDAS 8-13) groups.

RESULTS

Adjusting for confounding variables, high adherence to the MD was significantly associated with lower rates of SLD (odds ratio [OR] 0.818, 95% confidence interval [CI] 0.700-0.957, p = 0.012), MASLD (OR 0.839, 95% CI 0.714-0.986, p = 0.033), and ALD (OR 0.677, 95% CI 0.671-0.683, p < 0.001). Post-propensity score matching analysis revealed that the highly adherent group exhibited significantly lower triglyceride levels, triglyceride and glucose index, atherogenic Index of Plasma, and Framingham risk scores than the less adherent group.

CONCLUSIONS

Good adherence to the MD considerably reduces the risk of SLD, MASLD, and ALD, underscoring its protective effects and potential to prevent metabolic liver diseases and their complications.

Sex Differences in Kidney Health and Disease

BACKGROUND

Sex differences exist in kidney physiology and disease which are underpinned by the biological actions of the sex hormones estrogen, progesterone and testosterone. In this review, we present an up-to-date discussion of the hormonal and molecular signalling pathways implicated in sex differences in kidney health and disease.

SUMMARY

Estrogen and progesterone have protective effects on renal blood flow, glomerular filtration rate and nephron ion and water reabsorptive processes, whereas testosterone tends to compromise these functions. The biological effects of estrogen appear to be the most important in reinforcing kidney function and protecting against kidney diseases in females. The actions of estrogen are myriad but all tend to bolster kidney physiology to maintain a steady-state and adaptable extracellular fluid volume (ECFV) and blood pressure. Estrogen safeguards ECFV homeostasis by stimulating renal epithelial sodium channel (ENaC) and water channel (AQP2) expression and transport function. Renal maintenance of ECFV within narrow physiological limits is a first-line of defense against hypertension and lowers the risk of cardiovascular disease in women. The estrogenic and XX chromosome basis for a female advantage are evident in a wide range of kidney diseases including acute kidney injury, chronic kidney disease, end-stage kidney disease, diabetic kidney disease, and polycystic kidney disease. The molecular mechanisms involve estrogen regulation of nephron ion and water transport, genetic immunogenic responses, activation of the protective arm of the renin angiotensin-aldosterone system and XX chromosome reinforcement of immune responses. Kidney disease can also predispose patients to cancer and women are protected in renal cancer with lower incidence, morbidity, and mortality than age-matched men with the disease.

KEY MESSAGES

This review underscores the importance of incorporating sex-specific considerations into clinical practice and basic research to bridge the gap in understanding and addressing biological sex disparities in kidney disease and renal cancer.

Aortic stiffness: an age-related prognostic marker?

Aortic stiffness, a consequence of vascular aging, is an independent predictor of cardiovascular morbidity and mortality. However, the impact of age and sex on its predictive performance remains unclear. We have included 6046 individuals from the population-based Rotterdam study. Survival analyses were performed to investigate the impact of age and sex on the link between aortic stiffness and outcomes, including coronary heart disease (CHD), stroke, cardiovascular disease (CVD), cardiovascular and all-cause mortality. The added predictive value of aortic stiffness across age categories and by sex was assessed by using explained variation, Harrell's C index and Integrated Discrimination Improvement (IDI). Aortic stiffness was independently associated with all outcomes [hazard ratio (95% confidence interval; CI): 1.16 (1.04-1.22) for CHD, 1.09 (1.00-1.19) for stroke, 1.11 (1.05-1.18) for CVD, 1.14 (1.05-1.23) for cardiovascular mortality, 1.08 (1.03-1.13) for all-cause mortality]. The strength of the association between aortic stiffness and stroke, cardiovascular and all-cause mortality decreased significantly by advancing age. The variance of the outcome (R2) explained by aortic stiffness alone was noticeable in individuals younger than 60 years and negligible in the other age categories. The association of aortic stiffness and CHD was stronger in women than in men. Similarly, the difference in R2 between women and men was greater for CHD than for the other considered outcomes. Our findings suggest that the gain in explained variation caused by aortic stiffness for CVD and mortality might be limited to individuals younger than 60 years.

Association of hyperandrogenaemia with hypertension and cardiovascular events in pre-menopausal women: a prospective population-based cohort study

OBJECTIVE

The present study aimed to clarify the conflicting association of premenopausal hyperandrogenaemia (HA) with the development of hypertension and cardiovascular disease (CVDs) in women.

DESIGN

A population-based cohort study including 5889 women.

METHODS

The association of serum testosterone (T), sex hormone-binding globulin (SHBG), and free androgen index (FAI) at age 31 with blood pressure (BP) and hypertension (BP ≥ 140/90 mmHg and/or use of antihypertensive medication) at ages 31 and 46 and with CVDs (angina pectoris [AP] and/or acute myocardial infarction [AMI] n = 74, transitory cerebral ischaemia and/or stroke n = 150) and combined CVD events (AP, AMI, stroke, heart failure, or CVD mortality n = 160) by age 53 was investigated.

RESULTS

T and FAI were positively associated with systolic and diastolic BP at ages 31 and 46 in the multivariable model. Compared to their lowest quartile, the highest quartiles of T and FAI were positively associated with hypertension at age 31 in the multivariable model. During the 22-year follow-up, FAI was positively associated with increased risk of AP/AMI (hazard ratio [HR]: 2.02, 95% CI: 1.06-3.85) and overall CVD events or mortality (HR: 1.54, 95% CI: 1.02-2.33) in the unadjusted models. However, the significance disappeared after adjusting for body mass index (BMI).

CONCLUSIONS

Women with HA at premenopausal age had an elevated risk of hypertension, and together with BMI, increased risk of CVD events and CVD mortality during the 22-year follow-up. However, because of several study limitations regarding ethnicity and BMI characteristics, a longer follow-up of this cohort and future studies in ethnically diverse populations are needed to verify the results.

Novel diagnostic approaches and management of coronary microvascular dysfunction

The mechanism underlying ischaemic heart disease (IHD) has been primarily attributed to obstructive coronary artery disease (CAD). However, non-obstructive coronary arteries are identified in >50% of patients undergoing elective coronary angiography, recently leading to growing interest in the investigation and management of angina/ischaemia with non-obstructive coronary arteries (ANOCA/INOCA). INOCA is an umbrella term encompassing a multiple spectrum of possible pathogenetic entities, including coronary vasomotor disorders which consist of two major endotypes: coronary microvascular dysfunction (CMD) and vasospastic angina. Both conditions can coexist and be associated with concomitant obstructive CAD. Particularly, CMD refers to myocardial ischaemia due to reduced vasodilatory capacity of coronary microcirculation secondary to structural remodelling or impaired resting microvascular tone (functional) or a combination of both. CMD is not a benign condition and is more prevalent in women presenting with chronic coronary syndrome compared to men. In this setting, an impaired coronary flow reserve has been associated with increased risk of major adverse cardiovascular events. ANOCA/INOCA patients also experience impaired quality of life and associated increased healthcare costs. Therefore, research in this scenario has led to better definition, classification, and prognostic stratification based on the underlying pathophysiological mechanisms. The development and validation of non-invasive imaging modalities, invasive coronary vasomotor function testing and angiography-derived indices provide a comprehensive characterisation of CMD. The present narrative review aims to summarise current data relating to the diagnostic approach to CMD and provides details on the sequence that therapeutic management should follow.

Flow-mediated dilation is modified by exercise training status during childhood and adolescence: preliminary evidence of the youth athlete's artery

Chronic exercise training is associated with an "athlete's artery" phenotype in young adults and an attenuated age-related decline in endothelium-dependent arterial function. Adolescence is associated with an influx of sex-specific hormones that may exert divergent effects on endothelial function, but whether training adaptations interact with biological maturation to produce a "youth athlete's artery" has not been explored. We investigated the influence of exercise-training status on endothelium-dependent arterial function during childhood and adolescence. Brachial artery flow-mediated dilation (FMD) was assessed in n = 102 exercise-trained (males, n = 25; females, n = 29) and untrained (males, n = 23; females, n = 25) youths, characterized as pre (males, n = 25; females, n = 26)- or post (males, n = 23; females, n = 28)-predicted age at peak height velocity (PHV). Baseline brachial artery diameter was larger in post- compared with pre-PHV youths (P ≤ 0.001), males compared with females (P ≤ 0.001), and trained compared with untrained youths (3.26 ± 0.51 vs. 3.11 ± 0.42 mm; P = 0.041). Brachial FMD was similar in pre- and post-PHV youths (P = 0.298), and males and females (P = 0.946). However, exercise-trained youths demonstrated higher FMD when compared with untrained counterparts (5.3 ± 3.3 vs. 3.0 ± 2.6%; P ≤ 0.001). Furthermore, brachial artery diameter (r2 = 0.142; P = 0.007 vs. r2 = 0.004; P = 0.652) and FMD (r2 = 0.138; P = 0.008 vs. r2 = 0.003; P = 0.706) were positively associated with cardiorespiratory fitness in post-, but not pre-PHV youths, respectively. Collectively, our data indicate that exercise training is associated with brachial artery remodeling and enhanced endothelial function during youth. However, arterial remodeling and endothelium-dependent function are only associated with elevated cardiorespiratory fitness during later stages of adolescence.NEW & NOTEWORTHY We report preliminary evidence of the "youth athlete's artery," characterized by training-related arterial remodeling and elevated endothelium-dependent arterial function in children and adolescents. However, training-related adaptations in brachial artery diameter and flow-mediated dilation (FMD) were associated with cardiorespiratory fitness in adolescents, but not in children. Our findings indicate that endothelium-dependent arterial function is modifiable with chronic exercise training during childhood, but the association between FMD and elevated cardiorespiratory fitness is only apparent during later stages of adolescence.

Effect of menopausal hormonal therapy on cardiovascular risks in Korean postmenopausal women: A nationwide cohort study

OBJECTIVE

To evaluate the association between menopausal hormonal therapy (MHT) and the risk of cardiovascular disease (CVD), according to various regimens, dosages, routes of administration and starting ages of MHT.

DESIGN

A population-based cohort study using the Korean National Health Insurance Services database.

SETTING

Nationwide health insurance database.

POPULATION

Women who reported entering menopause at an age of ≥40 years with no history of CVD in the national health examination.

METHODS

The study population comprised 1 120 705 subjects enrolled between 2002 and 2019, categorised according to MHT status (MHT group, n = 319 007; non-MHT group, n = 801 698).

MAIN OUTCOME MEASURES

Incidence of CVD (a composite of myocardial infarction and stroke).

RESULTS

The incidence of CVD was 59 266 (7.4%) in the non-MHT group and 17 674 (5.5%) in the MHT group. After adjusting for confounding factors, an increased risk of CVD was observed with the administration of tibolone (hazard ratio, HR 1.143, 95% CI 1.117-1.170), oral estrogen (HR 1.246, 95% CI 1.198-1.295) or transdermal estrogen (HR 1.289, 95% CI 1.066-1.558), compared with the non-MHT group; the risk was based on an increased risk of stroke. The risk trends were consistent regardless of the age of starting MHT or the physicians' specialty. Among tibolone users, a longer period from entering menopause to taking tibolone and the use of any dosage (1.25 or 2.5 mg) were linked with a higher risk of CVD, compared with non-MHT users.

CONCLUSIONS

This nationwide cohort study demonstrated an increased risk of CVD, driven mainly by an increased risk of stroke, among tibolone and oral or transdermal estrogen users, compared with that of non-MHT users.

Endothelial cell dysfunction and targeted therapeutic drugs in sepsis

Sepsis is a life-threatening organ dysfunction caused by an abnormal host response to microbial infections. During its pathogenesis, vascular endothelial cells (ECs) play a pivotal role as essential components in maintaining microcirculatory homeostasis. This article aims to comprehensively review the multifaceted physiological functions of vascular ECs, elucidate the alterations in their functionality throughout the course of sepsis, and explore recent advancements in research concerning sepsis-related therapeutic drugs targeting ECs.

Age and sex differences in the effects of short- and long-term exposure to air pollution on endothelial dysfunction

BACKGROUND

The effects of air pollution on endothelial function remain unclear across populations. We aimed to use brachial artery flow-mediated dilatation (FMD) to identify demographic differences in the effects of air pollution exposure on endothelial dysfunction.

METHODS

We measured FMD in 850 participants from October 2016 to January 2020. Location-specific concentrations of fine particulate matter < 2.5 μm aerodynamic diameter (PM2.5), inhalable particulate matter < 10 μm aerodynamic diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) measured by fixed ambient air monitoring stations were collected for short- and long-term exposure assessment. Multiple linear regression models and restricted cubic splines were used to assess the associations before and after stratification by age and sex.

RESULTS

This study eventually included 828 participants [551 (66.5%) younger than 65 years and 553 (66.8%) men]. Each 10 µg/m3 increase in 7-day exposure to PM2.5 and PM10 was significantly linearly associated with a 0.07% (β = -0.07, 95% CI: -0.13 to -0.004) and 0.05% (β = -0.05, 95% CI: -0.10 to -0.004) decrease in FMD in the fully adjusted model. After full adjustment, long-term exposure to all air pollutants was significantly associated with impaired FMD. Each 10 µg/m3 increase in long-term exposure to PM2.5 and PM10 was significantly associated with a -0.18% (95% CI: -0.34 to -0.03) and - 0.23% (95% CI: -0.40 to -0.06) change in FMD, respectively. After stratification, the associations of lower FMD with long-term exposure to PM2.5, PM10, SO2, NO2, and CO significantly persisted in men and participants younger than 65 years instead of women or older participants. For short-term exposure, we observed differences consistent with long-term exposure and a stronger effect of 7-day exposure to SO2 in men due to a significant interaction effect.

CONCLUSION

Short- and long-term exposure to different air pollutants are strongly associated with decreased endothelial function, and susceptibility to air pollution varies significantly with age and sex.

The effects of citrus flavonoids supplementation on endothelial function: A systematic review and dose-response meta-analysis of randomized clinical trials

The present systematic review and dose-response meta-analysis was conducted to synthesize existing data from randomized clinical trials (RCTs) concerning the impact of citrus flavonoids supplementation (CFS) on endothelial function. Relevant RCTs were identified through comprehensive searches of the PubMed, ISI Web of Science, and Scopus databases up to May 30, 2023. Weighted mean differences and their corresponding 95% confidence intervals (CI) were pooled utilizing a random-effects model. A total of eight eligible RCTs, comprising 596 participants, were included in the analysis. The pooled data demonstrated a statistically significant augmentation in flow-mediated vasodilation (FMD) (2.75%; 95% CI: 1.29, 4.20; I2 = 87.3%; p < 0.001) associated with CFS compared to the placebo group. Furthermore, the linear dose-response analysis indicated that each increment of 200 mg/d in CFS led to an increase of 1.09% in FMD (95% CI: 0.70, 1.48; I2 = 94.5%; p < 0.001). The findings from the nonlinear dose-response analysis also revealed a linear relationship between CFS and FMD (Pnon-linearity = 0.903, Pdose-response <0.001). Our findings suggest that CFS enhances endothelial function. However, more extensive RTCs encompassing longer intervention durations and different populations are warranted to establish more precise conclusions.

Ultrasound and neuroinflammation: immune modulation via the heat shock response

Current pharmacological therapeutic approaches targeting chronic inflammation exhibit transient efficacy, often with adverse effects, limiting their widespread use - especially in the context of neuroinflammation. Effective interventions require the consideration of homeostatic function, pathway dysregulation, and pleiotropic effects when evaluating therapeutic targets. Signalling molecules have multiple functions dependent on the immune context, and this complexity results in therapeutics targeting a single signalling molecule often failing in clinical translation. Additionally, the administration of non-physiologic levels of neurotrophic or anti-inflammatory factors can alter endogenous signalling, resulting in unanticipated effects. Exacerbating these challenges, the central nervous system (CNS) is isolated by the blood brain barrier (BBB), restricting the infiltration of many pharmaceutical compounds into the brain tissue. Consequently, there has been marked interest in therapeutic techniques capable of modulating the immune response in a pleiotropic manner; ultrasound remains on this frontier. While ultrasound has been used therapeutically in peripheral tissues - accelerating healing in wounds, bone fractures, and reducing inflammation - it is only recently that it has been applied to the CNS. The transcranial application of low intensity pulsed ultrasound (LIPUS) has successfully mitigated neuroinflammation in vivo, in models of neurodegenerative disease across a broad spectrum of ultrasound parameters. To date, the underlying biological effects and signalling pathways modulated by ultrasound are poorly understood, with a diverse array of reported molecules implicated. The distributed nature of the beneficial response to LIPUS implies the involvement of an, as yet, undetermined upstream signalling pathway, homologous to the protective effect of febrile range hyperthermia in chronic inflammation. As such, we review the heat shock response (HSR), a protective signalling pathway activated by thermal and mechanical stress, as the possible upstream regulator of the anti-inflammatory effects of ultrasound.

Perivascular adipose tissue remodeling impairs vasoreactivity in thermoneutral-housed rats

Objective

Vascular pathology, characterized by impaired vasoreactivity and mitochondrial respiration, differs between the sexes. Housing rats under thermoneutral (TN) conditions causes vascular dysfunction and perturbed metabolism. We hypothesized that perivascular adipose tissue (PVAT), a vasoregulatory adipose depot with brown adipose tissue (BAT) phenotype, remodels to a white adipose (WAT) phenotype in rats housed at TN, driving diminished vasoreactivity in a sex-dependent manner.

Methods

Male and female Wistar rats were housed at either room temperature (RT) or TN. Endpoints included changes in PVAT morphology, vasoreactivity in vessels with intact PVAT or transferred to PVAT of the oppositely-housed animal, vessel stiffness, vessel mitochondrial respiration and cellular signaling.

Results

Remodeling of PVAT was observed in rats housed at TN; animals in this environment showed PVAT whitening and displayed diminished aortae vasodilation (p<0.05), different between the sexes. Juxtaposing PVAT from RT rats onto aortae from TN rats in females corrected vasodilation (p<0.05); this did not occur in males. In aortae of all animals housed at TN, mitochondrial respiration was significantly diminished in lipid substrate experiments (p<0.05), and there was significantly less expression of peNOS (p<0.001).

Conclusions

These data are consistent with TN-induced remodeling of PVAT, notably associated with sex-specific blunting of vasoreactivity, diminished mitochondrial respiration, and altered cellular signaling.

Correlation Between Blood Cadmium Levels and Platelet Characteristics, As Well As Their Impact on Susceptibility to Coronary Heart Disease: Findings from NHANES 2005-2018 Data

Investigating the correlation between blood cadmium levels, platelet characteristics, and susceptibility to coronary heart disease (CHD). Utilized NHANES 2005-2018 data with covariates such as age, sex, race, marital status, and socio-economic status. Blood cadmium served as the independent variable, while platelet count (PC) and mean platelet volume (MPV) were dependent variables. The average age of the participants was 68.77 ± 11.03 years, and 67.4% of them were male. The mean values for WBC, MPV, PC, and blood cadmium were 7.53 ± 3.36 × 103 cells/µL, 11.33 ± 0.27fL, 57.61 ± 5.34 × 103 cells/µL, and 2.58 ± 0.61 µg/L, respectively. Adjusting for other variables revealed increased MPV and PC with rising blood cadmium levels in cardiac patients, indicating a higher risk of CHD in those with elevated blood cadmium. The average age of the participants was 68.77 ± 11.03 years, and 67.4% of them were male. The mean values for WBC, MPV, PC, and blood cadmium were 7.53 ± 3.36 × 103 cells/µL, 11.33 ± 0.27fL, 57.61 ± 5.34 × 103 cells/µL, and 2.58 ± 0.61 µg/L, respectively. Adjusting for other variables revealed increased MPV and PC with rising blood cadmium levels in cardiac patients, indicating a higher risk of CHD in those with elevated blood cadmium. This study enhances understanding of how cadmium impacts platelet characteristics, contributing to increased CHD risk, providing insights for primary prevention strategies.