Assessment of Subclinical Atherosclerosis in Asymptomatic People In Vivo: Measurements Suitable for Biomarker and Mendelian Randomization Studies

Subclinical atherosclerosis is associated with future cardiovascular events in lupus patients at apparent low cardiovascular risk

ObjectivesPrediction models based on traditional risk factors underestimate the risk for cardiovascular events (CVE) in SLE. We aimed to assess the occurrence of CVE in SLE patients according to their baseline subclinical atherosclerosis status.MethodsCarotid intima-media thickness at the carotid bulb level (CIMT) was prospectively assessed in consecutive SLE patients followed in our national reference center for rare diseases by a single evaluator, between February 2012 and February 2013. SLE patients with known CVE were excluded. CIMT >1.5 mm defined carotid plaque as a measure of subclinical atherosclerosis. The main outcome was a CVE defined as the occurrence during follow-up of myocardial infarction, ischemic stroke or symptomatic peripheral arterial disease.Results63 SLE patients (82.5% female, median age 39 [32-44.5]) were included. Among them, 24 (38.1%) had a carotid plaque >1.5 mm at baseline and 7 (11.1%) experienced a cardiovascular event during a median follow-up of 10.7 [8.2-11.0] years. All CVE occurred in the group of patients who had a carotid plaque at baseline. In the multivariable analysis, we observed that, after adjusting for the Framingham score and the body mass index, the presence of a carotid plaque was significantly associated with the occurrence of a cardiovascular event: odds ratio [95% confidence interval] = 17.2 ; 95 CI: [1.15-2499]; p = 0.039).ConclusionSubclinical atherosclerosis defined as a carotid plaque >1.5 mm is significantly associated with the clinical cardiovascular risk in SLE. Subclinical atherosclerosis should be regularly assessed in this population as part of the global cardiovascular risk evaluation.

First presentation of atherosclerotic cardiovascular disease in previously healthy individuals: The multi-ethnic study of atherosclerosis

AIM

To evaluate the first presentation of atherosclerotic cardiovascular disease (ASCVD) in individuals without known ASCVD.

METHODS

Distribution of first ASCVD events (angina, stroke, myocardial infarction [MI], or death/resuscitated cardiac arrest [RCA]), and the association between traditional risk factors, coronary artery calcium (CAC) and lipoprotein(a) [Lp(a)] with these events in Cox proportional hazards models were evaluated in 6779 participants in the Multi-Ethnic Study of Atherosclerosis. Risk prediction improvement with addition of CAC to the pooled cohort equations (PCE) was evaluated using net reclassification improvement (NRI).

RESULTS

The mean age was 62.1 ± 10.2 years and 1037 participants (15.3 %) experienced an ASCVD event over a median of 15.8 years. The most common first presentation was cardiovascular death/RCA (n = 287;27.7 %). Among those with events, Black (35.6 %, p = 0.001)) individuals more often presented with death/RCA, Hispanic (29.3 %, p = 0.037) individuals more often presented with stroke compared to White individuals (24.8 % and 21.7 %, respectively). Compared to men, women more frequently presented with stroke (29.5 vs. 20.7 %, p = 0.002) and death/RCA (29.8 vs 26.3 %, p = 0.243) though this did not meet statistical significance. CAC score was significantly associated with first presentation of all events, including death/RCA (HR 1.13, 95 % CI 1.07-1.19) and improved risk prediction when added to the PCE (continuous NRI 0.6081, 95 % CI 0.4971-0.7141). Lp(a) was significantly associated with MI only (HR 1.15 per SD, 95 % CI 1.02-1.29).

CONCLUSIONS

In previously asymptomatic individuals, the most common initial presentation of ASCVD was death/resuscitated cardiac arrest, particularly among women, minority groups, and those with CAC. CAC scoring may identify individuals at risk for death/resuscitated cardiac arrest as a first presentation of ASCVD.

Serum midkine level and its association with subclinical coronary artery calcification and carotid atherosclerosis in chronic kidney disease

BACKGROUND

There are no studies investigating the role of midkine (MK) in vascular calcification (VC) or vascular disease associated with chronic kidney disease (CKD). This study assessed serum MK level and investigated its relationship with carotid atherosclerosis and coronary artery calcification (CAC) in non-dialysis CKD.

METHODS

The study comprised 80 controls and 185 adult patients with CKD at stages 3-5 who were free of cardiovascular diseases. Acute renal failure, chronic hemodialysis, severe liver disease, inflammatory states, anticoagulation therapy and cancer were excluded. The patients were classified based on presence of CAC score into severe and mild to moderate CAC groups. They were also divided into atherosclerotic and non-atherosclerotic groups based on carotid atherosclerosis. CBC, kidney function tests, lipid profile, intact parathyroid hormone (iPTH), and phosphorus were assessed. Serum levels of MK, tumor necrosis factor- α (TNF- α), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) were quantitatively tested using ELISA. Cardiac CT scan was done to calculate CAC score. Carotid ultrasonography was used to evaluate carotid intima media thickness (CIMT) and identify plaques.

RESULTS

All CKD categories, including CKD-3, CKD-4, and CKD-5, showed higher rates of carotid plaques (p = 0.007, p < 0.001, and p < 0.001, respectively), higher levels of MK (p < 0.001 for each), and higher CAC scores (p < 0.001 for each) as CKD worsened. Compared to mild to moderate CAC patients, severe CAC patients showed increased CIMT (p < 0.001) and raised serum levels of MK (p < 0.001), TNF-α (p = 0.001), IL-6 (p = 0.002), hs-CRP (p = 0.003), iPTH (p = 0.02), phosphorus (p < 0.001), total cholesterol (TC), and low density lipoprotein-cholesterol (LDL-C). Multivariate linear regression revealed that CAC was reliably predicted by MK (p = 0.008) and serum creatinine (p = 0.001). Carotid atherosclerotic patients had higher serum levels of MK, TNF-α, IL-6, hs-CRP, iPTH, phosphorus, TC, total triglycerides and LDL-C (p < 0.001 for each). Multivariate logistic regression showed that serum MK (p = 0.001), serum creatinine (p = 0.005), age (p < 0.001), iPTH (p = 0.007), and IL-6 (p = 0.024) were significant predictors of carotid atherosclerosis.

CONCLUSIONS

As CKD worsened, MK levels, carotid atherosclerosis and CAC increased. Serum MK was a reliable biomarker for asymptomatic carotid atherosclerosis and CAC in non-dialysis CKD, allowing prompt early diagnosis to avert cardiovascular morbidity and death in the future.

TRIAL REGISTRATION

The trial number was 1138 and its registration was approved by the hospital's Research Ethics Committee in 4/2024.

Regional heterogeneity in vascular contractile dysfunction in diabetic mice

Oxidative stress underlies many diabetic complications, including diabetic vasculopathy. It is unclear if oxidative stress has different effects in regionally distant arteries. We compared the contractile function of three arteries from diabetic mice and elucidated the mechanisms underlying their differential adaptation. We examined responses of the aorta, carotid and femoral arteries, isolated from the same diabetic (db/db) or normoglycemic control mice, to different vasoconstrictors in the presence and absence of indomethacin, apocynin, sulfaphenazole, L-NAME or a reactive oxygen species generating system to identify the enzyme(s) contributing to vascular dysfunction. Expression of superoxide dismutase (SOD) isoforms was measured. db/db aortae showed augmented contractile responses to KCl, phenylephrine, A23197 and U-46619 likely due to activated cyclooxygenases and hypersensitivity to thromboxane A2. Contractile responses of db/db carotid arteries were unaltered, likely due to higher SOD3 and SOD1 levels compared to the aortae. Femoral arteries were more vulnerable to oxidative stress, lacked SOD3 expression, and showed higher basal potassium channels activity. Phenylephrine contractions in femoral arteries were dependent on extracellular calcium entry; while contractions in aortae were dependent on extracellular calcium entry and intracellular calcium release. Femoral arteries from db/db mice exhibited higher basal potassium channels activity and attenuated contractility compared to control mice likely due to lower SOD levels. Heterogeneity exists between the three arteries at functional and molecular levels due to different signalling pathways and antioxidant defense mechanisms. Understanding regional differences in vasomotor control coupled with advanced delivery systems can help in developing therapies targeting specific vascular beds.

Genetic association of circulating lipids and lipid-lowering drug targets with vascular calcification

BACKGROUND AND AIMS

Vascular calcification (VC) significantly increases the incidence and mortality of many diseases. The causal relationships of dyslipidaemia and lipid-lowering drug use with VC severity remain unclear. This study explores the genetic causal associations of different circulating lipids and lipid-lowering drug targets with coronary artery calcification (CAC) and abdominal aortic artery calcification (AAC).

METHODS

We obtained single-nucleotide polymorphisms (SNPs) and expression quantitative trait loci (eQTLs) associated with seven circulating lipids and 13 lipid-lowering drug targets from publicly available genome-wide association studies and eQTL databases. Causal associations were investigated by univariable, multivariable, drug-target, and summary data-based Mendelian randomization (MR) analyses. Potential mediation effects of metabolic risk factors were evaluated.

RESULTS

MR analysis revealed that genetic proxies for low-density lipoprotein cholesterol (LDL-C), triglycerides (TC) and Lipoprotein (a) (Lp(a)) were causally associated with CAC severity, and apolipoprotein B (apoB) level was causally associated with AAC severity. A significant association was detected between hepatic Lipoprotein(A) (LPA) gene expression and CAC severity. Colocalisation analysis supported the hypothesis that the association between LPA expression and CAC quantity is driven by different causal variant sites within the ±1 Mb flanking region of LPA. Serum calcium and phosphorus had causal associations with CAC severity.

CONCLUSIONS

Inhibitors targeting LPA might represent CAC drug candidates. Moreover, T2DM, hypercalcemia, and hyperphosphatemia are positively causally associated with CAC severity, while chronic kidney disease and estimated glomerular filtration rate are not.

Trans 10, cis 12-conjugated linoleic acid alleviates vascular fibrosis in obese mice

Controlling food intake and improving fat distribution are crucial for preventing and treating cardiovascular disease. Trans-10, cis-12 conjugated linoleic acid (t10c12-CLA) can inhibit fat deposition and facilitate bodyweight reduction, suggesting its potential to safeguard against cardiovascular disease. The transgenic (tg) mice, which inserted Pai expression cassette into the Rosa26 locus, can produce endogenous t10c12-CLA. In the present study, we used tg mice to evaluate whether the long-term existence of t10c12-CLA has a protective effect on the vascular fibrosis phenotype. The male wild-type (wt) and tg mice were marked as wt+chow, tg+chow, wt+HFD and tg+HFD groups with 24 weeks feeding the chow diet or high-fat diet (HFD). Compared with wt+chow and tg+chow mice, wt+HFD mice showed a significant (P < 0.05) increase in bodyweight and circulating lipid levels. The arterial blood vessels of wt+HFD mice displayed obvious lipid streaks and disorganization of collagen fibers. While compared with wt+HFD mice, tg+HFD mice showed a significant (P < 0.05) decrease in body weight and circulating lipid levels. The arterial blood vessels of tg+HFD mice displayed slight foam cells, predicting that t10c12-CLA can alleviates vascular fibrosis degree caused by HFD. The RNA and protein expression of proinflammatory factors in arterial blood vessels of tg+HFD mice were significantly (P < 0.05) decreased than those of wt+HFD mice. In conclusion, long-term existence of t10c12-CLA can improve lipid metabolism and circulating lipid levels and inhibit vascular inflammation and vascular fibrosis degree in obese mice, thereby preventing the further development of cardiovascular disease.

Association Between Triglyceride Glucose Index and Risk of Carotid Plaques in Asia: A Systematic Review and Meta-Analysis

The triglyceride glucose (TyG) index is used to assess insulin resistance, which is associated with the occurrence and development of cardiovascular diseases, but the risk of carotid plaques is controversial in Asia. We searched PubMed, Embase, Scopus, and Cochrane Library for articles published up to October 15, 2023, to assess the association and dose-response association of the TyG index with the risk of carotid plaques in Asia. The random effects model was used to calculate the effect estimates and 95% confidence intervals (CIs). A total of 534 articles were retrieved, and eleven studies were selected, involving 145 218 Asian participants. When the TyG index was analyzed as a categorical variable, compared with the low TyG index, the high TyG index increased the risk of carotid plaques (OR=1.38, 95% CI: 1.20, 1.60, p<0.001). As continuous variables were analyzed, similar results were observed (OR=1.33, 95% CI: 1.22, 1.45, p<0.001). Meanwhile, dose-response analysis showed that the risk of carotid plaque increased by 1.03 times for every unit increase in the TyG index (RR=1.03, 95% CI: 1.02, 1.03, p<0.001). Our meta-analysis indicates an association between the TyG index and the risk of carotid plaques in Asia. Further studies are required to substantiate these findings.

Frontiers in subclinical atherosclerosis and the latest in early life preventive cardiology

ABSTRACT

Subclinical atherosclerosis underlies most cardiovascular diseases, manifesting before clinical symptoms and representing a key focus for early prevention strategies. Recent advancements highlight the importance of early detection and management of subclinical atherosclerosis. This review underscores that traditional risk factor levels considered safe, such as low-density lipoprotein cholesterol (LDL-C) and glycated haemoglobin (HbA1c), may still permit the development of atherosclerosis, suggesting a need for stricter thresholds. Early-life interventions are crucial, leveraging the brain's neuroplasticity to establish lifelong healthy habits. Preventive strategies should include more aggressive management of LDL-C and HbA1c from youth and persist into old age, supported by public health policies that promote healthy environments. Emphasising early education on cardiovascular health can fundamentally shift the trajectory of cardiovascular disease prevention and optimise long-term health outcomes.

Lower Sphingomyelin SM 42:1 Plasma Level in Coronary Artery Disease-Preliminary Study

Coronary artery atherosclerosis is a common condition characterized by different symptomatology and incidences of risk factors. The disease manifestation may differ; therefore, proper diagnosis is essential. The preventive, diagnostic, and therapeutic arms are still developing to improve patient outcomes. Among diagnostic steps, the non-invasive tools for evaluating non-classical factors related to metabolomic profiles are gaining attention. The aim of this study was to investigate possible metabolic profiling differences between patients with chronic coronary artery disease (CAD) and a control group based on plasma sphingomyelin levels. The study group consisted of 23 patients (72% male, median age of 69 (63-72) years) presenting with chronic coronary syndrome and confirmed epicardial disease in coronary angiography and 15 patients (33% male, median age of 70 (64-72) years) with normal angiographic results. Clinical data were recorded, and blood samples were collected for standard biochemical laboratory assessment and metabolomic profiling. The plasma sphingomyelin levels were evaluated in patients with different degrees of coronary artery atherosclerosis involvement. In addition, the severity of the epicardial disease was estimated by the Gensini Score. The study subgroups did not differ in terms of age (p = 0.765) and co-morbidities, though the male sex was more common in the CAD group (p = 0.007). The analysis revealed significant differences regarding neutrophil count (p = 0.014), neutrophil-to-lymphocyte ratio (NLR) (p = 0.016), and high-density lipoprotein (HDL) (p = 0.003). Among different plasma sphingomyelin species, there was a significant difference in plasma SM42:1 level (16.2 (14.2-19.1) vs. 20.8 (18.9-21.7) (p = 0.044) between the CAD and control groups, respectively. The SM 42:1 plasma level was independent of the number of involved epicardial arteries (p = 0.109). However, Spearman correlations tests were performed between the SM 42:1 plasma level and the number of coronary arteries diagnosed with atherosclerosis disease (rho = -0.356, p = 0.014) and the severity of the disease measured by the Gensini Score (rho = -0.403, p = 0.006). There was no correlation between plasma sphingomyelin levels and NLR (Spearman's rho = -0.135, p = 0.420), suggesting a lack of inflammatory associations. Further, sphingomyelins showed no relationship with coronary artery disease risk factors such as dyslipidemia and diabetes. Lower plasma SM 42:1 levels were revealed in the CAD group compared with the control group, indicating a possible significance of sphingomyelin 42:1 in coronary artery disease progression.

The BG Study Part 1 (Bergisch Gladbach): Development of a Prototype Coronary Artery Disease Risk Score Incorporating Peripheral Vascular Parameters-Preliminary Insights for Future CAD Risk Prediction Models in Vascular Patients

Background: Peripheral vascular parameters may provide valuable insights into coronary artery disease (CAD) risk stratification. This study aimed to develop a CAD risk score by integrating carotid duplex velocities, ankle-brachial index (ABI), and clinical history into a point-based model. Methods: We analyzed data from 902 cardiology patients, of whom 592 (65.6%) had confirmed CAD based on coronary angiography. Peripheral vascular assessments included carotid duplex ultrasonography and ABI measurements. Predictors were identified through multivariate logistic regression, addressing multicollinearity and interaction effects. A point-based scoring system was developed using statistically significant variables and evaluated via receiver operating characteristic (ROC) analysis. Results: Key predictors included external carotid artery velocities, ABI, carotid stenosis, chronic kidney disease (CKD) stage, smoking history, diabetes, hypertension, and age. The scoring system demonstrated moderate discriminative ability (AUC: 0.683) and high sensitivity (97%) for detecting CAD-positive cases but lower specificity (11%) for CAD-negative cases. Patients were stratified into risk categories, with an optimal threshold of ≥7 points maximizing the F1 score. Conclusions: This novel scoring system highlights the clinical relevance of integrating peripheral vascular assessments into CAD risk models. While its high sensitivity ensures robust detection of CAD-positive patients, future multicenter studies are needed to improve specificity and validate its broader clinical utility.

Triglyceride-glucose index: carotid intima-media thickness and cardiovascular risk in a European population

BACKGROUND

The triglyceride-glucose (TyG) index is now widely recognized as a marker of insulin resistance and has been linked to the development and prognosis of atherosclerotic cardiovascular diseases (ASCVD) in numerous populations, particularly in the Eastern world. Although there are fewer reports from the Western world, and they are sometimes contradictory, the absence of definitive data on the relationship between a raised TyG index and cardiovascular risk suggested the opportunity of testing this biochemical marker against a well-established vascular marker such as the carotid intima media thickness (c-IMT).

METHODS

Primary prevention patients were selected from a cohort of individuals who underwent c-IMT measurement between 1984 and 2018 at the Dyslipidemia Center at the ASST Grande Ospedale Metropolitano Niguarda in Milan, Italy. The TyG index was calculated as the Ln [fasting TG (mg/dL)×fasting glucose (mg/dL)/2]. Carotid ultrasonography was performed using echographic measurements of the far walls of the left and right common, internal carotids, and bifurcations. Patients were followed for up to 20 years with periodic evaluation of biochemical parameters. ASCVD events were monitored through hospital records, where all patients were regularly examined.

RESULTS

The analysis included 3108 individuals with a mean age of 54.9 ± 13.1 years. Participants were generally non-obese, with an average BMI of 24.6 ± 3.5 Kg/m2. Among the women, 83.1% were postmenopausal. The mean TyG index was 8.65 ± 0.59. There was a significant association between the TyG index and all c-IMT measurements. Those in the highest TyG index quartiles had significantly higher IMTmean and IMTmax compared to those in the lower quartiles. These associations were consistent across all vascular sites examined and remained significant after adjusting for all potential confounders. Kaplan-Meier survival analysis revealed an increased incidence of ASCVD events in the two highest TyG index quartiles.

CONCLUSIONS

TyG index is a sensitive marker of risk in a European population with moderate ASCVD risk, as assessed by c-IMT measurements, in a large cohort of Lipid Clinic patients.

Non-Hypertensive Effects of Aldosterone

Aldosterone, the primary adrenal mineralocorticoid hormone, as an integral part of the renin-angiotensin-aldosterone system (RAAS), is crucial in blood pressure regulation and maintaining sodium and potassium levels. It interacts with the mineralocorticoid receptor (MR) expressed in the kidney and promotes sodium and water reabsorption, thereby increasing blood pressure. However, MRs are additionally expressed in other cells, such as cardiomyocytes, the endothelium, neurons, or brown adipose tissue cells. Therefore, aldosterone (especially aldosterone excess) may have other major impacts besides simply regulating blood pressure and circulating ion balance. Recent studies have reported a non-hypertensive impact on the cardiovascular, immune, and metabolic systems, a pro-oxidant effect, and a pro-fibrotic effect. In this review, we emphasise the non-hypertension-related effects of aldosterone, including advances in our understanding of the cellular mechanisms by which aldosterone mediates its cellular effects. We also summarise potential clinical complications related to both the hypertensive and non-hypertensive effects of aldosterone.

The Use of Retinal Imaging Including Fundoscopy, OCT, and OCTA for Cardiovascular Risk Stratification and the Detection of Subclinical Atherosclerosis

PURPOSE OF REVIEW

Cardiovascular disease (CVD) is a leading cause of preventable morbidity and mortality globally, and retinal imaging modalities (old and new) are being explored as noninvasive tools to predict latent atherosclerosis and cardiovascular disease. This review focuses on the emerging promise of fundoscopy, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) in CVD prognostication.

RECENT FINDINGS

High-quality studies have established the utility of vessel-based parameters and discrete conditions diagnosable via fundoscopy in subclinical atherosclerosis detection or CVD prediction. Recent research shows OCT measurements of different retinal layers and specific imaging findings (such as retinal ischemic perivascular lesions) are widely accessible and objective biomarkers for incipient CVD and ensuing risk. Myriad OCTA metrics appear to reliably inform on current CVD burden and cardiovascular risk. Fundoscopy, OCT, and OCTA all have a growing body of literature supporting their utility as adjuncts in CVD prediction and risk stratification.

Charting the Unseen: How Non-Invasive Imaging Could Redefine Cardiovascular Prevention

Cardiovascular diseases (CVDs) remain a major global health challenge, leading to significant morbidity and mortality while straining healthcare systems. Despite progress in medical treatments for CVDs, their increasing prevalence calls for a shift towards more effective prevention strategies. Traditional preventive approaches have centered around lifestyle changes, risk factors management, and medication. However, the integration of imaging methods offers a novel dimension in early disease detection, risk assessment, and ongoing monitoring of at-risk individuals. Imaging techniques such as supra-aortic trunks ultrasound, echocardiography, cardiac magnetic resonance, and coronary computed tomography angiography have broadened our understanding of the anatomical and functional aspects of cardiovascular health. These techniques enable personalized prevention strategies by providing detailed insights into the cardiac and vascular states, significantly enhancing our ability to combat the progression of CVDs. This review focuses on amalgamating current findings, technological innovations, and the impact of integrating advanced imaging modalities into cardiovascular risk prevention, aiming to offer a comprehensive perspective on their potential to transform preventive cardiology.

The role of coffee and potential mediators in subclinical atherosclerosis: insights from Mendelian randomization study

Background and aims

Coffee contains many bioactive compounds, and its inconsistent association with subclinical atherosclerosis has been reported in observational studies. In this Mendelian randomization study, we investigated whether genetically predicted coffee consumption is associated with subclinical atherosclerosis, as well as the role of potential mediators.

Methods

We first conducted a two-sample Mendelian randomization analysis to examine the causal effect of coffee and its subtypes on subclinical atherosclerosis inferred from coronary artery calcification (CAC). Next, the significant results were validated using another independent dataset. Two-step Mendelian randomization analyses were utilized to evaluate the causal pathway from coffee to subclinical atherosclerosis through potential mediators, including blood pressure, blood lipids, body mass index, and glycated hemoglobin. Mendelian randomization analyses were performed using the multiplicative random effects inverse-variance weighted method as the main approach, followed by a series of complementary methods and sensitivity analyses.

Results

Coffee, filtered coffee, and instant coffee were associated with the risk of CAC (β = 0.79, 95% CI: 0.12 to 1.47, p = 0.022; β = 0.66, 95% CI: 0.17 to 1.15, p = 0.008; β = 0.66, 95% CI: 0.20 to 1.13, p = 0.005; respectively). While no significant causal relationship was found between decaffeinated coffee and CAC (β = -1.32, 95% CI: -2.67 to 0.04, p = 0.056). The association between coffee and CAC was validated in the replication analysis (β = 0.27, 95% CI: 0.07 to 0.48, p = 0.009). Body mass index mediated 39.98% of the effect of coffee on CAC (95% CI: 9.78 to 70.19%, p = 0.009), and 5.79% of the effect of instant coffee on CAC (95% CI: 0.54 to 11.04%, p = 0.030).

Conclusion

Our study suggests that coffee other than decaffeinated coffee increases the risk of subclinical atherosclerosis inferred from CAC. Body mass index mediated 39.98 and 5.79% of the causal effects of coffee and instant coffee on CAC, respectively. Coffee should be consumed with caution, especially in individuals with established cardiovascular risk factors, and decaffeinated coffee appears to be a safer choice.

Glycolipid Metabolic Disorders, Metainflammation, Oxidative Stress, and Cardiovascular Diseases: Unraveling Pathways

Glycolipid metabolic disorders (GLMDs) are various metabolic disorders resulting from dysregulation in glycolipid levels, consequently leading to an increased risk of obesity, diabetes, liver dysfunction, neuromuscular complications, and cardiorenal vascular diseases (CRVDs). In patients with GLMDs, excess caloric intake and a lack of physical activity may contribute to oxidative stress (OxS) and systemic inflammation. This study aimed to review the connection between GLMD, OxS, metainflammation, and the onset of CRVD. GLMD is due to various metabolic disorders causing dysfunction in the synthesis, breakdown, and absorption of glucose and lipids in the body, resulting in excessive ectopic accumulation of these molecules. This is mainly due to neuroendocrine dysregulation, insulin resistance, OxS, and metainflammation. In GLMD, many inflammatory markers and defense cells play a vital role in related tissues and organs, such as blood vessels, pancreatic islets, the liver, muscle, the kidneys, and adipocytes, promoting inflammatory lesions that affect various interconnected organs through their signaling pathways. Advanced glycation end products, ATP-binding cassette transporter 1, Glucagon-like peptide-1, Toll-like receptor-4, and sphingosine-1-phosphate (S1P) play a crucial role in GLMD since they are related to glucolipid metabolism. The consequences of this is system organ damage and increased morbidity and mortality.

Ultrasound Carotid Plaque Score and Severity of Coronary Artery Disease Assessed by Computed Tomography Angiography in Patients with Arterial Hypertension

The aim of the study was to assess the relationship between the presence of atherosclerotic lesions in the carotid arteries detected by ultrasound and the occurrence of atherosclerosis in the coronary arteries determined by computed tomography (CT) in patients with arterial hypertension (HTA). A total of 83 patients with HTA were qualified for the study (age: 71.3 ± 8.5 years). All subjects underwent carotid arteries ultrasound and coronary arteries CT. The carotid plaque score was assessed using ultrasound. The studied group was divided into two subgroups: a subgroup with the carotid plaque score ≤ 1 (A) and a subgroup with carotid plaque score ≥2 (B). Coronary arteries CT assessed coronary artery calcium score (CACS) and degree of coronary stenosis based on CAD-RADS. In subgroup B, a significantly higher CACS (411.3 ± 70.1 vs. 93.5 ± 31.8) and significantly higher grade in the CAD-RADS classification were demonstrated than in subgroup A (CAD-RADS ≥ 3: 21.8 vs. 6.0%). The regression analysis showed that carotid plaque score and age are independent risk factors for the severity of atherosclerotic lesions in the coronary arteries. In summary, ultrasound assessment of the carotid plaque score in patients with HTA could be considered as surrogate indicator of the risk and severity of atherosclerotic changes in the coronary arteries, but further studies are necessary to corroborate these results.

Atherosclerosis and the Bidirectional Relationship between Cancer and Cardiovascular Disease: From Bench to Bedside-Part 1

Atherosclerosis, a complex metabolic-immune disease characterized by chronic inflammation driven by the buildup of lipid-rich plaques within arterial walls, has emerged as a pivotal factor in the intricate interplay between cancer and cardiovascular disease. This bidirectional relationship, marked by shared risk factors and pathophysiological mechanisms, underscores the need for a comprehensive understanding of how these two formidable health challenges intersect and influence each other. Cancer and its treatments can contribute to the progression of atherosclerosis, while atherosclerosis, with its inflammatory microenvironment, can exert profound effects on cancer development and outcomes. Both cancer and cardiovascular disease involve intricate interactions between general and personal exposomes. In this review, we aim to summarize the state of the art of translational data and try to show how oncologic studies on cardiotoxicity can broaden our knowledge of crucial pathways in cardiovascular biology and exert a positive impact on precision cardiology and cardio-oncology.

Frequency and Clinical Significance of Incidental Findings on CBCT Imaging: a Retrospective Analysis of Full-Volume Scans

Objectives

This retrospective study aims to identify incidental findings in cone-beam computed tomography scans of patients irradiated for preoperative evaluation for implant placement and obtained using the same imaging unit as well as the same field of view. The incidence of each incidental finding, as well as the overall incidence, were calculated and the findings were ranked according to their clinical significance.

Material and Methods

A total of 741 cone-beam computed tomography (CBCT) examinations with extended field of view (15 x 15 cm) were retrospectively evaluated for incidental findings (IFs). These were identified, recorded, classified as to their location, and ranked according to their clinical significance.

Results

The vast majority of CBCT examinations presented at least one IF, resulting in a surprisingly high prevalence in total. If extreme anatomical variants are considered (nasal septum deviation, sinus septations etc.), the cumulative prevalence exceeds 99%. IFs of major significance, that may require immediate attention, are beyond 10% in frequency.

Conclusions

We found high prevalence of incidental findings on cone-beam computed tomography examinations performed for preoperative evaluation for implant placement (99.5% if anatomical variants included). Most incidental findings were of minor significance. Although the number of incidental findings that require immediate attention is relatively low, there is a considerable number of cases that need periodic evaluation and/or referral.