Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association

Injectable ionic hydrogel conductors: Advancing material design to transform cardiac pacing

Direct pacing of the mid myocardium where re-entry originates can be used to prevent ventricular arrhythmias and circumvent the need for painful defibrillation or cardiac ablation. However, there are no pacing electrodes small enough to navigate the coronary veins that cross these culprit scar regions. To address this need, we have developed an injectable ionically conductive hydrogel electrode that can fill the epicardial coronary veins and transform them into flexible electrodes. A new hydrogel chemistry based on a polyether urethane diacrylamide macromer was developed that matches myocardial stiffness and is resistant to hydrolysis. Conductivity was imparted using ionic precursor solutions with values in the range of 2-3X of native myocardium that was retained after implantation. Ionic hydrogel electrodes provided stable electrical stimuli over many cycles and across a substantial length of the cardiac vein. Rapid in situ cure was achieved with redox initiation after injection from a double-barrel syringe with a mixing head. An ex vivo porcine model was used to identify the requisite viscosity and cure rate for hydrogel retention and homogeneity. Finally, successful in vivo deployment and pacing in a porcine model demonstrated that the ionic hydrogel electrode filled the anterior interventricular vein to depths far more distal and refined than current technologies. Collectively, these studies demonstrate the potential of this injectable ionic hydrogel electrode to pace previously inaccessible mid-myocardial tissue and pave the pathway for painless defibrillation.

Exploring the role of exosomal and non-exosomal non-coding RNAs in Kawasaki disease: Implications for diagnosis and therapeutic strategies against coronary artery aneurysms

Kawasaki disease (KD) is an acute vasculitis primarily affecting children, with a potential risk of developing coronary artery aneurysms (CAAs) and cardiovascular complications. The emergence of non-coding RNAs (ncRNAs), including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), has provided insights into Kawasaki disease pathogenesis and opened new avenues for diagnosis and therapeutic intervention. Furthermore, polymorphism analysis of ncRNA genes offers significant insights into genetic predisposition to Kawasaki disease, facilitating tailored treatment approaches and risk assessment to improve patient outcomes. Exosomal ncRNAs, which are ncRNAs encapsulated within extracellular vesicles, have garnered significant attention as potential biomarkers for Kawasaki disease and CAA due to their stability and accessibility in biological fluids. This review comprehensively discusses the biogenesis, components, and potential of exosomal and non-exosomal ncRNAs in Kawasaki disease diagnosis and prognosis prediction. It also highlights the roles of non-exosomal ncRNAs, such as miRNAs, lncRNAs, and circRNAs, in Kawasaki disease pathogenesis and their implications as therapeutic targets. Additionally, the review explores the current diagnostic and therapeutic approaches for Kawasaki disease and emphasizes the need for further research to validate these ncRNA-based biomarkers in diverse populations and clinical settings.

Cardiomyocyte proliferation: Advances and insights in macrophage-targeted therapy for myocardial injury

In the mammalian heart, cardiomyocytes undergo a transient window of proliferation that leads to regenerative impairment, limiting cardiomyocyte proliferation and myocardial repair capacity. Cardiac developmental patterns exacerbate the progression of heart disease characterized by myocardial cell loss, ultimately leading to cardiac dysfunction and heart failure. Myocardial infarction causes the death of partial cardiomyocytes, which triggers an immune response to remove debris and restore tissue integrity. Interestingly, when transient myocardial injury triggers irreversible loss of cardiomyocytes, the subsequent macrophages responsible for proliferation and regeneration have a unique immune phenotype that promotes the formation of pre-existing new cardiomyocytes. During mammalian regeneration, mononuclear-derived macrophages and self-renewing resident cardiac macrophages provide multiple cytokines and molecular signals that create a regenerative environment and cellular plasticity capacity in postnatal cardiomyocytes, a pivotal strategy for achieving myocardial repair. Consistent with other human tissues, cardiac macrophages originating from the embryonic endothelium produce a hierarchy of contributions to monocyte recruitment and fate specification. In this review, we discuss the novel functions of macrophages in triggering cardiac regeneration and repair after myocardial infarction and provide recent advances and prospective insights into the phenotypic transformation and heterogeneous features involving cardiac macrophages. In conclusion, macrophages contribute critically to regeneration, repair, and remodeling, and are challenging targets for cardiovascular therapeutic interventions.

Cardiac Rehabilitation for Women with Heart Disease

Cardiovascular disease is the leading cause of morbidity and mortality in women globally. Cardiac rehabilitation (CR)-a comprehensive program including supervised progressive exercise, education, support, behavior modification, and nutritional guidance over 36 individual sessions-positively impacts morbidity, mortality, function, and quality of life. Overall, less than 30% of those who qualify are referred and participate in CR-referral and completion rates are significantly less in women compared with men despite evidence supporting equal benefit. Barriers contributing to these disparities have been identified, and CR programs can be modified to enhance the participation of women.

Associations of urinary incontinence, physical activity and cardiovascular disease risk among women in the United States

OBJECTIVE

Urinary incontinence (incontinence) is a common condition among women which may contribute to low moderate-to-vigorous physical activity (MVPA). Thus, women with incontinence may have increased risk for inactivity and related cardiovascular disease (CVD). The objective of this study was to determine the associations of incontinence with MVPA and CVD risk.

METHODS

This retrospective observational study used electronic medical records to capture data on incontinence diagnosis, self-reported MVPA using the Exercise Vital Sign, CVD risk factors and diagnosis using ICD-10 codes, and demographic information from July 2022-June 2024 in Connecticut. Multinomial logistic regression assessed the association of incontinence and MVPA classification (inactive: 0 min/week, insufficiently active: 1-149 min/week, and active ≥150 min/week). Logistic regression models assessed associations of incontinence with CVD risk calculator components and diagnosed CVD. All models adjusted for age, race, body mass index, and tobacco use.

RESULTS

Of 20,155 women who were included in analysis (mean age 50.36 ± 16.42 years), 5.4 % had an incontinence diagnosis. Compared to those without incontinence, those with incontinence did not differ in MVPA classification, but had greater odds of type two diabetes (aOR 1.25, 95 % CI: 1.06-1.48), dyslipidemia (aOR 1.37, 95 % CI: 1.19-1.58), stroke (aOR 1.55, 95 % CI: 1.06-2.25), and coronary artery bypass grafts (aOR 3.17, 95 % CI: 1.45-6.95) after adjustment.

CONCLUSIONS

Incontinence was not associated with MVPA classification but was associated with inactivity related CVD risk factors and cardiometabolic comorbid conditions. Future studies should investigate potential mechanisms of this association including incontinence severity, activity intensity, and chronic inflammation.

The Association of Sedentary Behavior and Physical Activity with Different Measurements of Metabolic Syndrome: The Jackson Heart Study

Purpose: Cross-sectional investigation of the association of sedentary behavior and physical activity with metabolic syndrome (MetS) among the African American participants in the Jackson Heart Study (JHS). Methods: Prevalence, number of individual components, and MetS severity z-score (MetS-Z) were examined. MetS was classified using ATP-III thresholds. MetS-Z was calculated using sex-, race-, and ethnicity-specific formulas. Sedentary behavior and physical activity were calculated from the JHS Physical Activity Cohort survey (JPAC). Associations between sedentary behavior and physical activity with MetS were assessed by logistic, negative binomial, and ordinary least squares regressions. Results: The mean participant age (N = 3370) was 61.7 ± 11.9 years and most were female (63.9%). Among all participants, 60.5% were classified with MetS. Overall MetS-Z was moderately high (.31 ± 1.07). Most waking hours were sedentary, with just under 40 daily minutes of self-reported physical activity. Physical activity was associated with lower prevalence of MetS, the number of individual components, and MetS-Z score (p < .05). Sedentary behavior was not associated with MetS in any fully adjusted models (p > .05). Conclusions: Physical activity was associated with lower cardiometabolic risk, irrespective of sedentary behavior. Further studies are needed to better understand why no relation was found between sedentary behavior and cardiometabolic risk in this cohort of African American adults.

PA System in the Pathogenesis of Ischemic Stroke

Ischemic stroke remains a leading cause of morbidity and mortality worldwide, driven by complex pathophysiological mechanisms that make finding effective treatments challenging. PAs (plasminogen activators) play a critical role in fibrinolysis and vascular homeostasis and as such are important factors affecting stroke outcome. This review examines the complex relationships between ischemic stroke and PAs, highlighting their physiological, pathological, and therapeutic effects on ischemic stroke. We focus on recombinant tissue-type PA as the only Food and Drug Administration-approved thrombolytic agent, describing its clinical impact and associated obstacles impacting its wide-scale use, such as blood-brain barrier disruption and inflammation. Furthermore, emerging PA-based therapies and combination strategies are explored to address the limitations of recombinant tissue-type PA. By integrating mechanistic information with clinical developments, this review aims to provide insights for the advancement of PA-centered approaches to improve the safety and efficacy of stroke treatments.

Integrating WGCNA and SVM-RFE identifies hub molecular biomarkers driving ischemic stroke progression

BACKGROUND

Stroke is the second most common cause of death worldwide and the leading cause of long-term severe disability with neurological impairment worsening within hours after stroke onset and being especially involved with motor function. So far, there are no established and reliable biomarkers to prognose stroke. Early detection of biomarkers that can prognose stroke is of great importance for clinical intervention and prevention of clinical deterioration of stroke.

METHODS

TGSE119121 dataset was retrieved from the Gene Expression Integrated Database (Gene Expression Omnibus, GEO) and weighted gene co-expression network analysis (WGCNA) was conducted to identify the key modules that could regulate disease progression. Moreover, functional enrichment analysis was conducted to study the biological functions of the key module genes. The GSE16561 dataset was further analyzed by the Support Vector Machines coupled with Recursive Feature Elimination (SVM-RFE)algorithm to identify the top genes regulating disease progression. The hub genes revealed by WGCNA were associated with disease progression using the receiver operating characteristic curve (ROC) analysis. Subsequently, functional enrichment of the hub genes was performed by deploying gene set variation analysis (GSVA). The changes at gene level were transformed into the changes at pathway level to identify the biological function of each sample. Finally, the expression level of the hub gene in the rat infarction model of MCAO was measured using RT-qPCR for validation.

RESULTS

WGCNA analysis revealed four hub genes: DEGS1, HSDL2, ST8SIA4 and STK3. The result of GSVA showed that the hub genes were involved in stroke progression by regulating the p53 signal pathway, the PI3K signal pathway, and the inflammatory response pathway. The results of RT-qPCR indicated that the expression of the four HUB genes was increased significantly in the rat model of MCAO.

CONCLUSION

Several genes, such as DEGS, HSDL2, ST8SIA4 and STK3, were identified and associated with the progression of the disease. Moreover, it was hypothesized that these genes may be involved in the progression stroke by regulating the P53 signal, the PI3K signal, and the inflammatory response pathway, respectively. These genes have potential prognostic value and may serve as biomarkers for predicting stroke progression.

Free-breathing, non-contrast, 3D whole-heart coronary MRI for the identification of culprit and vulnerable atherosclerotic plaque

BACKGROUND

Detection of vulnerable coronary plaque can predict future myocardial infarctions. We have developed a novel, non-contrast cardiovascular magnetic resonance sequence (iT2prep-BOOST), enabling simultaneous, co-registered coronary angiography and plaque detection.

OBJECTIVES

To validate iT2prep-BOOST in patients with non-ST-segment elevation myocardial infarction (NSTEMI).

METHODS

41 patients with suspected NSTEMI were recruited. Invasive coronary angiography ± intravascular imaging was used to classify coronary segments into the following categories: normal, non-culprit and culprit segments; stenosed segments as well as segments with vulnerable plaque features (lipid, calcium, fibroatheroma, thin cap fibroatheroma (TCFA), plaque-rupture and thrombus). The plaque/myocardial signal intensity ratio (PMR) in each coronary segment was analyzed on iT2prep-BOOST.

RESULTS

The mean ± standard deviation PMR of culprit segments was significantly higher than non-culprit segments and normal segments (1.01 ± 0.14 vs. 0.67 ± 0.18 vs. 0.35 ± 0.24, P<0.001 respectively). Coronary segments with lipid, calcium and fibroatheroma had a significantly higher PMR compared to normal coronary segments (P<0.001), but significantly lower than segments with plaque-rupture and intraluminal thrombus (P<0.05). There was a progressive increase in PMR with increasing coronary segment stenosis (P<0.001). There was a significant association on multivariable analysis between HbA1c as well as family history of coronary artery disease and mean PMR (P=0.05 and P=0.04 respectively).

CONCLUSIONS

iT2prep-BOOST has the potential to simultaneously visualize coronary artery lumen and plaque and differentiate normal segments from non-culprit and culprit plaque segments non-invasively and without contrast. The prognostic value of PMR needs to be investigated in a prospective multicenter study.

Neighborhood Safety and Hypertension Risk: A Systematic Review

BACKGROUND

Responding to the increasing focus on residential environments, our systematic review aimed to consolidate existing empirical evidence regarding the impact of neighborhood safety on blood pressure. We also summarized the mediating and moderating mechanisms through which neighborhood safety influences blood pressure, alongside their direct effects, to offer insights for future research.

METHODS

We searched 5 electronic databases (PubMed, Ovid MEDLINE, CINAHL Complete, ProQuest Dissertations and Theses Global, and Web of Science) for the period up to and including December 27, 2022. The initial search yielded 4944 studies reviewed, of which 19 met our criteria and were reviewed.

RESULTS

Our findings consistently show that living in a safe neighborhood is associated with lower blood pressure outcomes. While most cross-sectional studies found that the association was not statistically significant (7/10 studies showed insignificant results), longitudinal studies that tracked changes in neighborhood safety over time (4/5 studies) showed significant negative associations between neighborhood safety and blood pressure. Additionally, some studies identified sex (n=3), age (n=2), and neighborhood characteristics (n=4) as significant moderators, with the strength of the association between neighborhood safety and blood pressure varying across different demographic groups and neighborhood contexts.

CONCLUSIONS

Our findings suggest that unsafe neighborhoods may increase blood pressure and hypertension risk, warranting further research and interventions. This review also highlights the importance of adopting longitudinal designs, especially those using time-varying measures of neighborhood environments.

Liraglutide improves antioxidant defense in hearts of spontaneously hypertensive female rats independently of changes in blood pressure in a pre-clinical model of menopause

Liraglutide (LIRA) is an agonist of the GLP-1 receptor used in the treatment of type 2 diabetes with a cardioprotective effect, although little is known about the effects of LIRA in post-menopause. We aimed to evaluate the effects of LIRA in the cardiovascular system of ovariectomized spontaneously hypertensive rats (SHR). SHR rats were separated into two groups: ovariectomized (saline) and ovariectomized + liraglutide (0.6 and 1.2 mg/kg for 4+4 weeks, respectively). Systolic blood pressure (SBP) was indirectly evaluated at the beginning and end of treatment. Diastolic, systolic, and mean blood pressure were evaluated in the carotid artery of anesthetized animals, while left ventricle systolic blood pressure (LVSBP) and left ventricle derivatives (-dP/dt; +dP/dt) were evaluated in the left ventricle. An oral glucose tolerance test (GTT) was conducted. Antioxidant enzymes and calcium-handling proteins were analyzed in heart tissue by western blot. Treatment with LIRA increased the expression of antioxidant enzymes (superoxide dismutase (SOD2) and catalase). No changes were observed in the GTT, cardiac hemodynamics, blood pressure, and calcium-handling protein expression. A decrease in visceral fat depot was observed without changes in final body weight. LIRA induced an antioxidant subclinical effect in ovariectomized SHR female rats without changing glucose metabolism and cardiac blood pressure.

The Association of Elevated Depression Levels and Life's Essential 8 on Cardiovascular Health With Predicted Machine Learning Models and Interpretations: Evidence From NHANES 2007-2018

Background and Objective: The association between depression severity and cardiovascular health (CVH) represented by Life's Essential 8 (LE8) was analyzed, with a novel focus on ranked levels and different ages. Machine learning (ML) algorithms were also selected aimed at providing predictions to suggest practical recommendations for public awareness and clinical treatment. Methods: We included 21,279 eligible participants from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Weighted ordinal logistic regression (LR) was utilized with further sensitivity and dose-response analysis, and ML algorithms were analyzed with SHapley Additive exPlanations (SHAP) applied to make interpretable results and visualization. Results: Our studies demonstrated an inverse relationship between LE8 and elevated depressive levels, with robustness confirmed through subgroup and interaction analysis. Age-specific findings revealed middle-aged and older adults (aged 40-60 and over 60) which showed higher depresion severity, highlighting the need for greater awareness and targeted interventions. Eight ML algorithms were selected to provide predictive results, and further SHAP would become ideal supplement to increase model interpretability. Conclusions: Our studies demonstrated a negative association between LE8 and elevated depressive levels and provided a suite of ML predictive models, which would generate recommendations toward clinical implications and subjective interventions.

Implementing Remote Patient Monitoring to Improve Hypertension Control in a Primary Care Network: Rationale and Design of the Monitor-BP Cluster Randomized Trial

BACKGROUND

Home blood pressure monitoring with clinical or technological support (Supported HBPM) is an evidence-based intervention recommended by national guidelines for improving hypertension (HTN) control. However, few healthcare systems have implemented Supported HBPM because it remains unclear how best to promote uptake among patients and clinicians, and the real-world effectiveness of Supported HBPM is unknown. The Monitor-BP Trial aims to determine the impact of implementing a flexible Supported HBPM program on practice-level HTN control and to evaluate the reach, adoption, maintenance, and cost-effectiveness of the program in a socioeconomically diverse primary care network.

METHODS

The Monitor-BP Trial takes place in 15 primary care practices affiliated with two large academic medical centers in New York City. It is a hybrid 2 effectiveness-implementation cluster randomized pre-post trial testing early implementation of a Supported HBPM program (8 practices) versus usual care (7 practices). Adult patients with diagnosed HTN and their primary care clinicians are eligible for inclusion. The intervention consists of two options: 1. MyCare Hypertension, a low resource intensity option in which patients use their own BP devices to track home BP in the online patient portal with automated triage support for extreme readings and portal-delivered educational modules, and 2. RPM Hypertension, a high resource intensity option in which patients are loaned wireless BP devices that automatically transmit home BP data to the electronic health record (EHR) with telehealth navigator onboarding and nursing support to triage extreme readings. Both options include EHR-integrated ordering and home BP data visualization for clinicians. Key features of the implementation strategy include clinician education and training via presentations, clinician prompts and reminders via e-mails and mailed postcards, detailed instructional materials for patients and clinicians via websites, and at least monthly problem-solving meetings with clinical champions to iteratively tailor implementation to individual practices. The primary effectiveness outcome is practice-level pre- to post-implementation change in the mean 12-month change in office systolic BP among patients with uncontrolled office BP at baseline. The primary implementation outcomes are reach (uptake of the Supported HBPM program by patients) and adoption (uptake of the Supported HBPM program by clinicians). Secondary outcomes include estimating the short- and long-term cost-effectiveness of the program.

CONCLUSIONS

The Monitor-BP Trial tests a scalable approach to implementing telemonitoring-enabled Supported HBPM interventions into real-world clinical settings. Our findings have the potential to inform how health systems can shift the paradigm of BP assessments from the office to the home.

Acacetin as a natural cardiovascular therapeutic: mechanisms and preclinical evidence

Globally, cardiovascular disease (CVD) has emerged as a leading cause of mortality and morbidity. As the world's population ages, CVD incidence is on the rise, and extensive attention has been drawn to optimizing the therapeutic regimens. Acacetin, a natural flavonoid derived from various plants, has been demonstrated to have a wide spectrum of pharmacological properties, such as antioxidant, anti-inflammatory, anti-bacterial, and anti-tumor activities, as well as protective effects on diverse tissues and organs. Recently, increasing numbers of studies (mostly preclinical) have indicated that acacetin has potential cardiovascular protective effects and might become a novel therapeutic strategy for CVDs. The importance of acacetin in CVD treatment necessitates a systematic and comprehensive review of its protective effects on the cardiovascular system and the underlying mechanisms involved. Here, we first provide an overview of some basic properties of acacetin. Subsequently, the protective effects of acacetin on multiple CVDs, like arrhythmias, cardiac ischemia/reperfusion injury, atherosclerosis, myocardial hypertrophy and fibrosis, drug-induced cardiotoxicity, diabetic cardiomyopathy, hypertension, and cardiac senescence, are discussed in detail. The underlying mechanisms by which acacetin exhibits cardiovascular protection appear to involve suppressing oxidative stress, reducing inflammation, preventing cardiomyocyte apoptosis and endothelial cell injury, as well as regulating mitochondrial autophagy and lipid metabolism. Meanwhile, several critical signaling pathways have also been found to mediate the protection of acacetin against CVDs, including phosphoinositide 3-kinase/protein kinase B/mechanistic target of rapamycin (PI3K/Akt/mTOR), sirtuin 1/AMP-activated protein kinase/peroxisome proliferator-activated receptor-γ coactivator-1α (Sirt1/AMPK/PGC-1α), transforming growth factor-β1/small mothers against decapentaplegic 3 (TGF-β1/Smad3), protein kinase B/endothelial nitric oxide synthase (Akt/eNOS), and others. Finally, we highlight the existing problems associated with acacetin that need to be addressed, such as the requirement for clinical evidence and enhanced bioavailability, as well as its potential as a promising cardiovascular drug candidate.

The impact of oxidative stress on abnormal lipid metabolism-mediated disease development

Oxidative stress arises from an imbalance between cellular oxidation and anti-oxidation mechanisms, leading to various harmful effects on physiological health. These include inflammatory neutrophil infiltration, increased secretion of proteases, and increased production of oxidative intermediates, all of which significantly contribute to aging and the onset of multiple diseases. This review explores abnormal lipid metabolism, characterized by dysregulation in lipid synthesis, catabolism, digestion, absorption, and transport, with the potential to lead to lipid droplet accumulation or deficit across tissues, thus causing adverse health outcomes. Importantly, the intricate relationship between oxidative stress and inflammation plays a central role in exacerbating metabolic disorders, including diabetes, obesity, hypertension, non-alcoholic fatty liver disease, atherosclerosis, and lung fibrosis. This review seeks to compile and integrate recent research findings on the influence of oxidative stress on abnormal lipid metabolism pathology. A deeper understanding of this connection could reveal new perspectives for advancing the treatment and management of metabolic disorders.

Physiological and Psychological Changes in Patients Undergoing Percutaneous Coronary Intervention: An Integrative Review

BACKGROUND

Percutaneous coronary intervention has been the main percutaneous method of myocardial revascularization used in all clinical scenarios, but patients undergoing these procedures may experience negative physiological and psychological changes.

OBJECTIVE

To identify the physiological and psychological changes experienced by patients undergoing percutaneous coronary intervention.

METHODS

This integrative review was carried out through a search for primary studies included in the PubMed, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), LILACS (Latin America and the Caribbean Literature on Health Sciences), and Embase databases in February 2023. No publication time frame was delimited, and articles in English, Portuguese, and Spanish were considered.

RESULTS

Of the 889 studies initially identified in the search, 20 made up the final sample. The majority (n = 13) of the included studies predominantly assessed psychological changes after percutaneous coronary intervention, with follow-up periods ranging from 6 months to 1 year. A few studies (n = 6) explored physiological changes among patients undergoing percutaneous coronary intervention, and 1 study investigated the prevalence of depression and anxiety in patients with coronary heart disease in 24 European countries. The main psychological changes found after percutaneous coronary intervention were increased anxiety and depression. Anxiety and depression levels were reduced at long-term follow-up. Physiological changes included fatigue, shortness of breath, and chest discomfort.

CONCLUSION

The results of this review show an urgent need for health care professionals to better assess patients' psychological state and employ strategies aimed at providing comprehensive care.

Psychometric Testing of the Mutuality Scale in Patients and Caregiver Dyads After the Onset of Coronary Heart Disease

This study investigates the psychometric properties of the Mutuality Scale in a sample of patient-caregiver dyads following a recent episode of coronary heart disease. A cross-sectional analysis was conducted. Factorial validity was tested with confirmatory factory analysis. Internal consistency reliability was investigated with the model-based internal consistency reliability index. Pearson's correlation coefficient was used to test convergent validity between mutuality and other theoretical and empirical variables associated with it. We included 150 patient-caregiver dyads (patient: mean age 65 years, 77% males, 71% married; caregiver: mean age 54 years, 21% males, 71% married). The CFA testing the theoretical four-factors (love, shared pleasurable activities, shared values, and reciprocity) of mutuality demonstrated adequate fit to the data in both the patient and caregiver version of the scale. Reliability estimates were adequate for the whole scale (model-based internal consistency index = 0.95). Significant positive correlations were observed between mutuality and self-care behaviors, and caregiver preparedness, supporting convergent validity. The Mutuality Scale demonstrated satisfactory structural and convergent validity and reliability in patient-caregiver dyads after the onset of a coronary heart disease event.

Effect of epinephrine administration interval on cerebral perfusion in a porcine cardiac arrest model

OBJECTIVES

The recommended epinephrine administration interval during CPR is between 3 and 5 min. However, the optimal interval for improving cerebral perfusion remains controversial. This study aimed to evaluate the effects of epinephrine administration interval of 3 min or 5 min on cerebral perfusion pressure (CEPP) and cortical cerebral blood flow (CCBF) in a porcine cardiac arrest model.

METHODS

An experimental model of ventricular fibrillation (VF) cardiac arrest was conducted using 26 pigs, randomised into 3-min and 5-min interval groups. Six minutes after VF induction, all pigs received 4 min of chest compressions, followed by 20 min of advanced cardiovascular life support, including defibrillation and intravenous epinephrine administration. CEPP and CCBF were measured simultaneously throughout the experiment.

RESULTS

Each of the experimental groups comprised 13 pigs. The 3-min group showed higher CEPP compared with the 5-min group in between 16 min and 20 min, 26 min and 30 min from VF induction: mean (95 % Confidence intervals) 26.8 (4.7-49.0) mmHg for 3-min group and 11.3 (-5.7-28.3) mmHg for 5-min group in 18 to 20 min from VF induction, which showed biggest difference. No significant difference was observed in CCBF between the 3-min and 5-min groups throughout the resuscitation phase (from the first epinephrine administration): The relative ratios 6 to 8 min after VF induction ranged from 0.21 to 0.86 in the 3-min group, and 0.35 to 0.77 in the 5-min group.

CONCLUSION

The 3-min epinephrine administration interval showed a higher CEPP compared with the 5-min interval. No significant differences were found in the CCBF between the two interval groups.

Organelle interplay in cardiovascular diseases: Mechanisms, pathogenesis, and therapeutic perspectives

Cardiovascular diseases (CVDs) are the leading cause of rising morbidity and mortality among humans worldwide; however, our approach to the pathogenesis, exploration, and management of CVDs still remains limited. As the heart consists of cardiomyocytes, cardiac fibroblasts, endothelial cells, smooth muscle cells, and several types of cells, different types of dysfunction in the interplay between organelles play an important damaging role, resulting in cardiac pathologies. The interplay between cellular organelles is intricate and vital for maintaining cellular homeostasis, as highlighted by multiple diseases linked to the dysfunction of both organelles. Many studies have revealed the potential mechanisms by which organelles communicate with each other and regulate the pathological processes of CVDs together. However, gaps remain in fully understanding the complexity of these interactions and translating these insights into therapeutic approaches. In this review, we summarized how the interplay between cellular organelles in the cardiomyocytes alters in various heart diseases. We find underexplored areas, such as the crucial signaling pathways governing organelle communication, and discuss their implications for disease future progression. Furthermore, we evaluate emerging potential medicines aimed at restoring organelle interactions. Finally, we propose future directions for researching to advance the development of novel medicines and therapies, addressing current gaps and providing a theoretical basis for improved clinical outcomes in CVDs.

The effect of sarcopenia on prognosis in patients with mild acute ischemic stroke: a prospective cohort study

BACKGROUND

Ischemic stroke is a common chronic disease worldwide and is correlated with a high disability rate. Sarcopenia is considered a key factor in the disablement process. Limited evidence of sarcopenia in acute ischemic stroke is available. The aim of this study was to investigate the effect of sarcopenia on the prognosis of patients with acute ischemic stroke.

METHODS

A prospective cohort study was conducted and included patients who were diagnosed with acute ischemic stroke between August 2020 and May 2021. A modified Poisson regression was applied to determine the relative risk (RR) for the change in modified Rankin Scale (mRS) score and allow adjustment for confounders. The modified Poisson regression was used to identify associations between sarcopenia, and multiple linear regression analyses were used to assess the effect of sarcopenia on the Barthel Index (BI) and stroke-specific quality of life (SSQOL). The generalized linear mixed model was used to investigate the effect of sarcopenia on prognosis at 1, 3 and 6 months. Cox regression proportional risk model was used to analyze the effect of sarcopenia on readmission in patients with acute ischemic stroke.

RESULTS

The prevalence of sarcopenia was 39.83% among the 118 enrolled acute ischemic stroke patients (aged 64.98 ± 11.053 years; 72.88% males). Modified Poisson regression showed that a poor prognostic outcome occurred in sarcopenia patients (relative risk [RR] = 3.021, 95% CI: 1.621-5.633; P = 0.001). Even after adjusting for confounders, sarcopenia still was a risk predictor of the increase of mRS (RR = 2.149, 95% CI: 1.045-4.420; P = 0.038). And sarcopenia was positively correlated with BI and SSQOL with or without adjustment for confounding factors (P < 0.01). Patients with sarcopenia in mild acute ischemic stroke exhibit worse prognoses compared to those without sarcopenia. (t = 3.128, P = 0.002). Cox regression risk ratio model showed that sarcopenia was a predictor of readmission within 6 months after mild ischemic stroke (hazard ratio [HR] = 3.361, 95% CI: 1.277-8.848; P = 0.014). Sarcopenia remained an independent risk factor for mild acute ischemic stroke readmission after adjusting for confounders.

CONCLUSIONS

Sarcopenia has a high prevalence in mild acute ischemic stroke patients. Sarcopenia is an independent risk factor for poor outcomes following mild acute ischemic stroke and contributes to high rates of readmission. These findings may be useful for selecting therapeutic strategies for mild acute ischemic stroke patients with sarcopenia.

Effects of exercise combined with different dietary interventions on cardiovascular health a systematic review and network meta-analysis

BACKGROUND

Numerous studies have shown that exercise and dietary interventions positively impact CVD outcomes; however, there is substantial variability in the efficacy of different interventions. The absence of direct comparisons between multiple interventions complicates the determination of their relative effects. This study aims to synthesize the literature on the impacts of exercise, dietary, and combined interventions on cardiovascular health indicators, and to perform a network meta-analysis to rank the efficacy of these approaches, providing a theoretical foundation for selecting optimal intervention strategies.

METHODS

We systematically reviewed the literature from database inception through September 2024, searching PubMed, Web of Science, Embase, and the Cochrane Library. Data were aggregated and analyzed using network meta-analysis, with intervention efficacy ranked according to Surface Under the Cumulative Ranking (SUCRA) curves.

RESULTS

The efficacy of these interventions was ranked as follows: 1). Triglycerides (TG) Reduction: CR + EX > CR > 5/2F + EX > TRF + EX > KD > 5/2F > KD + EX > EX > CON > TRF. 2). Total Cholesterol (TC) Reduction: CR + EX > CR > 5/2F + EX > 5/2F > TRF + EX > EX > CON > KD > TRF > KD + EX. 3). High-Density Lipoprotein (HDL) Increase: 5/2F > KD > KD + EX > TRF + EX > CON > EX > TRF > 5/2F + EX > CR + EX > CR. 4). Low-Density Lipoprotein (LDL) Reduction: CR + EX > CR > TRF + EX > KD + EX > EX > KD > 5/2F > CON > 5/2F + EX > TRF. 5). Systolic Blood Pressure (SBP) Reduction: 5/2F > CR + EX > CR > EX > TRF > TRF + EX > CON > 5/2F + EX. 6). Diastolic Blood Pressure (DBP) Reduction: CR > CR + EX > TRF > 5/2F > TRF + EX > EX > CON > 5/2F + EX.

CONCLUSION

CR and CR + EX demonstrated the most positive effects on cardiovascular health indicators. In contrast, 5/2F + EX ranked relatively low in effectiveness, with its impact on several indicators being even lower than that of CON.

Profiling X chromosome genes expression relevant to sex dimorphism in stroke: insights from transcriptomics landscape analysis

Introduction

Although age is the most important non-modifiable risk factor for cerebral stroke, it is also apparent that females commonly exhibit longer lifespan and better outcome after stroke compared to the age-matched males. A critical event after stroke is the peripheral infiltration of immune cells across damaged blood-brain barrier, which induces inflammatory and immune responses within the brain parenchyma and consequently worsen brain injury. These events are also dependent on age and display a sex different pattern. Theoretically, X chromosome-encoded differential expression genes (DEGs) may explain differences between the sexes. However, the expression and regulation of these DEGs after stroke have not been studied in detail.

Methods

We conducted three datasets of human blood cells, mice brain, mice microglia and T cells that were previously published, and analyzed the contribution of gender, age and stroke insult on the X chromosome-encoded DEGs.

Results

The main findings were (i) compared to age, the stroke/hypoxia was a more potent factor in eliciting the DEGs. Particularly, older stroke patients exhibited more changes compared to young stroke group. (ii) After a stroke, the DEGs was diversely influenced by sex, age and cell types being studied. Particularly, either aging or gender led to more striking changes in brain-infiltrating T cells than in the resident immune cells.

Discussion

These findings highlight the complex interplay between sex, age, and immune responses in mediating stroke incidence and outcome. Investigation of the identified X chromosome-encoded genes in brain-infiltrating T cells deserves high priority, as they may play more important roles in explaining gender-related differences in stroke and brain injury.

Advance Care Planning Before and After In-Hospital Cardiac Arrest

Objective: In-hospital cardiac arrest (IHCA) is a common event with high morbidity and mortality. This study seeks to evaluate advance care planning (ACP) among hospitalized patients who experienced IHCA. Design: Single center retrospective cohort study. Measurement and Main Results: The primary objective was to compare whether certain clinical characteristics are associated with a physician's likelihood of having an ACP discussion with patients who subsequently have IHCA. We found that older age, White race, and higher GO-FAR score were associated with increased ACP documentation. In multivariate regression modeling, numerically higher GO-FAR score, ICU patients, hospitalization for ≥7 days, and having a normal mental status were consistently associated with ACP documentation (OR ∼2 for all). There was a persistent trend, significant in some models, to lower likelihood of ACP documentation for non-White patients. Among patients who had predicted low-to-very low likelihood of IHCA survival, most (56%) had no ACP documentation prior to IHCA. Conclusions: We found that the factors associated with an increased likelihood of ACP were age, ICU location, longer LOS prior to IHCA, higher GO-FAR score and normal mental status before IHCA. There was a worrying trend toward lower rates of ACP documentation among non-White patients. The overall rate of completion of ACP was low in patients with poor predicted IHCA outcomes. Ongoing efforts should continue to engage all patients in ACP irrespective of demographics, and there may be a role for utilizing standardized prognostication models to encourage ACP.

Adipokines as Cardioprotective Factors: BAT Steps Up to the Plate

Cardiovascular disease is the leading cause of death throughout most of the industrialized world. Metabolic syndrome (MetS) and its associated pathologies are underlying factors in the etiology of cardiovascular disease, as well as a plethora of other maladies which cause excess morbidity and mortality. Adipose tissue (AT) has come to be regarded as a bona fide endocrine organ which secretes specific molecular entities constituting part of a complex web of inter-organ crosstalk that functions as a key determinant of whole-body metabolic phenotype. Brown adipose tissue (BAT) has classically been regarded as a thermogenic tissue exerting its metabolic effects primarily through its capacity to oxidize substrates decoupled from ATP resynthesis, thereby resulting in increased energy expenditure (EE) and heat production. However, in recent years, BAT has begun to receive attention as a secretory organ in its own right. The molecules secreted specifically by BAT have been termed "batokines", and currently available evidence supports the notion that batokines exert favorable metabolic effects on multiple organ systems. While maintenance of healthy body composition by conferring resistance to excessive adiposity is a rather obvious mechanism by which BAT operates via increased EE, effects on critical organs such as the heart remain unclear. This narrative review focuses on four types of batokines (FGF21, neuregulin 4, 12,13-diHOME, and BAT-derived microRNAs) for which evidence of modulation of cardiovascular function exists in the context of pathological states such as hypertension, atherosclerosis, and ischemia/reperfusion injury. Given the overwhelming burden of cardiometabolic disease, further study of the functions of BAT and its secretome is warranted and will intensify in the future.

Clinical evidence of sesame (Sesamum indicum L.) products and its bioactive compounds on anthropometric measures, blood pressure, glycemic control, inflammatory biomarkers, lipid profile, and oxidative stress parameters in humans: a GRADE-assessed systematic review and dose-response meta-analysis

This comprehensive systematic review and meta-analysis aimed to assess the impact of sesame (Sesamum indicum L.) supplementation on cardiovascular disease risk factors. Relevant research was discovered via PubMed, Scopus, Web of Science, CENTRAL, and EMBASE up to June 2024. The assessment of study quality was conducted using the Cochrane risk-of-bias tool. Thirteen trials, with interventions ranging from 4 to 12 weeks and involving 521 participants, demonstrated significant reductions in glycated hemoglobin (HbA1c) (Standardized Mean Difference [SMD] = - 0.67; 95% Confidence Interval [CI] - 1.01, - 0.32; P < 0.001), C-reactive protein (CRP) (SMD = - 0.51; 95% CI - 0.96, - 0.05; P = 0.028), and interleukin-6 (IL-6) (SMD = - 0.74; 95% CI - 1.16, - 0.32; P < 0.001), and a marginally significant effect on fasting blood sugar (FBS) (SMD = - 0.57; 95% CI - 1.16, 0.02; P = 0.057). Subgroup analyses revealed that sesame supplementation significantly reduced CRP and malondialdehyde (MDA) in populations without chronic diseases, while total cholesterol (TC) and MDA were reduced in those with chronic diseases. MDA was significantly reduced in females, especially those aged 50 or older. At dosages of 10 g per day or less, CRP, high-density lipoprotein cholesterol (HDL), and TC showed significant improvements. Meta-regression highlighted a significant dose-dependent reduction in TC levels at 10 g/day, and a significant duration-dependent decrease in TG levels at 8 weeks of supplementation. Sesame supplementation demonstrates potential benefits in improving glycemic control, inflammatory markers, and lipid profiles, making it a promising adjunct therapy for reducing cardiovascular disease risk factors.

The role of estrogen in the sex difference for the risk factors of heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction (HFpEF) is a major subtype of heart failure, primarily characterized by a normal or mildly reduced left ventricular ejection fraction along with left ventricular diastolic dysfunction. Recent studies have shown that the prevalence of HFpEF is higher in women than that in men, particularly in postmenopausal women. Concurrently, it has been observed that the incidence of risk factors contributing to HFpEF (such as obesity, hypertension, diabetes, and atrial fibrillation) also notably increases post-menopause, affecting the incidence of HFpEF. This review aimed to examine the relationship between estrogen and risk factors associated with HFpEF, clarifying the underlying mechanisms through which estrogen affects these risk factors from epidemiological and pathophysiological perspectives. This review also provides a comprehensive understanding of the association between estrogen and the risk factors for HFpEF, thus helping explore potential targets for HFpEF treatment.

Predictive and prognostic values of serum C1q/tumor necrosis factor-related protein 9 for first-ever ischemic stroke

Background

The C1q/Tumor Necrosis Factor-related Protein 9 (CTRP9) is a relatively novel adipokine having showed protection on cerebrovascular system. However, its clinical values have not been well established. This work is to evaluate CTRP9 as predictors of onset risk and outcome of ischemic stroke.

Methods

One thousand one hundred and twenty-three patients undergoing first-ever ischemic stroke and 835 controls were enrolled. Serum CTRP9 was determined within 24 h after the onset. One thousand and twenty-six patients were successfully followed up for all-cause and cardiovascular deaths. Stepwise regression was conducted to screen the independent factors of stroke onset in the whole sample and mortality in the patient subgroup. Survival curves were plotted to evaluate the effect of baseline serum CTRP9 on 3-year all-cause and cardiovascular mortalities of stroke patients.

Results

At baseline, prevalence of first-ever onset of ischemic stroke in high CTRP9 group was significantly lower than that in low CTRP9 group (p < 0.05) in non-hyperlipidemic subjects. Accumulative all-cause and cardiovascular mortality of patients with high baseline CTRP9 was significantly lower for the first year post stroke onset (p < 0.05). Baseline low CTRP9 was one of the independent risk factors of 3-year all-cause mortality (p < 0.05) of ischemic stroke patients.

Conclusion

High serum CTRP9 exerted protection against first-ever onset of ischemic stroke in non-hyperlipidemic subjects, and also protected general stroke patients against all-cause and cardiovascular mortality at least 1 year post stroke onset. Our findings in this study may pinpoint both the predictive and prognostic values of CTRP9 as a promising biomarker.

Ultra-processed foods and coronary artery disease severity: a cross-sectional study of at-risk normal-weight and overweight patients undergoing elective angiography

INTRODUCTION

There is growing interest in the connection between ultra-processed food (UPF) and cardiovascular diseases. This study explores how UPF intake relates to the severity of coronary artery disease (CAD) in at-risk patients undergoing elective angiography.

METHODS

Data covering demographic, and clinical details, and dietary intakes (using a validated food frequency questionnaire) were gathered from the Nutrition Heshmat Registry (NUTHER) in Rasht, Iran. UPF consumption was evaluated using the NOVA food classification system, with the exception of core grain foods. The study comprised 1,015 participants, who were classified based on the severity of CAD using the Gensini score (severe-CAD = Gensini score ≥ 60). Logistic regression was used to analyze the odd ratio (OR) and 95%confidence interval (95%CI) for severe-CAD across UPF quartiles (percentage of energy), and for each 10% increase in UPF intake. Restricted cubic spline (RCS) regression was employed to explore nonlinear relationships between UPF and severe-CAD.

RESULTS

Following controlling for potential confounders, normal-weight participants in the highest quartile of UPF exhibited about 5 times greater odds of severe-CAD than those in the lowest category (OR(95%CI): 5.01 (1.89, 13.29); P-for-trend = 0.002). Overweight/obese participants in the higher UPF quartiles had approximately 2-3.5 times greater odds for severe-CAD than those in the 1st quartile (ORs (95%CIs): 3rd quartile 1.91 (1.14, 3.21); and 4th quartile: 3.53 (2.07, 5.99); P-for-trend < 0.001). Each 10% increase in daily energy intake from UPF was associated with about 1.6-2 times increased severe-CAD risk among overweight/obese and normal-weight individuals (ORs (95%CIs) of 1.64 (1.28, 2.11), and 2.24 (1.24, 4.05), respectively). RCS analysis showed an upward trend toward higher UPF intake in relation to increased risk of severe-CAD (P-for-overall-trend < 0.0001; P-for-nonlinearity = 0.005).

CONCLUSION

The findings obtained underscore a direct association between UPF and the risk of CAD progression among at-risk patients, independent of BMI. However, further prospective studies are essential to confirm these results and better understand this relationship.

Global Burden of the Key Components of Cardiovascular-Kidney-Metabolic Syndrome

Background:

Cardiovascular-Kidney-Metabolic (CKM) syndrome highlights the interconnected nature of metabolic diseases, chronic kidney disease, and cardiovascular diseases, representing a significant and growing public health burden. This study aimed to quantify the global burden of CKM syndrome by examining its key components, including high body mass index (BMI), diabetes, chronic kidney disease, atrial fibrillation and flutter, lower extremity peripheral arterial disease, ischemic heart disease, and stroke.

Methods:

Data were derived from the Global Burden of Disease (GBD) 2021 platform, which provided estimates for incidence, prevalence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs). A decomposition analysis was performed to assess the contributions of population growth, aging, and epidemiological changes to the burden of CKM syndrome. A NORDPRED model was employed to project future trends in DALYs, YLLs, and YLDs through 2046.

Results:

Globally, ischemic heart disease and stroke were the major contributors to the CKM syndrome-related burden in 2021. Regions with a middle Socio-Demographic Index (SDI), such as Southeast Asia and the Western Pacific, experienced the largest burden. However, age-standardized DALY rates were inversely related to SDI, with regions of lower SDI exhibiting higher rates. From 1990 to 2021, DALYs for the seven key components of CKM syndrome increased, primarily driven by population growth and aging. However, age-standardized DALY rates varied across components, with stroke (-38.7% [95% uncertainty interval (UI): -43.4% to -34.0%]), peripheral arterial disease (-30.1% [-33.5% to -27.2%]), and ischemic heart disease (-28.8% [-32.5% to -25.2%]) showing a declining trend, while diabetes (38.2% [29.7% to 47.0%]) and high BMI (25.5% [16.6% to 33.7%]) exhibited an increasing trend. Further projection analysis suggested a consistent trend in the changes in CKM syndrome-related burden from 2022 to 2046, with increases ranging from 55.9% for stroke to 105.7% for atrial fibrillation and flutter.

Conclusions:

The findings of this study highlight the substantial and growing CKM syndrome-related burden, emphasizing the urgent need for comprehensive and targeted interventions.

Management recommendations to reduce cardiac risk in chronic epilepsy

Multifactorial lines of evidence in adults point to a critical linkage between chronic epilepsy and elevated risk for cardiovascular disease and premature cardiac death. Diverse pathophysiological processes appear to be involved that include accelerated atherosclerosis, myocardial infarction, abnormal autonomic tone, heart failure, atrial and ventricular arrhythmias, and hyperlipidemia. Seizure-induced surges in catecholamines and hypoxia may be conducive to cardiovascular damage and the Epileptic Heart condition. The current review provides a systematic strategy for clinical management to reduce risk for cardiovascular disease in adult patients with epilepsy. The proposed approach includes adherence to cardiovascular risk guidelines, incorporation of standard monitoring using electrocardiographic and echocardiographic markers, and regular assessment of plasma lipid profiles. Attention is drawn to the arrhythmogenic risks associated with antiseizure medications (ASMs) with sodium channel blocking properties that can disrupt cardiac conduction and repolarization and predispose to ventricular and atrial arrhythmias. Caution is warranted regarding the use of enzyme-inducing ASMs that can increase plasma lipid levels. The ultimate goals of the proposed management recommendations are to mitigate cardiac risk and reduce premature cardiac death in individuals with chronic epilepsy.

Conduction system pacing in heart failure: Time for a paradigm shift?

Heart failure (HF) is a major clinical challenge characterized by significant morbidity and mortality. Electrical conduction abnormalities play a critical role in HF pathophysiology and progression, often leading to suboptimal outcomes with conventional pacing techniques. Con-duction system pacing (CSP), encompassing His bundle pacing and left bundle branch area pacing, has emerged as a novel approach. Despite data come from observational studies, recent guidelines recommend that a specific population may benefit from CSP. However, significant practical considerations and challenges need to be clarified before CSP can be routinely implemented in clinical practice. The reliance on observational studies means that long-term clinical outcomes for HF patients remain uncertain until data from randomized controlled trials (RCTs) become available. Current CSP practices face challenges with lead implantation, mechanical stress on leads, and the need for more advanced tools and artificial intelligence integration to improve procedure efficacy and safety. Future large-scale RCTs are essential to identify optimal candidates and address these technical challenges, potentially leading to a paradigm shift in HF management.

Machine Learning for In-hospital Mortality Prediction in Critically Ill Patients With Acute Heart Failure: A Retrospective Analysis Based on the MIMIC-IV Database

BACKGROUND

The incidence, mortality, and readmission rates for acute heart failure (AHF) are high, and the in-hospital mortality for AHF patients in the intensive care unit (ICU) is higher. However, there is currently no method to accurately predict the mortality of AHF patients.

METHODS

The Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) database was used to perform a retrospective study. Patients meeting the inclusion criteria were identified from the MIMIC-Ⅳ database and randomly divided into a training set (n = 3,580, 70%) and a validation set (n = 1,534, 30%). The variates collected include demographic data, vital signs, comorbidities, laboratory test results, and treatment information within 24 hours of ICU admission. By using the least absolute shrinkage and selection operator (LASSO) regression model in the training set, variates that affect the in-hospital mortality of AHF patients were screened. Subsequently, in the training set, five common machine learning (ML) algorithms were applied to construct models using variates selected by LASSO to predict the in-hospital mortality of AHF patients. The predictive ability of the models was evaluated for sensitivity, specificity, accuracy, the area under the curve of receiver operating characteristics, and clinical net benefit in the validation set. To obtain a model with the best predictive ability, the predictive ability of common scoring systems was compared with the best ML model.

RESULTS

Among the 5,114 patients, in-hospital mortality was 12.5%. Comparing the area under the curve, the XGBoost model had the best predictive ability among all ML models, and the XGBoost model was chosen as the final model for its higher net benefit. Its predictive ability was superior to common scoring systems.

CONCLUSIONS

The XGBoost model can effectively predict the in-hospital mortality of AHF patients admitted to the ICU, which may assist clinicians in precise management and early intervention for patients with AHF to reduce mortality.

Mitochondrial quality control: Biochemical mechanism of cardiovascular disease

Mitochondria play a key role in the regulation of energy homeostasis and ATP production in cardiac cells. Mitochondrial dysfunction can trigger several pathological events that contribute to the development and progression of cardiovascular diseases. These mechanisms include the induction of oxidative stress, dysregulation of intracellular calcium cycling, activation of the apoptotic pathway, and alteration of lipid metabolism. This review focuses on the role of mitochondria in intracellular signaling associated with cardiovascular diseases, emphasizing the contributions of reactive oxygen species production and mitochondrial dynamics. Indeed, mitochondrial dysfunction has been implicated in every aspect of cardiovascular disease and is currently being evaluated as a potential target for therapeutic interventions. To treat cardiovascular diseases and improve overall heart health, it is important to better understand these biochemical systems. These findings allow the achievement of targeted therapies and preventive measures. Therefore, this review investigates different studies that demonstrate how changes in mitochondrial dynamics like fusion, fission, and mitophagy contribute to the development or worsening of disorders related to heart diseases by summarizing current research on their role.

Sudden cardiac arrest prediction via deep learning electrocardiogram analysis

Aims

Sudden cardiac arrest (SCA) is a commonly fatal event that often occurs without prior indications. To improve outcomes and enable preventative strategies, the electrocardiogram (ECG) in conjunction with deep learning was explored as a potential screening tool.

Methods and results

A publicly available data set containing 10 s of 12-lead ECGs from individuals who did and did not have an SCA, information about time from ECG to arrest, and age and sex was utilized for analysis to individually predict SCA or not using deep convolution neural network models. The base model that included age and sex, ECGs within 1 day prior to arrest, and data sampled from windows of 720 ms around the R-waves from 221 individuals with SCA and 1046 controls had an area under the receiver operating characteristic curve of 0.77. With sensitivity set at 95%, base model specificity was 31%, which is not clinically applicable. Gradient-weighted class activation mapping showed that the model mostly relied on the QRS complex to make predictions. However, models with ECGs recorded between 1 day to 1 month and 1 month to 1 year prior to arrest demonstrated predictive capabilities.

Conclusion

Deep learning models processing ECG data are a promising means of screening for SCA, and this method explains differences in SCAs due to age and sex. Model performance improved when ECGs were nearer in time to SCAs, although ECG data up to a year prior had predictive value. Sudden cardiac arrest prediction was more dependent upon QRS complex data compared to other ECG segments.

Intraplaque Hemorrhage and Plaque Ulceration Are More Likely in Patients with Symptomatic Mild-to-Moderate Carotid Artery Stenosis than in Symptomatic and Asymptomatic High-Grade Stenosis: A Retrospective Cohort Study

BACKGROUND

To compare a cohort of symptomatic patients with mild-to-moderate (<70%) carotid artery stenosis (CAS) with those patients with high-grade (≥70%) CAS (symptomatic and asymptomatic) to assess for markers that places them at a higher risk for stroke.

METHODS

A propensity score-matched cohort study design for all patients who underwent carotid revascularization between 2015 and 2024 was utilized to compare the high-grade (≥70%) symptomatic and asymptomatic carotid stenosis groups against the mild to moderate (<70%) symptomatic carotid stenosis group. Matched variables included age, sex, and atrial fibrillation. Vulnerable plaque was defined as the presence of intraplaque hemorrhage, ulceration, lipid necrotic core, and inflammation on cross-sectional imaging. Images assessed included computed tomography angiography and magnetic resonance angiography with vessel wall imaging. Odds ratios (ORs) were then calculated to assess for risk of vulnerable features present on cross-sectional imaging before carotid intervention.

RESULTS

There were 58 patients in each cohort matched and analyzed. In our cohort of interest, there were fewer patients with diabetes and higher proportion of hyperlipidemia compared to those patients who were symptomatic with ≥70% CAS. Further, there were fewer patients with diabetes and none on dialysis compared to our asymptomatic high-grade stenosis group. The OR of presenting with vulnerable features in our mild-to-moderate stenosis symptomatic group was 5.85 (95% confidence interval (CI) 1.74-19.60, P = 0.002) compared to the high-grade asymptomatic stenosis patients and 7.52 (95% CI 3.22-17.66, P < 0.001) compared to the high-grade symptomatic stenosis patients. Additionally, the symptomatic <70% stenosis group had higher odds of intraplaque hemorrhage (OR 4.91, 95% CI 1.80-13.78, P < 0.001) and ulcerated plaque (OR 8.93, 95% CI 2.47-32.82, P < 0.001) compared to the asymptomatic ≥70% group, as well as increased odds of intraplaque hemorrhage (OR 4.14, 95% CI 1.59-10.74, P = 0.002) and ulcerated plaque (OR 5.16, 95% CI 1.77-15.03, P = 0.001) compared to the symptomatic ≥70% group. Composite outcomes of stroke, myocardial infarction, and death were no different in 30-day and mid-term follow-up.

CONCLUSION

High-risk plaque features on cross-sectional imaging studies may justify a short-term more aggressive medical management and/or early intervention in patients with mild-to-moderate CAS, even when luminal narrowing alone would not typically warrant such measures. As such, use of advanced imaging to assess for plaque characteristics may allow for improved risk stratification and guide earlier management of this patient population.

Composite cardiovascular risk factor control in US adults with diabetes and relation to social determinants of health: The All of Us research program

Background

Data are limited on composite cardiovascular risk factor control in patients with type 2 diabetes mellitus (T2DM). This study aims to identify disparities in cardiovascular risk factor control based on most recent recommendations and relationships to social determinants of health in a large-scale real-world cohort of US adults.

Methods

We analyzed data from 88,416 participants with T2DM in the NIH Precision Medicine Initiative All of Us Research Program 2018-2022. We investigated the management of five key cardiovascular risk factors-glycated hemoglobin (HbA1c), LDL cholesterol (LDL-C), body mass index (BMI), blood pressure (BP), and smoking status. Statistical methods included Chi-square tests for categorical comparisons, t-tests for mean differences, and multiple logistic regression to assess the impact of demographic and socioeconomic factors on risk factor control.

Results

The study revealed low risk factor control with only 27.7 % of participants achieving recommended levels for three or more risk factors (RFs) and 4.9 % for four or more RFs. Overall, while 81.0% were at target for HbA1c, only 37.9% were at target for BP and 10.4% for LDL-C. Notably, only 1.9 % and 6.9 % were at target for HbA1c, LDL-C, and BP together, based on current and prior recommendations, respectively. Significant disparities were observed across race/ethnicity, sex, and socioeconomic lines with 43.1 % of Asian participants at control for ≥3 RFs compared to 21.1 % of non-Hispanic black participants. In logistic regression analysis, factors such as higher income, higher educational attainment, and health insurance were associated with better RF control, while higher polysocial risk scores linked to poorer control.

Conclusions

Despite some progress in managing individual CVD risk factors in T2DM, overall composite risk factor control remains poor, especially among underrepresented and socioeconomically disadvantaged groups. The findings highlight the necessity for integrated healthcare strategies that address both medical and social needs to improve control of CVD risk factors and outcomes in T2DM.

The Metabolite Indole-3-Acetic Acid of Bacteroides Ovatus Improves Atherosclerosis by Restoring the Polarisation Balance of M1/M2 Macrophages and Inhibiting Inflammation

Emerging research has highlighted the significant role of the gut microbiota in atherosclerosis (AS), with microbiota-targeted interventions offering promising therapeutic potential. A central component of this process is gut-derived metabolites, which play a crucial role in mediating the distal functioning of the microbiota. In this study, a comprehensive microbiome-metabolite analysis using fecal and serum samples from patients with atherosclerotic cardiovascular disease and volunteers with risk factors for coronary heart disease and culture histology is performed, and identified the core strain Bacteroides ovatus (B. ovatus). Fecal microbiota transplantation experiments further demonstrated that the gut microbiota significantly influences AS progression, with B. ovatus alone exerting effects comparable to volunteer feces from volunteers. Notably, B. ovatus alleviated AS primarily by restoring the intestinal barrier and enhancing bile acid metabolism, particularly through the production of indole-3-acetic acid (IAA), a tryptophan-derived metabolite. IAA inhibited the TLR4/MyD88/NF-κB pathway in M1 macrophages, promoted M2 macrophage polarisation, and restored the M1/M2 polarisation balance, ultimately reducing aortic inflammation. These findings clarify the mechanistic interplay between the gut microbiota and AS, providing the first evidence that B. ovatus, a second-generation probiotic, can improve bile acid metabolism and reduce inflammation, offering a theoretical foundation for future AS therapeutic applications involving this strain.

Screening and referral programs for diabetes and cardiovascular disease: Can community pharmacists bridge the care gap?

Background and Objectives

Heart disease and diabetes are leading causes of death in the U.S., with timely screening, referrals, and education being critical for effective treatment. The Community-based Valued-driven Care Initiative (CVCI) aimed to develop, implement, and evaluate the feasibility of delivering patient-centered care interventions for high priority disease states in community pharmacies. This article focuses specifically on two of the selected interventions, both of which were screening and referral (S&R) programs for the prevention and treatment of cardiovascular disease (CVD) and diabetes (DM) respectively. This exploratory evaluation was designed as an effectiveness-implementation hybrid Type II study. Its objectives were to assess both implementation and preliminary program effectiveness using mixed data.

Methods

Fifteen community pharmacies opted to implement one of the two programs over a 12-month period. Implementation feasibility involved examining program adoption rates by sites and patients; acceptability, appropriateness, feasibility, and intent to sustain use survey scores; and pharmacists' interviews. Program effectiveness was based on patient referral rates, physician follow-up communication rates, and perceived outcomes, collected via patient logs, surveys, and interviews.

Results

Two of the 15 sites discontinued participation, yielding an 87 % adoption rate. Patient adoption varied based on contact and screening rates, due to differences in patient recruitment, staffing, and workflow. Pharmacist acceptability, compatibility, and feasibility remained high throughout implementation; however, only three pharmacy sites planned on continuing offering the programs. All at-risk patients were appropriately referred based on screening results, with 65 % having their screening results communicated to their primary healthcare providers. The programs were perceived as beneficial, increasing pharmacists' knowledge and motivation, enhancing relationships with patients, and producing an impact on patients'' health.

Discussion

Results highlight the implementation feasibility and preliminary outcomes of delivering DM and CVD S&R programs in community pharmacies. However, despite these positive results, most pharmacies did not intend to continue the programs, underscoring the continued need for sustainable clinical services models in non-traditional settings. Success with broader implementation will require a paradigm shift in support of community pharmacists as clinical care extenders.

Atherosclerosis in patients with cervical artery dissection

INTRODUCTION

Cervical artery dissection (CeAD) is considered a non-atherosclerotic arteriopathy, but atherosclerosis of the cervical arteries may co-exist. We explored the frequency and clinical importance of co-existent atherosclerosis in patients with CeAD.

PATIENTS AND METHODS

Single-center exploratory study from the Stroke Center Basel, Switzerland. We re-reviewed duplex ultrasound images at (i) baseline and (ii) last follow-up visit for the presence versus absence of the following atherosclerotic manifestations in the carotid arteries: (i) abnormal carotid intima-media thickness, (ii) plaques, and (iii) atherosclerotic stenosis. We investigated whether CeAD patients with versus without co-existing atherosclerosis differ regarding (a) recurrence of CeAD and (b) occurrence of vascular events (myocardial infarction, peripheral artery disease, or ischemic stroke) using logistic regression with adjustment for age and follow-up time.

RESULTS

Among 294 CeAD patients (median age 46 [IQR 37-53], 41.8% women), 35 (12%) had any atherosclerotic signs at baseline. Among 196 patients with available follow-up, another 21/196 (11%) patients developed atherosclerosis during a median follow-up of 55.7 months. Patients with atherosclerosis had decreased odds of recurrent CeADs when compared to patients without atherosclerosis (OR 0.03, 95% CI = 0.00-0.30). During follow-up, 6 (15%) vascular events occurred among 40 CeAD patients with atherosclerosis and 13 (8.5%) among 153 patients without atherosclerosis (OR 1.38, 95% CI = 0.39-4.55, data for 3 patients were missing).

DISCUSSION AND CONCLUSION

Signs of atherosclerosis in the carotid artery were detectable in 12% of CeAD patient at baseline. Additionally, 11% of CeAD patients developed new signs of atherosclerosis within the following 5 years. The presence of atherosclerosis may suggest a lower risk for recurrent CeAD. Whether it might indicate an increased risk for late clinical vascular events deserves further studies.

Multimodal deep learning for predicting in-hospital mortality in heart failure patients using longitudinal chest X-rays and electronic health records

Amid an aging global population, heart failure has become a leading cause of hospitalization among older people. Its high prevalence and mortality rates underscore the importance of accurate mortality prediction for swift disease progression assessment and better patient outcomes. The evolution of artificial intelligence (AI) presents new avenues for predicting heart failure mortality. Yet current research has predominantly leveraged structured data and unstructured clinical notes from electronic health records (EHR), underutilizing the prognostic value of chest X-rays (CXRs). This study aims to harness deep learning methodologies to explore the feasibility of enhancing the precision of predicting in-hospital all-cause mortality in heart failure patients using CXRs data. We propose a novel multimodal deep learning network based on the spatially and temporally decoupled Transformer (MN-STDT) for in-hospital mortality prediction in heart failure by integrating longitudinal CXRs and structured EHR data. The MN-STDT captures spatial and temporal information from CXRs through a Hybrid Spatial Encoder and a Distance-Aware Temporal Encoder, ultimately fusing features from both modalities for predictive modeling. Initial pre-training of the spatial encoder was conducted on CheXpert, followed by full model training and evaluation on the MIMIC-IV and MIMIC-CXR datasets for mortality prediction tasks. In a comprehensive view, the MN-STDT demonstrated the best performance, with an AUC-ROC of 0.8620, surpassing all baseline models. Comparative analysis revealed that the AUC-ROC of the multimodal model (0.8620) was significantly higher than that of models using only structured data (0.8166) or chest X-ray data alone (0.7479). This study demonstrates the value of CXRs in the prognosis of heart failure, showing that the combination of longitudinal CXRs with structured EHR data can significantly improve the accuracy of mortality prediction in heart failure. Feature importance analysis based on SHAP provides interpretable decision support, paving the way for potential clinical applications.

Case for Establishing a National Stroke Activation Fee in the United States: Learning From Trauma Centers

There is a large burden of stroke in the United States, and extensive systems of care have been established to address it. The resources devoted to stroke centers are analogous to those of trauma centers, both sharing many strict requirements for certification, clinical preparedness, quality improvement, data management, and reporting. However, trauma programs partly defray these costs through a trauma activation billing code, a billable fee that is charged for activation of the trauma team under strict criteria. There are potential benefits to establishing an analogous national stroke code activation fee. Although a billable stroke code activation fee may increase financial burden on patients, this may be counterbalanced by the significant potential for individual and societal benefits. Providing additional financial support for stroke systems of care may improve acute stroke treatment, reduce stroke burden and poststroke disability, and reduce inequality by broadening the reach of stroke systems of care to disadvantaged communities. Further evaluation of the costs and benefits of implementing a stroke code activation fee based on that currently used by trauma centers is needed.

Potential therapeutic value of dietary polysaccharides in cardiovascular disease: Extraction, mechanisms, applications, and challenges

Dietary polysaccharides, recognised as significant natural bioactive compounds, have demonstrated promising potential for the prevention and treatment of cardiovascular disease (CVD). This review provides an overview of the biological properties and classification of polysaccharides, with particular emphasis on their extraction and purification methods. The paper then explores the diverse mechanisms by which polysaccharides exert their effects in CVD, including their antioxidant activity, protection against ischemia-reperfusion injury, anti-apoptotic properties, protection against diabetic cardiomyopathy, anticoagulant and antithrombotic effects, prevention of ventricular remodeling, and protection against vascular injury. Furthermore, this paper summarises the current status of clinical trials involving polysaccharides in CVD and analyzes the support and challenges posed by these studies for the practical application of polysaccharides. Finally, the major challenges facing the therapeutic use of polysaccharides in CVD are discussed, particularly the issues of low bioavailability and lack of standardized quality control. Through this review, we aimed to provide a reference and guidance for further research on and application of dietary polysaccharides in CVD.

Sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and myocardial infarction undergoing percutaneous coronary intervention: A systematic review and meta-analysis

Background

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown benefits in improving cardiovascular (CV) outcomes in patients with heart failure (HF) and may mitigate symptom progression in myocardial infarction (MI). However, their effectiveness in patients with type 2 diabetes and MI undergoing percutaneous coronary intervention (PCI) is unclear.

Methods

To identify eligible studies, a comprehensive search of electronic databases, PubMed, Cochrane Library, Scopus and Embase, was conducted from inception until May 2024. Results were presented as risk ratios (RR) and their corresponding 95 % confidence intervals (CIs).

Results

Our analysis included 8 observational studies comprising 24,229 patients. The results indicated that SGLT2i with PCI was associated with a significantly reduced risk of all-cause death (RR=0.61; 95 % CI=0.54 to 0.68), CV death (RR=0.46; 95 % CI=0.22 to 0.94), major adverse cardiovascular events (RR=0.80;95 % CI: 0.66 to 0.96), HF-related hospitalizations (RR=0.63; 95 % CI=0.44 to 0.90), stroke (RR=0.77; 95 % CI: 0.62 to 0.96) and acute kidney injury (RR=0.46; 95 % CI: 0.25 to 0.84) compared to PCI without SGLT2i use. However, the risk of revascularization remained comparable between the groups.

Conclusion

Our study demonstrates that SGLT2i with PCI in patients with type 2 diabetes and MI are associated with improved CV outcomes compared to PCI without SGLT2i use. Randomized controlled trials are required to confirm the improvement in outcomes with SGLT2i therapy combined with PCI in patients with MI and diabetes.

Temporal Trends of Ischemic Stroke Risk in Patients With Incident Atrial Fibrillation Before Anticoagulation

BACKGROUND

Atrial fibrillation (AF) is a major risk factor for ischemic stroke (IS), but whether the magnitude of this risk has changed over time is unknown.

OBJECTIVES

This study sought to investigate temporal trends in IS rates in patients with incident AF before oral anticoagulant agent (OAC) therapy.

METHODS

The nationwide FinACAF (Finnish Anticoagulation in Atrial Fibrillation) study covers patients with AF at all levels of care in Finland from 2007 to 2018. A 4-week quarantine period from AF diagnosis was applied, and only follow-up time without OAC therapy was included. Incidence rates of IS were computed in 4-year intervals in relation to sex and non-sex CHA2DS2-VASc (ie, CHA2DS2-VA) score values.

RESULTS

In total, 129,789 patients with new-onset AF were identified (49.2% women; mean age: 71.4 ± 14.5 years). Between the calendar year intervals of 2007-2010 and 2015-2018, the patients' mean CHA2DS2-VA score increased from 2.5 to 3.0, and concurrently the overall IS rate decreased by 25% from 36.7 to 27.6 events per 1,000 patient-years. This trend was driven by a 32% decrease of IS rate in women, particularly among those with higher age and CHA2DS2-VA scores. The IS rate in patients with a CHA2DS2-VA score of 1 was 8.2 events per 1,000 patient-years and remained stable across the study period.

CONCLUSIONS

The initial IS risk in AF patients, before the initiation of OAC therapy, has decreased by 25% between 2007 and 2018 despite an increase in both age and stroke risk scores. The decrease has been most pronounced in older women with high stroke risk scores.

Mitochondrial DNA Polymorphisms of Peripheral Blood Mononuclear Cells Associated with Sustained Ventricular Tachycardia in Patients with Cardioverter-Defibrillator Implantation Indications

Background

Mitochondrial dysfunction in myocardium cells has been implicated in arrhythmogenesis, including ventricular tachycardia (VT). A carriage of point mitochondrial DNA (mtDNA) polymorphisms may contribute to the risk of certain arrhythmias. Therefore, it is hypothesized that mtDNA genotype could predict the risk of sustained VT (SVT). We aimed to explore whether specific mtDNA polymorphisms of peripheral blood mononuclear cells (PBMC) can serve as biomarkers for predicting the risk of SVT in patients with indications for an implantable cardioverter-defibrillator (ICD).

Methods

A total of 122 patients with ICD implantation indications who underwent transthoracic echocardiography (TTE) were enrolled in the study. Total DNA from PBMC was isolated using the phenol-chloroform extraction method. Genotyping of mtDNA polymorphisms A2706G, G3010A and G9055A was performed using restriction fragment length polymorphism analysis. Correlations between clinical parameters and mtDNA polymorphisms with SVT registered prior to ICD implantation were evaluated. Based on our data, we developed a risk model for SVT.

Results

Prior to ICD implantation, 70 (56.6%) patients had SVT (1st group) and 52 (43.4%) patients did not have SVT (2nd group). Patients with SVT were significantly older than patients without SVT (66.9 ± 9.9 year vs. 59.5 ± 10.6 year, p < 0.001), had a lower value estimated glomerular filtration rate (eGFR) (65.7 ± 19.7 mL/min/1.73 m2 vs. 77.9 ± 16.1 mL/min/1.73 m2, p < 0.001) and less frequently had A2706G mtDNA polymorphism (55.7% vs. 76.9%, p = 0.015). According to the multivariable logistic regression, age (odds ratio (OR) = 1.055, 95% confidence interval (CI) 1.009-1.103, p = 0.017), eGFR (OR = 0.974, 95% CI 0.949-0.999, p = 0.041) and absence of A2706G mtDNA polymorphism (OR = 0.335, 95% CI 0.141-0.797, p = 0.013) were independently associated with the SVT. We constructed a logistic equation with calculation of the cut-off value. The discriminative ability of the receiver operating characteristic curve (area under the curve) was 0.761 (95% confidence interval 0.675-0.833; sensitivity 65.71%; specificity 76.92%).

Conclusions

In patients with ICD implantation indications, a carriage of mtDNA polymorphism A2706G is associated with SVT. Our risk model including age, eGFR and absence of A2706G mtDNA substitution was able to distinguish patients with SVT. Further investigations of their predictive significance are warranted.

Clinical Trial Registration

NCT03667989 (https://clinicaltrials.gov/study/NCT03667989).

Pregnancy and Postpartum Effects of Electronic Cigarettes on Maternal Health and Vascular Function in the Fourth Trimester

Pregnancy is a vulnerable time with significant cardiovascular changes that can lead to adverse outcomes, which can extend into the postpartum window. Exposure to emissions from electronic cigarettes (Ecig), commonly known as "vaping," has an adverse impact on cardiovascular function during pregnancy and post-natal life of offspring, but the postpartum effects on maternal health are poorly understood. We used a Sprague Dawley rat model, where pregnant dams are exposed to Ecigs between gestational day (GD)2-GD21 to examine postpartum consequences. Litter and dam health were monitored during the weaning period, and maternal vascular and endocrine function were assessed after weaning. Exposure to Ecig emissions during pregnancy led to fetal losses (i.e., reabsorption in utero) and reduced survival of pups during weaning compared to controls (air-exposed dams). We find that maternal vaping during pregnancy, with or without nicotine (or flavoring) results in maternal vascular and hormonal dysfunction (i.e., reduced prolactin, increased expression of sirtuin 1 deacetylase in the brain). Both 5 and 30W Ecig aerosol exposures resulted in significant impairment of middle cerebral artery reactivity to acetylcholine-mediated dilation (decreasing ~ 22 and ~ 50%, respectively). We also observed an increase in the number of extracellular vesicles (EVs) in plasma from 30-W group that persists up to 3-week postpartum and that these EVs impaired endothelial cell function when applied to in vitro and ex vivo assays. Our data suggest (1) Ecig vaping, even without nicotine or flavorings, during pregnancy alters maternal circulating factors that influence maternal and fetal health, (2) circulating EVs may contribute to the etiology of vascular dysfunction, and (3) that the window for recovery from vascular dysfunction in the dam is likely to be longer than the exposure window.

Association between Type 2 Diabetes onset age and risk of cardiovascular disease and mortality: Two cohort studies from United Kingdom and Hong Kong

OBJECTIVE

This study aimed to evaluate the association between type 2 diabetes mellitus (T2DM) onset age and risk of cardiovascular disease (CVD) and mortality.

METHOD

Two retrospective cohort studies were conducted using the electronic health records from the United Kingdom (UK) and Hong Kong (HK) on adults without CVD. During 2008-2013, 128,918 and 185,646 patients with new-onset T2DM were assigned to the T2DM group, and 5,052,770 and 3,159,396 patients without T2DM were included as controls in the UK and HK cohort, respectively. Patients were stratified into six age groups. Multivariable Cox regression, adjusted for baseline characteristics and fine stratification weights, was used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) for each outcome.

RESULTS

New-onset T2DM was associated with increased CVD and mortality risk, but the risks decreased with age. Compared to those without T2DM in the same age groups, the HR (95 % CI) for CVD in the UK cohort was 3.22 (2.80, 3.71), 1.21 (1.15, 1.26), and 0.99 (0.93, 1.05) for T2DM individuals at ages 18-39, 60-69, and ≥ 80, respectively. Similarly, the HR (95 % CI) for mortality among new-onset T2DM patients was 2.41 (2.06, 2.83) for age 18-39, 1.40 (1.34, 1.46) for age 60-69, and 1.12 (1.08, 1.16) for age ≥ 80. Results from the HK cohort showed a similar pattern.

CONCLUSION

Young onset of T2DM is associated with a significant impact on cardiovascular health later in life. This highlights the importance of the prevention of DM in young adults.

Severity and Risk Factors Associated with Premature Coronary Artery Disease in Patients Under the Age of 50 in Saudi Population: A Retrospective Study

Background and Objectives: The average age of presentation of coronary artery disease (CAD) is one decade younger in the Saudi population relative to other patients worldwide. It is imperative to investigate the prevalence of premature coronary artery disease (PCAD) risk factors in Saudi Arabia's younger population in order to prevent the incidence of cardiovascular diseases in the future. Thus, the present study aimed to evaluate the severity and identify the risk factors associated with PCAD in patients under the age of 50 at King Saud University Medical City (KSUMC), Saudi Arabia. Methods: This observational retrospective study was conducted between June 2022 and June 2023 at King Saud University Medical City, Riyadh, Saudi Arabia. A total of 718 participants were included in the study. The patients, confirmed by electrocardiographic and/or angiographic findings of coronary artery disease, were divided into three age groups: group 1 (<40 years), group 2 (40-45 years), and group 3 (45-50 years). The severity of vessel occlusions was evaluated using the Gensini scoring system. Electrocardiographic findings, sociodemographic variables, and risk factors were also taken into consideration. Results: The mean age of patients in group 1 was 35.2 ± 4.5 years, in group 2 was 43.0 ± 1.3 years, and in group 3 was 48.4 ± 1.4 years. Patients in group 2 had a significantly higher BMI (31.3 ± 10.5) compared to patients in group 3 (29.4 ± 5.3; p = 0.015). Nearly 55% of patients under 40 years had 2 or 3 vessel occlusions according to the vessel score. The percentage of patients with inferior ST elevation was significantly higher in group 1 (<40 years, 11.2%) compared to groups 2 (40-45 years, 10.1%) and 3 (45-50 years, 6.0%; p = 0.001). Non-specific ST-T changes were more common in group 1 (31.4%) and group 2 (32.0%) compared to group 3 (28.4%). Although not statistically significant, left main artery occlusion tended to be higher in group 3 (8.6%) compared to groups 1 (4.6%) and 2 (4.5%; p = 0.229). Hyperlipidemia levels were significantly higher in patients with a Gensini score > 39 compared to those with a Gensini score < 39 (47.9% vs. 37.5%, respectively; p = 0.05). The prevalence of smoking was about 54% in group 1, followed by type 2 diabetes mellitus, dyslipidemia, and hypertension (37%, 36%, and 33%, respectively). Conclusions: This study suggested that PCAD Saudi patients below 40 years of age had a higher percentage of inferior ST elevation compared to older patients, while non-specific ST-T changes were significantly higher in older patients. Astonishingly, more than 50% of patients in all groups had two or three vessel occlusions. There was a high prevalence of modifiable risk factors, such as smoking, in younger patients, whereas hyperlipidemia was a risk factor for PCAD in all age groups. In addition, hyperlipidemia was highly correlated with severe vessel occlusion according to the Gensini score. Therefore, early preventive measures should be taken into consideration to reduce the future burden of cardiovascular complications in this population.