Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association

Cumulative blood pressure predicts risk of cardiovascular outcomes in middle-aged and older population

BACKGROUND

Cardiovascular disease (CVD) remains a major health concern globally, contributing to a considerable disease burden. However, few studies have considered long-term cumulative blood pressure (cBP) exposure in middle-aged and older population in China. The aim of this study was to investigate whether long-term cBP was associated with subsequent cardiovascular outcomes among participants without CVD at baseline in Chinese over 45 years old.

METHODS

6435 participants in China of the CHARLS (The China Health and Retirement Longitudinal Study) were included. Cumulative BP was calculated as the area under the curve using measurements from wave 1 (2011) to wave 2 (2013). Outcomes included CVD, heart disease and stroke.

RESULTS

During a median follow-up period of 5 years, 1101 CVD events, 826 heart disease, and 351 stroke were recorded. Each 1-SD increase in cumulative systolic blood pressure (cSBP), cumulative diastolic blood pressure (cDBP), and cumulative mean arterial pressure (cMAP) was associated with increased risk of CVD (HR, 1.12; 95%, 1.05-1.20, HR, 1.14; 95%, 1.07-1.22, HR, 1.14; 95%, 1.07-1.22), heart disease (HR, 1.05; 95%, 0.97-1.13, HR, 1.09; 95%, 1.01-1.17, HR, 1.08; 95%, 1.00-1.16) and stroke (HR, 1.35; 95%, 1.21-1.51, HR, 1.31; 95%, 1.17-1.46, HR, 1.36; 95%, 1.22-1.51). The relationship between cBP and CVD has only been found in people younger than 60 years of age. A significant association was observed for cumulative pulse pressure (cPP) with stroke (HR, 1.23; 95%, 1.10-1.38). None nonlinear relationships were identified (p-nonlinear > .05). For the prediction of cardiovascular outcomes, cBP load outperformed baseline BP in terms of C statistics (p < .001).

CONCLUSIONS

Long-term cSBP, cDBP and cMAP were associated with subsequent CVD and only found in people younger than 60 years of age, whereas cPP was associated with stroke only across all ages. Cumulative BP may provide a better prediction of cardiovascular outcomes compared with single BP measurement. Efforts are required to control long-term BP in assessing cardiovascular risks.

Prospective association between depressive symptoms and incident hypertension: Results from the Hispanic community health study/study of Latinos

OBJECTIVE

Previous research on depressive symptoms with incident hypertension has yielded mixed results, and this relationship has not been studied in a diverse group of Hispanic/Latino adults.

METHODS

We studied 5927 Hispanic/Latino adults aged 18-74 years from four U.S. cities who attended baseline (2008-2011) and follow-up (2014-2017) examinations of the Hispanic Community Health Study/Study of Latinos. Baseline depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale-10; clinically relevant depressive symptoms were defined as ≥10 points. Blood pressure (BP) was measured using a standardized protocol at both examinations. Hypertension was defined as measured systolic BP ≥130 mmHg, or diastolic BP ≥80 mmHg, or self-reported antihypertension medication use. Analyses accounted for the complex survey design.

RESULTS

Among 5927 persons without hypertension at baseline, the six-year age-adjusted incidence rates of hypertension were 40 and 31 per 1000 person-years among those with and without elevated depressive symptoms, respectively. Persons with elevated depressive symptoms had a 25 % (p = .003) higher 6-year incidence of hypertension than those with fewer symptoms, after adjusting for sociodemographic and clinical covariates. There was an interaction between depressive symptoms and age (pinteraction < 0.05). Among adults aged 18-34 years without hypertension at baseline (n = 1748), those with elevated depressive symptoms had 80 % higher 6-year incidence of hypertension than those with fewer symptoms (p = .001).

CONCLUSIONS

These findings suggest that depressive symptoms are a risk factor for hypertension in young Hispanic/Latino adults. Early screening and treatment of depressive symptoms may aid in the prevention of hypertension.

FKBP5 mediates glucocorticoid signaling in estrogen deficiency-associated endothelial dysfunction

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of mortality among postmenopausal women, with atherosclerosis being a major underlying factor. Endothelial dysfunction, a key initiating event in atherosclerosis, can be triggered by hormonal and metabolic changes. While estrogen deficiency has been linked to increased cardiovascular risk, the molecular mechanisms by which it exacerbates endothelial dysfunction, particularly in the presence of elevated glucocorticoid levels, remain poorly understood. This study aims to explore the role of FK506-binding protein 5 (FKBP5) in mediating glucocorticoid-induced endothelial dysfunction in estrogen-deficient females.

METHODS

Estrogen deficiency was developed in female mice by ovariectomy (OVX). Female mice and human umbilical vein endothelial cells (HUVECs) were treated with dexamethasone (DEX) to mimic elevated cortisol levels in vivo and vitro. Endothelial function of the mice aorta was assessed using wire myography. Oxidative stress and inflammation were evaluated through reactive oxygen species (ROS) detection, immunofluorescence and mRNA expression analysis. The selective FKBP5 inhibitor SAFit2 was used to study the functional role of FKBP5 in these processes.

RESULTS

Estrogen deficiency contributed to endothelial dysfunction in female mice, an effect exacerbated by elevated glucocorticoid levels. FKBP5 expression was upregulated in both ovariectomized mice aortas and DEX-treated endothelial cells. Inhibition of FKBP5 reversed endothelial dysfunction, reduced ROS levels, and suppressed the expression of pro-inflammatory mediators, including ICAM-1, IL-1β, TNF-α, and NF-κB.

CONCLUSION

FKBP5 mediates glucocorticoid-induced endothelial dysfunction under estrogen-deficient conditions. Inhibition of FKBP5 represents a promising therapeutic strategy to ameliorate endothelial dysfunction and improve vascular health in estrogen-deficient women.

Machine Learning Predicts Bleeding Risk in Atrial Fibrillation Patients on Direct Oral Anticoagulant

Predicting major bleeding in nonvalvular atrial fibrillation (AF) patients on direct oral anticoagulants (DOACs) is crucial for personalized care. Alternatives like left atrial appendage closure devices lower stroke risk with fewer nonprocedural bleeds. This study compares machine learning (ML) models with conventional bleeding risk scores (HAS-BLED, ORBIT, and ATRIA) for predicting bleeding events requiring hospitalization in AF patients on DOACs at their index cardiologist visit. This retrospective cohort study used electronic health records from 2010 to 2022 at the University of Pittsburgh Medical Center. It included 24,468 nonvalvular AF patients (age ≥18) on DOACs, excluding those with prior significant bleeding or warfarin use. The primary outcome was hospitalization for bleeding within one year, with follow-up at one, two, and five years. ML algorithms (logistic regression, classification trees, random forest, XGBoost, k-nearest neighbor, naïve Bayes) were compared for performance. Of 24,468 patients, 553 (2.3%) had bleeding within one year, 829 (3.5%) within two years, and 1,292 (5.8%) within five years. ML models outperformed HAS-BLED, ATRIA, and ORBIT in 1-year predictions. The random forest model achieved an AUC of 0.76 (0.70 to 0.81), G-Mean of 0.67, and net reclassification index of 0.14 compared to HAS-BLED's AUC of 0.57 (p < 0.001). ML models showed superior results across all timepoints and for hemorrhagic stroke. SHAP analysis identified new risk factors, including BMI, cholesterol profile, and insurance type. In conclusion, ML models demonstrated improved performance to conventional bleeding risk scores and uncovered novel risk factors, offering potential for more personalized bleeding risk assessment in AF patients on DOACs.

Nuclear factor erythroid 2-related factor improves depression and cognitive dysfunction in rats with ischemic stroke by mediating wolfram syndrome 1

OBJECTIVE

This research aims to investigate the molecular mechanism of nuclear factor erythroid 2-related factor (Nrf2) in improving post-stroke depression and cognitive impairment (PSDCI) by mediating wolfram syndrome 1 (Wfs1).

METHODS

PSDCI rat model was established through middle cerebral artery occlusion (MCAO) and chronic unpredictable mild stress (CUMS). Dimethyl fumarate (DMF) was utilized as an Nrf2 activator, while Wfs1 knockdown lentiviral plasmid was injected into rats for functional investigations. Cognitive function- and depression-relevant parameters were assessed using Morris water maze, forced swimming, sucrose preference, modified neurological severity score (mNSS) tests. The infarct size, pathological changes, and neuronal damage were also evaluated. Additionally, oxidative stress- and inflammatory response-associated proteins were detected by enzyme-linked immunosorbent assay. The binding relation between Nrf2 and the Wfs1 promoter region was analyzed and verified by dual-luciferase and chromatin immunoprecipitation assays.

RESULTS

PSDCI rats had reduced Nrf2 and Wfs1 expression in the hippocampal tissue and inhibited nuclear translocation of Nrf2, showing aggravated oxidative stress and inflammatory responses as well as cognitive dysfunction- and depressive-like symptoms. However, these symptoms in PSDCI rats can be alleviated in response to Nrf2 activation. Furthermore, Nrf2 activation increased the enrichment level of Nrf2 in the Wfs1 promoter region, promoting the transcriptional expression of Wfs1. Wfs1 knockdown partly reversed the effect of Nrf2 activation on the neuronal damage, cognitive dysfunction- and depressive-like symptoms of PSDCI rats.

CONCLUSION

Nrf2 activation can promote Wfs1 expression to reduce neuroinflammation and oxidative stress responses, ultimately alleviating PSDCI in rats.

Exploring OLR1-mediated inflammatory mechanisms in the hematoma microenvironment of acute intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is a devastating form of stroke with high mortality and limited therapeutic options. The current study investigates the role of oxidative low-density lipoprotein receptor 1 (OLR1) within the hematoma microenvironment, focusing on its impact on immune responses and disease progression in ICH patients. Through comprehensive bioinformatics analyses of datasets from the Gene Expression Omnibus (GEO), including peripheral blood, brain tissue, and hematoma samples, we identified significant upregulation of OLR1, particularly in hematoma regions. This upregulation was strongly correlated with increased monocyte and macrophage activity, exacerbating neuroinflammation and contributing to poor clinical outcomes. Single-cell RNA sequencing (scRNA-seq) further elucidated the involvement of OLR1 in monocyte-driven immune responses, suggesting its critical role in the pathophysiology of ICH. Validation through quantitative real-time PCR (qRT-PCR) confirmed that OLR1 expression was significantly higher in hematoma samples than in peripheral blood, with the most notable elevation observed in patients with poor prognoses. Our findings suggest that OLR1 could serve as a promising biomarker and therapeutic target for modulating immune responses in ICH. Targeted therapies to regulate OLR1 expression could potentially mitigate neuroinflammation and improve recovery outcomes. This study not only enhances the understanding of the molecular mechanisms underlying ICH but also provides a foundation for developing novel therapeutic strategies that focus on the hematoma microenvironment and immune modulation.

Draconis Sanguis (DS) from the fruit of Daemonorops draco Bl. ameliorates cardiac function through optimizing myocardial energy metabolism by promoting angiogenesis in ischemic heart failure

BACKGROUD

Draconis Sanguis (DS), a precious traditional Chinese medicine for activating blood and dissolving stasis, has been used in treating ischemic cardiovascular diseases. However, the underlying mechanism of DS against heart failure after myocardial ischemia (MI) remains unclear, especially concerning angiogenesis and energy metabolism, which have never been elucidated.

PURPOSE

This study aimed to explore the protective mechanism of DS in ischemic heart failure (IHF) from the perspectives of angiogenesis and energy metabolism.

METHODS

We investigated the effects of DS on an in vivo model of IHF induced by ligation of the left anterior descending coronary artery (LADCA) and an in vitro model of HUVECs injury induced by hypoxia. High-performance liquid chromatography (HPLC) was performed to identify components of DS. Echocardiography, histopathology, and cardiac enzymes analysis were used to examine the anti-ischemic heart failure effect of DS. Transcriptome sequencing, positron emission tomography (PET), HPLC, and chocardiography were performed on heart tissues to explore the underlying mechanism. Furthermore, the relevant targets were investigated by real-time quantitative PCR (RT-qPCR), Western blotting, immunohistochemistry, and immunofluorescence. Finally, potential pharmacodynamic substances were identified with a cell model and molecular docking.

RESULTS

The results showed DS increased survival of rats with IHF for 28 days by 10 %, significantly ameliorated cardiac function in rats with IHF, increased left ventricular ejection fraction by 20 %, and it reduced pathological changes and cardiac enzymes levels. These results indicated that DS alleviated myocardial ischaemia injury. The effects described above were related to the regulation of the HIF-1α/VEGF signallings pathway to promote angiogenesis in the ischemic myocardium, increase the local oxygen supply and optimize myocardial energy metabolism "promoting lipid and inhibiting glucose" and increasing local ATP production. Moreover, DS compounds were identified; these compounds protected HUVECs from hypoxia and glucose deprivation, significantly upregulated HIF-1α gene expression, and were shown to be related to this mechanism in vitro experiments.

CONCLUSIONS

DS ameliorates cardiac function by optimizing myocardial energy metabolism after promoting angiogenesis via HIF-1α/VEGF signalling pathway regulation.

Comparing perceptions of leading causes of death in a diverse sample of community-dwelling women in the United States

BACKGROUND

Heart disease is the leading cause of death (LCOD) for women in the United States. However, despite decades of public health campaigns, awareness of heart disease among women, especially those with racial/ethnic minority backgrounds and young women, significantly declined from 2009 to 2019.

OBJECTIVES

The aim of this study was to compare the differences in heart disease awareness as the LCOD among Black, Hispanic, White, and Asian/Other women groups.

METHODS

In this cross-sectional, online survey study, 422 community-dwelling women were analyzed. Heart disease as the LCOD was categorized as the correct answer. We implemented log-linear models via a Poisson regression to estimate unadjusted and adjusted relative risks [RRs] of race in predicting correct knowledge of LCOD.

RESULTS

The mean age was 41.2 (±12.9) years. The sample represents 39.8 % Hispanic, 28.4 % White, 19.9 % Black, 11.9 % Asian/others. After adjusting for age and cardiovascular disease risks, Black and Hispanic women, as compared to White women, had significantly lower awareness of heart disease as the LCOD [(Adjusted RR=0.69, 95 % CI: 0.52, 0.92); (Adjusted RR= 0.78, 95 % CI: 0.78 -0.94), respectively]. Additionally, physical inactivity and hypertension medication intake were significantly associated with this level of awareness (P < 0.5).

CONCLUSION

Lower heart disease awareness in Black and Hispanic women persists. It is crucial to develop more effective approaches to close this disparity. Testing new methods, such as applying artificial intelligence to send more culturally appropriate and personalized messages, is urgently needed to raise women's awareness of their heart disease risk.

Tracing Visual Expertise in ECG Interpretation: An Eye-Tracking Pilot Study

BACKGROUND

Visual expertise is pivotal for accurate ECG interpretation. We aimed to identify and measure expertise-based differences in visual search patterns, cognitive load, and diagnostic accuracy during ECG analysis using eye-tracking technology.

METHODS

First- to third-year residents and board-certified expert cardiologists interpreted ECGs of patients with suspected acute coronary syndrome, while eye-tracking glasses recorded fixation count, duration, and pupil dilation. Diagnostic accuracy and cognitive load via NASA Task Load Index were analyzed. Heatmaps illustrated relationships between cognitive load, perceived workload, and self-assessed performance across experience levels and ECG task complexities.

RESULTS

Expert readers interpreted ECGs significantly faster than residents (107.6 ± 32.8 vs. 205.31 ± 57.43 s; p < 0.001) and demonstrated higher diagnostic accuracy across all levels of task difficulty (p < 0.001). Eye-tracking analysis revealed that experts exhibited fewer fixations (67.7 ± 25.7 vs. 143.7 ± 29.9; p < 0.001) and longer fixation durations (3.9 ± 0.7 vs. 3.2 ± 1 s; p = 0.032) than residents. Experts also showed lower pupil dilation changes (4.8% ± 2% vs. 10.5% ± 4.2%; p = 0.015). Increased task difficulty was associated with greater pupil dilation, particularly among novices (mean pupil dilation for difficult tasks 13.4% ± 4.1% vs. 7.3% ± 2.3% for easy tasks; p = 0.008), indicating higher cognitive demand. Experts maintained superior self-assessed performance (8 ± 0 vs. 7 ± 1.2; p = 0.009) and reported lower perceived negative workload (4.5 ± 1.45 vs. 6 ± 0.55; p = 0.041).

CONCLUSIONS

In this pilot study, expert readers achieved faster and more accurate diagnoses, exhibiting more efficient visual search patterns and lower cognitive load. Pending external validation, our findings suggest that ECG training programs should focus on developing targeted visual techniques, cognitive efficiency, and adaptive coping strategies to enhance accurate interpretation.

Association Between High Blood Pressure-Specific Health Literacy and Health-Related Quality of Life Among Patients With Hypertension in Urban-Rural Fringe Communities in China: A Mediation Analysis of Social Support and Self-management

BACKGROUND

Despite rapid urbanization, no researchers have focused on patients with hypertension in urban-rural fringe areas, where rural characteristics are retained but the influences of urbanization are typically found.

OBJECTIVE

In this study, we aimed to reduce health inequities by examining the status quo of health-related quality of life (HRQOL), high blood pressure-specific health literacy (HBP-HL), and social support and self-management and to explore how HBP-HL influences HRQOL among patients with hypertension in urban-rural fringe communities.

METHODS

Four hundred six patients with hypertension completed physical examinations and HBP-HL, HRQOL, self-management, and social support assessments via in-person interviews. Bootstrap multiple mediating effect analysis was used to explore associations between HBP-HL and HRQOL.

RESULTS

Only 24.2% of participants had a high HRQOL. None of the participants had adequate HBP-HL, only 23.2% had limited HBP-HL, and 76.8% had moderate HBP-HL. The HBP-HL score was directly correlated with HRQOL (β = 0.802; 95% confidence interval, 0.344-1.259) and indirectly correlated with HRQOL via social support (β = 0.368; 95% confidence interval, 0.202-0.568) and self-management (β = 0.314; 95% confidence interval, 0.102-0.560). The total contribution rate of the mediating effect was 41.4%.

CONCLUSIONS

The HRQOL and HBP-HL scores of patients with hypertension were intermediate and inadequate, respectively. In addition, HBP-HL directly and indirectly influenced HRQOL through social support and self-management. Health providers should screen for inadequate HBP-HL in patients with hypertension before intervention. Health-promoting interventions involving HBP-HL as a breakthrough point should be tailored to control blood pressure and improve HRQOL.

Association between dental floss use and atherosclerotic cardiovascular disease in American adults

BACKGROUND

Atherosclerotic cardiovascular disease (ASCVD) remains a major cause of global morbidity and mortality. Emerging research suggests that oral hygiene practices, particularly dental floss use, may reduce the risk of ASCVD.

OBJECTIVES

The purpose of this study was to examine the association between dental floss use and ASCVD prevalence.

METHODS

Data from NHANES participants who completed home interviews and dental evaluations were analyzed. ASCVD was defined as angina, stroke, myocardial infarction, or coronary artery disease. Dental floss use was self-reported over the past seven days. Covariates included demographic, socioeconomic, lifestyle, and clinical factors. Weighted logistic regression was used to assess the relationship between dental floss use and ASCVD prevalence.

RESULTS

This study included a total sample of 7253 participants with a mean age of 53.8±14.6 years. The sample consisted of 47.6 % male participants. The ethnic composition included 64.3 % Non-Hispanic White. Regular dental floss use was correlated with a lower likelihood of developing ASCVD and Stringent Criteria (infarction or stroke), with ORs of 0.76 (95 % CI: 0.60, 0.97) p=0.028 and 0.68 (95 % CI: 0.49, 0.94) p=0.022, respectively. Flossing 3-4 days/week was associated with reduced ASCVD risk, OR = 0.57 (95 % CI: 0.38, 0.84) p=0.006. Similar reductions were seen for stringent criteria: flossing 3-4 days/week: OR = 0.57 (95 % CI: 0.32, 0.99) p=0.047, flossing ≥5 days/week: OR = 0.69 (95 % CI: 0.47, 1.00) p=0.049.

CONCLUSIONS

Regular dental floss use may reduce the risk of ASCVD. These results support the inclusion of oral hygiene practices in cardiovascular disease prevention strategies.

Incidence of new onset arterial hypertension after metabolic bariatric surgery: an 8-year prospective follow-up with matched controls

BACKGROUND

Metabolic bariatric surgery (MBS) reduces the risk of new-onset hypertension; however, it is unclear whether this effect varies according to patient sex, age, or socioeconomic background. This study aimed to assess the risk of new-onset arterial hypertension after MBS, with a special focus on these patient characteristics.

METHODS

This follow-up study with matched controls was nested in a large employee cohort, the Finnish Public Sector study, consisting of individuals with no hypertension at baseline. For each patient who underwent laparoscopic MBS between 2008 and 2016, two propensity-score matched controls were selected from individuals hospitalized with a diagnosis of obesity or individuals with self-reported severe obesity [body mass index (BMI) ≥ 35 kg/m 2 ] but no recorded history of MBS. Cases of new-onset hypertension were identified via linked electronic health records from the national health registries until December 31, 2016.

RESULTS

The study included 912 patients and 1780 matched controls. The rate of new-onset hypertension per 1000 person-years was 2.8 in the surgery group and 9.6 in the control group, with a rate ratio of 0.29 (95% confidence intervals 0.15-0.57) and a rate difference of -6.8 (95% confidence intervals -9.6 to -4.0) per 1000 person-years. No significant differences in rate reduction after MBS were observed to be associated with patient sex, age, or socioeconomic status.

CONCLUSION

Metabolic bariatric surgery reduces the risk of new-onset arterial hypertension across all age-, sex-, and socioeconomic subgroups.

Modeling diabetic cardiomyopathy using human cardiac organoids: Effects of high glucose and lipid conditions

Diabetic cardiomyopathy (DCM) is a complex metabolic disorder resulting from chronic hyperglycemia and lipid toxicity, which leads to cardiac dysfunction, fibrosis, inflammation, and mitochondrial impairment. Traditional two-dimensional (2D) cell cultures and animal models have limitations in replicating human cardiac physiology and pathophysiology. In this study, we successfully developed a three-dimensional (3D) model of DCM using cardiac organoids generated from human induced pluripotent stem cells (hiPSCs). These organoids were treated with varying concentrations of glucose and sodium palmitate to mimic the high-glucose and high-lipid environment associated with diabetes. At lower concentrations, glucose and sodium palmitate enhanced cell viability, while higher concentrations induced significant cardiotoxic effects, including apoptosis, oxidative stress, and mitochondrial dysfunction. The cardiac organoids also exhibited increased expression of cardiac injury markers, fibrosis-related genes, and inflammatory cytokines under high-glucose and high-lipid conditions. Treatment with metformin, a widely used antidiabetic drug, mitigated these adverse effects, indicating the model's potential for drug testing and evaluation. Our findings demonstrate that this human-derived 3D cardiac organoid model provides a more physiologically relevant platform for studying DCM and can effectively complement traditional models. This model holds promise for advancing the understanding of diabetic heart disease and for assessing the efficacy of potential therapeutic interventions.

In Vitro Comparison of Device-Induced Hemolysis, Platelet Defects, and von Willebrand Factor Degradation Between the HeartMate 2 and HeartMate 3 Pumps

BACKGROUND

Left ventricular assist devices (LVADs) have been utilized to maintain the circulatory demands of patients with end-stage heart failure. Despite their positive impact, hemocompatibility-related adverse events remain a major challenge. The aim of this study is to compare in vitro hemocompatibility performance between the HeartMate 2 (HM2) and HeartMate 3 (HM3) pumps by assessing device-induced blood damage in an in vitro circulatory loop.

METHODS

Fresh healthy human blood was circulated for 4 h in a circulatory loop assisted by an HM2 or HM3 pump at a flow rate of 4.5 L/min and a pressure head of 75 mmHg. Hourly blood samples were collected for analysis of hemolysis, platelet activation, platelet receptor shedding, and high molecular weight multimer (HMWM) degradation of von Willebrand factor (VWF).

RESULTS

The data from the hourly blood samples showed that the HM3 pump caused significantly lower levels of hemolysis, platelet activation, platelet receptor shedding, and HMWM degradation of VWF compared to the HM2 pump.

CONCLUSION

The HM3 exhibited superior overall hemocompatibility to the HM2, underscoring the advantages of the fully magnetically levitated centrifugal pump design in the HM3 compared to the mechanical bearing-supported axial pump design of the HM2.

Disparities in cardiovascular disease outcomes and economic burdens among minorities in southeastern Virginia

BACKGROUND

Cardiovascular diseases are the leading cause of mortality in the United States, presenting significant public health challenges and financial burdens, particularly in Southeastern Virginia, where African American and Hispanic (AA&H) populations are disproportionately affected.

METHODS

This retrospective observational study analyzed data from 30,855 hospital discharges of AA&H patients across Southeastern Virginia from 2016 to 2020, focusing on individuals aged 18 to 85 with cardiovascular diseases. Utilizing the Virginia Health Information database, we examined demographic information, clinical data, and healthcare utilization patterns through hypothesis tests and regression models to explore associations between these variables and the economic impacts of cardiovascular diseases.

RESULTS

Heart failure and shock (47.2% of discharges) and cardiac arrhythmia and conduction disorders (12.3%) were the most prevalent cardiovascular conditions. Female patients incurred significantly higher charges than males across conditions (7.1% higher in heart failure, p < 0.0001; 8.8% higher in chest pain, p < 0.01). Younger patients (< 65 years) faced 8.5% higher charges for cardiac arrhythmia with procedures (p < 0.0001) and 5.2% higher charges for circulatory disorders (p < 0.05). Year of discharge consistently predicted increasing costs (standardized coefficient 0.816 for acute myocardial infarction, p < 0.0001). The presence of fluid and electrolyte disorders was associated with significantly higher charges across conditions (standardized coefficient 0.042 for heart failure, p < 0.0001; 0.051 for acute myocardial infarction, p < 0.0001).

DISCUSSION

The findings highlight the complex interplay between demographic characteristics and healthcare costs among AA&H populations, underscoring the need for targeted interventions. The significant economic impact observed calls for culturally competent healthcare strategies that can mitigate high costs and improve health outcomes. However, the retrospective, administrative nature of the data limits establishing causality, with potential misclassification of some conditions.

CONCLUSION

This study provides crucial insights into cardiovascular disease management's demographic and economic dimensions among AA&H populations in Southeastern Virginia. By identifying key factors contributing to healthcare disparities, the research supports the development of tailored interventions aimed at reducing the burden of cardiovascular diseases, thereby improving overall health equity and reducing economic strains on the healthcare system.

Association of gut microbiota and immunometabolic profiles with ischemic stroke severity

This study investigates the influence of three regulators of human homeostasis-intestinal microbiota, immune profile, and circulating metabolites-on stroke severity. We conducted a study involving 33 patients with mild/moderate stroke (MS) and 32 with severe stroke (SS), all assessed during the acute phase (first 24 h). The analysis focused on microbiota composition (45 patients), serum metabolomics and inflammatory markers (20 patients). The patients with SS exhibited more pronounced insulin resistance associated with increased levels of branched-chain amino acids and their metabolites. SS patients showed an increase in inflammatory cytokines IL-6 and TNF-α, and surprisingly an increase in IL-10 and butyrate which are anti-inflammatory. SS patients also displayed a distinct microbiota profile, with statistically significant differences in β-diversity compared to the MS group, notably a higher prevalence of Pseudomonadota (formerly Proteobacteria). In summary, our data indicate that patients with SS, compared to those with MS, are characterized by a more inflammatory and insulin-resistant state, associated with three key regulators: microbiota, metabolites, and interleukins. These findings provide new insights into the regulatory components of the gut-brain axis, which could be developed into cost-effective and widely accessible therapies for SS.

Prediction model and scoring system for the risk of atrial fibrillation recurrence in patients with atrial fibrillation and obstructive sleep apnoea syndrome: a retrospective case-control study

BACKGROUND

The high prevalence of atrial fibrillation (AF) and obstructive sleep apnea syndrome (OSAS) imposes a substantial disease burden on public healthcare, making it a significant health concern in the current era. However, there is currently a lack of risk assessment tools for AF recurrence in patients with AF and OSAS. Therefore, this study aims to explore the factors influencing AF recurrence in patients with AF and OSAS, and to establish a predictive model and scoring system for AF recurrence rates.

METHODS

The study included a total of 423 patients with AF and OSAS, who were randomly divided into train set (n = 296) and test set (n = 127) in a ratio of 7:3. Afterwards, the train set was split into a recurrence group and a non-recurrence group for further analysis of indicators while in hospital.

RESULTS

Following Lasso regression screening, 8 variables were selected from a pool of 62 variables from patients with AF and OSAS. Additionally, the study incorporated the CHA2DS2-VASc score and its components of interest, the severity of OSAS and hypoxemia, and whether patients received catheter ablation (CA). Multivariable Cox regression analysis revealed: Hb < 115 g/L (HR = 2.27), P > 1.51mmol/L (HR = 3.77), PCT > 2ng/ml (HR = 15.72) as independent risk factors. Hb > 150 g/L (HR = 0.66), TT4 < 66 nmol/L (HR = 0.16) were identified as independent protective factors. The train set showed AUC values of 0.65, 0.71, and 0.71 at the 1st, 3rd, and 5th year, respectively, while the validation set displayed AUC values of 0.60, 0.59, and 0.64 at the 1st, 3rd, and 5th year, respectively, indicating good predictive performance of the model. The AF recurrence rate scoring system categorized patients in the train and test sets into low-risk, medium-risk, and high-risk groups, with HR values of 2.36 and 6.79 for AF recurrence rates in the medium-risk and high-risk groups of the train set, and an HR value of 2.77 for the medium-risk group in the test set.

CONCLUSION

The predictive models and scoring systems developed in this study demonstrate good predictive ability in assessing the recurrence of AF in patients with OSAS, offering invaluable clinical guidance and references.

CLINICAL TRIAL NUMBER

Not applicable.

"Gut Microbiota as a Therapeutic Target for Hypertension: Challenges and Insights for Future Clinical Applications" "Gut Microbiota and Hypertension Therapy"

PURPOSE OF REVIEW

Systemic hypertension is a major risk factor for cardiovascular disease and remains challenging to manage despite the widespread use of antihypertensive medications and lifestyle modifications. This review explores the role of gut microbiota in hypertension development and regulation, highlighting key mechanisms such as inflammation, gut-brain axis modulation, and bioactive metabolite production. We also assess the potential of microbiota-targeted therapies for hypertension management.

RECENT FINDINGS

Emerging evidence indicates that microbial dysbiosis, high-salt diets, and gut-derived metabolites such as short-chain fatty acids (SCFAs) and bile acids significantly influence blood pressure regulation. Preclinical and early clinical studies suggest that interventions targeting gut microbiota, including probiotics, prebiotics, synbiotics, fecal microbiota transplantation (FMT), and dietary modifications, may help modulate hypertension. However, variability in gut microbiota composition among individuals and limited human trial data pose challenges to translating these findings into clinical practice. While microbiota-based therapies show promise for hypertension management, further research is needed to establish their efficacy and long-term effects. Large-scale, standardized clinical trials are crucial for understanding the therapeutic potential and limitations of gut microbiota interventions. A deeper understanding of the gut-hypertension axis could lead to novel, personalized treatment strategies for hypertension.

Improving and preserving cardiorespiratory fitness, muscle strength and adiposity through a complex lifestyle intervention in community-dwelling older adults with elevated cardiometabolic risk: study protocol for the RESTART randomised controlled trial

INTRODUCTION

As the global population ages, the incidence of cardiometabolic diseases and associated healthcare costs rise. There is a critical need for preventive interventions enabling long-lasting treatment effects to address the decline in physical performance and metabolic health among older adults. The RESTART (RE-inventing Strategies for healthy Ageing: Recommendations and Tools) randomised controlled trial (RCT) aims to evaluate whether a complex lifestyle intervention can improve and maintain cardiorespiratory fitness, muscle strength and body composition among older adults with elevated cardiometabolic risk.

METHODS AND ANALYSIS

This is the study protocol for the RESTART trial, a two-arm, open-label, parallel-group RCT conducted in Tromsø, Norway, targeting adults aged 60-75 with obesity, a sedentary lifestyle and high cardiovascular risk. Participants are block-randomised (1:1) into either an intervention or active control group. The initial intervention phase (12 months) includes: (a) supervised high-intensity aerobic and strength training (≥85% of maximum capacity) performed two times weekly, (b) behavioural counselling based on acceptance and commitment therapy during six group sessions and (c) dietary guidance based on national nutrition recommendations during two group/two individual sessions. After 12 months, participants are gradually introduced to exercise sessions offered by local organisations and fitness centres, to enable independent maintenance of lifestyle change. The primary outcome is a change in cardiorespiratory fitness (V̇O2max) at 24 months. Secondary and tertiary outcomes include additional parameters potentially sensitive to lifestyle change, such as 1-repetition maximum muscle strength, muscular power, device-measured physical activity levels, body composition, waist circumference, body weight, cognitive function and self-reported health-related quality of life. Data collection is scheduled at baseline, 6, 12 and 24 months, with health economic and qualitative analyses to evaluate the intervention's impact and participant experiences.

ETHICS AND DISSEMINATION

Ethical approval for the RESTART trial was obtained from the Regional Committee for Medical Research Ethics in Northern Norway. Results will be disseminated through peer-reviewed publications, conferences and community-based channels targeting older adults, healthcare providers and municipal health organisations. This trial will also inform public health strategies for lifestyle interventions among ageing populations.

TRIAL REGISTRATION NUMBER

NCT06122441.

The Effectiveness of a Race-Based Stress Reduction Intervention on Improving Stress-Related Symptoms and Inflammation in African American Women at Risk for Cardiometabolic Disease: Protocol for Recruitment and Intervention for a Randomized Controlled Trial

BACKGROUND

In recent years, the prevalence of cardiometabolic disease (CMD) in African American women has risen; the risk also increases with age, in comparison to men. Evidence demonstrates that stressful life events, including experiences of racism and perceived discrimination, contribute substantially to inflammatory diseases, such as CMD. Despite this evidence, few evidence-based interventions are available to assist individuals from minoritized communities in coping with the chronic stress related to their racial or ethnic identity.

OBJECTIVE

Our proposed randomized controlled trial will test a novel, race-based intervention tailored to African American women, called Resilience, Stress, and Ethnicity (RiSE).

METHODS

In this randomized controlled trial, we will randomize participants 1:1 to the 8-week, group-based RiSE program (intervention) or a health education program (active control group). Both programs will consist of synchronous classes on Zoom and will be led by experts. The primary end point will be stress at 6 months after the intervention, and the efficacy of RiSE will be evaluated for improving stress-related symptoms (current perceived stress, depressive symptoms, fatigue, and sleep disturbance), improving coping strategies, and reducing inflammatory burden in African American women at risk for CMD. Validated survey measures and inflammatory biomarkers will be assessed at baseline, midintervention, intervention completion, and 6 months after the intervention, and differences over time by intervention will be evaluated using mixed effects models.

RESULTS

This study was funded by the National Institute on Aging on March 30, 2023, with recruitment and enrollment beginning in October 2023. The study is underway, with 120 participants enrolled as of March 2025.

CONCLUSIONS

This study will be one of the first to examine a race-based stress reduction intervention in African American women and has the potential to improve the health of minoritized groups faced with chronic stress associated with experiencing racism and discrimination. We anticipate that RiSE will reduce stress-related symptoms, enhance adaptive coping, and reduce inflammation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05902741; https://www.clinicaltrials.gov/study/NCT05902741.

Rare genetic variants involved in increased risk of paroxysmal atrial fibrillation in a Japanese population

Atrial fibrillation (AF) is the most prevalent arrhythmia in the world and can cause serious complications such as stroke or heart failure. Paroxysmal atrial fibrillation (PAF), a subtype of AF, accounts for approximately 25% of AF cases and is estimated to affect approximately 30 million people worldwide. Despite extensive genetic research on AF, the genetic factors involved in PAF in East Asian (EAS) populations remain unidentified. The aim of our study was to identify genetic factors associated with PAF in the Japanese population, contributing to our understanding of the genetic architecture of AF in Japanese populations. We conducted whole-exome sequencing on a cohort of 1176 PAF individuals and 1172 non-PAF control subjects in a Japanese population. We processed the sequencing data in accordance with the best practices outlined in the Genome Analysis Toolkit (GATK) and conducted gene-based association tests under three variant grouping strategies (masks) using the burden test, SKAT, and SKAT-O. We then performed a meta-analysis of the resulting P-values, which revealed that four genes-ZNF785, SMPD3, GFRA4, and LGALS1-were significantly associated with PAF, representing novel findings. These findings provide new insights into PAF pathogenesis and suggest potential biomarkers for early detection.

Loss of peptidylarginine deiminase 4 mitigates maladaptive cardiac remodeling after myocardial infarction through inhibition of inflammatory and profibrotic pathways

Inflammation and progressive fibrosis represent predictive risk factors for heart failure (HF) development following myocardial infarction (MI). Peptidylargininine deiminase 4 (PAD4) catalyzes the citrullination of arginine residues in polypeptides and has recently been identified as a contributor to HF pathogenesis. This study aimed to evaluate the role of PAD4 in monocytes / macrophages (Mo/Mφ) and cardiac fibroblasts (CFs) for cardiac repair following MI and HF progression. Cardiac Padi4 expression significantly increased in mice subjected to MI by permanent coronary artery ligation as well as in humans who died from MI. Transcriptome analysis revealed marked downregulation of inflammation-related genes in infarcted hearts and cardiac Mo/Mφ from global PAD4 knockout (PAD4-/-) mice on day 7 post-MI accompanied by increased frequency of reparative CD206+ macrophages. Mechanistically, pharmacological and genetic PAD4 inhibition abrogated nuclear NF-κB translocation and inflammatory gene expression in bone marrow-derived macrophages (BMDM). Simultaneously, reduced inflammation and diminished cardiac levels of transforming growth factor-β (TGF-β) along with impaired IL-6 / TGF-β signaling in PAD4-/- CFs were associated with decreased expression of fibrotic genes, reduced collagen deposition, improved cardiac function, and enhanced 28-day survival in PAD4-/- mice. Strikingly, whereas pharmacological PAD inhibition in the acute phase after MI exacerbated cardiac damage, treatment starting on day 7 ameliorated cardiac remodeling and improved long-term survival in mice. Collectively, we here identified PAD4 as a critical regulator of inflammatory genes in Mo/Mφ and of profibrotic pathways in CFs. Thus, therapeutic approaches directed against PAD4 are promising interventions to alleviate adverse cardiac remodeling and subsequent HF development.

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.

Trends in Risk Factor Management Among Stroke Survivors in a Representative US Population

Introduction: Whether stroke survivors can meet risk factor recommendations set by guidelines is unknown. We investigated the proportion of stroke survivors that met the secondary prevention guideline recommendations, analyzed the trends over time, and assessed the impact on mortality. Methods: Using cross-sectional data on stroke survivors from the National Health and Nutrition Examination Survey (NHANES) from 1999-2018, we determined the proportion of stroke survivors who met guideline recommendations. We performed linear regression analyses to determine trends and performed Cox-proportional hazards models to assess mortality. Results: We included 2197 stroke survivors (51% female, mean age 68). Most patients met guidelines set for alcohol consumption (93% [95% CI 91-95]), while few met the thresholds for physical activity (18% [95% CI 15-30]) or BMI (25% [95% CI 22-27]). The proportion that met guidelines for blood pressure (+1.4% every 2 years) and LDL (+3.0%) increased, while the proportion that met physical activity guidelines decreased (-1.1%). Mortality was increased in those that did not meet recommendations regarding blood pressure (HR 1.24 [95% CI 1.04-1.48]) and smoking (HR 1.30 [95% CI 1.03-1.64]). Conclusion: More than half of stroke survivors do not meet recommendations set by prevention guidelines on BMI, physical activity and LDL.

Effectiveness and Safety of Edoxaban in the Routine Clinical Care of Atrial Fibrillation Patients in Brazil: Prospective 1-Year Follow-Up Study - EdoBRA

BACKGROUND

Edoxaban, an orally administered anticoagulant, has been shown to be safe and effective in preventing stroke in atrial fibrillation (AF) patients. Given its widespread use since approval, evaluating edoxaban's real-world performance in the Brazilian clinical context is crucial.

OBJECTIVE

The study aimed to report the one-year safety and effectiveness of edoxaban in AF patients in Brazil.

METHODS

EdoBRA is a multi-center, prospective, observational investigation conducted across 30 Brazilian research sites. Bleeding events were considered as safety measures and cardiovascular events were considered for effectiveness measures. Descriptive analyses were performed. Kaplan-Meier curves were generated for time-to-event analysis and a 95% confidence interval was used as appropriate.

RESULTS

Among the 705 enrolled participants, 590 were included in the analysis for having at least one follow-up or one reported event. Mean (±SD) CHA2DS2-VASc risk score was 3 (3.3 ± 1.6) and the mean HAS-BLED risk score was 2 (1.8 ± 1.2). During the one-year follow-up period, nine major bleedings events were reported, including five cases of gastrointestinal bleeding (IP 0.85 [95% CI =0.82; 0.88]). Among the cardiovascular events recorded (N = 68), there were four stroke events (IP 0.68 [CI 95% 0.65;0.71]), one transient ischemic attack (IP 0.17 [CI 95% (0.16;0.18]) and 1 event was Venous Thromboembolic Events (IP 0.17 [CI 95% (0.16;0.18]). No systemic embolic event was exhibited by any patient.

CONCLUSION

In an elderly population with several comorbidities routinely treated with edoxaban for AF, the rates of cardiovascular event and major bleeding were low.

A nutrient wide association study of cardiovascular disease prevalence in older adults from NHANES 2007 to 2018

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, particularly among older adults. Identifying modifiable dietary factors associated with CVD prevalence is essential for prevention. This cross-sectional study analyzed 7,341 adults aged ≥ 65 years from NHANES 2007-2018. CVD was defined based on self-reported physician-diagnosed conditions, including coronary heart disease, heart failure, angina, heart attack, or stroke. A nutrient-wide association study (NWAS) evaluated associations between 56 dietary nutrients and CVD prevalence using multivariable logistic regression. Dose-response relationships were assessed using restricted cubic spline (RCS) models. Model discrimination was evaluated using receiver operating characteristic (ROC) analysis. Eight nutrients were significantly associated with CVD prevalence after adjusting for confounders and correcting for multiple comparisons: PUFAs 20:4 (OR 0.88, 95% CI 0.80-0.97, P = 0.024), 22:5 (OR 0.72, 95% CI 0.56-0.92, P = 0.019), and 22:6 (OR 0.92, 95% CI 0.87-0.99, P = 0.032); total choline (OR 0.96, 95% CI 0.93-0.99, P = 0.024); cholesterol (OR 0.89, 95% CI 0.82-0.96, P = 0.037); protein (OR 0.82, 95% CI 0.76-0.89, P = 0.040); vitamin A (OR 0.95, 95% CI 0.91-0.99, P = 0.045); and total sugars (OR 0.97, 95% CI 0.96-0.98, P = 0.049). Clustering analysis identified protective effects of fat-soluble vitamins and unsaturated fatty acids. The inclusion of these nutrients significantly improved model discrimination (P < 0.05). This study identified key dietary nutrients and clusters associated with CVD prevalence and characterized their dose-response relationships. Integrating these nutrients into predictive models enhances CVD risk discrimination, providing actionable dietary targets for prevention strategies in older adults.

Bryostatin-1 improves function in arteries with suppressed endothelial cell autophagy

We have previously reported that when autophagy is suppressed in endothelial cells (ECs), a glycolytic defect limits shear-stress -induced ATP production to an extent that purinergic 2Y1 receptor (P2Y1R)-mediated activation of EC nitric oxide (NO) synthase (eNOS) is compromised. Subsequently we demonstrated the functional relevance of this finding in arteries from mice with genetic, pharmacological, and age-associated EC autophagy impairment. Using gain and loss of function approaches in vitro, we further revealed that p-PKCδT505 serves as a signaling link between P2Y1R activation and NO generation. Here we sought to discern the functional relevance of this observation. First, shear-stress- induced activating phosphorylation of eNOS (p-eNOSS1177) that is otherwise prevented by knockdown of autophagy-related gene 3 (Atg3) in ECs was restored by the PKC agonist bryostatin-1. Next, in murine models of genetic and age-associated EC autophagy compromise, depressed vasodilation displayed by femoral and cerebral arteries was reversed by bryostatin-1 in a manner that could be prevented by concurrent NO synthase inhibition. Finally, the bryostatin-1-mediated normalization of intraluminal flow-induced vasodilation observed in femoral arteries from both models of EC autophagy disruption was mitigated by inhibiting downstream targets of p-PKCδT505 i.e., p-PKDS744/S748 and p-PKDS916. These findings provide evidence that stimulating PKC/PKD has strategic potential to restore compromised endothelial function in pathologies associated with suppressed EC autophagy e.g., aging.

Gender disparities in cangrelor usage for the treatment of patients with acute coronary syndrome undergoing percutaneous coronary intervention

BACKGROUND

Cangrelor is a rapid, potent intravenous P2Y12 inhibitor that reduces thrombotic and ischemic events in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI). This study aimed to investigate gender disparities in Cangrelor usage, efficacy, and safety across gender in patients presenting with acute coronary syndrome (ACS) undergoing PCI.

METHODS

This is an observational retrospective analysis included patients presented with ACS who underwent PCI and received Cangrelor at MedStar Washington Hospital Center (2018-2023). Access to Cangrelor across gender was recorded. The primary safety outcome was in-hospital thrombolysis in myocardial infarction (TIMI) major bleeding, while the primary efficacy outcome was in-hospital major adverse cardiac events (MACE): defined as the composite of in-hospital cardiac death, MI, and stroke. A control group was investigated gender disparities in patients with ACS who did not receive Cangrelor.

RESULTS

A total of 2859 patients with ACS underwent PCI (991 women and 1868 men). Among these patients, women were less likely to receive Cangrelor during PCI compared to men (40.2 % vs. 48 %; P < 0.001). The Cangrelor cohort consisted of 1295 patients (398 women, 897 men), and among those, women had significantly higher rates of in-hospital TIMI major bleeding (3.5 % vs. 0.6 %; P < 0.001) and higher in-hospital MACE (5.0 % vs. 1.3 %; P < 0.001) compared to men. Multivariate modeling after adjusting for differences in baseline characteristics showed that women were associated with increased TIMI major bleeding (OR 4.02, 95 %CI 1.09-14.79; P 0.037), but not in-hospital MACE (OR 2.11, 95 %CI 0.88-5.07; P 0.096). In the non-Cangrelor cohort, there were no significant difference between women and men in TIMI major bleeding (0.8 % vs. 0.9 %, P = 0.865) and MACE (1.5 % vs. 1.6, P = 0.842).

CONCLUSION

In patients presenting with ACS, women who received cangrelor had higher rates of TIMI major bleeding, without an impact on MACE. This may partially explain why women with ACS undergoing PCI receive less cangrelor compared to men. Therefore, increased bleeding events in women receiving cangrelor warrant further investigation.

Effectiveness of a BCW-based interactive pictorial health education program among patients with hypertension in the urban-rural fringe area in China

OBJECTIVE

To evaluate the effects of the interactive pictorial health education (IPHE) program on enhancing high blood pressure-specific health literacy (HBP-HL), controlling blood pressure, and improving self-management behavior (SMB) and Health-related Quality of Life (HRQOL) among hypertensive patients with inadequate HBP-HL (HPIH) in the urban-rural fringe area in China.

METHODS

A quasi-experimental study with repeated measures was used. The intervention group (n = 60) received IPHE program, while the control group (n = 60) received health education lectures. Outcome measures were HBP-HL, systolic blood pressure (SBP), diastolic blood pressure (DBP), SMB and HRQOL evaluated at baseline (T0), six months (T6), nine months (T9), and 12 months (T12).

RESULTS

The effects of intervention factors on HBP-HL, SBP and HRQOL were stronger over time (P < 0.05), but not on DBP and SMB. The SMB scores were better in the intervention group at T6, T9 and T12 (P < 0.05). Compared to T0, the SBP and DBP in the intervention group decreased by 9.22 and 4.27 mmHg at T12.

CONCLUSION

The IPHE program can enhance HBP-HL, control blood pressure, and improve SMB and HRQOL among HPIH.

PRACTICE IMPLICATIONS

The IPHE program was an active and promising method to manage HPIH.

Assessing Serum Apolipoproteins A-I and b100 and the Apo A-I/Apo b100 Ratio in Relation to Premature Coronary Artery Disease and Its Severity

BACKGROUND

Apolipoproteins are proposed to predict the status of CAD and its occurrence. The aim of this study was to assess the association between serum levels of apolipoproteins A-I, b100 and the ratio of Apo A-I/Apo b100 with the development and severity of premature coronary artery disease (PCAD).

METHODS

In this registry-based case-control study, patients under the age of 50 years with at least one coronary artery disease with stenosis ≥ 50% (PCAD group) were assessed and compared with patients without coronary artery involvement (normal group). The Gensini score considered to assess the CAD severity.

RESULTS

The mean Apo A-I and Apo A-I/Apo b100 levels were higher in the control group, but Apo b100 was higher in the patient group (p < 0.05). Apo A-I and Apo A-I/Apo b100 ratio had a negative correlations (rho = -0.57, rho = -0.71, respectively) with the severity of PCAD based on the Gensini score. Apo b100 also had a positive correlation (rho = 0.67) with the severity of PCAD (p < 0.05). Apo A-I and Apo b100 were significantly associated with the occurrence of PCAD. Based on the results of multivariable analysis, with a 1 mg/dL increase in Apo A-I levels and Apo b100, the odds of PCAD decreased by 13% and increased by 31%, respectively. With a 1 mg/dL increase in apolipoprotein A-I and apolipoprotein b100 levels, the odds of high Gensini score decreased by 7% and increased by 8%, respectively (p = 0.001).

CONCLUSION

The use of serum apolipoproteins in patients with suspected PCAD can predict the occurrence of CAD and its severity.

Exploring natural therapy for chronic heart failure: experience in traditional Chinese medicine treatment before 2022

Background

Traditional Chinese medicine has great advantages in improving symptoms of CHF such as chest tightness, shortness of breath, and fatigue. In addition, some traditional Chinese medicines can be used as both medicine and food, which have good effects on the prevention and treatment of CHF patients at home.

Method

A comprehensive search across China National Knowledge Infrastructure (CNKI), Wanfang, and Wei Pu (VIP) databases was conducted to retrieve pre-2022 literature related to CHF. After standardization, frequency analysis and Apriori algorithm were used to analyze these data.

Result

Among 626 effective medical records, Fuling, Huangqi, and Danshen are the most commonly used herbs; The medication for chest tightness is closely related to Tinglizi; The medication for palpitations is closely related to Guizhi, Fuzi, Zhigancao, and Wuweizi; The medication of fatigue and poor appetite is closely related to Huangqi and Baizhu; The medication for lower limb edema is closely related to Fuling and Tinglizi; The medication for coughing is closely related to the use of Tinglizi, Wuweizi, Kuxingren, and Sangbaipi; Insomnia is closely related to Suanzaoren and Dazao.

Conclusion

The components in traditional Chinese medicine that have anti heart failure effects and reliable evidence can be potential candidates for drug discovery, while dietary therapeutic herbs such as Fuling, Huangqi, Danshen, and Zhigancao can be developed as health products.

The severity of ischemic stroke and risk of all-cause mortality in patients with atrial fibrillation on different oral anticoagulant treatments admitted to the emergency department

Although direct oral anticoagulants (DOACs) are non-inferior to Vitamin K antagonists (VKA) in preventing ischemic stroke (IS) in atrial fibrillation (AF) patients, there are limited data regarding stroke severity and prognosis of patients admitted with IS during DOAC treatment. We performed a single center retrospective study including patients with AF on oral anticoagulants admitted to the Emergency Department for IS were included. The primary endpoint was to analyse the severity of stroke evaluated through NIHSS scale according to anticoagulant therapy. The secondary endpoint was 3-month all-cause mortality. A total of 106 AF patients were included, with a mean age of 81.3 ± 7.5 years. Overall, 54.7% were women and 61.3% on DOAC. The AF patients on DOAC were older, with no other clinical differences. Median NIHSS was 12 (Interquartile Range [IQR] 5-19). At multivariable logistic regression analysis DOAC use (compared to warfarin) was associated with lower risk of moderate-severe/severe stroke (NIHSS ≥ 16) (Odds Ratio [OR] 0.355, 95% confidence interval [95% CI] 0.127-0.995). Mechanical thrombectomy was strongly associated with higher severity of stroke (OR 6.113, 95%CI 2.186-17.099). During follow-up, 42 patients died. DOAC use inversely correlated with mortality risk (OR 0.323, 95%CI 0.127-0.822) after adjusting for CHA2DS2-VASc, time to hospital admission from symptom onset and type of acute treatment. In conclusion, in our contemporary real-world population, patients on DOACs treatment admitted for IS had better outcomes in terms of stroke severity and all-cause mortality compared with patients on VKAs.

Review of the Global Activity of Heart Transplant

Heart failure is a global disease with significant morbidity. Heart transplant (HT) can be a lifesaving therapy for select patients with end-stage heart failure. In 2020, over 7000 HTs were performed globally; 90% of HTs were performed in the United States and Western Europe, with only 10% throughout the rest of the world. In this article, we offer an overview of the global landscape of HT, exploring challenges and prospects worldwide. We review HT practices, rates and post-HT outcomes, underscoring the differences between countries within each region. We review limitations hindering HT expansion, such as sociocultural factors, as seen in Japan and Israel; health care funding, in countries like India and South Africa; socioeconomic disparities in access, like the United States; and shortage in organ supply, as seen in China and Saudi Arabia. This review underscores the need to address limitations and highlights opportunities to enhance global HT accessibility, especially in lower- and middle-income countries.

Gender Differences in Objective and Subjective Social Isolation and Self-Reported Hypertension in Older Adults

Hypertension is a major public health concern, especially in older adults, and gender differences are a factor in terms of its prevalence. Social connections benefit health, while social isolation is linked to negative outcomes. Prior studies suggest social isolation and connectedness vary by gender, but few have explored this relationship with hypertension. This study examined gender differences in the association between social isolation and hypertension in older adults using data from the National Survey of American Life (1280 adults aged ≥55). Weighted logistic regressions tested gender differences in objective and subjective social isolation and hypertension. Both men and women who were objectively isolated from family and friends, or only friends, were less likely to have hypertension than those not isolated. However, when accounting for subjective isolation, only isolation from family predicted hypertension. Gender moderated this relationship-men isolated from family and friends had a higher likelihood of hypertension, while no such association was found for women. Findings suggest that preventing objective isolation, particularly from family, may help reduce hypertension risk in older adults. This study highlights the need to further investigate social isolation's impact on health and its underlying mechanisms among older adults in the U.S.

Prevalence of anemia and associated factors in patients with heart failure admitted to Jimma university medical center

BACKGROUND

Anemia is common among adults with heart failure and is linked to increased risks of illness, decreased physical abilities, lower quality of life, more hospital visits, and higher mortality rates. In Ethiopia, about 23% of reproductive-age women and 18% of adult men suffer from anemia. However, data is lacking about its prevalence and associated factors in admitted heart failure patients in our setup.

OBJECTIVES

To determine the prevalence of anemia and associated factors in heart failure patients who were admitted to the emergency and medical ward at Jimma University Medical Center, Southwest Ethiopia.

METHODS

A cross-sectional study was conducted among all heart failure patients admitted to Jimma University Medical Centre from September 1, 2023, to February 30, 2024. A complete blood count was done for these patients. The demographic data and clinical characteristics of study participants were collected using a structured questionnaire. Data was collected on patients' admission and discharge and then data was cleared and entered into a computer using SPSS software version 26. Logistic regression was conducted to declare statistically significant variables with anemia at p-value < 0.05 with 95% CI of Adjusted odds ratio.

RESULTS

A total of 269 participants were involved in the analysis with a mean age of 50.39 ± 18.08 years. The prevalence of anemia among patients with heart failure was 49.8% (43.7-55.9%). Anemia was statistically significant with hypokalaemia: AOR%CI; 3.88(1.6-9.43), creatinine level: AOR%CI; 3.58(1.74-7.38), re-admission: AOR%CI; 3.7(1.63-8.39), and length of hospital stay AOR%CI; 4.11(2.18-7.78).

CONCLUSION

In the current study, nearly half of admitted heart failure patients had anemia, which is associated with hypokalaemia, high creatinine level, readmission, and a longer duration of hospital stay. There was a high prevalence and clinical impact of anemia heart failure patients in our study.

VERICIDuAT: Real-life study of vericiguat in patients with heart failure with reduced ejection fraction

INTRODUCTION AND OBJECTIVES

The aim of this study is to assess the safety in a real-world cohort of patients with heart failure with reduced ejection fraction (HFrEF).

METHODS

Observational, retrospective and single-center study with patients on vericiguat treatment from the Cardiology and Internal Medicine outpatient clinic of the Valencia General University Hospital Consortium during 2023 year and with minimum follow-up of 6 months. Patients with HFpEF diagnosis and optimized treatment according to the ESC 2021 clinical practice guidelines were included, to whom treatment with vericiguat was started.

RESULTS

We included 123 patients with a mean age of 78 years, mostly men (62%) and with NYHA II functional status (52%). 98 patients completed follow-up after a median follow-up of 162 days (IQR 13-343). The average dose of vericiguat used was 8,3 ± 2,7 mg and 75 patients achieved the target dose of 10 mg (71%). At the end of follow-up, no significant changes were observed in the values of proBNP (pg/mL), CA125, hemoglobin (mg/dl), electrolytes, glomerular filtration rate (mL/min/m2) and systolic blood pressure (mmHg). Of all the patients who completed follow-up, 11 (11%) discontinued treatment due to adverse effects, mostly symptomatic hypotension, digestive symptoms and pruritus; 25 died (20%).

CONCLUSIONS

The use of vericiguat is safe, if used according to the technical data sheet, in terms of the established parameters. Further long-term studies are needed to evaluate the impact of vericiguat as a potential disease-modifying treatment.

Silacrown ethers as ion transport modifiers and preliminary observations of cardiovascular cell line response

Crown ethers have been shown to have physiological effects ascribed to their ionophoric properties. However, high levels of toxicity precluded interest in their evaluation as therapeutic agents. We prepared new silacrown analogs of crown ethers. These initial studies focused on examples of large ring silacrown ethers having at least fourteen ring atoms with at least one lipophilic or hydrophobic substituent on the ring and/or on the silicon atom. The synthesis of silacrown ethers, ionophoric behavior, toxicity studies, and preliminary pharmacodynamic studies in cardiac myocyte cell lines are presented and compared to their carbon analogs. We report the effects of these compounds in HL-1 cells, an atrial muscle cell line with plasma membrane and sarcoplasmic reticulum Ca2+ channels that give rise to spontaneous Ca2+ transients driven by action potentials. Dicyclohexano-18-crown-6 and the silacrown equivalent dimethylsila-17-cyclohexanocrown-6 were both found to rapidly inhibit the Ca2+ transients after acute treatment, and these effects were reversed when extracellular KCl was increased to cause plasma membrane depolarization. The data suggest that the silacrowns can mimic the effects of crown ethers with similar ring sizes, and this appears to be due to their effects on membrane potential and suppression of action potential firing.

Nonprescription Magnesium Supplement Use and Risk of Heart Failure in Patients With Diabetes: A Target Trial Emulation

BACKGROUND

Both diabetes and low magnesium-containing food intake may increase the risk of heart failure (HF). However, the effect of nonprescription magnesium supplements on the risk of HF or major adverse cardiac events in patients with diabetes is unknown.

METHODS AND RESULTS

Using a target-trial-emulation approach, we assembled a national cohort of 94 239 veterans ≥40 years with diabetes, without prior HF or magnesium use, who received ambulatory care in the US veterans-health care system documented by electronic clinic notes between January 1, 2006 and December 31, 2020. A natural language processing approach was used to detect self-reported magnesium-supplement use from clinic notes, n=17 619 were identified as users versus n=76 620 as nonusers. Using inverse probability treatment weighting, we constructed a cohort balanced in 88 baseline characteristics between users and nonusers. The primary outcome was incident HF. Secondary outcomes were major adverse cardiac events (myocardial infarction, stroke, HF hospitalization, or death). Hazard ratios (HRs) associated with magnesium-supplement use and outcomes were estimated in the inverse probability treatment weighting weighted cohort using Cox regression. The inverse probability treatment weighting weighted cohort had a mean age of 67.4±10.3 years; 18.4% were Black, and 5.1% were women. The mean duration of magnesium-supplement use was 3.5±3.1 (interquartile range, 1.1-5.1) years. Incident HF occurred in 8.0% of users and 9.7% of nonusers of magnesium supplements (HR, 0.94 [95% CI, 0.89-0.99]). Magnesium-supplement use was also associated with a reduced risk of major adverse cardiac events (HR, 0.94 [95% CI, 0.90-0.97]).

CONCLUSIONS

Long-term nonprescription magnesium supplement use was associated with a lower risk of incident HF and major adverse cardiac events in patients with diabetes. These findings should be replicated in randomized controlled trials.

Adherence and persistence with direct oral anticoagulants by dose regimen: A systematic review

INTRODUCTION

Direct oral anticoagulants (DOACs) are used in patients with non-valvular atrial fibrillation (NVAF) to prevent complications such as embolic events. Poor adherence to DOACs increases the risk of these complications. This manuscript reviews the impact of once-daily (OD) vs twice-daily (BID) dosing regimens on adherence and persistence to the authorized DOACs (dabigatran, rivaroxaban, apixaban and edoxaban) in patients with NVAF, aiming to provide insights into guide clinical decision-making.

METHODS

A systematic review was performed. First, a bibliographical search was carried out in PubMed, Scopus and the Cochrane Library. Articles that provided quantitative data comparing adherence and/or persistence associated with OD vs BID regimens of DOACs among patients receiving treatment for NVAF were included. Two analyses of adherence and persistence were conducted, one based on the overall outcomes and another, more restricted, to minimize the risk of overestimating results. Additionally, univariate analyses were conducted based on the number of follow-up days and the DOAC molecule.

RESULTS

Thirty-nine studies, involving 976 494 patients, were analysed. The OD regimen demonstrated significantly higher adherence and persistence (P < .05) than the BID regimen in most outcomes. Adherence favoured OD in 53.1% of cases, while only 12.2% favoured BID. Similarly, persistence was higher with the OD regimen in 67.7% of cases compared to 14.9% for the BID regimen. These results remained consistent over time; nevertheless, variations were observed depending on the specific DOAC molecules.

CONCLUSION

Adherence and persistence of treatment with DOACs in patients with NVAF were greater for the OD than for the BID regimen.

Effects of a Behavior Intervention Based on the Recurrence Risk Perception and Behavioral Decision Model for Ischemic Stroke Patients: A Randomized Controlled Trial

Behavioral management is essential to preventing recurrence after stroke, but its adherence is limited worldwide. We aimed to assess the impact of the behavior intervention based on the Recurrence risk perception and Behavioral decision Model for ischemic stroke patients' health behavior. This study was a single-blind, randomized, controlled trial with a 3-month follow-up. The outcome measures were the perception of the risk of stroke recurrence, behavioral decision, and health behavior. A total of seventy participants were randomized to the intervention group (n = 35) or control group (n = 35). The former received a twelve-week theory-based intervention in addition to the routine education, while the control group received only the routine education. The generalized estimating equations results indicated that the intervention group had significantly greater improvements in perception of the risk of stroke recurrence compared to the control group at all T1 (B = 0.13, 95% CI: 0.03 to 0.23), T2 (B = 0.18, 95% CI: 0.07 to 0.28), and T3 (B = 0.16, 95% CI: 0.07 to 0.25) after adjusting for stroke frequency. Statistically significant improvements were found in behavioral decision for the intervention group compared with the control group at T2 (B = 0.25, 95% CI: 0.09 to 0.41) and T3 (B = 0.26, 95% CI: 0.10 to 0.43). Results also showed a significantly higher increase in health behavior at T1 (B = 0.29, 95% CI: 0.09 to 0.48) and T2 (B = 0.22, 95% CI: 0.04 to 0.40). The intervention can improve the perception of the risk of stroke recurrence, behavioral decision, and health behavior in ischemic stroke patients. IMPLICATIONS: This study provides a reference point for promoting healthy behaviors in patients with ischemic stroke. A recurrence risk perception and behavioral decision model-based intervention was deemed to be feasible and useful in practice. PATIENT OR PUBLIC CONTRIBUTION: Patients and their caregivers agreed to participate in the study and shared their experiences of participating in research with us.

Multi-Omic Insight Into the Molecular Networks in the Pathogenesis of Coronary Artery Disease

BACKGROUND

Genome-wide association studies have revealed numerous loci associated with coronary artery disease (CAD). However, some potential causal/risk genes remain unidentified, and causal therapies are lacking.

METHODS AND RESULTS

We integrated multi-omics data from gene methylation, expression, and protein levels using summary data-based Mendelian randomization and colocalization analysis. Candidate genes were prioritized based on protein-level associations, colocalization probability, and links to methylation and expression. Single-cell RNA sequencing data were used to assess differential expression in the coronary arteries of patients with CAD. TAGLN2 (Transgelin 2), APOB (Apolipoprotein B), and GIP (Glucose-dependent insulinotropic polypeptide) were identified as the genes most strongly associated with CAD, with TAGLN2 exhibiting the most significant association. Higher methylation levels of TAGLN2 at specific Cytosine-phosphate-Guanine sites were negatively correlated with its gene expression and associated with a lower risk of CAD, whereas higher circulating TAGLN2 protein levels were positively associated with CAD risk (odds ratio,1.66 [95% CI, 1.32-2.08). These results suggest distinct regulatory mechanisms for TAGLN2. In contrast, APOB and GIP showed positive associations with CAD risk, whereas DHX58 (DExH-box helicase 58) and SWAP70 (Switch-associated protein 70) were associated with decreased risk.

CONCLUSIONS

Our findings provide multi-omics evidence suggesting that TAGLN2, APOB, GIP, DHX58, and SWAP70 genes are associated with CAD risk. This work provides novel insights into the molecular mechanisms of CAD and highlights the potential of integrating multi-omics data to uncover potential causal relationships that cannot be fully captured by traditional genome-wide association studies.

Lower albumin levels are associated with 1-year mortality in older patients hospitalized for acute heart failure: THE ALBIMED-HF study

Hypoalbuminemia (i.e., albumin levels ≤ 3.5 g/dL) is a negative prognostic marker in several conditions, including acute heart failure (AHF). Hypoalbuminemia is common in patients hospitalized in Internal Medicine (IM) divisions. However, its role in predicting long-term mortality in AHF patients hospitalized in this setting is not clear. In THE ALBIMED-HF study, all patients hospitalized for AHF in the First Division of Internal Medicine at Ospedale di Circolo and Fondazione Macchi (ASST Sette Laghi, Varese, Italy) between January 1st and December 31st 2022 were retrospectively included. Clinical information was retrieved from patient electronic medical records. Four hundred and ninety-eight patients were considered for the present study (median age 85 [78-89] years). Median Charlson Comorbidity Index was 6 [5-7]. Heart failure (HF) with preserved ejection fraction was found in 40.6% of patients (N = 202/498). Median albumin levels were 3.2 [2.8-3.5] g/dL and hypoalbuminemia was recorded in 76.5% of patients (N = 381/498). At 12 months, 221 out of 498 patients (44.4%) died, and mortality was significantly higher in patients with hypoalbuminemia than in those without (N = 185/381 [48.6%] vs. N = 36/117 [30.8%], p < 0.001). Patients who died within 12 months were older, suffered more frequently from chronic kidney disease and active cancer, and exhibited higher C-reactive protein levels. At the multivariable analysis, hypoalbuminemia was independently associated with 12-month all-cause mortality (HR 2.41, 95% confidence interval 1.20-4.83). Hypoalbuminemia was independently associated with 12-month all-cause mortality in older patients with multiple comorbidities hospitalized for AHF in an IM division.

Systemic aging fuels heart failure: Molecular mechanisms and therapeutic avenues

Systemic aging influences various physiological processes and contributes to structural and functional decline in cardiac tissue. These alterations include an increased incidence of left ventricular hypertrophy, a decline in left ventricular diastolic function, left atrial dilation, atrial fibrillation, myocardial fibrosis and cardiac amyloidosis, elevating susceptibility to chronic heart failure (HF) in the elderly. Age-related cardiac dysfunction stems from prolonged exposure to genomic, epigenetic, oxidative, autophagic, inflammatory and regenerative stresses, along with the accumulation of senescent cells. Concurrently, age-related structural and functional changes in the vascular system, attributed to endothelial dysfunction, arterial stiffness, impaired angiogenesis, oxidative stress and inflammation, impose additional strain on the heart. Dysregulated mechanosignalling and impaired nitric oxide signalling play critical roles in the age-related vascular dysfunction associated with HF. Metabolic aging drives intricate shifts in glucose and lipid metabolism, leading to insulin resistance, mitochondrial dysfunction and lipid accumulation within cardiomyocytes. These alterations contribute to cardiac hypertrophy, fibrosis and impaired contractility, ultimately propelling HF. Systemic low-grade chronic inflammation, in conjunction with the senescence-associated secretory phenotype, aggravates cardiac dysfunction with age by promoting immune cell infiltration into the myocardium, fostering HF. This is further exacerbated by age-related comorbidities like coronary artery disease (CAD), atherosclerosis, hypertension, obesity, diabetes and chronic kidney disease (CKD). CAD and atherosclerosis induce myocardial ischaemia and adverse remodelling, while hypertension contributes to cardiac hypertrophy and fibrosis. Obesity-associated insulin resistance, inflammation and dyslipidaemia create a profibrotic cardiac environment, whereas diabetes-related metabolic disturbances further impair cardiac function. CKD-related fluid overload, electrolyte imbalances and uraemic toxins exacerbate HF through systemic inflammation and neurohormonal renin-angiotensin-aldosterone system (RAAS) activation. Recognizing aging as a modifiable process has opened avenues to target systemic aging in HF through both lifestyle interventions and therapeutics. Exercise, known for its antioxidant effects, can partly reverse pathological cardiac remodelling in the elderly by countering processes linked to age-related chronic HF, such as mitochondrial dysfunction, inflammation, senescence and declining cardiomyocyte regeneration. Dietary interventions such as plant-based and ketogenic diets, caloric restriction and macronutrient supplementation are instrumental in maintaining energy balance, reducing adiposity and addressing micronutrient and macronutrient imbalances associated with age-related HF. Therapeutic advancements targeting systemic aging in HF are underway. Key approaches include senomorphics and senolytics to limit senescence, antioxidants targeting mitochondrial stress, anti-inflammatory drugs like interleukin (IL)-1β inhibitors, metabolic rejuvenators such as nicotinamide riboside, resveratrol and sirtuin (SIRT) activators and autophagy enhancers like metformin and sodium-glucose cotransporter 2 (SGLT2) inhibitors, all of which offer potential for preserving cardiac function and alleviating the age-related HF burden.

Relationship Between CHA₂DS₂-VASc Score on Admission and In-Hospital Major Adverse Cardiovascular Events in Patients Diagnosed With ST-Elevation Myocardial Infarction

The CHA₂DS₂-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, sex) scoring system, which includes conventional risk factors of coronary artery disease, was originally created to quantify the risk of thromboembolism in patients with atrial fibrillation. This study evaluated the usefulness of this score to predict adverse outcomes in STEMI (ST-elevation myocardial infarction) patients without atrial fibrillation. Primary end points were identified as MACE (major adverse cardiovascular events) which included in-hospital death or cerebrovascular accident. MACE rate was 10% (193 patients). The CHA₂DS₂-VASc score was an independent predictor of MACE (95% CI, 2.31 [1.37-3.9]; P = .0016). Other independent predictors of MACE included heart rate (95% CI, 1.56 [0.97-2.50]; P = .0242), admission Killip class (95% CI, 24.19 [10.74-54.46]; P < .0001), admission creatinine level (95% CI, 1.54 [1.10-2.16]; P = .0024), peak CK-MB level (95% CI, 1.63 [0.98-2.70]; P = .0001), and no-reflow (95% CI, 2.45 [1.25-4.80]; P = .0085). A nomogram was developed to estimate the risk of in-hospital adverse outcomes for STEMI patients. The CHA₂DS₂-VASc score was an independent predictor of MACE in STEMI patients. Linear analysis of CHA₂DS₂-VASc score without dichotomization was the main difference of this study from others.

Dietary intake of coenzyme Q10 reduces oxidative stress in patients with acute ischemic stroke: a double-blind, randomized placebo-controlled study

OBJECTIVES

Ischemic stroke is one of the most common neurological disorders. Oxidative stress, inflammation, and the reduction of Brain-Derived Neurotrophic Factor (BDNF) are implicated in cell death during ischemic stroke. Several studies suggest that Coenzyme Q10 (CoQ10) has antioxidant, anti-inflammatory, neuroprotective properties and can increase BDNF levels. This study investigated the effects of oral CoQ10 supplementation on oxidative stress biomarkers Total Antioxidant Capacity (TAC), Superoxide Dismutase (SOD), Malondialdehyde (MDA), Total Thiol Groups (TTG) - as well as serum levels of Interleukin-6 (IL-6) and BDNF in ischemic stroke patients.

METHODS

Fifty patients hospitalized for acute ischemic stroke were randomly divided into two groups: placebo (n = 25) and CoQ10 (600 mg/day) supplementation (n = 25). The intervention began 24 hours after stroke onset and continued for 30 days.

RESULTS

Significant reductions in serum MDA and IL-6 levels, alongside increased SOD and BDNF levels, were observed in the CoQ10 group. No significant differences were found in TAC or TTG levels between the groups.

CONCLUSIONS

A 30-day regimen of CoQ10 (600 mg/day) resulted in reduced oxidative stress and inflammation, alongside increased BDNF, suggesting potential neuroprotective benefits for post-stroke rehabilitation. CoQ10 May be considered a therapeutic option for enhancing neuroprotection and rehabilitation in stroke patients.

Assessment of Risk Factors for Atrial Fibrillation With a Particular Focus on Echocardiographic Parameters, in Patients With Acute Myocardial Infarction

BACKGROUND

Atrial fibrillation is the most common arrhythmia worldwide, affecting between 2% and 4% of population. The projected further progression is a reason to consider AF as a global epidemic problem. The efficiency in diagnosing new cases is still unsatisfactory.

METHODS

The prospective study included 74 patients hospitalized for acute myocardial infarction. Echocardiography with advanced assessment of the left atrium was performed on all patients. R Statistical Software was used for statistical and graphical processing.

RESULTS

Atrial fibrillation was first diagnosed in 13.5% of patients with acute myocardial infarction, and in 5.4% of the patients the diagnosis was made during the long-term follow-up period. Analysis of the data collected showed that patients with arrythmia were older (71.79 vs 63.5 years; p = 0.047), had a higher BMI (30.15 vs 26.76 kg/m2; p = 0.039) and had a higher CHA2DS2 VASc score (4.14 vs 3.02 points). Among the echocardiographic parameters, those that significantly differentiated patients with arrythmia included larger LA area (21.62 vs 18.84 cm2; p = 0.027), lower LAEF 4CH (43.46 vs 55.93%; p = 0.029), lower LAEF mean (44.08 vs 55.63%; p = 0.014), lower EI (1.03 vs 1.49; p = 0.032), lower LASr 4CH (19.08 vs 26.72%; p = 0.020), lower LASr mean (18.62 vs 26.73%; p = 0.009), higher E/e' (12.62 vs 9.58; p = 0.01), higher LASI (0.95 vs 0.45; p = 0.016).

CONCLUSIONS

Among the echocardiographic parameters, those that may indicate an increased risk of atrial fibrillation and could be implemented in clinical practice are LASr and LASI. Determining them in risk profiling and the implementation of individualized arrhythmia detection methods could increase diagnostic efficiency.

Meta-analysis of sotagliflozin, a dual sodium-glucose-cotransporter 1/2 inhibitor, for heart failure in type 2 diabetes

Sodium-glucose co-transporters (SGLTs) mediate sodium and glucose transport across cell membranes. SGLT2 inhibitors have a recognized place within heart failure (HF) guidelines. We evaluated the effect of sotagliflozin on HF and cardiovascular outcomes in participants with type 2 diabetes. Scopus, Medline, Embase and Central were searched from inception until 2 June 2023. Randomized controlled trials evaluating sotagliflozin in type 2 diabetes participants and reporting HF events were selected. Major adverse cardiovascular events (MACE) and systolic blood pressure were evaluated. The Cochrane risk of bias tool (RoB 2.0) was used. Pooled mean difference (MD), relative risk (RR), 95% confidence intervals and the number needed to treat (NNT) were estimated (PROSPERO: CRD42023432732). We selected nine studies (n = 15 320 participants: n = 8040 intervention and n = 7280 control). The median follow-up was 13.4 months (Q1 = 13, Q3 = 21). One study recruited participants with HF at baseline. After a follow-up of >52 weeks, sotagliflozin significantly reduced the risk of HF [n = 8 studies; RR = 0.66 (0.64, 0.69)], stroke [n = 6 studies; RR = 0.75 (0.58, 0.97)] and MACE [n = 8 studies; RR = 0.73 (0.66, 0.81)]. The NNT was 20 and 26 for HF and MACE, respectively. Sotagliflozin lowered systolic blood pressure [n = 7; MD = -2.38 mmHg (-2.79, -1.97)]. No dose-dependent effect was identified for HF [200 mg: RR = 0.38 (0.16, 0.89), 400 mg: RR = 0.57 (0.39, 0.85), P-value = 0.22]. The high risk of bias was a limitation of this review. Sotagliflozin reduced HF and cardiovascular events in type 2 diabetes participants. Research exploring its effects in HF and comparisons with SGLT2 inhibitors is warranted to determine if dual SGLT inhibition surpasses selective inhibition.

Soluble urokinase plasminogen activator receptor (suPAR) as a prognostic biomarker in acutely admitted patients with atrial fibrillation

Background

Atrial fibrillation (AF) is associated with a higher incidence of stroke, heart failure, and mortality. Risk assessment of clinical outcomes in patients hospitalized acutely with AF remains a challenge.

Purpose

To investigate if soluble urokinase plasminogen activator receptor (suPAR) levels at admission to the Emergency Department (ED) are associated with 1-year all-cause mortality in patients admitted with AF.

Methods

A prospective cohort study of patients consecutively admitted to the medical ED of a university hospital in Copenhagen, Denmark, between 2020 and 2022 with symptoms of COVID-19. Patients were included if they were admitted with AF as the primary or secondary diagnosis. All patients had suPAR measured at the index admission, and follow-up was up to 1 year. The association between suPAR and 1-year mortality was investigated with multivariate Cox regression. We adjusted for age, sex, smoking, C-reactive protein, creatinine, hemoglobin, albumin, and comorbidities.

Results

Of the 7,258 patients included during the period, 362 (5.0%) patients were admitted with AF as the primary or secondary diagnosis. Due to missing data, 23 (6.4%) patients were excluded. Among the remaining 339 patients, 68 (20.1%) patients were dead at follow-up. The multivariate Cox regression showed that elevated suPAR was independently associated with an increased risk of 1-year mortality, with a hazard ratio of 1.12 (95% confidence interval: 1.05-1.20, p < 0.001).

Conclusion

Elevated suPAR levels were significantly associated with 1-year all-cause mortality in patients acutely admitted with AF to the ED.

Chronic Intermittent Hypoxia-Induced Neural Injury: Pathophysiology, Neurodegenerative Implications, and Therapeutic Insights

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a sleep-related respiratory disorder that poses a global threat to human health. Chronic intermittent hypoxia (CIH) is its main pathological feature. With the advancements in medical research, the study of CIH-induced neural injury has gained increasing attention. Studies have shown that CIH can lead to or aggravate neuroinflammation and apoptosis by increasing blood-brain barrier (BBB) permeability, promoting oxidative stress, activating glial cells, and triggering multiple signaling pathways, ultimately resulting in neural injury. These processes contribute to the development of Alzheimer's disease, Parkinson's disease, and stroke. This review aims to summarize the progress in CIH-induced neural injury and explore various underlying mechanisms, with the goal of providing new insights for the development of therapeutic interventions targeting CIH-related neural damage.

Emergency medicine updates: Sympathetic crashing acute pulmonary edema

INTRODUCTION

Patients with heart failure exacerbation can present in a variety of ways, including sympathetic crashing acute pulmonary edema (SCAPE). Emergency physicians play a key role in the diagnosis and management of this condition.

OBJECTIVE

This narrative review evaluates key evidence-based updates concerning the diagnosis and management of SCAPE for the emergency clinician.

DISCUSSION

SCAPE is a subset of acute heart failure, defined as a patient with sudden, severe pulmonary edema and hypertension, resulting respiratory distress, and hypoxemia. This is associated with significantly elevated afterload with fluid maldistribution into the pulmonary system. Evaluation and resuscitation should occur concurrently. Laboratory assessment, electrocardiogram, and imaging should be obtained. Point-of-care ultrasound is a rapid and reliable means of confirming pulmonary edema. Management focuses on respiratory support and vasodilator administration. Noninvasive positive pressure ventilation (NIPPV) with oxygen support is associated with reduced need for intubation, improved survival, and improved respiratory indices. If the patient does not improve or decompensates on NIPPV, endotracheal intubation is recommended. Rapid reduction in afterload is necessary, with the first-line medication including nitroglycerin. High-dose bolus nitroglycerin is safe and effective, followed by an infusion. If hypertension is refractory to NIPPV and high-dose nitroglycerin, other agents may be administered including clevidipine or nicardipine. Angiotensin-converting enzyme inhibitors such as enalaprilat are an option in those with normal renal function and resistant hypertension. Diuretics may be administered in those with evidence of systemic volume overload (e.g., cardiomegaly, peripheral edema, weight gain), but should not be routinely administered in patients with SCAPE in the absence of fluid overload. Caution is recommended in utilizing opioids and beta blockers in those with SCAPE.

CONCLUSION

An understanding of the current literature concerning SCAPE can assist emergency clinicians and improve the care of these patients.