Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

Poly-epigenetic scores for cardiometabolic risk factors interact with demographic factors and health behaviors in older US Adults

Poly-epigenetic scores (PEGS) are surrogate measures that help capture individual-level risk. Understanding how the associations between PEGS and cardiometabolic risk factors vary by demographics and health behaviors is crucial for lowering the burden of cardiometabolic diseases. We used results from established epigenome-wide association studies to construct trait-specific PEGS from whole blood DNA methylation for systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI), C-reactive protein (CRP), high- and low-density lipoprotein cholesterol (HDL-C, LDL-C), triglycerides (TG), and fasting glucose. Overall and race-stratified associations between PEGS and corresponding traits were examined in adults >50 years from the Health and Retirement Study (n = 3,996, mean age = 79.5 years). We investigated how demographics (age, sex, educational attainment) and health behaviors (smoking, alcohol consumption, physical activity) modified these associations. All PEGS were positively associated with their corresponding cardiometabolic traits (p < 0.05), and most associations persisted across all racial/ethnic groups. Associations for BMI, HDL-C, and TG were stronger in younger participants, and BMI and HDL-C associations were stronger in females. The CRP association was stronger among those with a high school degree. Finally, the HDL-C association was stronger among current smokers. These findings support PEGS as robust surrogate measures and suggest the associations may differ among subgroups.

The impact of uric acid on acute coronary syndrome prognosis in elderly patients

BACKGROUND

Uric acid (UA) plays an important role in cardiovascular diseases, yet its implications in elderly patients remains incompletely understood. This study aimed to explore the impact of UA on the prognosis in advanced-age patients with acute coronary syndrome (ACS).

METHODS

We included 526 patients aged 80 and older who were diagnosed with ACS. The UA levels were measured at admission, and patients were divided into four groups based on quartiles of UA levels. Major adverse cardiovascular events (MACE) during follow-up were recorded.

RESULTS

The median UA level was 344.09 μmol/L, while the median follow-up duration was 64 months. Kaplan-Meier curves demonstrated a higher cumulative incidence of MACE during long-term follow-up in the Q4 group (Log-rank p < 0.05). Cox regression analysis revealed an independent correlation between UA levels and an increased risk of MACE (HR 1.002, 95%CI 1.000-1.003, p = 0.021). The ROC curve indicated that the optimal UA value for predicting MACE was 324.25 μmol/L. After matching through PSM, the MACE-free survival rate was lower in both hyperuricemia group (UA> 420.00 μmol/L) and high UA group (324.25 μmol/L < UA≤ 420.00 μmol/L) compared to the control group. Both hyperuricemia and high UA levels were independent risk factors for long-term MACE in advanced-age ACS patients, with HR values of 1.546 (1.049-2.280, p = 0.028) and 1.491 (1.011-2.198, p = 0.044), respectively.

CONCLUSION

Elevated UA levels were identified as independent risk factors for MACE in elderly patients with ACS. The optimal predictive value of UA for poor cardiovascular prognosis was significantly lower than the traditional definition of hyperuricemia.

Machine learning-based radiomic features of perivascular adipose tissue in coronary computed tomography angiography predicting inflammation status around atherosclerotic plaque: a retrospective cohort study

OBJECTIVES

This study expolored the relationship between perivascular adipose tissue (PVAT) radiomic features derived from coronary computed tomography angiography (CCTA) and the presence of coronary artery plaques. It aimed to determine whether PVAT radiomic could non-invasively assess vascular inflammation associated with plaque presence.

METHODS

In this retrospective cohort study, data from patients undergoing coronary artery examination between May 2021 and December 2022 were analyzed. Demographics, clinical data, plaque location and stenosis severity were recorded. PVAT radiomic features were extracted using PyRadiomics with key features selected using Least Absolute Shrinkage and Selection Operator (LASSO) and recursive feature elimination (RFE) to create a radiomics signature (RadScore).Stepwise logistic regression identified clinical predictors. Predictive models (clinical, radiomics-based and combined) were constructed to differentiate plaque-containing segments from normal ones. The final model was presented as a nomogram and evaluated using calibration curves, ROC analysis and decision curve analysis.

RESULTS

Analysis included 208 coronary segments from 102 patients. The RadScore achieved an Area Under the Curve (AUC) of 0.897 (95% CI: 0.88-0.92) in the training set and 0.717 (95% CI: 0.63-0.81) in the validation set. The combined model (RadScore + Clinic) demonstrated improved performance with an AUC of 0.783 (95% CI: 0.69-0.87) in the validation set and 0.903 (95% CI: 0.83-0.98) in an independent test set. Both RadScore and combined models significantly outperformed the clinical model (p < .001). The nomogram integrating clinical and radiomics features showed robust calibration and discrimination (c-index: 0.825 in training, 0.907 in testing).

CONCLUSION

CCTA-based PVAT radiomics effectively distinguished coronary artery segments with and without plaques. The combined model and nomogram demostrated clinical utility, offering a novel approach for early diagnosis and risk stratification in coronary heart disease.

The triglyceride-glucose index and acute kidney injury risk in critically ill patients with coronary artery disease

BACKGROUND

The triglyceride-glucose (TyG) index, proven a reliable and simple surrogate of insulin resistance, has shown potential associations with cardiovascular outcomes and renal diseases. This research delved into the utility of the TyG index in predicting the risk of acute kidney injury (AKI) in patients with coronary artery disease (CAD), an area not extensively covered in existing literature.

METHODS

A cohort of patients with CAD was recruited from the Medical Information Mart for Intensive Care-IV database, and categorized into quartiles based on their TyG index. The primary outcome was AKI incidence, and the secondary outcome was renal replacement therapy (RRT). Scatterplot histograms, cox proportional hazards models, Kaplan-Meier survival curves, and restricted cubic splines were employed to investigate the association between the TyG index and the risk of AKI in patients with CAD.

RESULTS

A total of 1,501 patients were enrolled in this study, predominantly male (61.56%), with a median age of 69.80 years. The AKI incidence was 67.22% among all patients, with the AKI stages increased with higher TyG levels (P for trend <0.001). The Kaplan-Meier survival analyses demonstrated statistically significant differences in AKI incidence and RRT application throughout the entire cohort, stratified by the TyG index quartiles (p < 0.001). Additionally, the restricted cubic spline analysis revealed a non-linear association between the TyG index and the risk of AKI (P for non-linear =0.637). Both multivariate Cox proportional hazards analyses (HR 1.62; 95% CI 1.15-2.27; p = 0.005) and multivariate logistic regression analyses (OR 2.16; 95% CI 1.18-3.94; p = 0.012) showed that the elevated TyG index was significantly related to AKI incidence. The association between TyG index and the risk of AKI is more significant in patients without diabetes (HR 1.27; 95% CI 1.14-1.42; p < 0.001), compared to patients with diabetes (P for interaction =0.013).

CONCLUSIONS

In summary, the TyG index emerged as a reliable predictor for the occurrence of AKI in CAD patients during ICU stay. Furthermore, it is also anticipated to serve as a valuable indicator for non-diabetic patients in predicting the incidence of AKI.

p38γ modulates ferroptosis in brain injury caused by ethanol and cerebral ischemia/reperfusion by regulating the p53/SLC7A11 signaling pathway

Ischemic stroke, a neurological condition with a complicated etiology that is accompanied by severe inflammation and oxidative stress, and ethanol (EtOH) may aggravate ischemia/reperfusion (I/R)-induced brain damage. However, the effect of prolonged alcohol intake on acute brain injury remains ambiguous. As part of the mitogen-activated protein kinase (MAPK) family, p38γ is involved in ferroptosis and inflammation in various diseases. This study explored how p38γ is involved in the effects of chronic EtOH consumption and brain injury caused by cerebral I/R. Brain damage was induced in the mice via the administration of a liquid alcohol-containing diet for 8 weeks, middle cerebral artery occlusion reperfusion (MCAO/R), or a combination of both. We verified that EtOH significantly exacerbated MCAO/R-induced brain damage, ferroptosis and inflammation. Notably, p38γ levels were increased in experimental mouse and cell models. p38γ knockdown markedly attenuated brain tissue damage, oxidative stress, and inflammatory cell infiltration in EtOH + MCAO/R-treated mice. Mechanistic experiments revealed that p38γ may regulate inflammation and ferroptosis through the p53/SLC7A11 pathway. Overall, our experimental results indicate that p38γ is crucial for regulating EtOH- and I/R-induced brain damage by modulating the p53/SLC7A11 pathway.

Soft imperceptible wearable electronics for at-home cardiovascular monitoring of infants with single ventricle heart disease

Patients with single ventricle heart disease (SVHD) require multiple palliative surgeries. Due to high mortality rates observed during the four to sixth-month interstage period between the first and second surgery, at-home monitoring practices are important. However, modern-day interstage monitoring does not offer comprehensive quantitative tracking of health conditions since it relies on logging the infant's weight, feeding patterns, and oxygen saturation once a day in a journal. Here, we introduce a soft wearable electronic device for the home monitoring of SVHD patients. The ultrathin, imperceptible, wireless system is designed for safe integration with infants' delicate skin. The system features a chest-mounted biopatch and forehead-mounted pulse oximeter, streaming real-time data to a cloud-based platform. This smart device has built-in alert functions to help caregivers recognize when the patients should be returned to the hospital for in-person observation, easing decision-making from non-clinically trained personnel. In addition, the patient-tailored database also improves the communication between the home and hospital, reducing the load on caretakers during this stressful period.

Sex differences in proteomics of cardiovascular disease - Results from the Yale-CMD registry

Aims This study assessed sex-specific proteomic profiles by cardiovascular disease (CVD) phenotype (coronary artery disease [CAD] vs coronary microvascular dysfunction [CMD]) and describe their role in sex-specific pathways.

METHODS

In a secondary biobank analysis of the Yale-CMD registry, adults with ischemic symptoms who underwent cardiac positron emission test/computed tomography were categorized as a) controls (normal coronary flow reserve (CFR) > 2 without perfusion defect or coronary calcification), b) having CMD (CFR < 2 without defect or calcification), or c) having CAD (known CAD or new perfusion defect). Using proximity extension assays (Olink® Explore 3072), we examined 2944 proteins. Differential protein expression was assessed using linear regression models, adjusting for age, race, body mass index, diabetes, dyslipidemia, hypertension, or smoking.

RESULTS

Of 190 patients, 91 provided blood samples (mean age, 56 years; 66 %, females; 48 %, controls; 24 %, CAD; 27 %, CMD). Among controls, 15 proteins showed sex differences (5 proteins upregulated in females, 10 in males; false discovery rate [FDR < 0.05]). Upregulated in CAD patients were FSHB in females and INSL3 and EDDM3B in males (FDR < 0.05). Among CMD patients, SCGB3A1 and HGFAC were higher in females; INSL3, SPINT3, EDDM3B, and KLK3 were higher in males (FDR < 0.05). Per pathway analysis, females showed upregulation of immune pathways in CAD and lipid and glucose metabolism pathways in CMD. Males showed upregulated endothelial regulation of blood flow in CAD and increased angiogenesis in CMD.

CONCLUSIONS

Sex differences exist in the proteomic profiles of CAD and CMD patients, highlighting a need for precision medicine.

Association of cardiovascular-kidney-metabolic syndrome with all-cause and cardiovascular mortality: A prospective cohort study

Background

Given evidence on the cardiovascular disease (CVD) risk conferred by comorbidity risk factors, the American Heart Association (AHA) recently introduced a novel staging construct, named cardiovascular-kidney-metabolic (CKM) syndrome. This study examined the association of CKM syndrome stages with all-cause and cardiovascular mortality among US adults.

Methods

Data were from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 at baseline linked to the 2019 National Death Index records. For each participant, the CKM syndrome was classified into five stages: stage 0 (no CKM risk factors), 1 (excess or dysfunctional adiposity), 2 (metabolic risk factors and chronic kidney disease), 3 (subclinical CVD), or 4 (clinical CVD). The main outcomes were all-cause and cardiovascular mortality.

Results

Among 34,809 participants (mean age: 46.7 years; male: 49.2 %), the prevalence of CKM stages 0 to 4 was 13.2 %, 20.8 %, 53.1 %, 5.0 %, and 7.8 %, respectively. During a median follow-up of 8.3 years, compared to participants with CKM stage 0, those with higher stages had increased risks of all-cause mortality (stage 2: HR 1.43, 95 % 1.13-1.80; stage 3, HR 2.75, 95 % CI 2.12-3.57; stage 4, HR 3.02, 95 % CI 2.35-3.89). The corresponding hazard ratios (95 % confidence interval) of cardiovascular mortality risks were 2.96 (1.39-6.30), 7.60 (3.50-16.5), and 10.5 (5.01-22.2). The population-attributable fractions for advanced (stages 3 or 4) vs. CKM syndrome stages (stages 0, 1, or 2) were 25.3 % for all-cause mortality and 45.3 % for cardiovascular mortality.

Conclusion

Higher CKM syndrome stages were associated with increased risks of all-cause and cardiovascular mortality. These findings emphasize that primordial and primary prevention efforts on promoting CKM health should be strengthened to reduce mortality risk.

Psychosocial stress and cardiovascular disease

Mahatma Gandhi once famously said: "poverty is the worst type of violence". He was referring to the state of political and social unrest that was pervading his nation, and the impact that humiliating defeat had on those who suffered in dire straits. Today, there is mounting evidence that social disparities cause intense psychosocial stress on those on whom they are imposed and can result in adverse cardiovascular outcomes. In modern society we still witness large disparities in living conditions between races, regions, continents and nations. Even in more privileged nations, we often witness the existence of "food and social deserts" in the middle of large urban centers. Sizable segments of the population are deprived of the comforts and privileges enjoyed by others; food quality and choices are limited, opportunities to exercise and play are scarce or unsafe, physical and verbal violence are prevalent, and racially driven conflicts are frequent. It has become apparent that these conditions predispose to the development of cardiovascular disease and affect its outcome negatively. Besides the increase in incidence of traditional risk factors, such as smoking, hypertension, insulin resistance and obesity, several other pathophysiological mechanisms involving the neuro-endocrine, inflammatory and immune pathways may be responsible for the noted negative outcomes. In this manuscript we review some of the evidence linking social distress with adverse cardiovascular outcomes and the potential subtending mechanisms and therapeutic interventions.

Prognostic value of the HFA-PEFF and H(2) FPEF scores for clinical outcomes in patients with coronary artery disease and preserved ejection fraction

Background

Coronary artery disease (CAD) is a significant risk factor for heart failure with preserved ejection fraction (HFpEF). While the HFA-PEFF and H2FPEF scoring systems were developed to aid in the diagnosis of HFpEF, their predictive performance in patients with CAD remains underexplored.

Methods

This single-center retrospective cohort study included patients who underwent drug-eluting stent implantation between January 2018 and October 2022. The study's primary endpoint was a composite outcome of all-cause mortality and heart failure hospitalization during follow-up. Kaplan-Meier survival curves were used to evaluate time to adverse events, and differences between groups were analyzed using the log-rank test. Cox proportional hazards regression was applied to assess the independent predictive value of the HFA-PEFF and H2FPEF scores for adverse outcomes.

Results

The HFA-PEFF score categorized 65.7 % of patients as intermediate, 25.1 % as high, and 9.2 % as low probability for HFpEF. The H2FPEF score placed 77.3 % in the intermediate group, 19.3 % in the low, and 3.4 % in the high-probability group. The median follow-up period was 29 months. Adjusted Cox proportional hazard regression revealed the HFA-PEFF score was significantly associated with the composite endpoint of all-cause mortality and heart failure hospitalization (HR: 1.33, 95 % CI:1.07-1.65). Each point increase in the HFA-PEFF score raised heart failure hospitalization risk by 26 % (HR:1.26, 95 % CI: 1.05-1.51). In contrast, the H2FPEF score did not show a significant association with adverse events.

Conclusions

The HFA-PEFF score demonstrated superior prognostic value for predicting adverse outcomes in CAD patients with preserved ejection fraction compared to the H2FPEF score.

Calcium deblooming in coronary computed tomography angiography via semantic-oriented generative adversarial network

Calcium blooming artifact produced by calcified plaque in coronary computed tomography angiography (CCTA) is a significant contributor to false-positive results for radiologists. Most previous research focused on general noise reduction of CT images, while performance was limited when facing the blooming artifact. To address this problem, we designed an automated and robust semantics-oriented adversarial network that fully exploits the calcified plaques as semantic regions in the CCTA. The semantic features were extracted using a feature extraction module and implemented through a global-local fusion module, a generator with a semantic similarity module, and a matrix discriminator. The effectiveness of our network was validated both on a virtual and a clinical dataset. The clinical dataset consists of 372 CCTA and corresponding coronary angiogram (CAG) results, with the assistance of two cardiac radiologists (with 10 and 21 years of experience) for clinical evaluation. The proposed method effectively reduces artifacts for three major coronary arteries and significantly improves the specificity and positive predictive value for the diagnosis of coronary stenosis.

Trends and disparities in the prevalence of circulatory disease risk factors among U.S. adults from the National Health Interview Survey database (2019-2022)

Introduction

Circulatory diseases are the leading cause of mortality in the United States (U.S)., making it crucial to understand trends and disparities in the prevalence of cardiovascular risk factors including diabetes, obesity, smoking, and hyperlipidemia.

Methods

Data from the Centers for Disease Control and Prevention (CDC)'s National Health Interview Survey (NHIS) database was analyzed for adults aged 18 and older from 2019 to 2022. Prevalence percentages and Annual Percentage Changes (APCs) were calculated using regression analysis with Joinpoint, with 95 % confidence intervals (CI). The data was stratified by year, gender, age, race, nativity, veteran status, social vulnerability, employment status, and geographic distribution.

Results

Among circulatory disease risk factors, obesity had the highest prevalence remaining consistent across all years. The highest obesity rates were observed amongst females, those aged 45-64, and Black or African American adults, with regional peaks in the South and Midwest. High Cholesterol, the second most prevalent risk factor, rose significantly from 20.1 % to 22 % [APC: 3.3175∗ (95 % CI: 1.1417 to 5.5416)] with males [APC: 3.3175∗ (95 % CI: 1.1417 to 5.5416)] and females [APC: 3.1315∗ (95 % CI: 3.0191 to 3.2428)] both showing significant increases over time. Furthermore, those aged >65 yrs and White adults in addition to those residing in the Northeast and South revealed the highest rates. Smoking rates remained steady, with a higher male prevalence which showed a significant decrease [APC: -5.0336∗ (95 % CI: -9.156 to -0.6731)] over time. Diabetes prevalence was stable, with males, adults aged 64 and above, American Indians and Black or African American adults and those residing in the southern region consistently showing the highest rates of incidence.

Conclusion

Significant disparities and increasing trends in risk factors for circulatory diseases have been identified, highlighting the need for targeted interventions, particularly for high-risk groups such as males, older adults, veterans, and the unemployed.

Dietary sodium reduction lowers 10-year atherosclerotic cardiovascular disease risk score: Results from the DASH-sodium trial

Background

The Dietary Approaches to Stop Hypertension (DASH) diet lowers estimated 10-year ASCVD (atherosclerotic cardiovascular disease) risk. The effects of dietary sodium reduction on ASCVD risk are uncertain. This study aims to evaluate the impact of sodium reduction, alone and combined with the DASH diet, on 10-year ASCVD risk scores.

Methods

The DASH-Sodium trial randomized adults with elevated blood pressure (average systolic blood pressure of 120 to 159 mm Hg and average diastolic blood pressure of 80 to 95 mm Hg) to the DASH diet or typical American diet. Within each arm, individuals consumed 3 different levels of sodium in random order: low, medium, and high. Each period lasted 30 days. Pooled cohort equation-estimated 10-year ASCVD risk scores were calculated at baseline and at the end of each feeding period. The primary outcomes of interest were the absolute and relative differences in 10-year ASCVD risk scores from baseline.

Results

Among the 412 participants (mean age 48 ± 10 years; 57 % female, 57 % Black), sodium reduction decreased ASCVD risk scores in both dietary arms. Compared to high sodium intake, low sodium intake changed ASCVD risk by -9.4 % (95 % CI -11.7, -7.0). When compared to a typical American diet, the DASH diet changed 10-year ASCVD by -5.3 % (95 % CI -9.3, -1.2). Compared to a high sodium-control diet, the combination of both low sodium intake with DASH changed ASCVD risk by -14.1 % (95 % CI -18.6, -9.3).

Conclusions

Sodium reduction and the DASH diet both independently reduced 10-year ASCVD risk scores. Moreover, the combined impact was additive. These findings support dietary sodium reduction in addition to the DASH diet for ASCVD prevention.

Positive correlation between n- 6 : n- 3 PUFA ratio intake with serum oxHDL/HDL-c ratio in patients with coronary artery disease

BACKGROUND

Coronary artery disease (CAD) is one of the most prevalent cardiovascular diseases where serum lipoprotein oxidation plays a significant role. Polyunsaturated fatty acids (PUFA) n -6 :  n -3 unbalance ratio consumption, affects lipoprotein oxidation, and inflammation processes. This study aimed to analyze the relationship between n -6 :  n -3 PUFA ratio intake with oxidized lipoproteins in individuals with CAD.

METHODS

A cross-sectional study was performed including 105 subjects (51 diagnosed with CAD and 54 non-CAD) from western Mexico. Dietary information was collected using a habitual day food record. Serum oxidized low-density lipoprotein (oxLDL) and oxidized high-density lipoprotein (oxHDL) concentrations were quantified by enzyme linked immunosorbent assay.

RESULTS

CAD subjects had higher oxHDL/HDL cholesterol (HDL-c) ratio [0.102 (0.092-0.112) vs. 0.080 (0.070-0.090), P  = 0.004] and oxLDL/LDL cholesterol (LDL-c) ratio [129.2 (108-150.4) vs. 59.7 (39.3-80), P  < 0.001] compared to non-CAD subjects. Risk factors associated with CAD were a high n -6 :  n -3 PUFA ratio (odds ratio, OR = 2.3, P  = 0.046), hypoalphalipoproteinemia in men (OR = 3.2, P  = 0.014), moderate/high tobacco index (OR = 6.33, P  = 0.003), elevated waist circumference in women (OR = 7, P  = 0.004), hypertension (OR = 21.14, P  < 0.001), and type 2 diabetes (OR: 25, P  < 0.001). The oxHDL/HDL-c ratio was positively associated with the n -6 :  n -3 PUFA ratio [ r2  = 28.3, B  = 0.002 (0.001-0.003), P  < 0.001] in CAD patients.

CONCLUSIONS

This study showed that a higher n -6 :  n -3 PUFA ratio intake correlates with higher serum oxHDL/HDL-c in CAD patients.

The application of neighborhood area deprivation index to improve health equity across the spectrum of heart failure: a review

Neighborhood environments play a key role in the development of individual risk factors for heart failure (HF) and impact health outcomes across the spectrum of HF. The area deprivation index (ADI) is an important composite measure of neighborhood depravity that has been associated with poor cardiovascular outcomes. The objective of our review is to discuss how neighborhood deprivation, with an emphasis on ADI, influences the spectrum of HF among patients and to propose solutions for ADI applications to improve the implementation of equitable care across the HF spectrum. MEDLINE/Pubmed was systematically searched to identify observational studies published between 2016 and 2024, examining the impact of ADI on HF risk, management, and outcomes. The search involved crossing two sets of terms included in article titles and abstracts: (1) social deprivation, area deprivation index, and neighborhood deprivation; (2) cardiovascular disease risk, heart failure, heart failure medications, and heart failure outcomes. Additional references were identified through searching relevant author reference lists and review articles. Key findings suggest that (1) the prevalence of HF risk is increased in individuals residing in neighborhoods with higher ADI; (2) HF patients living in more deprived neighborhoods have increased odds of being hospitalized for HF; (3) after HF admission, the relationship between ADI and risk for readmissions varies by race; and (4) there is an excess 30-day mortality of HF associated with race and neighborhood deprivation. The ADI is an important value to consider in patients with HF, given its association with clinical outcomes. Therefore, we suggest practical ways to incorporate ADI into the management of patients with HF to improve equitable outcomes.

Prenatal Psychosocial Stressors and Blood Pressure Across 4 Years Postpartum

BACKGROUND

Psychosocial stress is a cardiovascular risk factor; however, little is known about whether prenatal psychosocial stressors influence postpartum cardiovascular health. We aimed to examine the associations of multiple measures of prenatal psychosocial stress on maternal blood pressure (BP) in the first 4 years after birth.

METHODS

Among 225 MADRES cohort (Maternal and Developmental Risks From Environmental and Social Stressors) participants, we examined associations of average prenatal Perceived Stress Scale (PSS), Center for Epidemiological Studies Depression (CES-D) scores, and second-trimester neighborhood social cohesion scores on systolic and diastolic BP collected at annual postpartum study visits (1-4 years) using linear mixed-effects models, adjusted for covariates.

RESULTS

Higher prenatal PSS and CES-D scores were associated with greater diastolic BP at 1 year postpartum (0.24 [95% CI, 0.01-0.46] and 0.24 [95% CI, 0.08-0.40] mm Hg per 1-unit higher PSS and CES-D, respectively) and greater systolic BP (0.25 [95% CI, 0.02-0.48] mm Hg per 1-unit higher CES-D). Overall associations of PSS and CES-D with BP were attenuated over the 4-year postpartum period (P<0.05). Stratified analyses suggested larger associations of PSS and CES-D among US-born participants and participants with normotensive pregnancies. While neighborhood social cohesion was not associated with postpartum BP overall, higher neighborhood social cohesion scores were associated with lower BP at 1 year postpartum among participants with normotensive pregnancies and lower systolic BP among foreign-born Hispanic participants.

CONCLUSIONS

Higher prenatal perceived stress and depressive symptoms were associated with greater 1-year postpartum BP, whereas neighborhood cohesion was associated with lower 1-year postpartum BP. These results suggest prenatal psychosocial factors may impact cardiovascular health within the first year after birth.

Unique Characteristics of Stroke in Women and Rehabilitation Considerations

Stroke is the third leading cause of death of women in the United States, and women have a higher lifetime risk of stroke than men. Studies show that women live longer but with poorer functional outcomes and higher rates of disability compared with men. Sex-specific disparities exist between clinical symptoms, medical evaluation, and management after stroke. Stroke rehabilitation strategies specific to women should take into consideration both physiologic and psychosocial demands more common in women to improve functional outcomes. Additional resources for education, clinical research, and implementation of best practices are needed to eliminate gender-related disparities in poststroke care.

Commotio Cordis: A Comprehensive Review

Commotio cordis is a rare, however, potentially fatal, cardiovascular phenomenon arising from direct chest wall trauma, causing sudden cardiac arrest and potentially death. It is primarily seen in young athletes who participate in contact and organized sports. Though debated, the cause of commotio cordis is believed to involve specific timing of chest impact during ventricular electrical activity leading to severe arrhythmic events. Due to sudden onset, the first step in management is immediate and effective basic life support with automated external defibrillation, followed by advanced cardiac life support. Future considerations should include secondary prevention measures such as protective padding in contact sports. It is paramount that clinicians are vigilant in recognizing potential cases of commotio cordis in the field and provide immediate care. This review consolidates the current understanding of commotio cordis, emphasizing the importance of awareness and early intervention. Future research is warranted, including retrospective and observational studies to identify high-risk patterns or trends associated with the condition.

Characteristics and outcomes of patients with acute coronary syndrome who present with atypical symptoms: a systematic review, pooled analysis and meta-analysis

How frequent and whether outcomes are worse for patients with atypical presentation in acute coronary syndrome (ACS) across the literature is not known. We conducted a systematic review of the literature on patients with ACS or acute myocardial infarction who reported whether their symptoms were atypical or typical. We determined the proportion of patients with atypical or no chest pain and used meta-analysis to evaluate predictors of atypical presentation and mortality associated with atypical presentation. A total of 43 studies were included with 1 691 401 patients (mean age: 65.4 years, 63.8% male). The proportion of patients with atypical presentation ranged from 4.6 to 74.2% while for those with no chest pain it ranged from 1.4 to 35.5%. Atypical presentation occurred in 11.6% of patients (28 studies) and no chest pain occurred in 33.6% of patients (16 studies). The three strongest factors associated with increased odds of atypical presentation or no chest pain presentation were non-ST-elevation myocardial infarction [odds ratio (OR): 2.38, 95% confidence interval (CI): 1.55-3.64], greater Killip class (OR: 2.22, 95% CI: 1.84-2.67), and prior heart failure (OR: 1.79, 95% CI: 1.76-1.82). There is a two-fold increase in odds of mortality with atypical or no chest pain presentation in ACS compared with the typical presentation (OR: 2.07, 95% CI: 1.71-2.50, I2  = 99%). Atypical presentation occurs in approximately 1 in 10 patients with ACS but can be as high as 1 in 3 in some populations. Patients who present atypically are at two-fold increased risk of mortality.

Cardiac Rehabilitation for Women with Heart Disease

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

Influence of Plant-Based Diet on the Cardiovascular System: A Narrative Review

A plant-based diet (PBD) includes multiple dietary patterns such as vegetarianism, veganism, lacto-ovo-vegetarianism, etc. A well-balanced PBD has positive effects on body mass index, hyperlipidemia, and type 2 diabetes, and it is associated with decreased risk of cardiovascular diseases. Due to its high fiber content, which lowers levels of low-density lipoprotein cholesterol, high antioxidant content, which prevents capillary wall damage; the presence of polyunsaturated fatty acids, which have an anti-inflammatory effect, improvement in glucose homeostasis through improved insulin sensitivity, and impact on the gut microbiota, it has been proven to be beneficial for the heart. Despite their possible benefits, PBDs can be low in essential nutrients such as vitamin B12, zinc, vitamin D, iodine, and amino acids. This review aims to analyze the influence of PBDs on the cardiovascular system and associated disease progression.

A STRONG call for intensive oral heart failure therapy in acute heart failure patients

Heart failure (HF), a chronic and progressive disease, is increasing in prevalence worldwide and is associated with increased hospitalizations and death. Despite notable improvements in medical therapy for HF, patients are still at risk of future negative outcomes. Current guidelines recommend four classes of medication for treating patients with HF, deemed guideline-directed medical therapy (GDMT). The use and adherence of these GDMTs serve as a major predictor of outcomes in those with chronic HF; however, implementation of therapy remains poor, despite substantial evidence of benefit. The acute hospitalization for HF and the subsequent vulnerable period serve as important milestones for adequate disease modification, and implementing a strategy for aggressive medical therapy can improve HF outcomes. Current guidelines also recommend that follow-up with multidisciplinary chronic disease management specific to HF be provided to those living with heart failure, which is essential for improving readmissions and mortality. This follow-up, although important by itself, serves as an important avenue for disease modification through medication titration, and implementing such structured follow-up is essential for further population-wide improvements in HF mortality. In this context, the STRONG-HF trial investigators developed an implementation trial providing evidence for the rapid inpatient initiation and subsequent titration of HF GDMT, demonstrating the importance of implementation strategies in the care of HF patients. In this narrative review, we review the evidence base for treating patients with HF, highlight deficits in our current real-world experience, and provide support for trial evidence like STRONG-HF in the global fight to reduce the burden of HF.

Endothelial SHP-1 regulates diabetes-induced abnormal collateral vessel formation and endothelial cell senescence

BACKGROUND

Critical limb ischemia is a major cause of peripheral arterial disease and morbidity affecting patients with diabetes. Diabetes-induced premature senescence of endothelial cells (EC) has been proposed as a mechanism leading to impaired ischemia-driven angiogenesis. We showed that hyperglycemia induced expression of the protein tyrosine phosphatase SHP-1, which reduced angiogenic factor activity in ischemic muscle of diabetic mice. Here, we evaluate the impact of SHP-1 deletion on EC function and senescence.

METHODS

Ligation of the femoral artery was performed in nondiabetic (NDM) and 3 months diabetic (DM) mice with EC-specific deletion of SHP-1. Cell migration, proliferation and protein expression were evaluated in EC exposed to normal (NG) or high glucose (HG) concentrations. Gastrocnemius and tibial artery of patients with diabetes were collected and analyzed.

RESULTS

Blood flow reperfusion and limb function were reduced by 43 % and 82 %, respectively in DM mice as compared to NDM mice. EC-specific deletion of SHP-1 in DM mice restored blood flow reperfusion by 60 %, and limb function by 86 %, while capillary density was similar to NDM mice. Moreover, ablation of SHP-1 in EC prevented diabetes-induced expression of the senescence markers p53 and p21 and counteracted Nrf2 downregulation. In EC, elevated expression of beta-galactosidase, p21 and p53, and suppression of Nrf2 and VEGF actions were observed in EC exposed to HG levels and human muscle and artery of patients with diabetes, effects that were reversed by overexpression of dominant negative SHP-1.

CONCLUSION

SHP-1 in EC is a central effector of diabetes-induced senescence and induces aberrant collateral vessel formation and blood flow reperfusion. Reduced SHP-1 expression counteracts these pathologic features.

SERCA2a dysfunction in the pathophysiology of heart failure with preserved ejection fraction: a direct role is yet to be established

With rising incidence, mortality and limited therapeutic options, heart failure with preserved ejection fraction (HFpEF) remains one of the most important topics in cardiovascular medicine today. Characterised by left ventricular diastolic dysfunction partially due to impaired Ca2+ homeostasis, one ion channel in particular, SarcoEndoplasmic Reticulum Ca2+-ATPase (SERCA2a), may play a significant role in its pathophysiology. A better understanding of the complex mechanisms interplaying to contribute to SERCA2a dysfunction will help develop treatments targeting it and thus address the growing clinical challenge HFpEF poses. This review examines the conflicting evidence present for changes in SERCA2a expression and activity in HFpEF, explores potential underlying mechanisms, and finally evaluates the drug and gene therapy trials targeting SERCA2a in heart failure. Recent positive results from trials involving widely used anti-diabetic agents such as sodium-glucose co-transporter protein 2 inhibitors (SGLT2i) and glucagon-like peptide-1 (GLP-1) agonists offer advancement in HFpEF management. The potential interplay between these agents and SERCA2a regulation presents a novel angle that could open new avenues for modulating diastolic function; however, the mechanistic research in this emerging field is limited. Overall, the direct role of SERCA2a dysfunction in HFpEF remains undetermined, highlighting the need for well-designed pre-clinical studies and robust clinical trials.

Measuring disparities in out of hospital cardiac arrest outcomes in Chicago community areas

Background

Advances in resuscitation science have improved survival rates after an out-of-hospital cardiac arrest (OHCA) in select geographies, but survival rates vary widely by community. The purpose of this study was to assess the variations in bystander interventions and subsequent OHCA outcomes by predominance of a race/ethnicity within community areas in a large city.

Methods

This is a retrospective cohort study of OHCA treated by Chicago Fire Department EMS from January 1st 2014 through December 31st 2021. Community areas were grouped into categories based on having a majority (>50%) of a race or ethnicity (i.e., predominantly White, Black, Hispanic, Integrated or Asian).

Results

Of the 13,778 OHCA cases meeting inclusion criteria, 62.1% were male, and 47.5% were from predominantly Black community areas, 17.9% from predominantly Hispanic community areas, 20.0% from White, and 14.0% from Integrated; the remaining 0.6% were from Asian community areas. Mean age was lowest (59.9 years) in Hispanic followed by Black (61.8 years) community areas compared to White (62.4 years) community areas. Cases from Black and Hispanic community areas had lower rates of shockable rhythms (12.6% and 14.9% versus 19.8%). Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use was lowest in Black community areas. OHCA in Hispanic and Black community areas > 30% less likely to have favorable neurologic survival compared to White community areas. Females were more likely to survive to hospital admission across all community areas; however, neurologic survival in females was better only in White and Integrated community areas. Public location and shockable rhythm were significant predictors of favorable neurologic survival across all community area categories; AED use before EMS was a significant predictor in Black, Hispanic and Integrated community areas but not in White community areas. Bystander CPR was associated with favorable neurologic survival White (aOR = 1.40) and Integrated (aOR = 2.02) community areas, but there was no significant association in Black or Hispanic community areas.

Conclusion

Our study revealed significant variations in favorable OHCA characteristics across different community areas. While certain cardiac arrest features and modifiable factors play a significant role in some community areas, their effect may be less pronounced in other community areas.

Cardiac Myosin Inhibitors for Obstructive Hypertrophic Cardiomyopathy: A Meta-analysis of Randomized Placebo-Controlled Trials

BACKGROUND

Cardiac myosin inhibitors (CMI) have emerged as the first disease-specific, noninvasive therapy with promising results in patients with hypertrophic cardiomyopathy. However, its role in obstructive hypertrophic cardiomyopathy (oHCM) remains uncertain, especially in secondary endpoints of randomized controlled trials (RCTs).

METHODS

We systematically searched PubMed, Embase, Web of Science, and Clinicaltrials.gov from inception to June 2024 for RCTs comparing CMI versus placebo in patients with oHCM. We applied a random-effects model to evaluate efficacy and safety outcomes and primary or secondary outcomes of RCTs.

RESULTS

We included five RCTs comprising 767 patients, of whom 402 (52.5%) were randomized to CMI. Relative to placebo, CMI were associated with a higher rate of improvement of at least one New York Heart Association (NYHA) functional class [risk ratio (RR) 2.33; 95% confidence interval (CI) 1.92-2.82]. In addition, CMI reduced resting left ventricular outflow tract (LVOT) [mean difference (MD) - 42.51 mmHg; 95% CI - 59.27 to - 25.75] and the provoked LVOT gradients (MD - 46.12 mmHg; 95% CI - 55.70 to - 36.54). However, CMI significantly increased the risk of reaching a left ventricular ejection fraction below 50% (RR 4.80; 95% CI 1.42-16.20), affecting 8% of patients during long-term follow-up of up to 120 weeks. There was no significant interaction across subgroups of class representatives, pointing to a class effect. The benefit-risk analysis indicated a larger benefit for NYHA class improvement than risk for systolic dysfunction.

CONCLUSION

In patients with oHCM, mavacamten and aficamten as a class improve clinical and hemodynamic endpoints compared with placebo, albeit with a higher incidence of a reduction in left ventricular ejection fraction.

REGISTRATION

PROSPERO CRD42023468079.

Physical Activity Habits and Incident First-Ever Stroke in Middle-Aged Adults-A Prospective Cohort Study

BACKGROUND

Lifestyle affects the risk of cardiovascular events such as myocardial infarction and stroke. Several lifestyle factors, such as physical activity (PA), are modifiable, and in this study, we examined the association between leisure-time PA habits and the risk of a first-ever stroke.

METHODS

This prospective study included residents in Västerbotten, Sweden, who participated in the Västerbotten Intervention Programme at 40, 50, and 60 years of age. Altogether, 31,855 individuals (50.5% women, mean age: 42.6 [6.9] y at baseline) participated between 1989 and 2016. Leisure-time PA was categorized as irregular (never/now and then) or regular (once a week/2 or 3 times a week/more than 3 times a week). Changes in PA were compared between examinations (10 y apart). Cases of stroke were validated according to World Health Organization MONICA (Monitoring Trends and Determinants of Cardiovascular Disease) criteria. The risk related to changes in leisure-time PA was estimated using a multivariable Cox regression model.

RESULTS

During an average follow-up of 9.8 years (4.4), 609 incident first-ever stroke cases occurred (1.9%). A multivariable model showed that, compared with individuals with irregular PA at both examinations, those reporting regular PA over time had a lower risk of stroke (hazard ratio: 0.78, 95% CI, 0.61-0.99).

CONCLUSION

Middle-aged adults who maintained regular PA during their leisure time over 10 years had a lower risk of a first-ever stroke. This association is probably partly mediated by lower body mass index and a reduced risk of hypertension and diabetes.

Heart failure outpatient clinics resources in Italy: a viewpoint of Italian Society of Cardiology organization

The current paper reports the model organization, level of health care, and type of medical and research activities related to the existing heart failure centers of the Italian Society of Cardiology. Of note, we conduced an internal survey among the members of heart failure working group and related hospital and territorial sites about the quality of care and assistance levels according to the local hospital resources and type of diagnostic therapeutic and management resources. Thirty-two hospital ambulatorial structures have been identified, the centers were equally distributed within the national ground, with similar concentration between north and south regions of the Italian country. We distinguished three different levels of organization: (1) basal territorial clinics in which patients with suspected or already diagnosed heart failure (HF) are initially identified and screened; (2) intermediate clinics in which HF patients can be routinary followed by HF specialists supported by a dedicated staff including imaging and arrythmologist experts, and interventional cardiologist; (3) advanced clinics composed by all the technical and staff resources capable of guarantying repetitive invasive assessment, continuous invasive monitoring, dedicated telemedicine structures focused on more advanced HF management integrated by heart transplantation or mechanical assistance programs. Different type of assistance is supported by a relevant number of research activity primarily conducted by the Italian Society of Cardiology or spontaneous studies arranged by HF specialist members. The number of HF centers has increased over the past few decades in proportion to the progressive rise in HF diagnoses and associated hospitalization. The expansion of ambulatory structures has been facilitated by an increasing socioeconomic and research influence. The quality of HF services in Italy could be raised by improving the network and connections between HF specialists, general practitioners (GPs), caregivers, and other specialists frequently working in this field.

Shexiang Tongxin Dropping Pills attenuate ischemic microvascular dysfunction via suppressing P66Shc-mediated mitochondrial respiration deficits

ETHNOPHARMACOLOGICAL RELEVANCE

Ischemic stroke (IS) disrupts mitochondrial energy metabolism, leading to cerebral microvascular dysfunction (CMD). Shexiang Tongxin Dropping Pills (STDP) is a traditional Chinese medicinal formulation that has been clinically used for treating microcirculatory dysfunction. We have previously reported its ability to improve cerebral microcirculatory abnormalities. Nevertheless, the protective effects of STDP on cerebral microvascular mitochondria in the context of energy metabolism repair remain underinvestigated.

AIM OF THE STUDY

This study aims to investigate the potential mechanisms by which STDP ameliorates IS-induced CMD through the restoration of mitochondrial function.

MATERIALS AND METHODS

An ischemic stroke/reperfusion model was established by occluding and subsequently reperfusing the middle cerebral artery (MCAO/R) in C57BL/6 J mice. Laser speckle contrast imaging, Y-maze, rotarod tests and TTC staining were employed to evaluate the anti-ischemic stroke effects of STDP. Histological examination of cell adhesion proteins (ICAM 1, VCAM 1) and tight junction proteins (VE-cadherin, occludin) was conducted to assess the effects of STDP on the cerebral microvascular endothelium. In vitro, a bEnd.3 cell model was established through oxygen-glucose deprivation followed by reoxygenation (OGD/R). The cytoprotective capability of STDP was assessed by quantifying endothelial permeability, reactive oxygen species (ROS) levels, and cell viability. Mendelian randomization (MR) analysis and bioinformatic studies were performed to elucidate the causal associations between mitochondrial biological function and IS. Mitochondrial membrane potential (MMP) was assessed using a tetramethylrhodamine ethyl ester perchlorate fluorescent probe, while ATP production was quantified using a commercially available assay kit. Mitochondrial respiration was evaluated by measuring the oxygen consumption rate (OCR). Finally, the verification of important targets in mouse brain slices and bEnd.3 cells was conducted through immunoblotting and immunofluorescence.

RESULTS

STDP significantly restored cerebral blood flow and neurological function, and reduced infarct volume in MCAO/R mice. Furthermore, STDP markedly alleviated inflammation and hyperpermeability of the cerebral microvascular endothelium in MCAO/R mice, as evidenced by the suppression of ICAM-1 and VCAM-1 expression, along with the upregulation of VE-cadherin and occludin protein levels. Moreover, STDP not only mitigated hyperpermeability and excessive production of ROS induced by OGD/R in bEnd.3 cells but also enhanced the protective effects of the ROS scavenger N-acetylcysteine on bEnd.3 cells. Results of MR analysis and bioinformation studies demonstrated that the disruption of mitochondrial respiration is a critical pathogenic factor in IS-induced CMD. Our data confirmed that STDP effectively restored MMP and ATP production in OGD/R-treated bEnd.3 cells. Furthermore, STDP significantly enhanced basal respiration, maximal OCR, and spare respiratory capacity in bEnd.3 cells compared to the OGD/R group. Mechanistically, STDP markedly increased endothelial cystathionine γ-lyase (CSE)-mediated hydrogen sulfide (H2S) production and S-sulfhydration of P66shc, resulting in reduced protein expression and phosphorylation levels of P66Shc. This inhibition prevented its translocation into mitochondria, thereby restoring mitochondrial respiration.

CONCLUSION

STDP facilitated CSE expression and promoted H2S production, contributing to the inactivation of P66shc by suppressing its expression and increasing its sulfhydration. This process impeded P66Shc translocation to mitochondria, subsequently restoring mitochondrial respiration and alleviating IS-induced cerebral microvascular endothelial dysfunction.

Xinyin tablets affect mitophagy and cardiomyocyte apoptosis to alleviate chronic heart failure by regulating histone deacetylase 3(HDAC3)-mediated PTEN induced putative kinase 1(PINK1)/Parkin signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Xinyin tablets, Chinese patent medicine, are composed of Panax ginseng C.A.Mey. (Araliaceae), Ilex pubescens Hook. & Arn. (Aquifoliaceae), Leonurus japonicus Houtt. (Lamiaceae), Plantago asiatica L. (Plantaginaceae), Ophiopogon japonicus (Thunb.) Ker Gawl. (Asparagaceae), Astragalus membranaceus (Fisch.) Bunge, and Draba nemorosa L. (Brassicaceae). It has been used for the prevention and treatment of chronic heart failure (CHF) clinically. However, its underlying mechanism of action is far from completely understood.

AIM OF THE STUDY

This study aimed to determine whether Xinyin tablets alleviate CHF in SPF C57 mice and to explore the potential mechanism of action in H9c2 cells.

MATERIALS AND METHODS

Liquid chromatography tandem mass spectroscopy (LC-MS/MS) was performed to identify the chemical compounds in Xinyin tablets. In vivo, 60 C57 mice were randomly divided into 6 groups: the sham group; model group; low-, medium-, and high-dose Xinyin tablets groups; and perindopril group. Animals in the sham group underwent thoracotomy only. The others were subjected to coronary artery ligation. After 4 weeks of drug intervention, the cardiac function of the mice in each group was detected via echocardiography, the myocardial cells were evaluated via HE staining, and the degree of myocardial fibrosis was detected via Masson's trichrome staining. The expression of PINK1/Parkin signaling pathway-related genes (HDAC3, PINK1, Parkin, P62, LC3II/I, caspase-3, caspase-9, and Bax) was analyzed via RT‒qPCR and Western blotting. The effects of Xinyin tablets on cardiomyocyte apoptosis and mitophagy mediated by the HDAC3 and PINK1/Parkin pathways in CHF model mice were evaluated. In vitro, H9c2 cardiomyocytes subjected to hypoxia were treated with different concentrations of Xinyin tablets. The mRNA transcription levels of HDAC3, PINK1, Parkin, P62, LC3II/I, caspase-3, caspase-9, and Bax were measured via fluorescence quantitative PCR. Western blotting was used to detect the protein expression levels of PINK1, Parkin, P62, LC3 II/I, caspase-3, caspase-9, and Bax. TUNEL staining was used to detect the number of apoptotic bodies in the myocardium to evaluate the level of apoptosis. Transmission electron microscopy was used to observe changes in the number of mitophagosomes. Rapamycin (mitophagy agonist), Mdivi-1 (mitophagy inhibitor), ITSA-1 (HDAC3 agonist) and RGFP966 (HDAC3 inhibitor) were used to create intervention conditions. The effects of rapamycin or Mdivi-1 on PINK1/Parkin-mediated mitophagy were observed. Then, the effects of HDAC3 on the PINK1/Parkin signaling pathway, mitophagy and apoptosis in hypoxic cardiomyocytes were observed. Hypoxic cardiomyocytes were treated with Xinyin tablets-containing serum or control serum to observe whether Xinyin tablets could still play a protective role in cardiomyocytes when HDAC3 is activated or mitophagy is inhibited.

RESULTS

785 compounds were characterized from Xinyin tablets, among which carbohydrates and glycosides, phenylpropanoids, terpenes were abundant, and a small number of amino acids, peptides and derivatives also existed in Xinyin tablets. In vivo, Xinyin tablets improved cardiac function (LVEF, LVFS, LVEDD, LVESD, and LVESV) and downregulated the expression of caspase-3, caspase-9, and Bax. The expression levels of PINK1 and Parkin subsequently increased. In vitro, the above findings were reinforced in H9c2 cardiomyocytes. Rapamycin and RGFP966 reduced the apoptosis of hypoxic H9C2 cardiomyocytes and increased mitophagy mediated by the HDAC3-mediated PINK1/Parkin signaling pathway.

CONCLUSIONS

Xinyin tablets have potential as an intervention for CHF by improving mitophagy and inhibiting cardiomyocyte apoptosis through the HDAC3-mediated PINK1/Parkin signaling pathway.

NRF2 activation in the heart induces glucose metabolic reprogramming and reduces cardiac dysfunction via upregulation of the pentose phosphate pathway

AIMS

The transcription factor nuclear factor erythroid-derived 2-like 2 (NRF2) is well recognized as a master regulator of antioxidant responses and cytoprotective genes. Previous studies showed that NRF2 enhances the resistance of mouse hearts to chronic haemodynamic overload, at least in part by reducing oxidative stress. Evidence from other tissues suggests that NRF2 may modulate glucose intermediary metabolism but whether NRF2 has such effects in the heart is unclear. Here, we investigate the role of NRF2 in regulating glucose intermediary metabolism and cardiac function during disease stress.

METHODS AND RESULTS

Cardiomyocyte-specific Keap1 knockout (csKeap1KO) mice, deficient in the endogenous inhibitor of NRF2, were used as a novel model of constitutively active NRF2 signalling. Targeted metabolomics and isotopomer analysis were employed in studies with 13C6-glucose in csKeap1KO and wild-type mice. Pharmacological and genetic approaches were utilized in neonatal rat ventricular myocytes (NRVMs) to explore molecular mechanisms. We found that cardiac-specific activation of NRF2 redirected glucose metabolism towards the pentose phosphate pathway (PPP), a branch pathway of glycolysis, and mitigated pressure overload-induced cardiomyocyte death and cardiac dysfunction. Activation of NRF2 also protected against myocardial infarction-induced DNA damage in remote myocardium and cardiac dysfunction. In vitro, knockdown of Keap1 upregulated PPP enzymes and reduced cell death in NRVM subjected to chronic neurohumoral stimulation. These pro-survival effects were abolished by pharmacological inhibition of the PPP or silencing of the PPP rate-limiting enzyme glucose-6-phosphate dehydrogenase. Knockdown of NRF2 in NRVM increased stress-induced DNA damage, which was rescued by supplementing the cells with either nicotinamide adenine dinucleotide phosphate (NADPH) or nucleosides, the two main products of the PPP.

CONCLUSION

These results indicate that NRF2 regulates cardiac metabolic reprogramming by stimulating the diversion of glucose into the PPP, thereby generating NADPH and providing nucleotides to prevent stress-induced DNA damage and cardiac dysfunction.

Racial and Ethnic Differences in Advance Care Planning and End-of-Life Care in Older Adults With Stroke: A Cohort Study

BACKGROUND AND OBJECTIVES

Stroke is a leading cause of death and disability in the United States and may result in cognitive impairment and the inability to participate in treatment decisions, attesting to the importance of advance care planning (ACP). Although racial and ethnic differences have been shown for ACP in the general population, little is known about these differences specific to patients with stroke. The aim of this study was to examine the presence of ACP and receipt of life-prolonging care by race and ethnicity among decedents who had suffered a stroke.

METHODS

We used the Health and Retirement Study, a nationally representative longitudinal survey. We conducted a cohort study of decedents who died between 2000 and 2018 using multivariable logistic regression models to explore the association between self-reported ethnicity and race and completion of ACP (including a living will [LW] and durable power of attorney for healthcare [DPOAH]) and receipt of life-prolonging care at end of life, controlling for covariates. Stratified models for each race and ethnicity also were conducted.

RESULTS

This study included 3,491 decedents with a reported history of stroke; 57.4% were women, and the mean age was 81.5 years (SD = 10.2). Decedents who identified as non-Hispanic White had the highest end-of-life planning rates (LW: 57%, DPOAH: 72%, and ACP conversation: 63%) compared with those identifying as non-Hispanic Black (LW: 20%, DPOAH 40%, and ACP conversation: 41%) and Hispanic (LW: 20%, DPOAH: 36%, and ACP conversation: 42%; p < 0.001). The presence of ACP discussions, LW, and DPOAH was associated with lower odds of receiving life-prolonging care at end-of-life among non-Hispanic White decedents (OR = .64, CI = .447-0.904; OR = .30, CI = .206-0.445; OR = .61, CI = .386-0.948) but not among those who identified as Hispanic or non-Hispanic Black.

CONCLUSIONS

Hispanic or non-Hispanic Black decedents with stroke had significantly lower rates of ACP discussions, LWs, and naming a DPOAH compared with those who identified as non-Hispanic White. In addition, ACP activities were inversely associated with receipt of life-prolonging care among non-Hispanic White decedents, but not among those who identified as non-Hispanic Black and Hispanic. Small ethnic/racial subgroup sizes limit the generalizability of this study.

A Pectic Polysaccharide From Stems and Leaves of Panacis Quinquefolii Radix: Preparation, Structural Characteristic, and Inhibition of Cardiac Hypertrophy

INTRODUCTION

Panacis Quinquefolii Radix, a valued herb in traditional Chinese medicine, is frequently prescribed for its immunomodulatory effects and its potential to improve cardiovascular function. Recently, there is an increasing amount of research on ginseng polysaccharides, due to their variety of pharmacological activities, including anti-inflammatory, hepatoprotective, cardiovascular protective, and the improvement of intestinal function.

OBJECTIVE

This study investigates the efficacy of Panacis Quinquefolii Radix polysaccharides in alleviating cardiovascular diseases and to achieve the high-value utilization of ginseng by-products.

METHODOLOGY

A pectic polysaccharide named XYSJY2-2 was extracted with hot water from stems and leaves of Panacis Quinquefolii Radix and further isolated by a DEAE Sepharose Fast Flow column and a Sephacry S-100 column. The structural characteristics of XYSJY2-2 was determined by monosaccharide composition, IR, NMR, and methylation analysis. The cardioprotective activity of this polysaccharide was evaluated in vitro and in vivo. With a relative molecular weight of 5.1 kDa, XYSJY2-2 is a type I rhamnogalacturonan featuring a core backbone made up of alternately linked rhamnose and galacturonic acid.

RESULTS

XYSJY2-2 effectively alleviated myocardial hypertrophy and remodeling induced by Ang II and TAC in vivo and in vitro, partly due to suppressing Nppa and Nppb expression.

CONCLUSION

A pectic polysaccharide from stems and leaves of Panacis Quinquefolii Radix has the potential to alleviate cardiovascular disease.

Dose-dependent effects of omega-3 polyunsaturated fatty acids on C-reactive protein concentrations in cardiometabolic disorders: a dose-response meta-analysis of randomized clinical trials

BACKGROUND

Based on current knowledge, omega-3 fatty acids help to reduce the concentration of C-reactive protein (CRP). However, the dose-response effect and the strength of this effect are not entirely clear.

METHODS

We systematically searched and screened databases to include eligible studies. This study incorporates a random effect, as well as dose-response meta-analyses using a restricted cubic spline model.

RESULTS

Forty randomized clinical trials were analyzed. Results demonstrated significant non-linear dose-response efficacy in the reduction of CRP concentration in patients with cardiovascular disease, metabolic syndrome, and hypertension up to 1200 mg/day of EPA and DHA. In addition, there was a linear decrease in CRP concentration in the dyslipidemia population. The meta-analysis results did not show any significant reduction of CRP in overweight and obese participants, and the dose-response analysis failed to show any apparent reduction. In type 2 diabetes, pooling the results revealed a significant reduction in CRP; however, the combination of EPA and DHA failed to show significant dose-response efficacy in changing CRP concentration.

CONCLUSION

1200 mg/day of EPA and DHA may help to reduce CRP concentration in patients with cardiometabolic disorders. This reduction is clinically significant, and thus intervention with omega-3 fatty acids should be considered for this population.

Machine Learning-Based Prediction Models for Healthcare Outcomes in Patients Participating in Cardiac Rehabilitation: A Systematic Review

PURPOSE

Cardiac rehabilitation (CR) has been proven to reduce mortality and morbidity in patients with cardiovascular disease. Machine learning (ML) techniques are increasingly used to predict healthcare outcomes in various fields of medicine including CR. This systemic review aims to perform critical appraisal of existing ML-based prognosis predictive model within CR and identify key research gaps in this area.

REVIEW METHODS

A systematic literature search was conducted in Scopus, PubMed, Web of Science, and Google Scholar from the inception of each database to January 28, 2024. The data extracted included clinical features, predicted outcomes, model development, and validation as well as model performance metrics. Included studies underwent quality assessments using the IJMEDI and Prediction Model Risk of Bias Assessment Tool checklist.

SUMMARY

A total of 22 ML-based clinical models from 7 studies across multiple phases of CR were included. Most models were developed using smaller patient cohorts from 41 to 227, with one exception involving 2280 patients. The prediction objectives ranged from patient intention to initiate CR to graduate from outpatient CR along with interval physiological and psychological progression in CR. The best-performing ML models reported area under the receiver operating characteristics curve between 0.82 and 0.91, with sensitivity from 0.77 to 0.95, indicating good prediction capabilities. However, none of them underwent calibration or external validation. Most studies raised concerns about bias. Readiness of these models for implementation into practice is questionable. External validation of existing models and development of new models with robust methodology based on larger populations and targeting diverse clinical outcomes in CR are needed.

StrokeNet Thrombectomy Endovascular Platform (STEP): A Catalyst for Stroke Research

Endovascular thrombectomy is a critical treatment for acute ischemic stroke. Challenges remain in extending treatment windows, refining patient selection, optimizing posttreatment interventions, and expanding endovascular thrombectomy indications. Traditional stroke trials have played a pivotal role in advancing care but are hindered by inefficiencies, rigid designs, high costs, long timelines, and slow enrollment. The StrokeNet Thrombectomy Endovascular Platform (STEP) represents an innovative paradigm shift in stroke research, offering a more agile, cost-effective, and flexible trial design. Here, we explore the architecture of STEP and its implications on stroke research.

Comparing efficacy and safety between pulsed field ablation, cryoballoon ablation and high-power short duration radiofrequency ablation in atrial fibrillation: a systematic review and network meta-analysis

BACKGROUND

Pulsed field ablation (PFA) and high-power short-duration radiofrequency ablation (HPSD) are emerging techniques for treating atrial fibrillation (AF), offering promising results compared to cryoballoon ablation (CBA). This network meta-analysis aims to evaluates the efficacy and safety of PFA, HPSD, and CBA.

METHOD

PubMed, Scopus and Cochrane Central Register of Controlled Trials were systematically searched for relevant studies until October 2024. The primary outcome is freedom from atrial arrhythmia. A random-effects model was used for data synthesis, and P-scores were employed for outcome ranking. Point estimation (odd ratios) was calculated for comparisons.

RESULTS

Eighteen studies were included in our network meta-analysis, involving 7,071 atrial fibrillation patients. Among them, 2,023 (29%), 3,725 (53%), and 1,323 (18%) patients underwent PFA, CBA, and HPSD, respectively. PFA demonstrated a higher freedom from atrial arrhythmia, with an odds ratio (OR) of 3.63 (95% CI: 2.95-4.46) compared to CBA and 1.89 (95% CI: 1.47-2.43) compared to HPSD. However, PFA was associated with a higher risk of complications (OR = 6.54, 95% CI: 2.13-20.00) compared to CBA, while HPSD showed an insignificant association with a lower risk of complications compared to CBA (OR = 0.61, 95% CI: 0.15-2.42). PFA had the shortest procedural time (P-score: 100%), while HPSD had the longest (P-score: 0%). In contrast, HPSD had the shortest fluoroscopic time, with P-scores of 100%, 46%, and 3% for HPSD, PFA, and CBA, respectively.

CONCLUSION

PFA demonstrated higher efficacy but also a higher risk of complications compared to HPSD and CBA. HPSD showed greater efficacy with comparable safety to CBA.

Validation and the psychometric properties of the Persian version of the sleep quality scale for coronary care patients: a methodological survey

Sleep quality is crucial for recovery in coronary care patients, yet sleep disturbances are prevalent in intensive care settings. This study aimed to validate the Persian version of the Sleep Quality Scale for Coronary Care Patients (SQ-CC-P) in the Iranian population and ensure its psychometric robustness for clinical and research applications. A methodological study was conducted in the Coronary Care Unit (CCU) and heart unit of Imam Khomeini Hospital in Ardabil Province, Iran, from May to September 2024, involving 220 participants diagnosed with acute coronary conditions. The SQ-CC-P, which includes self-assessment and environmental factors, was assessed for content validity, construct validity, and reliability in accordance with COSMIN guidelines. The SQ-CC-P demonstrated strong content validity, with CVI (0.80-0.92), CVR (0.70-1.00), S-CVI/UA (0.85), S-CVI/Ave (0.91), and Adjusted Kappa (0.697) confirming item relevance and necessity. Construct validity was supported by exploratory factor analysis (EFA), which revealed a two-factor structure explaining 62.4% of the variance, and confirmatory factor analysis (CFA), which showed strong factor loadings (0.72-0.82) and excellent model fit. The scale exhibited high internal consistency (Cronbach's alpha = 0.862, McDonald's omega = 0.864) and test-retest reliability (ICC = 0.785, 95% CI [0.718, 0.841]). The SQ-CC-P is a valid and reliable tool for assessing sleep quality among coronary care patients, addressing a critical gap in sleep assessment in intensive care settings.

Outcomes of patients with heart failure after thrombectomy for ischemic stroke: A systematic review and meta-analysis

BackgroundMechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke, but its outcomes in patients with heart failure (HF) are uncertain. Some studies suggest worse outcomes in these patients, while others show no significant differences in mortality or functional recovery.MethodsWe systematically searched the MEDLINE, Embase, and Cochrane databases until August 2024. Studies were included if they compared patients with HF to those without. All statistical analyses were carried out using R, version 4.1.1. A subanalysis examined outcomes in HF patients with reduced left ventricular ejection fraction (LVEF).ResultsWe included 3587 patients, of which 1187 (33.1%) were in the HF group. We found a significantly higher mortality (RR 2.01; 95% CI: 1.33-3.03; p < 0.01) and lower risk of favorable neurologic outcome (RR 0.76; 95% CI: 0.67-0.86; p < 0.01) at 90 days on HF group, without a notable difference in the occurrence of symptomatic intracranial hemorrhage (sICH) (RR 1.57; 95% CI: 0.98-2.51; p = 0.06) or recanalization success (RR 1.02; 95% CI: 0.98-1.07; p = 0.28). HF patients with reduced LVEF also showed higher mortality (RR 1.91; 95% CI: 1.05-3.49; p = 0.03) and worse functional outcomes (RR 0.83; 95% CI: 0.72-0.95; p < 0.01) compared to those without HF.ConclusionsHF patients undergoing MT for ischemic stroke may have worse functional outcomes and higher mortality at 90 days compared to non-HF patients despite similar rates of sICH and recanalization success. Our findings suggest that patients with HF may have a worse prognosis compared to those without HF following MT for ischemic stroke.

Multidimensional-based exploration of gut microbial and metabolite differences in patients with recurrent stroke

This study aims to explore the differences in gut microbes and their metabolites between patients with original and recurrent stroke, providing insights and justification for the diagnosis and prevention of ischemic stroke progression from the perspective of the gut microbiota-metabolite-brain axis. In this study, fecal samples were collected from patients with Original stroke (Os) and patients with Recurrent stroke (Rs) to assess differences in gut microbiota and to screen for different metabolites that reveal the physiological changes related to the recurrent of ischemic stroke. The results found that there was no significant change in Alpha diversity between the two groups. Beta diversity analysis revealed slight changes in community composition between two groups (Bray-Curtis), although their overall microbial abundance may not have changed (UniFrac). Compared with Os patients, Prevotella, Lachnospiraceae_UCG-010, Holdemanella, and Coprococcus were significantly depleted in the Rs group. Correlation analysis showed that the risk of stroke recurrence was negatively correlated with Lachnospiraceae_UCG-010. In Rs group, metabolites such as carbohydrates and terpene lactones were up-regulated, while those of sesquiterpenoids, triterpenoids, and fatty acids and their couplings were down-regulated. These metabolites are significantly enriched in the pathways of arachidonic acid metabolism, betaine biosynthesis, and linoleic acid metabolism. Compared with the Os, Rs was mainly characterized by minor destruction of anaerobic bacteria and significant depletion of SCFAs-producing bacteria. In addition, the related compounds involved in arachidonic acid metabolism and linoleic acid metabolism pathway may be associated with the progression of ischemic stroke.

An organ-wide spatiotemporal transcriptomic and cellular atlas of the regenerating zebrafish heart

Adult zebrafish robustly regenerate injured hearts through a complex orchestration of molecular and cellular activities. However, this remarkable process, which is largely non-existent in humans, remains incompletely understood. Here, we utilize integrated spatial transcriptomics (Stereo-seq) and single-cell RNA-sequencing (scRNA-seq) to generate a spatially-resolved molecular and cellular atlas of regenerating zebrafish heart across eight stages. We characterize the cascade of cardiomyocyte cell states responsible for producing regenerated myocardium and explore a potential role for tpm4a in cardiomyocyte re-differentiation. Moreover, we uncover the activation of ifrd1 and atp6ap2 genes as a unique feature of regenerative hearts. Lastly, we reconstruct a 4D "virtual regenerating heart" comprising 569,896 cells/spots derived from 36 scRNA-seq libraries and 224 Stereo-seq slices. Our comprehensive atlas serves as a valuable resource to the cardiovascular and regeneration scientific communities and their ongoing efforts to understand the molecular and cellular mechanisms underlying vertebrate heart regeneration.

Assessment of cardiovascular risk factors and effect of lifestyle in individuals without cardiovascular disease, diabetes or chronic kidney disease

Cardiovascular disease (CVD) are the leading cause of death globally and often go undetected. Modifiable risk factors for CVD include diet and physical activity. This study aimed to evaluate the health status of Polish patients without a prior diagnosis of CVD, diabetes, or chronic kidney disease (CKD), focusing on healthy dietary choices, dietary harm avoidance, daily routine, organized physical exercise, and social and mental balance (HLPCQ). The multicenter study involved patients without previous CVD, CKD, or diabetes, analyzing anthropometric measurements, blood pressure, heart rate, and laboratory test results. Participants also completed the HLPCQ questionnaire. The study included 836 patients, with a mean age of 48 ± 9.3 years. On the SCORE2 risk analysis, 173 (20.6%) met the criteria for very high risk. The average HLPCQ score was 65.6 ± 26.0. Regression analysis revealed that higher scores on the healthy food choices subscale correlated with lower serum non-HDL cholesterol levels (B = -0.009, SE = 0.003, t = -3.196, p = 0.001) and higher HDL cholesterol levels (B = 0.027, SE = 0.008, t = 3.529, p < 0.001). Similar correlations were observed with the Organized Exercise subscale. The study concluded that lifestyle choices significantly impact biochemical parameters, including blood lipid panels, highlighting the importance of educating both patients and medical professionals on the health impacts of lifestyle.

A molecular brain atlas reveals cellular shifts during the repair phase of stroke

Ischemic stroke triggers a cascade of pathological events that affect multiple cell types and often lead to incomplete functional recovery. Despite advances in single-cell technologies, the molecular and cellular responses that contribute to long-term post-stroke impairment remain poorly understood. To gain better insight into the underlying mechanisms, we generated a single-cell transcriptomic atlas from distinct brain regions using a mouse model of permanent focal ischemia at one month post-injury. Our findings reveal cell- and region-specific changes within the stroke-injured and peri-infarct brain tissue. For instance, GABAergic and glutamatergic neurons exhibited upregulated genes in signaling pathways involved in axon guidance and synaptic plasticity, and downregulated pathways associated with aerobic metabolism. Using cell-cell communication analysis, we identified increased strength in predicted interactions within stroke tissue among both neural and non-neural cells via signaling pathways such as those involving collagen, protein tyrosine phosphatase receptor, neuronal growth regulator, laminin, and several cell adhesion molecules. Furthermore, we found a strong correlation between mouse transcriptome responses after stroke and those observed in human nonfatal brain stroke lesions. Common molecular features were linked to inflammatory responses, extracellular matrix organization, and angiogenesis. Our findings provide a detailed resource for advancing our molecular understanding of stroke pathology and for discovering therapeutic targets in the repair phase of stroke recovery.

Use of pulse pressure index for cardiovascular outcomes assessment and development of a coronary heart disease model for the elderly

BACKGROUND AND AIMS

Pulse pressure has been commonly used to assess atherosclerosis and cardiovascular outcomes with the defects of fluctuation. However, the pulse pressure index (PPI), a feasible alternative with the advantage of lower fluctuations, has not been sufficiently researched.

METHODS

This study included 10,796 participants over 65 years from the National Health and Nutrition Examination Survey 1999-2018. Cox proportional hazards models, restricted cubic splines and subgroup analysis were used to investigate the association between PPI in the elderly and all-cause and cardiovascular mortality. Subsequently, a prediction model for identifying coronary heart disease (CHD) in elderly individuals was developed using three machine learning algorithms. The impact of each feature on CHD was visualized in the optimal model after comparing the performances of the models.

RESULTS

This study discovered that the highest levels of PPI were associated with a 28% increased all-cause [HR (95%CI) 1.28 (1.16, 1.42), P < 0.001] and a 36% increased risk of cardiovascular mortality [HR (95%CI) 1.36 (1.08, 1.72), P = 0.008] compared with the first quantile of PPI. The nonlinear relationships between PPI and mortality (all-cause: P for Nonlinear = 0.038; cardiovascular: P for Nonlinear = 0.005) were determined using restricted cubic spline curves. Among the three machine-learning models, random forest model showed the best performance (AUC 0.667 (0.638, 0.696)). In descending order of feature importance, PPI came in second place, with a positive relationship with CHD.

CONCLUSIONS

This study indicated a positive correlation between PPI and long-term adverse cardiovascular outcomes among the elderly. Notably, PPI has considerable predictive power for recognizing CHD.

Longitudinal Trends in Heart Failure Mortality Linked to Coronary Artery Disease Among Adults 65 years and older

BACKGROUND

Heart failure (HF) in patients with coronary artery disease (CAD) is a leading cause of mortality among older adults in the United States. This study examines trends in HF with CAD-related mortality among adults aged 65 and older.

METHODS

A retrospective analysis was performed using the CDC WONDER database death certificates from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.

RESULTS

HF associated with CAD led to 1,597,451 deaths among adults > 65, primarily occurring in medical facilities (37.1%). The AAMR for HF with CAD decreased from 241.7 in 1999 to 156.2 in 2020 (AAPC: -2.23, p < 0.001), which was significant from 1999 to 2014. Men had higher AAMRs than women (227.4 vs. 137.1), with women's rates declining more significantly (AAPC: -3.23, p < 0.001). White adults had the highest AAMRs (183.0), while Asians/Pacific Islanders (81.6) recorded the lowest. Geographically, AAMRs varied, from 92.1 in Hawaii to 257.3 in West Virginia, with the Midwest showing the highest mortality (191.0). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (202.6 vs. 166.1) CONCLUSION: Our study reveals striking disparities in HF-related mortality among adults aged 65 years and older in the United States. While AAMRs decreased overall from 1999 to 2014, they have reached an inflection point since 2019, indicating rising mortality rates. Persistent inequalities underscore the critical need for targeted public health interventions to address these issues.

Generation and purification of iPSC-derived cardiomyocytes for clinical applications

BACKGROUND

Over the past decade, the field of cell therapy has rapidly expanded with the aim to replace and repair damaged cells and/or tissue. Depending on the disease many different cell types can be used as part of such a therapy. Here we focused on the potential treatment of myocardial infarction, where currently available treatment options are not able to regenerate the loss of healthy heart tissue.

METHOD

We generated good manufacturing practice (GMP)-compatible cardiomyocytes (iCMs) from transgene- and xenofree induced pluripotent stem cells (iPSCs) that can be seamless adapted for clinical applications. Further protocols were established for replating and freezing/thawing iCMs under xenofree conditions.

RESULTS

iCMs showed a cardiac phenotype, with the expression of specific cardiac markers and absence of pluripotency markers at RNA and protein level. To ensure a pure iCMs population for in vivo applications, we minimized risks of iPSC contamination using RNA-switch technology to ensure safety.

CONCLUSION

We describe the generation and further processing of xeno- and transgene-free iCMs. The use of GMP-compliant differentiation protocols ab initio facilitates the clinical translation of this project in later stages.

Brain-targeting biomimetic nanozyme enhances neuroprotection in ischemic stroke by remodeling the neurovascular unit

Dysfunction of the neurovascular unit significantly impacts the prognostic outcomes of ischemic stroke. However, effective strategies to comprehensively modulate the neurovascular unit have yet to be developed. In this work, we introduce a brain-targeting biomimetic nanozyme, A@HPB@THSA, designed to mitigate neurovascular unit dysfunction following ischemia/reperfusion. Specifically, aspirin is encapsulated within hollow Prussian blue nanozyme, which is subsequently modified with brain-targeting T7 peptide-conjugated human serum albumin, ultimately forming the composite A@HPB@THSA. The overexpression of transferrin receptors on cerebral vascular endothelial cells, along with compromised blood-brain barrier (BBB) permeability, facilitates the accumulation of A@HPB@THSA at cerebral ischemic lesions. The hollow Prussian blue nanozyme component effectively scavenges reactive oxygen species in ischemia/reperfusion-affected brain cells. While the aspirin component inhibits platelets aggregation and neutrophils infiltration, thereby preventing microvascular "no-reflow" and preserving the integrity of the BBB. In rat models of transient middle cerebral artery occlusion, A@HPB@THSA demonstrated comprehensive modulation of the neurovascular unit, including reduced BBB permeability, promotion of microglia polarization toward an anti-inflammatory phenotype, and enhanced neuronal survival. This work provides a promising platform to reverse dysfunctional neurovascular unit for ischemic stroke treatment.

Acetyl-CoA synthetase 2 alleviates brain injury following cardiac arrest by promoting autophagy in brain microvascular endothelial cells

INTRODUCTION

Brain injury is a common sequela following cardiac arrest (CA), with up to 70% of hospitalized patients dying from it. Brain microvascular endothelial cells (BMVECs) play a crucial role in post-cardiac arrest brain injury (PCABI). However, the effects and mechanisms of targeting BMVEC energy metabolism to mitigate brain injury remain unclear.

METHODS

We established a mouse model of cardiac arrest by injecting potassium chloride into the right internal jugular vein. Mass spectrometry detected targeted changes in short-chain fatty acids and energy metabolism metabolites in the CA/CPR group compared to the sham group. Mice with overexpressed ACSS2 in BMVECs were created using an AAV-BR1 vector, and ACSS2 knockout mice were generated using the CRE-LOXP system. The oxygen glucose deprivation/re-oxygenation (OGD/R) model was established to investigate the role and mechanisms of ACSS2 in endothelial cells in vitro.

RESULTS

Metabolomics analysis revealed disrupted cerebral energy metabolism post-CA/CPR, with decreased acetyl-CoA and amino acids. Overexpression of ACSS2 in BMVECs increased acetyl-CoA levels and improved neurological function. Vascular endothelial cell-specific ACSS2 knockout mice exhibited reduced aortic sprouting in vitro. Overexpression of ACSS2 improved endothelial dysfunction following oxygen glucose deprivation/re-oxygenation (OGD/R) and influenced autophagy by interacting with transcription factor EB (TFEB) and modulating the AMP-activated protein kinase α (AMPKα) pathway.

CONCLUSION

Our study shows that ACSS2 modulates the biological functions of BMVECs by promoting autophagy. Enhancing energy metabolism via ACSS2 may target PCABI treatment development.

Oral anticoagulant use among Medicare patients newly diagnosed with venous thromboembolism (VTE): Factors associated with treatment status

OBJECTIVE

This study aimed to describe oral anticoagulant (OAC) use among patients with venous thromboembolism (VTE).

MATERIALS AND METHODS

This study included Medicare fee-for-service beneficiaries (data from 1/1/2014-12/31/2019) newly diagnosed with VTE. Factors associated with being untreated with OACs in the first month from VTE (vs. OAC-treated), with receiving direct-acting OACs ([DOACs] vs. warfarin), and with extended OAC treatment (>3 months) were assessed using multivariable logistic regressions.

RESULTS

Overall, 169,928 patients with VTE (50.3% OAC-untreated) were included. Among the 49.7% OAC-treated patients, 74.0% used DOACs and 62.5% had extended OAC treatment. Factors associated with being untreated with OACs in the first month from VTE (odds ratio; 95% confidence interval) included Hispanic ethnicity (vs. White;1.35; 1.29-1.42), having part D low-income subsidy (1.14; 1.07, 1.20), and comorbidities such as cardiovascular diseases. Among the OAC-treated cohort, patients with index VTE diagnosis in the emergency room (vs. outpatient) setting had higher odds of receiving DOAC vs. warfarin; patients with pulmonary embolism diagnosis (vs. deep vein thrombosis) had higher odds of extended OAC treatment.

CONCLUSIONS

In this study of Medicare patients newly diagnosed with VTE, half of the patients were not treated with OAC in the first month from initial diagnosis. Factors such as Hispanic ethnicity, having low-income subsidy, and comorbidity burden were found to be associated with being untreated with OAC. Among OAC-treated patients, the majority were treated with DOAC vs. warfarin. Interestingly, more than a third of OAC-treated patients were not treated beyond 3 months, which warrants further investigation.

Cross-sectional evaluation of the metabolic vulnerability index in heart failure populations

BACKGROUND

The Metabolic Vulnerability Index (MVX) is a novel multi-marker risk score derived from nuclear magnetic resonance (NMR) measures and has shown predictive value for mortality in heart failure. Hence, we aimed to evaluate the distribution of MVX and its clinical correlates within a clinical trial population and a comparable subpopulation of patients with heart failure with reduced ejection fraction and ischemic heart disease within a community cohort.

METHODS

We studied a clinical trial (2016-2018) and a community cohort (2003-2012), matched based on ejection fraction category and presence of ischemic heart failure. NMR LipoProfile analyses of plasma from both populations provided measures of valine, leucine, isoleucine, citrate, GlycA, and small high-density lipoprotein particles used to compute sex-specific MVX scores. Univariable and multivariable regression models assessed the relationship between MVX (modeled continuously), and selected demographic and clinical covariates.

RESULTS

Clinical trial patients (N = 101, median age: 63, 93% male, median EF: 28%) were younger and predominantly male compared to the cohort (N = 288, median age: 75, 70% male, median EF: 30%). The median MVX score was lower in the clinical trial (50, 42-61) compared to the cohort (66, 58-73). Male sex and hyperlipidemia were linked to higher MVX scores in the clinical trial, while obesity and NT-proBNP were linked to lower and higher MVX scores, respectively, in the cohort (p <.05). After adjusting for significant covariates from univariable analyses and age in multivariable analyses, only the associations between male sex and MVX scores in the clinical trial, and NT-proBNP levels with MVX in the cohort remained significant.

CONCLUSION

This study highlights significant differences in MVX distribution and its clinical correlates between a clinical trial and a community cohort despite matched heart failure subtypes. These findings have important implications for interpreting and applying the score in diverse study settings.