2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Atherogenic index of plasma and the clinical outcome of patients with acute coronary syndrome: a meta-analysis

BACKGROUND

The atherogenic index of plasma (AIP) has been related to an increased risk of coronary artery disease. However, previous studies evaluating the prognostic role of AIP for acute coronary syndrome (ACS) showed inconsistent results. This meta-analysis was conducted to systematically evaluate the association between AIP and the risk of major cardiovascular adverse events (MACE) of patients with ACS.

MATERIALS AND METHODS

Relevant cohort studies were retrieved by searching electronic databases, including PubMed, Web of Science, and Embase. A random-effects model was used to combine the data by incorporating the influence of between-study heterogeneity.

RESULTS

Thirteen datasets from nine cohort studies, involving 10,861 patients with ACS were included in the meta-analysis. Of them, 1546 (14.2%) developed MACE during follow-up. Pooled results suggested that a high AIP at admission was associated with an increased risk of MACE during follow-up (risk ratio [RR]: 1.54, 95% confidence interval [CI]: 1.30-1.82, p < 0.001; I2 = 48%). Subgroup analyses suggested a stronger association between a high AIP and an increased risk of MACE in older patients (mean age ≥60 years, RR: 2.26, 95% CI: 1.78-2.87, p < 0.001; I2 = 0%) than the younger ones (mean age <60 years, RR: 1.30, 95% CI: 1.17-1.44, p < 0.001; I2 = 0%; p for subgroup difference <0.001), which fully explained the heterogeneity.

CONCLUSION

A high AIP is associated with an increased risk of MACE in patients with ACS, particularly for older patients.

Epigenetic regulation of the inflammatory response in stroke

Stroke is classified as ischemic or hemorrhagic, and there are few effective treatments for either type. Immunologic mechanisms play a critical role in secondary brain injury following a stroke, which manifests as cytokine release, blood-brain barrier disruption, neuronal cell death, and ultimately behavioral impairment. Suppressing the inflammatory response has been shown to mitigate this cascade of events in experimental stroke models. However, in clinical trials of anti-inflammatory agents, long-term immunosuppression has not demonstrated significant clinical benefits for patients. This may be attributable to the dichotomous roles of inflammation in both tissue injury and repair, as well as the complex pathophysiologic inflammatory processes in stroke. Inhibiting acute harmful inflammatory responses or inducing a phenotypic shift from a pro-inflammatory to an anti-inflammatory state at specific time points after a stroke are alternative and promising therapeutic strategies. Identifying agents that can modulate inflammation requires a detailed understanding of the inflammatory processes of stroke. Furthermore, epigenetic reprogramming plays a crucial role in modulating post-stroke inflammation and can potentially be exploited for stroke management. In this review, we summarize current findings on the epigenetic regulation of the inflammatory response in stroke, focusing on key signaling pathways including nuclear factor-kappa B, Janus kinase/signal transducer and activator of transcription, and mitogen-activated protein kinase as well as inflammasome activation. We also discuss promising molecular targets for stroke treatment. The evidence to date indicates that therapeutic targeting of the epigenetic regulation of inflammation can shift the balance from inflammation-induced tissue injury to repair following stroke, leading to improved post-stroke outcomes.

Oral functional protein Z: Mitigation of thrombosis via thrombin inhibition to prevent cardiovascular disease

Thrombin, a serine protease, plays a crucial role in thrombosis and is considered a significant target for the treatment of thrombotic diseases. This study aimed to investigate the malt-derived serine protease inhibitor protein Z (PZ) as an oral food enrichment for inhibiting thrombosis. The ability of PZ to withstand gastrointestinal digestion was assessed through in vitro simulated gastrointestinal digestion experiments. Its effective ability to traverse the digestive tract was demonstrated in vivo experiments. To explore its antithrombotic mechanism, the antithrombin activity of PZ was evaluated using two thrombin substrates, suggesting that it may inhibit either the active site or exosite 1 of thrombin. Additionally, the half-life of PZ was 10.76 ± 0.45 min, indicating its favorable pharmacokinetic profile. The anticoagulant activity and antithrombotic effects of PZ were further assessed using a mice tail thrombosis model induced by κ-carrageenan. The black tail rate in the PZ group is 51.23 ± 1.72 % lower than that of the model group (71.87 ± 5.90 %). These results demonstrated that PZ significantly inhibited thrombosis, with its physiological mechanism linked to the coagulation pathway, particularly through the inhibition of thrombin activity. Therefore, PZ has the potential to be developed as an oral antithrombotic food enrichment.

Multidimensional Risk Factors for Heart Failure in Hispanic Adults: Findings from the All of Us Research Program

Heart failure (HF) is a leading cause of morbidity and mortality in the United States affecting approximately 6.7 million adults. In Hispanic adults, HF is underdiagnosed, leading to an incomplete characterization of the HF risk profiles in this population. Thus, the objective of the study was to investigate the multidimension HF risk factors among Hispanic adults. This cross-sectional study analyzed observational data collected from Hispanic adult participants in the All of Us Research Program. Sociodemographic, lifestyle, environmental, stress, and health care access and utilization data were retrieved from the survey domain. Past medical history was retrieved from the electronic health record domain. Using SAS, logistic regression was performed to identify multidimension risk factors for HF in Hispanic adults. The study subjects consisted of 5,281 Hispanic adults with 72.5% females and 27.5% males. The prevalence of HF was 3.6% (188/5,281). Males had a higher prevalence of HF than females (5.7% vs 2.7%). After adjusting for potential confounders with logistic regression, age (OR = 1.03, 95% CI [1.01, 1.04], p <0.0001), hypertension (OR = 5.75, 95% CI [3.23, 10.24], p <0.0001), heart attack (OR = 11.31, 95% CI [7.71, 16.58], p <0.0001), type 2 diabetes mellitus (OR = 1.45, 95% CI [1.02, 2.06], p = 0.0383), and obesity (OR = 2.32, 95% CI [1.60, 3.36], p <0.0001) were significant risk factors for HF. In conclusion, multidimension risk factors for HF among Hispanic adults were explored in this study. More research is needed to compare these risk factors to other non-Hispanic populations.

Mediating role of the ratio of family income to poverty in the association between depressive symptoms and stroke: Evidence from a large population-based study

BACKGROUND

Previous investigations have established a notable correlation between depressive symptoms and stroke incidence, as well as the link between stroke occurrence and the ratio of family income-to-poverty ratio (PIR). The intricate dynamics between depressive states and the incidence of stroke mediated by PIR, however, remains inadequately understood.

OBJECTIVE

The objective of this research is to scrutinize the link between depressive states and stroke, assessing how PIR functions as a mediator in this dynamic. Through an analysis of the economic status of individuals exhibiting depressive symptoms, this study explores their potential influence on the susceptibility to stroke. Such analysis aims to uncover the intricate interactions among depression, the PIR, and stroke occurrence.

METHODS

Data from 2015 to 2018 NHANES assessed adults' depressive symptoms using PHQ-9 scores. Participants reporting a stroke diagnosis by medical professionals were identified as the stroke cohort. The income levels were assessed using the PIR. To examine the relationship between depressive symptoms and stroke, weighted multivariate linear regression models, curve-fitting analyses, and subgroup assessments were employed, alongside mediation analyses to determine the role of PIR as a mediator.

RESULTS

In the analysis of 7204 participants, the data revealed a robust positive association between depressive symptoms and stroke risk within the comprehensively adjusted model. Additionally, the mediation analysis demonstrated that the PIR contributed to 10.3188 % of the explained variability in the link between depressive symptoms and stroke incidence, serving as a specific mediator of this association.

CONCLUSION

The findings of this research indicate that there is a significant positive link between depressive symptoms and the incidence of stroke, with the PIR serving as a notable mediator.

Background and design of the Physical Frailty and Symptom Monitoring and Management Behaviors in Heart Failure (PRISM-HF) study: A mixed methods study

Background

Many adults with heart failure (HF) are physically frail and have worse outcomes. While the biological profile of physical frailty in HF has been examined, the behavioral profile remains unstudied. Physical frailty may impact self-care behaviors, particularly symptom monitoring and management (SMM), which in turn results in adverse outcomes. This paper describes the background and design of a study that addresses this knowledge gap, entitled "Physical Frailty and Symptom Monitoring and Management Behaviors in Heart Failure" (PRISM-HF).

Study design and methods

PRISM-HF is a sequential mixed methods study where in Phase 1, we collect quantitative data from a sex-balanced sample of 120 adults with HF, and in Phase 2, we collect qualitative data from ∼32-40 adults from this sample, aiming to: (1) quantify associations among physical frailty, SMM behaviors, and outcomes; (2) describe the experience of SMM behaviors for physically frail and non-physically frail adults with HF; and (3) identify the SMM behavioral needs of physically frail and non-physically frail adults with HF. At baseline, we measure symptoms, SMM behaviors, and physical frailty and collect clinical events at 6-months. We will use generalized linear modeling and survival analysis in Aim 1, directed content analysis in Aim 2, and triangulation analyses using an informational matrix in Aim 3.

Conclusions

This innovative study will investigate the behavioral underpinnings of physical frailty in HF, incorporate the patient's perspective of SMM behaviors in the context of physical frailty, and identify possible explanations for the effect of physical frailty on outcomes.

Lipidomics and cardiovascular disease

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, necessitating innovative approaches for early detection and personalized interventions. Lipidomics, leveraging advanced mass spectrometry techniques, has become instrumental in deciphering lipid-mediated mechanisms in CVDs. This review explores the application of lipidomics in identifying biomarkers for myocardial infarction, heart failure, stroke, and calcific aortic valve stenosis (CAVS). This review examines the technological advancements in shotgun lipidomics and LC/MS, which provide unparalleled insights into lipid composition and function. Key lipid biomarkers, including ceramides and lysophospholipids, have been linked to disease progression and therapeutic outcomes. Integrating lipidomics with genomic and proteomic data reveals the molecular underpinnings of CVDs, enhancing risk prediction and intervention strategies. This review positions lipidomics as a transformative tool in reshaping cardiovascular research and clinical practice.

Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Case-Based Narrative Review

These 4 hypothetical cases highlight new features of the American Heart Association cardiovascular-kidney-metabolic (CKM) health construct. The cases incorporate the CKM staging system, estimates from the PREVENT risk calculator, and clinical approaches related to CKM stages and individual risk profiles. Topics include management considerations for (1) a patient with stage 1 obesity and impaired glucose tolerance, (2) a patient with metabolic risk factors and moderate-risk chronic kidney disease (CKD), (3) a patient with subclinical atherosclerotic cardiovascular disease and multiple comorbid conditions, and (4) a patient with metabolic risk factors, prior myocardial infarction, new-onset heart failure, atrial fibrillation, and CKD.

Roles of Adam8 in Neuroinflammation in experimental ischemic Stroke: Insights from single-cell and ribosome-bound mRNA sequencing

Stroke remains a leading cause of global mortality, with neuroinflammation significantly exacerbating clinical outcomes. Microglia serve as key mediators of post-stroke neuroinflammation, though the mechanisms driving their migration to injury sites remain poorly understood. In this study, using publicly available single-cell sequencing data (GSE234052), we identified a migration-associated microglial subtype in a murine model of distal middle cerebral artery occlusion (dMCAO). Additionally, ribosome-bound mRNA sequencing data (GSE225110) from microglia isolated from peri-infarct cortical tissue uncovered dMCAO-induced alterations in microglial mRNA translation. By integrating these datasets, we identified A Disintegrin And Metalloproteinase 8 (Adam8) as a key gene upregulated at both the transcriptional and translational levels post-dMCAO. Protein analysis revealed that both the precursor and active forms of Adam8 were predominantly expressed in microglia and significantly upregulated in peri-infarct regions following dMCAO. Notably, Adam8 inhibition with BK-1361 significantly reduced Adam8 cleavage, M1 microglial migration, inflammation, infarct size, and improved neurological outcomes. Bioinformatics analysis further identified Myo1e as a potential interacting partner of Adam8, a finding validated through immunofluorescence co-localization. These findings highlight Adam8 as a promising therapeutic target for mitigating post-stroke neuroinflammation and offer new insights into the mechanisms of microglial migration.

Patient and informal caregiver-centered nursing interventions for adults with heart failure: A systematic review and meta-analysis

BACKGROUND

Heart failure management requires active participation in self-care by both patients and family caregivers as a dyad.

OBJECTIVE

This systematic review and meta-analysis aimed to examine the impact of dyadic self-care interventions on patient outcomes in heart failure management.

METHODS

We searched databases including PubMed, Embase, Cochrane Library, Web of Science, CINAHL, CNKI, and Wanfang through May 14, 2024. Following PRISMA guidelines, we used the Cochrane Risk of Bias tool for quality assessment and Review Manager 5.4 for data analysis.

RESULTS

Twenty studies (18 Randomized Controlled Trials, 2 quasi-experimental) involving 3,266 patients and 3,091 family caregivers were included. Dyadic self-care interventions showed significant effects on patients' self-care maintenance (MD: 9.07, 95 % CI: 6.17-11.98) and management (MD: 5.03, 95 % CI: 3.96-6.10) across all time periods. Self-care confidence improved only in short-term (MD: 6.32, 95 % CI: 5.32-7.32) and medium-term (MD: 4.23, 95 % CI: 0.26-8.20). Quality of life improved only in short-term. The interventions reduced readmission rates and healthcare costs but showed no effect on mortality, anxiety, or depression.

CONCLUSIONS

Dyadic interventions effectively reduced readmissions and improved quality of life in heart failure management. Future research should focus on sustainable, cost-effective strategies for long-term outcomes.

IMPLICATIONS FOR CLINICAL PRACTICE

The findings support implementing dyadic interventions while emphasizing the need for continued focus on mental health and sustained support. Further research on caregiver outcomes is warranted.

Psychosocial factors and associations with preventive cardiovascular screening among U.S adults: Findings from the National Health Interview Survey, 2023

OBJECTIVE

Structural and COVID-related factors have been linked with the decline in preventive health screenings among adults. However, associations between psychosocial factors and undergoing preventive cardiovascular screening are not fully known. The current study examined associations between psychosocial factors and preventive cardiovascular screening among U.S. adults.

METHODS

We used data from the 2023 National Health Interview Survey (N = 23,428). Data were collected from January to December from adults living in U.S. Preventive cardiovascular (CV) screening (i.e., blood pressure, cholesterol, or blood sugar level) was defined as no screening, and undergoing screening for any CV risk within the past year. Psychosocial factors were defined as discrimination, life satisfaction, and depression. Multivariable logistic regression models examined the associations between psychosocial factors and preventive cardiovascular screening, adjusted for sociodemographic characteristics.

RESULTS

Adults with diagnosis of depression (OR: 1.93, 95 % CI: 1.65-2.25) had higher odds of undergoing screening for any CV risk. Adults who experienced discrimination had lower odds of undergoing screening for cholesterol (OR: 0.77, 95 % CI: 0.71-0.84) and blood sugar level specifically (OR: 0.78, 95 % CI: 0.72-0.85), while life dissatisfaction was associated with lower odds of screening for blood pressure (OR: 0.76, 95 % CI: 0.58-0.99) and blood sugar level specifically (OR: 0.80, 95 % CI: 0.65-0.97).

CONCLUSIONS

Discrimination and life dissatisfaction were associated with decreased odds of undergoing specific preventive cardiovascular screening, and depression is associated with increased odds of undergoing any preventive cardiovascular screening. Equitable health care policies focused on addressing psychosocial factors are needed to increase preventive cardiovascular screening among U.S. adults.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Mitochondria‑derived peptides: Promising microproteins in cardiovascular diseases (Review)

Mitochondria‑derived peptides (MDPs) are a unique class of peptides encoded by short open reading frames in mitochondrial DNA, including the mitochondrial open reading frame of the 12S ribosomal RNA type‑c (MOTS‑c). Recent studies suggest that MDPs offer therapeutic benefits in various diseases, including neurodegenerative disorders and types of cancer, due to their ability to increase cellular resilience. Mitochondrial dysfunction is a key factor in the onset and progression of cardiovascular diseases (CVDs), such as atherosclerosis and heart failure, as it disrupts energy metabolism, increases oxidative stress and promotes inflammation. MDPs such as humanin and MOTS‑c have emerged as important regulators of mitochondrial health, as they show protective effects against these processes. Recent studies have shown that MDPs can restore mitochondrial function, reduce oxidative damage and alleviate inflammation, thus counteracting the pathological mechanisms that drive CVDs. Therefore, MDPs hold promise as therapeutic agents that are capable of slowing, stopping, or even reversing CVD progression and their use presents a promising strategy for future treatments. However, the clinical application of MDPs remains challenging due to their low bioavailability, poor stability and high synthesis costs. Thus, it is necessary to improve drug delivery systems to enhance the bioavailability of MDPs. Moreover, integrating basic research with clinical trials is essential to bridge the gap between experimental findings and clinical applications.

Use of CPR feedback devices in resuscitation training: A systematic review and meta-analysis of randomized controlled trials

Objectives

The use of cardiopulmonary resuscitation (CPR) feedback devices during training is increasing. This review evaluates whether incorporating CPR feedback devices in training improves patient survival, CPR quality in actual resuscitation, skill acquisition and retention after training.

Methods

This systematic review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR). We searched MEDLINE, EMBASE, and SCOPUS databases from inception to September 30, 2024, including randomized controlled trials (RCTs) in all languages (with an English abstract) comparing CPR training with and without feedback devices. Outcome included patient survival, quality of clinical performance in resuscitation, and CPR skill acquisition and retention. Non-RCT studies, unpublished work without peer review or animal studies were excluded. Risk of bias was assessed using Cochrane tools, and certainty of evidence was graded using the Grading of Recommendations Assessment, development and Evaluation (GRADE) approach. Standardized mean difference (SMD) were calculated and pooled effects were analyzed using random-effects models. PROSPERO CRD42023488130.

Results

We identified 20 RCTs with 4579 participants. Risks of bias ranged from low to critical (low: 8, moderate: 9, and critical: 3). No studies evaluated the patient survival, clinical performance in resuscitation or cost-effectiveness. Compared to no feedback, using CPR feedback devices during training significantly improved key quality metrics. Pooled effect sizes were 0.76 (95%CI 0.02 - 1.50) for mean compression depth (15 studies), 0.98 (95%CI: 0.10 - 1.87) for depth compliance (16 studies), 0.29 (95%CI: 0.10 - 0.48) for mean rate (17 studies), 0.44 (95%CI: 0.23 - 0.66) for rate compliance (9 studies), and 0.53 (95%CI: 0.31 - 0.75) for recoil compliance (10 studies) in favour of using feedback devices during training. Heterogeneity was large (I2 > 50%) in all analyses. Planned subgroup analyses revealed no statistically significant interaction between healthcare professionals and laypersons. Using the GRADE approach, the certainty of evidence was downgraded for certain outcomes due to critical risk of bias for 3 studies and inconsistency but upgraded for strong association.

Conclusion

The use of CPR feedback devices during resuscitation training improves key quality metrics of CPR performance, with moderate to high certainty of evidence. However, further studies are needed to evaluate the impact on cost-effectiveness, clinical performance and patient outcomes.

Overexpression of adipose tissue ERα enhances PVAT anticontractility via NOX4-derived H2O2 and is protective against high-fat diet-induced dysfunction

Menopause has unequivocally been associated with cardiovascular risk and obesity. Loss of estrogen bioavailability is a hallmark of menopause. Estrogen is generally considered vasculoprotective, with estrogen receptor α (ERα) being the predominant receptor subtype that mediates these positive effects. Similarly, estrogen and ERα are known to stimulate white adipose tissue metabolism. However, it is unknown whether ERα could exert a beneficial effect on mesenteric perivascular adipose tissue (PVAT). PVAT is a heterogeneous tissue that surrounds most peripheral blood vessels. In physiological conditions, PVAT has an anticontractile effect on the vasculature. However, in several diseases, PVAT switches its phenotype to become procontractile. To date, the role of ERα in PVAT function in health and disease is unknown. Therefore, we hypothesized that overexpression of adipose tissue ERα (ERαOE) would 1) increase the anticontractile effect of PVAT in chow diet conditions and 2) protect mice against a high-fat diet (HFD)-induced PVAT dysfunction. To test this hypothesis, mesenteric resistance arteries, with and without PVAT, were isolated from female ERαOE mice, which had either been on a regular chow diet or an HFD for 19 wk. We observed that ERαOE amplifies the anticontractile effect of mesenteric PVAT via NADPH oxidase 4 (NOX4)-derived hydrogen peroxide (H2O2) in chow conditions, and ERαOE is protective against a dysfunctional PVAT that is observed after an HFD, via the same anticontractile mechanism. Collectively, these data demonstrate that ERα is vasculoprotective in the context of PVAT. Harnessing this signaling could be important for reducing cardiovascular risk in postmenopausal women.NEW & NOTEWORTHY We have revealed for the first time that overexpression of adipose tissue estrogen receptor α (ERαOE) amplifies the anticontractile effect of mesenteric PVAT via the biosynthesis of NADPH oxidase 4 (NOX4)-derived hydrogen peroxide (H2O2), and this overexpression is protective against HFD-induced PVAT dysfunction. Collectively, these data demonstrate an important mechanism by which ERα signaling is vasculoprotective in the context of PVAT.

Associations of Neighborhood Environments and Socioeconomic Status With Subclinical Atherosclerosis: An Integrative Review

BACKGROUND

A limited understanding exists on the associations of neighborhood environment with subclinical atherosclerosis and its progression.

PURPOSE

The purpose of this integrative review was to explore associations of neighborhood environments and socioeconomic status (SES) with subclinical atherosclerosis and its long-term progression.

RESULTS

Three themes were identified: environmental exposure affects the natural history of atherosclerosis, neighborhood characteristics are associated with subclinical atherosclerosis, and individual SES is associated with development and progression of subclinical atherosclerosis more so than neighborhood SES. Some variations in results were noted based on the vascular site examined.

CLINICAL IMPLICATIONS

Disadvantaged neighborhoods and low SES are associated with greater subclinical atherosclerosis. Inconsistencies in a few studies seemed to be related to lack of coronary artery progression among the relatively young adults. This suggests further examination is needed of the contextual associations of neighborhood and SES with markers of generalized atherosclerosis, such as carotid intima-media thickness.

Injectable myocardium-derived hydrogels with SDF-1α releasing for cardiac repair

Myocardial infarction (MI) is a predominant cause of morbidity and mortality globally. Therapeutic chemokines, such as stromal cell-derived factor 1α (SDF-1α), present a promising opportunity to treat the profibrotic remodeling post-MI if they can be delivered effectively to the injured tissue. However, direct injection of SDF-1α or physical entrapment in a hydrogel has shown limited efficacy. Here, we developed a sustained-release system consisting of SDF-1α loaded poly(lactic-co-glycolic acid) nanoparticles (PLGA NPs) and an injectable porcine cardiac decellularized extracellular matrix (cdECM) hydrogel. This system demonstrated a sustained release of SDF-1α over four weeks while there is one week release for SDF-1α directly encapsulated in the cdECM hydrogel during in vitro testing. The incorporation of PLGA NPs into the cdECM hydrogel significantly enhanced its mechanical properties, increasing the Young's modulus from 561 ± 228 kPa to 1007 ± 2 kPa and the maximum compressive strength from 639 ± 42 kPa to 1014 ± 101 kPa. This nanocomposite hydrogel showed good cell compatibility after 7 days of culture with H9C2 cells, while the released SDF-1α retained its bioactivity, as evidenced by its chemotactic effects in vitro. Furthermore, in vivo studies further highlighted its significant ability to promote angiogenesis in the infarcted area and improve cardiac function after intramyocardial injection. These results demonstrated the therapeutic potential of combining local release of SDF-1α with the cdECM hydrogel for MI treatment.

Effects of Social Isolation and Loneliness on Heart Failure Self-care: A Cross-sectional Analysis

BACKGROUND

Patients with heart failure (HF) who engage in effective HF self-care have better quality of life, and lower risks of all-cause and HF-related hospital readmission and mortality. It is unclear whether social isolation and loneliness, which are prevalent among patients with HF and known to affect other self-care behaviors, can predict HF self-care.

OBJECTIVE

The aim was to explore the relationship between social isolation, loneliness, and HF self-care.

METHODS

This was a cross-sectional secondary analysis (n = 49) of the GEtting iNTo Light Exercise for HF randomized controlled trial, a 6-month home-based live group gentle exercise intervention for patients with HF. Measures included the following: 6-item Lubben Social Network Scale for social isolation, Patient-Reported Outcomes Measurement Information System Social Isolation survey for loneliness, Self-Care of Heart Failure Index, and Patient-Reported Outcomes Measurement Information System Depression survey. Multiple linear regression modeling was used to examine the relationships of 4 HF self-care processes to social isolation and loneliness, adjusting for depression and grouping (control group or intervention group).

RESULTS

Scores indicating less social isolation predicted higher self-care maintenance ( B = 0.937, P = .015), monitoring ( B = 0.799, P = .041), and management ( B = 1.812, P < .001). Loneliness did not predict HF self-care.

CONCLUSIONS

To our knowledge, this is the first study to predict HF self-care using distinct measures for social isolation and loneliness. Patients who were less socially isolated engaged in better HF self-care; loneliness had no relationship with HF self-care. Prospective studies are needed to investigate causal relationships between social isolation and HF-self-care engagement to determine the effect on outcomes such as hospital readmission and mortality.

Safety and efficacy of transcranial direct current stimulation in addition to constraint-induced movement therapy for post-stroke motor recovery (TRANSPORT2): a phase 2, multicentre, randomised, sham-controlled triple-blind trial

BACKGROUND

Motor impairments contribute substantially to long-term disability following stroke. Studies of transcranial direct current stimulation (tDCS), combined with various rehabilitation therapies, have shown promising results in reducing motor impairment. We aimed to evaluate the safety and efficacy of three doses of tDCS in combination with modified constraint-induced movement therapy (mCIMT) in people who have had their first ischaemic stroke in the preceding 1-6 months.

METHODS

We conducted a phase 2, multicentre, randomised, triple-blind, sham-controlled study with a blinded centrally scored primary outcome. The trial was conducted at 15 medical centres in the USA. Eligible participants were enrolled between 1 month and 6 months after their first ischaemic stroke. Inclusion criteria required participants to have a persistent motor deficit, defined as a Fugl-Meyer Upper-Extremity (FM-UE) score of 54 or lower (out of 66), and two consecutive baseline visits (separated by 7-14 days) with an absolute difference of 2 or fewer points on the FM-UE scale. Participants were randomly assigned to treatment groups by an adaptive randomisation algorithm hosted on the TRANSPORT2 WebDCU study website. Participants received either sham, 2 mA, or 4 mA of bi-hemispheric tDCS for the first 30 min and mCIMT with 120 min of active therapy time per session, administered over ten sessions during a 2-week period. The primary endpoint was the change in FM-UE score from baseline to day 15, which was analysed in all participants who have data both at baseline and post-baseline (modified intention-to-treat group). Safety outcomes were analysed in all participants. TRANSPORT2 is registered at clinicaltrials.gov (NCT03826030) and its status is completed.

FINDINGS

129 participants were recruited between Sept 9, 2019, and June 14, 2024, and 43 participants were randomly assigned to each group. 54 (42%) of 129 participants were female, and 69 (53%) were White. Two participants in the sham plus mCIMT group withdrew consent before the day 15 assessment and were excluded from the primary analysis. The median baseline FM-UE score was 39·0 (IQR 30·0-46·0) in the sham plus mCIMT group, 39·0 (27·0-48·0) in the 2 mA plus mCIMT group, and 40·0 (27·0-48·0) in the 4 mA plus mCIMT group. For the primary outcome, the adjusted mean change from baseline to day 15 in FM-UE was 4·91 (3·00-6·82) for sham plus mCIMT, 3·87 (2·00-5·74) for 2 mA plus mCIMT, and 5·53 (3·64-7·42) for 4 mA plus mCIMT (p=0·39). No clinically important adverse events were observed in any group and no deaths were reported.

INTERPRETATION

tDCS at doses of 2 mA or 4 mA, in addition to mCIMT, did not lead to further reduction in motor impairment in patients 1-6 months after stroke, but it was safe, well tolerated, and feasible for clinical practice. tDCS at higher doses (ie, >4 mA) might be a consideration for future trials in addition to balancing known covariates affecting stroke recovery during the group allocation.

FUNDING

National Institute of Neurological Disorders and Stroke.

Cardioprotective effect of 19,20-epoxydocosapentaenoic acid (19,20-EDP) in ischaemic injury involves direct activation of mitochondrial sirtuin 3

AIMS

Although current clinical therapies following myocardial infarction (MI) have improved patient outcomes, morbidity, and mortality rates, secondary to ischaemic and ischaemia reperfusion (IR) injury remains high. Maintaining mitochondrial quality is essential to limit myocardial damage following cardiac ischaemia and IR injury. The mitochondrial deacetylase sirtuin 3 (SIRT3) plays a pivotal role in regulating mitochondrial function and cardiac energy metabolism. In the current study, we hypothesize that 19,20-epoxydocosapentaenoic acid (19,20-EDP) attenuates cardiac IR injury via stimulating mitochondrial SIRT3.

METHODS AND RESULTS

Ex vivo models of isolated heart perfusions were performed in C57BL/6 mice to assess the effect of 19,20-EDP on cardiac function and energy metabolism following IR injury. In vivo permanent occlusion of the left anterior descending coronary artery was performed to induce MI; mice were administered 19,20-EDP with or without the SIRT3 selective inhibitor 3-TYP. Mitochondrial SIRT3 targets and respiration were assessed in human left ventricular tissues obtained from individuals with ischaemic heart disease (IHD) and compared to non-failing controls (NFCs). Binding affinity of 19,20-EDP to human SIRT3 was assessed using molecular modelling and fluorescence thermal shift assay. Results demonstrated that hearts treated with 19,20-EDP had improved post-ischaemic cardiac function, better glucose oxidation rates, and enhanced cardiac efficiency. The cardioprotective effects were associated with enhanced mitochondrial SIRT3 activity. Interestingly, treatment with 19,20-EDP markedly improved mitochondrial respiration and SIRT3 activity in human left ventricle (LV) fibres with IHD compared to NFC. Moreover, 19,20-EDP was found to bind to the human SIRT3 protein enhancing the NAD+-complex stabilization leading to improved SIRT3 activity. Importantly, the beneficial effects of 19,20-EDP were abolished by SIRT3 inhibition or using the S149A mutant SIRT3.

CONCLUSION

These data demonstrate that 19,20-EDP-mediated cardioprotective mechanisms against ischaemia and IR injury involve mitochondrial SIRT3, resulting in improved cardiac efficiency.

Sleep Duration Alters Overfeeding-mediated Reduction in Insulin Sensitivity

CONTEXT

Weight gain and sleep restriction both reduce insulin sensitivity. However, it is not known if sleep duration alters glucose metabolism in response to overfeeding.

OBJECTIVE

To examine the effect of sleep duration on overfeeding-mediated alterations in carbohydrate metabolism and insulin sensitivity.

METHODS

Retrospective exploratory analysis of a longitudinal overfeeding study in healthy participants (n = 28, age: 26.9 ± 5.5 years, body mass index: 25.74 ± 2.45 kg/m2). After providing baseline study measures, participants were overfed 40% above weight maintenance calorie requirements for 8 weeks. Insulin sensitivity was determined by a 2-step hyperinsulinemic-euglycemic clamp. Baseline habitual sleep duration was estimated by accelerometry, and sleep groups were created based on median sleep duration (5.2 hours/night).

RESULTS

Overfeeding led to an average body weight gain of 7.3 ± .4 kg. Habitual sleep duration did not alter overfeeding-mediated body weight gain, fat gain, and fat distribution (all P > .15). Compared to participants with more sleep, fasting insulin (P = .01) and homeostatic model assessment for insulin resistance (P = .02) increased while fasting glucose remained unchanged (P = .68) with overfeeding in participants with shorter sleep duration. Glucose infusion rate during high insulin dose was reduced with overfeeding in participants with short sleep duration but not in participants with more sleep (P < .01).

CONCLUSION

Overfeeding mediated weight gain reduced liver, adipose, and whole-body insulin sensitivity prominently in individuals with short sleep duration but not in individuals with longer sleep duration. This suggests that promoting adequate sleep during short periods of overeating may prevent detrimental effects on glucose metabolism.

Endothelial-targeting miR-145 micelles restore barrier function and exhibit atheroprotective effects

Atherosclerosis remains the leading cause of death worldwide and is characterized by the accumulation of plaque beneath the endothelium. MicroRNA-145-5p (miR-145), which is downregulated in atherosclerosis, has been shown to mitigate plaque development by promoting the contractile vascular smooth muscle cell (VSMC) phenotype. Previously, our lab found that miR-145 micelles conjugated with MCP-1 peptides were able to inhibit atherosclerosis by targeting diseased VSMC via C-C chemokine receptor 2 (CCR2). Diseased endothelial cells similarly express CCR2; however, the impact of miR-145 micelles on endothelial cell function has not been explored. Thus, in this study, the in vitro therapeutic effects of miR-145 micelles in modulating the endothelium during atherosclerosis are evaluated. To that end, the MCP-1 peptide density on the micelle surface was first optimized for activated endothelial cell binding, followed by loading miR-145 into micelles with the optimal MCP-1 ratio. Following characterization, miR-145 micelle treatment of activated endothelial cells resulted in efficient miR-145 transfection, upregulation of atheroprotective genes, and suppression of atherogenic genes. Furthermore, the treatment enhanced the integrity of endothelial tight junctions and reduced monocyte migration. This work establishes miR-145 micelles as an effective nanotherapeutic for restoring endothelial cell health in cardiovascular disease for the first time.

Activation of ATF6 Signaling Confers Long-Term Beneficial Effects in Young and Aged Mice After Permanent Stroke

Ischemic stroke disrupts protein homeostasis in brain cells, causes endoplasmic reticulum (ER) stress, and consequently activates the unfolded protein response (UPR). The primary function of UPR activation is to help cells restore ER function, thereby promoting cell survival. A major adaptive UPR branch is mediated by activating transcription factor 6 (ATF6). We previously provided experimental evidence that activation of ATF6 signaling in neurons improves short-term outcome after both transient and permanent stroke. However, the effect of ATF6 activation in astrocytes on stroke outcome remains undetermined, and critically, the long-term therapeutic potential of targeting this UPR branch in permanent stroke has not been evaluated. The current study aimed to address these two critical unknowns. First, using conditional knock-in mice in which functional short-form ATF6 (sATF6) is specifically expressed in astrocytes, we demonstrated that astrocytic ATF6 activation modestly improved outcome after permanent stroke. Then, our pharmacokinetic analysis indicated that compound AA147, an ATF6-specific activator, can cross the blood-brain barrier. Lastly, we found that post-stroke treatment with AA147 had no significant beneficial effect on short-term outcome, but improved long-term functional recovery in both young and aged mice after permanent stroke. Together with previous findings, our data support the notion that the ATF6 pathway is a promising target for stroke therapy.

A Phase I Study to Evaluate the Relative Bioavailability, Pharmacodynamics, and Safety of a Single Subcutaneous Injection of Recaticimab at Three Different Sites in Healthy Chinese Subjects

BACKGROUND AND OBJECTIVES

Recaticimab (SHR-1209) is a humanized monoclonal antibody that binds to the proprotein convertase subtilisin/kexin type 9 (PCSK9) with high affinity. This study was conducted to compare the relative bioavailability, pharmacokinetics (PK), pharmacodynamics (PD), and safety of recaticimab following subcutaneous injection at three different sites in healthy Chinese subjects.

METHODS

In this randomized, parallel, open-label, phase I study, 159 healthy Chinese subjects were randomized to receive a single dose of 450 mg recaticimab subcutaneously into the abdomen, upper-arm, or thigh and were followed up until 113 days postdose. Adverse events were monitored, and serum samples were collected for PK, PD, and immunogenicity evaluation during the study.

RESULTS

The PK profiles of recaticimab were similar among different injection site groups. The geometric mean ratios of maximum serum concentration (Cmax), area under the serum concentration versus time curve (AUC) from time zero to the time of last quantifiable concentration (AUC0-last), and AUC from time zero extrapolated to infinity (AUC0-inf) between groups were all close to 1, with two-sided 90% confidence intervals within 0.8-1.25. Recaticimab showed similar effects on low-density lipoprotein cholesterol levels in all groups, with mean maximum percentage decreases ranging from 56.88% to 59.04%. The percentage changes from baseline in free PCSK9 and other lipid variables were similar across the three groups as well. Treatment-emergent adverse events were reported in 41/53 (77.4%, abdomen), 29/53 (54.7%, upper-arm), and 42/53 (79.2%, thigh) subjects, most of which were mild and resolved without treatment. The incidence of antidrug antibodies among the three groups was comparable.

CONCLUSIONS

A single subcutaneous injection of 450 mg recaticimab into the abdomen, upper-arm, or thigh was well-tolerated and presented similar PK and PD profiles, which supported the interchangeable use of the three injection sites for patients.

CLINICAL TRIAL IDENTIFIER

( www.

CLINICALTRIALS

gov ) NCT05370950 2022-05-07.

Enhancement of alginate/gelatin/polyvinyl alcohol hydrogels for multi-crosslinked 3D printed blood vessels

Given the significant social and clinical challenges posed by the increasing incidence of cardiovascular diseases (CVDs), the development of small-diameter artificial blood vessels utilizing biomacromolecular materials has emerged as a promising therapeutic strategy for addressing CVDs. In this paper, sodium alginate/gelatin/polyvinyl alcohol (SA/Gel/PVA) porous composite hydrogel ink is firstly prepared by multiple crosslinking method, aiming to solve the problems of poor mechanical properties and unsatisfactory printing effect of small diameter blood vessels. The effect of crosslinking order on the mechanical properties of the materials is explored by adjusting the ratio of SA/Gel/PVA hydrogel. In results, the mechanical strength (>20 %), swelling property (>250 %) and water content (>81 %) of the materials can be improved by appropriate crosslinking method and concentration ratio. Through comprehensive characterization encompassing mechanical properties, moisture content, and microscopic morphology analysis, this study investigates the influence of microscopic pore architecture on the physicochemical characteristics of hybrid hydrogels, aiming to optimize the hydrogel formulation for enhanced performance. Finally, the self-developed 3D printing equipment is utilized to verify the printing feasibility. This study can not only advance the performance of SA/Gel/PVA hydrogel, but also further advance the application of SA/Gel/PVA hydrogel in the field of vessel printing and molding.

AI analysis for ejection fraction estimation from 12-lead ECG

Heart failure (HF) remains a leading global cause of cardiovascular deaths, with its prevalence expected to rise in the upcoming decade. Measuring the heart ejection fraction (EF) is crucial for diagnosing and monitoring HF. Although echocardiography is the gold standard for EF measurement, it is often inaccessible in remote areas due to its cost and complexity. In contrast, electrocardiography (ECG) is more readily available and affordable, and emerging research suggests a possible link between ECG signals and EF. In this work, we explore the potential of 12-lead ECG signals to estimate EF using various machine learning (ML) and deep learning (DL) models. While recent studies have considered the use of ML or DL for estimating EF, these algorithms are often trained and tested on urban-based populations. However, demographics like those in rural Appalachia, where disease prevalence is extremely high, have been overlooked, potentially due to the unavailability of large volumes of data. Moreover, there have been concerning reports regarding the fairness of AI predictions across different populations, making it crucial to understand the performance of AI models across diverse demographics before their widespread application. To address this, our study focuses on analyzing AI models for EF estimation in the rural Appalachian population. We utilized a 12-lead ECG dataset of 55,500 patients from WVU Medicine hospitals in West Virginia and employed a wide array of AI algorithms, ranging from Random Forest to modern deep learning-based methods like Transformers, to estimate EF. We also considered different thresholds for analyzing these AI algorithms and examined the impact of single and multi-lead ECG signals, and conducted model interpretability analysis. Overall, our comprehensive analysis demonstrated that deep learning-based algorithms achieved the highest performance, with an AUROC of around 0.86 for EF estimation from 12-lead ECG signals. Additionally, we found that while individual ECG leads were insufficient for accurate EF estimation, specific lead combinations significantly improved classification performance.

Why do patients with ischemic heart disease modify their lifestyle? a qualitative study : Motivations for lifestyle modification after IHD

OBJECTIVE

Ischemic Heart Disease (IHD) is a major cause of death worldwide, particularly in low- to middle-income nations, such as Iran. Lifestyle modification (LSM) (e.g., healthy nutritional patterns, regular physical activity, smoking cessation, and stress management) can prevent the development of IHD. This study aimed to identify the motivations behind LSM in patients with IHD.

RESULTS

This qualitative study employed traditional content analysis and purposive sampling from cardiac rehabilitation (CR) centers in Iran. Data were collected through semi-structured interviews, analyzed using Graneheim and Lundman steps, conducted from October 2023 to September 2024. The participants included 15 IHD patients with LSM experience, one patient's son, and 4 healthcare professionals (nurses, clinical psychologists, cardiologists, and nutritionists). The patients had an average age of 63 years and varied in sex, occupation, education, and marital status. Interviews averaged 69 min, ranging from 50 to 100 min. The analysis revealed a theme of "seeking wise survival," with 10 subcategories and three categories: interest and fear (e.g., family interest, fear of death), comprehensive recommendations, and individual and social benefits (e.g., time and cost savings). The findings of this study provide scientific evidence for HCPs to encourage and educate patients and their families regarding the LSM.

Materials Advances in Devices for Heart Disease Interventions

Heart disease encompasses a range of conditions that affect the heart, including coronary artery disease, arrhythmias, congenital heart defects, heart valve disease, and conditions that affect the heart muscle. Intervention strategies can be categorized according to when they are administered and include: 1) Monitoring cardiac function using sensor technology to inform diagnosis and treatment, 2) Managing symptoms by restoring cardiac output, electrophysiology, and hemodynamics, and often serving as bridge-to-recovery or bridge-to-transplantation strategies, and 3) Repairing damaged tissue, including myocardium and heart valves, when management strategies are insufficient. Each intervention approach and technology require specific material properties to function optimally, relying on materials that support their action and interface with the body, with new technologies increasingly depending on advances in materials science and engineering. This review explores material properties and requirements driving innovation in advanced intervention strategies for heart disease and highlights key examples of recent progress in the field driven by advances in materials research.

Digital health intervention to optimise heart failure management after hospital discharge in Brazil (OPT-HF): a randomised clinical trial protocol

INTRODUCTION

Guideline-directed medical therapy (GDMT) for heart failure (HF) reduces adverse events, but is underused. Global barriers to GDMT optimisation include low frequency of visits, clinician inertia and poor patient knowledge, which may be mitigated by digital health interventions (DHI). In Brazil, low digital literacy and reduced access to technology may compromise these potential DHI's beneficial effects. Our objective is to develop and test the effectiveness of a DHI to optimise GDMT in patients recently hospitalised for HF in the Brazilian public health system (Sistema Único de Saúde (SUS)).

METHODS AND ANALYSIS

This is a randomised, controlled, multicentre, parallel-group, clinical trial in which 154 patients being discharged from an HF-related hospitalisation will be randomised. Inclusion criteria are ≥18 years of age, reduced ejection fraction HF (EF<50%) and medication optimisation gaps (at least one GDMT class not started or two among those with prescribed dosage≤50% of the target dose). All participants will receive a written booklet and SUS usual care. Randomisation will be stratified by site. The intervention includes a mobile application (app) to engage patients, developed through a human-centred design. The app's main features are a check-in page for daily collection of participants' health status, vital signs and weight; a remote educational programme; a chat function during working hours and longitudinal graphical representations of participants' data. The participants' data will be managed daily by a nurse, linked to a cardiologist for teleconsultations. Predefined clinical decision trees will guide actions, including alarm signs and GDMT optimisation. The primary outcome will be changes in GDMT from baseline to end of follow-up in 90 days. Secondary outcomes will include all-cause readmission, HF-related rehospitalisation, change in health status and HF knowledge, and implementation outcomes based on the RE-AIM framework. The analysis of outcomes will follow the intention-to-treat principle.

ETHICS AND DISSEMINATION

This study was approved by the Universidade Federal de Minas Gerais. Recruitment started in November 2023, and patients involved will sign an informed consent form. Results will be presented at scientific meetings and published in scientific journals in 2025, and will be disclosed in social media and presented to public health stakeholders.

TRIAL REGISTRATION NUMBER

Universal Trial Number U1111-1295-1864 Brazilian Clinical Trials Registry (https://ensaiosclinicos.gov.br/rg/RBR-10vpf9bm).

The relationship between state anxiety of surrogate decision-makers and decision-making duration in acute ischemic stroke thrombolysis

Intravenous thrombolysis is the preferred treatment for acute ischemic stroke (AIS). In China, obtaining written informed consent from patients or their surrogates is mandatory before administering thrombolysis, often leading to delays in treatment. This study aims to explore the relationship between the decision-making characteristics and psychological states of surrogates during thrombolysis for AIS patients. A total of 383 AIS patients and their surrogate decision-makers were recruited from the Emergency Department of the First Affiliated Hospital of Zhengzhou University between September 2021 and December 2023. Comprehensive sociodemographic and disease-related data were collected for both patients and surrogates. Surrogate decision-makers were assessed using the State-Trait Anxiety Inventory (STAI), Control Preference Scale(CPS), Wake Forest Physician Trust Scale (WFPTS), and Perceived Social Support Scale (PSS). Data were analyzed using SPSS 26.0 software. The average score of state anxiety of surrogates was 49.47 ± 9.04, indicating a relatively high level of anxiety. Specifically, the average state anxiety score of the surrogate decision-makers has already reached a moderate level, indicating significant anxiety. Additionally, 18.2% (70/383) of surrogates took more than 15 minutes to decide. There was a significant positive correlation between state anxiety scores and decision duration (r = 0.189, p < 0.001). Factors influencing surrogate anxiety included sociodemographic factors, psychological factors, patient-related factors, and decision-making process characteristics (all p < 0.05). In conclusion, the anxiety is influenced by various factors related to the decision-making process. Medical staff should address these emotional factors to reduce decision time, enhance decision quality, and expedite informed consent, thereby minimizing treatment delays.

Palliative Care and Advanced Cardiovascular Disease in Adults: Not Just End-of-Life Care: A Scientific Statement From the American Heart Association

Cardiovascular disease remains a leading cause of morbidity and mortality in adults despite recent scientific advancements. Although people are living longer lives, there may be an adverse impact on quality of life, necessitating a greater need for palliative care services and support. Palliative care for adults with advanced cardiovascular disease has the potential to significantly improve quality of life for individuals living with cardiovascular disease and their informal care partners. Effective communication, shared decision-making, age-friendly care principles, and advance care planning are vital components of palliative care and support comprehensive and holistic care throughout the advanced cardiovascular disease trajectory and across care settings. Current evidence highlights the benefits of palliative care in managing symptoms, reducing psychological distress, and supporting both people with cardiovascular disease and their care partners. However, significant gaps exist in palliative care research related to non-heart failure populations, care partner outcomes, and palliative care implementation in diverse populations. This scientific statement (1) discusses the application of effective communication, shared decision-making, age-friendly care, and advance care planning in advanced cardiovascular disease palliative care; (2) provides a summary of recent evidence related to palliative care and symptom management, quality of life, spiritual and psychological support, and bereavement support in individuals with advanced cardiovascular disease and their care partners; (3) discusses issues involving diversity, equity, and inclusion in cardiovascular disease palliative care; (4) highlights the ethical and legal concerns surrounding palliative care and implanted cardiac devices; and (5) provides strategies for palliative care engagement in adults with advanced cardiovascular disease for the care team.

Predicting cerebral infarction and transient ischemic attack in healthy individuals and those with dysmetabolism: a machine learning approach combined with routine blood tests

Ischemic cerebral infarction is the most prevalent type of stroke, causing significant disability and death worldwide. Transient ischemic attack (TIA) is a strong predictor of subsequent stroke. Individuals with dysmetabolism, such as hypertension, hypercholesterolemia, and diabetes, are at increased risk for cerebral infarction (CI) and TIA. In resource-limited settings, diagnosing CI and TIA can be particularly difficult due to a lack of advanced imaging and specialized expertise. Therefore, we aim to develop a simple, convenient, blood-based approach that could assist clinicians in diagnosing CI and TIA, especially in regions where advanced imaging or stroke-specific expertise is limited. All study subjects were patients admitted to the First Hospital of Xiamen University and healthy check-up populations between January 2018 and September 2023. This study employed five machine learning methods alongside 21 blood routine indicators, 30 blood biochemical indicators, age, and gender to construct predictive models for CI and TIA in both healthy individuals and those with dysmetabolism. The Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) served as the metric to assess the comprehensive predictive capability of the models. Subsequently, the SHAP package was employed for model interpretation. Extreme Gradient Boosting (XGBoost) outperforms other models in all predictive models. In the models predicting CI and TIA among healthy, the AUC is 0.9958 (0.9947-0.9969) and 0.9928 (0.9899-0.9951), respectively. Among the nine shared key features of the two models are indicators of glucose metabolism, lipid metabolism, and liver metabolism. In the models for predicting CI and TIA among patients with hypertension, hypercholesterolemia, diabetes, and those with all three metabolic disorders combined, the AUCs ranged from 0.6990 to 0.8591. We found that the indicators K significantly contributed to predict CI and TIA from those with dysmetabolism. Additionally, metabolic-related indicators, such as glucose (GLU) and high-density lipoprotein cholesterol (HDL-C), are ranked highly among the top ten contributing features. XGBoost performed the best in all models. It can effectively differentiate CI and TIA from healthy and dysmetabolic patients by combining blood routine and blood biochemical indicators. Moreover, it can also differentiate CI from TIA. Although any suspicious findings from this model would still require confirmatory imaging, the simplicity and low cost of blood-based testing may offer a practical adjunct for clinicians-particularly in areas lacking advanced imaging or extensive stroke expertise-and could facilitate earlier diagnostic decision-making.

Electronic Informed Consent in MOST: An Acute Ischemic Stroke Clinical Trial

BACKGROUND

Obtaining timely informed consent is a key barrier in acute ischemic stroke clinical trial recruitment. Electronic consent (eConsent) allows electronic delivery and documentation of the informed consent process, which may optimize recruitment. eConsent in acute ischemic stroke clinical trials, however, is limited and understudied. We conducted a post hoc analysis of eConsent adoption in MOST (Multi-Arm Optimization of Stroke Thrombolysis Trial), a phase III acute ischemic stroke clinical trial, and studied the impact on recruitment.

METHODS

From October 10, 2019, to July 5, 2023, MOST enrolled 514 participants at 57 sites in the United States. Study databases were reviewed to determine informed consent modality for each participant: paper-in person, paper-remote, eConsent-in person, and eConsent-remote. Study sites could use paper consent or eConsent for each enrollment. eConsent adoption trends and participant demographic diversity were reported using descriptive statistics. We utilized χ2 and Kruskal-Wallis tests to compare individual site enrollment, remote consent utilization, baseline neuroimaging-to-randomization times, data clarification requests, and reportable consent-related unanticipated events.

RESULTS

eConsent was utilized for 173 (33.7%) of 514 participants. Of 57 sites, 32 (56.1%) utilized eConsent at least once: those sites had higher median enrollment over the course of the entire trial than non-eConsent sites (7.5 [interquartile range, 5-17] versus 3 [interquartile range, 2-4]; P<0.001). eConsent was completed remotely more frequently than paper consent (46.2% versus 1.2%; P<0.001). Participant demographic diversity and baseline neuroimaging-to-randomization times were similar between eConsent-in person and paper-in person (median, 58.5 [interquartile range, 46.5-72.5] versus 55 [interquartile range, 39-70] minutes). Consent documentation adherence was superior with eConsent-in person compared with paper-in person including decreased data clarification requests (44 versus 81 per 100 participants) and reportable unanticipated events (6 versus 25 per 100 participants).

CONCLUSIONS

eConsent in MOST was associated with higher individual site enrollment, higher remote consent rates, and improved consent documentation adherence over paper consent. Our study outlines the potential advantages of eConsent adoption in future acute ischemic stroke clinical trials and stroke research networks.

Risk-Based Primary Prevention of Heart Failure: A Scientific Statement From the American Heart Association

The growing morbidity, mortality, and health care costs related to heart failure (HF) underscore the urgent need to prioritize its primary prevention. Whereas a risk-based approach for HF prevention remains in its infancy, several key opportunities exist to actualize this paradigm in clinical practice. First, the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guidelines provided recommendations, for the first time, on the clinical utility of multivariable risk equations to estimate risk of incident HF. Second, the American Heart Association recently developed the PREVENT (Predicting Risk of Cardiovascular Disease Events) equations, which not only enable prediction of incident HF separately, but also include HF in the prediction of total cardiovascular disease. Third, the predominant phenotype of HF risk has emerged as the cardiovascular-kidney-metabolic syndrome. Fourth, the emergence of novel therapies that prevent incident HF (eg, sodium-glucose cotransporter-2 inhibitors) and target multiple cardiovascular-kidney-metabolic axes demonstrate growing potential for risk-based interventions. Whereas the concept of risk-based prevention has been established for decades, it has only been operationalized for atherosclerotic cardiovascular disease prevention to date. Translating these opportunities into a conceptual framework of risk-based primary prevention of HF requires implementation of PREVENT-HF (Predicting Risk of Cardiovascular Disease Events-Heart Failure) equations, targeted use of cardiac biomarkers (eg, natriuretic peptides) and echocardiography for risk reclassification and earlier detection of pre-HF, and definition of therapy-specific risk thresholds that incorporate net benefit and cost-effectiveness. This scientific statement reviews the current evidence for accurate risk prediction, defines strategies for equitable prevention, and proposes potential strategies for the successful implementation of risk-based primary prevention of HF.

Achieving precision assessment of functional clinical scores for upper extremity using IMU-Based wearable devices and deep learning methods

Stroke is a serious cerebrovascular disease, and rehabilitation following the acute phase is particularly crucial. Not all rehabilitation outcomes are favorable, highlighting the necessity for personalized rehabilitation. Precision assessment is essential for tailored rehabilitation interventions. Wearable inertial measurement units (IMUs) and deep learning approaches have been effectively employed for motor function prediction. This study aims to use machine learning techniques and data collected from IMUs to assess the Fugl-Meyer upper extremity subscale for post-stroke patients with motor dysfunction. IMUs signals from 120 patients were collected during a clinical trial. These signals were fed into a gated recurrent unit network to complete the scoring of individual actions, which were then aggregated to obtain the total score. Simultaneously, on the basis of the internal correlation between the Fugl-Meyer assessment and the Brunnstrom scale, Brunnstrom stage prediction models of the arm and hand were established via the random forest and extremely randomized trees algorithm. The experimental results show that the proposed models can score Fugl-Meyer items with a high accuracy of 92.66%. The R2 between the doctors' score and the model's score is 0.9838. The Brunnstrom stage prediction models can predict high-quality stages, achieving a Spearman correlation coefficient of 0.9709. The application of the proposed method enables precision assessment of patients' upper extremity motor function, thereby facilitating more personalized rehabilitation programs to achieve optimal recovery outcomes. Trial registration: Clinical trial of telerehabilitation training and intelligent evaluation system, ChiCTR2200061310, Registered 20 June 2022-Retrospective registration.

Differences in Statin Eligibility With the Use of Predicting Risk of Cardiovascular Disease EVENTs Versus Pooled Cohort Equations in the UK Biobank

The Pooled Cohort Equations (PCEs), developed by the American Heart Association (AHA) and American College of Cardiology, have been widely used since 2013 to estimate 10-year atherosclerotic cardiovascular disease (ASCVD) risk and guide statin therapy. Recently, the AHA introduced the Predicting Risk of CVD EVENTs (PREVENT) equations to improve ASCVD risk estimation. However, the effect of using PREVENT instead of PCEs on risk classification and statin eligibility remains unclear. This retrospective cohort study analyzed 261,303 UK Biobank participants, aged 40 to 69 years, who were free from cardiovascular disease and not on statin therapy. The PCEs and the base PREVENT equations were used to estimate 10-year ASCVD risk, categorize risk levels, and determine statin eligibility based on a common risk threshold of 7.5%. The median 10-year ASCVD risk was 5.2% (2.2%, 10.6%) using the PCEs and 3.5% (1.8%, 5.8%) with the PREVENT equations. The PREVENT equations classified 14.0% of participants as high-risk (ASCVD risk >7.5%), compared to 36.9% classified by PCEs. Among participants classified as intermediate-risk by PCEs, 75.3% were reclassified as low-risk by PREVENT. The proportion of individuals eligible for statin use by the PREVENT equation was 19.9%, and by the PCEs was 40.7%. The corresponding difference was 20.8% (95% confidence intervals [CI]: 20.6% to 20.9%). More men (33.0% [95% CI: 32.7% to 33.3%]) than women (11.5% [95% CI: 11.3% to 11.7%]) and more individuals in the older age group (60 to 69 years: 34.0% [95% CI: 33.7% to34.3%]) than in the younger age group (40 to 49 years: 3.5% [95% CI: 3.3% to 3.6%]) would not be recommended for statin consideration with the PREVENT equations. In conclusion, based on the common risk threshold of 7.5%, replacing the PCEs with the base PREVENT equation would reduce statin eligibility in the UK Biobank participants by ∼20%, especially among men and older adults.

Colchicine for secondary prevention in patients with acute coronary syndrome: A systematic review and meta-analysis

BACKGROUND

Despite optimal therapy, coronary artery disease (CAD) remains a significant public health concern worldwide. Studies have increasingly recognized the role of inflammation in atherosclerosis. Colchicine, a potent anti-inflammatory drug commonly used to treat gout, and pericarditis is being evaluated in this study for its safety and efficacy in preventing CAD following an acute coronary syndrome (ACS).

METHODS

We searched PubMed and Embase for studies up to April 2024 comparing colchicine to standard medical treatment in ACS patients. Primary outcomes included major adverse cardiovascular events (MACE) and recurrent ACS, while secondary outcomes were cardiovascular death, congestive heart failure (CHF), stroke, hospitalizations, and gastrointestinal (GI) side effects. Data were pooled using a random-effects model.

RESULTS

We included nine studies with a pooled sample size of 7260 patients. The mean age was 60.1 (±11.8) years, with 19.3 % females and a mean follow-up duration of 8.5 (±6) months. Patients who received colchicine treatment demonstrated a reduced risk of re-hospitalizations (OR 0.52 [0.34-0.81]) but had increased GI effects (OR 2.10 [1.20-3.68]). There was no significant difference in cardiovascular death (OR 1.17 [0.52-2.63]), MACE (OR 0.68 [0.45-1.01]), stroke (OR 0.46 [0.18-1.18]), recurrent ACS (OR 0.55 [0.28-1.09]) and the incidence of CHF (OR 0.90 [0.38-2.12]) between patients treated with colchicine versus standard medical treatment.

CONCLUSION

Adding colchicine to standard medical therapy in ACS patients significantly reduced hospitalizations but is associated with increased GI side effects. Further prospective trials are required to validate these findings and determine if early intervention with colchicine treatment improves clinical outcomes in ACS patients.

Flavonoids serve as a promising therapeutic agent for ischemic stroke

Ischemic stroke (IS) continues to be a major public health concern and is characterized by significantly high mortality and disabling rates. Inhibiting nerve cells death and enhancing the repair of ischemic tissue are important treatment concepts for IS. Currently, the mainstream treatment strategies mainly focus on short-term care, which underscores the urgent need for novel therapeutic strategies for long-term care. Emerging data reveal that flavonoids have surfaced as promising candidates for IS patients' long-term care. Flavonoids can alleviate neuroinflammation and anti-apoptosis due to their characteristic pharmacological mechanisms. Clinical evidence suggests that long-term flavonoids intake improves IS patients' long-term outcomes. Though the effect of flavonoids in IS treatment has been explored for decades, the neuroprotective pharmacodynamics have not been well established. Thereby, the aim of current review is to summarize the pathways involved in neuroprotective effect of flavonoids. This review will also advance the potential of flavonoids as a viable clinical candidate for the treatment of IS.

Plasma proteomic biomarkers of physical frailty in heart failure: a propensity score matched discovery-based pilot study

BACKGROUND

Physical frailty is highly prevalent in heart failure (HF), but we lack an understanding of the underlying pathophysiology. Proteomic evaluation of plasma samples may elucidate potential mechanisms and biomarkers of physical frailty in HF.

OBJECTIVES

We aimed to identify plasma proteomic biomarkers that are differentially expressed between physically frail and non-physically frail adults with HF.

METHODS

This was a secondary analysis of a subset of data and plasma samples from a study of frailty among patients with New York Heart Association (NYHA) Functional Classification I-IV HF. Physical frailty was measured using the Frailty Phenotype Criteria. Propensity score matching was used to match pairs of physically frail (n = 20) vs. non-physically frail (n = 20) patients on clinical characteristics. Plasma samples were processed using a sensitive liquid chromatography mass spectrometry platform, utilizing a multiplexed tandem mass tag-labeled quantitative proteomics approach. Differentially expressed proteins were quantified individually using paired t tests with associated log fold change of 0.3 and Fisher's combined p values.

RESULTS

The sample (n = 40) was 62.8 ± 16.9 years old, 58% female, and 55% NYHA Class III/IV. Proteomic analysis revealed 7 proteins differentially expressed using full differential criteria: matrix metalloproteinase-14 was downregulated in frailty, and copine-1, low affinity immunoglobulin gamma Fc region receptor III-A and III-B, probable non-functional immunoglobulin kappa variable 2D-24, glutathione S-transferase Mu 1, and argininosuccinate lyase were upregulated in frailty.

CONCLUSIONS

Proteomic biomarkers related to the immune system, stress response, and detoxification were differentially expressed between physically frail and non-physically frail adults with HF.

Multidimensional Sleep Health: Definitions and Implications for Cardiometabolic Health: A Scientific Statement From the American Heart Association

Poor sleep health is associated with cardiometabolic disease and related risk factors, including heart disease, stroke, elevated blood pressure and lipid levels, inflammation, glucose intolerance, obesity, physical inactivity, poor diet, unhealthy substance use, poor mental health, and increased all-cause and cardiovascular mortality, and is associated with social determinants of cardiovascular health and health disparities. Therefore, sleep duration has been recognized by the American Heart Association as one of Life's Essential 8. Although chronic sleep duration is the sole metric used in Life's Essential 8, sleep health represents a multidimensional construct. This scientific statement outlines the concept of multidimensional sleep health (sleep duration, continuity, timing, regularity, sleep-related daytime functioning, architecture, and absence of sleep disorders) as it applies to cardiometabolic health. Considerations of how these dimensions are related to cardiometabolic health and patterned by sociodemographic status are explained, and knowledge gaps are highlighted. Additional data are needed to understand better how these various dimensions of sleep should be assessed and how interventions targeting sleep health in clinical and community settings can be leveraged to improve health.

Associations between folate intake, serum folate, and stroke risk: The mediating role of dietary inflammatory index from NHANES 2007-2018

BACKGROUND

This study investigates the relationships between folate intake, RBC folate, serum folate levels, and stroke risk, with an emphasis on the mediating roles of the dietary inflammatory index (DII) and systemic immune-inflammation index (SII).

METHODS

A cross-sectional analysis was conducted using 24,106 participants from NHANES (2007-2018). Associations were assessed with weighted multivariate logistic regression, adjusting for key confounders. Propensity score matching (PSM) was applied, yielding 1,838 matched participants, respectively. Nonlinear relationships were analyzed with restricted cubic splines, and mediation analysis was performed for DII and SII.

RESULTS

Post-PSM, folate intake in Q2 (252-350 μg/day), Q3 (350-484 μg/day), and Q4 (> 484 μg/day) was significantly inversely associated with stroke risk (trend P < 0.05), with adjusted ORs of 0.62 (95 % CI: 0.45-0.85), 0.65 (95 % CI: 0.46-0.90), and 0.60 (95 % CI: 0.42-0.86), respectively. Serum folate levels in Q3 (37.0 - 54.8 nmol/L) were also protective (OR: 0.47, 95 % CI: 0.32-0.68, trend P < 0.05). Serum folate levels exhibited a biphasic effect, with the lowest stroke risk at 41.9 nmol/L before PSM and 43.3 nmol/L after PSM. Mediation analysis showed DII mediated 45.2 % of the relationship between folate intake and stroke risk (P = 0.018), while SII's mediation effect was minimal (0.412 %, P = 0.016). No significant interactions were observed between folate intake, serum folate and stratified variables (P > 0.05) after PSM.

CONCLUSION

Higher folate intake lowers stroke risk, with DII playing a significant mediating role, while serum folate presents a biphasic risk pattern. Personalized dietary strategies addressing folate intake and inflammation may be crucial for stroke prevention.

The burden of ambient air pollution on years of life lost from ischaemic heart disease in Pudong new area, Shanghai

Ischaemic heart disease (IHD) remains a major public health threat globally. The aim of this study was to evaluate the short-term burden of air pollution exposure on years of life lost (YLLs) from IHD in Pudong New Area, Shanghai. Data on air pollutants, meteorological factors, and daily IHD deaths were collected from 2013 to 2021. A distributed lag nonlinear model (DLNM) combined with linear (for YLLs) and quasi-Poisson (for mortality) regression models was applied to analyse the association between air pollution exposure and the IHD burden. A stratified analysis was conducted according to sex, age, education level, and residence registration. Each 10 µg/m³ increase in PM10, SO2, and NO2 exposure was associated with YLL increases of 0.40 (95% CI: -0.32, 1.11), 4.38 (95% CI: 0.83, 7.92), and 0.67 (95% CI: -0.71, 2.04) years, respectively, at lag0-3. The corresponding YLL increase due to PM2.5 exposure was 0.28 (95% CI: -0.24, 0.80) years at lag0-1. The impacts of air pollution exposure on YLLs and daily IHD deaths were greater for male and urban groups than for female and rural groups. Furthermore, the difference in SO2 exposure was statistically significant among sex-stratified groups. Air pollution exposure was positively associated with IHD-related YLL increases in Pudong New Area, Shanghai.

Particulate matter and co-occurring genetic risk induce oxidative stress and cardiac and brain Alzheimer's pathology

Amyloid-beta (Aβ) aggregates, an Alzheimer's disease (AD) pathological hallmark, extend beyond the brain to the heart of heart failure (HF) and AD patients. Being diseases of the elderly, increased prevalence is expected as the population ages. However, changes in the incidence and prevalence of dementia over the past decades, and the independent association of exposure to air particulate matter (PM) with poor cognitive function, adverse cardiovascular effects, and oxidative stress hint to the contribution of other factors beyond senescence. Therefore we evaluate whether, and by which mechanism(s), PM exposure affects heart and brain proteinopathy with/without genetic predisposition.AD-prone and control mice are exposed for three months to filtered air (FA) or concentrated ambient PM < 2.5μm in diameter (PM2.5), and evaluated for Aβ pathology, cognitive and cardiac function, and markers of oxidative stress. Aβ pathology become noticeable in AD hearts and worsens with PM2.5 in AD brains. Functionally, PM2.5 lead to anxiety and memory deficits and worsens diastolic function. Redox homeostasis is negatively impacted by genotype and PM2.5. This study identifies environmental pollution as a potential key contributor to early progression of heart and brain proteinopathy, delineating a crucial timepoint for early interventions to limit multiorgan damage in vulnerable patients.

Myocardial flow reserve and resting contractility modulate the impact of contractile reserve in patients undergoing rubidum-82 positron emission tomography

Although ejection fraction reserve (EFR) harbors prognostic value in patients undergoing positron emission tomography (PET) myocardial perfusion imaging (MPI), whether resting EF and myocardial flow reserve (MFR) modulate its prognostic value has not been studied. Consecutive patients undergoing stress/rest MPI using Rb-82 PET between 2019 and 2024 were included. The primary outcome was a composite of death and heart failure (HF) hospitalizations. Multivariable Andersen-Gill Cox models were used to assess the association of EFR with the primary outcome across the spectrum of resting EF and MFR. Restricted cubic splines were used to allow non-linearity. The 50th percentile of EFR served as the reference, with the 25th and 75th percentiles representing low and high EFR. The analysis included 7,737 consecutive patients among whom 463 deaths and 821 HF hospitalizations occurred over a median follow-up of 554 days. A low EFR was associated with a 25% greater risk of the primary outcome (HR: 1.25; 95% CI: 1.16 to 1.35). The association was stronger at higher values of resting EF (HR at EFs of 40% and 70%: 0.99 and 1.21 respectively) and MFR (HR at MFRs of 1 and 3: 1.06 and 1.27 respectively). Similarly, a high EFR carried a protective association that was more pronounced at a higher resting EF and MFR. The prognostic implications of contractile reserve, as measured by EFR, are most pronounced in patients with a higher resting EF and MFR.

High-Throughput Echocardiography-Guided Induction of Myocardial Ischemia/Reperfusion in Mice

BACKGROUND

Mouse models of myocardial ischemia with subsequent heart failure are common approaches to examine heart failure pathology and possible treatment strategies. We sought to establish a high-throughput approach for echocardiography-guided induction of myocardial ischemia/reperfusion (IR) in mice.

METHODS

After visualization of the left coronary artery with high-resolution ultrasound imaging and echocardiographic definition of the level of coronary occlusion, the left anterior descending artery was temporarily occluded with 2 micromanipulator-controlled needles. Functional and molecular changes were assessed and compared with commonly performed surgical techniques.

RESULTS

Echocardiography-guided induction of myocardial IR enabled standardized induction of myocardial IR injury with subsequent left ventricular remodeling. Incorporation of various quality control measures throughout the procedure ensured a high success rate and the absence of relevant postinterventional mortality in experienced hands. Compared with surgical approaches, echocardiography-guided induction of myocardial IR showed a quicker recovery time and induced a less pronounced inflammatory response characterized by decreased local and systemic neutrophil counts. Notably, infarct size and subsequent post-myocardial infarction cardiac dysfunction were comparable between methods. The novel procedure was successfully implemented at different academic institutions with imaging expertise and demonstrated high interinstitutional reproducibility.

CONCLUSIONS

Echocardiography-guided induction of myocardial IR enables high-throughput induction of myocardial IR injury with precise echocardiographic definition of the occlusion level and immediate evaluation of cardiac function during ischemia. The method provides a more clinically relevant assessment of IR sequelae and offers notable animal welfare advantages by eliminating the need for ventilation and thoracotomy, thereby mitigating potential surgery-related confounders.

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

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