Quantifying Importance of Major Risk Factors for Coronary Heart Disease

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The role of long non-coding RNAs in cardiovascular diseases: A comprehensive review

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide, posing significant challenges to healthcare systems. Despite advances in medical interventions, the molecular mechanisms underlying CVDs are not yet fully understood. For decades, protein-coding genes have been the focus of CVD research. However, recent advances in genomics have highlighted the importance of long non-coding RNAs (lncRNAs) in cardiovascular health and disease. Changes in lncRNA expression specific to tissues may result from various internal or external factors, leading to tissue damage, organ dysfunction, and disease. In this review, we provide a comprehensive discussion of the regulatory mechanisms underlying lncRNAs and their roles in the pathogenesis and progression of CVDs, such as coronary heart disease, atherosclerosis, heart failure, arrhythmias, cardiomyopathies, and diabetic cardiomyopathy, to explore their potential as therapeutic targets and diagnostic biomarkers.

Gender correlation between sleep duration and risk of coronary heart disease: a systematic review and meta-analysis

Objective

The influence of extreme sleep duration on coronary heart disease (CHD) risk across genders remains a debated topic.

Methods

This analysis gathers observational studies that explore association between varying sleep durations and CHD risks. Trend estimation employs generalized least squares, converting specific category risk estimates into relative risks (RR) per hour of sleep increase. A two-stage hierarchical regression model evaluates potential linear dose-response relationships. Data analysis utilizes random-effects restricted cubic spline models with four knots.

Results

Involving 17 studies and 906,908 participants, this meta-analysis identifies a pronounced U-shaped nonlinear relationship between sleep duration and CHD risk applicable to both genders (P < 0.01). Notably, shorter sleep durations are linked to higher CHD risks in women, whereas longer durations are more consequential for men. The optimal sleep duration for minimizing CHD risk is between 7.0-8.0 h daily for men and 7.5-8.5 h for women.

Conclusion

The influence of sleep duration on CHD risk differs significantly between genders.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/myprospero, identifier (CRD42023478235).

Association between short-term exposure to ambient PM2.5 and its components with hospital admissions for patients with coronary heart disease and comorbid diabetes mellitus in Beijing, China

Existing researches had primarily investigated the associations between various air pollutants and the risk of coronary heart disease (CHD) or diabetes mellitus (DM) separately. However, the significance and effects of PM2.5 and its components in patients with CHD and comorbid DM (CHD-DM) remain unclear. Patient data was sourced from the Beijing Municipal Health Commission Information Centre between January 1, 2014, and December 31, 2018. We utilized Generalized Additive Models (GAM) to analyze the relationship between daily hospital admissions for CHD-DM patients and PM2.5 exposure. The hospital admissions were treated as count data, offset by the total CHD-DM population, with a logarithmic link function. Smooth functions were included to account for the non-linear effects of time trends and meteorological factors used in both Chinese and WHO air quality guidelines. In Beijing, records show 215,267 hospital admissions for patients with CHD-DM. Every 10 μg/m3 increase of particles with an aerodynamic diameter ≤2.5 μm (PM2.5) corresponded to a 0.62% (95%CI: 0.49 to 0.76) increment for CHD-DM patients' admissions. As for the PM2.5 components: Per 10 μg/m3 increase of SO42- was 2.31% (95%CI: 1.51 to 3.11), NO3- was 3.35% (95%CI: 2.47 to 4.23), for NH4+ the percentage change value was 4.37% (95%CI: 2.99 to 5.77), for OM was 5.36% (95%CI: 4.19 to 6.55), for BC was 36.51% (95%CI: 28.09 to 45.47) increment for CHD-DM patients' admissions. Based on the WHO 2021 air quality guideline, our estimation suggests that a reduction in PM2.5 concentrations could prevent approximately 2.62% (95%CI: 2.04%-3.2%) hospital admissions, corresponding to 5632 (95%CI: 4397 to 6879) CHD-DM patients, could be avoidable. Patients with CHD-DM who were exposed to PM2.5 and its components had an increased risk of hospital admissions. Furthermore, among all PM2.5 components, BC may be the most significant contributor to the association between PM2.5 and hospital admissions among CHD-DM patients.

Precision Medicine in Cardiovascular Disease Prevention: Clinical Validation of Multi-Ancestry Polygenic Risk Scores in a U.S. Cohort

BACKGROUND

Polygenic risk score (PRS) quantifies the cumulative effects of common genetic variants across the genome, including both coding and non-coding regions, to predict the risk of developing common diseases. In cardiovascular medicine, PRS enhances risk stratification beyond traditional clinical risk factors, offering a precision medicine approach to coronary artery disease (CAD) prevention. This study evaluates the predictive performance of a multi-ancestry PRS framework for cardiovascular risk assessment using the All of Us (AoU) short-read whole-genome sequencing dataset comprising over 225,000 participants.

METHODS

We developed PRSs for lipid traits (LDL-C, HDL-C, triglycerides) and cardiometabolic conditions (type 2 diabetes, hypertension, atrial fibrillation) and constructed two metaPRSs: one integrating lipid and cardiometabolic PRSs (risk factor metaPRS) and another incorporating CAD PRSs in addition to these risk factors (risk factor + CAD metaPRS). Predictive performance was evaluated separately for each trait-specific PRS and for both metaPRSs to assess their effectiveness in CAD risk prediction across diverse ancestries. Model predictive performance, including calibration, was assessed separately for each ancestry group, ensuring that all metrics were ancestry-specific and that PRSs remain generalizable across diverse populations Results: PRSs for lipids and cardiometabolic conditions demonstrated strong predictive performance across ancestries. The risk factors metaPRS predicted CAD risk across multiple ancestries. The addition of a CAD-specific PRS to the risk factors metaPRS improved predictive performance, highlighting a genetic component in CAD etiopathology that is not fully captured by traditional risk factors, whether clinically measured or genetically inferred. Model calibration and validation across ancestries confirmed the broad applicability of PRS-based approaches in multi-ethnic populations.

CONCLUSION

PRS-based risk stratification provides a reliable, ancestry-inclusive framework for personalized cardiovascular disease prevention, enabling better targeted interventions such as pharmacological therapy and lifestyle modifications. By incorporating genetic information from both coding and non-coding regions, PRSs refine risk prediction across diverse populations, advancing the integration of genomics into precision medicine for common diseases.

Sex Differences in the Relationship of Socioeconomic Position With Cardiovascular Disease, Cardiovascular Risk Factors, and Estimated Cardiovascular Disease Risk: Results of the German National Cohort

BACKGROUND

Using data from the largest German cohort study, we aimed to investigate sex differences in the relationship of socioeconomic position (SEP) with cardiovascular disease (CVD), CVD risk factors, and estimated CVD risk.

METHODS AND RESULTS

A total of 204 780 (50.5% women) participants from the baseline examination of the population-based NAKO (German National Cohort) were included. Logistic, multinomial, and linear regression models were used to estimate sex-specific odds ratios (ORs) and β coefficients with 95% CIs of CVD, CVD risk factors, and very high-risk score (Systemic Coronary Risk Estimation-2) for CVD associated with SEP. Women-to-men ratios of ORs (RORs) with 95% CIs were estimated. In women compared with men, low versus high SEP (educational attainment and relative income) was more strongly associated with myocardial infarction, hypertension, obesity, overweight, elevated blood pressure, antihypertensive medication, and current alcohol consumption, but less strongly with current and former smoking. In women with the lowest versus highest educational level, the OR for a very high 10-year CVD risk was 3.61 (95% CI, 2.88-4.53) compared with 1.72 (95% CI, 1.51-1.96) in men. The women-to-men ROR was 2.33 (95% CI, 1.78-3.05). For the comparison of low versus high relative income, the odds of having a very high 10-year CVD risk was 2.55 (95% CI, 2.04-3.18) in women and 2.25 (95% CI, 2.08-2.42) in men (women-to-men ROR, 1.31 [95% CI, 1.05-1.63]).

CONCLUSIONS

In women and men, there was an inverse relationship between indicators of SEP and the likelihood of having several CVD risk factors and a very high 10-year CVD risk. This association was stronger in women, suggesting that CVD risk is more strongly influenced by SEP in women compared with men.

The triglyceride-glucose index as a new predictor of coronary artery complexity in elderly patients with non-ST-segment elevation acute coronary syndrome

BACKGROUND

Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) has a significant impact on cardiovascular mortality in elderly patients. Identification of high-risk patients is essential to optimize clinical management. This study investigates the relationship between the TyG index and CAD complexity, as measured by the SYNTAX score, in elderly patients with NSTE-ACS.

METHODS

We performed a retrospective analysis of 216 patients aged >65 years undergoing coronary angiography stratified according to tertiles of the TyG index and the SYNTAX score (SYNTAX score ≤ 22 versus SYNTAX score > 22).

RESULTS

After adjustment for confounders, the TyG index was identified as an independent predictor of moderate/high scores (SYNTAX score > 22). As a continuous variable, it was significantly associated with moderate/high SYNTAX scores in both diabetic ( P  = 0.003) and nondiabetic groups ( P  = 0.004). When presented as a categorical variable, the TyG index remained a significant predictor after adjustment for sex, hypertension, BMI, and glomerular filtration rate. Compared with the T1 group, the risk of a moderate/high SYNTAX score was 5.410-fold (95% CI: 1.034-28.315; P  = 0.046) and 7.774-fold (95% CI: 1.836-32.916; P  = 0.005) higher in the T2 and T3 groups, respectively. The TyG index showed superior predictive ability for CAD complexity with an AUC of 0.747 compared with the AUC of 0.624 for HbA1c ( P  = 0.005).

CONCLUSION

This study showed that the TyG index is an independent predictor of moderate/high SYNTAX scores in elderly patients with NSTE-ACS, demonstrating superior predictive performance compared to HgA1c and highlighting its potential as a valuable tool for assessing CAD severity in this population.

A deep learning digital biomarker to detect hypertension and stratify cardiovascular risk from the electrocardiogram

Hypertension is a major risk factor for cardiovascular disease (CVD), yet blood pressure is measured intermittently and under suboptimal conditions. We developed a deep learning model to identify hypertension and stratify risk of CVD using 12-lead electrocardiogram waveforms. HTN-AI was trained to detect hypertension using 752,415 electrocardiograms from 103,405 adults at Massachusetts General Hospital. We externally validated HTN-AI and demonstrated associations between HTN-AI risk and incident CVD in 56,760 adults at Brigham and Women's Hospital. HTN-AI accurately discriminated hypertension (internal and external validation AUROC 0.803 and 0.771, respectively). In Fine-Gray regression analyses model-predicted probability of hypertension was associated with mortality (hazard ratio per standard deviation: 1.47 [1.36-1.60], p < 0.001), HF (2.26 [1.90-2.69], p < 0.001), MI (1.87 [1.69-2.07], p < 0.001), stroke (1.30 [1.18-1.44], p < 0.001), and aortic dissection or rupture (1.69 [1.22-2.35], p < 0.001) after adjustment for demographics and risk factors. HTN-AI may facilitate diagnosis of hypertension and serve as a digital biomarker of hypertension-associated CVD.

An efficient artificial neural network-based optimization techniques for the early prediction of coronary heart disease: comprehensive analysis

Coronary heart disease (CHD) is the world's leading cause of death, contributing to a high mortality rate. This emphasizes the requirement for an advanced decision support system in order to evaluate the risk of CHD. This study presents an Artificial Neural Network (ANN) based intelligent healthcare system to predict the risk of CHD. The proposed ANN model is trained using the Framingham Heart Study (FHS) dataset, which comprises 4240 data instances and 15 potential risk factors. To combat overfitting, the proposed model uses four hidden dense layers with dropout rates ranging from 0.5 to 0.2. Also, two activation functions, ReLU and LeakyReLU, are used in conjunction with four optimizers: Adam, SGD, RMSProp, and AdaDelta to fine-tune the parameters and minimize the loss functions. Moreover, three sophisticated preprocessing methods, SMOTE, SMOTETomek, and SMOTEENN, along with the proposed two-stage sampling approach, are applied to address the target class data imbalance. Experimental results demonstrate that the Adam optimizer coupled with the ReLU activation function and the combined sequential effect of SMOTEENN and SMOTETomek's two-stage sampling approach achieved superior performance. The validation accuracy reached 96.25% with a recall value of 0.98, outperforming existing approaches reported in the literature. The combined effect of approaches will be evidence of the modern healthcare decision-making support system for the risk prediction of CHD.

Usefulness of the addition of two-dimensional speckle tracking during dobutamine stress echocardiography for the detection of coronary artery disease

BACKGROUND

Coronary artery disease (CAD) is the most frequent type of cardiac disorder. Initial evaluation for ischaemia using dobutamine stress echocardiography (DSE) is based on a visual interpretation of the regional wall motion abnormality.

AIMS

To assess the usefulness of speckle tracking during DSE and evaluate the diagnostic accuracy of 2D global longitudinal strain (GLS) along with its additive role over wall motion abnormalities interpretation for the diagnosis of CAD.

MATERIALS AND METHODS

One hundred and twenty-five patients are included in the study. Full history, physical examination, ECG, echocardiography, DSE, speckle tracking echocardiography (STE) with global and regional post-systolic strain index (PSI) during rest, peak dobutamine stress and recovery phase, and coronary angiography are done.

RESULTS

In the rest study, there is a statistically significant difference in the global and regional PSIs, both are higher in patients with CAD (group 1) than in patients without CAD (group 2) (PSI 5.1 ± 3 in group 1 and 2.7 ± 2.4 in group 2, p value .02) (regional PSI 5.4 ± 4.1 in group 1 and 3 ± 3.3 in group 2, p value .02). At peak stress, the global PSI is higher in group 1 (7 ± 4.2, p value .01) and regional PSI is higher in group 1 (7.9 ± 8.5, p value .03). In recovery period, the global PSI is higher in group 1 (8 ± 6.1, p value .01), the regional PSI is higher in group 1 (9.8 ± 8.5, p value .001) and the GLS is lower in group 1 than in group 2 (-15.5 ± 4 vs. -19.1 ± 3.1, p value .03). The most sensitive and specific parameters are the global and regional PSI in the recovery period, where both showed sensitivities of 95% and 98%, respectively, and specificities of 93% and 95%, respectively.

CONCLUSIONS

Speckle tracking during rest and DSE seems feasible in detecting the stenosis of the coronary arteries in patients with chronic CADs through the evaluation of GLS, and global and regional PSIs. The combination of DSE and STE increases accuracy, sensitivity, and specificity of diagnosing CADs.

Patterns among factors associated with myocardial infarction: chi-squared automatic interaction detection tree and binary logit model

BACKGROUND

Although mortality from myocardial infarction (MI) has declined worldwide due to advancements in emergency medical care and evidence-based pharmacological treatments, MI remains a significant contributor to global cardiovascular morbidity. This study aims to examine the risk factors associated with individuals who have experienced an MI in Türkiye.

METHODS

Microdata obtained from the Türkiye Health Survey conducted by Turkish Statistical Institute in 2019 were used in this study. Binary logistic regression, Chi-Square, and CHAID analyses were conducted to identify the risk factors affecting MI.

RESULTS

The analysis identified several factors associated with an increased likelihood of MI, including hyperlipidemia, hypertension, diabetes, chronic disease status, male gender, older age, single marital status, lower education level, and unemployment. Marginal effects revealed that elevated hyperlipidemia levels increased the probability of MI by 4.6%, while the presence of hypertension, diabetes, or depression further heightened this risk. Additionally, individuals with chronic diseases lasting longer than six months were found to have a higher risk of MI. In contrast, factors such as being female, having higher education, being married, being employed, engaging in moderate physical activity, and moderate alcohol consumption were associated with a reduced risk of MI.

CONCLUSION

To prevent MI, emphasis should be placed on enhancing general education and health literacy. There should be a focus on increasing preventive public health education and practices to improve variables related to healthy lifestyle behaviours, such as diabetes, hypertension, and hyperlipidemia.

Cyclic nucleotide phosphodiesterases as drug targets

Cyclic nucleotides are synthesized by adenylyl and/or guanylyl cyclase, and downstream of this synthesis, the cyclic nucleotide phosphodiesterase families (PDEs) specifically hydrolyze cyclic nucleotides. PDEs control cyclic adenosine-3',5'monophosphate (cAMP) and cyclic guanosine-3',5'-monophosphate (cGMP) intracellular levels by mediating their quick return to the basal steady state levels. This often takes place in subcellular nanodomains. Thus, PDEs govern short-term protein phosphorylation, long-term protein expression, and even epigenetic mechanisms by modulating cyclic nucleotide levels. Consequently, their involvement in both health and disease is extensively investigated. PDE inhibition has emerged as a promising clinical intervention method, with ongoing developments aiming to enhance its efficacy and applicability. In this comprehensive review, we extensively look into the intricate landscape of PDEs biochemistry, exploring their diverse roles in various tissues. Furthermore, we outline the underlying mechanisms of PDEs in different pathophysiological conditions. Additionally, we review the application of PDE inhibition in related diseases, shedding light on current advancements and future prospects for clinical intervention. SIGNIFICANCE STATEMENT: Regulating PDEs is a critical checkpoint for numerous (patho)physiological conditions. However, despite the development of several PDE inhibitors aimed at controlling overactivated PDEs, their applicability in clinical settings poses challenges. In this context, our focus is on pharmacodynamics and the structure activity of PDEs, aiming to illustrate how selectivity and efficacy can be optimized. Additionally, this review points to current preclinical and clinical evidence that depicts various optimization efforts and indications.

Trends in Blood Pressure Control among US Adults With Hypertension, 2013-2014 to 2021-2023

BACKGROUND

Prior studies have reported a decrease in the proportion of US adults with hypertension who had controlled blood pressure (BP).

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (n = 25,128, ≥18 years of age) to determine changes in BP control from 2013-2014 to 2021-2023. Hypertension was defined as systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg, or antihypertensive medication use. BP control was defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg.

RESULTS

The age-adjusted prevalence of hypertension (95% CI) was 32.8% (31.2%-34.4%) in 2013-2014 and 32.0% (30.1%-33.9%) in 2021-2023. Among US adults with hypertension, the age-adjusted proportion (95% CI) with controlled BP was 54.1% (49.1%-59.2%), 48.6% (44.5%-52.7%), and 48.3% (45.8%-50.8%) in 2013-2014, 2015-2016, and 2017-2020, respectively, (P-trend = 0.058), and 51.1% (47.9%-54.3%) in 2021-2023 (P-value = 0.184 comparing 2021-2023 vs. 2017-2020). The proportion (95% CI) of US adults taking antihypertensive medication with controlled BP was 72.0% (68.5%-75.5%), 66.7% (62.9%-70.5%), and 67.8% (65.3%-70.3%) in 2013-2014, 2015-2016, and 2017-2020, respectively, (P-trend = 0.085), and 68.3% (64.8%-71.9%) in 2021-2023 (P-value = 0.654 comparing 2021-2023 vs. 2017-2020). Among non-Hispanic Black adults, BP control increased from 37.4% (95% CI 33.6%-41.1%) to 49.6% (95% CI 42.3%-56.9%) between 2017-2020 and 2021-2023 for those with hypertension (P-value = 0.005), and from 52.6% (95% CI 47.4%-57.8%) to 62.6% (95% CI 55.6%-69.7%) for those taking antihypertensive medication (P-value = 0.033). There was no difference in BP control across race/ethnicity groups in 2021-2023.

CONCLUSIONS

The decline in BP control from 2013-2014 to 2017-2020 did not continue through 2021-2023. An increase in BP control occurred from 2017-2020 and 2021-2023 among non-Hispanic Black adults.

Historical exposure to metals in contaminated areas and its impact on cardio- and cerebrovascular health

Environmental pollution is of global concern. In Southeast Sweden, historical glass production has contaminated communities with toxic metals. Long-term residency in these communities and high consumption of local foods may constitute a risk for cardiovascular disease (CVD) or stroke. The current study investigates if residency in these contaminated sites and long-term consumption of local foods is associated with self-reported CVD and stroke. In addition, the body burden of the toxic metals arsenic, cadmium, and lead, as well as inflammatory protein markers, were studied for association with CVD and stroke. From an existing questionnaire cohort and biomonitoring sub cohort (n = 2290/882) of people living in the contaminated areas, self-reported CVD cases (n = 366/166) and stroke cases (n = 78/25) were identified. Individuals were grouped based on their residency within a 2 km radius of glassworks with historical high, moderate, or low air-borne lead emissions. Body burden of arsenic, cadmium, and lead was analyzed using ICP-MS. Inflammatory markers were investigated using electrochemiluminescence. Long-term residency near glassworks with historically high levels of lead emissions, and high consumption of local foods, were associated with CVD. The risk was increasing for each year of residency in high emission areas. Increased body burden of arsenic in blood, and lead in urine, were associated with stroke. Five and two inflammatory markers, respectively, were elevated in CVD and stroke cases after adjusting for confounders. An increased risk for CVD was found in areas with historically high emissions of lead but possibly also other toxic metals. Interestingly, there was an indication of a dose-response relationship with increasing risk for CVD per year of residency time. Inhalation and consumption of local food may constitute major pathways for this association. The study shows that long-term exposure to toxic metals in these contaminated areas is associated with CVD and that there is a need to limit exposure in the general population.

Potential of Anthocyanin-rich Products to Prevent and Improve Endothelial Function and Senescence: Focus on Anthocyanins

Endothelial dysfunction is a pivotal early event in the development of major cardiovascular diseases including hypertension, atherosclerosis, diabetes, and aging. The alteration of the endothelial function is often triggered by an imbalance between the endothelial formation of vasoprotective factors, including nitric oxide (NO) and endothelium-dependent hyperpolarization (EDH), and vasocontracting factors, such as arachidonic acid-derived mediators generated by cyclooxygenases, and an increased level of oxidative stress. Recently, endothelial senescence was reported to be an early trigger of endothelial dysfunction. Preclinical studies indicate that polyphenol-rich food, including anthocyanin-rich products, can activate pathways promoting an increased formation of vasoprotective factors and can prevent the induction of endothelial dysfunction in endothelial cells and isolated blood vessels. Similarly, intake of anthocyanin-rich products has been associated with the prevention and/or the improvement of an endothelial dysfunction in several experimental models of cardiovascular diseases, including physiological aging. Moreover, clinical data indicate that polyphenol-rich and anthocyanin-rich products can improve endothelial function and vascular health in humans with cardiovascular diseases. The present review will discuss both experimental and clinical evidence indicating that several polyphenol-rich foods and natural products, and especially anthocyanin-rich products, can promote endothelial and vascular health, as well as the underlying mechanisms.

Prognostic impact of intravascular imaging in percutaneous coronary intervention according to atherothrombotic risk: a post hoc analysis of a randomized clinical trial

INTRODUCTION AND OBJECTIVES

Recent randomized controlled trials support the use of intravascular imaging-guided percutaneous coronary intervention (PCI) to improve patient prognosis. However, the subsequent risk of clinical events in patients with coronary artery disease is not determined solely by lesion characteristics or how these lesions are treated. The current study investigated whether the effects of intravascular imaging in complex PCI vary according to atherothrombotic risks.

METHODS

This study was a post hoc analysis of the RENOVATE-COMPLEX-PCI trial, which compared intravascular imaging-guided PCI with angiography-guided PCI in patients with complex coronary artery lesions. The study population was stratified by atherothrombotic risk, assessed using the Thrombolysis in Myocardial Infarction risk score for secondary prevention (TRS-2P). TRS-2P is calculated based on the presence of the following factors: age ≥ 75 years, diabetes mellitus, hypertension, smoking, peripheral arterial disease, stroke, coronary artery bypass grafting, heart failure, and renal dysfunction. Patients were categorized into low-risk (TRS-2P <3) or high-risk (TRS-2P ≥ 3) groups. The primary endpoint was target vessel failure, a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization.

RESULTS

Among the total study population, 1247 patients were categorized as low-risk, and 392 as high-risk. The risk of target vessel failure was significantly higher in the high-risk group than in the low-risk group (15.5% vs 7.2%; HR, 2.13; 95%CI, 1.51-3.00; P <.001). The benefits of intravascular imaging-guided PCI over angiography-guided PCI did not differ between the low-risk group (5.6% vs 10.4%; HR, 0.56; 95%CI, 0.36-0.86) and the high-risk group (14.1% vs 18.5%; HR, 0.71; 95%CI, 0.41-1.24), with no significant interaction (interaction P=.496).

CONCLUSIONS

In this hypothesis-generating post hoc analysis of the RENOVATE-COMPLEX-PCI trial, patients with high atherothrombotic risk had significantly worse clinical outcomes than those with low atherothrombotic risk. Nevertheless, the prognostic impact of intravascular imaging-guided PCI compared with angiography-guided PCI was similarly observed in both low- and high-risk groups. RENOVATE-COMPLEX-PCI clinical trial register number: NCT03381872.

Urinary metabolomics provide insights into coronary artery disease in individuals with type 1 diabetes

BACKGROUND

Type 1 diabetes increases the risk of coronary artery disease (CAD). High-throughput metabolomics may be utilized to identify metabolites associated with disease, thus, providing insight into disease pathophysiology, and serving as predictive markers in clinical practice. Urine is less tightly regulated than blood, and therefore, may enable earlier discovery of disease-associated markers. We studied urine metabolomics in relation to incident CAD in individuals with type 1 diabetes.

METHODS

We prospectively studied CAD in 2501 adults with type 1 diabetes from the Finnish Diabetic Nephropathy Study. 209 participants experienced incident CAD within the 10-year follow-up. We analyzed the baseline urine samples with a high-throughput targeted urine metabolomics platform, which yielded 54 metabolites. With the data, we performed metabolome-wide survival analyses, correlation network analyses, and metabolomic state profiling for prediction of incident CAD.

RESULTS

Urinary 3-hydroxyisobutyrate was associated with decreased 10-year incident CAD, which according to the network analysis, likely reflects younger age and improved kidney function. Urinary xanthosine was associated with 10-year incident CAD. In the network analysis, xanthosine correlated with baseline urinary allantoin, which is a marker of oxidative stress. In addition, urinary trans-aconitate and 4-deoxythreonate were associated with decreased 5-year incident CAD. Metabolomic state profiling supported the usage of CAD-associated urinary metabolites to improve prediction accuracy, especially during shorter follow-up. Furthermore, urinary trans-aconitate and 4-deoxythreonate were associated with decreased 5-year incident CAD. The network analysis further suggested glomerular filtration rate to influence the urinary metabolome differently between individuals with and without future CAD.

CONCLUSIONS

We have performed the first high-throughput urinary metabolomics analysis on CAD in individuals with type 1 diabetes and found xanthosine, 3-hydroxyisobutyrate, trans-aconitate, and 4-deoxythreonate to be associated with incident CAD. In addition, metabolomic state profiling improved prediction of incident CAD.

Coronary computed tomography angiography-derived fat attenuation index predict future percutaneous coronary intervention

OBJECTIVES

This study aims to investigate the differences in plaque characteristics and fat attenuation index (FAI) between in patients who received revascularization versus those who did not receive revascularization and examine whether the machine learning (ML)-based model constructed by plaque characteristics and FAI can predict revascularization.

METHODS

This study was a post hoc analysis of a prospective single-centre registry of sequential patients undergoing coronary computed tomography angiography, referred from inpatient and emergency department settings (n = 261, 63 years ± 8; 188 men). The primary outcome was revascularization by percutaneous coronary revascularization. The computed tomography angiography (CTA) images were analysed by experienced radiologists using a dedicated workstation in a blinded fashion. The ML-based model was automatically computed.

RESULTS

The study cohort consisted of 261 subjects. Revascularization was performed in 105 subjects. Patients receiving revascularization had higher FAI value (67.35 ± 5.49 vs -80.10 ± 7.75 Hu, P < .001) as well as higher plaque length, calcified, lipid, and fibrous plaque burden and volume. When FAI was incorporated into an ML risk model based on plaque characteristics to predict revascularization, the area under the curve increased from 0.84 (95% CI, 0.68-0.99) to 0.95 (95% CI, 0.88-1.00).

CONCLUSIONS

ML algorithms based on FAI and characteristics could help improve the prediction of future revascularization and identify patients likely to receive revascularization.

ADVANCES IN KNOWLEDGE

Pre-procedural FAI could help guide revascularization in symptomatic coronary artery disease patients.

Management of Acute Coronary Syndrome in Elderly Patients: A Narrative Review through Decisional Crossroads

Diagnosis and treatment of acute coronary syndrome (ACS) pose particular challenges in elderly patients. When high troponin levels are detected, the distinction between non-ischemic myocardial injury (NIMI), type 1, and type 2 myocardial infarction (MI) is the necessary first step to guide further care. However, the assessment of signs of ischemia is hindered in older patients, and no simple clinical or laboratory tool proved useful in this discrimination task. Current evidence suggests a benefit of an invasive vs. conservative approach in terms of recurrence of MI, with no significant impact on mortality. In patients with multivessel disease in which the culprit lesion has been treated, a physiology-guided complete percutaneous revascularization significantly reduced major events. The management of ACS in elderly patients is an example of the actual need for a multimodal, thorough clinical approach, coupled with shared decision-making, in order to ensure the best treatment and avoid futility. Such a need will likely grow throughout the next decades, with the aging of the world population. In this narrative review, we address pivotal yet common questions arising in clinical practice while caring for elderly patients with ACS.

Trends in population attributable fraction of modifiable risk factors for cardiovascular diseases across three decades

AIMS

To evaluate temporal trends, across three decades, in the population attributable fractions (PAFs) of modifiable risk factors for 5-year risk of cardiovascular diseases (CVDs).

METHODS AND RESULTS

Within population-based Rotterdam Study, we defined three time groups of individuals without established CVD at 'baseline' with a mean age of 70 years, and followed for five years: Epoch 1990s (1989-93, n = 6195), Epoch 2000s (1997-2001, n = 5572), and Epoch 2010s (2009-14, n = 5135). The prevalence of risk factors and related relative risks were combined to quantify PAFs. The PAF of the six risk factors combined for global CVD was 0.57 [95% confidence interval (CI) 0.47-0.65], 0.52 (0.39-0.62), and 0.39 (0.18-0.54) in three respective epochs. Hypertension contributed the highest PAF to global CVD in Epoch 1990s (0.37, 95% CI: 0.28-0.44) and 2000s (0.34, 95% CI: 0.22-0.43), while smoking was the largest contributor in Epoch 2010s (0.20, 95% CI: 0.06-0.32). Dyslipidaemia changed population-level coronary heart disease risk over time. For stroke, hypertension became a less significant contributor over time, but smoking became a larger contributor. For heart failure, all risk factors showed non-significant PAFs in Epoch 2010s. PAFs related to individual risk factor varied among women and men.

CONCLUSION

Six modifiable risk factors to population-level global CVD risk decreased over time, but still explained 39% of total CVD in the latest decade. PAFs changed considerably for hypertension, dyslipidaemia, and smoking. Risk factors had different PAFs for different CVDs with pronounced sex differences.

European Society of Cardiology: the 2023 Atlas of Cardiovascular Disease Statistics

This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the 2021 report in presenting cardiovascular disease (CVD) statistics for the ESC member countries. This paper examines inequalities in cardiovascular healthcare and outcomes in ESC member countries utilizing mortality and risk factor data from the World Health Organization and the Global Burden of Disease study with additional economic data from the World Bank. Cardiovascular healthcare data were collected by questionnaire circulated to the national cardiac societies of ESC member countries. Statistics pertaining to 2022, or latest available year, are presented. New material in this report includes contemporary estimates of the economic burden of CVD and mortality statistics for a range of CVD phenotypes. CVD accounts for 11% of the EU's total healthcare expenditure. It remains the most common cause of death in ESC member countries with over 3 million deaths per year. Proportionately more deaths from CVD occur in middle-income compared with high-income countries in both females (53% vs. 34%) and males (46% vs. 30%). Between 1990 and 2021, median age-standardized mortality rates (ASMRs) for CVD decreased by median >50% in high-income ESC member countries but in middle-income countries the median decrease was <12%. These inequalities between middle- and high-income ESC member countries likely reflect heterogeneous exposures to a range of environmental, socioeconomic, and clinical risk factors. The 2023 survey suggests that treatment factors may also contribute with middle-income countries reporting lower rates per million of percutaneous coronary intervention (1355 vs. 2330), transcatheter aortic valve implantation (4.0 vs. 153.4) and pacemaker implantation (147.0 vs. 831.9) compared with high-income countries. The ESC Atlas 2023 report shows continuing inequalities in the epidemiology and management of CVD between middle-income and high-income ESC member countries. These inequalities are exemplified by the changes in CVD ASMRs during the last 30 years. In the high-income ESC member countries, ASMRs have been in steep decline during this period but in the middle-income countries declines have been very small. There is now an important need for targeted action to reduce the burden of CVD, particularly in those countries where the burden is greatest.

Male Gender Expressivity and Diagnosis and Treatment of Cardiovascular Disease Risks in Men

Importance

Male gender expressivity (MGE), which reflects prevalent sociocultural pressures to convey masculinity, has been associated with health. Yet, little is known about associations of MGE with the diagnosis and treatment of modifiable cardiovascular disease (CVD) risks.

Objective

To investigate associations of MGE with modifiable CVD risk diagnoses and treatment in men.

Design, Setting, and Participants

This population-based cohort study included data from waves I (1994-1995), IV (2008-2009), and V (2016-2018) of the US National Longitudinal Study of Adolescent to Adult Health (Add Health). Participants were male adolescents (age 12-18 years) followed up longitudinally through younger adulthood (age 24-32 years) and adulthood (age 32-42 years). Data were analyzed from January 5, 2023, to August 28, 2024.

Exposure

Male gender expressivity was quantified in adolescence and younger adulthood using an empirically-derived and validated measurement technique that incorporates participants' responses to existing Add Health survey items to capture how similarly participants behave to same-gendered peers.

Main Outcomes and Measures

Outcomes included self-reported diagnoses of CVD risk conditions (hypertension, diabetes, or hyperlipidemia) in adult men with elevated blood pressure, hemoglobin A1c, or non-high-density lipoprotein cholesterol levels, and self-reported treatment with antihypertensive, hypoglycemic, or lipid-lowering medications in adults reporting hypertension, diabetes, or hyperlipidemia. Multivariable regression was used to examine associations of adolescent and younger adult MGE with adult CVD risk diagnoses and treatment, adjusting for sociodemographic covariates.

Results

Among 4230 eligible male participants, most were non-Hispanic White (2711 [64%]) and privately insured (3338 [80%]). Their mean (SD) age was 16.14 (1.81) years in adolescence, 29.02 (1.84) years in younger adulthood, and 38.10 (1.95) years in adulthood. Compared with participants whose younger adult MGE was below average, those with higher younger adult MGE were overall less likely to report hypertension (22% vs 26%; P < .001), diabetes (5% vs 8%; P < .001), and hyperlipidemia (19% vs 24%; P < .001) diagnoses and diabetes treatment (3% vs 5%; P = .02) as adults. In multivariable models, every SD increase in adolescent MGE was associated with lower probabilities of adult hypertension treatment (MGE,-0.11; 95% CI, -0.16 to -0.6) and diabetes diagnoses (MGE, -0.15; 95% CI, -0.27 to -0.03). Higher younger adult MGE was associated with lower probabilities of adult hypertension diagnoses (MGE, -0.04; 95% CI, -0.07 to -0.01), hypertension treatment (MGE, -0.07; 95% CI, -0.13 to -0.01), and diabetes treatment (MGE, -0.10; 95% CI, -0.20 to -0.01). Adolescent and younger adult MGE outcomes were not associated with other adult CVD outcomes.

Conclusions and Relevance

In this cohort study of US males, higher adolescent and younger adult MGE was associated with lower adult hypertension and diabetes diagnoses and treatment. These findings suggest that males with high MGE may bear distinctive risks and correspondingly benefit from tailored public health efforts to prevent downstream CVD.

Constipation is associated with an increased risk of major adverse cardiac events in a UK population

Traditional cardiovascular risk factors, including hypertension, only explain part of major adverse cardiac events (MACEs). Understanding what other risk factors contribute to MACE is essential for prevention. Constipation shares common risk factors with hypertension and is associated with an increased risk of several cardiovascular diseases. We hypothesized that constipation is an underappreciated risk factor for MACE. We used the population healthcare and genomic data in the UK Biobank (n = 408,354) to study the contribution of constipation (ICD10 K59.0) to the risk of MACE, defined by any episode of acute coronary syndrome (ACS), ischemic stroke, and heart failure (HF). Analyses were controlled for traditional cardiovascular risk factors. We also assessed genetic correlations (rg) between constipation and MACE. Constipation cases (n = 23,814) exhibited a significantly higher risk of MACE compared with those with normal bowel habits [odds ratio (OR) = 2.15, P < 1.00 × 10-300]. Constipation was also significantly associated with individual MACE subgroups, in order: HF (OR = 2.72, P < 1.00 × 10-300), ischemic stroke (OR = 2.36, P = 2.02 × 10-230), and ACS (OR = 1.62, P = 5.82 × 10-113). In comparison with patients with constipation-free hypertension, patients with hypertension with constipation showed significantly higher odds of MACE (OR = 1.68, P = 1.05 × 10-136) and a 34% increased risk of MACE occurrence (P = 2.3 × 10-50) after adjustment for medications that affect gut motility and other traditional cardiovascular risk factors. Finally, we detected positive genetic correlations between constipation and MACE subgroups ACS (rg = 0.27, P = 2.12 × 10-6), ischemic stroke (rg = 0.23, P = 0.011), and HF (rg = 0.21, P = 0.0062). We identified constipation as a potential risk factor independently associated with higher MACE prevalence. These findings warrant further studies on their causal relationship and identification of pathophysiological mechanisms.NEW & NOTEWORTHY Analyzing 408,354 participants of the UK Biobank, we show that constipation cases exhibited a significantly higher risk of major adverse cardiac events (MACEs) than those with regular bowel habits. In comparison with patients with constipation-free hypertension, patients with hypertension with constipation showed significantly higher odds of MACE and a 34% increased risk of subsequent MACE occurrence. Finally, we detected positive genetic correlations between constipation and MACE. This association holds potential for therapeutic exploitation and prevention based on individuals' risk assessment.

Genetic Risk and Coronary Artery Calcium in Personalizing Antihypertensive Treatment: A Pooled Cohort Analysis

OBJECTIVE

To assess the role of the systolic blood pressure polygenic risk score (SBP-PRS) in antihypertensive treatment initiation and its comparative efficacy with coronary artery calcium (CAC) scores.

PATIENTS AND METHODS

This retrospective cohort study included participants with whole genome sequencing data who underwent CAC scanning between 1971 and 2008, were free of prevalent cardiovascular disease (CVD), and were not taking antihypertensive medications. The cohort was stratified by blood pressure (BP) treatment group and SBP-PRS (low/intermediate, first and second tertiles; high, third tertile) and CAC score (0 vs >0) subgroups. The primary outcome was the first occurence of adjudicated coronary heart disease, heart failure, or stroke during 10-year follow-up. The 10-year number needed to treat (NNT) to prevent 1 event of the primary outcome was estimated. A relative risk reduction of 25% for the primary outcome based on the treatment effect of intensive control (SBP <120 mm Hg) of hypertension in SPRINT (Systolic Blood Pressure Intervention Trial) was used for estimating the NNT.

RESULTS

Among the 5267 study participants, the median age was 59 years (interquartile range, 51-68 years); 2817 (53.5%) were women and 2880 (54.7%) were non-White individuals. Among 1317 individuals with elevated BP/low-risk stage 1 hypertension not recommended treatment, the 10-year incidence rate of the primary outcome was 5.6% for low/intermediate SBP-PRS and 6.3% for high SBP-PRS with NNTs of 63 and 59, respectively. Similarly, the 10-year incidence rate of the primary outcome was 2.9% for CAC score 0 and 9.7% for CAC score greater than 0, with NNTs of 117 and 37, respectively.

CONCLUSION

Including genetic information in risk estimation of individuals with elevated BP/low-risk stage 1 hypertension has modest value in the initiation of antihypertensive therapy. Genetic risk and CAC both have efficacy in personalizing antihypertensive therapy.

Predicting angiographic coronary artery disease using machine learning and high-frequency QRS

AIM

Exercise stress ECG is a common diagnostic test for stable coronary artery disease, but its sensitivity and specificity need to be further improved. In this paper, we construct a machine learning model for the prediction of angiographic coronary artery disease by HFQRS analysis of cycling exercise ECG.

METHODS AND RESULTS

This study prospectively included 140 inpatients and 59 healthy volunteers undergoing cycling exercise ECG. The CHD group (N=104) and non-CHD group (N=95) were determined by coronary angiography gold standard. Automated HF QRS analysis was performed by the blinded method. The coronary group was predominantly male, with a higher prevalence of age, BMI, hypertension, and diabetes than the non-coronary group ( P < 0.001 ), higher lipid levels in the coronary group ( P < 0.005 ), significantly longer QRS duration during exercise testing ( P < 0.005 ), more positive leads ( P < 0.001 ), and a greater proportion of significant changes in HFQRS ( P < 0.001 ). Age, Gender, Hypertension, Diabetes, and HF QRS Conclusions were screened by correlation analysis and multifactorial retrospective analysis to construct the machine learning models of the XGBoost Classifier, Logistic Regression, LightGBM Classifier, RandomForest Classifier, Artificial Neural Network and Support Vector Machine, respectively.

CONCLUSION

Male, elderly, with hypertension, diabetes mellitus, and positive exercise stress test HFQRS conclusions suggested a high risk of CHD. The best performance of the Logistic Regression model was compared, and a column line graph for assessing the risk of CHD was further developed and validated.

Discordance among apoB, non-high-density lipoprotein cholesterol, and triglycerides: implications for cardiovascular prevention

BACKGROUND AND AIMS

Despite growing evidence that apolipoprotein B (apoB) is the most accurate marker of atherosclerotic cardiovascular disease (ASCVD) risk, its adoption in clinical practice has been low. This investigation sought to determine whether low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (HDL-C), and triglycerides are sufficient for routine cardiovascular care.

METHODS

A sample of 293 876 UK Biobank adults (age: 40-73 years, 42% men), free of cardiovascular disease, with a median follow-up for new-onset ASCVD of 11 years was included. Distribution of apoB at pre-specified levels of LDL-C, non-HDL-C, and triglycerides was examined graphically, and 10-year ASCVD event rates were compared for high vs. low apoB. Residuals of apoB were constructed after regressing apoB on LDL-C, non-HDL-C, and log-transformed triglycerides and used as predictors in a proportional hazards regression model for new-onset ASCVD adjusted for standard risk factors, including HDL-C.

RESULTS

ApoB was highly correlated with LDL-C and non-HDL-C (Pearson's r = .96, P < .001 for both) but less so with log triglycerides (r = .42, P < .001). However, apoB ranges necessary to capture 95% of all observations at pre-specified levels of LDL-C, non-HDL-C, or triglycerides were wide, spanning 85.8-108.8 md/dL when LDL-C 130 mg/dL, 88.3-112.4 mg/dL when non-HDL-C 160 mg/dL, and 67.8-147.4 md/dL when triglycerides 115 mg/dL. At these levels (±10 mg/dL), 10-year ASCVD rates for apoB above mean + 1 SD vs. below mean - 1 SD were 7.3 vs. 4.0 for LDL-C, 6.4 vs. 4.6 for non-HDL-C, and 7.0 vs. 4.6 for triglycerides (all P < .001). With 19 982 new-onset ASCVD events on follow-up, in the adjusted model, residual apoB remained statistically significant after accounting for LDL-C and HDL-C (hazard ratio 1.06, 95% confidence interval 1.0-1.07), after accounting for non-HDL-C and HDL-C (hazard ratio 1.04, 95% confidence interval 1.03-1.06), and after accounting for triglycerides and HDL-C (hazard ratio 1.13, 95% confidence interval 1.12-1.15). None of the residuals of LDL-C, non-HDL-C, or of log triglycerides remained significant when apoB was included in the model.

CONCLUSIONS

High variability of apoB at individual levels of LDL-C, non-HDL-C, and triglycerides coupled with meaningful differences in 10-year ASCVD rates and significant residual information contained in apoB for prediction of new-onset ASCVD events demonstrate that LDL-C, non-HDL-C, and triglycerides are not adequate proxies for apoB in clinical care.

Correlation between controlled attenuation parameter values with SYNTAX score in patients with significant coronary artery disease

Non-alcoholic fatty liver disease (NAFLD) is an emerging cause of chronic liver disease, with coronary artery disease (CAD) as the main cause of death in NAFLD patients. However, correlation between the severity of liver steatosis and coronary atherosclerosis is yet to be understood. Here we aim to explore the correlation between controlled attenuation parameter (CAP) values and SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score in adult patients with significant CAD, defined as ≥ 50% stenosis of the left main coronary artery, or ≥ 70% stenosis of the other major coronary arteries. A cross-sectional study was conducted on 124 adult patients with significant CAD who underwent coronary angiography. Transient elastography with CAP was used to assess liver steatosis severity, resulting in a mean CAP value of 256.5 ± 47.3 dB/m, with 52.5% subjects had significant steatosis (CAP value of ≥ 248 dB/m). Median SYNTAX score was 22. A statistically significant correlation was observed between CAP value and SYNTAX score (r = 0.245, p < 0.0001). The correlation was more pronounced in patients with prior history of PCI (r = 0.389, p = 0.037). Patients with high-risk SYNTAX score (> 32) had the highest CAP value (285.4 ± 42.6 dB/m), and it was significantly higher than those with low-risk SYNTAX score (0-22), with a mean difference of 38.76 dB/m (p = 0.006). Patients with significant liver steatosis should undergo periodic CAD assessment and lifestyle modification, especially those with severe liver steatosis.

Cardiovascular disease and preventive care service utilization among midlife adults: The roles of diagnosis and depression

Objectives

Secondary preventive care is important for monitoring the progression of cardiovascular disease (CVD). However, the factors that promote secondary prevention were not well understood. This study addressed this gap by investigating the impact of CVD diagnosis on preventive care utilization among midlife adults. Given the high prevalence of depression among this population, it further examined whether depression interacted with CVD diagnosis to affect preventive care utilization.

Methods

The study sample included 6,222 midlife adults from six waves of the National Longitudinal Survey of Youth 1979 (NLSY79) collected between 2006 and 2016. Multiple logistic regressions were conducted to examine the relationship between a CVD diagnosis and each of the five types of preventive care utilization: influenza vaccinations, electrocardiography (EKG) and screening for high blood pressure, cholesterol, and blood sugar. Depression was then added to examine its possible moderation effect.

Results

The results showed that midlife adults with a CVD diagnosis were more likely to utilize all five types of preventive care services. EKG, the most relevant preventive care type with CVD diagnosis, had the largest strength of likelihood. Depression strengthened the relationship between a CVD diagnosis and the utilization of blood pressure tests, but it showed no associations with other four types of preventive care utilization.

Conclusions

The study findings indicate that a CVD diagnosis could serve as an opportunity for promoting secondary preventive care utilization. Future research needs to explore how a CVD diagnosis affects different population groups, and further explore the roles of depression.

Clinical efficacy and gene chip expression analysis of Shenzhu Guanxin recipe granules in patients with intermediate coronary lesions

OBJECTIVE

To evaluate the clinical efficacy and safety of Shenzhu Guanxin recipe granules (, SGR) in treating patients with intermediate coronary lesions (ICL), and to investigate the potential mechanism though a transcriptome sequencing approach.

METHODS

ICL patients with Qi deficiency and phlegm stasis were adopted and randomly assigned to a case group or a control by random number generator in a 1:1 randomization ratio to evaluate the clinical efficacy.

RESULTS

There was no significant difference between the two groups in coronary computed tomography angiography related indexes in the two groups before and after intervention. Through the gene chip expression analysis, it is finally concluded that there are 355 differential mRNAs (190 up-regulated genes and 165 down regulated genes) when compared the SGR group and placebo group. Through protein-protein interaction network analysis of differentially expressed genes, 10 hub genes were finally obtained: CACNA2D2, CACNA2D3, DNAJC6, FGF12, SGSM2, CACNA1G, LRP6, KIF25, OXTR, UPB1.

CONCLUSIONS

SGR combined with Western Medicine can be safely used to treat ICL patients with Qi deficiency and phlegm stasis. The possible mechanism of action and relevant gene loci and pathway were proposed.

[Screening, risk stratification and CT imaging for assessment of coronary artery disease]

BACKGROUND

Early treatment of cardiovascular risk factors and characterization of coronary plaques is essential to collect prognostic information about coronary artery disease (CAD) and prevent cardiovascular events.

OBJECTIVES

Discussion of the most important risk factors of CAD, basic diagnostic of CAD, prevention, and prognostic factors of CAD with focus on cardiac computed tomography (CT).

MATERIALS AND METHODS

Prevalence and prognostic impact of CAD risk factors; description of specific assessment of risk profiles; estimation of pretest probability; conventional prevention of CAD; prognostic assessment of CAD using the Calcium Scoring and coronary CT angiography.

RESULTS

Assessment of risk profiles and estimation of pretest probability for obstructive coronary stenosis necessitates a thorough evaluation of medical history and laboratory values. The composition and extent of calcified and noncalcified plaques in CT exams based on the criteria of the Coronary Artery Disease-Reporting and Data System give important prognostic information about the risk of cardiovascular events, which increases with high plaque burden and vice versa. Initial imaging with CT for evaluation of CAD leads to a reduction of invasive coronary angiographies and catheter-associated complications.

CONCLUSIONS

Besides early detection of cardiovascular risk factors, the additional assessment of plaque burden and significant stenosis in CT gives further prognostic information to facilitate effective therapies to prevent cardiovascular events and in the case of low plaque burden avoid invasive coronary angiography. However, systmatic screening using Calcium Scoring is not established yet due to insufficient data, although it could potentially be used for an early risk stratification in patients with multiple risk factors.

Manifestations of human atherosclerosis across vascular beds

Objective

Atherosclerosis underlies the most common etiologies of mortality worldwide, resulting in nearly 10 million deaths annually. In atherosclerosis, inflammation, metabolic factors, and hemodynamics cause the accumulation of extracellular lipids and the formation of plaques in the tunica intima of specific arteries. Atherosclerotic plaques primarily form in the coronary and carotid arteries, the aorta, and the peripheral arteries of the lower extremities. Although a common conceptual model of atherogenesis across these arteries has evolved over decades, there is a limited understanding of the important differences in regional atherosclerotic disease.

Methods

This review summarizes clinical studies, meta-analyses, and case reports to compare and contrast the impact, risk, plaque features, and clinical management of carotid, coronary, and femoral atherosclerosis in humans.

Results

Common risk factors, such as smoking and diabetes, influence disease risk differently across vascular beds. In addition, biological variables demonstrate a region-specific relationship with disease as peripheral atherosclerosis is most heritable, and male sex increases the risk of coronary and carotid, but not peripheral artery disease. The pathology of atherosclerotic lesions also varies between vascular territories. Specifically, carotid plaques are primarily lipid rich, whereas coronary plaques more commonly include fibrotic components with lipid-rich features, and femoral plaques are predominantly fibrocalcific. Clinically, interventional outcomes are worst in the carotid arteries and response to medical therapies, particularly statins, is not consistent across diseased regions, even within individual patients.

Conclusions

Atherosclerosis manifests in site-specific ways with regional differences in susceptibility and treatment response. Despite advances in the scientific understanding and clinical management of atherosclerosis, little is known about the mechanisms determining vessel-specific disease patterns and risk. Further research is needed urgently to delineate factors controlling plaque initiation and progression specific to vascular beds.

Sex-Specific Deflection of Age-Related DNA Methylation and Gene Expression in Mouse Heart by Perinatal Toxicant Exposures

Background

Global and site-specific changes in DNA methylation and gene expression are associated with cardiovascular aging and disease, but how toxicant exposures during early development influence the normal trajectory of these age-related molecular changes, and whether there are sex differences, has not yet been investigated.

Objectives

We used an established mouse model of developmental exposures to investigate the effects of perinatal exposure to either lead (Pb) or diethylhexyl phthalate (DEHP), two ubiquitous environmental contaminants strongly associated with CVD, on age-related cardiac DNA methylation and gene expression.

Methods

Dams were randomly assigned to receive human physiologically relevant levels of Pb (32 ppm in water), DEHP (25 mg/kg chow), or control water and chow. Exposures started two weeks prior to mating and continued until weaning at postnatal day 21 (3 weeks of age). Approximately one male and one female offspring per litter were followed to 3 weeks, 5 months, or 10 months of age, at which time whole hearts were collected (n ≥ 5 per sex per exposure). Enhanced reduced representation bisulfite sequencing (ERRBS) was used to assess the cardiac DNA methylome at 3 weeks and 10 months, and RNA-seq was conducted at all 3 time points. MethylSig and edgeR were used to identify age-related differentially methylated regions (DMRs) and differentially expressed genes (DEGs), respectively, within each sex and exposure group. Cell type deconvolution of bulk RNA-seq data was conducted using the MuSiC algorithm and publicly available single cell RNA-seq data.

Results

Thousands of DMRs and hundreds of DEGs were identified in control, DEHP, and Pb-exposed hearts across time between 3 weeks and 10 months of age. A closer look at the genes and pathways showing differential DNA methylation revealed that the majority were unique to each sex and exposure group. Overall, pathways governing development and differentiation were most frequently altered with age in all conditions. A small number of genes in each group showed significant changes in DNA methylation and gene expression with age, including several that were altered by both toxicants but were unchanged in control. We also observed subtle, but significant changes in the proportion of several cell types due to age, sex, and developmental exposure.

Discussion

Together these data show that perinatal Pb or DEHP exposures deflect normal age-related gene expression, DNA methylation programs, and cellular composition across the life course, long after cessation of exposure, and highlight potential biomarkers of developmental toxicant exposures. Further studies are needed to investigate how these epigenetic and transcriptional changes impact cardiovascular health across the life course.

Association of Handgrip Strength and Cardiovascular Disease Risk Among Middle-Aged Postmenopausal Women: An Analysis of the Korea National Health and Nutrition Examination Survey 2014-2019

Purpose

Handgrip strength is an indicator of overall muscle strength and has been associated with an increased risk of cardiovascular disease. Evidence suggests that menopause is a risk factor for cardiovascular disease in women, and muscle strength decreases progressively after menopause. Despite the prognostic importance of the decline in muscle strength and increased cardiovascular disease risk among postmenopausal women, evidence of their association is limited. This study aimed to investigate the relationship between handgrip strength and cardiovascular disease risk among postmenopausal, middle-aged Korean women.

Patients and Methods

Using pooled cohort equations, we calculated the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) among postmenopausal women (N = 2019) aged 50-64 years without cardiovascular disease history from the 2014-2019 Korea National Health and Nutrition Examination Survey. Relative grip strength was defined as measured grip strength divided by body mass index. Logistic regression analysis of a complex sampling design was performed to evaluate the association between relative grip strength and a predicted 10-year ASCVD risk ≥7.5%.

Results

The average handgrip strength was 24.8 kg, and 5.2% of women were considered for sarcopenia (<18 kg). The quartile-stratified relative grip strength was negatively associated with 10-year ASCVD risk (p < 0.001). In the multiple logistic regression analysis, the adjusted odds ratio for the highest relative grip strength quartile was 0.53 (95% confidence interval [CI]: 0.36-0.78), and that of the group who breastfed for more than 12 months was 1.75 (95% CI: 1.36-2.25) for 10-year ASCVD risk.

Conclusion

Increased handgrip strength may be associated with lower cardiovascular disease risk among middle-aged postmenopausal women in Korea. Our findings provide critical evidence regarding the importance of increasing handgrip strength among postmenopausal, middle-aged women to reduce cardiovascular disease risk. Handgrip strength measurement might be a valuable screening tool for cardiovascular disease prevention.

An update on the cell-free DNA-derived methylome as a non-invasive biomarker for coronary artery disease

Cardiovascular diseases are the foremost contributor to global mortality, presenting a complex etiology and an expanding array of risk factors. Coronary artery disease characterized by atherosclerotic plaque build-up in the coronary arteries, imposes significant mortality and financial burdens, especially in low- and middle-income nations. The pathogenesis of coronary artery disease involves a multifaceted interplay of genetic, environmental, and epigenetic factors. Epigenetic regulation contributes to the dynamic control of gene expression without altering the underlying DNA sequence. The mounting evidence that highlights the pivotal role of epigenetic regulation in coronary artery disease development and progression, offering potential avenues for the development of novel diagnostic biomarkers and therapeutic targets. Abnormal DNA methylation patterns are linked to the modulation of gene expression involved in crucial processes like lipid metabolism, inflammation, and vascular function in the context of coronary artery disease. Cell-free DNA has become invaluable in tumor biology as a liquid biopsy, while its applications in coronary artery disease are limited, but intriguing. Atherosclerotic plaque rupture causes myocardial infarction, by depriving heart muscles of oxygen, releasing cell-free DNA from dead cardiac cells, and providing a minimally invasive source to explore tissue-specific epigenetic alterations. We discussed the methodologies for studying the global methylome and hydroxy-methylome landscape, their advantages, and limitations. It explores methylome alterations in coronary artery disease, considering risk factors and their relevance in coronary artery disease genesis. The review also details the implications of MI-derived cell-free DNA for developing minimally invasive biomarkers and associated challenges.

The Causal-Benefit Model to Prevent Cardiovascular Events

Selecting individuals for preventive lipid-lowering therapy is presently governed by the 10-year risk model. Once a prespecified level of cardiovascular disease risk is equaled or exceeded, individuals become eligible for preventive lipid-lowering therapy. A key limitation of this model is that only a small minority of individuals below the age of 65 years are eligible for therapy. However, just under one-half of all cardiovascular disease events occur below this age. Additionally, in many, the disease that caused their events after 65 years of age developed and progressed before 65 years of age. The causal-benefit model of prevention identifies individuals based both on their risk and the estimated benefit from lowering atherogenic apoB lipoprotein levels. Adopting the causal-benefit model would increase the number of younger subjects eligible for preventive treatment, would increase the total number of cardiovascular disease events prevented at virtually the same number to treat, and would be cost-effective.

Nontraditional Risk Markers for Incident Coronary Artery Calcium Among Persons ≥65 Years of Age

Background

The initiation of coronary artery calcium (CAC) is an important physiologic milestone associated with increased cardiovascular disease risk. However, traditional risk factors (RF) do not perform well for predicting incident CAC among the 54 million older U.S. adults.

Objectives

The authors sought to assess the association between nontraditional cardiovascular disease RF and incident CAC in older persons.

Methods

There were 815 MESA (Multi-Ethnic Study of Atherosclerosis) participants ≥65 years of age who had CAC = 0 at Visit 1 and a follow-up CAC scan. Multivariable adjusted Cox hazards ratios (aHR) and C-statistics were calculated to examine the association of nontraditional RF with incident CAC.

Results

The mean age was 70.2 years and 67% were women. The median follow-up time to repeat CAC scan was 3.6 years (IQR: 2.6-9.2 years) and 45% of participants developed incident CAC. Albuminuria (aHR: 1.50, 95% CI: 1.07-2.09), carotid plaque (aHR: 1.32, 95% CI: 1.04-1.66), and thoracic aortic calcification (TAC) (aHR: 1.38, 95% CI: 1.10-1.75) were significantly associated with incident CAC, while higher levels of nontraditional RF including apolipoprotein-B, lipoprotein(a), high-sensitivity troponin T, and N-terminal pro-brain natriuretic peptide were not. When added to demographics, albuminuria, carotid plaque, and TAC provided a greater C-statistic improvement (+0.047, P = 0.004) vs all traditional RF combined (+0.033, P = 0.05).

Conclusions

Among nontraditional RF and measures of subclinical atherosclerosis, only albuminuria, carotid plaque, and TAC were significantly associated with incident CAC in persons ≥65 years of age. Identification of albuminuria or extracoronary atherosclerosis may help guide the timing of repeat CAC scoring in older persons with baseline CAC = 0.

Pregnancy, cardiovascular health, and microchimerism

PURPOSE OF REVIEW

To provide an updated review of scientific literature concerning associations between pregnancy and cardiovascular health among women, and to discuss a possible impact of microchimerism on the association.

RECENT FINDINGS

In most studies, pregnancy and childbirth is associated with increased risk of cardiovascular disease in women. Some ascribe the association mainly to lifestyle, whereas others suggest that pregnancy itself negatively affects women's cardiovascular health. Pregnancy is a natural source of microchimerism, which in turn markedly affects female health. The only study published in the area surprisingly shows that among middle-aged women, male-origin microchimerism (MOM) is associated with half the risk of developing ischemic heart disease (IHD). No similar association is found between MOM and ischemic stroke.

SUMMARY

The sparse evidence published suggests reduced risk of developing IHD among MOM-positive women. Despite the association being biologically plausible, replication of the findings is warranted to support that this is not a chance finding.

Differences in vasomotor function of mesenteric arteries between Ossabaw minipigs with predisposition to metabolic syndrome and Göttingen minipigs

Metabolic syndrome predisposes and contributes to the development and progression of atherosclerosis. The minipig strain "Ossabaw" is characterized by a predisposition to develop metabolic syndrome. We compared vasomotor function in Ossabaw minipigs before they developed their diseased phenotype to that of Göttingen minipigs without such genetic predisposition. Mesenteric arteries of adult Ossabaw and Göttingen minipigs were dissected postmortem and mounted on a myograph for isometric force measurements. Maximal vasoconstriction to potassium chloride (KClmax) was induced. Cumulative concentration-response curves were determined in response to norepinephrine. Endothelium-dependent (with carbachol) and endothelium-independent (with nitroprusside) vasodilation were analyzed after preconstriction by norepinephrine. In a bioinformatic analysis, variants/altered base pairs within genes associated with cardiovascular disease were analyzed. KClmax was similar between the minipig strains (15.6 ± 6.7 vs. 14.1 ± 3.4 ΔmN). Vasoconstriction in response to norepinephrine was more pronounced in Ossabaw than in Göttingen minipigs (increase of force to 143 ± 48 vs. 108 ± 38% of KClmax). Endothelium-dependent and endothelium-independent vasodilation were less pronounced in Ossabaw than in Göttingen minipigs (decrease of force to 46.4 ± 29.6 vs. 16.0 ± 18.4% and to 36.7 ± 25.2 vs. 2.3 ± 3.7% of norepinephrine-induced preconstriction). Vasomotor function was not different between the sexes. More altered base pairs/variants were identified in Ossabaw than in Göttingen minipigs for the exon encoding adrenoceptor-α1A. Vasomotor function in lean Ossabaw minipigs is shifted toward vasoconstriction and away from vasodilation in comparison with Göttingen minipigs, suggesting a genetic predisposition for vascular dysfunction and atherosclerosis in Ossabaw minipigs. Thus, Ossabaw minipigs may be a better model for human cardiovascular disease than Göttingen minipigs.NEW & NOTEWORTHY Animal models with a predisposition to metabolic syndrome and atherosclerosis are attracting growing interest for translational research, as they may better mimic the variability of patients with cardiovascular disease. In Ossabaw minipigs, with a polygenic predisposition to metabolic syndrome, but without the diseased phenotype, vasoconstriction is more and vasodilation is less pronounced in mesenteric arteries than in Göttingen minipigs. Ossabaw minipigs may be a more suitable model of human cardiovascular disease.

Prevalence and trend of multiple coronary artery disease risk factors and their 5-year incidence rate among adult population of Kerman: results from KERCADR study

BACKGROUND

Coronary artery diseases (CADs) are the most important non‑communicable diseases (NCDs), which cause the highest number of deaths around the world. Hypertension (HTN), dyslipidemia (DL), diabetes mellitus (DM), obesity (OB), low physical activity (LPA), smoking, opium consumption (OC) and anxiety are the most important CAD risk factors, which are more dangerously present in combination in some patients.

METHODS

A total of 5835 people aged 15 to 75 years were enrolled in the phase 1 (2012) and followed up to the phase 2 (2017) of the population-based Kerman coronary artery diseases risk factors study (KERCADRS). The prevalence and pattern of different combinations of CAD risk factors (double to quintuple) and their 5-year incidence rates were assessed.

RESULTS

The prevalence of single CAD risk factors (RFs) in phase 2 was 50.2% (DL), 47.1% (LPA), 28.1% (abdominal obesity), 21.2% (OB), 16.5% (HTN), 9.2% (smoking), 9.1% (OC), and 8.4% (DM). The most frequent combination of risk factors was LPA plus DL (23.9%), metabolic syndrome (19.6%), and DL plus OB (17.8%). The 5-year incidence rates of multiple comorbidities (in persons per 100 person-years) was DL plus LPA (2.80%), HTN plus DL (1.53%), and abdominal obesity (AOB) plus DL (1.47%). The most participants (84.4%) suffered from at least one RF, while 54.9% had at least two and 29.9% had at least three RFs.

CONCLUSION

The results showed that a large portion of the study population suffers from multiple CAD RFs. The findings underscore the importance of identifying multiple CAD risk factors to reduce the overall burden of these NCDs.

Preventive cardiology for the aging population: how can we better design clinical trials of statins?

INTRODUCTION

Older adults form a fast-increasing proportion of the world population. However, gains in increasing quantity of life have not been accompanied by similar gains in quality of life. Older people frequently experience frailty, memory problems, and chronic diseases including cardiovascular disease (CVD) and neurodegenerative diseases. Recent trials have demonstrated the efficacy of anti-hypertensive therapy in older populations but failed to show benefits for aspirin.

AREA COVERED

Statins clearly reduce CVD events in middle-aged populations. There seems to be evidence that the effect is similar in primary prevention older populations based on meta-analyses mainly from sub-groups in large trials, but this becomes less clear with increasing age. However, given differences in drug metabolism and possibly efficacy, competing co-morbidities, their effects on mortality, disability, and dementia in this age group remain to be determined.

EXPERT OPINION

Two large trials are now underway to clarify the role of statin therapy in people aged over 70 years using endpoints of mortality, disability, and neurocognitive endpoints as well as standard cardiovascular disease outcomes. They may provide also provide more evidence on how to approach the over 80 year age group.

Risk Prediction for Atherosclerotic Cardiovascular Disease With and Without Race Stratification

Importance

Use of race-specific risk prediction in clinical medicine is being questioned. Yet, the most commonly used prediction tool for atherosclerotic cardiovascular disease (ASCVD)-pooled cohort risk equations (PCEs)-uses race stratification.

Objective

To quantify the incremental value of race-specific PCEs and determine whether adding social determinants of health (SDOH) instead of race improves model performance.

Design, Setting, and Participants

Included in this analysis were participants from the biracial Reasons for Geographic and Racial Differences in Stroke (REGARDS) prospective cohort study. Participants were aged 45 to 79 years, without ASCVD, and with low-density lipoprotein cholesterol level of 70 to 189 mg/dL or non-high-density lipoprotein cholesterol level of 100 to 219 mg/dL at baseline during the period of 2003 to 2007. Participants were followed up to 10 years for incident ASCVD, including myocardial infarction, coronary heart disease death, and fatal and nonfatal stroke. Study data were analyzed from July 2022 to February 2023.

Main outcome/measures

Discrimination (C statistic, Net Reclassification Index [NRI]), and calibration (plots, Nam D'Agostino test statistic comparing observed to predicted events) were assessed for the original PCE, then for a set of best-fit, race-stratified equations including the same variables as in the PCE (model C), best-fit equations without race stratification (model D), and best-fit equations without race stratification but including SDOH as covariates (model E).

Results

This study included 11 638 participants (mean [SD] age, 61.8 [8.3] years; 6764 female [58.1%]) from the REGARDS cohort. Across all strata (Black female, Black male, White female, and White male participants), C statistics did not change substantively compared with model C (Black female, 0.71; 95% CI, 0.68-0.75; Black male, 0.68; 95% CI, 0.64-0.73; White female, 0.77; 95% CI, 0.74-0.81; White male, 0.68; 95% CI, 0.64-0.71), in model D (Black female, 0.71; 95% CI, 0.67-0.75; Black male, 0.68; 95% CI, 0.63-0.72; White female, 0.76; 95% CI, 0.73-0.80; White male, 0.68; 95% CI, 0.65-0.71), or in model E (Black female, 0.72; 95% CI, 0.68-0.76; Black male, 0.68; 95% CI, 0.64-0.72; White female, 0.77; 95% CI, 0.74-0.80; White male, 0.68; 95% CI, 0.65-0.71). Comparing model D with E using the NRI showed a net percentage decline in the correct assignment to higher risk for male but not female individuals. The Nam D'Agostino test was not significant for all race-sex strata in each model series, indicating good calibration in all groups.

Conclusions

Results of this cohort study suggest that PCE performed well overall but had poorer performance in both BM and WM participants compared with female participants regardless of race in the REGARDS cohort. Removal of race or the addition of SDOH did not improve model performance in any subgroup.

Low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and apolipoprotein B for cardiovascular care

PURPOSE OF REVIEW

Some experts and consensus groups continue to argue that apolipoprotein B (apoB) should not be introduced broadly into clinical care. But, too often, the present approach to clinical care is not succeeding. An important reason for this failure, we believe, is that the conventional approach limits what the expert clinician can accomplish and is too complex, confusing, and contradictory for primary care physicians to apply effectively in their practise.

RECENT FINDINGS

There are four major reasons that apoB should be measured routinely in clinical care. First, apoB is a more accurate marker of cardiovascular risk than LDL-C or non-HDL-C. Second, the measurement of apoB is standardized whereas the measurements of LDL-C and non-HDL-C are not. Third, with apoB and a conventional lipid panel, all the lipid phenotypes can be simply and accurately distinguished. This will improve the care of the expert. Fourth, apoB, as the single measure to evaluate the success of therapy, would simplify the process of care for primary care physicians.

SUMMARY

By introducing apoB broadly into clinical care, the process of care will be improved for both the expert and the primary care physician, and this will improve the outcomes of care.

Optimization of time interval for the measurement of plasma lipids for cardiovascular disease risk assessment

BACKGROUND

Lipid testing for atherosclerotic cardiovascular disease (ASCVD) risk is often performed every 4-6 years, but we hypothesized that the optimum time interval may vary depending on baseline risk.

RESEARCH DESIGN AND METHODS

Using lipid values and other risk factors from the National Health and Nutrition Examination Survey (NHANES) (n = 9,704), we calculated a 10-year risk score with the pooled-cohort equations. Future risk scores were predicted by increasing age and projecting systolic blood pressure (SBP) and lipid changes, using the mean-percentile age group change in NHANES for SBP (n = 17,329) and the Lifelines Cohort study for lipids (n = 133,540). The crossing of high and intermediate-risk thresholds were calculated by time to determine optimum intervals for lipid testing.

RESULTS

Time to crossing risk thresholds depends on baseline risk, but the mean increase in the risk score plateaus at 1% per year for those with a baseline 10-year risk greater than 15%. Based on these findings, we recommend the following maximum time intervals for lipid testing: baseline risk < 15%: 5-years, 16%: 4-years, 17%: 3-years, 18%: 2-years, and 19%: ≤1-year.

CONCLUSIONS

Testing patients for lipids who have a higher baseline risk more often could identify high-risk patients sooner, allowing for earlier and more effective therapeutic intervention.

Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association

Cardiovascular-kidney-metabolic (CKM) syndrome is a novel construct recently defined by the American Heart Association in response to the high prevalence of metabolic and kidney disease. Epidemiological data demonstrate higher absolute risk of both atherosclerotic cardiovascular disease (CVD) and heart failure as an individual progresses from CKM stage 0 to stage 3, but optimal strategies for risk assessment need to be refined. Absolute risk assessment with the goal to match type and intensity of interventions with predicted risk and expected treatment benefit remains the cornerstone of primary prevention. Given the growing number of therapies in our armamentarium that simultaneously address all 3 CKM axes, novel risk prediction equations are needed that incorporate predictors and outcomes relevant to the CKM context. This should also include social determinants of health, which are key upstream drivers of CVD, to more equitably estimate and address risk. This scientific statement summarizes the background, rationale, and clinical implications for the newly developed sex-specific, race-free risk equations: PREVENT (AHA Predicting Risk of CVD Events). The PREVENT equations enable 10- and 30-year risk estimates for total CVD (composite of atherosclerotic CVD and heart failure), include estimated glomerular filtration rate as a predictor, and adjust for competing risk of non-CVD death among adults 30 to 79 years of age. Additional models accommodate enhanced predictive utility with the addition of CKM factors when clinically indicated for measurement (urine albumin-to-creatinine ratio and hemoglobin A1c) or social determinants of health (social deprivation index) when available. Approaches to implement risk-based prevention using PREVENT across various settings are discussed.

Proteome profiling of early gestational plasma reveals novel biomarkers of congenital heart disease

Prenatal diagnosis of congenital heart disease (CHD) relies primarily on fetal echocardiography conducted at mid-gestational age-the sensitivity of which varies among centers and practitioners. An objective method for early diagnosis is needed. Here, we conducted a case-control study recruiting 103 pregnant women with healthy offspring and 104 cases with CHD offspring, including VSD (42/104), ASD (20/104), and other CHD phenotypes. Plasma was collected during the first trimester and proteomic analysis was performed. Principal component analysis revealed considerable differences between the controls and the CHDs. Among the significantly altered proteins, 25 upregulated proteins in CHDs were enriched in amino acid metabolism, extracellular matrix receptor, and actin skeleton regulation, whereas 49 downregulated proteins were enriched in carbohydrate metabolism, cardiac muscle contraction, and cardiomyopathy. The machine learning model reached an area under the curve of 0.964 and was highly accurate in recognizing CHDs. This study provides a highly valuable proteomics resource to better recognize the cause of CHD and has developed a reliable objective method for the early recognition of CHD, facilitating early intervention and better prognosis.

Helicobacter pylori infection and rheumatoid arthritis as risk enhancers' factors for atherosclerotic cardiovascular diseases

BACKGROUND

In addition to established risk factors for atherosclerotic cardiovascular diseases (aCVDs), infections and autoimmune diseases, such as Helicobacter pylori (H. pylori) and rheumatoid arthritis (RA), have been reported as risk-enhancer factors. In this retrospective single-center, case-control study, the relative weight of RA and H. pylori infection on aCVD was evaluated in a cohort of patients from Northern Sardinia, Italy, where both conditions are frequent.

MATERIALS AND METHODS

Data were retrieved from records of subjects undergoing upper endoscopy and screened for H. pylori infection by at least four biopsies. The presence of H. pylori and chronic-active gastritis were labeled as a current infection or a long-lasting infection (LLHp) when atrophy and/or metaplasia and/or dysplasia were detected in at least one gastric specimen. Diagnosis of aCVD and RA was made by the cardiologist and the rheumatologist, respectively, according to guidelines. Odd ratios (ORs) for aCVD were evaluated, adjusting for age, sex, excess weight, cigarette smoking, blood hypertension, dyslipidemia, diabetes, H. pylori status, and RA.

RESULTS

Among 4821 records (mean age 52.1 ± 16.7 years; 66.0% female), H. pylori infection was detected in 2262 patients, and more specifically, a LLHp infection was present in 1043 (21.6%). Three-hundred-three (6.3%) patients were diagnosed with aCVD, and 208 (4.3%) with RA. In patients with aCVD (cases), the LLHp infection (33.3% vs. 20.8%, p < 0.0001) and RA (12.2% vs. 3.8%, p < 0.0001) were more frequent in cases compared with controls (patients without aCVD). After adjusting for traditional aCVD risk factors, ORs significantly increased for LLHp infection (1.57; 95% CI 1.20-2.06) and RA (2.63; 95% CI 1.72-4.02). Interestingly, the LLHp infection in patients with RA showed an overall addictive effect on the risk for aCVD (7.89; 95% CI 4.29-14.53).

CONCLUSIONS

According to our findings, patients with RA should benefit from being screened and eventually treated for H. pylori infection.

Gene Regulatory Networks in Coronary Artery Disease

PURPOSE OF REVIEW

Coronary artery disease is a complex disorder and the leading cause of mortality worldwide. As technologies for the generation of high-throughput multiomics data have advanced, gene regulatory network modeling has become an increasingly powerful tool in understanding coronary artery disease. This review summarizes recent and novel gene regulatory network tools for bulk tissue and single cell data, existing databases for network construction, and applications of gene regulatory networks in coronary artery disease.

RECENT FINDINGS

New gene regulatory network tools can integrate multiomics data to elucidate complex disease mechanisms at unprecedented cellular and spatial resolutions. At the same time, updates to coronary artery disease expression data in existing databases have enabled researchers to build gene regulatory networks to study novel disease mechanisms. Gene regulatory networks have proven extremely useful in understanding CAD heritability beyond what is explained by GWAS loci and in identifying mechanisms and key driver genes underlying disease onset and progression. Gene regulatory networks can holistically and comprehensively address the complex nature of coronary artery disease. In this review, we discuss key algorithmic approaches to construct gene regulatory networks and highlight state-of-the-art methods that model specific modes of gene regulation. We also explore recent applications of these tools in coronary artery disease patient data repositories to understand disease heritability and shared and distinct disease mechanisms and key driver genes across tissues, between sexes, and between species.