Rosuvastatin Slows Progression of Carotid Intima-Media Thickness: The METEOR-China Randomized Controlled Study

Activatable optical probe for non-invasive detection of APN activity in diabetes and its complications

BACKGROUND

Diabetes is a major global health issue, primarily characterized by chronic hyperglycemia, and can lead to severe complications such as ovarian dysfunction. Early and accurate diagnosis is critical for effective disease management and prevention of long-term complications. This study explores the clinical potential of Hcy-APN, a diagnostic probe designed to detect aminopeptidase N (APN) activity in solution, cells, and in vivo.

RESULTS

The Hcy-APN probe incorporates a hemicyanine moiety, remaining non-fluorescent until cleaved by APN, which enhances both fluorescence and photoacoustic (PA) signals. In vitro experiments demonstrated a strong correlation between APN concentration and PA intensity, with minimal interference from other bioenzymes. The probe exhibited high stability and consistent PA signals, enabling deep tissue imaging at depths up to 0.6 cm. Cellular imaging confirmed its low cytotoxicity, while in vivo studies in diabetic mice highlighted its effectiveness in monitoring APN activity. Additionally, fluorescence assays of human clinical samples revealed significantly higher signals in serum from patients with ovarian dysfunction, suggesting the probe's diagnostic utility in diabetes-related ovarian conditions.

SIGNIFICANCE

This study underscores the potential of Hcy-APN as a valuable tool for clinical diagnostics, particularly in monitoring diabetes-associated complications like ovarian dysfunction. The probe's dual-modality imaging capability (fluorescence and PA) enhances its applicability in deep tissue analysis. Further research is needed to optimize its clinical use and validate its efficacy in improving patient outcomes.

Diagnostic approaches optical imaging of GGT levels in lipid metabolism disorders: Insights from preclinical imaging and patients samples

Lipid metabolism diseases, particularly obesity (OB) and atherosclerosis (AS), pose significant global health challenges. This study introduces the Hcy-GGT probe, a novel hemicyanine-based sensor for real-time, high-sensitivity detection of glutamyl transpeptidase (GGT), crucial for assessing liver function and systemic lipid disorders like obesity (OB) and atherosclerosis (AS). The probe, activated by GGT, shows enhanced absorption, fluorescence, and photoacoustic signals, providing a linear response to GGT concentration with a detection limit of 57.5 ng/mL. Applied in cellular models and in vivo, Hcy-GGT effectively monitors GGT activity, demonstrating its potential for early disease diagnosis and monitoring, particularly in OB and AS contexts. Importantly, Hcy-GGT probe effectively distinguished between obese and non-obese in polycystic ovary syndrome (PCOS) patients by demonstrating stronger fluorescence intensity in the serum of the obese group, highlighting its utility in assessing obesity-associated metabolic risks. This probe's specificity and stability under physiological conditions underscore its utility for clinical diagnostics and biomedical research, offering a promising tool for non-invasive, dynamic disease monitoring and early intervention.

Development and Validation of a Nitric Oxide-Responsive Optical Probe for Cardiovascular Disease with Acute Lung Injury In Vivo Imaging

Nitric oxide plays an important role in the occurrence and development of cardiovascular disease. However, due to the reactive and transient nature of NO, directly detecting its levels is challenging in the clinic, and currently used imaging methods have difficulty imaging NO levels at the living level. In this study, we developed a nitric oxide (NO)-responsive probe (NOP) and its nanoformulation (NanoNOP). NanoNOP exhibited excellent stability, sensitivity, and selectivity toward NO, with enhanced fluorescence and photoacoustic (PA) signals upon NO exposure. In cellular studies, NanoNOP demonstrated strong NO responsiveness in foam cells, a key cell type in cardiovascular disease, with significantly higher photoacoustic and fluorescence signals compared to control macrophages. In vivo studies in mice with acute lung injury (ALI) revealed elevated NO levels in the aortic region, confirmed by ex vivo immunohistochemical analysis showing increased iNOS expression and NO production. NanoNOP also demonstrated excellent biocompatibility, with no significant changes in body weight or organ damage. These findings highlight NanoNOP as a promising tool for studying NO-related pathologies and developing targeted therapeutic strategies.

Tocilizumab Increases Serum Lipids but Does Not Increase Arteriosclerosis, As Measured by Intima-Media Thickness, in Patients With Rheumatoid Arthritis

Objectives Patients with rheumatoid arthritis (RA) have a high incidence of arteriosclerotic disease. These are partly attributed to high levels of C-reactive protein (CRP) and inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6. Tocilizumab (TCZ) is an IL-6 receptor antagonist that lowers CRP levels by directly blocking IL-6 signaling. Tocilizumab has been reported to increase serum lipid levels. However, its effect on arteriosclerosis remains unclear. Therefore, we investigated the effect of TCZ on arteriosclerosis in patients with RA. Methods Eighteen Japanese patients with RA who were administered TCZ were included and assessed at baseline and six and 12 months. The Disease Activity Score-28 with erythrocyte sedimentation rate (DAS28-ESR), CRP, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and carotid intima-media thickness (IMT) were measured and analyzed using high-resolution B-mode ultrasonography. Additionally, the effects of concurrent statin administration on any changes in IMT were evaluated. Results From baseline to six or 12 months, TCZ decreased CRP (P < 0.0005) and DAS28-ESR (P < 0.0005) significantly, whereas TC, LDL-C, and HDL-C levels increased significantly (P < 0.005). However, there was no change in the LDL-C/HDL-C ratio (P = 0.821 at six months and P = 0.168 at 12 months), and carotid IMT (P = 0.6874 at six months and P = 0.6951 at 12 months). Comparison of percentage changes in mean IMT revealed no statistical differences between the patient groups with or without statin administration (P = 0.7208 at six months, P = 0.5928 at 12 months). Conclusions According to the 12-month observation data, no significant association was detected between TCZ use and IMT changes in patients with RA, despite its effects on serum lipids. Further long-term studies are needed to confirm that IL-6 receptor blockers have cardiovascular effects.

Interaction between 24 h Urinary Free Cortisol and Obesity in Hypertension-Mediated Organ Damage in Patients with Untreated Hypertension

Background

Given the close relationship between excessive cortisol secretion and obesity, as well as their intimate associations with cardiometabolic sequelae, this study aimed to evaluate whether elevated cortisol levels and obesity are independently and potentially interactively related to hypertension-mediated organ damage (HMOD) in patients with untreated hypertension.

Methods

A total of 936 untreated hypertensive patients were recruited. Body mass index (BMI), 24-hour urinary free cortisol (24 h UFC), and HMOD indicators, including left ventricular hypertrophy (LVH), carotid intima-media thickness (CIMT), and albuminuria, were assessed. Multivariate logistic regression was conducted to evaluate the associations of HMOD indicators with 24 h UFC and obesity. Generalized linear models were used to test for the interaction effects of obesity in the associations between log 24 h UFC levels and HMOD indicators.

Results

Compared to non-obese patients, those who were obese had a greater left ventricular mass index (LVMI), greater CIMT, a higher level of 24-hour urinary albumin (24 h UALB) and more frequent albuminuria (all p < 0.05). In the obese group, elevated 24 h UFC was significantly associated with LVH (odds ratio (OR) = 2.53; 95% CI: 1.02-6.31, p = 0.044) and albuminuria (OR = 3.13; 95% CI: 1.31-7.43, p = 0.01), after multivariate adjusting. There was a significant interactive effect of obesity on the association between 24 h UFC and LVH and albuminuria (all p for interaction <0.05). A significant correlation was observed between 24 h UFC and LVMI in obese and non-obese patients. Conversely, the correlations of 24 h UFC and log 24 h UALB were found only in obese patients but not in non-obese patients.

Conclusions

Elevated 24 h UFC levels were associated with higher severity of HMOD, including more frequent LVH, albuminuria, and greater CIMT. Additionally, obesity modified the effects of 24 h UFC on both LVH and albuminuria.

Multifunctional Optical Sensor for the Comprehensive Detection of Zinc Ions in Cardiovascular Disease

Cardiovascular diseases (CVDs) are a major global health concern, highlighting the need for effective diagnostic tools. Zinc ions (Zn2+) play a role in CVDs, but their detection is challenging. This study presents a multifunctional optical sensor, HD-Zn, designed to detect Zn2+ in relation to CVDs. We developed a novel fluorescence probe, HD-Zn, by conjugating N,N-di(2-picolyl)ethylenediamine (DPEN) to HD via an amide bond, which results in fluorescence quenching due to photoinduced electron transfer (PeT). Adding Zn2+ significantly increased fluorescence intensity in the near-infrared region (NIR-I). The probe showed a linear response to varying Zn2+ concentrations, with a detection limit of 9.8 nM, appropriate for physiological conditions. Fluorescence imaging in RAW264.7 macrophages indicated lower intracellular Zn2+ levels in foam cells compared to healthy cells, linked to CVDsprogression. In vivo imaging in mouse models showed decreased fluorescence intensity in the aorta with disease progression. Our findings confirm that HD-Zn is a reliable tool for measuring Zn2+ levels in plaques and demonstrate its biosafety for detecting Zn2+ in serum and urine, offering potential for clinical applications in CVDs diagnosis and monitoring.

Novel Approach for Biosensor-Based Imaging of Cysteine Levels in Ischemeic Heart Disease: Insights from Preclinical Models and Human Samples

Cardiovascular diseases (CVDs) pose a serious threat to human health, with atherosclerosis being a leading cause of heart disease and stroke. Elevated cysteine (Cys) levels have been closely linked to an increased risk of cardiovascular diseases, underscoring its significance in cardiovascular health. However, current detection methods for cysteine in serum and atherosclerotic plaques present challenges in sensitivity, specificity, dynamic monitoring, and invasiveness. The development of more sensitive, specific, and noninvasive assays is needed to enable accurate monitoring of cysteine levels. This study introduces the development and characterization of Cys-NPs, a sensitive and selective tool for imaging cysteine in foam cells and atherosclerotic mice. Encapsulation of the HD-probe using DSPE-PEG to obtain Cys-NPs effectively reduced interference from glutathione (GSH), leading to successful preparation and validation of Cys-NPs's nanoscale structure. At the same time, Cys-NPs was able to use the differences in Hcy and Cys concentrations in vivo to better assess Cys levels in vivo. In vitro and in vivo studies demonstrated Cys-NPs's effective imaging of cysteine in foam cells and atherosclerotic mice, highlighting its potential for noninvasive assessment of cysteine levels in ischemic heart disease research and clinical practice.

The Possible Role of Rosuvastatin Therapy in HFpEF Patients-A Preliminary Report

BACKGROUND

An increasing number of heart failure with preserved ejection fraction (HFpEF) syndromes has been reported in tandem with increasing age and burdens of obesity and cardiometabolic disorders. Identifying possible risk and modulatory HFpEF factors has significant epidemiological and clinical value. This study aimed to assess the prevalence of echocardiographic diagnostic criteria of left ventricular dysfunction in patients with chronic coronary syndrome depending on rosuvastatin therapy.

METHOD

There were 81 (33 (41%) male) consecutive patients with a median age of 70 (62-75) years, presenting with stable heart failure symptoms according to the New York Heart Association (NYHA) classification I to III. They presented with chronic coronary syndrome and were hospitalized between March and August 2024. Patients were divided according to the type of long-term lipid-lowering therapy into patients with rosuvastatin and with other statin therapy. The echocardiographic analysis based on diastolic dysfunction evaluation was performed on admission and compared with demographical, clinical, and laboratory results.

RESULTS

In the multivariable model for diastolic dysfunction prediction in the analyzed group based on three echocardiographic parameters, septal E' below 7 cm/s, lateral E' below 10 cm/s, and LAVI above 34 mL/m2, the following factors were found to be significant: sex (male) (OR: 0.19, 95% CI: 0.04-0.83, p = 0.027), obesity (defined as BMI > 30) (OR: 12.78, 95% CI: 2.19-74.50, p = 0.005), and rosuvastatin therapy (OR: 0.09, 95% CI: 0.02-0.51, p = 0.007).

CONCLUSIONS

Rosuvastatin therapy can be regarded as a possible protective therapy against left ventricular diastolic dysfunction in chronic coronary syndrome.

Enzyme Activity-Based Optical Probe: Imaging Aminopeptidases N in Vulnerable Plaque and Serum

Cardiovascular disease, a chronic and progressive arterial wall disease, is increasingly recognized for its clinical significance. Aminopeptidases N (APN), crucial in the pathophysiological processes of vulnerable plaque, have been linked to endothelial dysfunction, oxidative stress, and plaque formation, thus highlighting their potential as biomarkers for disease progression. However, current detection methods for APN in body fluids and in vivo have limitations, including insufficient sensitivity and specificity, time delays, and the inability to directly reflect enzyme activity in plaques. To address these challenges, we developed an optical probe, HD-APN, for in vivo imaging of aminopeptidases, providing a potential implementation in cardiovascular disease. Our work demonstrated the applicability of HD-APN for specific monitoring of aminopeptidase levels in plaques and serum, shedding light on its potential for further research in cardiovascular disease.

Dual-Activated Photoacoustic Probe for Reliably Detecting Hydroxyl Radical in Ischemic Cardiovascular Disease in Mouse and Human Samples

Cardiovascular disease (CVD) is a chronic disease characterized by the accumulation of lipids and fibrous tissue within the arterial walls, potentially leading to vascular obstruction and an increased risk of heart disease and stroke. Hydroxyl radicals play a significant role in the formation and progression of CVD as they can instigate lipid peroxidation, resulting in cellular damage and inflammatory responses. However, precisely detecting hydroxyl radicals in CVD lesions presents significant challenges due to their high reactivity and short lifespan. Herein, we present the development and application of a novel activatable optical probe, Cy-OH-LP, designed to detect hydroxyl radicals in lipid-rich environments specifically. Built on the Cy7 molecular skeleton, Cy-OH-LP exhibits near-infrared absorption and fluorescence characteristics, and its specific response to hydroxyl radicals enables a turn-on signal in both photoacoustic and fluorescence spectra. The probe demonstrated excellent selectivity and stability in various tests. Furthermore, Cy-OH-LP was successfully applied in an in vivo model to detect hydroxyl radicals in mouse models, providing a potential tool for diagnosing and monitoring AS. The biosafety of Cy-OH-LP was also verified, showing low cytotoxicity and no significant organ damage in mice. The findings suggest that Cy-OH-LP is a promising tool for the specific detection of hydroxyl radicals in lipid-rich environments, providing new possibilities for research and clinical applications in the field of oxidative stress-related diseases.

Activatable Photoacoustic/Near-Infrared Probes for the Detection of Copper Ions of Cardiovascular Disease In Vivo and in Urine

Copper ions, implicated in processes such as oxidative stress and inflammation, are believed to play a crucial role in cardiovascular disease, a prevalent and deadly disease. Despite this, current diagnostic methods fail to detect early stage cardiovascular disease or track copper ion accumulation, limiting our understanding of the disease's progression. Therefore, the development of noninvasive techniques to image copper ions in cardiovascular disease is urgently needed to enhance diagnostic precision and therapeutic strategies. In this study, we report the successful synthesis and application of a copper ion-activated photoacoustic probe, CS-Cu, which exhibits high sensitivity and selectivity toward copper ions both in vitro and in vivo. CS-Cu was able to noninvasively monitor the changes in copper ion levels and differentiate between different mice based on copper ions in urine. Furthermore, the probe demonstrated good photoacoustic stability and exhibited no significant toxicity in the mice. These findings suggest that CS-Cu could be a promising tool for early detection and monitoring of Cu2+ levels in vivo and urine, providing a new perspective on the role of copper ions in cardiovascular disease.

The Effect of Statins on Carotid Intima-Media Thickness and C-Reactive Protein in Type 2 Diabetes Mellitus: A Meta-Analysis

BACKGROUND

The effect of statins on CIMT progression and C-reactive protein (CRP) in T2DM patients is widely reported. However, some studies demonstrated no effect of statins on CIMT and CRP in T2DM patients, while others reported otherwise. Thus, the current study comprehensively and quantitatively analyzes data from previous studies to evaluate the overall effect of statins on CIMT and CRP in T2DM to rule out any inconsistencies observed in previous clinical evidence. Therefore, the aim of this meta-oanalysis was to evaluate the effect of statins on CIMT progression and CRP in T2DM.

METHODS

A comprehensive search for studies was performed using PubMed, Scopus, Web of Sciences, and the Cochrane Library, for publications from their inception to 16 July 2024. The meta-analysis was conducted using Jamovi (version 4.2.8) and Review Manager (version 5.4), with the overall effect sizes reported as standardized mean differences (SMD) and 95% confidence intervals (CI).

RESULTS

Evidence from eleven studies (fifteen statin dosages) that met the inclusion criteria with a sample size of 983 T2DM patients on statin treatment was analyzed. The overall effect size from the random effect model meta-analysis showed a reduction in the CIMT status amongst T2DM patients post-statin treatment compared to at baseline [SMD = -0.47, 95%CI (-0.76, -0.18), p = 0.001]. Furthermore, there was a reduction in the level of CRP in T2DM patients post-treatment [SMD = -1.80, 95% CI (-2.76, -0.84), p < 0.001].

CONCLUSIONS

Evidence gathered in this study suggests that statin therapy effectively reduces CIMT and CRP levels among patients living with T2DM. Interestingly, this evidence suggests that 20 mg of atorvastatin is more effective in reducing CIMT and CRP. Therefore, we recommend conducting further trials with larger sample sizes and proper methodology for T2DM.

Advancements in molecular disassembly of optical probes: a paradigm shift in sensing, bioimaging, and therapeutics

The majority of self-assembled fluorescent dyes suffer from aggregation-caused quenching (ACQ), which detrimentally affects their diagnostic and therapeutic effectiveness. While aggregation-induced emission (AIE) active dyes offer a promising solution to overcome this limitation, they may face significant challenges as the intracellular environment often prevents aggregation, leading to disassembly and posing challenges for AIE fluorogens. Recent progress in signal amplification through the disassembly of ACQ dyes has opened new avenues for creating ultrasensitive optical sensors and enhancing phototherapeutic outcomes. These advances are well-aligned with cutting-edge technologies such as single-molecule microscopy and targeted molecular therapies. This work explores the concept of disaggregation-induced emission (DIE), showcasing the revolutionary capabilities of DIE-based dyes from their design to their application in sensing, bioimaging, disease monitoring, and treatment in both cellular and animal models. Our objective is to provide an in-depth comparison of aggregation versus disaggregation mechanisms, aiming to stimulate further advancements in the design and utilization of ACQ fluorescent dyes through DIE technology. This initiative is poised to catalyze scientific progress across a broad spectrum of disciplines.

Rosuvastatin-Based Lipid-Lowering Therapy for the Control of LDL Cholesterol in Patients at High Vascular Risk

Vascular diseases are the leading cause of death in Spain. Hypercholesterolemia is not only a cardiovascular risk factor, but also underlies the etiopathogenesis of atherosclerosis. Therefore, reducing LDL cholesterol (LDL-C) to the goals recommended by clinical practice guidelines, is essential to decrease the risk of vascular complications. Despite this, current LDL-C control is scarce, even in subjects with high and very high risk. This is mainly due to an insufficient intensification of lipid-lowering treatment. In this context, it is essential to prescribe the appropriate therapy, adjusted to patient's needs based on their LDL-C and their vascular risk. Rosuvastatin, alone or in combination with ezetimibe, provides intensive LDL-C reductions (up to 50-55% and 60-75%, respectively), with a low risk of side effects and in an efficient manner, in patients both without and with established atherosclerotic vascular disease.

Ethnic Differences in Carotid Intima-Media Thickness and Plaque Presence: The HELIUS Study

INTRODUCTION

In the Netherlands, the prevalence of cardiovascular diseases (CVDs) is higher among South-Asian Surinamese and lower among Moroccans compared to the Dutch. Traditional risk factors for atherosclerotic CVD do not fully explain these disparities. We aimed to assess ethnic differences in plaque presence and carotid intima-media thickness (cIMT) and explore to what extent these differences are explained by traditional risk factors.

METHODS

We used cross-sectional data from a subgroup of participants enrolled in the multi-ethnic population-based Healthy Life in an Urban Setting (HELIUS) study who underwent carotid ultrasonography. Logistic and linear regression models were built to assess ethnic differences in plaque presence and cIMT with the Dutch population as reference. Additional models were created to adjust for socioeconomic status, body height, and cardiovascular risk factors.

RESULTS

Of the 3,022 participants, 1,183, 1,051, and 790 individuals were of Dutch, South-Asian Surinamese, and Moroccan descent, respectively. Mean age was 60.9 years (SD: 8.0), and 52.8% were female. Compared to the Dutch, we found lower odds for plaque presence in Moroccans (0.77, 95% CI: 0.62; 0.95) and no significant differences between the South-Asian Surinamese and Dutch population (0.91, 95% CI: 0.76; 1.10). After adjustment for CVD risk factors, we found a lower plaque presence in South-Asian Surinamese (0.63, 95% CI: 0.48; 0.82). In both Moroccan and South-Asian Surinamese individuals, adjustment for socioeconomic status did not materially change the results. cIMT was lower in South-Asian Surinamese compared to the Dutch (-17.9 μm, 95% CI: -27.9; -7.9) and partly explained by ethnic differences in the body height as South-Asian Surinamese individuals were, on average, shorter than the Dutch population. No differences in cIMT between Moroccans and Dutch were found.

CONCLUSIONS

cIMT and plaque prevalence differ between ethnic groups independent of CVD risk. Lower plaque prevalence in Moroccans was partly attributable to a lower prevalence of traditional CVD risk factors, while body height was an important contributor to differences in cIMT in South Asians. This study emphasizes the need for ethnic-specific cut-off values for plaque presence and cIMT.

Landscape of Statin as a Cornerstone in Atherosclerotic Cardiovascular Disease

Atherosclerosis, the key pathogenesis of cardiovascular disease, is a leading cause of death and disability worldwide. Statins are first-line lipid-lowering drugs, which have been demonstrated to be powerful agents for anti-atherosclerosis. Numerous studies have confirmed the cardiovascular benefits and long-term safety of statins in a wide range of patients. Statins play an indispensable and irreplaceable part in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). In this article, we summarize the evolution of statins and their role in the treatment of cholesterol. The anti-atherosclerotic mechanism of statins, its efficacy, safety and clinical outcomes in secondary and primary prevention of ACSVD in different patient populations, the combination treatment effects, and guideline recommendations are also detailed. This paper highlights the profound significance of statins as the most successful anti-atherogenic drug in the cardiovascular field.

Rational Design of a Double-Locked Photoacoustic Probe for Precise In Vivo Imaging of Cathepsin B in Atherosclerotic Plaques

Atherosclerotic plaque rupture is a significant cause of acute cardiovascular events such as heart attack and stroke, triggered by the decomposition of fiber caps induced by cysteine cathepsin. However, the accurate measurement of cathepsin B (CTB) activity in plaques is challenging due to the low specificity and insufficient penetration depth of available atherosclerosis-associated cathepsin fluorescent probes, hampering reliable assessment of plaque vulnerability. To address these limitations, we added both lipophilic alkyl chain and hydrophilic CTB substrate to the hemicyanine scaffold to develop a lipid-unlocked CTB responsive probe (L-CRP) that uses lipids and CTB as two keys to unlock photoacoustic (PA) signals for measuring CTB activity in lipophilic environments. Such properties allow L-CRP for the reliable imaging of specific CTB activities in foam cells and atherosclerotic plaques while keeping in silence toward CTB in lipid-deficient environments, such as M1-type macrophages and LPS-induced inflammatory lesions. Moreover, the activatable PA signals of L-CRP exhibit a deeper tissue penetration ability (>1.0 cm) than current CTB probes based on near-infrared fluorescent imaging (∼0.3 cm), suitable for atherosclerosis imaging in living mice. In atherosclerotic mice, L-CRP dynamically reports intraplaque CTB levels, which is well-correlated with the plaque vulnerability characteristics such as fiber cap thickness, macrophage recruitment, and necrotic core size, thus enabling risk stratification of atherosclerotic mice complicated with pneumonia. Moreover, L-CRP successfully identifies atherosclerotic plaques in excised human artery tissues, promising for auxiliary diagnosis of plaque vulnerability in clinical application.

Pharmacological interventions for asymptomatic carotid stenosis

BACKGROUND

Carotid artery stenosis is narrowing of the carotid arteries. Asymptomatic carotid stenosis is when this narrowing occurs in people without a history or symptoms of this disease. It is caused by atherosclerosis; that is, the build-up of fats, cholesterol, and other substances in and on the artery walls. Atherosclerosis is more likely to occur in people with several risk factors, such as diabetes, hypertension, hyperlipidaemia, and smoking. As this damage can develop without symptoms, the first symptom can be a fatal or disabling stroke, known as ischaemic stroke. Carotid stenosis leading to ischaemic stroke is most common in men older than 70 years. Ischaemic stroke is a worldwide public health problem.

OBJECTIVES

To assess the effects of pharmacological interventions for the treatment of asymptomatic carotid stenosis in preventing neurological impairment, ipsilateral major or disabling stroke, death, major bleeding, and other outcomes.

SEARCH METHODS

We searched the Cochrane Stroke Group trials register, CENTRAL, MEDLINE, Embase, two other databases, and three trials registers from their inception to 9 August 2022. We also checked the reference lists of any relevant systematic reviews identified and contacted specialists in the field for additional references to trials.

SELECTION CRITERIA

We included all randomised controlled trials (RCTs), irrespective of publication status and language, comparing a pharmacological intervention to placebo, no treatment, or another pharmacological intervention for asymptomatic carotid stenosis.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodological procedures. Two review authors independently extracted the data and assessed the risk of bias of the trials. A third author resolved disagreements when necessary. We assessed the evidence certainty for key outcomes using GRADE.

MAIN RESULTS

We included 34 RCTs with 11,571 participants. Data for meta-analysis were available from only 22 studies with 6887 participants. The mean follow-up period was 2.5 years. None of the 34 included studies assessed neurological impairment and quality of life. Antiplatelet agent (acetylsalicylic acid) versus placebo Acetylsalicylic acid (1 study, 372 participants) may result in little to no difference in ipsilateral major or disabling stroke (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.47 to 2.47), stroke-related mortality (RR 1.40, 95% CI 0.54 to 3.59), progression of carotid stenosis (RR 1.16, 95% CI 0.79 to 1.71), and adverse events (RR 0.81, 95% CI 0.41 to 1.59), compared to placebo (all low-certainty evidence). The effect of acetylsalicylic acid on major bleeding is very uncertain (RR 0.98, 95% CI 0.06 to 15.53; very low-certainty evidence). The study did not measure neurological impairment or quality of life. Antihypertensive agents (metoprolol and chlorthalidone) versus placebo The antihypertensive agent, metoprolol, may result in no difference in ipsilateral major or disabling stroke (RR 0.14, 95% CI 0.02 to1.16; 1 study, 793 participants) and stroke-related mortality (RR 0.57, 95% CI 0.17 to 1.94; 1 study, 793 participants) compared to placebo (both low-certainty evidence). However, chlorthalidone may slow the progression of carotid stenosis (RR 0.45, 95% CI 0.23 to 0.91; 1 study, 129 participants; low-certainty evidence) compared to placebo. Neither study measured neurological impairment, major bleeding, adverse events, or quality of life. Anticoagulant agent (warfarin) versus placebo The evidence is very uncertain about the effects of warfarin (1 study, 919 participants) on major bleeding (RR 1.19, 95% CI 0.97 to 1.46; very low-certainty evidence), but it may reduce adverse events (RR 0.89, 95% CI 0.81 to 0.99; low-certainty evidence) compared to placebo. The study did not measure neurological impairment, ipsilateral major or disabling stroke, stroke-related mortality, progression of carotid stenosis, or quality of life. Lipid-lowering agents (atorvastatin, fluvastatin, lovastatin, pravastatin, probucol, and rosuvastatin) versus placebo or no treatment Lipid-lowering agents may result in little to no difference in ipsilateral major or disabling stroke (atorvastatin, lovastatin, pravastatin, and rosuvastatin; RR 0.36, 95% CI 0.09 to 1.53; 5 studies, 2235 participants) stroke-related mortality (lovastatin and pravastatin; RR 0.25, 95% CI 0.03 to 2.29; 2 studies, 1366 participants), and adverse events (fluvastatin, lovastatin, pravastatin, probucol, and rosuvastatin; RR 0.76, 95% CI 0.53 to1.10; 7 studies, 3726 participants) compared to placebo or no treatment (all low-certainty evidence). The studies did not measure neurological impairment, major bleeding, progression of carotid stenosis, or quality of life.

AUTHORS' CONCLUSIONS

Although there is no high-certainty evidence to support pharmacological intervention, this does not mean that pharmacological treatments are ineffective in preventing ischaemic cerebral events, morbidity, and mortality. High-quality RCTs are needed to better inform the best medical treatment that may reduce the burden of carotid stenosis. In the interim, clinicians will have to use other sources of information.

Molecularly targeted nanomedicine enabled by inorganic nanoparticles for atherosclerosis diagnosis and treatment

Atherosclerosis, a chronic cardiovascular disease caused by plaque development in arteries, remains a leading cause of morbidity and mortality. Atherosclerotic plaques are characterized by the expression and regulation of key molecules such as cell surface receptors, cytokines, and signaling pathway proteins, potentially facilitating precise diagnosis and treatment on a molecular level by specifically targeting the characteristic molecules. In this review, we highlight the recent progress in the past five years on developing molecularly targeted nanomedicine for imaging detection and treatment of atherosclerosis with the use of inorganic nanoparticles. Through targeted delivery of imaging contrast nanoparticles to specific molecules in atherogenesis, atherosclerotic plaque development at different stages could be identified and monitored via various molecular imaging modalities. We also review molecularly targeted therapeutic approaches that target and regulate molecules associated with lipid regulation, inflammation, and apoptosis. The review is concluded with discussion on current challenges and future development of nanomedicine for atherosclerotic diagnosis and treatment.