Association of high sensitive C-reactive protein with coronary heart disease: a Mendelian randomization study

Aptamers as Diagnostic and Therapeutic Agents for Aging and Age-Related Diseases

In the 21st century, the demographic shift toward an aging population has posed a significant challenge, particularly with respect to age-related diseases, which constitute a major threat to human health. Accordingly, the detection, prevention, and treatment of aging and age-related diseases have become critical issues, and the introduction of novel molecular recognition elements, called aptamers, has been considered. Aptamers, a class of oligonucleotides, can bind to target molecules with high specificity. In addition, aptamers exhibit superior stability, biocompatibility, and applicability, rendering them promising tools for the diagnosis and treatment of human diseases. In this paper, we present a comprehensive overview of aptamers, systematic evolution of ligands by exponential enrichment (SELEX), biomarkers associated with aging, as well as aptamer-based diagnostic and therapeutic platforms. Finally, the limitations associated with predicting and preventing age-related conditions are discussed, along with potential solutions based on advanced technologies and theoretical approaches.

Hs-CRP/ALB Levels Are Associated With Poor Long-term Prognosis in Patients With STEMI Undergoing Percutaneous Coronary Intervention

Research has explored the relationship between inflammatory biomarkers and cardiovascular diseases, highlighting the potential prognostic significance of the high-sensitivity C-reactive protein (hs-CRP)/albumin (ALB) ratio. However, it remains unclear whether this ratio is associated with adverse prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). This retrospective cohort study included 752 STEMI patients undergoing PCI at Tianjin Chest Hospital between January 2017 and December 2018. During a median follow-up of 52 months, 183 cases (24.0%) experienced major adverse cardiovascular events (MACE) events and 75 cases (10.0%) died. Cox regression analysis demonstrated that hs-CRP/ALB was independently associated with MACE as both a continuous (hazard ratio [HR] 1.152, 95% CI 1.097-1.210, P < .001) and categorical variable (HR 1.257, 95% CI 1.084-1.458, P = .027). Similar findings were observed for all-cause mortality (HR 1.119, 95% CI 1.058-1.183, P < .001; HR 2.228, 95% CI 1.009-4.920, P = .032). The receiver operating characteristic (ROC) curve indicated that hs-CRP/ALB levels have predictive capability for overall mortality in patients (the area under the curve [AUC] = 0.68). hs-CRP/ALB levels independently correlate with poor long-term prognosis in STEMI patients with prior PCI.

Association between inflammatory score, healthy lifestyle, and cardiovascular disease: a national cohort study

Background

The inflammation score is currently regarded as a reliable composite index for comprehensive assessment of inflammatory status. However, the relationship between inflammation score and cardiovascular disease (CVD) is unclear. Thus, we aimed to explore the association of inflammatory score with CVD, as well as to evaluate whether adhering to a healthy lifestyle could alleviate this association.

Methods

We analyzed 6,164 participants aged ≥45 years who entered a prospective cohort study of the China Longitudinal Study of Health and Retirement (CHARLS) between 2011 and 2012 and were followed up for CVD incidence untill 2018. The inflammatory score was measured by summing of the Z-scores for C-reactive protein and white blood cell count at baseline. The healthy lifestyle score was calculated by four factors, smoking status, alcohol consumption, body mass index, and sleep duration. Cox proportional hazard models were utilized to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of CVD.

Results

During the 7-year follow-up period, there were 761 incident cases of CVD. Compared with the lowest tertiles, the highest inflammatory score was associated with an elevated risk of CVD (HR = 1.25, 95% CI = 1.04-1.49). Compared to the unhealthy lifestyle, participants adhered to a healthy lifestyle was inversely associated with CVD risk (HR = 0.74, 95% CI = 0.60-0.93). Of note, when participants adhered to a healthy lifestyle, the higher inflammatory score was no longer significantly correlated with CVD risk (HR = 1.00, 95% CI = 0.76-1.34). Additionally, a multiplicative interaction was detected between inflammatory score and healthy lifestyle score for CVD risk (p interaction <0.05).

Conclusion

The inflammation score was associated with higher risk of CVD incidence, but adherence to a healthy lifestyle may mitigate the adverse association of inflammation score and CVD among the middle-aged and older participants.

Potentially causal association between immunoglobulin G N-glycans and cardiometabolic diseases: Bidirectional two-sample Mendelian randomization study

BACKGROUND

Observational studies support that altered immunoglobulin G (IgG) N-glycosylation and inflammatory factors are associated with cardiometabolic diseases (CMDs); nevertheless, the causality between them remains unclear.

METHODS

Two-sample Mendelian randomization (MR) analyses were conducted to systematically investigate the bidirectional causality between IgG N-glycans and nine CMDs in both East Asians and Europeans.

RESULTS

In the forward MR analysis, the univariable MR analysis presented suggestive causality of 14 and eight genetically instrumented IgG N-glycans with CMDs in East Asians and Europeans, respectively; the multivariable MR analysis showed that ten and 11 pairs of glycan-CMD associations were identified in East Asian and European populations, respectively. In the reverse MR analysis, based on East Asians and Europeans, the univariable MR analysis presented suggestive causality of seven and 12 genetically instrumented CMDs with IgG N-glycans, respectively; the multivariable MR analysis presented that six and five CMD-glycan causality were found in East Asian and Europeans, respectively.

CONCLUSIONS

The comprehensive MR analyses provide suggestive evidence of bidirectional causality between IgG N-glycans and CMDs. This work helps to understand the molecular mechanism of the occurrence/progression of CMDs, optimize existing and develop new strategies to prevent CMDs, and contribute to the early identification of high-risk groups of CMDs.

Association between Inflammatory Burden Index and cardiovascular disease in adult Americans: Evidence from NHANES 2005-2010

Aims

We aimed to assess the association between Inflammatory Burden Index (IBI) and cardiovascular disease (CVD) in adult Americans.

Methods

This cross-sectional investigation included people with comprehensive data on IBI and CVD from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 database. C-reactive protein (CRP) × neutrophil/lymphocyte (NLR) count was used to calculate IBI. CVD included angina pectoris, stroke, congestive heart failure (CHF), and coronary heart disease (CHD). Subgroup analysis and weighted multivariate regression were utilized to analyze the independent association between CVD and IBI.

Results

A total of 15,325 adult Americans were involved. There were 9.57 % of subjects having CVD, which was increased with increasing IBI quartiles (Tertile 1: 4.64 %; Tertile 2: 7.71 %; Tertile 3: 10.63 %; Tertile 4: 15.29 %; p < 0.001). After full adjustment, multivariate logistic regression analysis demonstrated a positive correlation between IBI level and CVD prevalence (OR = 1.43; 95 % CI, 1.16-1.76, p < 0.001). Subgroup analyses and interaction tests showed that the association between IBI and the prevalence of CVD was not affected by sex, age, body mass index, race, hypertension, and diabetes mellitus.

Conclusions

In adult Americans, There is an association between IBI levels and the prevalence of CVD. More large-scale future research is required to assess the effect of IBI on CVD.

The variations in health cost based on the traditional obesity parameters among patients with coronary artery diseases undergoing cardiac catheterization

BACKGROUND

In the literature, obesity has been correlated with coronary artery diseases (CADs) and high health costs. This study aimed to investigate the relationships between obesity parameters and the health costs among patients with CADs undergoing cardiac catheterization.

METHOD

A secondary data analysis was done for an original study. The original study was conducted among 220 hospitalized patients undergoing cardiac catheterization from two main hospitals located in the Middle and Northern regions of Jordan. Bivariate Pearson's correlation and forward linear regression analysis were calculated in this study.

RESULTS

The average health cost for the participants was 1,344 JOD (1,895.63 USD). A significant positive moderate correlation (r = 0.4) was found between hip circumference (HC) and health cost. There were significant positive weak correlations between low-density lipoprotein (LDL), triglycerides, high-sensitivity C-reactive protein (HS-CRP), hemoglobin A1c (HbA1c), and depression, and the health cost (correlation coefficient 0.17, 0.3, 0.29, 0.22 and 0.17, respectively. HC, waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), and body adiposity index (BAI) were significantly associated with health costs among male participants. In contrast, among females, none of the obesity parameters was significantly associated with health costs. The forward regression analysis illustrated that an increase of HC by 3.9 cm (β (0.292) * SD (13.4)) will increase the health cost by 1 JOD (0.71 USD). The same analysis revealed that HS-CRP increased by 0.4 mg/dl (β (0.258)*SD (1.43)), or triglycerides increased by 8.3 mg/dl (β (0.241)* SD (34.3)), or depression score increased by 0.32 score (β (0.137)* SD (2.3)), or total cholesterol increased by 4 mg/dl (β (0.163)* SD (24.7)), the health cost will increase by one JOD (0.71 USD).

CONCLUSION

Healthcare providers, including nurses, should significantly consider these factors to reduce the health costs for those at-risk patients by providing the appropriate healthcare on time.

Exploring the predictive values of CRP and lymphocytes in coronary artery disease based on a machine learning and Mendelian randomization

Purpose

To investigate the predictive value of leukocyte subsets and C-reactive protein (CRP) in coronary artery disease (CAD).

Methods

We conducted a Mendelian randomization analysis (MR) on leukocyte subsets, C-reactive protein (CRP) and CAD, incorporating data from 68,624 patients who underwent coronary angiography from 2010 to 2022. After initial screening, clinical data from 46,664 patients were analyzed. Techniques employed included propensity score matching (PSM), logistic regression, lasso regression, and random forest algorithms (RF). Risk factors were assessed, and the sensitivity and specificity of the models were evaluated using receiver operating characteristic (ROC) curves. Additionally, survival analysis was conducted based on a 36-month follow-up period.

Results

The inverse variance weight (IVW) analysis showed that basophil count (OR 0.92, 95% CI: 0.84-1.00, P = 0.048), CRP levels (OR 0.87, 95% CI: 0.73-1.00, P = 0.040), and lymphocyte count (OR 1.10, 95% CI: 1.04-1.16, P = 0.001) are significant risk factors for CAD. Using LASSO regression, logistic regression, and RF analysis, both CRP and lymphocyte counts were consistently identified as risk factors for CAD, prior to and following PSM. The ROC curve analysis indicated that the combination of lymphocyte and CRP levels after PSM achieves a higher diagnostic value (0.85). Survival analysis revealed that high lymphocyte counts and low CRP levels are associated with a decreased risk of Major Adverse Cardiovascular Events (MACE) (P < 0.001). Conversely, a higher CRP level combined with lymphocyte counts correlates with a poorer prognosis.

Conclusion

There is a causal relationship between lymphocytes, CRP and CAD. The combined assessment of CRP and lymphocytes offers diagnostic value for CAD. Furthermore, high CRP levels coupled with low lymphocyte counts are associated with a poor prognosis.

C-reactive protein (CRP) as a prognostic biomarker in patients with urothelial carcinoma: A systematic review and meta-analysis

C-reactive protein (CRP) may reflect a pro-inflammatory tumor microenvironment and could represent a biomarker to select patients with urothelial carcinoma more likely to benefit from therapies directed at modulating tumor-promoting inflammation. We performed a systematic review to evaluate survival outcomes based on pre-treatment CRP values in urothelial carcinoma. The hazard ratios (HRs) of survival such as overall survival (OS) and progression-free survival (PFS) between groups with high versus low CRP values were pooled by the random-effect model meta-analyses. Overall, 28 studies comprising 6789 patients were identified for meta-analyses. High CRP levels were associated with shorter OS (HR=1.96 [95% CI: 1.64-2.33], p < 0.01), particularly in advanced disease treated with immune checkpoint blockade (ICB, HR=1.78 [1.47-2.15], p < 0.01). Similar findings were observed in ICB-treated patients with PFS. These findings suggest that CRP could be an attractive biomarker to select patients with urothelial carcinoma for strategies seeking to modulate tumor-promoting inflammation.

C-Reactive Protein Levels and Risk of Cardiovascular Diseases: A Two-Sample Bidirectional Mendelian Randomization Study

Elevated C-reactive protein (CRP) levels are an indicator of inflammation, a major risk factor for cardiovascular disease (CVD). However, this potential association in observational studies remains inconclusive. We performed a two-sample bidirectional Mendelian randomization (MR) study using publicly available GWAS summary statistics to evaluate the relationship between CRP and CVD. Instrumental variables (IVs) were carefully selected, and multiple approaches were used to make robust conclusions. Horizontal pleiotropy and heterogeneity were evaluated using the MR-Egger intercept and Cochran's Q-test. The strength of the IVs was determined using F-statistics. The causal effect of CRP on the risk of hypertensive heart disease (HHD) was statistically significant, but we did not observe a significant causal relationship between CRP and the risk of myocardial infarction, coronary artery disease, heart failure, or atherosclerosis. Our primary analyses, after performing outlier correction using MR-PRESSO and the Multivariable MR method, revealed that IVs that increased CRP levels also increased the HHD risk. However, after excluding outlier IVs identified using PhenoScanner, the initial MR results were altered, but the sensitivity analyses remained congruent with the results from the primary analyses. We found no evidence of reverse causation between CVD and CRP. Our findings warrant updated MR studies to confirm the role of CRP as a clinical biomarker for HHD.

Acute coronary syndrome in antineutrophil cytoplasmic antibody-associated vasculitis: a Korean single-centre cohort study

Objective

This study investigated the incidence and patterns of the acute coronary syndrome (ACS) after AAV diagnosis and searched for the predictors of ACS in a single-centre cohort of Korean patients diagnosed with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).

Methods

A total of 262 patients with AAV were included in this study. ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA) were defined as ACS in this study. Only ACS that occurred during or after AAV diagnosis was counted.

Results

The incidence of ACS in patients with AAV was 2.7% (7 patients), and the most common type of ACS was NSTEMI regardless of the affected site or the number of coronary arteries. Five patients with ACS were diagnosed with microscopic polyangiitis (MPA) and all of them had myeloperoxidase (MPO)-ANCA (or perinuclear [P]-ANCA), whereas the remaining two patients were diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA). Of the seven patients, 2 patients experienced ACS within the first year after AAV diagnosis, and 2 experienced ACS 5 years after AAV diagnosis. Among clinical variables, only the male sex was a predictor of ACS during the follow-up period in patients diagnosed with AAV.

Conclusion

The incidence of ACS was 2.7%, and the most common type of ACS was NSTEMI in Korean patients with AAV.

Inflammation and kidney stones: cause and effect?

PURPOSE OF REVIEW

This short review is intended to highlight the potential role of inflammation as a key pathological driver, rather than a mere consequence, of nephrolithiasis. Although there is clearly a strong likelihood that the relationship is bidirectional, and that kidney stone-triggered inflammation can establish a vicious cycle of tissue injury and stone formation.

RECENT FINDINGS

These consist of data from both recent preclinical and clinical studies demonstrating the importance of inflammation in models of stone disease and in kidney tissue from patients with nephrolithiasis, and as a potential driver of disease recurrence and a suitable treatment target. In particular, the role of immune cells and their relationship to the NLRP3 inflammasome is becoming clearer, as well as the potential contribution to tissue injury and stone formation of the pro-inflammatory cytokines interleukin-1β and interleukin-18.

SUMMARY

This concept is not new and raises the possibility that targeting inflammation directly may prove to be a novel and suitable means of treatment for at least some types of kidney stone, and in certain clinical settings, both acutely and as prevention, especially in those patients experiencing recurrent stone episodes and/or who have a well defined metabolic cause such as uric acid or calcium oxalate stones.

Diagnostic value of peripheral blood miR-296 combined with vascular endothelial growth factor B on the degree of coronary artery stenosis in patients with coronary heart disease

OBJECTIVE

Coronary heart disease (CHD) is a disorder resulting from organic and functional coronary artery stenosis (CAS), thus causing reduced oxygenated blood in the heart. miRNAs are useful biomarkers in the diagnosis of atherosclerosis, CHD, and acute coronary syndrome. Vascular endothelial growth factor (VEGF) is closely related to CHD. This study explored the correlation of miR-296 and VEGF-B expression levels in peripheral blood with CAS degree in CHD patients.

METHODS

Totally 220 CHD patients were enrolled and classified into mild-(71 cases)/moderate-(81 cases)/severe-CAS (68 cases) groups, with another 80 healthy cases as controls. The serum miR-296 and VEGF-B expression levels were detected using reverse transcription quantitative polymerase chain reaction. The correlation between miR-296 and CAS-related indexes was assessed via Pearson analysis. The binding relationship of miR-296 and VEGF-B was first predicted and their correlation was further analyzed via the Pearson method. The clinical diagnostic efficacy of miR-296 or VEGF-B on CAS degree was evaluated by the receiver operating characteristic curve.

RESULTS

Serum miR-296 was downregulated in CHD patients and was the lowest in patients with severe-CAS. miR-296 was negatively-correlated with high-sensitivity C-reactive protein, brain natriuretic peptide, and cardiac troponin I. miR-296 targeted VEGF-B. VEGF-B was upregulated in CHD patients and inversely-related to miR-296. Low expression of miR-296 and high expression of VEGF-B both had high clinical diagnostic values on CAS degree in CHD patients. miR-296 combined with VEGF-B increased the diagnostic value on CAS.

CONCLUSION

Low expression of miR-296 combined with high expression of its target VEGF-B predicts CAS degree in CHD patients.

The association between victimization and inflammation: A meta-analysis

BACKGROUND

To meta-analyze the existing studies examining the association of childhood and adulthood victimization with inflammation and to explore the moderating variables that affect these relationships.

METHODS

Relevant work published before 28th February 2021 was identified by searching five major databases. We analyzed the cross-sectional data extracted from cross-sectional and longitudinal studies using the random-effects model to estimate the correlation (r) as the pooled effect size and further conducted subgroup analyses and sensitivity analyses.

RESULTS

A total of 37 articles finally met the inclusion criteria, including studies for C-reactive protein (CRP) (k = 23; N_CRP = 11,780), interleukin-6 (IL-6) (k = 31; N_IL-6 = 8943), and tumor necrosis factor-alpha (TNF-α) (k = 14; N_TNF-α = 4125). Overall, victimization has a significantly positive association with inflammation, with a small effect size (r = 0.122). Specifically, effect sizes were the largest for TNF-a (r = 0.152), followed by IL-6 (r = 0.119), and CRP (r = 0.084). Additionally, the effect sizes for victimization against children were r = 0.145 (k = 6) for childhood victimization - childhood inflammation, and r = 0.139 (k = 27) for childhood victimization - adulthood inflammation, which appear to be larger than that of victimization against adults (r = 0.039; k = 2).

LIMITATIONS

Only a small number of studies on adult victimization were included. In addition, we only analyzed the cross-sectional relationship and did not have sufficient data to compare different types of victimization and single vs. multiple victimizations.

CONCLUSIONS

Victimization is associated with a heightened inflammatory response. As victimization against children may have a stronger effect than victimization against adults, prevention of victimization targeting the childhood period may be necessary. Studies with more robust methodologies (i.e., representative, longitudinal, and multi-country designs) are needed to confirm these findings and to unpack the underlying mechanisms.

LDL-cholesterol control in the primary prevention of cardiovascular diseases: An expert opinion for clinicians and health professionals

AIMS

Although adequate clinical management of patients with hypercholesterolemia without a history of known cardiovascular disease is essential for prevention, these subjects are often disregarded. Furthermore, the scientific literature on primary cardiovascular prevention is not as rich as that on secondary prevention; finally, physicians often lack adequate tools for the effective management of subjects in primary prevention and have to face some unsolved relevant issues. This document aims to discuss and review the evidence available on this topic and provide practical guidance.

DATA SYNTHESIS

Available algorithms and risk charts represent the main tool for the assessment of cardiovascular risk in patients in primary prevention. The accuracy of such an estimate can be substantially improved considering the potential contribution of some additional risk factors (C-reactive protein, lipoprotein(a), family history of cardiovascular disease) and conditions (environmental pollution, sleep quality, socioeconomic status, educational level) whose impact on the cardiovascular risk has been better understood in recent years. The availability of non-invasive procedures to evaluate subclinical atherosclerosis may help to identify subjects needing an earlier intervention. Unveiling the presence of these conditions will improve cardiovascular risk estimation, granting a more appropriate intervention.

CONCLUSIONS

The accurate assessment of cardiovascular risk in subjects in primary prevention with the use of algorithms and risk charts together with the evaluation of additional factors will allow physicians to approach each patient with personalized strategies, which should translate into an increased adherence to therapy and, as a consequence, a reduced cardiovascular risk.

C-reactive protein and coronary atheroma regression following statin therapy: A meta-regression of randomized controlled trials

OBJECTIVE

Several clinical trials have indicated that statins stabilize and reverse atherosclerotic plaque. However, different studies have provided inconsistent findings regarding mechanisms and influencing factors of plaque regression under statin therapy. Apart from lipid-lowering effect, statins have pleiotropic effects including anti inflammation in humans. In this study, meta-analysis and meta-regression were used to determine the effects of statin medications on coronary plaque volume. Meanwhile, to assess whether statins promote plaque regression effect was related to their anti-inflammatory ability, the impact of CRP/hsCRP reduction during statin therapy on plaque regression was investigated.

METHODS

Up to June 15, 2022, a systematic PubMed, EMBASE, and Cochrane search was performed for randomized controlled trials that assessed treatment effect using total atheroma volume (TAV), percent atheroma volume (PAV), or plaque volume (PV). Only CRP/hsCRP and LDL-C values reported before and after treatment were considered.

RESULTS

12 studies (2,812 patients with heart and/or vascular disease) fulfilled the inclusion criteria and were included in the systematic review. A meta-analysis of 15 statin-treated arms reported a significant reduction in change of TAV/PV [standardized mean difference (SMD): -0.27, 95% confidence intervals (-CI): -0.42, -0.12, p < 0.001], compared with the control arms. Another meta-analysis of 7 trials also found that patients in the intervention group had a significant reduction in change of PAV (SMD: -0.16, 95% CI: -0.29, -0.03, p = 0.019), compared with those in the control group. Meta-regressionanalysis revealed that the percent change of CRP/hsCRP was significantly associated with SMD in change of TAV/PV after adjusting for percent change of LDL-C, age, gender and study duration. Meta-regression analysis showed that percent change of CRP/hsCRP statistically influenced SMD in change of PAV, when percent change of CRP/hsCRP was included separately. However, the percent change of CRP/hsCRP was not significantly associated with SMD of PAV change after adjusting for all covariates.

CONCLUSION

In conclusion, statin therapy is beneficial for plaque regression. Statins promote plaque regression, which might be associated to their anti-inflammatory ability.

Risk factors for early complications following arthroplasty in elderly patients with a femoral neck fracture

BACKGROUND

Early complications after arthroplasty for geriatric femoral neck fractures are known to negatively affect postoperative recovery and increase postoperative mortality. Identifying risk factors associated with early complications after arthroplasty may offer an opportunity to address and prevent these complications in many patients.

OBJECTIVE

To evaluate preoperative risk factors for early complications after arthroplasty in elderly patients with a femoral neck fracture.

METHODS

119 elderly patients with femoral neck fractures who had been treated with arthroplasty (hemiarthroplasty or total hip arthroplasty) between December 2015 and December 2018 were retrospectively analysed. Early complications were defined as any complications that did not exist preoperatively, and occurred during hospital stay after arthroplasty Preoperative clinical, epidemiological and laboratory data were collected. Binary univariable and multivariable logistic regression analysis were applied to identify predictors of early complications after arthroplasty for geriatric femoral neck fractures.

RESULTS

Median age of all patients was 80.0 (IQR 74.0-84.0) years. We identified 28 (23.5%) early complications after arthroplasty. Univariable logistic regression analysis found that preoperative body mass index (BMI p= 0.031), C-reactive protein (CRP p= 0.017) and serum Albumin (p= 0.006) were potential risk factors for early complications. Then preoperative BMI, CRP and serum Albumin were stratified and used for multivariable logistic regression analysis The multivariate logistic regression analysis showed that preoperative higher BMI (⩾ 28 kg/m2; OR 10.440; 95% CI 2.674-41.170; p= 0.001) and lower serum Albumin (⩽ 35 g/L; OR 3.933; 95% CI 1.509-10.800; p= 0.006) were independent risk factors for early complications after arthroplasty in geriatric femoral neck fractures. However, preoperative higher CRP levels (> 10 mg/L; OR 1.139; 95% CI 1034-1428; p= 0.833) was found to be not an independent risk factor for early complications.

CONCLUSION

Our results demonstrate that obesity and hypoalbuminemia are independent predictors for early complications during hospital stay after arthroplasty, which should be meticulously noted to minimize these risk factors in geriatric femoral neck fractures.

Electrochemical aptasensor based on anisotropically modified (Janus-type) gold nanoparticles for determination of C-reactive protein

Novel Janus nanoparticles based on Au colloids anisotropically modified with polyamidoamine dendrons were prepared though a masking/toposelective modification approach. These nanomaterials were further functionalized with horseradish peroxidase on the dendritic face and provided on the opposite metal surface with a ssDNA aptamer for C-reactive protein (CRP). The resulting nanoparticles were employed as biorecognition/signaling elements to construct an amperometric aptasensor with sandwich-type architecture for the specific detection of this cardiac biomarker. To do this, screen-printed carbon electrodes modified with electrodeposited Au nanoparticles and functionalized with anti-CRP aptamers were used as transduction interface. The aptasensor was employed for the amperometric detection of CRP (working potential: - 200 mV vs pseudo-Ag/AgCl) in the broad range from 10 pg·mL^-1 to 1.0 ng·mL^-1 with a detection limit of 3.1 pg·mL^-1. This electroanalytical device also showed good specificity, reproducibility (RSD = 9.8%, n = 10), and stability and was useful to quantify CRP in reconstituted human serum samples, with a RSD of 13.3%.

Study on the mechanism of Gualou Xiebai Guizhi decoction (GLXBGZD) in the treatment of coronary heart disease based on network pharmacology

BACKGROUND

This study aims to analyze the mechanism of Gualou Xiebai Guizhi decoction (GLXBGZD) in treating coronary heart disease (CHD) utilizing network pharmacology.

METHODS

The GLXBGZD effective components were searched on the pharmacological database platform of the Traditional Chinese Medicine Systems Pharmacol, and its potential target was predicted. The Online Mendelian Inheritance obtained CHD disease target in Man and GeneCards database. The Venn map of the intersection target for GLXBGZD and CHD was constructed by using Venn online website. The "drug-component-target-disease" network map was constructed by Cytoscape 3.7.2 software. The DAVID online platform was used to analyze the function of Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) at the intersection of targets of drugs and diseases.

RESULTS

A total of 27 articles were searched for GLXBGZD, including 111 potential targets, 5521 disease targets, 100 drug and disease intersection targets. The core target network map shows that Interleukin (IL)-6, TNF, vascular endothelial growth factor (VEGFA), TP53, EGF, JUN, MAPK1, Catalase (CAT), and prostaglandin-endoperoxide synthase 2 (PTGS2) may be the key targets in CHD therapy. GO functional enrichment analysis revealed that the biological functions of GLXBGZD involved biological processes such as response to drugs, positive regulation of nitric oxide biosynthesis process, and response to hypoxia. KEGG pathway enrichment analysis showed that GLXBGZD might participate in CHD treatment through Hypoxia-inducible factor-1 (HIF-1), Tumor necrosis factor (TNF), PhosphoInositide-3 Kinase--Threonine protein kinase (PI3K-Akt), and the calcium signal pathway.

CONCLUSIONS

This study reveals that the GLXBGZD mechanism in CHD treatment has the characteristics of multi-components, multi-targets, and multi-pathways, which provides a theoretical basis for its clinical application and subsequent experimental verification.

The role of inflammation and the possibilities of inflammation reduction to prevent cardiovascular events

Chronic systemic inflammation is a risk factor for cardiovascular (CV) disease (CVD). Whether this relationship extends to subclinical inflammation, quantified by values of circulating markers associated with inflammation in the high range of the normal interval, remains debatable. This narrative review evaluates evidence exploring this relationship. A review of pharmacological and non-pharmacological interventions, including diet and lifestyle strategies, supplements, nutraceuticals, and other natural substances aimed at reducing inflammation was also conducted, since few reviews have synthesized this literature. PubMed and EMBASE were used to search the literature and several well-studied triggers of inflammation [oxidized LDL, Lp(a), as well as C-reactive protein (CRP)/high-sensitivity CRP (hs-CRP)] were included to increase sensitivity and address the lack of existing reviews summarizing their influence in the context of inflammation. All resulting references were assessed. Overall, there is good data supporting associations between circulating hs-CRP and CV outcomes. However, the same was not seen in studies evaluating triggers of inflammation, such as oxidized LDL or Lp(a). There is also insufficient evidence showing treatments to target inflammation and lead to reductions in hs-CRP result in improvements in CV outcomes, particularly in those with normal baseline levels of hs-CRP. Regarding pharmacological interventions, statins, bempedoic acid, and apabetalone significantly reduce circulating hs-CRP, unlike PCSK-9 inhibitors. A variety of natural substances and vitamins were also evaluated and none reduced hs-CRP. Regarding non-pharmacological interventions, weight loss was strongly associated with reductions in circulating hs-CRP, whereas various dietary interventions and exercise regimens were not, unless accompanied by weight loss.

Circulating Myeloperoxidase (MPO)-DNA complexes as marker for Neutrophil Extracellular Traps (NETs) levels and the association with cardiovascular risk factors in the general population

Introduction

Neutrophil extracellular traps (NETs) are DNA scaffolds enriched with antimicrobial proteins. NETs have been implicated in the development of various diseases, such as cardiovascular disease. Here, we investigate the association of demographic and cardiovascular (CVD) risk factors with NETs in the general population.

Material and methods

Citrated plasma was collected from 6449 participants, aged ≥55 years, as part of the prospective population-based Rotterdam Study. NETs were quantified by measuring MPO-DNA complex using an ELISA. We used linear regression to determine the associations between MPO-DNA complex and age, sex, cardio-metabolic risk factors, and plasma markers of inflammation and coagulation.

Results

MPO-DNA complex levels were weakly associated with age (log difference per 10 year increase: -0.04 mAU/mL, 95% confidence interval [CI] -0.06;-0.02), a history of coronary heart disease (yes versus no: -0.10 mAU/mL, 95% CI -0.17;-0.03), the use of lipid-lowering drugs (yes versus no: -0.06 mAU/mL, 95% CI -0.12;-0.01), and HDL-cholesterol (per mmol/l increase: -0.07 mAU/mL/, 95% CI -0.12;-0.03).

Conclusions

Older age, a history of coronary heart disease, the use of lipid-lowering drugs and higher HDL-cholesterol are weakly correlated with lower plasma levels of NETs. These findings show that the effect of CVD risk factors on NETs levels in a general population is only small and may not be of clinical relevance. This supports that NETs may play a more important role in an acute phase of disease than in a steady state situation.

Long-term Trajectories of C-Reactive Protein Among Men Living With and Without HIV Infection in the Multicenter AIDS Cohort Study

BACKGROUND

C-reactive protein (CRP) is an inflammatory biomarker associated with all-cause mortality and morbidities such as cardiovascular disease. CRP is increased with HIV infection and thought to increase with age, though trajectories of CRP with aging have not been well characterized. We investigated trajectories of CRP in men from the Multicenter AIDS Cohort Study, according to HIV infection and HIV viral load status.

METHODS

CRP measurements from 12 250 serum samples, provided by 2132 men over a span of 30 years, were categorized by HIV status at sample collection: HIV uninfected (HIV-, n = 1717), HIV infected with undetectable RNA (HIV+ suppressed, n = 4075), and detectable HIV RNA (HIV+ detectable, n = 6458). Age-related trajectories of CRP were fit to multivariable linear mixed models; we tested for differences in trajectories by HIV status.

RESULTS

CRP increased with age in all sample groups. HIV+ detectable and HIV+ suppressed samples had higher CRP than HIV- samples throughout the observed age range of 20-70 years (p < .05). CRP concentrations at age 45 years were 38% (95% CI: 26%-50%) and 26% (15%-38%) higher in HIV+ detectable and HIV+ suppressed samples, respectively, relative to HIV- samples. HIV+ detectable samples showed more rapid linear increases with age (8% higher/decade, 0.3%-16%) than HIV- samples.

CONCLUSIONS

We observed higher concentrations of CRP across 5 decades of age in men living with HIV, and steeper increases with age in men with detectable HIV RNA, relative to HIV- men. These results are consistent with a contribution of inflammation to the higher risk of age-related comorbidities with HIV infection.

Clinical biomarkers and associations with healthspan and lifespan: Evidence from observational and genetic data

Background

Biomarker-disease relationships are extensively investigated. However, associations between common clinical biomarkers and healthspan, the disease-free lifespan, are largely unknown. We aimed to explore the predictive values of ten biomarkers on healthspan and lifespan, and to identify putative causal mechanisms.

Methods

Using data from 12,098 Swedish individuals aged 47–94 years, we examined both serum concentrations and genetically predicted levels of ten glycemic, lipid-, inflammatory, and hematological biomarkers. During a follow-up period of up to 16 years, 3681 incident cases of any chronic disease (i.e., end of healthspan) and 2674 deaths (i.e., end of lifespan) were documented. Cox regression models were applied to estimate the associations of a one standard deviation increase in biomarkers with healthspan and lifespan.

Findings

Seven out of ten serum biomarkers were significantly associated with risks of any chronic disease and death; elevated glycemic biomarkers and high-density lipoprotein-related biomarkers showed the strongest detrimental (hazard ratio [HR] 1·29 [95% CI 1·24–1·34]) and protective effects (HR 0·92 [95% CI 0·89–0·96]), respectively. Genetic predisposition to elevated fasting blood glucose (FBG) was associated with increased risks of any chronic disease (HR 1·05 [95% CI 1·02–1·09]); genetically determined higher C-reactive protein correlated with lower death risks (HR 0·91 [95% CI 0·87–0·95]). Notably, the genetically proxied FBG-healthspan association was largely explained by serum FBG concentration.

Interpretation

Circulating concentrations of glycemic, lipid-, and inflammatory biomarkers are predictive of healthspan and lifespan. Glucose control is a putative causal mechanism and a potential intervention target for healthspan maintenance.

Funding

This study was supported by the Swedish Research Council (2015–03,255, 2018–02,077), FORTE (2013–2292), the Loo & Hans Osterman Foundation, the Foundation for Geriatric Diseases, the Magnus Bergwall Foundation, the Strategic Research Program in Epidemiology at Karolinska Institutet (SH, JJ), the China Scholarship Council, and the Swedish National Graduate School for Competitive Science on Ageing and Health. The Swedish Twin Registry is managed by Karolinska Institutet and receives funding as an infrastructure through the Swedish Research Council, 2017–00,641.

The association between bacterial infections and the risk of coronary heart disease in type 1 diabetes

BACKGROUND

Diabetes increases the risk of infections and coronary heart disease (CHD). Whether infections increase the risk of CHD and how this applies to individuals with diabetes is unclear.

OBJECTIVES

To investigate the association between bacterial infections and the risk of CHD in type 1 diabetes.

METHODS

Individuals with type 1 diabetes (n = 3781) were recruited from the Finnish Diabetic Nephropathy Study (FinnDiane), a prospective follow-up study. CHD was defined as incident events: fatal or nonfatal myocardial infarction, coronary artery bypass surgery or percutaneous coronary intervention, identified through national hospital discharge register data. Infections were identified through national register data on all antibiotic purchases from outpatient care. Register data were available from 1 January 1995 to 31 December 2015. Bacterial lipopolysaccharide (LPS) activity was measured from serum samples at baseline. Data on traditional risk factors for CHD were collected during baseline and consecutive visits.

RESULTS

Individuals with an incident CHD event (n = 370) had a higher mean number of antibiotic purchases per follow-up year compared to those without incident CHD (1.34 [95% CI: 1.16-1.52], versus 0.79 [0.76-0.82], P < 0.001), as well as higher levels of LPS activity (0.64 [0.60-0.67], versus 0.58 EU mL^-1 [0.57-0.59], P < 0.001). In multivariable-adjusted Cox proportional hazards models, the mean number of antibiotic purchases per follow-up year was an independent risk factor for incident CHD (HR 1.21, 95% CI: 1.14-1.29, P < 0.0001). High LPS activity was a risk factor for incident CHD (HR 1.93 [1.34-2.78], P < 0.001) after adjusting for static confounders.

CONCLUSION

Bacterial infections are associated with an increased risk of incident CHD in individuals with type 1 diabetes.

Noncoding RNAs versus Protein Biomarkers in Cardiovascular Disease

The development of more sensitive protein biomarker assays results in continuous improvements in detectability, extending the range of clinical applications to the detection of subclinical cardiovascular disease (CVD). However, these efforts have not yet led to improvements in risk assessment compared with existing risk scores. Noncoding RNAs (ncRNAs) have been assessed as biomarkers, and miRNAs have attracted most attention. More recently, other ncRNA classes have been identified, including long noncoding RNAs (lncRNAs) and circular RNAs (circRNAs). Here, we compare emerging ncRNA biomarkers in the cardiovascular field with protein biomarkers for their potential in clinical application, focusing on myocardial injury.