Association of heart rate with cardiovascular events and mortality in hypertensive and normotensive population: a nationwide prospective cohort study

Multiple targets directed screening of compounds from northeastern Brazilian fruits with activity in oxidative stress pathways associated with vascular damage throughout ageing

Advancing age is a predominant risk factor for several important human pathologies, including cardiovascular diseases. The fruits Anacardium occidentale L., Spondias mombin Linn., Mangifera indica L., Malpighia emarginata DC., and Carica papaya L. are rich in compounds with antioxidant, anti-inflammatory, and anti-senescent functions. Several enzymatic pathways are involved in these diseases, such as the COX-2, iNOS, NADPH oxidase-1, and NRF2. Through a cheminformatics study by virtual screening, we aimed to investigate compounds found in the scientific literature as constituents of these five fruits on the pathways described above. We found 48 potentially active compounds with multitarget for 2 or more enzymes. The alpha terpineol was the most stable compound in relation to molecular dynamics simulation analyses. It is concluded that the compounds studied promote the activation of NRF2 and the inhibition of NOX-1, iNOS, and COX-2 pathways, especially those related to the involvement of the NRF2-Maf-G complex.

Impact of resting heart rate and predicted cardiovascular risk on mortality in nearly 110,000 Chinese adults

BACKGROUND

The association of mortality with resting heart rate (RHR) and predicted risk of incident cardiovascular disease (CVD) has not been comprehensively elucidated.

OBJECTIVE

The purpose of this study was to evaluate the individual and combined impacts of RHR and predicted CVD risk on mortality among Chinese adults.

METHODS

A total of 108,257 Chinese adults underwent follow-up during 1992 to 2015. The Cox proportional hazards model was used to assess the hazard ratio (HR) and 95% confidence interval (CI) of mortality associated with RHR and the predicted risk of incident CVD.

RESULTS

During an average of 8.53 years of follow-up, we identified 6267 nonaccidental deaths, including 2324 CVD deaths. High-RHR participants had higher HRs of nonaccidental (HR 1.58; 95% CI 1.47-1.70), CVD (HR 1.71; 95% CI 1.53-1.92), and non-CVD mortality (HR 1.50; 95% CI 1.37-1.64) than low-RHR participants. Compared to individuals with low CVD risk, those with high CVD risk demonstrated HRs of 1.67 (95% CI 1.51-1.83) and 3.90 (95% CI 3.29-4.61) for nonaccidental and CVD mortality, respectively. Mortality risk gradually increased with elevation of CVD risk and RHR, showing the greatest HRs of nonaccidental (HR 2.57; 95% CI 2.24-2.94) and CVD mortality (HR 7.16; 95% CI 5.52-9.29) among participants with both high CVD risk and high RHR.

CONCLUSION

Our findings demonstrated that RHR and CVD risk are independently associated with mortality, and integrating them potentially could refine risk stratification of mortality. The study highlighted their important role in personalized strategies for primordial and primary prevention.

Poor clinical outcome despite successful recanalisation in patients with acute myocardial infarction undergoing direct percutaneous coronary intervention: a retrospective cohort study

BACKGROUND

ST-segment elevation myocardial infarction (STEMI) remains a major cause of morbidity and mortality. Primary percutaneous coronary intervention (PPCI) is the preferred treatment, yet some patients experience major adverse cardiac events (MACE) within a year despite successful recanalisation. Identifying predictors of futile recanalisation-defined as achieving thrombolysis in myocardial infarction grade III flow after PPCI but still developing MACE-is essential for improving outcomes.

RESEARCH DESIGN AND METHODS

This single-centre, retrospective study included patients with STEMI treated with PPCI from January 2019 to January 2023. The primary outcome was futile recanalisation. Least absolute shrinkage and selection operator (LASSO) regression and logistic regression were used to identify independent predictors of futile recanalisation.

RESULTS

Of the 489 consecutive patients who achieved successful recanalisation, 20.9% met the criteria for futile recanalisation within 1 year. Multivariable analysis identified several independent predictors: heart rate at admission (OR 1.32, 95% CI 1.02 to 1.71), reduced left ventricular ejection fraction (LVEF; OR 0.30, 95% CI 0.22 to 0.41), advanced left ventricular diastolic dysfunction (OR 1.44, 95% CI 1.02 to 2.15), elevated cardiac troponin I (CTnI) levels (OR 1.42, 95% CI 1.08 to 1.90), high Selvester QRS scores (OR 1.59, 95% CI 1.20 to 2.13) and increased homocysteine (HCY) levels (OR 1.37, 95% CI 1.07 to 1.77).

CONCLUSION

Despite successful recanalisation, certain factors-high admission heart rate, low LVEF, advanced left ventricular diastolic dysfunction, elevated CTnI levels, high Selvester QRS scores, and increased HCY levels-are associated with futile recanalisation in patients with STEMI. These findings highlight the need for targeted monitoring and management strategies to reduce long-term MACE risks in this population.

Cardiometabolic Aspects of Congenital Adrenal Hyperplasia

Treatment of classic congenital adrenal hyperplasia (CAH) is directed at replacing deficient hormones and reducing androgen excess. However, even in the era of early diagnosis and lifelong hormonal substitution, the presence of CAH is still associated with numerous complications and also with increased mortality. The aim of this article was to create an authoritative and balanced review concerning cardiometabolic risk in patients with CAH. The authors searched all major databases and scanned reference lists of all potentially eligible articles to find relevant articles. The risk was compared with that in other forms of adrenal insufficiency. The reviewed articles, most of which were published recently, provided conflicting results, which can be partially explained by differences in the inclusion criteria and treatment, small sample sizes, and gene-environment interactions. However, many studies showed that the presence of CAH is associated with an increased risk of weight gain, worsening of insulin sensitivity, high blood pressure, endothelial dysfunction, early atherosclerotic changes in the vascular wall, and left ventricular diastolic dysfunction. These complications were more consistently reported in patients with classic than nonclassic CAH and were in part related to hormonal and functional abnormalities associated with this disorder and/or to the impact of overtreatment and undertreatment. An analysis of available studies suggests that individuals with classic CAH are at increased cardiometabolic risk. Excess cardiovascular and metabolic morbidity is likely multifactorial, related to glucocorticoid overtreatment, imperfect adrenal hormone replacement therapy, androgen excess, and adrenomedullary failure. Cardiometabolic effects of new therapeutic approaches require future targeted studies.

The Intrinsic Cardiac Nervous System: From Pathophysiology to Therapeutic Implications

The cardiac autonomic nervous system (CANS) plays a pivotal role in cardiac homeostasis as well as in cardiac pathology. The first level of cardiac autonomic control, the intrinsic cardiac nervous system (ICNS), is located within the epicardial fat pads and is physically organized in ganglionated plexi (GPs). The ICNS system does not only contain parasympathetic cardiac efferent neurons, as long believed, but also afferent neurons and local circuit neurons. Thanks to its high degree of connectivity, combined with neuronal plasticity and memory capacity, the ICNS allows for a beat-to-beat control of all cardiac functions and responses as well as integration with extracardiac and higher centers for longer-term cardiovascular reflexes. The present review provides a detailed overview of the current knowledge of the bidirectional connection between the ICNS and the most studied cardiac pathologies/conditions (myocardial infarction, heart failure, arrhythmias and heart transplant) and the potential therapeutic implications. Indeed, GP modulation with efferent activity inhibition, differently achieved, has been studied for atrial fibrillation and functional bradyarrhythmias, while GP modulation with efferent activity stimulation has been evaluated for myocardial infarction, heart failure and ventricular arrhythmias. Electrical therapy has the unique potential to allow for both kinds of ICNS modulation while preserving the anatomical integrity of the system.

Associations of dietary copper intake with cardiovascular disease and mortality: findings from the Chinese Perspective Urban and Rural Epidemiology (PURE-China) Study

BACKGROUND

Previous in vitro and animal experiments have shown that copper plays an important role in cardiovascular health. Dietary copper is the main source of copper in the human body and the association between dietary copper and cardiovascular disease remains unclear. Our study aimed to investigate the associations of dietary copper intake with the risk of major cardiovascular disease incidence, cardiovascular disease mortality, and all-cause mortality in Chinese adults.

METHODS

Our study is based on Prospective Urban Rural Epidemiology China (PURE-China), a large prospective cohort study of 47 931 individuals aged 35-70 years from 12 provinces in China. Dietary intake was recorded using a validated semi-quantitative food frequency questionnaire designed specifically for the Chinese population. The daily intake of copper was obtained by multiplying the daily food intake with the nutrient content provided in the Chinese Food Composition Table (2002). Cox frailty proportional hazards models were developed to evaluate the association between dietary copper intake with mortality, major cardiovascular disease events, and their composite.

RESULTS

A total of 45 101 participants (mean age: 51.1 ± 9.7 years old) with complete information were included in the current study. The mean dietary copper intake was 2.6 ± 1.1 mg/d. During the 482 833 person-years of follow-up, 2 644(5.9%) participants died, 4 012(8.9%) developed new cardiovascular diseases, and 5 608(12.4%) participants experienced the composite endpoint. Compared with those in the first and second quartile of dietary copper intake, individuals in the third and fourth quantile had higher risk of composite outcomes, all-cause death, cardiovascular disease death, major cardiovascular disease and stroke occurrences. The associations remained similar in the subgroup and sensitivity analyses.

CONCLUSIONS

Our findings demonstrated that excessive dietary copper intake was associated with higher risks of death and cardiovascular diseases in Chinese adults. Further studies in populations with different dietary characteristics are needed to obtain dose-response relationships and to refine global dietary recommendations.

Association of cumulative resting heart rate exposure with rapid renal function decline: a prospective cohort study with 27,564 older adults

OBJECTIVE

To evaluate the prospective association between cumulative resting heart rate (cumRHR) and rapid renal function decline (RRFD) in a cohort of individuals aged 60 and older.

METHODS

In the Tianjin Chronic Kidney Disease Cohort Study, the individuals who underwent three consecutive physical examinations between 2014 and 2017, with estimated glomerular filtration rate (eGFR) greater than 60 mL/min per 1.73 m2 and aged 60 years or older were enrolled. A total of 27,564 patients were prospectively followed up from January 1, 2017 to December 31, 2020. The 3-year cumRHR was calculated. The primary outcome was RRFD, defined as an annualized decline in eGFR of 5 mL/min per 1.73 m2 or greater. Logistic and restricted spline regression models and subgroup analysis were used to investigate the association of cumRHR with RRFD after adjusting for all confounders.

RESULTS

During a median follow-up of 3.2 years, a total of 4,347 (15.77%) subjects developed RRFD. In fully-adjusted models, compared with the lowest quartile of cumRHR, the odds ratio (OR) for the highest was 1.44 (1.28-1.61), P < 0.001. Furthermore, each 1-standard deviation (27.97 beats/min per year) increment in cumRHR was associated with a 17% (P < 0.001) increased risk of RRFD, with a linear positive correlation (P for non-linear = 0.803). Participants with a 3-year cumRHR ≥ 207 (beats/min) * year (equivalent to ≥ 69 beats/min per year in 3 years) were found to be at a higher risk of RRFD.

CONCLUSIONS

The cumRHR is significantly associated with a higher risk of RRFD among older adults. These results might provide an effective goal for managing and delaying the decline of renal function in the older adults.

The intracellular signaling pathways governing macrophage activation and function in human atherosclerosis

Atherosclerosis is a chronic inflammatory disease characterized by lipid accumulation and plaque formation in arterial vessel walls. Atherosclerotic plaques narrow the arterial lumen to increase the risk of heart attacks, ischemic stroke and peripheral vascular disease, which are major and worldwide health and economic burdens. Macrophage accumulation within plaques is characteristic of all stages of atherosclerosis and their presence is a potential marker of disease activity and plaque stability. Macrophages engulf lipids and modified lipoproteins to form foam cells that express pro-inflammatory and chemotactic effector molecules, stress inducing factors and reactive oxygen species. They control plaque stability and rupture through secretion of metalloproteinases and extracellular matrix degradation. Although macrophages can worsen disease by propagating inflammation, they can stabilize atherosclerotic plaques through tissue remodeling, promoting the formation of a fibrous cap, clearing apoptotic cells to prevent necrotic core formation and through vascular repair. In atherosclerosis, macrophages respond to dyslipidaemia, cytokines, dying cells, metabolic factors, lipids, physical stimuli and epigenetic factors and exhibit heterogeneity in their activation depending on the stimuli they receive. Understanding these signals and the pathways driving macrophage function within developing and established plaques and how they can be pharmacologically modulated, represents a strategy for the prevention and treatment of atherosclerosis. This review focusses on the current understanding of factors controlling macrophage heterogeneity and function in atherosclerosis. Particular attention is given to the macrophage intracellular signaling pathways and transcription factors activated by biochemical and biophysical stimuli within plaques, and how they are integrated to regulate plaque formation and stability.

Tackling Atherosclerosis via Selected Nutrition

The development and pathogenesis of atherosclerosis are significantly influenced by lifestyle, particularly nutrition. The modern level of science and technology development promote personalized nutrition as an efficient preventive measure against atherosclerosis. In this survey, the factors were revealed that contribute to the formation of an individual approach to nutrition: genetic characteristics, the state of the microbiota of the gastrointestinal tract (GIT) and environmental factors (diets, bioactive components, cardioprotectors, etc.). In the course of the work, it was found that in order to analyze the predisposition to atherosclerosis associated with nutrition, genetic features affecting the metabolism of nutrients are significant. The genetic features include the presence of single nucleotide polymorphisms (SNP) of genes and epigenetic factors. The influence of telomere length on the pathogenesis of atherosclerosis and circadian rhythms was also considered. Relatively new is the study of the relationship between chrono-nutrition and the development of metabolic diseases. That is, to obtain the relationship between nutrition and atherosclerosis, a large number of genetic markers should be considered. In this relation, the question arises: "How many genetic features need to be analyzed in order to form a personalized diet for the consumer?" Basically, companies engaged in nutrigenetic research and choosing a diet for the prevention of a number of metabolic diseases use SNP analysis of genes that accounts for lipid metabolism, vitamins, the body's antioxidant defense system, taste characteristics, etc. There is no set number of genetic markers. The main diets effective against the development of atherosclerosis were considered, and the most popular were the ketogenic, Mediterranean, and DASH-diets. The advantage of these diets is the content of foods with a low amount of carbohydrates, a high amount of vegetables, fruits and berries, as well as foods rich in antioxidants. However, due to the restrictions associated with climatic, geographical, material features, these diets are not available for a number of consumers. The way out is the use of functional products, dietary supplements. In this approach, the promising biologically active substances (BAS) that exhibit anti-atherosclerotic potential are: baicalin, resveratrol, curcumin, quercetin and other plant metabolites. Among the substances, those of animal origin are popular: squalene, coenzyme Q10, omega-3. For the prevention of atherosclerosis through personalized nutrition, it is necessary to analyze the genetic characteristics (SNP) associated with the metabolism of nutrients, to assess the state of the microbiota of the GIT. Based on the data obtained and food preferences, as well as the individual capabilities of the consumer, the optimal diet can be selected. It is topical to exclude nutrients of which their excess consumption stimulates the occurrence and pathogenesis of atherosclerosis and to enrich the diet with functional foods (FF), BAS containing the necessary anti-atherosclerotic, and stimulating microbiota of the GIT nutrients. Personalized nutrition is a topical preventive measure and there are a number of problems hindering the active use of this approach among consumers. The key factors include weak evidence of the influence of a number of genetic features, the high cost of the approach, and difficulties in the interpretation of the results. Eliminating these deficiencies will contribute to the maintenance of a healthy state of the population through nutrition.