Pathophysiology of Cardiovascular Diseases: New Insights into Molecular Mechanisms of Atherosclerosis, Arterial Hypertension, and Coronary Artery Disease

Comparison of the clinical value of inflammatory blood biomarkers in relation to disease severity and survival in chronic heart failure

BACKGROUND

Chronic heart failure (CHF) is a leading cause of hospitalization among the elderly in developed nations. CHF involves myocardial dysfunction and systemic disturbances, leading to high morbidity and mortality, particularly in the elderly. The New York Heart Association (NYHA) classification is the primary tool for stratifies severity of heart failure by patient-reported symptoms. Inflammation plays a key role in CHF progression, and identifying reliable inflammatory biomarkers is crucial for assessing disease severity and predicting outcomes.

AIMS

This study aimed to evaluate the diagnostic and predictive value of 27 different inflammatory blood biomarkers in differentiating patients with varying disease severity based on the NYHA classification and to assess their prognostic significance in CHF.

METHODS

A group of 154 CHF patients (mean age: 72.1 ± 13.5 years) was retrospectively analyzed. Inflammatory blood biomarkers were correlated with NYHA classification, left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure (PASP), NT-proBNP and patient survival.

RESULTS

Of 27 biomarkers, lymphocyte-to-CRP ratio (LCR), CRP-to-lymphocyte ratio (CLR) and CRP-to-albumin ratio (CAR) demonstrated highest diagnostic accuracy for distinguishing between NYHA classification (AUC > 0.700). Five biomarkers: CLR, CAR, LCR, CRP-to-hemoglobin ratio (CHR) and neutrophil-to-CRP ratio (NCR) correlates with NYHA, LVEF%, PASP, and NT-proBNP. CAR, CHR and platelet-to-CRP ratio (PCR) were identified as independent factors affecting patient survival.

CONCLUSIONS

Selected blood inflammatory biomarkers, including CAR, CLR, LCR, CHR, and PCR, which are based on CRP, are valuable for predicting disease severity and survival in CHF, offering potential for enhanced clinical management.

Emerging Biomarkers and Electrochemical Biosensors for Early Detection of Premature Coronary Artery Disease

Coronary artery disease (CAD) is one of the primary causes of morbidity and death worldwide. Premature CAD (pCAD) is the term used to describe the 3-10% of CAD occurrences that occur in people under 45 worldwide. Diagnostic difficulties arise from the different risk factor profiles of pCAD and late-onset CAD. Better cardiovascular risk prediction in younger populations has been made possible by the development of biomarker detection tools. This can be applied to a diagnostic tool, including electrochemical biosensors, which have been predicted to be instrumental because of their adaptability for point-of-care applications for quicker diagnoses. These biosensors provide efficient, scalable, and reasonably priced solutions for the quick identification and tracking of CAD. Multiplex biomarker detection has been adopted as a viable approach for early diagnosis and risk assessment due to the constraints of using a single biomarker for pCAD diagnosis. Thus, this study looks at current developments in biosensing technology and discusses established and new cardiac biomarker panels for pCAD identification.

Role of IL-2, IL-6, and TNF-α as Potential Biomarkers in Ischemic Heart Disease: A Comparative Study of Patients with CAD and Non-CAD

Background: Ischemic heart disease (CAD), a leading global health burden, arises primarily from atherosclerosis, an inflammatory condition characterized by lipid accumulation and metabolic dysregulation. The precise contribution of inflammatory cytokines (IL-2, IL-6, and TNF-α) to CAD pathogenesis remains an area of significant research. Aim: The primary aim of this study is to examine the IL-2, IL-6, and TNF-α in patients with coronary artery disease (CAD) and compare them with Non-CAD individuals to evaluate their potential as diagnostic biomarkers for CAD. Methodology: A prospective observational study was conducted over 3 years, involving 100 participants divided into CAD and non-CAD groups. Blood samples were isolated and analyzed for IL-2, IL-6, and TNF-α levels utilizing ELISA kits. Biochemical parameters, including lipid profiles, were also assessed. Results: This study observed significantly elevated IL-6 in patients with CAD compared with controls, while IL-2 and TNF-α levels did not reach statistical significance. The CAD group exhibited dyslipidemia characterized by elevated triglycerides and reduced HDL. Furthermore, the CAD group demonstrated alterations in biochemical parameters, including lower albumin and calcium levels, higher urea and uric acid levels, and an elevated erythrocyte sedimentation rate. These findings suggest a systemic inflammatory state and metabolic disturbances in patients with CAD. Conclusions: This study highlights IL-6 as a potential biomarker and key player in CAD pathogenesis. These findings warrant further investigation into the therapeutic potential of targeting inflammatory pathways for cardiovascular risk reduction.

Research progress of cPLA2 in cardiovascular diseases (Review)

Cytoplasmic phospholipase A2 (cPLA2) is a vital member of the PLA2 family. Studies have demonstrated that cPLA2 plays a key role in various inflammatory‑related diseases and cancers. However, limited research has focused on cPLA2 in cardiovascular diseases. The present review discussed and summarized the research progress on cPLA2 in atherosclerosis, cardiomyopathy, myocardial ischemia‑reperfusion injury and other related conditions. It also highlighted the critical molecular mechanisms by which cPLA2 regulates the pathophysiological processes of vascular endothelial cells, platelets and myocardial cells in cardiovascular diseases. Current studies confirm that cPLA2 plays an important role in cardiovascular diseases and has the potential to become a therapeutic target for the diagnosis, treatment evaluation and prognosis of these conditions. The present review systematically explored the significant role of cPLA2 in cardiovascular diseases and elaborated on its underlying molecular mechanisms. The findings aimed to refine the theoretical understanding of cardiovascular disease pathogenesis and provide a foundation for developing novel treatment strategies.

Immunotherapy and vaccine-based approaches for atherosclerosis prevention: a systematic review study

INTRODUCTION

Cardiovascular disease is a major global health issue, and atherosclerosis is a leading cause of cardiovascular conditions. Traditional approaches for managing atherosclerosis have limitations, creating a need for alternative preventive strategies such as vaccines.

METHODS

The authors conducted a systematic review following Cochrane Handbook and PRISMA guidelines. They searched multiple databases for studies on preventive vaccines against atherosclerosis, including clinical trials and experimental models. The search period was from 1950 to August 2024.

RESULTS

After screening and evaluation, 47 studies were included in the systematic review. The studies investigated various vaccine candidates and immunization strategies. Vaccination goals involve targeting proteins that are found in higher quantities in individuals with atherosclerosis, such as oxidized low-density lipoprotein (LDL), apolipoprotein B-100, proprotein convertase subtilisin/kexin type-9 serine protease (PCSK9), cholesteryl ester transfer protein (CETP), and heat shock proteins HSP60 and HSP65. The review highlights the potential of vaccines in preventing atherosclerosis by targeting specific antigens, modulating lipoprotein metabolism, and enhancing immune responses. Promising approaches included PCSK9 inhibitors, virus-like particle (VLP)-based vaccines, and gene-editing techniques. Monoclonal antibodies like alirocumab, designed to inhibit PCSK9, were also effective in reducing LDL cholesterol levels.

CONCLUSION

This systematic review provides insights into the progress, challenges, and future directions of preventive vaccine research against atherosclerosis. The findings support the development of effective vaccines to complement existing preventive strategies and reduce the global burden of cardiovascular diseases.

CLINICAL TRIAL NUMBER

It is not applicable.

Peripheral Arterial Disease in Diabetic Foot: One Disease with Multiple Patterns

Peripheral arterial disease (PAD) is a major complication in individuals with diabetes and is increasingly prevalent in those with diabetic foot ulcers (DFUs). Despite this, the characterisation of PAD in diabetic patients remains insufficiently refined, leading to suboptimal management and outcomes. This review underscores the necessity for a more nuanced understanding of PAD's anatomical and biological aspects in diabetic patients. The distribution of atherosclerotic plaques varies significantly among individuals, influencing prognosis and treatment efficacy. We describe three key patterns of PAD in diabetes: pattern 1 PAD-below-the-knee (BTK) disease (with infrageniculate disease where present); pattern 2-below-the-ankle (BTA) disease; and pattern 3-small artery disease (SAD), each presenting unique challenges and require tailored therapeutic approaches. BTK PAD, characterised by occlusions in the anterior tibial, posterior tibial, and peroneal arteries, necessitates targeted revascularisation to improve foot perfusion. BTA PAD, involving the pedal and plantar arteries, is associated with higher risks of amputation and requires advanced revascularisation techniques. SAD, affecting the small arteries of the foot, remains an enigma and is challenging to treat with the current mechanical methods, highlighting the potential of autologous cell therapy as a promising alternative. A refined characterisation of PAD in diabetes is crucial for developing effective, individualised treatment strategies, ultimately improving patient outcomes, and reducing the burden of diabetic foot complications. In light of these complexities, it is incredulous that we often use a single term, "peripheral arterial disease", to describe such a diverse array of disease patterns. This oversimplification can be perilous, as it may lead to inadequate therapeutic approaches and suboptimal patient care.

Predicting protein-protein interactions in microbes associated with cardiovascular diseases using deep denoising autoencoders and evolutionary information

Introduction

Protein-protein interactions (PPIs) are critical for understanding the molecular mechanisms underlying various biological processes, particularly in microbes associated with cardiovascular disease. Traditional experimental methods for detecting PPIs are often time-consuming and costly, leading to an urgent need for reliable computational approaches.

Methods

In this study, we present a novel model, the deep denoising autoencoder for protein-protein interaction (DAEPPI), which leverages the denoising autoencoder and the CatBoost algorithm to predict PPIs from the evolutionary information of protein sequences.

Results

Our extensive experiments demonstrate the effectiveness of the DAEPPI model, achieving average prediction accuracies of 97.85% and 98.49% on yeast and human datasets, respectively. Comparative analyses with existing effective methods further validate the robustness and reliability of our model in predicting PPIs.

Discussion

Additionally, we explore the application of DAEPPI in the context of cardiovascular disease, showcasing its potential to uncover significant interactions that could contribute to the understanding of disease mechanisms. Our findings indicate that DAEPPI is a powerful tool for advancing research in proteomics and could play a pivotal role in the identification of novel therapeutic targets in cardiovascular disease.

Oxygen-ozone therapy for myocardial ischemic stroke and cardiovascular disorders

Cardiovascular diseases (CVDs) represent a major concern for human health worldwide. Emergencies in this field include wide repertories of studies dealing primarily with CVD prevention. In addition to dietary habits and lifestyles, medical knowledge is fully needed to improve public educational programs toward cardiovascular risk factors and to enrich the endowment of pharmaceutical options and therapies to address CVDs, particularly for ischemic damage due to an impairment in the endothelial-myocardial relationship. Because ozone is a stimulator of the endothelial nitric oxide synthase/nitric oxide pathway, ozone therapy has been widely demonstrated to have the ability to counteract endothelial-cardiac disorders, providing a novel straightforward opportunity to reduce the impact of CVDs, including atrial fibrillation. In this review, we attempt to establish a state-of-the-art method for the use of ozone in CVD, suggesting that future remarks be addressed to provide fundamental insights into this issue. The purpose of this study was to highlight the role of ozone in the adjunctive medical treatment of cardiovascular pathologies such as acute myocardial infarction due to ischemic disorders.

Potential of SIRT6 modulators in targeting molecular pathways involved in cardiovascular diseases and their treatment-A comprehensive review

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity, accounting for major public health concerns worldwide. CVD poses an immense burden on the global healthcare system and economy. Ischemic heart disease, stroke, heart failure, atherosclerosis, and hypertension are the major diseases belonging to CVDs and ischemic heart diseases and stroke contribute to most CVD-induced deaths. Previously published review articles focused on the role of SIRT6 in CVDs but did not focus on the important role of SIRT6 in modulating the signaling pathways involved in CVDs and targeting them to treat CVDs. Thus, this review aims to identify and delineate the major signaling pathways that are involved in CVDs and whether SIRT6 can modulate those pathways to improve and treat CVDs. Alongside possible applications of small molecule modulators of SIRT6 in cardiovascular disease treatment have been comprehensively analyzed.

Vitamin C: A Comprehensive Review of Its Role in Health, Disease Prevention, and Therapeutic Potential

Since Albert Szent-Györgyi discovered it and it became used in treating scurvy, vitamin C has attracted interest in many studies due to its unique properties. It is an important cofactor in the synthesis of collagen and hormones, and it is involved in immunity, iron absorption, and processes requiring antioxidants. Thus, this review aims to emphasize the importance and usefulness of vitamin C in improving quality of life and preventing various diseases (e.g., chronic diseases, cardiovascular diseases, cancer) but also for its use in treatments against infections, neurodegenerative diseases, and cancer. Although the studies presented provide essential information about the properties of VIC and its beneficial effect on health, some studies contradict these theories. In this respect, further studies on larger samples and over a longer period are needed to demonstrate the therapeutic potential of this nutrient. However, VIC remains a necessary vitamin that should be consumed daily to maintain optimal health and prevent deficiencies that can lead to scurvy and its associated complications.

Integrated analysis of long non‑coding RNA megacluster, microRNA‑132 and microRNA‑133a and their implications for cardiovascular risk and kidney failure progression in diabetic patients

Inefficient control of elevated blood sugar levels can lead to certain health complications such as diabetic nephropathy (DN) and cardiovascular disease (CVD). The identification of effective biomarkers for monitoring diabetes was performed in the present study. The present study aimed to investigate the implications of long non-coding RNA megacluster (lnc-MGC), microRNA (miR)-132 and miR-133a, and their correlation with lactate dehydrogenase (LDH) activity and glycated hemoglobin (HbA1C) levels to identify biomarkers for the early diagnosis of diabetes mellitus, induced DN and CVD. The present study included a total of 200 patients with type 2 diabetes, as well as 40 healthy subjects as controls. The diabetic patients were classified into six groups based on their estimated HbA1c level, glomerular filtration rate and LDH activity, while the healthy controls constituted the seventh group. Diabetic patients exhibited significant increases in parameters related to diabetes as fasting blood sugar, HbA1c levels, cardiac injury and kidney failure. Furthermore, the expression levels of TNF-α were significantly increased in the diabetic groups compared with healthy controls. Diabetic patients with cardiovascular dysfunction showed significantly increased expression levels of miR-132, miR-133a and lnc-MGC, compared with the healthy group. The expression of circulating miR-132 in blood was low in the groups of diabetic patients compared with the healthy controls, and demonstrated a negative correlation with LDH and HbA1C levels. Expression levels of miR-132, miR-133a and lnc-MGC, along with their correlations with LDH and HbA1C levels, could be used to distinguish diabetic patients with reduced CVD from those at early stage diabetes, which indicated their potential as biomarkers for CV complications associated with diabetes mellitus in the future.

Cardiovascular protective effects of cinnamic acid as a natural phenolic acid: a review

Phenolic acids derived from plants have beneficial effects on cardiovascular diseases (CVD). Cinnamic acid (CA) is a crucial phenolic acid that can form numerous hydroxycinnamic derivate found in many food groups. We review current data on the cardiovascular pharmacology of CA with a focus on CVD and their risk factors including hyperlipidaemia, obesity, hyperglycaemia, cardiomyopathy and myocardial ischaemia, vascular dysfunction, oxidative stress and inflammation. Both in vivo and in vitro laboratory studies demonstrate the lipid-lowering, anti-obesity, anti-hyperglycemic, cardio-protective and vasorelaxant activities of CA. The protective impacts of CA against CVD occur by inhibiting inflammatory, oxidative, and apoptotic pathways, regulating the genes and enzymes involved in glucose and lipid metabolisms, and promoting vasodilation. This review showed that the most studied and prominent effects of CA are anti-hyperlipidemic and anti-diabetic properties. In conclusion, intake of plant foods rich in CA may reduce CVD risk especially through regulating blood glucose and lipids levels.

Exploring Cardiovascular Health: The Role of Dyslipidemia and Inflammation

BACKGROUND

Cardiovascular diseases (CVDs) are a major global health concern, with their prevalence rising significantly in developing regions like South India. This increase is driven by unique dietary patterns, lifestyle habits, and genetic predispositions contributing to the region's distinct cardiovascular risk profile. However, gaps remain in understanding the biochemical risk factors specific to this population. This study addresses these gaps by focusing on key markers, namely, low-density lipoprotein (LDL), high-density lipoprotein (HDL), high-sensitivity C-reactive protein (hs-CRP), and homocysteine, which are critical in dyslipidemia, inflammation, and endothelial dysfunction. Identifying these markers' prevalence and their role in CVD is essential for developing effective, region-specific preventive strategies.

METHODS

This study employed a cross-sectional design and included 1,200 participants aged between 30 and 70 years from both urban and rural areas in South India, selected through a multistage stratified random sampling approach to ensure demographic representation across socioeconomic groups, gender, and residential settings. Data on demographics, lifestyle choices, and medical histories were collected using structured questionnaires, which were validated through a pilot study involving 50 participants to ensure clarity, cultural relevance, and content validity. Biochemical assessments included lipid profiles, fasting glucose, hs-CRP, and serum homocysteine levels, which were conducted following standardized laboratory protocols. Quality control measures, such as duplicate testing of 10% of samples, ensured reliability. Statistical analyses included logistic regression to identify independent predictors of CVDs and ANOVA to compare mean biochemical parameter values between groups.  Results: The study reported that 274 participants (22.83%) were affected by CVDs, with a higher prevalence in urban areas (75 participants (27.37%)) compared to rural regions (48 participants (17.51%)). This disparity is likely attributed to urban-specific risk factors, including sedentary lifestyles, dietary patterns, and environmental stressors. Biochemical analysis revealed significant predictors of CVD, such as elevated LDL cholesterol (498 participants (41.5%), odds ratio (OR) = 2.1, 95% CI: 1.7-2.6), reduced HDL cholesterol (428 participants (35.7%), OR = 1.8, 95% CI: 1.4-2.3), and increased hs-CRP levels (353 participants (29.4%), OR = 1.9, 95% CI: 1.5-2.4), emphasizing the central roles of dyslipidemia and systemic inflammation in CVD pathogenesis.

CONCLUSION

The findings of this study highlight critical implications for public health policies and healthcare systems in South India. The higher prevalence of CVDs in urban areas necessitates targeted interventions such as community-based physical activity programs, dietary counseling, and stress management initiatives. Biochemical management strategies, including early screening and control of dyslipidemia through lipid-lowering agents and addressing elevated hs-CRP levels with anti-inflammatory measures, are essential. Supplementation with folate and vitamin B12 to manage hyperhomocysteinemia should also be considered. However, the cross-sectional nature of the study and its single-center design limit causal inference and generalizability, emphasizing the need for multicenter, longitudinal research to validate these findings and guide comprehensive CVD prevention strategies.

Evaluating Carotid Plaque Stiffness with Ultrasound 2D Shear-Wave Elastography in Patients Undergoing Coronary Artery Bypass Grafting

Background: Coronary and carotid artery diseases are manifestations of a systemic atherosclerotic process, often coexisting in patients affected by both conditions. This association emphasizes the importance of evaluating both coronary and carotid atherosclerosis in high-risk individuals. Ultrasound 2D shear-wave elastography (2D-SWE) has shown promise as a noninvasive technique for assessing carotid plaque stiffness. This prospective pilot study aimed to assess carotid plaque stiffness in patients undergoing coronary artery bypass grafting (CABG) and those not scheduled for the procedure as a control group. Methods: 32 patients (17 CABG and 15 controls) were recruited, collectively presenting 43 carotid plaques. Bilateral carotid ultrasound was performed using a high-resolution linear transducer. Plaque stiffness was quantified via 2D-SWE, expressed in shear-wave velocity (SWV, m/s) and Young's modulus (YM, kPa). Plaque characteristics, including GSM, were quantified. Intra-observer reproducibility was evaluated with intraclass correlation coefficients (ICCs) and Bland-Altman plots. Statistical differences and correlations were assessed using Mann-Whitney U and Spearman's correlation tests. Results: Carotid plaques in the CABG group exhibited significantly lower stiffness compared to controls (median stiffness SWV: 3.64 m/s vs. 4.91 m/s, p < 0.0001; YM: 20.96 kPa vs. 72.54 kPa, p < 0.0001). ICCs demonstrated excellent reproducibility for stiffness measurements (SWV: ICC = 0.992; YM: ICC = 0.992), with minimal bias in measurements. A positive correlation was observed between 2D-SWE and GSM values (SWV: r = 0.343, p = 0.024; YM: r = 0.340, p = 0.026). Conclusions: Ultrasound 2D-SWE has shown promise as a reliable tool for quantifying carotid plaque stiffness, demonstrating high reproducibility and a significant correlation with GSM. The observed reduction in plaque stiffness among CABG patients highlights its potential as a valuable parameter for identifying high-risk plaques and assessing cerebrovascular risk in patients undergoing CABG.

Exploration of phytochemical components, bioactivity based fractionation, and in silico HMG-CoA reductase inhibitory effect of Euphorbia dendroides chloroform extract

The chloroform extract of leaves of E. dendroides L, reduced the levels of lipid profile in rats with hypercholesterolaemia to near-normal levels. Additionally, it significantly decreased the amount of malondialdehyde (MDA). In addition, the extract augmented the levels of superoxide dismutase (SOD) and glutathione peroxidase (GSHPx) in the hypercholesterolemic treated rats. The docking results verified the binding mechanism of isolated compound as HMG-CoA reductase inhibitor. The identified compound has the essential pharmacophoric features of Simvastatin. Furthermore, the ADMET profile of an isolated terpene was computed and compared to that of simvastatin as a reference medication. This compound demonstrated a favourable absorption rate of 90.44, which is similar to that of simvastatin (94. 63). Additionally, it demonstrated better CNS penetration and lower excretion rates than simvastatin, resulting in a longer duration of action. It also has an extensive therapeutic window and better selectivity towards cancer cells in opposition to normal cells.

Delineating the NOX-Mediated Promising Therapeutic Strategies for the Management of Various Cardiovascular Disorders: A Comprehensive Review

Cardiovascular disorders (CVDs) are reported to occur with very high rates of incidence and exhibit high morbidity and mortality rates across the globe. Therefore, research is focused on searching for novel therapeutic targets involving multiple pathophysiological mechanisms. Oxidative stress plays a critical role in the development and progression of various CVDs, such as hypertension, pulmonary hypertension, heart failure, arrhythmia, atherosclerosis, ischemia- reperfusion injury, and myocardial infarction. Among multiple pathways generating reactive oxygen species (ROS), Nicotinamide adenine dinucleotide phosphate (NADPH) oxidases of the NOX family as the major source of ROS generation and plays an intricate role in the development and progression of CVDs. Therefore, exploring the role of different NADPH oxidase isoforms in various cardiovascular pathologies has attracted attention to current cardiovascular research. Focusing on NADPH oxidases to reduce oxidative stress in managing diverse CVDs may offer unique therapeutic approaches to prevent and treat various heart conditions. The current review article highlights the role of different NADPH oxidase isoforms in the pathophysiology of various CVDs. Moreover, the focus is also to emphasize different experimental studies that utilized various NADPH oxidase isoform modulators to manage other disorders. The present review article considers new avenues for researchers/scientists working in the field of cardiovascular pharmacology utilizing NADPH oxidase isoform modulators.

Association between thyroid hormone sensitivity and carotid plaque risk: a health examination cohort-based study

Introduction

The involvement of thyroid hormone in cardiovascular disease remains debated. The aim of our research was to ascertain whether thyroid hormone sensitivity indices are related to carotid plaque (CAP) risk in the general population.

Methods

We recruited 5,360 participants for health examinations to explore the correlation between thyroid hormone sensitivity indices and CAP risk. We then compared baseline characteristics of participants with CAP to those without CAP based on multivariate logistic regression analysis. Additionally, we conducted subgroup analyses stratified by gender and age to further elucidate this relationship.

Results

Among the 5,360 participants, 1,055 (19.7%) were diagnosed with CAP. After adjusting for various confounding factors, our results showed a positive association between CAP risk and the indices (TFQI, PTFQI, TSHI, and TT4RI). Conversely, the FT3/FT4 ratio showed a negative correlation with CAP risk. Sex-based subgroup analysis revealed a stronger correlation between thyroid hormone sensitivity and CAP in females compared to males. In the age subgroup, the significant association was observed in older individuals (age >60) compared to middle-aged participants (age ≤60).

Conclusion

Our study suggests a significant correlation between thyroid hormone sensitivity and CAP, particularly in females and participants over the age of 60.

Evaluating Binary Classifiers for Cardiovascular Disease Prediction: Enhancing Early Diagnostic Capabilities

Cardiovascular disease (CVD) is a significant global health concern and the leading cause of death in many countries. Early detection and diagnosis of CVD can significantly reduce the risk of complications and mortality. Machine learning methods, particularly classification algorithms, have demonstrated their potential to accurately predict the risk of cardiovascular disease (CVD) by analyzing patient data. This study evaluates seven binary classification algorithms, including Random Forests, Logistic Regression, Naive Bayes, K-Nearest Neighbors (kNN), Support Vector Machines, Gradient Boosting, and Artificial Neural Networks, to understand their effectiveness in predicting CVD. Advanced preprocessing techniques, such as SMOTE-ENN for addressing class imbalance and hyperparameter optimization through Grid Search Cross-Validation, were applied to enhance the reliability and performance of these models. Standard evaluation metrics, including accuracy, precision, recall, F1-score, and Area Under the Receiver Operating Characteristic Curve (ROC-AUC), were used to assess predictive capabilities. The results show that kNN achieved the highest accuracy (99%) and AUC (0.99), surpassing traditional models like Logistic Regression and Gradient Boosting. The study examines the challenges encountered when working with datasets related to cardiovascular diseases, such as class imbalance and feature selection. It demonstrates how addressing these issues enhances the reliability and applicability of predictive models. These findings emphasize the potential of kNN as a reliable tool for early CVD prediction, offering significant improvements over previous studies. This research highlights the value of advanced machine learning techniques in healthcare, addressing key challenges and laying a foundation for future studies aimed at improving predictive models for CVD prevention.

Influence of stent strut and its associated injury on thrombus formation: A dissipative particle dynamics study

Vascular stent intervention is a pivotal treatment for coronary atherosclerosis, though in-stent thrombosis remains a significant postoperative complication with an unclear underlying mechanism. This study utilized dissipated particle dynamics analysis to investigate the impact of stent and its injury on platelet behavior. The findings suggest that thrombus formation upstream of the stent is mainly initiated by upstream arterial injury, which leads to increased platelet accumulation and activation in that area. While thrombosis downstream of the stent is more directly influenced by the stent itself. The morphology and size of in-stent thrombosis can vary significantly due to the different contributions of the stent and underlying injuries. Additionally, the volume of in-stent thrombosis is affected by the extent of the injury and the viscosity of platelets, showing a notable increase in volume with the lengthening of the injury area and rise in platelet viscosity. This study provides a novel theoretical framework for optimizing stent placement strategies and structural designs by examining the effects of stent struts and associated injuries on thrombus formation.

Biomarkers and Seaweed-Based Nutritional Interventions in Metabolic Syndrome: A Comprehensive Review

Metabolic Syndrome (MetS) is a complex, multifactorial condition characterized by risk factors such as abdominal obesity, insulin resistance, dyslipidemia and hypertension, which significantly contribute to the development of cardiovascular disease (CVD), the leading cause of death worldwide. Early identification and effective monitoring of MetS is crucial for preventing serious cardiovascular complications. This article provides a comprehensive overview of various biomarkers associated with MetS, including lipid profile markers (triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio), inflammatory markers (interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), plasminogen activator inhibitor type 1 (PAI-1), C-reactive protein (CRP), leptin/adiponectin ratio, omentin and fetuin-A/adiponectin ratio), oxidative stress markers (lipid peroxides, protein and nucleic acid oxidation, gamma-glutamyl transferase (GGT), uric acid) and microRNAs (miRNAs) such as miR-15a-5p, miR5-17-5p and miR-24-3p. Additionally, this review highlights the importance of biomarkers in MetS and the need for advancements in their identification and use for improving prevention and treatment. Seaweed therapy is also discussed as a significant intervention for MetS due to its rich content of fiber, antioxidants, minerals and bioactive compounds, which help improve cardiovascular health, reduce inflammation, increase insulin sensitivity and promote weight loss, making it a promising nutritional strategy for managing metabolic and cardiovascular health.

Bioactive lipids improve serum HDL and PON1 activities in coronary artery disease patients: Ex-vivo study

BACKGROUND

Atherosclerotic cardiovascular disease (CVD) remains a leading cause of vascular disease worldwide. Atherosclerosis is characterized by the accumulation of lipids and oxidized lipids on the blood vessel walls. Coronary artery disease (CAD) is the most common display of atherosclerotic CVD.

OBJECTIVES

We investigated the effects of the bioactive lipids as lyso-diacylglyceryltrimethylhomoserine (lyso-DGTS (20,5,0)) and its derivative oleoyl-N-trimethyl homoserine amide (oleoyl amide-MHS) on the properties and functionality of HDL and paraoxonase 1 (PON1) activities in the serum of individuals who exhibited arterial plaque as observed by coronary CT angiography (CCTA).

METHODS

The study included two independent groups comprising 40 patients who had undergone arterial CCTA scans at Ziv Medical Center for various medical indications. The CAD group included 20 patients with coronary artery plaques with luminal stenosis of more than 50 % in a major coronary vessel. The control group consisted of 20 healthy patients (patients without artery plaques).

RESULTS

Serum samples from CAD patients exhibited lower serum PON1 and cholesterol efflux activities and higher pro-inflammatory than the control group. HDL isolated from CAD patients contains elevated levels of oxidizing lipids (specifically lyso- phosphatidyl ethanolamines and lyso-phosphocholines(compared to the control. However, incubation of the CAD patients' serum with lyso-DGTS and oleoyl amide-MHS restored the antiatherogenic activities of HDL. The lipids increased serum PON1 activities, enhanced apoB-depleted serum cholesterol-efflux activity, and elevated the serum's anti-inflammatory properties.

CONCLUSIONS

The results of the present study suggest the potential of the bioactive lipids lyso-DGTS and oleoyl amide-MHS to attenuate atherosclerosis via the improvement of dysfunctional HDL properties and PON1 activities. Further, in-vivo experiments are needed to assess the athero-protective effect of the lipids.

Environmental Heavy Metal Exposure and Associated Cardiovascular Diseases in Light of the Triglyceride Glucose Index

Cardiovascular diseases (CVD), primarily ischemic heart disease and stroke, remain leading global health burdens. Environmental risk factors have a major role in the development of CVD, particularly exposure to heavy metals. The Triglyceride Glucose Index (TyG), a measure of insulin resistance and CVD risk, is the primary focus of this study, which summarizes the most recent findings on the effects of lead (Pb), arsenic (As), and cadmium (Cd) on CVD risk. A higher risk of CVD is correlated with an elevated TyG index, which has been linked to insulin resistance. Exposure to Cd is associated with disturbance of lipid metabolism and oxidative stress, which increases the risk of CVD and TyG. Exposure reduces insulin secretion and signaling, which raises the TyG index and causes dyslipidemia. Pb exposure increases the risk of CVD and TyG index via causing oxidative stress and pancreatic β-cell destruction. These results highlight the need of reducing heavy metal exposure by lifestyle and environmental modifications in order to lower the risk of CVD. To comprehend the mechanisms and create practical management plans for health hazards associated with heavy metals, more study is required.

Magnesium and Potassium Supplementation for Systolic Blood Pressure Reduction in the General Normotensive Population: A Systematic Review and Subgroup Meta-Analysis for Optimal Dosage and Treatment Length

BACKGROUND/OBJECTIVES

Studies have shown that consistent reductions of 2 mm Hg in systolic blood pressure (SBP) for the general normotensive population can result in significant decreases in mortality from heart disease and stroke. The purpose of this meta-analysis was to determine the optimal dose and duration of treatment for magnesium and potassium supplementation, having previously discovered that both reduce SBP by -2.79 and -2.10 mm Hg, respectively.

METHODS

Placebo-controlled, randomized clinical trials examining the effects of magnesium and potassium supplementation on SBP were identified. Pairwise meta-analyses with subgroups for dosage and treatment duration were run.

RESULTS

Magnesium at dosages of ≤360 mg/day and durations greater than 3 months reduced SBP by -3.03 and -4.31 mm Hg, respectively. Potassium at dosages of ≤60 mmol/day and durations greater than 1 month reduced SBP by -2.34 and -2.80 mm Hg, respectively.

CONCLUSIONS

Both supplements demonstrated greater reductions in SBP for the general population at lower dosages and longer treatment durations. Future studies are needed to validate these findings and provide tailored recommendations. These studies could investigate varying dosages over long-term follow-up to provide robust data on optimal dosages and treatment durations, as our findings were limited due to reliance on previously published trials.

Association of Four Dietary Patterns and Stair Climbing with Major Adverse Cardiovascular Events: A Large Population-Based Prospective Cohort Study

BACKGROUND

The protective effect of a healthy diet combined with stair climbing on cardiovascular health is unclear. We aimed to assess the independent and joint associations of dietary patterns and stair climbing with major adverse cardiovascular events (MACEs).

METHODS

We included 117,384 participants with information on dietary intake and stair climbing from the UK Biobank (UKBB). We excluded participants with MACEs at baseline and death within two years of follow-up. We used restricted cubic spline (RCS) plots describing the linear or nonlinear associations between dietary patterns (the alternate Mediterranean diet score (AMED), dietary approaches to stop hypertension (DASH), the healthful planted-based diet index (HPDI) and the alternate healthy eating index-2010 (AHEI-2010)) and stair climbing and MACEs. COX regressions estimated the hazard ratios (HRs) for incident MACEs associated with dietary patterns combined with stair climbing, and adjusted for sociodemographic, lifestyle and medical factors.

RESULTS

The UKBB documented 9408 MACEs over a median follow-up of 13.3 years. Four dietary patterns were negatively and linearly associated with MACEs (P-nonlinear > 0.05), whereas daily stair climbing was negatively and nonlinearly associated with MACEs (P-nonlinear = 0.011). All of the dietary patterns had significant multiplicative interactions with stair climbing (all p-values < 0.05). The three dietary patterns had the lowest risk ratios for MACEs in the highest tertile (T3) combined with daily stair climbing of 60-100 steps (AMED: 0.78 (0.68, 0.89), DASH: 0.80 (0.70, 0.91) and HPDI: 0.86 (0.75, 0.98)), whereas the AHEI-2010 had the lowest HRs for MACEs in the T1 combined with stair climbing of 110-150 steps (AHEI-2010: 0.81 (0.71, 0.93)).

CONCLUSIONS

Maintaining healthy dietary patterns and adhering to an average of 60-100 steps of stair climbing per day at home can be effective in preventing cardiovascular health-related events.

Association of novel dietary and lifestyle inflammation scores with incidence and progression of coronary artery calcification in middle-late adulthood: a longitudinal cohort study

BACKGROUND

Dietary patterns and lifestyle factors can influence the intensity of systemic inflammation and, consequently, the development and progression of coronary artery calcification (CAC). This study aimed to explore the relationship between the inflammatory potentials of diet and lifestyle, as captured by novel dietary and lifestyle inflammation scores (DIS and LIS), with CAC incidence and progression.

METHODS

We analyzed data on 5949 Black and White men and women ≥ 45 years old participating in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Baseline data on diet and lifestyle factors were collected from 2000 to 2002 and used to construct the DIS and LIS, which reflect the overall inflammatory potential of diet and lifestyle. Cox proportional hazard regression was used to calculate the hazard ratios (HR) and 95% confidence intervals (95% CI) for CAC incidence and progression across quartiles of DIS and LIS, adjusting for potential confounders.

RESULTS

Over a median follow-up of 8.0 years, among 2638 participants with zero CAC score at baseline, 977 individuals developed positive scores, and 1681 out of 2561 participants showed CAC progression. For individuals in the highest (more pro-inflammatory) compared to the lowest (more anti-inflammatory) quartiles of the LIS, the multivariable-adjusted HR for CAC incidence was 1.35 (95% CI, 1.10-1.65; P trend < 0.002). This association was stronger among younger adults aged < 60 years compared to those aged ≥ 60 years, with respective values of 1.76 (1.34-2.30) and 1.02 (0.78-1.35) (P interaction < 0.001). However, the LIS was not significantly associated with the progression of existing CAC. Among the components of the LIS, a body mas index (BMI) ≥ 25 kg/m2 and current smoking were significant predictors for the incidence and progression of CAC, respectively. No significant association was found between DIS and CAC incidence and progression.

CONCLUSIONS

Lifestyle factors, through their impact on systemic inflammation, may be associated with a higher risk of CAC incidence in middle and late adulthood.

Human Breast Milk Exosomes: Affecting Factors, Their Possible Health Outcomes, and Future Directions in Dietetics

Background: Human breast milk is a complex biological fluid containing multifaceted biological compounds that boost immune and metabolic system development that support the short- and long-term health of newborns. Recent literature suggests that human breast milk is a substantial source of nutrients, bioactive molecules, and exosomes. Objectives: This review examines the factors influencing exosomes noted in human milk and the impacts of exosomes on infant health. Furthermore, it discusses potential future prospects for exosome research in dietetics. Methods: Through a narrative review of the existing literature, we focused on exosomes in breast milk, exosome components and their potential impact on exosome health. Results: Exosomes are single-membrane extracellular vesicles of endosomal origin, with an approximate radius of 20-200 nm. They are natural messengers that cells secrete to transport a wide range of diverse cargoes, including deoxyribonucleic acid, ribonucleic acid, proteins, and lipids between various cells. Some studies have reported that the components noted in exosomes in human breast milk could be transferred to the infant and cause epigenetic changes. Thus, it can affect gene expression and cellular event regulation in several tissues. Conclusions: In this manner, exosomes are associated with several pathways, including the immune system, oxidative stress, and cell cycle, and they can affect the short- and long-term health of infants. However, there is still much to learn about the functions, effectiveness, and certain impacts on the health of human breast milk exosomes.

A Machine Learning Approach to Gene Expression in Hypertrophic Cardiomyopathy

BACKGROUND/OBJECTIVES

Hypertrophic cardiomyopathy (HCM) is a common heart disorder characterized by the thickening of the heart muscle, particularly in the left ventricle, which increases the risk of cardiac complications. This study aims to analyze the expression of apoptosis-regulating genes (CASP8, CASP9, CASP3, BAX, and BCL2) in blood samples from HCM patients, to better understand their potential as biomarkers for disease progression.

METHODS

Quantitative real-time PCR (qPCR) was used to evaluate gene expression in blood samples from 93 HCM patients. The correlation between apoptosis-regulating genes was conducted and clinical parameters were integrated for feature importance and clustering analysis.

RESULTS

Most patients exhibited significant downregulation of CASP8, CASP9, and CASP3. In contrast, BAX expression was elevated in 71 out of 93 patients, while BCL2 was increased in 55 out of 93 patients. Correlation analysis revealed weak negative correlations between the BAX/BCL2 ratio and CASP gene expression.

CONCLUSIONS

These findings suggest that reduced expression of apoptotic genes may indicate a protective cellular mechanism, which could serve as a biomarker for disease progression. Further studies are needed to investigate the potential for therapeutic modulation of these pathways to improve patient outcomes.

Lymphocyte to White Blood Cell Count Ratio an Independent Risk Factor for Heart Failure

OBJECTIVE

Heart failure affects 1-2% of the population in developed countries. Hemogram biomarkers are cheap, rapid, readily accessible and are known to have prognostic benefit in cardiovascular, infectious and oncologic diseases.

METHODS

The aim of the current study is to evaluate lymphocyte-to-white-blood-cell ratio (LWR) as a prognostic predictor in patients with heart failure. Patients with heart failure were recruited between January 2000 and July 2001. Exclusion criteria included metastatic malignancy, exposure to chemotherapy, radiotherapy or medications known to affect complete blood count.

RESULTS

338 patients were enrolled, 33 were excluded. Mean age was 70.1 ± 10.8, 225 patients were male (73%) and 80 were female (27%). All patients were divided into three groups according to LWR. Group 1 < 0.2, group 2-0.2 < LWR < 0.35 and group 3 > 0.35. Patients with LWR ratio < 0.2 had the poorest survival while patients in the highest LWR (ratio > 0.35) had the best long-term survival.

CONCLUSIONS

Patients with congestive heart failure and LWR < 0.2 showed significant increased mortality. LWR was shown as independent prognostic predictor for HF patients compared to other main outcome parameters, including CRP, NYHA, EF and LDL.

Bridging the Gap: Tackling Racial and Ethnic Disparities in Hypertension Management

Hypertension is a prevalent health concern with significant implications for cardiovascular disease risk, affecting diverse populations worldwide and imposing substantial health system burdens. This review article explores racial and ethnic disparities in hypertension prevalence, treatment, and management, highlighting the disproportionate impact on minority populations. Certain racial and ethnic groups in the United States exhibit higher prevalence rates of hypertension and related complications due to a confluence of genetic, social, and economic factors. Despite comparable treatment rates, blood pressure control is often less effective among these groups, partly due to less intensive treatment and systemic barriers to care. Different populations encounter unique challenges, with prevalence and control rates influenced by dietary habits, socioeconomic status, and healthcare disparities. This review summarizes current management practices and highlights the necessity for tailored approaches that consider ethnic-specific treatment responses. It underscores the importance of addressing socioeconomic and cultural barriers while incorporating both pharmacological and nonpharmacological treatments. Future research should focus on developing culturally relevant assessment tools, enhancing data collection, and evaluating interventions designed to mitigate these disparities. To promote health equity and optimize the management of hypertension in a variety of populations, it is imperative to address these inequities using individualized, evidence-based strategies.

Exploring the therapeutic potential of interleukin-6 receptor blockade in cardiovascular disease treatment through Mendelian randomization

Interleukin-6 (IL-6) plays a crucial role in the pathogenesis of cardiovascular disease (CVD), and IL-6 receptor (IL-6R) blockade has emerged as a promising therapeutic option. However, their specific therapeutic effects in different types of CVDs remain unclear. This study aimed to assess the efficacy of IL-6R blockade in the management of various CVDs, including hypertension (HTN), coronary heart disease (CHD), myocardial infarction (MI), atrial fibrillation (AF), and heart failure (HF). The Mendelian randomization (MR) approach was utilized to investigate the therapeutic impact of IL-6R blockade on HTN, CHD, MI, AF, and HF based on the genome-wide association study (GWAS) summary statistics. MR-Egger intercept test, Cochran's Q test, and leave-one-out analysis were used for sensitivity analysis to verify the reliability of the MR results. The Bonferroni method was used to correct for bias caused by multiple comparisons. Inverse variance weighted (IVW) results demonstrated that IL-6R blockade significantly influenced CHD (odds ratio (OR) = 0.757, 95% confidence interval (CI): 0.690 - 0.832, P = 5.804 × 10-9) and MI (OR = 0.840, 95% CI: 0.744 - 0.949, P = 0.005). However, IL-6R blockade had no significant effect on HTN (OR = 1.015, 95% CI: 0.950 - 1.084, P = 0.663), AF (OR = 0.905, 95% CI: 0.800 - 1.025, P = 0.116) and HF (OR = 1.012, 95% CI: 0.921 - 1.113, P = 0.805). Genetically predicted IL-6R blockade was associated with a protective effect on CHD and MI, but not HTN, AF and HF. This study's findings offer valuable insights for tailoring IL-6R blockade treatment for different types of CVD, and serve as a reference for future research.

Treatment of Acute and Long-COVID, Diabetes, Myocardial Infarction, and Alzheimer's Disease: The Potential Role of a Novel Nano-Compound-The Transdermal Glutathione-Cyclodextrin Complex

Oxidative stress (OS) occurs from excessive reactive oxygen species or a deficiency of antioxidants-primarily endogenous glutathione (GSH). There are many illnesses, from acute and post-COVID-19, diabetes, myocardial infarction to Alzheimer's disease, that are associated with OS. These dissimilar illnesses are, in order, viral infections, metabolic disorders, ischemic events, and neurodegenerative disorders. Evidence is presented that in many illnesses, (1) OS is an early initiator and significant promotor of their progressive pathophysiologic processes, (2) early reduction of OS may prevent later serious and irreversible complications, (3) GSH deficiency is associated with OS, (4) GSH can likely reduce OS and restore adaptive physiology, (5) effective administration of GSH can be accomplished with a novel nano-product, the GSH/cyclodextrin (GC) complex. OS is an overlooked pathological process of many illnesses. Significantly, with the GSH/cyclodextrin (GC) complex, therapeutic administration of GSH is now available to reduce OS. Finally, rigorous prospective studies are needed to confirm the efficacy of this therapeutic approach.

Prevalence, Clinical Characteristics, and Treatment of Patients with Resistant Hypertension: A Single-Center Study

BACKGROUND

Resistant hypertension (HTN) is associated with a high risk of cardiovascular complications. Our study aimed to assess the prevalence, characteristics, and treatment of patients with resistant HTN.

METHODS

We screened 4340 consecutive cardiovascular patients hospitalized in our clinic and identified 3762 with HTN. Of them, 128 fulfilled criteria for resistant HTN and were included in our study. We matched these patients to 128 hospitalized patients with controlled HTN.

RESULTS

Resistant HTN patients comprised 3.4% of all hypertensive individuals. Most of these patients (67.2%) were at high or very high cardiovascular risk compared to controlled HTN patients (40.6%); p < 0001. Resistant HTN patients more commonly had concomitant chronic kidney disease (CKD) (60.9%), overweight/obesity (52.3%), dyslipidemias (35.2%), smoking (27.3%), and diabetes (21.9%) compared to controlled HTN patients (37.5%, 29.7%, 28.1%, 14.1%, and 7.8%, respectively); p < 0.001. Regression analysis showed the strongest association of resistant HTN with CKD (OR 6.64), stage III HTN (OR 3.07), and obesity/overweight (OR 2.60). In contrast, single-pill combinations (SPCs) were associated with a lower likelihood of uncontrolled HTN (OR 0.58).

CONCLUSIONS

Resistant HTN represented a small proportion of all hypertensives in our study, but it was characterized by high/very high cardiovascular risk. Optimized therapy including increased use of SPCs could improve blood pressure control and long-term prognosis for these patients.

Targeting Mitochondrial Dysfunction for the Prevention and Treatment of Metabolic Disease by Bioactive Food Components

Dysfunctional mitochondria have been linked to the pathogenesis of obesity-associated metabolic diseases. Excessive energy intake impairs mitochondrial biogenesis and function, decreasing adenosine-5'-triphosphate production and negatively impacting metabolically active tissues such as adipose tissue, skeletal muscle, and the liver. Compromised mitochondrial function disturbs lipid metabolism and increases reactive oxygen species production in these tissues, contributing to the development of insulin resistance, type 2 diabetes, and non-alcoholic fatty liver disease. Recent studies have demonstrated the therapeutic potential of bioactive food components, such as resveratrol, quercetin, coenzyme Q10, curcumin, and astaxanthin, by enhancing mitochondrial function. This review provides an overview of the current understanding of how these bioactive compounds ameliorate mitochondrial dysfunction to mitigate obesity-associated metabolic diseases.

Effect of cinnamon as a Chinese herbal medicine on markers of cardiovascular risk in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder in women associated with increased cardiovascular risk. Cinnamon, a Chinese herbal medicine, is known for its anti-inflammatory and insulin-sensitizing properties, making it a potential therapeutic agent for PCOS-related cardiovascular complications. This systematic review and meta-analysis aimed to assess the impact of cinnamon supplementation on cardiovascular risk markers in women diagnosed with PCOS.

METHODS

Twelve randomized controlled trials (RCTs) were included in the analysis. The primary outcomes assessed were body weight, insulin resistance measured by Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and fasting blood sugar (FBS).

RESULTS

The meta-analysis revealed a statistically significant effect of cinnamon on reducing weight. Under the random-effects model, the pooled weighted mean difference (WMD) was -0.47 kg (95 % CI: -0.80 to -0.15, p < 0.001; I2 = 0.0 %). There was also a beneficial impact on insulin resistance, with reduced HOMA-IR scores following cinnamon supplementation (SMD=0.5015, 95 % CI: 0.2496 to 0.7533, p < 0.0001). Additionally, there was a significant improvement in FBS levels (pooled WMD: -7.72 mg/dL, 95 % CI: -12.33 to -3.12, p < 0.001; I2 = 91.3 %). The meta-analysis indicated a tendency towards reduced total cholesterol (WMD: -11.12 mg/dL, 95 % CI: -19.06 to -3.18, p = 0.01; I2 = 0.0 %) and LDL levels (WMD: -11.11 mg/dL, 95 % CI: -18.22 to -4.00, p < 0.01; I2 = 0.0 %) following cinnamon intervention. Substantial heterogeneity was observed among the studies, indicating the need for further research with larger sample sizes and standardized methodologies.

CONCLUSION

Cinnamon supplementation demonstrates promising effects on body weight, blood sugar, total cholesterol, LDL, and insulin resistance in women with PCOS, indicating its potential in mitigating cardiovascular risk factors associated with this condition.

Garlic and Hypertension: Efficacy, Mechanism of Action, and Clinical Implications

Hypertension is a major risk factor for heart disease and stroke. Garlic has a long history of use in traditional medicine for various conditions, including hypertension. This narrative review examined the scientific evidence on the efficacy of garlic in lowering blood pressure. It explores the historical uses of garlic in different cultures for medicinal purposes and delves into the phytochemical composition of garlic, highlighting key components, like allicin and ajoene, that are believed to contribute to its potential health benefits. Clinical studies that investigated the effects of garlic and garlic-based supplements on blood pressure are presented, with the findings suggesting that garlic consumption may modestly reduce blood pressure, particularly in individuals with mild hypertension. Potential mechanisms of action include increased nitric oxide production, improved endothelial function, and antioxidant properties. While garlic may offer some benefits for blood pressure management, it should not be considered a substitute for conventional antihypertensive medications. Further large-scale, long-term clinical trials are warranted to establish the efficacy of garlic in managing hypertension, including the optimal dosage and formulation.

Epsins oversee smooth muscle cell reprograming by influencing master regulators KLF4 and OCT4

Smooth muscle cells in major arteries play a crucial role in regulating coronary artery disease. Conversion of smooth muscle cells into other adverse cell types in the artery propels the pathogenesis of the disease. Curtailing artery plaque buildup by modulating smooth muscle cell reprograming presents us a new opportunity to thwart coronary artery disease. Here, our report how Epsins, a family of endocytic adaptor proteins oversee the smooth muscle cell reprograming by influencing master regulators OCT4 and KLF4. Using single-cell RNA sequencing, we characterized the phenotype of modulated smooth muscle cells in mouse atherosclerotic plaque and found that smooth muscle cells lacking epsins undergo profound reprogramming into not only beneficial myofibroblasts but also endothelial cells for injury repair of diseased endothelium. Our work lays concrete groundwork to explore an uncharted territory as we show that depleting Epsins bolsters smooth muscle cells reprograming to endothelial cells by augmenting OCT4 activity but restrain them from reprograming to harmful foam cells by destabilizing KLF4, a master regulator of adverse reprograming of smooth muscle cells. Moreover, the expression of Epsins in smooth muscle cells positively correlates with the severity of both human and mouse coronary artery disease. Integrating our scRNA-seq data with human Genome-Wide Association Studies (GWAS) identifies pivotal roles Epsins play in smooth muscle cells in the pathological process leading to coronary artery disease. Our findings reveal a previously unexplored direction for smooth muscle cell phenotypic modulation in the development and progression of coronary artery disease and unveil Epsins and their downstream new targets as promising novel therapeutic targets for mitigating metabolic disorders.

The Application of Metabolomics in Hyperlipidemia: Insights into Biomarker Discovery and Treatment Efficacy Assessment

Hyperlipidemia is a lipid metabolism disorder that refers to increased levels of total triglycerides (TGs), cholesterol (TC), and low-density lipoprotein-cholesterol (LDL-C) and decreased levels of high-density lipoprotein-cholesterol (HDL-C). It is a major public health issue with increased prevalence and incidence worldwide. The ability to identify individuals at risk of this disorder before symptoms manifest will facilitate timely intervention and management to avert potential complications. This can be achieved by employing metabolomics as an early detection method for the diagnostic biomarkers of hyperlipidemia. Metabolomics is an analytical approach used to detect and quantify metabolites. This provides the ability to explain the metabolic processes involved in the development and progression of certain diseases. In recent years, interest in the use of metabolomics to identify disease biomarkers has increased, and several biomarkers have been discovered, such as docosahexaenoic acid, glycocholic acid, citric acid, betaine, and carnitine. This review discusses the primary metabolic alterations in the context of hyperlipidemia. Furthermore, we provide an overview of recent studies on the application of metabolomics to the assessment of the efficacy of traditional herbal products and common lipid-lowering medications.

International Headache Society global practice recommendations for the acute pharmacological treatment of migraine

BACKGROUND

In an effort to improve migraine management around the world, the International Headache Society (IHS) has here developed a list of practical recommendations for the acute pharmacological treatment of migraine. The recommendations are categorized into optimal and essential, in order to provide treatment options for all possible settings, including those with limited access to migraine medications.

METHODS

An IHS steering committee developed a list of clinical questions based on practical issues in the management of migraine. A selected group of international senior and junior headache experts developed the recommendations, following expert consensus and the review of available national and international headache guidelines and guidance documents. Following the initial search, a bibliography of twenty-one national and international guidelines was created and reviewed by the working group.

RESULTS

A total of seventeen questions addressing different aspects of acute migraine treatment have been outlined. For each of them we provide an optimal recommendation, to be used whenever possible, and an essential recommendation to be used when the optimal level cannot be attained.

CONCLUSION

Adoption of these international recommendations will improve the quality of acute migraine treatment around the world, even where pharmacological options remain limited.

Immunoexpression of aortic endothelial P-selectin and serum apolipoprotein A-1 levels after administration of arabica (Coffea arabica) and robusta (Coffea canephora) coffee bean extracts: In vivo study in atherosclerosis rat model

Atherosclerosis is a leading cause of cardiovascular disease-related death worldwide. Some studies suggested that the natural ingredients in coffee may negatively affect cardiovascular diseases, while other studies indicated that coffee contains anti-inflammatory compounds that are beneficial for cardiovascular diseases. The aim of this study was to measure the expression of P-selectin in aortic endothelial cells and the level of serum apolipoprotein A-1 (ApoA-1) in an atherosclerosis rat model after the administration of arabica and robusta coffee bean extracts at mild-moderate and high doses. An experimental study was conducted with a complete randomized design using 36 adult male white rats (Rattus norvegicus) divided into six groups: negative control (NC), positive control (PC), arabica mild-moderate dose (A1), arabica high dose (A2), robusta mild-moderate dose (R1), and robusta high dose (R2). Animals were induced atherosclerosis with atherogenic feed and then were treated with arabica and robusta coffee bean extracts at two different doses for four weeks. The results showed that the expression of P-selectin in the group of rats treated with robusta coffee bean extract was lower than arabica coffee bean extract group. Rats with robusta coffee bean extract mild-moderate dose had the highest ApoA-1 levels compared to other groups significantly (p<0.05). The level of ApoA-1 was higher in both mild-moderate and high dose of robusta coffee groups compared to the negative control group (both with p<0.001). In conclusion, mild-moderate intake of robusta coffee bean extract could reduce aortic P-selectin immunoexpression and increase serum ApoA-1 levels in an atherosclerosis rat model.

Treating Cardiovascular Disease in the Inflammatory Setting of Rheumatoid Arthritis: An Ongoing Challenge

Despite progress in treating rheumatoid arthritis, this autoimmune disorder confers an increased risk of developing cardiovascular disease (CVD). Widely used screening protocols and current clinical guidelines are inadequate for the early detection of CVD in persons with rheumatoid arthritis. Traditional CVD risk factors alone cannot be applied because they underestimate CVD risk in rheumatoid arthritis, missing the window of opportunity for prompt intervention to decrease morbidity and mortality. The lipid profile is insufficient to assess CVD risk. This review delves into the connection between systemic inflammation in rheumatoid arthritis and the premature onset of CVD. The shared inflammatory and immunologic pathways between the two diseases that result in subclinical atherosclerosis and disrupted cholesterol homeostasis are examined. The treatment armamentarium for rheumatoid arthritis is summarized, with a particular focus on each medication's cardiovascular effect, as well as the mechanism of action, risk-benefit profile, safety, and cost. A clinical approach to CVD screening and treatment for rheumatoid arthritis patients is proposed based on the available evidence. The mortality gap between rheumatoid arthritis and non-rheumatoid arthritis populations due to premature CVD represents an urgent research need in the fields of cardiology and rheumatology. Future research areas, including risk assessment tools and novel immunotherapeutic targets, are highlighted.

Potential antiplatelet agents with grape seed - backbone polyphenols: computational studies

The study focused on grape seed-derived polyphenols for their antiplatelet, anti-inflammatory, and fibrinolytic properties through molecular docking and dynamics simulations. Compounds were evaluated for their effects on P2Y12, PTP1B, thromboxane A2, and other targets. Compounds 1 and 6 showed strong inhibitory potential on P2Y12. Compounds 2 and 7, plus epigallocatechin gallate, demonstrated effective inhibition on NF-KB and COX1. The compounds exhibited drug-like properties and potential for new thrombotic disease therapies. The research sheds light on the interactions between polyphenols and target proteins, paving the way for novel antiplatelet strategies.

Comparison of Small Blood Vessel Diameter with Intravascular Ultrasound and Coronary Angiography for Guidance of Percutaneous Coronary Intervention

Major cardiovascular events (MACEs) are a cause of major mortality worldwide. The narrowing and blockage of coronary arteries with atherosclerotic plaques are diagnosed and treated with percutaneous coronary intervention (PCI). During this procedure, coronary angiography (CAG) remains the most widely used guidance modality for the evaluation of the affected blood vessel. The measurement of the blood vessel diameter is an important factor to consider in order to decide if stent colocation is suitable for the intervention. In this regard, a small blood vessel (<2.75 mm) is majorly left without stent colocation; however, small vessel coronary artery disease (SvCAD) is a significant risk factor for the recurrence of MACEs, maybe due to the lack of a standardized treatment related to the diameter of the affected blood vessel; therefore, a more precise measurement is needed. The use of CAG for the measurement of the blood vessel diameter has some important limitations that can be improved with the use of newer techniques such as intravascular ultrasound (IVUS), although at higher costs, which might explain its underuse. To address differences in blood vessel diameter measurements and identify specific cases where IVUS might be of additional benefit for the patient, we conducted a retrospective study in patients who underwent PCI for MACEs with affection for at least one small blood vessel. We compared the measurements of the affected small blood vessels' diameter obtained by CAG and IVUS to identify cases of reclassification of the affected blood vessel; additionally, we underwent a multivariate analysis to identify risk factors associated with blood vessel reclassification. We included information from 48 patients with a mean ± SD age of 69.1 ± 11.9 years; 70.8% were men and 29.2% were women. The mean diameter with CAG and IVUS was 2.1 mm (95% CI 1.9-2.2), and 2.8 (2.8-3.0), respectively. The estimated difference was of 0.8 mm (95% CI 0.7-0.9). We found a significant positive low correlation in diameter measurements of small blood vessels obtained with CAG and IVUS (r = 0.1242 p = 0.014). In total, 37 (77%) patients had a reclassification of the affected blood vessel with IVUS. In 21 cases, the affected blood vessel changed from a small to a medium size (2.75-3.00 mm), and in 15 cases, the affected vessel changed from a small to a large size (<3.00 mm). The Bland-Altman plot was used to evaluate agreement in measurements with CAG and IVUS. The change in blood vessel classification with IVUs was important for the decision of intervention and stent collocation. The only variable associated with reclassification of blood vessels after adjustment in a multivariate analysis was T2D (type 2 diabetes) (p = 0 0.035). Our findings corroborate that blood vessels might appear smaller with CAG, especially in patients with T2D; therefore, at least in these cases, the use of IVUS is recommended over CAG.

Primary Mouse Aortic Smooth Muscle Cells Exhibit Region- and Sex-Dependent Biological Responses In Vitro

Despite advancements in elucidating biological mechanisms of cardiovascular remodeling, cardiovascular disease (CVD) remains the leading cause of death worldwide. When stratified by sex, clear differences in CVD prevalence and mortality between males and females emerge. Regional differences in phenotype and biological response of cardiovascular cells are important for localizing the initiation and progression of CVD. Thus, to better understand region and sex differences in CVD presentation, we have focused on characterizing in vitro behaviors of primary vascular smooth muscle cells (VSMCs) from the thoracic and abdominal aorta of male and female mice. VSMC contractility was assessed by traction force microscopy (TFM; single cell) and collagen gel contraction (collective) with and without stimulation by transforming growth factor-beta 1 (TGF-β1) and cell proliferation was assessed by a colorimetric metabolic assay (MTT). Gene expression and TFM analysis revealed region- and sex-dependent behaviors, whereas collagen gel contraction was consistent across sex and aortic region under baseline conditions. Thoracic VSMCs showed a sex-dependent sensitivity to TGF-β1-induced collagen gel contraction (female > male; p = 0.025) and a sex-dependent proliferative response (female > male; p < 0.001) that was not apparent in abdominal VSMCs. Although primary VSMCs exhibit intrinsic region and sex differences in biological responses that may be relevant for CVD presentation, several factors-such as inflammation and sex hormones-were not included in this study. Such factors should be included in future studies of in vitro mechanobiological responses relevant to CVD differences in males and females.

Disparity of gene expression in coronary artery disease: insights from MEIS1, HIRA, and Myocardin

INTRODUCTION

Coronary artery disease (CAD) in young adults can have devastating consequences. The cardiac developmental gene MEIS1 plays important roles in vascular networks and heart development. This gene effects on the regeneration capacity of the heart. Considering role of MEIS1 in cardiac tissue development and the progression of myocardial infarction this study investigated the expression levels of the MEIS1, HIRA, and Myocardin genes in premature CAD patients compared to healthy subjects and evaluated the relationships between these genes and possible inflammatory factors.

METHODS AND RESULTS

The study conducted a case-control design involving 35 CAD patients and 35 healthy individuals. Peripheral blood mononuclear cells (PBMCs) were collected, and gene expression analysis was performed using real-time PCR. Compared with control group, the number of PBMCs in the CAD group exhibited greater MEIS1 and HIRA gene expression, with fold changes of 2.45 and 3.6. The expression of MEIS1 exhibited a negative correlation with IL-10 (r= -0.312) expression and positive correlation with Interleukin (IL)-6 (r = 0.415) and tumor necrosis factor (TNF)-α (r = 0.534) gene expression. Moreover, there was an inverse correlation between the gene expression of HIRA and that of IL-10 (r= -0.326), and a positive correlation was revealed between the expression of this gene and that of the IL-6 (r = 0.453) and TNF-α (r = 0.572) genes.

CONCLUSION

This research demonstrated a disparity in expression levels of MEIS1, HIRA, and Myocardin, between CAD and healthy subjects. The results showed that, MEIS1 and HIRA play significant roles in regulating the synthesis of proinflammatory cytokines, namely, TNF-α and IL-6.

Engineering blood and lymphatic microvascular networks

The human vasculature plays a crucial role in the blood supply of nearly all organs as well as the drainage of the interstitial fluid. Consequently, if these physiological systems go awry, pathological changes might occur. Hence, the regeneration of existing vessels, as well as approaches to engineer artificial blood and lymphatic structures represent current challenges within the field of vascular research. In this review, we provide an overview of both the vascular blood circulation and the long-time neglected but equally important lymphatic system, with regard to their organotypic vasculature. We summarize the current knowledge within the field of vascular tissue engineering focusing on the design of co-culture systems, thereby mainly discussing suitable cell types, scaffold design and disease models. This review will mainly focus on addressing those subjects concerning atherosclerosis. Moreover, current technological approaches such as vascular organ-on-a-chip models and microfluidic devices will be discussed.

Platelet-derived sTLT-1 is associated with platelet-mediated inflammation in coronary artery disease patients

The development of coronary artery disease (CAD) depends heavily on platelet activation, and inflammation plays a major role in all stages of atherosclerosis. Platelet-specific soluble triggering receptor expressed on myeloid cells like transcript 1 (sTLT-1) facilitate clot formation and have been linked to chronic inflammation. In this study, we explored the role of platelet-derived sTLT-1 in platelet-mediated inflammation in CAD patients. Plasma levels of sTLT-1 were measured using enzyme-linked immunosorbent assay in CAD patients (n = 163) and healthy controls (n = 99). Correlation analysis was performed to determine the circulatory sTLT-1 levels with platelet activation markers, immune cells, and inflammatory cytokines/chemokines. Increased plasma sTLT-1 levels were observed in CAD patients compared with those in healthy controls (p < 0.0001). A positive correlation was observed between sTLT-1 and platelet activation markers (P-selectin, PAC-1), CD14++ CD16- cells (classical monocytes), Natural killer T (NKT) cells, and platelet-immune cell aggregates with monocytes, neutrophils, dendritic cells, CD11c+ cells, and NKT cells. In contrast, a significant negative correlation was observed with CD8 cells. Furthermore, a significant positive correlation was observed between sTLT-1 and inflammatory markers (TNF-α, IL-1β, IL-2, IL-6, IL-12p70, IL-18, CXCL-12, and CCL-11). Logistic regression analysis identified sTLT-1 and triglycerides as predictors of CAD. Receiver operating characteristic curve (ROC) analysis showed that sTLT-1 had a higher sensitivity and specificity for predicting CAD. Our findings suggest that platelet activation induces the release of sTLT-1 into the circulation in CAD patients, which aggregates with immune cells and enhances inflammatory responses.

Effect of GLP-1RA Treatment on Adhesion Molecules and Monocyte Chemoattractant Protein-1 in Diabetic Patients with Atherosclerosis

Cardiovascular disease (CVD) remains a prominent cause of global mortality, primarily driven by atherosclerosis. Diabetes mellitus, as a modifiable risk factor, significantly contributes to atherogenesis. Monocyte recruitment to the intima is a critical step in atherosclerotic plaque formation, involving chemokines and adhesion molecules such as selectins, ICAM-1, and MCP-1. Glucagon-like peptide 1 receptor agonists (GLP-1RAs) are a promising group of drugs for reducing cardiovascular risk in diabetic patients, prompting investigation into their mechanisms of action. This interventional study enrolled 50 diabetes patients with atherosclerotic plaque, administering GLP-1RA for 180 days. Serum concentrations of MCP-1, ICAM-1, and L-selectin were measured before and after treatment. Anthropometric and biochemical parameters were also assessed. GLP-1RA treatment resulted in significant improvements in anthropometric parameters, glycemic control, blood pressure, and biochemical markers of liver steatosis. Biomarker laboratory analysis revealed higher baseline levels of MCP-1, ICAM-1, and L-selectin in diabetic patients with atherosclerotic plaque compared to healthy controls. Following treatment, MCP-1 and L-selectin levels decreased significantly (p < 0.001), while ICAM-1 levels increased (p < 0.001). GLP-1RA treatment in diabetic patients with atherosclerotic plaque leads to favorable changes in serum molecule levels associated with monocyte recruitment to the endothelium. The observed reduction in MCP-1 and L-selectin suggests a potential mechanism underlying GLP-1RA-mediated cardiovascular risk reduction. Further research is warranted to elucidate the precise mechanisms and clinical implications of these findings in diabetic patients with atherosclerosis.

SPECT-MPI for Coronary Artery Disease: A Deep Learning Approach

Background

Worldwide, coronary artery disease (CAD) is a leading cause of mortality and morbidity and remains to be a top health priority in many countries. A non-invasive imaging modality for diagnosis of CAD such as single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) is usually requested by cardiologists as it displays radiotracer distribution in the heart reflecting myocardial perfusion. The interpretation of SPECT-MPI is done visually by a nuclear medicine physician and is largely dependent on his clinical experience and showing significant inter-observer variability.

Objective

The aim of the study is to apply a deep learning approach in the classification of SPECT-MPI for perfusion abnormalities using convolutional neural networks (CNN).

Methods

A publicly available anonymized SPECT-MPI from a machine learning repository (https://www.kaggle.com/selcankaplan/spect-mpi) was used in this study involving 192 patients who underwent stress-test-rest Tc99m MPI. An exploratory approach of CNN hyperparameter selection to search for optimum neural network model was utilized with particular focus on various dropouts (0.2, 0.5, 0.7), batch sizes (8, 16, 32, 64), and number of dense nodes (32, 64, 128, 256). The base CNN model was also compared with the commonly used pre-trained CNNs in medical images such as VGG16, InceptionV3, DenseNet121 and ResNet50. All simulations experiments were performed in Kaggle using TensorFlow 2.6.0., Keras 2.6.0, and Python language 3.7.10.

Results

The best performing base CNN model with parameters consisting of 0.7 dropout, batch size 8, and 32 dense nodes generated the highest normalized Matthews Correlation Coefficient at 0.909 and obtained 93.75% accuracy, 96.00% sensitivity, 96.00% precision, and 96.00% F1-score. It also obtained higher classification performance as compared to the pre-trained architectures.

Conclusions

The results suggest that deep learning approaches through the use of CNN models can be deployed by nuclear medicine physicians in their clinical practice to further augment their decision skills in the interpretation of SPECT-MPI tests. These CNN models can also be used as a dependable and valid second opinion that can aid physicians as a decision-support tool as well as serve as teaching or learning materials for the less-experienced physicians particularly those still in their training career. These highlights the clinical utility of deep learning approaches through CNN models in the practice of nuclear cardiology.