Cigarette Smoking and Atherosclerotic Cardiovascular Disease

Effects of high-intensity interval training vs. moderate-intensity continuous training on arterial stiffness in adults: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Arterial stiffness (AS) is regarded as an independent predictor of cardiovascular events and all-cause mortality, and it is significantly associated with global mortality rates. Physical activity (PA) plays a positive role in reducing AS and improving cardiovascular health. The aim of this study is to compare the differences between high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) in their effects on reducing AS.

METHODS

We conducted a comprehensive search of the PubMed, Cochrane, Embase, Web of Science, and EBSCO electronic databases, covering the period from their inception to January 10, 2025. We used a fixed-effect model to compare the changes in pulse wave velocity (PWV) before and after intervention between the HIIT group and the MICT group. Data were reported using the weighted mean difference (WMD) and 95 % confidence interval (95 % CI).

RESULTS

This study included 619 participants from 22 studies. Compared to MICT, HIIT demonstrated a more significant reduction in PWV (-0.10 m/s [95 % CI:0.16 to -0.03], P = 0.005). Additionally, we found that HIIT was superior in reducing CF-PWV (-0.10 m/s [95 % CI:0.17 to -0.02], P = 0.01).

CONCLUSION

HIIT is more effective than MICT in improving PWV and promoting arterial health in adults.

Cigarette Smoking Patterns Among Racial and Ethnic Groups With Chronic Lung Diseases During the COVID-19 Pandemic

Introduction

Chronic obstructive pulmonary disease and asthma are significant respiratory conditions that contribute to substantial morbidity and mortality globally. Chronic obstructive pulmonary disease remains the third most prevalent cause of death worldwide, with 90% of chronic obstructive pulmonary disease deaths attributed to combustible cigarette smoking. Asthma, although often less fatal, leads to considerable health burdens, particularly among marginalized populations who are at higher risk for both more severe chronic obstructive pulmonary disease and asthma outcomes. This study investigates the association between race/ethnicity and current cigarette smoking among adults diagnosed with chronic obstructive pulmonary disease and/or asthma in the U.S. before, during, and after the COVID-19 pandemic.

Methods

The authors analyzed data from 10,763 adults (aged ≥40 years) with a history of chronic obstructive pulmonary disease and/or asthma surveyed in the 2019, 2021, and 2023 National Health Interview Survey. The authors estimated predicted probabilities derived from multiple logistic regression and negative binomial regression models to examine changes in (1) the prevalence of current cigarette smoking in the target population, (2) the mean number of days of cigarette smoking in the past 30 days, and (3) the mean number of cigarettes smoked in the past 30 days across racial/ethnic subgroups and prepandemic, pandemic, and postpandemic periods.

Results

Current cigarette smoking was reported by about one fifth (20%) of U.S. adults diagnosed with chronic obstructive pulmonary disease and asthma. Among them, the mean number of days of cigarette smoking in the past 30 days was 27 days, and the mean number of cigarettes smoked in the past 30 days was 14. Hispanic individuals had the lowest prepandemic rates of current cigarette smoking (10.5%); however, it was the only racial/ethnic group showing a significant change during the pandemic, with rates increasing to 14.9% during the pandemic. Non-Hispanic White individuals, who showed the highest rates of current cigarette smoking (21.1%) during the pandemic, were the only racial/ethnic group showing a significant decline in the postpandemic period (19.8%). No significant changes were observed in the mean number of days or cigarettes smoked in the past 30 days, except for a marginally significant increase in cigarette consumption among non-Hispanic Black individuals.

Conclusions

These analyses suggest that the pandemic had a differential impact on the rates of current smoking across racial/ethnic subgroups in adults with chronic obstructive pulmonary disease and/or asthma, with a detrimental effect in Hispanic individuals and an improvement among non-Hispanic White individuals. Given the dangers of smoking in chronic lung conditions, future research should investigate the factors behind these to develop targeted interventions.

Trimethylamine N-Oxide and Smoking Are Associated With the Progression of Thromboangiitis Obliterans

INTRODUCTION

Thromboangiitis obliterans (TAO) is potentially associated with smoking, although its precise pathogenesis remains unclear. Trimethylamine N-oxide (TMAO) has been implicated in the induction of various cardiovascular and cerebrovascular diseases. However, the role of TMAO in TAO has not been reported. This study aimed to investigate the relationship between smoking, TMAO, and TAO.

MATERIALS AND METHODS

Thirty-three patients diagnosed with TAO and hospitalized for treatment between January 2018 and July 2024 were included in the study. Healthy smokers (n = 38) and nonsmokers (n = 35) were randomly recruited and matched for age, sex, and education level as controls. Subsequently, we analyzed their clinical characteristics, levels of TMAO, and immune and inflammatory markers.

RESULTS

Patients with TAO exhibited significantly higher levels of TMAO, Toll-like receptor 4 (TLR4), receptor for advanced glycation end products, interleukin (IL)-1β, IL-18, tumor necrosis factor-alpha, high mobility group box 1, nuclear factor-κB (NF-κB), and phosphorylated NF-κB (pNF-κB) than those in the smoking and nonsmoking control groups (all P < 0.05). The smoking control group also exhibited significantly higher levels of TMAO, TLR4, IL-1β, NF-κB, and pNF-κB (all P < 0.05) than the nonsmoking control group. TMAO, IL-1β, and tumor necrosis factor-alpha levels were significantly higher in the underage smoking group (all P < 0.05) than in the adult smoking group. The level of TMAO was significantly correlated with the Rutherford classification in patients with TAO, patients' smoking status (including total years of smoking and average daily cigarette consumption), and immune and inflammatory markers (all P < 0.05).

CONCLUSIONS

These findings indicate that gut microbiota plays a significant role in the pathogenesis of TAO. TMAO is likely involved in the pathogenesis and progression of TAO, with smoking acting as a contributing factor. The underlying mechanism may involve the activation of immune-inflammatory pathways, specifically the high mobility group box 1-receptor for advanced glycation end products/TLR4-NF-κB pathway.

[Risk factors and treatment of post-dural puncture headache-an analysis of the German patients of the international EPIMAP study]

BACKGROUND

Accidental dural puncture (ADP) is a rare but serious complication that can lead to post-dural puncture headache (PDPH), a condition known to significantly impair the well-being of affected women.

OBJECTIVES

The present study examines the patient characteristics, symptoms, management and outcomes of women with PDPH after ADP and focuses on differences between conservative management and epidural blood patch (EBP).

MATERIALS AND METHODS

The data of nine German study sites of the European prospective, multicenter cohort EPIMAP (European Practice in the Management of Accidental Dural Puncture in Obstetrics) trial were analyzed. Only descriptive analyses were performed due to the small sample size.

RESULTS

Data were collected between 2016 and 2018 and 73 patients were included in Germany. Of the 73 patients (76.7%), 56 received an EBP and 17 were treated conservatively (23.3%). In the conservative treatment group, the median numeric rating score of pain (NRS) plus interquartile range (IQR) during the hospital stay was 2 (1; 3) at rest and 7 (5; 8) while sitting or standing. Upon discharge, the NRS had decreased to 0 (0; 1) at rest and 2 (1; 4) while sitting or standing. In the EBP group NRS was 3 (1; 7) at rest and 8.5 (7; 10) while sitting or standing 6-12 h before the intervention. Furthermore, 24 h after the EBP, NRS was 0 (0; 2) at rest and 1 (0; 2) while sitting or standing. A total of 15 women were readmitted to the hospital for recurrent PDPH after EBP (26.8%). A second EBP was administered to 9 patients (60%).

CONCLUSION

The EBP is an effective treatment option for post-puncture dural headache. The choice between the EBP and a conservative treatment seems to be influenced by the intensity of the PDPH. These results underline the importance of an individual treatment approach in patients with PDPH.

Developing and validating a predictive model for all-cause mortality in patients with metabolic dysfunction-associated steatotic liver disease

OBJECTIVE

This study aimed to construct a scientific, accurate, and readily applicable clinical all-cause mortality prediction model for patients with metabolic dysfunction-associated steatotic liver disease (MASLD) to enhance the efficiency of disease management and improve patient prognosis.

METHODS

This study was a retrospective cohort study based on the National Health and Nutrition Examination Survey database. The 17,861 participants diagnosed with MASLD were randomly assigned to either a training cohort (n = 12,503) or a validation cohort (n = 5358). Potential predictors were subjected to LASSO regression analysis, and independent risk factors were subsequently identified through multivariate Cox regression analysis. An all-cause mortality prediction model was constructed based on the significant predictors, and a nomogram was generated to illustrate the survival probability of patients at various time points. The model's performance was evaluated using receiver operating characteristic (ROC), calibration, and decision curve analysis (DCA) curves.

RESULTS

A multiple Cox regression analysis identified several independent predictors significantly influencing all-cause mortality in patients with MASLD. These included gender, age, smoking status, hypertension, red blood cell count, albumin, glutamyl transpeptidase, glycosylated hemoglobin, and creatinine. The constructed predictive model demonstrated high accuracy in the training and validation cohorts, with AUC values approaching 0.85 at 3, 5, and 10 years, respectively. Calibration and DCA curves were employed to verify the stability and generalizability of the model.

CONCLUSIONS

We successfully constructed and validated an all-cause mortality prediction model for MASLD patients. This model provides a powerful tool for clinical risk assessment and treatment decision-making.

Obesity-Related Serum Monocyte Chemoattractant Protein-1 (MCP-1) as a Biomarker of Plaque Instability in Patients Undergoing Carotid Endarterectomy

Atherosclerosis is a major contributor to ischemic stroke. Carotid plaque instability is a critical determinant of cerebrovascular events, yet its identification remains challenging. One chemokine with well-documented proatherogenic properties is MCP-1, whose levels are elevated in patients with conditions such as hypertension, obesity, and atherosclerosis. This study evaluated the association between obesity, serum MCP-1 levels, and carotid plaque instability as determined by ultrasound gray-scale median (GSM) analysis in 77 patients who underwent carotid endarterectomy. Patients were classified by body mass index. Serum MCP-1 concentrations were measured using the enzyme-linked immunosorbent assay technique. Analyses were performed to explore relationships between clinical parameters, biochemical markers, and plaque stability. Increasing body weight was paralleled by higher MCP-1 levels and lower GSM values, indicative of unstable plaques. Moreover, logistic regression analysis identified MCP-1 as one of the independent predictors of plaque instability, particularly in overweight and hypertensive patients. These results indicate the potential usefulness of MCP-1 as a biomarker of carotid plaque instability, confirming the negative effect of obesity in promoting other known cardiovascular risk factors causing plaque instability in patients with carotid atherosclerosis.

Global, regional, and national trends in tobacco-induced cardiovascular disease burden for 1990-2021 with projections to 2045: A comprehensive analysis based on the Global Burden of Disease Study 2021

INTRODUCTION

Tobacco use is a major risk factor for cardiovascular disease (CVD), and its global disease burden trends require further clarification. This study aims to analyze trends in global CVD burden attributable to tobacco in 1990-2021 and project mortality rates and disease burden through 2045.

METHODS

Using Global Burden of Disease Study (GBD) 2021 data, we analyzed temporal trends using age-period-cohort models, evaluated change points with Joinpoint regression, and conducted forecasting using Bayesian age-period-cohort (BAPC) models.

RESULTS

In 2021, tobacco-attributable CVD deaths reached 2.147 million globally (71.3% increase from 1990), although age-standardized mortality rates decreased to 25.36 per 100000 (83.3% reduction). Mortality rates were lowest in high SDI regions (326.71 per 100000) and highest in low-middle sociodemographic index (SDI) regions (788.05 per 100000). The proportion of deaths among those aged ≥80 years increased from 19.2% to 26.2%. Global mortality rates decreased by 1.8% annually, with a greater decline in females (-2.6%) than males (-1.6%). Projections suggest that by 2045, global CVD deaths may reach approximately 3.267 million (52.1% potential increase), although age-standardized mortality rates are expected to decrease to around 38.6 per 100000 (15.9% estimated reduction). Disability-adjusted life years (DALYs) are projected to potentially increase to 75.755 million (39.9% estimated increase), while age-standardized DALY rates could decline to approximately 1008.02 per 100000.

CONCLUSIONS

Between 1990 and 2021, global tobacco-attributable CVD mortality rates showed a declining trend, with notable regional, sex, and age disparities. Projections indicate that while age-standardized rates will continue to decrease, absolute numbers of deaths and disease burden will increase. The findings emphasize the need to strengthen tobacco control and CVD prevention in low-middle SDI regions.

Postoperative arrhythmias in geriatric lung cancer patients undergoing thoracoscopic surgery: an exploration of prevalence and influencing factors

BACKGROUND

Arrhythmias are a frequent complication in the postoperative period following surgical procedures. This study aims to investigate the incidence and contributing factors of arrhythmias in elderly patients with lung cancer who have undergone thoracoscopic surgery, thereby providing scientific evidence to support clinical treatment and nursing care.

METHODS

This retrospective cohort study included elderly patients diagnosed with lung cancer who underwent treatment at our hospital between June 1, 2022, and October 31, 2024. Patients were categorized into two groups based on the development of postoperative arrhythmias following thoracoscopic surgery: the arrhythmia group and the non-arrhythmia group. A comparative analysis of the clinical data was conducted between these two groups.

RESULTS

A total of 208 patients were enrolled, with an incidence of postoperative arrhythmias of 19.71% (41/208). Logistic regression analysis identified age ≥ 70 years (OR = 2.586, 95% CI: 1.805-3.221), hypertension (OR = 2.761, 95% CI: 2.103-3.588), history of smoking (OR = 2.070, 95% CI: 1.741-2.446), TNM stage II (OR = 3.181, 95% CI: 2.842-3.690), postoperative pulmonary infection (OR = 2.122, 95% CI: 1.836-2.690), and postoperative constipation (OR = 2.495, 95% CI: 1.988-3.072) as independent risk factors for postoperative arrhythmias (all p < 0.05).

CONCLUSION

The incidence of postoperative arrhythmias in elderly patients with lung cancer following thoracoscopic surgery is relatively high. Targeted interventions addressing the identified risk factors are essential to mitigate the risk of postoperative arrhythmias.

Association of the body roundness index with new-onset cardiovascular disease in middle-aged and older adults with and without diabetes: evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

Among noncommunicable diseases, cardiovascular disease (CVD) is the leading cause of mortality and morbidity. In China, diabetes is renowned for its high incidence rate, and the body roundness index (BRI) is an emerging indicator for assessing obesity, particularly abdominal obesity. High BRI may lead to new-onset CVD events. However, the relationships between the BRI and new-onset CVD in individuals with or without diabetes remain unclear.

METHODS

Data for this analysis were extracted from the China Health and Retirement Longitudinal Study (CHARLS). Our research utilized a cohort that was meticulously assessed over a period from 2011 to 2018, encompassing a comprehensive follow-up of 17,708 participants. Ultimately, this study focused on a subset of 6,737 individuals aged 45 years or older. Methodological approaches include Cox regression, Kaplan-Meier survival analysis, restricted cubic splines (RCS) analysis, receiver operating characteristic (ROC) curve analysis, subgroup analysis, and mediation analysis to explore the relationships of interest.

RESULTS

This study included 6,737 participants, all of whom were above the age of 45. Our findings revealed that within this demographic group, 1,481 (22.0%) patients experienced new-onset CVD. The Kaplan-Meier survival analysis further revealed that the group characterized by non-diabetes mellitus (Non-DM) had the lowest cumulative incidence of CVD compared with the diabetes mellitus (DM) group. Multivariate Cox regression revealed that in the fully adjusted model (Model 3) (HR = 1.122, 95% CI = 1.080 to 1.167), BRI was associated with the risk of CVD in the Non-DM group during the three-wave follow-up. RCS analysis revealed a positive, linear-like dose‒dependent relationship between BRI and new-onset CVD in Non-DM patients (P = 0.007, P for nonlinearity = 0.938). Smoking could affect the ability of the BRI to predict the incidence rate of CVD in the total population and in the population without diabetes (P interaction = 0.007). Moreover, the mediating effect of the BRI on new-onset CVD among diabetic patients was particularly pronounced in the long term, exceeding 4 years.

CONCLUSIONS

Our findings demonstrate a significant association between the BRI and CVD risk in non-diabetic individuals, with diabetes influencing the incidence and risk of new-onset CVD in middle-aged and elderly Chinese populations through the BRI playing a mediating role. As an obesity indicator, the BRI provides a valuable tool for early detection and intervention of CVD.

CLINICAL TRIAL NUMBER

Not applicable.

Natural history of asymptomatic mesenteric artery occlusive disease and predictors of symptomatic progression

OBJECTIVE

The objective of this study was to characterize the natural history of incidentally identified asymptomatic mesenteric artery stenosis and to identify clinical and radiographic predictors that differentiate patients with asymptomatic mesenteric artery occlusive disease (MAOD) and patients with symptomatic chronic mesenteric ischemia (CMI) diagnosed at the index study.

METHODS

This single-institution retrospective analysis included patients diagnosed with >70% stenosis of the celiac or superior mesenteric artery (SMA) on axial imaging or duplex ultrasound examination in an institutional radiology database. Patients were grouped into asymptomatic MAOD and symptomatic CMI cohorts according to their clinical presentation at index study. The primary end point was progression of disease from asymptomatic stenosis to CMI. Demographic, clinical, and imaging features at index study were also compared between asymptomatic and symptomatic cohorts.

RESULTS

Seventy-nine patients met the inclusion criteria, with 43 in the asymptomatic group and 36 in the symptomatic group. Patients in the asymptomatic group were followed for mean 32.7 ± 30.2 months; 60.5% (n = 26) were referred to and followed by a vascular surgeon for 21.5 ± 27.8 months. No asymptomatic patients developed symptoms during the follow-up period. All patients in the symptomatic group were evaluated by a vascular surgeon and underwent procedural intervention for CMI within 6 months of diagnosis. Patients with CMI were more likely to have a history of smoking (P = .02) and less likely to be anticoagulated (P < .01) than patients with asymptomatic MAOD. Symptomatic patients trended toward a greater prevalence of coronary artery disease (P = .06) and a lower prevalence of arrhythmia (P = .08). On imaging, the symptomatic cohort was more likely to have severe SMA stenosis (P < .001), multivessel mesenteric disease (P = .001), calcified aortic plaque (P = .01), and severe stenosis in one or both internal iliac arteries (P < .001). On multivariable analysis, a lack of anticoagulation use (P < .01) and severe SMA stenosis (P < .001) were associated independently with higher odds of symptomatic mesenteric stenosis. Although statistically insignificant, calcified aortic plaque (P = .08) and smoking history (P = .06) trended toward higher odds of symptomatic index presentation.

CONCLUSIONS

The rate of progression from asymptomatic MAOD to CMI seems to be exceedingly low in the first 2 to 3 years after diagnosis, suggesting that prophylactic revascularization is mostly unnecessary. Surveillance of asymptomatic MAOD may be personalized based on clinical and radiographic features of disease. SMA stenosis severity, anticoagulation use, and possibly smoking history and the presence of aortic plaque calcification may be promising markers to stratify the risk of ischemic progression.

Coronary Artery Spasm: From Physiopathology to Diagnosis

Coronary artery spasm (CAS) is a reversible vasoconstriction of normal or atherosclerotic epicardial coronary arteries with a subsequent reduction in myocardial blood flow, leading to myocardial ischemia, myocardial infarction, severe arrhythmias, or even sudden death. It is an entity that should be recognized based on a particular clinical presentation. Numerous differences exist between CAS and obstructive coronary disease in terms of mechanisms, risk factors, and therapeutic solutions. The gold standard for CAS diagnosis is represented by transitory and reversible occlusion of the coronary arteries at spasm provocation test, which consists of an intracoronary administration of Ach, ergonovine, or methylergonovine during angiography. The pathophysiology of CAS is not fully understood. However, the core of CAS is represented by vascular smooth muscle cell contraction, with a circadian pattern. The initiating event of this contraction may be represented by endothelial dysfunction, inflammation, or autonomic nervous system unbalance. Our study explores the intricate balance of these factors and their clinical relevance in the management of CAS.

Variants in candidate genes and their interactions with smoking on the risk of acute coronary syndrome

INTRODUCTION

Multiple genetic and environmental factors interact with the development of acute coronary syndrome. Smoking is one of the environmental factors that might alter the metabolic pathways shared by genes associated with this condition.

OBJECTIVE

To investigate the association of acute coronary syndrome with genetic variants related to inflammation, lipid metabolism, and platelet aggregation among subjects from the northeastern region of Colombia. The effects of interactions between polymorphisms and smoking were also evaluated.

MATERIALS AND METHODS

We analyzed data from 330 acute coronary syndrome cases and 430 controls. Associations between 20 polymorphisms and acute coronary syndrome were evaluated using logistic regression, adjusting for confounders. Gene and smoking interaction terms were calculated, and variants were analyzed separately in smokers and non-smokers for their association with acute coronary syndrome.

RESULTS

Two variants were associated with acute coronary syndrome, rs10455872 in the LPA gene (OR = 2.69; 95% CI: 1.61-4.49) and rs429358 in the APOE gene (OR = 1.93; 95% CI: 1.30-2.87). We identified smoking interactions with the variants rs6511720 in the LDLR gene (p = 0.04) and rs2227631 in the SERPINE1 gene (p = 0.02), with significant effects in non-smokers (rs6511720: OR = 0.40; 95% CI: 0.19-0.88; and rs2227631: OR = 0.69; 95% CI: 0.48-1.00), but not in smokers (rs6511720: OR = 1.28; 95% CI: 0.66-2.46; and rs2227631: OR = 1.30; 95% CI: 0.91-1.87).

CONCLUSIONS

Variants in the candidate genes LPA and APOE are associated with an increased risk of acute coronary syndrome in a population from northeastern Colombia. The effects of rs6511720 in LDLR and rs2227631 in SERPINE1 differ according to smoking habits and are significant in non-smokers. These results are helpful for early risk screening of acute coronary syndrome, mainly in individuals without defined conventional risk factors.

Treatment of endothelial cell dysfunction in atherosclerosis: a new perspective integrating traditional and modern approaches

Atherosclerosis (AS), a prime causative factor in cardiovascular disease, originates from endothelial cell dysfunction (ECD). Comprising a vital part of the vascular endothelium, endothelial cells play a crucial role in maintaining vascular homeostasis, optimizing redox balance, and regulating inflammatory responses. More evidence shows that ECD not only serves as an early harbinger of AS but also exhibits a strong association with disease progression. In recent years, the treatment strategies for ECD have been continuously evolving, encompassing interventions ranging from lifestyle modifications to traditional pharmacotherapy aimed at reducing risk factors, which also have demonstrated the ability to improve endothelial cell function. Additionally, novel strategies such as promising biotherapy and gene therapy have drawn attention. These methods have demonstrated enormous potential and promising prospects in improving endothelial function and reversing AS. However, it is essential to remain cognizant that the current treatments still present significant challenges regarding therapeutic efficacy, long-term safety, and ethical issues. This article aims to provide a systematic review of these treatment methods, analyze the mechanisms and efficacy of various therapeutic strategies, with the goal of offering insights and guidance for clinical practice, and further advancing the prevention and treatment of cardiovascular diseases.

Aerosolized nicotine-free e-liquid base constituents exacerbates mitochondrial dysfunction and endothelial glycocalyx shedding via the AKT/GSK3β-mPTP pathway in lung injury models

Smoking has been recognized as a risk factor of cancer, heart disease, stroke, diabetes, and lung diseases such as chronic obstructive pulmonary disease, and nicotine appears to be the responsible component of tobacco smoke that affects lung development. While nicotine-free electronic cigarettes (e-cigarettes) are often promoted as a safer alternative to traditional smoking, recent evidence suggests that they might pose significant health risks. This study investigates the effects of nicotine-free e-cigarette vapor (ECV) on lung tissue and endothelial function. A mouse model of ECV-induced lung injury and human pulmonary microvascular endothelial cells (HPMVECs) were utilized to evaluate the impact of ECV exposure on mitochondrial function, endothelial cell viability, and glycocalyx shedding. ECV exposure significantly damages lung tissue, characterized by alveolar enlargement, inflammation, and vascular remodeling, indicative of emphysematous changes. In vitro, HPMVECs exposed to nicotine-free e-cigarette extract (ECE) demonstrated dose-dependent increases in mitochondrial reactive oxygen species (ROS), mitochondrial membrane depolarization, mPTP opening, and reduced ATP production, leading to enhanced endothelial permeability and glycocalyx degradation. The inhibition of mPTP opening with Cyclosporin A (CsA) was found to mitigate the mitochondrial dysfunction and glycocalyx damage induced by ECE, indicating a protective role of mPTP inhibition in preserving endothelial integrity. The AKT/GSK3β signaling pathway was identified as a key regulator of these processes, with ECE exposure downregulating p-AKT and p-GSK3β, thereby promoting mPTP opening. Activation of AKT signaling partially reversed these effects, highlighting the potential of targeting the AKT/GSK3β-mPTP axis to mitigate the adverse effects of e-cigarette exposure on lung and endothelial function. These findings underscore the potential risks associated with nicotine-free e-cigarettes and suggest novel therapeutic targets for preventing lung injury progression.

Multidisciplinary Clinical Study on Retinal, Circulatory, and Respiratory Damage in Smoking-Dependent Subjects

Background and Objectives: Cigarette smoking is a widely prevalent risk factor in the global population, despite its well-recognized systemic impact. In this pilot study, an association was hypothesized between alterations in hemorheological and respiratory characteristics and damage at the chorioretinal level, considering that traditional cigarette smoking may increase oxidative stress, platelet activation, and thrombotic phenomena at the systemic level. Fundoscopy can provide information about the characteristics of the cerebral district and the entire circulatory system. Therefore, the aim of this research was to evaluate the impact of cigarette smoking on chorioretinal vascularization and pulmonary and blood parameters through investigations with optical coherence tomography angiography (OCTA), spirometry, and the total thrombus formation analysis system (T-TAS). Materials and Methods: Thirty subjects were recruited, divided into 20 traditional cigarette smokers (SMs) and 10 non-SMs, who underwent a comprehensive ocular examination, including OCTA. Spirometric evaluation and blood sampling were also performed on both groups to study pulmonary functional capacity, as well as T-TAS. Results: An analysis of the obtained data confirmed the systemic impact of smoking, evidenced by an increase in T-TAS and a decrease in forced expiratory volume in 1 s expressed in liters (FEV1 L) in SMs compared to the non-SMs group. Additionally, OCTA revealed a statistically significant alteration in macular vascular density (FD) in the right eye (RE) of the examined SMs. The other parameters evaluated did not show statistically significant differences. Conclusions: It is believed that FD, FEV1, and T-TAS may be promising values in correlating the alterations observed in SMs, as highlighted by the changes detected with OCTA, spirometry, and hemorheological data. Further research is needed to confirm and expand the results already obtained and to evaluate the systemic vascular damage and oxidative stress caused by tobacco consumption.

TCF7L2 as a target of peripheral artery disease in patients with type 2 diabetes: A 2-sample Mendelian randomization and bioinformatics study

This study examines the causal relationship between type 2 diabetes (T2D) and peripheral artery disease (PAD) and their potential mechanisms based on the analysis of the Gene Expression Omnibus database and 2-sample Mendelian randomization (MR). The first part involved a 2-sample MR study and a comprehensive meta-analysis. Differences in the results were assessed using inverse-variance weighting. Heterogeneity was examined using the Cochrane Q statistical test. The leave-one-out method was applied for sensitivity analysis. The potential horizontal pleiotropic effect was assessed using the MR-Egger intercept technique. The second part involved differential gene analysis and weighted gene coexpression network analysis. Subsequently, we overlapped and consolidated the results from the 2 parts to identify the key genes between them. MR analysis results suggested a statistically significant correlation between the incidence of PAD and T2D (odds ratio: 1.22, 95% confidence interval: 1.13-1.32, P = 3.74e-07). We anticipated a pivotal role for TCF7L2 in PAD and T2D. T2D was significantly associated with PAD risk. Simultaneously, the study deepened our understanding of the underlying mechanisms of both diseases, proposing TCF7L2 as a promising target.

Atherosclerosis: A Comprehensive Review of Molecular Factors and Mechanisms

Atherosclerosis, a condition characterized by the accumulation of lipids and a culprit behind cardiovascular events, has long been studied. However, in recent years, there has been an increase in interest in its initiation, with researchers shifting focus from traditional pathways involving the vascular infiltration of oxidized lipids and towards the novel presence of chronic inflammatory pathways. The accumulation of pro-inflammatory cytokines, in combination with the activation of transcription factors, creates a positive feedback loop that drives the creation and progression of atherosclerosis. From the upregulation of the nod-like receptor protein 3 (NLRP3) inflammasome and the Notch and Wnt pathways to the increased expression of VEGF-A and the downregulation of connexins Cx32, Cx37, and Cx40, these processes contribute further to endothelial dysfunction and plaque formation. Herein, we aim to provide insight into the molecular pathways and mechanisms implicated in the initiation and progression of atherosclerotic plaques, and to review the risk factors associated with their development.

Prevalence, characteristics and outcomes of patients with metabolic and alcohol related/associated liver disease (MetALD): a systematic review and meta-analysis

BACKGROUND

In light of the new nomenclature of steatotic liver disease (SLD), we aimed to enhance the existing knowledge on the epidemiology and clinical outcomes of metabolic and alcohol related/associated liver disease (MetALD).

METHODS

A systematic review and meta-analysis were performed in Medline/PubMed, Embase, Scopus and Cochrane databases to evaluate the prevalence and outcomes of MetALD within the SLD population and to compare the characteristics between MetALD patients and those with metabolic dysfunction associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD). Nineteen studies from nine countries that evaluated 4,543,341 adult participants with SLD were included.

RESULTS

The pooled overall prevalence of MetALD among the SLD population was 10 % (95%CI:7-13 %) without significant difference between Asian and non-Asian populations. However, MetALD was more frequent in men than women (86 % vs 14 %, p < 0.01), while Asian MetALD patients, were more frequent men (92 % vs 66 %, p < 0.01) compared to non-Asians. Additionally, in terms of metabolic characteristics there were no significant differences between MetALD, MASLD and ALD patients. Regarding outcomes, patients with MetALD, compared to non-SLD, were at increased risk of all-cause [HR 1.44 (95%CI:1.24-1.66)], cardiovascular disease (CVD) [HR 1.17 (95%CI:1.12-1.21)] and cancer-related mortality [HR 2.07 (95%CI:1.32-3.25)]. Finally, patients with MetALD, had increased incidence of CVD and liver decompensating events, compared to non-SLD participants [HR 1.49 (95%CI:1.03-2.15); HR 10.55 (95%CI:3.46-32.16) respectively].

CONCLUSIONS

Based on the existing literature, patients with MetALD consist a significant part of the SLD population, with high all-cause, CVD and cancer-related mortality and increased risk for CVD and hepatic decompensation.

Cystine transporter SLC7A11 regulates sensitivity to unsaturated carbonyl compounds in mouse macrophage cell lines

Cytotoxic effects of cigarette smoke are thought to be causes of cigarette smoking-related diseases such as respiratory infection, chronic obstructive pulmonary disease, and atherosclerosis. Unsaturated carbonyl compounds are major cytotoxic factors in the gas phase of cigarette smoke. Cell death induced by unsaturated carbonyl compounds in cigarette smoke is PKC-dependent ferroptosis. Although the cell sensitivity to unsaturated carbonyl compounds varies by cell types, the molecular mechanisms underlying this sensitivity remain unclear. In this study, we have examined the factors involved in determining sensitivity to unsaturated carbonyl compounds. We found that two mouse macrophage cell lines exhibited different sensitivities; J774.1 macrophages were sensitive to unsaturated carbonyl compounds, whereas RAW264.7 macrophages were resistant. Glutathione synthesis inhibitor increased the sensitivity of RAW264.7 macrophages to unsaturated carbonyl compounds. Quantitative RT-PCR revealed that the expression level of the cystine transporter SLC7A11 was higher in RAW264.7 macrophages than in J774.1 macrophages. Inhibition of SLC7A11 activity increased sensitivity to unsaturated carbonyl compounds, while overexpression of SLC7A11 enhances resistance to these compounds. The current results suggest that the SLC7A11 level is a key factor in determining the macrophage sensitivity to unsaturated carbonyl compounds.

Impact of smoking habits on cardiovascular and neoplastic events and all-cause death in people with HIV from the STOPSHIV cohort

OBJECTIVE

The study aimed to assess the impact of smoking exposure on major clinical events (MCEs) in a real-life setting of people with HIV (PWH).

DESIGN

An observational, longitudinal, multicenter cohort study from Italy.

METHODS

Consecutive 983 PWH were enrolled in "STOP Smoking in HIV people" (STOPSHIV) projects and followed from July 2014 until September 2023. The observed MCE defined as cardiovascular events, neoplastic diseases, or death for any reason was assessed according to smoking status and related variables (number of cigarettes smoked daily, pack-years, Fagerström test) in participants. The association between exposure variables and the event was evaluated using the Cox proportional hazard model [hazard ratios, and 95% confidence interval (95% CI)].

RESULTS

Over 6997.6 person-years of follow-up (PYFU), we found a total of 49 cardiovascular events, 61 neoplastic events, and 47 deaths. The overall incidence rate of MCE was 17.6 /1000 PYFU (95% CI 14.7-21.0). All-cause death rate was 6.7 (95% CI 5.0-8.9)/1000 PYFU. In a multivariate analysis, older age (hazard ratio 1.07, CI 1.05-1.09), high Fagerström Test for Nicotine Dependence (hazard ratio 1.09, CI 1.03-1.15), a low nadir CD4 + cell count less than 200 cells/μl (hazard ratio 1.63, CI 1.10-1.41), history of previous neoplasm (hazard ratio 2.41; CI 1.34-4.43), and IDU as a risk factor for HIV infection (hazard ratio 2.36; CI 1.52-3.68) were independent predictors of any MCE.

CONCLUSION

Non-AIDS clinical conditions are the most observed clinical events in PWH from Italy. Smoking exposure significantly increases the risk of MCE in PWH, and a high Fagerström Test for Nicotine Dependence is a predictor of MCE.

Trimethylamine N-Oxide (TMAO) and TNF-α Levels in Periodontal Disease Associated With Smoking

AIMS

Trimethylamine N-oxide (TMAO) is a compound involved in the pathogenesis of various systemic inflammatory diseases, including cardiovascular conditions. The aim of this study was to determine differences in saliva and serum levels of TMAO between periodontitis and healthy patients according to smoking status.

METHODS

The study included four systemically healthy groups: periodontally healthy non-smokers (NS-Control; n = 25), non-smokers with Stage-III-Grade-B periodontitis (NS-Periodontitis; n = 25), periodontally healthy smokers (S-Control; n = 25), and smokers with Stage-III Grade-C periodontitis (S-Periodontitis; n = 25). Periodontal parameters were recorded. TMAO levels were determined in saliva and serum samples using liquid chromatography-mass spectrometry (LC-MS/MS). TNF-α levels were measured by the ELISA method.

RESULTS

Salivary TNF-α and TMAO levels were significantly elevated in the smoking periodontitis group compared to other groups (p < 0.001 and p = 0.003, respectively). Serum TMAO levels were also significantly higher in the smoking periodontitis group compared to non-smoking controls and non-smoking periodontitis. TMAO/SFR ratios were notably higher in the smoking periodontitis group compared to other groups, and a strong positive correlation was observed between salivary TMAO and TNF-α levels (r = 0.892, p < 0.001).

CONCLUSION

The data suggested that TMAO and TNF-α are associated with inflammatory mechanisms of periodontitis in cases where periodontitis coexists with smoking.

TRIAL REGISTRATION

NCT06580431.

Sex-specific associations of cigarettes and e-cigarettes use with self-reported premature atherosclerotic cardiovascular disease among adults aged 18-54 in the United States

BACKGROUND

Premature atherosclerotic cardiovascular disease (ASCVD) is increasing in young adults (<55 years old). While research suggests females who smoke cigarettes have a higher risk of ASCVD than males, studies on the impact of exclusive e-cigarette and dual use on premature ASCVD are limited. This study investigated the association between tobacco use and self-reported premature ASCVD and explored potential sex differences.

METHODS

Using pooled data from 480,317 adults (ages 18-54; ∼50 % female) from the 2020-2022 Behavioral Risk Factor Surveillance System from the United States, logistic regression models assessed associations between cigarette and e-cigarette use patterns and self-reported premature ASCVD. Tobacco use categories were defined as: non-use, former use (cigarettes, e-cigarettes), and current use (cigarettes, e-cigarettes) and dual use. Self-reported premature ASCVD was defined as self-reported angina or coronary heart disease, heart attack, or stroke. Weighted analyses were conducted for the overall sample and stratified by sex.

RESULTS

After controlling for potential confounders, former exclusive cigarette (adjusted OR: 1.47 [95 % CI 1.29, 1.67]), current exclusive cigarette (1.68 [1.47-1.94]) and current dual (2.03 [1.69-2.44]) use were associated with higher odds of self-reported premature ASCVD. There was no significant association for e-cigarette use. Sex-specific analyses revealed similar patterns but the magnitude of these associations varied between males and females.

CONCLUSION

Both sexes showed higher odds of self-reported premature ASCVD for dual and exclusive cigarette use. Although the cross-sectional design precludes causal inferences, the findings suggest comprehensive tobacco cessation programs tailored to diverse use patterns are needed to reduce the burden of premature ASCVD.

Vascular Stress Markers Following Inhalation of Heated Tobacco Products: A Study on Extracellular Vesicles

The advent of heated tobacco products (HTPs) has introduced new variables in the study of nicotine delivery systems and their health implications. Amidst concerns over cardiovascular effects, this study aims to elucidate the acute impact of HTP inhalation on extracellular vesicles (EV) levels in young, healthy individuals. In this controlled, acute exposure study, 23 young, healthy volunteers were subjected to HTP inhalation. EV levels of endothelial and platelet origin were quantified through flow cytometry before and after exposure. Data analysis was performed using multiple measures ANOVA to assess changes in EV concentrations. Our findings reveal a significant increase in EVs of endothelial and platelet origin following short-term HTP inhalation with nicotine. Notably, no significant change was observed in leukocyte- and neutrophil-derived EVs. This increase in EVs suggests acute vascular stress, with peak levels observed 4 h post-exposure. The rise in endothelial and platelet-derived EVs aligns with documented responses to acute vascular injury, paralleling the effects seen with traditional cigarette and e-cigarette use. Despite HTPs being marketed as safer alternatives, our results indicate that nicotine-containing HTPs may still pose significant vascular risks. These findings contribute to the growing body of evidence cautioning against the perceived safety of HTPs and reinforce the importance of regulatory oversight and public health initiatives targeting nicotine delivery technologies. Trial Registrations: ClinicalTrials.gov ID: NCT04824495, registered 2021-01-07.

Breast Arterial Calcification on a Screening Mammogram: A Potential Cardiovascular Risk Stratification Tool in Women

Breast arterial calcification (BAC) is a common benign finding on a screening mammogram. Additionally, BAC is a type of medial calcification known as Mönckeberg medial calcific sclerosis, which differs from the intimal calcification seen in patients with coronary artery disease (CAD). Recently, BAC has appeared as a new cardiovascular risk stratification method. Studies have indicated a potential link between BAC and cardiovascular risk factors, particularly coronary artery calcification (CAC), as observed in coronary computed tomography. However, the association between BAC and myocardial ischemia and angiographic-proven CAD remains controversial. The usefulness of BAC during mammography as a potential screening tool for CAD has been the subject of uncertainty and debate for many years. This article reviews the current literature on BAC and its association with CAC, myocardial ischemia, and angiographic-proven CAD on both invasive and coronary computed tomography. Cardiovascular outcomes, current limitations, and future investigation and recommendations are also explored and discussed.

Estrogen administration enhances the adverse effects of cigarette smoking on the heart in cycling female mice

Smoking, particularly chronic smoking (CS), is a threat to global health, contributing to increased mortality and morbidity associated with cardiovascular disease (CVD). CS induces oxidative stress and endothelial dysfunction, which has a profound impact on cardiac structure and function. While the protective effects of estrogen, particularly 17β-estradiol (E2), on cardiovascular health are well-documented in premenopausal women, the interaction between estrogen and CS remains poorly understood. The aim of this study is to investigate the impact of chronic cigarette smoking on cardiac health in relation to ethinylestradiol (EE) oral contraceptive (OC) usage in premenopausal females. Female mice were exposed to chronic cigarette smoke and co-administered EE. Cardiac structural and functional parameters were assessed alongside inflammatory markers, oxidative stress indicators, and histological changes. Results revealed that the combination of EE and CS led to adverse cardiac remodeling characterized by increased left ventricular end-diastolic volume and elevated left ventricular mass. In addition, an inflammatory state was evident, marked by increased expression of IL-4, IL-1β, IL-13, IL-10, and PARP-1, as well as increased interstitial collagen deposition. These findings suggest a progression towards adverse cardiac remodeling resembling dilated cardiomyopathy. Furthermore, our observations highlight the complexity of the inflammatory response triggered by smoking, potentially exacerbated by estrogen supplementation. The main finding of this study is that the combination of CS and EE enhanced adverse cardiac remodeling, which was shown structurally, histologically, and biochemically.

Evaluation of Coronary Artery Calcium Score (CACS) in Dipper and Non-Dipper Hypertensive Patients with Moderate and High Cardiovascular Disease Risks

Background and Objectives: Hypertension is typically classified into two main groups, "dipper" and "non-dipper", based on nocturnal blood pressure decline. The coronary artery calcium score (CACS) is an essential biomarker used to assess the presence and severity of coronary artery disease (CAD). This study aims to demonstrate the relationship between CACS and hypertensive patients with moderate-to-high cardiovascular disease (CVD) risk classified as either dipper or non-dipper. Participants and Methods: A total of 167 patients with moderate-to-high CVD risk were divided into two subgroups: 95 patients with dipper hypertension (HT) and 72 with non-dipper hypertension. CACS was measured using coronary computed tomography angiography. Results: In the dipper HT group, there were 60 females (63.2%) and 35 males (36.8%), whereas the non-dipper HT group included 28 females (38.9%) and 44 males (61.1%) (p = 0.002). The mean age was 57 in the dipper HT group and 62 in the non-dipper HT group (p = 0.011). The mean CACS was 93 in the non-dipper HT group and 10 in the dipper HT group (p < 0.001). A history of coronary artery disease was more common in the non-dipper HT group (p = 0.003). Smoking prevalence was higher in the non-dipper HT group (31 patients, 43.1%) compared to the dipper HT group (25 patients, 26.3%) (p = 0.023). Correlation analysis showed that CACS was positively correlated with age, BMI, and HbA1c and negatively correlated with eGFR. Higher CACS values were also observed in males and patients with a history of coronary artery disease, diabetes mellitus, and hyperlipidemia. In univariate analysis, age, male sex, smoking, CAD, CACS, and elevated creatinine were identified as significant risk factors for non-dipper HT (p < 0.05). However, in multivariate analysis, only CACS emerged as a significant independent risk factor (p = 0.001), while other variables were not significant (p > 0.05). The area under the curve (AUC) for CACS was 0.759, indicating statistically significant and excellent discriminative capability (p < 0.001, 95% CI: 0.680-0.839). Conclusions: It was concluded that non-dipper hypertension is associated with higher CACS and indicates a higher cardiovascular risk for this group.

Mulberroside A attenuates cigarette smoke-induced atherosclerosis in ApoE-/- mice via the Sirt1-HIF-1α axis

OBJECTIVE

This study investigated whether Mulberryside A (MBA) can attenuate cigarette smoke extract (CSE)-induced autophagy through a Sirt1-dependent pathway, thereby attenuating atherosclerosis in ApoE-/- mice.

METHODS

After treating human umbilical vein endothelial cells (HUVECs) with CSE and MBA, an MTT assay was performed to detect cell activity. Immunofluorescence and Western blotting were used to determine the expressions of autophagy-related proteins, Sirt1 and HIF-1α. Lentivirus and siRNA were used to construct overexpression and silencing (Sirt1 and HIF-1α) models. The in vivo inflammatory effects of CS on atherosclerosis in ApoE-/- mice were assessed by exposing mice to CS and MBA treatment. HE staining was used to detect atherosclerosis in mouse aortic tissue, and electron microscopy was used to detect autophagy of endothelial cells.

RESULTS

CSE promoted autophagy in HUVECs, down-regulated Sirt1, and up-regulated HIF-1α expression. MBA treatment, overexpression of Sirt1, or silencing of HIF-1α attenuated CSE-induced autophagy, while MBA reversed CSE-induced downregulation of Sirt1 and upregulation of HIF-1α. However, overexpression of HIF-1α increased autophagy in HUVECs and attenuated the protective effect of Sirt1 overexpression or MBA on CSE-induced autophagy in HUVECs. In vivo experiments also demonstrated that MBA attenuates CS-induced aortic autophagy in ApoE-/- mice and up-regulates Sirt1 and downregulates HIF-1α expression.

CONCLUSIONS

MBA attenuates CSE-induced autophagy through the Sirt1-HIF-1α axis, thereby attenuating atherosclerosis in ApoE-/- mice.

Plaque Stabilization and Regression, from Mechanisms to Surveillance and Clinical Strategies

With advances in therapies to reduce cardiovascular events and improvements in coronary imaging, an increasing number of clinical trials have demonstrated that treatments to reduce cardiovascular events in coronary artery disease are associated with favorable effects on atherosclerotic plaque size and characteristics. It has been observed that various drugs may induce plaque regression and enhance plaque stability after plaque formation. Numerous clinical trials have been conducted to verify the occurrence of plaque stabilization and regression and their beneficial effects on cardiovascular events. Using invasive imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), researchers have been able to gather evidence supporting the existence of coronary plaque stabilization and regression. In this review, we explore the possible mechanisms of plaque stabilization and regression, summarize the imaging features of plaque stabilization and regression, and assemble the evidence from clinical studies that have used different features as observational endpoints.

Chronic exposure to E-cigarette aerosols potentiates atherosclerosis in a sex-dependent manner

Despite being designed for smoking cessation, e-cigarettes and their variety of flavors have become increasingly attractive to teens and young adults. This trend has fueled concerns regarding the potential role of e-cigarettes in advancing chronic diseases, notably those affecting the cardiovascular system. E-cigarettes contain a mixture of metals and chemical compounds, some of which have been implicated in cardiovascular diseases like atherosclerosis. Our laboratory has optimized in vivo exposure regimens to mimic human vaping patterns. Using these established protocols in an inducible (AAV-PCSK9) hyperlipidemic mouse model, this study tests the hypothesis that a chronic exposure to e-cigarette aerosols will increase atherosclerotic plaques. The exposures were conducted using the SCIREQ InExpose™ nose-only inhalation system and STLTH or Vuse products for 16 weeks. We observed that only male mice exposed to STLTH or Vuse aerosols had significantly increased plasma total cholesterol, triglycerides, and LDL cholesterol levels compared to mice exposed to system air. Moreover, these male mice also had a significant increase in aortic and sinus plaque area. Male mice exposed to e-cigarette aerosol had a significant reduction in weight gain over the exposure period. Our data indicate that e-cigarette use in young hyperlipidemic male mice increases atherosclerosis in the absence of significant pulmonary and systemic inflammation. These results underscore the need for extensive research to unravel the long-term health effects of e-cigarettes.

Functional Foods in Preventing Human Blood Platelet Hyperactivity-Mediated Diseases-An Updated Review

Backgrounds/Objectives: Abnormal platelet functions are associated with human morbidity and mortality. Platelets have emerged as critical regulators of numerous physiological and pathological processes beyond their established roles in hemostasis and thrombosis. Maintaining physiological platelet function is essential to hemostasis and preventing platelet-associated diseases such as cardiovascular disease, cancer metastasis, immune disorders, hypertension, diabetes, sickle cell disease, inflammatory bowel disease, sepsis, rheumatoid arthritis, myeloproliferative disease, and Alzheimer's disease. Platelets become hyperactive in obesity, diabetes, a sedentary lifestyle, hypertension, pollution, and smokers. Platelets, upon activation, can trawl leukocytes and progenitor cells to the vascular sites. Platelets release various proinflammatory, anti-inflammatory, and angiogenic factors and shed microparticles in the circulation, thus promoting pathological reactions. These platelet-released factors also maintain sustained activation, further impacting these disease processes. Although the mechanisms are unknown, multiple stimuli induce platelet hyperreactivity but involve the early pathways of platelet activation. The exact mechanisms of how hyperactive platelets contribute to these diseases are still unclear, and antiplatelet strategies are inevitable for preventing these diseases. Reducing platelet function during the early stages could significantly impact these diseases. However, while this is potentially a worthwhile intervention, using antiplatelet drugs to limit platelet function in apparently healthy individuals without cardiovascular disease is not recommended due to the increased risk of internal bleeding, resistance, and other side effects. The challenge for therapeutic intervention in these diseases is identifying factors that preferentially block specific targets involved in platelets' complex contribution to these diseases while leaving their hemostatic function at least partially intact. Since antiplatelet drugs such as aspirin are not recommended as primary preventives, it is essential to use alternative safe platelet inhibitors without side effects.

METHODS

A systematic search of the PUBMED database from 2000 to 2023 was conducted using the selected keywords: "functional foods", "polyphenols", "fatty acids", "herbs", fruits and vegetables", "cardioprotective agents", "plant", "platelet aggregation", "platelet activation", "clinical and non-clinical trial", "randomized", and "controlled".

RESULTS

Potent natural antiplatelet factors have been described, including omega-3 fatty acids, polyphenols, and other phytochemicals. Antiplatelet bioactive compounds in food that can prevent platelet hyperactivity and thus may prevent several platelet-mediated diseases, including cardiovascular disease.

CONCLUSIONS

This narrative review describes the work during 2000-2023 in developing functional foods from natural sources with antiplatelet effects.

Dose-Dependent association of cumulative tobacco consumption with the presence of carotid atherosclerosis in individuals with type 1 diabetes

AIMS

Evaluate the association between cumulative tobacco consumption (CTC; packs-year) and atherosclerosis in type 1 diabetes (T1D), and study whether the inclusion of CTC in the Steno T1 Risk Engine (ST1RE) equation improves the identification of plaques.

METHODS

Cross-sectional study in T1D patients without cardiovascular disease (CVD), with ≥ 1 of the following: ≥40 years-old, diabetic kidney disease, and/or T1D duration ≥ 10 years + cardiovascular risk factors.Preclinical atherosclerosis was evaluated by carotid ultrasonography.

RESULTS

N = 584 patients were included (46.1 % women, age 48.7 ± 10.5 years, T1D duration 27.3 ± 10.8 years, 26.2 % active smokers). The overall plaque prevalence was 40.9 %. In models adjusted for age, sex, lipids, blood pressure, kidney function, statin use, microvascular complications and HbA1c, CTC was dose-dependently associated with the number of plaques (none, 1-2, ≥3) overall and in both active and former smokers (p < 0.001). This association remained after adjusting for ST1RE (OR 1.11 [1.02-1.19]). Although the inclusion of CTC in the ST1RE did not improve plaque identification overall (p = 0.180), it did so when analyzing active smokers separately (AUC 0.738 vs. 0.768; p < 0.01).

CONCLUSIONS

In T1D patients, CTC is dose-dependently associated with atherosclerosis. Further prospective studies are needed to determine if CTC could identify T1D individuals more prone to accelerated atherosclerosis.