Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel

Remnant cholesterol inflammatory index and its association with all-cause and cause-specific mortality in middle-aged and elderly populations: evidence from US and Chinese national population surveys

BACKGROUND

The remnant cholesterol inflammatory index (RCII) is a novel metric that combines remnant cholesterol and high-sensitivity C-reactive protein, reflecting the metabolic and inflammatory risk. This study investigates the association between RCII and long-term risks of all-cause and cause-specific mortality in middle-aged and elderly populations in the US and China.

METHOD

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS), including 7,565 and 12,932 participants aged 45 years and older, respectively. The participants were categorized into quartiles based on natural log-transformed RCII (lnRCII) values. Kaplan-Meier survival analysis, Cox proportional hazards models, restricted cubic splines (RCS) and mediation analysis were used to examine the relationship between lnRCII and mortality outcomes, adjusting for potential covariates.

RESULT

The mean age of the participants was 59.90 ± 10.44 years (NHANES) and 58.64 ± 9.78 years (CHARLS), with 53.28% and 52.50% female, respectively. Kaplan-Meier survival analysis showed that higher lnRCII quartiles (≥ 0.79 in NHANES, ≥ -0.13 in CHARLS) were significantly associated with increased all-cause mortality risk (p < 0.001). Each standard deviation (SD) increase in lnRCII corresponded to a higher risk of all-cause mortality, and the hazard ratios (HRs) and 95% confidence interval (CI) were 1.29 (95% CI: 1.21-1.36) in NHANES and 1.26 (95% CI: 1.15-1.38) in CHARLS. In NHANES, lnRCII was also associated with elevated risks of cardiovascular mortality (HR = 1.21, 95% CI: 1.08-1.35) and cancer mortality (HR = 1.30, 95% CI: 1.09-1.55). RCS analysis indicated a J-shaped relationship between lnRCII and both all-cause and cardiovascular mortality, and a linear association with cancer mortality. Mediation analysis showed that systolic blood pressure and fasting plasma glucose partially mediated these associations. Subgroup analyses suggested a stronger association between lnRCII and all-cause mortality in middle-aged US participants (p for interaction = 0.010).

CONCLUSIONS

Elevated RCII levels are significantly associated with increased all-cause mortality risk middle-aged and elderly populations in both the US and China. In the US population, RCII is also associated with increased risks of cardiovascular and cancer mortality. By integrating metabolic and inflammatory risk factors, RCII may serve as a valuable tool for mortality risk stratification and clinical decision-making.

Metabolomic profiling of a cholesterol lowering plant-based diet from two randomized controlled feeding trials

BACKGROUND

Objective biomarkers of diet, such as metabolomics, may improve dietary assessment and provide additional insight into how diet influences disease risk. The portfolio diet, a cholesterol-lowering plant-based diet, is recommended for lowering low-density lipoprotein cholesterol (LDL-C). This diet is low in saturated fat and includes nuts, plant protein (legumes), viscous fiber, and phytosterols.

OBJECTIVE

We examined metabolomic profiles in response to the portfolio diet in two randomized controlled trials (RCTs), where all foods were provided to the participants, compared to a control vegetarian diet and the same control diet with a statin.

METHODS

The first RCT included 34 adults (age 58.4 ± 8.6 y) and the second RCT included 25 adults (age 61.0 ± 9.6 y), all with high LDL-C (>4.1 mmol/L). Plasma samples were obtained at baseline, week 2, and week 4 in both RCTs for metabolomics analysis using liquid chromatography-tandem mass spectrometry. Linear mixed models were used to examine effects of the interventions on the metabolites in each RCT, applying a Bonferroni correction.

RESULTS

Of 496 known metabolites, 145 and 63 metabolites significantly changed within the portfolio diet interventions in the first and second RCT, respectively. The majority were glycerophosphocholines (32%), triacylglycerols (20%), glycerophosphoethanolamines (14%), sphingomyelins (8%), and amino acids and peptides (8%) in the first RCT, and glycerophosphocholines (48%), glycerophosphoethanolamines (17%), and amino acids and peptides (8%) in the second RCT. Fifty-two metabolites were consistently changed in the same direction with the portfolio diet intervention across both RCTs, after Bonferroni correction.

CONCLUSIONS

Many of these metabolites likely reflect the plant-based nature, low saturated fat content, and cholesterol-lowering effects of the diet, such as increased N2-acetylornithine, L-pipecolic acid, lenticin, and decreased C18:0 lipids and cholesteryl esters. Further research is needed to validate these metabolites as biomarkers of a plant-based dietary pattern.

Plant-Based Diet and Erectile Dysfunction: A Narrative Review

Evidence shows that the consumption of plant foods, particularly those in their whole form (fruits, vegetables, whole grains, nuts, seeds, and legumes from which no edible part has been removed), improves cardiometabolic risk factors and is associated with reduced risk of cardiovascular diseases (CVDs), diabetes, cancer, chronic kidney disease and mortality compared with animal (meat, fish, eggs and dairy) and nonwhole plant foods (sugar-sweetened beverages, refined grains, etc.). Erectile dysfunction (ED) is considered a strong predictor of CVD. The underlying defect in arteriogenic ED is endothelial dysfunction. A plant-based diet focused on whole plant foods could enhance penile erection as it improves endothelial function through various mechanisms. First, it provides nitrates, L-arginine, and L-citrulline, substrates for nitric oxide production. In addition, this diet lowers low-density lipoprotein cholesterol, trimethylamine N-oxide, postprandial triglycerides, advanced glycation end product, inflammation, and vasoconstrictors levels, contributing to higher nitric oxide concentrations, increased endothelial progenitor cells preservation and decreased arterial stiffness. This review explores the epidemiological evidence of a plant-based diet emphasizing whole plant foods on ED and the potential biological pathways involved.

The crosstalk of breast cancer and ischemic heart disease

In recent years, the continuous optimization of anti-tumor therapy has greatly improved the cancer-specific survival rate for patients with breast cancer (BC). The prevention and treatment of breast cancer-related heart diseases have become a new breakthrough in improving the long-term survival for BC patient. The cardiac damages caused by BC treatment are increasingly prominent among BC patients, of which ischemic heart disease (IHD) is the most prominent. Besides, the systemic inflammatory response activated by tumor microenvironment c an induce and exacerbate IHD and increase the risk of myocardial infarction (MI). Conversely, IHD can also exert detrimental effects on tumors. MI not only increases the risk of BC, but also induces specialized immune cell to BC and accelerates the progression of BC. Meanwhile, the treatment of IHD can also promote BC metastasis and transition to more aggressive phenotypes. Although BC and IHD are diseases of two independent systems, their crosstalk increases the difficulty of anti-cancer treatment and IHD management, which reduces the survival for both diseases. Therefore, this review mainly explores the mutual influence and underlying mechanisms between BC and IHD, aiming to provide insights for improving the long-term survival for patients with BC or IHD.

Association of atherogenic indices and triglyceride-total cholesterol-body weight index (TCBI) with severity of stenosis in patients undergoing angiography: a case-control study

OBJECTIVES

Coronary artery disease, caused by atherosclerosis, necessitates assessing plaque formation risk using indices like the atherogenic index of plasma (AIP), Castelli's risk indexes (CRI-I and CRI-II), the atherogenic coefficient (AC), and the triglyceride-total cholesterol-body weight index (TCBI). Although TCBI primarily assesses mortality risk, its relationship with stenosis severity is unclear. Utilizing data from a prior study, a case-control analysis was conducted on 1,187 subjects, which included 781 patients who underwent coronary angiography and 406 healthy controls. The indices were compared across varying degrees of arterial blockages.

RESULTS

AIP significantly correlated with stenosis severity in women, increasing the risk of three-vessel stenosis by 2.5 times. AC raised the risk of single-vessel stenosis in men by 2.7 times. CRI-I and CRI-II showed a positive relationship with arterial stenosis in women, with CRI-I increasing the risk of two and three-vessel blockages by 21.9% and 22.4%, respectively. A one-unit increase in CRI-II raised the risk by 33.1% for two arteries and 25.3% for three. In conclusion, AIP, CRI-I, and CRI-II in women, along with AC in men, correlated with arterial stenosis severity, while TCBI did not. Further research is needed to determine which index is most effective in predicting CAD risk.

Clinical value of Lp-PLA2, LDL-C, HDL-C, hs-CRP, leukocyte, FPG and HbA1c in type 2 diabetes mellitus patients with acute ischemic stroke

Background

To evaluate the clinical significance of human plasma lipoprotein-associated phospholipase A2 (Lp-PLA2), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), high-sensitivity C-reactive protein (hs-CRP), leukocyte count, fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) in patients with Type 2 diabetes mellitus (T2DM) and acute ischemic stroke (AIS).

Methods

A total of 155 T2DM patients with AIS, admitted to the Second Affiliated Hospital of Shantou University Medical College between October 2023 and October 2024, were included in the stroke group. Additionally, 86 T2DM subjects from the same period were included in the T2DM control group. Serum levels of Lp-PLA2, LDL-C, HDL-C, hs-CRP, leukocyte count, FPG, and HbA1c were compared between the T2DM-AIS group and the T2DM control group, as well as among T2DM-AIS patients with different infarct sizes and degrees of neurological impairment. The clinical value of the above indexes in the diagnosis of T2DM with AIS was analyzed by receiver operating characteristic curve (ROC curve).

Results

Serum levels of Lp-PLA2 (142.9 [115.8, 178.3] ng/L), LDL-C (3.4 [2.6, 4.2] mmol/L), hs-CRP (3.6 [1.5, 11.2] mg/L), leukocytes (8.0 [6.8, 10.3] × 10^9/L), FPG (10.2 [7.5, 14.4] mmol/L), and HbA1c (10.2 [7.5, 14.4] %) were significantly higher in the T2DM-AIS group compared to the T2DM control group (Lp-PLA2: 102.1 [76.6, 121.9] ng/L, LDL-C: 3.2 [2.4, 3.7] mmol/L, hs-CRP: 2.4 [0.9, 5.2] mg/L, leukocytes: 7.0 [6.1, 8.1] × 10^9/L, FPG: 7.4 [6.1, 10.3] mmol/L, HbA1c: 7.0 [6.4, 8.2] %). In contrast, serum HDL-C levels (1.1 [0.9, 1.3] mmol/L) were significantly lower than those in the control group (1.3 [1.1, 1.5] mmol/L), which correlated with larger infarct size and greater neurological injury. ROC curve analysis indicated that the combined use of seven tests had an AUC of 0.906, with a sensitivity of 77.40% and a specificity of 95.30%.

Conclusion

Monitoring serum levels of Lp-PLA2, LDL-C, HDL-C, hs-CRP, leukocyte count, FPG, and HbA1c provides a comprehensive assessment of cerebral infarction in T2DM patients with AIS and serves as auxiliary indicators for evaluating disease severity.

Predicting cerebral infarction and transient ischemic attack in healthy individuals and those with dysmetabolism: a machine learning approach combined with routine blood tests

Ischemic cerebral infarction is the most prevalent type of stroke, causing significant disability and death worldwide. Transient ischemic attack (TIA) is a strong predictor of subsequent stroke. Individuals with dysmetabolism, such as hypertension, hypercholesterolemia, and diabetes, are at increased risk for cerebral infarction (CI) and TIA. In resource-limited settings, diagnosing CI and TIA can be particularly difficult due to a lack of advanced imaging and specialized expertise. Therefore, we aim to develop a simple, convenient, blood-based approach that could assist clinicians in diagnosing CI and TIA, especially in regions where advanced imaging or stroke-specific expertise is limited. All study subjects were patients admitted to the First Hospital of Xiamen University and healthy check-up populations between January 2018 and September 2023. This study employed five machine learning methods alongside 21 blood routine indicators, 30 blood biochemical indicators, age, and gender to construct predictive models for CI and TIA in both healthy individuals and those with dysmetabolism. The Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) served as the metric to assess the comprehensive predictive capability of the models. Subsequently, the SHAP package was employed for model interpretation. Extreme Gradient Boosting (XGBoost) outperforms other models in all predictive models. In the models predicting CI and TIA among healthy, the AUC is 0.9958 (0.9947-0.9969) and 0.9928 (0.9899-0.9951), respectively. Among the nine shared key features of the two models are indicators of glucose metabolism, lipid metabolism, and liver metabolism. In the models for predicting CI and TIA among patients with hypertension, hypercholesterolemia, diabetes, and those with all three metabolic disorders combined, the AUCs ranged from 0.6990 to 0.8591. We found that the indicators K significantly contributed to predict CI and TIA from those with dysmetabolism. Additionally, metabolic-related indicators, such as glucose (GLU) and high-density lipoprotein cholesterol (HDL-C), are ranked highly among the top ten contributing features. XGBoost performed the best in all models. It can effectively differentiate CI and TIA from healthy and dysmetabolic patients by combining blood routine and blood biochemical indicators. Moreover, it can also differentiate CI from TIA. Although any suspicious findings from this model would still require confirmatory imaging, the simplicity and low cost of blood-based testing may offer a practical adjunct for clinicians-particularly in areas lacking advanced imaging or extensive stroke expertise-and could facilitate earlier diagnostic decision-making.

Effect of Dietary Approaches to Stop Hypertension (DASH) diet on lipid profile in individuals with overweight/ obesity: A GRADE-assessed systematic review and meta-analysis of clinical trials

BACKGROUND AND AIM

Obesity is a major nutritional disease that increases the risk of developing serious health conditions like dyslipidemia. Plant-based diets, like DASH (dietary approaches to stop hypertension), can help lower the risk of dyslipidemia. However, evidence on the effect of DASH diet on lipid profile in populations with overweight/obesity is inconsistent. This meta-analysis of controlled trials investigated the effects of the DASH diet on lipid profile in individuals with overweight/obesity.

METHODS AND RESULTS

A search for relevant studies was conducted in databases like PubMed, Web of Science, and Scopus until January 2024. The calculation of weighted-mean differences (WMDs) and 95 % confidence intervals (CIs) was performed based on the random-effects model. Sensitivity, meta-regression and publication bias analyses were also conducted. 22 eligible studies with 26 arms and 3562 participants were included. DASH diet significantly reduced total cholesterol (TC) (WMD: 5.05 mg/dl, 95 % CI: 8.78, -1.31, p = 0.008), low-density lipoprotein cholesterol (LDL-C) (WMD: 5.33 mg/dl, 95 % CI: 8.54, -2.11, p = 0.001) and very low-density lipoprotein cholesterol (VLDL-C) (WMD: 3.26, 95 % CI: 6.19, -0.34, p = 0.029) levels. Greater reductions were observed in studies with durations ≤8 weeks. All of the included studies were classified as high quality except two, which were classified as moderate quality. LDL-C and VLDL-C were categorized as high-grade evidence, while others were categorized as moderate.

CONCLUSIONS

DASH diet could improve the lipid profile of individuals with overweight/obesity by decreasing TC, LDL-C and VLDL-C levels. However, it doesn't have significant effects on high-density lipoprotein cholesterol and triglyceride levels.

Non-High-Density Lipoprotein-to-High-Density Lipoprotein Cholesterol Ratio as a Predictive Biomarker for Diabetic Retinopathy Risk: A Population-Based Analysis of US Adults

INTRODUCTION

Diabetic retinopathy (DR) is a severe complication of diabetes, and lipid imbalances play a key role in its progression. The non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (NHHR) has been identified as a predictor of cardiovascular diseases, but its link to DR remains unclear. This study aimed to assess the association between NHHR and DR risk in diabetic patients.

METHODS

Data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. Multivariate logistic regression models were used to evaluate the relationship between NHHR and DR. Nonlinear associations were assessed using restricted cubic spline analysis.

RESULTS

Of the 4,935 participants, 1,193 had DR. Higher NHHR was strongly associated with increased DR risk. Each unit rise in NHHR increased the risk by 19% (OR = 1.19, 95% CI: 1.07-1.31, p < 0.05). In quartile analysis, participants in the highest NHHR quartile had nearly double the risk of DR compared to those in the lowest quartile (OR = 1.84, 95% CI: 1.62-2.06, p < 0.001). Subgroup analysis showed this association was consistent across different demographic groups, including age, gender, BMI, and smoking status.

CONCLUSION

NHHR is significantly linked to DR risk in diabetic patients and may be a valuable biomarker for early detection and prevention strategies in clinical settings.

Association between neutrophil-lymphocyte ratio levels and mortality related to cardiovascular cause and all causes in coronary artery disease patients with low-density lipoprotein cholesterol below 1.4 mmol/L: A multicenter cohort study

BACKGROUND AND AIMS

Neutrophil-lymphocyte ratio (NLR) can reflect the residual risk of patients with coronary atherosclerotic disease (CAD). However, in CAD patients with low density lipoprotein cholesterol (LDL-C) less than 1.4 mmol/L, the relationship between NLR and poor prognosis remains unclear. The purpose of this research is to examine the relationship between NLR and mortality from cardiovascular causes as well as all causes in the study group.

METHODS AND RESULTS

From the beginning of 2007 to the end of 2020, 2749 individuals with LDL-C under 1.4 mmol/L at baseline and CAD diagnosed via coronary angiography were part of this research. The selected population was divided into four groups according to the level of NLR, and Cox regression model was used mainly to evaluate the association between NLR and cardiovascular and all-cause mortality. After a follow-up of median 6 years, a total of 182 cardiovascular deaths and 460 all-cause deaths had occurred. The Cox regression analysis of fully adjusted model showed that an elevated NLR is connected to a higher risk of mortality from cardiovascular cause (HR: 2.18, 95 %CI: 1.38-3.43) and all causes (HR: 1.33, 95 %CI: 1.02-1.74) in the fourth quartile group. Subgroup analysis indicated that younger and middle-aged patients, as well as those with multivessel coronary artery disease, may have a heightened residual risk of inflammation.

CONCLUSION

NLR can be a useful risk factor indicator for cardiovascular and all-cause mortality in CAD patients with LDL-C levels below 1.4 mmol/L, and it also points to residual risk.

Achievement of low-density lipoprotein cholesterol thresholds in very high-risk atherosclerotic cardiovascular disease

BACKGROUND

The 2022 American College of Cardiology Expert Consensus Decision Pathway on the Role of Nonstatin Therapies recommended more aggressive management of low-density lipoprotein cholesterol (LDL-C) compared to the 2018 American Heart Association/American College of Cardiology/Multisociety Guideline. In congruence with European guidelines, a target LDL-C threshold of 55 mg/dL is recommended for patients with very high-risk atherosclerotic cardiovascular disease (ASCVD). Real-world status of the early implementation of this recommendation remains uncertain.

OBJECTIVE

To determine the proportion of patients with very high-risk ASCVD achieving an LDL-C <55 mg/dL and characterize differences between patients who did and did not achieve this LDL-C value.

METHODS

This retrospective cohort study evaluated patients between January 1, 2023, and December 31, 2023, who were ≥ 18 years old with very high-risk ASCVD from the University of Colorado Health system primary care practices. Very high-risk ASCVD was defined as a history of a major ASCVD event with at least 2 high-risk conditions.

RESULTS

A total of 8974 patients met inclusion criteria for very high-risk ASCVD. Of these, only 21.0% achieved an LDL-C <55 mg/dL, while 39.5% of patients achieved the previously recommended LDL-C threshold of <70 mg/dL. More than half of patients were prescribed a high-intensity statin-based regimen.

CONCLUSION

Within a large, academic health-system, achievement of LDL-C threshold among patients with very high-risk ASCVD was low. Recommendations from the 2022 ACC Expert Consensus Decision Pathway that endorse more aggressive LDL-C lowering and emphasize nonstatin therapies as an adjunct to statins are not fully implemented in real-world clinical practice.

Effect of PCSK9 inhibitor usage on coronary endothelial dysfunction in patients with hypercholesterolemia after coronary stenting: The CuVIC-2 trial

BACKGROUND

The effects of evolocumab on coronary endothelial dysfunction (CED), a hallmark of atherogenesis, are unknown. The aim of this study was to investigate whether evolocumab, in combination with high-dose statins, could ameliorate CED in patients who underwent coronary stenting.

METHODS

The CuVIC-2 trial was a multicenter randomized controlled trial. CED was defined as intracoronary acetylcholine (ACh)-induced contractile responses with signs of myocardial ischemia. We originally intended to enroll 160 participants but altered the study design due to the COVID-19 pandemic and then recruited 41 participants. The revised primary endpoint was the coronary contraction rate in response to ACh assessed in a core laboratory, ensuring a statistical power of over 80 % using the mixed model for repeated measures.

RESULTS

The evolocumab in combination with high-dose statins with or without ezetimibe (EV + S) group included 19 males and 4 females aged 62 ± 13 years. The high-dose statins with or without ezetimibe (S) group included 13 males and 5 females aged 64 ± 11 years. Compared with the S group, the EV + S group presented a significantly greater decrease in low-density lipoprotein cholesterol at 28 weeks; 83 ± 17 to 20 ± 16 mg/dL (-76 % from the baseline) in the EV + S group and 88 ± 16 to 81 ± 20 mg/dL (-7 % from the baseline) in the S group (p < 0.0001). At 28 weeks, there was no difference between the two groups in terms of the coronary artery constriction rate across all doses [mean difference: 4.8 % (95 % CI: -13.6 to 23.2); p = 0.6].

CONCLUSIONS

Amelioration of CED by evolocumab was not observed in this trial with several limitations.

Association of helicobacter pylori infection with lipid metabolism and 10-year cardiovascular risk in diabetes mellitus: A cross-sectional study

BACKGROUND

Previous studies have shown that Helicobacter pylori infection is not only a risk factor for gastrointestinal diseases but also associated with various non-digestive conditions. This study aimed to investigate the effect of Helicobacter pylori infection on the risk of lipid metabolism disorders and cardiovascular disease in individuals with diabetes mellitus.

METHODS

This cross-sectional study was conducted at a health examination center. Data from life questionnaires, laboratory tests, the carbon-13 urea breath test, and the Framingham Risk Score were collected from 266 patients with diabetes. All participants were categorized into Helicobacter pylori-uninfected and Helicobacter pylori-infected groups based on the carbon-13 urea breath test results. Differences in lipid levels, Framingham Risk Score, and cardiovascular disease risk were compared between the two groups. A logistic regression model was applied to analyze whether Helicobacter pylori infection is an independent risk factor for dyslipidemia in patients with diabetes.

RESULTS

Total cholesterol and low-density lipoprotein cholesterol levels were higher in the Helicobacter pylori-infected group than in the uninfected group, and high-density lipoprotein cholesterol levels were lower in the infected group (both P <  0.05). There was no statistically significant difference in triglyceride levels between the two groups. Regression analysis showed that Helicobacter pylori infection was an independent risk factor for dyslipidemia in patients with diabetes (P <  0.05). The Framingham Risk Score and 10-year cardiovascular disease risk were higher in the Helicobacter pylori-infected group compared with the uninfected group (P <  0.001).

CONCLUSION

Helicobacter pylori infection is associated with dyslipidemia and may contribute to an increased risk of cardiovascular disease in individuals with diabetes.

Autoimmune mechanisms and inflammation in obesity-associated type 2 diabetes, atherosclerosis, and non-alcoholic fatty liver disease

Obesity, characterized by the excessive accumulation of white adipose tissue, is a significant global health burden and a major risk factor for a range of diseases, including malignancies and metabolic disorders. Individuals with high visceral fat content are particularly susceptible to severe complications such as type 2 diabetes, cardiovascular diseases, and liver disorders. However, the pathogenesis of obesity-related metabolic diseases extends beyond simple adiposity. Chronic obesity triggers a prolonged inflammatory response, which leads to tissue fibrosis and sustained organ damage, contributing to multi-organ dysfunction. This review explores the autoimmune mechanisms and inflammatory pathways underlying obesity-induced type 2 diabetes, atherosclerosis, and non-alcoholic fatty liver disease, with an emphasis on their interrelated pathophysiology and the potential for therapeutic interventions.

Impact of evolocumab on plaque phenotypic changes in patients with acute coronary syndrome and elevated lipoprotein(a) levels: a HUYGENS secondary analysis

AIMS

The proprotein convertase subtilisin/kexin Type 9 inhibitor, evolocumab, promoted plaque stabilization on serial imaging in patients following an acute coronary syndrome. The impact of evolocumab in patients with varying lipoprotein(a) [Lp(a)] levels is unknown.

METHODS AND RESULTS

Serial optical coherence tomography imaging was performed to evaluate changes in plaque composition in response to treatment with evolocumab 420 mg or placebo for 50 weeks. The current post hoc analysis compared demographics, biochemistry, and plaque imaging changes in those with baseline Lp(a) levels <125 (n = 71) and ≥125 nmol/L (n = 46). Among those with high Lp(a) levels, evolocumab treatment produced lower levels of LDL cholesterol (LDL-C) (21.7 ± 10.3 vs. 94.5 ± 22.9 mg/dL; P < 0.001) and Lp(a) [156.0 (136.0, 187.0) vs. 204.0 (170.5, 290.5) nmol/L; P = 0.007], compared with placebo. Changes in minimum fibrous cap thickness (FCT) (+51.6 ± 40.9 vs. +12.4 ± 23.9 μm; P < 0.001) and lipid arc (-60.9 ± 56.5° vs. -9.1 ± 70.8°; P = 0.008) were greater in the high Lp(a) group with evolocumab compared with placebo. Among patients with low Lp(a) levels, evolocumab produced lower levels of LDL-C (23.3 ± 34.9 vs. 82.9 ± 46.5 mg/dL; P < 0.001) and Lp(a) [11.5 (5.8, 23.8) vs. 25.0 (13.5, 41.0) nmol/L; P = 0.01] compared with placebo, but no differences were observed between groups in changes in minimum FCT (+45.9 ± 37.8 vs. +34.7 ± 36.0 μm; P = 0.21) and lipid arc (-59.9 ± 50.1° vs. -44.5 ± 46.1°; P = 0.18). Baseline Lp(a) levels significantly interacted with the impact of evolocumab on changes in minimum FCT (interaction P = 0.04).

CONCLUSION

The ability of evolocumab to more effectively promote plaque stabilization, compared with statin monotherapy, appears more pronounced in patients with higher Lp(a) levels, suggesting that Lp(a) may help identify those who benefit most from intensive lipid-lowering therapy.

REGISTRATION

ClinicalTrials.gov: NCT03570697.

Estimated glucose disposal rate mediates the association between Life's Crucial 9 and congestive heart failure: a population-based study

Background

Life's Crucial 9 (LC9) is the latest indicator of cardiovascular health (CVH), and the estimated glucose disposal rate (eGDR) is a non-invasive indicator of insulin resistance (IR). However, the relationships between LC9 and eGDR and congestive heart failure (CHF) remain unknown.

Methods

In this cross-sectional study, participants aged ≥20 years in the NHANES database from 2005 to 2018 were analyzed. Weighted linear regression, logistic regression, subgroup analysis, and restricted cubic spline (RCS) analysis were employed to analyze the associations among LC9, eGDR, and CHF. Mediation analysis was used to explore the mediating role of eGDR in the association between LC9 and CHF.

Results

A total of 22,699 adult participants were included, among whom 661 suffered from CHF. The mean age of the participants was 47.52 (0.26) years old, with 11186 (48.68%) males and 11513 (51.32%) females. The average value of LC9 was 71.16 (0.22), and that of eGDR was 7.91 (0.04). After adjusting for confounding factors, linear regression showed that LC9 was independently and positively associated with eGDR (β: 1.11, 95%CI: 1.07 - 1.14, P < 0.0001). Logistic regression indicated that both LC9 (OR: 0.76, 95%CI: 0.65 - 0.88, P < 0.001) and eGDR (OR: 0.81, 95%CI: 0.76 - 0.86, P < 0.0001) were independently and negatively associated with the prevalence of CHF. Mediation analysis revealed that the association between LC9 and CHF was mainly mediated by eGDR, with a proportion of 66%.

Conclusion

This study suggests that higher LC9 scores and eGDR values imply a lower prevalence of CHF. Meanwhile, eGDR is the main intermediate factor in the association between LC9 and CHF, indicating that good CVH may reduce the prevalence of CHF by improving IR.

Non-invasive screening for coronary artery disease: current perspectives, patient, public health and ethical considerations in evaluating symptomatic and asymptomatic individuals

Coronary artery disease (CAD) is a leading cause of morbidity worldwide. Although non-invasive testing for CAD aims at reducing future disease burden, testing can often be associated with significant economic and other health-related costs, at both an individual and societal level. Although there is an established role for screening symptomatic patients for CAD, there is still considerable debate as to the best approach for individuals who are asymptomatic. In this review, various non-invasive tests commonly used in clinical practice will be discussed, including their potential utility, known limitations, and other considerations regarding their use. The use of such testing requires careful consideration of their diagnostic accuracy, availability, cost and patient-specific factors that may limit their utility and safety. Future recommendations for CAD screening, especially for lower-risk or asymptomatic individuals, should offer clinicians and patients some degree of flexibility and take into account the nuanced clinical approach that is often required to address the variability of each individual patient's biopsychosocial context and other factors relating to the suitability and accessibility of screening (e.g. financial cost and geographic location). Recommendations that are well suited to certain geographic locations or societal groups may be less appropriate for other populations, especially those that are marginalised, less well resourced or experiencing significant socioeconomic disadvantage. Screening for CAD should therefore endeavour to ensure equity and aim to improve outcomes in all patient groups, including those who are disadvantaged and most at risk.

Advancing atherosclerosis research: The Power of lipid imaging with MALDI-MSI

Atherosclerosis is a chronic inflammatory disease that is one of the leading causes of mortality globally. It is characterized by the formation of atheromatous plaques in the intima layer of larger arteries. The (fibro-)fatty plaques usually develop asymptomatically within the vessel until a serious event such as myocardial infarction or stroke occurs. Lipids play a pivotal role in disease progression, but while the causal role of cholesterol is beyond doubt, the distribution of numerous other lipids within the heterogeneous layers of atherosclerotic plaques, and their biological function remain unclear. A deeper understanding of the pathophysiological progression of the disease for prognostics, diagnostics, treatment, and prevention is of great need. Mass spectrometry imaging (MSI), in particular with matrix-assisted laser desorption/ionization (MALDI) offers an unprecedented untargeted characterization of the physiological microenvironment, unraveling the spatial distribution of numerous biochemical compounds. MALDI-MSI offers an advantageous balance of sample preparation, chemical sensitivity, and spatial resolution, and thus has been established as a key technology in modern biomedical analysis. This review focuses on the analysis of lipids in atherosclerotic lesions with MALDI-MSI, for which the past years showed major developments in the spatial characterization of lipids and their interaction within atherosclerotic plaques. We will cover main contributions with a focus on the recent decade, elaborate possibilities, limitations, main findings, and recent developments from sample handling to instrumentation, and estimate current challenges and potentials of MALDI-MSI with respect to a clinical application.

Differential lipid impact on mortality in patients undergoing CABG versus PCI

BACKGROUND AND AIMS

The impact of revascularization type, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), on lipid control efficacy remains unclear. We aim to assess the associations of lipid levels with all-cause and cardiovascular mortality in patients undergoing PCI or CABG.

METHODS

We used data from the ChinaHEART cohort and enrolled patients with a self-reported history of PCI or CABG. We employed Cox proportional hazards regression models to evaluate the associations between lipid levels and mortality.

RESULTS

Our analysis included 29 003 participants, of whom 23 959 (82.6 %) undergoing PCI and 5044 (17.4 %) undergoing CABG. Over a median follow-up of 3.22 years, 1007 deaths were recorded, with 579 attributed to cardiovascular causes. Each 1 mmol/L increase in TC, LDL-C, and non-HDL-C was associated with multivariable-adjusted HRs of 1.16 (95 % CI 1.10,1.22), 1.23 (1.15,1.32) and 1.16 (1.10,1.23) for all-cause mortality, respectively. Similar results were observed in patients undergoing PCI, while no significant associations were found in patients undergoing CABG.

CONCLUSIONS

Elevated lipid levels are associated with all-cause and cardiovascular mortality in revascularization patients. Suboptimal lipid control appears to have a more pronounced effect on mortality in patients undergoing PCI. The effects of elevated lipid levels on mortality in CABG patients may need a longer follow-up to manifest due to the more complex nature of the grafts and the long-term adaptation process.

Contemporary Medical Management of Peripheral Arterial Disease

PURPOSE

Peripheral arterial disease (PAD) is characterized by atherosclerotic arterial occlusive disease of the lower extremities and is associated with an increased risk of major adverse cardiovascular events (MACE) in addition to disabling clinical sequelae, including intermittent claudication and chronic limb-threatening ischemia (CLTI). Given the growing burden of disease, knowledge of modern practices to prevent MACE and major adverse limb events (MALE) is essential. This review article examines evidence for medical management of PAD and its associated risk factors, as well as wound prevention and care.

METHODS

A thorough review of the literature was performed, with attention to evidence for the management of modifiable atherosclerotic risk factors, claudication symptoms, wound prevention, and wound care.

RESULTS

Contemporary management of PAD requires a multi-faceted approach to care, with medical optimization of smoking, hypertension, hyperlipidemia, and diabetes mellitus. The use of supervised exercise therapy for intermittent claudication is highlighted. The anatomic disease patterns of smoking and diabetes mellitus are discussed further, and best practices for diabetic foot ulcer prevention, including offloading footwear, are described. Quality wound care is essential in this patient population and involves strategic use of debridement, wound-healing adjuncts, and skin substitutes, when appropriate.

CONCLUSION

The objective of medical management of PAD is to reduce the risk of MACE and MALE. Atherosclerotic risk factor optimization, appropriate wound care, and management of diabetic foot ulcers, foot infections, gangrene, and chronic, non-healing wounds are critical components of PAD care. Interdisciplinary care is essential to coordinate care, leverage expertise, and improve outcomes.

Effects of seal oil supplementation on lipid profile biomarkers: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Seal oil (SO) supplementation has been purported to have cardiovascular health benefits due to its content of omega-3 fatty acids; however, the clinical evidence base for this intervention has yet to be comprehensively assessed.

OBJECTIVE

We aimed to evaluate the effects of oral SO supplementation on lipid profile biomarkers.

METHODS

A systematic search was performed on Pubmed, Embase, Web of Science and Cochrane Library, from inception to August 2024. Only randomized controlled trials (RCTs) assessing the effect of SO on lipid profile biomarkers were included. A random-effects meta-analysis was applied to determine the overall effect estimate. The certainty of evidence (CoE) was evaluated using the GRADE approach.

RESULTS

Nine RCTs were included in the review after the screening of 242 studies, comprising a total of 626 patients. Supplementation of SO resulted in no statistically significant effects on LDL-C (MD -0.07 mmol/L; 95 % CI [-0.19, 0.05]; CoE: Low) and total cholesterol (MD -0.12 mmol/L; 95 % CI [-0.30, 0.06]; CoE: Very low). There were statistically significant results of modest-to-trivial clinical importance on triglycerides (MD -0.19 mmol/L, 95 % CI [-0.30, -0.08]; CoE: Low) and trivial importance on HDL-C (MD 0.07 mmol/L, 95 % CI [0.003, 0.13]; CoE: Very low).

CONCLUSION

There is no sufficiently certain evidence to determine the effects of SO on cardiovascular lipid biomarkers. Our analyses may suggest a modest-to-trivial, clinically uncertain beneficial effect on triglyceride levels; and little to no effect on LDL-C. Effect estimates for HDL-C and total cholesterol levels were highly uncertain. Further evidence is required to conclusively determine the effects of oral SO on lipid biomarkers.

PROTOCOL REGISTRATION NUMBER

CRD42024583739.

Isogenic induced pluripotent stem cell line ICGi036-A-1 from a patient with familial hypercholesterolaemia, derived by correcting a pathogenic variant of the gene LDLR c.530C>T

Familial hypercholesterolaemia is a common monogenic disorder characterized by high plasma cholesterol levels leading to chronic cardiovascular disease with high risk and often early manifestation due to atherosclerotic lesions of the blood vessels. The atherosclerotic lesions in familial hypercholesterolaemia are mainly caused by pathogenic variants of the low-density lipoprotein receptor (LDLR) gene, which plays an important role in cholesterol metabolism. Normally, cholesterol-laden low-density lipoproteins bind to the LDLR receptor on the surface of liver cells to be removed from the bloodstream by internalisation with hepatocytes. In familial hypercholesterolaemia, the function of the receptor is impaired and the uptake of low-density lipoproteins is significantly reduced. As a result, cholesterol accumulates in the subendothelial space on the inner wall of blood vessels, triggering atherogenesis, the formation of atherosclerotic plaques. At present, there are no effective and universal approaches to the diagnosis and treatment of familial hypercholesterolaemia. A relevant approach to study the molecular genetic mechanisms of the disease and to obtain systems for screening chemical compounds as potential drugs is the generation of cellular models based on patient-specific induced pluripotent stem cells. The aim of our work was to derive an isogenic genetically modified induced pluripotent stem cell line by correcting the pathogenic allelic variant c.530C of the LDLR gene in the original iPSC previously obtained from a compound heterozygote patient with familial hypercholesterolaemia. The resulting isogenic iPSC line differs from the original by only one corrected nucleotide substitution, allowing us to study the direct effect of this pathogenic genetic variant on physiological changes in relevant differentiated cells. CRISPR/Cas-mediated base editing was used to correct the single nucleotide substitution. The resulting genetically modified iPSC line has pluripotency traits, a normal karyotype, a set of short tandem repeats identical to that in the original line and can be used to obtain differentiated derivatives necessary for the elaboration of relevant cell models.

Therapeutic PCSK9 targeting: Inside versus outside the hepatocyte?

As a major regulator of LDL receptor (LDLR) activity and thus of LDL-cholesterol (LDL-C) levels, proprotein convertase subtilisin/kexin type 9 (PCSK9) represents an obvious therapeutic target for lipid lowering. The PCSK9 inhibitors, alirocumab and evolocumab, are human monoclonal antibodies (mAbs) that act outside the cell by complexing circulating PCSK9 and thus preventing its binding to the LDLR. In contrast, inclisiran, a small interfering RNA (siRNA), inhibits hepatic synthesis of PCSK9, thereby resulting in reduced amounts of the protein inside and outside the cell. Both approaches result in decreased plasma LDL-C concentrations and improved cardiovascular outcomes. Marginally superior LDL-C reduction (≈ 60 %) is achieved with mAbs as compared to the siRNA (≈ 50 %); head-to-head comparisons are required to confirm between-class differences in efficacy. Both drug classes have shown variability in LDL-C lowering response between individuals in waterfall analyses. Whereas mAb-mediated inhibition leads to a compensatory increase in plasma PCSK9 levels, siRNA treatment reduces them. These agents differ in their pharmacokinetic and pharmacodynamic features, which may translate into distinct clinical opportunities under acute (e.g. acute coronary syndromes) as compared to chronic conditions. Both drug classes provide additional reduction in LDL-C levels (up to 50 %) beyond those achieved with statin therapy, facilitating attainment of guideline-recommended LDL-C goals in high and very high-risk patients. Additional PCSK9 inhibitors, including an oral macrocyclic peptide, a small PCSK9 binding protein and a novel small molecule, plus hepatic gene editing of PCSK9, are under development. This review critically appraises pharmacological strategies to target PCSK9 either inside or outside the cell.

Polyguluronate sulfate has potential to mitigate hyperlipidemia by inhibiting the PCSK9-mediated degradation of LDLR

Hyperlipidemia has become a major global health challenge and one of the leading causes of mortality. Proprotein convertase subtilisin/kexin type 9 (PCSK9), a circulating plasma protein, promotes the lysosomal degradation of hepatic low-density lipoprotein receptors (LDLR), thereby reducing the clearance of low-density lipoprotein (LDL) from blood plasma. PCSK9 has increasingly become a prominent therapeutic target for the development of lipid-lowering agents. In this study, we firstly identified polyguluronate sulfate (PGS) as a novel PCSK9 inhibitor. PGS could bind to the positively charged domain of PCSK9 with a KD value of 3.198 μM, effectively blocking its mediated LDLR degradation. This interaction leads to increase in LDLR levels on hepatocyte surface, enhancing LDL clearance. Furthermore, we demonstrated that PGS more effectively activates the AMP-activated protein kinase (AMPK) pathway compared to polymannuronate sulfate (PMS) at 200 μg/mL, resulting in about 2-fold greater lipid-lowering effect. In summary, our findings highlight PGS as a promising candidate for the development of novel lipid-lowering drugs, offering new insights into the therapeutic potential of sulfate polysaccharides targeting PCSK9.

Risk factors for cardiovascular diseases: the focus on primary prevention

Views on the etiopathogenesis of atherosclerosis are subject to evolution. In addition to the classic well-known risk factors, new ones related to mental state, social life and environment are being discovered. Both acute and chronic stress stimulate inflammatory processes. Due to the change in lifestyle and eating habits, the accumulation of risk factors in childhood is an increasing problem. Knowledge of risk factors allows for effective primary prevention of cardiovascular diseases. The effectiveness of prevention increases when the activities cover the largest possible part of the society, and access to a doctor is easy. Therefore, government programs are being implemented offering patients easier access to diagnostics of cardiovascular diseases at the level of primary health care, which enables faster identification of people at the greatest cardiovascular risk. Easier access to primary care and a good doctor-patient relationship improve patient compliance. In this situation, the importance of the family doctor as a key link in the diagnosis, prevention and treatment of cardiovascular diseases is increasing.

Associations of Blood Lipid-Related Polygenic Scores, Lifestyle Factors and Their Combined Effects with Risk of Coronary Artery Disease in the UK Biobank Cohort

Circulating lipids play a crucial role in the development of coronary artery disease (CAD). However, it is unclear whether the genetic susceptibility to hyperlipidemia may interact with lifestyle factors in CAD risk. Using UK Biobank data from 328,606 participants, we evaluated combined effects of genetic susceptibility to hyperlipidemia and lifestyle factors with risk of CAD. We found that both blood lipid-related polygenic score (PGS) and healthy lifestyle score (HLS) are independently associated with CAD risk, and individuals with the highest-risk lipid-related PGS and the least healthy HLS had the highest CAD risk. This association was stronger in younger (< 60 years, hazard ratio: 4.46, 95% confidence interval: 3.44-5.78) than older adults (2.54, 2.13-3.03). Our study suggests that individuals, particularly younger adults, with higher-risk PGSs of blood lipid traits would benefit more substantially by adherence to a healthy lifestyle than those with lower PGSs.

Is L-Arginine an Appropriate Alternative for Conventional Anti-Atherosclerotic Therapy?: A Comprehensive Review

Background

Atherosclerosis is the leading cause of cardiovascular disease (CVD). Historically, the management of atherosclerosis was focused on decreasing lipid profile levels; however, recent evidence demonstrated that platelets and leukocytes play an important role in forming and exacerbating atherosclerosis. L-arginine (L-Arg), a precursor to nitric oxide (NO), plays a critical role in modulating oxidative stress and influencing platelet-leukocyte recruitment and has been extensively addressed in the context of CVD.

Objective

We aimed to perform a comprehensive literature review on l-Arg metabolism in the causative pathway of atherosclerosis compared to conventional treatment and it as a putative therapeutic approach.

Results

L-Arg supplementation has shown promising effects on NO production, improving endothelial function and reducing oxidative stress in preclinical models. Clinical studies have indicated moderate improvements in vascular health markers, including reductions in inflammation and oxidative stress, although results have varied across studies. The potential of l-Arg to modify platelet-leukocyte recruitment and slow the progression of atherosclerotic plaque development has been observed in certain studies. However, these benefits remain inconsistent, and more robust clinical trials are needed to confirm its effectiveness. Additionally, while l-Arg appears to be relatively safe, some studies reported mild gastrointestinal discomfort as a common side effect.

Conclusion

l-Arg holds potential as a complementary or alternative treatment for atherosclerosis, particularly in improving endothelial function and reducing inflammation and oxidative stress. However, the variability in clinical outcomes and the lack of long-term data required further investigation into assessing therapeutic benefits. Future studies should focus on determining optimal dosing regimens, evaluating their long-term safety, and assessing their potential in combination with other therapies to enhance cardiovascular outcomes.

Association of Achilles tendon thickness with lipid profile and carotid IMT in patients with familial hypercholesterolemia

BACKGROUND AND AIMS

Familial hypercholesterolemia (FH) is characterized by high levels of low-density lipoprotein cholesterol (LDL-C) and Achilles tendon (AT) thickening. AT thickness (ATT) is useful for diagnosing FH and assessing the risk of coronary artery disease (CAD). Nevertheless, the relationship between AT thickening and lipid profile is not clear. We investigated the association of ATT with lipid Profile and carotid IMT.

METHODS

We included 450 patients with clinically diagnosed heterozygous FH. ATT was measured by ultrasonography.

RESULTS

The rate of thickening increased for both AT and carotid-IMT according to age (p < 0.001). In the teens, there was no carotid-IMT thickening, but 39 % of the subjects had a thickened AT. The thresholds of cumulative LDL-C values for AT and carotid-IMT thickening based on ROC curves were 9210 mg/dL∗years (AUC: 0.66, 95 % CI: 0.61-0.72) for ATT and 11,255 mg/dL∗years (AUC: 0.79, 95 % CI: 0.75-0.84) for carotid-IMT. For cumulative LDL-C levels ≥ median, untreated HDL-C level was lower in the AT thickened group than in the non-thickened group (AT thickened: 52 (43-63) mg/dL, non-thickened: 63 (52-72) mg/dL). There was a significant correlation between ATT and cumulative LDL-C (Male: R = 0.48 p < 0.001, Female: R = 0.33 p < 0.001).

CONCLUSIONS

We clarified that both cumulative exposure to LDL-C and untreated HDL-C levels were closely related to AT thickening. Our results show that in ultrasonographic assessment, ATT is more useful than carotid-IMT for predicting the degree of lipid deposition in tissues, especially in young adults.

Acute Limb Ischemia Interventions

Acute limb ischemia (ALI) is characterized by a sudden decrease in limb perfusion that threatens the viability of the limb. ALI can result from various causes including arterial embolism, thrombosis, or trauma. The diagnosis is predominantly clinical, guided by the "6 Ps" mnemonic-pain, pallor, pulse deficit, paralysis, paresthesia, and poikilothermia-and confirmed through imaging modalities if needed. Treatment decisions are informed by the Rutherford classification, ranging from viable to irreversibly damaged limbs. Early diagnosis and timely intervention are critical for improving limb salvage and reducing amputation rates.

Positioning for the use of multivessel clinicalultrasound in vascular risk evaluation: VASUS+protocol. 2024 Recommendations of the Vascular Risk WorkingGroup of The Spanish Society of Internal Medicine (SEMI), Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Hypertension-Spanish League for the Fight against Arterial Hypertension (SHE-LELHA)

Atherosclerosis is the underlying disease in the entire spectrum of atherosclerotic vascular disease. Point of care ultrasound is a useful tool for its detection. Current guidelines recommend the use of scales such as SCORE 2 and SCORE 2OP in apparently healthy individuals and in those at intermediate-low risk, they recognize the role of the arterial plaque by ultrasound to refine risk stratification and the need for more aggressive preventive strategies. However, the way to evaluate the vascular territories in which there is presence of plaque, the amount or load of plaque is not homogeneous nor is it well protocolized. In this document, 2 protocols are proposed for the evaluation of vascular risk, VASUS and VASUS+, including the presence of ventricular hypertrophy with the objective of homogenizing clinical ultrasound in the assessment of vascular risk in clinical practice.

Association Between the Magnitude of Glycemic Control and Body Weight Loss With GLP-1 Receptor Agonists and Risk of Atherosclerotic Cardiovascular Disease: A Systematic Review and Meta-analyses of Randomized Diabetes Cardiovascular Outcomes Trials

PURPOSE

Reduction of major atherosclerotic cardiovascular events (MACE) has not been consistent among different glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to assess the association between the magnitude of glycemic control, body weight loss, and reductions in systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) achieved through GLP-1 RA therapy and MACE.

METHODS

Electronic databases (MEDLINE, CENTRAL, SCOPUS) were searched through March 2023. Studies were eligible if they were cardiovascular outcome trials (CVOTs) comparing GLP-1 RAs versus placebo in T2DM patients. The outcome of interest was 3-point MACE - cardiovascular death, myocardial infarction, or stroke. Random-effects meta-regression analyses evaluated the associations between reductions of HbA1c, body weight, SBP and LDL-C and reduction of MACE.

RESULTS

Overall, 8 CVOTs were included (60079 patients, 30693 with GLP-1 RAs). Reductions of HbA1C were associated with the reduction of 3P-MACE (Log RR -0.290 [95% CI -0.515;-0.064], p = 0.012), with an estimated RR reduction of 25% for each 1% absolute reduction in HbA1C levels. Body weight loss was associated with the reduction of 3P-MACE (Log RR -0.068 [95% CI -0.135;-0.001], p = 0.047), with an estimated RR reduction of 7% for each 1 kg reduction in body weight. Reductions of SBP (Log RR -0.058 [95% CI -0.192;0.076], p = 0.396) and LDL-C (Log RR -0.602 [95% CI -4.157;2.953], p = 0.740) were not associated with the reduction of 3P-MACE.

CONCLUSIONS

In T2DM patients, more potent GLP-1 RAs in reducing HbA1c and body weight were associated with greater reductions of MACE.

Low-density lipoprotein cholesterol levels and risk of incident dementia: a distributed network analysis using common data models

BACKGROUND

The link between low-density lipoprotein cholesterol (LDL-C) levels and dementia risk is poorly understood, with conflicting evidence on the role of LDL-C and the impact of statin therapy on cognitive outcomes. Thus, we aimed to examine the association between low-density LDL-C levels and the risk of dementia and assess the influence of statin therapy.

METHODS

We retrospectively analysed data from 11 university hospitals participating in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). Participants with a prior diagnosis of dementia or those with <180 days of observation before cohort inclusion, and those included in both cohorts were excluded. The primary outcome was all-cause dementia, with the secondary outcome being Alzheimer's disease-related dementia (ADRD). The study utilised 1:1 propensity score matching to compare individuals with LDL-C levels below 70 mg/dL (1.8 mmol/L) against those with levels above 130 mg/dL (3.4 mmol/L), resulting in a primary analysis cohort of 108 980 matched patients. Secondary analyses further examined LDL-C thresholds below 55 mg/dL (1.4 mmol/L) and the influence of statin use.

RESULTS

The LDL-C levels below 70 mg/dL (1.8 mmol/L) were associated with a 26% reduction in the risk of all-cause dementia and a 28% reduction in the risk of ADRD, compared with levels above 130 mg/dL (3.4 mmol/L). For LDL-C levels below 55 mg/dL (1.4 mmol/L), there was an 18% risk reduction for both outcomes. Among those with LDL-C <70 mg/dL (<1.8 mmol/L), statin use was associated with a 13% reduction in all-cause dementia risk and a 12% decrease in ADRD risk compared with non-users.

CONCLUSION

Low LDL-C levels (<70 mg/dL (<1.8 mmol/L)) are significantly associated with a reduced risk of dementia, including ADRD, with statin therapy providing additional protective effects. These findings support the necessity of targeted lipid management as a preventive strategy against dementia, indicating the importance of personalised treatment approaches.

Potential causal evidence for an ApoB-independent and HDL-related risk profile associated with coronary artery disease

Plasma 1H-NMR metabolomic measures have yielded significant insight into the pathophysiology of cardiometabolic disease, but their inter-related nature complicates causal inference and clinical interpretation. This study aimed to investigate the associations of unrelated 1H-NMR metabolomic profiles with coronary artery disease (CAD) and ischemic stroke (IS). Principal component (PC) analysis was performed on 168 1H-NMR metabolomic measures in 56,712 unrelated European participants from UK Biobank to retrieve uncorrelated PCs, which were used in Cox-proportional hazard models. For each outcome, two-sample Mendelian randomization analyses were then conducted based on three nonoverlapping databases, followed by a meta-analysis. The first six PCs collectively explaining 88% of the total variance were identified. For CAD, results from Cox and Mendelian randomization analyses were generally directionally consistent. The pooled odds ratios (95% CI) for CAD per one-SD increase in genetically influenced PC1 and PC3 (both characterized by distinct apolipoprotein B [ApoB]-associated lipoprotein profiles) were 1.04 (1.03, 1.05) and 0.94 (0.93, 0.96), respectively. Besides, the pooled odds ratio (95% CI) for CAD per one-SD increase in genetically influenced PC4, characterized by simultaneously decreased small HDL and increased large HDL, and independent of ApoB, was 1.05 (1.03, 1.07). For IS, increases of PC3 and PC5 (characterized by increased amino acids) were associated with a lower risk and a higher risk, respectively. This study confirms associations of ApoB-associated lipoprotein profiles with CAD and IS, and highlights the possible existence of an ApoB-independent lipoprotein profile, characterized by a distinctive HDL subparticle distribution, driving CAD.

Exploring the benefits of alirocumab as lipid-lowering therapy in people with diabetes and very high cardiovascular risk

People with diabetes mellitus (DM) are at a higher risk (2-4 times) for cardiovascular (CV) death and atherosclerotic CV disease (ASCVD) than the general population. A multifactorial approach is recommended to reduce CV risk. Since low-density lipoprotein cholesterol (LDL-C) is a major causal and cumulative risk factor for ASCVD, the management of lipids is a fundamental element in global risk reduction. Intensive lipid lowering therapy (LLT), such as the addition of a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i), to achieve LDL-C goals and reduce the risk of first or recurrent CV events in people with DM at very high CV risk (VHCVR) of ASCVD (i.e. acute coronary syndrome, coronary artery disease, peripheral artery disease) is often required. Alirocumab, a monoclonal antibody against PCSK9, as lipid-lowering therapy offers significant CV benefits and a favourable safety profile in people with DM and a VHCVR, with or without previous CV events. This review highlights the role of LDL-C in the complex pathogenesis of atherosclerosis, summarises the guidelines for CV risk reduction related to LDL-C in patients with DM and a VHCVR, and focuses on the role of alirocumab in managing LDL-C and consequent CV risk reduction in these patients.

[Update on cardiovascular prevention 2025]

Despite an expensive healthcare system Germany performs poorly with respect to life-expectancy compared to other countries, for which cardiovascular diseases and deficits in cardiovascular prevention in particular are responsible. The basis of cardiovascular prevention is a healthy lifestyle with regular physical exercise, a predominantly plant-based diet, nonsmoking, good sleep and mental health. In many cases additional lipid-lowering, antidiabetic and antihypertensive medications are necessary. Recent studies have proven the prognostic effects of different groups of medications, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, sodium-glucose transporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists, in the appropriate indication areas. To improve the cardiovascular prevention in Germany, intensified public efforts are crucial. In addition, individual support of patients is effective for long-term preventive measures. To achieve this healthcare professionals must be trained (physicians, cardiovascular prevention assistants), who can sustainably support patients in lifestyle modifications and medicinal prevention.

Acceptability of a Web-Based Health App (PortfolioDiet.app) to Translate a Nutrition Therapy for Cardiovascular Disease in High-Risk Adults: Mixed Methods Randomized Ancillary Pilot Study

BACKGROUND

The Portfolio Diet is a dietary pattern for cardiovascular disease (CVD) risk reduction with 5 key categories including nuts and seeds; plant protein from specific food sources; viscous fiber sources; plant sterols; and plant-derived monounsaturated fatty acid sources. To enhance implementation of the Portfolio Diet, we developed the PortfolioDiet.app, an automated, web-based, multicomponent, patient-facing health app that was developed with psychological theory.

OBJECTIVE

We aimed to evaluate the effect of the PortfolioDiet.app on dietary adherence and its acceptability among adults with a high risk of CVD over 12 weeks.

METHODS

Potential participants with evidence of atherosclerosis and a minimum of one additional CVD risk factor in an ongoing trial were invited to participate in a remote web-based ancillary study by email. Eligible participants were randomized in a 1:1 ratio using a concealed computer-generated allocation sequence to the PortfolioDiet.app group or a control group for 12 weeks. Adherence to the Portfolio Diet was assessed by weighed 7-day diet records at baseline and 12 weeks using the clinical Portfolio Diet Score, ranging from 0 to 25. Acceptability of the app was evaluated using a multifaceted approach, including usability through the System Usability Scale ranging from 0 to 100, with a score >70 being considered acceptable, and a qualitative analysis of open-ended questions using NVivo 12.

RESULTS

In total, 41 participants were invited from the main trial to join the ancillary study by email, of which 15 agreed, and 14 were randomized (8 in the intervention group and 6 in the control group) and completed the ancillary study. At baseline, adherence to the Portfolio Diet was high in both groups with a mean clinical Portfolio Diet Score of 13.2 (SD 3.7; 13.2/25, 53%) and 13.7 (SD 5.8; 13.7/25, 55%) in the app and control groups, respectively. After the 12 weeks, there was a tendency for a mean increase in adherence to the Portfolio Diet by 1.25 (SD 2.8; 1.25/25, 5%) and 0.19 (SD 4.4; 0.19/25, 0.8%) points in the app and control group, respectively, with no difference between groups (P=.62). Participants used the app on average for 18 (SD 14) days per month and rated the app as usable (System Usability Scale of mean 80.9, SD 17.3). Qualitative analyses identified 4 main themes (user engagement, usability, external factors, and added components), which complemented the quantitative data obtained.

CONCLUSIONS

Although adherence was higher for the PortfolioDiet.app group, no difference in adherence was found between the groups in this small ancillary study. However, this study demonstrates that the PortfolioDiet.app is considered usable by high-risk adults and may reinforce dietitian advice to follow the Portfolio Diet when it is a part of a trial for CVD management.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02481466; https://clinicaltrials.gov/study/NCT02481466.

Assessing LDL-C Levels and Lipid-Modifying Therapies in a Real-World Cohort of Patients with Atherosclerotic Cardiovascular Disease: The REALITY Study

Background and Objectives: Patients with atherosclerotic cardiovascular disease (ASCVD) remain at high risk of recurrent events. REALITY aims to analyse the actual levels of low-density lipoprotein cholesterol (LDL-C), the modalities of lipid-lowering therapies (LLT) used, and ASCVD patient outcomes in a real-world setting in Spain. Methods: REALITY is a retrospective observational study conducted using a healthcare database of 1.8 million patients representative of the Spanish population. The study included 26,976 patients with new or recurrent ASCVD events recruited from 2017 to 2019 and followed up for two years. Results: Management of ASCVD involved the utilisation of high-intensity (53%) or very high-intensity (36%) LLT. After two years, a decrease in total cholesterol (from 228.7 to 176.7 mg/dL), LDL-C (from 126.4 to 99.0 mg/dL), and triglycerides (from 216.7 to 163.7 mg/dL), accompanied by a moderate increase in HDL-C levels was observed. However, LDL-C goals of ESC/EAS guidelines were only reached by a minority of patients. Less than 15% of ASCVD patients achieved their LDL-C goals of <70, as stated in contemporary guidelines (3% if the present <55 mg/dL threshold in the ESC/EAS guidelines is considered). During the follow-up period, 9% of ASCVD patients died and 25% experienced a new ASCVD event. Conclusions: In the REALITY study, most patients did not achieve their target LDL-C goals despite receiving high- or very high-intensity LLT. Increasing the utilisation of extreme LLT is crucial to reducing recurrent ASCVD events and mitigating these patients' high morbidity and mortality risk.

[Practical approach to the patient with hypercholesterolemia in Spain. SEMERGEN position statement]

Hypercholesterolemia, specifically the increase in the set of lipoproteins containing apolipoproteinB and, in particular, low-density lipoprotein cholesterol (LDL-C), together with the decrease in high-density lipoprotein cholesterol (HDL-C) constitute the etiopathogenic basis of atherosclerotic vascular disease. Multiple clinical trials have shown that lowering LDL-C by lipid-lowering therapy is associated with a significant decrease in the risk of vascular complications. Thus, LDL-C is the main therapeutic target in patients with dyslipidemia. Unfortunately, current LDL-C control figures are still very low, partly due to insufficient intensification of lipid-lowering therapy, but also due to the need for new tools to achieve these goals. This paper reviews the different lipid-lowering treatment options, including the latest available therapies, and provides a practical approach to achieving LDL-C control goals in patients with hypercholesterolemia, as well as in different patient subgroups.

Genetic and pharmacological targeting of Snail inhibits atherosclerosis by relieving intraplaque endothelium dysfunction and associated inflammation

The intraplaque endothelium dysfunction and associated inflammation contribute to the progression of atherosclerosis. We previously show that zinc-finger transcription factor Snail is predominantly expressed in embryonic vascular endothelial cells (ECs), and deletion of Snail in ECs induces severe defects in vascular development and thus causes embryonic lethality. Snail is essentially absent at postnatal stage, and inducible deletion of Snail in ECs has no impact on physiological angiogenesis in postnatally developing or adult mice. In this study we investigated whether Snail was reactivated in vascular ECs during pathologically angiogenic process (e.g. the formation of atherosclerotic plaque) or could play a functional role in atherosclerosis progression. We showed that the expression levels of Snail were significantly elevated in ECs of human and mouse atherosclerotic plaques, and associated with the disease severity. In the accelerated and canonical mouse models of atherosclerosis, tamoxifen-inducible, EC-specific Snail deletion significantly reduced intraplaque endothelial dysfunction, inflammation and lipid uptake accompanied by enhanced plaque stability. By conducting scRNA-sequencing in ECs of ApoE-/-SnailiΔEC versus ApoE-/-Snailfl/fl arterial vessels, we demonstrated that Snail deletion significantly decreased histone acetylation on Ccl5 and Cxcl10 promoters, thereby decreased CCL5/CXCL10-driven vascular damage and inflammation. Administration with recombinant CXCL10 protein (2 μg/kg, i.v., once per week for three weeks) efficiently restored atherosclerosis in EC-specific Snail-deleted mice. Finally, we developed an orally bioavailable small-molecule Snail inhibitor LFW273 that displayed potent anti-atherosclerotic effects in mice. These results reveal Snail as a promising therapeutic target in atherosclerotic disease.

Safety and efficacy of antisense oligonucleotides on triglyceride, apolipoprotein C-III, and other lipid parameters levels in hypertriglyceridemia; a network meta-analysis of randomized controlled trials

BACKGROUND

Hypertriglyceridemia is an independent risk factor for cardiovascular diseases. In previous trials, apolipoprotein C-III (APOC3) inhibition through the antisense oligonucleotides volanesorsen, olezarsen, and plozasiran reduced triglyceride levels. However, the three medications' safety and efficacy have yet to be compared.

METHODS

A network meta-analysis was performed to compare multiple doses of the three medications to each other through the placebo. Randomized controlled trials (RCTs) were retrieved by searching PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane until November 22nd, 2024. The mean difference (MD) and 95% confidence interval (CI) were used for continuous outcomes. The risk ratio (RR) and 95% CI were used for dichotomous outcomes.

RESULTS

Ten RCTs with a total of 1,129 patients were included. volanesorsen 300 mg once weekly showed the most significant percent reduction in triglyceride levels (MD = -91.0%, 95% CI: (-109.2%; -72.8%); P < 0.01). Only plozasiran once monthly, regardless of the dose, showed a non-significant percent reduction in triglycerides. This finding should be taken cautiously as the data were derived from a phase 1 trial with a small sample size. All the regimens significantly reduced APOC3 levels compared to placebo, with plozasiran 100 mg monthly and volanesorsen 300 mg once weekly showing the most significant reduction (MD range: -92.8% to -88.5%; P < 0.01). None of the treatments showed a statistically significant difference in overall adverse events rate compared to the placebo.

CONCLUSION

APOC3 antisense oligonucleotide inhibitors effectively reduced triglyceride and APOC3 levels in hypertriglyceridemia with an acceptable safety profile. However, the results should be interpreted cautiously due to the small sample size. Further research is needed to confirm the beneficial effects of APOC3 inhibitors and show strong evidence of the impact of each regimen.

The Effect of Bauhinia bowkeri Extracts on Hypercholesterolemia: Insights from In Vitro and In Silico Investigations

Despite the many current cholesterol-lowering drugs on the market, the persistent surge of hypercholesterolemic-related complications ignites a fascinating search for the discovery of novel therapeutics. This study aimed at investigating the anti-hypercholesterolemic effect of Bauhinia bowkeri extracts. The plant material was sequentially extracted with n-hexane, dichloromethane (DCM), and 70% ethanol. The phytochemical constituents of the extracts were analyzed through GC-MS and the antioxidant activity of the extracts was screened against a wide range of free radicals (ABTS, DPPH, hydroxyl radical, and nitric oxide). The extracts were also screened for the metal iron chelating and reducing power potential. The enzyme inhibitory activity of the extracts on pancreatic lipase, cholesterol esterase, and HMG-CoA reductase as well as the bile acid binding capacity were evaluated. Among the total of 122 compounds detected in the three extracts, only 7 compounds (E-15-Heptadecenal, Diethyl Phthalate, 9,12,15-Octadecatrienoic acid ethyl ester, (Z,Z) Tetradecane 5-methyl, and Octadecane 5-methyl) were found to be common in all the extracts. The extract displayed a varying degree of efficiency on free radicals with IC50 values ranging from 0.07 mg/mL to 0.41 mg/mL. A concentration-dependent inhibition of pancreatic lipase and cholesterol esterase activities, along with a reduction in the bile-binding capacity exhibited by the extracts, was noted. In silico investigations of some of the phytoconstituent revealed significant inhibition of HMG-CoA reductase, cyclooxygenase, and hormone-sensitive lipase with a binding affinity that ranged between -5.1 and -7.0 kcal/mol. These findings suggest that Bauhinia bowkeri extracts possess potential antioxidant and anti-hypercholesterolemic properties.

Credibility assessment of a mechanistic model of atherosclerosis to predict cardiovascular outcomes under lipid-lowering therapy

Demonstrating cardiovascular (CV) benefits with lipid-lowering therapy (LLT) requires long-term randomized clinical trials (RCTs) with thousands of patients. Innovative approaches such as in silico trials applying a disease computational model to virtual patients receiving multiple treatments offer a complementary approach to rapidly generate comparative effectiveness data. A mechanistic computational model of atherosclerotic cardiovascular disease (ASCVD) was built from knowledge, describing lipoprotein homeostasis, LLT effects, and the progression of atherosclerotic plaques leading to myocardial infarction, ischemic stroke, major acute limb event and CV death. The ASCVD model was successfully calibrated and validated, and reproduced LLT effects observed in selected RCTs (ORION-10 and FOURIER for calibration; ORION-11, ODYSSEY-OUTCOMES and FOURIER-OLE for validation) on lipoproteins and ASCVD event incidence at both population and subgroup levels. This enables the future use of the model to conduct the SIRIUS programme, which intends to predict CV event reduction with inclisiran, an siRNA targeting hepatic PCSK9 mRNA.

Association of proprotein convertase subtilisin/kexin type-9 inhibitors with risk of nonmelanoma skin cancer: a retrospective cohort study

BACKGROUND

Growing evidence has shown that cholesterol metabolism abnormalities involve carcinogenesis. Proprotein convertase subtilisin/kexin type-9 (PCSK9) inhibitors have been reported to inhibit tumour progression and prevent ultraviolet-related skin damage.

OBJECTIVES

To investigate the association of PCSK9 inhibitors with the risk of nonmelanoma skin cancer (NMSC).

METHODS

This retrospective cohort study analysed data from the US Collaborative Network in the TriNetX database. Adults aged ≥ 40 years with atherosclerotic cardiovascular disease (ASCVD) under statin therapy between 2016 and 2022 were identified. A target trial design was used to compare the risk of NMSC, including basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), in patients also treated with PCSK9 inhibitors or continuing statin treatment (the control group). Each head-to-head comparison involved propensity score matching. Hazard ratios (HRs) were estimated using Cox proportional hazard models. Stratified analyses based on age, sex, Fitzpatrick skin type and immune status were also performed.

RESULTS

A total of 73 636 patients with ASCVD were analysed. Compared with the control group, patients with ASCVD initiating PCSK9 inhibitors had lower risks of developing NMSC [HR 0.78, 95% confidence interval (CI) 0.71-0.87], BCC (HR 0.78, 95% CI 0.69-0.89) and cSCC (HR 0.79, 95% CI 0.67-0.93). Subanalyses revealed a reduced risk of NMSC with each PCSK9 inhibitor, namely evolocumab and alirocumab. Stratified analyses showed similar results in patients aged 65-79 years, those older than 80 years and in men.

CONCLUSIONS

Our study indicated that patients with ASCVD taking PCSK9 inhibitors have a lower risk of incident NMSC than those not taking PCSK9 inhibitors.

Impact of Sex Differences on Lipids and Statin Utilization

PURPOSE OF THE REVIEW

Hypercholesterolemia is a significant and modifiable risk factor for cardiovascular disease (CVD), with Low-Density Lipoprotein Cholesterol (LDL-C) being the primary target for lipid-lowering therapies in both primary and secondary prevention. This review aims to explore the efficacy of statin therapy in women, its safety and application during pregnancy, and treatment disparities that contribute to undertreatment of dyslipidemia in women.

RECENT FINDINGS

Statins has demonstrated efficacy in reducing LDL-C and CVD risk in women. However, women are less likely to achieve LDL-C targets compared to men, largely due to undertreatment and delays in initiating therapy, often influenced by sex-specific factors. The unique considerations of lipid management during pregnancy, including suspension of statin therapy, present additional challenges in achieving optimal lipid control in high-risk women. Evidence also points to systemic disparities in healthcare delivery and treatment allocation, further exacerbating undertreatment of dyslipidemia among women. While LDL-C lowering remains a cornerstone of CVD prevention, women face distinct challenges in achieving lipid goals due to biological, clinical, and healthcare disparities. Addressing these barriers, including improving timely initiation of statins and addressing gaps in care during pregnancy, is essential to enhance the dyslipidemia management and reduce CVD risk in women.

A dual-reporter LDLR system integrating fluorescence and luminescence for understanding LDLR regulation and facilitating drug discovery

Introduction

The low-density lipoprotein receptor (LDLR) is integral to cholesterol metabolism and cardiovascular health. Enhancing LDLR expression is a promising strategy for treating hyperlipidemia and reducing the risk of atherosclerosis. However, current LDLR reporter systems have limitations in detecting both transcriptional and translational regulation. To address this, we developed a novel dual-reporter LDLR system incorporating Enhanced Green Fluorescent Protein (EGFP) and Gaussia luciferase (Gluc) to enable precise monitoring of LDLR expression and function.

Methods

A CRISPR/Cas9-mediated knock-in strategy was used to integrate EGFP and Gluc upstream of the stop codon located in exon 18 of the LDLR gene in HEK293 cells. The dual-reporter system allows real-time visualization of LDLR expression via EGFP fluorescence and quantitative assessment through secreted Gluc activity. The system was validated using western blotting, immunofluorescence, and functional assays, including DiI-LDL uptake and drug response analyses with statins and PCSK9 inhibitors.

Results

The established LDLR-EGFP-Gluc knock-in cell line faithfully recapitulates endogenous LDLR expression and function. EGFP fluorescence accurately reflects LDLR expression dynamics, while Gluc activity provides a highly sensitive and quantitative readout. Functional assays confirmed that LDLR expression responds appropriately to statins and PCSK9 inhibitors. Additionally, screening for transcriptional regulators identified FOXP3 and CREB as novel modulators of LDLR expression, with CREB-mediated regulation involving the sterol regulatory element-binding protein 2 (SREBP2) pathway.

Discussion

This dual-reporter system enables complementary monitoring of LDLR dynamics, providing enhanced sensitivity, accuracy, and versatility for studying LDLR regulation and function, as well as facilitating drug discovery targeting hyperlipidemia and cardiovascular diseases.

Positioning for the use of multivessel clinical ultrasound in vascular risk evaluation: VASUS+ protocol. 2024 recommendations of the Vascular Risk Group, clinical ultrasound of the Spanish Society of Internal Medicine and Spanish Society of Hypertension and Vascular Risk

Atherosclerosis is the underlying disease in the entire spectrum of atherosclerotic vascular disease. Point of care ultrasound is a useful tool for its detection. Current guidelines recommend the use of scales such as SCORE 2 and SCORE 2OP in apparently healthy individuals and in those at intermediate-low risk, they recognize the role of the arterial plaque by ultrasound to refine risk stratification and the need for more aggressive preventive strategies. However, the way to evaluate the vascular territories in which there is presence of plaque, the amount or load of plaque is not homogeneous nor is it well protocolized. In this document, 2 protocols are proposed for the evaluation of vascular risk, VASUS and VASUS+, including the presence of ventricular hypertrophy with the objective of homogenizing clinical ultrasound in the assessment of vascular risk in clinical practice.

Cardiac Repair and Regeneration via Advanced Technology: Narrative Literature Review

BACKGROUND

Cardiovascular diseases (CVDs) are the leading cause of death globally, and almost one-half of all adults in the United States have at least one form of heart disease. This review focused on advanced technologies, genetic variables in CVD, and biomaterials used for organ-independent cardiovascular repair systems.

OBJECTIVE

A variety of implantable and wearable devices, including biosensor-equipped cardiovascular stents and biocompatible cardiac patches, have been developed and evaluated. The incorporation of those strategies will hold a bright future in the management of CVD in advanced clinical practice.

METHODS

This study employed widely used academic search systems, such as Google Scholar, PubMed, and Web of Science. Recent progress in diagnostic and treatment methods against CVD, as described in the content, are extensively examined. The innovative bioengineering, gene delivery, cell biology, and artificial intelligence-based technologies that will continuously revolutionize biomedical devices for cardiovascular repair and regeneration are also discussed. The novel, balanced, contemporary, query-based method adapted in this manuscript defined the extent to which an updated literature review could efficiently provide research on the evidence-based, comprehensive applicability of cardiovascular devices for clinical treatment against CVD.

RESULTS

Advanced technologies along with artificial intelligence-based telehealth will be essential to create efficient implantable biomedical devices, including cardiovascular stents. The proper statistical approaches along with results from clinical studies including model-based risk probability prediction from genetic and physiological variables are integral for monitoring and treatment of CVD risk.

CONCLUSIONS

To overcome the current obstacles in cardiac repair and regeneration and achieve successful therapeutic applications, future interdisciplinary collaborative work is essential. Novel cardiovascular devices and their targeted treatments will accomplish enhanced health care delivery and improved therapeutic efficacy against CVD. As the review articles contain comprehensive sources for state-of-the-art evidence for clinicians, these high-quality reviews will serve as a first outline of the updated progress on cardiovascular devices before undertaking clinical studies.

Early prediction of postpartum dyslipidemia in gestational diabetes using machine learning models

This study addresses a gap in research on predictive models for postpartum dyslipidemia in women with gestational diabetes mellitus (GDM). The goal was to develop a machine learning-based model to predict postpartum dyslipidemia using early pregnancy clinical data, and the model's robustness was evaluated through both internal and temporal validation. Clinical data from 15,946 pregnant women were utilized. After cleaning, the data were divided into two sets: Dataset A (n = 1,116), used for training and evaluating the model, and Dataset B (n = 707), used for temporal validation. Several machine learning algorithms were applied, and the performance of the model was assessed with Dataset A, while Dataset B was used to validate the model across a different time period. Feature significance was evaluated through Information Value (IV), model importance analysis, and SHAP (SHapley Additive exPlanations) analysis. The results showed that among the five machine learning algorithms tested, tree-based ensemble models, such as XGBoost, LightGBM, and Random Forest, outperformed others in predicting postpartum dyslipidemia. In Dataset A, these models achieved accuracies of 70.54%, 70.54%, and 69.64%, respectively, with AUC-ROC values of 73.10%, 71.94%, and 76.14%. Temporal validation with Dataset B indicated that XGBoost performed best, achieving an accuracy of 81.05% and an AUC-ROC of 87.92%. The predictive power of the model was strengthened by key variables such as total cholesterol, fasting glucose, triglycerides, and BMI, with total cholesterol being identified as the most important feature. Further IV and SHAP analyses confirmed the pivotal role of these variables in predicting dyslipidemia. The study concluded that the XGBoost-based predictive model for postpartum dyslipidemia in GDM showed strong and consistent performance in both internal and temporal validations. By introducing new variables, the model can identify high-risk groups during early pregnancy, supporting early intervention and potentially improving pregnancy outcomes and reducing complications.