Key Updates to the 2024 ESC Hypertension Guidelines and Future Perspectives

Hypertension remains a critical global health challenge, significantly contributing to cardiovascular morbidity and mortality despite advancements in treatment. The 2024 ESC hypertension guidelines address persistent gaps in hypertension management by emphasizing comprehensive strategies encompassing early detection, socioeconomic barriers, lifestyle interventions, and personalized care. Enhanced screening protocols, including home and ambulatory blood pressure monitoring, aim for accurate diagnosis and risk stratification. Lifestyle recommendations now prioritize reducing sodium intake, increasing potassium consumption, and integrating tailored exercise regimens. Pharmacological updates advocate for single-pill combinations and stringent BP targets (<130/80 mmHg), emphasizing the benefits of sodium-glucose cotransporter-2 inhibitors for specific comorbidities. Minimally invasive therapies like renal denervation are explored for resistant hypertension, while digital tools such as telehealth and mobile applications enhance patient engagement and adherence. This multifaceted, patient-centered approach provides a roadmap for optimizing BP control, reducing cardiovascular risks, and addressing the complexities of hypertension in diverse populations.

Emergence of a Novel Dengue Virus Serotype-2 Genotype IV Lineage III Strain and Displacement of Dengue Virus Serotype-1 in Central India (2019-2023)

Dengue fever remains a significant public health concern in tropical regions, including Central India, where outbreaks are frequent and associated with high morbidity and mortality. This study investigated the dynamics of dengue virus transmission and evolution in Central India from 2019 to 2023, focusing on the emergence of new strains and their impact on outbreak patterns. For this, 40 mosquito pools and 300 patient samples were recruited for the study. Phylogenetic and Bayesian evolutionary analyses performed on CPrM region and whole genome sequences generated by Sanger and Illumina sequencing, respectively, revealed the emergence and predominance of a novel DENV-2 genotype IV lineage III strain in the 2019 and 2023 outbreaks, which displaced the previously circulating DENV-1 genotype responsible for the 2016-2017 outbreak. Despite pre-existing DENV-1 neutralizing antibodies in the community (67 healthy volunteers), the novel DENV-2 strain exhibited higher viral loads and a greater reproduction number (R0), contributing to rapid disease spread. Molecular clock and Shannon entropy analyses suggest that DENV evolution occurred within the mosquito vector, driven by natural selection. Our findings highlight the importance of continuous DENV surveillance, including genetic characterization in both vectors and hosts, to understand viral evolution and predict future outbreaks. Rapid urbanization and inadequate sanitation in densely populated regions like India create ideal breeding grounds for mosquitoes, facilitating the introduction and establishment of novel DENV strains. Interrupting the vector-DENV-host cycle through targeted interventions is crucial for effective dengue control.

Targeting Inflammation with Galectin-3 and PIIINP Modulation Among ST-Segment Elevation Acute Coronary Syndrome Patients Underwent Delayed Percutaneous Coronary Intervention

Background/Objectives: ST-segment elevation acute coronary syndrome (STE-ACS) represents a significant global health challenge, with cardiac remodeling and fibrosis critically affecting recovery after percutaneous coronary intervention (PCI). Colchicine, known for its anti-inflammatory effects, may regulate key fibrotic markers such as Procollagen III N-terminal Propeptide (PIIINP) and Galectin-3. This study assesses colchicine's effect on these biomarkers in STE-ACS patients undergoing delayed PCI. Methods: In this multicenter, randomized, double-blind trial, we examined colchicine's impact on Galectin-3 and PIIINP in 164 STE-ACS patients undergoing early or delayed PCI. Patients received colchicine shortly after hospital admission. Biomarker changes were evaluated at 24 h and five days post-treatment using two-way ANOVA. Results: Clinical trials in the early PCI group revealed that Galectin-3 levels decreased significantly on day one (p < 0.01) and further on day five (p < 0.0001), indicating Primary PCI has benefits to inhibition of fibrosis beyond colchicine add-on treatment. But, in the delayed PCI group, Galectin-3 levels significantly increased on day one (p < 0.01), but the decrease observed by day five was not statistically significant. It is related that the benefits of colchicine treatment may exceed PCI implantation in preventing cardiac remodeling. In the delayed PCI group, PIIINP levels showed a significant reduction on day five (p < 0.0001). Conclusions: This Colchicine demonstrates novel efficacy in delayed PCI, with a significant increase in Galectin-3 and a sharp reduction in PIIINP, indicating its ability to control fibrosis. This positions colchicine as a breakthrough therapy for improving outcomes in STE-ACS patients with delayed intervention.

A rare neurological complication of dengue: Guillain-Barré Syndrome in a dengue fever patient

Background

Dengue fever is a common viral illness in tropical and subtropical regions, typically presenting with fever, myalgia, and hemorrhagic symptoms. While neurological complications are rare, Guillain-Barré Syndrome (GBS) is a known but uncommon sequelae of viral infections, including dengue.

Case presentation

We report the case of a previously healthy 32-year-old male who developed acute flaccid paralysis secondary to GBS following a dengue fever infection. The patient initially presented with classic dengue symptoms-fever, severe headache, retro-orbital pain, and myalgia. Following resolution of the acute dengue phase, he developed ascending muscle weakness, areflexia, and numbness in both legs. Electromyography confirmed a diagnosis of GBS, and cerebrospinal fluid analysis revealed albuminocytologic dissociation. The patient was treated with intravenous immunoglobulin (IVIG), leading to significant clinical improvement, with gradual recovery of motor function.

Discussion

This case highlights the rare but significant neurological complication of GBS following dengue fever. Clinicians should maintain a high index of suspicion for GBS in patients recovering from dengue, especially in endemic regions. Early diagnosis and treatment with IVIG or plasmapheresis are critical for improving outcomes in these patients.

Conclusion

Dengue fever can lead to severe neurological sequelae such as GBS, and early recognition and intervention can prevent long-term disability. This case underscores the need for vigilance in identifying such complications in patients recovering from viral infections.

Longitudinal increase in physical activity and adverse cardiovascular outcomes following the diagnosis of acute coronary syndrome

OBJECTIVES

Physical activity (PA) provides protective effects against cardiovascular diseases, including ischaemic heart disease. However, recommending moderate to vigorous PA (MVPA) to patients with recent acute coronary syndrome (ACS) raises concerns owing to potential risk of recurrent ACS or fatal arrhythmias. This study investigated the association between longitudinal PA changes following an ACS diagnosis and subsequent cardiovascular outcomes, including non-fatal coronary events, non-fatal stroke and cardiovascular mortality.

METHODS

This longitudinal cohort study used Korean National Health Insurance Service data from 2010 to 2017, comprising 30 840 patients diagnosed with ACS following invasive coronary angiography or bypass surgery. Leisure-time PA was self-reported, with the frequency and intensity measured weekly. The primary endpoint was a composite of nonfatal coronary events, non-fatal stroke and cardiovascular mortality. Multivariable Cox proportional hazards regression models assessed the association between PA changes and cardiovascular outcomes.

RESULTS

Among patients with ACS (mean age: 60±11 years, men: 81.3%), mean PA levels increased from 544±556 metabolic equivalent task (MET)-min/week to 594±567 MET-min/week. Over 6.7 years of median follow-up, 5639 cardiovascular events occurred. Increased PA was associated with lower cardiovascular event risk (HR 0.95, 95% CI 0.92 to 0.98). Consistent MVPA pre-ACS and post-ACS reduced cardiovascular event risk (HR 0.87, 95% CI 0.79 to 0.96) and MVPA initiation showed a modest risk reduction (HR: 0.91, MET-min/95% CI 0.82 to 1.01).

CONCLUSIONS

Longitudinal increases in self-reported PA, maintenance of MVPA and possibly MVPA initiation after ACS reduced the risk of cardiovascular events. Initiating or maintaining MVPA could be an important strategy in improving cardiovascular outcomes following ACS.

Determinants of hypertension-related knowledge, attitude, and practices (KAP) among caregivers in Neno, rural Malawi: A cross-sectional study

Background

Hypertension, a significant health concern, increases the risk of cardiovascular disease and premature mortality. Caregivers play a crucial role in ensuring optimal care for hypertensive patients and reducing associated complications. Caregivers' basic knowledge, good attitude, and relevant practices are necessary to ensure high-quality care for patients with hypertension. However, there is no research conducted in Malawi that investigated the knowledge, attitude, and practices of caregivers towards hypertension prevention and management.

Objective

The study aimed to assess knowledge, attitude, and practices towards hypertension and their determinants among caregivers of hypertensive patients in Neno, Malawi.

Methods

Our study, conducted in Neno, Malawi, involved 422 caregivers of hypertensive patients. We used a cross-sectional study design. Data was collected through a structured questionnaire and analyzed using SPSS Version 22.0.

Results

The participants had a mean age of 44.94 years (SD = 9.889), with 63.3 % being female. The mean KAP scores were 38 %, 93.3 %, and 78.7 %, respectively. Positive correlations were found between knowledge and practice (r = +0.252; p < 0.001) and knowledge and attitude (r = +0.255; p < 0.001). However, no significant relationship was observed between attitude and practice (r = +0.064; p = 0.190). Age showed a strong correlation with attitude (r = +0.233; p < 0.001) but not with knowledge or practice. On the other hand, occupation, education level, and caregiver-patient relationship significantly influenced knowledge and attitude but not practice. Gender also demonstrated a notable association with KAP regarding hypertension.

Conclusion

Caregivers demonstrated poor knowledge but engaged in good practices. Despite their limited understanding, they maintained an excellent attitude towards hypertension. This highlights the necessity for increased prevention, and control strategies within communities, emphasizing health education on lifestyle modifications and to address the gaps identified in caregivers' understanding in the prevention and management of hypertension.

The Influence of Lifestyle Modifications on Cardiovascular Outcomes in Older Adults: Findings from a Cross-Sectional Study

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among older adults. Lifestyle modifications, including diet, physical activity, and smoking cessation, are key to reducing cardiovascular risk. This study examines the combined effects of these behaviors on cardiovascular outcomes and their mediating mechanisms. Methods: A cross-sectional study was conducted among older adults (aged ≥ 60 years) in Riyadh, Saudi Arabia. Data on dietary quality, physical activity, and smoking status were collected using validated questionnaires. Cardiovascular outcomes, including low-density lipoprotein cholesterol (LDL), systolic blood pressure (SBP), and body mass index (BMI), were measured. A composite cardiovascular risk score was computed. Path analysis was employed to assess direct and indirect effects of lifestyle factors on cardiovascular outcomes. Results: Participants adhering to a healthy diet, engaging in regular physical activity, and avoiding smoking had significantly lower composite cardiovascular risk scores. Non-smoking status showed the strongest direct effect (β = -0.20, p = 0.006), while dietary quality and physical activity exhibited significant indirect effects mediated by LDL, SBP, and BMI. Combined adherence to multiple healthy behaviors resulted in the greatest reductions in cardiovascular risk. The path analysis highlighted dietary quality and physical activity as critical mediators of cardiovascular health improvements. Conclusions: Lifestyle modifications significantly reduce cardiovascular risk in older adults, with cumulative benefits observed for combined adherence to healthy behaviors. These findings emphasize the importance of comprehensive lifestyle interventions targeting diet, physical activity, and smoking cessation to promote cardiovascular health in aging populations.

The effect of NLRP3 inflammasome on cardiovascular prognosis in patients with acute coronary syndrome

The NOD‑like receptor protein domain associated protein 3 (NLRP3) inflammasome is critical in inflammatory responses and may be a valuable prognostic biomarker in acute coronary syndrome (ACS). We aimed to investigate the association between NLRP3 inflammasome levels and short-term outcomes in patients with ACS. We enrolled 295 patients with ACS who were monitored for 6 months for major adverse cardiovascular events (MACEs). The NLRP3 inflammasome was quantified using enzyme-linked immunosorbent assays, with the Gensini score used to assess disease severity. A Cox regression model evaluated whether NLRP3 inflammasome levels were independent predictors of MACEs. Spearman correlation analysis demonstrated a significant positive correlation between NLRP3 inflammasome levels and the Gensini score (r = 0.55, p < 0.001). Plasma NLRP3 inflammasome levels were significantly higher in the MACEs group (8.48 ng/mL) compared with the no-MACEs group (3.48 ng/mL) (p < 0.001). Multivariate Cox regression identified NLRP3 inflammasome content as an independent risk factor for MACEs (hazard ratio 1.104, p = 0.001; area under the curve: 0.780 [95% confidence interval 0.721-0.840], p < 0.001). Elevated plasma NLRP3 inflammasome levels correlated with ACS severity and were associated with poorer short-term outcomes in patients with ACS.

Necrotizing Pancreatitis Following Acute Appendicitis: A Case Report of a Complex Clinical Course and Diagnostic Challenges

Necrotizing pancreatitis (NP) is a serious complication of acute pancreatitis. In this case report, we report a complex scenario in which a patient initially admitted for perforated appendicitis developed necrotizing pancreatitis during the hospital stay. Necrotizing pancreatitis is a rare clinical outcome, and by examining potential factors that contributed to this patient's condition, we offer insights into how to assess and potentially prevent future cases of necrotizing pancreatitis in similar patients. An 83-year-old male with a complex past medical history, including coronary artery disease with 12 cardiac stents, obesity, hypertension, hyperlipidemia, and a prior pulmonary embolism, presented to the emergency department with acute-onset right lower quadrant abdominal pain, fever, and nausea. He was diagnosed with acute appendicitis with micro-perforations and underwent a laparoscopic appendectomy and lysis of adhesions. Postoperatively, the patient developed hypotension and tachycardia, requiring vasopressor support, as well as hematemesis and sepsis. A CT scan revealed a partially necrotic pancreas, prompting an exploratory laparotomy and pancreatic debridement. Blood cultures identified Candida glabrata, leading to the initiation of antifungal therapy. Despite aggressive critical care, including multiple abdominal surgeries, broad-spectrum antibiotics, and antifungal treatment, the patient developed multiorgan failure. On day 16, after going into cardiac arrest, the patient was pronounced deceased.  This case highlights the importance of early diagnostic strategies for high-risk patients with possible overlapping symptoms in the setting of acute abdominal pain. A broader scope of clinical assessments with timely intervention and aggressive management may be crucial in preventing severe outcomes, such as necrotizing pancreatitis.

Ethnic differences in knowledge, attitudes, and practices related to dietary salt intake and association with hypertension in Malaysia: a multi-centre cross-sectional study

The association between high salt intake and elevated blood pressure levels has been well-documented. However, studies on how effectively this knowledge translates into actionable practices, particularly across different ethnic groups, remain limited. This study aimed to evaluate the knowledge, attitudes, and practices (KAP) towards dietary salt intake across ethnicities and determine its association with hypertension. 5128 Malaysian adults recruited from a national blood pressure screening study completed questionnaires on demographics, and KAP related to dietary salt intake. There were 57.4% Malay, 23.5% Chinese, 10.4% Indian, and 8.7% individuals of other ethnic groups. Overall, more than 90% of the participants knew that a high salt intake causes serious health problems, but only around one-third knew the relationship between high salt intake and strokes and heart failure. Participants of different ethnic groups displayed significant differences in the KAP domains, where Indians generally exhibited better knowledge, attitudes, and reported better practices such as reading salt labels and using spices. Those who were unaware of the difference between salt and sodium and who reported not reading salt labels had higher odds of having elevated blood pressure. These findings demonstrate that while there is a suboptimal translation of salt knowledge into practice in Malaysia, with significant differences in KAP observed between ethnic groups, the potential of improving health outcomes by improving the clarity and awareness of salt labels is substantial. Tailored education promoting salt-label reading, minimizing processed foods intake and discretionary salt use should be ethnic-specific to better curb this escalating hypertension epidemic.

Acute-on-Chronic Inflammation and Patients' Risk for Renal Support in Critically Ill Patients

Hypertension (HTN) and heart failure (HF) can chronically activate the renin-angiotensin-aldosterone system, a mechanism designed to maintain hemodynamic stability by reabsorption of water and electrolytes. Additionally, this system activates the sympathetic nervous system to increase vagal tone. When these patients face acute illness requiring hospitalization, the acute stressor or pathogen also activates the sympathetic nervous system. The combination of activation of both systems puts patients at increased risk of organ failure, specifically renal failure. With early recognition of renal insult, organ damage can be reversed. C-reactive protein (CRP) and D-dimer are commonly used to measure acute inflammation. These biomarkers can alert critical care nurses to excessive inflammation in patients with underlying HTN and HF, enabling nurses to make informed decisions to intervene at the earliest sign of renal failure. This retrospective study of adult SARS-CoV-2 patients in an intensive care unit setting sought to examine the relationship of CRP, D-dimer, and the need for eventual renal support in patients with HF and HTN. Of the sample (n + 189), mean age was 62 (SD = 14.0), and most (70.9%) were male. Thirty-nine patients (20.6%) required renal support. Of the cases requiring renal support, 21 (53.8%) had a history of prior renal disease (P < 0.001, r = 0.351). History of HTN was significantly correlated with requirement for renal support (P = 0.010, r = 0.187). D-dimer (P = 0.038, η = 1.0) and CRP (P = 0.018, η = 0.924) were also significant. Survival was significantly worse in the renal support group (P < 0.001, r = -0.310). D-dimer and CRP were correlated with more severe illness and need for renal support. Study findings have implications for future validation research of chronic inflammation and risk for renal support during acute severe illness.

Interdisciplinary perspectives on the co-management of metabolic dysfunction-associated steatotic liver disease and coronary artery disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a public health threat as it affects approximately 38% of the adult population worldwide, with its prevalence rising in step with that of obesity and type 2 diabetes. Beyond the implications of MASLD for liver health, it is also associated with cardiovascular and vascular dysfunction. Although the many shared risk factors and common metabolic milieu might indicate that cardiovascular disease and MASLD are discrete outcomes from common systemic pathogeneses, a growing body of evidence has identified a potential causal relationship between MASLD and coronary artery disease, which is the leading cause of morbidity and mortality in people with MASLD and all-cause mortality worldwide. This Review takes an interdisciplinary approach, drawing on hepatology, cardiology, endocrinology, and metabolic and internal medicine specialists to help to delineate the intricate interplay between MASLD and coronary artery disease. It sheds light on novel opportunities for targeted interventions and personalised management strategies.

2024 Latin American Society of Hypertension guidelines on the management of arterial hypertension and related comorbidities in Latin America

Hypertension is responsible for more than two million deaths due to cardiovascular disease annually in Latin America (LATAM), of which one million occurs before 70 years of age. Hypertension is the main risk factor for cardiovascular morbidity and mortality, affecting between 20 and 40% of LATAM adults. Since the publication of the 2017 LASH hypertension guidelines, reports from different LATAM countries have confirmed the burden of hypertension on cardiovascular disease events and mortality in the region. Many studies in the region have reported and emphasized the dramatically insufficient blood pressure control. The extremely low rates of awareness, treatment, and control of hypertension, particularly in patients with metabolic disorders, is a recognized severe problem in LATAM. Earlier implementation of antihypertensive interventions and management of all cardiovascular risk factors is the recognized best strategy to improve the natural history of cardiovascular disease in LATAM. The 2024 LASH guidelines have been developed by a large group of experts from internal medicine, cardiology, nephrology, endocrinology, general medicine, geriatrics, pharmacology, and epidemiology of different countries of LATAM and Europe. A careful search for novel studies on hypertension and related diseases in LATAM, together with the new evidence that emerged since the 2017 LASH guidelines, support all statements and recommendations. This update aims to provide clear, concise, accessible, and useful recommendations for health professionals to improve awareness, treatment, and control of hypertension and associated cardiovascular risk factors in the region.

Predictive role of CHA₂DS₂-VASc score in acute coronary syndrome patients and value of adding global longitudinal strain to CHA₂DS₂-VASc score

BACKGROUND

Future clinical management would be improved by accurate and early identification of ACS patients at high CV risk. In non-valvular atrial fibrillation patients, the prognostic risk of thromboembolism has been evaluated using CHA₂DS₂-VASc scores. It has recently been shown to assess the severity of CAD and foresee patient outcomes. Also, LV global longitudinal strain is an independent predictor of outcome. Our study aimed to determine the added value of LV longitudinal strain (GLS) to CHA₂DS₂-VASc in predicting the outcome and severity of CAD in patients with acute coronary syndrome (ACS).

METHODS

A total of 577 patients with primary diagnosis of ACS were included between January and July 2021. All patients had evaluations based on history, clinical examination, 12-lead ECG, TTE, and coronary angiography. Six months follow-up had been provided to all patients.

RESULTS

Syntax score was significantly higher among patients with high-risk CHA₂DS₂-VASc score (30.5 ± 6.1 vs. 17.34 ± 8.7 vs. 11.11 ± 8.2), p-value <0. 001. GLS was significantly lower among high SYNTAX score (-10.97 ± 2.68 vs. -12.61 ± 3.46 vs. -17.81 ± 2.89), p-value = 0.0001. There was a significant negative correlation between the CHA₂DS₂-VASc score and GLS. Moreover, adding GLS to CHA₂DS₂-VASc score significantly improved overall accuracy for the prediction of outcome and severity of CAD in ACS patients.

CONCLUSIONS

CHA₂DS₂-VASc score is an easy and simple parameter that can be used in predicting the severity of CAD & adverse clinical outcome in ACS patients and adding GLS to the CHA₂DS₂-VASc score significantly improved overall accuracy.

Cystatin C as a Biomarker for Identifying High-Risk Patients with Acute Coronary Syndrome: An Observational Study

BackgroundCystatin C is a cysteine protease inhibitor, synthesized by nucleated cells, and released into various body fluids. Lots of studies have reported an association between cystatin C and atherosclerotic cardiovascular disease. However, the association of cystatin C with high-risk patients with acute coronary syndrome(ACS) has not been well studied. In this study, we investigated potential association of cystatin C with high-risk patients with ACS, and assessed whether cystatin C provide discriminating power of clinical risk stratification in patients with ACS.MethodsWe enrolled 219 patients with ACS in the present study. The cystatin C concentration was measured in clinical laboratory. The global registry of acute coronary events (GRACE) scores was calculated to assess risk stratification. The high-risk patients with ACS were defined based on GRACE scores and killip classification.ResultsThe cystatin C levels were significantly higher in high-risk patients compared to non-high-risk patients, both in the overall ACS group and its subtypes, including non-ST elevation ACS (NSTE-ACS) and ST elevation ACS (STE-ACS)(P < 0.05). The receiver operating characteristic (ROC) curve analysis showed that cystatin C had a discriminative performance for identifying high-risk patients across these groups(P < 0.05). After adjusting for potential confounders, multivariate logistic regression confirmed that the elevated cystatin C levels were independently associated with high-risk patients with ACS(P < 0.05).ConclusionsThe cystatin C was obviously elevated in high-risk group in the patients with ACS and its subgroups. Cystatin C appears to be a valuable biomarker for distinguishing and predicting high-risk patients with ACS, suggesting its relevance in clinical risk stratification.

A comparison between 64-projection and 32-projection myocardial perfusion scintigraphy

Aims

While most clinical guidelines recommend using a 64-projection view technique, some protocols do not specify a preference between 32-projection and 64-projection methods for conducting myocardial perfusion scintigraphy (MPS), which shows the lack of consensus in this matter. Nevertheless, these guidelines and protocols have not provided us with compelling evidence to support why the 64-projection technique is usually chosen. Thus, we aimed to determine if there is a significant difference between them in the assessment of cardiac perfusion and functional indices.

Methods and results

Sixty-nine patients were included in this pilot prospective, cross-sectional, cross-over, same patient control protocol study and underwent 32- and 64-projection MPS at both stress and rest phases after injecting 740-925 MBq of 99mTc-MIBI for every patient. Then, cardiac indices, including summed stress, rest, and difference scores, extent-stress and rest, left ventricular volumes and ejection-fraction, peak filling rate (PFR), and time to peak filling rate (TTPF) were recorded. Lin's concordance correlation coefficient was used to assess the agreement between protocols, and a paired sample t-test was used to compare the means of variables where appropriate. Findings revealed no significant difference as well as excellent/good agreement between the two methods in either the stress or rest state, except for the TTPF and PFR.

Conclusion

The findings suggest that lower-projection techniques could be adequate for routine clinical assessments without sacrificing diagnostic accuracy. However, the poor agreement for PFR and TTPF indicates that the 32-projection method may not reliably assess diastolic function, implying that the 64-projection protocol is preferable when precise evaluations are necessary.

Chest Pain at Rest With Unremarkable ECG and Cardiac Enzymes: Case Study Emphasising the Importance of Clinical Suspicion in the Diagnosis of Coronary Artery Disease

BACKGROUND

Coronary artery disease (CAD), primarily caused by atherosclerosis, is a leading cause of death, presenting as angina or myocardial infarction. Advances in cardiac imaging, angiography, and procedures like percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery have improved early detection and management of this condition. This report presents the case of a man who experienced worsening exertional chest pain and discomfort while at rest.

CASE REPORT

A 66-year-old man with a history of neurogenic syncope and asthma presented at the same-day emergency care (SDEC) unit with worsening exertional chest pain and discomfort whilst at rest. Despite normal ECG and cardiac enzyme results, further cardiac computed tomography angiography (CTCA) revealed significant CAD with moderate stenosis in the right coronary artery (RCA) and severe stenosis at the left anterior descending artery (LAD) bifurcation, leading to CABG surgery. Echocardiography showed a left ventricular ejection fraction of 50-54% with mid-inferior and basal to mid-inferoseptal hypokinesia. The cardiology-cardiothoracic multidisciplinary team concluded that CABG surgery would provide the most durable long-term outcome.

CONCLUSION

This case demonstrates the high importance of clinical suspicion of CAD despite normal initial investigations in the early identification and timely investigation as well as the role multidisciplinary teams and CABG can play in the timely management of complex CAD, ultimately leading to improved patient outcomes.

Kounis syndrome following COVID-19 vaccination: Clinical manifestations, mechanisms and management

Kounis syndrome is an acute coronary syndrome triggered by allergic mediators that induce coronary vasoconstriction and thrombosis, leading to further myocardial damage and anaphylactic shock. Kounis syndrome is also a rare but severe adverse reaction to the COVID-19 vaccine, a phenomenon that underscores the importance of collecting and analyzing similar cases to improve treatment and prognosis. Through comprehensive searches of the Web of Science, Embase, and PubMed databases, this study aimed to gather detailed patient data on patients who developed Kounis syndrome after receiving the COVID-19 vaccine and to further investigate the possible underlying mechanisms using currently available studies. A total of 15 patients (8 females, 7 males) were found. We analyzed comprehensive patient data, including demographics, vaccination details, time of onset of illness after vaccination, clinical manifestations, treatment and outcomes, duration of illness, and relevant examination results. Analysis of these data combined with known allergy-related mechanisms indicated that, regardless of the vaccine type, the first dose of the vaccine was more likely to cause Kounis syndrome than subsequent doses. Therefore, early diagnosis and clinical symptomatic treatment are particularly crucial for managing the severity of Kounis syndrome and preventing further cardiac complications. Additionally, when an unusual and severe allergic reaction occurs within a few hours after vaccination, it is important to closely monitor the development of cardiac-related symptoms and prepare clinically for the potential onset of Kounis syndrome.

Evaluation of the Effects of Mulberry Leaf Extracts Morus alba L. on Cardiovascular, Renal, and Platelet Function in Experimental Arterial Hypertension

INTRODUCTION

Numerous epidemiological studies have demonstrated that consuming foods rich in polyphenols and flavonoids can have beneficial effects on various diseases, including arterial hypertension (HTN). Recent research from our laboratory has shown that certain flavonoids exhibit antihypertensive properties in several animal models of HTN. Our objective was to evaluate the effect of Morus alba L. (white mulberry) extracts in an experimental HTN model characterized by nitric oxide (NO) deficiency.

METHODS

Male Sprague-Dawley rats were divided into four groups: a control group, hypertensive rats treated with an NO synthesis inhibitor (L-NAME) in drinking water for six weeks, L-NAME rats treated with Morus alba L. extract, and L-NAME rats treated simultaneously with captopril. After six weeks of treatment, we measured blood pressure, endothelial vascular function in the aorta, and platelet aggregation function.

RESULTS

Morus alba L. extract partially prevented the development of arterial hypertension due to NO deficiency, although it did not completely normalize blood pressure as captopril did. The extract reduced the excessive vasoconstrictor response to phenylephrine in aortic rings and improved vasodilation in response to acetylcholine, with both effects dependent on increased NO production. Morus alba L. extract also reduced the increased platelet aggregation in response to ADP and collagen in hypertensive animals, although it did not fully normalize this function.

CONCLUSIONS

Morus alba L. extract demonstrates antihypertensive effects, improves vascular reactivity, and reduces platelet aggregation in a model of arterial hypertension. These effects are primarily related to an increase in nitric oxide activity.

Hypertension: A Continuing Public Healthcare Issue

Hypertension is a cardiovascular disease defined by an elevated systemic blood pressure. This devastating disease afflicts 30-40% of the adult population worldwide. The disease burden for hypertension is great, and it greatly increases the risk of cardiovascular morbidity and mortality. Unfortunately, there are a myriad of factors that result in an elevated blood pressure. These include genetic factors, a sedentary lifestyle, obesity, salt intake, aging, and stress. Although lifestyle modifications have had limited success, anti-hypertensive drugs have been moderately effective in lowering blood pressure. New approaches to control and treat hypertension include digital health tools and compounds that activate the angiotensin receptor type 2 (AT2), which can promote cardiovascular health. Nonetheless, research on hypertension and its management is vital for lessening the significant health and economic burden of this condition.

The Cross-Sectional Association Between Multimorbidity and Sleep Quality and Duration Among the Elderly Community Dwellers in Northwest China

Background

Multimorbidity, defined as the coexistence of two or more chronic diseases, is highly prevalent among the elderly population and is associated with adverse outcomes. However, little is known about its relationship with sleep issues, particularly in this demographic. Therefore, this study aimed to investigate its association with sleep quality and duration among the elderly.

Methods

This cross-sectional study was conducted in Emin County, Xinjiang, China, which included a population aged 60 years and above. We employed the Pittsburgh Sleep Quality Index (PSQI) score to assess sleep quality and duration. Multimorbidity was determined through self-reports, physical examination, blood tests, and imaging. Logistic regression analyses were used to explore the association between multimorbidity and sleep patterns, adjusting for confounders.

Results

A total of 8205 elderly participants were included, of whom 66.8% suffered from multimorbidity. Participants with multimorbidity exhibited higher total PSQI scores [6 (3,9)], and a higher percentage of poor sleep quality (50.6%), compared to those without multimorbidity. Multimorbidity was significantly associated with the presence of poor sleep quality (OR = 1.27, 95% CI: 1.14-1.41, P < 0.001) before and after adjusting for confounders. The risk of having poor sleep quality significantly increased as the number of multimorbidities increased. The OR (95% CI) values were 1.16 (1.02,1.32) for two diseases, 1.54 (1.26,1.90) for ≥5 diseases. In the adjusted model for total participants, having four diseases (OR = 1.26, 95% CI: 1.05-1.51, p = 0.013) and five or more diseases (OR = 1.29, 95% CI: 1.03-1.61, p = 0.029) were associated with shorter sleep duration. Furthermore, those with five or more diseases associated with longer sleep duration (OR = 1.40, 95% CI: 1.00-1.95, p = 0.057).

Conclusion

There is a significant association between multimorbidity and poor sleep quality in older community dwellers, which may provide clues for disease prevention.

Ventricular arrhythmias and haemodynamic collapse during acute coronary syndrome: increased risk for sudden cardiac death?

AIMS

In the acute phase of acute coronary syndrome (ACS), ventricular tachycardia (VT) and/or ventricular fibrillation (VF) leading to resuscitation are not considered to be associated with increased long-term sudden cardiac death (SCD) because the cause-acute ischaemia-is believed to be reversible. The aim of this study is to investigate whether ventricular arrhythmias (VAs) leading to sudden cardiac arrest during ACS are associated with the risk of incident SCD in patients with a normal or mildly impaired left ventricular ejection fraction (LVEF).

METHODS AND RESULTS

This study is based on a retrospective analysis of all 8062 consecutive ACS patients undergoing coronary angiography with the baseline LVEF ≥40% between 2007 and 2018 (follow-up until 31 December 2021). The primary outcome was SCD-equivalent life-threatening VAs (LTVAs) composed of true SCDs and SCDs aborted by successful resuscitation or appropriate implantable cardiac device (ICD) therapy. The risk of sudden LTVA was estimated with a multivariate subdistribution hazard model using other deaths as competing events. Two-hundred thirteen (n = 211, 2.6%) patients suffered acute phase VF/VT leading to resuscitation and survived to discharge, and most occurred before angiography (80.6%, n = 170) and were VF (92.9%, n = 196). During a median follow-up of 7.6 years, 3.9% (n = 316) of all the patients had LTVA (10.0% in the VF/VT group vs. 3.8% in other patients). Ventricular fibrillation/VTs during ACS are associated with an increased risk for future SCD (hazard ratio 3.07; 95% confidence interval 1.94-4.85, P < 0.001). Most LTVAs occurred in patients without ICDs.

CONCLUSION

Ventricular fibrillation/VT in ACS is associated with a remarkably high long-term risk for SCD in patients with an LVEF ≥40%.

sJAM-C as a Potential Biomarker for Coronary Artery Stenosis: Insights from a Clinical Study in Coronary Heart Disease Patients

Purpose

Coronary artery stenosis caused by atherogenesis is a major pathological link in coronary heart disease (CHD), which is a leading cause of global morbidity and mortality. Junctional adhesion molecule C (JAM-C) presents more and more association with atherosclerosis. However, no studies have shown the relationship between soluble JAM-C (sJAM-C) and the degree of coronary artery stenosis. This study aimed to analyze the effect of sJAM-C on coronary artery stenosis and to verify whether sJAM-C could be a biomarker for coronary artery stenosis.

Patients and Methods

The participants registered at the Beijing Luhe Hospital, Capital Medical University in the cross-sectional study. A total of 121 patients without coronary stenosis and 408 patients with coronary artery stenosis were enrolled after matching age and sex. Demographic information, medication history, and laboratory data were collected. The level of serum sJAM-C was detected by enzyme-linked immunosorbent assay (ELISA) kits. We used the logistic regression model to evaluate the association between sJAM-C and coronary artery stenosis. Furthermore, the receiver operating characteristic (ROC) curve and area under curve (AUC) were used to evaluate the diagnostic value of sJAM-C on coronary artery stenosis.

Results

The serum level of sJAM-C was remarkably higher in patients with coronary artery stenosis than those without stenosis (p < 0.0001). Logistic regression models showed that there were positive association between serum sJAM-C level and coronary artery stenosis after adjustment, with corresponding ORs were 3.088 (95% CI 1.922-4.960, p < 0.0001). And the ROC curve revealed a sensitivity of 65.7% and specificity of 60.3% with AUC of 0.676 (95% CI 0.622-0.730) for the diagnosis of coronary artery stenosis with serum sJAM-C at a cut-off value of 18.1 pg/mL, indicating a certain diagnostic value.

Conclusion

In summary, higher serum sJAM-C level was possibly associated with the more severe coronary artery stenosis. Additionally, sJAM-C demonstrates a certain diagnostic value of coronary artery stenosis. These findings suggest sJAM-C may be a biomarker for coronary artery stenosis.

BATF alleviates ox-LDL-induced HCAEC injury by regulating SIRT1 expression in coronary heart disease

BACKGROUND

Coronary heart disease (CHD) represents a significant global health concern, arising from an intricate interplay between genetic predisposition and environmental influences, with a pivotal involvement of oxidized low-density lipoprotein (ox-LDL) in the pathophysiology of it. We aimed to elucidate the synergistic dynamics of B cell activating transcription factor (BATF) and Sirtuin 1 (SIRT1) in cell injury caused by ox-LDL, reveal potential therapeutic strategies for CHD.

METHODS

The GSE42148 dataset was used to analyze Differentially expressed genes (DEGs) to construct a gene co-expression network. Then bioinformatics analysis was performed on key modules to select the BATF gene. In vitro experiments were conducted to investigate the protective impact of BATF against human coronary artery endothelial cells (HCAEC) injury induced by ox-LDL. Further investigations probed the synergistic impact of BATF and SIRT1 modulation on cellular apoptosis and damage in the presence of ox-LDL.

RESULTS

BATF was significantly down-regulated in the CHD sample of the GSE42148 dataset. In vitro assays have proven that BATF alleviates ox-LDL-induced HCAEC injury. Notably, BATF emerged as a pivotal regulator of SIRT1 expression post ox-LDL exposure. Subsequent experiments underscored the interplay between BATF and SIRT1 in mitigating ox-LDL-induced apoptosis and Lactate Dehydrogenase (LDH) activity elevation, highlighting their collaborative role in cellular protection.

CONCLUSION

The research findings suggested a prospective protective function of BATF in HCAEC injury induced by ox-LDL, likely through the mediation of SIRT1 regulation. These results could offer fresh perspectives on the etiology of CHD and possible treatment avenues.

The role for ω-3 polyunsaturated and short chain fatty acids in hypertension: An updated view on the interaction with gut microbiota

As of 2024, arterial hypertension is still considered the leading modifiable cardiovascular risk factor and, due to high rates of undertreatment and poor blood pressure control, the major contributor to human morbidity and mortality. Development of new treatment options and better interventions in lifestyle correction have become a priority of experimental and clinical research. In the last decades, dietary supplementation of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) and generation of gut microbiota-derived short chain fatty acids (SCFAs) have surged as potential and promising interventions for hypertension and cardiovascular prevention. ω-3 PUFAs are considered "essential" fatty acids that can be obtained only from dietary sources. Although previous intervention trials were not consistent in reporting a significant benefit of ω-3 PUFAs, the recent REDUCE-IT trial has provided robust evidence in support of their role in cardiovascular prevention. Recent studies have also identified the intestinal microbiota as a potential player in the pathophysiology and progression of hypertension. Although this might occur through many pathways, generation of SCFAs that is highly dependent on dietary fiber intake is primarily involved, providing an additional target for the development of novel therapeutic strategies. For these reasons, some scientific societies currently recommend dietary supplementation of ω-3 PUFAs and fiber-containing foods in patients with hypertension. In this narrative review, we summarize the results of studies that examined the effects of ω-3 PUFAs and SCFAs on blood pressure, highlighting the mechanisms of action on the vascular system and their possible impact on hypertension, hypertension-related organ damage and, ultimately, cardiovascular outcomes.

Resuscitation of a case of allergy, infarction, and ventricular fibrillation: Kounis syndrome type II and literature review

To study a case of Kounis syndrome (KS) type II, characterized by allergy, myocardial infarction, and ventricular fibrillation. A patient diagnosed with KS type II was admitted to Yangpu Hospital, School of Medicine, Tongji University in 2021. After systemic treatment, routine investigations, including blood tests, electrocardiography (ECG), and biochemical and coagulation analyses, were performed. The patient subsequently underwent coronary angiography and percutaneous coronary intervention, achieving a successful recovery. In patients with acute allergic reactions, particularly those presenting with severe manifestations or anaphylactic shock, timely ECG and cardiac enzyme testing are crucial to prevent misdiagnosis.

Association between trimethylamine N-oxide and prognosis of patients with myocardial infarction: a meta-analysis

Background

Trimethylamine N-oxide (TMAO) has been widely explored and considered as a biomarker for adverse cardiovascular events. However, the relationships between TMAO adverse cardiovascular events are inconsistent in patients. Therefore, this meta-analysis aimed to estimate association between TMAO levels and the prognosis of patients with myocardial infarction (MI).

Methods

We searched PubMed, EMBASE, the Cochrane Library, and Web of Science from inception to July 2, 2023, to retrieve all relevant clinical trials. Associations between TMAO levels, major adverse cardiovascular events (MACE), all-cause mortality, recurrent MI, stroke, etc., were systematically addressed. Outcomes included MACE, all-cause mortality, recurrent MI, rehospitalization caused by heart failure, stroke, revascularization, SYNTAX score, and multivessel disease. A fixed/random-effects model should be adopted to calculate the pooled estimates. Besides, funnel plot, Begg's test and Egger' test were used to test publication bias.

Results

A total of nine studies were included in our meta-analysis. Our results indicated that higher TMAO levels were associated with greater risk of MACE (RR = 1.94; 95% CI = 1.39 to 2.73), all-cause mortality (RR = 1.56; 95% CI = 1.00 to 2.44), and MI (RR = 1.21; 95% CI = 1.01 to 1.45). No significant association was found in stroke, SYNTAX, and multivessel disease. Besides, our results reported that the association between TMAO levels and MACE after MI was not affected by the geographic localization.

Conclusion

This study was the first meta-analysis that showed a significant positive association of TMAO levels with MACE, all-cause mortality, and recurrent MI in patients with MI.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=460400, PROSPERO (CRD42023460400).

MiRNA-34a, miRNA-145, and miRNA-222 Expression, Matrix Metalloproteinases, TNF-α and VEGF in Patients with Different Phenotypes of Coronary Artery Disease

The development of different phenotypes of coronary artery (CA) lesions is regulated via many various factors, such as pro-inflammatory agents, zinc-dependent endopeptidases, growth factors and circulating microRNAs (miRs). To evaluate the expression levels of miR-34a, miR-145 and miR-222, tumor necrosis factor α (TNF-α), matrix metalloproteinases (MMP-1, -9, -13 and -14) and vascular endothelial growth factor (VEGF) in patients with different phenotypes of coronary artery disease (CAD): ischemia/angina with non-obstructive coronary arteries (INOCA/ANOCA) and obstructive CAD (oCAD) compared with a control group. This cross-sectional observational study included 157 subjects with a verified CAD diagnosis (51 patients with INOCA, 76 patients with oCAD and 30 healthy volunteers). The expression of miR-34a, miR-145 and miR-222 (RT-PCR) and the levels of VEGF, TNF-α, MMP-1, MMP-9, MMP-13 and MMP-14 (ELISA) were estimated in plasma samples. A higher concentration of MMP-9 was found in oCAD-group samples compared to the INOCA/ANOCA group. The INOCA/ANOCA group was characterized by higher levels of TNF-α. Based on multivariate regression analysis, a mathematical model predicting the type of CA lesion was constructed. MiR-145 was the independent predictor of INOCA/ANOCA (p = 0.006). Changes in concentrations of MMP-9 and MMP-14 were found in both investigated CAD groups, with MMP-9 levels being significantly higher in obstructive CAD samples than in INOCA/ANOCA, which confirms the role of inflammation in the development of atherosclerosis. A multivariate regression analysis allowed us to achieve a model that can predict the phenotype of stable CAD, and MiR-145 can be assumed as an independent predictor of INOCA/ANOCA.

Sleep and hypertension - up to date 2024

People spend one-third of their lives sleeping, and adequate, restful sleep is an essential component of a healthy life. Conversely, disruption of sleep has been found to cause various physical and mental health problems. Emerging research has shown that blood pressure (BP) during sleep is a stronger predictor of cardiovascular events than conventional office BP or daytime BP. Thus, management of both sleep health and nighttime BP during sleep is important for preventing cardiovascular events. However, recent studies demonstrated that nighttime BP is poorly controlled compared with office BP and daytime BP. This finding is understandable, given the challenges in monitoring BP during sleep and the multiplicity of factors related to nocturnal hypertension and BP variability. This review summarizes recent evidence and considers future perspectives for the management of sleep and hypertension.

Pregnancy-associated plasma protein-A (PAPP-A) and cardiovascular disease

There is strong evidence that PAPP-A, a local regulator of insulin-like growth factor signaling through proteolytic cleavage of inhibitory binding proteins, is involved in multiple physiological processes associated with cardiovascular disease. This review will describe the various roles of PAPP-A with a focus on atherosclerosis, neointimal hyperplasia, and acute coronary syndrome in animal models and in humans.

Chemical characteristics and water stability evaluation of groundwater in the CKDu Zone of Sri Lanka

Groundwater is the main source of drinking water for the rural population in the chronic kidney disease of unknown etiology (CKDu) zone of the North Central Province (NCP) in Sri Lanka. In this study, a total of 334 groundwater samples (311 dug wells, 21 tube wells and 2 springs) during the wet season from two aquifers in the NCP were collected, and investigated their chemical characteristics and evaluate their water quality, including groundwater chemistry, main ion sources, the corrosion and scaling potential of groundwater. The results showed that the two hydrochemical types of groundwater in the NCP were mainly of the Ca-HCO3, Na·Ca-HCO3 types, with the main HCO3-, Na+ and Ca2+ ions in both types of groundwater originating from silicate and evaporite salt dissolution and influenced by alternating cation adsorption, while the presence of NO3- was mainly anthropogenic. Evaluation of water stability using namely Langelier saturation index (LSI), Ryznar stability index (RSI), Puckorius scaling index (PSI) and Larson-Skold index (LS), indicated that most groundwater presents corrosion potential and has corrosion behavior tendency of metals to some degrees. The water quality of Polonnaruwa was better than that of Anuradhapura in the NCP, and when the groundwater was worse than the "good" grade, which must be properly treated before it is used as drinking water.

Off-pump coronary artery bypass grafting versus percutaneous coronary intervention with second-generation drug-eluting stents for coronary artery revascularization

OBJECTIVE

This study compared the clinical efficacy of off-pump coronary artery bypass grafting (OPCAB) with percutaneous coronary intervention (PCI) in the treatment of left main coronary artery and/or triple-vessel disease (LM and/or TVD).

METHODS

We retrospectively enrolled 1484 consecutive patients with LM and/or TVD in Shanxi Cardiovascular Hospital from January 2015 to December 2022 and divided them into the OPCAB group (n = 583) and the PCI group (with second-generation drug-eluting stents) (n = 901). Propensity score matching was used for 316 equally matched pairs of patients in the groups. The outcomes were all-cause and cardiac mortality, angina recurrence, and major adverse cardiac and cerebrovascular events, which comprised non-lethal myocardial infarction, stroke, and repeat revascularization.

RESULTS

The mean follow-up was 3.93 years in the OPCAB group and 4.19 years in the PCI group. There were no significant differences in all-cause mortality, cardiac mortality, major adverse cardiac and cerebrovascular events, or non-lethal myocardial infarction between the groups. The incidence of repeat revascularization and angina recurrence was higher in the PCI group than in the OPCAB group. However, the incidence of stroke was higher in the OPCAB group than in the PCI group.

CONCLUSIONS

OPCAB may be a favorable coronary revascularization strategy for LM and/or TVD.

Severity prediction markers in dengue: a prospective cohort study using machine learning approach

BACKGROUND

Dengue virus causes illnesses with or without warning indicators for severe complications. There are no clear prognostic signs linked to the disease outcomes.

METHODS

Clinical and laboratory parameters among 102 adult including 17 severe dengue (SD), 33 with warning and 52 without warning signs during early and critical phases were analysed by statistical and machine learning (ML) models.

RESULTS

In classical statistics, abnormal ultrasound findings, platelet count and low lymphocytes were significantly linked with SD during the febrile phase, while low creatinine, high sodium and elevated AST/ALT during the critical phase. ML models highlighted AST/ALT and lymphocytes as key markers for distinguishing SD from non-severe dengue, aiding clinical decisions.

CONCLUSION

Parameters like liver enzymes, platelet counts and USG findings were linked with SD.USG testing at an earlier phase of dengue and a point-of-care system for the quantification of AST/ALT levels may lead to an early prediction of SD.

A benchmark dataset for analyzing hematological responses to dengue fever in Bangladesh

Dengue fever is an important public health problem in tropical and subtropical areas, and the understanding of its hematological changes is crucial for the improvement of diagnosis, treatment, and prognosis. This data set presents hematological parameters for the systematic record of patients suffering from dengue infection: age, sex, hemoglobin, WBC count, differential count, RBC panel, platelet count, and PDW. The dataset has in-depth records of patients admitted to Upazila Health Complex, Kalai, Jaipurhat, Bangladesh and thus offers an opportunity for further analysis of hematological changes produced by dengue infection. This dataset is valuable because of the potential contribution that these data will make to developing predictive models for disease severity and patient outcomes, enhancing clinical decision-making. It serves as a benchmark for the comparison of hematological responses across different demographics and geographical locations, adding value to the knowledge of dengue in the world. Moreover, the study has gone further to indicate how the characteristics related to blood may be affected by various treatment regimens, hence offering better treatment protocols. The data preprocessing in this study involved cleaning, normalization, and encoding of the variables before proceeding to perform the statistical analysis. This showed a Chi-Square test for no significant association of sex with the diagnostic outcome, as given by the p-value of 0.277. On the other hand, the Z-test and T-test results indicated a significant difference in the hemoglobin levels concerning gender; the obtained p-values are 2.534 × 10-8 and 4.325 × 10-8, respectively. These findings emphasize how gender influences hematological responses against dengue. In summary, this database will be a great help and will give a leading edge to the research studies of dengue, public health strategies, and improved diagnosis and treatment modalities for patients.

Unilateral pulmonary edema in a dog with a large, left-to-right shunting patent ductus arteriosus

A four-month-old, 5.0-kg male castrated mixed-breed dog was presented for further evaluation of a heart murmur. A grade 6/6 left basilar, continuous heart murmur, and bounding femoral arterial pulses were observed, consistent with a patent ductus arteriosus (PDA). Transthoracic echocardiography confirmed the diagnosis of a large, left-to-right shunting PDA with severe left heart volume overload. Thoracic radiography revealed severe, alveolar lung disease in the right cranial, right middle, and right caudal lung lobes; no pulmonary infiltrate was observed in the left lung lobes. Unilateral pulmonary edema secondary to the PDA was diagnosed, which later resolved with medical management and transcatheter occlusion of the PDA with an Amplatz Canine Ductal Occluder. Unilateral pulmonary edema secondary to a PDA has not been previously reported in the dog.

Epidemiology of cardiovascular risk factors: Behavioural risk factors

Cardiovascular diseases (CVDs) have a multifactorial origin. Among the risk factors, so-called behavioural risk factors play a major role in the onset of these diseases: smoking, unhealthy diet, lack of physical activity and sedentary lifestyle, alcohol, sleep disorders, depression and illicit drug use are among the main behavioural risk factors for CVD and are considered to be modifiable and accessible to prevention. The prevalence of these cardiovascular risk factors remains high among the French population. Nearly one in three adults are smokers, 71.7% do not meet the recommendation to eat five fruits and vegetables per day, and 4 out of 5 adults consume more than 6g of salt per day. Further, 38.7% of adults do not meet the recommendations for physical activity, 40.8% have a high level of sedentary, 49.4% report sleep problems in the last 8 days, and 12.5% have had a major depressive episode in the last 12 months. Despite some positive trends, such as an increase in the level of physical activity among men and the decline in smoking prevalence, the epidemiological situation regarding these risk factors remains a cause for concern in France. While the gap between risk factors in men and women is narrowing, this is often due to a worsening of the situation among women, who are increasingly adopting unfavourable behaviours and tending to reach the higher levels of risk factors traditionally observed among men. The epidemiological situation demonstrates the urgent need to strengthen policies to prevent these risk factors.

A Translational Perspective on the Interplay Between Hypertension, Inflammation and Cognitive Impairment

Hypertension represents the major risk factor in the onset of cardiovascular disease worldwide. Preclinically, several mouse models of hypertension have been developed to investigate the pathophysiological link between hypertension and vascular impairment. Specifically, angiotensin-II infusion, transverse aortic constriction, deoxycorticosterone acetate salt, and N(ω)-nitro-L-arginine methyl ester (L-NAME) administration as hypertensive stimuli at the preclinical level permit the unveiling of a proinflammatory response driven by the innate and adaptive immune system and leads to vascular injury in terms of structural and functional alterations. Vascular impairment seems to be particularly critical at the cerebral level wherein arterioles, venules, and capillaries finely tune blood supply across the whole brain leading to the onset of a well known clinical condition named cerebral small vessel disease (cSVD) characterized by extensive brain injury, which culminates in the decline of cognitive functions. Advances in magnetic resonance imaging permit identification and accurate diagnosis of specific cSVD biomarkers including white matter hyperintensities, lacunar strokes, cerebral microbleeds, and enlarged perivascular spaces, each of which proved to be associated with a specific cognitive domain impairment. Such an approach in combination with pharmacological interventions targeted to the lowering of blood pressure and the prevention of vascular thrombosis formation represents a solid strategy in the prevention and the management of cSVD cognitive decay.

V, Kujur P, N.A A, N.R P, Chenchula S. Prescribing trends and rational drug use patterns in cardiovascular patients: A cross-sectional observational study

Cardiovascular diseases (CVDs), encompassing conditions like coronary artery disease, hypertension and ischemic heart disease, are highly prevalent worldwide. This study analyzed prescribing trends and treatment appropriateness in CVD patients, focusing on adherence to guidelines, essential medicine use and generic drug prescriptions. A cross-sectional observational study was conducted on CVD-diagnosed patients. Data on prescribed medications-including drug classes, generic prescriptions and adherence to the Essential Drug List (EDL)-were collected and analyzed using IBM SPSS version 26.0. The most frequently prescribed drug classes included antiplatelets, diuretics and hypolipidemics. Aspirin was the most commonly prescribed medication (58.1%), followed by furosemide (36.5%), amlodipine (32.4%) and rosuvastatin (24.3%). Statins and calcium channel blockers were prescribed more often than angiotensin II receptor blockers and beta-blockers. On average, 13.2 drugs were prescribed per patient, with only 28.8% prescribed generically. Furthermore, 47.3% of medications were on the EDL. This study highlights the high prevalence of CVDs and the common drug classes prescribed to manage them. These findings provide important insights into current prescribing trends, particularly the frequent use of anti-hypertensive, antiplatelets, diuretics and hypolipidemics and suggest areas for optimizing medication management in this population. Additionally, there is a need to better manage polypharmacy in CVD patients.

CircRNA-mediated regulation of cardiovascular disease

Cardiovascular diseases (CVDs) encompass a range of disorders affecting the heart and blood vessels, such as coronary heart disease, cerebrovascular disease (e.g., stroke), peripheral arterial disease, congenital heart anomalies, deep vein thrombosis, and pulmonary embolism. CVDs are often referred to as the leading cause of mortality worldwide. Recent advancements in deep sequencing have unveiled a plethora of noncoding RNA transcripts, including circular RNAs (circRNAs), which play pivotal roles in the regulation of CVDs. A decade of research has differentiated various circRNAs by their vasculoprotective or deleterious functions, revealing potential therapeutic targets. This review provides an overview of circRNAs and a comprehensive examination of CVDs, the regulatory circRNAs within the vasculature, and the burgeoning research domain dedicated to these noncoding RNAs.

Non-Sleep Deep Rest Relaxation and Virtual Reality Therapy for Psychological Outcomes in Patients with Coronary Artery Disease: A Pilot Randomized Controlled Trial

Background: While cardiac rehabilitation (CR) primarily focuses on restoring physical strength, preventing relapse, and reducing rehospitalization rates, psychological interventions play a complementary role by supporting mental health, which is crucial for patients' long-term adherence and overall recovery. The effectiveness of psychological interventions in CR is debated, and while technologies like virtual reality (VR) therapy show promise, they have limitations for patients with coronary artery disease (CAD). Therefore, this study examines non-sleep deep rest (NSDR) relaxation, a novel and easily implementable technique, and compares its impact on depression, anxiety, and stress with VR therapy and standard care. Methods: Forty-five CAD patients undergoing CR in ambulatory conditions were divided into three groups: the NSDR group, which received eight sessions of NSDR relaxation as part of their rehabilitation; the VR group, which received eight sessions of VR therapy as part of their rehabilitation; and the control group, which received standard care including Schultz Autogenic Training (SAT). The outcomes were measured using the Hospital Anxiety and Depression Scale (HADS) and the Perception of Stress Questionnaire (PSQ). Results: Both NSDR relaxation and VR therapy were effective in reducing the HADS total score, anxiety levels, the PSQ general score, and emotional tension. No significant differences were observed between the two treatment approaches. However, SAT was found to be insufficient for effectively improving the mental state of cardiac patients. Conclusions: This study suggests that NSDR relaxation is an effective psychotherapeutic intervention in CR. NSDR and VR therapy showed similar benefits, offering promising alternatives to traditional methods. Integrating these techniques could enhance patient outcomes and adherence in CR. Further research is needed to refine these interventions and optimize their clinical application.

Evaluation of the patency rate and endothelialization of a poly-ε-caprolactone, nanofiber sheet-based vascular graft using a rat abdominal aortic implantation model

Introduction

The global increase in cardiovascular diseases has resulted in an augmented development of artificial small-caliber vascular grafts used in bypass graft surgeries, such as coronary and distal artery bypass graft surgeries. However, no consensus exists regarding the best method for creating vascular grafts. Poly-ε-caprolactone (PCL) is a biocompatible and biodegradable material that has been widely studied as a scaffold for tissue regeneration, inclusive of vascular grafts. In this study, a vascular graft was created from a PCL nanofiber sheet (PCL graft), and the performance thereof was examined using a rat abdominal aortic implantation model.

Methods

The PCL nanofiber sheets were created using an electrospinning machine. These nanofiber sheets were rolled up. Glue was applied between layers using a PCL solution to create a PCL nanofiber vascular graft, with an inner diameter of 1 mm. PCL grafts with 7 mm length were implanted into the abdominal aorta of rats. Thereafter, the patency was determined by pulsating blood flow from the hemiresection site of the distal aorta of the graft anastomosis, and endothelialization was examined using hematoxylin and eosin and immunofluorescent staining methods.

Results

The patency rate of the PCL graft at 2 weeks was 57.1% (12 of 21 cases), which is not satisfactory as a small-caliber vascular graft. Patent cases, however, revealed a CD31-positive endothelial cell layer in the inner lumen and autologous cell infiltration into the scaffold, indicating autologous vessel-like regeneration. By contrast, the occluded cases showed disassembly of the nanofiber layers; and the inner layers folded into the middle of the lumen. This observation suggested that the disassembled inner layer of the PCL graft disturbed the blood flow and triggered occlusion.

Conclusions

PCL grafts can exhibit autologous vessel-like regeneration; nonetheless, regarding patency, grafts made from rolled-up PCL nanofiber sheets have structural weaknesses. Further improvements are required to achieve a long-term and high patency rate for PCL grafts.

Long-term Survival in Elderly Patients after Coronary Artery Bypass Grafting Compared to the Age-matched General Population: A Meta-analysis of Reconstructed Time-to-Event Data

BACKGROUND

 Coronary artery disease (CAD) limits life expectancy compared to the general population. Myocardial infarctions (MIs) are the primary cause of death. The incidence of MI increases progressively with age and most MI deaths occur in the population older than 70 years. Coronary artery bypass grafting (CABG) may prevent the occurrence of new MIs by bypassing most CAD lesions, providing downstream "collateralization" to the diseased vessel, and consequently prolonging survival. We systematically assessed the survival-improving potential of CABG by comparing elderly CABG patients to the age-matched general population.

METHODS

 Three databases were assessed. The primary and single outcome was long-term all-cause mortality. Time-to-event data of the individual studies were extracted and reconstructed in an overall survival curve. As a sensitivity analysis, summary hazard ratios (HRs) and 95% confidence intervals (CIs) for all individual studies were pooled and meta-analytically addressed. The control group was based on the age-matched general population of each individual study.

RESULTS

 From 1,352 records, 4 studies (4,045 patients) were included in the analysis. Elderly patients (>70 years) who underwent CABG had a significantly lower risk of death in the follow-up compared to the general age-matched population in the overall survival analysis (HR: 0.88; 95% CI: 0.83, 0.94; p < 0.001: mean follow-up was 7 years).

CONCLUSION

 Elderly patients who undergo CABG appear to have significantly better long-term survival compared to the age-matched general population. This advantage becomes visible after the first year and underscores the life-prolonging effect of bypass surgery, which may eliminate the expected reduction in life expectancy through CAD.

Evolution of the Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) Indication and Mortality Rates in Spain from 2010 to 2019

Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are the main interventional treatments for coronary artery disease (CAD) patients. Both procedures are constantly being perfected and developed. This study aims to analyze the evolution of intervention mortality rates of PCI and CABG in recent years in Spain. We use a database of all hospital discharges from CABG and PCI procedures in Spain during two periods, between the years 2010 to 2012 and 2016 to 2019. We elaborate two multivariate regression logistic models to test the differences in mortality between the two periods and the two procedures, adjusting the mortality rates by age, gender, and comorbidities. We find strong evidence that CABG significantly reduced mortality rates, especially in complex patients, while PCI remained almost constant. We also discuss how physicians incorporate the improvement in procedures' performance into the decision-making for the recommendation of these two procedures in CAD patient management.

Heart regeneration from the whole-organism perspective to single-cell resolution

Cardiac regenerative potential in the animal kingdom displays striking divergence across ontogeny and phylogeny. Here we discuss several fundamental questions in heart regeneration and provide both a holistic view of heart regeneration in the organism as a whole, as well as a single-cell perspective on intercellular communication among diverse cardiac cell populations. We hope to provide valuable insights that advance our understanding of organ regeneration and future therapeutic strategies.

Colchicine in Patients With Coronary Disease Who Underwent Coronary Artery Bypass Surgery: A Meta-Analysis of Randomized Controlled Trials

Recent randomized evidence has shown that low-dose colchicine lowers the risk of cardiovascular events in patients with chronic coronary artery disease. Colchicine has also been used in coronary artery bypass grafting (CABG), with individual studies suggesting protective effects for postoperative atrial fibrillation (POAF). We performed a meta-analysis of studies assessing the effect of colchicine on outcomes in CABG surgery. We systematically searched 3 libraries (MEDLINE, Web of Science, and the Cochrane Library), selecting all randomized control trials including patients who underwent CABG and were randomized for perioperative administration of colchicine versus standard of care. The primary outcome was incidence of POAF. The inverse variance method (DerSimonian&Laird) and random-effects model were performed. The leave-one-out analysis was carried out as a sensitivity analysis to address possible outliers. From 205 screened studies, 5 met the inclusion criteria and were selected. The data from 839 patients were included in the final analysis. The included studies were published between 2014 and 2022. The perioperative administration of colchicine was associated with the reduction of POAF rates after CABG compared with standard of care (relative risk 0.54, 95% confidence interval 0.40 to 0.73, p <0.01). The leave-one-out analysis confirmed the robustness of the analysis, with minimal variations of the confidence interval. This meta-analysis of randomized studies suggests that the perioperative administration of colchicine is associated with significant reduction of POAF after CABG.

Culturally Tailored Lifestyle Modification Strategies for Hypertension Management: A Narrative Review

Hypertension (HTN) is a significant global health challenge affecting billions of individuals worldwide. The prevalence of HTN varies considerably across the globe due to diverse factors, such as lifestyle influenced by culture, genetics, health care access, and socioeconomic conditions. Lifestyle modification has a substantial impact on blood pressure management; however, some cultural practices and behaviors affect recommended lifestyle modification strategies for HTN management. The purpose of this review was to explore lifestyle modification strategies for HTN management from a cultural perspective. Lifestyle modification, including physical activity, stress reduction, changes in dietary patterns (adopting a low-sodium diet and intake of fruit and vegetables), and weight management, provide an effective non-pharmacologic intervention for the management of hypertension. Individual's cultural practices have the potential to determine their diet, physical activity levels, knowledge, and perception about HTN, adherence to treatment and medications, and the use of local herbal preparations for HTN management. Culture focuses on individuals' belief, practices and how these beliefs and practices influence their lifestyle behaviors for HTN management. It is important to consider patients' cultural beliefs before recommending lifestyle behaviors for HTN management.

Evaluation of Hypertension-Related Knowledge, Medication Adherence, and Associated Factors Among Hypertensive Patients in the Aljouf Region, Saudi Arabia: A Cross-Sectional Study

Background and Objectives: Hypertensive patients' knowledge and adherence to prescribed medicines are critical in managing their condition, as poor adherence may lead to adverse cardiac and cerebrovascular events. The present study assessed hypertension-related knowledge and medication adherence among hypertensive patients attending primary health centers (PHCs) in the Aljouf Province, Saudi Arabia. Materials and Methods: Using a cross-sectional design, we conducted this survey on 390 patients. Self-reported hypertension knowledge was assessed using the Hypertension Knowledge Level Scale (HK-LS), and medication adherence was determined using the Hill-Bone Medication Adherence Scale. We used binomial regression analysis (adjusted with other variables) to find the associated factors of medication adherence. Results: This study found that nearly half (49.2%) of the participants had inadequate knowledge, and poor medication adherence was noted in 40.8% of the participants. We found a positive correlation between HK-LS and the Hill-Bone Medication Adherence Scale scores (Spearman's rho = 0.312, p = 0.002). Medication adherence was significantly associated with job status (private sector (ref: public sector, adjusted odds ratio [AOR] = 2.02, 95% CI = 1.18-3.62, p = 0.005)), living in an urban region (ref: rural, AOR = 3.61, 95% CI = 1.85-5.72, p = 0.002), and duration since diagnosis of more than 5 years (ref: ≤1 year, AOR = 3.53, 95% CI = 2.36-4.95, p = 0.001). Conclusions: The present study findings indicate that there is still a critical gap in managing hypertension at the PHCs in this region, and this may lead to poor health outcomes among the patients and burden the healthcare system. Hence, continuous patient education and targeted counseling are recommended for those with poor medication adherence.