Global Overview of the Epidemiology of Atherosclerotic Cardiovascular Disease

Heart rate variability mediates the association between polycyclic aromatic hydrocarbons exposure and atherosclerotic cardiovascular disease risk in coke oven workers

Polycyclic aromatic hydrocarbons (PAHs) metabolites was related to heart rate variability (HRV) reduction and atherosclerotic cardiovascular disease (ASCVD), and ASCVD was also affected by HRV. However, the mediating role of HRV in the association between PAHs exposure and ASCVD risk was largely unknown. We aimed to investigate whether the relation of PAHs exposure with ASCVD risk was mediated by HRV among coke oven workers. A total of 1100 subjects with complete data were qualified in the current study. We measured 12 urinary PAHs metabolites by gas chromatography-mass spectrometry (GC-MS) and HRV indices by 3-channel digital Holter monitors. The associations between urinary PAHs metabolites, HRV indices, and ASCVD risk were explored using generalized linear models or multivariate logistic regression models. A mediation analysis was conducted to examine the role of HRV on the association between PAHs exposure and ASCVD risk. We found that urinary 1-hydroxynaphthalene (1-OHNa), 2-OHNa, and total PAH metabolites (ΣOH-PAH) were dose-responsive associated with increased risk of ASCVD. Compared with lowest quartile, the adjusted odds ratio (OR) for ASCVD risk in the highest quartile were 2.36 for 1-OHNa, 6.58 for 2-OHNa, and 1.60 for ΣOH-PAH (all P_trend<0.05). In addition, significant dose-dependent relationships were found across 2-OHNa quartiles with decreasing HRV indices, which in turn, were positively associated with elevated risk of ASCVD (all P_trend<0.05). Mediation analyses indicated that HRV mediate 2.7%-4.3% of the association between 2-OHNa exposure and higher ASCVD risk. Our data suggested that occupational exposure to PAHs may increase ASCVD risk, which was partially mediated by HRV.

Degenerative protein modifications in the aging vasculature and central nervous system: A problem shared is not always halved

Aging influences the pathogenesis and progression of several major diseases affecting both the cardiovascular system (CVS) and central nervous system (CNS). Defining the common molecular features that underpin these disorders in these crucial body systems will likely lead to increased quality of life and improved 'health-span' in the global aging population. Degenerative protein modifications (DPMs) have been strongly implicated in the molecular pathogenesis of several age-related diseases affecting the CVS and CNS, including atherosclerosis, heart disease, dementia syndromes, and stroke. However, these isolated findings have yet to be integrated into a wider framework, which considers the possibility that, despite their distinct features, CVS and CNS disorders may in fact be closely related phenomena. In this work, we review the current literature describing molecular roles of the major age-associated DPMs thought to significantly impact on human health, including carbamylation, citrullination and deamidation. In particular, we focus on data indicating that specific DPMs are shared between multiple age-related diseases in both CVS and CNS settings. By contextualizing these data, we aim to assist future studies in defining the universal mechanisms that underpin both vascular and neurological manifestations of age-related protein degeneration.

Homocysteine and education but not lipoprotein (a) predict estimated 10-year risk of cardiovascular disease in blood donors: a community based cross-sectional study

Background

With aging of the population, screening and prevention health programs for blood donors will increasingly be a priority. We aimed at: assessing the 10 year-cardiovascular disease (CVD) risk in blood donors, according to Italian CUORE risk score (CRS); determining the association of homocysteine (Hcy), lipoprotein (Lp)(a) and socio-demographic or lifestyle variables with estimated 10-year CVD risk.

Methods

Between June 2015 and July 2017, 1,447 (61.2% men) unselected blood donors (aged 18–69 years) were enrolled at the Blood Transfusion Service of the Pescara General Hospital, Italy. The project entailed evaluation of unalterable (age and gender) and modifiable CV risk factors (total cholesterol, HDL, LDL, triglycerides, fasting glucose, smoking, hypertension). The educational attainment, socio-demographic and lifestyle behavior information were obtained through a structured self-report questionnaire, and Health-related quality of life (HRQoL) through the Short Form Survey (SF-12). Plasma Hcy and Lp(a) were determined in the fasting state.

Results

A CRS within the moderate-high risk range was reported in 21.7% donors. Multivariate logistic regression, after adjustment for clinical and demographic variables, showed that Hcy [OR (95% CI): 1.09 (1.04–1.13); p < 0.001) and low educational attainment [1.71 (1.09–2.73); p = 0.019] are independent risk factors for moderate-to-high CVD risk. Instead, Lp(a), evaluated in 774 donors, was > 30 mg/dL in 22.4% of the examined population, but without any significant correlation with CRS.

Conclusions

Our study highlights a previously unappreciated need for CV risk assessment in blood donors, which may include evaluation of educational attainment as a non-traditional risk marker.

Relation of personality factors and life events to waist/height ratio and percentage of visceral fat in women and men

PURPOSE

The investigation aimed to explore the association between personality traits, stressful life events, quality of life on anthropometric characteristics (waist/height ratio and percentage of visceral fat).

METHOD

A total of 227 participants took part in this cross-sectional study. Participants completed the Social Readjustment Rating Scale (SRRS), Temperament and Character Inventory-Revised, Type-D Scale (DS-14), EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D), and demographic questionnaire. Two anthropometric parameters were measured: Waist/height ratio and Percentage of the visceral fat.

RESULTS

The average age of participants was 39.6±12.9 years, 60.4% women. The 41.8% of participants were overweight or obese. Regression analysis found a significant link between Harm-avoidance and EQ-5D visual analog scale (VAS) with Waist/height ratio in women and Reward dependence and Cooperativeness with Waist/height ratio in men. In regression analysis, the score of life events (SRRS) has statistically significant linked to Percentage of the visceral fat in women. The regression analysis also found a significant link between Novelty seeking, DS14, Negative affectivity, and EQ-5D VAS with Percentage of the visceral fat in women.

CONCLUSION

Significant associations between live events, personality traits, and body anthropometric measures were recognized. The differences were recognized between women and men. Outcomes propose some promising tools by which personality factors may influence overweight and obesity.

Oxytocin: Potential to mitigate cardiovascular risk

Cardiovascular disease (CVD) remains the leading cause of death worldwide, despite multiple treatment options. In addition to elevated lipid levels, oxidative stress and inflammation are key factors driving atherogenesis and CVD. New strategies are required to mitigate risk and most urgently for statin-intolerant patients. The neuropeptide hormone oxytocin, synthesized in the brain hypothalamus, is worthy of consideration as a CVD ancillary treatment because it moderates factors directly linked to atherosclerotic CVD such as inflammation, weight gain, food intake and insulin resistance. Though initially studied for its contribution to parturition and lactation, oxytocin participates in social attachment and bonding, associative learning, memory and stress responses. Oxytocin has shown promise in animal models of atherosclerosis and in some human studies as well. A number of properties of oxytocin make it a candidate CVD treatment. Oxytocin not only lowers fat mass and cytokine levels, but also improves glucose tolerance, lowers blood pressure and relieves anxiety. Further, it has an important role in communication in the gut-brain axis that makes it a promising treatment for obesity and type 2 diabetes. Oxytocin acts through its receptor which is a class I G-protein-coupled receptor present in cells of the vascular system including the heart and arteries. While oxytocin is not used for heart disease at present, residual CVD risk remains in a substantial portion of patients despite multidrug regimens, leaving open the possibility of using the endogenous nonapeptide as an adjunct therapy. This review discusses the possible role for oxytocin in human CVD prevention and treatment.

As time flies by: Investigating cardiac aging in the short-lived Drosophila model

Aging is associated with a decline in heart function across the tissue, cellular, and molecular levels. The risk of cardiovascular disease grows significantly over time, and as developed countries continue to see an increase in lifespan, the cost of cardiovascular healthcare for the elderly will undoubtedly rise. The molecular basis for cardiac function deterioration with age is multifaceted and not entirely clear, and there is a limit to what investigations can be performed on human subjects or mammalian models. Drosophila melanogaster has emerged as a useful model organism for studying aging in a short timeframe, benefitting from a suite of molecular and genetic tools and displaying highly conserved traits of cardiac senescence. Here, we discuss recent advances in our understanding of cardiac aging and how the fruit fly has aided in these developments.

Lipoproteins in Atherosclerosis Process

BACKGROUND

Dyslipidaemias is a recognized risk factor for atherosclerosis, however, new evidence brought to light by trials investigating therapies to enhance HDLcholesterol have suggested an increased atherosclerotic risk when HDL-C is high.

RESULTS

Several studies highlight the central role in atherosclerotic disease of dysfunctional lipoproteins; oxidised LDL-cholesterol is an important feature, according to "oxidation hypothesis", of atherosclerotic lesion, however, there is today a growing interest for dysfunctional HDL-cholesterol. The target of our paper is to review the functions of modified and dysfunctional lipoproteins in atherogenesis.

CONCLUSION

Taking into account the central role recognized to dysfunctional lipoproteins, measurements of functional features of lipoproteins, instead of conventional routine serum evaluation of lipoproteins, could offer a valid contribution in experimental studies as in clinical practice to stratify atherosclerotic risk.

Cognitive Decline in Asymptomatic Middle Cerebral Artery Stenosis Patients with Moderate and Poor Collaterals: A 2-Year Follow-Up Study

Background

The aim of this study was to determine whether poor collaterals contribute to the occurrence of certain types of cognitive disorders in asymptomatic middle cerebral artery stenosis (MCAS).

Material/Methods

Patients aged ≥45 years with asymptomatic MCAS confirmed by computed tomography angiography were included in a single-center retrospective study. They did not have prior stroke or dementia. Within 7 days of admission, MRI and comprehensive neuropsychological assessment were performed. Cognitive assessment was conducted after 2 years. Two independent neuroradiologists evaluated intracranial collaterals by using the Miteff scale. Demographic date and Fazekas scores were collected.

Results

A total of 173 patients with asymptomatic MCAS (66% men, mean age 59.4 years) and 42 controls (45% men, mean age 61.4 years) were enrolled. Executive function, attention, and information-processing speed in poor collateral circulation patients were more frequently and more often impaired than those in good collateral circulation patients. Throughout the study period, patients with poor collateral circulation had worse executive function, attention, and information-processing speed than those with moderate collateral circulation. Over time, MCAS patients with good collateral circulation did not show an association with cognitive function.

Conclusions

MCAS patients with moderate and poor collateral circulation have impairment of ≥1 cognitive domain over time. The affected domains are consistent with the profile of vascular cognitive impairment. Good collateral circulation is more important in patients with MCAS, and is associated with less risk of cognitive disorders.

Engineering blood vessels and vascularized tissues: technology trends and potential clinical applications

Vascular tissue engineering has the potential to make a significant impact on the treatment of a wide variety of medical conditions, including providing in vitro generated vascularized tissue and organ constructs for transplantation. Since the first report on the construction of a biological blood vessel, significant research and technological advances have led to the generation of clinically relevant large and small diameter tissue engineered vascular grafts (TEVGs). However, developing a biocompatible blood-contacting surface is still a major challenge. Researchers are using biomimicry to generate functional vascular grafts and vascular networks. A multi-disciplinary approach is being used that includes biomaterials, cells, pro-angiogenic factors and microfabrication technologies. Techniques to achieve spatiotemporal control of vascularization include use of topographical engineering and controlled-release of growth/pro-angiogenic factors. Use of decellularized natural scaffolds has gained popularity for engineering complex vascularized organs for potential clinical use. Pre-vascularization of constructs prior to implantation has also been shown to enhance its anastomosis after implantation. Host-implant anastomosis is a phenomenon that is still not fully understood. However, it will be a critical factor in determining the in vivo success of a TEVGs or bioengineered organ. Many clinical studies have been conducted using TEVGs, but vascularized tissue/organ constructs are still in the research & development stage. In addition to technical challenges, there are commercialization and regulatory challenges that need to be addressed. In this review we examine recent advances in the field of vascular tissue engineering, with a focus on technology trends, challenges and potential clinical applications.

Resveratrol inhibits lipid accumulation in the intestine of atherosclerotic mice and macrophages

Disordered intestinal metabolism is highly correlated with atherosclerotic diseases. Resveratrol protects against atherosclerotic diseases. Accordingly, this study aims to discover novel intestinal proatherosclerotic metabolites and potential therapeutic targets related to the anti‐atherosclerotic effects of resveratrol. An untargeted metabolomics approach was employed to discover novel intestinal metabolic disturbances during atherosclerosis and resveratrol intervention. We found that multiple intestinal metabolic pathways were significantly disturbed during atherosclerosis and responsive to resveratrol intervention. Notably, resveratrol abolished intestinal fatty acid and monoglyceride accumulation in atherosclerotic mice. Meanwhile, oleate accumulation was one of the most prominent alterations in intestinal metabolism. Moreover, resveratrol attenuated oleate‐triggered accumulation of total cholesterol, esterified cholesterol and neutral lipids in mouse RAW 264.7 macrophages by activating ABC transporter A1/G1‐mediated cholesterol efflux through PPAR (peroxisome proliferator‐activated receptor) α/γ activation. Furthermore, we confirmed that PPARα and PPARγ activation by WY14643 and pioglitazone, respectively, alleviated oleate‐induced accumulation of total cholesterol, esterified cholesterol and neutral lipids by accelerating ABC transporter A1/G1‐mediated cholesterol efflux. This study provides the first evidence that resveratrol abolishes intestinal fatty acid and monoglyceride accumulation in atherosclerotic mice, and that resveratrol suppresses oleate‐induced accumulation of total cholesterol, esterified cholesterol and neutral lipids in macrophages by activating PPARα/γ signalling.

Peroxisome proliferator-activated receptor A/G reprogrammes metabolism associated with lipid accumulation in macrophages

INTRODUCTION

Macrophage metabolism contributes to the progression of metabolic diseases, and peroxisome proliferator-activated receptors (PPARs) play vital roles in macrophage metabolism and the treatment of metabolic diseases. However, the role of PPARs in metabolic reprogramming related to lipid accumulation in macrophages, a key pathological event in metabolic diseases, remains unclear.

OBJECTIVES

We aimed to identify PPAR-mediated metabolic reprogramming and potential therapeutic targets associated with lipid accumulation in macrophages.

METHODS

Following treatment with oleate, oleate + WY-14643 and oleate + pioglitazone to induce alterations in PPAR signaling, lipids and relevant metabolism, macrophage samples were analyzed employing an untargeted metabolomics based on gas chromatography-mass spectrometry.

RESULTS

The metabolomics approach revealed that multiple metabolic pathways were altered during lipid accumulation in oleate-treated macrophages and responsive to WY-14643 and pioglitazone treatment. Notably, levels of most metabolites involved in amino acid metabolism and nucleotide metabolism were accumulated in oleate-treated macrophages, and these effects were alleviated or abolished by PPARA/G activation. Additionally, during oleate-induced lipid accumulation and lipid lowering with WY-14643 and pioglitazone in macrophages, levels of most amino acids were positively associated with neutral lipid, total cholesterol, cholesterol ester, total free fatty acid and triglyceride levels but negatively associated with expression of genes related to PPARA/G signaling. Furthermore, glycine was found to be a potential biomarker for assessing lipid accumulation and the lipid-lowering effects of PPARA/G in oleate-treated macrophages.

CONCLUSION

The results of this study revealed a high correlation of amino acid metabolism with lipid accumulation and the lipid-lowering effects of PPARA/G in macrophages.

Fatty acid levels alterations in THP-1 macrophages cultured with lead (Pb)

OBJECTIVE

As cardiovascular events are one of the main causes of death in developed countries, each factor potentially increasing the risk of cardiovascular disease deserves special attention. One such factor is the potentially atherogenic effect of lead (Pb) on lipid metabolism, and is significant in view of the still considerable Pb environmental pollution and the non-degradability of Pb compounds.

METHODS

Analysis of saturated fatty acids (SFA) (caprylic acid (C8:0), decanoic acid (C10:0), lauric acid (C12:0), tridecanoic acid (C13:0), myristic acid (C14:0), pentadecanoic acid (C15:0), palmitic acid (C16:0), heptadecanoic acid (C17:0), stearic acid (C18:0), and behenic acid (C22:0)), monounsaturated fatty acid (MUFA) (palmitoleic acid (C16:1), oleic acid (18:1w9), trans-vaccenic acid (C18:1 trans11)), and polyunsaturated fatty acid (PUFA) (linoleic acid (C18:2n6), gamma-linolenic acid (C18:3n6), arachidonic acid (C20:4n6)), was conducted by gas chromatography. Analysis of stearoyl-CoA desaturase (SCD), fatty acid desaturase 1 (FADS1) and fatty acid desaturase 2 (FADS2) expression was performed using qRT-PCR. Oxidative stress intensity (malondialdehyde - MDA concentration) was measured using spectrophotometric method. Intracellular generation of reactive oxygen species (ROS) in macrophages was visualized by fluorescence microscopy and quantitatively measured by plate reader.

RESULTS

Pb caused quantitative alterations in FAs profile in macrophages; the effect was Pb-concentration dependent and selective (i.e. concerned only selected FAs). In general, the effect of Pb was biphasic, with Pb levels of 1.25 μg/dL and 2.5 μg/dL being stimulatory, and 10 μg/dL being inhibitory on concentrations of selected FAs. The most potent Pb concentration, resulting in increase in levels of 9 FAs, was 2.5 μg/dL, the Pb-level corresponding to the mean blood Pb concentrations of people living in urban areas not contaminated by Pb. Pb was found to exert similar, biphasic effect on the expression of FADS1. However, Pb decreased, in a concentration-dependent manner, the expression of SCD and FADS2. Pb significantly increased MDA and ROS concentration in macrophages.

CONCLUSION

Environmental Pb exposure might be a risk factor resulting in alterations in FAs levels, oxidative stress and increased MDA concentration in macrophages, which might lead to the formation of foam cells and to inflammatory reactions.

Industrially produced trans fat in popular foods in 15 countries of the former Soviet Union from 2015 to 2016: a market basket investigation

OBJECTIVE

To minimise the intake of industrially produced trans fat (I-TF) and decrease the risk of coronary heart disease, several countries have implemented a legislative restriction on I-TF in foods. The objective of this study was to investigate the presence of I-TF in biscuits/cakes/wafers in 15 countries of the former Soviet Union that all have a high coronary mortality rate compared with countries in Western Europe.

METHODS

Three large supermarkets in 15 capitals were visited in 2015 or 2016. Prepackaged biscuits/cakes/wafers were bought if the list of ingredients disclosed that the product contained more than 15 g of fat per 100 g of product and if partially hydrogenated fat or a similar term, including margarine, refined fat or confectionery fat, were mentioned. Samples of the foods were subsequently analysed for total fat and TF.

RESULTS

Some 994 products contained more than 2% total fat as I-TF (illegal in Denmark). In Armenia, 91 different products had a mean value (SD) of 21 (11)% fat as I-TF. In Estonia, there were eight products with 14 (10)% fat as I-TF. The other 13 countries had values between those of Armenia and Estonia. In several countries, a major portion of the products was imported from Russia and Ukraine. The mean shelf life (SD) of 673 packages was 218 (75) days. The % TF in the fat of the products produced in Russia and in Ukraine in relation to the date of production both declined by approximately 10% points during the 2-year collection period.

CONCLUSIONS

The findings suggest that I-TF is used in popular foods in all 15 countries of the former Soviet Union. Therefore, these findings indicate a possible way for some reduction of the high coronary mortality rate in these countries.

Computational study on hemodynamic changes in patient-specific proximal neck angulation of abdominal aortic aneurysm with time-varying velocity

Aneurysms are considered as a critical cardiovascular disease worldwide when they rupture. The clinical understanding of geometrical impact on the flow behaviour and biomechanics of abdominal aortic aneurysm (AAA) is progressively developing. Proximal neck angulations of AAAs are believed to influence the hemodynamic changes and wall shear stress (WSS) within AAAs. Our aim was to perform pulsatile simulations using computational fluid dynamics (CFD) for patient-specific geometry to investigate the influence of severe angular (≥ 60°) neck on AAA's hemodynamic and wall shear stress. The patient's geometrical characteristics were obtained from a computed tomography images database of AAA patients. The AAA geometry was reconstructed using Mimics software. In computational method, blood was assumed Newtonian fluid and an inlet varying velocity waveform in a cardiac cycle was assigned. The CFD study was performed with ANSYS software. The results of flow behaviours indicated that the blood flow through severe bending of angular neck leads to high turbulence and asymmetry of flows within the aneurysm sac resulting in blood recirculation. The high wall shear stress (WSS) occurred near the AAA neck and on surface of aneurysm sac. This study explained and showed flow behaviours and WSS progression within high angular neck AAA and risk prediction of abdominal aorta rupture. We expect that the visualization of blood flow and hemodynamic changes resulted from CFD simulation could be as an extra tool to assist clinicians during a decision making when estimation the risks of interventional procedures.

Comparison of the Effects of Hand Reflexology versus Acupressure on Anxiety and Vital Signs in Female Patients with Coronary Artery Diseases

Hospitalization in the cardiac care unit can increase anxiety in patients. This study aimed to compare hand reflexology versus acupressure on anxiety and vital signs in female patients with coronary artery diseases. This double-blinded randomized placebo-controlled trial with a pre- and post-intervention design was conducted on 135 female patients with coronary artery diseases. Female patients hospitalized in a cardiac care unit were randomly divided into three groups of hand reflexology, acupressure and placebo (n = 45 patients in each group) using blocking and a table of random numbers. Data was collected using the Spielberger anxiety inventory. Also, their vital signs were measured before, immediately after and half an hour after the intervention. Data analysis was performed using descriptive and analytical statistics. Before the intervention, there was no statistically significant difference in anxiety levels between the groups (p > 0.05). Also, the effects of hand reflexology and acupressure immediately and half an hour later on the reduction of anxiety and vital signs were equal (p < 0.05). Implementation of hand reflexology and acupressure can have positive effects on anxiety and vital signs in patients with coronary artery diseases. They can reduce patients' anxiety with an equal effectiveness.

Formulation and Characterization of Quercetin-loaded Oil in Water Nanoemulsion and Evaluation of Hypocholesterolemic Activity in Rats

Due to poor water solubility and high susceptibility to chemical degradation, the applications of quercetin have been limited. This study investigated the effects of pH on the formation of quercetin-loaded nanoemulsion (NQ) and compared the hypocholesterolemic activity between quercetin and NQ to utilize the quercetin as functional food ingredient. NQ particle size exhibited a range of 207⁻289 nm with polydispersity index range (<0.47). The encapsulation efficiency increased stepwise from 56 to 92% as the pH increased from 4.0 to 9.0. Good stability of NQ was achieved in the pH range of 6.5⁻9.0 during 3-month storage at 21 and 37 °C. NQ displayed higher efficacy in reducing serum and hepatic cholesterol levels and increasing the release of bile acid into feces in rats fed high-cholesterol diet, compared to quercetin alone. NQ upregulated hepatic gene expression involved in bile acid synthesis and cholesterol efflux, such as cholesterol 7 alpha-hydroxylase (CYP7A1), liver X receptor alpha (LXRα), ATP-binding cassette transporter A1 (ABCA1) and ATP-binding cassette sub-family G member 1 (ABCG1). These results suggest at least partial involvement of hepatic bile acid synthesis and fecal cholesterol excretion in nanoemulsion quercetin-mediated beneficial effect on lipid abnormalities.

Multi-Teaching Styles Approach and Active Reflection: Effectiveness in Improving Fitness Level, Motor Competence, Enjoyment, Amount of Physical Activity, and Effects on the Perception of Physical Education Lessons in Primary School Children

Physical education (PE) researchers sustain that the teaching styles adopted by PE teachers play a key role in defining children’s positive experiences during lessons and have a relevant impact on their psychophysical health. However, a limited number of studies has examined the effect of teaching styles on these aspects. The aim of this study was to investigate the effectiveness of an integrated approach mainly based on integration of multi-teaching styles and active reflection (MTA) on the fitness level, motor competence, enjoyment, self-perception, amount of physical activity (PA), and children’s perception of PE, in Italian primary school children. Participants were 121 children from three elementary schools. Children were randomly assigned into two groups: (a) an intervention group (IG) that received PE lessons based on MTA provided by specifically trained PE students, and (b) a control group (CG) that received standard PE lessons (S-PE) from primary school classroom teachers. Both groups engaged in two PE lessons per week lasting 1 h each for 12 weeks. The findings revealed an increase in the children’s fitness level, motor competence, enjoyment and amount of PA in the IG compared to those in the CG. Furthermore, the children of the IG spent more time being engaged on a task, reflecting on it, and wasted less time during PE compared to the children of the CG. Finally, the children of the IG reported higher levels of satisfaction with PE lessons and teaching styles compared to children of the CG. Integration of different teaching styles lead by specifically trained educators can be suggested as a valuable strategy to provide learning experiences of children of primary school to have positive effects on their physical literacy development promoting healthy lifestyles.

Induced Pluripotent Stem Cell-Derived Endothelial Cells: Overview, Current Advances, Applications, and Future Directions

Endothelial cells are prevalent in our bodies and serve multiple functions. By lining the vasculature, they provide a barrier to tissues and facilitate the transport of molecules and cells. They also maintain hemostasis and modulate blood flow by reacting to chemokines and releasing signal molecules. Thus, endothelial dysfunction leads to a wide variety of diseases, including atherosclerosis and coronary artery disease. In today's era of stem cell research, induced pluripotent stem cell-derived endothelial cells (iPSC-ECs) have emerged for research and engineering purposes. They are not only tools for studying disease states but are also a crucial part of efforts to engineer vessel and organ grafts. As the techniques in cell culture, microfluidics, and personalized medicine concomitantly improve, the potential for iPSC-ECs is enormous. We review functions of endothelium in our bodies, the development and uses of iPSC-ECs, and the possible avenues to explore in the future.

Plasma Galectin-3 and Sonographic Measures of Carotid Atherosclerosis in the Atherosclerosis Risk in Communities Study

Galectin-3 is a β-galactoside-binding lectin that plays a role in the regulation of several conditions that are associated with atherosclerosis. The goal of this cross-sectional study was to assess the association of plasma galectin-3 concentrations with sonographic measures of carotid atherosclerosis in the Atherosclerosis Risk in Communities study. Linear regression was used to determine the difference and 95% confidence intervals (CIs) for carotid intima-media thickness (cIMT) by categorical and continuous representations of galectin-3. Logistic regression was used to determine the odds ratio and 95% CI, separately, for dichotomized cIMT (75th percentile = 0.9 mm) and carotid plaque and/or shadowing. Compared to those in the first quintile of galectin-3, those in the fifth quintile of galectin-3 level had higher cIMT (mean difference: 0.020 mm after multivariable adjustment; P trend = .04). Moreover, compared to those in the lowest galectin-3 quintile, those in the highest galectin-3 quintile had higher odds of carotid plaque/and or shadowing (odds ratio 1.13 after multivariable adjustment; P trend = .014). Higher levels of galectin-3 are associated with greater carotid atherosclerosis. Our findings provide support for the role of inflammatory biomarkers in the pathogenesis of atherosclerosis and suggest galectin-3 as a possible target for intervention in the prevention or management of atherosclerotic disease.

Targeting ALDH2 in Atherosclerosis: Molecular Mechanisms and Therapeutic Opportunities

Aldehyde dehydrogenase 2 (ALDH2) is an important member of the functional aldehyde dehydrogenases (ALDHs) family in human beings, playing a fundamental role in the detoxification of acetaldehyde and other aldehydes. In recent years, a number of researches have given attention to the association between ALDH2 and atherosclerosis, which provided insights on targeting ALDH2 for therapeutic intervention of atherosclerosis. In this review, these inspiring studies will be discussed, and the clinical implications and concerns will be expounded.

Klotho protein inhibits H2O2-induced oxidative injury in endothelial cells via regulation of PI3K/AKT/Nrf2/HO-1 pathways

Klotho protein secreted in the blood could act as a hormone to regulate various target organs and have a protective effect on the cardiovascular system. Numerous studies had shown that Klotho protein had antioxidative stress, anti-inflammatory, and antiapoptotic effects on vascular endothelial cells. The purpose of this study was to investigate the protective mechanism of Klotho protein on oxidative damage of vascular endothelial cells induced by H₂O₂. Klotho protein significantly enhanced human umbilical vein endothelial cells viability and increased the activities of antioxidant enzymes (superoxide dismutase, catalase, and heme oxygenase-1 (HO-1)), scavenged reactive oxygen species, and inhibited tumor necrosis factor alpha and interleukin 6 secretion. Klotho protein also reduced the rate of apoptosis of cells and improved the function of vascular endothelial cells (increased nitric oxide secretion). Klotho protein activated nuclear translocation of Nrf2 and increased HO-1 expression. Klotho protein also activated phosphorylation of protein kinase B (AKT), whereas the addition of LY294002, a pharmacological inhibitor of phosphatidylinositol 3-kinase (PI3K), blocked Klotho-protein-induced Nrf2/HO-1 activation and cytoprotection. Klotho protein enhanced the antioxidant defense ability of the cells by activating the PI3K/AKT pathway, which upregulated the expression of Nrf2/HO-1, thereby inhibiting H₂O₂-induced oxidative damage.

Ticagrelor suppresses oxidized low‑density lipoprotein‑induced endothelial cell apoptosis and alleviates atherosclerosis in ApoE‑/‑ mice via downregulation of PCSK9

Although ticagrelor has been demonstrated to possess an anti-atherosclerosis (AS) effect, its underlying mechanism remains unclear. In the present study, it was investigated whether ticagrelor reduces oxidized low-density lipoprotein (ox-LDL)-induced endothelial cell apoptosis, an initial step for the development of AS, and alleviates AS in apolipoprotein-E-deficient (ApoE^−/−) mice by inhibiting the expression of proprotein convertase subtilisin/kexin type 9 (PCSK9). The human endothelial cell line EAhy926 was treated with ox-LDL, ox-LDL + ticagrelor (40 µmol/l) and ox-LDL + ticagrelor (60 µmol/l) for 24 h. Cell apoptosis was detected using Annexin V-fluorescein isothiocyanate/propidium iodide staining. The expression levels of PCSK9, apoptosis-associated proteins and signaling pathways were determined by reverse transcription-quantitative polymerase chain reaction and western blotting. ApoE^−/− mice fed a high-fat diet were used to induce an AS model. After 20 weeks, ApoE^−/− mice were randomly assigned to receive saline or ticagrelor intragastrically for 10 days. The formation of atherosclerotic plaques was detected by hematoxylin and eosin staining. The expression of PCSK9 in the arterial tissues was measured by immunohistochemistry. The results demonstrated that treatment with ticagrelor was able to decrease ox-LDL-induced apoptosis in a concentration-dependent manner (40 µmol/l vs. ox-LDL, 17.58±2.66 vs. 27.25±5.54%; 60 µmol/l vs. ox-LDL, 12.26±1.54 vs. 27.25±5.54%). The mRNA and protein expression level of PCSK9 significantly decreased following treatment with ticagrelor, accompanied with upregulation of B-cell lymphoma (Bcl) 2 and downregulation of Bcl-2 associated X, apoptosis regulator, caspase-3, p38, phosphorylated-(p) p38, p-c-Jun N-terminal kinases (JNK), p-extracellular signal-regulated kinases and the ratio of p-JNK to JNK. Histological analysis of arterial tissues revealed ticagrelor markedly decreased the atherosclerotic plaque area and inhibited the expression of PCSK9. The present results suggested that ticagrelor may alleviate AS via downregulation of PCSK9-mediated endothelial cell apoptosis, which may be JNK-dependent.

How much for a broken heart? Costs of cardiovascular disease in Colombia using a person-based approach

The shift of the Noncommunicable Diseases (NCDs) epidemic, including cardiovascular disease, from developed to Low and Middle Income Countries (LMIC), creates new challenges in contexts where there is poor information on healthcare costs. Clearly this information is essential for planning, and its relevance is even more valuable as a driver for prevention and control of NCDs. This paper begins to address that handicap by estimating the healthcare cost of Cardiovascular Disease (Coronary Heart Disease and Stroke) in Colombia, using a person-based approach. Results show that the annual healthcare cost of a person with Coronary Heart Disease is between INT$ 4,277 and INT$ 4,846, while the cost for a person with Stroke varies between INT$5,816 and INT$6,616. The expansion of the NCDs epidemic combined with such high costs threatens the financial sustainability of health systems; primary prevention and policies targeting structural and intermediate determinants of health are a promising way to make health systems financially sustainable.

Specialized Pro-resolving Lipid Mediators: Modulation of Diabetes-Associated Cardio-, Reno-, and Retino-Vascular Complications

Diabetes and its associated chronic complications present a healthcare challenge on a global scale. Despite improvements in the management of chronic complications of the micro-/macro-vasculature, their growing prevalence and incidence highlights the scale of the problem. It is currently estimated that diabetes affects 425 million people globally and it is anticipated that this figure will rise by 2025 to 700 million people. The vascular complications of diabetes including diabetes-associated atherosclerosis and kidney disease present a particular challenge. Diabetes is the leading cause of end stage renal disease, reflecting fibrosis leading to organ failure. Moreover, diabetes associated states of inflammation, neo-vascularization, apoptosis and hypercoagulability contribute to also exacerbate atherosclerosis, from the metabolic syndrome to advanced disease, plaque rupture and coronary thrombosis. Current therapeutic interventions focus on regulating blood glucose, glomerular and peripheral hypertension and can at best slow the progression of diabetes complications. Recently advanced knowledge of the pathogenesis underlying diabetes and associated complications revealed common mechanisms, including the inflammatory response, insulin resistance and hyperglycemia. The major role that inflammation plays in many chronic diseases has led to the development of new strategies aiming to promote the restoration of homeostasis through the "resolution of inflammation." These strategies aim to mimic the spontaneous activities of the 'specialized pro-resolving mediators' (SPMs), including endogenous molecules and their synthetic mimetics. This review aims to discuss the effect of SPMs [with particular attention to lipoxins (LXs) and resolvins (Rvs)] on inflammatory responses in a series of experimental models, as well as evidence from human studies, in the context of cardio- and reno-vascular diabetic complications, with a brief mention to diabetic retinopathy (DR). These data collectively support the hypothesis that endogenously generated SPMs or synthetic mimetics of their activities may represent lead molecules in a new discipline, namely the 'resolution pharmacology,' offering hope for new therapeutic strategies to prevent and treat, specifically, diabetes-associated atherosclerosis, nephropathy and retinopathy.

Behavioral and subjective health changes in US and Mexico border residing participants in two promotora-led chronic disease preventive interventions

Chronic diseases are the primary health burden among Mexican-origin populations and health promotion efforts have not been able to change negative population trends. This research presents behavioral and subjective health impacts of two related community health worker (CHW) interventions conducted in the US-Mexico border region. Pasos Adelante (United States) and Meta Salud (Mexico) are 12-13 week CHW-led preventive interventions implemented with Mexico-origin adults. Curricula include active learning modules to promote healthy dietary changes and increasing physical activity; they also incorporate strategies to promote social support, empowerment and group exercise components responsive to their communities. Questionnaire data at baseline (N = 347 for Pasos; 171 for Meta Salud), program completion and 3-month follow-up were analyzed. Results showed statistically significant improvements in multiple reported dietary, physical activity and subjective health indicators. Furthermore, at follow-up across both cohorts there were ≥10% improvements in participants' meeting recommended physical activity guidelines, consumption of whole milk, days of poor mental health and self-rated health. While this study identifies some robust health improvements and contributes to the evidence base for these interventions current dissemination, the lack of change observed for some targeted behaviors (e.g. time sitting) suggests they may have stronger overall impacts with curricula refinement.

Suppression of Apoptosis in Human Umbilical Vein Endothelial Cells (HUVECs) by Klotho Protein is Associated with Reduced Endoplasmic Reticulum Oxidative Stress and Activation of the PI3K/AKT Pathway

BACKGROUND Klotho protein has been shown to act as a hormone on the cardiovascular system, and to have specific protective effects on vascular endothelial cells. The aim of this study was to investigate the mechanisms of the anti-oxidative and anti-apoptotic effects of klotho protein on hydrogen peroxide (H₂O₂)-induced apoptosis and endoplasmic reticulum oxidative stress in human umbilical vein endothelial cells (HUVECs). MATERIAL AND METHODS HUVECs were cultured in vitro and treated with H₂O₂. The MTT assay evaluated cell viability of H₂O₂-treated HUVECs, and flow cytometry measured cell apoptosis. An enzyme-linked immunosorbent assay (ELISA) measured the levels of nitric oxide (NO), tumor necrosis factor-alpha (TNF-α), and interleukin (IL)-6. Western blot was used to detect the expression of the proteins, 78 kD glucose-regulated protein (GRP78), CCAAT-enhancer-binding protein homologous protein (CHOP), caspase-3, caspase-9, caspase-12, and AKT. The effects of LY294002, a pharmacological inhibitor of PI3K, were evaluated. RESULTS Klotho protein increased the viability of H2O2-treated HUVECs and reduced the expression of NO, TNF-α, and IL-6. Klotho protein reduced the rate of apoptosis of H₂O₂-treated HUVECs and downregulated the expression of proteins associated with endoplasmic reticulum oxidative stress, GRP78 and CHOP, and the expression of the apoptotic proteins, caspase-3, caspase-9, and caspase-12, and activated the phosphorylation of AKT. The addition of LY294002 inhibited klotho protein downregulation of GRP78, CHOP, caspase-3, caspase-9, and caspase-12 expression. CONCLUSIONS In HUVECs, klotho protein suppressed apoptosis mediated by endoplasmic reticulum oxidative stress by activation of the PI3K/AKT pathway.

Plasma lipidomic analysis reveals strong similarities between lipid fingerprints in human, hamster and mouse compared to other animal species

Cardiovascular diseases are often associated with impaired lipid metabolism. Animal models are useful for deciphering the physiological mechanisms underlying these pathologies. However, lipid metabolism is contrasted between species limiting the transposition of findings from animals to human. Hence, we aimed to compare extended lipid profiles of several animal species to bring new insights in animal model selections. Human lipid phenotype was compared with those of 10 animal species. Standard plasma lipids and lipoprotein profiles were obtained by usual methods and lipidomic analysis was conducted by liquid chromatography-high-resolution mass spectrometry (LC-HRMS). As anticipated, we found contrasted lipid profiles between species. Some of them exhibited similar plasma lipids to human (non-human primate, rat, hamster, pig), but only usual lipid profiles of pigs were superimposable with human. LC-HRMS analyses allowed the identification of 106 other molecular species of lipids, common to all samples and belonging to major lipid families. Multivariate analyses clearly showed that hamster and, in a lower extent mouse, exhibited close lipid fingerprints to that of human. Besides, several lipid candidates that were previously reported to study cardiovascular diseases ranged similarly in human and hamster. Hence, hamster appeared to be the best option to study physiological disturbances related to cardiovascular diseases.

Benefits and limitations of implementing Chronic Care Model (CCM) in primary care programs: A systematic review

BACKGROUND

Chronic Care Model (CCM) has been developed to improve patients' health care by restructuring health systems in a multidimensional manner. This systematic review aims to summarize and analyse programs specifically designed and conducted for the fulfilment of multiple CCM components. We have focused on programs targeting diabetes mellitus, hypertension and cardiovascular disease.

METHOD AND RESULTS

This review was based on a comprehensive literature search of articles in the PubMed database that reported clinical outcomes. We included a total of 25 eligible articles. Evidence of improvement in medical outcomes and the compliance of patients with medical treatment were reported in 18 and 14 studies, respectively. Two studies demonstrated a reduction of the medical burden in terms of health service utilization, and another two studies reported the effectiveness of the programs in reducing the risk of heart failure and other cardiovascular diseases. However, CCMs were still restricted by limited academic robustness and social constraints when they were implemented in primary care. Higher professional recognition, tighter system collaborations and increased financial support may be necessary to overcome the limitations of, and barriers to CCM implementation.

CONCLUSION

This review has identified the benefits of implementing CCM, and recommended suggestions for the future development of CCM.

The many faces of CD8+ T cells in atherosclerosis

PURPOSE OF REVIEW

Atherosclerosis and the clinical consequence of cardiovascular disease remain the leading cause of death worldwide. Both an increase in cholesterol levels, as well as immune responses drive the pathogenesis of this disease. Although much is known about the role of many immune cell subsets in atherogenesis, research into the role of CD8 T cells is limited.

RECENT FINDINGS

Both atheroprotective and atherogenic functions of CD8 T cells have been reported. On the one hand, the inflammatory cytokines produced by CD8 T cells exacerbate inflammatory responses, and the cytotoxic activity of these cells toward lesion-stabilizing cells such as endothelial cells drives the progression and instability of atherosclerotic lesions. On the other hand, cytotoxic activity toward antigen presenting cells and the presence of regulatory CD8 T-cell subsets dampen immunity and can limit atherosclerosis.

SUMMARY

Here we review the different roles of CD8 T cells in atherosclerosis and discuss possible treatment strategies targeting these cells to reduce atherosclerotic lesion burden.

Atherosclerotic Lesions in the Superficial Femoral Artery (SFA) Characterized with Velocity Ratios using Vector Velocity Ultrasound

Purpose

Atherosclerotic arteries are challenging to evaluate quantitatively using spectral Doppler ultrasound because of the turbulent flow conditions that occur in relation to the atherosclerotic stenoses. Vector velocity ultrasound is angle independent and provides flow information, which could potentially improve the diagnosis of arterial stenoses. The purpose of the study is to distinguish significant stenoses in the superficial femoral artery (> 50% diameter reduction) from non-significant stenoses based on velocity ratios derived from the commercially available vector velocity ultrasound technique Vector Flow Imaging (VFI).

Materials and Methods

Velocity ratios (intrastenotic blood flow velocity divided by pre- or poststenotic velocity) from a total of 16 atherosclerotic stenoses and plaques in the superficial femoral artery of 11 patients were obtained using VFI. The stenosis degree, expressed as percentage diameter reduction of the artery, was determined from digital subtraction angiography and compared to the velocity ratios.

Results

A velocity ratio of 2.5 was found to distinguish clinically relevant stenoses with>50% diameter reduction from clinically non-relevant stenoses with<50% diameter reduction and the difference was statistically significant.

Conclusion

The study indicates that VFI is a potential future tool for the evaluation of arterial stenoses.

Estrogen in vascular smooth muscle cells: A friend or a foe?

Cardiovascular disease (CVD) continues to be the leading cause of death worldwide. The effect of estrogen on these diseases has been assessed in in vitro and in vivo models, as well as in observational studies. Collectively, these studies alluded to a cardiovasculo-protective effect of estrogen. However, comprehensive clinical investigation failed to produce concrete proof of a cardiovascular protective effect for hormone replacement therapy (HRT), let alone rule out potential harm. These seemingly paradoxical effects of estrogen were explained by the 'theory of timing and opportunity'. This theory states that the effect of estrogen, whether cardiovasculo-protective or pathological, significantly depends on the age of the individual when estrogen administration takes place. Here, we review the conflicting effects of estrogen on vascular smooth muscle cells, mainly proliferation and migration as two cellular capacities intimately related to physiology and pathophysiology of the cardiovascular system. Furthermore, we critically discuss the major parameters and signaling pathways that may account for the aforementioned paradoxical observations, as well as the key molecular players involved.

Localization of fat depots and cardiovascular risk

Despite the existing preventative and therapeutic measures, cardiovascular diseases remain the main cause of temporary disability, long-term disability, and mortality. Obesity is a major risk factor for cardiovascular diseases and their complications. However, not all fat depots have the same inflammatory, paracrine, and metabolic activities. In addition, recent studies have indicated that the accumulation of visceral fat, rather than subcutaneous fat, is associated with increased cardiometabolic risk. However, there is also evidence that increasing the area of visceral fat can help protect against lipotoxicity. This review aims to discuss the contemporary literature regarding the characteristics of the visceral, epicardial, and perivascular fat depots, as well as their associations with cardiovascular disease.

In silico assessment of the effects of material on stent deployment

Coronary stents are expandable scaffolds that are used to widen occluded diseased arteries and restore blood flow. Because of the strain they are exposed to and forces they must resist as well as the importance of surface interactions, material properties are dominant. Indeed, a common differentiating factors amongst commercially available stents is their material. Several performance requirements relate to stent materials including radial strength for adequate arterial support post-deployment. This study investigated the effect of the stent material in three finite element models using different stents made of: (i) Cobalt-Chromium (CoCr), (ii) Stainless Steel (SS316L), and (iii) Platinum Chromium (PtCr). Deployment was investigated in a patient specific arterial geometry, created based on a fusion of angiographic data and intravascular ultrasound images. In silico results show that: (i) the maximum von Mises stress occurs for the CoCr, however the curved areas of the stent links present higher stresses compared to the straight stent segments for all stents, (ii) more areas of high inner arterial stress exist in the case of the CoCr stent deployment, (iii) there is no significant difference in the percentage of arterial stress volume distribution among all models.

Alda‑1, an aldehyde dehydrogenase‑2 agonist, improves long‑term survival in rats with chronic heart failure following myocardial infarction

Alda‑1, an aldehyde dehydrogenase 2 (ALDH2) agonist, has been demonstrated to reduce injury caused by acute myocardial infarction (MI) and ischemia/reperfusion. The present study aimed to investigate whether oral administration of Alda‑1 improved long‑term survival of rats with chronic heart failure (CHF) post‑MI. MI model rats treated daily with Alda‑1 exhibited an increase in 20‑week survival rate compared with untreated MI rats. Alda‑1 treatment decreased the heart weight/body weight ratio, collagen volume, left ventricular (LV) internal diameter at the end of diastole and LV internal diameter at the end of systole, while increasing LV ejection fraction with evident LV fractional shortening. Myocardial cell apoptosis index, the activity of caspase‑3 and the expression of cleaved‑caspase‑3 were also reduced by Alda‑1 treatment. The protective effects of Alda‑1 were associated with reduced 4‑hydroxynonenal accumulation. The results of the present study revealed that the long‑term treatment with Alda‑1 prevented the progression of ventricular remodeling and improved the long‑term survival of rats with CHF post‑MI.

Novel iron oxide-cerium oxide core-shell nanoparticles as a potential theranostic material for ROS related inflammatory diseases

Reactive oxygen species (ROS) and reactive nitrogen species (RNS) are key signaling molecules that play an important role in the inflammation and progression of many diseases such as cardiovascular disease, especially atherosclerosis. ROS are in particular a significant factor in the development of rheumatoid arthritis and other autoimmune diseases such as allergies. In this study, novel Fe₃O₄/CeO₂ core-shell theranostic nanoparticles capable of reacting with ROS and of being detected by MRI were synthesized and thoroughly characterized. In vitro studies, such as measurement of cell uptake, magnetic resonance imaging, toxicity and ROS scavenging, were conducted. The results indicate that the novel Fe₃O₄/CeO₂ theranostic nanoparticles are effective for scavenging ROS and show excellent magnetic resonance (MR) imaging performance. These theranostic nanomaterials, therefore, show great potential for the treatment and diagnosis of ROS-related inflammatory diseases.

ECONOMIC BURDEN OF HYPERCHOLESTEROLEMIA IN THE RUSSIAN FEDERATION

Background. The prevalence of hypercholesterolemia (HCE) is quite high in the Russian Federation (RF), and it is associated with clinical consequences and with potential economic impact. Impact includes not only cost of its correction, but also the cost of treatment of diseases and complications, as well as the deficiency of the gross domestic product (GDP).

Aim. Evaluation of economic impact due to HCE in the Russian population, including direct expenditures of the Health Care System as well as nondirect impact in common economy.

Material and methods. Prevalence of HCE in the RF was identified based on local published studies. Local statistical data (2016) on cardio-vascular diseases (CVDs), including Ischemic Heart Disease (IHD), Myocardial Infarction and cerebral-vascular disease were included in the analysis. Population Attributive Risk (PAR) of HCE in CVDs has been extrapolated on all Russian population. Official statistics, parameters of Govern Guarantees Program of Free Medical Aid were used for modelling of direct and non-direct components of economic impact. Total amount of premature deaths with calculation of years of potential life lost until life expectation at 72 years was calculated. Economic impact due to premature CVDs mortality in economic activity age with consideration on ratio of employment have included GDP lost. Calculation of GDP lost also included monetary impact based on number of disability CVDs patients multiplied on GDP per capita in disability group.

Results.Visits to policlinics of patients with CVDs and HCE had a first place among all calls for medical aid. In the same time, hospitalization required in higher expenditures (outpatients cost treatment expenditures were 2.43 billion RUR, in-patients treatment – 18.21 billion RUR). IHD with HCE was most expensive for direct expenditures in comparison with other CVD groups: more than 28.9 billion RUR per year, and with direct non-medical expenditures of 29.3 billion RUR in total. Years of potential life lost in economic active age were one million in total, 1.29 trillion RUR per year mostly due to indirect expenditures due to premature deaths in economy activity age (99% of impact). Total Economic impact due to HCE in the Russian population for all HCE are estimated as 1.295 trillion RUR.

Conclusion. Total economic impact due to HCE in the RF is 1.5% of GDP (2016), 1.295 trillion RUR. Direct expenditures included Health Care System expenses; disability covering had 2.3% only. Main part of impact is economic lost due to premature mortality and decrease of labor productivity. HCE patients control at target levels with help of healthy lifestyle and adequate pharmaceutical therapy can decrease economic impact. 

Convolutional neural network-based image enhancement for x-ray percutaneous coronary intervention

Percutaneous coronary intervention (PCI) uses x-ray images, which may give high radiation dose and high concentrations of contrast media, leading to the risk of radiation-induced injury and nephropathy. These drawbacks can be reduced by using lower doses of x-rays and contrast media, with the disadvantage of noisier PCI images with less contrast. Vessel-edge-preserving convolutional neural networks (CNN) were designed to denoise simulated low x-ray dose PCI images, created by adding artificial noise to high-dose images. Objective functions of the designed CNNs have been optimized to achieve an edge-preserving effect of vessel walls, and the results of the proposed objective functions were evaluated qualitatively and quantitatively. Finally, the proposed CNN-based method was compared with two state-of-the-art denoising methods: K-SVD and block-matching and 3D filtering. The results showed promising performance of the proposed CNN-based method for PCI image enhancement with interesting capabilities of CNNs for real-time denoising and contrast enhancement tasks.

Prognostic usefulness of arm circumference and nutritional screening tools in older patients with cardiovascular disease

BACKGROUND AND AIM

Arm circumference (AC) and nutritional screening tools have been shown to have prognostic capability in patients with cardiovascular disease (CVD). This study aimed to compare the prognostic predictive capabilities of AC and nutritional screening tools in older patients with CVD.

METHODS AND RESULTS

The study population consisted of 949 admitted patients ≥60 years old with CVD. Patients underwent AC measurement and nutritional screening before hospital discharge. We used the controlling nutritional status index (CONUT), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index (PNI) as nutritional screening tools. The end point of the study was all-cause mortality. The mean age of the study population was 72.3 ± 7.2 years, and 68.2% of the patients were male. A total of 130 deaths occurred over a median follow-up period of 2.2 years (interquartile range, 1.1-3.8 years). After adjusting for other prognostic factors, AC (hazard ratio [HR]: 0.59; p < 0.001), CONUT (HR: 0.82; p = 0.016), GNRI (HR: 0.77; p = 0.040), and PNI (HR: 0.80; p = 0.014) were significant predictors of mortality. However, adding AC to the multivariate-adjusted model (0.739 vs. 0.714, respectively; p = 0.037), but not CONUT, GNRI, or PNI (0.724, 0.717, and 0.723 vs. 0.714; p = 0.072, p = 0.306, and p = 0.127, respectively), significantly increased the area under the curve on receiver operating characteristic curve.

CONCLUSIONS

AC, but not nutritional screening tools, plays a complementary role to preexisting prognostic factors for predicting prognosis in older patients with CVD.

Putative mechanisms Underlying Myocardial infarction onset and Emotions (PUME): a randomised controlled study protocol

INTRODUCTION

The experience of negative emotions (eg, anger, anxiety and sadness) is associated with an increased short-term risk of incident cardiovascular disease (CVD) events, independent of traditional CVD risk factors. Impairment in endothelial function is one possible biological mechanism which may explain the association between negative emotions and incident CVD events. This laboratory-based, single-blind, randomised controlled experimental study aims to investigate the impact of induced negative emotions including anger, anxiety and sadness on endothelial function.

METHODS AND ANALYSIS

In a between-subjects design, 280 healthy participants are randomised to one of four experimental negative emotion inductions: anger, anxiety, sadness or a neutral condition. Endothelium-dependent vasodilation, circulating levels of endothelial cell-derived microparticles and bone marrow-derived endothelial progenitor cells, and indices of nitric oxide inhibition are assessed before and 3, 40, 70 and 100 min after negative emotion induction. Finally, in a subsample of 84 participants, the potential moderating effects of cardiorespiratory fitness and habitual physical activity on the adverse effects of an acute negative emotion on endothelial function are investigated.

ETHICS AND DISSEMINATION

This study is conducted in compliance with the Helsinki Declaration and the Columbia University Medical Center Institutional Review Board. The results of the study will be disseminated at several research conferences and as published articles in peer reviewed journals. The study will be implemented and reported in line with the SPIRIT statement.

TRIAL REGISTRATION NUMBER

NCT01909895; Pre-results.

Regression of Atherosclerotic Plaques of Cholesterol-Fed Rabbits by Combined Chemotherapy With Paclitaxel and Methotrexate Carried in Lipid Core Nanoparticles

In previous studies, it was demonstrated that lipid core nanoparticles (LDE) resemble the low-density lipoprotein structure and carrying the antiproliferative agent paclitaxel (PTX) strongly reduced atherosclerosis lesions induced in rabbits by cholesterol feeding. Currently, the aim was to verify whether combining LDE-PTX treatment with methotrexate (MTX) associated with LDE (LDE-MTX) could accelerate the atherosclerosis regression attained with single LDE-PTX treatment, after withdrawing the cholesterol feeding. Thirty-eight rabbits were fed 1% cholesterol chow for 8 weeks. Six of these rabbits were then euthanized for analyses of the aorta (controls). In the remaining rabbits, cholesterol feeding was withdrawn, and those 32 animals were allocated to 3 groups submitted to different 8-week intravenous treatments, all once/week: LDE-PTX (n = 10; 4 mg/kg), LDE-PTX + LDE-MTX (n = 11; 4 mg/kg), and LDE-alone (n = 11). Rabbits were then euthanized and aortas were excised for morphometric, immunohistochemical, and gene expression analyses. After cholesterol feeding withdrawal, in comparison with LDE-alone group, both LDE-PTX and LDE-PTX + LDE-MTX treatments had the ability to increase the regression of plaque areas: -49% in LDE-PTX and -59% for LDE-PTX + LDE-MTX. However, only LDE-PTX + LDE-MTX treatment elicited reduction in the intima area, estimated in -57%. Macrophage presence in aortic lesions was reduced 48% by LDE-PTX and 43% by LDE-PTX + LDE-MTX treatment. Matrix metalloproteinase 9 was reduced by either LDE-PTX (74%) or LDE-PTX + LDE-MTX (78%). Tumor necrosis factor α gene expression was reduced 65% by LDE-PTX and 79% by LDE-PTX + LDE-MTX. In conclusion, treatment with LDE-PTX indeed accelerated plaque reduction after cholesterol feeding; LDE-PTX + LDE-MTX further increased this effect, without any observed toxicity. These results pave the way for the use of combined chemotherapy to achieve stronger effects on aggravated, highly inflamed atherosclerotic lesions.

Parameters of pulse wave velocity: determinants and reference values assessed in the population-based study LIFE-Adult

AIMS AND BACKGROUND

Parameters of arterial stiffness such as pulse wave velocity (PWV) were recently proposed as independent risk factors of cardiovascular events. We analyse three PWV parameters in the large population-based study LIFE-Adult to identify risk factors, normal and reference values.

METHODS AND RESULTS

Brachial-ankle (ba), brachial-femoral (bf) and carotid-femoral (cf) PWV assessment was performed using Vicorder device. 8509 participants aged 19-80 were analysed. PWV parameters were moderately correlated (r(ba/bf) = 0.6, r(ba/cf) = 0.46, r(bf/cf) = 0.59). Age and blood pressure are the dominant determinants of PWV parameters explaining > 18% of variability. Sex was only relevant for bfPWV and cfPWV. All further analysed cardiovascular and other risk factors are of minor importance. We provide age-dependent percentiles for the population (reference values) and for the subgroup of normotonic individuals. All percentiles show a strong increase with age. The difference between normotonic and all individuals is small for younger age groups but increases up to 1 m/s for elderly subjects.

CONCLUSION

Our study confirms and further underpins the strong impact of age and blood pressure on arterial stiffness and the relatively weak contribution of other factors, supporting an independent role of arterial stiffness in cardiovascular disease development. Age-dependent reference and normal values were provided on the basis of the so far largest study sample facilitating the implementation of PWV assessment in clinical practice. Due to better compliance, handling and stronger association with age and blood pressure, baPWV could serve as an alternative to cfPWV. Follow-up data are required to estimate the clinical significance of specified PWV cut-offs.

Scar Size and Other Parameters for Tracking Left Ventricular Dysfunction after Induction of Myocardial Infarcts in Sheep (Ovisaries)

In humans, cardiovascular disease (CVD) is the most frequent cause of death worldwide. Myocardial infarction (MI) is a leading cause of heart failure due to myocardial impairment, yet the progression of the resultant dysfunction is often undetected after incidental or induced myocardial infarction. In this study we tracked the progression of left-sided heart failure in 6-mo-old male castrated sheep in which we created 2 models of myocardial infarction, small and large. Myocardial infarction was induced through ligation of a single branch (obtuse marginal [OM] 1) of the left circumflex coronary artery to create small (mild) infarcts and of 2 branches (OM1 and OM2) for large (severe) infarcts. Progression of heart failure was evaluated by assessing scar size, the left ventricular ejection fraction, hematology, cardiac serum biochemical biomarkers, ST elevation, and clinical observation. All parameters were assessed at baseline and at 3 wk and 3 mo after infarction, except that clinical observation of the animals was conducted daily. The different parameters differed in their usefulness: some verified appropriate creation of the model, whereas others enabled assessment of the progression of heart disease. We hypothesize that myocardial scar size, as a function of induced ischemia, coupled with left ventricular ejection fraction are predictive indicators of postinfarction cardiac dysfunction.