Coronary Heart Disease in Young Adults

Coronary risk factor profiles according to different age categories in premature coronary artery disease patients who have undergone percutaneous coronary intervention

Many studies have investigated the coronary risk factors (CRFs) among premature coronary artery disease (PCAD) patients. However, reports on the proportion and CRFs of PCAD according to different age cut-offs for PCAD is globally under-reported. This study aimed to determine the proportion of PCAD patients and analyse the significant CRFs according to different age cut-offs among percutaneous coronary intervention (PCI)-treated patients. Patients who underwent PCI between 2007 and 2018 in two cardiology centres were included (n = 29,241) and were grouped into four age cut-off groups that defines PCAD: (A) Males/females: < 45, (B) Males: < 50; Females: < 55, (C) Males: < 55; Females: < 60 and (D) Males: < 55; Females: < 65 years old. The average proportion of PCAD was 28%; 9.2% for group (A), 21.5% for group (B), 38.6% and 41.9% for group (C) and (D), respectively. The top three CRFs of PCAD were LDL-c level, TC level and hypertension (HTN). Malay ethnicity, smoking, obesity, family history of PCAD, TC level and history of MI were the independent predictors of PCAD across all age groups. The proportion of PCAD in Malaysia is higher compared to other studies. The most significant risk factors of PCAD are LDL-c, TC levels and HTN. Early prevention, detection and management of the modifiable risk factors are highly warranted to prevent PCAD.

How Social Influence Promotes the Adoption of Mobile Health among Young Adults in China: A Systematic Analysis of Trust, Health Consciousness, and User Experience

As mobile health (mHealth) offers several advantages in healthcare, researchers are exploring the motivational factors for its adoption. However, few studies have elucidated the complex relationship between social influence and behavioral intentions to adopt mHealth among young adults in China. This study explored the impact of social influence on young adults' behavioral intentions to adopt mHealth, the mediating roles of trust and health consciousness, and the moderating effect of mHealth user experience on the relationship between the predictors. In total, 300 valid responses were collected from a university in China, and a research model was developed. The partial least squares structural equation modeling method was used to verify the relationship between the main research variables. mHealth adoption behavioral intentions among young adults were significantly positively impacted by social influence; it indirectly increased mHealth adoption behavioral intentions by positively affecting trust and health consciousness. mHealth use weakened the positive impact of social influence on trust and health consciousness, while user experience positively moderated the relationship between health consciousness and behavioral intentions. Trust and health consciousness play important roles in the complex multivariate relationships between social influence and behavioral intentions to adopt mHealth. Future research should consider the moderating role of the mHealth user experience. These findings enrich the mHealth technology acceptance theory framework and provide specific guidance strategies for marketing mHealth applications.

Identifying risk factors and mortality rate of premature coronary artery disease in young Saudi population

Coronary artery disease is a leading cause of morbidity and mortality worldwide. It occurs due to a combination of genetics, lifestyle, and environmental factors. Premature coronary artery disease (PCAD) is a neglected clinical entity despite the rising number of cases worldwide. This study aimed to investigate the risk factors of premature coronary artery disease. In this study, we searched articles that had studied the risk factors of premature coronary artery diseases from January 2000 to July 2022 in Saudi Arabia in Web of Science, Pub Med, Scopus, Springer, and Wiley databases. The final analysis is based on seven articles. The smoking prevalence was 39%, diabetes mellitus 41%, hypertension 33%, overweight and obesity 18%, family history of coronary artery disease (CAD) 19%, dyslipidemia 37%, and the prevalence range of low-density lipoprotein cholesterol was 33.8-55.0%. The results revealed a mortality prevalence of 4% ranging from 2 to 8% which is similar to the prevalence in older patients which was 2-10%. Smoking, diabetes mellitus, hypertension, family history of CAD, dyslipidemia, and overweight/obesity are significantly and positively associated with premature coronary artery diseases. The health authorities should design and implement an intensive and effective prophylactic plan to minimize the subsequent impact of PCAD on the young population. In addition, early diagnosis of PCAD has great value in providing timely treatment, managing the patients, and minimizing the burden of the disease.

Trends and Disparities in Treatment and Control of Atherosclerotic Cardiovascular Disease in US Adults, 1999 to 2018

BACKGROUND

Although cardiovascular mortality continued declining from 2000 to 2019, the rate of this decrease decelerated. We aimed to assess the trends and disparities in risk factor control and treatment among US adults with atherosclerotic cardiovascular disease to find potential causes of the deceleration.

METHODS AND RESULTS

A total of 55 ,021 participants, aged ≥20 years, from the 1999 to 2018 National Health and Nutrition Examination Survey were included, of which 5717 were with atherosclerotic cardiovascular disease. Risk factor control was defined as hemoglobin A1c <7%, blood pressure <140/90 mm Hg, and non-high-density lipoprotein cholesterol <100 mg/dL. The prevalence of atherosclerotic cardiovascular disease oscillated between 7.3% and 8.9% from 1999 to 2018. A significant increasing trend was observed in the prevalence of diabetes, obesity, heavy alcohol consumption, and self-reported hypertension within the population with atherosclerotic cardiovascular disease (Ptrend≤0.001). Non-high-density lipoprotein cholesterol <100 mg/dL increased from 7.1% in 1999 to 2002 to 15.7% in 2003 to 2006, before plateauing. Blood pressure control (<140/90 mm Hg) increased until 2011 to 2014, but declined to 70.1% in 2015 to 2018 (Ptrend<0.001, Pjoinpoint=0.14). Similarly, the proportion of participants achieving hemoglobin A1c control began to decrease after 2006 (Pjoinpoint=0.05, Ptrend=0.001). The percentage of participants achieving all 3 targets increased significantly from 4.5% to 18.6% across 1999 to 2018 (Ptrend=0.02), but the increasing trend decelerated after 2005 to 2006 (Pjoinpoint<0.001). Striking disparities in risk factor control and medication use persisted between sexes, and between different racial and ethnic populations.

CONCLUSIONS

Worsened control of glycemia, blood pressure, obesity, and alcohol consumption, leveled lipid control, and persistent socioeconomic disparities may be contributing factors to the observed deceleration in decreasing cardiovascular mortality trends.

Emerging Trends in Atherosclerosis: Time to Address Atherosclerosis From a Younger Age

Over the past two decades, research efforts into cardiovascular disease (CVD) have uncovered findings that fundamentally challenge our understanding of CVD, particularly atherosclerosis. Atherosclerosis was primarily attributed to the well-described abnormal lipid accumulation theory, involving plaque growth with subsequent plaque hemorrhage resulting in acute vessel thrombosis that may or may not rupture. This perspective has now evolved to encompass more complex pathways, wherein the accumulation of abnormal products of oxidation and inflammation is the most likely factor mediating atherosclerotic plaque growth. Furthermore, atherosclerosis was traditionally thought of as a disease in patients aged 40 and older. However, mounting evidence has demonstrated that significant atherosclerosis and CVD events are more prevalent in younger patients than previously realized and accelerating in incidence. With this alarming trend among younger individuals, our review sought to explore why this trend may be happening and what can be done about this developing problem.

Transient receptor potential channel TRPM4 favors oxidized low-density lipoprotein-induced coronary endothelial cell dysfunction via a mechanism involving ferroptosis

Accelerating the repair of damaged endothelium can effectively inhibit the progression of atherosclerosis (AS). Transient receptor potential channel TRPM4 is a non-selective cation channel activated by internal Ca2+, which is expressed in endothelial cells. This study aimed to reveal the potential role of TRPM4 in AS along with the mechanism. Human coronary artery endothelial cells (HCAECs) induced by ox-LDL was regarded as an in vitro model. The impacts of TRPM4 knockdown on cellular inflammation response, oxidative stress, normal endothelial function and lipid peroxidation were evaluated. Given that ferroptosis promotes AS progression, the effects of TRPM4 on intracellular iron ions and ferroptosis-related proteins was determined. Afterwards, HCAECs were treated with ferroptosis inducer erastin, and the influence of ferroptosis in the cellular model was revealed. TRPM4 was elevated in response to ox-LDL treatment in HCAECs. TRPM4 knockdown reduced the inflammation response, oxidative stress and lipid peroxidation caused by ox-LDL, and maintained the normal function of HCAECs. Erastin treatment destroyed the impacts of TRPM4 knockdown that are beneficial for cells to resist ox-LDL, showing the enhancement of the above adverse factors. Together, this study found that TRPM4 knockdown reduced ox-LDL-induced inflammation, oxidative stress, and dysfunction in HCAECs, possibly via a mechanism involving Fe2+ and ferroptosis-related proteins.

Oxysterols as Biomarkers of Aging and Disease

Oxysterols derive from either enzymatic or non-enzymatic oxidation of cholesterol. Even though they are produced as intermediates of bile acid synthesis pathway, they are recognised as bioactive compounds in cellular processes. Therefore, their absence or accumulation have been shown to be associated with disease phenotypes. This chapter discusses the contribution of oxysterol to ageing, age-related diseases such as neurodegeneration and various disorders such as cancer, cardiovascular disease, diabetes, metabolic and ocular disorders. It is clear that oxysterols play a significant role in development and progression of these diseases. As a result, oxysterols are being investigated as suitable markers for disease diagnosis purposes and some drug targets are in development targeting oxysterol pathways. However, further research will be needed to confirm the suitability of these potentials.

Percutaneous coronary intervention versus coronary artery by-pass grafting in premature coronary artery disease: What is the evidence? -A narrative review

Coronary artery disease (CAD) remains one of the leading causes of death globally. In the United States of America, in 2016, 19% of all patients under the age of 65 died of cardiovascular disease despite improvements in primary prevention. The premature clinical onset of symptoms in the young population (<60 years) is much more aggressive than in the older population, and the overall long-term prognosis is poor. CAD appears to have a rapidly progressive form in those under the age of 60 due to genetic predisposition, smoking, and substance abuse, however, the ideal management strategy is still yet to be established. The two primary methods of establishing coronary revascularization are percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Despite the increasing prevalence of CAD in the young population, they are consistently underrepresented in major randomized clinical trials of each revascularization strategy. Both CABG and PCI are known to have similar survival rates, but PCI is associated with higher repeat revascularization rate. Many argue this may be due to the progressive nature of CAD combined with the vessel patency time required in a patient under 60 with potentially another 20-30 years of life. There is little in literature regarding the outcomes of these various revascularization strategies in populations under 60 years with CAD. This review summarises the current evidence for each revascularisation strategy in patients under the age of 60 and suggests future avenues of research for this unique age group.

Prenatal Exposure to Severe Stress and Risks of Ischemic Heart Disease and Stroke in Offspring

Importance

Prenatal stress is associated with increased risks of several cardiovascular risk factors later in life. However, knowledge regarding the role of prenatal stress in the development of ischemic heart disease (IHD) and stroke is very limited.

Objective

To examine prenatal stress, defined as maternal bereavement, and risks of IHD and stroke in the offspring.

Design, Setting, and Participants

A cohort study was conducted using data from Danish and Swedish registries. Live singleton births during calendar years 1973-2016 in Denmark (followed up until December 31, 2016) and during calendar years 1973-2014 in Sweden (followed up until December 31, 2021) were included in the analysis.

Exposure

Maternal loss of a close family member (partner, older children, parents, or siblings) the year before or during the pregnancy.

Main Outcome and Measures

Diagnoses of IHD and stroke. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for IHD and stroke in the offspring according to maternal bereavement.

Results

The study included 6 758 560 births (39.4% from Denmark; 51.4% boys). During the median follow-up of 24.6 (IQR, 13.9-35.1) years, 8664 offspring (0.1%) were diagnosed with IHD and 13 094 with stroke (0.2%). Overall, maternal bereavement the year before or during pregnancy was not associated with IHD (adjusted HR [AHR], 0.98; 95% CI, 0.85-1.13) or stroke (AHR, 1.04; 95% CI, 0.94-1.16) in offspring. Similarly, no associations were observed when exposure was classified by the mother's relationship to the deceased individual, ie, loss of older child or partner (HR, 0.85; 95% CI, 0.64-1.14 for IHD and 0.98; 95% CI, 0.77-1.25 for stroke) or loss of parent or sibling (HR, 1.03; 95% CI, 0.87-1.21 for IHD and 1.06; 95% CI, 0.94-1.19 for stroke). However, associations between loss in the third trimester and IHD (AHR, 1.50; 95% CI, 1.06-2.13), and loss due to cardiovascular disease and stroke (AHR, 1.22; 95% CI, 1.03-1.44) were identified when exposure was classified by time of loss or the relative's cause of death.

Conclusions and Relevance

The findings of this study provide little support for the hypothesis that prenatal stress is associated with risks of IHD and stroke in the first 5 decades of life. However, the association observed between stress in the third trimester and IHD warrants further investigation.

Risk Factors for Early-Onset Versus Late-Onset Coronary Heart Disease (CHD): Systematic Review and Meta-Analysis

AIM

We aimed to systematically compare literature on prevalence of modifiable and non-modifiable risk factors for early compared to late-onset coronary heart disease (CHD).

METHODS

PubMed, CINAHL, Embase, and Web of Science databases were searched (review protocol registered in PROSPERO CRD42020173216). Study quality was assessed using the National Heart, Lung and Blood Institute tool for observational and case-control studies. Review Manager 5.3 was used for meta-analysis. Effect sizes were expressed as odds ratio (OR) and mean differences (MD)/standardised MD (SMD) with 95% confidence intervals (CI) for categorical and continuous variables.

RESULTS

Individuals presenting with early-onset CHD (age <65 years) compared to late-onset CHD had higher mean body mass index (MD 1.07 kg/m2; 95% CI 0.31-1.83), total cholesterol (SMD 0.43; 95% CI 0.23-0.62), low-density lipoprotein (SMD 0.26; 95% CI 0.15-0.36) and triglycerides (SMD 0.50; 95% CI 0.22-0.68) with lower high-density lipoprotein-cholesterol (SMD 0.26; 95% CI -0.42--0.11). They were more likely to be smokers (OR 1.76, 95% CI 1.39-2.22) and have a positive family history of CHD (OR 2.08, 95% CI 1.74-2.48). They had lower mean systolic blood pressure (MD 4.07 mmHg; 95% CI -7.36--0.78) and were less likely to have hypertension (OR 0.47, 95% CI 0.39-0.57), diabetes mellitus (OR 0.56, 95% CI 0.51-0.61) or stroke (OR 0.31, 95% CI 0.24-0.42).

CONCLUSION

A focus on weight management and smoking cessation and aggressive management of dyslipidaemia in young adults may reduce the risk of early-onset CHD.

Acute Myocardial Infarction in Young Individuals: Demographic and Risk Factor Profile, Clinical Features, Angiographic Findings and In-Hospital Outcome

BACKGROUND

Cardiovascular diseases (CVDs) are the leading cause of global mortality and disability. Acute myocardial infarction (AMI) in young individuals is a rare condition but can cause devastating socioeconomic and psychological consequences for both the patient and their family and an economic burden for the government. There is a paucity of data concerning the specific profile of these young patients in Bulgaria, a country with a high burden of cardiovascular morbidity and mortality. Therefore, the aim of the present study was to assess the baseline characteristics, demographic and risk factor profile, clinical features, angiographic findings and in-hospital outcomes of young patients with AMI. Additionally, these data were compared to those of the older age group.

METHODS

Retrospective data on 172 patients treated for AMI in "Prof. Alexandar Tschirkov", Bulgaria, from January 2018 to December 2021 were collected for the purpose of this study. Baseline characteristics, risk factor profile and clinical and angiographic features were compared in young (≤45 years) and older patients (>45 years).

RESULTS

Males were significantly predominant in the two age groups (p < 0.01), with an obviously increasing proportion of females in the older age group. Young patients were more likely to be smokers (55.7% vs. 28.8%; p=0.001); in contrast, hypertension (70.5% vs. 91.9%; p <0.001) and obesity (16.4% vs. 31.5%; p=0.031) were more prevalent in older patients. Anterior localization of myocardial infarction (MI) was most common in the two age groups (47.5% vs. 41.4%), respectively. Regarding the time delay from symptom onset to first medical contact, we found that young patients tended to present earlier than their older counterparts. Young patients had a higher incidence of single vessel disease (SVD) (49.2%) and nonobstructive coronary disease (NOCD) (11.5%) than older patients. Young patients with AMI had a lower in-hospital morbidity rate than older patients, but the in-hospital mortality, although lower, was not significantly different. A high prevalence of modifiable cardiovascular risk factors (RFs), such as smoking, dyslipidemia and arterial hypertension (AH), among the young group, less evolved CAD and similar high procedural success between age groups were established. Approximately 30% of young patients tend to present late in the hospital. The in-hospital mortality in the young population was lower than that in the older population but was still relatively higher than that previously reported.

CONCLUSION

The reported high prevalence of modifiable RFs and late presentation of young patients with AMI highlight the need for early recognition of these RFs, better prevention, deployment of educational programs, easy access to health care and high awareness of clinicians to reduce disability and mortality from CVD.

Impacts of Urban Green on Cardiovascular and Cerebrovascular Diseases-A Systematic Review and Meta-Analysis

Cardiovascular diseases (CVDs) are a leading cause of mortality globally. In particular, ischemic heart diseases (IHDs) and cerebrovascular diseases (CBVDs) represent the main drivers of CVD-related deaths. Many literature examples have assessed the association between CVD risk factors and urban greenness. Urban green (UG) may positively affect physical activity, reduce air and noise pollution, and mitigate the heat island effect, which are known risk factors for CVD morbidity. This systematic review aims to assess the effects of urban green spaces on CVD morbidity and mortality. Peer-reviewed research articles with a quantitative association between urban green exposure variables and cardiovascular and cerebrovascular outcomes were included. Meta-analyses were conducted for each outcome evaluated in at least three comparable studies. Most of the included studies' results highlighted an inverse correlation between exposure to UG and CVD outcomes. Gender differences were found in four studies, with a protective effect of UG only statistically significant in men. Three meta-analyses were performed, showing an overall protective effect of UG on CVD mortality (HR (95% CI) = 0.94 (0.91, 0.97)), IHD mortality (HR (95% CI) = 0.96 (0.93, 0.99)), and CBVD mortality (HR (95% CI) = 0.96 (0.94, 0.97)). The results of this systematic review suggest that exposure to UG may represent a protective factor for CVDs.

Immunophenotyping of Monocyte Migration Markers and Therapeutic Effects of Selenium on IL-6 and IL-1β Cytokine Axes of Blood Mononuclear Cells in Preoperative and Postoperative Coronary Artery Disease Patients

Multivessel coronary artery disease (CAD) is characterized by underlying chronic vascular inflammation and occlusion in the coronary arteries, where these patients undergo coronary artery bypass grafting (CABG). Since post-cardiotomy inflammation is a well known phenomenon after CABG, attenuation of this inflammation is required to reduce perioperative morbidity and mortality. In this study, we aimed to phenotype circulating frequencies and intensities of monocyte subsets and monocyte migration markers, respectively, and to investigate the plasma level of inflammatory cytokines and chemokines between preoperative and postoperative CAD patients and later, to intervene the inflammation with sodium selenite. We found a higher amplitude of inflammation, postoperatively, in terms of CCR1high monocytes and significantly increased pro-inflammatory cytokines, IL-6, IL-8, and IL-1RA. Further, in vitro intervention with selenium displayed mitigating effects on the IL-6/STAT-3 axis of mononuclear cells derived from postoperative CAD patients. In addition, in vitro selenium intervention significantly reduced IL-1β production as well as decreased cleaved caspase-1 (p20) activity by preoperative (when stimulated) as well as postoperative CAD mononuclear cells. Though TNF-α exhibited a positive correlation with blood troponin levels in postoperative CAD patients, there was no obvious effect of selenium on the TNF-α/NF-κB axis. In conclusion, anti-inflammatory selenium might be utilized to impede systemic inflammatory cytokine axes to circumvent aggravating atherosclerosis and further damage to the autologous bypass grafts during the post-surgical period.

The Role of Cytokines in Cholesterol Accumulation in Cells and Atherosclerosis Progression

Atherosclerosis is the most common cardiovascular disease and is the number one cause of death worldwide. Today, atherosclerosis is a multifactorial chronic inflammatory disease with an autoimmune component, accompanied by the accumulation of cholesterol in the vessel wall and the formation of atherosclerotic plaques, endothelial dysfunction, and chronic inflammation. In the process of accumulation of atherogenic lipids, cells of the immune system, such as monocytes, macrophages, dendritic cells, etc., play an important role, producing and/or activating the production of various cytokines—interferons, interleukins, chemokines. In this review, we have tried to summarize the most important cytokines involved in the processes of atherogenesis.

The mediation effects of metabolic and immune-inflammation factors on the depression-premature coronary heart disease association

BACKGROUND

Accumulated evidence confirmed depression was positively associated with CHD. But evidence of the association between depression and premature CHD is still unknown.

OBJECTIVES

To explore the association between depression and premature CHD, and to investigate whether and to what extent the association is mediated by metabolic factors and systemic immune-inflammation index (SII).

METHODS

In this large population-based cohort study based on the UK Biobank, 176,428 CHD-free (mean age: 52.70) adults were followed up for 15 years to detect incident premature CHD. Depression and premature CHD (mean age: female, 54.53; male, 48.13) were ascertained from self-report data and linked hospital-based clinical diagnosis. Metabolic factors included central obesity, hypertension, dyslipidemia, hypertriglyceridemia, hyperglycemia, and hyperuricemia. Systemic inflammation was evaluated by calculating SII, which equals platelet count (/L) × neutrophil count (/L) / lymphocyte count (/L). Data were analyzed using Cox proportional hazards models and generalized structural equation model (GSEM).

RESULTS

During follow-up (median: 8.0 years, interquartile range: 4.0 to 14.0 years), 2990 participants developed premature CHD (1.7 %). The adjusted hazard ratio (HR) and 95 % confidence interval (CI) of premature CHD related to depression were 1.72 (1.44-2.05). The association between depression and premature CHD was 32.9 % mediated by comprehensive metabolic factors (β = 0.24, 95 % CI: 0.17-0.32) and 2.7 % by SII (β = 0.02, 95 % CI = 0.01-0.04), respectively. Concerning metabolic factors, the strongest indirect association was for central obesity, accounting for 11.0 % of the association between depression and premature CHD (β = 0.08, 95 % CI: 0.05-0.11).

CONCLUSIONS

Depression was associated with an increased risk of premature CHD. Our study provided evidence that metabolic and inflammatory factors might play a mediating role in the association between depression and premature CHD, especially central obesity.

Sex Differences in Cardiac Risk Factors in Young Adults: A Secondary Analysis and Surveillance Study

BACKGROUND

Coronary artery disease (CAD) is increasing in young adults, and greater understanding of their cardiac risk factors is essential to ensure effective prevention. Given the sex differences in CAD observed in older adults, understanding sex differences in risk factors for this younger group of adults is important. Having insight of cardiac risk factors and sex differences in the young adult population is essential to creating personalized strategies for prevention in nursing care and in this age group.

OBJECTIVES

The aims of this study were to determine the differences in CAD risk factors for young adult men and women and examine which factors are related to CAD early in life, ultimately to guide approaches for CAD prevention in primary care.

METHODS

In this secondary analysis, 125 017 community-dwelling young adults were evaluated for health behaviors considered as risk factors for CAD. The 2017 Behavior Risk Factor Surveillance System database from the Center for Disease Control was utilized. This database contains questions asked of young adults that would help with risk management for chronic diseases like CAD. Young adults in this article were defined as being between 18 and 44 years of age.

RESULTS

Men reported more cardiovascular risk factors than women and developed risk factors at an earlier age. Women had greater percentages of obesity and low activity levels. In this population, those with hypertension had the highest odds ratio for developing CAD.

CONCLUSIONS

Differences between men and women in CAD risk factors included lifestyle and other chronic conditions. Greater prevention efforts should focus on these differences in young men and women to reduce risk factors and prevent the development of CAD.

Clinical and economic impact of coronary artery bypass graft and percutaneous coronary intervention in young individuals with acute coronary syndromes and multivessel disease: A real-world comparison in a middle-income country

Background

In recent decades, the world watched a dramatic increase in the incidence of acute coronary syndromes (ACS) among young individuals (≤55 years-old) and a relative decrease in the elderly. The management of ACS in young patients with multivessel disease still needs to be elucidated, as these individuals maintain a long life expectancy.

Research Question

To compare clinical outcomes and care costs in individuals with premature ACS and multivessel disease undergoing coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI).

Methods and Results

Participants included all individuals ≤55 years-old admitted with ACS to public hospitals in Brasília (Brazil) between 2013 and 2015 and who underwent cardiac catheterization with SYNTAX score ≥23 or Duke category 6. Outcomes were adjudicated with death certificates and data from medical records. The primary outcome was the occurrence of major adverse cardiovascular events (MACE), defined as death due to cardiovascular causes, recurrent hospitalizations due to cardiovascular ischemic events, and incident heart failure New York Heart Association III-IV. As secondary outcome we assessed indirect and direct costs by evaluating the cost of lost productivity (in international dollars (Int$) per year) due to illness and death, outpatient costs and costs with new hospitalizations. Multivariate and principal components (PC) adjusted analyzes were performed.

Results

Among 1,088 subjects (111 CABG and 977 PCI) followed for 6.2 years (IQR: 1.1), 304 primary events were observed. MACE was observed in 20.7% of the CABG group and 28.8% of the PCI group (p = 0.037). In multivariate analyses, PCI was associated with a hazard ratio (HR) = 1.227 (95% CI: 1.004–1.499; p = 0.0457) for MACE, and in PC-adjusted HR = 1.268 (95% CI: 1.048–1.548; p = 0.0271) compared with CABG. Despite direct costs were equivalent, the cost due to the loss of labor productivity was higher in the PCI group (Int$ 4,511 (IQR: 18,062)/year vs Int$ 3,578 (IQR: 13,198)/year; p = 0.049], compared with CABG.

Conclusions

Among young individuals with ACS and multivessel disease, surgical strategy was associated with a lower occurrence of MACE and lower indirect costs in the long-term.

Acute Coronary Syndromes Due to Atherosclerotic Coronary Artery Disease in Young Patients

Young patients represent about 4-10% of the population presenting with acute coronary syndrome. In this focused mini-review, we highlight the data regarding acute coronary syndromes in young patients with atherosclerotic coronary artery disease. Differences in the underlying pathologies and pathophysiological mechanisms should yield to different clinical management and treatment strategies.

Association of Maternal Preeclampsia With Offspring Risks of Ischemic Heart Disease and Stroke in Nordic Countries

IMPORTANCE

An association between maternal preeclampsia and an increased risk of cardiovascular disease in the offspring is plausible, but evidence in this area is limited.

OBJECTIVE

To investigate (1) the association between maternal preeclampsia and risks of ischemic heart disease (IHD) and stroke in the offspring, (2) whether the association varies by severity or timing of onset of preeclampsia, and (3) the role of preterm birth and small for gestational age (SGA) birth, both of which are related to preeclampsia and cardiovascular diseases, in this association.

DESIGN, SETTING, AND PARTICIPANTS

This multinational population-based cohort study obtained data from Danish, Finnish, and Swedish national registries. Live singleton births from Denmark (1973-2016), Finland (1987-2014), and Sweden (1973-2014) were followed up until December 31, 2016, in Denmark and December 31, 2014, in Finland and Sweden. Data analyses were performed between September 2020 and September 2022.

EXPOSURES

Preeclampsia and its subtypes, including early onset (<34 gestational weeks) and late onset (≥34 gestational weeks), severe and mild or moderate, and with and without SGA birth.

MAIN OUTCOMES AND MEASURES

Diagnoses of IHD and stroke were extracted from patient and cause-of-death registers. Cox proportional hazards regression models and flexible parametric survival models were used to analyze the associations. Sibling analyses were conducted to control for unmeasured familial factors.

RESULTS

The cohort included of 8 475 819 births (2 668 697 [31.5%] from Denmark, 1 636 116 [19.3%] from Finland, and 4 171 006 [49.2%] from Sweden, comprising 4 350 546 boys [51.3%]). Of these offspring, 188 670 (2.2%) were exposed to maternal preeclampsia, 7446 (0.1%) were diagnosed with IHD, and 10 918 (0.1%) were diagnosed with stroke during the median (IQR) follow-up of 19.3 (9.0-28.1) years. Offspring of individuals with preeclampsia had increased risks of IHD (adjusted hazard ratio [HR], 1.33; 95% CI, 1.12-1.58) and stroke (adjusted HR, 1.34; 95% CI, 1.17-1.52). These associations were largely independent of preterm or SGA birth. Severe forms of preeclampsia were associated with a higher stroke risk than less severe forms (severe vs mild or moderate: adjusted HR, 1.81 [95% CI, 1.41-2.32] vs 1.22 [95% CI, 1.05-1.42]; early vs late onset: adjusted HR, 2.55 [95% CI, 1.97-3.28] vs 1.18 [95% CI, 1.01-1.39]; with vs without SGA birth: adjusted HR, 1.84 [95% CI, 1.44-2.34] vs 1.25 [95% CI, 1.07-1.48]). Sibling analyses suggested that the associations were partially explained by unmeasured familial factors.

CONCLUSIONS AND RELEVANCE

Results of this study suggest that offspring born to individuals with preeclampsia had increased IHD and stroke risk that were not fully explained by preterm or SGA birth, and that the associated risks for stroke were higher for severe forms of preeclampsia.

Acute myocardial infarction in a young adult with hyperhomocysteinaemia secondary to tropical sprue

Coronary heart disease and its complications remain the most common cause of morbidity and mortality throughout the world. In addition, its incidence among adults <45 years of age has also been steadily increasing in the past few decades. Besides the typical aetiology such as coronary artery abnormalities or autoimmune disorders, increasing rates can be attributed to escalating trends of obesity, type 2 diabetes mellitus, and illicit abuse of drugs such as cocaine and amphetamines in the younger population.¹ Every cardiovascular event in a young adult must be thoroughly investigated as the aetiology is typically unconventional. Our case reports a young man who developed an acute inferior wall myocardial infarction (IWMI) in the setting of hyperhomocysteinaemia secondary to vitamin B12-folate deficiency itself due to tropical sprue.

MiR-146a Contributes to Thromboinflammation and Recurrence in Young Patients with Acute Myocardial Infarction

Studies on older patients have established notable conceptual changes in the etiopathogenesis of acute coronary syndrome (ACS), but little is known about this disease in young patients (<45 years). Of special interest is thromboinflammation, key at onset, evolution and therapy of cardiovascular pathology. Therefore, we explored whether ACS at an early age is a thromboinflammatory disease by analyzing NETs and rs2431697 of miR-146a (a miRNA considered as a brake of TLR/NF-kB pathway), elements previously related to higher rates of recurrence in atrial fibrillation and sepsis. We included 359 ACS patients (<45 years) and classified them for specific analysis into G1 (collected during the hospitalization of the first event), G2 and G3 (retrospectively collected from patients with or without ACS recurrence, respectively). cfDNA and citH3−DNA were quantified, and rs2431697 was genotyped. Analysis in the overall cohort showed a moderate but significant correlation between cfDNA and citH3−DNA and Killip−Kimball score. In addition, patients with citH3−DNA > Q4 more frequently had a history of previous stroke (6.1% vs. 1.6%). In turn, rs2431697 did not confer increased risk for the onset of ACS, but T carriers had significantly higher levels of NET markers. By groups, we found that cfDNA levels were similarly higher in all patients, but citH3−DNA was especially higher in G1, suggesting that in plasma, this marker may be attenuated over time. Finally, patients from G2 with the worst markers (cfDNA and citH3−DNA > Q2 and T allele) had a two-fold increased risk of a new ischemic event at 2-year follow-up. In conclusion, our data confirm that ACS is younger onset with thromboinflammatory disease. In addition, these data consolidate rs2431697 as a silent proinflammatory factor predisposing to NETosis, and to a higher rate of adverse events in different cardiovascular diseases.

Influence of statin therapy on antiphospholipid antibodies and endothelial dysfunction in young patients with coronary artery disease and systemic lupus erythematosus

INTRODUCTION

Antiphospholipid antibodies (aPL) affect atherogenesis and may cause thromboembolism in systemic lupus erythematosus (SLE) and coronary artery disease (CAD). Intensive treatment with statins may reduce inflammation and decrease the number of thrombotic events. That may explain the beneficial effect of statin therapy in SLE and CAD. This study was established to investigate the influence of statin treatment on aPL antibody levels and selected endothelial dysfunction markers in CAD and SLE patients.

MATERIAL AND METHODS

Fifty-eight patients - 40 after coronary revascularization (age 38.9 (27-46), 35 males) and 18 with clinically stable SLE (age 38.8 (18-62), 1 male) - were enrolled in the study. In both groups intensive atorvastatin treatment was administered. At baseline and after 1 year of follow-up serology tests were performed: anticardiolipin antibodies (aCL), anti-β2 glycoprotein I (aβ2GPI), lupus anticoagulant (LA), C-reactive protein (CRP), soluble form of intracellular adhesion molecule-1 (sICAM-1), vWF:Ag.

RESULTS

Coronary artery disease patients in 1 year follow-up revealed a decrease of aβ2GPI IgG and CRP. There was a significant increase in aCL IgG, sICAM-1 and vWF:Ag. In SLE patients aPL levels showed no significant reduction after treatment.

CONCLUSIONS

In clinically stable patients IgM and IgG class aβ2GPI levels are higher in CAD than in SLE, whereas IgG class aCL levels are lower. Statin treatment decreases the CRP level in both SLE and CAD patients, while decreasing the aβ2GPI IgG level only in CAD patients.

Association of road traffic noise exposure and prevalence of coronary artery disease: A cross-sectional study in North India

Epidemiological studies have established that noise from transportation sources exceeding the safe limits elevates the risk for cardiovascular diseases. The results however have remained heterogeneous. The present study was conducted to investigate the association between road traffic noise exposure and prevalence of coronary artery disease besides sub-group analysis was performed for identifying the most susceptible population. Traffic noise exposure was measured using the L_den metric in both continuous and categorical forms. A cross-sectional study was performed and information about sociodemographic, lifestyle, and health-related factors was collected. Noise level < 60 dB(A) representing the quiet areas was used as the reference group. Univariate and multivariate logistic regressions were performed to estimate the odds for self-reported coronary artery disease concerning road traffic noise after adjusting for confounding variables. The residents living in noisy areas were found to have a 2.25 times higher risk per 5 dB(A) increment in the noise levels (95% CI = 1.38 to 3.67). Males were at a higher risk of CAD (OR = 2.61; 95% CI = 1.84 to 3.72) as compared to females (OR = 2.07; 95% CI = 1.37-3.13). The subgroup analysis revealed that being sensitive to noise, belonging to a higher age group, reporting higher stress levels, and poor sleep quality were associated with higher risk. The study also provides evidence that exposure to noise levels greater than 60 dB(A) is associated with the prevalence of coronary artery disease in adults.

Marine Natural Products and Coronary Artery Disease

Coronary artery disease is the major cause of mortality worldwide, especially in low- and middle-income earners. To not only reduce angina symptoms and exercise-induced ischemia but also prevent cardiovascular events, pharmacological intervention strategies, including antiplatelet drugs, anticoagulant drugs, statins, and other lipid-lowering drugs, and renin-angiotensin-aldosterone system blockers, are conducted. However, the existing drugs for coronary artery disease are incomprehensive and have some adverse reactions. Thus, it is necessary to look for new drug research and development. Marine natural products have been considered a valuable source for drug discovery because of their chemical diversity and biological activities. The experiments and investigations indicated that several marine natural products, such as organic small molecules, polysaccharides, proteins, and bioactive peptides, and lipids were effective for treating coronary artery disease. Here, we particularly discussed the functions and mechanisms of active substances in coronary artery disease, including antiplatelet, anticoagulant, lipid-lowering, anti-inflammatory, and antioxidant activities.

The effects of olive oil and cholesterol enriched diets on aortic fatty streak development and lipid peroxidation in rabbits

BACKGROUND AND AIM

High plasma cholesterol levels, mainly low-density lipoprotein-cholesterol (LDL) is a widely recognized major risk factor for coronary heart disease (CHD). According to epidemiologic studies' findings, people from the Mediterranean countries have lower CHD rates than other countries; in these countries the usual diet is high in olive oil. The present study compares the effects of a cholesterol-enriched diet with or without adding olive oil on serum lipoproteins, lipid peroxidation, and atherosclerosis development.

METHODS

Twenty Dutch male rabbits were categorized into four groups (one group as control, and others as experimental). They received one of control (CON), olive oil-rich (OIL), cholesterol-rich (CHOL), and cholesterol + olive oil (COIL) diet for 12 weeks. Fasting blood samples from the heart were collected at the beginning and the end of the experimental period.

RESULTS

Means of serum lipids were not significantly different at the beginning of the experimental period. After the intervention, significant differences were shown in total cholesterol (TC) (CON: 27.75 ± 4.83, OIL: 19.75 ± 2.62, CHOL: 1757.20 ± 149.62, COIL: 2906.40 ± 421.01; P < 0.001), high-density lipoprotein-cholesterol (HDL-C) (CON: 16 ± 1.47, OIL: 10.25 ± 1.70, CHOL: 22.2 ± 3.83, COIL: 28.60 ± 6.27; P = 0.04), triglyceride (CON: 65 ± 12.21, OIL: 71.75 ± 6.23, CHOL: 244.2 ± 44.45, COIL: 775.6 ± 105.07; P < 0.001), and MDA between groups (CON: 0.57 ± 0.10, OIL: 0.63 ± 0.15, CHOL: 5.62 ± 0.18, COIL: 2.06 ± 0.64; P < 0.001). The comparison of CHOL and the COIL groups showed a higher mean of malondialdehyde (MDA) in group CHOL (4.47 ± 0.28 vs 1.1 ± 0.6; P < 0.001). Aortic lesion was not observed in CON and OIL groups. Aortic lesion degree was significantly lower in the COIL group compared to the CHOL (2.4 ± 0.6 vs 3.66 ± 0.33; P = 0.02).

CONCLUSIONS

These findings showed the preventive effect of olive oil on atherosclerosis development. However, it is independent of the plasma lipoprotein effect, and olive oil probably acts on arteries directly.

Clinical characteristics of premature cardiovascular disease in our health area

INTRODUCTION AND OBJECTIVES

Cardiovascular disease continues to be the main cause of mortality, but few data are available in the young population. The aim of our study was to know the incidence and clinical characteristics of premature cardiovascular disease in our health area.

METHODS

Cross-sectional study of patients admitted for acute episode of premature cardiovascular disease in a referral hospital during 2018.

RESULTS

We detected 367 subjects: 306 (83.4%) with atherosclerotic cardiovascular disease. Almost half (164, 44.7%) were diabetic, with primary hypercholesterolaemia or high cardiovascular risk, and 84 (22.9%) had a personal history of cardiovascular disease. Among those with elevated risk or history (n = 207) only 47 subjects had LDL cholesterol at therapeutic target.

CONCLUSIONS

Most of the subjects with premature cardiovascular disease in our study had higher cardiovascular risk than attributable to their age. Intensive diagnosis and treatment of cardiovascular risk factors may prevent cardiovascular disease in young adults.

Different Patterns in Ranking of Risk Factors for the Onset Age of Acute Myocardial Infarction between Urban and Rural Areas in Eastern Taiwan

This cross-sectional study aimed to investigate the difference in ranking of risk factors of onset age of acute myocardial infarction (AMI) between urban and rural areas in Eastern Taiwan. Data from 2013 initial onset of AMI patients living in the urban areas (n = 1060) and rural areas (n = 953) from January 2000 to December 2015, including onset age, and conventional risk factors including sex, smoking, diabetes, hypertension, dyslipidemia, and body mass index (BMI). The results of multiple linear regressions analysis showed smoking, obesity, and dyslipidemia were early-onset reversible risk factors of AMI in both areas. The ranking of impacts of them on the age from high to low was obesity (β = −6.7), smoking (β = −6.1), and dyslipidemia (β = −4.8) in the urban areas, while it was smoking (β = −8.5), obesity (β= −7.8), and dyslipidemia (β = −5.1) in the rural areas. Furthermore, the average onset ages for the patients who smoke, are obese, and have dyslipidemia simultaneously was significantly earlier than for patients with none of these comorbidities in both urban (13.6 years) and rural (14.9 years) areas. The findings of this study suggest that the different prevention strategies for AMI should be implemented in urban and rural areas.

Coronary Artery Disease as the Cause of Sudden Cardiac Death Among Victims < 50 Years of Age

Coronary artery disease (CAD) is the most common cause of sudden cardiac death (SCD). Atherosclerosis increases with age, but also many victims of SCD in young and middle-aged population have CAD at autopsy. The purpose of this study was to determine the characteristics and autopsy findings of SCD due to CAD among victims of SCD under the age of 50. Fingesture is a population-based study consisting of consecutive series of victims of autopsy verified SCD in Northern Finland between the years 1998 to 2017 (n = 5,869). Histological examinations were part of all autopsies and a toxicology investigation was performed if needed. Analyses included information accumulated from death certificates, medical records, autopsy data, standardized questionnaire to the closest family members of the victims of SCD and police reports of the conditions of the death. Overall, 10.4% of all SCDs occurred among victims under the age of 50 years (610 victims). Most common underlying cause of SCD among these younger SCD victims was CAD (43.6%). The prevalence of CAD as the cause of SCD became more common in young SCD victims after the age of 35 years. The mean age of ischemic SCD victims was 44±5 years and most were men (89.5%). Most victims (90.2%) had no clinical diagnosis of CAD, however 33.8% had an autopsy evidence of silent myocardial infarction. SCD occurred during physical activity in 24.1%. Three-vessel disease was detected in 44.4% of the study victims. Cardiac hypertrophy (58.3%) and myocardial fibrosis (82.6%) were also common. At least 1 cardiovascular risk factor was present in 64.7% of SCD victims. In conclusion, most SCDs among victims < 50 years of age are due to CAD.

Masculinising testosterone treatment and effects on preclinical cardiovascular disease, muscle strength and power, aggression, physical fitness and respiratory function in transgender men: protocol for a 10-year, prospective, observational cohort study in Denmark at the Body Identity Clinic (BIC)

INTRODUCTION

The number of individuals with gender dysphoria seeking gender-affirming treatment is increasing. The short-term and long-term effects of masculinising treatment with testosterone are debated as serum testosterone increases up to 20-fold compared with cisgender women. We will investigate short-term and long-term effects of masculinising testosterone treatment on preclinical and clinical coronary disease, muscle strength and power, oxygen consumption (VO₂) max, cardiac and respiratory function and quality of life including aggression in transgender men.

METHODS AND ANALYSES

Prospective, single-centre, observational cohort study at the Body Identity Clinic (BIC), Odense University Hospital, Denmark. Investigations are performed at inclusion and following 1, 3, 5 and 10 years of testosterone therapy. Non-calcified coronary plaque volume and calcium score are estimated by coronary CT angiography. CT is only performed at inclusion and following 1 and 10 years. Upper body muscle strength and power are measured by a 'low row' weight stack resisted exercise machine. Evaluation of aggression and quality of life is assessed by questionnaires, VO₂ max is estimated by maximal testing on bike ergometer, and cardiac and respiratory functions are measured by echocardiography and spirometry, respectively. Markers of cardiovascular risk and inflammation and also cortisol and cortisone are assessed in blood, diurnal urine and/or hair samples. Our cohort (BIC), including dropouts, will be an embedded subcohort in a future national registry study in all individuals with gender dysphoria and controls. Data are available on International Statistical Classification of Diseases and Related Health Problems 10^th version diagnostic codes, prescriptions, socioeconomics and causes of death.

ETHICS AND DISSEMINATION

The Regional Committee on Health Research Ethics for Southern Denmark (S-20190108) and the Danish Data Protection Agency (19/27572) approved the study. Signed informed consent will be obtained from all participants. All findings will be published in peer-reviewed journals or at scientific conferences.

TRIAL REGISTRATION NUMBER

NCT04254354.

Characteristics and Outcomes of Coronary Artery Involvement in Polyarteritis Nodosa

BACKGROUND

Coronary artery involvement is a severe but uncommon manifestation of polyarteritis nodosa (PAN), so clinicians have little knowledge of it. Our aim was to investigate the clinical characteristics, risk factors and outcomes of patients with PAN complicated with coronary artery lesions.

METHODS

Data from 145 patients with PAN who were admitted to Peking Union Medical College Hospital from January 2000 to September 2019 were retrospectively collected.

RESULTS

Nineteen patients (13.1%) had coronary artery lesions due to PAN. The age at the onset of PAN was 32.3 ± 11.8 years. There were no significant differences in common risk factors for coronary arterial atherosclerosis between the patients with coronary artery involvement and those without. Affected branches of the coronary arteries were left anterior descending branch (15 patients), right coronary artery (14 patients), and left circumflex branch (9 patients). Eleven of the 19 patients exhibited multivessel lesions. Multivariate logistic regression analysis showed that celiac artery involvement (odds ratio [OR] 3.722, 95% confidence interval [CI] 1.115-12.427; P = 0.033) and new-onset hypertension (OR 6.668, 95% CI 1.936-22.961; P = 0.003) were risk factors for coronary artery involvement in patients with PAN. Stent placement was performed for 2 patients, and in-stent restenosis occurred in 1 of those patients a year later.

CONCLUSIONS

PAN with coronary artery involvement exhibits more combined involvement of arteries of other organs and more severe diseases. PAN should be considered when treating young adults with an unknown origin of coronary artery lesions. In addition to systemic immunosuppressive treatment, other measures including antiplatelet and anticoagulation therapy should be initiated; however, determining the optimal time to perform procedures such as intervention or surgery is still challenging.

Acute Myocardial Infarction among Young Adult Men in a Region with Warm Climate: Clinical Characteristics and Seasonal Distribution

The aim of this cross sectional study was to investigate the influence of the seasons on acute myocardial infarction (AMI) among young adult among young adults aged <45 years compared to old adults aged ≥45 years. The seasonal distribution of AMI hospital admissions among young adult men in eastern Taiwan was assessed. Data were extracted from 1413 male AMI patients from January 1994 to December 2015, including onset date, the average temperature (Tave) on the date of AMI hospitalization (AMI-Tave), and conventional risk factors, notably smoking, diabetes, hypertension, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and body mass index (BMI). The 1413 cases were divided into two groups: the young group (n = 138, <45 y/o) and the older group (n = 1275, ≥45 y/o). The differences between groups were examined. Logistic regression analyses were used to evaluate the associations between the seasons and the AMI hospitalization among the young group. The young group showed significantly higher percentage of smokers, BMI, total cholesterol levels, and triglycerides levels but lower percentage of diabetes and hypertension than the older group (p < 0.05). AMI hospitalization in winter was significantly greater compared to the other seasons among the young group (p < 0.05). Winter hospitalization was significantly associated with the young group relative to the older group (adjusted OR 1.750; 95% CI 1.151 to 2.259), while winter AMI-Tave in the young group was similar to that in the older group. Young adult men diagnosed with AMI are more likely than older adult men to be smokers, obese, and show an onset dependent on winter but not low-temperature in a region with a warm climate.

Association of traditional cardiovascular risk factors in adults younger than 55 years with coronary heart disease. Case-control study

Objectives:

The traditional cardiovascular risk factors associated with coronary artery disease in individuals younger than 55 years old was determined in this study.

Methods:

A retrospective, paired case–control study comprised of patients younger than 55 years old who were admitted to the hospital due to acute coronary syndrome with coronary artery disease from 2011 to 2016. There were two controls per case, paired by age, gender, admission date, and health insurance. Data from patients were collected, such as sociodemographic information, cardiovascular risk factors, and drug therapy information. A conditional logistic regression model was created to evaluate the association between traditional cardiovascular risk factors and coronary artery disease.

Results:

There were 171 cases and 342 controls included in the study. The median age was 49 years, with a predominance of male gender (80.12%). Nearly 66% of cases had at least one traditional cardiovascular risk factor. The most common risk factors were obesity (57.31%), arterial hypertension (45.62%), and smoking (28.97%). Independent risk factors of coronary artery disease in patients younger than 55 years were arterial hypertension (odds ratio, 2.52; 95% confidence interval, 1.48–4.20; p = 0.001) and smoking (odds ratio, 7.15; 95% confidence interval, 3.19–15.99; p = 0.00). No significant association between diabetes mellitus and coronary heart disease in the global group (odds ratio, 2.04; 95% confidence innterval, 0.91–4.58; p = 0.083) was found.

Conclusion:

For patients younger than 55 years, with a theoretically lower risk of coronary artery disease due to their age, having one or several traditional risk factors (smoking, arterial hypertension, dyslipidemia, or diabetes mellitus) confers an increased risk of coronary artery disease regardless of age.

Influence of 8-Week Aerobic Training on the Skin Microcirculation in Patients with Ischaemic Heart Disease

Materials and Methods

In the study, 48 men took part with a stabilized and pharmacologically controlled ischaemic disease. The participants were randomly divided into two groups with 24 people in each of them. The research group participated in an aerobic march training. The march was taking place 3 times a week for 30-40 minutes over a period of 8 weeks. In the time of training, the subjects did not practise any other physical activity for 8 weeks. The measurement of skin microcirculation was done by using the laser Doppler flowmeter estimating the values of regular flow and the reactions provoked in response to occlusion and temperature. Signal frequency was also analysed which was received by means of laser Doppler flowmetry in the range from 0.01 to 2 Hz during the regular flow.

Results

During the first measurement in relation to the initial values, a decrease in body mass was noted by 2.21 kg on average as well as reduction of systolic and diastolic pressure by 10.4 mmHg and 3.68 mmHg, respectively. The regular flow (RF) increased after the training by 2.21%. The provoked reactions were as follows: hyperemic (PRHmax): an increase occurred by 8.76% and hyperthermic (THmax): an increase occurred by 5.38%. The time needed to achieve PRHmax was reduced by 42% and to achieve THmax, by 22%. The heart rhythm and the signal strength of neurogenic rhythm decreased by approximately 8% and 24%, respectively. The signal strength of endothelial rhythm increased by 19%. In the second measurement, a recourse was noted in the values of indicators under investigation, which were assuming values close to the initial ones. In the control group, the measurement values did not change significantly.

Conclusions

8 weeks of systematic aerobic training provides a significant improvement of endothelium functioning, expressed by reactivity improvement in skin microcirculation in patients suffering from ischaemic heart disease. It points to aerobic training as a nonpharmacological effective cardioprotective factor. The improvement effects of skin vascular bed functioning in the group of patients with IHD are impermanent, and they disappear after the period in which patients did not exercise physical activity.

A genetic risk score predicts recurrent events after myocardial infarction in young adults

INTRODUCTION AND OBJECTIVES

To evaluate whether a genetic risk score (GRS) improves prediction of recurrent events in young nondiabetic patients presenting with an acute myocardial infarction (AMI) and identifies a more aggressive form of atherosclerosis.

METHODS

We conducted a prospective study with consecutive nondiabetic patients aged <55 years presenting with AMI. We performed a genetic test, cardiac computed tomography, and analyzed several biomarkers. We studied the association of a GRS composed of 11 genetic variants and a primary composite endpoint (cardiovascular mortality, a recurrent event, and cardiac hospitalization).

RESULTS

A total of 81 patients were studied and followed up for a median of 4.1 years. There were 24 recurrent cardiovascular events. Compared with the general population, study participants had a higher prevalence of 9 out of 11 risk alleles. The GRS was significantly associated with recurrent cardiovascular events, especially when baseline low-density lipoprotein cholesterol (LDL-C) levels were elevated. Compared with the low-risk GRS tertile, the multivariate-adjusted HR for recurrences was 10.2 (95%CI, 1.1-100.3; P=.04) for the intermediate-risk group and was 20.7 (2.4-181.0; P=.006) for the high-risk group when LDL-C was≥2.8mmol/L (≥ 110mg/dL). Inclusion of the GRS improved the C-statistic (ΔC-statistic=0.086), cNRI (continuous net reclassification improvement) (30%), and the IDI (integrated discrimination improvement) index (0.05). Cardiac computed tomography frequently detected coronary calcified atherosclerosis but had limited value for prediction of recurrences. No association was observed between metalloproteinases, GRS and recurrences.

CONCLUSIONS

A multilocus GRS may identify individuals at increased risk of long-term recurrences among young nondiabetic patients with AMI and improve clinical risk stratification models, particularly among patients with high baseline LDL-C levels.

The Atherogenic Role of Circulating Modified Lipids in Atherosclerosis

Lipid accumulation in the arterial wall is a crucial event in the development of atherosclerotic lesions. Circulating low-density lipoprotein (LDL) is the major source of lipids that accumulate in the atherosclerotic plaques. It was discovered that not all LDL is atherogenic. In the blood plasma of atherosclerotic patients, LDL particles are the subject of multiple enzymatic and non-enzymatic modifications that determine their atherogenicity. Desialylation is the primary and the most important atherogenic LDL modification followed by a cascade of other modifications that also increase blood atherogenicity. The enzyme trans-sialidase is responsible for the desialylation of LDL, therefore, its activity plays an important role in atherosclerosis development. Moreover, circulating modified LDL is associated with immune complexes that also have a strong atherogenic potential. Moreover, it was shown that antibodies to modified LDL are also atherogenic. The properties of modified LDL were described, and the strong evidence indicating that it is capable of inducing intracellular accumulation of lipids was presented. The accumulated evidence indicated that the molecular properties of modified LDL, including LDL-containing immune complexes can serve as the prognostic/diagnostic biomarkers and molecular targets for the development of anti-atherosclerotic drugs.

Risk factors of premature coronary artery disease in Iran: A systematic review and meta-analysis

BACKGROUND

The aim of this study was to determine the mean age at which coronary artery disease (CAD) hase decreased in recent years in Iran. This systematic review and meta-analysis compares the prevalence of different risk factors of premature CAD (PCAD) in patients vs healthy individuals.

METHODS

Medline, Web of Science, Embase and Scientific Information Database were searched for studies about PCAD risk factors in Iran until 28 October 2017. Observational studies of Iranians, comparing risk factors between patients with PCAD and age- and sex-matched healthy subjects, were included. Fixed-effects and random-effects model were used for pooling data. Odds ratio (OR) with 95% CI and mean difference were used for effect size estimation among studies.

RESULTS

Twelve studies were eligible for meta-analysis. Diabetes mellitus (OR: 2.4, 95% CI: 1.9-3.03; P = 0.0001, I²  = 25.5%; P = 0.2), family history of CAD (OR: 2.09, 95% CI: 1.22-3.6; P = 0.007, I²  = 86%; P = 0.0001), dyslipidaemia (OR: 2.05, 95% CI: 1.15-3.64; P = 0.01, I²  = 54%; P = 0.08), smoking (OR: 1.65, 95% CI: 1.11-2.46; P = 0.01, I²  = 77.2%; P = 0.000) and hypertension (OR: 1.35, 95% CI: 1.21 to-1.50; P < 0.001, I²  = 31%, P = 0.1) associated with PCAD. Sensitivity analysis demonstrated that patients with PCAD had significantly lower levels of high-density lipoprotein (HDL) cholesterol and significantly higher levels of triglycerides compared to healthy subjects (MD: -2.56, 95% CI: -3.54 to -1.58, P < 0.001, I²  = 42%, P = 0.01 and MD: 21.17, 95% CI: 14.73-27.62, P < 0.001, I²  = 80.12%, P < 0.001, respectively). It should be noted that although high levels of heterogeneity in LDL and HDL values among the studies were observed, when dyslipidaemia was studied as a binary variable, no significant heterogeneity among studies was observed.

CONCLUSION

Diabetes mellitus, family history of CAD, dyslipidaemia, smoking, and hypertension were significantly and positively associated with CAD in young adults compared to healthy age- and sex-matched population in Iran.

Pathology of atherosclerotic coronary artery disease in the young Indian population

Atherosclerotic coronary artery disease (CAD) is of great concern in young adults because of its potential to cause great incapacitation. This arena of cardiology has gained importance in South Asian countries, particularly India due to increased prevalence that is related to traditional risk factors, altered life styles and inherent risk factors. In this study, we sought to evaluate, at autopsy, the pathology of atherosclerotic CAD in young patients with ischemic heart disease (IHD). A 10-year retrospective autopsy-based study was carried out in a large tertiary-care centre and patients aged ≤45 years with IHD were selected. Out of 545 autopsied cases of IHD, 95 patients (17.4%) were young. Among these 95 patients, 84 (88.4%) had IHD related to atherosclerotic CAD; the youngest patient was 18 years old. Predictably there was sole involvement of left anterior descending artery and the presence of fibrous plaques. Irrespective of the plaque morphology, the commonest complication was thrombosis produced by plaque erosion seen in 36.9% of patients. Acute coronary insufficiency was noted in 52 patients (61.9%), while healed infarctions were surprisingly noted in 28 patients (33.3%). Screening for IHD in the young population may help to improve prognosis by detecting subclinical disease, although more studies are necessary to establish reference limits for this young population. Additional research must also focus on treatment concerns that are specific to young patients.

Impact of gender and age on the association of the BUD13-ZNF259 rs964184 polymorphism with coronary heart disease

OBJECTIVE

Coronary heart disease (CHD) is the most common cause of death worldwide. This study aimed to validate the association of the rs964184 polymorphism with the CHD risk and included 874 CHD patients and 776 controls.

METHODS

rs964184 polymorphism genotyping was performed using Tm-shift polymerase chain reaction.

RESULTS

A strong association of the rs964184 polymorphism with CHD was found (genotype: X²=14.365, p=0.001; allele: X²=14.191, p=1.67x10^-4; power=0.965). Gender analysis revealed a significant association only in males (genotype: X²=12.387, p=0.002; allele: X²=12.404, p=4.32x10^-4; OR=1.467, 95% CI=1.185-1.817, power=0.945). Age and gender analyses revealed significant associations of the rs964184 polymorphism with CHD in males between the ages of 55 and 65 years (genotype: X²=10.070, p=0.007; allele: X²=10.077, p=0.002; OR=1.706, 95% CI=1.224-2.377, power=0.996) and in females older than 65 years (genotype: X²=9.462, p=0.009; allele: X²=9.560, p=0.002; OR=2.112, 95% CI=1.308-3.412, power=0.994). Further subgroup analysis suggested that rs964184 genotypes were significantly associated with TG levels in the patients (r=0.191, adjusted p=1.05x10^-5) and controls (r=0.101, adjusted p=0.026).

CONCLUSION

Our results indicate that both gender and age have great impacts on the association of the rs964184 polymorphism with CHD among Chinese.

Intravenous Cocaine Results in an Acute Decrease in Levels of Biomarkers of Vascular Inflammation in Humans

Cocaine use causes significant cardiovascular morbidity from its hemodynamic effects. It is less clear whether cocaine promotes atherosclerosis. Vascular inflammation is one of the earliest steps in the pathophysiology of atherosclerosis. We hypothesized that cocaine results in an increase in inflammatory markers. Study objective was to measure the acute effects of intravenous cocaine on biomarkers of vascular inflammation. Eleven chronic cocaine users were enrolled. After a drug-free period, they received intravenous cocaine at 0.36 mg/kg dose in an in-hospital controlled environment. Serum levels of soluble CD40 ligand, monocyte chemoattractant protein-1, interleukin 6, and soluble intercellular adhesion molecule-1 were measured at baseline, 6 h, 24 h, and 6 days after cocaine challenge and at baseline for controls. After cocaine challenge, sCD40 ligand levels decreased in subjects and were significantly lower at 24 h. MCP-1 levels decreased and were significantly lower at the 6-day time point. No significant changes in IL-6 or sICAM-1 level were found. In conclusion, intravenous cocaine did not result in an increase in levels of inflammatory markers. Levels of MCP-1 and sCD40L decreased significantly. This unexpected finding suggests that chronic effects of cocaine on inflammation may be different from acute effects or that higher dosing may have differential effects as compared to lower dose used here.

Coronary Artery Bypass in Young Patients-On or Off-Pump?

A definitive conclusion regarding whether on-pump or off-pump coronary artery bypass is preferable in young patients is lacking. The aim of our study was to perform a long-term comparison of the two approaches in young patients. We analyzed the National Health Insurance Research Database, using data for patients between 18 and 45 years of age who had undergone isolated coronary artery bypass between 2001 and 2011. The study endpoints were: all-cause death, major adverse cardiac and cerebrovascular events, and repeat revascularization within 30 days, 1 year, 5 years, and the entire 10-year follow-up period. A total of 344 patients received off-pump surgery and 741 patients received on-pump surgery. Preoperative characteristics and comorbidities were similar in both groups, and all-cause mortality was almost equal (p = 0.716). The 5-year survival rates were 93.9% and 92.2% in the off-pump and on-pump groups, respectively, and the 10-year survival rates were 86.3% and 82.1%, respectively. The repeat revascularization rate was significantly lower in the on-pump group (p = 0.0407). Both the on-pump and off-pump methods offer equally good long-term outcomes in terms of mortality and major adverse cardiac and cerebrovascular events. However, the need for repeat revascularization is a concern in the long term after off-pump surgery.

Re-examining the relationship between alcohol consumption and coronary heart disease with a new lens

Moderate alcohol consumption has been related to lower risk of coronary heart disease (CHD) in the literature. To examine whether alcohol drinking during the past 12 months and heaviest drinking period were differentially associated with the risk of CHD, we designed a case-control study using a population-based health survey of U.S. adults conducted from 2012 to 2013. Respondents who reported to have doctor-ascertained CHD served as cases (n = 1671), and those free of CHD and other alcohol-related health conditions served as controls (n = 17,629) in logistic regressions. Sex-specific quartiles of average daily ethanol intake were ascertained and calculated for the past 12 months and during the period of heaviest lifetime drinking. We further split current drinkers into reducers and non-reducers (past 12 months relative to the heaviest drinking period) to examine CHD risk profiles in association with the 12-month drinking level. Current-drinker reducers (AOR, 95% CI = 1.57 [1.10-2.27] for men; AOR, 95% CI = 1.33 [1.02-1.72] for women) and former drinkers (AOR, 95% CI = 2.06 [1.43-2.97] for men; AOR, 95% CI = 1.51 [1.19-1.92] for women) more often had CHD than lifetime abstainers. Male heavy drinkers during the heaviest drinking period (AOR, 95% CI = 2.25 [1.52-3.32]) were more likely to manifest CHD than lifetime abstainers. In addition, individuals with diagnosed CHD were significantly more likely to have reduced drinking in the past. A change in alcohol consumption over the life course among former and current drinkers may distort the true alcohol-CHD relationship.

Machine learning methodologies versus cardiovascular risk scores, in predicting disease risk

Background

The use of Cardiovascular Disease (CVD) risk estimation scores in primary prevention has long been established. However, their performance still remains a matter of concern. The aim of this study was to explore the potential of using ML methodologies on CVD prediction, especially compared to established risk tool, the HellenicSCORE.

Methods

Data from the ATTICA prospective study (n = 2020 adults), enrolled during 2001–02 and followed-up in 2011–12 were used. Three different machine-learning classifiers (k-NN, random forest, and decision tree) were trained and evaluated against 10-year CVD incidence, in comparison with the HellenicSCORE tool (a calibration of the ESC SCORE). Training datasets, consisting from 16 variables to only 5 variables, were chosen, with or without bootstrapping, in an attempt to achieve the best overall performance for the machine learning classifiers.

Results

Depending on the classifier and the training dataset the outcome varied in efficiency but was comparable between the two methodological approaches. In particular, the HellenicSCORE showed accuracy 85%, specificity 20%, sensitivity 97%, positive predictive value 87%, and negative predictive value 58%, whereas for the machine learning methodologies, accuracy ranged from 65 to 84%, specificity from 46 to 56%, sensitivity from 67 to 89%, positive predictive value from 89 to 91%, and negative predictive value from 24 to 45%; random forest gave the best results, while the k-NN gave the poorest results.

Conclusions

The alternative approach of machine learning classification produced results comparable to that of risk prediction scores and, thus, it can be used as a method of CVD prediction, taking into consideration the advantages that machine learning methodologies may offer.

Young adult cardiovascular diseases: a single center coronary computed tomography angiography study

PURPOSE AND BACKGROUND

Cardiovascular disease (CVD) is one of the leading causes of death. However, the prevalence of CVD in young adults (<40 years of age) has not been well documented. We conducted this study to determine the proportion of CVD in both symptomatic and asymptomatic young adults.

MATERIALS AND METHODS

Coronary CT angiography images obtained from April 2015 to July 2017 in our institution was retrospectively reviewed. Young adults were separated into two groups according to whether they had experienced chest discomfort. The diagnosis was classified as normal, coronary artery disease (CAD), myocardial bridging (MB), congenital coronary anomaly, congenital cardiac anomaly, cardiomyopathy, and aortic anomaly. The proportion of different diagnoses in two groups and cardiovascular risk factors were analyzed.

RESULTS

Totally 107 patients (mean age, 35.6 ± 3.55 years) were grouped into 36 cases of symptomatic group and 71 patients of asymptomatic group. Cardiovascular anomalies were found in 61 cases (41%). No significant difference in the occurrence rates of CAD (14% vs 11%, p = 0.53), MB (31% vs 42%, p = 0.51), and congenital coronary anomaly (7% vs 3%, p = 0.26) between groups. Mild arterial stenosis was implied in most CAD cases. Hypertension was the only risk factor significantly correlated with CAD.

CONCLUSIONS

Although young adults are conventionally identified as low-risk, more than 60% of the cases in our cohort were proved to present cardiovascular anomalies, with no significant relation to cardiac symptoms. Early interventions should be conducted for aggressive CVD subtypes to prevent future acute events.