Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons

Systemic immune-inflammation index and its relation to blood pressure and dyslipidemia in adults: A retrospective study

High blood pressure (BP) and dyslipidemia are major risk factors for cardiovascular disease mortality. The systemic immune-inflammation index (SII) has been suggested as a predictive tool to identify those at risk for chronic diseases, however, its use for predicting high BP and dyslipidemia has not been thoroughly investigated. This study aimed to examine the association between SII and high BP as well as lipid markers. Retrospective hospital data from a large cohort (n = 3895) of Saudi adults aged ≥18 years were analyzed. Lipid markers (cholesterol, high-density lipoprotein, low-density lipoprotein [LDL]), systolic BP, and diastolic BP measures were extracted. When the sample was divided into quartiles of SII, cholesterol, triglycerides, and LDL were higher in those with a higher SII than in those with a lower SII (P < .01). After adjusting for potential confounders, higher SII was significantly associated with higher odds of hypertension (odds ratio: 1.12, 95% confidence interval: 1.04-1.21) and elevated LDL (odds ratio: 1.07, 95% CI: 1.02-1.14), but not with elevated cholesterol. Across quartiles of SII, there was a significant trend between higher SII and the odds of hypertension in people with diabetes and those aged ≥65 years. The SII could be an economical predictive measure for identifying individuals at risk of hypertension and some aspects of dyslipidemia. Longitudinal studies are needed to confirm this relationship.

Marine Microalgal Products with Activities against Age-Related Cardiovascular Diseases

Heart disease is one of the leading causes of death worldwide, and it is estimated that 17.9 million people die of it each year. The risk factors for cardiovascular diseases are attributable to an unhealthy and sedentary lifestyle, poor nutrition, stress, genetic predisposition, diabetes, obesity, and aging. Marine microalgae have been the subject of numerous studies for their potential activity against several human diseases. They produce a plethora of primary and secondary metabolites such as essential nutrients, vitamins, pigments, and omega-3 fatty acid. Many of these molecules have antioxidant properties and have been shown to play a role in the prevention of heart diseases. The aim of this review is to summarize recent studies on the discovery of marine microalgal compounds and bioactivities for cardiovascular diseases, including in vitro and in vivo studies, showing and discussing recent discoveries and trends. The most promising results were found for microalgal polysaccharides, peptides and carotenoids. In conclusion, the overall data summarized here show that microalgae-based supplementation has the potential to improve age-related cardiovascular diseases and we expect more clinical studies in the future.

miR-1268a Regulates Fatty Acid Metabolism by Targeting CD36 in Angiotensin II-induced Heart Failure

Multiple RNAs have been involved in the progress of heart failure. However, the role of miR-1268a in heart failure is still unclear. The differentially expressed miRNAs in heart failure was analyzed based on GEO dataset GSE104150. AC16 cells were treated with Angiotensin II (Ang II) to explore the role of miR-1268a in heart failure. The web tool miRWalk was used to analyze the targets of miR-1268a. miR-1268a was up-regulated in Ang II-treated AC16 cells. Ang II treatment markedly inhibited cell proliferation, ATP production, fatty acid (FA) uptake and enhanced levels of HF markers BNP and ST2, and oxidative stress of AC16 cells. Notably, inhibition of miR-1268a eliminated the inhibiting effect of Ang II on cell proliferation, ATP production, FA uptake and decreased levels of BNP an ST2, and oxidative stress on AC16 cells. Furthermore, CD36 was a target of miR-1268a and the CD36 level was decreased by miR-1268a mimics but increased by miR-1268a inhibitor in AC16 cells. miR-1268a regulates FA metabolism and oxidative stress in myocardial cells by targeting CD36 in heart failure.

The underlying mechanisms by which Post-Traumatic Growth is associated with cardiovascular health in male UK military personnel: The ADVANCE cohort study

Post-Traumatic Growth (PTG) is associated with good cardiovascular health, but the mechanisms of this are poorly understood. This cross-sectional analysis assessed whether factors of PTG (Appreciation of Life (AOL), New Possibilities (NP), Personal Strength (PS), Relating to Others (RTO) and Spiritual Change (SC)) are associated with cardiovascular health in a cohort of 1006 male UK military personnel (median age 34). The findings suggest AOL, PS and RTO are associated with better cardiovascular health through cardiometabolic effects (lower levels of triglycerides, and total cholesterol) and haemodynamic functioning (lower diastolic blood pressure), but not inflammation. However, NP and SC were associated with poorer cardiovascular health through cardiometabolic effects (lower levels of high-density lipoproteins and higher levels of total cholesterol) and AOL had a non-linear association with low-density lipoproteins. These findings suggest that the relationship between PTG and cardiovascular functioning is complex and in need of further scrutiny.

Moxibustion for declined cardiorespiratory fitness of apparently healthy older adults: A study protocol for a randomized controlled trial

BACKGROUND

Aging and age-related declines lead to varying degrees of decreased cardiorespiratory fitness (CRF) in apparently healthy older adults. Exercise training, the primary approach for enhancing CRF, encounters several constraints when used with elderly individuals. Existing evidence implies that moxibustion might enhance the CRF of older adults. However, clinical research in this area still needs to be improved.

METHODS

This study will employ a randomized, assessor-blinded, controlled trial design involving 126 eligible participants. These participants will be stratified and randomly assigned to one moxibustion group, one sham moxibustion group, and one blank control group. Acupoints of bilateral Zusanli (ST36), Shenque (CV8), and Guanyuan (CV4) are selected for both real and sham moxibustion groups. The treatment will last 60 min per session, 5 sessions a week for 12 weeks. The blank control group will not receive any intervention for CRF improvement. Primary outcomes will be the mean change in peak oxygen uptake (VO2peak), anaerobic threshold (AT), and serum central carbon metabolites (CCB) from the baseline to observation points. Secondary outcome measures involve the six-minute walk distance (6MWD), the Short Form 36 Health Survey (SF-36), and the Qi and Blood Status Questionnaire (QBSQ). Outcome assessments will be conducted at weeks 4, 8, 12, and 24 as part of the follow-up. Adverse events will be assessed at each visit.

DISCUSSION

This trial can potentially ascertain moxibustion's effectiveness and safety in enhancing CRF among apparently healthy older adults.

TRAIL REGISTRATION

ChiCTR, ChiCTR2300070303. Registered on April 08, 2023.

Cardiometabolic risk factors in social housing residents: A multi-site cross-sectional survey in older adults from Ontario, Canada

OBJECTIVE

This study describes cardiometabolic diseases and related risk factors in vulnerable older adults residing in social housing, aiming to inform primary care initiatives to reduce health inequities. Associations between sociodemographic variables, modifiable risk factors (clinical and behavioural), health-related quality of life and self-reported cardiometabolic diseases were investigated.

DESIGN, SETTING, AND PARTICIPANTS

This was a cross-sectional study with an interviewer-administered questionnaire. Data was collected from residents aged 55 years and older residing in 30 social housing apartment buildings in five regions in Ontario, Canada.

OUTCOME MEASURES

The proportion of cardiometabolic diseases and modifiable risk factors (e.g., clinical, behavioural, health status) in this population was calculated.

RESULTS

Questionnaires were completed with 1065 residents: mean age 72.4 years (SD = 8.87), 77.3% were female, 87.2% were white; 48.2% had less than high school education; 22.70% self-reported cardiovascular disease (CVD), 10.54% diabetes, 59.12% hypertension, 43.59% high cholesterol. These proportions were higher than the general population. Greater age was associated with overweight, high cholesterol, high blood pressure and CVD. Poor health-related quality of life was associated with self-reported CVD and diabetes.

CONCLUSIONS

Older adults residing in social housing in Ontario have higher proportion of cardiovascular disease and modifiable risk factors compared to the general population. This vulnerable population should be considered at high risk of cardiometabolic disease. Primary care interventions appropriate for this population should be implemented to reduce individual and societal burdens of cardiometabolic disease.

Maternal Seafood Consumption during Pregnancy and Cardiovascular Health of Children at 11 Years of Age

Nutrition is critical during pregnancy for the healthy growth of the developing infant, who is fully dependent on maternal dietary omega-3 supply for development. Fatty fish, a main dietary source of omega-3, is associated with decreased cardiovascular risk in adults. We conducted a longitudinal study based on a mother-offspring cohort as part of the project Infancia y Medio Ambiente (INMA) in order to assess whether fish intake during pregnancy relates to cardiovascular health in children. A total of 657 women were included and followed throughout pregnancy until birth, and their children were enrolled at birth and followed up until age 11-12. A semi-quantitative food frequency questionnaire was used to assess the daily intake of foods during the 1st and 3rd trimesters of pregnancy. Cardiovascular assessments included arterial stiffness (assessed by carotid-femoral pulse wave velocity [PWV]) and retinal microcirculation (photographic assessment of central retinal arteriolar and venular equivalent [CRAE and CRVE]). The association between maternal fish consumption and cardiovascular outcomes of offspring at 11 years of age was evaluated using multivariable linear regression models. There were no statistically significant differences in any cardiovascular endpoint in children whose mothers had a higher fish consumption during pregnancy compared to those with a lower fish consumption. We found a slightly higher PWV (β = 0.1, 95% CI = 0.0; 0.2, p for trend = 0.047) in children whose mothers had a higher consumption of canned tuna during the 1st trimester of pregnancy. Fish intake during pregnancy was found to be unrelated to the offspring's cardiovascular health at 11 years of age. The beneficial cardiovascular effects of fish consumption during pregnancy on the offspring are still inconclusive.

Negative work-to-family spillover stress and heightened cardiovascular risk biomarkers in midlife and older adults

OBJECTIVES

The current study aimed to investigate the health implications of negative work-to-family spillover on cardiovascular risk biomarkers.

METHODS

In a large-scale cross-sectional dataset of working or self-employed midlife and older adults in the United States (N = 1179), we examined five biomarkers linked to cardiovascular risk, including high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, triglyceride, interleukin-6, and C-reactive protein. Negative work-to-family spillover, measured using a four-item self-reported questionnaire, was included into our model to study its association with these cardiovascular risk biomarkers.

RESULTS

Our findings indicate a significant association between negative work-to-family spillover and cardiovascular risk biomarkers - higher triglycerides (β = 0.108, p < .001), interleukin-6 (β = 0.065, p = .026), and C-reactive protein (β = 0.067, p = .022), and lower HDL cholesterol (β = -0.104, p < .001). The associations on triglycerides (β = 0.094, p = .001) and HDL cholesterol (β = -0.098, p < .001) remained significant even after controlling numerous control variables of demographics, medication, health-status, and health-related behaviors. The findings were also consistent against slight variations in the analytic method and adjustment for multiple comparisons.

CONCLUSIONS

The current study supports the premise that spillover of work-related tensions into family life is associated with objective physiological changes that contribute to cardiovascular risk.

Unlocking the Benefits of Fasting: A Review of its Impact on Various Biological Systems and Human Health

Fasting has gained significant attention in recent years for its potential health benefits in various body systems. This review aims to comprehensively examine the effects of fasting on human health, specifically focusing on its impact on different body's physiological systems. The cardiovascular system plays a vital role in maintaining overall health, and fasting has shown promising effects in improving cardiovascular health markers such as blood pressure, cholesterol levels, and triglyceride levels. Additionally, fasting has been suggested to enhance insulin sensitivity, promote weight loss, and improve metabolic health, thus offering potential benefits to individuals with diabetes and metabolic disorders. Furthermore, fasting can boost immune function, reduce inflammation, enhance autophagy, and support the body's defense against infections, cancer, and autoimmune diseases. Fasting has also demonstrated a positive effect on the brain and nervous system. It has been associated with neuroprotective properties, improving cognitive function, and reducing the risk of neurodegenerative diseases, besides the ability of increasing the lifespan. Hence, understanding the potential advantages of fasting can provide valuable insights for individuals and healthcare professionals alike in promoting health and wellbeing. The data presented here may have significant implications for the development of therapeutic approaches and interventions using fasting as a potential preventive and therapeutic strategy.

Association of Combined Metals and PFAS with Cardiovascular Disease Risk

This study sought to investigate the impact of exposure to metals and per- and polyfluoroalkyl substances (PFASs) on cardiovascular disease (CVD)-related risk. PFASs, including PFOA, PFOS, PFNA, and PFHxS, as well as metals such as lead (Pb), cadmium (Cd), and mercury (Hg), were analyzed to elucidate their combined effects on CVD risk.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2014, this investigation explored the effects of PFASs and metals on CVD risk. A spectrum of individual CVD markers, encompassing systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and triglycerides, was examined. Additionally, comprehensive CVD risk indices were evaluated, namely the Overall Cardiovascular Biomarkers Index (OCBI), including the Framingham Risk Score and an Overall Cardiovascular Index. Linear regression analysis was employed to probe the relationships between these variables. Furthermore, to assess dose-response relationships between exposure mixtures and CVD while mitigating the influence of multicollinearity and potential interaction effects, Bayesian Kernel Machine Regression (BKMR) was employed.

RESULTS

Our findings indicated that exposure to PFAS and metals in combination increased CVD risk, with combinations occurring with lead bringing forth the largest impact among many CVD-related markers.

CONCLUSIONS

This study finds that combined exposure to metals and PFASs significantly elevates the likelihood of CVD risk. These results highlight the importance of understanding the complex interplay between multipollutant exposures and their potential implications for cardiovascular health.

Urgent needs of caregiving in ageing populations with Alzheimer's disease and other chronic conditions: Support our loved ones

The ageing process begins at birth. It is a life-long process, and its exact origins are still unknown. Several hypotheses attempt to describe the normal ageing process, including hormonal imbalance, formation of reactive oxygen species, DNA methylation & DNA damage accumulation, loss of proteostasis, epigenetic alterations, mitochondrial dysfunction, senescence, inflammation, and stem cell depletion. With increased lifespan in elderly individuals, the prevalence of age-related diseases including, cancer, diabetes, obesity, hypertension, Alzheimer's, Alzheimer's disease and related dementias, Parkinson's, and other mental illnesses are increased. These increased age-related illnesses, put tremendous pressure & burden on caregivers, family members, and friends who are living with patients with age-related diseases. As medical needs evolve, the caregiver is expected to experience an increase in duties and challenges, which may result in stress on themselves, and impact their own family life. In the current article, we assess the biological mechanisms of ageing and its effect on body systems, exploring lifestyle and ageing, with a specific focus on age-related disorders. We also discussed the history of caregiving and specific challenges faced by caregivers in the presence of multiple comorbidities. We also assessed innovative approaches to funding caregiving, and efforts to improve the medical system to better organize chronic care efforts, while improving the skill and efficiency of both informal and formal caregivers. We also discussed the role of caregiving in end-of-life care. Our critical analysis strongly suggests that there is an urgent need for caregiving in aged populations and support from local, state, and federal agencies.

Hypertensive disorders of pregnancy and long-term risk of maternal stroke-a systematic review and meta-analysis

OBJECTIVE

Hypertensive disorders of pregnancy are associated with a long-term risk for cardiovascular disease among parous patients later in life. However, relatively little is known about whether hypertensive disorders of pregnancy are associated with an increased risk for ischemic stroke or hemorrhagic stroke in later life. This systematic review aimed to synthesize the available literature on the association between hypertensive disorders of pregnancy and the long-term risk for maternal stroke.

DATA SOURCES

PubMed, Web of Science, and CINAHL were searched from inception to December 19, 2022.

STUDY ELIGIBILITY CRITERIA

Studies were only included if the following criteria were met: case-control or cohort studies that were conducted with human participants, were available in English, and that measured the exposure of a history of hypertensive disorders of pregnancy (preeclampsia, gestational hypertension, chronic hypertension, or superimposed preeclampsia) and the outcome of maternal ischemic stroke or hemorrhagic stroke.

METHODS

Three reviewers extracted the data and appraised the study quality following the Meta-analyses of Observational Studies in Epidemiology guidelines and using the Newcastle-Ottawa scale for risk of bias assessment.

RESULTS

The primary outcome was any stroke (undifferentiated) and secondary outcomes included ischemic stroke and hemorrhagic stroke. The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews under identifier CRD42021254660. Of 24 studies included (10,632,808 study participants), 8 studies examined more than 1 outcome of interest. Hypertensive disorders of pregnancy were significantly associated with any stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.45-2.10). Preeclampsia was significantly associated with any stroke (adjusted risk ratio, 1.75; 95% confidence interval, 1.56-1.97), ischemic stroke (adjusted risk ratio, 1.74; 95% confidence interval, 1.46-2.06), and hemorrhagic stroke (adjusted risk ratio, 2.77; 95% confidence interval, 2.04-3.75). Gestational hypertension was significantly associated with any stroke (adjusted risk ratio, 1.23; 95% confidence interval, 1.20-1.26), ischemic stroke (adjusted risk ratio, 1.35; 95% confidence interval, 1.19-1.53), and hemorrhagic stroke (adjusted risk ratio, 2.66; 95% confidence interval, 1.02-6.98). Chronic hypertension was associated with ischemic stroke (adjusted risk ratio, 1.49; 95% confidence interval, 1.01-2.19).

CONCLUSION

In this meta-analysis, exposure to hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, seems to be associated with an increased risk for any stroke and ischemic stroke among parous patients in later life. Preventive interventions may be warranted for patients who experience hypertensive disorders of pregnancy to reduce their long-term risk for stroke.

The application of intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to examine birthweight inequities in New York City

Exploring the intersection of dimensions of social identity is critical for understanding drivers of health inequities. We used multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to examine the intersection of age, race/ethnicity, education, and nativity status on infant birthweight among singleton births in New York City from 2012 to 2018 (N = 725,875). We found evidence of intersectional effects of various systems of oppression on birthweight inequities and identified U.S.-born Black women as having infants of lower-than-expected birthweights. The MAIHDA approach should be used to identify intersectional causes of health inequities and individuals affected most to develop policies and interventions redressing inequities.

Association of hemoglobin variability with the risk of cardiovascular disease: a nationally representative retrospective cohort study from South Korea

Hemoglobin variability is known to increase cardiovascular mortality in chronic kidney disease, but the association of hemoglobin variability with the risk of cardiovascular disease (CVD) in the general population is yet unclear. This retrospective cohort study based on 'the South Korean National Health Insurance Service database' consisted of 198,347 adults who went through all three health examinations. Hemoglobin variability is defined as the average successive variability of three separate hemoglobin values from each health screening period. Participants were followed up for 6 years to determine the risk of coronary heart disease and stroke. We used multivariate Cox proportional hazards regression to examine the adjusted hazard ratios for CVD according to hemoglobin variability. Per 1 unit increase of hemoglobin variability, the risk for CVD (aHR 1.06, 95% CI 1.02-1.09) and stroke (aHR 1.08, 95% CI 1.03-1.13) increased significantly. The risk-increasing trend was preserved in the low-to-moderate risk group of CVDs (aHR 1.07, 95% CI 1.02-1.11). This result suggests that subjects with high hemoglobin variability who would otherwise be categorized as having low-to-moderate CVD risk may have higher risk of CVD than those with low hemoglobin variability.

Effects of Cardiovascular Disease Risk Factors, Musculoskeletal Health, and Physical Fitness on Occupational Performance in Firefighters-A Systematic Review and Meta-Analysis

Background: Firefighting is a strenuous occupation, which necessitates that firefighters stay in good physical condition and maintain adequate cardiovascular and musculoskeletal fitness to perform their duties with minimal health and safety risks. The aim of this review is to determine the effects of cardiovascular disease risk factors, musculoskeletal health, and physical fitness on the occupational performance of firefighters. Methods: PubMed/Medline, SCOPUS, Web of Science, EBSCOHost, and ScienceDirect were searched without time-restriction. The appraisal tool for cross-sectional studies and the Critical Appraisal Skills Programme toolkit were used to conduct the methodological assessment. Data were analyzed using Review Manager 5.3, and MedCalc^® statistical software. Results: Age had a moderate effect on occupational performance (Z = 5.15, p < 0.001), whereas gender had a large effect size on occupational performance (Z = 4.24, p < 0.001). A significant moderate negative correlation was found between cardiorespiratory fitness and occupational performance (R = -0.584, p < 0.001). Significant low negative correlations were found between upper body endurance (R = -0.344, p < 0.001), abdominal endurance (R = -0.308, p < 0.001), grip strength (R = -0.421, p < 0.001), upper body strength (R = -0.318, p < 0.001), and lower body strength (R = -0.216, p = 0.020) and occupational performance. Conclusions: Aged firefighters with poor body composition and lower levels of physical fitness performed worse on all occupational performance tasks.

The effect of aerobic exercise on pulse wave velocity in middle-aged and elderly people: A systematic review and meta-analysis of randomized controlled trials

A growing body of research examines the effect of aerobic exercise on pulse wave velocity (PWV) in middle-aged and elderly people, while findings of available studies were conflicting. The aim of this study was to explore the effect of aerobic exercise on PWV in middle-aged and elderly people. Searches were performed in PubMed, Web of Science, and EBSCO databases. Cochrane risk assessment tool was used to evaluate the methodological quality of the included literature. We included studies that satisfied the following criteria: (1) eligible studies should be randomized controlled trials (RCTs); (2) eligible studies should include both an intervention and a control group; (3) eligible studies should use the middle-aged or elderly people as subjects; and (4) eligible studies should use PWV as the outcome measure. From 972 search records initially identified, 11 studies with a total of 12 exercise groups (n = 245) and 11 control groups (n = 239) were eligible for meta-analysis. There was a significant effect of aerobic exercise on reducing PWV in middle-aged and elderly people [weighted mean difference (WMD), –0.75 (95% CI, –1.21 to –0.28), p = 0.002]. Specifically, a higher intensity [vigorous-intensity, –0.74 (–1.34 to –0.14), p = 0.02; moderate-intensity, –0.68 (–1.49 to 0.12), p = 0.10], a younger age [45 years ≤ age < 60 years, –0.57 (–0.78 to –0.37), p < 0.00001; age ≥ 60 years, –0.91 (–2.10 to 0.27), p = 0.13], a better health status [healthy, –1.19 (–2.06 to –0.31), p = 0.008; diseased, –0.32 (–0.64 to –0.01), p = 0.04], and a lower basal body mass index (BMI) [BMI < 25, –1.19 (–2.06 to –0.31), p = 0.008; 25 ≤ BMI < 30, –0.52 (–0.92 to –0.12), p = 0.01; BMI ≥ 30, –0.09 (–0.93 to 0.76), p = 0.84] were associatedwith larger reductions in PWV. Aerobic exercise, especially vigorous-intensity aerobic exercise, contributed to reducing PWV in middle-aged and elderly people. The effect of aerobic exercise on improving PWV was associated with characteristics of the participants. Specifically, a younger age, a better health status, and a lower basal BMI contributed to more significant reductions in PWV.

Frailty in older adults with heart disease

BACKGROUND

Heart failure prevalence will double in the next 40 years and affects more than 10% of persons over the age of 70 years in an age-dependent manner. Frailty is an age-associated clinical syndrome defined as a decrease in physiological reserve in situations of stress, such as operations, infections and acute illness based on a state of higher vulnerability. The prevalence is up to 74% in older individuals over the age of 80 years or those over 70 years old with a high burden of comorbidities and chronic diseases. This geriatric syndrome is associated with a worse clinical outcome and higher morbidity and mortality in acute and chronic disease than in age-matched cohorts without this syndrome.

METHODS

In this brief review, the scientific evidence of appropriate tools for diagnosis of frailty in heart failure patients is addressed. Heart failure management in this special group of patients requires a holistic care planning presented here in accordance with pathophysiologic particularities. A literature search in PubMed using the terms "heart failure" and "frailty" was carried out and a further search in the references based on the findings.

CONCLUSION

The diagnosis of frailty should influence the intensity of further diagnostic investigations and medical treatment based on the personal wishes of the patient, reduced organ reserves and general prognosis. The prognosis of heart failure patients remains poor, partially due to the intertwining with frailty. A clear statement for the use of an appropriate diagnostic tool for frailty and heart failure and specific therapeutic recommendations are presented based on clinical evidence.

Evaluating health outcome metrics and their connections to air pollution and vulnerability in Southern California's Coachella Valley

The ongoing desiccation of California's Salton Sea has led to increasing concerns about air quality and health for its surrounding communities, including the nearby Coachella Valley - a region already experiencing severe air quality and health disparities. Here we explore spatial air pollution and human health disparities in the Coachella Valley with particular attention to disparities arising across population characteristics including both socioeconomic and demographic vulnerabilities. We use two different measures of respiratory and cardiovascular health outcomes at the individual and census tract levels - one measure based on a randomly sampled telephone survey and the other measure based on emergency room visitation data - to investigate the degree to which these health outcomes are connected to air pollution and socioeconomic metrics. We further investigate biases and differences between the health outcome metrics themselves and suggest opportunities to address them in future analyses and survey efforts. We find that more vulnerable communities are associated with higher levels of fine particulates, but lower levels of ozone. While emergency visit rates show a significant positive correlation with both pollutants, no such association is found when using surveyed health outcome data. The ratio of emergency visits versus survey rates shows a positive relationship with socioeconomic and demographic vulnerability, indicating that vulnerable communities are less likely to self-report diagnoses despite higher rates of respiratory or cardiovascular hospitalization. Additionally, survey respondents tend to show less vulnerability relative to their surrounding census-based demographics. These findings suggest the need for greater attention to health issues specifically within disadvantaged communities in the Coachella Valley, building upon and working within existing community networks and local resources, to better address current and projected health needs. Our findings also highlight disparities in air pollution exposure, health outcomes, and population characteristics in the Coachella Valley, providing context for crucial pollution reduction efforts in the face of increasing environmental threats.

Longitudinal effect of myocardial fat deposition on left ventricular diastolic function: a retrospective cohort study

There is a known correlation between myocardial steatosis and heart function, but it is unclear how left ventricular diastolic function worsens over time in the myocardial steatosis setting. We sought to investigate whether intramyocardial fat deposition affects diastolic function over time. This was a retrospective analysis of patients who had undergone 1-3 echocardiography assessments between April 2011 and April 2017. Patients were divided into two groups: those with the presence of myocardial fat deposition in the left ventricular myocardium (assessed by having tissue within any 10-mm2 region with computed tomography values between - 190 and - 30 Hounsfield units; + MF), and those with absence of deposition not meeting the threshold (- MF). The rates of change of the standard early diastolic mitral annulus velocity (e') and the transmitral early peak velocity (E)/e' ratio at the second and third echocardiograph assessments were calculated relative to baseline. In total, 125 patients were eligible (+ MF, n = 39; - MF, n = 86) for inclusion. Compared with the - MF group, e' was significantly lower and E/e' was significantly higher in the + MF group at each scan timepoint, even when adjusted for body mass index and sex. A significant average decrease in e' and increase in E/e' was also observed in the + MF group across all scans compared with the - MF group. Myocardial steatosis was associated with an acceleration of decreased left ventricular diastolic function over time.

Prevalence of cardiovascular risk factors by HIV status in a population-based cohort in South Central Uganda: a cross-sectional survey

INTRODUCTION

Cardiovascular disease is one of the leading causes of mortality for people living with HIV, but limited population-based data are available from sub-Saharan Africa. This study aimed to determine the prevalence of key cardiovascular disease risk factors, 10-year risk of cardiovascular disease and type 2 diabetes mellitus through risk scores by HIV status, as well as investigate factors associated with hyperglycaemia, hypertension and dyslipidaemia in South-Central Uganda.

METHODS

A cross-sectional study was conducted in 37 communities of the population-based Rakai Community Cohort Study from May 2016 to May 2018. In total, 990 people living with HIV and 978 HIV-negative participants aged 35-49 years were included. Prevalence estimates and 10-year cardiovascular and type 2 diabetes risk were calculated by sex and HIV serostatus. Multivariable logistic regression was used to determine associations between socio-demographic, lifestyle and body composition risk factors and hyperglycaemia, hypertension and dyslipidaemia.

RESULTS

Overweight (21%), obesity (9%), abdominal obesity (15%), hypertension (17%) and low high-density lipoprotein (HDL) (63%) were the most common cardiovascular risk factors found in our population. These risk factors were found to be less common in people living with HIV apart from hypertension. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low in this population with <1% categorized as high risk. In HIV-adjusted multivariable analysis, obesity was associated with a higher odds of hypertension (odds ratio [OR] = 2.31, 95% confidence interval [CI] 1.35-3.96) and high triglycerides (OR = 2.08, CI 1.25-3.47), and abdominal obesity was associated with a higher odds of high triglycerides (OR = 2.55, CI 1.55-4.18) and low HDL (OR = 1.36, CI 1.09-1.71). A positive HIV status was associated with a lower odds of low HDL (OR = 0.43, CI 0.35-0.52).

CONCLUSIONS

In this population-based study in Uganda, cardiovascular risk factors of obesity, abdominal obesity, hypertension and dyslipidaemia were found to be common, while hyperglycaemia was less common. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low. The majority of cardiovascular risk factors were not affected by HIV status. The high prevalence of dyslipidaemia in our study requires further research.

Age-related differences in the vascular function and structure of South Africans living with HIV

Background

As the life expectancy of people living with the HIV increases because of antiretroviral treatment (ART), their risk for vascular co-morbidities and early vascular ageing (EVA) also increases.

Objective

We aimed to investigate whether HIV infection relates to vascular structure and function in black South African adults and whether this relationship is age dependent.

Method

This cross-sectional study carried out in urban and rural areas of North West province, South Africa, included 572 age- and sex-matched people living with HIV (PLWH) and without HIV. Participants from the EndoAfrica study and PURE study were stratified according to tertiles of age. Measures of vascular structure (carotid intima-media thickness) and function (carotid-femoral pulse wave velocity, central systolic blood pressure, central pulse pressure and pulse pressure amplification) were determined.

Results

Blood pressure measures were lower in PLWH compared with their controls (all P ≤ 0.001), especially in the younger and middle-aged groups (all P ≤ 0.031), whilst vascular measures did not differ (all P ≥ 0.611). In multivariate linear regression analyses, vascular measures were not associated with a HIV- positive status in either the total or any of the age groups.

Conclusion

Black South Africans living with HIV have a less adverse blood pressure profile than their counterparts without HIV. The HIV-positive status was not associated with measures of vascular structure or function in any age group. The results suggest that HIV does not contribute to EVA in this population; however, further longitudinal investigation is warranted.

Predicted cardiovascular risk for United States adults with diabetes, chronic kidney disease, and at least 65 years of age

BACKGROUND

The 2017 American College of Cardiology/American Heart Association blood pressure (BP) guideline recommends using 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk to guide decisions to initiate antihypertensive medication.

METHODS

We included adults aged 40-79 years from the National Health and Nutrition Examination Survey 2013-2018 (n = 8803). We computed 10-year predicted ASCVD risk using the Pooled Cohort risk equations. Clinical CVD was self-reported. Analyses were conducted overall and among those with stage 1 hypertension, defined by a mean SBP of 130-139 mmHg or DBP of 80-89 mmHg. In subgroups defined by diabetes, chronic kidney disease (CKD), and age at least 65 years, we estimated the proportion of United States adults with high ASCVD risk (i.e. 10-year predicted ASCVD risk ≥10% or clinical CVD) and estimated age-adjusted probability of having high ASCVD risk.

RESULTS

Among United States adults, an estimated 72.3, 64.5, and 83.9 of those with diabetes, CKD, and age at least 65 years had high ASCVD risk, respectively. Among United States adults with stage 1 hypertension, an estimated 55, 36.7, and 72.6% of those with diabetes, CKD, and age at least 65 years had high ASCVD risk, respectively. The probability of having high ASCVD risk increased with age and exceeded 50% for United States adults with diabetes and CKD at ages 52 and 57 years, respectively. For those with stage 1 hypertension, these ages were 55 and 64 years, respectively.

CONCLUSION

Most United States adults with diabetes, CKD, or age at least 65 years had high ASCVD risk. However, many with stage 1 hypertension did not.

Six Months of Inspiratory Muscle Training to Lower Blood Pressure and Improve Endothelial Function in Middle-Aged and Older Adults With Above-Normal Blood Pressure and Obstructive Sleep Apnea: Protocol for the CHART Clinical Trial

Background: Cardiovascular disease is a major global health concern and prevalence is high in adults with obstructive sleep apnea (OSA). Lowering blood pressure (BP) can greatly reduce cardiovascular disease risk and physical activity is routinely prescribed to achieve this goal. Unfortunately, many adults with OSA suffer from fatigue, daytime sleepiness, and exercise intolerance—due to poor sleep quality and nocturnal hypoxemia—and have difficulty initiating and maintaining an exercise program. High-resistance inspiratory muscle strength training (IMST) is a simple, time-efficient breathing exercise consistently reported to reduce BP in small, selective groups of both healthy and at-risk adults. Herein we present the study protocol for a randomized clinical trial to determine the long-term efficacy of IMST performed regularly for 24 weeks in middle-aged and older adults with OSA. The primary outcome is casual systolic BP. Secondary outcomes are 24-h systolic BP and circulating plasma norepinephrine concentration. Other outcomes include vascular endothelial function (endothelial-dependent and -independent dilation), aortic stiffness, casual and 24-h diastolic BP, and the influence of circulating factors on endothelial cell nitric oxide and reactive oxygen species production. Overall, this trial will establish efficacy of high-resistance IMST for lowering BP and improving cardiovascular health in middle-aged and older adults with OSA.

Methods: This is a single-site, double-blind, randomized clinical trial. A minimum of 92 and maximum of 122 male and female adults aged 50–80 years with OSA and above-normal BP will be enrolled. After completion of baseline assessments, subjects will be randomized in a 1:1 ratio to participate in either high-resistance or sham (low-resistance) control IMST, performed at home, 5 min/day, 5 days/week, for 24 weeks. Repeat assessments will be taken after the 24-week intervention, and after 4 and 12 weeks of free living.

Discussion: This study is designed to assess the effects of 24 weeks of IMST on BP and vascular function. The results will characterize the extent to which IMST can reduce BP when performed over longer periods (i.e., 6 months) than have been assessed previously. Additionally, this study will help to determine underlying mechanisms driving IMST-induced BP reductions that have been reported previously.

Clinical Trial Registration: This trial is registered with ClinicalTrials.gov (Registration Number: NCT04932447; Date of registration June 21, 2021).

ECG Abnormalities and Arterial Stiffness by HIV Status among High-Risk Populations in Rakai, Uganda: A Pilot Study

Background

People living with HIV are at increased risk for cardiovascular disease (CVD). In sub-Saharan Africa, population-based data on major CVD events such as stroke and myocardial infarction are difficult to collect. The use of proxy measures could be a feasible way to better study CVD in such settings. This study aimed to determine the acceptance of incorporating ECG and arterial function measurements into a population-based cohort study and to assess the prevalence of ECG abnormalities and arterial stiffness.

Methods

A pilot study was conducted within the Rakai Community Cohort Study in Uganda on two high-risk CVD populations; one determined by age (35-49) and Framingham CVD risk scores and the other by age alone (50+). Data on ECG, arterial function, blood pressure, and HIV status were collected. The acceptability of incorporating ECG and arterial function measurements was established as an acceptance rate difference of no more than 5% to blood pressure measurements.

Results

A total of 118 participants were enrolled, 57 participants living with HIV and 61 HIV-negative participants. Both ECG measurements and arterial function were well accepted (2% difference). Left ventricular hypertrophy (LVH) and arterial stiffness (>10 m/s) were common in both participants living with HIV and HIV-negative participants across the two high-risk populations. Prevalence rates ranged from 30% to 53% for LVH and 25% to 58% for arterial stiffness. Arterial stiffness at the 11 m/s cutoff (p = 0.03) was found to be more common among participants living with HIV in the 35-49 population.

Conclusions

The incorporation of ECG and arterial function measurements into routine activities of a population-based cohort was acceptable and incorporating these proxy measures into cohort studies should be explored further. LVH and arterial stiffness were both common irrespective of HIV status with arterial stiffness potentially more common among people living with HIV.

Label-free imaging of age-related cardiac structural changes in non-human primates using multiphoton nonlinear microscopy

Heart failure is one of the most common causes of morbidity and mortality. Both maturational abnormalities and age-associated cardiac pathologies contribute to heart failure. Imaging-based assessment to discern detailed cardiac structure at various maturational stages is imperative for understanding mechanisms behind cardiac growth and aging. Using multiphoton nonlinear optical microscopy (NLOM) based label-free imaging, we investigated cardiac structural composition in a human-relevant aging model, the common marmoset monkey (Callithrix jacchus). Animals were divided into three different age groups including neonatal, young adult and old. By devising a unique strategy for segregating collagen and myosin emitted second harmonic generation (SHG) signals, we performed a volumetric assessment of collagen and total scattering tissue (collagen + myosin). Aged marmoset hearts exhibited an increase in collagen and total scattering tissue volume at the sites of severe tissue remodelling indicating age-related cardiac fibrosis. Significantly low scattering tissue volume in neonatal marmoset hearts was attributed to a lack of binding between the myofibrils in maturing cardiac tissue. Comprehensive quantitative assessment of structural composition during maturation and aging of marmoset hearts revealed significant differences in myofibril length, alignment, curvature and angular distribution. In conclusion, label-free high-resolution NLOM facilitates visualization and quantification of subcellular structural features for understanding vital age-related morphological alterations in the marmoset heart.

Role of Autophagy in Cardiovascular Disease and Aging

Cardiovascular disease is the leading cause of death worldwide and is expected to further increase as people continue to live even longer. Although the life span of the general population is increasing, the con of such a prolonged life span is that aging has certain detrimental effects on the molecular, structural, and functional elements of the cardiovascular system. This review will discuss various molecular pathways linked to longevity, most notably autophagy and its associated mechanisms, and how these pathways can be targeted to promote cardiovascular health through the process of aging. It is to be noted that the process of autophagy decreases with aging; hence, this review concludes that the promotion of autophagy, through implementation of caloric restriction, intermittent fasting, and pharmacologic agents, has proven to be an efficacious means of stimulating cardiovascular health. Therefore, autophagy is an important target for prevention and procrastination of cardiovascular pathologies in the geriatric population.

Generalized Anxiety Disorder and Depressive Symptoms among Pakistani Population during the Second Wave of the COVID-19 Pandemic: A Regression Analysis

Over a span of 1 year, with millions infected, COVID-19 has spread to every part of the world and now poses a health threat to each and every one of us. The outbreak has consequently resulted in multiple health problems such as stress, anxiety, depressive symptoms, insomnia, panic, and denial globally. Several factors have contributed to this rising number of psychiatric consults all over the world. The primary objective of this study was to investigate the impact of COVID-19 pandemic on the mental health of Pakistani population during the second wave of the pandemic in this region. We conducted an online web-based cross-sectional survey comprising 500 participants. The questionnaire assessed the demographic information, attitude, and knowledge concerning COVID-19 outbreak in addition to generalized anxiety disorder (GAD) utilizing the GAD-7 scale and depressive symptoms using the Center for Epidemiology Scale for Depression (CES-D) scale. The response rate of the study was 90.9%. The results of the survey indicated a prevalence of 25.4% of GAD, and 18.8% of depressive symptoms. Furthermore, nearly 34.8% of participants feared contracting COVID-19, 62.8% obtained constant critical updates regarding COVID-19, while 17.6% did not understand the knowledge regarding COVID-19. In the multivariate regression models, GAD was significantly associated with gender, age, and checking constantly of critical updates regarding COVID-19. Similarly, participants under 30 years had a higher risk of developing depressive symptoms than those above (> 30 years). Lastly, participants with no formal education were also found to be more prone to developing depression. We identified a potential threat to mental health during the pandemic.

A Cross-Sectional Examination of 10-Year Atherosclerotic Cardiovascular Disease Risk Among US Firefighters by Age and Weight Status

Examine atherosclerotic cardiovascular disease (ASCVD) risk scores by age and weight status in career firefighters.

The Impact of Melatonin Supplementation and NLRP3 Inflammasome Deletion on Age-Accompanied Cardiac Damage

To investigate the role of NLRP3 inflammasome in cardiac aging, we evaluate here morphological and ultrastructural age-related changes of cardiac muscles fibers in wild-type and NLRP3-knockout mice, as well as studying the beneficial effect of melatonin therapy. The results clarified the beginning of the cardiac sarcopenia at the age of 12 months, with hypertrophy of cardiac myocytes, increased expression of β-MHC, appearance of small necrotic fibers, decline of cadiomyocyte number, destruction of mitochondrial cristae, appearance of small-sized residual bodies, and increased apoptotic nuclei ratio. These changes were progressed in the cardiac myocytes of 24 old mice, accompanied by excessive collagen deposition, higher expressions of IL-1α, IL-6, and TNFα, complete mitochondrial vacuolation and damage, myofibrils disorganization, multivesicular bodies formation, and nuclear fragmentation. Interestingly, cardiac myocytes of NLRP3^-/- mice showed less detectable age-related changes compared with WT mice. Oral melatonin therapy preserved the normal cardiomyocytes structure, restored cardiomyocytes number, and reduced β-MHC expression of cardiac hypertrophy. In addition, melatonin recovered mitochondrial architecture, reduced apoptosis and multivesicular bodies' formation, and decreased expressions of β-MHC, IL-1α, and IL-6. Fewer cardiac sarcopenic changes and highly remarkable protective effects of melatonin treatment detected in aged cardiomyocytes of NLRP3^-/- mice compared with aged WT animals, confirming implication of the NLRP3 inflammasome in cardiac aging. Thus, NLRP3 suppression and melatonin therapy may be therapeutic approaches for age-related cardiac sarcopenia.

MiR-125b inhibits cardiomyocyte apoptosis by targeting BAK1 in heart failure

Background

Although miR-125b plays a crucial role in many human cancers. However, its function in heart failure (HF) remains unclear. Our study aimed to investigate its involvement in heart failure.

Methods

In this study, the mouse HF model was successfully constructed through transverse aortic constriction (TAC) operation. Changes in mRNA and protein levels in isolated myocytes and heart tissues were examined using qRT-PCR, Western blot and Immunohistochemical staining and immunofluorescent staining. Changes in cardiac functions were examined using ultrasound. Interactions between miR-125b and BAK1 was analyzed using the luciferase reporter assay. Cardiomyocyte apoptosis was evaluated using the TUNEL staining.

Results

We found that miR-125b expression was significantly downregulated in myocardial tissues of HF mice. Moreover, miR-125b upregulation in HF mice injected with agomir-125b efficiently ameliorated cardiac function. Further, miR-125b upregulation significantly decreased the protein levels of apoptosis-related makers c-caspase 3 and Bax, while increased Bcl-2 expression. In addition, BAK1 was identified as a direct target of miR-125b. As expected, BAK1 overexpression observably reversed the effect of agomir-125b on cardiac function and on the expression of apoptosis-related makers in the heart tissues of HF mice.

Conclusions

Taken together, miR-125b overexpression efficiently attenuated cardiac function injury of HF mice by targeting BAK1 through inhibiting cardiomyocyte apoptosis, suggesting that miR-125b/BAK1 axis might be a potential target for the diagnosis or treatment of HF.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10020-021-00328-w.

Exercise, programmed cell death and exhaustion of cardiomyocyte proliferation in aging zebrafish

Exercise may ameliorate the eventual heart failure inherent in human aging. In this study, we use zebrafish to understand how aging and exercise affect cardiomyocyte turnover and myocardial remodelling. We show that cardiomyocyte proliferation remains constant throughout life but that onset of fibrosis is associated with a late increase in apoptosis. These findings correlate with decreases in voluntary swimming activity, critical swimming speed (Ucrit), and increases in biomarkers of cardiac insufficiency. The ability to respond to severe physiological stress is also impaired with age. Although young adult fish respond with robust cardiomyocyte proliferation in response to enforced swimming, this is dramatically impaired in older fish and served by a smaller proliferation-competent cardiomyocyte population. Finally, we show that these aging responses can be improved through increased activity throughout adulthood. However, despite improvement in Ucrit and the proliferative response to stress, the size of the proliferating cardiomyocyte population remained unchanged. The zebrafish heart models human aging and reveals the important trade-off between preserving cardiovascular fitness through exercise at the expense of accelerated fibrotic change.

High retinoic acid receptor-related orphan receptor A gene expression in peripheral blood leukocytes may be related to acute myocardial infarction

OBJECTIVE

This study aimed to investigate whether differential expression of the retinoic acid receptor-related orphan receptor A (RORA) gene is related to occurrence of acute myocardial infarction (AMI).

METHODS

This was a retrospective study. White blood cells of 93 patients with acute myocardial infarction and 74 patients with stable coronary artery disease were collected. Reverse transcription quantitative polymerase chain reaction and western blotting were used to measure RORA mRNA and protein expression, respectively.

RESULTS

RORA mRNA expression levels in peripheral blood leukocytes in patients with AMI were 1.57 times higher than those in patients with stable coronary artery disease. Protein RORA levels in peripheral blood of patients with AMI were increased. Binary logistic regression analysis showed that high expression of RORA was an independent risk factor for AMI, and it increased the risk of AMI by 2.990 times.

CONCLUSION

RORA expression levels in patients with AMI is significantly higher than that in patients with stable coronary artery disease. High expression of RORA is related to AMI and it may be an independent risk factor for AMI.

Exacerbation of cardiovascular ageing by diabetes mellitus and its associations with acyl-carnitines

Objective: To demonstrate differences in cardiovascular structure and function between diabetic and non-diabetic older adults. To investigate associations between acyl-carnitines and cardiovascular function as indexed by imaging measurements.

Methods: A community-based cohort of older adults without cardiovascular disease underwent current cardiovascular imaging and metabolomics acyl-carnitines profiling based on current and archived sera obtained fifteen years prior to examination.

Results: A total of 933 participants (women 56%, n=521) with a mean age 63±13 years were studied. Old diabetics compared to old non-diabetics had lower myocardial relaxation (0.8±0.2 vs 0.9±0.3, p=0.0039); lower left atrial conduit strain (12±4.3 vs 14±4.1, p=0.045), lower left atrial conduit strain rate (-1.2±0.4 vs -1.3±0.5, p=0.042) and lower ratio of left atrial conduit strain to left atrial booster strain (0.5±0.2 vs 0.7±0.3, p=0.0029). Higher levels of archived short chain acyl-carnitine were associated with present-day impairments in myocardial relaxation (C5:1; OR 1.03, p=0.011), worse left atrial conduit strain function (C5:1; OR 1.03, p=0.037). Increases in hydroxylated acyl-carnitines were associated with worse left atrial conduit strain [(C4-OH; OR 1.05, p=0.0017), (C16:2-OH; OR 1.18, p=0.037)]. Current, archived and changes in long chain acyl-carnitines were associated with cardiovascular functions [(C16; OR 1.02, p=0.002), (C20:3; OR 1.01, p=0.014), (C14:3; OR 1.12, p=0.033), (C18:1; OR 1.01, p=0.018), (C18:2; OR 1.01, p=0.028), (C20:4; OR 1.10, p=0.038)] (all p<0.05).

Conclusion: Older diabetic adults had significant impairments in left ventricular myocardial relaxation and left atrial strain, compared to older non-diabetic adults. Short chain and long chain, di-carboxyl and hydroxylated acyl-carnitines were associated with these cardiovascular functional differences.

Fractional-order model representations of apparent vascular compliance as an alternative in the analysis of arterial stiffness: anin-silicostudy

Objective. Recent studies have demonstrated the advantages of fractional-order calculus tools for probing the viscoelastic properties of collagenous tissue, characterizing the arterial blood flow and red cell membrane mechanics, and modeling the aortic valve cusp. In this article, we present novel lumped-parameter equivalent circuit models for apparent arterial compliance using a fractional-order capacitor (FOC). FOCs, which generalize capacitors and resistors, display a fractional-order behavior that can capture both elastic and viscous properties through a power-law formulation.Approach. The proposed framework describes the dynamic relationship between the blood-pressure input and the blood volume, using linear fractional-order differential equations.Main results. The results show that the proposed models present a reasonable fit with thein-silicodata of more than 4000 subjects. Additionally, strong correlations have been identified between the fractional-order parameter estimates and the central hemodynamic determinants as well as the pulse-wave velocity indexes.Significance. Therefore, the fractional-order-based paradigm for arterial compliance shows notable potential as an alternative tool in the analysis of arterial stiffness.

Relationship Between Various Coronary Artery Disease Risk Factors in Firefighters

OBJECTIVE

To determine the correlation between the various coronary artery disease risk factors in firefighters.

METHODS

The study used a quantitative, cross-sectional, and correlational study design. A total of 124 full-time firefighters were conveniently recruited to participate. Research procedures were based on the ACSM guidelines.

RESULTS

Significances were found between age and body mass index (BMI) (r = 0.42, P < 0.001), age and waist circumference (WC) (r = 0.52, P < 0.001), BMI and WC (r = 0.88, P < 0.001), BMI and diastolic blood pressure (DBP) (r = 0.48, P < 0.001), between WC and DBP (r = 0.48, P < 0.001) and between gender and cigarette smoking (χ2[1] = 5.66, P = 0.017).

CONCLUSION

There were significant strong relationships between BMI, SBP, DBP, dyslipidemia, and increasing age, especially in male firefighters. Reducing key risk factors should be emphasized.

The nuclear sirtuin SIRT6 protects the heart from developing aging-associated myocyte senescence and cardiac hypertrophy

Sirtuins have been shown to regulate the aging process. We have previously demonstrated that Sirt6 blocks the pressure overload-induced cardiac hypertrophy in mice. Here, we show that Sirt6 can also mitigate aging-induced cardiomyocyte senescence and cardiac hypertrophy. We found that aging is associated with altered Sirt6 activity along with development of cardiac hypertrophy and fibrosis. Compared to young mice (4-months), the hearts of aged mice (24-months) showed increased levels of mitochondrial DNA damage, shortened telomere length, and increased accumulation of 8-oxo-dG adducts, which are hallmarks of aging. The aged hearts also showed reduced levels of NAD⁺ and altered levels of mitochondrial fusion-fission proteins. Similar characteristics were observed in the hearts of Sirt6 deficient mice. Additionally, we found that doxorubicin (Dox) induced cardiomyocyte senescence, as measured by expression of p16^INK4a, p53, and β-galactosidase, was associated with loss of Sirt6. However, Sirt6 overexpression protected cardiomyocytes from developing Dox-induced senescence. Further, compared to wild-type mice, the hearts of Sirt6.Tg mice showed reduced expression of aging markers, and the development of aging-associated cardiac hypertrophy and fibrosis. Our data suggest that Sirt6 is a critical anti-aging molecule that regulates various cellular processes associated with aging and protects the heart from developing aging-induced cardiac hypertrophy and fibrosis.

Protein acetylation in cardiac aging

Biological aging is attributed to progressive dysfunction in systems governing genetic and metabolic integrity. At the cellular level, aging is evident by accumulated DNA damage and mutation, reactive oxygen species, alternate lipid and protein modifications, alternate gene expression programs, and mitochondrial dysfunction. These effects sum to drive altered tissue morphology and organ dysfunction. Protein-acylation has emerged as a critical mediator of age-dependent changes in these processes. Despite decades of research focus from academia and industry, heart failure remains a leading cause of death in the United States while the 5 year mortality rate for heart failure remains over 40%. Over 90% of heart failure deaths occur in patients over the age of 65 and heart failure is the leading cause of hospitalization in Medicare beneficiaries. In 1931, Cole and Koch discovered age-dependent accumulation of phosphates in skeletal muscle. These and similar findings provided supporting evidence for, now well accepted, theories linking metabolism and aging. Nearly two decades later, age-associated alterations in biochemical molecules were described in the heart. From these small beginnings, the field has grown substantially in recent years. This growing research focus on cardiac aging has, in part, been driven by advances on multiple public health fronts that allow population level clinical presentation of aging related disorders. It is estimated that by 2030, 25% of the worldwide population will be over the age of 65. This review provides an overview of acetylation-dependent regulation of biological processes related to cardiac aging and introduces emerging non-acetyl, acyl-lysine modifications in cardiac function and aging.

Kidney and hypertension in older adults

Individuals over 65years are the fastest expanding population throughout the world, due to the increase in human life expectancy. This growing geriatric population, with increasingly associated chronic diseases, has relevant medical, social, and economic impact. Aging is characterized by progressive structural and functional changes in the kidney and in the cardiovascular system, leading to decline in renal function and hypertension. The purpose of this review is to describe the aging-related renal changes and blood pressure regulation during the aging process, their impact with regards to morbidity and mortality in these patients, and to summarize the most appropriate therapeutic approaches in these situations based on the particularities of this population group.

Metabolomics and cardiovascular imaging: a combined approach for cardiovascular ageing

The purpose of this review is to explore how metabolomics can help uncover new biomarkers and mechanisms for cardiovascular ageing. Cardiovascular ageing refers to cardiovascular structural and functional alterations that occur with chronological ageing and that can lead to the development of cardiovascular disease. These alterations, which were previously only detectable on tissue histology or corroborated on blood samples, are now detectable with modern imaging techniques. Despite the emergence of powerful new imaging tools, clinical investigation into cardiovascular ageing is challenging because ageing is a life course phenomenon involving known and unknown risk factors that play out in a dynamic fashion. Metabolomic profiling measures large numbers of metabolites with diverse chemical properties. Metabolomics has the potential to capture changes in biochemistry brought about by pathophysiologic processes as well as by normal ageing. When combined with non-invasive cardiovascular imaging tools, metabolomics can be used to understand pathological consequences of cardiovascular ageing. This review will summarize previous metabolomics and imaging studies in cardiovascular ageing. These methods may be a clinically relevant and novel approach to identify mechanisms of cardiovascular ageing and formulate or personalize treatment strategies.

Novel Pickering High Internal Phase Emulsion Stabilized by Food Waste-Hen Egg Chalaza

A massive amount of chalaza with nearly 400 metric tons is produced annually as waste in the liquid-egg industry. The present study aimed to look for ways to utilize chalaza as a natural emulsifier for high internal phase emulsions (HIPEs) at the optimal production conditions to expand the utilization of such abundant material. To the author’s knowledge, for the first time, we report the usage of hen egg chalaza particles as particulate emulsifiers for Pickering (HIPEs) development. The chalaza particles with partial wettability were fabricated at different pH or ionic strengths by freeze-drying. The surface electricity of the chalaza particles was neutralized when the pH was adjusted to 4, where the chalaza contained a particle size around 1500 nm and held the best capability to stabilize the emulsions. Similarly, the chalaza reaches proper electrical charging (−6 mv) and size (700 nm) after the ionic strength was modified to 0.6 M. Following the characterization of chalaza particles, we successfully generated stable Pickering HIPEs with up to 86% internal phase at proper particle concentrations (0.5–2%). The emulsion contained significant stability against coalescence and flocculation during long term storage due to the electrical hindrance raised by the chalaza particles which absorbed on the oil–water interfaces. Different rheological models were tested on the formed HIPEs, indicating the outstanding stability of such emulsions. Concomitantly, a percolating 3D-network was formed in the Pickering HIPES stabilized by chalaza which provided the emulsions with viscoelastic and self-standing features. Moreover, the current study provides an attractive strategy to convert liquid oils to viscoelastic soft solids without artificial trans fats.

Pharmacokinetic considerations in geriatric cancer patients

Pharmacological anticancer therapy in elderly people has to account for pharmacokinetic aspects in view of age-related changes in organ function and disease-related alterations. Age-related changes in organ function might still be physiological and have to be discriminated from concomitant diseases and their pharmacotherapy. Although efficacy is retained with pharmacological anticancer therapies in elderly patients, plasma drug concentrations and the incidence of adverse reactions often increase. Thus, altered organ function in elderly will be reviewed with respect to clinically relevant outcomes. Furthermore, possible consequences of therapeutic drug monitoring will be discussed focusing on novel targeted therapies with small molecules. Examples of therapeutic drug monitoring during targeted therapies may represent an easy tool to overcome the individual pharmacokinetic situation of elderly cancer patients and may contribute to enhanced safety, when implemented in clinical routine.

The Role of Oxidative Stress in Cardiovascular Aging and Cardiovascular Diseases

Aging can be seen as process characterized by accumulation of oxidative stress induced damage. Oxidative stress derives from different endogenous and exogenous processes, all of which ultimately lead to progressive loss in tissue and organ structure and functions. The oxidative stress theory of aging expresses itself in age-related diseases. Aging is in fact a primary risk factor for many diseases and in particular for cardiovascular diseases and its derived morbidity and mortality. Here we highlight the role of oxidative stress in age-related cardiovascular aging and diseases. We take into consideration the molecular mechanisms, the structural and functional alterations, and the diseases accompanied to the cardiovascular aging process.

Some Exciting Future Directions for Work on Naked Mole-Rats

The naked mole-rat is a species of growing research interest. Recent focus on this species from both a biomedical and zoological perspective has led to important discoveries regarding eusociality and ecophysiological and sensory traits associated with life below ground as well as natural protection from variable oxygen availability, acid-induced pain, and the vagaries of aging. These features serve to remind us that many foundational discoveries have arisen using extremophilic organisms and elucidating the mechanisms they employ to survive the harsh environmental conditions they encounter. Investigating these evolved features also facilitates a better understanding of several human disease states that share features with this harsh subterranean milieu. Here, we provide an overview of some unanswered questions and future directions to advance this field, alongside discussion of the tools that could facilitate accelerated progression of research using this enigmatic model.

Folic acid attenuates remodeling and dysfunction in the aging heart through the ER stress pathway

AIMS

Age-related structure changes and dysfunction of heart are likely to contribute heart failure in elderly people. Recent studies have shown that folic acid supplementation effectively delays age-related declines; nevertheless, the role and mechanism of folic acid in protection against cardiac aging remain unclear. The aim of the current study was to determine whether folic acid inhibits remodeling and dysfunction during the aging process and to elucidate its underlying mechanisms.

MAIN METHODS

Male C57BL/6 mice aged 4 months (adult) and 14 months (aged) were fed a standard diet or a folic acid diet for 6 months. Echocardiograms and histological evaluations were used to detect left ventricle (LV) function, LV remodeling, cardiac fibrosis, apoptosis and oxidative stress. Senescence-associated β-galactosidase activity staining was used to detect cardiac senescence rate. Western blotting was employed to detect the levels of senescence and ER stress signaling.

KEY FINDING

LV hypertrophy was reduced and LV function was preserved in aged mice that consumed folic acid. LV remodeling, fibrosis, apoptosis and oxidative stress were also reduced in mice that consumed folic acid. Senescence-associated β-galactosidase activity staining revealed that folic acid attenuated cardiac senescence by down-regulating p53/p21/p16 levels. Protein assays of myocardial tissue revealed that the ER stress pathway is the important underlying mechanism during cardiac senescence. The involvement of these pathways was confirmed by doxorubicin-induced H9C2 cardiomyocyte senescence.

SIGNIFICANCE

These findings suggest that folic acid prevents age-related cardiac remodeling and dysfunction and attenuates cellular senescence. ER stress responses may be the mechanisms involved in the protective effect of folic acid against cardiac aging.

Factors That Predispose Women to Greater Depressive Symptoms: A Sex-, Age-, and Diagnosis-Matched Cardiac Rehabilitation Cohort

BACKGROUND

Depressive symptoms (DS) disproportionately affect women with cardiac disease; however, no analyses have been conducted that would allow for focused sex-specific interventions.

METHODS

Consecutively enrolled women (n = 663) were matched with men postcardiac revascularization at cardiac rehabilitation (CR) entry by primary diagnosis, age, and year of CR entry from database records (2006 to 2017). Multivariate analyses were conducted to determine predictors of DS (≥16 on the Center for Epidemiologic Studies Depression Scale) in all patients and men and women separately.

RESULTS

In bivariate analysis, women were more likely than men to have DS (30.2% vs 19.3%; P < 0.001) in the matched cohort. A greater proportion of women than men had DS in all 10-year age categories (P < 0.05) except youngest (<50 years; 37% vs 30.4%; P = 0.7) and oldest (≥80; 12.3% vs 10.3%; P = 0.8). DS peaked in women aged 50 to 59 (42.5%) and men <50 years (30.4%). In all patients, independent predictors of DS were younger age, lower cardiorespiratory fitness (VO_2peak), being unemployed, greater comorbidities, smoking, anxiolytics, antidepressants, not being married, but not sex. Shared predictors in women-only and men-only analyses were younger age, lower VO_2peak, antidepressants, and being unemployed. Unique predictors for women were obesity, smoking, and delayed CR entry and, for men, hypertension, myocardial infarction, anxiolytics, and not being married.

CONCLUSIONS

Despite matching for age and diagnosis, women were more likely to have DS than men. However, sex was not a predictor of DS in multivariate analyses. This suggests that the profile of women predisposes them to greater DS. Obesity, smoking, and greater delayed CR entry were unique correlates for women and targets for intervention.

Patterns of patients with multiple chronic conditions in primary care: A cross-sectional study

Objective

Our aim was to identify the patterns of multimorbidity among a group of patients who visited primary care in Singapore.

Methods

A cross-sectional study of electronic medical records was conducted on 437,849 individuals aged 0–99 years who visited National Healthcare Group Polyclinics from 1 Jul 2015 to 30 Jun 2016 for the management of chronic conditions. Patients’ health conditions were coded with the 10^th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and patient records were extracted for analysis. Patients’ diagnosis codes were grouped by exploratory factor analysis (EFA), and patterns of multimorbidity were then identified by latent class analysis (LCA).

Results

EFA identified 19 groups of chronic conditions. Patients with at least three chronic conditions were further separated into eight classes based on demographics and probabilities of various diagnoses. We found that older patients had higher probabilities of comorbid hypertension, kidney disease and ischaemic heart disease (IHD), while younger patients had a higher probability of comorbid obesity. Female patients had higher probabilities of comorbid arthritis and anaemia, while male patients had higher probabilities of comorbid kidney diseases and IHD. Indian patients presented with a higher probability of comorbid diabetes than Chinese and Malay patients.

Conclusions

This study demonstrated that patients with multimorbidity in primary care could be classified into eight patterns. This knowledge could be useful for more precise management of these patients in the multiethnic Asian population of Singapore. Programmes for early intervention for at-risk groups can be developed based on the findings.

T1 and T2∗ relaxation time in the parcellated myocardium of healthy Taiwanese participants: A single center study

Background

Quantitative maps from cardiac MRI provide objective information for myocardial tissue. The study aimed to report the T1 and T2∗ relaxation time and its relationship with clinical parameters in healthy Taiwanese participants.

Methods

Ninety-three participants were enrolled between 2014 and 2016 (Males/Females: 43/50; age: 49.7 ± 11.3/49.9 ± 10.3). T1 and T2∗ weighted images were obtained by MOLLI recovery and 3D fully flow compensated gradient echo sequences with a 3T MR scanner, respectively. The T1 map of the myocardium was parcellated into 16 partitions from the American Heart Association. The septal part of basal, mid-cavity, and apical view was selected for the T2∗ map. The difference of quantitative map by sex and age groups were evaluated by Student's TTEST and ANOVA, respectively. The relationship between T1, T2∗ map, and clinical parameters, such as ejection fraction, pulse rate, and blood pressures, were evaluated with partial correlation by controlling BMI and age.

Results

Male participants decreased T1 relaxation time in partitions which located in the mid-cavity and apical before 55 years old compared with females (Male/Female: 1143.1.4 ± 72.0–1191.1 ± 37.0/1180.1 ± 54.5–1326.1 ± 113.3 msec, p < 0.01). For female participants, T1 relaxation time was correlated negatively with systolic pressure (p < 0.01) and pulse rate (p < 0.01) before 45 years old. Besides, T1 and T2∗ relaxation time were positively and negatively correlated with ejection fraction and pulse rate after 45 years old in male participants, respectively. Decreased T2∗ relaxation time could be noticed in participants after 45 years old compared with youngers (26.0 ± 6.5/21.9 ± 8.0 msec; 25.2 ± 5.0/21.6 ± 7.2 msec, p < 0.05).

Conclusion

Reference T1 and T2∗ relaxation time from cardiac MRI in healthy Taiwanese participants were provided with sex and age-dependent manners. The relationship between clinical parameters and T1 or T2∗ relaxation time was also established and could be further investigated for its potential application in healthy/sub-healthy participants.

It's all in our skin-Skin autofluorescence-A promising outcome predictor in cardiac surgery: A single centre cohort study

BACKGROUND

The optimum risk score determining perioperative mortality and morbidity in cardiac surgery remains debated. Advanced glycation end products (AGEs) derived from glycaemic and oxidative stress accumulate to a comparable amount in skin and the cardiovascular system leading to a decline in organ function. We aimed to study the association between AGE accumulation measured as skin autofluorescence (sAF) and the outcome of cardiac surgery patients.

METHODS

Between April 2008 and November 2016, data from 758 consecutive patients undergoing coronary artery bypass grafting, aortic valve replacement or a combined procedure were analyzed. Skin autofluorescence was measured using an autofluorescence reader. Beside mortality, for the combined categorical morbidity outcome of each patient failure of the cardiac-, pulmonary-, renal- and cerebral system, as well as reoperation and wound healing disorders were counted. Patients without or with only one of the outcomes were assigned zero points whereas more than one outcome failure resulted in one point. Odds ratios (ORs) were estimated in multivariable logistic regression analysis with other preoperative parameters and the established cardiac surgery risk score systems EuroSCORE II and STS score.

RESULTS

Skin autofluorescence as non-invasive marker of tissue glycation provided the best prognostic value in identifying patients with major morbidity risks after cardiac surgery (OR = 3.13; 95%CI 2.16-4.54). With respect to mortality prediction the STS score (OR = 1.24; 95%CI 1.03-1.5) was superior compared to the EuroSCORE II (OR = 1.17: 95%CI 0.96-1.43), but not superior when compared to sAF (OR = 6.04; 95%CI 2.44-14.95).

CONCLUSION

This finding suggests that skin autofluorescence is a good biomarker candidate to assess the perioperative risk of patients in cardiac surgery. Since the EuroSCORE does not contain a morbidity component, in our view further sAF measurement is an option.