Environmental risk factors and cardiovascular diseases: a comprehensive review

Cardiovascular risk emerges earlier by birth weight and preterm birth status in the United States Add Health sample

BACKGROUND

Preterm birth and low birth weight are associated with an increased risk of chronic conditions such as hypertension, diabetes and cardiovascular disease, which significantly contribute to increased mortality. Much of the literature supporting these assertions are from countries outside of the United States. The current study aims to explore the relationship between preterm birth and birth weight status, and cardiovascular risk emergence among young adults in the United States.

METHODS

The National Longitudinal Study of Adolescent Health (Add Health) is a nationally representative sample from the United States. Survival analyses were conducted that compare the onset of high blood pressure, high cholesterol and diabetes across the sample members categorized by preterm birth and birth weight status. Body mass index was investigated for potential mediation for timing of diagnosis.

RESULTS

Across health outcomes, there was no evidence that BMI acted as a mediator between preterm low birth weight status and the timing of diagnoses. Preterm low birth weight participants were diagnosed with diabetes approximately 12 % earlier compared to normal birth weight groups. Effect sizes for full term low birth weight were small across high cholesterol and hypertension, but not significant in this sample.

CONCLUSIONS & RELEVANCE

This analysis highlights the importance of both preterm birth and birth weight in influencing adolescent and adult health. The two components are inextricably linked and contribute significantly to comorbidity. Risk mitigation through proactive lifestyle counseling and early treatment are critical to health risk mitigation for those born early or small.

Physical urban environment and cardiometabolic diseases in the five largest Bulgarian cities

This study investigated the associations between residential environmental characteristics and the prevalence of cardiometabolic diseases in the five largest Bulgarian cities. Representative cross-sectional survey data (N = 4640 adults) was collected in Sofia, Plovdiv, Varna, Burgas, and Ruse. Participants self-reported diagnosis or medication intake for hypertension, ischemic heart disease (IHD), stroke, and diabetes mellitus, as well as domestic burning of solid fuel and having a domestic garden. Residential addresses were linked to greenspace (overall vegetation level, tree cover, urban greenspace), bluespace, walkability, air pollution (NO2), and traffic noise (Lden). In the 300 m buffer, bluespace presence was inversely associated with hypertension (odds ratio [OR] = 0.67; 95% CI: 0.45, 1.00), IHD (OR = 0.45; 95% CI: 0.21, 0.99), and diabetes (OR = 0.51; 95% CI: 0.25, 1.04). Higher walkability and tree cover were inversely associated with hypertension (OR per 2 units = 0.85; 95% CI: 0.75, 0.96) and diabetes (OR per 10% = 0.77; 95% CI: 0.62, 0.97), respectively. These associations were stronger in larger buffers. Solid fuel burning was associated with IHD (OR = 1.63; 95% CI: 1.07, 2.50). There was an indication of a positive association between aircraft Lden and both stroke and IHD. The direction of the associations for domestic gardens, NO2, road traffic and railway Lden was counterintuitive. We detected some nonlinear associations. In conclusion, people living in urban neighborhoods that were more walkable, closer to bluespace, and greener had lower prevalence of cardiometabolic diseases, while solid fuel burning was associated with higher odds of cardiovascular diseases. Unexpected associations with some exposures may be due to unaccounted for urban fabric characteristics. This study is among the first assessing an understudied region in Southeastern Europe. Its findings have the potential to inform public discourse and provide evidence to support the implementation of urban design conducive to cardiometabolic health.

Higher Aircraft Noise Exposure Is Linked to Worse Heart Structure and Function by Cardiovascular MRI

BACKGROUND

Aircraft noise is a growing concern for communities living near airports.

OBJECTIVES

This study aimed to explore the impact of aircraft noise on heart structure and function.

METHODS

Nighttime aircraft noise levels (Lnight) and weighted 24-hour day-evening-night aircraft noise levels (Lden) were provided by the UK Civil Aviation Authority for 2011. Health data came from UK Biobank (UKB) participants living near 4 UK major airports (London Heathrow, London Gatwick, Manchester, and Birmingham) who had cardiovascular magnetic resonance (CMR) imaging starting from 2014 and self-reported no hearing difficulties. Generalized linear models investigated the associations between aircraft noise exposure and CMR metrics (derived using a validated convolutional neural network to ensure consistent image segmentations), after adjustment for demographic, socioeconomic, lifestyle, and environmental confounders. Mediation by cardiovascular risk factors was also explored. Downstream associations between CMR metrics and major adverse cardiac events (MACE) were tested in a separate prospective UKB subcohort (n = 21,360), to understand the potential clinical impact of any noise-associated heart remodeling.

RESULTS

Of the 3,635 UKB participants included, 3% experienced higher Lnight (≥45 dB) and 8% higher Lden (≥50 dB). Participants exposed to higher Lnight had 7% (95% CI: 4%-10%) greater left ventricular (LV) mass and 4% (95% CI: 2%-5%) thicker LV walls with a normal septal-to-lateral wall thickness ratio. This concentric LV remodeling is relevant because a 7% greater LV mass associates with a 32% greater risk of MACE. They also had worse LV myocardial dynamics (eg, an 8% [95% CI: 4%-12%] lower global circumferential strain which associates with a 27% higher risk of MACE). Overall, a hypothetical individual experiencing the typical CMR abnormalities associated with a higher Lnight exposure may have a 4 times higher risk of MACE. Findings were clearest for Lnight but were broadly similar in analyses using Lden. Body mass index and hypertension appeared to mediate 10% to 50% of the observed associations. Participants who did not move home during follow-up and were continuously exposed to higher aircraft noise levels had the worst CMR phenotype.

CONCLUSIONS

Higher aircraft noise exposure associates with adverse LV remodeling, potentially due to noise increasing the risk of obesity and hypertension. Findings are consistent with the existing literature on aircraft noise and cardiovascular disease, and need to be considered by policymakers and the aviation industry.

Combined Effects of Arsenic, Cadmium, and Mercury with Cardiovascular Disease Risk: Insights from the All of Us Research Program

BACKGROUND

Environmental exposures to heavy metals/metalloids such as arsenic, cadmium, and mercury have been implicated in adverse cardiovascular health outcomes. Using data from the All of Us research program, we investigated the associations between these metals/metalloids and six cardiovascular-related biomarkers: systolic blood pressure (SBP), HDL cholesterol, LDL cholesterol, C-reactive protein (CRP), total cholesterol, and triglycerides.

METHODS

This study explored the relationship between outcome cardiovascular variables (SBP, CRP, LDL, HDL, triglycerides, and total cholesterol) and predictor metal/metalloid variables (cadmium, mercury, and arsenic) among 136 participants (53.4 percent women). We initially conducted linear regression to determine the association between variables of interest. Bayesian Kernel Machine Regression (BKMR) analysis was subsequently performed to capture potential non-linear relationships, as well as interactions among metal/metalloid exposures. In the BKMR analysis, posterior inclusion probabilities (PIPs) quantified the contribution of each metal/metalloid to the outcomes, with higher PIP values indicating a greater likelihood of a specific exposure being a key predictor for a given cardiovascular biomarker. Within the BKMR framework, univariate, bivariate, and overall exposure-response analyses provided insights into the individual and combined effects of metal/metalloid exposures. These analyses identified the factors with the strongest associations and highlighted interactions between exposures.

RESULTS

In this study, the average age of male participants was 58.2 years, while female participants had an average age of 55.6 years. The study population included 104 individuals identifying as White (mean age: 57.5 years), 10 as Black or African American (mean age: 63.2 years), 7 as Hispanic (mean age: 48.2), 3 as Asian (mean age: 49.7 years), and 12 as Other race (mean age: 48.8 years). In our study, men exhibited higher levels of SBP, triglycerides, mercury, and arsenic, while women had higher levels of CRP, LDL cholesterol, HDL cholesterol, total cholesterol, and cadmium. Black people exhibited higher levels and greater variability in markers of cardiovascular risk and inflammation (e.g., blood pressure and CRP), Asians consistently showed the lowest levels across most biomarkers, while White people, Hispanics, and the "Other" group demonstrated moderate levels with some variability. In linear regression, we identified significant positive associations between mercury and HDL cholesterol, arsenic and triglycerides, and arsenic and total cholesterol. In BKMR analysis, PIP results revealed that mercury had the highest predictive contribution for SBP, HDL cholesterol, and triglycerides; cadmium for CRP; and arsenic for LDL and total cholesterol. Univariate and bivariate exposure-response analyses in BKMR demonstrated non-linear exposure-response patterns, including U-shaped and inverted U-shaped patterns for cadmium, particularly CRP and total cholesterol. Traditional linear regression techniques would have missed these patterns.

CONCLUSION

Our study results highlight the influence of environmental metal/metalloid exposures on cardiovascular biomarkers, providing evidence of non-linear and interactive effects that warrant further investigation to understand their role in cardiovascular disease risk better.

Cardiovascular Risk Assessment and Prevention in Cardio-Oncology: Beyond Traditional Risk Factors

This review goes beyond traditional approaches in cardio-oncology, highlighting often-neglected factors impacting patient care. Social determinants, environment, health care access, and gut microbiome significantly influence patient outcomes. Powerful tools like multi-omics and wearable technologies offer deeper insights into real-world experiences. The future lies in integrating these advancements with established practices to achieve precision cardio-oncology care. By crafting tailored therapies and continuously updating comprehensive management plans based on real-time data, we can unlock the full potential of personalized care for all patients.

A review on the role of nanocomposites for desulfurization of liquid transportation fuels

Stringent sulfur removal regulations from transportation fuels from typical levels of 500 ppm to ultra-low levels of 10 ppm (BS-6 standard) present a critical challenge for the crude processing industry. This research thoroughly investigates emerging desulfurization technologies, with a focus on nanocomposite (NC) materials that exhibit exceptional sulfur removal efficiency. Advanced nanocomposite catalysts, such as (TBA)4PW11Fe@TiO2@PVA, have near-complete removal rates of 96-99% for complicated sulfur compounds like dibenzothiophene (DBT) and derivatives. The performance spectrum spans from basic materials with 20-38% removal to advanced nanocomposite systems with up to 99% desulfurization efficiency. By synthesizing current strategies involving transition metal-based, polyoxometalate, and hybrid nanocomposite materials, this study highlights transformative approaches to meeting increasingly stringent environmental regulations in fuel processing, with selective removal techniques targeting specific sulfur molecular structures.

Environmental Pollutants as Emerging Concerns for Cardiac Diseases: A Review on Their Impacts on Cardiac Health

Comorbidities related to cardiovascular disease (CVD) and environmental pollution have emerged as serious concerns. The exposome concept underscores the cumulative impact of environmental factors, including climate change, air pollution, chemicals like PFAS, and heavy metals, on cardiovascular health. Chronic exposure to these pollutants contributes to inflammation, oxidative stress, and endothelial dysfunction, further exacerbating the global burden of CVDs. Specifically, carbon monoxide (CO), ozone, particulate matter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), heavy metals, pesticides, and micro- and nanoplastics have been implicated in cardiovascular morbidity and mortality through various mechanisms. PM2.5 exposure leads to inflammation and metabolic disruptions. Ozone and CO exposure induce oxidative stress and vascular dysfunction. NO2 exposure contributes to cardiac remodeling and acute cardiovascular events, and sulfur dioxide and heavy metals exacerbate oxidative stress and cellular damage. Pesticides and microplastics pose emerging risks linked to inflammation and cardiovascular tissue damage. Monitoring and risk assessment play a crucial role in identifying vulnerable populations and assessing pollutant impacts, considering factors like age, gender, socioeconomic status, and lifestyle disorders. This review explores the impact of cardiovascular disease, discussing risk-assessment methods, intervention strategies, and the challenges clinicians face in addressing pollutant-induced cardiovascular diseases. It calls for stronger regulatory policies, public health interventions, and green urban planning.

Towards personalized cardiometabolic risk prediction: A fusion of exposome and AI

The influence of the exposome on major health conditions like cardiovascular disease (CVD) is widely recognized. However, integrating diverse exposome factors into predictive models for personalized health assessments remains a challenge due to the complexity and variability of environmental exposures and lifestyle factors. A machine learning (ML) model designed for predicting CVD risk is introduced in this study, relying on easily accessible exposome factors. This approach is particularly novel as it prioritizes non-clinical, modifiable exposures, making it applicable for broad public health screening and personalized risk assessments. Assessments were conducted using both internal and external validation groups from a multi-center cohort, comprising 3,237 individuals diagnosed with CVD in South Korea within twelve years of their baseline visit, along with an equal number of participants without these conditions as a control group. Examination of 109 exposome variables from participants' baseline visits spanned physical measures, environmental factors, lifestyle choices, mental health events, and early-life factors. For risk prediction, the Random Forest classifier was employed, with performance compared to an integrative ML model using clinical and physical variables. Furthermore, data preprocessing involved normalization and handling of missing values to enhance model accuracy. The model's decision-making process were using an advanced explainability method. Results indicated comparable performance between the exposome-based ML model and the integrative model, achieving AUC of 0.82(+/-)0.01, 0.70(+/-)0.01, and 0.73(+/-)0.01. The study underscores the potential of leveraging exposome data for early intervention strategies. Additionally, exposome factors significant in identifying CVD risk were pinpointed, including daytime naps, completed full-time education, past tobacco smoking, frequency of tiredness/unenthusiasm, and current work status.

Association between Mediterranean diet and metabolic health status among adults was not mediated through serum adropin levels

BACKGROUND

Prevalence of metabolic disorders has been increased in recent years around the world. The relationship between Mediterranean diet (MD) with metabolic health status and serum adropin levels has been less examined in Iranian adults. We investigated the association between MD compliance with metabolic health status and adropin hormone in Iranian adults.

METHODS

This observational study was conducted on 527 men and women. Food intakes were evaluated by a validated food frequency questionnaire. Blood pressure and anthropometric parameters were measured. Fasting blood samples were drawn to measure serum adropin concentrations, blood glucose, triglycerides, high-density lipoprotein cholesterol, high sensitive C-reactive protein and insulin. Metabolic unhealthy (MU) status was defined as having ≥ 2 cardio-metabolic risk factors.

RESULTS

After adjustments for potential confounders, subjects in highest versus lowest tertile of MD had 52% lower odds of MU status (OR = 0.48, 95%CI: 0.23-0.97). Stratified analysis revealed a significant association in normal-weight participants (OR = 0.12; 95%CI: 0.02-0.64), but not in those with overweight/obesity (OR = 0.66, 95%CI: 0.27-1.57). By excluding each component of MD, the association disappeared, except for three components (vegetables, nuts and grains). MD adherence was not significantly related to serum adropin levels in multivariable-adjusted model (unstandardized B= -0.19, 95%CI: -4.97, 4.59; P = 0.94). Serum adropin hormone levels were also not substantially different among metabolic healthy versus unhealthy subjects (P = 0.66).

CONCLUSIONS

This cross-sectional study showed an inverse association between adherence to MD and odds of MU status, especially in subjects with normal-weight. Serum adropin concentrations were not associated with MD adherence or metabolic health status.

Cardiovascular health in perspective: a comprehensive five-year geodatabase of hospitalizations and environmental factors in Mashhad, Iran

OBJECTIVES

This data note presents a comprehensive geodatabase of cardiovascular disease (CVD) hospitalizations in Mashhad, Iran, alongside key environmental factors such as air pollutants, built environment indicators, green spaces, and urban density. Using a spatiotemporal dataset of over 52,000 hospitalized CVD patients collected over five years, the study supports approaches like advanced spatiotemporal modeling, artificial intelligence, and machine learning to predict high-risk CVD areas and guide public health interventions.

DATA DESCRIPTION

This dataset includes detailed epidemiologic and geospatial information on CVD hospitalizations in Mashhad, Iran, from January 1, 2016, to December 31, 2020. It contains 52,176 confirmed CVD cases and includes demographic information such as age, gender, admission date, ICD-10 codes, occurrence of death, and length of hospital stay. The median age of patients was 64 years, with 54.44% male. A notable 9.41% of patients died during hospitalization. In addition to the CVD hospitalization case file and its shape file created by joining with 1301 census tracts, this dataset includes environmental factors such as air quality indicators (SO2, PM2.5, CO, etc.). It also incorporates socio-economic variables (population density, illiteracy, and unemployment rates), public infrastructure, and built environment data, providing a comprehensive view of cardiovascular health in Mashhad.

Combined action of dietary-based approaches and therapeutic agents on cholesterol metabolism and main related diseases

BACKGROUND

Dyslipidaemia is among the major causes of severe diseases and, despite being well-established, the hypocholesterolaemic therapies still face significant concerns about potential side effects (such as myopathy, myalgia, liver injury digestive problems, or mental fuzziness in some people taking statins), interaction with other drugs or specific foods. Accordingly, this review describes the latest developments in the most effective therapies to control and regulate dyslipidaemia.

SCOPE AND APPROACH

Herein, the metabolic dynamics of cholesterol and their integration with the current therapies: statins, bile acid sequestrants, fibrates, niacin, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, reconstituted high-density lipoprotein (rHDL), or anti-inflammatory and immune-modulating therapies), were compared focusing their effectiveness, patients' adhesion and typical side-effects. Likewise, the interaction of these therapies with recommended dietary habits, focusing functional foods and nutraceuticals uptake were also considered.

KEY FINDINGS AND CONCLUSIONS

Since none of the current therapeutic alternatives represent an ideal solution (mainly due to side-effects or patients' tolerance), the potential adjuvant action of selected diets (and other healthy habits) was proposed as a way to improve the cholesterol-lowering effectiveness, while reducing the adverse effects caused by dose-increase or continuous uptake of alternating therapeutic agents. In general, the relevance of well-adapted diets must be acknowledged and their potential effects must be exhorted among patients, who need to be aware of the associated multifactorial advantages.

Burden trends and future predictions for hypertensive heart disease attributable to non-optimal temperatures in the older adults amidst climate change, 1990-2021

Background

Hypertensive heart disease (HHD) is a significant form of end-organ damage caused by hypertension, with profound impacts on global health and quality of life. Temperature anomalies driven by climate change, particularly extremes of heat and cold, are increasingly recognized as major contributors to the cardiovascular disease burden, notably impacting HHD. However, the specific spatiotemporal trends and gender-based differences in the burden of non-optimal temperatures on older adults HHD patients remain insufficiently explored. This study aims to evaluate the regional, gender-specific trends in the burden of HHD attributed to non-optimal temperatures among the older adults from 1990 to 2021, and to project future trends in HHD burden under climate-induced temperature anomalies from 2022 to 2050.

Methods

Data were sourced from the Global Burden of Disease Study (GBD 2021), which provides estimates of mortality and disability-adjusted life years (DALYs) at global, regional, and national levels. Age-standardized rates (ASR) and estimated annual percentage changes (EAPC) were analyzed. Future burden projections were modeled using age-period-cohort (APC) and Bayesian APC models to assess temperature impact by gender and age differences. Data analysis was conducted using R and STATA, examining the variations in temperature effects by gender and age.

Results

Between 1990 and 2021, cold-related HHD burden among the older adults significantly exceeded that of heat-related burden. However, heat-related HHD burden demonstrated a marked upward trend, projected to continue rising over the next two decades, particularly in low-income and tropical regions. Gender-specific analysis revealed that cold-related HHD burden was more pronounced in women, while heat-related burden was notably higher in men. Additionally, male heat-related HHD mortality rates have shown a substantial increase over the past 30 years, whereas female rates have exhibited a comparatively modest decline.

Conclusion

Although cold remains the dominant non-optimal temperature factor, rising global temperatures suggest an increasing burden of heat-related HHD among the older adults. Efforts should prioritize strengthening resilience in vulnerable regions and populations, with targeted interventions to mitigate future health risks associated with temperature extremes.

Association between lifestyle risk factors and mortality in the Mexico City prospective study

Unhealthy lifestyles risk factors, such as smoking, alcohol consumption, physical inactivity, poor diet, and obesity, have been associated with a higher risk of all-cause and cause-specific mortality. However, composite score of these unhealthy behaviours has not been considered, particularly in Latin American populations. Herein, we examined the association of lifestyle risk factors score with all-cause and cause-specific mortality in Mexican adults. A total of 159,517 adults from the Mexico City Prospective Study (MCPS) were included. Data on sociodemographic, lifestyle risk factors and medical histories was collected through a self-reported baseline questionnaire in a census-style door-to-door interviews. Lifestyle risk factors assessment was based on five modifiable lifestyle risk factors and their respective cut-off points according to current health recommendations, including obesity, physical inactivity, tobacco, alcohol consumption and fruits and vegetables intake. Multivariable Cox regression models were used to estimate the associations of lifestyle risk factor score (ranging from 0 to 5) with all-cause and cause-specific mortality (cardiovascular disease, renal or hepatobiliary diseases, diabetes, respiratory diseases, cancer and all-cause mortality). We excluded the first 2, 5, 10, and 15 years of follow-up to account for reverse causation bias. We found a high prevalence (77%) of Mexican adults, with two or more lifestyle risk factors. Hazard ratio for respiratory diseases and renal or hepatobiliary diseases were 1.86 (95%CI: 1.45-2.39) and 2.00 (95%CI: 1.60-2.52) comparing participants with 4-5 lifestyle risk factors vs. those with none. For all-cause mortality, participants with 4-5 lifestyle risk factors had a 49% (HR: 1.49; 95%CI: 1.03-2.16) higher risk as compared to participants with none. The magnitude of the associations increased as the exclusion of follow-up time increased after 2, 5, 10 and 15 years. There was a positive association between the number of lifestyle risk factors and all-cause and cause-specific mortality, showing the highest rate of respiratory, renal or hepatobiliary and all-cause mortality among participants with 4-5 lifestyle risk factors. After accounting for reverse causation, associations were stronger.

Effects of Extreme Humidity and Heat on Ventricular Arrhythmia Risk in Patients With Cardiac Devices

Background

Climate change is increasing the frequency of high heat and high humidity days. Whether these conditions can trigger ventricular arrhythmias [ventricular tachycardia/ventricular fibrillation, VT/VF] in susceptible persons is unknown.

Objectives

The purpose of this study was to determine the relationship between warm-season weather conditions and risk of VT/VF in individuals with pacemakers and defibrillators.

Methods

Baseline clinical and device data from 5,944 patients in North Carolina (2010-2021) were linked to daily weather data geocoded to individuals' residential addresses. Associations between extreme humidity, temperature, and VT/VF overall and by patient, community, and built environment factors were estimated using a case time-series design with distributed lag nonlinear models, adjusting for temporal trends and individual factors.

Results

VT/VF events occurred on 4,486 of the 484,988 person-days. Extreme humidity (95th percentile: 90% relative humidity) increased odds of VT/VF in the 7 days following exposure (aOR 1.23 [95% CI: 1.00-1.51]). Humidity-associated VT/VF risk was highest among those who were male (aOR: 1.38 [95% CI: 1.08-1.76]), age 67 to 75 years (aOR: 1.65 [95% CI: 1.16-2.35]) with coronary artery disease (aOR: 1.79 [95% CI: 1.25-2.57]), heart failure (aOR: 1.72 [95% CI: 1.2-2.46]), diabetes (aOR: 3.01 [95% CI: 1.99-4.56]), hypertension (aOR: 2.06 [95% CI: 1.48-2.88]), and prior myocardial infarction (aOR: 1.75 [95% CI: 1.23-2.48]). Communities with high socioeconomic deprivation (aOR: 1.83 [95% CI: 1.28-2.62]), high income inequality (aOR: 1.56 [95% CI: 1.19-2.04]), and urban areas with less greenspace (aOR: 1.29 [95% CI: 0.93-1.78]) also had increased VT/VF risk. High temperatures were not associated with VT/VF.

Conclusions

In patients with preexisting cardiovascular disease, exposure to extreme humidity increased VT/VF risk, especially among vulnerable individuals, disadvantaged communities, and urban areas with less green space. These findings emphasize the need for policies that address environmental risks in susceptible individuals and communities.

[The effects of environmental stressors on cardiovascular health]

Noncommunicable diseases (NCDs) are responsible for the premature deaths of more than 38 million people each year, making them the leading cause of the global burden of disease, accounting for 70% of global mortality. The majority of these deaths are caused by cardiovascular diseases. The risk of NCDs is closely related to exposure to environmental stressors such as air pollution, noise pollution, artificial light at night, and climate change, including extreme heat, sandstorms, and wildfires. In addition to the traditional risk factors for cardiovascular diseases such as diabetes, high blood pressure, smoking, hypercholesterolemia and genetic predisposition, there is increasing evidence that physicochemical factors in the environment significantly contribute to the high NCD numbers. In addition, urbanization is related to the accumulation and intensification of these stressors. This expert review will summarize the epidemiology and pathophysiology of environmental stressors with a focus on cardiovascular NCDs. In addition, solutions and measures to mitigate the effects of environmental risks, especially concerning cardiovascular diseases, will be discussed.

Comprehensive Analysis of Cardiovascular Diseases: Symptoms, Diagnosis, and AI Innovations

Cardiovascular diseases are some of the underlying reasons contributing to the relentless rise in mortality rates across the globe. In this regard, there is a genuine need to integrate advanced technologies into the medical realm to detect such diseases accurately. Moreover, numerous academic studies have been published using AI-based methodologies because of their enhanced accuracy in detecting heart conditions. This research extensively delineates the different heart conditions, e.g., coronary artery disease, arrhythmia, atherosclerosis, mitral valve prolapse/mitral regurgitation, and myocardial infarction, and their underlying reasons and symptoms and subsequently introduces AI-based detection methodologies for precisely classifying such diseases. The review shows that the incorporation of artificial intelligence in detecting heart diseases exhibits enhanced accuracies along with a plethora of other benefits, like improved diagnostic accuracy, early detection and prevention, reduction in diagnostic errors, faster diagnosis, personalized treatment schedules, optimized monitoring and predictive analysis, improved efficiency, and scalability. Furthermore, the review also indicates the conspicuous disparities between the results generated by previous algorithms and the latest ones, paving the way for medical researchers to ascertain the accuracy of these results through comparative analysis with the practical conditions of patients. In conclusion, AI in heart disease detection holds paramount significance and transformative potential to greatly enhance patient outcomes, mitigate healthcare expenditure, and amplify the speed of diagnosis.

Hypertension risk perception among young adults in Victoria University Kampala Uganda

Introduction

Globally, hypertension is becoming a more serious public health concern, with young adults also at risk. Effective intervention techniques require an understanding of young adults' perceptions of the risk factors, enablers, and barriers to adopting healthy lifestyle choices related to hypertension. This research aims to examine hypertension risk perception among young adults at Victoria University Kampala, Uganda.

Methods

Data were gathered using a structured questionnaire between November 2023 and January 2024. Convenience sampling was used to gather data from young adults at Victoria University Kampala, Uganda. Leslie Kish's formula was used to establish the sample size of 126 respondents. Multiple regression analysis was performed to examine the association between independent variables (barriers, and facilitators) and the dependent variable (perception of hypertension risk).

Results

The study found that perceptions of certain risk factors, such as smoking (OR = 2.418, p = 0.035), physical inactivity (OR = 1.731, p = 0.008), unhealthy diet (OR = 2.174, p = 0.048), and chronic stress (OR = 1.514, p = 0.028), significantly influenced the likelihood of adopting healthy lifestyle choices. Among the enablers, motivation (OR = 3.491, p = 0.005), availability of time (OR = 3.015, p = 0.011), financial resources (OR = 2.164, p = 0.017), and social support (OR = 2.014, p = 0.026) were strong predictors of healthy behaviour adoption.

Conclusion

Programs aimed at raising awareness of hypertension risk factors and enhancing enablers such as motivation, time management, and social support are recommended to effectively promote healthy behaviours among this population.

Source-Specific PM2.5 and Atherosclerotic Cardiovascular Disease Mortality

BACKGROUND

Fine particulate matter (PM2.5) exposure is adversely linked to atherosclerotic cardiovascular disease (ASCVD). However, most studies focused on PM2.5 mass rather than its chemical composition and specific sources. Particulate pollution sources can have distinct, cumulative, and potentially synergistic health impacts. We investigated the associations of source-specific PM2.5 exposure with ASCVD mortality in the United States, considering the combined associations and regional variations.

METHODS

We used data from the Centers for Medicare & Medicaid Services (including data from 65,838,403 participants) from 2000 to 2016. We estimated PM2.5 exposure using machine-learning models and attributed components to five source categories. We used Poisson survival models to assess the associations with the source categories.

RESULTS

Higher ASCVD mortality rate (rate ratio [95% confidence interval (CI)] per interquartile range increase) was associated with oil combustion (1.051 [1.049 to 1.052]), industrial pollution (1.054 [1.052 to 1.056]), coal and biomass burning (1.065 [1.062 to 1.067]), and motor vehicle pollution (1.044 [1.042 to 1.046]). These associations persisted even after limiting our sample to ZIP code-years with PM2.5<9 μg/m3 - the current National Ambient Air Quality Standard. In these areas the observed rate ratio for a one-unit increase in PM2.5 mass was 1.028 (95% CI, 1.026 to 1.029).

CONCLUSIONS

We found higher ASCVD mortality rate associated with PM2.5, with differential effects across sources. These data highlight the importance of considering local population characteristics and exposure patterns when assessing health risks associated with PM2.5.

Unraveling the enigma of cardiac damage caused by lead: Understanding the intricate relationship between oxidative stress and other multifactorial mechanisms

Lead (Pb) exposure remains a pressing concern in the realm of public health, with a mounting body of evidence underscoring its adverse impact on cardiovascular well-being. The exposure to Lead instigates the production of reactive oxygen species (ROS), leading to consequential cellular and physiological damage and a perturbation in redox equilibrium. The resultant oxidative stress, induced by ROS, disrupts endothelial functionality, propagates inflammatory processes, and initiates vascular remodeling, collectively contributing to the advancement of cardiovascular diseases (CVDs). The objective of this current review is to comprehensively expound upon the intricate mechanisms through which Lead induced toxicity affects cardiac cells. Additionally, it briefly addresses the ramifications of Lead exposure on the development of three interconnected cardiovascular conditions: atherosclerosis, hypertension, and myocardial infarction. Furthermore, the discourse delves into the specific repercussions of Lead exposure on lipid metabolism, blood pressure regulation, and cardiac performance, culminating in the initiation and progression of atherosclerotic plaque formation, elevated blood pressure, and an augmented risk of myocardial infarction. By understanding these intricate mechanisms, targeted interventions may be devised to counteract the deleterious effects of Lead on cardiovascular health. Thus, this review offers novel avenues for preventive and therapeutic strategies, ultimately serving to alleviate the burden of cardiovascular diseases associated with Lead toxicity.

Spatio-temporal distribution, prediction and relationship of three major acute cardiovascular events: Out-of-hospital cardiac arrest, ST-elevation myocardial infarction and stroke

Background

Predicting the incidence of time-sensitive cardiovascular diseases like out-of-hospital cardiac arrest (OHCA), ST-elevation myocardial infarction (STEMI), and stroke can reduce time to treatment and improve outcomes. This study analysed the spatio-temporal distribution of OHCAs, STEMIs, and strokes, their spatio-temporal correlation, and the performance of different prediction algorithms.

Methods

Adults who experienced an OHCA, STEMI, or stroke in Canton Ticino, Switzerland from 2005 to 2022 were included. Datasets were divided into training and validation samples. To estimate and predict the yearly per-capita population incidences of OHCA, STEMI, and stroke, the integrated nested Laplace approximation (INLA), machine learning meta model (MLMM), the Naïve prediction method, and the exponential moving average were employed and compared. The relationship between OHCA, STEMI, and stroke was assessed by predicting the incidence of one condition, considering the lagged incidence of the other two as explanatory variables.

Results

We included 3,906 OHCAs, 2,162 STEMIs, and 2,536 stroke patients. INLA and MLMM yearly predicted incidence OHCA, STEMI, and stroke at municipality level with very high accuracy, outperforming the Naïve forecasting and the exponential moving average. INLA exhibited errors of zero or one event in 82%, 87%, and 72% of municipalities for OHCA, STEMI, and stroke, respectively, whereas ML had errors in 81%, 89%, and 71% of municipalities for the same conditions. INLA had a prediction error of 0.87, 0.77, and 1.50 events per year per municipality for OHCA, STEMI and stroke, whereas MLMM of 0.70, 0.74, and 1.09 events, respectively. Including in the INLA model the lagged absolute values of the other conditions as covariates improved the prediction of OHCA and stroke but not STEMI. MLMM predictions were consistently the most accurate and did not benefit from the inclusion of the other conditions as covariates. All the three diseases showed a similar spatial pattern.

Conclusions

Prediction of incidence of OHCA, STEMI, and stroke is possible with very high accuracy using INLA and MLMM models. A robust spatio-temporal correlation between the 3 pathologies exists. Widespread implementation in clinical practice of prediction algorithms may allow to improve resource allocation, reduce treatment delays, and improve outcomes.

Tinnitus and cardiovascular disease: the population-based Tromsø Study (2015-2016)

Introduction

People with tinnitus are likely to have other co-occurring disorders that should be considered when diagnosing and understanding tinnitus as a health problem. The association between tinnitus and cardiovascular health in the general population is, however, unclear. This study aimed to examine whether tinnitus is associated with the prevalence of hypertension, myocardial infarction or stroke, in the general adult population.

Methods

We used data from the seventh survey of the Tromsø Study, a comprehensive population-based health study carried out in 2015-2016. All inhabitants aged ≥40 years in the municipality of Tromsø, Norway, (n=32 591) were invited, of which 21 083 individuals (65%), aged 40-99, participated. Poisson regression was used to analyse the relationships between tinnitus and cardiovascular disease, while adjusting for relevant covariates. We used three separate tinnitus variables as exposures in analyses: (1) 'tinnitus status', measured with the question 'During the last 12 months, have you experienced ringing in your ears lasting more than five min?'; (2) 'tinnitus symptom intensity', generated as a function of tinnitus frequentness and tinnitus bother; and (3) 'tinnitus bother', analysed only among participants with tinnitus. Hypertension (measured blood pressure and/or self-reported use of antihypertensives), and self-reported myocardial infarction and stroke were the outcomes of analyses.

Results

Analyses of the complete sample (n=17 288, 51.2% women), in fully adjusted models, revealed non-significant and very weak associations between tinnitus status and all three cardiovascular outcomes (prevalence ratios (PRs): 1.04-1.11), while for tinnitus symptom intensity, we found significant positive associations between low-intensity tinnitus and hypertension (PR: 1.08, 95% CI: (1.01 to 1.16) and myocardial infarction (PR: 1.39, 95% CI: 1.07 to 1.81). Among participants with tinnitus (n=3570), there were no associations between tinnitus bother and cardiovascular outcomes.

Conclusions

Results from the present study indicate that there is a weak association between tinnitus and cardiovascular disease and that tinnitus should be taken seriously even at low intensities.

Long-term exposure to air pollution and incidence risk of various arrhythmias: A prospective cohort study

To investigate the association of long-term exposure to air pollution with incident arrhythmia from various causes, this prospective cohort study included 442,386 participants from the UK Biobank cohort. Residential annual average exposures at baseline were evaluated, including fine particles (PM2.5), coarse particles (PM2.5-10), nitrogen dioxide (NO2), and nitrogen oxides (NOx). We further constructed a composite air pollution score (APS) to evaluate the concomitant exposure to these four pollutants. The associations of air pollutants with various arrhythmia subtypes were assessed utilizing the Cox proportional hazards model, and the hazard ratios (HRs) for incident arrhythmias were estimated. A total of 41,021 patients with incident arrhythmia were recorded. The HRs of overall arrhythmia associated with a 10 μg/m3 increment in PM2.5, PM2.5-10, NO2, and NOx were 1.26, 0.95, 1.03, and 1.02, respectively. The HR was 1.08 in the highest quintile of the APS compared to the lowest one. For cause-specific arrhythmias, the HRs per unit increment in APS were 1.45, 1.67, 1.51, 1.80, 2.63, and 4.66 for atrial fibrillation, atrioventricular block, ventricular fibrillation/tachycardia, intraventricular block, supraventricular tachycardia, and ventricular premature beats, respectively. Females, older individuals, overweight or obese individuals, and those with low education attainment, low income, or cardiometabolic morbidities had higher HRs associated with pollutants. Long-term exposure to air pollution is linked to increased incidence risks of atrial and ventricular arrhythmias. More focus should be shifted to the impact of air pollution on other arrhythmias besides atrial fibrillation.

Genetic variants of the XRCC3 DNA repair gene: risk implications in breast cancer among Iraqi patients

Introduction

Breast cancer is the predominant form of malignancy among women. Polymorphisms in DNA repair genes, such as X-ray repair cross complementing 3 (XRCC3), can influence an individual's capability to repair damaged DNA. This can result in genetic instability and potentially contribute to the development of cancer. This study investigates the correlation between the XRCC3 Thr241Met genetic variants and the risk of breast cancer.

Material and methods

This study is considered the first study in Iraq that sheds light on studying the effect of the XRCC3 Thr241Met genotype variants and their relationship with increased risk of breast cancer. The blood of 75 Iraqi women who had been diagnosed with breast cancer was used in this study to extract DNA, in addition to using 50 blood samples from women who appeared to be healthy and without a family history of any other cancer, as a control group. Genotyping of the XRCC3 Thr241Met gene was studied by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The single nucleotide polymorphism (SNP) genotypes were determined in all participants.

Results

The findings of this study demonstrated that the Met/Met allele occurred more frequently in patients than controls (OR = 3.3, 95% CI: 1.8-6.04; p = 0.0001), particularly in patients with positive lymph node metastases, grade II and III, and stages III/IV.

Conclusions

These findings established the association of the Thr241Met genotype with breast cancer among Iraqi women; specifically, the homozygous (Met/Met) genotype appeared to be correlated with risk of breast cancer and cancer prognosis. This genotype was notably more prevalent among women diagnosed with high-grade tumours, as well as advanced stage and metastatic breast cancer.

PM2.5-mediated cardiovascular disease in aging: Cardiometabolic risks, molecular mechanisms and potential interventions

Air pollution, particularly fine particulate matter (PM2.5) with <2.5 μm in diameter, is a major public health concern. Studies have consistently linked PM2.5 exposure to a heightened risk of cardiovascular diseases (CVDs) such as ischemic heart disease (IHD), heart failure (HF), and cardiac arrhythmias. Notably, individuals with pre-existing age-related cardiometabolic conditions appear more susceptible. However, the specific impact of PM2.5 on CVDs susceptibility in older adults remains unclear. Therefore, this review addresses this gap by discussing the factors that make the elderly more vulnerable to PM2.5-induced CVDs. Accordingly, we focused on physiological aging, increased susceptibility, cardiometabolic risk factors, CVDs, and biological mechanisms. This review concludes by examining potential interventions to reduce exposure and the adverse health effects of PM2.5 in the elderly population. The latter includes dietary modifications, medications, and exploration of the potential benefits of supplements. By comprehensively analyzing these factors, this review aims to provide a deeper understanding of the detrimental effects of PM2.5 on cardiovascular health in older adults. This knowledge can inform future research and guide strategies to protect vulnerable populations from the adverse effects of air pollution.

Road traffic noise and breast cancer: DNA methylation in four core circadian genes

BACKGROUND

Transportation noise has been linked with breast cancer, but existing literature is conflicting. One proposed mechanism is that transportation noise disrupts sleep and the circadian rhythm. We investigated the relationships between road traffic noise, DNA methylation in circadian rhythm genes, and breast cancer. We selected 610 female participants (318 breast cancer cases and 292 controls) enrolled into the Malmö, Diet, and Cancer cohort. DNA methylation of CpGs (N = 29) in regulatory regions of circadian rhythm genes (CRY1, BMAL1, CLOCK, and PER1) was assessed by pyrosequencing of DNA from lymphocytes collected at enrollment. To assess associations between modeled 5-year mean residential road traffic noise and differentially methylated CpG positions, we used linear regression models adjusting for potential confounders, including sociodemographics, shiftwork, and air pollution. Linear mixed effects models were used to evaluate road traffic noise and differentially methylated regions. Unconditional logistic regression was used to investigate CpG methylation and breast cancer.

RESULTS

We found that higher mean road traffic noise was associated with lower DNA methylation of three CRY1 CpGs (CpG1, CpG2, and CpG12) and three BMAL1 CpGs (CpG2, CpG6, and CpG7). Road traffic noise was also associated with differential methylation of CRY1 and BMAL1 promoters. In CRY1 CpG2 and CpG5 and in CLOCK CpG1, increasing levels of methylation tended to be associated with lower odds of breast cancer, with odds ratios (OR) of 0.88 (95% confidence interval (CI) 0.76-1.02), 0.84 (95% CI 0.74-0.96), and 0.80 (95% CI 0.68-0.94), respectively.

CONCLUSIONS

In summary, our data suggest that DNA hypomethylation in CRY1 and BMAL1 could be part of a causal chain from road traffic noise to breast cancer. This is consistent with the hypothesis that disruption of the circadian rhythm, e.g., from road traffic noise exposure, increases the risk of breast cancer. Since no prior studies have explored this association, it is essential to replicate our results.

Gender differences in the effects of urban environment on nighttime exercise behaviours: a qualitative study

Objective

With the acceleration of urbanization, nighttime exercise behaviours have rapidly emerged. Existing research indicates a correlation between urban environments and physical activity; however, studies focusing specifically on nighttime are still insufficient, particularly regarding gender differences. This study aims to identify the key factors in urban environments that influence residents' nighttime exercise behaviours and to explore the gender differences within these influences.

Methods

Purposeful sampling was employed to conduct semi-structured interviews with 30 residents who regularly engage in nighttime exercise. All transcribed interviews were analyzed using Colaizzi's phenomenological data analysis method.

Results

The findings revealed that physical environment and environmental perception are the two primary factors influencing nighttime exercise behaviour. These factors are further divided into 10 specific sub-themes: lighting, green spaces, site facilities and layout, traffic coherence, entertainment facilities, smart sports equipment, sense of safety, convenience, pleasure, and sense of belonging.

Conclusion

Females demonstrate a heightened sensitivity to the perception of the physical environment, placing greater emphasis on the feelings and experiences it provides. Males, on the other hand, focus more on the direct impact of the physical environment, such as its specific effects on exercise performance. Future urban planning and public policy should give greater consideration to gender differences in the use of urban exercise facilities, ensuring that nighttime exercise environments meet the needs of residents of different genders. This approach will contribute to enhancing overall community vitality and improving residents' health.

Environmental Heavy Metal Exposure and Associated Cardiovascular Diseases in Light of the Triglyceride Glucose Index

Cardiovascular diseases (CVD), primarily ischemic heart disease and stroke, remain leading global health burdens. Environmental risk factors have a major role in the development of CVD, particularly exposure to heavy metals. The Triglyceride Glucose Index (TyG), a measure of insulin resistance and CVD risk, is the primary focus of this study, which summarizes the most recent findings on the effects of lead (Pb), arsenic (As), and cadmium (Cd) on CVD risk. A higher risk of CVD is correlated with an elevated TyG index, which has been linked to insulin resistance. Exposure to Cd is associated with disturbance of lipid metabolism and oxidative stress, which increases the risk of CVD and TyG. Exposure reduces insulin secretion and signaling, which raises the TyG index and causes dyslipidemia. Pb exposure increases the risk of CVD and TyG index via causing oxidative stress and pancreatic β-cell destruction. These results highlight the need of reducing heavy metal exposure by lifestyle and environmental modifications in order to lower the risk of CVD. To comprehend the mechanisms and create practical management plans for health hazards associated with heavy metals, more study is required.

Air pollutants as modulators of mitochondrial quality control in cardiovascular disease

It is important to understand the effects of environmental factors such as air pollution on mitochondrial structure and function, especially when these changes increase cardiovascular disease risk. Although lifestyle choices directly determine many mitochondrial diseases, increasingly, it is becoming clear that the structure and function of mitochondria may be affected by pollutants found in the atmosphere (e.g., gases, pesticides herbicide aerosols, or microparticles). To date, the role of such agents on mitochondria and the potential impact on cardiovascular fitness is neglected. Here we offer a review of airborne stressors and pollutants, that may contribute to impairments in mitochondrial function and structure to cause heart disease.

Tele-Medical Nutrition Therapy to Promote Healthy Eating and Nutrition Adherence of Chronic Patients in the COVID-19 Pandemic: A Pragmatically Before-After Trial

Background and Aims

Patients find it difficult, during the pandemic, to receive appropriate nutrition services because of the limited access to health services. This study assessed the effectiveness of a tele-consulting nutrition intervention on the nutrition adherence of patients with diabetes and hypertension.

Methods

A tele-medical nutrition therapy (MNT) intervention was conducted as a one-group before-after trial. The estimated sample size was 314. Of these, 183 patients were selected from Hefdah-e-Shahrivar and 131 from Farabi Hospital. Patients were asked to complete an adapted version of the nutrition adherence self-reported instrument to compare nutrition adherence when they received face-to-face therapy versus tele MNT.

Results

In total, 166 completed all phases of the study. The results showed that the nutrition adherence score significantly increased compared to before the intervention. Hedges's g effect size also confirmed the high efficacy of telenutrition therapy. The magnitude of differences was within a high range (effect size 3.76 [CI: 3.40-4.12]).

Conclusions

The present findings showed that providing teleconsulting nutrition services to diabetic and hypertensive patients can positively affect their nutrition adherence. Telenutrition to promote a healthy diet can contribute to effectively controlling diseases in chronic patients during/after the pandemic with no gaps or failures.

Trial Registration

This study was a tele-nutrition intervention. In this study, we provided consultation on regular food consumption and did not order any chemical substances or nutritional supplements. Furthermore, we did not perform any treatment or invasive intervention, we assumed that a registration number was unnecessary, so we did not apply for clinical trial registration.

Time-varying exposure to food retailers and cardiovascular disease hospitalization and mortality in the netherlands: a nationwide prospective cohort study

BACKGROUND

Very few studies to date investigated the prospective association of changes in exposure to the food environment with cardiovascular disease (CVD) risk. We aim to explore if time-varying exposure to the food environment was associated with hospitalization and mortality due to total and specific types of CVD in The Netherlands.

METHODS

In this prospective cohort study, 4,641,435 Dutch adults aged 35 + years who did not change residence in 2002-2018 were identified through registry data. Exposure to the food environment was defined as time-varying Food Environment Healthiness Index (FEHI) scores (range: - 5 to 5) and time-varying kernel density of specific food retailers (e.g., fast food outlets, supermarkets) around the home location between 2004 and 2018. The main outcome measures were hospitalization and mortality due to overall CVD, stroke, HF, and CHD occurring between 2004 and 2020, based on hospital and death registries.

RESULTS

In Cox regression models, each unit increase in the FEHI was associated with a lower hospitalization and mortality of CVD (hospitalization hazard ratio (HRh) = 0.90 (0.89 to 0.91), mortality hazard ratio (HRm) = 0.85 (0.82 to 0.89)), CHD (HRh = 0.88 (0.85 to 0.91), HRm = 0.80 (0.75 to 0.86)), stroke (HRh = 0.89 (0.84 to 0.93)), HRm = 0.89 (0.82 to 0.98)), and HF (HRh = 0.90 (0.84-0.96), HRm = 0.84 (0.76 to 0.92)). Increased density of local food shops, fast food outlets, supermarkets, and convenience stores and decreased density of food delivery outlets and restaurants were associated with a higher risk of CVD, CHD, stroke, and HF hospitalization and mortality.

CONCLUSIONS

In this observational longitudinal study, changes in exposure to a healthier food environment over 14 years were associated with a risk reduction in CVD hospitalization and mortality, in particular in urbanized areas and for younger adults and those with higher incomes.

The effects of kiwifruit consumption on anthropometric and cardiometabolic indices in adults: A systematic review and meta-analysis

The current systematic review and meta-analysis was conducted to evaluate the effects of kiwifruit intake on anthropometric indices and key cardiometabolic parameters. Related articles were found by searching PubMed, ISI Web of Science, and Scopus to detect relevant Randomized Clinical Trials (RCTs) and novel systematic reviews relating to kiwi consumption in adults, up to August 2023. The weighted mean difference (WMD) and 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity, sensitivity analysis, and publication bias were assessed and reported using standard methods. Six RCTs were included in the meta-analysis. Analyzing overall effect sizes demonstrated a significant reduction in low-density lipoprotein cholesterol (LDL) levels (WMD: -9.30 mg/dL; 95% CI: -17.56 to -1.04, p = .027), whereas no significant alterations of triglycerides (TG) (WMD: -12.91 mg/dL; 95% CI: -28.17 to 2.34, p = .097), total cholesterol (TC) (WMD: -7.66 mg/dL; 95% CI: -17.85 to 2.52, p = .141), high-density lipoprotein cholesterol (HDL) (WMD: 2.87 mg/dL; 95% CI: -0.36 to 6.11, p = .141), fasting blood glucose (FBG) (WMD: 1.06 mg/dL; 95% CI: -1.43 to 3.56, p = .404), C-reactive protein (CRP) (WMD: 0.15 mg/dL; 95% CI: -0.40, 0.70, p = .0598), body weight (BW) (WMD: 0.85 kg; 95% CI: -1.34 to 3.04, p = .448), body mass index (BMI) (WMD: 0.04 kg/m2; 95% CI: -0.75 to 0.83, p = .920), and waist circumference (WC) (WMD: 0.18 cm; 95% CI: -1.81 to 2.19, p = .855) were found. Our findings suggest that consuming kiwifruit does not have a significant impact on anthropometric indices and cardiometabolic factors, except for LDL-C levels.

2024 Guidelines of the Taiwan Society of Cardiology on the Primary Prevention of Atherosclerotic Cardiovascular Disease --- Part I

Atherosclerotic cardiovascular disease (ASCVD) is one of the leading causes of death worldwide and in Taiwan. It is highly prevalent and has a tremendous impact on global health. Therefore, the Taiwan Society of Cardiology developed these best-evidence preventive guidelines for decision-making in clinical practice involving aspects of primordial prevention including national policies, promotion of health education, primary prevention of clinical risk factors, and management and control of clinical risk factors. These guidelines cover the full spectrum of ASCVD, including chronic coronary syndrome, acute coronary syndrome, cerebrovascular disease, peripheral artery disease, and aortic aneurysm. In order to enhance medical education and health promotion not only for physicians but also for the general public, we propose a slogan (2H2L) for the primary prevention of ASCVD on the basis of the essential role of healthy dietary pattern and lifestyles: "Healthy Diet and Healthy Lifestyles to Help Your Life and Save Your Lives". We also propose an acronym of the modifiable risk factors/enhancers and relevant strategies to facilitate memory: " ABC2D2EFG-I'M2 ACE": Adiposity, Blood pressure, Cholesterol and Cigarette smoking, Diabetes mellitus and Dietary pattern, Exercise, Frailty, Gout/hyperuricemia, Inflammation/infection, Metabolic syndrome and Metabolic dysfunction-associated fatty liver disease, Atmosphere (environment), Chronic kidney disease, and Easy life (sleep well and no stress). Some imaging studies can be risk enhancers. Some risk factors/clinical conditions are deemed to be preventable, and healthy dietary pattern, physical activity, and body weight control remain the cornerstone of the preventive strategy.

Prevalence of classic and non-classic pain sites of coronary artery disease: a cross-sectional study

STUDY OBJECTIVE

This study aims to assess the prevalence of both classic and non-classic pain sites in patients with ischemic heart disease, emphasizing the importance of recognizing and not disregarding non-classic symptoms.

METHODS

This cross-sectional study included 100 patients diagnosed with coronary artery disease (CAD) who were admitted to two major hospitals in Syria. classic pain was identified as pain located in the precordial area, with or without radiation to the neck, jaw, left shoulder or arm. Patients' demographics and previous medical history were documented to investigate any potential associations with non-classic pain.

RESULTS

62% of the patients experienced non-classic pain, while 12% had no precordial pain. For those without precordial pain, the most common pain site was the left chest (66.7%). Non-classic pain was significantly associated with smoking, with 72.2% of smokers experiencing non-classic pain compared to 35.7% non-smokers (p = 0.001). Additionally, patients with previous heart disease were more likely to have non-classic pain (71.7%), compared with patients with no history of heart disease (51.1%) (p = 0.03). Other factors such as age, sex, and diabetes were not statistically significant.

CONCLUSION

Non-classic pain is common, affecting 62% of individuals, primarily in the right shoulder, right arm, and back. This type of pain could be associated with smoking and prior heart disease. Misdiagnosing coronary artery disease can have serious consequences, as patients with non-classic symptoms may miss important pre-hospital procedures like ECG.

The effect of residential greenness on cardiovascular mortality from a large cohort in South China: An in-depth analysis of effect modification by multiple demographic and lifestyle characteristics

BACKGROUND

The potential for residential greenness to improve cardiovascular health through both physical and psychological mechanisms is well recognized. However, evidence from rapidly urbanizing developing countries and cohort-based causal inference approaches, remains limited. We aim to examine the effect of residential greenness and time to cardiovascular mortality in South China.

METHODS

We utilized data from a community-based population survey involving 748,209 participants at baseline from 2009 to 2015, followed up until 2020. Residential greenness exposure was assessed by the annual Normalized Difference Vegetation Index (NDVI) in the 500 m radius of each participant's residence. We used time-varying proportional hazard Cox models coupled with inverse probability weighting to fit marginal structural models and obtain hazard ratios (HRs) for cardiovascular disease (CVD) mortality after adjusting for confounders. Multiple effect modifiers on both additive and multiplicative scales were further explored.

RESULTS

A total of 15,139 CVD-related deaths were identified during a median of 7.9 years of follow-up. A protective effect was found between higher greenness exposure and reduced CVD mortality, with a 9.3 % lower rate of total CVD mortality (HR 0.907, 95 % CI 0.859-0.957) based on a 0.1 increase in annual average NDVI. Demographic (age, marital status) and lifestyle factors (smoking, drinking status) were found to modify the association between residential greenness and CVD mortality (all P interaction values < 0.05 or 95 %CI for RERI excluded the value 0). Notably, this effect was more pronounced among older adults, married, and individuals having healthier lifestyles, indicating a greater benefit from greenness for these subgroups.

CONCLUSIONS

Our findings support a causal link between increased residential greenness exposure and a reduced risk of CVD mortality in South China with marked heterogenous effects, which has public health implications for cultivating greener urban environments to mitigate the impact of CVD within the context of rapid urbanization.

A Systematic Review of Research Gaps in the Built Environment of Inpatient Healthcare Settings

OBJECTIVE

This study utilized the evidence-gap map method and critically examined the scope, methodologies, and focus of the studies that investigated the influence of the built environment on inpatient healthcare settings over a decade (2010-2021).

METHODS

We conducted a systematic review per the preferred reporting items for systematic reviews and meta-analyses guidelines and surveyed 406 articles, primarily from North America and Europe.

RESULTS

Our findings revealed a dominant focus on architectural features (73%), such as room design and ward layout. Comparatively, there was less emphasis on interior-, ambient-, social-, and nature-related features. Most previous studies explored multiple environmental features, which indicated the intricacy of this field. Research outcomes were diverse, with person-centered care (PCC) being the most frequently investigated, followed by safe care, emotional well-being, activity, and behavior. Furthermore, research methods varied considerably based on the study's outcomes and features. Clinical outcomes and safe care favored quantitative methods, activity and behavior favored mixed methods, and PCC favored qualitative research.

CONCLUSION

This review provides an in-depth overview of the existing studies on healthcare design research and sheds light on the current trends and methodological choices. The insights garnered can guide future research, policy-making, and the development of healthcare facilities.

Road traffic noise exposure and its impact on health: evidence from animal and human studies-chronic stress, inflammation, and oxidative stress as key components of the complex downstream pathway underlying noise-induced non-auditory health effects

In heavily urbanized world saturated with environmental pollutants, road traffic noise stands out as a significant factor contributing to widespread public health issues. It contributes in the development of a diverse range of non-communicable diseases, such as cardiovascular diseases, metabolic dysregulation, cognitive impairment, and neurodegenerative disorders. Although the exact mechanisms behind these non-auditory health effects remain unclear, the noise reaction model centres on the stress response to noise. When exposed to noise, the body activates the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, leading to the secretion of stress hormones like catecholamines and cortisol. Prolonged exposure to noise-induced stress results in chronic inflammation and oxidative stress. This review underscores the role of inflammation and oxidative stress in the progression of noise-induced vascular dysfunction, disruption of the circadian rhythm, accelerated aging, neuroinflammation, and changes in microbiome. Additionally, our focus is on understanding the interconnected nature of these health outcomes: These interconnected factors create a cascade effect, contributing to the accumulation of multiple risk factors that ultimately lead to severe adverse health effects.

Gastrodin Ameliorates Learning and Memory Impairments Caused by Long-Term Noise Exposure

The developing brain is significantly affected by long-term exposure to noise at an early age, leading to functional disorders such as learning and memory impairments. Gastrodin (GAS), a natural organic compound, is an extraction of phenolic glycoside from the rhizome of Gastrodia elata. Clinically, GAS is extensively utilised for the treatment of neurological disorders. This study aimed to explore the effect and mechanism of GAS on noise exposure-induced learning and memory impairments. Rats aged 21 days were exposed to a 90 dB noise environment for 4 weeks and divided into the noise group, the noise + GAS group, and the control group to establish a noise exposure model. After noise exposure treatment, the improvement effect of GAS on the memory of rats was evaluated by Y-maze and Morris water maze. Enzyme-linked immunosorbent assay was utilised to determine the effect of GAS on neurotransmitter levels in the hippocampal tissue of noise-exposed rats. Western blot was applied for the detection of the protein levels of neurotrophic factors. The GAS treatment significantly improved spatial memory and increased the levels of key neurotransmitters (norepinephrine, dopamine and serotonin) and neurotrophic factors (neurotrophin-3 and brain-derived neurotrophic factor) in the hippocampal tissues of noise-exposed rats. These alterations correlate with enhanced cognitive functions, suggesting a neuroprotective effect of GAS against noise-induced cognitive impairments. This study supports the potential of GAS to treat noise-induced learning and memory impairments by modulating neurotransmitter secretion and enhancing the expression levels of neurotrophic factors. These findings offer potential therapeutic avenues for cognitive impairments induced by noise exposure.

Metal mixture exposures and serum lipid levels in childhood: the Rhea mother-child cohort in Greece

BACKGROUND

Growing evidence suggests that cardiovascular disease develops over the lifetime, often beginning in childhood. Metal exposures have been associated with cardiovascular disease and important risk factors, including dyslipidemia, but prior studies have largely focused on adult populations and single metal exposures.

OBJECTIVE

To investigate the individual and joint impacts of multiple metal exposures on lipid levels during childhood.

METHODS

This cross-sectional study included 291 4-year-old children from the Rhea Cohort Study in Heraklion, Greece. Seven metals (manganese, cobalt, selenium, molybdenum, cadmium, mercury, and lead) were measured in whole blood using inductively coupled plasma mass spectrometry. Serum lipid levels included total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol. To determine the joint and individual impacts of child metal exposures (log2-transformed) on lipid levels, Bayesian kernel machine regression (BKMR) was employed as the primary multi-pollutant approach. Potential effect modification by child sex and childhood environmental tobacco smoke exposure was also evaluated.

RESULTS

BKMR identified a positive association between the metal mixture and both total and LDL cholesterol. Of the seven metals examined, selenium (median 90.6 [IQR = 83.6, 96.5] µg/L) was assigned the highest posterior inclusion probability for both total and LDL cholesterol. A difference in LDL cholesterol of 8.22 mg/dL (95% CI = 1.85, 14.59) was observed when blood selenium was set to its 75th versus 25th percentile, holding all other metals at their median values. In stratified analyses, the positive association between selenium and LDL cholesterol was only observed among boys or among children exposed to environmental tobacco smoke during childhood.

IMPACT STATEMENT

Growing evidence indicates that cardiovascular events in adulthood are the consequence of the lifelong atherosclerotic process that begins in childhood. Therefore, public health interventions targeting childhood cardiovascular risk factors may have a particularly profound impact on reducing the burden of cardiovascular disease. Although growing evidence supports that both essential and nonessential metals contribute to cardiovascular disease and risk factors, such as dyslipidemia, prior studies have mainly focused on single metal exposures in adult populations. To address this research gap, the current study investigated the joint impacts of multiple metal exposures on lipid concentrations in early childhood.

Changes in Acute Coronary Syndrome Clinic after the Devastating Earthquake in Türkiye

BACKGROUND

We aimed to investigate the clinical and angiographic characteristics of patients with acute coronary syndrome (ACS) who survived this devastating earthquake and were admitted to our hospital in Antakya/Türkiye.

METHODS

We retrospectively examined the impact of the earthquake on the occurrences of acute coronary syndromes in Antakya/Türkiye. All 248 consecutive patients with ACS, also survivors of the earthquake in Antakya, were enrolled as the earthquake group. The earthquake group was created from patients hospitalized between February and June in 2023 after the earthquake. In total, 209 consecutive ACS patients who were hospitalized in our cardiology clinic in similar months of 2022 named as the control group.

RESULTS

Patients admitted before the earthquake were more hospitalized with multivessel disease compared to after the earthquake group (P <.001). Myocardial infarction with non-obstructive coronary artery disease (MINOCA) was the main reason for the significant increase rate of ACS after the earthquake. The earthquake patient group had lesser diabetes mellitus than the control group (P <.001). The risk of men suffering from ACS after an earthquake is approximately 2.1 times higher than women (P =.023). Those with a history of revascularization are approximately 1.8 times more likely to have ACS after an earthquake (P =.05). The risk of experiencing ACS after an earthquake is approximately 3.5 times higher for those with a family history than for those without (P <.001).

CONCLUSION

Effects of the devastating earthquake on the heart are the increase in MINOCA patients triggered by great sudden environmental stress and the decrease in diabetes due to worsening nutritional conditions, respectively.

Effect of the PCSK9 R46L genetic variant on plasma insulin and glucose levels, risk of diabetes mellitus and cardiovascular disease: A meta-analysis

BACKGROUND AND AIM

The impact of the loss-of-function (LOF) genetic variant PCSK9 R46L on glucose homeostasis and cardiovascular disease (CVD) remains uncertain, despite its established correlation with diminished blood cholesterol levels. This meta-analysis aimed at exploring the effect of the PCSK9 R46L genetic variant on plasma insulin and glucose levels, risk of diabetes mellitus and CVD.

METHODS AND RESULTS

PubMed, Embase, and the Cochrane Library were searched for cohort and case-control studies published until October 1, 2023. The studies should report the association of the PCSK9 R46L genetic variant with one of the following: fasting plasma insulin, blood glucose levels, diabetes mellitus, and CVD risk. A dominant model of the PCSK9 R46L genetic variant was employed to statistical analysis. The meta-analyses were performed for continuous variables with standard mean difference (SMD), categorical variables with odds ratio (OR) using a random-effects model. A total of 17 articles with 20 studies engaging 1,186,861 population were identified and mobilized for these analyses. The overall results indicated that, compared with non-carriers of the PCSK9 R46L genetic variant, carriers of the PCSK9 R46L genetic variant did not increase or decrease the levels of fasting plasma insulin (3 studies with 7277 population; SMD, 0.08; 95% CI, -0.04 to 0.19; P = 0.270), and the levels of fasting plasma glucose (7 studies with 9331 population; SMD, 0.03; 95% CI, -0.08 to 0.13; P = 0.610). However, carriers of the PCSK9 R46L genetic variant indeed had 17% reduction in the risk of CVD (11 studies with 558,263 population; OR, 0.83; 95% CI, 0.71 to 0.98; P = 0.030), and 9% increase in the risk of diabetes mellitus (10 studies with 744,466 population; OR, 1.09; 95% CI, 1.04 to 1.14; P < 0.01). Meta-regression analyses indicated that the increased risk of diabetes mellitus and the reduced risk of CVD were positively correlated with reduction in LDL-C (P = 0.004 and 0.033, respectively).

CONCLUSIONS

PCSK9 R46L genetic variant exhibited an elevated susceptibility to diabetes mellitus alongside a reduced vulnerability to CVD.

Management of Cardiovascular Diseases by Short-Chain Fatty Acid Postbiotics

PURPOSE OF REVIEW

Global health concerns persist in the realm of cardiovascular diseases (CVDs), necessitating innovative strategies for both prevention and treatment. This narrative review aims to explore the potential of short-chain fatty acids (SCFAs)-namely, acetate, propionate, and butyrate-as agents in the realm of postbiotics for the management of CVDs.

RECENT FINDINGS

We commence our discussion by elucidating the concept of postbiotics and their pivotal significance in mitigating various aspects of cardiovascular diseases. This review centers on a comprehensive examination of diverse SCFAs and their associated receptors, notably GPR41, GPR43, and GPR109a. In addition, we delve into the intricate cellular and pharmacological mechanisms through which these receptors operate, providing insights into their specific roles in managing cardiovascular conditions such as hypertension, atherosclerosis, heart failure, and stroke. The integration of current information in our analysis highlights the potential of both SCFAs and their receptors as a promising path for innovative therapeutic approaches in the field of cardiovascular health. The idea of postbiotics arises as an optimistic and inventive method, presenting new opportunities for preventing and treating cardiovascular diseases.

Fine particulate matter-sudden death association modified by ventricular hypertrophy and inflammation: a case-crossover study

Background

Sudden death accounts for approximately 10% of deaths among working-age adults and is associated with poor air quality. Objectives: To identify high-risk groups and potential modifiers and mediators of risk, we explored previously established associations between fine particulate matter (PM2.5) and sudden death stratified by potential risk factors.

Methods

Sudden death victims in Wake County, NC, from 1 March 2013 to 28 February 2015 were identified by screening Emergency Medical Systems reports and adjudicated (n = 399). Daily PM2.5 concentrations for Wake County from the Air Quality Data Mart were linked to event and control periods. Potential modifiers included greenspace metrics, clinical conditions, left ventricular hypertrophy (LVH), and neutrophil-to-lymphocyte ratio (NLR). Using a case-crossover design, conditional logistic regression estimated the OR (95%CI) for sudden death for a 5 μg/m3 increase in PM2.5 with a 1-day lag, adjusted for temperature and humidity, across risk factor strata.

Results

Individuals having LVH or an NLR above 2.5 had PM2.5 associations of greater magnitude than those without [with LVH OR: 1.90 (1.04, 3.50); NLR > 2.5: 1.25 (0.89, 1.76)]. PM2.5 was generally less impactful for individuals living in areas with higher levels of greenspace.

Conclusion

LVH and inflammation may be the final step in the causal pathway whereby poor air quality and traditional risk factors trigger arrhythmia or myocardial ischemia and sudden death. The combination of statistical evidence with clinical knowledge can inform medical providers of underlying risks for their patients generally, while our findings here may help guide interventions to mitigate the incidence of sudden death.

The cGAS-STING pathway in cardiovascular diseases: from basic research to clinical perspectives

The cyclic guanosine monophosphate (GMP)-adenosine monophosphate (AMP) synthase-stimulator of interferon genes (cGAS-STING) signaling pathway, an important component of the innate immune system, is involved in the development of several diseases. Ectopic DNA-induced inflammatory responses are involved in several pathological processes. Repeated damage to tissues and metabolic organelles releases a large number of damage-associated molecular patterns (mitochondrial DNA, nuclear DNA, and exogenous DNA). The DNA fragments released into the cytoplasm are sensed by the sensor cGAS to initiate immune responses through the bridging protein STING. Many recent studies have revealed a regulatory role of the cGAS-STING signaling pathway in cardiovascular diseases (CVDs) such as myocardial infarction, heart failure, atherosclerosis, and aortic dissection/aneurysm. Furthermore, increasing evidence suggests that inhibiting the cGAS-STING signaling pathway can significantly inhibit myocardial hypertrophy and inflammatory cell infiltration. Therefore, this review is intended to identify risk factors for activating the cGAS-STING pathway to reduce risks and to simultaneously further elucidate the biological function of this pathway in the cardiovascular field, as well as its potential as a therapeutic target.

Geographical association of biodiversity with cancer and cardiovascular mortality rates: analysis of 39 distinct conditions

Background

Biodiversity has been recognized as a positive contributor to human health and wellbeing. Cardiovascular disease and cancer are the two most significant global health burdens, and understanding their relationship with biodiversity forms an essential step toward promoting biodiversity conservation and human health.

Methods

The species richness of birds is a common indicator of biodiversity, given their vast numbers, distinctive distribution, and acute sensitivity to environmental disturbances. This ecological study utilized avian observation data derived from the eBird database, human health data from the International Health Metrics and Evaluation, and county-level statistics, including population characteristics, socio-economics, healthcare service, residential environment, and geographic and climatic characteristics in 2014. We aimed to extensively explore the individual associations between biodiversity (i.e., avian species richness) and age-standardized cause-specific mortalities for different types of cancers (29 conditions) and cardiovascular diseases (10 conditions) across the United States (US).

Results

Our multiple regression analyses that adjusted for a variety of socio-demographic and geographical factors showed that increased rarefied species richness of birds was associated with reduced mortality rates for three of the five most common cancers, namely, tracheal, bronchus, and lung cancer, breast cancer (in women only), and colon and rectal cancer. For cardiovascular conditions, a similar relationship was observed for ischemic heart disease and cerebrovascular disease-the two most frequent causes of mortality. This study provided extended details regarding the beneficial effects of biodiversity on human health.

Personal Strategies to Reduce the Cardiovascular Impacts of Environmental Exposures

Ubiquitous environmental exposures increase cardiovascular disease risk via diverse mechanisms. This review examines personal strategies to minimize this risk. With regard to fine particulate air pollution exposure, evidence exists to recommend the use of portable air cleaners and avoidance of outdoor activity during periods of poor air quality. Other evidence may support physical activity, dietary modification, omega-3 fatty acid supplementation, and indoor and in-vehicle air conditioning as viable strategies to minimize adverse health effects. There is currently insufficient data to recommend specific personal approaches to reduce the adverse cardiovascular effects of noise pollution. Public health advisories for periods of extreme heat or cold should be observed, with limited evidence supporting a warm ambient home temperature and physical activity as strategies to limit the cardiovascular harms of temperature extremes. Perfluoroalkyl and polyfluoroalkyl substance exposure can be reduced by avoiding contact with perfluoroalkyl and polyfluoroalkyl substance-containing materials; blood or plasma donation and cholestyramine may reduce total body stores of perfluoroalkyl and polyfluoroalkyl substances. However, the cardiovascular impact of these interventions has not been examined. Limited utilization of pesticides and safe handling during use should be encouraged. Finally, vasculotoxic metal exposure can be decreased by using portable air cleaners, home water filtration, and awareness of potential contaminants in ground spices. Chelation therapy reduces physiological stores of vasculotoxic metals and may be effective for the secondary prevention of cardiovascular disease.

Sex-specific associations between the environmental exposures and low-grade inflammation and increased blood pressure in young, healthy subjects

Long-term exposures to environmental factors including airborne as well as noise pollutants, are associated with cardiovascular risk. However, the influence of environmental pollution on the young population is controversial. Accordingly, we aimed to investigate the relationships between long-term exposures to different environmental factors and major cardiovascular and inflammatory parameters and biomarkers in young, healthy subjects. Representative sample of permanent residents of two cities differing in air and noise pollution levels, aged 15-21 years, were recruited. Krakow and Lublin, both located in southern Poland, were chosen in relation to their similarities in demographic and geopolitical characteristics, but differences in air pollution (higher in Krakow) and noise parameters (higher in Lublin). A total of 576 subjects were studied: 292 in Krakow and 284 in Lublin. All subjects underwent health questionnaire, blood pressure measurements and biomarker determinations. Inflammatory biomarkers, such as CRP, hs-CRP, fibrinogen as well as homocysteine were all significantly higher in subjects living in Krakow as opposed to subjects living in Lublin (for hsCRP: 0.52 (0.32-0.98) mg/l vs. 0.35 (0.22-0.67) mg/l; p < 0.001). Increased inflammatory biomarker levels were observed in Krakow in both male and female young adults. Interestingly, significant differences were observed in blood pressure between male and female subjects. Males from Krakow had significantly higher mean systolic blood pressure (127.7 ± 10.4 mm/Hg vs. 122.4 ± 13.0 mm/Hg; p = 0.001), pulse pressure (58.7 ± 8.9 mm/Hg vs. 51.4 ± 12.3 mm/Hg; p < 0.001) and lower heart rate (p < 0.001) as compared to males living in Lublin. This was not observed in young adult females. Long-term exposure to environmental factors related to the place of residence can significantly influence inflammatory and cardiovascular parameters, even in young individuals. Interestingly, among otherwise healthy young adults, blood pressure differences exhibited significant variations based on biological sex.

The Association of Desert Dust with the Risk of Acute Coronary Syndrome in Subjects of a Younger Age

Objectives: Recently, desert dust in Europe has been recognized as a cardiovascular health problem. In Spain, desert dust inflows in recent years have been associated with worsening air quality. The present study examines whether desert dust events are related to the incidence of acute coronary syndrome (ACS) in patients under 55 years of age. Methods: Data from 2416 consecutive patients admitted to a tertiary hospital due to ACS were prospectively analyzed. A case-crossover time-stratified design using Poisson conditional regression models was applied to estimate the impact of desert dust events involving particulate matter concentrations of an aerodynamic diameter <10 μm (PM10) on the incidence of ACS in patients under 55 years of age. Results: Desert dust intrusion on days 0 to 5 before ACS onset showed no significant association with the incidence of ACS in patients under 55 years of age. The incidence rate ratios of PM10 concentrations 1, 2, 3, 3, 4, and 5 days before ACS onset (for changes of 10 µg/m3) were 1.02 (95% CI 0.97-1.1; p = 0.41), 1.01 (95% CI 0.96-1.07; p = 0.66), 0.99 (95% CI 0.94-1.05; p = 0.78), 0.96 (95% CI 0.9-1.02; p = 0.18), and 0.97 (95% CI 0.91-1.04; p = 0.41). Conclusions: Our findings suggest that desert dust is unlikely to be related to the incidence of ACS in patients under 55 years of age.

Effects of high-gravity acceleration forces and anti-gravity maneuver on the cardiac function of fighter pilots

The fighter pilots exposed to high gravitational (G) acceleration must perform anti-G maneuvers similar to the Valsalva maneuver. However, the effects of high-G acceleration and anti-G maneuvers on cardiac function have rarely been studied. This study aimed to investigate the effects of high-G forces on cardiac function of fighter pilots. Fighter pilots who underwent regular health check-ups and echocardiography were included (n = 29; 100% men, 41 ± 10 years old; mean flight time, 1821 ± 1186 h). Trainees who had not experienced any flights were included in the control group (n = 16; 100% men, 36 ± 17 years old). Echocardiographic data included left ventricular chamber size, systolic and diastolic functions, right ventricular systolic pressure (RVSP), inferior vena cava (IVC) collapsibility, and tricuspid annular plane systolic excursion (TAPSE). No significant differences in left ventricular ejection fraction, RVSP, or IVC collapsibility were observed between two groups. In the multivariate linear regression analysis with total flight time as an independent continuous variable for fighter pilots, TAPSE was positively correlated with total flight time. The experience of fighter pilots who were exposed to high-G acceleration forces and anti-G maneuvers did not cause cardiac structural changes, but the exposure might be associated with right heart function changes.