Coronary Artery Disease Evaluation and Management Considerations for High Risk Occupations: Commercial Vehicle Drivers and Pilots

Analysis of the correlation between pericoronary adipose tissue mean attenuation and plaque characteristics and stenosis in coronary CT angiography

Coronary artery disease (CAD) is a predominant cardiovascular disorder, particularly in the aging population. The pathophysiology of atherosclerosis involves lipid deposition and inflammation of the arterial walls. With coronary computed tomography angiography offering insights into coronary anatomy and pathology, parameters such as pericoronary adipose tissue mean attenuation (PCATMA) have gained significance in the understanding of cardiac diseases. A retrospective study encompassing 130 patients with CAD was conducted to analyze 269 observation points. Coronary CT Angiography was employed, with specific attention paid to the measurement of PCATMA and a qualitative and quantitative assessment of plaques. Statistical analyses were performed using Statistical Package for the Social Sciences software (version 27.0), independent samples t test, one-way ANOVA, and multivariate logistic regression analysis. There was a notable correlation between PCATMA expression and severity of coronary artery calcification and stenosis. Patients with higher coronary artery calcification scores and more pronounced stenosis had elevated PCATMA values. Variances in PCATMA based on plaque type and degree of stenosis were significant (P < .05). Multivariate logistic regression revealed that plaque presence, type, and degree of stenosis were independent determinants of PCATMA expression. PCATMA expression is closely associated with CAD progression. As plaque calcification and arterial stenosis increase, there is a concomitant increase in PCATMA expression, potentially serving as a pivotal prognostic indicator.

Coronary artery calcium and sudden cardiac death: current evidence and future directions

PURPOSE OF REVIEW

To provide a summary of the current evidence and highlight future directions regarding coronary artery calcium (CAC) and risk of sudden cardiac death (SCD).

RECENT FINDINGS

Although up to 80% of all SCD is attributed to coronary heart disease (CHD), the subclinical atherosclerosis markers that help to improve SCD risk prediction are largely unknown. Recent observational data have demonstrated that, after adjustment for traditional risk factors, there is a stepwise higher risk for SCD across increasing CAC burden such that asymptomatic patients without overt atherosclerotic cardiovascular disease (ASCVD) experience a three-fold to five-fold higher SCD risk beginning at CAC at least 100 when compared with CAC = 0. Although the mechanisms underlying increasing CAC and SCD risk have yet to be fully elucidated, risk for myocardial infarction and scar, and/or exercise-induced ischemia may be potential mediators.

SUMMARY

High CAC burden is an important risk factor for SCD in asymptomatic middle-aged adults, suggesting that SCD risk stratification can begin in the early stages of CHD via measurement of calcific plaque on noncontrast computed tomography. Despite the clinical inertia for downstream functional cardiac testing after detecting high CAC, comprehensive ASCVD prevention strategies should be the primary focus for SCD risk reduction.

Health in the Skies: A Narrative Review of the Issues Faced by Commercial Airline Pilots

While the health of airline pilots is crucial to ensuring the safe travel of millions of people worldwide, they remain vulnerable to a variety of health challenges due to the nature of their job. The purpose of this narrative review is to provide a comprehensive summary of the most common health issues experienced by commercial airline pilots. By examining the published literature on this topic, we sought to identify areas where further research is needed to understand better the health risks associated with being a pilot and to develop effective interventions to address these risks. We also highlight how recent technological advances in digital health can be leveraged to conduct research into the potential usefulness of telehealth assessments for identifying occupational hazards in the aviation sector and providing targeted interventions. Overall, addressing the challenges of taking care of pilots' health and ensuring public safety will require a collaborative effort among airlines, governments, and regulators. Prioritizing pilot health and safety can actually improve profitability in the aviation sector by reducing costs associated with absenteeism, turnover, and accidents.

Risk Factors for Heart Disease in Working Railwaymen

Heart diseases are the most common non-communicable diseases worldwide. We examined the prevalence of risk factors for heart disease among a sub-population of working men. In total, 11,059 railway crew workers of the Russian Railways Company were included in the study. We also asked participants to answer several questions based on the WHO STEPwise approach to surveillance (STEPS) translated into Russian. Only 30% of drivers had normal body mass index (BMI), whereas 70% were overweight or obese. In 12% of subjects, total cholesterol was higher than 5 mmol/L. In 15% of participants, glucose level was higher than 5.5 mmol/L. 38% of drivers reported smoking. Physical inactivity was registered in 54% of persons. Only 29% ate according to the key principles of good diet quality. 24% of respondents had a family history of heart disease. MANOVA demonstrated that BMI was determined by age, profession, smoking, physical inactivity, and diet quality. As age increased, the number of people with normal cholesterol levels decreased. It was demonstrated that a correlation existed between glucose levels and BMI. In the total group, the correlation was 0.46 (p < .05). The correlation between those parameters increased due to age, from 0.33 in the <30 years of age group up to 0.52 in the >50 years of age group. This study demonstrated that there is a high prevalence of risk factors for heart disease in train drivers in the Russian Federation.

Four common vitamin D receptor polymorphisms and coronary artery disease susceptibility: A trial sequential analysis

Background

Studies on the susceptibility of vitamin D receptor (VDR) polymorphisms to coronary artery disease (CAD) reached controversial results. We performed this study for a more accurate evaluation between the VDR polymorphisms and CAD susceptibility.

Methods

PubMed, Embase, CNKI, Wan Fang, and VIP databases were searched. The odds ratios (ORs) and 95% confidence intervals (95% CIs) were used to evaluate the associations. Trial sequential analysis (TSA) was introduced to estimate the positive associations. The potential functions of the VDR polymorphisms were analyzed based on the SNPinfo and ENSEMBL databases.

Results

Thirteen studies were finally included. In the overall analysis, increased CAD risks were observed in the VDR rs1544410 polymorphism and verified by the TSA; for the rs2228570 and rs731236 polymorphisms, significant associations with high heterogeneity were detected; decreased risk was remarkably observed for the rs7975232 polymorphism. In the subgroup analysis, wide associations with reduced heterogeneity were observed in the rs2228570, rs1544410, and rs731236 polymorphisms. The RNAfold analysis indicated the mutant G allele of the rs1544410 polymorphism was easier to disperse from the DNA double helix structure and may have a potential crucial role in the VDR transcription process.

Conclusions

Our analysis supports the role of the rs1544410 polymorphism in the VDR gene as a risk factor for CAD. The VDR rs2228570 and rs731236 polymorphisms were associated with increased CAD risks in the White population. Restrict decreased CAD risk was firstly discovered in the rs7975232 polymorphism.

Limitations

Firstly, the language was restricted to English and Chinese, which will cause the limited number of studies included; secondly, other unknown polymorphisms in VDR polymorphisms could also be associated the CAD susceptibility, and more case-control studies with comprehensive clinical outcomes and GWAS studies were required; thirdly, the rs1544410, rs7975232 and rs731236 polymorphism are in strong LD, haploid factors with CAD risk need to be considered; fourthly, the mechanisms of the VDR polymorphism on the VDR gene or RNA or protein were not discussed enough, further mechanistic studies are required; at last, genetic factor was the one side for CAD susceptibility, the interaction between environmental risk factors should be considered.

Dysfunction of resolution receptor triggers cardiomyopathy of obesity and signs of non-resolving inflammation in heart failure

Heart failure with preserved ejection fraction (HFpEF) has been an emerging type of cardiac disease since the pseudo-left ventricle function is preserved; therefore, challenges in finding the target and treatment. Damage and pathogen-associated molecular patterns (DAMPs and PAMPs) are widely investigated in acute and chronic inflammation in heart failure; however, lifestyle-associated molecular patterns (LAMPs: diet, sleep, exercise), particularly in obesity, remains of interest due to the enormous increase of HFpEF patients. In this review, we covered obesity-related cardiomyopathy, LAMPs, and resolution receptor dysfunction in the context of heart failure with preserved ejection fraction.