Smoking habits and incidence of cardiovascular diseases in men and women: findings of a 12 year follow up among an urban Eastern-Mediterranean population

Expression patterns and clinical value of key m6A RNA modification regulators in smoking patients with coronary artery disease

Even though N6-methyladenosine (m6A) RNA modifications are increasingly being implicated in human disease, their mechanisms are not fully understood in smokers with coronary artery disease (CAD). Thirty m6A-related regulators' expression (MRRE) in CAD individuals (smokers and non-smokers) were analyzed from GEO. Support Vector Machine, random forest, and nomogram models were constructed to assess its clinical value. Consensus clustering, principal component analysis, and ssGSEA were used to construct a full picture of m6A-related regulators in smokers with CAD. Oxygen-glucose deprivation (OGD) and qRT-PCR were used to validate hypoxia's effect on MRRE. A comparison between smokers with CAD and controls revealed lower expression levels of RBM15B, YTHDC2, and ZC3H13. Based on three key MRREs, all models showed good clinical value, and smokers with CAD were divided into two distinct molecular subgroups. The correlations were found between key MRRE and the degree of immune infiltration. Three key MRREs in HUVECs and FMC84 mouse cardiomyocytes were reduced in the OGD group. Through hypoxia, smoking might reduce the expression levels of RBM15B, YTHDC2, and ZC3H13 in smokers with CAD. Our findings provide an important theoretical basis for the treatment of smokers with CAD.

A dynamic nomogram for predicting in-hospital major adverse cardiovascular and cerebrovascular events in patients with both coronary artery disease and atrial fibrillation: a multicenter retrospective study

BACKGROUND AND OBJECTIVE

Patients with both coronary artery disease (CAD) and atrial fibrillation (AF) are at a high risk of major adverse cardiovascular and cerebrovascular events (MACCE) during hospitalization. Accurate prediction of MACCE can help identify high-risk patients and guide treatment decisions. This study was to elaborate and validate a dynamic nomogram for predicting the occurrence of MACCE during hospitalization in Patients with CAD combined with AF.

METHODS

A total of 3550 patients with AF and CAD were collected. They were randomly assigned to a training group and a validation group in a ratio of 7 : 3. Univariate and multivariate analyses were utilized to identify risk factors (P < 0.05). To avoid multicollinearity and overfit of the model, the least absolute shrinkage and selection operator was conducted to further screen the risk factors. Calibration curves, receiver operating characteristic curves, and decision curve analyses are employed to assess the nomogram. For external validation, a cohort consisting of 249 patients was utilized from the Medical Information Mart for Intensive Care IV Clinical Database, version 2.2.

RESULTS

Eight indicators with statistical differences were screened by univariate analysis, multivariate analysis, and the least absolute shrinkage and selection operator method (P < 0.05). The prediction model based on eight risk factors demonstrated good prediction performance in the training group, with an area under the curve (AUC) of 0.838. This performance was also maintained in the internal validation group (AUC = 0.835) and the external validation group (AUC = 0.806). Meanwhile, the calibration curve indicates that the nomogram was well-calibrated, and decision curve analysis revealed that the nomogram exhibited good clinical utility.

CONCLUSION

The nomogram we constructed may aid in stratifying the risk and predicting the prognosis for patients with CAD and AF.

The effect of obesity phenotype changes on cardiovascular outcomes in adults older than 40 years in the prospective cohort of the Tehran lipids and glucose study (TLGS): joint model of longitudinal and time-to-event data

BACKGROUND

Obesity is a worldwide health concern with serious clinical effects, including myocardial infarction (MI), stroke, cardiovascular diseases (CVDs), and all-cause mortality. The present study aimed to assess the association of obesity phenotypes and different CVDs and mortality in males and females by simultaneously considering the longitudinal and survival time data.

METHODS

In the Tehran Lipid and Glucose Study (TLGS), participants older than three years were selected by a multi-stage random cluster sampling method and followed for about 19 years. In the current study, individuals aged over 40 years without a medical history of CVD, stroke, MI, and coronary heart disease were included. Exclusions comprised those undergoing treatment for CVD and those with more than 30% missing information or incomplete data. Joint modeling of longitudinal binary outcome and survival time data was applied to assess the dependency and the association between the changes in obesity phenotypes and time to occurrence of CVD, MI, stroke, and CVD mortality. To account for any potential sex-related confounding effect on the association between the obesity phenotypes and CVD outcomes, sex-specific analysis was carried out. The analysis was performed using packages (JMbayes2) of R software (version 4.2.1).

RESULTS

Overall, 6350 adults above 40 years were included. In the joint modeling of CVD outcome among males, literates and participants with a family history of diabetes were at lower risk of CVD compared to illiterates and those with no family history of diabetes in the Bayesian Cox model. Current smokers were at higher risk of CVD compared to non-smokers. In a logistic mixed effects model, odds of obesity phenotype was higher among participants with low physical activity, family history of diabetes and older age compared to males with high physical activity, no family history of diabetes and younger age. In females, based on the results of the Bayesian Cox model, participants with family history of diabetes, family history of CVD, abnormal obesity phenotype and past smokers had a higher risk of CVD compared to those with no history of diabetes, CVD and nonsmokers. In the obesity varying model, odds of obesity phenotype was higher among females with history of diabetes and older age compared to those with no history of diabetes and who were younger. There was no significant variable associated with MI among males in the Bayesian Cox model. Odds of obesity phenotype was higher in males with low physical activity compared to those with high physical activity in the obesity varying model, whereas current smokers were at lower odds of obesity phenotype than nonsmokers. In females, risk of MI was higher among those with family history of diabetes compared to those with no history of diabetes in the Bayesian Cox model. In the logistic mixed effects model, a direct and significant association was found between age and obesity phenotype. In males, participants with history of diabetes, abnormal obesity phenotype and older age were at higher risk of stroke in the Bayesian Cox model compared to males with no history of diabetes, normal obesity phenotype and younger persons. In the obesity varying model, odds of obesity phenotype was higher in males with low physical activity, family history of diabetes and older age compared to those with high physical activity, no family history of diabetes and who were younger. Smokers had a lower odds of obesity phenotype than nonsmokers. In females, past smokers and those with family history of diabetes were at higher risk of stroke compared to nonsmokers and females with no history of diabetes in the Bayesian Cox model. In the obesity varying model, females with family history of diabetes and older ages had a higher odds of obesity phenotype compared to those with no family history of diabetes and who were younger. Among males, risk of CVD mortality was lower in past smokers compared to nonsmokers in the survival model. A direct and significant association was found between age and CVD mortality. Odds of obesity phenotype was higher in males with a history of diabetes than in those with no family history of diabetes in the logistic mixed effects model.

CONCLUSIONS

It seems that modifications to metabolic disorders may have an impact on the heightened incidence of CVDs. Based on this, males with obesity and any type of metabolic disorder had a higher risk of CVD, stroke and CVD mortality (excluding MI) compared to those with a normal body mass index (BMI) and no metabolic disorders. Females with obesity and any type of metabolic disorder were at higher risk of CVD(, MI and stroke compared to those with a normal BMI and no metabolic disorders suggesting that obesity and metabolic disorders are related. Due to its synergistic effect on high blood pressure, metabolic disorders raise the risk of CVD.

Methods and Annotated Data Sets Used to Predict the Gender and Age of Twitter Users: Scoping Review

BACKGROUND

Patient health data collected from a variety of nontraditional resources, commonly referred to as real-world data, can be a key information source for health and social science research. Social media platforms, such as Twitter (Twitter, Inc), offer vast amounts of real-world data. An important aspect of incorporating social media data in scientific research is identifying the demographic characteristics of the users who posted those data. Age and gender are considered key demographics for assessing the representativeness of the sample and enable researchers to study subgroups and disparities effectively. However, deciphering the age and gender of social media users poses challenges.

OBJECTIVE

This scoping review aims to summarize the existing literature on the prediction of the age and gender of Twitter users and provide an overview of the methods used.

METHODS

We searched 15 electronic databases and carried out reference checking to identify relevant studies that met our inclusion criteria: studies that predicted the age or gender of Twitter users using computational methods. The screening process was performed independently by 2 researchers to ensure the accuracy and reliability of the included studies.

RESULTS

Of the initial 684 studies retrieved, 74 (10.8%) studies met our inclusion criteria. Among these 74 studies, 42 (57%) focused on predicting gender, 8 (11%) focused on predicting age, and 24 (32%) predicted a combination of both age and gender. Gender prediction was predominantly approached as a binary classification task, with the reported performance of the methods ranging from 0.58 to 0.96 F1-score or 0.51 to 0.97 accuracy. Age prediction approaches varied in terms of classification groups, with a higher range of reported performance, ranging from 0.31 to 0.94 F1-score or 0.43 to 0.86 accuracy. The heterogeneous nature of the studies and the reporting of dissimilar performance metrics made it challenging to quantitatively synthesize results and draw definitive conclusions.

CONCLUSIONS

Our review found that although automated methods for predicting the age and gender of Twitter users have evolved to incorporate techniques such as deep neural networks, a significant proportion of the attempts rely on traditional machine learning methods, suggesting that there is potential to improve the performance of these tasks by using more advanced methods. Gender prediction has generally achieved a higher reported performance than age prediction. However, the lack of standardized reporting of performance metrics or standard annotated corpora to evaluate the methods used hinders any meaningful comparison of the approaches. Potential biases stemming from the collection and labeling of data used in the studies was identified as a problem, emphasizing the need for careful consideration and mitigation of biases in future studies. This scoping review provides valuable insights into the methods used for predicting the age and gender of Twitter users, along with the challenges and considerations associated with these methods.

The New FibroScan-AST (FAST) Score: Enhancing Diabetes Mellitus Impact on Metabolic-Associated Fatty Liver Disease

Background

Metabolic-associated fatty liver disease (MAFLD) is an increasingly prevalent cause of chronic liver disease. In 2020, the FibroScan-AST (FAST) score was internationally validated as a new tool able to identify patients with steatohepatitis who benefit the most from further therapies, based on liver transient elastography (LTE) findings and serum levels of aspartate aminotransferase (AST). We aimed to identify, in MAFLD patients, which metabolic features may predict a higher FAST score.

Methods

Retrospective study of consecutive patients with MAFLD submitted to LTE for two consecutive years. Patients without an AST sample collected within 6 months of the LTE were excluded. FAST score was calculated, stratifying the patient's risk as low (<0.35), medium (0.35-0.67), or high (>0.67).

Results

The sample included 117 patients, 53.0% of the female gender, with a mean age of 53 years. On multivariate analysis, patients with type 2 diabetes (T2DM) (p < 0.001), dyslipidemia (p = 0.046), and smoking habits (p = 0.037) presented with significantly higher FAST score values. Furthermore, diabetic patients did not only present significantly higher FAST scores but were also more frequently assigned to the high-risk group according to FAST score criteria (OR = 9.2; 95% CI = 1.8-45.5; p = 0.007).

Conclusions

Calculating the FAST score, patients with T2DM presented a significantly higher risk of having significant fibrosis and steatohepatitis. Physicians may rely on this validated instrument to more easily identify which patients with T2DM and MAFLD benefit the most from a specialized follow-up.

Nicotine Impairs the Anti-Contractile Function of Perivascular Adipose Tissue by Inhibiting the PPARγ-Adiponectin-AdipoR1 Axis

Nicotine is an addictive compound found in cigarette smoke that leads to vascular dysfunction and cardiovascular diseases. Perivascular adipose tissue (PVAT) exerts an anti-contractile effect on the underlying vasculature through the production of adipokines, such as adiponectin, which acts on adiponectin receptors 1 (adipoR1) to cause vasorelaxation. Peroxisome proliferator-activated receptor gamma (PPARγ) is a transcription factor that regulates adiponectin gene expression and PVAT development. This study aimed to determine the effect of nicotine on the anti-contractile function of PVAT via the PPARγ-adiponectin-adipoR1 axis. Male Sprague Dawley rats were divided into a control group (given normal saline), a nicotine group (given 0.8 mg/kg of nicotine), and a nicotine + PPARγ agonist group (given nicotine and 5 mg/kg of telmisartan). Thoracic aorta PVAT was harvested after 21 days of treatment. The results showed that nicotine reduced the anti-contractile effect of PVAT on the underlying thoracic aorta. Nicotine also decreased the gene and protein expression of PPARγ, adiponectin, and adipoR1 in PVAT. Treatment with telmisartan restored the anti-contractile effect of PVAT and increased the gene and protein expression of PPARγ, adiponectin, and adipoR1 in PVAT. In conclusion, nicotine attenuates the anti-contractile function of PVAT through inhibition of the PPARγ-adiponectin-adipoR1 axis.

The Pandemic of Coronary Heart Disease in the Middle East and North Africa: What Clinicians Need to Know

PURPOSE OF REVIEW

Coronary heart disease (CHD) is the leading cause of morbidity, mortality, and disability in the Middle East and North Africa (MENA). While the prevention, diagnosis, and management of CHD have been detailed in international guidelines, we aimed in this review to quantify the pandemic of CHD in the MENA region and highlight regional patient characteristics, clinical challenges, and future directions to optimize CHD care in the region.

RECENT FINDINGS

Patients with CHD in the MENA feature younger age at presentation and worse prognosis in women. Despite the high burden of CHD risk factors, many of these factors remain underrecognized, undertreated, and uncontrolled. Additionally, CHD care is hampered by poor patient awareness, inefficient preventive strategies, and limited access to guideline-recommended therapeutics. All stakeholders involved in healthcare should work together to develop and execute strategies aimed at tackling the burden of CHD in the MENA.

Epidemiological Trends in Cardiovascular Disease Mortality Attributable to Modifiable Risk Factors and Its Association with Sociodemographic Transitions across BRICS-Plus Countries

BRICS-Plus countries (Brazil, Russia, India, China, South Africa, and 30 other countries) is a group of 35 countries with emerging economies making up more than half of the world's population. We explored epidemiological trends of cardiovascular disease (CVD) mortality attributable to modifiable risk factors and its association with period and birth cohort effects and sociodemographic index (SDI) across BRICS-Plus countries by using joinpoint regression and age-period-cohort modeling from 1990 to 2019. Between 1990 and 2019, the all-ages CVD deaths increased by 85.2% (6.1 million to 11.3 million) across BRICS-Plus countries. The CVD age-standardized mortality rate attributable to dietary risks and smoking significantly decreased across BRICS-Plus countries, with some exceptions. However, four-fifths of BRICS-Plus countries observed a remarkable increasing trend of high body mass-index (BMI)-related CVD deaths, in particular, among younger adults (25-49 years). Early birth cohorts and individuals aged greater than 50 years showed a higher risk of CVD mortality. Both the China-ASEAN FTA and Mercosur regions stand out for their successful sociodemographic transition, with a significant reduction in CVD mortality over the study period. Singapore and Brazil achieved great progress in CVD mortality reduction and the other BRICS-Plus countries should follow their lead in adopting public health policies and initiatives into practice.

Relationship between hypertension and smoking: A preliminary study in South Kashmiri population of J&K

Background

Smoking has been found to have a profound effect on mortality and cause-specific cardiovascular events in hypertension with significant interactions between the effects of smoking and hypertension and diabetes. Nevertheless, smoking is a major modifiable risk factor for cardiovascular disease (CVD).

Materials and Methods

The present study was conducted on the patients visiting the medical Out Patient Department, Government Medical College (OPD GMC), Anantnag, for consultation with an aim to find whether smoking can be linked with CVD as a cause. A total of 304 patients were observed during this period for health check-ups.

Results

The result reveals that 90% of male subjects across the age groups formulated in this study were in habit of smoking. In addition, 75% of female subjects across all age groups were also found to be in the habit of smoking. The majority of subjects including male subjects were potentially susceptible to CVD. The present prospective study was carried out to assess the role of smoking in causing hypertension and thereby various CVDs among the south Kashmiri population with high blood pressure levels in presence of high smoking rates.

Discussions

Smoking acutely exerts a hypertensive effect, mainly through the stimulation of the sympathetic nervous system. Chronic smoking affecting arterial stiffness and wave reflection has greater detrimental effect on central blood pressure, which is more closely related to target organ damage than brachial blood pressure. Hypertensive smokers are more likely to develop severe forms of hypertension, including malignant and renovascular hypertension, an effect likely due to accelerated atherosclerosis.

Conclusion

Smoking is potentially a leading cause of CVD among the South Kashmiri Population with high blood pressure levels in presence of high-smoking rates. Therefore, imperative measures regarding cessation of smoking are essential to prevent CVD which in line with clinical practice guidelines and policies should be emphasized to treat nicotine addiction in smokers by incorporating multicomponent and multilevel approaches for the better management of BP among the population studied.

Smoking is associated with lower brain volume and cognitive differences: A large population analysis based on the UK Biobank

The evidence about the association of smoking with both brain structure and cognitive functions remains inconsistent. Using structural magnetic resonance imaging from the UK Biobank (n = 33,293), we examined the relationships between smoking status, dosage, and abstinence with total and 166 regional brain gray matter volumes (GMV). The relationships between the smoking parameters with cognitive function, and whether this relationship was mediated by brain structure, were then investigated. Smoking was associated with lower total and regional GMV, with the extent depending on the frequency of smoking and on whether smoking had ceased: active regular smokers had the lowest GMV (Cohen's d = -0.362), and former light smokers had a slightly smaller GMV (Cohen's d = -0.060). The smaller GMV in smokers was most evident in the thalamus. Higher lifetime exposure (i.e., pack-years) was associated with lower total GMV (β = -311.84, p = 8.35 × 10-36). In those who ceased smoking, the duration of abstinence was associated with a larger total GMV (β = 139.57, p = 2.36 × 10-08). It was further found that reduced cognitive function was associated with smoker parameters and that the associations were partially mediated by brain structure. This is the largest scale investigation we know of smoking and brain structure, and these results are likely to be robust. The findings are of associations between brain structure and smoking, and in the future, it will be important to assess whether brain structure influences smoking status, or whether smoking influences brain structure, or both.

Exploring the impact of particulate matter on mortality in coastal Mediterranean environments

Air pollution is one of the most important problems the world is facing nowadays, adversely affecting public health and causing millions of deaths every year. Particulate matter is a criteria pollutant that has been linked to increased morbidity, as well as all-cause and cause-specific mortality. However, this association remains under-investigated in smaller-size cities in the Eastern Mediterranean, which are also frequently affected by heat waves and dust storms. This study explores the impact of particulate matter with an aerodynamic diameter ≤ 10 μm (PM₁₀) and ≤ 2.5 μm (PM_2.5) on mortality (all-cause, cardiovascular, respiratory) in two coastal cities in the Eastern Mediterranean; Thessaloniki, Greece and Limassol, Cyprus. Generalized additive Poisson models were used to explore overall and gender-specific associations, controlling for long- and short-term patterns, day of week and the effect of weather variables. Moreover, the effect of different lags, season, co-pollutants and dust storms on primary associations was investigated. A 10 μg/m³ increase in PM_2.5 resulted in 1.10 % (95 % CI: -0.13, 2.34) increase in cardiovascular mortality in Thessaloniki, and in 3.07 % (95 % CI: -0.90, 7.20) increase in all-cause mortality in Limassol on the same day. Additionally, significant positive associations were observed between PM_2.5 as well as PM₁₀ and mortality at different lags up to seven days. Interestingly, an association with dust storms was observed only in Thessaloniki, having a protective effect, while the gender-specific analysis revealed significant associations only for the males in both cities. The outcome of this study highlights the need of city- or county-specific public health interventions to address the impact of climate, population lifestyle behaviour and other socioeconomic factors that affect the exposure to air pollution and other synergistic effects that alter the effect of PM on population health.

Prevalence and associated factors of cardiovascular diseases among men and women aged 45 years and above: Analysis of the longitudinal ageing study in India, 2017-2019

OBJECTIVE

Epidemiological studies on the prevalence and associated factors of cardiovascular diseases (CVDs) representative of all states of India among middle-aged and elderly are not much reported. The present study estimates the prevalence and associated factors of cardiovascular diseases across Indian states among men and women aged ≥45 years.

METHODS

We used data from the Longitudinal Ageing Study in India wave 1 (2017-2019), which included a final analytical sample size of 56,935 adults and their spouses aged 45 years and above. We estimated CVDs prevalence for sociodemographic and behavioural variables, and multivariable logistic regression was used to assess the association between behavioural factors and CVDs in both men and women.

RESULTS

The prevalence of CVDs was 5.2% among adults ≥45 years (women: 4.6%; men: 5.9%), hypertension was 46.7% (women:48.9%; men:44%). Men and women have a similar prevalence of diabetes (11.9%) and cholesterol (2.3%). Prevalence of physical inactivity was 30.3% (women:27%; men:34.1%). Hypertension (adjusted odds ratio; aOR women:2.60, 95% CI: 2.08-3.25, men:1.88, 95% CI 1.54-2.29), hypercholesterolemia (aOR women:1.70; 95% CI 1.07-2.69, men 3.55; 95% CI 2.66-4.74), diabetes (aOR women:2.53; 95% CI 1.83-3.51, men:1.77 95% CI 1.44-2.17), obesity, physical inactivity, and smoking in men were significantly associated with CVDs.

CONCLUSION

The prevalence of CVDs and lifestyle risk factors among middle-aged and elderly poses severe concerns regarding noncommunicable disease (NCD) healthcare services provided in a lower-middle-income country like India. The key to preventing CVDs is controlling hypertension, diabetes, hypercholesterolemia, and increasing physical activity among adults aged ≥45 years.

Gender dimension in cardio-pulmonary continuum

Cardio-pulmonary diseases, which were once regarded as a man's illness, have been one of the leading causes of morbidity and mortality for both men and women in many countries in recent years. Both gender and sex influence the functional and structural changes in the human body and therefore play an important role in disease clinical manifestation, treatment choice, and/or response to treatment and prognosis of health outcomes. The gender dimension integrates sex and gender analysis in health sciences and medical research, however, it is still relatively overlooked suggesting the need for empowerment in the medical research community. Latest advances in the field of cardiovascular research have provided supportive evidence that the application of biological variables of sex has led to the understanding that heart disease in females may have different pathophysiology compared to males, particularly in younger adults. It has also resulted in new diagnostic techniques and a better understanding of symptomatology, while gender analysis has informed more appropriate risk stratification and prevention strategies. The existing knowledge in the pulmonary field shows the higher prevalence of pulmonary disorders among females, however, the role of gender as a socio-cultural construct has yet to be explored for the implementation of targeted interventions. The purpose of this review is to introduce the concept of gender dimension and its importance for the cardiopulmonary continuum with a focus on shared pathophysiology and disease presentation in addition to interrelation with chronic kidney disease. The review presents basic knowledge of what gender dimension means, and the application of sex and gender aspects in cardiovascular medicine with a specific focus on early pulmonary development, pulmonary hypertension, and chronic obstructive pulmonary disease (COPD). Early vascular aging and inflammation have been presented as a potential pathophysiological link, with further interactions between the cardiopulmonary continuum and chronic kidney disease. Finally, implications for potential future research have been provided to increase the impact of gender dimension on research excellence that would add value to everybody, foster toward precision medicine and ultimately improve human health.

Learning Needs and Educational Strategies for Adult Patients in the Preoperative Period of Myocardial Revascularization: Scoping Review

Objective: To identify and map learning needs and educational strategies for adult patients in the preoperative period of myocardial revascularization. Materials and method: Scoping review conducted between March and April 2021 in national and international databases to identify records published in scientific journals and gray literature, without period. Results: The selected sample consisted of 35 records, composed mostly of articles (32; 91.42 %) published from 1990 to 2021. The learning needs of patients before surgery were categorized into cardiovascular system and coronary artery disease; procedures and routines before, during, and after surgery. In addition, several educational strategies implemented in the studies were identified. Conclusions: The learning needs identified can contribute to planning and implementing patient-centered educational strategies before surgery.

Cardiovascular Disease Risk Modeling for Astronauts: Making the Leap From Earth to Space

NASA has recently completed several long-duration missions to the International Space Station and is solidifying plans to return to the Moon, with an eye toward Mars and beyond. As NASA pushes the boundaries of human space exploration, the hazards of spaceflight, including space radiation, levy an increasing burden on astronaut health and performance. The cardiovascular system may be especially vulnerable due to the combined impacts of space radiation exposure, lack of gravity, and other spaceflight hazards. On Earth, the risk for cardiovascular disease (CVD) following moderate to high radiation doses is well-established from clinical, environmental, and occupational exposures (largely from gamma- and x-rays). Less is known about CVD risks associated with high-energy charged ions found in space and increasingly used in radiotherapy applications on Earth, making this a critical area of investigation for occupational radiation protection. Assessing CVD risk is complicated by its multifactorial nature, where an individual's risk is strongly influenced by factors such as family history, blood pressure, and lipid profiles. These known risk factors provide the basis for development of a variety of clinical risk prediction models (CPMs) that inform the likelihood of medical outcomes over a defined period. These tools improve clinical decision-making, personalize care, and support primary prevention of CVD. They may also be useful for individualizing risk estimates for CVD following radiation exposure both in the clinic and in space. In this review, we summarize unique aspects of radiation risk assessment for astronauts, and we evaluate the most widely used CVD CPMs for their use in NASA radiation risk assessment applications. We describe a comprehensive dual-use risk assessment framework that supports both clinical care and operational management of space radiation health risks using quantitative metrics. This approach is a first step in using personalized medicine for radiation risk assessment to support safe and productive spaceflight and long-term quality of life for NASA astronauts.

A Signature for Smoking Status of Coronary Heart Disease Patients through Weighted Gene Coexpression Network Analysis

Background. Smoking is one of the risk factors of coronary heart disease (CHD), while its underlying mechanism is less well defined. Purpose. To identify and testify 6 key genes of CHD related to smoking through weighted gene coexpression network analysis (WGCNA), protein-protein interaction (PPI) network analysis, and pathway analysis. Methods. CHD patients’ samples were first downloaded from Gene Expression Omnibus (GEO). Then, genes of interest were obtained after analysis of variance (ANOVA). Thereafter, 23 coexpressed modules that were determined after genes with similar expression were incorporated via WGCNA. The biological functions of genes in the modules were researched by enrichment analysis. Pearson correlation analysis and PPI network analysis were used to screen core genes related to smoking in CHD. Results. The violet module was the most significantly associated with smoking ( $r=-0.28$ , $p=0.006$ ). Genes in this module mainly participated in biological functions related to the heart. Altogether, 6 smoking-related core genes were identified through bioinformatics analyses. Their expressions in animal models were detected through the animal experiment. Conclusion. This study identified 6 core genes to serve as underlying biomarkers for monitoring and predicting smoker’s CHD risk.

The First Cigarette Smoking Experience and Future Smoking Behaviors Among Adolescents with Different Parental Risk: a Longitudinal Analysis in an Urban Iranian Population

BACKGROUND

Longitudinal research among Iranian adolescent smoking is limited. The current study aimed to investigate (1) the first smoking experience (FSE) and future smoking behaviors of adolescents with different parental risk factors and (2) the association between age of the FSE and future smoking behaviors over a 12-year follow-up.

METHOD

Based on Tehran Lipid and Glucose Study (TLGS) database, 1487 adolescents (12-18 years) with complete baseline parental data were recruited. Using two-step cluster analysis, families were classified as either high or low risk; these were based on parental risk factors including age, education, employment, and smoking status. Participants were examined four times in 12 years and their data were used for survival analysis. After exclusion of 24 cases who were smokers at baseline, Cox proportional hazard modeling was used to evaluate the effect of parental clusters on the FSE in 1463 nonsmoking adolescents who completed all prospective follow-ups. Logistic regression analysis was used to examine the effect of the age of FSE on future smoking behaviors.

RESULTS

The mean age of adolescents was 14.63 ± 2.07 years at baseline. Adolescents in the high-risk cluster group were 49% more likely to try smoking for their first time, and 55% more likely to smoke in the future. Compared with girls, boys had 83% higher chance of trying their first cigarette. Moreover, 1-year delay in the FSE resulted in 25% reduction in the probability of smoking in the future.

CONCLUSION

The findings show that compared with adolescents living in low-risk families, teenagers living in high-risk families are at greater risk of smoking at an earlier age; therefore, this group could benefit from gender- and culture specific preventive interventions.

Dose-related effect of secondhand smoke on cardiovascular disease in nonsmokers: Systematic review and meta-analysis

BACKGROUND

Despite the positive association between secondhand smoke (SHS) and cardiovascular diseases (CVD), no comprehensive assessment on the dose-response relationship between SHS and CVD has yet been reported. Therefore, a meta-analysis was conducted to update the binary association, and to elucidate the dose-response relationship of both self-reported and objectively measured SHS exposure with CVD.

METHODS

PubMed and Embase databases were searched for articles published up to November 12, 2019. Random-effects models were used to assess the summary odds ratios (ORs) of CVD with SHS exposure. Restricted cubic splines were used to fit the dose-response relationship.

RESULTS

Fifty-five eligible observational studies were included in this meta-analysis to investigate the association between SHS exposure and CVD. Based on the meta-analysis, the pooled OR of CVD was 1.22 (95% CI 1.17-1.28) for the self-reported SHS individuals as comparing to the non-exposed group. The result of restricted cubic splines showed a risk plateau of SHS exposure at 15 cigarettes per day (P_{non-linearity} = 0.042), while other characteristics s of SHS exposure (amount, daily and cumulative duration, and cotinine) were in linear relationships with CVD (P_{non-linearity} >0.05). In addition, an estimated of 6.77% (95% CI: 5.31%-8.46%) of all CVD cases in men and 7.15% (95% CI: 5.62%-8.93%) in women might be attributed to SHS exposure worldwide.

CONCLUSIONS

Exposure to SHS is associated with an increased risk of CVD regardless of the modes. And thus, well-enforced smoke-free laws could possibly reduce a substantial risk of CVD caused by SHS.

Nicotine in Senescence and Atherosclerosis

Cigarette smoke is a known exacerbator of age-related pathologies, such as cardiovascular disease (CVD), atherosclerosis, and cellular aging (senescence). However, the role of nicotine and its major metabolite cotinine is yet to be elucidated. Considering the growing amount of nicotine-containing aerosol use in recent years, the role of nicotine is a relevant public health concern. A number of recent studies and health education sites have focused on nicotine aerosol-induced adverse lung function, and neglected cardiovascular (CV) impairments and diseases. A critical review of the present scientific literature leads to the hypothesis that nicotine mediates the effects of cigarette smoke in the CV system by increasing MAPK signaling, inflammation, and oxidative stress through NADPH oxidase 1 (Nox1), to induce vascular smooth muscle cell (VSMC) senescence. The accumulation of senescent VSMCs in the lesion cap is detrimental as it increases the pathogenesis of atherosclerosis by promoting an unstable plaque phenotype. Therefore, nicotine, and most likely its metabolite cotinine, adversely influence atherosclerosis.

Short-term effects of particulate matter exposure on emergency room visits for cardiovascular disease in Lanzhou, China: a time series analysis

Cardiovascular disease (CVD) has been the leading cause of death in China. Identifying the relationship between particulate matter (PM) and CVD in China is a significant challenge. In this study, daily CVD emergency room visit, environmental monitoring, and weather data from January 1, 2017, to December 31, 2018, in Lanzhou were collected. Generalized additive models (GAMs) were constructed to estimate the short-term effects of daily PM_2.5, PM_C, and PM₁₀ concentrations on CVD emergency room visits with different lag structures after controlling for the influence of meteorological elements and gaseous pollutants. Stratified analyses were conducted according to age (≥ 65 years and < 65 years), sex (male and female), cold season (from November to April), and warm season (from May to October). The results showed that each 10 μg/m³ increase in PM_2.5 was associated with a 1.93% (95% CI 0.12-3.78%) increase in CVD emergency room visits at lag03, and no single lag model was statistically significant. The excess relative risks (ERRs) of PM₁₀ and PM_C were not statistically significant at any lag pattern. The exposure-response curves demonstrated a nonlinear upward trend for these three PM pollutants. When adjusting for other gaseous pollutants, such as NO₂, SO₂, CO, and O₃, in the two-pollutant models, the associations between PM₁₀ and PM_C and CVD emergency room visits did not change compared with the single-pollutant models. The ERRs of PM_2.5 were 1.67% (95% CI 0.03-3.34%) at lag02 after adjustment for NO₂ and 1.65% (95% CI 0.02-3.30%) at lag02 after adjustment for SO₂. The ERRs of PM_2.5 were still statistically significant at lag03 when we adjusted for any one of the gaseous pollutants. Susceptibility to PM_2.5 was increased in people aged < 65 years, in males, and in the warm season. The findings are very important for local governments to develop environmental policies and strategies to reduce ambient PM_2.5 levels.