Association between cardiometabolic index and depression in a stroke population: a cross-sectional study of NHANES

Vascular depression: A comprehensive exploration of the definition, mechanisms, and clinical challenges

Vascular depression (VaDep), which was proposed over two decades ago, is a distinct subtype of depression primarily observed in patients with stroke and cerebral small-vessel disease and is characterized by white matter hyperintensities; however, the lack of standardized diagnostic criteria and consensus limits its clinical application. This review explores the pathological conditions and vascular risk factors that may precipitate VaDep, particularly in relation to stroke and cerebral small-vessel disease. VaDep is distinguished by unique pathophysiological mechanisms and treatment responses. We categorize these mechanisms into three groups: 1) macroscopic mechanisms, including vascular aging, cerebral hypoperfusion, blood-brain barrier disruption, and neural circuit dysfunction; 2) microscopic mechanisms, involving the inflammatory response, hypothalamic-pituitary-adrenal axis dysregulation, impaired monoamine synthesis, and mitochondrial dysfunction; and 3) undetermined mechanisms, such as microbiota-gut-brain axis dysbiosis. These insights support VaDep as a distinct depression subtype, differentiating it from late-life depression and major depressive disorder. Treatment is challenging, as patients with VaDep often exhibit resistance to conventional antidepressants. Addressing vascular risk factors and protecting vascular integrity are essential for effective management. Future research should validate these mechanisms and develop novel diagnostic and therapeutic approaches to improve VaDep outcomes.

L-shaped correlation between serum alpha-1-acid glycoprotein concentration and urinary albumin creatinine ratio in females: a cross-sectional survey

Background

Alpha-1-acid glycoprotein (AGP) is a vital acute phase reactant that increases when glomerular filtration is impaired, making it a potential biomarker of kidney disease. The urine albumin-to-creatinine ratio (UACR) is a sensitive indicator of proteinuria and is frequently used to screen for kidney disease in its early stage. The aim of this study was to explore their correlation in order to advance our understanding of the mechanisms underlying kidney damage.

Methods

This study included 2579 female participants with serum AGP and UACR from the National Health and Nutrition Examination Survey (2015-2018). We divided all participants equally into three groups based on their serum AGP concentration. The univariate and multivariate regression models were for assessing the correlation between AGP and UACR. Subgroup analyses were then performed to explore the effect of each covariate on the correlation. Smoothing splines was utilized to explore their nonlinear correlation and identify thresholds within it.

Results

After adjusting for multivariate models, AGP was significantly and positively associated with UACR (p<0.0001). The study identified a specific cohort of non-Hispanic Black individuals under 20 years of age, characterized by a BMI below 25 kg/m² and a waist circumference of 80 cm or more. Within this cohort, those with hypertension and sleep disorders but without hypercholesterolemia or diabetes exhibited significantly higher UACR (p < 0.001). Furthermore, we discovered an L-shaped correlation between serum AGP concentration and UACR. Specifically, when the serum AGP concentration was less than 140 mg/dL, the UACR plateaued.

Conclusions

This study is the first to address the correlation between serum AGP and UACR and found an L-shaped correlation with a threshold of 140 mg/dl. This could be a target for intervention to reduce the risk of kidney disease.