Aging and Cardiovascular Disease: Current Status and Challenges

Ruptured AAA: bridging the gap between international guidelines and local clinical realities

BACKGROUND

Treatment of asymptomatic Abdominal Aortic Aneurysms (AAA) presents a clinical challenge, requiring a delicate balance between rupture risk, patient comorbidities, and intervention-related complications. International guidelines recommend intervention for specific AAA size thresholds, but these are based on historical trials with limited female representation. We aimed to analyse disease characteristics, AAA size at rupture, and intervention outcomes in patients with ruptured AAA from 2009 to 2023 to investigate the gap between guidelines and local realities.

METHODS

This single-centre retrospective cohort study analysed electronic health records of patients treated for a ruptured AAA, excluding those who were managed palliatively. The study assessed patients' demographics, risk factors, comorbidities, clinical presentation, radiological characteristics, and outcomes.

RESULTS

Of 164 patients (41 females, 123 males, median age 73.5), 93.3% presented with abdominal or back pain. The median AAA size at rupture was 8.0 cm in males and 7.6 cm in females. No significant correlations were found between demographic characteristics, risk factors, AAA size, repair modality, and outcomes. Trends show a decline in AAA prevalence and rupture rates, aligning with global health initiatives. Post-intervention survival rates at 30 days were 70.7% (67.5% in males and 80.0% in females), and at 2 years were 65.85% (61.7% in males and 70.0% in females).

CONCLUSION

Evolving AAA trends and improved post-intervention survival rates warrant a critical reassessment of existing intervention recommendations. Adjusting intervention thresholds to larger sizes may be justified to optimise the risk-benefit ratio.

Elucidating the role of chemokines in inflammaging associated atherosclerotic cardiovascular diseases

Age-related inflammation or inflammaging is a critical deciding factor of physiological homeostasis during aging. Cardiovascular diseases (CVDs) are exquisitely associated with aging and inflammation and are one of the leading causes of high mortality in the elderly population. Inflammaging comprises dysregulation of crosstalk between the vascular and cardiac tissues that deteriorates the vasculature network leading to development of atherosclerosis and atherosclerotic-associated CVDs in elderly populations. Leukocyte differentiation, migration and recruitment holds a crucial position in both inflammaging and atherosclerotic CVDs through relaying the activity of an intricate network of inflammation-associated protein-protein interactions. Among these interactions, small immunoproteins such as chemokines play a major role in the progression of inflammaging and atherosclerosis. Chemokines are actively involved in lymphocyte migration and severe inflammatory response at the site of injury. They relay their functions via chemokine-G protein-coupled receptors-glycosaminoglycan signaling axis and is a principal part for the detection of age-related atherosclerosis and related CVDs. This review focuses on highlighting the detailed intricacies of the effects of chemokine-receptor interaction and chemokine oligomerization on lymphocyte recruitment and its evident role in clinical manifestations of atherosclerosis and related CVDs. Further, the role of chemokine mediated signaling for formulating next-generation therapeutics against atherosclerosis has also been discussed.

A prospective cohort study on the effect of lipid accumulation product index on the incidence of cardiovascular diseases

BACKGROUND

Cardiovascular disease (CVD) is a chronic disease with a serious prognosis, and obesity is a risk factor for CVD. Lipid accumulation product index (LAP) is a new indicator of obesity, waist circumference, and triglycerides were included in the formula, but its association with CVD is inconsistent. Therefore, this study researched the effect of LAP levels on CVD.

METHODS

This prospective cohort study was based on the Kailuan cohort. A total of 95,981 participants who completed the first physical examination in 2006 and had no history of CVD or LAP absence were included. The participants were divided into four groups according to the LAP quartile (Q1 - Q4). Up until December 31, 2022, incidence density was calculated for each group. The hazard ratio (HR) and 95% confidence interval (CI) of CVD in each group were calculated by the Cox proportional hazards model.

RESULTS

During a median follow-up period of 15.95 years, 9925 incident CVD events occurred (2123 myocardial infarction and 8096 stroke). There were differences in potential confounders among the four groups (P < 0.001). The incidence density and 95% CI of CVD in Q1-Q4 groups were 4.76(4.54, 5.00), 6 0.50(6.24, 6.77), 8.13(7.84, 8.44) and 9.34(9.02, 9.67), respectively. There were significant differences in the survival curves among the four groups by log-rank test (P < 0.001). After adjusting for potential confounders, Cox proportional hazards model results showed that compared with the Q1 group, the HR and 95% CI of CVD in the Q2, Q3, and Q4 groups were1.15(1.08, 1.23), 1.29(1.21, 1.38) and 1.39(1.30, 1.49), respectively. The HR and 95%CI of myocardial infarction were 1.28(1.10, 1.49), 1.71(1.47, 1.98) and 1.92(1.64, 2.23), respectively. The HR and 95%CI of stroke were 1.11 (1.03, 1.19), 1.20 (1.12, 1.29) and 1.28 (1.19, 1.38), respectively. After subgroup analysis by gender, there was no significant interaction (P = 0.169), and the relationship between LAP and CVD in different genders was consistent with the main results. After subgroup analysis by age, there was a significant interaction (P = 0.007), and the association between LAP and CVD in different age groups was consistent with the main results. After subgroup analysis by BMI, there was no significant interaction (P = 0.506), and the association between LAP and CVD in different BMI groups was consistent with the main results. The results remained robust after sensitivity analyses. For each unit increase in ln(LAP), the HR and 95%CI of CVD were 4.07 (3.92, 4.23).

CONCLUSION

This study demonstrated that the risk of CVD increased with the increase of LAP level. The risk of CVD in group Q2 - Q4 was 1.15, 1.29, and 1.39 times higher than that in group Q1, respectively.

CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR2000029767.

Molecular mechanisms of aging and anti-aging strategies

Aging is a complex and multifaceted process involving a variety of interrelated molecular mechanisms and cellular systems. Phenotypically, the biological aging process is accompanied by a gradual loss of cellular function and the systemic deterioration of multiple tissues, resulting in susceptibility to aging-related diseases. Emerging evidence suggests that aging is closely associated with telomere attrition, DNA damage, mitochondrial dysfunction, loss of nicotinamide adenine dinucleotide levels, impaired macro-autophagy, stem cell exhaustion, inflammation, loss of protein balance, deregulated nutrient sensing, altered intercellular communication, and dysbiosis. These age-related changes may be alleviated by intervention strategies, such as calorie restriction, improved sleep quality, enhanced physical activity, and targeted longevity genes. In this review, we summarise the key historical progress in the exploration of important causes of aging and anti-aging strategies in recent decades, which provides a basis for further understanding of the reversibility of aging phenotypes, the application prospect of synthetic biotechnology in anti-aging therapy is also prospected.

Research on the assignment of elderly care service personnel with time window constraints

As the population continues to age, there is a growing need for elderly care services. In China, home care is widely embraced as a preferred method of caring for the elderly, and it has a promising commercial outlook. The strategic allocation of Elderly Care Service Personnel (ECSP) is a crucial component of the operational procedures for home care services. By strategically assigning elderly service personnel, it is possible to enhance the satisfaction and simultaneously minimize expenses. The issue of rationalizing the assignment of ECSP in the face of restricted resources is a genuine challenge that requires a solution, given the many types of elderly service demands and the skill requirements and time limits of certain projects. This study presents a strategy for assigning personnel on an hourly basis, taking into account time frame limits. This method involves several steps. Firstly, it involves assessing the specific service needs of the elderly, including the required door-to-door service time, service level, and gender preferences. Secondly, it calculates the service satisfaction and service operation cost of the Home Care Service Platform (HCSP) separately. Finally, it constructs a multi-objective elderly service personnel assignment method. This method aims to minimize the ECSP 's travel time and wasted time, maximize the satisfaction of the elderly by considering priority levels and ECSP scores, and minimize the operation cost of the HCSP. A model is developed to assign ECSP for elderly individuals, with the goal of minimizing travel time and wasted time, maximizing elderly satisfaction by considering priority and service personnel rating, and minimizing operating costs for the HCSP. Additionally, if there are unserved elderly individuals, an optimized path model is constructed using a cross-modified genetic algorithm to obtain the optimal matching result. Ultimately, an arithmetic example is employed to demonstrate the practicality and efficiency of the strategy put forth in this research. The findings demonstrate that the model presented in this research possesses distinct advantages in comparison to other conventional models.

The Impact of Long Noncoding RNAs in Tissue Regeneration and Senescence

Overcoming senescence with tissue engineering has a promising impact on multiple diseases. Here, we provide an overview of recent studies in which cellular senescence was inhibited through the up/downregulation of specific lncRNAs. This approach prevented senescence in the bones, joints, nervous system, heart, and blood vessels, with a potential impact on regeneration and the prevention of osteoarthritis and osteoporosis, as well as neurodegenerative and cardiovascular diseases. Senescence of the skin and liver could also be prevented through the regulation of cellular levels of specific lncRNAs, resulting in the rejuvenation of cells from these organs and their potential protection from disease. From these exciting achievements, which support tissue regeneration and are not restricted to stem cells, we propose lncRNA regulation through RNA or gene therapies as a prospective preventive and therapeutic approach against aging and multiple aging-related diseases.

Cells in Atherosclerosis: Focus on Cellular Senescence from Basic Science to Clinical Practice

Aging is a major risk factor of atherosclerosis through different complex pathways including replicative cellular senescence and age-related clonal hematopoiesis. In addition to aging, extracellular stress factors, such as mechanical and oxidative stress, can induce cellular senescence, defined as premature cellular senescence. Senescent cells can accumulate within atherosclerotic plaques over time and contribute to plaque instability. This review summarizes the role of cellular senescence in the complex pathophysiology of atherosclerosis and highlights the most important senotherapeutics tested in cardiovascular studies targeting senescence. Continued bench-to-bedside research in cellular senescence might allow the future implementation of new effective anti-atherosclerotic preventive and treatment strategies in clinical practice.

Length of hospital stay for elective electrophysiological procedures: a survey from the European Heart Rhythm Association

AIMS

Electrophysiological (EP) operations that have traditionally involved long hospital lengths of stay (LOS) are now being undertaken as day case procedures. The coronavirus disease-19 pandemic served as an impetus for many centres to shorten LOS for EP procedures. This survey explores LOS for elective EP procedures in the modern era.

METHODS AND RESULTS

An online survey consisting of 27 multiple-choice questions was completed by 245 respondents from 35 countries. With respect to de novo cardiac implantable electronic device (CIED) implantations, day case procedures were reported for 79.5% of implantable loop recorders, 13.3% of pacemakers (PMs), 10.4% of implantable cardioverter defibrillators (ICDs), and 10.2% of cardiac resynchronization therapy (CRT) devices. With respect to CIED generator replacements, day case procedures were reported for 61.7% of PMs, 49.2% of ICDs, and 48.2% of CRT devices. With regard to ablations, day case procedures were reported for 5.7% of atrial fibrillation (AF) ablations, 10.7% of left-sided ablations, and 17.5% of right-sided ablations. A LOS ≥ 2 days for CIED implantation was reported for 47.7% of PM, 54.5% of ICDs, and 56.9% of CRT devices and for 54.5% of AF ablations, 42.2% of right-sided ablations, and 46.1% of left-sided ablations. Reimbursement (43-56%) and bed availability (20-47%) were reported to have no consistent impact on the organization of elective procedures.

CONCLUSION

There is a wide variation in the LOS for elective EP procedures. The LOS for some procedures appears disproportionate to their complexity. Neither reimbursement nor bed availability consistently influenced LOS.

Recent development of piezoelectric biosensors for physiological signal detection and machine learning assisted cardiovascular disease diagnosis

As cardiovascular disease stands as a global primary cause of mortality, there has been an urgent need for continuous and real-time heart monitoring to effectively identify irregular heart rhythms and to offer timely patient alerts. However, conventional cardiac monitoring systems encounter challenges due to inflexible interfaces and discomfort during prolonged monitoring. In this review article, we address these issues by emphasizing the recent development of the flexible, wearable, and comfortable piezoelectric passive sensor assisted by machine learning technology for diagnosis. This innovative device not only harmonizes with the dynamic mechanical properties of human skin but also facilitates continuous and real-time collection of physiological signals. Addressing identified challenges and constraints, this review provides insights into recent advances in piezoelectric cardiac sensors, from devices to circuit systems. Furthermore, this review delves into the integration of machine learning technologies, showcasing their pivotal role in facilitating continuous and real-time assessment of cardiac status. The synergistic combination of flexible piezoelectric sensor design and machine learning holds substantial potential in automating the detection of cardiac irregularities with minimal human intervention. This transformative approach has the power to revolutionize patient care paradigms.

Global burden of cardiovascular disease from 1990 to 2019 attributable to dietary factors

BACKGROUND

While dietary factors play a crucial role in the incidence of cardiovascular disease, the specific dietary risk factors vary across regions and require further investigation.

OBJECTIVE

The burden of cardiovascular disease (CVD) due to different dietary factors was analyzed by determining sex, age, and sociodemographic index (SDI) values for 204 countries and territories between 1990 and 2019.

METHODS

Data were extracted from the Global Burden of Disease (GBD) 2019 and analyzed to determine population attributable fractions (PAFs), mortality, and disability-adjusted life years (DALYs), and trends thereof, for CVDs attributable to dietary risk factors from 1990 to 2019. We used a generalized linear model with a Gaussian distribution to calculate the estimated annual percentage changes (EPACs) in CVD mortality and DALY rates attributable to dietary risk factors. We also used a comparative risk-assessment framework to estimate the CVD mortality and DALYs attributable to dietary risk factors.

RESULTS

Approximately 40% of CVD mortality and DALY rates were attributable to dietary risk factors, with high sodium intake, low whole-grain intake, and low legume intake being the greatest dietary risk factors globally. Moreover, high-SDI regions had the highest PAFs for CVD mortality and DALYs associated with high red and processed meat intake, middle-SDI regions had the highest PAFs with high sodium intake, and low-SDI regions had the highest PAFs with low fruit and vegetable intake. The highest PAFs for CVD mortality and DALYs were associated with low whole-grain intake in 13 and 9 regions, respectively.

CONCLUSION

Reducing sodium intake and increasing whole-grain and legume intake should be the top priority worldwide for improving regional diets and thereby decreasing CVD burdens. Other priorities should be set for different SDI-value regions, depending on the predominant dietary risk factors for CVDs in the respective regions.

A Novel Master-Slave Interventional Surgery Robot with Force Feedback and Collaborative Operation

In recent years, master-slave vascular robots have been developed to address the problem of radiation exposure during vascular interventions for surgeons. However, the single visual feedback reduces surgeon immersion and transparency of the system. In this work, we have developed a haptic interface based on the magnetorheological fluid (MRF) on the master side. The haptic interface can provide passive feedback force with high force fidelity and low inertia. Additionally, the manipulation of the master device does not change the operating posture of traditional surgery, which allows the surgeon to better adapt to the robotic system. For the slave robot, the catheter and guidewire can be navigated simultaneously which allows the two degrees of action on the catheter and axial action of a guidewire. The resistance force of the catheter navigation is measured and reflected to the user through the master haptic interface. To verify the proposed master-slave robotic system, the evaluation experiments are carried out in vitro, and the effectiveness of the system was demonstrated experimentally.

Modulatory Effect of Lifestyle-Related, Environmental and Genetic Factors on Paraoxonase-1 Activity: A Review

Paraoxonase-1 (PON1) is a calcium-dependent, HDL-bound serum hydrolase active toward a wide variety of substrates. PON1 displays three types of activities, among which lactonase, paraoxonase, arylesterase and phosphotriesterase can be distinguished. Not only is this enzyme a major organophosphate compound detoxifier, but it is also an important constituent of the cellular antioxidant system and has anti-inflammatory and antiatherogenic functions. The concentration and activity of PON1 is highly variable among individuals, and these differences can be both of genetic origin and be a subject of epigenetic regulation. Owing to the fact that, in recent decades, the exposure of humans to an increasing number of different xenobiotics has been continuously rising, the issues concerning the role and activity of PON1 shall be reconsidered with particular attention to growing pharmaceuticals intake, dietary habits and environmental awareness. In the following manuscript, the current state of knowledge concerning the influence of certain modifiable and unmodifiable factors, including smoking, alcohol intake, gender, age and genotype variation on PON1 activity, along with pathways through which these could interfere with the enzyme's protective functions, is presented and discussed. Since exposure to certain xenobiotics plays a key role in PON1 activity, the influence of organophosphates, heavy metals and several pharmaceutical agents is also specified.

Association of Health Literacy With the Prevalence of Cardiovascular Diseases and Their Risk Factors Among Older Japanese Health Management Specialists

In this study, we aimed to determine the association between health literacy and the development of cardiovascular diseases (CVDs), among an older population. This cross-sectional study was conducted among Japanese health management specialists (N = 593). Higher levels (communicative and critical) of health literacy and CVD risk factors (diabetes mellitus, hypertension, dyslipidemia, and obesity) were measured. The mean patient age was 71.3 years. Logistic regression analyses showed statistically significant associations between higher levels of health literacy and the prevalence of CVDs (β coefficient = -.091, p < .05) and metabolic risk factors (β coefficient = -.084, p < .01). There was a statistically significant association between health literacy and the count of CVDs (and its risk factors) (β coefficients of Poisson regression = -.036, p < .05). The results show health literacy to be fundamentally related to low prevalence of cardiovascular diseases and their associated metabolic risk factors.