Focus on the Most Common Paucisymptomatic Vasculopathic Population, from Diagnosis to Secondary Prevention of Complications

Sexual and Cardiovascular health.Factors Influencing on the Quality of Sexual Life of Coronary Heart Disease Patients - a Narrative Review

Regular sexual activity is comparable to moderate exercise and may be safe for patients with cardiovascular disease (CVD). According to the recommendations of the Princeton III Conference (P3), people with a low risk of adverse cardiac events can undertake sexual activity safely, while other patients must first stabilise their cardiovascular status. Exercise testing is recommended to assess the safety of sexual activity in people with questionable or uncertain cardiac risk (P3). Patients after successful and uncomplicated treatment of myocardial infarction (MI) can return to sexual activity after 3 weeks if the stress test is negative. The 4th Princeton Conference (P4) recommends the use of the 2019 regimen developed by the American College of Cardiology (ACC) and American Heart Association (AHA) to assess the risk of atherosclerotic cardiovascular disease (ASCVD) in men with ED (ACC/AHA ASCVD 2019). Sexual health education plays an important role in the successful return to safe sexual activity, which should include post-MI patients and their relatives. The responsibility for counselling lies with cardiologists, general practitioner (GP) and nursing staff. Sexual rehabilitation should be an integral part of cardiac rehabilitation, and lifestyle modification and optimal treatment of underlying medical conditions are key to maintaining psychophysical well-being and a successful sex life.

Absence of Standard Modifiable Risk Factors in Middle Eastern Patients with Atherosclerotic Cardiovascular Disease. The Jordan Absence of Standard Modifiable Risk Factors (SMuRF-Less) Study

Background

A growing number of individuals develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of the standard modifiable risk factors (hypertension, diabetes, dyslipidemia, and cigarette smoking) (SMuRF-less patients). Prevalence of SMuRF-less patients in the Middle East has not been studied. This study investigates the prevalence, clinical profiles and outcomes of SMuRF-less patients compared with those who have SMuRFs.

Methods

We analyzed data from 6 published registries and from the Jordan SMuRF-less patients study, including baseline demographic features, cardiovascular risk factors, comorbid diseases, utilization of secondary prevention pharmacotherapy and one year outcome in SMuRF-less patients, those with 1-2 SMuRFs and with 3-4 SMuRFs. Results. A total of f 5540 ASCVD patients were enrolled. Mean age was 57.5 ± 11.6 years, and 1333 (24.1%) were women. Of the whole group, 214 (3.9%) were SMuRF-less, 3014 (54.4%) had 1-2 SMuRFs and 2312 (41.7%) had 3-4 SMuRFs. Compared with the SMuRFs groups, SMuRF-less group were younger, more likely to be men, and had lower prevalence of obesity, physical inactivity, metabolic syndrome, heart failure and chronic kidney disease. SMuRF-less patients were less likely to receive secondary prevention cardiovascular medications (antiplatelet agents, statins, renin angiotensin blockers and beta blockers); all p < 0.001. One year survival in the SMuRF-less patients was significantly lower than that in the SMuRFs groups (97.7% vs.98.4% vs.98.3%, respectively, p = 0.01). Multivariate analysis showed that young age, absence of heart failure and utilization of secondary preventive medications were associated with better one year outcome.

Conclusion

In this cohort of ME patients with ASCVD, nearly four in 100 were SMuRF-less. This rate is lower than that reported by most of published studies, mainly due to the high prevalence of the 4 SMuRFs. SMuRF-less patients were younger, had less comorbid disease, received less secondary prevention pharmacotherapy and had higher rate of one year mortality than those with SMuRFs.

Clinical Trials

The study is registered with ClinicalTrials.gov, unique identifier number NCT06199869.

Meta-analysis on the primary approach: Aspiration versus stent retrieval for internal carotid artery occlusion

BACKGROUND

Previous studies have not provided consistent findings regarding the efficacy of aspiration thrombectomy versus stent retriever thrombectomy in patients with acute internal carotid artery occlusion. This study aimed to evaluate the preferable endovascular technique (aspiration or stent retriever) and the impact of stent retriever utilization on both clinical and angiographic outcomes.

METHODS

We collected potential scholarly articles from a variety of databases including the PubMed, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov, and the World Health Organization, International Clinical Trials Registry Platform. The search spanned from the establishment of electronic databases up to March 2024. Additionally, gray literature was sourced from the references cited in the included literature reports. Statistical analysis of the combined data was performed using STATA version 11.0 (Stata Corporation, TX).

RESULTS

Our analysis comprises a total of 4 studies, involving 759 participants in total. Among these individuals diagnosed with internal carotid artery occlusion, 435 were assigned to the aspiration group, while 324 were designated to the stent retriever group. The findings indicated a significant increase in the rate of successful reperfusion in the stent retriever group compared to the aspiration group. Furthermore, it was observed that the incidence of overall complications, intracerebral hemorrhage, embolization formation, puncture to reperfusion time, and onset to reperfusion time in the stent retriever group did not significantly exceed that in the aspiration group.

CONCLUSION

In our review on intracranial internal carotid artery occlusion, stent retrievers outperformed direct aspiration in achieving successful reperfusion. However, further studies evaluating the effects of different approaches to internal carotid artery clot removal are required to confirm these results.

Quality of life and utility of patients with peripheral artery disease (PAD): a systematic review and meta-analysis

Peripheral artery disease (PAD) patients experience low utility, especially those having undergone amputation. Utility is one of the quality weights of health status, converted from quality of life (QOL). This study aimed to systematically review published literature and analyze a pooled estimate of utility in PAD patients. The following databases were queried for articles published from inception up to August 30, 2022: PubMed, ScienceDirect, Scopus, ThaiJo, and the Thai thesis database. Four quality assessment tools were used, tailored to each study's design. A pooled utility was estimated by the random effect and reported using Rutherford and Fontaine classification systems due to their common use in practice. The protocol was registered with the International Prospective Registration of Systematic Reviews (CRD42023392775). Fourteen high-quality studies were included, pooling utility from 3,664 PAD patients. The pooled utility by the Rutherford categories was 0.67, with scores for categories 0, 1-3, 4, and 5 being 0.88, 0.65, 0.68, and 0.58, respectively. The pooled utility by the Fontaine stage was 0.68, with stages 1, 2, 3, and 4 scoring 0.88, 0.65, 0.67, and 0.58, respectively. PAD utility is comparable to that of other chronic diseases. The pooled utility could be a valuable parameter for cost-utility analysis in PAD management.

Study on the Anti-Atherosclerotic Mechanisms of Xin-Tong-Tai Granule Through Network Pharmacology, Molecular Docking, and Experimental Validation

Background

Xin-Tong-Tai Granule (XTTG), a Chinese medicine (CM) formula, has demonstrated significant therapeutic effects on atherosclerosis (AS) in both clinical and experimental settings. Nonetheless, the mechanisms underlying XTTG's efficacy remain largely unexplored. This study aimed to elucidate the mechanisms through which XTTG acts against AS, employing network pharmacology, molecular docking, and experimental validation techniques.

Methods

Initially, target identification for the main chemical components of XTTG was conducted using database, followed by determining the intersection targets between these compounds and disease. Protein-protein interaction (PPI) network analysis, Gene Ontology (GO) enrichment, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were subsequently utilized to investigate the potential pathways through which XTTG exerts its effects on AS. Molecular docking was done to confirm the binding efficacy of XTTG's active components. Additionally, the effects of XTTG were evaluated in vitro using oxidized low-density lipoprotein (ox-LDL) induced human aortic vascular smooth muscle cells (HAVSMCs) and in vivo in apolipoprotein E gene knockout (ApoE-/-) mice fed a high-fat diet (HFD).

Results

229 therapeutic targets were screened for PPI network and enrichment analysis. Notably, the nuclear factor kappa-B (NF-κB) signaling pathway, along with processes related to inflammation and autophagy, were significantly enriched, highlighting their importance. In vitro studies showed that XTTG repressed cell proliferation and lipid droplet aggregation in ox-LDL-induced HAVSMCs. It also decreased the ratio of phosphorylated NF-κB p65/ NF-κB p65, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels, and elevated microtubule-associated protein light chain 3 (LC3) and decreased p62 protein expression. In vivo, XTTG ameliorated blood lipid profiles and aortic pathology in HFD-fed ApoE-/- mice, reduced NF-κB p65 expression and serum levels of TNF-α and IL-6, increased the ratio of LC3II/LC3I while decreasing p62 protein expression.

Conclusion

XTTG mitigates AS primarily through anti-inflammatory and autophagy-modulating mechanisms, particularly via inhibition of NF-κB p65 expression. These findings underscore the potential of CM in treating AS and support its further clinical exploration.

Apolipoprotein E Gene ε4 Allele is Associated with Atherosclerosis in Multiple Vascular Beds

Background

Atherosclerosis is a systemic disease that can involve multiple vascular beds. The risk factors for atherosclerosis in multiple vascular beds remain unclear. Apolipoprotein E (APOE) is involved in inflammation and lipid deposition in the process of atherosclerosis. The objective of this study was to investigate whether APOE polymorphisms are associated with atherosclerosis in multiple vascular beds.

Methods

A total of 416 patients with atherosclerosis in single vascular bed and 658 patients with atherosclerosis in multiple vascular beds were included. APOE genotypes were detected and the differences of APOE genotypes between the groups were compared. Logistic regression analysis was performed to analyze the relationship between APOE genotypes and atherosclerosis in multiple vascular beds.

Results

APOE E3/E4 genotype frequency was lower in the patients with atherosclerosis in multiple vascular beds than that of patients with atherosclerosis in single vascular bed (11.4% vs 17.8%, P=0.004). There was no significant difference in age and gender distribution, proportion of history of smoking, alcohol consumption, hypertension, and diabetes mellitus between the two groups (all P>0.05), and among patients with different APOE alleles (all P>0.05). Logistic regression analysis indicated that APOE E3/E4 genotype (E3/E4 vs E3/E3: odds ratio (OR) 0.598, 95% confidence interval (CI): 0.419-0.854, P=0.005), and APOE ε4 allele (ε4 vs ε3: OR 0.630, 95% CI: 0.444-0.895, P=0.010) associated with atherosclerosis in multiple vascular beds.

Conclusion

APOE ε4 allele is associated with atherosclerosis in multiple vascular beds.

Collaborative teaching among ultrasonographers, anesthesiologists, and vascular surgeons: its unique role in specialty training for vascular surgeons in developing countries

This study explored the unique role of collaborative teaching among ultrasonographers, anesthesiologists, and vascular surgeons in the training of vascular surgeons in developing countries. Using qualitative research methods, data were collected through in-depth interviews and observations to analyze the improvement in ultrasound operational skills and basic anesthesia skills among trainees, as well as their satisfaction with collaborative teaching. The results indicate that collaborative teaching significantly enhances trainees' professional skills and interdisciplinary collaboration abilities, gaining widespread recognition from trainees. This teaching model provides trainees with a comprehensive learning experience through interdisciplinary cooperation, hands-on practice, contributing to the cultivation of vascular surgeons with comprehensive qualities and professional competencies. This study offers new ideas and methods for the training of vascular surgeons in developing countries, holding significant implications for the development of medical education.

Integrated Health Education Programmes With Physical Activity Among Community-Dwelling Older Adults at Risk of Atherosclerotic Cardiovascular Disease: An Integrative Review of Experimental Studies

AIMS

To examine the effects of integrated health education programmes with physical activity among community-dwelling older adults at risk of atherosclerotic cardiovascular disease (ASCVD).

DESIGN

Integrative review.

DATA SOURCES

A systematic search of experimental studies was conducted in six electronic databases and one registry from inception to December 2022.

METHODS

Two researchers independently conducted the eligibility screening, quality appraisal and data extraction. A total of 11 studies, which were published between 1996 and 2021, were included in the review and were analysed by narrative synthesis.

RESULTS

The 11 included studies involved 1973 participants. The findings indicate that integrated health education programmes with physical activity have potential benefit in short-term weight management among community-dwelling older adults at risk of ASCVD. Nevertheless, the programmes appear ineffective on body mass index, short-term lipid profiles, diastolic blood pressure (BP) and blood glucose. Further investigation is recommended to confirm the programme effects on physical activity level, exercise self-efficacy, systolic BP, waist circumference, long-term lipid profiles, long-term weight management and cardiac endurance. The findings suggest that body mass index may not be a sensitive indicator of obesity in the elderly population and should be measured along with waist circumference to better predict the risk of ASCVD. The available evidence is restricted in its robustness and generalisability. As most included studies were conducted in the United States, more studies should be implemented in other countries to enhance study generalisability.

CONCLUSIONS

The effects of integrated health education programmes with physical activity among community-dwelling older adults at risk of ASCVD remain inconclusive. Further research with adequate statistical power and good methodology is warranted.

IMPACT

The findings provide insights into whether health education programmes with physical activity effectively improve various outcomes, and suggest that researchers should include exercise self-efficacy and cardiac endurance in future studies.

REPORTING METHOD

Adhered to PRISMA reporting guidelines.

NO PATIENT OR PUBLIC CONTRIBUTION

This review was conducted without patient or public participation.

Cost-effectiveness of diagnostic imaging modalities in symptomatic patients with lower limb peripheral arterial disease: discrete event simulation model

Objective

Lower limb peripheral arterial disease in the symptomatic stage has a significant effect on patients´ functional disability. Before an intervention, an imaging diagnostic examination is necessary to determine the extent of the disability. This study evaluates cost-effectiveness of duplex ultrasonography (DUS), digital subtraction angiography (DSA), computed tomography angiography (CTA) and magnetic resonance angiography (MRA) in the diagnostics of symptomatic patients with lower limb peripheral arterial disease indicated for endovascular or surgical intervention.

Methods

Discrete event simulation was used to capture lifetime costs and effects. Costs were calculated from the perspective of the health care payer, and the effects were calculated as quality-adjusted life year's (QALY's). The cost-effectiveness analysis was performed to pairwise compare CTA, MRA and DSA with DUS as the baseline diagnostic modality. A scenario analysis and probabilistic sensitivity analysis were carried out to evaluate the robustness of the results.

Results

In the basic case, the DUS diagnostic was the least expensive modality, at a cost of EUR 10,778, compared with EUR 10,804 for CTA, EUR 11,184 for MRA, and EUR 11,460 for DSA. The effects of DUS were estimated at 5.542 QALYs compared with 5.554 QALYs for both CTA and MRA, and 5.562 QALYs for DSA. The final incremental cost-effectiveness ratio (ICER) value of all evaluated modalities was below the cost-effectiveness threshold whereas CTA has the lowest ICER of EUR 2,167 per QALY. However, the results were associated with a large degree of uncertainty, because iterations were spread across all cost-effectiveness quadrants in the probabilistic sensitivity analysis.

Conclusion

For imaging diagnosis of symptomatic patients with lower limb peripheral arterial disease, CTA examination appears to be the most cost-effective strategy with the best ICER value. Baseline diagnostics of the DUS modality has the lowest costs, but also the lowest effects. DSA achieves the highest QALYs, but it is associated with the highest costs.

The Impact of Anxiety and Depression Symptoms on Cardiovascular Risk Factor Control in Patients Without a History of Atherosclerotic Cardiovascular Disease

Background

Anxiety and depression by affecting lifestyle interfere with preventive actions aimed at eliminating or reducing modifiable risk factors for cardiovascular diseases (CVD).

Purpose

The objective of the study was to assess the impact of anxiety and depression on the achievement of therapeutic goals regarding CVD risk factors in patients without a history of atherosclerotic CVD.

Patients and Methods

The study included 200 patients (median age 52.0 [IQR 43.0-60.5] years). Control of the basic risk factors was assessed: blood pressure, BMI, waist circumference, physical activity, smoking status, LDL cholesterol, triglycerides, and blood glucose. The data analysis included a comparison of the number of controlled risk factors and the percentage of subjects who achieved the therapeutic goal for each of the cardiovascular risk factors. The risk of CVD was assessed with SCORE2 and SCORE2-OP. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). On both subscales (HADS Anxiety and HADS Depression), subjects could achieve normal, borderline, and abnormal scores.

Results

The median number of controlled CVD risk factors was 4.0 (IQR 3.0-5.0), and the median CVD risk assessed with SCORE2 and SCORE2-OP was 3.0% (IQR 1.5-7.0%). Median scores for HADS Anxiety were 3.0 (IQR 2.0-6.0) and for HADS Depression 3.0 (1.0-5.0). Patients with symptoms of anxiety and depression had significantly fewer controlled risk factors (HADS Anxiety p=0.0014; HADS Depression p=0.0304). Among subjects with anxiety and depression, there was a significantly lower percentage of those with a normal waist circumference (HADS Anxiety p=0.0464; HADS Depression p=0.0200) and regular physical activity (HADS Anxiety p=0.0431; HADS Depression p=0.0055). Among subjects with anxiety, there was a significantly lower percentage of those with a normal BMI (p=0.0218) and normal triglyceride concentrations (p=0.0278).

Conclusion

The presence of anxiety and depression may affect the control of CVD risk factors in individuals without a history of atherosclerotic CVD. Assessment of anxiety and depression symptoms should be part of a comprehensive examination of patients with high CVD risk.

Cardiovascular Risk Factors Among First-Degree Relatives of Patients with Premature Cardiovascular Disease in Malta. Baseline Findings from the CRISO Project

Purpose

A family history of premature atherosclerotic cardiovascular disease (ASCVD) confers a greater risk of developing ASCVD. However, the prevalence of ASCVD risk factors among asymptomatic Maltese adults with parental or fraternal history of premature ASCVD is unknown. The study aimed to evaluate and compare their risk with the general population.

Patients and Methods

Posters to market the project were distributed in cardiac rehabilitation areas. Patients with premature cardiovascular disease facilitated recruitment by informing their relatives about the project. Medical doctors and cardiac rehabilitation nurses referred first-degree relatives. Posters were put up in community pharmacies, and an explanatory video clip was shared on social media for interested individuals to contact researchers. Those eligible were enrolled in a preventive cardiology lifestyle intervention. Their data were compared with the risk in the general population.

Results

Many first-degree relatives had a suboptimal risk profile, with 60% (N = 89) having a total cholesterol level of >5.0 mmol/L; 54% having a low-density lipoprotein-cholesterol level of >3 mmol/L; 70.5% being overweight/obese, with 62% having a waist circumference greater than the recommended values; 34.8% having hypertension; 56.2% being inadequately adherent to the Mediterranean diet; 62% being underactive, with 18% being sedentary; and 25.8% being smokers. First-degree relatives had significantly higher proportions of underactive lifestyle (p = 0.00016), high body mass index (>25kg/m2) (p = 0.006), and systolic blood pressure (p = 0.001) than the general population, with 30% having metabolic syndrome.

Conclusion

This study determined the prevalence of lifestyle, biochemical, physiological, and anthropometric cardiovascular risk factors among asymptomatic first-degree relatives of Maltese patients with premature ASCVD. First-degree relatives had considerable prevalences of an underactive lifestyle, hypertension, and obesity, suggesting better screening and early risk factor intervention are needed to modify their risk of ASCVD.

Clinical recurrence and antiplatelet drug resistance among patients with lower limb ischemia

There is a high prevalence rate of peripheral artery disease worldwide, with estimated cases exceeding 200 million. Most patients are under-diagnosed and under-treated, and there is a lack of knowledge regarding the best therapeutic regimen and therapy duration, which leads to many cases of recurrence, complications, and amputations. This study aims to explore clinical recurrence, which was defined as the worsening of chronic peripheral artery disease requiring hospital admission, and its relationship with antiplatelet drug resistance among patients with lower limb ischemia. This cohort study includes both retrospective and prospective recruitment of patients with chronic lower limb ischemia. Platelet aggregation tests were offered to the patients. Between February 2018 and November 2020, 147 patients were recruited from King Abdullah University Hospital and followed up for at least 1 year. Platelet aggregation tests were done for 93 patients who agreed to participate in this part of the study. The prevalence of chronic lower limb ischemia was higher in young male patients who are current smokers with co-morbid diseases such as hypertension, diabetes mellitus, and/or dyslipidemia. There was a significant association only of clinical recurrence with younger age (P = .011) and with low platelets count in severe stages of the disease (P = .047). No significant association was found in terms of laboratory resistance. The clinical recurrence rates of chronic lower limb ischemia were higher in younger patients and among those with low platelet counts in the severe stages of the disease. Despite the laboratory responsiveness to anti-platelet therapy, we observed significant clinical resistance and increased recurrence rates.

Trends in population-based incidence, diagnostics, and mortality of acute superior mesenteric artery occlusion

Acute occlusion of the superior mesenteric artery (SMA) results in lethal intestinal ischemia. Results from two previous population-based studies in Malmö, Sweden, suggest a decreasing incidence of acute SMA occlusion. This study aimed to evaluate trends in the epidemiology of acute SMA occlusion in Malmö. The report was a retrospective population-based study conducted from 2014 to 2019 on patients with acute SMA occlusion residing in Malmö municipality. Patient data were retrieved from Skåne University Hospital and postmortem examinations. Epidemiological data were compared to those of the two earlier studies, in particular to the one conducted from 2000 to 2006. Sixteen patients with acute SMA occlusion resided in Malmö municipality. The incidence of acute SMA occlusion significantly decreased from 5.4/100,000 person-years to 0.8/100,000 person-years. The ratio of acute SMA occlusion to non-occlusive mesenteric ischemia (NOMI) decreased from 12.5:1 to 0.9:1 (p < 0.0001), the proportion of inhabitants aged 80 years or above in the population decreased from 6.0% to 4.3% (p < 0.0001), and the autopsy rate decreased from 25% to 14% (p < 0.0001). The in-hospital mortality rate decreased from 63% to 44% (p = 0.14). The incidence of acute SMA occlusion seems to have decreased significantly in Malmö, probably due to high-resolution computed tomography angiographies being available around the clock to distinguish acute SMA occlusion from NOMI, a reduced proportion of elderly individuals, improved control of medical risk factors, and a decrease in autopsy rates.