Cardiovascular Risks Associated with Gender and Aging

High prevalence of low vitamin D status in the Czech Republic: a retrospective study of 119,925 participants

OBJECTIVES

Given the high worldwide prevalence of vitamin D deficiency and its role in numerous diseases affecting mortality and morbidity, this study seeks to determine the prevalence of low 25-hydroxyvitamin D levels in the Czech Republic, where population-level data are currently lacking.

STUDY DESIGN

This retrospective study utilized a large dataset to analyze 25-hydroxyvitamin D levels over an extended period.

METHODS

We analyzed data from 119,925 individuals aged 0-100 years categorizing them as sufficient (75-250 nmol/L), insufficient (50-75 nmol/L), or deficient (<50 nmol/L). We also examined levels of CRP, homocysteine, and their correlations with 25-hydroxyvitamin D levels across age groups. Age, sex, sampling month, sunlight exposure (monthly and annual), and influenza virus positivity were assessed for their relationship with the 25-hydroxyvitamin D levels.

RESULTS

The study found a high prevalence of 25-hydroxyvitamin D inadequacy, with sufficient levels observed in 65.6% of infants (0-12 months). The lowest prevalence of sufficiency was in the 6-15 years (19.2%) and 16-30 years (22.1%) groups. The highest deficiency prevalence was in the 91-100 years group (51.8%). 25-hydroxyvitamin D levels in all age groups and both sexes correlated with all selected parameters. Lower sun exposure, higher flu virus positivity, male gender, and elevated homocysteine and CRP levels were negatively correlated with 25-hydroxyvitamin D levels.

CONCLUSIONS

The prevalence of 25-hydroxyvitamin D inadequacy in the Czech Republic is high. It is advisable to consider testing, monitoring, and providing medical recommendations for vitamin D supplementation as part of health prevention strategies in the general population.

Key Determinants of Cardiovascular Outcomes in Multi-Ethnic Patients With Rheumatic Disease Using JAK Inhibitors

BACKGROUND

Janus kinase (JAK) inhibitors are effective therapies for autoimmune rheumatic diseases (ARDs), but concerns persist regarding their cardiovascular effects, particularly in diverse patient populations. Identifying determinants of cardiovascular risk is essential for optimising therapy and outcomes, especially in multi-ethnic cohorts.

OBJECTIVE

To assess clinical and socioeconomic determinants, including age, deprivation decile and ethnicity, in predicting cardiovascular events among patients on JAK inhibitors in a multi-ethnic cohort.

METHODS

A retrospective cohort study of 309 patients with ARDs (mean age 59.3 years, 77% female, 73% White, 25% South Asian) receiving JAK inhibitors at a UK teaching hospital was conducted. Cardiovascular events, including myocardial infarctions, strokes and cardiovascular-related deaths, were recorded. Multivariate logistic regression assessed associations between age, deprivation decile, ethnicity and cardiovascular outcomes.

RESULTS

The combined effect of age and deprivation decile significantly predicted cardiovascular events (p = 0.031). Older age demonstrated an odds ratio (OR) of 1.06 (95% CI: 1.00-1.13). Neither age nor deprivation decile alone achieved statistical significance, but their combination provided a robust model with an AUC of 0.837. Ethnicity was not independently predictive in this cohort.

CONCLUSIONS

In a multi-ethnic cohort, age and deprivation decile jointly predict cardiovascular events in patients on JAK inhibitors. Socioeconomic factors should be integrated into cardiovascular risk assessment models to inform personalised care strategies for patients receiving JAK inhibitor therapy.

Qualitative American Heart Association plot of late gadolinium enhancement with mortality and ventricular arrhythmia prediction using artificial intelligence

Background

The prognostic value of late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) imaging is well-established. However, the direct relationship between image pixels and outcomes remains poorly understood. We hypothesised that leveraging artificial intelligence (AI) to analyse qualitative LGE images based on American Heart Association (AHA) guidelines could elucidate this relationship.

Methods

We collected retrospective CMR cases from a stress perfusion database, selecting LGE images comprising three long-axis views and 10 short-axis views. Clinical CMR reports served for annotation. We trained a multi-label convolutional neural network (CNN) to predict each AHA segment. Additionally, we transformed LGE image pixels into features, combined them with clinical data features, and trained a hybrid neural network (HNN) to predict mortality and ventricular arrhythmia. The dataset was divided into training (70%), validation (15%), and test (15%) sets. Evaluation metrics included the area under the curve (AUC).

Results

The total number of cases included was 2,740, with 218 patients experiencing positive mortality events (8%). The total number of cases with at least one AHA segment positive for LGE was 823 (30%), among which 111 (13%) experienced mortality events, and 84 (10%) had ventricular arrhythmia events. When assessing all segments combined, the most common cases were those classified as normal studies, with each AHA segment having a score of 0 (1,661 cases, 60.6%). The multi-label classifier demonstrated fair performance (AUC: 64%), whereas the cluster classifier did not yield any predictions (AUC: 53%, P<0.001). The mortality HNN achieved a satisfactory performance with an AUC of 77%, as did the ventricular arrhythmia HNN with an AUC of 75%.

Conclusions

Our study demonstrates the feasibility of generating qualitative AHA LGE maps using AI. Furthermore, the prediction of mortality and ventricular arrhythmia using HNN represents a potent new approach for risk stratification in patients with known or suspected coronary artery disease (CAD).

ECM Modifications Driven by Age and Metabolic Stress Directly Promote Vascular Smooth Muscle Cell Osteogenic Processes

BACKGROUND

The ECM (extracellular matrix) provides the microenvironmental niche sensed by resident vascular smooth muscle cells (VSMCs). Aging and disease are associated with dramatic changes in ECM composition and properties; however, their impact on VSMC phenotype remains poorly studied.

METHODS

Here, we describe a novel in vitro model system that utilizes endogenous ECM to study how modifications associated with age and metabolic disease impact VSMC phenotype. ECM was synthesized using primary human VSMCs and modified during culture or after decellularization. Integrity, stiffness, and composition of the ECM was measured using superresolution microscopy, atomic force microscopy, and proteomics, respectively. VSMCs reseeded onto the modified ECM were analyzed for viability and osteogenic differentiation.

RESULTS

ECMs produced in response to mineral stress showed extracellular vesicle-mediated hydroxyapatite deposition and sequential changes in collagen composition and ECM properties. VSMCs seeded onto the calcified ECM exhibited increased extracellular vesicle release and Runx2 (Runt-related transcription factor 2)-mediated osteogenic gene expression due to the uptake of hydroxyapatite, which led to increased reactive oxygen species and the induction of DNA damage signaling. VSMCs seeded onto the nonmineralized, senescent ECM also exhibited increased Runx2-mediated osteogenic gene expression and accelerated calcification. In contrast, glycated ECM specifically induced increased ALP (alkaline phosphatase) activity, and this was dependent on RAGE (receptor for advanced glycation end products) signaling with both ALP and RAGE receptor inhibition attenuating calcification.

CONCLUSIONS

ECM modifications associated with aging and metabolic disease can directly induce osteogenic differentiation of VSMCs via distinct mechanisms and without the need for additional stimuli. This highlights the importance of the ECM microenvironment as a key driver of phenotypic modulation acting to accelerate age-associated vascular pathologies and provides a novel model system to study the mechanisms of calcification.

Unraveling trends and disparities in acute myocardial infarction-related mortality among adult cancer patients: A nationwide CDC-WONDER analysis (1999-2020)

Background

Cancer patients are at an increased risk for the incidence and complications of acute myocardial infarction (AMI) due to shared risk factors and treatment-related adverse effects. Mortality trends for AMI-related deaths in adult cancer patients in the U.S. remain unexplored.

Methodology

This study used CDC WONDER data for death certificates from 1999 to 2020, identifying U.S. adults (≥25 years) with cancer (ICD-10: C00-D49) who died of AMI (ICD-10: I21) as the underlying cause. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) were calculated and stratified by gender, age, race, and geographic location.

Results

Between 1999 and 2020, there were 109,462 AMI-related deaths in adult cancer patients. The AAMR decreased from 4.3 per 100,000 in 1999 to 1.4 in 2020. A significant decline occurred from 1999 to 2015 (APC: 6.65; 95 % CI: 6.95 to -6.40; p < 0.001), followed by a stable trend from 2015 to 2020 (APC: 1.36; 95 % CI: 2.69 to 0.91; p = 0.152). Men had higher AAMRs than women (3.5 vs. 1.5). AAMRs were highest in older adults (10.5) compared to middle-aged (0.7) and young adults (0.1). Racial disparities showed the highest AAMRs in non-Hispanic (NH) Black patients (2.7), followed by NH Whites (2.4), NH American Indian/Alaska Native (1.6), Hispanic/Latino (1.3), and NH Asian/Pacific Islander (1.1). Non-metropolitan areas had higher AAMRs than metropolitan areas (2.8 vs. 2.2).

Conclusions

This analysis highlights a significant decline in AMI-related mortality among cancer patients in the U.S., with persistent disparities by gender, age, race and geographical location.

A Genetic Test to Identify People at High Risk of Heart Failure

Earlier intervention may delay or prevent heart failure (HF), a widespread health problem. However, it is not currently possible to identify those who are most at risk, especially before the appearance of any clinical signs. This study presents the development and subsequent validation of a novel genetic test for predicting the risk of HF, utilizing data from three independent cohorts of Australian and US subjects. We developed a first-phase test using the Baker Biobank case-control cohort, identifying 41 genetic variants indicative of HF risk through genome-wide interaction and association analyses. Subsequently, a second-phase test was designed. This identified 29 additional single-nucleotide polymorphisms. The combination of these two tests resulted in an aggregate test with a high predictive accuracy, achieving an Area Under the Curve of 0.93 and a balanced accuracy of 0.89. High genetic risk subjects in the Baker Biobank cohort had an odds ratio of 533.2. The test's robustness was validated by applying it to data from the Busselton Health Study and the Atherosclerosis Risk in Communities cohorts, yielding, respectively, Areas Under the Curve of 0.83 and 0.72, a balanced accuracy of 0.76 and 0.67, and Odds Ratios of 12.3 and 4.6. These results highlight the critical role of genetic factors in the development of heart failure and demonstrate this test's potential as a significant tool for clinical HF risk prediction.

Sex Chromosomes and Sex Hormones: Dissecting the Forces That Differentiate Female and Male Hearts

The heart is a highly sex-biased organ, as sex shapes innumerable aspects of heart health and disease. Sex chromosomes and sex hormones -testosterone, progesterone, and estrogen- establish and perpetuate the division between male and female myocardium. Of these differentiating factors, the insulating effects of estrogen have been rigorously interrogated and reviewed, whereas the influence of sex chromosomes, testosterone, and progesterone remains in dispute or ill-defined. Here, we synthesize growing evidence that sex chromosomes and sex hormones substantially bias heart form, function, and dysfunction in a context-dependent fashion. The discrete protective functions ascribed to each of the 3 estrogen receptors are also enumerated. Subsequently, we overview obstacles that have historically discouraged the inclusion of female subjects in basic science such as the impact of the female estrus cycle and reproductive senescence on data reliability and reproducibility. Furthermore, we weigh the utility of several common strategies to intercept and rescue sex-specific protection. Last, we warn of common compounds in animal chow and cell culture that interfere with estrogen signaling. In sum, we survey the controversies and challenges that stem from sex-inclusive cardiovascular research, comparing the possible causes of cardiac sex bias, elucidating sex chromosome or hormone-dependent processes in the heart, describing common lapses that imperil female and male cell and animal work, and illuminating facets of the female heart yet unexplored or still uncertain.

Blunted Blood Pressure Dipping During Night Shift Work: Does It Matter? Can We Intervene?

Cardiovascular disease (CVD) is the leading cause of adult death in the United States. Numerous studies show that night shift workers face a disproportionately higher risk of CVD compared to non-shift workers. Despite these data, the scientific and medical communities have not identified the physiological mechanisms that contribute to increased CVD risks for night shift workers. We propose that repetitive exposure to blunted blood pressure (BP) dipping associated with sleep loss during night shift work is an important, clinically meaningful, understudied, and modifiable contributor to increased risk of CVD. Blunted BP dipping occurs when BP fails to decrease or "dip" 10%-20% during nighttime hours (typically while sleeping) relative to daytime hours (typically while awake). Blunted BP dipping is widely considered a clinically meaningful indicator of poor cardiovascular health. Previous research suggests it is a common consequence of night shift work and occurs during sleep before and immediately after night shifts. Relatively few studies of shift work and CVD have focused on blunted BP dipping as a mechanism of CVD risk. Recent experimental research shows that restoration of normal BP patterns-during night shift work-is achievable with strategic napping and may reduce the risk of CVD. We present a series of important mechanistic-related questions and next steps for future research focused on blunted BP dipping and night shift work.

Pharmacological and psychological approaches to insomnia treatment in cardiac patients: a narrative literature review

Sleep disorders are highly prevalent in the general population and are considered a major public health issue. Insomnia constitutes the most frequent sleep disorder in healthy individuals and has been shown to be even more frequent in patients with physical illnesses including cardiovascular diseases. Inadequate sleep quality and short sleep duration, independent of underlying causes, have been linked to the development and progression of cardiometabolic disorders. Additionally, insomnia has been found to be associated with adverse outcome measures, including daytime sleepiness, fatigue, decreased self-reported physical functioning, lower exercise capacity, poor health related quality of life, depressive symptoms, higher rates of hospitalization and increased mortality in patients with cardiovascular diseases. Against this background, comparatively little information is available in the literature regarding the treatment of chronic insomnia in cardiac patient populations. While guidelines for the general population suggest cognitive behavioral therapy for insomnia as a first-line treatment option and preliminary evidence suggests this treatment to be beneficial in cardiac patients with insomnia symptoms, it is often limited by availability and possibly the clinician's poor understanding of sleep issues in cardiac patients. Therefore, pharmacologic treatment remains an important option indicated by the high number of hypnotic drug prescriptions in the general population and in patients with cardiovascular disorders. In this narrative review of the literature, we summarize treatment options for chronic insomnia based on clinical guidelines for the general population and highlight necessary considerations for the treatment of patients with cardiovascular diseases.

Genetic and epigenetic bases of long-term adverse effects of childhood cancer therapy

Over the past decade, genome-scale molecular profiling of large childhood cancer survivorship cohorts has led to unprecedented advances in our understanding of the genetic and epigenetic bases of therapy-related adverse health outcomes in this vulnerable population. To facilitate the integration of knowledge generated from these studies into formulating next-generation precision care for survivors of childhood cancer, we summarize key findings of genetic and epigenetic association studies of long-term therapy-related adverse effects including subsequent neoplasms and cardiomyopathies among others. We also discuss therapy-related genotoxicities including clonal haematopoiesis and DNA methylation, which may underlie accelerated molecular ageing. Finally, we highlight enhanced risk prediction models for survivors of childhood cancer that incorporate both genetic factors and treatment exposures, aiming to achieve enhanced accuracy in predicting risks for this population. These new insights will hopefully inspire future studies that harness both expanding omics resources and evolving data science methodology to accelerate the translation of precision medicine for survivors of childhood cancer.

Angiopoietin-2 reverses endothelial cell dysfunction in progeria vasculature

Hutchinson-Gilford progeria syndrome (HGPS) is a rare premature aging disorder in children caused by a point mutation in the lamin A gene, resulting in a toxic form of lamin A called progerin. Accelerated atherosclerosis leading to heart attack and stroke are the major causes of death in these patients. Endothelial cell (EC) dysfunction contributes to the pathogenesis of HGPS related cardiovascular diseases (CVD). Endothelial cell-cell communications are important in the development of the vasculature, and their disruptions contribute to cardiovascular pathology. However, it is unclear how progerin interferes with such communications that lead to vascular dysfunction. An antibody array screening of healthy and HGPS patient EC secretomes identified Angiopoietin-2 (Ang2) as a down-regulated signaling molecule in HGPS ECs. A similar down-regulation of Ang2 mRNA and protein was detected in the aortas from an HGPS mouse model. Addition of Ang2 to HGPS ECs rescues vasculogenesis, normalizes endothelial cell migration and gene expression, and restores nitric oxide bioavailability through eNOS activation. Furthermore, Ang2 addition reverses unfavorable paracrine effects of HGPS ECs on vascular smooth muscle cells. Lastly, by utilizing adenine base editor (ABE)-corrected HGPS ECs and progerin-expressing HUVECs, we demonstrated a negative correlation between progerin and Ang2 expression. Lastly, our results indicated that Ang2 exerts its beneficial effect in ECs through Tie2 receptor binding, activating an Akt-mediated pathway. Together, these results provide molecular insights into EC dysfunction in HGPS and suggest that Ang2 treatment has potential therapeutic effects in HGPS-related CVD.

Identifying sources of bias when testing three available algorithms for quantifying white matter lesions: BIANCA, LPA and LGA

Brain magnetic resonance imaging frequently reveals white matter lesions (WMLs) in older adults. They are often associated with cognitive impairment and risk of dementia. Given the continuous search for the optimal segmentation algorithm, we broke down this question by exploring whether the output of algorithms frequently used might be biased by the presence of different influencing factors. We studied the impact of age, sex, blood glucose levels, diabetes, systolic blood pressure and hypertension on automatic WML segmentation algorithms. We evaluated three widely used algorithms (BIANCA, LPA and LGA) using the population-based 1000BRAINS cohort (N = 1166, aged 18-87, 523 females, 643 males). We analysed two main aspects. Firstly, we examined whether training data (TD) characteristics influenced WML estimations, assessing the impact of relevant factors in the TD. Secondly, algorithm's output and performance within selected subgroups defined by these factors were assessed. Results revealed that BIANCA's WML estimations are influenced by the characteristics present in the TD. LPA and LGA consistently provided lower WML estimations compared to BIANCA's output when tested on participants under 67 years of age without risk cardiovascular factors. Notably, LPA and LGA showed reduced accuracy for these participants. However, LPA and LGA showed better performance for older participants presenting cardiovascular risk factors. Results suggest that incorporating comprehensive cohort factors like diverse age, sex and participants with and without hypertension in the TD could enhance WML-based analyses and mitigate potential sources of bias. LPA and LGA are a fast and valid option for older participants with cardiovascular risk factors.

Associating regulatory actions on diclofenac use with Danish trends in utilization by route of administration 1999-2023

AIMS

With the growing evidence of cardiovascular risks associated with diclofenac use, regulatory measures governing its application and sales have intensified since 2008. We evaluated the association between central regulatory actions and trends in diclofenac use in Denmark from 1999 to 2023, according to different dosage forms and routes of administration.

METHODS AND RESULTS

Data on diclofenac sales in Denmark from 1999 to 2023 were retrieved from the publicly available web database MEDSTAT, based on the Danish Register of Medicinal Products Statistics. The annual sales of various diclofenac dosage forms, including systemic (tablets, modified-release dosage forms, and suppositories) and topical (nonspecific and ophthalmic) dosage forms, were calculated and displayed by sales unit. From 1999 to 2008, sales of all systemically administered diclofenac forms increased: tablets by 51% (2000-2008), modified-release dosage forms by 40% (2003-2007), and suppositories by 44% (1999-2008). Thereafter, sales of tablets declined by 86% and modified-release dosage forms by 90% through 2023. The sales of suppositories declined somewhat lesser, by 34%, during 2008 to 2018 and then increased by 67% through 2023. Sales of nonspecific topical diclofenac increased by several thousandfold from 2005, although with brief periods of decline.

CONCLUSION

Sales of systemically administered diclofenac dosage forms, particularly tablets and modified-release drugs, declined by approximately 90% from about 2008 to 2023, indicating compliance with Danish and international regulatory actions. Conversely, sales of topically administered diclofenac increased heavily from 2005 to 2023, denoting a policy-driven shift toward these lower risk dosage forms.

Patterns among factors associated with myocardial infarction: chi-squared automatic interaction detection tree and binary logit model

BACKGROUND

Although mortality from myocardial infarction (MI) has declined worldwide due to advancements in emergency medical care and evidence-based pharmacological treatments, MI remains a significant contributor to global cardiovascular morbidity. This study aims to examine the risk factors associated with individuals who have experienced an MI in Türkiye.

METHODS

Microdata obtained from the Türkiye Health Survey conducted by Turkish Statistical Institute in 2019 were used in this study. Binary logistic regression, Chi-Square, and CHAID analyses were conducted to identify the risk factors affecting MI.

RESULTS

The analysis identified several factors associated with an increased likelihood of MI, including hyperlipidemia, hypertension, diabetes, chronic disease status, male gender, older age, single marital status, lower education level, and unemployment. Marginal effects revealed that elevated hyperlipidemia levels increased the probability of MI by 4.6%, while the presence of hypertension, diabetes, or depression further heightened this risk. Additionally, individuals with chronic diseases lasting longer than six months were found to have a higher risk of MI. In contrast, factors such as being female, having higher education, being married, being employed, engaging in moderate physical activity, and moderate alcohol consumption were associated with a reduced risk of MI.

CONCLUSION

To prevent MI, emphasis should be placed on enhancing general education and health literacy. There should be a focus on increasing preventive public health education and practices to improve variables related to healthy lifestyle behaviours, such as diabetes, hypertension, and hyperlipidemia.

Risk Assessment Prior to Cardiotoxic Anticancer Therapies in 7 Steps

The burdens of cardiovascular (CV) diseases and cardiotoxic side effects of cancer treatment in oncology patients are increasing in parallel. The European Society of Cardiology (ESC) 2022 Cardio-Oncology guidelines recommend the use of standardized risk stratification tools to determine the risk of cardiotoxicity associated with different anticancer treatment modalities and the severity of their complications. The use of the Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) is essential for assessing risk prior to starting cancer treatment, and validation of these methods has been performed in patients receiving anthracyclines, human epidermal receptor 2 (HER2)-targeted therapies and breakpoint cluster region-abelson oncogene locus (BCR-ABL) inhibitors. The benefits of performing baseline CV risk assessment and stratification include early recognition of cardiotoxicities, personalisation of cancer treatment and monitoring strategies, and allocation of cardioprotection to those at the highest risk. This review summarizes the key points of risk stratification in these patients. The steps include identifying the target population, assessing nonmodifiable and modifiable CV risk factors, reviewing previous oncologic therapies and CV histories, and performing baseline investigations. In summary, this review aims to provide general physicians with a simple 7-step guide that will help steer and navigate them through cardiac risk evaluation of potentially cardiotoxic oncologic treatment strategies.

Preeclampsia as a Study Model for Aging: The Klotho Gene Paradigm

Aging and pregnancy are often considered opposites in a woman's biological timeline. Aging is defined by a gradual decline in the functional capabilities of an organism over its lifetime, while pregnancy is characterized by the presence of the transient placenta, which fosters the cellular fitness necessary to support fetal growth. However, in the context of preeclampsia, pregnancy and aging share common hallmarks, including clinical complications, altered cellular phenotypes, and heightened oxidative stress. Furthermore, women with pregnancies complicated by preeclampsia tend to experience age-related disorders earlier than those with healthy pregnancies. Klotho, a gene discovered fortuitously in 1997 by researchers studying aging mechanisms, is primarily expressed in the kidneys but also to a lesser extent in several other tissues, including the placenta. The Klotho protein is a membrane-bound protein that, upon cleavage by ADAM10/17, is released into the circulation as soluble Klotho (sKlotho) where it plays a role in modulating oxidative stress. This review focuses on the involvement of sKlotho in the development of preeclampsia and age-related disorders, as well as the expression of the recently discovered Mytho gene, which has been associated with skeletal muscle atrophy.

Blood Pressure on Ambulatory Monitoring and Risk for Cardiovascular Disease and All-Cause Mortality: Ecological Validity or Measurement Reliability?

BACKGROUND

The association with cardiovascular disease (CVD) is stronger for mean systolic blood pressure (SBP) estimated using ambulatory blood pressure monitoring (ABPM) vs. office measurements. Determining whether this is due to ABPM providing more measurement reliability or greater ecological validity can inform its use.

METHODS

We estimated the association of mean SBP based on 2 office measurements and 2, 5, 10, and 20 measurements on ABPM with incident CVD in the Jackson Heart Study (n = 773). Hazard ratios (HRs) for CVD were estimated per standard deviation higher mean SBP. CVD events were defined by incident fatal or non-fatal stroke, non-fatal myocardial infarction, or fatal coronary heart disease.

RESULTS

There were 80 CVD events over a median of 15 years. The adjusted HRs for incident CVD were 1.03 (95% CI: 0.90-1.19) for mean office SBP and 1.30 (95% CI: 1.12-1.50), 1.34 (95% CI: 1.15-1.56), 1.36 (95% CI: 1.17-1.59), and 1.38 (95% CI: 1.17-1.63) for mean SBP using the first 2, 5, 10, and 20 ABPM readings. The difference in the HRs for incident CVD ranged from 0.26 (95% CI: 0.07-0.46) to 0.35 (95% CI: 0.15-0.54) when comparing mean office SBP vs. 2, 5, 10, or 20 sequential ABPM readings. The association with incident CVD was also stronger for mean SBP based on 2, 5, 10, and 20 randomly selected ABPM readings vs. 2 office readings.

CONCLUSIONS

Mean SBP based on 2 ABPM readings vs. 2 office measurements had a stronger association with CVD events. The increase in the strength of the association with more ABPM readings was small.

Diabetic Heart Disease: An Intricate Interplay of a Widespread Metabolic Disorder with the Cardiovascular System

Diabetes is a chronic medical condition that causes high glycaemic levels, leading to damage to vital organs over time. It is a common disease worldwide, affecting around 422 million individuals living in middle- and low-income countries, which make up most of the population. Unfortunately, diabetes results in 1.5 million deaths annually. Diabetic patients are at a higher risk for developing cardiovascular conditions. Diabetic heart disease constitutes multiple genres, including diabetic cardiomyopathy, coronary artery disease, and heart failure. Hypoglycaemic agents aim to prevent these metabolic issues however some of these are cardiotoxic in nature. In contrast, other hypoglycaemic agents work beyond controlling glycaemic levels with their cardioprotective properties. Given that there is an alarming increase in diabetic heart disease cases universally, we have attempted to review the existing data on the topic and the effects of hypoglycaemic drugs on heart diseases.

Effects of combo therapy with coenzyme Q10 and mitochondrial transplantation on myocardial ischemia/reperfusion-induced arrhythmias in aged rats

Objectives

Ischemia/reperfusion (IR)-induced ventricular arrhythmia, which mainly occurs after the opening of coronary artery occlusion, poses a clinical problem. This study aims to investigate the effectiveness of pretreatment with coenzyme Q10 (CoQ10) in combination with mitochondrial transplantation on IR-induced ventricular arrhythmias in aged rats.

Materials and Methods

Myocardial IR induction was performed by left anterior descending coronary artery occlusion for 30 min, followed by re-opening for 24 hr. CoQ10 was administered intraperitoneally at a dosage of 10 mg/kg/day for two weeks before inducing IR. At the start of reperfusion, 500 µl of the respiration buffer containing 6×106±5×105 mitochondria/ml of respiration buffer harvested from the pectorals major muscle of young donor rats were injected intramyocardially. To investigate arrhythmias, the heart's electrical activity during ischemia and the first 30 min of reperfusion were recorded by electrocardiogram. After 24 hr of reperfusion, cardiac histopathological changes, creatine kinase-MB, nitric oxide metabolites (NOx), oxidative stress markers (malondialdehyde, total anti-oxidant, superoxide dismutase, and glutathione peroxidase), and the expression of genes regulating mitochondrial fission/fusion were measured.

Results

Pretreatment with CoQ10 in combination with mitochondrial transplantation reduced ventricular arrhythmias, cardiac histopathological changes, and creatine kinase-MB levels. Simultaneously, this combined therapeutic approach increased myocardial NOx levels, fostering an improved oxidative balance. It also triggered the down-regulation of mitochondrial fission genes, coupled with the up-regulation of mitochondrial fusion genes.

Conclusion

The combination of CoQ10 and mitochondrial transplantation demonstrated a notable anti-arrhythmic effect by elevating NOx levels, reducing oxidative stress, and improving mitochondrial fission/fusion in aged rats with myocardial IRI.

Improvement of salivary biomarkers vitronectin and fetuin-A levels in periodontitis patients with coronary artery disease post scaling and root planing

INTRODUCTION

Two biomarkers that are gaining attention for their roles in the progression of both periodontal and cardiovascular diseases are vitronectin and fetuin-A. This study evaluated vitronectin and fetuin-A expression in saliva samples of periodontitis (P) patients with and without coronary artery disease (CAD) after scaling and root planing (SRP).

METHODS

Sixty patients were divided into three groups: PH + SH (periodontally and systemically healthy), P (stage II/III grade B periodontitis), and P + CAD (periodontitis with CAD). Demographic, periodontal, and cardiac parameters were recorded. Unstimulated saliva samples were collected at baseline (day 0) and after SRP. On day 90, periodontal parameters and vitronectin/fetuin-A expression were reassessed.

RESULTS

P + CAD patients had higher age, weight, BMI, and lower income (p < .001, .025, .002, < .001, respectively), along with elevated plaque index, bleeding on probing, probing pocket depth, and reduced clinical attachment levels (p < .001). Vitronectin was elevated, while fetuin-A was lower in P + CAD, but both improved post-SRP (p < .001).

CONCLUSIONS

Enhanced vitronectin and fetuin-A levels post-SRP indicate their potential as biomarkers and therapeutic targets for both periodontal and CAD.

Microgravity and Cardiovascular Health in Astronauts: A Narrative Review

Background

Space exploration has become a major interest for scientific and medical research. With increasing duration and frequency of manned space missions, it is crucial to understand the impact of microgravity on the cardiovascular health of astronauts. We focus on this relationship by reviewing literature that explores how microgravity affects several hemodynamic parameters and cardiovascular biomarkers.

Methods

We conducted a search updated to November 2024 across several databases, including PubMed, Cochrane Library, ESA, NASA and DLR, using relevant MeSH terms and selection criteria.

Results

The 22 selected articles detail how microgravity impacts the cardiovascular system and its adaptations. We identify some clear patterns, such as loss of ventricular mass and increased QT intervals (corrected for heart rate) indicating increased risk of arrhythmias. Our analysis confirms that head-down tilt is an accurate analog of microgravity.

Conclusions

While a direct link between microgravity and cardiovascular disease, such as coronary heart disease and myocardial infarction, remains elusive, the documented physiological changes pose a potential threat to the astronauts' health. We suggest that future research focus on long-term effects, particularly on female subjects.

Evidence of content validity of the nursing diagnosis risk for unstable blood pressure

PURPOSE

To analyze evidence of content validity of the nursing diagnosis (ND) Risk for Unstable Blood Pressure in incarcerated women.  METHOD: A methodological study assessing the content validity of an ND, was performed in Brazil, between June and September 2022, with 49 nurses as experts. The label, definition, and relevance of the 19 risk factors of the ND Risk for Unstable Blood Pressure were appraised. Based on the predictive diversity model, the content validity index (CVI) and respective 95% confidence intervals were calculated for each risk factor. A CVI ≥ 0.8 was considered adequate evidence of content validity.

FINDINGS

The label and the definition of the diagnosis was reformulated. The relevance of 19 etiological factors showed a CVI ≥ 0.8. According to the recommendation of the panel of experts, one of the etiological factors was split in two and two label of etiological factors were changed.

CONCLUSIONS

A new label (Risk for Imbalanced Blood Pressure), new definition, and 20 etiological factors (11 risk factors, five associated conditions, and four at-risk populations) of the ND Risk for Unstable Blood Pressure in incarcerated women were considered valid.

IMPLICATIONS FOR NURSING PRACTICE

NANDA-I accepted the proposal for this nursing diagnosis; hence this study contributed to updating the classification based on scientific evidence. This evidence will favor diagnostic reasoning and recognition of the diagnosis during clinical assessment, and support studies assessing the clinical validity of these elements in incarcerated women.

Sitting time at work and cardiovascular disease risk-a longitudinal analysis of the Study on Mental Health at Work (S-MGA)

PURPOSE

This study analyzed longitudinal data to examine whether occupational sitting time is associated with increases in body mass index (BMI) and five-year cardiovascular disease (CVD) risk.

METHODS

We included 2,000 employed men and women (aged 31-60) from the German Study on Mental Health at Work (S-MGA) for a BMI analysis and 1,635 participants free of CVD at baseline (2011/2012) for a CVD analysis. Occupational sitting time was categorized into five groups (< 5, 5 to < 15, 15 to < 25, 25 to < 35, and ≥ 35 h per week). BMI change was measured from baseline (2011/2012) to follow-up (2017). Incident CVD included hypertension, heart disease, myocardial infarction, and stroke (all self-reported). Multiple linear regression examined the association between sitting time and BMI change, while modified Poisson regression analyzed CVD incidence, adjusting for age, sex, occupation, shift work, leisure activity, and smoking by sex. Covariates were self-reported.

RESULTS

Over five years, the average BMI change was 0.49 (SD 1.9). We found no association between baseline occupational sitting time and BMI changes, with consistent results in sensitivity analyses. During this period, 245 participants developed cardiovascular disease. There was no increased risk of CVD among those with more sitting time compared to less. No differences in risk were found between women and men.

CONCLUSION

There was no association between occupational sitting time and five-year changes in BMI or incident CVD.

Effect of Creatine Monohydrate Supplementation on Macro- and Microvascular Endothelial Function in Older Adults: A Pilot Study

Background/Objectives: A pilot study was conducted to investigate the effect of four weeks of creatine monohydrate (CrM) on vascular endothelial function in older adults. Methods: In a double-blind, randomized crossover trial, twelve sedentary, healthy older adults were allocated to either the CrM or placebo (PL) group for four weeks, at a dose of 4 × 5 g/day for 5 days, followed by 1 × 5 g/day for 23 days. Macrovascular function (flow-mediated dilation [FMD%], normalized FMD%, brachial-ankle pulse wave velocity [baPWV], pulse wave analysis [PWA]), microvascular function (microvascular reperfusion rate [% StO2/sec]), and biomarkers of vascular function (tetrahydrobiopterin [BH4], malondialdehyde [MDA], oxidized low-density lipoprotein [oxLDL], glucose, lipids) were assessed pre- and post-supplementation with a four-week washout period. Results: CrM significantly increased FMD% (pre-CrM, 7.68 ± 2.25%; post-CrM, 8.9 ± 1.99%; p < 0.005), and normalized FMD% (pre-CrM, 2.57 × 10-4 ± 1.03 × 10-4%/AUCSR; post-CrM, 3.42 × 10-4 ± 1.69 × 10-4%/AUCSR; p < 0.05), compared to PL. Microvascular reperfusion rates increased following CrM (pre-CrM, 2.29 ± 1.42%/sec; post-CrM, 3.71 ± 1.44%/sec; p < 0.05), with no change following PL. A significant reduction in fasting glucose (pre-CrM, 103.64 ± 6.28; post-CrM, 99 ± 4.9 mg/dL; p < 0.05) and triglycerides (pre-CrM, 99.82 ± 35.35; post-CrM, 83.82 ± 37.65 mg/dL; p < 0.05) was observed following CrM. No significant differences were observed for any other outcome. Conclusions: These pilot data indicate that four weeks of CrM supplementation resulted in favorable effects on several indices of vascular function in older adults.

A nomogram to distinguish noncardiac chest pain based on cardiopulmonary exercise testing in cardiology clinic

BACKGROUND

Psychological disorders, such as anxiety and depression, are considered to be one of the causes of noncardiac chest pain (NCCP). And these patients can be challenging to differentiate from coronary artery disease (CAD), leading to a considerable number of patients still undergoing angiography. We aim to develop a practical prediction model and nomogram using cardiopulmonary exercise testing (CPET), to help identify these patients.

METHODS

1,531 eligible patients' electronic medical record data were obtained from Guangdong Provincial People's Hospital. They were randomly divided into a training dataset (N = 918) and a testing dataset (N = 613) at a ratio of 6:4, and 595 cases without missing data were also selected from testing dataset to form a complete dataset. The training set is used to build the model, and the testing set and the complete set are used for internal validation. Eight machine learning (ML) methods are used to build the model and the best model is finally adopted.

RESULTS

The model built by logistic regression performed the best, and among the 29 parameters, six parameters were determined to be valuable parameters for establishing the diagnostic equation and nomogram. The nomogram showed favorable calibration and discrimination with an area under the receiver operating characteristic curve (AUC) of 0.857 in the training set, 0.851 in the testing set, and 0.848 in the complete set. Meanwhile, decision curve analysis demonstrated the clinical utility of the nomogram.

CONCLUSIONS

A nomogram using CPET to distinguish anxiety/depression from CAD was developed. It may optimize the disease management and improve patient prognosis.

A Life Course Approach to Cardiovascular Disease Prevention

ABSTRACT

During the past 3 decades, life course socio-ecological frameworks have received considerable attention from clinical and public health professionals; developmental, social, and behavioral scientists; and scholars. Substantial evidence underscores the importance of a life course approach to prevention of cardiovascular (CV) disease and the promotion of optimal CV health. This article provides an overview of evidence on early origins and progression of CV disease (CVD) processes across the life course of individuals from diverse populations. Emphasis is placed on the evidence-based guidelines designed to prevent CVD and promote CV health with recommendations for implementation by CV health professionals and directions for future research in global CVD prevention.

Multiomics of Aging and Aging-Related Diseases

Despite their astonishing biological diversity, surprisingly few shared traits connect all or nearly all living organisms. Aging, i.e., the progressive and irreversible decline in the function of multiple cells and tissues, is one of these fundamental features of all organisms, ranging from single-cell creatures to complex animals, alongside variability, adaptation, growth, healing, reproducibility, mobility, and, finally, death. Age is a key determinant for many pathologies, shaping the risks of incidence, severity, and treatment outcomes for cancer, neurodegeneration, heart failure, sarcopenia, atherosclerosis, osteoporosis, and many other diseases. In this review, we aim to systematically investigate the age-related features of the development of several diseases through the lens of multiomics: from genome instability and somatic mutations to pathway alterations and dysregulated metabolism.

Challenges and Future Directions in Lipoprotein Measurement for Atherosclerosis Prevention and Treatment

Atherosclerosis can cause severe damage to the heart, brain, and other vital organs [...].

Determinants of developing cardiovascular disease risk with emphasis on type-2 diabetes and predictive modeling utilizing machine learning algorithms

This research aims to enhance our comprehensive understanding of the influence of type-2 diabetes on the development of cardiovascular diseases (CVD) risk, its underlying determinants, and to construct precise predictive models capable of accurately assessing CVD risk within the context of Bangladesh. This study combined data from the 2011 and 2017 to 2018 Bangladesh Demographic and Health Surveys, focusing on individuals with hypertension. CVD development followed World Health Organization (WHO) guidelines. Eight machine learning algorithms (Support Vector Machine, Logistic Regression, Decision Tree, Random Forest, Naïve Bayes, K-Nearest Neighbor, Light GBM, and XGBoost) were analyzed and compared using 6 evaluation metrics to assess model performance. The study reveals that individuals aged 35 to 54 years, 55 to 69 years, and ≥ 70 years face higher CVD risk with adjusted odds ratios (AOR) of 2.140, 3.015, and 3.963, respectively, compared to those aged 18 to 34 years. "Rich" respondents show increased CVD risk (AOR = 1.370, P < .01) compared to "poor" individuals. Also, "normal weight" (AOR = 1.489, P < .01) and "overweight/obese" (AOR = 1.871, P < .01) individuals exhibit higher CVD risk than "underweight" individuals. The predictive models achieve impressive performance, with 75.21% accuracy and an 80.79% AUC, with Random Forest (RF) excelling in specificity at 76.96%. This research holds practical implications for targeted interventions based on identified significant factors, utilizing ML models for early detection and risk assessment, enhancing awareness and education, addressing urbanization-related lifestyle changes, improving healthcare infrastructure in rural areas, and implementing workplace interventions to mitigate stress and promote physical activity.

Wildfire Smoke: Health Effects, Mechanisms, and Mitigation

Wildfires are becoming more frequent and intense on a global scale, raising concerns about their acute and long-term effects on human health. We conducted a systematic review of the current epidemiological evidence on wildfire health risks and a meta-analysis to investigate the association between wildfire smoke exposure and various health outcomes. We discovered that wildfire smoke increases the risk of premature deaths and respiratory morbidity in the general population. Meta-analysis of cause-specific mortality and morbidity revealed that wildfire smoke had the strongest associations with cardiovascular mortality (RR: 1.018, 95% CI: 1.014-1.021), asthma hospitalization (RR: 1.054, 95% CI: 1.026-1.082), and asthma emergency department visits (RR: 1.117, 95% CI: 1.035-1.204) in the general population. Subgroup analyses of age found that adults and elderly adults were more susceptible to the cardiopulmonary effects of wildfire smoke. Next, we systematically addressed the toxicological mechanisms of wildfire smoke, including direct toxicity, oxidative stress, inflammatory reactions, immune dysregulation, genotoxicity and mutations, skin allergies, inflammation, and others. We discuss wildfire smoke risk mitigation strategies including public health interventions, regulatory measures, and personal actions. We conclude by highlighting current research limitations and future directions for wildfire research, such as elucidating the complex interactions of wildfire smoke components on human health, developing personalized risk assessment tools, and improving resilience and adaptation strategies to mitigate the health effects of wildfires in changing climate.

Implication of knowledge, lifestyle and self-efficacy in the prevention of cardiovascular diseases' risk factors among the urban elderly

Background: Cardiovascular disease (CVD) is preventable by effectively managing its risk factors. Such risk factors (smoking, unhealthy eating habits, sedentary lifestyles, etc.) are judged to reflect an individual's self-efficacy, lifestyle modification, and CVD knowledge. Objectives: To evaluate the relationship between lifestyle practices, self-efficacy, and knowledge of CVDs risk factors among the elderly. Methods: A descriptive cross-sectional study was conducted on 424 randomly individuals whose age is ≥60 years. A questionnaire-based survey was administered on the self-efficacy rate, lifestyle practices, and respondents' knowledge of CVDs risk factors. Respondents with a score of ≤50%, 51%-74.99%, and ≥75% were classified as having low, medium, or high self-efficacy. Similarly, the same score was used to classify poor, fair, or good lifestyle; and low, average, or high knowledge. Data were analysed using Statistical Package for Social Sciences, while association among variables was determined using chi-square. Results: Few respondents were involved in physical exercise (1.7%), cigarette smoking (4.5%), regular soft drinks (18.2%), and alcohol consumption (13.2%). Many respondents used excess salt during cooking (92.7%) or ate outside their homes (64.6%). 58.5%, 30.0%, and 11.6% of the respondents had fair, good, and poor lifestyle practices. 11.3%, 58.7%, and 30.0% had low, medium, and high self-efficacy scores. A total of 45.3%, 35.4%, and 19.3% had low, average, and high knowledge. Knowledge and self-efficacy scores were significantly different (P  =  0.001). Conclusion: High self-efficacy and its significant relationship with knowledge could mean that CVD risk factors can be checked if the elderly have a proper lifestyle, positive attitudes, and nutrition education.

The Role of Primary Care in Achieving Life's Essential 8: A Scientific Statement From the American Heart Association

To reduce morbidity and mortality rates of cardiovascular disease, an urgent need exists to improve cardiovascular health among US adults. In 2022, the American Heart Association issued Life's Essential 8, which identifies and defines 8 health behaviors and factors that, when optimized through a combination of primary prevention, risk factor management, and effective treatments, can promote ideal cardiovascular health. Because of its central role in patient care across the life span, primary care is in a strategic position to promote Life's Essential 8 and improve cardiovascular health in the United States. High-quality primary care is person-centered, team-based, community-aligned, and designed to provide affordable optimized health care. The purpose of this scientific statement from the American Heart Association is to provide evidence-based guidance on how primary care, as a field and practice, can support patients in implementing Life's Essential 8. The scientific statement aims to describe the role and functions of primary care, provide evidence for how primary care can be leveraged to promote Life's Essential 8, examine the role of primary care in providing access to care and mitigating disparities in cardiovascular health, review challenges in primary care, and propose solutions to address challenges in achieving Life's Essential 8.

Sex Disparities in In-Hospital Outcomes After Percutaneous Coronary Intervention (PCI) in Patients With Acute Myocardial Infarction and a History of Coronary Artery Bypass Grafting (CABG): A Cross-Sectional Study

Background and Aims

The role of sex disparities in in-hospital outcomes after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in patients with a history of coronary artery bypass grafting (CABG) remains underexplored. This study aimed to identify sex disparities in in-hospital outcomes after PCI in patients with AMI and a history of CABG.

Methods

Using the National Inpatient Sample database, we identified patients hospitalized for AMI with a history of CABG who underwent PCI between 2016 and 2019. 1:1 propensity score matching was used to minimize standardized mean differences of baseline variables and compare in--hospital outcomes.

Results

In total, 75,185 weighted hospitalizations of patients were identified. Compared with male patients, female patients exhibited elevated risks of in-hospital mortality (3.72% vs. 2.85%; adjusted odds ratio [aOR] 1.48; 95% confidence interval [CI] 1.14-1.93), major adverse cardiac or cerebrovascular events (MACCEs) (4.96% vs. 3.75%; aOR 1.46; 95% CI 1.18-1.82), bleeding (4.91% vs. 3.01%; aOR 1.56; 95% CI 1.27-1.79), and longer length of stay (4.64 days vs. 3.96 days; β 0.42; 95% CI 0.28-0.55). After propensity matching, female patients remained associated with increased risks of in-hospital mortality (3.81% vs. 2.81%; aOR 1.37; 95% CI 1.06-1.78), MACCEs (5.08% vs. 3.84%; aOR 1.35; 95% CI 1.08-1.70), bleeding (5.03% vs. 3.11%; aOR 1.57; 95% CI 1.24-2.00), and longer length of stay (4.61 ± 4.76 days vs. 4.06 ± 4.10 days; β 0.39; 95% CI 0.18-0.59). Female patients aged > 60 years were more vulnerable to in-hospital mortality than were their male counterparts (3.06% vs. 4.15%; aOR 1.56; 95% CI 1.18-2.05).

Conclusions

Female patients who underwent PCI for AMI with a history of CABG had higher risks of in-hospital mortality, MACCEs, bleeding, and longer length of stay, with in-hospital mortality rates being particularly pronounced among older patients.

Dietary Intake of Polyunsaturated Fatty Acids Is Associated with Blood Glucose and Diabetes in Community-Dwelling Older Adults

OBJECTIVES

The present study was conducted to examine the cross-sectional associations between the dietary intake of polyunsaturated fatty acids (PUFAs) and cardiometabolic risk factors in a large sample of Italian community-dwelling older adults.

METHODS

This is a cross-sectional study. Longevity Check-up 8+ (Lookup 8+) is an ongoing project that started in June 2015. The project is conducted in unconventional settings (e.g., exhibitions, malls, and health promotion campaigns) across Italy with the aim of fostering the adoption of healthy lifestyles in the general population. For the present study, participants were eligible if they were 65+ years and provided written informed consent. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), and blood glucose and cholesterol levels were assessed. A 12-item food frequency questionary was used to estimate the dietary intake of PUFAs, which included omega-3 (α-linolenic acid [ALA], eicosapentaenoic acid [EPA], and docosahexaenoic acid [DHA]) and omega-6 fatty acids.

RESULTS

Data of 4461 older adults (♀56%, mean age: 72.9 years, mean body mass index [BMI]: 26.1 kg/m2, blood glucose: 109 mg/dL, total blood cholesterol: 198.5 mg/dL, ALA: 8.8%, EPA: 16.0%, and DHA: 26.1%) were cross-sectionally analyzed. Multilinear regression results indicated that a high consumption of EPA, DHA, and DHA+EPA was negatively and significantly associated with glucose levels. Furthermore, binary regression analysis indicated that the dietary intake of ALA and omega-6 PUFAs was inversely and significantly associated with the prevalence of diabetes. In contrast, BMI values were positively associated with ALA and omega-6 PUFAs, and negatively with the consumption of EPA and DHA+EPA.

CONCLUSIONS

Findings of the present study indicate that the dietary intake of PUFAs was cross-sectionally, inversely, and significantly associated with blood glucose levels and the prevalence of diabetes in a large sample of Italian community-dwelling older adults.

CircRNA-mediated regulation of cardiovascular disease

Cardiovascular diseases (CVDs) encompass a range of disorders affecting the heart and blood vessels, such as coronary heart disease, cerebrovascular disease (e.g., stroke), peripheral arterial disease, congenital heart anomalies, deep vein thrombosis, and pulmonary embolism. CVDs are often referred to as the leading cause of mortality worldwide. Recent advancements in deep sequencing have unveiled a plethora of noncoding RNA transcripts, including circular RNAs (circRNAs), which play pivotal roles in the regulation of CVDs. A decade of research has differentiated various circRNAs by their vasculoprotective or deleterious functions, revealing potential therapeutic targets. This review provides an overview of circRNAs and a comprehensive examination of CVDs, the regulatory circRNAs within the vasculature, and the burgeoning research domain dedicated to these noncoding RNAs.

Type of menopause, age of menopause and cardiovascular disease: a cross-sectional study based on data from Rafsanjan cohort study

BACKGROUND

Cardiovascular disease is the leading cause of death among women, but sex-specific risk factors are incompletely understood. In this study, we aimed to assess the associations between the type of menopause, and age at natural menopause with the odds of cardiovascular disease (CVD), and coronary heart disease (CHD).

METHODS

This cross-sectional study is a part of data from the Rafsanjan Cohort Study (RCS) which is a branch of the Prospective Epidemiological Research Studies in Iran (PERSIAN). A sample of 1767 postmenopausal women were included. The diagnosis for CVD and CHD was based on self-report questionnaires. Menopause age was categorized as < 40, 40-44, 45-49, and ≥ 50. Also, the menopause types were classified as natural and induced menopause (surgery or chemotherapy). The association was evaluated by logistic regressions.

RESULTS

The menopause age < 40 years had higher odds of CVD compared to women with menopause age > 40 years (OR: 2.66; 95%CI 1.29-5.48). Women with induced menopause had higher odds of CVD compared to women with natural menopause (OR = 1.44, 95% CI 1.04-1.98). In terms of the odds of CHD, the results showed that the odds of CHD increased in menopause age < 40 years and induced menopause compared to reference groups (OR: 2.49, 95% CI 1.15-5.37, OR = 1.48; 95% CI 1.06-2.07, respectively).

CONCLUSION

Premature menopause and induced menopause should be considered as important risk factors for CVD, and CHD. Health policymakers should pay more attention to the type of menopause and the age of menopause in postmenopausal women to predict the risk of CVD and preventive strategies.

Time to development of macrovascular complications and its predictors among type 2 diabetes mellitus patients at Jimma University Medical Center

BACKGROUND

Type 2 diabetes mellitus is a serious metabolic disease that is often associated with vascular complications. The increasing prevalence of type 2 diabetes mellitus poses significant public health challenges, particularly in Low and Middle-Income Countries where healthcare resources are often limited. In Africa, the burden of T2DM is rising rapidly, leading to a consequential increase in macrovascular complications such as cardiovascular disease and stroke. These complications not only affect the quality of life but also significantly contribute to morbidity and mortality among affected individuals. The main objective of this study was to assess the time to development of macrovascular complications and identify its predictors among type 2 diabetes mellitus patients in Jimma University medical center from 2018-2022.

METHODS

Institutional-based retrospective follow-up study was conducted in Jimma University Medical Center among newly diagnosed type 2 diabetes mellitus patient from 2018, to 2022. A systematic sampling technique was used to recruit 452 records of type 2 diabetes mellitus patients. The Kaplan-Meier curve and the log-rank tests were used to determine the time to macro-vascular complications, and evaluate the significant difference in survival probability among predictors respectively. The overall goodness of the Cox proportional hazard model was checked by Cox-Snell residuals. Bivariable and multivariable cox-proportional hazard regression were used to identify the association between the variables and survival time.

RESULTS

The median survival time to development of macro vascular complications was 24 months. Urban residence [(Adjusted hazard ratio = 2.02; 95% CI: (1.33, 3.05)], having hypertension at start of diabetic treatment [(AHR = 1.52; 95% CI: (1.06, 2.13)], baseline age ≥ 60 years [(AHR = 4.42; 95% CI: (1.72, 11.29)], having dyslipidemia at baseline [(AHR = 1.82; 95% CI: (1.13, 2.93)], High density lipoprotein cholesterol levels < 40 mg/dl [(AHR = 2.11; (1.16, 3.81)], triglycerides > 150 mg/dl [(AHR = 1.48; 95% CI:( 1.02, 2.13)], Hemoglobin A1C level > 7% [(AHR = 1.49; 95% CI: (1.04, 2.14)], and Oral hypoglycemic agents + insulin [(AHR = 2.73; 95% CI: (1.81, 4.09)] were the significant predictors of the time to development of macro vascular complications.

CONCLUSION

Findings in this study indicated that the median time to development of macro vascular complications among type 2 diabetes mellitus patients was 24 months. Baseline age category in years, residence, presence of hypertension, presence of dyslipidemia, High density lipoprotein-cholesterol level < 40 mg/dl, triglyceride > 150 mg/dl, HgbA1C > 7% at baseline, and medication regimens were identified as independent significant predictors of the time to development of macro vascular complications among type 2 diabetes mellitus patients. The findings call attention to the role of treatment regimens, particularly the use of combination therapies involving oral hypoglycemic agents and insulin, which were associated with increased hazards for complications. High incidence of macrovascular complications within a short follow-up period underscores the need for proactive, individualized care strategies in T2DM management. By focusing on early identification of at-risk patients and tailoring treatment plans accordingly, healthcare providers can potentially improve outcomes and reduce the burden of macro vascular complications in this population.

Insulin-like Growth Factor-Binding Protein-1 (IGFBP-1) as a Biomarker of Cardiovascular Disease

Insulin-like growth factor-binding protein-1 (IGFBP-1) contributes to the regulation of IGFs for metabolism and growth and has IGF-independent actions. IGFBP-1 in the circulation is derived from the liver, where it is inhibited by insulin and stimulated by multiple factors, including proinflammatory cytokines. IGFBP-1 levels are influenced by sex and age, which also determine cardiometabolic risk and patterns of disease presentation. While lower circulating IGFBP-1 concentrations are associated with an unfavorable cardiometabolic risk profile, higher IGFBP-1 predicts worse cardiovascular disease outcomes. This review explores these associations and the possible roles of IGFBP-1 in the pathophysiology of atherosclerosis. We recommend the evaluation of dynamic approaches, such as simultaneous measurements of fasting IGFBP-1 and proinsulin level in response to an oral glucose challenge, as well as multi-marker approaches incorporating markers of inflammation.

Mediterranean Diet in Older Adults: Cardiovascular Outcomes and Mortality from Observational and Interventional Studies-A Systematic Review and Meta-Analysis

BACKGROUND/OBJECTIVES

there is conflicting evidence on the role of the Mediterranean Diet (MD) in reducing the risk of long-term outcomes in older adults. The aim of our study was to assess the effectiveness of high adherence to MD in reducing all-cause mortality and cardiovascular outcomes among older adults.

METHODS

PubMed database was searched up to 31 May 2023. We included randomized controlled trials (RCT) and cohort studies in the English language which evaluated the Mediterranean diet's adherence to exposure on a population with a mean age > 60 years. The main outcomes were cardiovascular fatal and non-fatal events, and all-cause mortality. A sub-analysis on individuals > 70 years old was conducted. Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used for assessing data quality and validity. Pooled data were obtained by using random-effects models.

RESULTS

a total of 28 studies were included in this meta-analysis (26 observational studies and 2 randomized trials), reporting a total of 679,259 participants from different continents. Our results showed that high adherence to the MD reduces all-cause mortality risk by 23% (95% CI: 0.70-0.83), while it decreases the risk of cardiovascular mortality by 27% (95% CI: 0.64-0.84) and that of non-fatal cardiovascular events by 23% (95% CI: 0.55-1.01).

CONCLUSIONS

MD is a promising dietary pattern for promoting health among older adults, as it is associated with reduced risks of all-cause and cardiovascular mortality, and non-fatal cardiovascular events. Adopting a Mediterranean Diet may contribute to better overall health and a lower likelihood of cardiovascular-related health issues in older individuals.

Screening for Frailty According to Rural and Suburban Health Areas in the Context of Adapted Integrated Care for Older People Approach: The FRAGING Study

BACKGROUND

The integrated care for older people (ICOPE) program, developed by the World Health Organization, serves as a public health initiative to maintain older adults' functional abilities and promote healthier aging. Here, we adapted the ICOPE approach to assess overall prevalence of frailty in rural and semi-urban areas. We also investigated health-related quality of life and physical activity and sedentary behavior in older people.

METHODS

The FRAGING multicenter cohort study was performed on screening days dedicated to older adults (≥65 years) without chronic disease in a rural area (RU) and in a semi-urban area (SU).

RESULTS

The study included a total of 105 participants: 98.4% of participants were frail, with a mean of 4.3 [SD: 2.5] frailties per participant. RU participants had higher number of frailties (p = 0.02) and a higher percentage of frail participants in the dimensions of health-related quality of life (p < 0.0001), socioeconomical level (p = 0.008), colorectal cancer screening (p = 0.022), and tetanus booster doses (p = 0.008). Globally, women were less sedentary than men (p = 0.02) and engaged more in low physical activity (LPA) than men (p = 0.01). RU participants engaged more in LPA than SU participants (p = 0.03).

CONCLUSIONS

The prevalence of frailty is alarmingly underestimated in older adults without chronic disease. This study demonstrated the need to propose appropriate, validated screening tests that consider territorial issues and organization of care delivery. The ICOPE framework serves as a good startpoint for reorganizing person-centered healthcare pathways.

Acute Coronary Syndrome After Aneurysmal Subarachnoid Hemorrhage: Incidence, Risk Factors and Impact on the Outcome

Background and Objectives: Development of acute coronary syndrome (ACS) after aneurysmal subarachnoid hemorrhage (aSAH) strongly affects further neuro-intensive care management. We aimed to analyze the incidence, risk factors and clinical impact of ACS in aSAH patients. Materials and Methods: This retrospective analysis included 855 aSAH cases treated between 01/2003 and 06/2016. The occurrence of ACS during 3 weeks of aSAH was documented. Patients' demographic, clinical, radiographic and laboratory characteristics at admission were collected as potential ACS predictors. The association between ACS and the aSAH outcome was analyzed as the occurrence of cerebral infarcts in the computed tomography scans and unfavorable outcome (modified Rankin scale > 3) at 6 months after aSAH. Univariable and multivariable analyses were performed. Results: ACS was documented in 28 cases (3.3%) in the final cohort (mean age: 54.9 years; 67.8% females). In the multivariable analysis, there was a significant association between ACS, an unfavorable outcome (adjusted odds ratio [aOR] = 3.43, p = 0.027) and a borderline significance with cerebral infarcts (aOR = 2.5, p = 0.066). The final prediction model for ACS occurrence included five independent predictors (age > 55 years [1 point], serum sodium < 142 mmol/L [3 points], blood sugar ≥ 170 mg/dL [2 points], serum creatine kinase ≥ 255 U/L [3 points] and gamma-glutamyl transferase ≥ 36 U/L [1 point]) and showed high diagnostic accuracy for ACS prediction (AUC = 0.879). Depending on the cumulative score value, the risk of ACS in the cohort varied between 0% (0 points) and 66.7% (10 points). Conclusions: ACS is a rare, but clinically very relevant, complication of aSAH. The development of ACS can reliably be predicted by the presented prediction model, which enables the early identification of aSAH individuals at high risk for ACS. External validation of the prediction model is mandatory.

Renal tubular damage as an independent risk factor for all-cause and cardiovascular mortality in a community-based population: the Takahata study

BACKGROUND

Renal tubular damage plays a crucial role in the development of end-stage kidney disease, a risk factor for cardiovascular events and mortality. However, the relationship between renal tubular damage and all-cause and cardiovascular mortality rates in the general population remains unclear. To address this gap, we conducted a cohort study in the general population using the urinary β2-microglobulin-creatinine ratio (UBCR) as a marker of renal tubular damage.

METHODS

This study included 3427 residents aged ≥ 40 years in Takahata, Japan. We examined the association between the UBCR values in single-spot urine samples at enrollment and all-cause and cardiovascular mortality rates within a median follow-up of 9.2 years.

RESULTS

The participants were divided into two groups based on their UBCR levels (< 300 μg/g and ≥ 300 μg/g groups). Kaplan-Meier analysis showed a significantly higher incidence of all-cause and cardiovascular mortality rates in the high UBCR group (log-rank P < 0.01). Multivariable Cox proportional hazards model adjusted for age, sex, estimated glomerular filtration rate (eGFR), urine albumin level, smoking, and comorbidities showed a significantly higher hazard ratio of 1.49 (95% confidence interval (CI) 1.10-2.03, P = 0.01) for all-cause mortality and a hazard ratio of 1.73 (95% CI 1.00-2.98, P = 0.048) for cardiovascular mortality in the high-UBCR group. The net reclassification index was significantly improved by adding a high UBCR to the conventional risk factors.

CONCLUSION

UBCR is an independent risk factor for all-cause and cardiovascular mortality in the general population, independent of eGFR and urinary albumin levels.

Endothelial Dysfunction with Aging: Does Sex Matter?

Oxidative stress and inflammation accompany endothelial dysfunction that results from the excessive or uncontrolled production of reactive oxygen and nitrogen species (RONS) in older adults. This study was designed to assess the usefulness of serum oxi-inflammatory component combinations in vascular disease prediction and prevention with regard to sex. Women (n = 145) and men (n = 50) aged 72.2 ± 7.8 years participated in this project. The females demonstrated the elevated production of hydrogen peroxide (H2O2) and nitric oxide (NO) responsible for intravascular low-density lipoprotein oxidation. NO generation was enhanced in the women, but its bioavailability was reduced, which was expressed by a high 3-nitrotyrosine (3-NitroT) concentration. The relation of NO/3-NitroT (rs = 0.811, p < 0.001) in the women and NO/3-NitroT (rs = -0.611, p < 0.001) in the men showed that sex determines endothelial dysfunction. RONS generation in the women simultaneously promoted endothelial regeneration, as demonstrated by a ~1.5-fold increase in circulating progenitor cells. Inflammation-specific variables, such as the neutrophil-to-lymphocyte ratio, the systemic immune inflammation index, and the neutrophil-to-high-density lipoprotein (HDL) ratio, were reduced in the women and showed their diagnostic utility for clinical prognosis in vascular dysfunction, especially the C-reactive-protein-to-HDL ratio (AUC = 0.980, specificity 94.7%, sensitivity 93.3%, OR = 252, 95% CI 65-967, p < 0.001). This study is the first to have revealed sex-specific changes in the oxi-inflammatory response, which can generate the risk of cardiovascular events at an older age.

Economic burden of cardiovascular diseases among elderly patients in Iran: a case from a developing country

BACKGROUND

Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity worldwide, particularly among the aging population. This study aims to evaluate the economic burden of CVDs among Iranians aged 60 years and older.

METHODS

A cost-of-illness study was conducted using a prevalence-based approach from a societal perspective. Cost analysis employed the bottom-up micro-costing method to assess direct medical and non-medical costs, while indirect costs were calculated using the human capital approach. Data were sourced from medical records of individuals aged 60 and older with CVDs registered in the hospital information systems of public and private hospitals in southeastern Iran. Additionally, structured face-to-face interviews were conducted with 160 caregivers or relatives serving as companions of elderly patients, using a structured questionnaire to gather data on healthcare utilization. Sensitivity analyses were performed, along with projections of the future economic burden of CVDs.

RESULTS

The annual total cost of CVDs among people aged 60 years and above in Iran was estimated at US$ 1,885,091,171.7 (about 1.88 billion), equivalent to 1.27% of the Iran's GDP in 2021. Direct medical costs accounted for 90.62% of the total, with 54.72% attributed to ambulatory care. The average cost of CVDs per patient was US$ 446.2. The results of two-way sensitivity analysis provided an estimated cost range between US$ 1.2 billion and US$ 2.7 billion. By 2030, the total cost of CVDs is projected to reach US$ 21 billion.

CONCLUSIONS

The elderly population with CVDs imposes a growing economic burden on Iran's healthcare system and society. This underscores the urgent need for effective and cost-effective interventions to prevent and manage CVDs in Iran.

A rare HSC-derived megakaryocyte progenitor accumulates via enhanced survival and contributes to exacerbated thrombopoiesis upon aging

Distinct routes of cellular production from hematopoietic stem cells (HSCs) have defined our current view of hematopoiesis. Recently, we challenged classical views of platelet generation, demonstrating that megakaryocyte progenitors (MkPs), and ultimately platelets, can be specified via an alternate and additive route of HSC-direct specification specifically during aging. This "shortcut" pathway generates hyperactive platelets likely to contribute to age-related platelet-mediated morbidities. Here, we used single-cell RNA/CITEseq to demonstrate that these age-unique, non-canonical (nc)MkPs can be prospectively defined and experimentally isolated from wild type mice. Surprisingly, this revealed that a rare population of ncMkPs also exist in young mice. Young and aged ncMkPs are functionally distinct from their canonical (c)MkP counterparts, with aged ncMkPs paradoxically and uniquely exhibiting enhanced survival and platelet generation capacity. We further demonstrate that aged HSCs generate significantly more ncMkPs than their younger counterparts, yet this is accomplished without strict clonal restriction. Together, these findings reveal significant phenotypic, functional, and aging-dependent heterogeneity among the MkP pool and uncover unique features of megakaryopoiesis throughout life, potentially offering cellular and molecular targets for mitigation of age-related adverse thrombotic events.

Nonlinear dynamics of multi-omics profiles during human aging

Aging is a complex process associated with nearly all diseases. Understanding the molecular changes underlying aging and identifying therapeutic targets for aging-related diseases are crucial for increasing healthspan. Although many studies have explored linear changes during aging, the prevalence of aging-related diseases and mortality risk accelerates after specific time points, indicating the importance of studying nonlinear molecular changes. In this study, we performed comprehensive multi-omics profiling on a longitudinal human cohort of 108 participants, aged between 25 years and 75 years. The participants resided in California, United States, and were tracked for a median period of 1.7 years, with a maximum follow-up duration of 6.8 years. The analysis revealed consistent nonlinear patterns in molecular markers of aging, with substantial dysregulation occurring at two major periods occurring at approximately 44 years and 60 years of chronological age. Distinct molecules and functional pathways associated with these periods were also identified, such as immune regulation and carbohydrate metabolism that shifted during the 60-year transition and cardiovascular disease, lipid and alcohol metabolism changes at the 40-year transition. Overall, this research demonstrates that functions and risks of aging-related diseases change nonlinearly across the human lifespan and provides insights into the molecular and biological pathways involved in these changes.

Prolonged Time-to-antihypertensive Therapy Worsens Organ Damage and Blood Pressure Control in Arterial Hypertension

INTRODUCTION

Delay in arterial hypertension (AH) diagnosis and late therapy initiation may affect progression towards hypertensive-mediated organ damage (HMOD) and blood pressure (BP) control.

AIM

We aimed to assess the impact of time-to-therapy on BP control and HMOD in patients receiving AH diagnosis.

METHODS

We analysed data from the Campania Salute Network, a prospective registry of hypertensive patients (NCT02211365). At baseline visit, time-to-therapy was defined as the interval between the first occurrence of BP values exceeding guidelines-directed thresholds and therapy initiation; HMOD included left ventricular hypertrophy (LVH), carotid plaque, or chronic kidney disease. Optimal BP control was considered for average values < 140/90 mmHg. Low-risk profile was defined as grade I AH without additional cardiovascular risk factors.

RESULTS

From 14,161 hypertensive patients, we selected 1,627 participants who were not on antihypertensive therapy. This population was divided into two groups based on the median time-to-therapy (≤ 2 years n = 1,009, > 2 years n = 618). Patients with a time-to-therapy > 2 years had higher risk of HMOD (adjusted odds ratio, aOR:1.51, 95%, CI:1.19-1.93, p < 0.001) due to increased risks of LVH (aOR:1.43, CI:1.12-1.82, p = 0.004), carotid plaques (aOR:1.29, CI:1.00-1.65, p = 0.047), and chronic kidney disease (aOR:1.68, CI:1.08-2.62, p = 0.022). Time-to-therapy > 2 years was significantly associated with uncontrolled BP values (aOR:1.49, CI:1.18-1.88, p < 0.001) and higher number of antihypertensive drugs (aOR:1.68, CI:1.36-2.08, p < 0.001) during follow-up. In low-risk subgroup, time-to-therapy > 2 years did not impact on BP control and number of drugs.

CONCLUSIONS

In hypertensive patients, a time-to-therapy > 2 years is associated with HMOD and uncontrolled BP.

A study to compare and correlate the effect of a yogic lifestyle on Framingham, Q RISK 3, and WHO risk scores among high-risk cardiovascular subjects

Background

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. Yoga is a low-cost, easily accessible lifestyle modification program that holds as an approach to decreasing cardiometabolic risk factors and increasing exercise self-efficacy among high-risk subjects. This study aimed to assess the impact of the yogic lifestyle (including diet) on cardiovascular risk scores by using the Framingham (FRS), QRISK3 score, and World Health Organization (WHO) CVD risk prediction charts at baseline, three months, and six months. The present study compares and correlates FRS, QRISK3, and WHO cardiovascular risk scores.

Methodology

The experimental interventional study was conducted among the high-risk population at RUHS College of Medical Sciences and Associated Group of Hospitals, Jaipur. Framingham risk Score, QRISK3 score, and WHO CVD risk prediction charts were used as a method of measurement for the outcome of interest at baseline, three months, and six months in the study and control group. Randomization and allocation in yoga and control groups were performed using computer-generated random numbers. The statistical analysis was done using advanced SPSS-22 software at significant level tests as p≤0.05, ensuring the highest level of accuracy. Data were analyzed using a one-way variance ANOVA test analysis at baseline, three, and six months. Pearson correlation analysis was done to compare different risk scores.

Results

Participants had a mean age of 48.43 ± 6.4 years. Baseline values (mean±SD) of FRS, Qrisk3, WHO were 24.59±10.15,28.59±10.11,15.71±6.07. After six months of yogic lifestyle, these values decreased significantly to 15.1±7.05, 20.09±7.08, and 13.85±4.96. The decrease in cardiovascular scores was statistically significant (p<0.0001), providing strong evidence for the effectiveness of the yogic lifestyle. Pearson correlation analysis results depict that FRS and Q risk 3 (r=0.840, p<0.0001), FRS and WHO risk chart (r=0.768, p<0.0001), Q risk3 and WHO risk chart (r=0.778, p<0.0001) have a statistically significant strong positive correlation.

Conclusion

This study's findings suggest that a 24-week yogic lifestyle intervention (including diet) significantly decreased FRS, Q RISK 3, and WHO CVD risk scores among high-risk subjects compared to the control group.

Short Physical Performance Battery (SPPB) and Its Relationship with the Predisposition to Muscle and Joint Injuries Associated with the COL1A1 and IL-6 Gene in Older Adults

Background/Objectives: Aging leads to physiological changes influenced by lifestyle, environment, and genetics, increasing the risk of morbidity and mortality in older adults. COL1A1 gene encodes an essential protein in connective tissues, which is associated with musculoskeletal lesions. The interleukin-6 (IL-6) gene is a proinflammatory and anti-inflammatory regulator and has a greater predisposition to fractures and osteoporosis reported. In turn, these alterations are associated with a decrease in physical capacity, leading to a progressive loss of functionality and quality of life in older adults. Methods: A cross-sectional study was designed to identify the relationship between physical condition as determined using the Short Physical Performance Battery (SPPB) and the predisposition parameters for muscle and joint injuries in a population of 422 older adults, active and of ≥60 years. The variables evaluated were sociodemographic data, SPPB evaluation, and COL1A1 and IL-6 gene DNA extracted by buccal scraping. Results: SPPB total score was significantly correlated with age -0.07, weight -0.02, waist circumference -0.02, and body mass index -0.05 (p < 0.005). Conclusions: Regarding genetic variables, there were no significant differences. However, lower SPPB values were observed in the GG genotype and GT of COL1A1 when compared to the CC genotype and GC of IL-6.

Association Between Cognitive Function and the Autonomic Nervous System by Photoplethysmography

This study explored the relationship between cognitive function and the autonomic nervous system by categorizing participants into two groups based on their cognitive function scores in each domain of the SNSB-D: a High Cognitive Performance (HCP) group and a Low Cognitive Performance (LCP) group. We analyzed the Pulse Rate Variability (PRV) parameters for each group. Photoplethysmography (PPG) data were collected and processed to remove noise, and the PRV parameters in the time and frequency domains were extracted. To minimize the impact of age and years of education on the PRV parameters, we performed an adjusted analysis using a Generalized Linear Model (GLM). The analysis revealed that the autonomic nervous system, particularly the parasympathetic nervous system, was more activated in the LCP group compared to the HCP group. This finding suggests that in individuals with low cognitive function, the sympathetic nerves in the autonomic nervous system are less activated, so the parasympathetic nerves are relatively more activated. This study investigated the correlation between cognitive function and PRV parameters, highlighting the potential use of these parameters as indicators for the early diagnosis and classification of cognitive decline.