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Photoplethysmogram is a noninvasive technique used to detect volumetric changes in the blood. Cardiovascular diseases, related to heart and blood supply problems, are one of the largest causes of death in the world. Our study explored the possibility of classifying different cardiovascular diseases using photoplethysmogram signals for quick diagnosis. Using the support vector machine technique, the classification is done at the software level, while Xilinx Zynq 7000 field-programmable gate array (FPGA) chip is utilized for hardware design. The overall accuracy for detecting cerebral infarction and cerebrovascular disease is 93.48% and 96.43%, respectively, using eleven features. In addition, diabetes which is linked to cardiovascular diseases is classified, and an accuracy of 88.46% is achieved. Considering the PPG signal with a higher signal quality index, the overall accuracy for all the diseases can be further increased. The resource and power utilization of the implemented system is analyzed, which shows that 0.693 W power is required. The developed prototype can be further extended as a point-of-care system for cardiovascular disease detection. [ABSTRACT FROM AUTHOR]

Serum uric acid (SUA) has been linked to mortality in heart failure, hypertension, diabetes, hyperlipidemia, obstructive sleep apnea, and metabolic dysfunction-associated fatty liver disease. However, data are lacking on how it affects the mortality risk of patients with cardiovascluar disease (CVD). This study evaluated the data of 4 308 individuals from the National Health and Nutrition Examination Survey 1999–2008 using multivariate Cox proportional hazards regression, trend, restricted cubic splines (RCS), subgroup and inflection point analyses. All-cause and cardiovascular mortality accounted for 42.8% and 17.6% of cases, respectively, over a median 80- month follow-up. Upon control for confounding variables, no linear trend was seen in the Cox proportional hazards regression analysis between SUA and all-cause (P = 0.001) or cardiovascular death (P = 0.007) mortality. On the RCS analysis, SUA showed an L-shaped connection with all-cause (non-linear P < 0.001) and cardiovascular mortality (non-linear P = 0.003) mortality. On the inflection point analysis, patients with CVD and an SUA ≥ 6.127 mg/dL had an all-cause mortality hazard ratio of 1.146 (95% confidence interval, 1.078–1.217; P < 0.001), while those with CVD and an SUA ≥ 5.938 mg/dL had a cardiovascular mortality hazard ratio of 1.123 (95% confidence interval, 1.03–1.225; P = 0.007). In patients with CVD, higher SUA was non-linearly correlated with all-cause and cardiovascular mortality. [ABSTRACT FROM AUTHOR]

Arteriosclerosis (AS) presents a significant global health challenge, demanding innovative therapeutic strategies. This review explores the potential of nanoparticles (NPs) and mesenchymal stem cells (MSCs) as promising modalities for treating AS. NPs enable targeted drug delivery, while MSCs possess immunomodulatory and regenerative capabilities. We discuss recent advances in NP-based drug delivery systems tailored for AS treatment and highlight MSCs’ roles in modulating inflammation and promoting vascular repair. Additionally, we examine the synergistic effects of combining NPs and MSCs for enhanced therapeutic outcomes. Furthermore, this paper provides insights into targeting endothelial cells, T-cells, macrophages, lipid levels, and plaques in AS using MSCs. It also reviews various types of metal-based and non-metallic NPs utilized in AS therapy. This comprehensive overview underscores the potential synergies between MSCs and NPs in cardiovascular disease therapy, emphasizing the need for further research to fully realize their therapeutic implications. [ABSTRACT FROM AUTHOR]

Nowadays, automated analysis of the electrocardiogram (ECG) signal is a popular choice to facilitates easy and expert-independent detection of lethal cardiovascular diseases (CVDs). Although, a majority of the state-of-the-art algorithms are found to be lagging due to the use of complicated methodologies, limited dataset, high feature dimension, feature selection or intense classification techniques. In this research an original, easy-to-use ECG based methodology is proposed for completely automated identification of multiple types of critical CVDs. Primarily, after preprocessing the algorithm uses a simplified technique for exact detection of ECG fiducial points. Then, based on detected fiducial points, some well interpretable and prominent ECG time domain features are efficiently extracted and a binary feature matrix has been derived using those features from different leads. Finally, a distinctive score is evaluated from the binary feature matrix calculating the sum of weighted feature value and only by utilizing the score,discrimination between the various types of CVDs is highly detectable. Proficiency of the algorithm is widely evaluated on the 12-lead ECG signal data collected from Physikalisch-Technische-Bundesanstalt (PTB) and PTB-XL database. The algorithm presents promising outcome with average accuracy, sensitivity and specificity of 99.43%, 98.27% and 99.59%, respectively. Evidently, the algorithm is capable enough and efficient as well in comparison with other reported techniques till date. Moreover, the use of a unique score derived from the binary matrix ascertains the exact detection of multiple cardiac abnormalities and the superior classification accuracy makes the algorithm promising for personal computerized health monitoring applications. [ABSTRACT FROM AUTHOR]

Introduction: Trinidad & Tobago has the highest prevalence of cardiovascular disease (CVD) in the Caribbean and clopidogrel is a ubiquitously used treatment. Yet, the extent of genetically mediated clopidogrel resistance is unknown. To determine this, we investigated whether the association between CYP2C19*2 and CYP2C19*3 genetic variants and clopidogrel resistance holds, and calculated the frequencies of these in the Trinidadian CVD population. Methods: Demographic data, clinical data, and a saliva sample were collected under informed consent from 22 patients with CVD on dual anti-platelet therapy whose biochemical resistance to clopidogrel is known, and a further 162 patients accessing the main public CVD clinic in Trinidad and who are either currently being treated or are likely to be treated with clopidogrel. A polymerase chain reaction (PCR) and restriction enzyme digestion procedure was used to genotype each patient for the CYP2C19*2 and CYP2C19*3 allelic variants. Genotype was compared to known clopidogrel resistance in the 22 patients, and to disease status and clopidogrel usage in the larger cohort. Results: CYP2C19*2 genotype was concordant with clopidogrel resistance. CYP2C19*2 was detected in 61.1% (99/162) of patients and CYP2C19*3 was undetected. Clopidogrel was the most prescribed antiplatelet therapy (42%). A total of 120 people presented with coronary artery disease (CAD) and 52.5% of these (n = 63/120) are currently prescribed clopidogrel. 63.5% (40/63) of patients with CAD who are prescribed clopidogrel carry the CYP2C19*2 allele; ten homozygous and 30 heterozygous. Indian patients comprised 65% of the cohort and were four times more likely to carry the CYP2C19*2 allele than African patients. Conclusions: A large proportion of Trinidadian patients with CVD who are prescribed or may be prescribed clopidogrel carry genetic variants associated with clopidogrel resistance. These results emphasize the clinical need for further investigation into whether CYP2C19*2 genotype should guide clopidogrel use for the cardiovascular disease population in Trinidad & Tobago. A slide deck is available for this article. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) can independently increase the risk of stroke, affecting both young and adult RA patients. Recent attention has been drawn to the association between stroke and RA, supported by mounting evidence. Given that stroke is a significant and an urgent public health concern, this review aims to highlight the relationship between stroke and RA, covering mechanisms, underlying risk factors, early detection tools, and treatment implications. By uncovering the connection that links RA to stroke, we can pave the way for targeted healthcare practices and the development of preventive strategies for individuals with RA. Therefore, further research is imperative to deepen our understanding of this association and, ideally, guide treatment decisions for individuals at risk of both RA and stroke. [ABSTRACT FROM AUTHOR]

Purpose of Review: Cardiovascular disease (CVD) is the leading cause of death in women. This review highlights contraceptive options and their effects on the cardiovascular system (CVS). It provides guidance to cardiologists to make informed decisions regarding the safety of contraceptive use and cardiovascular risk stratification in the care of women of childbearing age. Recent Findings: Approximately 44% of American women live with some type of CVD. Many women use hormonal contraception during their lifetime. It is imperative that cardiologists have a robust understanding of the forms of contraception in current use and their cardiovascular effects. Summary: This contemporary review provides a comprehensive summary of available contraceptive methods to practicing cardiologists and aims to be used as a resource to guide cardiovascular specialists on contraception in the context of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Purpose of Review: To provide an update of the current evidence of cardiac disease–induced posttraumatic stress disorder (CDI-PTSD) with a focus on acute coronary events. Recent Findings: A cardiovascular disease, particularly a life-threatening cardiac event is often a highly stressful experience that can induce PTSD in patients and their caregivers, taking a chronic course if left untreated. There are several features distinguishing CDI-PTSD from "traditional" PTSD induced by external trauma, namely enduring somatic threat, inability to avoid trauma-related cues and hyperarousal with internal body sensations leading to constant fear of recurrent cardiac events. An increased risk of recurrent CVD events may be explained by pathophysiological changes, an unhealthy lifestyle and non-adherence to cardiac treatment. A trauma-focused approach might be useful to treat CDI-PTSD. Summary: Treatment options for patients and caregivers as well as long-term effects of trauma-focused interventions on physical and mental health outcomes should be future research directions. [ABSTRACT FROM AUTHOR]

Circular RNA (circRNA) has a closed-loop structure, and its 3' and 5' ends are directly covalently connected by reverse splicing, which is more stable than linear RNA. CircRNAs usually possess microRNA (miRNA) binding sites, which can bind miRNAs and inhibit miRNA function. Many studies have shown that circRNAs are involved in the processes of cell senescence, proliferation and apoptosis and a series of signalling pathways, playing an important role in the prevention and treatment of diseases. CircRNAs are potential biological diagnostic markers and therapeutic targets for cardiovascular diseases (CVDs). To identify biomarkers and potential effective therapeutic targets without toxicity for heart disease, we summarize the biogenesis, biology, characterization and functions of circRNAs in CVDs, hoping that this information will shed new light on the prevention and treatment of CVDs. [ABSTRACT FROM AUTHOR]

Inflammation characterizes all stages of atherothrombosis and provides a critical pathophysiological link between plaque formation and its acute rupture, leading to coronary occlusion and heart attack. In the last 20 years the possibility of quantifying the degree of inflammation of atherosclerotic plaques and, therefore, also of vascular inflammation aroused much interest. 18Fluoro-deoxy-glucose photon-emissions-tomography (18F-FDG-PET) is widely used in oncology for staging and searching metastases; in cardiology, the absorption of 18F-FDG into the arterial wall was observed for the first time incidentally in the aorta of patients undergoing PET imaging for cancer staging. PET/CT imaging with 18F-FDG and 18F-sodium fluoride (18F-NaF) has been shown to assess atherosclerotic disease in its molecular phase, when the process may still be reversible. This approach has several limitations in the clinical practice, due to lack of prospective data to justify their use routinely, but it's desirable to develop further scientific evidence to confirm this technique to detect high-risk patients for cardiovascular events. [ABSTRACT FROM AUTHOR]

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The identification of which patients with obstructive sleep apnea (OSA) are more likely to develop cardiovascular disease (CVD) remains a challenge. OSA causes oxidative stress (OS) which may contribute to CVD pathogenesis. Therefore, OS markers could be useful in risk-stratifying cardiovascular (CV) risk in OSA patients. The purpose of this pilot study was to assess whether three OS marker levels could be associated with incident CVD in suspected OSA patients. Morning plasma levels of 8-isoprostane, 8-hydroxy-2′-deoxyguanosine (8-OHdG) and superoxide dismutase (SOD) were measured in patients with suspected OSA referred for a polysomnogram (PSG). A composite outcome of CV events was defined by linkage with provincial administrative health databases. Cox proportional hazards models were used to assess the relationship between the levels of OS markers and events. 352 patients were included (mean age of 51.4 years, 68% male, median apnea hypopnea index of 16/h). Thirty-one first CV events occurred over an 8-year follow-up. In univariate or fully adjusted models, none of the OS markers were significantly associated with incident CV events (hazard ratio in adjusted models of: 1.25 (95% CI 0.56–2.80, p = 0.59), 1.15 (0.52–2.57, p = 0.73), 0.77 (0.37–1.61, p = 0.48), for 8-OHdG, 8-isoprostane and SOD; however, confidence intervals were wide. In this small preliminary study, oxidative stress markers were not significantly associated with risk of CV events. However, moderate associations between these markers and risk of CV events are possible and should be the focus of future larger studies. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is the major cause of death worldwide. Extensive cardiovascular biomarkers are available using blood tests but very few, if any, investigations have described non-invasive tests for cardiovascular biomarkers based on readily available hair samples. Here we show, first, that human hair proteins are post-translationally modified by arginine methylation (ArgMe). Using western blot, proteomic data mining and mass spectrometry, we identify several ArgMe events in hair proteins and we show that keratin-83 is extensively modified by ArgMe in the human hair. Second, using a preliminary cohort (n = 18) of heterogenous healthy donors, we show that the levels of protein ArgMe in hair correlate with serum concentrations of a well-established cardiovascular biomarker, asymmetric dimethylarginine (ADMA). Compared to blood collection, hair sampling is cheaper, simpler, requires minimal training and carries less health and safety and ethical risks. For these reasons, developing the potential of hair protein ArgMe as clinically useful cardiovascular biomarkers through further research could be useful in future prevention and diagnosis of cardiovascular disease. [ABSTRACT FROM AUTHOR]

A novel coronavirus disease (COVID-19), caused by a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was discovered in Wuhan, China, in December 2019, and the world has suffered from a pandemic. As of 22nd March 2020, at least 185 countries worldwide had been affected by COVID-19. SARS-CoV-2, leading to COVID-19 pneumonia, infects cells through ACE-2 receptors. The disease has different clinical signs and symptoms, including chills, high fever, dyspnea, and cough. Other symptoms including haemoptysis, myalgia, diarrhoea, expectoration, and fatigue may also occur. The rapid rise in confirmation cases is severe in preventing and controlling COVID-19. In this review, the article will explore and evaluate the insights into how COVID influences patients with other comorbid conditions such as cardiovascular disease, diabetes, Parkinson's, and how conditions Urolithiasis, anosmia, and anuria may develop after infection. The virus mutates and the variants are now prevalent in the present scenario where the world stands in eradicating the pandemic by looking into the development of vaccines by several countries and how the vaccination can temporarily help prevent COVID spread. [ABSTRACT FROM AUTHOR]

Purpose of Review: Cardiovascular disease secondary to diabetes continues to threaten the survivability of many people all over the world. We assess the most recent findings of synergistic effects of combined glucagon-like peptide 1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 (SGLT2) inhibitors in lowering cardiac complications in the diabetic population. We describe drug therapies' mechanism of action, postulated cardioprotective process, the additive value of conjugated therapy, and analyze recently reported study and its limitation. Recent Findings: SGLT2 inhibitors and GLP-1RAs have gained popularity due to their ability to reduce major adverse cardiovascular events in diabetic patients. There is emerging evidence of the additional cardiovascular benefit from the combined application of SGLT2 inhibitors and GLP-1RAs therapy demonstrated by a recent real-world cohort study. Summary: Reducing cardiac mortality in patients with diabetes by administering dual antihyperglycemic therapies (GLP-1Rs and SGLT2 inhibitors) might play a key role in the future treatment of the diabetic population. [ABSTRACT FROM AUTHOR]

Purpose of Review: Cardiac rehabilitation (CR) referral is a Class I post-myocardial infarction (MI) recommendation from the American Heart Association and the American College of Cardiology, yet referral rates remain strikingly low, with cardiologists some of the worst under-referring offenders. This paper seeks to review the evolution of CR and its well-established benefits, as well as reasons behind the poor referral and utilization. Recent Findings: CR is a secondary prevention program for cardiovascular disease (CVD) that was first initiated in the 1970s as a hospital-based exercise program after an acute MI, but then evolved into a comprehensive multi-disciplinary program for patients with a wider range of cardiovascular diseases. CR mortality and morbidity benefits have endured over decades, even as interventional and pharmacological cardiovascular therapeutics have improved and as patients have become relatively more stable. Summary: Despite being an evidence-based clinical standard, referral and participation in CR are disconcertingly low. In efforts to combat poor referral rates, and improve care in the contemporary care environment, the approach to CR is evolving. Innovations include broadening CR beyond the hospital setting into remote- and hybrid-based formats, while still incorporating exercise training, risk factor reduction, and education, as well as behavioral and psychosocial support. Nonetheless, there still remain many challenges to overcome in order to increase participation of all ages, financials, races, and sexes. With new performance measures as well as an increasing number of NIH-funded studies on the horizon, there is hope that CR will become a relatively more valued and utilized component of cardiovascular preventative care. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is a life-limiting condition in patients with chronic kidney disease (CKD) and is rapidly progressive, especially in those with stage 5 CKD and on dialysis. Cardiovascular mortality, although reducing, remains at least 30 times higher than in the general pediatric population. The American Heart Association guidelines for cardiovascular risk reduction in high-risk pediatric patients has stratified pediatric CKD patients in the "high risk" category for the development of CVD, with associated pathological and/or clinical evidence for manifest coronary disease before 30 years of age. While improving patient survival is a key priority, other patient-related outcomes, such as psychosocial development, quality of life and growth are of major importance to children and their caregivers. Once vascular damage or calcification has developed, there are no data to suggest that they can be reversed. Treatments such as intensified dialysis and transplantation may attenuate the progression of subclinical cardiovascular disease, but no treatment to date has shown that the inexorable progression of CVD in CKD can be reversed. Thus, our management must focus on early diagnosis and robust preventative strategies to give our patients the best chance of optimal cardiovascular health and survival. In this review, the pathophysiology and importance of preventing the development of CVD in CKD is discussed. [ABSTRACT FROM AUTHOR]

With the continuous improvement of computer performance and related technology, the combination of molecular communication networks (MCN) and artificial intelligence (AI) can find the prediction to analyze target methods that are molecular diagnosis (MD) and more efficient. To overcome this issue, researchers have suggested the novel paradigm of the MD that combines nanoparticles-medicine (NPs-M) with tools from synthetic biology to provide re-engineering of biological computing devices. Here, in this work, the prediction model of the target is established by combining the drug calculation model of MCN and deep neural network (DNN) including classification performance for prediction. We developed a numerical analysis model to refer to drug target scalability (DTS), on a genome-wide scale based on protein to protein interaction (PPI) such as in-term of cardiac-disease. Finally, the prediction of the strength and direction of binding affinity between drugs and targets is achieved. Furthermore, to expand the application of the model, with a combination of genetic databases, the micro-processes related to genes are displayed. Then, to combine medicine, a multi-layer network is established based on the effect on/off mechanism. We establish a systematic MCN evaluation model that reveals the basis of MD of medicine and serves for screening, reorientation, drug development, and other fields of medical healthcare industries (MHI). The engineering finding demonstrates that the integration of phenotypic, chemical index in the NPs-M and PPI cannot only achieve scalability but also finds new applications for an existing drug. [ABSTRACT FROM AUTHOR]

Nowadays, people are living longer than in the past which leads to dramatically increasing numbers of elderly people in the world's populations. Correspondingly, the elderly are facing critical health concerns, particularly Cardiovascular Disease (CVD). CVD is recognized as the main cause of death worldwide for the aged people. Consequently, prevention of CVD complication is extremely significant for the elderly. The purpose of this research study is to determine a personalized recommendation to the elderly for preventing themselves from the complication of CVDs. Therefore, the personalized recommendation method using integrated objective distance is proposed in this study. The integrated objective distance is a new measurement for computing the distance score for indicating a personal suggestion effectively. Importantly, the proposed personalized recommendation method provides the potential direction for an individual lifestyle adjustment. An experiment of this study is conducted in the context of hypertension, which is one of the most significant risk factors for developing CVD. Input data is collected from 121 elderly people who have a high risk of CVD in Chiang Rai, Thailand. An experimental result shows that the proposed method can provide efficient suggestions to elderly people when compared to those from human experts with 95% accuracy. [ABSTRACT FROM AUTHOR]

Nowadays, people are getting caught in their day-to-day lives doing their work and other things and ignoring their health. Due to this hectic life and ignorance towards their health, the number of people getting sick increases every day. Moreover, most of the people are suffering from a disease like heart disease. Global deaths of almost 31% population are due to heart-related disease as data contributed by the World Health Organization (WHO). So, the prediction of happening heart disease or not becomes important for the medical field. However, data received by the medical sector or hospitals is so huge that sometimes it becomes difficult to analyze. Using machine learning techniques for this prediction and handling of data can become very efficient for medical people. Hence in this study, we have discussed the heart disease and its risk factors and explained machine learning techniques. Using that machine learning techniques, we have predicted heart disease and provided a comparative analysis of the algorithms for machine learning used for the experiment of the prediction. The goal or objective of this research is completely related to the prediction of heart disease via a machine learning technique and analysis of them. [ABSTRACT FROM AUTHOR]

With the increasing aging population worldwide, cardiovascular disease (CVD) has become the leading cause of disability and death. Hypertension is one of the most critical factors causing CVD complication. Determining risk factors of hypertension is extremely important for preventing elderly people with hypertension from CVD complication. Accordingly, this study proposes a new measurement so-called objective distance that is influenced by the significant risk factors of hypertension development. The assumption is made that the maximum objective distance is derived from significant risk factors. This study employs the secondary data of 121 elderly people aged 65 and over, derived from hospitals in Chiang Rai, Thailand. The gathered data contains all potential risk factors of hypertension development, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), physical activity, smoking, medication adherence, and body mass index. The decision tree is employed in this study for determining the significant risk factors in order to verify the proposed assumption. The results show that the obtained significant risk factors are TC, LDL-C, HDL-C, physical activity, and smoking. Importantly, the combination of obtained significant risk factors provides the maximum objective distance regarding the proposed assumption. [ABSTRACT FROM AUTHOR]

NRF2 is a transcription factor which, during oxidative stress, activates transcription of its target antioxidant genes. Polymorphisms in NRF2 and its target antioxidant genes: HMOX-1, NQO1, and MT, have been associated with cardiovascular diseases (CVDs) and diabetes in various ethnic groups, however, with variable results. The aim of this study was to investigate the association of NRF2, HMOX-1, NQO1, and MT gene polymorphisms with CVD risk factors in Thais. The study was conducted in two groups: group with high-risk for coronary artery disease (CAD) and health check-up group. Polymorphisms in NRF2 (rs6721961), NQO1 (rs1800566), MT1A (rs11640851), and HMOX-1 (rs2071746) were genotyped. Expressions of NRF2, HMOX-1, and NQO1 were also determined. In high-risk group, NRF2 rs6721961-TT was associated with CAD [OR (95% CI) 5.07 (1.42–18.10)] and severity of coronary atherosclerosis [Gensini score > 32, OR (95% CI) 4.31 (1.67–11.09)]; rs6721961 GT and TT revealed significant association with lower mRNA expression than GG (p = 0.021). NQO1 rs1800566 also revealed association with CAD, only in female. Combined effect of NQO1-rs1800566, HMOX1-rs2071746, and MT1A-rs11640851 was evaluated on the risks of DM and hypertension. With a combination of risk alleles as genetic risk score (GRS), the highest GRS (score 6) increased risk for hypertension, comparing with GRS 0–2 [OR (95% CI) 1.89 (1.02–3.49)]; group with score 5–6 revealed association with risk of DM [OR (95% CI) 1.481 (1.08–2.04)]. In conclusion, NRF2 rs6721961 associated with CAD and severity of coronary atherosclerosis. NQO1 rs1800566 also associated with CAD, only in female. Combined polymorphisms of three NRF2-regulated genes increased risk of DM and hypertension. [ABSTRACT FROM AUTHOR]

Objective: There is an increased risk for cardiovascular disease (CVD) in patients with radiographic axial spondyloarthritis (r-axSpA). In this cross-sectional study, we aimed to, overall and stratified by sex, (i) compare ultrasound derived carotid intima media thickness (cIMT), between patients and controls, and (ii) investigate associations between cIMT, clinical disease activity and inflammation-related laboratory markers in patients with r-axSpA.In total, 155 patients diagnosed with r-axSpA using the modified New York criteria and 400 controls were included. Bilateral carotid ultrasound, laboratory testing, and questionaries were acquired. Disease-specific assessments were carried out for patients. Linear regression analysis was used to assess associations.Linear regression analyses showed that patients with r-axSpA had increased mean cIMT compared to controls (mean ± SD, 0.8 ± 0.1 mm vs 0.7± 0.1 mm, respectively, unstandardized β (95% CI) -0.076 (-0.10, -0.052), P < 0.001) adjusted for smoking status and age. Linear regression analyses for patients with r-axSpA showed that only males presented significant associations between cIMT and inflammation-related laboratory markers, white blood cell (WBC) count (mean ± SD, 6.8 ± 1.6 109/L) and monocytes (0.6 ± 0.2 109/L); WBC count (unstandardized β (95% CI) 0.019 (0.0065, 0.031), P = 0.003, R2 = 0.57) and monocytes (0.13 (0.0047, 0.26), P = 0.041, R2 = 0.55), adjusted for age, smoking status, body mass index, hypertension, dyslipidemia, diabetes mellitus, ASDAS-CRP, and treatment with DMARDs and glucocorticoids. No significant association was found between cIMT and clinical disease activity assessed by ASDAS-CRP.Patients with r-axSpA had significantly increased cIMT compared to controls. In male patients, higher WBC and monocyte count were associated with an increase in cIMT suggesting the role of inflammation in the development of atherosclerosis.Key Points•Carotid intima-media thickness was increased in patients with radiographic axial spondyloarthritis compared to controls.•White blood cell and monocyte counts were associated with carotid intima-media thickness in male patients with radiographic axial spondyloarthritis.Key Points•Carotid intima-media thickness was increased in patients with radiographic axial spondyloarthritis compared to controls.•White blood cell and monocyte counts were associated with carotid intima-media thickness in male patients with radiographic axial spondyloarthritis.Method: There is an increased risk for cardiovascular disease (CVD) in patients with radiographic axial spondyloarthritis (r-axSpA). In this cross-sectional study, we aimed to, overall and stratified by sex, (i) compare ultrasound derived carotid intima media thickness (cIMT), between patients and controls, and (ii) investigate associations between cIMT, clinical disease activity and inflammation-related laboratory markers in patients with r-axSpA.In total, 155 patients diagnosed with r-axSpA using the modified New York criteria and 400 controls were included. Bilateral carotid ultrasound, laboratory testing, and questionaries were acquired. Disease-specific assessments were carried out for patients. Linear regression analysis was used to assess associations.Linear regression analyses showed that patients with r-axSpA had increased mean cIMT compared to controls (mean ± SD, 0.8 ± 0.1 mm vs 0.7± 0.1 mm, respectively, unstandardized β (95% CI) -0.076 (-0.10, -0.052), P < 0.001) adjusted for smoking status and age. Linear regression analyses for patients with r-axSpA showed that only males presented significant associations between cIMT and inflammation-related laboratory markers, white blood cell (WBC) count (mean ± SD, 6.8 ± 1.6 109/L) and monocytes (0.6 ± 0.2 109/L); WBC count (unstandardized β (95% CI) 0.019 (0.0065, 0.031), P = 0.003, R2 = 0.57) and monocytes (0.13 (0.0047, 0.26), P = 0.041, R2 = 0.55), adjusted for age, smoking status, body mass index, hypertension, dyslipidemia, diabetes mellitus, ASDAS-CRP, and treatment with DMARDs and glucocorticoids. No significant association was found between cIMT and clinical disease activity assessed by ASDAS-CRP.Patients with r-axSpA had significantly increased cIMT compared to controls. In male patients, higher WBC and monocyte count were associated with an increase in cIMT suggesting the role of inflammation in the development of atherosclerosis.Key Points•Carotid intima-media thickness was increased in patients with radiographic axial spondyloarthritis compared to controls.•White blood cell and monocyte counts were associated with carotid intima-media thickness in male patients with radiographic axial spondyloarthritis.Key Points•Carotid intima-media thickness was increased in patients with radiographic axial spondyloarthritis compared to controls.•White blood cell and monocyte counts were associated with carotid intima-media thickness in male patients with radiographic axial spondyloarthritis.Results: There is an increased risk for cardiovascular disease (CVD) in patients with radiographic axial spondyloarthritis (r-axSpA). In this cross-sectional study, we aimed to, overall and stratified by sex, (i) compare ultrasound derived carotid intima media thickness (cIMT), between patients and controls, and (ii) investigate associations between cIMT, clinical disease activity and inflammation-related laboratory markers in patients with r-axSpA.In total, 155 patients diagnosed with r-axSpA using the modified New York criteria and 400 controls were included. Bilateral carotid ultrasound, laboratory testing, and questionaries were acquired. Disease-specific assessments were carried out for patients. Linear regression analysis was used to assess associations.Linear regression analyses showed that patients with r-axSpA had increased mean cIMT compared to controls (mean ± SD, 0.8 ± 0.1 mm vs 0.7± 0.1 mm, respectively, unstandardized β (95% CI) -0.076 (-0.10, -0.052), P < 0.001) adjusted for smoking status and age. Linear regression analyses for patients with r-axSpA showed that only males presented significant associations between cIMT and inflammation-related laboratory markers, white blood cell (WBC) count (mean ± SD, 6.8 ± 1.6 109/L) and monocytes (0.6 ± 0.2 109/L); WBC count (unstandardized β (95% CI) 0.019 (0.0065, 0.031), P = 0.003, R2 = 0.57) and monocytes (0.13 (0.0047, 0.26), P = 0.041, R2 = 0.55), adjusted for age, smoking status, body mass index, hypertension, dyslipidemia, diabetes mellitus, ASDAS-CRP, and treatment with DMARDs and glucocorticoids. No significant association was found between cIMT and clinical disease activity assessed by ASDAS-CRP.Patients with r-axSpA had significantly increased cIMT compared to controls. In male patients, higher WBC and monocyte count were associated with an increase in cIMT suggesting the role of inflammation in the development of atherosclerosis.Key Points•Carotid intima-media thickness was increased in patients with radiographic axial spondyloarthritis compared to controls.•White blood cell and monocyte counts were associated with carotid intima-media thickness in male patients with radiographic axial spondyloarthritis.Key Points•Carotid intima-media thickness was increased in patients with radiographic axial spondyloarthritis compared to controls.•White blood cell and monocyte counts were associated with carotid intima-media thickness in male patients with radiographic axial spondyloarthritis.Conclusion: There is an increased risk for cardiovascular disease (CVD) in patients with radiographic axial spondyloarthritis (r-axSpA). In this cross-sectional study, we aimed to, overall and stratified by sex, (i) compare ultrasound derived carotid intima media thickness (cIMT), between patients and controls, and (ii) investigate associations between cIMT, clinical disease activity and inflammation-related laboratory markers in patients with r-axSpA.In total, 155 patients diagnosed with r-axSpA using the modified New York criteria and 400 controls were included. Bilateral carotid ultrasound, laboratory testing, and questionaries were acquired. Disease-specific assessments were carried out for patients. Linear regression analysis was used to assess associations.Linear regression analyses showed that patients with r-axSpA had increased mean cIMT compared to controls (mean ± SD, 0.8 ± 0.1 mm vs 0.7± 0.1 mm, respectively, unstandardized β (95% CI) -0.076 (-0.10, -0.052), P < 0.001) adjusted for smoking status and age. Linear regression analyses for patients with r-axSpA showed that only males presented significant associations between cIMT and inflammation-related laboratory markers, white blood cell (WBC) count (mean ± SD, 6.8 ± 1.6 109/L) and monocytes (0.6 ± 0.2 109/L); WBC count (unstandardized β (95% CI) 0.019 (0.0065, 0.031), P = 0.003, R2 = 0.57) and monocytes (0.13 (0.0047, 0.26), P = 0.041, R2 = 0.55), adjusted for age, smoking status, body mass index, hypertension, dyslipidemia, diabetes mellitus, ASDAS-CRP, and treatment with DMARDs and glucocorticoids. No significant association was found between cIMT and clinical disease activity assessed by ASDAS-CRP.Patients with r-axSpA had significantly increased cIMT compared to controls. In male patients, higher WBC and monocyte count were associated with an increase in cIMT suggesting the role of inflammation in the development of atherosclerosis.Key Points•Carotid intima-media thickness was increased in patients with radiographic axial spondyloarthritis compared to controls.•White blood cell and monocyte counts were associated with carotid intima-media thickness in male patients with radiographic axial spondyloarthritis.Key Points•Carotid intima-media thickness was increased in patients with radiographic axial spondyloarthritis compared to controls.•White blood cell and monocyte counts were associated with carotid intima-media thickness in male patients with radiographic axial spondyloarthritis. [ABSTRACT FROM AUTHOR]

Purpose of Review: This study aims to review the evidence on telehealth interventions in rural communities that use primary, secondary, or tertiary strategies for the prevention and management of cardiovascular disease (CVD). Recent Findings: Studies focused on the reduction of CVD risk factors and mitigation of disease progression among rural populations using telehealth are limited in number but appear to be increasing in the last 5 years. These studies suggest primary-, secondary-, and tertiary-level interventions can impact CVD risk and management. The current review found more studies addressing primary CVD intervention strategies, although the evidence for efficacy at all intervention levels is in the early stages. Summary: Leveraging prevention strategies via telehealth may be an effective vehicle to facilitate improved CVD outcomes among populations traditionally marginalized by geographic location. [ABSTRACT FROM AUTHOR]

Antiplatelet drugs are effective in preventing recurrence of atherosclerosis in type 2 diabetes (T2D) patients. However, the efficacy and usefulness of antiplatelet drugs on the progression of carotid intima-media thickness (IMT), a marker for evaluating early atherosclerotic vascular disease, has not been analyzed. We conducted a prospective, randomized, open, 36-month trial comparing cilostazol vs. aspirin. A total of 415 T2D patients (age range 38–83 years; 206 females) without macrovascular complications were randomized to either an aspirin (100 mg/day) or cilostazol (200 mg/day) treatment. Patients underwent B-mode ultrasonography annually to assess the IMT and serum levels of inflammatory markers were measured before and after each treatment. Potential confounders were statistically adjusted, and included lipid profiles, HbA1c, body mass index, waist circumference, anti-hypertensive and statin medications. The decrease in mean left, maximum left, mean right and maximum right IMT were significantly greater with cilostazol compared with aspirin (− 0.094 ± 0.186 mm vs. 0.006 ± 0.220 mm, p < 0.001; − 0.080 ± 0.214 mm vs. 0.040 ± 0.264 mm, p < 0.001; − 0.064 ± 0.183 mm vs. 0.004 ± 0.203 mm, p = 0.015; − 0.058 ± 0.225 mm vs. 0.023 ± 0.248 mm, p = 0.022, respectively). And these differences remained significant after adjustment of potential confounders. Compared with aspirin, cilostazol treatment was associated with significantly increased HDL cholesterol (p = 0.039) and 25-hydroxy vitamin D levels (p = 0.001). Cilostazol treatment was associated with significantly lowered IMT in T2D patients compared to aspirin, independent of conventional cardiovascular risk factors. Cilostazol may inhibit plaque formation and have beneficial effects on atherosclerosis through vasodilatory and antiplatelet effects. [ABSTRACT FROM AUTHOR]

Background: Serum amyloid A (SAA) is secreted by liver hepatocytes in response to increased inflammation whereupon it associates with high-density lipoprotein (HDL) and alters the protein and lipid composition of HDL negating some of its anti-atherogenic properties. Aims: To identify variants within the SAA gene that may be associated with SAA levels and/or cardiovascular disease (CVD). Methods: We identified exonic variants within the SAA genes by deoxyribonucleic acid (DNA) Sanger sequencing. We tested the association between SAA variants and serum SAA levels in 246 individuals with and without CVD. Results: Increased SAA was associated with rs2468844 (beta [β] = 1.73; confidence intervals [CI], 1.14–1.75; p = 0.01), rs1136747 (β = 1.53 (CI, 1.11–1.73); p = 0.01) and rs149926073 (β = 3.37 (CI, 1.70–4.00); p = 0.02), while rs1136745 was significantly associated with decreased SAA levels (β = 0.70 (CI, 0.53–0.94); p = 0.02). Homozygous individuals with the SAA1.3 haplotype had significantly lower levels of SAA compared with those with SAA1.1 or SAA1.5 (β = 0.43 (CI, 0.22–0.85); p = 0.02) while SAA1.3/1.5 heterozygotes had significantly higher SAA levels compared with those homozygous for SAA1.1 (β = 2.58 (CI, 1.19–5.57); p = 0.02). Conclusions: We have identified novel genetic variants in the SAA genes associated with SAA levels, a biomarker of inflammation and chronic disease. The utility of SAA as a biomarker for inflammation and chronic disease may be influenced by underlying genetic variation in baseline levels. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD), including heart failure (HF), is a leading cause of morbidity and mortality in people with type 2 diabetes mellitus (T2DM). CVD and T2DM share common risk factors for development and progression, and there is significant overlap between the conditions in terms of worsening outcomes. In assessing the cardiovascular (CV) safety profiles of anti-diabetic drugs, sodium-glucose co-transporter-2 inhibitor (SGLT2i) therapies have emerged with robust evidence for reducing the risk of adverse CVD outcomes in people with T2DM who have either established CVD or are at risk of developing CVD. A previous consensus document from the Improving Diabetes Steering Committee has examined the potential role of SGLT2is in T2DM management and considered the risk–benefit profile of the class and the appropriate place for these medicines within the T2DM pathway. This paper builds on these findings and presents practical guidance for maximising the pleiotropic benefits of this class of medicines in people with T2DM in terms of reducing adverse CVD outcomes. The Improving Diabetes Steering Committee aims to offer evidence-based practical guidance for the use of SGLT2i therapies in people with T2DM stratified by CVD risk. This is of particular importance currently because some treatment guidelines have not been updated to reflect recent evidence from cardiovascular outcomes trials (CVOTs) and real-world studies that complement the CVOTs. The Improving Diabetes Steering Committee seeks to support healthcare professionals (HCPs) in appropriate treatment selection for people with T2DM who are at risk of developing or have established CVD and examines the role of SGLT2i therapy for these people. Funding: Napp Pharmaceuticals Limited. [ABSTRACT FROM AUTHOR]

Background: Hypertension and dyslipidemia are major risk factors for cardiovascular disease (CVD). In 2012, over 270 million patients (25.2%) in China were hypertensive and 40.4% was dyslipidemic. The majority of these patients rely on statins for the prevention of cardiovascular disease. However, certain types of statins (e.g., atorvastatin), compared to others (e.g., pitavastatin), may be associated with unfavorable effects on glucose metabolism. This leads to concerns when prescribing statins to patients who also have a predisposition to glucose metabolic disorders (i.e., prediabetes). Thus, this study aims to investigate the effect of pitavastatin, compared to atorvastatin, on glucose metabolism, as measured by hemoglobin A1c (HbA1c), in Chinese prediabetics with hypertension and dyslipidemias.Methods: The China hemoglobin A1c Metabolism Protection Union Study (CAMPUS) is a multi-center, prospective, open-label, 12-month, two-arm parallel group, and non-inferiority randomized controlled trial (RCT). A total of 396 prediabetics with hypertension and dyslipidemias will be randomly assigned 1:1 to either pitavastatin 2 mg/day or atorvastatin 20 mg/day, and followed for 12 months (follow-up visits at 1, 3, 6, and 12 months) for HbA1c levels, as well as other measures of glucose metabolism, serum lipid levels, blood pressure control, measures of inflammation, vascular endothelial function, carotid atherosclerosis, and hypertension-related left ventricular hypertrophy. If the results of low-density lipoprotein cholesterol (LDL-C) levels in month 3 after treatment initiation do not meet individual target, drug dose for the participant would be doubled.Discussion: CAMPUS will be the first RCT to investigate the effect of pitavastatin, compared to atorvastatin, on glucose metabolism in Chinese prediabetics with hypertension and dyslipidemias. Further, this study might eventually provide information to design a clinical strategy, and facilitate the improvement of primary prevention in patients at risk for diabetes and CVD.Trial Registration: ClinicalTrials.gov number: NCT03532620. Registered 22 May 2018 [ABSTRACT FROM AUTHOR]

Testosterone is commonly known for its role in the regulation of reproductive physiology in men. Epidemiologic studies suggest that endogenous testosterone levels may be implicated in cardiovascular diseases (CVDs). Our study aimed to investigate the relationship between serum total testosterone (TT) levels and lipid profile as well as fasting blood glucose (FBG) levels in male patients ranging from 40 to 70 years old with angiographically proven CVDs from Nadia and Murshidabad district of West Bengal, India. These data were compared with the normal men with no CVD history. We observed a significantly low serum TT levels in CVD patient group compared to the normal group. Among CVD patients, a significant (p < 0.05) negative association was found between serum TT and total cholesterol, triglyceride, low density lipoprotein and very low density lipoprotein, whereas a significant positive correlation (p < 0.05) was found between serum TT and high density lipoprotein. We also observed a highly significant negative correlation between TT and FBG levels in CVD patient group. Thus, in these two densely populated district of West Bengal with poor socio-economic condition, low levels of serum TT in elderly men is associated with CVD that appear together with an atherogenic lipid milieu that may be involved in the pathogenesis of CVD. Results further indicate that low serum TT might have a role in the development of hyperglycemia as evidenced from high FBG level in elderly men. [ABSTRACT FROM AUTHOR]

Background: Serum ferritin concentration >100 ng/mL was associated with a higher risk of death in hemodialysis patients in Japan, whereas such an association was less clear in hemodialysis patients in Western countries. Since Japanese dialysis patients are generally less inflamed than those in Western countries, inflammation may modify the association between serum ferritin and the adverse outcomes. Methods: We performed an observational cohort study using data from 2606 Japanese hemodialysis patients who participated in the Dialysis Outcomes and Practice Patterns Study (DOPPS) III (2005-2008) or DOPPS IV (2009-2012). The predictor was serum ferritin category (<50, 50-99.9, 100-199.9, and ≥200 ng/mL), and the primary and secondary outcomes were all-cause mortality and cardiovascular hospitalization, respectively. C-reactive protein (CRP, cut-off by 0.3 mg/dL) and serum albumin (cut-off by 3.8 g/dL) were stratification factors related to systemic inflammation. Results: After adjustment for relevant confounding factors, a U-shaped association was observed between serum ferritin and all-cause mortality in the group with low CRP levels, whereas such relationship was not significant in the high CRP counterparts. In contrast, we found a linear association between serum ferritin and cardiovascular hospitalization in the low CRP and high CRP groups commonly. Similar results were obtained when the total cohort was stratified by serum albumin. Conclusions: Serum ferritin showed different patterns of association with all-cause mortality in hemodialysis patients with versus without inflammation, whereas its association with cardiovascular hospitalization was similar regardless of inflammatory conditions. [ABSTRACT FROM AUTHOR]

Purpose of Review: Obesity, which has reached epidemic proportions in industrialized regions, is associated with myriad cardiovascular abnormalities and several different types of cardiovascular disease (CVD). However, the finding of an obesity paradox among patients with prevalent CVD and limited cardiovascular outcomes data from clinical trials of medical weight loss have raised questions regarding the cardiovascular benefits of weight loss, particularly among those with existing CVD. Therefore, in this manuscript, we review recent investigative developments regarding the effects of bariatric surgery on the cardiovascular system. Recent Findings: Emerging evidence demonstrates several beneficial cardiovascular changes following bariatric surgery. The weight loss consequent to bariatric surgery is associated with improved vascular function, lessened atherosclerosis, reversals of cardiac remodeling, and improved surrogate measures of arrhythmia. Additionally, a growing body of prospective, nonrandomized data also demonstrates a reduction in hard cardiovascular endpoints, including coronary heart disease events, heart failure rates, and incident atrial fibrillation. Summary: Surgical weight loss is linked to several improvements in cardiovascular structure and function, as well as a reduction in cardiovascular events. However, there is a need for additional data examining the effects of bariatric surgery on cardiovascular outcomes, particularly related to heart failure and arrhythmias and among patients with existing CVD. Despite the noted obesity paradox in CVD, it is likely that marked intentional weight loss among patients with morbid obesity is associated with significant cardiovascular risk reduction. [ABSTRACT FROM AUTHOR]

Insulin resistance is a condition in which cells fail to respond to the normal actions of insulin. Dietary fat, obesity and smoking have been attributed to increase insulin resistance. However, the prevalence of insulin resistance in young obese subjects and its relation to smoking is not well established. This study comprising seventy-five healthy young adults was undertaken to find insulin resistance in obese smokers and non smokers both. Present study showed an overall prevalence of raised homeostatic model assessment of insulin resistance in 14.7 % otherwise healthy young subjects (20-30 years age group). Non-smokers did not show any significant correlation between insulin resistance and body mass index at either stage (normal, pre-obese as well as obese). Smokers also did not show any significant difference of insulin resistance in normal and pre-obese stages. However, marked increase in homeostatic model assessment of insulin resistance was observed in obese smokers. Homeostatic model assessment of insulin resistance showed a linear trend in relation to body mass index and its values were found to be higher in smokers. Obesity combined with smoking demonstrated statistically significant increase in homeostatic model assessment of insulin resistance. [ABSTRACT FROM AUTHOR]

Background: Trimethylamine-N-oxide (TMAO) is a metabolite of phosphatidylcholine generated by gut microbiota and liver enzymes, and has recently been recognized as contributing to atherosclerosis. Elevated serum TMAO levels have been shown to increase the risk of cardiovascular disease (sudden death, myocardial infarction, or stroke) in patients undergoing elective coronary angiography. We aimed to clarify whether TMAO levels are associated with the number of infarcted coronary arteries as a measure of the severity of atherosclerosis, with adjustment using a priori-defined covariates such as kidney function. Methods: By conducting a cross-sectional study of 227 patients who underwent cardiovascular surgery for coronary artery disease, valvular heart disease, or aortic disease, the association between serum TMAO levels as measured by HPLC-APCI-MS/MS and the number of infarcted coronary arteries was evaluated using ordered logistic regression models with adjustment of 10 covariates, including chronic kidney disease (CKD) stage. Unadjusted and adjusted odds ratios (ORs) and 95 % confidence intervals (95 % CIs) were determined. Results: Significantly higher TMAO levels were observed in advanced-stage CKD ( p ≤ 0.001). In fully adjusted models with the 10 covariates, a significantly increased number of infarcted coronary arteries was identified in the highest quartile and quintile of TMAO compared to the lowest quartile (OR 11.9; 95 % CI 3.88-36.7, p ≤ 0.001) and quintile (OR 14.1; 95 % CI 3.88-51.2; p ≤ 0.001), respectively, independent of dyslipidemia. Conclusions: Higher serum TMAO levels may be associated with advanced CKD stages and with an increased number of infarcted coronary arteries in patients who undergo cardiovascular surgery. [ABSTRACT FROM AUTHOR]

Age-related changes in the immune system, commonly termed 'immunosenescence,' contribute to deterioration of the immune response and fundamentally impact the health and survival of elderly individuals. Immunosenescence affects both the innate and adaptive immune systems; however, the most notable changes are in T cell immunity and include thymic involution, the collapse of T cell receptor (TCR) diversity, an imbalance in T cell populations, and the clonal expansion of senescent T cells. Senescent T cells have the ability to produce large quantities of proinflammatory cytokines and cytotoxic mediators; thus, they have been implicated in the pathogenesis of many chronic inflammatory diseases. Recently, an increasing body of evidence has suggested that senescent T cells also have pathogenic potential in cardiovascular diseases, such as hypertension, atherosclerosis, and myocardial infarction, underscoring the detrimental roles of these cells in various chronic inflammatory responses. Given that cardiovascular disease is the number one cause of death worldwide, there is great interest in understanding the contribution of age-related immunological changes to its pathogenesis. In this review, we discuss general features of age-related alterations in T cell immunity and the possible roles of senescent T cells in the pathogenesis of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide with an increased prevalence of metabolic, macro-, and microvascular complications. The primary causes of mortality in NAFLD are cardiovascular disease (CVD), malignancy, and liver disease. NAFLD is a multisystem disease that affects a variety of extrahepatic organ systems. The main focus of this review is to summarize the reported extrahepatic associations, which include CVD, chronic kidney disease, obstructive sleep apnea, osteoporosis, psoriasis, colorectal cancer, iron overload, and various endocrinopathies (e.g., type 2 diabetes mellitus, thyroid dysfunction, and polycystic ovarian syndrome). Due to the systemic manifestations of NAFLD, patients require a multidisciplinary assessment and may benefit from more rigorous surveillance and early treatment interventions to decrease mortality related to malignancy or cardiometabolic diseases. [ABSTRACT FROM AUTHOR]

Background: To improve outcomes in patients with chronic kidney disease (CKD), it is important to identify prognostic factors for end-stage renal disease (ESRD) as well as cardiovascular disease (CVD). This study assessed urinary concentrations of albumin, N-acetyl-β-D-glucosaminidase (NAG), and liver-type fatty acid-binding protein (L-FABP), as predictors of ESRD and CVD. Methods: A prospective, observational, multicenter study, comprising 244 Japanese outpatients with CKD who had a follow-up period of at least 3 months. The primary endpoint was the first onset of a nonfatal or fatal CVD event and progression to ESRD, defined as myocardial infarction, stroke, or artery revascularization (coronary, carotid or peripheral), and initiation of dialysis. Results: During a median follow-up of 3.8 years, the primary endpoint occurred in 39 (15.8 %) patients. Irrespective of diabetes, high urinary L-FABP correlated with the development of ESRD and CVD. The areas under the receiver-operator characteristic curves (AUCs) for predicting the primary endpoint for urinary concentrations of L-FABP, albumin, and NAG were 0.825, 0.797, and 0.722, respectively. Cox regression analyses, which were adjusted for factors known to influence the primary endpoint, including patient characteristics, and serum and urinary parameters, demonstrated that the primary outcome was associated with high urinary L-FABP and low eGFR [ p = 0.049, hazard ratio = 1.341 (95 % CI 1.005-1.790); and p < 0.000, hazard ratio = 0.953 (95 % CI 0.930-0.976), respectively]. Conclusions: Urinary L-FABP may be a useful prognostic marker of progression to ESRD and the onset of CVD in patients with CKD. [ABSTRACT FROM AUTHOR]

Purpose: The effect of exercise intensity and sex on postprandial risk factors for cardiovascular disease in adolescents is unknown. We examined the effect of a single bout of work-matched high-intensity interval exercise (HIIE) and moderate-intensity exercise (MIE) on postprandial triacylglycerol (TAG) and systolic blood pressure (SBP) in adolescents. Method: Twenty adolescents (10 male, 14.3 ± 0.3 years) completed three 1-day trials: (1) rest (CON); (2) 8 × 1 min cycling at 90 % peak power with 75 s recovery (HIIE); (3) cycling at 90 % of the gas exchange threshold (MIE), 1 h before consuming a high-fat milkshake (1.50 g fat and 80 kJ kg). Postprandial TAG, SBP and fat oxidation were assessed over 4 h Results : Compared to CON, the incremental area under the curve for TAG (IAUC-TAG) was not significantly lowered in HIIE [ P = 0.22, effect size (ES) = 0.24] or MIE ( P = 0.65, ES = 0.04) for boys. For girls, HIIE and MIE lowered IAUC-TAG by 34 % ( P = 0.02, ES = 0.58) and 38 % ( P = 0.09, ES = 0.73), respectively, with no difference between HIIE and MIE ( P = 0.74, ES = 0.14). Changes in TAG were not related to energy expenditure during exercise or postprandial fat oxidation. Postprandial SBP (total-AUC pooled for both sexes) was lower in HIIE compared to CON ( P = 0.01, ES = 0.68) and MIE ( P = 0.02, ES = 0.60), with no difference between MIE and CON ( P = 0.45, ES = 0.14). Conclusion: A single bout of HIIE and MIE, performed 1 h before an HFM, can meaningfully attenuate IAUC-TAG in girls but not boys. Additionally, HIIE, but not MIE, may lower postprandial SBP in normotensive adolescents. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: Potential differences in cardiovascular risk by ethnicity remain uncertain. We evaluated the association of ethnicity with cardiovascular disease (CVD) incidence in a large cohort of people with type 2 diabetes living in Scotland. Methods: Data from Scottish Care Information-Diabetes (SCI-Diabetes) were linked to Scottish Morbidity Records (SMR01) and National Records of Scotland data for mortality for dates between 2005 and 2011. Of 156,991 people with type 2 diabetes with coded ethnicity, 121,535 (77.4%) had no CVD at baseline (White: 114,461; Multiple Ethnic: 2,554; Indian: 797; Other Asian: 319; Pakistani: 2,250; Chinese: 387; African-Caribbean: 301 and Other: 466) and were followed up (mean ± SD: 4.8 ± 2.3 years) for the development of fatal and non-fatal CVD. Results: During follow-up, 16,265 (13.4%) patients developed CVD (ischaemic heart or cerebrovascular diseases). At baseline, Pakistanis were younger and had developed diabetes earlier, had higher HbA and longer duration of diabetes, but had lower BP, BMI, creatinine, proportion of smokers and proportion on antihypertensive therapy than whites. The age and sex adjusted HRs for CVD were HR 1.31 (CI 1.17, 1.47), p < 0.001 in Pakistanis and HR 0.66 (CI 0.47, 0.92), p = 0.014 in Chinese compared with whites. Adjusting additionally for an area measure of deprivation, duration of diabetes, conventional CVD and other risk factors, the HR for Pakistanis (HR 1.45 [CI 1.14, 1.85], p = 0.002) was significantly higher, and that for Chinese (HR = 0.58 [CI 0.24, 1.40], p = 0.228) lower, compared with whites. Conclusions/interpretation: Compared with whites with type 2 diabetes, those of Pakistani ethnicity in Scotland were at increased risk of CVD, whereas Chinese were at lower risk, with these differences unexplained by known risk factors. [ABSTRACT FROM AUTHOR]

Stroke is a major cause of death and permanent disability in the USA; primary prevention and risk reduction are a critical health concern. A wealth of research investigated stroke risk factors, including primary hypertension, diabetes, and atrial fibrillation. Research has expanded to examine lifestyle factors, such as diet/dietary patterns, physical activity, cigarette smoking, and obesity distribution, as critical modifiable risk factors. Emerging evidence suggests diet/dietary patterns may lead to heightened risk of stroke. Despite a growing literature, research has yet to implement dietary interventions to explore this relationship within a US sample. This review discusses available clinical research findings reporting on the relationship among diet/dietary patterns, cardiovascular disease, and risk of stroke. We will assess challenges, limitations, and controversies, and address future research directions. [ABSTRACT FROM AUTHOR]

Personalized mobile medicine will continue to advance through the development of wearable sensors that can wirelessly provide pertinent health information while remaining unobtrusive, comfortable, low cost, and easy to operate and interpret. It is the intention that the sensor presented hereafter can contribute to such innovation. By applying a combination of emerging microfluidic and electronic technologies, a miniature, flexible, transparent, highly sensitive and wearable pressure sensor with microfluidic elements has been implemented, referred to as a microflotronic device. High sensitivity of 0.1 kPa and fast response time on the order of tens of milliseconds has been achieved on the microflotronic sensor design. Its sensitivity is among the highest in impedance-based flexible pressure sensors. Once configured into an array, the transparent device can be easily aligned over the target artery to measure blood pressure noninvasively and continuously. In addition, the ultraflexible and thin plastic construct of the microflotronic sensor (of 270 µm in height) can be worn comfortably for extended periods of time. Importantly, the proposed microflotronic sensor has been utilized to perform arterial tonometry with the capability of noninvasive monitoring of arterial blood pressure waveforms in a real-time and continuous fashion. [ABSTRACT FROM AUTHOR]

Background: An increase in the number of circulating endothelial cells (CEC) indicates endothelial damage and the risk of cardiovascular disease. The aim of our study was to investigate the association of CEC with various clinical parameters in pediatric renal transplant recipients. Methods: CEC, defined as CD45CD146, were enumerated by flow cytometry from the peripheral blood of 50 pediatric renal transplant recipients and 20 healthy controls. Clinical parameters, including renal function tests, fasting blood glucose, serum cholesterol and triglyceride, cyclosporine A (CsA) (trough and 2nd-hour) and tacrolimus (tac) trough blood levels and their association with CEC numbers were analyzed. Results: CEC numbers of patients were higher than those of controls (respectively, 128 ± 89 cells/ml (42-468 cells/ml), 82 ± 33 cells/ml (32-137 cells/ml), p = 0.024). There was a statistically significant negative correlation between CEC numbers and glomerular filtration rate (GFR) ( r = −0.300, p = 0.012). There was also a statistically positive association between CEC numbers and transplant duration as well as cyclosporine trough level (respectively, r = 0.397, p = 0.004, r = 0.714, p = 0.004). CEC numbers in patients on tac and CsA were similar ( p = 0.716). Conclusions: Our results demonstrate that renal transplant recipients with high CsA trough blood level, longer transplant duration, and lower GFR, are at greater risk of developing endothelial damage. [ABSTRACT FROM AUTHOR]

The concept that the Mediterranean diet was associated with a lower incidence of cardiovascular disease (CVD) was first proposed in the 1950s. Since then, there have been randomized controlled trials and large epidemiological studies that reported associations with lower CVD: in 1994 and 1999, the reports of the intermediate and final analyses of the trial Lyon Diet Heart Study; in 2003, a major epidemiological study in Greece showing a strong inverse association between a Mediterranean score and the risk of cardiovascular complications; in 2011–2012, several reports showing that even non-Mediterranean populations can gain benefits from long-term adhesion to the Mediterranean diet; and in 2013, the PREDIMED trial showing a significant risk reduction in a low-risk population. Contrary to the pharmacological approach of cardiovascular prevention, the adoption of the Mediterranean diet has been associated with a significant reduction in new cancers and overall mortality. Thus, in terms of evidence-based medicine, the full adoption of a modern version of the Mediterranean diet pattern can be considered one of the most effective approaches for the prevention of fatal and nonfatal CVD complications. [ABSTRACT FROM AUTHOR]

Abstract: Introduction and objectives: Cardiovascular disease and its associated comorbidities, including diabetes mellitus, obesity and dyslipidemia, represent a significant socioeconomic burden, particularly in low- to middle-income countries. Pharmacological intervention with statins, which reduce low-density lipoprotein–cholesterol levels, has been demonstrated to reduce cardiovascular risk. This study assessed the prevalence of lipid abnormalities as well as risk factors for dyslipidemia in Egyptian patients on chronic statin treatment. Methods: DYSIS is a cross-sectional, observational, multinational study. Key eligibility criteria were age of at least 45years and stable statin treatment for at least three months. In the Egyptian DYSIS cohort, a total of 1466 patients, 920 men and 532 women, were enrolled in 24 different centers. Patient characteristics and lipid measurements were documented, and multivariate regression modeling was used to assess factors associated with dyslipidemia. Results: Most patients (85%) were defined as being at very-high risk of cardiovascular disease. Gender-specific differences included higher rates of tobacco smoking and metabolic syndrome in men and women, respectively. Goal LDL–C levels were not achieved by 67.2% of the population, rising to 72% in both high- and very-high risk patients. Factors independently associated with LDL–C levels not being at goal included diabetes mellitus, ischemic heart disease, and high blood pressure. Conclusions: Despite chronic statin treatment, two-thirds of patients in the DYSIS-Egypt study had elevated LDL–C levels. A dual strategy, comprising modification of lifestyle factors together with novel treatment options, appears to be necessary to combat the rise in cardiovascular-related morbidity and mortality. [Copyright &y& Elsevier]

Abstract: Aim of the work: The present study aimed at evaluating the prevalence of subclinical atherosclerosis and cardiovascular disease by means of assessment of carotid intima media thickness and endothelium dependent function through assessment of brachial artery flow mediated dilatation in patients with rheumatoid arthritis. Materials and methods: Twenty six patients with rheumatoid arthritis and 20 healthy control subjects underwent measurement of brachial artery FMD and CIMT using B-mode gray scale US for evaluating cardiovascular risk. Results: The brachial artery FMD was –96.6–6.6% in rheumatoid arthritis (indicating ED), and 20–25% in the control group. The CIMT was 0.50–0.72mm in rheumatoid arthritis and 0.35–0.47mm in the control group. Conclusion: The results from the present study support the use of carotid US and endothelial function assessment by means of FMD as a useful tool to predict the increased risk of cardiovascular disease in patients with rheumatoid arthritis. We suggest that the carotid artery US should be performed for all patients with rheumatoid arthritis to establish the risk of cardiovascular complication which requires more aggressive therapy. [Copyright &y& Elsevier]

The association between chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) has been documented through a substantial number of studies within the past few decades. This review examines the historical development of pulmonary function as a risk factor for CVD and elucidates on the possible mechanisms of this association prescribed by the contemporary literature. Most data indicates pulmonary inflammation as a substantial factor in the initiation of CVD, but the precise mechanism remains ambiguous. Additionally, COPD often remains misdiagnosed or underdiagnosed due to the lack of apparent symptoms and an adequate classification scheme, exacerbating the high costs of managing this illness. Furthermore, there are no well proven methods for the prevention of COPD outside of smoking cessation. The current literature reveals a discrepancy in the assessment of COPD as a predictor of CVD and highlights a need for future studies. [ABSTRACT FROM AUTHOR]

Purpose: This study seeks to establish the construct validity of Health Utilities Index Mark 3 (HUI3)-a health state utility measure-in a Nigerian population of hypertensive patients. Methods: A descriptive cross-sectional study was conducted in a population of hypertensive patients in two tertiary hospitals located in South-Eastern Nigeria. A priori hypotheses were tested to establish construct validity. Results: A total of 384 participants were interviewed. Hypertensive patients with stroke or coronary heart disease (CHD) had a lower overall utility value compared to those with hypertension alone. There was a significant difference in group means of 0.53 (95 % confidence interval of 0.44-0.62); t = 11.8, p < 0.01, between participants that had hypertension alone and participants with hypertension and stroke. Also, there was a significant difference in group means of 0.44 (95 % confidence interval of 0.34-0.56); t = 8.2, p < 0.01, between participants that had hypertension alone and participants with hypertension and CHD. Generally, there was a significant health-related quality of life deficit among patients with severe clinical variables compared to those with milder clinical variables. Conclusion: HUI3 demonstrated constructed validity among a population of Nigerian patients with high blood pressure. [ABSTRACT FROM AUTHOR]

The prevalence of obesity in children and adolescents has reached significant proportions worldwide, escalating the potential for the development of co-morbid conditions such as type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Obesity represents a toxic low-grade inflammatory condition contributing to the pathogenesis of these comorbidities. While the detrimental health effects of the obesity-related chronic inflammatory state are extensively studied in adults, data on the long-term consequences of obesity-driven, low-grade inflammation that begins in childhood and its potential impact on future CVD are scarce. The purpose of this paper is to review: (i) the role of inflammatory factors such as hepatic acute phase proteins, cytokines and adipokines in pediatric obesity and understand whether these pose the same threat as the inflammatory profile in adults and (ii) the effectiveness of lifestyle-based therapies in improving obesity related subclinical inflammation in children. [ABSTRACT FROM AUTHOR]