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Cardiology and Neurophysiological Stimulation of Internet Gaming Disorders: A Systematic Review. 网络游戏障碍的心脏病学和神经生理学刺激:系统综述》。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X295560240530104352
Immaculate Joy Selvam
<p><strong>Background: </strong>Internet Gaming Disorder (IGD) is recognized as a mental health condition associated with excessive video gaming, leading to functional impairments. The inclusion of IGD in the DSM-5 has underscored the importance of comprehensively understanding its physiological and psychological effects.</p><p><strong>Objective: </strong>This systematic review aims to analyze and synthesize existing literature on the cardiophysiological and neurophysiological activities of individuals diagnosed with IGD, with a focus on identifying patterns, trends, and implications for clinical practice and future research.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed and Scopus databases to identify relevant studies published up to 2023. The search strategy included terms related to IGD, cardiophysiology, neurophysiology, and relevant measurement techniques. Inclusion criteria encompassed peer-reviewed research articles and clinical trials examining cardiophysiological (e.g., heart rate variability, blood pressure) and neurophysiological (e.g., brain imaging, electroencephalography) parameters in individuals with IGD. Exclusion criteria were applied to ensure methodological rigor and relevance to the research question.</p><p><strong>Results: </strong>The initial search yielded 1320 papers related to IGD, of which twenty studies met the eligibility criteria and were included in the review. Data extraction and synthesis focused on key cardiophysiological and neurophysiological outcomes observed in individuals with IGD compared to healthy controls. Findings revealed decreased Heart Rate Variability (HRV), increased sympathetic activity, and executive control deficits in IGD individuals based on Electrocardiogram (ECG) recordings and cognitive assessments. Neuroimaging studies demonstrated heightened brain activation in the lateral and prefrontal cortex, altered reward processing, and impulse control mechanisms among IGD subjects. Gender-specific differences were noted, with males exhibiting distinct thalamic activation striatum and decreased Regional Homogeneity (ReHo) in the right Posterior Cingulate (rPCC) compared to females.</p><p><strong>Discussion: </strong>The synthesized evidence indicates a complex interplay between excessive gaming and cardiophysiological/neurophysiological changes, highlighting the need for multidimensional assessments in diagnosing and managing IGD. Implications for clinical practice include early detection using ECG, EEG, and advanced neuroimaging techniques, as well as personalized interventions tailored to individual characteristics and gender-specific differences.</p><p><strong>Conclusion: </strong>This systematic review provides a comprehensive overview of the cardiophysiological and neurophysiological activities associated with Internet Gaming Disorder. The findings underscore the need for further research to elucidate underlying mechanisms, develop standardized diagnostic protocol
背景:网络游戏障碍(Internet Gaming Disorder,IGD)被认为是一种与过度视频游戏有关的精神疾病,会导致功能障碍。IGD被纳入DSM-5后,强调了全面了解其生理和心理影响的重要性:本系统性综述旨在分析和归纳有关被诊断为 IGD 患者的心脏生理和神经生理活动的现有文献,重点是确定模式、趋势以及对临床实践和未来研究的影响:在 PubMed 和 Scopus 数据库中进行了系统检索,以确定截至 2023 年发表的相关研究。搜索策略包括与 IGD、心脏生理学、神经生理学和相关测量技术相关的术语。纳入标准包括经同行评审的研究文章和临床试验,这些文章和试验检查了 IGD 患者的心脏生理学(如心率变异性、血压)和神经生理学(如脑成像、脑电图)参数。为确保方法的严谨性和与研究问题的相关性,采用了排除标准:初步检索结果显示,有 1320 篇论文与 IGD 相关,其中有 20 项研究符合资格标准并被纳入综述。数据提取和综合的重点是与健康对照组相比,在 IGD 患者身上观察到的主要心脏生理学和神经生理学结果。研究结果显示,根据心电图(ECG)记录和认知评估,IGD 患者的心率变异性(HRV)降低,交感神经活动增加,执行控制能力不足。神经影像学研究表明,IGD 受试者的大脑外侧和前额叶皮层激活增强,奖赏处理和冲动控制机制发生改变。研究还发现了性别差异,与女性相比,男性丘脑激活纹状体明显,右侧后扣带回(rPCC)区域同质性(ReHo)降低:综合证据表明,过度游戏与心脏生理/神经生理变化之间存在复杂的相互作用,这凸显了在诊断和管理 IGD 时进行多维评估的必要性。对临床实践的启示包括利用心电图、脑电图和先进的神经影像学技术进行早期检测,以及根据个体特征和性别差异采取个性化干预措施:本系统综述全面概述了与网络游戏障碍相关的心脏生理和神经生理活动。研究结果强调了进一步研究的必要性,以阐明潜在机制、制定标准化诊断方案并优化针对 IGD 患者的干预措施。
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引用次数: 0
Heart Disease in Mothers of Children with Duchenne Muscular Dystrophy. 杜兴氏肌肉萎缩症患儿母亲的心脏病。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X292850240719074112
Rose Mary Ferreira Lisboa da Silva

Female carriers of Duchenne Muscular Dystrophy (DMD) carry a heterozygous pathogenic variant in the dystrophin gene and can transmit pathogenic variants to their offspring. DMD is an X-linked recessive disease that affects up to 19.8 in every 100,000 male births. Those carriers with symptoms can be referred to as women with dystrophinopathy. Even among asymptomatic carriers, cardiac involvement can be verified in between 2.5% and 75% through echocardiography. The most commonly affected wall of the left ventricle is the inferolateral, with myocardial fibrosis detected by cardiac nuclear resonance. Therefore, screening is recommended for these women carriers due to the risk of cardiomyopathy. There is a lack of longitudinal studies on the evolution of these carriers. In this article, data on clinical presentation, cardiac assessment for female patients with dystrophinopathy and DMD carriers, and approaches for these patients are discussed.

杜兴氏肌肉萎缩症(DMD)的女性携带者携带肌营养不良蛋白基因中的杂合致病变体,并可将致病变体遗传给后代。DMD 是一种 X 连锁隐性遗传病,每 10 万名男婴中就有 19.8 人患病。有症状的携带者可被称为女性肌营养不良症患者。即使在无症状的携带者中,也有 2.5% 至 75% 的人可通过超声心动图检查发现心脏受累。最常受影响的左心室壁是下外侧,通过心脏核共振可发现心肌纤维化。因此,由于心肌病的风险,建议对这些女性携带者进行筛查。目前还缺乏对这些携带者演变情况的纵向研究。本文讨论了肌营养不良症女性患者和 DMD 携带者的临床表现、心脏评估数据以及治疗这些患者的方法。
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引用次数: 0
Cardiac Complications and COVID-19: A Review of Life-threatening Co-morbidities. 心脏并发症与 COVID-19:威胁生命的并发症回顾。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X279782240206091322
Zeinab Eftekhar, Habib Haybar, Alireza Mohebbi, Najmaldin Saki

The novel 2019 coronavirus disease (COVID-19) was first reported in the last days of December 2019 in Wuhan, China. The presence of certain co-morbidities, including cardiovascular diseases (CVDs), are the basis for worse outcomes in patients with COVID-19. Relevant English-language literature was searched and retrieved from the Google Scholar search engine and PubMed database up to 2023 using COVID-19, SARS-CoV-2, Heart failure, Myocardial infarction, and Arrhythmia and Cardiac complication as keywords. Increased hemodynamic load, ischemia-related dysfunction, ventricular remodeling, excessive neurohumoral stimulation, abnormal myocyte calcium cycling, and excessive or insufficient extracellular matrix proliferation are associated with heart failure (HF) in COVID-19 patients. Inflammatory reaction due to the excessive release of inflammatory cytokines, leads to myocardial infarction (MI) in these patients. The virus can induce heart arrhythmia through cardiac complications, hypoxia, decreased heart hemodynamics, and remarkable inflammatory markers. Moreover, studies have linked cardiac complications in COVID-19 with poor outcomes, extended hospitalization time, and increased mortality rate. Patients with COVID-19 and CVDs are at higher mortality risk and they should be given high priority when receiving the treatment and intensive care during hospitalization.

2019年新型冠状病毒病(COVID-19)于2019年12月最后几天在中国武汉首次报告。包括心血管疾病(CVDs)在内的某些并发症的存在是导致COVID-19患者预后更差的基础。以 COVID-19、SARS-CoV-2、心力衰竭、心肌梗死、心律失常和心脏并发症为关键词,在谷歌学术搜索引擎和 PubMed 数据库中搜索并检索了截至 2023 年的相关英文文献。血流动力学负荷增加、缺血相关功能障碍、心室重塑、过度神经体液刺激、心肌细胞钙循环异常以及细胞外基质增殖过度或不足与 COVID-19 患者的心力衰竭(HF)有关。炎症细胞因子的过度释放导致的炎症反应会导致这些患者发生心肌梗死(MI)。病毒可通过心脏并发症、缺氧、心脏血流动力学下降和显著的炎症标志物诱发心律失常。此外,研究还发现 COVID-19 的心脏并发症与不良预后、住院时间延长和死亡率增加有关。COVID-19 和心血管疾病患者的死亡风险较高,在住院期间接受治疗和重症监护时应给予高度重视。
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引用次数: 0
Impact of Caffeine Intake Strategies on Heart Rate Variability during Post-Exercise Recovery: A Systematic Review and Meta-Analysis. 咖啡因摄入策略对运动后恢复期心率变异性的影响:系统回顾与元分析》。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X289842240307114736
Bianca Araujo Almeida, Anderson Pontes Morales, José Ricardo Claudino Ribeiro, Felipe Sampaio-Jorge, Yasmin Garcia Ribeiro, Thiago Barth, Beatriz Gonçalves Ribeiro

Objectives: The objective of this systematic review and meta-analysis is to evaluate the influence of caffeine (CAF) intake strategies, taking into account their form, timing, and dosage, on heart rate variability (HRV) indices in the post-exercise recovery period.

Methods: The meta-analysis adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and is registered in the PROSPERO database (CRD42023425885). A comprehensive literature search was carried out across MEDLINE, Web of Science, LILACS, and SCOPUS, concluding in May 2023. We concentrated on randomized clinical trials comparing CAF supplementation effects to placebo on HRV indices post-exercise in active adults aged 18 and above. The primary endpoint was the assessment of HRV indices, measured both prior to and following exercise.

Results: Of the 10 studies included, 7 were used for the meta-analysis, and all contributed to the systematic review. The research explored a variety of CAF strategies, spanning different forms (capsule, drink, gum), times (10, 45, 60 min) and doses (2.1 to 6.0 mg/kg). The outcomes revealed no substantial variations between the placebo and CAF conditions in terms of both the square root of the average of successive squared differences between adjacent RR intervals (RMSSD) (standardized mean difference (SMD) -0.03, 95% CI -0.265 to 0.197, p=0.77) and high frequency (HF) index (SMD -0.061, 95% CI -0.272 to 0.150, p=0.57). Furthermore, metaregression analysis, employing a fixed-effects model and accounting for the administered CAF doses, revealed no significant correlation between caffeine doses and HRV indices (p>0.05).

Conclusion: In conclusion, there is moderate-certainty evidence suggesting that different CAF intake strategies, encompassing aspects such as form, time, and dose, do not have a significant impact on HRV indices recovery post-exercise (i.e., vagal modulation).

研究目的本系统综述和荟萃分析的目的是评估咖啡因(CAF)摄入策略对运动后恢复期心率变异性(HRV)指数的影响,同时考虑其形式、时间和剂量:该荟萃分析符合系统综述和荟萃分析首选报告项目(PRISMA)指南,并已在 PROSPERO 数据库(CRD42023425885)中注册。我们在 MEDLINE、Web of Science、LILACS 和 SCOPUS 上进行了全面的文献检索,并于 2023 年 5 月结束。我们主要研究了在 18 岁及以上的活跃成年人中,比较 CAF 补充剂和安慰剂对运动后心率变异指数影响的随机临床试验。主要终点是评估心率变异指数,在运动前和运动后均进行测量:结果:在纳入的 10 项研究中,7 项用于荟萃分析,所有研究都为系统综述做出了贡献。这些研究探索了多种 CAF 策略,包括不同的形式(胶囊、饮料、口香糖)、时间(10、45、60 分钟)和剂量(2.1 至 6.0 毫克/千克)。结果显示,安慰剂和 CAF 条件下的相邻 RR 间期连续平方差平均值的平方根(RMSSD)(标准化平均差(SMD)-0.03,95% CI -0.265 至 0.197,p=0.77)和高频(HF)指数(SMD -0.061,95% CI -0.272 至 0.150,p=0.57)均无实质性差异。此外,采用固定效应模型并考虑 CAF 施用剂量的元回归分析表明,咖啡因剂量与心率变异指数之间没有显著相关性(P>0.05):总之,有中等确定性的证据表明,不同的咖啡因摄入策略(包括形式、时间和剂量等方面)对运动后心率变异指数的恢复(即迷走神经调节)没有显著影响。
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引用次数: 0
Breathomics Detect the Cardiovascular Disease: Delusion or Dilution of the Metabolomic Signature. 呼吸组学检测心血管疾病:妄想还是稀释代谢组特征?
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X283768240124065853
Basheer Marzoog

Volatile organic compounds (VOCs) can be subdivided into exogenous and endogenous categories based on their origin. Analyzing the endogenous VOCs can provide insights into maintaining the internal organs' homeostasis. Despite the ongoing development and the current understanding, studies have suggested a link between cardiovascular metabolic alterations in patients with ischemic heart disease and elevated levels of ethane and isoprene detectable through exhaled breath analysis. Conversely, patients with chronic heart failure exhibit elevated acetone and pentane in their exhaled air. These substances originate from disturbances in the heart tissue, including cellular and subcellular modulations. Hypothetically, ethane levels in the exhaled breath analysis can demonstrate the severity of ischemic heart disease and, consequently, the risk of death in the next 10 years due to cardiovascular disease (CVD). Real-time direct mass spectrometry is the preferred method for assessing VOCs in exhaled breath analysis. The accuracy of this analysis depends on several factors, including the selection of the relevant breath fraction, the type of breath collection container (if used), and the pre-concentration technique.

挥发性有机化合物(VOCs)可根据其来源细分为外源性和内源性两类。分析内源性挥发性有机化合物可为维持内脏器官的平衡提供见解。尽管目前的研究还在不断发展和深入,但研究表明,缺血性心脏病患者的心血管代谢改变与通过呼出气体分析检测到的乙烷和异戊二烯水平升高之间存在联系。相反,慢性心力衰竭患者呼出的气体中丙酮和戊烷含量升高。这些物质来源于心脏组织的紊乱,包括细胞和亚细胞的调节。根据推测,呼出气体分析中的乙烷含量可以显示缺血性心脏病的严重程度,进而显示未来 10 年因心血管疾病(CVD)死亡的风险。实时直接质谱法是评估呼气分析中挥发性有机化合物的首选方法。这种分析方法的准确性取决于多个因素,包括相关呼气成分的选择、呼气收集容器的类型(如果使用)以及预浓缩技术。
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引用次数: 0
Assessment of Lifetime Risk for Cardiovascular Disease: Time to Move Forward. 心血管疾病终生风险评估:是时候向前迈进了。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X311031240703080650
Evangelia G Sigala, Demosthenes B Panagiotakos

Over the past decades, there has been a notable increase in the risk of Cardiovascular Disease (CVD), even among younger individuals. Policymakers and the health community have revised CVD prevention programs to include younger people in order to take these new circumstances into account. A variety of CVD risk assessment tools have been developed in the past years with the aim of identifying potential CVD candidates at the population level; however, they can hardly discriminate against younger individuals at high risk of CVD.Therefore, in addition to the traditional 10-year CVD risk assessment, lifetime CVD risk assessment has recently been recommended by the American Heart Association/American College of Cardiology and the European Society of Cardiology prevention guidelines, particularly for young individuals. Methodologically, the benefits of these lifetime prediction models are the incorporation of left truncation observed in survival curves and the risk of competing events which are not considered equivalent in the common survival analysis. Thus, lifetime risk data are easily understandable and can be utilized as a risk communication tool for Public Health surveillance. However, given the peculiarities behind these estimates, structural harmonization should be conducted in order to create a sex-, race-specific tool that is sensitive to accurately identifying individuals who are at high risk of CVD. In this review manuscript, we present the most commonly used lifetime CVD risk tools, elucidate several methodological and critical points, their limitations, and the rationale behind their integration into everyday clinical practice.

在过去的几十年中,心血管疾病(CVD)的风险明显增加,甚至在年轻人中也是如此。政策制定者和卫生界已经修订了心血管疾病预防计划,将年轻人纳入其中,以便将这些新情况考虑在内。因此,除了传统的 10 年心血管疾病风险评估外,美国心脏协会/美国心脏病学会和欧洲心脏病学会的预防指南最近还建议进行终生心血管疾病风险评估,尤其是针对年轻人。从方法学上讲,这些终生预测模型的优点在于纳入了生存曲线中观察到的左截断和竞争事件风险,而这些在普通生存分析中并不被视为等同的。因此,终生风险数据易于理解,可用作公共卫生监测的风险交流工具。然而,考虑到这些估计值背后的特殊性,应进行结构协调,以创建一个针对不同性别和种族的工具,该工具应能准确识别心血管疾病高危人群。在这篇综述手稿中,我们介绍了最常用的终生心血管疾病风险工具,阐明了几种方法和关键点、它们的局限性以及将它们纳入日常临床实践的理由。
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引用次数: 0
Pharmacological Treatment of Heart Failure: Recent Advances. 心力衰竭的药物治疗:最新进展。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X270178231228061314
Jonathan C H Chan, Areeb Siddiqui

Background: Heart failure is a clinical condition with high mortality and morbidity that occurs when the heart is unable to pump enough blood to meet the metabolic demands of the body. The pharmacological management of heart failure has been revolutionized over the past decade with novel treatments.

Objective: The aim of the review is to highlight the recent pharmacological advances in the management of heart failure.

Results: Sodium-glucose cotransporter-2 inhibitor (SGLT2i), iron carboxymaltose, finerenone, omecamtiv mecarbil, and vericiguat have been shown to reduce hospitalization for heart failure. However, only SGLT2i, vericiguat, and omecamtiv mecarbil have been shown to reduce cardiovascular death. Finerenone has been shown to reduce cardiovascular events and renal adverse outcomes in patients with diabetes and kidney disease. Currently, only SGLT2i has been studied in patients beyond the heart failure with reduced ejection fraction population.

Conclusion: The current quadruple therapy in the treatment of heart failure has demonstrated a reduction in the hospitalization of patients and a decrease in mortality associated with the condition. Individualized heart failure therapy research have shown some benefit in select heart failure patients. Further research on novel therapies will help improve heart failure patient outcomes.

背景:心力衰竭是一种死亡率和发病率都很高的临床病症,当心脏无法泵出足够的血液来满足机体的代谢需求时就会出现心力衰竭。过去十年间,心衰的药物治疗发生了革命性的变化,出现了新的治疗方法:综述旨在重点介绍心力衰竭药物治疗的最新进展:结果:钠-葡萄糖共转运体-2抑制剂(SGLT2i)、羧甲基铁、非诺酮、奥美卡米肼和维利奎特已被证明可减少心力衰竭的住院治疗。然而,只有 SGLT2i、vericiguat 和 omecamtiv mecarbil 能减少心血管死亡。菲尼酮已被证明可减少糖尿病和肾病患者的心血管事件和肾脏不良反应。目前,只有 SGLT2i 在心衰射血分数降低人群以外的患者中进行了研究:结论:目前治疗心力衰竭的四联疗法已证明可减少患者的住院时间,降低与心力衰竭相关的死亡率。个性化心衰治疗研究显示,部分心衰患者可从中获益。对新型疗法的进一步研究将有助于改善心衰患者的治疗效果。
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引用次数: 0
The Role of Triglycerides in Atherosclerosis: Recent Pathophysiologic Insights and Therapeutic Implications. 甘油三酯在动脉粥样硬化中的作用:最新病理生理学见解和治疗意义。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X272750240109052319
Yonatan Akivis, Hussam Alkaissi, Samy I McFarlane, Inna Bukharovich

Triglycerides have long been recognized as a cardiovascular disease risk factor. However, their precise role in atherosclerosis and potential utility as a therapeutic target remains debated topics. This review aims to shed light on these aspects by exploring the complex relationship between triglycerides and atherosclerosis from pathophysiological and pharmacological perspectives. Triglycerides, primarily carried by chylomicrons and very low-density lipoproteins, play an essential role in energy storage and utilization. Dysregulation of triglyceride homeostasis and triglyceride- rich lipoproteins metabolism often leads to hypertriglyceridemia and subsequently increases atherosclerosis risk. Triglyceride-rich lipoproteins remnants interact with arterial wall endothelial cells, get retained in the subendothelial space, and elicit inflammatory responses, thereby accelerating atherogenesis. Despite the clear association between high triglyceride levels and increased cardiovascular disease risk, intervention trials targeting triglyceride reduction have produced mixed results. We discuss a range of triglyceride-lowering agents, from fibrates to omega-3 fatty acids, with a focus on their mechanism of action, efficacy, and major clinical trial outcomes. Notably, the role of newer agents, such as angiopoietin-like protein 3 and apolipoprotein C3 inhibitors, is also explored. We highlight the challenges and controversies, including the ongoing debate on the causal role of triglyceride in atherosclerosis and the discordant outcomes of recent clinical trials. The potential confounding effects of associated risk factors, such as elevated apolipoprotein B, insulin resistance, and metabolic syndrome, are considered. In conclusion, this review underscores the importance of a nuanced approach to understanding the role of triglycerides in atherosclerosis and their potential as a therapeutic target. Further research is needed to unravel the complex interplay between triglycerides, triglyceride-rich lipoproteins, and associated factors in atherosclerosis pathogenesis and refine triglyceride-targeted therapeutic strategies.

长期以来,人们一直认为甘油三酯是心血管疾病的危险因素。然而,它们在动脉粥样硬化中的确切作用以及作为治疗靶点的潜在效用仍是备受争议的话题。本综述旨在从病理生理学和药理学的角度探讨甘油三酯与动脉粥样硬化之间的复杂关系,从而阐明这些方面的问题。甘油三酯主要由乳糜微粒和极低密度脂蛋白携带,在能量储存和利用方面发挥着重要作用。甘油三酯稳态和富含甘油三酯的脂蛋白代谢失调往往会导致高甘油三酯血症,进而增加动脉粥样硬化的风险。富含甘油三酯的脂蛋白残渣与动脉壁内皮细胞相互作用,滞留在内皮下空间,引起炎症反应,从而加速动脉粥样硬化的发生。尽管甘油三酯水平高与心血管疾病风险增加之间存在明显的关联,但以降低甘油三酯为目标的干预试验却取得了好坏参半的结果。我们讨论了从纤维酸盐到欧米伽-3 脂肪酸等一系列降低甘油三酯的药物,重点关注其作用机制、疗效和主要临床试验结果。值得注意的是,我们还探讨了血管生成素样蛋白 3 和脂蛋白 C3 抑制剂等新型药物的作用。我们强调了面临的挑战和争议,包括正在进行的关于甘油三酯在动脉粥样硬化中的因果作用的争论以及近期临床试验的不一致结果。我们还考虑了相关风险因素的潜在混杂效应,如载脂蛋白 B 升高、胰岛素抵抗和代谢综合征。总之,本综述强调了采用细致入微的方法了解甘油三酯在动脉粥样硬化中的作用及其作为治疗靶点的潜力的重要性。还需要进一步的研究来揭示甘油三酯、富含甘油三酯的脂蛋白和动脉粥样硬化发病机制中相关因素之间复杂的相互作用,并完善甘油三酯靶向治疗策略。
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引用次数: 0
Adherence to Congestive Heart Failure Guidelines and Outcome in the Middle East. 中东地区对充血性心力衰竭指南的依从性和结果。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X256576231017110252
Raed Aqel, Tareq Alzughayyar, Jihad Zalloum, Qais Salah, Qutaiba Qafisheh, Mahmoud Izraiq

Background: Adherence to Congestive Heart Failure with reduced Ejection Fraction (CHFrEF) guidelines is not easily attainable everywhere, particularly in countries with a high prevalence of low socioeconomic status, which includes many Middle Eastern countries. However, it is well-established that adherence to the guidelines is associated with lower mortality and morbidity rates.

Objective: Our objective is to investigate the adherence to the degree of treatment guideline in CHFrEF within a patient population in the Middle East and correlate the level of compliance both fully and partially with morbidity and mortality outcomes. Methods and Statistics: We conducted a retrospective study on patients with CHFrEF in the Middle East region who were maintained on Sacubitril/Valsartan for up to 4 years (190 patients). This study included follow-up assessments for morbidity and mortality rates and their correlation with the level of adherence to guidelines.

Results: Statistical analysis was performed using IBM SPSS® 27th version. In both the partial adherence group and the full adherence group, there was a statistically significant improvement in NYHA (pretreatment and post-treatment) and Ejection fraction (pretreatment and posttreatment). This means that regardless of the level of adherence to the use of Sacubitril/Valsartan in CHFrEF, there was an overall improvement in the morbidity and mortality rates over the four years of follow-up.

Conclusion: While we fully support the idea of achieving full CHFrEF guideline adherence, we recognize the difficulty of this task. Nevertheless, this study reinforces the notion that any degree of adherence to guideline is correlated with better morbidity and mortality rates over a long-term follow-up.

背景:充血性心力衰竭伴射血分数降低(CHFrEF)指南并不是在所有地方都能得到遵守,特别是在社会经济地位低下的国家,这与许多中东国家相似。然而,遵守指南与较低的死亡率和发病率相关。目的:我们将调查中东患者人群中CHFrEF治疗指南的遵守程度,并将遵守程度与发病率和死亡率联系起来。方法和统计:一项对中东地区CHFrEF患者进行的回顾性研究,190例患者持续使用Sacubitril/缬沙坦长达4年,包括对发病率和死亡率的随访,以及它们与指南依从性水平的相关性。结果:采用IBM SPSS®27版进行统计分析。NYHA(治疗前和治疗后)在部分依从组和完全依从组均有统计学意义。此外,在部分依从组和完全依从组中,射血分数(治疗前和治疗后)具有统计学意义,因此,无论在CHFrEF中使用Sacubitril/缬沙坦的依从程度如何,在长达4年的随访中,发病率和死亡率都有改善。结论:尽管我们完全支持完全遵守CHFrEF指南,但我们认识到这项任务很难实现,尽管如此,本研究支持任何指南的遵守都与长期随访中更好的发病率和死亡率相关的主题。
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引用次数: 0
A Systematic Review of Economic Evidence of Cardiovascular Interventions in India. 印度心血管干预经济证据的系统性回顾。
IF 2.4 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-01-01 DOI: 10.2174/011573403X309363240730095253
Saba Abidi, Anandita Nair, Rakhi Ahuja, Shridhar Dwivedi, Sushama Talegaonkar

Background: Cardiovascular diseases (CVDs) continue to be the primary cause of mortality globally and invariably in India as well. The rapid upsurge in the prevalence of CVDs in India has created a pressing need to promote contemporary, sustainable, and cost-effective interventions to tackle the CVD burden. This systematic review integrates the research-based evidence of the cost-effectiveness of various interventions that can be adapted to control CVDs in India.

Methods: Databases, namely, PubMed, Cochrane Library, Embase, and Google Scholar, were searched for data on the economic evaluation of interventions targeting CVD based on the Indian population for a period of 30 years (1991-2021). Two reviewers assessed the articles for eligibility, and data were extracted from the shortlisted articles as per a predefined template, including the quantification of methodological aspects.

Results: In total, 1249 studies were examined, out of which 23 completely met the inclusion criteria for full-text review. A total of 16 studies were based solely on the Indian population, while the rest (7) included South Asia/Asia for the intervention, of which India was a participant nation. Most of the economic evaluations targeted treatment-based or pharmacological interventions (14) for CVDs. The evaluations were based on Decision-based models (10), Randomized controlled Trials (RCTs) (9), and Observational studies (4). The cost-effectiveness ratio for the included studies exhibited a diverse range due to variations in methodological approaches, such as differences in study settings, populations, and inconsistencies in study design. The mean ICER (Incremental Cost-effectiveness ratio) for primordial and primary preventions was found to be 3073.8 (US $2022) and 17489.9 (US $2022), respectively. Moreover, the combined mean value for secondary and tertiary prevention was 2029.6 (US$2022).

Conclusion: The economic evidence of public health interventions are expanding, but their focus is restricted towards pharmacological interventions. There is an urgency to emphasize primordial and primary prevention for better outcomes in health economics decision-making. Technology- based avenues for intervention need more exploration in order to cater to a large population like India.

背景:心血管疾病(CVD)仍然是全球死亡的主要原因,在印度也不例外。印度心血管疾病发病率的快速飙升迫切需要推广现代、可持续和具有成本效益的干预措施,以解决心血管疾病造成的负担。本系统性综述整合了有关各种干预措施成本效益的研究证据,这些干预措施可用于控制印度的心血管疾病:方法:在 PubMed、Cochrane Library、Embase 和 Google Scholar 等数据库中搜索了 30 年间(1991-2021 年)印度人口心血管疾病干预措施的经济评估数据。两名审稿人对文章进行了资格评估,并按照预先确定的模板从入围文章中提取数据,包括方法学方面的量化:共审查了 1249 项研究,其中 23 项完全符合全文审查的纳入标准。共有 16 项研究仅以印度人口为对象,其余(7 项)的干预措施包括南亚/亚洲,其中印度是参与国之一。大多数经济评估针对的是心血管疾病的治疗或药物干预措施(14 项)。这些评估基于决策模型(10 项)、随机对照试验(9 项)和观察研究(4 项)。由于研究方法的不同,如研究环境、研究人群和研究设计的不一致,纳入研究的成本效益比呈现出不同的范围。研究发现,初级和一级预防的平均 ICER(增量成本效益比)分别为 3073.8(2022 美元)和 17489.9(2022 美元)。此外,二级和三级预防的综合平均值为 2029.6(2022 美元):结论:公共卫生干预措施的经济学证据正在扩大,但其重点仅限于药物干预。现在迫切需要强调初级和一级预防,以便在卫生经济决策中取得更好的结果。需要进一步探索基于技术的干预途径,以满足印度这样一个人口大国的需求。
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Current Cardiology Reviews
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