Current Atherosclerosis Reports最新文献

Purpose of review: This review summarizes the current applications of animal models in studying oral bacteria and atherosclerotic thrombotic disease (ATD), providing a reference for future research.

Recent findings: ATD is characterized by plaque formation, rupture, and thrombus aggregation, leading to vascular lumen occlusion or stenosis. It is a major contributor to cardiovascular events, linked to risk factors such as hypertension and hyperlipidemia. Recent studies have focused on the relationship between oral bacteria and ATD, suggesting that oral bacteria and their metabolites contribute to ATD through inflammatory responses, endothelial dysfunction, procoagulant effects, and metabolic changes. Although the correlation between oral bacteria and ATD is established, the underlying molecular mechanisms and signaling pathways remain unclear. Animal models are essential for investigating these mechanisms and replicating pathological processes. However, the lack of standardized methodologies introduces bias. This review provides a comparative analysis of the advantages and limitations associated with animal models of atherosclerosis, arterial thrombosis, combined atherosclerosis and thrombosis, as well as models incorporating oral bacteria in atherosclerotic thrombotic disease. It systematically summarizes animal models of atherosclerotic thrombosis and proposes that, when investigating the interaction between oral bacteria and ATD, both the atherosclerotic thrombosis model and oral bacteria introduction methods may be cross-utilized, depending on specific research requirements. This study proposes a more suitable model: combining a periodontitis model with an atherosclerotic plaque model and using P53 adenovirus to induce controlled plaque rupture.

Purpose of review: To evaluate the effect of pioglitazone, a member of the thiazolidinedione family of drugs known for its antihyperglycemic properties, on lipoprotein (a) [Lp(a)]. Pioglitazone is recognized for enhancing insulin sensitivity and β-cell function, and it also has a positive influence on the overall lipid profile.

Recent findings: Meta-analysis of 7 studies (4 RCTs and three non-RCTs) including 254 patients showed a significant decrease of circulating Lp(a) levels after treatment with pioglitazone (SMD: -0.373, 95% CI: -0.642, -0.104, p = 0.007). The reduction in circulating Lp(a) was robust in the leave-one-out sensitivity analysis. The presented results were obtained following a comprehensive literature search conducted in PubMed, Scopus, Embase, and Web of Science, covering studies from their inception up to March 1, 2025. Pioglitazone significantly decreases circulating Lp(a) concentrations. This decrease might have a beneficial effect on atherosclerotic cardiovascular disease (ASCVD) in high-risk patients.

Purpose of review: This paper reviews the effects of major macronutrients and specific dietary interventions on atherogenic dyslipidemia, a common trait characterized by increased concentrations of triglyceride-rich and small, dense LDL particles, and reduced HDL-cholesterol.

Recent findings: Studies have shown that reducing carbohydrate intake is the most effective dietary approach for managing atherogenic dyslipidemia, particularly in individuals with excess adiposity and/or metabolic syndrome. Plant protein sources can also be beneficial, possibly due to their content of phytochemicals. Whereas dietary guidelines emphasize limiting intake of saturated fat for reducing cardiovascular risk by lowering concentrations of LDL cholesterol, this has not been shown to have an impact on atherogenic dyslipidemia. Attenuation or reversal of atherogenic dyslipidemia can be achieved by adopting a dietary pattern that emphasizes moderating carbohydrate intake, in particular processed grains and added sugars, rather than by focusing primarily on limiting saturated fat and its effects on LDL-cholesterol.

Purpose of review: Peripheral artery disease (PAD) is a leading cause of cardiovascular morbidity and mortality. Despite its growing clinical burden, the disease remains relatively understudied and underdiagnosed relative to other cardiovascular diseases, especially in female patients. While PAD prevalence is similar in males and females, sex-based disparities have been noted in the presentation, diagnosis rates, treatment methods, and clinical outcomes of PAD patients. This article serves to provide an overview of existing knowledge on sex-based differences in the epidemiology, pathophysiology, clinical presentation, management, and patient outcomes of PAD.

Recent findings: Female patients with PAD remain underdiagnosed and undertreated, with females receiving lower referral rates to supervised exercise therapy and guideline-directed medical therapy despite observing similar benefits from treatment as males. Surgical interventions also see conflicting outcomes in male and female patients, with females now seeing improved outcomes despite prior studies indicating worsened quality of life. Cardiovascular risk factors such as history of smoking, chronic kidney disease, and diabetes also place females at heightened risk of PAD compared to male patients. There are also physiological disparities observed that affect the presentation and diagnosis rates of PAD, with female patients seeing increased platelet reactivity and aggregation yet receiving later diagnoses at more severe stages due to postmenopausal effects. In addition, female patients remain underrecruited in clinical research studies for cardiovascular disease, highlighting a need for further research focused on female patients and sex disparities in PAD. This article identifies key disparities between male and female patients with PAD, with inequities noted in the epidemiology, pathophysiology, risk factors, clinical presentation, and treatment approaches and outcomes. Further research is warranted to better understand sex-based differences in PAD and better inform patient treatment decisions.

Purpose of the review: This review aims to examine the clinical relevance of cardio-kidney-metabolic syndrome (CKMS) in oncology, highlighting its role as both a preexisting comorbidity and a consequence of cancer treatment. It aims to integrating CKMS staging into personalized cancer care.

Recent findings: CKMS is a progressive syndrome marked by dysfunction across cardiovascular, renal, and metabolic systems. Cancer therapies-particularly hormonal agents, immune checkpoint inhibitors, and chemotherapeutics-can accelerate or reveal underlying CKMS through inflammatory and metabolic pathways. Early risk stratification based on CKMS stage enables more effective monitoring, referral, and therapeutic strategies. A stage-based, multidisciplinary approach tailored to cancer type and comorbidity burden is essential for optimizing outcomes. With rising multimorbidity among cancer patients, recognizing and addressing CKMS is increasingly critical. Routine CKMS assessment in oncology offers a pathway for earlier intervention and potentially altering its course. A comprehensive, individualized care model based on CKS stage is necessary to mitigate CKMS-related complications and deliver high-quality, integrated cancer care.

Purpose of review: Despite major advances in the treatment and prevention of atherosclerotic cardiovascular disease (ASCVD), a substantial burden of residual risk remains Obesity has been redefined as a primary and independent drivers of cardiovascular morbidity and mortality warranting focused attention.

Recent findings: Obesity is now recognized as a chronic disease and a central contributor to residual cardiovascular risk through mechanisms including systemic inflammation, insulin resistance, dyslipidemia, and endothelial dysfunction. This review addresses the limitations of conventional obesity management and highlights emerging pharmacological therapies targeting the underlying adiposopathy. Additionally, we examine the impact of stigma and biases as well as social determinants of health on obesity management and explore novel application of imaging, biomarkers and technology to risk stratification tools and innovative care models . Addressing obesity as a modifiable and high-impact disease is essential to advancing ASCVD prevention and treatment.

Purpose of review: This review aims to characterize the known cardiovascular (CV) manifestations associated with inflammatory bowel disease (IBD) and the underlying mechanisms driving these associations.

Recent findings: Gut dysbiosis, a hallmark of patients with IBD, can result in both local and systemic inflammation, thereby potentially increasing the risk of cardiovascular disease (CVD) in the IBD population. Micronutrient deficiencies, anemia, and sarcopenia independently increase the risk of CVD and are frequent comorbidities of patients with IBD. IBD is a chronic inflammatory condition with significant and underrecognized cardiovascular complications. Patients with IBD frequently develop coronary artery disease (CAD) in the absence of traditional risk factors such as obesity and smoking and experience an earlier onset of CVD compared to the general population. Moreover, IBD has been associated with increased risks of arrhythmia, myocarditis, pericarditis, heart failure, and venous thromboembolism. Nontraditional risk factors related to IBD, including disease activity, prolonged disease duration, and cardiovascular risks associated with certain IBD medications, significantly contribute to the increased risk of CVD. While additional prospective research is required to fully elucidate the mechanisms driving CVD in IBD patients, current evidence suggests that minimizing disease activity, optimizing nutritional status, addressing gut dysbiosis, and mitigating the traditional risk factors could significantly reduce the burden of CVD in the IBD population. As our understanding of the link between IBD and cardiovascular disease grows, healthcare providers must closely monitor cardiovascular health and risk factors in patients with IBD, particularly during flares, active disease, and hospitalizations.

Purpose of review: This review examines cardiovascular disease (CVD) risk prediction models relevant to older adults, a rapidly expanding population with elevated CVD risk. It discusses model characteristics, performance metrics, and clinical implications.

Recent findings: Some models have been developed specifically for older adults, while several others consider a broader age range, including some older individuals. These models vary in terms of predictors, outcomes, horizon, and statistical approaches, with some accounting for competing risks and considering age-predictor interactions. Discrimination is generally acceptable and more modest in older versus younger individuals. Calibration shows great variation across populations. Accurate CVD risk prediction is essential to guide individualized prevention strategies and support shared decision-making in older adults. CVD risk prediction in this population is challenged by age-related CVD risk heterogeneity, elevated competing risk due to non-CVD mortality, and comorbidities. Further refinement by incorporating geriatric-specific factors may help to enhance discrimination.

Purpose of review: This review describes and summarizes the relationships between psychosocial stress and cardiovascular disease risk in women and offers strategies and recommendations to improve health outcomes.

Recent findings: Psychosocial stress plays a pivotal role in the cardiovascular health of women, acting both as a precipitant and an outcome of CVD. As a precipitant, chronic stressors such as caregiving responsibilities, socioeconomic adversity, intimate partner violence, and gendered barriers to healthcare can exacerbate stress-related CVD risk factors which in turn predispose to upregulation of inflammatory factors. Mental health conditions (anxiety, depression, and post-traumatic stress disorder) are more prevalent in women and further contribute to cardiovascular risk through sex-specific mechanisms mediated by dysregulation of the hypothalamic-pituitary-adrenal axis and associated autonomic nervous system dysfunction. Conversely, women with CVD may experience psychosocial stress, with higher levels of anxiety, depression, and fear of recurrence, which negatively affects recovery and long-term health outcomes. Psychosocial stress plays a pivotal role in the cardiovascular health of women, acting both as a precipitant and an outcome of CVD. This bidirectional relationship highlights the need for integrated, sex- and gender-based approaches to cardiovascular care that address both physical and psychosocial stressors, improving outcomes and quality of life for women at risk or living with CVD.

Purpose of review: To define the emerging role of artificial intelligence-enhanced electrocardiography (AI-ECG) in advancing population-level screening for atherosclerotic cardiovascular disease (ASCVD), we provide a comprehensive overview of its role in predicting major adverse cardiovascular events and detecting subclinical coronary artery disease. We also outline the clinical, methodological, and implementation challenges that must be addressed for widespread adoption.

Recent findings: State-of-the-art AI-ECG models exhibit high accuracy, correctly re-classifying patients deemed 'low risk' by traditional risk models. They also compress the prediction horizon from a decade to just a few years, suggesting opportunities for early detection and more personalized intervention. However, validation remains largely retrospective and hospital-based, with referral and ascertainment biases limiting generalizability. There is no evidence thus far for an externally validated AI-ECG model that can either define or improve the detection of ASCVD outcomes independent of standard risk factors. AI-enhanced ECG interpretation has the potential to transform a universal, inexpensive test into a powerful screening and prognostication tool for ASCVD. Realizing this potential will require prospective studies to confirm that AI-ECG-guided ASCVD screening improves patient outcomes across diverse populations. Earning trust among physicians and patients will require addressing key logistical challenges, including robust data governance, seamless workflow integration, and ongoing performance monitoring. Technological innovation, such as algorithms for single-lead ECGs on wearable and portable devices, could help enable the scalability needed for global impact on cardiovascular health.