High Blood Pressure & Cardiovascular Prevention最新文献

Introduction: Evidence on left ventricular (LV) myocardial deformation, assessed by speckle tracking echocardiography (STE), in children and adolescents with obesity is scanty.

Aim: This meta-analysis aimed to provide a new piece of information on LV systolic function, phenotyped by global longitudinal strain (GLS) and LV ejection fraction (LVEF), in pediatric obesity.

Methods: Following the PRISMA guidelines, systematic searches were conducted in Pub-Med, OVID, EMBASE, and Cochrane Library to identify eligible studies from inception up to February 28^th 2025. Studies comparing LV mechanics in pediatric obesity and normal weight controls were included. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using random-effects models to assess differences in GLS and LVEF.

Prospero-id: 635938.

Results: Twenty-seven studies including 1398 individuals with obesity and 2376 age-matched healthy controls were considered for the analysis. Pooled average GLS values were 20±0.4% in the control group and 17±0.5% in the obese group (SMD - 1.28±0.14, CI - 1.57/- 1.0, p<0.0001). Overall, LVEF was lower in the obese group (SMD - 0.14±0.15, CI - 0.22/- 0.05, p <0.001), although this parameter, at difference from GLS, in the majority of studies did not reach the statistical significance between groups. The metaregression analysis of GLS on BMI showed a significant inverse correlation between the two parameters (coefficient= - 0.33±0.11, p=0.003), this was not the case for LVEF.

Conclusions: Our data suggest that targeting LV mechanics may more accurately assess the systolic function in pediatric obesity; implementing STE in clinical practice may be highly useful in unmasking early LV functional alterations in this setting.

Cardiovascular diseases (CVDs) continue to be the topmost cause of the worldwide morbidity and mortality. Risk factors such as diabetes, hypertension, obesity and smoking are significantly worsening the situation. The COVID-19 pandemic has powerfully highlighted the undeniable connection between viral infections and cardiovascular health. Current literature highlights that SARS-CoV-2 contributes to myocardial injury, endothelial dysfunction, thrombosis, and systemic inflammation, increasing the severity of CVD outcomes. Long COVID has also been associated with persistent cardiovascular complications, including myocarditis, arrhythmias, thromboembolic events, and accelerated atherosclerosis. Addressing these challenges requires continued research and public health strategies to mitigate long-term risks. Artificial intelligence (AI) is changing cardiovascular medicine and community health through progressive machine learning (ML) and deep learning (DL) applications. AI enhances risk prediction, facilitates biomarker discovery, and improves imaging techniques such as echocardiography, CT, and MRI for detecting coronary artery disease and myocardial injury on time. Remote monitoring and wearable devices powered by AI enable real-time cardiovascular assessment and personalized treatment. In public health, AI optimizes disease surveillance, epidemiological modeling, and healthcare resource allocation. AI-driven clinical decision support systems improve diagnostic accuracy and health equity by enabling targeted interventions. The integration of AI into cardiovascular medicine and public health offers data-driven, efficient, and patient-centered solutions to mitigate post-COVID cardiovascular complications.

Introduction: The Chinese visceral adiposity index (CVAI), a favorable surrogate index for assessing visceral fat distribution and function, has been proven to be associated with various conditions, including diabetes mellitus, cardiovascular diseases, and strokes. Nevertheless, evidence on the association of CVAI with the risk of incident hypertension among older adults is limited.

Aim: This study aimed to explore the association between CVAI and the risk of incident hypertension among older adults.

Methods: Data were collected from the annual health examination dataset in Xinzheng, Henan Province from 2018 to 2023. A total of 10,353 participants aged ≥ 60 years were included. Cox proportional hazard models were used to examine the association between CVAI and the risk of incident hypertension by using hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed to confirm the association's robustness. Additionally, the restricted cubic spline (RCS) was used to fit the dose-response association between CVAI and the risk of incident hypertension.

Results: During a median of 2.72 years of follow-up, hypertension developed in 6990 participants. In the fully-adjusted model, compared with participants in the tertile 1 of CVAI, the tertile 3 (HR = 1.26, 95% CI: 1.19-1.34) of CVAI was associated with an increased risk of incident hypertension and per standard deviation (SD) increase was associated with a 12% (HR = 1.12, 95% CI: 1.09-1.15) increased risk of incident hypertension. Similar significant associations were observed in subgroup and sensitivity analyses. Additionally, the RCS analysis showed a significant dose-response association of CVAI with the risk of incident hypertension (P overall < 0.001 and P nonlinear = 0.238).

Conclusions: These results suggested a positive association between CVAI and the risk of incident hypertension among older adults.

Introduction: Bempedoic acid can interfere with creatinine excretion, thereby potentially altering the calculation of glomerular filtration rate (eGFR), but is not known to have an effect on cystatin C metabolism.

Aim: The aim of this pilot observational study was to assess the impact of 3-months bempedoic acid treatment on renal function assessed by serum creatinine and cystatin C.

Methods: Consecutive hypercholesterolemic outpatients with indication to be started on bempedoic acid and available serum creatinine and cystatin C levels were enrolled. Follow-up (45-90 days) renal function markers were assessed. Lipid profile, uric acid levels, and CRP levels were also recorded.

Results: Bempedoic acid reduced LDL-c and total cholesterol levels by day 45. No changes were observed in HDL-c, triglycerides, Lp(a), serum creatinine, eGFR_cr, BUN, uric acid, or CRP levels throughout the study. The sensitivity analysis on individuals with complete data for cystatin C during follow-up (42%) confirmed the overall observations, while also showing neutral effects of bempedoic acid eGFR_cys and eGFR_cr-cys.

Conclusions: Three-months administration of bempedoic acid did not affect cystatin C levels. Adequately powered studies are needed to test these findings and, ultimately, the renal safety of bempedoic acid.

Introduction: Adequate blood pressure control (BPC) is crucial for preventing hypertension, as well as for mitigating the risks associated with inadequate control among hypertensive older adults. Identifying modifiable factors (i.e., dietary and biochemical patterns, sociodemographic characteristics, and health habits) and non-modifiable factors (i.e., genetic background) is crucial for improving control rates.

Aim: This study aimed to analyze the association between Renin-Angiotensin-Aldosterone System gene polymorphisms, sociodemographic characteristics, health and lifestyle habits, and BPC in older adults.

Methods: one hundred and forty-three older adults comprised the study population, and were genotyped for angiotensinogen (AGT) [M235T], renin (REN) [G2646A] angiotensin-converting enzyme (ACE) [InDel], angiotensin II type 1 receptor (AT1R) [A1166C] aldosterone synthase (CYP11B2) [C344T] gene polymorphisms. Sociodemographic characteristics, health, and lifestyle habits were recorded using questionnaires, and blood pressure was measured using standard methods. A Poisson multivariate regression was applied.

Results: Our finding indicated that, together, LDL-C, the A allele of the REN gene (G2646A), and genotype II of the ACE gene (InDel) were significantly associated with inadequate BPC in the community-dwelling older adults.

Conclusions: Due to its non-modifiable nature, the genetic background has the potential to identify individuals with a greater risk of illness. The knowledge of the genetic profiles prone to impaired BPC and its interaction with modifiable factors could guide more effective behaviors and/or treatments aiming to mitigate the morbidity and mortality related to poor BPC among hypertensive older adults.

Introduction: Epigenetic changes are important modulators of gene expression. The histone acetyltransferase gene non-derepressible 5 (Gcn5) is emerging as a pivotal epigenetic player in metabolism and cancer, yet its role in obesity and cardiovascular disease remains elusive.

Aims: To investigate Gcn5 role in obesity-related endothelial dysfunction.

Methods: Human aortic endothelial cells (HAECs) were exposed to vehicle or palmitic acid (200 uM) in the presence or in the absence of the Gcn5 pharmacological inhibitor CPTH2 or gene silencing. Ex-vivo inhibition of Gcn5 was performed in aortic rings from diet-induced obese and control mice. Chromatin immunoprecipitation (ChIP) was performed to investigate the epigenetic regulation of Nox2 promoter. In parallel, Gcn5/Nox2 expression was assessed by real-time PCR in vascular specimens isolated from obese patients and age-matched healthy controls. Endothelial-dependent vasodilation was also assessed in human vessels.

Results: PA increased Gcn5 gene expression in HAECs. Gcn5 upregulation was associated with increased expression of the pro-oxidant enzyme Nox2. Interestingly, either Gcn5 inhibition or gene silencing prevented PA-induced Nox2 upregulation and oxidative stress accumulation. ChiP assay showed increased Gcn5 occupancy and enhanced histone 3 acetylation of lysine 14 (H3K14ac) on Nox2 promoter. In aortic rings from obese mice, pharmacological inhibition of Gcn5 by CPTH2 rescued endothelial-dependent vasorelaxation as compared to vehicle. Finally, Gcn5 was increased in vessels from obese patients and correlated with Nox2 expression and endothelial dysfunction.

Conclusions: Our findings shed light on the importance of epigenetic regulation in obesity and pinpoint Gcn5 as a therapeutic target to prevent endothelial dysfunction in cardiometabolic disease.

Introduction: Hypertension is a common and persistent disorder and mostly causes myocardial structural and functional abnormalities. As a subtype pattern of HT, the reverse-dipper blood pressure (BP) is associated with worse cardiovascular outcomes and early-phase subclinical myocardial damage compared to other patterns. The Left Atrial Coupling Index (LACI) is a novel echocardiographic parameter developed to assess the mechanical function.

Aim: The aim of this study was to investigate the role of the LACI in predicting the reverse-dipper BP pattern in patients with hypertension.

Methods: A total of 404 hypertensive patients who underwent 24-hour ambulatory blood pressure monitoring were prospectively enrolled. Patients were classified into dipper, non-dipper, and reverse-dipper groups based on their nocturnal BP profiles. Comprehensive echocardiographic evaluations were performed, and LACI was calculated for each patient.

Results: A reverse-dipper BP pattern was observed in 26%(n = 105) of the 404 patients. Those with a reverse-dipper BP pattern exhibited higher mitral E/A ratio, E/Em means, left atrial volume index (LAVI), and LACI, along with lower Em septal, Am lateral mitral, and Am septal values. LACI (OR:3.837, 95% CI: 2.620-5.620, p < 0.001), LAVI, and Am lateral mitral value were found to be independent predictors of the reverse-dipper BP pattern. ROC curve comparison demonstrated that LACI was a better predictor of the reverse-dipper BP pattern than LAVI.

Conclusions: Our study demonstrates that LACI, an easily accessible echocardiographic parameter, is a more robust predictor of the reverse-dipper BP pattern compared to traditional echocardiographic markers.

Blood pressure variability (BPV), independent of mean BP, is an emerging predictor of cardiovascular risk and hypertension-mediated organ damage. However, its clinical utility remains limited due to the lack of clear guideline recommendations, leading to variability in physician practices. Using the modified Delphi method, this is the first Egyptian consensus to provide expert recommendations for integrating BPV in Egypt's resource-limited settings.

Introduction: Autoimmune rheumatic diseases (ARD) increase the risk of early subclinical vascular damage such as arterial stiffness (AS), which is associated with cardiovascular events. It remains unclear whether this also occurs during clinical remission or low disease activity (CR/LDA).

Aims: We aimed to evaluate carotid-femoral pulse wave velocity (cf-PWV) in ARD-patients in CR/LDA and to compare them with a control group.

Methods: A cross-sectional study was conducted in Argentina (2022-2023). Group 1: ARD subjects in CR/LDA, without systemic organ involvement, office blood pressure (BP) <140/90 mmHg, and low 10-year cardiovascular risk (CVR) <5% according to WHO's calculator. Group 2: healthy controls.

Exclusion criteria: associated clinical conditions, evidence of target organ damage, presence of traditional cardiovascular risk factors, and use of antihypertensives, statins, or aspirin. cf-PWV was measured using the Aortic device.

Results: A total of 97 subjects were included: 48 ARD and 49 controls. Among those with high-normal BP: Group 1 showed higher cf-PWV (6.81±1.14 vs. 5.98±0.82 m/s, p<0.0001) and more AS (22/48 vs. 2/49, p<0.0001). In a sub-analysis restricted to subjects with normal-BP: Group 1 also showed higher cf-PWV and more AS (6.57±1.09 vs. 5.84±0.65 m/s, p=0.005; 14/36 vs. 0/37, p<0.0001). Among ARD patients the frequency of AS was 45.8% with high-normal BP and 38.8% with normal BP. Multivariate analysis showed that ARD and diastolic BP were independently associated with AS.

Conclusions: ARD patients in CR/LDA even with traditional low-CVR showed higher cf-PWV.