Vascular Health and Risk Management最新文献

Background: Stroke remains a leading cause of mortality in Australia. Over the past three decades, carotid endarterectomy (CEA) has been the gold standard for stroke prevention in patients with symptomatic high-grade carotid stenosis. Carotid artery stenting (CAS) has emerged as a minimally invasive alternative, particularly for high-risk surgical candidates. This study aims to evaluate national trends in CEA and CAS in Australia over a 15-year period, reflecting evolving practices in the post-CREST era.

Methods: A population-level retrospective trend analysis was conducted using Australian Institute of Health and Welfare Procedures Data Cubes to identify CEA and CAS procedures performed between 2009 and 2023. Population-adjusted incidence rates were calculated using data from the Australian Bureau of Statistics. Simple linear regression analysis was used to assess changes in procedure rates overtime.

Results: A total of 41,845 carotid interventions were performed during the study period, with males accounting for 70.47% of procedures. CEA comprised the majority of interventions (78.86%), while CAS accounted for 21.14%. The population-adjusted incidence of CEA declined significantly by 0.346 procedures per 100,000 people annually (p < 0.001), consistent across all age groups and genders. Conversely, CAS incidence increased modestly by 0.061 procedures per 100,000 people annually (p = 0.044), with the most significant rise observed in patients aged 60-69 years.

Conclusion: This study highlights significant changes in carotid revascularisation practices in Australia, with a marked decline in revascularisation procedures overall, primarily driven by a significant decline in CEA overtime. CAS showed a modest but significant increase over the study period. These findings align with global trends, reflecting the impact of improved medical management, shifting clinical guidelines, and the growing role of minimally invasive techniques. Future research should investigate the clinical outcomes and indications associated with these trends to optimise patient selection and refine management strategies for carotid artery disease.

Background: Stroke is a major cause of mortality and disability worldwide, with a particularly high burden in China. While dynapenic abdominal obesity (DAO) is associated with adverse cardiometabolic outcomes, its relationship with stroke risk remains unclear. We examined whether DAO predicts stroke using interpretable machine learning in a nationally representative cohort of middle-aged and older Chinese adults.

Methods: We analysed prospective data from the China Health and Retirement Longitudinal Study, including 11,207 participants aged ≥ 45 years. Dynapenia was defined as a handgrip strength ≤ 28 kg (men)/≤ 18 kg (women); abdominal obesity was defined as a waist circumference ≥ 90 cm (men)/≥ 80 cm (women). Stroke events were identified via self-reported physician diagnoses. We employed logistic regression, subgroup analyses, multiple machine learning models, and Shapley additive explanations (SHAP) to assess the association and evaluate robustness.

Results: Over the 4-year follow-up period, 210 (1.9%) participants experienced stroke. DAO was significantly associated with increased stroke risk (adjusted OR = 1.58, 95% CI: 1.21-2.06). Subgroup analysis demonstrated consistent associations across all subgroups (all interaction p-values > 0.05). XGBoost demonstrated the highest predictive performance (AUC = 0.92, accuracy = 0.84). SHAP analysis ranked DAO as the fourth most important predictor after age, BMI, and residence.

Conclusion: DAO was independently associated with an increased risk of stroke, with an interpretable machine learning model further supporting its potential as a predictor. Maintaining muscle strength and managing abdominal obesity may reduce the risk of stroke in older adults. These findings suggest that DAO may serve as a potential risk marker for stroke. Future research, including external validation and implementation studies, is needed before any recommendations for screening or intervention can be made.

Aim: Primary cardiac intimal sarcoma is a rare entity with a poor prognosis, often requiring distinction from other undifferentiated cardiac sarcomas.

Case presentation: A 55-year-old female presented with symptoms of heart failure. Imaging identified dual left atrial masses compromising mitral inflow and pulmonary venous return. Surgical excision was performed, and morphological analysis revealed a high-grade spindle cell sarcoma. Crucially, the diagnostic dilemma was resolved through molecular testing; immunohistochemistry showed diffuse overexpression of MDM2 and CDK4, and fluorescence in situ hybridization (FISH) confirmed the amplification of the MDM2 and CDK4 loci.

Conclusion: This case illustrates the diagnostic utility of MDM2 and CDK4 as specific biomarkers for cardiac intimal sarcoma. It reinforces the necessity of a multidisciplinary approach involving advanced molecular pathology to ensure accurate classification and appropriate management of rare cardiac malignancies.

Background: Frailty is common among patients with cardiovascular disease (CVD) and is associated with adverse clinical outcomes. However, practical tools for predicting frailty risk in middle-aged and older patients with CVD remain limited. This study aimed to develop and validate a prediction model for frailty risk in patients with CVD.

Methods: A cross-sectional study was conducted using data from the 2015 China Health and Retirement Longitudinal Study (CHARLS). A total of 1184 participants aged ≥45 years with CVD were included and randomly divided into training and validation cohorts at a 7:3 ratio. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection, followed by multivariable logistic regression to construct a nomogram model. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration plots, the Hosmer-Lemeshow test, and decision curve analysis (DCA).

Results: Frailty was identified in 148 participants (12.5%). Sleep duration, activities of daily living (ADL), waist circumference, cognitive function, handgrip strength, age, and depression were independent predictors of frailty. The nomogram demonstrated good discrimination, with area under the curve (AUC) values of 0.851 (95% CI: 0.814-0.888) in the training cohort and 0.861 (95% CI: 0.804-0.917) in the validation cohort. Calibration showed good agreement between predicted and observed outcomes (Hosmer-Lemeshow test, P>0.05). DCA indicated favorable clinical utility.

Conclusion: This nomogram provides a simple and effective tool for predicting frailty risk in patients with CVD and may facilitate early screening and risk stratification in clinical practice.

Purpose: The TyG index is a reliable marker of insulin resistance, and studies suggest its association with hypertension risk. However, no relevant research has been conducted among employees of titanium dioxide (TiO₂) manufacturing enterprises. This study aims to investigate the association between the TyG index and hypertension risk in this population.

Methods: This study employed a cross-sectional design, conducting questionnaire surveys and health examinations among 596 employees at a titanium dioxide manufacturing enterprise in Guangxi. The TyG index was calculated, and the relationship between TyG and hypertension risk, along with its predictive value, was analyzed using multivariate logistic regression, restricted cubic splines, and ROC curve analysis.

Results: The prevalence of hypertension among titanium dioxide workers was 17.22%. Univariate analysis showed that age, gender, work experience, alcohol consumption, hyperglycemia, abnormal liver function, dyslipidemia, and the TyG index were associated with hypertension (P<0.05). Multivariate analysis revealed that the hypertension risk in the highest TyG quartile (Q4) was 11.12 times higher than that in the lowest quartile (Q1) (95% CI: 3.52-35.16). Results from the restricted cubic spline model indicated a nonlinear association between the TyG index and hypertension risk (P for overall < 0.0001, P for nonlinearity < 0.0001). Stratified analysis confirmed the TyG index as a major risk factor with a positive effect (P < 0.05). The ROC curve AUC was 0.775, indicating that the TyG index has good predictive ability for hypertension.

Conclusion: A high TyG index increases the risk of hypertension among workers in titanium dioxide production enterprises. As a low-cost, easily implemented early screening tool, the TyG index facilitates early identification and intervention for high-risk populations, providing scientific basis for developing targeted intervention measures for hypertension and cardiovascular health among occupational populations.

Background: Antithrombotic therapy is a cornerstone of managing cardiac diseases, necessitating routine monitoring of coagulation parameters like Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT). Data on the coagulation profiles of treated patients in resource limited settings like Yemen are scarce.

Objective: This study aimed to evaluate PT and APTT in antithrombotic-treated cardiovascular patients and assess their variation across different cardiac diagnoses and therapy regimens in Sana'a, Yemen.

Methods: A cross-sectional study was conducted on 200 cardiovascular patients on antithrombotic therapy at selected hospitals in Sana'a City between January and March 2024. Demographic, clinical, and therapeutic data were collected. Coagulation parameters (PT, INR, APTT) were measured and compared across diagnostic groups and treatment types using Kruskal-Wallis and Mann-Whitney U-tests, with Bonferroni correction for multiple comparisons.

Results: The study group was predominantly male (69.0%), aged 51-80 years (57.0%). Coagulation parameters varied significantly across cardiac diagnoses (p <0.01 for PT, INR, APTT). Patients with Mitral Valve Replacement (MVR) had the highest median PT (36.45s) and INR (2.75). Post-hoc analysis confirmed MVR patients had significantly elevated parameters compared to other groups (e.g. PT 19.01s higher than Segment Elevation Myocardial Infarction (STEMI), p=0.003). Rheumatic Heart Disease (RHD) patients showed intermediate PT elevation. No significant differences were found between STEMI and Non-ST-segment Elevation - Acute Coronary Syndrome (NSTE-ACS) subtypes. Antithrombotic type significantly influenced results: warfarin patients had the highest median PT (20.00s), INR (1.53), and APTT (40.00s) (p<0.05). Dosage analysis confirmed warfarin's significant impact compared to aspirin doses.

Conclusion: Coagulation profiles in cardiovascular patients vary significantly according to both the underlying cardiac diagnosis and the type of antithrombotic therapy. MVR and RHD patients display notably elevated parameters, while ACS subtypes show similar profiles. These findings underscore the need for diagnosis-specific monitoring strategies and confirm the expected pharmacological effects of different antithrombotic agents in a Yemeni population.

A Spinal epidural and dural Arteriovenous Fistula is a rare vascular malformation that rarely presents as multiple synchronous lesions. We report a rare case of three synchronous lumbar spinal arteriovenous shunts in a 22-year-old male presenting with subarachnoid hemorrhage (SAH) symptoms. Angiographic evaluation revealed a complex vascular pathology consisting of one anterior epidural arteriovenous fistula (AVF) fed by the L3 radiculomedullary branch and two smaller dural AVFs at L4-L5 levels. Initial cranial imaging was unremarkable, but spinal MRI demonstrated intrathecal hemorrhage with perimedullary flow voids. The dominant epidural fistula, characterized by a large venous pouch draining into medullary veins, was successfully treated with endovascular embolization, fistula and staged management was planned for the remaining lesions. This case highlights three important clinical aspects: (1) the coexistence of epidural and dural spinal shunts represents a distinct pathological entity from classic spinal dural AVFs; (2) hemorrhagic presentation may occur in spinal AVFs with epidural venous drainage; and (3) comprehensive spinal angiography is crucial when evaluating SAH of unknown origin. The anatomical and hemodynamic differences between these fistula types underscore the need for precise angiographic characterization to guide appropriate management.

Purpose: To describe postoperative blood glucose trajectories in patients with acute ischemic stroke treated by mechanical thrombectomy (MT) and to examine their associations with 90-day functional outcomes and early postoperative inflammatory markers.

Patients and methods: This retrospective cohort study included 150 patients who underwent MT for large vessel occlusion (LVO) stroke between March 2023 and September 2024. Daily capillary blood glucose levels (fasting and postprandial) were recorded for seven days post-procedure, and linear regression was used to calculate individual postoperative glucose slopes. Patients were classified into a Glucose-Increasing Group or Glucose-Decreasing Group based on the median slope. The primary outcome was the 90-day modified Rankin Scale (mRS). Secondary outcomes included postoperative day-1 levels of C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-10 (IL-10). Statistical analyses included group comparisons and multivariate logistic regression adjusting for potential confounders.

Results: Patients in the Glucose-Increasing Group had significantly higher median 90-day mRS scores compared with the Glucose-Decreasing Group (4.0 vs 3.0; P = 0.030). They also exhibited higher postoperative inflammatory markers: CRP (5.2 vs 4.1 mg/L; P = 0.022), IL-6 (6.9 vs 5.7 pg/mL; P = 0.015), and IL-10 (134 vs 104 pg/mL; P = 0.0017). However, in multivariate logistic regression, glucose trajectory was not an independent predictor of poor outcome (mRS ≥ 3; OR 0.67, 95% CI 0.34-1.37; P = 0.272).

Conclusion: An increasing postoperative blood glucose trend is associated with higher early inflammatory marker levels and poorer 90-day functional outcomes in LVO stroke patients undergoing thrombectomy. Although not an independent predictor after adjustment, postoperative glycemic trajectory may reflect underlying metabolic and inflammatory stress. Prospective studies are needed to further clarify these relationships.

The emerging concept of the cardiovascular-kidney-metabolic (CKM) syndrome encapsulates the interrelated nature of metabolic processes and metabolic dysfunction. Prediabetes, which describes the presence of elevations of blood glucose measurements insufficient to provoke a diagnosis of type 2 diabetes (T2D), is an important, - and crucially, reversible - early manifestation of the CKM syndrome. Numerous clinical studies and meta-analyses have shown that a substantial minority of people with prediabetes have microvascular and/or macrovascular complications reminiscent of those seen in clinical T2D. Prediabetes therefore represents an early stage of a continuum of increased insulin resistance, hyperglycaemia and associated vascular risk that begins at blood glucose concentrations that are well below those required for a diagnosis of diabetes. This condition also provides an opportunity for early intervention. All people with prediabetes should receive a multifactorial lifestyle intervention that focuses of weight management, nutrition, physical activity and smoking cessation. Where this is insufficient, ineffective or not followed, metformin remains the best studied pharmacotherapy for the management of prediabetes, with formal therapeutic indications for this purpose in many countries and support within international guidelines. Weight management is crucial for diabetes prevention, and weight loss during receipt of incretin agonist drugs is effective in diabetes prevention in populations with prediabetes, although consideration should be given to how long the treatment should be maintained and how the patient should be managed when it is ultimately withdrawn.

Although physical activity has beneficial effects for health, athletes also suffer from cardiovascular diseases (CVD). The type and prevalence of CVD in athletes depend on their age, but typically include hypertrophic cardiomyopathy, arrhythmias, and valve diseases. In pediatric athletes <18 years old, congenital heart diseases (CHD) are prevalent, while in master athletes >35 years old, coronary artery disease (CAD) is the most common. Cardiopulmonary exercise testing (CPET) is a gold standard to evaluate cardiorespiratory fitness (CRF). Although CRF is most often identified as peak oxygen uptake ([Formula: see text]O_2peak), CPET provides a multidimensional assessment through several other cardiorespiratory variables. CVD aggravates CRF and reduces [Formula: see text]O_2peak. While there is no universal pattern of alteration in the remaining CPET parameters, the specific deviations depend on the type of CVD. Therefore, precise monitoring of changes in CPET scores is crucial for risk stratification, adjusting exercise intensity, enabling safe sports participation, and authorizing return to sport after treatment. Among athletes, CPET plays a pivotal role across all fields. Therefore, this review aimed to evaluate the value of CPET in 1) identification of risk factors of CVD among athletes, considered as changes in CRF, 2) monitoring of treatment, and 3) making shared decisions on returning to sport. A special focus was placed on the needs of emerging age groups - pediatric and master athletes. Additionally, evidence gaps and directions for future research were discussed.