Vascular Health and Risk Management最新文献

Background: Hypertension (HT) is a major risk factor for adult morbidity and mortality in low- and middle-income countries and little is known regarding the distribution of HT risk and treatment access within urban areas.

Patients and methods: We used data from the Vientiane Multi-Generational Birth Cohort in urban Lao PDR to assess the prevalence of loss and retention across five stages of HT care for 40+ year old adults: i) prevalence of hypertension, ii) hypertensives who ever had their BP measured by a health care professional, iii) hypertensives ever diagnosed with HT by a professional, iv) patients currently treated with HT medication, and v) patients with currently controlled BP. We estimated associations between sociodemographic and lifestyle predictors and the proportion of participants who reached each care cascade step using mutually adjusted Poisson regression modeling.

Results: Among the 3196 participants aged 40 to 99 years, the overall prevalence of HT was 16.3%, with higher rates for women, people over 60 years, peripheral district residents, low educated, widowed, and obese. Among people with HT, 90.2% ever had their BP measured by a health care professional, 69.3% ever received a HT diagnosis, 60.9% HT were currently on (drug) treatment, and 39.5% had currently controlled BP. The largest cascade of care losses occurred at the diagnosis and control stages with better outcomes for women. While central districts showed higher rates of diagnosis, control levels were lower than in peripheral districts, but there these differences appeared to be explained by adjusting for sociodemographic and lifestyle factors.

Conclusion: While HT prevalence in Lao PDR is lower than reported for other LMICs, more than 16% over the age of 40 years suffer from HT, and 60% of these cases are currently not controlled. Major policy efforts are needed to support this population and to prevent HT-driven excess mortality.

Background: Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome, is a systemic immune vasculitis with an unclear etiology. It is often complicated by coronary artery disease. This study uses bidirectional Mendelian randomization (MR) to investigate the interaction between KD and circulating inflammatory factors, providing insights into their causal relationships.

Methods: We conducted a two-way pooled MR analysis to examine the causal links between 41 circulating inflammatory regulators and the risk of KD. Genetic data related to inflammation were sourced from three genome-wide association studies (GWASs) involving CRP, PCT, and cytokines, while KD data were derived from other studies. Inverse-variance weighting (IVW) was the primary MR method, with sensitivity analyses performed using MR‒Egger, weighted median, weighted mode, and MR-PRESSO to ensure robustness.

Results: Forward MR analyses showed no significant relationship between inflammatory factors and KD outcomes. In contrast, reverse MR, with KD as the exposure factor, revealed that interleukin-2 (IL-2) and interleukin-8 (IL-8) were significantly associated with KD (IL-2: OR=1.0085, P=0.037; IL-8: OR=1.0099, P=0.014). Borderline significant associations were observed for factors such as B_NGF, EOTAXIN, HGF, and IL_12_P70 in MR‒Egger and weighted median analyses.

Conclusion: This bidirectional MR study highlights the role of circulating inflammatory modulators in KD risk, offering insights into KD pathogenesis and potential therapeutic targets.

Introduction: The association between depressive symptoms and cardiovascular disease (CVD) is widely acknowledged. However, there is a lack of relevant evidence among the middle-aged population in developing countries where depressive symptoms often go undetected and untreated. The objectives of this study were to assess the association between depressive symptoms and CVD in Indonesia and to compare the association between the middle-aged and elderly population.

Methods: This national cross-sectional population-based survey used secondary data from the publicly available Indonesian Family Life Survey (IFLS-5). Depressive symptoms were assessed using a modified Center for Epidemiologic Studies Depression (CESD-R-10) scale, and data on CVD and sociodemographic variables were self-reported. Binary logistic regression was performed to determine the association between depressive symptom and self-reported CVD after adjusting for confounding factors, with an adjusted odds ratio (AOR) and 95% confidence interval (CI) reported. Subgroup analysis was performed based on the age group.

Results: The study included 9049 respondents, predominantly the middle-aged (71.1%), female (52.6%), elementary school graduates (50.7%), non-smokers (59.0%), non-obese (77.3%), without depressive symptoms (82.2%), and without self-reported CVD (96.7%). Respondents with depressive symptoms were more likely to experience self-reported CVD (AOR = 1.56; 95% CI = 1.18-2.05; p-value = 0.002), after adjusting for potential confounders. A significant association was observed between depressive symptoms and self-reported CVD in elderly respondents (AOR = 1.89; 95% CI = 1.22-2.94; p-value = 0.005), whereas no significant association was observed in the middle-aged group (AOR = 1.39; 95% CI = 0.98-1.98; p-value = 0.063) after adjusting for confounders.

Conclusion: Respondents with depressive symptoms were associated with an increased risk of self-reported CVD, highlighting the urgent need for targeted prevention strategies, especially for those struggling with depressive symptoms.

Background: Scientific societies universally recommend evaluating the accuracy of electronic devices designed for blood pressure (BP) measurement using established validation protocols.

Objective: This study aimed to assess the accuracy of the Combei BP880W wrist device for BP measurement in the general population, according to the ISO 81060-2:2018/AMD 1:2020 Universal Standard.

Methods: The Combei BP880W is an oscillometric device designed to measure BP at the wrist. This study adhered to the ISO 81060-2:2018/AMD 1:2020 protocol and employed the same-arm sequential BP measurement method. A total of 85 participants, meeting protocol-specified age, gender, BP, and cuff distribution criteria, were included. The accuracy analysis utilized Criterion 1 (differences and standard deviations between reference and test device measurements) and Criterion 2 (intra-individual standard deviation of BP differences).

Results: Eighty-five participants were included. Mean BP differences between the simultaneous observer measurements were -0.2 ± 1.9 mmHg for systolic BP (SBP) and 0.1 ± 1.9 mmHg for diastolic BP (DBP). For Criterion 1, the mean difference ± standard deviation (SD) between the reference and test device measurements were -2.7 ± 5.9 mmHg (SBP) and -2.0 ± 3.9 mmHg (DBP), meeting the required threshold (≤ 5 ± 8 mmHg). For Criterion 2, intra-individual SDs were 4.6 mmHg (SBP) and 3.4 mmHg (DBP), both below the respective limits (≤ 6.39 mmHg for SBP and ≤ 6.65 mmHg for DBP).

Conclusion: The Combei BP880W wrist device meets the accuracy requirements of the ISO 81060-2:2018/AMD 1:2020 protocol, supporting its use for home BP monitoring in the general population.

Introduction: Previous studies with visible light spectroscopy (VLS) and laser Doppler flowmetry (LDF) have shown reduced mucosal circulation of the stomach and duodenal wall in patients with median arcuate ligament syndrome (MALS) and chronic mesenteric ischemia (CMI). However, transserosal microcirculatory assessment during the operative treatment of patients with these conditions has not yet been performed. We aimed to investigate if laparoscopic decompression for MALS and aortomesenteric bypass in CMI can result in immediate measurable increase in the microcirculation in stomach and duodenum.

Patients and methods: In a single center, prospective comparative cohort study, twenty-eight patients suspected of MALS, and eleven with CMI underwent assessment of transserosal microcirculation of stomach and duodenum with Visible Light Spectroscopy (VLS) and Laser Doppler flowmetry (LDF), during surgery. Patients with computed tomography angiography (CTA) verified stenosis grade ≥50% in MALS and ≥70% in CMI were included in the study. Duplex ultrasound (DUS) was performed before and after the surgical treatment. The changes in the pre- and postoperative microcirculation were calculated with paired sample t-test.

Results: VLS showed significant increase in the transserosal relative hemoglobin concentration (rHb) after laparoscopic decompression in patients with MALS (Stomach, before: 58AU±13, after: 62AU±14, p = 0.017) and (Duodenum, before: 62AU±15, after:70AU±15, p = 0.004). Furthermore, a significantly increased blood flow was found in duodenum (Before: 276AU±89, After: 315AU±93, p = 0.015). However, the SaO2 was decreased significantly in the stomach (Before: 86AU±10, After: 82AU±14, p = 0.015), but remained unchanged in the duodenal serosa.The study did not find any increase in the microcirculation of the CMI patients after revascularization. The baseline transserosal microcirculation was indifferent between the groups.

Conclusion: Laparoscopic decompression leads to enhanced transserosal microcirculation in stomach and duodenum in the patients with MALS. The baseline transserosal microcirculation in stomach and duodenum is indifferent in the MALS and CMI.

Background: A growing number of individuals develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of the standard modifiable risk factors (hypertension, diabetes, dyslipidemia, and cigarette smoking) (SMuRF-less patients). Prevalence of SMuRF-less patients in the Middle East has not been studied. This study investigates the prevalence, clinical profiles and outcomes of SMuRF-less patients compared with those who have SMuRFs.

Methods: We analyzed data from 6 published registries and from the Jordan SMuRF-less patients study, including baseline demographic features, cardiovascular risk factors, comorbid diseases, utilization of secondary prevention pharmacotherapy and one year outcome in SMuRF-less patients, those with 1-2 SMuRFs and with 3-4 SMuRFs. Results. A total of f 5540 ASCVD patients were enrolled. Mean age was 57.5 ± 11.6 years, and 1333 (24.1%) were women. Of the whole group, 214 (3.9%) were SMuRF-less, 3014 (54.4%) had 1-2 SMuRFs and 2312 (41.7%) had 3-4 SMuRFs. Compared with the SMuRFs groups, SMuRF-less group were younger, more likely to be men, and had lower prevalence of obesity, physical inactivity, metabolic syndrome, heart failure and chronic kidney disease. SMuRF-less patients were less likely to receive secondary prevention cardiovascular medications (antiplatelet agents, statins, renin angiotensin blockers and beta blockers); all p < 0.001. One year survival in the SMuRF-less patients was significantly lower than that in the SMuRFs groups (97.7% vs.98.4% vs.98.3%, respectively, p = 0.01). Multivariate analysis showed that young age, absence of heart failure and utilization of secondary preventive medications were associated with better one year outcome.

Conclusion: In this cohort of ME patients with ASCVD, nearly four in 100 were SMuRF-less. This rate is lower than that reported by most of published studies, mainly due to the high prevalence of the 4 SMuRFs. SMuRF-less patients were younger, had less comorbid disease, received less secondary prevention pharmacotherapy and had higher rate of one year mortality than those with SMuRFs.

Clinical trials: The study is registered with ClinicalTrials.gov, unique identifier number NCT06199869.

Regular sexual activity is comparable to moderate exercise and may be safe for patients with cardiovascular disease (CVD). According to the recommendations of the Princeton III Conference (P3), people with a low risk of adverse cardiac events can undertake sexual activity safely, while other patients must first stabilise their cardiovascular status. Exercise testing is recommended to assess the safety of sexual activity in people with questionable or uncertain cardiac risk (P3). Patients after successful and uncomplicated treatment of myocardial infarction (MI) can return to sexual activity after 3 weeks if the stress test is negative. The 4th Princeton Conference (P4) recommends the use of the 2019 regimen developed by the American College of Cardiology (ACC) and American Heart Association (AHA) to assess the risk of atherosclerotic cardiovascular disease (ASCVD) in men with ED (ACC/AHA ASCVD 2019). Sexual health education plays an important role in the successful return to safe sexual activity, which should include post-MI patients and their relatives. The responsibility for counselling lies with cardiologists, general practitioner (GP) and nursing staff. Sexual rehabilitation should be an integral part of cardiac rehabilitation, and lifestyle modification and optimal treatment of underlying medical conditions are key to maintaining psychophysical well-being and a successful sex life.

Objective: An association between white blood cell count (WBC-C) before percutaneous coronary intervention (PCI) and prognosis has been established in patients undergoing PCI. However, the effect of WBC-C after PCI on the long-term prognosis of patients with unstable angina pectoris (UA) is unclear.

Methods: A retrospective cohort study was conducted in 1811 consecutive patients with UA. The changes of WBC and subgroup counts before and in the early postoperative stages after PCI were observed by paired Wilcoxon signed-rank test. The Kaplan-Meier method and COX proportional regression model were used to evaluate the association between the incidence of 5-year endpoint events and post-PCI leukocytosis.

Results: Leukocytosis and neutrocytosis within 24 hours after PCI were observed in majority of patients with UA, while lymphocyte count significantly decreased after PCI in those patients. There were no significant differences in 5-year all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE) between patients in the post-PCI leukocytosis and the control group. However, the 5-year incidence of major adverse cardiovascular events (MACE) was significantly increased in the post-PCI leukocytosis group (p = 0.017, Log rank test). Leukocytosis after PCI was independently associated with the occurrence of MACE (hazard ratio: 1.36; 95% confidence interval: 1.06-1.75; p = 0.015).

Conclusion: Peripheral WBC and neutrophil counts within 24 hours after PCI significantly increased in response to PCI in patients with UA, while lymphocyte count significantly decreased after PCI in those patients. The post-PCI leukocytosis offered predictive value for an increased risk of MACE for up to 5 years in patients with UA.