Vascular Health and Risk Management最新文献

Introduction: This study investigates the molecular and cellular mechanisms of vascular aging and its critical role in the pathogenesis of aortic dissection (AD), employing an integrative approach that includes bioinformatics and single-cell transcriptomic analyses.

Methods: Differentially expressed genes (DEGs) were identified from publicly available datasets (GSE52093, GSE153434), with 194 upregulated and 518 downregulated genes, 16 of which were associated with vascular aging. Superoxide dismutase 2 (SOD2) was identified as a critical gene, demonstrating significant diagnostic accuracy for AD through ROC analysis. Single-cell RNA sequencing of AD tissues revealed cellular heterogeneity, with a predominant macrophage infiltration and altered proportions of endothelial and smooth muscle cells.

Results: SOD2 was notably expressed in macrophages and dendritic cells, particularly in AD tissues, suggesting its involvement in immune modulation. Validation of SOD2 at both mRNA and protein levels showed elevated expression in AD tissues and serum, correlating with increased oxidative stress and immune cell infiltration. Elevated serum SOD2 levels were linked to poor clinical outcomes, particularly higher in-hospital mortality. Immune profiling further identified significant associations between SOD2 and macrophage activity.

Conclusion: These findings suggest SOD2 as a potential diagnostic biomarker and therapeutic target for AD. A gene-drug interaction network proposed pharmacological candidates for SOD2 modulation, paving the way for targeted therapies. This study advances the understanding of AD pathogenesis, emphasizing the interplay between oxidative stress, immune response, and vascular aging at both molecular and cellular levels.

Lipoprotein (a) (Lp[a]) is an independent risk factor for cardiovascular disease (CVD). Structurally like low-density lipoprotein, Lp(a) is distinguished by the covalent attachment of apolipoprotein(a) to apolipoprotein B-100. Although its physiological role remains incompletely understood, evidence suggests that Lp(a) may facilitate wound healing and inhibit cancer growth and metastasis. In contrast, Lp(a) exhibits proatherogenic properties; it transports proinflammatory oxidized phospholipids, induces the secretion of proinflammatory cytokines, increases endothelial permeability, promotes smooth muscle cell migration and proliferation, and upregulates adhesion molecules that facilitate monocyte recruitment and retention. In addition, Lp(a) exerts prothrombotic activity by enhancing platelet aggregation, suppressing plasminogen activation, and inhibiting fibrinolysis. Although its clinical relevance in CVD is well established, the role of Lp(a) in peripheral arterial disease (PAD) remains unclear. This narrative review aimed to synthesize and critically examine the current evidence on the biological role of Lp(a) in PAD pathogenesis and identify knowledge gaps in PAD-specific outcomes. This review summarizes the epidemiology, pathophysiology, and management of elevated Lp(a) levels in patients with PAD and examines their association with post-treatment clinical outcomes. Elevated Lp(a) levels are associated with an increased PAD incidence and a higher risk of restenosis post-revascularization. Understanding the mechanisms by which Lp(a) contributes to PAD pathogenesis is essential for developing effective targeted therapeutic approaches and improving the identification and management of high-risk patients.

Cerebrovascular diseases (CVDs) impose a heavy global health burden, necessitating efficient management strategies. Artificial intelligence (AI) has become a key transformative tool across the CVD care continuum, and this review systematically synthesizes AI's latest advancements, limitations, and clinical translation pathways in CVD management, adhering to PRISMA-ScR guidelines. A literature search was performed in four core databases (PubMed, Web of Science, EMBASE, IEEE Xplore) for studies published between 2018-2023. After strict screening (inclusion: original research/clinical trials with clear indicators; exclusion: unvalidated studies/conference abstracts), 128 high-quality studies were included, with quality assessed via NOS and QUADAS-2. Key AI applications in CVD management include: (1) Risk prediction: Multimodal models (radiomics-CFD, EHR-imaging) achieve AUC >0.9, but performance declines in elderly patients (>75 years, ΔAUC=0.08-0.12); (2) Diagnosis: Systems like Viz LVO and DeepHemorrhage reduce LVO detection time to 6 minutes and hemorrhage segmentation Dice to 0.94, yet face false positives (3.5-5%) and workflow delays; (3) Therapeutic optimization: Intraoperative AI (eg, Siemens AI-Path) shortens microcatheter placement time by 61%, and pharmacogenomic models cut antiplatelet complications by 37%; (4) Long-term monitoring: Mobile platforms (eg, NeuroVision™) automate NIHSS scoring (ICC=0.93) but lose accuracy in home settings (ICC=0.85-0.88). Critical limitations of current AI include single-center data bias, poor interpretability, and legal risks (unclear misdiagnosis liability). This review proposes three innovative solutions: a "data-model-clinical" closed loop, a multidimensional AI value evaluation system, and defining the "human-AI collaboration boundary" in neurointerventions. Future directions focus on primary care-adapted lightweight models, comorbidity-specific algorithms, and AI-assisted rehabilitation. This review emphasizes that physician-AI collaboration and standardized frameworks (eg, AI-RADS, WHO-ITU guidelines) are critical for AI's sustainable translation in CVD care. Addressing current gaps will enable AI to further improve therapeutic efficiency and functional outcomes, alleviating the global CVD burden.

Background: High blood pressure is a major risk factor for cardiovascular and renal diseases, and lipid metabolism disorders may affect blood pressure through mechanisms such as endothelial inflammation. Remnant cholesterol, a key component of triglyceride-rich lipoproteins, has been recognized as a causal factor for atherosclerosis and metabolic disorders. This study aims to investigate the relationship of remnant cholesterol with blood pressure control in the general US population.

Methods: A total of 3915 participants with self-reported hypertension from NHANES from 2007 to 2018 were included in this study. Demographic and behavior parameters, blood pressure, and blood samples were conducted. Remnant cholesterol was estimated as total cholesterol minus low-density lipoprotein cholesterol minus high-density lipoprotein cholesterol. Control of hypertension was defined as systolic blood pressure less than 140 mmHg and diastolic blood pressure less than 90 mmHg in participants with hypertension.

Results: The mean age was 56.98 ± 0.28 years, and 2021 (weighted percentage 51.34%) were female. Among all participants, 2650 participants had their blood pressure well controlled. In multivariate logistic regression, the associations between remnant cholesterol and blood pressure control were statistically significant after adjusting age, sex, race/ethnicity, education level, poverty income ratio, smoking and drinking status, metabolic equivalent, HbA1c, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (Model 1: OR=0.74, 95% CI: 0.57-0.95; Model 2: OR=0.72, 95% CI: 0.55-0.94; Model 3: OR=0.73, 95% CI: 0.56-0.93; Model 4: OR=0.60, 95% CI: 0.46-0.78). The subgroup analysis revealed generally consistent associations with the main results.

Conclusion: Remnant cholesterol is associated with blood pressure control. Targeting remnant cholesterol through lifestyle modifications or lipid-lowering therapies may improve blood pressure control in high-risk patients.

Objective: To evaluate the relationship between Renin-Angiotensin-Aldosterone System (RAAS) activity and Perfusion Index (PI) in children with Postural Tachycardia Syndrome (POTS), and to assess the diagnostic performance of Angiotensin II (AngII) and PI for POTS status.

Methods: A total of 65 children with POTS and 65 age- and sex-matched healthy controls were enrolled. Plasma renin, angiotensin I (AngI), AngII, and aldosterone were quantified via enzyme-linked immunosorbent assay, and PI was measured using a pulse oximetry-based monitor during head-up tilt testing. Statistical analyses included Receiver Operating Characteristic (ROC) curve analysis of AngII and PI for POTS status, binary logistic regression, and Pearson correlation.

Results: Compared to controls, children with POTS demonstrated a significantly lower PI (4.64 ± 1.54 vs 6.19 ± 1.64%; adjusted p < 0.005) and higher AngII levels (114.07 ± 7.69 vs 109.20 ± 10.44 pg/mL; adjusted p = 0.012). ROC analysis indicated that PI had a stronger diagnostic value (AUC = 0.753, 95% CI: 0.670-0.836) than AngII (AUC = 0.654, 95% CI: 0.559-0.749) in identifying POTS. In logistic regression, only PI remained an independent predictor of POTS (Odds Ratio = 0.577, 95% CI: 0.442-0.755, p < 0.001). A significant inverse correlation was observed between AngII and PI (r = -0.459, p < 0.001).

Conclusions: PI is a valuable, noninvasive clinical marker for POTS in children, demonstrating superior diagnostic utility compared to AngII. While elevated AngII retains clinical significance by reflecting underlying pathophysiology and disease severity, its independent predictive value is limited. The combined assessment of PI and AngII may enhance the pathophysiological understanding and management strategies for pediatric POTS.

Background: This study investigated the efficacy and safety profile of cardiac shock wave therapy (CSWT) in the treatment of ischemic heart disease (IHD) with refractory angina pectoris.

Methods: A single-arm, pre-post prospective cohort study was conducted on 65 patients with IHD and refractory angina pectoris who were treated at the Department of Cardiology, 108 Military Central Hospital, between March 2015 and March 2021. The participants were prospectively monitored over a 6-month follow-up period.

Results: Significant improvements were observed in angina symptoms, 6-minute walk test performance, Canadian Cardiovascular Society (CCS) angina classification, and New York Heart Association (NYHA) functional class. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels decreased from 942.75 pg/mL to 410.45 pg/mL. Echocardiographic parameters demonstrated enhanced cardiac function, with the left ventricular ejection fraction (LVEF) increasing from 43.89 ± 12.27% to 48.48 ± 10.57% (p < 0.05). The wall motion septal index (WMSI) decreased from 1.54 ± 0.18 to 1.24 ± 0.12, while global longitudinal strain (GLS) improved from -10.28 ± 2.82 to -12.74 ± 2.42. Myocardial perfusion imaging revealed marked reductions in summed stress score (SSS: 17.45 ± 8.61 vs 12.18 ± 7.89), summed rest score (SRS: 11.09 ± 7.74 vs 9.46 ± 7.23), and summed difference score (SDS: 4.37 ± 2.31 vs 2.57 ± 1.56; all p < 0.05). Severe perfusion defects decreased from 46.2% to 12.3% and extensive perfusion defect areas decreased from 60% to 26.2%. No adverse events, including arrhythmias or elevated cardiac enzyme levels, were reported.

Conclusion: Cardiac shock wave therapy is effective in patients with ischemic heart disease and refractory angina, as evidenced by improvements in clinical, functional, and imaging parameters, along with a favourable safety profile.

Background: Long-term venous access devices, including PICCs and implantable ports, increase the risk of catheter-related thrombosis (CRT) in cancer patients. The role of prophylactic rivaroxaban in this setting remains uncertain.

Methods: We retrospectively analyzed adult cancer patients who underwent peripherally inserted central catheter (PICC) or implantable port (PORT) placement between January 2019 and May 2023. CRT was diagnosed via B-ultrasound. To reduce surveillance bias, only patients who underwent ≥4 ultrasound examinations were included. Kaplan-Meier and Cox regression were used to assess the effect of rivaroxaban prophylaxis and to explore subgroup differences.

Results: Among 1,585 patients with upper-limb catheters, 822 met inclusion criteria, with 135 CRT events. The median time to CRT was 55 days (IQR: 29.5-121.5), and 66.2% occurred within 90 days post-catheterization. Prophylactic rivaroxaban significantly reduced CRT risk (HR = 0.47, 95% CI: 0.33-0.67; p < 0.001), particularly in high-risk groups such as those with PICC lines or active tumors. No significant benefit was observed in patients with no-evidence-of-disease (NED) or those with cardiac stents, atrial fibrillation, or prior cerebral infarction. In the PORT subgroup, risk reduction was not statistically significant overall (HR = 0.66, p = 0.07), but became significant after excluding NED and cardiovascular conditions (HR = 0.52, p = 0.0195).

Conclusion: Rivaroxaban prophylaxis reduces CRT in cancer patients with long term central venous catheters, particularly those with PICCs or active disease. Routine use appears unnecessary in NED or patients on antiplatelet therapy, highlighting the importance of individualized prophylaxis strategies.

Purpose: The Sarcopenia Index (SI), derived from the serum creatinine to cystatin C ratio, is a potential biomarker for cardiovascular disease (CVD). However, its prognostic significance for incident CVD in aging Chinese populations remains insufficiently characterized, despite established links between sarcopenia and CVD progression.

Patients and methods: This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 4979 participants aged > 45 years without prevalent CVD at baseline were included (mean age 58.0 years). Participants were categorized into Sarcopenia Index (SI) tertiles as follows: Q1 (SI ≤ 71.10), Q2 (71.10 < SI ≤ 84.75), and Q3 (SI > 84.75). Incident CVD events were assessed over a 9-year follow-up period. Multivariable Cox proportional hazards models, adjusted for demographic factors, comorbidities, and lipid profiles, were employed to evaluate associations. Restricted cubic spline (RCS) analysis was used to evaluate the dose-response relationship between SI and CVD risk.

Results: In the total population, the cumulative incidence of CVD was 23.5%. The lowest SI tertile (Q1) exhibited the highest cumulative CVD incidence (27.0%), compared to Q2 (23.2%) and Q3 (20.4%). After multivariable adjustment, individuals in Q1 showed a significantly increased risk of CVD compared to those in Q3 (HR: 1.249, 95% CI: 1.054, 1.478, P=0.010). RCS analysis confirmed a non-linear inverse association between SI and CVD risk (P for non-linearity = 0.003). Significant associations were particularly pronounced in males, current smokers, non-drinkers, urban residents, individuals with body mass index (BMI) ≥28 kg/m², and participants without hypertension or diabetes (all P < 0.05).

Conclusion: Reduced SI independently predicts elevated CVD risk in aging adults, underscoring its potential as an accessible, cost-effective screening biomarker. Integration of SI into routine clinical assessments may enhance early risk stratification and guide targeted preventive strategies, particularly for high-risk subgroups.

Introduction: A greater association of systemic arterial hypertension with worse prognosis in patients hospitalized with COVID-19 was described. Early in the pandemic, concerns were raised that the use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) could lead to unfavorable outcomes.

Objective: To evaluate whether there is an association between the use of the ACEi and ARB medications with unfavorable outcomes in hypertensive patients hospitalized with COVID-19.

Methods: This is a descriptive and retrospective study, collecting data through electronic medical records of patients with COVID-19 admitted to a University Hospital in 2020. Demographic data, use of ACEi or ARB medications, comorbidities, and outcomes, defined by the use of invasive ventilatory support (IVS), renal failure with progression to renal replacement therapy, and death were evaluated.

Results: 700 medical records were analyzed, 374 were of hypertensive individuals. The mean age of the patients was 66 ± 14 years, 51% were male, and 89% were white. There was a significantly higher prevalence of hospital discharge among patients who received ACEi/ARB compared to those who did not take these medications, (p-value = 0.027). There was no statistically significant difference in the use of ACEi/ARB for IVS (p-value = 0.062) and for renal replacement therapy (p-value = 0.587).

Conclusion: The use of ACEi/ARB drugs is not associated with worse outcomes in individuals with COVID-19. The present study demonstrated lower mortality rate associated with the use of these classes of drugs, similar to recent studies.

Purpose: No study has systematically evaluated the impact of education on improving venous thromboembolism (VTE) knowledge in surgical patients despite its significance. This study a assessed the baseline VTE knowledge among patients undergoing major surgery and their healthcare providers (HCPs), and evaluated the impact of educational materials on knowledge and acceptance of VTE prophylaxis.

Patients and methods: In this prospective, single-center, non-randomized controlled trial, VTE knowledge in surgical patients was measured using a validated questionnaire. Two sets of materials including questionnaire and educational videos were developed: Set A for patients and Set B for HCPs. The intervention was a 2‑minute educational video. VTE knowledge was initially assessed in the control group. Four weeks later, a separate group of patients (intervention group) and HCPs completed the questionnaire, before and immediately after the intervention. The primary outcome was post‑intervention knowledge difference between control and intervention patients. Secondary outcomes included pre‑/post‑intervention knowledge change in HCPs, VTE prophylaxis use, patient satisfaction, and VTE occurrence.

Results: 200 patients (100 in the control group and 100 in the intervention group) and 17 HCPs participated in the study. Patients had limited knowledge of VTE at baseline (29.4% and 29.6% in the respective groups), whereas HCPs had scores of 73.5%. After the intervention, the patients' knowledge significantly improved to 46.1%, while HCPs scores showed no notable increase. VTE prophylaxis compliance was 42.5% and was similar in both groups, with no VTE occurrence reported. Patient satisfaction with prophylaxis improved significantly in the intervention group from 67% to 93%.

Conclusion: Patients undergoing major surgery exhibited a low baseline knowledge of VTE, highlighting the need for targeted education. A brief, structured educational intervention effectively improved awareness and patient satisfaction, supporting the integration of targeted education into perioperative care.