Vascular Health and Risk Management最新文献

Background: Exploring an integrated care management model to effectively deliver the standardized management to atrial fibrillation (AF) elderlies in rural China.

Purpose: The objective of this study was to assess whether intensified multifaceted education (IME) targeting AF elderlies, their family members, and the village doctors (VD) can increase compliance for rural AF elderlies with integrated care based on the AF Better Care (ABC) pathway. Additionally, the capacity of VD to deliver integrated AF care was investigated.

Patients and methods: This is a self-controlled cohort study before and after IME, including AF patients aged ≥65 years identified in phase-I of The Jiangsu Province Rural Community AF Project. The IME model was defined as 12 months of continuous knowledge education on integrated care management of AF based on the ABC pathway, delivered to AF patients, their family members and the village doctors. AF knowledge evaluation from VD and compliance with the ABC pathway before and after the IME model were evaluated.

Results: A total of 810 AF patients (mean age 76.1 ± 5.9 years; 51.4% women) were enrolled. After 12 months, the AF knowledge score of VD was significantly improved [(65.0 ± 13.0) scores vs (53.1 ± 9.8) scores, P < 0.001]. Although the compliance of AF patients with the ABC pathway was improved statistically (4.3% vs 1.7%, P = 0.003), the absolute increase was small.

Conclusion: Although VD have the potential to serve as AF integrated care management providers, the impact of the IME model used to improve the standard AF care in rural elderly AF population was small.

Background: Cerebral air embolism infarction (CAEI) is a rare but life-threatening condition that can affect the venous or arterial blood supply to the brain. Its aetiology is mostly iatrogenic, often resulting from complications of cardiothoracic or neurosurgical procedures, as well as manipulations with peripheral or central catheters. If undiagnosed and untreated, cerebral air embolism infarction can lead to long-term neurological consequences or even death. Diagnosis relies on clinical presentation and neuroimaging findings from CT and MRI, which are time-sensitive and not well described in the current literature.

Case presentation: We present a rare case of cerebral infarction as a complication of retrograde cerebral venous air embolism following haemodialysis catheter removal in a young patient, with management leading to a favourable outcome. The diagnosis was confirmed based on clinical manifestations and neuroimaging findings, with air emboli identified in the subarachnoid space on the CT scan, followed by characteristic MRI changes defined for cerebral air embolism infarcts. Timely diagnosis allowed for the rapid initiation of hyperbaric oxygen therapy and the rehabilitation process, resulting in positive outcomes.

Conclusion: Timely neuroimaging-particularly CT within the first 2 hours-is critical for diagnosing CAEI. MRI findings, including cytotoxic and vasogenic oedema in a distal vascular distribution and leptomeningeal enhancement, further support diagnosis. Early identification and treatment initiation are essential for improving patient outcomes.

Introduction: The cardio-ankle vascular index (CAVI) is an important metric for evaluating arterial stiffness (AS). In this study, we used cardio-ankle vascular index (CAVI) to predict CAD severity of coronary artery lesions.

Methods: This case-control study was conducted between October 2019 and December 2022. There were 222 patients divided into two groups: those with chronic coronary artery disease (CAD group), with 160 patients and a control group (non-CAD group) with 62 patients. The CAVI measurement and severity of coronary artery lesion parameters were evaluated (severity of stenosis, number of coronary artery diseases, syntax scores, and Gensini scores).

Results: The CAVI in the CAD group (9.21 ± 0.79) was significantly higher than that in the non-CAD group (8.48 ± 0.62) (p < 0.001). CAVI, with a cut-off point ≥8.83, was a significant predictor of chronic CAD (OR = 9.6; 95% CI: 4.0-18.8) with an area under the curve (AUC) of 0.796 (95% CI: 0.736-0.856; p < 0.001). CAVI was significantly higher in severe stenosis (≥75%) compared to moderate stenosis (9.41 ± 0.81 vs 9.02 ± 0.75, p = 0.002). CAVI was higher in multivessel disease compared to single-vessel disease (9.43 ± 0.80 vs 8.90 ± 0.70, p < 0.001). CAVI increased with higher SYNTAX scores (mild, moderate, and severe: 9.09 ± 0.65, 9.80 ± 1.05, and 9.45 ± 0.46, respectively; p < 0.001) and Gensini scores (mild, moderate, and severe: 8.90 ± 0.65, 9.37 ± 0.95, and 9.43 ± 0.59, respectively; p < 0.001).

Conclusion: CAVI is higher in chronic CAD and can predict chronic CAD with a cut-off point of ≥8.83. The CAVI is higher in patients with severe stenosis, multivessel coronary artery disease, higher syntax scores, and higher Gensini scores.

Patients with inflammatory joint diseases, including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, have an elevated risk of cardiovascular complications due to systemic inflammation, immune-mediated endothelial dysfunction, and associated metabolic changes. Disease-modifying antirheumatic drugs (DMARDs) influence cardiovascular risk through their effects on inflammation, lipid metabolism, and endothelial function. Methotrexate has demonstrated cardioprotective properties, likely mediated through anti-inflammatory mechanisms rather than direct metabolic effects. However, other conventional DMARDs, such as sulfasalazine and hydroxychloroquine, also continue to play a role in routine practice; their cardiovascular effects appear more heterogeneous and less well established. Biologic DMARDs, particularly tumor necrosis factor (TNF) inhibitors, are associated with a reduction in major cardiovascular events despite inducing lipid profile alterations. However, data on newer biologic agents, such as interleukin (IL)-17 and IL-23 inhibitors, remain limited. Janus kinase (JAK) inhibitors present concerns regarding dyslipidemia and thrombotic risk, necessitating individualized cardiovascular risk assessment. Nonsteroidal anti-inflammatory drugs (NSAIDs) remain controversial due to their potential to exacerbate cardiovascular risk, particularly with long-term use. Given the variability in drug effects, treatment strategies must balance effective disease control with cardiovascular safety. This narrative review summarizes current evidence on the impact of both conventional and biologic DMARDs on cardiovascular risk, drawing from randomized clinical trials and real-world observational data. The review also compares available data across different inflammatory joint diseases and highlights areas of uncertainty that remain in clinical decision-making. A multidisciplinary and individualized approach remains essential for optimizing long-term cardiovascular outcomes in these patients.

Purpose: Blood pressure (BP) response observed during exercise stress tests has been recognized as a predictor of the onset of hypertension and arterial stiffness. However, access to such testing is often limited to specialized clinical settings. The purpose of this study was to assess the utility of a simple, equipment-free exercise, self-paced spot marching exercise (SME), along with the subsequent recovery BP in evaluating vascular functions.

Patients and methods: A cross-sectional study was conducted with 107 participants aged 40-59 years, including those with and without hypertension. During the 6-min recovery period following SME, systolic BP (SBP) and diastolic BP (DBP) were measured every 2 min. Flow-mediated dilation (FMD) and cardio-ankle vascular index (CAVI) were used to evaluate endothelial function and arterial stiffness. Pearson's correlation and multiple linear regression analyses were performed to assess the associations between recovery BP and vascular parameters.

Results: Among total participants, 4-min recovery SBP was independently associated with FMD, whereas resting BP showed no such association. CAVI was not correlated with any recovery BP. In non-hypertensive individuals, 4-min recovery SBP remained independently associated with FMD, whereas age and resting SBP were linked to CAVI.

Conclusion: These findings suggest that recovery SBP following SME reflects early endothelial dysfunction and vascular impairment. Therefore, using recovery SBP after the SME demonstrates the potential to be a tool for the early detection of vascular risk in middle-aged adults.

Background: Abdominal aortic calcification (AAC) is a reliable predictor of cardiovascular events. Sleep is an essential component of cardiovascular health. This study aimed to assess the association between sleep patterns (including sleep duration, trouble sleeping, and sleep disorders) and the risk of AAC.

Methods: A total of 2801 participants from the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES) 2013-2014 cycle were included in the study. AAC score was assessed using the Kauppila scoring system. Sleep patterns were defined according to the overall sleep score, which was calculated based on the sleep duration, self-reported trouble sleeping, and sleep disorders. Weighted multivariable linear regression models were used to analyze the association between sleep patterns and AAC.

Results: AAC prevalence was higher in older age groups, smokers, those with hypertension or diabetes, and those with less physical activity, lower eGFR, or higher levels of total 25-hydroxyvitamin D, serum uric acid, and serum calcium. Compared with the healthy sleep pattern group, participants in the poor sleep pattern group had a higher prevalence of AAC (odds ratio [OR] = 1.664, 95% CI: 1.286-2.152) and a higher prevalence of severe AAC (OR = 2.179, 95% CI: 1.539-3.087). After adjusting for potential confounders, the poor sleep pattern group remained significantly associated with a higher risk of AAC (OR = 1.657, 95% CI: 1.235-2.222) and severe AAC (OR = 2.374, 95% CI: 1.616-3.488).

Conclusion: Sleep patterns were related to the risk of AAC in middle-aged and elderly populations. Poor sleep patterns may increase AAC prevalence.

Patients and methods: The study retrospectively collected 8086 clinical data from 2019 to 2021. Latent Class Trajectory Modeling (LCTM) was utilized to identify the longitudinal trajectories of the triglyceride-glucose index, and logistic regression was employed to analyze the relationship between different triglyceride-glucose trajectories and the incidence and recurrence of cardiovascular diseases.

Results: During the study period, 1484 patients in the cohort experienced cardiovascular events. Using LCTM, three distinct triglyceride-glucose index trajectories were identified. In the overall cohort of recurrent patients, as well as among those with higher triglyceride-glucose levels (triglyceride-glucose > 8.309) within it, a high-gradual-increase trajectory was found to be significantly associated with cardiovascular disease risk compared to a low-stable trajectory. Similar observations were seen in incidence patients with higher triglyceride-glucose levels (OR 1.179; 95% CI 1.017-1.368), which adjusted the demographic characteristics and the test indicators.

Conclusion: A high baseline level of triglyceride-glucose index with a high-gradual-increasing trajectory was significantly associated with incidence and recurrence of cardiovascular disease. Early identification of such populations can aid in the prevention of both incidence and recurrent cardiovascular diseases in the future.

Purpose: The triglyceride-glucose index is related to the cerebrovascular diseases. This study aimed to investigate the relationship between different triglyceride-glucose index trajectories and incidence and recurrence of cardiovascular disease.

Background: Large and giant intracranial aneurysms, exceeding 10 mm and 25 mm in diameter, respectively, are rare in neurosurgery. These lesions carry substantial morbidity and mortality risks, often causing mass effects, intracranial hemorrhage, stroke, or seizures.

Methods: We present our experience with 54 patients diagnosed with these aneurysms. We conducted neurological assessments and preoperative evaluations using the modified Rankin Scale. Individualized treatment strategies, employing surgical techniques or endovascular embolization, were tailored to each patient.

Results: The cohort included 28 females and 26 males, averaging 46.9 years. Aneurysms were predominantly in the anterior circulation (80.6%), with initial symptoms including mass effect (78.7%), cerebral ischemia (8.3%), intracranial hemorrhage (3%), and seizures (2.8%). Surgical interventions, including direct clipping, aneurysmal wall resection, aneurysmorrhaphy with clipping, and cross-clamping (average duration: 20 minutes), were performed in 32 cases (59.2%). Endovascular coiling was utilized in 22 patients (40.8%), with 10 requiring flow diverter stents. Of the cases, 32 were giant aneurysms, and 22 were large aneurysms. Outcomes ranged from favourable to excellent in 70.4% of patients, while 18.5% experienced poor outcomes, primarily in posterior circulation aneurysms or due to poor preoperative conditions. The overall mortality rate was 11.1%, with eight fatalities.

Conclusion: Management of giant intracranial aneurysms remains challenging, with higher morbidity and mortality rates compared to other neurosurgical conditions. No universally effective technique exists, emphasizing the importance of meticulous perioperative planning and surgical expertise. Further research and treatment advancements are needed to enhance the management of these complex aneurysms.

Hypertension affects one-third of the worldwide adult population and is a major contributor to premature mortality in Thailand. However, hypertension is mainly preventable, highlighting the need for effective prevention strategies to mitigate this critical health concern. This scoping review aimed to identify existing knowledge gaps and provide a comprehensive understanding of hypertension prevention interventions. Keywords were identified, and an unrestricted search for empirical studies was conducted until December 20, 2024. The search strategy encompassed 11 databases. Ultimately, studies focusing on preventive interventions targeting the Thai population at risk of hypertension were included in this review. Finally, we included 41 studies: 35 in community settings, two in hospital clinics, and four in Buddhist temples. The total number of participants was 16,401, ranging from 32 to 4,786, aged between 18 and 74. Research designs comprised 32 quasi-experimental studies, seven randomized controlled trials, one action research, and one research and development. Researchers primarily delivered interventions. The interventions focused on hypertension monitoring, knowledge promotion, health behavior modification, social support, and counseling, emphasizing preventive behaviors, nutrition promotion, and disease awareness. Researchers commonly took outcome measurements before and 12 weeks after intervention. Manuals, logbooks, and lectures with presentation slides were the primary platforms. Finally, knowledge, behaviors, and biomarkers were the most frequently assessed outcomes. This scoping review provided recommendations that future research should expand intervention strategies, emphasize biomarkers, adopt modern delivery methods like AI chatbots and mobile apps, and include follow-ups beyond 12 weeks to ensure lasting impact.

Background: Intravascular Ultrasound (IVUS) has been shown in smaller studies to improve outcomes when used to guide infrainguinal peripheral arterial interventions. The iDissection series of studies were conducted to determine the presence of dissections with various prepping devices in femoropopliteal and infrapopliteal arteries. The impact of IVUS-directed treatment on the long-term outcomes in these patients remains unclear.

Methods: All patients were enrolled at a single center with the exception of the Auryon BTK study (at 4 US centers). Seven prospective iDissection studies had been previously conducted with IVUS and the data was core lab adjudicated. We retrospectively analyzed major adverse limb events, freedom from target lesion revascularization (freedom from TLR) and patency at 1 year in these patients using medical records. The study was approved by a central ethics committee. Proportional and Kaplan-Meier survival analysis were performed. Logistic regression analysis to determine independent predictors of patency was performed.

Results: A total of 102 patients (n=135 encounters) were included. The median age was 72 years. 49.0% were diabetics and 50.0% had chronic limb-threatening ischemia (CLTI). 69.6% of lesions are de novo, 32.6% chronic total occlusion, 60.7% with moderate or severe calcium, and 72.6% femoropopliteal. Stent use was 38.5% (of which 53.8% drug eluting and 73.1% primary stenting), and drug-coated balloons 55.6%. Vessel prepping included atherectomy (66.7%), angioplasty (14.8%) and Flex VP (18.5%). Proportional Freedom from TLR at 1 year was 89.4%, and patency 89.4%. There was one major amputation. Mortality was 7.8% (95% CI; 3.49, 14.87). Logistic regression analysis showed that post balloon stenosis (odds ratio (OR) 1.07, p=0.015), tobacco use (OR 0.20, p=-0.007), presence of CTO (OR 3.59, p=0.019), and male sex (OR 3.85, p=0.035) were predictors of patency loss.

Conclusion: Infrainguinal arteries treated with IVUS guidance appears to have good patency and freedom from TLR. The presence of adventitial dissections does not appear to be predictive of patency likely confounded with the high use of drug-coated balloons and drug-eluting stents.