Vascular Medicine最新文献

Background: Inflammation and immune dysregulation are thought to drive residual cardiovascular disease risk among persons living with human immunodeficiency virus (HIV) (PLWH) despite effective viral suppression with antiretroviral therapy (ART).

Methods: We investigated differences in carotid inflammation and atherosclerosis in a longitudinal cohort of virally suppressed PLWH (N = 50; on stable ART with CD4 > 250 cells/mm³, viral load < 200 copies/mL for > 6 months) and HIV-uninfected controls (N = 51) matched for age, sex, hypertension, diabetes, smoking, hyperlipidemia, and family history of premature coronary artery disease (CAD). Participants were ≥ 40 years old at enrollment. Measures of carotid vascular inflammation (K^trans), neovascularization (V_p), and wall thickness were assessed at baseline, 1 year, and change over 1 year by dynamic contrast-enhanced magnetic resonance imaging (MRI).

Results: Among 101 participants, 8% were women, 42% had hypertension, 52% had hyperlipidemia, 16% had diabetes, and 48% had a family history of CAD. Both PLWH and control participants demonstrated a reduction in systolic and diastolic blood pressures and total cholesterol over 1 year; however, the difference was not significant by HIV status. PLWH had a significant reduction in triglycerides compared with controls (-48.8 vs 12.8 mg/dL, p = 0.026). HIV was not associated with baseline, follow up, or change in markers of systemic inflammation assessed by plasma cytokines, nor vascular inflammation as assessed by K^trans, V_p, carotid wall thickness, or percent wall volume (a measure of plaque burden).

Conclusion: In contrast to other studies of treated and virally suppressed PLWH, HIV infection was not associated with carotid inflammation or plaque in our hypothesis-generating study.

Adherence to guideline-recommended therapies for peripheral artery disease (PAD), including pharmacotherapy (antiplatelet, lipid-lowering, and antihypertensive agents) and lifestyle modifications (smoking cessation, diet, weight management, and physical activity) remains low. Though single-component interventions targeting smoking cessation, exercise, or medication adherence show some efficacy, comprehensive multicomponent interventions are vital for addressing the complexity of PAD management. This review systematically synthesized multicomponent interventions for patients with PAD. A systematic search was conducted in Embase, MEDLINE, Cochrane Library, APA PsycINFO, CINAHL, Web of Science Core Collection, ProQuest, and Google Scholar to identify primary research describing multicomponent interventions supporting PAD treatment adherence, published between 2007 and 2024. A narrative synthesis was reported using the Template for Intervention Description and Replication (TIDieR) checklist and the behavioral change techniques (BCT) taxonomy. Out of 15 studies (2462 patients, 60.4% men) included in this review, only two addressed all guideline-recommended treatment aspects. Key intervention components included structured exercise (12/15) and education programs (10/15). Most interventions were delivered by multidisciplinary teams in hospital settings over 3 months. Only one study employed behavioral theory in its development, and most interventions (13/15) focused on the BCT 'instructions on how to perform a behavior' rather than diverse BCTs. No interventions significantly increased adherence to all PAD therapies. Few studies measured the intervention's impact on adherence, making it difficult to determine effective intervention characteristics. Most interventions lacked behavioral science approaches and were not designed to address specific adherence determinants. Future interventions should incorporate these elements to effectively address patients' needs. Open Science Framework Registry ID: osf.io/7xqzj.