Vascular Medicine最新文献

Background: The association between ectopic fat and vascular stiffness is poorly studied and has never been systematically reviewed. We conducted a systematic review and meta-analysis aimed to systematize current literature and investigate the association of perivascular adipose tissue (PVAT) and the indices of vascular wall remodeling and arterial stiffness, such as pulse wave velocity (PWV), augmentation index (AI), cardio-ankle vascular index (CAVI), endothelium-dependent vasodilation (EDV), and intima-media thickness (IMT).

Methods: A systematic literature review was performed according to PRISMA guidelines via searching PubMed, Scopus, and Web of Science databases using specific keywords. Data were extracted from eight studies with 1244 participants that fit the criteria and analyzed using a random-effects model.

Results: Our pooled analysis revealed stronger correlations between carotid-femoral pulse wave velocity (cfPWV), AI, and the density of thoracic periaortic adipose tissue (r = 0.56, p < 0.05, n = 14); carotid extra-media thickness (EMT) and average daily PWV in the aorta (r = 0.56, p < 0.05, n = 84); and thoracic periaortic fat volume and CAVI (r = 0.49, p < 0.05, n = 318).

Conclusion: Our results demonstrate the association between PVAT and vascular wall remodeling, emphasizing the need for early detection of dysfunctional PVAT as the contributor to higher cardiovascular risk, not only in patients with risk factors and cardiovascular diseases, but also in healthy individuals. (PROSPERO Registration No.: CRD42023443139).

Background: In patients with chronic limb-threatening ischemia (CLTI), a subset of patients are beneficiaries of welfare assistance. We sought to investigate the clinical features and prognosis of patients with CLTI receiving welfare compared to those not receiving welfare in the Japanese population.

Methods: This is a subanalysis of the multicenter, prospective Wound-directed Angiosome RevasculaRIzation apprOach to patients with cRitical limb iSchemia (WARRIORS) registry. We evaluated 440 patients with CLTI accompanied by tissue loss undergoing infrapopliteal revascularization. The outcome measures included a 24-month wound-healing rate, and overall survival and follow-up continuity. We compared the outcomes between the welfare and nonwelfare groups (n = 48 and 392, respectively) using the Kaplan-Meier method and log-rank tests.

Results: Frequencies of nonambulatory status, diabetes mellitus, hemodialysis, and wound severity stratified by Wound, Ischemia, and foot Infection classification showed no significant inter-group differences. The number of patients treated with bypass surgery was lower in the welfare group than in the nonwelfare group. The 24-month wound healing and follow-up continuity rates were significantly lower in the welfare group compared to the nonwelfare group (37.3% vs 59.6%, p = 0.005 and 47.9% vs 58.0%, p = 0.048, respectively). In contrast, the 24-month overall survival rate did not differ significantly between the groups (63.1% vs 71.7%, p = 0.27).

Conclusions: Patients receiving welfare had significantly worse wound-healing rates and a higher loss to follow up even within the framework of the Japanese universal health insurance system.

Rare vascular diseases are a diverse group of life-threatening conditions defined by their low prevalence but profound impact on patient morbidity and quality of life. Diagnosing these disorders remains a significant clinical challenge due to their genetic heterogeneity, overlapping phenotypes, and limited patient populations. As such, the development of robust and human-relevant disease models is critical for elucidating pathogenic mechanisms and guiding therapeutic discovery. The advent of human induced pluripotent stem cell (iPSC) technology has opened new avenues for modeling rare vascular diseases by enabling the generation of patient-specific vascular cell types, including endothelial cells, smooth muscle cells, and fibroblasts, and the creation of both two-dimensional cultures and three-dimensional vascular organoids. Together with genome editing and next-generation multiomics, these platforms represent new approach methodologies (NAMs) that allow for detailed investigation of disease biology, facilitate the correction of pathogenic mutations, and enable high-throughput drug screening in a personalized context. In this review, we highlight the advancements in iPSC-derived vascular modeling, discuss the integration of gene editing and multiomics technologies, and explore their transformative potential for uncovering mechanisms and developing precision therapies for rare vascular diseases.

Introduction: Vascular contributions to cognitive impairment and dementia are potentially modifiable. Early detection of reversible arterial injury may improve risk stratification and provide treatment monitoring. We hypothesized that carotid ultrasound grayscale median (GSM), a novel imaging biomarker of early arterial injury, would predict incident all-cause dementia in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods: The MESA enrolled adults free of atherosclerotic cardiovascular disease. Common carotid GSM was measured at baseline. Incident all-cause dementia events were identified by hospital and death records. Cox proportional hazards models with natural cubic splines investigated the association of baseline GSM and all-cause dementia.

Results: The 1788 participants were a mean (SD) 63.1 (10.3) years old and 53% were women. Over a median 13.7 years, 157 all-cause dementia events occurred. In fully adjusted models, with additional adjustment for carotid intima-media thickness, lower (worse) GSM independently predicted incident all-cause dementia (hazard ratio, 1st to 3rd tertile, 1.45 [95% CI, 1.11-1.90], p = 0.021).

Conclusions: Lower GSM independently predicts all-cause dementia, beyond traditional arterial injury measures, suggesting it may serve as an early marker of dementia risk.