International Journal of Cardiology Cardiovascular Risk and Prevention最新文献

Interplay between lifestyle factors and polygenic risk for incident coronary heart disease in a large multiethnic cohort 在一个大型多种族队列中，生活方式因素与冠心病发病多基因风险之间的相互作用

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2024-11-06 DOI: 10.1016/j.ijcrp.2024.200350

Carlos Iribarren , Meng Lu , Martha Gulati , Nathan D. Wong , Roberto Elosua , Jamal S. Rana

Introduction

The objective of this study was to examine the interplay of polygenic risk and individual lifestyle factors (and a composite score of lifestyle) as antecedents of CHD in a large multiethnic cohort.

Methods

We used Genetic Epidemiology Resource in Adult Health and Aging (GERA) cohort participants free of CHD at baseline (n = 60,568; 67 % female; 18 % non-European). The individual and joint associations of smoking, Mediterranean diet pattern, level of physical activity and polygenic risk with incident CHD were assessed using Cox regression adjusting for genetic ancestry and non-mediating risk factors. Hazard ratios (HRs) and number needed to treat (NNT) were estimated according to these lifestyle factors and polygenic risk categories. Strengths included large sample size, long-follow-up, ethnic diversity, a clinically-validated polygenic risk score (PRS), and rich phenotype information.

Results

After 14 years of follow-up, there were 3159 incident CHD events. We observed no statistically significant interactions between individual lifestyle factors and polygenic risk (all p > 0.23). For individuals with a high genetic risk, moving from the worse lifestyle combination (no favorable lifestyle factors) to the best lifestyle combination (all three) is associated with 52 % lower rate of CHD. The NNT was highest in the low polygenic risk group (34), lowest in the high polygenic risk group [19] and in-between (Jin et al., 2011) [24] in the intermediate polygenic risk group.

Conclusions

Lifestyle and polygenic risk together influence the risk of incident CHD. Our results support consideration of polygenic risk in lifestyle interventions because those with high polygenic risk are likely to derive the most benefit.

导言：本研究的目的是在一个大型多种族队列中研究多基因风险和个体生活方式因素（以及生活方式的综合评分）作为冠心病前兆的相互作用。方法我们使用了成人健康和老龄化遗传流行病学资源（GERA）队列中基线无冠心病的参与者（n = 60,568; 67 % 女性; 18 % 非欧洲人）。在对遗传血统和非中介风险因素进行调整后，采用 Cox 回归评估了吸烟、地中海饮食模式、体育锻炼水平和多基因风险与冠心病发病的个体和联合关系。根据这些生活方式因素和多基因风险类别估算了危险比（HRs）和治疗所需人数（NNT）。该研究的优势包括样本量大、随访时间长、种族多样化、多基因风险评分（PRS）经临床验证以及丰富的表型信息。我们观察到个人生活方式因素与多基因风险之间没有统计学意义上的交互作用（所有 p 均为 0.23）。对于遗传风险较高的人来说，从较差的生活方式组合（无有利的生活方式因素）到最佳的生活方式组合（所有三种因素）可降低 52% 的冠心病发病率。低多基因风险组的 NNT 最高（34），高多基因风险组最低[19]，中间多基因风险组介于两者之间（Jin 等人，2011 年）[24]。我们的研究结果支持在生活方式干预中考虑多基因风险，因为多基因风险高的人群可能获益最多。

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引用次数: 0

Comorbidities and determinants of health on heart failure guideline-directed medical therapy adherence: All of us 合并症和健康决定因素对心力衰竭指南指导下的药物治疗依从性的影响：我们所有人

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2024-11-02 DOI: 10.1016/j.ijcrp.2024.200351

Trinh Do , Kyrillos Grace , Dawn Lombardo , Nathan D. Wong , Andy Y. Lee

Background

Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) are challenging conditions to treat due to complex pathophysiology and associated comorbidities. However, recent trials have demonstrated improved outcomes with guideline-directed medical therapy (GDMT) for each subtype of heart failure.

Objective

We investigated the relationship of determinants of health and risk factors with GDMT use for HFrEF and HFpEF in a large, diverse US cohort.

Methods

Using the NIH-sponsored All of Us Program, we compared demographics, risk factors (e.g., hypertension, diabetes, smoking), and SDOH measures between HFrEF and HFpEF in US adults aged 18 years and older. We examined the proportions of HFrEF patients receiving fewer than four or all four GDMTs. HFpEF patients receiving two medications were compared with those receiving less than two recommended medications. Multiple logistic regression was used for data analysis.

Result

Of 6049 HFrEF patients, 5838 (97 %) received fewer than four GDMTs, and 210 (3 %) received quadruple therapy. Of 3774 HFpEF patients, 162 (4 %) were on 2/3 GDMT, and only 38 (1 %) were on all three recommended medications. Patients with ASCVD and diabetes had higher odds of being on more than half of the recommended GDMT for both HFrEF and HFpEF. Additionally, females had higher odds of being on 2/3 GDMT for HFpEF (1.46 [1.08, 2.00]). Race, income, education, and health insurance types did not predict GDMT optimization.

Conclusion

HFrEF and HFpEF GDMT remain underutilized. Future efforts to address comorbidities and system-wide healthcare interventions may improve heart failure GDMT.

背景射血分数减低型心力衰竭（HFrEF）和射血分数保留型心力衰竭（HFpEF）由于病理生理学复杂且伴有合并症，因此治疗难度很大。我们在一个大型的、多样化的美国队列中调查了健康决定因素和风险因素与使用 GDMT 治疗 HFrEF 和 HFpEF 之间的关系。我们研究了接受少于四种或全部四种 GDMTs 治疗的 HFrEF 患者的比例。接受两种药物治疗的 HFpEF 患者与接受少于两种推荐药物治疗的患者进行了比较。结果在 6049 名 HFrEF 患者中，5838 人（97%）接受了少于四种 GDMT，210 人（3%）接受了四联疗法。在 3774 名高频低氧血症患者中，162 人（4%）接受了 2/3 种 GDMT 治疗，只有 38 人（1%）接受了所有三种推荐药物治疗。对于 HFrEF 和 HFpEF 患者而言，患有 ASCVD 和糖尿病的患者接受一半以上推荐 GDMT 治疗的几率更高。此外，女性服用 2/3 GDMT 治疗 HFpEF 的几率更高（1.46 [1.08, 2.00]）。种族、收入、教育程度和医疗保险类型并不能预测 GDMT 的优化情况。未来解决合并症和全系统医疗干预的努力可能会改善心衰 GDMT。

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引用次数: 0

Case detection of familial hypercholesterolemia using various criteria during an annual health examination in the workplace 在工作场所的年度健康检查中使用各种标准发现家族性高胆固醇血症病例

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2024-11-01 DOI: 10.1016/j.ijcrp.2024.200349

Poranee Ganokroj , Suwanna Muanpetch , Nitt Hanprathet , Wiroj Jiamjarasrangsi , Weerapan Khovidhunkit

Background

Early diagnosis and appropriate treatment of subjects with familial hypercholesterolemia (FH) could prevent cardiovascular disease (CAD).

Objective

We aimed to identify potential cases of FH during a workplace screening and to explore their clinical data.

Method

Personnel who attended an annual health examination were invited to answer a questionnaire and to provide consent to review their laboratory results. FH was clinically diagnosed using any one of the three standard criteria: Dutch Lipid Clinic Network (DLCN), Simon Broome (SB), and Make Early Diagnosis to Prevent Early Deaths (MEDPED). Clinical characteristics were compared between FH and unlikely FH subjects.

Results

Among 6607 participants, potential cases of FH were identified in 2.5 % by DLCN, 4.0 % by SB, and 0.8 % by MEDPED alone. Premature CAD, hypertension, and current smoking were significantly more common in potential FH subjects than in unlikely FH subjects. Potential FH subjects also had significantly higher body mass index, waist circumference, blood pressure, fasting plasma glucose and triglyceride levels than unlikely FH subjects. Among potential FH subjects, lipid-lowering medication was used in 28.4 %. The achievement of the LDL-C goal (<100 mg/dL) in potential FH subjects was significantly lower than that in unlikely FH subjects (15 % vs. 28 %, respectively, P = 0.005) despite a higher rate of high-intensity statin use (25 % vs. 10 %, respectively, P = 0.002).

Conclusion

The workplace screening of FH detected a significant number of potential FH subjects with higher cardiovascular risk. This strategy identified individuals for whom intensification of both lifestyle modifications and pharmacological treatment should be a priority.

背景家族性高胆固醇血症（FH）患者的早期诊断和适当治疗可预防心血管疾病（CAD）。FH的临床诊断采用三种标准中的任意一种：荷兰血脂诊所网络（DLCN）、西蒙-布鲁姆（SB）和早期诊断预防早期死亡（MEDPED）。结果在 6607 名参与者中，2.5% 通过 DLCN、4.0% 通过 SB、0.8% 仅通过 MEDPED 发现了潜在的 FH 病例。潜在先天性心脏病患者中早发冠状动脉粥样硬化、高血压和目前吸烟的比例明显高于不可能先天性心脏病患者。潜在 FH 受试者的体重指数、腰围、血压、空腹血浆葡萄糖和甘油三酯水平也明显高于不可能患有 FH 的受试者。在潜在的 FH 受试者中，28.4% 的人使用了降脂药物。尽管高强度他汀类药物的使用率更高（分别为 25% 对 10%，P = 0.002），但潜在 FH 受试者低密度脂蛋白胆固醇目标（100 mg/dL）的实现率明显低于不可能 FH 受试者（分别为 15% 对 28%，P = 0.005）。这一策略发现了应优先加强生活方式调整和药物治疗的人群。

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引用次数: 0

Does the timing of blood pressure medication really matter? 服用降压药的时间真的重要吗？

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2024-10-30 DOI: 10.1016/j.ijcrp.2024.200348

Yuan-Yuan Kang, Ji-Guang Wang

引用次数: 0

Predictive value of glucose coefficient of variation for in-hospital mortality in acute myocardial infarction patients undergoing PCI: Insights from the MIMIC-IV database 接受 PCI 治疗的急性心肌梗死患者血糖变异系数对院内死亡率的预测价值：MIMIC-IV 数据库的启示

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2024-10-26 DOI: 10.1016/j.ijcrp.2024.200347

Zixuan Zhang , Mengmeng Ji , Qingqing Zhao , Luying Jiang , Shilang Fan , Houjuan Zuo

Background

Acute myocardial infarction (AMI) carries a high short-term risk of death, even after percutaneous coronary intervention (PCI). Glucose variability (GV), measured by the glucose coefficient of variation (GluCV), is a potential risk factor for adverse outcomes. This study investigates GluCV's predictive value for in-hospital mortality in AMI patients undergoing PCI.

Method

This study involved 2325 AMI patients who were admitted to the ICU and underwent PCI from the MIMIC-IV database. Patients were categorized into quartiles based on GluCV: <0.13, 0.13–0.20, 0.20–0.29, and ≥0.29. Multivariable logistic regression and Restricted cubic spline (RCS) analysis were employed to analyze the relationship between GluCV and in-hospital mortality. Mediation analysis was used to evaluate the role of GluCV in the relationship between disease complexity and severity.

Results

Among the 2325 patients, 203 (8.7 %) died during hospitalization. Higher GluCV was associated with increased in-hospital mortality. Adjusted odds ratios for mortality were 1.35 (95 % CI: 0.71–2.55), 1.91 (95 % CI: 1.04–3.51), and 3.32 (95 % CI: 1.83–6.02) for the second, third, and fourth groups, respectively. RCS analysis indicated a linear relationship between Log GluCV and mortality risk, with each 1 SD increase in Log GluCV associated with a 1.70-fold increase in mortality. Subgroup analysis showed a stronger relationship between GluCV and mortality in patients younger than 70. Mediation analysis indicated that GluCV partially mediates the effect of comorbidities on organ dysfunction.

Conclusions

GluCV is an important predictor of in-hospital mortality in AMI patients undergoing PCI. Managing GV to minimize fluctuations may improve patient prognosis.

背景急性心肌梗死（AMI）具有很高的短期死亡风险，即使在经皮冠状动脉介入治疗（PCI）后也是如此。用葡萄糖变异系数（GluCV）测量的葡萄糖变异性（GV）是导致不良后果的潜在风险因素。本研究调查了 GluCV 对接受 PCI 的 AMI 患者院内死亡率的预测价值。方法本研究涉及 MIMIC-IV 数据库中 2325 名入住 ICU 并接受 PCI 的 AMI 患者。根据 GluCV 将患者分为四等分：<0.13、0.13-0.20、0.20-0.29 和≥0.29。采用多变量逻辑回归和受限立方样条曲线（RCS）分析来分析 GluCV 与院内死亡率之间的关系。结果 2325 名患者中有 203 人（8.7%）在住院期间死亡。GluCV 越高，院内死亡率越高。第二、第三和第四组的调整后死亡率几率分别为 1.35 (95 % CI: 0.71-2.55)、1.91 (95 % CI: 1.04-3.51) 和 3.32 (95 % CI: 1.83-6.02)。RCS 分析表明，Log GluCV 与死亡风险呈线性关系，Log GluCV 每增加 1 SD，死亡率就增加 1.70 倍。亚组分析显示，70 岁以下患者的 GluCV 与死亡率之间的关系更密切。中介分析表明，GluCV 可部分调节合并症对器官功能障碍的影响。管理 GV 以减少波动可改善患者的预后。

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引用次数: 0

Impact of lifestyle risk factors on atrial fibrillation: Mechanisms and prevention approaches – A narrative review 生活方式风险因素对心房颤动的影响：机制和预防方法--叙述性综述

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2024-10-24 DOI: 10.1016/j.ijcrp.2024.200344

Jasper R. Vermeer , Johannes L.P.M. van den Broek , Lukas R.C. Dekker

Both the development and progression of atrial fibrillation (AF) are affected by a range of modifiable lifestyle risk factors. These key modifiable risk factors encompass obesity, hypertension, hypercholesterolemia, diabetes mellitus, smoking, chronic obstructive pulmonary disease, alcohol consumption, exercise, sedentary lifestyle and obstructive sleep apnoea. These lifestyle-dependent factors rarely exist in isolation, but rather exist together, exerting a complex influence on the development of AF. This comprehensive review elucidates the interplay and interdependency of these lifestyle factors in the arrhythmogenesis of AF, by exploring their role in AF substrate formation, modulating properties and triggering mechanisms. We emphasize the importance of targeted prevention strategies by discussing available literature on the effectiveness of treatment strategies targeting multiple risk factors. Additionally, the clinical impacts of integrated care, nurse-led care and mobile health are discussed in the context of lifestyle improvement. These management strategies have favourable applicability in both paroxysmal and persistent AF, and are also beneficial for patients receiving AF ablation. Despite the challenges accompanying lifestyle and prevention strategies, substantial benefits are apparent, such as improved quality of life and better ablation outcomes. This review further emphasizes the essential nature of awareness of appropriate lifestyle modifications as fundamental pillars in the management of individuals with AF.

心房颤动（房颤）的发生和发展都受到一系列可改变的生活方式风险因素的影响。这些主要的可改变风险因素包括肥胖、高血压、高胆固醇血症、糖尿病、吸烟、慢性阻塞性肺病、饮酒、运动、久坐不动的生活方式和阻塞性睡眠呼吸暂停。这些依赖于生活方式的因素很少单独存在，而是共同存在，对房颤的发展产生复杂的影响。本综述通过探讨这些生活方式因素在房颤基质形成、调节特性和触发机制中的作用，阐明了它们在房颤心律失常发生过程中的相互作用和相互依存关系。通过讨论针对多种风险因素的治疗策略的有效性，我们强调了有针对性的预防策略的重要性。此外，我们还从改善生活方式的角度讨论了综合护理、护士主导的护理和移动医疗的临床影响。这些管理策略适用于阵发性和持续性房颤，对接受房颤消融术的患者也有好处。尽管生活方式和预防策略面临诸多挑战，但仍有明显的实质性益处，如改善生活质量和提高消融效果。这篇综述进一步强调了适当调整生活方式的重要性，它是心房颤动患者管理的基本支柱。

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引用次数: 0

Treatment optimisation for blood pressure with single-pill combinations in India (TOPSPIN) – Protocol design and baseline characteristics 印度单药组合血压优化治疗（TOPSPIN）--方案设计和基线特征

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2024-10-24 DOI: 10.1016/j.ijcrp.2024.200346

Gaia Kiru , Ambuj Roy , Dimple Kondal , Ambalam M. Chandrasekaran , Somnath Mukherjee , Bishav Mohan , Kavita Singh , Hyndavi Salwa , Edmin Christa , Ameeka Shereen Lobo , Gayatri Mahajan , Aman Khanna , Amit Malviya , Satish G. Patil , Vinod K. Abichandani , Bhupinder Singh , Bal Kishan Gupta , Balsubramaiam Yellapantula , Dandge Shailendra , Shantanu Sengupta , Neil Poulter

Background

The burden of over 300 million individuals living with hypertension in India is increasing steadily. Most current guidelines recommend initial combination therapy for effective blood pressure (BP) control. However, there is no randomised evidence to inform which combinations to use in the South Asian population, who account for over one-quarter of the world's population.

Methods

This multi-centre, single-blind, randomised, three-arm trial recruited men and women aged 30–79 years with hypertension. The trial compares the efficacy of commonly recommended single pill combinations (SPCs) of three drug classes – calcium channel blocker (amlodipine), ACE inhibitor (perindopril), and a thiazide-like diuretic (indapamide). The primary objective is to determine the most effective two-drug combination, initially at starting doses with forced up-titration at 2 months, in reducing 24-h ambulatory systolic blood pressure (ASBP) at 6 months. The trial has 85 % power to detect a difference of 3 mmHg in 24-h ASBP amongst the groups.

Participant recruitment took place from August 2022 to February 2024.

Baseline results

The 1981 participants (42.0 % women) enrolled had a mean age of 52.1 (SD 11.3) years and a mean body mass index of 26.5 (SD 4.2) kg/m2. 58.1 % of participants had a previous diagnosis of hypertension and 18.6 % of participants were known to diabetes. The mean ASBP was 135.6 (SD 17.0) mmHg, and the mean ambulatory diastolic BP was 84.5 (SD 10.9) mmHg.

Conclusion

The TOPSPIN trial is the first randomised evaluation of commonly used BP-lowering combination therapies in a South Asian population. The results have potentially significant implications for choosing first-line antihypertensive agents among Indians and the South Asian diaspora.

背景在印度，3 亿多高血压患者的负担正在稳步加重。目前大多数指南都建议采用初始联合疗法来有效控制血压（BP）。方法这项多中心、单盲、随机、三臂试验招募了 30-79 岁的男性和女性高血压患者。该试验比较了三种药物（钙通道阻滞剂（氨氯地平）、血管紧张素转换酶抑制剂（培哚普利）和噻嗪类利尿剂（吲哒帕胺））的常用单药组合（SPC）的疗效。试验的主要目的是确定最有效的双药组合，即最初的起始剂量和 2 个月时的强制加量剂量，以降低 6 个月时的 24 小时动态收缩压 (ASBP)。基线结果1981名参与者（42.0%为女性）的平均年龄为52.1岁（标准差为11.3岁），平均体重指数为26.5（标准差为4.2）kg/m2。58.1%的参与者曾被诊断患有高血压，18.6%的参与者已知患有糖尿病。平均 ASBP 为 135.6 (SD 17.0) mmHg，平均动态舒张压为 84.5 (SD 10.9) mmHg。试验结果对印度人和南亚侨民选择一线降压药物具有潜在的重要意义。

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引用次数: 0

Impact of biological sex on heart transplant patients admitted to cardiac rehabilitation: A 10-year retrospective cohort study 生理性别对接受心脏康复治疗的心脏移植患者的影响：一项为期 10 年的回顾性队列研究

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2024-10-17 DOI: 10.1016/j.ijcrp.2024.200345

Andrea Tedeschi , Ignazio Cusmano , Francesca Di Salvo , Letizia Oreni , Anastasia Toccafondi , Monica Tavanelli , Paola Grati , Luca Mapelli , Luisa Arrondini , Gianmarco Cannadoro , Matteo Gonella , Chiara Barcella , Leone Stilo , Alessandro Verde , Gabriella Masciocco , Giacomo Ruzzenenti , Marco Biolcati , Andrea Garascia , Nuccia Morici

Introduction

Heart transplantation (HTx) serves as the gold-standard therapy for end-stage heart failure, yet patients often experience physical deconditioning and cognitive impairments post-surgery. Cardiac rehabilitation (CR) has shown promise in the HTx context. However, uncertainty surrounds the impact of biological sex. Accordingly, the aim of this paper was to investigate the impact of biological sex in a cohort of patients with HTx early admitted to a residential CR program.

Methods

This was a retrospective analysis involving patients who underwent HTx at Niguarda Hospital and who subsequently participated in a CR program at IRCCS Fondazione Don Gnocchi, Milan, Italy, between 2010 and 2022. The primary endpoint was time to event (in months), with an event defined as a composite outcome of whichever occurred first of death, allograft rejection, or cardiac allograft vasculopathy up to 30 months follow-up.

Results

In a total of 129 patients, 60 % male, and 40 % female, baseline characteristics presented comparably between the sexes. At 6 months, no significant sex differences were observed for the primary composite outcome. However, at 30 months, females exhibited a significantly lower incidence of the primary composite outcome and an increased survival rate. Multivariable analysis confirmed a protective effect of female sex against mortality (F vs. M, HR 0.164, 95 % CI 0.038–0.716, P = 0.0161).

Conclusions

Despite limitations, our findings emphasize that sex affects post-HTx long-term follow-up following CR discharge, with more favorable outcomes for female recipients. In an era of tailored management algorithms, it is imperative to take into account the gender gap even in cardiac rehabilitation.

导言心脏移植（HTx）是治疗终末期心力衰竭的金标准疗法，但患者在术后往往会出现身体机能减退和认知障碍。心脏康复（CR）在心脏移植中的应用前景良好。然而，生物性别的影响还存在不确定性。方法这是一项回顾性分析，涉及 2010 年至 2022 年期间在 Niguarda 医院接受过 HTx 手术、随后参加了意大利米兰 IRCCS Fondazione Don Gnocchi 的 CR 项目的患者。主要终点是发生事件的时间（以月为单位），事件定义为在30个月随访期内死亡、异体移植排斥反应或心脏异体移植血管病变（以先发生者为准）的综合结果。结果在129名患者中，男性占60%，女性占40%，男女患者的基线特征相当。在6个月的主要综合结果中，没有观察到明显的性别差异。但在 30 个月时，女性的主要综合结果发生率明显降低，存活率也有所提高。多变量分析证实了女性性别对死亡率的保护作用（F vs. M，HR 0.164，95 % CI 0.038-0.716，P = 0.0161）。结论尽管存在局限性，但我们的研究结果强调性别会影响 CR 出院后的 HTx 长期随访，女性受者的结果更有利。在量身定制管理算法的时代，即使在心脏康复中也必须考虑到性别差异。

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引用次数: 0

Leukotrienes E4 and B4 and vascular endothelium – New insight into the link between vascular inflammation and peripheral arterial 白三烯 E4 和 B4 与血管内皮--血管炎症与外周动脉之间联系的新见解

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2024-10-16 DOI: 10.1016/j.ijcrp.2024.200343

Paweł Maga , Agnieszka Wachsmann-Maga , Aleksandra Włodarczyk , Mikołaj Maga , Krzysztof Batko , Katarzyna Bogucka , Maria Kapusta , Piotr Terlecki

Leukotrienes are proinflammatory mediators that participate in the process of atherogenesis and contribute to the development of symptomatic peripheral arterial disease. The aim was to evaluate the relationship between leukotriene E4 (LTE4) and B4 (LTB4) with parameters reflecting endothelial vascular function in patients with chronic lower limb ischemia. This prospective observational study enrolled 50 consecutive patients undergoing endovascular treatment due to chronic lower limb ischemia (Rutherford 3). All participants were followed-up for one year (after 1, 3, 6 and 12 months), with a sequential assessment of urinary LTE4 and LTB4, as well as measures of endothelial and vascular function: Flow-Mediated Dilatation (FMD), Intima-Media Thickness (IMT), corrected Augmentation Index (AI75), Shear Rate (SR), Ankle-Brachial Index (ABI), Toe-Brachial Index (TBI). There was a significant relationship between LTE4 and measures of vascular function: FMD (R2 = 0.69, P < 0.001), IMT (R2 = 0.12, P < 0.01), AI75 (R2 = 0.43, P < 0.001), SR (R2 = 0.48, P < 0.001). Similar findings were noted for LTB4: FMD (R2 = 0.47, p < 0.001), IMT (R2 = 0.23, P < 0.001), AI75 (R2 = 0.61, P < 0.001) and SR (R2 = 0.33, P < 0.001). Alterations in parameters were significantly related: ΔLTE4 vs ΔFMD(R2 = 0.63, P < 0.001), ΔSR (R2 = 0.42, P < 0.001) and ΔLTB4 vs AI75(R2 = 0.40, P < 0.001), SR(R2 = 0. 29, P < 0.001). We conclude, that increasing concentrations of LTE4 and LTB4 are associated with impairment of vascular and endothelial function, which may lead to worse endovascular treatment clinical outcomes.

白三烯是一种促炎介质，参与动脉粥样硬化的形成过程，并导致无症状外周动脉疾病的发生。本研究旨在评估白三烯 E4（LTE4）和 B4（LTB4）与反映慢性下肢缺血患者血管内皮功能的参数之间的关系。这项前瞻性观察研究连续纳入了 50 名因慢性下肢缺血而接受血管内治疗的患者（Rutherford 3）。所有参与者均接受了为期一年（1、3、6 和 12 个月后）的随访，并对尿液中的 LTE4 和 LTB4 以及内皮和血管功能进行了连续评估：血流介导的扩张（FMD）、内膜厚度（IMT）、校正增强指数（AI75）、剪切率（SR）、踝肱指数（ABI）、趾肱指数（TBI）。LTE4 与血管功能测量之间存在明显的关系：FMD (R2 = 0.69, P < 0.001)、IMT (R2 = 0.12, P < 0.01)、AI75 (R2 = 0.43, P < 0.001)、SR (R2 = 0.48, P < 0.001)。LTB4也有类似发现：FMD（R2 = 0.47，P < 0.001）、IMT（R2 = 0.23，P < 0.001）、AI75（R2 = 0.61，P < 0.001）和SR（R2 = 0.33，P < 0.001）。各参数的变化有明显相关性：ΔLTE4 vs ΔFMD（R2 = 0.63，P <；0.001）、ΔSR（R2 = 0.42，P <；0.001）和 ΔLTB4 vs AI75（R2 = 0.40，P <；0.001）、SR（R2 = 0. 29，P <；0.001）。我们得出结论，LTE4 和 LTB4 浓度的增加与血管和内皮功能受损有关，这可能会导致血管内治疗的临床结果更差。

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引用次数: 0

2024 ESC Guidelines for the management of elevated blood pressure and hypertension – How practical is it for clinical practice? 2024 ESC《血压升高和高血压管理指南》--在临床实践中的实用性如何？

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2024-10-11 DOI: 10.1016/j.ijcrp.2024.200341

Elisabeta Badila

引用次数: 0