JRSM Cardiovascular Disease最新文献

Background & aim: Previous studies link marital status to mortality across diverse populations. This study examines how sex influences its association with all-cause, cardiovascular disease (CVD), and cancer mortality.

Method: The search was conducted through PubMed, Scopus, and Google Scholar databases and included related articles up to September 16, 2025. The titles, abstracts, and full texts of the included articles were reviewed, and data were extracted and analyzed.

Result: Twelve cohort studies (1,785,857 individuals) were analyzed. Unmarried status was significantly associated with an increased risk of all-cause, CVD, and cancer mortality. Specifically, single individuals showed a higher risk of all-cause (hazard ratio [HR]: 1.55, 95% CI: 1.37-1.74), cancer (HR: 1.14, 95% CI: 1.07-1.22), and CVD mortality (HR: 1.52, 95% CI: 1.28-1.84). Divorced individuals had an increased risk of all-cause (HR: 1.39, 95% CI: 1.12-1.66) and CVD mortality (HR: 1.27, 95% CI: 1.02-1.52). Widowed individuals showed a higher risk of all-cause (HR: 1.43, 95% CI: 1.11-1.74), cancer (HR: 1.13, 95% CI: 1.03-1.23), and CVD mortality (HR: 1.67, 95% CI: 1.23-2.10).

Conclusion: Unmarried status is significantly associated with an increased risk of all-cause, cancer, and CVD mortality. The association between marital status and mortality differs by sex and geographic region. For instance, the link between divorced status and all-cause mortality is significantly stronger in men, while the association between single status and cancer mortality is significantly stronger in women. These findings highlight the importance of considering sex and regional differences in public health interventions.

Background: Timely fibrinolysis remains the cornerstone of reperfusion for ST-elevation myocardial infarction (STEMI) in settings without reliable access to primary percutaneous coronary intervention (PCI). International guidelines recommend a door-to-needle time (DTNT) of 30 min or less.

Aim: We conducted the first continent-wide meta-analysis to quantify real-world DTNTs and adherence to guideline benchmarks in African hospitals.

Methods: We systematically searched PubMed/MEDLINE, Scopus, and Web of Science through July 2, 2025, for studies reporting DTNT for adult STEMI patients treated with thrombolysis in Africa. Pooled mean DTNT was estimated via random-effects meta-analysis with restricted maximum likelihood and Knapp-Hartung adjustment. Heterogeneity was assessed by Cochran's Q and I ², and sensitivity analyses evaluated robustness.

Results: Across 12 eligible studies encompassing a total of 2193 STEMI patients, about 1261 individuals (57.5%) received thrombolytic therapy. Among the 11 studies reporting mean reperfusion times (1011 patients), the overall pooled mean DTNT was 74.8 min (95% confidence interval: 44.4-105.2; I ² = 99.4%), substantially exceeding the recommended benchmark. Notably, only 36.3% of thrombolyzed patients achieved a DTNT of ≤30 min. Furthermore, none of the included study cohorts reported an overall mean DTNT within 30 min.

Conclusion: African STEMI patients experience door-to-needle delays more than twice the guideline target, with fewer than 4 in 10 receiving timely fibrinolysis. In such settings lacking widespread PCI, implementation of standardized reperfusion protocols, optimized in-hospital workflows, and targeted quality-improvement initiatives is urgently needed to accelerate fibrinolysis, maximize myocardial salvage, and reduce adverse cardiovascular outcomes.

Background: Dilated cardiomyopathy is defined by left ventricular dilatation and systolic dysfunction and may rarely be complicated by left ventricular thrombi, which carry a significant risk of systemic embolization.

Case presentation: A 77-year-old woman with dyslipidemia and depression presented with progressive dyspnea (NYHA IV) and palpitations. Transthoracic echocardiography revealed severe biventricular dysfunction (left ventricular ejection fraction 24%) and multiple partially mobile thrombi in the left ventricular. Coronary angiography excluded obstructive coronary artery disease, and cardiac magnetic resonance confirmed severe left ventricular dilatation, diffuse hypokinesia, extensive fibrosis, and thrombotic appositions. Secondary causes of dilated cardiomyopathy and thrombophilia were excluded; genetic testing revealed a heterozygous BAG3 variant.

Management: The patient was treated with intravenous diuretics, non-invasive ventilation, unfractionated heparin followed by apixaban, and guideline-directed medical therapy for heart failure, including a beta-blocker, angiotensin receptor-neprilysin inhibitor, MRA, and SGLT2 inhibitor. Serial imaging at 7 days showed a reduction of thrombotic burden, with complete resolution confirmed at 2-month follow-up.

Outcome: At 4-month follow-up, the patient was asymptomatic (NYHA I-II) with improved left ventricular ejection fraction (35%) and no documented arrhythmias. Given functional recovery and absence of significant conduction delay, device implantation was not indicated.

Conclusion: This case highlights the importance of early recognition and prompt anticoagulation in dilated cardiomyopathy complicated by left ventricular thrombi. A structured diagnostic and therapeutic strategy-integrating multimodality imaging, exclusion of secondary causes, and genetic assessment-can lead to complete thrombus resolution and favorable remodeling.

Objectives: The aim of this study is to evaluate the impact of anticoagulation strategy, stent type, and pulmonary artery (PA) jailing on unplanned reintervention rates and PA growth in neonates undergoing patent ductus arteriosus (PDA) stenting. Specifically, we compared aspirin monotherapy versus aspirin plus Enoxaparin, bare metal versus drug-eluting stents, and jailed versus non-jailed PAs.

Methods: A retrospective chart review was conducted on neonates who underwent PDA stenting between 2014 and 2024. Patients were categorized by stent type, anticoagulation regimen, and PA jailing status. Unplanned reintervention rates were assessed using chi-square analysis and logistic regression. PA growth was evaluated using catheterization, MRI, and CT imaging. Statistical analyses of PA growth included t-tests and regression models.

Results: Among 116 neonates analyzed, aspirin monotherapy was associated with a significantly lower unplanned reintervention rate compared to combination therapy with Enoxaparin (p = 0.0447). Stent type did not significantly impact reintervention rates. Additionally, intrapatient jailed PAs exhibited significantly reduced distal growth compared to non-jailed PAs (p = 0.0070).

Conclusions: For neonatal PDA stenting, aspirin monotherapy may be as effective as aspirin plus Enoxaparin for post-stenting anticoagulation, and drug eluting stents may not have a significant benefit over bare metal stents. Furthermore, PA jailing may negatively impact distal vessel growth, highlighting the need for refined stent placement techniques, although further prospective studies are needed to optimize procedural strategies and long-term outcomes in this high-risk neonatal population.

Background: Acute myocardial infarction (AMI) remains a major cause of global mortality, with post-infarction cardiovascular events significantly contributing to poor outcomes. Emerging evidence suggests that gut microbiome dysbiosis may influence cardiovascular risk through increased intestinal permeability and systemic inflammation. Although lactulose-a prebiotic known to modulate gut microbiota-has shown beneficial effects in experimental models, its impact on major adverse cardiovascular events (MACEs) after AMI remains unclear.

Methods: In this single-center retrospective cohort study, we analyzed 165 AMI patients hospitalized between 2016 and 2019. Participants were stratified by lactulose use during hospitalization. The primary outcome was in-hospital MACEs. Multivariable logistic regression was used. Secondary outcomes included pneumonia incidence and length of hospital stay.

Results: After adjustment for confounders, lactulose use was independently associated with a reduced risk of MACEs (adjusted odds ratio (OR) 0.40, 95% confidence interval (CI) 0.16-0.95; p = 0.038). The overall incidence of MACEs was 18.2% in the lactulose group versus 30.0% in controls, though this difference was not statistically significant in unadjusted analysis (χ² = 2.41, p = 0.12), likely reflecting limited statistical power. No significant associations were observed for pneumonia (OR = 0.17, p = 0.09) or hospital stay duration (p = 0.60).

Conclusions: In this retrospective analysis, lactulose supplementation was associated with reduced in-hospital cardiovascular events following AMI. However, these preliminary findings require validation in larger prospective studies to establish causality and elucidate underlying gut-mediated mechanisms. If confirmed, lactulose may represent a simple and accessible adjunct therapy in post-infarction care.

Background: A variety of studies have reported the associations between histone deacetylases (HDACs) genes and cardio-cerebrovascular diseases. The identification of variants in the HDACs genes and the determination of risk alleles could open novel therapeutic avenues for these diseases. This article summarized variants in HDACs genes and different sub-types of cardio-cerebrovascular diseases. Methods: A comprehensive literature search was conducted across PubMed, Web of Science and Scopus databases to identify studies published prior to 27 June 2025. We registered this protocol in the PROSPERO database (CRD420251010100). The Venice Criteria were applied to assess the statistically significant associations identified by meta-analyses. The single-nucleotide polymorphisms were mapped to their corresponding genes, and functional annotation was conducted using the Encyclopedia of DNA Elements tool, HaploReg and the UCSC Genome browser. Results: We finally included 34 published studies and 160 datasets to assess the associations between variants in HDAC genes and cardio-cerebrovascular diseases. Rs2107595 in HDAC 9 was the variant found to be associated with four sub-types identified by genome-wide association study or meta-analyses. Rs11984041 was related to ischemic stroke. Rs10230207 and rs2192476 were associated with intracranial aneurysm. Conclusions: HDACs genes were associated with multiple cardio-cerebrovascular diseases. However, ethnic disparities were observed in their effects. Therefore, ethnicity-targeted treatments, including specific HDAC inhibitors, should be developed in the future.

Objective: This study aimed to investigate the association between smoking and plasma levels of sCD40L, sP-selectin, and sICAM-1 in patients with coronary heart disease (CHD), and to evaluate their correlations with smoking intensity and coronary anatomical complexity assessed by the SYNTAX score.

Methods: We analyzed data from 244 patients with CHD undergoing percutaneous coronary intervention, categorized into smokers (n = 150) and nonsmokers (n = 94). Smoking intensity was quantified using the smoking index (SI). Plasma biomarker levels were measured via ELISA. SYNTAX scores I and II were assessed by two experienced interventional cardiologists to evaluate coronary lesion complexity. Group comparisons, Spearman's correlation adjusted with the Benjamini-Hochberg method, tests for interaction (Gender × Smoking Status), and multivariate regression models were employed.

Results: Smokers exhibited significantly higher sICAM-1 levels than nonsmokers (662.6 vs. 548.6 ng/ml, P = 0.007). sICAM-1 was an independent risk factor for CHD in smokers (OR = 1.001, 95% CI: 1.00003-1.033, P = 0.043). Strong correlations were observed among all three biomarkers (all P < 0.001). Subgroup analyses showed significant correlations between SI and all three biomarkers, and both SI and sP-selectin correlated positively with SYNTAX scores I and II (all P < 0.01). Formal interaction analysis indicated no significant effect modification by gender on the observed associations (all P >> 0.05).

Conclusion: Elevated levels of sICAM-1, sCD40L, and sP-selectin are interrelated and associated with smoking intensity and coronary anatomical complexity, highlighting their role as key inflammatory mediators in smoking-related CHD.

Background: Climate change and increasing environmental pollution are emerging as significant threats to global health, notably through their impact on cardiovascular diseases (CVD). The World Health Organization (WHO) attributes millions of premature deaths annually to air pollution and extreme temperatures. Despite extensive research on air pollution and temperature extremes separately, their combined effects on cardiovascular health remain inadequately explored.

Methods: We plan to conduct a systematic review and meta-analysis to assess the impact of climate change, including extremes of temperature and air pollution, on CVD. We will search PubMed, CINAHL, SCOPUS, ClinicalTrials.gov, and additional databases for studies published between August 12, 2019, and August 11, 2024. The review will include observational and quasi-experimental (pre and post-test) studies. Data extraction and quality assessment will be performed using EndNote, Rayyan.ai, and the National Heart, Lung, and Blood Institute (NHLBI) quality appraisal tool. The statistical analysis will be conducted using RevMan 5.4, with risk ratios, mean differences, and heterogeneity evaluated.

Discussion: This review aims to synthesize evidence on how ambient air pollutants (PM_2.5, CO, O₃) and extreme temperatures contribute to cardiovascular morbidity and mortality. It will highlight the synergistic effects of air pollution and temperature extremes, with a particular focus on low- and middle-income countries where the burden is most pronounced.

Conclusion: By integrating the impacts of both climate change and air pollution on cardiovascular health, this review will provide comprehensive insights into the global health burden of CVD. The findings will inform public health strategies and interventions to mitigate the adverse effects of environmental factors on cardiovascular health.

Background: Statins are the most widely prescribed drugs for dyslipidemia and CAD. But evidence on their cognitive effects is conflicting. A unique genetic makeup and variable lipid patterns make South Asians more susceptible to statin adverse effects. But literature on statin safety in this group is scarce. We aimed to assess the cognitive status of adult Indian statin users over two years and explore factors associated with it.

Methods: A prospective cohort was established for cognitive profiling of adult statin users, visiting the out-patient cardiology department of a tertiary care center in North India. The Montreal Cognitive Assessment Scale measured cognitive function. Analysis was conducted using mixed-effects linear regression modelling to account for repeated measurements.

Results: 273 participants were enrolled. The mean cognitive score was 15. Age and education were significant predictors of cognition (P-value .005 and <.001 respectively). Participants over 60 scored had significantly lower scores and those who had completed secondary school and above scored significantly higher scores. No significant associations were observed between cognitive score and other covariates- sex, follow-up period, statin type and duration of use.

Conclusion: The statins-cognition relationship is controversial. This study demonstrated statistically significant relationships of cognition with age and education and showed no change in cognition over 2 years. The findings provide hypotheses for more in-depth assessments. Statins remain the most effective lipid-lowering treatment. However, further research is warranted for a more holistic understanding of the issue & optimizing their risk-benefit ratio.

Objective: This study aimed to investigate the relationship between the stress hyperglycaemia ratio and haemorrhagic transformation after intravenous thrombolysis in acute ischaemic stroke patients.

Methods: We analysed data in Shanghai General Hospital from 2019 to 2022 on 161 men and 68 women with valid data on fasting blood glucose, glycated haemoglobin, and cranial computed tomography using multivariable regression models to examine the relationship between hyperglycaemia ratio and haemorrhagic transformation.

Results: All 229 patients in this study were included, with 161 males (70.3%) and a mean age of 69.0 (SD = 11.3). According to the median hyperglycaemia ratio (0.87), all patients were divided into two groups (M1 ≤ 0.87). Patients in the M2 group tended to have a higher fasting blood glucose, body mass index, glycated albumin, and apolipoprotein E, while the door-to-needle time in M2 was longer than in M1 (all p values < 0.05). The fasting blood glucose, hyperglycaemia ratio, urea nitrogen, glycated albumin, D-dimer, and the score of NIHSS in the haemorrhagic transformation group were higher than in the non-haemorrhagic transformation group, but the haemoglobin was lower (all p values < 0.05). In the overall population, the hyperglycaemia ratio was associated with haemorrhagic transformation after intravenous thrombolysis before and after full adjustment for age, sex, body mass index, hyperglycaemia ratio, glycated albumin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein E, door-to-needle time and the score of National Institute of Health Stroke Scale [OR = 3.34, 95% CI: 1.27-7.76].

Conclusions: This result implied that the hyperglycaemia ratio is significantly associated with haemorrhagic transformation after intravenous thrombolysis in stroke patients. The stress hyperglycaemia ratio should be borne in mind after intravenous thrombolysis regarding the incidence of haemorrhagic transformation.