American heart journal plus : cardiology research and practice最新文献_第2页

Predicting cardiovascular diseases using imbalanced data: An XGBoost-based analysis of the 2022 BRFSS dataset 使用不平衡数据预测心血管疾病：基于xgboost的2022年BRFSS数据集分析

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-10 DOI: 10.1016/j.ahjo.2026.100719

Masoud Imani , Ali Maroosi , Seyedshayan Shojaei , Kimia Heidari , Seyed Mahdi Hoseinzadeh , Nima Daneshi , Zahra Saber , Negar Sajadi , Morteza Mohammadzadeh

Background

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, arising from complex interactions among demographic, clinical, behavioral, and social determinants. Leveraging large, nationally representative datasets such as the 2022 Behavioral Risk Factor Surveillance System (BRFSS) offers a unique opportunity to identify emerging risk patterns, monitor population-level disparities, and inform more targeted prevention strategies.

Methods

A total of 221,643 participants from the BRFSS 2022 survey were included after excluding records with missing data. Thirteen key predictors spanning demographics, chronic conditions, and social factors were selected. Data were split into training (80%) and testing (20%) sets. Four machine learning models, XGBoost, Random Forest, Logistic Regression, and Naive Bayes, were developed and evaluated using stratified 10-fold cross-validation. Model performance was assessed via accuracy, F1 score, precision, sensitivity, and ROC AUC. Synthetic Minority Over-sampling Technique (SMOTE) addressed class imbalance. SHAP values provided insights into feature importance and model interpretability.

Results

XGBoost demonstrated the best predictive performance (accuracy 94.2%, F1 score 85.3%, ROC AUC 0.94). SHAP analysis highlighted age ≥ 65, male gender, and diabetes as the strongest predictors, with additional contributions from kidney disease, employment status, and social isolation. Protective effects were observed for never smoking and higher education. Stratified analyses revealed that while overweight/obesity (BMI ≥25) was generally associated with higher CVD prevalence, the association was attenuated in older adults, smokers, and those with diabetes or kidney disease, suggesting illness-related weight loss, frailty, and behavioral confounding. These subgroup insights contextualize the apparent “BMI paradox” observed in the aggregate data.

Conclusions

Findings from the BRFSS 2022 highlight both established and emerging determinants of CVD risk, including the modifying effects of comorbidities, social isolation, and BMI-related heterogeneity. Beyond algorithmic performance, these results underscore the value of national surveillance data for informing applied, actionable strategies in CVD prevention and risk stratification.

背景：心血管疾病（cvd）仍然是世界范围内导致死亡的主要原因，由人口统计学、临床、行为和社会决定因素之间复杂的相互作用引起。利用2022年行为风险因素监测系统（BRFSS）等具有全国代表性的大型数据集，为识别新出现的风险模式、监测人口水平差异和提供更有针对性的预防战略提供了独特的机会。方法从BRFSS 2022调查中剔除缺失数据后，共纳入221643名参与者。选择了13个关键预测因素，包括人口统计、慢性病和社会因素。数据分为训练集（80%）和测试集（20%）。开发了XGBoost、随机森林、逻辑回归和朴素贝叶斯四种机器学习模型，并使用分层10倍交叉验证进行了评估。通过准确性、F1评分、精度、灵敏度和ROC AUC来评估模型的性能。合成少数派过采样技术（SMOTE）解决了类不平衡问题。SHAP值提供了对特征重要性和模型可解释性的见解。结果xgboost预测准确率为94.2%，F1评分为85.3%，ROC AUC为0.94。SHAP分析强调，年龄≥65岁、男性和糖尿病是最强的预测因素，肾脏疾病、就业状况和社会孤立也有额外的影响。从不吸烟和受过高等教育的人可以起到保护作用。分层分析显示，虽然超重/肥胖（BMI≥25）通常与较高的心血管疾病患病率相关，但在老年人、吸烟者、糖尿病或肾病患者中，这种关联减弱，这表明与疾病相关的体重减轻、虚弱和行为混杂。这些亚组洞察将总体数据中观察到的明显的“BMI悖论”置于背景中。BRFSS 2022的研究结果强调了心血管疾病风险的既有决定因素和新出现的决定因素，包括合并症、社会隔离和bmi相关异质性的调节作用。除了算法性能之外，这些结果还强调了国家监测数据在为心血管疾病预防和风险分层提供应用的、可操作的战略信息方面的价值。

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引用次数: 0

Three different indications for left ventricular unloading in one patient with severe heart failure 1例严重心力衰竭患者左心室卸荷的三种不同适应症

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-09 DOI: 10.1016/j.ahjo.2026.100716

Thomas Gausepohl , Ulrike Flierl , Vera Garcheva , Marcel Ricklefs , Bernd Schwedhelm , Johann Bauersachs , Tobias J. Pfeffer , Andreas Schäfer

Background

The percutaneous microaxial flow pump (mAFP) is an established mechanical circulatory support (MCS) device for cardiogenic shock (CS) and can also stabilize hemodynamics during cardiac and noncardiac procedures. This case series describes the safety and feasibility of repeated mAFP use for three indications in a single patient.

Methods

We retrospectively reviewed three consecutive mAFP deployments in one patient enrolled in the Hannover-Cardiac-Unloading-REgistry between October 2021 and August 2023. Indications included acute myocardial infarction–related CS (AMI-CS), ventricular tachycardia (VT) ablation one year later, and elective thyroidectomy for amiodarone-induced hyperthyroidism another year later.

Results

A 62-year-old patient with ischemic cardiomyopathy (initial LVEF 34%) achieved hemodynamic stabilisation during AMI-CS, successful protected VT ablation without compromise, and stable perioperative support during thyroidectomy. No major adverse events occurred.

Conclusions

Repeated mAFP use for AMI-CS, VT ablation, and high-risk surgery was feasible and safe, supporting its versatility in complex clinical care.

经皮微轴流泵（mAFP）是一种成熟的用于心源性休克（CS）的机械循环支持（MCS）装置，也可以在心脏和非心脏手术期间稳定血液动力学。本病例系列描述了一名患者在三种适应症中重复使用mAFP的安全性和可行性。方法回顾性回顾了2021年10月至2023年8月汉诺威心脏卸载注册中心登记的一名患者中连续三次mAFP部署。适应症包括急性心肌梗死相关CS (AMI-CS)，一年后室性心动过速（VT）消融，一年后选择性甲状腺切除术治疗胺碘酮诱导的甲状腺功能亢进。结果1例62岁缺血性心肌病患者（初始LVEF 34%）在AMI-CS期间血流动力学稳定，保护VT消融成功且无损害，甲状腺切除术期间获得稳定的围手术期支持。未发生重大不良事件。结论mAFP在AMI-CS、VT消融及高危手术中反复应用是可行且安全的，在复杂的临床护理中具有通用性。

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引用次数: 0

Digital phenotyping and ASCVD risk: An exploratory cross-sectional analysis using online behavioral data 数字表型和ASCVD风险：使用在线行为数据的探索性横断面分析

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-09 DOI: 10.1016/j.ahjo.2026.100717

Lauren Southwick , Neil K.R. Sehgal , Dena Torrente , Veronica Murgulescu , Devon Schroeder , David A. Asch , Lyle Ungar , Nandita Mitra , Peter Groenveld , Stephen E. Kimmel , Gary E. Weissman , Sharath Chandra Guntuku , Raina M. Merchant

A retrospective, exploratory cross-sectional analysis exploring whether social media data is associated with cardiovascular disease (CVD) risk beyond traditional clinical models. While social media data may capture behavioral and social markers relevant to CVD, their associations with CVD risk remains uncertain.

一项回顾性、探索性横断面分析，探讨社交媒体数据是否与传统临床模型之外的心血管疾病（CVD）风险相关。虽然社交媒体数据可以捕捉到与心血管疾病相关的行为和社会标记，但它们与心血管疾病风险的关联仍然不确定。

引用次数: 0

Symptom phenotypes and coronary microvascular function in non-obstructive coronary artery disease: Insights beyond epicardial ischemia 非阻塞性冠状动脉疾病的症状、表型和冠状动脉微血管功能：心外膜缺血以外的见解

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-07 DOI: 10.1016/j.ahjo.2026.100714

Kotaro Matsumoto , Kenichiro Otsuka , Shunsuke Kagawa , Hiroki Yamaura , Tsubasa Miura , Kazuya Sugioka , Wataru Saitoh , Akihiro Okamoto , Go Kajio , Naoki Fujisawa , Tomohiro Yamaguchi , Takenobu Shimada , Yusuke Hayashi , Atsushi Shibata , Asahiro Ito , Takanori Yamazaki , Daiju Fukuda

Study objective

To examine the relationship between coronary microvascular dysfunction (CMD) indices and chest pain presentation in patients with non-obstructive coronary artery disease (NOCA).

Design and setting

Retrospective, single-center observational study.

Participants

Patients with angiographically intermediate left anterior descending artery (LAD) stenosis and preserved epicardial physiology (fraction flow reserve, FFR >0.80), with no significant stenosis in vessels other than the LAD.

Interventions

Invasive CMD assessment using coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and myocardial resistance reserve (MRR).

Main outcome measures

Associations between symptom phenotypes and physiological indices, and the diagnostic performance of symptom-based assessment for detecting CMD.

Results

Among 59 patients (mean age 69.2 years; 71 % male), CFR and MRR differed significantly across symptom phenotypes (both p < 0.001), whereas IMR did not. Patients with typical angina exhibited the lowest CFR and MRR, indicating impaired microvascular vasodilatory reserve despite preserved epicardial physiology. Conversely, patients with atypical symptoms had the highest CFR and MRR, whereas asymptomatic patients had intermediate values. FFR was comparable across groups (median 0.89, p = 0.21). In age-adjusted analyses, symptom severity was inversely associated with CFR (β = −1.085, p = 0.004) and MRR (β = −1.062, p = 0.003), but not with IMR. Symptom-based assessment showed higher specificity than sensitivity across CMD definitions and performed best for impaired MRR (sensitivity 60.9 %, specificity 80.6 %). Functional CMD was observed even in asymptomatic patients.

Conclusion

In patients with NOCA, coronary microvascular vasodilatory reserve varies according to symptom phenotype, highlighting the limited reliability of symptom assessment alone and underscoring the importance of objective physiological evaluation for characterizing CMD.

研究目的探讨非阻塞性冠状动脉疾病（NOCA）患者冠状动脉微血管功能障碍（CMD）指数与胸痛表现的关系。设计与背景回顾性、单中心观察性研究。参与者：血管造影显示为左前降支（LAD）中度狭窄，心外膜生理保存（血流储备分数，FFR >0.80），除LAD外其他血管无明显狭窄的患者。介入方法：冠脉血流储备（CFR）、微循环阻力指数（IMR）和心肌阻力储备（MRR）评估有创CMD。主要结局指标：症状表型与生理指标的关系，以及基于症状的评估对CMD的诊断效果。结果在59例患者（平均年龄69.2岁，71%为男性）中，不同症状表型的CFR和MRR差异显著（p < 0.001），而IMR无显著差异。典型心绞痛患者表现出最低的CFR和MRR，表明尽管心外膜生理保持，微血管血管舒张储备受损。相反，非典型症状患者的CFR和MRR最高，而无症状患者的CFR和MRR为中间值。各组间FFR具有可比性（中位数0.89,p = 0.21）。在年龄校正分析中，症状严重程度与CFR （β = - 1.085, p = 0.004）和MRR （β = - 1.062, p = 0.003）呈负相关，但与IMR无关。基于症状的评估在CMD定义中特异性高于敏感性，并且对受损的MRR效果最好（敏感性60.9%，特异性80.6%）。即使在无症状的患者中也观察到功能性CMD。结论在NOCA患者中，冠状动脉微血管血管舒张储备随症状表型的变化而变化，强调了单纯症状评估的可靠性有限，强调了客观生理评估对表征CMD的重要性。

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引用次数: 0

A risk model to predict atrial fibrillation in diabetes using machine learning: The ACCORD study 使用机器学习预测糖尿病房颤的风险模型：ACCORD研究

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-07 DOI: 10.1016/j.ahjo.2026.100715

Erik J. Offerman , Joseph Phan , Sarah Harirforoosh , Wenjun Fan , Nathan D. Wong , David M. Donaldson

Background

Machine learning (ML) may improve prediction of atrial fibrillation (AF), but its value compared with traditional models such as Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE-AF) in patients with diabetes remains unclear.

Methods

Among 9,307 patients in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) with type 2 diabetes and no prior AF, a random forest (RF) classifier using clinical and metabolic variables was compared with a CHARGE-AF Cox model. Discrimination was assessed by five-fold cross-validated area under receiver operating curve (AUC).

Results

Over 6.26 years, 175 patients developed AF. The RF model (AUC = 0.731) performed comparably to CHARGE-AF (AUC = 0.756; p = 0.18). Age, waist circumference, race, total cholesterol, and estimated glomerular filtration rate were the top predictors.

Conclusion

ML matched CHARGE-AF performance and revealed distinct predictors supporting personalized AF risk prevention.

机器学习（ML）可以提高对房颤（AF）的预测，但与传统模型（如基因组流行病学心脏与衰老研究队列（CHARGE-AF））相比，其在糖尿病患者中的价值尚不清楚。方法对9307例2型糖尿病患者进行临床和代谢变量随机森林（RF）分类，并与CHARGE-AF Cox模型进行比较。用5倍交叉验证的受试者工作曲线下面积（AUC）评估鉴别性。结果在6.26年的时间里，175例患者发生了房颤。RF模型（AUC = 0.731）与CHARGE-AF模型（AUC = 0.756; p = 0.18）的表现相当。年龄、腰围、种族、总胆固醇和估计的肾小球滤过率是最重要的预测因素。结论ml与CHARGE-AF表现相匹配，并显示出支持个性化房颤风险预防的独特预测因子。

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引用次数: 0

Unraveling the genetic blueprint of coronary artery disease: The role of polygenic risk scores in risk prediction 揭示冠状动脉疾病的遗传蓝图：多基因风险评分在风险预测中的作用

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-02 DOI: 10.1016/j.ahjo.2025.100712

Alaaeddine El Ghazawi , Akl C. Fahed , Nour Fawaz , Yeva Fakih , Samir Alam , Marwan Refaat

Cardiovascular diseases, and most notably coronary artery disease (CAD), carry a large burden of mortality and morbidity, highlighting the need for better risk prediction and prevention. Several risk scoring tools for CAD have been developed to improve early detection, reduce the risk of acute cardiac events, and ensure adequate monitoring and follow-up of high-risk individuals. One that seized attention, especially with the groundbreaking advancements in disease's genetic buildup, was the polygenic risk score (PRS) for CAD. It was developed for potentially improving risk prediction at an early age, with individualized patient care. Our review aims to review the latest advances in this field of polygenic risk prediction, highlighting background information about PRS, current evidence supporting the utility of PRS for CAD, challenges associated with its implementation, and its complementary role with the coronary artery calcium score (CAC). Our review demonstrates that PRS could be a strong predictive indicator of CAD, especially when combined with other clinical factors. However, concerns remain regarding its applicability to genetically diverse populations, the ethical and psychological challenges, and practical feasibility. Lastly, PRS can augment and predict CAC in terms of risk discrimination and reclassification. In conclusion, PRS is a valuable tool that is upscaling with wider adoption. This requires a proper handling of its associated challenges to better shape the future of individualized care.

心血管疾病，尤其是冠状动脉疾病（CAD），带来了很大的死亡率和发病率负担，突出了更好的风险预测和预防的必要性。已经开发了几种CAD风险评分工具，以提高早期发现，降低急性心脏事件的风险，并确保对高风险个体进行充分的监测和随访。随着疾病遗传积累的突破性进展，CAD的多基因风险评分（PRS）引起了人们的关注。它的开发是为了潜在地改善早期的风险预测，并提供个性化的患者护理。我们的综述旨在回顾多基因风险预测领域的最新进展，重点介绍PRS的背景信息、支持PRS在CAD中的应用的现有证据、实施PRS所面临的挑战，以及它与冠状动脉钙评分（CAC）的补充作用。我们的综述表明，PRS可能是CAD的一个强有力的预测指标，特别是当与其他临床因素结合时。然而，对其在遗传多样性人群中的适用性、伦理和心理挑战以及实际可行性的关注仍然存在。最后，PRS可以增强和预测CAC的风险识别和重新分类。总而言之，PRS是一种有价值的工具，随着更广泛的采用而不断升级。这需要妥善处理相关的挑战，以更好地塑造个性化护理的未来。

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引用次数: 0

Improving the management of acute myocardial infarctions: There's an App for that 改善急性心肌梗死的管理：有一个应用程序

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 DOI: 10.1016/j.ahjo.2025.100700

Katelyn J. Cullen , Mathew Mercuri , Hassan Mir , Karen Mosleh , Rafi Setrak , Sanjit S. Jolly , Michael Tsang , Renu Syal , James Nkurunziza , Michelle Welsford , JD Schwalm , Madhu K. Natarajan

Background

ST-Elevation Myocardial Infarction (STEMI) is a critical emergency. Managing care requires accurate diagnosis, shared communication between decision-makers, and timely transport and reperfusion at a hospital with capacity for such interventions. This study examines the implementation of a smartphone application (SMART AMI-ACS App) to facilitate real-time ECG sharing, enhancing communication and decision-making in STEMI management.

Methods

This multi-centre study evaluated the implementation, acceptability and uptake of the App among interventional cardiologists and emergency medicine (EM) physicians managing suspected STEMI patients between April 1st 2022 and March 31st 2023. Guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, STEMI registry data and post-implementation surveys from a large regional cardiac centre and its 13 partner emergency departments in Ontario, Canada, were used to assess App uptake and effectiveness.

Results

During the 12-month evaluation 254 (84 %) of the eligible 300 regional EM physicians downloaded the App, with > 1400 ECG images sent from 724 patients. Users reported the App helped in communication and timing of care. No degradation of ECG images was observed. App use was associated with lower door-in-door-out (DIDO) times 48 min (IQR 31–67) vs 55 min (IQR 39–77) and lower proportion of non-STEMI cases accepted to interventional cardiology (22 % vs 39 %, p < 0.0001).

Conclusion

Uptake of the SMART AMI-ACS App was positive and may be associated with lower non-STEMI cases and lower DIDO times. The App provided a secure channel for communication of information and point-of-care transfer of images across healthcare providers. Uptake of the App has expanded to other regions.

st段抬高型心肌梗死（STEMI）是一种严重的急症。管理护理需要准确的诊断，决策者之间的共享沟通，以及在有能力进行此类干预的医院及时运送和再灌注。本研究探讨了智能手机应用程序（SMART AMI-ACS App）的实施，以促进实时心电共享，加强STEMI管理中的沟通和决策。方法本多中心研究评估了2022年4月1日至2023年3月31日期间管理疑似STEMI患者的介入性心脏病专家和急诊医学（EM）医生对App的实施、可接受性和使用情况。在Reach、有效性、采用、实施、维护（RE-AIM）框架的指导下，使用STEMI注册数据和来自加拿大安大略省一家大型区域心脏中心及其13个合作伙伴急诊科的实施后调查来评估App的使用情况和有效性。结果在12个月的评估中，符合条件的300名地区急诊医生中有254名（84%）下载了该应用程序，并发送了来自724名患者的1400张心电图像。用户报告称，该应用程序有助于沟通和安排护理时间。未观察到心电图图像的退化。应用程序的使用与较低的室内外（DIDO）时间(48分钟（IQR 31-67）和55分钟（IQR 39 - 77）有关，并且接受介入心脏病学治疗的非stemi病例比例较低（22%对39%，p < 0.0001）。结论SMART AMI-ACS App的使用是阳性的，可能与较低的非stemi病例和较低的DIDO时间有关。该应用程序为医疗保健提供者之间的信息通信和护理点图像传输提供了安全通道。这款应用已经扩展到其他地区。

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引用次数: 0

Coronary artery disease and cancer: Shared risk factors, pathogenesis, and treatment effects 冠状动脉疾病和癌症：共同的危险因素、发病机制和治疗效果

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 DOI: 10.1016/j.ahjo.2025.100702

Nicole Charbel , Karl Aramouni , Sam Sater , Firas Kreidieh

As cancer survival improves, cardiovascular health has become an increasingly important concern, particularly given the elevated risk of coronary artery disease (CAD) in patients with cancer. This review examines the complex relationship between cancer and CAD, focusing on shared epidemiological trends, overlapping risk factors, converging pathophysiological mechanisms, and cancer treatment–related cardiovascular toxicities. Cancer and CAD share modifiable risk factors, including obesity, diabetes, hypertension, hyperlipidemia, smoking, alcohol use, physical inactivity, and poor diet, that may act synergistically to promote both conditions. In addition, biological processes such as chronic inflammation, oxidative stress, platelet activation, and clonal hematopoiesis of indeterminate potential further contribute to disease progression. Several cancer therapies, including antimetabolites, platinum-based agents, immune checkpoint inhibitors, tyrosine kinase inhibitors, and radiotherapy, have been implicated in vascular injury, plaque destabilization, and accelerated atherosclerosis, increasing the risk of CAD. Understanding these shared mechanisms is essential for reducing cardiovascular complications in patients with cancer. This review outlines the epidemiology, risk factors, and biological mechanisms linking CAD and cancer, and evaluates the cardiotoxic effects of commonly used cancer therapies.

随着癌症生存率的提高，心血管健康已成为越来越重要的问题，特别是考虑到癌症患者冠状动脉疾病（CAD）的风险升高。本文综述了癌症和CAD之间的复杂关系，重点关注共同的流行病学趋势、重叠的危险因素、趋同的病理生理机制以及癌症治疗相关的心血管毒性。癌症和CAD有共同的可改变的危险因素，包括肥胖、糖尿病、高血压、高脂血症、吸烟、饮酒、缺乏运动和不良饮食，这些因素可能协同作用，促进这两种疾病的发生。此外，潜在的慢性炎症、氧化应激、血小板活化和克隆造血等生物过程进一步促进疾病进展。一些癌症治疗，包括抗代谢物、铂类药物、免疫检查点抑制剂、酪氨酸激酶抑制剂和放疗，都与血管损伤、斑块不稳定和动脉粥样硬化加速有关，增加了冠心病的风险。了解这些共同机制对于减少癌症患者的心血管并发症至关重要。本文综述了CAD与癌症的流行病学、危险因素和生物学机制，并评价了常用的癌症治疗方法的心脏毒性作用。

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引用次数: 0

The gut-heart axis: Exploring the role of the gut microbiome in cardiovascular health – A focused systematic review 肠-心轴：探索肠道微生物组在心血管健康中的作用-一项重点系统综述

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 DOI: 10.1016/j.ahjo.2025.100687

Yahya Makkieh , Haider Hussain Shah , Sakan Binte Imran , Shadman Mahmood Khan Pathan , Anagha Chirayath Saju , Mounica Majooju , Aastha Garg , Tarun Naag , Rabeeul Islam , Cheeranthodika Fahima , Ramsha Ali

This focused systematic review examines the role of the gut microbiota in cardiovascular disease (CVD). The review explores mechanisms linking gut dysbiosis with CVD via microbial metabolites such as trimethylamine-N-oxide (TMAO) and short-chain fatty acids (SCFAs), which affect inflammation, endothelial function, and lipid metabolism. Interventions including dietary modifications, probiotics, prebiotics, fecal microbiota transplantation, and pharmacological agents such as statins, rifaximin, and empagliflozin are evaluated for their impact on microbial composition and cardiovascular outcomes. Probiotic strains and fiber-rich diets demonstrated modest improvements in blood pressure, lipid profiles, and inflammatory markers. Studies revealed that gut microbiome alterations influence drug metabolism and bleeding risk in patients taking oral anticoagulants. Limited evidence suggests that modulation of the microbiota may reduce chemotherapy-induced cardiotoxicity. However, only nine eligible studies met the inclusion criteria, reflecting the early and heterogeneous nature of this research area. Consequently, these findings should be interpreted as exploratory and hypothesis-generating. The focused review emphasizes the need for large-scale trials to validate microbiome-targeted strategies in CVD prevention and management. This focused systematic review is registered with PROSPERO (ID: CRD420251022190).

这篇集中的系统综述探讨了肠道微生物群在心血管疾病（CVD）中的作用。本综述通过微生物代谢物如三甲胺- n -氧化物（TMAO）和短链脂肪酸（SCFAs）探讨了肠道生态失调与心血管疾病之间的联系机制，这些代谢物影响炎症、内皮功能和脂质代谢。干预措施包括饮食调整、益生菌、益生元、粪便微生物群移植和他汀类药物、利福昔明和恩格列净等药物对微生物组成和心血管结局的影响进行了评估。益生菌菌株和富含纤维的饮食在血压、血脂和炎症标志物方面表现出适度的改善。研究表明，肠道微生物组的改变会影响口服抗凝药物患者的药物代谢和出血风险。有限的证据表明，微生物群的调节可能会减少化疗引起的心脏毒性。然而，只有9项符合纳入标准的研究，反映了该研究领域的早期和异质性。因此，这些发现应该被解释为探索性和假设生成。重点综述强调需要大规模试验来验证心血管疾病预防和管理中的微生物组靶向策略。该重点系统评价已在PROSPERO注册（ID: CRD420251022190）。

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引用次数: 0

Differential effects of pre-procedural atorvastatin versus rosuvastatin on hematologic and inflammatory markers in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: A randomized controlled trial 一项随机对照试验：术前阿托伐他汀与瑞舒伐他汀对st段抬高型心肌梗死患者经皮冠状动脉介入治疗后血流变和炎症指标的差异影响

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice

Pub Date : 2026-01-01 DOI: 10.1016/j.ahjo.2025.100701

Ramin Khameneh Bagheri , Ali Eshraghi , Hasan Amirsoleimani , Faeze Keihanian

Background

The pleiotropic effects of statins may benefit patients with acute coronary syndromes. This study compared the impact of pre-procedural atorvastatin versus rosuvastatin on hematologic and inflammatory indexes in the hyper-acute setting of ST-elevation myocardial infarction (STEMI).

Methods

In this pre-specified, multi-centric, triple-blind trial, STEMI patients were randomized to receive either 80-mg atorvastatin (n = 98) or 40-mg rosuvastatin (n = 102) before primary percutaneous coronary intervention (PPCI). Key hematologic indexes—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet distribution width (PDW)—were measured at baseline, 24, and 48 h post-PPCI. Contrast-induced nephropathy (CIN) incidence was also assessed.

Results

The incidence of CIN was similarly low in both groups (atorvastatin 3.0 % vs. rosuvastatin 3.5 %, p = 0.99). However, hematologic markers showed significant differences. The atorvastatin group had a significantly lower NLR at 48 h compared to the rosuvastatin group (Median [IQR]: 5.1 [3.2–8.1] vs. 7.8 [4.9–10.2], p = 0.003). Conversely, the rosuvastatin group demonstrated a significantly higher PDW at 24 h (15.6 ± 1.5 vs. 14.7 ± 1.5, p < 0.001). No significant inter-group difference was found in the 48-h PLR.

Conclusion

While both high-intensity statins provided similar nephroprotection, they exhibited distinct modulatory effects. Atorvastatin was associated with a more pronounced anti-inflammatory effect (lower NLR), whereas rosuvastatin was linked to increased platelet activity (higher PDW). These findings suggest differential pleiotropic properties that warrant further investigation for their impact on clinical outcomes.

Registry Accessibility: http://irct.ir/trial/27377

Trial registration code: IRCT2017101236737N1.

背景：他汀类药物的多效性可能使急性冠脉综合征患者受益。本研究比较了手术前阿托伐他汀与瑞舒伐他汀对st段抬高型心肌梗死（STEMI）超急性背景下血液和炎症指标的影响。方法在这项预先指定的多中心三盲试验中，STEMI患者在经皮冠状动脉介入治疗（PPCI）前随机接受80 mg阿托伐他汀（n = 98）或40 mg瑞舒伐他汀（n = 102）。关键的血液学指标-中性粒细胞与淋巴细胞比率（NLR），血小板与淋巴细胞比率（PLR）和血小板分布宽度(PDW) -在ppci后基线，24和48小时进行测量。对比剂肾病（CIN）的发生率也进行了评估。结果两组CIN的发生率相似（阿托伐他汀3.0% vs瑞舒伐他汀3.5%,p = 0.99）。然而，血液学指标显示有显著差异。阿托伐他汀组48 h NLR显著低于瑞舒伐他汀组（中位数[IQR]: 5.1[3.2-8.1]比7.8 [4.9-10.2],p = 0.003）。相反，瑞舒伐他汀组在24 h时PDW显著升高（15.6±1.5 vs. 14.7±1.5,p < 0.001）。48h PLR组间差异无统计学意义。结论两种高强度他汀类药物具有相似的肾保护作用，但具有不同的调节作用。阿托伐他汀与更明显的抗炎作用（更低的NLR）相关，而瑞舒伐他汀与血小板活性增加（更高的PDW）相关。这些发现表明不同的多效性特性值得进一步研究其对临床结果的影响。注册中心访问：http://irct.ir/trial/27377Trial注册代码：IRCT2017101236737N1。

{"title":"Differential effects of pre-procedural atorvastatin versus rosuvastatin on hematologic and inflammatory markers in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: A randomized controlled trial","authors":"Ramin Khameneh Bagheri , Ali Eshraghi , Hasan Amirsoleimani , Faeze Keihanian","doi":"10.1016/j.ahjo.2025.100701","DOIUrl":"10.1016/j.ahjo.2025.100701","url":null,"abstract":"<div><h3>Background</h3><div>The pleiotropic effects of statins may benefit patients with acute coronary syndromes. This study compared the impact of pre-procedural atorvastatin versus rosuvastatin on hematologic and inflammatory indexes in the hyper-acute setting of ST-elevation myocardial infarction (STEMI).</div></div><div><h3>Methods</h3><div>In this pre-specified, multi-centric, triple-blind trial, STEMI patients were randomized to receive either 80-mg atorvastatin (<em>n</em> = 98) or 40-mg rosuvastatin (<em>n</em> = 102) before primary percutaneous coronary intervention (PPCI). Key hematologic indexes—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet distribution width (PDW)—were measured at baseline, 24, and 48 h post-PPCI. Contrast-induced nephropathy (CIN) incidence was also assessed.</div></div><div><h3>Results</h3><div>The incidence of CIN was similarly low in both groups (atorvastatin 3.0 % vs. rosuvastatin 3.5 %, <em>p</em> = 0.99). However, hematologic markers showed significant differences. The atorvastatin group had a significantly lower NLR at 48 h compared to the rosuvastatin group (Median [IQR]: 5.1 [3.2–8.1] vs. 7.8 [4.9–10.2], <em>p</em> = 0.003). Conversely, the rosuvastatin group demonstrated a significantly higher PDW at 24 h (15.6 ± 1.5 vs. 14.7 ± 1.5, <em>p</em> < 0.001). No significant inter-group difference was found in the 48-h PLR.</div></div><div><h3>Conclusion</h3><div>While both high-intensity statins provided similar nephroprotection, they exhibited distinct modulatory effects. Atorvastatin was associated with a more pronounced anti-inflammatory effect (lower NLR), whereas rosuvastatin was linked to increased platelet activity (higher PDW). These findings suggest differential pleiotropic properties that warrant further investigation for their impact on clinical outcomes.</div><div>Registry Accessibility: <span><span>http://irct.ir/trial/27377</span><svg><path></path></svg></span></div><div>Trial registration code: IRCT2017101236737N1.</div></div>","PeriodicalId":72158,"journal":{"name":"American heart journal plus : cardiology research and practice","volume":"61 ","pages":"Article 100701"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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