Canadian Journal of Cardiology最新文献

Hypertension is a leading contributor to global morbidity and mortality, arising from the interplay of genetic and environmental risk factors together with the dysregulation of multiple physiological systems involved in blood pressure control. Recent advances have established the gut as a central regulator, implicating the intestinal microbiota and barrier integrity in the modulation of blood pressure. Alterations in the gut microbial consortium, along with changes in levels of metabolites produced by the microbiota, have been associated with blood pressure regulation in animal models and human studies. Key microbial metabolites, including short-chain fatty acids, trimethylamine-N-oxide, and bile acids influence endothelial function, immune activation, and renal signalling pathways. Concurrently, intestinal permeability facilitates the translocation of microbial products, such as lipopolysaccharides, and triggers systemic inflammation, which leads to renal and vascular dysfunction. Diet plays a pivotal role in shaping microbiome composition and barrier integrity. Western-style diets rich in saturated fats, sugars, and processed additives promote gut dysbiosis and increased permeability, whereas fibre-rich, plant-based diets support microbial diversity, short-chain fatty acid production, and tight-junction integrity. In this review we provide a synthesises the current evidence that links diet, microbiota, and gut permeability to hypertension, and integrate mechanistic insights from preclinical models with emerging human data. We propose a conceptual framework in which the gut serves as a modifiable target for the prevention and treatment of hypertension. By exploring dietary strategies that restore microbial balance and barrier function, we underscore the potential of integrative, gut-targeted approaches to address a major global health burden.

Gene-based molecular therapies (GMTs) have the potential to transform cardiovascular care through single-administration interventions with durable or curative effects. While RNA-based therapies such as inclisiran are already approved for lipid lowering, no in vivo gene addition or gene editing therapy has yet received approval for a primary cardiovascular indication. As these therapies approach clinical readiness, their adoption will be shaped less by scientific feasibility than by economic viability. This commentary examines the key economic barriers to pricing, reimbursement, and adoption of cardiovascular GMTs, and reviews emerging payment models aimed at aligning cost with long-term therapeutic value.

Background: To date, the optimal revascularization strategy for patients with ostial left circumflex artery (LCX) lesions has not been established. In this study we sought to assess the cardiovascular outcomes of the crossover stenting (CSI) and ostial stent implantation (OSI) for the ostial LCX lesions under long-term follow-up.

Methods: This large-scale, multicenter (n = 12), observational retrospective study included 414 patients (290 [70%] men and 124 women, mean age 64.95 ± 11.73 years) who underwent PCI with CSI or OSI for ostial LCX lesions between 2014 and 2025. The primary outcome was major adverse cardiac events (MACE), including cardiac death, target lesion revascularization, and target vessel myocardial infarction.

Results: The study cohort was divided into 2 groups as OSI (n = 212) and CSI (n = 202). SYNTAX scores and the use of intravascular imaging rates were similar in both groups. Side-branch (left anterior descending artery) interventions were more frequent in the CSI group compared with OSI, with higher rates of side-branch ballooning (36.1% vs 2.8%, P < 0.001) and bailout 2-stent implantation (13.9% vs 5.7%, P = 0.005). The risk-adjusted long-term MACE (hazard ratio [HR] 0.357, P = 0.001), major adverse cardiac and cerebral events (HR 0.397, P = 0.001) significantly differed in individuals with ostial LCX lesions to revascularize with CSI and OSI. In addition, diabetes mellitus, chronic kidney disease, intravascular imaging, reduced left ventricle ejection fraction, high SYNTAX score, and direct stenting were found to be independent predictors of MACE.

Conclusions: The findings from this study suggest that CSI was associated with lower risk-adjusted MACE and MACCE rates, whereas the CSI technique leads to notably higher side-branch interventions.