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Cardiovascular diseases as a primary driver of global morbidity and mortality. Despite the array of therapeutic avenues in clinical practice, predominantly pharmaceutical and surgical interventions, they often fall short of fully addressing the clinical exigencies of cardiovascular patients. In recent years, nanocarriers have shown great potential in the treatment and diagnose of cardiovascular diseases. They can enhance drug targeting and bioavailability while reducing side effects. Additionally, by improving imaging and detection technologies, they enhance early diagnosis and disease monitoring capabilities. These advancements in technology offer new solutions for precision medicine in cardiovascular diseases, advancing treatment efficacy and disease management. Crafted from biomaterials, metals, or their amalgamations, these nanocarriers approximate the dimensions of biologically active molecules like proteins and DNA. Cardiovascular nanomedicine, in its infancy, has only recently burgeoned. Yet, with continual refinement in nanocarrier architecture, drug delivery mechanisms, and therapeutic outcomes, the potential of nanomedical technologies in clinical contexts becomes increasingly evident. This review aims to consolidate the strides made in nanocarrier research concerning the treatment and diagnose of cardiovascular diseases., Competing Interests: Declaration of competing interest The authors have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Cardiovascular diseases (CVDs) and strokes are the leading cause of death worldwide. To estimate the number and incidence of cardiovascular hospitalizations and deaths in adults and children and strokes and acute coronary syndromes (ACS) among pregnant women in France. Using National Health Data, we identified all hospitalizations for CVD in 2022 and cardiovascular deaths in 2021. We also identified all women in the general health insurance scheme who gave birth in France during 2010-2018 after 22 weeks' gestation and all strokes and ACS that occurred during pregnancy and postpartum. In adults in 2022, there were 1,229,003 hospitalizations for CVD among 925,936 adults (59.2% men) for a standardized rate of 1614 per 100,000. This was twice as high in men versus women and increased with age and social deprivation. In 2021, 138,137 adults died of CVD (47.4% men), i.e. 216 per 100,000 adults. Among children born during the first 6 months of 2022, a congenital heart defect (CHD) was identified in 3876 (1068 cases per 100,000 live births). In 2021, 193 children died of a CHD (1.4 per 100,000) and 100 of another CVD (0.7 per 100,000). In the women accounting for the 6.3 million deliveries during 2010-2018, 1261 strokes and 225 ACS were identified during pregnancy and the postpartum period, i.e. respective incidence rates of 24.0 and 4.3 per 100,000 person-years. The burden of CVD calls for large-scale action to improve the prevention, screening and management of CVD in these different populations., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: Older adults with intellectual disabilities (ID) have a high risk of cardiovascular diseases (CVD). At the same time, challenging diagnostic work-up increases the likelihood of underdiagnosis of CVD in this population. To limit this underdiagnosis, it would be beneficial to use objective measures such as the electrocardiogram (ECG). However, little is known about the feasibility of ECG recording and the prevalence of ECG abnormalities in this population. Therefore, the aims of this study were to investigate the feasibility of resting ECG recording, to study the prevalence of ECG abnormalities, and to compare the frequency of ECG abnormalities with medical records in older adults with ID., Method: A cross-sectional study was performed within a cohort of older adults (≥60 years) with ID as part of the Healthy Ageing and Intellectual Disabilities (HA-ID) study. A resting 12-lead ECG was attempted, and the ECG recording was considered feasible if the recording could be made and if the ECG could be interpreted by a cardiologist and the Modular ECG Analysis System (MEANS). ECGs were assessed for the presence of ECG abnormalities and medical record review was performed. If the cardiologist or MEANS concluded that there was evidence of myocardial infarction, atrial fibrillation or QTc prolongation on the ECG in the absence of this ECG diagnosis in the participant's medical record, this was classified as a previously undiagnosed ECG diagnosis., Results: ECG recording was feasible in 134 of the 200 participants (67.0%). Of these 134 participants (70.6 ± 5.8 years; 52.2% female), 103 (76.9%) had one or more ECG abnormality, with the most prevalent being prolonged P-wave duration (27.6%), QTc prolongation (18.7%), minor T-wave abnormalities (17.9%), first degree atrioventricular block (12.7%) and myocardial infarction (6.7%). Eight out of 9 (88.9%) myocardial infarctions and all cases of (significant) QTc prolongation (100%) were previously undiagnosed., Conclusions: This study showed that ECG recording is feasible in the majority of older adults with ID and revealed a substantial underdiagnosis of ECG abnormalities. These results stress the importance of ECG recording and warrant further research into the yield of opportunistic ECG screening in older adults with ID., (© 2024 The Author(s). Journal of Intellectual Disability Research published by John Wiley & Sons and MENCAP.)

To reduce morbidity and mortality rates of cardiovascular disease, an urgent need exists to improve cardiovascular health among US adults. In 2022, the American Heart Association issued Life's Essential 8, which identifies and defines 8 health behaviors and factors that, when optimized through a combination of primary prevention, risk factor management, and effective treatments, can promote ideal cardiovascular health. Because of its central role in patient care across the life span, primary care is in a strategic position to promote Life's Essential 8 and improve cardiovascular health in the United States. High-quality primary care is person-centered, team-based, community-aligned, and designed to provide affordable optimized health care. The purpose of this scientific statement from the American Heart Association is to provide evidence-based guidance on how primary care, as a field and practice, can support patients in implementing Life's Essential 8. The scientific statement aims to describe the role and functions of primary care, provide evidence for how primary care can be leveraged to promote Life's Essential 8, examine the role of primary care in providing access to care and mitigating disparities in cardiovascular health, review challenges in primary care, and propose solutions to address challenges in achieving Life's Essential 8.

Background and Aim: During the last few years, the Seven Countries Study of Cardiovascular Diseases (SCS) produced some new analyses dealing with the relationships of a dietary score, the pool of dietary fatty acids and serum cholesterol with major types of cardiovascular disease (CVD) mortality in 10 cohorts of 6 countries made of middle-aged men followed-up for 60 years until extinction. This sparse evidence is condensed here to provide a coherent view., Methods and Results: The Mediterranean Adequacy Index (MAI, a dietary score whose high levels depict the characteristics of the Mediterranean Diet), was highly and significantly associated in an inverse way, at country levels, with the Atherogenicity (ATI) and the Thrombogenicity (THI) indexes that included a series of dietary fatty acids. These indexes were highly and significantly associated in a direct way with country baseline serum cholesterol levels. Countries with high serum cholesterol had largely higher death rates from coronary heart disease (CHD) and lower rates from other heart diseases of uncertain etiology and stroke. The reverse was observed in countries with low serum cholesterol., Conclusion: The chain of diet, dietary fatty acids and serum cholesterol seems to be responsible in various ways for the different distribution of major CVD mortality subtypes in extincted cohorts., Competing Interests: Declaration of competing interest The authors report no relationships that could be construed as a conflict of interest. The authors certify that they complied with the Principles of Ethical Publishing Rules., (Copyright © 2024 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. All rights reserved.)

Using a systematic meta-analysis, we investigated if patients with type 2 diabetes (T2D) and with varying baseline blood pressure (BP) differ in the cardiorenal benefits received from sodium-glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs). Design: Randomized, placebo-controlled, cardiovascular outcome trials (CVOTs) of SGLT-2is and GLP-1RAs were identified from MEDLINE, Embase, and the Cochrane Library up to April 2024. Hazard ratios (HRs) with 95% CIs were pooled. The differential treatment effect by baseline BP category within each trial was estimated as the ratio of the HR (RHR) and pooled. Results: Seventeen publications based on 9 unique CVOTs (4 SGLT-2is and 5 GLP-1RAs) were eligible. In participants with normal baseline BP, comparing SGLT-2is with placebo, the HRs (95% CIs) were 0.88 (0.79-0.97) for major adverse cardiovascular events (MACE), 0.73 (0.59-0.91) for heart failure (HF) hospitalization, 0.78 (0.65-0.94) for composite CVD death/HF hospitalization, and 0.55 (0.41-0.73) for composite renal outcome. The corresponding estimates for participants with higher baseline BP were 0.88 (0.81-0.96), 0.67 (0.57-0.79), 0.73 (0.65-0.82), and 0.61 (0.48-0.77), respectively. In participants with normal baseline BP, GLP-RAs had no strong effect on MACE, stroke and nephropathy, but reduced stroke and nephropathy risk in those with higher baseline BP. Estimated RHRs showed no statistical evidence that baseline BP modified the cardiorenal benefits of SGLT-2is and GLP-1RAs. Conclusions: In patients with T2D, the cardiorenal benefits of treatment with SGLT2-Is and GLP1-RAs were similar in patients with normal baseline BP compared to those with a higher baseline BP.

Aims: Skin perfusion pressure (SPP) and ankle-brachial index (ABI) are useful in screening for peripheral arterial disease in patients undergoing hemodialysis (HD). We compared the prognostic abilities of the SPP and ABI in predicting the composite outcomes of mortality and atherosclerotic vascular events., Methods: This single-center prospective cohort study enrolled 258 patients undergoing HD. The patients with SPP and ABI measurements were divided into tertiles. Log-rank tests, Cox regression analyses, and discrimination parameters were used for comparisons., Results: Over a median follow-up period of 3.7 (1.4-5.0) years, 119 composite events were recorded. The incidence rates of composite events were 27.5, 13.3, and 9.1 per 100 person years, respectively, across the SPP tertiles (log-rank: p＜0.001), and 23.2, 13.2, and 11.6 per 100 person years across the ABI tertiles (p=0.003). With the 3rd tertiles as references, the 1st tertiles of the SPP and ABI were significantly associated with the composite outcome (adjusted hazard ratio [aHR]: 2.58, 95% confidence interval [CI]: 1.57-4.23 and aHR: 1.70, 95% CI: 1.06-2.73, respectively). Adding the tertiles of the SPP to a predictive model with established risk factors significantly improved the model performance. This improvement was larger than that of the ABI in terms of net reclassification (0.330 vs. 0.275) and integrated discrimination (0.045 vs. 0.012). Furthermore, in patients with a normal ABI, the 1st SPP tertile (＜71 mmHg) was significantly associated with the outcome (aHR, 1.97; 95% CI, 1.13-3.41) when compared to the 3rd tertile., Conclusions: Even patients with a normal ABI have a poor prognosis if their SPP levels are low. SPP outperformed ABI in predicting mortality and cardiovascular outcomes in HD patients.

Aim: To identify risk factors associated with major adverse cardiovascular events (MACE) and malignancies in patients with rheumatoid arthritis (RA) using real-world data from Japan., Methods: This cohort study used the Real World Data database of medical institutions in Japan. Eligible patients (January 2013-December 2021) had ≥ 1 RA diagnosis, were aged ≥ 18 years, prescribed ≥ 1 antirheumatic drug, had no psoriasis diagnosis, and had a record postindex. Patients had no myocardial infarction/stroke ≤ 31 days (MACE cohort) or malignancy < 1 year (malignancy cohort) before index. Cohorts were determined by incidence of initial MACE or malignancy. Known/exploratory variables were selected using Cox regression models., Results: Across MACE (n = 16 012) and malignancy (n = 14 545) cohorts, most patients were female and aged ≥ 65 years. Overall, 214 MACE per 43964.7 patient-years (incidence rate 0.49 per 100 patient-years) and 315 malignancies per 40251.6 patient-years (incidence rate 0.78 per 100 patient-years) occurred. Male sex, older age (≥ 65 years), hypertension, renal disease, cerebrovascular disease, and prior X-ray examination were significantly associated with increased MACE risk. Male sex, older age (≥ 50 years), nonsteroidal anti-inflammatory drug use, emphysema, serious infection, malignancy history, and prior X-ray examination were significantly associated with increased malignancy risk. Conversely, glucocorticoid use and fracture diagnosis were significantly associated with reduced malignancy risk., Conclusion: In patients with RA in Japan, male sex, older age, and prior X-ray examination were associated with increased MACE and malignancy risk., (© 2024 The Author(s). International Journal of Rheumatic Diseases published by Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Aims: The objective of this research is to develop an effective cardiovascular disease prediction framework using machine learning techniques and to achieve high accuracy for the prediction of cardiovascular disease., Methods: In this paper, we have utilized machine learning algorithms to predict cardiovascular disease on the basis of symptoms such as chest pain, age and blood pressure. This study incorporated five distinct datasets: Heart UCI, Stroke, Heart Statlog, Framingham and Coronary Heart dataset obtained from online sources. For the implementation of the framework, RapidMiner tool was used. The three-step approach includes pre-processing of the dataset, applying feature selection method on pre-processed dataset and then applying classification methods for prediction of results. We addressed missing values by replacing them with mean, and class imbalance was handled using sample bootstrapping. Various machine learning classifiers were applied out of which random forest with AdaBoost dataset using 10-fold cross-validation provided the high accuracy., Results: The proposed model provides the highest accuracy of 99.48% on Heart Statlog, 93.90% on Heart UCI, 96.25% on Stroke dataset, 86% on Framingham dataset and 78.36% on Coronary heart disease dataset, respectively., Conclusions: In conclusion, the results of the study have shown remarkable potential of the proposed framework. By handling imbalance and missing values, a significantly accurate framework has been established that could effectively contribute to the prediction of cardiovascular disease at early stages., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Traditionally, machine learning-based clinical prediction models have been trained and evaluated on patient data from a single source, such as a hospital. Cross-validation methods can be used to estimate the accuracy of such models on new patients originating from the same source, by repeated random splitting of the data. However, such estimates tend to be highly overoptimistic when compared to accuracy obtained from deploying models to sources not represented in the dataset, such as a new hospital. The increasing availability of multi-source medical datasets provides new opportunities for obtaining more comprehensive and realistic evaluations of expected accuracy through source-level cross-validation designs. In this study, we present a systematic empirical evaluation of standard K-fold cross-validation and leave-source-out cross-validation methods in a multi-source setting. We consider the task of electrocardiogram based cardiovascular disease classification, combining and harmonizing the openly available PhysioNet/CinC Challenge 2021 and the Shandong Provincial Hospital datasets for our study. Our results show that K-fold cross-validation, both on single-source and multi-source data, systemically overestimates prediction performance when the end goal is to generalize to new sources. Leave-source-out cross-validation provides more reliable performance estimates, having close to zero bias though larger variability. The evaluation highlights the dangers of obtaining misleading cross-validation results on medical data and demonstrates how these issues can be mitigated when having access to multi-source data., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Chronic kidney disease and dialysis-dependent end-stage renal disease are increasing in prevalence in the United States. The costs associated with end-stage renal disease management comprise approximately 1% of the federal government's annual budget. Chronic kidney disease and end-stage renal disease cause significant derangements of the cardiac and vascular system. Pathophysiologic hallmarks include alterations of the renin-angiotensin system, chronically increased sympathetic tone, calcium and phosphate imbalance, pro-inflammatory cytokine release, and uremic toxin accumulation. This results in several pathologies specific to the cardiac and vascular systems, which will each be reviewed separately herein., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Published by Elsevier Inc.)

In 2020, the NIH and FDA issued guidance documents that laid the foundation for human subject research during an unprecedented pandemic. To bridge these general considerations to actual applications in cardiovascular interventional device trials, the PAndemic Impact on INTErventional device ReSearch (PAIINTERS) Working Group was formed in early 2021 under the Predictable And Sustainable Implementation Of National CardioVascular Registries (PASSION CV Registries). The PAIINTER's Part I report, published by Rymer et al. [5], provided a comprehensive overview of the operational impact on interventional studies during the first year of the Pandemic. PAIINTERS Part II focused on potential statistical issues related to bias, variability, missing data, and study power when interventional studies may start and end in different pandemic phases. Importantly, the paper also offers practical mitigation strategies to adjust or minimize the impact for both SATs and RCTs, providing a valuable resource for researchers and professionals involved in cardiovascular clinical trials., Competing Interests: Declaration of competing interest The authors of this publication include representatives employed by Boston Scientific, Abbott Cardiovascular, Edwards Lifesciences, FDA, Medtronic, Columbia University, Yale University, and Duke University., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Elevated concentrations of low-density lipoprotein cholesterol (LDL-C) are highly prevalent and are associated with the development of cardiovascular diseases., Aim: To estimate the proportion of cardiovascular disease cases attributable to high concentrations of LDL-C (population attributable fraction [PAF]) in France in 2017, based on the most recent individual data on LDL-C, and the attributable burden on hospitalizations and death., Methods: We estimated the PAF of high LDL-C concentrations for ischaemic heart disease (IHD), ischaemic stroke and aortic valve stenosis (AVS). Distributions of LDL-C concentrations were obtained from the most recent French health examination representative survey (ESTEBAN). The relative risks of each disease per 1-mmol/L increase in blood LDL-C were obtained either from the most appropriate meta-analyses or from Mendelian randomization., Results: The PAF of high LDL-C concentrations varied between 44.2% (95% CI 24.6%-60.5%) for IHD-related death and 49.4% (95% CI 35.6-60.8%) for IHD-related years-of-life lost (YLL), 22.5% (95% CI 0.0-43.3%) and 25.5% (95% CI 11.6-36.8%) for ischaemic stroke indicators, and 29.0% (95% CI 8.6-45.4%) and 29.3% (95% CI 8.4-45.6%) for AVS indicators. Overall, 230,000 hospitalizations, 1,303,000 prevalent cases and 23,000 deaths were estimated to be attributable to high LDL-C concentrations, with most cases related to IHD. PAFs were similar across sex and cardiovascular diseases, whereas PAF strongly varied with age for IHD and ischaemic stroke, with PAF reaching 80.6% (95% CI 55.3-92.7%) and 60.9% (95% CI 33.8-80.8%), respectively, in the group aged 35-44 years., Conclusion: The high estimated PAF of elevated LDL-C concentrations for IHD, ischaemic stroke and AVS support the urgent need to reduce the prevalence of hypercholesterolaemia in this French population., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: The prognosis of individuals with and without an established heart failure (HF) diagnosis and similarly elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels is not well-known., Methods and Results: CANVAS (Canagliflozin Cardiovascular Assessment Study) trial participants were stratified according to baseline NT-proBNP quartiles and history of HF at baseline. Adjusted event rates per 1000 patient-years of follow-up for hospitalizations for HF, cardiovascular mortality, and kidney events were assessed, and hazard ratios (HR) were calculated using Cox proportional hazard models. Of the 3507 participants with available NT-proBNP concentrations, 471 (13.4%) had history of HF. The incidence rate per 1000 patient-years for hospitalizations for HF increased across the NT-proBNP quartiles in patients with (0, 2.8, 13.4, and 40.1; P < .001) and without (1.8, 3.1, 6.0, and 19.1; P < .001) HF, with a significantly higher risk in patients with HF compared with those without (with HF, quartile 3 HR 9.28 [interquartile range (IQR) 1.15-75.05]; P = .04; without HF, quartile 4 HR 4.86 [95% CI, 2.08-11.35]; P < .001). A similar higher risk for kidney events was seen in HF patients (with HF, quartile 4 HR 6.94 [95% CI, 2.66-18.08]; P = .001; without HF, quartile 4 HR 4.85 [95% CI, 3.02-7.80]; P = .001). Similar trends were seen for cardiovascular mortality., Conclusions: Among patients with type 2 diabetes and cardiovascular risk, an elevated NT-proBNP level was associated with worse HF and kidney outcomes in general, regardless of history of HF; however, the presence of a clinical diagnosis of HF at baseline was associated with an incrementally higher risk, particularly in higher NT-proBNP quartiles., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Inflammatory bowel diseases (IBD) are chronic inflammatory and pathological conditions of the gastrointestinal tract, which include two main clinical subtypes: Crohn's disease (CD) and ulcerative colitis (UC). IBDs show an increase in their age-standardized global incidence rate worldwide, with no gender differences, although the age-standardized mortality rate has decreased over the years. Indeed, thanks to recent therapies with novel mechanisms of action, including those with biologics and small molecules, it has been possible to reduce the mortality rate of IBDs. However, a significant percentage of IBD patients remain refractory to these multiple advanced therapies. Therefore, another challenge of IBD research remains the development of novel therapies with novel agents or cells that could improve the quality of life and outcome of IBD patients. Furthermore, another aspect to be studied in IBDs is not only the high risk of progression not only to neoplastic transformation but also to the development of cardiovascular disease (CVD). Consequently, 25-40 % of IBD patients present with cardiovascular manifestations. Here, we propose that the altered number and functions of endothelial progenitor cells (EPCs) may represent one of the crucial mechanisms associated with incomplete/delayed healing of IBD and may offer the possibility of using them, as well as their vesicles and content, as novel biomarkers and potential candidates of cell therapy for IBD. The advantages and limitations are extensively described and discussed., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Cardiovascular diseases (CVDs) have a multifactorial origin. Among the risk factors, so-called behavioural risk factors play a major role in the onset of these diseases: smoking, unhealthy diet, lack of physical activity and sedentary lifestyle, alcohol, sleep disorders, depression and illicit drug use are among the main behavioural risk factors for CVD and are considered to be modifiable and accessible to prevention. The prevalence of these cardiovascular risk factors remains high among the French population. Nearly one in three adults are smokers, 71.7% do not meet the recommendation to eat five fruits and vegetables per day, and 4 out of 5 adults consume more than 6g of salt per day. Further, 38.7% of adults do not meet the recommendations for physical activity, 40.8% have a high level of sedentary, 49.4% report sleep problems in the last 8 days, and 12.5% have had a major depressive episode in the last 12 months. Despite some positive trends, such as an increase in the level of physical activity among men and the decline in smoking prevalence, the epidemiological situation regarding these risk factors remains a cause for concern in France. While the gap between risk factors in men and women is narrowing, this is often due to a worsening of the situation among women, who are increasingly adopting unfavourable behaviours and tending to reach the higher levels of risk factors traditionally observed among men. The epidemiological situation demonstrates the urgent need to strengthen policies to prevent these risk factors., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Cardiovascular disease (CVD) is the leading cause of mortality in women. We aimed to assess whether adding female-specific risk factors to traditional factors could improve CVD risk prediction., Methods: We used a cohort of women from the UK Biobank Study aged 45 to 69 years, free of CVD at baseline (2006-2010) followed until the end of 2019. We developed Cox proportional hazards models using the risk factors included in 3 contemporary CVD risk calculators: Pooled Cohort Equation - Atherosclerotic Cardiovascular Disease, Qrisk2, and PREDICT. We added each of the following female-specific risk factors, individually and all together, to determine if these improved measures of discrimination and calibration for predicting CVD: early menarche (<11 years), endometriosis, excessive, frequent or irregular menstruation, miscarriage, number of miscarriages, number of stillbirths, infertility, preeclampsia or eclampsia, gestational diabetes (without subsequent type 2 diabetes), premature menopause (<40 years), early menopause (<45 years), and natural or surgical early menopause (menopause <45 years or timing of menopause reported as unknown and oophorectomy reported at age <45)., Results: In the model of 135 142 women (mean age, 57.5 years; SD, 6.8) using risk factors from Pooled Cohort Equation - Atherosclerotic Cardiovascular Disease, CVD incidence was 5.3 per 1000 person-years. The c-indices for the Pooled Cohort Equation - Atherosclerotic Cardiovascular Disease, Qrisk2, and PREDICT models were 0.710, 0.713, and 0.718, respectively. Adding each of the female-specific risk factors did not improve the c-index, the net reclassification index, the integrated discrimination index, the slope of the regression line for predicted versus observed events, and the Brier score or plots of calibration. Adding all female-specific risk factors simultaneously increased the c-index for the Pooled Cohort Equation - Atherosclerotic Cardiovascular Disease, Qrisk2, and PREDICT models to 0.712, 0.715, and 0.720, respectively., Conclusions: Although several female-specific factors have been shown to be early indicators of CVD risk, these factors should not be used to reclassify risk in women aged 45 to 69 years when considering whether to commence a blood pressure or lipid-lowering medication., Competing Interests: None.

Cardiovascular disease is the leading cause of death worldwide, and the second leading cause in France. Among the modifiable cardiovascular risk factors, metabolic diseases (hypertension, low-density lipoprotein hypercholesterolaemia, diabetes and obesity) play a major role, contributing to the development and progression of atherosclerosis. This review summarizes the latest epidemiological data available at a national level. In 2015, the prevalence among adults aged 18-74years was 17.2% for obesity, 7.4% for diabetes, 30.6% for hypertension, 23.3% for low-density lipoprotein hypercholesterolaemia and 1.5% for stage 3-5 chronic kidney disease. Awareness of these diseases among affected individuals was very poor, ranging from 23% for diabetes to 45% for hypertension. While the prevalence of obesity and hypertension remained stable between 2006 and 2015, the prevalence of diabetes increased significantly. Prevention of these risk factors, particularly through nutrition, as well as awareness and management of them, must be intensified to reduce the burden of cardiovascular diseases in France. Whereas the prevalence of metabolic factors remains higher in men, particular attention should also be paid to risk factors specific to women, such as gynaecological diseases (endometriosis, polycystic ovary syndrome) and pregnancy disorders (hypertensive disorders in pregnancy, gestational diabetes), which contribute significantly to cardiovascular risk., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Subtle, prognostically important ECG features may not be apparent to physicians. In the course of supervised machine learning, thousands of ECG features are identified. These are not limited to conventional ECG parameters and morphology. We aimed to investigate whether neural network-derived ECG features could be used to predict future cardiovascular disease and mortality and have phenotypic and genotypic associations., Methods: We extracted 5120 neural network-derived ECG features from an artificial intelligence-enabled ECG model trained for 6 simple diagnoses and applied unsupervised machine learning to identify 3 phenogroups. Using the identified phenogroups, we externally validated our findings in 5 diverse cohorts from the United States, Brazil, and the United Kingdom. Data were collected between 2000 and 2023., Results: In total, 1 808 584 patients were included in this study. In the derivation cohort, the 3 phenogroups had significantly different mortality profiles. After adjusting for known covariates, phenogroup B had a 20% increase in long-term mortality compared with phenogroup A (hazard ratio, 1.20 [95% CI, 1.17-1.23]; P <0.0001; phenogroup A mortality, 2.2%; phenogroup B mortality, 6.1%). In univariate analyses, we found phenogroup B had a significantly greater risk of mortality in all cohorts (log-rank P <0.01 in all 5 cohorts). Phenome-wide association study showed phenogroup B had a higher rate of future atrial fibrillation (odds ratio, 2.89; P <0.00001), ventricular tachycardia (odds ratio, 2.00; P <0.00001), ischemic heart disease (odds ratio, 1.44; P <0.00001), and cardiomyopathy (odds ratio, 2.04; P <0.00001). A single-trait genome-wide association study yielded 4 loci. SCN10A , SCN5A , and CAV1 have roles in cardiac conduction and arrhythmia. ARHGAP24 does not have a clear cardiac role and may be a novel target., Conclusions: Neural network-derived ECG features can be used to predict all-cause mortality and future cardiovascular diseases. We have identified biologically plausible and novel phenotypic and genotypic associations that describe mechanisms for the increased risk identified., Competing Interests: None.

Aims: The utilization of sulfonylurea (SU) for the management of Type 2 Diabetes Mellitus (T2DM) has witnessed a decline, attributed to the rising popularity of alternative medications and uncertainties surrounding the cardiovascular risk profile of SUs. This study aimed to investigate the potential association between SU intake and the incidence of cardiovascular events in patients with T2DM., Methods: A retrospective cohort study, based on a general practice (GP) registry, was designed, encompassing patients diagnosed with T2DM between 2005 and 2014.Follow-up persisted until the occurrence of a cardiovascular event, loss to follow-up, or until December 31, 2022. Comparative analyses were conducted between patients, receiving SU treatment and those without RESULTS: Data from a cohort comprising 5589 patients revealed that 13 % and 13.1 % of individuals in the comparator group and the SU group, respectively, experienced a cardiovascular event. However, no statistically significant elevation in the risk of cardiovascular events was observed after SU usage. Furthermore, the glycated haemoglobin (HbA1c) levels were significantly higher in the SU group (7.0 % vs. 6.4 %, p < 0.001)., Conclusions: The findings from this study indicate that the use of sulfonylureas SUs is not associated with a statistically significant increase in the risk of cardiovascular events among patients with type T2DM. These results contribute to the ongoing discourse on the safety and efficacy of SU therapy in diabetes management., Competing Interests: Conflict of Interest There were no conflicts of interest for this study., (Copyright © 2024 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Aim: Arterial stiffness, a significant cardiovascular risk marker, is particularly important in patients with diabetes mellitus (DM). Pulse wave velocity (PWV), a non-invasive measure of arterial stiffness, has emerged as an independent predictor of cardiovascular morbidity and mortality. However, its precise prognostic value in DM patients for cardiovascular risk stratification remains unclear. To address this, a systematic review was conducted., Method: A thorough search of Ovid and Scopus databases was performed for cohort studies on PWV measurements for cardiovascular risk stratification in DM patients. Nine studies were included, examining the relationship between PWV and cardiovascular events or composite endpoints in DM patients asymptomatic of cardiovascular diseases (CVD)., Results: The review revealed that optimal PWV cutoffs to predict composite cardiovascular events ranged from 10 to 12.16 m/s (aortic PWV) and 14 to 16.72 m/s (brachial-ankle PWV). In addition, meta-analysis yielded a HR of 1.15 (95 % CI 1.07-1.24, p < 0.001, I 2  = 70 %) for aortic PWV in predicting cardiovascular events., Conclusion: The assessment of arterial stiffness via PWV shows promise as an early diagnostic marker for CVD in DM patients, aiding in improved disease management. This underscores the potential of PWV in enhancing cardiovascular risk assessment and guiding clinical decisions in this high-risk population, without invasive procedures or radiation exposure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

High blood pressure (BP) remains a major health problem globally, with a proportion of hypertension-mediated organ damage (HMOD) increasing worldwide including in Asia region. Cardiovascular (CV), cerebral and kidney diseases related to hypertension were reported to be closely associated with morning surge and nocturnal hypertension-a subset of BP variability-which can be detected by out-of-office BP measurement. Ambulatory BP monitoring (ABPM) and Home BP monitoring (HBPM) have been recommended by major guidelines to be used in the evaluation of BP variability and outcomes' prediction of hypertension patients. However, an interesting profile of ABPM in Asia has been reported and hypothesized to correlate with different outcomes. This review will focus on the current recommendation of ABPM use by the guidelines, the major different profiles of ABPM in Asia as compared to Western countries according to clinical indications, and the challenges in implementing optimal use of ABPM in Asian countries based on available evidence., (© 2024 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Background and Aims: Uric acid has been positively associated with the risk of developing heart failure in the general population. Nevertheless, it remains unclear whether hyperuricemia is an independent risk factor for heart failure and further contributes to the risk of heart failure among the already at-risk cardiovascular disease (CVD) population. This study aimed to evaluate the association between uric acid and incident heart failure in individuals with established CVD., Methods and Results: Included were 18,438 adults with established CVD but free of heart failure at baseline, from the Kailuan Study. Incident heart failure cases were ascertained by medical records. Cause-specific Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) of heart failure according to uric acid tertiles. Over a median follow-up of 6.1 years, we identified 1215 incident heart failure cases. Higher uric acid was associated with a higher risk of incident heart failure, with adjusted HR for the last vs. first tertile of 1.50 (95%CI:1.30-1.73). Higher uric acid concentrations were associated with an increased risk of heart failure in individuals with coronary heart disease, atrial fibrillation, and ischemic stroke, but not in those with hemorrhagic stroke. Moreover, the observed association between uric acid and heart failure risk was more pronounced in individuals diagnosed with heart failure with reduced ejection fraction subtype compared with heart failure with preserved ejection fraction., Conclusions: In individuals with CVD, uric acid was positively associated with the risk of heart failure, in a dose-response manner., Competing Interests: Declaration of competing Interest None reported., (Copyright © 2024 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

The risk of sudden cardiac death (SCD) is increased during endurance competitive sports. Coronary artery disease (CAD) is the most common cause of SCD in master athletes ≥ 35 years old (MAs). To reduce the risk of SCD self-assessment of symptoms by questionnaire, and evaluation of cardiovascular risk-score, are recommended as pre-participation cardiovascular evaluation (PCVE). We aimed to examine whether PCVE predicts CVD in MAs with or without increased risk as measured by validated score instruments., We performed a single-site observational cohort study of healthy MAs based on findings at PCVE. They were allocated in two different groups: those MAs with reported symptoms on the questionnaire and/or with elevated cardiovascular risk score were allocated to a symptom group (SG), while MAs with no symptoms, nor raised risk score were defined as control group (CG). Thereafter, all were examined with extended examinations: resting-ECG, cardiorespiratory exercise testing and echocardiography., Total, 81 (18 women) MAs participated in the study. There were no differences at baseline between SG ( n  = 39) and CG ( n  = 42); sex ( p  = 0.11), age (55.0 ± 9.8 vs. 51.9 ± 11.1 years; p  = 0.18), maximal oxygen uptake (49.8 ± 7.6 vs. 51.6 ± 7.0 ml/kg/min; p  = 0.26), resting heart rate (61.4 ± 12.8 vs. 60.2 ± 11.0/min; p  = 0.66), training hours/week (7.0 ± 3.2 vs. 7.1 ± 3.1; p  = 0.88). After further examination, sixteen (20%) MAs were found with CVD: 12 in SG, 4 in CG ( p  = 0.024). The negative predictive value and specificity of the PCVE were 90% and 58%, respectively., Negative findings on PCVE by questionnaire and cardiovascular risk-score may be a strategy to exclude subjects from preparticipation screening, thus saving resources.

In this paper, we propose a new Modified Laplacian Vector Median Filter (MLVMF) for real-time denoising complex images corrupted by "salt and pepper" impulsive noise. The method consists of two rounds with three steps each: the first round starts with the identification of pixels that may be contaminated by noise using a Modified Laplacian Filter. Then, corrupted pixels pass a neighborhood-based validation test. Finally, the Vector Median Filter is used to replace noisy pixels. The MLVMF uses a 5 × 5 window to observe the intensity variations around each pixel of the image with a rotation step of π/8 while the classic Laplacian filters often use rotation steps of π/2 or π/4. We see better identification of noise-corrupted pixels thanks to this rotation step refinement. Despite this advantage, a high percentage of the impulsive noise may cause two or more corrupted pixels (with the same intensity) to collide, preventing the identification of noise-corrupted pixels. A second round is then necessary using a second set of filters, still based on the Laplacian operator, but allowing focusing only on the collision phenomenon. To validate our method, MLVMF is firstly tested on standard images, with a noise percentage varying from 3% to 30%. Obtained performances in terms of processing time, as well as image restoration quality through the PSNR (Peak Signal to Noise Ratio) and the NCD (Normalized Color Difference) metrics, are compared to the performances of VMF (Vector Median Filter), VMRHF (Vector Median-Rational Hybrid Filter), and MSMF (Modified Switching Median Filter). A second test is performed on several noisy chest x-ray images used in cardiovascular disease diagnosis as well as COVID-19 diagnosis. The proposed method shows a very good quality of restoration on this type of image, particularly when the percentage of noise is high. The MLVMF provides a high PSNR value of 5.5% and a low NCD value of 18.2%. Finally, an optimized Field-Programmable Gate Array (FPGA) design is proposed to implement the proposed method for real-time processing. The proposed hardware implementation allows an execution time equal to 9 ms per 256 × 256 color image. [ABSTRACT FROM AUTHOR]

Routine screening for cardiovascular diseases (CVDs) through point-of-care assays for at-home or community-based testing of salivary biomarkers can significantly improve patient outcomes. However, its translatability has been hindered by a dearth of biosensing devices that streamline assay procedures for rapid biomarker quantitation. To address this challenge through end-to-end engineering, we developed an in-house, all-in-one microfluidic immunosensing device that integrates on-chip vibration-enhanced incubation, magnetic-assisted separation using immune magnetic bead probes, and colorimetric readout via absorbance measurements. This device enables probe preparation and one-pot immunoassay procedures on a reusable microfluidic chip. By engaging the vibrator with the reaction chamber, the vibration-enhanced incubation module significantly accelerates immune complex formation, drastically reducing the sample-to-answer timeline of approximately 1 h required for room temperature enzyme-linked immunosorbent assay (ELISA) to just under 15 min. We showcase the utility of the device with an on-demand assay for a biomarker panel comprising C-reactive protein (CRP), interleukin 6 (IL-6), and procalcitonin (PCT). The device achieved a linear detection range of 1.75-28 ng mL -1 for CRP and 1.56-100 ng mL -1 for IL-6 and PCT with an R 2  > 0.98 for all three biomarkers. The limits of detection were 0.295, 0.400, and 0.947 ng mL -1 , respectively. Results from real saliva samples were consistent with standard ELISA (R 2  = 0.952). This fully integrated, modular immunosensing device opens up opportunities for household CVD screening and could be adapted for rapid, affordable multiplexed biosensing for other major chronic diseases at the point of care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The unique nature of the retinal microvasculature that permits non-invasive visualization has garnered interest as a potential method for detecting microvascular alterations indicative of systemic diseases. This concept, supported by advancements in imaging technologies, has been increasingly validated by studies linking retinal microvasculature with systemic conditions such as diabetes, hypertension, and cerebrovascular disease. Structural changes in the retinal microvasculature are associated with cardiovascular risk factors, metabolic diseases, and are significant predictors of systemic hypertensive damage and mortality. Given that most systemic diseases present life-long burdens and complications if undetected or untreated, the development of diagnostic tools like retinal vascular imaging becomes important for early detection, monitoring of disease progression, and facilitating timely interventions. Technological advancements have enabled objective and accurate quantification of retinal microvascular characteristics. We consolidate current literature on retinal vascular changes across various systemic health conditions, including metabolic diseases, cerebrovascular diseases, pregnancy complications, systemic inflammatory conditions, leukemia, human immunodeficiency virus infection, and COVID-19. We also emphasizes the need for dynamic parameters, an understanding of 3-dimensional vascular architecture, and larger-scale longitudinal studies to elucidate the temporal relationship between retinal vascular changes and systemic diseases, helping shape future diagnostic and monitoring approaches., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 Elsevier Inc. All rights reserved.)

Clinical reports show that COVID-19 disease has impacts on the cardiovascular system in addition to the respiratory system. Available COVID-19 diagnostic methods have been shown to have limitations. In addition to current diagnostic methods such as low-sensitivity standard RT-PCR tests and expensive medical imaging devices, the development of alternative methods for the diagnosis of COVID-19 disease would be beneficial for control of the COVID-19 pandemic. Further, it is important to quickly and accurately detect abnormalities caused by COVID-19 on the cardiovascular system via ECG. In this study, the diagnosis of COVID-19 disease is proposed using a novel deep Convolutional Neural Network model by using only ECG trace images created from ECG signals of COVID-19 infected patients based on the abnormalities caused by the COVID-19 virus on the cardiovascular system. An overall classification accuracy of 98.57%, 93.20%, 96.74% and AUC value of 0.9966, 0.9771, 0.9905 is achieved for COVID-19 vs. Normal, COVID-19 vs. Abnormal Heartbeats, COVID-19 vs. Myocardial Infarction binary classification tasks, respectively. In addition, an overall classification accuracy of 86.55% and 83.05% is achieved for COVID-19 vs. Abnormal Heartbeats vs. Myocardial Infarction and Normal vs. COVID-19 vs. Abnormal Heartbeats vs. Myocardial Infarction multi-classification tasks. This study is believed to have great potential to speed up the diagnosis and treatment of COVID-19 patients, saving clinicians time and facilitating the control of the pandemic. [ABSTRACT FROM AUTHOR]

This narrative review describes the impetus for health screening for non-communicable diseases in dental settings and highlights important considerations for evaluating such interventions. Real world cases are presented that showcase health screening interventions implemented in the UK. Non-communicable diseases including diabetes and cardiovascular disease are a global public health challenge. They are largely preventable by implementing lifestyle changes such as healthy eating and participation in physical activity, regular health screening for disease prevention, and/or early initiation of treatment. Hypertension case finding and control is one of the key five areas of focus for adult health, and oral health and diabetes are two of five key clinical areas for children and young people where efforts should be focused to intervene, improve outcomes and reduce inequalities. Links between oral and chronic diseases have been discussed in recent years. Therefore, screening for diabetes and cardiovascular disease has become of greater relevance to the dental profession. There is emerging evidence indicating that screening for the risk factors of cardiovascular diseases and diabetes in dental settings shows promise for improving health outcomes and may offer a cost-effective preventive approach for the detection of diabetes. Real-world services implementing health screening in dental settings have highlighted possibilities for the future and highlight the potential for the role of the dental team in detecting chronic diseases., (Copyright© 2024 Dennis Barber Ltd.)

Purpose: The triglyceride glucose (TyG) index is a dependable indicator of insulin resistance (IR), serves as a valuable biomarker for identifying obstructive sleep apnea (OSA) and predicting its comorbidities. Both OSA and the TyG index are significantly related to the incidence and development of cardiovascular disease (CVD). We focus on investigating the relationship between the TyG index and the incidence of CVD risk in OSA., Methods: The TyG index, homeostatic model assessment of IR (HOMA-IR) index, and polysomnography were assessed in 191 participants with OSA and without pre-existing CVD. To estimate the lifetime CVD risk, we employed the 'Prediction for Atherosclerotic CVD Risk in China' equation. The TyG index's association with CVD risk was scrutinized using multivariable logistic regression models, contrasting it with the HOMA-IR index. We compared the predictive power for high lifetime CVD risk of the TyG index and the HOMA-IR index using receiver-operating characteristic (ROC) curve analysis., Results: A total of 89 participants had high lifetime CVD risk. In fully adjusted model and additionally adjusted for HOMA-IR index, participants situated within the fifth quantile of the TyG index exhibited an increased lifetime CVD risk, with OR of 4.32 (95% CI, 1.19-15.67). The TyG index demonstrated significant predictive power for high lifetime CVD risk across varying severities of OSA and outperformed the HOMA-IR index, as evidenced by a larger area under the ROC curve., Conclusion: The TyG index, independent of the HOMA-IR index and obesity, was linked to an increased lifetime CVD risk. In predicting cardiovascular outcomes, the TyG index could potentially outperform the HOMA-IR index among individuals with OSA., Competing Interests: Declarations. Ethics approval: This study protocol was approved by the ethics committees of PUMCH (JS-3573), and informed consent for involvement in the study was obtained from each participant. Conflict of interest: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: The inverse relationship between serum Klotho levels and systemic inflammation, particularly C-reactive protein (CRP), has been suggested in limited studies. However, the association within a large and diverse population remains underexplored., Methods: We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) to investigate the association between serum Klotho levels and CRP among a nationally representative sample of the US population. Multiple linear regression analyses were performed to assess this relationship while adjusting for relevant covariates. Stratified analysis with interaction, restricted cubic splines (RCS) were employed to support the research objectives., Results: A total of 5901 participants had a mean age of 57.9 ± 11.0 years, with 49.4% of them being male and 50.6% of them being female. A negative association between serum Klotho and CRP was revealed in the fully adjusted model (β -0.26; 95% CI -0.41∼-0.11). When serum Klotho was taken as quartiles with Q1 as reference, the adjusted β that were lowest in Q4 were - 0.1 (95% CI -0.16∼-0.04, p-value = 0.002) in model 4, respectively. These statistics were robust in stratified analyses., Conclusion: While our study demonstrates an inverse association between serum Klotho levels and CRP, suggesting a potential cardioprotective role of Klotho, it is important to note that our cross-sectional design does not permit the establishment of causality. Therefore, we cannot definitively conclude that increasing Klotho levels will directly reduce cardiovascular risk. Our findings do, however, highlight the need for further research to explore the potential of Klotho as a therapeutic target for cardiovascular health., Competing Interests: Declarations. Ethics approval and consent to participate: The NCHS Research Ethics Review Board approved the NHANES study protocol, and participants provided written informed consent at enrollment (the website is https://www.cdc.gov/nchs/nhanes/irba98.htm ). Ethical approval and consent were not required as this study was based on publicly available de-identified data. Consent for publication: not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Respiratory viruses are linked to cardiovascular complications. We aim to compare cardiovascular complications due to COVID-19, influenza and RSV., Methods: We analyzed cross-sectional data from hospitalized children and young adults (≤ 20 years) from 2020 and 2021 using National Inpatient Sample (NIS). We included individuals hospitalized for COVID-19, RSV, and influenza, and weighted data were used to compare cardiovascular complications., Results: Of 212,655 respiratory virus admissions, 85,055 were from COVID-19, 103,185 were from RSV, and 24,415 were from influenza. Myocarditis was higher in COVID-19 [0.9%, n = 740] as compared to influenza [0.2%, n = 55] and RSV [0.1%, n = 65]. In the adjusted logistic regression, the odds of myocarditis was 61% lower in influenza [aOR = 0.39 (0.20-0.76), P = 0.006], and 85% lower in RSV [aOR = 0.15 (0.07-0.34) P < 0.001] as compared to COVID-19. Bradyarrhythmias/heart block was higher in COVID-19 [0.8%, n = 690] versus influenza [0.5%, n = 110] and RSV [0.2%, n = 205]. After adjusting for confounders for bradyarrhythmias/heart block, compared to COVID-19, the odds were 49% lower in RSV [aOR = 0.51 (0.33-0.80), P = 0.004] but no statistically significant difference in influenza [aOR = 0.79 (0.48-1.31), P = 0.374] was seen. Tachyarrhythmias, sudden cardiac arrest, and in-hospital mortality showed no differences after adjusting for covariates., Conclusion: Individuals with COVID-19 infection are more likely to develop cardiovascular complications compared to influenza and RSV, highlighting the need for higher index of suspicion and prompt treatment, as well as steps to limit infection and transmission of this virus in children., Competing Interests: Declarations. Ethics approval and consent to participate: Approval from an institutional review board and informed consent were not required for this study, as it adheres to the regulations set forth in 45 CFR §46, which exempts certain research involving publicly available or de-identified data from these requirements. As this study utilized publicly available de-identified data, it received expedited review approval from the University of California San Francisco, Fresno Community Medical Regional Center. IRB No: 2023024. The need for informed consent to participate was waived by the ethics committee of University of California San Francisco, Fresno Community Medical Regional Center. IRB No: 2023024. The authors listed in this manuscript are not employed by any government agency whose primary role is not research or education. Moreover, none of the authors are presenting this manuscript as an official representative or on behalf of the government. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Systemic lupus erythematosus (SLE) poses a diagnostic challenge due to its heterogeneity. This study examines the cardiac complications of SLE comprehensively, covering pericarditis, myocarditis, pleural effusion, valvular disease, atherosclerosis, and cardiac arrhythmias. Nearly one-third of SLE-related deaths are attributed to cardiovascular diseases, necessitating a deeper understanding of cardiac pathophysiology. The impact of SLE on the cardiovascular system manifests in various ways, including recurrent and resistant pericarditis, severe myocarditis, and pleural effusion. Valvular diseases, atherosclerosis, and cardiac arrhythmias are prevalent, with immune complex deposition playing a role in atherosclerosis. Diagnostic criteria involve clinical features, laboratory findings, and autoantibodies, emphasizing the need for early diagnosis and a multidisciplinary diagnostic approach. The review explores pharmacological and non-pharmacological modalities for managing cardiac manifestations in SLE. Recommendations include NSAIDs, colchicine, and proton pump inhibitors for acute pericarditis, while selective immunosuppressive therapy is emerging for myocarditis. Valvular diseases require individualized treatment approaches, and careful corticosteroid management is crucial to avoid increased cardiovascular events. Anti-malarial therapy, particularly hydroxychloroquine, shows promise in mitigating cardiovascular risk factors. Non-pharmacological modifications, such as diet, exercise, and smoke cessation, significantly contribute to cardiovascular health in SLE patients. Adjuvant therapies involving glutathione and glutathione peroxidase focus on redox balance, offering potential interventions. This integrated approach combines diagnostic insights with diverse treatment modalities, providing a holistic strategy for managing cardiac complications in SLE. Ongoing research is essential to refine these strategies and optimize individualized treatment plans for improved patient outcomes., (© 2024 the author(s), published by De Gruyter.)

Purpose: The aim of this research was to investigate the relationship between socio-economic inequalities and fatal and non-fatal cardiovascular events., Methods: A systematic review of recently published cohort studies and a meta-analysis of relative risk (RR) of low compared with high socio-economic status (SES) in relation to cardiovascular incidence and mortality was conducted. Supplementary evaluations were conducted considering different proxies of SES in relation to different types of cardiovascular disease (CVD)., Results: We identified 17 studies including approximately 26.5 million of participants with more than 900,000 CVD events. We estimated a 50% increased CVD risk for low SES with respect to high SES (RR = 1.49 [95% confidence interval: 1.26, 1.78]). For sex-specific risk, we estimated a 79% increased CVD risk for women of low SES (RR = 1.79 [1.30, 2.46]). In men, the same investigation found a 45% increased CVD risk (RR = 1.45 [1.09, 1.92]). We reported that low education (RR = 1.56 [1.27, 1.91]), increased CVD risk the most, more than low income (RR = 1.38 [1.12, 1.70])., Conclusion: Although not statistically significant, women of low SES were at higher CVD risk than men. CVD risk was more relevant to educational inequality than economic inequality., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Aims: The purpose of this prospective cohort study was to examine the association of Life Essential 8 (LE8), the recently updated algorithm for quantifying cardiovascular health (CVH) by the American Heart Association (AHA), with the risk of mortality in Chronic Obstructive Pulmonary Disease (COPD) patients., Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2012 and the National Death Index mortality data up to December 31, 2019, were included in this cohort analysis. To characterize the relationship between LE8 and CVD and all-cause mortality as well as assess any potential nonlinear relationships, the limited cubic spline mixed with the Cox proportional hazards model was used., Results: The final analysis included 785 subjects. The weighted mean age of the study population was 59 years, and 479 were male. In the overall population, every 10-point increase in the LE8 score was individuals with associated with reduced risks of 4% for CVD mortality; moderate CVH had a 23% lower risk of COPD, while high CVH was linked to a 40% lower risk compared to low CVH. Among the COPD individuals, every 10-point increase in the LE8 score was associated with reduced risks of 4% for all-cause mortality,8% for CLRD mortality, and 12% for cancer mortality., Conclusion: This study demonstrates that low levels of LE8 were associated with increased risks of all-cause and cause-specific mortality in COPD individuals., Competing Interests: The authors declare that they have no competing interests., (© 2024 Sun et al.)

Background: Globally, cardiovascular disease (CVD) constitutes the primary cause of death, with insulin resistance (IR), measured by the triglyceride-glucose (TyG) index, and visceral obesity, reflected by the Chinese Visceral Adiposity Index (CVAI), as key contributors. However, the relationship between the TyG index and CVAI regarding CVD risk remains insufficiently understood. This research investigates the interactive impact of the TyG index and CVAI on the risk of cardiovascular disease., Methods: We analyzed data from 8,358 participants from the China Health and Retirement Longitudinal Study (CHARLS) over a 9-year follow-up period. Participants were classified into four groups based on median TyG index (8.59) and CVAI values (101.26), and baseline characteristics were summarized. Missing data were addressed using multiple imputation by chained equations (MICE). Cox proportional hazards models assessed associations between TyG index, CVAI, CVD, coronary heart disease (CHD), and stroke risks, with Kaplan-Meier analysis used for cumulative hazard. Interaction effects were evaluated using both multiplicative and additive measures. Subgroup analyses by age, gender, and clinical conditions were conducted to explore interaction effects across different populations. Sensitivity analyses re-tested models, excluding the covariates BMI and diabetes, using tertiles for classification, and re-evaluating imputed data., Results: Over the 9-year follow-up, 1,240 participants (14.8%) developed CVD, including 896 cases of CHD and 475 strokes. Kaplan-Meier curves indicated that participants with low TyG index but high CVAI had the highest cumulative hazard of CVD. Cox regression showed that this group had the highest CVD risk (HR = 1.87, 95% CI: 1.57-2.24), followed by those with both high TyG index and high CVAI (HR = 1.75, 95% CI: 1.49-2.06). Interaction analysis revealed a negative interaction effect between high TyG and high CVAI on CVD and CHD risks, with no significant effect on stroke. Subgroup and sensitivity analyses further confirmed these findings, showing consistent results across demographic groups and under various analytical conditions., Conclusion: This study suggests that the interaction between IR (TyG index) and visceral fat accumulation (CVAI) plays a complex role in CVD risk, with a potential antagonistic effect observed between high TyG and high CVAI on CVD events. These findings highlight the importance of considering both IR and visceral adiposity in CVD risk assessments to improve the identification of high-risk individuals., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Review Committee of Peking University (IRB00001052-11015), and written informed consent was obtained from all participants. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

To examine the relationship between age at diagnosis of type 2 diabetes (T2DM) with cardiovascular and all-cause mortality in the U.S. population. Data was used from NHANES 1999 ~ 2018, which were screened to include a total of 8,654 participants with a diagnosis of diabetes for the study. We estimated the association between age at diagnosis and cardiovascular and all-cause mortality using weighted multivariate Cox regression analyses. Subgroup analyses and sensitivity analyses were performed to ensure the robustness of the data analysis. The number of participants diagnosed with diabetes at ages < 40, between 40 and 59, and > 60 are 1,492, 3,970, and 3,192, respectively, with median ages of 44.04, 57.59, and 72.24. Among patients diagnosed with T2DM, the relative risk of all-cause mortality increased with younger age at diagnosis: compared to patients with late-onset diabetes (age at type 2 diabetes diagnosis ≥ 60), the hazard ratio for all-cause mortality was 2.72 (95% CI 1.83-4.05) in those with early-onset diabetes (age at type 2 diabetes diagnosis < 40). Similarly, the risk of cardiovascular disease death was observed to be a higher relative risk with younger age at diagnosis. Exposure-effect analysis indicated that younger age at diagnosis is associated with higher risk of all-cause mortality. Subgroup analysis found that the association between age at diagnosis and cardiovascular and all-cause mortality was stronger in the current smokers and hypertensive population. The results of this study suggest that younger age at diagnosis of T2DM is associated with higher risk of death in patients. Younger patients diagnosed with T2DM had a higher risk of cardiovascular and all-cause mortality. These findings strengthen the understanding of the risk of death from T2DM and emphasize the importance of early prevention of diabetes., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics statement: This study was reviewed and approved by the National Center for Health Statistics Research Ethics Review Board, and written informed consent was obtained from all NHANES participants., (© 2024. The Author(s).)

Cardiovascular diseases are a major cause of mortality worldwide. Long-term monitoring of nighttime heart rate (HR) and heart rate variability (HRV) may be useful in identifying latent cardiovascular risk. The Oura Ring has shown excellent correlation only with ECG-derived HR, but not HRV. We thus assessed if stringent data quality filters can improve the accuracy of time-domain and frequency-domain HRV measures. 92 younger (<45 years) and 22 older (≥45 years) participants from two in-lab sleep studies with concurrent overnight Oura and ECG data acquisition were analyzed. For each 5 min segment during time-in-bed, the validity proportion (percentage of interbeat intervals rated as valid) was calculated. We evaluated the accuracy of Oura-derived HR and HRV measures against ECG at different validity proportion thresholds: 80%, 50%, and 30%; and aggregated over different durations: 5 min, 30 min, and Night-level. Strong correlation and agreements were obtained for both age groups across all HR and HRV metrics and window sizes. More stringent validity proportion thresholds and averaging over longer time windows (i.e., 30 min and night) improved accuracy. Higher discrepancies were found for HRV measures, with more than half of older participants exceeding 10% Median Absolute Percentage Error. Accurate HRV measures can be obtained from Oura's PPG-derived signals with a stringent validity proportion threshold of around 80% for each 5 min segment and aggregating over time windows of at least 30 min.

Background: Insulin resistance coexist with many metabolic disorders, whether these disorders were promotors or pathway-factors for the association of insulin resistance and cardiovascular disease (CVD) remained unclear. We aimed to investigate the pathways related to elevated the triglyceride-glucose (TyG) index and pathways through elevated TyG index to the occurrence of CVD in Chinese adults., Methods: A total of 96,506 participants were enrolled from the Kailuan study. Bayesian network model with the max-min hill climbing algorithm and maximum likelihood estimation was applied to identify factors and pathways related to the TyG index, and quantitatively infer the impact of associated factors on elevated TyG index and the occurrence of CVD by computing conditional probabilities., Results: A final Bayesian network was constructed with 14 nodes and 25 arcs, creating 28 pathways related to elevated TyG index and 8 pathways from elevated TyG index to CVD. Elevated TyG index was causally associated with CVD, the condition probability was 11.9%. Pathways to elevated TyG index were mainly through unhealthy lifestyles and the subsequent increase in lipid profiles, especially smoking and low-density lipoprotein cholesterol. The most important pathway from elevated TyG index to CVD was through overweight/obesity, hypertension, and chronic kidney disease, with a condition probability of 18.5%. The maximum relative change rate related to elevated TyG index was observed for overweight/obesity (64.3%)., Conclusions: Elevated TyG index was causally associated with the risk of CVD, a combined control of lifestyles and metabolic factors may contribute to the reduction of TyG index and the prevention of CVD., Competing Interests: Declarations. Ethics approval and consent to participate: The study was performed according to the guidelines of the Helsinki Declaration and was approved by the Ethics Committee of Kailuan General Hospital (approval number: 2006-05). All participants were agreed to take part in the study and provided informed written consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Disclosure: None., (© 2024. The Author(s).)

Objectives: This study aimed to investigate the impact of hepatic steatosis on cardiometabolic outcomes in young adults with prediabetes., Methods: A nationwide cohort study was conducted with 896,585 young adults under 40 years old without diabetes or previous history of cardiovascular disease. Hepatic steatosis was identified using a fatty liver index of ≥ 60. The outcomes of this study were incident diabetes (DM) and composite major adverse cardiovascular events (MACE), including myocardial infarction, stroke, or cardiovascular death., Results: During a median follow-up of 11.8 years, 27,437 (3.1%) incident DM cases and 6,584 (0.7%) MACE cases were recorded. Young adults with prediabetes had a significantly higher risk of incident DM (hazard ratio [HR]: 2.81; 95% confidence interval [CI]: 2.74-2.88; P-value: <0.001) and composite MACE risk (HR: 1.10; 95% CI: 1.03-1.17; P-value: 0.003) compared to individuals with normoglycemia, after adjusting for relevant covariates. Stratification based on hepatic steatosis showed that the combination of prediabetes and hepatic steatosis posed the highest risk for these outcomes, after adjusting for relevant covariates. For incident DM, the HRs (95% CI; P-value) were: 3.15 (3.05-3.26; <0.001) for prediabetes without hepatic steatosis, 2.89 (2.78-3.01; <0.001) for normoglycemia with hepatic steatosis, and 6.60 (6.33-6.87; <0.001) for prediabetes with hepatic steatosis. For composite MACE, the HRs (95% CI; P-value) were 1.05 (0.97-1.13; 0.235) for prediabetes without hepatic steatosis, 1.39 (1.27-1.51; <0.001) for normoglycemia with hepatic steatosis, and 1.60 (1.44-1.78; <0.001) for prediabetes with hepatic steatosis., Conclusions: Prediabetes and hepatic steatosis additively increased the risk of cardiometabolic outcomes in young adults. These findings hold significance for physicians as they provide insights into assessing high-risk individuals among young adults with prediabetes., Competing Interests: Declarations. Ethics approval and consent to participate: The study protocol adhered the ethical guidelines of the Declaration of Helsinki and received approval from the Institutional Review Board of Chonnam National University Hwasun Hospital (CNUHH-2022-109). Informed consent was waived due to participants deidentification. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Biomarkers play a crucial role in various stages of disease management, including screening, diagnosis, prediction, prognosis, treatment, and safety monitoring. Although they are powerful tools in disease diagnosis, management, and drug development, identifying and validating reliable biomarkers remains a significant challenge. Among potential microbiome-derived biomarkers, trimethylamine N-oxide (TMAO) has gained notable attention for its link to atherosclerosis and cardiovascular risk. However, despite the growing body of research on TMAO, its practical application in clinical settings for disease management and patient outcome enhancement is still not a reality. This paper presents recent data on the utility of TMAO as a cardiovascular biomarker, categorized by its various roles: diagnostic, prognostic, susceptibility/risk, monitoring, pharmacodynamic/response, predictive, and safety. It also briefly discusses research on TMAO's potential role in cardiovascular disease development. While TMAO shows promise, particularly in prognostic applications, its reliability as a biomarker has been inconsistent across studies. These variances may result from several confounding factors that affect TMAO plasma levels, including diet, kidney function, and demographic variables. The review aims to elucidate the specific contexts in which TMAO can be valuable, potentially leading to more personalized and effective management of cardiovascular disease.

Background: Despite widespread use of high-intensity statin monotherapy, achieving target LDL-C levels and reducing cardiovascular events in patients with or at high risk of developing ASCVD remains challenging. Our study measured the effects of low/moderate-intensity statins and ezetimibe combination therapy compared to high-dose statin monotherapy on major adverse cardiovascular events (MACEs) and coronary atherosclerotic plaque reduction., Methods: We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL register of trials for studies comparing the combination therapy to high-intensity statin monotherapy in terms of MACEs and coronary atherosclerotic plaque reduction. The primary outcome was a composite of cardiovascular death or major cardiovascular events (MI, HF, Revascularization, or non-fatal stroke). Other outcomes included other MACEs, lipid-lowering efficacy, and safety outcomes. A protocol was registered to PROSPERO under registration number [CRD42024545807]., Results: 15 studies encompassing 251,450 participants were included in our meta-analysis. In our pooled analysis of observational studies, combination therapy was associated with lower rates of the primary composite outcome (HR = 0.76, CI 95% [0.73, 0.80]), cardiovascular death (HR = 0.80, CI 95% [0.74, 0.88]), all-cause death (HR = 0.84, CI 95% [0.78, 0.91]), and non-fatal stroke (HR = 0.81, CI 95% [0.75, 0.87]). However, the pooled analysis of RCTs did not demonstrate a statistically significant difference between both arms concerning clinical endpoints. Combination therapy had a higher number of patients with LDL-C < 70 mg/dL (RR = 1.27, CI 95% [1.21, 1.34]), significantly lowered LDL-C (MD = -7.95, CI 95% [-10.02, -5.89]) and TC (MD = -26.77, CI 95% [-27.64, -25.89]) in the pooled analysis of RCTs. In terms of safety, the combination therapy lowered muscle-related adverse events (RR = 0.52, CI 95% [0.32, 0.85]) and number of patients with liver enzyme elevation (RR = 0.51, CI 95% [0.29, 0.89]) in the pooled analysis of RCTs and was associated with lower rates of new-onset diabetes (HR = 0.80, CI 95% [0.74, 0.87]) in the pooled analysis of observational studies., Conclusion: Evidence from RCTs indicates that low/moderate statin therapy in combination with ezetimibe has a superior lipid-lowering effect and reduces side effects compared to high-dose statins. Observational studies suggest improved clinical outcomes but need to be corroborated by large, outcomes-powered RCTs over longer follow-up periods., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Our aim was to assess the relationships of cardiovascular health metrics, cardiorespiratory fitness, lean mass, and fat percentage with arterial structure and function from childhood to adolescence., Methods and Results: Five hundred four children aged 6 to 9 years were examined in the PANIC (Physical Activity and Nutrition in Children) study at baseline, 2 and 8 years later. The associations of adjusted American Heart Association cardiovascular health metrics (smoking status, body mass index-SD score, moderate-to-vigorous physical activity, diet quality, plasma total cholesterol, systolic blood pressure, plasma glucose categorized into poor, intermediate, and ideal), the American Heart Association cardiovascular health score, cardiorespiratory fitness measured by maximal oxygen uptake in a bicycle exercise test, lean mass and fat percentage with carotid intima-media thickness (cIMT) and pulse wave velocity (PWV) were analyzed cross-sectionally and longitudinally in 277 participants at age 15 to 17 years. Higher American Heart Association cardiovascular health score at baseline was associated with lower PWV at 8-year follow-up (ß, -0.19 [95% CI, -0.32 to -0.05]). Higher body mass index-SD score and systolic blood pressure were associated with higher cIMT (ß, 0.18 [95% CI, 0.05-0.31]); and (ß, 0.13 [95% CI, 0.00-0.25]; respectively) and PWV (ß, 0.20 [95% CI, 0.07-0.34]) and (ß, 0.13 [95% CI, 0.00-0.26]; respectively) at 8-year follow-up. Higher moderate-to-vigorous physical activity was associated with higher cIMT (ß, 0.25 [95% CI, 0.07-0.43]); yet lower PWV (ß, -0.25 [95% CI, -0.44 to -0.06]) at 8-year follow-up. Better cardiorespiratory fitness (ß, 0.29 [95% CI, 0.08-0.51]) and higher lean mass (ß, 0.51 [95% CI, 0.03-0.98]) were associated with higher cIMT after accounting for American Heart Association cardiovascular health score at 8-year follow-up., Conclusions: While our results suggest that higher cardiometabolic risk factors in childhood may exert unfavorable effects on arterial health during adolescence, we demonstrated the complexity of relationships between cardiovascular health metrics and arterial health indicators in childhood and adolescence. We found different associations of cardiovascular health metrics with cIMT and PWV in childhood and adolescence, calling for caution when interpreting the results of various cardiovascular risk factors with measures of arterial health, particularly in youth., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01803776.

Background: Sex differences in obesity and fat distribution may in part explain differences in cardiovascular risk in men versus women. We sought to examine sex differences in the associations of obesity and adiposity measures with cardiovascular disease-related protein biomarkers., Methods and Results: In a cross-sectional observational cohort study, we examined whether the association of obesity (body mass index [BMI] and waist circumference) and adiposity measures (visceral adipose tissue) with biomarkers demonstrates effect modification by sex using multiplicative interaction terms in multivariable linear regression models. Among 3143 participants (mean age, 50 years; 49% women), sex modified the association of BMI, waist circumference, and visceral adipose tissue with cardiovascular disease-related protein biomarkers (7 for BMI, 3 for waist circumference, and 23 for visceral adipose tissue, false discovery rate [FDR]-q int <0.05 for all). For example, higher BMI was associated with lower α 1 -microglobulin levels in men but not in women (ß, -0.113; SE, 0.028; P <0.001 in men versus ß, -0.007; SE, 0.024; P =0.78 in women). By contrast, higher BMI was associated with higher adipsin levels in men and women, but the association was more pronounced in women (ß, 0.287; SE, 0.023; P <0.001 in women versus ß, 0.189; SE, 0.026; P <0.001 in men). The associations of higher visceral adipose tissue with biomarkers representing adiposity, inflammation, and fibrosis were more pronounced in women versus men., Conclusions: We found that sex modified the associations of obesity and adipose traits with cardiovascular risk ascertained by cardiovascular disease-related biomarkers including markers of adiposity, inflammation, and fibrosis. These findings highlight potential biological pathways that may underlie some of the observed differences in obesity-related cardiovascular disease between women and men.

Purpose of Review:  Ceramides are lipid species that play several physiological roles in the body, including stress response, inflammation, and apoptosis, and their involvement in lipid metabolism and energy production makes them crucial in the pathophysiology of heart failure (HF)., Recent Findings:  Several species of ceramides and ceramide signatures have recently been investigated as possible biomarkers of cardiovascular disease (CVD), and risk scores have demonstrated prognostic value in stratifying patients by risk and possibly predicting adverse cardiac events. With growing interest in targeting metabolic dysfunction, understanding the role of ceramides in CVD also opens the possibility of novel therapeutics that target ceramide metabolism to improve cardiac function and cardiac outcomes in patients.  Understanding the role of ceramides in CVD opens the possibility of novel diagnostics and theragnostic targeting ceramide metabolism to improve cardiac function and cardiac outcomes in patients with heart failure., Competing Interests: Declarations Competing Interests Dr. Tang has served as consultant for Sequana Medical, Cardiol Therapeutics, Genomics plc, Zehna Therapeutics, WhiteSwell, Boston Scientific, CardiaTec Biosciences, Bristol Myers Squibb, Alleviant Medical, Alexion Pharmaceuticals, Salubris Biotherapeutics, BioCardia, and has received honorarium from Springer, Belvoir Media Group, and American Board of Internal Medicine. All other authors have no relationships to disclose., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Cardiovascular diseases (CVDs) are recognized as a significant threat to global health. The rapid, sensitive, and precise measurement of relevant biomarkers is essential for the timely diagnosis of CVDs. Molecularly imprinted polymers (MIPs), which act as artificial receptor recognition materials, have been extensively utilized in the detection of CVD biomarkers. Their widespread application is due to their cost-effectiveness, physical and chemical stability, straightforward preparation processes, and excellent compatibility with various sensor types. This review introduces the principles of MIP sensors in combination with electrochemical, optical, thermal transfer, and acoustic detection techniques for detecting CVD-related biomarkers. It then discusses methods developed over the past decade for detecting biomarkers of three major CVDs-coronary artery disease (CAD), acute myocardial infarction (AMI), and heart failure (HF)-using MIP sensors. Finally, the review summarizes the potential of MIP sensors in CVD biomarker detection and provides an outlook on future research directions.