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Psychosocial stress can affect cardiovascular health through multiple pathways. Certain stressors, such as socioeconomic disadvantage, childhood adversity, intimate partner violence, and caregiving stress, are especially common among women. The consequences of stress begin at a young age and persist throughout the life course. This is especially true for women, among whom the burden of negative psychosocial experiences tends to be larger in young age and midlife. Menarche, pregnancy, and menopause can further exacerbate stress in vulnerable women. Not only is psychosocial adversity prevalent in women, but it could have more pronounced consequences for cardiovascular risk among women than among men. These differential effects could reside in sex differences in responses to stress, combined with womens propensity toward vasomotor reactivity, microvascular dysfunction, and inflammation. The bulk of evidence suggests that targeting stress could be an important strategy for cardiovascular risk reduction in women.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide. It has been known for some considerable time that radiation is associated with excess risk of CVD. A recent systematic review of radiation and CVD highlighted substantial inter-study heterogeneity in effect, possibly a result of confounding or modifications of radiation effect by non-radiation factors, in particular by the major lifestyle/environmental/medical risk factors and latent period. METHODS: We assessed effects of confounding by lifestyle/environmental/medical risk factors on radiation-associated CVD and investigated evidence for modifying effects of these variables on CVD radiation dose-response, using data assembled for a recent systematic review. RESULTS: There are 43 epidemiologic studies which are informative on effects of adjustment for confounding or risk modifying factors on radiation-associated CVD. Of these 22 were studies of groups exposed to substantial doses of medical radiation for therapy or diagnosis. The remaining 21 studies were of groups exposed at much lower levels of dose and/or dose rate. Only four studies suggest substantial effects of adjustment for lifestyle/environmental/medical risk factors on radiation risk of CVD; however, there were also substantial uncertainties in the estimates in all of these studies. There are fewer suggestions of effects that modify the radiation dose response; only two studies, both at lower levels of dose, report the most serious level of modifying effect. CONCLUSIONS: There are still large uncertainties about confounding factors or lifestyle/environmental/medical variables that may influence radiation-associated CVD, although indications are that there are not many studies in which there are substantial confounding effects of these risk factors.

OBJECTIVE: Many studies support the notion that polygenic risk scores (PRS) improve risk prediction for coronary heart disease (CHD) beyond conventional risk factors. However, PRS are not yet considered risk-enhancing factor in guidelines. Our objective was to determine the predictive performance of a commercially available PRS (CARDIO inCode-Score®) compared with the Pooled Cohorts Equations (PCE) in a contemporary, multi-ethnic cohort. METHODS: Participants (n = 63,070; 67 % female; 18 % non-European) without prior CHD were followed from 2007 through 12/31/2022. The association between the PRS and incident CHD was assessed using Cox regression adjusting for genetic ancestry and risk factors. Event rates were estimated by categories of PCE and by low/intermediate/high genetic risk within PCE categories; risk discrimination and net reclassification improvement (NRI) were also assessed. RESULTS: There were 3,289 incident CHD events during 14 years of follow-up. Adjusted hazard ratio (aHR) for incident CHD per 1 SD increase in PRS was 1.18 (95 % CI:1.14-1.22), and the aHR for the upper vs lower quintile of the PRS was 1.66 (95 % CI:1.49-1.86). The association was consistent in both sexes, in European participants compared with all minority groups combined and was strongest in the first 5 years of follow-up. The increase in the C-statistic was 0.004 (0.747 vs. 0.751; p < 0.0001); the NRI was 2.4 (0.9-3.8) for the entire cohort and 9.7 (7.5-12.0) for intermediate PCE risk individuals. After incorporating high genetic risk, a further 10 percent of participants at borderline/intermediate PCE risk would be candidates for statin therapy. CONCLUSION: Inclusion of polygenic risk improved identification of primary prevention individuals who may benefit from more intensive risk factor modification.

Depression is known to be associated with inflammation among patients with established coronary heart disease (CHD), but it is unclear whether this is due to individual depression symptoms or to the broader construct of depression. We addressed this gap by using moderated non-linear factor analysis (MNLFA) to determine the extent that inflammation is associated with latent depression and/or individual symptoms in this patient group. We evaluated 1,024 outpatients with stable CHD from the baseline cross-sectional data of the Heart and Soul Study. Depression was assessed using the 9-item Patient Health Questionnaire, while inflammation was evaluated via C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and monocyte chemoattractant protein-1 (MCP-1) levels. MNLFA is based on the concept of model parameter moderation with regard to individual characteristics. Using the MNLFA approach, we simultaneously tested for differences in (1) latent depression, (2) individual depression items, and (3) the factor loading of the item on latent depression as a function of inflammatory markers, with and without covariate adjustment. Higher TNF-α levels were associated with both higher levels of a latent depression factor and greater endorsement of an individual symptom (appetite changes). Increased CRP levels were significantly associated with greater appetite changes, lower concentration difficulty, and greater fatigue. Elevated IL-6 levels were only related to greater fatigue, while increased MCP-1 levels were linked to greater sleep disturbance. After adjusting for covariates, some associations became insignificant. Inflammatory markers were not consistent predictors of factor loadings. This study represents the initial step to discussing how inflammation biology is truly related to depression among patients with established CHD.

BACKGROUND: Dyslipidemia is an independent risk factor for coronary heart disease (CHD). Standard lipid panel cannot capture the complexity of the blood lipidome (ie, all molecular lipids in the blood). To date, very few large-scale epidemiological studies have assessed the full spectrum of the blood lipidome on risk of CHD, especially in a longitudinal setting. METHODS AND RESULTS: Using an untargeted liquid chromatography-mass spectrometry, we repeatedly measured 1542 lipid species from 1835 unique American Indian participants who attended 2 clinical visits (≈5.5 years apart) and followed up to 17.8 years in the Strong Heart Family Study (SHFS). We first identified baseline lipid species associated with risk of CHD, followed by replication in a European population. The model adjusted for age, sex, body mass index, smoking, hypertension, diabetes, low-density lipoprotein cholesterol, estimated glomerular filtration rate, education, and physical activity at baseline. We then examined the longitudinal association between changes in lipid species and changes in cardiovascular risk factors during follow-up. Multiple testing was controlled by the false discovery rate. We found that baseline levels of multiple lipid species (eg, phosphatidylcholines, phosphatidylethanolamines, and ceramides) were associated with the risk of CHD and improved the prediction accuracy over conventional risk factors in American Indian people. Some identified lipids in American Indian people were replicated in European people. Longitudinal changes in multiple lipid species (eg, acylcarnitines, phosphatidylcholines, and triacylglycerols) were associated with changes in cardiovascular risk factors. CONCLUSIONS: Baseline plasma lipids and their longitudinal changes over time are associated with risk of CHD. These findings provide novel insights into the role of dyslipidemia in CHD.

AIM: The 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS: A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE: Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation and the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

[Display omitted] • A panel of seven lipids increased c-statistic by an increment of 0.077, the greatest added value for prediction of incident CVD ever achieved by prospective lipidomics studies to the best of our knowledge. • Considerable mediations were observed through SM 41:1b, presumably SM(d18:1/23:0), in the associations between established cardiovascular risk factors and CHD risk, diabetes in particular. • CHD risk associated with increased levels of PC 36:0a, SM 41:1b, LPC 18:0 and LPC 20:3, and decreased levels of CE 18:2 were aggravated by long-term exposure to ambient air pollution. Previous lipidomics studies have identified various lipid predictors for cardiovascular risk, however, with limited predictive increment, sometimes using too many predictor variables at the expense of practical efficiency. To search for lipid predictors of future coronary heart disease (CHD) with stronger predictive power and efficiency to guide primary intervention. We conducted a prospective nested case-control study involving 1,621 incident CHD cases and 1:1 matched controls. Lipid profiling of 161 lipid species for baseline fasting plasma was performed by liquid chromatography-mass spectrometry. In search of CHD predictors, seven lipids were selected by elastic-net regression during over 90% of 1000 cross-validation repetitions, and the derived composite lipid score showed an adjusted odds ratio of 3.75 (95% confidence interval: 3.15, 4.46) per standard deviation increase. Addition of the lipid score into traditional risk model increased c-statistic to 0.736 by an increment of 0.077 (0.063, 0.092). From the seven lipids, we found mediation of CHD risk from baseline diabetes through sphingomyelin (SM) 41:1b with a considerable mediation proportion of 36.97% (P < 0.05). We further found that the positive associations of phosphatidylcholine (PC) 36:0a, SM 41:1b, lysophosphatidylcholine (LPC) 18:0 and LPC 20:3 were more pronounced among participants with higher exposure to fine particulate matter or its certain components, also to ozone for LPC 18:0 and LPC 20:3, while the negative association of cholesteryl ester (CE) 18:2 was attenuated with higher black carbon exposure (P < 0.05). We identified seven lipid species with greatest predictive increment so-far achieved for incident CHD, and also found novel biomarkers for CHD risk stratification among individuals with diabetes or heavy air pollution exposure. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) is one of the most common cardiovascular diseases. This study analyzed the diagnostic value of echocardiography combined with serum homocysteine (Hcy) and proprotein convertase subtilisin 9 (PCSK9) in CHD. Here, 108 CHD patients were selected as the study group. Additionally, 108 patients with suspected CHD excluded by coronary angiography were selected as the control group. Serum Hcy and PCSK9 levels were detected by circulating enzymatic and biochemical analysis assay. The contrast echocardiography showed that the contrast agent filling velocity (β) and the maximum number of microbubbles (A) in the study group were declined compared to the control group. Serum Hcy and PCSK9 levels in the study group were higher than those in the control group. In addition, β, A, Hcy and PCSK9 are important influencing factors of CHD. The coronary artery disease branch numbers and the degree of stenosis in CHD patients were negatively correlated with β and A values, and positively correlated with serum Hcy and PCSK9 levels. β, A combined with serum Hcy and PCSK9 levels have diagnostic value for CHD, and are significantly correlated with the severity of CHD. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Guidelines and studies provide conflicting information on whether type 2 diabetes (T2D) should be considered a coronary heart disease risk (CHD) equivalent in older adults.We synthesized participant‐level data on 82,723 individuals aged ≥65 years from five prospective studies in two‐stage meta‐analyses. We estimated multivariable‐adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D (presence versus absence) on a primary composite outcome defined as cardiovascular events or all‐cause mortality. Secondary outcomes were the components of the composite. We evaluated CHD risk equivalence by comparing outcomes between individuals with T2D but no CHD versus CHD but no T2D.The median age of participants was 71 years, 20% had T2D and 17% had CHD at baseline. A total of 29,474 participants (36%) experienced the composite outcome. Baseline T2D was associated with higher risk of cardiovascular events or all‐cause mortality versus no T2D (HR 1.44, 95% CI [1.40–1.49]). The association was weaker in individuals aged ≥75 years versus 65–74 years (HR 1.32 [1.19–1.46] vs. 1.56 [1.50–1.62]; p‐value for interaction = .032). Compared to individuals with CHD but no T2D, individuals with T2D but no CHD had a similar risk of the composite outcome (HR 0.95 [0.85–1.07]), but a lower risk of cardiovascular events (HR 0.76 [0.59–0.98]).T2D was associated with increased risk of cardiovascular events and all‐cause mortality in older adults, but T2D without CHD conferred lower risk of cardiovascular events compared to CHD without T2D. Our results suggest that T2D should not be considered a CHD risk equivalent in older adults. [ABSTRACT FROM AUTHOR]

Background: Depression, anxiety and high-sensitivity C-reactive protein (hs-CRP) are individually associated with poor prognosis in patients with coronary heart disease (CHD). However, the combined effects of depression with inflammation or anxiety with inflammation on the prognosis have been rarely explored. Methods: This prospective cohort study included 414 patients diagnosed with CHD. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety. A score ≥ 5 points was defined as elevated depression or anxiety. High hs-CRP was defined as ≥ 3 mg/L. Follow-up was performed 2 years after the patients were discharged. The clinical results included noncardiac readmission, cardiac readmission, major cardiovascular events (MACEs), and composite events. The composite events included noncardiac readmission and MACEs. The Cox proportional hazard regression model was used to analyze the prognostic risk. Results: After full adjustment, patients with elevated depression and high hs-CRP had a higher risk in predicting noncardiac readmission (hazard ratio (HR) = 3.87, 95% confidence interval (CI) = 1.10–9.02, p = 0.002) and composite events (HR = 1.93, 95% CI = 1.13–3.30, p = 0.016) than those with high hs-CRP alone. For the anxiety and hs-CRP group, high hs-CRP alone predicted a higher risk of noncardiac readmission (HR = 3.32, 95% CI = 1.57–7.03, p = 0.002) and composite events (HR = 1.75, 95% CI = 1.12–2.76, p = 0.015) than references. Elevated anxiety had no significant effects on all the endpoints. Furthermore, we didn't find interactions between depression and hs-CRP or anxiety and hs-CRP. Conclusion: In patients with CHD, elevated depression with high hs-CRP was found to be significant in predicting the risk of noncardiac readmission and composite events. Early diagnosis and treatment of depression with inflammation are necessary in CHD patients. [ABSTRACT FROM AUTHOR]

Background: The red blood cell distribution width (RDW)-to-albumin ratio (RAR) has emerged as a potentially valuable prognostic indicator in diverse medical conditions. However, the prognostic significance of RAR in intensive care unit (ICU) patients with coronary heart disease (CHD) and diabetes mellitus (DM) remains uncertain and requires further investigation. Methods: This study aims to investigate the prognostic significance of RAR in ICU patients with coexisting CHD and DM through a retrospective cohort analysis using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (version 2.2). The study population included patients aged 18 years or older who were diagnosed with both CHD and DM. The primary endpoint was 1-year mortality, and the secondary endpoints included 30-day mortality, 90-day mortality, hospital length of stay (LOS), and ICU LOS. Results: A total of 3416 patients, of whom 64.64% were male, were included in the study. The 30-day mortality, 90-day mortality, and 1-year mortality were 7.08%, 7.44%, and 7.49%, respectively. After adjusting for confounding factors, multivariate Cox proportional risk analysis demonstrated that high RAR levels were associated with an increased risk of 30-day mortality (HR, 1.53 [95% CI 1.17-2.07], P = 0.006), 90-day mortality (HR, 1.58 [95% CI 1.17-2.13], P = 0.003), and 1-year mortality (HR, 1.58 [95% CI 1.17-2.13], P = 0.003). Furthermore, the restricted cubic spline (RCS) model indicated a linear relationship between RAR and 1-year mortality. Conclusion: The results suggest that RAR holds potential as a valuable prognostic biomarker in ICU patients with both CHD and DM. Elevated RAR levels were found to be significantly associated with increased mortality during hospitalization, facilitating the identification of individuals at higher risk of adverse outcomes. These findings underscore the importance of incorporating RAR into risk stratification and overall management strategies for ICU patients with coexisting CHD and DM. [ABSTRACT FROM AUTHOR]

Background and Aims INTERASPIRE is an international study of coronary heart disease (CHD) patients, designed to measure if guideline standards for secondary prevention and cardiac rehabilitation are being achieved in a timely manner. Methods Between 2020 and 2023, adults hospitalized in the preceding 6–24 months with incident or recurrent CHD were sampled in 14 countries from all 6 World Health Organization regions and invited for a standardized interview and examination. Direct age and sex standardization was used for country-level prevalence estimation. Results Overall, 4548 (21.1% female) CHD patients were interviewed a median of 1.05 (interquartile range.76–1.45) years after index hospitalization. Among all participants, 24.6% were obese (40.7% centrally). Only 38.6% achieved a blood pressure (BP) < 130/80 mmHg and 16.6% a LDL cholesterol (LDL-C) of <1.4 mmol/L. Of those smoking at hospitalization, 48% persisted at interview. Of those with known diabetes, 55.2% achieved glycated haemoglobin (HbA1c) of <7.0%. A further 9.8% had undetected diabetes and 26.9% impaired glucose tolerance. Females were less likely to achieve the targets: BP (females 36.8%, males 38.9%), LDL-C (females 12.0%, males 17.9%), and HbA1c in diabetes (females 47.7%, males 57.5%). Overall, just 9.0% (inter-country range 3.8%–20.0%) reported attending cardiac rehabilitation and 1.0% (inter-country range.0%–2.4%) achieved the study definition of optimal guideline adherence. Conclusions INTERASPIRE demonstrates inadequate and heterogeneous international implementation of guideline standards for secondary prevention in the first year after CHD hospitalization, with geographic and sex disparity. Investment aimed at reducing between-country and between-individual variability in secondary prevention will promote equity in global efforts to reduce the burden of CHD. [ABSTRACT FROM AUTHOR]

Objective: To explore the diagnostic value of intermittent changes in the nocturnal ST segment trend graph in a dynamic electrocardiogram (ECG) for coronary heart disease (CHD). Methods: A total of 205 patients who underwent coronary angiography were included in this retrospective study. The study sample was determined through a power analysis aimed at achieving power of 80% with a significance level of 0.05. The participants were divided into the CHD (n = 101) and the non-CHD (n = 104) group, based on the degree of coronary artery diameter stenosis. The morphological changes in the ST segment trend graph were observed and divided into two categories: 'wall-shaped' and 'peak-shaped' changes. Results: Among the 205 patients, 94 had nocturnal ST segment dynamic changes and 111 did not. The detection rate of CHD without nocturnal ST segment dynamic changes was 21.59%, significantly lower than the detection rate of 93.18% in those with nocturnal ST segment changes, reflecting a statistically significant difference (P < 0.05). The positive rate of ST segment in patients with single-vessel disease (71.88%) was lower than in patients with multi-vessel disease (78.57%), and both differences were statistically significant (P < 0.05). The duration of ST segment trend graph changes in 94 cases in the CHD group with intermittent changes in the nocturnal ST segment trend graph was higher than in the non-CHD group, but no significant difference was observed (P > 0.05). The detection rate of CHD in the peak-shaped dynamic change group of the nocturnal ST segment trend graph was significantly higher (76/82) than in the wall-shaped (6/82) dynamic change group (P < 0.05). Conclusion: Peak-shaped changes in the nocturnal ST segment trend graph indicate coronary artery lesions. Nocturnal ST segment changes observed through dynamic ECG monitoring can serve as a valuable non-invasive predictor for CHD, providing a feasible method for early diagnosis and intervention in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Hypothyroidism and coronary heart disease are both common diseases in life and both are increasing in prevalence. Many studies have found a strong association between the two. However, they have not been able to prove a causal relationship. Furthermore, numerous studies have demonstrated that glycemic traits play a role in both. Consequently, the objective of this study was to ascertain the causal estimation of the association between hypothyroidism and coronary heart disease and to quantify the potential mediating role of glycemic traits in this relationship. Methods: We used two-sample Mendelian randomisation (UVMR) to explore causality between hypothyroidism and coronary heart disease. Additionally, multivariate Mendelian randomisation (MVMR) was applied to quantify the potential mediation of glycemic traits in this relationship. A variety of Mendelian randomization methods were employed in this study, including the inverse variance weighting (IVW) method, weighted median method, and MREgger test. Heterogeneity and horizontal pleiotropy were evaluated through MREgger intercept test, Cochran's Q test, and leave-one-out analysis to ensure the robustness of the study results. Results: The results of the MR analyses indicated that hypothyroidism was associated with an increased risk of coronary heart disease (IVW: OR=2.75, 95% CI: 1.53-4.94). In mediation analyses, the proportion of HbA1c-mediated effects of hypothyroidism on coronary heart disease was 7.3% (2.2%-12.5%). Conclusion: The results of our study indicate a causal relationship between hypothyroidism and coronary heart disease. Furthermore, HbA1c partially mediated the causal effect of hypothyroidism on coronary heart disease. Consequently, intervention in this factor may reduce the risk of coronary heart disease associated with hypothyroidism. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of Internet+cardiac rehabilitation on hypertension patients with coronary heart disease. Methods 80 patients with hypertension and coronary heart disease admitted to our hospital from January 2022 to April 2023 were randomly divided into the combined group (n = 40) and the conventional group (n = 40). Both groups were given routine cardiac rehabilitation interventions. The combined group combined adoptionof the Internet for continuous interventionson the basis of routine cardiac rehabilitation interventions. Compare the oxygen uptake, blood pressure, compliance, and self-management scores between two groups before intervention and three months after discharge. Results The AT Mets, AT VO2, peak VO2, and expected value compliance ratio in the combined group were all higher than those in the conventional group (P < 0.05) ; The systolic and diastolic blood pressure in the combination group were lower than those in the control group, and the proportion of complete compliance was significantly higher than that in the control group (P < 0.05); The self-management scores of the joint group were higher than those of the conventional group (P < 0.05). Conclusion The continuous interventions of Internet plus cardiac rehabilitation can control the blood pressure of patients with hypertension and coronary heart disease, and patients' compliance behavior is significantly improved, andthus improving patients' self-management ability, which can be used for reference and promotion in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The red blood cell distribution width (RDW)-to-albumin ratio (RAR) has emerged as a potentially valuable prognostic indicator in diverse medical conditions. However, the prognostic significance of RAR in intensive care unit (ICU) patients with coronary heart disease (CHD) and diabetes mellitus (DM) remains uncertain and requires further investigation. Methods: This study aims to investigate the prognostic significance of RAR in ICU patients with coexisting CHD and DM through a retrospective cohort analysis using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (version 2.2). The study population included patients aged 18 years or older who were diagnosed with both CHD and DM. The primary endpoint was 1-year mortality, and the secondary endpoints included 30-day mortality, 90-day mortality, hospital length of stay (LOS), and ICU LOS. Results: A total of 3416 patients, of whom 64.64% were male, were included in the study. The 30-day mortality, 90-day mortality, and 1-year mortality were 7.08%, 7.44%, and 7.49%, respectively. After adjusting for confounding factors, multivariate Cox proportional risk analysis demonstrated that high RAR levels were associated with an increased risk of 30-day mortality (HR, 1.53 [95% CI 1.17- 2.07], P = 0.006), 90-day mortality (HR, 1.58 [95% CI 1.17-2.13], P = 0.003), and 1-year mortality (HR, 1.58 [95% CI 1.17-2.13], P = 0.003). Furthermore, the restricted cubic spline (RCS) model indicated a linear relationship between RAR and 1-year mortality. Conclusion: The results suggest that RAR holds potential as a valuable prognostic biomarker in ICU patients with both CHD and DM. Elevated RAR levels were found to be significantly associated with increased mortality during hospitalization, facilitating the identification of individuals at higher risk of adverse outcomes. These findings underscore the importance of incorporating RAR into risk stratification and overall management strategies for ICU patients with coexisting CHD and DM. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Trial Registration This study examines the perspectives of individuals with coronary heart disease (CHD) on a nurse‐led eHealth cardiac rehabilitation (NeCR) program, which included a website, tele‐monitoring device, and social media chatroom.Using a descriptive qualitative approach, semi‐structured interviews were conducted with 18 participants to capture their feedback and experiences with the NeCR program.Participants found the NeCR program valuable in addressing gaps in cardiac rehabilitation services in China, empowering them to make behavioral changes and enhancing their social motivation. However, they also highlighted the need for a more user‐friendly website, better symptom management during exercise, and stronger privacy protections in the peer networking chatroom. The study concludes that the NeCR program is feasible in providing accessible rehabilitative services at home post‐discharge. Recommendations include improving the self‐monitoring platform for ease of use, incorporating immediate symptom management guidance during exercise, and ensuring a secure environment for online peer support.These findings offer crucial insights for developing patient‐centered eHealth cardiac rehabilitation services, emphasizing the importance of user‐friendly design, effective symptom management features, and privacy protection in promoting participant engagement with e‐platforms.ChiCTR1800020411 (http://www.chictr.org.cn/showprojen.aspx?proj=33906) [ABSTRACT FROM AUTHOR]

Human monocytes can be subdivided into phenotypically and functionally different classical, intermediate and non-classical monocytes according to the cell surface expression of CD14 and CD16. A precise identification and characterisation of monocyte subsets is necessary to unravel their role in inflammatory diseases. Here, we compared three different flow cytometric strategies (A–C) and found that strategy C, which included staining against CD11b, HLA-DR, CD14 and CD16, followed by several gating steps, most reliably identified monocyte subtypes in blood samples from healthy volunteers and from patients with stable coronary heart disease (CHD) or ST-elevation myocardial infarction (STEMI). Additionally, we established a fixation and permeabilisation protocol to enable the analysis of intracellular markers. We investigated the phagocytosis of lipid nanoparticles, the uptake of 2-NBD-glucose and the intracellular levels of CD74 and HLA-DM. This revealed that classical and intermediate monocytes from patients with STEMI showed the highest uptake of 2-NBD-glucose, whereas classical and intermediate monocytes from patients with CHD took up the largest amounts of lipid nanoparticles. Interestingly, intermediate monocytes had the highest expression level of HLA-DM. Taken together, we present a robust flow cytometric approach for the identification and functional characterisation of monocyte subtypes in healthy humans and patients with diseases. [ABSTRACT FROM AUTHOR]

Background: The association among coronary heart disease, ischemic stroke, and hydrocephalus remains ambiguous. Objectives: There is a need for a Mendelian randomization study to evaluate the underlying causality between coronary heart disease, ischemic stroke, and hydrocephalus. Methods: The data source utilized genome‐wide association studies, employing a threshold of p < 5 × 10−8 to identify single nucleotide polymorphisms strongly linked to ischemic stroke and coronary heart disease as instrumental variables (IVs). Five methods—inverse variance weighted (IVW), Mendelian randomization (MR) Egger, Weighted Median, Weighted mode, and Simple mode—utilized the selected IVs to estimate the causality between ischemic stroke, coronary heart disease, and hydrocephalus. Results: The IVW demonstrated that ischemic stroke and coronary heart disease serve as risk factors for hydrocephalus (odds ratio [OR] = 1.650, 95% CI: 1.066–2.554, p = 0.025; OR = 1.307, 95% CI: 1.023–1.668, p = 0.032). Both the MR‐Egger intercept test and Cochran's Q test affirmed the relative reliability of the IVW analysis results. However, no evidence of a reverse causation was observed between hydrocephalus and coronary heart disease or ischemic stroke. Conclusions: Coronary heart disease and Ischemic stroke may increase the risk of hydrocephalus. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of Danshen Baoxin Cha (DBC) on a rat model of coronary heart disease combined with cognitive impairment. Methods Male Sprague-Dawley (SD) rats were randomly assigned to two groups: normal group and model group. Streptozotocin was injected into the bilateral ventricles of rats in the model group to establish cognitive impairment model, then isoproterenol hydrochloride was injected subcutaneously to model myocardial ischemia. Behavioral experiments were conducted to verify the success of the model of cognitive dysfunction. The rats of the model group were randomly divided into five groups: model control group, Tongxinluo Capsule group (TXL group, 1.6 g·kg-1), and low- (4 g·kg-1), medium- (8 g·kg-1), and high- (16 g·kg-1) dose DBC groups. These groups were received the respective treatments continuously for two weeks. Subsequently, the Y-maze, novel object recognition and Morris water maze experiment were employed to assess the learning and memory abilities of rats. A kit was utilized to quantify the level of oxidative stress in the brain and the adenosine triphosphate (ATP) content in the brain and mitochondria. Hematoxylin-eosin (HE) staining and Nissl staining were employed to observe the pathological changes of neurons in hippocampus CA1 region. Electron microscopy was utilized to observe the pathological changes of mitochondria in hippocampal CA1 region. The expression levels of peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), glucose transporter type 4 (GLUT4), and optic atrophy 1 (OPA1) were quantified by real-time fluorescence quantitative polymerase chain reaction (PCR), and the expression of proteins related to the AMPK/OPA1 signaling pathway was determined by Western Blot analysis. Results Compared with the normal group, the spontaneous alternating reaction rate, the novel object recognition index, number of crossing the original platform, and distance ratio in the model group were obviously decreased (P＜0.01). Neuronal density in the CA1 region of the hippocampus was decreased, Nissl bodies were decreased, and nucleus consolidation was increased. The ATP level in mitochondria, and the levels of ATP, SOD, and GSH-PX in brain were significantly decreased (P＜0.05, P＜0.01), as well as the content of ROS and MDA were significantly increased (P＜0.05, P＜0.01). The mitochondria of hippocampus in CA1 region were swollen, with sparse and vacuolated cristae. The mRNA expression levels of GLUT4, PGC-1α, and OPA1 were significantly decreased (P＜0.01). The protein expression levels of GLUT4, SIRT1, PGC-1α and OPA1, and p-AMPK/ AMPK ratio were significantly decreased (P＜0.05, P＜0.01). Compared with the model group, the behavioral indexes of rats in the DBC groups were significantly improved (P＜0.05, P＜0.01), the number of neurons in the hippocampal CA1 area, Nissl bodies and nucleus consolidation were improved. The ATP level in mitochondria and the levels of ATP, SOD, and GSH-PX in brain were significantly increased (P＜0.05, P＜0.01). The levels of ROS and MDA were significantly decreased (P＜0.05, P＜0.01). The structure of mitochondrial cristae in hippocampal CA1 region were relatively intact. The mRNA expression levels of GLUT4, PGC-1α and OPA1 were increased (P＜0.05, P＜0.01), and the expression of proteins related to the AMPK/OPA1 signaling pathway was significantly increased (P＜0.05, P＜0.01). Conclusion DBC can enhance learning and memory abilities, reduce neuronal damage in a rat model of coronary heart disease combined with cognitive impairment. The mechanism may be related to the reduction of oxidative stress damage in the brain, the activation of the AMPK/OPA1 signaling pathway, and the restoration of energy levels. [ABSTRACT FROM AUTHOR]

Objective To explore the mechanism of action of Danshen Baoxin Cha (DBC) on depressed mice with coronary heart disease (CHD) based on network pharmacology and NLRP3 inflammatory pathway. Methods (1) TCMSP and BATMAN-TICAM databases were used to screen the DBC active ingredients and targets. The targets of CHD with depression were screened using the OMIM and Genecards databases. The targets of DBC active ingredients and related targets of CHD with depression were imported into Venny 2.1 online platform to obtain the intersection targets, which was the potential target of DBC in the treatment of CHD with depression. Protein-protein interaction (PPI) analysis was performed on the intersection targets using the STRING platform to screen the key targets. A "drug- active ingredients - disease- targets" network was created to select the main active ingredients and core targets of DBC for the treatment of CHD with depression. Thereafter, the primary targets were examined by GO function and KEGG pathway enrichment using the Metascape database. (2) Kunming mice were split into six groups of eight mice each at random： the control group, the model group, the positive control group (metoprolol tartrate 5.14 mg·kg-1 + sertraline hydrochloride 10.3 mg·kg-1), and the DBC high-, middle-, and low- dose groups (30.8, 15.4 and 7.7 g·kg-1·d-1). Chronic unpredictable mild stimulation (CUMS) and subcutaneous injection of isoprenaline hydrochloride (ISO) were used to induce a mice model of CHD with depression. Mice were treated orally with the corresponding drug once a day for 18 consecutive days. Behavioral experiments involving forced swimming test, tail suspension test, and open-field test were applied to detect depression levels of mice. Histopathological alterations in hippocampus tissues were noted using HE and Nissl staining. qPCR was used to determine the mRNA expression levels of IL-6, TNF-α, NLRP3, IL-1β, IL-10, and Caspase-1 in hippocampus tissues. Results (1) Sixty-five active components in Salvia and seven active components in green tea were screened out. A total of 1 042 potential targets and 2 116 CHD complicated with depression-related targets were obtained. The intersection of the targets of active components and disease- related targets was performed by Venny 2.1.0 platform to obtain 299 potential targets (common targets) of DBC in the treatment of CHD with depression. The core targets including IL-1β, AKT1, TNF-α, IL-6, VEGFA, CASP3 and IL-10 were screened through PPI network analysis of potential targets. Key active ingredients including vitamin B, luteolin, salvianolic acid, tanshinone IIA and catechin, as well as key targets, such as PTGS2、 IL-1β、 IL-6、 TNF- α and IL-10, were obtained by network analysis of “drugs-active ingredients-disease-targets”. The potential targets were correlated with biological processes such as inflammation response, regulation of tumour necrosis factor (TNF), glucocorticoid regulation, regulation of nuclear factor kappa B (NF-κB) transcription factor, as well as major pathways including PI3K-Akt signaling pathway, TNF signaling pathway, apoptosis signaling pathway, and NF-κB signaling pathway. (2) Compared with the control group, mice in the model group showed a significant decrease in the total and center distance of the open field (P＜0.01) and a significant increase in the time of forced swimming and immobility time of tail suspension test (P＜0.01). The mRNA expression of IL-6, TNF- α, NLRP3, IL-1β, and Caspase-1 was significantly up-regulated (P＜0.01) in the hippocampus tissues, but IL-10 mRNA expression was down-regulated (P＜0.05). Compared with the model group, the total and center distance in DBC high-, middle-, and low- dose groups were significantly up-regulated (P＜0.05, P＜0.01), and the time of forced swimming and immobility time of tail suspension test were significantly down-regulated (P＜0.01). The mRNA expression of IL-6, TNF- α, NLRP3, IL-1β and Caspase-1 of the DBC high-, middle-, and low- dose groups were significantly down- regulated (P＜0.01), IL-10 mRNA expression in mice hippocampus tissue of DBC high- and middle- dose groups was up-regulated (P＜0.01). Conclusion The intervention effect of DBC on depressed mice with CHD may be achieved by active ingredients including luteolin, tanshinone, salvianolic acid and catechin acting on the key targets, such as IL-6,TNF-α, IL-1β and IL-10, to regulate the NLRP3 inflammatory signaling pathway. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the effects of brief mindfulness meditation training on improving negative emotions, mindfulness attention awareness, and sleep quality in patients after percutaneous coronary intervention (PCI) for coronary heart disease. Methods: Eighty-four patients with coronary heart disease after PCI admitted to the cardiology department were selected. According to the principle of simple randomization, they were divided into an intervention group of 42 cases and a control group of 42 cases. The Self Rating Anxiety Scale/Self Rating Depression Scale, Mindfulness Attention Awareness Scale, and Pittsburgh Sleep Quality Index Scale were used as evaluation indicators before and after intervention. Results: The difference in total scores of anxiety, depression, and mindfulness attention awareness before and after intervention in the intervention group was higher than that in the control group (P<0.05). The difference in total sleep score, sleep quality, time to fall asleep, sleep duration, use of hypnotic drugs, daytime dysfunction, and total sleep score before and after intervention was higher than that of the control group (P<0.05). Conclusion: It suggests that brief mindfulness meditation training could alleviate negative emotions in patients with coronary heart disease after PCI, improve mindfulness awareness, and improve sleep quality. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the combined impact of diet quality and rheumatoid arthritis (RA) on development of cardiovascular and mortality outcomes among postmenopausal women. Methods: A total of 99,840 women without baseline RA and 10,494 women with baseline RA were prospectively followed for an average of 12.7 years through the Women's Health Initiative. Diet quality was evaluated using food frequency questionnaires and the Healthy Eating Index 2015. Cardiovascular and mortality outcomes were identified through study follow-up. Four patient groups were used: Reference Group (no RA and healthy diet), Group 1 (no RA and unhealthy diet), Group 2 (RA and healthy diet), Group 3 (RA and unhealthy diet). Data was analyzed using multivariable Cox proportional regression models. Results: After adjustment for confounders, Groups 1 and 3 developed significantly more cardiovascular disease (CVD), coronary heart disease, and incident stroke as compared to the reference. All groups developed more CVD-related mortality and all-cause mortality as compared to the reference. Among patients who already have RA, the incidence of these poorer cardiovascular outcomes does not significantly increase based on diet quality. Conclusion: While healthy diet quality is associated with reduced adverse cardiovascular and mortality outcomes, RA overpowers the benefits that may be attained through a healthy diet, resulting in the fact that diet quality does not significantly change cardiovascular and mortality outcome incidence in those who already have RA. Conversely, in those who do not have RA, the benefits of a healthy diet are realized with significant reduction of adverse cardiovascular and mortality outcomes as compared to those with an unhealthy diet. Key Points •Healthy diet quality is associated with reduced adverse cardiovascular and mortality outcomes. •RA is associated with increased adverse cardiovascular and mortality outcomes. •While diet quality does not significantly change cardiovascular and mortality outcomes in those who already have RA, those without RA experience significant reduction of these adverse outcomes by adhering to a healthy diet. [ABSTRACT FROM AUTHOR]

The prognostic value of growth differentiation factor-15 (GDF-15) in predicting long-term adverse outcomes in coronary heart disease (CHD) patients remains limited. Our study examines the association between GDF-15 and adverse outcomes over an extended period in CHD patients and firstly assesses the incremental prognostic effect of incorporating GDF-15 into the Framingham risk score (FRS)-based model. This single-center prospective cohort study included 3,321 patients with CHD categorized into 2,479 acute coronary syndrome (ACS) (74.6%) and 842 non-ACS (25.4%) groups. The median age was 61.0 years (range: 53.0–70.0), and 917 (27.6%) were females. Mortality and major adverse cardiovascular events (MACEs) included cardiovascular mortality, myocardial infarction (MI), stroke, and heart failure (HF) (inclusive of HF episodes requiring outpatient treatment and/or hospital admission). Cox regression models assessed the associations between GDF-15 and the incidence of all-cause mortality and MACEs. Patients were stratified into three groups based on GDF-15 levels: the first tertile group (< 1,370 ng/L), the second tertile group (1,370–2,556 ng/L), and the third tertile group (> 2,556 ng/L). The C-index, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA) were used to assess incremental value. Over a median 9.4-year follow-up, 759 patients (22.9%) died, and 1,291 (38.9%) experienced MACEs. The multivariate Cox model indicated that GDF-15 was significantly associated with all-cause mortality (per ln unit increase, HR = 1.49, 95% CI: 1.36–1.64) and MACEs (per ln unit increase, HR = 1.29, 95% CI: 1.20–1.38). These associations persisted when GDF-15 was analyzed as an ordinal variable (p for trend < 0.05). Subgroup analysis of ACS and non-ACS for the components of MACEs separately showed a significant association between GDF-15 and both cardiovascular mortality and HF, but no association was observed between GDF-15 and MI /stroke in both ACS and non-ACS patients. The addition of GDF-15 to the FRS-based model enhanced the discrimination for both all-cause mortality (∆ C-index = 0.009, 95% CI: 0.005–0.014; IDI = 0.030, 95% CI: 0.015–0.047; continuous NRI = 0.631, 95% CI: 0.569–0.652) and MACEs (∆ C-index = 0.009, 95% CI: 0.006–0.012; IDI = 0.026, 95% CI: 0.009–0.042; continuous NRI = 0.593, 95% CI: 0.478–0.682). DCA suggested that incorporating GDF-15 into the FRS-based model demonstrated higher net benefits compared to FRS-based models alone (All-cause mortality: FRS-based model: area under the curve of DCA (AUDC) = 0.0903, FRS-based model + GDF-15: AUDC = 0.0908; MACEs: FRS-based model: AUDC = 0.1806, FRS-based model + GDF-15: AUDC = 0.1833). GDF-15 significantly associates with the long-term prognosis of all-cause mortality and MACEs in CHD patients and significantly improves the prognostic accuracy of the FRS-based model for both outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular disease (CVD) surveillance in Quebec and the rest of Canada is carried out using health administrative databases, which in Quebec includes the physician claims database. The presence of billing claims without diagnoses can lead to the number of CVD cases being underestimated. The purpose of this study is to estimate the proportion of CVD diagnoses and CVD cases that may be missing from these databases. Methods: The study was conducted using a prospective cohort of 8781 participants living in the Québec City area. Access to health administrative databases was granted for the entire 28-year follow-up period. First, we performed frequency analyses to estimate the proportion of missing CVD diagnoses. Then we used validated algorithms to identify CVD cases and estimate the proportion of CVD cases that were potentially not captured over the 28-year period. Results: About one-fifth (22.1%) of the diagnoses in the physician claims database were missing. The proportion of missing CVD cases was estimated at 12.7% for 1991-2018, although this varied with the period covered (1991-1996: 15.5%; 1997-2013: 10.7%; and 2014-2018: 16.3%). Conclusion: Approximatively 1 in 10 CVD cases are not identified due to a missing diagnosis. This underestimation of CVD cases is a potential limitation that should be considered when using Quebec health administrative databases to identify CVD cases for surveillance work and epidemiological studies. [ABSTRACT FROM AUTHOR]

Background: The impact of marital status on cardiovascular disease (CVD) remains controversial in the general population. Aim: The present investigation sought to delineate the association between marital status and long-term major non-fatal and fatal CVD, along with all-cause mortality within the scope of the RIFLE project (Risk Factors and Life Expectancy). Methods: We examined the incidences of CVD, including cerebrovascular accidents and coronary heart disease (CHD), as well as all-cause mortality. In total, 47,167 individuals (46% female, average age 50 ± 9 years) were included in the analysis. Marital status at inception was categorized into married (inclusive of married or cohabitating) versus unmarried cohorts (including widowed, separated, divorced, or single individuals). Results: Compared to their married counterparts, unmarried subjects demonstrated a heightened risk for CVD in both females and males. Throughout a median follow-up span of 7.4 years (interquartile range from 6 to 9 years), married participants, adjusting for standard risk factors, exhibited reduced mortality rates attributed to CHD [hazard ratio (HR) 0.54 (95% confidence interval (CI) 0.33–0.86)) and all causes (HR 0.75 (95% CI 0.62–0.91)] within the aggregate population; this reduction persisted for both CHD-specific [HR 0.39 (95% CI 0.51–0.90)]and all-cause mortality [HR 0.68 (95% CI 0.51–0.90)], independent of traditional risk factors in women. No associations were evident between matrimonial status and any measured outcomes in males. Conclusions: Within primary care settings, marital status should be considered a potential correlate of long-term CHD and overall mortality risks, especially among women. [ABSTRACT FROM AUTHOR]

One of the causes of coronary heart disease (CHD) is genetic factors. In this study, we explored the relationship between CYP2D7 and TCF20 gene polymorphisms and the risk of CHD in the Han Chinese population. Three single nucleotide polymorphisms (CYP2D7 rs1800754, CYP2D7 rs2743461, and TCF20 rs760648) were selected and genotyped from 490 cases and 480 controls. The odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the association between CYP2D7 and TCF20 polymorphisms and the risk of CHD. The association between clinical indicators and polymorphisms was analyzed using one-way ANOVA and Tukey's HSD. The SNP-SNP interactions were obtained by performing multifactor dimensionality reduction (MDR). CYP2D7 rs1800754 and rs2743461 were closely associated with increased risk of CHD (alleles: p = 0.014, p = 0.031). Stratified analysis showed that CYP2D7 rs1800754 and rs2743461 were associated with an increased risk of CHD in men, age > 60 years, BMI ≥ 24, and smoking. Rs1800754 is also associated with an increased risk of CHD associated with alcohol consumption. In addition, TCF20 rs760648 was associated with a reduced risk of CHD in patients aged ≤ 60 years and with CALs. A significant association was found between CYP2D7 rs1800754 and rs2743461 genotypes and levels of UREA, Cr, and LDL-C; TCF20 rs760648 genotypes and levels of RBC. The MDR analysis showed that the three-locus interaction model was the best in the multi-locus model. In conclusion, CYP2D7 rs1800754 and rs2743461 polymorphisms were associated with CHD risk. [ABSTRACT FROM AUTHOR]

Aims: Depressive symptoms are comorbid with coronary heart disease (CHD). There is a controversial debate about whether screening and intervention for depressive symptoms could improve cardiovascular prognosis. This study characterizes the prevalence, characteristics, cardiovascular prognosis and management need of depressive symptoms among CHD patients. Methods: CHD patients were recruited between November 18, 2020 and November 26, 2021. Depressive symptoms were evaluated with the Patient Health Questionnaire (PHQ-9). During the 12-month follow-up, cardiovascular disease (CVD) was the endpoint. Time-to-event data were estimated by Kaplan-Meier curves and Cox models. Results: Of 582 patients (25% women), 21.0% had mild depressive symptoms, and 7.5% had moderate-to-severe depressive symptoms during hospitalization. Mild and moderate-to-severe depressive symptoms were risk factor-adjusted predictors of the primary composite endpoints (adjusted HR = 2.20; 95%CI 1.19–4.03, and adjusted HR = 2.70; 95%CI 1.23–5.59, respectively). Platelet count and low-density lipoprotein were higher in mild depressive symptoms compared to no depressive symptoms. Conclusion: Depressive symptoms are prevalent in CHD patients. Mild and moderate-to-severe depressive symptoms are associated with higher risk of further CVD in CHD patients. Platelet function and behavioral mechanisms may contribute to this association. Trial registration: This research was registered at https://www.chictr.org.cn. Full data of first registration is 11/09/2020. The registration number is ChiCTR2000038139. [ABSTRACT FROM AUTHOR]

Background: Retention of apolipoprotein B (apoB)-containing lipoproteins within the arterial wall plays a major causal role in atherosclerotic cardiovascular disease (ASCVD). There is a single apoB molecule in all apoB-containing lipoproteins. Therefore, quantitation of apoB directly estimates the number of atherogenic particles in plasma. ApoB is the preferred measurement to refine the estimate of ASCVD risk. Low-density lipoprotein (LDL) particles are by far the most abundant apoB-containing particles. In patients with elevated lipoprotein(a) (Lp(a)), apoB may considerably underestimate risk because Mendelian randomization studies have shown that the atherogenicity of Lp(a) is approximately 7-fold greater than that of LDL on a per apoB particle basis. In subjects with increased Lp(a), the association between LDL-cholesterol and incident CHD (coronary heart disease) is increased, but the association between apoB and incident CHD is diminished or even lost. Thus, there is a need to understand the mechanisms of Lp(a), LDL-cholesterol and apoB-related CHD risk and to provide clinicians with a simple practical tool to address these complex and variable relationships. How can we understand a patient's overall lipid-driven atherogenic risk? What proportion of this risk does apoB capture? What proportion of this risk do Lp(a) particles carry? To answer these questions, we created a novel metric of atherogenic risk: risk-weighted apolipoprotein B. Methods: In nmol/L: Risk-weighted apoB = apoB - Lp(a) + Lp(a) x 7 = apoB + Lp(a) x 6. Proportion of risk captured by apoB = apoB divided by risk-weighted apoB. Proportion of risk carried by Lp(a) = Lp(a) × 7 divided by risk-weighted apoB. Results: Risk-weighted apoB agrees with risk estimation from large epidemiological studies and from several Mendelian randomization studies. Conclusions: ApoB considerably underestimates risk in individuals with high Lp(a) levels. The association between apoB and incident CHD is diminished or even lost. These phenomena can be overcome and explained by risk-weighted apoB. [ABSTRACT FROM AUTHOR]

Sodium is crucial for maintaining cardiovascular health, especially in relation to heart failure. The impact of baseline serum sodium concentrations on the outcomes of newly diagnosed coronary heart disease (CHD) without heart failure remains unclear. This prospective cohort study included 681 patients who were newly diagnosed with CHD. Cox proportional hazards models and restricted cubic spline (RCS) analysis were used to assess the relationship between serum sodium concentrations and major adverse cardiovascular events. The improvement in traditional prediction models by the addition of serum sodium concentrations was assessed using changes in the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). During a median follow-up of 51.04 months (IQR: 40.88–53.80 months), 131 events were recorded. Multivariate Cox proportional hazards models showed that the L2 group (136–138.9 mmol/L) had the highest MACE risk. Compared to L2, the hazard ratios (HRs) and 95% confidence intervals (CIs) for the L1 (130–135.9 mmol/L), L3 (139–140.9 mmol/L), L4 (141–142.9 mmol/L), and L5 (143–147.0 mmol/L) groups were 0.31 (0.14–0.70, P = 0.005), 0.48 (030–0.78, P = 0.003), 0.56 (0.34–0.92, P = 0.022), and 0.37 (0.22–0.64, P < 0.001), respectively. Including serum sodium concentrations in the prediction model significantly improved the C-statistic from 0.647 to 0.679 (P = 0.022), with an NRI of 0.338 (P < 0.001) and an IDI of 0.026 (P < 0.001). RCS analysis showed a nonlinear relationship: within the 130–138 mmol/L sodium range, MACE risk gradually increased with higher sodium levels (HR 1.39, 95% CI 1.09–1.76, P = 0.008); whereas within the 138–147 mmol/L range, the risk gradually decreased (HR 0.88, 95% CI 0.80–0.98, P = 0.014). Baseline serum sodium concentrations are significantly associated with long-term cardiovascular risk in newly diagnosed CHD patients, showing an inverted U-shaped relationship, whereas low serum sodium may be specifically linked to higher risks of death and nonfatal myocardial infarction. Further research is needed to explore the impact of long-term changes in serum sodium concentrations on disease prognosis. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Methods Results Conclusion Relevance to Clinical Practice Patient or Public Contribution Reporting Method To explore risk factors for Coronary Heart Disease (CHD) in secondary prevention for patients with the disease in China.Cross‐sectional study.A two‐stage sampling method was used (stratified sampling and systematic sampling). Patients who met WHO diagnostic criteria for CHD, had the capacity to give informed consent and volunteered to participate were recruited from five districts in Hengyang city, Hunan province, China. Six instruments were used: A general socio‐demographic questionnaire, Coronary Heart Disease Self‐Management Scale, International Physical Activity Questionnaires, Chinese Eight‐Item Morisky Medication Adherence Scale, Zung's Self‐Rating Anxiety Scale and Sexual Health Questionnaires. Participants completed the questionnaires in person or via telephone. Single‐factor correlation analysis, Pearson correlation analysis and multiple linear regression analysis were carried out.A total of 373 patients were recruited with a mean age of 66.25 years (standard deviation = 9.98). The mean score was 57.00 (14.23) for self‐management, 5.41 (1.82) for medication adherence, 53.61 (9.26) for anxiety, 8.66 (3.18) for sexual knowledge and 22.20 (9.68) for the need for sexual health education. The median was 1563.90 MET‐min/day for total energy consumption of physical activity. Self‐management, physical activity, medication adherence, anxiety and sexual health were significantly correlated with a range of demographic variables (age, gender, marital status, occupation, education levels, types of medical insurance, personal monthly income, living arrangements) and illness‐related variables (illness duration, number of hospital admissions, type of therapy, number of other chronic diseases, cardiac function grading and BMI).This research has showed the risk factors related to self‐management skills, medication adherence, anxiety, physical activity, sexual knowledge and the need for sexual health education in secondary prevention for patients with CHD. Health professionals play an important role in helping patients reduce risk factors for CHD to minimise its reoccurrence and mortality.Both hospital‐based and community‐based health professionals, especially nurses, have an important role to play in developing and implementing health promotion interventions to help patients with CHD reduce risk factors for the disease and thus reduce mortality.No patient contribution. Community nursing staff contributed to the design of the general socio‐demographic questionnaire for this study.The STROBE checklist was used to ensure comprehensive reporting (Appendix S1). [ABSTRACT FROM AUTHOR]

Heart rate recovery, a widely used indicator in clinical evaluation of the autonomic nervous system, refers to the difference between maximum heart rate during exercise and the heart rate after 1 or a few minutes of cessation. It possesses advantages of being noninvasive and repeatable. Currently, heart rate recovery is extensively applied in cardiovascular diseases for evaluating disease severity, prognosis, risk of cardiovascular events, and mortality. This article primarily discusses the application value and current research progress of heart rate recovery in cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of individual exercise training on the rehabilitation of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). Methods A total of 81 patients between January 2021 and December 2023 were randomly allocated into an observation group (n = 41) and a control group (n = 40) using a simple random number Tab.method. The control group received routine post- operative rehabilitation intervention, while the observation group received individualized exercise training as the core component of cardiac rehabilitation intervention. The study compared the effects of rehabilitation, cardiac function parameters [left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD)], exercise endurance measures [6-minute walking distance (6MWD)], and quality of life assessed by Seattle Angina Pecina Scale (SAQ) scores between the two groups before and after a three-month intervention period. Results The total recovery response rate in the observation group was higher than that in the control group (P < 0.05). LVEF, LVEDD, 6 MWD, maximum exercise load and SAQ scales (P > 0.05), LVEF were higher than before intervention (t = 3.345, 2.480, 3.165, 5.016, 2.059, 4.582, 4.443, 3.353, P < 0.05), and LVEDD was lower than before intervention (t = 3.335, P < 0.05). Conclusion The individualized exercise training-based cardiac rehabilitation program demonstrates potential for enhancing cardiac function and exercise endurance in patients with CHD following PCI, thereby improving their overall quality of life. This finding holds significant clinical implications. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusion The distribution pattern of abdominal adiposity may help determine cardiovascular disease (CVD). Waist circumference (WC) is the most common but imprecise method for measuring abdominal adiposity, as it fails to differentiate between visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (ASAT). This study aimed to determine whether elevated VAT or ASAT provides greater prognostic value for CVD events compared to elevated WC in the general population using data from the UK Biobank.In this secondary analysis of UK Biobank study, 24 265 participants with available abdominal magnetic resonance imaging data were included. The primary outcome of the study was coronary heart disease (CHD), and secondary outcomes included stroke, heart failure (HF) and atrial fibrillation (AF). Cox regressions for VAT, ASAT and WC were examined in relation to the predefined outcomes on continuous scales using standard deviation (SD) changes and by categories of concordant and discordant values defined by medians.During a mean follow‐up period of 12.9 ± 1.8 years, 2641 participants developed CVD events (1296 CHD, 165 stroke, 286 HF and 894 AF) Each 1 SD increase in VAT yielded a hazard ratio (HR) of 1.15 (95% confidence interval [CI]: 1.09–1.22) for CHD risk, whereas ASAT had a HR of 1.10 (95% CI: 1.04–1.18). Further adjustment for WC eliminated the association between ASAT and CHD risk, in contrast to the association between VAT and CHD risk, which remained almost unaffected. Discordant VAT above the median with WC below presented a HR of 1.43 (95% CI: 1.15–1.78) for CHD, compared with concordant VAT and WC below the median. Similar results were found for discordant WC above the median with VAT below, with a HR of 1.46 (95% CI: 1.18–1.81). In contrast, discordant ASAT above the median with WC below was not associated with an increased risk of CHD. Similarly, discordant ASAT above the median with VAT below was not associated with an increased risk of CHD. Additionally, there was no observed association between VAT or ASAT and the risks of stroke, HF or AF after further adjustment for WC. Additionally, there was no observed association between VAT or ASAT and the risks of stroke, HF or AF after further adjustment for WC.Incorporating VAT measurements alongside WC data improved the ability to identify individuals at high risk for CHD compared to using WC alone. Both VAT and WC proved to be more accurate indicators of CHD risk than ASAT. However, VAT alone did not fully account for the CHD risk associated with elevated WC levels. Neither VAT nor ASAT showed an association with the risk of stroke, HF and AF. [ABSTRACT FROM AUTHOR]

Background: Cannabis use is associated with an increased risk of coronary heart disease (CHD), including angina pectoris (AP), and myocardial infarction (MI). However, it is not clear whether cannabis use is an independent risk factor of AP and/or MI, because cannabis is often smoked together with tobacco. We investigated whether cannabis is an independent risk factor of MI and whether this risk is similar in cannabis smokers, cannabis vapers, and those who use cannabis edibles. Methods: A systematic review was performed, according to the PRISMA guidelines and using Medline (PubMed), Embase, and Google Scholar as databases. Results: Twenty-two eligible papers were identified. After adjustment for concurrent tobacco use, cannabis smoking remained significantly associated with incidents of MI, with aORs ranging between 1.03 and 5.24, and particularly high aORs in the younger age group. In never-tobacco smokers, frequent cannabis smoking was also associated with a significant MI risk (aOR = 1.88). Frequent and current cannabis use in any form other than smoking (e.g., vaping, but mostly ingestion) was not associated with a significantly increased cardiovascular risk (frequent use: aOR = 1.00 ns; current use: aOR = 1.31 ns). Conclusions: Like tobacco smoking, cannabis smoking may independently provoke MI. Vaping and ingestion of cannabis might be less harmful, probably because absence of combustion prevents exposure to certain toxins in cannabis smoke, including carbon monoxide. [ABSTRACT FROM AUTHOR]

Familial hypercholesterolemia (FH) is the most significant inherited risk factor for coronary heart disease (CHD). Current guidelines focus on monogenic FH, but the polygenic form is more common and less understood. This study aimed to assess the clinical utility of an 8-SNP LDLC polygenic score in a central Romanian cohort. The cohort included 97 healthy controls and 125 patients with premature (P)CHD. The weighted LDLC polygenic risk score (wPRS) was analyzed for associations with relevant phenotypic traits, PCHD risk, and clinical FH diagnosis. The wPRS positively correlated with LDLC and DLCN scores, and LDLC concentrations could be predicted by wPRS. A trend of increasing LDLC and DLCN scores with wPRS deciles was observed. A +1 SD increase in wPRS was associated with a 36% higher likelihood of having LDLC > 190 mg/dL and increases in LDLC (+0.20 SD), DLCN score (+0.16 SD), and BMI (+0.15 SD), as well as a decrease in HDLC (−0.14 SD). Although wPRS did not predict PCHD across the entire spectrum of values, individuals above the 90th percentile were three times more likely to have PCHD compared to those within the 10th or 20th percentiles. Additionally, wPRS > 45th percentile identified "definite" clinical FH (DLCN score > 8) with 100% sensitivity and 45% specificity. The LDLC polygenic score correlates with key phenotypic traits, and individuals with high scores are more likely to have PCHD. Implementing this genetic tool may enhance risk prediction and patient stratification. These findings, the first of their kind in Romania, are consistent with the existing literature. [ABSTRACT FROM AUTHOR]

Background: Coronary heart disease (CHD) and stroke have become the leading cause of premature mortality and morbidity worldwide. Therefore, sensitive and accurate biomarkers for early detection of CHD and stroke are urgently needed for effective prevention and treatment. We aim to investigate the association between blood-based HYAL2 methylation and the risk of CHD and stroke in Chinese population. Methods: In a prospective nested case–control study comprising 171 CHD cases, 139 stroke cases, who developed the diseases after recruitment and 356 controls who remained healthy during the 2.5 years of follow-up time, the methylation level of HYAL2 in the peripheral blood was quantified using mass spectrometry, and the association was calculated by logistic regression adjusted for covariant. Results: Significant association between HYAL2 methylation in the peripheral blood and increased risk of preclinical CHD and stroke were identified [odds ratios (ORs) per − 10% methylation: 1.35–1.64, p ≤ 0.045 for HYAL2_CpG_1, HYAL2_CpG_2 and HYAL2_CpG_3 in CHD; ORs per − 10% methylation: 0.76–1.64, p ≤ 0.033 for HYAL2_CpG_2 and HYAL2_CpG_4 in stroke]. The association in CHD was further enhanced by female gender, younger age (< 70 years old), without the history of hypertension and cancer. The combination of four HYAL2 methylation sites showed an effective discrimination of CHD and stroke cases without hypertension from controls [area under curve (AUC) = 0.78 and 0.75, respectively]. Conclusions: This study presents a strong association of altered HYAL2 methylation in peripheral blood with preclinical CHD and stroke, providing a novel biomarker for risk assessment and early detection of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Background: Inflammation and malnutrition are related to adverse clinical outcomes in patients with coronary artery disease (CAD). However, it is unclear whether there is a relationship between the PNI (prognostic nutritional index) and RDW (red blood cell distribution width) regarding the impact on the prognosis in patients with CAD undergoing percutaneous coronary intervention (PCI). Methods: A total of 5605 consecutive CAD patients undergoing PCI were selected retrospectively. The patients were stratified into four groups according to the PNI [high PNI (H-PNI) and low PNI (L-PNI)] and RDW [high RDW (H-RDW) and low RDW (L-RDW)]. The cutoff values of RDW and PNI were calculated using receiver-operating characteristic curve analysis. The primary endpoint was 1-year all-cause mortality (ACM). The secondary endpoint was major adverse cardiac cerebrovascular events (MACCEs), the composite of cardiac death (CD), the recurrence of MI, target lesion revascularization (TLR), and stroke. A Cox proportional hazards model was used to evaluate the association between the PNI, RDW, and clinical endpoints. Results: During 1-year follow-up, 235 (4.19%) patients died. In multivariate regression analysis, the L-PNI/H-RDW group was found to have the highest risk of 1-year ACM [hazard ratio (HR) = 8.85, 95% confidence interval (CI): 5.96–13.15, p = 0.020] with the H-PNI/L-RDW group as a reference, followed by the L-PNI/L-RDW (HR = 3.96, 95% CI: 2.60–6.00, p < 0.001) and H-RDW/H-PNI groups (HR = 3.00, 95% CI: 1.99–4.50, p < 0.001). Nomograms were developed to predict the probability of 1-year ACM and MACCEs. Conclusions: CAD patients with L-PNI and H-RDW experienced the worst prognosis. The combination of PNI and RDW was a strong predictor of 1-year ACM. The coexistence of PNI and RDW appears to have a synergistic effect, providing further information for the risk stratification of CAD patients. [ABSTRACT FROM AUTHOR]

Interleukin-6 (IL-6) plays a crucial role in the pathogenesis of cardiovascular disease (CVD), and IL-6 receptor (IL-6R) blockade has emerged as a promising therapeutic option. However, their specific therapeutic effects in different types of CVDs remain unclear. This study aimed to assess the efficacy of IL-6R blockade in the management of various CVDs, including hypertension (HTN), coronary heart disease (CHD), myocardial infarction (MI), atrial fibrillation (AF), and heart failure (HF). The Mendelian randomization (MR) approach was utilized to investigate the therapeutic impact of IL-6R blockade on HTN, CHD, MI, AF, and HF based on the genome-wide association study (GWAS) summary statistics. MR-Egger intercept test, Cochran's Q test, and leave-one-out analysis were used for sensitivity analysis to verify the reliability of the MR results. The Bonferroni method was used to correct for bias caused by multiple comparisons. Inverse variance weighted (IVW) results demonstrated that IL-6R blockade significantly influenced CHD (odds ratio (OR) = 0.757, 95% confidence interval (CI): 0.690 - 0.832, P = 5.804 × 10–9) and MI (OR = 0.840, 95% CI: 0.744 - 0.949, P = 0.005). However, IL-6R blockade had no significant effect on HTN (OR = 1.015, 95% CI: 0.950 - 1.084, P = 0.663), AF (OR = 0.905, 95% CI: 0.800 - 1.025, P = 0.116) and HF (OR = 1.012, 95% CI: 0.921 - 1.113, P = 0.805). Genetically predicted IL-6R blockade was associated with a protective effect on CHD and MI, but not HTN, AF and HF. This study's findings offer valuable insights for tailoring IL-6R blockade treatment for different types of CVD, and serve as a reference for future research. [ABSTRACT FROM AUTHOR]

Objective: To analyze the influential factors of frailty in elderly patients with coronary heart disease (CHD), develop a nomogram-based risk prediction model for this population, and validate its predictive performance. Methods: A total of 592 elderly patients with CHD were conveniently selected and enrolled from 3 tertiary hospitals, 5 secondary hospitals, and 3 community health service centers in China between October 2022 and January 2023. Data collection involved the use of the general information questionnaire, the Frail scale, and the instrumental ability of daily living assessment scale. And the patients were categorized into two groups based on frailty, and χ2 test as well as logistic regression analysis were used to identify and determine the influencing factors of frailty. The nomograph prediction model for elderly patients with CHD was developed using R software (version 4.2.2). The Hosmer–Lemeshow test and the area under the receiver operating characteristic (ROC) curve were employed to assess the predictive performance of the model. Additionally, the Bootstrap resampling method was utilized to validate the model and generate the calibration curve of the prediction model. Results: The prevalence of frailty in elderly patients with CHD was 30.07%. The multiple factor analysis revealed that poor health status (OR = 28.169)/general health status (OR = 18.120), age (OR = 1.046), social activities (OR = 0.673), impaired instrumental ability of daily living (OR = 2.384) were independent risk factors for frailty (all P < 0.05). The area under the ROC curve of the nomograph prediction model was 0.847 (95% CI: 0.809 ~ 0.878, P < 0.001), with a sensitivity of 0.801, and specificity of 0.793; the Hosmer- Lemeshow χ2 value was 12.646 (P = 0.125). The model validation results indicated that the C value of 0.839(95% CI: 0.802 ~ 0.879) and Brier score of 0.139, demonstrating good consistency between predicted and actual values. Conclusion: The prevalence of frailty is high among elderly patients with CHD, and it is influenced by various factors such as health status, age, lack of social participation, and impaired ability of daily life. These factors have certain predictive value for identifying frailty early and intervention in elderly patients with CHD. [ABSTRACT FROM AUTHOR]

Introduction: Patients with coronary artery disease (CAD) have a higher risk of developing cognitive impairment and mental health disorders compared to the general population. Physical exercise might improve their brain health. The overall goal of the HEART-BRAIN randomized controlled trial (RCT) is to investigate the effects of different types of exercise on brain health outcomes in patients with CAD, and the underlying mechanisms. Methods: This three-arm, single-blinded RCT will include 90 patients with CAD (50-75 years). Participants will be randomized into: (1) control group--usual care (n = 30), (2) aerobic high-intensity interval training (HIIT) (n = 30), or (3) HIIT combined with resistance exercise training (n = 30). The 12-week intervention includes 3 supervised sessions (45-min each) per week for the exercise groups. Outcomes will be assessed at baseline and post-intervention. The primary outcome is to determine changes in cerebral blood flow assessed by magnetic resonance imaging. Secondary outcomes include changes in brain vascularization, cognitive measures (i.e., general cognition, executive function and episodic memory), and cardiorespiratory fitness. Additional health-related outcomes, and several potential mediators and moderators will be investigated (i.e., brain structure and function, cardiovascular and brain-based biomarkers, hemodynamics, physical function, body composition, mental health, and lifestyle behavior). Conclusion: The HEART-BRAIN RCT will provide novel insights on how exercise can impact brain health in patients with CAD and the potential mechanisms explaining the heart-brain connection, such as changes in cerebral blood flow. The results may have important clinical implications by increasing the evidence on the effectiveness of exercise-based strategies to delay cognitive decline in this high-risk population. [ABSTRACT FROM AUTHOR]

Background: To date, no studies have investigated the correlation between the neutrophil-to-lymphocyte ratio (NLR) and the long-term risk of mortality in individuals with both coronary heart disease (CHD) and hypertension. This study aims to evaluate the association between NLR and all-cause and cardiovascular mortality among this patient population. Methods: National Death Index (NDI) and National Health and Nutrition Examination Survey (NHANES 2001–2018) were the data sources. A nonlinear association between the NLR and mortality risk was shown by restricted cubic spline (RCS) analysis. Using a weighted Cox proportional hazards model, we quantitatively evaluated the effect of NLR on mortality risk.The capacity of NLR to forecast survival was assessed by evaluating time-dependent receiver operating characteristic (ROC) curves. A mediating influence analysis was conducted to assess the influence of NLR on mortality through eGFR as a mediator. Results: The study involved a total of 2136 individuals. During the median followup interval of 76.0 months, 801 deaths were recorded. The RCS analysis showed NLR and mortality risk to have a nonlinear relationship. Two groups were established based on the participants’ NLR levels: a group with high NLR (NLR > 2.65) and a group with low NLR (NLR < 2.65). After adjusting for potential confounding factors, the Cox proportional hazards model revealed that participants with an increased NLR faced a significantly higher risk of cardiovascular mortality. (HR 1.58, 95% CI 1.33–1.82, p < 0.0001) and all-cause mortality (HR 1.46, 95% CI 1.30–1.62, p < 0.0001). An analysis of interactions and data stratification corroborated the validity of our findings. eGFR was identified as a partial mediator in the association between NLR and mortality rates, contributing 12.17% and 9.66% of the variance in all-cause and cardiovascular mortality, respectively. The predictive performance for cardiovascular mortality was quantified using ROC curves, with respective AUC values of 0.67, 0.65, and 0.64 for predictions over 3, 5, and 10 years. The AUC values for all-cause mortality were 0.66, 0.64, and 0.63 for the same time frames. Conclusion: For patients with CHD and hypertension, an elevated NLR serves as an independent prognostic indicator for both all-cause and cardiovascular mortality. [ABSTRACT FROM AUTHOR]

Asia has the highest mortality rate from cardiovascular disease worldwide, with almost more than 80% of these deaths occurring in lower-middle income countries (LMIC). These problems, coupled with existing problems at LMIC, such as limited health budgets and unequal access to health facilities, make early detection approaches using advanced tools difficult to implement. Physical examination by looking at the earlobe crusade (ELC), a marker of atherosclerosis, is the answer to this problem. This study aimed to investigate the association between ELC and coronary artery disease as evidenced by angiography in an Asian population with LMIC. This study used the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) protocol to find studies regarding the association of ELC with CHD as evidenced by coronary angiography (CAD-CAG-Confirmed) in LMIC populations in Asia. Based on the PICO criteria, this study systematically searched several different scientific databases such as MEDLINE, Embase, ProQuest and Scopus. After that, an assessment of the bias and diagnostic value was carried out. This systematic review found six articles with a sample of 1657. All studies showed a significant relationship between the presence of ELC and CHD. ELC Diagnostic Value for CHD; sensitivity 74% - 98% and specificity 52.5% - 91.49%. Several studies using multivariate regression analysis showed that ELC was independently associated with CHD. Physical examination of the ELC is the most ideal approach for CHD screening in countries with limited resources and facilities. ELC can be applied because it is easy to do, cheaper, and quite effective as an early marker of CHD. [ABSTRACT FROM AUTHOR]

BACKGROUND: Endothelial dysfunction is an early and pre-clinical manifestation of coronary heart disease (CHD). OBJECTIVE: This study investigates the role of DDX5 in oxidized low-density lipoprotein (ox-LDL)-induced endothelial cell injury to confer novel targets for the treatment of CHD. METHODS: Endothelial cells were induced by ox-LDL. DDX5, pri-miR-640, pre-miR-640, miR-640, and SOX6 expressions were analyzed by RT-qPCR and Western blot. DDX5 expression was intervened by shRNA, followed by CCK-8 analysis of proliferation, flow cytometry detection of apoptosis, and tube formation assay analysis of angiogenic potential of cells. The binding between DDX5 and pri-miR-640 was determined by RIP, and the pri-miR-640 RNA stability was measured after actinomycin D treatment. Dual-luciferase assay verified the targeting relationship between miR-640 and SOX6. RESULTS: DDX5 and miR-640 were highly expressed while SOX6 was poorly expressed in ox-LDL-induced endothelial cells. Silence of DDX5 augmented cell proliferation, abated apoptosis, and facilitated angiogenesis. Mechanistically, RNA binding protein DDX5 elevated miR-640 expression by weakening the degradation of pri-miR-640, thereby reducing SOX6 expression. Combined experimental results indicated that overexpression of miR-640 or low expression of SOX6 offset the protective effect of DDX5 silencing on cell injury. CONCLUSION: DDX5 elevates miR-640 expression by repressing the degradation of pri-miR-640 and then reduces SOX6 expression, thus exacerbating ox-LDL-induced endothelial cell injury. [ABSTRACT FROM AUTHOR]

Clarity regarding self-efficacy (SE) in coronary heart disease (CHD) patients is essential. Concept analysis studies have yet to be genuinely comprehensive in determining the characteristics, origins, and outcomes of SE in CHD patients. This paper uses Rodger's concept analysis approach to conduct an in-depth analysis of the SE concept in CHD patients. Reference sources were obtained from three databases: EBSCO-host, PubMed, Scopus, and one search engine: Google Scholar. This review identified the attributes, antecedents, and consequences of SE in CHD patients. Four categories of antecedents include personal, environmental, behavioural, and psychological factors. The three attributes that are the basis for forming SE are personal belief, perception of self-ability, and ability to understand learning needs. The long-term consequence of a lack of self-efficacy is poor self-care, impacting the quality of life. The clarity of this concept will make it easier for health professionals, including nurses and other scientific disciplines, to use the SE concept with this population in health service practice and the field of research. [ABSTRACT FROM AUTHOR]

Objectives: Cardiovascular diseases are among the leading causes of death worldwide. ST Elevation Myocardial Infarction (STEMI) is one of the most important causes of cardiovascular mortality and morbidity. It has been determined that Elabela (ELA), a member of the apelinergic system, increases myocardial contractility and coronary vasodilation, and decreases blood pressure. The aim of this study was to evaluate the relationship between circulating ELA levels and various clinical, biochemical, and angiographic parameters in STEMI patients undergoing primary percutaneous coronary intervention (PCI). Methods: Seventy-four patients hospitalized with the diagnosis of STEMI who underwent coronary angiography and primary PCI, and seventy-four patients with chest pain but no pathology detected in coronary angiography, were included in the study as the control group. Coronary lesion severity was measured using the SYNTAX score tool. Routine laboratory tests and ELA levels were measured. Results: Plasma levels of ELA were significantly lower in patients with STEMI (0.68±0.68 ng/mL) than in controls (1.34±0.88 ng/mL, p<0.001). Glucose, cholesterol, LDL, CRP, troponin I, and SYNTAX score levels were statistically higher in the STEMI group, while ELA and HDL levels were lower. There was a high level of negative correlation between ELA and troponin I, SYNTAX score, cholesterol, LDL, and CRP. Conclusion: In this study, it was determined that the level of ELA decreased in the first 24 hours of STEMI patients. In addition, a highly negative correlation was found between ELA and troponin I and SYNTAX scores. [ABSTRACT FROM AUTHOR]

Objective: To investigate effect of Picroside Ⅱ (P- Ⅱ) on endothelial cell damage in rats with coronary heart disease (CHD) by regulating high mobility group box 1 protein (HMGB1)/receptor for advanced glycation end products (RAGE) signaling pathway. Methods: SPF grade SD rats were randomly separated into control group, CHD group, P-Ⅱ low, medium, high doses groups and P-Ⅱ high dose+DEX group (P-Ⅱ high dose+HMGB1/RAGE signaling pathway activator DEX). Except for control group, CHD rat model was established by high-fat diet combined with intraperitoneal injection of pituitrin, corresponding drugs were administered by gavage or intraperitoneal injection, once a day for 4 consecutive weeks. Biochemical analyzer was applied to measure blood lipid levels; ELISA was applied to detect levels of serum nitric oxide (NO), endothelin (ET)-1, angiotensin Ⅱ (AngⅡ), TNF-α, IL-1β and IL-6; kits were applied to detect levels of reactive oxygen species (ROS)and glutathione peroxidase (GSH-Px) in coronary artery tissue; HE staining was applied to observe pathological damage in coronary artery tissue; TUNEL staining was applied to observe apoptosis of vascular endothelial cells; Western blot was applied to detect expressions of vascular endothelial growth factor (VEGF), HMGB1 and RAGE proteins in coronary artery tissue. Results: Compared with control group, levels of TC, TG, LDL-C, ET-1, Ang Ⅱ, TNF-α, IL-1β, IL-6, ROS, endothelial cell apoptosis rate, and expressions of HMGB1 and RAGE in rats in CHD group were signifi‑ cantly increased, levels of HDL-C, NO, GSH-Px, and expression of VEGF were significantly reduced (P<0.05); compared with CHD group, levels of TC, TG, LDL-C, ET-1, AngⅡ, TNF-α, IL-1β, IL-6, ROS, endothelial cell apoptosis rate, and expressions of HMGB1 and RAGE in P-Ⅱ low, medium and high doses groups were obviously reduced, levels of HDL-C, NO, GSH-Px, and expression of VEGF were obviously increased (P<0.05); HMGB1/RAGE signaling pathway activator DEX was able to attenuate protective effect of P-Ⅱ on endothelial cell damage in CHD rats. Conclusion: P- Ⅱ can effectively alleviate endothelial cell damage in CHD rats, whose mechanism may be related to inhibition of HMGB1/RAGE pathway activation. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to develop and validate an eMCI‐CHD tool based on clinical data to predict mild cognitive impairment (MCI) risk in patients with coronary heart disease (CHD). Methods: This cross‐sectional study prospectively collected data from 400 patients with coronary heart disease (aged 55–90 years, 62% men) from July 2022 to September 2023 and randomized (7:3 ratio) them into training and validation sets. After determining the modeling variables through least absolute shrinkage and selection operator regression analysis, four ML classifiers were developed: logistic regression, extreme gradient boosting (XGBoost), support vector machine, and random forest. The performance of the models was evaluated using area under the ROC curve, accuracy, sensitivity, specificity, and F1 score. Decision curve analysis was used to assess the clinical performance of the established models. The SHapley Additive exPlanations (SHAP) method was applied to determine the significance of the features, the predictive model was visualized with a nomogram, and an online web‐based calculator for predicting CHD‐MCI risk scores was developed. Results: Of 400 CHD patients (average age 70.86 ± 8.74 years), 220 (55%) had MCI. The XGBoost model demonstrated superior performance (AUC: 0.86, accuracy: 78.57%, sensitivity: 0.74, specificity: 0.84, F1: 0.79) and underwent validation. An online tool (https://mr.cscps.com.cn/mci/index.html) with seven predictive variables (APOE gene typing, age, education, TyG index, NT‐proBNP, C‐reactive protein, and occupation) assessed MCI risk in CHD patients. Conclusion: This study highlights the potential for predicting MCI risk among CHD patients using an ML model‐driven nomogram and risk scoring tool based on clinical data. [ABSTRACT FROM AUTHOR]

Background To evaluate the midterm follow-up and 5-year survival outcome of the minimally invasive direct coronary artery bypass (MIDCAB) procedure compared with the survival of the general Swiss population. Methods Retrospective study on preoperative data, intraoperative data, and postoperative outcome of patients who underwent MIDCAB surgery between June 2010 and February 2019. To assess validity of this surgical therapy, outcomes were compared with survival data of a gender- and age-matched cohort of the general Swiss population taken from the database of the Swiss Federal Statistical Office. Results A total of 88 patients were included. Median (interquartile range [IQR[) age was 66 (56–75) years, and 27% (n = 24) were female. The median (IQR) length of the in-hospital stay was 7 (6–8) days. No postoperative stroke occurred. The 30-day mortality was 1.1% (n = 1). Reintervention for failed left internal mammary artery was needed in 1.1% (n = 1). The median (IQR) ejection fraction was 58% (47–60) preoperatively and remained stable during follow-up. The median (IQR) follow-up period was 3 (1.1–5.2) years. Five years postoperatively, 83% (confidence interval, 69–91) of the patients were alive, showing an overlap with the range of survival of the matched subcohort of the general Swiss population (range, 84–100%). Conclusion Though suffering from coronary heart disease, patients after MIDCAB show almost equal survival rates as an equivalent subcohort corresponding to the general Swiss population matched on age and gender. Thus, our data show this treatment to be safe and beneficial. [ABSTRACT FROM AUTHOR]