Search Results (3,580)

Background: Physical activity (PA) is associated with cardiometabolic health and functional performance, yet sex-specific evidence from real-world primary care populations remains limited. Objective: This study evaluated whether associations between self-reported PA categories and LDL-C concentrations and Timed Up and Go (TUG) functional performance differed between males and females in a real-world primary care cohort. Methods: This cross-sectional observational study included 863 adult primary care patients (424 males, 439 females). PA was categorized as low, moderate, or high based on World Health Organization recommendations. LDL-C and TUG were assessed as primary outcomes. Sex-stratified analyses included one-way ANOVA with Bonferroni post hoc comparisons and multivariable linear regression adjusted for age, BMI, arterial hypertension (AH), and diabetes mellitus (DM). An interaction term (PA × sex) was included to formally test for sex modification. Results: Males and females did not differ significantly in age, BMI, LDL-C, TUG, AH prevalence, DM prevalence, or PA distribution (all p > 0.05). Higher PA categories were associated with lower LDL-C in both males (ANOVA F = 13.03, p < 0.001) and females (ANOVA F = 14.92, p < 0.001), and with better TUG performance in both males (F = 44.21, p < 0.001) and females (F = 36.09, p < 0.001). In multivariable regression, PA was the strongest independent predictor of both LDL-C (males: β = −0.301, p < 0.001; females: β = −0.323, p < 0.001) and TUG performance (males: β = −1.235, p < 0.001; females: β = −1.170, p < 0.001) in both sexes. The interaction term (PA × sex) was not statistically significant for either LDL-C (p = 0.804) or TUG (p = 0.944), indicating no significant sex modification of the PA–outcome associations. Conclusions: The associations between self-reported PA and both LDL-C concentrations and TUG functional performance were consistent across sexes in this real-world primary care cohort. These findings support the clinical relevance of routine PA assessment as a sex-independent indicator of cardiometabolic risk and functional health in primary care. Because of the cross-sectional design, causality cannot be established. Full article

Hypoxic pulmonary hypertension (HPH) is a progressive vascular disease characterized by an abnormal increase in pulmonary arterial pressure resulting from pulmonary vasoconstriction and pulmonary vascular remodeling (PVR). Excessive proliferation and migration of pulmonary artery smooth muscle cells (PASMCs) are key drivers of PVR. Caragana jubata (Pall.) Poir. (C. jubata), known as “zuomaoxing” in Tibetan medicine, is traditionally used to treat blood-related disorders. However, the potential preventive and therapeutic effects of C. jubata on HPH remain unclear. Here, we integrated in vivo pharmacology, serum pharmacochemistry, PASMC assays, DARTS-MS chemoproteomics, and pathway validation to investigate the effects of C. jubata ethanol extract (ECJ) on HPH-associated PVR and the effects of a serum-exposed candidate component on CoCl₂-induced PASMC activation. In HPH rats, ECJ reduced mean pulmonary arterial pressure and alleviated right ventricular hypertrophy and PVR. Serum pharmacochemistry detected 47 ECJ-derived serum-exposed features, including one prototype putatively annotated as ginkgolide J. Ginkgolide J attenuated CoCl₂-induced PASMC proliferation, Ki-67 positivity, and migration without significantly affecting PASMC viability. DARTS-MS identified 1235 ginkgolide J-associated protease-susceptibility candidate proteins, and pathway validation indicated that ginkgolide J suppressed CoCl₂-induced MEK1/ERK1/2 activation. These findings suggest that ECJ has potential value against HPH-associated PVR and that ginkgolide J is a candidate anti-proliferative compound in PASMCs. Full article

Background and Objectives: Ultrasound-guided placement of tunneled hemodialysis catheters may be useful when fluoroscopy is unavailable or radiation exposure should be avoided. This study describes a technique based on direct ultrasound visualization of the metallic guidewire within the right atrium and evaluates one-year clinical and functional outcomes. Materials and Methods: We conducted a single-center retrospective observational study of 319 adult hemodialysis patients undergoing tunneled catheter placement. The technique combined intravascular guidewire length measurement with subcostal ultrasound visualization of the guidewire tip in the right atrium. Baseline characteristics, insertion site, immediate complications, blood flow rate, Kt/V, and extracorporeal circuit pressures were analyzed. Results: Mean age was 55.9 ± 14.5 years, and 58.6% were women. The main causes of chronic kidney disease were diabetes mellitus and arterial hypertension. Mean blood flow rate was 349 mL/min at 3 months and 357 mL/min at 12 months. Mean Kt/V at 12 months was 1.57. No catheter malpositions requiring immediate repositioning were documented. Procedure-related complications were infrequent and mainly local. Conclusions: Ultrasound-guided tunneled catheter placement using direct visualization of the guidewire within the right atrium was technically feasible and associated with favorable functional parameters and few immediate complications. Given the retrospective design and lack of a comparative group, these findings should be interpreted with caution. Prospective comparative studies are needed to confirm safety, reproducibility, and clinical utility. Full article

Thrombospondin-2 (TSP-2) is an extracellular matrix glycoprotein involved in angiogenesis, vascular remodeling, cell adhesion, and tissue repair. Its expression is induced by pathological stimuli, including mechanotransduction, hypoxia, and TGF-β signaling, and has been associated with several cardiovascular diseases (CVDs), such as heart failure, coronary artery disease, abdominal aortic aneurysm, and hypertension. Elevated circulating TSP-2 levels, particularly in combination with NT-proBNP, as well as alterations in THBS2 and its regulatory non-coding RNAs, have been linked to disease severity and adverse cardiovascular outcomes. This review summarizes current evidence on the role of TSP-2 in cardiovascular pathophysiology and its involvement in cardiovascular homeostasis. Although accumulating data suggest that TSP-2 may have diagnostic, prognostic, and therapeutic relevance, its clinical utility as a biomarker or therapeutic target has not yet been established. Further large-scale studies and standardized assessment methods are required to validate its potential and support future clinical translation. Full article

Objective: Malignant middle cerebral artery infarction is associated with high mortality despite decompressive craniectomy. Reliable biomarkers predicting early outcome remain limited. The aim of this study was to evaluate the prognostic significance of inflammatory biomarkers, particularly the systemic immune–inflammation index (SII), for predicting in-hospital mortality in patients undergoing decompressive craniectomy for malignant middle cerebral artery infarction. Methods: This retrospective study included 31 patients who underwent decompressive craniectomy for malignant MCA infarction between 2014 and 2024. Demographic, clinical, radiological, and laboratory variables were analyzed. Results: Overall in-hospital mortality was 61.3%. Non-survivors had significantly higher SII, neutrophil count, neutrophil-to-lymphocyte ratio, serum creatinine, and higher prevalence of hypertension and anticoagulant therapy. ROC analysis showed that SII had the highest predictive performance (AUC = 0.833). Multivariate analysis identified age, serum creatinine, NLR, SII, hypertension, and anticoagulant therapy as independent predictors of mortality. Patients aged ≥65 years had significantly higher in-hospital mortality than younger patients. Conclusions: Elevated SII is a strong independent predictor of early mortality after decompressive craniectomy and may serve as a simple and clinically applicable biomarker for risk stratification. Full article

Background: Hyperhomocysteinemia (homocysteine [Hcy] ≥15 μmol/L) is frequently observed in patients with impaired kidney function and has been associated with vascular remodeling and increased cardiovascular risk. We aimed to evaluate the relationship between Hcy, arterial stiffness, coronary artery disease (CAD), peripheral arterial disease, and biomarkers of kidney injury in patients undergoing elective coronary angiography. Methods: In this prospective observational study, 133 patients undergoing elective coronary angiography were stratified according to serum Hcy levels (Hcy <15 vs. Hcy ≥15 μmol/L). CAD severity was assessed angiographically. Arterial stiffness was evaluated using carotid–femoral pulse wave velocity (cfPWV), while peripheral arterial disease was assessed using ankle–brachial index (ABI). Kidney function was evaluated using serum creatinine, estimated glomerular filtration rate (eGFR), cystatin C, and urinary albumin-to-creatinine ratio (UACR). Correlation, multivariable regression, logistic regression, and receiver operating characteristic (ROC) analyses were performed. Results: Patients with hyperhomocysteinemia demonstrated significantly worse kidney function, including higher serum creatinine, cystatin C, and UACR levels, and lower eGFR (all p < 0.01). Patients with elevated Hcy levels also exhibited significantly higher cfPWV values (11.4 ± 3.3 vs. 9.7 ± 2.1 m/s, p < 0.001). Hcy correlated positively with cystatin C, creatinine, UACR, and cfPWV, and inversely with eGFR. In multivariable linear regression analysis, Hcy remained independently associated with increased cfPWV after adjustment for age, sex, and eGFR (β = 0.137, 95% CI 0.047–0.226, and p = 0.003). This association remained significant in sensitivity analyses incorporating hypertension, diabetes mellitus, LDL cholesterol, and statin therapy (β = 0.124, 95% CI 0.032–0.216, and p = 0.008). No independent associations were observed between Hcy and angiographic CAD severity or ABI values. ROC analysis demonstrated modest discrimination for elevated arterial stiffness (AUC = 0.66, 95% CI 0.56–0.76) and good discrimination for impaired kidney function (AUC = 0.82, 95% CI 0.69–0.92). Conclusions: Elevated Hcy levels were independently associated with impaired kidney function and increased central arterial stiffness, but not with angiographic CAD severity or peripheral arterial disease. These findings suggest that hyperhomocysteinemia may reflect cardiorenal vascular dysfunction and diffuse vascular remodeling rather than focal obstructive atherosclerotic disease. Further studies are needed to determine its clinical utility and prognostic value. Full article

Background: Cardiovascular (CV) risk estimation is usually based on the assessment of classic risk factors and the extent of coronary artery stenosis. However, a substantial rate of acute coronary syndromes (ACS) and sudden cardiac deaths (SCD) is observed in patients with high-risk atherosclerotic plaques (HRP), even in the absence of significant stenosis. Therefore, this study aimed to evaluate the predictive value of traditional clinical risk factors for the presence of HRP in patients scheduled for coronary computed tomography (CCT). Methods: This single-center study included 123 patients undergoing CCT for suspected coronary artery disease (CAD). Atherosclerotic plaque morphology (HRP) and the degree of coronary artery stenosis (CAD-RADS categories) were assessed in all the patients. CV risk factors, including LDL serum levels and CT Calcium score (CS), were analyzed. Results: The study cohort was mostly males (54.5%), with an average age of 60.40 ± 12.45 years and typical risk factors: hypertension (70%), diabetes (22%), obesity (30%), and smoking (20%). Most patients (88%) were found to have coronary atherosclerosis with nonobstructive disease (CAD-RADS 1–2) in 39% of patients. HRP was confirmed in over one-fifth of the participants (22%), with half of the patients in the CAD-RADS 2 category. There were no differences in CV risk factors between patients with and without HRP in CCT. No significant clinical predictor of HRP in CCT was identified. Conclusions: CV risk factors do not predict HRP in CCT, which may underestimate the real risk of ACS and SCD. Full article

Introduction: Giant sinus of Valsalva aneurysms (SVA) represent a rare cardiovascular pathology that may remain asymptomatic for an extended period. However, they are associated with a high risk of life-threatening complications, including compression of adjacent structures and aneurysm rupture. Case presentation: We report a clinical case of a 71-year-old female patient with a long-standing history of arterial hypertension and cardiac arrhythmias, in which echocardiography revealed aneurysmal dilatation of the right coronary sinus. Cardiac computed tomography (CT) confirmed the presence of a giant aneurysm of the right sinus of Valsalva measuring 70 × 51 × 49 mm, compressing the outflow tracts of both ventricles (right—up to 7 mm, left—up to 8 mm) and the left inferior pulmonary vein (up to 3 mm), which clinically manifested as dyspnoea, lower-extremity oedema, and rhythm disturbances. The patient successfully underwent complex reconstructive surgery, including aortic root replacement and valve repair. Despite the technical success of the operation, the patient died from pneumonia three months postoperatively. Discussion: This observation underscores the critical role of imaging modalities (echocardiography and CT) in verifying this pathology. The use of multimodal imaging facilitated both a timely diagnosis and a detailed three-dimensional evaluation of the aneurysm’s relationship with adjacent structures. This information, in turn, guided personalised surgical planning. Conclusions: This case highlights the necessity of considering giant SVA in the differential diagnostic workup of patients who present with unexplained symptoms of heart failure. Full article

Background/Objectives: Chronic kidney disease (CKD) is associated with numerous oral manifestations that may negatively affect quality of life, nutrition, and overall health. This narrative review aimed to summarize current evidence regarding oral manifestations of CKD and kidney transplantation, examine their proposed underlying mechanisms, and discuss implications for dental management. Methods: A structured literature search of PubMed/MEDLINE was conducted for English-language publications from January 2000 to March 2026. Original studies, systematic reviews, meta-analyses, clinical guidelines, and relevant narrative reviews were included. Additional references were identified through manual screening of bibliographies. Results: Oral manifestations associated with CKD include xerostomia, periodontal disease, oral infections, anemia-related mucosal pallor, developmental enamel defects, and medication-related gingival overgrowth. Kidney transplant recipients are additionally at risk of opportunistic infections and oral malignancies related to long-term immunosuppressive therapy. While oral diseases, particularly periodontal disease and oral infections, may contribute to systemic inflammation, much of the available evidence remains observational. Similarly, many recommendations for dental management are based on expert consensus and clinical experience rather than high-quality interventional studies. Conclusions: Oral complications are common throughout the CKD continuum and warrant regular assessment and preventive care. Multidisciplinary collaboration is essential, while further prospective studies are needed to strengthen the evidence base for clinical management. Full article

Background: The 2022 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggest the use of Renin–angiotensin–aldosterone system inhibitors (RAASIs) in chronic Kidney Disease (CKD) stages IV–V, in contrast to the 2012 KDIGO guidelines, which discouraged it. This study aims to assess the impact of RAASIs on kalemia and mortality in a large sample of dialysis patients, where longitudinal data remain scarce, comparing traditional statistical methods with machine learning (ML) algorithms. Methods: This observational longitudinal analysis included 4764 hemodialysis (HD) patients from the Sicilian Registry of Nephrology, Dialysis and Transplantation, with a total of 56,964 longitudinal measurements. We evaluated the impact of RAASIs on serum potassium levels and all-cause mortality in the dialysis setting, comparing traditional statistics and ML. Linear Mixed Models (LMM) and Cox models with mixed effects were used for longitudinal and survival analyses. These were compared with ML approaches, including Random Forest (RF) for potassium variability and Lasso-regularized models for mortality, using four-fold cross-validation. Results: The study included 4764 patients, of whom 1207 (25%) were treated with RAASis. The mean age was 66 ± 15 years, 62% were male, 33% were diabetic, and a history of arterial hypertension was reported in 74% of patients. Hyperkalaemia at baseline was present in 1848 patients. The longitudinal model showed a statistically significant increase in kalemia [adjβ = 0.10 mmol/L, 95%CI 0.05/0.15, p < 0.001], but it was clinically negligible. Indeed, RF did not detect RAASIS as a relevant variable. Association between RAASIs and mortality was not detected either with Cox or ML models. Furthermore, the RF model outperformed traditional LMMs in explaining total potassium variability (56% vs. 43%). Conclusions: RAASI therapy in HD patients is associated with a minimal, non-clinically significant increase in serum potassium and does not impact all-cause mortality. The integration of ML reinforces the robustness of these findings, supporting the safety of RAASIs in the dialysis setting. Full article

Background: Dynamic risk stratification is fundamental to the modern management of pulmonary arterial hypertension (PAH). However, data on the impact of sequential add-on therapy in patients with Group 1.4 PAH—particularly in Latin American populations—remains limited. This study evaluated changes in risk classification using COMPERA 2.0 and REVEAL Lite 2 scores in patients treated with endothelin receptor antagonist (ERA) and phosphodiesterase type 5 inhibitor (PDE5i) combination therapy (macitentan + sildenafil) at a referral center in Mexico. Methods: In this single-center, retrospective cohort study, 25 patients with a confirmed diagnosis of PAH between 1st January 2022 and 31st December 2024 were evaluated at baseline and after 24 weeks of treatment. Clinical, functional, and biochemical parameters were recorded. Within-patient changes were analyzed using the Wilcoxon signed-rank test, and agreement between risk assessment tools was assessed using Spearman’s correlation coefficient. Results: At 24 weeks, patients demonstrated significant improvement in World Health Organization functional class (p = 0.002) and a significant reduction in brain natriuretic peptide levels (p = 0.003). Both COMPERA 2.0 and REVEAL Lite 2 scores showed a consistent shift toward lower-risk categories. A strong concordance between the two tools was observed. Conclusions: Sequential add-on ERA + PDE5i therapy was associated with meaningful improvement in risk stratification among patients with Group 1.4 PAH. These findings support the clinical utility of simplified, noninvasive risk assessment tools in real-world settings, particularly in resource-constrained environments. Full article

Systemic arterial hypertension (SAH) is a multifaceted condition marked by sustained elevations in arterial blood pressure. Its occurrence is closely related to alterations in target organs, such as the liver. Non-pharmacological treatments have been proposed for these effects. Thus, the aim of this study was to investigate the effects of açaí supplementation and resistance training, applied individually or in combination, on blood pressure and liver structural parameters. An experimental, quantitative, and longitudinal study was conducted using young Wistar rats (~60 days old) and spontaneously hypertensive rat (SHR) strains. Fifty rats were divided into five experimental groups: Wistar Control (C), Hypertensive Control (H), Hypertensive Trained (HT), Hypertensive Açaí-Supplemented (HA), and Hypertensive Trained plus Açaí Supplementation (HAT). Each group consisted of ten animals. Subsequently, analyses were performed for the antioxidant capacity and proximate composition of the açaí pulp, systolic blood pressure assessment, and histological evaluation of the liver. The açaí used exhibited high antioxidant capacity. At the end of the experimental period, the trained groups increased their maximal load carried, along with a reduction in systolic blood pressure in all treated groups. Açaí supplementation resulted in lower relative liver mass compared with the H group. The hypertensive condition promoted extracellular matrix expansion and a reduction in hepatocyte proportion. Both interventions attenuated these effects, and the combined treatment (HAT) produced the greatest improvement, indicating an additive response. Hypertension also elevated hepatic glycogen concentration, and the treatments reduced this alteration. It is concluded that açaí supplementation and resistance training could promote positive adaptations in the liver of hypertensive animals. Full article

Background and Objectives: ABO and Rh blood group systems represent clinically relevant genetic polymorphisms with established associations beyond transfusion medicine, including thrombotic risk. We investigated the prevalence of ABO and Rh blood group phenotypes in hemodialysis patients and their associations with documented vascular access thrombosis and all-cause mortality. Materials and Methods: This retrospective cohort study analyzed 3027 patients receiving maintenance hemodialysis in Hatay province, Türkiye, between January 2010 and April 2025. Data included ABO and Rh blood group determination, demographics, comorbidities, dialysis vintage, vascular access type, vascular access thrombosis events, and mortality. Multivariable binary logistic regression was used to identify independent factors associated with documented vascular access thrombosis. Multivariable Cox proportional hazards regression with vascular access thrombosis modeled as a time-dependent covariate was used to identify independent predictors of all-cause mortality. Results: Mean patient age was 63.95 ± 13.74 years; 58.3% were men. Blood group A was most prevalent (41.4%), followed by O (35.8%), B (15.9%), and AB (6.9%); 92.7% were Rh-positive. Documented vascular access thrombosis differed significantly by ABO group (p = 0.027), with the highest rate in group A (14.1%). In multivariable logistic regression, non-O blood group (OR 1.34, 95% CI 1.06–1.70; p = 0.014) and longer dialysis vintage (OR 1.01 per month, 95% CI 1.00–1.01; p < 0.001) were independently associated with documented vascular access thrombosis. In multivariable Cox regression, time-dependent vascular access thrombosis was independently associated with higher all-cause mortality (HR 1.33, 95% CI 1.12–1.59; p = 0.002), as were age (HR 1.02; p < 0.001), diabetes mellitus (HR 1.49; p < 0.001), coronary artery disease (HR 1.34; p < 0.001), and hypertension (HR 1.19; p < 0.001). Arteriovenous fistula was associated with lower mortality compared with temporary catheter (HR 0.46, 95% CI 0.37–0.58; p < 0.001). Blood group phenotype was not independently associated with all-cause mortality (all p > 0.5 vs. group O). Conclusions: In hemodialysis patients, non-O blood groups were modestly but independently associated with documented vascular access thrombosis, and vascular access thrombosis was independently associated with increased mortality when modeled as a time-dependent exposure. Blood group phenotype was not independently associated with mortality after adjustment for established risk factors. Blood group may contribute incrementally to vascular access risk awareness alongside established clinical risk factors, but its modest absolute risk difference limits standalone clinical utility. Full article

Background: Systemic arterial hypertension (SAH) induced by Nω-nitro-L-arginine methyl ester (L-NAME) is a well-established model characterized by nitric oxide (NO^●) synthase inhibition and vascular dysfunction. The transient receptor potential vanilloid 1 (TRPV1) regulates Ca²⁺ flux and may contribute to mitochondrial homeostasis. We hypothesized that TRPV1 activation modulates mitochondria function and attenuates cardiac damage during SAH. Methods: Hypertension was induced in Wistar rats by administration of L-NAME (200 mg/L) for 40 days. During the last four days, hypertensive animals received capsaicin (5 mg/kg/day), capsazepine (6 mg/kg/day), or their combination. Cardiac function was evaluated in isolated hearts using the Langendorff perfusion system. Myocardial tissue viability was assessed by triphenyltetrazolium chloride (TTC) staining, and mitochondrial function was evaluated by measuring respiratory control and apoptosis-related proteins. Results: Capsaicin treatment was associated with significant cardioprotective effects in hypertensive rats. Although the findings are consistent with a role of TRPV1 activation in mediating these effects, the partial protection observed with capsazepine suggests that TRPV1-independent mechanisms may also contribute. Conclusions: TRPV1 activation contributes to cardioprotection in SAH, likely through preservation of mitochondrial function and redox balance. However, additional mechanisms beyond TRPV1 modulation may also participate in the observed protective effects. Further studies—including direct assessment of mitochondrial Ca²⁺ flux and the use of more selective or genetic approaches—are currently underway to clarify the underlying mechanisms. Full article

Peripheral Artery Disease (PAD) is increasingly recognized as a complex environmental pathology driven by “contaminant metals,” rather than solely lifestyle factors. This scoping review (2016–2025) analyses the correlation between anthropogenic soil/water-derived Cadmium (Cd) and Lead (Pb) and progressive vascular hardening. The analysis confirms a robust, non-linear dose–response relationship. Chronic Cd exposure functions as a potent independent toxicant (Risk Ratio = 2.58 at 1 µg/L), significantly lowering Ankle–Brachial Index scores by inducing oxidative stress, inhibiting nitric oxide bioavailability, and displacing calcium in endothelial walls. Synergistically, Pb exposure, even at levels <5 µg/dL, compounds toxicity, amplifying arterial stiffness and hypertension. Consequently, “Heavy Metal Hardening” constitutes a critical link between water quality management and public health. Current regulatory thresholds appear insufficient to prevent chronic vascular remodeling, mandating urgent remediation of metal-laden aquifers and agricultural soils to mitigate this silent cardiovascular epidemic. Full article