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Keywords = fatal coronary heart disease

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9 pages, 216 KiB  
Article
Cardiovascular Toxicities in Chimeric Antigen Receptor Therapy in Relapsed and Refractory Multiple Myeloma and Lymphoma Using FAERS Database
by Fathima Shehnaz Ayoobkhan, Suryakumar Balasubramanian, Arindam Bagga and Tarun Parvataneni
Lymphatics 2025, 3(3), 16; https://doi.org/10.3390/lymphatics3030016 - 20 Jun 2025
Viewed by 319
Abstract
Introduction: In the past decade, chimeric antigen receptor T-cell therapy (CAR-T) has revolutionized the treatment of relapsed refractory multiple myeloma (RRMM) and lymphoma, but it is associated with significant cardiovascular adverse effects. We aim to analyze the incidence, patterns, and outcomes of cardiac [...] Read more.
Introduction: In the past decade, chimeric antigen receptor T-cell therapy (CAR-T) has revolutionized the treatment of relapsed refractory multiple myeloma (RRMM) and lymphoma, but it is associated with significant cardiovascular adverse effects. We aim to analyze the incidence, patterns, and outcomes of cardiac events in RRMM and lymphoma patients undergoing CAR-T therapy utilizing the FDA Adverse Event Reporting System (FAERS) database, paving the way for future research and being more vigilant in treating high-risk populations. Methods: We conducted a retrospective post-marketing pharmacovigilance inquiry using the FDA Adverse Event Reporting System (FAERS) database and the Medical Dictionary for Regulatory Activities (MEDRA). We examined the adverse effects associated with CAR-T and TCE since their FDA approval in US and non-US populations (accessed 5 January 2024), and we analyzed the incidence of cardiac events related to six CAR-T products: Idecabtagene vicleucel, Ciltacabtagene autoleucel, Axicabtagene ciloleucel, Tisagenlecleucel, Lisocabtagene maraleucel, and Brexucabtagene autoleucel since FDA approval. Cardiotoxicities were assessed, including coronary artery disease (CAD), myocardial infarction (MI), arrhythmia, heart failure, and hypotension. Results: Out of 12,949 adverse events, we identified 675 (5.2%) cardiac events irrespective of severity. Almost 440 (65%) cardiac events were associated with cytokine release syndrome (CRS). The most common cardiotoxic event was atrial fibrillation (122), followed by the development of heart failure (113), ventricular arrhythmia (108), hypotension (87), and bradyarrhythmia (41). The mortality rate was highest among Brexucabtagene autoleucel recipients (n = 26, 2.3%), followed by Tisagenlecleucel (n = 71, 2.1%) and Lisocabtagene maraleucel (n = 10, 2.1%). Conclusions: CAR-T therapy can result in fatal adverse events due to its cardiotoxic properties. Timely monitoring, such as screening echocardiography and electrocardiograms, can help identify the at-risk population and allow for early intervention—particularly in patients with high baseline cardiovascular risk or previous exposure to cardiotoxic agents—thereby improving outcomes by enabling risk stratification and supportive management. Full article
(This article belongs to the Collection Lymphomas)
27 pages, 3177 KiB  
Article
Integrating the Interleukins in the Biomarker Panel for the Diagnosis and Prognosis of Patients with Acute Coronary Syndromes: Unraveling a Multifaceted Conundrum
by Amalia-Stefana Timpau, Egidia-Gabriela Miftode, Irina-Iuliana Costache-Enache, Antoniu-Octavian Petris, Ionela-Larisa Miftode, Ivona Mitu and Radu-Stefan Miftode
Diagnostics 2025, 15(10), 1211; https://doi.org/10.3390/diagnostics15101211 - 11 May 2025
Viewed by 574
Abstract
Background and Objectives: Despite the latest advancements in interventional procedures and pharmacological therapy, the incidence of heart failure and death rate following an acute myocardial remain unacceptably high. This study was designed in response to the limited and conflicting literature data regarding the [...] Read more.
Background and Objectives: Despite the latest advancements in interventional procedures and pharmacological therapy, the incidence of heart failure and death rate following an acute myocardial remain unacceptably high. This study was designed in response to the limited and conflicting literature data regarding the diagnostic and prognostic role of modern inflammatory biomarkers in patients with coronary artery disease. Materials and Methods: We conducted a case–control, prospective observational study. A total of 145 patients were analyzed, of whom 105 patients had an acute coronary syndrome diagnosis and represented the study group, while 40 patients with a chronic coronary syndrome diagnosis represented the control group. This study investigates the diagnostic and prognostic role of the interleukin 1β (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10), Growth differentiation factor 15 (GDF-15), and classic biomarkers in patients with ischemic coronary heart disease. Results: IL-1β exhibited a prognostic role, being significantly correlated with a left ventricular ejection fraction below 30%. GDF-15 plays a dual role, as a cardio-inflammatory biomarker, being significantly correlated with both N-terminal pro-brain natriuretic peptide (NT-proBNP), and IL-1β, IL-6, and CRP. At the same time, GDF-15 represents a surrogate marker for renal dysfunction. According to the ROC analysis, patients at high mortality risk can be identified with adequate accuracy by cardiac troponin, GDF-15, and IL-10, in addition to NT-proBNP. Logistic regression models confirmed NT-proBNP and IL-10 as mortality predictors. Conclusions: IL-1β stands out for its significant prognostic role, while IL-6 did not demonstrate a diagnostic or prognostic role in acute myocardial infarction patients. IL-10 demonstrated superior predictive value in terms of fatal prognosis compared with the other modern biomarkers. GDF-15 is representative of a multivalent biomarker involved in inflammation, heart failure, and renal dysfunction. Full article
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15 pages, 891 KiB  
Article
The Association Between Peripheral Arterial Disease and Long-Term Bleeding Events in Patients with Acute Myocardial Infarction
by Soichiro Ban, Kenichi Sakakura, Hiroyuki Jinnouchi, Yousuke Taniguchi, Kei Yamamoto, Takunori Tsukui, Masashi Hatori, Taku Kasahara, Shun Ishibashi, Yusuke Watanabe, Masaru Seguchi and Hideo Fujita
J. Clin. Med. 2025, 14(9), 3183; https://doi.org/10.3390/jcm14093183 - 4 May 2025
Viewed by 497
Abstract
Background: Peripheral arterial disease (PAD) is associated with cardiovascular events in patients with acute myocardial infarction (AMI). However, there are limited reports regarding the association between PAD and bleeding events. In this study, we aimed to evaluate whether PAD is independently associated [...] Read more.
Background: Peripheral arterial disease (PAD) is associated with cardiovascular events in patients with acute myocardial infarction (AMI). However, there are limited reports regarding the association between PAD and bleeding events. In this study, we aimed to evaluate whether PAD is independently associated with an increased risk of major bleeding events, in addition to major adverse cardiovascular events (MACEs), in patients with AMI undergoing percutaneous coronary intervention (PCI). Methods: We included 1391 patients with AMI who underwent PCI and divided them into the PAD group (n = 210) and the non-PAD group (n = 1181). The primary endpoint was total bleeding events, defined as Bleeding Academic Research Consortium type 3/5. The secondary endpoint was MACE, defined as the composite of all-cause death, non-fatal myocardial infarction, and hospitalization for heart failure. Results: The median follow-up duration was 653 days. Total bleeding events were more frequently observed in the PAD group than in the non-PAD group (24.8% vs. 11.3%, p < 0.001). The multivariate Cox hazard analysis confirmed that PAD was significantly associated with total bleeding events (HR 1.509; 95% CI 1.056–2.156, p = 0.024) as well as MACEs (HR 2.152; 95% CI 1.510–3.066, p < 0.001) after controlling for confounding factors. Conclusions: PAD was independently associated with a higher risk of major bleeding and cardiovascular events in patients with AMI undergoing PCI. These findings suggest that PAD should be recognized as a critical factor in risk stratification for AMI and may affect individualized bleeding risk management strategies in patients with AMI. Full article
(This article belongs to the Section Cardiovascular Medicine)
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18 pages, 1223 KiB  
Review
Molecular and Pathophysiological Mechanisms Leading to Ischemic Heart Disease in Patients with Diabetes Mellitus
by Stefan Juricic, Jovana Klac, Sinisa Stojkovic, Milorad Tesic, Ivana Jovanovic, Srdjan Aleksandric, Milan Dobric, Stefan Zivkovic, Bojan Maricic, Dejan Simeunovic, Ratko Lasica, Miodrag Dikic, Marko Banovic and Branko Beleslin
Int. J. Mol. Sci. 2025, 26(9), 3924; https://doi.org/10.3390/ijms26093924 - 22 Apr 2025
Viewed by 1079
Abstract
Coronary atherosclerosis in patients with diabetes mellitus is the most significant pathophysiological mechanism responsible for ischemic heart disease. Atherosclerosis in diabetes is premature, more diffuse, and more progressive, and it affects more coronary blood vessels compared to non-diabetics. Atherosclerosis begins with endothelial dysfunction, [...] Read more.
Coronary atherosclerosis in patients with diabetes mellitus is the most significant pathophysiological mechanism responsible for ischemic heart disease. Atherosclerosis in diabetes is premature, more diffuse, and more progressive, and it affects more coronary blood vessels compared to non-diabetics. Atherosclerosis begins with endothelial dysfunction, continues with the formation of fatty streaks in the intima of coronary arteries, and ends with the appearance of an atherosclerotic plaque that expands centrifugally and remodels the coronary artery. If the atherosclerotic plaque is injured, a thrombus forms at the site of the damage, which can lead to vessel occlusion and potentially fatal consequences. Diabetes mellitus and atherosclerosis are connected through several pathological pathways. Among the most significant factors that lead to atherosclerosis in diabetics are hyperglycemia, insulin resistance, oxidative stress, dyslipidemia, and chronic inflammation. Chronic inflammation is currently considered one of the most important factors in the development of atherosclerosis. However, to date, no adequate anti-inflammatory therapeutic measures have been found to prevent the progression of the atherosclerotic process, and they remain a subject of ongoing research. In this review, we summarize the most significant pathophysiological mechanisms that link atherosclerosis and diabetes mellitus. Full article
(This article belongs to the Section Molecular Pathology, Diagnostics, and Therapeutics)
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16 pages, 1601 KiB  
Article
A Retrospective Evaluation of the Cardiometabolic Profile of Patients with COPD-Related Type 2 Respiratory Failure in the Intensive Care Unit
by Oral Mentes, Deniz Celik, Murat Yildiz, Kerem Ensarioglu, Mustafa Ozgur Cirik, Tulay Tuncer Peker, Fatma Canbay, Guler Eraslan Doganay and Abdullah Kahraman
Medicina 2025, 61(4), 705; https://doi.org/10.3390/medicina61040705 - 11 Apr 2025
Viewed by 868
Abstract
Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a notable cause of morbidity and mortality worldwide and can become complicated by Type 2 respiratory failure. This study aimed to analyze the cardiological and metabolic comorbidities of patients admitted to the intensive [...] Read more.
Background and Objectives: Chronic obstructive pulmonary disease (COPD) is a notable cause of morbidity and mortality worldwide and can become complicated by Type 2 respiratory failure. This study aimed to analyze the cardiological and metabolic comorbidities of patients admitted to the intensive care unit (ICU) due to COPD-related Type 2 respiratory failure and evaluate their effects on clinical outcomes. Materials and Methods: A retrospective analysis was conducted on 258 patients admitted to the secondary-level pulmonary disease intensive care unit between January 2022 and January 2024. Patients’ demographic data, cardiological and metabolic comorbidities, laboratory parameters, and ICU-related variables were evaluated using statistical analysis methods. Results: The most common comorbidities were hypertension (57.0%), congestive heart failure (48.1%), diabetes mellitus (31.4%), and obesity (37.6%). Female patients had significantly higher rates of hypothyroidism, hypertension, obesity, and congestive heart failure compared to males. Patients diagnosed with chronic kidney disease (CKD) had markedly higher cardiothoracic ratios and proBNP levels. ICU length of stay was considerably longer in patients with acute kidney injury (AKI) and coronary artery disease (CAD). Cardiomegaly and obstructive sleep apnea syndrome (OSAS) were more frequently observed in obese patients. Additionally, in COPD patients, a body mass index (BMI) threshold of 25.5 was determined as a cutoff value for radiological cardiomegaly findings with a sensitivity of 69.9% and a specificity of 59.5%. Elevated pCO2 and bicarbonate levels in patients receiving long-term oxygen therapy (LTOT) were associated with advanced-stage COPD. Conclusions: Metabolic and cardiological comorbidities notably impact the clinical prognosis and ICU management of patients diagnosed with COPD and Type 2 respiratory failure. This study, which aims to provide a snapshot of the comorbidities in patients requiring ICU admission due to COPD exacerbation-related Type 2 respiratory failure but without a fatal course, seeks to highlight the key areas where preventive and protective healthcare services should be focused in this patient group. Special attention should be given to monitoring female and obese patients. Future studies should explore how individualized and preventive follow-ups and treatment approaches can improve patient outcomes, with a particular emphasis on these identified areas. Full article
(This article belongs to the Section Pulmonology)
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19 pages, 1651 KiB  
Review
Artificial Intelligence in Nuclear Cardiac Imaging: Novel Advances, Emerging Techniques, and Recent Clinical Trials
by Ilana S. Golub, Abhinav Thummala, Tyler Morad, Jasmeet Dhaliwal, Francisco Elisarraras, Ronald P. Karlsberg and Geoffrey W. Cho
J. Clin. Med. 2025, 14(6), 2095; https://doi.org/10.3390/jcm14062095 - 19 Mar 2025
Cited by 1 | Viewed by 1647
Abstract
Cardiovascular disease (CVD) is a leading cause of death, accounting for over 30% of annual global fatalities. Ischemic heart disease, in turn, is a frontrunner of worldwide CVD mortality. With the burden of coronary disease rapidly growing, understanding the nuances of cardiac imaging [...] Read more.
Cardiovascular disease (CVD) is a leading cause of death, accounting for over 30% of annual global fatalities. Ischemic heart disease, in turn, is a frontrunner of worldwide CVD mortality. With the burden of coronary disease rapidly growing, understanding the nuances of cardiac imaging and risk prognostication becomes paramount. Myocardial perfusion imaging (MPI) is a frequently utilized and well established testing modality due to its significant clinical impact in disease diagnosis and risk assessment. Recently, nuclear cardiology has witnessed major advancements, driven by innovations in novel imaging technologies and improved understanding of cardiovascular pathophysiology. Applications of artificial intelligence (AI) to MPI have enhanced diagnostic accuracy, risk stratification, and therapeutic decision-making in patients with coronary artery disease (CAD). AI techniques such as machine learning (ML) and deep learning (DL) neural networks offer new interpretations of immense data fields, acquired through cardiovascular imaging modalities such as nuclear medicine (NM). Recently, AI algorithms have been employed to enhance image reconstruction, reduce noise, and assist in the interpretation of complex datasets. The rise of AI in nuclear medicine (AI-NM) has proven itself groundbreaking in the efficiency of image acquisition, post-processing time, diagnostic ability, consistency, and even in risk-stratification and outcome prognostication. To that end, this narrative review will explore these latest advances in AI in nuclear medicine and its rapid transformation of the cardiac diagnostics landscape. This paper will examine the evolution of AI-NM, review novel AI techniques and applications in nuclear cardiac imaging, summarize recent AI-NM clinical trials, and explore the technical and clinical challenges in its implementation of artificial intelligence. Full article
(This article belongs to the Special Issue Review Special Issue Series: New Advances in Cardiovascular Medicine)
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12 pages, 908 KiB  
Article
One-Year Prognosis for Patients Diagnosed with Acute Coronary Syndrome Compared to Those with Chronic Coronary Syndrome Following Complex Coronary Procedures
by Patrycja Woźniak, Konrad Stępień, Wojciech Wańha, Anna Smukowska-Gorynia, Aleksander Araszkiewicz, Maciej Lesiak, Weronika Jędraszak, Tatiana Mularek-Kubzdela and Sylwia Iwańczyk
J. Clin. Med. 2025, 14(3), 730; https://doi.org/10.3390/jcm14030730 - 23 Jan 2025
Viewed by 1074
Abstract
Background: Acute coronary syndrome (ACS) remains the primary cause of mortality worldwide. Performing complex coronary intervention in patients with ACS is considered a significant factor for worsening prognosis. This study aimed to evaluate the prognosis of patients with ACS treated with complex procedures [...] Read more.
Background: Acute coronary syndrome (ACS) remains the primary cause of mortality worldwide. Performing complex coronary intervention in patients with ACS is considered a significant factor for worsening prognosis. This study aimed to evaluate the prognosis of patients with ACS treated with complex procedures compared to patients with chronic coronary syndrome (CCS). Methods: Among 980 patients from the Polish Complex Registry, we enrolled 829 consecutive patients who underwent complex percutaneous coronary intervention (PCI) for acute or chronic coronary syndrome with a completed one-year follow-up. The primary endpoint is defined as the major adverse cardiac event (MACE) at 12 months, a composite endpoint including all-cause death, target lesion revascularization, target vessel revascularization, and non-fatal myocardial infarction. Results: The incidence of the composite endpoint of MACE at one-year follow-up was comparable between the patients with acute and chronic coronary syndrome who underwent complex PCI (12.4% vs. 7.6%, LogRank p = 0.035). Cox multivariate analysis indicated that ACS is an independent risk factor for death at one-year follow-up. Additionally, age and comorbidities, such as heart failure and chronic kidney disease, along with procedural factors, including lesion length and pre-procedural diameter stenosis, are independent predictors of death in patients with complex lesions. Independent risk factors for MACE at one-year follow-up include age, heart failure, previous PCI, in-stent restenosis, and pre-procedural diameter stenosis. Conclusions: The prognosis of patients with acute and chronic coronary syndrome in the annual follow-up is comparable in the context of cardiovascular events. The clinical presentation of ACS is an independent risk factor for all-cause death. Full article
(This article belongs to the Section Cardiovascular Medicine)
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7 pages, 218 KiB  
Perspective
From a Few Cardiovascular Risk Factors to the Prediction of Age at Death: The Shifting Interests of Cardiovascular Epidemiologists
by Alessandro Menotti and Paolo Emilio Puddu
J. Cardiovasc. Dev. Dis. 2025, 12(2), 35; https://doi.org/10.3390/jcdd12020035 - 21 Jan 2025
Viewed by 855
Abstract
We describe the changing research interests and goals of the responsible investigators of the Italian Rural Areas (IRA) of the Seven Countries Study of cardiovascular diseases (CVD) during a period of 60 years, dealing with a cohort of middle-aged men. Our initial interest [...] Read more.
We describe the changing research interests and goals of the responsible investigators of the Italian Rural Areas (IRA) of the Seven Countries Study of cardiovascular diseases (CVD) during a period of 60 years, dealing with a cohort of middle-aged men. Our initial interest was to discover the basic risk factors of coronary heart disease (CHD). Subsequently, the same problem was tackled regarding stroke and heart diseases of uncertain etiology. Later on, cancer deaths also became an end-point for which risk factors were investigated. The long duration of the study and the fact that CVD and cancer fatalities already cover 70% of all-cause mortality prompted the idea to focus on all-cause mortality, and particularly on age-at-death when the follow-up period reached 61 years together with the extinction of the cohort. At that point, a larger number of risk factors measured at baseline, including those which were unable to predict CVD, became the determinants of all-cause mortality and age-at-death, a metric that summarizes the life-span of health and disease. This study is supported by the presentation of data derived from published papers. Full article
(This article belongs to the Section Epidemiology, Lifestyle, and Cardiovascular Health)
16 pages, 290 KiB  
Article
Time-Dependent ECG-AI Prediction of Fatal Coronary Heart Disease: A Retrospective Study
by Liam Butler, Alexander Ivanov, Turgay Celik, Ibrahim Karabayir, Lokesh Chinthala, Mohammad S. Tootooni, Byron C. Jaeger, Luke T. Patterson, Adam J. Doerr, David D. McManus, Robert L. Davis, David Herrington and Oguz Akbilgic
J. Cardiovasc. Dev. Dis. 2024, 11(12), 395; https://doi.org/10.3390/jcdd11120395 - 8 Dec 2024
Viewed by 1301
Abstract
Background: Fatal coronary heart disease (FCHD) affects ~650,000 people yearly in the US. Electrocardiographic artificial intelligence (ECG-AI) models can predict adverse coronary events, yet their application to FCHD is understudied. Objectives: The study aimed to develop ECG-AI models predicting FCHD risk [...] Read more.
Background: Fatal coronary heart disease (FCHD) affects ~650,000 people yearly in the US. Electrocardiographic artificial intelligence (ECG-AI) models can predict adverse coronary events, yet their application to FCHD is understudied. Objectives: The study aimed to develop ECG-AI models predicting FCHD risk from ECGs. Methods (Retrospective): Data from 10 s 12-lead ECGs and demographic/clinical data from University of Tennessee Health Science Center (UTHSC) were used for model development. Of this dataset, 80% was used for training and 20% as holdout. Data from Atrium Health Wake Forest Baptist (AHWFB) were used for external validation. We developed two separate convolutional neural network models using 12-lead and Lead I ECGs as inputs, and time-dependent Cox proportional hazard models using demographic/clinical data with ECG-AI outputs. Correlation of the predictions from the 12- and 1-lead ECG-AI models was assessed. Results: The UTHSC cohort included data from 50,132 patients with a mean age (SD) of 62.50 (14.80) years, of whom 53.4% were males and 48.5% African American. The AHWFB cohort included data from 2305 patients with a mean age (SD) of 63.04 (16.89) years, of whom 51.0% were males and 18.8% African American. The 12-lead and Lead I ECG-AI models resulted in validation AUCs of 0.84 and 0.85, respectively. The best overall model was the Cox model using simple demographics with Lead I ECG-AI output (D1-ECG-AI-Cox), with the following results: AUC = 0.87 (0.85–0.89), accuracy = 83%, sensitivity = 69%, specificity = 89%, negative predicted value (NPV) = 92% and positive predicted value (PPV) = 55% on the AHWFB validation cohort. For this, the 2-year FCHD risk prediction accuracy was AUC = 0.91 (0.90–0.92). The 12-lead versus Lead I ECG FCHD risk prediction showed strong correlation (R = 0.74). Conclusions: The 2-year FCHD risk can be predicted with high accuracy from single-lead ECGs, further improving when combined with demographic information. Full article
(This article belongs to the Section Electrophysiology and Cardiovascular Physiology)
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16 pages, 799 KiB  
Review
Active Commuting as a Factor of Cardiovascular Disease Prevention: A Systematic Review with Meta-Analysis
by Claudia Baran, Shanice Belgacem, Mathilde Paillet, Raphael Martins de Abreu, Francisco Xavier de Araujo, Roberto Meroni and Camilo Corbellini
J. Funct. Morphol. Kinesiol. 2024, 9(3), 125; https://doi.org/10.3390/jfmk9030125 - 18 Jul 2024
Cited by 1 | Viewed by 2020
Abstract
Active commuting (AC) may have the potential to prevent the incidence of cardiovascular disease (CVD). However, the evidence for a correlation between AC and the risk of CVD remains uncertain. The current study thoroughly and qualitatively summarized research on the relationship between AC [...] Read more.
Active commuting (AC) may have the potential to prevent the incidence of cardiovascular disease (CVD). However, the evidence for a correlation between AC and the risk of CVD remains uncertain. The current study thoroughly and qualitatively summarized research on the relationship between AC and the risk of CVD disease. From conception through December 2022, researchers explored four databases (PubMed, PEDro, Cochrane, and Bibliothèque Nationale of Luxembourg [BnL]) for observational studies. The initial findings of the search yielded 1042 references. This systematic review includes five papers with 491,352 participants between 16 and 85 years old, with 5 to 20 years of follow-up period. The exposure variable was the mode of transportation used to commute on a typical day (walking, cycling, mixed mode, driving, or taking public transportation). The primary outcome measures were incident CVD, fatal and non-fatal (e.g., ischemic heart disease (IHD), ischemic stroke (IS), hemorrhagic stroke (HS) events, and coronary heart disease (CHD). Despite methodological variability, the current evidence supports AC as a preventive measure for the development of CVD. Future research is needed to standardize methodologies and promote policies for public health and environmental sustainability. Full article
(This article belongs to the Special Issue Physical Activity for Optimal Health)
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14 pages, 2585 KiB  
Article
Evaluating the Efficacy and Safety of Aspirin for Primary Cardiovascular Prevention in Asian Patients with Type 2 Diabetes: A Population-Based and Propensity Score-Matched Study
by Kai-Wei Chang, Jing-Yang Huang, Shun-Fa Yang and Kwo-Chang Ueng
Diagnostics 2024, 14(12), 1211; https://doi.org/10.3390/diagnostics14121211 - 7 Jun 2024
Cited by 1 | Viewed by 1651
Abstract
The risk of developing cardiovascular disease is significantly higher for individuals with diabetes compared to those without. Aspirin has been widely used for primary prevention in diabetic patients. However, evidence is limited in the Asian population. We aimed to compare the effectiveness and [...] Read more.
The risk of developing cardiovascular disease is significantly higher for individuals with diabetes compared to those without. Aspirin has been widely used for primary prevention in diabetic patients. However, evidence is limited in the Asian population. We aimed to compare the effectiveness and safety of aspirin versus placebo for primary cardiovascular prevention in the Asian population with type 2 diabetes. In this study, we performed propensity score matching with non-aspirin users from January 2006 to December 2015 (n = 37,095 in each group after matching, PSM). We analyzed the incidence risk of all-cause mortality, composite cardiovascular events, and hospitalized major bleeding. The propensity score-matched (PSM) cohort of patients who received aspirin within one year of diabetes diagnosis was compared with the non-aspirin diabetic (DM) cohort. Baseline characteristics were balanced between the two groups. The median follow-up duration was 78 months. Aspirin users exhibited a slightly but significantly lower rate of all-cause mortality (HR: 0.92; 95% CI: 0.87 to 0.96). However, they also had a significantly higher composite cardiovascular risk (HR: 1.34; 95% CI: 1.28–1.40), including non-fatal acute myocardial infarction (HR: 1.33; 95% CI: 1.18 to 1.50), non-fatal ischemic stroke (HR: 1.38; 95% CI: 1.30 to 1.45), heart failure (HR: 1.18; 95% CI: 1.09 to 1.27), and coronary revascularization (HR: 1.94; 95% CI: 1.73 to 2.17). Aspirin users also faced a significantly higher risk of hospitalized major bleeding (HR: 1.08; 95% CI: 1.03 to 1.14). The presence of one or more additional risk factors did not influence the effectiveness and safety outcomes of aspirin, according to stratified analysis. In conclusion, in this real-world Asian diabetic population, aspirin was associated with a significantly lower mortality risk but also with higher risks of cardiovascular events and hospitalized bleeding. Aspirin may not play a role in the primary prevention of cardiovascular disease in such patients, regardless of additional risk factors. Full article
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14 pages, 1969 KiB  
Article
Circulating Omega-3 Polyunsaturated Fatty Acids Levels in Coronary Heart Disease: Pooled Analysis of 36 Observational Studies
by Yanan Xiao, Yifang Chen, Anne Pietzner, Ulf Elbelt, Zhimin Fan and Karsten H. Weylandt
Nutrients 2024, 16(11), 1610; https://doi.org/10.3390/nu16111610 - 24 May 2024
Cited by 6 | Viewed by 2552
Abstract
Long-chain n-3 polyunsaturated fatty acid (PUFA) supplementation has shown potential benefits in the prevention of coronary heart disease (CHD); however, the impact of omega-3 fatty acid levels on CHD risk remains a subject of debate. Here, we aimed to investigate the association [...] Read more.
Long-chain n-3 polyunsaturated fatty acid (PUFA) supplementation has shown potential benefits in the prevention of coronary heart disease (CHD); however, the impact of omega-3 fatty acid levels on CHD risk remains a subject of debate. Here, we aimed to investigate the association between n-3 PUFA levels and the risk of CHD, with particular reference to the subtypes of n-3 PUFA. Methods: Prospective studies and retrospective case-control studies analyzing n-3 PUFA levels in CHD, published up to 30 July 2022, were selected. A random effects meta-analysis was used for pooled assessment, with relative risks (RRs) expressed as 95% confidence intervals (CIs) and standardized mean differences expressed as weight mean differences (WMDs). Subgroup and meta-regression analyses were conducted to assess the impact of n-3 PUFA exposure interval on the CHD subtype variables of the study. Results: We included 20 prospective studies (cohort and nested case-control) and 16 retrospective case-control studies, in which n-3 PUFAs were measured. Higher levels of n-3 PUFAs (ALA, EPA, DPA, DHA, EPA + DHA, total n-3 PUFAs) were associated with a reduced risk of CHD, with RRs (95% CI) of 0.89 (0.81, 0.98), 0.83 (0.72, 0.96); 0.80 (0.67,0.95), 0.75 (0.64, 0.87), 0.83 (0.73, 0.95), and 0.80 (0.70, 0.93), respectively, p < 0.05. CHD patients had significantly lower n-3 PUFA levels compared to healthy controls (p < 0.05). In the subgroup analysis, a significant inverse trend was found for both fatal CHD and non-fatal CHD with n-3 PUFA (EPA + DHA) levels. Also, the link between n-3 PUFA levels in erythrocytes with total CHD was generally stronger than other lipid pools. Conclusions: n-3 PUFAs are significantly related to CHD risk, and these findings support the beneficial effects of n-3 PUFAs on CHD. Full article
(This article belongs to the Section Lipids)
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15 pages, 1415 KiB  
Article
Early and Long-Term Results of Simultaneous and Staged Revascularization of Coronary and Carotid Arteries
by Elena Golukhova, Igor Sigaev, Milena Keren, Inessa Slivneva, Bektur Berdibekov, Nina Sheikina, Olga Kozlova, Valery Arakelyan, Irina Volkovskaya, Tatiana Zavalikhina and Susanna Avakova
Pathophysiology 2024, 31(2), 210-224; https://doi.org/10.3390/pathophysiology31020017 - 13 Apr 2024
Cited by 1 | Viewed by 1441
Abstract
Background: Carotid artery disease is prevalent among patients with coronary heart disease. The concomitant severe lesions in the carotid and coronary arteries may necessitate either simultaneous or staged revascularization involving coronary bypass and carotid endarterectomy. However, there is presently a lack of consensus [...] Read more.
Background: Carotid artery disease is prevalent among patients with coronary heart disease. The concomitant severe lesions in the carotid and coronary arteries may necessitate either simultaneous or staged revascularization involving coronary bypass and carotid endarterectomy. However, there is presently a lack of consensus on the optimal choice of surgical treatment tactics for patients with significant stenoses in both carotid and coronary arteries. The aim of the current study was to compare the 30-day and long-term outcomes of coronary and carotid artery revascularization surgery based on the simultaneous or staged surgical tactics. Material and Methods: This single-center retrospective study involved 192 patients with concurrent coronary artery disease and carotid artery stenosis ≥ 70%, of whom 106 patients underwent simultaneous intervention (CABG + CEA) and 86 patients underwent staged CABG/CEA. The mean time between stages ranged from 1 to 4 months (mean 1.88 ± 0.9 months). The endpoints included death from any cause, non-fatal stroke, non-fatal myocardial infarction (MI), and major adverse cardiovascular events (MACEs) (death + non-fatal MI + non-fatal stroke) within 30 days after the last intervention and in the long-term follow-up period (median follow-up—6 years). Results: The 30-day all-cause mortality, incidence of postoperative non-fatal MI, non-fatal stroke, and MACEs did not exhibit differences between the groups after single-stage and staged interventions. However, the overall risk of postoperative complications (adjusted for the risk of any complication per patient) (OR 2.214, 95% CI 1.048–4.674, p = 0.035), as well as the duration of ventilatory support (p = 0.004), was elevated in the group after simultaneous interventions compared with the staged intervention group. This difference did not result in an increased incidence of death and MACEs in the group after simultaneous interventions. In the long-term follow-up period, there were no significant differences observed when comparing simultaneous or staged surgical tactics in terms of overall survival (54.9% and 62.6% in Groups 1 and 2, respectively, P log-rank = 0.068), non-fatal stroke-free survival (45.6% and 33.6% in Groups 1 and 2, respectively, P log-rank = 0.364), non-fatal MI-survival (57.6% and 73.5% in Groups 1 and 2, respectively, P log-rank = 0.169), and MACE-free survival (7.1% and 30.2% in Groups 1 and 2, respectively, P log-rank = 0.060). The risk factors associated with an unfavorable outcome included age, smoking, BMI, LV EF, and atherosclerosis of the lower extremity arteries. Conclusions: This study revealed no significant difference in the impact of simultaneous CABG + CEA or staged CABG/CEA on the incidence of death, stroke, MI, and MACEs over a 30-day and long-term follow-up period. Although the immediate results indicated an increased risk of a complicated course (attributable to overall complications) and more prolonged ventilation after simultaneous CABG + CEA compared with staged CABG/CEA, this did not lead to an increase in fatal complications. Therefore, the implementation of either tactic is considered eligible and appropriate following a thorough operative risk assessment. Full article
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12 pages, 1212 KiB  
Article
Prognostic Value of Standard Heart Failure Medication in Patients with Cardiac Transthyretin Amyloidosis
by Fabian aus dem Siepen, Selina Hein, Eva Hofmann, Christian Nagel, Stéphanie K. Schwarting, Ute Hegenbart, Stefan O. Schönland, Markus Weiler, Norbert Frey and Arnt V. Kristen
J. Clin. Med. 2024, 13(8), 2257; https://doi.org/10.3390/jcm13082257 - 12 Apr 2024
Cited by 6 | Viewed by 1578
Abstract
Introduction: Cardiac transthyretin amyloidosis (ATTR) is a progressive, fatal disease leading to heart failure due to accumulation of amyloid fibrils in the interstitial space and may occur as a hereditary (ATTRv) or wild-type (ATTRwt) form. Guidelines recommend the use of ACE inhibitors [...] Read more.
Introduction: Cardiac transthyretin amyloidosis (ATTR) is a progressive, fatal disease leading to heart failure due to accumulation of amyloid fibrils in the interstitial space and may occur as a hereditary (ATTRv) or wild-type (ATTRwt) form. Guidelines recommend the use of ACE inhibitors (ACEis) and beta-blockers (BBs) as heart failure therapy (HFT) in all patients with symptomatic heart failure and reduced ejection fraction, independent of the underlying etiology. However, the prognostic benefit of ACEis and BBs in ATTR has not been elucidated in detail yet. We thus sought to retrospectively investigate the outcome of patients with ATTRwt or ATTRv under HFT. Methods: Medical records of 403 patients with cardiac ATTR (ATTRwt: n = 268, ATTRv: n = 135) were screened for long-term medication as well as clinical, laboratory, electrocardiographic and echocardiographic data. Patients were assessed between 2005 and 2020 at the University Hospital Heidelberg. Kaplan–Meier analysis was used to analyze potential differences in survival among different subgroups. Results: The mean follow-up was 28 months. In total, 43 patients (32%) with ATTRv and 140 patients (52%) with ATTRwt received HFT. Survival was significantly shorter in patients receiving HFT in ATTRv (46 vs. 83 months, p = 0.0007) vs. non-HFT. A significantly better survival was observed in patients with comorbidities (coronary artery disease, arterial hypertension) and HFT among ATTRwt patients (p = 0.004). No significant differences in survival were observed in the other subgroups. Conclusions: Survival analysis revealed a potential benefit of HFT in patients with ATTRwt and cardiac comorbidities such as coronary artery disease and/or arterial hypertension. In contrast, HFT should be used with caution in patients with ATTRv. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Cardiomyopathy)
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15 pages, 3129 KiB  
Article
Associations between Cholesterol Intake, Food Sources and Cardiovascular Disease in Chinese Residents
by Yuxue Cao and Yan Yu
Nutrients 2024, 16(5), 716; https://doi.org/10.3390/nu16050716 - 29 Feb 2024
Cited by 5 | Viewed by 4880
Abstract
Cholesterol is a nutrient commonly found in the human diet. The relationship between dietary cholesterol, its sources, and cardiovascular disease (CVD) is still a topic of debate. This study aimed to investigate the association between dietary cholesterol, its sources, and cardiovascular events in [...] Read more.
Cholesterol is a nutrient commonly found in the human diet. The relationship between dietary cholesterol, its sources, and cardiovascular disease (CVD) is still a topic of debate. This study aimed to investigate the association between dietary cholesterol, its sources, and cardiovascular events in a Chinese population. The present study analyzed data from the China Health and Nutrition Survey (CHNS) cohort between 1991 and 2015. This study analyzed data from 3903 participants who were 40 years of age or older at baseline and had no history of cardiovascular disease, diabetes, or hypertension. During a median follow-up of 14 years, 503 cardiovascular disease events were identified through follow-up questionnaires administered every 2–3 years. The events included fatal and nonfatal coronary heart disease, stroke, heart failure, and other cardiovascular disease deaths. Cox regression was used to estimate risk ratios (HR) for CVD events after adjusting for demographic, socioeconomic, and behavioral factors. It was discovered that sources of dietary cholesterol varied among different subgroups of the population. The top three sources of cholesterol among all participants were eggs, red meat, and seafood, accounting for 57.4%, 28.2%, and 9.0% of total daily cholesterol intake, respectively. The present study found that there was a significant association between total dietary cholesterol intake, and the risk of developing cardiovascular disease (adjusted HR [95% CI]: total cholesterol (highest and lowest quartiles compared) 1.57 [1.17–2.11]). Cholesterol from poultry, seafood, and eggs was also significantly associated with a reduced risk of CVD (adjusted HR [95% CI]: poultry 0.18 [0.04–0.82], seafood 0.11 [0.02–0.54], and eggs 0.16 [0.03–0.73]). After adjusting for daily caloric intake, daily fat intake, and daily saturated fat intake, the previously observed association between red meat cholesterol and cardiovascular events (unadjusted HR [95% CI]: 0.44 [0.35–0.55]) was no longer statistically significant (adjusted HR [95% CI]: 0.21 [0.04–1.01]). Full article
(This article belongs to the Section Nutritional Epidemiology)
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