Search Results (75)

Freshwater clams (Corbicula spp.), commonly known as shijimi in East Asia, have long been valued for their functional and nutritional properties. In this review, we summarise the physiological effects of hot water extracts derived from Taiwanese freshwater clams (FCE), particularly in relation to metabolic syndrome and other lifestyle-related disorders. Traditionally, shijimi has been used to alleviate hepatic dysfunction and symptoms associated with alcohol consumption. FCE significantly suppresses galactosamine-induced increases in serum aspartate aminotransferase and alanine aminotransferase. In addition, FCE reduces alcohol-induced hepatic lipid accumulation and lowers hepatic cholesterol levels. FCE also influences alcohol metabolism: animals receiving FCE exhibit lower blood alcohol concentrations and a faster rate of alcohol clearance following ethanol administration. These findings suggest that shijimi may protect against alcohol- or drug-induced liver damage, potentially by enhancing alcohol metabolism. Beyond its role in liver protection, shijimi has been associated with the alleviation of jaundice, possibly through increased bile secretion linked to improved cholesterol homeostasis. Supporting this, studies using models of exogenous hypercholesterolemia show that FCE lowers both serum and hepatic cholesterol levels in a dose-dependent manner. Overall, traditional claims regarding the hepatoprotective effects of shijimi are increasingly supported by mechanistic and molecular evidence. This is the first clarified review of the various effects of shijimi. Full article

Evidence suggests that a gluten-free diet may increase the risk of metabolic abnormalities associated with cardiovascular disease in adults with Coeliac Disease (CeD). This 9-week, double-blind, placebo-controlled, randomised pilot study investigated the effects of a combined supplement containing probiotic Lactiplantibacillus plantarum ECGC 13110402 and plant sterols and stanols, on cardiometabolic biomarkers and gut microbiota diversity and composition in adults with CeD and hypercholesterolaemia. Blood lipid profiles and vitamin D concentrations were analysed, and gut microbiota was profiled via 16S rRNA amplicon sequencing. In the active group, significant reductions in total cholesterol, LDL-cholesterol, non-HDL cholesterol, and apolipoprotein B were observed at multiple time points during the treatment phase, with changes generally greater in magnitude compared with the placebo group. Vitamin D levels also increased in the active group during supplementation. Microbiota analysis revealed potentially beneficial changes in participants receiving the active formulation, including higher alpha diversity and higher proportions of Bifidobacterium spp., Christensenellaceae R-7 group, and Lachnospiraceae ND3007 group. Overall, this feasibility study provides exploratory findings that a combined Lactiplantibacillus plantarum ECGC 13110402-phytosterol formulation may support lipid management and beneficially modulate gut microbiota in adults with CeD, particularly for those seeking non-pharmacological approaches to improving cardiometabolic health biomarkers. Full article

Peripheral artery disease (PAD) is found in 10.9% of patients with ischaemic stroke (IS). This cross-sectional study was performed to investigate the prevalence of PAD and its risk factors among acute IS patients in Singapore. Patients admitted for IS were recruited. Data was collected on sex, age, body mass index (BMI), history of hypertension, diabetes mellitus (DM), hypercholesterolaemia, cigarette smoking, prior stroke (PS) and ischaemic heart disease (IHD). IS was classified as a lacunar infarct (LI) or non-lacunar infarct (NLI) based on neuroimaging. Carotid intima–medial thickening (IMT) and carotid plaques (CP) were determined by ultrasonography. The ankle–brachial Index (ABI) was calculated in both lower limbs; PAD was diagnosed if the ABI was ≤0.9 in any limb. The estimated sample size was 150 subjects. In total, 150 subjects were recruited; the mean age was 62.7 ± 10.2 years, 44.7% were female, and the mean BMI was 24.1 ± 4.1. A total of 63.3% reported hypertension, 42.7% DM, 30.0% hypercholesterolaemia, 38.0% smoking, 18.7% PS, and 6.0% IHD. A total of 30.7% had IMT, 77.3% had CP, and 8.0% had carotid stenosis ≥50%. LI occurred in 64.7%. PAD was diagnosed in 22.0% (95% CI 16.1–29.3). On univariate analysis, based on vascular risk factors alone, PAD was associated with age (p = 0.03), hypercholesterolaemia (p = 0.03), and IHD (p = 0.004). On logistic regression, PAD was only associated with IHD (aOR 6.42, 95% CI 1.25–32.84; p = 0.03). When IMT and CP were added to the model, the association with IHD remained (aOR 5.45, 95% CI 1.03–28.71; p = 0.045). When the results of neuroimaging were added, the association was only with NLI (aOR 2.78, 95% CI 1.09–7.14; p = 0.03). This study found a high prevalence of PAD among Asian patients with IS. It was associated with a non-lacunar infarction. Full article

Background. Atherosclerosis is a long-standing process that starts in childhood and leads to a number of major adverse cardiovascular events in adulthood. It is therefore crucial that children at potential risk of atherosclerosis-related harmful consequences are identified. Nevertheless, relatively few studies have focused on primary prevention in paediatric patients. Methods. Fifty-four children (mean age 9.0 ± 2.8 years) and 72 parents (mean age 44.0 ± 8.2 years) were recruited. Blood pressure (BP) was measured and lipid panel was checked, together with carotid intima–media thickness (IMT) and several indexes of carotid stiffness. Results. No statistically significant differences in IMT and indexes of carotid stiffness were detected between children and parents, with the exception of the alpha index (p < 0.05). In children, IMT was correlated with the alpha index (p = 0.01). Seventeen children (31%) had a pathological IMT. The diastolic BP difference between children with normal and pathological IMT was statistically significant (p < 0.05). Parents’ total, LDL and HDL cholesterol, as well as triglyceride levels, differed statistically from those of children with both physiological and pathological IMT: p < 0.05 for all differences. Children with hypercholesterolemia had a three-fold higher likelihood of having a pathological IMT than children with normal cholesterol (p < 0.01). Among children with pathological IMT, 59 percent had one and 41 percent had two parents who were affected by pathological IMT. Conclusions. Carotid stiffness was similar in children and their parents, suggesting early familial influences on vascular properties. Many children had a pathological carotid IMT, highlighting how subclinical atherosclerosis is diffuse even at a young age. IMT in children was associated with cholesterol levels, underscoring the importance of early lipid screening and management. The strong association between pathological IMT in both children and their parents supports the hypothesis of a shared genetic or environmental predisposition to early vascular alterations. Full article

The objective was to expand community-based dementia screening across diverse settings in Brunei and evaluate the prevalence of risk factors, cognitive symptoms and factors associated with suspected cognitive impairment using the Mini-COG. Cross-sectional community screening was conducted across community and healthcare settings among adults aged 60 years and older, or aged 50 years and older with dementia risk factors. Participants completed a structured questionnaire on demographics, dementia risk factors and cognitive symptoms, followed by the Mini-COG. Multivariable logistic regression was used to examine factors associated with suspected cognitive impairment. A total of 1358 participants were included, with a median age of 60 years, and 63.5% were female. Two-thirds had hypertension, over half had hypercholesterolaemia and over one-third had diabetes mellitus. The most commonly reported symptoms were misplacing things (42.6%), forgetfulness (32.5%) and visuospatial difficulties (24.2%). Among those with symptoms, 14.5% reported worsening symptoms and 12.0% had impaired activities of daily living. From the Mini-COG, 14.4% had suspected cognitive impairment. Multivariable analysis revealed that older age (adjusted OR 1.06 per year, p < 0.001) and education level (adjusted OR 2.25 for primary versus tertiary, p = 0.007) were independently associated with Mini-COG impairment, while vascular risk factors showed no significant associations. Community-based dementia screening using a brief questionnaire and the Mini-COG was feasible across multiple settings in Brunei. There was a high prevalence of vascular risk factors and cognitive symptoms. Age and educational attainment were stronger predictors of abnormal Mini-COG results compared to vascular risk factors in this study. These findings support opportunistic screening in healthcare and community settings, and an emphasis on public education on dementia symptoms and risk reduction. Full article

Background: Familial hypercholesterolaemia (FH) is an inherited condition that substantially increases the risk of premature atherosclerotic cardiovascular disease (ASCVD). Despite effective therapies, many affected individuals remain undiagnosed. Incorporation of FH testing into newborn screening (NBS) is a potential strategy to increase detection. This study explores the attitudes of expectant parents toward NBS for FH. Methods: Expectant parents attending Obstetrics and/or Obstetric Medicine clinics at a tertiary referral centre were invited to participate in a semi-structured interview in person or via telephone. The interview explored views on screening children for FH in general, preferred timing of screening, opinions on integrating FH screening into routine NBS, acceptability of genetic testing in children and newborns, willingness to engage in family screening and any potential impact on participation in routine NBS programmes. Participants were also invited to discuss concerns and benefits. Results: All participants (n = 22) supported screening children for FH with the majority (n = 19, 86%) preferring screening during the newborn period, and all but one (n = 21, 95%) supporting adding FH to routine NBS. All participants (n = 22, 100%) considered genetic testing for FH acceptable for children, 21 (95%) considered it acceptable for newborns. All participants would partake in extended family screening and none indicated that including FH genetic testing would reduce their willingness to engage in routine NBS. Concerns raised by participants included administering lipid-lowering therapy to children and potential post-diagnosis stress and anxiety. All participants reported that a diagnosis would not affect parent–child bonding. Key perceived benefits raised by participants included early diagnosis and prevention of heart disease, family screening, and broader health system and community advantages. Conclusions: Expectant parents demonstrated strong support for FH NBS and indicated no negative impact on uptake of routine NBS. Further work is needed to address parental concerns and guide implementation strategies. Full article

Background: Sex-related differences in outcomes following cardiac surgery are well documented, with females generally experiencing higher postoperative mortality rates than males. However, the underlying factors driving this disparity remain incompletely understood. This study aimed to compare the preoperative risk characteristics of female and male patients who died within one year after elective cardiac surgery with those who survived, in order to identify sex-specific risk profiles associated with postoperative mortality. Methods: In this retrospective single-centre cohort study, data were derived from a prospective quality assurance database at Amsterdam University Medical Centres (Amsterdam UMC), The Netherlands, covering January 2001 to December 2020. All adult patients (≥18 years) undergoing elective cardiac surgery were included. Descriptive and comparative analyses were performed to characterise sex-specific preoperative differences between survivors and non-survivors. Results: The study cohort comprised 10,614 patients, including 2804 females (26%; median age 72 years [IQR 65–77]) and 7810 males (74%; median age 67 years [IQR 59–73]). In both sexes, non-survivors more frequently had major comorbidities, including atrial fibrillation, history of reoperation, pulmonary hypertension, chronic obstructive pulmonary disease, cerebrovascular disease, and kidney dysfunction. Within one year post-surgery, 143 (5.1%) females and 299 (3.8%) males had died. Among females, non-survivors within one year of surgery more frequently had several preoperative risk factors compared with survivors, including moderately impaired left ventricular function (16% vs. 11%), pulmonary hypertension (12% vs. 3%), extracardiac arteriopathy (25% vs. 9%), and kidney dysfunction (46% vs. 21%) dependent on the type of surgery (combined valve + coronary artery bypass grafting (CABG) (29% vs. 15%) or aortic surgery (14% vs. 4%)). In male patients, however, different risk factors such as higher age (median 73 years [IQR 66–77] vs. 67 [59–73]), lower Body Surface Area (mean 1.96 m² (SD ± 0.19) vs. 2.02 ± 0.18), hypercholesterolaemia (35% vs. 44%), severely impaired left ventricular function (14% vs. 6%), myocardial infarction (31% vs. 22%), and type of surgery (aortic surgery (9% vs. 3%), or combined valve + CABG (22% vs. 12%)) were preoperative predictors of mortality compared to non-survivors. Conclusions: Our study demonstrates that one-year mortality following elective cardiac surgery is driven by distinct preoperative risk profiles in females and males. Recognising that mortality in females is associated with systemic disease and males by direct cardiac damage is a critical step toward developing more equitable, precise, and effective perioperative management strategies. Full article

Background: Lowering lipid levels after an acute coronary syndrome is critical for preventing recurrent adverse cardiovascular events. Multiple medications are now available, but there is limited evidence comparing how frequently they lead to the achievement of guideline-recommended lipid targets. Methods and Results: This observational study evaluated the impact of novel lipid-lowering therapies (alirocumab, evolocumab, inclisiran, and bempedoic acid) in patients with a history of atherosclerotic cardiovascular disease or familial hypercholesterolaemia treated with maximum-tolerated doses of high-intensity statin therapy with or without ezetimibe. Our primary assessment was the achievement of LDL-C below 1.4 mmol/L as per the European Society of Cardiology guidelines. The study comprised of 256 patients. Reduction in LDL-C was greatest with alirocumab and evolocumab, achieving a reduction of 62% (95% confidence interval [CI], 51 to 93; p < 0.001) and 58% (95% CI, 47 to 88; p < 0.001) after 12 months, respectively. This was followed by inclisiran with a reduction of 47% (95% CI, 37 to 78; p < 0.001) and bempedoic acid with a reduction of 36% (95% CI, 22 to 69; p < 0.001). Patients treated with alirocumab and evolocumab started from a higher baseline LDL-C than inclisiran, due to the higher LDL threshold required for initiation of alirocumab and evolocumab in the UK. Despite this, inclisiran, evolocumab, and alirocumab were all associated with similar proportions of patients achieving LDL targets: 35%, 42%, and 37% of patients achieved a guideline-recommended LDL-C target of <1.4 mmol/L. Patients with a baseline LDL-C > 4 mmol/L were more likely to reach the ESC target when treated with alirocumab or evolocumab compared to inclisiran, with results of 33.3% vs. 24.1% (p = 0.016) and 35.7% vs. 24.1% (p = 0.05). Conclusions: Alirocumab and evolocumab were associated with the greatest reductions in LDL-C, followed by inclisiran and bempedoic acid. Overall, alirocumab, evolocumab, and inclisiran led to approximately 40% of patients reaching ESC targets for LDL-C. In patients with a baseline LDL-C > 4 mmol/L, significantly more patients achieved LDL-C targets when treated with alirocumab or evolocumab compared to inclisiran. Strength and limitations: This was the first study to comprehensively compare the efficacy of novel lipid-lowering therapies in achieving guideline-recommended LDL targets within a high-risk cardiovascular population. The sample size was relatively small, especially for patients treated with bempedoic acid. Full article

Monascus purpureus is a filamentous fungus known for producing pharmaceutically valuable secondary metabolites, including azaphilone pigments and lovastatin. Lovastatin is an HMG-CoA reductase inhibitor widely used to manage hypercholesterolaemia, while Monascus pigments serve as natural colourants with antioxidant and antimicrobial properties. This study evaluated the impact of quorum-sensing molecules (QSMs)—tyrosol (0.3 mM), farnesol (0.2 mM) and linoleic acid (0.4 mM)—on pigment and lovastatin yields in shake flasks and 2.5 L stirred-tank bioreactors. QSMs were introduced 48 h post-inoculation in shake flasks and 24 h in bioreactors. All QSMs increased yellow (OD₄₀₀), orange (OD₄₇₀), and red (OD₅₁₀) pigments and lovastatin concentration relative to the control, with scale-up further enhancing yields. Farnesol produced the most pronounced effect: in flasks, OD₄₀₀ 7.10 (1.86-fold), OD₄₇₀ 8.00 (2.12-fold), OD₅₁₀ 7.80 (2.08-fold), and 74.6 mg/L lovastatin (2.05-fold); in bioreactors, OD₄₀₀ 11.9 (2.06-fold), OD₄₇₀ 15.1 (2.71-fold), OD₅₁₀ 13.7 (2.47-fold), and 97.2 mg/L lovastatin (2.48-fold). This was followed by tyrosol treatment and then linoleic acid. These findings demonstrate that QSMs—particularly farnesol—significantly (p < 0.01) stimulate pigment and lovastatin biosynthesis in M. purpureus. Quorum sensing modulation represents a promising, scalable strategy to optimise fungal fermentation for industrial metabolite production. Full article

To screen older people and /or those with risk factors for dementia in the community to identify risk factors and possible symptoms of dementia A community-based cross-sectional survey was conducted among older people aged 60 years and older or aged 50 years and older with non-communicable diseases or risk factors for developing dementia. Participants were recruited from Senior Citizen Activity Centres and other areas where older people meet in the community, such as marketplaces. Participants completed a structured, self-administered questionnaire regarding self-reported dementia risk factors, cognitive symptoms, concerns regarding symptoms and a brief cognitive assessment tool (Mini-COG). This approach was piloted in the Senior Citizen Activity Centres. There were 178 participants, median age 67 years with two-thirds being female. Two-thirds had hypertension and over 40% had hypercholesterolaemia. The most commonly reported symptoms were misplacing things (41.6%), visuospatial difficulties (22.7%) and forgetfulness (20.8%). Among those with symptoms, 7.3% reported worsening symptoms, 5.1% had impaired activities of daily living, and 22.5% thought they should get their cognition assessed. For the Mini-COG, 65% recalled all 3 words, while a quarter made at least one error in the clock-drawing test. Community-based dementia screening using a questionnaire on risk factors, cognitive symptoms and the Mini-COG was feasible and acceptable in Brunei. Despite participants being socially active, there was a surprisingly high prevalence of risk factors for dementia and symptoms of possible cognitive impairment. Further roll-out of the community screening is planned in other locations. Full article

Background: The progressive course of coronavirus disease 2019 (COVID-19) is more frequently observed in individuals with obesity, diabetes, pulmonary and cardiovascular disease, or arterial hypertension. Many patients with these conditions are prescribed statins to treat hypercholesterolaemia. However, statins exhibit additional pleiotropic effects. The present study aims to investigate the effects of all eight currently existing statins on the expression of genes whose products have been reported to be directly associated with complicated COVID-19 disease. Methods: We extended the interpretation of the whole-genome DNA microarray analyses of pancreatic cancer cells MiaPaCa-2 and whole-transcriptome analyses of adipose tissue-derived mesenchymal stem cells AD-MSC that we had performed in the past. From the number of genes with altered expression induced by statins, we focused on those reported to be involved in a complicated course of COVID-19, including APOE and ACE2, genes encoding proteins involved in innate antiviral immunity and respiratory failure genes. Results: Although we did not observe statin-induced changes in the expression of APOE, ACE2 and any of the six genes clustered in the locus associated with respiratory failure in patients with COVID-19, some statins induced changes in the expression of genes encoding their interaction partners. Among genes associated with the immune system, all statins, which are effective in vitro affected the expression of genes encoding IL-6 and IL-8 and interaction partners of NF-kB, which may influence the duration of viral persistence. Conclusions: Statins act on multiple pathways simultaneously, some of which support COVID-19 development, while others suppress it. Full article

Background/Objectives: Atherosclerotic cardiovascular diseases (ASCVDs) remain the leading cause of morbimortality worldwide. The objectives of this study were to update the prevalence rates of ASCVDs and to evaluate their relationship with cardiovascular–kidney–metabolic (CKM) disorders. Methods: This cross-sectional observational study included 6588 adults selected through a simple random population-based sample from the Health Service database of the Madrid Region (Spain). Adjusted prevalence rates were calculated by the direct method, according to Spanish population data from the National Institute of Statistics. The relationships of CKM disorders with coronary heart disease (CHD), stroke, peripheral arterial disease (PAD), and ASCVD were assessed by bivariate and multivariate analyses. Results: The age- and sex-adjusted prevalence rates among overall adults with CHD, stroke, PAD, and ASCVD were 3.8%, 3.0%, 1.8%, and 7.3%, respectively, and they reached 5.6%, 4.4%, 2.6%, and 10.8%, respectively, among people aged 40 years and older. The prevalence rates were higher in men than women aged over 40 years for CHD and ASCVD, between 50 and 69 years for stroke, and aged over 60 years for PAD. The mean ages of women and men with ASCVD were 74.9 and 70.2 years, respectively. Hypertension, heart failure (HF), hypercholesterolaemia, diabetes, low eGFR, atrial fibrillation (AF), prediabetes, and low HDL-c were independently associated with ASCVD, highlighting hypertension and HF for all of them, in addition to hypercholesterolaemia for CHD and stroke, and specifically, AF for stroke. Conclusions: More than one in ten people aged over 40 suffer from CHD, stroke, or PAD. Hypertension, HF, hypercholesterolaemia, diabetes, and low eGFR are the major CKM disorders associated with ASCVD. Full article

Multimorbidity poses significant challenges for resource-constrained healthcare systems, particularly in low and middle income countries where specific combinations of chronic conditions may differentially impact function. This cross-sectional study examined multimorbidity patterns and associations with functioning among 165 adults attending semi-rural primary healthcare facilities in South Africa. Participants completed performance-based measures (handgrip strength, five-times sit-to-stand test, step test and exercise prescription tool [STEP] maximum oxygen consumption) and self-reported function (12-item WHODAS 2.0). Exploratory factor analysis identified three multimorbidity patterns: HIV-hypercholesterolaemia-obesity (Pattern 1), hypertension-anaemia-lung disease (Pattern 2), and stroke-heart disease-hypercholesterolaemia (Pattern 3). Pattern 1 was associated with reduced aerobic capacity (β = −6.41, 95% CI: −9.45, −3.36) and grip strength (β = −0.11, 95% CI: −0.14, −0.07). Pattern 2 showed associations with mild (β = 1.12, 95% CI: 0.28, 1.97) and moderate (β = 1.48, 95% CI: 0.53, 2.43) self-reported functional problems and reduced grip strength (β = −0.05, 95% CI: −0.09, −0.003). Pattern 3 was associated with all self-reported impairment levels, with the strongest association for severe impairment (β = 2.16, 95% CI: 0.32, 4.01). These findings highlight the convergence of infectious and non-communicable diseases in this setting. Simple clinical measures like grip strength and self-reported function may hold potential as screening or monitoring tools in the presence of disease patterns, warranting further research. Full article

Background/Objectives: The current study aims to estimate the frequency of abnormal renal status (ARS, defined as chronic kidney disease (CKD) diagnosis in electronic medical records or current albuminuria) in people with newly diagnosed diabetes mellitus (DM), to determine the associated risk factors, and to evaluate the level of compliance with good clinical practice recommendations. Methods: Cross-sectional study with 1030 adults diagnosed with DM in the last 4 years. Anthropometric, clinical, analytical, and lifestyle variables were collected. Multivariate analyses were performed to determine the factors associated with ARS. Results: Hypercholesterolaemia, metabolic syndrome, hypertension, obesity, hypertriglyceridaemia, and cardiovascular disease (CVD) were the most prevalent comorbidities. ARS was present in 11.5% of patients. The variables associated with ARS were male sex (OR: 1.78; 95% CI, 1.16–2.75), age ≥70 years (OR: 2.96; 95% CI: 1.92–4.56), hypertension (OR: 1.59; 95% CI: 1.03–2.44), CVD (OR: 1.73; 95% CI: 1.03–2.90), and hemoglobin A1c (HbA1c) ≥8% (OR: 2.26; 95% CI, 1.19–4.27). Among patients with hypertension and albuminuria, 80% received angiotensin-converting enzyme inhibitors (ACE inhibitor) or an angiotensin receptor blocker (ARB), compared to 60% of those with albuminuria without hypertension. The 42.4% patients with ARS were treated with sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and 72% with statins, but only 31.5% achieved the target low density lipoproteins cholesterol (LDLc) < 70 mg/dL. Conclusions: ARS in newly diagnosed patients with DM is less common than described in the literature, but risk factors for its development are highly prevalent. Adherence to good clinical practice recommendations was poor, especially in LDL cholesterol targets and the use of SGLT2i. Full article

Enhanced external counterpulsation (EECP) treatment has been demonstrated to be effectively vasculoprotective and anti-atherosclerotic in clinical observations and controlled trials. The diastolic blood flow augmentation induced by EECP greatly affected the local hemodynamic environment in multiple arterial segments. In this study, a porcine model of hypercholesterolaemia was developed to perform an invasive physiological measurement involving electrocardiogram, blood flow wave, and arterial pressure. Subsequently, a three-dimensional carotid bifurcation model was developed to evaluate the variations in wall shear stress (WSS) and its temporal and spatial oscillations. The results show that, compared to the pre-EECP state, EECP stimulus led to an increase of 28.7% in the common carotid artery (CCA) blood flow volume over a cardiac cycle, as well as an augmentation of 22.73% in the diastolic pressure. Meanwhile, the time-average wall shear stress (TAWSS) over the cardiac cycle increased 25.1%, while the relative residence time (RRT) declined 45.7%. These results may serve to reveal the hemodynamic mechanism of EECP treatment that contributes to its anti-atherosclerotic effects. Full article