Search Results (470)

Background: Cardiovascular disease (CVD) is the leading cause of mortality in peritoneal dialysis (PD) patients, with traditional risk factors failing to fully explain the accelerated atherosclerosis observed in this group. Hepcidin, a major regulator of iron metabolism and inflammation, has emerged as a potential contributor to vascular remodeling. Methods: We conducted a cross-sectional study of 82 PD patients to assess the relationship between serum hepcidin levels and carotid intima–media thickness (CIMT), a surrogate marker of subclinical atherosclerosis. Clinical, biochemical, and dialysis-related data were collected. Patients were stratified into tertiles by hepcidin levels, and correlation, regression, and ROC analyses were performed. Results: Serum hepcidin levels showed a strong positive correlation with CIMT (ρ = 0.788, p < 0.001). In multivariate linear regression, hepcidin (β = 0.0057, p = 0.012) and dialysis duration (β = 0.0018, p = 0.015) remained independent predictors of CIMT. ROC analysis demonstrated excellent discriminative ability of hepcidin for elevated CIMT (AUC = 0.922), which improved further with the inclusion of dialysis duration (AUC = 0.952). Conclusions: Serum hepcidin is a strong, independent predictor of subclinical atherosclerosis in PD patients. These findings suggest that iron dysregulation and inflammation may play a more prominent role than traditional cardiovascular risk factors in this population. Hepcidin may serve as a valuable biomarker for early vascular risk stratification and a potential therapeutic target. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in T2DM, likely due to insulin resistance and obesity. Although screening is recommended in high-risk patients, its prevalence in outpatient cardiovascular clinical settings remains unclear. Methods: We analyzed data from 475 patients attending a cardiovascular outpatient clinic: 142 with T2DM, 78 with T1DM, and 255 non-diabetic individuals at elevated cardiovascular risk. Liver steatosis and fibrosis were assessed using vibration-controlled transient elastography (Fibroscan^®): steatosis by controlled attenuation parameter (CAP ≥ 275 dB/m), and fibrosis risk by liver stiffness measurement (LSM ≥ 8.1 kPa). Carotid intima-media thickness (cIMT) was also measured. Results: The cohort (47% women, mean age 53 years, BMI 29.8 kg/m²) showed MASLD in 39.2% and fibrosis risk in 18.3%. MASLD was most prevalent in T2DM (57.0%), followed by non-diabetics (35.3%) and T1DM (19.2%) (p < 0.001). Fibrosis risk was also highest in T2DM (22.5%) vs. T1DM (7.7%) and non-diabetics (19.2%) (p = 0.02). CAP values were higher in those with fibrosis risk. T2DM patients with MASLD had higher LSM (7.0 ± 3.0 kPa) compared to those without MASLD (5.1 ± 2.2 kPa; p < 0.001). cIMT was highest in T2DM (0.73 ± 0.12 mm; p = 0.04), but not associated with MASLD or fibrosis. BMI and triglycerides were the strongest predictors of both MASLD and fibrosis. Conclusions: MASLD and risk of significant fibrosis were highest among T2DM patients. Within T2DM, those with MASLD had higher LSM, indicating increased risk of fibrosis. The presence of MASLD and risk of significant fibrosis was not associated with cIMT in this cardiometabolic cohort. BMI and plasma TG were consistent predictors across groups urging for more strict control by body weight reduction and lifestyle interventions. Full article

We describe a case of an asymptomatic 70-year-old female patient on whom a carotid ultrasound examination was performed that showed intima–media thickening and a 4 mm long carotid web with a 50% web-to-bulb ratio. Spectral Doppler waveform demonstrated a turbulent flow pattern and a peak systolic velocity increase of 100% (velocity ratio = 2) when compared with the common carotid artery. Therefore, the patient seemed to be at risk of stroke, and antiaggregant treatment was suggested. Full article

Carotid artery intima–media thickness (cIMT), a pre-clinical vascular change that accompanies atherosclerosis is considered as a cardiovascular risk factor. Coagulation factor XIII (FXIII) stabilizes the fibrin clot and increases its resistance to fibrinolysis. Regarding FXIII Val34Leu polymorphism, the protective effect of the Leu34 allele in the presence of elevated fibrinogen levels against myocardial infarction was demonstrated. Our aim was to investigate the effect of FXIII polymorphisms on cIMT. Patients with obesity (n = 69), type 2 diabetes mellitus (T2DM) (n = 104), and age- and sex-matched healthy controls (n = 82) were enrolled. FXIII polymorphisms (Val34Leu, His95Arg, Intron-K C>G) were determined by RT-PCR with FRET detection and melting curve analysis. cIMT was determined by B-mode ultrasound. Differences in cIMT between control (median: 0.5965, IQR: 0.5115–0.6580 mm) and T2DM (median: 0.7105, IQR: 0.5948–0.7568 mm), as well as between obese (median: 0.6105, IQR: 0.5455–0.6780 mm) and diabetic groups, were found (p < 0.0001 and p = 0.003, respectively). Genotype and allele frequencies of the studied polymorphisms did not differ between subgroups. In the study group (n = 255) after adjustment for age and sex, the presence of Intron-K G allele showed a significant and independent protective effect against cIMT progression in a separate model (p = 0.005) and after adjusting for other parameters associated with cIMT (p = 0.015). FXIII Intron-K G allele provides a protective effect against subclinical vascular disease in the studied population, and this effect is independent of the presence of obesity, as well as T2DM, Leu34 allele, and fibrinogen levels. Full article

Introduction: Long COVID (LC) is associated with an increase in cardiovascular risk and chronic inflammation, whereas the Mediterranean Diet (MD) seems to improve the aforementioned factors. The aim of this study is to analyse the relationship between MD and its components with vascular structure, function, and aging in patients diagnosed with LC globally and by sex. Methods: This study was a cross-sectional study with 304 subjects diagnosed with LC; 207 were women and 97 men. Adherence to MD was evaluated with a validated MEDAS questionnaire, composed of 14 items. The vascular structure was assessed using carotid intima-media thickness (cIMT). Three measurements were carried out to evaluate vascular function: cardio-ankle vascular index (CAVI), brachial-ankle pulse wave velocity (baPWV), and carotid-femoral pulse wave velocity (cfPWV). Vascular aging index (VAI) was estimated. Results: The MD score was 7.80 ± 2.33, with no difference between sexes. Vascular function and aging parameter values were higher in men than in women. Use of olive oil as the principal source of fat for cooking, and consuming <1 serving of butter/day and <1 sugar-sweetened beverage/day showed >90% adherence. Logistic regression analysis displayed associations between cIMT < 0.625 and use of olive oil in the global analysis (OR = 0.148) and among men (OR = 0.120), and <2 commercial pastries/week in global (OR = 0.536). cfPWV < 7.400 m/s was associated with DM score ≥ 8 in global (OR = 0.444) and in women, as well as with <2 pastries/week in women (OR = 0.405). baPWV < 12.315 m/s was associated with ≥3 servings of pulses/week in global (OR = 0.481) and among women, as was <2 pastries/week in global (OR = 0.471) and in women. CAVI < 7.450 was associated with ≥4 tablespoons of olive oil/day in men. VAI < 63.693 was associated with DM score ≥ 8 in global (OR = 0.458) and in women, as well as <2 pastries/week in global (OR = 0.392). Conclusions: Adherence to MD was associated with lower cfPWV and VAI measures in the global analysis and among women. In particular, several of the components were associated with a better vascular profile in LC patients. Full article

Background: Cardiovascular disease (CVD) is a major complication of systemic lupus erythematosus (SLE). This study compared several CV risk scores in Korean female patients with SLE and searched for an association with subclinical atherosclerosis and lipid metabolism. Methods: Female SLE patients and healthy controls (HCs) underwent carotid ultrasonography and pulse wave velocity (PWV), and serum efflux cholesterol capacity was measured. The Framingham risk scores (FRSs), American College of Cardiology/American Heart Association (ACC/AHA) scores, and Korean Risk Prediction Model (KRPM) scores were calculated. Results: While carotid intima-media thickness (IMT) and the prevalence of carotid plaque did not differ between 67 SLE patients and 37 HCs, carotid plaque scores were higher in SLE patients compared with HCs. While the FRS and the ACC/AHA CV risk scores did not differ, the KRPM scores were higher in SLE patients. The carotid IMT, plaque score, and PWV were correlated with the FRS, ACC/AHA CV risk, and KRPM score in SLE patients. SLE patients with carotid plaque had higher FRS, ACC/AHA CV risk, and KRPM scores than those without carotid plaque. In addition, the serum cholesterol efflux capacity did not differ between SLE patients with and without carotid plaque but was correlated with carotid IMT. Conclusions: The scores obtained from the CV risk-prediction models were correlated with subclinical atherosclerosis in SLE. A cardiovascular risk assessment tool developed specifically for Koreans is suitable for evaluating the CV risk in Korean SLE patients. Full article

Background: Cardiovascular disease (CVD) is the leading cause of mortality in chronic kidney disease (CKD), driven by mechanisms distinct from the general population. Fibroblast Growth Factor 23 (FGF-23), a phosphaturic hormone elevated early in CKD, has been mechanistically linked to left ventricular hypertrophy, vascular dysfunction, and disordered mineral metabolism. This study examines the associations between FGF-23 and key renal, mineral, and cardiovascular parameters and its utility in risk stratification. Methods: We conducted a cross-sectional study of 60 adults with CKD stages 1–5. Serum FGF-23 was quantified using ELISA, alongside measures of iPTH, phosphorus, calcium, and eGFR (Estimated Glomerular Filtration Rate). Cardiovascular evaluation included transthoracic echocardiography and carotid intima-media thickness (CIMT). Associations were analyzed using Spearman correlations, ROC analysis, and multivariable logistic regression. Results: FGF-23 levels were significantly associated with declining eGFR (r = –0.288; p < 0.05), elevated iPTH (Intact Parathyroid Hormone) (r = 0.361; p < 0.05), and serum phosphorus (r = 0.335; p < 0.05). Patients with structural cardiac abnormalities (left atrial enlargement or left ventricular hypertrophy) exhibited higher FGF-23 concentrations (154 vs. 128 pg/mL; p = 0.027). FGF-23 alone predicted high cardiovascular risk with moderate accuracy (AUC 0.70; sensitivity 76%; specificity 67%). A composite model including iPTH and eGFR improved discriminatory power (AUC 0.76). Conclusions: FGF-23 correlates with subclinical cardiovascular remodeling and key mineral abnormalities in CKD. Its integration with iPTH and eGFR enhances cardiovascular risk stratification, supporting its potential as a multidimensional biomarker in early CKD. However, the cross-sectional design and modest correlation strengths limit causal inference and generalizability of the findings. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is prevalent in adolescents with obesity and is linked to insulin resistance and cardiovascular disease (CVD). Pancreas steatosis might be associated with MASLD and early CVD. Imaging-based analyses of these associations have not been studied extensively in children. Objectives: To assess the reproducibility of liver and pancreatic steatosis and volume measurement on MRI in adolescents with obesity and MASLD and their association with homeostatic model assessment of insulin resistance (HOMA-IR) and subclinical vascular changes on ultrasound. Methods: This is an observational study on adolescents with MASLD and obesity. Hepatic and pancreatic steatosis, volume, and abdominal fat were assessed using magnetic resonance spectroscopy and proton density fat fraction. Reproducibility of these measurements was performed. Vascular markers included non-invasive vascular elastography (NIVE), carotid artery intima-media thickness (IMT), and pericardial fat thickness. Fasting blood tests measured the HOMA-IR. Bivariate correlation and simple linear regression were performed using SPSS. Results: We obtained 23 participants aged 12 to 17 years (78.3% male). Measurements were reproducible [ICC 0.807–0.998]. Liver steatosis was positively correlated with HOMA-IR (p = 0.015). Pancreas steatosis was positively correlated with HOMA-IR (p = 0.02), IMT/diameter (p = 0.002), and pericardial fat (p = 0.03). Liver steatosis was not significantly correlated with pancreas steatosis nor vascular markers. There were negative associations between NIVE metrics and visceral abdominal fat (p = 0.009) and intraperitoneal fat (p = 0.047). Conclusions: Liver and pancreas steatosis measurements on MRI are reproducible. In this exploratory study, adolescents with obesity and MASLD, pancreas steatosis, and pancreas volume show association with subclinical CVD markers. Visceral and intraperitoneal abdominal fat show association with increased vascular stiffness, suggesting a potential role of imaging-based cardiovascular risk assessment in this population if validated. These preliminary findings require validation in larger, diverse prospective cohorts. Full article

Background: Carotid intima-media thickness (CIMT) is an established risk factor for adverse cardiovascular events in the general population, but its impact on patients after heart transplantation (HTX) remains unknown. We investigated the effects of an increased pre-transplant CIMT > 0.9 mm on outcomes after HTX. Methods: This observational retrospective single-center study included 311 patients receiving HTX at Heidelberg Heart Center between 2002 and 2014. Patients were stratified by degree of pre-transplant CIMT (CIMT ≤ or >0.9 mm, threshold defined by ESC guidelines). Analysis covered donor and recipient demographics, post-transplant medications, mortality (including causes of death after HTX), early post-transplant atrial fibrillation (AF), and stroke after HTX. Results: A total of 37 of 311 HTX recipients (11.9%) had a pre-transplant CIMT > 0.9 mm. These patients showed an increased 10-year post-transplant mortality (81.1% versus 41.2%, p < 0.001) and had a higher percentage of death due to graft failure (24.3% versus 10.6%, p = 0.017), as well as due to thromboembolic events/bleeding (10.8% versus 2.9%, p = 0.019). Multivariate analysis demonstrated pre-transplant CIMT > 0.9 mm as an independent risk factor for 10-year mortality after HTX (HR: 2.599, 95% CI: 1.683–4.014, p < 0.001). Secondary outcomes showed a significantly higher rate of 30-day post-transplant AF (27.0% versus 10.9%, p = 0.006) and 30-day stroke after HTX (10.8% versus 1.1%, p < 0.001) in patients with a pre-transplant CIMT > 0.9 mm. Conclusion: Pre-transplant CIMT > 0.9 mm is a prognostic marker for early post-transplant AF, stroke, and reduced long-term survival after HTX. Preventive measures, including close monitoring and management of cardiovascular risk factors, are warranted in these high-risk patients. Full article

There are many contradictory opinions, and the role of TGF-β1 in the vascular effects of atherosclerosis remains unclear. This study aims to verify whether plasma TGF-β1 concentrations are correlated with changes in echocardiographic and vascular parameters in individuals with early coronary artery disease (CAD), including those with type 2 diabetes mellitus (T2DM). The study group consisted of 100 patients with early-onset CAD. Patients underwent echocardiography and electrocardiography. The thickness of the internal and middle membrane complex of the carotid and brachial arteries, the ankle-brachial index, and the atherosclerotic plaques present were assessed via Doppler ultrasound. No statistically significant correlation of TGF-β1 with diabetes, hypertension, metabolic syndrome, or myocardial infarction was observed, only weak associations with impaired ventricular function. The positive correlations between right and left ventricular parameters and TGF-β1 level, as well as the negative correlations fractional shortening and deceleration time, were found. The last correlation was strong. There is a strong positive correlation between TGF-β1 and QRS II width and QRS V5 width. The positive correlation was found between TGF-β1 and PLA density and thickness of the intima-media. These associations are very weak. In patients with early-onset CAD, high TGF-β1 concentrations are not associated with heart attacks or the associated risk factors. However, these cases are potentially those with stable plaques. Our study indicates a significant association between TGF-β1 levels and left ventricular diastolic dysfunction and arrhythmia risk in these patients. Full article

Background: Multiple sclerosis (MS) is an immune-mediated neuroinflammatory disorder with a multifactorial etiology involving genetic susceptibility, environmental triggers, and vascular contributions. Carotid intima–media thickness (CIMT) is a significant marker of endothelial dysfunction. Endothelial cell-specific molecule-1 (endocan) and hyaluronic acid, key components implicated in endothelial and vascular remodeling, may significantly contribute to the inflammatory and vascular pathologies observed in MS. We aimed to investigate the relationship between CIMT and endothelial biomarkers, such as endocan and hyaluronic acid, in patients with MS. Methods: In this cross-sectional study, 100 patients with relapsing–remitting MS and 56 healthy controls were included. Demographic, clinical, laboratory, and imaging data were documented. CIMT was measured bilaterally using high-resolution B-mode ultrasonography. Serum endocan and hyaluronic acid levels were quantified via enzyme-linked immunosorbent assays. Results: MS patients exhibited significantly higher CIMT and serum endocan levels compared with controls (p < 0.001). CIMT values were significantly elevated in MS patients, with longer disease duration, higher expanded disability status scale scores, and an older diagnosis age (p < 0.05). However, serum endocan and hyaluronic acid levels did not significantly differ between MS subgroups based on disease duration, disability severity, and diagnosis age. Additionally, there was no correlation between CIMT and serum endocan and hyaluronic acid levels in MS patients (p > 0.05). Conclusions: Increased CIMT and serum endocan levels in MS patients may indicate endothelial dysfunction suggesting vascular involvement in MS. The lack of a correlation between CIMT and endocan and hyaluronic acid levels reveals the complexity of vascular and immune interactions in MS, which needs further research. Full article

Background: Atherosclerosis is a chronic inflammatory condition that underlies both cardiovascular and cerebrovascular complications. Emerging evidence suggests that COVID-19 may play a role in its progression. Purpose: The aim of the study was to evaluate the potential impact of SARS-CoV-2 infection on the development of atherosclerosis. Patients and Methods: Common carotid artery (CCA) intima media thickness (IMT) was measured by ultrasonography twice, 12–18 months apart, in a cohort of 92 patients (47 with COVID-19 and 45 controls). Clinical data were collected from medical histories, physical examinations, and laboratory findings. Results: Baseline IMT values were comparable between the study groups (0.85 mm vs. 0.78 mm). However, the COVID-19 group exhibited a significantly greater increase in IMT over time, with a median change of 0.13 mm compared to 0.05 mm in the controls (p = 0.018). Furthermore, 69.2% of COVID-19 patients exceeded the median IMT progression threshold compared to 36% in the control group (p = 0.017). An elevated level of C-reactive protein (CRP) and a higher triglyceride (Tg)-to-High-Density Lipoprotein Cholesterol (HDL) ratio were significantly associated with increased IMT in the COVID-19 group. Age and heart rate were identified as significant predictors of IMT progression across both groups. Conclusions: COVID-19 may accelerate the progression of subclinical atherosclerosis. The strong associations of CRP and the TG/HDL ratio with IMT highlight the potential roles of chronic inflammation and metabolic dysregulation in driving these vascular changes. Further large-scale, multicenter studies are needed to elucidate the underlying mechanisms, confirm these observations, and guide targeted preventive and therapeutic strategies for individuals with an increased cardiovascular and cerebrovascular risk. Full article

Background: Fetuin-A, a hepatokine implicated in metabolic regulation, has been associated with both metabolic syndrome and cardiovascular disease. However, its specific role in type 2 diabetes mellitus (T2DM) remains incompletely understood. Objective: This study aimed to investigate the relationship between fetuin-A levels and key components of metabolic syndrome (abdominal obesity, arterial hypertension, hyperglycemia, hypertriglyceridemia and low high-density lipoprotein cholesterol) as well as other cardiovascular risk markers, including metabolic dysfunction-associated fatty liver disease (MAFLD), carotid intima-media thickness (CIMT), and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Methods: A total of 51 patients with T2DM not receiving insulin therapy were enrolled. Participants underwent clinical, biochemical, and imaging evaluations. Hepatic steatosis was assessed via abdominal ultrasonography, and subclinical atherosclerosis was evaluated using CIMT measured with Doppler ultrasonography. Serum fetuin-A was quantified by ELISA. Results: Hepatic steatosis was significantly associated with metabolic syndrome, increased CIMT, and dyslipidemia (elevated total cholesterol, triglycerides, and reduced HDL cholesterol). Although no direct correlation was found between fetuin-A levels and hepatic steatosis, multivariate analysis revealed that fetuin-A concentrations were significantly influenced by total cholesterol and LDL cholesterol levels. Conclusions: Fetuin-A appears to be linked to lipid abnormalities in T2DM and may contribute to cardiovascular risk in this population. These findings support the potential utility of fetuin-A as a biomarker and possible therapeutic target for dyslipidemia management in diabetic patients. Full article

For nearly 30 years, a chronic disease causing severe chronic subcutaneous edema of unknown etiology has been affecting cattle in the Central–Northern and Central–Southern mesoregions of the State of Bahia, Brazil. In this research we investigated 15 outbreaks of the disease, from October 2023 to April 2025, to determine its etiopathogenesis, epidemiology, clinical signs, and pathology. The disease occurs during the dry season in areas of native forest. It is characterized by chronic subcutaneous edema, especially in the regions of the head, dewlap, chest, and thoracic limbs, and by hydropericardium, hydrothorax, ascites, and right ventricular dilation. Marked hypertrophy of smooth muscle cells in the tunica media of arteries and arterioles, sometimes with an eccentric, irregular, and asymmetric arrangement, were the main histologic lesions observed. The thicknesses of the media of pulmonary and heart arteries and arterioles of 10 affected cattle were significantly thicker than those from 10 control cattle. The tunica adventitia was thickened with increased deposition of collagen, and the intima was hyperplasic. The aorta and carotid arteries showed multifocal smooth muscle cell proliferation in the tunica media. It is concluded that the disease is due to right heart failure due to pulmonary arterial hypertension (chronic cor pulmonale). Epidemiological data and inspections of affected pastures suggest that the disease is caused by a toxic plant. Full article