Search Results (58)

Cardiovascular disease remains the leading global cause of mortality, with inflammation now recognized as a central driver of atherosclerosis and other cardiometabolic conditions. Recent advances have repositioned perivascular adipose tissue from a passive structural element to an active endocrine and immunomodulatory organ, now a key focus in cardiovascular and metabolic research. Among the most promising tools for assessing perivascular adipose tissue inflammation is the fat attenuation index, a non-invasive imaging biomarker derived from coronary computed tomography angiography. This review explores the translational potential of the fat attenuation index for cardiovascular risk stratification and treatment monitoring in both coronary artery disease and systemic inflammatory or metabolic conditions (psoriasis, systemic lupus erythematosus, inflammatory bowel disease, obesity, type 2 diabetes, and non-obstructive coronary syndromes). We summarize evidence linking perivascular adipose tissue dysfunction to vascular inflammation and adverse cardiovascular outcomes. Clinical studies reviewing the fat attenuation index highlight its ability to detect subclinical inflammation and monitor treatment response. As research advances, standardization of measurement protocols and imaging thresholds will be essential for routine clinical implementation. Full article

Background: Coronary artery disease (CAD) is a leading global cause of mortality. The role of calcium (Ca), a key metabolic and structural element, in atherosclerosis and inflammation remains unclear. Ca influences immune cell function and is a component of atherosclerotic plaques. Hair analysis reflects long-term mineral exposure and may serve as a non-invasive biomarker. Objectives: This pilot study aimed to investigate the association between hair Ca levels and acute coronary syndrome (ACS), and to evaluate correlations with the Systemic Inflammatory Index (SII), Systemic Inflammatory Response Index (SIRI), and selected CAD risk factors. Methods: Ca levels were measured in hair samples from patients undergoing coronary angiography for suspected myocardial infarction. Associations with ACS diagnosis, Syntax score, SII, SIRI, and CVD risk factors were analyzed. Results: Serum calcium levels were not significantly associated with the presence of acute coronary syndrome (ACS) (p = 0.392) or with its clinical subtypes, including ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA) (p = 0.225). Diagnosis of ACS was linked to higher SII (p = 0.028) but not SIRI (p = 0.779). Ca levels correlated negatively with Syntax score (R = −0.19, p = 0.035) and SII (R = −0.22, p = 0.021) and positively with HDL-C (R = 0.18, p = 0.046). Conclusions: Hair calcium content may reflect subclinical inflammation and CAD severity. Although no direct link to ACS was observed, the associations with SII, HDL-C, and Syntax score suggest a potential diagnostic role which should be further explored in larger, well-controlled studies. Full article

Background and Objectives: This study investigated the frequency and clinical significance of subclinical but substantial peripheral arterial disease (PAD), identified using PAD evaluation, including pulse volume recording/ankle–brachial index (PVR/ABI), transcutaneous oxygen pressure (TcpO2), and skin perfusion pressure (SPP) tests in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Materials and Methods: This study included 54 patients with PAD evaluation results at or after AAV diagnosis. PVR/ABI and/or TcpO2 and/or SPP were performed on the same day. Abnormal PVR/ABI, TcpO2, and SPP were defined as PVR/ABI < 0.97, TcpO2 < 40 mmHg, and SPP < 50 mmHg, respectively. Poor outcomes included all-cause mortality, end-stage kidney disease (ESKD), cerebrovascular accidents, and acute coronary syndrome after PAD evaluation. Results: The median age of the 54 patients was 67 years, and 48.1% were male. In total, 3 of 54 patients (5.6%), 6 of 16 (37.5%), and 6 of 23 (26.1%) had abnormal PVR/ABI, TcpO2, and SPP, respectively. The concordance rate between abnormal PVR/ABI and abnormal TcpO2 or SPP was very low. Among the 54 patients, 5 (9.3%) died, and 2 (3.7%) progressed to ESKD. Abnormal SPP was significantly associated with cutaneous and renal manifestations at the time of PAD evaluation and had the potential to predict progression to ESKD during follow-up in patients with AAV. Conclusions: This study is the first to reveal the clinical usefulness of PAD evaluation: abnormal SPP may have the potential to identify subclinical but substantial PAD and can predict simultaneous kidney involvement as well as future progression to ESKD in patients with AAV. Full article

Background/Objectives: Estrogen deficiency is strongly related to osteoporosis, but its role in the development of atherosclerotic cardiovascular disease (CVD), particularly in postmenopausal women, is unclear. The aim of this study was to assess the relationship between osteopenia and subclinical atherosclerosis in asymptomatic non-diabetic postmenopausal women. Methods: This prospective study included 117 consecutive postmenopausal women (mean age 59 ± 7 years) referred from the outpatient Rheumatology Clinic of the University Clinical Centre of Kosovo, recruited between September 2021 and December 2022. Clinical, biochemical, bone mineral density (BMD), carotid ultrasound and coronary CT angiography data were analyzed. Subclinical atherosclerosis was diagnosed as the presence of carotid plaques and/or increased intima-media thickness (CIMT) > 1.0 mm. Results: Of the 117 studied women, 83 (71%) had osteopenia or osteoporosis (T-score < −1 SD), who had higher prevalence of carotid artery plaques (27.7 vs. 8.8%, p = 0.019), compared to those with normal BMD. They were, also, older (p < 0.001), had a longer duration of menopause (p = 0.004) and higher CAC scores (p < 0.019), compared to those without plaques. In multivariate analysis [odds ratio 95% confidence interval], age [1.244 (1.052–1.470), p = 0.001], osteoporosis [0.197 (0.048–0.806), p = 0.024] and CAC score > 10 HU [0.174 (0.058–0.806), p = 0.006] were independently associated with the presence of carotid plaques. Conclusions: Reduced BMD is highly prevalent in asymptomatic non-diabetic postmenopausal women and is associated with a high prevalence of subclinical carotid atherosclerosis. Age, osteoporosis and CAC score > 10 HU were independently associated with atherosclerotic carotid plaque formation. These findings highlight the potential pathophysiological link between osteoporosis and subclinical atherosclerosis. Full article

Cardiovascular disease remains the leading cause of morbidity and mortality worldwide, especially in regions like Eastern Europe, South Asia, and Latin America. A significant portion of these cases (80%) is linked to atherosclerosis, which can lead to severe conditions like ischemic heart disease and stroke, with atherosclerosis (ATS) responsible for the majority of cases. This review explores the multifaceted relationship between insulin resistance (IR) and ATS, highlighting their roles as both independent and interrelated contributors to cardiovascular risk. ATS is characterized by lipid accumulation and chronic inflammation within arterial walls, driven by factors such as hypertension, dyslipidemia, and genetic predisposition, with endothelial dysfunction as a key early event. The early detection of subclinical ATS is critical and can be achieved through a combination of non-invasive imaging techniques—such as coronary artery calcium scoring and carotid ultrasound—and comprehensive risk profiling. IR, marked by impaired glucose uptake in liver, muscle, and adipose tissue, often precedes early diabetes and is associated with metabolic disturbances, including dyslipidemia and chronic inflammation. The diagnosis of IR relies on surrogate indices such as HOMA-IR, the QUICKI, and the TyG index, which facilitate screening in clinical practice. Compelling evidence indicates that IR independently predicts the progression of atherosclerotic plaques, even in non-diabetic individuals, and operates through both traditional risk factors and direct vascular effects. Understanding and targeting the IR–ATS axis is essential for the effective prevention and management of cardiovascular disease. Full article

People with HIV (PWH) have an increased risk of developing cardiovascular disease (CVD). Our recent data demonstrated that the multi-isoform proinflammatory cytokine IL-32 is upregulated in PWH and is associated with arterial stiffness and subclinical atherosclerosis. However, the mechanisms by which IL-32 contributes to the pathogenesis of these diseases remain unclear. Here, we show that while the less expressed IL-32α isoform induces the differentiation of human classical monocytes into the calcium-resorbing osteoclast cells, the dominantly expressed isoforms IL-32β and IL-32γ suppress this function through the inhibition of TGF-β and induce the differentiation of monocytes into the calcium-depositing osteocalcin+ osteoblasts. These results aligned with the increase in plasma levels of osteoprotegerin, a biomarker of vascular calcification, and its association with the presence of coronary artery subclinical atherosclerosis and calcium score in PWH. These findings support a novel role for the proinflammatory cytokine IL-32 in the pathophysiology of CVD by increasing vascular calcification in PWH. Full article

Background/Objectives: This study investigates the association between mild first-wave COVID-19 infection and subclinical abnormalities in echocardiographic strain parameters and myocardial perfusion using single-photon emission computed tomography (SPECT). Methods: We conducted a retrospective analysis of patients from June 2020 to March 2021 with a history of mild first-wave COVID-19 infection, presenting with nonspecific cardiac symptoms and referred for SPECT myocardial perfusion stress testing. Patients had no obstructive coronary artery disease (CAD) on follow-up invasive angiography or cardiac computed tomography angiography (CCTA) and had transthoracic echocardiographic images of sufficient quality for strain analysis using AutoSTRAIN (TOMTEC^®). Results: Fifteen patients met the inclusion criteria. SPECT and echocardiography were reviewed for perfusion and strain defects, respectively, in the inferior, anterior, lateral, and septal myocardial segments. All patients had at least one perfusion abnormality on SPECT: 2/15 (13%) had a fixed defect in one segment, 3/15 (20%) in two, 3/15 (20%) in three, and 7/15 (47%) in four. While 13/15 (87%) patients had normal qualitative findings on traditional echocardiography, 12/15 (80%) had abnormal global longitudinal strain (GLS) (>−18%) and transregional wall strain abnormality in at least one segment. Abnormalities on SPECT and strain echocardiography demonstrated a moderate but significant 60% concordance, with an intraclass correlation coefficient (ICC) of 0.486 (p = 0.028). Conclusions: Patients with ‘mild’ COVID-19 infection demonstrated a high frequency of abnormalities on SPECT myocardial perfusion imaging (even in the absence of obstructive CAD) which appeared to be concordant with abnormal strain parameters on echocardiography, suggesting possible subclinical effects on myocardial tissue. Full article

Background/Objectives: Familial Mediterranean fever (FMF) is a chronic autoinflammatory disease. Throughout the disease, subclinical inflammation persists into the remission period. It is known that chronic inflammation causes endothelial dysfunction and, as a consequence, arterial stiffness occurs. In this study, carotid and aortic intima–media thicknesses (IMT) and arterial stiffness were measured in FMF patients to evaluate the risk of possible vascular damage due to chronic inflammation. Methods: The study included pediatric patients with FMF who had been in remission for a minimum of 3 months. Carotid and aortic IMT and arterial stiffness measurements were conducted using sonoelastography. The acute-phase reactants were also evaluated in all participants. Results: Carotid artery stiffness measurements by strain elastography were significantly higher in the patient group than in the control group. However, the aortic and carotid IMT were similar between the two groups. The acute-phase reactants were significantly higher in the patient group than in the control group. Conclusions: This study demonstrated that arterial stiffness increased in pediatric FMF patients. According to the results of the present study, the effects of chronic inflammation on arterial tissues may lead to atherosclerotic changes in the later stages of the disease and may pose a risk for coronary diseases. Arterial ultrasonographic and elastographic measurements to be performed periodically in children with FMF are noninvasive methods that can be used to evaluate the course of endothelial damage. We aimed to show that arterial stiffness may be a marker of early cardiovascular disease. Full article

Cardiovascular diseases (CVDs) are one of the most critical public health problems in the contemporary world because they are the leading cause of morbidity and mortality. Diabetes mellitus (DM) is one of the most substantial risk factors for developing CVDs. Glycated hemoglobin is a product of the non-enzymatic glycation of hemoglobin present in erythrocytes. The determination of the percentage of glycated hemoglobin (HbA1c) is commonly used in clinical practice to assess glycemic control in patients diagnosed with DM. This method is much more informative than repeated blood glucose tests, because the HbA1c value reflects the degree of glycemic control over the last three months. It is, therefore, not surprising that the HbA1c value correlates with the presence and severity of diabetes complications, including CVDs, in the population of diabetic patients. The purpose of this publication was to present the results of a literature review on the relationship between the HbA1c value in people without DM, the presence and severity of subclinical cardiovascular dysfunction, and the presence of clinically overt CVDs. The most important tools used to assess subclinical cardiovascular dysfunction included the measurement of intima-media thickness (IMT), especially carotid IMT (cIMT), arterial stiffness assessment by the measurement of pulse wave velocity (PWV), and ankle–brachial index (ABI). According to the results of the studies cited in this literature review, it can be concluded that there are certain relationships between HbA1c, the presence and severity of subclinical cardiovascular dysfunction, and the presence of clinically overt CVDs such as coronary heart disease, cerebrovascular disease, and chronic lower extremity ischemia in non-diabetic patients. It is worth noting, however, that the results of studies conducted so far in this area are not fully unambiguous. Further studies are needed to better understand the influence of additional factors on the relationship between HbA1c and cardiovascular dysfunction in non-diabetic patients. Full article

Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide despite significant improvements in diagnostic modalities. Emerging evidence suggests that erythrocytes, or red blood cells (RBCs), are one of the most important contributors to the events implicated in atherosclerosis, although the molecular mechanisms behind it are under investigation. We used NMR-based lipidomic technology to investigate the RBC lipidome in patients with CHD compared to those with normal coronary arteries (NCAs), all angiographically documented, and its correlation with coronary artery stenosis. Targeted and untargeted lipidomic analysis revealed that CHD patients presented significant lipid alterations in the RBC membrane, characterized by higher cholesterol, sphingolipids, saturated and monounsaturated fatty acids, lower phospholipids (glycerophospholipids and ether glycerolipids), and unsaturated and polyunsaturated fatty acids. These aberrations gradually distinguish the three subgroups of patients with mild, moderate, and severe coronary stenosis, potentially indicating their non-negligible involvement in the onset and progression of atherosclerosis. The comprehensive analysis of RBC-membrane-derived lipids with omics approaches could unravel specific lipid abnormalities taking place at the silent subclinical stage of atherosclerosis and could have the potential to identify patients with subtle, but still proatherogenic, abnormalities that may confer a higher risk for the development of CHD. Full article

Despite increased availability of effective drug therapy for treatment of heart failure (HF), the morbidity and mortality in chronic heart failure (CHF) are unacceptably high. Therefore, there is an urgent need to ascertain new imaging techniques to identify early sub-clinical forms of cardiac dysfunctions, to guide early relevant treatment. It seems that all the behavioral risk factors—such as tobacco, alcoholism, Western-type diet, sedentary behavior and obesity, emotional disorders, and sleep disorder are associated with early cardiac dysfunction, which may be identified by speckle-tracking echocardiography (STE). Cardiac remodeling can also occur chronologically in association with biological risk factors of CHF, such as diabetes mellitus (DM), hypertension, cardiomyopathy, valvular heart disease, and coronary artery disease (CAD). In these conditions, twisting and untwisting of the heart, cardiac fibrosis, and hypertrophy can be identified early and accurately with 2-Dimentional (2D) and 3D echocardiography (2D echo and 3D echo) with tissue Doppler imaging (TDI), strain imaging via STE, and cardiac magnetic resonance imaging (CMR). Both 2D and 3D echo with STE are also useful in the identification of myocardial damage during chemotherapy and in the presence of risk factors. It is possible that global longitudinal systolic strain (GLS) obtained by STE may be an accurate marker for early identification of the severity of CAD in patients with non-ST segment elevation MI. Left ventricular ejection fraction (LVEF) is not the constant indicator of HF and it is normal in early cardiac dysfunction. In conclusion, this review suggests that GLS can be a useful early diagnostic marker of early or pre-cardiac dysfunction which may be treated by suitable drug therapy of HF along with the causes of HF and adhere to prevention strategies for recurrence. In addition, STE may be a superior clinical tool in the identification of cardiac dysfunction in its early stages compared to ejection fraction (EF) based on conventional echocardiography. Therefore, it is suggested that the chances of either stalling or reversing HF are far better for patients who are identified at an early stage of the disease. Full article

Polycystic Ovarian Syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, with significant variations in presentation characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Beyond reproductive health, it may also pose crucial long-term cardiometabolic risks, especially for women with specific types of PCOS, contributing to early subclinical cardiovascular atherosclerotic alterations such as endothelial dysfunction, increased arterial stiffness, and coronary artery calcium levels, respectively. Moreover, the precise relationship between clinical cardiovascular disease (CVD) and PCOS remains debated, with studies demonstrating an elevated risk while others report no significant association. This review investigates the pathophysiology of PCOS, focusing on insulin resistance and its link to subclinical and clinical cardiovascular disease. Diagnostic challenges and novel management strategies, including lifestyle interventions, medications like metformin and glucagon-like peptide-1 receptor agonists (GLP-1RAs), hormonal contraceptives, and bariatric surgery, are further discussed. Recognizing the cardiometabolic risks associated with PCOS, a comprehensive approach and early intervention should address both the reproductive and cardiometabolic dimensions of the syndrome. Full article

(1) Background: Atherosclerosis is a leading cause of vascular death worldwide. High urinary phosphate has recently been identified as a cardiovascular risk factor, but its role has not been fully established. The aim of this study was to investigate the association between urinary phosphate and subclinical atherosclerosis in the carotid, femoral as well as coronary territories; (2) Methods: We performed a cross-sectional analysis of a sample of 1169 middle-aged men, aged 50.9 years (SD 3.7), without previous cardiovascular disease, belonging to the Aragon Workers Health Study (AWHS). Urinary phosphate was analyzed in urine samples using the Fiske-Subbarow method. The presence of carotid plaque and femoral plaque was assessed by ultrasound and coronary artery calcium score (CACS) by computed tomography. Demographic, anthropometric and clinical data were collected at annual medical examinations. Logistic regression models were used to estimate the prevalence of adjusted atherosclerosis in the different vascular arteries; (3) Results: A significant inverse association was observed between urinary phosphate and subclinical atherosclerosis in the carotid [OR 95% CI 0.69 (0.49–0.99)] and coronary (CACS > 200) [OR 95% CI 0.46 (0.23–0.88)] arteries; however, no statistically significant association was found between urinary phosphate and the presence of atheroma plaques in the femoral territory [OR 1.02 (0.72–1.45)]; (4) Conclusions: In middle-aged men, a higher urinary phosphate concentration is associated with a lower prevalence of subclinical carotid and coronary atherosclerosis compared with those with a lower urinary phosphate concentration. Full article

Objective: The coronary artery calcium score (CACS) is used as a screening tool to identify the presence/absence of subclinical atherosclerosis in asymptomatic individuals. We evaluated the risk categories and medical therapy of asymptomatic individuals with subclinical atherosclerosis (CACS > 0) and applied the atherosclerotic cardiovascular disease (ASCVD) score and Framingham risk score (FRS) to assess those at a high risk of subclinical atherosclerosis (CACS ≥ 400). Methods: We retrospectively enrolled 218 asymptomatic individuals (65.6% women, and mean age 67.5 ± 10.3 years) who had their CACS evaluated at the cardiovascular department of our hospital between 2016 and 2020. Results: Among the 218 participants, 24.3% were classified as low-risk according to the FRS, and 19.3% had no subclinical atherosclerosis. However, only 12.8% and 27.5% of the study population were taking statins and aspirin, respectively. Furthermore, although more than half of the individuals without subclinical atherosclerosis were in the intermediate- and high-risk groups according to the risk scores, there were no considerable differences in the rates of taking aspirin and statins between the groups. When patients in the very-high-risk group according to the CACS and low-intermediate-risk patients were compared, there was no considerable difference in the rates of risk subgroups and taking statins, whereas high-risk patients took statistically significantly more aspirin. Conclusions: In primary prevention screening, CACS can be used as a reliable marker of subclinical ASCVD and help physicians optimize and improve adherence to medical therapy, including aspirin and statins, particularly for high-risk individuals. Full article

The early diagnosis and appropriate treatment of subclinical atherosclerosis before the onset of life-threatening cardiovascular (CV) diseases are major unmet medical needs in current clinical practice. Noninvasive arterial stiffness indices, the arterial velocity–pulse index (AVI) and the arterial pressure–volume index (API) have been associated with CV risks, conventional arterial stiffness indices, and the severity of coronary atherosclerosis. However, few studies have examined the relationship between these indices and the occurrence of CV events. We measured the AVI and API in 113 consecutive patients admitted to Yokohama City University Hospital for cardiac catheterization between June 2015 and March 2016. Patients were followed until September 2022, and the occurrence of CV events was assessed. The mean age was 71.2 ± 10.7 years, and 83 patients (73.5%) were male. In total, 80 patients (70.8%) had hypertension, 87 (77.0%) had dyslipidemia, and 91 (80.5%) had a history of ischemic heart disease (IHD). The mean follow-up duration was 1752 ± 819 days. Patients who received elective percutaneous coronary intervention (PCI) based on the results of coronary angiography (CAG) at the time of enrollment had significantly higher API than those who did not (38.5 ± 12.6, n = 17 vs. 31.3 ± 7.4, n = 96, p = 0.001). The API was independently associated with the risk of elective PCI in multiple logistic regression analysis. In conclusion, the API could be a useful indicator for estimating the need for coronary interventional treatment in patients with a high CV risk. Full article