Search Results (1,082)

Sulfamethoxazole (SMX), a commonly used sulfonamide antibiotic, poses a threat to aquatic life due to its widespread presence in the environment. This study aims to investigate the specific effects of SMX on the development of marine medaka (Oryzias melastigma) embryos and larvae. Marine medaka embryos were exposed to SMX at concentrations of 0 (solvent control group, SC group), 1 μg/L (low concentration group, L group), 60 μg/L (middle concentration group, M group), and 1000 μg/L (high concentration group, H group). The results indicated that SMX exposure significantly accelerated the heart rate of embryos (p < 0.0001) and shortened the hatching time while also causing anomalies such as reduced pigmentation, smaller eye size, spinal curvature, and yolk sac edema. SMX also led to a decrease in the total length of the larvae. The M group and the H group exhibited a significant increase (p < 0.05) in lipid accumulation in the visceral mass of the larvae. In the L group and the M group, there was a significant increase (p < 0.0001) in the swimming distance of the larvae. At the molecular level, SMX exposure affected the transcript levels of the genes involved in the cardiovascular system (ahrra, arnt2, atp2a1, and cacan1da), antioxidant and inflammatory systems (cat, cox-1, gpx, pparα, pparβ, and pparγ), nervous system (gap43, gfap, α-tubulin), intestinal barrier function (claudin-1), detoxification enzymes (ugt2c1-like), and lipid metabolism (rxraa) in the embryos to larval stage. The microbiome analysis showed that at the phylum level, exposure to SMX resulted in an increase in the abundance of Proteobacteria. Additionally, the abundance of Actinobacteriota significantly increased in the L group (p < 0.05). At the genus level, the abundance of Bifidobacterium significantly increased in the L group (p < 0.05), while the abundance of Vibrio significantly increased in the H group (p < 0.05). The alpha diversity analysis revealed a significant decrease in the Chao1 index in the L and H groups, indicating a reduction in microbial richness. The beta diversity analysis showed differences in the microbial communities of marine medaka larvae among different SMX exposure groups. This study elucidates the negative impacts of SMX on the development of marine medaka embryos and larvae and their microbial composition, providing a scientific basis for assessing the risks of SMX in marine ecosystems. Full article

Background/Objectives: Chlorella and Spirulina supplementation may reduce the risk of cardiometabolic diseases by better controlling blood cholesterol, triglycerides, glucose, weight, and blood pressure (BP). However, the available studies are limited in size and have used different outcomes. Methods: To gain power in assessing the impact of microalgae supplements on cardiovascular risk factors, we searched PubMed on 3 February 2023 for randomised controlled trials assessing the effects of Chlorella and Spirulina on modifiable cardiovascular risk factors. Results: We found 12 studies in Chlorella and 9 studies on Spirulina. Depending on the available outcomes, varying numbers of participants (Chlorella: 168 to 279; Spirulina: 101 to 299) were included. Our analysis showed that Chlorella supplementation had a neutral effect on BP and lipemia. On the other hand, Spirulina intake led to a significant reduction in diastolic BP (−0.42, 95% CI: −0.81 to −0.02, p = 0.04) but did not significantly affect lipemia indexes, despite a trend toward a reduction in total cholesterol (−0.17, 95% CI: −0.39 to 0.06, p = 0.15). This meta-analysis suggests Spirulina supplementation can be used as an adjuvant to control cardiometabolic risk factors, particularly for BP. However, the magnitude of this effect is small and of uncertain clinical significance. Conclusions: Further randomised trials are needed to better assess the potential of these supplements as adjuvants for the control of cardiovascular risk factors. Full article

Low-dose oral minoxidil (LDOM) has emerged as a widely used off-label treatment for different types of alopecia, showing a favorable safety profile and effectiveness. Despite its growing use, it is essential to understand the possible associated adverse events (AEs) and their appropriate management to optimize this therapy. The aim of this article was to comprehensively review the AEs of LDOM treatment, describing their frequency, risk factors, affected anatomical sites, and management strategies. A search in the PubMed and EMBASE databases was performed for studies published before 31 December 2024, reporting the treatment of any type of hair loss with oral minoxidil. The most frequent AE is hypertrichosis, occurring in approximately 15% of patients, with a higher incidence in women and patients with higher doses. Fluid retention affects 1.3–10% of patients, particularly women, and typically occurs within 1–3 months of treatment. Other cardiovascular AEs, such as tachycardia or dizziness, occur in fewer than 5% of cases and are usually mild and transient. Severe AEs, including pericardial effusion, are extremely rare and often linked to compounding errors comprising an excessive dose. Management strategies include dose reduction, pharmacological interventions like diuretics for edema, and lifestyle measures such as sodium restriction. In most cases, AEs resolve without the need for treatment discontinuation. The favorable safety profile of LDOM makes it a valuable therapeutic option for alopecia, though careful patient selection, dose titration, and monitoring are essential to minimize risks. Full article

Background/Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is a progressive genetic disorder marked by bilateral renal cysts and extrarenal manifestations, ultimately resulting in renal failure. Emerging research indicates that metformin might influence the intracellular mechanisms of ADPKD, though its clinical significance remains uncertain. Methods: We applied the Taiwan National Health Insurance Database (NHIRD) to investigate the clinical impact of metformin utilization in ADPKD patients in real-world practice. The metformin user group was defined by more than 90 days of usage. To mitigate selection bias, we established a non-user group with a 1:2 ratio, matching for age, sex, and comorbidities by a propensity score matching method. Results: A total of 10,222 ADPKD cases were identified in the NHIRD between 2009 and 2018. After matching, the metformin user group was composed of 778 cases with a mean age of 59.5 ± 13.9 years, and the non-user group of 1546 cases with a mean age of 59.3 ± 14.4 years. The time from the index date to the outcome of ESKD in ADPKD was 5.3 ± 2.2 years in the metformin user group and 5.3 ± 2.3 years in the metformin non-user group, respectively. The metformin user group exhibited a significant reduction in the risk of end-stage kidney disease (ESKD), as indicated in the fully adjusted model (0.75, 95% CI 0.58–0.97, p = 0.03). A decreased risk of major adverse cardiovascular events (MACEs) was noted in metformin users, with an adjusted hazard ratio (HR) of 0.78 (95% CI 0.65–0.95, p = 0.01). Sensitivity analysis showed similar results by excluding late-stage CKD (CKD stage 5 or erythropoietin-stimulating agents use). Conclusions: Metformin usage in real-world practice showed lower hazards of ESKD and MACEs in patients with ADPKD, except for those with advanced CKD. Full article

Background: Metabolic syndrome (MS) is a cluster of cardiovascular and metabolic risk factors that increase the likelihood of both acute events and chronic conditions. While exercise has been shown to improve individual risk factors associated with MS; research on its effects on MS as an integrated condition remains limited. This study aims to evaluate the effectiveness of a 6-month Adapted Personalized Motor Activity (AMPA) program for improving the health outcomes of individuals with MS. Methods: Seventy-one sedentary participants with MS (mean age: 63 ± 9.4 years, 46.5% female) completed a 6-month intervention, incorporating moderate-intensity aerobic and resistance training. Each participant received a personalized exercise plan prescribed by a sports medicine physician. The training was monitored via telemetry to ensure safety. No dietary recommendations were provided during the intervention. Baseline and post-intervention assessments included Cardiopulmonary Exercise Testing (CPET), anthropometric measurements, blood pressure, heart rate, lipid profile (total cholesterol, HDL, LDL, and triglycerides), fasting glucose, and HbA1c. Results: Significant improvements were observed in fasting glucose (−10.6%, p < 0.001), HbA1c (−3.88%, p < 0.001), HDL cholesterol (+20.8%, p < 0.001), LDL cholesterol (−25.1%, p < 0.001), and VO₂max (+8.6%, p < 0.001). Systolic and diastolic blood pressure also decreased significantly, with reductions of −12% (p < 0.001) and −5.9% (p < 0.001), respectively. Reductions in weight and waist circumference were statistically significant but modest and clinically irrelevant, showing no correlation with improvements in cardio-metabolic parameters. Logistic regression and correlation matrix analyses were performed to identify key predictors of changes in individual risk factors. Conclusions: While personalized exercise alone may not fully control individual risk factors of metabolic syndrome, its overall effect is comparable to low-intensity pharmacological polytherapy with minimal adverse effects. These benefits appear to be independent of dietary habits, gender, and both baseline and post-intervention physical performance and anthropometric measures. Full article

Metabolic syndrome (MetS) constitutes a spectrum of interconnected conditions comprising obesity, dyslipidemia, hypertension, and insulin resistance (IR). While a singular, all-encompassing treatment for MetS remains elusive, an integrative approach involving tailored lifestyle modifications and emerging functional food therapies holds promise in preventing its multifaceted manifestations. Our main objective was to scrutinize the efficacy of cranberry proanthocyanidins (PAC, 200 mg/kg/day for 12 weeks) in mitigating MetS pathophysiology in male mice subjected to standard Chow or high-fat/high-fructose (HFHF) diets while unravelling intricate mechanisms. The administration of PAC, in conjunction with an HFHF diet, significantly averted obesity, evidenced by reductions in body weight, adiposity across various fat depots, and adipocyte hypertrophy. Similarly, PAC prevented HFHF-induced hyperglycemia and hyperinsulinemia while also lessening IR. Furthermore, PAC proved effective in alleviating key risk factors associated with cardiovascular diseases by diminishing plasma saturated fatty acids, as well as levels of triglycerides, cholesterol, and non-HDL-C levels. The rise in adiponectin and drop in circulating levels of inflammatory markers showcased PAC’s protective role against inflammation. To better clarify the mechanisms behind PAC actions, gut–liver axis parameters were examined, showing significant enhancements in gut microbiota composition, microbiota-derived metabolites, and marked reductions in intestinal and hepatic inflammation, liver steatosis, and key biomarkers associated with endoplasmic reticulum (ER) stress and lipid metabolism. This study enhances our understanding of the complex mechanisms underlying the development of MetS and provides valuable insights into how PAC may alleviate cardiometabolic dysfunction in HFHF mice. Full article

Objective: Homoarginine is a cationic amino acid derived from lysine. Evidence indicates that low-circulating homoarginine concentration is a risk factor for cardiovascular disease and all-cause mortality. A reduction in homoarginine concentrations has been observed in patients with ischemic heart disease, ischemic stroke, ischemic heart disease, and heart failure. The SYNTAX score (SS), an angiographic scoring system, defines the grade and complexity of coronary artery disease (CAD). The objective of this study was to evaluate the relationship between homoarginine level and the severity of CAD according to the SYNTAX score in patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 67 subjects were enrolled into the study with the diagnosis of STEMI of those who underwent coronary angiography. STEMI patients were divided into two groups: low-medium SYNTAX score ≤ 14 (35 patients) and high SYNTAX score > 14 (32 patients). Results: Within the high SS group, serum homoarginine levels were markedly lower (2 ± 0.9 vs. 1.3 ± 0.7; p = 0.001). Homoarginine levels and SS showed a significant negative correlation in entire study cohort In multivariate regression analysis, serum homoarginine levels along with serum urea levels were significantly associated with having higher SS (OR 1.073 p = 0.049 and OR 0.346, p = 0.012, respectively). Conclusions: In conclusion, the diminished plasma homoarginine level emerges as an independent predictor of high atherosclerotic burden among STEMI patients. To the best of our knowledge, this is the first study to demonstrate the relationship between homoarginine and coronary artery complexity. Full article

Background: The REGUEIFA registry aims to assess the contemporary treatment of patients with atrial fibrillation (AF) in the community health area of Galicia. Due to the prognostic relevance of anticoagulation status, we used it to differentiate patients by adding a category to the stroke domain of the 4S-AF score. Methods: A Cox proportional hazards analysis was used to identify the prognostic value of the modified 4S-AF score regarding mortality, cardiovascular mortality, and thromboembolic events. For bleeding events, we used a Poisson regression model to account for recurrent events. Results: When considering the stroke risk domain as a categorical variable, the risk stratification for all-cause mortality improved by more than 2 times (stroke risk: 2 vs. 1; hazard ratio (HR): 2.17; 95% confidence interval (CI): 1.03–4.55), p = 0.04). According to the Poisson regression model, the stroke risk domain was also an independent factor for hemorrhagic events (HR: 2.83; 95% CI 1.69–4.74, p < 0.001). For patients with permanent AF, the mortality rate was more than 2 times higher than that of patients with paroxysmal AF or their first episode of AF (HR: 2.53; 95% CI; 1.53–4.18); p < 0.001. Anticoagulation therapy was the only independent domain treatment associated with a reduction in all-cause mortality (HR: 0.41; 95% CI 0.19–0.89 p < 0.0023). Conclusions: The modification of the stroke risk score to reflect anticoagulation status may improve the characterization and stratification of overall mortality risk, as demonstrated in the contemporary AF cohort from the REGUEIFA study. The permanent form of AF was associated with a higher risk of overall mortality and cardiovascular mortality. Full article

Background/Objectives: Hypercholesterolemia is commonly viewed as a risk factor for coronary heart disease; however, several studies have reported an inverse relationship between cholesterol levels and cardiovascular mortality, particularly in older adults. This “cholesterol paradox” challenges the conventional understanding of lipid metabolism. Despite often being dismissed as a result of reverse causality, the precise causes of this paradox remain poorly understood. This study aimed to investigate the potential existence of the cholesterol paradox in a long-lived population from central Sardinia, Italy. Methods: We recruited 168 baseline nonagenarians (81 males, 87 females) from the longevity Blue Zone area in 2018 and followed them until December 2024. The lipid profile was determined for all participants according to current guidelines, and its impact on survival was analyzed with Kaplan–Meier curves and Cox proportional hazards regression models. Results: The median total cholesterol was 199.5 (range 89–314) mg/dL in males and 202.5 (range 89–324) mg/dL in females. Survival time was significantly longer in participants with LDL cholesterol (LDL-C) above 130 mg/dL compared to that in nonagenarians with LDL-C lower than 130 mg/dL (3.82 ± 1.88 years vs. 2.79 ± 1.56 years, p < 0.0001). Cox regression analysis revealed a significant reduction in the hazard ratio (HR) for mortality in participants with mild hypercholesterolemia (LDL-C ≥ 130 mg/dL) compared to that in those with normal cholesterol (OR 0.600, 95%CI 0.405–0.891). Conclusions: In the long-lived population examined, the cholesterol paradox was unlikely to be a reflection of reverse causality. Our results challenge the common view that longevity is invariably associated with low cholesterol levels. Furthermore, moderate hypercholesterolemia does not preclude the oldest adult from attaining advanced ages, contrary to common belief. Full article

Cardiovascular involvement in patients with human immune deficiency (HIV) has gained significant attention as the improved life expectancy of individuals with HIV has changed the paradigm regarding the long-term impact of the virus on cardiovascular health. We reviewed current literature on the prevalence, diagnosis, and unique characteristics of cardiovascular disease (CVD) in HIV patients, including those treated with protease inhibitors (PIs) and complementary therapies. The incidence of infectious, immunosuppressive, and nutritionally related pathologies in HIV patients has declined, largely due to advancements in highly active antiretroviral therapies (HAART) and supportive care. However, issues related to autoimmunity and chronic inflammation persist. Elevated levels of high-sensitivity C-reactive protein, along with activated cytokines and other pro-inflammatory molecules, are common in HIV patients and contribute significantly to the increased risk for endothelial dysfunction, coagulation disorders, and accelerated atherogenesis. The advent of HAART has significantly improved the prognosis for HIV patients, leading to prolonged life expectancy and a reduction in AIDS-related complications. However, this success has also resulted in a shift in the clinical presentation, with HIV patients showing more chronic and insidious cardiovascular manifestations. Full article

The aim was to determine the influence of a complex intervention based on pharmacotherapeutic follow-up (PTF) and the application of therapeutic education (TE) protocols on the clinical and educational parameters of patients at cardiovascular risk (CVR) attending community pharmacies (CPs). A prospective, longitudinal, randomized, controlled clinical trial was conducted over 6 months in patients from four Spanish CPs, divided into control (CG) and intervention (IG) groups. CG patients received usual pharmacy care and IG patients received a PTF- and TE-based intervention. The sample consisted of 85 elderly patients. After pharmaceutical follow-up of the IG patients, the following results were observed: significant reductions in cardiovascular risk (CVR) (p < 0.005), blood pressure (BP) (p < 0.05), and sedentary lifestyle (p < 0.001), as well as an improved knowledge of CVR and cardiovascular risk factors (CVRFs) (p < 0.001). Target values for BP were achieved in 27.2% of patients and for triglycerides in 12.4% of patients. The PTF of the patients showed that 29.2% did not have the expected response to some treatments, while 25% had untreated pathologies and 10% had adverse reactions. The TE protocols related to the patients’ educational needs, applied individually and in conjunction with the PTF, were able to improve their lifestyle habits, their knowledge of CVR, CVRFs, and pharmacotherapy, and their clinical parameters, and, thus, the level of development of their disease Full article

Overweight patients with cardiovascular disease (CVD) tend to survive longer than normal-weight patients, a phenomenon known as the “obesity paradox”. The phenotypic characteristics of adipose distribution in these patients (who survive longer) often reveal a larger proportion of subcutaneous white adipose tissue (scWAT), suggesting that the presence of scWAT is negatively associated with all-cause mortality and that scWAT appears to provide protective benefits in patients facing unhealthy states. Exercise-mediated browning is a crucial aspect of the benign remodeling process of adipose tissue (AT). Reduced accumulation, reduced inflammation, and associated adipokine secretion are directly related to the reduction in CVD mortality. This paper summarized the pathogenetic factors associated with AT accumulation in patients with CVD and analyzed the possible role and pathway of exercise-mediated adipose browning in reducing the risk of CVD and CVD-related mortality. It is suggested that exercise-mediated browning may provide a new perspective on the “obesity paradox”; that is, overweight CVD patients who have more scWAT may gain greater cardiovascular health benefits through exercise. Full article

Smoking is one of the strongest modifiable risk factors for coronary artery disease. It is the cause of approximately 10–30% of deaths due to cardiovascular disease around the world. There is a 50% reduction in the risk of myocardial infarction by one year for people who successfully quit smoking. Considering the risk associated with smoking and the benefits of smoking cessation, it is important to identify and implement effective smoking cessation strategies. There are pharmacological as well as non-pharmacological interventions to assist in smoking cessation. Pharmacological therapies including nicotine replacement therapy; bupropion and varenicline have generally been studied more in patients with cardiovascular disease than the non-pharmacological interventions. Non-pharmacological strategies for smoking cessation include behavioural interventions such as counselling sessions and cognitive behavioural therapy. Studies and randomised controlled trials have demonstrated the safety of most of the pharmacological interventions. Nonetheless, the success rates are variable for the different pharmacological options. Data suggest that greater success can be achieved in smoking cessation with a combination of pharmacological and non-pharmacological treatment. However, more studies are needed to explore the best therapeutic options to improve the success of smoking cessation. Full article

Environmental particulate pollution is a major global environmental health risk factor, which is associated with numerous adverse health outcomes, negatively impacting public health in many countries, including China. Despite the implementation of strict air quality management policies in China and a significant reduction in PM_2.5 concentrations in recent years, the health burden caused by PM_2.5 pollution has not decreased as expected. Therefore, a comprehensive analysis of the health burden caused by PM_2.5 is necessary for more effective air quality management. This study makes an innovative contribution by integrating the Enhanced Vegetation Index (EVI), Normalized Difference Vegetation Index (NDVI), and Soil-Adjusted Vegetation Index (SAVI), providing a comprehensive framework to assess the health impacts of green space coverage, promoting healthy urban environments and sustainable development. Using Nanjing, China, as a case study, we constructed a health impact assessment system based on PM_2.5 concentrations and quantitatively analyzed the spatiotemporal evolution of premature deaths caused by PM_2.5 from 2000 to 2020. Using Multiscale Geographically Weighted Regression (MGWR), we explored the impact of greening improvement on premature deaths attributed to PM_2.5 and proposed relevant sustainable governance strategies. The results showed that (1) premature deaths caused by PM_2.5 in Nanjing could be divided into two stages: 2000–2015 and 2015–2020. During the second stage, deaths due to respiratory and cardiovascular diseases decreased by 3105 and 1714, respectively. (2) The spatial variation process was slow, with the overall evolution direction predominantly from the southeast to northwest, and the spatial distribution center gradually shifted southward. On a global scale, the Moran’s I index increased from 0.247251 and 0.240792 in 2000 to 0.472201 and 0.468193 in 2020. The hotspot analysis revealed that high–high correlations slowly gathered toward central Nanjing, while the proportion of cold spots increased. (3) The MGWR results indicated a significant negative correlation between changes in green spaces and PM_2.5-related premature deaths, especially in densely vegetated areas. This study comprehensively considered the spatiotemporal changes in PM_2.5-related premature deaths and examined the health benefits of green space improvement, providing valuable references for promoting healthy and sustainable urban environmental governance and air quality management. Full article

Background: Penetrating aortic ulcer (PAU) is an acute aortic syndrome characterized by a high rupture risk. There are several PAU-treatment procedures indicated for the management of this pathology associated with different effects on vessel morphology and hemodynamics. A deep evaluation of the different types of treatment may be helpful in decision making. Computational Fluid Dynamics (CFD) is a powerful tool for detailed inspection of cardiovascular diseases. The aim of this work was to implement a comparative analysis based on CFD evaluation of the effects of two type of PAU treatments. Methods: Thoracic endovascular aortic repair (TEVAR) with a left subclavian artery (LSA) branched aortic endograft (SBSG) and a hybrid approach including TEVAR and carotid-LSA bypass were considered. Aortic anatomical models were created from computed tomography (CT) images acquired before and after PAU treatment with SBSG for three patients. Starting from these models, a new aortic geometry corresponding to the outcome of the hybrid strategy was generated. Morphological analysis and CFD simulations were carried out for all aortic models to evaluate LSA outflow for the same predefined boundary conditions. Results: Reductions in LSA diameter were found between aortic models before and after the SBSG (18.2%, 20.8%, and 12.4% for CASE 1, CASE 2, and CASE 3, respectively). The flow rate at LSA changed between pre-configuration and aortic configuration after the PAU treatments: an averaged decrement of 1.08% and 7.5% was found for SBSG and the hybrid approach, respectively. The larger increase in pressure drop between the aortic arch and the LSA extremity was shown in the hybrid approach for all cases. Conclusions: CFD simulations suggest that SBSG preserves LSA perfusion more than a hybrid strategy and has less impact on thoracic aorta hemodynamics. Full article