Peripheral Artery Disease (PAD) is a chronic condition that requires prolonged and consistent management. Failure to recognize the necessity for prolonged treatment and care may result in a lack of acceptance of the disease, feelings of hopelessness, and a lack of emphasis on healthy living, which can lead to an unmanageable disease, serious complications, increased care costs, elevated mortality, and morbidity rates. The objective of this study is to examine the relationships between healthy lifestyle behaviors (HLBs), hopelessness, and illness acceptance levels among individuals diagnosed with lower extremity PAD and related factors.

This analytical cross-sectional study was conducted with 87 patients diagnosed with lower extremity PAD who were hospitalized for a surgical procedure in the cardiovascular surgery clinic of a university hospital. The data were collected using the Patient Information Form, the Healthy Lifestyle Behaviors Scale (HLBS)-II, the Beck Hopelessness Scale (BHS), and the Illness Acceptance Scale (IAS). The analysis was conducted using the IBM SPSS Statistics software (version 25; IBM Corp., New York, NY).

The mean total scores from HLBS, BHS, and IAS for the patients were found to be 124.17, 12.57, and 24.40, respectively. Patients with a secondary or higher education level who also had a family history of cardiovascular disease exhibited higher scores on the HLBS. Conversely, patients whose family situations and social lives were affected by the disease demonstrated lower scores on the IAS. Patients who evaluated their physical and mental health as good exhibited higher scores on the IAS. Patients with a primary school or lower education who also lacked social support related to the disease processes demonstrated higher scores on the BHS. A weak negative correlation was identified between hopelessness and the level of illness acceptance.

This study highlights that the adoption of HLBs and the acceptance of the disease among patients diagnosed with PAD remain suboptimal. In addition, the study reveals that the level of hopelessness among these patients is significantly elevated. It can be inferred that there is a strong correlation between the level of hopelessness and the acceptance of the disease. The findings of this study may inform the design of awareness training programs for the management of the disease, the development of HLBs, and the enhancement of illness acceptance and hopelessness levels among individuals diagnosed with PAD in Turkey.

Aortofemoral or aortoiliac bypasses (AFBs/AIBs) are considered the gold standard treatment for patients with aortoiliac occlusive disease. Myocardial infarction (MI) is a postoperative risk in AFB/AIB surgeries and preoperative stress test (PST) is frequently utilized to inform operative planning and preoperative risk discussions. The aim of this study is to assess the utility of PST in determining outcomes following AFB/AIB in patients with chronic limb-threatening ischemia (CLTI).

This is a retrospective study from Vascular Quality Initiative database. Patients undergoing AFB/AIB for chronic limb-threatening ischemia during 2009-2023 were stratified by PST result. Primary outcomes included postoperative MI and 30-day mortality. Secondary outcomes included in-hospital death, in-hospital death/MI, postoperative respiratory complications, postoperative congestive heart failure, intensive care unit stay > 3 days, and 1-year mortality. Logistic and Cox regressions were used for multivariate analyses.

The study included 2 cohorts of patients: negative (N = 1,809, 81.2%) and positive PST (N = 420, 18.8%). The patients with positive PST had increased rate of postoperative MI compared to the patients with negative PST (6.7% vs. 2.9%, P < 0.001). The rate of 30-day mortality was greater for patients with positive PST but the difference was not significant (3.8% vs. 2.9%, P = 0.315). After adjusting for potential confounders, positive PST was associated with increased risk of postoperative MI (adjusted odds ratio = 1.89 [95% confidence interval: 1.04-3.43], P = 0.038). However, positive PST was not associated with 30-day mortality. Pulmonary complications, congestive heart failure, and intensive care unit stay >3 days were also not associated with PST result. The overall survival rate at 1-year was 93.3% and 92.0% for patients with negative and positive PSTs (P = 0.343), respectively. After adjusting for potential confounders, postoperative MI was associated with increased hazards of death at 1 year (adjusted hazard ratio = 3.62 [95% confidence interval: 2.21-5.92], P < 0.001).

This study emphasizes the important of appropriate preoperative planning. A positive stress test before open aortic reconstruction for aortoiliac occlusive disease is associated with increased risk of postoperative MI. Although this was neither associated with increased risk of 30-day nor 1-year mortality, the negative impact of MI on patient functionality, quality of life, and 1-year death cannot be ignored.

A New Ultra-Low Pulse width 355 nm Solid-State Laser Shows Superior Performance to 308 nm Lasers in Preclinical Trials. Real-world statistics, however, are currently scarce. The purpose of this study is to assess the CLA-355 nm laser system's clinical safety and feasibility in human trials.

This study is a prospective, non-randomized, first-in-human trial. The main inclusion criterion was patients with peripheral artery disease (PAD), and the main exclusion criterion was the presence of vascular grafts in the target vessel. Enrolled patients received treatment with the 355 nm Laser Plaque Ablation System (Shenzhen Vivolight, China) in combination with a drug-coated balloon (Endovastec, China) during hospitalization. Efficacy was assessed by the improvement in the percent diameter stenosis (DS) of the target vessel after laser ablation. The primary endpoint was the 6-month primary patency, while secondary endpoints included 6-month clinically driven target lesion revascularization (CD-TLR), amputation, and death. Safety endpoints included device-oriented clinical events (MoCEs) and major adverse cardiovascular events.

Nine patients (10 limbs affected) were enrolled in this study; their average age was 69.55 ± 7.99 years, and 44.44% of the patients were male. The femoral artery contained 60% of the lesions, 70% of which were eccentric, and the average lesion length was 49.13 ± 53.87 mm. Chronic occlusive lesions accounted for 40% of lesions. One patient had vascular lesions that were extensively calcified, and the other patient had an aneurysm. Thrombosis and ulcerative lesions were absent from every lesion. Prior to the treatment, the minimal vessel diameter was 0.53 ± 0.68 mm, and the DS was 88.09 ± 15.26%. The reference vessel had a diameter of 4.22 ± 0.69 mm. The residual stenosis after laser atherectomy was 47.94 ± 16.78%, with a minimum lumen diameter of 2.26 ± 0.75 mm. Following the procedure, after subsequent DCB angioplasty, the DS was reduced to 26.07 ± 6.411% with a minimal vessel diameter of 3.00 ± 0.54 mm. During the perioperative phase, there were no MoCEs (distal embolization, perforation, acute occlusion, vasospasm, or intravascular thrombosis). 90% of patients remained patent after six months, and CD-TLR was 100% free. None of the patients experienced MACEs, amputations, or any other problems.

This is the first exploratory study on treating PAD in people using the CLA-355 nm laser plaque ablation device. According to preliminary findings, this device exhibits good safety and feasibility in plaque ablation.

Sepsis is common, deadly, and exacerbated by comorbid conditions. Atherosclerotic cardiovascular disease (ASCVD), including coronary artery disease (CAD) and peripheral artery disease (PAD), are risk factors for sepsis with minimal data on the association between PAD and outcomes. We aimed to evaluate the prevalence of ASCVD and the association between ASCVD and in-patient mortality and limb outcomes among sepsis hospitalizations.

We generated ASCVD prevalence estimates among survey-weighted adult sepsis hospitalizations within the National Inpatient Sample (2016-2020). We included hospitalizations with a primary diagnosis of sepsis and excluded non-adult patients (<18 years), and those with missing outcome (i.e., in-hospital mortality) and demographic (i.e., age, sex, race/ethnicity) data. Associations between ASCVD and in-hospital mortality and major or transmetatarsal amputation among sepsis hospitalizations were evaluated using Cox regression, adjusting for demographics (age, sex, race/ethnicity, income) and comorbidities (diabetes mellitus, end-stage renal disease, cerebrovascular disease, hypertension). Subgroup analyses were conducted to assess moderation of the association between ASCVD and outcomes by antithrombotic therapy.

Of 174,776,160 estimated hospitalizations (age mean±standard error 50±0.2 years, 44% male, 65% White), 5.5% (5.5-5.6%) had a primary diagnosis of sepsis (age 69±0.1, 51% male, 70% White); of which, 9.5% (9.3-9.6%) had a secondary diagnosis of PAD (age 73±0.05, 58% male, 73% White). PAD was associated with 18% higher adjusted risk of in-hospital mortality (95%CI 1.17-1.20) and 4.36 times the risk of major or transmetatarsal amputation (95%CI 4.18-4.56). Sepsis hospitalizations with joint ASCVD had the highest risk of in-hospital mortality (adjusted hazard ratio (aHR): 1.34; 95%CI 1.31-1.36) compared to those with CAD alone (aHR: 1.25; 95%CI 1.24-1.27) or PAD alone (aHR: 1.23; 95%CI 1.21-1.26). Yet sepsis hospitalizations with PAD had higher risk of in-hospital major or transmetatarsal amputation (aHR: 5.03; 95%CI 4.76-5.32) compared to those with joint ASCVD (aHR: 3.89; 95%CI 3.66-4.14), while CAD was expectedly not associated with amputation (aHR: 1.05; 95%CI 0.999-1.1). Subgroup analyses revealed significant interactions between ASCVD and antithrombotic therapy, such that among those taking antithrombic therapy, the associations between ASCVD and in-hospital mortality (p<0.001) and amputation (p<0.05) were smaller when compared to the associations examined in the whole sample.

Sepsis and ASCVD are common and associated with a higher risk of adverse outcomes. PAD diagnosis occurred among 9.5% of sepsis hospitalizations and, mirroring CAD, increased the risk of in-hospital mortality by ∼25%. Expectedly, PAD was associated with a higher risk of in-hospital amputation. Antithrombotic therapies, a staple of ASCVD medical optimization, reduced the risk of in-hospital amputation and mortality among patients with PAD hospitalized for sepsis. Medical optimization may improve outcomes in patients with sepsis and ASCVD.

Peripheral arterial disease (PAD) is a consequence of systemic atherosclerosis, resulting in arterial narrowing and diminished blood flow, leading to complications like claudication, rest pain, ulcers, gangrene, and functional limitations. Despite its impact on cardiovascular mortality, physical function, and quality of life, PAD has received less attention than other atherosclerotic disorders. This study addresses the paucity of comprehensive clinical data on PAD in Taiwan, aiming to analyze its incidence, risk factors, pharmacological and interventional treatments, and outcomes.

This prospective, multicenter, observational registry includes PAD patients from 10 medical centers or teaching hospitals across Taiwan. Data collected encompass demographic characteristics, medical history, laboratory results, and treatment history. Patients are followed up annually to monitor all-cause mortality, major clinical events (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke), and total cardiovascular events (including hard events, unplanned revascularizations, hospitalizations for endovascular therapy, stroke, transient ischemic attacks, and heart failure).

From September 2020 to December 2022, 1005 patients were enrolled. The mean age of the cohort was 70.3 years, with men constituting the majority (59.3%). The prevalence rates of key medical conditions were 68.2% for diabetes, 76.3% for hypertension, 72.6% for hypercholesterolemia, 40.6% for smoking, and 26.2% for end-stage renal disease. Central Taiwan patients were younger and had a higher body mass index (BMI) and prevalence of obesity, but lower rates of comorbidities such as hypertension, diabetes, and smoking history. In contrast, eastern Taiwan patients who were older had a lower BMI and prevalence of obesity, but exhibited higher levels of comorbidity.

The TwPAD registry provides comprehensive insights into patient characteristics, treatments, and outcomes. Regional variations in age, BMI, and comorbidity levels were noted between central and eastern Taiwan. Importantly, the registry identified gaps in adherence to guideline-directed medical therapy, particularly in statin use. Continued data collection will support improvements in PAD management nationwide.

First-pass stress perfusion cardiovascular magnetic resonance (CMR) imaging is the guidelines-recommended non-invasive test for the detection of obstructive coronary artery disease (CAD). Recently developed quantitative perfusion CMR (QP CMR) allows quantification of myocardial blood flow. Moreover, the latest developments established several methods of CAD assessment without the need for a contrast agent, including stress T1 mapping reactivity (∆T1) and oxygenation-sensitive CMR (OS-CMR). These methods might eliminate the need for contrast administration in clinical practice, reducing time, invasiveness, and costs, thereby simplifying the evaluation of patients with suspected obstructive CAD. The ADVOCATE-CMR study aims to validate QP CMR, ∆T1 and OS-CMR imaging against invasive fractional flow reserve (FFR) for the detection of obstructive CAD. The study also aims to head-to-head compare the diagnostic accuracy of these CMR techniques with the conventional visual assessment of stress perfusion CMR and to correlate them to short- and long-term clinical outcomes.

ADVOCATE-CMR is a single-center, observational, prospective, cross-sectional cohort study. The study will enroll 182 symptomatic patients with suspected obstructive CAD scheduled for invasive coronary angiography (ICA). Before ICA, all participants will undergo CMR imaging including OS-CMR with breathing maneuvers, rest and adenosine stress T1 mapping and rest and adenosine stress first-pass perfusion. Subsequently, ICA will be performed including FFR, instantaneous wave-free ratio (iFR), resting Pd/Pa, coronary flow reserve (CFR) and index of microvascular resistance (IMR) measurements in all main coronary arteries. A follow-up CMR scan with the same protocol will be performed at 3 months after ICA. Clinical follow-up will be performed at 3, 6 months, 1 and 3 years after ICA.

The ADVOCATE-CMR will be the first study comprehensively evaluating and comparing head-to-head the diagnostic performance of a range of contrast- and non-contrast agent-based CMR imaging methods (including QP CMR, ∆T1 and OS-CMR) for the detection of FFR-defined obstructive CAD. We expect to establish a validated and time-efficient diagnostic workflow available to a wide range of general CMR services. Finally, these improvements may enable CMR to become an effective non-invasive, radiation-free gatekeeper for ICA in patients with suspected obstructive CAD, potentially without the need for a contrast agent.

Peripheral artery disease (PAD) has traditionally been identified as a male-dominant disease, however, current literature suggests that female patients may be at increased risk of adverse outcomes. Given key differences between sexes, we conducted a retrospective review to identify pre-surgery risk predictors that may increase morbidity within the female PAD population.

Data was extracted from the Vascular Quality Initiative database for patients who underwent supra- or infra-inguinal bypass surgery for PAD between 2009 and 2020. Binary logistic regression was used to assess for sex differences in risk predictors, drug administration characteristics, and post-operative outcomes; analysis was adjusted for potential covariates.

A total of 79,981 patients were included based on our eligibility criteria, 34% of which were female. Female patients typically presented at an older age, were more frequently hypertensive and diabetic, and were significantly less likely to be prescribed ACE-inhibitors, anticoagulants, and statin pre-operatively. Women had a significantly higher post-operative risk of all-cause morbidity (1.06 (1.03, 1.09);p=0.004), mortality (1.09 (1.05, 1.13);p<0.001), stroke (1.48 (1.35, 1.62);p<0.001), and major adverse cardiovascular events (1.19 (1.10, 1.28);p<0.001) when compared to male patients. No pre-operative statin use was a significantly greater predictor for all cause morbidity in women.

Following surgery for PAD, our results suggests that female patients have a significantly greater risk of adverse outcomes as compared to male patients. Reduced administration of key medication including statin and ACE-inhibitors along with a greater comorbidity burden in female patients may be major contributors to this greater morbidity risk.

One of the recognized effects of systematic physical activity is the improvement of physical fitness, with a negative correlation found between physical fitness and cardiovascular and cardiometabolic risk. The purpose of this study is to analyze the influence of single nucleotide polymorphisms (SNPs) of the adenylate cyclase 3 (ADCY3) gene on the effect of high-intensity interval training (HIIT) on blood lipids, and simultaneously screen out the genetic markers sensitive to HIIT in Chinese Han youth.

In the 12-week HIIT program, a total of 237 Chinese Han college students with non-regular exercise habits were recruited, and these volunteers participated in the training three times a week. Baseline and after the HIIT program, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured, respectively. DNA was extracted from the white blood cells of volunteers and genotyping was carried out. The PLINK v1.09 software was used to conduct quality control screening on the obtained SNPs, and a linear regression model was constructed to analyze the association between ADCY3 gene SNPs and the effect of HIIT on blood lipids. ANOVA multiple comparison (LSD) was performed to test the difference between groups (P < 0.05).

(1) Through the analysis of Illumina CGA chip scanning, a total of 22 SNPs of the ADCY3 gene were identified. Following rigorous quality control screening, 15 SNPs were included in the subsequent analysis. Notably, it was found that the rs2241759 locus is associated with the effect of HIIT on blood lipid profiles. (2) Among male volunteers, significant differences in the baseline HDL-C values were observed among the three genotypes at the rs2241759 locus of the ADCY3 gene (β =  - 0.019, P = 0.040). The baseline value for the GG genotype was higher than that AA/AG genotypes. (3) After HIIT, the total levels of TC and HDL-C in volunteers increased significantly (P < 0.05). In contrast, the total levels of TG and LDL-C decreased significantly (P < 0.05). Further statistical analysis categorized by gender revealed that, with the exception of TC values in men, significant changes were observed for TC, TG, HDL-C, and LDL-C across both genders (P < 0.05). (4) Compared to male volunteers with the GG genotype, male volunteers carrying the A allele exhibited a more pronounced change in TC values following training (β = 0.044, P = 0.038). (5) The rs2241759 locus demonstrated a significant association with the effect of HIIT on LDL-C (β =  - 0.065, P = 0.04363).

(1) The implementation of a 12-week HIIT regimen can significantly enhance the blood lipid status of college students. (2) The locus rs2241759 of the ADCY3 gene is significantly associated with the sensitivity of LDL-C to HIIT.

Coronary artery stenosis detection by invasive coronary angiography plays a pivotal role in computer-aided diagnosis and treatment. However, it faces the challenge of stenotic morphology confusion stemming from coronary-background similarity, varied morphology, and small-area stenoses. Furthermore, existing automated methods ignore long-temporal information mining. To address these limitations, this paper proposes a long-term temporal enhanced You Only Look Once (YOLO) method for automatic stenosis detection and assessment in invasive coronary angiography. Our approach integrates long-term temporal information and spatial information for stenosis detection with state-space models and YOLOv8. First, a spatial-aware backbone based on a dynamic Transformer and C2f Convolution of YOLOv8 combines the local and global feature extraction to distinguish the coronary regions from the background. Second, a spatial-temporal multi-level fusion neck integrates the long-term temporal and spatial features to handle varied stenotic morphology. Third, a detail-aware detection head leverages low-level information for accurate identification of small stenoses. Extensive experiments on 350 invasive coronary angiography (ICA) video sequences demonstrate the model's superior performance over seven state-of-the-art methods, particularly in detecting small stenoses (<50%), which were previously underexplored.

Ultrasound (US) imaging enables the evaluation of vascular structures in real time, and it can provide morphological and pathological information during US-guided procedures. Automatic prediction of vascular structure boundaries can help clinicians in locating and measuring target structures more accurately and efficiently. Most existing US segmentation methods use per-pixel classification or regression, which require post-processing to obtain contour coordinates. In this work, we present ACE-Net, a novel approach that directly predicts the contour coordinates for every scanning line (A-line) in US images. ACE-Net combines two main modules: a boundary regression module that predicts the upper and lower coordinates of the target area for each A-line, and an A-line classification module that determines whether an A-line belongs to the target area or not. We evaluated our method on three clinical US datasets using, among others, dice similarity coefficient (DSC) and inference time as performance metrics. Our method outperformed state-of-the-art segmentation methods in inference time while achieving superior or comparable performance in DSC. ACE-Net is publicly available at https://github.com/bfarolabarata/ace-net .

ST-segment elevation myocardial infarction (STEMI) is treated with immediate primary percutaneous coronary intervention (pPCI) to restore coronary blood flow in the acutely ischaemic territory, but is associated with reperfusion injury limiting the benefit of the therapy. No treatment has proven effective in reducing reperfusion injury. Transcoronary hypothermia has been tested in clinical studies and is well tolerated, but is generally established after crossing the occlusion with a guidewire therefore after initial reperfusion, which might have contributed to the neutral outcomes. Transcatheter strategies may also offer additional benefit through haemodilution and the resultant controlled reperfusion, but this has not been fully investigated for pPCI.

STEMI-Cool is a pragmatic, registry-based randomised clinical pilot trial to test the recruitment rate, feasibility, and safety of a simple transcoronary cooling and dilution protocol. Sixty STEMI patients undergoing pPCI will be randomised 1:1 to standard of care or continuous infusion of room temperature saline through the guiding catheter to achieve intracoronary temperature reductions of 6 to 8°C, commencing before crossing the coronary occlusion with a guidewire. Mechanistic outcome measures will include microvascular resistance, biomarkers of inflammation before infusion and at 24 hour, and magnetic resonance imaging of myocardial salvage and infarct size.

STEMI-Cool will investigate the recruitment rate, feasibility and safety of an innovative and simple cooling and diluting strategy for cardioprotection before and during reperfusion with pPCI, aiming to address limitations faced in other studies. Mechanistic outcome measures will allow insight into inflammatory, microvascular and structural changes induced by transcoronary cooling and dilution.

Cardio-cerebrovascular diseases (CCVDs) are the leading cause of global mortality, yet effective treatment options remain limited. Ferroptosis, a novel form of regulated cell death, has emerged as a critical player in various CCVDs, including atherosclerosis, myocardial infarction, ischemia-reperfusion injury, cardiomyopathy, and ischemic/hemorrhagic strokes. This review highlights the core mechanisms of ferroptosis, its pathological implications in CCVDs, and the therapeutic potential of targeting this process. Additionally, it explores the role of Chinese herbal medicines (CHMs) in mitigating ferroptosis, offering novel therapeutic strategies for CCVDs management. Ferroptosis is regulated by several key pathways. The GPX4-GSH-System Xc- axis is central to ferroptosis execution, involving GPX4 using GSH to neutralize lipid peroxides, with system Xc- being crucial for GSH synthesis. The NAD(P)H/FSP1/CoQ10 axis involves FSP1 regenerating CoQ10 via NAD(P)H, inhibiting lipid peroxidation independently of GPX4. Lipid peroxidation, driven by PUFAs and enzymes like ACSL4 and LPCAT3, and iron metabolism, regulated by proteins like TfR1 and ferritin, are also crucial for ferroptosis. Inhibiting ferroptosis shows promise in managing CCVDs. In atherosclerosis, ferroptosis inhibitors reduce iron accumulation and lipid peroxidation. In myocardial infarction, inhibitors protect cardiomyocytes by preserving GPX4 and SLC7A11 levels. In ischemia-reperfusion injury, targeting ferroptosis reduces myocardial and cerebral damage. In diabetic cardiomyopathy, Nrf2 activators alleviate oxidative stress and iron metabolism irregularities. CHMs offer natural compounds that mitigate ferroptosis. They possess antioxidant properties, chelate iron, and modulate signaling pathways like Nrf2 and AMPK. For example, Salvia miltiorrhiza and Astragalus membranaceus reduce oxidative stress, while some CHMs chelate iron, reducing its availability for ferroptosis. In conclusion, ferroptosis plays a pivotal role in CCVDs, and targeting it offers novel therapeutic avenues. CHMs show promise in reducing ferroptosis and improving patient outcomes. Future research should explore combination therapies and further elucidate the molecular interactions in ferroptosis.

Chronic inflammation and immune dysregulation are key drivers of diabetes complications. Rivaroxaban (RX) and sitagliptin (SITA) are established therapies for thromboembolism and glycemic control, respectively. This study evaluated the novel therapeutic potential of nano-rivaroxaban (NRX) alone and in combination with sitagliptin (SITA) in mitigating inflammation and restoring immune balance in streptozotocin (STZ)-induced diabetic rats.

Type 2 diabetes was induced in rats using a single injection of STZ (60 mg/kg). Animals were divided into five groups: control, STZ-diabetic, RX-treated (5 mg/kg), NRX-treated (5 mg/kg), and NRX+SITA-treated (5 mg/kg + 10 mg/kg). After 4 weeks of treatment, blood glucose, coagulation markers, pro-inflammatory cytokines (TNF-α, IL-1β, IL-6), and anti-inflammatory cytokines (IL-35, TGF-β1, IL-10) were analyzed. Histopathological examination of the liver, kidney, pancreas, and spleen was conducted. Immunohistochemistry was used to assess hepatic NF-κB expression.

STZ significantly elevated pro-inflammatory cytokines (IL-1β, TNF-α, IL-6) and anti-inflammatory cytokines (IL-35, TGF-β1, IL-10), along with increased hepatic NF-κB expression and histopathological abnormalities in immune organs. NRX significantly reduced inflammatory cytokines, improved histopathological changes in organs, and decreased hepatic NF-κB expression. The combination therapy (NRX + SITA) achieved superior immune modulation, with enhanced cytokine profile restoration, reduced hepatic NF-κB expression, and near-complete histopathological normalization.

This study underscores the promise of combining nanoparticle-based drug delivery with established therapies like sitagliptin to achieve superior immune modulation and inflammation control, presenting a potential therapeutic strategy for managing diabetes complications.

Background Coronary artery disease (CAD) is a major public health concern, yet reliable sources of relevant information are limited. TikTok, a popular social media platform in China, hosts diverse health-related videos, including those on CAD; however, their quality varies and is largely unassessed. Objective This study aimed to investigate the quality of CAD-related videos on TikTok and explore the correlation between video characteristics and high-quality videos. Methods A total of 122 CAD-related short videos on TikTok were analyzed on July 18, 2023. Basic video information and sources were extracted. Two evaluators independently scored each video using DISCERN (a health information quality scale), the Patient Education Materials Assessment Tool (PEMAT) and the Health on the Net (HONcode) scales. Videos were categorized into four groups based on their source, with the medical professional group further categorized by job titles. Simple linear analysis was used to examine the linear relationship across different scales and to explore the relationship between video characteristics (video length, time since posting, the number of "likes", comments and "favorites", and the number of followers of the video creator) and different scales. Results AQVideos were categorized into four groups based on their source: medical professionals (n = 98, 80.3%), user-generated content (n = 11, 9.0%), news programs (n = 4, 3.3%), and health agencies or organizations (n = 9, 7.4%). The score of DISCERN was 46.5 ± 7.6/80, the score rate of PEMAT was 79.2 ± 12.6%/100%, and the number of score items for HONcode was 1.4 ± 0.6/8. In Sect. 1 of DISCERN, user-generated content scored highest (29.1 ± 3.6), followed by medical professionals (28.6 ± 2.4), health agencies or organizations (28.0 ± 0.0) and news programs (28.0 ± 0.0)(P = 0.047). In HONcode, most videos met only one or two of the eight evaluation criteria. PEMAT scores varied slightly across categories without significant differences (P = 0.758). Medical professionals were further divided into senior (n = 69, 70.4%) and intermediate (n = 29, 29.6%) groups, with intermediate professionals scoring higher in DISCERN (P < 0.001). In simple linear analysis models, no linear correlation was found between DISCERN and PEMAT scores (P = 0.052). Time since posting on TikTok was negatively correlated with DISCERN (P = 0.021) and PEMAT scores (P = 0.037), and the number of "favorites" was positively correlated to DISCERN score (P = 0.007). Conclusion The quality of CAD-related videos on China's TikTok is inconsistent and varies across different evaluation scales. Videos posted by medical professionals with intermediate titles tended to offer higher quality, more up-to-date content, as reflected by higher "favorite" counts. HONcode may not be suitable for short video evaluation due to its low score rate, while DISCERN and PEMAT may be effective tools for short video evaluation. However, their lack of consistency in evaluation dimensions highlight the need for a tailored scoring system for short videos.

Care4Today is a digital health platform developed by Johnson & Johnson comprising a patient mobile app (Care4Today Connect), a health care provider (HCP) portal, and an educational website. It aims to improve medication adherence; enable self-reporting of health experiences; provide patient education; enhance connection with HCPs; and facilitate data and analytics learning across disease areas, including cardiovascular disease.

This study aimed to gather patient feedback on Care4Today Connect, specifically the coronary artery disease (CAD) and peripheral artery disease (PAD) module, and to cocreate and validate features with patients to optimize the app experience for those with CAD, PAD, or both.

We conducted 3 research engagements between November 2022 and May 2023. Participants were US-based adults recruited and consented through the sponsor's Patient Engagement Research Council program. Participants self-reported a diagnosis of cardiovascular disease, and in some cases, specifically, CAD, PAD, or both. Part 1, internet survey, posed quantitative questions with Likert-scale answer options about existing app features. Part 2, virtual focus group, and part 3, virtual individual interviews, both used semistructured qualitative discussion to cocreate and validate new app enhancements. The quantitative data from part 1 was evaluated descriptively to categorize mobile health app use, confidence in the ability to use the app, and motivations for app use. The qualitative discussions from parts 2 and 3 were synthesized to understand participants' app needs and preferences to inform an optimal app experience.

The response rate for part 1, internet survey, was 67% (37/55). Most participants felt at least somewhat confident using the app after seeing the newly added app tutorial (33/37, 89%), and at least somewhat confident in their ability to earn points for completing activities using app instructions (33/37, 89%). In part 2, virtual focus group (n=3), and part 3, virtual individual interviews (n=8), participants collectively preferred to enhance the app with (1) the ability to automatically add medication data for tracking and (2) the ability to receive relevant care team feedback on their self-reported health experiences. Participants would be willing to spend 10-15 minutes a day tracking 4-5 health experiences, especially those requested by their HCP.

Participants prefer apps that can reduce user burden and provide information relevant to them. Care4Today Connect can optimize the user experience for patients with CAD, PAD, or both with the automatic addition of medication data for tracking and in-app care team feedback on patient self-reported health experiences.

Smoking is a strong independent risk factor for peripheral arterial disease (PAD) incidence, and quitting is a key factor of the disease evolution. This study aimed to describe the characteristics of smokers with PAD included in the French smoking cessation services (SCS) database CDTnet, as well as to identify factors associated with their abstinence. We hypothesized that certain characteristics of smokers with PAD would influence quit rates.

This retrospective cohort analysis included adult smokers with PAD who were registered in CDTnet between 2001 and 2018 and who had completed at least 28 days of follow-up in SCS. One-month self-reported abstinence was confirmed by exhaled carbon monoxide <5 ppm. Descriptive and logistic analysis were performed.

Among the 3656 smokers with PAD included in CDTnet, 76% were male, with a median age of 57 years, who mainly were hospital-referred. They presented a severe smoking profile. Indeed, one-half of them (48%) smoked >20 cigarettes per day, 65% presented high nicotine dependence, and 30% had never quit previously. Among the sample, 46% stopped smoking at least 1 month. Factors favoring abstinence were at least one previous quit attempt, a high confidence in quitting, an increasing number of follow-up visits, and the prescription of nicotine patches associated with not to nicotine oral forms, as well as the prescription of varenicline at the first visit.

Quitting smoking is reachable for patients with PAD with an intensive management consisting of the prescription of a smoking cessation pharmacologic treatment and a follow-up in SCS.

Coronary bifurcation lesions present complex challenges in interventional cardiology, necessitating effective stenting techniques to achieve optimal results. This literature review comprehensively examines the application of computational and bench testing methods in coronary bifurcation stenting, offering insights into procedural aspects, stent design considerations, and patient-specific characteristics. Structural mechanics finite element analysis, computational fluid dynamics, and multi-objective optimization are valuable tools for evaluating stenting strategies, including provisional side branch stenting and two-stenting techniques. We highlight the impact of procedural factors, such as balloon positioning and rewiring techniques, and stent design features on the outcome of percutaneous coronary interventions with stents. We discuss the importance of patient-specific characteristics in deployment strategies, such as bifurcation angle and plaque properties. This understanding informs present and future research and clinical practice on bifurcation stenting. Computational simulations are a continuously maturing advance that has significantly enhanced stenting devices and techniques for coronary bifurcation lesions over the years. However, the accurate account of patient-specific vessel and lesion characteristics, both in terms of anatomical and accurate physiological behavior, and their large variation between patients, remains a significant challenge in the field. In this context, advancements in multi-objective optimization offer significant opportunities for refining stent design and procedural practices.

Background: This study examined the link between the Life's Essential 8 (LE8) metric and peripheral artery disease (PAD) prevalence in the U.S. Patients and methods: This population-based prospective cohort study analyzed data from 6,076 participants aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004. LE8 scores were categorized into low, moderate, and high cardiovascular health (CVH) levels. Multivariable weighted logistic regression and subgroup analyses were performed to examine the relationship between CVH and PAD, adjusting for demographic and clinical variables. Results: In final analysis, a total of 6,076 individuals were included, with a mean age of 59.41±12.80 years and 51.3% (n=3,115) being male. The prevalence of PAD was 6.9% (n=418). After adjusting for confounding factors, compared to participants with low CVH, those with moderate CVH had a 34% lower risk of PAD (OR: 0.66, 95% CI: 0.53-0.82), and those with high CVH had a 62% lower risk of PAD (OR: 0.38, 95% CI: 0.25-0.58). Conclusions: In conclusion, we report that lower CVH scores are associated with higher PAD risk among U.S. adults. These findings may contribute to the prevention strategies for PAD.

Background: Dual-pathway inhibition (DPI) with aspirin and rivaroxaban exhibited a net clinical benefit for patients with cardiovascular disease in the randomized COMPASS trial. The non-observational, international XATOA registry showed that the COMPASS results can be reproduced in clinical practice in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). Here we report patient characteristics and clinical outcomes for the subgroup of German PAD patients of the XATOA registry and compare them to COMPASS PAD patients. Patients and methods: XATOA was an international prospective registry of patients receiving DPI with a mean follow-up period of 15 months. The subgroup of German patients with PAD in XATOA comprised 1,819 patients, of which 925 patients (50.9%) had only PAD and 894 patients (49.1%) had both CAD and PAD. Patient characteristics such as prior medical history and prior medications as well as clinical outcomes such as incidences of major adverse limb events (MALE), major adverse cardiovascular events (MACE) and major bleeding events were assessed. Results: DPI was well-tolerated in clinical practice. Patient characteristics and clinical outcomes especially for patients with only PAD differed from characteristics and outcomes of the overall German XATOA population as well as the PAD subgroup of COMPASS. Patients with only PAD were markedly less supplied with lipid-lowering agents and betablockers. Incidences of MALE were high in German PAD patients of XATOA (9.0%) and markedly higher than in the PAD subgroup of COMPASS (1.2%). Incidences of MACE and major bleeding events were lower in German PAD patients of XATOA (MACE: 2.9%, major bleeding: 1.4%) than in PAD patients of COMPASS (MACE: 5.1%, major bleeding: 3.1%). Conclusions: DPI with rivaroxaban and aspirin is well-tolerated by PAD patients in German clinical practice. PAD patients in Germany exhibit different characteristics and show a different clinical outcome profile than PAD patients in COMPASS.

Low-dose aspirin and rivaroxaban are the cornerstone treatment for cardiovascular prevention in patients with peripheral artery disease (PAD) and/or stable coronary artery disease (SCAD). The combination of rivaroxaban with aspirin imposes a synergistic effect on the inhibition of factor-induced platelet aggregation. The present work aimed at comparing the cost-utility and cost-effectiveness of rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban alone (5 mg twice daily) with aspirin alone in patients with peripheral artery disease (PAD) or coronary artery disease (CAD) and related subgroups.

This pharmacoeconomic study was performed based on the insurance organization and utilized a state-transition decision Markov model. From the COMPASS trial, Clinical efficacy and Clinical events were collected. Health outcomes and cost were assessed over a 20-year time horizon (lifetime). The direct costs of medical services were included in the analysis. The results were stated based on Incremental Cost-Utility (ICUR) and Incremental Cost Effectiveness Ratio (ICER). Uncertainty was assessed utilizing deterministic and probabilistic sensitivity analyses. Discount rates of .058 and .03 were included for cost and effectiveness data, respectively. The budget impact based on the Markov model was estimated as the financial burden resulting from the insurance coverage of rivaroxaban.

In the total of CAD and PAD patients, treatment with rivaroxaban plus aspirin and rivaroxaban alone were more expensive than the aspirin alone, but also more effective, resulting in ICUR being $4594/QALY and $13601/QALY respectively, and for ICER being $3348/LYG and $9901/LYG. In PAD patients rivaroxaban plus aspirin had higher effectiveness than aspirin alone that ICUR and ICER being $11929/QALY and $9896/LYG respectively. In CAD patients, treatment with rivaroxaban plus aspirin was expensive and less effective than aspirin alone. The estimated annual budget impact was $28,253,135 for the rivaroxaban plus aspirin and $292,593,909 for the rivaroxaban alone in the total of CAD and PAD patients.

This study showed that rivaroxaban plus aspirin is a cost-effective alternative in PAD and total of CAD and PAD patients. In CAD patients, rivaroxaban plus aspirin and rivaroxaban alone were not cost-effective.

Atherosclerotic heart disease (ASHD) remains a leading cause of mortality worldwide, especially among older adults. Understanding the long-term mortality trends in ASHD can guide public health strategies and address demographic disparities.

Mortality data for individuals aged 35 years and older were extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMR) per 100,000 persons were calculated and stratified by year, gender, race, urbanization, and place of death. The trends were assessed using the annual percent change (APC) and average annual percent change (AAPC) with 95 % confidence intervals (CI) calculated through Joinpoint regression analysis.

From 1999 to 2020, 7,638,608 ASHD-related deaths were recorded. The overall AAMR declined from 291.08 in 1999 to 170.07 in 2020, with an AAPC of -2.70 % (95 % CI: 2.96 to -2.54). However, an abrupt rise was observed from 2018 to 2020 (APC: 4.55; 95 % CI: 0.77 to 6.75). Males reported higher AAMR than females (Males: 271.9 vs. Females: 151.9). Non-Hispanic (NH) White individuals had the highest AAMR (209.38), followed by NH Black (202.47), NH American Indian (176.12), Hispanic (158.1), and NH Asian (113.7) populations. Nonmetropolitan areas reported the highest AAMR (214.77), while medium metropolitan areas reported the lowest (195.41). The majority of deaths occurred in medical facilities (42.81 %), followed by decedent's homes (25.67 %), and nursing homes (24.79 %).

Despite a long-term decline in ASHD-related mortality, the recent increase from 2018 to 2020 requires further study. Gender and racial disparities persist, highlighting the need for targeted public health efforts to reduce these inequities.

Acute myocardial infarction (AMI) significantly contributes to the progression of heart failure (HF). Standard treatment for HF has long been angiotensin-converting enzyme inhibitors (ACEIs), targeting the renin-angiotensin-aldosterone system (RAAS). Recent developments in HF management introduced sacubitril/valsartan (S/V), a novel angiotensin receptor-neprilysin inhibitor (ARNI), showing promising results in global trials. This study aimed to assess the efficacy of early S/V application compared to angiotensin-converting enzyme inhibitors (ACEIs) in reducing NT-proBNP levels and improving clinical outcomes, specifically focusing on dyspnea symptomatology, in Chinese patients with AMI complicated by HF.

This single-center, mixed methods study was conducted at Tangshan Gongren Hospital from January to December 2021, including 88 patients diagnosed with AMI and HF. Patients were divided into two groups: 31 received S/V, while 57 were treated with ACEIs. Data collection encompassed baseline demographic, clinical, and biochemical variables, NT-proBNP levels, blood pressure measurements, and dyspnea symptom severity. Follow-up assessments were conducted 1 year post-discharge to evaluate NT-proBNP levels, and symptom progression. Statistical analyses, including t-tests, Wilcoxon rank-sum tests, and chi-square tests, were performed to compare outcomes between the two groups.

At baseline, no significant differences were observed between the two groups in terms of demographic, lifestyle, and medical history. Although patients in the S/V group presented with more severe baseline renal impairment and cardiac dysfunction, there was no significant difference in NT-proBNP levels from admission to discharge. 1-year follow-up showed a trend towards reduced NT-proBNP levels in the S/V group, though this difference did not reach statistical significance. All patients in both groups reported improvements in dyspnea at discharge and at follow-up, with no significant inter-group difference. Notably, the S/V group demonstrated a more significant reduction in both systolic and diastolic blood pressure from admission to discharge compared to the ACEIs group.

This study found that S/V had similar effects to ACEIs in reducing NT-proBNP levels among Chinese patients with AMI complicated by HF, though S/V was associated with greater reductions in blood pressure. These findings suggest that while S/V may offer additional benefits in blood pressure management, its impact on cardiac biomarkers in acute settings may not significantly differ from ACEIs. Given the study's limitations, including its single-center design, small sample size, and baseline differences. Further multi-center, randomized controlled trials are warranted to validate these findings and explore tailored treatment strategies for AMI patients with concurrent HF.

Remote ischaemic preconditioning (RIPC) is a promising non-invasive strategy in which brief episodes of ischaemia and reperfusion can increase skeletal muscle resistance to ischaemia and improve mobility. This study aimed to determine whether 28 consecutive days of RIPC improved intermittent claudication (IC) symptoms compared with sham intervention.

This single centre, parallel, randomised, sham controlled, double blind trial was conducted from January 2022 to April 2023 in outpatient settings. Forty two patients with stable IC Fontaine stage IIa or IIb were randomised to RIPC or sham for 28 days. The pre-specified primary outcome was a change in the maximum walking distance (MWD) after 28 days measured with a treadmill test. A > 10% change in MWD was considered clinically significant. Change in intermittent claudication distance (ICD), time to relief from claudication (TRC), and health related quality of life (HRQoL) measured with the VascuQoL-6 questionnaire were the secondary outcomes (ClinicalTrials.gov ID: NCT05084066).

Forty one men (RIPC = 23, sham = 18) aged 64.9 ± 7.4 years were analysed. A change of > 10% in MWD occurred in 14 patients in the RIPC group vs. eight patients in the sham group (relative risk 1.37, 95% confidence interval 0.74 - 2.25; p = .35). Changes in ICD, TRC, and HRQoL between the groups were not statistically significant.

In this trial, RIPC did not significantly improve MWD, ICD, or TRC compared with treatment with a sham device.

Coronary artery disease (CAD) remains a significant public health concern due to its high morbidity and mortality rates. Early detection and timely evaluation are crucial for improving patient outcomes. While both invasive and non-invasive methods are available for assessing CAD risk, non-invasive approaches minimize the complications associated with invasive procedures. Over the past two decades, advancements in artificial intelligence (AI), particularly machine learning techniques such as deep learning and natural language processing, have revolutionized cardiology. These technologies enhance diagnostic accuracy and clinical efficiency in non-invasive CAD evaluation. However, the broader adoption of AI faces critical challenges, including ethical concerns such as data privacy, high computational costs, and resource allocation disparities. This article explores the current landscape of non-invasive CAD assessment, highlighting the transformative potential and associated challenges of AI integration.

Cardiovascular diseases such as coronary artery disease (CAD) have a high prevalence of psychiatric comorbidities, that may impact clinically relevant outcomes (e.g., cognitive impairment and executive dysfunction). Obsessive-compulsive personality disorder (OCPD) is a common psychiatric comorbidity in CAD. It has a distinct cognitive profile characterised by inflexible thinking and executive dysfunction, which in turn may affect treatment adherence. However, the impact of OCPD on cognitive functioning in CAD is under-researched. We aimed to investigate the impact of OCPD on executive function in individuals with CAD undergoing rehabilitation, using cognitive tests relating to inflexibility and executive planning.

Seventy-eight adults (median age 59 [53.0-66.0] years) with CAD were tested within three days of hospital admission for cardiac rehabilitation occurring within two weeks of experiencing an episode of unstable angina or myocardial infarction. The Compulsive Personality Assessment Scale (CPAS) was used to evaluate OCPD traits. Neurocognitive testing was performed using the Cambridge Automated Neuropsychological Test Battery (CANTAB) including tests of set shifting (Intra-Extra Dimensional [IED] Set Shifting), and executive planning (Stockings of Cambridge [SOC]).

Ten individuals with CAD fulfilled the operational criteria for DSM-5 OCPD. Individuals with comorbid OCPD made more IED intra-dimensional shift reversal errors (2.0 [2.0-4.0] vs. 1.0 [1.0-2.0], p = .004), reflecting a difficulty inhibiting previously learnt responses. When all participants were analysed as a group, negative associations were found between individual OCPD traits and other aspects of cognitive performance. Hoarding trait was associated with increased initial thinking time on the SOC at five moves (ρ = 0.242, p = .033), while the need for control and rigidity traits were each associated with increased initial thinking time on the SOC at two moves (respectively, ρ = 0.259, p = .022; ρ = 0.239, p = .035), reflecting slower executive planning. A preoccupation with details trait was associated with fewer errors on a compound discrimination stage of the IED (ρ = -0.251, p = .026). After controlling these correlations for gender and age, significant associations remained with hoarding (β = 0.243, p = .036), need for control (β = 0.341, p = .005) and rigidity (β = 0.259, p = .038) traits.

Preliminary evidence suggests that individuals with CAD and comorbid OCPD traits show greater inflexibility than those without OCPD. Several OCPD traits were associated with slower planning, even after controlling them for age and gender. This may have implications for the success of rehabilitation.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly utilized as a life-saving modality in patients with cardiopulmonary compromise. Acute limb ischemia (ALI) has been reported when the femoral artery was accessed, and it was associated with higher mortality in patients on extracorporeal membrane oxygenation (ECMO). However, prior studies were limited by small sample size and the lack of long-term follow-up. We aimed to investigate the predictors of ALI in ECMO and the effect of ALI on long-term mortality.

Retrospective institutional chart review was performed. Patients who underwent VA-ECMO (Jan/2008-Jan/2018) were identified. Primary outcomes were ALI and 4-year mortality. Logistic regression analysis was used to investigate the predictors of ALI. Survival analysis methods were used to examine 4-year mortality.

A total of 377 patients were included. Vascular complications took place in 149 (39.5%) patients. The majority was ALI (107, 75.4%). Eleven patients had limb loss. ALI patients were younger (mean age: 50.2 ± 15.9 vs. 54.1 ± 15.5; P = 0.03), were more likely to have history of peripheral arterial disease (PAD) (7.6% vs. 3.0%; P = 0.047), were less likely to be on aspirin (40.2% vs. 54.4%; P = 0.013), and were more likely to be on vasopressors (97.1% vs. 88.0%; P = 0.007). Arterial cannula size was not associated with ALI so as the concurrent use of ventricular offloading devices (intra-aortic balloon pump or Impella (Abiomed Inc, Dancers, MA)). The use of distal perfusion catheter (DPC) was not protective against ALI in this cohort. However, DPC was associated with less likelihood to require vascular intervention (20.1% vs. 32.0%; P = 0.009). In adjusted analysis, aspirin use was protective against ALI [adjusted odds ratios (aOR) 95% CI: 0.52(0.30 - 0.90); P = 0.018]. The only predictor of ALI was the use of vasopressors [aOR (95% CI): 6.8 (1.5 - 30.4); P = 0.012]. For those who were successfully decannulated, 4-year survival was 65.1% in patients without ALI versus 46.8% in ALI (P = 0.044). After adjusting for potential risk factors, 4-year mortality hazard was significantly higher in patients with ALI [HR: 1.80(1.04 - 3.12); P = 0.035].

Patients requiring ECMO are critically ill. The development of ALI is detrimental to this population. This effect extends beyond the acute period. ALI increased 4-year mortality risk by 80%. The use of DPC did not protect against ALI, but it was associated with less vascular interventions.

Hypertension is the most common chronic disease and a major modifiable risk factor for cardio-cerebrovascular and renal diseases. This study estimated the national burden of hypertension, defined as systolic blood pressure ≥140 mm Hg, on morbidity and mortality in 2021 in France.

For all diseases causally associated with hypertension (cardiovascular diseases, chronic kidney diseases, and dementia), the number and proportion of cases attributable to hypertension in adults aged ≥35 years were estimated using population attributable fractions. Age- and sex-specific population attributable fractions were computed using the distribution of hypertension in the French population. These population attributable fractions were applied to nationwide statistics for mortality, hospitalizations, disease prevalence, years of life lost, years of life lived with disability, and disability-adjusted years of life.

The largest population attributable fractions were for ischemic heart disease and hemorrhagic stroke, with over 40% of cases attributable to hypertension. Overall, more than 385 000 patients were hospitalized due to hypertension, with 3.7 million hospitalizations and 6.2 million hospital days (all hospitalizations, including 3.4 million for chronic kidney disease) and including 390 000 overnight hospitalization. In 2021, more than 1.15 million individuals lived with ischemic heart disease attributable to hypertension, 1.26 million with chronic kidney diseases, and 358 033 with heart failure. Among 184 059 annual deaths from cardiovascular diseases, dementia, and chronic kidney diseases, 30% (55 280 deaths) were attributable to hypertension. Hypertension accounted for 8.5% of all deaths and 498 052 years of life lost.

In France, despite near-universal health coverage and free health care access, the burden attributable to hypertension remains high.

Peripheral arterial disease (PAD) and coronary artery disease (CAD) are manifestations of atherosclerosis, affecting a substantial proportion of the population. Despite their interrelation, the prevalence of CAD in severe PAD varies, prompting the need to understand their complex relationship. This study retrospectively analyzes prospectively collected data from a high-volume vascular center to assess CAD prevalence, risk factors, and implications for patients undergoing vascular surgery. Among 667 arterial disease patients, 19.5% underwent coronary angiography, with CAD detected in 61.5% of cases. CAD varied across vascular beds. Decision-making around preoperative coronary angiography and revascularization remains complex, with benefits for high-risk patients still being debated. In accordance with current guidelines, the routine practice of coronary revascularization preceding vascular surgery is generally discouraged. This study underscores the need for risk stratification to identify patients who might benefit from coronary revascularization prior to vascular surgery while adhering to cost-effectiveness and avoiding unnecessary and time-consuming diagnostics in the majority of patients. Patient demographics, risk factors, and clinical presentation were analyzed alongside hospital stay, mortality, and complications. The study highlights the challenges in managing patients with concurrent CAD and PAD and calls for improved protocols for treating this high-risk group.

To analyze the disease burden and inequalities of lower extremity peripheral artery disease (LEPAD) among people aged 40 and above in the Belt and Road partner countries from 1990 to 2021.

Data were retrieved from the Global Burden of Disease 2021 database. The age-standardized prevalence rates, mortality rates, and the annual rate of years lived with disability (YLDs) of LEPAD were analyzed. Trends were measured using the estimated annual percentage change (EAPC), and the slope index of inequality (SII) and concentration index were used to quantify the absolute and relative inequalities.

In 2021, the age-standardized prevalence and mortality rates of LEPAD were 3168.26/105 and 3.09/105, increasing by 4.30% and 19.31% compared to 1990, while YLDs rates decreased by 4.00%. Females had higher age-standardized prevalence and YLDs rates, while males had higher mortality rates. The EAPC for prevalence rates was slightly higher in males (0.22%) than in females (0.17%); while the EAPC of age-standardized mortality rate was 2.02% for females, compared to 1.45% for males. From 1990 to 2021, the age-standardized YLDs rates decreased from 16.23/105 to 15.58/105, with a faster decline in females (－0.12%) than in males (－0.06%). LEPAD prevalence varied across countries, with higher burden in Europe and faster growth in Gulf states. Higher socio-demographic index countries had higher prevalence. Inequity improved, with the SII at 52.90/105 and concentration index at 0.038 in 2021. Gender disparities persisted, with concentration index increased to 0.058 in females and reduced to －0.026 in males.

LEPAD prevalence and mortality among people aged 40 and above in the Belt and Road partner countries increased, while YLDs rates decreased from 1990 to 2021. Significant differences among people exist depending on gender and country, highlighting the need for enhanced screening, health education, and shared public health strategies across the Belt and Road partner countries.

The main objective was to evaluate the cost-effectiveness of various medical therapy combinations in managing chronic coronary syndrome (CCS) in Iran, based on real-world and patient-level data.

A cost-utility analysis employing a Markov model was conducted using data from a retrospective cohort study.

The study was conducted in the healthcare setting of Iran, focusing on primary and secondary care.

Patients with CCS were included in the study. Numbers entering and completing the study were reported, with clear definitions of selection, entry and exclusion criteria.

All combinations of recommended medical therapies for CCS were permitted. Ultimately, taking into account the sample size and study power, a comparison was made between the combination therapy of β-blockers (BB), long-acting nitroglycerin (LAN), aspirin (ASA) and statin versus the group receiving only BB, ASA and statin.

The primary outcome measure was the incremental cost-effectiveness ratio, along with an initial evaluation of disability-adjusted life-years (DALYs) and costs related to the interventions.

The BB/LAN/ASA/statin combination was cost-saving and effective, averting 0.02 DALYs and saving $172 compared with BB/ASA/statin. This combination was cost-effective in over 97% of the probabilistic sensitivity analysis results.

Incorporating LAN into the combination therapy of BB, ASA and statin is cost-effective in Iran. This finding provides evidence for policymakers on resource allocation in low-income countries.

Chronic coronary syndromes (CCS) is a common clinical condition that increases the risk of cardiovascular events at any time. Tongxinluo capsules (TXL) are widely used in China for treating CCS.

To systematically evaluate the therapeutic effects and safety of adding TXL to Western medical treatment (WM) for CCS.

We searched PubMed, Cochrane Library, CNKI, VIP, and Wanfang databases up to August 2024 for randomized controlled trials (RCTs) investigating the therapeutic effects and safety of combining TXL with WM compared to WM alone for CCS. Data analyses were conducted using RevMan 5.4 software.

Twenty studies involving 2091 participants were identified. Evidence supports the use of TXL plus WM for reducing angina frequency [SMD -2.50, 95% CI (-3.53, -1.48)], improving seattle angina questionnaire scores (P < 0.05), decreasing nitroglycerin dose [SMD -1.63, 95% CI (-2.26, -1.00)], and shortening angina duration [MD -1.50 min/once, 95% CI (-1.98, -1.02)]. Adding TXL to WM showed a non-significant trend toward reducing myocardial infarction [RR 0.34, 95% CI (0.05, 2.12); NNT = 41] and sudden cardiac death [RR 0.34, 95% CI (0.01, 8.28); NNT = 65]. No increase in adverse events was observed when TXL was added to WM [RR 1.02, 95% CI (0.70, 1.49); NNT = 149].

Our review suggests that TXL may offer additional therapeutic benefits for CCS patients and appears to be safe when combined with WM. Further investigations are warranted to confirm the potential impact of adding TXL to WM for CCS.

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024499031, PROSPERO (CRD42024499031).

The impact of low levels of vitamin D (Vit D) on the severity of cardiovascular diseases has become a significant challenge. This study aimed to assess this impact.

This pilot cross-sectional study enrolled two hundred patients referred to Namazi Hospital, Shiraz, Iran for myocardial perfusion imaging in 2019. The assessment included myocardial perfusion imaging and Vit D level evaluation. Quantitative ischemia analysis utilized Estimated Summed Stress Scores (SSS), Summed Rest Scores (SRS), and Summed Difference Scores (SDS). Myocardial Perfusion Imaging (MPI) results were categorized into normal, mild ischemia, moderate ischemia, and severe ischemia based on estimated SSS. Ischemia severity was aligned with established criteria, designating severe quantitative ischemia as SSS>13. Vit D was categorized using cutoffs at 10, 20, and 30 ng/mL. Mann-Whitney U-test was used for quantitative variables and Chi Square test for qualitative variables.

Chi Square test revealed a significant association between categorized Vit D levels below 10 ng/mL and severe ischemia (SSS>13) (P<0.001). Total Vit D level and also categorized Vit D with cut-offs of 10, 20, and 30 ng/mL showed no association with abnormal MPI. SSS was notably higher in patients with Vit D levels below 10 ng/mL (P=0.026).

The findings of this study emphasize an association between Vit D level below 10 ng/mL and severe myocardial ischemia, as indicated by SSS.

Optimal medical therapy (OMT) is a modifiable factor that decreases mortality and cardiovascular events in patients with severe peripheral arterial disease. We hypothesized that preintervention OMT would be associated with improved 1-year reintervention and major adverse limb event (MALE) rates after elective endovascular revascularization for intermittent claudication (IC).

Using the Vascular Quality Initiative (2010-2020), we identified patients with IC undergoing elective endovascular, hybrid, and open surgical interventions. Preoperative antiplatelet, statin, and nonsmoking status defined OMT components and created three groups: complete (all components), partial (1-2 components), and no OMT. The primary outcome was 1-year reintervention. Secondary outcomes included MALE and factors associated with OMT usage. Multivariable logistic regression generated adjusted odds ratios (aOR).

There were 39,088 patients (14,907 [38.1%] complete, 22,054 [56.4%)] partial, 2127 [5.4%] no OMT) who met our criteria. Patients with any OMT were more frequently older with more cardiovascular diseases and diabetes (P < .0001). Patients without OMT were more likely to be Black or with Medicare or Medicaid (P < .05). Observed 1-year reintervention (5.3% complete OMT, 6.1% partial OMT, 8.3% no OMT; P < .001) and MALE (5.6% complete OMT, 6.3% partial OMT, 8.8% no OMT; P < .001) were decreased by partial or complete OMT compared with no OMT. Complete OMT significantly decreased the adjusted odds of reintervention and MALE by 28% (aOR, 0.72, 95% confidence interval [95% CI], 0.59-0.88) and 30% (aOR, 0.70; 95% CI, 0.58-0.85), respectively, compared with no OMT. Partial OMT decrease the adjusted odds of reintervention and MALE by 24% (aOR, 0.76; 95% CI, 0.63-0.92) and 26% (aOR, 0.74; 95% CI, 0.62-0.89), respectively.

Preintervention OMT is an underused, modifiable risk factor associated with improved 1-year reintervention and MALE. Vascular surgeons are uniquely positioned to initiate and maintain OMT in patients with IC before revascularization to optimize patient outcomes.

Coronary artery disease (CAD) is the most prevalent heart disease and a leading cause of death among both men and women. It is worth noting that anxiety is highly prevalent among patients with CAD, and it can significantly affect their overall performance and well-being. This study aimed to determine the impact of self-care training, specifically using the teach-back method, on health anxiety in patients with CAD.

In this randomized controlled clinical trial, a total of 50 patients with coronary artery disorders were selected from the coronary care unit of Rasool Hospital in Ferdows City, Iran, in 2022. The participants were randomly assigned to two groups. The intervention group received self-care training based on the teach-back method, which consisted of three individual sessions lasting 30-45 minutes each, conducted over the course of one week. However, the control group received routine care. To collect data, the researchers utilized Salkovskis et al.'s (2002) health anxiety questionnaire. The collected data were analyzed using the Chi-square test, Fisher's exact test, independent t-test, and paired t-test at a significance level of P < 0.05.

Most participants in the control and intervention groups were female. The mean ages of the intervention and control groups were 47.1 ± 12.83 and 48.1 ± 44.81 years, respectively, with no statistically significant difference (P = 0.67). The results indicated that there was a statistically significant difference in the total mean score (P = 0.000) and mean scores of subscales of health anxiety (awareness of bodily sensations or changes (P = 0.001), feared consequences of having an illness (P = 0.001), and worry about health (P = 0.008)) between the two groups.

The self-care training based on the teach-back method reduced health anxiety in patients with CAD. Therefore, it is recommended to incorporate the teach-back method as an educational approach by nursing team to effectively reduce health anxiety in patients with CAD.

Peripheral arterial disease (PAD) and coronary artery disease (CAD) are major contributors to global morbidity and mortality. Many PAD patients remain asymptomatic for CAD, which often leads to undetected coronary artery involvement. This hidden coronary disease poses significant risks, particularly following peripheral revascularization, as increased cardiac demand can precipitate complications.

This cross-sectional descriptive study assessed the prevalence of coronary artery stenosis in patients with Fontaine Stage IV peripheral arterial disease. Simultaneous angiography of both the coronary and lower extremity arteries was performed, and the severity of arterial stenosis was rigorously evaluated. The correlation between the extent of peripheral and coronary artery disease was analyzed.

A total of 60 patients (63.3% male, 36.7% female; mean age 65.23 ± 9.86 years) were included. Comorbidities were common, with 90% having diabetes, 50% hypertension, 23.3% hyperlipidemia, and 30% smoking history. Severe peripheral artery stenosis was frequently observed, particularly in the posterior tibial artery (total occlusion in 26.6% and 20% of the right and left arteries, respectively). Significant coronary involvement was also prevalent, with 51.7% exhibiting three-vessel disease. Coronary revascularization was required in the majority of cases (CABG: 40%, PCI: 35%), with a higher proportion among women (77.2%) and men (73.7%).

This study highlights the necessity of comprehensive coronary evaluation in patients with advanced lower limb ischemia. A substantial proportion of these patients have silent but critical coronary disease, which, if left unaddressed, could result in serious post-revascularization complications.

Coronary heart disease (CHD) is a prevalent cardiovascular disease with high mortality rates worldwide. Patients with CHD often experience adverse psychological stress related to the disease's diagnosis, treatment and recovery phases. This stress can hurt sleep quality and overall quality of life. Mindfulness-based interventions (MBIs) have been studied as a psychotherapeutic approach to alleviating the psychological stress associated with CHD. This study aimed to determine the effectives of MBIs for health outcomes in patients with CHD.

A total of eight English-language databases were searched, and eight relevant studies were included in the analysis. The included studies were assessed for literature quality, and data were extracted and analysed using Review Manager 5.3.

A total of eight studies involving 802 participants were included in the analysis. Compared to control groups, MBIs significantly reduced anxiety, depression, perceived stress, and systolic blood pressure. However, there was no significant effect on diastolic blood pressure, quality of life or body mass index. One study reported that MBIs significantly improved sleep quality in patients with acute myocardial infarction after percutaneous coronary intervention but had no significant effect on body mass index.

MBIs had significant effects on anxiety and depression in patients with CHD, reduced perceived stress and were associated with reductions in systolic blood pressure and improvements in sleep quality. However, they did not significantly affect diastolic blood pressure, quality of life or body mass index.

Hemodialysis (HD) patients with peripheral arterial disease (PAD) are at heightened risk of adverse vascular events, and aspirin positively affects those outcomes. We aimed to investigate the association between different patterns of aspirin use and clinical vascular events in chronic HD patients with PAD.

This retrospective nationwide cohort study enrolled 758 chronic HD patients who had been diagnosed with PAD between January 1, 2008, and December 31, 2012, and followed up until the end of 2020. Patients were divided into three groups according to medication possession ratio (MPR) and continued use of aspirin (i.e., low MPR, high MPR but discontinuous prescription, and high MPR and continuous prescription). Percutaneous transluminal angioplasty (PTA), surgical bypass, lower leg amputation, cardiovascular events, cerebrovascular events, and all-cause mortality were evaluated.

High MPR and continuous aspirin use had the lowest incidence of all-cause mortality and cardiovascular events compared with the two other groups, and it was significantly associated with low risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality (aHR: 0.58 [0.41-0.83], 0.49 [0.25-0.95], 0.57 [0.40-0.81], and 0.70 [0.55-0.88], respectively). Kaplan-Meier analysis revealed that event-free rates of PTA, cardiovascular events, and all-cause mortality of patients with high MPR and continuous aspirin treatment were the highest among the three groups (p < 0.05).

Among HD patients with PAD, high MPR and continuous aspirin use significantly reduced the risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality and improved the event-free rates of PTA, cardiovascular events, and all-cause mortality during long-term follow-up.