Effect of plateletcrit and methylenetetrahydrofolate reductase(MTHFR)C677T genotypes on folic acid efficacy in stroke prevention

Previous studies have shown that low platelet count combined with high plasma total homocysteine(tHcy)increased stroke risk and can be lowered by 73% with folic acid.However,the combined role of other platelet activation parameters and the methylenetetrahydrofolate reductase(MTHFR)C677T genotypes on stroke risk and folic acid treatment benefit remain to be examined.This study aimed to investigate if platelet activation parameters and MTHFR genotypes jointly impact folic acid treatment efficacy in first stroke prevention.Data were derived from the China Stroke Primary Prevention Trial.This study includes a total of 11,185 adult hypertensive patients with relevant platelet activation parameters and MTHFR genotype data.When simultaneously considering both platelet activation parameters(plateletcrit,platelet count,mean platelet volume,platelet distribution width)and MTHFR genotypes,patients with both low plateletcrit(Q1)and the TT genotype had the highest stroke incidence rate(5.6%)in the enalapril group.This subgroup significantly benefited from folic acid treatment,with a 66% reduction in first stroke(HR:0.34;95%CI:0.14-0.82;p=0.016).Consistently,the subgroup with low plateletcrit(Q1)and the CC/CT genotype also benefited from folic acid treatment(HR:0.40;95%CI:0.23-0.70;p=0.001).In Chinese hypertensive adults,low plateletcrit can identify those who may greatly benefit from folic acid treatment,in particular,those with the TT genotype,a subpopulation known to have the highest stroke risk.

Sex difference in human diseases:mechanistic insights and clinical implications

Sex characteristics exhibit significant disparities in various human diseases,including prevalent cardiovascular diseases,cancers,metabolic disorders,autoimmune diseases,and neurodegenerative diseases.Risk profiles and pathological manifestations of these diseases exhibit notable variations between sexes.The underlying reasons for these sex disparities encompass multifactorial elements,such as physiology,genetics,and environment.Recent studies have shown that human body systems demonstrate sex-specific gene expression during critical developmental stages and gene editing processes.These genes,differentially expressed based on different sex,may be regulated by androgen or estrogen-responsive elements,thereby influencing the incidence and presentation of cardiovascular,oncological,metabolic,immune,and neurological diseases across sexes.However,despite the existence of sex differences in patients with human diseases,treatment guidelines predominantly rely on male data due to the underrepresentation of women in clinical trials.At present,there exists a substantial knowledge gap concerning sex-specific mechanisms and clinical treatments for diverse diseases.Therefore,this review aims to elucidate the advances of sex differences on human diseases by examining epidemiological factors,pathogenesis,and innovative progress of clinical treatments in accordance with the distinctive risk characteristics of each disease and provide a new theoretical and practical basis for further optimizing individualized treatment and improving patient prognosis.

Epigenetic regulation in cardiovascular disease:mechanisms and advances in clinical trials

Epigenetics is closely related to cardiovascular diseases.Genome-wide linkage and association analyses and candidate gene approaches illustrate the multigenic complexity of cardiovascular disease.Several epigenetic mechanisms,such as DNA methylation,histone modification,and noncoding RNA,which are of importance for cardiovascular disease development and regression.Targeting epigenetic key enzymes,especially the DNA methyltransferases,histone methyltransferases,histone acetylases,histone deacetylases and their regulated target genes,could represent an attractive new route for the diagnosis and treatment of cardiovascular diseases.Herein,we summarize the knowledge on epigenetic history and essential regulatory mechanisms in cardiovascular diseases.Furthermore,we discuss the preclinical studies and drugs that are targeted these epigenetic key enzymes for cardiovascular diseases therapy.Finally,we conclude the clinical trials that are going to target some of these processes.