Novel wine in an old bottle:Preventive and therapeutic potentials of andrographolide in atherosclerotic cardiovascular diseases

Atherosclerotic cardiovascular disease(ASCVD)frequently results in sudden death and poses a serious threat to public health worldwide.The drugs approved for the prevention and treatment of ASCVD are usually used in combination but are inefficient owing to their side effects and single therapeutic targets.Therefore,the use of natural products in developing drugs for the prevention and treatment of ASCVD has received great scholarly attention.Andrographolide(AG)is a diterpenoid lactone compound extracted from Andrographis paniculata.In addition to its use in conditions such as sore throat,AG can be used to prevent and treat ASCVD.It is different from drugs that are commonly used in the prevention and treatment of ASCVD and can not only treat obesity,diabetes,hyperlipidaemia and ASCVD but also inhibit the pathological process of atherosclerosis(AS)including lipid accumulation,inflammation,oxidative stress and cellular abnormalities by regulating various targets and pathways.However,the pharmacological mechanisms of AG underlying the prevention and treatment of ASCVD have not been corroborated,which may hinder its clinical development and application.Therefore,this review summarizes the physiological and pathological mechanisms underlying the development of ASCVD and the in vivo and in vitro pharmacological effects of AG on the relative risk factors of AS and ASCVD.The findings support the use of the old pharmacological compound(‘old bottle’)as a novel drug(‘novel wine’)for the prevention and treatment of ASCVD.Additionally,this review summarizes studies on the availability as well as pharmaceutical and pharmacokinetic properties of AG,aiming to provide more information regarding the clinical application and further research and development of AG.

The role of periodontal disease in atherosclerotic cardiovascular disease

Atherosclerotic cardiovascular disease(ASCVD)includes a group of disorders of the heart and blood vessels and accounts for major morbidity and premature death worldwide.Periodontitis is a chronic inflammatory disease with the gradual destruction of supporting tissues around the teeth,including gingiva,periodontal ligament,alveolar bone,and cementum.Periodontitis has been found to potentially increase the risk of ASCVD.Generally,oral microorganisms and inflammation are the major factors for periodontitis to the incidence of ASCVD.Recently,evidence has shown that the loss of masticatory function is another important factor of periodontitis to the incidence of ASCVD.In this review,we illustrate the recent finding of the relationship between periodontitis and ASCVD,from a microscale perspective-oral microorganisms,inflammation,and tooth loss.With the high prevalence of periodontitis,it is important to add oral therapy as a regular ASCVD prevention strategy.Regular dental visits could be a helpful strategy for ASCVD patients or general medical practitioners.

Prediction of 10-year Atherosclerotic Cardiovascular Disease Risk among Adults Aged 40-79 Years in China:a Nationally Representative Survey

Objective To establish the distribution of 10-year atherosclerotic cardiovascular disease （ASCVD） risk among Chinese adults. Methods We estimated the 10-year ASCVD risk by applying the 2013 American College of Cardiology/ American Heart Association pooled cohort equations （PCEs） to the data obtained from the 2010 China Chronic Disease and Risk Factor Surveillance that involved 61,541 participants （representing 520,158,652 Chinese adults） aged 40-79 years. We also compared the ASCVD risk with the 10-year ischemic cardiovascular disease （ICVD） risk, which was calculated using the simplified scoring tables recommended by the Chinese Guidelines for Prevention of Cardiovascular Diseases （Chinese model）. Results Based on the PCEs, the average 10-year ASCVD risk among adults without self-reported stroke or myocardial infraction was 12.5%. Approximately 247 million （47.4%） and 107 million （20.6%） adults had 〉 7.5% and 〉 20% 10-year ASCVD risks, respectively. The 10-year ASCVD risk 〉 20% was higher among men, less educated individuals, smokers, drinkers, and physically inactive individuals than among their counterparts. Overall, 29.0% of adults categorized using the Chinese model were overclassified with the PCEs. Conclusion Our results define the distribution of 10-year ASCVD risk among Chinese adults. The 10-year ASCVD risk predicted by the PCEs was higher than the ICVD risk predicted by the Chinese model.

Association between Coronary Atherosclerotic Plaque Composition and Cardiovascular Disease Risk

Objective The objective of this study is to determine whether coronary atherosclerotic plaque composition is associated with cardiovascular disease(CVD) risk in Chinese adults. Methods We performed a cross-sectional analysis in 549 subjects without previous diagnosis or clinical symptoms of CVD in a community cohort of middle-aged Chinese adults. The participants underwent coronary computed tomography(CT) angiography for the evaluation of the presence and composition of coronary plaques. CVD risk was evaluated by the Framingham risk score(FRS) and the 10-year atherosclerotic cardiovascular disease(ASCVD) risk score. Results Among the 549 participants, 267(48.6%) had no coronary plaques, 201(36.6%) had noncalcified coronary plaques, and 81(14.8%) had calcified or mixed coronary plaques. The measures of CVD risk including FRS and ASCVD risk score and the likelihood of having elevated FRS significantly increased across the groups of participants without coronary plaques, with noncalcified coronary plaques, and with calcified or mixed coronary plaques. However, only calcified or mixed coronary plaques were significantly associated with an elevated ASCVD risk score [odds ratio(OR) 2.41; 95% confidence interval(CI) 1.09-5.32] compared with no coronary plaques, whereas no significant association was found for noncalcified coronary plaques and elevated ASCVD risk score(OR 1.25; 95% CI 0.71-2.21) after multivariable adjustment. Conclusion Calcified or mixed coronary plaques might be more associated with an elevated likelihood of having CVD than noncalcified coronary plaques.

Decreased expression of Klotho in cardiac atria biopsy samples from patients at higher risk of atherosclerotic cardiovascular disease

Background Klotho proteins （α- and β） are membrane-based circulating proteins that regulate cell metabolism, as well as the lifespan modulating activity of Fibroblast Growth Factors （FGFs）. Recent data has shown that higher plasma circulating Klotho levels reduce cardio- vascular risk, suggesting Klotho has a protective role in cardiovascular diseases. However, although so far it has been identified in various organs, it is unknown whether cardiomyocytes express Klotho and FGFs, and whether high cardiovascular risk could affect cardiac expres- sion ofKlotho, FGFs and other molecules. Methods We selected 20 patients with an estimated 10-year high atherosclerotic cardiovascular disease and 10 age-matched control subjects with an estimated 10-year low risk undergone cardiac surgery for reasons other than coronary artery by-pass. In myocardial biopsies, we evaluated by immuno-histochemistry whether Klotho and FGFs were expressed in cardiomyo- cytes, and whether higher cardiovascular risk influenced the expression of other molecules involved in endoplasmic reticulum stress, oxida- tive stress, inflammation and fibrosis. Results Only cardiomyocytes of patients with a higher cardiovascular risk showed lower expression of Klotho, but higher expressions of FGFs. Furthermore, higher cardiovascular risk was associated with increased expression of oxidative and endoplasmic reticular stress, inflammation and fibrosis. Conclusions This study showed for the first time that Klotho proteins are ex- pressed in human cardiomyocytes and that cardiac expression of Klotho is down-regulated in higher cardiovascular risk patients, while expression of stress-related molecules were significantly increased.

Prediction of presence and severity of coronary artery disease using prediction for atherosclerotic cardiovascular disease risk in China scoring system

BACKGROUND Coronary artery disease(CAD)is one of the leading causes of death and disease burden in China and worldwide.A practical and reliable prediction scoring system for CAD risk and severity evaluation is urgently needed for primary prevention.AIM To examine whether the prediction for atherosclerotic cardiovascular disease risk in China(China-PAR)scoring system could be used for this purpose.METHODS A total of 6813 consecutive patients who underwent diagnostic coronary angiography were enrolled.The China-PAR score was calculated for each patient and CAD severity was assessed by the Gensini score(GS).RESULTS Correlation analysis demonstrated a significant relationship between China-PAR and GS(r=0.266,P<0.001).In receiver operating characteristic curve analysis,the cut-off values of China-PAR for predicting the presence and the severity of CAD were 7.55%with a sensitivity of 55.8%and specificity of 71.8%[area under the curve(AUC)=0.693,95%confidence interval:0.681 to 0.706,P<0.001],and 7.45%with a sensitivity of 58.8%and specificity of 67.2%(AUC=0.680,95%confidence interval:0.665 to 0.694,P<0.001),respectively.CONCLUSION The China-PAR scoring system may be useful in predicting the presence and severity of CAD.

Sodium glucose cotransporter-2 inhibitors and heart disease:Current perspectives

Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are antidiabetic medications with remarkable cardiovascular(CV)benefits proven by multiple randomised controlled trials and real-world data.These drugs are also useful in the prevention of CV disease(CVD)in patients with diabetes mellitus(DM).Although DM as such is a huge risk factor for CVD,the CV benefits of SGLT-2i are not just because of antidiabetic effects.These molecules have proven beneficial roles in prevention and management of nondiabetic CVD and renal disease as well.There are various molecular mechanisms for the organ protective effects of SGLT-2i which are still being elucidated.Proper understanding of the role of SGLT-2i in prevention and management of CVD is important not only for the cardiologists but also for other specialists caring for various illnesses which can directly or indirectly impact care of heart diseases.This clinical review compiles the current evidence on the rational use of SGLT-2i in clinical practice.

Serum Uric Acid is Associated with the Predicted Risk of Prevalent Cardiovascular Disease in a Community-dwelling Population without Diabetes

Objective To examine the association between serum uric acid levels and cardiovascular disease risk among individuals without diabetes.Methods We investigated the association between serum uric acid levels and the risk of prevalent cardiometabolic diseases, 10-year Framingham risk for coronary heart disease, and 10-year risk for atherosclerotic cardiovascular diseases （ASCVD） among 8,252 participants aged 〉 40 years without diabetes from Jiading district, Shanghai, China.Results Body mass index, waist circumference, blood glucose, glycated hemoglobin, blood pressure, and serum lipids increased progressively across the sex-specific quartiles of uric acid （all P trend 〈 0.05）. Compared with individuals in the lowest quartile, those in the higher quartiles had a significantly higher prevalence of obesity, hypertension, and dyslipidemia （all P trend 〈 0.05）. A fully adjusted logistic regression analysis revealed that individuals in the highest quartile had an increased risk of predicted cardiovascular disease compared with those in the lowest quartile of uric acid. The multivariate adjusted odds ratios （ORs） [95% confidence intervals （C/s）] for the highest quartiles for high Framingham risk were 3.00 （2.00-4.50） in men and 2.95 （1.08-8.43） in women. The multivariate adjusted ORs （95% C/s） for the highest quartile for high ASCVD risk were 1.93 [1.17-3.17） in men and 4.53 （2.57-7.98） in women.Conclusion Serum uric acid level is associated with an increased risk of prevalent obesity, hypertension, dystipidemia, 10-year Framingham risk for coronary heart disease, and lO-year risk for ASCVD among Chinese adults without diabetes.

High-density lipoproteins:an emerging target in the prevention of cardiovascular disease

High-density lipoproteins （HDLs） have been well established to protect against the development of atherosclerotic cardiovascular disease. It has become apparent that in addition to the promotion of reverse cholesterol transport, HDLs possess a number of additional functional properties that may contribute to their beneficial influence on the arterial wall. A number of exciting therapeutic strategies have been developed that target HDL and its ability to protect against the development of atherosclerotic plaque. This paper will review how the promotion of the functional properties of HDL inhibits the formation of atherosclerotic plaque and stabilises lesions in patients with established disease.

Should patients with erectile dysfunction be evaluated for cardiovascular disease？

The landmark Massachusetts Male Ageing Study shed new light on the prevalence of erectile dysfunction （ED） and drew attention to ED as a disease of ageing. Over the years, ED has been linked to the development of cardiovascular disease （CVD） in some patients. There is clear evidence that ED and CVD share and have a similar risk factor profile. CVD is one of the most recognizable causes of mortality and early detection coupled with prevention of mortality from CVD has been the prime interest of many researchers. Consequently, there has been a multidisciplinary curiosity regarding the proposal to use ED as a marker for future CVD. I n fact, there have been several proposals to use ED as a screening tool for future CVD. We performed a comprehensive Search of two main databases--PubMed and Cochrane Library using a combination of keywords such as acute myocardial infarction, coronary artery disease （CAD） and ED. Journal articles from January 2000 to June 2011 were reviewed. We included all articles discussing the relationship between ED and CVD in the English language. All the relevant randomized controlled trials, cohort and retrospective studies, and review articles were included in our overall analysis in an attempt to answer the question whether all patients with ED should be clinically evaluated for CVD. The results showed a link between ED and the development of future CVD in some patients, but ED was not shown to be an independent risk predictor that is any better than the traditional Framingham risk factors. Screening for CVD may, however, be rewarding in younger patients with severe ED and in patients with concurrent CVD risk factors.

司美格鲁肽对2型糖尿病并ASCVD住院患者的临床疗效分析

目的:分析司美格鲁肽对2型糖尿病(T2DM)合并动脉粥样硬化性心血管疾病(ASCVD)住院患者的临床疗效。方法:选取2022年12月—2023年12月佳木斯市中心医院收治的60例T2DM合并ASCVD(T2DM-ASCVD)住院患者,采用随机数字表法将其分为两组,每组30例。对照组采用预混胰岛素治疗,观察组采用预混胰岛素联合司美格鲁肽治疗。比较两组糖代谢、血压、体重和脂代谢指标水平,颈动脉超声参数,血清骨膜蛋白(POSTN)水平,不良反应和主要不良心血管事件(MACE)发生率。结果:治疗后,两组糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)和收缩压(SBP)、舒张压(DBP)均较治疗前降低,且观察组均低于对照组(P<0.05)。治疗后,两组体重和总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)均较治疗前降低,且观察组均低于对照组(P<0.05)。治疗后,两组颈动脉内膜中层厚度(IMT)、颈动脉斑块积分(Crouse积分)和血清POSTN水平均较治疗前降低,且观察组均低于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05),但观察组MACE发生率低于对照组(P<0.05)。结论:司美格鲁肽可有效调控T2DM-ASCVD患者的血糖、血脂代谢,并可减重、降压、减少颈动脉斑块的数量和面积、降低血清POSTN水平、降低MACE发生风险。

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease:A narrative review

Coronavirus disease 2019(COVID-19)is a global pandemic where several comorbidities have been shown to have a significant effect on mortality.Patients with diabetes mellitus(DM)have a higher mortality rate than non-DM patients if they get COVID-19.Recent studies have indicated that patients with a history of diabetes can increase the risk of severe acute respiratory syndrome coronavirus 2 infection.Additionally,patients without any history of diabetes can acquire newonset DM when infected with COVID-19.Thus,there is a need to explore the bidirectional link between these two conditions,confirming the vicious loop between“DM/COVID-19”.This narrative review presents(1)the bidirectional association between the DM and COVID-19,(2)the manifestations of the DM/COVID-19 loop leading to cardiovascular disease,(3)an understanding of primary and secondary factors that influence mortality due to the DM/COVID-19 loop,(4)the role of vitamin-D in DM patients during COVID-19,and finally,(5)the monitoring tools for tracking atherosclerosis burden in DM patients during COVID-19 and“COVID-triggered DM”patients.We conclude that the bidirectional nature of DM/COVID-19 causes acceleration towards cardiovascular events.Due to this alarming condition,early monitoring of atherosclerotic burden is required in“Diabetes patients during COVID-19”or“new-onset Diabetes triggered by COVID-19 in Non-Diabetes patients”.

中青年男性腹部脂肪厚度与ASCVD危险分层的相关性

目的:探讨中青年男性腹部各部位脂肪厚度与ASCVD危险分层之间的相关性。方法:以2022年1月—6月于重庆医科大学第二附属医院进行体检的190名中青年男性体检者为研究对象,所有研究对象按照ASCVD危险分层分为四组(低危组、中危组、高危组和极高危组),利用超声测量各组人群不同部位脂肪厚度,分析各部位脂肪厚度与危险分层之间的相关性。结果:(1)肝前内脏脂肪(VAT)剑下、肝前VAT最大、脐上VAT、脐下皮下脂肪(SAT)、脐下VAT、右肾VAT、左肾VAT以及平均VAT(mVAT)的组间差异有统计学意义(P<0.05)。(2)脐上VAT、脐下VAT、左肾VAT、右肾VAT、mVAT与危险分层之间呈低度正相关(rs分别为0.28、0.23、0.23、0.19、0.28,P<0.05)。(3)mVAT是影响危险分层的独立危险因素(P<0.05)。结论:脐上VAT、脐下VAT、左肾VAT、右肾VAT、mVAT增加,危险分层增高的风险性增高。超声检测腹部脂肪厚度可为心血管疾病防控提供一项辅助手段。

The rate of patients at high risk for cardiovascular disease with an optimal low-density cholesterol level: a multicenter study from Thailand

Background Hypercholesterolemia is a major risk factor for cardiovascular events in patients with established atherosclerotic disease (EAD) and in those with multiple risk factors (MRFs). This study aimed to investigate the rate of optimal low-density lipoprotein (LDL) cholesterol level in a multicenter registry of patients at high risk for cardiovascular events. Methods A multicenter registry of EAD and MRF patients was conducted. Demographic data,medical history,cardiovascular risk factors,anthropometric data,laboratory data,and medications were recorded and analyzed. We classified patients according to target LDL levels based on recommendation by the European Society of Cardiology (ESC) 2011 into Group 1 which is EAD and diabetes or chronic kidney disease (CKD)–target LDL below 70 mg/dL,and Group 2 which is MRF without diabetes or CKD–target LDL below 100 mg/dL. The rate of optimal LDL level in patients with Group 1 and Group 2 was analyzed and stratified according to the treatment pattern of lipid-lowering medications. Results A total of 3100 patients were included. Of those,51.7% were male. Average age was 65.8 ± 9.7 years. Average LDL level was 96.3 ± 32.6 mg/dL. A vast majority (92.7%) received statin and 9.3% received ezetimibe. Optimal LDL level was achieved in 20.3% of patients in Group 1 (LDL < 70 mg/dL),and in 46.6% in Group 2 (LDL < 100 mg/dL). The overall rate of optimal LDL control was 23% since 89.6% of study population belongs to Group 1. The rate of optimal LDL was not different between high and low potency statin. Factors that were associated with optimal LDL control were older age,the presence of coronary artery disease or peripheral artery disease. Conclusions The rates of optimal LDL level were unacceptably low in this study population. As such,a strategy to improve LDL control in high-risk population should be implemented.

The Rationale for a Different Approach to Preventing Cardiovascular Disease

The Problem: We have previously suggested that an alternative approach to preventing cardiovascular disease is necessary because atherosclerotic cardiovascular disease (ASCVD) has been increasing for the last 50 years and has now reached epidemic status. Since the year 2000, approximately 600,000 heart attacks and ASCVD related deaths have occurred annually in the United States. It is the most common cause of death in the U.S., more than all cancers combined. The financial costs are staggering, amounting to 555 billion dollars per year in direct and indirect costs. Outlook for an improvement in these statistics is not encouraging as the U.S. population continues to become more obese and to develop diabetes. The Question: Why is ASCVD continuing to be a major challenge to healthcare providers when the pathogenesis is known and inexpensive preventative treatment is available? The reasons are multiple and complex. First, present financial reimbursement policies of healthcare organizations reward treatment of a disease and its complications instead of preventing the disease. Second, professional guidelines and treatment goals are often too complex, subject to interpretation, and time-consuming to be useful in the clinical setting. Third, no specific follow-up of patients at risk for ASCVD is recommended when the risk assessment changes. Fourth, many expensive cardiovascular diagnostic tests are utilized without meeting appropriate guidelines for their use. Fifth, treatment of individuals without first proving the presence of disease results in poor adherence to therapy. The Solution: This article describes the rationale for a new approach to the prevention of ASCVD in asymptomatic individuals. It is based upon preventing ASCVD by identifying all asymptomatic individuals with subclinical disease before an ASCVD event occurs. It recommends that all adults be screened for ASCVD on or before the age of 50 using a non-invasive atherosclerosis specific coronary artery calcium heart scan. Further recommendations include treating all calcium positive individuals to reverse their atherosclerotic coronary artery plaques with a combination of a low cholesterol diet, rosuvastatin 10 mg/day, and ezetimibe 10 mg/day. The therapeutic goal is a low-density lipoprotein cholesterol below 50 mg/dl to ensure regression of atherosclerosis. For individuals who have a zero calcium score, a repeat scan in 3 to 5 years is recommended. This new approach can easily be integrated into ongoing heart disease prevention programs to reduce the burden of ASCVD within the next five years. Conclusion: The mortality, morbidity, and cost of ASCVD have reached unacceptable levels. Reducing this disease to a rare condition will require the efforts of many individuals to organize, educate, and facilitate the goal of identifying all individuals with subclinical ASCVD. Once identified, aggressive therapy is required to reverse their atherosclerotic plaques in order to prevent heart attacks and atherosclerotic strokes. If successful, within 5 years the majority of the patients with asymptomatic ASCVD can be identified and if treated appropriately, reduce the prevalence and cost of ASCVD by 90%.

Lipoprotein(a)and Atherosclerotic Cardiovascular Diseases:Evidence from Chinese Population

Cardiovascular disease(CVD)is the leading cause of mortality worldwide.Multiple factors are involved in CVD,and emerging data indicate that lipoprotein(a)(Lp(a))may be associated with atherosclerotic cardiovascular disease(ASCVD)independent of other traditional risk factors.Lp(a)has been identified as a novel therapeutic target.Previous studies on the influence of Lp(a)in CVD have mainly used in western populations.In this review,the association of plasma Lp(a)concentration with ASCVD was summarized,with regards to epidemiological,population-based observational,and pathological studies in Chinese populations.Lp(a)mutations and copy number variations in Chinese populations are also explored.Finally,the impact of plasma Lp(a)levels on patients with type 2 diabetes mellitus,cancer,and familial hypercholesterolemia are discussed.

Ursodeoxycholic acid as a means of preventing atherosclerosis,steatosis and liver fibrosis in patients with nonalcoholic fatty liver disease

BACKGROUND Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of mortality in patients with nonalcoholic fatty liver disease(NAFLD).Weight loss is a key factor for successful NAFLD and CVD therapy.Ursodeoxycholic acid(UDCA),which is one of the first-line therapeutic agents for treatment of NAFLD,is reported to have a beneficial effect on dyslipidemia and ASCVD risk because of antioxidant properties.AIM To evaluate the effects of 6 mo of UDCA treatment on hepatic function tests,lipid profile,hepatic steatosis and fibrosis,atherogenesis,and ASCVD risk in men and women with NAFLD,as well as to assess the impact of>5%weight reduction on these parameters.METHODS An open-label,multicenter,international noncomparative trial was carried out at primary health care settings and included 174 patients with ultrasound-diagnosed NAFLD who received 15 mg/kg/d UDCA for 6 mo and were prescribed lifestyle modification with diet and exercise.The efficacy criteria were liver enzymes,lipid profile,fatty liver index(FLI),noninvasive liver fibrosis tests(nonalcoholic fatty liver disease fibrosis score and liver fibrosis index),carotid intima-media thickness(CIMT),and ASCVD risk score.To test statistical hypotheses,the Wilcoxon test,paired t-test,Fisher’s exact test,and Pearson's chi-squared test were used.RESULTS The alanine aminotransferase(ALT)level changed by-14.1 U/L(-31.0;-5.3)from baseline to 3 mo and by-6.5 U/L(-14.0;0.1)from 3 to 6 mo.The magnitude of ALT,aspartate transaminase,and glutamyltransferase decrease was greater during the first 3 mo of treatment compared to the subsequent 3 mo(P<0.001,P<0.01,P<0.001,respectively).At 6 mo,in the total sample,we observed a statistically significant decrease in body weight and levels of FLI:84.9±10.4 vs 72.3±17.6,P<0.001,total cholesterol:6.03±1.36 vs 5.76±1.21,Р<0.001,lowdensity lipoprotein:3.86±1.01 vs 3.66±0.91,Р<0.001,and triglyceride:3.18(2.00;4.29)vs 2.04(1.40;3.16),Р<0.001.No effect on nonalcoholic fatty liver disease fibrosis score or liver fibrosis index was found.The CIMT decreased significantly in the total sample(0.985±0.243 vs 0.968±0.237,P=0.013),whereas the highdensity lipoprotein(Р=0.036)and 10-year ASCVD risk(Р=0.003)improved significantly only in women.Fifty-four patients(31%)achieved>5%weight loss.At the end of the study,the FLI decreased significantly in patients with(88.3±10.2 vs 71.4±19.6,P<0.001)and without>5%weight loss(83.5±10.3 vs 72.8±16.7,P<0.001).The changes in ALT,aspartate transaminase,glutamyltransferase,total cholesterol,and low-density lipoprotein levels were similar between the subgroups.CONCLUSION UDCA normalizes liver enzymes greatly within the first 3 mo of treatment,improves lipid profile and hepatic steatosis independent of weight loss,and has a positive effect on CIMT in the total sample and 10-year ASCVD risk in women after 6 mo of treatment.

血脂水平波动的危险因素及其与ASCVD的关系研究进展

血脂水平波动受多种危险因素的影响,除了受年龄和性别、妊娠和遗传、气象因素等不可干预的危险因素影响外,还与吸烟和饮酒、超重和肥胖、体重指数、饮食和运动、药物因素、高血压、糖尿病、高尿酸血症等可干预的危险因素密切相关,血脂异常增加了动脉粥样硬化性心血管疾病(ASCVD)的发生风险,定期健康体检监测血脂水平的动态变化、早期发现血脂异常,采取综合的管理措施以降低或延缓ASCVD的进程。

立足分级诊疗的血脂异常管控体系的建立与推广

血脂异常是动脉粥样硬化性疾病重要的危险因素。回顾历史,从把不同类型的血脂指标作为心血管疾病风险预测标志物,到以低密度脂蛋白胆固醇为主要降脂靶点应用于心血管疾病的一级预防及二级预防,相关研究和临床实践提示立足分级诊疗的血脂异常管控体系是进行有效血脂管控、切实降低心脑血管疾病的重要措施。不断优化心血管疾病预测模型、加强血脂异常专病医联体建设、推广立足分级诊疗的血脂异常管控体系将有助于提升我国血脂异常整体防治水平,达到心血管疾病防治的重心下沉、关口前移,降低心血管疾病对我国居民的健康威胁。

准分子激光消蚀术在药物球囊扩张成形术治疗冠状动脉粥样硬化性心脏病中的应用

目的:探讨准分子激光消蚀术(ELCA)在药物球囊扩张成形术(DCB)治疗冠状动脉粥样硬化性心脏病(简称冠心病)中的应用价值。方法:选取2020年5月至2022年5月诊治的86例冠心病患者作为研究对象,采用随机数排秩法分为观察组(予以DCB联合ELCA治疗)与对照组(予以单纯DCB治疗),各43例。对比2组治疗前后肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)、B型脑钠肽(BNP)、氨基末端脑钠肽前体(NT-proBNP)、小而密低密度脂蛋白(sd-LDL)、生长分化因子15(GDF-15)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)以及治疗后1 a内主要心血管不良事件(MACE)发生率。结果:治疗后观察组CK-MB、cTnⅠ、BNP、NT-proBNP、sd-LDL、GDF-15、LVESD、LVEDD降低的程度,LVEF升高的程度,均大于对照组(P<0.05)。观察组治疗后1 a内MACE发生率低于对照组(P=0.019)。结论:ELCA联合DCB治疗冠心病效果显著,有利于改善心功能和减轻心肌损伤,并降低MACE发生率。