Personalized smart voice-based electronic prescription for remote at-home feedback management in cardiovascular disease rehabilitation: a multi-center randomized controlled trial.

Objective: To investigate the quality and efficacy of remote at-home rehabilitation for patients with cardiovascular disease (CVD) using personalized smart voice-based electronic prescription, and further explore the standardized health management mode of remote family cardiac rehabilitation. Trial design: A multicenter, randomized (1:1), non-blind, parallel controlled study. Methods: A total of 171 patients with CVD who were admitted to 18 medical institutions in China from April 2021 to October 2022 were randomly divided into a treatment group (86 cases) and a control group (85 cases) in a non-blinded experiment, based on the sequence of enrollment. The control group received routine at-home rehabilitation training, and the treatment group received remote feedback-based at-home cardiac rehabilitation management based on routine at-home rehabilitation training. The primary outcome was the difference in VO2peak (mL/min/kg) after 12 weeks. A linear mixed model was developed with follow-up as the dependent variable. Age and baseline data were utilized as covariates, whereas hospital and patient characteristics were adjusted as random-effect variables. As the linear mixed model can accommodate missing data under the assumption of random missing data, there was no substitute missing value for quantitative data. Results: A total of 171 participants, with 86 in the experimental group and 85 in the control group, were included in the main analysis. The analysis, which used linear mixing model, revealed significant differences in cardiopulmonary function indexes (VO2/kg peak, VO2peak, AT, METs, and maximum resistance) at different follow-up time (0, 4, and 12 weeks) in the experimental group (p < 0.05). In the control group, there was no significant difference in cardiopulmonary values at different follow-up time (0, 4, and 12 weeks; p > 0.05). VO2/kg peak (LS mean 1.49, 95%CI 0.09-2.89, p = 0.037) and other indicators of cardiopulmonary function (p < 0.05) were significantly different between the experimental group and the control group at week 12. The results were comparable in the complete case analysis. Conclusion: The remote home cardiac rehabilitation management mode using personalized smart voice-based electronic prescription provides several benefits to patients, including improvements in muscle strength, endurance, cardiopulmonary function, and aerobic metabolism. It also helps reduce risk factors for cardiovascular disease and enhances patients' self-management abilities and treatment compliance.Clinical trial registration: http://www.chictr.org.cn, identifier ChiCTR2100044063.

Genetic Polymorphism of Matrix Metalloproteinase-9 and Susceptibility to Myocardial Infarction: A Meta-Analysis.

OBJECTIVE: Current findings on the association between MMP-9 rs3918242 and susceptibility to myocardial infarction (MI) are inconsistent, and their definite relationship is discussed in this meta-analysis. METHODS: Eligible literatures reporting MMP-9 rs3918242 and susceptibility to MI were searched in PubMed, Cochrane Library, CNRI, and VIP using keywords such as "MMP-9", "matrix metallopeptidase-9" and "myocardial infarction", "acute myocardial infarction", "AMI", and "polymorphism". Data from eligible literatures were extracted for calculating OR and corresponding 95% CI using RevMan 5.3 and STATA12.0. RESULTS: Ten independent literatures reporting MMP-9 rs3918242 and susceptibility to MI were enrolled. Compared with subjects carrying CT&TT genotype of MMP-9 rs3918242, susceptibility to MI was lower in those carrying CC genotype (OR = 1.49, 95%CI = 1.19-1.86, P = 0.0004). Such a significance was observed in the overdominant (OR = 1.27, 95%CI = 1.14-1.41, P < 0.0001) and allele genetic models (OR = 1.43, 95%CI = 1.17-1.74, P = 0.0005) as well. This finding was also valid in the Asian population. CONCLUSIONS: Mutation on MMP-9 rs3918242 has a potential relevance with susceptibility to MI.

Circulating miR-29b decrease in response to sarcopenia in patients with cardiovascular risk factors in older Chinese.

Introduction: Sarcopenia is a clinical syndrome characterized by a progressive and extensive decline in skeletal muscle mass, muscle strength, and function. Sarcopenia and cardiovascular diseases (CVDs) can coexist, which further decreases the quality of life of patients, and increases the mortality rate. MicroRNAs (miRNAs) are unique posttranscriptional regulators of gene expression whose function in aging-related sarcopenia and CVDs has recently begun to unravel. The aim of the present study is to investigate the relationship between sarcopenia and cardiovascular risk factors (CVRF) in the Chinese elderly and describe the circulating miRNAs in sarcopenia patients with the intention of identifying novel diagnostic and therapeutic tools. Methods: The well-established CVRF of diabetes, hypertension, and dyslipidemia were assessed. Multiple logistic regression analyses and linear regressions were used to evaluate the components of CVRF and the number of CVRF in elderly patients with sarcopenia. Moreover, we used real-time RT-PCR to measure the abundance of the CVRF-related miRNAs in the plasma of a cohort of 93 control and sarcopenia individuals, including miR-29b, miR-181a, and miR-494. Results: We found that CVRF was associated with a high prevalence of sarcopenia in elderly Chinese populations After adjusting for potential confounders. Furthermore, hypertension and dyslipidemia, but not diabetes, were found to be significantly associated with sarcopenia. A linear increase in the prevalence of sarcopenia was found to be associated with the number of CVRF components in the elderly population. We found that plasma miR-29b levels were significantly down-regulated in response to sarcopenia in the elderly with CVRF. In particular, there was a remarkable correlation between miR-29b and appendicular skeletal muscle mass (ASM)/height2. Collectively, knowledge of CVRF, particularly hypertension and dyslipidemia, may help predict the risk of sarcopenia in the elderly. Our data also show that circulating miR-29b can be considered as possible biomarkers for sarcopenia, which may also be used in the CVD assessment of these patients. Discussion: We found that the prevalence of sarcopenia was significantly proportional to the number of CVRF components. In particular, hypertension and dyslipidemia were significantly associated with a higher risk of sarcopenia in the adjusted models. Moreover, our study has been proven that c-miRNAs may be considered as possible biomarkers for sarcopenia as a new diagnostic tool to monitor response to treatment. There is also a pressing need for further research on sarcopenia and CVRF to understand their relationship and mechanism. These can provide more evidence to develop potential interventions to improve clinical outcomes.

Association of stent diameter and target vessel revascularization in patients undergoing percutaneous coronary intervention: a secondary retrospective analysis based on a Chinese cohort study.

BACKGROUND: In the treatment of coronary heart disease, target vessel revascularization (TVR) has attracted increasing attention as an efficient means of percutaneous coronary intervention (PCI). The purpose of this study was to explore the association between stent diameter and TVR in patients undergoing PCI. METHODS: This was a secondary retrospective analysis involving patients with PCI with at least one stent implanted. Information was obtained from the Dryad Digital Repository. Multivariable logistic regression models, interaction analyses, subgroup analyses and piecewise linear regression models were used to evaluate the association between stent diameter and TVR. RESULTS: A total of 2522 patients were eventually enrolled in this study, of which 122 (4.8%) had undergone TVR. Significant positive associations were observed between stent diameter and TVR (continuous: odds ratio [OR] 0.485, 95% confidence interval [CI] 0.305-0.773, P = 0.002; categorical variable: T2 vs. T1, OR 0.541, 95% CI 0.348-0.843; T3 vs. T1, OR 0.520, 95% CI 0.334-0.809; P for trend = 0.005). The association remained stable in the fully adjusted model (continuous: OR 0.526, 95% CI 0.306-0.902, P = 0.020; categorical variable: T2 vs. T1, OR 0.510, 95% CI 0.310-0.839; T3 vs. T1, OR 0.585, 95% CI 0.352-0.973; P for trend = 0.042). Among the subgroups of differing clinical presentations, stent diameter was a powerful protective factor for TVR, especially in the delayed PCI group (P for interaction = 0.002). The association was highly consistent across all the other subgroups studied (all P for interaction > 0.05). In the piecewise linear regression model, the need for TVR decreased with an increase in stent diameter when this ranged between 2.5 and 2.9 mm (OR 0.01, 95% CI: 0.01-0.13, P < 0.001). CONCLUSIONS: A large stent diameter is a powerful protective factor for TVR in PCI patients, especially in the delayed PCI group. This "bigger-is-better" protective effect is remarkable in stents with diameter 2.5-2.9 mm.

Increasing Fracture Risk Associates With Plasma Circulating MicroRNAs in Aging People's Sarcopenia.

Aging generally coincides with a gradual decline in mass and strength of muscles and bone mineral density (BMD). Sarcopenia is closely linked to osteoporosis in the elderly, which can lead to abnormal gait, balance disorders, and dysfunctions, as well as increase in the risks of falls, fractures, weakness, and death. MicroRNAs (miRNAs, miRs) are a kind of short and non-coding RNA molecules but can regulate posttranscriptional protein expression. However, we have known little about their participation in age-associated osteoporosis and sarcopenia. The current study aims to confirm those miRNAs as biomarkers for age-related reduction in muscular atrophy associated with human blood fractures. In our study, 10 fracture-risk-related miRNAs (miR-637, miR-148a-3p, miR-125b-5p, miR-124-3p, miR-122-5p, miR-100-5p, miR-93-5p, miR-21-5p, miR-23a-3p, and miR-24-3p) were analyzed. For the initial screening, we determined the abundance of fracture-risk-associated miRNAs by RT-PCR most frequently detected in enrolled 93 elderly with sarcopenia and non-sarcopenia, respectively. Statistically, the relative expression levels of plasma miR-23a-3p, miR-93-5p, and miR-637 in the sarcopenia group were significantly lower than that in the non-sarcopenia group, while the levels of other miRNAs did not change significantly. Moreover, we showed that the levels of ASM/height2, handgrip strength, and 4-m velocity in the sarcopenia group were significantly lower than in the non-sarcopenia group. Whereafter, we expanded the sample for further detection and analysis and revealed that the levels of plasma miR-23a-3p, miR-93-5p, and miR-637 in the sarcopenia group were significantly lower than that in the non-sarcopenia group, which is consistent with the initial screening experiment. From our analysis, changes in levels of plasma miR-93-5p and miR-637 were dramatically related to ASM/height2. Furthermore, changes in miR-23a and miR-93-5p were significantly affected by ASM/height2 in female individuals, with no significant correlations between miRNAs changes and these diagnostic indexes in male individuals after adjusting sex. The study showed that plasma miRNAs changed in an aging-related sarcopenia manner and were associated with increased fracture risk. In aging patients, plasma miR-23a-3p, miR-93-5p, and miR-637 have the potential as biomarkers of sarcopenia, which can affect the development of physiological dysfunction and may be also used in the fracture risk assessment of these patients.

Association between sleep disturbance with motoric cognitive risk syndrome in Chinese older adults.

BACKGROUND AND PURPOSE: Sleep disturbance and cognitive impairment are common and related in the elderly population worldwide. The aim of the present study was to explore the association between sleep disturbance and motoric cognitive risk (MCR) syndrome, which is characterized by subjective cognitive complaints and objective slow gait in older individuals without dementia or any mobility disability in the community-dwelling elderly Chinese population. METHODS: We recruited 940 participants aged ≥65 years from November 2016 to March 2017 in the Ningbo Community Study on Aging (NCSA). Self-reported sleep duration and sleep-quality variables, comprehensive geriatric evaluation, as well as indicators for diagnosing MCR syndrome were evaluated in this cross-sectional study. RESULTS: Multiple logistic regression analysis showed that a 1-SD increase in night (1.1 h) and 24-h sleep duration (1.3 h) was associated, respectively, with a 21% (95% confidence interval [CI], 1%-47%; p = 0.04) and 30% (95% CI, 3%-64%; p = 0.03) higher odds of having MCR syndrome. Considering sleep duration as a categorical variable, longer night-sleep duration (>8.5 h) was associated with MCR syndrome (OR, 2.03; p = 0.02) compared to shorter night-sleep duration (<8 h). For sleep-quality factors, increasing frequency of trouble falling asleep, waking early or easily, nightmares, and taking sleep drugs were significantly associated with MCR syndrome after adjusting for potential covariables (all p for trend < 0.05), but not for self-perceived sleep quality (p for trend = 0.10). CONCLUSIONS: Long sleep duration, poor sleep quality, and taking sleep drugs were associated with higher odds of having MCR syndrome in the community-dwelling elderly Chinese population. Further research is needed to explore the underlying mechanisms.

Predictive Value of Blood Interleukin-6 Level in Patients with Acute Coronary Syndrome: A Meta-analysis.

OBJECTIVE: Conflicting results have been reported on the association between blood level of interleukin-6 and adverse outcomes in patients with acute coronary syndrome (ACS). The current meta-analysis aimed to evaluate the predictive utility of elevated blood interleukin-6 level in patients with ACS. METHODS: A systematically literature search was performed using PubMed and Embase databases up to December 31, 2019. Observational studies or post hoc analysis of randomized controlled trials investigating the values of blood interleukin-6 level for predicting major adverse cardiovascular events (MACE including death, re-infarction, revascularization, angina, heart failure, malignant arrhythmia, or stroke), all-cause mortality or cardiovascular mortality in ACS patients were eligible. The predictive values were summarized by pooling the multivariable-adjusted risk ratio (RR) and 95% confidence intervals (CI) for the highest versus lowest category of interleukin-6 level. RESULTS: Thirteen studies enrolling 30,289 patients with ACS were included. When comparing the highest with lowest category of interleukin-6 level, the pooled RR was 1.29 (95% CI 1.12-1.48) for MACE, 1.50 (95% CI 1.35-1.67) for all-cause mortality, and 1.55 (95% CI 1.06-2.28) for cardiovascular mortality, respectively. Moreover, the predictive values of interleukin-6 level on MACE were consistently found in different study designs, subtypes of patients, sample sizes, follow-up duration, and cutoff value of interleukin-6 elevation subgroups. CONCLUSION: Increased blood level of interleukin-6may be independently associated with higher risk of MACE, cardiovascular and all-cause mortality in patients with ACS. Measurement of blood interleukin-6 level has potential to improve risk stratification of ACS.

Prognostic value of geriatric nutritional risk index in elderly patients with heart failure: a meta-analysis.

BACKGROUND: Geriatric Nutritional Risk Index (GNRI) is a promising tool for predicting nutrition-related complications. This meta-analysis sought to determine the prognostic utility of GNRI in elderly patients with heart failure. METHODS: We comprehensively searched the PubMed and Embase databases from their inception to July 2019. Original studies investigating the prognostic value of GNRI in patients with heart failure were included. Outcome of interests were all-cause mortality and major cardiovascular events. The prognostic value of GNRI was expressed as risk ratios (RR) with 95% confidence intervals (CI) for the lowest versus the highest GNRI category or continuous GNRI analysis. RESULTS: Eleven articles (10 studies) involving 10,589 elderly heart failure patients were included. Meta-analysis indicated that heart failure patients with the lowest GNRI had an increased risk of all-cause mortality (RR 2.11; 95% CI 1.72-2.58) and major cardiovascular events (RR 2.00; 95% CI 1.24-3.22) after adjustment for confounding. In addition, each unit reduction in GNRI significantly increased 6% risk of all-cause mortality. CONCLUSION: Lower GNRI independently predicts all-cause mortality and major cardiovascular events in elderly patients with heart failure. Determination of nutritional status using GNRI may improve risk stratification in elderly patients with heart failure.

Exercise Mediates Heart Protection via Non-coding RNAs.

Cardiovascular diseases (CVDs) have become the central matter of death worldwide and have emerged as a notable concern in the healthcare field. There is accumulating evidence that regular exercise training can be as a reliable and widely favorable approach to prevent the heart from cardiovascular events. Non-coding RNAs (ncRNAs) could act as innovative biomarkers and auspicious therapeutic targets to reduce the incidence of CVDs. In this review, we summarized the regulatory effects of ncRNAs in the cardiac-protection provided by exercise to assess potential therapies for CVDs and disease prevention.

Circulating MicroRNAs in Plasma Decrease in Response to Sarcopenia in the Elderly.

sarcopenia has been defined as the aging-related disease with the declined mass, strength, and function of skeletal muscle, which is a major cause of morbidity and mortality in elders. Current diagnostic criteria of sarcopenia have not been agreed internationally, and the clinical diagnostic biomarkers for sarcopenia have not been identified. Circulating miRNAs (miRNAs, miRs) have recently been characterized as novel biomarkers for sarcopenia. However, the change of circulating miRNAs in response to sarcopenia are still not fully understood. Here, we enrolled a total of 93 elderly patients clinically diagnosed with sarcopenia and matching 93 non-sarcopenia elderly in this study. Specifically, levels of candidate circulating miRNAs which were involved in angiogenesis, inflammation and enriched in muscle and/or cardiac tissues were detected in these two groups. In small-sample screening experiments, plasma miR-155, miR-208b, miR-222, miR-210, miR-328, and miR-499 levels were significantly down-regulated in sarcopenia compared to those who non-sarcopenia. In contrast, miR-1, mir-133a, miR-133b, miR-21, miR-146a, miR-126, miR-221, and miR-20a were not changed significantly. Subsequently, we expanded the sample size to further detection and verification, and found that plasma miR-155, miR-208b, miR-222, miR-210, miR-328, and miR-499 levels in the sarcopenia group were significantly reduced compared to the non-sarcoma group, which is consistent with the results of the small-sample screening experiment. In addition, we showed that ASM/Height2, handgrip strength, knee extension and 4-meter velocity in sarcopenia group were significantly lower than those in non-sarcopenia group. Here we correlated the decrease of miR-208b, miR-499, miR-155, miR-222, miR-328, and miR-210 in sarcopenia group and non-sarcopenia group with diagnostic indexes of sarcopenia (ASM/Height2, Handgrip strength and 4-meter velocity) after adjusting sex. The results showed that miR-208b and miR-155 changes were significantly correlated with handgrip strength in woman, miR-208b, miR-499, and miR-222 changes were significantly correlated with ASM/Height2 in man, while other miRNAs changes did not show a strong correlation with these diagnostic indexes. In conclusion, plasma miR-208b, miR-499, miR-155, miR-222, miR-328, and miR-210 decrease in response to sarcopenia in the elderly. Although further studies are needed to clarify the potential use of circulating miRNAs as biomarkers of sarcopenia, present findings set the stage for defining circulating miRNAs as biomarkers and suggesting their physiological roles in elderly with sarcopenia.

Protective effects of glucagon-like peptide-1 on cardiac remodeling by inhibiting oxidative stress through mammalian target of rapamycin complex 1/p70 ribosomal protein S6 kinase pathway in diabetes mellitus.

AIMS/INTRODUCTION: Although increased reactive oxygen species (ROS) generation is a major mechanism leading to cardiac remodeling in diabetes mellitus, research into the effects of anti-oxidation on diabetic cardiac remodeling remains scarce and controversial. Glucagon-like peptide-1 (GLP-1) shows potential anti-oxidative effects besides lowering blood glucose. The objective of this research was to investigate the effects of GLP-1 on cardiac remodeling and the molecular mechanism involved in diabetes mellitus. MATERIALS AND METHODS: Streptozotocin-induced diabetic rats received exenatide treatment for 3 months. Cardiac function, cardiac weight index and myocardial interstitial fibrosis were measured. Cardiomyocytes were cultured in high-glucose medium with GLP-1 treatment. The ROS production, apoptosis and the levels of mammalian target of rapamycin complex 1/p70 ribosomal protein S6 kinase protein expression in cardiomyocytes were analyzed. RESULTS: Experimental diabetes mellitus showed impaired cardiac diastolic function, increased brain natriuretic peptide expression and increased interstitial collagen deposition in the myocardium, which were ameliorated by exenatide treatment. Exenatide reduced myocardial ROS production and apoptosis in diabetes mellitus. Also, high glucose-induced ROS generation and apoptosis in cardiomyocytes were inhibited by GLP-1, as well as the levels of mammalian target of rapamycin complex 1/p70 ribosomal protein S6 kinase phosphorylation. Furthermore, GLP-1 treatment upregulated adenosine monophosphate-activated protein kinase activity in high-glucose-induced cardiomyocyte. CONCLUSIONS: Glucagon-like peptide-1 protects the cardiomyocytes from oxidative stress and apoptosis in diabetes mellitus, which might contribute to the improvement of cardiac remodeling. The cardiac protection of GLP-1 might be dependent on inhibition of mammalian target of rapamycin complex 1/p70 ribosomal protein S6 kinase, through an adenosine monophosphate-activated protein kinase-mediated pathway.