Serum lipoprotein(a) predicts 1-year major cardiovascular events in patients after percutaneous coronary intervention.

BACKGROUND: Lipoprotein(a) [Lp(a)], which is predictive of coronary heart disease (CHD), plays an important role in the pathogenesis of atherosclerosis. This study aimed to evaluate the association of Lp(a) with major adverse cardiovascular events (MACEs) and readmission in individuals who had undergone a percutaneous coronary intervention (PCI). METHODS: A total of 1,938 patients with CHD who had undergone a PCI from January 2010 to December 2018 were assigned to three groups based on Lp(a) level. Follow-up was performed to assess the 1-year occurrence of MACEs and readmission. RESULTS: Kaplan-Meier survival curves showed that the cumulative hazard incidence rate of MACEs and repeat PCI (re-PCI) significantly increased with Lp(a) level. Multivariate Cox proportional hazards regression analysis further confirmed Lp(a) as a significant independent predictor of MACEs. The area under the curve of the complex index risk score was significantly larger than those of other independent indicators. In individuals with low-density lipoprotein-cholesterol (LDL-C) levels either below 70 mg/dL or between 70 mg/dL and 100 mg/dL, Lp(a) was associated with increased rates of MACEs and readmission. In addition, a nomogram was constructed to predict 1-year MACE. CONCLUSIONS: High Lp(a) levels may be a residual risk factor for MACEs in individuals with LDL-C levels under 100 mg/dL. Additionally, the built nomogram could predict 1-year MACEs with high accuracy. Lp(a) independently predicts 1-year MACEs, indicating its importance in risk assessment and the selection of clinical strategies in patients who have undergone a PCI.

Dawning public health services dogma: An indigenous Southwest Chinese perspective in managing hypertension-with or without the "BPHS"?

Background: To alleviate the rising mortality burden due to hypertension and other non-communicable diseases, a new public health policy initiative in 2009 called the Basic Public Health Services (BPHS). Program was introduced by the Chinese government. The goal of the study is to assess the feasibility and impact of a nationwide health care service-the "BPHS". Methods: From January to December 2021, a stratified multistage random sampling method in the survey was conducted to select 6,456 people from 8 cities/districts in Yunnan Province, China, who were above the age of 35 years. 1,521 hypertensive patients were previously aware of their high blood pressure status were matched to the BPHS program database based on ID number and then further divided into BPHS group and non-BPHS (control) group. The results of the current study are based on their responses to a short structured questionnaire, a physical examination, and laboratory tests. The association between BPHS management and its effect on the control of hypertension was estimated using multivariable logistic regression models. We evaluated the accessibility and efficacy of BPHS health care services by analyzing various variables such as blood pressure, BMI, lifestyle modification, anti-hypertensive drugs taken, and cardiovascular risk factors. Results: Among the 1,521 hypertensive patients included in this study, 1,011 (66.5%) were managed by BPHS programme. The multivariable logistic regression model demonstrated that the BPHS facilitated hypertension control (OR = 1.640, 95% CI: 1.237-2.175). A higher proportion of participants receiving lifestyle guidance from the BPHS management showed lowering of total cholesterol. In comparison to the non-BPHS group, those under BPHS management adhered better to antihypertensive medications either single drug (54.3%) or in combination (17.3%) of drugs. Additionally, we also noticed that urban areas with centralized and well-established digital information management system had better hypertension treatment and control. Conclusions: Nearly two-thirds of the hypertensive patients in Yunnan Province were included in BPHS management. The impact of the national BPHS program was evident in lowering risk factors for cardiovascular diseases, promoting healthy lifestyles, lowering blood pressure, increasing medication adherence, and the better control rate of hypertension.

ER stress induces myocardial dysfunction and cardiac autophagy in Sestrin2 knockout mice.

OBJECTIVES: Sestrin2 is an essential regulator of the cellular adaptive response against various stresses. The endoplasmic reticulum (ER) is critical in maintaining normal cardiac function by controlling intracellular Ca2+ accumulation, as well as protein folding and processing. Autophagy contributes to stress-associated heart dysfunction. AMP-activated protein kinase (AMPK) is important in energy homeostasis in cardiomyocytes. However, the function of Sestrin2 (Sesn2) in ER stress-induced autophagy that induces myocardial dysfunction has not been clarified. In this study, mice and cardiac tissues were treated with tunicamycin (TN), an inducer of ER stress. We then explored the roles of Sesn2 and the AMPK pathway associated with autophagy in ER stress-induced myocardial dysfunction in mice. METHODS: Echocardiography, contractile function analysis, intracellular Ca2+ status, and immunoblot analysis of AMPK pathway were performed, ER stress and autophagy markers were examined. RESULTS: The study revealed that ER stress caused significant heart dysfunction and cardiotoxicity in the mouse heart and cardiomyocytes. Biochemical analysis indicated enhanced cardiac autophagy mediated by ER stress and AMPK/mTOR activation. Sesn2 knockout exacerbated ER stress-related myocardial dysfunction due to the failed response of cardiac autophagy and AMPK/mTOR pathway activation. Further, pharmacological inhibition of AMPK or autophagy worsened TN-induced cardiac dysfunction. CONCLUSION: Taken together, loss of the Sesn2 protein exacerbates ER stress-induced cardiac dysfunction through the AMPK/mTOR signaling cascade and loss of autophagy response.

A Detailed Study to Discover the Trade between Left Atrial Blood Flow, Expression of Calcium-Activated Potassium Channels and Valvular Atrial Fibrillation.

Background: The present study aimed to explore the correlation between calcium-activated potassium channels, left atrial flow field mechanics, valvular atrial fibrillation (VAF), and thrombosis. The process of transforming mechanical signals into biological signals has been revealed, which offers new insights into the study of VAF. Methods: Computational fluid dynamics simulations use numeric analysis and algorithms to compute flow parameters, including turbulent shear stress (TSS) and wall pressure in the left atrium (LA). Real-time PCR and western blotting were used to detect the mRNA and protein expression of IKCa2.3/3.1, ATK1, and P300 in the left atrial tissue of 90 patients. Results: In the valvular disease group, the TSS and wall ressure in the LA increased, the wall pressure increased in turn in all disease groups, mainly near the mitral valve and the posterior portion of the LA, the increase in TSS was the most significant in each group near the mitral valve, and the middle and lower part of the back of the LA and the mRNA expression and protein expression levels of IKCa2.3/3.1, AKT1, and P300 increased (p < 0.05) (n = 15). The present study was preliminarily conducted to elucidate whether there might be a certain correlation between IKCa2.3 and LA hemodynamic changes. Conclusions: The TSS and wall pressure changes in the LA are correlated with the upregulation of mRNA and protein expression of IKCa2.3/3.1, AKT1, and P300.

Effect of 2 Different Dosages of Rosuvastatin on Prognosis of Acute Myocardial Infarction Patients with New-Onset Atrial Fibrillation in Jinan, China.

BACKGROUND Atrial fibrillation (AF) often occurs in patients with acute myocardial infarction (AMI). This study aimed to observe the influence of different dosages of rosuvastatin on the prognosis of AMI patients with AF. MATERIAL AND METHODS We performed an observational, retrospective cohort study in Jinan, China, in which 323 AMI patients were recruited. All patients were randomized to receive optimal medication treatment and 10 mg or 20 mg of rosuvastatin. Holter monitor results, serum lipid levels, and heart function were recorded. We used multivariate Cox and Kaplan-Meier analyses to assess the independent factors and differences in AF and ischemia events and safety of rosuvastatin administered at different dosages. RESULTS TC, LDL-C, and TG at 1 and 12 months were significantly lower compared with those observed prior to treatment in both groups. The heart function of both groups was significantly improved after 12 months of treatment, especially in the 20 mg group. Multivariate Cox analysis showed that different dosages of rosuvastatin, age, smoking, drinking alcohol, and diabetes are independent factors related to the occurrence of AF and ischemic events. In addition, according to Kaplan-Meier analysis, no significant difference in adverse clinical events existed at different dosages of rosuvastatin. CONCLUSIONS Treatment with rosuvastatin can reduce the serum lipid level and improve cardiac function. Different dosages of rosuvastatin, age, smoking, drinking alcohol, and diabetes are independent risk factors for AF and ischemia events. The results suggested it is safe to use 20 mg rosuvastatin in the 12 months after hospital admission.

Different postconditioning cycles affect prognosis of aged patients undergoing primary percutaneous coronary intervention.

BACKGROUND: Postconditioning can affect the infarct size in acute myocardial infarction (AMI). How-ever, few studies show an effect of different postconditioning cycles on AMI aged patients. This study sought to assess the effect of different postconditioning cycles on prognosis in aged patients with AMI who underwent primary percutaneous coronary intervention (PCI). METHODS: Seventy four aged patients were randomly assigned to three groups. Control group; PC-1 group accepted postconditioning 4 cycles of 30 s inflation and 30 s deflation; PC-2 group accepted postconditioning 4 cycles of 60 s. Creatine kinase MB (CK-MB), troponin I (cTnI), high-sensitive C-reactive protein (hs-CRP) and corrected Thrombolysis in Myocardial Infarction (TIMI) frame counts (CTFC) were analyzed before and after treatment. All patients received an echocardiographic examina-tion for whole heart function, wall motion score index (WMSI) and single-photon emission computed tomography (SPECT) examination at 7 days and 6 months after treatment. RESULTS: The peak of CK-MB, postoperative 72 h cTnI and CTFC were significantly attenuated by postconditioning when compared with the control group. The hs-CRP of the postconditioning group was lower than the control group 24 h postoperative. No difference was observed between PC-1 and PC-2 group about the effect described above. At 7 days, heart function in the postconditioning group was im-proved when compared with the control group. At 6 months, the WMSI and SPECT score significantly reduced in the PC-2 group compared with the control and PC-1 groups, but there was no difference among the three groups about echo data except the left ventricular end-systolic diameter. CONCLUSIONS: Postconditioning is significantly beneficial to prognosis in aged patients with AMI. The cardiac protective effect of 4 cycles of 60 s procedure was observed in WMSI and SPECT. It is favorable to implement this procedure in aged patients with AMI in clinic.