Cardiovascular Diseases

Despite advancements in antimicrobial and anti-inflammatory treatments, inflammation and its repercussions continue to pose a considerable challenge in medicine. Acute inflammation may cause life-threatening conditions like septic shock, while chronic inflammation leads to tissue degeneration and impaired function. Lipopolysaccharides (LPS), a well-known pathogenic trigger contributing to several dysfunctions, is a crucial part of the outer membrane of gr-negative bacteria. LPS are well-known for eliciting acute inflammatory responses by activating a pathogen-associated molecular pattern (PAMP), which stimulates the innate immune system and triggers local or systemic inflammatory responses. LPS also activate numerous intracellular molecules that modulate the expression of a wide range of inflammatory mediators. These mediators subsequently initiate or exacerbate various inflammatory processes. Beyond immune cells, LPS can also activate non-immune cells, leading to inflammatory reactions. These excessive inflammatory responses are often detrimental and typically result in chronic and progressive inflammatory diseases, including neurodegenerative, cardiovascular diseases, and cancer. This review delves into the mechanisms by which the bacterial endotoxin LPS contribute to multiple inflammatory diseases. These insights into LPS signaling pathways could inform the design of new treatment strategies such as TLR4, NLRP3, HMGA1, MAPK, and NF-kB inhibitors. This enables precise targeting of inflammation-related processes in disease management.

Factors related to diet, particularly the intake of fats through various sources, significantly influence cardiovascular diseases. This review examined the existing evidence and the mechanisms by which dietary fats affect cardiovascular diseases. A search was conducted in PubMed, Web of Science, and Scopus using relevant keywords, and the results of 16 studies up to 2024 were analyzed. This study's findings indicated that dietary fats' impact on the composition of plasma lipoproteins and inflammation are two key mechanisms in the development of cardiovascular diseases. Saturated and trans fatty acids are associated with an increased risk of these diseases due to their role in raising LDL levels and stimulating inflammatory pathways. Conversely, omega-3 fatty acids reduce the risk of cardiovascular diseases by clearing triglyceride-rich lipoproteins and decreasing pro-inflammatory eicosanoids. On the other hand, excessive consumption of omega-6 fatty acids and an imbalance between omega-3 and omega-6 can increase the risk of these diseases by promoting chronic inflammation. Additionally, omega-9 fatty acids reduce inflammation and cardiovascular disease risk by inducing antioxidant pathways and decreasing the production of pro-inflammatory mediators. Overall, the findings of this study suggest that improving the lipid profile and managing inflammation through changes in the types of fatty acids consumed can be associated with a reduction in the burden of cardiovascular diseases and an improvement in the overall health of the community. These findings can guide physicians and nutritionists in designing appropriate dietary plans for patients with cardiovascular diseases.

Metabolic syndrome is a clustering of metabolic abnormalities and anthropometric factors that increase the risk of cardiovascular disease and type 2 diabetes mellitus. As the search for effective treatments intensifies, attention has turned towards natural substances with potential medicinal benefits. Among them, vanillic acid, a phenolic acid present in many plants, has attracted some attention due to its wide range of biological activities. This review aimed to provide an in-depth summary of the potential therapeutic use of vanillic acid in metabolic syndrome. The potential mechanisms of action of vanillic acid, including its anti-oxidant, anti-inflammatory, and hypolipidemic properties, are discussed. The effect of vanillic acid on glucose homeostasis, insulin sensitivity, and adipocyte activity is also addressed. The effect of vanillic acid on lipid metabolism, including the control of lipid synthesis, breakdown, and transport, is also reviewed. The emerging evidence for the beneficial effects of vanillic acid in animal models, in vitro studies, and preliminary clinical studies is also highlighted. The data suggests that vanillic acid has the potential to ameliorate metabolic syndrome. However, further preclinical and clinical research is needed to determine the specific mechanisms of action, appropriate dose, and subsequent advantages of vanillic acid. A more comprehensive understanding of the therapeutic potential of vanillic acid could pave the way for developing innovative techniques for preventing and treating metabolic syndrome and its implications.

Introduction. This study aimed to analyze the correlation between blood pressure variability (BPV), crystalloid osmotic pressure, and cardiovascular events (CEs) in patients undergoing maintenance hemodialysis (MHD). Methods. This retrospective analysis was conducted on 71 patients with end-stage kidney disease who underwent hemodialysis at Beilun District People’s Hospital from September 2021 to September 2022. The patients were divided into two groups based on the occurrence of CEs: a cardiovascular event group and a non-cardiovascular event group. Results. The 71 patients were divided into two groups based on the occurrence of CEs: the CEs group (25 patients who experienced CEs) and the non-CEs group (46 patients who did not experience CEs). The CEs group had significantly higher levels of crystalloid osmotic pressure, standard deviation of systolic BP (SBP-SD), coefficient of variation of SBP (SBP-CV), SD of diastolic BP (DBP-SD), and DBP-CV (P < .05). Multivariate logistic regression analysis identified crystalloid osmotic pressure, SBP-CV, and DBP-CV as independent risk factors for CEs. The ROC curve analysis indicated that the combined predictive value of crystalloid osmotic pressure, SBP-CV, and DBP-CV was significant, with an area under the curve (AUC) of 0.963. Conclusion. Elevated crystalloid osmotic pressure, SBP-CV, and DBP-CV are critical risk factors with strong predictive value for predicting CEs in MHD patients

Elevated blood lipid levels can lead to the deposition of lipids within the vascular walls, resulting in vessel constriction. Prompt and appropriate intervention for hyperlipidemia is crucial not only to prevent the onset of coronary artery narrowing but also to hinder its progression and potentially facilitate its reversal. Many plants, including vegetables and fruits, demonstrate cholesterol-lowering properties attributed to their fiber content. This study aims to identify medicinal plants within Iranian ethnobotanical knowledge that exhibit potential efficacy in managing hyperlipidemia. This review employed reputable databases to aggregate data on phytotherapeutic species with potential efficacy in managing hyperlipidemia. A comprehensive search strategy was implemented, utilizing specific keywords such as 'medicinal plants,' 'blood lipids,' 'hyperlipidemia,' 'phytotherapy,' and 'ethnobotany' in both English and their respective translations. The selected articles underwent a rigorous screening process, adhering to criteria such as publication date within the past twelve years, unrestricted access, and substantial information on the impact of botanical species on hyperlipidemia. Based on the obtained results, it was determined that the medicinal plant's Thymus vulgare, Apium graveolens, Cichorium intybus, Fumaria officinali, Cynodon dactylon, Heracleum rawianum, Anthemis altissima, Gundelia tourneforttii, Anthriscus sylvestris, Silybum marianum, Tragopogon aureus, Trigonella foenum-graecum , Solanum nigrum, Berberis vulgaris, Glycyrrhiza glabra, Cichorium intybus, Arum elongatum, Rheum ribes, Mentha spicata, and several other medicinal plants are used in different regions of Ayaran for hyperlipidemia. The use of indigenous medicinal plants from Iran in the management of hyperlipidemia, grounded in ethnobotanical knowledge, is not only historically significant but also supported by contemporary scientific research. These botanical agents can effectively lower blood lipid levels through various mechanisms, including the inhibition of lipid absorption and the enhancement of metabolic rates. The growing interest in traditional medicine and the utilization of these botanical resources has gained popularity due to their inherent advantages and reduced side effects compared to synthetic pharmaceuticals. Continued scholarly investigation in this area holds promise for the development of innovative and effective therapeutic agents derived from these plants.

It is critical to precisely assess the presence of cardiovascular (CV) risk in military personnel, in order to avoid potentially CV-events. In Iran limited number of studies have been performed on military personnel and their CV-risk. We aimed to investigate correlation between obesity and cardiovascular disease (CVD) risk factors in military personnel.

The present cross-sectional analytical study, analyzed the data of 559 military personnel in Tehran, Iran in 2023. The dataset sourced from the registry system. The biochemical analysis of blood samples was performed by a biomedical analysis company. The univariate regression analyses were conducted through separate univariate linear regression within the obesity group.

The mean age of personnel was 36.58 years. Among obese personel, there was an inverse relationship between age and cholesterol β=-0.11. Moreover, hemoglobin β=-0.68 and MCH β=-0.33 were significantly related to high cholesterol, MCH is associated with risk of metabolic syndrome (β=-0.57). Moreover among obese personnel, lower uric acid levels and higher ALT levels are correlated with an increased risk of Diabetes.

The prevalence of obesity in military personnel was the same as in the general population. Diabetes, hyperlipidemia, high blood pressure, obesity, and metabolic syndrome were all linked to CVD risk factors among military personnel. Although the prevalence of metabolic syndrome in military personnel was lower than their peers in other countries, other risk factors of CVD were prevalent among military personnel.

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.

Context: 

Cardiovascular diseases (CVDs) are among the leading causes of mortality globally, posing unique challenges for dental practitioners. Effective dental care for these patients requires careful planning and adherence to guidelines to prevent complications such as infective endocarditis (IE), excessive bleeding, or cardiovascular emergencies during procedures.

Evidence Acquisition: 

This review synthesizes evidence from clinical guidelines and peer-reviewed studies on managing patients with cardiovascular conditions in dental settings. Focus areas include antibiotic prophylaxis, anticoagulant management, stress reduction, and emergency preparedness.

Key strategies include tailored antibiotic prophylaxis, cautious management of anticoagulants, and minimizing systemic risks through procedural modifications. Dentists must also be prepared to address stress-induced complications and manage emergencies like angina or arrhythmias during procedures.

Interdisciplinary collaboration between dentists and cardiologists is essential for optimizing the safety and outcomes of dental treatments for cardiovascular patients. By adhering to evidence-based protocols, dentists can significantly enhance both oral and systemic health in this patient population.

Context: 

Periodontal disease, a chronic inflammatory condition resulting from bacterial infection, has systemic implications, with one of the most concerning associations being infective endocarditis (IE). The entry of oral pathogens into the bloodstream can lead to heart infections, especially in individuals with.

Evidence Acquisition: 

A thorough review of studies that examine the relationship between periodontal disease and infective endocarditis was conducted. This includes research on microbiological mechanisms, bacteremia, and the epidemiological association of oral infections with heart disease.

The findings confirm that periodontal disease increases the risk of bacteremia, which can contribute to infective endocarditis. Studies showed that endocarditis cases may be linked to oral pathogens, particularly in patients with heart risk factors such as prosthetic heart valves or a history of endocarditis.

The link between periodontal disease and infective endocarditis underlines the importance of maintaining oral health, especially for individuals at increased cardiovascular risk. Effective prevention, including oral hygiene and prophylactic antibiotics, is essential to reduce the incidence of heart-related infections.

To develop a deep learning model to predict the risk of cardiovascular diseases (CVDs) events based on features found in fundus images.

We developed a predicting model for cardiovascular diseases based on retinal fundus images using the deep learning method. We trained our model using 2,091 retinal fundus images obtained from 211 patients. Our dataset included demographic information of each person, conventional CVD risk factors, CVD risk estimated number (calculated using the Framingham method), strokes and heart attack incidents during 5 years (patients who were referred to the ICU or CCU), and retinal fundus images for each person. We used receiver operating characteristic (ROC) analysis to assess the accuracy of our classification model.

Our proposed algorithm was able to identify high-risk individuals from no-risk individuals with 83% accuracy and a high confidence level (AUC = 0.91, P value < 0.0001). The results also showed that our model could predict cardiovascular events such as stroke with a probability of 72% (AUC = 0.83, P value< 0.0001). In comparing our model’s ability to predict CVD risk with the Framingham risk score, the Framingham model’s accuracy was 65 % in our dataset (with a best AUC of 0.78).

Our deep learning prediction model developed based on retinal fundus image findings to predict the risk of CVD, showed a relatively high accuracy. Its accuracy was higher than traditional prediction models like the Framingham model and comparable to other models based on fundus images for predicting CVD.

According to World Health Organisation data, on the top ten causes of death in the world in 2019, ischemic heart diseases ranked first, followed by stroke and chronic respiratory diseases. This study aimed to make cross-section of the current mortality rates of indicators of circulatory diseases, ischemic heart diseases and cerebrovascular diseases, access the trends of indicators in Serbia more than two decades and to find the correlation of these observed indicators between males and females.

Medical indicators were taken from the publicly available Health for all databases that deals with long-term evaluation and monitoring of indicators obtained from national authorities. In this epidemiological study, following indicators were analysed: indicator of standardized circulatory diseases, ischemic heart disease, and cerebrovascular diseases. SPSS was used for statistical analysis.

Between 1998 and 2021 all of the mortality indicators were decreasing in Serbia. Between 2002 and 2005 observed indicators had almost constant decreasing trend. The standardized mortality for circulatory disease along with indicators for mortality from ischemic diseases and cerebrovascular disease was more prevalent among males than females,

Continuing the follow of indicators is of the great importance for public health and macroeconomic of countries. This decreasing trend in Serbia must remain constant and that can be effectively done through continuous improvement of health systems, focusing on the primary health care and conducting pharmacoeconomic studies and epidemiological studies.

Carotid atherosclerosis disease assessment can predict the patient’s risk of cardiovascular disease (CVD). The purpose of this review is to provide a comprehensive review of carotid atherosclerosis disease’s pathophysiology, diagnostic evaluation, imaging applications, and treatment strategies. Carotid atherosclerosis is diagnosed using a variety of techniques, including transcranial Doppler imaging (TCD), computed tomography angiography (CTA), magnetic resonance angiography (MRA), and cerebral digital subtraction angiography (DSA), with duplex ultrasound (DUS) as the primary screening. Measurements of carotid intima-media thickness (CIMT) have drawn attention recently as a marker of early-stage carotid atherosclerosis or CVD risk prediction. The classification of cardiovascular risk may be enhanced by the expanding fields of stress testing and carotid plaque screening.

Viral infections may play a significant role in the development of heart failure, especially in people with related cardiac conditions such as myocarditis. Hepatitis B and D viruses (HBV-HDV) are potentially fatal liver infections. This study examined the influence of metabolic syndrome and its associated disorders.

This cross-sectional study investigated hepatitis D antibody and hepatitis B surface antigen (HBsAg) in 239 people aged 35 to 65 years in Mashhad, Khorasan Razavi Province, Iran in 2018-2019. There were two study groups: those with cardiovascular diseases (CVD) and healthy individuals. Serum samples of all subjects in both groups were examined using enzyme-linked immunosorbent assay (ELISA).

HDV infection was detected in none of the study groups. Only one patient (0.8%) in the case group tested positive for HBsAg. The average LDL (low-density lipoprotein) (p= .8) and cholesterol (p= .3) levels in terms of lipid profiles were similar in both groups. Although the mean high-density lipoprotein (HDL) level in the patient group was lower, the mean triglyceride level in this group was higher than in the control group. Fasting blood sugar (FBS) (p= .009) and aspartate aminotransferase (AST) levels were significantly higher in CVD patients, while 59.3% of them exhibited metabolic syndrome.

This study results demonstrate no connection between HBV/HDV infection and cardiovascular diseases. The findings confirm that metabolic syndrome and hyperglycemia are underlying factors in cardiovascular diseases. Changes in HDL and triglyceride levels could impact cardiovascular diseases more than other lipids.

Human group box protein 1 (HMGB1) is a nuclear protein critical in various cellular processes. It is released in response to stress, infection, or tissue damage and acts as a danger signal, triggering immunological responses. Elevated HMGB1 levels are linked to various diseases, including atherosclerosis. This review investigated the role of HMGB1 in atherosclerosis and assessed the effectiveness of current and emerging treatment approaches that target HMGB1. Data was obtained from various indexed scientific databases. The inclusion and exclusion criteria were based on the relevance to atherosclerosis and HMGB1, the types of intervention (herbal, synthetic, and experimental compounds), the mechanism of action, and the outcome measured (inflammatory markers, cellular responses, and atherosclerotic plaque evolution). The findings present a promising future for atherosclerosis treatment, with herbal extracts, and experimental and synthetic compounds showing significant potential in preclinical studies. Herbal compounds like glycyrrhizin, ginsenosides, and mogrosides demonstrate anti-inflammatory and antioxidant properties. Synthetic drugs like metformin, statins, and sodium-glucose transporter inhibitors (SGLT2) show significant promise by modulating HMGB1 activity and related pathways. Additionally, monoclonal antibodies and specific inhibitors targeting toll-like receptor 2 (TLR2), Toll-like receptor 4 (TLR4), and receptors of advanced glycated endpoints (RAGE) show potential for reducing vascular inflammation. Atherosclerosis is a multifaceted condition that requires a comprehensive approach, including cholesterol-lowering therapy. However, to fully harness the potential of HMGB1-targeted treatments, further research and clinical trials are necessary. These trials will be crucial in developing HMGB1-targeted therapies as effective adjuvants to cholesterol-targeting compounds in managing cardiovascular diseases.

Varenicline is a medication used to help people quit smoking when used in conjunction with education and counseling. It is the first-line treatment for smoking cessation and is available in 0.5 mg and 1 mg strength oral tablets. Varenicline is primarily eliminated via the kidney through glomerular filtration, and its excretion is via the renal route, so it is important to monitor renal function before and during treatment. Varenicline has been associated with an increased risk of new psychiatric conditions, anxiety, and mood disorders in some individuals. The use of Varenicline should be accompanied by close monitoring and careful consideration of individual patient factors. While Varenicline can be used in a wide range of patients, its use should be carefully considered in patients with heart or blood vessel disease, renal impairment, psychiatric disorder, or seizure.

 The Package of Essential Non-Communicable (PEN) Disease Control was implemented in the primary healthcare system to manage cardiovascular disease (CVD) risk factors in Iran. This study aimed to evaluate the status of CVD risk factor control following the implementation of the PEN.

 This historical cohort study was conducted among 60-65-year-old residents to compare hypertension (HTN) control via mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), diabetes mellitus (DM) control via fasting blood sugar (FBS) and HbA1C tests, hyperlipidemia control via serum cholesterol and triglyceride levels, and overweight and obesity via body mass index (BMI) measurement in 2016 (before the implementation of the PEN project) and 2021 (after 5 years).

 A total of 1,583 residents with a mean age of 62.32±1.70 years were included in the study. In 2021, compared to 2016, there was a significant decrease in the relative frequency of residents with high SBP from 13.7% to 9.3%, high DBP from 11.3% to 3.4%, FBS≥126 mg/dL from 25.6% to 19.7%, and BMI≥30 from 25.7% to 23.4%. Additionally, the mean DBP and the mean serum levels of FBS among all participants decreased significantly. However, the relative frequency of residents with total cholesterol≥200 mg/dL increased significantly from 11.5% to 14.2%.

 Following the implementation of the PEN, the control of HTN, DM, and obesity improved among 60-65-year-old residents. However, the control of hypercholesterolemia did not improve.