Abstract:

The “Diagnosis and Management Guidelines for Chronic Coronary Syndrome Patients in China” published in 2024 was led by the Atherosclerosis and Coronary Heart Disease Group of the Cardiology Branch of the Chinese Medical Association and the Editorial Board of the Chinese Journal of Cardiovascular Diseases, in conjunction with the Intervention Group, Intravascular Imaging and Functional Group, Cardiovascular Disease Imaging Group, and Basic Science Group. The guideline is the first in China to provide guidance for the diagnosis and management of patients with chronic coronary syndrome (CCS), comprehensively introducing the definition, diagnostic process, treatment strategies, and long-term management of CCS. The guideline aims to improve the prognosis and quality of life by providing the best diagnostic or treatment methods. This article focuses on the antithrombotic therapy, lipid-lowering therapy, and management of special populations for patients with CCS, further interpreting the updates and recommendations in the guidelines.

Abstract:

In September 2024, the “Clinical Practice Guidelines for the Management of Hypertension in China” was officially released by the Chinese Society of Cardiology, Chinese Medical Association and other academic institutions.The guideline encompasses 98 recommendations for 44 key clinical issues in the management of hypertension. This article presents a concise summary of 10 highlights of the guideline, including the scientific foundation of the guideline, the concept and definition of prehypertension, simplified risk stratification for hypertension, antihypertensive treatment initiation timing, antihypertensive targets for different populations, first-line antihypertensive drugs, antihypertensive programs for various clinical complications, non-drug therapies, indications for renal denervation, and screening for secondary hypertension, in order to help doctors better understand the guidelines, promote their implementation, and guide clinical practice.

Abstract:

Aim Investigating the effects of exercise during pregnancy on blood pressure and brain ischemia-reperfusion injury in 1-month-old (1M) and 3-month-old (3M) offspring of spontaneously hypertensive rat (SHR). Methods SHR and Wistar Kyoto rats (WKY) were selected, they were paired in a 1∶1 male-to-female ratio within the same strain, and the first day of pregnancy was confirmed by the presence of copulatory plugs and sperm on a vaginal smear. Pregnant rats were randomly divided into pregnancy sedentary group (p-WKY-SED, p-SHR-SED) and pregnancy exercise group (p-WKY-EX, p-SHR-EX). The rats in the exercise group were performed non-weight-bearing swimming for 60 minutes per day, 6 days per week, in water 40 cm deep at a temperature of 34～35 ℃, until the 20th day of pregnancy. The body weight of the pregnant rats, as well as physiological indicators such as fetal weight, body length, and placental efficiency were monitored to reflect the growth and development of the fetus. 1M and 3M offspring were selected as research subjects, non-invasive blood pressure was measured in the tail artery, a rat middle cerebral artery occlusion (MCAO) model was prepared by using the thread embolism method, and the area of cerebral infarction was observed 24 hours after reperfusion. Results (1) Compared with p-WKY-SED group, the body weight of p-SHR-SED pregnant rats was significantly decreased (P＜0.01); there was no significant difference in the litter size among all groups of pregnant rats (P＞0.05). (2) Compared with p-SHR-SED group, exercise during pregnancy can significantly increase the body weight and placental efficiency of both female and male fetal rats in the p-SHR-EX group (P＜0.05), and decrease the weight of the placenta (P＜0.05). (3) Compared with p-WKY-SED group, the body weight of both female and male offspring rats at 1M and 3M was significantly decreased in the p-SHR-SED group, and their blood pressure was significantly increased (P＜0.01); Compared with p-SHR-SED group, exercise during pregnancy had no significant effect on the body weight and blood pressure of 1M offspring in the p-SHR-EX group (P＞0.05), but it could significantly reduce the blood pressure of 3M male offspring in the p-SHR-EX group (P＜0.01); The body weight and blood pressure of 3M male offspring were significantly higher in p-WKY-SED group and p-SHR-SED group than those of female in the same group (P＜0.01). (4) Compared with p-WKY-SED group, the infarct area of MCAO injury in both female and male offspring rats at 1M and 3M was significantly increased in the p-SHR-SED group (P＜0.01); Compared with p-SHR-SED group, exercise during pregnancy can significantly reduce the infarct area of MCAO injury in both female and male offspring at 1M and 3M in the p-SHR-EX group (P＜0.05). Conclusion Aerobic exercise during pregnancy can significantly improve blood pressure in the offspring of hypertensive rats, and reduce their susceptibility to ischemic reperfusion injury in the brain as adults.

Abstract:

Aim To observe the effect of intraperitoneal injection of hydrogen-rich saline (HRS) on reverse cholesterol transport in golden hamsters with high fat diet. Methods The male golden hamsters were divided into three groups:chow diet group, high-fat diet group, and high-fat diet＋HRS group. After 12 weeks of high-fat diet feeding and HRS administration, macrophages labeled with ³H-cholesterol were injected into hypercholesterolemic golden hamsters, and then radioactivity in blood, liver, bile, and feces was measured. RT-qPCR and Western blot were used to assess the transcription and protein expression levels of cholesterol reverse transport-related genes in liver tissue. Results Long-term feeding with a high-fat diet induced significant hyperlipidemia and liver lipid accumulation in golden hamsters. Compared with the high-fat diet group, after HRS intervention, the body mass of golden hamsters decreased (P＜0.01), plasma TC and LDLC significantly decreased (P＜0.05), TG slightly decreased (P＝0.11), HDLC significantly increased (P＜0.01), oxidative stress index MDA in plasma and liver significantly decreased (P＜0.05 or P＜0.01), antioxidant index glutathione (GSH) significantly increased (P＜0.01), liver weight/body weight ratio slightly decreased (P＝0.05), TC and TG in liver decreased by 10.8% (P＝0.05) and 20.1% (P＜0.01), respectively. Liver steatosis was significantly relieved, but there was no significant change in inflammatory factor levels. In isotopic tracing, high-fat diet fed golden hamsters treated with HRS showed decreased ³H radioactivity in plasma at 24 and 48 hours by 16.5% (P＜0.01) and 8.9% (P＜0.05) respectively, while increased ³H radioactivity was observed in liver, bile, and feces by 1.2-fold (P＜0.05), 1.2-fold (P＝0.08), and 1.1-fold (P＝0.08) respectively, compared to those fed a high-fat diet alone. Furthermore, RT-qPCR and Western blot analyses of liver tissue demonstrated that HRS intervention resulted in a decrease of CD36, scavenger receptor-B1 (SR-B1), and low density lipoprotein receptor (LDLR) protein levels by 39.5% (P＜0.05), 40.5% (P＜0.01), and 28.0% (P＜0.01) respectively, an increase of ATP-binding cassette transporter G5 (ABCG5) and sterol regulatory element-binding protein (SREBP2) protein levels by 1.5-fold (P＜0.05) and 1.3-fold (P＜0.01), and an increase of mRNA levels of ATP-binding cassette transporter A1 and G8 by 2.9-fold (P＜0.05) and 3.2-fold (P＜0.01) respectively in high-fat diet-fed hamsters. Conclusions Intraperitoneal injection of HRS promotes reverse cholesterol transport in high-fat diet-fed golden hamsters and exerts lipid-lowering effects. Additionally, intraperitoneal injection of HRS may alleviate hepatic lipid accumulation by inhibiting hepatic lipid uptake and promoting cholesterol excretion from liver.

Abstract:

Aim To study the relationship between white blood cell count and clinical classification in patients with coronary heart disease and its clinical significance. Methods A total of 301 patients diagnosed with coronary heart disease in the Second Affiliated Hospital of Harbin Medical University from January 2022 to December 2023 were selected as the research subjects, and divided into stable angina pectoris (SAP) group and acute coronary syndrome (ACS) group based on their clinical manifestations and results of electrocardiogram, the differences of general data, biochemical indexes and cardiovascular indexes between the two groups were compared. Spearman correlation analysis was used to analyze the relationship between white blood cell count, neutrophil count and cardiovascular related indicators, including troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), ejection fraction, left ventricular end-diastolic diameter (LVEDD), left atrial diameter, Gensini score, etc. ROC curve was employed to determine the cut-off point for diagnosing ACS and SAP classification of coronary heart disease based on white blood cell count, and dividing patients into a group with normal white blood cell level and a group with above normal white blood cell level based on this cut-off point, the differences between the two groups were compared. Results The ratio of hyperlipidaemia history, white blood cell count, neutrophil count, C-reactive protein, platelet count, total cholesterol (TC), low density lipoprotein cholesterol (LDLC), troponin I, NT-proBNP and Gensini score in the ACS group were significantly higher than those in the SAP group (all P＜0.05), while the ratio of aspirin use, the ratio of statin use, and ejection fraction in the ACS group were lower than those in the SAP group (all P＜0.05). Spearman correlation analysis results showed that white blood cell count was positively correlated with C-reactive protein (r＝0.443, P＜0.001), troponin I (r＝0.333, P＜0.001), NT-proBNP (r＝0.245, P＜0.001) and Gensini score (r＝0.341, P＜0.001), but negatively correlated with LVEDD (r＝－0.212, P＜0.001). Similarly, neutrophil count was positively correlated with C-reactive protein (r＝0.430, P＜0.001), troponin I (r＝0.325, P＜0.001), NT-proBNP (r＝0.292, P＜0.001) and Gensini score (r＝0.353, P＜0.001), but negatively correlated with LVEDD ( r＝－0.175, P＝0.002). The cut-off point of white blood cell count in the diagnosis of ACS was 9.35×10⁹ L－1 (sensitivity was 56.7%, specificity was 93.1% ). The patients were divided into normal white blood cell level group (n＝202) and above normal white blood cell level group (n＝99). Hyperlipidemia, smoking history, TC, LDLC, C-reactive protein, troponin I, NT-proBNP and Gensini scores in above normal white blood cell level group were significantly higher than those in the normal white blood cell level group (all P＜0.05), while LVEDD was lower than that in the normal white blood cell level group (all P＜0.05). Conclusion White blood cell count can easily identify the high-risk type of coronary heart disease, and the cut-off point for the diagnosis of ACS is 9.35×10⁹ L－1.

Abstract:

Aim To explore the association between mental health status and post-ablation recurrence in elderly atrial fibrillation patients. Methods Consecutive patients aged≥60 years who underwent catheter ablation for atrial fibrillation in Beijing Anzhen Hospital were enrolled, baseline clinical characteristics, comorbidities and treatment were collected. Five item mental health inventory (MHI-5) was used to evaluate the mental health status, and 76 points were taken as the cut-off value. Each patient was followed up at 3,6 and 12 months after ablation to assess atrial fibrillation recurrence, mental health status and other adverse events. Multivariate Logistic regression analysis was conducted to examine the association between mental health status and the risk of atrial fibrillation recurrence. Results A total of 238 elderly patients with atrial fibrillation were enrolled, including 58 patients in the MHI-5≤76 points group and 180 patients in the MHI-5＞76 points group. During 12 months follow-up, 73 patients (30.7%) developed atrial fibrillation recurrence, and the recurrence rate in the MHI-5≤76 points group was significantly higher than that in the MHI-5＞76 points group [58.6%(34/58) vs. 21.7%(39/180), P＜0.001]. Multivariate Logistic analysis showed that after adjusting for demographic data and clinical factors, MHI-5≤76 points was significantly associated with a higher risk of atrial fibrillation recurrence after catheter ablation (OR＝6.3,5%CI:3.08～12.24, P＜0.001). Conclusion Poor mental health status is significantly associated with higher post-ablation recurrence in elderly atrial fibrillation patients.

Abstract:

Aim To investigate the effect of combined enhanced exteral counterpulsation (EECP) therapy on blood lipids, inflammatory status, and cardiorespiratory function in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI), under the premise of standardized drug treatment. Methods A total of 93 patients diagnosed with CHD and undergoing PCI surgery at Cardiovascular Department, the Second Hospital of Shanxi Medical University were selected for screening from June 2022 to December 2023. According to the patients' treatment intention, they were randomly divided into control group and EECP group. The control group received simple drug treatment, while the EECP group received combined EECP treatment for 3 months on the basis of drug treatment. Blood lipids, monocyte to high density lipoprotein cholesterol ratio (MHR), neutrophil to lymphocyte ratio (NLR), and exercise endurance indicators were recorded and compared before and after treatment. Results After treatment, the patients in EECP group showed a 19.6% decrease in total cholesterol (TC), a 27.0% decrease in triglyceride (TG), a 25.0% decrease in low density lipoprotein cholesterol (LDLC), a 25.4% decrease in MHR, a 37.2% decrease in NLR, and a 6.7% increase in maximum exercise time, with statistical significance (P＜0.05). The treatment effect was better than that of the control group. Conclusion On the basis of standardized drug treatment, the combination of EECP treatment in patients with CHD after PCI can effectively reduce blood lipid levels, improve systemic inflammation, promote the improvement of motor function, and improve patients' quality of life.

Abstract:

Aim To explore the effect of estimated pulse wave velocity (ePWV) changes on cardiovascular and cerebrovascular events. Methods A total of 61 714 employees who participated in the 2006—2007 physical examination and 2010—2011 physical examination of Kailuan Group were selected as the research subjects. The subjects were divided into four groups according to the ePWV values at baseline and at the end of the observation period:sustained normal group, normal-high group, high-normal group and sustained high group, Cox regression model was used to analyze the effect of different changes of ePWV on cardiovascular and cerebrovascular events. Results A total of 3 715 (6.02%) cases of cardiovascular and cerebrovascular events occurred after a mean follow-up of (8.52±1.59) years. The incidence density of cardiovascular events was 3.1,0.0,3.54 and 15.85 per 1 000 person-year respectively in the sustained normal group, the normal-high group, the high -normal group and the sustained high group. After adjusting for confounders, the risk of cardiovascular and cerebrovascular events was significantly increased in the normal-high group, the high-normal group and the sustained high group compared with the sustained normal group, the HR (95%CI) were 2.68(2.44~2.95), 3.14(2.67~3.69) and 4.03(3.71~4.38), respectively. Conclusion Maintaining normal ePWV can effectively reduce cardiovascular and cerebrovascular events.

Abstract:

Aim To systematically evaluate the efficacy and safety of Tongxinluo capsule combined with rosuvastatin in the treatment of carotid atherosclerosis. Methods A comprehensive screening of Tongxinluo capsule combined with rosuvastatin was performed by Web searching the CNKI, Wanfang Data, VIP, PubMed, Embase, The Cochrane Library, and Web of Science from the construction of the database to August 1,3, to comprehensively screen the literature of randomized controlled studies of Tongxinluo capsule combined with rosuvastatin in the treatment of carotid atherosclerosis in the literature of randomized controlled studies, and Meta-analysis was performed using RevMan 5.4 software. Results A total of 8 studies were included with 858 total cases, 426 in the treatment group and 432 in the control group.Meta-analysis showed that the addition of Tongxinluo capsule to rosuvastatin treatment lowered total cholesterol (MD＝－0.4,5%CI:－0.61～－0.46, P＜0.00001), triglyceride (MD＝－0.8,5%CI:－0.37～－0.20, P＜0.00001), low density lipoprotein cholesterol (MD＝－0.5,5%CI:－0.42～－0.29, P＜0.00001) and increased high density lipoprotein cholesterol (MD＝0.7,5%CI:0.05～0.50, P＝0.02) levels, lowered carotid intima-media thickness (MD＝－0.5,5%CI:－0.48～－0.22, P＜0.00001) and plaque Crouse's score (MD＝－1.3,5%CI:－2.11～－0.55, P＝0.0009), and the differences were statistically significant (P＜0.05). Adverse effects were reported in five studies, and the difference was not statistically significant (MD＝1.0,5%CI:0.80～4.08, P＝0.16). Conclusion Tongxinluo capsule combined with rosuvastatin in the treatment of carotid atherosclerosis can improve the blood lipid level and reduce the degree of atherosclerosis, with better efficacy and safety, which can be further promoted for clinical use.

Abstract:

Timely restoration of blood supply after myocardial infarction is crucial for saving the infarcted myocardium. So far, the most effective method is to restore myocardial oxygenation and coronary blood flow through coronary interventional therapy. However, reperfusion may also lead to greater heart damage due to the reintroduction of molecular oxygen. New treatments are needed to protect the heart from myocardial ischemia-reperfusion injury (MIRI) to improve clinical outcomes in patients with acute myocardial infarction and heart failure (HF). A deeper understanding of the mechanisms of MIRI and the search for new treatments could provide key evidence to mitigate myocardial damage and improve patient survival. At present, it has been found that copper, as a trace element in human body, can have a significant protective effect on MIRI. Copper can reduce apoptosis in cardiomyocytes, that is, control the self-destruction process of cell, so as to reduce the degree of myocardial injury. However, the potential relationship between abnormal copper ion metabolism as well as cuproptosis and MIRI as well as HF has not been explored. In this review, we focus on potential therapeutic strategies for MIRI and understand the metabolic pathways of copper in the human body, so as to provide more options and hope for the treatment of cardiovascular diseases.

Abstract:

Cardiac magnetic resonance (CMR) has the advantages of being radiation-free, multi-parameter, multi-sequence, and multi-planar, enabling one-stop assessment of cardiac motion and morphologic function, blood flow and perfusion in patients with coronary artery disease. This article briefly introduces the typical imaging indicators of CMR and highlights the application in the diagnosis, treatment and prognostic assessment of coronary artery disease.

Abstract:

Myocardial ischemia-reperfusion injury (MIRI) is one of the reasons for the high mortality in patients with acute myocardial infarction after percutaneous coronary intervention, which is regulated by several cell death pathways including apoptosis, autophagy, and pyroptosis. Recently, it has been found that ferroptosis, a unique programmed cell death, appears to be a therapeutic target for MIRI. However, the mechanisms remain incompletely elucidated. This review summarizes the latest research progress on the role of ferroptosis in MIRI, including mitochondrial dysfunction, endoplasmic reticulum stress (ERS), oxidative stress, calcium overload, epigenetic modification, apoptosis, autophagy, etc. Moreover, the signaling pathways between ferroptosis and MIRI are elaborated, which will provide new insights for the prevention and treatment of MIRI.