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| In-depth inventory of research progress in the field of cardiovascular disease in 2020 |
Magic 2020 is finally coming to an end. multiple industries around the world have been affected by the new crown outbreak, but this has not prevented the global medical research community from stopping exploring the mysteries of life.
Today, let's take mace medicine back to some of the most valuable research developments in cardiovascular medicine in 2020! we selected high blood pressure redefinition, gut microorganisms, the new use of akitosan, heart transplantation, cardiovascular disease and diet, and many other top-journal basis and clinical research progress, etc. you come to review to enjoy.
1. JAMA and BMJ: the new definition of hypertension controversial, how to scientifically maintain healthy blood pressure?
In 2017, the latest guidelines issued by the American College of Cardiology (ACC)/American Heart Association (AHA) changed the definition of the latest hypertension from ≥ 140/90 mmHg standard for diagnosing hypertension (which is still used in China) to ≥130/80 mmHg. At the same time, the new guidelines change the threshold for simple diastic hypertension (IDH) to 80mmHg. However, after the publication of the guide, scholars have questioned it.
A study published January 28 in JAMA by johns Hopkins University School of Medicine suggests that the new definition of IDH may not be appropriate. The researchers found that if systolic pressure was less than 130 mmHg and only diastolic pressure ≥ 80 mmHg, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, heart disease, and heart disease The risk of vascular death and all-cause death does not increase significantly. At the same time, according to the old diagnostic criteria of simple diaspic hypertension, but also with the above-mentioned adverse event risk is not significantly associated.
Using data from 9,590 adults in the 2013-2016 National Health and Nutrition Survey (NHANES), the researchers first found that the prevalence of IDH was 6.5 percent and 1.3 percent, respectively, according to the new and old guidelines. Subsequently, using community atherosclerosis risk (ARIC) to study a 25-year follow-up of 8,703 adults, it was found that patients with ATHERS diagnosed with the new guidelines had no higher risk of developing atherosclerosis cardiovascular disease, heart failure, or chronic kidney disease than those with normal blood pressure.
To this end, lead researcher John W. McEvoy believes that if a person's systolic pressure is normal (< 130 mmHg), then the height of diastolic pressure is not significantly associated with CVD risk. According to the 2017 edition of the U.S. High Blood Pressure Guidelines, 12 million adults in the U.S. alone will be labeled "hypertension" for diastic pressure ≥ 80 mmHg, but they will not benefit from a diagnosis of high blood pressure and may instead receive unnecessary treatment.
Although hypertension is traditionally a more common disease among older persons, recent epidemiological studies have shown that the incidence of hypertension among young people is also increasing. To this end, a team of experts from the Guangdong Academy of Medical Sciences conducted a systematic review and meta-analysis to quantify the relationship between blood pressure categories and the risk of future cardiovascular events (CVDs) in young people. The results were published September 3 in the journal BMJ.
The study included about 4.5 million young people aged 18-45 with elevated blood pressure, followed up for an average of 14.7 years. It was found that young people with normal blood pressure had a 19 percent increased risk of CVD compared to those with optimal blood pressure status. At the same time, a progressive link was found between blood pressure classification and increased risk of CVD (normal hypertension-level 2 hypertension: HR from 1.35-4.24). In addition, coronary heart disease and stroke have similar results.
Overall, the proportion of people with CVD associated with elevated blood pressure was 23.8%. In the young subgroup, high blood pressure-induced CVD accounted for nearly a third of the total CVD events in young people. However, common risk prediction models have not been validated in young people, and there is insufficient evidence to support the start-up of antihypertensive drugs. Active intervention should therefore be cautious.
While there is further discussion about the intervention of young hypertension, a study published on February 26th in BMJ confirmed that even people without high blood pressure should reduce their salt intake.
The team from the University of London in the United Kingdom included 133 studies of 12,197 participants and found that for every 50 mmol reduction in sodium urinary excretion during the 24-hour period, systolic and diastolic pressure decreased by an average of 1.10mmHg and 0.33mmHg, and the phenomenon persisted in non-hypertensive groups. Among them, the elderly, non-white people and people with higher blood pressure had a larger rate of blood pressure reduction, suggesting that reducing salt intake could effectively reduce the blood pressure value of these three groups.
2. NEJM: 4 studies revealed that stable coronary heart disease may not benefit from interventional therapy
A COURAGE study published in 2007 showed that there was no additional benefit to the better drug treatment (OMT) for blood transport reconstruction in patients with qualitative coronary heart disease (SIHD). There is some controversy in the medical profession. The ISCHEMIA study again supports these findings during the 2019 American Heart Association Annual Meeting (AHA 2019). In April,NEJMpublished all the results of the ISCHEMIA study.
THE ISCHEMIA TRIAL, FUNDED BY THE NATIONAL HEART, LUNG AND BLOOD INSTITUTE (NHLBI), AIMS TO COMPARE THE EFFICACY OF OMT WITH INVASIVE TREATMENT STRATEGIES IN PATIENTS WITH MODERATE TO SEVERE SIHD. A TOTAL OF 5,179 SUBJECTS FROM 320 CENTRES IN 37 COUNTRIES AND REGIONS WERE INCLUDED AND RANDOMLY DIVIDED INTO TWO GROUPS: THE DRUG CONSERVATIVE GROUP (2591) AND THE INTERVENTION GROUP (2588). PATIENTS IN THE INTERVENTION GROUP WERE TREATED WITH CORONARY INTERVENTION ON THE BASIS OF OPTIMAL DRUG THERAPY (PCI) OR CORONARY ARTERY BYPASS (CABG). THE MAIN ENDPOINTS OF THE STUDY WERE CARDIOVASCULAR DEATH, HEART ATTACK, CARDIAC ARREST RESUSCITATION, AND COMPOUND EVENT ENDPOINTS HOSPITALIZED FOR UNSTABLE ANGINA OR HEART FAILURE. THE PRIMARY SECONDARY ENDPOINT IS CARDIOVASCULAR DEATH OR HEART ATTACK.
DURING THE 3.2-YEAR FOLLOW-UP PERIOD, 318 AND 352 MAJOR OUTCOME EVENTS OCCURRED IN THE INTERVENTION AND CONSERVATIVE GROUPS, RESPECTIVELY. OVER A SIX-MONTH PERIOD, THE CUMULATIVE INCIDENT RATE WAS 5.3 PER CENT IN THE INTERVENTION GROUP AND 3.4 PER CENT IN THE CONSERVATIVE GROUP, WHILE IN THE FIVE-YEAR PERIOD, THE CUMULATIVE INCIDENT RATE WAS 16.4 PER CENT AND 18.2 PER CENT, RESPECTIVELY. SECONDARY RESULTS ARE SIMILAR BETWEEN GROUPS. THERE WERE 145 DEATHS IN THE INTERVENTION GROUP AND 144 DEATHS IN THE CONSERVATIVE GROUP (HR=1.05).
the study concluded that for patients with stable coronary artery disease and moderate to severe ischemia, active intervention strategies did not reduce the risk of ischemic cardiovascular events or death for any cause compared to conservative drug treatment.
So, are there any differences in the quality of life of patients with different interventions? To do this, the researchers used the Seattle Angina Questionnaire (SAQ) to assess patients' health at different stages before and after randomization. The primary quality of life endpoint is the SAQ score, and the secondary endpoint includes SAQ angina frequency (AF) and quality of life results (QoL).
The primary outcome SAQ score supports patient benefits in the 3-month, 1-year, and 3-year intervention groups. Among them, patients with daily/weekly angina or at least 1 angina per month benefit the most. Secondary results show that PCI or CABG can significantly relieve angina after angiography. At 1 year, the proportion of patients with no angina in the intervention group and the conservative group was 50% and 20%, respectively.
Thus, compared with purely drug conservative treatment, interventional therapy can improve the health status of SIHD and moderate and severe ischemic patients.
In addition, in the ISCHEMIA-Chronic Kidney Disease Trial reported by NEJM, it was also found that there was no significant difference between interventional and conservative treatment in this group of populations. Taking into account the above findings, Metz Medical believes: "For patients with ischemic heart disease with stable conditions, the best drug treatment in accordance with the current guidelines should be the main treatment method, for coronary stent treatment should be more strictly mastered."
3. Lancet double pounds: 70 years old to start fat reduction is still too far!
ATHEROSCLEROSIS BEGINS EARLY IN LIFE AND, OVER THE YEARS, EVENTUALLY LEADS TO ACUTE CARDIOVASCULAR EVENTS, INCLUDING MYOCARDIAL INFARCTION AND ATHEROSCLEROSIS (ASCVD). LOW-DENSITY LIPOPROTEIN CHOLESTEROL (LDL-C), AS THE CENTRAL DRIVER OF THIS PROCESS, IS THE PRIMARY TREATMENT GOAL FOR PRIMARY AND SECONDARY PREVENTION IN ALL GUIDELINES.
PREVIOUS STUDIES (MOSTLY COHORT STUDIES FROM 40-50 YEARS AGO) HAVE SHOWN THAT CLINICAL EVENTS IN PEOPLE OVER 70 YEARS OF AGE HAVE LITTLE CORRELATION WITH ELEVATED CHOLESTEROL, AND THAT SUCH OLDER PEOPLE ARE EXCLUDED FROM ALMOST ALL CLINICAL DRUG TRIALS, SO EVIDENCE OF SENIOR LIPID MANAGEMENT HAS BEEN CONTROVERSIAL. WITH THE INCREASE OF LIFE EXPECTANCY AND THE DECREASE OF THE INCIDENCE OF HEART ATTACK IN YOUNG PEOPLE, THE RISK OF CARDIOVASCULAR EVENTS IN OLDER PEOPLE IS RELATIVELY HIGH. IN ADDITION TO THE FACT THAT YOUNG PEOPLE WHO WERE IN THE GROUP ARE NOW MOVING INTO OLD AGE, IT IS PARTICULARLY IMPORTANT TO UNDERSTAND THE RISK OF CARDIOVASCULAR DEVELOPMENT IN OLDER ADULTS AT LDL-C LEVELS.
An study published in the Journal of Lancet by a team at the University of Copenhagen in Denmark on November 10th found that higher LDL-C levels in people aged 70-100 also increased the risk of heart attack and ASCVD.
The researchers used data from the Copenhagen General Population Study (CGPS) for the period 2003.11-2015.02 on more than 90,000 people aged 20-100 without basic cardiovascular disease and diabetes and without statins. After an average of 7.7 years of follow-up,it was found thatfor every 1.0mmol/L increase in LDL-C, the overall risk of myocardial attack and ASCVD increased by 34% and 16%, respectively, with the 70-100 age group being particularly significant.
Further analysis found that compared with people with LDL-C below 3.0mmol/L, the risk of heart attack increased by 199% and 82% respectively in people aged 80-100 and 70-79 years old with LDL-C levels above 5.0mmol/L (e.g. familial hyperlipidemia), and the risk of ASCVD increased by 90% and 25%, respectively. The study also found thatfor every1.0mmol/L increase in LDL-C, the risk of heart attack and ASCVD was highest for every 1,000 people aged 70-100. But if all people were treated with moderate-intensity statins, the number of people aged 70-100 who needed to prevent a heart attack and ASCVD was the lowest, meaning that the group would benefit the most from statin treatment.
It can be seen that with the increasing aging of the population, the 70-100-year-old population for myocardial infarction and ASCVD prevention is particularly important. Interestingly, on the same day,Lancet published another systematic review and meta-analysis related to LDL-C, which further corroborated these results.
The study was a meta-analysis of 29 clinical trials published between 2015.03 and 2020.08 by the Marc Sabatine team at Harvard Medical School's Bregan Women's Hospital to look for evidence of LDL-C lipid reduction therapy in older patients. A total of more than 240,000 people were included in the analysis, with a medium follow-up time of 2.2-6.0 years.
The results showed thatthe decline in LDL-C levels significantly reduced major cardiovascular events in elderly patients. For every 1.0mmol/L reduction in LDL-C over 75 years of age and under 75 years of age, the primary cardiovascular risk decreased by 26% and 15%, respectively, with no statistical difference. At the same time, there was no significant difference in the protective effects of statins and non-statins such as espresso and PCSK9 inhibitors. Among them, cardiovascular death, heart attack, stroke and coronary reconstruction decreased by 15%, 20%, 27% and 20%, respectively.
both studies show thatpeople aged 70 or over can still benefit from fat-lowering treatments. it's not too late to start liposuction treatment no matter how old you are.
4. JACC: 1.36 million people data show that men are more likely to get heart attacks, women have a worse prognosis?
coronary artery heart disease is a chronic cardiovascular disease that threatens human health, characterized by high incidence, high disability rate and high fatality rate. coronary heart disease is the world's number one cause of death, according to a 2017 report by the global international center for the burden of disease. in the past decade or so, coronary heart disease mortality has been on the decline in developed countries, while in low- and middle-income countries it has been on the rise.
A study published in the 2017 issue of the journal BMJ found that men have higher mortality rates for coronary heart disease and heart attacks than women. However, after a coronary heart disease event has occurred, there does not appear to be a gender difference in the probability of recurrence of coronary heart disease events. The results were further demonstrated in a study published in JACC on October 13th by the University of Utrecht in the Netherlands.
the researchers obtained patient data from the u.s. insurance database, which included 1359560 non-coronary heart patients and 339,890 people with heart attacks between 2015 and 2016. after multifactorial correction, the risk of heart attack was 0.64 for women without a history of coronary heart disease and 0.94 for women with a history of coronary heart disease compared to men. at the same time, the risk of new coronary heart disease in women was 0.53 for men and 0.87 for men without coronary heart disease.
further analysis found that women without coronary heart disease had a mortality rate of 0.72 for all causes and 0.90 for people with heart attacks. thus, in the non-coronary heart disease group, women had a lower risk of heart attack, coronary heart disease, heart failure and all-cause death than men, but in the heart attack group, the risk of recurrence was similar for men and women.
5. Cell: CVD-related gut microbial metabolites can be operated by adrenaline receptors
A team of researchers from the Cleveland Clinic has discovered a by-product of gut microbes that are clinically and institutionally related to cardiovascular disease (CVD). The metabolite, called pagln, has been shown to function through epinephrine receptors, leading to increased platelet activity and aggregation, and the formation of blood clots in the body.
Using non-targeted metabolomics, the team found that the plasma metabolites PHacetylglutamine (PAGln) were associated with cardiovascular disease (CVD) and major cardiovascular adverse events, such as myocardial infarction, stroke or death.
PAGln is a by-product of phenylalanine, an essential amino acid for the breakdown of gut microorganisms. Phenylalanine is found in proteins from many plant and animal sources, including meat and beans. After proteins are digested and broken down into individual amino acids, most phenylalanine is absorbed by the small intestine, the team said. Unabsorbed phenylalanine in the large intestine can be metabolized by intestinal flora, forming phenylatonic acid and phenylphenic acid. Phenylacetic acid is metabolized by the liver to produce PAGln. The quick-control step is that bacteria use phenylalanine as a source of energy, and the resulting metabolites are converted into PAGln.
The team began using an emerging platform called non-targeted metabolomics to identify plasma metabolites associated with cardiovascular disease (CVD). They chose patients with type 2 diabetes (n-1162) as the subjects because they were more likely to develop CVD-related metabolic disorders, increasing the likelihood that researchers would discover new pathways.
Next, paGln, a metabolite derived from intestinal flora, was found to enhance the likelihood of phenotype and thrombosis associated with platelet activation in animal models of whole blood, isolated platelets and arterial damage. Microbial implantation in sterile mice with human function and genetic engineering shows that the porA gene helps convert phenylalanine into phenylalanine in the diet, and then the host produces PAGln and paglyglycine (PAGly) which can improve platelet reactiveness and thrombosis potential. Functional acquisition and dysfunction studies using genetic and pharmacological tools have shown that PAGln mediates cell events through G protein conjugate receptors, including alpha2A, alpha 2B, and beta 2-adrenaline receptors. Thus,PAGln represents a new CVD-promoting gut microbiome-dependent metabolite that can signal through adrenaline receptors.
the team expanded their understanding of the mechanisms of the potential gut microbiome of diabetes and heart disease and demonstrated their potential as therapeutic targets. overall, the study used new tools to show how the foods we eat are linked to health and disease risk through gut microbes, which could help in future personalized cardiovascular disease diagnosis and treatment.
6. BMJ and Traffic: eat less red meat, eat more plant protein, can reduce the risk of coronary heart disease
MEAT PLAYS AN IMPORTANT ROLE IN THE HUMAN DIET, WHETHER IT IS LIVING AT HOME OR ON NEW YEAR'S DAY, AS LONG AS A FULL MEAL OF MEAT CAN BRING GREAT HAPPINESS. HOWEVER, THERE IS AMPLE EVIDENCE THAT EATING LARGE AMOUNTS OF MAMMALIAN-DERIVED FOODS INCREASES THE RISK OF CANCER AS WELL AS CVD.
On December 2nd, a 30-year follow-up study of more than 40,000 people published in the journal BMJ showed that excessive consumption of red meat was positively correlated with the risk of coronary heart disease, while reducing red meat intake and replacing it with plant protein, whole grains or dairy products reduced the risk of coronary heart disease.
THE RESEARCHERS FOLLOWED 43,272 AMERICAN MEN FROM 1986 TO 2016 WITHOUT CVD OR CANCER. AT THE SAME TIME, THE RESEARCHERS ASKED PARTICIPANTS TO FILL OUT A SEMI-QUANTITATIVE FOOD FREQUENCY QUESTIONNAIRE, INCLUDING DETAILS SUCH AS MEDICAL HISTORY, LIFESTYLE AND SPECIAL EATING HABITS, EVERY FOUR YEARS SINCE 1986 TO UPDATE INFORMATION ABOUT POTENTIAL RISK FACTORS AND THE OCCURRENCE OF NEW DISEASES.
the results showed that total intake of red meat, unprocessed red meat and processed red meat were associated with a higher risk of coronary heart disease after multivariate adjustment of dietary and non-dietary risk factors. the risk ratio of adding one serving of red meat per day was 1.12, 1.11 and 1.15, respectively. consuming one serving of plant protein (nuts, beans and soy) per day reduces the risk of coronary heart disease. replacing red meat with whole grains and dairy products and eggs with processed red meat can also reduce the risk of coronary heart disease.
in addition, milk (skimmed and full-fat), yogurt and cheese reduce the risk of coronary heart disease by 10 to 22 percent compared to red meat. when a processed red meat is replaced by a dairy product, the association is more pronounced. however, replacing red meat with fish (blackfish, canned tuna and other fish) is not associated with the risk of coronary heart disease, which may be due to different types of fish and different processing methods. the study found that the intake of black fish reduced the risk of coronary heart disease, while the intake of other fish was associated with a higher risk of coronary heart disease.
In fact, the role of plant proteins in cardiovascular disease has long been demonstrated. On April 7, a team of experts from the Harvard Medical School Center for Public Health summarized the results of three prospective studies and found that increasing the intake of soy isoflavones reduced the risk of CHD in men and women.
A total of 8359 CHD cases were recorded over the 4826122 follow-up years throughout the queue. In multivariate correction analysis, isoflavone (an active substance in soybeans) intake reduced the risk of CHD by 13%. Eating tofu at least once a week was associated with an 18% lower risk of CHD than eating it less than once a month, but there was no such correlation with drinking soy milk (HR 0.87 (0.69-1.10). Further analysis showed that the good correlation between tofu and coronary heart disease was most pronounced in young women and in women who did not use hormones after menopause.
Thus, replacing red meat with high-quality plant foods such as soy products (such as tofu), nuts or soy can reduce the risk of CHD.
7. NEJM LoDoCo2 Study: The Role of Autumn Daffodils in Patients with Chronic Coronary Heart Disease.
autumn daffodils are anti-inflammatory drugs that were originally extracted from autumn daffodils (autumn daffodils) used by the ancient greeks and egyptians. compared to canakinumab's selective inhibition of leukocyte interleukin-1 beta, autumn daffodils have a wide range of cellular effects, including inhibition of microtube protein polymerization and changes in leukocyte reflexivity.
evidence from a recent trial suggests that the anti-inflammatory effects of akitathanine can reduce the risk of cardiovascular disease in patients with recent myocardial infarction the event risk, but there is limited evidence of such a reduction in risk in patients with chronic coronary artery disease.
To this end, researchers conducted a randomized, controlled, double-blind, event-driven trial of low-dose LoDoCo2 to determine whether taking 0.5 mg of autumn daffodil daily could prevent cardiovascular events in patients with chronic coronary heart disease compared to placebo.
The results of the LoDoCo2 study, which were actually presented at the 2020 ESC annual meeting, confirm once again that small doses of akitosan may have magical effects.
in the randomized, controlled, double-blind trial, the researchers assigned patients with chronic coronary heart disease a daily dose of 0.5 mg of cactus or a matching placebo. the main endpoints were cardiovascular death, spontaneous (non-procedural) myocardial infarction, ischemic stroke, or ischemic-driven coronary artery revascularization. the key secondary endpoints are a combination of cardiovascular death, spontaneous myocardial infarction, or ischemic stroke.
It was found that the main endpoint events in the autumn daffodil group occurred in 187 patients (6.8%), while in the placebo group occurred in 264 patients (9.6%) (risk ratio of 0.69). an important secondary endpoint event occurred in 115 cases (4.2%) in the autumn daffodil group and 157 cases (5.7%) in the placebo group (risk ratio of 0.72).
Compared to the placebo group, the incidence of spontaneous myocardial infarction or ischemic coronary artery reconstruction (composite endpoint), cardiovascular death or spontaneous myocardial infarction (composite endpoint), ischemic-driven coronary artery blood transport reconstruction, and spontaneous myocardial infarction was also significantly reduced. the incidence of non-cardiovascular disease deaths in the akitosan group was higher than in the placebo group (risk ratio: 1.51).
In this study, the majority of patients with chronic coronary heart disease had received effective secondary preventive treatment, and taking 0.5 milligrams of akitathane per day reduced the relative risk of cardiovascular death, spontaneous myocardial infarction, ischemic stroke by 31 percent, or ischemic-driven coronary artery hemodysis (primary endpoint) with a risk ratio of 0.69 over placebo. autumn daffodils appear to have the same effect on each component of the primary and all secondary composite endpoints.
The results showed that the cardiovascular incidence rate of small and medium doses of autumn daffodils was significantly lower than that of placebos in patients with chronic coronary heart disease.
Overall, in this randomized trial involving patients with chronic coronary artery disease, the risk of cardiovascular events was significantly lower in patients who had already received secondary preventive treatment, who took 0.5 milligrams of niacin once a day.
8. JAMA and JACC issued a text: high sensitivity to troponin levels to predict cardiovascular risk of the new role, is expected to rewrite the guidelines
Last year, a study published in BMJ by Imperial College London showed that elevated levels of troponin, regardless of age, represent a high risk of death, especially among 19- to 29-year-olds, who are 10 times more likely to die from heart attacks than those with normal levels!
To this end, the assessment of CVD prediction and even risk of death by troponin was further studied. Among them, high-sensitivity troponin (hs-cTn) kit detection is mostly used in large-scale experimental platforms in hospitals. On March 17, a study published in JACC assessed the diagnostic value of instant hs-cTn test kits (POC-hs-cTn) for patients with suspected heart attacks.
The main purpose of this study was to compare the diagnostic differences between POC-hs-cTn kits and central laboratory-confirmed kits in patients with suspected myocardial infarction in emergency departments. The final analysis included 1,261 suspected patients, 178 patients diagnosed, the poC-hs-cTn kit curve under the area (AUC) of 0.95, and no significant difference with other hs-cTn kits. At concentrations <3 ng/l, the negative prediction (NPV) for 45% of low-risk patients was 100% (95%CI: 99.4%-100%) and the positive forecast (PPV) for high-risk patients with concentrations >60 ng/l was 76.8% (95%CI:68.9%-83.6%).
The results showed that the instant hs-cTn test kit had a high diagnostic rate for suspected myocardial infarction patients and was not significantly different from the laboratory's high-sensitivity troponin kit.
The 2018 American Heart Association/American College of Cardiology (AHA/ACC) Cholesterol Guidelines group patients and target fat-lowering treatment based on CVD and high-risk factors. However, a new study published online August 5 in the journal JAMA Women's Hospital at Harvard Medical School suggests that the guidelines are flawed in cardiovascular risk assessment methods for cardiovascular patients and should include high sensitivity to troponin levels.
THE RESEARCHERS CONDUCTED A PROSPECTIVE COHORT STUDY THAT INCLUDED 8,635 PATIENTS SELECTED FOR THE PEGASUS-TIMI 54 STUDY, ALL OF WHOM HAD MYOCARDIAL INFARCTION IN THE FIRST 1 TO 3 YEARS OF THEIR LIVES, AT LEAST 50 YEARS OF AGE, AND AT LEAST ONE HIGH-RISK FACTOR. PATIENTS WERE THEN CLASSIFIED AS EXTREMELY HIGH-RISK AND NON-EXTREMELY HIGH-RISK GROUPS ACCORDING TO THE 2018 AHA/ACC CHOLESTEROL MANAGEMENT STANDARDS.
It was found that the incidence of CVD in non-extremely high-risk patients with high sensitivity to troponin I levels above 6 ng/L (risk threshold) was the same as in patients with very high risk (8.8%). In patients with very high risk as defined in the guidelines, the incidence of CVD (2.7%) was similar to that in patients with non-extremely high risk patients (5%), with high sensitivity to troponin levels below the lower detection limit (<2 ng/L). At the same time, the risk of CVD occurring in 3 years in patients at very high risk assessed according to clinical standards was twice that of non-high risk patients.
fter further addition of hypersensitivity to the assessment, 11.9% of cardiovascular patients were reclassified, of which 9.1% (1/11) of patients at high risk and 25% of patients at low risk were reclassified.
To this end, the researchers noted that the 2018 AHA/ACC Cholesterol Management Guidelines were flawed in cardiovascular risk assessment methods for cardiovascular patients, and that adding hypersensitivity to the cardiovascular risk assessment methodology proposed in the guidelines significantly improved risk stratification in cardiovascular patients.
9. Nature: Two Chinese men are the first to receive pioneering stem cells to treat heart disease
heart surgeons who performed the operation said two men in china were among the first in the world to receive experimental treatment for heart disease that "re-edited" stem cells and made a successful recovery a year later.
In May 2019, Wang Dongjin, a Chinese cardiologist who performed the procedure, told Nature magazine that the two men were injected with heart muscle cells extracted from induced omnomic stem cells, the first clinical application of omnicellular stem cell technology in the treatment of damaged hearts. No results have been published, so researchers who were not involved in the study cautioned that there was no way to determine whether the treatment was effective, and it was not known whether the reported benefits were due to iPS-derived cells or simply to the heart bypass therapy that accompanied iPS.
The head of nanjing biotechnology, said the team plans to publish the results of the study later this year, which uses myocardial cells for treatment. they have been approved to expand the study to another 20 patients.
In January 2021, Japanese cardiologist Yoshiki Sawa introduced plubacetic stem cell-derived heart muscle cells used to treat heart disease into a heart patient, using an alternative method of transplanting cells into the heart rather than injecting them into organs.
10. Torment: Transplanted pig heart will be possible
Heart transplants are often their only hope of survival for patients with severe heart failure and some other heart disease that does not respond to other therapies. in 2019, surgeons in the united states performed 3,552 heart transplants, according to the organ sharing network. patients who need a new heart usually have to wait more than six months for the donor organ to become available, and it usually takes longer. for many people, the waiting time is too long.
Surgeons may transplant a pig's heart into the body within the next year, according to a new study published in The Move. The team behind the new analysis from the Massachusetts General Hospital (MGH) says recent breakthroughs in genetic engineering and drug development could help save many lives by enabling heart transplants between pigs and humans.
Genetic engineering, for example, helps prevent primates' immune systems from attacking pig hearts as foreign injuries, the authors explain, and clinicians believe the same process could work with humans. pigs have also been engineered to produce a human protein to limit blood clotting, solving an important problem usually associated with heart transplants.
The team also developed new drugs that suppress the immune system of transplant recipients when organs come from different species. if this extraordinary achievement proves repeatable and can be carried out, then the heterogeneous movement of the heart is expected to be achieved.
Innovations in drug development have also made it possible to transplant different types of the heart. Transplant recipients must take drugs that suppress the immune system to prevent organ rejection. "But when you put a pig's organs in a cricket, these drugs don't work," Pierson said. He suggests that traditional immunosuppression is also ineffective in humans. To solve this problem, Pierson worked with other researchers to develop monoclonal antibodies that block CD40 and CD154, molecules called "co-stimulation." These monoclonal antibodies are more effective than conventional immunosuppressants in preventing human or immune cells from attacking pig organs.
Finally, the authors answered the question of whether transplanting animal organs into humans could spread infectious diseases, and the current coronavirus pandemic has raised concerns,Pierson said. "As a result of a lot of research and effort by our team and others over the past 35 years, it now appears that pig-to-human heart transplants are feasible." He predicts that the earliest humans will receive a transplanted pig's heart by the end of 2021.
If successfully applied clinically, this study would be a landmark discovery in the treatment of cardiovascular disease.
Well, that's the top 10 inventory of cardiovascular fields this year! little partners have what need to add can leave a message oh! let's look forward to 2021 together.
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