Post hoc analysis of the SuperB and Zilverpass trials for treatment of long and complex superficial femoral artery lesions.

OBJECTIVE: In two randomized controlled trials, the outcomes of endovascular treatment of complex femoropopliteal arterial lesions were compared with bypass surgery and considered a valid alternative treatment. The aim of this study was to compare both endovascular treatment options with the hypothesis that implantation of heparin-bonded self-expanding covered stents (Viabahn [SECS]) or drug-eluting stents (ZilverPTX [DES]) are related to similar clinical outcomes at 1-year follow-up. METHODS: In a post-hoc analysis, the SuperB trial and Zilverpass databases were merged. Patients in the endovascular treatment arms were included, and data was analyzed in an intention-to-treat (ITT) and a per-protocol (PP) fashion. Data included baseline and lesion characteristics, procedural details, and follow-up data. The primary endpoint of this study was primary patency at 1-year follow-up. The secondary endpoints were secondary patency, target lesion revascularization (TLR), limb loss, and all-cause mortality. RESULTS: A total of 176 patients were included; 63 in the SECS arm and 113 in the DES arm. Through 1-year follow-up, there were no significant differences in primary patency (ITT: 63.4% vs 71.1%: P = .183 and PP: 60.8% vs 71.1%; P = .100). Secondary patency rates were not significantly different in the ITT analysis (86.5% vs 95.1%; P = .054), but in the PP analysis, there was a significant difference in favor of the DES group (SECS, 85.6% vs DES, 95.1%; P = .038). There was no significant difference in freedom from TLR between groups (79.6% vs 77.0%; P = .481). No major amputations were performed in the SECS group, and two were performed in the DES group (1.8%). Survival rate was 98.2% in the SECS group, and 91.3% in the DES group after 1-year follow-up (P = .106). Based on diagnosis (intermittent claudication vs chronic limb-threatening ischemia) no differences between patients with intermittent claudication and chronic limb-threatening ischemia were observed in primary patency, secondary patency and freedom from TLR. CONCLUSIONS: Treatment of complex femoropopliteal arterial disease with the heparin-bonded Viabahn endoprosthesis and the Zilver PTX drug-eluting stent are related to similar primary and secondary patency, and TLR rates at 1 year, except for secondary patency in the PP analysis. This study further supports the endovascular treatment of long complex lesions in the femoropopliteal artery.

Erythrocyte Very Long-Chain Saturated Fatty Acids, Gut Microbiota-Bile Acid Axis, and Incident Coronary Artery Disease in Adults: A Prospective Cohort Study.

BACKGROUND: Prior research has highlighted inverse associations between concentrations of circulating very long-chain saturated fatty acids (VLCSFAs) and coronary artery disease (CAD). However, the intricate links involving VLCSFAs, gut microbiota, and bile acids remain underexplored. OBJECTIVES: This study examined the association of erythrocyte VLCSFAs with CHD incidence, focusing on the mediating role of gut microbiota and fecal bile acids. METHODS: This 10-y prospective study included 2383 participants without CHD at baseline. Erythrocyte VLCSFAs [arachidic acid (C20:0), behenic acid (C22:0), and lignoceric acid (C24:0)] were measured using gas chromatography at baseline, and 274 CHD incidents were documented in triennial follow-ups. Gut microbiota in 1744 participants and fecal bile acid metabolites in 945 participants were analyzed using 16S ribosomal ribonucleic acid sequencing and ultra-performance liquid chromatography-tandem mass spectrometry at middle-term. RESULTS: The multivariable-adjusted hazard ratios (95% confidence interval) for CHD incidence in highest compared with lowest quartiles were 0.87 (0.61, 1.25) for C20:0, 0.63 (0.42, 0.96) for C22:0, 0.59 (0.41, 0.85) for C24:0, and 0.57 (0.39, 0.83) for total VLCSFAs. Participants with higher total VLCSFA concentrations exhibited increased abundances of Holdemanella, Coriobacteriales Incertae Sedis spp., Ruminococcaceae UCG-005 and UCG-010, and Lachnospiraceae ND3007 group. These 5 genera generated overlapping differential microbial scores (ODMSs) that accounted for 11.52% of the total VLCSFAs-CHD association (Pmediation = 0.018). Bile acids tauro_α_ and tauro_ß_muricholic acid were inversely associated with ODMS and positively associated with incident CHD. Opposite associations were found for glycolithocholic acid and glycodeoxycholic acid. Mediation analyses indicated that glycolithocholic acid, glycodeoxycholic acid, and tauro_α_ and tauro_ß_muricholic acid explained 56.40%, 35.19%, and 26.17% of the ODMS-CHD association, respectively (Pmediation = 0.002, 0.008, and 0.020). CONCLUSIONS: Elevated erythrocyte VLCSFAs are inversely associated with CHD risk in the Chinese population, with gut microbiota and fecal bile acid profiles potentially mediating this association. The identified microbiota and bile acid metabolites may serve as potential intervention targets in future studies. This trial was registered at www. CLINICALTRIALS: gov as NCT03179657.

Interaction between genetic risk score and dietary fat intake on lipid-related traits in Brazilian young adults.

The occurrence of dyslipidaemia, which is an established risk factor for cardiovascular diseases, has been attributed to multiple factors including genetic and environmental factors. We used a genetic risk score (GRS) to assess the interactions between genetic variants and dietary factors on lipid-related traits in a cross-sectional study of 190 Brazilians (mean age: 21 ± 2 years). Dietary intake was assessed by a trained nutritionist using three 24-h dietary recalls. The high GRS was significantly associated with increased concentration of TAG (beta = 0·10 mg/dl, 95 % CI 0·05-0·16; P < 0·001), LDL-cholesterol (beta = 0·07 mg/dl, 95 % CI 0·04, 0·11; P < 0·0001), total cholesterol (beta = 0·05 mg/dl, 95 % CI: 0·03, 0·07; P < 0·0001) and the ratio of TAG to HDL-cholesterol (beta = 0·09 mg/dl, 95 % CI: 0·03, 0·15; P = 0·002). Significant interactions were found between the high GRS and total fat intake on TAG:HDL-cholesterol ratio (Pinteraction = 0·03) and between the high GRS and SFA intake on TAG:HDL-cholesterol ratio (Pinteraction = 0·03). A high intake of total fat (>31·5 % of energy) and SFA (>8·6 % of energy) was associated with higher TAG:HDL-cholesterol ratio in individuals with the high GRS (beta = 0·14, 95 % CI: 0·06, 0·23; P < 0·001 for total fat intake; beta = 0·13, 95 % CI: 0·05, 0·22; P = 0·003 for SFA intake). Our study provides evidence that the genetic risk of high TAG:HDL-cholesterol ratio might be modulated by dietary fat intake in Brazilians, and these individuals might benefit from limiting their intake of total fat and SFA.

Comparison of the impact of saturated fat from full-fat yogurt or low-fat yogurt and butter on cardiometabolic factors: a randomized cross-over trial.

PURPOSE: Dairy foods are often a major contributor to dietary saturated fatty acids (SFA) intake. However, different SFA-rich foods may not have the same effects on cardiovascular risk factors. We compared full-fat yogurt with low-fat yogurt and butter for their effects on cardiometabolic risk factors in healthy individuals. METHODS: Randomized, two-period crossover trial conducted from October 2022 to April 2023 among 30 healthy men and women (15 to receive full-fat yogurt first, and 15 to receive low-fat yogurt and butter first). Participants consumed a diet with 1.5-2 servings of full-fat (4%) yogurt or low-fat (< 1.5) yogurt and 10-15 g of butter per day for 4 weeks, with 4 weeks wash-out when they consumed 1.5-2 servings of low-fat milk. At baseline, and the end of each 4 weeks, fasting blood samples were drawn and plasma lipids, glycemic and inflammatory markers as well as expression of some genes in the blood buffy coats fraction were determined. RESULTS: All 30 participants completed the two periods of the study. Apolipoprotein B was higher for the low-fat yogurt and butter [changes from baseline, + 10.06 (95%CI 4.64 to 15.47)] compared with the full-fat yogurt [-4.27 (95%CI, -11.78 to 3.23)] and the difference between two treatment periods was statistically significant (p = 0.004). Non-high-density lipoprotein increased for the low-fat yogurt and butter [change, + 5.06 (95%CI (-1.56 to 11.69) compared with the full-fat yogurt [change, - 4.90 (95%CI, -11.61 to 1.81), with no significant difference between two periods (p = 0.056). There were no between-period differences in other plasma lipid, insulin, and inflammatory biomarkers or leukocyte gene expression of ATP-binding cassette transporter 1 and CD36. CONCLUSION: This study suggests that short-term intake of SFAs from full-fat yogurt compared to intake from butter and low-fat yogurt has fewer adverse effects on plasma lipid profile. CLINICALTRIALS: GOV: NCT05589350, 10/15/2022.

A food-exchange model for achieving the recommended dietary intakes for saturated fat in Irish children: analysis from the cross-sectional National Children's Food Survey II.

OBJECTIVE: To identify the main foods determining SFA intakes and model the impact of food exchanges to improve compliance with dietary fat recommendations in Irish children. DESIGN: Estimated food and nutrient intakes were obtained from a cross-sectional study, the National Children's Food Survey II. Participants were categorised into low, medium and high SFA consumers, and the contribution of food categories to SFA intakes was compared. A food-exchange model was developed, whereby a selected range of high SFA foods was exchanged with lower SFA or unsaturated fat alternatives. SETTING: Participants were randomly selected from primary schools throughout the Republic of Ireland. PARTICIPANTS: A representative sample of 600 Irish children (5-12 years). RESULTS: The main determinants of low and high SFA consumers were milk, cheese and butter. These foods, including snack foods and meat and meat products, were considered exchangeable foods within the model. Compared with baseline data, modelled intakes for total fat, SFA, MUFA and trans-fat presented decreases of 3·2, 2·7, 1·6 and < 0·1 % of total energy (% TE), respectively. PUFA, n-6, n-3 and alpha-linolenic acid showed increases of 1·0, 0·8, 0·2 and 0·1 % TE, respectively. Compliance with total fat, MUFA and trans-fat recommendations remained adequate (100 %). Adherence to SFA and PUFA recommendations improved from 18 to 63 % and 80 to 100 %, respectively. CONCLUSION: The food-exchange model decreased SFA intakes and increased PUFA intakes, suggesting modest dietary changes to children's diets can effectively improve their overall dietary fat profile.

The Relationship Between the Global Limb Anatomic Staging System and Midterm Outcomes of Subintimal Angioplasty of Superficial Femoral Artery Atherosclerotic Disease in Chronic Limb Threatening Ischemia.

BACKGROUND: Superficial femoral artery (SFA) is commonly affected with atherosclerotic peripheral arterial disease leading to chronic limb-threatening ischemia (CLTI). Subinitimal angioplasty (SIA) is a minimally invasive option. We aimed to examine the relationship between the Global Limb Anatomic Staging System and SIA midterm limb and survival-related outcomes. METHOD: A prospective observational study was conducted on all patients with CLTI (Rutherford 4-6 or WIFI stages 2-4), with diseased femoropopliteal segment underwent SIA from August 2020 to September 2021. Patients with non-atherosclerotic SFA occlusion and those requiring primary major amputation were excluded. Multivariable Cox proportional hazard regression was performed to assess possible predictors of midterm clinical outcomes. Kaplan-Meier survival curves were used to estimate limb-based patency (LBP), limb salvage, amputation-free survival (AFS), and overall survival. RESULTS: The study included 138 patients with CLTI due to chronic total occlusion of the SFA and underwent SIA ± treatment of associated ipsilateral hemodynamically significant inflow/outflow disease. Primary technical success was achieved in 116 cases (84%), with primary patency at 1, 6, and 12 months being 100%, 84%, and 79% respectively, while the limb-salvage rate at 6 and 12 months was 100% and 94%, respectively. The result of the comparison between CLASS 1 and Global Limb Anatomic Staging System III (GLASS III) revealed significantly worse patency with GLASS III (p=0.005), and better overall survival (p=0.037), limb salvage (p=0.021), and AFS (p<0.001) with GLASS I. CONCLUSION: Subinitimal angioplasty is a safe, effective, and minimally invasive treatment option for lengthy SFA lesions by avoiding the patients' anesthesia and operative risk. Our study suggests that the GLASS stage may be a useful predictor of midterm limb and survival-related outcomes of this approach. GLASS III anatomy in comparison with GLASS I is associated with a statistically significantly worse LBP, limb salvage, AFS, and overall survival. CLINICAL IMPACT: This study is discussing a very hot interesting challenging topic in vascular surgery and its management as SFA atherosclerotic lesion is the most common lesion faced by vascular surgeons subintimal angioplasty SIA is considered feasible and effective method in dealing with this lesion with accepted durability and lower rates of complications.The subintimal angioplasty is made by opening an extraluminal track behind the intimal layer and between the media and intima of the artery surrounding atherosclerotic plaque and thrombus. Hence, the track has a low thrombus or plaque burden content, making the SIA easier than intraluminal angioplasty and with comparable results. GLASS stage III was an independent predictor of loss of LBP, worse AFS, and major amputation.

The optimal size of territorial units in the outsourcing of waste service: An empirical approach.

This study provides new insights into the relation between the size of the territorial units for which the provision of waste services is entrusted to external operators and their efficiency. The need for a deeper investigation of this relation arises from the fact that on the one hand, the European Union is pushing its Member States towards the adoption of laws aimed at ensuring competition for the market whenever competition in the market is possible; on the other, both the theoretical and the empirical literature cautions policymakers against the risks associated with contracting out. This problem is addressed here through an efficiency analysis of Italian municipalities in the organization of waste services. The stochastic frontier analysis (SFA) is applied to estimate efficiency scores for the municipalities. Then, a regression analysis is carried out to investigate the relation between the efficiency scores and the size of the municipality. This analysis has been carried out using data on a sample of 6,916 Italian municipalities (87.39% of the entire population) for the year 2019. The method adopted here can also support regulatory authorities in defining the size of the territorial units in which other types of local public service should be outsourced.

The Effect of Altitude on Phenolic, Antioxidant and Fatty Acid Compositions of Some Turkish Hazelnut (Coryllus avellana L.) Cultivars.

Turkey is the leading producer and exporter of hazelnuts, producing approximately 64% of global hazelnut production. This research investigated the effects of cultivars and altitude on the phenolic, antioxidant, and fatty acid compositions of five hazelnut cultivars grown at three different altitudes, 100 m, 350 m, and 800 m, in Ordu province, one of the territories that produce the most hazelnuts. The results showed that the cultivar and location significantly affected phenolic compounds, antioxidant activity, and fatty acid (FA) content. The lowest (2.30 mg/kg-Yagli) and highest (21.11 mg/kg-Kara) gallic acids were obtained at 100 m. The highest total phenolic content and antioxidant activity were found in the nuts grown at 350 m in the Kara and Palaz cultivars, at 100 m in the Yagli and Sivri cultivars, and at 800 m in the Çakildak cultivar. Oleic acid was the predominant FA in the cultivars and possessed a diverse trend according to the altitude and cultivar, ranging from 76.04% to 84.80%, increasing with altitude in all cultivars except Çakildak. Palmitic acid was the predominant saturated FA followed by stearic acid, which significantly varied according to the elevations. This study suggests that the responses of hazelnuts to altitude depend on the cultivar; hence, a proper approach to producing nuts containing more phenolic, fatty acids, and antioxidant activity includes choosing a suitable cultivar for a specific elevation.

Broccoli, Kale, and Radish Sprouts: Key Phytochemical Constituents and DPPH Free Radical Scavenging Activity.

Our research group previously found that broccoli sprouts possess neuroprotective effects during pregnancy. The active compound has been identified as sulforaphane (SFA), obtained from glucosinolate and glucoraphanin, which are also present in other crucifers, including kale. Sulforaphene (SFE), obtained from glucoraphenin in radish, also has numerous biological benefits, some of which supersede those of sulforaphane. It is likely that other components, such as phenolics, contribute to the biological activity of cruciferous vegetables. Notwithstanding their beneficial phytochemicals, crucifers are known to contain erucic acid, an antinutritional fatty acid. The aim of this research was to phytochemically examine broccoli, kale, and radish sprouts to determine good sources of SFA and SFE to inform future studies of the neuroprotective activity of cruciferous sprouts on the fetal brain, as well as product development. Three broccoli: Johnny's Sprouting Broccoli (JSB), Gypsy F1 (GYP), and Mumm's Sprouting Broccoli (MUM), one kale: Johnny's Toscano Kale (JTK), and three radish cultivars: Black Spanish Round (BSR), Miyashige (MIY), and Nero Tunda (NT), were analyzed. We first quantified the glucosinolate, isothiocyanate, phenolics, and DPPH free radical scavenging activity (AOC) of one-day-old dark- and light-grown sprouts by HPLC. Radish cultivars generally had the highest glucosinolate and isothiocyanate contents, and kale had higher glucoraphanin and significantly higher sulforaphane content than the broccoli cultivars. Lighting conditions did not significantly affect the phytochemistry of the one-day-old sprouts. Based on phytochemistry and economic factors, JSB, JTK, and BSR were chosen for further sprouting for three, five, and seven days and subsequently analyzed. The three-day-old JTK and radish cultivars were identified to be the best sources of SFA and SFE, respectively, both yielding the highest levels of the respective compound while retaining high levels of phenolics and AOC and markedly lower erucic acid levels compared to one-day-old sprouts.

Focusing on the locus of the breakdown for treatment of anomia: a pilot study.

The primary goal of this study was to evaluate the treatment effects of semantic feature analysis (SFA) and phonological components analysis (PCA) on word retrieval processing in persons with aphasia (PWAs). After identifying the locus of the breakdown in lexical retrieval processing, 15 monolingual native Persian speakers with aphasia were divided into two groups. After three naming trials, participants with dominant semantic deficits received SFA, and participants with primary phonological deficits were provided with PCA three times a week for eight weeks. Both approaches improved participants' naming and performance on language tests, including spontaneous speech, repetition, comprehension, and semantic processing. However, the correct naming of treated and untreated items was higher in mild-to-moderate participants, with mostly circumlocution and semantic paraphasias in the SFA group. The same holds for mild-to-moderate participants with mostly phonemic paraphasia who received PCA therapy. Moreover, the results showed that participants' baseline naming performance and semantic abilities could be associated with the treatment outcomes. Although limited by a lack of a control group, this study provided evidence supporting the possible benefits of focusing on the locus of the breakdown for treating anomia through SFA and PCA approaches, specifically in participants with mild to moderate aphasia. However, for those with severe aphasia, the treatment choice may not be as straightforward because several variables are likely to contribute to this population's word-finding difficulties. Replication with larger, well-stratified samples, use of a within-subjects alternating treatment design and consideration of treatments' long-term effects are required to better ascertain the effects of focusing on the locus of breakdown for treatment of anomia.

The efficiency of government finanical expenditures before and during the COVID-19 pandemic: A cross-country investigation.

This paper examines the way government spending affected productivity and its decomposition before and during the COVID-19 outbreak. Using panel data from 158 economies, the research shows that spending on health care increases productivity, while spending on the military slows down productivity and its decompositions. These effects are even greater in the context of COVID-19, showing that spending on health care and avoiding conflict and military escalation will be important for future economies to grow in a sustainable way.

A prospective randomized trial on endovascular recanalization with stenting versus remote endarterectomy for the superficial femoral artery total occlusive lesions.

OBJECTIVE: The objective of this randomized study was to compare the short- and long-term safety and efficacy of endovascular recanalization with stenting (EI) and remote endarterectomy (RE) for patients with superficial femoral artery (SFA) total occlusive lesions (≥250 mm). METHODS: Between July 2013 and July 2017, eligible patients with SFA total occlusive lesions were randomized to EI or RE. The EI group underwent recanalization and stenting of long SFA atherosclerotic occlusive lesions. The RE group underwent semiclosed endarterectomy. Short- (30-day) and long-term (48-month) morbidity, mortality, and patency rates were compared between both groups. RESULTS: Of 400 patients assessed, 238 were ultimately randomized (119 EI and 119 RE). The cumulative primary patencies were 83% (EI) vs 82% (RE) at 12 months and 28% (EI) vs 46% (RE) at 48 months (P = .04). The limb salvage was 98% (EI) vs 95% (RE) at 12 months and 87% (EI) vs 92% (RE) at 48 months (P = .26). One-year and 4-year secondary patencies were 98% and 87% in the EI group and 100% and 90% in the RE group, respectively (P = .4). A total of 65 patients in the stenting group and 32 patients in the endarterectomy group underwent endovascular reintervention. Four-year patencies of endovascular reintervention subgroups were 37% and 60% (P = .04), respectively. CONCLUSIONS: RE shows significantly better results in the long term than primary stenting of SFA long lesions (TASC-II D lesions). In case of loss patency, a desobliterated artery can be successfully subjected to endovascular revascularization and stenting with good short- and long-term results.

Individual SFA intake and risk of overweight/obesity: findings from a population-based nationwide cohort study.

The relationship between SFA consumption and the risk of overweight/obesity remains unclear. Epidemiological evidence is lacking among Chinese population. This study aimed to investigate the association between individual dietary SFA intake and the risk of overweight/obesity in Chinese adults. Data from 8465 adults with BMI < 24 kg/m2 at entry in the China Health and Nutrition Survey (1989-2011) were analysed. Three-day 24-h dietary records were used to collect dietary data. Cox proportional hazards regression models were constructed to estimate hazard ratios (HR) and 95 % CI for the risk of developing overweight or obesity. A total of 3171 incident cases of overweight/obesity were identified (1649 for women and 1522 for men) during a median of 11 years of follow-up. Compared with the lowest category, the intake of total SFA (TSFA) showed no significant association with the risk of overweight/obesity. However, an increased risk of overweight/obesity was observed with a higher intake of medium chain SFA (MCSFA) (Ptrend = 0·004), especially decanoic acid (10:0) (HR was 1·25 (95 % CI 1·10, 1·42) comparing the highest category with the reference group; Ptrend < 0·001), whereas an inverse relationship was observed for hexanoic acid (6:0) consumption; compared with non-consumers, 6:0 intake was associated with 32 % lower risk of overweight/obesity (HR: 0·68 (95 % CI 0·56, 0·84); Ptrend < 0·001). Overall, the intake of subtypes of MCSFA but not TSFA was associated with the risk of overweight/obesity. Increasing hexanoic acid (6:0) and limiting decanoic acid (10:0) consumption may be protective for overweight/obesity among Chinese population.

Dairy product consumption is associated with a lowering of linoleic acid within serum TAG in adolescent females with overweight or obesity: a secondary analysis.

Dairy fat is rich in SFA such as palmitic acid (16:0) but low in linoleic acid (18:2n-6). The natural carbon 13 enrichment (δ13C) of 16:0 is higher in dairy fat than in most of the food supply. In adults, serum levels of pentadecanoic acid (15:0) and heptadecanoic acid (17:0) are recognised as biomarkers of dairy intake. In adolescents, no study has evaluated serum fatty acid levels or δ13C in response to chronic dairy consumption. The objectives of this study were to evaluate whether increased dairy product consumption can modulate (1) serum fatty acid levels and (2) 16:0 δ13C in adolescents with overweight/obesity who followed a 12-week weight management programme. This secondary analysis of a randomised control trial included two groups of adolescent females: recommended dairy (RDa; n 23) and low dairy (LDa; n 23). The RDa group was given 4 servings/d of dairy products while the LDa group maintained dairy intakes at ≤ 2 servings/d. Blood was sampled before and after the intervention. Lipids were extracted and separated, and fatty acids were quantified by GC. Isotope ratio MS was used to assess 16:0 δ13C. There were no group differences on serum changes of 15:0 or 17:0. Within TAG, 18:2n-6 was lowered by 7·4 % only in the RDa group (P = 0·040). The difference in delta 16:0 δ13C between the LDa and RDa groups did not reach statistical significance (P = 0·070). Reductions in serum 18:2n-6 by dairy consumption could have positive health implications, but more studies are needed to confirm this assertion.

Effects of diets rich in ghee or olive oil on cardiometabolic risk factors in healthy adults: a two-period, crossover, randomised trial.

This study aimed to evaluate the cardiovascular health-related effects of consuming ghee in the usual diet. Thirty healthy men and women were studied in a free-living outpatient regimen. The participants were instructed for the isoenergetic inclusion of ghee or olive oil in their diets for 4 weeks using a randomised crossover design. At the end of run-in (baseline), 2-week wash-out and interventions, fasting blood samples were drawn. In addition, 2-h postprandial blood samples were collected after ingestion of a meal containing olive oil or ghee at week 4 of each dietary intervention. Body weight was not different between the two interventions. Compared with the olive oil, the diet with ghee increased fasting plasma apo-B (apo B) (0·09, 95 % CI 0·02, 0·17 g/l, P = 0·018), non-HDL-cholesterol (non-HDL-cholesterol) (0·53, 95 % CI 0·01, 1·05 mmol/l, P = 0·046) and LDL-cholesterol did not differ significantly between diet groups (0·29, 95 % CI -0·05, 0·63 mmol/l, P = 0·092), but had no significant effect on total cholesterol:HDL-cholesterol ratio (0·75, 95 % CI - 0·24 to 1·74 mmol/l, P = 0·118). No significant difference was observed in fasting as well as 2-h postprandial plasma TAG, glucose, insulin and plasminogen activator inhibitor-1 concentrations. This study showed that ghee that is predominantly saturated fats had an increasing effect on plasma apo B and non-HDL-cholesterol compared with olive oil, adding further evidence to the existing recommendations to replace dietary fats high in SFA with dietary fats high in unsaturated fats to reduce CVD risk.

Polymorphisms in the stearoyl-CoA desaturase gene modify blood glucose response to dietary oils varying in MUFA content in adults with obesity.

Diets varying in SFA and MUFA content can impact glycaemic control; however, whether underlying differences in genetic make-up can influence blood glucose responses to these dietary fatty acids is unknown. We examined the impact of dietary oils varying in SFA/MUFA content on changes in blood glucose levels (primary outcome) and whether these changes were modified by variants in the stearoyl-CoA desaturase (SCD) gene (secondary outcome). Obese men and women participating in the randomised, crossover, isoenergetic, controlled-feeding Canola Oil Multicenter Intervention Trial II consumed three dietary oils for 6 weeks, with washout periods of ˜6 weeks between each treatment. Diets studied included a high SFA/low MUFA Control oil (36·6 % SFA/28·2 % MUFA), a conventional canola oil (6·2 % SFA/63·1 % MUFA) and a high-oleic acid canola oil (5·8 % SFA/74·7 % MUFA). No differences in fasting blood glucose were observed following the consumption of the dietary oils. However, when stratified by SCD genotypes, significant SNP-by-treatment interactions on blood glucose response were found with additive models for rs1502593 (P = 0·01), rs3071 (P = 0·02) and rs522951 (P = 0·03). The interaction for rs3071 remained significant (P = 0·005) when analysed with a recessive model, where individuals carrying the CC genotype showed an increase (0·14 (sem 0·09) mmol/l) in blood glucose levels with the Control oil diet, but reductions in blood glucose with both MUFA oil diets. Individuals carrying the AA and AC genotypes experienced reductions in blood glucose in response to all three oils. These findings identify a potential new target for personalised nutrition approaches aimed at improving glycaemic control.

Angiographic flow velocity predicts lower limb outcomes after endovascular therapy: Application of the frame count method.

INTRODUCTION: Several factors related to lesion characteristics and endovascular therapy (EVT) procedures have been reported to affect primary patency after EVT. However, it is unknown why these factors were associated with primary patency. We hypothesized patency failure was related to poor blood flow in affected arteries. METHODS: This retrospective study included 131 consecutive patients who had received EVT with bare metal stents for peripheral artery disease caused by femoropopliteal artery lesions. Based on the tertile post-EVT flow velocity of the superficial femoral artery (SFA), patients were divided into high (n = 43), middle (n = 44), and low (n = 44) flow velocity groups. Flow velocity was measured using the frame count method. We measured incidence of major adverse limb events (MALE), composed of target lesion revascularization (TLR), non-TLR, and major amputation. RESULTS: At a median follow-up period of 22.7 months, MALE had occurred in 7 (16.3%), 10 (22.7%), and 29 (65.9%) of patients from the high, middle, and low SFA flow velocity groups, respectively (p < 0.001). Kaplan-Meier analysis showed incidence of MALE was significantly higher in the patients of low SFA flow velocity (log-rank test χ2 = 38.8, p < 0.001). Multivariate analysis found low SFA flow velocity to be an independent predictor for MALE (hazard ratio: 4.42; 95% CI: 2.27 to 8.60; p < 0.001) as was ankle-brachial index. CONCLUSION: Post-EVT SFA flow velocity for femoropopliteal artery lesions treated with bare metal stents is an independent predictor of limb patency. The frame count method for assessing arterial flow velocity is convenient and has potential for wide applications in EVT.

Intake of carbohydrates and SFA and risk of CHD in middle-age adults: the Hordaland Health Study (HUSK).

OBJECTIVE: Limiting SFA intake may minimise the risk of CHD. However, such reduction often leads to increased intake of carbohydrates. We aimed to evaluate associations and the interplay of carbohydrate and SFA intake on CHD risk. DESIGN: Prospective cohort study. SETTING: We followed participants in the Hordaland Health Study, Norway from 1997-1999 through 2009. Information on carbohydrate and SFA intake was obtained from a FFQ and analysed as continuous and categorical (quartiles) variables. Multivariable Cox regression estimated hazard ratios (HR) and 95 % CI. Theoretical substitution analyses modelled the substitution of carbohydrates with other nutrients. CHD was defined as fatal or non-fatal CHD (ICD9 codes 410-414 and ICD10 codes I20-I25). PARTICIPANTS: 2995 men and women, aged 46-49 years. RESULTS: Adjusting for age, sex, energy intake, physical activity and smoking, SFA was associated with lower risk (HRQ4 v. Q1 0·44, 95 % CI 0·26, 0·76, Ptrend = 0·002). For carbohydrates, the opposite pattern was observed (HRQ4 v. Q1 2·10, 95 % CI 1·22, 3·63, Ptrend = 0·003). SFA from cheese was associated with lower CHD risk (HRQ4 v. Q1 0·44, 95 % CI 0·24, 0·83, Ptrend = 0·006), while there were no associations between SFA from other food items and CHD. A 5 E% substitution of carbohydrates with total fat, but not SFA, was associated with lower CHD risk (HR 0·75, 95 % CI 0·62, 0·90). CONCLUSIONS: Higher intake of predominantly high glycaemic carbohydrates and lower intake of SFA, specifically lower intake from cheese, were associated with higher CHD risk. Substituting carbohydrates with total fat, but not SFA, was associated with significantly lower risk of CHD.

Deranged Myocardial Fatty Acid Metabolism in Heart Failure.

The heart requires fatty acids to maintain its activity. Various mechanisms regulate myocardial fatty acid metabolism, such as energy production using fatty acids as fuel, for which it is known that coordinated control of fatty acid uptake, ß-oxidation, and mitochondrial oxidative phosphorylation steps are important for efficient adenosine triphosphate (ATP) production without unwanted side effects. The fatty acids taken up by cardiomyocytes are not only used as substrates for energy production but also for the synthesis of triglycerides and the replacement reaction of fatty acid chains in cell membrane phospholipids. Alterations in fatty acid metabolism affect the structure and function of the heart. Recently, breakthrough studies have focused on the key transcription factors that regulate fatty acid metabolism in cardiomyocytes and the signaling systems that modify their functions. In this article, we reviewed the latest research on the role of fatty acid metabolism in the pathogenesis of heart failure and provide an outlook on future challenges.

Complication rates associated with antegrade use of vascular closure devices: a systematic review and pooled analysis.

BACKGROUND: Vascular closure devices (VCDs) have become a mainstay in endovascular interventions in recent years. On-label use only allows for retrograde interventions originating at the common femoral artery (CFA). However, off-label use in antegrade and/or superficial femoral artery (SFA) access has become more common in the treatment of peripheral arterial disease. Despite this, there is a paucity of comparative literature assessing individual VCD safety profiles and relative complication risks of CFA vs SFA applications. METHODS: MEDLINE and EMBASE systematic searches were performed from inception to October 2019 to identify studies assessing VCD use in antegrade CFA and SFA interventions. Abstract selection and data extraction were performed by two independent reviewers. Primary outcomes included bleeding-related complications, vessel occlusion or stenosis, embolization, pseudoaneurysm formation, or arteriovenous fistula formation. RESULTS: Twenty-four unique studies with 4124 vascular closure events via six unique VCDs were included (Angioseal, Exoseal, Femoseal, Glubran 2, Mynx, Starclose; 3698 CFA, 426 SFA). Pooled occurrence of all complications across closure devices used in the CFA and SFA ranged from 0.9% (Mynx) to 7.4% (Starclose) and 0% (Perclose) to 10.1% (Starclose), respectively, depending on VCD type. Clinically meaningful differences were identified between devices with a trend toward significance (P = .08 CFA, P = .07 SFA). Individual devices demonstrated a range of bleeding complication rates from 0.4% (Mynx) to 7.2% (Femoseal) for the CFA site and from 0% (Perclose) to 6.4% (Starclose) for the SFA site (P = .01 and P = .03, respectively). Significant heterogeneity between studies precludes definitive characterization of the device as cause for variations in bleeding complication rates. Pooled complication rates did not differ between the CFA and SFA arms (4.6% vs 5.8%, P = .56). Bleeding complication rates also did not differ between the CFA and SFA arms (3.6% vs 3.6%, P = .98). CONCLUSIONS: Clinically meaningful differences in overall pooled complications were identified between VCDs with a trend toward significance. Significant differences between VCDs exist with respect to bleeding risk. However, this must be interpreted with caution as these differences could be secondary to interstudy heterogeneity. Finally, no difference was identified between antegrade SFA and CFA VCD use with respect to overall complication and bleeding risks.