Cardiocerebrovascular benefits of early rhythm control in patients with atrial fibrillation detected after stroke: a systematic review and meta-analysis.

Objective: This study aimed to evaluate the impact of early rhythm control (ERC) on the occurrence of cardiocerebrovascular events in patients diagnosed with atrial fibrillation detected after stroke (AFDAS). Methods: A systematic search was conducted across nine databases from inception to October 15, 2023 to identify clinical trials comparing ERC with usual care interventions in AFDAS patients. The primary outcome assessed was recurrent stroke, with secondary outcomes including all-cause mortality, adverse events related to arrhythmias, and dementia. Results: Analysis of five studies, consisting of two randomized clinical trials (RCTs) involving 490 patients and three cohort studies involving 95,019 patients, revealed a reduced rate of recurrent stroke [odds ratio (OR) = 0.30, 95% confidence interval (CI) 0.11-0.80, P = 0.016 in RCTs; OR = 0.64, 95% CI 0.61-0.68, P < 0.00001 in cohort studies] and all-cause mortality (hazards ratio = 0.94, 95% CI 0.90-0.98, P = 0.005 in cohort studies) in the ERC group compared to the usual care group. In addition, ERC was associated with superior outcomes in terms of dementia. Conclusions: Patients with AFDAS who underwent ERC treatment exhibited a decreased risk of cardiocerebrovascular events compared to those receiving usual care. These results support the potential benefits of implementing an ERC strategy for this specific patient population. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, Identifier [CRD42023465994].

Dissecting the mediating and moderating effects of depression on the associations between traits and coronary artery disease: A two-step Mendelian randomization and phenome-wide interaction study.

Background: Depression is often present concurrently with coronary artery disease (CAD), a disease with which it shares many risk factors. However, the manner in which depression mediates and moderates the association between traits (including biomarkers, anthropometric indicators, lifestyle behaviors, etc.) and CAD is largely unknown. Methods: In our causal mediation analyses using two-step Mendelian randomization (MR), univariable MR was first used to investigate the causal effects of 108 traits on liability to depression and CAD. The traits with significant causal effects on both depression and CAD, but not causally modulated by depression, were selected for the second-step analyses. Multivariable MR was used to estimate the direct effects (independent of liability to depression) of these traits on CAD, and the indirect effects (mediated via liability to depression) were calculated. To investigate the moderating effect of depression on the association between 364 traits and CAD, a cross-sectional phenome-wide interaction study (PheWIS) was conducted in a study population from UK Biobank (UKBB) (N=275,257). Additionally, if the relationship between traits and CAD was moderated by both phenotypic and genetically predicted depression at a suggestive level of significance (Pinteraction≤0.05) in the PheWIS, the results were further verified by a cohort study using Cox proportional hazards regression. Results: Univariable MR indicated that 10 of 108 traits under investigation were significantly associated with both depression and CAD, which showed a similar direct effect compared to the total effect for most traits. However, the traits "drive faster than speed limit" and "past tobacco smoking" were both exceptions, with the proportions mediated by depression at 24.6% and 7.2%, respectively. In the moderation analyses, suggestive evidence of several traits was found for moderating effects of phenotypic depression or susceptibility to depression, as estimated by polygenic risk score, including chest pain when hurrying, reason of smoking quitting and weight change. Consistent results were observed in survival analyses and Cox regression. Conclusion: The independent role of traits in CAD pathogenesis regardless of depression was highlighted in our mediation analyses, and the moderating effects of depression observed in our study may be helpful for CAD risk stratification and optimized allocation of scarce medical resources.

Yoga for secondary prevention of coronary heart disease: A systematic review and meta-analysis.

OBJECTIVES: Yoga has been widely practiced and has recently shown benefits in patients with coronary heart disease (CHD), however, evidence is inconsistent. METHODS: We conducted a systematic review and meta-analysis by searching PubMed/Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and Web of Science from inception to May 31, 2020 for randomised controlled trials (RCTs) comparing yoga with usual care or non-pharmacological interventions in patients with CHD. The primary outcomes were all-cause mortality and health related quality of life (HR-QoL). Secondary outcomes were a composite cardiovascular outcome, exercise capacity and cardiovascular risk factors (blood pressure, lipid profiles and body mass index). RESULTS: Seven RCTs with a total of 4671 participants were included. Six RCTs compared yoga with usual care and one compared yoga with designed exercise. The mean age of the participants ranged from 51.0-60.7 years and the majority of them were men (85.4 %). Pooled results showed that compared with usual care, yoga had no effect on all-cause mortality (RR, 1.02; 95 % CI, 0.75-1.39), but it significantly improved HR-QoL (SMD, 0.07; 95 % CI, 0.01 - 0.14). A non-significant reduction of the composite cardiovascular outcome was observed (133 vs. 154; RR, 0.63; 95 % CI, 0.15-2.59). Serum level of triglyceride and high density lipoprotein cholesterol, blood pressure and body mass index were also significantly improved. The study comparing yoga with control exercise also reported significantly better effects of yoga on HR-QoL (85.75 vs. 75.24, P < 0.001). No severe adverse events related to yoga were reported. CONCLUSIONS: Yoga might be a promising alternative for patients with CHD as it is associated with improved quality of life, less number of composite cardiovascular events, and improved cardiovascular risk factors.

Acute myocardial infarction in a young woman with ulcerative colitis: A case report and literature review.

RATIONALE: Myocardial infarction due to nonatherosclerotic coronary thrombosis in young woman with ulcerative colitis is rare. PATIENT CONCERNS: A 23-year-old Chinese woman with a 3-year history of ulcerative colitis was admitted to the coronary care unit due to prolonged chest pain. DIAGNOSES: Myocardial infarction due to nonatherosclerotic coronary thrombosis was diagnosed in this young woman. LESSONS: Coronary artery thrombosis in ulcerative colitis is a serious condition and can occur in the young population.