ECG-based data-driven solutions for diagnosis and prognosis of cardiovascular diseases: A systematic review.

Cardiovascular diseases (CVD) are a leading cause of death globally, and result in significant morbidity and reduced quality of life. The electrocardiogram (ECG) plays a crucial role in CVD diagnosis, prognosis, and prevention; however, different challenges still remain, such as an increasing unmet demand for skilled cardiologists capable of accurately interpreting ECG. This leads to higher workload and potential diagnostic inaccuracies. Data-driven approaches, such as machine learning (ML) and deep learning (DL) have emerged to improve existing computer-assisted solutions and enhance physicians' ECG interpretation of the complex mechanisms underlying CVD. However, many ML and DL models used to detect ECG-based CVD suffer from a lack of explainability, bias, as well as ethical, legal, and societal implications (ELSI). Despite the critical importance of these Trustworthy Artificial Intelligence (AI) aspects, there is a lack of comprehensive literature reviews that examine the current trends in ECG-based solutions for CVD diagnosis or prognosis that use ML and DL models and address the Trustworthy AI requirements. This review aims to bridge this knowledge gap by providing a systematic review to undertake a holistic analysis across multiple dimensions of these data-driven models such as type of CVD addressed, dataset characteristics, data input modalities, ML and DL algorithms (with a focus on DL), and aspects of Trustworthy AI like explainability, bias and ethical considerations. Additionally, within the analyzed dimensions, various challenges are identified. To these, we provide concrete recommendations, equipping other researchers with valuable insights to understand the current state of the field comprehensively.

Yoga Nidra for hypertension: A systematic review and meta-analysis.

BACKGROUND: Hypertension is a prevalent chronic condition that affects a substantial proportion of the world's population. Medications are commonly prescribed for hypertension management, but non-pharmacological interventions like yoga are gaining popularity. OBJECTIVE: The purpose of this systematic review and meta-analysis is to assess the efficacy of Yoga Nidra (YN) for the management of hypertension. METHODS: A systematic review and meta-analysis of clinical trials, i.e., non-randomized and randomized controlled trials (RCTs) was conducted to investigate the effects of YN on hypertension. PubMed, the Cochrane Library, SCOPUS, and EBSCO were searched for relevant studies published up to September 2022. The quality of the included studies was assessed using the Cochrane risk of bias tool. The primary outcome measure was the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP) after YN intervention, analyzed as weighted mean difference (WMD), in comparison to control groups. The random-effects model was used for the meta-analysis. Risk of bias was assessed for RCTs and non-RCTs using Cochrane's RoB-2 and ROBINS-I tools, respectively. RESULTS: Five RCTs and three Non-RCTs involving a total of 482 participants (239 for YN vs 243 for controls) were included in this review. The meta-analysis indicated that YN significantly reduced SBP (WMD = 12.03 mm Hg, 95% CI [7.12, 16.93], Z = 4.80, p < 0.00001) and DBP (WMD = 6.32 mm Hg, 95% CI [3.53, 9.12], Z = 4.43, p < 0.00001) compared to control groups. The overall risk of bias for the three RCTs was high, whereas for the five non-RCTs, one had an overall moderate risk while the other four had an overall serious risk of bias. DISCUSSION: This systematic review and meta-analysis provides evidence supporting the efficacy of YN as a complementary therapy for hypertension management. YN is a safe, cost-effective, and easily accessible intervention that primarily relies on interoception and induces a deep relaxation response in practitioners, aiding them in coping with various components of high blood pressure, such as stress, vascular inflammation, peripheral vascular resistance, etc. Our understanding of the mechanisms of YN is constantly evolving, and there is a need for further research to fully explore and appreciate the significance of this ancient science and its potential efficacy on BP. Considering the results and the multifactorial role of YN, it can act as a safe and reliable adjuvant therapy to complement the pharmacological treatment of hypertension. However, further studies with larger sample sizes, longer follow-up periods, and homogenous populations are warranted. CONCLUSION: This meta-analysis suggests that YN is effective in reducing SBP and DBP, particularly in individuals with hypertension. The results highlight the potential of YN as a complementary therapy for hypertension management. Healthcare providers may consider recommending YN to patients with hypertension as an adjuvant therapy to medication. Further studies are required to identify standardized optimal forms and durations of YN best suited for hypertension management.

Association of serum 25-hydroxyvitamin D concentrations with all-cause and cardiovascular mortality among US adults with prehypertension: a prospective cohort study.

BACKGROUND: Prehypertension affects 25-50% of adults worldwide and no prior study has examined the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and mortality risk in individuals with prehypertension. This study aims to investigate the association of serum 25(OH)D concentrations with all-cause and CVD mortality among prehypertensive adults by utilizing data from the US National Health and Nutrition Examination Survey (NHANES) 2007-2014 and linked 2019 mortality file. METHODS: We included 4345 prehypertensive adults who participated in the NHANES between 2007 and 2014 and were followed up until 31 December 2019. Weighted Cox proportional hazards models were used with adjustments for multiple covariates to calculate the hazard ratio (HR) and 95% confidence interval (CI) for the risks of dying from any cause and CVD. RESULTS: During a median follow-up of 8.8 years, 335 deaths from any causes were documented, of which 88 participants died from CVD. Compared with participants with sufficient 25(OH)D (≥ 75 nmol/L), the multivariate-adjusted HRs and 95% CIs for participants with severe deficiency (< 25 nmol/L), moderate deficiency (25-49.9 nmol/L), and insufficient concentrations (50-74.9 nmol/L) of serum 25(OH)D for all-cause death were 2.83 (1.46-5.52), 1.17 (0.74-1.86), and 1.36 (0.93-1.98), respectively. Similarly, the multivariable-adjusted HRs and 95%CIs for CVD death were 4.14 (1.10-15.51), 1.23 (0.46-3.28), and 1.73 (0.96-3.14), respectively. We found that there was a 9% reduction in the risk of death from all causes and a 14% reduction in the risk of death from CVD for every 10 nmol/L increase in serum 25(OH)D concentrations. CONCLUSION: Severe serum 25(OH)D deficiency among prehypertensive adults was associated with increased risk of mortality from all causes as well as from CVD. Our work suggests that supplementing with vitamin D may prevent premature death in severely deficient individuals with prehypertension.

Trends of serum 25(OH) vitamin D and association with cardiovascular disease and all-cause mortality: from NHANES survey cycles 2001-2018.

Background: The focus of this survey is on survey data for adults aged 20 and above, covering nine survey cycles from 2001 to 2018. Additionally, the present study explored the correlation between vitamin D concentrations and both cardiovascular disease (CVD) and all-cause mortality. Objective: The objectives of this study were to evaluate the trend of changes in the serum 25(OH)D concentration changes in US adults during the survey period, the prevalence of vitamin D deficiency, and the current status of vitamin D dietary intake and supplementation. Methods: In-home health interviews were performed using meticulously designed questionnaires that gathered information on demographic details, socioeconomic conditions, dietary patterns, and overall health status. Health assessments were conducted in specially designed mobile centers. Results: Survey data from 2001 to 2018 revealed a rise in serum 25(OH)D levels, from a weighted mean (95% CI) of 65.6 (63.8-67.4) nmol/L during 2001-2002 to 73.5 (70.4-76.5) nmol/L during 2017-2018, among US adults, while overall vitamin D deficiency rates remained stable (p = 0.152). Notably, in adults aged 20-39, 25(OH)D levels decreased (p = 0.002 for trend), and 25(OH)D deficiency increased (p = 0.003 for trend), especially among those with low incomes (deficiency >30%). Upon multivariable adjustment, an L-shaped relationship was found between serum 25(OH)D concentrations and both CVD and all-cause mortality (p < 0.001 for nonlinearity), as corroborated by sensitivity analyses. Conclusion: From 2001 to 2018, US adults experienced a significant increase in their serum 25(OH) D concentration. However, subgroups of individuals, including young adults and individuals with lower socioeconomic status, exhibited a heightened risk of 25(OH)D deficiency. Furthermore, an L-shaped relationship was found between 25(OH)D concentration and both all-cause and CVD mortality among US adults.

CVD phenotyping in oncologic disorders: cardio-miRNAs as a potential target to improve individual outcomes in revers cardio-oncology.

With the increase of aging population and prevalence of obesity, the incidence of cardiovascular disease (CVD) and cancer has also presented an increasing tendency. These two different diseases, which share some common risk factors. Relevant studies in the field of reversing Cardio-Oncology have shown that the phenotype of CVD has a significant adverse effect on tumor prognosis, which is mainly manifested by a positive correlation between CVD and malignant progression of concomitant tumors. This distal crosstalk and the link between different diseases makes us aware of the importance of diagnosis, prediction, management and personalized treatment of systemic diseases. The circulatory system bridges the interaction between CVD and cancer, which suggests that we need to fully consider the systemic and holistic characteristics of these two diseases in the process of clinical treatment. The circulating exosome-miRNAs has been intrinsically associated with CVD -related regulation, which has become one of the focuses on clinical and basic research (as biomarker). The changes in the expression profiles of cardiovascular disease-associated miRNAs (Cardio-miRNAs) may adversely affect concomitant tumors. In this article, we sorted and screened CVD and tumor-related miRNA data based on literature, then summarized their commonalities and characteristics (several important pathways), and further discussed the conclusions of Cardio-Oncology related experimental studies. We take a holistic approach to considering CVD as a risk factor for tumor malignancy, which provides an in-depth analysis of the various regulatory mechanisms or pathways involved in the dual attribute miRNAs (Cardio-/Onco-miRNAs). These mechanisms will be key to revealing the systemic effects of CVD on tumors and highlight the holistic nature of different diseases. Therefore, the Cardio-miRNAs should be given great attention from researchers in the field of CVD and tumors, which might become new targets for tumor treatment. Meanwhile, based on the principles of precision medicine (such as the predictive preventive personalized medicine, 3PM) and reverse Cardio-oncology to better improve individual outcomes, we should consider developing personalized medicine and systemic therapy for cancer from the perspective of protecting cardiovascular function.

Association Between Nutrients and Cardiovascular Diseases.

Cardiovascular diseases (CVD) constitute a leading cause of global mortality. Inflammation and oxidative stress are key molecular underpinnings of CVD pathogenesis. This comprehensive review explores the multifaceted role of nutrients in cardiovascular health beyond their impact on cardiac events. The manuscript examines the influence of macronutrients such as fats and carbohydrates, as well as micronutrients including vitamins and folate, on CVD. Additionally, the interplay between dietary supplements and CVD risk reduction is investigated. The purpose of this manuscript is to provide a comprehensive overview of the diverse mechanisms through which nutrients contribute to cardiovascular well-being, addressing both cardioprotective effects and their broader implications. Through an analysis of pertinent studies, we illuminate the complex relationship between nutrition, lifestyle, and cardiovascular health, underscoring the significance of a holistic approach to CVD prevention and management.

A comprehensive calibration of integrated magnetron sputtering and plasma enhanced chemical vapor deposition for rare-earth doped thin films.

A new integrated deposition system taking advantage of magnetron sputtering and electron cyclotron-plasma enhanced chemical vapour deposition (IMS ECR-PECVD) is presented that mitigates the drawbacks of each fabrication system. This tailor-made system provides users with highly homogeneous and pure thin films with less undesired hydrogen and well-controlled rare-earth concentration compared to existing methods of rare-earth doping, such as metalorganic powders, sputtering, and ion implantation. We established the first comprehensive report on the deposition parameters of argon flow and sputtering power to achieve desired rare-earth concentrations in a wide composition range of terbium (Tb) doped-silicon oxide (Tb:SiOx) matrices including silicon-rich (x < 2), oxygen-rich (x > 2), and stoichiometric silicon oxide (x = 2). The deposition parameters to fabricate crystalline structure (Tb2Si2O7) in oxygen-rich samples are reported where Tb ions are optically active. IMS ECR-PECVD pushes the solubility limit of the rare-earth dopant in silicon films to 17 at.% for the desired future nanophotonic devices. Supplementary Information: The online version contains supplementary material available at 10.1557/s43578-023-01207-2.

Flaxseed oil fraction reverses cardiac remodeling at a molecular level: improves cardiac function, decreases apoptosis, and suppresses miRNA-29b and miRNA 1 gene expression.

Flaxseed is an ancient commercial oil that historically has been used as a functional food to lower cholesterol levels. However, despite its longstanding treatment, there is currently a lack of scientific evidence to support its role in the management of cardiac remodeling. This study aimed to address this gap in knowledge by examining the molecular mechanism of standardized flaxseed oil in restoring cardiac remodeling in the heart toxicity vivo model. The oil fraction was purified, and the major components were standardized by qualitative and quantitative analysis. In vivo experimental design was conducted using isoproterenol ISO (85 mg/kg) twice subcutaneously within 24 h between each dose. The rats were treated with flaxseed oil fraction (100 mg/kg orally) and the same dose was used for omega 3 supplement as a positive control group. The GC-MS analysis revealed that α-linolenic acid (24.6%), oleic acid (10.5%), glycerol oleate (9.0%) and 2,3-dihydroxypropyl elaidate (7%) are the major components of oil fraction. Physicochemical analysis indicated that the acidity percentage, saponification, peroxide, and iodine values were 0.43, 188.57, 1.22, and 122.34 respectively. As compared with healthy control, ISO group-induced changes in functional cardiac parameters. After 28-day pretreatment with flaxseed oil, the results indicated an improvement in cardiac function, a decrease in apoptosis, and simultaneous prevention of myocardial fibrosis. The plasma levels of BNP, NT-pro-BNP, endothelin-1, Lp-PLA2, and MMP2, and cTnI and cTn were significantly diminished, while a higher plasma level of Topo 2B was observed. Additionally, miRNA - 1 and 29b were significantly downregulated. These findings provide novel insight into the mechanism of flaxseed oil in restoring cardiac remodeling and support its future application as a cardioprotective against heart diseases.

Mechanism of Ferroptosis in Myocardial Cells and Protective Effect of Traditional Chinese Medicine / 中国实验方剂学杂志

Ferroptosis is a new type of programmed cell death， characterized by iron overload and lipid peroxidation. Cardiovascular disease （CVD） is an ischemic or hemorrhagic disease of the heart caused by various factors， mainly including myocardial infarction， heart failure， etc. Ferroptosis is involved in the process of myocardial cell damage and plays a driving role in the progression of various CVDs. Its main mechanisms include the destruction of iron homeostasis， the production of reactive oxygen species， the disorder of the antioxidant system， mitochondrial membrane damage， endoplasmic reticulum stress， tumor suppressor gene p53， transcription factor Nrf2 pathway， etc. Myocardial injury is one of the causes of death in many patients with heart disease. Monomers or compounds of traditional Chinese medicine have shown good effects in the treatment of myocardial cell injury caused by ferroptosis， including baicalin protecting cardiac microvascular endothelial cells of myocardial ischemia-reperfusion （I/R） rats through intracellular phosphatidylinositol kinase/phosphokinase B/endothelial nitric oxide synthase （PI3K/Akt/eNOS） pathway， Aralia elata saponin inhibiting myocardial cell ferroptosis through glucocorticoid receptor/p53/solute carrier family 7 members 11 （NR3C1/p53/SLC7A11） pathway， Xinyang tablets improving oxidative stress by regulating phosphorylated serine/threonine protein kinase/stress-activated protein kinase/p53 （MLK3/JNK/p53） signaling pathway. It is of great significance to explore the mechanism of ferroptosis and the protective effect of related traditional Chinese medicine after myocardial cell injury. This article reviews the mechanism of ferroptosis and its relationship with myocardial cells， as well as traditional Chinese medicine monomers and formulas for treating CVDs through the ferroptosis pathway. The article focuses on the pathways and effects of traditional Chinese medicine treatment， so as to provide a reference for the treatment of CVDs with traditional Chinese medicine.

Genomic insights into heart health: Exploring the genetic basis of cardiovascular disease.

Cardiovascular diseases (CVDs) are considered as the leading cause of death worldwide. CVD continues to be a major cause of death and morbidity despite significant improvements in its detection and treatment. Therefore, it is strategically important to be able to precisely characterize an individual's sensitivity to certain illnesses. The discovery of genes linked to cardiovascular illnesses has benefited from linkage analysis and genome-wide association research. The last 20 years have seen significant advancements in the field of molecular genetics, particularly with the development of new tools like genome-wide association studies. In this article we explore the profound impact of genetic variations on disease development, prognosis, and therapeutic responses. And the significance of genetics in cardiovascular risk assessment and the ever-evolving realm of genetic testing, offering insights into the potential for personalized medicine in this domain. Embracing the future of cardiovascular care, the article explores the implications of pharmacogenomics for tailored treatments, the promise of emerging technologies in cardiovascular genetics and therapies, including the transformative influence of nanotechnology. Furthermore, it delves into the exciting frontiers of gene editing, such as CRISPR/Cas9, as a novel approach to combat cardiovascular diseases. And also explore the potential of stem cell therapy and regenerative medicine, providing a holistic view of the dynamic landscape of cardiovascular genomics and its transformative potential for the field of cardiovascular medicine.

Clinical effectiveness of krill oil supplementation on cardiovascular health in humans: An updated systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The potential role of krill oil (KO) supplementation on cardiovascular health are inconsistent in several clinical trials. Therefore, our present meta-analysis aimed to systematically evaluate the impacts of supplementation of KO on cardiovascular disease risk factors (CVDRFs). METHODS: Intervention trials assessing KO supplementation on cardiovascular disease (CVD) outcomes were systematically retrieved for pooling. The primary outcome was lipid profile. Secondary outcomes were consisted by blood pressure, glycemic indices, body composition together with inflammatory markers. We synthesized the effect sizes with 95% confidence intervals and weighted mean difference. To explore the heterogeneity source, we employed meta-regression and subgroup analysis. Quality assessment, publication bias, sensitivity-analysis and the certainty of evidence were also carried out. RESULTS: We included 14 trials (18 treatment arms) with 1458 participants. KO supplementation had beneficial effects on total cholesterol (P = 0.01), low-density lipoprotein cholesterol (P = 0.006), and triglycerides (P = 0.0005). However, no effects were found for other CVDRFs, such as blood pressure, glycemic control, body composition as well as inflammatory markers. Subgroup analyses indicated that these notably favorable effects were observed in trials with a parallel design, treatment duration <8 weeks and subjects with baseline body mass index <28 kg/m2. The above findings remained consistent in the sensitivity analysis, without obvious publication bias detected. CONCLUSIONS: The current evidence demonstrated that daily KO supplementation may as a candidate for lipid management strategies. In future, studies should pay attention to the relationships of KO intake with the incidence of CVD events or all-cause mortality.

Vitamin E Supplementation and Cardiovascular Health: A Comprehensive Review.

This article conducts a thorough investigation into the potential role of vitamin E in preventing cardiovascular diseases (CVDs) in the context of shifting mortality patterns from infectious diseases to the continued prominence of CVDs in modern medicine. The primary focus is on vitamin E's antioxidant properties and its specific ability to counter lipid peroxidation, a pivotal process in the early stages of atherosclerosis, a precursor to CVDs. The research spans a wide range of methodologies, including in vitro, in vivo, clinical, and experimental studies, examining how vitamin E affects critical aspects of cardiovascular health, such as signaling pathways, gene expression, inflammation, and cholesterol metabolism. It also explores vitamin E's influence on complex processes like smooth muscle cell development, oxidative stress reduction, foam cell formation, and the stability of atherosclerotic plaques. In the context of clinical studies, the article presents findings that both support and yield inconclusive results regarding the impact of vitamin E supplementation on CVDs. It acknowledges the intricate interplay of factors such as patient selection, pathophysiological conditions, and genetic variations, all of which can significantly influence the efficacy of vitamin E. The article underscores the need for ongoing research, with a specific focus on understanding the regulatory metabolites of vitamin E and their roles in modulating cellular processes relevant to CVDs. It highlights the potential for innovative therapeutic approaches based on a deeper comprehension of vitamin E's multifaceted effects. However, it also candidly addresses the challenges of translating clinical trial findings into practical applications and emphasizes the importance of considering diverse variables to optimize therapeutic outcomes. In summary, this meticulously conducted study provides a comprehensive examination of vitamin E's potential as a preventive agent against CVDs, recognizing the complexity of the subject and the need for continued research to unlock its full potential in cardiovascular health.

How to fix a broken heart-designing biofunctional cues for effective, environmentally-friendly cardiac tissue engineering.

Cardiovascular diseases bear strong socioeconomic and ecological impact on the worldwide healthcare system. A large consumption of goods, use of polymer-based cardiovascular biomaterials, and long hospitalization times add up to an extensive carbon footprint on the environment often turning out to be ineffective at healing such cardiovascular diseases. On the other hand, cardiac cell toxicity is among the most severe but common side effect of drugs used to treat numerous diseases from COVID-19 to diabetes, often resulting in the withdrawal of such pharmaceuticals from the market. Currently, most patients that have suffered from cardiovascular disease will never fully recover. All of these factors further contribute to the extensive negative toll pharmaceutical, biotechnological, and biomedical companies have on the environment. Hence, there is a dire need to develop new environmentally-friendly strategies that on the one hand would promise cardiac tissue regeneration after damage and on the other hand would offer solutions for the fast screening of drugs to ensure that they do not cause cardiovascular toxicity. Importantly, both require one thing-a mature, functioning cardiac tissue that can be fabricated in a fast, reliable, and repeatable manner from environmentally friendly biomaterials in the lab. This is not an easy task to complete as numerous approaches have been undertaken, separately and combined, to achieve it. This review gathers such strategies and provides insights into which succeed or fail and what is needed for the field of environmentally-friendly cardiac tissue engineering to prosper.

Clustering of gout-related comorbidities and their relationship with gout flares: a data-driven cluster analysis of eight comorbidities.

OBJECTIVES: To study the aggregation of multiple comorbidities in people with gout and explore differences in prognosis of gout flares among different subgroups. METHODS: Hierarchical clustering was performed to identify homogeneous subgroups among 2639 people with gout using eight comorbidities. A one-year follow-up of acute gout flares in 463 of these people was conducted; the incidence and the timing of gout flares in each cluster were assessed to explore prognosis of gout flares. Binary logistic regression was applied to assess factors associated with gout flares. RESULTS: In baseline study, we identified five subgroups (C1-C5). C1 (n = 671, 25%) was characterized by isolated gout with few comorbidities. C2 (n = 258, 10%) were all obese. Almost all people in C3 (n = 335, 13%) had diabetes (99.7%). All people in C4 (n = 938, 36%) had dyslipidemia. C5 (n = 437, 17%) had the highest proportion of cardiovascular disease (CVD, 53%), chronic kidney disease (CKD, 56%), and cancer (7%). In follow-up study, C5 had the highest incidence (71.9%) and earliest onset (median 3 months) of gout flares. C2 had the lowest incidence (52.1%) and the latest onset (median 10 months) of gout flares. The highest relative risk for gout recurrent was seen for C5 (OR = 2.09). Other factors associated with the risk of gout flares were age at diagnosis of gout, duration of gout, presence of tophi, and smoking ≥ 20 cigarettes/day. CONCLUSIONS: We clustered people with gout into five groups with varying comorbidities. People with CVD, CKD, and cancer had the highest risk of gout flares and should receive comprehensive care.

Association of marine PUFAs intakes with cardiovascular disease, all-cause mortality, and cardiovascular mortality in American adult male patients with dyslipidemia: the U.S. National Health and Nutrition Examination Survey, 2001 to 2016.

BACKGROUND: The relationship between marine polyunsaturated fatty acid (PUFA) intake and cardiovascular disease and mortality in dyslipidemic patients is unclear. Men with dyslipidemia have a higher risk of cardiovascular disease than women, and PUFA supplementation may be more beneficial in men. OBJECTIVE: The purpose of this study was to assess the relationship between different types of marine polyunsaturated fatty acids intakes and cardiovascular disease, all-cause mortality, and cardiovascular mortality in adult U.S. males with dyslipidemia. METHODS: The study ultimately included 11,848 adult men with dyslipidemia who were screened from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2016. This was linked to the 2019 National Death Index (NDI) records to establish a prospective cohort. In the study, a logistic regression model was established to assess the relationship between PUFA intake and prevalent CVD, and a Cox proportional hazards regression model was established to assess the relationship between PUFA intake and death. RESULTS: In the fully adjusted models, compared with participants in the lowest tertile, participants with the highest DPA intake were associated with a lower risk of CVD (CVD: OR = 0.71, 95%CI: 0.55, 0.91; angina: OR = 0.54, 95%CI: 0.38, 0.79; stroke: OR = 0.62, 95%CI: 0.43, 0.89), but not with three subtypes of congestive heart failure, coronary heart disease, and myocardial infarction. And the highest tertile level of DPA intake can reduce all-cause mortality (HR = 0.77, 95%CI: 0.64, 0.91) and CVD mortality (HR = 0.68, 95%CI: 0.52, 0.90). CONCLUSIONS: Cardiovascular disease risk, all-cause mortality, and CVD mortality were inversely associated with dietary DPA intake but not EPA and DHA intakes in U.S. male participants with dyslipidemia.

Vitamin C Improves Inflammatory-related Redox Status in Hyperlipidemic Rats.

Excessive dietary fat is mainly responsible for metabolic diseases including atherosclerosis and cardiovascular disease. We have evaluated the role of Vitamin C in an experimental hyperlipidemic model of rats (male Wistar rat 12-16 months). The hyperlipidemic model of the rat was created by treatment with an atherogenic suspension: cholesterol, cholic acid, and coconut oil, for 30 days once daily, and supplemented with Vitamin C (Ascorbic acid) doses of 0.5 g/kg body weight (orally) for the 30 days once daily. Bodyweight, fasting glucose, triglyceride, cholesterol, ROS (Reactive oxygen species), MDA (Malondialdehyde), FRAP (Ferric reducing the ability of plasma), GSH (Reduced glutathione), PCO (Protein carbonyl), PON-1(Paraoxonase-1), AGE (Advanced glycation end product), PMRS (Plasma membrane reduced system), and inflammatory cytokines (TNF-α and IL-6) were estimated in blood and plasma. Our result shows that oxidative stress, and inflammatory markers, were increased in the HFD-treated group of rats. Vitamin C supplementation protected against lipidemic and, oxidative stress. We conclude that Vitamin C may be useful in maintaining cellular redox balance and protecting against lipidemic stress.

Effects of long-term consumption of two plant-based dietary supplements on cardiovascular health and low-grade inflammation in middle-aged and elderly people: study protocol for a randomised, controlled trial.

BACKGROUND: Ageing is a process characterised by chronic low-grade inflammation and oxidative stress which could lead to increased prevalence of both physical and mental age-related chronic conditions. A healthy balanced diet, rich in fruit and vegetables as well as omega-3 polyunsaturated fatty acids (n3 PUFA), could reduce oxidative stress and improve markers of low-grade inflammation. Nonetheless, considering that a large part of the population struggles to meet current guidelines on fruit and vegetable and n3 PUFA recommendations, fruit and vegetable concentrate supplements and mixed omega fatty acid supplements could be an effective strategy to bridge the gap between actual and recommended intakes. METHODS: In this randomised, controlled, open-labelled, parallel-grouped clinical trial, 112 participants will be allocated to one of four arms (n = 28 on each arm): an encapsulated juice powder concentrate, a plant-based omega fatty acid supplement, both or a control group. We aim to investigate whether long-term separate or combined ingestion of the two can affect biomarkers of cardiovascular health, low-grade inflammation and indicators of ageing, including cognitive function, in middle-aged and elderly people. We will additionally explore the effect of the different supplementations on plasma levels of vitamins, carotenoids and fatty acids. Intervention will last 2 years and participants will be assessed at baseline and at follow-up visits at 6, 12, 18 and 24 months. DISCUSSION: This study will provide evidence whether long-term, plant-based dietary supplementation can support cardiovascular health, anti-inflammatory processes, immunity and nutritional status in ageing. Trial registration This trial was registered at ClinicalTrials.gov (NCT04763291) on February 21, 2021.

Vitamin E and Multiple Health Outcomes: An Umbrella Review of Meta-Analyses.

The relationship between vitamin E intake or circulating α-tocopherol and various health outcomes is still debatable and uncertain. We conducted an umbrella review to identify the relationships between vitamin E intake or circulating tocopherol and health outcomes by merging and recalculating earlier meta-analyses. The connections that were found to be statistically significant were then classified into different evidence levels based on p values, between-study heterogeneity, prediction intervals, and small study effects. We finally included 32 eligible meta-analyses with four vitamin E sources and 64 unique health outcomes. Only the association between circulating α-tocopherol and wheeze or asthma in children was substantiated by consistent evidence. Suggestive evidence was suggested for seven results on endothelial function (supplemental vitamin E): serum C-reactive protein (CRP) concentrations (supplemental vitamin E), cervical cancer (dietary vitamin E), esophageal cancer (dietary vitamin E), cervical intraepithelial neoplasia (CIN, dietary vitamin E), pancreatic cancer (total vitamin E intake), and colorectal cancer (circulating α-tocopherol levels); all of these showed a protective effect consistent with the vitamin E source. In conclusion, our work has indicated that vitamin E is protective for several particular health outcomes. Further prospective studies are required when other factors that may contribute to bias are considered.

The Ketogenic Diet and Cardiovascular Diseases.

The most common and increasing causes of death worldwide are cardiovascular diseases (CVD). Taking into account the fact that diet is a key factor, it is worth exploring this aspect of CVD prevention and therapy. The aim of this article is to assess the potential of the ketogenic diet in the prevention and treatment of CVD. The article is a comprehensive, meticulous analysis of the literature in this area, taking into account the most recent studies currently available. The ketogenic diet has been shown to have a multifaceted effect on the prevention and treatment of CVD. Among other aspects, it has a beneficial effect on the blood lipid profile, even compared to other diets. It shows strong anti-inflammatory and cardioprotective potential, which is due, among other factors, to the anti-inflammatory properties of the state of ketosis, the elimination of simple sugars, the restriction of total carbohydrates and the supply of omega-3 fatty acids. In addition, ketone bodies provide "rescue fuel" for the diseased heart by affecting its metabolism. They also have a beneficial effect on the function of the vascular endothelium, including improving its function and inhibiting premature ageing. The ketogenic diet has a beneficial effect on blood pressure and other CVD risk factors through, among other aspects, weight loss. The evidence cited is often superior to that for standard diets, making it likely that the ketogenic diet shows advantages over other dietary models in the prevention and treatment of cardiovascular diseases. There is a legitimate need for further research in this area.

Cardiovascular disease treatment using traditional Chinese medicine：Mitochondria as the Achilles' heel.

Cardiovascular disease (CVD), involving the pathological alteration of the heart or blood vessels, is one of the main causes of disability and death worldwide, with an estimated 18.6 million deaths per year. CVDs are caused by a variety of risk factors, including inflammation, hyperglycemia, hyperlipidemia, and increased oxidative stress. Mitochondria, the hub of ATP production and the main generator of reactive oxygen species (ROS), are linked to multiple cellular signaling pathways that regulate the progression of CVD and therefore are recognized as an essential target for CVD management. Initial treatment of CVD generally focuses on diet and lifestyle interventions; proper drugs or surgery can prolong or save the patient's life. Traditional Chinese medicine (TCM), a holistic medical care system with an over 2500-year history, has been proven to be efficient in curing CVD and other illnesses, with a strengthening effect on the body. However, the mechanisms underlying TCM alleviation of CVD remain elusive. Recent studies have recognized that TCM can alleviate cardiovascular disease by manipulating the quality and function of mitochondria. This review systematically summarizes the association of mitochondria with cardiovascular risk factors, and the relationships between mitochondrial dysfunction and CVD progression. We will investigate the research progress of managing cardiovascular disease by TCM and cover widely used TCMs that target mitochondria for the treatment of cardiovascular disease.