Abstract Background The morphology of the aorta changes with age, our study aims to investigate sex differences in the aortic aging by analyzing aortic diameter and tortuosity in different segments of aorta across the age spectrum, using enhanced CT imaging. Methods Between July 2021 and April 2022, a retrospective study screened patients with chest and abdomen contrast CT images. The outer edge-to-outer edge method was utilized to measure aortic diameters at five aortic levels, while arterial tortuosity of various segments was measured and calculated using imaging software. Mean values were compared at different age groups, including by sex, and correlation with age was determined. To validate the coherence of arterial elasticity and anticipated age-related arterial alterations, a subset of data from a previously published article in BMJ Open was extracted for the purpose of examining the correlation between age and arterial stiffness, stratified by sexes. Results 208 participants (56.6% men, mean age 60.13±16.33 years old, mean BMI 23.07±4.03 kg/m2, mean BSA 1.70±0.19 m2) were enrolled in this study. The BSA-adjusted aortic diameters showed a positive correlation with age in both sexes, but females demonstrated a more rapid increase in progressive aortic diameters throughout their lifespan than males. In the age groups of 60-69 and above 80 years old, males exhibited significantly larger L1 measurements than females. Conversely, in individuals over 80 years old, females displayed greater L3 values compared to their male counterparts. However, no sexual disparities were observed for L2, L4 and L5 across all ages. Females exhibited greater aortic tortuosity in the descending thoracic region compared to males across all age groups, whereas this sex-based distribution of aortic and abdominal tortuosity was only evident among individuals over 40 years old. The tortuosity of the aorta and descending thoracic aorta exhibits a marked increase with advancing age, particularly in females, while a non-significant linear correlation is observed between abdominal aortic tortuosity and age in both genders. BaPWV consistently increased with age in both males and females, but the increase was more significant in females. Although males initially had higher arterial stiffness, females surpassed them as they aged. Conclusions Patterns of vascular aging in aortic morphology differ between the sexes across the life course, with women experiencing more significant changes, especially in advanced age groups.
One of the key concerns of the clinician is to identify and manage risk factors for major adverse cardiovascular events (MACEs) in nondiabetic and diabetic patients with acute coronary syndrome (ACS) undergoing stent implantation. Mean corpuscular volume (MCV) is a marker of erythrocyte size and activity and is associated with prognosis of cardiovascular disease. However, the role of admission MCV in predicting MACEs following stent implantation in diabetes mellitus (DM), non-DM, or whole patients with ACS remains largely unknown.A total of 437 ACS patients undergoing stent implantation, including 294 non-DM (59.08 ± 10.24 years) and 143 DM (63.02 ± 9.92 years), were analyzed. Admission MCV was higher in non-DM than DM patients. During a median of 31.93 months follow-up, Kaplan-Meier curve demonstrated that higher admission MCV level was significantly associated with increased MACEs in whole and non-DM, but not in DM patients. In Cox regression analysis, the highest MCV tertile was associated with higher MACEs in whole ([HR] 1.870, 95% CI 1.113-3.144, P = 0.018), especially those non-DM ([HR] 2.089, 95% CI 1.077-4.501, P = 0.029) patients after adjustment of several cardiovascular risk factors. MCV did not predict MACEs in DM patients. During landmark analysis, admission MCV showed better predictive value for MACEs in the first 32 months of follow-up than in the subsequent period. Finally, the receiver operating characteristic (ROC) curve was conducted to confirmed the value of admission MCV within 32 months.In patients with ACS, elevated admission MCV is an important and independent predictor for MACEs following stent implantation, especially amongst those without DM even after adjusting for lifestyle and clinical risk factors. However, as the follow-up period increased, the admission MCV lost its ability to predict MACEs.
Patients with type 2 diabetes mellitus (T2DM) are susceptible to coronary artery disease (CAD), and coronary outcomes in these patients are heterogeneous. However, the impact of coronary plaque compositions on rapid plaque progression (RPP) in patients with T2DM has rarely been reported. This study aimed to investigate the association of coronary plaque compositions with rapid lesion volume progression in patients with T2DM.A total of 159 subjects (aged 62.51 ± 10.3 years, 68.6% were male) who underwent serial coronary computed tomography angiography (CCTA) with type 2 diabetic status were enrolled. Annual change of plaque volume (PV) (mm3/year) was defined as PV change divided by inter-scan period. RPP was defined as the progression of plaque burden (PV divided by vessel volume multiplied by 100) ≥0.59%/year. Plaque components were compared between RPP and no RPP groups. Then all patients were divided into 3 groups according to the baseline calcified plaque volume tertiles. The outcome was whether RPP occurred.The median inter-scan period was 2.09 (range 1.41-3.33) years. The overall incidence of RPP was 61.0%. The calcified plaque volume decreased significantly in the RPP group as compared to the no RPP group. The risk of RPP (odds ratio [OR] 0.39; 95% confidence interval [CI]: 0.17-0.88; p = 0.024) was reduced in tertiles III as compared to that in tertiles I even after adjustment for baseline variables (OR 0.21; 95% CI: 0.07-0.63; p = 0.005). Moreover, adding the calcified plaque volume significantly raised the predictive value for the RPP (0.370, p = 0.030, and 0.059, p = 0.025, NRI, and IDI respectively) as compared to traditional factors.The baseline calcified plaque volume is an independent protective factor for the rapid progression of coronary atherosclerosis in patients with T2DM.The calcified plaque volume of the coronary was significantly lower in T2DM subjects with RPP than in those without RPP.Higher levels of atherosclerotic calcification may have a protective value on plaque stabilization in patients with T2DM.Calcified plaque volume of the coronary should be considered when proposing risk stratification in T2DM patients.
The identification of drugs or biomolecules for public health monitoring requires facile analytical technologies with excellent sensitivity, portability and reliability. In the past decades, different sensing materials have inspired the development of various bioanalytical strategies. However, sensing platforms based on powder materials are not suitable for medical diagnosis, which limits further exploration and application of biosensors. Herein, a point-of-care testing (POCT) membrane was designed from an energy competition mechanism and achieved the detection of the nonsteroidal antiphlogistic diclofenac, and exhibited remarkable testing efficacy at the ppb level. The mixed matrix membrane (MMM) sensor consists of electrospun polyacrylonitrile nanofibers and luminescent Tb-MOFs and possess the advantages of high stability, outstanding anti-interference ability, efficient detection (LOD = 98.5 ppb) and easy visual recognition. Furthermore, this MMM sensor exhibits excellent recyclability in serum, which is beneficial for developing a portable and convenient device to distinguish diclofenac in practical sensing applications. Meanwhile, the feasibility and mechanism of this recyclable sensor were verified by theory and experiments, indicating that it is a promising device for diclofenac detection in biological environments to evaluate the toxic effect caused by the accumulation of nonsteroidal drugs.
Abstract Aim To investigate sex differences in the aortic aging by analyzing aortic diameter and tortuosity in different segments of aorta across the age spectrum, using enhanced CT imaging. Method Between July 2021 and April 2022, a retrospective study screened patients with chest and abdomen contrast CT images. The outer edge-to-outer edge method was utilized to measure aortic diameters at five aortic levels, while arterial tortuosity of various segments was measured and calculated using imaging software. Mean values were compared at different age groups, including by sex, and correlation with age was determined. To validate the coherence of arterial elasticity and anticipated age-related arterial alterations, a subset of data from a previously published article in BMJ Open was extracted for the purpose of examining the correlation between age and arterial stiffness, stratified by sexes. Results 208 participants (56.6% men, mean age 60.13±16.33 years old, mean BMI 23.07±4.03 kg/m2, mean BSA 1.70±0.19 m2) were enrolled in this study. The BSA-adjusted aortic diameters showed a positive correlation with age in both sexes, but females demonstrated a more rapid increase in progressive aortic diameters throughout their lifespan than males. In the age groups of 60-69 and above 80 years old, males exhibited significantly larger L1 measurements than females. Conversely, in individuals over 80 years old, females displayed greater L3 values compared to their male counterparts. However, no sexual disparities were observed for L2, L4 and L5 across all ages. Females exhibited greater aortic tortuosity in the descending thoracic region compared to males across all age groups, whereas this sex-based distribution of aortic and abdominal tortuosity was only evident among individuals over 40 years old. The tortuosity of the aorta and descending thoracic aorta exhibits a marked increase with advancing age, particularly in females, while a non-significant linear correlation is observed between abdominal aortic tortuosity and age in both genders. BaPWV consistently increased with age in both males and females, but the increase was more significant in females. Although males initially had higher arterial stiffness, females surpassed them as they aged. Conclusion Patterns of vascular aging in aortic morphology differ between the sexes across the life course, with women experiencing more significant changes, especially in advanced age groups.
Abstract Recent studies reveal that bile acid metabolite composition and its metabolism are changed in metabolic disorders, such as obesity, type 2 diabetes and metabolic associated fatty liver disease (MAFLD), yet its role and the mechanism remain largely unknown. In the present study, metabolomic analysis of 163 serum and stool samples of our metabolic disease cohort was performed, and we identified glycoursodeoxycholic acid (GUDCA), glycine-conjugated bile acid produced from intestinal bacteria, was decreased in both serum and stool samples from patients with hyperglycemia. RNA-sequencing and quantitative PCR results indicated that GUDCA alleviated endoplasmic reticulum (ER) stress in livers of high fat diet (HFD)-fed mice without alteration of liver metabolism. In vitro, GUDCA reduced palmitic acid induced-ER stress and -apoptosis, as well as stabilized calcium homeostasis. In vivo, GUDCA exerted effects on amelioration of HFD-induced insulin resistance and hepatic steatosis. In parallel, ER stress and apoptosis were decreased in GUDCA-treated mice as compared with vehicle-treated mice in liver. These findings demonstrate that reduced GUDCA is an indicator of hyperglycemia. Supplementation of GUDCA could be an option for the treatment of diet-induced metabolic disorders, including insulin resistance and hepatic steatosis, with inhibiting ER stress.
Purpose: Our objection is to examine the association between moderate-intensity PA, healthcare utilization and expenditure.Methods: Data were extracted from China Health and Retirement Longitudinal Study (CHARLS) 2011, 2013, and 2015. We included participants aged 50 years and older in 2015, who had complete follow-up for the three waves.We calculated the total time of moderate-intensity PA (TPA) per week level for each study participant by converting vigorous-intensity PA into the equivalent moderate-intensity PA. According to the tertiles of TPA, TPA per week was categorised into 15-599, 600-1999, ≥2000 minutes/week. Healthcare utilization including the number of inpatient and outpatient visits. Healthcare expenditure including total healthcare expenditure and catastrophic health expenditures (CHE) were measured.Results: 12927 of the 17708 participants in CHARLS were included in our analysis. More than one-third of participants aged at least 50 years old who never participated in any moderate or intensity activity in 2015. With the time of TPA per week increases, the number of inpatient visits and inpatient hospital days has fallen, and the same with the cost of hospitalization and total healthcare expenditure. Compared to inactive subjects, the highest level of TPA was associated with a significantly reduced risk for the number of inpatient visits, inpatient hospital days, healthcare expenditure and CHE after adjusting for covariates.Conclusions: People engaging in moderate-to-vigorous PA reduced the healthcare utilization,healthcare expenditure and household financial risk with a dose-response relationship in China. Our findings indicate that advocating and promoting exercise in public health policy may be beneficial in reducing the burden of individuals and social healthcare systems.Funding Information: This study was supported by the National Key R&D Program of China (grant no. 2019YFA 0802300).Declaration of Interests: The authors declare that they have no competing interests.Ethics Approval Statement: The Biomedical Ethics Review Committee of Peking University approved CHARLS, and all participants were required to provide written informed consent. The ethical approval number was IRB00001052-11015.
In this study, 39915 inpatients with a discharge diagnosis of STEMI from the CCC‐ACS project phase I and II were included. The prevalence of the medical history, clinical complications on admission and treatment during hospitalization in the STEMI inpatients with and without in‐hospital reinfarction was presented. The factors that were differentially distributed and of critical clinical significance (e.g., age, sex, heart rate, smoking, MI history, HF history, COPD history, stroke, hypertension, diabetes, PCI treatment, administration of DAPT, and statins) were entered into standard Cox regression model and competing risk model for potential influential factors of in‐hospital reinfarction. Patients with a higher heart rate (OR 1.018; 95% CI 1.003 to 1.033) were more susceptible to in‐hospital reinfarction. Myocardial infarction history (OR 2.840; 95% CI 1.160 to 6.955) was a risk factor of in‐hospital reinfarction independent of hypertension, diabetes, and dyslipidaemia.
Abstract Pyroptosis, a type of Gasdermin-mediated cell death, contributes to an exacerbation of inflammation. To test the hypothesis that GSDME-mediated pyroptosis aggravates the progression of atherosclerosis, we generate ApoE and GSDME dual deficiency mice. As compared with the control mice, GSDME −/− /ApoE −/− mice show a reduction of atherosclerotic lesion area and inflammatory response when induced with a high-fat diet. Human atherosclerosis single-cell transcriptome analysis demonstrates that GSDME is mainly expressed in macrophages. In vitro, oxidized low-density lipoprotein (ox-LDL) induces GSDME expression and pyroptosis in macrophages. Mechanistically, ablation of GSDME in macrophages represses ox-LDL-induced inflammation and macrophage pyroptosis. Moreover, the signal transducer and activator of transcription 3 (STAT3) directly correlates with and positively regulates GSDME expression. This study explores the transcriptional mechanisms of GSDME during atherosclerosis development and indicates that GSDME-mediated pyroptosis in the progression of atherosclerosis could be a potential therapeutic approach for atherosclerosis.
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