Synergistic effects of short sleep duration and metabolic syndrome on major adverse cardiovascular events in older adults with obstructive sleep Apnea: A prospective cohort study.

Phenotype Characterization of Natural Killer Cells in Patients With Carotid Atherosclerosis

Lymphedema therapy in head & neck cancer with carotid stenosis: a systematic review and care pathway.

Serum uric acid has been consistently associated with cardiovascular risk, yet whether this relationship reflects independent vascular pathology or cardiometabolic risk clustering remains unresolved. We examined associations of serum uric acid and hyperuricemia with imaging-defined subclinical coronary and carotid atherosclerosis in a large population-based cohort. We analyzed data from the Paracelsus 10,000 study, a population-based cohort of adults aged 40-77years recruited from the Austrian national population registry. Coronary artery calcium (CAC) was assessed by computed tomography in 1561 participants with available cardiac computed tomography and polygenic risk score data; carotid plaque burden was assessed by ultrasonography in 8970 participants. Associations were evaluated using ordinal logistic regression - with CAC categorized by Agatston score (0, 1-99, 100-299, ≥ 300) and carotid plaque burden categorized by total plaque area - with sequential adjustment for cardiovascular risk score (SCORE2), metabolic syndrome, polygenic cardiovascular risk, lipoprotein(a) and systemic inflammation. Higher serum uric acid levels were strongly associated with greater CAC burden in unadjusted analyses (OR 1.60 per 1mg/dL, 95% CI 1.48-1.74). This association was attenuated but remained significant after adjustment for cardiovascular risk score, metabolic syndrome, polygenic risk, lipoprotein(a), and inflammatory markers (OR 1.26, 95% CI 1.14-1.38). Hyperuricemia was independently associated with higher CAC categories after adjustment (OR 1.67, 95% CI 1.20-2.32). Carotid plaque burden showed a strong unadjusted association with serum uric acid that was substantially attenuated after multivariable adjustment, although a weak association remained statistically significant (OR 1.06, 95% CI 1.01-1.10). Serum uric acid and hyperuricemia are independently associated with subclinical coronary atherosclerosis beyond established cardiovascular risk factors, genetic susceptibility and systemic inflammation. The attenuation of carotid plaque associations after full adjustment suggests that extracoronary plaque burden is largely driven by cardiometabolic risk clustering rather than urate-specific pathways. These findings position uric acid as a clinically accessible marker of subclinical coronary atherosclerosis and raise the question of whether systematic urate assessment should inform cardiovascular risk stratification beyond established risk scores.

There is a significant association between carotid artery (CA) stenosis and atherosclerosis, with those patients often presenting with carotid tortuosity. However, the relationship between atherosclerotic risk factors and carotid tortuosity remains controversial. Previous assessments of tortuosity have predominantly utilized qualitative 2D methods. This retrospective study aimed to quantitatively evaluate the tortuosity of CAs in 3D geometry and to investigate the relationship with atherosclerotic risk factors. A total of 168 CAs in 96 patients diagnosed with at least either-side CA stenosis on magnetic resonance angiography (MRA) between 2011 and 2019 were included in this single-center study, following the exclusion of post-treatment CAs and those with poor imaging quality. The 3D geometries of CAs were segmented using MRA and the centerlines were generated. Vascular tortuosity rate (VTR) was calculated as the curved distance divided by the linear distance between the specified 2 points. The relationship between VTRs and 8 atherosclerotic risk factors-age, body mass index, systolic blood pressure, hemoglobin A1c, high-density lipoprotein, total cholesterol (TC), non-fasting serum triglyceride (TG), and Brinkman index-was analyzed. Higher VTRs were associated with ≥65 years of age, body mass index ≥25 [kg/m2], serum TC ≥220 [mg/dL], and non-fasting serum TG ≥175 [mg/dL] in common CAs, and body mass index ≥25 [kg/m2], and systolic blood pressure ≥140 [mmHg] in internal CAs. Quantitative assessment of carotid tortuosity revealed significant associations with several atherosclerotic risk factors, including obesity, hypertension, advanced age, and dyslipidemia, suggesting that VTRs may reflect the presence of these risk factors.

Inflammasome activation has emerged as a promising therapeutic target to reduce residual cardiovascular risk in patients on guideline lipid-lowering therapy. IL-1β and IL-6 have been intensively studied, whereas the role of the inflammasome-related cytokine IL-18 has gained less attention. Here we aimed to assess the associations of IL-18 with risk of coronary events and severity of atherosclerosis. The study included 4,742 participants participating in a prospective Swedish Malmö Diet and Cancer (MDC) cohort study, 54,219 general population participants in the UK Biobank, and 1,500 participants with type 2 diabetes and/or known cardiovascular disease in the European multicenter SUMMIT VIP imaging study. Plasma levels of IL-18 were analyzed using proximity extension assay and atherosclerosis by carotid ultrasound. The incidence of MI and CV death was registered during a 23-year follow-up for MDC cohort and for a 15-year follow-up for the UK Biobank cohort.There were 617 cases of MI and 644 CV deaths in the MDC cohort and 2,454 cases of MI and 1,537 CV deaths in the UK Biobank cohort. Elevated IL-18 was associated with an increased risk of MI and CV death independent of hsCRP and IL-6 in both cohorts. In Cox proportional hazards regression models this association was independent of major CV risk factors in the UK Biobank but not in the MDC cohort. IL-18 did not provide clinically meaningful risk reclassification in the UK biobank cohort. The association of IL-18 with carotid atherosclerosis in the SUMMIT VIP cohort was weaker than that of IL-6. IL-18 is independently associated with risk of MI and CV death in the general population but does not improve clinical risk stratification. Targeting IL-18 directly or through inflammasome inhibition represents a promising approach for treatment of residual inflammatory risk in high-risk atherosclerosis patients that merits to be evaluated in future randomized clinical trials.

Rheumatoid arthritis (RA) is a chronic inflammatory disorder associated with cardiovascular risk (CVR), regardless of traditional risk factors. The objective of this study was to assess subclinical cardiovascular changes in RA, including cardiac and carotid parameters, and to examine their correlation with disease activity in 60 RA patients and 60 age and sex-matched healthy controls. The clinical variables included epidemiological and laboratory data and disease activity scores (DAS28-PCR). CVR was stratified using SCORE/mSCORE and Framingham scores. The ultrasound (US) methods employed (transthoracic echocardiography and Doppler carotid ultrasonography) allowed to evaluate carotid intima-media thickness (CIMT), atherosclerosis plaque, and cardiac function. The female sex was predominant (RA = 91.7%; controls = 90%) and the mean age was 52 ± 12years and 52 ± 13years, respectively. The mean disease duration was 10.43 ± 7.55years. Serum testing for rheumatoid factor and anti-CCP was double-negative in 36.7%. The DAS28-PCR scores identified 61.7% as 'remission/low activity' and 31.3% as 'moderate/high activity'. CVR was similar in the two groups (p = 0.261). When the echocardiographic data was stratified, diastolic dysfunction was significantly more prevalent in subjects with higher disease activity (p = 0.04). In addition, high clinical CVR scores were associated with greater CIMT and carotid plaque (p < 0.05). Our results suggest that inflammatory activity may play a major role in subclinical cardiovascular dysfunction in RA.

MCL inhibits macrophage ferroptosis through the NRF2/HO-1/GPX4 axis to attenuate carotid atherosclerotic plaque formation.

Atherosclerotic plaque rupture is a major cause of cerebrovascular events, yet the molecular determinants underlying vulnerability-related plaque morphology, including fibrous-cap thickness, remain incompletely defined. Using histomorphology-guided spatial proteomics, here we delineate molecular programs associated with plaque cap phenotype across discrete plaque subregions. In 112 carotid endarterectomy specimens, differences between thin-cap and thick-cap plaques were predominantly localized to the necrotic core and fibrous cap. These differences were enriched for processes related to inflammation, lipid handling, extracellular matrix remodeling and ossification/calcification, and supported the presence of proteome-based plaque subtypes. PCSK9 was among the proteins most strongly associated with thin-cap plaques. Consistently, an in vitro model of necrotic core-like oxidative and inflammatory stress increased PCSK9 secretion in primary vascular smooth muscle cells. Together, these findings localize molecular programs associated with cap phenotype to plaque compartments and provide a framework for spatially informed biomarker discovery in advanced carotid atherosclerosis.

Eclampsia and pre-eclampsia are hypertensive disorders of pregnancy (HDPs) that may pose significant long-term risk to maternal patients during the post-partum period. Acute neurological complications of these conditions include recurrent seizures, cerebral edema, intracerebral hemorrhage, stroke, and altered mental status. The long-term neurological sequelae of each condition, and how they differ, remain understudied. To systematically review and compare long-term neurological outcomes including cognitive impairment, and cerebrovascular events in individuals who experience eclampsia and pre-eclampsia. A systematic review was conducted via PubMed including studies published from 2005 to 2025. Eligible studies included human participants with a history of HDP, and results of neurological outcomes assessed at least three months postpartum. Outcomes of interest included cognitive impairment, structural brain changes, and stroke/stroke risk factors. A total of 49 studies met inclusion criteria for final synthesis. The findings of our literature review suggest individuals with a history of HDP have an elevated long-term risk of stroke, with greatest hazard ratios present in hemorrhagic stroke. Eclampsia was linked to higher stroke risk compared to preeclampsia. In terms of structural outcomes found on imaging, all HDPs were strongly associated with white matter lesions, atrophy, blood-brain barrier (BBB) leakage, and carotid atherosclerosis, supporting a pathway of persistent cerebrovascular and neurovascular injury. Cognitive impairment in patient-reported data showed deficits; however, objective testing showed non-significant differences. These findings suggest that stroke and structural brain abnormalities are well-supported sequelae of long-term HDP complications, particularly in eclampsia, while cognitive outcomes remain heterogeneous. Thus, differentiated postpartum care and neurologic evaluation may be warranted in at-risk mothers. Further studies are needed to confirm these findings, investigate possible external contributing factors, and inform evidence-based risk assessment and surveillance guidelines.

Correlation between uric acid/high-density lipoprotein cholesterol ratio and carotid plaque formation: A retrospective cross-sectional study in Anhui's health check-up population.

Carotid artery calcification is commonly assessed on computed tomography angiography (CTA) using a threshold of ≥130 Hounsfield units (HU), yet this may overestimate its volume and merge distinct calcifications due to blooming and partial-volume effects. The aim of our study was to determine the effect of incrementally increasing segmentation thresholds on the number of clusters and calcification morphology on CTA in patients with carotid atherosclerosis. In a cross-sectional study of 107 carotid atherosclerotic plaques on CTA, three-dimensional calcification masks at the carotid bifurcation were segmented using incremental thresholds from 130 to 1000 HU. For each calcification cluster, volume, eccentricity, compactness, aspect ratio, and mean attenuation were quantified. Associations between features were assessed using Spearman correlation, and changes in cluster number and inter-parameter relationships across thresholds were analyzed. The total number of calcification clusters increased at HU ranges between 130 (n = 149) to 450-500 HU (n = 188), reflecting improved separation of clusters at 450-500 HU, and decreased at thresholds above 500 HU as low-attenuation clusters were excluded. Inter-parameter correlations changed markedly between 130 and 250-400 HU, after which relationships stabilized, indicating more consistent morphology. CTA segmentation HU thresholds for calcifications substantially influence the apparent number, volume, and morphological parameters of carotid calcifications. These findings suggest that 130 HU may misrepresent calcification burden, whereas thresholds of ∼300 HU may provide more accurate and better representation of the morphology of calcification clusters. Future studies examining the role of calcifications in plaque vulnerability should account for the influence of attenuation thresholds during calcification segmentation.

Effects of a cardiometabolic risk\u2013reducing dietary pattern health education intervention on cardiometabolic disease risk in community-dwelling older adults in China: a cluster-randomized clinical trial

Facial iPPG heatmap patterns based on period-aware autoencoder show association with carotid atherosclerosis towards non-contact hemodynamic assessment.

Feasibility of low-dose carotid CT angiography (CTA) for quantitative carotid plaque evaluation.

This study aimed to develop and validate nomogram risk estimation models for assessing the risk of microvascular complications, specifically diabetic retinopathy (DR) and diabetic kidney disease (DKD), in patients with type 2 diabetes mellitus (T2DM). A retrospective cross-sectional study was conducted involving 6,043 T2DM patients. Clinical and laboratory data were collected. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to identify significant risk factors from 38 initial variables. These selected variables were then incorporated into multivariate logistic regression analyses to build the risk estimation models. The models were presented as nomograms and were internally validated using bootstrap resampling. Their performance was evaluated by assessing discrimination (using Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC)), calibration (using calibration plots), and clinical utility (using Decision Curve Analysis (DCA)). The LASSO regression identified 8 and 15 independent risk factors for DR and DKD, respectively. The DR model included age, DM duration, insulin use, peripheral neuropathy, heart rate, HbA1c, and total protein. The DKD model included carotid atherosclerosis, diabetic foot, DM duration, α-glucosidase inhibitor use, insulin use, hypertension history, systolic blood pressure, lymphocyte count, total cholesterol, triglycerides, albumin, BMI, uric acid, and creatinine. Multivariate logistic analysis confirmed these associations. The nomograms demonstrated acceptable discrimination, with AUCs of 0.703 (training) and 0.732 (validation) for the DR model, and 0.802 (training) and 0.713 (validation) for the DKD model. Calibration curves showed good agreement between estimated and observed probabilities. This study successfully established and validated effective nomogram models for estimating the risk of DR and DKD in T2DM patients. Utilizing readily available clinical parameters, these models demonstrate moderate discriminative ability and clinical utility, potentially aiding in the early identification of high-risk individuals for targeted screening and improved management of microvascular complications in T2DM.

The comparative superiority among the triglyceride-glucose (TyG) index and its obesity-related composite indicators in identifying hypertension and carotid atherosclerosis (CAS) remains unknown. This study aims to evaluate and compare the discriminative ability of these indices in a large-scale population to identify the optimal marker for cardiovascular risk assessment. This cross-sectional study included 154,873 participants who underwent routine physical examinations and carotid ultrasonography. Binary logistic regression, restricted cubic spline (RCS), receiver operating characteristic (ROC) analyses, and mediation analyses were used to evaluate the associations of TyG, TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), and TyG-body mass index (TyG-BMI) with hypertension and CAS. The mean age of participants was 45.7 ± 12.5 years, with 42.1% being female and 91.0% being married. A total of 16,235(10.5%) participants had hypertension, and 81,337 (52.5%) had CAS. Comparing the highest to the lowest quartile, TyG-WHtR demonstrated the strongest association with hypertension (OR = 8.644, 95% CI: 7.927-9.426) and CAS (OR = 2.173, 95% CI: 2.086-2.263). RCS analyses revealed monotonic increases for hypertension and complex nonlinear patterns for CAS. Stratified analyses revealed distinct phenotypic signatures. For hypertension, risk magnitudes were markedly amplified in younger adults (≤ 60 years) (P for interaction < 0.001 for all indices). For CAS, a significant interaction between sex and the indices was observed (P for interaction < 0.05 for TyG, TyG-WHtR, and TyG-BMI): TyG-WHtR exhibited the strongest association in women (OR = 1.504), whereas in men, the isolated TyG index was inversely associated with CAS, and only TyG-BMI showed a significant positive association (OR = 1.091). Mediation analyses revealed that obesity indicators (WHtR, BMI) demonstrated substantial direct associations with on outcomes, with TyG providing negligible or partial mediation, which may account for the stronger associations observed with composite indices. TyG-obesity composite indices are strongly associated with hypertension and CAS, particularly in younger adults. TyG-WHtR is optimal for women and the general population, while TyG-BMI is superior for men. These easily accessible and cost-effective metrics can serve as practical tools for early cardiovascular risk screening in primary care. Implementing such age-targeted and sex-specific risk stratification could facilitate more precise and timely preventive interventions.

Background: Carotid atherosclerosis is a recognised manifestation of systemic vascular disease, and its association with coronary artery disease (CAD) has been well described. However, previous studies have largely been conducted under conventional diagnostic conditions and have focused on carotid plaque, intima–media thickness, or simple present-versus-absent stenosis classifications, rather than duplex-derived haemodynamic markers across the spectrum of angiographic CAD burden. The COVID-19 pandemic and post-pandemic period changed referral patterns and created more variable cardiovascular presentations, including symptoms that could resemble or mask obstructive CAD. Therefore, we investigated whether the established association between carotid stenosis severity and CAD burden remains detectable in a diagnostically heterogeneous real-world cohort, and whether routinely available carotid duplex haemodynamic parameters provide a clinically relevant signal in this setting. Methods: This single-centre, cross-sectional study was performed as a carotid-focused secondary analysis of the BG Study cohort. We included 902 consecutive patients who underwent invasive coronary angiography between 2021 and 2023 and carotid duplex ultrasonography during the same hospitalisation. CAD burden was defined according to the number of major coronary vessels with ≥70% diameter stenosis and classified as no CAD, one-vessel, two-vessel, or three-vessel disease. Carotid duplex parameters included peak systolic velocities of the common, internal, and external carotid arteries, as well as ICA stenosis severity graded according to NASCET criteria. Associations with CAD burden were assessed using a staged statistical approach combining χ2 tests, Kruskal–Wallis tests with post hoc pairwise comparisons, Spearman correlation, inverse probability weighting, and ordered logistic regression. Results: The prevalence of measured ICA stenosis of any grade and severe ICA stenosis increased with greater CAD burden (both p < 0.001). Median PSV values of the bilateral ICAs and ECAs differed significantly across CAD groups on global intergroup testing. Post hoc pairwise analyses showed that significant corrected differences were concentrated between patients without CAD and those with multivessel or three-vessel CAD, particularly for ICA stenosis measures and bilateral ECA PSV. Spearman analysis demonstrated weak but statistically significant correlations between carotid parameters and CAD burden (ρ = 0.085–0.134). After inverse probability weighting, covariate balance was achieved, with all post-IPW standardised mean differences being <0.01. In ordered logistic regression (OLR) analysis, patient-reported history of carotid stenosis (OR 2.25, 95% CI 1.38–3.67; p < 0.001), right external carotid artery PSV per 10 cm/s (OR 1.31, 95% CI 1.09–1.57; p = 0.004), left ICA PSV per 10 cm/s (OR 1.17, 95% CI 1.01–1.36; p = 0.034), and left ICA stenosis per 10% (OR 1.24, 95% CI 1.11–1.39; p < 0.001) were independently associated with higher CAD burden. Exploratory ratio-based analyses showed that the ECA/CCA PSV ratio was associated with CAD presence and higher CAD burden, whereas the ICA/CCA ratio showed weaker associations; neither ratio-based index outperformed absolute ECA PSV. Conclusions: In this carotid-focused secondary analysis of a pandemic-era angiography cohort, carotid stenosis severity and duplex-derived haemodynamic parameters were independently but modestly associated with increasing angiographic CAD burden. These findings support carotid duplex markers as adjunctive indicators of systemic atherosclerotic burden rather than standalone tools for CAD detection or treatment decision-making. Future validation in vascular surgery populations is warranted to determine whether routinely available carotid duplex parameters can contribute to targeted cardiovascular risk recognition before major vascular procedures.

Current European guidelines for primary atherosclerotic cardiovascular disease (ASCVD) prevention recommend using Systematic Coronary Risk Evaluation 2 (SCORE2) algorithms for risk classification and decision-making. For the Greek population, an updated model - HellenicSCORE II+ - has been developed. This cross-sectional study compared SCORE2 versus HellenicSCORE II+ in detecting preclinical carotid atherosclerosis. Middle-aged (40-69 years) individuals from the general population without ASCVD, were invited to participate on a voluntary basis in screening programs in 3 municipalities of Attica, Greece (2023-2025). Handheld carotid ultrasonography was performed and carotid plaque score (CPS) was calculated by summing points allocated to the number/height of plaques. A total of 965 individuals were analyzed [mean age 57.1±8.0 (SD) years, men 43.2%, body mass index 27.6±4.7 kg/m2, smokers 27.8%, diabetes 7%, antihypertensive/lipid-lowering drug treatment 41.6%/46.5% respectively, SCORE2 5.2±3.4%, HellenicSCORE II+ 3.7±2.4%]. Participants classified as low-moderate/high/very-high ASCVD risk were 50.9%/43.3%/5.8% according to SCORE2, 74.4%/23%/2.6% with HellenicSCORE II+ and 55.6%/36.4%/8% with CPS. The agreement between SCORE2 and HellenicSCORE II+ was 67.2% (kappa 0.37, P<0.01), whereas between CPS and SCORE2/HellenicSCORE II+ 57.6%/56.2% (kappa 0.24/0.13, P<0.01 for each, P<0.01 for comparison). Receiver operating characteristic curve analysis demonstrated similar discrimination of SCORE2/HellenicSCORE II+ for detecting carotid atherosclerosis (AUC 0.74, 95% confidence intervals 0.71-0.78 and 0.71, 0.68-0.74 respectively, P=NS for comparison). SCORE2 classified a higher proportion of participants as high/very-high ASCVD risk compared with HellenicSCORE II+. Both models demonstrated moderate discrimination for detecting carotid plaque burden, highlighting the need for carotid imaging in refining ASCVD risk.

Blood DNA Methylation Patterns Across Carotid, Coronary, and Peripheral Atherosclerosis: A Comparative Analysis in 2 Prospective Cohorts.