Emerging Risk Factors Research Articles

Lipoprotein(a) and Long-Term Recurrent Infarction After an Acute Myocardial Infarction

Lipoprotein(a) (Lp[a]) is an emerging risk factor for incident ischemic heart disease. However, its role in risk stratification in in-hospital survivors to an index acute myocardial infarction (AMI) is scarcer, especially for predicting the risk of long-term recurrent AMI. We aimed to assess the relation between Lp(a) and very long-term recurrent AMI after an index episode of AMI. It is a retrospective analysis that included 1,223 consecutive patients with an AMI discharged from October 2000 to June 2003 in a single-teaching center. Lp(a) was assessed during index admission in all cases. The relation between Lp(a) at discharge and total recurrent AMI was evaluated through negative binomial regression. The mean age of the patients was 67.0 ± 12.3years, 379 (31.0%) were women, and 394 (32.2%) were diabetic. The index event was more frequently non-ST-segment elevation myocardial infarction (66.0%). The median Lp(a) was 28.8 (11.8 to 63.4)mg/100ml. During a median follow-up of 9.9 (4.6 to 15.5)years, 813 (66.6%) deaths and 1,205 AMI in 532 patients (43.5%) occurred. Lp(a) values were not associated with an increased risk of long-term all-cause mortality (p=0.934). However, they were positively and nonlinearly associated with an increased risk of total long-term reinfarction (p=0.016). In the subgroup analysis, there was no evidence of a differential effect for the most prevalent subgroups. In conclusion, after an AMI, elevated Lp(a) values assessed during hospitalization were associated with an increased risk of recurrent reinfarction in the very long term. Further prospective studies are warranted to evaluate their clinical implications.

Changes in SMEs financing: risks and opportunities for agro-food companies

The financial and real crisis started in 2007-2008 has deeply transformed the way the Italian financial and capital market act. Italian SMEs need to be aware of the transformation not to be pushed out of the market itself and to take profit of the new relevant opportunities coming out thanks to the emerging new products and new intermediaries.The paper focuses the disappear of banks relationship lending and provides evidence about how to approach the market in the emerging "competing for capital" prevailing rule.It also stresses the relevance of ESG topics as emerging risk factor companies must look at when asking for new finance because of the Regulation (EU) 2019/2088 of the European Parliament and of the Council of 27 November 2019 on sustainability related disclosures in the financial services (SFDR).

Vitamin B-12, Homocysteine, and Hematological Parameters in Ischemic Stroke Patients

Background: A cerebrovascular accident or stroke is one of the leading causes of disability and death in the world. Several risk factors have been detected and extensively studied and are part of preventive strategies. Emerging risk factors for ischemic that have recently acquired interest are vitamin B-12 and homocysteine levels. A study has been conducted in a tertiary hospital in Chennai to evaluate the levels of vitamin B-12, homocysteine, and hematological variables. Aims: The objective of the study was to estimate the serum levels of homocysteine and vitamin B-12 in patients with ischemic stroke and transient ischemic attack and to analyze hematological parameters, including complete blood counts and peripheral smear and correlate with vitamin B-12. Materials and Methods: A total of 80 individuals with either ischemic stroke or transient ischemic attack were included in the study. Vitamin B-12, homocysteine, complete blood counts, and peripheral smear were analyzed for the patients. Results: Either frank or subclinical vitamin B-12 deficiencies were noted in 59 (73.8%) of the study population. Fifty-seven (71.2%) of the study population had elevated homocysteine. Fifty (62.5%) had a high neutrophil-to-lymphocyte (N:L) ratio and 52 (65%) had elevated red cell distribution width. Conclusion: High homocysteine levels are prevalent among ischemic stroke patients and this elucidates that homocysteine has a role in the thrombus formation and is a risk factor for the development of the stroke. It was also noted that vitamin B-12 deficiency, either frank or subclinical, is prevalent among these patients and can be a target for supplementation strategies.

Changing epidemiology of colorectal cancer - birth cohort effects and emerging risk factors.

Incidence and mortality of colorectal cancer (CRC) are increasing worldwide, suggesting broad changes in the epidemiology of CRC. In this Review, we discuss the changes that are becoming evident, including trends in CRC incidence and mortality by age and birth cohort, and consider the contributions of early-life exposures and emerging risk factors to these changes. Importantly, incidence of CRC has increased among people born since the early 1950s in nearly all regions of the world. These so-called birth cohort effects imply the involvement of factors that influence the earliest stages of carcinogenesis and have effects across the life course. Accumulating evidence supports the idea that early-life exposures are important risk factors for CRC, including exposures during fetal development, childhood, adolescence and young adulthood. Environmental chemicals could also have a role because the introduction of many in the 1950s and 1960s coincides with increasing incidence of CRC among people born during those years. To reverse the expected increases in the global burden of CRC, participation in average-risk screening programmes needs to be increased by scaling up and implementing evidence-based screening strategies, and emerging risk factors responsible for these increases need to be identified.

Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation

The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.

Tumour budding in cutaneous squamous cell carcinoma: A novel prognosis risk factor.

Most cutaneous squamous cell carcinomas (cSCC) have a good prognosis, there is a small group where metastasis and death occur and the evaluation of this risk is still cause for controversy. Tumour budding is a pattern of histological invasion that is an emerging risk factor in other solid tumours. To examine the association between tumour budding and other known high-risk predictors in cSCC. In addition, the impact of tumour budding on overall survival (OS) and disease-specific survival (DSS) was analysed. Retrospective study. It included patients with a diagnosis of non-genital cSCC by excisional biopsy at a university hospital, between 2010 and 2020. A pathologist re-analysed their histological slides and evaluated budding. Univariate and multivariate analyses were made to study the associations. 156 cSCC biopsies were found, and positive tumour budding was found in 13.5%. This correlated with worse DSS and OS. On univariate analysis, budding was correlated with the diameter, thickness of the tumour, histological grade, level of invasion, perineural and lymphovascular invasion, previous radiotherapy, recurrent tumours and lymph node metastasis (LNM). Multivariate analysis: tumour budding was associated with poorly differentiated tumours, prior radiotherapy and LNM. An association was found between tumour budding and most known risk factors in cSCC. We found findings that indicate that the presence of tumour budding is associated with a worse prognosis in terms of LNM, OS and DSS. This supports the results of previous work which has suggested that budding could be related to high-risk cSCC.

Mathematical model for the analysis of environmental risk factors

The article studies the economic consequences of harmful effects on the environment. A mathematical model has been developed for the analysis of environmental risk factors. When constructing a model, the probability of an insured event depending on time is taken into account. It is shown that different probabilistic impact models can be used for different categories of risk factors. The development of a dynamic model is based on the methods of probability theory, actuarial mathematics and, accordingly, on the, numerical methods and simulation methods. Analytical expressions for the risk factor integral value of environmental management are obtained in the work. The mathematical calculation of the distribution function, or the survival function before the time period occurrence of an insured event in different cases is performed, namely: in the case of a risk factor with a constant intensity, in the case of gradually emerging risk factors with their constant intensities, in the case when the survival function is decreasing at a linear rate, as well as in the case when equipment wear and tear leads to an exponential increase in the risk intensity.

Disruptors on Male Reproduction – Emerging Risk Factors

Disruptors on Male Reproduction – Emerging Risk Factors

Galectin-3 and HFpEF: Clarifying an Emerging Relationship.

HFpEF is one of the leading causes of death whose burden is estimated to expand in the coming decades. This paper examines the relationship between circulating levels of galectin-3, an emerging risk factor for cardiovascular disease, and the clinical diagnosis of HFpEF. The authors reviewed peer-reviewed literature and 18 studies met the inclusion criteria. Study characteristics, study outcome definitions, assay characteristics, main findings, and measures of association were tabulated and summarized. Five studies found significant associations between galectin-3 and HFpEF diagnosis compared to healthy controls, and one did not. Five studies found significant associations between galectin- 3 concentration in circulation and severity of diastolic dysfunction. Three studies found a statistically significant association between circulating galectin-3 and all-cause mortality or rehospitalization. Two studies found levels of circulating galectin-3 to be a statistically significant predictor of later HFpEF onset. Finally, two studies examined whether galectin-3 was associated with incident HFpEF, one found a significant association and the other did not. Given the paucity of effective therapeutics for HFpEF, galectin-3 shows promise as a possible HFpEF-linked biomarker that may, with further study, inform and predict treatment course to reduce morbidity and mortality.

Lipoprotein(a): Just an Innocent Bystander in Arterial Hypertension?

Elevated plasma lipoprotein(a) [Lp(a)] is a relatively common and highly heritable trait conferring individuals time-dependent risk of developing atherosclerotic cardiovascular disease (CVD). Following its first description, Lp(a) triggered enormous scientific interest in the late 1980s, subsequently dampened in the mid-1990s by controversial findings of some prospective studies. It was only in the last decade that a large body of evidence has provided strong arguments for a causal and independent association between elevated Lp(a) levels and CVD, causing renewed interest in this lipoprotein as an emerging risk factor with a likely contribution to cardiovascular residual risk. Accordingly, the 2022 consensus statement of the European Atherosclerosis Society has suggested inclusion of Lp(a) measurement in global risk estimation. The development of highly effective Lp(a)-lowering drugs (e.g., antisense oligonucleotides and small interfering RNA, both blocking LPA gene expression) which are still under assessment in phase 3 trials, will provide a unique opportunity to reduce "residual cardiovascular risk" in high-risk populations, including patients with arterial hypertension. The current evidence in support of a specific role of Lp(a) in hypertension is somehow controversial and this narrative review aims to overview the general mechanisms relating Lp(a) to blood pressure regulation and hypertension-related cardiovascular and renal damage.

The interplay between macronutrients and sleep: focus on circadian and homeostatic processes.

Sleep disturbances are an emerging risk factor for metabolic diseases, for which the burden is particularly worrying worldwide. The importance of sleep for metabolic health is being increasingly recognized, and not only the amount of sleep plays an important role, but also its quality. In this review, we studied the evidence in the literature on macronutrients and their influence on sleep, focusing on the mechanisms that may lay behind this interaction. In particular, we focused on the effects of macronutrients on circadian and homeostatic processes of sleep in preclinical models, and reviewed the evidence of clinical studies in humans. Given the importance of sleep for health, and the role of circadian biology in healthy sleep, it is important to understand how macronutrients regulate circadian clocks and sleep homeostasis.

Impact of heat waves and cold spells on mortality in cities located in the Russian Arctic macroregion

BACKGROUND: Climate warming in Russia is most pronounced in the Arctic, where it is accompanied by an increase in the frequency and duration of heat waves. This emerging risk factor for the health of the population in major cities has not yet received adequate scientific attention. To effectively plan for adaptation to these phenomena, it is crucial to understand their specific impacts in regions with different climate types. Therefore, comprehensive analysis of the associations between climatic factors and health is needed for informed decision-making and strategic adaptation planning.
 AIM: To assess the impact of heat waves and cold spells on excess age-specific mortality within the urban populations of the Arctic macroregion. Furthermore, we analyzed the potential differences in the studied outcomes across climate types, ranging from marine to continental.
 METHODS: We analyzed the daily counts of deaths in Arkhangelsk, Magadan, Murmansk, and Yakutsk from 1999 through 2019. Poisson generalized linear regression models were employed to determine the relative mortality risks during heat waves and cold spells. All models accounted for potential lagged effects, seasonal and weekly patterns, and long-term mortality trends. Pearsons chi-squared tests were used to study the differences between the effects of heat and cold, as well as site-specific and age-specific variations in mortality.
 RESULTS: Effects of the studied climatic phenomena were more pronounced in continental than in marine climate. The age group 65+ years was more susceptible to the effects of extreme heat and cold than the middle-age group. Cold spells had a greater impact on the health of the residents of Murmansk, Arkhangelsk, and Magadan than heat waves, while the opposite was observed in Yakutsk. Cerebrovascular mortality during heath waves was 1.69 (95% CI: 1.342.13) times as high as during periods with normal temperature in the age-group 65+ in Yakutsk while cold spells were associated with 1.54 (95% CI: 1.182.01) greater risk of death from respiratory causes in the same age-group in Arkhangelsk.
 CONCLUSION: Our findings can be utilized by public health authorities to effectively prevent further fatalities among subarctic populations during heatwaves and cold spells.

A cohort study investigating the role of Bisphenol A in the molecular pathogenesis of breast cancer.

Breast cancer is an abnormal division of breast cells. Bisphenol A (BPA), an environmental toxicant, is identified as an emerging risk factor for breast cancer development. However, to the best of our knowledge, no previous study has investigated the BPA levels in breast cancer patients in Pakistan. The present study sought to explore the role of BPA in tumor growth among the Pakistani population. The levels of BPA were analyzed in the serum samples of breast cancer patients and controls by using HPLC. To elucidate the role of BPA to initiate tumorigenic events in breast tissue different biochemical assays along with expression analysis of tumor markers were performed. The level of BPA in the serum samples of breast cancer patients was significantly higher than control. Histological analysis of breast cancer tissue samples revealed distinct subtypes of tumor, such as ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC). There was a significant increase in ROS level while a significant decrease in the levels of superoxide dismutase (SOD) and catalase (CAT) enzymes in malignant breast tissue samples as compared to control tissue samples. We found upregulated expression of p53, ZEB1 and WNT1 genes at mRNA level in malignant breast tissue samples by 17 folds, 328 folds and 35 folds, respectively. p53 protein expression in malignant breast tissue samples was also enhanced at the translational level. Current findings suggest a relationship between BPA and the progression of breast cancer among the Pakistani population.

Unpacking Occupational Health Data in the Service Sector: From Bayesian Networking and Spatial Clustering to Policy-Making

The health status of the service sector workforce is a significant unknown in the field of medical geography. While spatial epidemiology has made progress in predicting the relationship between human health and the environment, there are still important challenges that remain unsolved. The main issue lies in the inability to statistically determine and visually represent all spatial concepts, as there is a need to cover a wide range of service activities while also considering the impact of numerous traditional medical variables and emerging risk factors, such as those related to socioeconomic and bioclimatic factors. This study aims to address the needs of health professionals by defining, prioritizing, and visualizing multiple occupational health risk factors that contribute to the well-being of workers. To achieve this, a methodological approach based on the synergy of Bayesian machine learning and geostatistics is proposed. Extensive data from occupational health surveillance tests were collected in Spain, along with socioeconomic and bioclimatic covariates, to assess potential social and climate impacts on health. This integrated approach enabled the identification of relevant patterns related to risk factors. A three-step geostatistical modeling process, including variography, ordinary kriging, and G clustering, was used to generate national distribution maps for various factors such as annual mean temperature, annual rainfall, spine health, limb health, cholesterol, age, and sleep quality. These maps considered four target activities—administration, finances, education, and hospitality. Remarkably, bioclimatic variables were found to contribute approximately 9% to the overall health status of workers.

Population attributable proportion and number of cancer cases attributed to potentially modifiable risk factors in Iran in 2020.

In the current study, we aimed to calculate the fraction of cancer attributable to modifiable risk factors in Iran in 2020. Population attributable fractions (PAFs) were calculated for established cancer risk factors using three data sources: the national cancer incidence reports, relative risks extracted from global and national meta-analyses, and exposure prevalence from national/subnational population-based surveys. In addition to overall cancers, the PAFs were estimated separately for each cancer site among men and women. Overall, 32.6% of cancers in 2020 in Iran were attributable to known risk factors. The PAF in men (40.2%) was twice as high as in women (21.1%). Cigarette smoking (15.4%), being overweight (5.0%), opium use (3.9%) and H. pylori infection (3.8%) were the leading causes of cancers. For men, the highest PAFs belonged to cigarette smoking (26.3%), opium use (6.8%) and being overweight (3.1%), while for women, the highest PAFs belonged to being overweight (7.2%), H. pylori infection (2.7%) and cigarette smoking (2.7%). Among Iranian men and women, the PAFs of waterpipe smoking were 2% and 0.9%, respectively. A third of incident cancers in Iran are due to modifiable exposures, mainly cigarette smoking, being overweight, and H. pylori infection. Opium consumption and waterpipe smoking collectively accounted for 8.8% of cancer occurrence in men and 1.3% in women in Iran. These emerging risk factors should be taken into consideration in future PAF studies.

METTL3 drives NAFLD-related hepatocellular carcinoma and is a therapeutic target for boosting immunotherapy

Non-alcoholic fatty liver disease (NAFLD) is an emerging risk factor of hepatocellular carcinoma (HCC). However, the mechanism and target therapy of NAFLD-HCC are still unclear. Here, we identify that the N6-methyladenosine (m6A) methyltransferase METTL3 promotes NAFLD-HCC. Hepatocyte-specific Mettl3 knockin exacerbated NAFLD-HCC formation, while Mettl3 knockout exerted the opposite effect in mice. Single-cell RNA sequencing revealed that METTL3 suppressed antitumor immune response by reducing granzyme B (GZMB+) and interferon gamma-positive (IFN-γ+) CD8+ Tcell infiltration, thereby facilitating immune escape. Mechanistically, METTL3 mediates sterol regulatory element-binding protein (SREBP) cleavage-activating protein (SCAP) mRNA m6A to promote its translation, leading to the activation of cholesterol biosynthesis. This enhanced secretion of cholesterol and cholesteryl esters that impair CD8+ Tcell function in the tumor microenvironment. Targeting METTL3 by single-guide RNA, nanoparticle small interfering RNA (siRNA), or pharmacological inhibitor (STM2457) in combination with anti-programmed cell death protein 1 (PD-1) synergized to reinvigorate cytotoxic CD8+ Tcells and mediate tumor regression. Together, METTL3 is a therapeutic target in NAFLD-HCC, especially in conjunction with immune checkpoint blockade (ICB) therapy.

Incidence of Head and Neck Cancer in East Sudan

This review aims to provide an updated and detailed overview of the incidence of head and neck cancer in the eastern region of Sudan, focusing on studies conducted between 2018 and 2023. It aims to shed light on changes in incidence rates, emerging risk factors, advancements in diagnostic techniques, treatment modalities, and preventive strategies. Accurate knowledge of the latest trends and developments in head and neck cancer incidence is essential for effective public health planning and intervention. One significant aspect that the review highlights is the limited number of head and neck surgeons in East Sudan. It emphasizes the need for specialized training in staging malignancies using head and neck anatomy, as this information is vital for determining appropriate treatment approaches. With a shortage of trained professionals, it becomes even more critical to enhance the anatomic understanding and staging capabilities in order to improve patient outcomes and optimize treatment plans. The review underscores the urgency of addressing this gap in healthcare infrastructure. By increasing the number of head and neck surgeons in East Sudan and providing them with the necessary training, the region can improve its capacity to accurately stage head and neck cancers, leading to more effective treatment decisions and improved patient care. This review provides a comprehensive resource for understanding the current landscape of head and neck cancer incidence in the eastern region of Sudan. It addresses recent trends, emerging risk factors, and the need for improved anatomic understanding and staging capabilities. The findings can guide policymakers, healthcare providers, and researchers in implementing targeted strategies to reduce the burden of head and neck cancer in East Sudan and improve patient outcomes.

Vaccination as a Significant Factor Influencing the Psychoemotional State of Medical Students During the Sars-Cov-2 Pandemic: An International Aspect.

The rapid spread of SARS-COV-2, characterized by its severe course in the absence of effective specific treatment for this infection, may become a significant risk factor for psycho-emotional disorders' emergence during this pandemic. One of the vulnerable groups in the current situation are first-year medical students, whose problems associated with an unfavorable sanitary-epidemiological situation and an increased infection risk are compounded by the difficulties of adapting to specific professional environments. In this situation, along with strict adherence to nonspecific prevention methods, the mass student SARS-COV-2 vaccination acquires particular importance. To compare the attitudes of first-year medical students in Russia and Azerbaijan toward SARS-COV-2 immunization and to assess the vaccination impact on the student's psycho-emotional state during the SARS-COV-2 pandemic. The study involved 594 first-year students at the Moscow and Baku branches of Sechenov University. The Google Forms platform was used to conduct an anonymous sociological survey. To compare the psychoemotional state of vaccinated freshmen and non-vaccinated students, we used the State-Trait Anxiety Inventory, STAI, to assess reactive anxiety and the Beck Depression Inventory test - to diagnose depressive symptoms. The online survey was conducted during the fourth wave of coronavirus infection. WHO official sources were used to analyze the current epidemiological SARS-COV-2 situation during the study data provided by the Russian Federal Service on Customers' Rights Protection and Human Well-Being Surveillance and JHU CSSE. Statistical analysis was carried out using RStudio. The study results showed that vaccination coverage of first-year students at the Moscow branch of Sechenov University during the fourth wave of the SARS-COV-2 pandemic was 42,9±5,13%, at the Baku branch - 69,6±5,86%. The lack of reliable information about anticovid vaccines, indicated by a third of all respondents, may largely determine the motivated participation in the vaccination SARS-COV-2 campaign. The role of medical school in imparting knowledge about active SARS-COV-2 immunization to medical students was found to be insignificant. It was shown that the percentage of students willing to recommend SARS-COV-2 vaccination to the people around them and thereby contribute to increasing collective immunity level significantly depends on the percentage of students vaccinated. It was proved that vaccinated students were characterized by significantly greater psychological stability regardless of their study place. Vaccination is not only a good preventive measure against the infection spread but also a significant factor in stabilizing the psycho-emotional state of first-year students, which significantly affects the quality of their educational process and its effectiveness.

Pre-pregnancy obesity is associated with greater systemic inflammation and increased risk of antenatal depression

BackgroundPre-pregnancy obesity is an emerging risk factor for perinatal depression. However, the underlying mechanisms remain unclear. We investigated the association between pre-pregnancy body mass index (BMI) and perinatal depressive symptoms in a large population-based pre-birth cohort, the Barwon Infant Study. We also assessed whether the levels of circulating inflammatory markers during pregnancy mediated this relationship. MethodsDepressive symptoms were assessed in 883 women using the Edinburgh Postnatal Depression Scale (EPDS) and psychological stress using the Perceived Stress Scale (PSS) at 28 weeks gestation and 4 weeks postpartum. Glycoprotein acetyls (GlycA), high-sensitivity C-reactive protein (hsCRP) and cytokines were assessed at 28 weeks gestation. We performed regression analyses, adjusted for potential confounders, and investigated mediation using nested counterfactual models. ResultsThe estimated effect of pre-pregnancy obesity (BMI ≥ 30 kg/m2) on antenatal EPDS scores was 1.05 points per kg/m2 increase in BMI (95% CI: 0.20, 1.90; p = 0.02). GlycA, hsCRP, interleukin (IL) −1ra and IL-6 were higher in women with obesity, compared to healthy weight women, while eotaxin and IL-4 were lower. Higher GlycA was associated with higher EPDS and PSS scores and partially mediated the association between pre-pregnancy obesity and EPDS/PSS scores in unadjusted models, but this association attenuated upon adjustment for socioeconomic adversity. IL-6 and eotaxin were negatively associated with EPDS/PSS scores, however there was no evidence for mediation. ConclusionsPre-pregnancy obesity increases the risk of antenatal depressive symptoms and is also associated with systemic inflammation during pregnancy. While discrete inflammatory markers are associated with antenatal depressive symptoms and perceived stress, their role in mediating the effects of pre-pregnancy obesity on antenatal depression requires further investigation.

A Woman's Heart: Improving Uptake and Awareness of Cardiovascular Screening for Middle-Aged Populations.

Mid-life, the years leading up to and following the menopause transition, in women is accompanied by a change in cardiometabolic risk factors, including increases in body weight, changes in body composition, a more insulin-resistant state, and a shift towards a more atherogenic dyslipidemia pattern. Cardiovascular disease (CVD) risk assessment should be performed continually throughout the lifespan, as risk is not stagnant and can change throughout the life course. However, mid-life is a particularly important time for a woman to be evaluated for CVD risk so that appropriate preventive strategies can be implemented. Along with assessing traditional risk factors, ascertainment of a reproductive history is an integral part of a comprehensive CVD risk assessment to recognize unique female-specific or female-predominant factors that modify a woman's risk. When there is uncertainty about CVD risk and the net benefit of preventive pharmacotherapy interventions (such as statins), measuring a coronary artery calcium score can help further refine risk and guide shared decision-making. Additionally, there should be heightened sensitivity around identifying signs and symptoms of ischemic heart disease in women, as these may present differently than in men. Ischemia from coronary microvascular disease and/or vasospasm may be present even without obstructive coronary artery disease and is associated with a heightened risk for major cardiovascular events and reduced quality of life. Therefore, correctly identifying CVD in women and implementing preventive and treatment therapies is paramount. Unfortunately, women are underrepresented in cardiovascular clinical trials, and more data are needed about how to best incorporate novel and emerging risk factors into CVD risk assessment. This review outlines an approach to CVD screening and risk assessment in women using several methods, focusing on the middle-aged population.