Stable Angina Research Articles

This study assesses the causal relationship between bone mineral density (BMD) and stable angina pectoris (SAP) using Mendelian randomization analysis. We obtained genome-wide association study databases for stable angina and BMD, and conducted Mendelian randomization analysis with BMD as the exposure factor and SAP as the outcome. The inverse variance weighted (IVW) method was used as the primary analytical approach, complemented by Cochran Q test, the weighted median method, MR-Egger regression, and the simple weighted model to evaluate the robustness and reliability of the results. The IVW results revealed a significant positive correlation between BMD and the incidence of SAP. When BMD was considered as the exposure factor, the analysis indicated an increased risk of SAP with higher BMD. Similarly, when only left heel BMD was considered as the exposure factor, a positive correlation with SAP was observed. However, no significant associations were observed between BMD at other sites and SAP. When SAP is the exposure factor and BMD is the outcome factor, left heel BMD and right heel BMD are both negatively correlated with SAP, while no significant correlation is observed for the remaining sites. There is a positive correlation between BMD and left calcaneal BMD with SAP, whereas SAP exhibits a negative correlation with both left and right calcaneal BMD. These findings are consistent with previous observational studies.

Coronary artery disease (CAD) is a major cause of health problems and deaths worldwide. Endothelial function is an independent predictor of CAD. Chinese herbal medicine has been proven to effectively improve the clinical symptoms and prognosis of patients with CAD. The purpose of this study was to evaluate the efficacy and safety of Chaihu Guizhi granules in patients with stable angina pectoris (SAP), explore the possible mechanism through which Chaihu Guizhi formula (CHGZ) improves vascular endothelial function, and provide evidence-based medical support for the rational clinical use of CHGZ. In this randomized, double-blind, placebo-controlled study, 90 patients were randomly assigned to the control group or the CHGZ group. The patients in the CHGZ group received conventional Western medicine and CHGZ granules for 4 weeks, while the patients in the placebo group received conventional Western medicine and placebo. The efficacy for angina pectoris, nitroglycerin discontinuation rate, traditional Chinese medicine (TCM) syndrome score, seattle angina questionnaire (SAQ) score, cardiac markers, vascular endothelial function and safety indicators were evaluated before and after the intervention. At the end of this study, compared with those in the control group, the curative effect on angina pectoris; the total nitroglycerin discontinuation rate; the total TCM syndrome score; and the scores of several dimensions of the SAQ, B-type natriuretic peptide precursor (NT-proBNP), asymmetric dimethylarginine, endothelial nitric oxide synthase, nitric oxide (NO) and endothelin 1 in CHGZ group were significantly greater (P < .05 or P < .01). CHGZ may be a beneficial adjuvant treatment for SAP patients. CHGZ can effectively improve clinical symptoms, quality of life, and vascular endothelial function and is safe. The detailed mechanism through which CHGZ affects vascular endothelial function should be further studied in the future.

Introduction: Cardiovascular disease remains the leading cause of morbidity and death in the US, with coronary disease being the leading cause of death. Statins are a cornerstone of preventive cardiology practice, and their initiation for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) when appropriate is of utmost importance. The present study explored statin prescribing trends for primary prevention of ASCVD in the US. Methods: We conducted a pooled cross-sectional analysis using EHRs from Epic Cosmos, an integrated, deduplicated database including more than 290 million patients across the US. Patients eligible for statin therapy for primary prevention between 1/2017 and 12/2024, according to current guidelines, were included (adults aged 40-75 years with a 10-year ASCVD risk ≥ 7.5%, adults ≥40 years with DM (HbA1c &gt;6.5%), or individuals with an LDL cholesterol ≥190 mg/dL). Patients with established ASCVD (ACS, stable angina, PCI /CABG, PAD, or CVA) were excluded. National prescribing trends were analyzed. Results: A total of 15,770,021 patients met inclusion criteria. Among them, 9,377,988 (59.5%) were prescribed a statin, while 6,392,033 (40.5%) were not. Of those prescribed a statin, 3,485,418 (37.2%) were on a high-intensity statin. Baseline characteristics were generally similar between patients prescribed statins and those who were not, including average age (67 ± 20 vs. 66 ± 19 years), sex distribution (49.9% vs. 50.4% female), and race/ethinicity (White: 76.0% vs. 74.6%; Black: 16.0% vs. 16.1%; Hispanic: 8.6% vs. 7.9%). The average Area Deprivation Index was comparable between both groups (53 each). On trend analysis, the rate of statin prescriptions for primary prevention among eligible patients increased significantly from 52.8% in 2017 (95% CI: 52.3–53.2) to 62.8% in 2024 (95% CI: 62.5–63.1) (p &lt; 0.001) ( Figure 1). In subgroup analysis, 64.5% of adults aged 40–75 years with a 10-year ASCVD risk ≥ 7.5%, 60.4% of adults ≥40 years with DM, and 63.3% of patients with LDL ≥ 190 mg/dL were prescribed a statin in 2024. The difference in statin prescribing rates across the subgroups was statistically significant (p &lt; 0.001). Conclusions: Statin prescribing for primary prevention has increased significantly in the US over the past decade, yet almost 40% of eligible patients remained untreated in 2024. These findings highlight ongoing gaps in preventive care and the need for enhanced implementation of guideline-directed statin therapy.

Clinical profile and optical coherence tomography based morphological characteristics of coronary in-stent restenosis: A cross-sectional study.

Serum vitamin A is associated with variations in the relationship between plasma B6 vitamers and cardiovascular risk.

Little correlation exists between the burden of ischemia and severity of angina in patients with stable coronary artery disease. This placebo-controlled, n-of-1 study investigated the relationship between ischemia, the collateral circulation, and symptoms in stable coronary artery disease. Additionally, it explored the association between progressive collateral recruitment and ischemic preconditioning. Fifty-one participants with severe single-vessel coronary artery disease and angina were recruited. Antianginal medications were stopped, and daily angina symptoms were documented using a dedicated smartphone application (ORBITA [Objective Randomized Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina] app) for 14 days before undergoing invasive pressure wire studies and coronary flow reserve assessment. Each participant then underwent four 60-s episodes of low-pressure balloon occlusion across their coronary stenosis. Each episode was paired with an audiovisually identical placebo inflation in a randomized order. After each episode, participants scored pain intensity on a 10-point scale, and a placebo-controlled pain intensity score was calculated. Collateral flow index was calculated from simultaneous measures of aortic, right atrial, and distal coronary wedge pressure during balloon occlusion. Higher Pr values from Bayesian models indicate a greater likelihood of association. The mean (±SD) age of participants was 63±9 years, and 78% were men. The median (interquartile range) fractional flow reserve was 0.68 (0.57-0.79), the median instantaneous wave-free ratio was 0.80 (0.48-0.89), and the median coronary flow reserve was 1.42 (1.08-1.85). Daily angina frequency showed little correlation with severity of ischemia, as assessed by fractional flow reserve (Somers' D 0.124, Pr=0.057) or instantaneous wave-free ratio (Somers' D 0.056, Pr=0.150). However, there was strong evidence of an association between lower fractional flow reserve and instantaneous wave-free ratio values and greater collateral flow (Somers' D 0.302, Pr=0.998 and Somers' D 0.316, Pr=0.999, respectively). There was also strong evidence of an association between more collateralization (higher collateral flow index) and lower pain intensity scores (Somers' D 0.341, Pr=0.999). Finally, pain intensity scores and collateral flow index remained stable between sequential balloon occlusion episodes within individual patients, indicating little evidence of ischemic preconditioning. Coronary collateralization is associated with ischemic burden and may reduce the intensity of ischemic chest pain. This may explain the nonlinear relationship between stenosis, ischemia, and angina.

Background As a major contributor to global death rates, coronary heart disease (CHD) remains critical. This investigation examines CD147's utility for assessing plaque characteristics among CHD patients, with a focus on moderate altitude populations. Methods Initially, high-throughput sequencing was performed on platelet samples obtained from three individuals with stable angina (SA) and three with unstable angina (UA), serving as the discovery cohort for subsequent bioinformatics analysis. Based on the insights gained from this initial phase, the investigation was extended to a larger cohort comprising 90 SA patients and 90 individuals diagnosed with acute coronary syndrome (ACS). Platelets isolated from these patients underwent flow cytometry analysis for CD147 expression. Furthermore, a logistic regression analysis incorporating traditional CHD risk factors was conducted to determine the odds ratio (OR) for CD147 expression in differentiating between stable and unstable plaques. Results High-throughput sequencing revealed distinct CD147 levels between SA and UA groups (log₂FC = 2.3). The logistic regression analysis demonstrated that heightened platelet CD147 correlated with plaque instability (OR = 9.21, 95% CI: 2.33–36.42, P = 0.002), persisting beyond conventional risk adjustment. Conclusion This study identifies platelet CD147 as a promising predictor for differentiating plaque stability in CHD under moderate altitude conditions. Our findings suggest that CD147 not only contributes to platelet activation and thrombus formation but may also directly influence plaque stability. The impact of chronic hypoxia and other environmental stressors in moderate altitude regions on CD147 expression provides new insights for risk stratification and targeted therapeutic strategies in altitude-specific populations.

The purpose of scientific research there was a studying of distribution of frequencies of alleles of a polymorphic marker 4G(-675)5G of PAI-1 gene among patients with ischemic heart disease (IHD) and at patients with risk factors of IHD. In our scientific research included 63 patients with the diagnosis ischemic heart disease (IHD) especially with stable angina (48 men and the 15 woman) passing on hospitalization in I-cardiology department of Multidisciplinary clinic of Tashkent Medical Academy. Average age of patients was 56,8±6,40 years (42 up to 66 years). Average age of men were 56,4±6,60 years and women age were 58,0±5,52 years. The state of hypercoagulability was assessed by measures of polymorphism gene of PAI-1 and plasma level of PAI-1. Besides in our research work we assessed the main risk factor of IHD such as, obesity, smoking, anxiety-depressive syndrome (ADS). Obesity was calculated with Quetelet's formula. Smoking was estimated by Fagerstrem’s test. ADS was assesses by using Hospital Anxiety and Depression Scale (HADS). Assessment of occurrence of various genotypes of a polymorphic marker 4G(-675)5G of PAI-1 gene, established that differences between distribution 5G/5G,4G/5G,4G/4G of genotypes depending on FC of CVD weren't reliable as CHI – a square on persen turned out χ2=1,85 that corresponds (р0.05). On the basis of these results it is possible to assume that, existence of heterozygous and homozygous mutagen genotypes of a gene of PAI-1 doesn't influence disease severity in a particular on degree of FC of SA. Our investigation results show thatPAI-14G/5G polymorphism was significant associated with CAD risk in uzbek nationality. In the subgroup analysis according to FC of SA, the results suggested thatPAI-14G/5G polymorphism was associated with CAD risk and high level of PAI-1 in plasma.

Invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) are common procedures for the diagnosis and treatment of coronary artery disease (CAD). These procedures are typically performed within the parameters of insurance coverage, but little is known about how insurance policies align with guidelines and landmark randomized clinical trials. We developed 6 use cases (3 each for ICA and PCI) of clinical scenarios for stable CAD commonly encountered in clinical practice and compared policies of the largest US public and private payers (based on total revenue and number of beneficiaries) to the 2012 and 2023 professional society guidelines as well as the ORBITA (Objective Randomized Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) and ISCHEMIA (Initial Invasive or Conservative Strategy for Stable Coronary Disease) trials. We classified policies as more restrictive, equal, or less restrictive than the guidelines and published randomized clinical trials by evaluating them on parameters of optimal medical therapy (OMT) and noninvasive imaging for ICA policies; and OMT, anatomic severity of CAD, and ability to proceed with PCI for PCI policies. We summarized findings with descriptive statistics. Among 33 payers, 18 (55%) ICA and 14 (42%) PCI policies were publicly available. When comparing requirements for OMT among symptomatic patients before ICA, 22% of policies were less restrictive, 75% were equivalent, and 3% were more restrictive than the 2012 and 2023 professional society guidelines. For the number of OMT medications among symptomatic patients before ICA, 44% were less restrictive and 56% were equivalent compared with the ORBITA trial. When comparing requirements for OMT for symptomatic patients before PCI, 21% of policies were less restrictive, 75% were equivalent, and 4% were more restrictive than the 2012 and 2023 guidelines. ICA and PCI coverage policies were only publicly available for approximately half of the largest US insurers, indicating need for greater transparency. When available, policies were variable in their alignment with clinical practice guidelines.

Despite the clinical guidelines favoring medical therapy for stable angina, the optimal management of these patients remains unclear. Here, we compare medical management (MM) versus PCI in patients with stable angina. An extensive literature search was conducted using PubMed and Embase to identify randomized controlled trials (RCTs) of interest. Data were extracted and analyzed using a random-effects model to calculate pooled odds ratios (OR). Our meta-analysis of 28 RCTs included 9,346 PCI patients and 9,503 medically managed patients. The mean age was 62.5 ± 7.6 years in the PCI group and 62.8 ± 7.4 years in the other group. Men comprised 68% and 70% of PCI and MM groups, respectively.Over a mean follow-up of 2.64 years, PCI was associated with a significantly lower incidence of myocardial infarction (MI) compared to medical management (OR 0.84, 95% CI 0.74-0.96, p = 0.01). Although PCI showed trends toward lower odds of unplanned revascularizations and major adverse cardiovascular events, these differences were not statistically significant. There were no differences in outcomes of freedom from angina, unstable angina, nonfatal MI, stroke, all-cause mortality, or CV death. Advances in cardiovascular imaging and catheterization techniques have improved risk stratification and outcomes of PCI in stable angina. Further research is needed to identify clinical subgroups that benefit most from each treatment modality.

Diabetes with chronic total arterial occlusion carries a poor prognosis. Little is known about patients with diabetes and stable left circumflex artery (LCX) chronic total occlusion (LCX-CTO). We aimed to determine whether stable LCX-CTO should be recanalized in patients with diabetes. We analyzed patients with LCX-CTO, diabetes, and stable clinical symptoms (i.e., silent ischemia or symptomatic stable angina), who underwent successful revascularization (SR) or medical therapy (MT). The primary endpoint was major adverse cardiac events. Propensity score-matched analyses and Cox regression were performed. The proximal LCX-CTO subpopulation was analyzed. A stratified subgroup analysis was conducted for the primary endpoint. We enrolled 620 patients, stratified into MT (448, 72.26%) and SR groups (172, 27.74%). After a median 44-month follow-up, univariate and multivariable models showed that SR offered no clinical benefits regarding major adverse cardiac events (adjusted hazard ratio [aHR]: 0.860, 95% confidence interval [CI]: 0.520-1.423, P = .558). This was consistent for other clinical endpoints as well. However, in the subpopulation with proximal LCX-CTO, SR was superior in terms of cardiac (aHR: 0.284, 95% CI: 0.082-0.984) and all-cause mortality (aHR: 0.455, 95% CI: 0.167-1.239). Revascularization should be attempted in patients with diabetes who have proximal LCX-CTO.

Ischaemic heart disease (IHD) is the primary cause of cardiovascular death worldwide. Worryingly, the prevalence of IHD is increasing in younger women, with a 3% increase between 1990 and 2019. Although global IHD death rates have decreased in younger women overall, IHD mortality in younger women is increasing in certain high-income countries. Angina is the primary presenting symptom of suspected IHD and coronary artery disease. The presence of angina in patients with stable coronary artery disease is associated with an increased risk of major cardiovascular events compared with those without angina. Angina in young women is linked to future premature IHD events. There are particular features to consider in younger women presenting with stable angina-anginal symptom characterization may align with older women, but angina may occur cyclically in younger women and a similar pattern may be evident on diagnostic testing. Pathophysiologic mechanisms for angina in some young women may involve effects of ovarian hormones on vascular beds of the cardiovascular system. Traditional IHD risk factors are common to women and men; however, there are certain sex differences in their relevance to IHD risk, as well as influences that female hormones and reproduction have over a life course that affect IHD risk. In this review, we will explore stable angina in young women, consider possible pathophysiological mechanisms involved in their symptom presentation, and present risk factors associated with IHD in women. In addition, potential treatment options will be discussed and attention will be drawn to gaps in the evidence, proposing areas where more research is necessary.

Objective. To develop a digital platform and methodology for the immediate organization of regular medical check-up of patients with ischemic heart diseases with an algorithm of actions, monitoring, control, analysis and evaluation of its effectiveness. Materials and methods. Based on the data of the regional information system on medical services, a «Report on district service information distribution» digital platform, allowing to carry out daily monitoring of the results of medical care in polyclinics for patients with ischemic heart diseases at the level of ambulance service, polyclinic and inpatient hospital, was created. On the basis of this digital platform, a methodology for the organization of regular medical check-up of patients with ischemic heart diseases in the form of an algorithm of actions for monitoring of linkage to regular medical check-up, control and analysis was developed. Implementation into practice was done in 2018. Comparison of patients with stable effort angina — residents of Orenburg, who were under regular medical check-up in 2017, 2019 and 2024, including in 13 208, 10 205 and 13 405 patients, respectively, with adverse outcomes (with cases of emergency hospitalization, with ambulance calls on ischemic heart disease, development of myocardial infarction), was performed. The coverage with regular medical check-up of patients with angina during these years was calculated. Results. Organization of regular medical check-up using the methodology developed by us has shown an increase in the coverage with regular medical check-up of patients with angina from 77 to 85% and a decrease in the proportion of patients with myocardial infarction among them from 4.71% to 3.97%, with emergency hospitalization cases and ambulance calls from 33.6% to 27.9% for 2017—2024. Conclusion. Increase in the coverage with regular medical check-up of patients with stable effort angina, with the decrease in the proportions of patients with myocardial infarction among them, with ambulance calls and emergency hospitalizations on ischemic heart diseases demonstrate the effectiveness of regular medical check-up based on the created digital platform and methodology of its organization.

Background: Chronic Obstructive Pulmonary Disease (COPD) and Ischemic Heart Disease (IHD) are leading causes of global morbidity and mortality, frequently coexisting as comorbid conditions. Their interplay creates a complex pathophysiological state that exacerbates the clinical course and worsens prognosis. The simultaneous assessment of pulmonary function, systemic inflammation, and cardiac strain in this comorbid population remains a critical area of investigation. Objective: To study the changes in external respiratory function, the levels of key inflammatory cytokines (IL-6, TNF-α), and brain natriuretic peptide (NT-proBNP) in patients with COPD, particularly when it occurs in comorbidity with IHD. Materials and Methods: A single-center, cross-sectional study was conducted at the Clinics of Tashkent State Medical University. A total of 120 male participants aged 45-70 years were enrolled and divided into three groups: Group 1 (n=40) - patients with COPD alone; Group 2 (n=40) - patients with IHD alone (stable angina, FC II); Group 3 (n=40) - patients with comorbid COPD and IHD. A control group (n=30) of healthy, age-matched individuals was also included. All participants underwent spirometry with bronchodilator testing. Serum levels of IL-6, TNF-α, and NT-proBNP were measured using enzyme-linked immunosorbent assay (ELISA). Results: Patients with comorbid COPD and IHD (Group 3) demonstrated the most pronounced impairments in spirometric parameters (FEV1: 48.2±5.1% pred., FVC: 72.5±6.8% pred., FEV1/FVC: 52.8±4.9%) compared to other groups (p&lt;0.001). These patients also exhibited a significant synergistic increase in inflammatory markers (IL-6: 8.45±1.32 pg/mL; TNF-α: 12.89±2.11 pg/mL) and NT-proBNP levels (485.6±75.4 pg/mL), which were substantially higher than in the groups with isolated diseases (p&lt;0.001). Strong negative correlations were found between FEV1 and IL-6 (r = -0.78, p&lt;0.01), FEV1 and NT-proBNP (r = -0.71, p&lt;0.01), and a strong positive correlation between IL-6 and NT-proBNP (r = 0.82, p&lt;0.01) in the comorbid group. Conclusion: The comorbidity of COPD and IHD leads to a significant mutual aggravation of both conditions, characterized by severe obstructive ventilatory disorders, heightened systemic inflammation, and increased cardiac strain. The strong intercorrelations between these parameters suggest a shared pathophysiological pathway and highlight the need for an integrated diagnostic and therapeutic approach targeting both pulmonary and cardiovascular systems in this high-risk patient population.

The 7-year extended prognostic data from the Assessing Diagnostic Value of Non-invasive CT-FFR in Coronary Care, or ADVANCE-DK, trial indicate that the results from coronary CT angiography–derived fractional flow reserve remain consistently associated with long-term risk of adverse cardiovascular events.

Pain following myocardial ischemia is a significant clinical concern, contributing to increased sympathetic tone, mortality and morbidity. Standard management includes beta blockers, nitrates, aspirin-clopidogrel and opioids. We propose a robust pain portal block technique using 0.5% lignocaine at designated sites on the chest wall and upper limb. This method offers rapid and effective analgesia for both cardiac and non-cardiac chest pain, extending beyond lignocaine's typical duration of action. Early implementation of this technique may positively impact the management and outcomes of acute myocardial infarction.

BACKGROUNDStable angina pectoris, a clinical manifestation of coronary artery disease (CAD), is commonly evaluated using non-invasive diagnostic tools. Traditionally, stress testing modalities such as exercise electrocardiography (ECG), myocardial perfusion imaging (MPI), and stress echocardiography have been the first-line strategies. However, coronary computed tomography angiography (CCTA), an anatomic imaging modality, is increasingly used for its ability to directly visualize coronary artery stenoses and plaque burden. Despite growing adoption, the comparative effectiveness of CCTA and stress testing in terms of diagnostic accuracy, prognostic value, and clinical outcomes in stable angina remains an area of active debate.AIMTo compare the diagnostic and prognostic performance of CCTA with various forms of stress testing in adult patients presenting with suspected or confirmed stable angina.METHODSA comprehensive literature search was performed across PubMed, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials in accordance with the PRISMA guidelines. Only randomized controlled trials (RCT) published in English within the last 15 years were included. Studies involving adult patients (≥ 18 years) with stable angina or low-risk chest pain were selected. The intervention was CCTA, and the comparators included ECG, MPI, and stress echocardiography. Data were extracted using a standardized process, and study quality was assessed using the Cochrane Risk of Bias 2.0 tool. Due to heterogeneity in outcome measures and modalities, narrative synthesis was employed.RESULTSFive high-quality RCTs encompassing a total of 5551 patients were included. CCTA demonstrated superior diagnostic accuracy and prognostic capability across multiple studies. It was more effective in predicting major adverse cardiac events, including myocardial infarction and cardiac death, and was associated with fewer unnecessary invasive coronary angiographies and better event-free survival. Studies also reported improved revascularization rates in patients evaluated with CCTA, particularly within tiered diagnostic protocols. Stress testing, while useful, showed limitations in sensitivity and downstream clinical decision-making.CONCLUSIONCCTA offers a diagnostically superior and clinically impactful strategy for the initial evaluation of patients with stable angina, especially those with intermediate pretest probability of CAD. Compared to conventional stress testing, it enhances risk stratification, reduces unnecessary procedures, and may improve long-term outcomes. These findings support its broader integration into diagnostic pathways for stable angina.

BackgroundAlthough the relationship between viscera and somato remains unclear, a deeper comprehension of the relationship will maximize the diagnostic and therapeutic benefits. Therefore, this study was conducted to explore the specificity of visceral-somatic associations in the pathological state of chronic stable angina pectoris (CSAP).Methods40 individuals with CSAP participated in the study, while 40 individuals in the healthy control group were age-matched healthy individuals. Four distinct somatic locations dispersed along the heart and lung meridians were subjected to laser doppler flowmetry, infrared thermography, and functional near-infrared spectroscopy in order to assess (1) perfusion unit (PU), (2) temperature, and (3) regional oxygen saturation (rSO2). These three outcomes represented the somatic sites’ microcirculatory, thermal, and metabolic properties.ResultsRegarding the microcirculatory characteristics, PU at the somatic sites of the heart meridian (Shenmen(HT7)/Shaohai(HT3)) in the CSAP group substantially increased (P < 0.05) compared to the healthy control group, while there was no statistically significant difference in PU at the somatic sites of the lung meridian between the two groups. Regarding the thermal characteristics, compared with the healthy control group, the temperature of the somatic sites of the heart meridian (Shenmen(HT7)/Shaohai(HT3)), as well as Taiyuan (LU9) of the lung meridian, increased significantly (P < 0.05). With regard to the metabolic features, rSO2 of the somatic site of the heart meridian (Shaohai (HT3)) in the CSAP group decreased significantly (P < 0.05) as compared to the healthy control group. The between-group difference in rSO2 in the lung and heart meridians (Taiyuan (LU9)/Chize (LU5)) and Shenmen (HT7), respectively, was not statistically significant.ConclusionsSpecific somatic sites in the heart meridian typically exhibit more significant changes in their microcirculatory, thermal, and metabolic characteristics than those in the lung meridian, thereby supporting the relative specificity for the visceral-somatic association in the disease state of CSAP. Trial registration: Clinicaltrials.gov (registration number: NCT04046640)

Background: COPD and stable angina are common in older adults, increasing the risk of respiratory and cardiovascular complications. Pneumococcal vaccination is recommended to reduce this burden. This study evaluated the 10-year impact of 13-valent pneumococcal conjugate vaccine (PCV13) on community-acquired pneumonia (COPD), COPD exacerbations, hospitalizations, and survival in this cohort. Methods: A total of 483 male patients with COPD and/or stable angina received a single dose of PCV13 and were divided into three groups: Group 1 (n = 140): vaccinated with COPD; Group 2 (n = 167): vaccinated with COPD and stable angina; and Group 3 (n = 176): unvaccinated with COPD. Primary endpoints were CAP cases, COPD exacerbations, and hospitalizations; the secondary endpoint was survival. Analysis used generalized linear models, Cox regression, and Kaplan–Meier survival curves. Results: PCV13 significantly reduced CAP in patients with COPD alone but not in those with comorbid angina. Although CAP, exacerbations, and hospitalizations increased over time, vaccinated groups consistently showed lower rates than the unvaccinated group. Survival was higher in both vaccinated groups over 10 years. Conclusions: PCV13 was associated with a reduced risk of CAP, COPD exacerbations, hospitalizations, and improved survival in older adults with COPD and stable angina. These findings support the vaccine’s potential to improve outcomes in multimorbid populations and its inclusion in clinical guidelines and adult immunization programs for high-risk older adults.

We aimed to investigate metabolomic alterations in peripheral artery disease (PAD) by analyzing blood from the femoral artery and vein, assessing metabolite release/uptake in chronically ischemic lower limbs (PAD group) and nonischemic limbs (controls), and evaluating the representativeness of upper-limb venous samples. In this exploratory case-control study, 24 patients with PAD (Fontaine IIb and III) and 18 control subjects with stable angina were enrolled. Blood was drawn from the femoral artery and vein, and the antecubital fossa. Metabolomic profiling of serum samples was performed using liquid chromatography and tandem mass spectrometry. We analyzed 560 metabolites, including amino acids and derivatives, acylcarnitines, ceramides, phosphatidylcholines, tri- and diglycerides, cholesteryl esters, sphingomyelins, and fatty acids, as well as 52 metabolic ratios/sums across various biochemical classes. Femoral arteriovenous (AV) concentration differences with in-group significance in at least one group and between-group significance was observed for 47 metabolites and five metabolic sums. Among these, eight metabolic variables in antecubital vein samples were significant. Correlation between AV differences and antecubital vein samples was weak. Using the femoral AV concentration differences of metabolites, we identified significant local metabolomic shifts in the PAD group. Most of these changes were not revealed using traditional upper-limb venous blood sampling. Further study of AV differences could improve the understanding of the pathophysiology of PAD.