Vascular Risk Research Articles

Chronic obstructive pulmonary disease (COPD) is responsible for many global cases of illness and death and often occurs together with systemic vascular conditions such as peripheral arterial disease (PAD) [1], [2]. Because PAD, inflammation, atherosclerosis, and lifestyle factors are all related, quantifying PAD may lead to better risk assessment in COPD. In this report, National Health and Nutrition Examination Survey (NHANES) data from 2011–2020 are used to determine a score for four heart and circulation diseases—elevated blood pressure, smoking, high cholesterol, and chronic kidney disease—and this risk score is matched with information about demographics, height and weight, laboratory values and lifestyle behaviors to predict self-reported COPD status. Adults over 18 years old with complete data were included after the NHANES datasets were merged (N = 4,470). Before analysis, the data was pre-processed with imputation based on K nearest neighbors, limiting outliers and making sure all data had the same range (standard scaling). Because there was an imbalance in the classes (6.4% COPD), the SMOTE technique was used. Five deep-learning models were prepared and compared to tree-based ensembles (LightGBM, XGBoost, CatBoost) and a hybrid combination of CNN-LSTM and an ensemble classifier (LightGBM). Out of all the models, the CNN-LSTM showed the highest test AUC (0.8319) and accuracy (0.8255). Including a PAD score in the model leads to better classification of COPD, proving that considering vascular risk information helps predict respiratory diseases [3],[4],[5].

Objective:This study aimed to investigate the effects of electroencephalographic biofeedback (EEG-BF) treatment on cognitive function, sleep quality, anxiety and depression levels and quality of life in patients with vascular cognitive impairment-no dementia (VCI-ND).Methods:This study was a retrospective study that included a total of 128 patients diagnosed with VCI-ND at the Affiliated Hospital of North Sichuan Medical College from July 2022 to July 2024. The patients were divided into an EEG-BF group and a control group in accordance with whether they received EEG-BF treatment or not. Both groups received standard vascular risk factor management. The EEG-BF group separately received EEG-BF intervention two times a week for 12 weeks. Propensity score matching (PSM) was used to perform 1:1 nearest-neighbour matching between the two groups with respect to baseline characteristics. The matching variables included age; education; place of residence; family income; type of health insurance; number of underlying diseases; and pre-intervention scores on the Montreal Cognitive Assessment (MoCA), Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS). The main outcome measures were the PSQI, MoCA, SAS, 36-item Short-Form Questionnaire (SF-36) and SDS before and after treatment.Results:After PSM, the baseline covariates between the two groups were well balanced, with no significant differences. The Love plot showed a significant decrease in standardised differences in covariates after matching. After 12 weeks of intervention, the EEG-BF group was significantly better than the control group in terms of MoCA scores (p = 0.013), SAS scores (p = 0.002), SDS scores (p = 0.004) and some of the SF-36 dimensions, and the within-group before and after comparisons was statistically different (p < 0.05). The sleep quality of the EEG-BF group improved after treatment, whereas that of the control group exhibited no notable variation before and after the intervention (p > 0.05).Conclusion:EEG-BF may help improve cognitive function, sleep quality, emotional state and life quality in patients with VCI-ND, offering a promising individualised non-pharmacological intervention for this population. Future multicentre, prospective studies are needed to further validate its prolonged therapeutic effect and neuromodulatory mechanisms.

ABSTRACTIntroductionPrevious studies have linked Syndecans (SDCs) to hypertension (HTN), BMI and the prevalence of coronary artery disease (CAD). The relationship between SDCs and metabolic syndrome (MetS) has not been explored. This study aimed to investigate the association between serum SDC1 level and MetS.MethodsThis was a comparative cross‐sectional study conducted on the subjects from phase II of the MASHAD study. A total of 81 subjects were divided into three groups: (1) healthy controls (N = 26), (2) subjects with MetS and hypertension with serum ALT < 43 U/L (MetS+ HTN+ ALT–), (N = 29), and (3) subjects with MetS and hypertension with serum ALT ≥ 43 U/L (MetS+ HTN+ ALT+), (N = 26). Serum SDC1 levels were measured using a commercial ELISA kit. Data were analysed using SPSS version 26 and R version 4.0.5 software.ResultsThe analysis showed that mean serum SDC1 levels did not significantly differ between healthy and MetS+ groups overall. Among MetS+ subjects, males had significantly higher SDC1 levels than females (17.57 ± 8.48 vs. 12.85 ± 5.59 ng/mL, p = 0.018). In the MetS+ HTN+ ALT+ group, males also had higher SDC1 levels compared to females (20.19 ± 10.56 vs. 11.82 ± 5.09 ng/mL, p = 0.020), while no significant differences were observed across the MetS groups overall (p = 0.474). Additionally, in both the total study sample and the MetS+ HTN+ ALT+ group, SDC1 levels were positively correlated with diastolic blood pressure (DBP) (r = 0.256, p = 0.021; r = 0.463, p = 0.017, respectively), with no significant associations found with other metabolic parameters.ConclusionsThese findings suggest that SDC1 levels are higher in males with MetS, particularly those with hypertension and elevated ALT, and are positively associated with DBP in both the total study sample and the MetS+ HTN+ ALT+ group. There were no significant associations with other metabolic parameters. This indicates that SDC1 may serve as a gender‐specific biomarker for vascular risk in MetS, potentially aiding clinicians in identifying high‐risk MetS subjects.

Metabolic syndrome (MS) in young adults has emerged as an increasingly prevalent health challenge, with recent studies reporting a 4.8–7.0% occurrence among individuals aged 18–30 years, primarily associated with decreased HDL cholesterol levels. The progressive rise in obesity and related metabolic disorders underscores the importance of early identification of neuroendocrine and circadian disturbances contributing to MS pathogenesis. Melatonin, a key regulator of circadian homeostasis and a potent endogenous antioxidant, plays a crucial role in metabolic regulation, including glucose control, lipid balance, and anti-inflammatory defense. This study examines the features of daily melatonin secretion in young patients with MS, emphasizing its diagnostic and pathogenetic significance. A reduction in nocturnal melatonin release and flattening of its circadian rhythm were observed, correlating with increased insulin resistance, dyslipidemia, and endothelial dysfunction. Altered melatonin excretion patterns, assessed through urinary 6-sulfatoxymelatonin profiles, reflect an early manifestation of chronobiological imbalance or “chronodissonance.” The findings highlight that disruption of melatonin rhythm may serve as an early biomarker of metabolic and vascular risk, supporting the role of circadian regulation in preventive and therapeutic strategies for metabolic syndrome in young adults.

Effect of repurposed simvastatin on disability progression in secondary progressive multiple sclerosis (MS-STAT2): a phase 3, randomised, double-blind, placebo-controlled trial.

Evaluating the endothelial and metabolic effects of CPAP therapy in obstructive sleep apnea patients: Insights from a comprehensive meta-analysis.

Elastohydrodynamic lubrication in rotational atherectomy: Fluid film thickness characteristics and reduction of vascular damage risk

S364 Lighting the Fuse: Uncovering the Vascular and Intestinal Risks of Smoking in a Nationwide Study

INTRODUCTIONBlue spaces (i.e., water bodies) may benefit cognitive health depending on their uses and surrounding spatial context. We examined associations between blue spaces and incident dementia in the Cardiovascular Health Cognition Study, and specifically within Pittsburgh, given its industrial uses of blue spaces.METHODSParticipants were 2924 adults (Pittsburgh: n = 651) ≥65 years of age. Dementia was clinically adjudicated (1992–1999). Water density was measured using both 1 km radial buffers and U.S. Census tracts.RESULTSIn Pittsburgh only, greater buffer‐level blue space predicted a higher risk of mixed/vascular dementia (highest vs lowest tertile: hazard ratio [HR] = 2.87, 95% confidence interval [CI]: 1.43–5.74), but not Alzheimer's disease (p > 0.05). This was attenuated adjusting for individual/neighborhood confounders (HR = 2.65, 95% CI: 0.99–7.07). Tract‐level associations were attenuated but significant after adjustment.DISCUSSIONBlue space was related to vascular dementia risk after accounting for social context and using more personalized buffer‐level measures. Future studies should carefully consider spatial units and differentiate blue spaces by historical uses.HighlightsExamined associations between nearby blue spaces and incident dementia.Tested multiple spatial units (buffer, tract) and separately for the Pittsburgh site.Blue space density was not related to dementia risk in overall sample.Greater blue space density predicted a higher risk of dementia for the Pittsburgh site.Associations were attenuated after adjusting for neighborhood confounders.

A man in his 60s, with no vascular risk factors, was referred for recurrent intracerebral haemorrhages. He had a subarachnoid haemorrhage in his 20s and underwent craniotomy for a right internal carotid artery aneurysm, with no record of a cadaveric dura graft. 35 years later, he experienced a right temporal lobar haemorrhage, followed by a left thalamic haemorrhage 6 months later in his 60s. A brain MRI could not be performed due to unknown materials from the previous clipping. Although over 55, his history of neurosurgery, negative genetic analysis for Alzheimer's and positive PET/CT for amyloid led to a diagnosis of iatrogenic cerebral amyloid angiopathy (CAA), which is more commonly observed in patients under 55. Given the thalamic haemorrhage, usually not associated with CAA, he would typically be diagnosed with hypertensive cerebral haemorrhage. This indicates that some patients diagnosed as hypertensive haemorrhage may actually represent iatrogenic CAA.

BackgroundDementia and cognitive impairment are major public health challenges in our aging societies. Lifestyle interventions may have positive impact on cognition and health of older adults. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) previously showed that a 2-year multidomain lifestyle intervention has beneficial effect on cognitive function among older adults. Here we investigated the long-term effects of the intervention on lifestyles and cognition over 11 years.MethodsFINGER included 1259 participants, aged 60-77 years, with some risk factors for dementia. They were randomized to regular health advice group (control) or a multidomain intervention group including exercise, dietary counselling, cognitive training, and vascular risk factor management (intervention), both lasting for 2 years. Follow-up visits took place approximately 5, 7 and 11 years after the baseline visit. Lifestyles were measured with an index comprising questions on diet, physical activity, cognitive and social activities, smoking and alcohol use. Cognition was measured with a neuropsychological test battery.ResultsThe beneficial effect of the intervention on lifestyles was sustained until 7 years (p = 0.005 for intervention vs. control). Among older participants the beneficial effect was significant until 11 years. Drop-out from the study was linked to worse lifestyles. Individuals with high intervention participation had better cognitive change than the control group until 7 years (p = 0.003). Those with low intervention participation had worse cognition.DiscussionLifestyle-based interventions can have beneficial effects on lifestyles and cognition even several years after the intervention. Especially participants who adhered well to the intervention had sustained benefits. The findings support the implementation of preventive activities for older adults.Key messages• Beneficial effect of a 2-year multidomain lifestyle intervention on lifestyles and cognition among older adults was sustained several years after the intervention.• Active participation in the intervention was associated with better lifestyles and cognitive function later on.

Emerging evidence indicates that blood pressure variability (BPV) is a modifiable vascular risk factor for Alzheimer's disease (AD). Herein, we aimed to systematically evaluate the potential role of short-term BPV across the AD continuum. This study included 263 patients on the AD continuum from the Chinese Imaging, Biomarkers, and Lifestyle study between January 1, 2023, and December 31, 2023. 24-h ambulatory blood pressure monitoring was performed to obtain blood pressure measurements and evaluate BPV. Partial Spearman's correlation and restricted cubic spline analysis were performed to assess the associations between BPV and neuropsychological tests, cerebrospinal fluid biomarkers, and multimodal neuroimaging measures, respectively. The mediating effects of multimodal neuroimaging measures on the association between BPV and neuropsychiatric symptoms (NPS) were analyzed. The elevated standard deviation (SD) and average real variability of nightly diastolic blood pressure (DBP) were correlated with higher Neuropsychiatric Inventory (NPI) scores (r = 0.19, p = 0.034; r = 0.22, p = 0.013). The increased SD of nightly systolic blood pressure (SBP) was correlated with increased Hamilton Anxiety Scale (HAMA) scores and total tau levels (r = 0.20, p = 0.026; r = 0.17, p = 0.027), and elevated coefficient of variation (CV) of nightly SBP was correlated with higher HAMA scores and lower Aβ42/40 levels (r = 0.20, p = 0.026; r = -0.18, p = 0.021). The nightly variability of SBP showed an inverted U-shaped relationship with Montreal Cognitive Assessment scores (P for nonlinear = 0.008; P for nonlinear = 0.015; P for nonlinear = 0.021). The left cuneus volume mediated 29.41% of the association between the CV of nightly SBP and HAMA scores, while the right medial orbitofrontal thickness mediated 35.44% of the association between the CV of nightly DBP and NPI scores. This study suggests that short-term BPV may play a role in the AD continuum. These findings provide evidence of a vascular pathway to AD, as well as a potential and accessible intervention target for patients on the AD continuum.

Thresholds of fat mass index percentiles and their association with cardiovascular risk in adolescents: Results from the EVA4YOU study.

AimMigraine with aura is a risk factor for ischemic stroke. To further assess this risk factor in relation to ischemic stroke, along with other risk factors, we created the migraine associated risk of stroke score (MARS+), making it applicable to migraineurs. The risk score includes vascular risk factors, migraine characteristics and medications used in migraine patients.MethodsWe prospectively evaluated participants in Atherosclerosis Risk in Communities Cohort (ARIC) with a history of migraine. In this population, we tested the association of potential risk factors for ischemic stroke using a Cox proportional hazards model. The coefficient of each variable was divided by the lowest β value and rounded to the nearest integer. The sum of the weighted score of the reported risk factors was found and categorized into two prognostic groups.ResultsWe assessed migraine characteristics (aura, migraine frequency and duration) and medications that were in current use by participants, mean ± SD age 58 ± 5.5 years, 86% white, 14% black and 77% women (ergot alkaloids, triptans, hormone replacement therapy, sympathomimetics, steroids, selective serotonin reuptake inhibitors and opioids), in addition to traditional risk factors. Based on the points derived from the significant factors we assigned age ≥65 years = 1, non-white race = 2, hypertension = 2, diabetes = 3, body mass index ≥30 = 2, atrial fibrillation = 2, use of steroid medications = 3, use of selective serotonin reuptake inhibitor medications = 1, opioids = 2, presence of aura = 2 and duration <5 years = 1 to total 21 points. A cut-off of MARS+ ≥5 was considered as a lifetime high risk for ischemic stroke based on receiver operating characteristic curve and Youden's index. Of the 1485 participants with migraine, 112 had an ischemic stroke. MARS+ ≥5 revealed a hazard ratio of 4.09 (95% confidence interval = 2.67-6.26).ConclusionsThe MARS+ score is used to predict ischemic stroke in middle-aged migraine sufferers. This risk score, in addition to generalizability, includes factors such as migraine characteristics and medications that may increase stroke risk.

Corrigendum to “Dietary glycocalyx mimetic reduces vascular risk in Type 2 diabetes: evidence from urinary peptidomic classifiers in a South–Asian Surinamese Cohort”. [DIAB 229 (2025) 112931

Long-Term Effectiveness and Safety of Dacron Patch (Uni-Graft®) Closure in Carotid Endarterectomy.

Putamen vascularization on high-resolution 7T MRI is associated with perfusion and cognitive performance in cerebral small vessel disease.

Despite having few vascular risk factors, people with Down syndrome (DS) have MRI evidence of cerebrovascular disease (CVD) and neuroinflammation that worsens with Alzheimer's disease (AD) severity. We investigated whether markers of CVD and inflammation are associated with AD-related diagnostic progression in people with DS. We included 149 participants (mean age [SD]=44.6 [9]) from the Alzheimer's Biomarkers Consortium-Down Syndrome who had two (n=24) or three follow-up visits (n=125). We derived white matter hyperintensity (WMH) volume and plasma biomarker (glial fibrillary acidic protein [GFAP], amyloid beta [Aβ]42/Aβ40, hyperphosphorylated tau-217 [p-tau217], and neurofilament light [NfL]) concentrations at baseline and examined their association with progression in clinical diagnosis. Higher baseline WMH volumeand higher GFAPwere associated with a greater likelihood of diagnostic progression. Combining WMH and GFAP with p-tau217 improved clinical conversion classification accuracy over AD biomarkers alone. Among individuals with evidence of amyloidosis, both WMH and GFAP were associated with clinical progression. In DS, markers of CVD and inflammation are independently and synergistically associated with clinical AD progression. Higher baseline white matter hyperintensity (WMH) volume and plasma glial fibrillary acidic protein (GFAP) concentration were associated with a higher likelihood of progressing from cognitively stable to either mild cognitive impairment or clinical Alzheimer's disease in Down syndrome. WMH volume and GFAP concentration discriminated between those who progressed and those who did not. Models including the independent and interactive effects of WMH and GFAP more accurately discriminated between participants who progressed diagnostically from those who did not. Individuals with evidence of amyloid pathology were more likely to progress if they also had elevated WMH or GFAP.

White matter hyperintensities (WMHs) of presumed vascular origin are common in the elderly and are associated with vascular risk factors. There is evidence that vascular risk factors, in particular hypertension, are associated with WMH in particular locations of the white matter. However, it remains unclear whether this is true for all risk factors and whether signature WMH locations differ between risk factors. We aimed to identify WMH locations associated with vascular risk factors in community-dwelling individuals. We pooled cross-sectional data from 16 population-based cohorts (15 653 individuals; mean age, 64.2±11.8 years; 52.2% female) through the Meta VCI Map Consortium. We quantified associations between WMH volumes in 50 white matter regions and 6 vascular risk factors using linear mixed models. Analyses were corrected for age, sex, study site, and total WMH volume. Hypertension (B=0.141; P<0.001), smoking (B=0.096; P<0.001), diabetes (B=0.059; P<0.001), and history of vascular disease (B=0.056; P=0.034) were significantly associated with higher total WMH volume, whereas obesity (B=0.023; P=0.139) and hypercholesterolemia (B=0.009; P=0.531) were not. After correcting for total WMH volume, hypertension was associated with WMH volume in 10 regions (ie, bilateral external capsule, superior longitudinal fasciculus, superior corona radiata, anterior limb of the internal capsule, left anterior corona radiata, and left superior fronto-occipital fasciculus), smoking (body corpus callosum), diabetes (genu corpus callosum), and obesity (left inferior fronto-occipital fasciculus), each with one region. Hypertension has a signature WMH pattern, whereas associations between other vascular risk factors and regional WMH volumes seem to be mainly explained by a global increase in WMH rather than region-specific effects.

Background: Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus and remains a significant contributor to morbidity, limb amputation, and mortality. Although substantial efforts have been made in prevention and treatment, ulcer recurrence continues to pose a critical clinical challenge. Understanding the multifactorial nature of recurrence and identifying reliable predictors are essential for improving long-term outcomes. Methods: This retrospective case-control study included 230 patients diagnosed with DFU and treated between October 2020 and January 2025. Patients were stratified into recurrence (n = 103) and non-recurrence (n = 127) groups based on ulcer outcomes within a two-year follow-up period. Clinical, demographic, foot-related, comorbid, and biochemical variables were extracted from medical records and follow-up assessments. Statistical analyses included univariate tests and binary logistic regression to determine independent predictors of DFU recurrence. Results: Significant differences were found between groups across multiple domains. Patients with recurrence had lower body mass index (BMI, p = 0.045) and a higher prevalence of poor financial status (p = 0.021). Foot-specific characteristics, including higher Wagner grade, prolonged ulcer duration, prior amputations, and plantar ulcer location, were all significantly associated with recurrence (p &lt; 0.05). Laboratory findings revealed elevated C-reactive protein and decreased serum albumin levels in the recurrence group (p &lt; 0.001). Notably, lower total bilirubin (TBIL) levels were observed in recurrent cases and remained an independent protective factor (OR = 0.898, p = 0.041). Multivariate analysis identified diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), prior amputations, and plantar ulceration as significant predictors of recurrence. Conclusion: DFU recurrence is driven by a complex interplay of vascular, neurological, anatomical, and biochemical factors. The identification of total bilirubin as a potential protective biomarker highlights new avenues for risk stratification. These findings underscore the importance of a comprehensive, multidisciplinary approach in DFU management to reduce recurrence and improve patient outcomes.