-
Advances in Clinical and Experimental... May 2024Atherosclerosis is a complex process involving endothelial dysfunction, vascular inflammation, vascular smooth muscle cell (VSMC) proliferation, angiogenesis, and... (Review)
Review
Atherosclerosis is a complex process involving endothelial dysfunction, vascular inflammation, vascular smooth muscle cell (VSMC) proliferation, angiogenesis, and calcification. One of the pathomechanisms of atherosclerosis is the upregulation of Wnt signaling. This study aimed to summarize the current knowledge regarding the role of Wnt signaling and sclerostin in atherosclerosis, vascular calcification, aneurysms, and mortality based on the PubMed database. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendation and identified 160 papers that were included in this systematic review. The published data highlight that the upregulation of Wnt components facilitates the initiation and progression of atherosclerosis, arterial remodeling, VSMCs proliferation and phenotypic transition to the osteoblastic lineage in the arterial wall. This results in protein secretion, cell migration, calcification, fibrosis and aneurysm formation. The transformation of VSMCs into osteoblast-like cells that is observed in atherosclerosis results in sclerostin expression inhibiting the Wnt pathway. Furthermore, it was shown that sclerostin, expressed in atherosclerotic plaques, inhibits aneurysm formation in a mouse model. However, in humans, while the antisclerostin antibody romosozumab inhibits bone resorption, biochemical parameters of endothelial activation and inflammation are not affected, and the incidence of aneurysms is not increased. It was suggested that detecting sclerostin in the calcified aortic atherosclerotic plaques reflects a defense mechanism against Wnt activation and inhibition of atherosclerosis, although this has only been shown in animal models. Moreover, an increased number of vascular cells converted to osteogenic phenotypes results in increased plasma sclerostin concentrations. Therefore, plasma sclerostin derived from bone limits its importance as a global marker of vascular calcification.
Topics: Humans; Vascular Calcification; Atherosclerosis; Animals; Wnt Signaling Pathway; Adaptor Proteins, Signal Transducing; Genetic Markers
PubMed: 37676098
DOI: 10.17219/acem/169567 -
European Heart Journal Mar 2023Optimal endovascular management of intermittent claudication (IC) remains disputed. This systematic review and meta-analysis compares efficacy and safety outcomes for... (Meta-Analysis)
Meta-Analysis
AIMS
Optimal endovascular management of intermittent claudication (IC) remains disputed. This systematic review and meta-analysis compares efficacy and safety outcomes for balloon angioplasty (BA), bare-metal stents (BMS), drug-coated balloons (DCB), drug-eluting stents (DES), covered stents, and atherectomy.
METHODS AND RESULTS
Electronic databases were searched for randomized, controlled trials (RCT) from inception through November 2021. Efficacy outcomes were primary patency, target-lesion revascularization (TLR), and quality-of-life (QoL). Safety endpoints were all-cause mortality and major amputation. Outcomes were evaluated at short-term (<1 year), mid-term (1-2 years), and long-term (≥2 years) follow-up. The study was registered on PROSPERO (CRD42021292639). Fifty-one RCTs enrolling 8430 patients/lesions were included. In femoropopliteal disease of low-to-intermediate complexity, DCBs were associated with higher likelihood of primary patency [short-term: odds ratio (OR) 3.21, 95% confidence interval (CI) 2.44-4.24; long-term: OR 2.47, 95% CI 1.93-3.16], lower TLR (short-term: OR 0.33, 95% CI 0.22-0.49; long-term: OR 0.42, 95% CI 0.29-0.60) and similar all-cause mortality risk, compared with BA. Primary stenting using BMS was associated with improved short-to-mid-term patency and TLR, but similar long-term efficacy compared with provisional stenting. Mid-term patency (OR 1.64, 95% CI 0.89-3.03) and TLR (OR 0.50, 95% CI 0.22-1.11) estimates were comparable for DES vs. BMS. Atherectomy, used independently or adjunctively, was not associated with efficacy benefits compared with drug-coated and uncoated angioplasty, or stenting approaches. Paucity and heterogeneity of data precluded pooled analysis for aortoiliac disease and QoL endpoints.
CONCLUSION
Certain devices may provide benefits in femoropopliteal disease, but comparative data in aortoiliac arteries is lacking. Gaps in evidence quantity and quality impede identification of the optimal endovascular approach to IC.
Topics: Humans; Popliteal Artery; Vascular Patency; Peripheral Arterial Disease; Treatment Outcome; Femoral Artery; Angioplasty, Balloon; Risk Factors
PubMed: 36721954
DOI: 10.1093/eurheartj/ehac722 -
European Review For Medical and... Sep 2023Hyperhomocysteinemia is a well-known marker that is associated with an increased risk of atherosclerosis due to its toxic effect on endothelial cells. This, in turn,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Hyperhomocysteinemia is a well-known marker that is associated with an increased risk of atherosclerosis due to its toxic effect on endothelial cells. This, in turn, leads to cardiovascular injury and increases morbidity. Different studies have shown alterations in the levels of homocysteine with respect to multiple disease states. Whether this non-traditional marker is associated with cardiovascular injury or not is subject to conflicting results. The purpose of this systematic review is to evaluate the role of homocysteine in the formation of atherosclerotic cardiovascular disease in young adults and children.
MATERIALS AND METHODS
This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). A search was done using specific keywords, including "homocysteine", "coronary artery disease", and "atherosclerosis", amongst several others, from the databases of PubMed, COCHRANE, and EBSCO. The data items included the diseased sample population along with the intervention used, or investigations carried out and the findings of the studies. Finally, 35 eligible studies were included.
RESULTS
Young patients with atherosclerotic cardiovascular disease were more likely to have elevated levels of homocysteine compared to elderly patients. Elevated levels of homocysteine have been observed with several genetic, nutritional deficiencies, and autoimmune states such as rheumatoid arthritis. On the other hand, decreased levels of homocysteine have been observed after certain intervention treatments, such as oral contraceptive pills, L-thyroxine, and even the adoption of certain diets. In the majority of studies, whenever homocysteine levels were higher than normal, this was reflected by an increased carotid intima-media thickness.
CONCLUSIONS
Homocysteine has a high correlation with atherosclerotic cardiovascular disease in young and overweight patients. In addition, the relationship of homocysteine with smoking, genetic polymorphism, specific hormonal and renal disorders, nutritional deficiencies (vitamin B12 and folic acid), and the use of specific medicines are among the other recurring findings. Given that many of these studies focus only on women, the relationship between homocysteine and atherosclerotic cardiovascular diseases in males is still unclear. Whether males are more prone to hyperhomocysteinemia needs to be assessed. Still, precise processes underlying variations in homocysteine in relation to all influencing factors are unclear and need further studies.
Topics: Male; Child; Humans; Female; Aged; Cardiovascular Diseases; Carotid Intima-Media Thickness; Prognosis; Hyperhomocysteinemia; Homocysteine; Endothelial Cells; Atherosclerosis; Folic Acid; Vitamin B 12; Risk Factors
PubMed: 37782175
DOI: 10.26355/eurrev_202309_33784 -
Biomolecules Nov 2023Peripheral artery disease (PAD) involves atherosclerosis of the lower extremity arteries and is a major contributor to limb loss and death worldwide. Several studies... (Review)
Review
Peripheral artery disease (PAD) involves atherosclerosis of the lower extremity arteries and is a major contributor to limb loss and death worldwide. Several studies have demonstrated that interleukins (ILs) play an important role in the development and progression of PAD; however, a comprehensive literature review has not been performed. A systematic review was conducted and reported according to PRISMA guidelines. MEDLINE was searched from inception to 5 December 2022, and all studies assessing the association between ILs and PAD were included. We included 17 studies from a pool of 771 unique articles. Five pro-inflammatory ILs (IL-1β, IL-2, IL-5, IL-6, and IL-8) and one pro-atherogenic IL (IL-12) were positively correlated with PAD diagnosis and progression. In contrast, two anti-inflammatory ILs (IL-4 and IL-10) were protective against PAD diagnosis and adverse limb events. Specifically, IL-6 and IL-8 were the most strongly associated with PAD and can act as potential disease biomarkers to support the identification and treatment of PAD. Ongoing work to identify and validate diagnostic/prognostic inflammatory biomarkers for PAD has the potential to assist clinicians in identifying high-risk patients for further evaluation and management which could reduce the risk of adverse cardiovascular and limb events.
Topics: Humans; Interleukin-6; Prognosis; Interleukin-8; Peripheral Arterial Disease; Atherosclerosis; Biomarkers; Risk Factors
PubMed: 38002322
DOI: 10.3390/biom13111640 -
International Journal of Molecular... May 2023Atherosclerosis is a complex pathological condition marked by the accumulation of lipids in the arterial wall, leading to the development of plaques that can eventually... (Review)
Review
Atherosclerosis is a complex pathological condition marked by the accumulation of lipids in the arterial wall, leading to the development of plaques that can eventually rupture and cause thrombotic events. In recent years, hydrogen sulfide (HS) has emerged as a key mediator of cardiovascular homeostasis, with potential therapeutic applications in atherosclerosis. This systematic review highlights the importance of understanding the complex interplay between HS, oxygen homeostasis, and atherosclerosis and suggests that targeting HS signaling pathways may offer new avenues for treating and preventing this condition. Oxygen homeostasis is a critical aspect of cardiovascular health, and disruption of this balance can contribute to the development and progression of atherosclerosis. Recent studies have demonstrated that HS plays an important role in maintaining oxygen homeostasis by regulating the function of oxygen-sensing enzymes and transcription factors in vascular cells. HS has been shown to modulate endothelial nitric oxide synthase (eNOS) activity, which plays a key role in regulating vascular tone and oxygen delivery to tissues. The comprehensive analysis of the current understanding of HS in atherosclerosis can pave the way for future research and the development of new therapeutic strategies for this debilitating condition. PROSPERO ID: 417150.
Topics: Humans; Hydrogen Sulfide; Atherosclerosis; Molecular Biology; Arteries; Homeostasis; Oxygen; Nitric Oxide
PubMed: 37176083
DOI: 10.3390/ijms24098376 -
Environmental Pollution (Barking, Essex... Jun 2024Phthalates may be associated with an increased risk of cardiometabolic diseases by interfering with glucose and lipid metabolism and by promoting adipogenesis. This... (Meta-Analysis)
Meta-Analysis Review
Phthalates may be associated with an increased risk of cardiometabolic diseases by interfering with glucose and lipid metabolism and by promoting adipogenesis. This study aimed to perform a systematic review and meta-analysis of the association between phthalate exposure and subclinical carotid atherosclerosis, using surrogate markers such as carotid intima-media thickness (IMT) and carotid plaques. The literature search was performed using four databases (Web of Science, Medline, PubMed, and Scopus), and this systematic review includes all available observational studies until July 6th, 2023. The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias. Meta-analyses were performed, and random effects models were used. Six high-quality cross-sectional studies and 2570 participants aged 12 to 70 were included. Six phthalate metabolites showed significant associations with subclinical carotid atherosclerosis. Exposure to MBzP, ΣDEHP, and MnBP was associated with increased carotid IMT. Exposure to MEP was associated with a higher prevalence of carotid plaques, and MiBP was associated with a lower prevalence. Mixed results were observed for MMP in older adults. The meta-analyses showed a high degree of heterogeneity, and the results are based on single studies. This study accurately describes the evidence of this association to date, suggesting that phthalates are associated with increased carotid IMT and a higher prevalence of carotid plaques. Further research is needed to elucidate this association, as phthalates are still used in the manufacture of everyday products, humans continue to be exposed to them, and atherosclerosis is a public health concern.
Topics: Humans; Phthalic Acids; Carotid Artery Diseases; Environmental Exposure; Carotid Intima-Media Thickness; Environmental Pollutants; Adult; Aged; Middle Aged; Child; Adolescent; Young Adult; Cross-Sectional Studies
PubMed: 38677462
DOI: 10.1016/j.envpol.2024.124044 -
Frontiers in Cardiovascular Medicine 2022Psoriasis and atherosclerosis have overlapping pathophysiological mechanisms. However, the association between psoriasis and coronary artery calcification (CAC), a...
BACKGROUND
Psoriasis and atherosclerosis have overlapping pathophysiological mechanisms. However, the association between psoriasis and coronary artery calcification (CAC), a hallmark of atherosclerosis and a predictor of poor cardiovascular prognosis, remains to be determined. We performed a systematic review and meta-analysis to comprehensively evaluate the association between these related inflammatory conditions.
METHODS
Observational studies evaluating the relationship between psoriasis and CAC were retrieved by searching PubMed, Cochrane's Library, and Embase databases. Presence of CAC was confirmed according to an Agatston's Score >0 upon computed tomography examination. A random-effect model incorporating between-study heterogeneity was used to pool the results.
RESULTS
Sixteen studies involving 3,039 patients with psoriasis and 46,191 controls without psoriasis were included in the meta-analysis. All participants were without previously known cardiovascular diseases. Pooled results showed that psoriasis was associated with overall CAC [odds ratio (OR): 1.54, 95% confidence interval: 1.23-1.91, 0.001; = 57%], after matching or adjusting the conventional cardiovascular risk factors. Subgroup analyses showed that study country, comorbidity of psoriatic arthritis, baseline Psoriasis Area and Severity Index, and duration of psoriasis ( for subgroup difference all >0.05) did not significantly affect the association of psoriasis and CAC. However, a stronger association was observed in younger patients (mean age <50 years, OR: 2.63, < 0.001) compared to older patients (≥50 years, OR: 1.24, = 0.02; for subgroup difference <0.001).
CONCLUSION
Psoriasis is associated with CAC, and the association may be stronger in younger patients.
PubMed: 36505373
DOI: 10.3389/fcvm.2022.1044117 -
Brain and Behavior Apr 2020To evaluate the relationship between atherosclerosis and Alzheimer's disease (AD), we conducted a systematic review and meta-analysis to study the difference of carotid... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To evaluate the relationship between atherosclerosis and Alzheimer's disease (AD), we conducted a systematic review and meta-analysis to study the difference of carotid intima-media thickness (CIMT) and the prevalence of atherosclerosis between AD patients and non-AD controls.
METHODS
The studies on the association between atherosclerosis and AD were manually searched in PubMed, Embase, Cochrane Library, and CNKI (China National Knowledge Infrastructure) spanned to September 2018 according to PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
RESULTS
Thirteen studies were included in the final analysis, seven studies with data on the mean CIMT (610 cases and 417 controls) and ten studies reporting on the prevalence of atherosclerosis (1,698 cases and 6,452 controls). Compared with controls, AD group showed a significantly higher CIMT (overall standard mean difference = 0.94; 95% CI, 0.48-1.40; p < .0001) and an increased prevalence of atherosclerosis (OR = 1.46; 95% CI, 1.26-1.68; p < .0001).
CONCLUSIONS
Atherosclerosis is significantly associated with AD. CIMT might be a useful marker to predict the risk of AD and assess the vascular burden. The finding is also important for possible prevention and treatment of AD in the future.
Topics: Alzheimer Disease; Atherosclerosis; Biomarkers; Carotid Intima-Media Thickness; China; Comorbidity; Humans; Prevalence; Risk Factors
PubMed: 32162494
DOI: 10.1002/brb3.1601 -
Cardiovascular Diabetology Dec 2022Apolipoprotein C1 (apoC1) is a small size apolipoprotein whose exact role is not totally clarified but which seems to modulate significantly the metabolism of... (Review)
Review
Apolipoprotein C1 (apoC1) is a small size apolipoprotein whose exact role is not totally clarified but which seems to modulate significantly the metabolism of lipoproteins. ApoC1 is involved in the metabolism of triglyceride-rich lipoproteins by inhibiting the binding of very low density lipoproteins (VLDL) to VLDL-receptor (VLDL-R), to low density lipoprotein receptor (LDL-R) and to LDL receptor related protein (LRP), by reducing the activity of lipoprotein lipase (LPL) and by stimulating VLDL production, all these effects leading to increase plasma triglycerides. ApoC1 takes also part in the metabolism of high density lipoproteins (HDL) by inhibiting Cholesterol Ester Transfer Protein (CETP). The functionality of apoC1 on CETP activity is impaired in diabetes that might account, at least in part, for the increased plasma CETP activity observed in patients with diabetes. Its different effects on lipoprotein metabolism with a possible role in the modulation of inflammation makes the net impact of apoC1 on cardiometabolic risk difficult to figure out and apoC1 might be considered as pro-atherogenic or anti-atherogenic depending on the overall metabolic context. Making the link between total plasma apoC1 levels and the risk of cardio-metabolic diseases is difficult due to the high exchangeability of this small protein whose biological effects might depend essentially on its association with VLDL or HDL. The role of apoC1 in humans is not entirely elucidated and further studies are needed to determine its precise role in lipid metabolism and its possible pleiotropic effects on inflammation and vascular wall biology. In this review, we will present data on apoC1 structure and distribution among lipoproteins, on the effects of apoC1 on VLDL metabolism and HDL metabolism and we will discuss the possible links between apoC1, atherosclerosis and diabetes.
Topics: Humans; Apolipoprotein C-I; Atherosclerosis; Cholesterol Ester Transfer Proteins; Diabetes Mellitus; Inflammation; Lipoproteins, HDL; Lipoproteins, VLDL; Triglycerides
PubMed: 36471375
DOI: 10.1186/s12933-022-01703-5 -
Annals of Palliative Medicine Jun 2021It was a meta-analysis on the efficacy of statins in the treatment of atherosclerosis. (Meta-Analysis)
Meta-Analysis
BACKGROUND
It was a meta-analysis on the efficacy of statins in the treatment of atherosclerosis.
METHODS
The PubMed, Medline, Embase, Web of Sciences, and other Chinese and English databases were used to retrieve literature on randomized controlled trials (RCTs) of statins in the treatment of atherosclerosis, published from January 2000 to January 2021. The Cochrane Handbook for Systematic Reviews of Intervention 5.0.2 was used to conduct bias risk assessment, and Review Manager 5.3 software (RevMan) was used for meta-analysis.
RESULTS
A total of 12 articles with 1,180 participants were included in the meta-analysis. In the observation group, the plaque area [mean difference (MD) =-1.21; 95% confidence interval (CI): -2.03 to -0.38; Z =2.87; P=0.004], total cholesterol (TC) level (MD =-0.72; 95% CI: -1.01 to -0.43; Z =4.83; P<0.00001), triglyceride (TG) level (MD =-0.43; 95% CI: -0.76 to -0.09; Z =2.51; P=0.01), and the low-density lipoprotein (LDL-C) level (MD =-0.79; 95% CI: -1.41 to -0.18; Z =2.54; P=0.01) were lower, while the clinical effective rate (MD =3.64; 95% CI: 1.39 to 9.53; Z =2.64; P=0.008) was higher, and the difference was notable. No notable difference was noted in intra-media thickness (IMT) (MD =-0.41; 95% CI: -0.88 to -0.06; Z =1.7; P=0.09), hypersensitive C-reactive protein (hs-CRP) level (MD =-1.61; 95% CI: -3.59 to 0.37; Z =1.7; P=0.09), and high-density lipoprotein (HDL-C) level (MD =0.14; 95% CI: -0.02 to 0.30; Z =2.54; P=0.09) between the 2 groups.
DISCUSSION
The use of statins in the treatment of atherosclerosis can reduce the levels of TC, TG, and LDL-C, mitigate clinical symptoms, and reduce blood lipids with good efficacy.
Topics: Atherosclerosis; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Lipoproteins, LDL; Randomized Controlled Trials as Topic
PubMed: 34237978
DOI: 10.21037/apm-21-1243