The aim of this systematic review was to assess dysregulated miRNA biomarkers in coronary artery disease (CAD). Dysregulated microRNA (miRNAs) have been shown to be linked to cardiovascular pathologies including CAD and may have utility as diagnostic and prognostic biomarkers. We compared miRNAs identified in acute coronary syndrome (ACS) compared with stable CAD and control populations. We conducted a systematic search of controlled vocabulary and free text terms related to ACS, stable CAD and miRNA in Biosis Previews (OvidSP), The Cochrane Library (Wiley), Embase (OvidSP), Global Health (OvidSP), Medline (PubMed and OvidSP), Web of Science (Clarivate Analytics), and ClinicalTrials.gov which yielded 7370 articles. Of these, 140 original articles were appropriate for data extraction. The most frequently reported miRNAs in any CAD (miR-1, miR-133a, miR-208a/b, and miR-499) are expressed abundantly in the heart and play crucial roles in cardiac physiology. In studies comparing ACS cases with stable CAD patients, miR-21, miR-208a/b, miR-133a/b, miR-30 family, miR-19, and miR-20 were most frequently reported to be dysregulated in ACS. While a number of miRNAs feature consistently across studies in their expression in both ACS and stable CAD, when compared with controls, certain miRNAs were reported as biomarkers specifically in ACS (miR-499, miR-1, miR-133a/b, and miR-208a/b) and stable CAD (miR-215, miR-487a, and miR-502). Thus, miR-21, miR-133, and miR-499 appear to have the most potential as biomarkers to differentiate the diagnosis of ACS from stable CAD, especially miR-499 which showed a correlation between the level of their concentration gradient and myocardial damage. Although these miRNAs are potential diagnostic biomarkers, these findings should be interpreted with caution as the majority of studies conducted predefined candidate-driven assessments of a limited number of miRNAs (PROSPERO registration: CRD42017079744).

Background Randomized controlled trials showed that newer glucose‐lowering agents are cardioprotective, but most participants were men. It is unknown whether benefits are similar in women. Methods and Results Among adults with type 2 diabetes mellitus not controlled with metformin with no prior use of insulin, we assessed for sex differences in the cardiovascular effectiveness and safety of sodium‐glucose‐like transport‐2 inhibitors ( SGLT ‐2i), glucagon‐like peptide‐1 receptor agonists ( GLP ‐1 RA ), dipeptidyl peptidase‐4 inhibitors, initiated as second‐line agents relative to sulfonylureas (reference‐group). We studied type 2 diabetes mellitus American adults with newly dispensed sulfonylureas, SGLT ‐2i, GLP ‐1 RA , or dipeptidyl peptidase‐4 inhibitors (Marketscan‐Database: 2011–2017). We used multivariable Cox proportional hazards models with time‐varying exposure to compare time to first nonfatal cardiovascular event (myocardial infarction/unstable angina, stroke, and heart failure), and safety outcomes between drugs users, and tested for sex–drug interactions. Among 167 254 type 2 diabetes mellitus metformin users (46% women, median age 59 years, at low cardiovascular risk), during a median 4.5‐year follow‐up, cardiovascular events incidence was lower in women than men (14.7 versus 16.7 per 1000‐person‐year). Compared with sulfonylureas, hazard ratios ( HR s) for cardiovascular events were lower with GLP ‐1 RA (adjusted HR ‐women: 0.57, 95% CI : 0.48–0.68; aHR ‐men: 0.82, 0.71–0.95), dipeptidyl peptidase‐4 inhibitors ( aHR ‐women: 0.83, 0.77–0.89; aHR ‐men: 0.85, 0.79–0.91) and SGLT ‐2i ( aHR ‐women: 0.58, 0.46–0.74; aHR ‐men: 0.69, 0.57–0.83). A sex‐by‐drug interaction was statistically significant only for GLP ‐1 RA ( P =0.002), suggesting greater cardiovascular effectiveness in women. Compared with sulfonylureas, risks of adverse events were similarly lower in both sexes for GLP ‐1 RA ( aHR ‐women: 0.81, 0.73–0.89; aHR ‐men: 0.80, 0.71–0.89), dipeptidyl peptidase‐4 inhibitors ( aHR ‐women: 0.82, 0.78–0.87; aHR ‐men: 0.83, 0.78–0.87) and SGLT ‐2i ( aHR ‐women: 0.68, 0.59–0.78; aHR ‐men: 0.67, 0.59–0.78) (all sex–drug interactions for adverse events P >0.05). Conclusions Newer glucose‐lowering drugs were associated with lower risk of cardiovascular events than sulfonylureas, with greater effectiveness of GLP ‐1 RA in women than men. Overall, they appeared safe, with a better safety profile for SGLT ‐2i than for GLP ‐1 RA regardless of sex.

What ' s known on the subject? and What does the study add? ADIPOSE tissue secretes various endocrine and paracrine mediators. Some authors have begun to consider whether peri-prostatic fat (PPF) may interact with the prostate and play a role in carcinogenesis. It has recently been shown that the PPF quantity measured by CT is associated with more aggressive disease in patients undergoing radiation therapy.Our group studied a population not yet diagnosed with prostate cancer. By doing so we were able to identify PPF thickness on transrectal ultrasonography as a risk factor for prostate cancer detection upon biopsy, and as a risk factor for high-grade disease. Our study also raises interesting questions about the underlying mechanisms of the association between PPF quantity and prostate cancer. Study Type -Prognosis (cohort) Level of Evidence 2b OBJECTIVE• To determine if the amount of periprostatic fat (PPF) on transrectal ultrasonography (TRUS) is a risk factor for incident prostate cancer overall and high-grade prostate cancer (Gleason ≥ 4). PATIENTS AND METHODS• A prospectively maintained database of patients undergoing prostate biopsy at Princess Margaret Hospital for cancer suspicion was used.• All TRUS examinations were retrospectively reviewed upon ' blinding ' to outcome.• PPF thickness, measured as the distance between the prostate and the pubic bone, was used as an index of the quantity of PPF.• PPF measurements, together with other prostate cancer risk factors, were evaluated against prostate cancer and high-grade prostate cancer detection upon biopsy with univariable and multivariable logistic regression and area under the receiver operating characteristic curve (AUC) analysis. RESULTS• Of the 931 patients, 434 (47%) were diagnosed with prostate cancer and 218 (23%) were diagnosed with high-grade prostate cancer.• The mean (range) PPF thickness was 5.3 (0 -15) mm.• Increasing PPF thickness was associated with prostate cancer and high-grade prostate cancer diagnosis, with graded effect. When adjusting for other variables, the odds of detecting any prostate cancer and high-grade prostate cancer increased 12% (odds ratio [ OR ] 1.12, 95% confi dence interval [ CI ] 1.02 -1.23) and 20% (OR 1.20, 95% CI 1.07 -1.34), respectively, for each millimetre increase in PPF thickness.• The AUCs for the association of PPF with prostate cancer and high-grade prostate cancer were 0.58 (95% CI 0.54 -0.62) and 0.59 (95% CI 0.55 -0.64), respectively. CONCLUSION• The amount of PPF can be estimated with TRUS and is a predictor of prostate cancer and high-grade prostate cancer at biopsy. To our knowledge, this study is the fi rst to investigate PPF quantity in patients without prior prostate cancer diagnosis. KEYWORDSperi-prostatic fat , prostate cancer , transrectal ultrasonography (TRUS)

No abstract

Although preeclampsia is associated with subjective cognitive symptoms, our systematic review did not demonstrate clear evidence of impairment on standard neurocognitive tests. There is a paucity of high-quality studies assessing cognitive outcomes after preeclampsia.

No abstract

Preeclampsia increases a woman’s risk of stroke and leads to short-term cognitive complaints. Our objective was to assess the impact of preeclampsia on long-term cognitive performance. This is a retrospective cohort study using data from the Coronary Artery Risk Development in Young Adults cohort of healthy individuals (18–30 years) recruited from the general population in 3 cities in the United States, followed for 25 years (1985–2010). Psychomotor speed (Digit Symbol Substitution Test), executive function (Stroop Test), and memory (Rey Auditory Verbal Learning Test) were contrasted between women with and without preeclampsia using multivariate linear regression. We included 568 parous women (193 with preeclampsia and 375 with normotensive pregnancy) without baseline neurological disease or depression matched according to delivery period. Approximately 18 years after delivery, preeclamptic women scored significantly lower on Digit Symbol Substitution Test than women with normotensive pregnancy (73.21±14.79 versus 75.87±15.22; P =0.047) and on the third trial of Stroop Test (correct answers: 38.85±3.62 versus 39.42±1.87; P =0.014; completion time: 44.02±10.48 versus 41.62±10.61 seconds; P =0.01), but there were no differences in Rey Auditory Verbal Learning Test. These differences were attenuated after adjustment for age, body mass index, hypertension, education, and depression. Similar differences in neurocognitive scores were noted between women with other hypertensive disorders of pregnancy and normotensive pregnancy. Hypertension in pregnancy does not seem to be independently associated with neurocognitive impairment later in life.

Aim To investigate the ability of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS‐HFDM) to stratify patients with type 2 diabetes mellitus (T2DM) and high cardiovascular risk for heart failure (HF) hospitalization. Materials and Methods We used data from the control group of the Action to Control Cardiovascular Risk in Diabetes Study Group (ACCORD) trial (n = 5123; mean follow‐up 4.8 years). The TRS‐HFDM includes: prior HF (2 points), atrial fibrillation (1 point), coronary artery disease (1 point), estimated glomerular filtration rate <60 mL/min/1.73 m2 (1 point), and urine albumin‐to‐creatinine ratio (>300 mg/g: 2 points; 30–300 mg/g: 1 point). We evaluated the discrimination (Harrell's C‐index) and calibration (Nam‐D'Agostino calibration statistic) of the TRS‐HFDM with regard to time to HF hospitalization or death due to HF. Results The mean age of the participants was 62.8 ± 6.6 years, and 38% were women. The prevalences of TRS‐HFDM 0, 1, 2, 3 and ≥4 were 42.1%, 34.9%, 14.6%, 6.0% and 2.5%, respectively. Increasing TRS‐HFDM corresponded to an increasing HF risk: 1.3 per 1000 person‐years for a TRS‐HFDM of 0 to 64.7 per 1000 person‐years for TRS‐HFDM of ≥4. The TRS‐HFDM demonstrated robust discrimination of HF outcomes (C‐index 0.78). Furthermore, the score was well calibrated for HF outcomes (calibration statistic P = 0.13). Similar results were seen in participants without baseline HF (C‐index 0.75). Conclusion The TRS‐HFDM discriminates HF‐specific risk among people with T2DM. The use of TRS‐HFDM to identify those who would maximally benefit from therapies that reduce HF risk warrants evaluation.