Citations

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia detected in hospitalized patients. It is independently associated with an increased risk of stroke. Anti-fibrotic properties of mineralocorticoid receptor antagonists (MRA) have been proposed to modulate AF burden. Gender differences in patients with AF exist within the epidemiology and causative mechanisms to outcomes and complications. We compared men and women with known AF while treated with MRA to assess potential differences in stroke rate. Method: After IRB approval, we performed a retrospective chart review of all patients with confirmed HF and AF diagnoses. Patient data were extracted from electronic medical records. Patients with AF and HF treated with MRA were included in this study. Results: 64 patients with HF and AF treated with MRA were reviewed between January 2021 and September 2022. 34 were male, and 30 were female. Females were younger, 66 years (57 -74) compared to males, 73 years (60 - 78), p=.13. The median ejection fraction was similar among women, 42% (31 - 50) compared to men, 41% (33 - 49), p = .43. A significantly higher incidence of atrial fibrillation was found in our male group (59%) compared to the female group (30%), p=.02. There was no significant difference in MRA or anticoagulation use between male and female patients (p = .11, p = .12 respectively). More men had strokes compared to females (16% vs. 26% p = .17). Men were also more likely to be hypertensive compared to females (47% vs. 25%, p<.01). Conclusion: Men were more likely to have AF and stroke compared to females with HF on MRA therapy. Males were more likely to be hypertensive, which may relate to increased stroke rate in this patient population. Increased awareness of the gender-based prevalence of stroke rate in patients with HF and AF may allow for earlier recognition and reduction in stroke events.

Perivascular adipose tissue (PVAT) has emerged as a regulator of blood pressure by releasing anticontractile factors, which may be disrupted in disease. The production of adipocyte anticontractile factors is driven by norepinephrine (NE), a sympathetic neurotransmitter; however, the source of NE remains unknown. Here, we tested the hypothesis that neuronal innervation of PVAT stimulates adipocytes via NE. Mesenteric (mPVAT), aortic (aPVAT), and subcutaneous fat (sc) depots were studied in healthy male and female mice aged 8-12 weeks. Immunostaining with neuronal and vasculature markers was performed to assess anatomical evidence of neural innervation (n=3 region/sex). Adipocyte activity was studied in Adiponectin Cre;GCaMP 5g-tdT mice, which express the calcium indicator GCaMP5g in adipocytes (125-350 cells/group). Adipocytes were challenged with NE, a parasympathomimetic (bethanechol, 10uM, bath application), and nerve fibers were activated by electrical field stimulation (EFS; +100V, 0.1ms, 10 Hz). Immunolabeling data show that nerve fibers run adjacent to the larger blood vessels within adipose tissue, rather than radiating throughout. Stimulation with NE induced large responses (female: 0.91±0.73, 1.15±0.73, 1.45±0.9 dF/F 0 ; male: 0.75±0.57, 1.01±0.78, 0.73±0.53 dF/F 0 in aPVAT, mPVAT, sc, respectively). Both the parasympathomimetic and EFS induced minimal adipocyte responses compared to NE (% NE = [dF/F 0 bethanechol or EFS / dF/F 0 NE]*100%; bethanechol - female: 39.5%, 13.9%, 9.7%, male: 24.0%, 14.6%, 15.1% in aPVAT, mPVAT, sc, respectively; EFS - female: 31%, 12.2%, 9.7%, male: 28%, 13.9%, 13.7% in aPVAT, mPVAT, sc, respectively). These findings suggest that neural innervation within the PVAT, and functional regulation of adipocytes, is limited. Nerve fibers present within the PVAT are not the primary source of NE driving adipocyte production of anticontractile factors in the PVAT. Rather, this NE originates from other mechanisms including local production by non-neuronal cells or circulation of neurotransmitters.

Opportunities exist to promote inclusive cancer care and clinical research to reduce disparity and achieve health equity. Through raising awareness of the nuances of the clinical encounter to promote inclusivity as well as reducing barriers to access and enrollment in clinical trials, a more complete understanding regarding the spectrum of disease and opportunity for inclusive cancer care can be achieved.

Nonalcoholic fatty liver disease (NAFLD) represents a significant health threat worldwide. The aging population and a rise in metabolic syndrome in Asia might influence the epidemiology of NAFLD among the elderly. However, there is a lack of understanding of the burden and recommendations for NAFLD in this group. Our study sought to investigate the trends in the NAFLD burden among the elderly in the Asia-Pacific region. We employed data from the Global Burden of Disease 2019 study for an in-depth analysis of the prevalence and disability-adjusted life years (DALYs) along with age-standardized rate (ASR) associated with NAFLD in elderly populations (age 65–89 years) across the Asia-Pacific region, including the Southeast Asia (SEA) and Western Pacific (WP) regions, from 2010 to 2019. This study also examined the trends and disparities in NAFLD burden across different nations and sexes. In 2019, there were over 120 million cases of NAFLD in the elderly in the Asia-Pacific region. The ASR of prevalence was higher in SEA compared to WP (36,995.37 vs. 32,821.78 per 100,000). ASR of prevalence increased with annual percentage change (APC) +0.95% in the WP while it increased by +0.87% in SEA. During the study period, the ASR of DALYs decreased in SEA (APC −0.41%) but remained stable in the WP region. The burden of NAFLD in the elderly population in Asia-Pacific has increased, underscoring the timely intervention to tackle this high and rising burden.