Summary Environmental exposures in low- and middle-income countries lie at the intersection of increased economic development and the rising public health burden of cardiovascular disease. Increasing evidence suggests an association of exposure to ambient air pollution, household air pollution from biomass fuel, lead, arsenic, and cadmium with multiple cardiovascular disease outcomes including hypertension, coronary heart disease, stroke, and cardiovascular mortality. While populations in low- and middle-income countries are disproportionately exposed to environmental pollution, the bulk of evidence that links these exposures to cardiovascular disease is derived from populations in high-income countries. More research is needed to further characterize the extent of environmental exposures and develop targeted interventions towards reducing cardiovascular disease in at-risk populations in low- and middle-income countries.

Introduction: Therapies for heart failure (HF) in the United States have been approved to decrease hospitalizations and mortality rather than to make patients feel better. Patients considering possible benefits of a new therapy may express different preferences for feeling well versus living longer. Methods: During collection of patient-reported outcomes at HF clinic visits, patients described along a five-point scale the benefits they would want from an additional HF therapy in relation to feeling well or living longer. They were also asked if their quality of life (QOL) was limited mostly by HF, equally by HF and other medical problems, or mostly by other medical or non-medical problems. Pairwise comparisons were made between patients in 3 groups defined by those who valued living longer in preference to feeling well, those who regarded those benefits equally, and those who valued feeling well over living longer. Results: Between 7/2019-3/2021, responses during HF clinic visit at an academic center were provided by 1,876 patients. When asked what benefit they would want from a new treatment, 12% valued longevity over feeling well, 69% equally valued feeling well and living long, and 19% valued feeling well over living longer (Figure). Patients placing higher value on living longer were more likely to be younger and more likely to be African-American (both p< 0.001). A majority of patients perceived that their QOL was limited as much or more by other medical or non-medical factors as by their HF. Conclusions: For an additional therapy, contemporary outpatients with HF express preference at least as often for benefit to feel well as to live longer, with the majority of patients ranking them as equal. As new treatments for HF are developed and approved, increasing emphasis is warranted on investigating their impacts on how patients feel.

No abstract

Mitochondria typically move non‐randomly due to attachment to cytoskeletal components. We investigated whether variation in ambient salinity affects mitochondrial movement in coelomocytes (nucleated “blood cells”) from the estuarine annelid Glycera dibranchiata using high‐resolution fluorescence video microscopy of live coelomocytes labeled with MitoTracker Green FM. Cells were exposed to normal seawater (1000 mOsm/L) or seawater diluted to 750, 500 and 250 mOsm/L (all with 10 mM HEPES and 0.1% glucose). Cell area and mitochondrial motion were analyzed in 100 cells and 400 mitochondria in a split plot, fully nested design (5 mitochondria x 5 cells x 4 worms x 4 dilutions). Surprisingly, mitochondrial movement at 1000 mOsm/L was continuous and random, characteristic of Brownian motion. Decreasing osmolarity proportionally increased the cell volume (P<0.001), as expected, but also increased the length of each mitochondrial track (P<0.0001) and the average total displacement (P<0.001), with mitochondrial movement at 250 mOsm/L being 2.8‐fold greater than at 1000 mOsm/L. Furthermore, the change in the mitochondrial diffusion coefficient was 3‐fold greater than that predicted by the direct effect of salinity on water viscosity. We propose that changes in the composition of intracellular organic osmolytes associated with salinity adaptation substantially affect the motion of these organelles.

Background: In the non-transplant population, hyperlipidaemia has shifted from targeting LDL goals to statin intensity-based treatment. It is unknown whether this strategy is also beneficial in cardiac transplantation. Methods: This single-centre retrospective study evaluated the effect of statin use and intensity on time to cardiac allograft vasculopathy (CAV) after cardiac transplantation. Kaplan–Meier and Cox proportional hazards regression survival methods were used to assess the association of statin intensity and median post-transplant LDL on CAV-free survival. Results: The study involved 143 adults (71% men, average follow-up of 25 ± 14 months) who underwent transplant between 2013 and 2017. Mean CAV-free survival was 47.5 months (95% CI [43.1–51.8]), with 29 patients having CAV grade 1 or greater. Median LDL was not associated with time to CAV (p=0.790). CAV-free survival did not differ between intensity groups (p=0.435). Conclusion: Given the non-statistically significant difference in time to CAV with higher intensity statins, the data suggest that advancing moderate- or high-intensity statin after cardiac transplantation may not provide additional long-term clinical benefit. Trial registration: Not applicable.