Diabetes Mellitus (DM) is an inflammatory clinical entity with different mechanisms involved in its physiopathology. Among these, the dysfunction of the gut microbiota stands out. Currently, it is understood that lipid products derived from the gut microbiota are capable of interacting with cells from the immune system and have an immunomodulatory effect. In the presence of dysbiosis, the concentration of lipopolysaccharides (LPS) increases, favoring damage to the intestinal barrier. Furthermore, a pro-inflammatory environment prevails, and a state of insulin resistance and hyperglycemia is present. Conversely, during eubiosis, the production of short-chain fatty acids (SCFA) is fundamental for the maintenance of the integrity of the intestinal barrier as well as for immunogenic tolerance and appetite/satiety perception, leading to a protective effect. Additionally, it has been demonstrated that alterations or dysregulation of the gut microbiota can be reversed by modifying the eating habits of the patients or with the administration of prebiotics, probiotics, and symbiotics. Similarly, different studies have demonstrated that drugs like Metformin are capable of modifying the composition of the gut microbiota, promoting changes in the biosynthesis of LPS, and the metabolism of SCFA.

To determine the incidence of major adverse cardiovascular events (MACE) and identify long-term clinical predictors in patients with carotid artery disease following carotid endarterectomy (CEA). We prospectively enrolled patients from the Mayo Clinic Carotid Artery Atherosclerosis Trial (MCAT) cohort, who underwent CEA between February 13, 2002, and July 17, 2023. MACE was defined as cardiac events, cerebrovascular accidents (CVA), and all-cause mortality after CEA. Two prespecified models for multivariable and covariate analyses were used to identify clinical predictors of MACE and its individual components. Among 710 patients (median age 72.0 [66.0-78.0] years; 465 (65.5%) males), MACE occurred in 442 (62.3%) over a median follow-up of 7.1 [2.9-11.9] years post-CEA. In both multivariable models, age (HR 1.02 [95% CI 1.01-1.04], P=.002; HR 1.03 [95% CI 1.02-1.04], P<.001) and history of cardiac events (HR 1.48 [95% CI 1.17-1.87], P=.001; HR 1.56 [95% CI 1.28-1.89], P<.001) were independently associated with MACE and all-cause mortality (age: HR 1.08 [95%CI 1.05 - 1.10]; P<.001; HR 1.07 [95%CI 1.05 - 1.08]; P<.001, respectively; history of cardiac events: HR 1.48 [95%CI 1.13 - 1.94]; P=.005; HR 1.58 [95%CI 1.27 - 1.97]; P<.001, respectively). Long-term survival of our cohort was significantly lower than in the general population (p<0.001). Traditional clinical risk factors showed limited ability to explain the high incidence of MACE following CEA in patients with carotid artery disease. Novel approaches to patient profiling may improve risk assessment and guide targeted secondary prevention in this population.

Background and Objectives: Coronavirus disease 2019 (COVID-19) caused several cardiovascular complications, including acute myocardial infarction (AMI), in infected patients. This study aims to understand the overall trends of AMI among COVID-19 patients during the first two years of the pandemic and the disparities and outcomes between the first and second years. Materials and Methods: The retrospective analysis was conducted via the 2020 and 2021 National Inpatient Sample (NIS) database for hospitalizations between April 2020 and December 2021 being analyzed for adults with a primary diagnosis of COVID-19 who experienced events of AMI. A comparison of month-to-month events of AMI and mortality of AMI patients with concomitant COVID-19 was made alongside their respective patient characteristics. Results: Out of 2,541,992 COVID-19 hospitalized patients, 3.55% experienced AMI. The highest rate of AMI was in December 2021 (4.35%). No statistical differences in trends of AMI mortality were noted over the 21 months. AMI cases in 2021 had higher odds of undergoing PCI (aOR 1.627, p < 0.01). They experienced higher risks of acute kidney injury (aOR 1.078, p < 0.01), acute ischemic stroke (aOR 1.215, p < 0.01), cardiac arrest (aOR 1.106, p < 0.01), need for mechanical ventilation (aOR 1.133, p < 0.01), and all-cause mortality (aOR 1.032, 95% CI 1.001–1.064, p = 0.043). Conclusions: The incidence of AMI among COVID-19 patients fluctuated over the 21 months of this study, with a peak in December 2021. COVID-19 patients reporting AMI in 2021 experienced higher overall odds of multiple complications, which could relate to the exhaustive burden of the pandemic in 2021 on healthcare, the changing impact of the virus variants, and the hesitancy of infected patients to seek care.

Background: Coronavirus disease 2019 (COVID-19) caused several cardiovascular complications, including acute myocardial infarction(AMI) in infected patients. Our study aims to understand the overall trends of AMI among COVID-19 patients during the first two years of the pandemic and the disparities and outcomes between the first and second years. Methods: Our retrospective analysis via the 2020 and 2021 National Inpatient Sample(NIS) for hospitalizations between April 2020 and December 2021 analyzed adults with a primary diagnosis of COVID-19 who experienced events of AMI. We compared month-to-month events of AMI and mortality of AMI patients with COVID-19, patient characteristics, and outcomes between the 2020 and 2021 AMI samples. Results: There were 2,541,992 COVID-19 patients, with 3.55% experiencing AMI. The highest rate of AMI was in December 2021 (4.35%). No statistical differences in trends of AMI mortality were noted over the 21 months. AMI cases in 2021 had higher odds of undergoing PCI (aOR 1.627, p