Abstract
Aims
Despite the effects of statins in reducing cardiovascular events and slowing progression of coronary atherosclerosis, significant cardiovascular (CV) risk remains. Icosapent ethyl ...(IPE), a highly purified eicosapentaenoic acid ethyl ester, added to a statin was shown to reduce initial CV events by 25% and total CV events by 32% in the REDUCE-IT trial, with the mechanisms of benefit not yet fully explained. The EVAPORATE trial sought to determine whether IPE 4 g/day, as an adjunct to diet and statin therapy, would result in a greater change from baseline in plaque volume, measured by serial multidetector computed tomography (MDCT), than placebo in statin-treated patients.
Methods and results
A total of 80 patients were enrolled in this randomized, double-blind, placebo-controlled trial. Patients had to have coronary atherosclerosis as documented by MDCT (one or more angiographic stenoses with ≥20% narrowing), be on statin therapy, and have persistently elevated triglyceride (TG) levels. Patients underwent an interim scan at 9 months and a final scan at 18 months with coronary computed tomographic angiography. The pre-specified primary endpoint was change in low-attenuation plaque (LAP) volume at 18 months between IPE and placebo groups. Baseline demographics, vitals, and laboratory results were not significantly different between the IPE and placebo groups; the median TG level was 259.1 ± 78.1 mg/dL. There was a significant reduction in the primary endpoint as IPE reduced LAP plaque volume by 17%, while in the placebo group LAP plaque volume more than doubled (+109%) (P = 0.0061). There were significant differences in rates of progression between IPE and placebo at study end involving other plaque volumes including fibrous, and fibrofatty (FF) plaque volumes which regressed in the IPE group and progressed in the placebo group (P < 0.01 for all). When further adjusted for age, sex, diabetes status, hypertension, and baseline TG, plaque volume changes between groups remained significantly different, P < 0.01. Only dense calcium did not show a significant difference between groups in multivariable modelling (P = 0.053).
Conclusions
Icosapent ethyl demonstrated significant regression of LAP volume on MDCT compared with placebo over 18 months. EVAPORATE provides important mechanistic data on plaque characteristics that may have relevance to the REDUCE-IT results and clinical use of IPE.
We introduce a simple, low-cost, and environment friendly method to obtain high-fluorescence carbon dots and activated carbon via a one-step hydrothermal process using banana peels. The dispersion of ...carbon dots generated strong, bright-blue photoluminescence (average diameter 3–6 nm), which could be further used in biosensing, electronics, and catalysis applications research. Moreover, the precipitation accumulated at the bottom of the hydrothermal process contained activated carbon with a highly porous structure and large specific surface area (294.6 m
2
g
−1
), which could be used as a supercapacitor electrode. The three-electrode cell exhibited excellent capability and stability of the activated carbon as the working electrode in various aqueous electrolytes, with a high specific capacitance (199 F g
−1
) in an aqueous electrolyte (1-M KOH) and a high energy density of 54.15 Wh kg
−1
at a current density of 0.5 A g
−1
. Thus, based on the excellent characteristics of the carbon dots and the strong electrochemical properties of the activated carbon as an electrode material, the banana peels, as an abundant bioresource, can provide two excellent produces.
Electrical double-layer capacitors (EDLCs) using a biomass-derived activated carbon electrode with Na
2
SO
4
–NaI–KI as a redox additive electrolyte were investigated. Biomass-derived activated ...carbon materials from pomelo peels were prepared by chemical activation in potassium hydroxide followed by carbonization. The biomass-derived activated carbon has a high specific surface area of 1360 m
2
g
−1
, which is suitable for electrode materials. Moreover, a stable couple inorganic redox additive electrolyte were studied by the addition of NaI and KI to Na
2
SO
4
forming a redox additive electrolyte. The electrical double-layer based on activated carbon/Na
2
SO
4
–NaI–KI/activated carbon has an excellent specific capacitance (334.3 F g
−1
), which is 412% higher in comparison with that of activated carbon/Na
2
SO
4
/activated carbon (81.14 F g
−1
) at the same current density of 0.5 A g
−1
. The EDLC using Na
2
SO
4
–NaI–KI electrolyte has a high energy density of 22.75 W h kg
−1
, which is approximately four times higher than EDLCs based on Na
2
SO
4
(5.52 W h kg
−1
).
Difficulties in the production of lignin from rice straw because of high silica content in the recovered lignin reduce its recovery yield and applications as bio-fuel and aromatic chemicals. ...Therefore, the objective of this study is to develop a novel method to reduce the silica content in lignin from rice straw more effectively and selectively. The method is established by monitoring the precipitation behavior as well as the chemical structure of precipitate by single-stage acidification at different pH values of black liquor collected from the alkaline treatment of rice straw. The result illustrates the significant influence of pH on the physical and chemical properties of the precipitate and the supernatant. The simple two-step acidification of the black liquor at pilot-scale by sulfuric acid 20w/v% is applied to recover lignin at pH 9 and pH 3 and gives a percentage of silica removal as high as 94.38%. Following the developed process, the high-quality lignin could be produced from abundant rice straw at the industrial-scale.
Abstract
Aims
Though statin therapy is known to slow coronary atherosclerosis progression and reduce cardiovascular (CV) events, significant CV risk still remains. In the REDUCE-IT study, icosapent ...ethyl (IPE) added to statin therapy reduced initial CV events by 25% and total CV events by 30%, but its effects on coronary atherosclerosis progression have not yet been fully investigated. Therefore, this study is to determine whether IPE 4 g/day will result in a greater change from baseline in plaque volume measured by serial multidetector computed tomography than placebo in statin-treated patients.
Methods and results
EVAPORATE is a randomized, double-blind, placebo-controlled trial. Patients had to have coronary atherosclerosis by coronary computed tomographic angiography (CCTA) (≥1 angiographic stenoses with ≥20% narrowing), on stable statin therapy with low-density lipoprotein cholesterol levels 40–115 mg/dL, and persistently high triglyceride levels (135–499 mg/dL). Patients underwent an interim scan at 9 months and were followed for an additional 9 months with CCTA at 0, 9, and 18 months. Here, we present the protocol-specified interim efficacy results. A total of 80 patients were enrolled, with 67 completing the 9-month visit and having interpretable CCTA at baseline and at 9 months (age = 57 ± 6 years, male = 36, 63%). At the 9-month interim analysis, there was no significant change in low attenuation plaque (LAP) between active and placebo groups (74% vs. 94%, P = 0.469). However, there was slowing of total non-calcified plaque (sum of LAP, fibrofatty, and fibrous plaque) (35% vs. 43%, P = 0.010), total plaque (non-calcified + calcified plaque) (15% vs. 26%, P = 0.0004), fibrous plaque (17% vs. 40%, P = 0.011), and calcified plaque (−1% vs. 9%, P = 0.001), after adjustment by baseline plaque, age, sex, diabetes, baseline triglyceride levels, and statin use.
Conclusion
EVAPORATE is the first study using CCTA to evaluate the effects of IPE as an adjunct to statin therapy on atherosclerotic plaque characteristics in a high-risk CV population with persistently high triglyceride levels. It provides important mechanistic data in regards to the reduction in CV events in the REDUCE-IT clinical trial.
ClinicalTrials. govIdentifier
NCT029226027.
Black Soldier Fly (BSF) is a novel option to convert organic waste into high economic products such as protein, lipid, and chitin. Due to the drawbacks of petrochemical-based plastic, the ...biodegradable film has attracted much attention; among these, chitin-based packaging film is a promising material. This study extracted the chitin from BSF using a co-solvent of glycerol and hydrochloric acid (HCl). The chitin nanofiber has a dimension of 34 nm in width and 494 in length following Transmission Electron Microscopy analysis (TEM). Besides, the obtained chitin was also added to the gelatin-based film for packaging application. The chitin/gelation packaging was evaluated for its suitability in food application by testing its antioxidant activity, thickness, grammage, opacity, moisture, and water solubility. The film developed with more than 0.5 wt.% chitin and nanochitin showed high antioxidant activity, while adding chitin does not significantly change the thermal stability of the gelatin films. The chemical structure of chitin and bio-packaging was determined by Fourier Transform Infrared (FTIR), X-Ray Diffraction (XRD), and Thermogravimetric Analysis (TGA). This study provides a green and facile approach for chitin production from BSF by using co-solvent and reveals the potential of insect chitin in creating active bio-packaging.
Graphical Abstract
Should social media be constructed as a Trojan horse (as its detractors fear) or the Flame of Prometheus (as its proponents argue)? Social media take-up in Vietnam arouses both hope and scepticism, ...and becomes an innovative tool for critical matters. This article examines the blogosphere in Vietnam through a comparative study of the Vietnamese blogosphere and state media. The research found that while state media operate as a voice of the agents of the state, social media provide a means to capture the voice of the community and to participate in public discussion through commentary to posts, as well as a platform for those who want to speak out. As a result, there is a tension between the reporting of general information and the voice of state agencies in state media. The 'two stories' that emerge in some political and social issues are told through different approaches and perspectives.
Despite reducing progression and promoting regression of coronary atherosclerosis, statin therapy does not fully address residual cardiovascular (CV) risk. High‐purity eicosapentaenoic acid (EPA) ...added to a statin has been shown to reduce CV events and induce regression of coronary atherosclerosis in imaging studies; however, data are from Japanese populations without high triglyceride (TG) levels and baseline EPA serum levels greater than those in North American populations. Icosapent ethyl is a high‐purity prescription EPA ethyl ester approved at 4 g/d as an adjunct to diet to reduce TG levels in adults with TG levels >499 mg/dL. The objective of the randomized, double‐blind, placebo‐controlled EVAPORATE study is to evaluate the effects of icosapent ethyl 4 g/d on atherosclerotic plaque in a North American population of statin‐treated patients with coronary atherosclerosis, TG levels of 200 to 499 mg/dL, and low‐density lipoprotein cholesterol levels of 40 to 115 mg/dL. The primary endpoint is change in low‐attenuation plaque volume measured by multidetector computed tomography angiography. Secondary endpoints include incident plaque rates; quantitative changes in different plaque types and morphology; changes in markers of inflammation, lipids, and lipoproteins; and the relationship between these changes and plaque burden and/or plaque vulnerability. Approximately 80 patients will be followed for 9 to 18 months. The clinical implications of icosapent ethyl 4 g/d treatment added to statin therapy on CV endpoints are being evaluated in the large CV outcomes study REDUCE‐IT. EVAPORATE will provide important imaging‐derived data that may add relevance to the clinically derived outcomes from REDUCE‐IT.
Intermittent fasting (IF) has been connected with health benefits such as weight loss, lower risk of coronary artery disease (CAD) and diabetes, increased longevity, and improved quality of life. ...However, the mechanisms of these IF benefits in humans require further investigation. This study sought to elucidate some of these mechanisms through secondary analyses of the Fasting and ExprEssion of Longevity Genes during fOOD abstinence (FEELGOOD) trial, in which apparently healthy participants were randomized in a Latin square design to a 24-h water-only fast and a 24-h ad libitum fed day. Two pathways were investigated, with trimethylamine
-oxide (TMAO) levels measured due to their association with elevated risk of CAD, along with conductance of a broad panel of metabolic analytes. Measurements were made at baseline, at the end of the fasting day, and at the end of the fed day. A fasting mean of 14.3 ng in TMAO was found versus the baseline mean of 27.1 ng with
= 0.019, although TMAO levels returned to baseline on refeeding. Further, acute alterations in levels of proline, tyrosine, galactitol, and urea plasma levels were observed along with changes in 24 other metabolites during the fasting period. These acute changes reveal short-term mechanisms which, with consistent repeated episodes of IF, may lead to improved health and reduced risk of CAD and diabetes.
Medication adherence is generally low and challenging to address because patient actions control healthcare delivery outside of medical environments. Behavioral nudging changes clinician behavior, ...but nudging patient decision-making requires further testing. This trial evaluated whether behavioral nudges can increase statin adherence, measured as the proportion of days covered (PDC).
In a 12-month parallel-group, unblinded, randomized controlled trial, adult patients in Intermountain Healthcare cardiology clinics were enrolled. Inclusion required an indication for statins and membership in SelectHealth insurance. Subjects were randomized 1:1 to control or nudges. Nudge content, timing, frequency, and delivery route were personalized by CareCentra using machine learning of subject motivations and abilities from psychographic assessment, demographics, social determinants, and the Intermountain Mortality Risk Score. PDC calculation used SelectHealth claims data.
Among 182 subjects, age averaged 63.2±8.5 years, 25.8% were female, baseline LDL-C was 82.5±32.7 mg/dL, and 93.4% had coronary disease. Characteristics were balanced between nudge (n = 89) and control arms (n = 93). The statin PDC was greater at 12 months in the nudge group (PDC: 0.742±0.318) compared to controls (PDC: 0.639±0.358, P = 0.042). Adherent subjects (PDC ≥80%) were more concentrated in the nudge group (66.3% vs controls: 50.5%, P = 0.036) while a composite of death, myocardial infarction, stroke, and revascularization was non-significant (nudges: 6.7% vs control: 10.8%, P = 0.44).
Persuasive behavioral nudges driven by artificial intelligence resulted in a clinically important increase in statin adherence in general cardiology patients. This precision patient decision support utilized computerized nudge design and delivery with minimal on-going human input.
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