Cardiovascular damage caused by cancer treatment has become an important cause of death for tumor survivors.With the recognition of cardiovascular diseases and cancer therapy-related cardiovascular toxicity(CTR-CVT)in...Cardiovascular damage caused by cancer treatment has become an important cause of death for tumor survivors.With the recognition of cardiovascular diseases and cancer therapy-related cardiovascular toxicity(CTR-CVT)in tumor patients,noninvasive imaging technologies play pivotal roles in the risk stratification,early diagnosis,monitoring and follow-up for CTR-CVT.In recent years,the field of cardio-oncology has witnessed continual updates in diagnostic and therapeutic strategies,with several pertinent guidelines and expert consensus documents issued in China and abroad.However,there remains a conspicuous absence of systematic guidance documents on the application of imaging techniques in the clinical practice of cardio-oncology.Therefore,the Chinese Anti-Cancer Association Society of Integrative Cardio-oncology,the Ultrasound Branch of the Chinese Medical Association,and the Chinese Society of Echocardiography convened experts to formulate the"Chinese guideline for the clinical application of noninvasive imaging technology in accessing cancer therapy-related cardiovascular toxicity".Building upon the systematic evaluation of guidelines and the latest evidence-based medical research in the field of cardio-oncology domestically and abroad,and in conjunction with data derived from evidence-based medical research in China,this guideline proposes noninvasive imaging examination methods and monitoring strategies for CTR-CVT,aiming to further standardize and guide the clinical practice of multidisciplinary physicians specializing in cardio-oncology in China.展开更多
Caffeine is a widely consumed stimulant known for its cardiovascular and metabolic effects.However,its impact on cardiovascular risk,including arrhythmias,in older adults remains underexplored.Emerging evidence highli...Caffeine is a widely consumed stimulant known for its cardiovascular and metabolic effects.However,its impact on cardiovascular risk,including arrhythmias,in older adults remains underexplored.Emerging evidence highlights sex-specific differences in caffeine metabolism,which may influence its role in cardiovascular health.This perspective examines the interaction between caffeine,hormonal changes,metabolic processes,and lifestyle factors,focusing on older women compared to men.Understanding these differences is essential for tailoring dietary and clinical recommendations to mitigate cardiovascular risks and promote healthy aging.展开更多
Colchicine is an anti-inflammatory alkaloid that reduces cardiovascular events through its actions on the interleukin(IL)-1β/IL-6/C-reactive protein pathway,which promotes the degradation and rupture of atherosclerot...Colchicine is an anti-inflammatory alkaloid that reduces cardiovascular events through its actions on the interleukin(IL)-1β/IL-6/C-reactive protein pathway,which promotes the degradation and rupture of atherosclerotic plaques.Low-dose colchicine(0.5 mg/day)has been shown to decrease major adverse car-diovascular events(MACE)by 31%among patients with stable atherosclerosis and 23%among those after a recent myocardial infarction.In patients with coronary artery disease(CAD)already taking a statin,colchicine in conjunction with lipid-lowering therapy has additionally been shown to provide a larger benefit with respect to secondary prevention of MACE.The drug is contrain-dicated in patients with renal or hepatic impairment and should be avoided in patients taking strong cytochrome P4503A4 or P-glycoprotein inhibitors.Low-dose colchicine was recently approved by the United States Food and Drug Administration in 2023 to reduce the risk of stroke,coronary revascularization,myocardial infarction,and cardiovascular death among patients with athero-sclerotic disease or multiple risk factors.This article focuses on the use of colchicine and its anti-inflammatory effects in preventing MACE among patients with CAD and patients without CAD with multiple risk factors.展开更多
Due to population aging,urbanization,and increasing prevalence of unhealthy lifestyles,the prevalence of cardiovascular disease(CVD)in China is on the rise.It is estimated that there are 330 million people with CVD,in...Due to population aging,urbanization,and increasing prevalence of unhealthy lifestyles,the prevalence of cardiovascular disease(CVD)in China is on the rise.It is estimated that there are 330 million people with CVD,including 13.00 million cases of stroke and 11.39 million cases of coranary heart disease.CVD remains the leading cause of death,with mortality projected to rise in the following two decades[1,2].Since 2005,the National Center for Cardiovascular Diseases(NCCD)has compiled comprehensive reports on CVD to guide prevention and treatment efforts,support government decision-making,and promote international exchange and collaboration.展开更多
BACKGROUND The neutrophil-lymphocyte ratio(NLR)has been proposed as a potential prognostic marker for mortality outcomes in various conditions,yet its association with chronic hemodialysis(HD)remains underexplored.We ...BACKGROUND The neutrophil-lymphocyte ratio(NLR)has been proposed as a potential prognostic marker for mortality outcomes in various conditions,yet its association with chronic hemodialysis(HD)remains underexplored.We aim to study its utility by conducting a meta-analysis of this specific population.AIM To determine whether elevated NLR is associated with all-cause mortality(ACM)and cardiovascular mortality(CVM)in patients undergoing chronic HD.METHODS A comprehensive search from PubMed,Google Scholar,and Scopus identified studies showing the association between NLR and mortality outcomes in patients with chronic HD.Random-effects models with 95%CIs were employed to pool adjusted hazard ratios(aHRs),odds ratios(ORs),and I²statistics for evaluating the heterogeneity of findings.Leave-one-out sensitivity and meta-regression analyses assessed changes in overall effects and identified confounders,respectively.The Joanna Briggs Institute(JBI)tool was used to assess the quality of studies.RESULTS 19 studies comprising 9047 patients with a mean age of 59.5±5.86 years and a mean follow-up duration of 46.7 months were included in our study.Our meta-analysis revealed a significant association between NLR>2.5 and increased risks of ACM(aHR:1.25,95%CI:1.14-1.37,P<0.0001)and CVM(aHR:1.24,95%CI:1.02-1.49,P=0.03).Studies reporting outcomes in OR reported similar findings for ACM(OR:4.59,95%CI:1.74-12.11,P=0.002)and CVM(OR:1.11,95%CI:1.01-1.23,P=0.03).Sensitivity analysis revealed no variations.Meta-regression revealed increasing male proportion is positively associated with ACM.Pooled area under the curve(AUC)was 0.71(95%CI:0.63-0.80,P<0.0001).The JBI tool revealed high-quality studies.CONCLUSION This meta-analysis suggests that elevated NLR may serve as a useful prognostic marker for ACM and CVM in patients on chronic HD and can be useful in planning for the prevention of mortality-related strategies.展开更多
Cardiovascular disease(CVD)represents the foremost cause of mortality globally,imposing a substantial economic burden.In 2021,approximately 19.4 million deaths were attributed to cardiovascular conditions,constituting...Cardiovascular disease(CVD)represents the foremost cause of mortality globally,imposing a substantial economic burden.In 2021,approximately 19.4 million deaths were attributed to cardiovascular conditions,constituting 32%of global mortality[1].Over three-quarters of these fatalities occurred in low and middle-income nations.Notably,ischemic heart disease and stroke were responsible for 84%of CVD-related deaths.Among them,the number of cases of ischemic cardiomyopathy increased by 68%in 2021 compared to 1990(Figure 1A).展开更多
Elevated lipoprotein(a)[Lp(a)]is a major independent risk factor for atheroscle-rotic cardiovascular disease(ASCVD),with limited response to traditional lipid-lowering therapies.Lepodisiran,a novel N-acetylgalactosami...Elevated lipoprotein(a)[Lp(a)]is a major independent risk factor for atheroscle-rotic cardiovascular disease(ASCVD),with limited response to traditional lipid-lowering therapies.Lepodisiran,a novel N-acetylgalactosamine-conjugated small interfering RNA,targets hepatic LPA message RNA to reduce apolipoprotein(a)production.Early-phase trials demonstrated>90%sustained Lp(a)reduction with excellent safety and tolerability.The phase 2 ALPACA trial confirmed dura-ble effects lasting up to one year after biannual dosing.Compared to other thera-pies,lepodisiran offers longer duration,high efficacy,and minimal side effects.Ongoing phase 3 studies aim to determine its impact on cardiovascular outcomes,potentially establishing a new standard in precise ASCVD risk management.展开更多
BACKGROUND Physical inactivity is a significant yet underappreciated risk factor for cardiovascular disease(CVD),particularly among older adults.The aim of this study was to analyze the global burden of CVD attributab...BACKGROUND Physical inactivity is a significant yet underappreciated risk factor for cardiovascular disease(CVD),particularly among older adults.The aim of this study was to analyze the global burden of CVD attributable to physical inactivity in individuals aged 70 years and older from 1990 to 2021 using the Global Burden of Disease data.METHODS We assessed trends in disability-adjusted life years(DALYs)and deaths,decomposed changes into population growth,aging,and epidemiological factors,and examined health inequalities across sociodemographic index(SDI)regions.RESULTS From 1990 to 2021,a substantial rise in DALYs was observed,especially in low and middle SDI regions,with a 120.06% increase in the low SDI region,but a 23.10% decline in the high SDI region.Decomposition analysis identified population aging and growth as primary drivers for the burden,contributing 66.39% and 83.56% to the increase in middle and low SDI regions,respectively.By contrast,epidemiological improvements alleviated burden in the high SDI region(54.91%).Gender disparities persisted,with women experiencing a higher burden.Inequality analysis indicated a shift in CVD burden towards the low SDI region,with declining concentration indices for DALYs(-0.03 to-0.13)and deaths(-0.07 to-0.15).The Bayesian age-period-cohort projections suggest continued increases in DALYs and deaths through 2050,with women disproportionately affected.CONCLUSIONS These findings highlight the urgent need for targeted interventions promoting physical activity,improving healthcare access,and implementing region-specific prevention strategies.展开更多
BACKGROUND Major adverse cardiovascular(CV)events(MACEs)are the primary cause of morbidity and mortality in kidney transplantation(KT)recipients.The risk for MACEs is impacted by an array of traditional and transplant...BACKGROUND Major adverse cardiovascular(CV)events(MACEs)are the primary cause of morbidity and mortality in kidney transplantation(KT)recipients.The risk for MACEs is impacted by an array of traditional and transplant-related non-traditional CV risk factors.AIM To investigate the association between potential CV risk factors related to KT and MACEs,and their potential modification by hyperuricemia(HU).METHODS The relationship between CV risk factors related to KT and MACEs was examined in a cohort of 545 patients who underwent transplantation between 2008 and 2019.The mean age of patients at KT was 55.0 years±14.2 years(range 15.0–89.0 years).Univariate and multivariate logistic regression models were constructed to identify risk factors influencing MACEs.To explore the potential effect modification by uric acid(UA),patients were categorized into groups based on UA levels:(1)Low(<356μmol/L);(2)Normal(356–416μmol/L);(3)High(416–475μmol/L);and(4)Very high(>475μmol/L).RESULTS MACEs occurred in 145 of 545(26.6%)KT recipients.The most prevalent comorbidities were hypertension(87%),dyslipidemia(78%),secondary hyperparathyroidism(68%),HU(63%)and anemia(33%).In the multivariate logistic regression model,the most significant factors associated with MACEs were previous CV events[odds ratio(OR)=70.6,95%CI:24.9–200.1],left ventricular hypertrophy(LVH)(OR=12.6,95%CI:2.7–58.3),HU treatment(OR=4.3,95%CI:2.4–7.6),and anemia(OR=5.3,95%CI:2.9–9.8).Effect modification by the presence of HU revealed that independent factors associated with MACEs were age(OR=1.03,95%CI:1.0–1.1),previous CV events(OR=41.7,95%CI:13.6–127.6),LVH(OR=15.3,95%CI:2.0–116.6),HU treatment(OR=2.5,95%CI:1.3–4.6)and anemia(OR=5.4,95%CI:2.8–10.5).Effect modification by UA levels dichotomized at 475μmol/L(very high level of UA)revealed that HU treatment was not associated with MACEs in groups with or without very high UA levels.CONCLUSION A very high level of UA was observed to act as an effect-modifying factor for MACEs,especially when combined with other risk factors such as age,previous CV events,LVH,and anemia.展开更多
Cardiovascular disease remains the leading global cause of mortality,projected to increase by 73.4%from 2025 to 2050 despite declining age-standardized rates.Contemporary interventions,such as percutaneous coronary in...Cardiovascular disease remains the leading global cause of mortality,projected to increase by 73.4%from 2025 to 2050 despite declining age-standardized rates.Contemporary interventions,such as percutaneous coronary intervention and statins,reduce major adverse cardiovascular events(MACE)by 25%-30%,yet a 20%five-year MACE risk persists in high-risk cohorts.These approaches,histor-ically focused on luminal stenosis,fail to address systemic atherogenesis drivers like endothelial dysfunction and inflammation.Specifically,dietary linoleic acid restriction(<5 g/day)reduces oxidized low-density lipoprotein by approximately 15%by limiting peroxidation-prone bisallylic bonds,mitigating arterial inflam-mation,a key atherogenic trigger.Enhanced external counterpulsation,through pulsatile shear stress,enhances nitric oxide-mediated coronary perfusion,alle-viating angina in approximately 70%of refractory cases unresponsive to revascu-larization.Nanoparticle-facilitated chelation targets atherosclerotic plaques with precision,reducing calcium content by up to 30%in preclinical models,offering a novel avenue for lesion reversal.These innovations collectively address residual risk by tackling root causes,oxidative stress,endothelial dysfunction,and plaque instability,potentially halving MACE rates with widespread adoption.Despite promising preliminary data,gaps remain in long-term safety and scalability.Robust clinical trials are needed to validate these approaches,which collectively aim to transform cardiovascular disease management by prioritizing prevention and vascular restoration,potentially reducing coronary events to a public health rarity.展开更多
Background Cardiovascular disease(CVD)and frailty are interrelated conditions prevalent in aging populations,yet their dynamic temporal relationship remains underexplored.This study investigates longitudinal changes i...Background Cardiovascular disease(CVD)and frailty are interrelated conditions prevalent in aging populations,yet their dynamic temporal relationship remains underexplored.This study investigates longitudinal changes in frailty trajectories before and after incident CVD across diverse cohorts.Methods Utilizing data from four longitudinal,multinational cohorts(ELSA,HRS,CHARLS,SHARE;n=66,537),we constructed the frailty index(FI)based on age-related health deficits,using 40,40,42,and 44 items from ELSA,HRS,CHARLS and SHARE,respectively.Linear mixed models assessed FI changes pre-and post-CVD,adjusting for demographics,lifestyle,and baseline FI.Sensitivity analyses excluded hypertension,diabetes,and arthritis to mitigate confounding.Results Frailty increased steadily before CVD onset(pre-CVD slope:ELSAβ=0.005,HRSβ=0.005,CHARLSβ=0.012,SHAREβ=0.007;all P<0.001),with an acute FI spike at diagnosis(post-CVD acute change:ELSAβ=0.024,HRSβ=0.031,CHARLSβ=0.046,SHAREβ=0.038;all P<0.001).Post-CVD,frailty progression further accelerated(ELSAβ=0.008,HRSβ=0.005,CHARLSβ=0.017,SHAREβ=0.010;all P<0.001).Sensitivity analyses confirmed robustness across age strata and FI definitions.Conclusions This first multinational study demonstrates bidirectional acceleration of frailty around CVD onset,highlighting their close temporal interplay.These findings suggest that incorporating frailty assessment into CVD management may help identify high-risk individuals and support timely,multidimensional care in aging populations.展开更多
Background Cardiovascular disease(CVD)remains a major health challenge globally,particularly in aging populations.Using data from the China Health and Retirement Longitudinal Study(CHARLS),this study examines the Trig...Background Cardiovascular disease(CVD)remains a major health challenge globally,particularly in aging populations.Using data from the China Health and Retirement Longitudinal Study(CHARLS),this study examines the Triglyceride-glucose(TyG)index dynamics,a marker for insulin resistance,and its relationship with CVD in Chinese adults aged 45 and older.Methods This reanalysis utilized five waves of CHARLS data with multistage sampling.From 17,705 participants,5,625 with TyG index and subsequent CVD data were included,excluding those lacking 2011 and 2015 TyG data.TyG derived from glucose and triglyceride levels,CVD outcomes via self-reports and records.Participants divided into four groups based on TyG changes(2011–2015):low-low,low-high,high-low,high-high TyG groups.Results Adjusting for covariates,stable high group showed a significantly higher risk of incident CVD compared to stable low group,with an HR of 1.18(95%CI:1.03–1.36).Similarly,for stroke risk,stable high group had a HR of 1.45(95%CI:1.11–1.89).Survival curves indicated that individuals with stable high TyG levels had a significantly increased CVD risk compared to controls.The dynamic TyG change showed a greater risk for CVD than abnormal glucose metabolism,notably for stroke.However,there was no statistical difference in single incidence risk of heart disease between stable low and stable high group.Subgroup analyses underscored demographic disparities,with stable high group consistently showing elevated risks,particularly among<65 years individuals,females,and those with higher education,lower BMI,or higher depression scores.Machine learning models,including random forest,XGBoost,CoxBoost,Deepsurv and GBM,underscored the predictive superiority of dynamic TyG over abnormal glucose metabolism for CVD.Conclusions Dynamic TyG change correlate with CVD risks.Monitoring these changes could predict and manage cardiovascular health in middle-aged and older adults.Targeted interventions based on TyG index trends are crucial for reducing CVD risks in this population.展开更多
BACKGROUND The correlation between geriatric nutritional risk index(GNRI)and the prognosis of patients with osteoporosis or osteopenia has not been studied.This study aims to explore the relationship between GNRI and ...BACKGROUND The correlation between geriatric nutritional risk index(GNRI)and the prognosis of patients with osteoporosis or osteopenia has not been studied.This study aims to explore the relationship between GNRI and the cardiovascular disease(CVD)and all-cause mortality rates in elderly patients with osteoporosis or osteopenia.METHODS This study included 4756 patients with osteoporosis and osteopenia from five cycles of the National Health and Nutrition Examination Survey(NHANES).We used multivariable Cox regression and subgroup analyses to investigate the correlation between GNRI and mortality rates.The restricted cubic spline analysis was used to assess the dose-response relationship between GNRI and mortality risk.Mediation analysis was conducted to examine the mediating effect of chronic kidney disease on the relationship between nutritional risk and mortality.RESULTS During a median follow-up period of 114 months,a total of 1241 deaths(26.09%)occurred,including 300 deaths due to CVD(6.31%).In the fully adjusted Model 3,compared to the no-risk group,the risk group showed significantly increased all-cause mortality risk(HR=2.05,95%CI:1.74–2.40)and CVD mortality risk(HR=1.88,95%CI:1.30–2.71).The restricted cubic spline analysis indicated a non-linear association between GNRI and all-cause mortality risk as well as CVD mortality risk.The mediation analysis results indicated that chronic kidney disease mediates 16.9%of the effect of nutritional risk on all-cause mortality and 25.3%on CVD mortality risk.CONCLUSIONS GNRI can serve as a predictive factor for all-cause and CVD mortality rates in elderly patients with osteoporosis or osteopenia.展开更多
Background It remains unclear whether sleep duration and physical activity(PA)trajectories in middle-aged and older adults are associated with different risks of cardiovascular diseases(CVDs).This study aimed to explo...Background It remains unclear whether sleep duration and physical activity(PA)trajectories in middle-aged and older adults are associated with different risks of cardiovascular diseases(CVDs).This study aimed to explore the trajectories of total sleep duration and PA among middle-aged and older Chinese adults and their impact on CVD risk.Methods This study was based on the China Health and Retirement Longitudinal Study.12009 adults aged 45 years and older from five waves were included.CVD events were measured by self-reports of heart disease and stroke.We first used groupbased trajectory modeling to identify total sleep duration and PA trajectories from 2011 to 2020,and then employed logistic regression models to analyze their risk for CVD.Results We identified three sleep duration and PA trajectories.The risk of heart disease increased by 33%(OR=1.31,95%CI:1.12-1.53)for the short sleep duration trajectory(vs.moderate sleep duration trajectory),by 40%(OR=1.40,95%CI:1.06-1.84)for the high decreasing PA trajectory,and by 20%(OR=1.20,95%CI:1.01-1.42)for the low stable PA trajectory(vs.high stable PA trajectory),respectively.Similar results for stroke and CVD as the outcomes were also observed,but the higher risk of stroke in the high decreasing PA trajectory group was not statistically significant.The joint effects of sleep and PA showed lower risks of heart disease and stroke in trajectories with moderate or long sleep duration and high stable PA compared with short sleep duration and a low stable PA trajectory.Conclusions Short total sleep duration,high decreasing PA,and low stable PA trajectories could increase the risk of CVDs among middle-aged and older adults.Long-term moderate to long total sleep durations and high stable PA trajectories might be optimal for preventing CVDs.展开更多
BACKGROUND Patients with type 2 diabetes mellitus(T2DM)face a heightened risk of future cardiovascular events.It is therefore important to stratify these patients according to their future cardiovascular event risk to...BACKGROUND Patients with type 2 diabetes mellitus(T2DM)face a heightened risk of future cardiovascular events.It is therefore important to stratify these patients according to their future cardiovascular event risk to allow early intervention and improve prognosis.Recent proposals have indicated that nontraditional lipoprotein ratios may be superior predictors of cardiovascular events compared to traditional lipid parameters.However,further evidence is required for widespread clinical ap-plication.AIM To elucidate the associations of nontraditional lipoprotein ratios with future cardiovascular events in patients with T2DM.METHODS This study performed post-hoc analysis of data obtained during a clinical trial involving 10182 participants.To ascertain the correlations between nontraditional lipoprotein ratios and future cardiovascular events,including major adverse cardiovascular events(MACEs)and congestive heart failure(CHF).We employed univariable and multivariable-adjusted Cox proportional hazards regression models.Potential dose-response relationships and threshold values were explored by conducting restricted cubic spline analyses and two-piecewise linear regression models.Possible relevant interactions influencing independent relationships were tested using subgroup and interaction analyses.RESULTS After adjustment for confounding factors,all nontraditional lipoprotein ratios studied were strongly associated with MACE risk in patients with T2DM.In comparison with patients in the lowest quartile,the hazard ratios(95%confidence intervals)of those in the highest quartile were 1.50(1.29-1.73),1.51(1.30-1.74),1.50(1.29-1.73),and 1.30(1.12-1.50)for total cholesterol/high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.Similar findings were noted for CHF.Dose-response relationships between nontraditional lipoprotein ratios and MACE were observed,with threshold values of 7.29,6.29,and 2.15 for total cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.However,no notable dose-response relationships were detected between nontraditional lipoprotein ratios and CHF.CONCLUSION Elevated nontraditional lipoprotein ratios may independently predict the risk of MACE and CHF in patients with T2DM.展开更多
BACKGROUND Metabolic dysfunction-associated fatty liver disease(MAFLD)and type 2 diabetes mellitus(T2DM)are independent risk factors for the development of cardiovascular disease(CVD)and an exaggerated CVD risk is exp...BACKGROUND Metabolic dysfunction-associated fatty liver disease(MAFLD)and type 2 diabetes mellitus(T2DM)are independent risk factors for the development of cardiovascular disease(CVD)and an exaggerated CVD risk is expected when both diseases co-exist.Therefore,thorough risk stratification is important to inform better clinical practice decisions based on good quality evidence for patient with MAFLD and T2DM.AIM To identify the CVD and cardiovascular event(CVE)risk in a systematic review when MAFLD and T2DM co-exist to inform better clinical practice decisions.METHODS A systematic review was performed by compiling data by searching PubMed,EMBASE and Cochrane Library databases.Quality appraisal of retrieved studies and the meta-analysis were performed using Joanna Briggs Institute(JBI)tool and RevMan 5.4 software respectively.The effect indicators for CVE and CVD risk were expressed as odds ratios(OR)and 95%CI with P-values<0.05 as significant.RESULTS Fourteen(5 cohort and 9 cross-sectional)studies with 370013 participants were included in this review.The metaanalysis of CVE showed that the risk of CVE in T2DM was higher in the MAFLD group when compared to the non-MAFLD group[OR 1.28(95%CI,1.04-1.56)P=0.02]with follow up duration ranging between 5-6 years.The prevalence of CVD in the metanalysis of cross-sectional studies was found to be higher[OR 1.47(95%CI,1.21-1.78)P=0.0001]in T2DM with MAFLD when compared to T2DM without MAFLD.Significant heterogeneity exists due to variations in study design,methodologies,and MAFLD diagnostic criteria,which may have influenced the study's findings.CONCLUSION The presence of MAFLD in T2DM increased the risk of CVE.The prevalence of CVD is higher in T2DM with MAFLD as compared to T2DM without MAFLD.Large well-designed multicentric long-term prospective studies are necessary to appropriately risk stratify the cardiovascular effect of the MAFLD in T2DM patients.展开更多
Metabolic-associated fatty liver disease(MAFLD),formerly known as nonalcoho-lic fatty liver disease,is an increasing global health challenge with substantial implications for metabolic and cardiovascular health(CVH).A...Metabolic-associated fatty liver disease(MAFLD),formerly known as nonalcoho-lic fatty liver disease,is an increasing global health challenge with substantial implications for metabolic and cardiovascular health(CVH).A recent study by Fu et al investigated the relationship between CVH metrics,specifically Life’s Simple 7 and Life’s Essential 8,and the prevalence of MAFLD.While this study offered important insights into the relationship between CVH and MAFLD,several me-thodological limitations,unaddressed confounding factors,and potential biases that could impact the interpretation of their findings should be considered.The study’s cross-sectional nature restricted the ability to draw causal conclusions,and it did not fully account for potential confounding factors such as dietary habits,genetic predispositions,and medication use.Furthermore,relying on tran-sient elastography to diagnose MAFLD introduces certain diagnostic limitations.Longitudinal study designs,advanced statistical modeling techniques,and diverse population groups should be utilized to strengthen future research.Exploring the mechanistic pathways that link CVH metrics to MAFLD through multi-omics approaches and interventional studies will be essential in formulating targeted prevention and treatment strategies.Structural equation modeling and machine learning techniques could provide a more refined analysis of these interrelated factors.Additionally,future research should employ longitudinal study designs and explore genetic and epigenetic influences to enhance our un-derstanding of CVH and MAFLD interactions.展开更多
Type 2 diabetes mellitus is associated with a 2-4 times increased risk of cardiovascular(CV)disease.Glucagon-like polypeptide-1 receptor agonists(GLP1RA)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)are two imp...Type 2 diabetes mellitus is associated with a 2-4 times increased risk of cardiovascular(CV)disease.Glucagon-like polypeptide-1 receptor agonists(GLP1RA)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)are two important classes of drugs with CV benefits independent of their antihyperglycemic efficacy.The CV outcome trials of both GLP1RA and SGLT2i have demonstrated CV superiority/neutrality concerning major adverse CV events(MACE).While GLP1RAs have exhibited a significant reduction in ischemic stroke and myocardial infarction(MI),SGLT2i have demonstrated a uniformly significant reduction in hospitalization for heart failure(HF)as a class effect.The unique clinical benefits and the distinct but complementary mechanisms of action make the combination of these drugs a mechanistically sound one.Recent meta-analyses suggest an independent and additive benefit of combination therapy of GLP1RA/SGLT2i vs monotherapy.Zhu et al,in a recent issue of the World Journal of Diabetes,demonstrates a numerically lower hazard ratio(HR)for CV outcomes with combination therapy vs monotherapy with either agent,with a reduction in MACE compared to GLP1RA alone[HR=0.51,95%confidence interval(CI):0.16-1.65],or SGLT2i alone(HR=0.48,95%CI:0.15-1.54).The CV death rate was also lower with combination therapy compared to GLP1RA alone(HR=0.58,95%CI:0.08-3.39),or SGLT2i alone(HR=0.55,95%CI:0.07-3.25).Fatal and non-fatal MI and fatal and non-fatal stroke were reduced with combination therapy compared to GLP1RA alone(HR=0.45,95%CI:0.10-2.18 and HR=0.86,95%CI:0.12-6.23,respectively),or SGLT2i alone(HR=0.44,95%CI:0.09-2.10 and HR=0.74,95%CI:0.10-5.47,respectively).Hospitalization for HF was prevented with combination therapy compared to GLP1RA alone(HR=0.26,95%CI:0.03-1.88),or SGLT2i alone(HR=0.33,95%CI:0.04-2.53).They also demonstrated that GLP1RA or SGLT2i monotherapy may not provide significant improvement in CV death and recurrent MI in patients with prior MI or HF,proposing a role for combination therapy in this subgroup.Appropriate patient selection is vital to optimize CV risk reduction as well as the cost-effectiveness of this combination therapy.展开更多
BACKGROUND Recent studies have indicated that triglyceride glucose(TyG)-waist height ratio(WHtR)and TyG-waist circumference(TyG-WC)are effective indicators for evaluating insulin resistance.However,research on the ass...BACKGROUND Recent studies have indicated that triglyceride glucose(TyG)-waist height ratio(WHtR)and TyG-waist circumference(TyG-WC)are effective indicators for evaluating insulin resistance.However,research on the association in TyG-WHtR,TyG-WC,and the risk and prognosis of major adverse cardiovascular events(MACEs)in type 2 diabetes mellitus(T2DM)cases are limited.AIM To clarify the relation in TyG-WHtR,TyG-WC,and the risk of MACEs and overall mortality in T2DM patients.METHODS Information for this investigation was obtained from Action to Control Cardiovascular Risk in Diabetes(ACCORD)/ACCORD Follow-On(ACCORDION)study database.The Cox regression model was applied to assess the relation among TyG-WHtR,TyG-WC and future MACEs risk and overall mortality in T2DM cases.The RCS analysis was utilized to explore the nonlinear correlation.Subgroup and interaction analyses were conducted to prove the robustness.The receiver operating characteristic curves were applied to analysis the additional predicting value of TyG-WHtR and TyG-WC.RESULTS After full adjustment for confounding variables,the highest baseline TyG-WHtR cohort respectively exhibited a 1.353-fold and 1.420-fold higher risk for MACEs and overall mortality,than the lowest quartile group.Similarly,the highest baseline TyG-WC cohort showed a 1.314-fold and 1.480-fold higher risk for MACEs and overall mortality,respectively.Each 1 SD increase in TyG-WHtR was significantly related to an 11.7%increase in MACEs and a 14.9%enhance in overall mortality.Each 1 SD increase in TyG-WC corresponded to an 11.5%in MACEs and a 16.6%increase in overall mortality.Including these two indexes in conventional models significantly improved the predictive power for MACEs and overall mortality.CONCLUSION TyG-WHtR and TyG-WC were promising predictors of MACEs and overall mortality risk in T2DM cases.展开更多
Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible ligh...Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals.This direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced artifacts.In pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young age.Enhanced spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart defects.Additionally,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media doses.Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular cases.As PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.展开更多
基金National Key Research and Development Program of China(2022YFC 3602400)Shanghai Municipal Health Commission“Top Priority Research Center”(2023-ZZ02021)+2 种基金Shanghai Public Health Key Discipline Construction Project(GWVI-11.1-26)Shanghai Academic/Technology Research Leader(21XD1432100)Key Research and Development Program of Shandong Province(2021SFGC0503)。
文摘Cardiovascular damage caused by cancer treatment has become an important cause of death for tumor survivors.With the recognition of cardiovascular diseases and cancer therapy-related cardiovascular toxicity(CTR-CVT)in tumor patients,noninvasive imaging technologies play pivotal roles in the risk stratification,early diagnosis,monitoring and follow-up for CTR-CVT.In recent years,the field of cardio-oncology has witnessed continual updates in diagnostic and therapeutic strategies,with several pertinent guidelines and expert consensus documents issued in China and abroad.However,there remains a conspicuous absence of systematic guidance documents on the application of imaging techniques in the clinical practice of cardio-oncology.Therefore,the Chinese Anti-Cancer Association Society of Integrative Cardio-oncology,the Ultrasound Branch of the Chinese Medical Association,and the Chinese Society of Echocardiography convened experts to formulate the"Chinese guideline for the clinical application of noninvasive imaging technology in accessing cancer therapy-related cardiovascular toxicity".Building upon the systematic evaluation of guidelines and the latest evidence-based medical research in the field of cardio-oncology domestically and abroad,and in conjunction with data derived from evidence-based medical research in China,this guideline proposes noninvasive imaging examination methods and monitoring strategies for CTR-CVT,aiming to further standardize and guide the clinical practice of multidisciplinary physicians specializing in cardio-oncology in China.
文摘Caffeine is a widely consumed stimulant known for its cardiovascular and metabolic effects.However,its impact on cardiovascular risk,including arrhythmias,in older adults remains underexplored.Emerging evidence highlights sex-specific differences in caffeine metabolism,which may influence its role in cardiovascular health.This perspective examines the interaction between caffeine,hormonal changes,metabolic processes,and lifestyle factors,focusing on older women compared to men.Understanding these differences is essential for tailoring dietary and clinical recommendations to mitigate cardiovascular risks and promote healthy aging.
文摘Colchicine is an anti-inflammatory alkaloid that reduces cardiovascular events through its actions on the interleukin(IL)-1β/IL-6/C-reactive protein pathway,which promotes the degradation and rupture of atherosclerotic plaques.Low-dose colchicine(0.5 mg/day)has been shown to decrease major adverse car-diovascular events(MACE)by 31%among patients with stable atherosclerosis and 23%among those after a recent myocardial infarction.In patients with coronary artery disease(CAD)already taking a statin,colchicine in conjunction with lipid-lowering therapy has additionally been shown to provide a larger benefit with respect to secondary prevention of MACE.The drug is contrain-dicated in patients with renal or hepatic impairment and should be avoided in patients taking strong cytochrome P4503A4 or P-glycoprotein inhibitors.Low-dose colchicine was recently approved by the United States Food and Drug Administration in 2023 to reduce the risk of stroke,coronary revascularization,myocardial infarction,and cardiovascular death among patients with athero-sclerotic disease or multiple risk factors.This article focuses on the use of colchicine and its anti-inflammatory effects in preventing MACE among patients with CAD and patients without CAD with multiple risk factors.
文摘Due to population aging,urbanization,and increasing prevalence of unhealthy lifestyles,the prevalence of cardiovascular disease(CVD)in China is on the rise.It is estimated that there are 330 million people with CVD,including 13.00 million cases of stroke and 11.39 million cases of coranary heart disease.CVD remains the leading cause of death,with mortality projected to rise in the following two decades[1,2].Since 2005,the National Center for Cardiovascular Diseases(NCCD)has compiled comprehensive reports on CVD to guide prevention and treatment efforts,support government decision-making,and promote international exchange and collaboration.
文摘BACKGROUND The neutrophil-lymphocyte ratio(NLR)has been proposed as a potential prognostic marker for mortality outcomes in various conditions,yet its association with chronic hemodialysis(HD)remains underexplored.We aim to study its utility by conducting a meta-analysis of this specific population.AIM To determine whether elevated NLR is associated with all-cause mortality(ACM)and cardiovascular mortality(CVM)in patients undergoing chronic HD.METHODS A comprehensive search from PubMed,Google Scholar,and Scopus identified studies showing the association between NLR and mortality outcomes in patients with chronic HD.Random-effects models with 95%CIs were employed to pool adjusted hazard ratios(aHRs),odds ratios(ORs),and I²statistics for evaluating the heterogeneity of findings.Leave-one-out sensitivity and meta-regression analyses assessed changes in overall effects and identified confounders,respectively.The Joanna Briggs Institute(JBI)tool was used to assess the quality of studies.RESULTS 19 studies comprising 9047 patients with a mean age of 59.5±5.86 years and a mean follow-up duration of 46.7 months were included in our study.Our meta-analysis revealed a significant association between NLR>2.5 and increased risks of ACM(aHR:1.25,95%CI:1.14-1.37,P<0.0001)and CVM(aHR:1.24,95%CI:1.02-1.49,P=0.03).Studies reporting outcomes in OR reported similar findings for ACM(OR:4.59,95%CI:1.74-12.11,P=0.002)and CVM(OR:1.11,95%CI:1.01-1.23,P=0.03).Sensitivity analysis revealed no variations.Meta-regression revealed increasing male proportion is positively associated with ACM.Pooled area under the curve(AUC)was 0.71(95%CI:0.63-0.80,P<0.0001).The JBI tool revealed high-quality studies.CONCLUSION This meta-analysis suggests that elevated NLR may serve as a useful prognostic marker for ACM and CVM in patients on chronic HD and can be useful in planning for the prevention of mortality-related strategies.
基金supported by the National Natural Science Foundation of China(No.82270364)Science and Technology Program of Guizhou Province(No.ZK[2023]321)+3 种基金Guizhou Provincial Youth Science and Technology Talents Growth Project(No.KY[2022]214)Excellent Young Talents Plan of Guizhou Medical University(No.[2023]112)Guizhou Medical University Key Laboratory of Cardiovascular Disease Basic and Clinical Research(No.2024001)Start-up Fund of Guizhou Medical University(No.J2021032).
文摘Cardiovascular disease(CVD)represents the foremost cause of mortality globally,imposing a substantial economic burden.In 2021,approximately 19.4 million deaths were attributed to cardiovascular conditions,constituting 32%of global mortality[1].Over three-quarters of these fatalities occurred in low and middle-income nations.Notably,ischemic heart disease and stroke were responsible for 84%of CVD-related deaths.Among them,the number of cases of ischemic cardiomyopathy increased by 68%in 2021 compared to 1990(Figure 1A).
文摘Elevated lipoprotein(a)[Lp(a)]is a major independent risk factor for atheroscle-rotic cardiovascular disease(ASCVD),with limited response to traditional lipid-lowering therapies.Lepodisiran,a novel N-acetylgalactosamine-conjugated small interfering RNA,targets hepatic LPA message RNA to reduce apolipoprotein(a)production.Early-phase trials demonstrated>90%sustained Lp(a)reduction with excellent safety and tolerability.The phase 2 ALPACA trial confirmed dura-ble effects lasting up to one year after biannual dosing.Compared to other thera-pies,lepodisiran offers longer duration,high efficacy,and minimal side effects.Ongoing phase 3 studies aim to determine its impact on cardiovascular outcomes,potentially establishing a new standard in precise ASCVD risk management.
基金supported by the Jiangsu Commission of Health(LR2022004&LKZ2023005)the Project of Zhongda Hospital Affiliated to Southeast University for Cultivating Academic Talent(CZXM-GSPRC22)+2 种基金the Zhongda Hospital Affiliated to Southeast University,Jiangsu Province High-Level Hospital Pairing Assistance Construction Funds(ZDLYG10)the Zhongda Hospital Affiliated to Southeast University,Jiangsu Province High-Level Hospital Construction Funds(GSP-LCYJFH17)the Nanjing Commission of Health(YKK24257).
文摘BACKGROUND Physical inactivity is a significant yet underappreciated risk factor for cardiovascular disease(CVD),particularly among older adults.The aim of this study was to analyze the global burden of CVD attributable to physical inactivity in individuals aged 70 years and older from 1990 to 2021 using the Global Burden of Disease data.METHODS We assessed trends in disability-adjusted life years(DALYs)and deaths,decomposed changes into population growth,aging,and epidemiological factors,and examined health inequalities across sociodemographic index(SDI)regions.RESULTS From 1990 to 2021,a substantial rise in DALYs was observed,especially in low and middle SDI regions,with a 120.06% increase in the low SDI region,but a 23.10% decline in the high SDI region.Decomposition analysis identified population aging and growth as primary drivers for the burden,contributing 66.39% and 83.56% to the increase in middle and low SDI regions,respectively.By contrast,epidemiological improvements alleviated burden in the high SDI region(54.91%).Gender disparities persisted,with women experiencing a higher burden.Inequality analysis indicated a shift in CVD burden towards the low SDI region,with declining concentration indices for DALYs(-0.03 to-0.13)and deaths(-0.07 to-0.15).The Bayesian age-period-cohort projections suggest continued increases in DALYs and deaths through 2050,with women disproportionately affected.CONCLUSIONS These findings highlight the urgent need for targeted interventions promoting physical activity,improving healthcare access,and implementing region-specific prevention strategies.
文摘BACKGROUND Major adverse cardiovascular(CV)events(MACEs)are the primary cause of morbidity and mortality in kidney transplantation(KT)recipients.The risk for MACEs is impacted by an array of traditional and transplant-related non-traditional CV risk factors.AIM To investigate the association between potential CV risk factors related to KT and MACEs,and their potential modification by hyperuricemia(HU).METHODS The relationship between CV risk factors related to KT and MACEs was examined in a cohort of 545 patients who underwent transplantation between 2008 and 2019.The mean age of patients at KT was 55.0 years±14.2 years(range 15.0–89.0 years).Univariate and multivariate logistic regression models were constructed to identify risk factors influencing MACEs.To explore the potential effect modification by uric acid(UA),patients were categorized into groups based on UA levels:(1)Low(<356μmol/L);(2)Normal(356–416μmol/L);(3)High(416–475μmol/L);and(4)Very high(>475μmol/L).RESULTS MACEs occurred in 145 of 545(26.6%)KT recipients.The most prevalent comorbidities were hypertension(87%),dyslipidemia(78%),secondary hyperparathyroidism(68%),HU(63%)and anemia(33%).In the multivariate logistic regression model,the most significant factors associated with MACEs were previous CV events[odds ratio(OR)=70.6,95%CI:24.9–200.1],left ventricular hypertrophy(LVH)(OR=12.6,95%CI:2.7–58.3),HU treatment(OR=4.3,95%CI:2.4–7.6),and anemia(OR=5.3,95%CI:2.9–9.8).Effect modification by the presence of HU revealed that independent factors associated with MACEs were age(OR=1.03,95%CI:1.0–1.1),previous CV events(OR=41.7,95%CI:13.6–127.6),LVH(OR=15.3,95%CI:2.0–116.6),HU treatment(OR=2.5,95%CI:1.3–4.6)and anemia(OR=5.4,95%CI:2.8–10.5).Effect modification by UA levels dichotomized at 475μmol/L(very high level of UA)revealed that HU treatment was not associated with MACEs in groups with or without very high UA levels.CONCLUSION A very high level of UA was observed to act as an effect-modifying factor for MACEs,especially when combined with other risk factors such as age,previous CV events,LVH,and anemia.
文摘Cardiovascular disease remains the leading global cause of mortality,projected to increase by 73.4%from 2025 to 2050 despite declining age-standardized rates.Contemporary interventions,such as percutaneous coronary intervention and statins,reduce major adverse cardiovascular events(MACE)by 25%-30%,yet a 20%five-year MACE risk persists in high-risk cohorts.These approaches,histor-ically focused on luminal stenosis,fail to address systemic atherogenesis drivers like endothelial dysfunction and inflammation.Specifically,dietary linoleic acid restriction(<5 g/day)reduces oxidized low-density lipoprotein by approximately 15%by limiting peroxidation-prone bisallylic bonds,mitigating arterial inflam-mation,a key atherogenic trigger.Enhanced external counterpulsation,through pulsatile shear stress,enhances nitric oxide-mediated coronary perfusion,alle-viating angina in approximately 70%of refractory cases unresponsive to revascu-larization.Nanoparticle-facilitated chelation targets atherosclerotic plaques with precision,reducing calcium content by up to 30%in preclinical models,offering a novel avenue for lesion reversal.These innovations collectively address residual risk by tackling root causes,oxidative stress,endothelial dysfunction,and plaque instability,potentially halving MACE rates with widespread adoption.Despite promising preliminary data,gaps remain in long-term safety and scalability.Robust clinical trials are needed to validate these approaches,which collectively aim to transform cardiovascular disease management by prioritizing prevention and vascular restoration,potentially reducing coronary events to a public health rarity.
基金Natural Science Foundation of Shandong Province(Grant No.ZR2021QH176)。
文摘Background Cardiovascular disease(CVD)and frailty are interrelated conditions prevalent in aging populations,yet their dynamic temporal relationship remains underexplored.This study investigates longitudinal changes in frailty trajectories before and after incident CVD across diverse cohorts.Methods Utilizing data from four longitudinal,multinational cohorts(ELSA,HRS,CHARLS,SHARE;n=66,537),we constructed the frailty index(FI)based on age-related health deficits,using 40,40,42,and 44 items from ELSA,HRS,CHARLS and SHARE,respectively.Linear mixed models assessed FI changes pre-and post-CVD,adjusting for demographics,lifestyle,and baseline FI.Sensitivity analyses excluded hypertension,diabetes,and arthritis to mitigate confounding.Results Frailty increased steadily before CVD onset(pre-CVD slope:ELSAβ=0.005,HRSβ=0.005,CHARLSβ=0.012,SHAREβ=0.007;all P<0.001),with an acute FI spike at diagnosis(post-CVD acute change:ELSAβ=0.024,HRSβ=0.031,CHARLSβ=0.046,SHAREβ=0.038;all P<0.001).Post-CVD,frailty progression further accelerated(ELSAβ=0.008,HRSβ=0.005,CHARLSβ=0.017,SHAREβ=0.010;all P<0.001).Sensitivity analyses confirmed robustness across age strata and FI definitions.Conclusions This first multinational study demonstrates bidirectional acceleration of frailty around CVD onset,highlighting their close temporal interplay.These findings suggest that incorporating frailty assessment into CVD management may help identify high-risk individuals and support timely,multidimensional care in aging populations.
基金the National Natural Science Foundation of China(grant numbers 82070434,LYQ)。
文摘Background Cardiovascular disease(CVD)remains a major health challenge globally,particularly in aging populations.Using data from the China Health and Retirement Longitudinal Study(CHARLS),this study examines the Triglyceride-glucose(TyG)index dynamics,a marker for insulin resistance,and its relationship with CVD in Chinese adults aged 45 and older.Methods This reanalysis utilized five waves of CHARLS data with multistage sampling.From 17,705 participants,5,625 with TyG index and subsequent CVD data were included,excluding those lacking 2011 and 2015 TyG data.TyG derived from glucose and triglyceride levels,CVD outcomes via self-reports and records.Participants divided into four groups based on TyG changes(2011–2015):low-low,low-high,high-low,high-high TyG groups.Results Adjusting for covariates,stable high group showed a significantly higher risk of incident CVD compared to stable low group,with an HR of 1.18(95%CI:1.03–1.36).Similarly,for stroke risk,stable high group had a HR of 1.45(95%CI:1.11–1.89).Survival curves indicated that individuals with stable high TyG levels had a significantly increased CVD risk compared to controls.The dynamic TyG change showed a greater risk for CVD than abnormal glucose metabolism,notably for stroke.However,there was no statistical difference in single incidence risk of heart disease between stable low and stable high group.Subgroup analyses underscored demographic disparities,with stable high group consistently showing elevated risks,particularly among<65 years individuals,females,and those with higher education,lower BMI,or higher depression scores.Machine learning models,including random forest,XGBoost,CoxBoost,Deepsurv and GBM,underscored the predictive superiority of dynamic TyG over abnormal glucose metabolism for CVD.Conclusions Dynamic TyG change correlate with CVD risks.Monitoring these changes could predict and manage cardiovascular health in middle-aged and older adults.Targeted interventions based on TyG index trends are crucial for reducing CVD risks in this population.
文摘BACKGROUND The correlation between geriatric nutritional risk index(GNRI)and the prognosis of patients with osteoporosis or osteopenia has not been studied.This study aims to explore the relationship between GNRI and the cardiovascular disease(CVD)and all-cause mortality rates in elderly patients with osteoporosis or osteopenia.METHODS This study included 4756 patients with osteoporosis and osteopenia from five cycles of the National Health and Nutrition Examination Survey(NHANES).We used multivariable Cox regression and subgroup analyses to investigate the correlation between GNRI and mortality rates.The restricted cubic spline analysis was used to assess the dose-response relationship between GNRI and mortality risk.Mediation analysis was conducted to examine the mediating effect of chronic kidney disease on the relationship between nutritional risk and mortality.RESULTS During a median follow-up period of 114 months,a total of 1241 deaths(26.09%)occurred,including 300 deaths due to CVD(6.31%).In the fully adjusted Model 3,compared to the no-risk group,the risk group showed significantly increased all-cause mortality risk(HR=2.05,95%CI:1.74–2.40)and CVD mortality risk(HR=1.88,95%CI:1.30–2.71).The restricted cubic spline analysis indicated a non-linear association between GNRI and all-cause mortality risk as well as CVD mortality risk.The mediation analysis results indicated that chronic kidney disease mediates 16.9%of the effect of nutritional risk on all-cause mortality and 25.3%on CVD mortality risk.CONCLUSIONS GNRI can serve as a predictive factor for all-cause and CVD mortality rates in elderly patients with osteoporosis or osteopenia.
基金supported by Peking University,the National Natural Science Foundation of China,the National Institute on Aging and the World Bank。
文摘Background It remains unclear whether sleep duration and physical activity(PA)trajectories in middle-aged and older adults are associated with different risks of cardiovascular diseases(CVDs).This study aimed to explore the trajectories of total sleep duration and PA among middle-aged and older Chinese adults and their impact on CVD risk.Methods This study was based on the China Health and Retirement Longitudinal Study.12009 adults aged 45 years and older from five waves were included.CVD events were measured by self-reports of heart disease and stroke.We first used groupbased trajectory modeling to identify total sleep duration and PA trajectories from 2011 to 2020,and then employed logistic regression models to analyze their risk for CVD.Results We identified three sleep duration and PA trajectories.The risk of heart disease increased by 33%(OR=1.31,95%CI:1.12-1.53)for the short sleep duration trajectory(vs.moderate sleep duration trajectory),by 40%(OR=1.40,95%CI:1.06-1.84)for the high decreasing PA trajectory,and by 20%(OR=1.20,95%CI:1.01-1.42)for the low stable PA trajectory(vs.high stable PA trajectory),respectively.Similar results for stroke and CVD as the outcomes were also observed,but the higher risk of stroke in the high decreasing PA trajectory group was not statistically significant.The joint effects of sleep and PA showed lower risks of heart disease and stroke in trajectories with moderate or long sleep duration and high stable PA compared with short sleep duration and a low stable PA trajectory.Conclusions Short total sleep duration,high decreasing PA,and low stable PA trajectories could increase the risk of CVDs among middle-aged and older adults.Long-term moderate to long total sleep durations and high stable PA trajectories might be optimal for preventing CVDs.
文摘BACKGROUND Patients with type 2 diabetes mellitus(T2DM)face a heightened risk of future cardiovascular events.It is therefore important to stratify these patients according to their future cardiovascular event risk to allow early intervention and improve prognosis.Recent proposals have indicated that nontraditional lipoprotein ratios may be superior predictors of cardiovascular events compared to traditional lipid parameters.However,further evidence is required for widespread clinical ap-plication.AIM To elucidate the associations of nontraditional lipoprotein ratios with future cardiovascular events in patients with T2DM.METHODS This study performed post-hoc analysis of data obtained during a clinical trial involving 10182 participants.To ascertain the correlations between nontraditional lipoprotein ratios and future cardiovascular events,including major adverse cardiovascular events(MACEs)and congestive heart failure(CHF).We employed univariable and multivariable-adjusted Cox proportional hazards regression models.Potential dose-response relationships and threshold values were explored by conducting restricted cubic spline analyses and two-piecewise linear regression models.Possible relevant interactions influencing independent relationships were tested using subgroup and interaction analyses.RESULTS After adjustment for confounding factors,all nontraditional lipoprotein ratios studied were strongly associated with MACE risk in patients with T2DM.In comparison with patients in the lowest quartile,the hazard ratios(95%confidence intervals)of those in the highest quartile were 1.50(1.29-1.73),1.51(1.30-1.74),1.50(1.29-1.73),and 1.30(1.12-1.50)for total cholesterol/high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.Similar findings were noted for CHF.Dose-response relationships between nontraditional lipoprotein ratios and MACE were observed,with threshold values of 7.29,6.29,and 2.15 for total cholesterol/HDL-C,non-HDL-C/HDL-C,and remnant cholesterol/HDL-C,respectively.However,no notable dose-response relationships were detected between nontraditional lipoprotein ratios and CHF.CONCLUSION Elevated nontraditional lipoprotein ratios may independently predict the risk of MACE and CHF in patients with T2DM.
文摘BACKGROUND Metabolic dysfunction-associated fatty liver disease(MAFLD)and type 2 diabetes mellitus(T2DM)are independent risk factors for the development of cardiovascular disease(CVD)and an exaggerated CVD risk is expected when both diseases co-exist.Therefore,thorough risk stratification is important to inform better clinical practice decisions based on good quality evidence for patient with MAFLD and T2DM.AIM To identify the CVD and cardiovascular event(CVE)risk in a systematic review when MAFLD and T2DM co-exist to inform better clinical practice decisions.METHODS A systematic review was performed by compiling data by searching PubMed,EMBASE and Cochrane Library databases.Quality appraisal of retrieved studies and the meta-analysis were performed using Joanna Briggs Institute(JBI)tool and RevMan 5.4 software respectively.The effect indicators for CVE and CVD risk were expressed as odds ratios(OR)and 95%CI with P-values<0.05 as significant.RESULTS Fourteen(5 cohort and 9 cross-sectional)studies with 370013 participants were included in this review.The metaanalysis of CVE showed that the risk of CVE in T2DM was higher in the MAFLD group when compared to the non-MAFLD group[OR 1.28(95%CI,1.04-1.56)P=0.02]with follow up duration ranging between 5-6 years.The prevalence of CVD in the metanalysis of cross-sectional studies was found to be higher[OR 1.47(95%CI,1.21-1.78)P=0.0001]in T2DM with MAFLD when compared to T2DM without MAFLD.Significant heterogeneity exists due to variations in study design,methodologies,and MAFLD diagnostic criteria,which may have influenced the study's findings.CONCLUSION The presence of MAFLD in T2DM increased the risk of CVE.The prevalence of CVD is higher in T2DM with MAFLD as compared to T2DM without MAFLD.Large well-designed multicentric long-term prospective studies are necessary to appropriately risk stratify the cardiovascular effect of the MAFLD in T2DM patients.
文摘Metabolic-associated fatty liver disease(MAFLD),formerly known as nonalcoho-lic fatty liver disease,is an increasing global health challenge with substantial implications for metabolic and cardiovascular health(CVH).A recent study by Fu et al investigated the relationship between CVH metrics,specifically Life’s Simple 7 and Life’s Essential 8,and the prevalence of MAFLD.While this study offered important insights into the relationship between CVH and MAFLD,several me-thodological limitations,unaddressed confounding factors,and potential biases that could impact the interpretation of their findings should be considered.The study’s cross-sectional nature restricted the ability to draw causal conclusions,and it did not fully account for potential confounding factors such as dietary habits,genetic predispositions,and medication use.Furthermore,relying on tran-sient elastography to diagnose MAFLD introduces certain diagnostic limitations.Longitudinal study designs,advanced statistical modeling techniques,and diverse population groups should be utilized to strengthen future research.Exploring the mechanistic pathways that link CVH metrics to MAFLD through multi-omics approaches and interventional studies will be essential in formulating targeted prevention and treatment strategies.Structural equation modeling and machine learning techniques could provide a more refined analysis of these interrelated factors.Additionally,future research should employ longitudinal study designs and explore genetic and epigenetic influences to enhance our un-derstanding of CVH and MAFLD interactions.
文摘Type 2 diabetes mellitus is associated with a 2-4 times increased risk of cardiovascular(CV)disease.Glucagon-like polypeptide-1 receptor agonists(GLP1RA)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)are two important classes of drugs with CV benefits independent of their antihyperglycemic efficacy.The CV outcome trials of both GLP1RA and SGLT2i have demonstrated CV superiority/neutrality concerning major adverse CV events(MACE).While GLP1RAs have exhibited a significant reduction in ischemic stroke and myocardial infarction(MI),SGLT2i have demonstrated a uniformly significant reduction in hospitalization for heart failure(HF)as a class effect.The unique clinical benefits and the distinct but complementary mechanisms of action make the combination of these drugs a mechanistically sound one.Recent meta-analyses suggest an independent and additive benefit of combination therapy of GLP1RA/SGLT2i vs monotherapy.Zhu et al,in a recent issue of the World Journal of Diabetes,demonstrates a numerically lower hazard ratio(HR)for CV outcomes with combination therapy vs monotherapy with either agent,with a reduction in MACE compared to GLP1RA alone[HR=0.51,95%confidence interval(CI):0.16-1.65],or SGLT2i alone(HR=0.48,95%CI:0.15-1.54).The CV death rate was also lower with combination therapy compared to GLP1RA alone(HR=0.58,95%CI:0.08-3.39),or SGLT2i alone(HR=0.55,95%CI:0.07-3.25).Fatal and non-fatal MI and fatal and non-fatal stroke were reduced with combination therapy compared to GLP1RA alone(HR=0.45,95%CI:0.10-2.18 and HR=0.86,95%CI:0.12-6.23,respectively),or SGLT2i alone(HR=0.44,95%CI:0.09-2.10 and HR=0.74,95%CI:0.10-5.47,respectively).Hospitalization for HF was prevented with combination therapy compared to GLP1RA alone(HR=0.26,95%CI:0.03-1.88),or SGLT2i alone(HR=0.33,95%CI:0.04-2.53).They also demonstrated that GLP1RA or SGLT2i monotherapy may not provide significant improvement in CV death and recurrent MI in patients with prior MI or HF,proposing a role for combination therapy in this subgroup.Appropriate patient selection is vital to optimize CV risk reduction as well as the cost-effectiveness of this combination therapy.
文摘BACKGROUND Recent studies have indicated that triglyceride glucose(TyG)-waist height ratio(WHtR)and TyG-waist circumference(TyG-WC)are effective indicators for evaluating insulin resistance.However,research on the association in TyG-WHtR,TyG-WC,and the risk and prognosis of major adverse cardiovascular events(MACEs)in type 2 diabetes mellitus(T2DM)cases are limited.AIM To clarify the relation in TyG-WHtR,TyG-WC,and the risk of MACEs and overall mortality in T2DM patients.METHODS Information for this investigation was obtained from Action to Control Cardiovascular Risk in Diabetes(ACCORD)/ACCORD Follow-On(ACCORDION)study database.The Cox regression model was applied to assess the relation among TyG-WHtR,TyG-WC and future MACEs risk and overall mortality in T2DM cases.The RCS analysis was utilized to explore the nonlinear correlation.Subgroup and interaction analyses were conducted to prove the robustness.The receiver operating characteristic curves were applied to analysis the additional predicting value of TyG-WHtR and TyG-WC.RESULTS After full adjustment for confounding variables,the highest baseline TyG-WHtR cohort respectively exhibited a 1.353-fold and 1.420-fold higher risk for MACEs and overall mortality,than the lowest quartile group.Similarly,the highest baseline TyG-WC cohort showed a 1.314-fold and 1.480-fold higher risk for MACEs and overall mortality,respectively.Each 1 SD increase in TyG-WHtR was significantly related to an 11.7%increase in MACEs and a 14.9%enhance in overall mortality.Each 1 SD increase in TyG-WC corresponded to an 11.5%in MACEs and a 16.6%increase in overall mortality.Including these two indexes in conventional models significantly improved the predictive power for MACEs and overall mortality.CONCLUSION TyG-WHtR and TyG-WC were promising predictors of MACEs and overall mortality risk in T2DM cases.
文摘Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals.This direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced artifacts.In pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young age.Enhanced spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart defects.Additionally,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media doses.Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular cases.As PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.
