Objectives This study aimed to examine the associations between depression,resilience,and fatigue in patients with multivessel coronary disease and verify their causal relationships.Methods Between October 2023 and Ju...Objectives This study aimed to examine the associations between depression,resilience,and fatigue in patients with multivessel coronary disease and verify their causal relationships.Methods Between October 2023 and June 2024,316 patients with multivessel coronary disease were recruited from three tertiary hospitals in Tangshan,China.The Patient Health Questionnaire,Connor-Davidson Resilience Scale,and the Multidimensional Fatigue Inventory were administered to the patients on the third day of admission(T1),one month after discharge(T2),and three months after discharge(T3).Pearson correlation analysis was conducted to examine the relationships among depression,resilience,and fatigue in patients with multivessel coronary disease,and cross-lagged analysis to explore the temporal causal relationships.Results In patients with multivessel coronary disease,levels of depression and fatigue decreased from T1 to T3,while resilience scores increased during the same period.The correlation analysis revealed significant relationships among depression,resilience,and fatigue at T1,T2,and T3(P<0.01).The autoregressive paths indicated high stability over time for depression,medium stability for resilience,and low stability for fatigue.Cross-lagged paths demonstrated that depression at T1 significantly predicted fatigue at T2(β=0.461,P<0.001),and depression at T2 significantly predicted fatigue at T3(β=0.957,P<0.001).And resilience at T1 significantly predicted fatigue at T2(β=−0.271,P<0.001),and resilience at T2 significantly predicted fatigue at T3(β=−0.176,P<0.001).Additionally,resilience had a moderating effect on the relationship between depression and fatigue(β=−0.760,P<0.001).Conclusions Our study confirmed that depression and resilience predicted fatigue in patients with multivessel coronary disease.To prevent and mitigate fatigue,alleviating depressive symptoms and enhancing resilience levels in patients at an early stage is essential.展开更多
Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction （STEMI） pa- tients during admission is still debatable. Methods A total of 1406 STEMI patients from t...Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction （STEMI） pa- tients during admission is still debatable. Methods A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention （PPCI） were analyzed. We used propensity score matching （PSM） to control differences of baseline characteristics between culprit only intervention （CP） and multivessel percutaneous coronary interventions （MP）, and between double vessel disease （DVD） and triple vessel disease （TVD）. The major adverse cardiac event （MACE） was analyzed for one year after discharge. Results TVD patients showed higher incidence of MACE （14.2% vs. 8.6%, P = 0.01）, any cause of revascularization （10.6% vs. 5.9%, P - 0.01）, and repeated PCI （9.5% vs. 5.7%, P = 0.02）, as compared to DVD patients during one year after discharge. MP reduced MACE effectively （7.3% vs. 13.8%, P = 0.03）, as compared to CP for one year, but all cause of death （1.6% vs. 3.2%, P= 0.38）, Ml （0.4% vs. 0.8%, P = 1.00）, and any cause ofrevascularization （5.3% vs. 9.7%, P = 0.09） were comparable in the two treatment groups. Conclusions STEMI patients with TVD showed higher rate of MACE, as compared to DVD MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.展开更多
Background Statins reduce adverse cardiovascular outcomes and slow the progression of coronary atherosclerosis in proportion to their ability to reduce low-density lipoprotein （LDL） cholesterol. However, few studies...Background Statins reduce adverse cardiovascular outcomes and slow the progression of coronary atherosclerosis in proportion to their ability to reduce low-density lipoprotein （LDL） cholesterol. However, few studies have either assessed the ability of intensive statin treatments to achieve disease regression or compared alternative approaches to maximal statin administration.展开更多
Background Thiazolidinediones （TZDs） not only improve insulin resistance, lowering blood sugar, also has anti-atherosclerotic effect. However, whether the protective effect on cardiovascular pioglitazone is still co...Background Thiazolidinediones （TZDs） not only improve insulin resistance, lowering blood sugar, also has anti-atherosclerotic effect. However, whether the protective effect on cardiovascular pioglitazone is still controversial. Methods Totally 98 patients with coronary disease and diabetes mellitus were randomly divided into pioglitazone group （n = 48） receiving conventional therapy and pioglitazone （15 mg/day）, and control group （n = 50） merely receiving conventional therapy. The patients were followed up for 12 months. The plasma level of Plasminogen activator Inhibitor 1 （PAI-1） and P-selectin were detected at baseline and after treatment for 12 months by ELISA, and major adverse cardiac events （MACE） were studied. Results Pioglitazone therapy for 12 months was associated with a significant decrease of PAI-1 [（7.9 ± 1.4 vs 4.2 ± 0.5）ng/mL, P 〈 0.05] and P-selectin [（16.6 ± 6.8 vs 12.4 ± 3.6）ng/mL, P 〈 0.05], MACE was significantly lower in the pioglitazone group than in the control group [acute coronary syndrome （ACS）： 32.0% vs 10.4%, P 〈 0.05; target vessel revascularization： 22.0% vs 6.3%, P 〈 0.05 ]. Conclusions Pioglitazone can effectively reduce the plasma level of PAI-1, P-selectin and the occurrence of MACE in patients with coronary heart disease and diabetes mellitus.展开更多
Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study i...Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy （OMT） and revascularization-plus-OMT in elderly patients with high-risk angina. Methods In this prospective non-randomized study, 241 consecutive high-risk elderly male patients （65-92 years of age） with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. Results After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who under- went OMT than in those who underwent revascularization （6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04）. However, the overall risks of major adverse cardiac cerebrovascular events （MACCE） were similar among all patients （6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67）. Conclusions OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease.展开更多
Background and objective The value of D-dimer in the risk stratification of patients with coronary artery disease(CAD)and the relationship between D-dimer and the diseased coronary arteries remains controversial or un...Background and objective The value of D-dimer in the risk stratification of patients with coronary artery disease(CAD)and the relationship between D-dimer and the diseased coronary arteries remains controversial or unclear,especially in the elderly.This study was to evaluate the usefulness of D-dimer as a biomarker in assessing the vulnerable blood in the elderly patients with coronary disease.Methods Sixty elderly(≥60 years old)male patients with suspected CAD were enrolled in this prospective study.Patients were divided into CAD group(n=41,10 with stable angina and 31 with unstable angina)and control group(n=19)according to their coronary angiography Results Clinical information including age,body mass index(BMI),smoking index,and the complications of primary hypertension or diabetes,and CAD family history was collected.Venous blood was sampled serially for the determination of total cholesterol,HDL cholesterol,LDL cholesterol,triglycerides,apoA1,apoB,glucose,uric acid,homocysteine(Hcy),hs-CRP,soluble thrombomodulin(sTM),and markers of fibrinolytic system and hypercoagulability,such as D-dimer,fibrinogen,etc.The extent of coronary atherosclerosis was assessed,using the Gensini scoring system on the basis of coronary angiography.Results Compared with the controls,the patients with CAD had significantly higher levels of D-dimer.D-dimer level was significantly correlated to age,hs-CRP,Hcy,and PAI-1.Patients with D-dimer levels in the top triplicate of D-dimer level had significantly higher prevalence of unstable angina compared with patients in the lowest triplicate(OR=4.8,Z=3.28,P=0.001).In an ordinal logistic regression,the OR value of developing more serious CAD augmented 3.1-fold with each increasing triplicate of D-dimer.Patients with unstable angina had a significantly higher level of D-dimer than the controls(P=0.005),and an increasing trend compared with patients with stable angina(P=0.059),whereas there was no difference between the patients with stable angina and the controls(P=0.885).D-dimer was significantly correlated with Gensini scores(r=0.3930,P=0.0019).Ordinal logistic regression showed that the OR value of increasing one or two triplicates of Genslni’s scores augmented 1.44-fold with each increasing triplicate of D-dimer(OR=2.44,Z=2.87,P=0.004).Conclusions D-dimer may be a helpful biomarker in identifying the severity of vulnerable blood in elderly patients with CAD.展开更多
Background There is still limited data on predictive value of coronary computed tomography angiography(CCTA)–derived fractional flow reserve(CT-FFR) for long term outcomes. We examined the long-term prognostic value ...Background There is still limited data on predictive value of coronary computed tomography angiography(CCTA)–derived fractional flow reserve(CT-FFR) for long term outcomes. We examined the long-term prognostic value of CT-FFR combined with CCTA–defined atherosclerotic extent in diabetic patients with coronary artery disease(CAD).Methods A retrospective pooled analysis of individual patient data was performed. Deep-learning-based vessel-specific CTFFR was calculated. All patients enrolled were followed-up for at least 5 years. Predictive abilities for major adverse cardiac events(MACE) were compared among three models(model 1), constructed using clinical variables;model 2, model 1+CCTA–derived atherosclerotic extent(Leiden risk score);and model 3, model 2+CT-FFR.Results A total of 480 diabetic patients [median age, 61(55–66) years;52.9% men] were included. During a median follow-up time of 2197(2126–2355) days, 55 patients(11.5%) experienced MACE. In multivariate-adjusted Cox models, Leiden risk score(HR: 1.06;95% CI: 1.01–1.11;P = 0.013) and CT-FFR ≤ 0.80(HR: 6.54;95% CI: 3.18–13.45;P < 0.001) were the independent predictors. The discriminant ability was higher in model 2 than in model 1(C-index, 0.75 vs. 0.63;P < 0.001) and was further promoted by adding CT-FFR to model 3(C-index, 0.81 vs. 0.75;P = 0.002). Net reclassification improvement(NRI) was 0.19(P = 0.009) for model 2 beyond model 1. Of note, adding CT-FFR to model 3 also exhibited significantly improved reclassification compared with model 2(NRI = 0.14;P = 0.011).Conclusion In diabetic patients with CAD, CT-FFR provides robust and incremental prognostic information for predicting longterm outcomes. The combined model exhibits improved prediction abilities, which is beneficial for risk stratification.展开更多
As one of the main chronic diseases in modern society,coronary heart disease,as a major disease that affects people’s lives and health,has the characteristics of hidden onset and sudden onset.Coronary heart disease h...As one of the main chronic diseases in modern society,coronary heart disease,as a major disease that affects people’s lives and health,has the characteristics of hidden onset and sudden onset.Coronary heart disease has relatively clear risk factors.Among them,blood lipid levels and blood sugar levels,as two main risk factors,play an important role in promoting the onset of coronary heart disease.The two complement each other in a vicious cycle,synergize and promote each other,promote the process of coronary atherosclerosis,thereby causing coronary heart disease.Multiple components in blood lipids and poor management of long-term blood sugar levels play a major role in specific clinical problems.This article reviews the different components of blood lipids and the effects of hyperglycemia on coronary heart disease,and initially expounds the mechanism by which blood lipids and blood sugar levels synergize each other to aggravate the risk of coronary heart disease,and combines them with relevant clinical issues,in order to help clinicians guide the prevention of coronary heart disease in terms of blood lipids and blood sugar levels.展开更多
Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods W...Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.展开更多
BACKGROUND The atherogenic index of plasma(AIP)has been shown to be positively correlated with cardiovascular disease in previous studies.However,it is unclear whether elderly people with long-term high AIP levels are...BACKGROUND The atherogenic index of plasma(AIP)has been shown to be positively correlated with cardiovascular disease in previous studies.However,it is unclear whether elderly people with long-term high AIP levels are more likely to develop coronary heart disease(CHD).Therefore,the aim of this study was to investigate the relationship between AIP trajectory and CHD incidence in elderly people.METHODS 19,194 participants aged≥60 years who had three AIP measurements between 2018 and 2020 were included in this study.AIP was defined as log10(triglyceride/high-density lipoprotein cholesterol).The group-based trajectory model was used to identify different trajectory patterns of AIP from 2018 to 2020.Cox proportional hazards models were used to estimate the hazard ratio(HR)with 95%CI of CHD events between different trajectory groups from 2020 to 2023.RESULTS Three different trajectory patterns were identified through group-based trajectory model:the low-level group(n=7410,mean AIP:-0.25 to-0.17),the medium-level group(n=9981,mean AIP:0.02-0.08),and the high-level group(n=1803,mean AIP:0.38-0.42).During a mean follow-up of 2.65 years,a total of 1391 participants developed CHD.After adjusting for potential confounders,compared with the participants in the low-level group,the HR with 95%CI of the medium-level group and the high-level group were estimated to be 1.24(1.10-1.40)and 1.43(1.19-1.73),respectively.These findings remained consistent in subgroup analyses and sensitivity analyses.CONCLUSIONS There was a significant correlation between persistent high AIP level and increased CHD risk in the elderly.This suggests that monitoring the long-term changes in AIP is helpful to identify individuals at high CHD risk in elderly people.展开更多
BACKGROUND Coronary heart disease(CHD)has shown a consistent upward trend in global incidence in recent years.Notably,older adults with CHD complicated by arrhy-thmia exhibit significantly higher susceptibility to psy...BACKGROUND Coronary heart disease(CHD)has shown a consistent upward trend in global incidence in recent years.Notably,older adults with CHD complicated by arrhy-thmia exhibit significantly higher susceptibility to psychological distress com-pared with the general CHD population.This increased vulnerability has garn-ered growing clinical and research interest in the potential therapeutic benefits of structured psychological interventions for alleviating comorbid depressive and anxiety symptoms in this high-risk demographic.AIM To evaluate the efficacy of psychological care in reducing anxiety and depressive symptoms among older adult patients with CHD and comorbid arrhythmia.METHODS This retrospective analysis included 100 patients with CHD and arrhythmia admitted to the First Affiliated Hospital of Jinzhou Medical University from June 2024 to December 2024.Of these,49 patients in the control group received routine care,whereas 51 patients in the observation group received psychological care in addition to routine care.Therapeutic outcomes were compared between the two groups.Psychological distress was assessed before and after providing nursing care.A treatment compliance scale developed by the hospital was used to assess adherence.Complication rates were also compared.Quality of life was evaluated using the Short Form-36 Health Survey after providing nursing care.Patient satisfaction with nursing care was assessed using a self-designed questionnaire.RESULTS The observation group demonstrated a higher overall treatment effectiveness compared with the control group(P<0.05).After nursing care,both groups showed reduced scores on the Self-Rating Anxiety Scale and Self-Rating Depression Scale compared with baseline(P<0.05),with significantly greater improvements in the observation group(P<0.05).Treatment compliance was higher and complication rates were lower in the observation group(P<0.05).Additionally,the observation group demonstrated better quality of life after 1 month of care and higher satisfaction with nursing services(P<0.05).CONCLUSION Psychological care for patients with CHD and comorbid arrhythmia effectively enhanced therapeutic outcomes,reduced anxiety and depression,improved treatment compliance and quality of life,and lowered the risk of complications.These findings support the broader implementation of psychological care for patients with CHD in clinical practice.展开更多
Interleukins(ILs),a subset of cytokines,play a critical role in the pathogenesis of coronary heart disease(CHD)by mediating inflammation.This review article summarizes the role of ILs such as IL-1,IL-2,IL-3,IL-4,IL-5,...Interleukins(ILs),a subset of cytokines,play a critical role in the pathogenesis of coronary heart disease(CHD)by mediating inflammation.This review article summarizes the role of ILs such as IL-1,IL-2,IL-3,IL-4,IL-5,IL-6,IL-7,IL-8,IL-9,and IL-10 in the pathogenesis of CHD.Individuals with mild coronary artery disease(CAD)and angina who have ischemic heart disease have higher serum concentrations of IL-1b.Larger studies are needed to verify the safety and assess the effectiveness of low-dose IL-2 as an anti-inflammatory treatment.IL-3 is found more often in patients receiving coronary angioplasty compared to patients with asymptomatic CAD or without CAD.Serum levels of IL-4 are reliable indicators of CAD.An independent correlation between IL-5 and the incidence of CAD was demonstrated.IL-6 helps serve as a reliable biomarker for the degree of CAD,as determined by the Gensini score,and is a key factor in the development of atherosclerosis.Also,variants of IL-7/7R have been linked to the Han Chinese population's genetic susceptibility to CHD.IL-8 plays a role in the progression of CAD occurrences.By interacting with conventional risk factors for CAD,IL-9 may contribute to the development of CAD and offer an innovative approach to its prevention and management.There was a 34%increased risk of a CHD incident for every standard deviation rise in baseline IL-10 levels.展开更多
Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide ...Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide mononitrate sustained-release capsules(IMSRC)combined with conventional treatments,compared to isosorbide mononitrate tablets(IMT)combined with conventional treatments,for managing angina pectoris in patients with coronary heart diseases.A network meta-analysis(NMA)was conducted to assess the efficacy and safety of IMSRC and IMT.Relevant literature was sourced from databases,including PubMed,Embase,Cochrane Library,ScienceDirect,Web of Science,CNKI,Wanfang,and VIP,covering publications up to July 2023.The cost-effectiveness analysis(CEA)was performed from the perspective of China’s healthcare system,utilizing inputs derived from the NMA.The analysis included 15 studies.The NMA results revealed no significant difference in efficacy and safety between IMSRC plus conventional treatments and IMT plus conventional treatments.However,both combinations were more effective than conventional treatments without isosorbide mononitrate.No differences in safety were observed among the three groups.The surface under the cumulative ranking(SUCRA)of the NMA indicated that IMT had a slight edge over IMSRC in the total effective rate of angina pectoris,whereas IMSRC showed higher probabilities for markedly effective rate and ECG effective rate compared to IMT.The incidence of adverse events was ranked as IMT>conventional preparation>IMSRC.The CEA results highlighted that the incremental cost-effectiveness ratios(ICERs)for the markedly effective and total effective rates of angina pectoris were-133.41 and-260.20,respectively.The ICERs for ECG effective rates were-83.34 and-234.24,respectively.In conclusion,while IMSRC combined with conventional treatments and IMT combined with conventional treatments were similar in efficacy and safety,IMSRC proved to be more economical.展开更多
BACKGROUND The persistent burden of cardiovascular(CV)disease in the United States requires innovative and cost-effective prognostic markers that can be relied upon.AIM To provide insights into how adiponectin can pre...BACKGROUND The persistent burden of cardiovascular(CV)disease in the United States requires innovative and cost-effective prognostic markers that can be relied upon.AIM To provide insights into how adiponectin can predict all-cause mortality and major adverse CV events(MACE)in patients with coronary artery disease(CAD)and to determine the prognostic value of adiponectin in predicting all-cause mortality and MACE in patients with stable CAD.METHODS We conducted a systematic search on PubMed,Scopus,and Google Scholar to find relevant studies published through June 2023 evaluating the long-term prognostic role of adiponectin in patients with stable CAD.Using a random effects model with 95%CI,we estimated the odds ratio(OR)while assessing heterogeneity through I^(2)statistics.To ensure robustness,we performed a sensitivity analysis using the leave-one-out approach.RESULTS After screening,we included five prospective studies involving 3225 patients who were followed up for a median duration of 3.8 years.Within the study population,prevalent risk factors included hypertension,diabetes,hyperlipidemia,and smoking.The commonly prescribed medications were angiotensin-converting enzyme inhibitors,beta blockers,and statins.The combined adjusted OR for all-cause mortality was found to be 2.51(95%CI:1.36–4.62),showing heterogeneity(I^(2)=65.51%,P=0.03).On the other hand,the combined adjusted OR for MACE was determined to be 1.04(95%CI:1.02–1.06)with no significant heterogeneity observed(I^(2)=0%,P=0.68).Through a sensitivity analysis,it was discovered that none of the studies significantly impacted the overall results of the meta-analysis,thus indicating their robustness.CONCLUSION Higher levels of adiponectin were found to be associated with an increased risk of long-term mortality and MACE in patients with CAD,which highlights its potential as a cost-effective marker for risk assessment and guiding treatment strategies.Further research on the role of adiponectin could greatly influence decision-making and resource allocation in CV care.展开更多
BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships bet...BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships between postdischarge cancers and all-cause mortality and cardiovascular mortality in CAD patients.METHODS In this retrospective cohort study,25%of CAD patients without prior cancer history who underwent coronary artery angiography between January 1,2011 and December 31,2015,were randomly enrolled using SPSS 26.0.Patients were monitored for the incidence of postdischarge cancer,which was defined as cancer diagnosed after the index hospitalization,survival status and cause of death.Cox regression analysis was used to explore the association between postdischarge cancer and all-cause mortality and cardiovascular mortality in CAD patients.RESULTS A total of 4085 patients were included in the final analysis.During a median follow-up period of 8 years,174 patients(4.3%)developed postdischarge cancer,and 343 patients(8.4%)died.A total of 173 patients died from cardiovascular diseases.Postdischarge cancer was associated with increased all-cause mortality risk(HR=2.653,95%CI:1.727–4.076,P<0.001)and cardiovascular mortality risk(HR=2.756,95%CI:1.470–5.167,P=0.002).Postdischarge lung cancer(HR=5.497,95%CI:2.922–10.343,P<0.001)and gastrointestinal cancer(HR=1.984,95%CI:1.049–3.750,P=0.035)were associated with all-cause mortality in CAD patients.Postdischarge lung cancer was significantly associated with cardiovascular death in CAD patients(HR=4.979,95%CI:2.114–11.728,P<0.001),and cardiovascular death was not significantly correlated with gastrointestinal cancer or other types of cancer.CONCLUSIONS Postdischarge cancer was associated with all-cause mortality and cardiovascular mortality in CAD patients.Compared with other cancers,postdischarge lung cancer had a more significant effect on all-cause mortality and cardiovascular mortality in CAD patients.展开更多
Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to...Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to explore the association of SIRI with all-cause and cause-specific mortality in a nationally representative sample of CAD patients from United States.Methods A total of 3386 participants with CAD from the National Health and Nutrition Examination Survey(NHANES)1999-2018 were included in this study.Cox proportional hazards model,restricted cubic spline(RCS),and receiver operating characteristic curve(ROC)were performed to investigate the association of SIRI with all-cause and cause-specific mortality.Piecewise linear regression and sensitivity analyses were also performed.Results During a median follow-up of 7.7 years,1454 all-cause mortality occurred.After adjusting for confounding factors,higher lnSIRI was significantly associated with higher risk of all-cause(HR=1.16,95%CI:1.09-1.23)and CVD mortality(HR=1.17,95%CI:1.05-1.30)but not cancer mortality(HR=1.17,95%CI:0.99-1.38).The associations of SIRI with all-cause and CVD mortality were detected as J-shaped with threshold values of 1.05935 and 1.122946 for SIRI,respectively.ROC curves showed that lnSIRI had robust predictive effect both in short and long terms.Conclusions SIRI was independently associated with all-cause and CVD mortality,and the dose-response relationship was Jshaped.SIRI might serve as a valid predictor for all-cause and CVD mortality both in the short and long terms.展开更多
Background Frailty is a major determinant of outcomes in patients with coronary artery disease(CAD)undergoing lower limb amputation.This study evaluates the impact of frailty on in-hospital outcomes in these patients....Background Frailty is a major determinant of outcomes in patients with coronary artery disease(CAD)undergoing lower limb amputation.This study evaluates the impact of frailty on in-hospital outcomes in these patients.Methods We performed a retrospective analysis of the National Inpatient Sample(2016–2021)to identify adult patients with CAD who underwent lower limb amputation.Frailty was defined using the Johns Hopkins Adjusted Clinical Groups(ACG)frailty indicator.Multivariable logistic regression was used to assess the independent association of frailty with in-hospital outcomes,and propensity score matching(PSM)was performed to further account for confounding factors.Results After PSM,9,990 patients were included in each cohort.Frail patients experienced higher rates of in-hospital mortality(3.9%vs.1.5%,P<0.001),acute limb ischemia(3.8%vs.3.1%,P=0.015),fasciotomy(2.1%vs.1.4%,P<0.001),stump infection(7.9%vs.6.6%,P<0.001),cardiogenic shock(0.9%vs.0.7%,P=0.032),sudden cardiac arrest(2.7%vs.2.1%,P=0.004),mechanical circulatory support(0.3%vs.0.2%,P=0.028),major adverse cardiac and cerebrovascular events(7.7%vs.5.4%,P<0.001),and sepsis(18.3%vs.13.8%,P<0.001).In multivariable logistic regression analysis,frailty remained an independent predictor of inhospital mortality and major complications.Conclusion Frailty is independently associated with increased in-hospital mortality and adverse events among CAD patients undergoing lower limb amputation.Incorporating frailty assessment into preoperative evaluation may improve risk stratification and guide clinical decision-making in this high-risk population.展开更多
Background and Objective Hypertension(HT)and atrial fibrillation(AF)are highly prevalent cardiovascular conditions that frequently coexist.Coronary artery disease(CAD)is a major global cause of mortality.The co-occurr...Background and Objective Hypertension(HT)and atrial fibrillation(AF)are highly prevalent cardiovascular conditions that frequently coexist.Coronary artery disease(CAD)is a major global cause of mortality.The co-occurrence of HT,AF,and CAD presents significant management challenges.This study aims to explore the clinical characteristics and risk factors associated with CAD in patients with HT and persistentAF(HT-AF).Methods In this retrospective cross-sectional study,data were collected from 384 hospitalized HT-AF patients at the People's Liberation Army General Hospital between January 2010 and December 2019.CAD diagnosis was confirmed by coronary angiography or computed tomography angiography.Clinical characteristics and comorbidities were compared between patients with and without CAD.Multivariate logistic regression analyses were performed to identify independent risk factors associated with CAD development.Results The prevalence of CAD among HT-AF patients was 66.41%(255/384).Cardiovascular complications,particularly heart failure(44.7%vs 25.6%,P<0.05),were significantly more prevalent in the CAD group than in the non-CAD group.Only age was identified as an independent risk factor for CAD(adjusted OR:1.047;95%CI:1.022–1.073;P=0.000).Of all HT-AF patients,54.7%had a CHA2DS2-VASc score of≥4,indicating high stroke risk.There was a slightly higher anticoagulant usage rate in the CAD group than those without CAD(8.6%vs 4.7%,P=0.157),and the overall anticoagulant usage remained low.Conclusion There is a high prevalence of CAD among hospitalized HT-AF patients,among whom age is the sole independent risk factor for CAD.Despite a high stroke risk,the utilization of oral anticoagulants is alarmingly low.展开更多
Background Coronary heart disease with myocardial ischemia is closely associated with vascular endothelial dysfunction,dyslipidemia,and chronic inflammatory response.Atorvastatin,a classic lipid-lowering agent,exhibit...Background Coronary heart disease with myocardial ischemia is closely associated with vascular endothelial dysfunction,dyslipidemia,and chronic inflammatory response.Atorvastatin,a classic lipid-lowering agent,exhibits pleiotropic effects including plaque stabilization,endothelial function improvement,and anti-inflammatory actions.Nicorandil,as a potassium channel opener with additional nitrate-like effects,directly dilates coronary arteries and improves myocardial microcirculation.Theoretically,the two drugs may synergistically enhance myocardial perfusion and endothelial function through distinct mechanisms.However,clinical evidence regarding the comprehensive impact of their combination on vascular endothelial function,blood lipid profiles,and systemic inflammatory status in patients with coronary heart disease and myocardial ischemia remains insufficient.Further studies are warranted to clarify their synergistic effects and clinical value.Methods A total of 60 patients with coronary heart disease and myocardial ischemia admitted to our hospital from January 2023 to October 2024 were enrolled and randomly divided into combination group and control group using a random number table,with 30 patients in each group.The control group received atorvastatin treatment,while the combination group received nicorandil combined with atorvastatin.After 12 weeks of continuous treatment,the clinical efficacy,vascular endothelial function,blood lipid profiles,inflammatory factors,and adverse reactions were compared between the two groups.Results The total effective rate in the combination group(93.33%)was significantly higher than that in the control group(70.00%)(P<0.05).After treatment,serum endothelin(ET)level was lower in the combination group than in the control group(P<0.05),while nitric oxide(NO)level was higher(P<0.05).In the combination group,the levels of total cholesterol(TC),triglyceride(TG),and low-density lipoprotein cholesterol(LDL-C)were all lower than those in the control group(P<0.05),while high-density lipoprotein cholesterol(HDL-C)level was higher(P<0.05).Levels of C-reactive protein(CRP),interleukin(IL)-8,and IL-6 in the combination group were also lower compared with the control group(P<0.05).No significant difference was observed in the incidence of adverse reactions between the two groups(P>0.05).Conclusions The combination of nicorandil and atorvastatin demonstrated certain short-term therapeutic effects in patients with coronary heart disease and myocardial ischemia.It not only effectively improves vascular endothelial function and regulates lipid metabolism but also suppresses the levels of inflammatory factors,with a favorable safety profile.展开更多
Colchicine is one of the most widely used drugs in the world.While it is most commonly used in the treatment and prevention of gout,it is also widely used to treat other chronic inflammatory diseases,such as familial ...Colchicine is one of the most widely used drugs in the world.While it is most commonly used in the treatment and prevention of gout,it is also widely used to treat other chronic inflammatory diseases,such as familial Mediterranean fever and Behçet’s disease.Regarding cardiovascular disease,an established use of colchicine concerns pericarditis,both acute and chronic,and its effectiveness in this context is supported by multiple studies and robust evidence.Regarding coronary artery disease(CAD),colchicine use has been endorsed in both acute and chronic coronary syndromes(CCS),primarily because of two randomized controlled trials:The COLCOT trial for patients with acute coronary syndromes(ACS)and the LoDoCo2 trial for patients with CCS.Considering this robust evidence,CCS 2024 European Society of Cardiology(ESC)Guidelines recommended 0.5 mg daily colchicine in patients with atherosclerotic CAD to reduce the risk of myocardial infarction,stroke and need for revascularization.However,a few months after the publication of 2024 ESC Guidelines on CCS,the“CLEAR”trial demonstrated that among patients who had experienced an acute myocardial infarction,when initiated shortly after the event and continued for a median of 3 years,colchicine did not reduce the incidence of the composite outcome of death from cardiovascular causes,recurrent myocardial infarction,stroke,or unplanned ischemia-driven coronary revascularization.This result casts doubt on the indication for colchicine use in ACS and weakens evidence that had previously led to the routine use of colchicine in clinical cardiology practice.This review aims to shed light on the current and past scientific evidence underlying the use of colchicine in ACS,CCS and cerebrovascular disease,and thus seeks to provide a quick yet effective tool for cardiologists facing the long-standing issue of reducing residual inflammatory risk in patients with coronary atherosclerotic disease.展开更多
基金supported by the Medical Science Research Project of Hebei(No.20241512).
文摘Objectives This study aimed to examine the associations between depression,resilience,and fatigue in patients with multivessel coronary disease and verify their causal relationships.Methods Between October 2023 and June 2024,316 patients with multivessel coronary disease were recruited from three tertiary hospitals in Tangshan,China.The Patient Health Questionnaire,Connor-Davidson Resilience Scale,and the Multidimensional Fatigue Inventory were administered to the patients on the third day of admission(T1),one month after discharge(T2),and three months after discharge(T3).Pearson correlation analysis was conducted to examine the relationships among depression,resilience,and fatigue in patients with multivessel coronary disease,and cross-lagged analysis to explore the temporal causal relationships.Results In patients with multivessel coronary disease,levels of depression and fatigue decreased from T1 to T3,while resilience scores increased during the same period.The correlation analysis revealed significant relationships among depression,resilience,and fatigue at T1,T2,and T3(P<0.01).The autoregressive paths indicated high stability over time for depression,medium stability for resilience,and low stability for fatigue.Cross-lagged paths demonstrated that depression at T1 significantly predicted fatigue at T2(β=0.461,P<0.001),and depression at T2 significantly predicted fatigue at T3(β=0.957,P<0.001).And resilience at T1 significantly predicted fatigue at T2(β=−0.271,P<0.001),and resilience at T2 significantly predicted fatigue at T3(β=−0.176,P<0.001).Additionally,resilience had a moderating effect on the relationship between depression and fatigue(β=−0.760,P<0.001).Conclusions Our study confirmed that depression and resilience predicted fatigue in patients with multivessel coronary disease.To prevent and mitigate fatigue,alleviating depressive symptoms and enhancing resilience levels in patients at an early stage is essential.
文摘Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction （STEMI） pa- tients during admission is still debatable. Methods A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention （PPCI） were analyzed. We used propensity score matching （PSM） to control differences of baseline characteristics between culprit only intervention （CP） and multivessel percutaneous coronary interventions （MP）, and between double vessel disease （DVD） and triple vessel disease （TVD）. The major adverse cardiac event （MACE） was analyzed for one year after discharge. Results TVD patients showed higher incidence of MACE （14.2% vs. 8.6%, P = 0.01）, any cause of revascularization （10.6% vs. 5.9%, P - 0.01）, and repeated PCI （9.5% vs. 5.7%, P = 0.02）, as compared to DVD patients during one year after discharge. MP reduced MACE effectively （7.3% vs. 13.8%, P = 0.03）, as compared to CP for one year, but all cause of death （1.6% vs. 3.2%, P= 0.38）, Ml （0.4% vs. 0.8%, P = 1.00）, and any cause ofrevascularization （5.3% vs. 9.7%, P = 0.09） were comparable in the two treatment groups. Conclusions STEMI patients with TVD showed higher rate of MACE, as compared to DVD MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.
文摘Background Statins reduce adverse cardiovascular outcomes and slow the progression of coronary atherosclerosis in proportion to their ability to reduce low-density lipoprotein （LDL） cholesterol. However, few studies have either assessed the ability of intensive statin treatments to achieve disease regression or compared alternative approaches to maximal statin administration.
文摘Background Thiazolidinediones （TZDs） not only improve insulin resistance, lowering blood sugar, also has anti-atherosclerotic effect. However, whether the protective effect on cardiovascular pioglitazone is still controversial. Methods Totally 98 patients with coronary disease and diabetes mellitus were randomly divided into pioglitazone group （n = 48） receiving conventional therapy and pioglitazone （15 mg/day）, and control group （n = 50） merely receiving conventional therapy. The patients were followed up for 12 months. The plasma level of Plasminogen activator Inhibitor 1 （PAI-1） and P-selectin were detected at baseline and after treatment for 12 months by ELISA, and major adverse cardiac events （MACE） were studied. Results Pioglitazone therapy for 12 months was associated with a significant decrease of PAI-1 [（7.9 ± 1.4 vs 4.2 ± 0.5）ng/mL, P 〈 0.05] and P-selectin [（16.6 ± 6.8 vs 12.4 ± 3.6）ng/mL, P 〈 0.05], MACE was significantly lower in the pioglitazone group than in the control group [acute coronary syndrome （ACS）： 32.0% vs 10.4%, P 〈 0.05; target vessel revascularization： 22.0% vs 6.3%, P 〈 0.05 ]. Conclusions Pioglitazone can effectively reduce the plasma level of PAI-1, P-selectin and the occurrence of MACE in patients with coronary heart disease and diabetes mellitus.
基金This study was supported by the grant from the National Natural Science Foundation of China （No. 81100160, 81470504）. The authors declare no conflicts of interest.
文摘Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy （OMT） and revascularization-plus-OMT in elderly patients with high-risk angina. Methods In this prospective non-randomized study, 241 consecutive high-risk elderly male patients （65-92 years of age） with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. Results After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who under- went OMT than in those who underwent revascularization （6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04）. However, the overall risks of major adverse cardiac cerebrovascular events （MACCE） were similar among all patients （6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67）. Conclusions OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease.
文摘Background and objective The value of D-dimer in the risk stratification of patients with coronary artery disease(CAD)and the relationship between D-dimer and the diseased coronary arteries remains controversial or unclear,especially in the elderly.This study was to evaluate the usefulness of D-dimer as a biomarker in assessing the vulnerable blood in the elderly patients with coronary disease.Methods Sixty elderly(≥60 years old)male patients with suspected CAD were enrolled in this prospective study.Patients were divided into CAD group(n=41,10 with stable angina and 31 with unstable angina)and control group(n=19)according to their coronary angiography Results Clinical information including age,body mass index(BMI),smoking index,and the complications of primary hypertension or diabetes,and CAD family history was collected.Venous blood was sampled serially for the determination of total cholesterol,HDL cholesterol,LDL cholesterol,triglycerides,apoA1,apoB,glucose,uric acid,homocysteine(Hcy),hs-CRP,soluble thrombomodulin(sTM),and markers of fibrinolytic system and hypercoagulability,such as D-dimer,fibrinogen,etc.The extent of coronary atherosclerosis was assessed,using the Gensini scoring system on the basis of coronary angiography.Results Compared with the controls,the patients with CAD had significantly higher levels of D-dimer.D-dimer level was significantly correlated to age,hs-CRP,Hcy,and PAI-1.Patients with D-dimer levels in the top triplicate of D-dimer level had significantly higher prevalence of unstable angina compared with patients in the lowest triplicate(OR=4.8,Z=3.28,P=0.001).In an ordinal logistic regression,the OR value of developing more serious CAD augmented 3.1-fold with each increasing triplicate of D-dimer.Patients with unstable angina had a significantly higher level of D-dimer than the controls(P=0.005),and an increasing trend compared with patients with stable angina(P=0.059),whereas there was no difference between the patients with stable angina and the controls(P=0.885).D-dimer was significantly correlated with Gensini scores(r=0.3930,P=0.0019).Ordinal logistic regression showed that the OR value of increasing one or two triplicates of Genslni’s scores augmented 1.44-fold with each increasing triplicate of D-dimer(OR=2.44,Z=2.87,P=0.004).Conclusions D-dimer may be a helpful biomarker in identifying the severity of vulnerable blood in elderly patients with CAD.
文摘Background There is still limited data on predictive value of coronary computed tomography angiography(CCTA)–derived fractional flow reserve(CT-FFR) for long term outcomes. We examined the long-term prognostic value of CT-FFR combined with CCTA–defined atherosclerotic extent in diabetic patients with coronary artery disease(CAD).Methods A retrospective pooled analysis of individual patient data was performed. Deep-learning-based vessel-specific CTFFR was calculated. All patients enrolled were followed-up for at least 5 years. Predictive abilities for major adverse cardiac events(MACE) were compared among three models(model 1), constructed using clinical variables;model 2, model 1+CCTA–derived atherosclerotic extent(Leiden risk score);and model 3, model 2+CT-FFR.Results A total of 480 diabetic patients [median age, 61(55–66) years;52.9% men] were included. During a median follow-up time of 2197(2126–2355) days, 55 patients(11.5%) experienced MACE. In multivariate-adjusted Cox models, Leiden risk score(HR: 1.06;95% CI: 1.01–1.11;P = 0.013) and CT-FFR ≤ 0.80(HR: 6.54;95% CI: 3.18–13.45;P < 0.001) were the independent predictors. The discriminant ability was higher in model 2 than in model 1(C-index, 0.75 vs. 0.63;P < 0.001) and was further promoted by adding CT-FFR to model 3(C-index, 0.81 vs. 0.75;P = 0.002). Net reclassification improvement(NRI) was 0.19(P = 0.009) for model 2 beyond model 1. Of note, adding CT-FFR to model 3 also exhibited significantly improved reclassification compared with model 2(NRI = 0.14;P = 0.011).Conclusion In diabetic patients with CAD, CT-FFR provides robust and incremental prognostic information for predicting longterm outcomes. The combined model exhibits improved prediction abilities, which is beneficial for risk stratification.
文摘As one of the main chronic diseases in modern society,coronary heart disease,as a major disease that affects people’s lives and health,has the characteristics of hidden onset and sudden onset.Coronary heart disease has relatively clear risk factors.Among them,blood lipid levels and blood sugar levels,as two main risk factors,play an important role in promoting the onset of coronary heart disease.The two complement each other in a vicious cycle,synergize and promote each other,promote the process of coronary atherosclerosis,thereby causing coronary heart disease.Multiple components in blood lipids and poor management of long-term blood sugar levels play a major role in specific clinical problems.This article reviews the different components of blood lipids and the effects of hyperglycemia on coronary heart disease,and initially expounds the mechanism by which blood lipids and blood sugar levels synergize each other to aggravate the risk of coronary heart disease,and combines them with relevant clinical issues,in order to help clinicians guide the prevention of coronary heart disease in terms of blood lipids and blood sugar levels.
基金supported by the R&D project of Pazhou Lab(Huangpu)under Grant 2023K0610the National Natural Science Foundation of China(Grants 12126602)+4 种基金the National Natural Science Foundation of China(Grants 82030102)the Shenzhen Medical Research Fund(Grants C2302001)the Shenzhen Science and Technology Innovation Committee(No.ZDSYS20200810171403013)the Chinese Postdoctoral Science Foundation(No.2022M721463)the Ministry of Science and Technology of China(Grants 2022YFC3702703).
文摘Objective This study aimed to investigate the impact of glycemic control and diabetes duration on subsequent myocardial infarction(MI)in patients with both coronary heart disease(CHD)and type 2 diabetes(T2D).Methods We conducted a retrospective cohort study of 33,238 patients with both CHD and T2D in Shenzhen,China.Patients were categorized into 6 groups based on baseline fasting plasma glucose(FPG)levels and diabetes duration(from the date of diabetes diagnosis to the baseline date)to examine their combined effects on subsequent MI.Cox proportional hazards regression models were used,with further stratification by age,sex,and comorbidities to assess potential interactions.Results Over a median follow-up of 2.4 years,2,110 patients experienced MI.Compared to those with optimal glycemic control(FPG<6.1 mmol/L)and shorter diabetes duration(<10 years),the fullyadjusted hazard ratio(HR)(95%Confidence Interval[95%CI])for those with a diabetes duration of≥10 years and FPG>8.0 mmol/L was 1.93(95%CI:1.59,2.36).The combined effects of FPG and diabetes duration on MI were largely similar across different age,sex,and comorbidity groups,although the excess risk of MI associated with long-term diabetes appeared to be more pronounced among those with atrial fibrillation.Conclusion Our study indicates that glycemic control and diabetes duration significant influence the subsequent occurrence of MI in patients with both CHD and T2D.Tailored management strategies emphasizing strict glycemic control may be particularly beneficial for patients with longer diabetes duration and atrial fibrillation.
基金supported by the National Key Research and Development Program of China(2017YFC1307705).
文摘BACKGROUND The atherogenic index of plasma(AIP)has been shown to be positively correlated with cardiovascular disease in previous studies.However,it is unclear whether elderly people with long-term high AIP levels are more likely to develop coronary heart disease(CHD).Therefore,the aim of this study was to investigate the relationship between AIP trajectory and CHD incidence in elderly people.METHODS 19,194 participants aged≥60 years who had three AIP measurements between 2018 and 2020 were included in this study.AIP was defined as log10(triglyceride/high-density lipoprotein cholesterol).The group-based trajectory model was used to identify different trajectory patterns of AIP from 2018 to 2020.Cox proportional hazards models were used to estimate the hazard ratio(HR)with 95%CI of CHD events between different trajectory groups from 2020 to 2023.RESULTS Three different trajectory patterns were identified through group-based trajectory model:the low-level group(n=7410,mean AIP:-0.25 to-0.17),the medium-level group(n=9981,mean AIP:0.02-0.08),and the high-level group(n=1803,mean AIP:0.38-0.42).During a mean follow-up of 2.65 years,a total of 1391 participants developed CHD.After adjusting for potential confounders,compared with the participants in the low-level group,the HR with 95%CI of the medium-level group and the high-level group were estimated to be 1.24(1.10-1.40)and 1.43(1.19-1.73),respectively.These findings remained consistent in subgroup analyses and sensitivity analyses.CONCLUSIONS There was a significant correlation between persistent high AIP level and increased CHD risk in the elderly.This suggests that monitoring the long-term changes in AIP is helpful to identify individuals at high CHD risk in elderly people.
文摘BACKGROUND Coronary heart disease(CHD)has shown a consistent upward trend in global incidence in recent years.Notably,older adults with CHD complicated by arrhy-thmia exhibit significantly higher susceptibility to psychological distress com-pared with the general CHD population.This increased vulnerability has garn-ered growing clinical and research interest in the potential therapeutic benefits of structured psychological interventions for alleviating comorbid depressive and anxiety symptoms in this high-risk demographic.AIM To evaluate the efficacy of psychological care in reducing anxiety and depressive symptoms among older adult patients with CHD and comorbid arrhythmia.METHODS This retrospective analysis included 100 patients with CHD and arrhythmia admitted to the First Affiliated Hospital of Jinzhou Medical University from June 2024 to December 2024.Of these,49 patients in the control group received routine care,whereas 51 patients in the observation group received psychological care in addition to routine care.Therapeutic outcomes were compared between the two groups.Psychological distress was assessed before and after providing nursing care.A treatment compliance scale developed by the hospital was used to assess adherence.Complication rates were also compared.Quality of life was evaluated using the Short Form-36 Health Survey after providing nursing care.Patient satisfaction with nursing care was assessed using a self-designed questionnaire.RESULTS The observation group demonstrated a higher overall treatment effectiveness compared with the control group(P<0.05).After nursing care,both groups showed reduced scores on the Self-Rating Anxiety Scale and Self-Rating Depression Scale compared with baseline(P<0.05),with significantly greater improvements in the observation group(P<0.05).Treatment compliance was higher and complication rates were lower in the observation group(P<0.05).Additionally,the observation group demonstrated better quality of life after 1 month of care and higher satisfaction with nursing services(P<0.05).CONCLUSION Psychological care for patients with CHD and comorbid arrhythmia effectively enhanced therapeutic outcomes,reduced anxiety and depression,improved treatment compliance and quality of life,and lowered the risk of complications.These findings support the broader implementation of psychological care for patients with CHD in clinical practice.
文摘Interleukins(ILs),a subset of cytokines,play a critical role in the pathogenesis of coronary heart disease(CHD)by mediating inflammation.This review article summarizes the role of ILs such as IL-1,IL-2,IL-3,IL-4,IL-5,IL-6,IL-7,IL-8,IL-9,and IL-10 in the pathogenesis of CHD.Individuals with mild coronary artery disease(CAD)and angina who have ischemic heart disease have higher serum concentrations of IL-1b.Larger studies are needed to verify the safety and assess the effectiveness of low-dose IL-2 as an anti-inflammatory treatment.IL-3 is found more often in patients receiving coronary angioplasty compared to patients with asymptomatic CAD or without CAD.Serum levels of IL-4 are reliable indicators of CAD.An independent correlation between IL-5 and the incidence of CAD was demonstrated.IL-6 helps serve as a reliable biomarker for the degree of CAD,as determined by the Gensini score,and is a key factor in the development of atherosclerosis.Also,variants of IL-7/7R have been linked to the Han Chinese population's genetic susceptibility to CHD.IL-8 plays a role in the progression of CAD occurrences.By interacting with conventional risk factors for CAD,IL-9 may contribute to the development of CAD and offer an innovative approach to its prevention and management.There was a 34%increased risk of a CHD incident for every standard deviation rise in baseline IL-10 levels.
基金The 2022 Ministry of Education General Project for Humanities and Social Sciences Research(Grant No.22YJAZH147)the General Subject of Guangzhou Philosophy and Social Science Development“14th Five-Year Plan”in 2023(Grant No.2023GZYB68)+2 种基金China University Industry-Academia-Research Innovation Fund-Huatong Guokang Medical Research Special Project(Grant No.2023HT017)2024 Guangdong Province General Project for the Planning of Philosophy and Social Sciences(Grant No.GD24CGL29)the Innovation Team Project of Colleges and Universities in Guangdong Province(Grant No.2022WCXTD011).
文摘Different dosage forms can significantly impact pharmacokinetics in vivo,leading to varied effects and potential adverse reactions.This study aimed to evaluate the efficacy,safety,and cost-effectiveness of isosorbide mononitrate sustained-release capsules(IMSRC)combined with conventional treatments,compared to isosorbide mononitrate tablets(IMT)combined with conventional treatments,for managing angina pectoris in patients with coronary heart diseases.A network meta-analysis(NMA)was conducted to assess the efficacy and safety of IMSRC and IMT.Relevant literature was sourced from databases,including PubMed,Embase,Cochrane Library,ScienceDirect,Web of Science,CNKI,Wanfang,and VIP,covering publications up to July 2023.The cost-effectiveness analysis(CEA)was performed from the perspective of China’s healthcare system,utilizing inputs derived from the NMA.The analysis included 15 studies.The NMA results revealed no significant difference in efficacy and safety between IMSRC plus conventional treatments and IMT plus conventional treatments.However,both combinations were more effective than conventional treatments without isosorbide mononitrate.No differences in safety were observed among the three groups.The surface under the cumulative ranking(SUCRA)of the NMA indicated that IMT had a slight edge over IMSRC in the total effective rate of angina pectoris,whereas IMSRC showed higher probabilities for markedly effective rate and ECG effective rate compared to IMT.The incidence of adverse events was ranked as IMT>conventional preparation>IMSRC.The CEA results highlighted that the incremental cost-effectiveness ratios(ICERs)for the markedly effective and total effective rates of angina pectoris were-133.41 and-260.20,respectively.The ICERs for ECG effective rates were-83.34 and-234.24,respectively.In conclusion,while IMSRC combined with conventional treatments and IMT combined with conventional treatments were similar in efficacy and safety,IMSRC proved to be more economical.
文摘BACKGROUND The persistent burden of cardiovascular(CV)disease in the United States requires innovative and cost-effective prognostic markers that can be relied upon.AIM To provide insights into how adiponectin can predict all-cause mortality and major adverse CV events(MACE)in patients with coronary artery disease(CAD)and to determine the prognostic value of adiponectin in predicting all-cause mortality and MACE in patients with stable CAD.METHODS We conducted a systematic search on PubMed,Scopus,and Google Scholar to find relevant studies published through June 2023 evaluating the long-term prognostic role of adiponectin in patients with stable CAD.Using a random effects model with 95%CI,we estimated the odds ratio(OR)while assessing heterogeneity through I^(2)statistics.To ensure robustness,we performed a sensitivity analysis using the leave-one-out approach.RESULTS After screening,we included five prospective studies involving 3225 patients who were followed up for a median duration of 3.8 years.Within the study population,prevalent risk factors included hypertension,diabetes,hyperlipidemia,and smoking.The commonly prescribed medications were angiotensin-converting enzyme inhibitors,beta blockers,and statins.The combined adjusted OR for all-cause mortality was found to be 2.51(95%CI:1.36–4.62),showing heterogeneity(I^(2)=65.51%,P=0.03).On the other hand,the combined adjusted OR for MACE was determined to be 1.04(95%CI:1.02–1.06)with no significant heterogeneity observed(I^(2)=0%,P=0.68).Through a sensitivity analysis,it was discovered that none of the studies significantly impacted the overall results of the meta-analysis,thus indicating their robustness.CONCLUSION Higher levels of adiponectin were found to be associated with an increased risk of long-term mortality and MACE in patients with CAD,which highlights its potential as a cost-effective marker for risk assessment and guiding treatment strategies.Further research on the role of adiponectin could greatly influence decision-making and resource allocation in CV care.
基金supported by the National Natural Science Foundation of China(No.82173450&No.81770237).
文摘BACKGROUND Our understanding of the correlation between postdischarge cancer and mortality in patients with coronary artery disease(CAD)remains incomplete.The aim of this study was to investigate the relationships between postdischarge cancers and all-cause mortality and cardiovascular mortality in CAD patients.METHODS In this retrospective cohort study,25%of CAD patients without prior cancer history who underwent coronary artery angiography between January 1,2011 and December 31,2015,were randomly enrolled using SPSS 26.0.Patients were monitored for the incidence of postdischarge cancer,which was defined as cancer diagnosed after the index hospitalization,survival status and cause of death.Cox regression analysis was used to explore the association between postdischarge cancer and all-cause mortality and cardiovascular mortality in CAD patients.RESULTS A total of 4085 patients were included in the final analysis.During a median follow-up period of 8 years,174 patients(4.3%)developed postdischarge cancer,and 343 patients(8.4%)died.A total of 173 patients died from cardiovascular diseases.Postdischarge cancer was associated with increased all-cause mortality risk(HR=2.653,95%CI:1.727–4.076,P<0.001)and cardiovascular mortality risk(HR=2.756,95%CI:1.470–5.167,P=0.002).Postdischarge lung cancer(HR=5.497,95%CI:2.922–10.343,P<0.001)and gastrointestinal cancer(HR=1.984,95%CI:1.049–3.750,P=0.035)were associated with all-cause mortality in CAD patients.Postdischarge lung cancer was significantly associated with cardiovascular death in CAD patients(HR=4.979,95%CI:2.114–11.728,P<0.001),and cardiovascular death was not significantly correlated with gastrointestinal cancer or other types of cancer.CONCLUSIONS Postdischarge cancer was associated with all-cause mortality and cardiovascular mortality in CAD patients.Compared with other cancers,postdischarge lung cancer had a more significant effect on all-cause mortality and cardiovascular mortality in CAD patients.
基金National Key Research and Development Program of China(2022YFC2503500 and 2022YFC2503504)。
文摘Background The association of systemic inflammatory response index(SIRI)with prognosis of coronary artery disease(CAD)patients has never been investigated in a large sample with long-term follow-up.This study aimed to explore the association of SIRI with all-cause and cause-specific mortality in a nationally representative sample of CAD patients from United States.Methods A total of 3386 participants with CAD from the National Health and Nutrition Examination Survey(NHANES)1999-2018 were included in this study.Cox proportional hazards model,restricted cubic spline(RCS),and receiver operating characteristic curve(ROC)were performed to investigate the association of SIRI with all-cause and cause-specific mortality.Piecewise linear regression and sensitivity analyses were also performed.Results During a median follow-up of 7.7 years,1454 all-cause mortality occurred.After adjusting for confounding factors,higher lnSIRI was significantly associated with higher risk of all-cause(HR=1.16,95%CI:1.09-1.23)and CVD mortality(HR=1.17,95%CI:1.05-1.30)but not cancer mortality(HR=1.17,95%CI:0.99-1.38).The associations of SIRI with all-cause and CVD mortality were detected as J-shaped with threshold values of 1.05935 and 1.122946 for SIRI,respectively.ROC curves showed that lnSIRI had robust predictive effect both in short and long terms.Conclusions SIRI was independently associated with all-cause and CVD mortality,and the dose-response relationship was Jshaped.SIRI might serve as a valid predictor for all-cause and CVD mortality both in the short and long terms.
文摘Background Frailty is a major determinant of outcomes in patients with coronary artery disease(CAD)undergoing lower limb amputation.This study evaluates the impact of frailty on in-hospital outcomes in these patients.Methods We performed a retrospective analysis of the National Inpatient Sample(2016–2021)to identify adult patients with CAD who underwent lower limb amputation.Frailty was defined using the Johns Hopkins Adjusted Clinical Groups(ACG)frailty indicator.Multivariable logistic regression was used to assess the independent association of frailty with in-hospital outcomes,and propensity score matching(PSM)was performed to further account for confounding factors.Results After PSM,9,990 patients were included in each cohort.Frail patients experienced higher rates of in-hospital mortality(3.9%vs.1.5%,P<0.001),acute limb ischemia(3.8%vs.3.1%,P=0.015),fasciotomy(2.1%vs.1.4%,P<0.001),stump infection(7.9%vs.6.6%,P<0.001),cardiogenic shock(0.9%vs.0.7%,P=0.032),sudden cardiac arrest(2.7%vs.2.1%,P=0.004),mechanical circulatory support(0.3%vs.0.2%,P=0.028),major adverse cardiac and cerebrovascular events(7.7%vs.5.4%,P<0.001),and sepsis(18.3%vs.13.8%,P<0.001).In multivariable logistic regression analysis,frailty remained an independent predictor of inhospital mortality and major complications.Conclusion Frailty is independently associated with increased in-hospital mortality and adverse events among CAD patients undergoing lower limb amputation.Incorporating frailty assessment into preoperative evaluation may improve risk stratification and guide clinical decision-making in this high-risk population.
文摘Background and Objective Hypertension(HT)and atrial fibrillation(AF)are highly prevalent cardiovascular conditions that frequently coexist.Coronary artery disease(CAD)is a major global cause of mortality.The co-occurrence of HT,AF,and CAD presents significant management challenges.This study aims to explore the clinical characteristics and risk factors associated with CAD in patients with HT and persistentAF(HT-AF).Methods In this retrospective cross-sectional study,data were collected from 384 hospitalized HT-AF patients at the People's Liberation Army General Hospital between January 2010 and December 2019.CAD diagnosis was confirmed by coronary angiography or computed tomography angiography.Clinical characteristics and comorbidities were compared between patients with and without CAD.Multivariate logistic regression analyses were performed to identify independent risk factors associated with CAD development.Results The prevalence of CAD among HT-AF patients was 66.41%(255/384).Cardiovascular complications,particularly heart failure(44.7%vs 25.6%,P<0.05),were significantly more prevalent in the CAD group than in the non-CAD group.Only age was identified as an independent risk factor for CAD(adjusted OR:1.047;95%CI:1.022–1.073;P=0.000).Of all HT-AF patients,54.7%had a CHA2DS2-VASc score of≥4,indicating high stroke risk.There was a slightly higher anticoagulant usage rate in the CAD group than those without CAD(8.6%vs 4.7%,P=0.157),and the overall anticoagulant usage remained low.Conclusion There is a high prevalence of CAD among hospitalized HT-AF patients,among whom age is the sole independent risk factor for CAD.Despite a high stroke risk,the utilization of oral anticoagulants is alarmingly low.
文摘Background Coronary heart disease with myocardial ischemia is closely associated with vascular endothelial dysfunction,dyslipidemia,and chronic inflammatory response.Atorvastatin,a classic lipid-lowering agent,exhibits pleiotropic effects including plaque stabilization,endothelial function improvement,and anti-inflammatory actions.Nicorandil,as a potassium channel opener with additional nitrate-like effects,directly dilates coronary arteries and improves myocardial microcirculation.Theoretically,the two drugs may synergistically enhance myocardial perfusion and endothelial function through distinct mechanisms.However,clinical evidence regarding the comprehensive impact of their combination on vascular endothelial function,blood lipid profiles,and systemic inflammatory status in patients with coronary heart disease and myocardial ischemia remains insufficient.Further studies are warranted to clarify their synergistic effects and clinical value.Methods A total of 60 patients with coronary heart disease and myocardial ischemia admitted to our hospital from January 2023 to October 2024 were enrolled and randomly divided into combination group and control group using a random number table,with 30 patients in each group.The control group received atorvastatin treatment,while the combination group received nicorandil combined with atorvastatin.After 12 weeks of continuous treatment,the clinical efficacy,vascular endothelial function,blood lipid profiles,inflammatory factors,and adverse reactions were compared between the two groups.Results The total effective rate in the combination group(93.33%)was significantly higher than that in the control group(70.00%)(P<0.05).After treatment,serum endothelin(ET)level was lower in the combination group than in the control group(P<0.05),while nitric oxide(NO)level was higher(P<0.05).In the combination group,the levels of total cholesterol(TC),triglyceride(TG),and low-density lipoprotein cholesterol(LDL-C)were all lower than those in the control group(P<0.05),while high-density lipoprotein cholesterol(HDL-C)level was higher(P<0.05).Levels of C-reactive protein(CRP),interleukin(IL)-8,and IL-6 in the combination group were also lower compared with the control group(P<0.05).No significant difference was observed in the incidence of adverse reactions between the two groups(P>0.05).Conclusions The combination of nicorandil and atorvastatin demonstrated certain short-term therapeutic effects in patients with coronary heart disease and myocardial ischemia.It not only effectively improves vascular endothelial function and regulates lipid metabolism but also suppresses the levels of inflammatory factors,with a favorable safety profile.
文摘Colchicine is one of the most widely used drugs in the world.While it is most commonly used in the treatment and prevention of gout,it is also widely used to treat other chronic inflammatory diseases,such as familial Mediterranean fever and Behçet’s disease.Regarding cardiovascular disease,an established use of colchicine concerns pericarditis,both acute and chronic,and its effectiveness in this context is supported by multiple studies and robust evidence.Regarding coronary artery disease(CAD),colchicine use has been endorsed in both acute and chronic coronary syndromes(CCS),primarily because of two randomized controlled trials:The COLCOT trial for patients with acute coronary syndromes(ACS)and the LoDoCo2 trial for patients with CCS.Considering this robust evidence,CCS 2024 European Society of Cardiology(ESC)Guidelines recommended 0.5 mg daily colchicine in patients with atherosclerotic CAD to reduce the risk of myocardial infarction,stroke and need for revascularization.However,a few months after the publication of 2024 ESC Guidelines on CCS,the“CLEAR”trial demonstrated that among patients who had experienced an acute myocardial infarction,when initiated shortly after the event and continued for a median of 3 years,colchicine did not reduce the incidence of the composite outcome of death from cardiovascular causes,recurrent myocardial infarction,stroke,or unplanned ischemia-driven coronary revascularization.This result casts doubt on the indication for colchicine use in ACS and weakens evidence that had previously led to the routine use of colchicine in clinical cardiology practice.This review aims to shed light on the current and past scientific evidence underlying the use of colchicine in ACS,CCS and cerebrovascular disease,and thus seeks to provide a quick yet effective tool for cardiologists facing the long-standing issue of reducing residual inflammatory risk in patients with coronary atherosclerotic disease.
