Stress hyperglycemia ratio: a novel predictor of left ventricular dysfunction in peripartum cardiomyopathy

OBJECTIVE

This study aims to assess the predictive value of the stress hyperglycemia ratio (SHR) for left ventricular (LV) systolic dysfunction in patients with peripartum cardiomyopathy (PPCM).

METHODS

We conducted a retrospective analysis of 78 consecutive PPCM patients from January 2007 to March 2023. Their clinical, laboratory, and auxiliary examination data were collected. The estimated average glucose (eAG) was calculated using the formula: eAG = [1.59 × hemoglobin A1c (%) -%2.59]. The SHR was determined by the formula: SHR = (blood glucose at admission)/eAG. The primary outcome measured was the recovery of LV systolic function. A receiver operating characteristic (ROC) curve was used to evaluate the SHR. Logistic regression analysis was performed to identify risk factors for LV systolic dysfunction in PPCM patients.

RESULTS

The mean random blood glucose level in the PPCM patients was 6.38 mmol/L, with an SHR of 1.16. Among these patients, 37 (47.4%) exhibited persistent LV systolic dysfunction during follow-up. The SHR was significantly higher in the non-recovery group than in the recovery group (1.45 vs. 0.91, p < .001). An SHR cutoff of 1.079 predicted persistent LV systolic dysfunction with a sensitivity of 81.1% and a specificity of 90.2%, yielding a Youden index of 0.713. Logistic regression identified an SHR ≥ 1.079, a left ventricular end-diastolic diameter (LVEDD) > 55 mm, and digoxin usage as risk factors for LV systolic dysfunction.

CONCLUSIONS

PPCM patients with an SHR of 1.079 or higher should receive increased scrutiny for persistent LV systolic dysfunction.

Bleeding risk and prediction model to predict bleeding risk of tissue biopsy for definitive diagnosis in patients with suspected amyloidosis

INTRODUCTION

Bleeding from the affected organs is a common manifestation of amyloidosis. The risk for perioperative bleeding in patients with amyloidosis remains controversial. In this study, we aimed to compare the bleeding risk of tissue biopsies for a definitive diagnosis between patients with and without amyloidosis, identify risk factors, and generate a prediction model for bleeding risk in these patients.

METHODS

We enrolled patients aged >15 years who had amyloidosis as part of their differential diagnosis before tissue biopsy. After obtaining histopathological reports, we randomly selected patients with and without amyloidosis at a ratio of 4:1.

RESULTS

A total of 360 patients were enrolled before tissue biopsy. Bleeding complications were observed in 5.6% and 4.2% of patients with and without amyloidosis, respectively. Amyloidosis was not associated with an increased perioperative bleeding risk (adjusted odds ratio 1.19; 95% confidence interval 0.17-8.41, p = 0.859). Kidney biopsy was a significant risk factor for perioperative bleeding in tissue biopsies. A KiHPL model was generated to predict the bleeding risk. The area under the curve was 0.87, with a good calibration plot for this model.

CONCLUSIONS

Amyloidosis is not associated with an increased risk of bleeding in tissue biopsies. The KiHPL model can predict the bleeding risk of tissue biopsies for a definitive diagnosis in patients with suspected amyloidosis.

Efficacy and safety of intensive blood pressure control in patients over 60 years: A systematic review and meta-analysis

OBJECTIVES

To evaluate the efficacy and safety of intensive blood pressure control in patients over 60 years.

METHODS

Databases including PubMed, Embase and Cochrane library were searched from inception through February 1, 2024. Randomized controlled trials evaluating the efficacy or safety of intensive blood pressure control in patients over 60 years were included in the meta-analysis.

RESULTS

Intensive blood pressure control in individuals with mild hypertension has been shown to reduce the risk of heart failure, stroke, myocardial infarction, major cardiovascular events, cardiovascular mortality, and all-cause mortality. The benefits of intensive blood pressure control in patients with moderate to severe hypertension are comparable to those observed in individuals with mild hypertension, with the exception of a reduced impact on all-cause mortality and cardiovascular mortality. Compared with maintaining systolic blood pressure (SBP) above 140 mmHg, SBP below 140 mmHg is associated with a decreased risk of major cardiovascular events in patients aged over 70, as well as a reduced risk of stroke in patients aged 60-69. Furthermore, compared to maintaining SBP above 130 mmHg, SBP below 130 mmHg is linked to a lower risk of major cardiovascular events, heart failure and myocardial infarction in patients over 60, a reduced risk of stroke and cardiovascular mortality in patients aged 60-69, and a decreased risk of all-cause mortality in patients over 70. However, a lower baseline blood pressure or more aggressive blood pressure control may be associated with an increased risk of hypotension.

CONCLUSIONS

Patients with hypertension aged over 60 years can derive benefits from intensive blood pressure management without experiencing significant adverse events, aside from hypotension.

Clinical characterization of blood pressure phenotypes: the BP phenotype score

BACKGROUND

Evidence has linked blood pressure (BP) phenotypes with certain clinical, psychosocial, and occupational features, and characteristic BP variability.

OBJECTIVE

We aimed to evaluate the value of a diagnostic score developed from these characteristics in predicting BP phenotypes, when used in a manner comparable to the application of out-of-office techniques.

METHODS

Adult patients with no prior diagnosis of hypertension attending their office appointments, were prospectively enrolled. Their clinical, psychosocial, and occupational data were collected. 3-consecutive pre-appointment BP measurements, and BP variability with standing and the 6-minute walk test (6MWT) were obtained. All participants underwent 24-hour BP monitoring which was paired with office BP as the reference standard for BP phenotyping. Two scores were developed from the variables selected using linear regression analysis to differentiate between masked hypertension (MH) and normotension, and sustained hypertension (SH) and white coat hypertension (WCH).

RESULTS

In total 212 participants completed the study. Among office-normotensives, a score of 7 (calculated from, variables (points): dyslipidemia (3), irritable bowel syndrome (IBS) (3), orthostatic increase in SBP >5 mmHg (1), SBP increase >10 after 6MWT (1), and BP ≥130/80 after 6MWT (3)) identified MH with 90% sensitivity, 86% specificity, 70% positive predictive value (PPV), and 96% negative predictive value (NPV). Conversely, among office-hypertensives, a score of 6 (male sex (2), no IBS (2), ≥3 metabolic syndrome criteria (3), obesity (3), standing BP ≥140/90 (3), BP ≥140/90 after 6MWT (1)) identified SH with 82% sensitivity, 78% specificity, 90% PPV, and 64% NPV.

CONCLUSIONS

BP phenotypes correspond to distinct clinical phenotypes and can be predicted with acceptable sensitivity and specificity using BP phenotype scores. This novel approach to BP phenotyping provides an accessible addition, not a replacement, to available out-of-office techniques, particularly useful for screening for MH, and to support office diagnosis of SH when out-of-office measures are unavailable or not tolerated.

The role of endothelin receptor antagonists in kidney disease

Kidney diseases are among the most prevalent conditions worldwide, impacting over 850 million individuals. They are categorized into acute kidney injury and chronic kidney disease. Current preclinical and clinical trials have demonstrated that endothelin (ET) is linked to the onset and progression of kidney disease. In kidney diseases, pathological conditions such as hyperglycemia, acidosis, insulin resistance, and elevated angiotensin II levels lead to an increase in ET. This elevation activates endothelin receptor type A, resulting in harmful effects like proteinuria and a reduced glomerular filtration rate (GFR). Therefore, to slow the progression of kidney disease, endothelin receptor antagonists (ERAs) have been proposed as promising new therapies. Numerous studies have demonstrated the efficacy of ERAs in significantly reducing proteinuria and improving GFR, thereby slowing the progression of kidney diseases. This review discusses the mechanisms of action of ERAs in treating kidney disease, their efficacy and safety in preclinical and clinical studies, and explores future prospects for ERAs.

Association of thrombocytopenia and D-dimer elevation with in-hospital mortality in acute aortic dissection

BACKGROUND

Data on the association between the degree of platelet and coagulative-fibrinolytic variables abnormalities and the risk of in-hospital mortality in acute aortic dissection (AAD) are limited.

MATERIALS AND METHODS

This multicentre retrospective cohort study included patients diagnosed with AAD by aortic computed tomographic angiography between 2010 and 2021 in five tertiary hospitals in China. The primary outcome was defined as all-cause mortality during hospitalization. Associations between platelet counts, coagulation-fibrinolytic parameters and all-cause in-hospital mortality were assessed using Cox proportional hazards regression models.

RESULTS

Among the 2567 participants, the median age was 54 years (interquartile range, IQR: 47-63); 531 (20.7%) were female, and the in-hospital mortality rate was 589 (23.0%). The Cox proportional hazards regression model indicated that lower platelet count, prothrombin activity (PTA), and fibrinogen levels and longer prothrombin time (PT) and thrombin time (TT) were linearly positively associated with an increased risk of in-hospital mortality (p < 0.05). A non-linear and positive association was confirmed between D-dimer levels and in-hospital mortality risk (p < 0.05). Additionally, a significant interaction between platelet counts and D-dimer levels was observed (p = 0.029). According to the subgroup analysis, compared to those in the reference group, those with thrombocytopenia (<140 × 109/L) and high D-dimer levels (>14.6 µg/mL) had a 3.59-fold increased risk of in-hospital mortality (HR, 3.59; 95% CI, 2.00-6.42).

CONCLUSIONS

Our analysis revealed associations between changes in platelet count, PT, PTA, TT, fibrinogen and D-dimer levels and outcomes in patients with AAD. Furthermore, the combined effect of thrombocytopenia and high D-dimer levels significantly increased the risk of in-hospital mortality.

Association between ACEI/ARB and short-term prognosis in dialysis patients with hypertension admitted to intensive care unit

INTRODUCTION

To investigate the association between angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) and short-term prognosis in dialysis patients with hypertension admitted to intensive care unit (ICU).

METHODS

Patients with a diagnosis of hypertension and dialysis who received antihypertensive agents during hospitalisation were included. Based on whether treated with ACEI/ARB, patients were divided to ACEI/ARB group and non- ACEI/ARB group. In-hospital mortality and 30-day all-cause mortality were compared between the two groups in the overall participants and after propensity score matching.

RESULTS

The study included 647 patients, among which 227 (34.70%) were treated with ACEI/ARB. Compared to the non-ACEI/ARB group, fewer patients in the ACEI/ARB group suffered from atrial fibrillation/flutter (17.2% vs 31.9%, p < 0.001). The overall hospital mortality rate was 5.1%, and 9.0% of patients died during the 30-day follow-up period. ACEI/ARB group were with better clinical outcomes during hospitalisation (2.2% vs 6.7%, p = 0.023) and after 30-day follow-up (5.3% vs 11.0%, p = 0.016). ACEI/ARB treatment was independently associated with lower risk of hospital mortality (OR 0.24, 96% CI: 0.051 - 0.82, p = 0.038) and 30-day mortality (HR 0.36, 95% CI:0.15-0.89, p = 0.029) after adjusting confounding factors. After propensity score matching (PSM, 112 pairs), the ACEI/ARB group showed higher in-hospital (99.1% vs 91.1%, p = 0.013) and 30-day (95.5% vs 88.4%, p = 0.048) survival rates compared to the control group. ACEI/ARB was identified as an independent protector for 30-day mortality in the matched cohort (HR 0.33, 95% CI: 0.11-0.95, p = 0.041).

CONCLUSION

ACEI/ARB treatment showed a significant association with improved in-hospital and 30-day outcomes in dialysis patients with hypertension in the ICU.

An interactive care plan plus remote blood pressure monitoring in a rural primary care clinic: a pilot study

BACKGROUND

Remote blood pressure monitoring (RBPM), an effective method of enhancing BP control for patients with hypertension, can potentially helpovercome geographic limitations of health care services. We conducted a 90-day pilot to explore combining an interactive care plan (ICP) with RBPM.

METHOD

The pilot invited fifty adult patients with uncontrolled hypertension (BP ≥140/90 mm Hg) empanelled to a rural primary care practice in midwestern United States. Participants received instructions for downloading an ICP app and were given a wireless BP monitoring device that automatically transmitted readings to their care team. Patients were surveyed after 30 and 90 days about program experience.

RESULTS

Thirty-six patients enrolled. Mean participant age was 59.1 years; most were male, married, and White. Mean baseline BP was 153/89 mm Hg. Participants who engaged in the program for at least 75 days (n = 15) had a postintervention mean BP of 135/80 mm Hg. Sixteen participants (44%) had 1 outpatient visit (no multiple outpatient visits): only 4 (11%) had an emergency department visit. Among survey respondents, most strongly agreed or agreed that 1) ICP app was easy to use, 2) BP device was helpful in home care, 3) interacting remotely with care team was smooth, and 4) they were satisfied with functionality of the RBPM device.

CONCLUSION

An ICP paired with an RBPM device is a reasonable intervention for managing hypertension in a primary care practice particularly for patients in rural areas. New strategies must be developed to reduce barriers to meaningful engagement, achieve sustainability, and ensure successful widespread adoption.

Anti-inflammatory effects of immunotherapy in clinical treatment and its potential mechanism in alleviating sleeping disorders: A systematic bibliometric study

Sleeping disorders negatively affect cancer patient management, quality of life, and recovery. Immunotherapy, a rising cancer treatment, shows potential to improve sleep quality by reducing inflammation. This study analyzed 255 publications (2000-2024) from the Web of Science Core Collection using bibliometric methods. The US and China dominate research output, with The Mayo Clinic as a key contributor. Core topics are "immunotherapy," "quality of life," and "antibodies." Emerging keywords like "cancer," "encephalitis," and "depression" highlight a shift toward clinical psychology in treating tumors and rare diseases. It is noteworthy that with the rapid expansion of immunotherapy in cancer treatment, clinical trials have shown that it can improve sleep quality in cancer patients by reducing inflammation. As its application in cancer treatment expands, immunotherapy's potential for treating sleep disorders is promising. Future development is expected to improve sleep quality and address clinical issues, offering broad prospects for patient outcomes.

Machine learning-based analyses of contributing factors for the development of hypertension: a comparative study

OBJECTIVES

Sufficient attention has not been given to machine learning (ML) models using longitudinal data for investigating important predictors of new onset of hypertension. We investigated the predictive ability of several ML models for the development of hypertension.

METHODS

A total of 15 965 Japanese participants (men/women: 9,466/6,499, mean age: 45 years) who received annual health examinations were randomly divided into a training group (70%, n = 11,175) and a test group (30%, n = 4,790). The predictive abilities of 58 candidates including fatty liver index (FLI), which is calculated by using body mass index, waist circumference and levels of γ-glutamyl transferase and triglycerides, were investigated by statistics analogous to the area under the curve (AUC) in receiver operating characteristic curve analyses using ML models including logistic regression, random forest, naïve Bayes, extreme gradient boosting and artificial neural network.

RESULTS

During a 10-year period (mean period: 6.1 years), 2,132 subjects (19.1%) in the training group and 917 subjects (19.1%) in the test group had new onset of hypertension. Among the 58 parameters, systolic blood pressure, age and FLI were identified as important candidates by random forest feature selection with 10-fold cross-validation. The AUCs of ML models were 0.765-0.825, and discriminatory capacity was significantly improved in the artificial neural network model compared to that in the logistic regression model.

CONCLUSIONS

The development of hypertension can be simply and accurately predicted by each ML model using systolic blood pressure, age and FLI as selected features. By building multiple ML models, more practical prediction might be possible.

An overview of downhill esophageal varices: a challenge for medical practice

OBJECTIVES

Unlike the commonly seen uphill esophageal varices in clinical practice, downhill esophageal varices are caused by obstruction of the superior vena cava and azygous venous system. The predominant causes of downhill esophageal varices are hemodialysis in end-stage renal disease patients and mediastinal malignancies. The cornerstone of the treatment for downhill esophageal varices is to address the underlying primary causes. Without this, patients may suffer from recurrent bleeding, and the bleeding can be fatal.

METHODS

This review is primarily summarized through previous case reports. Meanwhile, it emphasizes the significance of case reports.

RESULTS

Clinicians should be conscious that esophageal varices are not necessarily caused by liver cirrhosis or non-cirrhotic portal hypertension.

CONCLUSIONS

Specifically, when varices are only observed in the upper and middle esophagus, and the patient presents with evidence of superior vena cava obstruction, clinicians should be particularly vigilant for downhill esophageal varices. Moreover, a thorough investigation and definitive treatment of the underlying primary causes should be implemented.

Diabetic peripheral neuropathy and neuromodulation techniques: a systematic review of progress and prospects

Neuromodulation for diabetic peripheral neuropathy represents a significant area of interest in the management of chronic pain associated with this condition. Diabetic peripheral neuropathy, a common complication of diabetes, is characterized by nerve damage due to high blood sugar levels that lead to symptoms, such as pain, tingling, and numbness, primarily in the hands and feet. The aim of this systematic review was to evaluate the efficacy of neuromodulatory techniques as potential therapeutic interventions for patients with diabetic peripheral neuropathy, while also examining recent developments in this domain. The investigation encompassed an array of neuromodulation methods, including frequency rhythmic electrical modulated systems, dorsal root ganglion stimulation, and spinal cord stimulation. This systematic review suggests that neuromodulatory techniques may be useful in the treatment of diabetic peripheral neuropathy. Understanding the advantages of these treatments will enable physicians and other healthcare providers to offer additional options for patients with symptoms refractory to standard pharmacologic treatments. Through these efforts, we may improve quality of life and increase functional capacity in patients suffering from complications related to diabetic neuropathy.

Encouraging the prescribing of SGLT2i and GLP-1RA medications to reduce cardiovascular and renal risk in patients with type 2 diabetes: Rationale and design of a randomized controlled trial

BACKGROUND

Sodium-glucose cotransporter-2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1RA) medications reduce the risk of cardiovascular and renal complications among patients with type 2 diabetes but are underutilized. There are numerous barriers to prescribing including insurance coverage, medication availability, comfort with prescribing, and diffusion of responsibility of prescribing across specialists. Methods are needed to support prescribing in primary care.

METHODS

This was a pragmatic, randomized controlled trial testing interventions to increase appropriate SGLT2i and GLP-1RA prescribing. Primary care providers (PCPs) were randomized to 1 of 3 arms: (1) peer champion support (2) peer champion support and information on insurance coverage, or (3) usual care (no intervention). PCPs in both intervention arms received a welcome email and electronic health record (EHR) messages before visits with patients who had sub-optimally controlled diabetes and an indication for 1 of these medications. In the peer champion support only arm the EHR messages included prescribing tips. In the arm that provided peer champion support and information on insurance coverage, EHR messages contained information on medications in each class that would be most affordable for the patient based on their insurance coverage and offered support for prior authorizations if needed. The primary outcome was prescriptions for an SGLT2i or GLP-1RA medication, beginning 3 days before the targeted visit and continuing through 28 days, in each intervention arm compared to control.

RESULTS

191 primary care providers were included in the study. 1,389 patients had at least 1 visit scheduled with their PCP during the 6-month intervention period; of these 1,079 patients attended at least 1 of these visits and will be included in the primary outcome analysis. 66 providers (484 patients) received the peer champion intervention alone, 63 providers (446 patients) received the peer champion intervention and information on insurance coverage, and 62 providers (459 patients) received usual care. On average, patients were 66 years old, 46% were female, 61% were white, and 16% were Hispanic. There were small differences between groups with regards to patient sex, race, ethnicity, partner status, and percent with Medicare insurance.

CONCLUSIONS

These medication classes have the potential to reduce cardiovascular and kidney disease among patients with type 2 diabetes. This study tests interventions to support prescribing of these medications in primary care.

CLINICAL TRIAL

Clinicaltrials.gov. Unique identifier: (NCT, Registered: NCT05463705).

Calycosin treats acute myocardial infarction via NLRP3 inflammasome: Bioinformatics, network pharmacology and experimental validation

BACKGROUND

Calycosin (CA) is a flavonoid natural product that may effectively treats acute myocardial infarction (AMI), but its mechanism is unclear.

METHODS

Targets related to AMI and CA were identified using the GEO database, SwissTargetPrediction, PharmMapper and literature searches. Protein-protein interactions analysis and Cytoscape were used to screen the core targets of CA for AMI treatment. Enrichment analysis identified biological pathways linked to AMI and potential mechanisms of CA. Immune infiltration analysis was used to explore the role of immune cells in AMI and the correlation between core targets and immune cells. And further validated in AMI rats with ligated left anterior descending.

RESULTS

Bioinformatics identified relevant targets and biological mechanisms of AMI, and network pharmacology revealed 31 potential targets affected by CA, with NLRP3, IL-18, IL-1β, MMP9, and TLR4 as core targets. Enrichment analysis demonstrated the biological roles of these potential targets and NLRP3, IL1β and IL18 were selected for further analysis. Immune infiltration analysis showed that both NLRP3 and IL-1β were closely associated with monocytes, mast cells activated and neutrophils, and IL-18 was closely associated with monocytes. CA exerted cardioprotective effects in AMI rats by inhibiting NLRP3 inflammasome activation and reducing IL-18 and IL-1β levels, improving cardiac function and attenuating myocardial injury and fibrosis.

CONCLUSION

CA effectively protects cardiac function and mitigates myocardial injury in post-AMI rats, probably through NLRP3 inflammasome inhibition.

A Pilot Project to Implement a Pharmacist-Managed Remote Blood Pressure Monitoring Service

Background: Clinicians often hesitate to adjust antihypertensive medications based solely on clinic blood pressure (BP) readings. Limitations to obtaining home readings include access to sphygmomanometers and ability to provide accurate, reliable readings upon follow-up. Objective: This study examined whether an online platform linked to remote BP monitoring improved BP management and facilitated effective clinical interventions by pharmacists. Methods: Thirty patients with uncontrolled hypertension were enrolled and provided a remote BP monitor for home use. BP data downloaded to an online platform were monitored by two clinic pharmacists. Daily BP checks were requested (up to twice daily), and pharmacists called patients approximately weekly for 6 months. Through approved protocols, pharmacists individualized interventions to improve patient care. Descriptive statistics were used for demographic and clinical data. Results: The average systolic BP reduction was 39 mmHg (IQR = 17-52.5) for the 21 patients included in analysis. A target BP <140/<90 was achieved by 67%, and 76% had improved BP control. Patients utilized the cuff 2-4 times (n = 10) or >5 times weekly (n = 11). Through 261 patient contact attempts, the pharmacists requested more BP checks (n = 62), changed medications (n = 57), or provided non-pharmacologic counseling (n = 24) most often. Medication changes commonly included dose increases (n = 35) and additional agents (n = 17) for BP control. Spironolactone (n = 5) and thiazide diuretics (n = 5) were the most added medications. Conclusions: Most patients were willing to check their BP when provided with devices. The majority achieved a clinically significant decrease in home BP readings, demonstrating that pharmacist-driven home-monitoring programs can improve the optimization of hypertension regimens.

Clinical profile, short and long-term outcomes of non-ischaemic cardiogenic shock: A FRENSHOCK sub-analysis

AIMS

Although predominant in routine practice, non-ischaemic cardiogenic shock (NICS) remains underrepresented in past studies, mainly focused on ischaemic cardiogenic shock (CS). This study aims to describe the current NICS picture and define its independent correlates of short- and long-term outcomes.

METHODS AND RESULTS

FRENSHOCK is a prospective registry including 772 CS patients from 49 centers. One-year mortality was the primary outcome. One-month mortality and the composite of 1-year mortality, heart transplantation (HTx), or ventricular assistance device (VAD) were secondary outcomes. Within 772 patients included, 492 (63.7%) were NICS. One-month and 1-year mortality rates were 25.6% and 45.7%, with a combined endpoint of 1-year mortality, HTx, or VAD of 53.9%. Multivariate analysis showed five independent factors for 1-year mortality: age (per year: aHR 1.03 [1.01-1.05], P < 0.01), chronic kidney disease (CKD) (aHR 1.87 [1.25-2.80], P < 0.01), norepinephrine use (aHR 1.52 [1.02-2.26], P = 0.04), active cancer (aHR 1.91 [1.07-3.42], P = 0.03) and acute renal replacement therapy (aHR 1.57 [1.01-2.46], P = 0.049). Age, CKD and norepinephrine were also predictive of 1-month mortality and 1-year mortality and/or HTx and/or VAD. Additionally, 1-month mortality was associated with septic triggers, and 1-year mortality and/or HTx and/or VAD with acute mechanical circulatory support, NYHA stage ≥ 3 and fluid administration.

CONCLUSIONS

In this large study, NICS accounted for almost two-thirds of all CS cases, with substantial rates of short- and long-term mortality. Future studies should evaluate interventions to improve early stratification and management. NCT02703038.

Age and sex differences in the efficacy of early invasive strategy for non-ST-elevation acute coronary syndrome: A comparative analysis in stable patients

Objective

Previous works have struggled to clearly define sex-specific outcomes based on initial management in NSTE-ACS patients. We examined if early revascularization (<24 h) versus conservative strategy impacts differently based on sex and age in stable NSTE-ACS patients upon hospital admission.

Methods

We identified 8905 patients with diagnosis of non-ST elevation acute coronary syndromes (NSTE-ACS) in the ISACS-TC database. Patients with cardiac arrest, hemodynamic instability, and serious ventricular arrhythmias were excluded. The final cohort consisted of 7589 patients. The characteristics between groups were adjusted using inverse probability of treatment weighting models. Primary outcome measure was all-cause 30-day mortality. Risk ratios (RRs) with their 95 % CIs were employed.

Results

Of the 7589 NSTE-ACS patients identified, 2450 (32.3 %) were women. The data show a notable reduction in mortality for the older women (aged 65 years and older) undergoing early invasive strategy compared to those receiving an initial conservative (3.0 % versus 5.1 %; RR: 0.57; 95 % CI: 0.32 - 0.99) Conversely, younger women did not exhibit a significant association between early invasive strategy and mortality reduction (2.0 % versus 0.9 %; RR: 2.27; 95 % CI: 0.73 - 7.04). For men, age stratification did not markedly alter the observed benefits of an early invasive strategy over a conservative approach in the overall population, with reduced death rates in both older (3.1 % versus 5.7 %; RR: 0.52; 95 % CI: 0.34 - 0.80) and younger age groups (0.8 % versus 1.7 %; RR: 0.46; 95 % CI: 0.22 - 0.94). These age and sex-specific mortality patterns did not significantly change within subgroups stratified by the presence of NSTEMI, or a GRACE risk score>140.

Conclusion

Early coronary revascularization is associated with improved 30-day survival in older men and women and younger men who present to hospital in stable conditions after NSTE-ACS. It does not confer a survival advantage in young women. Further studies are needed to more accurately risk-stratify young women to guide treatment strategies.

Registration

ClinicalTrials.gov: NCT01218776.

Vortioxetine Can Be Used Safely to Treat Depression After Implantable Cardioverter Defibrillator Implantation for Congenital Long QT Syndrome: A Case Report

BACKGROUND

Vortioxetine, an antidepressant, acts on multiple 5-hydroxytryptamine receptors in addition to inhibiting the 5-hydroxytryptamine transporter. Currently, data on the effect of vortioxetine on the QT interval are limited. To the best of our knowledge, whether vortioxetine can safely be used for congenital long QT syndrome (LQTS) has not been reported.

CASE PRESENTATION

We here present the case of a 50-year-old Japanese woman who was rushed to our hospital because of a sudden cardiopulmonary arrest. Her corrected QT interval was prolonged to 535 ms. After a thorough examination in the cardiology department, she was diagnosed with congenital LQTS and an implantable cardioverter defibrillator (ICD) implanted. Thereafter, she gradually developed severe depression because of stress associated with ICD implantation. Mirtazapine induced daytime somnolence and duloxetine was relatively ineffective, prompting replacement with vortioxetine at 20 mg daily, which relieved her depression. During the treatment period, her corrected QT interval did not exceed 500 ms, beyond which the risk of cardiac events increases. To our knowledge, this is the first report of the safe use of vortioxetine in a patient with depression comorbid with congenital LQTS.

CONCLUSIONS

After ICD implantation, a patient's mental status should be monitored carefully. Our findings suggest that vortioxetine may be a safe treatment option for depression associated with congenital LQTS.

Triggering type and long-term survival following ST segment elevation-myocardial infarction treated with primary percutaneous coronary intervention

BACKGROUND

Physical and emotional stress are recognized triggers of acute coronary syndromes, including ST segment elevation-myocardial infarction (STEMI). We have previously shown that identifiable triggers precede symptoms in over one-third of STEMI patients and inversely correlate with the extent of coronary artery disease (CAD). This study aims to investigate the association between trigger type (physical vs. emotional) and long-term mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI).

METHODS

This retrospective, single-center observational study included all patients admitted with an STEMI diagnosis from January 2008 to December 2013. Physical and emotional triggers were identified retrospectively from patient records. Mortality data were obtained from the Israeli Ministry of Health.

RESULTS

Of 1345 consecutive STEMI patients treated with primary PCI, mortality data were available for 1267 patients (median age: 61 years). A trigger preceding symptoms onset was identified in 36.5% of patients, with 85% experiencing physical stress and 15% emotional stress. Triggered STEMI patients tended to be younger with fewer comorbidities and lower incidence of multiple vessel CAD compared with nontriggered patients. Notably, emotionally triggered STEMI patients exhibited improved long-term survival compared with those without emotional triggers or with physical triggers. Emotional triggering was identified as an independent predictor of enhanced long-term survival post-PCI compared with physical triggering.

CONCLUSION

Patients with emotionally triggered STEMI showed less extensive CAD and improved long-term survival following PCI compared with those with physically triggered STEMI. These findings highlight the importance of considering both the presence and type of trigger in the management of STEMI patients and their long-term prognosis.

Validation of the A&D BP UA-1100NFC/UA-1100NFC-W, hoseless upper arm-type home blood pressure devices, according to the ISO81060-2:2018/Amd 1:2020 protocol

The aim of this study was to validate the performance of the A&D UA-1100NFC hoseless devices of two cuff sizes in monitoring blood pressure (BP) in the upper arm according to the International Organization for Standardization (ISO) 81060-2:2018/amendment (Amd) 1:2020 protocol. The accuracy of the UA-1100NFC (for arm circumferences of 22.0-32.0 cm) and the UA-1100NFC-W (for arm circumferences of 22.0-42.0 cm) was assessed using the same-arm sequence protocol as per the ISO 81060-2:2018/Amd 1:2020 standard. Individuals aged >12 years were recruited from the outpatients and volunteers of Jichi Medical University (Tochigi, Japan); 85 participants were included in the final analyses for each device. Both devices performed well against the standard; mean and SD values for the differences between the device-measured and observer-measured SBP and DBP values met both criterion 1 and criterion 2 of the standard [(UA-1100NFC) criterion 1: -3.71 ± 6.82 mmHg and 0.86 ± 6.33 mmHg, respectively; criterion 2: 5.65 mmHg and 5.87 mmHg, respectively; (UA-1100NFC-W) criterion 1: 0.73 ± 7.84 mmHg and 1.72 ± 6.44 mmHg, respectively; criterion 2: 6.49 mmHg and 5.86 mmHg, respectively]. The Bland-Altman plots did not show any systematic variation in the error. Both the UA-1100NFC and UA-1100NFC-W hoseless devices had a high level of accuracy and fulfilled the requirements of the ISO81060-2:2018/Amd 1:2020 validation standard. They are therefore suitable as home BP monitoring tools in patients with hypertension.

The Bad Reputation of Digoxin in Atrial Fibrillation-Causality or Bias? Nationwide Nested Case-Control Study

Aims

Studies have reported excess risk of mortality associated with digoxin in atrial fibrillation (AF).This study sought to investigate if these findings could be replicated and whether a potential association could be explained by bias.

Methods

Using Danish Nationwide registers, a nested-case control study from 2012 to 2022 was conducted in a cohort of patients with AF. Cases were defined as death of any cause and the exposure was treatment with digoxin compared with beta blockers/verapamil. To investigate bias, additional analyses with negative control outcomes as case definitions-in which we would not expect a plausible association (eg, nursing home admission)-were employed. Associations were reported as hazard ratios (HRs) with 95% confidence intervals (95% CI).

Results

A total of 59,748 cases were identified and matched 1:10 with controls (53% men, median age: 84 [IQR: 77-89]). Digoxin was associated with increased rates of mortality in the entire cohort (HR 1.85, 95% CI 1.78-1.92) as well as subgroups such as patients with heart failure (HR 1.84, 95% CI 1.65-2.06), diabetes (HR 1.85, 95% CI 1.6-2.14), and kidney disease (HR 1.37, 95% CI 1.04-1.8). Significant associations with all negative control outcomes were also found, most notably nursing home admissions (HR 1.79, 95% CI 1.67-1.93).

Conclusion

Digoxin use was associated with increased mortality in AF. However, negative control outcomes were also associated with digoxin use indicating that the described association between digoxin and mortality is likely not causal and being prescribed digoxin is merely a marker of more advanced disease and frailty.

The association between duration of metformin and sulfonylurea treatment and microvascular complications in patients with incident type 2 diabetes: a pooled cohort analysis

Objectives

The effect of the duration of medication with metformin and sulfonylurea (SUs) on microvascular complications based on the duration of type 2 diabetes (DM2) is unclear. The aim of this study was to investigate the association of medication time with metformin and SUs and microvascular complications in newly diagnosed DM2 patients.

Methods

In this prospective multi-cohort study, data from 3,904 newly diagnosed DM from three cohorts of the Tehran Lipid and Glucose Study (TLGS), the Multi-Ethnic Study of Atherosclerosis (MESA), and the Atherosclerosis Risk in Communities (ARIC) with a mean age of 59.6 ± 08 years were pooled. Metformin medication time alone, SUs alone, and a combination of both since drug initiation were defined as exposure. The incidence of microvascular complications (diabetic nephropathy or retinopathy) was defined as outcomes. The cumulative exposure to metformin, SUs, aspirin, statin, and anti-hypertensive medication was also determined using the same approach.

Results

Metformin alone, SUs alone, and the combination of both reduced the hazard of microvascular complications by 8%(HRAdj: 0.92, 95% CI: 0.89, 0.96, P: 0.001), 6%(HRAdj: 0.94, 95% CI: 0.92, 0.97, P: 0.004), and 9%(HRAdj: 0.91, 95% CI: 0.89, 0.94, P: 0.001) for each year of use, respectively (p < 0.05). The protective effect of metformin and SUs, individually or in combination, on microvascular complications started approximately five years after the initial treatment and continued until approximately 15 years after the initial treatment and then reached a plato.

Conclusion

long-term use of metformin and SUs individually and in combination was associated with a decrease in the risk of microvascular outcomes in newly diagnosed DM for up to about one decade. These findings highlight the importance of choosing an appropriate treatment regimen for new patients with type 2 diabetes. Appropriate oral therapy can minimize microvascular complications and improve overall well-being.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01577-w.

Acute myocardial infarction-related mortality among older adults (≥65 years) with malignancy in the U.S. from 1999 to 2020

Background

Acute Myocardial Infarction (AMI) in malignancy is a global threat, causing significant mortality and economic burden. They share common risk factors, highlighting the urgency of addressing this critical issue.

Objective

This study analyzed demographic trends and disparities in mortality rates due to AMI in malignancy among adults aged 65 and older from 1999 to 2020.

Methods

We used the CDC WONDER database to analyze Age-adjusted mortality rates (AAMRs) for AMI in malignancy patients (ICD-10 I21, C00-C97) from 1999 to 2020, stratifying by sex, race, geography, and metropolitan status. We calculated Average Annual Percentage Changes (AAPCs) and Annual Percentage Changes (APCs) per 100,000 with 95 % confidence intervals (CI) using Joinpoint regression.

Results

Between 1999 and 2020, AMI in malignancy accounted for 172,691 deaths among adults aged ≥65 years, with the majority of deaths occurring in medical facilities (56.9 %). The overall AAMR for AMI in malignancy-related deaths decreased from 30.2 in 1999 to 14.2 in 2020, with an AAPC of -3.90 (p < 0.000001). Men showed higher AAMRs than women (28.6 vs. 12.3), with a more pronounced decrease in men (AAPC: 4.22, p < 0.000001) compared to women (AAPC: 3.78, p < 0.000001). Black individuals have the highest AAMR (22.7), followed by Whites (19.3). Arkansas had the highest AAMR (32.3), while Nevada had the lowest (8.1), with the Northeastern region having the highest regional AAMR (20.2), and nonmetropolitan areas had higher AAMRs.

Conclusion

This study reveals significant demographic disparities in mortality rates related to AMI in malignant older adults. These findings emphasize the need for targeted interventions and improved access to care.

Cardiogenic shock in patients with active onco-hematological malignancies: A multicenter retrospective study

PURPOSE

Onco-hematological (OH) patients face significant cardiovascular risks due to malignancy and drug toxicity. Data are limited on the characteristics and outcomes of OH patients with cardiogenic shock (CS) in intensive care units (ICUs).

METHODS

This multicenter retrospective study included 214 OH patients with CS across 22 ICUs (2010-2021). The objectives were to (i) identify risk factors for 30-day mortality, (ii) describe early and long-term outcomes, and (iii) assess the prognostic impact of malignancy by comparing OH patients to a control group of CS patients.

RESULTS

The 30-day survival rate was 44.8 %. Multivariate analysis identified previous cardiomyopathy (OR = 1.61), acute kidney injury (OR = 1.62), lactate levels (OR = 1.08 per 1 mmol/L), pulmonary embolism (OR = 3.04), invasive mechanical ventilation (OR = 3.48), and epinephrine use (OR = 2.09) as factors associated with 30-day mortality. Among ICU survivors, 54 % were alive at 1 year with a median left ventricular ejection fraction of 52 %. OH malignancy was significantly associated with 30-day mortality (HR 2.54).

CONCLUSION

The prognosis for OH patients with CS in the ICU is poor, with epinephrine use associated with worse outcomes. Further research is needed to refine risk stratification and improve treatments for this population.

Analysis and comparison of trends in the burden of subarachnoid hemorrhage in china and globally, 1990-2021

BACKGROUND

Subarachnoid hemorrhage (SAH), the rarest form of hemorrhagic stroke, is associated with high mortality and disability rates. Therefore, it is a major public health concern.

METHODS

This study reviewed the epidemiological characteristics of SAH in China and worldwide, focusing on the 2021 Global Burden of Disease (GBD) database. Researchers, using the GBD database, conducted epidemiological studies that included joinpoint regression analyses covering the incidence, mortality, prevalence, and disability-adjusted life years of SAH in the years 1990-2021. This analysis revealed the trends and effects of SAH in China and globally.

RESULTS

From 1990 to 2021, the age-standardized incidence rate (ASIR) in China decreased from 17.96 to 7.81 per 100,000 people. The age-standardized mortality rate (ASMR) decreased from 27.29 to 4.72 per 100,000 people. This resulted in a 51.58 % reduction in mortality. In contrast, both the ASIR and ASMR showed a slower decline at the global level. China has reported that women aged 70 years and older are at a high risk for SAH. Furthermore, middle-aged men have high prevalence and mortality rates.

CONCLUSIONS

The current observations warrant the design of focused interventions for both the elderly and female patients with oblique stroke. They can be useful for addressing the SAH burden globally. This study provides valuable information regarding the effectiveness of existing healthcare interventions. This information can also inform future strategies for the prevention and management of SAH.

High-intensity circuit training improves cognitive performance independent of changes in sBDNF levels in active college students

High-intensity circuit training (HICT) is an exercise modality converging aerobic and resistance exercises executed at high-intensity interspersed by recovery periods. During the HICT, the participants use their body weight as resistance. The impact of HICT on metabolic and cardiovascular markers has been reported, the effect of HICT on brain function remains unknown. The current study was focus to evaluate the impact of 24 HICT sessions on the serum BDNF (sBDNF) levels and cognition skills in young adults. Fifteen college students (22.1 ± 5.3 yr.) were randomly assigned to a control (CTRL) (n = 7) or a HICT (n = 8) group. The CTRL group continued their daily activities without restricting their physical activities, the HICT group carried out 24 HICT sessions. The sBDNF levels of all participants pre- and post-HICT intervention were determined by ELISA method. Visual memory, verbal memory, semantic verbal fluency, and attention were evaluated with specific neuropsychological tests. The heart rate variability (HRV) was recorded at rest in the supine position (5 min) for both groups at the beginning of the HICT program and 24 h after the intervention. The sBDNF levels increased in both groups at the end of the study (p < 0.0001). Visual memory (delayed recall) and long-term verbal memory significantly improved after HICT (p < 0.01). The HRV was unchanged by HICT. In conclusion, HICT might be a feasible method to improve cognition abilities in active young adults, and it is becoming a good option for college students since the intervention did not induce physiological stress in the participants.

Comparing adolescent glomerular disease clinical outcomes to the clinical outcomes in childhood, young adult, and adult-onset glomerular disease in the CureGN database

BACKGROUND

There is a lack of evidence to suggest that outcomes of adolescent and adult-onset glomerular disease differ. Still, most glomerular disease trials include adults but exclude adolescents.

METHODS

We designed a retrospective study using the CureGN database to compare individuals with adolescent-onset glomerular disease relative to individuals with older and younger age at onset. The two main outcomes were sustained proteinuria remission off immunosuppression treatment and composite eGFR decline.

RESULTS

Our data did not show a significant difference in sustained proteinuria remission off treatment or composite eGFR decline between adolescent onset glomerular disease and either childhood (age 5-12), young adult (age 20-29), or adult (age 30-39) onset glomerular disease. Having high-risk APOL1 alleles and hypertension at the time of study enrollment decreased the likelihood of achieving sustained proteinuria remission off treatment. While participants with minimal change disease and IgA nephropathy were similarly likely to achieve sustained proteinuria remission off treatment, participants with focal segmental glomerulosclerosis and membranous nephropathy were less likely to achieve sustained proteinuria remission off treatment compared to participants with minimal change disease. CKD stage, high-risk APOL1 alleles, hypertension stage, and education all significantly impacted the likelihood of progression to the composite eGFR decline outcome.

CONCLUSIONS

Approximately 25% of each age cohort reached the composite eGFR decline outcome within 5 years. As more glomerular disease clinical trials become available, we must consider opening these trials to people with childhood and adolescent onset disease since like adults they are at high risk of progressive kidney function decline.

Artificial intelligence based predictive tools for identifying type 2 diabetes patients at high risk of treatment Non-adherence: A systematic review

AIMS

Several Artificial Intelligence (AI) based predictive tools have been developed to predict non-adherence among patients with type 2 diabetes (T2D). Hence, this study aimed to describe and evaluate the methodological quality of AI based predictive tools for identifying T2D patients at high risk of treatment non-adherence.

METHODS

A systematic search was conducted across multiple databases including, EMBASE, Cochrane Library, MedLine, and Google Scholar search. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) was used to assess the quality of studies. The performances of tools were assessed by Area Under the Curve (AUC), precision, recall, C-index, accuracy, sensitivity, specificity or F1 score.

RESULTS

Most studies measured predictive ability using AUC (75 %), and some only reported precision (25 %), recall (12.5 %), C-index (12.5 %), accuracy (37.5), sensitivity (12.5 %), specificity (12.5 %) or F1 score (25 %). All tools had moderate to high predictive ability (AUC > 0.70). However, only one study conducted external validation. Demographic characteristics, HbA1c, glucose monitoring data, and treatment details were typical factors used in developing tools.

CONCLUSIONS

The existing AI based tools holds significant promise for improving diabetes care. However, future studies should focus on refining the existing tools, validating in other settings, and evaluating the cost-effectiveness of AI-supported interventions.

Association between the triglyceride-glucose index and cognitive function in stroke free patients with atrial fibrillation: A cross-sectional study

OBJECTIVES

No existing research has documented the correlation between the triglyceride-glucose (TyG) index and cognitive function in patients suffering from atrial fibrillation (AF). The objective of this study is to examine this potential association.

METHODS

Patients diagnosed with AF were enrolled in this study from March 2021 to May 2022 at the cardiology department of West China Hospital, Sichuan University. TyG index was calculated. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE) scale and Montreal Cognitive Assessment (MoCA), Verbal Fluency Test (VFT), Shape Trail Test (STT), Digit Symbol Substitution Test (DSST), and Stroop C scores and seconds. Logistic regression analyses were conducted to examine the association between the TyG index (continuous and quartiles) and cognitive function.

RESULTS

A total of 142 patients were included. The median value of the TyG index was 1.28 (1.01, 1.71). After adjusted potential confounding factors, participants in the 4th quartile of the TyG index were not found to be associated with cognitive function (all P > 0.05). The findings for TyG as a continuous variable were consistent with these results.

CONCLUSION

In patients with AF, the TyG index was found to be unrelated to low cognitive function as assessed by a comprehensive battery of tests. These findings should be validated in further studies.

A decision rule algorithm for the detection of patients with hypertension using claims data

Objectives

Claims data covers a large population and can be utilized for various epidemiological and economic purposes. However, the diagnosis of prescriptions is not determined in the claims data of many countries. This study aimed to develop a decision rule algorithm using prescriptions to detect patients with hypertension in claims data.

Methods

In this retrospective study, all Iran Health Insurance Organization (IHIO)-insured patients from 24 provinces between 2012 and 2016 were analyzed. A list of available antihypertensive drugs was generated and a literature review and an exploratory analysis were performed for identifying additional usages. An algorithm with 13 decision rules, using variables including prescribed medications, age, sex, and physician specialty, was developed and validated.

Results

Among all the patients in the IHIO database, a total of 4,590,486 received at least one antihypertensive medication, with a total of 79,975,134 prescriptions issued. The algorithm detected that 76.89% of patients had hypertension. Among 20.43% of all prescriptions the algorithm detected as issued for hypertension, mainly were prescribed by general practitioners (55.78%) and hypertension specialists (30.42%). The validity assessment of the algorithm showed a sensitivity of 100.00%, specificity of 48.91%, positive predictive value of 69.68%, negative predictive value of 100.00%, and accuracy of 76.50%.

Conclusion

The algorithm demonstrated good performance in detecting patients with hypertension using claims data. Considering the large-scale and passively aggregated nature of claims data compared to other surveillance surveys, applying the developed algorithm could assist policymakers, insurers, and researchers in formulating strategies to enhance the quality of personalized care.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01519-y.

Rehospitalization, mortality and associated variables in primary care patients with heart failure and preserved ejection fraction after first hospitalization

Introduction

There is a paucity of studies providing insights into the progression of primary care patients with heart failure and preserved ejection fraction (HFpEF).

Objetive

To investigate the characteristics associated with mortality and rehospitalizations in primary care patients with heart failure and preserved ejection fraction (HFpEF), previously hospitalized.

Methods

Retrospective cohort study that included primary care patients with previous heart failure (HF) hospitalization and ejection fraction ≥50 of 328 primary care centers of Catalonia. Demographic, comorbidities, clinical, and treatment variables were collected. Outocomes: Mortality and HF rehospitalization. Adjusted Cox regression models were performed.

Results

Study included 2895 patients. Mean age was 77(SD 9.7) years, 57 % were female. Mean follow up was 2.0[1.0-9.0] years. A total of 864(29.8 %) patients died, 831(28.7 %) were hospitalized. Mortality was associated with male sex(HR 1.26, 95 % CI 1.06-1.49), age >75 years(HR 2.76, 95 % CI 2.24-3.39), Charlson Index(HR 2.03, 95 % CI 1.21-3.42), body mass index(BMI) ≤30 kg/m2(HR 1.44, 95 % CI 1.22-1.69) and loop diuretics(HR 1.36, 95 % CI 1.11-1.65); hemoglobin levels(HR 0.87, 95 % CI 95 % 0.82-0.91) were protective. HF rehospitalization was associated with male sex(HR 1.14, 95 % CI 1.03-1.33), age >75 years(HR 1.37, 95 % CI 1.17-1.61), atrial fibrillation(HR 1.44, 95 % CI 1.25-1.67), and loop diuretics(HR 1.37, 95 % CI 1.15-1.63). Hemoglobin(HR 0.91, 95 % CI 0.87-0.95) were protective.

Conclusion

High proportion of HFpEF patients were hospitalized or died at 5 years follow up. Comorbidities, demographic, analytical and treatment variables played a relevant role as prognostic factors.

Obesity paradox in coronary artery disease: national inpatient sample analysis

BACKGROUND

Although existing literature highlights obesity as a significant predictor for coronary artery disease (CAD), the impact of BMI on hospital outcomes among CAD patients remains unclear.

METHODS

We extracted data from the National Inpatient Sample database for adult patients with CAD from 2018 to 2020. The study cohort was stratified into six BMI categories: underweight, normal weight, overweight, class I obesity, class II obesity, and class III obesity. Using multivariable logistic and linear regression, we assessed the impact of BMI on in-hospital mortality, length of stay (LOS), and inflation-adjusted total charges.

RESULTS

We identified a total of 3 693 570 hospitalizations (mean age: 69 ± 12 years). Underweight individuals had the highest in-hospital mortality rate (6.8%), followed by normal weight (5.2%), overweight (3.2%), class III obese (2.5%), class I obese (1.9%), and class II obese (1.8%) individuals. After adjusting for covariates, underweight patients had higher odds of in-hospital mortality compared to normal-weight individuals [odds ratio (OR), 1.38; 95% confidence interval (CI), 1.31-1.45; P < 0.001], while overweight or obese individuals had lower odds: overweight (OR, 0.75; 95% CI, 0.70-0.79; P < 0.001), obese class I: (OR, 0.54; 95% CI, 0.51-0.57; P < 0.001), obese class II: (OR, 0.56; 95% CI, 0.53-0.59; P < 0.001), obese class III: (OR, 0.78; 95% CI, 0.74-0.82; P < 0.001). Normal weight and underweight patients had the longest median LOS [5 days (3.0-9.0)]. Overweight patients incurred the highest total charges [$53 730 (28 587-105 184)].

CONCLUSION

Underweight patients experienced higher, while overweight and obese patients experienced lower in-hospital mortality than normal-weight patients, suggesting a protective effect of higher BMI against mortality in CAD.

A hands-on approach: Developing a longitudinal physical assessment curriculum for pharmacy students

OBJECTIVE

To develop and implement a longitudinal pharmacy student physical assessment curriculum within an accelerated pharmacy school curriculum.

METHODS

A team consisting of a primary care pharmacist and two patient care lab (PCL) course directors identified relevant pharmacist physical assessment skills and aligned the teaching of these skills with concurrent pharmacotherapeutic modules. Formative and summative assessments identified competency related to identified skills.

RESULTS

In the first academic year, students successfully completed physical assessment workshops in vitals collection, performing cardiovascular, respiratory, and endocrine physical assessments. In the second academic year, students successfully completed workshops in performing advanced cardiovascular, respiratory, pain and inflammation, neurology and behavioral health, immunological and gastrointestinal disorders, special populations, and critical care, toxicology, and substance abuse. Students successfully completed summative assessments at prespecified intervals.

CONCLUSION

Faculty successfully developed and implemented a longitudinal physical assessment curriculum within an accelerated pharmacy school curriculum which incorporated intentional alignment with concurrent pharmacotherapeutic courses.

Unravelling the association of glycosylated haemoglobin A1c, blood pressure, and LDL-cholesterol (ABC) with all-cause mortality in Type 2 diabetes patients: insights from a middle-income country

Introduction

This study evaluated the risk of all-cause mortality among Type 2 Diabetes (T2D) patients in Malaysia, correlating it with glycosylated haemoglobin A1c (HbA1c), blood pressure (BP), and LDL-Cholesterol (LDL-C) - the ABC parameters. This would fill the evidence gap from middle-income countries like Malaysia.

Methods

This retrospective cohort study analysed data from National Diabetes Registry and death records for 90,933 T2D patients in southern Malaysia (2011-2021). ABC parameters were categorized into quantiles, and adjusted hazard ratios (aHR) were estimated using Cox regression with the lowest-risk quantile as reference.

Results

All-cause mortality showed a 'J-shaped' association across ABC parameters. For HbA1c, aHRs (95% CI) were 1.11 (1.03-1.19) and 1.51 (1.40-1.63) in the first and last deciles (reference: fourth decile). For BP and LDL-C (reference: third quantile), aHRs were 1.11 (1.05-1.17) and 1.19 (1.13-1.24) for systolic BP, and 1.08 (1.03-1.14) and 1.16 (1.11-1.22) for LDL-C at the lowest and highest quintiles. For diastolic BP, aHRs were 1.09 (1.02-1.16) and 1.11 (1.04-1.19) at the lowest and highest quartiles.

Conclusion

Maintaining optimal ABC parameters is crucial to reduce mortality in T2D patients. These findings fill critical gap in the literature, particularly for the Malaysian population.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01620-w.

Trends in cardiac arrest care and mortality in United States emergency departments over eight years

INTRODUCTION

Cardiac arrest in the emergency department (ED) is a rare event. Prior studies have used dedicated cardiac arrest registries, but few have leveraged "big data" from electronic healthcare vendors to analyze trends in the care of patients excluded from registries.

METHODS

This was a retrospective cohort study of adult patients in the ED with cardiac arrest from Epic Cosmos, a database with 277 million patients. Patients with ICD-10 codes corresponding to cardiac arrest in the ED were included. Outcomes included the incidence of cardiac arrest, mortality, code length, and extracorporeal membrane oxygenation (ECMO). Data were compared using odds ratio with 95 % confidence intervals (CI).

RESULTS

Among 196,834,283 ED visits from 1/1/2016 to 12/31/2023, there were 429,917 (0.22 %) cardiac arrests and 197,233 (45.88 %) patients who died in the ED. The incidence of cardiac arrest (0.26 %) and death in the ED (55.70 %) peaked in 2020. Cardiac arrest was more common in male and older patients, between 00:00-05:59, on weekends, and in the South (p < 0.001). The median code length was 10-20 min. Only 0.29 % of cardiac arrest patients received ECMO. Compared to 2016, the odds of a code length > 90 min and ECMO in 2023 were 1.43 (95 % CI 1.32-1.54) and 3.58 (95 % CI 2.41-5.31) times greater, respectively.

CONCLUSION

Although cardiac arrest in the ED is a rare event, almost half of patients die in the ED. The use of ECMO after cardiac arrest is increasing but remains low. Further research is needed to mitigate these differences in care.

Gut microbiota contributes to obstructive sleep apnea-induced hypertension by gut-heart axis in mice

BACKGROUND

The gut microbiome has been closely linked to obstructive sleep apnea (OSA)-associated hypertension (HTN). However, its precise role in the pathogenesis of OSA-induced HTN remains unclear.

METHODS

To clarify the causal relationship between gut dysbiosis and OSA-related HTN, C57BL6J mice were randomly assigned to four groups. Each group underwent fecal microbiota transplantation from healthy individuals (control), OSA patients (OSA group), OSA patients with pre-hypertension (OSA-pHTN group), or OSA patients with HTN (OSA-HTN group). The pro-hypertensive effects of the OSA gut microbiota were verified, and the composition and function of the gut microbiota were compared using 16S rDNA gene sequencing. Additionally, the gut microbiota-related lipopolysaccharide (LPS)/ Toll-like receptor 4 (TLR4)/nuclear factor-kappaB (NF-κB) pathway in aortic tissues was investigated.

RESULTS

Fecal microbiota transplantation induced increased systolic blood pressure and aortic injury in mice from the OSA, OSA-pHTN and OSA-HTN groups, whereas no significant injury was observed in the control group. These three groups exhibited dysbiosis and impaired intestinal barrier function as evidenced by a reduction in Akkermansia and decreased expression of zonula occludens-1 and Occludin proteins. In addition, LPS, TLR4 and phosphorylated NF-κB expression were increased in aortic tissue from the three groups, and immunofluorescence showed a significant upregulation of TLR4 expression in aortic endothelial cells compared to controls.

CONCLUSION

This study demonstrates the pro-hypertensive effects of gut microbiota in OSA, mediated through the gut-derived LPS/TLR4/NF-κB pathway. These findings may guide the development of therapeutic strategies focused on restoring gut microbiome homeostasis.

Prevalence of cardiovascular disease risk factors associated with residential natural hazard risk

BACKGROUND

Specific natural hazards are associated with increased chronic disease risk. Less is known about the impact of living in regions with elevated natural hazards risk.

OBJECTIVE

We evaluated cross-sectional associations between predicted residential natural hazard risk and CVD-related risk factors.

METHODS

We used data from the Gulf Long-term Follow-up Study, a prospective cohort enrolled following the Deepwater Horizon disaster (N = 32,608). We evaluated diabetes prevalence among 29,714 participants who provided enrollment data on self-reported physician diagnosis of diabetes. In separate analyses, we evaluated obesity and hypertension using data from 10,727 home visit participants with measured height, weight, and blood pressure. We linked geocoded residential enrollment and home visit addresses to the National Risk Index (NRI, 1960-2020), a monetized risk score that quantifies overall and hazard-specific risk at the census-tract level. Modified Poisson regression estimated prevalence ratios (PRs) and 95 % confidence intervals (CIs) for associations between quartiles of overall and natural hazard-specific risks and prevalence of diabetes, hypertension (systolic/diastolic blood pressure ≥ 140/90 mmHg or antihypertensive medication use), and obesity (BMI ≥ 30.0 kg/m2).

RESULTS

The highest quartile of overall NRI was associated with hypertension (Q4 vs. Q1 PR:1.16[1.09,1.24]) but not diabetes or obesity. All quartiles of hurricane risk were associated with higher diabetes prevalence (PR1.33 to 1.36). Increasing quartiles of heatwave risk were associated with increasing prevalence of diabetes, hypertension, and obesity, with PRs 1.23[1.09,1.38], 1.12[1.04,1.19] and 1.09[1.03,1.16] for Q4 vs. Q1, respectively.

CONCLUSION

Residing in areas prone to natural disasters is associated with higher prevalence of key cardiovascular disease risk factors.

Construction of a risk prediction model for hypertension in type 2 diabetes: Independent risk factors and nomogram

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder increasingly linked with hypertension, posing significant health risks. The need for a predictive model tailored for T2DM patients is evident, as current tools may not fully capture the unique risks in this population. This study hypothesizes that a nomogram incorporating specific risk factors will improve hypertension risk prediction in T2DM patients.

AIM

To develop and validate a nomogram prediction model for hypertension in T2DM patients.

METHODS

A retrospective observational study was conducted using data from 26850 T2DM patients from the Anhui Provincial Primary Medical and Health Information Management System (2022 to 2024). The study included patients aged 18 and above with available data on key variables. Exclusion criteria were type 1 diabetes, gestational diabetes, insufficient data, secondary hypertension, and abnormal liver and kidney function. The Least Absolute Shrinkage and Selection Operator regression and multivariate logistic regression were used to construct the nomogram, which was validated on separate datasets.

RESULTS

The developed nomogram for T2DM patients incorporated age, low-density lipoprotein, body mass index, diabetes duration, and urine protein levels as key predictive factors. In the training dataset, the model demonstrated a high discriminative power with an area under the receiver operating characteristic curve (AUC) of 0.823, indicating strong predictive accuracy. The validation dataset confirmed these findings with an AUC of 0.812. The calibration curve analysis showed excellent agreement between predicted and observed outcomes, with absolute errors of 0.017 for the training set and 0.031 for the validation set. The Hosmer-Lemeshow test yielded non-significant results for both sets (χ² = 7.066, P = 0.562 for training; χ² = 6.122, P = 0.709 for validation), suggesting good model fit.

CONCLUSION

The nomogram effectively predicts hypertension risk in T2DM patients, offering a valuable tool for personalized risk assessment and guiding targeted interventions. This model provides a significant advancement in the management of T2DM and hypertension comorbidity.

Triple Antihypertensive Medication Prediction Score After Intracerebral Hemorrhage (the TRICH Score)

BACKGROUND AND OBJECTIVES

Poor long-term blood pressure (BP) control due to undertreatment of hypertension is not uncommon after intracerebral hemorrhage (ICH). It heightens the risk of ICH recurrence and subsequent stroke, which is the highest within the first year. Promptly achieving BP targets would significantly reduce these risks. To accomplish this, upfront triple antihypertensive medications could be prescribed soon after ICH because many ICH survivors require ≥3 antihypertensives. However, not all would suit this approach, particularly those with cerebral amyloid angiopathy (CAA), where elevated admission BP may be due to acute hypertensive response rather than underlying hypertension. In addition, overtreatment and excessive BP lowering would cause more side effects and have been associated with increased mortality in older patients. Hence, to facilitate individualized treatment, we aimed to develop a score (TRICH) to predict the need for ≥3 antihypertensives at 3 months after ICH.

METHODS

We developed the score using data from the University of Hong Kong prospective ICH registry (2011-2022) and validated it in 3 hospitals (2020-2022) locally. Consecutive patients with spontaneous ICH who survived >90 days and had follow-up BP 3 months after ICH were included. Predictors for needing ≥3 antihypertensive medications at 3 months were identified using multivariate logistic regression, and the score was created using the β-coefficients.

RESULTS

The TRICH score was developed from 462 patients (mean age 66.6 ± 14.3 years, 60% male) and validated in 203 patients (mean age 66.3 ± 14.6 years, 62% male). The 9-point score (age younger than 60 years = 1, male = 1, ischemic heart disease = 1, admission estimated glomerular filtration rate <60 mL/min/1.73 m2 = 2, admission systolic BP 190-230 mm Hg = 2 while >230 mm Hg = 4) has a c-statistic (95% CI) of 0.79 (0.75-0.83) in the development cohort and 0.76 (0.69-0.82) in validation. A dichotomized score (≥3 points) predicted the need for ≥3 antihypertensives with 0.73 (95% CI 0.67-0.80) sensitivity and 0.76 (95% CI 0.70-0.81) specificity. The score performed better in patients with untreated/uncontrolled hypertension before ICH than in controlled patients (c-statistic [95% CI] 0.81 [0.77-0.86] vs 0.74 [0.69-0.80], p = 0.037) but showed no difference between patients with CAA and non-CAA patients.

DISCUSSION

The TRICH score identifies patients with ICH who need ≥3 antihypertensive medications 3 months after ICH with good discrimination ability. It may guide upfront triple antihypertensive prescription, but further research is warranted, particularly in non-Han Chinese populations.

Impact of COPD and sarcopenia on all-cause and respiratory mortality in US adults: NHANES 1999-2018

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) and sarcopenia (SAR) are major public health problems in aging societies, as they share common pathophysiological mechanisms and are associated with serious health consequences. We estimated the impact of COPD and SAR on all-cause and respiratory mortalities in the US adult population.

METHODS

The study analyzed data from the National Health and Nutrition Examination Surveys (NHANES), a representative sample of the US population. Participants aged 20 years or older who had reported whole-body dual X-ray absorptiometry data and data required for the diagnosis of COPD were included. Participants were divided into four groups based on the presence of COPD and SAR.

RESULTS

Compared to the COPD-/SAR - group, the COPD-/SAR+, COPD+/SAR-, and COPD+/SAR + groups all demonstrated increased all-cause mortality with Hazard Ratios (HRs) of 1.33 (95% CI 1.20-1.48), 1.51 (95% CI 1.21-1.88), and 1.87 (95% CI 1.32-2.66), respectively. In addition, both the COPD+/SAR - and COPD+/SAR + groups demonstrated increased respiratory mortality with HRs of 5.16 (95% CI 2.96-9.01), and 8.69 (95% CI 3.95-19.1) compared to the COPD-/SAR - group.

CONCLUSIONS

The coexistence of COPD and SAR additively increased the risk of all-cause and respiratory mortality. Individuals with one of these diseases may need to be treated more carefully to prevent the development of the other disease and thus reduce mortality.

Cardiotoxicity of small-molecule kinase inhibitors in cancer therapy

Cancer is one of the leading causes of death worldwide. Recent advances in precision oncology have enabled many specific cancer patient populations to respond well and achieve longer survival with small-molecule kinase inhibitors, which have become a new therapeutic strategy for tumors. Since 2001, the Food and Drug Administration has approved 108 and 63 new anticancer drugs for treating solid tumors and hematological malignancies, respectively, 89 of which belong to the large group of small-molecule kinase inhibitors (SMKIs). Compared to conventional chemotherapeutic agents such as cyclophosphamide, doxorubicin, and 5-FU, SMKIs offer better efficacy with fewer toxic side effects. Nevertheless, with the development of more novel SMKIs and their wider clinical application to a larger population of cancer patients, variable degrees of cardiotoxic adverse events have emerged for some SMKIs during cancer therapy. This review comprehensively summarizes the most updated progress in the cardiotoxicity of SMKIs in cancer therapy and discusses the new findings and mechanisms, which will provide emerging strategies for the prevention of cardiotoxicity caused by small molecule targeted drugs and the design of the next generation of low cardiotoxicity targeted drugs.

Association of total cholesterol to high-density lipoprotein cholesterol ratio with diabetes risk: a retrospective study of Chinese individuals

A common complication of type 2 diabetes is hypercholesterolemia in many patients. It is still unclear, nevertheless, how high-density lipoprotein cholesterol ratio (TC/HDL-C), total cholesterol, and diabetes are related. The purpose of this study is to look at the prediction ability and causal relationship between TC/HDL-C and diabetes. This study included 117,268 subjects who were undergoing physical examinations. The subjects were grouped into four equal groups according to the TC/HDL-C quartiles; the main outcome was the occurrence of diabetes events. TC/HDL-C is calculated as total cholesterol divided by high-density lipoprotein cholesterol. In 3.1 years (± 0.95) of follow-up, 795 women (0.68%) and 1,894 men (1.62%) received new diabetes diagnoses. TC/HDL-C is an independent predictor of new-onset diabetes, according to multivariable Cox regression analysis (HR 1.27 per SD increase, 95% CI: 1.09-1.48, P for trend < 0.001). It turned out that a cutoff value of 3.55 (area under the curve 0.64, sensitivity 0.66, specificity 0.56), was ideal for TC/HDL-C in predicting new-onset diabetes. A subgroup analysis demonstrated that the younger population had a significantly higher risk of TC/HDL-C-related diabetes than the middle-aged group (interaction P < 0.05). After controlling for confounding variables, this Chinese cohort study reveals a direct correlation between TC/HDL-C and diabetes, with a stronger independent association observed in younger and middle-aged individuals.

Heart rate variability in children and adolescents with incidentally found early repolarization pattern

BACKGROUND

Early repolarization pattern (ERP) on electrocardiogram (ECG) was long considered benign, but recent data suggest a potential association with fatal arrhythmia and sudden cardiac death. Its relevance in pediatric populations remains unclear. This study investigated the risk of premature death and arrhythmia in children with incidentally found early repolarization using ECG and heart rate variability parameters.

METHODS

This cross-sectional study included healthy children aged 6-18 years with incidentally detected ERP (study group) and age- and sex-matched controls without ERP. All participants underwent medical history evaluation, physical examination, 12-lead ECG, transthoracic echocardiography, and 24-h Holter monitoring. ECG parameters (P wave, QTc, JT, Tp-e, and their dispersions), time-domain (SDNN, SDANN, SDNN-i, r-MSSD, pNN50), and frequency-domain (HF, LF, LF/HF) HRV parameters were analyzed.-i, r-MSSD, pNN50 and "Frequency-domain" parameters HF, LF, LF/HF were obtained.

RESULTS

The study group had lower heart rates (p = 0.020) and increased JT dispersion (p = 0.025). Interventricular septal thickness was significantly greater in the ERP group (p = 0.030). LF/HF ratio (p = 0.045), awake HF (p = 0.046), and awake LF/HF (p = 0.036) were significantly higher in ERP patients. Parasympathetic activity predominance was more evident in males. ERP localized in inferolateral leads was associated with higher heart rate and lower SDNN and VLF during sleep (p = 0.049, p = 0.040, p = 0.040, respectively).

CONCLUSION

Incidental ERP in children was not associated with arrhythmic events but correlated with increased parasympathetic tone. Inferolateral ERP may indicate a relatively higher autonomic imbalance risk.

Left ventricular unloading during extracorporeal cardiopulmonary resuscitation: a target trial emulation of the ELSO registry

BACKGROUND

Patients who undergo extracorporeal cardiopulmonary resuscitation (ECPR) are at risk of left ventricular distention and complications. There is emerging evidence that concurrent mechanical left ventricular (LV) unloading (e.g. an intra-aortic balloon pump, or microaxial left ventricular assist device) may improve survival. Despite this, there are no large, well-conducted studies investigating the impact of LV unloading on outcomes in ECPR.

METHODS

We queried the Extracorporeal Life Support Organisation (ELSO) registry between 2020 and 2023, and used an emulated target trial framework to investigate the association between concurrent mechanical left ventricular unloading and outcomes in patients receiving ECPR. We imputed missing data using multiple imputation with chained equations, and identified potential confounders implicated in the causal pathway between ECPR and survival time up to 90 days (primary outcome). We used propensity score-matching to adjust for potential confounders, and analysed the primary outcome using a Cox proportional hazards model. We then emulated further target trials based on the inclusion criteria of prior ECPR RCTs to assess whether concurrent unloading was associated with better outcomes based on these criteria. Secondary outcomes included complications from ECPR as classified by ELSO, and survival with favourable functional outcome defined as a Cerebral Performance Category (CPC) 1-2.

RESULTS

Of the 3,215 patients included in our analysis, we matched 621 pairs of patients who did and did not receive LV unloading. There were no significant differences in survival time between both groups (HR 0.92, 95%-CI 0.79-1.08), nor survival with favourable functional outcomes (OR 1.15, 95%-CI 0.67-1.99). This was concordant across several sensitivity analyses. Of note, LV unloading was associated with a higher rate of renal (OR 1.55, 95%-CI 1.16-2.07) and cardiovascular (OR 1.60, 95%-CI 1.14-2.26) complications. LV unloading was also associated with central nervous system bleeding (OR 1.75, 95%-CI 1.03-2.96), arrhythmias (OR 1.56, 95%-CI 1.04-2.36), and haemolysis (OR 1.85, 95%-CI 1.10-3.09).

CONCLUSIONS

Left ventricular unloading was not associated with improved survival in the context of ECPR and may increase complication rates. Randomised data are required to confirm these findings.

Risk factors for pneumonia after radical gastrectomy for gastric cancer: a systematic review and meta-analysis

OBJECTIVE

The objective is to systematically gather relevant research to determine and quantify the risk factors and pooled prevalence for pneumonia after a radical gastrectomy for gastric cancer.

METHODS

The reporting procedures of this meta-analysis conformed to the PRISMA 2020. Chinese Wan Fang data, Chinese National Knowledge Infrastructure (CNKI), Chinese Periodical Full-text Database (VIP), Embase, Scopus, CINAHL, Ovid MEDLINE, PubMed, Web of Science, and Cochrane Library from inception to January 20, 2024, were systematically searched for cohort or case-control studies that reported particular risk factors for pneumonia after radical gastrectomy for gastric cancer. The pooled prevalence of pneumonia was estimated alongside risk factor analysis. The quality was assessed using the Newcastle-Ottawa Scale after the chosen studies had been screened and the data retrieved. RevMan 5.4 and R 4.4.2 were the program used to perform the meta-analysis.

RESULTS

Our study included data from 20,840 individuals across 27 trials. The pooled prevalence of postoperative pneumonia was 11.0% (95% CI = 8.0% ~ 15.0%). Fifteen risk factors were statistically significant, according to pooled analyses. Several factors were identified to be strong risk factors, including smoking history (OR 2.71, 95% CI = 2.09 ~ 3.50, I2 = 26%), prolonged postoperative nasogastric tube retention (OR 2.25, 95% CI = 1.36-3.72, I2 = 63%), intraoperative bleeding ≥ 200 ml (OR 2.21, 95% CI = 1.15-4.24, I2 = 79%), diabetes mellitus (OR 4.58, 95% CI = 1.84-11.38, I2 = 96%), male gender (OR 3.56, 95% CI = 1.50-8.42, I2 = 0%), total gastrectomy (OR 2.59, 95% CI = 1.83-3.66, I2 = 0%), COPD (OR 4.72, 95% CI = 3.80-5.86, I2 = 0%), impaired respiratory function (OR 2.72, 95% CI = 1.58-4.69, I2 = 92%), D2 lymphadenectomy (OR 4.14, 95% CI = 2.29-7.49, I2 = 0%), perioperative blood transfusion (OR 4.21, 95% CI = 2.51-7.06, I2 = 90%), and hypertension (OR 2.21, 95% CI = 1.29-3.79, I2 = 0%). Moderate risk factors included excessive surgery duration (OR 1.51, 95% CI = 1.25-1.83, I2 = 90%), advanced age (OR 1.91, 95% CI = 1.42-2.58, I2 = 94%), nutritional status (OR 2.62, 95% CI = 1.55-4.44, I2 = 71%), and history of pulmonary disease (OR 1.61, 95% CI = 1.17-2.21, I2 = 79%).

CONCLUSIONS

This study identified 15 independent risk factors significantly associated with pneumonia after radical gastrectomy for gastric cancer, with a pooled prevalence of 11.0%. These findings emphasize the importance of targeted preventive strategies, including preoperative smoking cessation, nutritional interventions, blood glucose and blood pressure control, perioperative respiratory training, minimizing nasogastric tube retention time, and optimizing perioperative blood transfusion strategies. For high-risk patients, such as the elderly, those undergoing prolonged surgeries, experiencing excessive intraoperative blood loss, undergoing total gastrectomy, or receiving open surgery, close postoperative monitoring is essential. Early recognition of pneumonia signs and timely intervention can improve patient outcomes and reduce complications.

Association between adverse childhood experiences and long-term blood pressure variability: Insights from a pooled analysis

BACKGROUND

The association between adverse childhood experiences (ACEs) and long-term blood pressure variability (BPV) remains unexamined. This study aimed to identify the longitudinal association between ACEs and BPV and explore the potential modification effect by using a polled analysis.

METHODS

Participants with complete information from the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), and the China Health and Retirement Longitudinal Study (CHARLS) were included. A score of ACEs was summed by questionnaires, and the standard deviation (SD) was calculated to assess the BPV in main analyses. A linear regression model was performed to explore the association between ACEs and BPV.

RESULTS

The study included 6187, 2654, and 2929 eligible participants from the HRS, the ELSA, and the CHARLS, respectively. After adjusting for covariates, ACEs were significantly associated with higher SD of systolic blood pressure (BP) (pooled β: 0.131, [95%CI: 0.029, 0.233]), and associated with higher SD of diastolic BP (pooled β: 0.092, [95%CI: -0.016, 0.200]). A pooled analysis showed that the association between ACEs and BPV were more pronounced among hypertensive participants, especially in systolic BP (pooled β: 0.189, [95%CI: 0.035, 0.342].

CONCLUSION

We for the first time reported that ACEs were significantly associated with long-term BPV, and hypertension status played a role in this relationship. More early intervention and support should be provided to the population with ACEs, especially for those with hypertension.

Exercise prescriptions for ischemic cardiomyopathy: a scoping review

This review explores the critical role of exercise as a non-pharmacological intervention in managing ischemic cardiomyopathy (ICM), a leading cause of heart failure. It highlights the profound cardiovascular benefits of exercise, such as improved cardiopulmonary parameters, decreased morbidity and mortality, and enhanced functional capacity. It also critically evaluates existing literature on the efficacy of various exercise types and intensities, including aerobic, resistance, and high-intensity interval training. There is a significant gap in current clinical guidelines, which lack specific exercise prescriptions tailored to the unique pathophysiology of ICM. By synthesizing data from both older and contemporary studies, this review highlights specific, evidence-based exercise regimens and promotes supervised cardiac rehabilitation programs. This review also addresses potential barriers to cardiac rehabilitation participation and proposes future directions, which include the use of technology to improve adherence and outcomes.

Pentoxifylline uses in inner ear diseases

BACKGROUND

Labyrinth or the inner ear consists of the cochlea (for hearing) and vestibular system (for balance), with disorders affecting hearing, balance, or both, and symptomatology including hearing loss, tinnitus, and vertigo. Regulatory-approved medications for inner ear diseases are rare worldwide relative to the frequency of those diseases. There are no FDA-approved medications for any inner ear disease. This is due to multiple reasons, including the lack of conclusive evidence for various drugs that have been investigated. We aim to contribute to the review endeavor by addressing pentoxifylline (PTX), a medication that has been studied for cochlear and vestibular disorders, yet its efficacy and safety have not been systematically reviewed in a publication.

METHODS

More than a dozen databases from around the globe were systematically searched, including PubMed, EMBASE, Scopus, Web of Science, Cochrane/CENTRAL, ScienceDirect, Google Scholar, Europe PMC, ICTRP, ClinicalTrials.gov, EU-CTR, PsycInfo, LILACS, WPRIM, IBECS, SciELO, CNKI, VIP, and Wanfang, to methodically compile experimental and analytical studies. Search results are up to January 2025. This work focused on workable reports in which PTX had distinct or attributable results and organized them into overarching categories of vertigo, hearing loss, and tinnitus.

RESULTS

Forty studies, including 15 randomized controlled trials (RCTs), were included. Each condition was addressed in seven RCTs, with some overlap. Studies on inner ear vertigo reported significant outcomes for PTX. A large proportion of the literature involved idiopathic sudden sensorineural hearing loss (ISSNHL), but its results were mixed. Studies on tinnitus suggest that PTX has similar efficacy to Ginkgo biloba extract and corticosteroids, two of the most prescribed medications. Adverse events were generally mild and rarely necessitated discontinuation.

CONCLUSION

Pentoxifylline could improve inner ear vertigo and tinnitus. In ISSNHL, results are inconsistent in the context of spontaneous recovery rates, albeit leaning toward ineffectiveness. Over a variety of regimens, it sustained good safety. The rigor and designs of the reports could not produce robust recommendations.

Clinical staging to guide management of metabolic disorders and their sequelae: a European Atherosclerosis Society consensus statement

Obesity rates have surged since 1990 worldwide. This rise is paralleled by increases in pathological processes affecting organs such as the heart, liver, and kidneys, here termed systemic metabolic disorders (SMDs). For clinical management of SMD, the European Atherosclerosis Society proposes a pathophysiology-based system comprising three stages: Stage 1, where metabolic abnormalities such as dysfunctional adiposity and dyslipidaemia occur without detectable organ damage; Stage 2, which involves early organ damage manifested as Type 2 diabetes, asymptomatic diastolic dysfunction, metabolic-associated steatohepatitis (MASH), and chronic kidney disease (CKD); and Stage 3, characterized by more advanced organ damage affecting multiple organs. Various forms of high-risk obesity, driven by maintained positive energy balance, are the most common cause of SMD, leading to ectopic lipid accumulation and insulin resistance. This progression affects various organs, promoting comorbidities such as hypertension and atherogenic dyslipidaemia. Genetic factors influence SMD susceptibility, and ethnic disparities in SMD are attributable to genetic and socioeconomic factors. Key SMD features include insulin resistance, inflammation, pre-diabetes, Type 2 diabetes, MASH, hypertension, CKD, atherogenic dyslipidaemia, and heart failure. Management strategies involve lifestyle changes, pharmacotherapy, and metabolic surgery in severe cases, with emerging treatments focusing on genetic approaches. The staging system provides a structured approach to understanding and addressing the multi-faceted nature of SMD, which is crucial for improving health outcomes. Categorization of SMD abnormalities by presence and progression is aimed to improve awareness of a multi-system trait and encourage a tailored and global approach to treatment, ultimately aiming to reduce the burden of obesity-related comorbidities.