Monocyte to high-density lipoprotein cholesterol ratio as a marker of the presence and progression of diabetic kidney disease

BACKGROUND

Monocyte to high-density lipoprotein cholesterol ratio (MHR) is considered a novel marker of inflammation. However, whether MHR can predict the risk of diabetic kidney disease (DKD) remains uncertain. Our research aimed to investigate the relationship between MHR and DKD.

METHODS

This was a cross-sectional retrospective study of 159 participants with type 2 diabetes mellitus. MHR, urinary albumin-to-creatinine ratio (UACR) and other indexes were measured. According to UACR, participants were divided into normal group (UACR < 30 mg/g), moderately increased group (UACR 30-300 mg/g) and severely increased group (UACR > 300 mg/g). The association between MHR and DKD was analyzed.

RESULTS

MHR was significantly elevated in severely increased albuminuria group (p = 0.029). The prevalence of DKD increased in parallel with the elevation in MHR (p = 0.009). MHR was positively related with DKD in univariate logistic regression analysis (ORs = 11.27, 95%CI 1.26-101.24, p = 0.031). Multivariable logistic regression analysis showed MHR significantly correlated with DKD (ORs = 6.20, 95%CI 1.49-25.84, p = 0.012). Each quartile elevation in MHR was associated with an increased risk of DKD (ORs = 1.90, 95%CI 1.19-3.01, p = 0.007). In subgroup analyses MHR was a risk factor for DKD, particularly in patients with HbA1c <8.0%.

CONCLUSIONS

Our findings suggest that MHR can be used as a marker for the presence and progression of DKD.

Gut microbiota as a new target for hyperuricemia: A perspective from natural plant products

BACKGROUND

Hyperuricemia, a prevalent chronic metabolic disorder caused by purine metabolism disturbances, is characterized by elevated serum uric acid (UA) levels. Prolonged hyperuricemia can cause severe complications such as gout or kidney damage. However, the toxic side effects of and adverse reactions to UA-lowering drugs are becoming increasingly prominent. Therefore, new targets and drugs for hyperuricemia are needed.

PURPOSE

This review aims to summarize recent research progress on the prevention and treatment mechanisms for gut microbiota-hyperuricemia from the perspective of plant-derived natural products.

METHODS

Data from PubMed, Web of Science, ScienceDirect, and the CNKI databases spanning from January 2020 to December 2024 were reviewed. The aim of this study is to categorize and summarize the relevant mechanisms through which natural products improve hyperuricemia via the gut microbiota. The retrieved data followed PRISMA criteria (Preferred Reporting Items for Systematic reviews and Meta-Analyses).

RESULTS

Regulating gut microbiota as a treatment for hyperuricemia. Targeting the gut microbiota could reduce host UA levels by promoting purine degradation, reducing UA production, and increasing UA excretion. Moreover, the gut microbiota also exerts anti-inflammatory and antioxidant effects that alleviate complications such as renal damage caused by hyperuricemia. Due to their diverse sources, multicomponent synergy, multitarget effects, and minimal side effects, plant-derived natural products have been extensively utilized in the management of hyperuricemia. Especially, utilizing natural products from plants to regulate the gut microbiota has become a new strategy for reducing UA levels.

CONCLUSION

This review comprehensively summarizes recent advances in understanding the preventive and therapeutic mechanisms of plant-derived natural products in ameliorating hyperuricemia and its comorbidities through gut microbiota modulation. This review contributes a novel perspective for the development of safer and more efficacious UA-lowering products.

Risk of Major Adverse Cardiovascular Events After SARS-CoV-2 Infection in British Columbia: A Population-Based Study

BACKGROUND

COVID-19 is associated with increased risk of post-acute cardiovascular outcomes. Population-based evidence for long periods of observation is still limited.

METHODS

This population-based cohort study was conducted using data (2020-2021) from the British Columbia COVID-19 Cohort. The exposure of interest was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, identified through reverse transcription-polymerase chain reaction (RT-PCR) assay. Individuals who tested positive (exposed) on RT-PCR were matched to negative controls (unexposed) on sex, age, and RT-PCR collection date in a 1:4 ratio. Outcomes of interest were incident major adverse cardiovascular events and acute myocardial infarction, identified more than 30 days after RT-PCR collection date. The association between SARS-CoV-2 infection and cardiovascular risk was assessed through multivariable survival models. Population attributable fractions were computed from Cox models.

RESULTS

We included 649,320 individuals: 129,864 exposed and 519,456 unexposed. The median duration of follow-up was 260 days; 1,786 events (0.34%) took place among the unexposed, and 702 (0.54%) in the exposed. The risk of major adverse cardiovascular events was higher in the exposed (adjusted hazard ratio [aHR] 1.34; 95% confidence interval [CI], 1.22-1.46), with greater risk observed in those who were hospitalized (aHR 3.81; 95% CI, 3.12-4.65) or required intensive care unit admission (aHR 6.25; 95% CI, 4.59-8.52) compared with the unexposed group. The fraction of cardiovascular events attributable to SARS-CoV-2 was 7.04% (95% CI, 4.67-9.41%). Comparable results were observed for acute myocardial infarction.

CONCLUSIONS

SARS-CoV-2 infection was associated with higher cardiovascular risk, with graded increase across the acute COVID-19 severity, contributing to 7% of incident major adverse cardiovascular events. These findings suggest that long-term monitoring of cardiovascular risk is required in COVID-19 survivors.

Prevalence and Determinants of Long-Term Post-COVID Conditions in the United States: 2022 Behavioral Risk Factor Surveillance System

BACKGROUND

A significant proportion of COVID survivors experience lingering and debilitating symptoms following acute COVID-19 infection. According to the national research plan on long COVID, it is a national priority to identify the prevalence of post-COVID conditions and their associated factors.

METHOD

We performed a cross-sectional analysis of the Prevention Behavioral Risk Factor Surveillance System (BRFSS) 2022, the largest continuously gathered health survey dataset worldwide by the Centers for Disease Control. After identifying individuals with a positive history of COVID-19, we grouped COVID-19 survivors based on whether they experienced long-term post-COVID conditions. Using survey-specific R packages, we compared the two groups' socio-demographics, comorbidities, and lifestyle-related factors. A logistic regression model was used to identify factors associated with post-COVID conditions.

RESULTS

The overall estimated prevalence of long-term post-COVID conditions among COVID survivors was 21.7%. Fatigue (5.7%), dyspnea (4.2%), and anosmia/ageusia (3.8%) were the most frequent symptoms. Based on multivariate logistic regression analysis, female sex, body mass index (BMI)≥25, lack of insurance, history of pulmonary disease, depression, and arthritis, being a former smoker, and sleep duration <7 h/d were associated with higher odds of post-COVID conditions. On the other hand, age >64 y/o, Black race, and annual household income ≥$100k were associated with lower odds of post-COVID conditions.

CONCLUSION

Our findings indicate a notable prevalence of post-COVID conditions, particularly among middle-aged women and individuals with comorbidities or adverse lifestyles. This high-risk demographic may require long-term follow-up and support. Further investigations are essential to facilitate the development of specified healthcare and therapeutic strategies for those suffering from post-COVID conditions.

Relationship between atherogenic index of plasma and length of stay in critically ill patients with atherosclerotic cardiovascular disease: a retrospective cohort study and predictive modeling based on machine learning

BACKGROUND

The atherogenic index of plasma (AIP) is considered an important marker of atherosclerosis and cardiovascular risk. However, its potential role in predicting length of stay (LOS), especially in patients with atherosclerotic cardiovascular disease (ASCVD), remains to be explored. We investigated the effect of AIP on hospital LOS in critically ill ASCVD patients and explored the risk factors affecting LOS in conjunction with machine learning.

METHODS

Using data from the Medical Information Mart for Intensive Care (MIMIC)-IV. AIP was calculated as the logarithmic ratio of TG to HDL-C, and patients were stratified into four groups based on AIP values. We investigated the association between AIP and two key clinical outcomes: ICU LOS and total hospital LOS. Multivariate logistic regression models were used to evaluate these associations, while restricted cubic spline (RCS) regressions assessed potential nonlinear relationships. Additionally, machine learning (ML) techniques, including logistic regression (LR), decision tree (DT), random forest (RF), extreme gradient boosting (XGB), and light gradient boosting machine (LGB), were applied, with the Shapley additive explanation (SHAP) method used to determine feature importance.

RESULTS

The study enrolled a total of 2423 patients with critically ill ASCVD, predominantly male (54.91%), and revealed that higher AIP values were independently associated with longer ICU and hospital stays. Specifically, for each unit increase in AIP, the odds of prolonged ICU and hospital stays were significantly higher, with adjusted odds ratios (OR) of 1.42 (95% CI, 1.11-1.81; P = 0.006) and 1.73 (95% CI, 1.34-2.24; P < 0.001), respectively. The RCS regression demonstrated a linear relationship between increasing AIP and both ICU LOS and hospital LOS. ML models, specifically LGB (ROC:0.740) and LR (ROC:0.832) demonstrated superior predictive accuracy for these endpoints, identifying AIP as a vital component of hospitalization duration.

CONCLUSION

AIP is a significant predictor of ICU and hospital LOS in patients with critically ill ASCVD. AIP could serve as an early prognostic tool for guiding clinical decision-making and managing patient outcomes.

Assessing the Predictive Significance of Carotid Ultrasound Parameters for Coronary Artery Disease: A 3-Year Single-Center Experience

Aims/Background Coronary angiography is a widely used invasive approach for diagnosing coronary atherosclerotic heart disease (CHD). However, carotid ultrasound may predict CHD by assessing carotid atherosclerosis. Therefore, this study explores the predictive significance of carotid ultrasound parameters in accurately diagnosing coronary artery disease. Methods This retrospective analysis included 82 CHD patients who underwent carotid ultrasound scans at the Funan County Hospital of Traditional Chinese Medicine, China, between July 2021 and February 2024. Based on coronary angiography results, patients were divided into the CHD (n = 48) and non-CHD (n = 34) groups. Differences in clinical data, biochemical indicators, and carotid ultrasound parameters were evaluated between the two experimental groups. Furthermore, correlation analysis assessed the association between ultrasound parameters and CHD occurrence and severity. Additionally, multivariable logistic regression analyses were performed, followed by developing a CHD prediction nomogram model. Finally, the model's performance was evaluated through analyses of receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curves. Results The CHD group had higher body mass index (BMI), smoking history, diabetes, total cholesterol (TC), and triglycerides (TG) levels (p < 0.05). Furthermore, significantly higher intima-media thickness (IMT) and plaque score and lower plaque echogenicity grey scale median (GSM) were observed in the CHD group (p < 0.05). Pearson correlation showed a positive correlation between Gensini score and IMT, plaque score, and a negative association with plaque echogenicity GSM (p < 0.05). Spearman correlation revealed positive correlations between BMI, smoking history, diabetes, TG, TC, IMT, plaque score, and CHD diagnosis, and a negative correlation with plaque echogenicity GSM (p < 0.05). IMT and plaque score were identified as CHD risk factors and plaque echogenicity GSM as a protective factor (p < 0.05). The model based on carotid ultrasound parameters demonstrated high predictive performance for CHD, with an area under the curve (AUC) of 0.866 (95% confidence interval [CI]: 0.779-0.953). DCA and calibration curves supported the model's accuracy. Conclusion Carotid ultrasound parameters differ significantly between CHD and non-CHD patients. The developed model using these parameters effectively predicts CHD occurrence, providing a valuable diagnostic alternative for coronary angiography.

Sex-related hormonal variances and clinical outcomes in TAVR patients

BACKGROUND

Sex-related differences play a pivotal role in disease manifestation and outcome in patients with cardiovascular disease, including aortic valve stenosis (AS). However, data regarding sex-related hormonal differences in AS patients undergoing transcatheter aortic valve replacement (TAVR) is lacking.

OBJECTIVES

We aimed to assess sex-related hormonal variances in patients with severe symptomatic AS and to evaluate the impact of these hormonal differences on the clinical outcomes after TAVR.

METHODS

In a total of 361 TAVR patients, we assessed the hormonal status, including cortisol, parathormone (PTH), insulin-like growth factor 1 (IGF-1), dehydroepiandrosterone sulfate (DHEAs), estradiol, progesterone and testosterone prior to TAVR. We compared baseline characteristics and outcome data according to sex and hormonal parameters. The primary endpoint was 1-year all-cause mortality according to sex; secondary endpoints included the risk of 1-year all-cause mortality in conjunction with hormone levels, with pre-specified cut-off values.

RESULTS

Rates of 1-year all-cause mortality were comparable between the sexes (p = 0.285). Cox regression analysis revealed significant associations between 1-year mortality and levels of cortisol (HR 2.30; p = 0.007), PTH (HR 2.09; p = 0.019), DHEA-S (HR 0.47; p = 0.016), and IGF-1 (HR 0.42; p = 0.004) in the overall cohort. Elevated cortisol levels (p = 0.011), decreased DHEA-S levels (p = 0.007), and lower IGF-1 levels (p = 0.017) were significantly associated with higher rates of 1-year all-cause mortality in males. Conversely, higher PTH levels were significantly associated with an increased risk of 1-year mortality in females (p = 0.012).

CONCLUSION

Sex-specific hormonal differences significantly impact the prognosis of severe AS patients undergoing TAVR. Elevated cortisol levels and decreased DHEA-S and IGF-1 levels in males, as well as higher levels of PTH in females, were associated with an increased mortality risk.

Prognostic value of liver fibrosis scores in ambulatory patients with heart failure

OBJECTIVES

To investigate the association of four liver fibrosis scores - Fibrosis-4 (FIB-4), AST/ALT ratio, AST-to-platelet ratio index (APRI) and Gamma-glutamyl transferase-to-platelet ratio index (GPRI) - and clinical outcomes in ambulatory patients with heart failure (HF).

METHODS

We conducted a retrospective study involving 2379 patients with HF referred to a specialized clinic from January 2010 to June 2022. We used multivariable Cox´s regression models to study the association between liver fibrosis scores and long-term clinical outcomes (all-cause death and the combined endpoints all-cause death or HF hospitalization and cardiovascular death or heart transplantation). Areas under receiver-operator curves were used to evaluate the discriminative capacity of each score for predicting 1-year clinical outcomes, as well as to analyze their incremental predictive value in addition to the broadly validated MAGGIC risk score.

RESULTS

Median follow up was 1568 days. GPRI was identified as an independent predictor of all-cause death or HF hospitalization (HR 1.12, 95% CI 1.07-1.18), all-cause death (HR 1.14, 95% CI 1.08-1.20) and cardiovascular death or heart transplantation (HR 1.10, 95% CI 1.03-1.17). FIB-4 and AST/ALT ratios were also independently associated with all-cause mortality. According to receiver-operator curve analyses, GPRI showed the best discriminative capacity among the four liver fibrosis scores evaluated in the study to predict 1-year clinical outcomes. The predictive value of GPRI was incremental to the one of the MAGGIC risk score.

CONCLUSIONS

Liver fibrosis scores are associated with long-term clinical outcomes in ambulatory patients with HF. In our study, the predictive capacity of GPRI outperformed the one of FIB-4, APRI and AST/ALT and was incremental to the one of the MAGGIC risk score.

Pathogenesis and therapeutic effect of sitagliptin in experimental diabetic model of COVID-19

This study evaluates the pathogenesis of COVID-19 and the therapeutic efficacy of sitagliptin in diabetic and obese mice. Using a novel double-transgenic mouse model (db/db and K18-hACE2), the findings demonstrates that SARS-CoV-2 infection (Delta variant) causes severe multi-organ damage, glucose metabolism abnormalities, insulin resistance, and pancreatic islet cell damage in diabetic mice. Infected diabetic mice displayed higher mortality, inflammation (elevated TNF-α, IL-6, IL-1β), and fibrinolytic activity (PAI-1), alongside dysregulated diabetes-related hormones (GLP-1, leptin, ghrelin, resistin) compared to non-diabetic controls. Sitagliptin treatment reduced organ injury, hyperglycemia, inflammation, and fibrinolytic activity while improving insulin resistance and glucose metabolism. This was evidenced by decreased fasting blood glucose levels, improved insulin sensitivity, and elevated insulin and GLP-1 levels. These findings suggest sitagliptin is a promising therapeutic strategy to mitigate the severity of COVID-19 in experimental diabetes by modulating inflammation and improving metabolic syndrome. Further mechanistic investigations revealed that the level of hACE2 expression, along with the activation of NF-κB and IRS-1, play critical roles in the development of SARS-CoV-2-induced diabetes, the exacerbation of pre-existing diabetes, and the therapeutic efficacy of sitagliptin.

Impact of myocardial injury on cardiovascular complications in hospitalized patients with COVID-19: insights from Latin America

Introduction

Viral infection by SARS-CoV2 is a pandemic affecting over 600 million people worldwide. One of five hospitalized patients may present myocardial injury, strongly associated with disease severity and mortality.

Methodology

Retrospective cross-sectional study of hospitalized COVID-19 patients diagnosed between May 01, 2020, and June 30, 2021, from the database of the Registro Latinoamericano de Enfermedad Cardiovascular y COVID-19 (CARDIO COVID 19-20) with a troponin value recorded during hospitalization. A descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was conducted according to the presence or absence of myocardial injury. Survival analysis was made using Kaplan-Meier curves, by the presence of myocardial injury. A multivariate Poisson regression model was performed to determine factors associated with mortality. Statistical analyses were performed using the RStudio V.1.4.1717 package.

Results

A total of 2,134 patients were included, 64.2% were male, and 911 patients had myocardial injury. The median age of the total population was 61 years. Individuals with myocardial injury had a higher prevalence of hypertension, diabetes, and dyslipidemia. Survival probability was lower in this subgroup. Patients with myocardial injury had a 1.95 times higher risk of death. Age, male sex, chronic kidney disease, arrhythmias, decompensated heart failure, requirement of inotropic/vasopressor, and invasive mechanical ventilation were related to higher mortality risk in patients with myocardial injury.

Conclusion

Patients with COVID-19 and myocardial injury exhibit a broad spectrum of cardiac abnormalities. Myocardial injury is associated with a higher disease severity and risk of in-hospital mortality. This multicenter study uniquely represents data from 13 Latin American countries, offering regional insights into the impact of myocardial injury during the COVID-19 pandemic.

The BG Study Part 1 (Bergisch Gladbach): Development of a Prototype Coronary Artery Disease Risk Score Incorporating Peripheral Vascular Parameters-Preliminary Insights for Future CAD Risk Prediction Models in Vascular Patients

Background: Peripheral vascular parameters may provide valuable insights into coronary artery disease (CAD) risk stratification. This study aimed to develop a CAD risk score by integrating carotid duplex velocities, ankle-brachial index (ABI), and clinical history into a point-based model. Methods: We analyzed data from 902 cardiology patients, of whom 592 (65.6%) had confirmed CAD based on coronary angiography. Peripheral vascular assessments included carotid duplex ultrasonography and ABI measurements. Predictors were identified through multivariate logistic regression, addressing multicollinearity and interaction effects. A point-based scoring system was developed using statistically significant variables and evaluated via receiver operating characteristic (ROC) analysis. Results: Key predictors included external carotid artery velocities, ABI, carotid stenosis, chronic kidney disease (CKD) stage, smoking history, diabetes, hypertension, and age. The scoring system demonstrated moderate discriminative ability (AUC: 0.683) and high sensitivity (97%) for detecting CAD-positive cases but lower specificity (11%) for CAD-negative cases. Patients were stratified into risk categories, with an optimal threshold of ≥7 points maximizing the F1 score. Conclusions: This novel scoring system highlights the clinical relevance of integrating peripheral vascular assessments into CAD risk models. While its high sensitivity ensures robust detection of CAD-positive patients, future multicenter studies are needed to improve specificity and validate its broader clinical utility.

Uncovering the role of prokineticin pathway on Epicardial Adipose Tissue (EAT) development and EAT-associated cardiomyopathy

Epicardial adipose tissue (EAT), a unique fat depot surrounding the heart, plays a multifaceted role in glucose and lipid metabolism, thermogenesis, and the secretion of bioactive molecules that influence cardiac structure and function. Its proximity to the myocardium allows it to contribute directly to CVDs, including coronary artery disease, arrhythmias, and heart failure. In particular, excessive EAT has emerged as a significant factor in heart failure with preserved ejection fraction (HFpEF), the most common form of heart failure, especially in individuals with obesity and diabetes. Traditional metrics like body mass index (BMI) fail to capture the complexities of visceral fat, as patients with similar BMIs can exhibit varying CVD risks. EAT accumulation induces mechanical stress and fosters a pro-inflammatory and fibrotic environment, driving cardiac remodeling and dysfunction. Pharmacological modulation of EAT has shown promise in delivering cardiometabolic benefits. Recent advancements in diabetes therapies, such as SGLT2 inhibitors and GLP-1 receptor agonists, and antilipidemic drugs have demonstrated their potential in reducing pro-inflammatory cytokine production and improving glucose regulation, which directly influences EAT. These discoveries suggest that EAT could be a significant therapeutic target, though further investigation is necessary to elucidate its role in HFpEF and other CVDs. Recent advances have identified the prokineticin/PKR1 signaling pathway as pivotal in EAT development and remodeling. This pathway regulates epicardial progenitor cells (EPDCs), promoting angiogenesis while reducing EAT accumulation and metabolic stress on the heart, particularly under high-calorie conditions. Prokineticin, acting through its receptor PKR1, limits visceral adipose tissue growth, enhances insulin sensitivity, and offers cardioprotection by reducing oxidative stress and activating cellular survival pathways. In this review, we provide a comprehensive analysis of EAT's role in CVDs, explore novel therapeutic strategies targeting EAT, and highlight the potential of prokineticin signaling as a promising treatment for HFpEF, obesity, and diabetes.

Gender-specific association between a novel atherogenic index of plasma, metabolic parameters and inflammation among obese adults

BACKGROUND

Previous studies have demonstrated the association between lipoprotein combined index (LCI), as a novel atherogenic index with cardiovascular disease, fatty liver, diabetes and numerous other health problems; however, its association with metabolic syndrome risk and its components has not been investigated before. The current study was aimed to investigate the association between LCI metabolic and inflammatory risk factors among obese men and women.

METHODS

In the current cross-sectional study, the association between LCI, anthropometric parameters and metabolic risk factors including serum lipids, glycemic markers, insulin resistance and C - reactive protein (CRP) concentrations were measured. LCI was calculated as (total cholesterol [TC] × triglyceride [TG] × low density lipoprotein cholesterol [LDL]) / (high density lipoprotein cholesterol [HDL]).

RESULTS

Highest quartiles of LCI was accompanied with higher waist to hip ratio (P = 0.017). Also, higher systolic and diastolic blood pressure, higher serum lipids and lower high density lipoprotein concentrations were observed in higher quartiles of LCI HDL (P < 0.05). Among men and women, higher LCI was also associated with higher CRP and lower HDL in men (P < 0.05); while among women, higher CRP, TG, TC and lower HDL was observed in highest versus lowest quartiles of LCI (P < 0.05). Among anthropometric and biochemical variables, TG has the highest power for identification of metabolic syndrome with area under curve (AUC) of 0.82 and Youden index of 0.58 while LCI was in the second place after TG in prediction of metabolic syndrome (e.g. AUC of 0.80 and Youden index of 0.47).

CONCLUSION

LCI was in direct association with lipid parameters and inflammation among obese men and women. Although predictive power of LCI for metabolic syndrome was acceptable, but it came in the second place after TG for men and women. Further studies are warranted to make a better conclusion.

CLINICAL TRIAL NUMBER

Not applicable.

Association of fibrinogen-to-albumin ratio with all-cause and cardiovascular mortality in patients on dialysis with acute coronary syndrome

PURPOSE

This study aimed to investigate the association of the fibrinogen-to-albumin ratio (FAR) and all-cause mortality as well as cardiovascular mortality in patients on dialysis with acute coronary syndrome (ACS). Furthermore, we explored the incremental prognostic value of incorporating the FAR into the Global Registry of Acute Coronary Events (GRACE) score.

METHODS

We retrospectively enrolled 1035 patients on dialysis with ACS between January 2015 and June 2021. The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. Multivariate Cox regression model, restricted cubic spline analysis, and C-statistic were performed to evaluate the prognostic value of FAR on outcomes.

RESULTS

After a median follow-up of 21.8 months, 369 (35.7%) patients died, including 250 cardiovascular deaths. Patients with the highest FAR tertile had significantly increased risks of all-cause mortality (46.1% vs 27.8%; adjusted hazard ratio [HR], 1.790; 95% confidence interval [CI], 1.372-2.336) and cardiovascular mortality (33.0% vs 16.5%; adjusted HR, 2.086; 95% CI, 1.496-2.908) compared to those in the lowest tertile. Restricted cubic spline analysis revealed a J-shaped association between the FAR and all-cause mortality and cardiovascular mortality, with HRs increasing significantly when the FAR exceeded 94.15. Furthermore, integrating the FAR into the GRACE score significantly improved its predictive accuracy for all-cause mortality and cardiovascular mortality, as measured by C-statistic, continuous net reclassification index, and integrated discriminatory index.

CONCLUSIONS

In patients on dialysis with ACS, the FAR was independently associated with increased risks of all-cause mortality and cardiovascular mortality. Incorporating the FAR might improve the predictive accuracy of the GRACE score in patients on dialysis with ACS.

Dietary and plasma atherogenic and thrombogenic indices and cardiometabolic risk factors among overweight and individuals with obesity

BACKGROUND

Obesity and hyperlipidemia are the two central metabolic disorders linked to non-communicable diseases (NCDs) that increase the risk of cardiovascular disease (CVD). Apart from dyslipidemia, the Atherogenic Index of Plasma (AIP), which is associated with dietary consumption, is another marker for predicting the risk of CVD. Healthy fat quality indicators may impact AIP. The purpose of this study is to ascertain whether there is any connection between Iranian obese people's plasma and dietary indices and cardiometabolic risk factors.

METHODS

This cross-sectional study, consisted of 645 overweight and obese participants. The study included assessments of body composition and anthropometric measurements. Dietary fatty acid consumption was evaluated using a validated Food Frequency Questionnaire (FFQ) containing 168 items. Additionally, biochemical parameters, including serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), fasting serum glucose (FSG), and insulin levels, were measured using enzymatic methods. The lipid profile was quantified.

RESULTS

For participants in higher tertiles of the AIP, the percentage of men was significantly higher than women (men: 48.1%, women: 51.7%, p < 0.001). Additionally, individuals in higher tertiles of AIP had a higher waist-to-hip ratio (WHR) (mean WHR: 0.92 ± 0.05 vs. 0.86 ± 0.04 in lower tertile, p < 0.001). Participants in the highest tertile of AIP had higher systolic blood pressure (SBP: 132 ± 8 mmHg vs. 118 ± 6 mmHg in lower tertile, p < 0.001), total cholesterol (TC: 210 ± 15 mg/dL vs. 185 ± 12 mg/dL, p < 0.001), triglycerides (TG: 180 ± 20 mg/dL vs. 120 ± 15 mg/dL, p < 0.001), and glucose concentrations (fasting glucose: 105 ± 10 mg/dL vs. 90 ± 8 mg/dL, p < 0.001). Participants in the lower tertile of AIP had higher HDL cholesterol levels (HDL: 60 ± 5 mg/dL vs. 45 ± 4 mg/dL in higher tertile, p < 0.001). In the model for Thrombogenicity Index (TI), participants in the higher tertile had higher glucose concentrations (glucose: 110 ± 12 mg/dL vs. 95 ± 9 mg/dL in lower tertile, p = 0.04).

CONCLUSION

This research introduces a novel field of investigation and emphasizes the possible importance of TI, AI, and AIP indices in regulating cardiometabolic risk factors.

The Heme Oxygenase/Biliverdin Reductase System and Its Genetic Variants in Physiology and Diseases

Heme oxygenase (HO) metabolizes heme into ferrous iron, carbon monoxide (CO), and biliverdin-IXα (BV), the latter being reduced into bilirubin-IXα (BR) by the biliverdin reductase-A (BVR). Heme oxygenase exists as two isoforms, HO-1, inducible and involved in the cell stress response, and HO-2, constitutive and committed to the physiologic turnover of heme and in the intracellular oxygen sensing. Many studies have identified genetic variants of the HO/BVR system and suggested their connection in free radical-induced diseases. The most common genetic variants include (GT)n dinucleotide length polymorphisms and single nucleotide polymorphisms. Gain-of-function mutations in the HO-1 and HO-2 genes foster the ventilator response to hypoxia and reduce the risk of coronary heart disease and age-related macular degeneration but increase the risk of neonatal jaundice, sickle cell disease, and Parkinson's disease. Conversely, loss-of-function mutations in the HO-1 gene increase the risk of type 2 diabetes mellitus, chronic obstructive pulmonary disease, and some types of cancers. Regarding BVR, the reported loss-of-function mutations increase the risk of green jaundice. Unfortunately, the physiological role of the HO/BVR system does not allow for the hypothesis gene silencing/induction strategies, but knowledge of these mutations can certainly facilitate a medical approach that enables early diagnoses and tailored treatments.

Prevalence of cardiovascular symptoms in post-acute COVID-19 syndrome: a meta-analysis

BACKGROUND

Since its emergence in 2019, COVID-19 has continued to pose significant threats to both the physical and mental health of the global population, as well as to healthcare systems worldwide (Raman et al., Eur Heart J 43:1157-1172, 2022). Emerging evidence indicates that COVID-19 may lead to post-acute COVID-19 syndrome (PACS) with cardiovascular implications, potentially driven by factors such as ACE2 interaction with viruses, systemic inflammation, and endothelial dysfunction. However, there remains a limited amount of research on the cardiovascular manifestations of PACS, which may delay the development of optimal treatment strategies for affected patients. Therefore, it is crucial to investigate the prevalence of cardiovascular sequelae in COVID-19 patients and to determine whether COVID-19 infection acts as an independent risk factor for these outcomes.

METHODS

This meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024524290). A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to March 17, 2024. The primary outcomes included hypertension, palpitations, and chest pain, with pooled effect estimate reported as proportions and odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity and subgroup analysis were performed to assess the robustness of the results and to identify sources of heterogeneity.

RESULTS

A total of 37 studies, encompassing 2,965,467 patients, were included in the analysis. Pooled results from case-control studies revealed that, compared to the control group, the ORs of chest pain in the COVID-19 group was 4.0 (95% CI: 1.6, 10.0). The ORs for palpitation and hypertension were 3.4 (95% CI: 1.1, 10.2) and 1.7 (95% CI: 1.6, 1.8), respectively. The proportions of PACS patients experiencing chest pain, palpitation, and hypertension as sequelae were 22% (95% CI: 14%, 33%), 18% (95% CI: 13%, 24%), and 19% (95% CI: 12%, 31%), respectively.

CONCLUSIONS

Our findings indicate that 15% of COVID-19 patients experience cardiovascular sequelae. Furthermore, COVID-19 infection significantly increases the likelihood of developing these sequelae compared to uninfected individuals. Future research should prioritize investigating the underlying pathological mechanisms and developing targeted preventive and management strategies.

TRIAL REGISTRATION

CRD42024524290.

The relationship between the atherogenic index of plasma and postoperative myocardial injury following non-cardiac surgery under general anaesthesia: a retrospective cohort study

BACKGROUND

The atherogenic index of plasma (AIP) is a reliable lipid marker associated with coronary artery stenosis (CAS) and cardiovascular events. However, the relationship between AIP and myocardial injury after non-cardiac surgery (MINS) remains insufficiently explored.

METHODS

This retrospective study included adult patients who underwent non-cardiac surgery under general anaesthesia. The primary exposure was preoperative AIP, with MINS as the primary outcome. The predictive accuracy of AIP for MINS was assessed using the area under the curve (AUC). Restricted cubic splines (RCS) were used to explore the potential nonlinear relationship between AIP and MINS. Logistic regression analysis was conducted to examine the association of AIP with MINS. Subgroup and interaction analyses were carried out across multiple factors, including age, gender, body mass index, medical history, and the type of surgery (emergency or elective).

RESULTS

The cohort consisted of 1,160 adult patients, with a median preoperative AIP of -0.05. The incidence of MINS was 7.9%. The AUC for AIP in predicting MINS was 0.719, surpassing the AUCs of triglycerides and high-density lipoprotein cholesterol (0.644 and 0.683, respectively). RCS analysis demonstrated a linear relationship between AIP and MINS (P for nonlinear = 0.165). Patients in the highest quartile of AIP had significantly higher odds of developing MINS than those in the lowest quartile (adjusted OR, 8.05; 95% confidence interval [CI], 3.44 to 18.80; P < 0.001). The results across most subgroups were consistent with the primary analysis, showing no significant interaction effects.

CONCLUSIONS

A significant and independent linear relationship exists between preoperative AIP and the risk of MINS. As an economical and easily accessible lipid marker, AIP holds potential for preoperative screening of patients at risk of postoperative cardiovascular events.

Exploring the mechanism of Paotianxiong polysaccharide in the treatment of chronic kidney disease combining metabolomics and microbiomics technologies

A close relationship between the pathogenesis of chronic kidney disease (CKD) and abnormalities in the gut-kidney axis. Paotianxiong polysaccharides (PTXP) that have demonstrated therapeutic effects on CKD. However, the specific mechanism by which PTXP ameliorates CKD through the gut-kidney axis remains to be explored. In this study, the microbiomes and metabolomics were combined to investigate the impact of PTXP on intestinal flora structure and metabolism, further unveiling the relationship through correlation analysis. The results showed that PTXP intervention significantly modulated renal function abnormalities in CKD rats and significantly modulates gut microbial disorders, evidenced by an increased abundance of Lactobacillus murinus, Bacteroides fragilis, and a decreased abundance of Bifidobacterium pseudolongum. Furthermore, PTXP reversed the changes in intestinal metabolites, such as linoleic acid and docosahexaenoic acid, induced by CKD and identified unsaturated fatty acid metabolism as a key metabolic pathway. Correlation analyses also revealed associations among gut microorganisms, metabolites, and renal function indexes, confirming that PTXP alleviated CKD through the gut-kidney axis. Moreover, the above conclusions were verified by fecal bacteria transplantation experiments. These findings provide insights into the mechanism of PTXP for the treatment of CKD and provide new targets for the treatment of CKD.

Intracrine Formation of Steroid Hormones in Breast Cancer, Epidermal Keratinocyte, Dermal Fibroblast, and Adipocyte Cell Lines Measured by LC-MS/MS

Peripheral tissues such as skin and adipose tissue play a crucial role in the intracrine formation of sex steroid hormones, complementing the endocrine and paracrine systems. These mechanisms involve the conversion of dehydroepiandrosterone (DHEA) and its sulfated form-DHEAS-into potent androgenic and estrogenic hormones. In vitro studies using tissue-specific cell lines are essential for unraveling the complex intracrine synthesis of these hormones. This study examined the formation of DHEA, androstenedione (A4), testosterone (T), dihydrotestosterone (DHT), and estradiol (E2) from DHEAS in four cell lines: MCF-7 breast cancer cells, HaCaT keratinocytes, human dermal fibroblasts (HDF), and 3T3-L1 preadipocytes and mature adipocytes, using liquid chromatography-mass spectrometry (LC-MS/MS). MCF-7 cells converted DHEAS to DHEA, A4, T, E2, and DHT, while HaCaT cells produced all these steroids except DHT. Mature 3T3-L1 adipocytes produced DHEA, A4, T, and DHT. By contrast, HDF and 3T3-L1 preadipocytes converted DHEAS only to DHEA and A4. This study highlights the vital role of peripheral tissues, such as skin and adipose tissue, for the intracrine formation of sex hormones and underlines the crucial role of in vitro cell culture models to analyze such effects. The data shed light on the significant impact of androgen metabolism in skin and adipose tissue, which is of great relevance for aging, wound healing, obesity, and lipid metabolism.

Atherogenic index of plasma and coronary artery disease: a systematic review and meta-analysis of observational studies

BACKGROUND

Atherogenic index of plasma (AIP), a novel logarithmic index that combines fasting triglyceride and high-density lipoprotein cholesterol concentrations, is associated with the burden of atherosclerosis. This study aimed to evaluate the relationship between AIP and coronary artery disease (CAD) risk, severity, and prognosis in populations with and without established CAD.

METHODS

PubMed, Embase, and Web of Science were systematically searched from the inception of each database to August 13, 2024. Cross-sectional studies, case-control studies, and prospective or retrospective cohort studies using multivariate analysis were included. Given that the true effect size may differ across studies, a random-effects model for all analyses was applied.

RESULTS

Fifty-one observational studies were included in this study. Patients with higher AIP were more likely to have CAD (odds ratio (OR): 2.79, 95% CI 1.75-4.45, P < 0.00001). Furthermore, these patients were more likely to have coronary artery calcification (OR: 2.28, 95% CI 1.74-3.00, P < 0.00001), multivessel CAD (OR: 2.04, 95% CI 1.50-2.77, P < 0.00001), and an increased risk of plaque progression (OR: 1.49, 95% CI 1.17-1.91, P = 0.001). In populations without established CAD, higher AIP levels were associated with an increased risk of Major adverse cardiovascular events (MACE) (hazard ratio (HR): 1.28, 95% CI 1.22-1.35, P < 0.00001). Interestingly, this finding was consistent in patients presenting with acute coronary syndrome (HR: 1.59, 95% CI 1.33-1.89, P < 0.00001) and patients with chronic coronary syndrome or stable CAD (HR: 1.65, 95% CI 1.15-2.37, P = 0.007).

CONCLUSIONS

This meta-analysis demonstrates that elevated AIP is strongly associated with increased CAD risk, greater severity, and poorer prognosis in populations with and without established CAD. However, more studies are needed to evaluate the predictive performance and determine the optimal cut-off for AIP in different populations.

Exploring the hemoglobin-to-red blood cell distribution width ratio (HRR) to peripheral arterial disease nexus: a comprehensive analysis of NHANES data from 1999 to 2004

Objective

This study aimed to investigate the correlation between the Hemoglobin-to-Red Blood Cell Distribution Width Ratio (HRR) and Peripheral Artery Disease (PAD) prevalence, utilizing data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004.

Methods

The study employed a cross-sectional design, analyzing data from 5,196 participants aged 40 and above. PAD was diagnosed using the Ankle-Brachial Index (ABI), with ABI less than 0.9 indicating PAD. HRR, calculated as the ratio of hemoglobin (HB) to red blood cell distribution width (RDW), was stratified into quartiles. Covariates included demographic and clinical variables such as BMI, lipid profiles, and diabetes status. Logistic regression analysis was conducted to assess the relationship between HRR and PAD, adjusting for potential confounders.

Results

The study found that higher HRR quartiles were associated with a decreased risk of PAD. After adjusting for confounders, the odds ratios for PAD in relation to the second, third, and fourth quartiles of HRR compared to the first quartile were 0.71, 0.62, and 0.44, respectively (P < 0.001). A one-unit increase in HRR corresponded to a 56% reduction in the probability of PAD. ROC analysis indicated HRR as a stronger protective factor for PAD compared to other variables. Stratified analyses revealed that younger age and lower BMI amplified the protective effect of HRR on PAD.

Conclusion

The study demonstrated a significant inverse relationship between HRR and PAD, suggesting that HRR may serve as a protective factor against PAD. This finding highlights the potential role of HRR in the pathogenesis of PAD and its clinical implications.

Potential roles of cigarette smoking on gut microbiota profile among Chinese men

BACKGROUND

Cigarette smoking is posited as a potential factor in disrupting the balance of the human gut microbiota. However, existing studies with limited sample size have yielded inconclusive results.

METHODS

Here, we assessed the association between cigarette smoking and gut microbial profile among Chinese males from four independent studies (N total = 3308). Both 16S rRNA and shotgun metagenomic sequencing methods were employed, covering 206 genera and 237 species. Microbial diversity and abundance were compared among non-smokers, current smokers, and former smokers.

RESULTS

Actinomyces[g], Atopobium[g], Haemophilus[g], Turicibacter[g], and Lachnospira[g] were found to be associated with smoking status (current smokers vs. non-smokers). Metagenomic data provided a higher resolution at the species level, particularly for the Actinomyces[g] branch. Additionally, serum γ-glutamylcysteine (γ-Glu-Cys) was found to have a potential role in connecting smoking and Actinomyces[g]. Furthermore, we revealed putative mediation roles of the gut microbiome in the associations between smoking and common diseases including cholecystitis and type 2 diabetes.

CONCLUSIONS

We characterized the gut microbiota profile in male smokers and further revealed their potential involvement in mediating the impact of smoking on health outcomes. These findings advance our understanding of the intricate association between cigarette smoking and the gut microbiome.

Applying two approaches to detect unmeasured confounding due to time-varying variables in a self-controlled risk interval design evaluating COVID-19 vaccine safety signals, using myocarditis as a case example

We test the robustness of the self-controlled risk interval (SCRI) design in a setting where time between doses may introduce time-varying confounding, using both negative control outcomes (NCOs) and quantitative bias analysis (QBA). All vaccinated cases identified from 5 European databases between September 1, 2020, and end of data availability were included. Exposures were doses 1-3 of the Pfizer, Moderna, AstraZeneca, and Janssen COVID-19 vaccines; outcomes were myocarditis and, as the NCO, otitis externa. The SCRI used a 60-day control window and dose-specific 28-day risk windows, stratified by vaccine brand and adjusted for calendar time. The QBA included two scenarios: (1) baseline probability of the confounder was higher in the control window and (2) vice versa. The NCO was not associated with any of the COVID-19 vaccine types or doses except Moderna dose 1 (IRR = 1.09; 95% CI 1.01-1.09). The QBA suggested that even the strongest literature-reported confounder (COVID-19; RR for myocarditis = 18.3) could only explain away part of the observed effect, from IRR = 3 to IRR = 1.40. The SCRI seems robust to unmeasured confounding in the COVID-19 setting, although a strong unmeasured confounder could bias the observed effect upward. Replication of our findings for other safety signals would strengthen this conclusion. This article is part of a Special Collection on Pharmacoepidemiology.

Comparison of Gensini score and SYNTAX score for predicting in-stent restenosis in patients with coronary artery disease and drug-eluting stent implantation

The present study was aimed to investigate whether Gensini score or SYNTAX score was a valuable tool to predict in-stent restenosis (ISR) in coronary artery disease (CAD) patients with drug-eluting stents (DES) implantation. A retrospective case-control study and a validating retrospective cohort study were designed. All subjects' information was collected from the First Affiliated Hospital of Xinjiang Medical University. A total of 916 patients were enrolled in the case-control study, and 961 subjects were included in the retrospective-cohort study. In the case-control study, significant differences were observed between the ISR and non-ISR groups regarding baseline characteristics and clinical examinations, including waist circumference, systolic blood pressure, blood glucose levels, ApoA1 levels, left ventricular ejection fraction, lesion vessels, Gensini score, and SYNTAX score (all P < 0.05). All parameters showing significant differences were also associated with ISR (all P < 0.05). However, after adjustment for confounders, both Gensini score [tertile 3 vs. tertile 1 with OR 95%CI: 15.61 (5.37-45.39)] and SYNTAX score [high risk ≥ 33 vs. low risk ≤ 22 with OR 95%CI 12.61 (5.14-30.94)] were still independently associated with ISR. Furthermore, Gensini score [AUC 95%CI: 0.81 (0.78-0.84)] and SYNTAX score [AUC 95%CI: 0.76 (0.72-0.79)] showed a moderate ability to predict ISR. The predictors were further verified in a cohort validation study, which confirmed that the Gensini score was a better predictor for ISR than SYNTAX score, with an AUC and 95%CI of 0.67 (0.60-0.73) and 0.53 (0.46-0.60), respectively. Gensini score showed a higher capability to predict ISR than SYNTAX score in CAD patients with DES implantation. SYNTAX score may also be a useful tool for assessing the risk of ISR in patients with multivessel lesions.

The correlation and predictive value of Hb, RDW and their association for short-term and long-term mortality in patients with acute aortic dissection

Background

This study examines the relationship between Hb, RDW and their association and both short-term and long-term mortality in patients with acute aortic dissection (AAD), aiming to establish combined effect between Hb and RDW as a potential prognostic biomarker for AAD outcomes.

Methods

We extracted clinical data from the Medical Information Mart for Intensive Care (MIMIC) databases for this analysis. Using adjusted Cox regression and Kaplan-Meier survival curve analyses, we assessed the relationship between Hb, RDW and their association at admission and mortality at multiple post-discharge intervals (30 days, 90 days, 1 year, and 5 years) among patients with AAD. Additionally, subgroup analyses and receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive accuracy of Hb, RDW and their association for mortality in this patient population.

Results

High RDW combined with low Hb (RDW ≥ 13.60 and Hb < 7.9) significantly predicted increased mortality at 30 days, 90 days, 1 year, and 5 years post-diagnosis, with hazard ratios (HRs) as follows: 4.33 (95% CI: 1.82-10.33, P < 0.001), 4.48 (95% CI: 2.06-9.77, P < 0.001), 3.38 (95% CI: 1.70-6.70, P < 0.001), and 3.07 (95% CI: 1.66-5.66, P < 0.001), respectively.

Conclusion

Hb and RDW are both abnormal (Hb with low level, RDW with high level) is positively correlated with 30 days, 90 days, 1 year, and 5 years mortality risk in patients with AAD. This suggests that combined effect between Hb and RDW is a significant predictor of short-term to long-term mortality risk in this patient population, highlighting its potential utility as a prognostic marker in clinical settings.

Coronary Intervention Outcomes in Patients with Liver Cirrhosis

PURPOSE OF REVIEW

This review assesses the outcomes of coronary interventions in patients with liver cirrhosis and coronary artery disease (CAD), focusing on the clinical challenges posed by cirrhosis-related hemodynamic and coagulopathic changes. It highlights essential considerations for managing these patients, who have an increased risk of adverse events during coronary procedures.

RECENT FINDINGS

Recent studies have shown that patients with liver cirrhosis undergoing PCI experience significantly higher mortality rates compared to non-cirrhotic patients, particularly in the context of STEMI and NSTEMI. Coagulopathy and thrombocytopenia increase the risk of bleeding and vascular complications during interventions. Radial access has been suggested as a safer alternative to femoral access in these patients due to reduced bleeding complications. Additionally, contrast-induced nephropathy (CIN) is a prevalent risk, with cirrhotic patients demonstrating higher rates of acute kidney injury post-PCI. Preventive strategies such as minimizing contrast exposure and utilizing intravascular ultrasound (IVUS) are recommended. Managing CAD in cirrhotic patients requires careful consideration of their unique pathophysiological state. Higher in-hospital mortality, bleeding risks, and vascular complications necessitate tailored procedural strategies, such as radial access and contrast minimization. The balance between thrombotic and bleeding risks is critical in decision-making, with IVUS and hydration strategies being promising approaches. Further research is required to optimize treatment protocols and improve long-term outcomes for this high-risk population.

Genetic and Epigenetic Determinants of COVID-19 Susceptibility: A Systematic Review

BACKGROUND

The molecular mechanisms regulating coronavirus pathogenesis are complex, including virus-host interactions associated with replication and innate immune control. However, some genetic and epigenetic conditions associated with comorbidities increase the risk of hospitalization and can prove fatal in infected patients. This systematic review will provide insight into host genetic and epigenetic factors that interfere with COVID-19 expression in light of available evidence.

METHODS

This study conducted a systematic review to examine the genetic and epigenetic susceptibility to COVID-19 using a comprehensive approach. Through systematic searches and applying relevant keywords across prominent online databases, including Scopus, PubMed, Web of Science, and Science Direct, we compiled all pertinent papers and reports published in English between December 2019 and June 2023.

RESULTS

The findings reveal that the host's HLA genotype plays a substantial role in determining how viral protein antigens are showcased and the subsequent immune system reaction to these antigens. Within females, genes responsible for immune system regulation are found on the X chromosome, resulting in reduced viral load and inflammation levels when contrasted with males. Possessing blood group A may contribute to an increased susceptibility to contracting COVID-19 as well as a heightened risk of mortality associated with the disease. The capacity of SARS-CoV-2 involves inhibiting the antiviral interferon (IFN) reactions, resulting in uncontrolled viral multiplication.

CONCLUSION

There is a notable absence of research into the gender-related predisposition to infection, necessitating a thorough examination. According to the available literature, a significant portion of individuals affected by the ailment or displaying severe ramifications already had suppressed immune systems, categorizing them as a group with elevated risk.

Association Between Nontraditional Lipid Profiles and the Risk of Type 2 Diabetes Mellitus in Chinese Adults With Hypertension: Findings From the China Hypertension Registry Study

The relationship between nontraditional lipid profiles and type 2 diabetes mellitus (T2DM) remains ambiguous within the hypertension population. The objective of this study is to examine the association between nontraditional lipid profiles and T2DM in Chinese adults with hypertension. The current investigation encompassed 13 728 participants with hypertension from the China Hypertension Registry Study. Logistic regression analysis and smooth curve fitting were employed to evaluate the association between nontraditional lipid profiles and T2DM. The prevalence of T2DM was found to be 17.8%. In the fully adjusted model, atherogenic index of plasma (AIP) exhibited the highest odds ratios (ORs) for T2DM (OR: 2.71, 95% confidence interval [CI]: 2.26-3.26). Conversely, the fully adjusted ORs (95% CI) for total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)/HDL-C, and non-high-density lipoprotein cholesterol (Non-HDL-C) were 1.33 (1.25-1.41), 1.40 (1.29-1.51), and 1.41 (1.34-1.49), respectively. Additionally, the study demonstrated that AIP had a superior ability to identify T2DM. Subgroup analyses indicated that the relationship between AIP and Non-HDL-C with T2DM was more significant in the lighter weight population. In addition, the association of TC/HDL-C with LDL-C/HDL-C with T2DM was stronger in the lower homocysteine level population. Among the southern Chinese population with hypertension, all nontraditional lipid indices positively correlated with the risk of T2DM. Among these lipid indices, AIP exhibited superior discriminatory power in identifying T2DM compared to TC/HDL-C, LDL-C/HDL-C. Trial Registration: ChiCTR1800017274.

Demographic diversity in platelet function and response to antiplatelet therapy

Recent studies have highlighted the complexity of platelet biology, revealing their diverse roles beyond hemostasis. Pathological platelet activation is now recognized as a key contributor to thrombosis and inflammation that are both central to cardiovascular disease (CVD). Emerging research emphasizes the significant impact of demographic factors - such as age, sex, race, and ethnicity - on CVD risk and responses to antiplatelet therapies. These population-based differences, shaped by genetic and non-genetic factors, highlight the need for reevaluation of antiplatelet strategies. We address current knowledge and emphasize the pressing need for further research into platelet biology and cardiovascular outcomes across diverse populations. In this review we advocate for tailored therapeutic approaches in CVD based on the recent demographic-focused findings.

Short-term efficacy of moderate-intensity rosuvastatin in coronavirus disease 2019 patients: A randomized clinical trial

As the coronavirus disease 2019 (COVID-19) pandemic persists, the exploration of adjunct therapies to mitigate disease severity remains a priority. Statins, known for their pleiotropic effects, have been under investigation for their potential role in managing COVID-19 complications. The study was conducted in a single referral hospital and adhered to Consolidated Standards of Reporting Trials guidelines. Eligible participants were randomized in a 1:1 ratio into either the rosuvastatin group or the control group. Outcome measures included vital signs, laboratory data, clinical outcomes, and patient symptoms. Statistical analysis was performed using SPSS software (version 26.0, IBM Corp., Armonk, New York). A total of 100 patients were enrolled. No significant differences were observed between the rosuvastatin and control groups in terms of baseline characteristics and laboratory parameters, except for the fact that rosuvastatin-treated patients showed lower levels of C-reactive protein in comparison with the controls on both the 1st and 5th days (38.1 ± 16.3 vs 50.5 ± 25.3) compared to the control group. Clinical outcomes, including hospital length of stay, intensive care unit admission, need for intubation, and 1-month mortality, did not differ significantly between the two groups. Symptom scales, as assessed by the Borg Rating of Perceived Exertion and Leicester Cough Questionnaire, showed significant improvement in the rosuvastatin group compared to controls. Our study provides insights into the short-term efficacy of moderate-intensity rosuvastatin in COVID-19 patients. Further research is warranted to elucidate the long-term effects and optimal dosing of statins in COVID-19 management.

COVID-19 is associated with cardiac structural and functional remodelling in healthy middle-aged and older individuals

BACKGROUND

Coronavirus disease 2019 (COVID-19) was declared a global pandemic in 2019. It remains uncertain to what extent COVID-19 effects the heart in heathy individuals. To evaluate the effect of the COVID-19 on cardiac structure and function in middle-aged and older individuals.

METHODS

A single-centre prospective observational study enroled a total of 124 participants (84 with history of COVID-19 [COVID-19 group] and 40 without a history of COVID-19 [non-COVID group]). All participants underwent echocardiography with speckle tracking to assess cardiac structure and function at rest and during peak exercise.

RESULTS

There were no differences in left and right ventricular diastolic function (p ≥ 0.05) between the COVID-19 and non-COVID-19 groups. Participants in COVID-19 group demonstrated higher left ventricular mass (130 ± 39.8 vs. 113 ± 27.2 g, p = 0.008) and relative wall thickness (0.38 ± 0.07 vs. 0.36 ± 0.13, p = 0.049). Left ventricular global longitudinal strain was reduced in the COVID-19 group at rest and at peak-exercise (rest: 18.3 ± 2.01 vs. 19.3 ± 1.53%, p = 0.004; peak exercise: 19.1 ± 2.20 vs. 21.0 ± 1.58%, p ≤ 0.001). However, no difference was seen in resting left ventricular ejection fraction (58 ± 2.89 vs. 59 ± 2.51%, p = 0.565) between groups. Right ventricular fractional area change was reduced in the COVID-19 group (p = 0.012).

CONCLUSION

Cardiac structural and functional remodelling was observed in middle-aged and older otherwise healthy individuals with a history of COVID-19.

Interindividual variability in platelet reactivity among individuals with or without antiplatelet therapy: results from a large tertiary care hospital

Antiplatelet therapy is crucial for reducing thrombotic events in patients with atherosclerotic disease, but the response vary widely among individuals. The identification of patients at high (HPR), optimal (OPR) or low platelet reactivity (LPR) is dependent on high interlaboratory variability. We report results of a large dataset of patients to assess the gold standard light transmission aggregometry (LTA). A total of 11,913 patients who sequentially underwent LTA assessment using several stimuli (ADP-2µM, collagen-2 µg/ml, arachidonic acid 0.5 mM, epinephrine 10µM) with a standardized methodology between 2004 and 2022 were screened. After application of inclusion-exclusion criteria, 5,901 patients were included and divided into five groups: healthy-volunteers (HV; N = 534); controls (CTR; N = 1073); aspirin-treated patients (ASA; 75-150 mg/die; N = 3280); clopidogrel-treated patients (CLOP; 75 mg/die; N = 495) and patients treated with dual antiplatelet therapy, ASA plus CLOP (DAPT; N = 519). The mean PA% in response to ADP 2 μm was 72.4 ± 33.3 in the CTR population, 40.6 ± 29.9 in the ASA group, 25.1 ± 35.1 in the CLOP group and 10.2 ± 18.5 in the DAPT group. The mean PA% in response to collagen 2 ug/ml was 90.7 ± 10.5 in the CTR population, 40.8 ± 26.3 in the ASA group, 79.4 ± 21.8 in the CLOP group and 17.9 ± 19.9 in the DAPT group. The percentage of patients at OPR following ADP stimuli was 66%, 25%, and 26%, in the ASA, CLOP, and DAPT group, respectively. The percentage of patients at OPR following collagen stimuli was 56%, 22%, and 41%, in the ASA, CLOP, and DAPT group, respectively. LTA was significantly increased in response to ADP (72.4 ± 33.3vs62.7 ± 37.1; p < 0.001) and AA (90.7 ± 15.6vs87.6 ± 20.5; p < 0.001) in CTR compared to HV. Our findings support the concept that a significant proportion of individuals present a hyper- or hypo-reactive platelet phenotype potentially affecting the safety and efficacy of antiplatelet therapy. The variability in response to antiplatelet therapy was particularly evident in patients undergoing single as opposed to dual antiplatelet therapy regimens. These data support ongoing strategies of guided selection of antiplatelet therapy in patients with cardiovascular disease.

A bidirectional Mendelian randomization analysis between COVID-19 and cardiac arrest

Epidemiological studies link COVID-19 to increased cardiac arrest (CA) risk, but causality remains unclear due to potential confounding factors in observational studies . We conducted a Mendelian randomization (MR) analysis using genome-wide association study (GWAS) data, employing COVID-19-associated single nucleotide polymorphisms (SNPs) with significance values smaller than 5 × 10⁻⁸. We calculated inverse-variance weighted (IVW) MR estimates and performed sensitivity analyses using MR methods robust to horizontal pleiotropy. Additionally, a reverse MR analysis was conducted using CA-associated SNPs with significance values smaller than 1 × 10⁻⁵. Results indicated that infected COVID-19 (OR = 1.12, 95% CI = 0.47-2.67, p = 0.79), hospitalized COVID-19 (OR = 1.02, 95% CI = 0.70-1.49, p = 0.920), and severe respiratory COVID-19 (OR = 0.99, 95% CI = 0.81-1.21, p = 0.945) did not causally influence CA risk. Reverse MR analysis also did not support a causal effect of CA on COVID-19. Thus, associations in observational studies may stem from shared biological factors or environmental confounding.

Association between reduced hemoglobin-to-red cell distribution width ratio and elevated cardiovascular mortality in patients with diabetes: Insights from the National Health and Nutrition Examination Study, 1999-2018

OBJECTIVE

The purpose of this research was to examine the relationship between the hemoglobin-to-red blood cell distribution width ratio (HRR) and cardiovascular disease (CVD)-related mortality in people who have diabetes.

METHODS

Data derived from the National Health and Nutrition Examination Survey (NHANES), between the years 1999 to 2018, were meticulously analyzed. Mortality data, encompassing events until December 31, 2019, were systematically collected. A comprehensive group comprising of 8,732 participants were subjected to scrutiny, and subsequently, classified into four distinct groups predicated upon quartiles of baseline HRR levels: Q1 (n = 2,183), Q2 (n = 2,181), Q3 (n = 2,185), and Q4 (n = 2,183). The correlation between HRR and CVD-related mortality was examined through the use of survival curves and Cox proportional hazard regression models, the latter incorporating weights as advised by NHANES.

RESULTS

Among the 8,732 participants in the study cohort, CVD-related mortality was identified in 710 cases. The Kaplan-Meier analysis demonstrated a significant association, indicating that a decreased HRR was correlated with a reduction in survival in cases with CVD. Both univariate and multivariable Cox proportional hazard regression analyses consistently indicated that patients exhibiting a lower HRR exhibited a markedly elevated risk of CVD-related mortality in comparison to those with higher HRR. Notably, the correlation between HRR and decreasing CVD-related mortality was discerned to be non-linear.

CONCLUSION

In patients with diabetes, a decreased HRR was associated with an increased risk of CVD-related mortality.

SS-OCTA assessment of fundus microvascular changes and their correlation with coronary lesion severity in severe coronary heart disease

This study aimed to quantify fundus microvascular alterations in patients requiring revascularization for coronary heart disease (CHD) using swept-source optical coherence tomography angiography (SS-OCTA) and to investigate the correlation between these alterations and the severity of coronary artery lesions. SS-OCTA was employed to assess the fundus neurovascular parameters of all participants, while the Gensini score was utilized to gauge the severity of coronary artery lesions in observation group. A total of 98 participants (49 CHD patients and 49 controls) were included. Analysis of the SS-OCTA parameters revealed that the vascular density (VD) of the superficial vascular plexus (SVP), the superficial vascular complex (SVC), the intermediate capillary plexus (ICP) in the parafoveal region, the mean ICP in the macula, deep capillary plexus (DCP) and deep vascular complex (DVC) in each macular region were significantly reduced in the observation group compared to the control group (P < 0.05). Multivariate logistic regression indicated that lower VD values in the SVP, SVC, ICP, DCP and DVC across macular regions were significantly associated with an increased likelihood of severe CHD (OR < 1, P < 0.05). ROC curve analysis revealed that the maximum area under the curve for overall DCP VD in the macula was 0.707, with a cutoff value of 19.64, sensitivity of 65.30%, and specificity of 73.50%. In CHD group, Pearson correlation analysis demonstrated a negative correlation between the Gensini score and mean DCP VD (r = - 0.491, P < 0.001). Retinal VD in patients requiring revascularization for CHD is significantly lower compared to healthy controls. SS-OCTA-based retinal microvascular damage assessment is a valuable tool for risk stratification and early intervention in CHD.

Combined effect of triglyceride-glucose index and atherogenic index of plasma on cardiovascular disease: a national cohort study

The triglyceride-glucose (TyG) index and the Atherogenic Index of Plasma (AIP) are both predictors of cardiovascular diseases (CVD). However, their combined and individual contributions to CVD risk are not well understood. This study evaluate the joint and individual associations of the TyG index and AIP with CVD events in middle-aged and older Chinese adults. This nationwide, retrospective cohort study utilized data from CHARLS. The diagnosis of CVD in this study was determined based on self-reported information provided by participants regarding their medical history( heart disease and/or stroke). Cross-sectional analyses in 2011 and longitudinal analyses over a 9-year follow-up were conducted to assess these associations. In the cross-sectional analysis, 8,531 participants were included at baseline. The odds ratio (OR) for TyG alone was 1.06 (95% CI 0.96-1.22) for CVD, while the OR for AIP alone was 1.16 (95% CI 1.02-1.33). Combined analysis showed that compared to the low TyG & low AIP group, the OR for the high TyG & high AIP group was 1.23 (95% CI 1.07-1.42) for CVD. In the survival Analysis, the hazard ratio (HR) for TyG alone was 1.19 (95% CI 1.04-1.35) for CVD, while the HR for AIP alone was 1.25 (95% CI 1.09-1.43). Combined analysis showed that compared to the low TyG & low AIP group, the HR for the high TyG & high AIP group was 1.27 (95% CI 1.10-1.43) for CVD. The findings underscore the significant coexposure effects of the TyG index and AIP on CVD, particularly in middle-aged adults.

The progression of non-culprit coronary lesion is related to higher SII, SIRI, and PIV in patients with ACS

Coronary heart disease pathogenesis is intricately linked to inflammation. Acute coronary syndrome (ACS) is a coronary heart disease that seriously affects the prognosis of patients. New immune-inflammatory indices such as systemic immune inflammation index (SII), system inflammation response index (SIRI), and pan-immune-inflammation value (PIV) have emerged as potential biomarkers, offering reflection into systemic inflammatory states and assisting in the prognosis of diverse diseases. This research explored the association between the new immune-inflammatory indices (SII, SIRI, and PIV) and the progression of non-culprit coronary lesions (NCL) in patients with ACS after percutaneous coronary intervention (PCI). Our study investigated the potential association between the immune-inflammatory index (SII, SIRI, and PIV) and NCL progression in patients with ACS following PCI. We conducted a retrospective analysis of patients with ACS who underwent PCI twice at a single-center from 2019 to 2023. Clinical and angiographic features were collected from electronic medical records. The primary outcome was NCL progression. All patients were divided into a progression group and a non-progression group based on angiographies. The clinical and angiographic features were analyzed. The study included 311 ACS patients (progression group: 97 males, 34 females; non-progression group: male 146 males, 34 females). The SII, SIRI, and PIV were significantly higher in the NCL progression group than in the non-progression group (P < .001). Logistic regression analysis showed that SII, SIRI, and PIV were independent risk factors for the NCL progression and positively correlated with it (OR: 1.002, P < .001; OR: 2.188, P < .001; OR: 1.003, P < .001). ROC showed that the SII value was the highest in terms of sensitivity with a value of 67.18% (AUC = 0.7288, P < .001), and the SIRI was the highest in terms of specificity with a value of 79.44% (AUC = 0.6974, P < .001). The SII, SIRI, and PIV are valuable predictors of NCL progression in patients with ACS. Higher SII, SIRI, and PIV are related to the progression of NCL.

Interaction Effects Between COVID-19 Outbreak and Fever on Mortality Among OHCA Patients Visiting Emergency Departments

Background and Objectives: Fever in patients who have suffered an out-of-hospital cardiac arrest (OHCA) has been linked to poor clinical outcomes, as a fever can exacerbate neurological damage, increase metabolic demands, and trigger inflammatory responses. This study evaluates the impact of the COVID-19 outbreak and associated fevers on OHCA outcomes and examines how they can worsen patient prognosis. Materials and Methods: Our retrospective observational analysis used data from the National Emergency Department Information System (NEDIS), comprising adult OHCA patients at 402 EDs in Korea between 27 January and 31 December 2020 (COVID-19 pandemic period) and the corresponding period in 2019 (pre-COVID-19). The primary outcome was in-hospital mortality, with the COVID-19 outbreak as the main exposure variable and fever as an important interaction variable. We employed multilevel multivariate logistic regression with an interaction term (year of visit × fever) to examine the effects of COVID-19 and fever on mortality. Risk-adjusted mortality rates were calculated, and a difference-in-difference analysis evaluated the impact of COVID-19 on excess mortality by fever status. Results: During COVID-19, in-hospital mortality was higher among OHCA patients compared to the pre-pandemic period (adjusted OR 1.22, 95% CI 1.11-1.34), particularly among febrile patients (adjusted OR 1.40, 95% CI 1.24-1.59). Interaction analysis revealed that COVID-19 disproportionately increased mortality in febrile OHCA patients compared with non-febrile patients (difference-in-difference: 0.8%, 95% CI 0.2-1.5). Conclusions: Our study found that the COVID-19 pandemic significantly increased mortality among OHCA patients, with febrile patients experiencing disproportionately worse outcomes due to systemic delays and pandemic-related disruptions.

Predictive properties of novel anthropometric and biochemical indexes for prediction of cardiovascular risk

OBJECTIVE

Our aim was to examine the correlation between CVDs and various anthropometric and biochemical indices in the Iranian population.

METHODS

9704 healthy individuals without CVD aged 35-65 were enrolled in our study. The anthropometric indices including Body Adiposity Index (BAI), Abdominal Volume Index (AVI), Body Roundness Index (BRI), Waist to Hip Ratio (WHR), Weight-adjusted Waist Index (WWI), Conicity Index (C-Index), A Body Shape Index (ABSI), Waist to Height Ratio (WHtR), Body Surface Area (BSA), Body Mass Index (BMI), Lipid Accumulation Product (LAP) and Visceral Adiposity Index (VAI) were calculated. The biochemical indices including Cardiac Risk Ratio (CRR), Atherogenic Index of Plasma (AIP), Triglycerides-Glucose Index (TyG), Cardiac Risk Index (CRI), Atherogenic Coefficient (AC), and high-sensitivity C-Reactive Protein (hs-CRP) were investigated. The association of the above indices with CVD was analyzed using logistic regression (LR) and the decision tree (DT) models.

RESULTS

The LR showed age, hs-CRP, AIP, AVI, LAP, and TyG had significant associations with CVDs in men (p-value < 0.002). Also, age, hs-CRP, LAP, TyG, BRI, VAI, and CRR had significant associations with CVDs in women (p-value < 0.002). The DT showed 95% of men with age > = 48, AIP > = 0.94, TyG > = 9.71, and AVI > = 14.24 had CVDs. Also, 97% of women with age > = 54, TyG > = 8.33, and hs-CRP > = 36.69 had CVDs.

CONCLUSION

Age, TyG, AIP, AVI, hs-CRP and LAP were the best predictors of CVD in men. Moreover, age, TyG, hs-CRP and BAI were the best indicators of CVD in women.

sST2 levels and 3D speckle tracking as predictors of CAD severity in chronic coronary syndrome

BACKGROUND

Previous studies on the relation of sST2 with atherosclerotic disease mostly focused on the predictive value of sST2 for heart failure. However, there is no definite conclusion about the correlation between sST2 level and a complex coronary lesion morphology detected with coronary angiography (CAG). The purpose of this work was to know sST2 level and 3D speckle-tracking echocardiography as predictor of coronary artery disease (CAD) severity in chronic coronary syndrome (CCS) individuals using Gensini score. This prospective cohort work was performed on 90 participants aging from 18 to 80 years old, both sexes, with stable angina pectoris. Participants had been categorized into three groups: Group I (n = 30): control group scheduled by normal coronary angiography and group II (n = 60): case group which subdivided according to Gensini score into two equal subgroups: IIa: simple lesion (Gensini score < 20) and group IIb: complex lesion (Gensini score of ≥ 20). Plasma sST2 levels were measured in all participants using ELISA technique.

RESULTS

GLS, GAS, GCS and ST2 can significantly predict severity of CAD in CCS, respectively (P < 0.001 and AUC (95% CI) = 0.949(0.881-0.984), 0.980(0.925 to 0.998), 0.908(0.828 to 0.959) and 0.702(0.597 to 0.794)) at cutoff ≥ - 10, - 21, - 12 and ≥ 10 with 96.67% (82.8% to 99.9%), 96.67% (82.8 to 99.9), 86.67% (69.3 to 96.2) and 63.33% (43.9 to 80.1) sensitivity (95% CI), 76.67% (64.0% to 86.6%), 85.0% (73.4 to 92.9), 73.33% (60.3 to 83.9) and 65.0% (51.6 to 76.9) specificity (95% CI), 67.44%, 76.32%, 61.90% and 47.50% PPV and 97.87%, 98.08%, 91.67% and 78.00%, NPV with accuracy of 83.33%, 88.89%, 77.78% and 64.44%.

CONCLUSIONS

sST2 level, GLS, GAS and GCS can significantly predict severity of CAD in CCS.

Viral sepsis: diagnosis, clinical features, pathogenesis, and clinical considerations

Sepsis, characterized as life-threatening organ dysfunction resulting from dysregulated host responses to infection, remains a significant challenge in clinical practice. Despite advancements in understanding host-bacterial interactions, molecular responses, and therapeutic approaches, the mortality rate associated with sepsis has consistently ranged between 10 and 16%. This elevated mortality highlights critical gaps in our comprehension of sepsis etiology. Traditionally linked to bacterial and fungal pathogens, recent outbreaks of acute viral infections, including Middle East respiratory syndrome coronavirus (MERS-CoV), influenza virus, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), among other regional epidemics, have underscored the role of viral pathogenesis in sepsis, particularly when critically ill patients exhibit classic symptoms indicative of sepsis. However, many cases of viral-induced sepsis are frequently underdiagnosed because standard evaluations typically exclude viral panels. Moreover, these viruses not only activate conventional pattern recognition receptors (PRRs) and retinoic acid-inducible gene-I (RIG-I)-like receptors (RLRs) but also initiate primary antiviral pathways such as cyclic guanosine monophosphate adenosine monophosphate (GMP-AMP) synthase (cGAS)-stimulator of interferon genes (STING) signaling and interferon response mechanisms. Such activations lead to cellular stress, metabolic disturbances, and extensive cell damage that exacerbate tissue injury while leading to a spectrum of clinical manifestations. This complexity poses substantial challenges for the clinical management of affected cases. In this review, we elucidate the definition and diagnosis criteria for viral sepsis while synthesizing current knowledge regarding its etiology, epidemiology, and pathophysiology, molecular mechanisms involved therein as well as their impact on immune-mediated organ damage. Additionally, we discuss clinical considerations related to both existing therapies and advanced treatment interventions, aiming to enhance the comprehensive understanding surrounding viral sepsis.

Long-Term Outcomes of Patients with Pre-Existing Essential Tremor After SARS-CoV-2 Infection

BACKGROUND/OBJECTIVES

Although COVID-19 has been linked to worse outcomes in patients with neurological disorders, its impact on those with essential tremor (ET) remains unclear. To investigate clinical outcomes of ET patients with and without COVID-19 three and a half years post-pandemic.

METHODS

1074 ET patients were evaluated in this retrospective study in the Montefiore Health System from January 2016 to July 2023. Comparisons between ET patients with and without a positive SARS-CoV-2 polymerase chain reaction test were made. Outcomes included post-index date major adverse cardiovascular events (MACEs), new-onset sleep disturbances, fatigue, dyspnea, first-time fall, new-onset anxiety, new-onset depression, headache, new-onset imbalance, new-onset mild cognitive impairment, and all-cause mortality, adjusted hazard ratios (aHR) adjusting for covariates were calculated.

RESULTS

ET patients with COVID-19 had higher prevalence of pre-existing type-2 diabetes, depression, and anxiety compared to ET patients without COVID-19. COVID-19 was significantly associated with higher risk of MACEs, (aHR = 2.39 [1.49, 3.82]), new-onset sleep disturbance, (aHR = 2.12 [1.44, 3.13]), fatigue, (aHR = 1.83 [1.27, 2.65]), dyspnea, (aHR = 1.98 [1.40, 2.80]), first-time fall, (aHR = 4.76 [2.24, 10.14]), new-onset anxiety, (aHR = 3.66 [2.02, 6.64]), and new-onset depression, (aHR = 2.38 [1.20, 4.70]). COVID-19 was not associated with all-cause mortality.

CONCLUSIONS

In patients with ET, COVID-19 significantly increases the risk of several long-term adverse health outcomes, but not mortality.

The Role of Age and Comorbidity Interactions in COVID-19 Mortality: Insights from Cardiac and Pulmonary Conditions

Background: Understanding the interactions between age and comorbidities is crucial for assessing COVID-19 mortality, particularly in patients with cardiac and pulmonary conditions. This study investigates the relationship between comorbidities and mortality outcomes in a cohort of hospitalized COVID-19 patients, emphasizing the interplay of age, cardiac, and pulmonary conditions. Methods: We analyzed a cohort of 3005 patients hospitalized with COVID-19 between 2020 and 2022. Key variables included age, comorbidities (diabetes, cardiac, pulmonary, and neoplasms), and clinical outcomes. Chi-square tests and logistic regression models were used to assess the association between comorbidities and mortality. Stratified analyses by age, diabetes, and pulmonary conditions were conducted to explore interaction effects. Additionally, interaction terms were included in multivariable logistic regression models to evaluate the combined impact of age, comorbidities, and mortality. Results: Cardiac conditions such as hypertension, ischemic cardiopathy, and myocardial infarction showed significant protective effects against mortality in younger patients and in those without pulmonary conditions (p < 0.001). However, these protective effects were diminished in older patients and those with pulmonary comorbidities. Age was found to be a significant modifier of the relationship between cardiac conditions and mortality, with a stronger protective effect observed in patients under the median age (p < 0.001). Pulmonary comorbidities significantly increased the risk of mortality, particularly when co-occurring with cardiac conditions (p < 0.001). Diabetes did not significantly modify the relationship between cardiac conditions and mortality. Conclusions: The findings highlight the complex interactions between age, cardiac conditions, and pulmonary conditions in predicting COVID-19 mortality. Younger patients with cardiac comorbidities show a protective effect against mortality, while pulmonary conditions increase mortality risk, especially in older patients. These insights suggest that individualized risk assessments incorporating age and comorbidities are essential for managing COVID-19 outcomes.

The relationship between composite lipid indices and baveno classification in patients with obstructive sleep apnoea

Obstructive Sleep Apnoea (OSA) is associated with the development of cardiovascular disease (CVD); however, the risk is only weekly related to OSA severity traditionally determined by the apnoea-hypopnoea index. The Baveno classification was developed to improve patient selection who would benefit from OSA treatment in terms of symptoms improvement and CVD risk reduction. However, it is unclear how the classification relates to biomarkers of CVD risk. Composite lipid indices were evaluated in various populations and showed good predictive value for incident CVD. One thousand two hundred and forty-two patients with OSA were included in the study. Composite lipid indices, including the atherogenic index of plasma (AIP), visceral adiposity index (VAI), lipid accumulation product (LAP) and cardiometabolic index (CMI) were compared between different Baveno groups (A - minor symptoms, minor comorbidities, B - severe symptoms, minor comorbidities, C - minor symptoms, severe comorbidities, D - severe symptoms, severe comorbidities). All composite lipid indices were higher in group D versus groups A and C. Only LAP (86.93 /58.40-119.49/ vs. 75.73 /48.37-99.04/) and CMI (1.03 /0.69-1.42/ vs. 0.91 /0.63-1.12/) were significantly different between the minimally symptomatic groups (C vs. A), and solely LAP was significantly higher (110.69 /76.76-147.22/ vs. 82.32 /60.35-113.50/) when the highly symptomatic groups (D vs. B) were compared. The Baveno classification correlates with cardiovascular risk estimated with composite lipid indices. Composite lipid indices may help better stratifying cardiovascular risk in both minimally- and highly symptomatic patients.

Increased risk of arrhythmias, heart failure, and thrombosis in SARS-CoV-2 positive individuals persists at one year post-infection

Risk of cardiovascular events is increased after COVID-19. However, information on cardiovascular risk trends after COVID-19 infection is lacking and estimates by sex are inconsistent. Our aim was to examine cardiovascular outcomes and mortality in a large cohort (164,346 participants) of SARS-CoV-2 positive individuals compared to non-positive individuals, stratified by sex. Data were obtained from the Spanish Health System's electronic medical records. Selected individuals were ≥ 45 years old with/without a positive SARS-CoV-2 test in the period March-May 2020. Follow-up was obtained until January 31, 2021, for cardiovascular events (angina/myocardial infarction, arrhythmias, bypass/revascularization, heart failure, peripheral artery disease, stroke/transient ischemic attack, and thrombosis), and until March 31, 2021, for mortality. Individuals were matched by propensity score. Incidence of cardiovascular events and mortality was compared with accelerated failure time models. The effect of matching and of COVID-19 severity was assessed with sensitivity analyses. In the first 3 months of follow-up, SARS-CoV-2 positive individuals had a higher risk of mortality and of all cardiovascular events. From 4-12 months, there was increased risk of mortality in SARS-CoV-2 positive individuals overall, of heart failure in SARS-CoV-2 positive females (HR= 1.26 [1.11-1.42]), and of arrhythmias and thrombosis in SARS-CoV-2 positive males (HR= 1.29 [1.14-1.47] and HR= 1.35 [1.03-1.77], respectively). When COVID-19 patients admitted to the ICU were excluded, incidence of thrombosis was similar in males regardless of positive/non-positive SARS-CoV-2 status. In the full year of follow-up, increased incidence of heart failure and of arrhythmias and thrombosis was observed in SARS-CoV-2 positive females and males, respectively.

Comprehensive Risk Assessment of Infection Induced by SARS-CoV-2

The pandemic COVID-19 (coronavirus disease 2019) is caused by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which devastated the global economy and healthcare system. The infection caused an unforeseen rise in COVID-19 patients and increased the mortality rate globally. This study gives an overall idea about host-pathogen interaction, immune responses to COVID-19, recovery status of infection, targeted organs and complications associated, and comparison of post-infection immunity in convalescent subjects and non-infected individuals. The emergence of the variants and episodes of COVID-19 infections made the situation worsen. The timely introduction of vaccines and precautionary measures helped control the infection's severity. Later, the population that recovered from COVID-19 grew significantly. However, understanding the impact of healthcare issues resulting after infection is paramount for improving an individual's health status. It is now recognised that COVID-19 infection affects multiple organs and exhibits a broad range of clinical manifestations. So, post COVID-19 infection creates a high risk in individuals with already prevailing health complications. The identification of post-COVID-19-related health issues and their appropriate management is of greater importance to improving patient's quality of life. The persistence, sequelae and other medical complications that normally last from weeks to months after the recovery of the initial infection are involved with COVID-19. A multi-disciplinary approach is necessary for the development of preventive measures, techniques for rehabilitation and strategies for clinical management when it comes to long-term care.

Plasma Levels of Magnesium, Calcium, Calcium to Magnesium Ratio, and Associations with Metabolic Syndrome and Cardiometabolic Risk Factors

Magnesium and calcium are elements that have been associated with cardiometabolic risk factors related to metabolic syndrome (MetS). However, there are gaps in the knowledge regarding the impact of the calcium to magnesium (Ca/Mg) ratio in plasma. Thus, we aim to evaluate the associations between magnesium and calcium levels in plasma, and the Ca/Mg ratio in plasma with MetS components and other cardiometabolic risk factors. This cross-sectional study was carried out with 112 adults and older people, distributed into groups with (n = 60) and without MetS (n = 52). We evaluated sociodemographic, anthropometric, and biochemical data. Magnesium and calcium levels in plasma were measured by inductively coupled plasma mass spectrometry technique (ICP-MS). There was a high frequency of MetS, with no significant differences in magnesium and calcium levels and Ca/Mg ratio in plasma observed between groups. There were no associations between magnesium and MetS components or other cardiometabolic risk factors (all p > 0.05). Calcium levels were associated with total cholesterol (β =  - 0.020; p = 0.000) and high-density lipoprotein cholesterol (HDL-c) (β =  - 0.046; p = 0.005). The total cholesterol (β =  - 0.025; p = 0.000) and low-density lipoprotein cholesterol (LDL-c) (β = 0.017; p = 0.020) were preditors of the Ca/Mg ratio. These results indicate important associations of calcium and the Ca/Mg ratio in plasma with cardiometabolic risk factors related to MetS.

Hair Cortisol/DHEA-S Ratios in Healthcare Workers and Their Patients During the COVID-19 Pandemic: A Case Study

BACKGROUND

Unlike psychological distress, which has been extensively studied during the COVID-19 pandemic, the impact of the pandemic on stress hormones has been overlooked. The aim of this study is to examine the hair cortisol/dehydroepiandrosterone sulfate (DHEA-S) ratios as markers of HPA axis dysregulation in healthcare workers and their patients.

METHODS

A total of 200 healthcare workers and 161 "patients" patients with special healthcare needs due to chronic illness or motor disabilities were included in this study. The hormone concentrations were measured using a radioimmunoassay.

RESULTS

Our results show that the patients had significantly higher cortisol/DHEA-S ratios than the workers. A high cortisol/DHEA-S ratio in the patients reflects higher cortisol concentrations (p < 0.001) and lower DHEA-S (p < 0.05) concentrations compared to those of the healthcare workers, suggesting that they may be exposed to a greater degree of stress and a decrease in their ability to cope with their disease. The cut-off value of the hair cortisol/DHEA-S ratio in our study for detecting people with needs that require special consideration and attention was 1.46 (p ≤ 0.01).

CONCLUSIONS

Assessing the hair cortisol/DHEA-S ratios in both healthcare workers and the patients allowed us to identify a non-homeostatic condition that could lead to disease and to understand psychophysical well-being during the COVID-19 pandemic. They also play a crucial role in preventive and personalized medicine.