The effect of sarcopenic obesity on glycaemic status based on fasting plasma glucose and glycated haemoglobin: A prospective cohort study

AIM

To investigate the effect of sarcopenic obesity on the progression of glycaemic status in middle-aged and older adults without diabetes.

MATERIALS AND METHODS

This research involved 4637 participants without diabetes from the China Health and Retirement Longitudinal Study 2011-2015. Sarcopenic obesity at baseline was evaluated based on the Asian Working Group for Sarcopenia 2019 criteria. According to the American Diabetes Association criteria, we used fasting plasma glucose and glycated haemoglobin to define glycaemic status. Cox proportional hazard models were applied to obtain adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

The mean age of included participants was 58.98 ± 8.82 years, and 45.35% were men. During 18,497 person-years of follow-up, 1743 (37.59%) cases with glycaemic status progression were identified. Compared with participants without sarcopenia and obesity, participants with sarcopenic obesity, but not sarcopenia only or obesity only, exhibited a higher risk of progression from normoglycaemia to diabetes (HR = 2.11; 95% CI: 1.10-4.04). Moreover, participants with sarcopenic obesity (HR = 1.65; 95% CI: 1.04-2.63), sarcopenia only (HR = 1.78; 95% CI: 1.11-2.86), or obesity only (HR = 2.00; 95% CI: 1.29-3.12) had increased the risk of progression from prediabetes to diabetes.

CONCLUSIONS

The effect of sarcopenic obesity on the progression of glycaemic status based on fasting plasma glucose and glycated haemoglobin may be more pronounced than that of sarcopenia only or obesity only.

Long-Term Cognitive Safety of Achieving Very Low LDL Cholesterol with Evolocumab

BACKGROUND

Concerns persist regarding the cognitive safety of achieving very low levels of low-density lipoprotein (LDL) cholesterol. Although short-term studies are reassuring, the long-term cognitive effects of sustained exposure to very low LDL cholesterol levels through combined proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibition and statin therapy remain unknown.

METHODS

This prospective study enrolled a subset of adults with atherosclerotic cardiovascular disease who had completed a neurocognitive substudy (EBBINGHAUS) of a placebo-controlled randomized trial of evolocumab (FOURIER) and were eligible for a long-term open-label extension. The objective of this current study was to assess the long-term effect of evolocumab on cognitive function. Cognitive function was assessed annually, and the primary end point was change from baseline in executive function within each group, measured using the spatial working memory strategy index score (range, 4-28), with lower scores indicating better performance.

RESULTS

A total of 473 patients out of the 1974 patients in the parent EBBINGHAUS study were enrolled and additionally followed for a median of 5.1 years (maximum follow-up since original random assignment 7.2 years). The median age was 62 years; 70% were male, and 91% were White. At 12 weeks into the open-label extension period, median LDL cholesterol across the overall population was 35 mg/dl (interquartile range, 21-55 mg/dl). Treatment with evolocumab was not associated with a change in executive function during the open-label extension in either patients who were originally randomly assigned to and continued evolocumab (mean±standard deviation of 0.1±2.8, P=0.49) or patients originally randomly assigned to placebo who then started on evolocumab (-0.1±2.5, P=0.64). At the final study visit, executive function scores were similar between randomly assigned groups (17.5±3.7 and 17.3±3.7, respectively).

CONCLUSIONS

Exposure to very low levels of LDL cholesterol, achieved via PCSK9 inhibition and statin therapy, was not associated with cognitive impairment through long-term follow-up. Further studies are needed to assess the generalizability to adults at higher risk of dementia.

An extended PFAS profiling of a Swedish subpopulation and mixture risk assessments using multiple approaches

Per- and polyfluoroalkyl substances (PFAS) have been detected worldwide, from the deep seas to polar regions. A previous review showed that PFAS are risk drivers of the chemical mixture present in human blood. This study focused on establishing the PFAS exposure of a Swedish subpopulation and investigated whether the exposure poses a risk of adverse health effects. Human serum from 60 blood donors in Stockholm, Sweden, was analyzed. A target method including 32 PFAS analytes and over 270 suspect features was used to detect and quantify PFAS. Twenty-six PFAS were quantified, and 7 suspect PFAS features (6 H-PFCAs and PFECHS) were semi-quantified. Nine mixture risk assessment (MRA) strategies were used to assess the risk of health outcomes. Fifteen effect levels were derived and used, along with 15 already established values. The certainty of various derivation techniques was discussed. The MRAs showed that the entire studied population exceeded some of the risk thresholds, with effects including high cholesterol and immune suppression. However, the certainty was lower when deriving these two effect levels. The MRA, using human biomonitoring guidance values (high certainty), concluded that for 63 % of the individuals, a risk for adverse health effects cannot be excluded. This study has demonstrated that there is a reason for concern regarding PFAS exposure in the general population of Sweden. To our knowledge, this is the first time the H-PFCAs have been semi-quantified in human blood using a reference standard.

Investigation of adipocyte differentiation based on proteomics and intact N-glycopeptide modificationomics

OBJECTIVE

To investigate the role of N-glycosylation modification of proteins in adipocyte differentiation during the adipogenic process.

METHODS

SVF cells and adipocytes were analyzed for proteomics and intact N-glycopeptide modificationomics.Differential expression of proteins, glycoforms, and sites between the two groups was screened and subjected to Gene Ontology (GO) functional enrichment analysis, KEGG pathway enrichment analysis, and protein-protein interaction (PPI) network analysis. The top 20 most significantly differentially expressed adipogenic differentiation-related proteins were identified, and the most pronouncedly altered proteins were analyzed for glycoforms, glycan chains, and sites.

RESULTS

Proteomics analysis identified 39,392 peptides and 5208 proteins, while intact N-glycopeptide modification profiling identified 3293 intact glycopeptides, 426 proteins, and 161 glycan chains. Proteomics identified 2510 differentially expressed proteins, with CD36 (Cluster of Differentiation 36, CD36) significantly upregulated. In adipocytes, CD36 had 4 N-glycosylation sites: N79, N220, N320, N417, with N320 being a newly identified site. GO enrichment results indicated that CD36 is associated with fatty acid oxidation, lipid oxidation, and fatty acid uptake into cells.

CONCLUSION

Multiple proteins undergo N-glycosylation modification during adipocyte differentiation, with CD36, a fatty acid translocase, being significantly expressed in adipocytes. This suggests that N-glycosylation modification of CD36 may play a crucial role in adipocyte differentiation, providing a foundation for further investigation into the function of CD36 N-glycosylation in adipocyte differentiation.

Neuropsychiatric Manifestations of COVID-19 Disease and Post COVID Syndrome: The Role of N-acetylcysteine and Acetyl-L-carnitine

COVID-19 is associated with neuropsychiatric symptoms, such as anosmia, anxiety, depression, stress-related reactions, and psychoses. The illness can cause persistent cognitive impairment and "brain fog", suggesting chronic brain involvement. Clinical entities of ongoing symptomatic COVID-19 and Post COVID Syndrome (PCS) mainly present neuropsychiatric symptoms such as dysgeusia, headache, fatigue, anxiety, depression, sleep disturbances, and post-traumatic stress disorder. The pathophysiology of COVID-19-related brain damage is unclear, but it is linked to various mechanisms such as inflammation, oxidative stress, immune dysregulation, impaired glutamate homeostasis, glial and glymphatic damage, and hippocampal degeneration. Noteworthy is that the metabotropic receptor mGluR2 was discovered as a mechanism of internalisation of SARS-CoV-2 in Central Nervous System (CNS) cells. N-acetylcysteine (NAC) and acetyl-L-carnitine (ALC) are two supplements that have already been found effective in treating psychiatric conditions. Furthermore, NAC showed evidence in relieving cognitive symptomatology in PCS, and ALC was found effective in treating depressive symptomatology of PCS. The overlapping effects on the glutamatergic system of ALC and NAC could help treat COVID-19 psychiatric symptoms and PCS, acting through different mechanisms on the xc-mGluR2 network, with potentially synergistic effects on chronic pain and neuro-astrocyte protection. This paper aims to summarise the current evidence on the potential therapeutic role of NAC and ALC, providing an overview of the underlying molecular mechanisms and pathophysiology. It proposes a pathophysiological model explaining the effectiveness of NAC and ALC in treating COVID-19-related neuropsychiatric symptoms.

Using Limited Trial Evidence to Credibly Choose Treatment Dosage when Efficacy and Adverse Effects Weakly Increase with Dose

It has become standard in medical treatment to base dosage on evidence in randomized trials. Yet it has been rare to study how outcomes vary with dosage. In trials to obtain drug approval, the norm has been to compare some dose of a new drug with an established therapy or placebo. Standard trial analysis views each trial arm as qualitatively different, but it may be credible to assume that efficacy and adverse effects weakly increase with dosage. Optimization of patient care requires joint attention to both, as well as to treatment cost. This article develops a methodology to use limited trial evidence to choose dosage when efficacy and adverse effects weakly increase with dose. I suppose that dosage is an integer t ∊ (0,1,..., T ), T being a specified maximum dose. I study dosage choice when trial evidence on outcomes is available for only K dose levels, where K < T + 1. Then the population distribution of dose response is partially identified. I show that the identification region is a convex polygon. I characterize clinical and population decision-making using the minimax regret criterion. A simple analytical solution exists when T = 2. Computation is tractable when T is larger.

Revised definition of obesity in Asian Indians living in India

AIM

The prevailing guidelines for obesity in Asian Indians, published in 2009, relied solely on body mass index (BMI) criteria. Recognizing the limitations of BMI in accurately diagnosing obesity and the emergence of new research revealing the association between generalized and abdominal adiposity in Asian Indians and early-onset co-morbid diseases, a comprehensive redefinition was needed.

METHOD

In a Delphi process focused on obesity in India, experts were invited via email to participate in five rounds. The survey questions were administered through Google Form to gather insights from the selected experts.

RESULTS

In Stage 1 Obesity, individuals exhibit increased adiposity (BMI>23 kg/m2) without discernible effects on organ functions or daily activities. Stage 2 Obesity denotes a more advanced state characterized by heightened adiposity (generalized and abdominal), impacting both physical and organ functions, resulting in functional limitations during day-to-day activities, and contributing to co-morbid diseases. The criteria for Stage 2 Obesity include a mandatory BMI exceeding 23 kg/m2 and at least one of the following: excess waist circumference or waist-to-height ratio. Additionally, the presence of one or more symptoms indicative of limitations in daily activities or one or more obesity-related comorbid conditions/diseases are needed to support the stage 2 obesity.

CONCLUSION

This refined framework seeks to enhance precision in identifying obesity and its associated health risks among Asian Indians living in India, and facilitation of rational management, and aligns with worldwide initiative of new definition of obesity.

Efficacy and safety of triple hormone receptor agonist retatrutide for the management of obesity: a systematic review and meta-analysis

INTRODUCTION

Retatrutide is a novel triple hormone receptor agonist which has shown great promise in tackling obesity in preliminary trials. We did this systematic review and meta-analysis to pool the results of all available trials and ascertain its safety and efficacy in the treatment of obesity.

MATERIAL AND METHODS

A literature search was conducted in PubMed, Cochrane Central and Embase using appropriate search terms and randomized control trials (RCTs) were identified which reported the safety and efficacy of retatrutide. Data was pooled using mean differences for continuous variables and risk ratios for the safety profile in RStudio.

RESULTS

After the initial search four RCTs were included in the analysis which compared the safety and efficacy of retatrutide versus placebo. Retatrutide showed a dose dependent relationship with the 12 mg dose causing the maximum reductions across all the outcomes considered. The safety profile of retatrutide was found to be comparable to the control group.

CONCLUSION

In conclusion our analysis found retatrutide to be clinically and statistically better than placebo in the various studies outcomes. We eagerly await the conduction of further trials for more robust and substantial results.

PROTOCOL REGISTRATION

www.crd.york.ac.uk/prospero identifier is CRD42024566153.

Cutaneous Adverse Drug Reactions Associated with SGLT2 Inhibitors

Diabetes is a complex global healthcare burden involving multiple organ systems with its prevalence on the rise. SGLT2 inhibitors enhance glucose excretion. The objective of our literature review was to determine the association between cutaneous adverse drug reactions (CADRs) and the use of SGLT2 inhibitors. We collected data on CADRs related to the use of SGLT2 inhibitors from all available published articles and studied their details to understand the patterns of their association. PubMed, Cochrane, Google, and Embase were searched for relevant articles. A total of 37 papers were included and studied. Most articles were case reports followed by pharmacovigilance studies, case series, and reviews. The cutaneous findings ranged from benign eruptions to severe reactions. The available literature suggests a strong link between the use of SGLT2 inhibitors and Fournier's gangrene/necrotizing fasciitis. T2DM patients using SGLT2 inhibitors have also developed fixed drug eruptions, drug-induced pruritus, and Sweet syndrome/acute febrile neutrophilic dermatosis, among other skin lesions. We found that SGLT2 inhibitors present a risk of developing CADRs. Raising awareness among healthcare providers regarding CADRs to SGLT2 inhibitors can reduce complications, minimize hospitalizations, and improve patient care in the vulnerable population of diabetes patients.

PCSK9 in T-cell function and the immune response

Proprotein convertase subtilisin/kexin type 9 (PCSK9) was first reported in 2003 and confirmed to be strongly associated with familial hypercholesterolemia. Small-molecule inhibitors targeting PCSK9 provide an effective and safe method for managing hypercholesterolemia and reducing the cardiovascular risk. In recent years, increasing evidence has indicated other important roles for PCSK9 in inflammation, tumors, and even immune regulation. PCSK9 might be an attractive regulator of T-cell activation and expansion. It might mediate inflammation and regulate other types of immune cells. In this review, we summarize the current advances in the field of PCSK9 and provide a narrative of the biological processes associated with PCSK9. The relationships between PCSK9 and different T cells were investigated in depth. Finally, the signaling pathways associated with PCSK9 and the immune response are also summarized in this review.

Effects of stress hyperglycemia ratio upon long-lasting prognosis in coronary artery disease patients with or lacking chronic renal impairment: findings from a Chinese multi-center observational study

BACKGROUND

Lately, numerous researches have portrayed stress hyperglycemia ratio (SHR) is predominantly connected with short-term adverse prognosis among individuals who have acute coronary syndrome. Nevertheless, the relation of SHR with prolonged effects and the value of SHR in predicting in coronary artery disease (CAD) patients with or lacking chronic kidney disease (CKD) remain unclear. The present study was designed to elucidate the relation of SHR with prolonged prognosis and the value of SHR in predicting the long-term all-cause and cardiovascular death of CAD patients with CKD or non-CKD.

METHODS

We assessed 45,780 adults with CAD from a Chinese multi-center registry. SHR was computed via a formula [SHR = (admission glucose) (mmol/L) / (1.59 * HbA1c [%] - 2.59)]. Based on the presence or absence of CKD and SHR levels, patients were categorized into four groups. Long-term all-cause and cardiovascular mortality were the primary endpoints. The Kaplan-Meier method, restricted cubic spline (RCS), cox regression analysis, subgroups analysis, and sensitivity analysis were employed to estimate the connection between SHR and all-cause as well as cardiovascular mortality.

RESULTS

During a median follow-up of 5.2 years ( IQR 3.0-8.0), among 45,780 CAD patients (mean age [SD]: 62.8 ± 10.6 years; 23.9% female), the number of all-cause deaths was 7144(15.6%), and cardiovascular-related deaths was 3255 (7.1%). In cohorts with CKD, patients with high SHR had higher all-cause mortality (30.2% vs. 27.6%; adjusted hazard ratio HR 1.13, 95% CI 1.04-1.22; P = 0.003) and cardiovascular mortality (18.2% vs. 15.6%; HR adjusted 1.17, 95% CI 1.06-1.30; P = 0.002) compared to the individuals in low SHR. However, this was not the case in CAD cohorts without CKD [all-cause mortality (12.9% vs. 11.9%; HR adjusted 1.04, 95%CI 0.98-1.10, P = 0.206); cardiovascular mortality (5.1% vs. 4.4%; HR adjusted 1.09, 95%CI 0.99-1.20, P = 0.084)]. KM analysis revealed that high SHR is linked with all-cause mortality [CKD (log-rank P < 0.001); no-CKD (log-rank P = 0.024)] and cardiovascular mortality [CKD (log-rank P < 0.001); no-CKD (log-rank P = 0.01)] in CAD patients with or without CKD. RCS demonstrated that the relation between SHR and all-cause mortality was U-shaped after full modification, which was shown for CKD patients (P for non-linearity = 0.003) and also for patients without CKD (P for non-linearity = 0.001). Analogous effects were discovered for cardiovascular mortality, which was the case for CKD patients (P for non-linearity < 0.001) and also for patients without CKD (P for non-linearity = 0.001).

CONCLUSIONS

Among patients with CAD, an elevated stress hyperglycemia ratio (SHR) is implicated in a heightened risk of long-term outcomes, particularly in those with CKD. This signifies that SHR might have a latent function in the cardiovascular risk categorization of the CAD population.

Association of Preoperative Physical Fitness With Post-Esophagectomy Pneumonia in Older With Locally Advanced Esophageal Cancer: An Exploratory Prospective Study

BACKGROUNDS

Currently, there is a lack of evidence of prehabilitation during neoadjuvant chemotherapy (NAC) to prevent pneumonia of older patients. This study aimed to investigate the association of preoperative physical fitness after NAC with post-esophagectomy pneumonia in older patients with locally advanced esophageal cancer (LAEC).

METHODS

This single-center exploratory prospective cohort study included 80 patients aged ≥ 65 years with LAEC scheduled for curative esophagectomy after NAC between 2021 and 2023. The post-NAC short incremental shuttle walk test (ISWT) by sex was established using the Youden index. The association of the post-NAC short ISWT with postoperative pneumonia was investigated via Firth's penalized logistic regression model with statistical significance set as two-tailed p < 0.05.

RESULTS

A total of 69 patients were analyzed. The mean post-NAC ISWT values were 353.5 m. Short ISWT distance was defined as ≤ 395 and ≤ 195 m for men and women, respectively. Postoperative pneumonia developed in 17 (25%) patients. Short post-NAC ISWT distance was significantly associated with postoperative pneumonia (adjusted odds ratio: 1.840, 95%CI: 1.760-28.440, p = 0.004).

CONCLUSIONS

Decline in physical fitness was associated with post-esophagectomy pneumonia, which may be a key targeted factor of prehabilitation during NAC for older patients with LAEC.

Association between stress hyperglycemia ratio and mortality in patients with heart failure complicated by sepsis

Individuals afflicted with heart failure complicated by sepsis often experience a surge in blood glucose levels, a phenomenon known as stress hyperglycemia. However, the correlation between this condition and overall mortality remains unclear. 869 individuals with heart failure complicated by sepsis were identified from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and categorized into five cohorts based on their stress hyperglycemia ratio (SHR). The primary endpoints evaluated were mortality within the intensive care unit (ICU), all-cause mortality within 28 days, and all-cause mortality during hospitalization. Cox proportional hazards regression and restricted cubic spline analyses were employed to unravel the association between SHR and mortality. The ICU mortality, in-hospital mortality, and 28-day all-cause mortality were 10.01%, 13.69%, and 16.46%, respectively. Multivariable Cox proportional hazards regression analysis revealed a significant association between elevated SHR and all-cause mortality. After adjusting for confounding variables, elevated SHR was significantly associated with increased risk of ICU mortality (hazard ratio [HR] = 1.67; 95% confidence interval [CI], 1.03-2.70)), in-hospital mortality (HR = 1.53; 95% CI, 1.00-2.33)), and 28-day all-cause mortality (HR = 1.49; 95% CI, 1.02-2.17)). Restricted cubic spline analysis demonstrated a significant U-shaped relationship between SHR and the risk of all-cause mortality. This study revealed that stress hyperglycemia ratio is an independent prognostic factor in patients with heart failure complicated by sepsis. Notably, both very high and very low SHR values were associated with increased mortality risk.

Efficacy of antiobesity medications for weight reduction in older adults: a systematic review

OBJECTIVE

The objective of this study was to examine weight reduction and adverse events associated with use of antiobesity medications (AOMs) in older adults ages ≥65 years.

METHODS

Seven databases were searched for studies evaluating weight reduction of Food and Drug Administration (FDA)-approved AOMs. Studies had to include adults ages ≥65 years with obesity (BMI ≥ 30 kg/m2 or ≥27 kg/m2 with one weight-related condition), with independent analysis of weight reduction for adults ages ≥65 years. Two coauthors extracted and evaluated studies for risk of bias using standardized forms.

RESULTS

Six experimental studies (five secondary analyses of randomized clinical trial data and one single-arm trial) and two observational studies met inclusion criteria. Seven medications were studied. Sample size of older adults ranged from 13 to 6728. Experimental studies predominantly included patients with concurrent prediabetes or cardiovascular disease. All studies found statistically significant weight reduction between intervention and placebo groups or compared with baseline weight. Few studies reported on adverse events.

CONCLUSIONS

Limited evidence suggests weight reduction of AOMs in older adults, with the best current evidence for the use of semaglutide in older adults with obesity and cardiovascular disease. Larger, more inclusive studies of older adults are needed to guide clinical care and determine the tolerability of AOMs for older adults.

The Beneficial Effects of GLP-1 Receptor Agonists Other than Their Anti-Diabetic and Anti-Obesity Properties

As an incretin hormone, Glucagon-like peptide-1 (GLP-1) has obvious effects on blood glucose regulation and weight loss. GLP-1 receptor (GLP-1R) agonists are synthetic products that have similar effects to GLP-1 but are less prone to degradation, and they are widely used in the treatment of type 2 diabetes and obesity. In recent years, different beneficial effects of GLP-1R agonists were discovered, such as reducing ischemia-reperfusion injury, improving the function of various organs, alleviating substance use disorder, affecting tumorigenesis, regulating bone metabolism, changing gut microbiota composition, and prolonging graft survival. Therefore, GLP-1R agonists have great potential for clinical application in various diseases. Here, we briefly summarized the beneficial effects of GLP-1R agonists other than the anti-diabetic and anti-obesity effects.

Exploring the link between dietary inflammatory index and NAFLD through a structural equation modeling approach

Nonalcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant global public health dilemma with wide-ranging social and economic implications. Diet and lifestyle modifications remain essential components of NAFLD management. The current study investigated the association between diet-related inflammation and NAFLD among 3110 Iranian adults participating in the Amol Cohort Study (AmolCS), employing the Structural Equation Modeling (SEM) approach.The inflammatory potential of the diet was quantified using an energy-adjusted dietary index (E-DII) score. Findings showed that in the total sample and separately in males, the E-DII score had a significant effect on NAFLD, with mediation through hypertension (βstandardized = 0.16, and 0.13, p < 0.001, respectively) and c-reactive protein (CRP) (βstandardized = 0.07, and 0.07, p < 0.001, respectively). In the total sample and separately in females, the E-DII score significantly affected NAFLD, with mediation through diabetes (βstandardized = 0.06, p < 0.001, and 0.07, p = 0.006, respectively). In full and both gender-specific models, dyslipidemia was a risk factor for NAFLD and partially mediated the effect of hypertension on NAFLD.The current study concluded a mediated association between dietary inflammation and NAFLD through hypertension, CRP, diabetes, and dyslipidemia, suggesting further longitudinal studies, especially in high-risk populations. These findings underscore the complex interplay between diet, inflammation, and NAFLD in Iranian adults.

Evaluation and comparison of efficacy and safety of tirzepatide, liraglutide and SGLT2i in patients with type 2 diabetes mellitus: a network meta-analysis

OBJECTIVE

The objective is to assess the effectiveness and safety of tirzepatide, liraglutide, and SGLT2i in individuals diagnosed with type 2 diabetes.

METHODS

An inquiry was undertaken within the electronic database spanning from its inception to February 11th, 2024, aimed at identifying randomized controlled trials that assess the efficacy and safety of tirzepatide, liraglutide, canagliflozin, ertugliflozin, empagliflozin, dapagliflozin, and henagliflozin. Perform a network meta-analysis to examine the distinctions among them (PROSPERO registration number: CRD42024537006).

RESULTS

Twenty-eight RCTs were included, involving 8499 participants. Compared with placebo, all treatments improved HbA1c levels: tirzepatide 15 mg reduced HbA1c the most (MD [95% CI], -2.24% [-2.52, -1.96]%), followed by tirzepatide 10 mg (MD [95% CI], -1.99% [-2.29, -1.69]%), tirzepatide 5 mg (MD [95% CI], -1.82% [-2.11, -1.53]%), and liraglutide 1.2 mg (MD [95% CI], -1.23% [-1.41, -1.05]%). Canagliflozin 300 mg also showed a significant reduction in HbA1c (MD [95% CI], -1.00% [-1.18, -0.82]). Tirzepatide was also the most effective in promoting weight loss, with the following results compared with placebo: tirzepatide 15 mg (MD [95% CI], -8.74 kg [-9.83, -7.66] kg), tirzepatide 10 mg (MD [95% CI], -7.13 kg [-8.40, -5.88] kg), tirzepatide 5 mg (MD [95% CI], -5.38 kg [-6.65, -4.11] kg), canagliflozin 300 mg (MD [95% CI], -2.31 kg [-2.79, -1.83] kg), and empagliflozin 10 mg (MD [95% CI], -2.00 kg [-2.44, -1.55] kg). In reducing systolic blood pressure (SBP), canagliflozin 300 mg showed the greatest effect (MD [95% CI], -5.96% [-7.96, -3.96] %). For diastolic blood pressure (DBP), henagliflozin 5 mg demonstrated the most significant reduction compared to placebo (MD [95% CI], -2.46% [-3.82, -1.10] %). Liraglutide 1.8 mg was most likely to cause adverse events (AE) (OR [95% CI], 2.57 [1.78, 3.70]), but there was no significant difference in serious adverse events (SAEs) between the interventions (including placebo).

CONCLUSION

Out of the seven medications examined in this study, tirzepatide demonstrates the most effective antidiabetic and weight-reducing effects. Furthermore, the dosage of Liraglutide at 1.2 mg and above demonstrates a more pronounced hypoglycemic effect in comparison to SGLT2 inhibitors. SGLT2 inhibitors exhibit a distinct hypotensive effect and are suitable for diabetic individuals experiencing hypertension.

Hypoglycemic agents and bone health; an umbrella systematic review of the clinical trials' meta-analysis studies

BACKGROUND

No clear consensus exists regarding the safest anti-diabetic drugs with the least adverse events on bone health. This umbrella systematic review therefore aims to assess the published meta-analysis studies of randomized controlled trials (RCTs) conducted in this field.

METHODS

All relevant meta-analysis studies of RCTs assessing the effects of anti-diabetic agents on bone health in patients with diabetes mellitus (DM) were collected in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). English articles published until 15 March 2023 were collected through the search of Cochrane Library, Scopus, ISI Web of Sciences, PubMed, and Embase using the terms "Diabetes mellitus", "anti-diabetic drugs", "Bone biomarker", "Bone fracture, "Bone mineral density" and their equivalents. The methodological and evidence quality assessments were performed for all included studies.

RESULTS

From among 2220 potentially eligible studies, 71 meta-analyses on diabetic patients were included. Sodium-glucose cotransporter-2 inhibitors (SGLT-is) showed no or equivalent effect on the risk of fracture. Dipeptidyl peptidase-4 inhibitors (DPP-4is) and Glucagon-like peptide-1 receptor agonists (GLP-1Ras) were reported to have controversial effects on bone fracture, with some RCTs pointing out the bone protective effects of certain members of these two medication classes. Thiazolidinediones (TZDs) were linked with increased fracture risk as well as higher concentrations of C-terminal telopeptide of type I collagen (CTx), a bone resorption marker.

CONCLUSION

The present systematic umbrella review observed varied results on the association between the use of anti-diabetic drugs and DM-related fracture risk. The clinical efficacy of various anti-diabetic drugs, therefore, should be weighed against their risks and benefits in each patient.

Long-term rate of ventricular arrhythmia in autoimmune disease

AIMS

Although selected autoimmune diseases (AIDs) have been linked to an increased risk of ventricular arrhythmias (VAs), data on the long-term rate of VAs across the spectrum of AIDs are lacking. The aim of this study was to investigate the long-term rate of VAs (a composite of ventricular tachycardia, ventricular fibrillation, ventricular flutter, or cardiac arrest) in individuals with a history of 28 different AIDs.

METHODS AND RESULTS

Individuals diagnosed with an AID (2005-18) were identified through Danish nationwide registries. Each patient with an AID was matched with four individuals from the background population by age and sex. Multivariable Cox regression was used to compare the rate of VAs between the AIDs and background population, overall and according to individual AIDs. In total, 186 733 patients diagnosed with AIDs were matched with 746 932 individuals without AIDs (median age 55 years; 63% female; median follow-up 6.0 years). The 5-year cumulative incidence of VAs was 0.5% for patients with AIDs and 0.3% for matched individuals. Patients with any AIDs had a higher associated rate of VAs than matched individuals {hazard ratio (HR) 1.39 [95% confidence interval (CI), 1.29-1.49]}. The highest HR was observed in patients with systemic sclerosis [3.86 (95% CI, 1.92-7.75)]. The higher rate of VAs in patients with AIDs, compared with individuals from the background population, was more pronounced in patients without ischaemic heart disease or heart failure/cardiomyopathy compared with those with these conditions (Pinteraction <0.05).

CONCLUSION

Despite a low cumulative incidence, patients with a history of AIDs had a higher relative rate of VAs than matched individuals.

Assessing the comparative effects of interventions in COPD: a tutorial on network meta-analysis for clinicians

To optimize patient outcomes, healthcare decisions should be based on the most up-to-date high-quality evidence. Randomized controlled trials (RCTs) are vital for demonstrating the efficacy of interventions; however, information on how an intervention compares to already available treatments and/or fits into treatment algorithms is sometimes limited. Although different therapeutic classes are available for the treatment of chronic obstructive pulmonary disease (COPD), assessing the relative efficacy of these treatments is challenging. Synthesizing evidence from multiple RCTs via meta-analysis can help provide a comprehensive assessment of all available evidence and a "global summary" of findings. Pairwise meta-analysis is a well-established method that can be used if two treatments have previously been examined in head-to-head clinical trials. However, for some comparisons, no head-to-head studies are available, for example the efficacy of single-inhaler triple therapies for the treatment of COPD. In such cases, network meta-analysis (NMA) can be used, to indirectly compare treatments by assessing their effects relative to a common comparator using data from multiple studies. However, incorrect choice or application of methods can hinder interpretation of findings or lead to invalid summary estimates. As such, the use of the GRADE reporting framework is an essential step to assess the certainty of the evidence. With an increasing reliance on NMAs to inform clinical decisions, it is now particularly important that healthcare professionals understand the appropriate usage of different methods of NMA and critically appraise published evidence when informing their clinical decisions. This review provides an overview of NMA as a method for evidence synthesis within the field of COPD pharmacotherapy. We discuss key considerations when conducting an NMA and interpreting NMA outputs, and provide guidance on the most appropriate methodology for the data available and potential implications of the incorrect application of methods. We conclude with a simple illustrative example of NMA methodologies using simulated data, demonstrating that when applied correctly, the outcome of the analysis should be similar regardless of the methodology chosen.

Overview of chitin dissolution, hydrogel formation and its biomedical applications

Chitin hydrogel and hydrogel-based products are some of the frequently reported biomaterials for biomedical applications. Yet there is a void in understanding chitin's dissolution mechanism and its most suitable solvent system(s). Chitin is a natural polysaccharide polymer which can be dissolved in solvents such as calcium chloride- methanol, sodium hydroxide/urea (NaOH/urea), lithium chloride diacetamide (LiCl/DMAc), ionic liquids and deep eutectic solvents. Among the alkali/urea dissolution systems such as NaOH/urea, KOH/urea, LiOH/urea for dissolution of chitin we will be focussing on NaOH-based system here for ease of comparison with the other systems. Chitin has been used for decades in the biomedical field; however, new solvent systems are still being explored even to this day to identify the most suitable chemical(s) for dissolving it. Chitin, due to its biocompatibility, allows us to use it for multifaceted purposes. Hence, it is important to consolidate the available studies for better understanding about the most sought-after biomaterial. This overview deeply delves into the mechanism of action of the existing solvent systems and highlights its merits and demerits. It discusses the rheological properties of the chitin gel from different solvent systems and puts forth the current biomedical applications of chitin gel in areas such as tissue engineering, drug delivery, biosensing, hemostasis and wound healing. It also outlines recent advances and highlights the potential gaps which need to be addressed in future studies.

Clinical practice guideline for the management of hypertension in China

In China, hypertension is the most common chronic non-communicable disease and the most significant risk factor for cardiovascular mortality among urban and rural residents. To standardize the clinical diagnosis and treatment of hypertension and to improve the prevention and control level of hypertension in China, Chinese Society of Cardiology, Chinese Medical Association; Hypertension Committee of Cross-Straits Medicine Exchange Association; Cardiovascular Disease Prevention and Rehabilitation Committee, Chinese Association of Rehabilitation Medicine, jointly collaborated to formulate the Clinical Practice Guideline for Hypertension Management in China. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence and strength of recommendations, and the reporting items for practice guidelines in healthcare (RIGHT) were followed to establish the guideline. Detailed evidence-based recommendations for the diagnosis, evaluation, and treatment of 44 clinical questions in the field of hypertension, including essential and secondary hypertension, have been provided to guide clinical practice.

REGISTRATION

International Practice Guidelines Registry Platform, http://www.guidelines-registry.cn/ , No. IPGRP-2021CN346.

Association between serum urate levels and all-cause mortality, cardiovascular and renal outcomes among gout patients in Singapore

OBJECTIVES

We investigated the longitudinal association between Serum Urate (SU) level and Acute Myocardial Infarction (AMI), Stroke, End Stage Renal Failure (ESRF) and all-cause mortality.

DESIGN

We conducted a retrospective hospital-based cohort study of individuals with gout managed in specialist outpatient clinics. Cox proportional hazards regression was used to estimate HR and 95% CI, with adjustments for potential confounders. Where the proportional hazard assumption was violated, stratified Cox regression was applied instead.

SETTING

An acute care tertiary hospital in Singapore.

PARTICIPANTS

Individuals with a first gout diagnosis between 2007-2017, identified through (i) primary discharge diagnosis, (ii) diagnosis from the Rheumatology SOC (iii) patient history of a clinical encounter at the Rheumatology SOC plus use of urate-lowering therapy/colchicine.

MAIN OUTCOME MEASURES

All-cause mortality, AMI, Stroke and ESRF ascertained through data linkage with the National Registry of Diseases Office.

RESULTS

The final cohort comprised 2,866 individuals. Post follow-up, there were 800 deaths and 362, 218 and 191 occurrences of AMI, ESRF and stroke respectively. Compared to the reference (second-lowest) SU quartile, being in the highest SU quartile was associated with a significantly increased hazard for mortality (HR:1.66, 95% CI:1.36-2.03), incident ESRF (HR:3.02, 95% CI:2.00-4.56), and increased hazard for incident AMI (HR:1.42, 95% CI:1.06-1.91). The p-trend for all 3 outcomes was significant. No significant association was found between SU quartile and hazard for incident stroke.

CONCLUSIONS

This study found that individuals with gout managed at SOC who had higher baseline SU levels had an increased hazard for all-cause mortality, ESRF, and AMI.

CLINICAL TRIAL NUMBER

Not applicable.

Age at menarche, type 2 diabetes, and heart failure: A Mendelian randomization study

BACKGROUND AND AIMS

Observational studies suggested that early menarche was associated with type 2 diabetes mellitus (T2DM) and heart failure (HF), but the causal relationships remain uncertain. We aimed to examine the causal relationships of age at menarche (AAM) with T2DM, hemoglobin A1c (HbA1c) and HF using Mendelian randomization (MR).

METHODS AND RESULTS

A 2-sample MR analysis was conducted using genome-wide association study (GWAS) summary statistics for AAM (n = 279,470), T2D (n = 490,089), HbA1c (n = 389,889) and HF (n = 977,323), and all summary statistics are from European ancestry. Genome-wide significant (P < 5 × 10-8) single nucleotide polymorphisms (SNP) connected to AAM were considered as instrumental variables (IVs). Inverse variance weighted (IVW) method was used for primary analysis. Sensitivity analyses were performed to evaluate the robustness of the results. More than 200 SNPs significantly correlated with AAM were screened as IVs. Later genetically predicted AAM decreased risk of T2DM (odds ratio [OR], 0.881; 95%CI, 0.838-0.926; P = 6.92 × 10-7), HbA1c level (OR, 0.964; 95%CI, 0.948-0.980; P = 2.06 × 10-5), and risk of HF (OR, 0.907; 95%CI, 0.870-0.947; P = 7.98 × 10-6). After excluding SNPs associated with body mass index (BMI), there was still a causal relationship between AAM and outcomes (T2DM: OR [95%CI], 0.926 [0.888-0.966]; HbA1c: OR [95%CI], 0.975 [0.960-0.992]; HF: OR [95%CI], 0.933 [0.894-0.972]).

CONCLUSION

This MR study provided evidence supporting the causal effect of AAM on T2DM, HbA1c and HF. Routine evaluation of AAM may contribute to the clinical risk stratification and making prevention strategies.

The Effect of Using Chlorhexidine Gluconate and Povidone Iodine Solution on the Healing Process Before a Cesarean Section

PURPOSE

This study aimed to compare the effect of povidone iodine (PI) and chlorhexidine gluconate (CG) shower groups on the healing process in cesarean section operations.

DESIGN

Randomized controlled trial.

METHODS

Patients were recruited from Gynecology and Obstetrics Hospital in Turkey between February and May 2021. In total, 102 pregnant women were scheduled for elective cesareans. They were randomly divided into PI group (A), CG group (B), and CG shower group (C) operated by three gynecology and obstetrics physicians. During the data collection, a demographics form, an incision site evaluation form, a visual analog scale (VAS), and a postpartum comfort questionnaire (PPCQ) were used. Data from the in-house blinding study to avoid bias and follow-up of the women were done for 7-day duration following postnatal to assess postoperative comfort, pain, and wound complications.

FINDINGS

The VAS, pain, erythema, warm, edema, discharge, and wound opening were statistically evaluated at the incision site with 3 measurements for each of the groups. There was a significant difference in the CG groups (2 and 3) (VAS P < .000, erythema P < .05, and edema P < .05). The mean PPCQ score was higher in the CG groups (2 and 3) and showed a significant difference compared with the PI group (P < .000).

CONCLUSIONS

Due to the antiseptic and nonirritating properties of CG, showering 6 hours before the operation contributed to the wound healing process according to the incision site evaluation form and to a corresponding increased PPCQ level of the mother in the postoperative period.

Association and predictive ability between significant perioperative cardiovascular adverse events and stress glucose rise in patients undergoing non-cardiac surgery

BACKGROUND

The predictive importance of the stress hyperglycemia ratio (SHR), which is composed of admission blood glucose (ABG) and glycated hemoglobin (HbA1c), has not been fully established in noncardiac surgery. This study aims to evaluate the association and predictive capability the SHR for major perioperative adverse cardiovascular events (MACEs) in noncardiac surgery patients.

METHODS

Individuals who underwent noncardiac surgical procedures between 2011 and 2020, including both diabetic and non-diabetic patients, were identified in the perioperative medicine database (INSPIRE 1.1) and classified into tertiles based on their SHR. The connection between the SHR and the risk of MACEs was studied using Cox proportional hazards regression analysis, then restricted cubic spline (RCS) was employed to assess the association's form. Additionally, the SHR's incremental predictive utility for MACEs was assessed by the C-statistic, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI), thereby quantifying the enhancement in predictive accuracy brought by incorporating the SHR into existing risk models. Feature importance and predictive models were generated utilizing the Boruta algorithm and machine learning approaches.

RESULTS

A total of 5609 patients were enrolled. With an upwards shift in SHR vertices, the rate of perioperative MACEs and cardiac death event steadily rose. The RCS analysis for perioperative MACEs and cardiac death event both indicated J-shaped associations. Inflection points occurred at SHR = 0.81 for MACEs and SHR = 0.97 for cardiac death. The model's fit improved significantly, with a continuous NRI of 0.067 (95% CI: 0.025-0.137, P < 0.001) and an IDI of 0.305 (95% CI: 0.155-0.430, P < 0.001). When SHR was added as a categorical variable (> 0.81), the C-statistic increased to 0.785 (95% CI: 0.756-0.814) with a ΔC-statistic of 0.035 (P = 0.009), a continuous NRI of 0.007 (95% CI: 0.000-0.021, P = 0.016), and an IDI of 0.076 (95% CI -0.024-0.142, P = 0.092). In the Boruta algorithm, variables identified as important features in the green area were incorporated into the machine learning models development.

CONCLUSIONS

The SHR was related with an increased risk of perioperative MACEs in patients following noncardiac surgery, highlighting its potential as a useful and reliable predictive tool for assessing the risk of perioperative MACEs.

Apolipoprotein A-I infusions and cardiovascular outcomes in acute myocardial infarction according to baseline LDL-cholesterol levels: the AEGIS-II trial

BACKGROUND AND AIMS

In the AEGIS-II trial (NCT03473223), CSL112, a human apolipoprotein A1 derived from plasma that increases cholesterol efflux capacity, did not significantly reduce the risk of the primary endpoint through 90 days vs. placebo after acute myocardial infarction (MI). Nevertheless, given the well-established relationship between higher low-density lipoprotein cholesterol (LDL-C) and plaque burden, as well as greater risk reductions seen with PCSK9 inhibitors in patients with baseline LDL-C ≥ 100 mg/dL on statin therapy, the efficacy of CSL112 may be influenced by baseline LDL-C.

METHODS

Overall, 18 219 patients with acute MI, multivessel coronary artery disease, and additional risk factors were randomized to either four weekly infusions of 6 g CSL112 or placebo. This exploratory post-hoc analysis evaluated cardiovascular outcomes by baseline LDL-C in patients prescribed guideline-directed statin therapy at the time of randomization (n = 15 731).

RESULTS

As baseline LDL-C increased, the risk of the primary endpoint at 90 days lowered in those treated with CSL112 compared with placebo. In patients with LDL-C ≥ 100 mg/dL at randomization, there was a significant risk reduction of cardiovascular death, MI, or stroke in the CSL112 vs. placebo group at 90, 180, and 365 days [hazard ratio .69 (.53-.90), .71 (.57-.88), and .78 (.65-.93)]. In contrast, there was no difference between treatment groups among those with LDL-C < 100 mg/dL at baseline.

CONCLUSIONS

In this population, treatment with CSL112 compared to placebo was associated with a significantly lower risk of recurrent cardiovascular events among patients with a baseline LDL-C ≥ 100 mg/dL. Further studies need to confirm that CSL112 efficacy is influenced by baseline LDL-C.

Healthcare professionals' perspectives on the use of PCSK9 inhibitors in cardiovascular disease: an in-depth qualitative study

AIMS

Injectable medicines such as PCSK9 inhibitors are increasingly used to manage risk factors for cardiovascular events with little information around the perceptions of healthcare professionals (HCPs) on the administrative and clinical practicalities. The aim was to identify the facilitators and barriers on the use of injectable therapies with cardiovascular benefits through interviews with HCPs.

METHODS AND RESULTS

Qualitative interviews were conducted in the UK (London and Leeds) and Italy (Rome and Milan) in 2021. Coding was undertaken using NVivo and thematic analysis performed. A total of 38 HCPs were interviewed, 19 in each country composing of physicians (n = 18), pharmacists (n = 10), nurses (n = 9), and pharmacy technician (n = 1). Four themes emerged: (i) clinicians' previous experiences with injectable therapies, (ii) challenges with patients' behaviours and beliefs, (iii) clinicians' knowledge of injectable therapies and therapeutic inertia, and (iv) organizational and governance issues. The behaviour and beliefs from HCPs focused on facilitating behaviour change as well as the poor interdisciplinary working and collaboration. Therapeutic inertia was raised where physicians either lacked awareness of injectable therapies or were unwilling to prescribe them. The importance of facilitating patient education on injection techniques was highlighted, while organizational and governance issues identified the lack of guidance to inform practice. Clear pathways are required to identify those who were eligible for injectable therapies as well as on how injectables should be prescribed.

CONCLUSION

If medicine optimization is to be achieved, there need to be structured processes in place to identify eligible patients and the development of educational material.

Identification of potential pathogenic genes for urolithiasis through multi-omics Mendelian randomization analysis

Urolithiasis, a common urological disorder affecting about 10% of the global population, is known for its high recurrence rate, yet its genetic mechanisms remain poorly understood. This study aimed to fill this gap by identifying potential pathogenic genes associated with urolithiasis using a multi-omics Mendelian randomization approach. We conducted a comprehensive analysis that integrated genome-wide association studies (GWAS), expression quantitative trait loci (eQTL), methylation quantitative trait loci (mQTL), and protein quantitative trait loci (pQTL) data. Summary Data-Based Mendelian Randomization (SMR) and Bayesian colocalization analyses were employed to investigate causal relationships between gene expression and urolithiasis, while external validation and multivariable MR controlled for confounding factors. Seven genes were identified as significantly associated with urolithiasis, with LMAN2, NUCKS1, and L3MBTL3 highlighted as key contributors. LMAN2 was positively associated with urolithiasis risk (SMR b = 0.842, FDR < 0.05), with evidence that increased LMAN2 expression elevates stone formation likelihood, supported by findings from DNA methylation and protein level analyses. Conversely, NUCKS1 and L3MBTL3 exhibited protective effects, with NUCKS1 expression negatively associated with urolithiasis and supported by methylation at the cg12081870 site. Bayesian colocalization analysis showed strong shared genetic bases for NUCKS1 and L3MBTL3 with urolithiasis, with further multivariable MR confirming these associations were independent of BMI, smoking, alcohol consumption, and serum calcium levels. Genetic correlation analysis revealed significant positive genetic correlations between LMAN2 and urolithiasis (rg = 1.12, P = 8.11e-11), while NUCKS1 (rg = - 0.60, P = 3.10e-03) and L3MBTL3 (rg = - 0.38, P = 1.20e-03) showed strong negative correlations. These findings provide critical insights into the genetic basis of urolithiasis, identifying LMAN2, NUCKS1, and L3MBTL3 as potential biomarkers and therapeutic targets, offering a pathway toward personalized treatment strategies.

Understanding the Epidemiology of Monkeypox Virus to Prevent Future Outbreaks

Monkeypox (Mpox) is an infectious disease caused by the Mpox virus belonging to the Orthopoxvirus genus in the Poxviridae family and has been declared by the WHO as a global health emergency owing to its rapid spread during 2022 and 2023. All patients diagnosed with Mpox who were confirmed by PCR between July 2022 and April 2023 were included in this study. In total, 405 patients in whom clade 2 was identified were included. Notably, 99% of included patients were men, with 82% of them aged 20-39 years. Furthermore, 71% were men who had sex with men, and 34% were HIV carriers. Regarding the morphology of the lesions, approximately 63% presented with papulonecrotic rash, which sometimes alternated with pustules depending on the stage they were in. All patients presented with systemic symptoms. Five patients required hospital admission, one of whom died, and presented with HIV and severe immunosuppression. Clinical findings suggest that contact during sexual intercourse is the most likely transmission mechanism and genital involvement is the most frequent clinical form. HIV was the primary comorbidity. Genital lesions were common, especially in vulnerable populations such as those who engage in high-risk sexual behaviors.

Causal relationship between immune cells and periodontitis: A Mendelian randomization study

This study employed Mendelian randomization (MR) analysis to explore potential causal relationships between 731 immune cell subtypes and periodontitis. Utilizing a 2-sample MR design, our study delved into the diverse landscape of immune cell interactions with periodontitis-associated factors. Multiple MR methods, including inverse variance weighting, weighted median, and MR-Egger tests, were employed to ensure reliability and mitigate potential pleiotropic effects. The study revealed significant causal effects (FDR < 0.15) between immune cells (B cells, maturation stages of T cells, Treg) and periodontitis. Notably, receptors like triggering receptor expressed on myeloid cells-1 (TREM-1) and triggering receptor expressed on myeloid cells-2 (TREM-2) exhibited intricate roles, warranting further investigation. In conclusion, this MR analysis elucidates complex causal relationships between immune cell subtypes and periodontitis. The findings provide a foundation for understanding systemic implications, offering insights for clinical practice and highlighting avenues for future research.

Exploring the role of NLRP3 infalmmasome in diabetes: a literature review and bibliometric analysis

Background

Diabetes has emerged as the foremost public health challenge of the 21st century, with a notable shift towards managing it through an inflammatory lens. This study seeks to investigate the role of NLRP3 infalmmasome in diabetes over the past ten years, leveraging bibliometric analysis to pinpoint prevailing trends, underscore critical focal points, and establish a roadmap for subsequent research endeavors.

Method

A literature search was conducted based on the SCI-E database, and all recorded results were downloaded in plain text format for subsequent analysis. The analysis was carried out using Vosviewer1.6.18, citespace6.3R1, and Microsoft Excel 2021 software, focusing on the following terms: country, institution, author, journal, references, and keywords.

Results

From January 1, 2014, to December 31, 2023, a total of 1373 articles were retrieved, with China, the United States, and Italy contributing the majority of records. Harbin Medical University, Nanjing Medical University, and Central South University stand as the top three most productive institutions. "International Journal of Molecular Sciences" leads the way with the highest number of publications, closely followed by "Frontiers in Immunology" and "Frontiers in Pharmacology." Authors Wang Wei boast the most publications, closely followed by Li Xiang and Wang Yan. Within the superimposed keyword network, four primary clusters emerge: (1) exploring the link between NLRP3 infalmmasome and inflammatory diseases like diabetes; (2) investigating the cellular-level pathogenesis of diabetes-related conditions; (3) examining diabetes characteristics and associated suppression techniques; (4) studying cell morphology alterations, including pyroptosis. Over the past five years, key topics in this field have revolved around the "heart", "damage", "caspase 1 activation", "NLRP3", and "diabetic kidney disease".

Conclusion

This paper has identified the hot spots and trends concerning the role of NLRP3 infalmmasome in diabetes, thereby providing a valuable reference for future research. Furthermore, it is anticipated that pyroptosis and diabetes-related diseases will become frontier research topics that may garner significant attention in the coming years.

Prescribing Trends of Fixed-Dose Combination Antibiotics Not Recommended by the WHO (FNRs) for ICU Patients in Six Major Areas of China During a Seven-Year Period

Objective

To evaluate the prescribing trends of fixed-dose combination antibiotics not recommended by the WHO (FNRs) for intensive care unit (ICU) patients in six major areas of China from 2013 to 2019.

Methods

A descriptive analysis was conducted using the pharmacy prescription data. Prescription data for patients admitted to the ICU were extracted from the Hospital Prescription Analysis Cooperative Project. Trends in FNR use were analyzed over a seven-year period, and the trends were further analyzed at the specific drug and hospital levels.

Results

A total of 15,596,620 prescriptions were eligible for analysis, and 1,492,793 patients were included. Among these patients, 91,515 (6.13%) received FNRs. The annual number of ICU patients who received FNR showed an increasing trend (P=0.007), but the percentage per year did not (P=0.764). The FNR use was usually higher in male patients than in female patients (P<0.001). Patients aged > 60 years had the highest percentage of patients who received FNRs (P<0.001). Among the eight FNRs identified in this study, cefoperazone/sulbactam was the most commonly used FNR in both patient numbers and prescribed hospitals, followed by piperacillin/sulbactam. The use of cefotaxime/sulbactam was less common but showed an increasing trend. There were significant differences among the regions.

Conclusion

This study investigated the national landscape of FNR use among ICU patients. Attention should be given to the frequent use of FNRs in these patients. Data on the real-world effectiveness and safety of FNRs are urgently required.

Atherogenic circulating lipoproteins in ischemic stroke

The fundamental role of qualitative alterations of lipoproteins in the early development of atherosclerosis has been widely demonstrated. Modified low-density lipoproteins (LDL), such as oxidized LDL (oxLDL), small dense LDL (sdLDL), and electronegative LDL [LDL(-)], are capable of triggering the atherogenic process, favoring the subendothelial accumulation of cholesterol and promoting inflammatory, proliferative, and apoptotic processes characteristic of atherosclerotic lesions. In contrast, high-density lipoprotein (HDL) prevents and/or reverses these atherogenic effects. However, LDL's atherogenic and HDL's anti-atherogenic actions may result altered in certain pathological conditions. The molecular mechanisms underlying the impaired effects of altered lipoproteins have been studied in numerous in vitro and in vivo studies, and have been extensively analyzed in coronary atherosclerosis, especially in the context of pathologies such as dyslipidemia, diabetes, obesity, and metabolic syndrome. However, the corresponding studies are scarcer in the field of ischemic stroke, despite carotid arteriosclerosis progression underlies at least 20% of ischemic strokes. The present review relates qualitative alterations of LDL and HDL with the development of carotid arteriosclerosis and the occurrence of ischemic stroke.

The Neisseria meningitidis urethritis clade (NmUC) acts as a "chimeric pathogen" during infection of primary, human male, urethral epithelial cells

BACKGROUND

Clusters of male urethritis cases, caused by a novel clade of non-groupable Neisseria meningitidis (NmUC, "the clade"), have been reported globally. Genetic features unique to NmUC isolates include: the acquisition of the gonococcal denitrification loci, norB-aniA; a unique factor H binding protein (fHbp) variant; and loss of group C capsule and intrinsic lipooligosaccharide sialylation. We hypothesized that these characteristics might confer a colonization and survival advantage to NmUC during male urethral infection relative to non-clade group C Neisseria meningitidis.

METHODS

NmUC, gonococcal, and non-clade meningococcal strains were comparatively evaluated in primary, human male, urethral epithelial cell (UEC) infection studies.

RESULTS

NmUC strains were approximately six times more invasive in UECs than the gonococcal strains tested, which could not be attributed to loss of capsule expression alone. Whereas gonococci and NmUC strains survived and proliferated within UECs, negligible survival was observed for non-clade meningococcal strains. NmUC adherence to, invasion of, and survival within UECs was significantly decreased when host receptors known to mediate gonococcal or meningococcal interactions with epithelial cells were blocked. Infection studies indicated that fHbp contributes to clade survival independent of its ability to bind extracellular factor H, and the gonococcal denitrification pathway, particularly NorB, plays an important role in promoting clade intracellular survival.

CONCLUSIONS

Whereas mechanisms used by NmUC to infect UECs are shared with other neisserial strains, hybrid mechanisms unique to the clade also mediate infection and allow adaptation to the male urethra. Thus, NmUC is a "chimeric pathogen", displaying facets of gonococcal and meningococcal pathogenesis.

A Saudi Heart Association Position Statement on Cardiovascular Diseases and Diabetes Mellitus

Background

Cardiovascular disease (CVD) and diabetes mellitus are prominent public health concerns in Saudi Arabia owing to their increasingly high prevalence and burden. Based on this, the Saudi Heart Association (SHA) set out to develop an official position statement on CVD and diabetes mellitus, with a focus on the prevention and management of these conditions and relevant special populations in the context of Saudi Arabia.

Methods

A multidisciplinary panel of experts met under the auspices of the SHA in a series of meetings to review and discuss available evidence on the prevention and management of comorbid CVD and diabetes mellitus. Specialized subcommittees reviewed the data and offered context-specific recommendations (taking into account Saudi population characteristics, local healthcare system, available resources and medical expertise), which were later approved by the full expert panel.

Results and conclusions

The prevalence of diabetes mellitus and CVD is alarming in the Saudi Arabian population. Diabetes mellitus and CVD are interconnected on several levels, including cellular and molecular events as well as epigenetic and genetic mechanisms. Screening for CVD is a priority for patients with diabetes and concomitant risk factors. The expert panel also recommends aggressive management of high blood pressure and dyslipidemia in addition to lifestyle changes and achieving glycemic targets for the prevention of CVD in patients with diabetes. Some glucose-lowering drug classes, namely SGLT2-inhibitors and GLP-1 receptor agonists, offer significant benefits on the level of cardiovascular risk reduction and are thus a powerful addition to the clinical management armamentarium in CVD and diabetes. Special consideration is also advised for patient populations with distinct clinical presentation and needs, such as coronary artery disease, heart failure, and chronic kidney disease, among others.

Pharmacological Nephroprotection in Chronic Kidney Disease Patients with Type 2 Diabetes Mellitus-Clinical Practice Position Statement of the Polish Society of Nephrology

Both chronic kidney disease (CKD) and type 2 diabetes (T2D) are modern epidemics worldwide and have become a severe public health problem. Chronic kidney disease progression in T2D patients is linked to the need for dialysis or kidney transplantation and represents the risk factor predisposing to serious cardiovascular complications. In recent years, important progress has occurred in nephroprotective pharmacotherapy in CKD patients with T2D. In the current position paper, we described a nephroprotective approach in CKD patients with T2D based on the five following pillars: effective antihyperglycemic treatment, SGLT2 inhibitor or semaglutide, antihypertensive therapy, use of RASi (ARB or ACEi), and in selected patients, finerenone, as well as sodium bicarbonate in patients with metabolic acidosis. We thought that the current statement is comprehensive and up-to-date and addresses multiple pathways of nephroprotection in patients with CKD and T2D.

Targeting Dlat-Trpv3 pathway by hyperforin elicits non-canonical promotion of adipose thermogenesis as an effective anti-obesity strategy

INTRODUCTION

Promoting adipose thermogenesis is considered as a promising therapeutic intervention in obesity. However, endeavors to develop anti-obesity medications by targeting the canonical thermogenesis regulatory pathway, particularly β3-adrenergic receptor (β3-AR)-dependent mechanism, have failed due to the off-target effects of β3-AR agonists, exacerbating the risk of cardiovascular disease. Hyperforin (HPF), a natural compound extracted from the traditional herbal St. John's Wort, binds to Dihydrolipoamide s-acetyltransferase (Dlat) and exerts effective anti-obesity properties through promoting adipose thermogenesis.

OBJECTIVES

The objective of this study was to investigate the oral efficacy and pharmacokinetics profile of HPF, and explore the detailed mechanism by which Dlat modulates HPF-mediated adipose thermogenesis.

METHODS

To assess the anti-obesity efficacy of orally administered HPF in vivo, Dlat heterozygous knockout (Dlat+/-) mice and wild-type (WT) mice, both fed a high-fat diet (HFD), underwent a validation process that involved the use of metabolic cages, NMR analysis, and infrared imaging. Sprague Dawley rats were employed to determine the pharmacokinetic parameters of HPF. Seahorse assays, JC-1 staining, qPCR, and immunoblotting were performed to evaluate cellular thermogenic efficacy of HPF and Dlat in vitro.

RESULTS

Our study uncovered a non-canonical thermogenesis pathway involving Dlat, transient receptor potential vanilloid 3 (Trpv3, a calcium channel) and AMPK. Dlat interacted with Trpv3 to activate it, resulting in an increase in intracellular calcium (Ca2+) and the activation of Camkkβ. Camkkβ then stimulated AMPK, leading to elevated Ucp1 expression and initiating adipose thermogenesis. HPF promoted thermogenesis in adipose tissues through enhancing the Dlat-Trpv3 interaction independently of β3-AR, causing minimal cardiac side effects. Notably, HPF's thermogenic effects were reduced in Dlat+/- mice. Moreover, HPF exerted favorable oral bioavailability, a relatively long half-life, and extensive distribution within adipose tissues.

CONCLUSION

In summary, our study demonstrates that HPF targets a novel mechanism for promoting adipose thermogenesis and exhibits potent and safe anti-obesity efficacy.

Impact of DPP-4 Inhibitors in Patients with Diabetes Mellitus and Heart Failure: An In-Depth Review

The increasing prevalence of both type 2 diabetes mellitus and heart failure has underscored the urgent need for optimized therapeutic strategies that address the complex interplay between these conditions. Dipeptidyl peptidase-4 (DPP-4) inhibitors have emerged as a popular class of glucose-lowering agents due to their favorable glycemic effects, safety profile, and potential cardiovascular benefits. However, the impact of DPP-4 inhibitors on heart failure outcomes in patients with diabetes remains contentious, with conflicting evidence from clinical trials and observational studies. This review critically examines current evidence on the use of DPP-4 inhibitors in patients with coexisting diabetes and heart failure, focusing on pharmacodynamics, safety, and efficacy outcomes. We explore the physiological mechanisms by which DPP-4 inhibitors may influence heart failure risk, including modulation of inflammation, oxidative stress, and myocardial fibrosis. Clinical trials such as SAVOR-TIMI 53, EXAMINE, and TECOS are evaluated to provide a comprehensive analysis of DPP-4 inhibitors' effects on hospitalization for heart failure, mortality, and cardiovascular events in diabetic patients. While some trials suggest an increased risk of HF hospitalizations with specific DPP-4 inhibitors (e.g., saxagliptin), others report neutral effects, raising questions about the class effects versus individual drug characteristics within this group. Additionally, we address discrepancies in outcomes related to patient demographics, HF phenotype, and comorbid conditions that may influence DPP-4 inhibitors' risk-benefit profile. Comparative insights into alternative glucose-lowering therapies such as SGLT2 inhibitors and GLP-1 receptor agonists are also provided, highlighting potential implications for treatment selection in this high-risk population. In summary, this review synthesizes available evidence on DPP-4 inhibitors' impact in diabetic patients with heart failure, aiming to guide clinicians in making informed therapeutic decisions. While DPP-4 inhibitors remain a viable option in diabetes management, caution is warranted in patients with advanced heart failure, and future research is essential to refine patient-specific guidelines.

Increased risk of adverse events among patients with vs. without systemic autoimmune rheumatic disease prescribed sodium-glucose cotransporter 2 inhibitors: a retrospective cohort study

BACKGROUND

Systemic autoimmune rheumatic disease (SARD) patients have been excluded from sodium-glucose cotransporter 2 inhibitor (SGLT2i) trials given putative risks, but this risk magnitude is unknown. We aimed to quantify SGLT2i adverse event risks among patients with vs. without SARD.   METHODS: In a retrospective cohort study, patients with SARD at Mass General Brigham, a multihospital system in Boston, Massachusetts, prescribed SGLT2i were age-, self-reported race-, and sex-matched to patients prescribed the same SGLT2i between 1/1/2016 and 12/10/2021. Cumulative incidence and Cox models, overall and sex-stratified, estimated patient-reported adverse event risks from prescription date, censoring for discontinuation, death, or study end (12/12/2022).

RESULTS

Four hundred sixty-eight SARD and 420 matched non-SARD patients were compared: mean age 64 years (SD 11.3), 61% female, and 70% White. SARD patients had shorter SGLT2i use duration (8.4 vs. 12.7 months; p < 0.0001) and time to adverse event (0.59 vs. 0.85 years; p 0.04). Yeast infections (9.8% vs. 6.2%; p 0.047) and muscular symptoms (3.4% vs. 1.0%, p 0.01) were more prevalent among those with SARD. Adjusting for baseline demographics, adverse event risk was higher (MV HR 1.68; 95% CI 1.28, 2.21), in patients with vs. without SARD. Risk was higher in women than men overall and in women with SARD vs. without (adjusted HR 1.86; 95% CI 1.36, 2.54).

CONCLUSION

Patients with vs. without SARD had 68% higher adverse event risk with SGLT2i use. Women with vs. without SARD had > 85% higher adverse event risks, although most were not serious. Trials of safety and efficacy of SGLT2i among SARD patients are warranted. Key Points •To our knowledge, this is the first study to compare adverse events associated with SGLT2i utilization in patients with vs. without SARD, despite RCT exclusion and documented SGLT2i use in the population. •In our comparison of 468 patients with SARD and 420 patients without, we identified a greater than 65% increase in risk of adverse event outcomes among patients with SARD. •Furthermore, we found that this risk disproportionately affected female patients, with a 4.4-fold increased risk among women with SARD compared to men without.

Sarcopenia interventions in long-term care facilities targeting sedentary behaviour and physical inactivity: A systematic review

BACKGROUND

Sedentary behaviour and physical inactivity are independent risk factors for sarcopenia for long-term care facility residents. Understanding the components, mechanisms and context of interventions that target change in these risk factors can help optimize sarcopenia management approaches. This study aimed to identify, appraise and synthesize the interventions targeting sedentary behaviour and physical inactivity, construct a Theory of Change logic model, inform complex sarcopenia intervention development and identify areas for improvement.

METHODS

Eight electronic databases, including Embase and Web of Science, were searched for eligible interventional studies from inception until February 2024. Narrative synthesis was used. The Theory of Change was applied to develop a logic model presenting the synthesized results. A Cochrane risk of bias assessment tool was used for quality appraisal.

RESULTS

The study included 21 articles involving 1014 participants, with mean ages ranging from 72.5 to 90.4 years. The proportion of female participants ranged from 8.0% to 100.0%. The applied sarcopenia diagnosis criteria varied, including those of the Asian Working Group for Sarcopenia and the European Working Group on Sarcopenia in Older People. The overall risk of bias in the included studies was moderate. Interventions primarily targeted physical inactivity, with resistance training being the most common intervention type. The reporting of intervention adherence was insufficient (only 11 out of 21 included studies provided adherence reports), and adherence overall and by intervention type was not possible to discern due to inconsistent criteria for high adherence across these studies. Four categories of intervention input were identified: educational resources; exercise equipment and accessories; monitoring and tailoring tools; and motivational strategies. Intervention activities fell into five categories: determining the intervention plan; educating; tailoring; organizing, supervising, assisting and motivating; and monitoring. While sarcopenia-related indicators were commonly used as desired outcomes, intermediate outcomes (i.e., sedentary time and physical activity level) and other long-term outcomes (i.e., economic outcomes) were less considered. Contextual factors affecting intervention use included participant characteristics (i.e., medical condition and education level) and intervention provider characteristics (i.e., trustworthiness).

CONCLUSIONS

The findings led to the development of a novel logic model detailing essential components for interventions aimed at managing sarcopenia in long-term care facilities, with a focus on addressing sedentary behaviour and physical inactivity. Future sarcopenia interventions in long-term care facilities should fully attend to sedentary behaviour, enhance adherence to interventions through improved education, monitoring, tailoring and motivation and establish an agreed standard set of outcome measures.

Efficacy and safety of lipid-lowering therapies in combination with or without statin to reduce the cardiovascular risk: A systematic review of randomised controlled trials

Background and aims

Cardiovascular diseases (CVD) pose a significant global health burden. Lowering low-density lipoprotein-cholesterol is the primary therapeutic aim for preventing primary and secondary CVD events. While statins are the standard treatments, their limitations, such as side effects and intolerance in certain patient groups, necessitate exploration of alternative lipid-lowering therapies (LLTs). We systematically reviewed randomised controlled trials (RCTs) evaluating cardiovascular outcomes associated with non-statin LLTs (bempedoic acid, alirocumab, evolocumab, ezetimibe, and inclisiran) in adults with CVD or high cardiovascular risk.

Methods

EMBASE, Medline, Cochrane Library, and clinical trial registries were systematically searched for eligible studies, from inception until February 08, 2023. Two reviewers independently screened the studies, with discrepancies resolved by a third reviewer. Data extraction and validation were conducted, and the risk of bias was assessed using the Cochrane Risk-of-Bias tool-2 for RCTs.

Results

The search strategy yielded 2104 citations. Post screening for eligibility, nine unique trials/studies (84 publications) were identified. Among these, one trial each was identified for bempedoic acid and alirocumab, three for evolocumab, and four for ezetimibe. No published literature documenting the cardiovascular outcomes of inclisiran was identified. Only one trial (CLEAR Outcomes) included statin-intolerant patients at baseline. Most studies evaluated a 3-component, 4-component, or 5-component major adverse cardiovascular events composite as an outcome along with individual components. The quality of the included trials was found to be fair-to-good.

Conclusions

The systematic review findings emphasise the significance of considering non-statin LLTs as viable treatment options for individuals with CVD or high cardiovascular risk who cannot tolerate or achieve optimal lipid control with statin therapy alone.

Benefits of intensive lipid-lowering therapies in patients with acute coronary syndrome: a systematic review and meta-analysis

BACKGROUND

Previous meta-analyses have investigated the efficacy of lipid-lowering therapies for atherosclerotic cardiovascular disease; however, few have focused on patients with acute coronary syndrome (ACS). This meta-analysis aimed to compare the benefits of intensive lipid-lowering therapy with those of background statin therapy in patients with ACS.

METHODS

Searches were performed on PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for articles published until April 13, 2023. Randomized controlled trials that compared intensive lipid-lowering therapies and background statin therapies in patients with prior ACS and recorded the outcome of three-point major cardiovascular events (MACE) were included. The risk ratio (RR) with 95% confidence interval (CI) was used as a measure of primary and secondary outcomes.

RESULTS

Nine trials involving 38,640 patients with ACS were identified. Pooled results suggested that intensive lipid-lowering therapies are associated with a reduction in the risk of three-point MACE (RR, 0.88; 95% CI, 0.83-0.94; p < 0.001), recurrent ACS (RR, 0.82; 95% CI, 0.71-0.96; p = 0.013), nonfatal myocardial infarction (MI) (RR, 0.87; 95% CI, 0.81-0.93; p < 0.001), stroke (RR, 0.83; 95% CI, 0.73-0.94; p = 0.003), and unstable angina-related hospitalization (RR, 0.57; 95% CI, 0.33-0.99; p = 0.046), but not all-cause mortality (RR, 0.94; 95% CI, 0.82-1.07; p = 0.329), cardiovascular disease-related mortality (RR, 0.96; 95% CI, 0.88-1.06; p = 0.457) or coronary revascularization (RR, 0.89; 95% CI, 0.79-1.00; p = 0.057).

CONCLUSIONS

Intensive lipid-lowering therapies may reduce the risk of three-point MACE, recurrent ACS, nonfatal MI, stroke, and hospitalization for unstable angina in patients with ACS undergoing background statin therapy. These results may assist in clinical decision-making for the secondary prevention of cardiovascular events to initiate intensive lipid-lowering therapies immediately after ACS.

PCSK9 inhibitor attenuates cardiac fibrosis in reperfusion injury rat by suppressing inflammatory response and TGF-β1/Smad3 pathway

Progressive cardiac fibrosis, a hallmark of heart failure, remains poorly understood regarding Proprotein convertase subtilisin/kexin type 9 (PCSK9) 's role. This study aims to elucidate PCSK9's involvement in cardiac fibrosis. After ischemia/reperfusion (I/R) injury surgery in rats, PCSK9 inhibitors were used to examine their effects on the transforming growth factor-β1 (TGF-β1)/small mother against decapentaplegic 3 (Smad3) pathway and inflammation. Elevated PCSK9, TGF-β1, and Smad3 levels were observed in cardiac tissues post-I/R injury, indicating fibrosis. PCSK9 inhibition reduced pro-fibrotic protein expression, protecting the heart and mitigating I/R-induced damage and fibrosis. Additionally, it ameliorated cardiac inflammation and reduced post-myocardial infarction (MI) size, improving cardiac function and slowing heart failure progression. PCSK9 inhibitors significantly attenuate myocardial fibrosis induced by I/R via the TGF-β1/Smad3 pathway.

Efficacy and safety of generic cefoperazone/sulbactam versus branded cefoperazone/sulbactam in the treatment of bacterial infections: a systematic review and meta-analysis

This study aim to assess the clinical efficacy and safety of generic cefoperazone/sulbactam compared to the branded cefoperazone/sulbactam (Sulperazon) in treating bacterial infections through a meta-analysis. Searches were conducted across PubMed, Embase, Cochrane Library, CNKI, WanFang, VIP databases, and Clinical Trials database, resulting in the inclusion of 11 studies comprising 7 randomized controlled trials (RCTs) and 4 retrospective cohort studies (RCSs). Meta-analysis of the RCTs indicated no statistical differences in clinical success rates, clinical cure rates, microbiological eradication rates, and incidence of adverse reactions between the generic cefoperazone/sulbactam and the branded version. Findings from the RCSs aligned with those from the RCTs, demonstrating that generic versions of cefoperazone/sulbactam are equivalent in efficacy and safety to their branded counterparts in treating bacterial infections.

PCSK9 Monoclonal Antibodies Have Come a Long Way

PURPOSE OF THE REVIEW

This review examines the pivotal role of monoclonal antibodies against PCSK9 in lipid-lowering therapy, emphasizing their biological and clinical impact.

RECENT FINDINGS

Randomized controlled trials have validated that PCSK9 monoclonal antibodies (Mabs) effectively reduce LDL-c levels by approximately 50%, even when added to maximal statin therapy. They moreover produce a notable 15-20% relative decrease in major cardiovascular events, with a greater reduction among high-risk patients and no evidence for serious adverse effects, assuaging previous concerns. This review highlights the benefits of PCSK9 Mabs in high cardiovascular risk patients. Despite their efficacy and safety, these therapies are hindered by limited access, and require broader integration into clinical practice to optimize therapeutic outcomes.

A review of the last decade: pancreatic cancer and type 2 diabetes

Pancreatic cancer (PC) is a prevalent gastrointestinal tumour known for its high degree of malignancy, resulting in a mere 10% five-year survival rate for most patients. Over the past decade, a growing body of research has shed light on the intricate bidirectional association between PC and Type 2 diabetes (T2DM). The collection of PC- and T2DM-related articles is derived from two comprehensive databases, namely WOS (Web of Science Core Collection) and CNKI (China National Knowledge Infrastructure). This article discusses the last 10 years of research trends in PC and T2DM and explores their potential regulatory relationship as well as related medications.

Estimation of the proportion of cardiovascular disease cases in France attributable to high concentrations of low-density lipoprotein cholesterol

BACKGROUND

Elevated concentrations of low-density lipoprotein cholesterol (LDL-C) are highly prevalent and are associated with the development of cardiovascular diseases.

AIM

To estimate the proportion of cardiovascular disease cases attributable to high concentrations of LDL-C (population attributable fraction [PAF]) in France in 2017, based on the most recent individual data on LDL-C, and the attributable burden on hospitalizations and death.

METHODS

We estimated the PAF of high LDL-C concentrations for ischaemic heart disease (IHD), ischaemic stroke and aortic valve stenosis (AVS). Distributions of LDL-C concentrations were obtained from the most recent French health examination representative survey (ESTEBAN). The relative risks of each disease per 1-mmol/L increase in blood LDL-C were obtained either from the most appropriate meta-analyses or from Mendelian randomization.

RESULTS

The PAF of high LDL-C concentrations varied between 44.2% (95% CI 24.6%-60.5%) for IHD-related death and 49.4% (95% CI 35.6-60.8%) for IHD-related years-of-life lost (YLL), 22.5% (95% CI 0.0-43.3%) and 25.5% (95% CI 11.6-36.8%) for ischaemic stroke indicators, and 29.0% (95% CI 8.6-45.4%) and 29.3% (95% CI 8.4-45.6%) for AVS indicators. Overall, 230,000 hospitalizations, 1,303,000 prevalent cases and 23,000 deaths were estimated to be attributable to high LDL-C concentrations, with most cases related to IHD. PAFs were similar across sex and cardiovascular diseases, whereas PAF strongly varied with age for IHD and ischaemic stroke, with PAF reaching 80.6% (95% CI 55.3-92.7%) and 60.9% (95% CI 33.8-80.8%), respectively, in the group aged 35-44 years.

CONCLUSION

The high estimated PAF of elevated LDL-C concentrations for IHD, ischaemic stroke and AVS support the urgent need to reduce the prevalence of hypercholesterolaemia in this French population.