C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis

Inflammatory and metabolic markers mediate the association of hepatic steatosis and fibrosis with 10-year ASCVD risk

BACKGROUND AND AIMS

Liver steatosis and fibrosis increase the predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk, though the roles of chronic inflammation and metabolic dysregulation remain unclear. This cross-sectional study quantitatively assesses this association and evaluates the mediating effects of metabolic dysregulation and chronic inflammation.

METHODS

In this study, we enrolled 6110 adults from ten communities in Canton, China. Hepatic steatosis and fibrosis were assessed using vibration-controlled transient elastography (VCTE) through controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), while predicted 10-year ASCVD risk was calculated using the China-PAR project model. Associations between CAP/LSM values and predicted 10-year ASCVD risk were analyzed. Mediation analysis quantified the effects of high-sensitivity C-reactive protein (hs-CRP), homeostasis model assessment of insulin resistance (HOMA-IR), remnant cholesterol (RC), and non-high-density lipoprotein cholesterol (non-HDL-C). The main statistical methods used included logistic regression, restricted cubic splines (RCS) analysis, interaction calculations, and mediation analysis to examine the relationships and mediators.

RESULTS

The study population had a mean age of 50.1 years (SD = 9.7), with 3927 females (64.3%) and 2183 males (35.7%). Additionally, 808 participants (13.2%) had type 2 diabetes, and 1911 participants (31.3%) had hypertension. Compared to the first CAP quartile (Q1), higher CAP quartiles showed increased odds ratios (OR) for predicted moderate to high 10-year ASCVD risk: 1.14 (0.89, 1.45), 1.37 (1.08, 1.73), and 2.44 (1.93, 3.10). Mediation analysis showed hs-CRP and HOMA-IR mediated CAP's link to ASCVD risk, with mediation proportions of 15.40% and 27.37%. RC and non-HDL-C mediated this association at 7.12% and 6.26%. Among patients with hepatic steatosis (CAP ≥ 248 dB/m), LSM Q4 participants had a significantly higher predicted 10-year ASCVD risk than those in LSM Q1 (OR 2.22, [1.52, 3.25]), with hs-CRP and HOMA-IR mediating 2.62% and 13.75%, respectively.

CONCLUSION

Liver steatosis and fibrosis were associated with the increased predicted ASCVD risk, with mediation effects from hs-CRP, HOMA-IR, RC, and non-HDL-C.

Association of low-grade inflammation and elevated remnant cholesterol with risk of ASCVD and mortality in impaired renal function

BACKGROUND AND AIMS

Low-grade inflammation and elevated remnant cholesterol are associated with increased risk of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality. We hypothesized that each confers risk of myocardial infarction, ASCVD, and all-cause mortality in individuals with impaired renal function.

METHODS

We included 102 906 individuals from the Copenhagen General Population Study, of which 9 935 had impaired renal function with estimated glomerular filtration rate <60 mL/min/1.73 m2. Remnant cholesterol was calculated from a standard lipid profile. ASCVD was myocardial infarction, coronary heart disease death, ischemic stroke, or coronary revascularization.

RESULTS

In individuals with impaired renal function, we observed 566 myocardial infarctions, 1 122 ASCVD events, and 3 139 deaths. Compared to individuals with low C-reactive protein and remnant cholesterol, multivariable adjusted hazard ratios for myocardial infarction were 1.12 (95 % confidence intervals: 0.86-1.46) in individuals with low C-reactive protein and high remnant cholesterol, 1.28 (1.00-1.65) in individuals with high C-reactive protein and low remnant cholesterol, and 1.39 (1.10-1.76) in individuals with both high C-reactive protein and remnant cholesterol. Corresponding hazard ratios for ASCVD were 1.07 (0.89-1.28), 1.09 (0.91-1.30), and 1.33 (1.13-1.57); and for all-cause mortality 0.96 (0.85-1.07), 1.18 (1.07-1.30), and 1.20 (1.09-1.33), respectively.

CONCLUSIONS

In individuals with impaired renal function, low-grade inflammation and elevated remnant cholesterol jointly conferred the highest risk of myocardial infarction, ASCVD, and all-cause mortality.

Association of distinct biomarker profiles with all-cause and cause-specific mortality in older adults: Prospective cohort study across 12 countries

BACKGROUND AND AIM

Biomarkers may help predict mortality risk in older adults, yet their combined effects remain unclear. This study aims to identify distinct biomarker profiles in older adults and assess their association with all-cause and cause-specific mortality risk.

METHODS AND RESULTS

We analyzed data from 12,960 older adults (67.8 ± 9.4 years, 58 % women) from 11 European countries and Israel participating in Survey of Health, Ageing and Retirement in Europe. Seven biomarkers were assessed from dried blood spot samples. K-means cluster analysis identified nine distinct biomarker profiles. Cox regression and Fine and Gray subdistribution hazard models assessed the association between biomarker profiles and all-cause and cause-specific mortality, respectively, adjusting for relevant covariates. During a median follow-up of 6.3 years, 1270 (9.8 %) died. Compared to the largest cluster (n = 7005) with generally normal biomarker levels, clusters characterized by elevated C-reactive protein (CRP) and cystatin C showed increased risk of all-cause mortality, cardiovascular disease mortality and to some extent cancer mortality. A cluster with elevated glycated hemoglobin (HbA1c) (n = 1959) showed slightly increased mortality risk (HR 1.29, 95%CI 1.08-1.54). A cluster with high triglyceride and total cholesterol (n = 1622) showed decreased cancer mortality risk (SHR 0.60, 95 % CI: 0.38-0.96).

CONCLUSIONS

Biomarker profiles characterized by elevated inflammatory and renal function markers were strongly associated with increased mortality risk, even when other biomarkers were within normal ranges. Surprisingly, high levels of triglyceride and total cholesterol may be protective against cancer mortality. These findings highlight the importance of considering multiple biomarkers simultaneously in mortality risk stratification for older adults.

The impact of nutritional and inflammatory status on mortality in stroke patients: Results from NHANES 2005-2018

BACKGROUND

Stroke significantly impacts global health, being a primary cause of disability, dementia, and mortality. The interplay of nutritional deficiency and systemic inflammation plays a pivotal role in determining stroke outcomes. While the Prognostic Nutritional Index (PNI) and the Advanced Lung Cancer Inflammation Index (ALI) have been recognized for their prognostic value in various diseases, their relevance in stroke prognosis necessitates further exploration.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018, analyzing 908 stroke survivors to examine the associations between PNI, ALI, and mortality outcomes. Weighted Cox proportional hazards models were applied to assess the associations, controlling for demographic and health-related variables. Kaplan-Meier curves and restricted cubic splines were used to evaluate survival differences and non-linear relationships, respectively. Additionally, subgroup and sensitivity analyses were conducted to verify the robustness of the associations.

RESULTS

In our cohort, elevated PNI was associated with significantly lower risks of all-cause mortality (Hazard Ratio [HR]: 0.53, 95 % Confidence Interval [CI]: 0.37-0.75, p < 0.001) and cardiovascular mortality (HR: 0.60, 95 % CI: 0.38-0.94, p = 0.028). Similarly, higher ALI levels correlated with a reduced risk of all-cause mortality (HR: 0.53, 95 % CI: 0.37-0.72, p < 0.001), though its impact on cardiovascular mortality did not reach statistical significance after adjustment. Subgroup analysis revealed that gender, age, and diabetes status modulated the relationship between PNI/ALI and mortality outcomes, with significant interactions observed especially in diabetic patients (PNI: P for interaction = 0.025 and ALI: P for interaction = 0.007).

CONCLUSIONS

This study confirms that higher PNI and ALI are associated with lower all-cause mortality in stroke survivors. Elevated PNI also reduces cardiovascular mortality risk. Gender, age, and diabetes status influence these associations. These findings highlight the importance of monitoring nutritional and inflammatory status in stroke recovery.

Comparing the effectiveness of Rosuvastatin and Atorvastatin on changes in LDL, TG and HDL: A systematic review and meta-analysis

AIM

Elevated levels of LDL and triglycerides, along with low levels of HDL, are key contributors to cardiovascular disease. If the increase of harmful fats is prevented, it will be a great step towards the prevention of diseases. The two drugs atorvastatin and rosuvastatin are the most commonly used drugs to reduce LDL and triglycerides and increase HDL in patients. The present study aimed to compare the effectiveness of Rosuvastatin and Atorvastatin on changes in LDL, TG and HDL using a systematic review and meta-analysis method.

MATERIALS AND METHODS

The present study was conducted on the basis of the protocol of systematic review and meta-analyses. The ISI, Cochrane Library, Google Scholar, PubMed, Scopus, and Elsevier databases were independently searched by two researchers using Mesh keywords in different regions of the world during 2003 to 2025. Data was analyzed using the STATA software.

KEY FINDINGS

Effectiveness of Atorvastatin on the reduction of LDL was 51.49 mg/dl (42.75-60.23 %, CI =95 %) versus Rosuvastatin with a reduction of 55.66 mg/dl (46.32-65 and CI =95 %). The effectiveness of Atorvastatin on the rise of HDL was 1.85 mg/dl (-3.23-0.46 and CI =95 %) versus Rosuvastatin with a rise of 3.87 mg/dl (2.08-5.66 and CI =95 %); and the effectiveness of atorvastatin on the reduction of TG was 24.76 mg/dl (18.14-31.88 and CI = 95 %) versus the effectiveness of Rosuvastatin with a reduction of 31.98 mg/dl (24. 41-39.55 and CI = 95 %).

SIGNIFICANCE

According to research results, Rosuvastatin was better than Atorvastatin and decreased triglyceride and LDL and increased HDL in all cases.

Is chronic inflammation a risk factor for perioperative myocardial injury or heart failure in pancreatic surgery patients?

Background

Chronic inflammation is associated with cardiovascular disease. Whether cardiac risk is increased in surgical patients with chronic inflammation is unknown. We hypothesised that preoperative interleukin 6 (IL-6) is associated with postoperative biomarker release indicative of myocardial injury and heart failure.

Methods

In this prospective cohort study in pancreatic surgery patients, concentrations of IL-6, high-sensitive cardiac troponin-T (hs-cTnT), growth differentiation factor 15 (GDF-15), and N-terminal pro B-type natriuretic peptide (NT-proBNP) were assessed before surgery and 4, 12, 24, and 48 h after surgery. The primary outcome was perioperative myocardial injury (PMI), defined as an absolute hs-cTnT increase ≥14 pg ml-1. Secondary outcomes were postoperative concentrations of GDF-15 and NT-proBNP. We used the χ2 test and generalised linear mixed effects models for analyses.

Results

Of 88 patients, 24 (27%) had high preoperative IL-6 (>7 pg ml-1). PMI occurred in two (8.3%) and eight (12.5%) patients with high and normal concentrations, respectively (P=0.86). Patients with high IL-6 had higher preoperative concentrations of hs-cTnT (11.0 [inter-quartile range 7.0-15.0] vs 8.0 [5.0-11.0] pg ml-1, P=0.01), GDF-15 (1924.5 [1403.8-2797.5] vs 1445.0 pg ml-1 [1006.5-1905.3] pg ml-1, P=0.021) and NT-proBNP (279.5 [128.8-569.0] vs 116.5 [65.1-226.5] pg ml-1, P=0.012). All biomarkers increased after surgery (all P<0.05), yet this increase was similar among patients with high or normal preoperative IL-6 concentrations.

Conclusions

Preoperative inflammation was not associated with PMI or postoperative biomarkers of heart failure after pancreatic surgery. However, patients with high IL-6 concentrations had higher preoperative concentrations of cardiac biomarkers, suggesting the presence of subclinical cardiovascular disease.

Clinical trial registration

NCT03460938.

Expression level and clinical significance of IL-29 in serum of patients with coronary heart disease

BACKGROUND

Coronary heart disease (CHD) is a chronic inflammatory disease carrying high morbidity and mortality. Interleukin (IL)-29 may be used as a biomarker for autoimmune diseases. This paper investigates the diagnostic value of serum IL-29 in CHD patients.

METHODS

A total of 90 CHD patients (39 mild and 51 severe patients) and 90 controls were included. Serum IL-29 levels were detected by ELISA, and the diagnostic value of IL-29 in CHD was analyzed by ROC curve. According to the median value of serum IL-29 level, CHD patients were categorized into IL-29 low-level group and high-level group. The correlation between IL-29 and pathological indexes of CHD patients was analyzed by chi-square test. SYNTAX score was used to classify CHD patients into mild CHD and moderate/severe CHD. Pearson coefficient analyzed the correlation between IL-29 and CHD severity. Multivariate logistic regression analyzed the risk factors for CHD exacerbation.

RESULTS

IL-29 serum levels were elevated in CHD patients. The AUC for CHD diagnosis by serum IL-29 was 0.789 (65.6% sensitivity and 76.7% specificity). IL-29 was correlated with BMI, PHASE score, and CRP. IL-29 serum level was positively correlated with CHD severity. The AUC for differentiating mild and moderate/severe CHD patients by IL-29 level was 0.739 (70.6% sensitivity and 66.7% specificity). IL-29 was an independent risk factor for CHD exacerbation, and each one-unit increase in IL-29 increased the risk of exacerbation in CHD patients by 1.065-fold.

CONCLUSION

IL-29 is highly expressed in CHD patients and has auxiliary diagnostic value for CHD.

Renal-Cardiac Crosstalk in the Pathogenesis and Progression of Heart Failure

Chronic kidney disease (CKD) represents a global health issue with a high socioeconomic impact. Beyond a progressive decline of kidney function, patients with CKD are at increased risk of cardiovascular diseases, including heart failure (HF) and sudden cardiac death. HF in CKD can manifest both as HF with reduced ejection fraction and HF with preserved ejection fraction, with the latter further increasing in relative importance in the more advanced stages of CKD. Typical cardiac remodeling characteristics in uremic cardiomyopathy include left ventricular hypertrophy, myocardial fibrosis, cardiac electrical dysregulation, capillary rarefaction, and microvascular dysfunction, which are triggered by increased cardiac preload, cardiac afterload, and preload and afterload-independent factors. The pathophysiological mechanisms underlying cardiac remodeling in CKD are multifactorial and include neurohormonal activation (with increased activation of the renin-angiotensin-aldosterone system, the sympathetic nervous system, and mineralocorticoid receptor signaling), cardiac steroid activation, mitochondrial dysfunction, inflammation, innate immune activation, and oxidative stress. Furthermore, disturbances in cardiac metabolism and calcium homeostasis, macrovascular and microvascular dysfunction, increased cellular profibrotic responses, the accumulation of uremic retention solutes, and mineral and bone disorders also contribute to cardiovascular disease and HF in CKD. Here, we review the current knowledge of HF in CKD, including the clinical characteristics and pathophysiological mechanisms revealed in animal studies. We also elaborate on the detrimental impact of comorbidities of CKD on HF using hypertension as an example and discuss the clinical characteristics of hypertensive heart disease and the genetic predisposition. Overall, this review aims to increase the understanding of HF in CKD to support future research and clinical translational approaches for improved diagnosis and therapy of this vulnerable patient population.

Stress-related genetic factors modify the effect of socioeconomic status on cardiovascular risk

Lower socioeconomic status (SES) and higher neuroticism polygenic risk score (NEU-PGS) associate with cardiovascular disease (CVD). Chronic stress increases CVD risk via activation of neural, autonomic, and immune pathways. We evaluated whether 1) higher NEU-PGS accentuates the association between lower SES and major adverse cardiovascular events (MACE); and 2) higher stress-associated neural activity and C-reactive protein and lower heart rate variability contribute to the SES-MACE link among those with higher NEU-PGS. NEU-PGS (from those with European ancestry) and SES data were derived from individuals in the Mass General Brigham Biobank. SES was assessed as median household income (N = 18,093) and area deprivation index (ADI, N = 15,276). Lower household income was defined as the lowest tertile and higher ADI as the highest. NEU-PGS was stratified about the population median. MACE, stress-associated neural activity, heart rate variability, and C-reactive protein were assessed from clinical data. Among individuals with higher (but not lower) NEU-PGS, lower household income associated with MACE (N = 6,574; OR: 1.22, p = 0.005), stress-associated neural activity (N = 480; standardized β: 0.14, p = 0.003), and heart rate variability (1,361; -0.05, p = 0.041). Higher ADI associated with MACE (5,441; 1.24, p = 0.008) and heart rate variability (1,127; -0.09, p = 0.001) among those with higher (but not lower) NEU-PGS. Lower SES associated with higher C-reactive protein across NEU-PGS groups. The mediating effect of stress-associated neural activity, heart rate variability and C-reactive protein in the SES-MACE relationship was moderated by higher NEU-PGS. Individuals with higher NEU-PGS experience greater CVD risk related to lower SES via alterations in neural, autonomic, and immune mechanisms.

Associations of the Hs-CRP/HDL-C ratio with stroke among US adults: Evidence from NHANES 2015-2018

BACKGROUND

The high-sensitivity C-reactive protein (Hs-CRP)-to-high-density lipoprotein cholesterol (HDL-C) ratio, which integrates insights into inflammation and lipid metabolism, serves as a comprehensive indicator. The association between this ratio and stroke prevalence is endeavored to be explored in this research.

METHODS

Drawing on information gathered during the 2015-2018 cycles of the NHANES, the association between the Hs-CRP/HDL-C ratio and stroke was examined through multivariate logistic regression. Additionally, subgroup analysis, interaction test, and restricted cubic spline (RCS) were carried out. Multiple machine learning methods were used to identify the key factors affecting stroke and combined with Shap interpretable models to determine the degree of influence of the key factors. Finally, the results of the logistic regression analysis are used to construct a predictive model, which is represented using a nomogram.

RESULTS

This research sample comprised 8,064 participants, yielding a stroke prevalence of 4.04%. A positive correlation was shown between the Hs-CRP/HDL-C ratio and stroke (OR: 1.17, 95% CI: 1.02, 1.35). Interaction tests demonstrated that younger participants were more sensitive to higher Hs-CRP/HDL-C ratios, with a significant interaction in stroke. The RCS analysis indicated a nonlinear association between the exposure variable and to outcome variable. The AUC > 0.8 for a random forest model and an XGBoost model demonstrated their strong predictive value. Ultimately, the generated predictive model is a visual nomogram with an AUC of 0.799.

CONCLUSION

The results of the study showed a positive correlation between Hs-CRP/HDL and the prevalence of stroke, with higher Hs-CRP/HDL levels associated with a higher likelihood of stroke. As a stroke prediction model incorporating Hs-CRP/HDL, the nomogram may play a significant role in the early identification of high-risk populations.

The role of immune cell phenotypes and metabolites in the risk of ischemic stroke: a Mendelian randomization-based mediation analysis

BACKGROUND

Ischemic stroke (IS) occurs when a blood clot obstructs a blood vessel supplying blood to the brain, leading to brain tissue damage due to insufficient oxygen and nutrients. The roles of immune cells and metabolites in IS are increasingly recognized, yet their specific mechanisms remain unclear.

METHODS

This study conducted a comprehensive statistical analysis to explore the relationships between immune cell phenotypes, metabolite levels, and IS. We utilized methods such as inverse variance weighted (IVW), weighted median, and MR Egger to ensure robust results. Sensitivity analyses were performed to confirm the absence of significant heterogeneity or pleiotropy.

RESULTS

We identified several immune cell phenotypes significantly associated with IS. Notably, IgD + CD24 + AC showed a positive association with IS (OR = 1.045601, p = 0.011562), while CD62L- HLA DR + + monocyte AC demonstrated a negative association (OR = 0.948673, p = 0.005415). Among metabolites, adenosine 5'-monophosphate (AMP) to cysteine ratio was positively associated with IS (OR = 1.083144, p = 0.000310), whereas xanthurenate levels were negatively associated (OR = 0.926100, p = 0.001614). Mediation analysis revealed a significant mediating effect of acetylcarnitine levels on the relationship between IgD + CD24 + AC and IS, with an estimated mediation effect of 0.00606 (p = 0.036834077).

CONCLUSION

Our study highlights the crucial roles of specific immune cell phenotypes and metabolites in IS, suggesting their potential as novel therapeutic targets or biomarkers. The mediation analysis underscores the complex interactions between immune cells and metabolites in IS, providing valuable insights for future research. These findings pave the way for further exploration of the pathophysiological mechanisms and therapeutic strategies for IS.

Efficacy and Safety of Moderate-Intensity Statin and Ezetimibe Combination Therapy Versus High-Intensity Statin Monotherapy in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Statins represent the first-line therapy for cholesterol management. However, for patients prone to statin side effects, unable to tolerate higher doses, or requiring additional low-density lipoprotein cholesterol (LDL-C) reduction, ezetimibe alone or in combination with statins is recommended. This meta-analysis aimed to evaluate the safety and efficacy of combining low- or moderate-intensity statins with ezetimibe compared to high-intensity statin monotherapy, yielding reliable evidence to guide clinical decision-making and personalize treatment strategies. PubMed, Embase, and Scopus were systematically searched from inception until May 2023. All randomized controlled trials (RCTs) comparing a high-intensity statin with a low/moderate-intensity statin with ezetimibe were included. The outcomes of interest comprised changes in concentrations of lipids-LDL-C, high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TGs)-and apolipoprotein (Apo) A1, Apo B, and high-sensitivity C-reactive protein (hs-CRP), along with major adverse cardiovascular events (MACE). All data were analyzed using Review Manager version 5.4. p-values less than 0.05 were considered to indicate statistical significance. Overall, 20 RCTs, with 5,412 participants, were included. A low/moderate-intensity statin combined with ezetimibe yielded a significantly greater reduction in LDL-C levels than high-intensity statin monotherapy (mean difference [MD], -6.59; 95% confidence interval [CI], -10.95, -2.24; p=0.003; I2=84%). No significant differences were observed between combination and high-intensity statin monotherapy regarding TC, TG, or HDL-C levels. However, hs-CRP levels were significantly higher with combination therapy (MD, 0.32; 95% CI, 0.01, 0.64; p=0.04; I2=0%). Combination therapy involving a low/moderate-intensity statin with ezetimibe was significantly associated with lower LDL-C levels than high-intensity statin monotherapy. No significant differences were observed for TC, TGs, HDL-C, alanine transaminase, or MACE. However, creatine phosphokinase levels significantly increased with monotherapy.

Neuroimaging Findings From Cerebral Structure and Function in Coronary Artery Disease

An increasing number of evidence suggests that bidirectional communication between the cardiovascular system and the central nervous system (CNS), known as the heart-brain interaction, is crucial in understanding the impact of coronary artery disease (CAD) on brain health. The multifactorial role of CAD in the brain involves processes such as inflammation, oxidative stress, neuronal activity, neuroendocrine imbalances, and reduced cerebral perfusion, leading to various cerebral abnormalities. The mechanisms underlying the relationship between CAD and brain injury are complex and involve parallel pathways in the CNS, endocrine system, and immune system. Although the exact mechanisms remain partially understood, neuroimaging techniques offer valuable insights into subtle cerebral abnormalities in CAD patients. Neuroimaging techniques, including assessment of neural function, brain metabolism, white matter microstructure, and brain volume, provide information on the evolving nature of CAD-related cerebral abnormalities over time. This review provides an overview of the pathophysiological mechanisms of CAD in the heart-brain interaction and summarizes recent neuroimaging studies utilizing multiparametric techniques to investigate brain abnormalities associated with CAD. The application of advanced neuroimaging, particularly functional, diffusion, and perfusion advanced techniques, offers high resolution, multiparametric capabilities, and high contrast, thereby allowing for the early detection of changes in brain structure and function, facilitating further exploration of the intricate relationship between CAD and brain health. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.

Association between atherosclerosis risk and dietary inflammatory index: A systematic review and meta-analysis

BACKGROUND

The Dietary Inflammatory Index (DII), a novel tool for quantifying the inflammatory potential of one's diet, has been extensively employed in various chronic disease research. However, there remains no consensus regarding the association between DII and atherosclerosis (AS). This study aims to systematically evaluate the correlation between DII and the occurrence and progression of AS, thereby providing valuable insights for the prevention of cardiovascular and cerebrovascular diseases.

METHODS

A comprehensive search was conducted in several databases, to identify observational studies investigating the correlation between DII and AS. The search was conducted from the inception of each database until October 1, 2024. Two independent researchers were responsible for the literature screening, quality assessment, and data extraction of the included studies. Meta-analysis was performed using Stata 17.0 software to synthesize the odds ratios (ORs) and 95 % confidence intervals (CIs). Subgroup analysis was also conducted based on factors.

RESULTS

This study included a total of seven studies from three different countries, encompassing a sample size of 2879 participants. The meta-analysis findings revealed a significant association between higher DII scores and an increased risk of AS.

CONCLUSIONS

A diet characterized by a high DII score may elevate the risk of developing AS, particularly in terms of its impact on plaque vulnerability. Therefore, increasing the intake of anti-inflammatory dietary components holds significant implications for the prevention and management of AS.

Non-Traditional Cardiovascular Risk Factors: Tailored Assessment and Clinical Implications

Non-traditional cardiovascular risk factors (RFs) are increasingly emerging as important modifiers of cardiovascular risk (CVR), offering insights beyond traditional metrics like hypertension, diabetes, and dyslipidemia. These include novel biomarkers, chronic conditions (e.g., chronic kidney disease and chronic obstructive pulmonary disease), environmental exposures, chronic inflammation, infections, psychosocial factors, and sex-specific conditions, all of which influence the prediction, management, and outcomes of cardiovascular disease (CVD). These additional RFs may impact on CVD prediction and add valid information during tailored patient assessment and management. Therefore, a careful assessment of both traditional and non-traditional cardiovascular RFs, with a personalized treatment, could dramatically reduce the total CVD burden. Nevertheless, further research is needed to precisely estimate the magnitude of their impact as risk and prognosis modifiers in order to be included in future risk charts. This review provides a critical analysis of non-traditional RFs, their pathophysiological mechanisms, and their implications for personalized care. Integrating these factors into CVR assessment can reclassify patient risk categories, optimize therapeutic strategies, and improve prognosis. However, further research is needed to refine their inclusion in risk charts and evaluate their impact on public health outcomes. A tailored, multidisciplinary approach is essential to reduce the burden of CVD and associated mortality.

Association Between White Blood Cell Counts at Diagnosis and Clinical Outcomes in Venous Thromboembolism - From the COMMAND VTE Registry-2

BACKGROUND

White blood cell (WBC) counts were reported to be a risk factor for acute adverse events in patients with venous thromboembolism (VTE). However, there are limited data on VTE patients without active cancer.

METHODS AND RESULTS

The COMMAND VTE Registry-2 was a multicenter study enrolling 5,197 consecutive patients with acute symptomatic VTE. We divided 3,668 patients without active cancer into 4 groups based on WBC count quartiles (Q1-Q4) at diagnosis: Q1, ≤5,899 cells/μL; Q2, 5,900-7,599 cells/μL, Q3, 7,600-9,829 cells/μL; and Q4, ≥9,830 cells/μL. Patients in Q4 more often presented with pulmonary embolism (PE) than patients in Q1, Q2, and Q3 (68% vs. 37%, 53%, and 61%, respectively; P<0.001). The proportion of massive PEs among all PEs was higher in Q4 than in Q1, Q2, and Q3 (21% vs. 3.4%, 5.8%, and 11%, respectively; P<0.001). Compared with Q1, Q2, and Q3, patients in Q4 had a higher cumulative 5-year incidence of all-cause death (17.0%, 15.2%, 16.1%, and 22.8%, respectively; P<0.001) and major bleeding (10.9%, 11.0%, 10.3%, and 14.4%, respectively; P=0.002). The higher mortality risk of Q4 relative to Q2 was consistent regardless of the presentations of VTEs.

CONCLUSIONS

An elevated WBC count on VTE diagnosis was associated with a higher risk of mortality and major bleeding regardless of VTE presentation, suggesting the potential usefulness of WBC counts for further risk stratification.

Remnant cholesterol inflammatory index and its association with all-cause and cause-specific mortality in middle-aged and elderly populations: evidence from US and Chinese national population surveys

BACKGROUND

The remnant cholesterol inflammatory index (RCII) is a novel metric that combines remnant cholesterol and high-sensitivity C-reactive protein, reflecting the metabolic and inflammatory risk. This study investigates the association between RCII and long-term risks of all-cause and cause-specific mortality in middle-aged and elderly populations in the US and China.

METHOD

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS), including 7,565 and 12,932 participants aged 45 years and older, respectively. The participants were categorized into quartiles based on natural log-transformed RCII (lnRCII) values. Kaplan-Meier survival analysis, Cox proportional hazards models, restricted cubic splines (RCS) and mediation analysis were used to examine the relationship between lnRCII and mortality outcomes, adjusting for potential covariates.

RESULT

The mean age of the participants was 59.90 ± 10.44 years (NHANES) and 58.64 ± 9.78 years (CHARLS), with 53.28% and 52.50% female, respectively. Kaplan-Meier survival analysis showed that higher lnRCII quartiles (≥ 0.79 in NHANES, ≥ -0.13 in CHARLS) were significantly associated with increased all-cause mortality risk (p < 0.001). Each standard deviation (SD) increase in lnRCII corresponded to a higher risk of all-cause mortality, and the hazard ratios (HRs) and 95% confidence interval (CI) were 1.29 (95% CI: 1.21-1.36) in NHANES and 1.26 (95% CI: 1.15-1.38) in CHARLS. In NHANES, lnRCII was also associated with elevated risks of cardiovascular mortality (HR = 1.21, 95% CI: 1.08-1.35) and cancer mortality (HR = 1.30, 95% CI: 1.09-1.55). RCS analysis indicated a J-shaped relationship between lnRCII and both all-cause and cardiovascular mortality, and a linear association with cancer mortality. Mediation analysis showed that systolic blood pressure and fasting plasma glucose partially mediated these associations. Subgroup analyses suggested a stronger association between lnRCII and all-cause mortality in middle-aged US participants (p for interaction = 0.010).

CONCLUSIONS

Elevated RCII levels are significantly associated with increased all-cause mortality risk middle-aged and elderly populations in both the US and China. In the US population, RCII is also associated with increased risks of cardiovascular and cancer mortality. By integrating metabolic and inflammatory risk factors, RCII may serve as a valuable tool for mortality risk stratification and clinical decision-making.

Residual Inflammation in Patients with Psoriasis Treated with Biologic Therapy: Findings from 3 Prospective Observational Cohorts

Psoriasis is associated with a higher cardiovascular disease burden, with systemic inflammation being the root cause of this association. The concept of residual inflammation (RI) was defined in patients with features of high-risk atherosclerosis who had increased inflammatory markers in blood, as characterized by high-sensitivity CRP, despite receiving optimal medical therapy. This study aims to assess RI in patients with psoriasis undergoing biologic therapy, specifically defined as high-sensitivity CRP ≥ 2 mg/l despite achieving a PASI ≤ 2. A prospective observational study was conducted across 3 international cohorts (Spain, United States, and Sweden) comprising 209 patients with psoriasis who achieved a PASI ≤ 2 after stable biologic therapy. RI was observed in 36.3% of patients and was significantly associated with higher body mass index, metabolic dysfunction-associated steatotic liver disease, increased baseline systemic inflammation, and visceral adipose tissue. Female sex was identified as a predictor of RI in the 3 cohorts. The study concludes that RI persists despite optimal skin response and is strongly linked with obesity and fatty liver disease. These conditions are highlighted as critical drivers and treatment targets of inflammation in psoriasis.

High-sensitivity C-reactive protein and risk of retinal artery occlusion and ischaemic stroke: a cross-cohort study

AIMS

Previous studies have suggested an association between retinal artery occlusion (RAO) and ischaemic stroke (IS), both associated with elevated inflammatory factors. However, the role of high-sensitivity C-reactive protein (hs-CRP) in the sequential onset of these two diseases is still unclear. Based on this evidence, we evaluated the association of hs-CRP with RAO and IS.

METHODS

We examined hs-CRP from both the large multicentre cohort study UK Biobank and Chinese Retinal Artery Occlusion study. Cox proportional hazard models were used to study the association of hs-CRP with incident RAO and IS during the long-term follow-up in the UK Biobank. Logistic regression analysis was employed to assess the cross-sectional relationship between hs-CRP with RAO and IS in the Chinese cohort. A restricted cubic spline (RCS) approach was employed to evaluate potential non-linear associations of hs-CRP with IS.

RESULTS

After exclusions, the analysis included 459 188 participants from the UK and 338 participants from China. Over a median follow-up of 12.2 years, 136 cases of incident RAO and 3206 cases of incident IS events were recorded in the UK Biobank. After multivariable adjustment, higher hs-CRP (per 10 mg/L) level was associated with increased risks of RAO (HR: 1.34, 95% CI: 1.01 to 1.76) and IS (HR: 1.24, 95% CI: 1.17 to 1.33). RCS analysis revealed a significant non-linear relationship between hs-CRP levels and incident IS (Pnon-linear<0.001). Furthermore, RAO patients with higher hs-CRP levels were more likely to be combined with IS (2.81 mg/L vs 10.14 mg/L, p<0.001). In the Chinese cohort, the association between hs-CRP with RAO and IS was further confirmed. Higher hs-CRP (per 1 mg/L) level was associated with increased risks of RAO (OR: 1.43, 95% CI: 1.15 to 1.78) and IS (OR: 1.13, 95% CI: 1.03 to 1.24).

CONCLUSIONS

Our findings underscore hs-CRP as a robust risk factor for both RAO and IS. Controlling hs-CRP levels might reduce the incidence of RAO and secondary stroke.

Jatrorrhizine retard obesity by modulating transcription factor c-Jun/c-Fos to downregulate Mmp12-mediated inflammation

Obesity is a systemic, chronic, low-grade inflammatory disease. Nutritional obesity, in particular, is also accompanied by inflammation and metabolic disorders, which are the primary causes of malignant metabolic diseases. Rhizoma Coptidis (Coptis Chinensis Franch) (RC), a traditional Chinese medicine, is primarily used for its anti-inflammatory and anti-diarrheal properties. Our previous studies have shown that RC can reduce body weight and lower fat levels, demonstrating its potential to improve nutritional obesity.However, the effects and mechanisms of the active small molecules in RC extracts in treating obesity-induced chronic inflammation need to be further investigated. In this study, we investigated the ameliorative effect and mechanism study of the monomeric jatrorrhizine (JAT) extracted from RC on high-fat diet-induced obese mice. First, JAT could dose-dependently reduce body weight and decrease the expression of inflammatory factors such as IL6, IL1β, and TNFα in the tissues of obese mice.Secondly, transcriptomics and bioinformatics studies of epididymal white adipose tissue (eWAT) identified Mmp12 as a key target through which JAT may alleviate obesity. Next, the effect of JAT on c-Jun/c-Fos promoter activity, which in turn down-regulates the transcript and protein levels of Mmp12, was analyzed and determined by qPCR, transcription factor prediction, single fluorescent promoter activity assay, Cell thermodynamic stability analysis (CETSA), molecular dynamics simulation mimicry, circular dichroism (CD) and Co-Immunoprecipitation (Co-IP). In conclusion, JAT may ameliorate high-fat diet-induced obesity and its associated inflammation through the c-Jun/c-Fos-Mmp12 axis.

Extreme events in gene regulatory networks with time-delays

This work explores distinct complex dynamics of simplified two nodes of coupled gene regulatory networks with multiple delays in two self-inhibitory and mutually activated genes. We have identified the emergence of extreme events within a specific range of system parameter values. A detailed analysis of the time delay-induced emergence of extreme events is illustrated using bifurcation analysis, two-parameter phase diagrams, return maps, temporal plots, and probability density functions. The reasons behind the advent of extreme events are discussed in detail, with possible analogies to simplified two nodes of gene regulatory networks. The occasional large-amplitude bursting originated in the system via interior crisis-induced intermittency, Pomeau-Manneville intermittency, and the breakdown of quasiperiodic intermittency routes. Additionally, we have used various recurrence quantification statistical measures, such as mean recurrence time, determinism, and recurrence time entropy, to describe the transition from periodic or chaotic to unforeseen large deviations. Our approach shows that the sudden surge of variance and mean recurrence time at the transition points can be used as a new metric to detect the critical transitions of distinct extreme bursting events. The comprehensive overview of the interaction between gene regulatory networks, with insights into the formation of unusual dynamics, is beneficial to grasping different neuronal diseases.

Dynamic and Static Effects of the Systemic Inflammatory Response Index on All-Cause Mortality in Individuals With Atherosclerotic Cardiovascular Disease: Evidence From National Health and Nutrition Examination Survey

Objective: This research focuses on analyzing the link between the systemic inflammatory response index (SIRI) and all-cause mortality in individuals with atherosclerotic cardiovascular disease (ASCVD) . Methods: This research analyzed data from 4693 patients using nine cycles of the National Health and Nutrition Examination Survey (NHANES). The connection between SIRI and mortality was determined by employing survey-weighted Cox models, with hazard ratios (HRs) and 95% confidence intervals (CIs) being computed. Kaplan-Meier method illustrated survival differences across SIRI levels. Sensitivity analyses involved restricted cubic splines (RCS), stratified analysis, and E-value calculations. Landmark analysis assessed survival differences at multiple follow-up intervals, while time-dependent receiver operating characteristic curves evaluated SIRI's prognostic value. Mediation analysis identified potential intermediaries impacting the SIRI-mortality relationship. Results: Over 406,564 person-months, 1933 deaths occurred. Adjusted Cox models discovered that higher SIRI was connected with elevated overall mortality [HR 1.192, (95% CI 1.131-1.256), p < 0.001]. Higher SIRI consistently showed lower survival probabilities. RCS and stratified analysis confirmed the robustness of these findings. Survival probability at different follow-up periods was considerably lower in those with higher SIRI. Additionally, SIRI demonstrated a prognostic value of 0.66 for all-cause mortality at 1 year and 3 years, and 0.65 at 5 years. Notably, serum uric acid (6.2%) partially mediated the connection between SIRI and mortality from all causes. Conclusion: In ASCVD patients, SIRI was robustly correlated with all-cause mortality, partially mediated by serum uric acid.

The Advanced Glycation End-Products (AGE)-Receptor for AGE System (RAGE): An Inflammatory Pathway Linking Obesity and Cardiovascular Diseases

The AGE (advanced glycation end-products)-RAGE (receptor for AGE) system is a pro-inflammatory pathway that contributes to the pathogenesis of obesity and obesity-related cardiovascular disorders (CVD). Circulating AGE and the soluble form of RAGE (sRAGE) has been suggested as a potential biomarker of CVD related to obesity. In this study, we aim to (1) summarize the current knowledge about the role of obesity in the onset and progression of CVD, (2) discuss the role of the AGE-RAGE system as a pathway promoting obesity and linking obesity to CVD, and (3) highlight available strategies for reducing AGE-RAGE system activation and the associated beneficial effects.

A Phenome-Wide association study (PheWAS) of genetic risk for C-reactive protein in children of European Ancestry: Results from the ABCD study

BACKGROUND

C-reactive protein (CRP) is a moderately heritable marker of systemic inflammation that is associated with adverse physical and mental health outcomes. Identifying factors associated with genetic liability to elevated CRP in childhood may inform our understanding of variability in CRP that could be targeted to prevent and/or delay the onset of related health outcomes.

METHODS

We conducted a phenome-wide association study (PheWAS) of genetic risk for elevated CRP (i.e. CRP polygenic risk score [PRS]) among children genetically similar to European ancestry reference populations (median analytic n = 5,509, range = 120-5,556) from the Adolescent Brain and Cognitive DevelopmentSM (ABCD) Study baseline assessment. Associations between CRP PRS and 2,377 psychosocial and neuroimaging phenotypes were estimated using independent mixed effects models nested by recruitment site (or scanner) and family, with ancestral genomic principal components (n = 10), age, and sex, as well as global brain metrics (when relevant) included as fixed effect covariates. Post hoc analyses examined whether: (1) covarying for measured body mass index (BMI) or removing the shared genetic architecture between CRP and BMI altered phenotypic associations, (2) sex moderated CRP PRS associations, and (3) associations were unconfounded by assortative mating or passive gene-environment correlations (using within-family analyses). Multiple testing was adjusted for using Bonferroni and false discovery rate (FDR) correction.

RESULTS

Nine phenotypes were positively associated with CRP PRS after multiple testing correction: five weight- and eating-related phenotypes (e.g. BMI, overeating), three phenotypes related to caregiver somatic problems (e.g. caregiver somatic complaints), as well as weekday video watching (all ps = 1.2 x 10-7 - 2.5 x 10-4, all pFDRs = 0.0002-0.05). No neuroimaging phenotypes were associated with CRP PRS (all ps = 0.0003-0.998; all pFDRs = 0.08-0.998) after correction for multiple testing. Eating and weight-related phenotypes remained associated with CRP PRS in within-family analyses. Covarying for BMI resulted in largely consistent results, and sex did not moderate any CRP PRS associations. Removing the shared genetic variance between CRP and BMI attenuated all relationships; associations with weekday video watching, caregiver somatic problems and caregiver report that the child is overweight remained significant while associations with waist circumference, weight, and caregiver report that child overeats did not.

DISCUSSION

Genetic liability to elevated CRP is associated with higher weight, eating, and weekday video watching during childhood as well as caregiver somatic problems. These associations were consistent with direct genetic effects (i.e., not solely due to confounding factors like passive gene-environment correlations) and were independent of measured BMI. The majority of associations with weight and eating phenotypes were attributable to shared genetic architecture between BMI and inflammation. The relationship between genetics and heightened inflammation in later life may be partially attributable to modifiable behaviors (e.g. weight and activity levels) that are expressed as early as childhood.

Exploring the Link Between C-Reactive Protein Change and Stroke Risk: Insights From a Prospective Cohort Study and Genetic Evidence

BACKGROUND

Previous research on how changes in CRP (C-reactive protein) levels predict stroke risk is limited. This study aimed to examine the association between CRP change and the risk of stroke and its subtypes.

METHODS AND RESULTS

Based on the UK Biobank data, we investigated the association between CRP change and the risk of stroke and its subtypes with Cox proportional hazards regression analysis. We further performed genetic analyses including genetic correlation, pairwise genome-wide association study, and polygenic risk score. Our study involved 14 754 participants with a median follow-up time of 10.4 years. After categorizing participants by CRP percentage change and making adjustments for potential confounders, it was observed that those with an elevated percentage of CRP change had a higher risk of any stroke (hazard ratio [HR], 1.44 [95% CI, 1.12-1.85]) and ischemic stroke (HR, 1.65 [95% CI, 1.24-2.18]). After categorization by CRP change types and adjustment for confounders, the group that became high level had a higher any-stroke risk (HR, 1.45 [95% CI, 1.04-2.02]), with the group that remained at a high level facing the greatest risk (HR, 1.74 [95% CI, 1.30-2.33]). Similar trends were observed for ischemic stroke. The group that remained at a high level also had a heightened hemorrhagic stroke risk (HR, 1.91 [95% CI, 1.07-3.44]). Genetic analysis showed a significant genetic correlation between CRP and stroke (rg, 0.257; rg_P=2.39E-07). Pairwise genome-wide association study analysis identified 5 shared genomic regions between CRP and stroke. Polygenic risk score analysis showed that participants with high stroke polygenic risk score and elevated or remaining high CRP levels have the highest risk of stroke.

CONCLUSIONS

Both any stroke and ischemic stroke are related to elevated and remaining high CRP levels, while hemorrhagic stroke is only related to remaining high CRP levels.

Chronic Inflammatory-Related Disease and Cardiovascular Disease in MESA

BACKGROUND

Inflammation plays a role in cardiovascular disease (CVD). We defined various noncardiovascular and noncancer conditions, both infectious and noninfectious, with a common basis of inflammation, collectively termed chronic inflammatory-related disease (ChrIRD). We describe ChrIRD and its interplay with CVD during follow-up in the Multi-Ethnic Study of Atherosclerosis.

OBJECTIVES

The aim of the study was to describe ChrIRD, its associations with CVD, and its association with mortality.

METHODS

Participants were free of overt CVD at baseline with median 17.9 (Q1-Q3: 14.9-18.6) years of follow-up. ChrIRD was determined by review of hospitalization and death records of International Classification of Diseases codes. CVD diagnosis was adjudicated based on medical records. We performed time-dependent proportional hazard regressions to identify risks related to ChrIRD or CVD events.

RESULTS

MESA (Multi-Ethnic Study of Atherosclerosis) participants (n = 6,791) had a mean age of 62 ± 10 years, with 47% (3,201/6,791) men, 39% (2,617/6,791) White, 28% (1,882/6,791) Black, 22% (1,489/6,791) Hispanic, and 12% (803/6,791) Chinese race/ethnicity. ChrIRD was observed in 29% (1,965/6,791) and CVD in 21% (1,420/6,791); including 11% (761/6,791) with both conditions. Mortality after ChrIRD only was 47% (567/1,204; 95% CI: 44%-49%); after CVD only was 45% (300/659; 95% CI: 41%-49%); and after both conditions was 67% (510/761; 95% CI: 63%-70%). CVD was associated with increased risk of ChrIRD (HR: 1.48; 95% CI: 1.23-1.77) and ChrIRD was associated with increased risk of CVD (HR: 2.23; 95% CI: 1.97-2.52). Baseline inflammatory markers predicted both conditions.

CONCLUSIONS

ChrIRD is common, present in all organ systems, and is associated with significant mortality, particularly in combination with CVD. The association between CVD and ChrIRD is bidirectional, and baseline inflammatory markers are associated with ChrIRD and CVD.

Associations of the hs-CRP/HDL-C ratio with cardiovascular disease among US adults: Evidence from NHANES 2015-2018

BACKGROUND AND AIMS

Inflammation, lipid signaling, and their interplay are involved in the pathogenesis and development of cardiovascular diseases (CVDs), while the relationships of composite indices combining inflammation and lipids with CVD remained inexplicit.

METHODS AND RESULTS

Our study enrolled 8581 adults from the National Health and Nutrition Examination Survey 2015-2018. Logistic regression model was applied to assess the associations of high-sensitivity C-reactive protein (hs-CRP)-to-high-density lipoprotein cholesterol (HDL-C) ratio with CVD prevalence. Potential mediating effects of hypertension, diabetes, hypercholesterolemia, and obesity on significant associations were explored. Receiver operating characteristic (ROC) curves were generated to compare diagnostic values of the hs-CRP/HDL-C ratio, HDL-C, and hs-CRP. Compared with those in the first quartile of the hs-CRP/HDL-C ratio, participants in the fourth quartile presented higher risks of CVD subtypes and total CVD. Each one-unit increment of the log-transformed hs-CRP/HDL-C ratio was associated with a 25 % increase in CVD risk (95 % confidence interval: 1.11, 1.41) with significant uptrends across the hs-CRP/HDL-C ratio quartiles. Four metabolic disorders significantly mediated associations of the hs-CRP/HDL-C ratio with CVDs. Younger participants were more sensitive to higher hs-CRP/HDL-C ratio with significant interactions in CVD. ROC curves further illustrated the relatively good diagnostic efficacy of the hs-CRP/HDL-C ratio for CVD.

CONCLUSION

The hs-CRP/HDL-C ratio was a significant risk factor for CVD among US adults, in which hypertension, diabetes, hypercholesterolemia, and obesity played important mediating roles. Early attention to people with elevated hs-CRP/HDL-C ratio would be helpful for CVD risk reduction.

Associations Between Inflammatory Potential of Diet with the Risk of All-Cause Mortality and Greenhouse Gas Emissions in Chinese Adults

Background: Current research inadequately substantiates the impacts of dietary inflammatory potential based on the dietary inflammatory index (DII) on population health and environmental sustainability in Chinese adults. Objectives: We aimed to investigate the associations between the DII with the risk of all-cause mortality and greenhouse gas (GHG) emissions in Chinese adults. Methods: Data from adults (N = 15,318) in the China Health and Nutrition Survey 1997-2015 wave were included in the analysis. DII and energy-adjusted DII (E-DII) were calculated using dietary intake data collected with a combination of 3-day consecutive 24-h dietary recalls and the food weighing method. The total GHG emissions were calculated by summing the amount of emissions from all the food groups consumed by the participants. Cox proportional hazards regression models and linear regression models were conducted for statistical analysis. Results: A pro-inflammatory diet, as reflected by higher DII and E-DII scores was associated with an increased risk of all-cause mortality (DII: Q5 vs. Q1: HR = 1.82; 95% CI: 1.45-2.30; p-trend < 0.0001; E-DII: Q5 vs. Q1: HR = 1.86; 95% CI: 1.38-2.52; p-trend < 0.0001) and higher amounts of GHG emissions (both p-trend < 0.0001). Conclusions: These findings demonstrated positive associations between pro-inflammatory potentials with an increased risk of all-cause mortality and higher GHG emissions among Chinese adults, suggesting dual adverse impacts of a pro-inflammatory diet on health and environmental sustainability.

Association between C-reactive protein-triglyceride glucose index and stroke risk in different glycemic status: insights from the China Health and Retirement Longitudinal Study (CHARLS)

OBJECTIVE

C-reactive protein-triglyceride-glucose index (CTI) has been proposed as a novel biomarker for insulin resistance and inflammation. However, the association between CTI and the risk of stroke, particularly in individuals with different glycemic status, remains unclear.

METHODS

A total of 10,443 middle-aged and elderly participants were enrolled from the China Health and Retirement Longitudinal Study (CHARLS). The primary endpoint was the occurrence of stroke events. The CTI was calculated using the formula 0.412* Ln (CRP [mg/L]) + Ln (TG [mg/dl] × FPG [mg/dl])/2. The Kaplan-Meier curves, Cox proportional hazard models, and restricted cubic spline analysis were applied to explore the association between CTI and the risk of stroke according to gender, age and glycemic status.

RESULTS

During a median follow-up of 9 years, 960 (9.2%) participants experienced a stroke. Our findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association was similar between male and female, despite the HR tended to be higher in females (HR 1.22, 95% CI 1.09, 1.36) than males (HR 1.15, 95% CI 1.02, 1.29), and similar in middle-aged (HR 1.25, 95% CI 1.11, 1.41) and elderly participants (HR 1.12, 95% CI 1.00, 1.26). In different glycemic status, high levels of CTI were found to be linked to an increased risk of stroke in individuals with normal glucose regulation (NGR) (HR 1.33, 95% CI 1.11, 1.59) and prediabetes mellitus (Pre-DM) (HR 1.20, 95% CI 1.04, 1.39). However, this association was not observed in individuals with diabetes mellitus (DM).

CONCLUSIONS

Our findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association between CTI and stroke was similar between male and female, and similar in middle-aged and elderly participants. In different glycemic status, the association was significant in individuals with NGR and Pre-DM.

Nonlinear relationship and predictive value of systemic immune-inflammation index for atrial fibrillation recurrence after catheter ablation in hypertensive patients

BACKGROUND

Atrial fibrillation (AF) is a prevalent arrhythmia in hypertensive patients and significantly increases mortality. Chronic inflammation plays a critical role in the pathophysiology of AF.

OBJECTIVE

This study aimed to evaluate the prognostic value of systemic immune-inflammation index (SII) in predicting AF recurrence after catheter ablation in hypertensive patients.

METHODS

This retrospective cohort study included 418 hypertensive patients with paroxysmal AF who underwent catheter ablation between January 2019 and January 2023. Cox proportional hazards models, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) curves were used to evaluate the association between SII and AF recurrence. The predictive performance of SII was compared with that of C-reactive protein (CRP) and high-sensitivity C-reactive protein (hsCRP). Sensitivity analyses were performed to assess the robustness of findings.

RESULTS

AF recurrence occurred in 17.94% of patients. SII was an independent predictor of recurrence (HR 1.13, 95% CI 1.09-1.19; P < .001). RCS analysis revealed a nonlinear relationship with a threshold of 457.41 × 109/L, above which the risk of recurrence increased markedly. ROC analysis demonstrated that SII had superior predictive performance compared to CRP and hsCRP (AUC 0.688 vs 0.510 and 0.542). Sensitivity analyses confirmed the robustness of SII across subgroups.

CONCLUSION

SII is a valuable marker for predicting AF recurrence postablation in hypertensive patients. It supports inflammation-based risk assessments and should be considered in clinical risk stratification. Further research is needed to explore inflammation-targeted therapies.

A biopsychological network approach to variables contributing to preoperative quality of life in patients undergoing cardiac surgery

Quality of life (QoL) in cardiac surgery patients is increasingly recognized as a critical outcome, influenced by biopsychosocial variables. This study aims to explore the associations between preoperative QoL and various psychological and biomedical variables in patients undergoing cardiac surgery. The study includes cross-sectional baseline data from 204 cardiac surgery patients in two distinct cardiac surgery samples: Data collection for the PSY-HEART I trial (coronary artery bypass grafting) was conducted from 2011 to 2015, while data for the ValvEx (valvular surgery) trial were collected between 2020 and 2022. We assessed psychological variables, such as illness beliefs and expectations, alongside biomedical variables, including body mass index, EuroSCORE II, and C-reactive protein levels. Data analysis involved partial correlation Gaussian Graphical Models (GGM) and Directed Acyclic Graphs (DAGs) to identify key nodes and pathways affecting QoL. The resulting GGM was estimated to be rather sparse (38 of 136 possible edges were present) and the case-drop bootstrap node stability estimates ranged from sufficient (CS-Coefficient Bridge Expected Influence = 0.28) to good (CS-Coefficient Expected Influence = 0.51). Our analyses revealed strong associations between psychological variables and preoperative QoL, with current and expected illness-related disability being central to the network. Medical variables showed weaker connections to QoL. The DAG indicated that expected disability influenced current disability and preoperative QoL, suggesting that preoperative expectations may be crucial for postoperative outcomes. This study underscores the importance of psychological variables, particularly illness perceptions and expectations, in determining QoL in cardiac surgery patients. Targeting these variables through preoperative interventions may enhance postoperative recovery and QoL, advocating for a biopsychosocial approach in cardiac surgery care.

Assessment of inflammatory status in long-term night shift workers using the CRP-albumin ratio and neutrophil-lymphocyte ratio

Long-term night shift (NS) work is known to affect the body's circadian rhythm, leading to chronic low-level inflammation. We aimed to evaluate this information for the first time through CRP-Albumin Ratio [CAR] and Neutrophil-Lymphocyte Ratio [NLR] levels. Design is descriptive, cross-sectional. After exclusion criteria, a total of 84 males were included in the study, 38 of whom had been working at NS for at least three months and 46 who had been working on the day shift. Both NLR and CAR levels were significantly higher in NS workers compared to day shift workers (2.19 [%95 CI 1.99-2.39]; 1.84 [%95 CI 1.65-2.03] p = 0.012 and 0.44 [%95 CI 0.32-0.56]; 0.24 [%95 CI 0.18-0.29] p = 0.002, respectively). This supports the idea that chronic low inflammation may occur as a result of disruption of the circadian rhythm.

Systemic inflammation prevalence in patients with atherosclerotic cardiovascular disease and chronic kidney disease: a population-based study using a nationwide primary care database in Spain

Introduction

Systemic inflammation is recognised as a critical driver of atherosclerotic cardiovascular disease (ASCVD), especially in patients with comorbid chronic kidney disease (CKD). This study aims to assess the prevalence of systemic inflammation in the ASCVD population in Spain.

Methods

Outpatient electronic medical records from The Health Improvement Network (THIN®) database were used to identify patients with ASCVD and a C-reactive protein (CRP) measurement ≥1 between January 2014 and July 2023 in Spain. The proportion of patients with systemic inflammation (defined as CRP ≥ 2 mg/L) was estimated at the first CRP measurement (index date) and at the end of the study. The patients' characteristics, comorbidities, and drug dispensation in the prior 12 months were reported by systemic inflammation status at the index date.

Results

Overall, 15,798 patients with ASCVD were included in the study (mean age: 71.1 years; 57% men), of whom 34% had CKD. The proportion of patients with systemic inflammation at the index date was 58% (65% among CKD patients) and 56% (62% among CKD patients) at the end of the study. Patients with systemic inflammation were more frequently smokers, obese, with comorbidities, and had higher low-density lipoprotein cholesterol and triglycerides levels than patients without systemic inflammation. Overall, patients with ASCVD and systemic inflammation used statins and aspirin less frequently compared to patients without systemic inflammation, while they used antibiotics, anticoagulants, and antihypertensives more frequently.

Conclusion

Systemic inflammation prevalence is high among patients with ASCVD in Spain, especially among patients with comorbid CKD. Therapeutic strategies focused on targeting systemic inflammation may have beneficial effects in reducing the burden of ASCVD.

Estimating inflammatory risk in atherosclerotic cardiovascular disease: plaque over plasma?

Inflammation is an important driver of disease in the context of atherosclerosis, and several landmark trials have shown that targeting inflammatory pathways can reduce cardiovascular event rates. However, the high cost and potentially serious adverse effects of anti-inflammatory therapies necessitate more precise patient selection. Traditional biomarkers of inflammation, such as high-sensitivity C-reactive protein, show an association with cardiovascular risk on a population level but do not have specificity for local plaque inflammation. Nowadays, advancements in non-invasive imaging of the vasculature enable direct assessment of vascular inflammation. Positron emission tomography (PET) tracers such as 18F-fluorodeoxyglucose enable detection of metabolic activity of inflammatory cells but are limited by low specificity and myocardial spillover effects. 18F-sodium fluoride is a tracer that identifies active micro-calcification in plaques, indicating vulnerable plaques. Gallium-68 DOTATATE targets pro-inflammatory macrophages by binding to somatostatin receptors, which enhances specificity for plaque inflammation. Coronary computed tomography angiography (CCTA) provides high-resolution images of coronary arteries, identifying high-risk plaque features. Measuring pericoronary adipose tissue attenuation on CCTA represents a novel marker of vascular inflammation. This review examines both established and emerging methods for assessing atherosclerosis-related inflammation, emphasizing the role of advanced imaging in refining risk stratification and guiding personalized therapies. Integrating these imaging modalities with measurements of systemic and molecular biomarkers could shift atherosclerotic cardiovascular disease management towards a more personalized approach.

Cytokine-Based Validation of the Inflammation-Based Risk Score in Patients with ST-Segment Elevation Myocardial Infarction

This study aimed to validate an inflammation-based risk score in patients with ST-segment elevation myocardial infarction (STEMI) by examining their cytokine profiles. Upon admission, patients were evaluated for systemic inflammation using a risk score that assigned points based on specific biomarkers: 1 point for leukocyte count ≥9.3 × 10³ cells/μL, 2 points for high-sensitivity C-reactive protein (hsCRP) ≥13.0 mg/L, and 3 points for serum albumin ≤3.6 g/dL. Patients were categorized into three groups: no inflammation (0 points, n = 13), mild inflammation (1-2 points, n = 35), and severe inflammation (3-6 points, n = 26). Serum levels of 16 key cytokines were measured. Patients with higher risk scores showed elevated interleukin (IL)-6 levels (19.6 vs. 8.5 vs. 6.8 pg/mL; P = 0.021) and decreased interferon-γ-induced protein-10 (IP-10) levels (73.4 vs. 68.8 vs. 112.2 pg/mL; P = 0.011). IL-6 was positively correlated with hsCRP (ρ 0.307) and negatively correlated with albumin (ρ -0.298), while IP-10 was negatively correlated with leukocyte count (ρ -0.301). No other cytokines showed significant association with the risk score. Higher inflammation scores were also associated with an increased incidence of major adverse cardiovascular events, particularly acute heart failure. This study underscores the association between the inflammation-based risk score and cytokine levels, specifically IL-6 and IP-10, in patients with STEMI.

Elevated C-reactive protein and cardiovascular risk

PURPOSE OF REVIEW

This review critically examines the evolving role of C-reactive protein (CRP) in cardiovascular disease (CVD), addressing its pathogenesis and relationship with various CVDs including coronary artery disease (CAD), heart failure, and atrial fibrillation.

RECENT FINDINGS

CRP is mechanistically implicated in endothelial dysfunction, oxidative stress, and plaque destabilization. Recent studies demonstrate that lipid-lowering agents (statins, bempedoic acid) and anti-inflammatory therapies (canakinumab, colchicine) reduce CRP levels and improve outcomes in CAD. In heart failure, elevated CRP predicts adverse events, though evidence on phenotypes varies, and novel therapies (glucagon-like peptide-1 agonists, sodium-glucose cotransporter-2 inhibitors) lower CRP independently of weight loss. For atrial fibrillation, CRP correlates with postoperative incidence and recurrence postablation, though data remain inconsistent. Guidelines offer differing opinion with the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines cautiously endorsing CRP for risk stratification in intermediate-risk individuals, while European guidelines advise against its routine use for primary prevention, reflecting unresolved questions about CRP's additive value.

SUMMARY

CRP remains a pivotal inflammation biomarker in CVD, yet its causal role and clinical applicability require clarification. While CRP-guided therapies show promise, discrepancies in guidelines highlight the need for robust trials to determine whether targeting CRP directly improves outcomes. Future research should focus on CRP's pathophysiological mechanisms and validate its utility in personalized CVD management.

Vessel wall enhancement and high-sensitivity CRP as prognostic markers in intracranial atherosclerotic stroke: A prospective cohort study

INTRODUCTION

Eccentric vessel wall enhancement (EVWE) and high-sensitivity C-reactive protein (hs-CRP) are inflammatory biomarkers associated with atherosclerotic disease. We investigated their prognostic value in patients with acute ischemic stroke receiving guideline-adherent medical treatment.

PATIENTS AND METHODS

In this prospective observational cohort study, patients with acute ischemic stroke attributed to intracranial arterial disease (ICAD) underwent vessel wall MRI and hs-CRP testing. The study included intracranial cases of both large artery atherosclerosis (LAA) and small vessel occlusion (SVO). The primary outcome was subsequent ischemic stroke during the follow-up period. The median follow-up duration was 21 months. Kaplan-Meier survival and Cox regression analysis was used to determine the associations between EVWE, hs-CRP levels, and subsequent ischemic stroke.

RESULTS

Among 191 patients, 81 (42.4%) had EVWE. EVWE positivity showed a trend toward a lower risk of subsequent ischemic stroke compared to EVWE negativity (HR 0.32, 95% CI 0.12-0.87; p = 0.061). Hs-CRP levels were not associated with recurrent stroke risk. The combination of EVWE positivity and low hs-CRP levels (<1.25 mg/l) was associated with a favorable outcome, while EVWE negativity and high hs-CRP levels (⩾1.25 mg/l) were associated with an unfavorable outcome (HR 0.143, 95% CI 0.04-0.50; p = 0.031).

DISCUSSION

In this observational study of patients with intracranial atherosclerotic stroke receiving optimal medical therapy, EVWE positivity appeared to be associated with a trend toward lower risk of recurrent stroke, though this relationship requires further validation.

CONCLUSION

The combination of EVWE and hs-CRP status might potentially offer prognostic information, with preliminary data suggesting that EVWE positivity and low hs-CRP levels could be associated with more favorable outcomes in patients receiving guideline-adherent medical treatment. These preliminary findings suggest a possible role for combining imaging and serum inflammatory biomarkers in risk stratification, though larger prospective studies are needed to confirm these associations.

Chronic Stress and Severe Water Insecurity During the Historic 2022 Drought in Northern Kenya Were Associated With Inflammation Among Daasanach Seminomadic Pastoralists

OBJECTIVE

Extreme climatic events, like droughts, are increasing in frequency and severity. Droughts disrupt community livelihoods and resources with serious implications for human biology. This study investigated how chronic stress, measured by fingernail cortisol concentration (FCC), and water insecurity status were predictive of C-reactive protein (CRP), a biomarker of inflammation, during a historic drought among Daasanach seminomadic pastoralists.

METHODS

Data were collected at the height of the 2022 drought from 128 Daasanach household heads aged 16-80 years in northern Kenya using household surveys, anthropometric measurements, and dried blood spots to assess CRP levels and fingernails to assess FCC. We employed mixed-effects linear and logistic regression models to examine the relationships between log-transformed FCC, high water insecurity status measured via the Household Water Insecurity Experiences (HWISE ≥ 24) scale, and serum-equivalent CRP (log-transformed and dichotomized at mild, low-grade inflammation ≥ 1 mg/L) adjusted for covariates.

RESULTS

The mean serum-equivalent CRP was 4.1 mg/L and 56.3% of Daasanach adults had at least mild, low-grade inflammation. Linear models indicated that ln(FCC) was positively associated with ln(CRP) (β = 0.56, SE = 0.12; p < 0.001). Further, logistic models demonstrated that ln(FCC) (OR = 2.69, 95% CI: 1.84-3.95; p < 0.001) and high water insecurity (OR = 2.23, 95% CI: 1.34-3.72; p = 0.002) were both associated with greater odds of low-grade inflammation.

CONCLUSION

This study provides evidence for how chronic stress and severe water insecurity may impact inflammation levels among pastoralists during drought. Since inflammation is central to cardiometabolic disease etiology, this is an additional reason to mitigate the negative health impacts of droughts and water insecurity exacerbated by climate change.

Left atrial appendage velocity, association with inflammatory indices in non-valvular atrial fibrillation patients

INTRODUCTION

Decreased left atrial appendage emptying velocity (LAAV) is a marker for thrombus formation. This study evaluates the association between LAAV and inflammatory indices in non-valvular atrial fibrillation (AF) patients.

METHODS

The study population was 1428 patients with AF, 875 of whom enrolled. Based on the LAAV, patients were divided into three groups of 262 patients with a velocity of <25 cm/s, 360 patients with a velocity of 25 to 55 cm/s, and 253 patients with a velocity of >55 cm/s to assess and compare in terms of inflammatory indices, including the platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, systemic immune inflammation index, neutrophil - to - platelet ratio and white blood cell-to-platelet ratio (WPR).

RESULTS

There was no statistical difference in the level of inflammatory indices between the three groups, and none of them were related to LAAV (p > .05) except WPR with a weak negative correlation (p = 0.01, r = -0.10). Patients with lower LAAV were found to have a higher age (p = 0.001), decreased left ventricular ejection fraction (p = 0.001) and greater left atrial volume index (p = 0.001).

CONCLUSION

This study did not show any association between inflammatory indices and LAAV in non-valvular AF patients except for the WPR.

Short-Term Assessment of High-Sensitivity C-Reactive Protein (hs-CRP) Changes Following One Anastomosis Gastric Bypass (OAGB) in Patients with Obesity: A Prospective Cohort Study

BACKGROUND

Obesity, characterized by excessive adipose tissue, is associated with chronic low-grade inflammation and elevated inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP). This inflammation is linked to obesity-associated medical problems, including cardiovascular diseases. One anastomosis gastric bypass (OAGB) has emerged as an effective metabolic and bariatric surgical procedure to address severe obesity and its associated inflammatory state. This study aims to evaluate the changes in hs-CRP levels following OAGB in patients with obesity.

METHODS

In this prospective cohort study, 71 participants with BMI > 35 kg/m2, with or without obesity-associated medical problems, underwent OAGB. The hs-CRP levels were measured at baseline, 1 day, 5 days, 30 days, and 6 months post-surgery.

RESULTS

The median baseline hs-CRP level was 8.5 mg/L, initially increasing post-surgery to 19 mg/L, but significantly decreased to 3.5 mg/L at 6 months (p < 0.001). Significant reductions in weight and BMI were also observed, with median total weight loss (%TWL) of 29% and excess weight loss (%EWL) of 68.2% over 6 months. Pre-operative hs-CRP levels were the only significant predictor of CRP reduction post-surgery.

CONCLUSIONS

OAGB significantly reduces systemic inflammation by decreasing hs-CRP levels, alongside substantial weight loss. These findings support OAGB as a beneficial intervention for mitigating inflammation and improving metabolic conditions in patients with obesity. Further, long-term studies are warranted to evaluate the sustained impact of OAGB on inflammatory markers and obesity-associated medical problems.

Interactive effects of short-term ozone exposure and plasma biomarkers related to nitric oxide pathway and inflammation on myocardial ischemia

BACKGROUND

No study has explored the possible interactive effects of short-term ozone (O3) exposure and plasma endothelial and inflammatory biomarkers, including cyclic guanosine monophosphate (cGMP), nitric oxide metabolite (NOx), myeloperoxidase (MPO), and high-sensitive C-reactive protein (hs-CRP), on myocardial ischemia, indicated by ST-segment depression events (STDE) recorded in ambulatory electrocardiograms.

METHODS

A L-arginine (L-Arg) intervention study with 118 participants was carried out using a standardized 24-h exposure protocol, employing a multivariable linear regression model to assess the effects of O3 exposure on plasma biomarkers, and a generalized linear model to investigate the effects on 24-hour STDE. The possible interactive effects of short-term O3 exposure and plasma biomarkers on indicators of myocardial ischemia were also investigated by including product interaction terms between ambient O3 and plasma biomarkers in the models. We also explored whether L-Arg supplementation could alleviate the adverse effects of ambient O3 exposure.

RESULTS

Data from 107 participants were included in final analysis. Short-term O3 exposure was associated with significantly decreased plasma cGMP and MPO levels, and increased 24-h STDE risk, with plasma cGMP and MPO modifying the O3-STDE associations. Participants with lower plasma levels of cGMP or higher MPO demonstrated increased vulnerability to the harmful effects of ambient O3 on 24-h STDE in inferior leads. L-Arg supplementation attenuated the effects of short-term O3 exposure on plasma MPO and hs-CRP.

CONCLUSIONS

Plasma biomarkers (cGMP and MPO) are likely involved in the potential pathways connecting ambient O3 exposure and harmful cardiac effects. Supplementation with L-Arg showed the potential to mitigate the inverse effects of ambient O3 exposure on inflammation.

Vascularization, Innervation, and Inflammation: Pathways Connecting the Heart-Brain Axis and Implications in a Clinical Setting

With an aging population, the incidence of both ischemic heart disease and strokes have become the most prevalent diseases globally. These diseases have similar risk factors, such as hypertension, diabetes, and smoking. However, there is also evidence of a relationship between the heart and the brain, referred to as the heart-brain axis. In this relationship, dysfunction of either organs can lead to injury to the other. There are several proposed physiologies to explain this relationship. These theories usually involve vascular, neuromodulatory, and inflammatory processes; however, few articles have explored and compared these different mechanisms of interaction between the heart and brain. A better understanding of the heart-brain axis can inform physicians of current and future treatment and preventive care options in heart and brain pathologies. The relationship between the brain and heart depends on inflammation, vascular anatomy and function, and neuromodulation. The pathways connecting these organs often become injured or dysfunctional when a major pathology, such as a myocardial infarction or stroke, occurs. This leads to long-term impacts on the patient's overall health and risk for future disease. This study summarizes the current research involved in the heart-brain axis, relates these interactions to different diseases, and proposes future research in the field of neurocardiology. Conditions of the brain and heart are some of the most prevalent diseases. Through understanding the connection between these two organs, we can help inform patients and physicians of novel therapeutics for these pathologies.

Residual Traditional Risk in Non-Traditional Atherosclerotic Diseases

Individuals with chronic inflammatory and immune disorders are at an increased risk of atherosclerotic events and premature cardiovascular (CV) disease. Despite extensive literature exploring the relationship between "non-traditional" atherosclerotic conditions and CV risk, many aspects remain unresolved, including the underlying mechanisms promoting the "non-traditional CV risk", the development of an innovative and comprehensive CV risk assessment tool, and recommendations for tailored interventions. This review aims to evaluate the available evidence on key "non-traditional" CV risk-enhancer conditions, with a focus on assessing and managing CV risk factors. We conducted a comprehensive review of 412 original articles, narrative and systematic reviews, and meta-analyses addressing the CV risk associated with "non-traditional" atherosclerotic conditions. The analysis examined the underlying mechanisms of these relationships and identified strategies for assessing and mitigating elevated risk. A major challenge highlighted is the difficulty in quantifying the contribution of individual risk factors and disease-specific elements to CV risk. While evidence supports the cardiovascular benefits of statins beyond lipid lowering, such as pleiotropic and endothelial effects, current guidelines lack specific recommendations for the use of statins or other therapies targeting non-traditional CV risk factors. Additionally, the absence of validated cardiovascular risk scores that incorporate non-traditional risk factors hinders accurate CV risk evaluation and management. The growing prevalence of "non-traditional CV risk-enhancer conditions" underscores the need for improved awareness of CV risk assessment and management. A thorough understanding of all contributing factors, including disease-specific elements, is crucial for accurate prediction of cardiovascular disease (CVD) risk. This represents an essential foundation for informed decision-making in primary and secondary prevention. We advocate for future research to focus on developing innovative, disease-specific CV risk assessment tools that incorporate non-traditional risk factors, recognizing this as a promising avenue for translational and clinical outcome research.

Long COVID Syndrome: A Case-Control Study

BACKGROUND

Acute coronavirus disease 2019 (COVID-19) causes various cardiovascular complications. However, it is unknown if there are cardiovascular sequelae in the medium and long-term. The aim of this study was dual. Firstly, we wanted to investigate symptomatology and health-related quality of life (HRQoL) at medium-term follow-up (6 months post-COVID). Secondly, we wanted to assess whether history of COVID-19 and persistent shortness of breath at medium-term follow-up are associated with ongoing inflammation, endothelial dysfunction, and cardiac injury.

METHODS

A case-control study was performed. Virologically proven COVID-19 cases and age- and gender-matched controls were interviewed to assess symptoms and HRQoL. Biochemical tests were also performed.

RESULTS

The study comprised 174 cases and 75 controls. The mean age of the participants was 46.1±13.8 years. The median follow-up was 173.5 days (interquartile range 129-193.25 days). There was no significant difference in the demographics between cases and controls. At follow-up, cases had a higher frequency of shortness of breath, fatigue, arthralgia, abnormal taste of food (P <.001), and anosmia. Cases also exhibited worse scores in the general health and role physical domains of the Short Form Survey-36. High-sensitivity C-reactive protein (hsCRP) was significantly higher in the cases, and there was a positive correlation of hsCRP with time. Significant determinants of shortness of breath were age, female gender and white cell count, troponin I, and lower hemoglobin levels at follow-up.

CONCLUSION

Post-COVID-19 patients have persistent symptomatology at medium-term follow-up. Higher hsCRP in cases and the positive association of hsCRP with time suggest ongoing systemic inflammation in patients persisting for months after COVID-19.

Effects of fortified eggs and time-restricted eating on cardiometabolic health: The prosperity trial

BACKGROUND

Given the increasing interest in dietary interventions to improve cardiovascular health, this trial assessed the impact of fortified eggs (FE) versus nonegg supplemented diet and time-restricted eating (TRE) versus usual care diet on cardiovascular biomarkers.

METHODS

The study was a unblinded, 2-by-2 factorial design, which randomized patients, with either a prior cardiovascular event or 2 cardiovascular risk factors, to FE or a nonegg supplemented diet and TRE or usual care diet. Patients randomized to FE were instructed to consume at least 12 FE/week (with eggs provided); those on a nonegg supplemented diet restricted egg consumption to <2 eggs/week. TRE participants were instructed to consume all calories within an 8-hour window daily and fasted for the remaining 16 hours. Patients randomized to usual diet were advised to maintain current dietary habits. Follow-up was performed in-person at 1 and 4 months, and telephone calls at 2 and 3 months. Co-primary endpoints were 4-month LDL- and HDL-cholesterol. Secondary endpoints included additional lipids, cardiometabolic- and inflammatory biomarkers and micronutrient levels at 4-months.

RESULTS

Overall, 140 patients were randomized with median (25th, 75th percentiles) age 66 (58, 73) years; 72 (51%) women, 38 (27%) Black, and 33 (24%) with diabetes mellitus. The difference in least squares (LS) means from baseline to 4-months for HDL and LDL levels revealed no significant clinical difference between FE vs nonegg supplemented diet (HDL: -0.64 mg/dL [95% CI: -3.86, 2.58]; LDL: -3.14 mg/dL [-10.81, 4.52]) and TRE vs usual care diet (HDL: 1.51 mg/dL [-1.65, 4.68]; LDL 1.17 mg/dL [-6.36, 8.70]). Prespecified subgroups revealed a nonsignificant HDL increase and LDL decrease with FE in patients ≥65 years.

CONCLUSIONS

These data did not demonstrate clinically relevant differences in changes in LDL and HDL levels over 4 months with FE and TRE compared with nonegg supplemented diet and usual care diet, respectively, providing evidence that adverse short-term lipid and biomarker changes did not occur with FE consumption.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04673721.

Monocyte-lymphocyte ratio predicts cardiovascular diseases death in individuals with type 2 diabetes

PURPOSE

Previous studies have shown higher cardiovascular mortality risk with higher monocyte-lymphocyte ratio levels in general population. However, the levels of oxidative stress in individuals with type 2 diabetes are higher than those in the general population, which may affect the link between monocyte-to-lymphocyte ratio and cardiovascular disease deaths. And the association between the monocyte-to-lymphocyte ratio and mortality risk in people with type 2 diabetes still be unknown. This study aimed to investigate the prognostic significance of monocyte-to-lymphocyte ratio in type 2 diabetes.

METHODS

This analysis involved 2,954 individuals with type 2 diabetes from the National Health and Nutrition Examination Survey 1999-2010. The National Death Index records through December 31, 2019, was used to determine all-cause and cardiovascular mortality. The prognostic roles were determined using Cox regression models, restricted cubic spline analysis, and time-dependent receiver operating characteristic curve analysis.

RESULTS

During an average follow-up period of 12.4 years, a total of 1,007 deaths occurred, while 252 were due to cardiovascular disease. An elevated monocyte-to-lymphocyte ratio level exhibited a significant dose-response relationship with an increased risk of all-cause mortality (1.34 [95% CI 1.12, 1.60] for all-cause mortality [P trend = 0.001]). The multivariable-adjusted HR was 1.81 (95% CI 1.25, 2.63) (P trend = 0.001) for cardiovascular mortality indicating a U-shaped relationship (P nonlinear = 0.013).

CONCLUSIONS

The results of this study indicate a U-shaped relationship between the monocyte-to-lymphocyte ratio and cardiovascular mortality in individuals with diabetes. Both very low and high monocyte-to-lymphocyte ratio monocyte-to-lymphocyte ratio values were found to be associated with increased cardiovascular mortality risk.

Association Between Occupational Sitting With High Sensitivity C-Reactive Protein: The Jackson Heart Study

Modifiable, behavioral risk factors like occupational sitting may contribute to inflammation, an important cardiovascular risk factor. This study evaluated the association of self-reported occupational sitting with changes in c-reactive protein (CRP) and the role of sex. We examined occupational sitting and baseline CRP levels for 2889 African American participants in the Jackson Heart Study. Four multivariable linear regression models were estimated to determine the association of occupational sitting and CRP. Analyses were conducted in 2020. The mean age was 50.8 years and 61% were female. Participants who reported occupational sitting as "often/always" had CRP levels of 4.9±6.8 mg/L, "sometimes" had levels of 4.8±8.1 mg/L, and "never/seldom" had levels of 4.3±6.8 mg/L. In the unadjusted model, "often/always" engaging in occupational sitting was significantly associated with higher levels of CRP when compared to "never/seldom" (P < .05). This differed by sex with female participants who reported "often/always" occupational sitting had CRP levels of 6.0±7.6 mg/L compared to only 5.1±6.9 mg/L for "never/seldom." Neither the overall association nor the female-specific association remained statistically significant in the adjusted models. We found an association between occupational sitting and inflammation, measured by CRP. This association varied by sex but did not remain significant after fully adjusting for covariates.

The impact of elevated C-reactive protein levels on long-term outcomes of patients undergoing transcatheter aortic valve replacement

BACKGROUND

In patients undergoing transcatheter aortic valve replacement (TAVR), elevated pre-procedural C-reactive protein (CRP) levels are frequently observed. Its impact on long-term results of TAVR is unclear. The aim of the study was to investigate the long-term (up to six years) clinical outcomes of TAVR patients with normal compared to elevated CRP levels before TAVR.

METHODS

Consecutive patients undergoing TAVR between August 2012 and January 2023 at a tertiary cardiology facility were included. Patients were divided into two cohorts based on the baseline CRP levels: normal CRP (≤ 5 mg/l) and elevated CRP (>5 mg/l). The cohorts were followed clinically for up to six years after TAVR.

RESULTS

From a total of 1000 TAVR patients (mean age 81 ± 6 years), 268 patients (27 %) were found to have elevated baseline CRP (>5 mg/l). Such patients had significantly more co-morbidities (e.g. chronic obstructive pulmonary disease, atrial fibrillation, heart failure, concomitant valvopathies). They also developed periprocedural infections more frequently (3 % vs. 1 %, p = 0.007) and required more commonly repeat hospitalizations for infections during follow-up (HR 1.97, CI 1.47-2.64, p < 0.001). All-cause mortality and development of valve dysfunction did not significantly differ between patients with elevated and normal baseline CRP levels.

CONCLUSION

Albeit long-term results of TAVR patients with elevated pre-procedural CRP levels seem favorable in terms of survival and development of valve dysfunction, they have an increased risk for periprocedural infections and re-admissions due to infections of any type during the follow-up period.

Association of the triglyceride-glucose index with cardiovascular mortality risk and competing risks in arthritis patients

This study aims to investigate the relationship between the triglyceride-glucose index (TyG) and all-cause mortality as well as cardiovascular mortality in arthritis patients. Additionally, it seeks to analyze the nonlinear characteristics and threshold effects of TyG index. We included 5,559 adult participants with arthritis from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). The TyG index was calculated using fasting triglycerides and glucose levels. We employed Cox proportional hazards models and restricted cubic spline analyses to examine the relationship between TyG index and all-cause mortality in arthritis patients. Competing risks models were used to analyze the association between TyG index and cardiovascular mortality as well as mortality from other causes. Over a median follow-up period of 7.8 years, 1,388 cases of all-cause mortality were recorded among arthritis patients, including 369 cases of cardiovascular mortality. After adjusting for confounding factors, TyG index was found to be nonlinearly positively associated with all-cause mortality (P = 0.0019), with a significant increase in mortality risk when TyG index ≥ 8.43. Compared to the quartile 2 of TyG index, the highest quartile was associated with a 36% increased risk of all-cause mortality (HR 1.36, 95% CI 1.12-1.65). Additionally, competing risks models indicated that high TyG index levels were significantly associated with increased risks of cardiovascular mortality and mortality from other causes. Subgroup analyses confirmed the robustness of the association between TyG index and cardiovascular mortality in arthritis patients. The TyG index is nonlinearly associated with all-cause mortality and represents a potential prognostic indicator for mortality risk in arthritis patients.

Association between life's essential 8 and periodontitis in U.S. adults

Periodontitis is closely related to lifestyle habits. Our objective was to examine the relationship between the Life's Essential 8 (LE8) and the prevalence of periodontitis in American adults. This study used data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES). LE8 scores (range 0-100) were measured according to the definition by the American Heart Association (AHA) and were categorized as low (0-49), medium (50-79), and high (80-100). The NHANES database on periodontal health was used to data to determine the prevalence of periodontitis. Multivariate regression models and restricted cubic spline (RCS) models were used to assess correlations. Weighted quantile sum (WQS) regression was used to explore the association of LE8 and its components with periodontitis risk. Stratified analysis and interaction analysis were conducted to assess the consistency of the results. In addition, mediation analyses were performed to investigate the role of systemic inflammation in mediating the association of LE8 with periodontitis risk. Participants with moderate (LE8 score 50-79) and high (LE8 score 80-100) scores had 58% (95% CI 0.43-0.79, P < 0.001) and 55% (95% CI 0.37-0.84, P = 0.010) less periodontitis prevalence, respectively, compared with adults with lower total scores. Among all 8 indicators, nicotine exposure (62.3%), blood glucose (18.2%), sleep heath (8.2%), and blood pressure (7.7%) had the most significant impact on periodontitis. Notably, no statistically significant interactions were observed in all subgroup analyses except age (P for interaction < 0.05), indicating that the protective effect of LE8 on periodontitis was shown to be more pronounced in individuals between 40 and 60 years of age. In addition, neutrophil, white blood cell (WBC), and albumin levels mediated the association between LE8 and periodontitis risk, mediating proportions of 13.3%, 21.4%, and 8.3%, respectively. These findings suggest that poorer LE8 scores increase the risk of periodontitis, which may be partly mediated by systemic inflammation.