The association between atherogenic index of plasma and all-cause mortality and cardiovascular disease-specific mortality in hypertension patients: a retrospective cohort study of NHANES

The association of depression with all-cause and cardiovascular disease mortality risk among transgender and gender diverse and cisgender patients

BACKGROUND

Transgender and gender diverse (TGD) individuals have elevated mental and physical health disparities and a greater mortality risk compared to their cisgender (non-TGD) counterparts.

METHODS

We assessed differences in the association of depression with all-cause and cardiovascular disease (CVD) mortality among TGD and cisgender Veterans Administration patients. A sample of 8981 TGD patients, matched 1:3 with cisgender patients (n = 26,924) patients, was created from administrative and electronic health record data from October 1, 1999 to December 31, 2016. Cox proportional regression models stratified by gender modality (i.e., TGD and cisgender) were used to assess the hazard of all-cause and CVD mortality associated with a history of depression.

RESULTS

Adjusted models demonstrated that depression was significantly associated with a greater hazard of all-cause mortality among both TGD (aHR:1.18, 95 % CI: 1.04-1.34) and cisgender (aHR:1.22, 95 % CI: 1.17-1.28) patients. Similar to all-cause mortality, depression was significantly associated with a greater hazard of CVD mortality among cisgender patients ≥65 years (aHR = 1.23, 95 % CI = 1.13-1.35). Findings for TGD patients showed a similar pattern, though results were not significant.

LIMITATIONS

Hazards may be underestimated since depression may be underdiagnosed. Further, we were unable to adjust for other health-related risk factors tied to mortality (e.g., smoking).

CONCLUSION

Overall, depression was associated with a greater hazard of all-cause mortality among both TGD and cisgender patients. Future work should assess the equity of reach, quality, and outcomes of treatment for depression for TGD populations given the lack of attention to addressing the needs of this important patient demographic.

Association between atherogenic index of plasma and all-cause mortality and specific-mortality: a nationwide population‑based cohort study

BACKGROUND

Atherogenic index of plasma (AIP), a marker of atherosclerosis and cardiovascular disease (CVD). However, few studies have investigated association between AIP and all-cause mortality and specific-mortality in the general population.

METHODS

This study included data from 14,063 American adults. The exposure variable was the AIP, which was defined as log10 (triglycerides/high-density lipoprotein cholesterol). The outcome variables included all-cause mortality and specific-mortality. Survey-weighted cox regressions were performed to evaluate the relation between AIP and all-cause mortality and specific-mortality. Weighted restricted cubic spline was conducted to examin the non-linear relationship.

RESULTS

During 10 years of follow-up, we documented 2,077, 262, 854, and 476 cases of all-cause mortality, diabetes mortality, CVD mortality and cancer mortality, respectively. After adjustment for potential confounders, we found that atherogenic index of plasma (AIP) was significantly associated with an increased risk of diabetes mortality when comparing the highest to the lowest quantile of AIP in female (p for trend = 0.001) or participants older than 65 years (p for trend = 0.002). AIP was not significantly associated with all-cause mortality, CVD mortality and cancer mortality (p > 0.05). Moreover, a non-linear association was observed between AIP and all-cause mortality in a U-shape (p for non-linear = 0.0011), while a linear relationship was observed with diabetes mortality and non-diabetes mortality (p for linear < 0.0001).

CONCLUSIONS

In this study, there is a no significant association between high AIP levels and a high risk of all-cause and cardiovascular mortality. Besides, a higher AIP was significantly associated with an increased risk of diabetes mortality, which only found in women older than 65 years. AIP was associated with all-cause mortality in a U-shape. This association could be explained by the finding that higher AIP predicted a higher risk of death from diabetes, and that lower AIP predicted a higher risk of death from non-diabetes causes.

Association of atherogenic index of plasma with cardiovascular disease mortality and all-cause mortality in the general US adult population: results from NHANES 2005-2018

BACKGROUND

The atherogenic index of plasma (AIP) is a critical metric for predicting cardiovascular outcomes. However, its associations with cardiovascular disease mortality (CVM) and all-cause mortality (ACM) remain unclear. This study aims to elucidate the relationship between baseline AIP levels and CVM and ACM among a broad cohort of US adults.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey (2005-2018), we analyzed 18,133 adults aged ≥ 18. Baseline triglycerides and high-density lipoprotein cholesterol levels were measured to calculate the AIP. Mortality outcomes were determined through linkage with the National Death Index database, with follow-up through December 31, 2019. Multivariable Cox proportional hazard models examined the associations between baseline AIP and mortality risks. Additionally, restricted cubic splines were utilized to investigate potential non-linear relationships, with subgroup analyses conducted across strata defined by age, gender, body mass index, diabetes, hypertension, and metabolic syndrome to assess variability in these associations.

RESULTS

Over a median 95.0-month follow-up, there were 1870 all-cause deaths and 579 cardiovascular disease-related deaths. Our findings indicate a J-shaped association between the AIP and ACM (threshold = 0.0905); specifically, when baseline AIP exceeded 0.0905, a significant positive association with ACM emerged (hazard ratio, HR (95% confidence interval, CI): 1.61(1.08-2.37)). However, after adjusting for confounders, the relationship between AIP and CVM was not statistically significant (HR 1.31, 95% CI 0.93-1.86). Notably, in the 40-60-year age group, AIP was significantly positively associated with ACM and CVM, with HRs and 95% CIs of 1.51 (1.08v2.10) and 2.63 (1.39-4.98), respectively.

CONCLUSIONS

A J-shaped relationship was observed between baseline AIP levels and ACM within the general US population, with a threshold of 0.0905. Moreover, AIP could potentially be an effective predictor for future ACM or CVM, particularly among individuals aged 40-60. Further investigation is warranted to corroborate these findings.

The correlation of atherogenic index of plasma with non-obstructive CAD and unfavorable prognosis among patients diagnosed with MINOCA

BACKGROUND

The atherogenic index of plasma (AIP) is linked to lipid metabolism and has shown considerable prognostic value in cardiovascular disorders. However, its role in myocardial infarction with non-obstructive coronary arteries (MINOCA) has not been investigated. We assessed the relationship between AIP, the severity of coronary stenosis, and prognosis in MINOCA.

METHODS

We included consecutive patients who were diagnosed with MINOCA. AIP was calculated using the base 10 logarithm of the ratio between the levels of TG and HDL-C. The patients were divided into four groups based on their AIP quartiles: Q1 (AIP<-0.145), Q2 (AIP≥-0.145and≤0.049), Q3 (AIP>0.049and≤0.253), and Q4 (AIP>0.253). All patients underwent follow-up for MACE.

RESULTS

The final analysis included 421 patients, with 188 having normal coronaries (0 stenosis) and 233 exhibiting non-obstructive coronary artery disease (CAD) (<50 % stenosis). In the multivariate logistic analysis, highest AIP (Q4) group was significantly associated with increased risk of non-obstructive CAD in MINOCA (OR,1.994;95 % CI:1.075-3.698; P = 0.029). During the follow-up period, MACE occurred in 22.8 % of MINOCA patients. Q4 group exhibited a significantly higher rate of MACE (P = 0.021). Furthermore, when both AIP and coronary stenosis status were considered, the results revealed individuals in the Q4 group with non-obstructive CAD had the highest risk of MACE (log-rank P = 0.027). The adjusted Cox analysis indicated that the Q4 group was associated with a 2.052-fold increase in the HR of MACE.

CONCLUSION

AIP exhibits a notable association with the incidence of MACE in MINOCA patients and serves as a substantial marker for non-obstructive CAD in this patient group.

Is systemic inflammation a missing link between cardiometabolic index with mortality? Evidence from a large population-based study

BACKGROUND

This study sought to elucidate the associations of cardiometabolic index (CMI), as a metabolism-related index, with all-cause and cardiovascular mortality among the older population. Utilizing data from the National Health and Nutrition Examination Survey (NHANES), we further explored the potential mediating effect of inflammation within these associations.

METHODS

A cohort of 3029 participants aged over 65 years old, spanning six NHANES cycles from 2005 to 2016, was enrolled and assessed. The primary endpoints of the study included all-cause mortality and cardiovascular mortality utilizing data from National Center for Health Statistics (NCHS). Cox regression model and subgroup analysis were conducted to assess the associations of CMI with all-cause and cardiovascular mortality. The mediating effect of inflammation-related indicators including leukocyte, neutrophil, lymphocyte, systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR) were evaluated to investigate the potential mechanism of the associations between CMI and mortality through mediation package in R 4.2.2.

RESULTS

The mean CMI among the enrolled participants was 0.74±0.66, with an average age of 73.28±5.50 years. After an average follow-up period of 89.20 months, there were 1,015 instances of all-cause deaths and 348 cardiovascular deaths documented. In the multivariable-adjusted model, CMI was positively related to all-cause mortality (Hazard Ratio (HR)=1.11, 95% CI=1.01-1.21). Mediation analysis indicated that leukocytes and neutrophils mediated 6.6% and 13.9% of the association of CMI with all-cause mortality.

CONCLUSION

Elevated CMI is positively associated with all-cause mortality in the older adults. The association appeared to be partially mediated through inflammatory pathways, indicating that CMI may serve as a valuable indicator for poor prognosis among the older population.

Association between atherogenic index of plasma control level and incident cardiovascular disease in middle-aged and elderly Chinese individuals with abnormal glucose metabolism

BACKGROUND

The atherogenic index of plasma (AIP) and cardiovascular disease (CVD) in participants with abnormal glucose metabolism have been linked in previous studies. However, it was unclear whether AIP control level affects the further CVD incidence among with diabetes and pre-diabetes. Therefore, our study aimed to investigate the association between AIP control level with risk of CVD in individuals with abnormal glucose metabolism.

METHODS

Participants with abnormal glucose metabolism were included from the China Health and Retirement Longitudinal Study. CVD was defined as self-reporting heart disease and/or stroke. Using k-means clustering analysis, AIP control level, which was the log-transformed ratio of triglyceride to high-density lipoprotein cholesterol in molar concentration, was divided into five classes. The association between AIP control level and incident CVD among individuals with abnormal glucose metabolism was investigated multivariable logistic regression analysis and application of restricted cubic spline analysis.

RESULTS

398 (14.97%) of 2,659 participants eventually progressed to CVD within 3 years. After adjusting for various confounding factors, comparing to class 1 with the best control of the AIP, the OR for class 2 with good control was 1.31 (95% CI, 0.90-1.90), the OR for class 3 with moderate control was 1.38 (95% CI, 0.99-1.93), the OR for class 4 with worse control was 1.46 (95% CI, 1.01-2.10), and the OR for class 5 with consistently high levels was 1.56 (95% CI, 1.03-2.37). In restricted cubic spline regression, the relationship between cumulative AIP index and CVD is linear. Further subgroup analysis demonstrated that the similar results were observed in the individuals with agricultural Hukou, history of smoking, diastolic blood pressure ≥ 80mmHg, and normal body mass index. In addition, there was no interaction between the AIP control level and the subgroup variables.

CONCLUSIONS

In middle-aged and elderly participants with abnormal glucose metabolism, constant higher AIP with worst control may have a higher incidence of CVD. Monitoring long-term AIP change will contribute to early identification of high risk of CVD among individuals with abnormal glucose metabolism.

Age-Dependent Association Between Body Mass Index and All-Cause Mortality Among Patients with Hypertension: A Longitudinal Population-Based Cohort Study in China

PURPOSE

The association between body mass index (BMI) and all-cause mortality may vary among hypertensive patients of different ages. This study aimed to investigate the age-dependent association between BMI and all-cause mortality among patients with hypertension.

PATIENTS AND METHODS

A total of 212,394 participants with hypertension aged 20-85 years from Minhang Hypertension Standardization Management System in Shanghai of China were included. Follow-up began at the time when individuals were first recorded and ended at death, loss to follow-up, or December 31, 2018, whichever came first. Additive Cox proportional hazards models with thin plate smoothing functions and conventional Cox proportional hazards models were adopted to examine the relationship between BMI, age, and mortality. The joint effect of BMI and age on mortality was assessed using a bivariate response model.

RESULTS

We found that the BMI-mortality relationship followed a U-shaped pattern, with a trough at 26-27 kg/m2. Compared with normal weight, underweight was associated with a 50% increased risk of premature mortality (hazard ratio 1.50, 95% confidence interval 1.43 to 1.57). Whereas among those aged 45-59 and 60-85 years, overweight was associated with 13% (0.87, 0.80 to 0.94) and 18% (0.82, 0.80 to 0.84) reduction in risk of death, respectively. Bivariate response model indicated a significant interaction between BMI and age (P < 0.05). Among younger and older patients, we found a descending trend for mortality risk, with BMI increasing at different age levels, whereas a reverse J-shaped relation pattern was observed among middle-aged patients.

CONCLUSION

The impact of BMI on all-cause mortality in hypertensive patients varies with age, and moderate weight gain may benefit longevity in middle-aged and older patients.