Biologic Therapies and Major Cardiovascular Events in Psoriasis: Updated Systematic Review and Meta-analysis

Objective To explore the predictive effect of negative emotions such as anxiety and depression on the poor prognosis of coronary heart disease (CHD) patients with stent implantation and to seek the improvement of clinical intervention measures. Methods A total of 303 patients with CHD and PCI were recruited from February 2019 to April 2021. The risk factors of CHD such as anxiety and depression, age, sex, smoking and drinking, BMI, hypertension, diabetes, dyslipidemia, and family history of CHD were collected. Meanwhile, clinical data such as laboratory examination, angiography, diseased vessels, and stent types were collected. The patients were followed up for 1 year, and the medical records, hospitalization records, or death records were checked by telephone interview once a month. Major adverse cardiovascular events (MACE) such as emergency and causes, readmission times and causes, new nonfatal myocardial infarction, stent restenosis, heart failure, arrhythmia, and death were recorded. The incidence of anxiety and depression in patients after PCI was counted, and Cox regression was applied to analyze the influence and prediction of anxiety and depression on MACE in patients with CHD stent implantation and improve clinical intervention measures. Results Compared with those without MACE, anxiety (56.25% vs 30.63%), depression (62.5% vs 22.88%, P < 0.01), anxiety combined with depression (46.88% vs 15.50%, P < 0.01), and hypertension history (71.8% vs 39.11%, P < 0.01) were more common in patients with MACE. Uncorrected Cox proportional hazard regression found that people with anxiety had a higher risk of developing MACE than those without anxiety (HR 3.181, P < 0.01). Multiple Cox proportional hazard regression analysis of anxiety showed that anxiety was an independent predictor of cumulative MACE (P < 0.01). The risk of developing MACE in patients with anxiety was 3.742 times higher than that in patients without anxiety (P < 0.01). Uncorrected Cox hazard regression analysis showed that people with depression had a higher risk of developing MACE than those without depression (HR 5.434, P < 0.01). Furthermore, the results also uncovered that depression was an independent predictor of cumulative MACE (P < 0.01). The risk of MACE in patients with depression was 3.087 times higher than that in patients without depression (P < 0.01). Cox hazard regression showed that the risk of MACE in patients with anxiety and depression was significantly higher than that in patients without anxiety and depression (HR 4.642, P < 0.01). After screening, it was found that anxiety with depression could predict the occurrence of MACE (P < 0.01). The risk of MACE in patients with anxiety and depression was 3.702 times higher than that in patients without anxiety and depression (P < 0.01). Cox regression analysis showed that the risk of MACE with only anxiety and depression was 2.793 times higher than that without anxiety and depression (95% CI 0.914 8.526), with no statistical significance (P > 0.05), and the risk of MACE with depression without anxiety was significantly higher than that without anxiety and depression (P < 0.01). The risk of MACE in patients with anxiety and depression was 7.303 times higher than that in patients without anxiety and depression (P < 0.01). Conclusion Negative emotions such as anxiety and depression can increase the risk of poor prognosis of patients with CHD. Therefore, in clinical work, in addition to routine treatment and nursing during hospitalization, it is recommended to screen patients with depression in CHD patients. Medical staff should use simple and effective assessment tools in time and take active measures to improve the depression of patients. This trial is registered with ChiCTR2200055645.

Myocardial infarction with nonobstructive coronary arteries (MINOCA) represents a clinical challenge due to its diverse etiologies and uncertain prognosis. Dual antiplatelet therapy (DAPT) is a cornerstone of secondary prevention in traditional myocardial infarction, but its role in MINOCA remains unclear. The purpose of this review was to systematically search the literature and perform a meta-analysis on the effect of DAPT for secondary prevention in patients with MINOCA. A systematic search was conducted in PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) up to June 2024. Cohort studies involving MINOCA patients treated with DAPT and reporting major adverse cardiovascular events (MACE) during follow-up were included. Meta-analysis was conducted using DerSimonian and Laird random-effects model. Seven studies with 12,307 MINOCA patients were included. Meta-analysis showed a trend toward a lower risk of MACE in patients receiving DAPT (pooled hazard ratio: 0.82, 95% confidence interval: 0.66–1.03); however, the results were not statistically significant. DAPT may reduce the risk of MACE in MINOCA patients, but the evidence is not conclusive. Further trials are needed to confirm these findings.

Introduction/Background Chronic systemic inflammation is a recognized risk factor for cardiovascular disease. Atopic dermatitis (AD) has been associated with multiple comorbidities.1 However, risk of major adverse cardiovascular events (MACE) among patients with moderate-to-severe AD is not well understood in the US population. Objectives To characterize risk of MACE in patients with AD vs matched controls without AD (non-AD) and patients with rheumatoid arthritis (RA). To evaluate the effect of disease activity, analyses were repeated in patients with moderate-to-severe disease. Methods In this retrospective analysis of US administrative claims data from Optum's Clinformatics Data Mart, eligible patients were aged ≥18 years with diagnosed AD (≥2 claims for AD or ≥1 claim for AD or eczema with asthma and/or hay fever, food allergies, or allergic rhinitis) from 03/2017–03/2023. The date of the first qualifying disease diagnosis was defined as the cohort entry date. Comparator groups included non-AD controls (matched 1:1 by age, sex, and cohort entry) and patients diagnosed with RA (≥2 claims ≥7 days apart; diagnostic codes identified by rheumatologists). Patients were classified as having moderate-to-severe disease if they received dupilumab for AD or advanced systemic therapy for RA at any time during the follow-up period. Patients with moderate-to-severe AD were also matched to a non-AD control cohort. The crude incidence of MACE, defined as inpatient hospitalization with myocardial infarction or stroke, was quantified. Relative risk was calculated using multivariable Cox proportional hazards model adjusted for baseline demographics, comorbidities, and medication use. Results This analysis included 391,753 patients with AD (7136 with moderate-to-severe AD) and 97,445 patients with RA (35,846 with moderate-to-severe RA). The matched AD and non-AD cohorts included 381,221 patients each; the matched moderate-to-severe AD and non-AD cohorts comprised 7134 patients each. Mean (SD) age in years at cohort entry was 58.0 (18.8) for AD, 67.0 (13.6) for RA, and 58.1 (18.8) for non-AD controls. Incidence of MACE (per 100 patient-years) in patients with AD (1.78 [95% CI 1.76, 1.81]) was similar to non-AD matched controls (1.83 [1.80, 1.86]) and lower vs patients with RA (2.12 [2.07, 2.17]). Patients with moderate-to-severe AD had a lower MACE incidence (1.18 [95% CI 1.01, 1.35]) than non-AD matched controls (1.52 [1.33, 1.74]) and patients with moderate-to-severe RA (1.67 [1.59, 1.75]). The relative risk of MACE in patients with AD was lower vs non-AD controls (adjusted hazard ratio [aHR] [95% CI]: 0.91 [0.89, 0.93]) and patients with RA (0.83 [0.80, 0.85]). Among patients with moderate-to-severe AD, MACE risk was similar to non-AD matched controls (aHR [95% CI]: 0.92 [0.73, 1.14]) and lower vs moderate-to-severe RA (0.83 [0.73, 0.94]). MACE risk in AD was greater in patients who were older (per year, aHR [95% CI]: 1.05 [1.05, 1.05]), male (1.23 [1.19, 1.27]), Black vs White (1.16 [1.11, 1.21]), received systemic corticosteroids in the 3 months before diagnosis (1.10 [1.06, 1.14]), hospitalized in the year before diagnosis (1.35 [1.30, 1.41]); and had history of smoking (1.20 [1.16, 1.24]) and drug abuse (1.34 [1.25, 1.43]). History of cardiovascular disease and other comorbidities were significantly associated with increased MACE risk. Conclusions Among patients with AD, the risk of MACE was lower than the risk in non-AD matched controls and patients with RA. Among patients with moderate-to-severe AD, the risk of MACE was similar to the risk in non-AD matched controls but lower than the risk in moderate-to-severe RA. Patients with AD had an increased MACE risk if they were older, male, Black, hospitalized in the year before diagnosis; and had a history of smoking/drug abuse, cardiovascular disease, and other comorbidities. Characterizing the underlying MACE risk in AD can inform treatment benefit-risk assessments.

BackgroundThe purpose of this study was to explore the incremental predictive value of liver fat fraction (LFF) in forecasting major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM).MethodsWe prospectively enrolled 265 patients with T2DM who presented to our hospital with symptoms of chest distress and pain suggestive of coronary artery disease (CAD) between August 2021 and August 2022. All participants underwent both coronary computed tomography angiography (CCTA) and upper abdominal dual-layer spectral detector computed tomography (SDCT) examinations within a 7-day interval. Detailed clinical data, CCTA imaging features, and LFF determined by SDCT multi-material decomposition algorithm were meticulously recorded. MACE was defined as the occurrence of cardiac death, acute coronary syndrome (ACS), late-phase coronary revascularization procedures, and hospital admissions due to heart failure.ResultsAmong 265 patients (41% male), 51 cases of MACE were documented during a median follow-up of 30 months. The LFF in T2DM patients who experienced MACE was notably higher compared to those without MACE (p < 0.001). The LFF was divided into tertiles using the cutoffs of 4.10 and 8.30. Kaplan-Meier analysis indicated that patients with higher LFF were more likely to develop MACE, regardless of different subgroups in framingham risk score (FRS) or coronary artery calcium score (CACS). The multivariate Cox regression results indicated that, compared with patients in the lowest tertile, those in the second tertile (hazard ratio [HR] = 3.161, 95% confidence interval [CI] 1.163–8.593, P = 0.024) and third tertile (HR = 4.372, 95% CI 1.591–12.014, P = 0.004) had a significantly higher risk of MACE in patients with T2DM. Even after adjusting for early revascularization, both LFF tertile and CACS remained independently associated with MACE. Moreover, compared with the traditional FRS model, the model that included LFF, CACS, and FRS showed stable clinical net benefit and demonstrated better predictive performance, with a C-index of 0.725, a net reclassification improvement (NRI) of 0.397 (95% CI 0.187–0.528, P < 0.01), and an integrated discrimination improvement (IDI) of 0.100 (95% CI 0.043–0.190, P < 0.01).ConclusionsThe elevated LFF emerged as an independent prognostic factor for MACE in patients with T2DM. Incorporating LFF with FRS and CACS provided incremental predictive power for MACE in patients with T2DM.Graphical abstractResearch insightsWhat is currently known about this topic?T2DM is associated with increased MACE rates, underscoring the need for improved risk prediction. CACS is a well-established tool for MACE risk assessment but may not capture all risk factors. Hepatic steatosis is a common comorbidity in metabolic syndrome and T2DM.What is the key research question?Does the incorporation of LFF derived from SDCT into existing risk prediction models enhance the accuracy of MACE forecasting in patients with T2DM?What is new?SDCT-LFF measurement introduces a more accurate method for assessing hepatic steatosis. LFF as an independent predictor of MACE in T2DM patients is a novel finding. The study presents LFF as an additional tool for risk stratification, complementing FRS and CACS.How might this study influence clinical practice?Study findings may guide personalized prevention for T2DM patients at higher MACE risk.

Recurrent acute myocardial infarction requiring unplanned percutaneous coronary intervention (PCI) is one of the major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS) after PCI. There is a continuing controversy about the association between serum cystatin C, a biomarker for the evaluation of renal function, and the prognosis of ACS patients following PCI. The retrospective study evaluated the association between serum cystatin C level and MACE in ACS patients after PCI. Data were retrieved for 330 patients with ACS for primary PCI in a single center. Serum cystatin C levels were measured before PCI. All patients underwent regular follow-ups after PCI, and the studied endpoint was MACE, defined as the need for a repeat revascularization in the heart. The predictive value of serum cystatin C for MACE was analyzed using univariate and multivariate analysis. Restricted cubic spline (RCS) analysis was applied to evaluate the dose-response relationship between serum cystatin C level and MACE in ACS patients following PCI. After a median follow-up of 63 months (range, 1-148 months), 121 of the 330 patients experienced MACE. Compared to patients who did not have MACE, patients who had MACE showed a significant decrease in serum cystatin C levels (0.99±0.32 vs. 1.15±0.78 mg/L, P=0.03). In multivariate regression analysis, serum cystatin C level was an independent risk factor for MACE. According to the serum cystatin C level, patients were divided into 4 categories, Cox regression analysis illustrated that the second quartile of serum cystatin C level indicated an increased risk of MACE in patients with PCI for primary ACS compared to the highest quartile [Q2: adjusted hazard ratio (HR) =2.109; 95% confidence interval (CI): 1.193-3.727; P=0.01]. RCS analysis showed a significant U-shaped dose-response relationship between cystatin C level and MACE in patients with PCI for ACS (P for non-linearity =0.004). These results indicated an association between serum cystatin C level and post-PCI MACE in ACS patients.

Association between the systemic treatment of psoriasis and cardiovascular risk.

BackgroundPatients with IMID, and notably patients with rheumatoid arthritis (RA), are at increased risk of major adverse cardiovascular event (MACE) compared with the general population [1,2]. It is hence paramount...

Long-term Antithrombotic Therapy in Patients With Chronic Coronary Syndrome: An Updated Review of Current Evidence.

The prognostic value of triglyceride-glucose (TyG) has been well described in patients with coronary artery disease (CAD). Hyperhomocysteinemia (HHcy) promotes insulin resistance and has also been regarded as a potential risk factor for cardiovascular disease. However, the prognostic value of TyG in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) and the interaction between TyG and HHcy remain unclear. A total of 1,734 ACS patients undergoing PCI were continuously enrolled between June 2016 and November 2017 at Beijing Anzhen Hospital. Patients were categorized into four groups based on HHcy status and the optimal cut-off value of TyG. The primary endpoint was major adverse cardiovascular events (MACE), a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and unplanned repeat revascularization. Over a median follow-up of 927 days, 358 patients (20.6%) experienced MACE. The Kaplan-Meier curves showed significant differences in the cumulative incidence of MACE among prespecified groups (p < 0.001). Multivariable Cox regression analysis revealed that higher TyG was significantly associated with an increased risk of MACE in patients without HHcy (HR: 2.36, 95% CI: 1.53-3.64, p < 0.001), but not in patients with HHcy (HR: 1.31, 95% CI: 0.60-2.87, p = 0.503). Restricted cubic splines only demonstrated the prognostic value of TyG in patients without HHcy. A significant interaction was observed for MACE between TyG and HHcy (p for interaction = 0.01). The prognostic value of TyG was modified by HHcy in ACS patients undergoing PCI. Higher TyG was only associated with an increased risk of MACE in ACS patients without HHcy, but not in ACS patients with HHcy.

44 Background: The association between androgen deprivation therapy (ADT) and increased cardiovascular (CV) risk in prostate cancer (PCa) patients is controversial.1-2 Major adverse cardiovascular events (MACE) occurred in 3-6% of patients in a 48-week ADT trial,2 but meta-analysis from a 2011 study found no association between ADT and increased risk of CV death.1 Body mass index (BMI) is a potential risk factor; Lee et al. found a lower risk of MACE in patients with high BMI than those with a normal weight, and patients with low BMI had a higher risk of all-cause mortality.3 This study evaluates the association between BMI and MACE risk in PCa patients on ADT using real-world data. Methods: Analyses of US electronic medical records (2010 to 2020) of PCa patients (n=36,249) receiving LHRH agonist/antagonist injections were conducted to calculate the risk of MACE since ADT initiation for the following BMI groups: &lt;18.5, 18.5 to &lt;25, 25 to &lt;30, 30 to &lt;35, and &gt;35. BMI groups were based on the standard weight status associated with each BMI range (underweight, normal or healthy weight, overweight, obese, and severely obese, respectively).4 The database contained 178,388 LHRH agonist/antagonist injection entries and 965 documented MACE events. Exclusion criteria included lack of ADT initiation date, lack of BMI data, and MACE within 6 months prior to ADT initiation. MACE was defined as myocardial infarction, stroke, and death from any cause based on a recent study in this field.2 Kaplan-Meier event-free survival curves were constructed to compare the risk of MACE between BMI groups. Statistical significance between survival curves was evaluated by log-rank test. Results: Differences in MACE incidence between BMI groups were not significant. (Table). Conclusions: MACE risk was similar across BMI subgroups after ADT initiation. This is consistent with the literature that higher BMIs do not confer additional CV/MACE risk as might be expected (a lower risk of MACE in patients with high BMI than those with normal weight).3 This 10-year analysis in &gt;35,000 patients is likely reflective of the real world, but further study is recommended to evaluate whether BMI should be considered a predisposing risk factor for CV disease in PCa patients undergoing ADT. As the association between ADT and increased CV risk in PCa patients is controversial, future studies evaluating the role of co-morbidities on MACE risk for PCa patients during ADT may be helpful to identify other CV predictors.[Table: see text]

Pulse pressure for selecting the optimal cardiac strategy in patients with type 2 diabetes and coronary artery disease

The aim of the present study was to analyse the incidence of major adverse cardiovascular events in patients undergoing either coronary artery bypass grafting (CABG) or percutaneous coronary intervention with drug-eluting stents for left main stem disease. Five manuscripts publishing 5-year results of 4 trials (SYNTAX, PRECOMBAT, NOBLE and EXCEL) were included. Overall meta-analysis with inclusion of the 5-year results from the EXCEL trial using the protocol definition for myocardial infarction showed that CABG is associated with a significant reduction in the risk of major adverse cardiovascular events (MACE) (risk ratio = 0.74; 95% confidence interval = 0.68-0.80). When the universal definition was used to define myocardial infarction in the EXCEL trial, the analysis demonstrated a larger benefit of coronary surgery in terms of reduction in the risk of MACE (risk ratio = 0.70; 95% confidence interval = 0.63-0.76). Non-significant differences were detected in terms of risk of overall mortality, cardiac mortality or stroke. In conclusion, this meta-analysis shows that CABG significantly reduces the risk of MACE in patients with left main stem disease. The inclusion of the 5-year results of the EXCEL trial using third universal definition amplifies the benefit of CABG over percutaneous coronary intervention.

BackgroundImmune checkpoint inhibitors (ICI) can persistently augment immune and inflammatory pathways. While cardiovascular immune-related adverse events (irAE) such as myocarditis are well identified, less is known about other potential cardiovascular...

The systemic immune-inflammation index (SII) has been used effectively to effectively assess the prognosis of patients with a variety of diseases. But few evidence on the relationship between SII and long-term prognosis of myocardial infarction. We thus aimed to evaluate the relationships of cumulative exposure to SII and its accumulation time course with major adverse cardiovascular events (MACE) events in patients with acute myocardial infarction after percutaneous coronary intervention. To evaluate the predictive value of SII in MACE events in patients with acute myocardial infarction. A total of 480 patients with acute ST-elevation myocardial infarction who underwent emergency coronary angiography at the Department of Cardiology, Affiliated Hospital of Hebei University from August 2022 to August 2023 were enrolled in this study. Eighteen patients were lost to follow-up, with a loss rate of 3.8%. Time-weighted cumulative SII was calculated as the weighted sum of the mean SII value for each time interval, then normalized by total exposure duration, the exposure duration was from hospitalization to 1-year follow-up. Duration of high SII exposure was defined as the duration with high SII and ranged from hospitalization to 1-year follow-up. The time course of SII accumulation was categorized by the combination of time-weighted cumulative SII < or ≥ median and SII slope. At 1-year follow-up, after adjusting for potential confounders, the time-weighted cumulative SII was divided into 2 groups. The S2 group which is above the median had a higher risk of MACE (hazard ratio, 1.090; 95% confidence interval 1.035-1.149), the high time-weighted cumulative SII group with a positive slope had a higher risk of MACE (hazard ratio, 4.096; 95% confidence interval 1.851-9.065). Long-term cumulative exposure to SII increases the risk of MACE in patients with acute ST-elevation myocardial infarction undergoing coronary angiography, and late high SII results in a higher risk of MACE events at the same time-weighted cumulative SII, underscoring the importance of late inflammation control.

The high risk of major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD) has been well described. However, the efficacy of fibrates on the risk of MACE in patients with CKD remains unclear. We conducted a nested case-control study using data from a large administrative database that included more than 1.5 million Japanese patients. We defined cases as CKD patients with incidences of MACE and matched them with controls based on age, sex, calendar year of cohort entry and CKD stage. Fibrate exposure timing was categorized as current, recent or past. A conditional logistic regression analysis was used to investigate the association between fibrate use and the risk of MACE. Our study included 47 490 patients with CKD, with 15 830 MACE identified during a median follow-up of 9.4 months. The numbers of fibrates used during the study period were 556 (3.5%) in the case group and 1109 (3.5%) in the control group. Fibrate use was significantly associated with a decreased risk of MACE [odds ratio (OR) 0.84; 95% confidence interval (CI) 0.75-0.94], particularly for current (OR 0.81; 95% CI 0.68-0.97) and recent use (OR 0.65; 95% CI 0.48-0.90). Regarding the class effect of fibrates, pemafibrate use, but not bezafibrate or fenofibrate use, was significantly associated with a decreased risk of MACE (OR 0.73; 95% CI 0.528-0.997). Recent and current fibrate use, especially pemafibrate use, was associated with a reduced risk of MACE in patients with CKD. This suggests the potential benefits of continuous fibrate therapy and the possible superiority of pemafibrate over other fibrates. However, further investigations in different populations are required to confirm the generalizability of these findings.