Effect of glucagon-like peptide-1 receptor agonists on major adverse cardiovascular events in patients with inflammatory bowel disease

Background: Acute heart failure is a global health problem with high morbidity and mortality. Short term and long term prognosis of these patients is poor. Therefore, early identification of patients at high risk for major adverse cardiovascular events (MACEs) during hospitalization was needed to improve outcome. Creatinine levels at admission could be used as predictors of major adverse cardiovascular events in acute heart failure patients because creatinine is a simple and routine biomarker of renal function examined in patients with acute heart failure. This study aimed to determine whether creatinine can be used as a predictor of major adverse adverse cardiovascular events in patients with acute heart failure.Methods: This study is a prospective cohort study of 108 acute heart failure patients treated at H. Adam Malik Hospital from July 2018 to January 2019. Creatinine cut-off points were determined using the ROC curve, then bivariate and multivariate analyzes were performed to determine predictors of major adverse cardiovascular events during hospitalization.Results: From 108 study subjects, 24 (22.2%) subjects experienced major adverse cardiovascular events during hospitalization. The subjects who died were 20 people (83.4%), subjects with arrhythmia were 2 people (8.3%), and those who had stroke were 2 people (8.3 %). Through the ROC curve analysis, we found creatinine cut-off values of ≥1.7 mg / dl (AUC 0.899, 95% CI 0.840- 0.957, p <0.05). Creatinine ≥1.7 mg/dl could predict major adverse cardiovascular events with a sensitivity of 87.5% and specificity of 79.5%. Multivariate analysis showed that creatinine ≥1.7 mg / dl was an independent factor to predict MACEs during hospitalization in this study (OR 18,310, p 0.001) as well as creatinine clearance and heart rate.Conclusion: Creatinine levels at admission is an independent predictor for major adverse cardiovascular events during hospitalization in acute heart failure patients.

Monoclonal gammopathy of undetermined significance (MGUS) is associated with an increased risk of cardiovascular disease. Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have demonstrated cardiorenal benefits in patients with type 2 diabetes, but their effectiveness in patients with MGUS remains unexplored. To assess the effectiveness of GLP-1 RAs for primary prevention of major adverse cardiovascular and cerebrovascular events (MACCE) in patients with MGUS and diabetes. This retrospective cohort study used a propensity score-matched analysis of data from the TriNetX Global Database, encompassing patients diagnosed with diabetes and MGUS between January 1, 2018, and January 13, 2023. Patients with prior heart failure (HF), ischemic heart disease, coronary revascularization, or stroke or transient ischemic attack before MGUS diagnosis were excluded. The cohort was divided into 2 groups: GLP-1 RA users and nonusers at baseline. After 1:1 propensity score matching, GLP-1 RA users and nonusers were compared up to 5 years from the MGUS diagnosis date. Data analyses were completed January 19, 2025. GLP-1 RA use within 1 year before MGUS diagnosis. The primary end point was MACCE, defined as a composite of all-cause mortality, new-onset HF, acute coronary syndrome, and stroke or transient ischemic attack. Secondary end points included individual MACCE components, decompensated HF, and acute kidney injury or end-stage kidney disease. A total of 4871 patients with MGUS (mean [SD] age, 68.9 [10.1] years; 2366 [48.5%] male) were included (473 GLP-1 RA users and 4398 non-users). A total of 460 users were matched to 460 nonusers, with balanced characteristics (mean [SD] age, 65.0 [10.6] vs 65.1 [11.0] years; 229 [49.7%] male vs 234 [50.8%] male), including 14 patients (3.0%) vs 13 patients (2.8%) identifying as Asian, 8 (21.3%) vs 92 (20.0%) as Black or African American, 25 patients (5.4%) vs 20 patients (4.3%) as Hispanic or Latino, and 243 patients (52.8%) vs 250 patients (54.3%) as White. GLP-1 RA use was associated with a significantly lower risk of MACCE (hazard ratio [HR], 0.75; 95% CI, 0.60-0.93). Significant reductions were also observed in all-cause mortality (HR, 0.57; 95% CI, 0.37-0.87), new-onset HF (HR, 0.69; 95% CI, 0.54-0.90), decompensated HF (HR, 0.60; 95% CI, 0.43-0.84), and acute kidney injury or end-stage kidney disease (HR, 0.73; 95% CI, 0.57-0.92). The findings of this cohort study of GLP-1 RA use vs no use in patients with MGUS and diabetes suggest the potential of GLP-1 RA for primary prevention of MACCE. These findings warrant further investigation in prospective randomized trials.

BackgroundSerum uric acid(SUA) is proinflammatory and increases the risk of cardiovascular events in patients with coronary artery disease. SUA levels differ between men and women, and it is unclear whether there are gender differences in the correlation between SUA levels and major adverse cardiovascular events (MACE) in patients with acute coronary syndromes (ACS). In this paper, we analyze the correlation between SUA and MACE in men and women with ACS respectively, to achieve a more accurate prognosis prediction and to determine the optimal level of SUA control in ACS patients of different genders.MethodsThis was a retrospective cohort study that ultimately selected 2799 ACS patients who were hospitalized in the Department of Cardiology of the Affiliated Hospital of Jining Medical College from May 2013 to October 2015, and grouped the patients according to the gender-specific criteria for hyperuricemia(HUA). With a mean follow-up of 4.42 years after discharge, MACE were collected, and the correlation between SUA and MACE risk in patients of different genders was investigated using the Cox proportional risk regression model. Smooth curve fitting was used to analyze the nonlinear relationship between SUA and MACE, and sensitivity and subgroup analyses were performed to investigate further the correlation between SUA and MACE in different populations.ResultsA total of 309 patients developed MACE during the follow-up period. Kaplan-Meier curves showed that patients with HUA had a higher risk of MACE (p < 0.01). Multivariate Cox proportional risk regression modeling analysis revealed a significant correlation between SUA and MACE risk. In crude Cox analyses, SUA levels were associated with higher risk of MACE (total: HR 1.22,95% CI 1.13, 1.31, p < 0.0001, men: HR 1.24, 95% CI 1.14, 1.35, p < 0.0001, women: HR 1.16, 95% CI 1.00, 1.34, p = 0.0477). However, after adjusting for various covariates including SYNTAX scores(SS), the prediction of MACE risk by SUA was clinically significant only in men (HR 1.21, 95% CI 1.03, 1.42, p = 0.0191), and the incidence of MACE events was elevated with elevated uric acid in women but was not clinically significant (HR 1.06, 95% CI 0.82, 1.38, p = 0.6633). In addition, when results were analyzed according to SUA tertiles and gender, men with higher SUA tertiles had a higher risk of MACE (p < 0.0001). After adjusting for variables, smoothed-fit curve analysis similarly showed a trend toward higher MACE occurrence with elevated uric acid in a variety of populations. The inflection points present in the threshold effect analysis in the whole population, men and women curve fits were 7.11 mg/dL, 7.13 mg/dL, and 6.31 mg/dL, respectively, and for every 1-unit increase in uric acid to the right of the inflection point, the risk of MACE increased by 1.48-fold, 1.24-fold, and 1.48-fold, respectively. (( HR (95%) CI: 2.48 (1.57, 3.90) p < 0.0001, in total; 2.24 (1.37, 3.65) p = 0.0013, in men; 2.48 (1.02, 6.01) p = 0.0442, in women)). Subgroup analyses and interaction tests showed that the association between uric acid and MACE was more significant in men in the high triglyceride and high LDL population, whereas in women it was more significant in patients with high BMI, mild coronary artery stenosis, high creatinine, and normoglycemia (interaction p-value < 0.05).ConclusionsThere is a gender difference in the risk of MACE and uric acid levels in patients with ACS, with elevated uric acid levels being more likely to lead to cardiovascular events in men patients, whereas there was no significant difference in women patients.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12872-025-05262-x.

Impact of Paradoxical Decrease in High-density Lipoprotein Cholesterol Levels After Statin Therapy on Major Adverse Cardiovascular Events in Patients with Stable Angina Pectoris

This study aims to evaluate whether radiomic features of pericoronary adipose tissue (PCAT) derived from coronary computed tomography angiography (CCTA) can better predict major adverse cardiovascular events (MACE) in patients with angina pectoris. A single-center retrospective study included 239 patients with angina pectoris who underwent coronary CT examinations. Participants were divided into MACE (n = 46) and non-MACE (n = 193) groups based on the occurrence of MACE during follow-up, and further allocated into a training cohort (n = 167) and a validation cohort (n = 72) at a 7:3 ratio. Automatic segmentation of PCAT surrounding the proximal segments of the left anterior descending artery (LAD), left circumflex coronary artery (LCX), and right coronary artery (RCA) was performed for all patients. Radiomic features of the coronary arteries were extracted, screened, and integrated while quantifying the fat attenuation index (FAI) for the three vessels. Univariate and multivariate logistic regression analyses were utilized to select clinical predictors of adverse cardiovascular events. Subsequently, machine learning techniques were employed to construct models based on FAI, clinical features, and radiomic characteristics. The predictive performance of each model was assessed and compared using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis for clinical utility. The radiomics model demonstrated superior performance in predicting MACE in patients with angina pectoris within both the training and validation cohorts, yielding areas under the curve (AUC) of 0.83 and 0.71, respectively, which significantly outperformed the FAI model (AUC = 0.71, 0.54) and the clinical model (AUC = 0.81, 0.67), with statistically significant differences in AUC (p < 0.05). Calibration curves for all three predictive models exhibited good fit (all p > 0.05). Decision curve analysis indicated that the radiomics model provided higher clinical benefit than the traditional clinical and FAI models. The CCTA-based PCAT radiomics model is an effective tool for predicting MACE in patients with angina pectoris, assisting clinicians in optimizing risk stratification for individual patients. The CCTA-based radiomics model significantly surpasses traditional FAI and clinical models in predicting major adverse cardiovascular events in patients with angina pectoris.

Introduction: Meta-analyses on glucagon-like peptide-1 (GLP-1) receptor agonists have shown beneficial effects in reducing major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus. However, it is unclear if they have similar beneficial effects in patients with type 2 diabetes mellitus and chronic heart failure. Methods: A search was performed on online databases - MEDLINE (via PubMed) and ClinicalTrials.gov, using the search words GLP-1 receptor agonist and cardiovascular outcomes. The references from the search results were also reviewed for potential studies that can be included. We identified four cardiovascular outcome studies with GLP-1 receptor agonists on patients with type 2 diabetes mellitus with data on patients with chronic heart failure, and included them in our meta-analysis. Results: 6189 patients were evaluated in this meta-analysis, with 3053 in the GLP-1 receptor agonist group and 3136 in the placebo group. Among them, 475 (15.56%) major adverse cardiovascular events (i.e., cardiovascular death, stroke, or myocardial infarction) occurred in the GLP-1 receptor agonist group and 536 events (17.09%) in the placebo group with a hazard ratio (HR) of 0.90, 95% confidence interval (CI) of 0.79 to 1.01 and a p-value of 0.08, indicating a favorable effect with GLP1 agonists though statistically not significant. Conclusion: In patients with type 2 diabetes mellitus and chronic heart failure, GLP-1 receptor agonists may have a favorable effect in reducing major adverse cardiovascular events, though statistically not significant.

Inadequate anticoagulation by Vitamin K antagonists and major adverse cardiovascular events other than stroke

BackgroundCurrent evidence on the efficacy and safety of colchicine after acute myocardial infarction (AMI) remains controversial. This study aims to clarify early low-dose long-term colchicine's exact efficacy and safety in AMI patients via more studies.MethodsWe searched PubMed, Web of Science, Embase, and Cochrane Library databases for randomized controlled trials assessing the efficacy of colchicine on major adverse cardiovascular events (MACE) in recent AMI patients from inception to January 29, 2023, without any restriction. Additionally, we conducted subgroup analyses to assess the impact of early (≤3 days) long-term (≥1 year) low-dosage (0.5 mg/d) colchicine. Summary estimates were computed using Mantel-Haenszel and reported as risk ratios (RRs) or standard mean differences (SMDs), mean differences (MDs) with 95% confidence intervals (CIs). Sensitivity analyses were performed to explore the potential sources of heterogeneity. Review Manager software was used for the meta-analysis.ResultsEight studies identified from 564 screened records were analyzed, with 5,872 patients after AMI. The length of follow-up varied from five days to 22.7 months, and 0.5–1.0 mg colchicine was administered daily. In summary, compared to the control group, colchicine reduced the occurrence of MACE (RR, 0.56; 95% CI, 0.48–0.67) with 2.99-fold gastrointestinal adverse events in patients with recent AMI. Moreover, the relation referred to a gradual decrease in the occurrence of MACE with a longer follow-up duration (≥1 year) and lower dosage (0.5 mg/d) without leading more gastrointestinal adverse events. Colchicine decreased the follow-up levels of C-reactive protein (CRP) (MD −0.66, 95% CI, −0.98– −0.35) and neutrophils (SMD −0.22, 95% CI, −0.39– −0.55) when the follow-up period was 30 days.ConclusionEarly long-term low-dose colchicine decreases the risk of MACE via anti-inflammation without leading more gastrointestinal adverse events in patients with AMI.

BackgroundThe triglyceride‒glucose index (TyG index) is a reliable surrogate for insulin resistance (IR) in individuals with type 2 diabetes mellitus and is associated with cardiovascular disease. Recent studies have reported that H-type hypertension is likewise a predictor of adverse events in patients with coronary heart disease (CHD). However, the relationship between the TyG index and prognosis in patients with H-type hypertension combined with CHD has not yet been reported. In this study, we investigated the relationship between the TyG index and adverse outcomes in patients with H-type hypertension combined with CHD.MethodsThis was a single-center retrospective cohort study that included patients who were diagnosed with H-type hypertension combined with CHD between 2018 and 2023 at Beijing Anzhen Hospital of Capital Medical University. The TyG index was divided into three groups according to tertiles. Kaplan–Meier curves were used to analyze the cumulative risk of major adverse cardiovascular events (MACEs), and ROC curve analysis was performed by the log-rank test. Cox proportional hazards regression models were adopted to explore the relationship between the TyG index and MACEs. C-statistics, NRI, and IDI were used to evaluate the incremental predictive ability of the TyG index.ResultsA total of 546 patients were included, with a median follow-up time of 39.00 ± 0.69 months, and 73 MACEs occurred, with higher tertiles of the TyG index associated with a higher cumulative risk of MACEs (log-rank, P = 0.001). After adjusting for confounders, the fully adjusted ORs (95% CI) for T2 and T3 of the TyG index, with the lowest tertile as reference, were 1.64 (0.80–3.36) and 2.43 (1.19–4.97), respectively. The addition of the TyG index led to a significant improvement in the overall predictive power of the baseline model. [C-statistic increased from 0.63 to 0.66, p = 0.031; continuous NRI (95% CI) 0.13 (0.001–0.276), p = 0.038; IDI (95% CI) 0.01 (0.000–0.031), p = 0.047].ConclusionThe TyG index may be an independent risk factor for predicting adverse postoperative cardiovascular events in patients with H-type hypertension combined with CHD, indicating its potential significance in improving risk stratification strategies.Graphical

Objective: To determine the impact of low T3 syndrome on adverse cardiovascular events in adult patients with acute viral myocarditis. Methods: The study population consisted of 134 consecutive patients admitted between January 2002 and March 2018 with diagnoses of acute viral myocarditis (onset of symptoms<1 month,patients were divided into low serum free triiodothyronine (FT3, n=20) group and normal FT3 (n=114) group. General information, clinical presentation,electrocardiography at admission,laboratory tests,echocardiography features were analyzed. Low T3 syndrome was defined as a state with decreased FT3 and total triiodothyronine (TT3), normal or decreased free thyroxine (FT4) and total thyroxine (TT4) as well as normal thyroid stimulating hormone (TSH). Composite adverse cardiovascular events included death, persistent ventricular tachycardia (VT) or ventricular fibrillation (VF) and cardiac arrest. Risk factors related with composite adverse cardiovascular events in adult patients with acute viral myocarditis were analyzed by logistic regression analysis. Results: Systolic blood pressure was significantly lower (P<0.01),while heart rate (P=0.004) and the prevalence of VT/VF were significantly higher (P=0.017) in low T3 group than in the normal T3 group. Level of white blood cell,C response protein,fasting glucose (all P<0.01) as well as creatinine (P=0.035) were significantly higher, while level of FT3 and left ventricular ejection fraction (LVEF) were significantly lower (both P<0.01) in low T3 group than in normal T3 group. Multivariate logistic regression analysis revealed that LVEF at admission less than 40% (OR=6.615,95%CI 1.186-36.907, P=0.031) and FT3 level less than 1.79 ng/L (OR=9.131, 95%CI 1.577-52.857, P=0.014) were independent risk factors of increased composite adverse cardiovascular events in patients with acute viral myocarditis. Conclusion: Low FT3 increases the risk of adverse cardiovascular events in adult patients with acute viral myocarditis.

Intermediate monocytes are associated with the first major adverse cardiovascular event in patients with stable coronary artery disease

Prognostic value of malnutrition using geriatric nutritional risk index in patients with coronary chronic total occlusion after percutaneous coronary intervention

To investigate the relationship between serum kallikrein 1 (KLK1) and SRY-box transcription factor 6 (SOX6) levels and major adverse cardiovascular events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI) following percutaneous coronary intervention (PCI). A total of 150 STEMI patients who underwent PCI from October 2021 to October 2022 were included in this study. Patients were divided into MACE and Non-MACE groups based on the occurrence of postoperative adverse cardiovascular events. General data, laboratory findings, and imaging results were compared between the two groups. Logistic regression analysis was used to identify factors influencing MACE, which were further used to develop a joint prediction model. ROC curves were plotted to assess the predictive values of the model. MACE occurred in 20 patients (13.33%). The MACE group had significantly higher Killip grade (P = 0.020), elevated serum levels of cardiac troponin I (cTnI) (P = 0.040), creatine kinase (CK) (P = 0.044), KLK1 (P < 0.001), creatine kinase isoenzyme (CK-MB) (P = 0.043), and SOX6 (P < 0.001), as well as higher Gensini score (P = 0.040) and Grace score (P = 0.045). Logistic regression analysis identified KLK1 (OR = 1.015, P = 0.016) and SOX6 (OR = 1.823, P < 0.001) as independent risk factors for MACE. The combination of KLK1 and SOX6 showed excellent predictive value for MACE, with an AUC of 0.889. Elevated levels of KLK1 and SOX6 are associated with an increased risk of MACE. The combined detection of these biomarkers can effectively predict MACE, aiding in early identification and timely intervention for high-risk patients.

Introduction: Concern for an increased risk of pancreatitis in patients prescribed glucagon-like peptide-1 receptor agonists (GLP1RAs) persists despite the lack of firm causality. Clinicians may therefore be hesitant to prescribe this treatment in patients at higher risk of pancreatitis, such as those with hypertriglyceridemia (HTG). Conversely, GLP-1RAs can positively affect triglyceride (TG) homeostasis and lead to lower plasma TG. This study evaluated whether GLP1RAs were associated with an increased risk of pancreatitis and major adverse cardiovascular events (MACE) in patients with and without HTG. Methods: We queried the Intermountain Health electronic medical records for patients ≥18 years old from January 2006 to April 2025 with Type 2 diabetes (T2D) and/or body mass index (BMI) ≥27 either on GLP1RA at baseline or never on GLP1RA with measured TG. Propensity score (PS) matching with a greedy nearest neighbor algorithm was used to pair the groups. Using the PS matched pairs, Cox-proportional hazard regressions (unadjusted and adjusted) were used to examine the risk of follow-up pancreatitis and MACE. Results: Of the 346,677 patients, 3834 (1.1%) patients were prescribed GPL1RA (342,843 (98.9%) without GLP1RA). Those on a GLP1RA were older, more likely to be non-Hispanic, have lower rates of alcohol abuse and higher BMI, Hgb A1C, and TG, and tended to have more comorbidities and medication use (Table 1). The PS matching resulted in a well-matched cohort of 3833 pairs (Table 1). The rate of pancreatitis was similar in those on GLP1RA compared to those not (2.5% vs 2.6%, p=0.72) (Table 2). The risk of pancreatitis was further examined by baseline TG levels. For patients with severe TG levels (≥500 mg/dL), those on a GLP1RA had a non-significant decrease in pancreatitis (8.7% vs 10.9%, p=0.60); however, after adjustment for prior pancreatitis history the hazard ratio (HR) for pancreatitis was over 4 times greater for those not on GLP1RA vs those on a GLP1RA. MACE events on GLP1RA were also lower (14.9% vs 18.5%, p&lt;0.0001) with MACE HR of 1.25 when not on GLP1RA (Table 2). Conclusions: These results support findings of prior studies that did not identify an increased risk of pancreatitis in patients prescribed a GLP1RA. Additionally, there was not an increased risk of pancreatitis in patients with HTG, including those with TG ≥ 500 mg/dL. Based on this analysis, prescribers may feel more confident about prescribing GLP1RAs to patients with HTG.

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.