Erectile dysfunction and major adverse cardiovascular events in prostate cancer: A propensity score matching study

To explore the association between the use of β-blockers and the risks of all-cause mortality and major adverse cardiovascular events (MACEs) in patients with stable coronary artery disease (SCAD) after percutaneous coronary intervention (PCI). We performed secondary analyses of the data of 55 SCAD patients receiving post-PCI β-blocker treatment and 149 patients without post-PCI β‑blockers (control group) from the Dryad database. The clinical and coronary artery disease characteristics of the patients were analyzed, and propensity score matching was used to compare all-cause mortality and MACEs (including cardiovascular death, non-fatal myocardial infarction and non-fatal stroke) between the two groups. The overall patients (69.6% were male) had a mean age of 72.6±10.3 years with a median follow-up time of 783 days. A total of 18 patients (8.8%) died, and MACEs occurred in 19 patients (9.3%), including cardiovascular death in 6 cases (2.9%), non-fatal myocardial infarction in 3 cases (1.5%) and non-fatal stroke in 11 cases (5.4%). In the β‑blocker group, deaths occurred in 5 cases (9.1%), and MACEs in 4 cases (7.3%), including 2 cases with cardiovascular death (3.6%) and 2 cases with non-fatal stroke (3.6%). Kaplan-Meier survival curve analysis showed that the use of β-blockers after PCI was not associated with a reduced all-cause mortality (8.7% vs 9.1%, log-rank P=0.870) or incidence of MACEs (10.1% vs 7.3%, log-rank P=0.510) either before or after adjusting for age, sex, aspartate aminotransferase, estimated glomerular filtration rate, left ventricular ejection fraction, and history of atrial fibrillation (HR=0.81, 95% CI: 0.24-2.72; HR=0.62, 95% CI: 0.22-1.69). No significant differences were found in all-cause death or MACEs between the two groups after propensity score adjustment, matching, or IPTW inverse probability weighting (all P>0.05). Routine use of β-blockers after PCI does not reduce the incidence of all-cause death or MACEs in patients with SCAD.

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.

The association between the triglyceride–glucose (TyG) index and the risk of major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD) stages 3–4 has not been extensively studied. This study aims to investigate the relationship between baseline TyG index and MACE risk in a CKD stage 3–4 population. This study utilized data from the 2000–2022 China Renal Data System. Multivariate regression analysis models were constructed to explore the association between baseline TyG index and MACE. We employed restricted cubic splines to examine potential nonlinear correlations between these variables. Subgroup analyses were performed for different clinical endpoints. A total of 48,935 participants with CKD stages 3–4 were enrolled, with a mean TyG index of 8.88 [8.45, 9.38]. Participants were divided into quartiles based on TyG index values (quartile thresholds: 8.33, 8.78, 9.24). The overall prevalence of MACE was 15.90%. Multivariate Cox regression indicated a significant association between TyG quartiles and MACE occurrence, with hazard ratios (HR) of 1.08 (95% CI: 1.01–1.15, p = 0.016) for Quartile 1 and 1.12 (95% CI: 1.05–1.20, p = 0.001) for Quartile 4. Restricted cubic spline analysis revealed a nonlinear relationship between TyG index and MACE risk (P for nonlinearity < 0.001) among individuals with CKD stages 3–4. In patients with CKD stages 3–4, the TyG index shows a nonlinear association with the risk of MACE and all-cause mortality. These findings suggest that both elevated and reduced TyG index levels may increase the likelihood of MACE and all-cause mortality.

BackgroundAs defined by the Controlling Nutrition Status (CONUT) score, the prognostic significance of nutritional status has attracted attention in patients with cardiovascular disease. This meta-analysis aimed to determine the importance of CONUT score for prediction of all-cause mortality and major adverse cardiovascular events (MACE) in adult patients with coronary artery disease (CAD).MethodsObservational studies conducted to evaluate the association of CONUT score with adverse clinical outcomes in patients with CAD were included. We searched MEDLINE, Embase, Scopus, Cochrane library, Google scholar, medRxiv pre-print as well as Science Direct search engine for studies published from the inception of each database until March 21, 2022. Studies reporting the utility of CONUT score in prediction of all-cause mortality and MACE among patients with CAD were eligible. Predictive potential of the CONUT score were summarized by pooling the multivariable adjusted hazard ratio (aHR) with 95% CI for the malnourished vs. normal nutritional status or per point CONUT score increase.ResultsOf 2,547 screened citation, nine observational studies involving 81,257 patients with CAD were analyzed. Malnutrition defined by the CONUT score was associated with significantly increased risk of all-cause mortality when compared with the normal nutritional state (aHR for mild, moderate, and severe malnutrition, respectively: (1.21 [95% CI: 1.15–1.27], I2 = 0%), (1.53 [95% CI: 1.26–1.84], I2 = 84%), and (2.24 [95% CI: 1.57–3.19], I2 = 77%). Similarly, moderate (aHR 1.71 [95% CI: 1.44–2.03], I2 = 0%) and severe (aHR 2.66 [95% CI: 1.82–3.89], I2 = 0%) malnutrition was associated with a significantly higher risk of MACE compared with the normal nutritional state. Additionally, per point increase in the CONUT score was correlated with 20 and 23% additional risk of all-cause mortality and MACE, respectively.ConclusionAs defined by the CONUT score, malnutrition is an independent predictor of all-cause mortality and MACE in CAD patients. Nutritional assessment with CONUT score could allow clinicians to identify patients with CAD at high risk for adverse clinical outcomes.

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 &lt;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.

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.

Background The triglyceride-glucose index (TyG) has gained attention as an alternative indicator for assessing insulin resistance (IR). The purpose of this study was to comprehensively summarize the correlation between the TyG index and cardiovascular events in patients with coronary revascularization. Methods PubMed, Web of Science, Embase, and The Cochrane Library databases were searched to find relevant literature on the prognostic assessment of TyG index in patients undergoing coronary artery revascularization. Utilize the risk ratio (RR) and its 95% confidence interval (CI) as the standard for assessing the correlation between TyG and major adverse cardiovascular events (MACEs) in patients undergoing coronary artery revascularization. Conduct sensitivity analysis and subgroup analysis to detect the sources of heterogeneity and assess the stability of the results. Results A total of 12 studies involving 9,973 participants were included. The results of the study indicate that a high TyG index was related to the major adverse cardiovascular event in patients undergoing coronary artery revascularization (RR:2.0,95%CI: 1.71–2.35, I2 =76.2%, p < 0.0001). Subgroup analysis reveals that the probability of MACEs occurring in patients with high TyG index is higher than in those with low TyG index after two different coronary artery revascularization procedures: CABG group (RR:2.10, 95%CI:1.80–2.45, I2 = 20.9%, p = 0.0001). PCI group: (RR:1.94, 95%CI:1.54–2.46, I2 = 84.2%, p < 0.00001). Additionally, we also demonstrated the prognostic value of the TyG index in all-cause mortality(p = 0.003), non-fatal myocardial infarction(p = 0.003), non-fatal stroke(p < 0.0001) and repeat revascularization(p < 0.0001). Conclusions Higher TyG index may be independently associated with higher incidence of MACEs in patients with coronary revascularization.

The triglyceride-glucose (TyG) index, a surrogate marker for insulin resistance, has been shown to be closely associated with cardiovascular risk. However, it remains unclear whether diabetes status affects the association between the TyG index and the risk of major adverse cardiovascular events (MACEs) in patients with coronary heart disease (CHD). The aim of this study is to systematically evaluate the relationship between the TyG index and MACEs among CHD patients with different diabetes statuses. We systematically searched PubMed, the Cochrane Library, Web of Science, and Embase from inception to March 13, 2025, for cohort studies examining the association between TyG and MACEs in patients with CHD with different diabetes statuses. The outcomes included all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, and revascularization. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were extracted for the TyG index as both categorical and continuous variables. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). All the statistical analyses were performed using Stata (version 17.0) and R (version 4.4.1). Depending on heterogeneity, either a fixed-effect or random-effects model was used to pool the data. Subgroup analysis and meta-regression are used to explore the sources of heterogeneity. This study was registered in PROSPERO (CRD: 420251018545). A total of 36 longitudinal cohort studies comprising 173,851 participants (119,232 with diabetes and 54,619 without diabetes) were included, with 9159 MACEs reported during the follow-up period. In diabetic patients, a higher TyG index significantly increased the risk of MACEs (categorical HR = 1.98, 95% CI 1.61-2.43; continuous HR = 1.57, 95% CI 1.38-1.78), all-cause mortality (HR = 1.74, 95% CI 1.45-2.08), nonfatal myocardial infarction (HR = 2.05, 95% CI 1.52-2.77), nonfatal stroke (HR = 1.73, 95% CI 1.12-2.66), and revascularization (HR = 2.52, 95% CI 1.26-5.04). In nondiabetic patients, a higher TyG index also significantly increased the risk of MACEs (categorical HR = 1.65, 95% CI 1.33-2.05; continuous HR = 1.74, 95% CI 1.46-2.06), all-cause mortality (HR = 1.50, 95% CI 1.18-1.90), nonfatal myocardial infarction (HR = 2.46, 95% CI 1.11-5.47), and revascularization (HR = 2.09, 95% CI 1.57-2.76). However, no association was observed between the TyG index and nonfatal stroke (HR = 1.66, 95% CI 0.88-3.12) in nondiabetic patients. Higher TyG index values appear to be associated with an increased risk of adverse cardiovascular events, all-cause mortality, nonfatal myocardial infarction, and revascularization in both diabetic and nondiabetic patients with CHD. However, no significant association was found between the TyG index and the risk of nonfatal stroke in nondiabetic patients. These findings suggest that the TyG index may offer potential prognostic value in CHD, but further high-quality prospective studies are warranted to confirm these associations and clarify their clinical implications.

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.

Objective: To evaluate the association between peripheral artery disease (PAD) and major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) in the Arabian Gulf. Methods: Data from 4,044 consecutive patients diagnosed with ACS admitted to 29 hospitals in four Arabian Gulf countries from January 2012 to January 2013 were analyzed. PAD was defined as any of the following: claudication, amputation for arterial vascular insufficiency, vascular reconstruction, bypass surgery, or percutaneous intervention in the extremities, documented aortic aneurysm or an ankle brachial index of <0.8 in any of the legs. MACE included stroke/transient ischemic attack (TIA), myocardial infarction (MI), all-cause mortality, and readmissions for cardiac reasons diagnosed between hospital admission and at 1-year post discharge. Analyses were performed using univariate and multivariate statistical techniques. Results: The overall mean age of the cohort was 60 ± 13 years and 66% (n = 2,686) were males. A total of 3.3% (n = 132) of the patients had PAD. Patients with PAD were more likely to be associated with smoking, prior MI, hypertension, diabetes mellitus, and stroke/TIA. At the 1-year follow-up, patients with PAD were significantly more likely to have MACE (adjusted OR [aOR], 2.07; 95% confidence interval [CI]: 1.41–3.06; p< 0.001). The higher rates of events were also observed across all MACE components; stroke/TIA (aOR, 3.22; 95% CI: 1.80–5.75; p< 0.001), MI (aOR, 2.15; 95% CI: 1.29–3.59; p =0.003), all-cause mortality (aOR, 2.21; 95% CI: 1.33–3.69; p =0.002), and readmissions for cardiac reasons (aOR, 1.83; 95% CI: 1.24–2.70; p =0.003). Conclusions: PAD was significantly associated with MACE in ACS patients in the Arabian Gulf.

Chronic kidney disease's impact on revascularization and subsequent major adverse cardiovascular events in patients with chronic coronary syndrome

BackgroundDespite optimal standard therapy, residual inflammation continues to increase major adverse cardiovascular events (MACE) in patients with coronary heart disease (CHD). New immunomodulatory drugs targeting specific immune pathways have shown mixed efficacy across trials, warranting comprehensive evaluation of their role in secondary prevention.MethodsWe performed a systematic review and meta-analysis of 25 randomized controlled trials (RCTs) from January 1, 2014, to October 1, 2024, identified from eight databases: the cochrane library, (public medicine) pubmed, embase, web of science, china national knowledge infrastructure (CNKI), wanfang data knowledge service platform(WanFang), Weipu information database(VIP), and china biomedical literature database (SinoMed). Eligible studies assessed the efficacy of immunomodulatory agents, including colchicine, and canakinumab on MACE. Primary outcome was MACE incidence; secondary outcomes included, angina, and inflammatory biomarkers. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using fixed or random-effects models. Subgroup analyses were conducted by drug class, follow-up duration, and CHD subtype (acute vs. chronic coronary syndrome). Risk of bias was assessed via Cochrane RoB 1.0, and evidence certainty rated with GRADE.ResultsOverall, new immunomodulatory drugs did not significantly reduce MACE (RR = 0.92; 95% CI: [0.84,1.01]; P = 0.09; I²=60%). However, subgroup analyses revealed heterogeneous effects across drug classes. Significant reductions in MACE were observed with NLRP3 inflammasome inhibitors (RR = 0.75; 95% CI: 0.65,0.86; P < 0.0001) and interleukin-pathway inhibitors (RR = 0.86; 95% CI: 0.75,0.97; P = 0.02). In contrast, no significant reduction in MACE incidence was found in the broad-spectrum immunomodulator group, Lp-PLA2 inhibitor group, or p38 MAPK kinase inhibitor group (all P > 0.05). Besides, benefits were evident only in trials with follow-up exceeding 6 months (RR = 0.89; 95% CI: [0.82,0.98]. Secondary outcomes showed significant reductions in angina (RR = 0.72; 95%CI: [0.58,0.90], P = 0.004), revascularization (RR = 0.85; 95%CI: [0.73,0.98], P = 0.03), IL-6 (SMD = − 0.82;95༅CI: [-1.62,-0.03], P = 0.02), and neutrophil count, but no effect on (cardiac arrest)CA, all-cause mortality, incidence of gastrointestinal adverse effect and high-sensitivity c-reactive protein(hs-CRP). The quality of evidence for MACE was assessed as moderate.ConclusionTargeted anti-inflammatory therapies, particularly colchicine and canakinumab, significantly reduce MACE in CHD patients when used for longer than six months. Efficacy varies by mechanism of action, supporting precision use of NLRP3 and IL-1β inhibitors. Future trials should been focus on biomarker-guided, long-term anti-inflammatory interventions in cardiovascular care.Trial Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024597008PROSPERO: CRD42024597008.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12872-025-05250-1.

PurposeChronic heart failure (CHF) is a major public health issue with high morbidity and mortality, where inflammation plays a key role in its progression. Tumor necrosis factor alpha-induced protein 3 (TNFAIP3) and NOD-like receptor protein 3 (NLRP3) regulate inflammatory responses, but their prognostic value in CHF remains unclear. This study aims to investigate the association between serum levels of TNFAIP3 and NLRP3 and the risk of major adverse cardiovascular events (MACEs) in patients with CHF.Patients and MethodsA cohort study was conducted involving 318 patients with CHF and 122 controls. Serum levels of TNFAIP3 and NLRP3 were measured using enzyme-linked immunosorbent assay method. Propensity score matching (PSM) was used to control for confounders. Multivariable logistic regression, restricted cubic spline, threshold effect, and receiver operating characteristic (ROC) analyses were employed to evaluate the associations between biomarker levels and MACEs over a 6-month follow-up.ResultsAfter PSM, patients with CHF had significantly higher TNFAIP3 and NLRP3 levels than controls (both p < 0.001). Compared to CHF patients without MACEs, those with MACEs exhibited significantly lower levels of TNFAIP3 and higher levels of NLRP3. Multivariable analysis confirmed TNFAIP3 as an independent protective factor [odds ratio (OR)= 0.61, 95% confidence interval (CI): 0.40–0.93) and NLRP3 as an independent risk factor (OR = 1.24, 95% CI: 1.17–1.31) for MACEs. ROC analysis demonstrated NLRP3 (AUROC = 0.756) had better predictive ability than TNFAIP3 (AUROC = 0.611).ConclusionTNFAIP3 and NLRP3 are significantly associated with the risk of MACEs in patients with CHF and NLRP3 demonstrates stronger predictive performance than TNFAIP3.

To investigate the association between the prognostic nutritional index (PNI) and major adverse cardiovascular events (MACE) and all-cause mortality in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). A total of 734 consecutive patients with AF and HFpEF were included in this retrospective cohort study, which was conducted at Yancheng First Hospital from July 2022 to July 2025. Cox proportional hazards regression models were applied to evaluate the relationship between PNI with MACE and all-cause mortality, with additional subgroup analyses performed across major clinical strata. The discriminative ability of PNI was examined using receiver operating characteristic (ROC) curve analysis, and restricted cubic spline (RCS) modeling was used to examine dose-response patterns. During a median follow-up of 35 months, 131 MACE were recorded (17.8%). In multivariable Cox regression, PNI analyzed as a continuous variable was inversely associated with MACE risk, with an adjusted hazard ratio (HR) of 0.904 (95% CI: 0.869-0.940); standardized PNI showed a similar and consistent association (HR = 0.578). Similarly, higher PNI was significantly associated with a reduced risk of all-cause mortality (P < 0.001). When assessed categorically by tertiles, patients in the highest PNI group (T3) had significantly lower risks of both MACE (HR = 0.366) and all-cause mortality (HR = 0.174) compared with the lowest tertile (P < 0.05). Similar inverse trends were observed across median, optimal cutoff, and quartile-based groupings (P < 0.05). Most subgroup analyses supported the inverse relationship between PNI and MACE (P < 0.05). ROC curve analysis showed that PNI demonstrated limited discriminatory ability for MACE with an area under the curve (AUC) of 0.654 (95% CI: 0.603-0.705). RCS analysis indicated a significant linear inverse association between PNI and MACE (P-overall < 0.001), with no evidence of non-linearity (P-nonlinear = 0.330). In patients with AF and HFpEF, higher PNI levels were independently associated with a reduced risk of MACE and all-cause mortality, indicating that PNI may serve as a potential adjunctive marker for risk stratification.

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