Adverse Cardiovascular Research Articles

Differential Expression of Circulating miRNAs and Carfilzomib-Related Cardiovascular Adverse Events in Patients with Multiple Myeloma.

This study investigates the association between circulating microRNA (miRNA) expression and cardiovascular adverse events (CVAE) in multiple myeloma (MM) patients treated with a carfilzomib (CFZ)-based regimen. A cohort of 60 MM patients from the Prospective Observation of Cardiac Safety with Proteasome Inhibitor (PROTECT) study was analyzed. Among these, 31 patients (51.6%) developed CVAE post-CFZ treatment. The Taqman OpenArray Human microRNA panels were used for miRNA profiling. We identified 13 differentially expressed miRNAs at baseline, with higher expressions of miR-125a-5p, miR-15a-5p, miR-18a-3p, and miR-152-3p and lower expression of miR-140-3p in patients who later developed CVAE compared to those free of CVAE, adjusting for age, gender, race, and higher B-type natriuretic peptide levels. We also identified three miRNAs, including miR-150-5p, that were differentially expressed in patients with and without CVAE post-treatment. Additionally, five miRNAs responded differently to CFZ treatment in CVAE vs. non-CVAE patients, including significantly elevated post-treatment expression of miR-140-3p and lower expressions of miR-598, miR-152, miR-21, and miR-323a in CVAE patients. Pathway enrichment analysis highlighted the involvement of these miRNAs in cardiovascular diseases and vascular processes. These findings suggest that specific miRNAs could serve as predictive biomarkers for CVAE and provide insights into the underlying mechanisms of CFZ-CVAE. Further investigation is warranted before these findings can be applied in clinical settings.

Impact of Multiarterial Revascularization on Long-term Major Adverse Cardiovascular Events After Coronary Bypass in 23,798 Patients

BackgroundThis study evaluated the association between bypass grafting with multiarterial grafts (MAG) and single arterial grafts (SAG) and all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE), overall and across different patient subgroups from a Middle Eastern nation. MethodsThis single-center retrospective cohort study included 23,798 patients. MAG and SAG groups were balanced using inverse probability weighting (IPW). Associations between MAG and outcomes were assessed using Cox regression. A series of covariate-adjusted Cox models were conducted to evaluate the effect of MAG on outcomes at different levels of independent variables, including age, sex, and cardiovascular risk factors. ResultsIn the study population (73.9% were men, 65.11 ± 9.94 years), 986 patients (4.1%) underwent MAG. Compared with the SAG group, MAG had lower crude mortality (14.1% vs 21.6%) and MACCE (28.8% vs 34.7%) rates during a median follow-up of 9.23 years (quartile 1-quartile 3, 9.13-9.33 years). Although MAG was significantly associated with reduced risk of study outcomes at the univariate level, these associations disappeared after matching (all-cause mortality (IPW hazard ratio, 0.90; 95% CI, 0.67-1.22) and MACCEs (IPW hazard ratio, 0.94; 95% CI, 0.76-1.15). However, covariate-adjusted models indicated that MAG was associated with a significantly reduced risk of adverse events, particularly MACCEs, in men, younger patients, and those without risk factors. ConclusionsMAG was not associated with improved postsurgery outcomes among the total coronary artery bypass graft population. Our findings, however, should be interpreted in the context of a relatively low total institutional MAG burden. Choosing a second arterial conduit over saphenous vein grafts in specific patient subgroups might be reasonable. This hypothesis-generating finding should be investigated in future clinical trials in these patients.

Value of Echocardiographic Evaluation of Myocardial Performance Index in Predicting Major Adverse Cardiovascular Events Within 1 Year after Percutaneous Coronary Intervention in Patients with Coronary Heart Disease

Objective: This study aimed to evaluate the predictive efficacy of the echocardiography-derived Tei index for the occurrence of major adverse cardiovascular events (MACE) within 1 year post-percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Methods: A total of 98 patients diagnosed with CHD and admitted to our hospital between January 2021 and May 2023 were retrospectively selected for this study, and the two groups were divided into good prognosis group (n = 67) and poor prognosis group (n = 31) according to whether cardiovascular adverse events occurred within 1 year after PCI. Univariate and multivariate logistic regression analyses were conducted to identify the influencing factors of adverse cardiovascular events in patients with CHD following PCI, and receiver operating characteristic (ROC) analysis was employed to evaluate the efficacy of myocardial performance index measured by echocardiography in predicting adverse cardiovascular events within 1 year post-PCI in patients with CHD. The inflammatory factors of patients with different Tei indices were compared before and 24 h after PCI. Results: The differences in general data, including preoperative Tei index, left anterior descending (LAD) level, left ventricular diameter in diastole (LVDd) level, and the number of cases with left ventricular outflow tract obstruction, were not statistically significant between two groups (p > 0.05). Left ventricular ejection fraction (LVEF), maximum left ventricular thickness, postoperative Tei index, plaque score, and carotid intima–media thickness (IMT) showed statistically significant differences (p < 0.05). The findings from logistic regression analysis, considering multiple factors, indicated that Tei index, plaque score, and carotid IMT were independent predictors for adverse cardiovascular events following PCI in patients with CHD (p < 0.05). ROC analysis demonstrated an impressive area under the curve of 0.967 for echocardiographic assessment of myocardial performance index as a predictor for adverse cardiovascular events within 1 year after PCI in patients with CHD. The standard error was 0.017, 95% confidence interval was 0.935–0.999, optimal cut-off value was 0.88, sensitivity was 95.0%, and specificity was 93.3%. The comparison of inflammatory factors among patients with different Tei index values before PCI did not yield any statistically significant differences (p > 0.05), and the comparison of inflammatory factors in patients with different Tei index 24 h after PCI. The levels of inflammatory cytokines in patients with Tei ≤0.5 were lower than those in patients with Tei >0.5 (p < 0.05). Conclusion: Evaluating the myocardial performance index through echocardiography holds considerable value in predicting MACE within one year following PCI in patients diagnosed with CHD.

Carotid Plaque Score is Associated with 10-year Major Adverse Cardiovascular Events in Low-Intermediate Risk Patients Referred to a General Cardiology Community Clinic.

Atherosclerotic carotid plaque assessments have not been integrated into routine clinical practice due to the time-consuming nature of both imaging and measurements. Plaque score, Rotterdam method, is simple, quick, and only requires 4-6 B-mode ultrasound images. The aim was to assess the benefit of plaque score in a community cardiology clinic to identify patients at risk for major adverse cardiovascular events (MACE). Patients ≥40 years presenting for risk assessment were given a carotid ultrasound. Exclusions included a history of vascular disease or MACE and being >75 years. Kaplan-Meier curves and hazard ratios were performed. The left and right common carotid artery (CCA), bulb, and internal carotid artery (ICA) were given 1 point per segment if plaque present (plaque score 0 to 6). Administrative data holdings at ICES were used for 10-year event follow-up. Of 8,472 patients, 60% were females (n = 5,121). Plaque was more prevalent in males (64% vs 53.9%; P <0.0001). The 10-year MACE cumulative incidence estimate was 6.37% with 276 events (males 6.9 % vs females 6.0%; P = 0.004). Having both maximal CCA IMT <1.00 mm and plaque score = 0, was associated with less events. A plaque score <2 was associated with a low 10-year event rate (4.1%) compared to 2-4 (8.7%) and 5-6 (20%). A plaque score ≥2 can re-stratify low-intermediate risk patients to a higher risk for events. Plaque score may be used as a quick assessment in a cardiology office to guide treatment management of patients.

The Characteristics of Cardiovascular Adverse Events in Therapy with Immune Checkpoint Inhibitors: The Result of Work of the Multi-Disciplinary Team

The Characteristics of Cardiovascular Adverse Events in Therapy with Immune Checkpoint Inhibitors: The Result of Work of the Multi-Disciplinary Team

Cardiovascular and Cerebrovascular Adverse Events Associated with Intravitreal Anti-VEGF Monoclonal Antibodies: A World Health Organization Pharmacovigilance Study

PurposeTo analyze cardiovascular and cerebrovascular adverse events (ADRs) after intravitreal anti-vascular endothelial growth factor (VEGF; aflibercept, bevacizumab, brolucizumab, and ranibizumab) treatment. SubjectsVigiBase, a World Health Organization (WHO) global safety report database DesignPharmacovigilance study MethodsThe individual-case-safety reports (ICSR) of cardiovascular and cerebrovascular ADRs after intravitreal anti-VEGF treatment were compared with those reported in the full database. From 2004 to 2023, 23,129 ADRs after intravitreal anti-VEGF therapy and 25,015,132 ADRs associated with any drug (full database). Main Outcome MeasuresThe reporting odds ratio (ROR) and information components (IC) were calculated, and the 95% lower credibility interval endpoint of the information component (IC025) was used for disproportionate Bayesian reporting. Inter-drug comparisons were performed using the ratio of odd ratio (rOR). ResultsCompared with the full database, anti-VEGFs were associated with an increased reporting of myocardial infarction (IC025 0.75; ROR: 1.78 [95% CI 1.70–1.86]), angina pectoris (IC025 0.53; ROR: 1.61 [95% CI 1.47–1.77]), arrythemias including atrial fibrillation, atrial flutter, ventricular fibrillation, supraventricular tachycardia (all IC025 >0, ROR>1), hypertension (IC025 2.22; ROR: 4.91 [95% CI 4.82–5.01]), and hypertensive crisis (IC025 1.97; ROR: 4.49 [95% CI 4.07–4.97]). Moreover, anti-VEGFs were associated with a higher reporting of cerebrovascular ADRs such as cerebral infarction (IC025 4.34; ROR: 23.19 [95% CI 22.10–24.34]), carotid artery stenosis (IC025 1.85; ROR: 5.24 [95% CI 3.98–6.89]), cerebral hemorrhage (IC025 2.29; ROR: 5.38 [95% CI 5.03–5.76]), and subarachnoid hemorrhage (IC025 1.98; ROR: 4.81 [95% CI 4.14–5.6]). Inter-drug comparison indicated that compared to ranibizumab, patients with aflibercept showed overall under-reporting of cardiovascular and cerebrovascular ADRs such as myocardial infarction (rOR 0.55 [95% CI 0.49–0.52]), atrial fibrillation (rOR 0.28 [95% CI 0.23–0.35]), cerebrovascular accident (rOR, 0.15 [95% CI 0.14–0.17]), and cerebral hemorrhage (rOR, 0.51 [95% CI 0.40–0.65]). ConclusionsIn this pharmacovigilance case-noncase study, significantly increased reporting of cardiovascular and cerebrovascular ADRs were identified after intravitreal anti-VEGF treatment. While ranibizumab may exhibit superior systemic safety regarding its biological characteristics, it is crucial not to overlook the occurrence of cardiovascular and cerebrovascular ADRs considering its higher reporting rate than bevacizumab or aflibercept.

Clinical Characteristics and Major Adverse Cardiovascular Events in Diabetic and Non-Diabetic Patients with Vasospastic Angina [Letter

Clinical Characteristics and Major Adverse Cardiovascular Events in Diabetic and Non-Diabetic Patients with Vasospastic Angina [Letter

Glucagon-Like Peptide-1 Receptor Agonists and Major Adverse Cardiovascular Events in Patients With and Without Diabetes: A Meta-Analysis of Randomized-Controlled Trials.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown encouraging results regarding cardiovascular outcomes mainly in patients with diabetes. In the present study, we compared the efficacy of GLP-1 RAs in cardiovascular events between patients with and without diabetes. After finding eligible studies assessing the impact of GLP-1 RAs on cardiovascular events in patients with and without diabetes using a systematic search, we performed a meta-analysis on randomized-controlled trials (RCTs) comparing cardiovascular outcomes between patients taking GLP-1 RAs and placebo stratified by the presence or absence of diabetes. Relative risk (RR) and its 95% confidence interval (CI) were set as the reporting effect size using the random-effects model. A total of 24 RCTs (50 033 with GLP-1 RAs and 44 514 with placebo) were included. Patients on GLP-1 RAs had lower risk of major adverse cardiovascular events (MACE) (RR 0.87, 95% CI0.82-0.93), cardiovascular death (RR 0.88, 95% CI0.82-0.94), myocardial infarction (MI) (RR 0.87, 95% CI0.77-0.97), stroke (RR 0.86, 95% CI0.80-0.92), and hospitalization for heart failure (RR 0.90, 95% CI0.83-0.98). Both subgroups were shown to be effective in terms of MACE and mortality. Nondiabetic patients had decreased risk of hospitalization for heart failure and MI, whereas the diabetic subgroup had marginally nonsignificant efficacy. The findings of this meta-analysis indicated that patients who are overweight/obese but do not have diabetes have a comparable reduction in the risk of adverse cardiovascular events as those with diabetes. These results need to be confirmed further by large-scale randomized trials in the future.

Non-Calcified Plaque Burden Is Associated With Increased Major Adverse Cardiovascular Events In A High Risk Appalachian Population With Low Coronary Artery Calcium Scores (0-100)

Non-Calcified Plaque Burden Is Associated With Increased Major Adverse Cardiovascular Events In A High Risk Appalachian Population With Low Coronary Artery Calcium Scores (0-100)

The Role Of Peri-coronary Fat Attenuation Index In Predicting Future Major Adverse Cardiovascular Events Across Baseline Cardiovascular Risk: Findings From A Large-scale Meta-analysis

The Role Of Peri-coronary Fat Attenuation Index In Predicting Future Major Adverse Cardiovascular Events Across Baseline Cardiovascular Risk: Findings From A Large-scale Meta-analysis

Triglyceride-Glucose Index as a Predictor of Major Adverse Cardiovascular Events in Post-PCI Patients Diagnosed with In-Stent Restenosis.

The triglyceride-glucose index (TyG) is a reliable indicator for predicting the prognosis of patients with coronary heart disease (CAD) after percutaneous coronary intervention (PCI). However, its influence on patients with in-stent restenosis (ISR) is unclear. This study was designed to evaluate the association between the TyG index and the occurrence of major adverse cardiovascular events (MACEs) after PCI in patients with ISR. This retrospective study included 1654 patients who underwent PCI between 2016 and 2022 at Nanjing First Hospital. Patients were stratified into three groups based on the quantile level of the TyG index. The TyG index was determined as Ln (triglycerides [mg/dL] × fasting plasma glucose [mg/dL]/2). Individuals with the highest TyG index showed an increased risk of MACEs compared to those with the lowest level of the TyG index (HR 1.60; 95% CI 1.11-2.30; P = 0.01). When analyzing the TyG index as a continuous variable, each standard deviation increase was associated with an HR of 1.51 (95% CI: 1.11-2.05; P = 0.01). For the male subgroup and the diabetes subgroup, this trend was even more pronounced (HR 1.269; 95% CI 1.055-1.527; P = 0.011; HR 1.385; 95% CI 1.125-1.706; P = 0.002). Additionally, the landmark analysis showed that patients with the highest level of TyG had an increased risk of MACEs 6 months after the PCI (P = 0.019). Elevated TyG index is associated with increased risk of adverse cardiovascular events in patients with ISR, and the extent of increase in the risk is more significant in male patients with diabetes.

Relation Of Coronary Calcium Scoring And Adverse Cardiovascular Events In Middle-aged Adults With Anomalous Coronary Arteries: A Retrospective Analysis

Relation Of Coronary Calcium Scoring And Adverse Cardiovascular Events In Middle-aged Adults With Anomalous Coronary Arteries: A Retrospective Analysis

Association of Hematological Biomarkers of Inflammation with 10-Year Major Adverse Cardiovascular Events and All-Cause Mortality in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: The ARIC Study.

Metabolic dysfunction-associated steatotic liver disease (MASLD) increases the risk of cardiovascular disease and existing evidence indicates that MASLD affects the cardiovascular system through systemic inflammation. Our aim was to assess the association of hematological biomarkers of inflammation with the 10-year risk of major adverse cardiovascular events (MACE) and all-cause mortality in MASLD patients. A total of 1858 MASLD participants from the Atherosclerosis Risk in Communities cohort study at visit 2 (1990-1992) were included. A total of 1338 non-MASLD participants were also included in the comparison. At baseline, hematological biomarkers of inflammation such as leukocytes, neutrophils, lymphocytes, monocytes, and C-reactive protein (CRP) were measured. Participants were followed up for MACE and all-cause mortality for a period of 10 years. Multivariate adjusted Cox models were used to estimate hazard ratios (HR). The 10-year MACE was higher in MASLD participants than in non-MASLD participants (20.8% vs 9.3%). Monocytes (HR 1.114, [95% CI, 1.022-1.216] per 1-SD, P=0.015) and CRP (HR 1.109 [95% CI, 1.032-1.190] per 1-SD, P=0.005) were associated with an increased 10-year risk of MACE, independent of other cardiovascular risk factors. This association was specific to the MASLD population. None of these hematological biomarkers demonstrated a significant association with 10-year all-cause mortality. Increased levels of monocytes and CRP were associated with an increased 10-year risk of MACE in the MASLD population. Hematological biomarkers of inflammation may help identify MASLD populations at higher risk for cardiovascular events.

Pericoronary Adipose Tissue Density Relates To Increased Cardiovascular Adverse Events In Patients With Stable Chest Pain: Insights From The PROMISE Trial

Pericoronary Adipose Tissue Density Relates To Increased Cardiovascular Adverse Events In Patients With Stable Chest Pain: Insights From The PROMISE Trial

Pericoronary Adipose Tissue Density Relates To Increased Cardiovascular Adverse Events In Patients With Stable Chest Pain: Insights From The PROMISE Trial

Pericoronary Adipose Tissue Density Relates To Increased Cardiovascular Adverse Events In Patients With Stable Chest Pain: Insights From The PROMISE Trial

COMPARATIVE EFFICACY OF INTRACORONARY VERAPAMIL AND ADRENALINE IN MANAGING CORONARY NO-REFLOW DURING PRIMARY PCI IN STEMI PATIENTS AT A TERTIARY CARE HOSPITAL

Coronary No-Reflow (CNR) is a significant complication during Primary Percutaneous Coronary Intervention (PPCI) for ST-Elevation Myocardial Infarction (STEMI), often leading to poor clinical outcomes. Management strategies for CNR include various pharmacological agents, among which intracoronary verapamil and intracoronary adrenaline are commonly used alongside Glycoprotein IIb/IIIa inhibitors. Objective: This study aims to compare the effectiveness of intracoronary verapamil versus intracoronary adrenaline, alongside Glycoprotein IIb/IIIa inhibitors, in managing Coronary No-Reflow (CNR) during Primary Percutaneous Coronary Intervention (PPC1) for STEMI patients. Methodology: This randomized-control-trial was conducted at the Department of Cardiology, MTI Lady Reading Hospital Peshawar, Pakistan, from May 2023 to April 2024. Fifty patients diagnosed with CNR during PPC1 were randomised into two groups: adrenaline and verapamil. The primary outcome measures were TIMI Flow Grade (TFG) and Myocardial Blush Grade (MBG) immediately post-intervention. In contrast, secondary outcomes included Major Adverse Cardiovascular Events (MACE), myocardial infarction, stroke, target vessel revascularisation, mortality, and Left Ventricular Ejection Fraction (LVEF) assessed at baseline and one-month follow-up. Statistical analyses were performed using IBM SPSS version 20, with significance at P&lt;0.05. Results: Baseline characteristics, procedural details, and initial TIMI flow grades were similar between groups. Adrenaline achieved universal TIMI 3 flow compared to 84% with verapamil (p=0.049), but no significant differences were noted in myocardial blush grades. Adrenaline led to significantly higher follow-up LVEF (45.0 ± 9.0 vs. 39.0 ± 9.0, p=0.027) and a more significant percentage change in LVEF (20.97% vs. 8.94%, p=0.042) than verapamil. Adverse event rates were comparable except for lower MACE incidence at 30 days with adrenaline (8.0% vs. 24.0%, p=0.039). Conclusion: Adrenaline notably enhanced TIMI 3 flow rates, improved left ventricular ejection fraction, and decreased significant adverse cardiovascular events at 30 days compared to verapamil. These findings suggest that adrenaline may be a superior option for improving coronary blood flow and early clinical outcomes in this patient population.

Risk factors for MACE and bleeding in atrial fibrillation patients undergoing surgery: Insights from the bridge trial

IntroductionPatients with atrial fibrillation (AF) undergoing elective procedures are at risk for Major Adverse Cardiovascular Events (MACE) and symptomatic bleeding. We aimed to identify risk factors to guide perioperative risk stratification. MethodsWe conducted a post-hoc analysis of the “Bridging Anticoagulation in Patients who Require Temporary Interruption of Warfarin Therapy for an Elective Invasive Procedure or Surgery” randomized trial. The primary outcomes were MACE and symptomatic bleeding. Our statistical approach encompassed standard univariate analysis, logistic stepwise regression, and Cox regression models. Additional interaction analyses evaluated the interplay between low-molecular-weight heparin bridge therapy and other identified risk factors. ResultsAmong a total of 1,813 participants (mean age 71.6 ± 8.8, 73.3 % male), MACE occurred in 25 (1.4 %) individuals, with pre-procedure clopidogrel use (adjusted hazard ratio [aHR] 7.73, 95 % CI 2.63-22.72, p < 0.001) and CHA2DS2-VASc score ≥ 5 (aHR 2.89, 95 % CI 1.26-6.63, p = 0.012) identified as risk factors. Symptomatic bleeding occurred in 57 (3.1 %) individuals, with bridge therapy (aHR 1.84, 95 % CI 1.07-3.19, p = 0.029), renal disease (aHR 2.50, 95 % CI 1.34-4.67, p = 0.004), post-procedure aspirin use (aHR 2.86, 95 % CI 1.66-4.91, p < 0.001), post-procedure nonsteroidal anti-inflammatory drug use excluding aspirin (aHR 3.40, 95 % CI 1.22-9.43, p = 0.019), and major surgery (aHR 3.94, 95 % CI 2.26-6.85, p < 0.001) identified as risk factors. The interactions between risk factors and bridging therapy on MACE and symptomatic bleeding outcomes were not significant (p > 0.05). ConclusionWe identified predictors for MACE and symptomatic bleeding in AF patients undergoing elective procedures. These insights may help guide perioperative decisions to reduce the risk of adverse outcomes.

Myocardial Bridging Increases the Risk of Adverse Cardiovascular Events in Patients without Coronary Atherosclerosis.

Background: Myocardial bridging (MB) is a congenital coronary anomaly and an important cause of chest pain. The long-term effects of MB on cardiovascular events remain elusive. Methods: We used the National Health Insurance Research Database of Taiwan to conduct an analysis. All patients who had undergone coronary angiography were considered for inclusion. The primary endpoint was a composite of nonfatal myocardial infarction, nonfatal ischemic stroke, and cardiovascular death. Results: We identified 10,749 patients from 2008 to 2018 and matched them with an equal number of controls by propensity-score matching. The mean follow-up period was 5.78 years. In patients without coronary artery disease, MB increased the risk of the composite endpoint (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.44-1.72, p < 0.001), which was driven by increased risks of nonfatal myocardial infarction and cardiovascular death. In patients with significant coronary artery disease, MB did not increase the risk of major adverse cardiovascular events. MB was identical to insignificant coronary artery disease from the viewpoint of clinical outcomes. Conclusions: The presence of MB significantly increases cardiovascular risks in patients with normal coronary vessels. Atherosclerotic coronary artery disease mitigates the effect of MB on cardiovascular outcomes. MB can be considered an insignificant coronary artery disease equivalent.

Risk factors and prognostic value of endotoxemia in patients with acute myocardial infarction.

There is increasing evidence regarding the association between endotoxemia and the pathogenesis of atherosclerosis and myocardial infarction (MI). During the acute phase of MI, endotoxemia might increase inflammation and drive adverse cardiovascular (CV) outcomes. We aimed to explore the risk factors and prognostic value of endotoxemia in patients admitted for acute MI. Patients admitted to the coronary care unit of Dijon University Hospital for type 1 acute MI between 2013 and 2015 were included. Endotoxemia, assessed by plasma lipopolysaccharide (LPS) concentration, was measured by mass spectrometry. Major adverse CV events were recorded in the year following hospital admission. Data from 245 consecutive MI patients were analyzed. LPS concentration at admission markedly increased with age and diabetes. High LPS concentration was correlated with metabolic biomarkers (glycemia, triglyceride, and total cholesterol) but not with CV (troponin Ic peak and N-terminal pro-brain natriuretic peptide) or inflammatory biomarkers (C-reactive protein, IL6, IL8, and TNFα). LPS concentration was not associated with in-hospital or 1-year outcomes. In patients admitted for MI, higher levels of endotoxins were related to pre-existing conditions rather than acute clinical severity. Therefore, endotoxins measured on the day of MI could reflect metabolic chronic endotoxemia rather than MI-related acute gut translocation.

Adverse Cardiovascular Outcomes in Patients With Obstructive Sleep Apnea and Obesity: Metabolic Surgery vs Usual Care

BackgroundNo therapy has been shown to reduce the risk of major adverse cardiovascular events (MACE) and death in patients with obstructive sleep apnea (OSA). ObjectivesThe authors sought to investigate the long-term relationship between metabolic surgery and incident MACE in patients with OSA and obesity. MethodsAdult patients with a body mass index 35 to 70 kg/m2 and moderate-to-severe OSA at a U.S. health system (2004-2018) were identified. Baseline characteristics of patients who underwent metabolic surgery were balanced with a nonsurgical control group using overlap-weighting methods. Multivariable Cox regression analysis estimated time-to-incident MACE. Follow-up ended in September 2022. ResultsA total of 13,657 patients (7,496 [54.9%] men; mean age 52.0 ± 12.4 years; median body mass index 41.0 kg/m2 [Q1-Q3: 37.6-46.2 kg/m2]), including 970 patients in the metabolic surgery group and 12,687 patients in the nonsurgical group, with a median follow-up of 5.3 years (Q1-Q3: 3.1-8.4 years) were analyzed. The mean between-group difference in body weight at 10 years was 26.6 kg (95% CI: 25.6-27.6 kg) or 19.3% (95% CI: 18.6%-19.9%). The 10-year cumulative incidence of MACE was 27.0% (95% CI: 21.6%-32.0%) in the metabolic surgery group and 35.6% (95% CI: 33.8%-37.4%) in the nonsurgical group (adjusted HR: 0.58 [95% CI: 0.48-0.71]; P < 0.001). The 10-year cumulative incidence of all-cause mortality was 9.1% (95% CI: 5.7%-12.4%) in the metabolic surgery group and 12.5% (95% CI: 11.2%-13.8%) in the nonsurgical group (adjusted HR: 0.63 [95% CI: 0.45-0.89]; P = 0.009). ConclusionsAmong patients with moderate-to-severe OSA and obesity, metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident MACE and death.