Cardiovascular Disease Mortality Research Articles

Cardiovascular mortality trends and disparities in U.S. breast cancer patients, 1999–2020: a population-based retrospective study

BackgroundBreast cancer survivors face a higher risk of cardiovascular disease (CVD) compared to non-breast cancer patients, yet contemporary data on CVD-related mortality within this group remains scarce.ObjectiveTo investigate trends and disparities in CVD mortality among breast cancer patients.MethodsWe queried the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC Wonder) and conducted serial cross-sectional analyses on national death certificate data for CVD mortality in breast cancer patients aged 25 and above from 1999 to 2020. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and analyzed trends over time using the Joinpoint Regression Program, with further analyses stratified by age, race, census region, and urbanization level.ResultsA total of 74,733 CVDs with comorbid breast cancer in the United States were identified between 1999 and 2020. The AAMR from CVDs with comorbid breast cancer decreased from 2.57 (95% CI [2.50–2.65]) in 1999 to 1.20 (95% CI [1.15–1.24]) in 2020, with an average annual percent change (AAPC) of − 4.3. The three most common causes of CVDs were ischemic heart disease (47.8%), cerebrovascular disease (17.1%), and hypertensive disease (10.6%). Our analysis revealed a significant decrease in AAMR for all CVD subtypes, except for hypertensive diseases and arrhythmias. The decrease in annual percent change (APC) was more pronounced in individuals aged ≥ 65 years compared to those < 65 years (-4.4, 95%CI [-4.9, -3.9] vs. -2.9, 95%CI [-4.1, -1.7], respectively. Notably, non-Hispanic Blacks consistently exhibited the highest AAMR (1.95, 95%CI [1.90–1.99]), whereas Hispanic or Latina patients had the lowest AAMR (0.75, 95% CI [0.72–0.78]). The AAMR was also higher in rural regions than in urban areas (1.64, 95%CI [1.62–1.67] vs. 1.55, 95%CI [1.53–1.56]).ConclusionThe study highlights a significant decline in CVD mortality among breast cancer patients over two decades, with persistent disparities by race and region. Exceptionally, hypertensive diseases and arrhythmias did not follow this declining trend.

Optimal Cut-off Points of the Standardized Continuous Metabolic Syndrome Severity Score (cMetS-S) for Predicting Cardiovascular Disease (CVD) and CVD Mortality in the Tehran Lipid and Glucose Study (TLGS)

Background: Metabolic Syndrome (MetS) is a prevalent condition associated with an increased risk of cardiovascular disease (CVD) and CVD mortality. Due to the limited clinical applicability of MetS, the standardized continuous metabolic syndrome severity score (cMetS-S) has the potential to provide continuous assessment of metabolic risk. Objectives: This study evaluated the optimal cMetS-S cut-off points in the Tehran lipid and glucose study (TLGS) for predicting CVD and CVD mortality. Methods: The study included 7,776 participants over 30 years old at baseline, followed for 18 years. Sex-specific sensitivity (SS) and specificity (SP) of cMetS-S measures for predicting CVD and CVD mortality were evaluated using a receiver operating characteristic (ROC) curve, along with the area under the curve (AUC), employing a naive estimator and considering event failure status and MetS variables. Results: The cut-off point of cMetS-S for CVD was 0.13 (SS: 65.5%, SP: 59.6%) for the total population, 0.44 (SS: 49.6%, SP: 68.1%) for males, and 0.27 (SS: 64.2%, SP: 69.2%) for females. The cut-off point of cMetS-S for CVD mortality was 0.53 (SS: 51.3%, SP: 71.9%) for the total population, 0.76 (SS: 35.1%, SP: 76.2%) for males, and 0.28 (SS: 78.8%, SP: 66.4%) for females. The AUC (95% CI) of MetS based on the International Diabetes Federation (IDF) and Joint Interim Statement (JIS) definitions were 60.0 (65.3 - 56.8) and 61.1 (59.6 - 56.8) for CVD, and 59.3 (56.0 - 62.5) and 59.4 (56.3 - 62.6) for CVD mortality. Conclusions: The cut-off points of cMetS-S for CVD and CVD mortality differ between men and women. The cMetS-S could be a better predictive tool for CVD and CVD mortality than MetS.

Association of altitude with all-cause and cardiovascular mortality among patients with hypertension: a cohort study in Southwest China

BackgroundAvailable evidence falls short in assessing the risk of long-term outcomes among individuals with hypertension residing at various altitudes. We aimed to investigate the association between residential altitude and the risk of all-cause and cardiovascular disease (CVD) mortality among hypertensive patients.MethodsThis cohort study encompassed 67,275 hypertensive patients aged ≥35 years who participated in China’s Basic Public Health Service Program in 2018. Participants were categorized into four groups based on their residence altitude: <500 m, 500-1,499 m, 1,500-2,500 m, and > 2,500 m. The associations between residential altitude and the risks of all-cause and CVD mortality were analyzed using Cox proportional hazards regression models. The dose-response relationship was performed by the restricted cubic spline with multivariable adjusted models.ResultsAmong the 67,275 hypertensive patients included in the study (mean age of 63.9 years, with 45.3% male), 8,768 deaths were recorded, of which 5,666 were attributed to CVD. Following multivariate adjustment, when compared to the group residing at altitudes < 500 m, the groups living at altitudes of 500-1,499 m, 1500-2,500 m, and > 2,500 m exhibited significantly risks of all-cause mortality [HR = 1.45 (95% CI: 1.36–1.54), 1.35 (95% CI: 1.28–1.43), and 1.41 (95% CI: 1.28–1.54), respectively] and CVD mortality [HR = 1.47 (95% CI: 1.35–1.58), 1.42 (95% CI: 1.33–1.52), and 1.46 (95% CI: 1.31–1.62), respectively]. The restricted cubic spline curves revealed a nonlinear relationship between residential altitude and all-cause and CVD mortality. The risk of mortality was higher among participants with poorly controlled blood pressure, aged 65 years and above, and living in rural areas.ConclusionsThis study demonstrated a significant association between long-term residential high-altitude exposure and increased risks of all-cause and CVD mortality among hypertension patients. The implications of the findings call for a prioritization of public health resource allocation and early intervention efforts, especially for those living at high altitudes and in low-income areas where hypertension is prevalent.

Life’s essential 8 and mortality in US adults with metabolic dysfunction-associated steatotic liver disease

BackgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) is linked to increased all-cause mortality due to metabolic dysfunctions like obesity, diabetes, and cardiovascular diseases. This study examines the association between Life’s Essential 8 (LE8) scores and both all-cause and cardiovascular disease (CVD) mortality in MASLD participants.MethodsData from 5,916 MASLD participants in the NHANES (2005–2018) were analyzed. Associations between LE8 scores and all-cause and CVD mortality were assessed using Cox proportional hazards models, with follow-up until December 31, 2019. Dose-response relationships and survival differences were evaluated using Kaplan-Meier survival curves and Restricted Cubic Spline models.ResultsOver a median follow-up of 7.6 years, moderate and high LE8 scores were associated with 33% (HR: 0.67; 95% CI: 0.56–0.79) and 47% (HR: 0.53; 95% CI: 0.33–0.84) lower risk of all-cause mortality, respectively, compared to low scores. For CVD mortality, the adjusted HRs were 0.56 (95% CI: 0.41–0.78) and 0.35 (95% CI: 0.12-1.0). Higher LE8 scores were significantly associated with reduced cumulative incidence of all-cause and CVD mortality (log-rank P < 0.001). A 10-point increase in health behavior scores, particularly in diet, physical activity, and nicotine exposure, was linked to an 11% reduction in all-cause mortality risk and an 11% reduction in CVD mortality risk. Among health factors, only blood glucose showed a significant association with CVD mortality.ConclusionHigher LE8 scores in MASLD patients are associated with lower mortality risk, suggesting the potential value of promoting cardiovascular health in this population. Further research is needed to confirm these associations.Graphical

Relationships among Helicobacter pylori seropositivity, the triglyceride-glucose index, and cardiovascular disease: a cohort study using the NHANES database

BackgroundHelicobacter pylori (H. pylori), a widely prevalent pathogen that can be cured through relatively simple medical methods, is thought to be potentially associated with the risk of cardiovascular diseases (CVD), although controversy remains. Currently, it is unclear whether the triglyceride-glucose index (TGI), a classic indicator of insulin resistance, influences the relationship between H. pylori infection and CVD. The present work explored the relationships between H. pylori seropositivity, the TGI and CVD, and the potential effect of TGI in this association.MethodsIn this cross-sectional and cohort study, data from the National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and NHANES (1999–2000) were used. The effects of the TGI, H. pylori seropositivity, and their interaction on the risk of CVD were assessed using logistic regression models. The hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality (ACM) were calculated using the Cox proportional hazards model. Restricted cubic spline (RCS) curves were employed to investigate potential non-linear or linear relationships among the TGI, H. pylori seropositivity, occurrence of CVD, and ACM. Mediation analyses were employed to assess the potential effects of H. pylori seropositivity and TGI on the risk of CVD and mortality.ResultsOf the 9,399 participants, 4,488 (47.75%) were H. pylori-immunoglobulin G (IgG)-positive, and 3,934 (41.86%) were diagnosed with CVD. In the general population, participants with a TGI ≥ 75th percentile who were positive for H. pylori-IgG antibody had the highest risk of developing CVD (odds ratio = 1.487; 95% CI: 1.088–2.033). Among patients with CVD, those with a TGI ≥ 75th percentile & positive for H. pylori-IgG antibody were at a higher ACM risk (HR = 1.227; 95% CI: 1.009–1.491). H. pylori exhibited a significant mediating effect on CVD occurrence (Pindir = 0.004) and mortality (Pindir = 0.004) via the TGI.ConclusionsH. pylori seropositivity may indirectly elevate the risk of CVD and mortality via the TGI. Combining the patient’s H. pylori serological status with their TGI could enhance the predictive ability for CVD occurrence and related mortality. Therefore, the clinical practice of screening for and eradicating H. pylori in CVD patients may be anticipated.Graphical abstract

Impaired sensitivity to thyroid hormones is associated with all-cause and cause-specific mortality among chronic kidney disease patients: results from National Health and Nutrition Examination Survey (NHANES) 2007–2012

Background Resistance to thyroid hormone shows underlying mechanical link with chronic kidney disease (CKD) and is prevalent in CKD population. However, whether it attributes to mortality risk among CKD population is unknown. This study aimed to examine the association of thyroid hormone resistance (THR) with all-cause and cause-specific mortality among CKD individuals. Methods This study extracted CKD population from the National Health and Nutrition Examination Survey (NHANES) 2007–2012. Death outcomes were ascertained by linkage to National Death Index records through 31 December 2019. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) for mortality from all causes, cardiovascular disease (CVD). Results A total of 1,634 adults with CKD were included in the cohort, in which 663 deaths were recorded during an average follow-up of 8.72 years. After multivariate adjustment, resistance to thyroid hormone was significantly associated with higher all-cause and CVD mortality. There was an 18% and 31% increase in risks of all-cause and CVD mortality per-standard deviation (SD) increment in Parametric Thyroid Feedback Quantile-based Index (PTFQI) respectively. When PTFQI was analyzed as categorical variable (classified according to PTFQI percentiles), after adjusted for potential confounders and taking PTFQI ≤ P 5 as reference, the HRs and 95% CIs in category with PTFQI > P 95 for all-cause mortality and CVD mortality were 2.12 [1.10, 4.09] (p for trend 0.026) and 5.14 [1.81, 14.60] for (p for trend 0.018), respectively. Conclusions Resistance to thyroid hormone, centered on variations in the typical pituitary response to thyroid hormones, may independently correlate with all-cause and CVD mortality in CKD patients.

Focus on cardiovascular metabolism research and guide the prevention and control of chronic diseases in the older adults

With the acceleration of global population aging, the incidence and mortality of cardiovascular disease (CVD) among the older adults are continuously rising, posing an essential public health challenge that severely threatens their health and quality of life. In recent years, significant progress has been made in the research on epidemiological characteristics, risk factors, and prevention strategies of CVD in older adults. This review aims to summarize the current research status of CVD in the old adults, explore key factors affecting cardiovascular health, including genetic factors, lifestyle, and metabolic abnormalities, and evaluate the effectiveness of novel interventions. The goal is to provide a scientific basis for developing CVD prevention and management strategies tailored to the old adults.

Shensu IV maintains the integrity of the glomerular filtration barrier and exerts renal protective effects by regulating endogenous hydrogen sulfide levels

BackgroundNephrotic syndrome has a significant impact on global health, often leading to cardiovascular disease and high mortality due to limited effective treatments. This study investigates the efficacy of Shensu IV in a puromycin aminonucleoside (PAN)-induced rat model of nephropathy.MethodsRat models and in vitro podocyte PAN nephropathy models were established with PAN and treated with Shensu IV. Renal function was evaluated by measuring urine output and protein content, while hydrogen sulfide (H2S) and oxidative stress markers were quantified in serum and podocyte lysates. We conducted histological examination on kidney tissues and analyzed molecular markers (CD2AP, nephrin, and PI3K/AKT pathway) using RT-qPCR and Western blot.ResultsShensu IV significantly improved urine output and proteinuria, and attenuated glomerular damage, fibrosis, and mitochondrial swelling in PAN-treated rats. Mechanistically, Shensu IV enhanced endogenous H2S production, reducing oxidative stress and activating the PI3K/AKT pathway in vivo and in vitro. This facilitated the upregulation of the target genes CD2AP and nephrin, which are critical for maintaining glomerular integrity and improving renal function in PAN nephropathy models.ConclusionShensu IV and NaHS confer renal protection primarily by modulating oxidative stress and restoring the integrity of the glomerular filtration barrier through mechanisms involving the enhancement of the PI3K/AKT pathway and modulation of H2S levels. These findings suggest a promising therapeutic potential for these metabolites in the treatment of nephrotic syndrome.

Trends in sepsis-associated cardiovascular disease mortality in the United States, 1999 to 2022

PurposeCardiovascular disease (CVD) is the leading cause of death in the United States, and sepsis significantly contributes to hospitalization and mortality. This study aims to assess the trends of sepsis-associated CVD mortality rates and variations in mortality based on demographics and regions in the US.MethodsThe Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database was used to identify CVD and sepsis-related deaths from 1999 to 2022. Data on gender, race and ethnicity, age groups, region, and state classification were statistically analyzed to obtain crude and age-adjusted mortality rates (AAMR). The Joinpoint Regression Program was used to determine trends in mortality within the study period.ResultsDuring the study period, there were a total of 1,842,641 deaths with both CVD and sepsis listed as a cause of death. Sepsis-associated CVD mortality decreased between 1999 and 2013, from AAMR of 65.7 in 1999 to 58.8 in 2013 (APC −1.06*%, 95% CI: −2.12% to −0.26%), then rose to 74.3 in 2022 (APC 3.23*%, 95% CI: 2.18%–5.40%). Throughout the study period, mortality rates were highest in men, NH Black adults, and elderly adults (65+ years old). The Northeast region, which had the highest mortality rate in the initial part of the study period, was the only region to see a decline in mortality, while the Northwest, Midwest, and Southern regions experienced significant increases in mortality rates.ConclusionSepsis-associated CVD mortality has increased in the US over the past decade, and both this general trend and the demographic disparities have worsened since the onset of the COVID-19 pandemic.

Predictive role of neutrophil percentage-to-albumin ratio, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index for mortality in patients with MASLD

There are no studies discussing the significance of neutrophil-to-lymphocyte ratio (NLR), neutrophil-percentage-to-albumin ratio (NPAR), and systemic immune-inflammation index (SII) in predicting poor prognosis in patients with metabolic dysfunction associated steatotic liver disease (MASLD); this study aimed to investigate the relationship between these three inflammatory markers and all-cause mortality and cardiovascular disease (CVD) mortality in patients with MASLD. Survival data for 3970 participants were obtained from National Death Index (NDI) records associated with the National Health and Nutrition Examination Survey (NHANES) dataset, the associations of NPAR, NLR, and SII with all-cause and CVD mortality were analyzed using multivariate COX regression modeling, restricted cubic spline (RCS) was used to explore nonlinear relationships and to determine the inflection point, regrouping was done according to the nonlinear inflection point, using multivariate COX regression modeling, subgroup analysis, and the Kaplan-Meier survival curves to evaluate differences in risk of death between the two groups. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to assess the predictive efficacy of NPAR, NLR, and SII on survival outcomes. Multivariate COX regression and RCS analyses revealed a positive linear correlation between NLR and all-cause and CVD mortality, whereas a nonlinear relationship was found between NPAR and SII and all-cause and CVD mortality. Further reclassified into two groups according to the inflection point, multivariate COX regression analyses showed a significant difference in the risk of death between the two NPAR groups (HR 1.37, 95% CI = (1.01, 1.86) for all-cause mortality and HR 2.03, 95% CI = (1.24, 3.32) for CVD mortality ) and no difference in the risk of death between the two SII groups (HR 1.11, 95% CI = (0.87, 1.42) for all-cause mortality and HR 1.35, 95% CI = (0.86, 2.12) for CVD mortality), and Kaplan-Meier survival curves showed that both all-cause and CVD mortality rates were higher in patients with MASLD above the NPAR inflection point (log-rank P < 0.05). Subgroup analyses showed that the associations between high levels of NPAR and all-cause mortality were generally consistent across populations (P interaction > 0.05). Also, COPD subgroups had a significant effect on the correlation between high levels of NPAR and CVD mortality (P interaction < 0.05). Time-dependent ROC show the predictive value of NPAR, NLR, and SII for all-cause and CVD mortality in MASLD patients. The correlation between NPAR and mortality was nonlinear, and NLR was linearly and positively correlated with mortality, Measuring NPAR and NLR may be useful in assessing risk and predicting prognosis in populations of patients with MASLD.

The effect of heatwave and cold spell on cardiovascular disease mortality in central China, 2018-2022.

A time series study in Hunan province, central of China, from 2018 to 2022, was conducted to test the relationship between heatwave, cold spell and CVD mortality. According to different percentiles of daily mean temperatures and exposure duration, we built 9 kind of definitions for heatwave and cold spell. Distributed lag non-linear model was used to analyze the associations between heatwave, cold spell and CVD mortality, and the attributable fraction (AF) were estimated. The relative risks of CVD mortality associated with heatwave and cold spell varied depending on the definitions, ranging from 1.154 (95% CI: 1.148-1.160) to 1.229 (95% CI: 1.215-1.243) for heatwaves, and from 1.196 (95% CI: 1.192-1.201) to 1.290 (95% CI: 1.282-1.297) for cold spells. Under the definition of 95th percentile with ≥ 4-d duration (P95_4d), the total AF of CVD mortality attributable to heatwave was the largest at 8.43 (95% CI: 7.92-8.94). For the definition of 5th percentile with ≥ 3-d duration (P5_3d), the total AF attributable to cold spell was the largest at 12.96 (95% CI: 12.64-13.28). For heatwave and cold spell, higher CVD mortality risks were observed in females and the elderly over 75 years than males and young people. We found that both heatwave and cold spell could increase the mortality risk of CVD. The results highlight the importance of implementing warning systems for extreme temperature.

Association between DNA methylation predicted growth differentiation factor 15 and mortality: results from NHANES 1999–2002

BackgroundGrowth differentiation factor 15 (GDF15) is a crucial biomarker in various physiological and pathological processes. While elevated GDF15 levels are linked to increased mortality risk, the role of DNA methylation (DNAm)-predicted GDF15 in predicting mortality has not been extensively studied. The purpose of the study is to investigate the association between DNAm-predicted GDF15 levels and all-cause and cardiovascular disease (CVD) mortality in a nationally representative cohort.MethodsData from NHANES 1999–2002 were analyzed. DNAm-predicted GDF15 levels were estimated using a regression model. Weighted multivariate Cox regressions were employed to assess the relationship between DNAm-predicted GDF15 and mortality outcomes. Restricted cubic splines were used to explore dose-response relationships, and subgroup analyses were conducted to enhance result reliability.ResultsHigher DNAm-predicted GDF15 levels were significantly associated with increased all-cause mortality risk (HR = 1.08, 95% CI: 1.02–1.15). Participants in the highest DNAm-predicted GDF15 tertile showed significantly higher all-cause mortality risk (HR = 1.56, 95% CI: 1.16–2.10) and a 2.52-fold increased risk of cardiovascular mortality (HR = 2.52, 95% CI: 1.22–5.19). Kaplan-Meier curves revealed decreasing survival probability with higher DNAm-predicted GDF15 tertiles. Restricted cubic spline analysis demonstrated a non-linear dose-response relationship between DNAm-predicted GDF15 levels and cardiovascular mortality. The positive correlation between DNAm-predicted GDF15 and mortality remained robust in most of subgroups.ConclusionsDNAm-predicted GDF15 independently predicts all-cause and cardiovascular mortality. This association persists across multiple models and stratified subgroups, supporting GDF15’s value as a biomarker for mortality risk stratification. Future research should elucidate underlying biological mechanisms and evaluate GDF15’s clinical utility in guiding mortality risk reduction interventions.

Use of consensus clustering to identify distinct subtypes of chronic kidney disease and associated mortality risk

BackgroundChronic kidney disease (CKD) is a complex condition with diverse etiology and outcomes. Utilizing a data-driven clustering approach holds promise in identifying distinct CKD subgroups associated with specific risk profiles for death.MethodsUnsupervised consensus clustering was utilized to classify chronic kidney disease (CKD) into subtypes based on 45 baseline characteristics in a cohort of 6,526 participants from the US National Health and Nutrition Examination Survey (NHANES) spanning the years 1999–2000 to 2017–2018.We examined the associations between CKD subgroups and clinical endpoints related to mortality, including all-cause mortality, cardiovascular disease mortality, cancer mortality, and mortality due to other causes.ResultsA total of 6,526 individuals with CKD were classified into four clusters at baseline. Cluster 1 (n = 508) comprised patients with relatively favorable levels of cardiac and kidney function markers, lower prevalence of cancer and higher prevalence of obesity, lower medication usage, and younger age. Cluster 4 (n = 2,029) comprised patients with the worst cardiac and kidney function markers. The characteristics of cluster 2 (n = 1,439) and 3 (n = 2,550) fell in between these two clusters. From cluster 1 to cluster 4, we observed a gradual increase in the hazard ratios of all-cause mortality, cardiovascular disease mortality, and mortality due to other causes. Additionally, further sensitivity analysis revealed patient heterogeneity among predefined subgroups with similar baseline kidney function and mortality risks.ConclusionsConsensus clustering integrated baseline clinical and laboratory measures, revealing distinct CKD subgroups with markedly different risks of death, suggesting that further examination of patient subgroups could advance precision medicine.

Examining the Nexus Between Renewable Energy, CO2 Emissions, and Economic Factors: Implications for Countries Marked by High Rates of Coronary Heart Disease

This study investigates the complex interconnections between renewable energy adoption, carbon dioxide (CO2) emissions, and economic factors in 50 countries marked by high rates of coronary heart disease (CHD) between 2000 and 2020. Utilizing a sophisticated two-step system generalized method of moments (GMM) estimator and panel data method, our analysis reveals a significant negative impact of renewable energy on greenhouse gas emissions, emphasizing the role of sustainable energy sources in mitigating environmental and quality of life degradation. Additionally, our findings support the existence of the environmental Kuznets curve (EKC), demonstrating an inverted U-shaped relationship between gross domestic product (GDP) per capita and CO2 emissions. In line with nascent studies, the EKC for CO2 emissions suggests that as a country’s GDP per capita increases, the CO2 emissions initially rise but eventually decline after reaching a certain level of economic development, forming an inverted U-shaped relationship. Specifically, nations facing high cardiovascular heart disease mortality rates display an important link between renewable energy integration and improved environmental quality. These insights underscore the urgency for countries to transition rapidly to green energy, advocating for policies that promote renewable technologies through partnerships between the public, private sector, and government entities. Furthermore, the study emphasizes the necessity of innovative structural reforms in developing countries to stimulate economic growth beyond the EKC turning point, ensuring sustainable development while curbing their carbon footprint resulting from economic activities. Future research should explore the broader global contexts, considering variables like social capital and globalization to inform targeted policies aimed at safeguarding public health and the environment.

Russian extreme hypertriglyceridemia registy (REGGI): a call to action

Hypertriglyceridemia (HTG) is associated with an increased risk of atherosclerotic cardiovascular disease, pancreatitis developing, and all-cause mortality. The risk escalates with rising triglyceride levels and is most significant in extreme HTG (triglycerides above 10 mmol/L). According to epidemiological studies in the Russian Federation, the extreme HTG prevalence varies between 0.1-0.2% (affecting 146,000 to 292,000 Russians). Extreme HTG can be monogenic or polygenic (multifactorial), this determines the clinical course of the disease. Registries are among the most effective models for studying disease development, as they can compile information on clinical, laboratory, instrumental, and molecular data from patients with specific pathologies, and enable analysis of this data and the subsequent development and integration of improved diagnostic and treatment models into clinical practice. The establishment of a registry for extreme HTG will deepen our understanding of the hyperlipidemia nature, regional characteristics of its prevalence, and the phenotypic manifestation of the disease in our country. It will also facilitate the organized and standardized collection of patient information. Data obtained through registry monitoring will enhance diagnostic and monitoring approaches for patients with extreme HTG in practical healthcare settings. The purpose is to present current information on the diagnosis, monitoring, and treatment of patients with extreme HTG, and to announce the creation of the Russian Extreme hypertriGlyceridemia reGIstry (REGGI).

Association between handgrip strength and mortality risk among cardiovascular disease patients: A cohort study from the NHANES 2011-2014.

Cardiovascular disease (CVD) and handgrip strength (HGS) are recognized mortality risk factors. However, the synergistic effect of CVD and HGS on mortality remains unclear. This study investigated the relationship between HGS and mortality in CVD patients. Data from the National Health and Nutrition Examination Survey (2011-2014) were analyzed. Weighted Cox proportional hazards models and restricted cubic splines (RCS) were used to examine associations, with subgroup, sensitivity and predictive performance analyses. Among 8,262 adults (50.56% female; 851 with CVD), 695 deaths (6.74%) occurred over a median follow-up of 80 months. Compared to non‒CVD individuals with high-HGS, CVD patients with low-HGS had the highest risk of all-cause mortality [hazard ratio (HR)=8.76; 95% CI: 4.20-18.30] and CVD mortality (HR=4.83; 95% CI: 3.48-6.70), while CVD patients with high-HGS showed no significant mortality risk increase. Among CVD patients, the HRs for all-cause and CVD mortality in the low-HGS group were 3.60 (95% CI, 2.21-5.86) and 4.01 (95% CI, 1.68-9.59). RCS analyses revealed that the relationships were linear (P‒nonlinear >0.05), and subgroup analyses revealed stroke status potentially modified the association for CVD mortality (P‒interaction=0.002). The addition of HGS significantly improved the predictive performance of current models for mortality (P<0.001). Low HGS may be associated with a higher risk of all-cause and CVD mortality among CVD patients. High HGS appears to reduce mortality risk among CVD patients. These findings suggest that HGS may serve as a valuable predictor of mortality risk in CVD patients.

Long-term weight change, incident cardiovascular disease and all-cause mortality among diabetic adults

We aimed to explore the impact of weight change from young to middle adulthood on incident cardiovascular disease (CVD) and all-cause mortality in US diabetic adults. All study subjects aged 40–79 years were from the US National Health and Nutrition Examination Survey (NHANES) 1988–2018, and they were non-pregnant and had complete data on self-reported weight at age 25 and 10 years before baseline enrollment over average 29.4 years. CVD events occurring from 10 years ago to baseline enrollment were recorded. Relative to stable non-obesity group, the strongest association was noted for the weight-losing group, followed by the stable-obesity group and weight-gaining group over following 10 years. Referring to the stable-obesity group identified significance for the stable non-obesity group. If total population had maintained non-obese from young to middle adulthood, 12 % of CVD cases could have been averted. Relative to the stable non-obesity group, subjects who maintained obese between young and middle adulthood had an increased risk of all-cause mortality. Our findings indicated that the risk for incident CVD and all-cause mortality was potentially reinforced in diabetic adults who were obese at age 25 but non-obese at midlife and who remained stable obese vis-à-vis those with stable non-obesity.

Association of the Inflammatory Burden Index With Increased Mortality Among Cancer Patients: Insights From the NHANES Study.

The systemic inflammatory response significantly influences the progression and prognosis of various cancers. The novel Inflammatory Burden Index (IBI) was recently introduced as a biomarker to gauge systemic inflammation and evaluate cancer patient prognosis. However, studies investigating the relationship between IBI and mortality rates in cancer patients remain limited. This study analyzed data from 2748 cancer patients enrolled in the National Health and Nutrition Examination Surveys between 1999 and 2018. We used weighted Cox regression analysis and restricted cubic spline models to examine the relationship between the IBI and mortality due to all causes, cardiovascular disease (CVD), and cancer. Furthermore, we employed Kaplan-Meier survival curves, subgroup analyses, and receiver operating characteristic curves to elaborate on these associations. Over a median follow-up period of 112 months, the cohort experienced 1067 deaths, including 320 from cancer, 239 attributable to heart disease, and 508 from various other causes. The Kaplan-Meier curve indicated that individuals in the higher quartiles of the IBI faced significantly increased mortality risks compared to those in lower quartiles. Analyses using weighted Cox proportional hazards models demonstrated that subjects in the top IBI quartile were at a substantially higher risk for all-cause mortality (Hazard Ratio [HR] 2.09, 95% Confidence Interval [CI] 1.67-2.62, p < 0.001), CVD mortality (HR = 1.95, 95% CI= 1.18-3.23, p = 0.010), and cancer mortality (HR = 2.06, 95% CI = 1.31-3.26, p = 0.002). Furthermore, stratification and interaction analyses affirmed the uniformity of these initial findings. The areas under the curve for the 3-, 5-, and 10-year survival predictions for all-cause mortality were 0.62, 0.62, and 0.67, respectively; for cardiovascular mortality, they were 0.64, 0.64, and 0.70; and for cancer mortality, they were 0.62, 0.77, and 0.70. In cancer patients, higher IBI levels significantly correlate with increased mortality from all causes, CVD, and cancer-specific deaths. This index could possess considerable diagnostic and prognostic importance, possibly acting as a new biomarker for evaluating outcomes in cancer patients.

Impact of short-term aircraft noise on cardiovascular disease risk in the area surrounding London Heathrow airport: the RISTANCO epidemiological study.

Long-term exposure to aircraft noise has been associated with small increases in cardiovascular disease risk, but there are almost no short-term exposure studies. Research questions were: Is there an association between short-term changes in exposure to aircraft noise and cardiovascular morbidity and mortality? What are the key effect modifiers? Is there variability in risk estimates between areas with consistent versus changing patterns of noise exposure? Do risk estimates differ when using different noise metrics? Descriptive analyses of noise levels and variability at different times of day, analyses of inequalities in noise exposure and case-crossover analyses of cardiovascular events in relation to aircraft noise exposure. Area surrounding London Heathrow airport. 2014-18. Whole population in study area. Cardiovascular disease hospitalisations and mortality. Aircraft noise levels modelled using a standard noise model for: (1) daily equivalent continuous sound levels at different times of day; (2) daily number of events above defined noise thresholds (2018 only). National Health Service digital hospital admission records and Office for National Statistics mortality records for 2014-18 for cardiovascular outcomes, plus individual-level confounders available from healthcare records. Confounder data including road traffic noise (Leicester modelled), rail noise and air pollution (Department for Environment, Food and Rural Affairs), area level deprivation and ethnicity (UK Census). The morning shoulder period (06.00-07.00 hours) was the noisiest of all eight bands (mean: 50.92 dB). The morning shoulder period also had the third highest number of noisy events (flights) > 60 dB per day, with three events across postcodes on average. However, the highest number of noisy events occurred in daytime (highest between 07.00 and 15.00 hours, second highest 15.00 and 19.00 hours). To identify areas with high variability in aircraft noise exposure (due to changes in flight paths because of wind direction and airport operations), we used coefficients of variation (CoV). The period 24.00-04.30 hours had the highest mean CoV (67.33-74.16), followed by 04.30-06.00 hours and 23.00-24.00 hours. Postcodes in the least deprived quintiles of Carstairs index or avoidable death rate had the lowest noise levels. In case-crossover analyses, we observed increased risk for cardiovascular disease hospital admissions for evening noise 19.00-23.00 hours (odds ratio 1.005, 95% confidence interval 1.000 to 1.010 per 5 dB), but not for other periods or mortality. Further analyses suggested that increased risks were occurring in postcodes with low CoV for noise. We found effect modification by age, sex, ethnicity, deprivation and season. The industry standard noise model, the Aviation Environmental Design Tool, used does not take account of wind direction, which may have led to some exposure misclassification. We developed a comprehensive dataset of daily aircraft noise variability. We found small associations between cardiovascular hospitalisations (but not deaths) and evening aircraft noise levels, particularly in areas with low variability of noise. More studies are needed to understand the effect of noise variation and respite/relief on cardiovascular disease. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 15/192/13) and is published in full in Public Health Research; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.

Association of trimethylamine N-oxide and metabolites with kidney function decline in patients with chronic kidney disease

BackgroundTrimethylamine N-oxide (TMAO) is a gut microbial metabolite derived from dietary L-carnitine and choline. High plasma TMAO levels are associated with cardiovascular disease and overall mortality, but little is known about the associations of TMAO and related metabolites with the risk of kidney function decline among patients with chronic kidney disease (CKD). MethodsWe prospectively followed 152 nondialysis patients with CKD stages 3–5 and measured plasma TMAO and related metabolites (trimethylamine [TMA], choline, carnitine, and γ-butyrobetaine) via liquid chromatography‒mass spectrometry. An estimated glomerular filtration rate (eGFR) slope >3 ml/min/per 1.73 m2 per year was defined as a rapid decline. We performed logistic regression to determine the probability of rapid or slow eGFR decline, with each metabolite as the main predictor. The gut microbiota was profiled via whole metagenomic sequencing. ResultsThe participants had a median age of 66 years, 41.4% were women, 39.5% had diabetes, and the median eGFR was 23 mL/min/1.73 m2. A rapid decrease in the eGFR occurred in 65 patients (42.8%) over a median follow-up of 3.3 years. After adjustment for baseline eGFR, proteinuria, and clinical factors, plasma TMAO levels were independently associated with increased odds of rapid eGFR decline (odds ratio, 2.42; 95% CI, 1.36–4.32), whereas plasma TMA, choline, carnitine, and γ-butyrobetaine levels were not. Patients who exhibited rapid eGFR decline had a distinct gut microbial composition characterized by increased α-diversity and an abundance of TMA-producing bacteria, including those of the genera Desulfovibrio and Collinsella tanakaei, as well as increased expression of the TMA-producing enzymes bbuA and cutC. ConclusionOur findings suggest the relevance of plasma TMAO in the progression of kidney disease among patients with CKD.