Coronary Heart Disease Research Articles

Systolic blood pressure variability: risk of cardiovascular events, chronic kidney disease, dementia, and death.

Systolic blood pressure variability: risk of cardiovascular events, chronic kidney disease, dementia, and death.

Use of pulse pressure index for cardiovascular outcomes assessment and development of a coronary heart disease model for the elderly

Background and aimsPulse pressure has been commonly used to assess atherosclerosis and cardiovascular outcomes with the defects of fluctuation. However, the pulse pressure index (PPI), a feasible alternative with the advantage of lower fluctuations, has not been sufficiently researched.MethodsThis study included 10,796 participants over 65 years from the National Health and Nutrition Examination Survey 1999–2018. Cox proportional hazards models, restricted cubic splines and subgroup analysis were used to investigate the association between PPI in the elderly and all-cause and cardiovascular mortality. Subsequently, a prediction model for identifying coronary heart disease (CHD) in elderly individuals was developed using three machine learning algorithms. The impact of each feature on CHD was visualized in the optimal model after comparing the performances of the models.ResultsThis study discovered that the highest levels of PPI were associated with a 28% increased all-cause [HR (95%CI) 1.28 (1.16, 1.42), P < 0.001] and a 36% increased risk of cardiovascular mortality [HR (95%CI) 1.36 (1.08, 1.72), P = 0.008] compared with the first quantile of PPI. The nonlinear relationships between PPI and mortality (all-cause: P for Nonlinear = 0.038; cardiovascular: P for Nonlinear = 0.005) were determined using restricted cubic spline curves. Among the three machine-learning models, random forest model showed the best performance (AUC 0.667 (0.638, 0.696)). In descending order of feature importance, PPI came in second place, with a positive relationship with CHD.ConclusionsThis study indicated a positive correlation between PPI and long-term adverse cardiovascular outcomes among the elderly. Notably, PPI has considerable predictive power for recognizing CHD.Graphical

Predicting coronary heart disease with advanced machine learning classifiers for improved cardiovascular risk assessment

Worldwide, coronary heart disease (CHD) is a leading cause of mortality, and its early prediction remains a critical challenge in clinical data analysis. Machine learning (ML) offers valuable diagnostic support by leveraging healthcare data to enhance decision-making and prediction accuracy. Although numerous studies have applied ML classifiers for heart disease prediction, their contributions often lack clarity in addressing key challenges. In this paper, we present a comprehensive ML framework that systematically tackles these issues. First, we employ mutual information (MI) for effective feature selection to isolate the most informative predictors. Second, we address the significant class imbalance in the dataset using the Synthetic Minority Oversampling Technique (SMOTE), which substantially improves model training. Third, we propose a novel hybrid model that integrates particle swarm optimization (PSO) with an artificial neural network (ANN) to optimize feature weighting and bias training. Additionally, we conduct a comparative analysis with traditional classifiers, including Logistic Regression and Random Forest, using the National Health and Nutritional Examination Survey dataset. Our results demonstrate that while conventional classifiers achieve an accuracy of 95.8%, the proposed PSO-ANN model attains an enhanced accuracy of up to 97% in predicting CHD. This work clearly defines its contributions by improving feature selection, handling data imbalance, and introducing an innovative hybrid model for superior prediction performance.

Association of FGF21 with Metabolic and Cardiovascular Diseases: A Mendelian Randomization Analysis.

Studies have covered a possible relevance between fibroblast growth factor 21 (FGF21) and obesity-related metabolic complications and cardiovascular disease (CVD). Nevertheless, whether FGF21 is a causative factor in these diseases is not known. Using a bidirectional, two-sample Mendelian randomization (MR) approach, this study sought to establish a causal relationship between FGF21 and seven metabolic diseases and six CVDs. A large-scale meta-analysis dataset of genome-wide association studies (GWAS) was analyzed to generate summary-level statistics for FGF21. The diseases we studied included non-alcoholic fatty liver disease (NAFLD), obesity, type 2 diabetes (T2DM), hypertension, gestational diabetes (GDM), gestational hypertension (GHTN), pre-eclampsia or eclampsia (PE), atherosclerosis, cardiomyopathy (CMP), coronary heart disease (CHD), coronary atherosclerosis, heart failure (HF), myocardial infarction (MI) and the corresponding summary GAWS data were retrieved from the FinnGen Biobank and IEU Open GWAS Project database. The inverse variance-weighted (IVW) algorithm was the primary approach utilized for the MR analysis. The MR-Egger regression and MR-PRESSO tests were implemented to evaluate horizontal pleiotropy. The heterogeneity of instrumental variables was subsequently assessed utilizing Cochran's Q statistics.When diseases are used as exposures, MR analysis results of the IVW method indicated that NAFLD (Beta=- 0.047, 95% CI=- 0.08 to - 0.014; p=0.006), obesity (Beta=0.087, 95% CI=0.021-0.153; p=0.009), T2DM (Beta=0.071, 95% CI=0.037-0.106; p<0.001) correlated causally with FGF21. Nevertheless, FGF21 was not causally related to the remaining metabolic diseases and CVDs, according to the results of the MR analysis (p>0.05). It was demonstrated that the aforementioned results were robust and devoid of pleiotropy.Our study supports a causal association between NAFLD, obesity, and T2DM with FGF21. No substantial evidence exists to establish a causal relationship between FGF21 and other diseases. This study provides opportunities for the early prevention and innovative therapy of NAFLD, obesity, and T2DM.

Association of epicardial fat volume with the severity of coronary artery disease: a preliminary study on risk prediction of obstructive coronary heart disease

BackgroundWe aimed to explore the correlation between epicardial fat volume (EFV) and the severity of coronary atherosclerotic artery disease (CAD), evaluate the predictive value of EFV for obstructive CAD, and provide prediction for the selection of clinical treatment schemes for CAD.MethodsA total of 203 patients undergoing chest computed tomography (CT) and Coronary Artery Angiography (CAG) were included in this retrospective study. The severity of coronary stenosis and SYNTAX score were evaluated by CAG images. There were 141 patients in obstructive CAD group which was defined as coronary stenosis severity ≥ 70% and 62 patients in non obstructive CAD group.ResultsMultivariate logistic regression analysis showed that after adjusting for confounding factors, EFV (OR, 1.008; 95% CI, 1.000-1.016; p = 0.039) was an independent risk factor for obstructive CAD. Spearman correlation analysis showed a significant positive correlation between EFV and SYNTAX score, as well as the number of coronary lesions (r = 0.157, p = 0.026; r = 0.231, p = 0.002). The EFV of males was significantly higher than that of females (p < 0.001). EFV was significantly positively correlated with intrathoracic fat volume (IFV) (p < 0.001).ConclusionsEFV maybe an independent risk factor for obstructive CAD. Quantitative measurement of EFV by QCT can predict the severity of CAD. EFV was significantly correlated with IFV, but not with BMI.Clinical trial numberNot applicable.

VEGF-A cis-located SNPs on human chromosome 6 associated with VEGF-A plasma levels and survival in a coronary disease cohort

BackgroundCardiovascular disease (CVD) is the leading cause of death worldwide. Risk stratification of CVD patients may be improved by predictive biomarkers, including genetic markers. Elevated circulating vascular endothelial growth factor A (VEGF-A) levels have been linked to CVD development. We explored whether single nucleotide polymorphisms (SNPs) at the VEGFA locus on human chromosome 6 were associated with VEGF-A levels and clinical outcomes in established CVD. VEGF-A levels were compared between coronary heart disease patients and heart healthy controls.MethodsImputed genotypes of 30 SNPs from the VEGFA region for 1935 patients from the Coronary Disease Cohort Study (CDCS) and 1183 individuals from the Canterbury Healthy Volunteers Study (HVOL) were analysed for associations with cardiometabolic parameters. Association with clinical endpoints was assessed using Kaplan-Meier analysis and multivariate regression models. To validate the findings from imputed data, DNA samples of 2027 CDCS patients and 227 HVOL participants were manually genotyped for variants rs6921438 and rs7767396. Baseline plasma VEGF-A assayed by ELISA in 227 HVOL participants was compared with levels in 549 CDCS patients.ResultsManual genotyping showed rs6921438 AA and rs7767396 GG genotype groups had lower VEGF-A levels at baseline (CDCS: rs6921438 AA (27.7 pg/mL), AG (43.3 pg/mL), GG (63.2 pg/mL), p = 4.49 × 10− 22; rs7767396: GG (27.4 pg/mL), AG (42.8 pg/mL), AA (61.5 pg/mL) p = 3.47 × 10− 21; HVOL rs6921438 AA (12.8 pg/mL), GA (19.9 pg/mL), GG (26.4 pg/mL) p = 0.021; rs7767396 GG (12.6 pg/mL), AG (19.6 pg/mL), AA (25.9 pg/mL) p = 0.029). In the CDCS cohort rs6921438 AA was associated with increased risk of all-cause death (p = 0.03); non ST-elevated myocardial infarction (NSTEMI, p = 0.0003), heart failure (HF, p = 0.035) and major adverse cardiovascular events (p = 0.032); rs7767396 GG was associated with increased NSTEMI (p = 0.001) and HF (p = 0.023) risk; rs6921438 AA (Hazard Ratio (HR) = 6.55 p = 0.017), rs7767396 GG (HR = 0.149, p = 0.017) and VEGF-A (HR = 2.55, p = 0.018) were independent HF admission risk predictors.ConclusionsVariants rs6921438 and rs7767396 are associated with plasma VEGF-A levels. Both SNPs and VEGF-A may be useful in prognosis for HF after acute coronary events.

Differences in Coronary Heart Disease and Stroke Incidence Among Single-Race and Multiracial Asian and Pacific Islander Subgroups in Hawaii and California: A Retrospective Cohort Study.

Little is known about clinical and sociodemographic factors affecting coronary heart disease (CHD) and stroke incidence in single-race and multiracial American Asian, Native Hawaiian, and Pacific Islander subgroups. As the US population becomes more diverse, it is important to characterize differences in risks for CHD and stroke, and their contributing factors, in these populations. The study population included 303 958 patients from Kaiser Permanente Hawaii and Palo Alto Medical Foundation in California. Self-reported race and ethnicity were derived from electronic health records and 12 mutually exclusive single-race and multiracial groups were created for analyses. Cox proportional hazard models were used to compare CHD and stroke incidence. Unadjusted models were compared with models adjusted for age, income, education, body mass index, smoking, and comorbidities. We found up to a 4-fold variation in CHD and stroke rates among American Asian, Native Hawaiian, and Pacific Islander subgroups. Multiracial subgroups had higher rates than single-race groups. While most single-race American Asian, Native Hawaiian, and Pacific Islander groups had lower CHD and stroke risks, middle-aged Asian Indian men and Native Hawaiian women had higher stroke risks than non-Hispanic White controls. Income, education, body mass index, smoking, and comorbidities contributed significantly to risks in all groups, especially in Native Hawaiian, Pacific Islander, and multiracial groups. Risks for CHD and stroke vary by racial and ethnic subgroups, demonstrating the need to unmask risks by disaggregating racial and ethnic subgroups. Multiracial American Asian, Native Hawaiian, and Pacific Islander groups had higher risks that were only partially explained by modifiable risk factors. Future studies should further explore lifestyle, psychosocial, and sociocultural factors.

Association between the uric acid-to-HDL-cholesterol ratio (UHR) and the risk of cardiovascular disease and dyslipidemia: a population-based study

Background and aimsThe uric acid-to-HDL-cholesterol ratio (UHR), a novel marker of metabolism and inflammation, has been investigated in various diseases. However, its potential associations with the incidence of cardiovascular disease (CVD) and dyslipidemia remain unclear. This study aimed to examine the relationships between the UHR and the incidence of CVD and dyslipidemia. The primary objective was to evaluate the role of the UHR in predicting CVD and dyslipidemia, whereas the secondary objective was to analyze the predictive effects of the UHR in different subgroups.MethodsWe conducted a cross-sectional analysis using data from the 2001–2018 National Health and Nutrition Examination Survey (NHANES), which included 6,370 adults aged 18–80 years. Weighted binary logistic regression and subgroup analyses were performed to evaluate the independent associations between the UHR and the risk of various cardiovascular conditions, including overall CVD, congestive heart failure, myocardial infarction, angina, coronary heart disease, and dyslipidemia. To investigate potential nonlinear relationships between the UHR and these outcomes, restricted cubic spline modeling was applied to further elucidate the associations.ResultsAmong the 6,370 participants included in the study, 559 were diagnosed with CVD. Elevated UHR values were strongly associated with a greater incidence of CVD and its subtypes, including congestive heart failure, myocardial infarction, angina, and coronary heart disease (all P < 0.001). After accounting for weighted factors, participants in the higher UHR quartiles presented progressively higher rates of CVD: Quartile 1 (4.7%), Quartile 2 (6.3%), Quartile 3 (7.4%), and Quartile 4 (11%). A nonlinear relationship between the UHR and the risk of developing CVD was identified through restricted cubic spline (RCS) analysis. Among the subgroup of 4,117 participants with dyslipidemia, multivariable linear regression analysis demonstrated a significant positive association between the UHR and dyslipidemia (OR 17.38, 95% CI 16.24–18.60). This association remained robust even after adjusting for covariates (OR 11.65, 95% CI 8.995–15.17). RCS analysis further confirmed the nonlinear nature of this relationship. Subgroup analysis revealed no significant interaction between the UHR and overall CVD or CVD-related variables, such as congestive heart failure, myocardial infarction, angina, or coronary heart disease. However, for dyslipidemia, BMI showed a significant interaction, indicating that the positive association between the UHR and dyslipidemia risk is influenced by participants’ BMI.ConclusionA high UHR is associated with an increased risk of various cardiovascular conditions and dyslipidemia. The incorporation of routine UHR monitoring into clinical practice can support the early identification of high-risk individuals, facilitate timely interventions, and reduce the burden of cardiovascular and metabolic diseases.

Progress in the study of the mechanism of ferroptosis in coronary heart disease and clinical intervention strategies

Coronary heart disease (CHD), a serious cardiovascular condition with complex and diverse pathogenesis, has recently seen increased attention to the role of ferroptosis—a novel iron-dependent form of programmed cell death. This review synthesizes current research on ferroptosis mechanisms in CHD and emerging clinical intervention strategies. Ferroptosis is characterized by dysregulated iron metabolism, lipid peroxidation, and reactive oxygen species (ROS) accumulation, processes intimately linked to CHD pathophysiology. Under ischemic and hypoxic conditions commonly seen in coronary artery disease (CAD), cardiomyocytes become particularly susceptible to ferroptosis, resulting in cellular dysfunction and diminished cardiac performance. Mechanistic studies have revealed that altered expression of iron metabolism-related proteins (including GPX4, FTH1, TfR1, and HO-1), accumulation of lipid peroxidation products, and disruption of antioxidant defense systems (particularly the Nrf2/GPX4 pathway) are central to ferroptosis progression in cardiac tissue. Clinically, both specific ferroptosis inhibitors (such as Ferrostatin-1) and traditional medicine components (such as Puerarin) have emerged as promising therapeutic candidates, showing cardioprotective effects in experimental models. However, research into ferroptosis mechanisms in CHD remains in its early stages, with significant questions regarding its relationship with other cell death pathways and the clinical efficacy of ferroptosis-targeting interventions requiring further investigation. Future research directions should include in-depth mechanistic exploration and the development of more effective, safer clinical interventions targeting the ferroptosis pathway in cardiovascular disease.

Hypothalamic Gliosis Is Associated With Multiple Cardiovascular Disease Risk Factors in the Framingham Heart Study.

Hypothalamic gliosis is mechanistically linked to obesity and insulin resistance in rodent models. We tested cross-sectional associations between radiologic measures of hypothalamic gliosis in humans and clinically relevant cardiovascular disease risk factors, as well as prevalent coronary heart disease. Using brain magnetic resonance imaging from FHS (Framingham Heart Study) participants (N=867; mean age, 55 years; 55% women), T2-signal intensities were extracted bilaterally from the region of interest in the mediobasal hypothalamus (MBH) and reference regions in the amygdala and putamen. T2-signal ratios were created in which greater relative T2-signal intensity suggests gliosis. The primary measure compared MBH with amygdala (MBH/amygdala). Outcomes were body mass index, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting triglycerides, and the presence of hypertension (n=449), diabetes (n=66), metabolic syndrome (n=254), or coronary heart disease (n=25). Statistical testing was performed using linear or logistic regression. Greater MBH/amygdala T2-signal ratios were associated with higher body mass index (P<0.001), higher fasting triglycerides (P<0.001), lower high-density lipoprotein cholesterol (P=0.034), and presence of hypertension (P=0.0088), and the latter 2 were independent of body mass index. Findings for diabetes were mixed, whereas metabolic syndrome was strongly associated with greater MBH/amygdala T2-signal ratios (P<0.001). T2-signal ratios were not associated with prevalent coronary heart disease (all P>0.05), but CIs were wide. Using a well-established study of cardiovascular disease development, we found evidence linking hypothalamic gliosis to multiple cardiovascular disease risk factors, independent of adiposity. Our results highlight the need to consider central nervous system mechanisms to understand and improve cardiometabolic health.

Coronary imaging characteristics and risk factors in patients with type 2 diabetes mellitus with coronary heart disease complication.

Coronary heart disease (CHD) is a prevalent type 2 diabetes mellitus (T2DM) complication. Further, the risk stratification before angiography may help diagnose T2DM with CHD early. However, few studies have investigated the coronary imaging characteristics and risk factors of patients with T2DM complicated with CHD. To compare the differences in coronary imaging between patients with T2DM with and without CHD, determine the risk factors of T2DM complicated with CHD, and establish a predictive tool for diagnosing CHD in T2DM. This study retrospectively analyzed 103 patients with T2DM from January 2022 to May 2024. They are categorized based on CHD occurrence into: (1) The control group, consisting of patients with T2DM without CHD; and (2) The observation group, which includes patients with T2MD with CHD. Age, sex, smoking and drinking history, CHD family history, metformin (MET) treatment pre-admission, body mass index, fasting blood glucose (FBG), triglyceride (TG), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), serum creatinine, blood urea nitrogen (BUN), alanine aminotransferase, aspartate aminotransferase, glycosylated hemoglobin (HbA1c), and coronary imaging data of both groups were collected from the medical record system. Logistic risk analysis was conducted to screen risk factors. The prediction model's prediction efficiency was evaluated with receiver operating characteristic curves. The control and observation groups consisted of 48 and 55 cases, respectively. The two groups were statistically different in terms of age (t = 2.006, P = 0.048), FBG (t = 6.038, P = 0.000), TG (t = 2.015, P = 0.047), LDL-C (t = 2.017, P = 0.046), and BUN (t = 2.035, P = 0.044). The observation group demonstrated lower proportions of patients receiving MET (χ 2 = 5.073, P = 0.024) and higher proportions of patients with HbA1c of > 7.0% (χ 2 = 6.980, P = 0.008) than the control group. The observation group consisted of 15, 17, and 23 cases of moderate stenosis, severe stenosis, and occlusion, respectively, with a greater number of coronary artery occlusion cases than the control group (χ 2 = 6.399, P = 0.041). The observation group consisted significantly higher number of diffuse lesion cases at 35 compared with the control group (χ 2 = 15.420, P = 0.000). The observation group demonstrated a higher right coronary artery (RCA) stenosis index (t = 6.730, P = 0.000), circumflex coronary artery (LCX) stenosis index (t = 5.738, P = 0.000), and total stenosis index (t = 7.049, P = 0.000) than the control group. FBG [odds ratio (OR) = 1.472; 95% confidence interval (CI): 1.234-1.755; P = 0.000] and HbA1c (OR = 3.197; 95%CI: 1.149-8.896; P = 0.026) were independent risk factors for T2DM complicated with CHD, whereas MET (OR = 0.350; 95%CI: 0.129-0.952; P = 0.040) was considered a protective factor for CHD in T2DM. Coronary artery occlusion is a prevalent complication in patients with T2DM. Patients with T2MD with CHD demonstrated a higher degree of RCA and LCX stenosis than those with T2DM without CHD. FBG, HbA1c, and MET treatment history are risk factors for T2DM complicated with CHD.

Low Carotid Mean Flow Velocity: A Noninvasive Marker for Coronary Heart Disease—A Community-Based Study

Background: Coronary heart disease (CHD) remains a leading cause of global mortality, often sharing pathophysiologic pathways with cerebrovascular atherosclerosis. Carotid duplex ultrasonography provides a convenient, noninvasive assessment of both vascular structure and hemodynamics. However, the clinical implications of specific carotid flow velocities for predicting CHD risk have not yet been fully explored. Methods: We conducted a case–control study using two community-based cohort datasets from Taiwan’s northern coastal region, enrolling individuals during two periods: from September 2010 to May 2011 and September 2014 to May 2020. Among 4102 participants aged 40–74 years, 45 were excluded for insufficient Doppler waveforms, leaving 4057 eligible subjects. Of these, 165 individuals with physician-confirmed myocardial infarction or prior coronary intervention/surgery were classified as CHD cases; the remaining 3892 served as controls. Carotid blood flow parameters—peak systolic (PSV), end-diastolic (EDV), and time-average maximal flow velocity (MFV), as well as resistance and pulsatility indices (RIs and PIs)—were determined by color Doppler ultrasound at the bilateral common carotid arteries (CCAs). Associations between these measurements and CHD were evaluated through logistic regression, adjusting for conventional cardiovascular risk factors. Results: Participants diagnosed with CHD exhibited significantly lower carotid flow velocities as well as higher RIs and PIs. After multivariable adjustments, right-sided common carotid artery (CCA) flow velocities have a relatively better predictive capacity than left-sided CCA flow velocities. However, left-sided RIs (adjusted OR per 0.1 increase = 1.41, p = 0.027) and PIs (adjusted OR per 1.0 increase = 1.60, p = 0.037) have better predictive value. Right-sided CCA MFV emerged as an independent predictor of CHD which was the most important (adjusted OR per 5.0 cm/s increase = 0.85; 95% CI: 0.77–0.95, p = 0.0038). As compared to subjects with high MFV (≥44.2 cm/s), the multivariable-adjusted OR of having CHD was significantly elevated for subjects with low MFV (&lt;36.02 cm/s; OR = 1.79; 95% CI: 1.13–2.84, p = 0.013). Combinatory analysis further revealed that individuals with low right MFV, particularly when combined with hypertension, had substantially elevated odds of CHD. Conclusions: Reduced right CCA MFV may serve as a clinically informative signal for the presence of CHD. These findings highlight the potential role of detailed carotid Doppler profiling in refining CHD risk assessment, especially among hypertensive patients. Future prospective investigations are warranted to validate the predictive utility of the MFV for coronary events and to explore whether modifying this parameter through targeted interventions can mitigate cardiovascular risk.

Long-Term Impact of Subclinical Hypothyroidism on Cardiovascular Outcomes in Adults: A Meta-Analysis of Cohort and Observational Studies

Background: Subclinical hypothyroidism (SCH), defined by elevated thyroid-stimulating hormone (TSH) levels with normal free thyroxine (FT4), has been increasingly linked to cardiovascular disease. However, evidence remains mixed regarding its long-term impact on coronary outcomes. Objective: To evaluate the association between subclinical hypothyroidism and the risk of coronary heart disease (CHD) events, cardiovascular mortality, and all-cause mortality in adults using data from cohort and observational studies. Methods: A systematic search was conducted across PubMed, Scopus, Embase, and Web of Science from 2015 to 2024. Eligible studies included prospective cohorts reporting cardiovascular outcomes in adults with SCH versus euthyroid controls. Pooled hazard ratios (HRs) and relative risks (RRs) were calculated using a random-effects model. Subgroup analysis was conducted based on TSH levels (&lt;10 mIU/L vs. ≥10 mIU/L). Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Results: Three high-quality cohort studies involving 60,047 participants were included. SCH was significantly associated with an increased risk of CHD events (HR/RR = 1.20; 95% CI: 1.02–1.41; p = 0.03). The association with CHD mortality (HR/RR = 1.18; 95% CI: 0.97–1.43) and total mortality (HR/RR = 1.12; 95% CI: 0.99–1.26) was not statistically significant. Subgroup analysis revealed that individuals with TSH ≥10 mIU/L had a markedly increased CHD risk (HR/RR = 1.89; 95% CI: 1.28–2.80; p = 0.002). Conclusion: Subclinical hypothyroidism, particularly at higher TSH levels (≥10 mIU/L), is associated with an increased risk of coronary heart disease events. While associations with mortality were non-significant, the observed trends highlight the need for closer monitoring and targeted intervention strategies in patients with elevated TSH. Further large-scale studies are warranted to establish causality and optimize clinical management.

Cardiac Troponins and Cardiovascular Disease Risk Prediction: An Individual-Participant-Data Meta-Analysis.

Cardiac Troponins and Cardiovascular Disease Risk Prediction: An Individual-Participant-Data Meta-Analysis.

The Impact of Comorbidities on the Treatment Outcome in Patients With Severe Covid-19-Associated Pneumonia

BACKGROUND. A significant role in the course and outcome of COVID-19, alongside other clinical and laboratory factors, is played by comorbidities.THE AIM OF THE STUDY. We studied the impact of comorbidities on the course and outcomes of severe COVID-19-associated pneumonia.MATERIAL AND METHODS. The study was conducted at the Yakut Republican Clinical Hospital. We analyzed treatment outcomes of 450 patients with severe COVID-19-associated pneumonia who were hospitalized in the intensive care unit. An observational case-control study was conducted, in accordance with the research objective, comorbidities were analyzed in detail in two groups of patients: survivors — 144 (32.0%) and deceased — 306 (68.0%). The endpoint of the study was a fatal outcome. The modified Charlson comorbidity index was used to assess the patients’ comorbidity status.RESULTS. The study revealed the presence of concomitant pathology in 446 (99.1%) patients. 57 (12.7%) patients had two concomitant diseases, 369 (82%) patients had three or more pathologies. A statistically significant impact on the risk of death for the following combinations of comorbid conditions were found: chronic central nervous system diseases with chronic kidney disease; hypertension with chronic kidney disease; coronary heart disease with chronic kidney disease; severe obesity (class III) with coronary heart disease and chronic kidney disease; severe obesity (class III) with type 2 diabetes mellitus. The mortality rate of patients increases linearly with the growth of the Charlson comorbidity index (p&lt;0.001).CONCLUSION. The obtained data indicate a significant increase in the risk of death in patients with severe COVID-19-associated pneumonia in the presence of comorbidities. Therefore, when predicting the outcome and improving the treatment results of this category of patients, one should take into account the patient’s comorbidity.

Association between high triglyceride-glucose index and MACCE in hypertriglyceridemia patients undergoing percutaneous coronary intervention

BackgroundWith a focus on metabolism-related cardiovascular diseases, the triglyceride-glucose (TyG) index has been used as a surrogate marker of insulin resistance in the prognosis of coronary heart disease. However, the prognostic role of the TyG index in patients with elevated triglycerides, still requires further research. This study aimed to investigate the association between the TyG index and Major Adverse Cardiac and Cerebrovascular Events (MACCE) in patients with hypertriglyceridemia undergoing drug-eluting stent percutaneous coronary intervention (DES-PCI).MethodsOut of 2250 patients, 813 with hypertriglyceridemia who underwent DES-PCI were retrospectively analyzed. MACCE was regarded as the primary endpoint. Kaplan–Meier (KM) curves were used to evaluate the association between the TyG index and different endpoints. Restricted cubic spline (RCS) analysis was used to examine the relation between the TyG index and MACCE. Subgroup analysis was conducted to further evaluate the interaction between the TyG index and subgroup indicators.ResultsCox regression analysis identified the TyG index as an independent predictor of MACCE (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.15–2.04, P = 0.004). Receiver operating characteristic (ROC) analysis determined 9.19 as the cutoff value of TyG index. The Kaplan–Meier curve indicated that patients with a TyG index &amp;gt; 9.19 had higher risks of MACCE (HR 2.23, 95% CI 1.35–3.67, P = 0.002), MACE (HR 2.38, 95% CI 1.39–4.09, P = 0.002), unplanned repeat revascularization (HR 2.05, 95% CI 1.02–4.09, P = 0.043) and all-cause death (HR 3.31, 95%CI 1.15–9.47, P = 0.026) than those of patients with a low TyG index. RCS analysis revealed a linear relation between the TyG index and MACCE risk (P for nonlinearity = 0.879, P for overall trend = 0.044).ConclusionsThis study demonstrated that a high TyG index is associated with an increased risk of MACCE, suggesting that the TyG index may serve as a valuable prognostic marker in patients with hypertriglyceridemia undergoing DES-PCI.

Remote cardiovascular events in patients with psoriasis, coronary heart disease and their combination

Psoriasis is a chronic immune-inflammatory dermatological disease that affects not only the skin, but can also cause systemic inflammation, increasing cardiovascular endpoints.Aim: To examine long-term cardiovascular endpoints in patients with coronary heart disease (CHD), psoriasis and their combination in a prospective observational study.Material and Methods. 3 groups of patients with moderate-to-severe psoriasis (n = 30), coronary artery disease (CHD) (n = 32) and psoriasis + coronary artery disease (n = 28) were enrolled in the study. They were observed for 48 months in terms of unfavourable endpoints (exacerbation of psoriasis, cardiac vascular hospitalizations, death, heart attacks and strokes).Results. The CHD group had a higher frequency of diabetes mellitus (DM) (30 vs. 3.6%, p = 0.008) and worse systolic blood pressure (SBP) control (142 (134.0–149.8) vs. 136 (128.0–144.6) mmHg, p = 0.048) compared with the CHD comorbidity group. Cardiovascular mortality was higher in patients with CHD compared with the group with psoriasis (p = 0.027) and CHD with psoriasis (p = 0.040). The rate of cardiovascular hospitalizations did not differ in pairs with CHD versus CHD and exacerbations of psoriasis in the groups with psoriasis and psoriasis with CHD (p &gt; 0.05), but the total rate of both types of hospitalizations was higher in the group of patients with CHD and psoriasis (p = 0.009).Conclusion. In case of comorbidity of psoriasis with CHD, the frequency of cardiovascular hospitalizations and exacerbation of psoriasis increased. CHD reduced the time to the first exacerbation of psoriasis.

A nutrient wide association study of cardiovascular disease prevalence in older adults from NHANES 2007 to 2018

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, particularly among older adults. Identifying modifiable dietary factors associated with CVD prevalence is essential for prevention. This cross-sectional study analyzed 7,341 adults aged ≥ 65 years from NHANES 2007–2018. CVD was defined based on self-reported physician-diagnosed conditions, including coronary heart disease, heart failure, angina, heart attack, or stroke. A nutrient-wide association study (NWAS) evaluated associations between 56 dietary nutrients and CVD prevalence using multivariable logistic regression. Dose–response relationships were assessed using restricted cubic spline (RCS) models. Model discrimination was evaluated using receiver operating characteristic (ROC) analysis. Eight nutrients were significantly associated with CVD prevalence after adjusting for confounders and correcting for multiple comparisons: PUFAs 20:4 (OR 0.88, 95% CI 0.80–0.97, P = 0.024), 22:5 (OR 0.72, 95% CI 0.56–0.92, P = 0.019), and 22:6 (OR 0.92, 95% CI 0.87–0.99, P = 0.032); total choline (OR 0.96, 95% CI 0.93–0.99, P = 0.024); cholesterol (OR 0.89, 95% CI 0.82–0.96, P = 0.037); protein (OR 0.82, 95% CI 0.76–0.89, P = 0.040); vitamin A (OR 0.95, 95% CI 0.91–0.99, P = 0.045); and total sugars (OR 0.97, 95% CI 0.96–0.98, P = 0.049). Clustering analysis identified protective effects of fat-soluble vitamins and unsaturated fatty acids. The inclusion of these nutrients significantly improved model discrimination (P < 0.05). This study identified key dietary nutrients and clusters associated with CVD prevalence and characterized their dose–response relationships. Integrating these nutrients into predictive models enhances CVD risk discrimination, providing actionable dietary targets for prevention strategies in older adults.

The severity of coronary heart disease and the incidence and severity of following obstructive sleep apnea: a population-based cohort study

Obstructive sleep apnea (OSA) is characterized by pharyngeal collapse, hypoxia, and hypercapnia. However, the impact of coronary heart disease (CHD) severity on OSA development has been rarely explored. This study aimed to evaluate the correlation between CHD severity and OSA incidence. This retrospective cohort study was conducted using the National Health Insurance Research Database (NHIRD). Patients with CHD were categorized into three groups: those with severe CHD who underwent percutaneous coronary intervention (PCI), those with CHD without PCI, and those receiving medical treatment. The primary outcome was the development of OSA at least six months after CHD onset. Cox proportional hazards regression was used to calculate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for OSA across the different CHD groups. A total of 5,193 and 8,313 OSA events were recorded in the CHD-PCI and CHD groups, respectively. After adjusting for multiple confounders, the incidence of OSA was significantly higher in the CHD-PCI group than in the CHD group (aHR: 1.267, 95% CI: 1.220–1.315, P = 0.0135). Subgroup analyses showed that the association between severe CHD with PCI and OSA was more pronounced in older CHD patients (P < 0.05). The cumulative incidence of both OSA and severe OSA was significantly higher in the CHD-PCI group than in the CHD group (both P < 0.001). Severe CHD requiring PCI is associated with a higher incidence of subsequent OSA compared to mild CHD. This association is particularly significant in patients older than 70 years.

Investigating psychological difference between two genders in mental health after percutaneous coronary intervention for elderly patients with acute coronary syndrome

ObjectivePsychological factors are closely correlated with coronary heart disease, and gender discrepancies occurs in mental health after percutaneous coronary intervention (PCI) for acute coronary syndrome patients (ACS) are worth studying.MethodsThis study collected data from patients aged ≥ 60 diagnosed with ACS who underwent PCI treatment within one week of admission to the Cardiovascular Department of Ji’an Central People’s Hospital between June 2021 and December 2022. The study group consisted of 113 female patients, whereas the control group consisted of 121 male patients. Baseline patient data, demography, and laboratory test results were collected. Anxiety and depression were assessed using the Self-rating anxiety scale (SAS) and Self-rating depression scale (SDS) before PCI and at 1, 4, and 12 weeks post-procedure. Descriptive data are presented as x̄±s. Group comparisons for continuous variables were conducted using t-tests, while categorical data were analyzed using chi-square tests. Multiple group comparisons were conducted using analysis of variance.ResultsThere were no statistically significant disparities observed in baseline characteristics between these two groups. The assessment of SAS and SDS scores exhibited no statistically significant difference between the two groups before PCI; however, after the procedure, elderly female ACS patients demonstrated notably elevated SAS and SDS scores when contrasted with their elderly male ACS counterparts. Both cohorts manifested their highest SAS and SDS scores before PCI, with a gradual reduction in these scores after the procedure. Elderly female ACS patients experienced a statistically significant reduction in SAS and SDS scores at both 4- and 12 weeks post-PCI compared to their pre-PCI scores.ConclusionsTaken together, elderly female ACS patients undergoing PCI are more susceptible to the manifestation of anxiety and depression symptoms compared to their elderly male counterparts.