Multivariable-adjusted Analyses Research Articles

Guideline-directed medical therapy and in-hospital mortality in acute coronary syndrome patients with advanced renal dysfunction

Abstract Background It is unclear whether early (initiated within 24 hours of admission) guideline-directed medical therapy [GDMT, i.e., the combined use of β-blocker, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, dual antiplatelet drugs and statin] could benefit acute coronary syndrome (ACS) patients with advanced renal dysfunction [estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2]. Objectives The purpose of this study was to verify whether GDMT could improve in-hospital mortality in ACS patients with advanced renal dysfunction. Methods This study included 3,288 and 3,520 ACS patients with admission with advanced renal dysfunction from the CNEDSSP and CCC-ACS cohorts, respectively. Multivariable-adjusted analysis and propensity score matching (PSM) were employed to assess the impact of GDMT on in-hospital mortality. Results In a pooled analysis of the CNEDSSP and CCC-ACS cohorts, early GDMT was associated with significantly lower in-hospital mortality (relative ratio [RR]: 0.62, 95% CI: 0.47 to 0.81). PSM revealed an attenuation of the association of in-hospital mortality with early GDMT in ACS patients, with statistically significant associated reductions observed only in myocardial infarction (MI) patients (hazard ratio [HR]: 0.45, 95% CI: 0.27 to 0.75 in CNEDSSP cohort; HR: 0.48, 95% CI: 0.27 to 0.84 in CCC-ACS cohort). A random-effect pooled analysis for MI patients with admission advanced renal dysfunction demonstrated a 56% lower in-hospital mortality among GDMT users (RR: 0.44, 95% CI: 0.31 to 0.65). Conclusions This nationwide study highlights that early GDMT is associated with a reduced risk of in-hospital mortality in ACS patients (particularly in MI patients) with advanced renal dysfunction.

Risk of death in patients with early cardiovascular complications following ischaemic stroke: an individual patient data pooled analysis from the VISTA database

Abstract Background Early cardiovascular complications may occur in patients following ischaemic stroke (stroke-heart-syndrome, SHS). We investigated the risk of death in patients with SHS, and across the SHS manifestations. Methods Data were sought from the Virtual International Stroke Trials Archive (VISTA), an international repository of clinical trials data. We reviewed relevant adverse events and classified patients into two cohorts based on the incidence of cardiovascular complications within 30 days post-stroke (acute coronary syndrome [ACS] including acute myocardial injury, heart failure [HF]/left ventricular [LV] dysfunction, atrial fibrillation [AF]/atrial flutter [AFL], other arrhythmia/ ECG abnormalities, and cardio-respiratory arrest [CRA]), i.e. those with SHS and those with stroke-only (without SHS). Using Cox proportional hazards model, we evaluated the 90-day risk of death trajectories associated with SHS. We also compared the 90-day risk of death across SHS manifestations excluding CRA, using multivariate analysis. Results Among 15,054 patients with ischaemic stroke (mean age 72±11 years; 55% male), 1,787 (11.8%; 95% confidence interval [CI]: 11.3-12.3, Table 1) developed SHS, with incidence peaked at day 3 post-stroke (interquartile range: 2-5). Other arrhythmia/ECG abnormalities were the most prevalent (6.5%; 95%CI: 6.1-6.9), followed by AF/AFL, HF/LV dysfunction, ACS/acute myocardial injury, and CRA. Patients who developed SHS between 10-30 days post-stroke had significantly higher risks of death compared to those with SHS within the first 0-3 days (adjusted hazard ratio [HR]: 2.13 [1.57-2.89]). In the multivariate-adjusted analysis which includes 13 background factors such as age and sex, SHS manifested as ACS/acute myocardial injury and HF/LV dysfunction were associated with highest risk of death within 90-day post-stroke (adjusted hazard ratio [HR] [95% CI], HR 2.13 (1.08-4.18) and HR 2.28 (1.42-3.66), respectively, Figure 1). Conclusions Stroke-heart syndrome is associated with high risk of death, with greater risk observed with the delayed SHS onset. Among the SHS manifestations, ACS/acute myocardial injury and HF/LV dysfunction were associated with the highest risk of death post-stroke.Figure 1

CRT should be recommended for all heart failure patients with mechanical dyssynchrony and a ventricular conduction delay regardless of the QRS morphology

Abstract Introduction Two recent meta-analyses displayed the heterogeneous effect of cardiac resynchronization therapy (CRT) in patients with a non-left bundle branch block (non-LBBB) and found an increased burden of ventricular arrhythmias after CRT (1,2). Careful patient selection is therefore paramount. Evidence suggests the assessment of mechanical dyssynchrony may guide decision-making to CRT in this challenging population. Purpose To assess the effect of CRT in patients with and without mechanical dyssynchrony compared to medication only, and in particular in patients with a non-LBBB morphology. Methods We retrospectively screened for symptomatic heart failure patients who presented between 2012 and 2018 at our clinic with a QRS duration ≥130ms and a left ventricular ejection fraction (LVEF) ≤35%. We identified 361 patients who received CRT and 1107 patients who could have been considered for CRT. Patients were excluded if echocardiographic data was unavailable, they received CRT after 2018, were 80 years or older, or had other significant co-morbidities. We enrolled the remaining 220 CRT patients ("CRT") and 124 patients treated with medication only ("Control") for analysis. Patients were categorized for the presence of mechanical dyssynchrony on echocardiography, defined as the presence of either septal flash, apical rocking, or both. Multivariable-adjusted Cox regression analyses, including stratification by the presence of dyssynchrony, was performed to compare the effect of CRT to medication only. Hazard ratios (aHR) were obtained after adjustment for age, sex, atrial rhythm, QRS duration, QRS morphology, ischemic disease, kidney function, medication and presence of a defibrillator. Sensitivity analysis was performed in patients with a non-LBBB morphology. Results The CRT and Control group were comparable except for the QRS duration (163±22ms vs 152±16ms, p<0.001), the proportion of patients on optimal medical therapy (64% vs 47%, p=0.001), patients with a defibrillator (81% vs 19%, p<0.001), and patients with a LBBB morphology (75% vs 47%, p<0.001). During an average follow-up of 6.0(±3.2) years, 162 patients (47%) died. In the overall cohort, CRT did not significantly improve survival (aHR: 0.66, p=0.065). There was, however, a marked survival benefit for CRT over medication only in patients with mechanical dyssynchrony (aHR: 0.37, p=0.001). In patients without dyssynchrony there was a trend towards harm due to CRT (aHR: 2.05, p=0.062). These results were consistent in the sub-cohort of patients with a non-LBBB morphology. Conclusion CRT significantly improves the life expectancy of patients with mechanical dyssynchrony, including patients with a non-LBBB morphology. These results add to the evidence that all heart failure patients with LVEF≤35%, QRS≥130ms and mechanical dyssynchrony should be recommended (Class I) for CRT regardless of QRS morphology, while awaiting the results of ongoing randomized controlled trials.

Urinary artificial sweeteners and breast cancer risk in women from the Moli-sani Study

Abstract Background Artificial sweeteners (AS) are chemical substances developed by the food industry to reduce sugar and calories while maintaining sweetness. Cohort studies suggested an increased risk of certain cancers, including breast cancer (BC), associated with AS intake, however evidence exclusively relied on self-reported dietary data rather than objectively measured AS. We examined the association of urinary biomarkers denoting AS intake with BC risk in women from the large Moli-sani Study. Methods Using a case-cohort design, a sample of 987 middle-aged women (mean age 55±12 y) was randomly selected as sub-cohort and compared with 273 women with incident BC (26 of them also belong to the sub-cohort). A total of 6 commonly used AS (i.e. aspartame, acesulfame, saccharine, sucralose, cyclamate, and steviol glycosides) were measured through liquid chromatography-mass spectrometry in urinary samples (creatinine-adjusted concentrations; µg/mg) collected at baseline (2005-2010). The multivariable hazard ratios (HRs) were estimated through Cox regression models using the Prentice method, where each AS was dichotomized as absence/presence, independent of concentrations. Results The main urinary AS was saccharine (E954), contributing to 71% of total AS, followed by steviol glycosides (E960;11%). During a median follow-up of 13.2 y we identified 38 premenopausal and 235 postmenopausal incident BC cases. In multivariable-adjusted Cox analyses, none of the individual AS was associated with overall BC risk, nor was the total urinary AS (HR = 0.93; 95%CI 0.63-1.37 for 1-unit increment). Compared to absence, presence of sucralose (E955) in urine was linked to premenopausal BC (HR = 4.23: 95%CI 1.23-14.51; p = 0.022). Conclusions Urinary artificial sweeteners were not associated with BC risk. However, sucralose presence in urine was linked to a higher risk of premenopausal BC. Prospective, dose-related studies with larger sample size are warranted to possibly confirm our findings. Key messages • The presence in the urine of commonly used artificial sweeteners was not associated with breast cancer risk. • Presence of urinary sucralose was linked to higher risk of premenopausal breast cancer.

Investigating the diverse role of ultra-processed foods on cardiometabolic multimorbidity: Highlights from the ATTICA prospective study (2002-2022)

Abstract Background/Introduction The role of ultra-processed foods (UPF) on multimorbidity is currently unknown with limited research implying the existence of complex associations among the diverse UPF categories. Purpose The aim of the present work was to investigate the association of total and subgroup intake of UPF with cardiometabolic multimorbidity, after twenty years of observation, in a Mediterranean region. Methods In 2001-2002, n=3,042 free-of-cardiovascular disease (CVD) men and women from Attica, Greece, were recruited. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. The NOVA Food Classification system was used to assign the food products as UPF using a standard methodology. The food products assigned as UPF were further grouped as "bread and cereals", "spreads and sauces", "sweets and desserts", "artificially and sugar-sweetened beverages", "processed meat products" and "savory snacks". Cardiometabolic multimorbidity was defined as the co-occurrence of two cardiometabolic diseases i.e., type 2 diabetes and CVD within a 20-year follow-up period in a sample of n=1,846 participants with available data. Results The median consumption level of UPFs was 26.6 (16.3) servings/week contributing to around 40% of participants total daily energy intake. Over the 20–year follow–up period, n=231 cases of cardiometabolic multimorbidity were recorded. Ranking from 1st tertile (lower intake– 11.8 mean servings/week) to 2nd tertile (23.3 mean servings/week) and 3rd tertile (44.7 mean servings/week) regarding the consumption level of UPF, 20-year cardiometabolic multimorbidity was 9.5%, 13.4% and 14.7% respectively. Multi-adjusted analysis revealed that one standard deviation (SD) increase in UPF intake (servings/week) or in contribution of UPFs to total energy intake (% total energy intake) was associated with 26% [Odds ratio (OR)=1.26, 95% Confidence Interval (95%CI) (1.17–1.85)] and 29% higher risk of cardiometabolic multimorbidity [OR=1.29, 95%CI (1.08–1.69)]. Among UPF subgroups, only in case of artificial and sugar-sweetened beverages [OR=1.06, 95%CI (1.02–1.13)] as well as spreads and sauces [OR=1.06, 95%CI (1.02–1.13)] a positive association was observed. In case of breads and cereals an inverse association was observed [OR=0.95, 95%CI (0.92–0.98)]. In the rest categories even if a positive trend was observed (all ORs>1) significance was not reached (all p-values<0.05). Conclusion A dose-response relationship between UPF consumption and elevated risk of cardiometabolic multimorbidity was emerged. However, the diverse categorization of UPFs accompanied by the contradicting associations revealed herein among the different subcategories of UPFs could imply the need to return to the evaluation of foods more on the basis of their nutritional role and less on the basis of their degree of processing. The nation context accompanied by specific dietary habits should also be taken into consideration.

The incidence and outcome of patients with early cardiovascular complications following intracerebral haemorrhage: An individual patient data pooled analysis from the VISTA database

Abstract Background Early cardiovascular (CV) complications in patients following intracerebral haemorrhage (ICH) is poorly understood. Such incident CV complications could be part of the so-called stroke-heart-syndrome occurring following ICH (SHS-ICH). We investigated the incidence and outcomes of patients with SHS-ICH. Methods Data were sought from the Virtual International Stroke Trials Archive (VISTA), an international repository of clinical trials data. We reviewed relevant adverse events and identified patients based on the incidence of cardiovascular complications within 30 days of post-ICH or ischaemic stroke (acute coronary syndrome [ACS] including acute myocardial injury, heart failure [HF]/left ventricular [LV] dysfunction, atrial fibrillation [AF]/atrial flutter [AFL], other arrhythmia/ ECG abnormalities, and cardio-respiratory arrest [CRA]). We conducted propensity score matching (PSM) to compare the incidence and outcomes of patients with SHS following ICH (SHS-ICH) with patients with SHS following acute ischaemic stroke (AIS). Poor outcome was defined as modified Rankin Scale, mRS ≥2, at 90 days. Results We pooled data from 12,438 participants recruited in acute stroke trials (mean age 68±12 years; 56% male), of which 1,171 (9.4%) were patients with ICH. Of the ICH patients, 150 patients (12.8%) had SHS-ICH. Following PSM, a total of 2,342 patients (1,171 for each of the ICH and AIS cohorts) were analysed. The incidence of SHS was not significantly different in the ICH and AIS cohorts (Table 1). The incidence of AF was significantly lower in patients with ICH compared to patients with AIS (1.5% vs. 4.5%, p<0.0001), despite comparable incidences of other arrhythmia/ECG abnormalities (9% vs. 9%, p=0.9). Multivariate-adjusted analysis found that SHS-ICH was associated with poor outcomes (Table 2, odds ratio, OR 1.08 [95%CI: 1.03-1.16], p=0.04, compared to ICH patients without SHS). Conclusions Stroke-heart syndrome is common and serves as a crucial prognostic marker in patient with ICH, with outcomes similar to SHS patients related to AIS. The development of SHS-ICH was associated with poorer outcomes compared to ICH patients without SHS.

The association between dietary patterns and cardiovascular disease risk factors in Iranian adults: a cross-sectional study

BackgroundDietary patterns are important factors associated with cardiovascular diseases (CVDs). We examined the association between dietary patterns derived from factor analysis and CVD risk factors.MethodsIn the present cross-sectional study, a total of 3,687 adults (aged 40 to 70 years) with one or more types of CVDs were enrolled as participants. A validated semi-quantitative food-frequency questionnaire was utilized to assess food intakes, and then dietary patterns were extracted by factor analysis. Fasting blood sugar (FBS), lipid profile, anthropometric indices, and blood pressure (BP) were measured. Multivariable-adjusted logistic regression analysis was employed to ascertain the odds ratio (OR) of CVD risk factors associated with posteriori dietary patterns. In this study, healthy and unhealthy dietary patterns were identified.ResultsAdherence to a healthy dietary pattern was associated with a decrease in systolic BP (SBP) (OR = 0.78; 95% confidence interval (CI): 0.62–0.99) and high-density lipoprotein cholesterol (HDL-C) levels (OR = 1.32; 95% CI: 1.06–1.64). Additionally, greater adherence to the unhealthy dietary pattern was positively associated with SBP (OR = 1.43; 95% CI: 1.13–1.80) and diastolic BP (DBP) (OR = 1.33; 95% CI: 1.01–1.76).ConclusionsWe concluded that greater adherence to an unhealthy dietary pattern was associated with an increase in SBP and DBP. On the other hand, greater adherence to a healthy dietary pattern could be effective in reducing SBP. Further investigation is recommended to validate these findings.

Association between serum calcium and in-hospital mortality in intensive care unit patients with cerebral infarction: a cohort study

BackgroundThe relationship between serum calcium levels and the prognosis of cerebral infarction remains controversial.PurposeThis study aims to investigate the correlation between serum calcium levels and in-hospital mortality in critically ill patients with ischemic stroke admitted to the intensive care unit (ICU).MethodsA retrospective cohort study was conducted using data from the MIMIC-IV database. Demographic and clinical data of all participants were collected including gender, age, hypertension, diabetes, myocardial infarction, heart failure, chronic obstructive pulmonary disease, hemoglobin, potassium, sodium, anion gap, platelets, white blood cells, glucose, creatinine, Glasgow coma score (GCS), IV-tPA administration (rt-PA), and mechanical thrombectomy (MT). The outcome measure was in-hospital death. Multivariable-adjusted logistic regression analysis, curve fitting, interaction analysis, and threshold effect analysis were employed to evaluate the relationship between serum calcium levels and in-hospital mortality among ICU patients with cerebral infarction.ResultsA total of 2,680 critically ill patients with cerebral infarction were enrolled, with a mean serum calcium level of 8.6 ± 0.8 mg/dL. The overall in-hospital mortality rate was 19.5%, where Group 1 (serum calcium < 8.0 mg/dL) had a mortality rate of 27.7%, Group 2 (serum calcium 8–9 mg/dL) had a rate of 19.8%, and Group 3 (serum calcium ≥ 9 mg/dL) had a rate of 13.9%. There was a non-linear, S-shaped relationship between serum calcium levels and in-hospital mortality. Serum calcium levels within the range of 7.70–9.50 mg/dL were found to be independently associated with increased in-hospital mortality in ICU patients with cerebral infarction. No significant interactions were detected in subgroup analyses, and the results of sensitivity analyses remained stable.ConclusionSerum calcium levels are independently associated with in-hospital mortality in critically ill patients with cerebral infarction in the ICU setting. Within the range of 7.70–9.50 mg/dL, lower serum calcium levels increase the risk of in-hospital death among these patients, emphasizing the importance of close monitoring by ICU physicians.

Malnutrition is associated with severe outcome in elderly patients hospitalised with COVID-19

Some studies have identified influencing factors of COVID-19 illness in elderly, such as underlying diseases, but research on the effect of nutritional status is still lacking. This study retrospectively examined the influence of nutritional status on the outcome of elderly COVID-19 inpatients. A retrospective analysis of the clinical data of 4241 COVID-19 patients who were admitted to a third-class hospital of Nanchang between November 1, 2022 and January 31, 2023 was conducted. Nutritional status was assessed using the prognostic nutritional index (PNI) and controlling nutritional status score (CONUT). The influence of nutritional status on the outcome of COVID-19 patients was determined through multivariate adjustment analysis, restrictive cubic spline, and receiver operating characteristic curve (ROC). Compared with mild/no malnutrition, severe malnutrition substantially increased the critical outcome of COVID-19. A linear relationship was observed between the odds ratio (OR) and PNI and CONUT (P > 0.05). The area under the ROC curve indicated that PNI was the better predictor. The optimal cutoff value of PNI was 38.04 (95%CI: 0.797 ~ 0.836, AUC = 0.817), with a sensitivity of 70.7% and a specificity of 79.6%. The critical illness of elderly COVID-19 patients shows a linear relationship with malnutrition at admission. The use of PNI to assess the prognosis of COVID-19 eldeely patients is reliable, highlighting the importance for doctors to closely pay attention to the nutritional status of COVID-19 patients. Focusing on nutritional status in clinical practice can effectively reduce the critical illness of elderly COVID-19 patients.

Blood L-cystine levels positively related to increased risk of hypertension.

Hypertension is one component of metabolic syndrome (MetS). Here, the study evaluated hypertension-associated metabolites in relation to other MetS components. Fasting plasma samples were collected from 22 hypertensive and 63 normotensive subjects for non-targeted metabolomics. Compared with normotensive subjects, hypertensive patients were more diabetic (6.3%vs. 36.4%) and had dyslipidemia (27.0%vs. 63.6%) (both p<.05). By non-targeted metabolomics, 758 metabolites in 22 classes were identified and 56 were differentially regulated between hypertensive and normotensive groups. Amongst these 56 metabolites, receiver operating characteristic analysis showed that 14 had an area under the curve above 0.6. Multivariate-adjusted logistic regression analysis demonstrated that per one-fold increase of L-glutmatic acid, L-cystine, (9S,10E,12Z,15Z)-9-Hydroxy-10,12,15-octadecatrienoic acid, deoxyribose 5-phosphate, and falcarinolone, the odds ratios were 3.64, 4.61, 0.26, 0.26, and 0.37 for having the risk of hypertension, respectively. Of five metabolites, by Spearman's correlation analysis, only L-glutmatic acid and L-cystine levels were positively associated with systolic and diastolic blood pressure (all p<.05). Spearman's correlation analysis further revealed that L-glutmatic acid levels were positively correlated with to body mass index (BMI), fasting blood glucose, and serum triglyceride but negatively associated with HDL-c (all p<.05) whereas L-cystine levels were not related to any of these components (p ≥.13). Multivariate-adjusted linear regression analysis confirmed the positive correlation between L-cystine levels and systolic or diastolic blood pressure (β=2.66 for SBP; β=2.50 for DBP; both p<.05). In conclusion, L-cystine could be a potent metabolite for increased risk of hypertension.

Association of weight-adjusted-waist index with all-cause and cardiovascular mortality in individuals with diabetes or prediabetes: a cohort study from NHANES 2005–2018

Weight-adjusted waist index (WWI) is a new marker of central obesity. This study explored the association of WWI with all-cause and cardiovascular disease (CVD) mortality in individuals with diabetes or prediabetes. 6551 participants with diabetes or prediabetes from the National Health and Nutrition Examination Survey (NHANES) records between 2005 and 2018 were included. The association of WWI with all-cause and CVD mortality was assessed using Kaplan-Meier survival analysis, Cox proportional hazards model (Cox regression), and restricted cubic spline (RCS). The predictive value of WWI for mortality was analyzed using time-dependent receiver operating characteristic curves (ROC). There were 1083 all-cause deaths and 360 CVD deaths. Multivariable-adjusted Cox regression analyses showed WWI was positively correlated with the risk of all-cause and CVD mortality in subjects with diabetes or prediabetes. Multivariate-adjusted RCS analyses showed a linear and positive correlation of WWI with all-cause mortality risk, and a nonlinear relationship with CVD mortality, with a threshold of 12.35. The area under the curve (AUC) for 3, 5, and 10-years survival for all-cause mortality was 0.795, 0.792, and 0.812, respectively, and for CVD mortality was 0.815, 0.833, and 0.831, respectively. WWI is a valuable predictor of all-cause mortality risk in patients with diabetes and prediabetes, and a valuable predictor of CVD mortality risk when patients with diabetes and prediabetes are considered as a whole.

Investigating Frailty, Polypharmacy, Malnutrition, Chronic Conditions, and Quality of Life in Older Adults: Large Population-Based Study.

Aging, a significant public health issue, is associated with multiple concurrent chronic diseases and aging-related conditions (geriatric syndromes). This study aims to investigate the impact of age and chronic conditions on geriatric syndromes and the intercorrelations between multiple geriatric syndromes and quality of life (QoL) in older adults (aged ≥65 years) at the population level. A large representative sample was randomly selected from a county in China, Feidong, with 17 towns and 811,867 residents. Multiple chronic conditions, geriatric syndromes (frailty, polypharmacy, and malnutrition), and QoL were assessed and compared. Associations of demographic information and chronic conditions with geriatric conditions and QoL in older adults were assessed using multivariable-adjusted logistic regression. Intercorrelations between age, multiple geriatric syndromes, and QoL were investigated using both correlation analysis and restricted cubic splines-based multivariable-adjusted dose-response analysis. Older adults comprised 43.42% (3668/8447) of the entire study population. The prevalence of frailty, premalnutrition or malnutrition, polypharmacy, and impaired QoL (median age 73, IQR 69-78 years; 1871/3668, 51% men) was 8.26% (303/3668), 15.59% (572/3668), 3.22% (118/3668), and 10.8% (396/3668), respectively. Different age and sex subgroups mostly had similar prevalence of geriatric syndromes (except that frailty occurred more often with older age). Premalnutrition or malnutrition were associated with a lower frequency of obesity and a higher frequency of constipation, polypharmacy with a higher frequency of diabetes and constipation, frailty with a higher frequency of constipation and hernia, and impaired QoL with a higher frequency of hypertension, diabetes, physical disability, and constipation. Mini Nutritional Assessment-Short Form, Groningen Frailty Indicator, and EQ-5D-5L scores, as well as the number of medications used, mostly predicted each other and QoL. Impaired QoL was associated with a higher frequency of frailty, premalnutrition or malnutrition, and polypharmacy, and frailty with a higher frequency of premalnutrition or malnutrition and polypharmacy. At a 1.5-year follow-up, impaired QoL was linked to polypharmacy and frailty at baseline, premalnutrition or malnutrition and polypharmacy were associated with frailty at baseline, and frailty was linked to both premalnutrition or malnutrition and polypharmacy at baseline. Causal mediation analyses showed that frailty mediated the link between polypharmacy and worse QoL and that polypharmacy mediated the link between frailty and worse QoL. In this large population-based study of older adults, multiple chronic conditions were associated with ≥1 of the investigated geriatric syndromes. Geriatric syndromes were mostly intercorrelated with, and well predictive of, each other and QoL; and causal relationships existed between geriatric syndromes and QoL, with other geriatric syndromes being mediators. The findings might be biased by residual confounding factors. It is important to perform personalized geriatric syndrome assessments stratified by chronic condition; active prevention of, or intervention for, any syndrome might help to reduce the others and improve QoL.

Effect of air pollution, genetic susceptibility on the risk of all-cause mortality and cardiovascular outcomes among atrial fibrillation patients

Objective: To analyze the association between air pollution, genetic susceptibility, and the risk of all-cause mortality and cardiovascular outcomes in patients with atrial fibrillation (AF). Methods: AF patients aged between 40-69 years old registered in the United Kingdom Biobank from 2006 to 2010 were included. After excluding those lost to follow-up or with incomplete data during follow-up, 5 814 subjects were analyzed. Long-term exposure to air pollution was estimated at the geocoded residential address of each participant. Genetic risk scores for all-cause mortality, cardiovascular disease, heart failure, myocardial infarction, and stroke were constructed separately for each object to assess the corresponding genetic susceptibility. The Cox proportional hazards model was used to analyze the association between air pollution, genetic susceptibility, and the risk of all-cause mortality and cardiovascular outcomes in AF patients. Results: During a median follow-up of 12.4 years, there were 929 of all-cause mortality (15.98%) and 1 772 of cardiovascular events (30.48%). Multivariable-adjusted analyses revealed that higher exposure to PM2.5, PM10, NOx, and NO2 was associated with an increased risk of cardiovascular disease mortality, heart failure, myocardial infarction, and stroke, with hazard ratios (HRs) ranging from 1.26 to 1.48. Specifically, for each interquartile range (IQR) increase in PM2.5 exposure, the HRs for the outcomes mentioned above were 1.33 (95%CI: 1.14-1.54), 1.42 (95%CI: 1.31-1.54), 1.46 (95%CI: 1.30-1.64), and 1.43 (95%CI: 1.27-1.61), respectively. Both NOx and NO2 exposures were associated with a 9% increased risk of all-cause mortality per IQR increment, with corresponding HRs of 1.09 (95%CI: 1.02-1.17) and 1.09 (95%CI: 1.01-1.17), respectively. Individuals with high genetic susceptibility to AF had a higher risk of myocardial infarction and stroke compared to those with low genetic susceptibility, with corresponding HRs of 1.39 (95%CI: 1.04-1.87) and 1.46 (95%CI: 1.09-1.95), respectively. Compared to AF patients with low air pollution exposure, those with high air pollution exposure have adjusted population attributable fractions of up to 33.57% (95%CI: 17.87%-46.26%) for cardiovascular mortality, 28.61% (95%CI: 20.67%-35.75%) for heart failure, 33.35% (95%CI: 20.97%-43.79%) for myocardial infarction, and 42.29% (95%CI: 30.05%-52.71%) for stroke. Furthermore, there was an additive interaction between PM2.5, NOx, and NO2 exposure and high genetic susceptibility on the incidence of myocardial infarction. An additive interaction was also observed between NOx, NO2 exposure, and high genetic susceptibility on the incidence of heart failure (all P<0.05). Conclusions: Both air pollution and genetic susceptibility increase the risk of all-cause mortality and cardiovascular outcomes in AF patients.

The association between food insecurity and obesity, a body shape index and body roundness index among US adults

Research has established a positive association between food insecurity and obesity, typically assessed by body mass index (BMI); However, studies examining the relationship between food insecurity and measures of body fat content and distribution are lacking. The aim of this study was to examine the association between food insecurity and obesity ([BMI] ≥ 30 kg/m2) and body fat indicators assessed by body roundness index ([BRI] > 6.72) and a body shape index ([ABSI] > 0.08). This is a cross-sectional study using NHANES data 2007–2020. Household food security was assessed by U.S. Food Security Survey Module questionnaire. Multivariable-adjusted binary logistic regression analyses were used to calculate odds ratios and 95% CIs. Compared to those with full food security, the adjusted ORs for obesity were 1.28 (95% CI:1.18, 1.39), 1.40 (95% CI:1.28, 1.53), and 1.43 (95% CI:1.30, 1.57) for those with marginal, low and very low food security, respectively. The corresponding ORs for high BRI were, respectively, 1.39 (95% CI:1.26, 1.52), 1.50 (95% CI:1.36, 1.66), and 1.60 (95% CI:1.43, 1.78). Similar results were observed for ABSI. The analyses of BMI suggested a potential sex difference, as significant associations were found in women, but not in men. This study confirms previous evidence of the positive association between food insecurity and obesity among US adults.

Apolipoprotein C-III in association with metabolic-dysfunction associated steatotic liver disease: A large, multicenter study

Background & AimsThe available literature on the effect of apolipoprotein C-III (ApoC-III) inhibition in MASLD reveals inconsistencies. The aim of the present work was to examine levels of ApoC-III in the entire spectrum of metabolic-dysfunction associated steatotic liver disease (MASLD). MethodsThis is a multicenter study with liver biopsies from patients in two Gastroenterology-Hepatology Clinics (Greece and Australia) and in one Bariatric-Metabolic Surgery Clinic (Italy). ApoC-III was measured through enzyme-linked immune sorbent assay in n=354 patients with MASLD. ResultsComparing simple MASL to steatohepatitis (MASH) with fibrosis stage F≥2 (at-risk MASH), revealed a marginally significant trend for decreased ApoC-III levels in the latter group (p=0.07). Multi-adjusted analysis revealed an inverse association between ApoC-III and at-risk MASH (Odds Ratioper 1 mg/dL increase in ApoC-III= 0.91, 95% Confidence Interval (0.83, 0.99)). ApoC-III interacted with triglycerides in predicting at-risk MASH (p-for-interaction=0.002). Participants with ApoC-III>median (∼3.75 mg/dL) and normal triglycerides (triglyceridese≤150mg/dL) had the lowest likelihood to present at-risk MASH (31.8%) in contrast with participants with ApoC-III<median and hypertriglyceridemia among whom at-risk MASH was recorded in 57.1%. In multi-adjusted analysis participants with normal triglycerides and high ApoC-III had 64% lower odds of at-risk MASH compared with their counterparts with ApoC-III<median (OR=0.36, 95%CI (0.14, 0.86)). Among participants with hypertriglyceridemia, those with ApoC-III<median had less prevalent at-risk MASH compared with those with ApoC-III≥median (OR=0.54, 95%CI (0.32, 0.98)); however in all cases significance was lost when liver enzymes were taken into account. ConclusionsIn advanced disease stages, ApoC-III levels seem to be decreased and advanced organ damage may be a potential explanation. Mendelian randomization studies are needed to confirm or refute this hypothesis.

Economic hardship resulting from the late 2000s Great Recession and long-term changes in mental health: a prospective analysis from the Moli-sani study.

Economic downturns may have detrimental effects on mental health. We investigated the association of economic hardship resulting from the late 2000s Great Recession with long-term changes in mental health. We analysed data from 1,647 participants to the larger Moli-sani cohort (2005-2010, Italy), who were re-examined between 2017 and 2020. To evaluate economic hardship, we performed a Latent Class Analysis on nine items linked to change in employment status and financial hardship. Depression symptoms were measured by the Patients' Health Questionnaire (PHQ-2; higher values indicate more depressive symptoms; data available in N = 941 individuals) and health perception as assessed by the 36-Item Short Form Health Survey (decreased values indicate worsening of health perception). Economic hardship was categorized into three classes: "None", "Average" and "High", the latter reflecting increasing economic hardship. Mean (standard deviation) changes in PHQ-2, SF-36 mental and physical after 12.8 years (median) were - 0.1 (1.3), 0.5 (9.9) and - 2.2 (6.2) units, respectively. Changes in SF-36 mental score decreased by 1.0 unit (0.3) monotonically across "none" to "average" to "high" category in a multivariable-adjusted model analysis; the SF-36 physical score decreased by 0.4 (0.2) unit and PHQ-2 increased by 0.1 (0.1). In comparison with participants in the "none", those in the "high" class had 84% (95%CI: 26%-170%) higher odds to report an increment in PHQ-2 values from baseline to re-examination. Economic hardship resulting from the Great Recession in late 2000s was associated with deterioration of mental health, as reflected by increased depression symptoms and reduced perceived mental health.

Baseline Blood Pressure Was Associated with Hemispheric Cerebral Blood Flow in Acute Small Subcortical Infarcts

Introduction: While increased baseline blood pressure (BP) is a prevalent comorbidity in the acute phase of ischemic stroke, the association between baseline BP and the state of hemispheric perfusion in patients with acute small subcortical infarcts (SSIs) has not been studied in detail. The aim of this study was to investigate the relationship between baseline BP and hemispheric cerebral blood flow (CBF) in acute SSIs. Methods: This retrospective study included 101 patients with acute SSIs. Baseline hemispheric CBF was assessed through co-registration of baseline CT perfusion imaging and follow-up diffusion-weighted imaging. The association between baseline BP, CBF, and different cerebral small vessel disease (CSVD) biomarkers was assessed. Results: Baseline systolic BP (SBP) and diastolic BP (DBP) were negatively associated with contralateral hemispheric CBF after multivariate-adjusted linear analysis (SBP: β = −0.001, 95% CI: −0.002 to 0.000, p = 0.030; DBP: β = −0.002, 95% CI: −0.003∼0.001, p = 0.006). Among other CSVD biomarkers, the presence of any cerebral microbleeds showed a significant association with lower CBF in the contralateral hemisphere of the infarct lesion (r = −0.270, p = 0.035). Conclusion: In patients with acute SSIs, increased baseline BP was associated with reduced CBF in the contralateral hemisphere of the infarct lesion, which probably could be interpreted by the exacerbation of the CSVD burden, suggesting a potential mechanistic link between BP autoregulation dysfunction and the aggravation of neurovascular impairment in SSIs.

Association of a composite trait for anthropometrics, adiposity and energy expenditure with cardiometabolic diseases: An age-stratified cohort and genetic risk score analysis.

Various anthropometric measures capture distinct as well as overlapping characteristics of an individual's body composition. To characterize independent body composition measures, we aimed to reduce easily-obtainable individual measures reflecting adiposity, anthropometrics and energy expenditure into fewer independent constructs, and to assess their potential sex- and age-specific relation with cardiometabolic diseases. Analyses were performed within European ancestry participants from UK Biobank (N = 418,963, mean age 58.0 years, 56% women). Principal components (PC) analyses were used for the dimension reduction of 11 measures of adiposity, anthropometrics and energy expenditure. PCs were studied in relation to incident type 2 diabetes mellitus (T2D) and coronary artery disease (CAD). Multivariable-adjusted Cox regression analyses, adjusted for confounding factors, were performed in all and stratified by age. Genome-wide association studies were performed in half of the cohort (N = 156,295) to identify genetic variants as instrumental variables. Genetic risk score analyses were performed in the other half of the cohort stratified by age of disease onset (N = 156,295). We identified two PCs, of which PC1 reflected lower overall adiposity (negatively correlated with all adiposity aspects) and PC2 reflected more central adiposity (mainly correlated with higher waist-hip ratio, but with lower total body fat) and increased height, collectively capturing 87.8% of the total variance. Similar to that observed in the multivariable-adjusted regression analyses, we found associations between the PC1 genetic risk score and lower risks of CAD and T2D [CAD cases <50 years, odds ratio: 0.91 (95% confidence interval 0.87, 0.94) per SD; T2D cases <50 years, odds ratio: 0.76 (0.72, 0.81)], which attenuated with higher age (p-values 8.13E-4 and 2.41E-6, respectively). No associations were found for PC2. The consistently observed weaker associations of the composite traits with cardiometabolic disease suggests the need for age-specific cardiometabolic disease prevention strategies.

Incidence and Outcomes of Patients With Early Cardiac Complications After Intracerebral Hemorrhage: A Report From VISTA.

The incidence and outcomes of early cardiac complications in patients with intracerebral hemorrhage (ICH) are poorly understood. These cardiac complications may be part of the so-called stroke-heart syndrome in patients with ICH. We investigated this issue in an individual patient data pooled analysis from an international repository of clinical trial data. We used the Virtual International Stroke Trials Archive to investigate the incidence of cardiac complications within 30 days post-ICH or acute ischemic stroke (AIS). These complications included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/atrial flutter, other arrhythmia/ECG abnormalities, and cardiorespiratory arrest. We used propensity score matching to compare the incidence of patients with stroke-heart syndrome in patients with ICH with those following AIS. Factors associated with 90-day mortality were evaluated using multivariate logistic regression analysis in the ICH cohort. We pooled data from 8698 participants recruited in acute stroke trials (mean age, 68±12 years; 56% male), of whom 914 (11%) were patients with ICH. Among the patients with ICH, 123 (13%) had stroke-heart syndrome in patients with ICH. Following propensity score matching, a total of 1828 patients (914 for each of the cohorts) were analyzed. While the overall incidence of cardiac events tended to be lower in the ICH group compared with the AIS group (the cumulative incidence freedom from the event, 86.3% [95% CI, 84.1-88.6] versus 83.6% [95% CI, 81.2-86.0]; P=0.100), the incidences cardiac events other than atrial fibrillation/atrial flutter were comparable between the 2 matched groups. The incidence of atrial fibrillation/atrial flutter was significantly lower in the ICH group than in the AIS group (P<0.001). The multivariate-adjusted analysis found that stroke-heart syndrome in patients with ICH was associated with 90-day mortality (adjusted odds ratio, 1.12 [95% CI, 1.06-1.19]; P<0.001). Cardiac events are common and negatively affect prognosis in patients with ICH, just as seen in AIS.

Women undergoing primary total hip arthroplasty (THA) for hip fracture have lower in-hospital mortality compared to men

IntroductionWe evaluated the association of patient sex with in-patient mortality and discharge disposition after primary total hip arthroplasty (THA) for hip fracture in the U.S. MethodsUsing the 2016-2019 U.S. National Inpatient Sample (NIS), we calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association of sex with post-procedural complications and in-hospital mortality after primary THA for hip fracture, adjusting for demographics, social determinants of health, medical comorbidity, hospital characteristics, and post-procedural complications. ResultsThere were 400,930 primary THA procedure hospitalizations for hip fracture in the 2016-2019 NIS data. In multivariable-adjusted analysis, compared to males, female sex was associated with lower in-hospital mortality following THA for hip fracture (aOR 0.65, 95% CI 0.58 - 0.74; p < 0.001). Multivariable-adjusted analysis showed that female sex was associated with higher odds of discharge to a non-home destination after a THA for hip fracture (aOR 1.14, 95% CI 1.07 - 1.22; p < 0.001). ConclusionsFemale sex was associated with lower in-hospital mortality after a THA for hip fracture. Further insights into the protective mechanisms that mediate this lower mortality in women undergoing a THA for hip fracture are needed to achieve better outcomes for men in the future.