Reduction In All-cause Mortality Research Articles

Association of lifes essential 8 and mortality among adults with and without CVD

Abstract Background Differences in the American Heart Association’s Life’s Essential 8 (LE8) score and its association with mortality based on the presence of clinically prevalent cardiovascular disease (CVD) has not been assessed previously. Methods Data from the National Health and Nutrition Examination Survey (NHANES) 2009-2018 was utilized to calculate LE8 scores among adult patients, stratified by the presence of existing CVD. Health metrics were further divided into health behaviors and health factors. Scores were also evaluated based on sex, age, race/ethnicity, and socioeconomic status. Cox proportional hazard models were used to evaluate the association between the levels of cardiovascular health (CVH) and risk of all-cause and cardiovascular mortality. Results 25,359 patients were included in the analysis, of which 10.2% had known CVD. Individuals with known CVD had lower overall CVH (55.9 vs. 65.8, p <0.001), health behaviors (60.6 vs. 67.9, p <0.001), and health factors (51.3 vs. 63.8, p <0.001) scores. The lower CVH scores in those with prior CVD persisted after stratification by sex, age, race/ethnicity, and socioeconomic status. When assessing the association of CVH metrics with mortality, for every 10-point increase in LE8 score, there was a significant reduction (17%-27%) in all-cause and CV mortality in those with and without CVD. Conclusions Individuals with known CVD have lower CVH metric scores. Overall, the LE8 score is able to predict future CV outcomes in both individuals with and without CVD and highlights the importance of effective implementation strategies that target health factors and behaviors in primary and secondary prevention populations.

Outcomes of bariatric surgery in obese patients with heart failure:a meta-analysis

Abstract Background Patients with heart failure possess an increased risk for adverse outcomes with noncardiac surgery (1). While bariatric surgery is frequently performed in patients with obesity, there remains a limited understanding of the impact of bariatric surgery in obese patients with heart failure. Purpose The purpose of this study was to compare outcomes of bariatric surgery versus nonsurgical management in obese patients with heart failure. Methods We searched PubMed, EMBASE, and the Cochrane Library, through February 2024, for studies evaluating outcomes in obese patients with heart failure who underwent bariatric surgery compared to nonsurgical management. Outcomes assessed were postoperative atrial fibrillation, all-cause mortality, and hospital readmission. We used a fixed-effect model to calculate hazard ratios (HR) with 95% confidence intervals (CI) in R studio for outcomes assessed. In outcomes where significant heterogeneity was found (P< 0.05 and I2 > 60%), a random effects model was used. Results A total of 3 studies were identified, consisting of 260,186 patients. Compared to nonsurgical management, bariatric surgery was associated with a significant reduction in postoperative atrial fibrillation (HR 0.72; 95% CI: 0.62-0.84), all-cause mortality (HR 0.50; 95%CI 0.35-0.72), and hospital readmission (HR 0.73; 95% CI 0.69-0.78) in obese patients with heart failure. Conclusion Our study suggests that bariatric surgery significantly reduces post-operative atrial fibrillation, mortality, and hospital readmission among obese patients with heart failure.Our findings demonstrate that bariatric surgery should be considered as a viable intervention in obese patients with heart failure. Further studies are warranted to confirm our findings.Forest Plots of Outcomes Assessed

Exploring the long-term effects of dapagliflozin in patients with stable acute myocardial infarction and preserved ejection fraction through a propensity score matching study

Abstract Background and Aims The recent Emmy trial underscored notable improvements in cardiac structure and function among post-acute myocardial infarction (AMI) patients treated with Empagliflozin, compared to those receiving a placebo. However, limitations such as a small sample size and a short follow-up period hindered the assessment of potential differences in actual clinical events between the groups. Consequently, our study aimed to evaluate the long-term outcomes, survival rates, rates of major adverse cardiovascular events (MACE), and heart failure (HF) incidence in patients with preserved ejection fraction (EF) who experienced AMI and underwent successful percutaneous coronary intervention (PCI), comparing those who received early initiation of Dapagliflozin with those who did not. Methods Data from the Taipei Medical University Research Database in Taiwan identified 7,081 inpatients who met the criteria of AMI status post successful PCI, with a left ventricular ejection fraction (LVEF) greater than 50% and absence of clinical symptoms indicative of heart failure. Exclusion criteria included individuals with a pre-existing diagnosis of heart failure before the index AMI episode and those with an LVEF below 50%, resulting in the exclusion of 357 patients from our study. The study subjects were then divided into two groups: those treated with Dapagliflozin and those not treated with Dapagliflozin, with matching for age, diabetes mellitus, and chronic kidney disease in a 1:2 ratio. Results The cohort study included of 756 patients who met the criteria of this study, among whom 252 were Dapagliflozin users and 504 were not. Over a 7-year follow-up period, Kaplan-Meier survival analyses revealed a significant reduction in cardiovascular mortality and all-cause mortality among Dapagliflozin users compared to non-users (p < 0.01). However, no significant differences were observed in heart failure, recurrent AMI, or stroke during the follow-up. Multivariate Cox analysis indicated the use of Dapagliflozin (hazard ratio = 0.310, 95% confidence interval = 0.188-0.510, p < 0.001) and age of diagnosis (hazard ratio = 1.063, 95% confidence interval =1.045-1.081, p < 0.001) were both independent predictors of all cause death. Conclusions In patients with stabilized AMI, the use of Dapagliflozin was associated with a decreased risk of all-cause death, especially cardiovascular mortality. However, there were no significant differences observed in the rates of heart failure, recurrent AMI, or stroke over the seven-year follow-up period.Baseline characteristicsKaplan–Meier curves of all cause death

Cangrelor versus no cangrelor during percutaneous coronary intervention in hemodynamically unstable patients: a cohort study on benefits and risks

Abstract Background Cangrelor is an intravenous P2Y12 inhibitor which, according to the European guidelines, may be considered for administration in acute coronary syndrome during percutaneous coronary intervention (PCI). Little is known regarding benefits and risks of such administration in hemodynamically unstable patients. Purpose To investigate the effects of cangrelor versus no cangrelor during PCI regarding major adverse cardiac events (MACE), in-hospital bleeding, and all-cause mortality in patients with cardiogenic shock and/or cardiac arrest. Methods The study population was extracted from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and included patients with cardiogenic shock or cardiac arrest undergoing PCI during the years 2016-2022. Propensity score matching (PSM) was used to create comparable groups. After matching, all variables used for calculating propensity score were balanced (standardized mean difference<0.1). Outcomes were MACE within 30 days, in-hospital bleeding, and all-cause mortality within 30 days. Risk ratios (RR) with 95% confidence intervals (CI) were calculated. When RR deviated from the null, the risk difference (RD) was determined. Results In all, 2,100 (66%) out of 3,206 patients with cardiogenic shock and/or cardiac arrest were included in the PSM analyses (median age: 69 years; 76% male; 78% ST-elevation myocardial infarction (STEMI)). Comparing cangrelor versus no cangrelor in this matched set of patients, the RR was 0.93 (95% CI: 0.84; 1.04) for MACE; 1.51 (1.02; 2.25) for in-hospital bleeding, with an RD of 1.9 percentage points (0.10; 3.7); and 0.93 (0.82; 1.04) for all-cause mortality (Table). In the PSM analysis regarding patients with cardiogenic shock, 1,098 (60%) out of 1,815 patients were included (median age: 71 years; 68% male; 82% STEMI). For these patients, RR was 0.85 (95% CI: 0.74; 0.97) for MACE, with an RD of -7.5 percentage points (-1.6; -13); 1.31 (0.82; 2.09) for in-hospital bleeding; and 0.83 (0.72; 0.95) for all-cause mortality, with an RD of -8.0 percentage points (-2.2; -14). In the PSM analysis regarding patients with cardiac arrest, 1,388 (76%) out of 1,827 patients were included (median age: 67 years; 81% male; 75% STEMI). RR was 0.98 (95% CI: 0.86; 1.12) for MACE; 1.53 (0.95; 2.49) for in-hospital bleeding; and 0.98 (0.86; 1.13) for all-cause mortality. Conclusion For patients with cardiogenic shock, but not for patients with cardiac arrest, administration of cangrelor versus no cangrelor during PCI was associated with a reduction in both MACE and all-cause mortality, with numbers needed to treat of 14 and 13, respectively. Overall, for patients with cardiogenic shock or cardiac arrest, administration of cangrelor versus no cangrelor during PCI was associated with an increased risk of in-hospital bleeding with a number needed to harm of 53.

What is the optimal range of fasting stress hyperglycemia ratio for all-cause mortality in American adults: An observational study.

To date, no studies have been conducted to assess the impact of fasting stress hyperglycemia ratio (SHR) on all-cause mortality. Therefore, the objective of our study is to investigate the association between SHR and all-cause mortality in a population of American adults. The study population was derived from NHANES data spanning from 2005 to 2018. The exposure variable SHR was derived from fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c%), and the specific calculation formula was as follows: (FBG (mmol/L))/(1.59 × HbA1c (%) - 2.59). The outcome variable was all-cause mortality. A total of 18,457 participants were enrolled in this prospective cohort study. Following a median follow-up period of 90 months, all-cause mortality was observed in 10.32% of the subjects. Cox proportional hazards regression model indicates that there is no significant difference between SHR and all-cause mortality in the fully adjusted model, whether analyzed as a continuous or categorical variable (P for trend > 0.05). Through the 2-piecewise Cox proportional hazards regression model, we have determined that the inflection point of SHR in relation to all-cause mortality is 0.88. It has also been observed that when the value of SHR is on the left side of the inflection point (SHR ≤ 0.88), there is a significant 77% (HR: 0.23; 95% CI: 0.10-0.50) reduction in all-cause mortality for each additional unit increase in SHR. Conversely, when the value of SHR exceeds 0.88, there is a substantial 2.40-fold (HR: 2.40; 95% CI: 1.61-3.58) increase in the risk of all-cause mortality (P for log likelihood ratio test < .001). The subgroup analysis results demonstrate that sex has the potential to modify the association between SHR and all-cause mortality within the population exhibiting SHR ≤ 0.88. The relationship between SHR and all-cause mortality follows a U-shaped pattern, where in the lowest risk of death for the average American adult is observed at an SHR value of 0.88. Furthermore, in men with SHR ≤ 0.88, there is a significant inverse relationship between the increase in SHR and the risk of all-cause mortality.

Effect of hemodiafiltration and hemodialysis on mortality of patients with end-stage kidney disease: a meta-analysis

IntroductionPrevious randomized controlled trials (RCTs) and meta-analyses comparing Hemodiafiltration (HDF) with conventional hemodialysis (HD) on the effectiveness of HDF for mortality in end-stage renal disease (ESRD) patients have yielded contrasting results. Importantly, we sought to compile the available information to provide the most up-to-date and reliable evidence.MethodsWe systematically searched PubMed, Embase and Cochrane Library for RCTs up to January 14, 2024. Review Manager 5.3 software was used to analyze relevant data and evaluate the quality of evidence.ResultsOur study involved 10 randomized controlled trials with 4654 chronic dialysis patients. Compared to hemodialysis, hemodiafiltration demonstrated a reduction in all-cause mortality (relative risk [RR] 0.84, 95% confidence intervals [CI] 0.72–0.99, P = 0.04) and cardiovascular mortality (RR 0.74, 95% CI 0.61–0.90, P = 0.002). However, it did not reduce the rate of sudden death (RR 0.92, 95% CI 0.64–1.34, P = 0.68) and infection-related mortality (RR 0.70, 95% CI 0.47–1.03, P = 0.07). A subgroup analysis revealed that HDF demonstrated superiority over high-flux hemodialysis in terms of all-cause mortality, while not over low-flux hemodialysis (RR 0.81, 95% CI 0.69–0.96, P = 0.01; RR 0.93, 95% CI 0.77–1.12, P = 0.44, respectively). Furthermore, a subgroup analysis for convection volume found that hemodiafiltration with a convection volume of 22 L or more reduced all-cause and cardiovascular mortality (RR 0.76, 95% CI 0.65–0.88, P = 0.0002, RR 0.73, 95% CI 0.54–0.94, P = 0.01, respectively).ConclusionIn maintenance hemodialysis patients, hemodiafiltration can reduce mortality compared to conventional hemodialysis. Furthermore, this effect is more pronounced in HDF with high convection volume.

Joint associations of handgrip strength and physical activity with incident cardiovascular disease and overall mortality in the UK Biobank

Background & aimsQuestions remain whether higher handgrip strength confers additional health advantages beyond adherence to current physical activity guidelines. We aimed to evaluate prospective associations of joint objectively measured handgrip strength and physical activity with incident cardiovascular disease (CVD) and all-cause mortality. MethodsWe analysed the UK Biobank study in a cohort of participants who wore accelerometers for one week, with follow-up based on hospital records until 2022. Patterns of physical activity were compared: participants who met current moderate-vigorous physical activity guidelines (150 minutes per week) and those who did not. Handgrip strength was classified into sex- and age-specific tertiles. CVD events were identified as primary or secondary by examination of inpatient records and data extracted from the death registry. CVD-related deaths were also identified from the death registry. We examined prospective associations of moderate-vigorous physical activity with incident CVD and all-cause mortality by level of handgrip using Cox regressions, adjusted for confounding factors. ResultsA total of 76 074 persons were included (mean 55.2 years). Meeting physical activity guidelines is necessary to reduce all-cause mortality in those at the lower and middle thirds of handgrip strength. However, meeting physical activity guidelines did not confer additional reduction of all-cause mortality of those with high handgrip strength. Those with the lowest handgrip strength showed the greatest benefit from meeting physical activity guidelines for reducing all-cause mortality (HR 0.74; 95% CI 0.65-0.85). ConclusionOur results indicate that, while following physical activity guidelines does not reduce mortality in individuals with high handgrip strength, it is essential for preventing cardiovascular disease across all levels of handgrip strength. This underscores the importance of these guidelines for cardiovascular health.

Statins for the treatment of COVID-19 patients: an updated meta-analysis of randomized controlled trials

BackgroundStatin is a low-cost and easily accessible therapeutic option for COVID-19 patients. Previous observational studies and meta-analyses suggest using statins for COVID-19 patients.MethodsDatabases including Medline, Scopus, Embase, Cochrane Library, and clinicaltrials.gov were systematically searched.ResultsAfter screening 754 records, 9 trials were included. Overall, the study demonstrated a non-significant reduction in all-cause mortality (p = 0.14, RR 0.90, 95% CI 0.79–1.03), no significant difference in the need for mechanical ventilation (p = 0.62, RR 0.95, 95% CI 0.77–1.17), and a non-significant reduction in length of hospitalization (p = 0.71, MD − 0.17 (95% CI − 1.09, 0.76)). The certainty of evidence varied across outcomes, with most demonstrating reasonable certainty.ConclusionOur study did not support clinical efficacy of statins for the treatment of COVID-19.

Effectiveness of Risk-Adapted Upper Gastrointestinal Cancer Screening in China: Prospective Cohort Study.

Previous studies have proved the effectiveness of endoscopic screening in rural areas; however, long-term, high-quality evidence regarding the effectiveness of risk-adapted upper gastrointestinal cancer (UGC) sequential screening strategies in resource-rich regions is currently lacking. The objectives were to validate the effectiveness of risk-adapted sequential screening strategies in UGC prevention and control and assess the potential of sequential screening to lower mortality rates. Based on the Cancer Screening Program in Urban China, a prospective, large-scale cohort study based on population was conducted to recruit individuals from 4 cities in China from 2013-2019. Those identified as having a high risk of UGC according to a validated risk-score model were advised to undergo endoscopy tests. Follow-up outcomes were tracked until June 2021. Incidence of UGC, UGC-related mortality, and all-cause mortality were evaluated between the screened and nonscreened cohorts. The study included 153,079 participants at baseline. In total, 113,916 (74.42%) of the participants were designated as low risk of UGC. The remaining 39,163 (25.68%) participants were deemed to be at high risk of UGC and were offered gastroscopy tests. Among the high-risk participants, 9627 (compliance rate 24.6%) adhered to the gastroscopy tests. Over a median follow-up of 6.05 (IQR 3.06-7.06) years, 622 UGC cases, 180 UGC deaths, and 1958 all-cause death cases were traced. The screened cohort exhibited the highest cumulative incidence of UGC (119.2 per 100,000 person-years), followed by the nonscreened and low-risk cohorts. Obvious reductions in both all-cause mortality and UGC mortality were observed between those who undertook screening (153.7 and 4.7 per 100,000 person-years, respectively) and the nonscreened group (245.3 and 27 per 100,000 person-years, respectively). The screening population showed a significant 36% and 82% reduction in both all-cause mortality (hazard ratio [HR] 0.64, 95% CI 0.49-0.83, P<.001) and UGC mortality (HR 0.18, 95% CI 0.04-0.74, P=.02), respectively, compared to the nonscreened group. Reductions of 35% in all-cause mortality (HR 0.65, 95% CI 0.49-0.86, P=.003) and 81% in UGC mortality (HR 0.19, 95% CI 0.05-0.80, P=.02) were observed in participants aged older than 55 years in the screened group compared to the nonscreened group. The reductions in all-cause mortality and UGC mortality were statistically significant in males (all-cause mortality: HR 0.64, 95% CI 0.47-0.88, P=.005; UGC mortality: HR 0.10, 95% CI 0.01-0.72, P=.02), but significant reductions were not observed in females (all P values were >.05). Our study suggests the significance of one-off risk-adapted UGC screening in reducing both all-cause mortality and UGC mortality, particularly among high-risk individuals, indicating its effectiveness in UGC prevention and management.

Associations of composite dietary antioxidant index with suicidal ideation incidence and mortality among the U.S. population.

The relationship between CDAI and suicidal ideation is unclear. This study investigates the relationship between CDAI and suicidal ideation and examines the association between CDAI and all-cause mortality (ACM) or cardiovascular disease mortality (CVM) among participants with and without suicidal ideation. Data from seven NHANES cycles (2005-2018) were analyzed using cross-sectional and prospective cohort studies. Weighted multivariable logistic regression models, restricted cubic spline (RCS) plots, and subgroup analyses explored the association between CDAI and suicidal ideation. Kaplan-Meier (KM) curves, weighted multivariable Cox proportional hazards models, and RCS assessed the relationship between CDAI and CVM or ACM. Among 30,976 participants aged over 20, 1,154 (3.72%) had suicidal ideation. Higher CDAI levels (Quartile 4) were associated with a 28% reduction in suicidal ideation compared to lower levels (Quartile 1). Over an average follow-up of 89 months, 3,267 participants (7.6%) died, including 808 (1.8%) from cardiovascular causes. Higher CDAI levels were linked to a 30, 68, and 28% reduction in ACM in the total population, those with suicidal ideation, and those without, respectively. CVM was reduced by 40% in the total population and by 41% in those without suicidal ideation. CDAI is negatively associated with suicidal ideation and correlated with reduced ACM and CVM among participants with and without suicidal ideation.

Cardiovascular Events After Chimeric Antigen Receptor T-Cell Therapy for Advanced Hematologic Malignant Neoplasms

The frequency and clinical phenotypes of cardiotoxic events in chimeric antigen receptor (CAR) T-cell recipients remain poorly understood given that landmark approval trials typically exclude patients with high-risk cardiovascular profiles and data from nontrial settings are scarce. To summarize the prevalence of adverse cardiovascular events among adults receiving CAR T-cell therapies for advanced hematologic malignant neoplasms. MEDLINE, Embase, Cochrane Library, and Google Scholar were systematically searched from database inception until February 26, 2024. Observational studies were included if they comprised adult CAR T-cell recipients with advanced hematologic malignant neoplasms and if they systematically evaluated cardiovascular complications. Extraction of prespecified parameters related to the patient population, study design, and clinical events was performed at the study level by 2 independent reviewers in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline. Meta-analysis of single proportions was conducted using random-effect models with Freeman-Tukey double arcsine transformations to calculate pooled prevalence estimates. Sensitivity analysis was performed using generalized linear mixed models with logit transformations. Ventricular and supraventricular arrhythmias, heart failure events, reduction in left ventricular ejection fraction, myocardial infarction, and cardiovascular and all-cause mortality. Thirteen studies comprising 1528 CAR T-cell recipients (median [IQR] age, 61 [58.7-63.0] years; 1016 males [66%]; 80% patients with lymphoma) were included. The median (IQR) duration of follow-up was 487 (294-530) days. On random-effects meta-analysis, we observed a pooled prevalence of 0.66% (95% CI, 0.00%-2.28%) for ventricular arrhythmia, 7.79% (95% CI, 4.87%-11.27%) for supraventricular arrhythmia, 8.68% (95% CI, 2.26%-17.97%) for left ventricular dysfunction, 3.87% (95% CI, 1.77%-6.62%) for heart failure events, 0.62% (95% CI, 0.02%-1.74%) for myocardial infarction, and 0.63% (95% CI, 0.13%-1.38%) for cardiovascular death. The pooled prevalence of all-cause mortality was 30.01% (95% CI, 19.49%-41.68%). Sensitivity analyses generated similar findings. This meta-analysis found a low prevalence of ventricular arrhythmia, myocardial infarction, and cardiovascular death among CAR T-cell recipients over a short-term to midterm follow-up. Left ventricular dysfunction and supraventricular arrhythmia were the most commonly reported cardiovascular complications, suggesting that cardiovascular surveillance strategies should focus on decreases in ejection fraction and supraventricular arrhythmia.

5185 A Meta-Analysis Evaluating the Efficacy of Liraglutide in Reducing Cardiovascular Complications Among Patients With Type 2 Diabetes

Abstract Disclosure: M.P. Del Rosario: None. C. Ong-Ramos: None. Background: The objective of this study was to determine the efficacy of Liraglutide in reducing cardiovascular complications Methodology: Literature searches of electronic databases (PubMed and ScienceDirect) were performed to identify relevant studies. Relevant journals included were electronically searched for randomized controlled trials (RCTs) regarding the use of Liraglutide versus placebo in reducing the rate of cardiovascular complications. Data extraction and quality assessment were done from independent reviewers. Statistical analysis of the study was accomplished using Cochrane Systematic Review Software Review Manager. A p-value of less than 0.05 for the observed effect size was considered statistically significant. Results: A total of 2 RCTs with 16, 977 patients were included in this meta-analysis. The results showed that in the Liraglutide group there is a lower rate of the following: Major Adverse Cardiovascular Events (MACE) (risk ratio of 0.86 [0.78, 0.95]), cardiovascular events (risk ratio 0.75 [0.63, 0.89]), and all-cause mortality (risk ratio 0.81 [0.70, 0.93]), but is not statistically significant when compared to the placebo group in terms of non-fatal myocardial infarction and and non-fatal stroke. There is no significant difference in rates of severe adverse events in general (p &amp;gt; 0.05). However, Liraglutide caused significant reduction in rates of severe hypoglycemia as an independent secondary outcome (p &amp;lt; 0.05). Conclusions: Compared with placebo, Liraglutide provided significant reduction in MACE, cardiovascular events, all-cause mortality and severe hypoglycemia as an adverse event. Presentation: 6/3/2024

Association of PCSK9 inhibitors with mortality: insights from a retrospective cohort analysis.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are effective in reducing cardiovascular events, but their impact on all-cause mortality and medical utilization compared to statins is unclear. This study investigated PCSK9 inhibitor use and its impact on mortality and medical utilization vs. statins, using TriNetX database data with up to 9 years of follow-up. This retrospective cohort study analysed TriNetX data spanning 1 July 2015, to 31 December 2023, including 79194 PCSK9 inhibitor users (alirocumab, evolocumab, inclisiran) and 5437513 statin users with hyperlipidaemia. The primary outcomes were all-cause mortality and medical utilization, including hospital inpatient services, emergency department visits, critical care, and mechanical ventilation. Propensity score matching showed that PCSK9 inhibitor use was associated with a 28.3% lower risk of all-cause mortality [adjusted hazard ratio (aHR) 0.717, 95% confidence interval (CI): 0.673-0.763] and significant reductions in medical utilization (hospital inpatient services usage: aHR 0.692, 95% CI: 0.664-0.721; emergency department services: aHR 0.756, 95% CI: 0.726-0.788; critical care services: aHR 0.619, 95% CI: 0.578-0.664; and mechanical ventilation: aHR 0.537, 95% CI: 0.484-0.596) compared to statins. These findings were consistent across various demographics and clinical subgroups. The sensitivity analyses supported the robustness of the findings. PCSK9 inhibitors significantly reduced all-cause mortality and medical utilization compared to statins, suggesting their important role in dyslipidaemia management, particularly for statin-naïve or intolerant patients. Further research, including randomized controlled trials, is needed to confirm these findings and explore the underlying mechanisms.

Optimal medical therapy, clinical outcome and its predictors in patients with acute coronary syndrome after discharge with secondary prevention medications at University of Gondar Comprehensive Specialized Hospital, North West Ethiopia, 2023: A retrospective follow-up study

BackgroundThe life-threatening diseases known as ACS (acute coronary syndrome) continue to produce considerable rates of morbidity and mortality despite breakthroughs in therapy. The study determined clinical outcome and its predictors in patients at the University of Gondar Comprehensive and Specialized Hospital (UOGCSH), North West Ethiopia.Design, setting, and participantsA retrospective cohort study design was employed at UOGCSH from January 31, 2018 to February 1, 2023. The hospital used a systematic random sampling procedure to select study participants from the medical records of patients in chronic cardiac follow-up clinics.Main outcome measuresExposures were optimal medical therapy (OMT) versus non-optimal medical therapy collected from May to August 2023. Descriptive and analytical statistics were employed to compare study groups. A binary logistic regression model was employed to identify candidate variables for further analysis. Cox's proportional hazard model and log-rank test were employed, with a P-value < 0.05 used to evaluate statistical significance. A five-year all-cause mortality after discharge estimate was displayed by using Kaplan–Meier curves.ResultsAmong 422 patients with ACS [mean age, 61.56 (SD = 9.686) years; 54.7% male], of whom only 59.2% (250) received optimal medical therapy at discharge. Age ≥ 65, atrial fibrillation, chronic kidney diseases, and cardiogenic shock were negative independent predictors of optimal medical therapy. On the other hand, male sex was independently associated with the use of optimal medical therapy. All-cause mortality occurred in 16.6% (n = 70) and major adverse cardiac events occurred in 30.8% (n = 130) of patients with a 95% CI of 0.132–0.205 and 0.264–0.355, respectively. Multivariate analyses indicated that OMT was significantly associated with reduced all-cause mortality (aHR: 0.431, 95% CI: 0.222–0.835; P = 0.013).ConclusionThis study revealed that the use of preventive OMT in patients discharged with acute coronary syndrome was associated with a reduction in all-cause mortality. However, the use of this OMT is suboptimal.

Dose-response association of an accelerometer-measured physical activity with all-cause mortality and cardiovascular disease incidence: Prospective cohort with 76,074 participants

ObjectiveTo investigate the prospective dose-response association of accelerometer-measured moderate-to-vigorous physical activity (PA;MVPA) with all-cause mortality and cardiovascular disease (CVD) incidence. MethodsThis prospective cohort of 76,074 participants from the UK Biobank study contained one week of individual accelerometer-based PA data collected between June 1, 2013 and December 23, 2015. Using restricted cubic splines to allow for potential non-linearity, we examined dose-response associations of MVPA with all-cause mortality and incident CVD, respectively. ResultsThe median follow-up time was 8.0 years (IQR 7.5–8.5). The dose-response association of MVPA with all-cause mortality and CVD showed a similar L-shaped association, with significant risk reductions already from 10 min of MVPA per week for all-cause mortality (hazard ratio [HR], 0.98 [95 % CI,0.98–0.99]) and 15 min per week for CVD incidence (HR, 0.99 [95 % CI,0.98–0.99]). Doing more MVPA was associated with further risk reduction, but beyond around 500 min per week the benefits levelled off at HR's around 0.6 to 0.7. The highest additional benefit of adding more minutes per week for all-cause mortality and CVD incidence were observed between 100 and 250 weekly minutes of MVPA. From this point forward, the mean risk reduction rates decreased and were close to 0 beyond 500 weekly minutes. ConclusionsSignificant, but small, risk reductions in all-cause mortality and CVD incidence can be achieved with as little as 10 and 15 min of MVPA per week, respectively. However, public health organizations should promote the attainment of 250 min of MVPA per week (with 100 min as a possible first target for inactive individuals), as these thresholds are associated with the greatest efficiency. Beyond that, less pronounced risk reductions can be achieved by accumulating additional MVPA, with hardly any additional benefits beyond 500 weekly minutes.

The Impact of Hormone Replacement Therapy on the Riskof Heart Failure in Postmenopausal Women: A Meta-Analysis of Clinical and Observational Studies.

The relationship between heart failure (HF) and hormone replacement therapy (HRT) in postmenopausal women remains unclear. This paper aimed to elucidate the association between HRT and HF outcomes in postmenopausal women by scrutinizing evidence from clinical trials and observational studies. The meta-analysis was systematically executed following the PRISMA guidelines to include studies identified from the electronic databases, including PubMed, EMBASE, EBSCO, ICTRP, and NIH clinical trials. The primary endpoint of the effect comprised risk ratios (RR) for HF incidence and mortality, attended by 95% confidence intervals (CIs). The risk of bias was assessed employing the Cochrane Risk of Bias 2 (RoB2) tool for clinical trials and the Newcastle-Ottawa Scale (NOS) for observational studies. The search yielded a total of eight reports, originating from six individual studies, for inclusion in the current study, and 25 047 participants were included. The meta-analysis demonstrated no remarkable association between HRT and the incidence of HF in postmenopausal women (RR: 1.07, 95% CI: 0.91-1.25, p = 0.37). However, a significant reduction in all-cause mortality was observed among post-menopausal HF patients who received HRT (RR: 0.65, 95% CI: 0.49-0.87, p = 0.003). In age-related subgroup analyses, no significant change in the risk of HF was noticed among participants on HRT. The findings of this paper demonstrate that HRT use is not associated with a significant increase in the risk of incident HF. This meta-analysis also suggests a benefit in all-cause mortality when HRT is administered to postmenopausal women with HF.

Efficacy of Sentinel Cerebral Embolic Protection Device in Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials and Propensity Score-Matched Studies.

Transcatheter aortic valve replacement (TAVR) is frequently associated with stroke due to debris embolization. Although the risk of stroke with newer-generation devices is lower, stroke still represents a significant cause of mortality and morbidity post-TAVR. The Sentinel cerebral embolic protection device (CEPD) is a dual-embolic filter device designed to capture debris dislodged during TAVR. A systematic literature search was performed on the major bibliographic databases to retrieve studies that compared TAVR with and without Sentinel CEPD. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the DerSimonian-Laird random-effects model, with a P value of <0.05 considered statistically significant. This meta-analysis included 6 studies with 25,130 patients undergoing TAVR (12,608: Sentinel CEPD; 12,522: without Sentinel CEPD). The use of the Sentinel CEPD in TAVR was associated with a statistically significant lower risk of acute kidney injury (OR: 0.89; 95% CI: 0.81-0.97; P = 0.01]. The use of Sentinel CEPD in TAVR was associated with a statistically insignificant trend toward a reduction in stroke (OR: 0.80; 95% CI: 0.58-1.10; P = 0.18), all-cause mortality (OR: 0.74; 95% CI: 0.51-1.07; P = 0.11), and major vascular complications (OR: 0.74; 95% CI: 0.46-1.19; P = 0.21). The use of Sentinel CEPD in patients undergoing TAVR does not lead to a statistically significant reduction in stroke, all-cause mortality, or major vascular complications; however, the risk of acute kidney injury is lower. Further randomized studies are warranted to confirm these findings.

Association between oxidative balance scores and all-cause and cardiovascular disease-related mortality in patients with type 2 diabetes: data from the national health and nutrition examination survey (2007–2018)

BackgroundOxidative Balance Scores (OBS) is composite measures that assess the balance between pro-oxidant and antioxidant factors in an individual’s diet and lifestyle. Evidence on OBS and cardiovascular disease (CVD) in diabetic patients is scarce. This study investigates the potential association between OBS and CVD-prevalence and all-cause and CVD-related mortality in adult diabetic patients.MethodsParticipants were selected from the National Health and Nutrition Examination Survey (NHANES) 2007–2018. OBS-related data collection was initiated by linking the National Death Index to determine mortality due to all-cause and cardiovascular disease until December 31, 2019. Weighted logistic regression analyses explored the relationship between OBS and CVD. In addition, multivariable Cox proportional risk regression models and Kaplan–Meier curves were used to determine the correlation between OBS and mortality, with time to event as the time variable, as well as to estimate hazard ratios (HR) and 95% confidence interval (CI).ResultsA total of 3491 participants were included in the final analysis. Weighted logistic regression analysis of the relationship between OBS and CVD prevalence found that higher OBS was not associated with CVD prevalence compared with lower levels after fully adjustment in model 3 (OR: 0.82, 95% CI: 0.51–1.31, P = 0.39). During 3,491 person-years of follow-up, 408 deaths were recorded, of which 105 deaths were attributed to CVD. In fully adjusted model 3, participants in the highest quartile of OBS had significant reductions in all-cause mortality of 53% [HR: 0.47, 95% CI: 0.29–0.77), Ptrend= 0.002] and in cardiovascular disease mortality of 78% [HR: 0.22, 95% CI: 0.08–0.56), Ptrend= 0.004], compared with the lowest quartile groups of OBS. The Kaplan–Meier analysis results showed that participants in the highest quartile of OBS had the lowest risk of all-cause and CVD-related mortality and were statistically different (P < 0.05). Subgroup analysis confirmed that P for interaction was significant only concerning the educational level attained and in individuals with a history of CKD (P < 0.05).ConclusionsAlthough OBS wasn’t very useful for assessing CVD prevalence outcomes, higher OBS was significantly associated with lower all-cause and CVD-related mortality, suggesting that maintaining adequate OBS may reduce mortality in patients with DM.Graphical

Cause-Specific Mortality among Infants in a Randomized Controlled Trial of Azithromycin Compared to Placebo for Prevention of Mortality.

Although community randomized trials have found a reduction in all-cause child mortality in communities receiving mass azithromycin distribution compared with placebo, individually randomized trials have not found similar protective effects. If a direct effect of azithromycin for prevention of child mortality exists, it is likely due to reduction in infectious mortality. Here, we assessed cause-specific mortality in a large randomized controlled trial of azithromycin administered during well-infant visits in Burkina Faso for prevention of mortality. Among 32,877 enrolled infants, the most common causes of death by 6 months of age were malaria, acute respiratory infections, and diarrheal disease. We found no evidence of a difference in the distribution of cause of death by randomized treatment assignment (P = 0.42) or in any infectious-specific cause of death. The results of this analysis are consistent with no direct effect of azithromycin on infant mortality when administered during well-infant visits.

Beta-Blockers for Secondary Prevention following Myocardial Infarction in Patients Without Reduced Ejection Fraction or Heart Failure: An Updated Meta-Analysis.

The 2023 ESC guidelines for acute coronary syndrome note that contemporary data are heterogenous regarding beta-blockers (BB) use post-myocardial infarction (MI) in patients without reduced ejection fraction (EF) or heart failure (HF). We aimed to address the heterogeneity in contemporary data around BB post-MI in this population. We searched 6 databases from Jan 1, 2000 to Sep 1, 2024 to identify contemporary studies enrolling MI patients without reduced EF (≤40%) or history of HF receiving BB at index MI, and comparing outcomes between BB users and non-users. The primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE) and cardiovascular (CV) mortality. Random-effects meta-analysis was conducted using the restricted maximum likelihood method. There were 24 studies including 290,349 patients enrolled in the contemporary era. Overall, BB use was associated with a significant 11% reduction in all-cause mortality (HR, 0.89; 95% CI, 0.81 to 0.97; I2 = 40%; Figure 1), however with moderate-to-high statistical heterogeneity. Prespecified subgroup analyses demonstrate comparable all-cause mortality (HR, 0.99; 95% CI, 0.94 to 1.06; I2 = 0%), CV mortality (HR, 0.99; 95% CI, 0.85 to 1.15; I2 = 0%), and MACCE (HR, 1.24; 95% CI, 1.01 to 1.52; I2 = 0%) in patients with a 1-year event-free period, defined as no death, recurrent MI, or HF while on BB following index MI. In patients with no event-free period, meta-regression revealed that BB mortality benefits were modified by the study inclusion period (P = 0.01), reflecting a temporal trend of decreasing BB mortality benefits over time. Based on the temporal trend, in patients with preserved EF post-2010, BB exhibited no reduction in all-cause mortality (HR, 0.97; 95% CI, 0.90 to 1.04; I2 = 0%), but a non-significant trend towards increased CV mortality (HR, 1.29; 95% CI, 0.96 to 1.72; I2 = 0%) and a significant increase in MACCE (HR, 1.24; 95% CI, 1.01 to 1.52; I2 = 0%). In the contemporary reperfusion era, BB may not confer additional mortality benefits beyond a 1-year event-free period post-MI in patients without reduced EF. Moreover, post-MI BB use was associated with detrimental effects in patients with preserved EF.