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The relationship between the systemic immune inflammatory index (SII) and the prognosis of hypertensive patients is unclear. This study aims to explore the association of SII with all-cause and cause-specific mortality in patients with hypertension. This study included 8524 adults with hypertension from the National Health and Nutritional Examination Surveys (NHANES) 2011-2018, and followed for survival through December 31, 2019. Cox proportional hazards models were used to investigate the associations between SII and mortality from all causes, cardiovascular disease (CVD), and cancer. Restricted cubic spline, piecewise linear regression, subgroup and sensitivity analyses were also used. During a median follow-up of 4.58 years, 872 all-cause deaths occurred. After adjusting for covariates, higher SII was significantly associated with an elevated risk of CVD mortality. There was a 102% increased risk of CVD mortality per one-unit increment in natural log-transformed SII (lnSII) (P < 0.001). Consistent results were also observed when SII was examined as categorical variable (quartiles). The associations of SII with all-cause and cancer mortality were detected as U-shaped with threshold values of 5.97 and 6.18 for lnSII respectively. Below thresholds, higher SII was significantly associated with lower all-cause mortality (HR=0.79, 95%CI=0.64-0.97) and cancer mortality (HR=0.73, 95%CI=0.53-1.00). Above thresholds, SII was significantly positive associated with all-cause mortality (HR=1.93, 95%CI=1.55-2.40) and cancer mortality (HR=1.93, 95%CI=1.22-3.05). The results were robust in subgroup and sensitivity analyses. Higher SII (either as a continuous or categorical variable) were significantly associated with a higher risk of CVD mortality. The U-shaped associations were observed between SII and all-cause and cancer mortality.

The triglyceride to high density lipoprotein cholesterol (TG/HDL-C) ratio has been consistently linked with the risk of coronary heart disease (CHD). Nevertheless, there is a paucity of studies focusing on acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) or experiencing bleeding events. The study encompassed 17,643 ACS participants who underwent PCI. Survival analysis, Cox regression analysis and restricted cubic spline (RCS) were employed to assess the associations between TG/HDL-C ratio and the risk of major adverse cardiovascular events (MACE), all-cause death, cardiac death and all-cause bleeding events. Over a 12-month follow-up period, 638 (3.9%) patients experienced MACE while 2837 (16.1%) patients experienced bleeding events. The TG/HDL-C ratio exhibited significant positive correlations with the incidence of MACE, all-cause death and cardiac death; conversely it displayed significant negative correlations with the incidence of all-cause bleeding. Patients in the high quartile TG/HDL-C category demonstrated significantly higher risks for MACE compared to those in the low quartile category, with hazard ratio (HR) [95%confidence interval (CI)] of 1.46 (1.17–1.83); conversely, they showed significantly lower risks for all-cause bleeding compared to their counterparts in the low quartile group, with HR (95%CI) of 0.72 (0.65–0.81). The structure of subgroup analyses remained robust and consistent, with gender being the sole factor interacting with TG/HDL-C specifically in relation to MACE events ( P for interaction = 0.037). A higher baseline TG/HDL-C ratio was associated with an elevated risk of MACE but a reduced risk of bleeding events in ACS patients undergoing PCI.

Acute myocardial infarction (AMI) patients with a prior stroke face higher in-hospital risks than those with AMI alone, yet the association between neurological status—assessed via the modified Rankin Scale (mRS)—and long-term mortality in AMI patients remains understudied. This retrospective study analyzed 10,084 AMI patients, categorizing them into three groups: no prior stroke, prior ischemic stroke (IS) with mRS 0–1 (no disability), or mRS 2–5 (disability), with mortality tracked via the China National Death Registration System over a median 5.26 years. Among the cohort, 8.9% ( n  = 893) had prior IS, and 18.1% ( n  = 1,829) died, including 1,454 cardiovascular deaths. Compared to non-stroke patients, those with prior IS and mRS 0–1 exhibited elevated all-cause (hazard ratio [HR] = 1.42, 95% CI 1.20–1.67) and cardiovascular mortality (HR = 1.46, 95% CI 1.21–1.76), while the mRS 2–5 group faced significantly higher risks (all-cause: HR = 2.18, 95% CI 1.84–2.60; cardiovascular: HR = 2.10, 95% CI 1.73–2.55), all P  < 0.001. Prior IS, even without residual disability, is linked to increased long-term mortality in AMI patients, with the highest risk among those with post-stroke disability. These findings emphasize the need for enhanced secondary prevention strategies to reduce mortality in this high-risk population.

The causal relationship between visceral adipose tissue (VAT) and hypertension remains unclear. We aimed to examine the potential association between them using observational and two‐sample Mendelian randomization (MR) analyses. Data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018 were used, applying multivariable logistic regression analysis to investigate the association between VAT mass and hypertension risk. Independent genetic variants related to VAT mass were derived from genome‐wide association studies (GWAS) in 325 153 UK Biobank participants. The primary analysis employed the random‐effects inverse‐variance weighted (IVW) method, with MR‐Egger, weighted median, simple mode, and weighted mode as sensitivity analyses. A total of 7661 participants were included. After adjusting for confounding factors, increased VAT mass was associated with a higher risk of hypertension (quartile 4 vs. quartile 1: OR:1.85, 95% confidence intervals [CI]: 1.31–2.63). Furthermore, VAT mass exhibited greater accuracy than body mass index (BMI) in predicting hypertension (areas under the curve [AUC]: 0.701 vs. 0.676, p for comparison < 0.001). The MR analyses demonstrated a causal relationship between increased VAT mass and the risk of hypertension in primary analyses (odds ratio [OR]:1.768, 95% CI: 1.594–1.861). Consistent findings across various MR models substantiate the robustness and strength of this causal relationship. These analyses provide additional support for both the positive association and causal relationship between elevated VAT and the risk of developing hypertension, suggesting that targeted interventions for VAT may be beneficial in preventing hypertension.

Whether an in-hospital hemoglobin drop adversely affects the prognosis of patients with acute myocardial infarction (AMI) remains controversial. The present study aimed to investigate the impacts of in-hospital hemoglobin drop without overt bleeding on 1-year clinical outcomes of AMI patients after percutaneous coronary intervention (PCI). A total of 5,036 AMI patients who underwent PCI and presented with an in-hospital hemoglobin decline without overt bleeding were recruited in this study. Subsequently, these patients were stratified into three cohorts based on tertiles of hemoglobin drop values: < 0.8 g/dL (n = 1652), 0.8–1.49 g/dL (n = 1651) and ≥ 1.5 g/dL (n = 1733). The primary endpoint was defined as ischemic events at 1 year, composed of cardiac death, myocardial infarction (MI), and stroke. Secondary endpoints were defined as 1-year all-cause death, Bleeding Academic Research Consortium (BARC) types 2, 3, or 5, and 3 or 5 bleeding. There were significant differences in 1-year incidence of ischemic events (1.88% vs. 3.27% vs. 3.46%; P  = 0.0114), all-cause death (1.45% vs. 2.18% vs. 2.94%; P  = 0.0128), as well as cardiac death (1.15% vs. 1.82% vs. 2.37%; P  = 0.0282) and MI (0.30% vs. 1.15% vs. 0.92%; P  = 0.0175) across tertiles of hemoglobin drop values. For each 1 g/dL drop in hemoglobin values, the adjusted risk for ischemic events and all-cause death increased by 2% and 3%, respectively. Among AMI patients undergoing PCI, an in-hospital decline in hemoglobin levels was associated with an increased risk of 1-year ischemic events and all-cause death, even in the absence of overt bleeding.

This research aimed to explore the association of high-sensitivity C-reactive protein to albumin ratio (CAR) with death events in community-based patients with coronary heart disease (CHD). 624 CHD participants were followed for 36 months using data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES). The CAR was dichotomized at 0.075 mg/g to stratify inflammation levels. Relationships between CAR, high-sensitivity C-reactive protein (hsCRP), albumin (ALB) and all-cause and cardiac death in all participants and subgroups were analyzed using restricted cubic spline (RCS), Kaplan-Meier survival curves and Cox proportional hazards models. Both CAR and hsCRP showed positive correlations with all-cause and cardiac death risk while ALB exhibited a U-shaped correlation with all-cause death risk but a negative correlation with cardiac death risk. The high-CAR group had higher risks of all-cause (P = 0.04) and cardiac death (P = 0.02). The hazard ratios (HR) (95% confidence intervals (CI)) for all-cause death was 1.77 (1.15-2.74) (P = 0.010), while it was 2.99 (1.44-6.22) (P = 0.003) for cardiac death. No significant interaction was observed in subgroup analyses. A CAR threshold of 0.075 mg/g effectively distinguished between high and low inflammation risks. Elevated CAR significantly increased the risk of all-cause and cardiac death in community CHD patients.

Background Acute coronary syndrome (ACS) patients without standard modifiable cardiovascular risk factors (SMuRFs) have a higher risk of early mortality. However, little is known about their long-term outcomes, especially for patients undergoing percutaneous coronary intervention (PCI). This study aims to explore the long-term outcomes and identify independent factors associated with adverse clinical outcomes in patients with ACS undergoing PCI without SMuRFs. Methods This study used data from O ptimal anti P latelet T herapy for Chinese patients with C oronary A rtery D isease (OPT-CAD) registry study. Clinical characteristics and outcomes of patients with and without SMuRFs were examined. The primary outcomes were major adverse cardia-cerebrovascular events (MACCE). The long-term (5 years) outcomes were compared between the without and with SMuRFs group in such cohort. An exploratory Cox proportional hazards regression was performed to identify the independent demographic and clinical predictors of the adverse clinical outcomes in the SMuRFs-absent cohort. Results Among 5688 patients with ACS undergoing PCI, 392 (6.9%) were in the absence of SMuRFs and 5296 (93.1%) were in the presence of SMuRFs. There were no significant differences in MACCE rates between the two cohorts (9.44% vs. 9.76%, log-rank P  = 0.90). Cox proportional hazards regression indicated that age (HR, 1.06; 95% CI, 1.03–1.10; P  = 0.001) and thrombus lesions (HR, 2.58; 95% CI, 1.24–5.40; P  = 0.011) were independently associated with MACCE in the SMuRFs-absent cohort. Conclusions Among patients with ACS undergoing PCI, SMuRFs-absent patients had similar MACCE rates when compared with those with one or more SMuRFs at 5 years. This suggests that effective intervention strategies and updated risk assessment models are urgently needed in the SMuRFs-absent cohort. Graphical Abstract

Background Residual risk assessment for acute coronary syndrome (ACS) patients after sufficient medical management remains challenging. The usefulness of measuring high-sensitivity C-reactive protein (hsCRP) and remnant cholesterol (RC) in assessing the level of residual inflammation risk (RIR) and residual cholesterol risk (RCR) for risk stratification in these patients needs to be evaluated. Methods Patients admitted for ACS on statin treatment who underwent percutaneous coronary intervention (PCI) between March 2016 and March 2019 were enrolled in the analysis. The included patients were stratified based on the levels of hsCRP and RC during hospitalization. The primary outcome was ischemic events at 12 months, defined as a composite of cardiac death, myocardial infarction, or stroke. The secondary outcomes included 12-month all-cause death and cardiac death. Results Among the 5778 patients, the median hsCRP concentration was 2.60 mg/L and the median RC concentration was 24.98 mg/dL. The RIR was significantly associated with ischemic events (highest hsCRP tertile vs. lowest hsCRP tertile, adjusted hazard ratio [aHR]: 1.52, 95% confidence interval [CI]: 1.01–2.30, P  = 0.046), cardiac death (aHR: 1.77, 95% CI:1.02–3.07, P  = 0.0418) and all-cause death (aHR: 2.00, 95% CI: 1.24–3.24, P  = 0.0048). The RCR was also significantly associated with these outcomes, with corresponding values for the highest tertile of RC were 1.81 (1.21–2.73, P  = 0.0043), 2.76 (1.57–4.86, P  = 0.0004), and 1.72 (1.09–2.73, P  = 0.0208), respectively. The risks of ischemic events (aHR: 2.80, 95% CI: 1.75–4.49, P  < 0.0001), cardiac death (aHR: 4.10, 95% CI: 2.18–7.70, P  < 0.0001), and all-cause death (aHR: 3.00, 95% CI, 1.73–5.19, P  < 0.0001) were significantly greater in patients with both RIR and RCR (highest hsCRP and RC tertile) than in patients with neither RIR nor RCR (lowest hsCRP and RC tertile). Notably, the RIR and RCR was associated with an increased risk of ischemic events especially in patients with adequate low-density lipoprotein cholesterol (LDL-C) control (LDL-C < 70 mg/dl) ( P interaction =0.04). Furthermore, the RIR and RCR provide more accurate evaluations of risk in addition to the GRACE score in these patients [areas under the curve (AUC) for ischemic events: 0.64 vs. 0.66, P  = 0.003]. Conclusion Among ACS patients receiving contemporary statin treatment who underwent PCI, high risks of both residual inflammation and cholesterol, as assessed by hsCRP and RC, were strongly associated with increased risks of ischemic events, cardiac death, and all-cause death.

Background Whether percutaneous coronary intervention (PCI) can improve the long-term prognosis of patients with stable coronary artery disease (SCAD) in comparison to conservative treatment remains controversial. The present study sought to evaluate the impacts of initial invasive versus conservative strategy on long-term clinical outcomes for patients with SCAD stratified by risk scores. Methods This was a sub-analysis of the multicenter, observational Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study. Clinical outcomes were compared in SCAD patients who initially received PCI (invasive strategy) or conservative treatment according to risk stratification by OPT-CAD score. The primary outcome was ischemic events at 5 years, composed of cardiac death, myocardial infarction, and ischemic stroke. Secondary outcomes included all-cause death, Bleeding Academic Research Consortium (BARC) types 2, 3, or 5, and 3 or 5 bleeding. Results The conservative group comprised 1767 (58.0%) patients and the invasive group comprised 1278 (42.0%) patients. Overall, invasive strategy did not reduce the risk of ischemic events compared with conservative strategy but was associated with an increased risk of BARC 2, 3, or 5 bleeding (adjusted hazard ratio (HR), 1.59; 95% confidence interval (CI), 1.13–2.26; P  = 0.009). Similar results were observed in the low-risk patient subset ( N  = 2030). While in the moderate-to-high-risk subset ( N  = 1015), invasive strategy was associated with a reduced risk of ischemic events (HR, 0.67; 95% CI, 0.48–0.95; P  = 0.02) and all-cause death (HR, 0.73; 95% CI, 0.51–1.03; P  = 0.07), and with no excessive risk of bleeding. Conclusions Invasive strategy could not confer additional clinical benefits in patients with SCAD compared to conservative strategy, except in patients at moderate-to-high risk. The OPT-CAD risk score may be valuable to the guidance of optimal treatment strategy in SCAD patients.