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Stress Hyperglycemia Ratio (SHR) has been confirmed to be a predictor for adverse outcomes in cardiovascular diseases in recent years. However, the impact of SHR on one-year mortality in patients diagnosed with heart failure (HF) is still unclear. This study aims to explore the relationship between SHR and one-year mortality in HF patients, both complicated with and without diabetes mellitus (DM). This study enrolled 3747 patients with HF from the Medical Information Mart for Intensive Care (MIMIC-IV) database. 1865 patients were set into the group of lower SHR (SHR < 0.964) and 1882 patients were in the higher group (SHR ≥ 0.964). The primary endpoint was one-year mortality. The mean age of the total study population was 69 ± 13, and 1530 (40.8%) of them were female. Finally, 188 (5.0%) patients died in the hospital and 766 (20.4%) patients died during a one-year follow-up. Patients in the higher SHR group had a longer hospital stay (2.7% vs. 2.4%, p < 0.001) and higher in-hospital mortality (8 vs. 7, p < 0.001) than those in the lower group. The Kaplan-Meier curves also show that higher SHR is associated with an elevated risk of one-year mortality in patients with HF, both in the DM and non-DM groups (all log-rank p < 0.0001). As a continuous variable, SHR was an independent predictor for one-year mortality [hazard ratio (HR), 2.893; 95% confidence interval (CI), 2.198-3.808]. Elevated SHR was significantly associated with higher risk of one-year mortality in patients with (HR, 1.499; 95% CI, 1.104-2.036) and without DM (HR, 1.300; 95% CI, 1.096-1.542), consistently. The RCS curve shows a gradual increase in the probability of one-year mortality as the value of SHR increases for HF patients. Our findings indicated that a higher level of SHR was associated with elevated one-year mortality in HF patients both with and without DM, suggesting that SHR is a promising stratification indicator for predicting the risk of death in patients with HF.

Backgrounds This study aimed to investigate the cross-sectional association between social risk profile (SRP) and the strict control of cardiovascular risk factors, and the prospective association between cardiovascular risk factors controlled and cardiovascular mortality in different SRP grades. Methods Data from 12,695 participants of the National Health and Nutrition Examination Surveys (NHANES) (2005–2018) were included in the analysis. Logistic analysis was performed to assess the relationships between SRP and the strict control of cardiovascular risk factors. Kaplan–Meier curves and Cox regression models were used to analyze the associations between the number of cardiovascular risk factors controlled and outcomes incidence in different SRP grades. Results Compared to individuals with low SRP, those with high SRP had greater odds of strict control of blood pressure (OR = 1.996, 95% CI: 1.733–2.299) and glucose (OR = 1.797, 95% CI: 1.556–2.074), but lower odds of lipid control (OR = 0.810, 95% CI: 0.717–0.915,). Controlling two or three risk factors significantly reduced all-cause and cardiovascular mortality risk compared to no controlled risk factors ( P  < 0.05). Conclusions SRP grades were positively related to the strict control of blood pressure and glucose; and negatively related to the strict control of lipids. Controlling more risk factors is associated with a lower mortality risk. The lower the SRP grades, the greater the reduction in all-cause and cardiovascular mortality risk due to cardiovascular risk factor control.

This study aimed to evaluate the association between conventional and unconventional lipid parameters and the risk of future chronic kidney disease (CKD) and progression of renal function decline. Data from 4,542 participants who were free of CKD at baseline were analyzed using information from the China Health and Retirement Longitudinal Study (2011-2015). The follow-up period was four years. The primary endpoints were incident CKD and rapid progression of renal function decline. The associations between lipid parameters and the risk of CKD and rapid progression of renal function decline were assessed using restricted cubic splines (RCS) and logistic regression analysis. Logistic regression analysis showed that high-density lipoprotein cholesterol (HDL-C) was negatively associated with CKD risk, while remnant cholesterol (RC) and the atherogenic index of plasma (AIP) were positively associated. Triglycerides (TG), RC, and AIP were positively correlated with rapid renal function decline, whereas low-density lipoprotein cholesterol (LDL-C) and HDL-C were negatively correlated. Among these parameters, AIP was the most strongly associated with CKD [adjusted odds ratio (OR) (95% CI): 2.091 (1.199, 3.649),  = 0.009] and rapid progression of renal function decline [adjusted OR (95% CI): 3.996 (2.632, 6.068),  < 0.001]. LDL-C and HDL-C were negatively associated with rapid progression of renal function decline, while TG, RC, and AIP were positively associated with this outcome. Among the lipid parameters examined, AIP was the most strongly associated with CKD and rapid progression of renal function decline.

Background The combination of hemoglobin, albumin, lymphocytes, and platelets (HALP) is a comprehensive index of nutrition and systemic inflammation. This study aimed to assess the association between HALP score and major adverse cardiovascular events (MACEs) in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). Methods 2182 patients with AF and ACS or undergoing PCI were recruited and followed up for a median survival time of 1128 (807–1391) days. The endpoint was the incidence of MACEs including all-cause death, myocardial infarction, stroke, non-central nervous system embolism, and ischemia-driven revascularization. Kaplan-Meier curve was used to compare the MACEs risk in four groups divided by the HALP quartile. Cox analysis was performed to assess the relationships between HALP and MACE risk. Restricted cubic spline (RCS) was used to clarify the non-linear correlation of HALP with MACEs risk. Results The Kaplan-Meier curves showed statistically significant differences in outcomes among the four groups (log-rank P  < 0.01). The results of Cox analysis demonstrated that compared with participants with low HALP scores, participants with the highest HALP score had a lower MACE risk [adjusted HR: 0.61 (95% CI (0.45–0.81), P  < 0.01]. The RCS curve revealed that the HALP was non-linearly and L-shaped correlated with MACEs (P for overall = 0.02, P for nonlinear = 0.02). Two-stage Cox analysis showed that in patients with HALP scores < 44.95, for every 1-unit decrease in HALP, the risk of MACEs increased by 1.8%. Adding the HALP score into the GRACE model or CHA2DS2-VASc model significantly increased the original predictive value on MACEs or all-cause death. Conclusions High HALP was associated with a reduced risk of MACEs risk in patients with AF and ACS or undergoing PCI. HALP may be a potential marker for independently predicting MACEs in patients with AF and ACS or undergoing PCI.

Background The type of atrial fibrillation (AF) is assumed as a vital factor in AF patients’ prognosis. However, its impact on clinical outcomes remains unclear in patients with AF complicated with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). Methods This study was a prospective, observational, single center study of adults with AF and ACS/PCI. The primary endpoint was major adverse cardiovascular events (MACE), and secondary endpoint was net adverse clinical outcome events (NACE), a composite of MACE events and major bleeding events. Results A total of 1,762 participants were enrolled in this study, 1,137 of them were paroxysmal AF and 625 were non- paroxysmal AF, with a median follow up time of 1,023 days. The mean age of this population was 67 ± 10 and 27.2% were female. Kaplan–Meier curves showed patients were under a higher incidence of both MACE ( p  < 0.001) and NACE ( p  < 0.001) in patients with non-paroxysmal AF. Multivariate Cox analysis showed that patients with non-paroxysmal AF had a higher risk of MACE (HR: 1.322; 95%CI 1.074–1.626) and NACE (HR: 1.341; 95%CI 1.095–1.644) compared to those with paroxysmal AF. Conclusions Our study demonstrated that among patients with ACS/PCI, those with non-paroxysmal AF were more likely to experience MACE and NACE.

Objective There is limited evidence on the relationship between remnant cholesterol (RC) and low-density lipoprotein cholesterol (LDL-C) discordance and type 2 diabetes or prediabetes. This study aimed to investigate the association between RC and LDL-C discordance and type 2 diabetes or prediabetes in the general US adult population. Methods Data from 19,604 participants in the National Health and Nutrition Examination Surveys (NHANES) (2005–2018) were analyzed. The percentile difference between RC and LDL-C was used to define discordance. Logistic regression models were performed to assess the relationships between RC, LDL-C, RC and LDL-C percentile difference, LDL-C and RC discordant. Nonlinear relationships were explored using restricted cubic splines. Mediation analysis was conducted to evaluate the direct and indirect relationships between abdominal obesity and type 2 diabetes through RC. Results RC was non-linearly and J-shaped correlated with type 2 diabetes and prediabetes, whereas LDL-C was non-linearly and U-shaped correlated with type 2 diabetes and was S-shaped correlated with prediabetes. Compared to concordant participants, those with discordantly low RC population had lower type 2 diabetes odds, while those with the discordantly high RC population had higher type 2 diabetes and prediabetes odds. When a clinical LDL-C cut-off of 2.60 mmol/L was applied, participants in the high LDL-C and low RC group had the lowest odds of type 2 diabetes, while those in the low LDL-C and high RC group had the highest odds. Significant interactions between LDL-C and RC discordance and factors such as age, MetS, and lipid-lowering medications were observed in relation to type 2 diabetes odds. RC was found to mediate 15.86% of the association between abdominal obesity and type 2 diabetes, and 16.22% of the association between abdominal obesity and prediabetes in the non-diabetes population. Conclusions Discordantly high RC was associated with higher odds of type 2 diabetes and prediabetes, while discordantly low RC was associated with lower odds of type 2 diabetes.

Background The triglyceride-glucose body mass index (TyG-BMI) is a reliable marker of insulin resistance and has been linked to cardiovascular outcomes. However, data on the relationship between TyG-BMI and prognosis in patients with atrial fibrillation (AF) complicated by acute coronary syndrome (ACS) are limited. This study aimed to evaluate the association between baseline TyG-BMI and prognosis in AF-ACS patients. Methods We conducted a single-center prospective analysis of 832 AF-ACS patients hospitalized at Fuwai Hospital from January 2017 to December 2019. The primary outcome was the incidence of major adverse cardio-cerebrovascular events (MACCEs) during the 1-year follow-up. Kaplan-Meier curves compared MACCE risk across four TyG-BMI quartiles. Cox proportional hazards regression and restricted cubic spline (RCS) analyses assessed the relationship between TyG-BMI and patient outcomes. Results The mean age of participants was 68.15 ± 9.59 years, with 569 (68.39%) being male. Kaplan-Meier analysis showed significant differences in 1-year MACCE risk between the four groups. Cox regression revealed that patients in the lowest TyG-BMI quartile had a significantly higher 1-year MACCE risk. RCS analysis indicated a linear increase in MACCE risk with decreasing TyG-BMI. Conclusion TyG-BMI is closely associated with the prognosis of AF-ACS patients. Lower TyG-BMI is significantly linked to a higher risk of MACCEs in this population.

Background The purpose of this study was to assess the relationship between admission inflammatory indexes neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII), and the risk of in-hospital all-cause mortality in acute aortic dissection (AAD) patients. Methods A retrospective analysis was conducted on 597 AAD patients (Stanford classification: Stanford type A 365 patients, Stanford type B 232 patients) at a single center. Outcomes were the incidence of in-hospital all-cause mortality. The risk of all-cause death was compared between the groups with low and high inflammatory indexes using the Kaplan-Meier curve. The association between admission inflammatory indexes and outcomes was evaluated using the Cox regression model and restricted cubic splines (RCS). Stratified analysis was performed based on AAD type, age (< 50 years or ≥ 50 years), and gender. Results The Kaplan-Meier curves revealed statistically significant differences in outcomes among the low and high inflammatory indexes groups. Cox regression analysis revealed that the in-hospital mortality risk was significantly high in the high inflammatory index groups. MLR was the strongest associated with in-hospital mortality risk. The RCS curve revealed that NLR was non-linearly and J-shaped correlated with in-hospital mortality, and MLR and SII were linearly correlated with in-hospital mortality. Stratified analysis showed interactions between NLR, MLR, and SII and AAD type and age for the risk of in-hospital mortality. Conclusion Admission high inflammatory indexes were independently associated with an increased risk of in-hospital all-cause mortality in AAD patients. The inflammatory indexes NLR, MLR, and SII may be useful indicators for predicting in-hospital all-cause mortality in AAD patients.

Background Patients with atrial fibrillation (AF) often underwent percutaneous coronary intervention (PCI), and the complexity of PCI has risen in recent years. However, there is limited data available on clinical outcomes in patients with AF who underwent complex PCI. Methods This was a prospective, observational study. Complex PCI was defined as PCI performed to ≥ 3 separate major coronary vessels; ≥3 stents implanted; ≥3 lesions treated; or total stented length > 60 mm. The primary outcome was defined as major adverse cardiovascular event (MACE) including all-cause death, spontaneous myocardial infarction (MI), stroke/ transient ischemic attack (TIA), systemic embolism or ischemia-driven revascularization. The secondary outcome was defined as net adverse clinical events (NACE), which included major adverse cardiovascular events (MACE) and major bleeding. Results A total of 1132 patients who underwent PCI with AF were enrolled consecutively. The mean age was 67 ± 9, and 75.1% were male. 320 participants (28.2%) underwent complex PCI. During a median follow-up of 1045 days (interquartile range: 666–1327), the primary outcome occurred in 52 out of 320 patients (16.2%), while the secondary outcome was observed in 55 out of 320 patients (17.2%) in the complex PCI group. MACE showed no differences between groups (hazard ratio [HR], 1.30; 95% confidence interval [CI], 0.93–1.82), nor did NACE (HR:1.34, 95%CI: 0.97–1.85). Patients with complex PCI still had a higher likelihood of experiencing spontaneous MI (HR, 2.17, 95%CI, 1.00-4.70) and ischemic driven revascularization (HR, 1.86, 95%CI, 1.01–3.45) after adjusted for confounders. Conclusion The complexity of PCI was an independent risk factor for adverse clinical outcomes, particularly for myocardial infarction and revascularization events in patients with atrial fibrillation. However, it was not associated with major bleeding, all-cause mortality, or stroke/TIA. Clinical trial number Not applicable

Background This study aimed to describe the status of antithrombotic therapy at discharge and prognosis in patients with atrial fibrillation (AF) and chronic coronary syndrome (CCS) who underwent percutaneous coronary intervention (PCI). Methods This was an observational, prospective study. The primary endpoint was major adverse cardiovascular events (MACE), including all-cause death, myocardial infarction, stroke/transient ischemic attach (TIA), systemic embolism or ischemia-driven revascularization. Bleeding events were collected according to the Thrombolysis in Myocardial Infarction (TIMI) criteria. Results Between 2017 and 2019, a cohort of 516 patients (mean age 66, [SD 9], of whom 18.4% were female) with AF and CCS who underwent PCI were evaluated, with a median followed-up time of 36 months (Interquartile range: 22–45). MACE events occurred in 13.0% of the patients, while the TIMI bleeding events were observed in 17.4%. Utilization of TAT (triple antithrombotic therapy) ( P  < 0.001) and oral anticoagulation (OAC) therapy ( P  < 0.001) increased through years. History of heart failure (HF) (Hazard ratio [HR], 1.744; 95% confidence interval [CI], 1.011–3.038) and TAT (HR, 2.708; 95%CI, 1.653–4.436) had independent associations with MACE events. OAC (HR, 10.378; 95%CI, 6.136–17.555) was identified as a risk factor for bleeding events. A higher creatine clearance (HR, 0.986; 95%CI, 0.974–0.997) was associated with a lower incidence of bleeding events. Conclusions Antithrombotic therapy has been improved among patients with AF and CCS who underwent PCI these years. History of HF and TAT were independently associated with MACE events. Higher creatine clearance was protective factor of bleeding events, while OAC was a risk factor for TIMI bleeding events.