Non-alcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide, its close correlation with metabolic disorders has been demonstrated in numerous studies in recent years and an expert panel has proposed renaming it metabolic-associated fatty liver disease (MAFLD). NAFLD/MAFLD may not only increase the incidence and mortality of liver-related diseases but also relate to the incidence and mortality of cardiovascular diseases. This article compares the diagnostic criteria of NAFLD/MAFLD and reviews the research progress in the correlation of non-alcoholic fatty liver disease and metabolic-associated fatty liver disease with cardiovascular diseases. The results show that both NAFLD/MAFLD are significantly associated with the increased incidence of cardiovascular diseases and independent risk factors for cardiovascular diseases. Furthermore, MAFLD patients have a higher risk of developing cardiovascular diseases than NAFLD patients. This article provides clinical physicians with the basis for cardiovascular risk assessment and management in NAFLD/MAFLD patients, emphasizing that in addition to the treatment of liver disease, clinical physicians should also focus on the risk of cardiovascular disease in NAFLD/MAFLD patients.

Coronary heart disease (CHD) is one of the major public health burdens in the world. Although treatment strategies have been developed, but CHD remains a leading cause of morbidity and mortality worldwide. The diagnosis of CHD mainly relies on coronary angiography or contrast-enhanced computed tomography. However, due to the lack of equipment in primary hospitals, early diagnosis and prognosis judgment are relatively difficult. Therefore, the search for relatively simple and easy-to-obtain laboratory indicators is conducive to providing basis for primary care physicians to diagnose and treat CHD.

To investigate the correlation of serum interleukin-6 (IL-6) and fasting blood glucose (FPG) levels with the degree and clinical classification of coronary stenosis, number of lesions and adverse cardiovascular events in patients with CHD.

CHD patients admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from September to November 2020 were included as the study objects, and their general data and laboratory test results were collected. According to Gensini score criteria, the patients were divided into the mild stenosis group (group A, Gensini score≤33.25 points, n=40) and moderate and severe stenosis group (group B, Gensini score>33.25 points, n=40) based on the Gensini scoring criteria. According to the results of coronary angiography results, patients were divided into the single-vessel lesion group (n=28), double-vessel lesion group (n=21) and multi-vessel lesion group (number of lesion branch≥3, n=31) based on the number of lesions. According to the clinical classification, patients were divided into stable angina group (n=34) and acute coronary syndrome group (n=46). Spearman rank correlation analysis was used to explore the relationship of serum IL-6, FPG with relevant data of patients. Survival curves of patients were plotted using the Kaplan-Meier method, and the comparison of survival curves was performed by Log-rank test. Univariate and multivariate Cox proportional hazard regression analyses were used to explore the factors influencing the risk of adverse cardiovascular events in patients with CHD. The receiver operating characteristic (ROC) curve of IL-6 predicting the occurrence of adverse events was plotted.

IL-6 and FPG in group A were lower than those in group B, IL-6 in the multi-vessel lesion group was higher than that in the single-vessel lesion group, FPG was higher than that in double-vessel lesion group, and IL-6 and FPG in acute coronary syndrome group was higher than that in stable angina group, with statistical significance (P<0.05). Spearman rank correlation analysis showed that serum IL-6 was correlated with clinical type, number of coronary lesions, Gensini score, gender, triglyceride (TG) and FPG, and FPG was correlated with clinical type, number of coronary lesions, Gensini score, age and IL-6 (P<0.05). The patients were divided into IL-6>45.8 ng/L group (n=39) and IL-6≤45.8 ng/L group (n=41) according to the median IL-6 expression level (45.8 ng/L), and the upper limit of normal FPG (6.1 mmol/L) was used as the grouping standard to divide the patients into FPG>6.1 mmol/L group (n=36) and FPG≤6.1 mmol/L group (n=44). Log-rank test results showed that the incidence of adverse cardiovascular events in IL-6>45.8 ng/L group was higher than that in IL-6≤45.8 ng/L group (76.9% vs. 36.6%; χ²=16.075, P < 0.001), FPG>6.1 mmol/L group had a higher incidence of adverse cardiovascular events than FPG≤6.1 mmol/L group (69.4% vs. 45.5%; χ²=4.292, P=0.038). Multivariate Cox proportional hazard regression analysis showed that IL-6 was a significant factor in adverse cardiovascular events in patients with CHD (HR=2.396, 95%CI=1.203-6.054, P<0.05). The area under ROC curve of IL-6 for predicting adverse cardiovascular events was 0.769 (95%CI=0.658-0.880), the best optimal value was 40.97 ng/L, with the sensitivity and specificity of 0.867 and 0.683.

Serum IL-6 and FPG levels are associated with CHD and its poor prognosis. Serum IL-6 is an independent risk factor for adverse cardiovascular events in patients with CHD.

Cardiovascular disease is a major chronic disease that seriously endangers human health, and remains a public health problem to be solved in China and even globally.

To explore the epidemic characteristics and disease burden of cardiovascular diseases in China from 1990 to 2019, forecast the incidence of cardiovascular diseases in China from 2020 to 2050, and provide a reference for the formulation of relevant prevention and treatment strategies of cardiovascular diseases.

The 2019 Global Burden of Disease Study (GBD 2019) database was searched to extract and analyze relevant data on cardiovascular disease burden and risk factors in China and globally from 1990 to 2019. The prevalence of cardiovascular diseases was quantified by using the publicly available incidence, prevalence, mortality, and corresponding age-standardized rate (referred to as standardized rate) based on GBD 2019 database, and the burden of diseases was quantified by years lived with disability (YLD), years of life lost (YLL) and disability adjusted life year (DALY), and the ARIMA model was constructed to predict the incidence of cardiovascular diseases in China from 2020 to 2050.

Compared with 1990, the incidence, prevalence and mortality of cardiovascular diseases in China showed an increasing trend by year up to 2019, in which the incidence, prevalence and mortality increased by 93.75%, 99.75% and 57.39%, respectively. The standardized incidence and prevalence of females were higher than those of males, while the standardized mortality was lower than that of males (P<0.05). According to the data in 2019, the overall incidence of cardiovascular diseases in China showed an increasing trend with age, reaching its highest value in the age group of 95 years and above. Incidence trends for both men and women were similar to the overall trend, with slight differences. The overall prevalence also increases with age and is higher in women than men. There is an increasing trend in cardiovascular disease mortality after the age of 45, with males having a higher mortality rate than females at all ages. Compared with 1990, the rates of YLL, YLD and DALY in Chinese men increased by 36.99%, 102.42% and 40.78%, respectively, and increased by 2.79%, 107.13% and 11.50% in women in 2019. According to the data in 2019, the YLL rate, YLD rate and DALY rate of cardiovascular diseases in Chinese population showed an upward trend with the increase of age, with no inflection point. YLL rate and DALY rate of males gradually increased with the progress of population aging and were much higher than females, YLD rate gradually increased in the age group of 55-59 years and was much higher than males. From 1990 to 2019, the global standardized incidence, standardized prevalence and standardized mortality of cardiovascular diseases showed a downward trend by year, while the standardized morbidity and standardized mortality still increased in China, the standardized incidence and prevalence decreased, but that was still higher than the global scale. From the global level, the standardized YLL rate and DALY rate of cardiovascular diseases in China showed a downward trend along with the global level, but the disease burden of cardiovascular diseases in China was higher than the global level after 2000, and the standardized YLD rate increased by year. Risk factors associated with death from cardiovascular diseases mainly included smoking, second-hand smoke, alcohol consumption, low physical activity, high fasting blood glucose, high systolic blood pressure, high BMI, high low density lipoprotein cholesterol and renal insufficiency. From the relevant data in China and globally, high systolic blood pressure (hypertension) was still the primary risk factor for death from cardiovascular diseases, and the number of deaths was increasing by year. High density lipoprotein cholesterol (hyperlipidemia) was the second cause of death from cardiovascular diseases globally and in China in recent years. From 2020 to 2050, the standardized incidence of cardiovascular diseases in China is still on the rise, and it is expected that the standardized incidence of cardiovascular diseases will reach 663.618 per 100 000 by 2050.

The incidence, prevalence and mortality of cardiovascular diseases in China from 1990 to 2019 have shown an increasing trend by year. The disease burden caused by cardiovascular diseases is more severely, and there is no inflection point in the next 50 years. The prevalence and burden of diseases are higher than those of the world. It is expected that the standardized incidence of cardiovascular diseases will reach 663.618 per 100 000 by 2050.

Due to the acceleration of population aging and the prevalence of unhealthy lifestyles, the huge population with cardiovascular disease (CVD) risk factors, the burden of CVD continues to increase in China. CVD is still the leading cause of death among urban and rural residents in China. In 2020, CVD accounted for 48.00% and 45.86% of the causes of death in rural and urban areas, respectively, and two out of every five deaths were due to CVD. It is estimated that the number of current CVD patients in China is 330 million, including 13 million cases of stroke, 11.39 million cases of coronary heart disease, 8.9 million cases of heart failure, 5 million cases of pulmonary heart disease, 4.87 million cases of atrial fibrillation, 2.5 million cases of rheumatic heart disease, 2 million cases of congenital heart disease, 45.3 million cases of peripheral artery disease, and 245 million cases of hypertension. The total hospitalization costs were 270.901 billion yuan for CVD in China in 2020. The prevention and treatment of CVD in China still has a long way to go. In general, we should not only do a good job in secondary prevention and treatment of CVD, but also further strengthen the upstream treatment of modifiable risk factors such as hypertension, hyperglycemia and hyperlipidemia starting with both preventive treatment and treatment diseases. In addition, attention should be paid to the allocation and prioritization of health care and public health resources, so as to reach the inflection point of CVD prevention and treatment as early as possible.

The advantages of mobile smart healthcare in screening, intervention, treatment, and management of cardiovascular diseases have become increasingly prominent in recent years. The application value of wearable single lead electrocardiogram equipment in the early screening and diagnosis of arrhythmia patients out of the hospital has been recognized by scholars and clinical workers. However, its application in risk screening and long-term follow-up management of chronic disease patients in primary care is limited by the single function of the cloud platform led and matched by it.

To explore the application value of mobile smart healthcare in the prevention and control of cardiovascular disease risk in elderly patients with chronic disease in primary care from the perspective of chronic disease prevention and control and using wearable single lead electrocardiogram equipment as carriers, based on hierarchical medical system.

A total of 3 000 patients with chronic disease aged above 65 years admitted to primary care institutions in Ningxia from January 2022 to August 2022 were selected as research subjects, including 1 202 males and 1 798 females with an average age of (71.3±5.0) years. The baseline data were recorded by primary care physicians through mobile phone APP and cloud platform of patient management, 72-hour ECG data collected by wearable single lead electrocardiogram equipment were also uploaded to cloud platform of patient management. Analysis of data and risk stratification for arrhythmia, heart rate variability (HRV) and obstructive sleep apnea hypopnea syndrome (OSAHS) were performed by professional electrocardiographers, and the corresponding marks on the cloud platform for the data with low, medium and high risk of cardiovascular disease were ticked according to the stratification results of the three analysis methods. The cloud platform notifies primary care physicians of high and medium risk data in the form of SMS for the management of different processes of patients. The number of detected cases with different risk stratification, the number of detected cases and rates of management according to the process among patients with low, medium and high risk of cardiovascular disease were counted.

Arrhythmias were detected in 1 526 (50.87%), 1 349 (44.97%), and 125 (4.17%) cases consistent with negativity, positivity, and significant positivity, respectively; HRV was mildly, moderately, and severely reduced in 2 330 (78.50%), 630 (21.23%), and 8 (0.27%) cases, respectively; OSAHS was consistent with mild, moderate, and severe abnormalities in 1 769 (59.60%), 573 (19.31%), and 626 (21.09%) cases, respectively. The comprehensive risk of cardiovascular disease was low, moderate, and high in 744 (24.80%), 1 640 (54.67%), and 616 (20.53%) patients, respectively. The rates of management according to the process in patients with high, medium and low comprehensive risk of cardiovascular disease were 94.49% (703 cases), 88.10% (1 445 cases) and 100% (616 cases), respectively.

The elderly patients with chronic disease in primary care with combined application of mobile smart healthcare technology and arrhythmia, HRV, OSAHS analysis methods to the prevention and control of cardiovascular diseases have higher detection rate of cardiovascular disease risk and management rate, which is conducive to the establishment of a cardiovascular disease prevention and control system for them.

Wilson disease (WD) is a rare autosomal recessive disease that causes impaired copper excretion, mainly manifestedashepatic and/or neuropsychiatric symptoms, but diversifies with the varying affected organs and severity of the disease. The accumulation of copper in various organs and systems throughout the bodyleads to other (usually milder) clinical symptoms such as Kayser-fleischer ring (K-F), hemolytic disease, impaired renal function, abnormal bone metabolism, myocarditis, arrhythmias, other organ and systemic damage. It has been recently found that WD may result in varying degrees of cardiac damage and even fatal cardiac disorder inextensive studies. Clinical examination of the cardiovascular system has not been included in the routine testing of WD patients. Therefore, early attention and intervention of subclinical cardiac disease in WD patients are of great significance for the treatment and prognosis.

To observe the dynamic changes in cardiac structure and function in WD patients based on real-time three-dimensional transesophageal echocardiography (RT-3DE), electrocardiogram (ECG) and serological indicators such as myocardial injury markers, so as to provide objective imaging and serological basis for the assessment of early cardiac involvement in WD and facilitating timely intervention in WD patients with early subclinical cardiac damage.

From October 2021 to October 2022, 60 patients with WD admitted to the neurological department of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine were selected as the WD group, and 60 healthy physical examiners were selected as the control group during the same time. The included WD patients were divided into the neurologic-type (mainly manifested as neuropsychiatric symptoms) and hepatic-type (mainly manifested ashepatic symptoms) groups according the mainsymptoms. ECG, RT-3DE-related parameters and serum myocardial injury markerssuch ashomocysteine (Hcy), cystatin C (CysC), cardiac troponin I (cTnI), amino-terminal B-type natriuretic peptide precursor (NT-proBNP), and total serum bilirubin (TBIL) of the both groups were recorded.

There were significant differences in the proportion of abnormal ECG results between the two groups, with 37 abnormal cases in the WD group and 14 abnormal cases in the control group (P<0.001) ; compared with the control group, HR, QRS duration, QT interval were increased and P-R interval were decreased in the WD group (P<0.01). There were significant differences in the proportion of abnormal RT-3DE results between the two groups, with 23 abnormal cases in the WD group and 10 abnormal cases in the control group (P<0.001) ; compared with the control group, LAD, E/E', EDV, ESV, PAP were increased and E', EF, SV were decreased in the WD group (P<0.01). Compared with the control group, Hcy, TBIL, CysC, cTnI were increased in the WD group. Compared with the hepatic-type group, QRS duration, QT interval and QTc interval were increased (P<0.05), LAD, IVST, LVD, ESV, EDV were increased, SV was decreased (P<0.05), Hcy, CysC, cTnI were increased (P<0.01) in the neurologic-type group.

No features of structural heart disease were found in WD patients, however, WD patients had a higher risk of developing subclinical cardiac damage than healthy controls. In particular, neurologic-type WD patients had a higher risk of subclinical cardiac dysfunction, ventricular remodeling, and myocardial fibrosis than hepatic-type WD patients. RT-3DE technique has high value in assessing cardiac function in WD patients.

Congenital heart disease (CHD) is one of the major types of birth defects in the world, which is the leading cause of death in children. However, the current situation of delayed diagnosis of CHD is not optimistic, making the early detection, diagnosis and treatment of children with CHD a hot research topic.

To establish and apply the appropriate technology system for screening, diagnosis and evaluation of CHD in neonates in Hainan Province, evaluate operational effect of the technology for its further promotion.

In accordance with the requirements of the Program of Neonatal CHD Screening Project issued by the National Health Commission, the relevant literatures were reviewed to establish the appropriate technology system for screening, diagnosis and evaluation of CHD in neonates, in which screening staff perform CHD screening on liveborn neonates within 6-72 hours after birth using integration of cardiac murmur auscultation and transcutaneous pulse oximetry (POX) , in all midwifery institutions of 17 cities and counties in Hainan province, as well as the local neonatology departments or neonatal intensive care units (NICUs) . Positive results of heart murmur auscultation and/or POX were considered positive for screening. 31 diagnostic facilities authorized by Hainan Provincial Health Commission were responsible for the echocardiography examinations for liveborn neonates with positive screening results. The qualified cardiovascular physicians and cardiac surgeons in the 6 certified tertiary hospitals reviewed the diagnosis results and made necessary re-evaluations, suggested or implemented medical intervention and proposed suggestions on clinical follow-up (3 to 12 months) according to the conditions. Screening, diagnosis, evaluation and treatment data were filled, uploaded and managed online through the neonatal CHD screening information management network. The operational effectiveness of this appropriate health technology was evaluated in 17 cities (counties) in Hainan Province from 2020-01-01 to 2021-12-31.

From 2020-01-01 to 2021-12-31, the count of liveborn neonates in Hainan Province was 206 761, 204 442 of them were included in the screening program with an overall screening rate of 98.88% and screen-positive rate of 2.86% (5 847/204 442) . A total of 527 cases diagnosed with CHD by echocardiography, showing a CHD prevalence of 2.58‰ (527/204 442) , and atrial septal defect as the most common CHD lesion with a composition ratio of 38.14% (201/527) , including 291 insignificant type CHD cases (55.22%) , 142 significant type CHD cases (26.94%) , 88 serious type CHD cases (16.70%) and 6 critical type CHD cases (1.14%) . The sensitivity of auscultation, POX and combination of 2 indicators for CHD screening was 67.93%, 37.00% and 93.35%, respectively, and the specificity was 98.07%, 99.28% and 97.30%, respectively. Neonates with positive results for both indicators (heart murmur auscultation and POX) were more likely to suffer from severe CHD (severe and critical types) than those with positive results for a single indicator (P<0.001) . A total of 94 cases with severe CHD were treated promptly. A total of 4 cases with severe CHD died, the standardized mortality of neonates aged 0-1 year with CHD was 1.96/100 000, the mortality rate of neonates with severe CHD was 4.26% (4/94) .

The combination of two indicators (heart murmur auscultation and POX) for CHD screening is favorable to promotion for the characteristics of noninvasion, simplicity, ease of operation and reliability. The establishment of appropriate technology system for screening, diagnosis, and evaluation of neonatal CHD is of great significance for its advantages in the timely diagnosing and treatment of CHD, especially in severe CHD, and reduction of mortality in neonates with CHD.

SYNTAX score is the most common system for predicting the prognosis of patients with coronary heart disease based on coronary anatomy and lesions, and an evaluation method based on general clinical data is needed to improve the effectiveness of prediction.

To investigate the relationship between CHA₂DS₂-VASc scores and major adverse cardiovascular events in patients with three-vessel disease (TVD) or left main coronary artery disease (LMD) .

A total of 630 TVD/LMD patients were enrolled, and 276 patients were divided into the mild lesion group (0—22 points), 249 cases in the moderate lesion group (23—32 points) and 105 cases in the severe lesion group (≥33 points) according to SYNTAX score. Pearson correlation analysis and partial correlation analysis were used to explore the correlation between quantitative data, and univariate and multivariate Logistic regression analysis were used to investigate whether CHA₂DS₂-VASc and SYNTAX scores were risk factors for the incidence of MACEs within 3 years. The receiver operating characteristic (ROC) curve was plotted to evaluate the CHA₂DS₂-VASc score in predicting the occurrence of MACEs within 3 years. The ROC curves for predicting MACEs of CHA₂DS₂-VASc score, SYNTAX score, and the combination of the two scoring systems were compared using the Delong method.

There were statistically significant differences in age, congestive heart failure, eGFR, LVEF, SYNTAX score, CHA₂DS₂-VASc score, MACEs within 3 years, death and non-fatal myocardial infarction among the groups with diferent degree of coronary stenosis (P<0.05), and CHA₂DS₂-VASc score was positively correlated with SYNTAX score (r=0.109, P=0.003). Multivariate Logistic regression analysis showed that hypertension〔OR=1.753, 95%CI (1.047, 2.938) 〕, LVEF 〔OR=0.962, 95%CI (0.942, 0.982) 〕, SYNTAX score 〔OR=1.028, 95%CI (1.002, 1.055) 〕, and CHA₂DS₂-VASc score 〔OR=1.210, 95%CI (1.070, 1.369) 〕 were independent influencing factors of MACEs of TVD/LMD patients within 3 years (P<0.05). ROC curve analysis showed that AUC of SYNTAX score predicting MACEs is 0.638, and AUC of CHA₂DS₂-VASc score predicting MACEs is 0.619. The AUC of combined SYNTAX and CHA₂DS₂-VASc score predicting MACEs was 0.685. The AUC difference between SYNTAX and CHA₂DS₂-VASc score was 0.019 (P=0.587) by Delong method, indicating that both SYNTAX and CHA₂DS₂-VASc scores had a predictive effect on MACEs, but the AUC difference was not statistically significant. The AUC difference between the combined two kind of score and SYNTAX score alone was 0.046 9 (P=0.046), and the AUC difference between the combined two kind of scores and CHA₂DS₂-VASc score oalone was 0.065 9 (P=0.043) .

The CHA₂DS₂-VASc score can be used to predict coronary artery severity and MACEs within 3 years in patients with three-vessel disease/left main coronary artery disease. Combined CHA₂DS₂-VASc and SYNTAX scoring system can effectively improved the predictive value of MACEs within 3 years.

Triglyceride-glucose (TyG) index is an index to evaluate insulin resistance (IR) and obesity-related metabolic diseases, which is closely related to the high risk of cardiovascular disease (CVD). However, TyG index may be different from the high risk of CVD in middle-aged obese people of different genders.

To investigate the relationship between TyG index and the high risk of CVD in middle-aged obese people of different genders, and to evaluate its role in the prevention and treatment of CVD.

A total of 30 425 middle-aged obese residents were selected from 10 early screening and comprehensive intervention projects of high-risk CVD population in Anhui Province and investigated by investigators who were trained and qualified, using the preliminary screening questionnaire and basic information registration form designed by the National Cardiovascular Center. The main survey contents included gender, age, hypertension, dyslipidemia, diabetes, smoking and alcohol consumption, etc, and perform a CVD high-risk assessment. The included residents were divided into the male group (n=11 566) and female group (n=18 859). The male group was divided into T₁ (7.417-8.870) (n=2 892), T₂ (8.871-9.204) (n=2 891), T₃ (9.205-9.578) (n=2 892) and T₄ (9.579-11.435) (n=2 891) subgroups, the female group was divided into F₁ (7.579-8.876) (n=4 715), F₂ (8.877-9.183) (n=4 720), F₃ (9.184-9.526) (n=4 710) and F₄ (9.527-11.647) (n=4 714) subgroups according to the quartiles of TyG index. Binary Logistic regression analysis was used to explore the relationship between TyG index and the high risk of CVD, and Z-test was used to compare the differences in effect values among subgroups.

The high risk rate of CVD was 28.4% (3 280/11 566) in the male group and 26.0% (4 909/18 859) in the female group. Binary Logistic regression analysis showed that TyG index T₂ (F₂), T₃ (F₃), T₄ (F₄) in male group (female group) were correlated with the high risk of CVD (P<0.05), and the correlation with the high risk of CVD increased with the gradual increase of TyG index. In the male group, the risk of developing high risk of CVD in the T₄ subgroup compared to T₁ was OR (95%CI) =1.827 (1.622, 2.058) ; In the female group, the risk of developing high risk of CVD in the F₄ subgroup compared to F₁ was OR (95%CI) =1.552 (1.410, 1.708). There were significant differences in the TyG index and risk of developing high risk of CVD between the T₄ and F₄ subgroups in both male and female groups (P<0.05). After further adjustment for total cholesterol and other indicators (model 2), the correlation between T₂ (F₂), T₃ (F₃), T₄ (F₄) and the risk of developing high risk of CVD was attenuated. However, in both male and female groups, T₂ (F₂), T₃ (F₃) and T₄ (F₄) were all correlated with the high risk of CVD (P<0.05), and the correlation increased with the gradual increase of TyG index level. In the male group, the risk of developing high risk of CVD in the T₄ subgroup compared to T₁ subgroup was OR (95%CI) =1.804 (1.584, 2.055), in the female group, the risk of developing high risk of CVD in the F₄ subgroup compared to F₁ subgroup was OR (95%CI) =1.496 (1.345, 1.665) ; There were significant differences in the risk of developing high risk of CVD between the T₄ and F₄ subgroup in both male and female groups (P<0.05) .

Middle-aged obese men with high TyG index are more prone to develop high risk for CVD, and more attention should be paid to the TyG index level of the population.

Coronary heart disease (CHD) is the leading cause of death world wide. Coronary angiography is often used as an effective approach for the diagnosis of CHD. However, coronary angiography accounts for relatively low percentagein examination approaches due to the limitation of various conditions in primary care, and more meaningful biomarkers need to be explored to provide a basis for primary care physicians to diagnose and treat CHD. In the previous study of our research group, it is found that early growth response 3 (Egr3) gene may be a susceptibility factor in the heterogeneity of CHD pathogenesis, and there are few reports on the correlation between CHD and Egr3 gene and inflammatory biomarkers.

To investigate the correlation between Egr3, interleukin-6 (IL-6) and CHD, as well as their expression levels and the severity of coronary stenosis, so as to provide a favorable laboratory basis for clinical diagnosis and treatment inprimary care.

A total of 110 patients who admitted to the Fifth Affiliated Hospital of Xinjiang Medical University for CHD symptoms and completed coronary artery angiography (CAG) during June to December 2021 were collected and divided into the mild stenosis group (group A≤52 points, n=50) , moderate-severe stenosis group (group B>52 points, n=30) and control group (group C, n=30) according to the CAG results and median Gensini score (52 points) . Serum Egr3 and IL-6 levels of the included patients were measured by enzyme-linked immunosorbent assay.

The IL-6 level in group B was higher than that in group A and group C (P<0.05) , and Egr3 expression level in the group A and group B was higher than that in group C, respectively (P<0.05) ; the area under the ROC curve of Egr3 expression level in the diagnosis of coronary heart disease was 0.648, with a sensitivity of 35.0% and specificity of 93.3%. There was positive correlation between IL-6 and Egr3 in CHD patients (r=0.231, P<0.01) ; Egr3 and IL-6 levels were positively correlated with Gensini score (r_s=0.39, 0.317, P<0.01) .

Egr3 has good specificity for the diagnosis of CHD, and the expression levels of Egr3 and IL-6 were positively correlated with the severity of coronary stenosis.

Hypertensive patients with moderate or high risk of ASCVD had low lipid goal attainment rate. And those with high risk of ASCVD and concomitant other high risk factors had unsatisfactory lipid control status. Attention should be paid to the management of blood lipid in hypertension patients to improve their blood lipid control rate and reduce their risk of ASCVD.

It has been a consensus that cardiac rehabilitation is an effective comprehensive intervention for patients with coronary heart disease (CHD), but the quality of relevant guidelines is still unclear, and recommendations from the guidelines need to be integrated.

To systematically review the guidelines on cardiac rehabilitation in patients with CHD, providing evidence to inform clinical practice.

In June 2022, guidelines on cardiac rehabilitation in patients with CHD were searched in electronic databases of the Cochrane Library, Web of Science, PubMed, CNKI, CQVIP and Wanfang Data, relevant guideline repositories and association websites from inception to 30 June 2022. Literature screening and data extraction were performed by two researchers separately according to the inclusion and exclusion criteria. The quality of included guidelines was assessed using the Appraisal of Guidelines for Research & EvaluationⅡ (AGREEⅡ), and recommendations from which were summarized.

Ten guidelines (eight of them are foreign guidelines) with publication time ranging from 2011 to 2020 were eventually included. The average score of every AGREEⅡ domain was 71% for scope and purpose, 65% for stakeholder involvement, 58% for rigor of development, 80% for clarity of presentation, 64% for applicability, and 45% for editorial independence. Four guidelines were rated as grade A and the remaining six as grade B. Six aspects are involved in recommendations, including basic requirements of cardiac rehabilitation, heath education, risk factors control, psychological support, exercise training, and improvement of cardiac rehabilitation participation.

The quality of included guidelines is at a moderate to high level. More efforts are needed to improve the domains in stakeholder involvement, rigor of development, applicability, and editorial independence. Recommendations of the 10 guidelines tend to be consistent, but there are still insufficient recommendations on improving cardiac rehabilitation participation. There is a gap in the quality between domestic and foreign guidelines, so it is necessary to develop a high-quality guideline on cardiac rehabilitation for patients with CHD in China.

Exposure to indoor air particles pollution increases the incidence and mortality of respiratory and cardiovascular diseases, especially in the elderly population.

To explore the effect of indoor air particles on cardiopulmonary-related physiological indexes of the elderly and short-term use of air purifiers on the improvement of cardiopulmonary health of the elderly.

A randomized, double-blind, crossover trial was conducted in January 2020 on 24 healthy older adults selected from a senior apartment in Jiangbei District of Chongqing. These included older adults equally divided into two groups alternately using real and sham air purifiers for 48 h with a 12-days washout interval by complete randomization. 14 health indexes including biomarkers of circulatory system inflammation, coagulation, oxidative stress and pulmonary function, blood pressure, heart rate, exhaled fractional nitric oxide (FeNO) were measured. Linear mixed-effect model was used to evaluate the effect of the air purifiers on health indexes.

The results of the linear mixed-effect model showed that compared with the sham purifiers, fibrinogen, MCP-1 and MPO in the blood inflammatory indicators were changed by -15.1%〔95%CI (-23.1%, -6.3%) , P<0.05〕, -17.7%〔95%CI (-22.9%, -12.3%) , P<0.05〕 and -17.2%〔95%CI (-23.9%, -9.8%) , P<0.05〕, PAI-1 and t-PA in the coagulation factors changed by -14.9%〔95%CI (-21.1%, -8.2%) , P<0.05〕 and -13.5%〔95%CI (-18.7%, -8.0%) , P<0.05〕, heart rate changed by -5.8%〔95%CI (-10.6%, -0.8%) , P<0.05〕in the real purifiers, respectively. For every 1 μg/m³ increase in PM_2.5 concentration, fibrinogen, MCP-1, MPO, PAI-1, t-PA, D-dimer and heart rate in the elderly increased by 0.51%, 0.48%, 0.56%, 0.49%, 0.43%, 0.31% and 0.20%, respectively (P<0.05) .

Indoor air purifiers are associated with decreased concentrations of systemic and local inflammation and coagulation biomarkers. Reducing air particles may be a public health measure to improve circulatory and cardiopulmonary health in the elderly.

The importance of phase Ⅰ cardiac rehabilitation after percutaneous coronary intervention (PCI) has been confirmed, but there is suboptimal adherence among patients. Therefore, investigating the adherence of PCI patients to phaseⅠ cardiac rehabilitation and the influencing factors can provide a theoretical foundation for improving the adherence of patients.

To clarifythe influencing factors of the adherence of PCI patients to phaseⅠ cardiac rehabilitation and the effect pathways by the structural equation model construction, in order to provide the oretical support for improving the adherence of PCI patients to phase Ⅰ cardiac rehabilitation.

Patients with PCI enrolled in the Cardiac Rehabilitation Center of the Second Hospital of Harbin Medical University from August to December in 2021 were selected as the research objects by convenience sampling. The general demographic information questionnaire, therapy adherence questionnaire, health belief of coronary heart disease questionnaire, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiexy Disorde-7 (GAD-7), Family Adaptability and Cohesion Evaluation Scale (FACES), Chronic Illness Resource Survey (CIRS), Gensini score were used to investigate the patients by the end of phaseⅠ cardiac rehabilitation. Spearman rank correlation analysis was used to verify the correlations between health belief, depression, anxiety, family adaptability and cohesion, chronic illness resource utilization and cardiac rehabilitation adherence, respectively. Based on correlation analysis, the hypothetical model of the influencing factors of the adherence of PCI patients to phaseⅠ cardiac rehabilitation was constructed combined with Anderson's model of health service utilization. Maximum likelihood method was used to fit and modify the model constantly. Structural equation model was used to analyze the relationship among influencing factors.

A total of 443 questionnaires were distributed and 430 valid questionnaires were returned, with a valid return rate of 97.06%. The results of multiple linear regression analysis showed that health belief (β=0.427), depression (β=-0.057), anxiety (β=-0.130), family adaptability and cohesion (β=0.242), chronic illness resource (β=0.140) were independent factors of the adherence to phaseⅠcardiac rehabilitation of PCI patients (P<0.05). The results of the correlation analysis showed that cardiac rehabilitation adherence score of PCI patients was positively correlated with health beliefs, family adaptability and cohesion, chronic illness resource utilization (P<0.05) and negatively correlated with depression and anxiety (P<0.05). A structural equation model of the adherence of PCT patients to phaseⅠ cardiac rehabilitation was constructed using health belief, depression, anxiety, family adaptability and cohesion, chronic illness resource and the model fits well: χ²/df=3.092<5, standardized root mean square residual (SRMR) =0.070<0.080, goodness of fit indices (GFI) =0.981, adjusted goodness of fitindices (AGFI) =0.936, comparative fit index (CFI) =0.992, normed fit indexes (NFI) =0.989, with all of them>0.9. The results of the intermediate effects test showed that health belief, family adaptability and cohesion, chronic illness resource had positive direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation (β=0.395, 0.277, 0.152, P<0.01) ; health belief, family adaptability and cohesion had a positive indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through chronic disease resource utilization (β=0.057, 0.065, P<0.01). Depression and anxiety had a direct negative effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation (β=-0.055, -0.116, P<0.05) .

The adherence of PCI patients to phaseⅠ cardiac rehabilitation is influenced by multiple factors. There are complex pathway relationships among the influencing factors. Health belief, family adaptability and cohesion, chronic illness resource have a positive direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation; depression and anxiety have a negative direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation; health beliefs, family adaptability and cohesion have a positive indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through chronic illness resource utilization, and have a negative indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through anxiety and depression.

Cardiometabolic risk factor cluster (CRFC) is a common health issue among aged 55 and over adults. Available studies mainly focus on the distribution of its epidemiological characteristics, but rarely assess the association between CRFC and all-cause mortality risk.

To explore the association between CRFC and all-cause mortality risk among community-dwelling aged 55 and over adults, to provide evidence for developing healthcare interventional programs for this group.

By use of typical sampling, this study selected 1 046 community-dwelling aged 55 and over adults from five urban communities in Wuzhong and Yinchuan cities of Ningxia Hui Autonomous Region during September to November 2011. And sociodemographic questionnaire survey, health check-up, ultrasonic examination, laboratory test and CRFC assessment 〔nine cardiometabolic risk factors, including central obesity, hypercholesterolemia, hypertriglyceridemia, elevated LDL-cholesterol, decreased HDL-cholesterol, hypertension, diabetes, hyperuricemia, and nonalcoholic fatty liver disease (NAFLD) 〕, were included in the multivariate Cox regression model to calculate the regression coefficient β of them after adjusting for confounders, then the coefficient of each factor was used as the weight to calculate the total risk score by adding them together were finished at baseline. The participants were followed up in 2017, 2019, and 2021 by face-to-face interview coupled with searching the national death surveillance system. Log-rank test was used to compare the survival curves for all-cause mortality plotted using the Kaplan-Meier method for tertile groups of the total cardiometabolic risk score (<P₅₀, P₅₀-P₇₅, and >P₇₅) . The Cox regression model was employed to assess the association of all-cause mortality risk with sociodemographics, cardiometabolic risk factors, the total cardiometabolic risk score, the level of the total cardiometabolic risk score, and age.

The participants had an average age of (66.4±6.6) years (range: 55-88) at baseline. One hundred and six death cases were identified with a ten-year accumulated mortality rate of 10.13%. The individuals in >P₇₅ group had much lower accumulated mortality rate than the other two groups, indicating that the median survival time decreased with the increase in the total cardiometabolic risk score. Multivariate Cox regression analysis showed that age, sex, living alone and education level may be associated with all-cause mortality risk (P<0.05) . After adjusting for sociodemographic variables, the multivariate Cox regression model revealed that the cardiometabolic risk factor cluster was associated with increased risk of all-cause mortality〔HR=3.04, 95%CI (1.55, 5.97) , P=0.001〕, and a dose-response effect was found that higher score was associated with an increased risk of death〔HR=2.02, 95%CI (1.16, 3.50) , P=0.013〕for > P₇₅ when compared with risk score lower than P₅₀) . When stratified by age group, the association only persisted among those aged 65 and over〔HR=2.79, 95%CI (1.36, 5.74) , P=0.005〕; >P₇₅ group had higher risk of death than P₅₀ group〔HR=1.83, 95%CI (1.02, 3.28) , P=0.042〕.

The CRFC was positively associated with all-cause mortality risk among community-dwelling aged 55 and over adults, and higher level of clustering was associated with higher all-cause mortality risk. The findings indicate that early assessment and intervention of CRFC may play a role in improving the healthcare and reducing the risk of death in this population .

Cardiometabolic index (CMI) is a simple index to measure blood lipid, which is closely related to diabetes and stroke. Metabolically obese normal weight (MONW) individuals have higher risks of morbidity and mortality of diabetes and cardiovascular and cerebrovascular diseases. Correctly identifying individuals with MONW phenotype is essential for the prevention and control of metabolism-related diseases. However, there are few studies on the predictive value of CMI for MONW phenotype.

To investigate the association between CMI and MONW phenotype, and to evaluate the predictive value of CMI for MONW phenotype.

The multistage stratified cluster sampling method was used to select permanent residents aged ≥18 years as subjects from Nanjing. The investigation time was from January 1, 2017 to June 30, 2018. The basic data of subjects were collected and multivariate robust Poisson regression model was used to evaluate the RR value with 95%CI of CMI for MONW phenotype. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of CMI, waist-to-height ratio (WHtR) , triglyceride/ high-density lipoprotein cholesterol (TG/HDL-C) ratio, waist circumference (WC) and body mass index (BMI) for MONW phenotype. DeLong test was used to compare the area under the ROC curve (AUC) of the above-mentioned five indicators, and to further explore the value of CMI in predicting MONW phenotype in different gender and age groups.

A total of 30 408 people were included, including 13 213 males and 17 195 females, 23 691 cases of MHNW and 6 717 cases of MONW. There was statistically significant difference in age, education, occupation, current smoking, alcohol consumption, physical activity, duration of static behavior, high red meat intake, disease history, medication history, height, waist circumference (WC) , body mass index (BMI) , total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) , systolic blood pressure (SBP) , diastolic blood pressure (DBP) , fasting blood glucose (FPG) , TG/HDL-C, waist-height ratio (WHtR) and CMI (P<0.05) . There was statistically significant difference in age, education, occupation, current smoking, alcohol consumption, duration of static behavior, high red meat intake, history of disease, medication, height, WC, BMI, TC, TG, HDL-C, LDL-C, SBP, DBP, FPG, TG/HDL-C, WHtR, and CMI of male MHNW and NONW phenotypes (P<0.05) . There was statistically significant difference in age, education, occupation, current smoking, alcohol consumption, physical activity, duration of static behavior, history of disease, medication, height, WC, BMI, TC, TG, HDL-C, LDL-C, SBP, DBP, FPG, TG/HDL-C, WHtR, and CMI of the female MHNW and NOWN phenotype subjects (P<0.05) . The number of Q1 to Q4 groups was 7 739, 7 940, 7 904, 6 825, and the CMI range was ≤0.253, 0.254 to 0.382, 0.383 to 0.539, and ≥0.540, respectively. Male subjects in Q1 to Q4 were 2 697, 3 410, 3 661, 3 445, and the CMI range was ≤0.281, 0.282 to 0.407, 0.408 to 0.569, and ≥0.570, respectively. 5 042, 4 530, 4 243 and 3 380 female subjects in Q1 to Q4 group were studied, and the CMI ranges were ≤0.235, 0.236-0.361, 0.362-0.516 and ≥0.517, respectively. After adjusting for confounding factors, the CMI quartile grouping was the factor affecting metabolic phenotype in all subjects, male subjects, and female subjects (P<0.05) . Multivariate robust Poisson regression model analysis showed that the risk of MONW phenotype in the general population, male and female increased by 68%, 55% and 81% with each additional SD of CMI. In male subjects, CMI predicted MONW phenotype better than WHtR (Z=18.97, P<0.001) , TG/HDL-C (Z=12.53, P<0.001) , WC (Z=23.85, P<0.001) and BMI (Z=24.13, P<0.001) . The predictive power of CMI for MONW phenotype in female subjects was higher than that of WHtR (Z=27.38, P<0.001) , TG/HDL-C (Z=15.27, P<0.001) , WC (Z=30.83, P<0.001) and BMI (Z=30.84, P<0.001) . The AUC value of CMI predicted MONW phenotype in female subjects was higher than that in male subjects (Z=-6.10, P<0.001) , and the difference was statistically significant. In male subjects, the AUC predicted by CMI from 18 to 34 years old was 0.835〔95%CI (0.818, 0.852) 〕, higher than that of 35 to 44 years old (Z=1.55, P=0.04) , 45 to 54 years old (Z=6.92, P<0.001) , 55 to 64 years old (Z=4.95, P<0.001) , ≥65 years old (Z=7.92, P<0.001) ; In female subjects, the AUC predicted by CMI from 18 to 34 years old was 0.832〔95%CI (0.817, 0.847) 〕, which was higher than that of 35 to 44 years old (Z=1.95, P=0.03) , 45 to 54 years old (Z=2.56, P=0.02) , 55 to 64 years old (Z=3.79, P<0.001) , ≥65 years old (Z=5.71, P<0.001) .

CMI was positively associated with the risk of the MONW phenotype, which has strong predictive power and can be used as an effective tool to identify MONW phenotype in the general population, especially in 18-34 years-old people.

Dyslipidemia is closely related to the occurrence of acute myocardial infarction (AMI) and affects the prognosis of patients. Understanding blood lipid changes in patients with AMI is of great significance for improving lipid-lowering treatments for these patients.

To explore the evolution of blood lipid levels in patients with AMI during hospitalization and post-discharge follow-up.

This study consecutively selected 457 cases of AMI who were hospitalized in Department of Cardiology, Peking University People's Hospital from January 1, 2015 to February 28, 2018. They were monitored for blood lipid levels during hospitalization and the first post-discharge follow-up. The patient's medication status was recorded.

The low-density lipoprotein cholesterol (LDL-C) level in AMI patients varied statistically significantly by the measurement time point (P<0.05). Specifically, LDL-C showed a decreasing trend within 24 h after the onset of AMI, then reached (2.21±0.63) mmol/L at about 24 h after the onset, which decreased by (0.98±0.34) mmol/L on average compared with the admission level. After that, the level of LDL-C gradually stabilized. The total cholesterol (TC) level differed statistically significantly across measurement time points (P<0.05). To be specific, it decreased by an average of (1.34±0.46) mmol/L at about 24 h after the onset of the disease, and then stabilized. There were statistically significant differences in the high-density lipoprotein cholesterol (HDL-C) level of AMI patients at different time points (P<0.05). The HDL-C level of patients decreased within 12 h after onset, and then stabilized. There were statistically significant in triglyceride (TG) levels of AMI patients at different time points (P<0.05). After the onset of the disease, the TG level of the patients increased within 12 h and decreased after 24 h, and then stabilized. In terms of lipid-regulating therapy, 36.8% (168/457) of AMI patients received lipid-regulating therapy before the hospitalization. Among those who were not engaged in lipid-regulating treatment prior to hospitalization, 28.2% (129/457) had already suffered from arteriosclerotic cardiovascular disease. During the hospitalization, 99.2% (453/457) of the patients were treated with lipid-regulating therapy, mainly statins at medium doses. By one year after discharge, only 59.3% (271/457) of patients still regularly took lipid-regulating drugs. In the follow-up period after discharge, 43.7% (200/457) of patients met the standard of blood lipids.

At about 24 h after the onset of AMI, the LDL-C of AMI patients dropped to the bottom, and the trend of decline was more obvious in those who received no lipid-lowering drugs before hospitalization. The lipid-lowering treatment for them was mainly based on medium-dose statins, and the in-hospital statin usage rate reached 99.2%, but the rate of patients meeting the target LDL-C level during follow-up period was 43.7%, which may be enhanced by improving patient compliance.

The family management style directly affects the prognosis of children with complex congenital heart disease (CCHD) after palliative surgery. But it is still unsatisfactory for these children in China. Research on family management of these children based on the Family Management Style Framework in foreign countries has achieved certain achievements while domestic research is still in its infancy.

To explore the family management style and its factors in children with CCHD after palliative surgery.

This study is a cross-sectional study. From May to September 2021, a total of 245 children after palliative surgery for CCHD and their families were selected from Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 1, 2016 to August 31, 2021 by convenient sampling. The following questionnaires were used for collecting information from the major caregiver of the children (father or mother) : the Chinese version of the Family Management Measure (FaMM-C), the Chinese version of the Family Assessment Device (FAD-C), the Chinese version of the Parenting Stress Index Short Form (PSI-SF-C), and the socioeconomic status index. The children's height and body weight were measured to assess the prevalence of malnutrition, and their cardiac functions were also evaluated. The family management style of the children's families was classified by clustering the score of each dimension of FaMM-C using clustering analysis. Multinomial Logistic regression was used to analyze the factors associated with different types of family management style.

Four types of family management style were identified: the normal-perspective and collaborative〔28.6% (70/245) 〕, the chaotic and strenuous〔11.0% (27/245) 〕, the confident and concerning〔21.6% (53/245) 〕and the laissez faire〔38.8% (95/245) 〕. When the normal-perspective and collaborative group compared to the other three groups: the higher the score of the PSI-SF-C, the more inclined the family management was to the normal-perspective and collaborative style (P<0.05). Meanwhile the higher the score of the FAD-C, the less inclined the family management was to the normal-perspective and collaborative style (P<0.05). Moreover, compared the laissez faire group with the normal-perspective and collaborative group: the family of male children was more inclined to the normal perspective and collaborative style (P<0.05) ; the older the children were at follow-up or the time from surgery to follow-up of those children was less than one year, the less inclined the family management was to the normal perspective and collaborative style (P<0.05) .

Family caregivers cope with the situation of children with CCHD after palliative surgery through four different management styles, which are shaped by multiple factors from children and families. Findings of this study suggest the necessity to carry out long-term care for the children adopting a family-centered care model, and to develop individualized interventions for the families to establish a scientific and effective family management style based on the type of family management style and its related factors.

Type 2 diabetes mellitus increases the risk of early onset of cardiovascular disease in patients, which poses a major threat to human health. Exploring the impact of type 2 diabetes mellitus on prognosis of patients with dilated cardiomyopathy is good for patient management.

To evaluate the effect of type 2 diabetes mellitus on the prognosis of patients with dilated cardiomyopathy.

This study retrospectively analyzed 313 patients with dilated cardiomyopathy who were admitted to the Department of Cardiology in the First Affiliated Hospital of Guangxi Medical University from January 2015 to May 2020. Patients were divided to a diabetic group (n=66) or a non-diabetic group (n=247) according to whether they suffered from type 2 diabetes mellitus. General date and laboratory indices were collected. Follow-up was conducted until December 31, 2021. The primary endpoint was all-cause death. This study used landmark analysis to compare survival rate between these two groups. A multivariate Cox proportional hazards regression model was used to analyze the influencing factors of all-cause mortality in patients with dilated cardiomyopathy.

Landmark analysis showed that there was no significant difference in one-year survival rate between these two groups (χ²=1.520, P=0.218). After 1 year, the survival rate in the diabetic group was lower than that of the non-diabetic group (χ²=4.414, P=0.036). In the multivariate Cox proportional hazards regression model constructed by piecewise fitting method, systolic blood pressure〔HR=0.965, 95%CI (0.948, 0.982) 〕, N-terminal pro-B-type natriuretic peptide〔HR=9.928, 95%CI (4.791, 20.576) 〕 and β-receptor blocker〔HR=0.317, 95%CI (0.168, 0.598) 〕 were the influencing factors of all-cause mortality in patients with dilated cardiomyopathy within one year (P<0.05), while LVEDD〔HR=1.057, 95%CI (1.028, 1.087) 〕and type 2 diabetes mellitus〔HR=1.756, 95%CI (1.011, 3.050) 〕were influencing factors of all-cause mortality in patients with dilated cardiomyopathy after one year (P<0.05) .

Type 2 diabetes mellitus was not associated with adverse outcomes in patients with dilated cardiomyopathy at 1 year of follow-up, but was strongly associated with poor outcomes after 1 year in patients with dilated cardiomyopathy.

People with normal weight obesity (NWO) are prone to cardiovascular diseases in their middle and old age. High-intensity interval training (HIIT) has been demonstrated to effectively improve cardiovascular health. However, whether HIIT can decrease the risk of cardiovascular diseases in NWO population is not clear.

To explore the effects of HIIT on the advanced glycation end-products (AGEs) and the risk of cardiovascular disease in NWO female university students.

From November to December 2020, 137 female college students were recruited in Shanghai University of Medicine & Health Sciences, among whom 40 NWO cases were screened out as subjects by the Asian female NWO standard. They were equally and randomly divided into a control group (n=20) and a HIIT intervention group (n=20) to receive no interventions or weekly five-day interventions, for consecutive four weeks after one-week adaptive training. Body weight, body mass index (BMI) , body fat percentage (BF%) , visceral fat level (VFL) , visceral fat area (VFA) , waist circumference, levels of four blood lipids 〔high-density lipoprotein (HDL) , low-density lipoprotein (LDL) , triglyceride (TG) , and total cholesterol (TC) 〕, cardiovascular disease risk (assessed by the China-PAR model) , AGEs, and fasting blood glucose of two groups were observed before and after intervention. The correlation between AGEs and cardiovascular disease risk was analyzed.

Except for 10 dropouts, the remaining 30 cases (13 in the control group and 17 in the HIIT intervention group) were finally included for analysis. After intervention, the average BMI, BF%, VFA, VFL, waist circumference, TC/HDL ratio, LDL/HDL ratio, TG/HDL ratio, AGEs and fasting blood glucose in HIIT intervention group were lower than those in control group (P<0.05) . Nine subjects in the HIIT intervention group were evaluated for the risk of cardiovascular and cerebrovascular diseases as the China-PAR model was applicable to subjects aged 20 years or older. The risk of cardiovascular disease was (11.82±0.47) % and (9.79±0.57) % in control group and HIIT intervention group, respectively, before intervention, and (14.13±0.97) % and (6.93±1.17) % in the two groups, respectively, after intervention. The post-intervention risk of cardiovascular disease in HIIT intervention group was lower than that in control group (P<0.05) . Spearman rank correlation analysis showed that AGEs were not correlated with cardiovascular disease risk (r_s=-0.006, P=0.979) .

The four-week HIIT can effectively reduce the body fat, the levels of AGEs and fasting blood glucose as well as the risk of cardiovascular disease in NWO female university students.

Global population epidemiology research shows that by 2019, there were 1.28 billion hypertensive patients, and about 59.7 million patients with atrial fibrillation (AF) worldwide. Hypertension greatly increases the risk of AF. And in older hypertensive patients, the incidence of AF will be higher than 60%. Moreover, AF increases the risk of ischemic stroke, heart failure, myocardial infarction, chronic kidney disease and dementia. However, there are few studies on whether AF increases the risk of new-onset myocardial infarction, and whether the risk interacts with age is still unclear in large hypertensive populations.

To examine whether AF increases the risk of new-onset myocardial infarction in hypertensive patients.

Individuals with hypertension were selected as subjects from the employees of Kailuan Group who underwent the medical check-up in Tangshan Gongren Hospital and Kailuan General Hospital from June 2006 to October 2007. General data and laboratory test results of subjects were collected. And all of them were regularly followed up until 2020-12-31. The endpoint event was new-onset myocardial infarction. The finally enrolled cases (n=42 833) included 270 with AF diagnosed by baseline ECG (AF group) and 42 563 without (non-AF group) . The cumulative incidence of myocardial infarction was calculated by the life table method. The survival curve for the cumulative incidence of new-onset myocardial infarction was plotted by Kaplan-Meier method. The difference of the cumulative incidence of myocardial infarction between AF and non-AF groups was compared by Log-rank test. Multivariate Cox proportional hazards regression model was used to investigate the effect of AF on new-onset myocardial infarction in hypertension.

AF group had greater mean age, and lower mean levels of diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol than non-AF group (P<0.05) . There were also statistically differences in the incidence of myocardial infarction and cumulative incidence of new-onset myocardial infarction between the two groups (P<0.05) . After age-stratification, it was found that the differences in the incidence of new-onset myocardial infarction and cumulative incidence of myocardial infarction were statistically significant between those aged ≤60 years with AF and without AF (P<0.05) , but were insignificant between those aged > 60 years with and without AF (P>0.05) . Adjusted multivariate Cox proportional hazards regression analysis showed that AF was a risk factor for new-onset myocardial infarction in hypertensive population〔HR=2.89, 95%CI (1.74, 4.82) , P<0.01〕, and also in hypertensive population aged ≤60 years old〔HR=4.72, 95%CI (2.11, 10.56) , P<0.01〕.

AF is a risk factor for new-onset myocardial infarction in hypertensive population, especially in those ≤60 years old. Active control of blood pressure and treatment of AF are important prevention and treatment measures for new-onset myocardial infarction.

There are numerous patients with diabetes complicated with heart failure. Dapagliflozin is a new hypoglycemic drug that has been used for heart failure according to guideline recommendation, however, its mechanism of improving heart function has not been fully defined.

To study the effects of dapagliflozin on the expression of plasma miRNA-423-5p and cardiac function in patients with type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) .

Fifty patients with T2DM complicated with CHF admitted to the 960th Hospital of PLA from April 1 to November 30, 2021 were enrolled and randomly divided into dapagliflozin group (n=25) and control group (n=25) . Both groups received the same treatment for six months except that dapagliflozin group received dapagliflozin 10 mg/d per day, and the control group received other hypoglycemic drugs. They were compared to healthy physical examinees with normal cardiac function (healthy group, n=25) . Basic data of the patients were collected through the electronic medical record system, including age, sex, smoking history, hypertension, blood pressure level, body mass index (BMI) , blood lipid, blood glucose, creatinine (Cr) , amino-terminal pro-B-type natriuretic peptide precursor (NT-proBNP) , alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , NYHA class, results of cardiac color ultrasound and drug combination. Blood samples were collected for the detection of miRNA-423-5p. A six-month follow-up was given to the patients with the time of first administration of dapagliflozin after inclusion as the starting point, during which patients' cardiac function indices and miRNA-423-5p were measured and collected at the end of four weeks of treatment, and their cardiac function indices, blood pressure level, ALT, AST, and Cr were measured at six months of treatment. Pearson correlation analysis or Spearman rank correlation analysis was used to analyze the correlation between miRNA-423-5p expression level and cardiac function indices of the patients.

After 6 months of intervention, left ventricular ejection fraction (LVEF) , stroke output (SV) and left ventricular short-axis shortening rate (LVFS) in daglizin group were higher than those in control group, while left ventricular end-diastolic diameter (LVEDD) was lower than those in control group (P<0.05) . After 4 weeks and 6 months of intervention, LVEDD in 2 groups was lower than before intervention, while LVEF, SV and LVFS in 2 groups were higher than before intervention (P<0.05) . After 4 weeks of intervention, the level of NT-proBNP and miRNA-423-5p in Dagliegine group was lower than that in control group (P<0.05) , the level of NT-proBNP and miRNA-423-5p in two groups after intervention was lower than that before intervention in the same group (P<0.05) . The results of correlation analysis showed that the expression level of miRNA-423-5p was positively correlated with the level of NT-proBNP (r_s=0.609, P<0.05) , and negatively correlated with the level of LVEF (r=-0.406, P<0.05) .

Dapagliflozin could improve cardiac function, reduce the levels of NT-proBNP and LVEDD, and increase the levels of LVEF, SV and LVFS in patients with T2DM and CHF, and the mechanism of action may be related to its regulation of the expression of plasma miRNA-423-5p .

As an alternative indicator of atherosclerosis, the prevention of carotid intima-media thickening is conductive to the primary prevention of atherosclerosis, but contributions of cardiovascular risk factors to carotid intima-media thickening are not clear.

To identity the controllable risk factors of carotid intima-media thickening, and to perform a dominance analysis of these factors in terms of percentage of contribution in people without major diseases, so as to provide a reference for the determination of key issues related to early prevention and control of cardiovascular diseases.

A total of 738 residents were recruited from Liuzhou, Guangxi Zhuang Autonomous Region from 2019 to 2021. By use of a questionnaire survey and a physical examination, participant information was collected, including demographics, biomarkers in fasting whole blood and urine samples, carotid intima-media thickness (CIMT) and internal diameter of the common carotid artery measured by color Doppler ultrasonography. The aforementioned information was compared between residents with normal CIMT (CIMT <1 mm, n=693) and those with thickened CIMT (CIMT≥1 mm, n=45) . Logistic regression model with adaptive Lasso was established with thickened CIMT as dependent variable to screen its potentially associated factors, then the identified ones were further analyzed using multivariate logistic regression, and the percentage of contribution of each identified associated factor to thickened CIMT was estimated using dominance analysis. Moreover, potential factors associated with naturally logarithmized CIMT were screened using Adaptive Lasso linear regression, then the identified ones were further analyzed using multiple linear regression, and the percentage of contribution of identified associated factors to CIMT was estimated and ranked in descending order.

There was statistically significant difference in gender, age, ethnicity, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , smoking status, common carotid artery diameter, total cholesterol (TC) , urinary microalbumin creatinine ratio (ACR) , lipoprotein A (LPA) , vascular cell adhesion factor 1, apolipoprotein A/ Apolipoprotein B (ApoA/ApoB) , C-reactive protein (CRP) , urinary microalbumin (ALB) and physical activity level (PHYMET) (P<0.05) . Eleven factors potentially associated with thickened CIMT were identified by adaptive Lasso-logit regression analysis, including internal diameter of the common carotid artery, SBP, TC, overweight/obesity, ACR, physical activity level, CRP, LPA, renal function, VCAM-1, and ApoA/ApoB ratio. And 12 factors potentially associated with CIMT were identified by adaptive Lasso linear regression analysis, i.e., internal diameter of the common carotid artery, SBP, TC, physical activity level, ACR, smoking, alcohol consumption, CRP, LPA, ApoA/ApoB ratio, fasting plasma glucose, and family history of diabetes mellitus. Multivariate Logistic regression analysis revealed that risk factors for thickened CIMT were elevated SBP〔OR=1.032, 95%CI (1.013, 1.050) 〕, TC〔OR=1.558, 95%CI (1.049, 2.315) 〕, decreased physical activity level〔OR=2.226, 95%CI (1.289, 3.844) 〕, and elevated CRP〔OR=1.462, 95%CI (1.043, 2.050) 〕, and the percentage of contribution to thickened CIMT of them ranked from high to low was elevated SBP (63.7%) , elevated CRP (16.1%) , elevated TC (12.4%) and decreased physical activity level (7.8%) . Multiple linear regression analysis showed that SBP (β=0.017, P<0.001) , current smoking (β=0.076, P=0.021) , TC (β=0.020, P=0.021) , and physical activity level (β=0.022, P=0.034) were influential factors for CIMT (P<0.05) , and the percentage of contribution to thickened CIMT of them ranked descendingly was SBP (68.7%) , current smoking (19.9%) , TC (8.8%) , and physical activity level (2.6%) .

In our study, elevated SBP, TC, and CRP as well as reduced physical activity level were risk factors of CIMT thickening, and the percentage of contribution of them ranked from high to low was elevated SBP, elevated CRP, elevated TC, reduced physical activity level. The CIMT was significantly correlated with SBP, current smoking, TC and physical activity level, and the percentage of contribution of them ranked descendingly was SBP, current smoking, TC, physical activity level. Therefore, targeted measures for early control and prevention of cardiovascular diseases should keep in line with the controllable influencing factors and their contribution levels.

Cardiovascular disease (CVD) is a common and frequently occurring disease, and the prevalence and mortality of which are increasing rapidly. Atherosclerosis (AS) is the pathological basis of ischemic CVD. Studies have shown that epicardial adipose tissue (EAT) promotes the progression of AS by secreting exosomes and bioactive substances, but the mechanism of action still needs to be further studied.

To perform a bioinformatics analysis of role of EAT in coronary artery disease (CAD) at cellular and molecular levels by identifying the differentially expressed genes (DEGs) in EAT to explore the status of immune cell infiltration, and to assess and verify whether EAT is derived from DEGs in exosomes in CAD patients.

We downloaded GSE64554 and GSE120774 datasets about EAT from the GEO database and performed a bioinformatics analysis using R language and related packages. We first used R language to screen the DEGs in EAT and CAD patients, then used GO/KEGG enrichment analysis to establish a protein interaction network to explore biological functions of the screened genes and transcription factors potentially involved in their regulation process. After that, we conducted a weighted gene co-expression network analysis (WGCNA) of EAT in GSE64554 dataset to obtain a gene module related to CAD phenotype, then crossed the hub genes in this module and DEGs in EAT to obtain the key common genes. We used Cibersort to characterize the immune cell infiltration in EAT. Then we obtained DEGs from blood exosomes of CAD patients and healthy controls included in the exoRbase database, crossed DEGs in EAT and blood exosomes to identify the common genes to be used as diagnostic and therapeutic markers for CAD, and their values were tested by qRT-PCR measurement of clinical samples. The selected genes were analyzed by GO/KEGG and Metascape enrichment analyses.

A total of 1 511 DEGs in EAT of CAD patients were identified, including 956 with up-regulated expression and 555 with down-regulated expression. By crossing the DEGs in EAT and hub genes in modules associated with CAD closely, we identified DDX47, FEM1C, NOL11, SRP54, ABI1, PATL1, BNIP2, C1orf159, and CHCHD4 as key genes in the development of CAD. Immune cell infiltration analysis showed that the abundance of immature CD₄⁺ T cells increased while expression abundance of resting dendritic cells decreased in EAT of CAD patients (P<0.05). A total of 1 658 DEGs in exosomes of CAD patients, including 278 with up-regulated expression and 1 380 with down-regulated expression. One hundred and twenty-nine common DEGs were obtained by cross-tabbing DEGs in EAT and exosomes of CAD patients, among which BPI, BIRC5, CXCL12, RNASE1 and F2R with higher expression abundance were selected as potential diagnostic and therapeutic markers for CAD. By qRT-PCR detection, CAD patients were found with increased mRNA expression levels of BPI, BIRC5, CXCL12, RNASE1 (P>0.05), and decreased F2RmRNA expression level (P<0.05) than controls. GO/KEGG enrichment analysis showed that DEGs in EAT were mainly involved in the cytosol, MHC protein complex, RNA degradation, antigen processing and presentation. A PPI network was built, in which RPS27A gene was identified as a gene with the highest degree of connectivity by use of Cytoscape plugin CytoHubba with MCC algorithm. Metascape enrich analysis indicated that DEGs enriched mainly in cellular response to DNA damage, RNA metabolism, regulation of cell stress responses, and adaptive immune system. By an analysis of TRRUST datasets, we predicted that transcription factor CIITA may play a role in the regulation of DEGs in EAT influencing CAD.

EAT may be involved in the development of CAD through proinflammatory and immune pathways, in which DDX47, FEM1C, NOL11, SRP54, ABI1, PATL1, BNIP2, C1orf159, CHCHD4 and RPS27A may play a vital role as the key genes. The abundance of naive CD₄⁺ T cells significantly increased while that of resting dendritic cells decreased obviously in EAT from CAD patients. BPI, BIRC5, CXCL12, RNASE1 and F2R may be excreted by EAT and have the potential as markers in CAD diagnosis and treatment.

Atrial fibrillation (AF) is a common clinical tachyarrhythmia with high prevalence, and a predisposing factor of stroke. In addition, it has a causal relationship with heart failure (HF) . Treatment options for AF have changed recently owing to the emergence of new drugs. Many investigations are focused on anticoagulant therapies for AF, but relevant multicenter investigations on AF and HF are rare.

To investigate the clinical characteristics and treatment of patients with AF combined with HF in Chongqing, China.

A total of 4 011 patients with AF and HF who were discharged from 21 hospitals in Chongqing in 2018 were included. Data were collected through the electronic medical record system of the hospitals, including sex, age, basic comorbid conditions, type of AF, NYHA class, thromboembolism history, bleeding history, Color Doppler echocardiography results, HF type and use of drugs (including antithrombotic drugs, rhythm/ventricular rate-control drugs, ACEIs/ARBs, cardiotonic drugs) . The risk of thromboembolism and bleeding were assessed using admission CHA₂DS₂-VASc score and HAS-BLED score. Sex, basic comorbid conditions, AF type, NYHA class, admission CHA₂DS₂-VASc score and HAS-BLED score, left atrial diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, endpoint events (thromboembolism and bleeding) , HF type, and treatment options were compared across three age groups (<65, 65-75, >75) and across patients by the level of hospitalized hospital (secondary and tertiary) .

In terms of clinical characteristics, the patients had an average age of (74.0±10.6) years, 2 279 (56.8%) were female. The top three prevalent basic comorbid conditions were coronary heart disease (65.1%) , hypertension (51.0%) , and diabetes (17.5%) . 3 346 (83.4%) patients with nonvalvular atrial fibrillation (NVAF) . NYHA class was Ⅲ and Ⅳ in 3 059 patients (76.3%) , thromboembolism events occurred in 531 patients (13.2%) , and bleeding events occurred in 176 patients (4.4%) . In Color Doppler echocardiography results, The average left atrial diameter was (44.12±9.21) mm. The average left ventricular end-diastolic diameter was (48.45±10.06) mm. The average left ventricular ejection fraction was (54.23±11.94) mm. The main type of HF was HF with preserved ejection fraction, accounting for 66.2%. The average CHA₂DS₂-VASc score was (3.9±1.5) points, and the admission CHA₂DS₂-VASc score was positively correlated with age (r=0.589, P<0.001) . The average HAS-BLED score was (1.7±1.0) points. 3 641 (90.8%) patients were at high risk of thromboembolism and 723 (18.0%) patients were at high risk of bleeding. In terms of antithrombotic treatment, the overall prevalence of anticoagulation treatment was 47.1%, warfarin was the main anticoagulant (37.8%) , the prevalence of use of the new oral anticoagulant was only 9.3%. The overall prevalence of antiplatelet treatment was 44.6%, most of them were monoclonal antiplatelet agents (13.2%) . The prevalence of anticoagulation treatment decreased with age (χ²_trend=136.502, P<0.001) , but that of antiplatelet treatment increased with age (χ²_trend=135.730, P<0.001) . The prevalence of anticoagulation treatment, and use of warfarin and new oral anticoagulants in secondary hospitals was significantly lower than that in tertiary hospitals (P<0.001) . A total of 3 162 (78.8%) patients with atrial fibrillation received ventricular rate control. The prevalence of use of beta-blockers, digoxin and ACEIs/ARBs was 61.6%, 17.6%, and 59.7%, respectively.

The majority of patients with AF complicated with HF in Chongqing are elderly, and the proportion of women is relatively high. HFpEF is the main type of atrial fibrillation, and the NYHA classification is mainly classⅢandⅣ. Most were at high risk for thromboembolism, but less than 1/4 were at high risk of bleeding. The prevalence of antithrombotic treatmentin all ages and levels of hospitals was unsatisfactory, and there was a large gap between current treatment and guideline recommendations in improving HF. In view of this, hospitalphysicians should increase their awareness and capability of standardized diagnosis and treatmentregarding AF with HF.

Thrombotic events are a major complication of hypertrophic cardiomyopathy (HCM). There are only two available risk prediction models for thrombotic events, HCM Risk-CVA score and French HCM score developed by foreign scholars, yet the former one has been found to have limited predictive value in Chinese HCM patients.

To develop a risk prediction model for thrombotic events in Chinese patients with HCM.

A retrospective cohort study design was used. Five hundred and thirty-seven HCM patients who admitted to West China Hospital of Sichuan University from 2010 to 2018 were recruited. Post-discharge health status was collected by use of telephone follow-up or checking the treatment status recorded in the electronic medical record system once every 6 to 12 months until a composite thrombotic event (defined as the endpoint event) or death occurred or the determined thrombotic risk assessment day of this study (2019-12-31). Univariate and multvariate Cox regression analyses were applied to build a thrombotic risk prediction model, and its internal validation was tested in a resample using the bootstrapping technique.

Due to data missing, 24 cases were excluded, and the other 513 cases were finally included. During a median follow-up of 4.2 years (IQR: 1.3-6.2 years), thrombotic events occurred in 42 cases (8.18%), with an annual morbidity rate of 2.10%〔95%CI (1.47%, 2.73%) 〕. By multivariate Cox regression analysis, age, prior thrombotic event and left ventricular ejection fraction (LVEF) were identified (P<0.05) and used for constructing the formula of SAAE score (S=prior stroke and other thrombotic events, A=atrial fibrillation, A=age, E=LVEF) for predicting thrombotic events after being weighted based on the regression coefficient. Internal validation suggested that SAAE score could discriminate thrombotic events in the whole population {Harrell's C-index=0.773〔95%CI (0.688, 0.858) 〕}, with a calibration slope of 1.006, and could well discriminate 1-year, 3-year and 5-year thrombotic events (Harrell's C-index=0.790, 0.799, 0.735), with a good calibration ability. In addition, the SAAE score also performed well in distinguishing thrombotic events in patients with or without atrial fibrillation {Harrell's C-index=0.669〔95%CI (0.548, 0.791) 〕, 0.647〔95%CI (0.498, 0.795) 〕}, with good calibration ability. Besides that, SAAE score could partially discriminate 1-year, 3-year and 5-year thrombotic events in these two groups, with certain calibration ability. For three groups (whole study population, patients with/without atrial fibrillation), SAAE score could discriminate the risk of thrombotic events (either low, moderate or high) excellently. For the whole study population, SAAE score was better than HCM Risk-CVA score in distinguishing thrombotic events (P=0.013). Decision curve analysis showed the net benefit of SAAE score was better than HCM Risk-CVA score at different prediction time points (1, 3 and 5 years) .

This thrombotic events risk prediction model developed by us for Chinese HCM patients, namely SAAE score, could well stratify the risk of thrombotic events.

Culprit-only revascularization and complete revascularization are two major treatments for acute myocardial infarction (AMI) with multivessel disease. Many systematic reviews have compared the efficacy and safety of the two treatments, but the review results are inconsistent and cannot be directly applied to clinical practice.

To perform an overview of the systematic reviews of the efficacy and safety of complete revascularization versus culprit-only revascularization for AMI with multivessel disease.

PubMed, Cochrane Library, Embase and PROSPERO databases were searched from inception to February, 2022 for systematic reviews/meta-analyses about complete revascularization versus culprit-only revascularization for AMI with multivessel disease regardless of the language and status of publication. Two researchers independently evaluated the methodological quality and evidence quality of included studies using the AMSTAR 2 and GRADE, respectively.

A total of 25 systematic reviews or meta-analyses were included. The methodological quality of the included studies was generally low, with one being of high quality, two being of moderate quality, and 22 being of critical low quality. Eight outcomes and 135 evidence bodies (eight were of high quality, 17 were of moderate quality, and the rest were of low or very low quality according to the GRADE classification) were identified in the studies in total.

Compared with culprit-only revascularization, complete revascularization can partially improve clinical outcomes in patients with AMI with multivessel disease, but its safety needs to be further evaluated by high-quality, large-sample clinical studies.

Dysphagia incidence after cardiac surgery is increasing due to increased complexity of the surgery and number of older patients, which has become one of the most severe complications of cardiac surgery, affecting patients' physical health and recovery.

To perform a review of available evidence on the incidence of dysphagia after cardiac surgery.

Databases of PubMed, Embase, Cochrane Library, CINAHL, Web of Science, CBM, CNKI, Wanfang Data, and VIP were searched from inception to May 2022 for published studies on the incidence of dysphagia after cardiac surgery. Two researchers independently conducted a literature enrollment, quality assessment, and data extraction. Meta-analysis was conducted using Stata 15.0.

Fifteen studies with 7 880 patients were included. The meta-analysis revealed that the overall incidence of dysphagia after cardiac surgery was 13.3%〔95%CI (10.1%, 16.5%) 〕. Further region-specific analysis indicated that, the incidence of dysphagia following cardiac surgery in Asia, North America, and Oceania was 16.6%〔95%CI (10.4%, 22.8%) 〕, 10.0%〔95%CI (6.1%, 13.8%) 〕, and 17.4%〔95%CI (12.3%, 23.5%) 〕, respectively. According to sex-specific analysis, the incidence of dysphagia following cardiac surgery was 16.9%〔95%CI (11.8%, 21.9%) 〕, and 16.4%〔95%CI (11.1%, 21.8%) 〕 in male and female patients, respectively. The analysis based on age group indicated that the dysphagia incidence following cardiac surgery in patients aged <70 years and ≥70 years was 10.9%〔95%CI (8.6%, 13.5%) 〕 and 28.4%〔95%CI (19.7%, 37.9%) 〕, respectively. And analysis based on NYHA class found that the dysphagia incidence was 11.8%〔95%CI (7.4%, 16.3%) 〕 in patients with NYHA classⅠ or Ⅱ, and was 21.0%〔95%CI (11.0%, 30.9%) 〕 in those with NYHA class Ⅲ or Ⅳ. In accordance with analysis based on the duration of perioperative endotracheal intubation, the incidence of dysphagia following cardiac surgery in patients with <12 hours, 12-24 hours, 25-48 hours and >48 hours was 1.0%〔95%CI (0.3%, 1.8%) 〕, 6.4%〔95%CI (4.4%, 8.3%) 〕, 16.8%〔95%CI (9.5%, 24.1%) 〕, and 55.0%〔95%CI (28.0%, 82.0%) 〕, respectively. In addition, chronic kidney disease, chronic lung disease, previous history of cerebrovascular accident, atrial fibrillation, heart failure, intraoperative transesophageal echocardiography, perioperative stroke and sepsis were associated with a higher incidence of dysphagia after cardiac surgery. The results of the meta-analysis were robust, as shown by sensitivity analysis. Both Begg's and Egger's tests yielded P-value<0.05, indicating that publication bias existed in the studies.

Current evidence indicates that the incidence of dysphagia after cardiac surgery is high (13.3%), therefore, prompt postsurgical screening and treatment of dysphagia should be administered.

Clinical treatment of target organ damage in hypertension is mainly based on systemic hypotension supplemented by topical medication, but the treatment is unsatisfactory due to different or even mutually exclusive responses of tissues to the drugs. The relationship between calcium-sensing receptors (CaSR) and hypertension has been investigated, however, studies on their role and mechanisms in hypertensive retinal disease are still lacking.

To investigate the expression level of CaSR in hypertensive retina and its relationship with myocardial remodeling and retinal vascular changes in hypertension.

Ten 8-week-old healthy wistar-kyoto rats (WKY) were selected as the WKY group, and 20 homologous spontaneous hypertensive rats (SHR) of the same age were randomly divided into SHR group and inhibitor (SHR+NPS2143) group from May to December 2021. During a 16-week intervention, the SHR+NPS2143 group received intraperitoneal injection of CaSR inhibitor NPS2143, while WKY and SHR groups were intraperitoneally injected with the equal volume of normal saline. At baseline and the end of intervention, blood pressure was measured by non-invasive blood pressure monitor in all rats, and from each group, five rats were selected and executed, and myocardial and retinal tissues were taken out for testing. Masson's Trichrome staining was used to measure the collagen deposition in the myocardium. H & E staining was used to detect the pathological changes in retinal tissues. The distribution and expression of CaSR and vascular endothelial growth factor A (VEGFA) in retinal tissues were detected using immunohistochemical staining and qRT-PCR.

SHR group had significantly higher levels of systolic blood pressure (SBP) , diastolic blood pressure (DBP) and mean arterial pressure (MAP) than WKY group either at baseline or the end of intervention (P<0.05) . SHR group had much lower levels of SBP, DBP and MAP levels than SHR+NPS2143 group at the end of intervention (P<0.05) . At the end of the intervention, a significant growth was found in SBP, DBP and MAP levels in both SHR and SHR+NPS2143 groups (P<0.05) . Compared with SHR group, heart weight/body weight ratio (HW/BW%) , left ventricle weight/body weight ratio (LVW/BW%) , and myocardial collagen volume fraction (CVF) were significantly decreased in WKY group but increased significantly in SHR+NPS2143 group (P<0.05) . A significant growth was found in HW/BW%, LVW/BW% and CVF in both SHR and SHR+NPS2143 groups (P<0.05) . The total retinal thickness and inner plexiform layer thickness were higher in SHR group than in WKY group at baseline and 16 weeks of intervention (P<0.05) . The total retinal thickness and inner plexiform layer thickness were lower in the SHR group than in the SHR+NPS2143 group at 16 weeks of intervention (P<0.05) . Compared with SHR group, the inner plexiform layer thickness at 16 weeks of intervention was decreased in WKY group and increased in SHR+NPS2143 group (P<0.05) . CaSR in the retina of SHR group was lower than that of WKY group but higher than that of SHR+NPS2143 group (P<0.05) at 16 weeks of intervention. VEGFA in the retina of SHR group was higher than that of WKY group but lower than that of SHR+NPS2143 group (P<0.05) at 16 weeks of intervention.

The use of CaSR inhibitor could reduce the activation of CaSR, increase the expression of VEGFA in the retina, exacerbate hypertension-induced myocardial remodeling and the development of retinal vasculopathy.

Acute myocardial infarction (AMI) can be found in some patients with normal serum lipids although abnormal lipid metabolism is a major risk of AMI. The association of AMI with two unconventional lipid parameters, namely residual lipoprotein-cholesterol (RLP-C) and atherogenic index of plasma (AIP), has been studied rarely, and the predictive value of RLP-C and AIP for first-time AMI in young adults still needs to be explored.

To assess the value of RLP-C and AIP in predicting first-time AMI in young adults.

A total of 1 201 inpatients aged 18-45 years old with an initial diagnosis of coronary heart disease (CHD) were selected from Northern Jiangsu People's Hospital from November 2014 to November 2021, including 627 with first-time AMI and 574 without. General demographics, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and other indicators were collected, and RPL-C and AIP were calculated according to the formula for statistical analysis. Logistic regression analysis was used to explore the influencing factors of first-time AMI. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive value of RLP-C and AIP for first-time AMI.

CHD patients with and without first-time AMI had significant differences in male ratio, smoking history, hypertension history, and average levels of TG, TC, HDL-C, LDL-C, RLP-C and AIP (P<0.05). Multivariate Logistic regression analysis showed that smoking history〔OR=2.541, 95%CI (1.824, 3.538) 〕, TC≥5.17 mmol/L〔OR=2.787, 95%CI (1.405, 5.531) 〕, RLP-C≥0.6 mmol/L〔OR=3.786, 95%CI (2.648, 5.413) 〕 and AIP≥0.2〔OR=3.427, 95%CI (2.106, 5.576) 〕independently increased the risk for first-time AMI (P<0.05), while HDL-C≥1.19 mmol/L〔OR=0.049, 95%CI (0.025, 0.093) 〕independently decreased the risk of first-time AMI (P<0.05). In ROC analysis, the performance of RLP-C and AIP predicting first-time AMI was as follows: RLP-C had an AUC of 0.851〔95%CI (0.830, 0.873) 〕, with 0.535 mmol/L as the optimal cut-off value, 0.848 sensitivity and 0.699 specificity; AIP had an AUC of 0.813〔95%CI (0.789, 0.837) 〕, with 0.122 as the optimal cut-off value, 0.852 sensitivity and 0.660 specificity.

The risk of first-time AMI in young adults may be increased by smoking history, TC≥5.17 mmol/L, RLP-C≥0.6 mmol/L and AIP≥0.2, and decreased by HDL-C≥1.19 mmol/L. RLP-C and AIP may partially predict first-time AMI.

Cardiovascular disease is a leading cause of death and disability worldwide. There is still a lack of research reports on the risk assessment of cardiovascular disease in rural populations in Naxi, an area in low-to-high altitudes (1 000-3 500 meters) .

To investigate the exposure and aggregation of cardiovascular disease risk factors, and to assess the 10-year risk of ischemic cardiovascular disease (ICVD) in rural population aged 35-75 years in Naxi area of Yunnan's Lijiang City from August to September 2020.

By use of random sampling, 35-75-year-old Naxi people were selected from 8 villages in Yunnan, and received a questionnaire survey, physical examination and laboratory examination. The 10-year ICVD risk was used to assess the modified 10-year ICVD risk Scale in Chinese Adults, and statistically analyzed.

A total of 381 cases were included. Individuals from high altitudes had higher systolic blood pressure and triacylglycerol (TG) , and lower total cholesterol (TC) , low-density lipoprotein cholesterol (LDL-C) , and fasting blood glucose than those from moderate altitudes (P<0.05) . The exposure prevalence of hypertension, diabetes, smoking, dyslipidemia, overweight and obesity was 48.8%, 4.7%, 24.7%, 57.7%, and 29.1%, respectively. The smoking prevalence in men was significantly higher than that in women (P<0.01) .The exposure prevalence of hypertension and abnormal body weight increased with age (P<0.05) . Individuals from high altitudes had higher exposure prevalence of hypertension and lower exposure prevalence of diabetes than those moderate altitudes. There were 29.1%, 33.6%, and 21.5% of the participants with 1, 2, and 3 ICVD risk factors respectively. There was significant difference in ICVD risk factors clustered in different gender and age (P<0.05) .The absolute 10-year risk of ICVD in men was higher than that in women (P<0.05) . The absolute 10-year risk of ICVD differed significantly by age in both men and women (P<0.05) .

The 10-year risk of ICVD in 35-75-year-old rural Naxi people was high. Future prevention and treatment of cardiovascular diseases should focus on male and elderly groups.

The prevalence of heart failure (HF) is growing in a rapidly increased number of older adults (≥60 years) , which, together with older age, produces an impact on nutritional status of the HF cases. But there are relatively few studies on the impact of nutritional status on the prognosis in elderly patients with chronic HF.

To investigate the association of nutritional status with prognosis in elderly patients with HF with preserved ejection fraction (HFpEF) and coronary heart disease.

A retrospective cohort study was conducted. Inpatients with HFpEF and coronary heart disease (≥60 years old, NYHA gradeⅡ-Ⅳ) treated in Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University between 2017 and 2019 were enrolled. Clinical and laboratory data were collected. HF-related readmission and all-cause mortality within one year after discharge were followed up. Nutritional status was evaluated by controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) . Patients were divided into non-malnutrition group (CONUT score 0-1, n=42) , low malnutrition risk group (CONUT score 2-4, n=181) and medium-high malnutrition risk group (CONUT score 5-12, n=156) . The differences in clinical data and prognosis among the three groups were compared. Univariate and multivariate logistic regression analyses were used to explore the influencing factors of readmission due to HF and all-cause mortality within one year after discharge. ROC analysis was used to analyze the prognostic value of CONUT score, GNRI and PNI for readmission due to HF and all-cause mortality within 1 year after discharge.

Age, proportion of elderly patients, sex, BMI, bed rest, length of hospital stay, NYHA grade, hemoglobin, lymphocytes, urea nitrogen, creatinine, total protein, albumin, triacylglycerol, total cholesterol, low density lipoprotein cholesterol, B-type brain natriuretic peptide (BNP) , all-cause death within 1 year were compared among the three groups, and there were statistically significant differences (P<0.05) ; among them, age, proportion of elderly patients, bed rest, length of hospital stay, NYHA grade, old myocardial infarction, urea nitrogen, creatinine, BNP, and all-cause death within 1 year in the no-malnutrition risk group and the low-malnutrition risk group were significantly lower than those in the medium-high malnutrition risk group (P<0.05) , and BMI, hemoglobin, lymphocytes, total protein, albumin, triacylglycerol, total cholesterol and low-density lipoprotein cholesterol were significantly higher than those in the medium-high malnutrition risk group (P<0.05) . Univariate logistic regression analysis showed that age, bed rest, length of stay, NYHA grade, hemoglobin, albumin, BNP, left ventricular ejection fraction, CONUT score, GNRI and PNI are the influencing factors of readmission due to HF and all-cause death within 1 year (P<0.05) . Multivariate logistic regression analysis showed that CONUT score〔OR=1.567, 95%CI (1.302, 1.885) , P<0.05〕 is an influence factor of all-cause death within 1 year (P<0.05) . ROC analysis estimating the performance in predicting all-cause mortality within one year after discharge showed that the AUC of CONUT score was 0.780〔95%CI (0.714, 0.845) 〕 with 0.723 sensitivity and 0.722 specificity when the optimal cut-off value was determined as 7.5, the AUC of GNRI was 0.695〔95%CI (0.604, 0.786) 〕with 0.532 sensitivity and 0.833 specificity when the optimal cut-off value was determined as 89, and the AUC of PNI was 0.722〔95%CI (0.643, 0.800) 〕 with 0.723 sensitivity and 0.654 specificity when the optimal cut-off value was determined as 41.

CONUT score can be used as the preferred nutritional evaluation tool for mortality risk assessment in elderly patients with HFpEF and coronary heart disease, and nutritional intervention may become one of the therapeutic targets for reducing mortality in the future.

Tolvaptan is widely used in elderly patients with chronic heart failure (CHF) , but the effect of different doses of tolvaptan on the prognosis of elderly CHF patients is unclear.

To investigate the effect of two commonly used doses of tolvaptan, 7.5 mg/d and 15.0 mg/d, on the prognosis of elderly patients with CHF.

This is a retrospective cohort study. This study selected patients (age≥80 years) with CHF treated with tolvaptan in the health care ward of the 960th Hospital of PLA Joint Logistics Support Force of China from February 2016 to February 2022, and analyzed their clinical data. The patients were divided into 7.5 mg/d and 15.0 mg/d groups based on the dose of tolvaptan. The end point of follow-up was the occurrence of all-cause mortality or cardiovascular mortality or until the end of follow-up. This study used Kaplan-Meier method to perform survival curves analysis and used Cox proportional hazards regression models to analyze the effect of two doses of tolvaptan on all-cause mortality and cardiovascular mortality in elderly patients with CHF.

This study enrolled 212 elderly patients with CHF, and the follow-up was 374.5 (155.5, 940.5) days. 124 (58.5%) patients died from all-cause mortality and 54 (25.5%) patients died from cardiovascular mortality during the follow-up. Kaplan-Meier survival curve showed that 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality compared with 7.5 mg/d group (P=0.004 3, P=0.001 2) . Multivariate Cox proportional hazards regression model analysis showed that after adjusting for age, NYHA cardiac functional class, chronic kidney disease, diabetes, hypertension, coronary artery disease, diuretics, albumin (ALB) , serum N-terminal brain natriuretic peptide precursor (NT-proBNP) and estimated glomerular filtration rate (eGFR) , 15.0 mg/d group had a 1.03-fold increased risk of all-cause mortality〔HR=2.03, 95%CI (1.34, 2.99) 〕and 1.51-fold increased risk of cardiovascular mortality〔HR=2.51, 95%CI (1.40, 4.50) 〕compared with 7.5 mg/d group. This study stratified analysis by eGFR, age, ALB, and NT-proBNP, the results showed that tolvaptan 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality.

Tolvaptan 15.0 mg/d group had higher rates of all-cause mortality and cardiovascular mortality compared with tolvaptan 7.5 mg/d in elderly CHF patients (age≥80 years) . We may recommend using low-dose tolvaptan.

Atrial fibrillation (AF) patients are prone to stroke and peripheral arterial embolism. Studying the pathogenesis of thrombosis formation in AF and providing effective interventions to reduce the risk is an important direction of clinical and basic research on AF.

To investigate the correlation of markers of inflammation and endothelial injury with thrombosis in the left atrium (LA) in AF patients.

Twenty-nine patients with valvular heart disease and 10 patients with coronary heart disease who underwent thoracotomy at the First Affiliated Hospital of Guangxi Medical University from July 2017 to December 2019 were selected, and divided into sinus rhythm group (15 cases) and AF group 〔24 cases, including 12 with left atrial appendage thrombus (LAAT), and 12 without LAAT〕 according to heart rhythm. General demographics were collected. Besides that, other data were also collected, including left atrial diameter (LAD) and left ventricular ejection fraction (LVEF), levels of protein kinase B (AKT), nuclear factor-κ B (NF-κ B), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), IL-8, tumor necrosis factor (TNF-α), endothelin-1 (ET-1), nitric oxide (NO), von Willebrand factor (VWF), intercellular adhesion molecule (ICAM-1) and vascular cell adhesion factor (VCAM-1) in the left atrial blood sample, and calculated thrombus area in patients with AF and LAAT. The relationships of LAD, LVEF, markers of inflammation and endothelial injury with calculated area of thrombus in AF with LAAT patients were analyzed by Pearson correlation.

There were significant differences in LAD and LVEF between sinus rhythm patients and AF patients with or without LAAT (P<0.05). AF patients with and without LAAT had no significant differences in LAD and LVEF (P>0.05). AF patients without LAAT had higher levels of AKT, NF-κB, IL-8, ET-1, ICAM-1 and VCAM-1 and lower NO level in left atrium than patients with sinus rhythm (P<0.05). AF patients with LAAT had higher levels of AKT and hs-CRP, and lower NO level in left atrium than those without (P<0.05). AF patients with and without LAAT had no significant differences in levels of NF-κB, IL-6, IL-8, TNF-α, ET-1, vWF, ICAM-1 and VCAM-1 (P>0.05). The maximum area, minimum area, and average area of the left atrial appendage thrombus in AF patients with LAAT were 4.8 cm², 1.67 cm², and (3.48±0.83) cm², respectively. Pearson correlation analysis showed LAD, LVEF, AKT, NF-κB, hs-CRP, IL-6, IL-8, TNF-α, ET-1, NO, vWF, ICAM-1, and VCAM-1 had no linear correlation with the area of thrombus in AF patients with LAAT (P>0.05) .

Increased levels of markers of inflammation and endothelial injury in left atrium were found in AF patients, which were even more higher when the patients also had LAAT. Detecting the markers of inflammation and endothelial injury in left atrium is helpful to evaluate the thrombus prevalence in AF patients.

As one exercise program of cardiac rehabilitation, the role of high-intensity interval training (HIIT) in improving myocardial infarction is still controversial, and the mechanism is unclear.

To investigate the effect of HIIT on improving the cardiac structure and function in a rat model of myocardial infarction.

An experiment was conducted from September 2020 to October 2021. From a random sample of 78 3-month-old male SD rats, 56 were eventually included, and 14 of them were randomly selected as sham-surgery group (Sham group) , and the remaining 42 rats were equally randomized into MI-sedentary group (MI-SED group) , MI-HIIT group (MI-HIIT group) , and MI-medium-intensity continuous training (MI-MICT group) after being used for preparing a model of acute myocardial infarction (AMI) . Sham group and MI-SED group were not trained, MI-HIIT group received high-intensity and medium-intensity training alternately, MI-MICT group received medium-intensity continuous training. After 1 week of AMI modeling, MI-HIIT and MI-MICT groups received 8 weeks of training. At the end of 4 weeks of training, 7 rats in each of the 4 groups were randomly selected for detecting cardiac ultrasound, and weighing body weight, then were sacrificed, and their heart weight and serum tumor necrosis factor (TNF-α) were measured, cardiac mass index was calculated, and heart tissues were measured using H&E staining, Masson's Trichrome staining and immunohistochemical staining. At the end of 8 weeks of training, the same operation was performed on the remaining 7 rats in each of the groups.

After 4 weeks of training, the standardized cardiac mass index of MI-HIIT group was higher than that of each of the other three groups (P<0.05) . The sham group had higher ejection fraction (EF) , fractional shortening (FS) and left ventricular end-systolic posterior wall thickness (LVPWs) than MI-HIIT and MI-MICT groups (P<0.05) . MI-SED group had lower EF, FS, and LVPWs, and higher left ventricular end-systolic diameter (LVESD) than MI-HIIT and MI-MICT groups (P<0.05) . After 8 weeks of training, MI-HIIT group had lower body weight than sham and MI-SED groups, higher heart weight than sham, MI-SED and MI-MICT groups, and higher standardized cardiac mass index than sham and MI-MICT groups (P<0.05) . MI-HIIT group demonstrated higher EF, LVESD, left ventricular end-diastolic diameter (LVEDD) , left ventricular end-systolic anterior wall thickness (LVAWs) than sham and MI-SED groups (P<0.05) . Moreover, MI-HIIT group also showed higher FS and LVPWs than MI-SED group (P<0.05) . HE staining results showed that MI-HIIT group had significantly improved inflammatory changes of heart tissue and more closely arranged myocardial cells at the end of the 8th week of training compared with at the end of 4 weeks of training. Masson's Trichrome staining results showed that after 8 weeks of training, the proportion of myocardial fibrillar collagen in myocardial tissues of MI-SED group was higher than that of MI-HIIT and MI-MICT groups. Immunohistochemical results showed that MI-HIIT group had more newly formed blood vessels in cardiac tissues than sham and MI-SED groups after 4 and 8 weeks of training, so did the MI-MICT group. The number of newly formed blood vessels in cardiac tissues of MI-HIIT group was more than that in MI-MICT group after 8 weeks of training. MI-HIIT group had higher serum TNF-α than MI-SED group after 4 weeks of training. After 8 weeks of training, the serum TNF-α in MI-HIIT group was higher than that in MI-MICT group.

HIIT performed in the early stage of AMI could improve cardiac mass index, induce early inflammatory response in myocardial tissue, reduce myocardial fibrosis, promote angiogenesis and ventricular remodeling. HIIT had better overall effect than MICT.