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.

In the social situation of "three child" policy opening and late marriage to become the norm, the topic of female reproduction and health has attracted increasing attention. As one of the important markers of ovarian reserve in women, the relationship between anti-Mullerian hormone (AMH) and cardiovascular disease and cardiovascular risk indicators has become a hot research issue.

To establish a reference range of AMH in healthy women of reproductive age in Urumqi region, and to investigate the association between AMH and risk factors associated with cardiovascular disease.

From May to July 2018, healthy women aged 19-50 years who met the criteria were selected from the natural population of a community-based epidemiological survey with four living residents area in Urumqi city by targeted sampling, and the serum AMH, fasting plasma glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triacylglyceride (TG), serum uric acid, and thyroid stimulating hormone (TSH) levels of the survey subjects were tested. Height, body mass, abdominal circumference, hip circumference, blood pressure, and other indicators were measured to analyze the relationship between AMH and the above indicators related to cardiovascular risk factors.

The median AMH among 855 healthy women of reproductive age was 1.58 (0.01, 8.78) μg/L. The reference range of AMH in healthy women of reproductive age in our region was established, that was, 0.89 to 10.94μg/L for 19-24 years old, 0.66 to 11.77 μg/L for 25-29 years old, 0.27 to 8.25μg/L for 30-34 years old, 0.01 to 6.87μg/L for 35-39 years old, 0.01 to 3.98μg/L for 40-44 years old, <0.01-1.87μg/L for 45-50 years old. Spearman correlation analysis showed that AMH was negatively correlated with age, body fat index (BMI), abdominal circumference, hip circumference, systolic blood pressure, diastolic blood pressure, TSH, TC, LDL-C (P<0.05), but not with blood glucose, TG, HDL-C, uric acid (P>0.05) .

In this study, the reference range of serum AMH in healthy women of reproductive age in Urumqi was established, which may provide a basis for the functional assessment of ovarian reserve in women of different ages. Low AMH levels in women of reproductive age are associated with cardiovascular risk factors such as increased age, obesity, abdominal obesity, hypertension, and hyperlipidemia.

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 .

Chronic heart failure is a syndrome occurring at the end-stage of multiple cardiovascular diseases. In the condition, nutritional and metabolic problems such as loss of appetite, diarrhea, abdominal distension, and constipation are highly prevalent, which in turn affect the prognosis of heart failure. The relationship of nutritional assessment results with prognosis in chronic heart failure has been studied extensively, while nutritional assessment for older adults with chronic heart failure has been rarely studied, and there is no clinically recognized assessment method.

To perform a comparative analysis of four nutritional assessment methods in terms of clinical prognosis prediction in elderly patients with chronic heart failure.

Eligible older inpatients with chronic heart failure (n=199) were recruited from Department of Cardiology, ICU, and Department of Geriatrics, Linyi People's Hospital from June 2018 to June 2020. Data were collected via reviewing the medical records and telephone-based follow-ups, including sex, age, height, weight, serum albumin (ALB) level, BMI, Geriatric Nutritional Risk Index (GNRI) , and result of Nutrition Risk Screening 2002 (NRS2002) , as well as prognosis〔containing three classifications: in-hospital deaths (n=43) and in-hospital survivors (n=156) ; one-year deaths (n=51) and one-year survivors (n=148) ; readmission within half a year (n=69) and readmission after half a year (n=130) 〕. Multivariate Logistic regression analysis was used to explore the prognostic factors of chronic heart failure. The analysis of ROC curve with AUC value was carried out to comparatively estimate prognosis predictive values of the nutritional assessment methods.

There were significant differences in mean age, serum ALB, GNRI and NRS2002 score between in-hospital deaths and survivors (P<0.05) . The mean age, height, serum ALB, GNRI and NRS2002 score were also significantly different between one-year deaths and survivors (P<0.05) . Those with readmission within half a year had significantly different mean BMI, serum ALB, GNRI and NRS2002 score compared with those with readmission after half a year (P<0.05) . For predicting in-hospital death, the AUC of serum ALB was 0.76〔95%CI (0.68, 0.84) , P<0.001〕, and that of NRS2002 score was 0.80〔95%CI (0.73, 0.86) , P<0.001〕. In predicting one-year death, the AUC of serum ALB was 0.75〔95%CI (0.67, 0.82) , P<0.001〕, and that of NRS2002 score was 0.82〔95%CI (0.76, 0.88) , P<0.001〕. The AUC of NRS2002 score in predicting readmission within half a year was 0.73〔95%CI (0.65, 0.80) , P<0.001〕.

On the whole, NRS2002 score could be the first choice for prognostic assessment in elderly patients with chronic heart failure, for it was more effective in predicting the risks of in-hospital death, one-year death and readmission within half a year than serum ALB level, GNRI and BMI.

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.

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.

Atrial fibrillation is the most obvious arrhythmia in medical practice. Atrial fibrillation has been listed as one of the eight fastest-growing causes of death since 1990. Epidemiological investigation shows that the highest incidence of atrial fibrillation is 9% in people over 65 years old and 17% in people over 80 years old; more than 60% of patients with hypertension will develop atrial fibrillation after the age of 60. Atrial fibrillation increases the risk of ischemic stroke, heart failure, chronic kidney disease, cognitive impairment and dementia, but it is unclear whether it increases the risk of new onset myocardial infarction.

To investigate whether atrial fibrillation increases the risk of new onset myocardial infarction.

From June 2006 to October 2007, 96 750 employees of Kailuan Group in Tangshan, Hebei Province (Kailuan population) were selected for the study, including 458 patients with atrial fibrillation (atrial fibrillation group) and 96 292 patients without atrial fibrillation (non atrial fibrillation group) . The general information of patients was recorded, including age, gender, personal history (smoking history, drinking history) , past medical history (hypertension, coronary heart disease, diabetes, dyslipidemia) , anthropometric parameters (weight, height, blood pressure, etc.) . Total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) and fasting blood glucose (FPG) were collected. The patients were followed up every 2 years, respectively, that was from 2008 to 2009, 2010 to 2011, 2012 to 2013, 2014 to 2015, and 2016 to 2017. The median follow-up was 10 years, and the end point was new onset myocardial infarction. Multivariate Cox regression model was used to analyze the effect of atrial fibrillation on new onset myocardial infarction.

(1) There were significant differences in age, body mass index (BMI) , systolic blood pressure (SBP) , LDL-C, FPG, diabetes, smoking, drinking and new onset myocardial infarction between atrial fibrillation group and non atrial fibrillation group (P<0.05) . (2) Multivariate Cox regression analysis showed that atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.841, 95%CI (1.118, 2.869) , P<0.05〕. After adjusting for age and gender (male) , atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.635, 95%CI (1.049, 2.547) , P<0.05〕, after further adjustment for BMI, SBP, LDL-C, FPG, smoking and drinking, atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.381, 95%CI (1.087, 1.573) , P<0.05〕; drinking was the protective factor of new onset myocardial infarction 〔RR=0.664, 95%CI (0.572, 0.770) , P<0.05〕.

Atrial fibrillation is an independent risk factor of new onset myocardial infarction.

Cognitive impairment (CI) is a common complication of chronic heart failure (CHF) , which may significantly increase the risk of poor prognosis, so early identification of associated factors of CI in CHF is of great significance. Although there have been many relevant studies recently, their conclusions are inconsistent.

To perform a systematic review of the influencing factors of CI in CHF.

In August 2021, studies relevant to influencing factors of CI among patients with CHF were searched in databases including PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, PsychINFO, CNKI, Wanfang Data, CQVIP, and SinoMed from inception to August 2021. Two researchers independently screened studies based on the inclusion and exclusion criteria, extracted data, and performed risk of bias assessment using the Newcastle-Ottawa Scale and The Agency for Healthcare Research and Quality methodology checklist, then conducted a descriptive analysis of the factors associated with CI in CHF. RevMan 5.3 was adopted for meta-analysis.

Fourteen studies were included, involving 6 324 cases of CHF, and 1 753 of them also with CI. Descriptive analysis indicated that five factors decreased the risk of CI in CHF, and 22 factors increased the risk, but the influence of sex and systolic blood pressure on CI is still far from inclusive. Meta-analysis demonstrated that education level〔OR=0.45, 95%CI (0.30, 0.70) 〕, age〔OR=1.17, 95%CI (1.10, 1.24) 〕, diabetes〔OR=2.17, 95%CI (1.17, 4.01) 〕, anemia〔OR=3.03, 95%CI (1.80, 5.10) 〕and left ventricular ejection fraction〔OR=0.91, 95%CI (0.88, 0.94) 〕were associated with CI in CHF.

High education level lowered the risk of CI in CHF, while older age, diabetes, anemia and decreased left ventricular ejection fraction increased the risk. Due to limited number and quality of included studies, the above-mentioned conclusion still needs to be verified by more high-quality studies.

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.

As the main cause of death in the world, the morbidity and mortality of cardiovascular diseases are increasing year by year. Chronic inflammation of circulatory system is common in middle-aged and older people, which is closely related to the pathogenesis of various cardiovascular diseases. Dyslipidemia is also one of the age-specific cardiovascular risk factors. Exercise has attracted much attention as an important intervention method, among which resistance training can reduce the risk of cardiovascular diseases in middle-aged and older people, but the regulation effect of inflammation and dyslipidemia is still controversial.

To explore the effect of resistance training on cardiovascular risk factors in middle-aged and older people, and to provide a basis for formulating exercise prescriptions for middle-aged and elderly people.

PubMed, Cochrane, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Chinese Science and Technology Journal Full-text Database were retrieve by computer for randomized controlled trials on the effects of resistance training on cardiovascular risk factors in middle-aged and older people published from the date of establishment to 2021-08-31. The retrieved literatures were screened and data extracted, including the first author, the year of publication, general characteristics of the study population, resistance training protocols and outcome indicators. The bias risk assessment tool of Cochrane system evaluation manual was used to evaluate the bias risk of literature. Meta-analysis was performed using RevMan 5.3 software, including the statistics of combined effect size, heterogeneity test, sensitivity analysis, and subgroup analysis. Publication bias of included studies was analyzed using Stata 16.0 software, using Egger's test.

Fifteen papers with 476 observations were included. Meta-analysis showed that, resistance training were superior to control group in decreasing C-reactive protein〔SMD (95%CI) =-0.67 (-0.89, -0.46) , P<0.01〕, total cholesterol〔SMD (95%CI) =-0.37 (-0.66, -0.08) , P=0.01〕, triglyceride〔SMD (95%CI) =-0.29 (-0.53, -0.05) , P=0.02〕, low-density lipoprotein cholesterol〔SMD (95%CI) =-0.37 (-0.67, -0.06) , P=0.02〕 and improving high-density lipoprotein cholesterol levels〔SMD (95%CI) =0.33 (0.09, 0.57) , P<0.01〕. Subgroup analysis showed that C-reactive protein and total cholesterol levels were lower in the resistance training group than in the control group at training duration ≤12 weeks, with statistically significant differences (P<0.05) . In both the training intensity of high intensity and the chronic disease population, C-reactive protein levels were lower in the resistance training group than in the control group and high-density lipoprotein cholesterol levels were higher, with statistically significant differences (P<0.05) .

Resistance training has been shown to be effective in reducing cardiovascular risk factors, reducing chronic inflammation and improving dyslipidaemia in the middle-aged and older population.

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.

Acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) is a common emergency and severe disease in the department of cardiology. Timely and effective hemodynamic support is one of the important means to save the lives of such patients. Research on intraaortic balloon pumping (IABP) combined with extracorporeal membrane oxygenation (ECMO) had important clinical significance for the efficacy of these patients.

To explore the efficacy of IABP combined with ECMO in patients with AMI and CS and the inflencing factor of the need for ECMO support in patients with AMI and CS.

A total of 91 patients with AMI and CS treated with IABP in the Coronary Care Unit (CCU ward) of the First Affiliated Hospital of Zhengzhou University from October 2014 to October 2020 were collected and divided into IABP group (n=65) and IABP+ECMO group (n=26) according to the use of ECMO. The clinical data of the patients in both groups were collected and analyzed. The 12-months survival rate of patients discharged from hospital was followed up. The inflecting factors of AMI patients complicated with CS treated with IABP needed ECMO support by Multivariate logistic regression analysis.

Rate of cardiac arrest after IABP, VIS level at 24 h, survival rate at 12 months after discharge and proportion of continuous renal replacement therapy (CRRT) , tracheal intubation, pulmonary infection, lower extremity ischemia, acute kidney injury and gastrointestinal bleeding, 12-month survival rate after discharge, the use ratio of epinepHrine and norepinepHrine in IABP group were lower than those in IABP+ECMO group (P<0.05) . And the duration of CCU hospitalization in IABP group was shorter than that of IABP+ECMO group (P<0.05) . Age in IABP group was higher than that of IABP+ECMO group (P<0.05) . The results of two-factor repeated measures Anova showed that the group and time had no significant interaction effects on systolic blood pressure, diastolic blood pressure and heart rate (P>0.05) . The group and time had significant interaction effects on lactic acid and pH (P<0.05) . The main effect of time on systolic blood pressure, diastolic blood pressure, lactic acid and pH was significant (P<0.05) . The main effect of time on heart rate was not significant (P>0.05) . The main effect of group on systolic blood pressure, diastolic blood pressure, heart rate, lactic acid and pH was not significant (P>0.05) . Systolic blood pressure, pH at 24 h after treatment and 72 h after treatment were higher than that before treatment in both groups (P<0.05) . The level of lactic acid at 24 h after treatment and 72 h after treatment was lower than that before treatment in both groups (P<0.05) . Systolic blood pressure, pH at 72 h after treatment were higher than that at 24 h after treatment in both groups (P<0.05) . The level of lactic acid at 72 h after treatment was lower than that at 24 h after treatmen in both groups (P<0.05) . Systolic blood pressure of IABP+ECMO group was higher than IABP group at 72 h after treatment (P<0.05) . The diastolic blood pressure at 24 h and 72 h after treatment in the IABP group was higher than that before the machine treatment (P<0.05) . The IABP+ECMO group had a lower lactate level 24 hours after treatment than that in the IABP group, the pH value was higher than that in the IABP group (P<0.05) . Multivariate logistic regression analysis showed that age, VIS level at 24 h after treatment, and cardiac arrest after IABP could predict whether AMI patientscomplicated with CS treated with IABP needed ECMO support (P<0.05) .

IABP combined with ECMO can improve the hemodynamic indexes and survival rate of patients with AMI complicated with CS at 12 months after discharge. Age, 24 h VIS and cardiac arrest after IABP could predict whether AMI patients complicated with CS treated with IABP needed ECMO support.

There may be sex-specific differences in the treatment and outcome of elderly people with acute myocardial infarction (AMI) . However, few studies have reported sex-specific differences in management and prognosis of older Chinese people with AMI.

To assess the sex-specific differences in management strategies, in-hospital mortality and cardiovascular mortality within one year after discharge in older Chinese people with AMI.

We consecutively enrolled 1 579 elderly (>60 years of age) patients with AMI admitted to 11 tertiary general hospitals in Chengdu between January 2017 and June 2019, including 1 056 men and 523 women. Sex-specific analysis of clinical characteristics, management strategies and 1-year outcome were performed. Kaplan-Meier estimator was used to describe the incidences of cardiovascular death within one year after discharge between men and women and the associated factors were explored using multivariate Cox proportions hazards regression analysis.

Female patients had lower prevalence of smoking, and alcohol consumption, history of percutaneous coronary intervention and chronic obstructive pulmonary disease, typical symptoms including chest pain and chest tightness, and use of dual antiplatelet agents and statins, and lower mean creatinine levels than male patients (P<0.05) . Moreover, female patients had older mean age, diabetes, and higher mean heart rate, greater prevalence of Killip class≥Ⅱ, and higher mean level of total cholesterol, longer mean symptom-onset-to-balloon time and first medical contact to balloon dilation time, and higher in-hospital mortality rate (P<0.05) . Furthermore, the cardiovascular mortality rate within one year after discharge was higher in women (P<0.05) . Multivariate Cox proportions hazards regression analysis showed sex〔HR=1.830, 95%CI (1.029, 3.255) , P=0.040〕, age〔HR=1.063, 95%CI (1.031, 1.095) , P<0.001〕, ST-segment elevation myocardial infarction〔HR=2.382, 95%CI (1.380, 4.113) , P=0.002〕, cardiogenic shock〔HR=2.474, 95%CI (1.259, 4.859) , P=0.009〕, creatinine〔HR=1.004, 95%CI (1.001, 1.006) , P=0.003〕 and PCI〔HR=0.228, 95%CI (0.135, 0.386) , P<0.001〕 were associated with cardiovascular death within one year after discharge.

The rates of reperfusion treatment in older women and men with AMI were similar, but there were differences in treatment efficiency and outcome. Older women with AMI had lower in-hospital treatment efficacy, longer total myocardial ischemia time, lower prevalence of pharmacological treatment, and higher in-hospital all-cause mortality and cardiovascular mortality within one year after discharge.

Due to long treatment cycle and medication dependence, patients with chronic heart failure (CHF) face many risks of out-of-hospital medication. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based patient safety tool, which has been studied rarely in the management of out-of-hospital medication safety in CHF patients.

To discuss the role of TeamSTEPPS in the out-of-hospital medication safety management in CHF patients.

A total of 134 CHF patients hospitalized in the First Affiliated Hospital of Chongqing Medical University from June 2019 to June 2020 were selected, and were divided into the intervention group (n=62) and control group (n=61) according to the number of ward, receiving routine medication safety management, and TeamSTEPPS-based medication safety management, respectively. The medication error was evaluated before discharge and 6 months after discharge by the Medication Error Questionnaire developed by us. The medication knowledge, attitude and practice (KAP) were evaluated before discharge, 1, 3 and 6 months after discharge by a self-developed Medication KAP Scale. Cardiac function, dyspnea and edema were evaluated before discharge, 3 and 6 months after discharge. The readmission and all-cause mortality were collected 3 and 6 months after discharge. The safety attitude of medical workers was measured before intervention and 6 months after intervention by the Chinese version of the Safety Attitudes Questionnaire (SAQ-C) .

The prevalence of ignoring the content of the prescription, omission error, wrong time error, wrong dose error, taking medication without a doctor's advice and unauthorized drug withdrawal differed between the two groups 6 months after discharge (P<0.05) . The readmission rates of the intervention group 3 and 6 months after discharge were lower than those of the control group (P<0.05) . The scores of teamwork climate, safety climate, perceptions of management, job satisfaction and stress recognition in medical workers providing services for the intervention group 6 months after intervention were higher than those before intervention (P<0.05) . The results of two-factor repeated measures ANOVA showed that the duration and type of medication safety management had significant interaction effects on the medication KAP scores, NYHA class, dyspnea and edema in two groups (P<0.05) . The duration of medication safety management had an significant main effect on the medication KAP scores, dyspnea and edema in two groups (P<0.05) . The type of medication safety management had a significant main effect on the medication KAP and edema in two groups (P<0.05) . The medication knowledge scores of the intervention group 3 and 6 months after discharge were higher than those of the control group (P<0.05) . The intervention group had higher medication attitude score but lower medication practice score than the control group 1, 3 or 6 months after discharge (P<0.05) . The medication knowledge and medication attitude scores increased in both groups 1, 3, 6 months after discharge (P<0.05) . The medication practice score increased in the intervention group 1, 3, 6 months after discharge, but decreased in the control group at 1 month after discharge (P<0.05) . The medication knowledge score at 1 month after discharge was lower than that 3 or 6 months after discharge in the intervention group (P<0.05) , but the opposite was found in the control group (P<0.05) . The dyspnea score at 6 months after discharge was lower than that before discharge in the intervention group (P<0.05) . The edema score before discharge was higher than that 3 and 6 months after discharge in the intervention group (P<0.05) . The intervention group had higher edema score 3 and 6 months after discharge than the control group (P<0.05) .

The use of TeamSTEPPS in out-of-hospital medication safety management in CHF patients could improve the medication safety and symptoms in patients as well as enhance the safety culture of the healthcare team.

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.

Active and effective coping is contributive to the prevention of disease recurrence and delay the development of complications. It has been reported that more than 50% of young and middle-aged patients with acute myocardial infarction (AMI) adopt a negative response to the disease, which negatively influences their prognosis and quality of life. But the underlying personal and sociocultural factors associated with the choice of disease coping styles in this population are still unclear. Self-regulation theory has been extensively used in studies of behaviors, comprehensive intervention, and health promotion in patients with stroke, chronic heart failure, or chronic obstructive pulmonary disease. Currently, there is a lack of research on disease coping style and its influencing factors in young and middle-aged patients with first AMI using the framework of this theory.

To explore disease coping styles in young and middle-aged patients with first AMI using the four-component framework of self-regulation theory.

Purposive sampling was used to recruit young and middle-aged patients with first AMI from the First Affiliated Hospital of Jinan University from January to June 2021. They were invited to attend an individual, semi-structured interview guided using an outline determined based on our research team members and experts' consensuses on the analysis results of a relevant pre-interview. The interview was conducted till data saturation, and the interview results were analyzed using Colaizzi's phenomenological methodology.

Altogether, the study included 15 cases. Two themes arose from the results of interview with them: (1) the coexistence of positive coping (adjustment of mentality, emotional control, positive attitude towards AMI, self-motivation, lifestyle change, exploring a new way to achieve psychological balance) and negative coping (tolerance, avoidance, reluctant acceptance, submission, concealment) ; (2) influencing factors of coping styles (social support, prognosis estimation, behavioral benefit acquisition, and the powder of role models) .

Both positive and negative methods for coping with first AMI were found in the young and middle-aged patient population, and the negative coping cannot be overlooked. To improve the physical and mental recovery of these patients via reducing patients' negative coping styles and increasing their positive coping styles, medical workers should guide the patients and their families to make full use of the social support system, provide them with individualized health education and education on benefits of healthy behaviors through multiple ways, and set a good example of leadership, motivation and supervision.

Stroke is highly prevalent in patients with atrial fibrillation (AF) , a most common cardiac arrhythmia with high morbidity, and anticoagulation therapy is a key strategy to prevent AF-related stroke. However, there is short of research on the use of anticoagulation therapy in patients with AF in the community.

To explore the prevalence of use of anticoagulation therapy and influencing factors in elderly patients with nonvalvular atrial fibrillation (NVAF) in Shanghai's communities.

A cross-sectional survey design was used. Stratified sampling was used to select elderly patients with AF who received the 2018 annual physical examination at four community health centers in Shanghai during July to December 2019, and they were surveyed using a questionnaire (consisting of three parts: demographics, CHA2DS2-VASc score and ORBIT score) compiled by our research team for collecting information on their AF prevalence and associated medication use, awareness of AF, comorbidities, and complication, as well as risk for stroke and bleeding. Based on the results of the survey, we excluded those without previous AF-related medical experience and valvular AF, then analyzed the prevalence of anticoagulation therapy in those with NVAF. Anticoagulation therapy was recommended for patients at high risk for stroke in accordance with the CHA2DS2-VASc score. Univariate and multivariate Logistic regression analyses were used to identify influencing factors of anticoagulation therapy in NVAF patients at high risk of stroke.

Three hundred and two patients with NVAF were finally included, of whom the prevalence of current use of anticoagulant and antiplatelet drugs was 29.5% (89/302) , and 39.7% (120/302) , respectively, and that of non-use of anticoagulant or antiplatelet drugs was 30.8% (93/302) . By the CHA2DS2-VASc score, 279 of the 302 NVAF patients (92.4%) were assessed with high risk of stroke, among whom the prevalence of current use of anticoagulant and antiplatelet drugs was 30.5% (85/279) , 40.1% (112/279) , respectively, and the rest 29.4% (82/279) did not take anticoagulant or antiplatelet drugs. Univariate Logistic regression analysis demonstrated that age, marital status, type of AF, onset of AF symptoms, duration of AF, prescription of anticoagulants at the first visit for AF, knowledge of the harmfulness of AF, prevalence of hyperlipidemia, and risk of bleeding were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) . Multivariate Logistic regression analysis showed that age, type of AF, prescription of anticoagulants at the first visit for AF, and knowledge of the harmfulness of AF were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) .

The prevalence of the use of anticoagulation therapy in community-living NVAF patients at higher risk of stroke is unsatisfactory, so the use of anticoagulation therapy for this population needs to be further standardized, especially in patients with advanced age and low awareness of the harmfulness of AF.

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.

Risk stratification for acute myocardial infarction (AMI) is important for clinical decision-making and prognosis evaluation. As changes have been found in clinical characteristics and management of AMI, the current existing clinical risk score for AMI may be inapplicable to clinical practice. To effectively implement strategies of individualized management for AMI patients, it is necessary to improve the prediction accuracy of long-term major adverse cardiovascular events (MACEs) in AMI after percutaneous coronary intervention (PCI) .

To develop a predictive model for long-term MACEs in AMI patients after PCI.

Among the 1 130 AMI patients treated with PCI in Beijing Anzhen Hospital from January 1 to July 31, 2019, 962 eligible cases were enrolled, and their clinical data and laboratory examination indices were collected. Follow-up of the patients was performed via telephone interviews at a median of 2.4 years. The primary endpoint was a composite of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, malignant arrhythmia, new heart failure or readmission due to exacerbated heart failure, and unplanned revascularization. Patients were divided into event (122 cases) and non-event (840 cases) groups according to the prevalence of MACEs during the follow-up period. Lasso regression was conducted to identify candidate risk factors of long-term MACEs. Multivariate Logistic regression analysis was used to construct the prediction model and the nomograms. The receiver operating characteristic curve was used to evaluate the discrimination ability of the prediction model. The efficacy of the predictive model was assessed by comparing with that of the Global Registry of Acute Coronary Events (GRACE) score in terms of the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) .

The prevalence of MACEs was 12.7% (122/962) . Five predictive variables were identified by Lasso regression, which included ST-segment deviation, diabetes history, hemoglobin (Hb) , left ventricular ejection fraction (LVEF) , and estimated glomerular filtration rate (eGFR) . The algorithm of the prediction model developed using multivariate Logistic regression was: logit (P) =3.596-0.023×X1-0.014×X2-0.036×X3+0.726×X4+1.372×X5 (X1-X5 indicate Hb, eGFR, LVEF, diabetes, and ST-segment deviation, respectively) . ST-segment deviation, diabetes, LVEF, and Hb were associated with MACEs in AMI patients after PCI (P<0.05) . ST-segment deviation, diabetes, eGFR and Hb were associated with MACEs in ST-segment elevation myocardial infarction (STEMI) patients after PCI (P<0.05) . ST-segment deviation, diabetes, and Hb were associated with MACEs in non-STEMI patients after PCI (P<0.05) . The prediction model exhibited an area under the curve (AUC) of 0.774〔95%CI (0.710, 0.834) 〕 for the training cohort, and an AUC of 0.751〔95%CI (0.686, 0.815) 〕for the testing cohort. The NRI estimated by the predictive model in AMI, STEMI, and non-STEMI patients was 0.493〔95%CI (0.303, 0.682) 〕, 0.459〔95%CI (0.195, 0.724) 〕, and 0.455〔95%CI (0.181, 0.728〕, respectively. The IDI estimated by the predictive model in AMI, STEMI, and non-STEMI patients was 0.055〔95%CI (0.028, 0.081) 〕, 0.042〔95%CI (0.015, 0.070〕, and 0.069〔95%CI (0.022, 0.116) 〕, respectively. The predictive efficiency of the predictive model in the three groups was significantly better than that of the GRACE score (P<0.05) . The predictive model was significantly better than the GRACE score in all participants 〔ΔAUC=0.050, P=0.015; IDI=0.055, 95%CI (0.028, 0.081) , P<0.001; NRI=0.493, 95%CI (0.303, 0.682) , P<0.001) 〕.

Our predictive model containing five factors (ST-segment deviation, diabetes, LVEF, eGFR and Hb) may be useful for early risk stratification and long-term prognosis prediction in patients with AMI after PCI.