Journal of cardiology最新文献

Background: Influenza infection remains a major cause of illness and death among the elderly and high-risk groups. Besides respiratory illnesses (RTIs), influenza is increasingly recognized as a trigger for cardiovascular diseases (CVDs). The long-term and cumulative effects of vaccination remain unclarified.

Methods: We conducted a population-based cohort study using the Longitudinal Health Insurance Database, a random subset of the Taiwan National Health Insurance Research Database to evaluate the associations among influenza vaccination and subsequent CVDs, RTIs, renal disease, and sepsis. Diagnoses and outcomes were ascertained using ICD-9-CM codes.

Results: Throughout a two-year period, individuals who received the influenza vaccine had a lower risk of CVDs [adjusted hazard ratio (aHR) = 0.617, p < 0.001], RTIs (aHR = 0.559, p < 0.001), and antiviral drug use (aHR = 0.707, p = 0.010) compared to the unvaccinated group. During the entire follow-up period (2000-2015), vaccinated individuals continued to have a reduced risk of developing CVDs (aHR = 0.723, p = 0.002) and RTIs (aHR = 0.614, p < 0.001) relative to their unvaccinated counterparts. Those who received three doses exhibited lower risks of CVDs (aHR = 0.638, p < 0.001), RTIs (aHR = 0.580, p < 0.001), and antiviral drug use (aHR = 0.718, p = 0.010) compared to unvaccinated individuals.

Conclusions: We demonstrated that influenza vaccination was associated with a significantly lower risk of developing CVDs and RTIs during both 2-year and 16-year follow-up periods. Repeated influenza vaccination confers cumulative protection against CVDs and RTIs. Vaccinations also reduced the use of antiviral drugs over two years after vaccination and with repeated doses.

Background: Blood urea nitrogen-to-albumin ratio (BAR) is a prognostic biomarker in heart failure (HF), but its age-specific implications and longitudinal changes remain unclear. This study evaluated the prognostic significance of BAR at discharge and its 1-year change across age groups.

Methods: From the Acute Heart Failure Registry in Osaka Rosai Hospital (AURORA), 1944 patients hospitalized for HF between 2015 and 2022 were analyzed. BAR was calculated as blood urea nitrogen (mg/dL) divided by serum albumin (g/dL). The composite endpoint was HF readmission or all-cause death. Time-dependent receiver operating characteristic (ROC) analysis identified optimal age-specific cut-off values. Among 945 event-free patients 1 year after discharge, the association between a BAR increase (ΔBAR≥20%) and outcomes was evaluated.

Results: Median BAR values increased with age (<70 years: 6.32; 70-79 years: 7.47; ≥80 years: 9.39; p < 0.001). Optimal cut-off values for predicting the composite endpoint showed a U-shaped trend (8.06, 7.27, and 10.88). A high BAR (≥9.50, by ROC analysis) independently predicted adverse outcomes in the overall cohort (HR 2.26, 95% CI 2.02-2.54; p < 0.001). Kaplan-Meier analysis revealed consistently higher event rates in the high-BAR group across all ages (log-rank p < 0.001). Among event-free survivors, a BAR increase ≥20% was associated with greater risk of subsequent events. Factors associated with BAR elevation included higher body mass index, diabetes, elevated B-type natriuretic peptide, and vasopressin V₂ receptor antagonist use.

Conclusion: BAR increases with age and exhibits age-specific prognostic thresholds. Monitoring BAR dynamics after discharge may enhance risk stratification and guide individualized management of HF patients.