Vascular Health and Risk Management最新文献

Background: Anthropometric indicators are known to be closely related to pre-hypertension and hypertension. This study aimed to explore the association of conventional and unconventional anthropometric indicators with pre-hypertension and hypertension.

Methods: About 8787 adults (aged ≥18 years) who joined in the Chinese Residents Cardiovascular Disease and Risk Factors Surveillance Project (2020) were included. Twenty-four anthropometric indicators were measured and calculated, including conventional anthropometric indicators [eg, weight, fat mass (FM), body mass index (BMI), height-adjusted weight (HtaW), fat mass index (FMI), fat-free mass index (FFMI)] and unconventional anthropometric indicators [eg, atherogenic index of plasma (AIP), triglyceride-glucose index (TyG)]. LASSO regressions were used to identify key anthropometric indicators associated with pre-hypertension/hypertension. Multivariate logistic regression model, RCS regression analysis, subgroup analyses and sensitivity analyses were conducted to explore the association between anthropometric indicators and pre-hypertension/hypertension. ROC and AUC were also utilized to evaluate the performance of anthropometric indicators in identifying pre-hypertension/ hypertension.

Results: After adjustment for potential confounders, multivariate logistic regression showed that weight, BMI, HtaW, FMI, FFMI, AIP, and TyG were significantly associated with pre-hypertension, while FM, AIP, and TyG were significantly associated with hypertension. ROC analysis showed that conventional anthropometric indicators were slightly superior to unconventional anthropometric indicators in identifying pre-hypertension and hypertension. RCS models suggested that weight, FMI, FFMI, AIP, and TyG had linear dose-response relationships with pre-hypertension risk, while BMI and HtaW were nonlinearly associated with pre-hypertension risk; FM, AIP and TyG had nonlinear dose-response relationships with hypertension risk (P _nonlinear < 0.05). The results from the subgroup analysis and sensitivity analysis basically supported the primary findings.

Conclusion: As one of the first comprehensive comparisons of 24 anthropometric indicators in a large Chinese population, this study found that BMI and TyG were the best anthropometric indicators for identifying pre-hypertension, while TyG showed a significantly stronger association with hypertension.

Cardiopulmonary resuscitation (CPR) remains a fundamental intervention in the management of cardiac arrest, with timely initiation and optimal performance serving as critical determinants of survival and neurological recovery. In recent years, the application of artificial intelligence (AI) has emerged as a promising approach to enhance the effectiveness of CPR by delivering real-time feedback, supporting clinical decision-making, and enabling individualized resuscitation strategies. This narrative review summarizes the current applications of AI in CPR, including rhythm interpretation, quality monitoring, and post-resuscitation care. In addition, it discusses major challenges related to data privacy, system interoperability, algorithmic fairness, and ethical governance. Future directions emphasize the importance of interdisciplinary collaboration, rigorous model validation, and structured training for clinical users. Although additional validation is required, the integration of AI into resuscitation practices holds significant promise for enhancing patient outcomes and potentially reducing mortality associated with sudden cardiac arrest.

Background: Self-monitoring of blood pressure (SMBP) is crucial for managing hypertension (HTN). However, there is a lack of information on the knowledge, attitudes and practices (KAPs) of hypertensive patients regarding SMBP in Yemen. Therefore, this study evaluated these KAPs among hypertensive patients in Yemen.

Methods: A descriptive cross-sectional study was conducted among 598 adult hypertensive patients conveniently sampled from 19 hospitals in five governorates of Yemen (Amran, Dhamar, Sa'dah, Sana'a, and Ibb) in 2023. Data about demographics, HTN, and KAPs regarding SMBP were collected using a structured questionnaire and analyzed using descriptive statistics.

Results: The response rate was 90.6% (598/660). Of respondents, 30.6% were aware of SMBP, with 72.1% of these practicing it at home. Only 20.2% of patients with perceived awareness knew the optimal timing for BP measurements, and 30% were unaware of any of the precautions SMBP. Although 96.2% of patients believed that SMBP can reduce organ complications, only 39.9% considered it accurate. Of patients aware of SMBP, most (84.2%) endorsed recommending it. Nevertheless, 30.3% of those using SMBP practiced it irregularly, and 53% documented their BP readings, 57.6% shared their home BP readings with physicians, 56.1% compared home and clinic values, and 8.3% reported considering all precautions. Healthcare provider advice (85.6%) and family motivation (75.6%) were the most common reasons for practicing SMBP, followed by owning BP devices (46.2%), while difficulty to operate devices (41.2%), and inability to afford them (35.3%) were the most common reasons for not practicing it.

Conclusion: Adult hypertensive patients in Yemen show low awareness of SMBP, with notable gaps in understanding proper measurement timing, frequency, and precautions. Doubts about SMBP's accuracy are concerning, yet many express willingness to recommend it, trusting healthcare providers' guidance. Reducing cost barriers and simplifying device use could enhance SMBP adoption, improving HTN management in this vulnerable population.

Objective: To investigate the serum levels of Chemokine CCL26 (CCL26) and Receptors, CCR3 (CCR3) in patients with Diabetes Mellitus, Type 2 (T2DM) complicated by lower extremity artery disease (LEAD), and to evaluate their potential as diagnostic biomarkers for T2DM with LEAD.

Methods: A retrospective study was conducted involving 197 patients with T2DM between June 2022 and February 2025. Patients were divided into T2DM group (n=157) and LEAD group (n=40). Clinical data and fasting venous blood were collected to measure serum CCL26 and CCR3 levels. Pearson correlation analysis was used to assess the correlation between CCL26 and CCR3. Lasso regression and logistic regression models were employed to identify risk factors for LEAD. The receiver operating characteristic (ROC) curve was constructed to evaluate the predictive efficacy of CCL26 and CCR3 for LEAD.

Results: The LEAD group had significantly higher BMI, disease duration, HbA1C, FINS, and HOMA-IR compared to the T2DM group (P<0.05). Serum levels of CCL26 and CCR3 were elevated in the LEAD group (P<0.05). A positive correlation was found between CCL26 and CCR3 (r=0.337, P=0.034). Lasso regression identified 12 indicators, including CCL26 and CCR3, as predictors of LEAD. Logistic regression revealed that BMI, disease duration, HbA1C, CCL26, and CCR3 were independent risk factors for LEAD (P<0.05). The combined detection of serum CCL26 and CCR3 had an AUC of 0.812, indicating high predictive value for LEAD in T2DM patients.

Conclusion: Serum CCL26 and CCR3 levels are elevated in T2DM patients with LEAD and are closely associated with its occurrence. Combined detection of these biomarkers shows good predictive value for LEAD in T2DM patients.

Purpose: The optimal plasma lipoprotein(a) [Lp(a)] cutoff level for predicting atherosclerotic cardiovascular disease (ASCVD) in Southeast Asian populations remains limited. Therefore, our study aimed to identify the optimal plasma Lp(a) cutoff for predicting ASCVD in Thai patients.

Patients and methods: We conducted a retrospective analysis of patients who underwent Lp(a) measurement at Siriraj Hospital between January 2019 and August 2024. Inclusion criteria included Thai ethnicity and age ≥15 years. Baseline characteristics, comorbidities, laboratory data, and Lp(a) levels were extracted from medical records. Lp(a) levels were compared between ASCVD and non-ASCVD groups. Odds ratios (OR) for ASCVD and coronary artery disease (CAD) were calculated using Lp(a)<25 nmol/L as the reference.

Results: A total of 2341 patients (age 54.4±17.7 years, 42.0% male) were included. Among them, 413 (17.6%) had ASCVD, 254 (10.9%) had CAD, 186 (7.9%) had ischemic stroke, 21 (0.9%) had peripheral arterial disease (PAD), and 14 (0.6%) had abdominal aortic aneurysm. Median Lp(a) levels (nmol/L) were significantly higher in patients with ASCVD [37.2 vs 24.4, p<0.001], CAD [43.8 vs 24.5, p<0.001], and AS [51.6 vs 25.3, p=0.002] compared to those without diseases. After adjusting for other risk factors, Lp(a)≥40 nmol/L was associated with increased risks of ASCVD [OR 1.538 (1.203-1.958)] and CAD [OR 1.877 (1.407-2.505)]. A multivariate model incorporating Lp(a)≥40 nmol/L with other risk factors demonstrated 70-80% sensitivity and specificity for predicting ASCVD and CAD.

Conclusion: Elevated plasma Lp(a) levels are significantly associated with ASCVD and CAD. An Lp(a) cutoff of≥40 nmol/L predicted ASCVD and CAD risk in Thai.

Background: Acute type A aortic dissection (ATAAD) surgery is often complicated by postoperative acute refractory hypoxemia (ARH). Multiple risk factors contribute to ARH, and perioperative blood transfusion is a potential risk factor. This study investigates the association between perioperative blood product transfusion and ARH in ATAAD surgical patients.

Methods: This retrospective cohort study included 282 patients who underwent surgical repair of ATAAD between 2015 and 2020. Perioperative blood product transfusion volumes, postoperative oxygenation indices, laboratory and radiological findings were analyzed. The primary outcome, ARH, was defined as moderate-to-severe hypoxemia (P/F ≤ 200 mmHg) within 72 hours postoperatively. Multivariate logistic regression was used to identify risk factors for ARH, confounders were adjusted for, and platelet transfusion association was further evaluated.

Results: Acute refractory hypoxemia occurred in 35.8% of the total patient cohort. At baseline, ARH patients had significantly higher BMI and a high prevalence of hypertension and coronary artery disease. Marfan syndrome was significantly more prevalent in the non-ARH group. Platelet transfusion was administered in 81.2% of patients, and a significantly higher frequency of ARH patients received platelet transfusion [p=0.013; Adjusted OR 95% CI; 3.43 (1.54-7.63)]. A synergistic effect was observed between high preoperative C-reactive protein (CRP) and platelet transfusion in the resulting ARH [p < 0.001; adjusted OR 95% CI: 16.06 (3.02-85.50)]. After multivariate logistic regression analysis, platelet transfusion, high CRP, brachiocephalic trunk involvement, and prolonged hypothermic circulatory arrest time were independent risk factors for postoperative ARH after ATAAD surgery. ARH patients required a significantly longer duration of mechanical ventilation.

Conclusion: Platelet transfusion was independently associated with risk of postoperative ARH, supporting a potential TRALI-like mechanism. Findings suggest that in high-risk ATAAD surgery, the synergistic effect of preoperative systemic inflammation and platelet transfusion may contribute to lung injury compatible with the "two-hit" model. This potential pathway requires further investigation.

Purpose: To determine the impact of 24-hour post-reperfusion glycemic control on 90-day functional outcomes in acute large vessel occlusion (ALVO) patients after successful recanalization.

Materials and methods: This multi-center retrospective study analyzed 2056 ALVO patients (male: 1488; female: 568) from three cerebrovascular centers achieving successful reperfusion via mechanical thrombectomy with/without bridging thrombolysis. Using 1:1 propensity score matching (covariates: gender, age, Diabetes mellitus, hypertension, hyperlipidemia, cardiac disease, smoking status, glucose measurement timing, baseline NIHSS, and preoperative mRS), 194 matched pairs (mean age 63[IQR 55-71] years; male: 278) were stratified by 90-day modified Rankin Scale (mRS) outcomes into favorable (mRS 0-2) and poor prognosis (mRS 3-6) cohorts.

Results: The poor prognosis cohort demonstrated significantly elevated mean fasting blood glucose (MFBG) levels (7.22 mmol/L [6.66-8.50] vs 6.86 mmol/L [6.28-7.58], P<0.001). Multivariable logistic regression adjusted for sex, age, vascular risk profile, and baseline NIHSS (adjusted OR=0.819, 95% CI 0.714-0.940, P=0.004) confirmed MFBG elevation as an independent risk factor for unfavorable outcomes.

Conclusion: Sustained hyperglycemia during the initial 24-hour post-recanalization period independently predicts impaired 90-day functional recovery in ALVO patients. These findings highlight the imperative for standardized glucose monitoring protocols during the hyperacute post-thrombectomy phase, while optimal glycemic targets (<7.0 mmol/L vs individualized thresholds) and therapeutic windows for neuroprotection warrant validation through prospective multicenter RCTs.

Purpose: Advanced catheter ablation using three-dimensional electroanatomic mapping (EAM) has shown favorable outcomes in high-income countries, but real-world evidence from low- and middle-income settings is scarce. This study aimed to assess the clinical characteristics, procedural features, and outcomes of radiofrequency ablation using EAM in patients with ventricular tachycardia (VT) or premature ventricular contractions (PVCs) at a tertiary cardiac center in Vietnam.

Methods: We analyzed 233 patients who underwent VT and PVC ablation at Cho Ray Hospital from March 2021 to December 2023. Patients were categorized into two groups based on left ventricular ejection fraction (LVEF) with the cut-off value of 50%: reduced (LVEF < 50%, n = 39) and preserved (LVEF ≥ 50%, n = 194). Data on demographics, arrhythmia burden, ablation protocol, and follow-up outcomes were collected and compared.

Results: Patients with reduced LVEF more frequently presented with ventricular tachycardia (23.1% vs 6.7%, p < 0.001), ischemic heart disease (23.1% vs 7.7%, p = 0.008), and were more likely to require irrigated catheters (46.2% vs 20.1%, p = 0.001). The PVC burden prior to ablation was significantly different between groups (36.3% ± 17.2 vs 27.8% ± 12.2, p = 0.014) and patients with reduced LVEF exhibited remarkable recovery after ablation, with LVEF improving from 33.7 ± 8.1 to 55.2 ± 9.1 (p < 0.001). The acute ablation success rate was 100% in both groups. The procedure demonstrated high levels of safety, with a non-severe complication rate of 4.7% (n = 11) and low radiation exposure (median 16 mGy [inter-quartile range: 11-26]).

Conclusion: Catheter ablation is highly effective and safe in treating ventricular arrhythmias across different LVEF, especially in ventricular arrhythmia-induced cardiomyopathy group, leading to rapid recovery of left ventricular function and reduction in arrhythmia burden. These findings provide important real-world evidence from a resource limited setting, providing multiple use of catheters and skin patches.

Background: Few studies have explored the link between body fluid ion levels (sodium, calcium, magnesium, phosphorus) and blood pressure circadian rhythm. This study investigates these ions' relationship with the dipping blood pressure pattern in hypertensive patients, highlighting their potential for monitoring electrolyte levels in hypertension management.

Methods: According to 2018 Chinese guidelines for hypertension management, hypertensive patients were classified into dipping/super-dipping and non-dipping/reverse-dipping groups based on nocturnal blood pressure decline. Clinical data and serum/24-hour urine electrolyte levels were then collected from these patients. Logistic regression and advanced statistical modeling were used to identify influencing factors.

Results: Age and alpha-blockers negatively correlate with the likelihood of dipping blood pressure in hypertensive patients (P<0.05). Highest chance of dipping occurs at age 54 years, with serum sodium at 139.55 mmol/L and 24-hour urinary calcium at 5.34 mmol (P<0.05). The lowest likelihood is at a 24-hour urinary calcium level of 1.65 mmol (P<0.05). The largest nocturnal systolic drop is at age 57 years, serum calcium at 2.41 mmol/L, and 24-hour urinary calcium at 5.34 mmol (P<0.05). The largest diastolic drop is at age 54 years, with serum sodium at 139.03 mmol/L, serum calcium at 2.42 mmol/L, and serum magnesium at 0.95 mmol/L (P<0.05). A serum calcium level over 2.20 mmol/L significantly boosts the chance of dipping and nocturnal diastolic drop (P<0.05).

Conclusion: In hypertensive patients, the chance of a dipping blood pressure pattern declines with age, possibly peaking between 54-57 years. Optimal serum sodium for dipping is 139 mmol/L, and higher serum calcium (peaking at 2.41 mmol/L) increases this likelihood. Alpha-blockers may negatively affect the dipping blood pressure pattern.

Objective: This study aims to identify latent classes of proactive health behavior and to explore the predictive factors associated with various clusters of proactive health behavior among patients with atrial fibrillation-related ischemic stroke.

Methods: A multi-center cross-sectional study was conducted, recruiting a total of 1,250 participants through cluster random sampling from January 2023 to May 2024. Latent class analysis was performed to identify classes of proactive health behavior within the sample of atrial fibrillation-related ischemic stroke patients. Additionally, multinomial regression analyses were utilized to investigate the predictive factors associated with the different latent classes identified. This study adhered to the STROBE checklist.

Results: Out of the 1,250 participants, 1,196 (91.6%) completed the survey, including 809 males and 387 females, with 71% of them reporting moderate or lower levels of proactive health behavior. The findings revealed three latent classes: (1) low proactive health behavior with health responsibility deficiency (n=426, 35.6%); (2) moderate proactive health behavior with stress and coping disorder (n=464, 38.7%); and (3) high proactive health behavior with light physical activity (n=306, 25.5%). Factors correlated with the latent classes of proactive health behavior were identified. Protective factors included a high level of stroke knowledge, strong awareness of health beliefs, and better environmental and social support (all p < 0.05). Conversely, risk factors for the latent classes of proactive health behavior included low education, being unmarried, lack of thrombolysis, and low household income (all p < 0.05).

Conclusion: This study successfully identified three different latent classes of proactive health behaviors and their related predictors in Chinese atrial fibrillation-related ischemic stroke patients. These findings provide theoretical guidance and practical insights for the development of targeted intervention programs aimed at improving proactive health behaviors in patients with atrial fibrillation-related ischemic stroke patients.