Pub Date : 2025-09-21DOI: 10.1016/j.ijcrp.2025.200518
Muzamil Akhtar , Rayyan Nabi , Raheel Ahmed
{"title":"Response to \"Letter to the editor related to the article \"Trends in mortality due to ischemic heart diseases among patients with Alzheimer's disease in the United States from 1999 to 2020. International journal of cardiology. Cardiovascular risk and prevention, 25, 200390″","authors":"Muzamil Akhtar , Rayyan Nabi , Raheel Ahmed","doi":"10.1016/j.ijcrp.2025.200518","DOIUrl":"10.1016/j.ijcrp.2025.200518","url":null,"abstract":"","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"27 ","pages":"Article 200518"},"PeriodicalIF":2.1,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-20DOI: 10.1016/j.ijcrp.2025.200472
Md Abul Kalam Azad , Md Abu Sufian , Lujain Alsadder , Sadia Zaman , Wahiba Hamzi , Amira Ali , Md. Zakir Hossain , Boumediene Hamzi
<div><h3>Background:</h3><div>Hypertension continues to be a pivotal driver of global cardiovascular disease burden and adverse health outcomes, particularly in resource-constrained settings where disparities in socioeconomic status and clinical infrastructure hinder effective management. Despite medical advancements, achieving optimal blood pressure (BP) control remains a formidable challenge, necessitating a nuanced understanding of multifactorial risk determinants.</div></div><div><h3>Methods:</h3><div>A cross-sectional analysis was conducted on 1,000 hypertensive patients from a larger dataset comprising 100,000 population size. Three hundred patients were examined for personalised BP control predictors who met the inclusion criteria of being treated for at least one year at the Hypertension and Research Centre in Rangpur, Bangladesh, between January 2020 and January 2021. BP control was assessed using World Health Organisation (WHO) and National Institute for Clinical Excellence (NICE) guidelines, and a comprehensive analysis of the sociodemographic and clinical variables was performed using multivariate logistic regression. Machine learning models such as K-Nearest Neighbours (KNN) were utilised to predict BP control with good performance using cross-validation techniques compared to other models. Explainable AI tools like Shapley Additive exPlanations (SHAP) and Local Interpretable Model-agnostic Explanations (LIME) provide interpretations of key variables with predictive qualities.</div></div><div><h3>Results:</h3><div>The mean age of participants was 49.37 ± 12.81 years, with 54.7% aged 40–59 years and 57.7% male. The overall BP control rate among the study population was 28%. Among those with controlled hypertension, 42% were rural residents (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0</mn><mo>.</mo><mn>005</mn></mrow></math></span>) and 37% were homemakers (<span><math><mi>p</mi></math></span> <span><math><mo><</mo></math></span> 0.001), indicating better control in these subgroups. Key facilitators of BP control included higher education levels (e.g., post-graduate OR = 1.17, <span><math><mrow><mi>p</mi><mo><</mo><mn>0</mn><mo>.</mo><mn>001</mn></mrow></math></span>), lower cholesterol levels (SHAP value = 0.097), and adherence to combination therapy (75% of controlled cases). Conversely, diabetes mellitus (SHAP value = 0.069) and ischemic heart disease (OR = 0.95, <span><math><mrow><mi>p</mi><mo>=</mo><mn>0</mn><mo>.</mo><mn>004</mn></mrow></math></span>) emerged as significant impediments to BP control. Advanced machine learning models, including KNN, achieved an unparallelled predictive accuracy of 99%, underscoring precision-based interventions’ transformative potential. SHAP analysis revealed dietary habits (SHAP value = 0.077) and physical activity (SHAP value = 0.079) as modifiable predictors, highlighting the efficacy of personalised lifestyle strategies. Simulation-based interventions grounded in machine learning insigh
{"title":"Hypertension control in resource-constrained settings: Bridging socioeconomic gaps with predictive insights","authors":"Md Abul Kalam Azad , Md Abu Sufian , Lujain Alsadder , Sadia Zaman , Wahiba Hamzi , Amira Ali , Md. Zakir Hossain , Boumediene Hamzi","doi":"10.1016/j.ijcrp.2025.200472","DOIUrl":"10.1016/j.ijcrp.2025.200472","url":null,"abstract":"<div><h3>Background:</h3><div>Hypertension continues to be a pivotal driver of global cardiovascular disease burden and adverse health outcomes, particularly in resource-constrained settings where disparities in socioeconomic status and clinical infrastructure hinder effective management. Despite medical advancements, achieving optimal blood pressure (BP) control remains a formidable challenge, necessitating a nuanced understanding of multifactorial risk determinants.</div></div><div><h3>Methods:</h3><div>A cross-sectional analysis was conducted on 1,000 hypertensive patients from a larger dataset comprising 100,000 population size. Three hundred patients were examined for personalised BP control predictors who met the inclusion criteria of being treated for at least one year at the Hypertension and Research Centre in Rangpur, Bangladesh, between January 2020 and January 2021. BP control was assessed using World Health Organisation (WHO) and National Institute for Clinical Excellence (NICE) guidelines, and a comprehensive analysis of the sociodemographic and clinical variables was performed using multivariate logistic regression. Machine learning models such as K-Nearest Neighbours (KNN) were utilised to predict BP control with good performance using cross-validation techniques compared to other models. Explainable AI tools like Shapley Additive exPlanations (SHAP) and Local Interpretable Model-agnostic Explanations (LIME) provide interpretations of key variables with predictive qualities.</div></div><div><h3>Results:</h3><div>The mean age of participants was 49.37 ± 12.81 years, with 54.7% aged 40–59 years and 57.7% male. The overall BP control rate among the study population was 28%. Among those with controlled hypertension, 42% were rural residents (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0</mn><mo>.</mo><mn>005</mn></mrow></math></span>) and 37% were homemakers (<span><math><mi>p</mi></math></span> <span><math><mo><</mo></math></span> 0.001), indicating better control in these subgroups. Key facilitators of BP control included higher education levels (e.g., post-graduate OR = 1.17, <span><math><mrow><mi>p</mi><mo><</mo><mn>0</mn><mo>.</mo><mn>001</mn></mrow></math></span>), lower cholesterol levels (SHAP value = 0.097), and adherence to combination therapy (75% of controlled cases). Conversely, diabetes mellitus (SHAP value = 0.069) and ischemic heart disease (OR = 0.95, <span><math><mrow><mi>p</mi><mo>=</mo><mn>0</mn><mo>.</mo><mn>004</mn></mrow></math></span>) emerged as significant impediments to BP control. Advanced machine learning models, including KNN, achieved an unparallelled predictive accuracy of 99%, underscoring precision-based interventions’ transformative potential. SHAP analysis revealed dietary habits (SHAP value = 0.077) and physical activity (SHAP value = 0.079) as modifiable predictors, highlighting the efficacy of personalised lifestyle strategies. Simulation-based interventions grounded in machine learning insigh","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"27 ","pages":"Article 200472"},"PeriodicalIF":2.1,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-17DOI: 10.1016/j.ijcrp.2025.200517
Jeff Clyde G. Corpuz
This correspondence responds to the review by Rafiei et al. on circulating-free DNA (cfDNA) as a biomarker for early detection of myocardial infarction (MI). CfDNA shows potential for rapid diagnosis and real-time monitoring, but major barriers remain. Lack of standardized testing methods, uncertain utility in emergency care, and high costs risk delaying adoption and widening health inequities, particularly in low- and middle-income countries (LMICs). Key priorities include harmonizing laboratory protocols, developing point-of-care platforms, and integrating cfDNA into diagnostic algorithms with cardiac troponins and electrocardiograms (ECG). Research should focus on large, long-term cohorts that include diverse populations, and test multi-marker strategies combining cfDNA with microRNAs and DNA methylation profiles. Ensuring affordability and accessibility will be critical to translate cfDNA from experimental promise to routine cardiovascular practice.
{"title":"Circulating-free DNA and myocardial infarction: From diagnostic promise to clinical translation","authors":"Jeff Clyde G. Corpuz","doi":"10.1016/j.ijcrp.2025.200517","DOIUrl":"10.1016/j.ijcrp.2025.200517","url":null,"abstract":"<div><div>This correspondence responds to the review by Rafiei et al. on circulating-free DNA (cfDNA) as a biomarker for early detection of myocardial infarction (MI). CfDNA shows potential for rapid diagnosis and real-time monitoring, but major barriers remain. Lack of standardized testing methods, uncertain utility in emergency care, and high costs risk delaying adoption and widening health inequities, particularly in low- and middle-income countries (LMICs). Key priorities include harmonizing laboratory protocols, developing point-of-care platforms, and integrating cfDNA into diagnostic algorithms with cardiac troponins and electrocardiograms (ECG). Research should focus on large, long-term cohorts that include diverse populations, and test multi-marker strategies combining cfDNA with microRNAs and DNA methylation profiles. Ensuring affordability and accessibility will be critical to translate cfDNA from experimental promise to routine cardiovascular practice.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"27 ","pages":"Article 200517"},"PeriodicalIF":2.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Japan had the highest proportion of the elderly in the world, with one in 10 individuals aged ≥80 years. Consequently, the number of patients with cardiovascular diseases is increasing. Older patients often have comorbidities such as frailty, sarcopenia, and cognitive decline that leads to a decreased quality of life (QOL). We analyzed the effects of outpatient cardiac rehabilitation (OCR) in elderly patients with cardiovascular disease.
Methods
The comprehensive OCR had been provided by a multidisciplinary team. We analyzed data from 49 patients with cardiovascular diseases, aged ≥80 years, who received cardiopulmonary exercise (CPX) tests based OCR. Frailty, physical function, QOL, exercise tolerance, and vascular endothelial function were assessed before and after OCR.
Results
All 49 patients had completed the OCR program. The mean patients’ age was 84.1 ± 3.6 years and 32.7 % were male. The proportion of frailty and pre-frailty participants significantly decreased from 92 % to 67 % following OCR. The QOL (KCCQ: 76.8 ± 18.4 vs. 81.4 ± 20.4; P = 0.0196), exercise tolerance (peak VO2: 14.1 ± 4.0 vs. 15.4 ± 3.9 mL/min/kg; P = 0.0017), and vascular endothelial function (Ln-RHI: 0.48 ± 0.39 vs. 0.57 ± 0.3; P = 0.027) significantly improved after OCR.
Conclusions
The comprehensive OCR with CPX-based exercise therapy and the multidisciplinary approach significantly improved frailty, the QOL, physical function, exercise tolerance, and vascular endothelial function in patients with cardiovascular diseases aged ≥80 years.
日本是世界上老年人比例最高的国家，每10个人中就有1人的年龄≥80岁。因此，心血管疾病患者的数量正在增加。老年患者通常有合并症，如虚弱、肌肉减少症和认知能力下降，导致生活质量下降（QOL）。我们分析了门诊心脏康复（OCR）在老年心血管疾病患者中的效果。方法由多学科团队提供全面的OCR。我们分析了49例年龄≥80岁的心血管疾病患者的数据，这些患者接受了基于OCR的心肺运动（CPX）试验。在OCR前后评估虚弱、身体功能、生活质量、运动耐量和血管内皮功能。结果49例患者均完成了OCR计划。患者平均年龄84.1±3.6岁，男性占32.7%。在OCR之后，虚弱和虚弱前参与者的比例从92%显著下降到67%。QOL （KCCQ: 76.8±18.4 vs. 81.4±20.4,P = 0.0196）、运动耐量（峰值VO2: 14.1±4.0 vs. 15.4±3.9 mL/min/kg, P = 0.0017）和血管内皮功能（Ln-RHI: 0.48±0.39 vs. 0.57±0.3,P = 0.027）均显著改善。结论综合OCR结合cpx为基础的运动疗法和多学科联合治疗可显著改善≥80岁心血管疾病患者的虚弱、生活质量、身体功能、运动耐量和血管内皮功能。
{"title":"Cardiac rehabilitation for outpatients aged over 80 years with cardiovascular diseases","authors":"Ryoko Someya , Yasushi Matsuzawa , Yoshitaka Shimizu , Hidefumi Nakahashi , Masaaki Konishi , Eiichi Akiyama , Yohei Hanajima , Hisaya Kondo , Tomohiro Yoshii , Ryosuke Sato , Kazuko Hayashi , Kozo Okada , Teruyasu Sugano , Kiyoshi Hibi","doi":"10.1016/j.ijcrp.2025.200516","DOIUrl":"10.1016/j.ijcrp.2025.200516","url":null,"abstract":"<div><h3>Background</h3><div>Japan had the highest proportion of the elderly in the world, with one in 10 individuals aged ≥80 years. Consequently, the number of patients with cardiovascular diseases is increasing. Older patients often have comorbidities such as frailty, sarcopenia, and cognitive decline that leads to a decreased quality of life (QOL). We analyzed the effects of outpatient cardiac rehabilitation (OCR) in elderly patients with cardiovascular disease.</div></div><div><h3>Methods</h3><div>The comprehensive OCR had been provided by a multidisciplinary team. We analyzed data from 49 patients with cardiovascular diseases, aged ≥80 years, who received cardiopulmonary exercise (CPX) tests based OCR. Frailty, physical function, QOL, exercise tolerance, and vascular endothelial function were assessed before and after OCR.</div></div><div><h3>Results</h3><div>All 49 patients had completed the OCR program. The mean patients’ age was 84.1 ± 3.6 years and 32.7 % were male. The proportion of frailty and pre-frailty participants significantly decreased from 92 % to 67 % following OCR. The QOL (KCCQ: 76.8 ± 18.4 vs. 81.4 ± 20.4; P = 0.0196), exercise tolerance (peak VO<sub>2</sub>: 14.1 ± 4.0 vs. 15.4 ± 3.9 mL/min/kg; P = 0.0017), and vascular endothelial function (Ln-RHI: 0.48 ± 0.39 vs. 0.57 ± 0.3; P = 0.027) significantly improved after OCR.</div></div><div><h3>Conclusions</h3><div>The comprehensive OCR with CPX-based exercise therapy and the multidisciplinary approach significantly improved frailty, the QOL, physical function, exercise tolerance, and vascular endothelial function in patients with cardiovascular diseases aged ≥80 years.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"27 ","pages":"Article 200516"},"PeriodicalIF":2.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-15DOI: 10.1016/j.ijcrp.2025.200513
Angel M. Alonso-Gómez , Leire Goicolea-Güemez , Dora Romaguera , Estefania Toledo , Aniqa B. Alam , Lucas Tojal-Sierra , Luis López Rodriguez , Raúl Ramallal , María Garrido Uriarte , Inés Gonzalez-Casanova , Jordi Salas-Salvadó , Montserrat Fitó , Alvaro Alonso
{"title":"Glycemic status and left atrial structure and function in adults with metabolic syndrome and overweight-obesity","authors":"Angel M. Alonso-Gómez , Leire Goicolea-Güemez , Dora Romaguera , Estefania Toledo , Aniqa B. Alam , Lucas Tojal-Sierra , Luis López Rodriguez , Raúl Ramallal , María Garrido Uriarte , Inés Gonzalez-Casanova , Jordi Salas-Salvadó , Montserrat Fitó , Alvaro Alonso","doi":"10.1016/j.ijcrp.2025.200513","DOIUrl":"10.1016/j.ijcrp.2025.200513","url":null,"abstract":"","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"27 ","pages":"Article 200513"},"PeriodicalIF":2.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-12DOI: 10.1016/j.ijcrp.2025.200515
Yang Yu , Chen Jiang , Yan gao , Dingqi Li , Chongcheng Xi , Quansheng Feng , Rui He
Background
Emerging evidence suggests a potential link between hypertension and cancer, yet the relationship between elevated blood pressure and lung cancer risk remains underexplored, particularly in large, population-based settings.
Objective
To investigate temporal trends in hypertension prevalence among lung cancer patients and to assess whether hypertension is independently associated with lung cancer risk in the Chinese adult population.
Methods
We analyzed data from 2,745,893 adults aged ≥18 years who participated in the China Chronic Disease and Risk Factor Surveillance (CCDRFS) program from 2002 to 2019. Trends in hypertension prevalence among lung cancer patients were assessed across demographic strata. Multivariable logistic regression models adjusted for age, sex, smoking, obesity, and region were used to estimate adjusted odds ratios (aORs) for lung cancer associated with hypertension.
Results
Among 168,427 lung cancer patients (6.1 % of total), 58.3 % had coexisting hypertension. Hypertension prevalence among lung cancer patients rose from 47.2 % in 2002 to 62.8 % in 2019, with sharper increases in rural (49.3 %–66.1 %) and western regions (50.4 %–66.9 %). After adjustment, hypertension was independently associated with lung cancer (aOR = 1.37; 95 % CI: 1.31–1.43), with stronger associations observed in females (aOR = 1.49), individuals aged ≥60 years (aOR = 1.54), non-smokers (aOR = 1.44), and obese participants (aOR = 1.46).
Conclusions
Hypertension is highly prevalent among lung cancer patients in China and appears to be independently associated with increased lung cancer risk. These findings suggest the need for integrated cardio-oncology surveillance and prevention strategies, particularly for high-risk subpopulations such as older adults, women, and non-smokers. Further prospective studies are warranted to explore the mechanisms underlying this association and to evaluate whether hypertension control may influence lung cancer burden.
{"title":"Hypertension and lung cancer in China (2002–2019): A nationwide study of temporal trends, demographic disparities, and independent risk associations","authors":"Yang Yu , Chen Jiang , Yan gao , Dingqi Li , Chongcheng Xi , Quansheng Feng , Rui He","doi":"10.1016/j.ijcrp.2025.200515","DOIUrl":"10.1016/j.ijcrp.2025.200515","url":null,"abstract":"<div><h3>Background</h3><div>Emerging evidence suggests a potential link between hypertension and cancer, yet the relationship between elevated blood pressure and lung cancer risk remains underexplored, particularly in large, population-based settings.</div></div><div><h3>Objective</h3><div>To investigate temporal trends in hypertension prevalence among lung cancer patients and to assess whether hypertension is independently associated with lung cancer risk in the Chinese adult population.</div></div><div><h3>Methods</h3><div>We analyzed data from 2,745,893 adults aged ≥18 years who participated in the China Chronic Disease and Risk Factor Surveillance (CCDRFS) program from 2002 to 2019. Trends in hypertension prevalence among lung cancer patients were assessed across demographic strata. Multivariable logistic regression models adjusted for age, sex, smoking, obesity, and region were used to estimate adjusted odds ratios (aORs) for lung cancer associated with hypertension.</div></div><div><h3>Results</h3><div>Among 168,427 lung cancer patients (6.1 % of total), 58.3 % had coexisting hypertension. Hypertension prevalence among lung cancer patients rose from 47.2 % in 2002 to 62.8 % in 2019, with sharper increases in rural (49.3 %–66.1 %) and western regions (50.4 %–66.9 %). After adjustment, hypertension was independently associated with lung cancer (aOR = 1.37; 95 % CI: 1.31–1.43), with stronger associations observed in females (aOR = 1.49), individuals aged ≥60 years (aOR = 1.54), non-smokers (aOR = 1.44), and obese participants (aOR = 1.46).</div></div><div><h3>Conclusions</h3><div>Hypertension is highly prevalent among lung cancer patients in China and appears to be independently associated with increased lung cancer risk. These findings suggest the need for integrated cardio-oncology surveillance and prevention strategies, particularly for high-risk subpopulations such as older adults, women, and non-smokers. Further prospective studies are warranted to explore the mechanisms underlying this association and to evaluate whether hypertension control may influence lung cancer burden.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"27 ","pages":"Article 200515"},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To systematically evaluate the efficacy and safety of direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) for anticoagulation in patients with atrial fibrillation (AF) and chronic kidney disease (CKD).
Methods
PubMed, Embase, Web of Science, and the Cochrane Library were searched from their inception through May 2025 to collect relevant clinical studies comparing the use of DOAC versus VKA for the treatment of patients with AF combined with chronic kidney disease. Literature screening, data extraction, analysis, quality evaluation, and risk of bias assessment were conducted by independent reviewers. The outcomes of interest included all-cause mortality, cardiovascular death, stroke or systemic embolism, major bleeding, gastrointestinal bleeding, intracranial bleeding, myocardial infarction, and stroke. Analysis was performed using RevMan 5.4 software, with I2 statistics employed to assess heterogeneity.
Results
16 studies were included in the analysis. Compared with VKA, DOAC can significantly reduced the risks of cardiovascular mortality (HR = 0.78; 95 %CI 0.70–0.87; P < 0.05), major bleeding (HR = 0.79; 95 %CI 0.64–0.97; P < 0.05), and intracranial hemorrhage (HR = 0.50; 95 %CI 0.37–0.66; P < 0.05). No significant differences were observed between the DOAC and VKA groups regarding all-cause death (HR = 0.98; 95 %CI 0.81–1.19; P = 0.82), stroke or systemic embolism (HR = 0.84; 95 %CI 0.68–1.04; P = 0.12), gastrointestinal bleeding (HR = 0.87; 95 %CI 0.61–1.24; P = 0.43), myocardial infarction (HR = 0.98; 95 %CI 0.78–1.23; P = 0.84), or stroke (HR = 0.85; 95 %CI 0.72–1.00; P = 0.06). Overall, DOACs demonstrated superior efficacy in reducing cardiovascular mortality, major bleeding, and intracranial hemorrhage. Among patients with end-stage renal disease, those treated with DOACs showed a tendency toward reduced major bleeding (HR = 0.58; 95 % CI 0.50–0.68; P < 0.05), gastrointestinal hemorrhage (HR = 0.65; 95 %CI 0.48–0.98 P < 0.05), and intracranial hemorrhage (HR = 0.56; 95 % CI, 0.38–0.82; P < 0.05). For patients without end-stage renal disease, the DOAC group had greater benefits in reducing the risks of all-cause death (HR = 0.91; 95 %CI 0.84–0.99; P = 0.03), cardiovascular mortality (HR = 0.77; 95 %CI 0.69–0.86; P < 0.05), major bleeding (HR = 0.85; 95 %CI 0.77–0.83; P < 0.05, and intracranial hemorrhage (HR = 0.42; 95 % CI, 0.28–0.65; P < 0.05). Conversely, the VKA group was more effective in reducing the risk of gastrointestinal hemorrhage events (HR = 1.38; 95 % CI 1.13–1.68; P < 0.05).
Conclusion
In patients with non-valvular AF complicated by CKD, the use of DOAC is associated with a moderate reduction in the risks of cardiovascular mortality, major bleeding, and intracranial hemorrhage. Among patients with end-stage renal disease, DOACs offer more significant
目的系统评价直接口服抗凝剂（DOAC）与维生素K拮抗剂（VKA）在房颤（AF）合并慢性肾脏疾病（CKD）患者抗凝治疗中的疗效和安全性。方法检索spubmed、Embase、Web of Science和Cochrane图书馆自成立至2025年5月的相关临床研究，比较DOAC与VKA治疗房颤动合并慢性肾病患者的疗效。文献筛选、数据提取、分析、质量评价和偏倚风险评估均由独立审稿人进行。研究结果包括全因死亡率、心血管死亡、中风或全身性栓塞、大出血、胃肠道出血、颅内出血、心肌梗死和中风。采用RevMan 5.4软件进行分析，采用I2统计量评估异质性。结果共纳入16项研究。与VKA相比，DOAC可显著降低心血管死亡风险（HR = 0.78; 95% CI 0.70-0.87; P < 0.05）、大出血风险（HR = 0.79; 95% CI 0.64-0.97; P < 0.05）、颅内出血风险（HR = 0.50; 95% CI 0.37-0.66; P < 0.05）。DOAC组和VKA组在全因死亡（HR = 0.98; 95% CI 0.81-1.19; P = 0.82）、中风或全身栓塞（HR = 0.84; 95% CI 0.68-1.04; P = 0.12）、胃肠道出血（HR = 0.87; 95% CI 0.61-1.24; P = 0.43）、心肌梗死（HR = 0.98; 95% CI 0.78-1.23; P = 0.84）或中风（HR = 0.85; 95% CI 0.72-1.00; P = 0.06）方面无显著差异。总体而言，DOACs在降低心血管死亡率、大出血和颅内出血方面表现出优越的疗效。在终末期肾病患者中，经DOACs治疗的患者大出血（HR = 0.58; 95% CI 0.50-0.68; P < 0.05）、胃肠道出血（HR = 0.65; 95% CI 0.48-0.98 P < 0.05）和颅内出血（HR = 0.56; 95% CI 0.38-0.82; P < 0.05）倾向减少。对于无终末期肾病的患者，DOAC组在降低全因死亡（HR = 0.91; 95% CI 0.84-0.99; P = 0.03）、心血管死亡率（HR = 0.77; 95% CI 0.69-0.86; P < 0.05）、大出血（HR = 0.85; 95% CI 0.77 - 0.83; P < 0.05）和颅内出血（HR = 0.42; 95% CI 0.28-0.65; P < 0.05）的风险方面有更大的益处。相反，VKA组在降低胃肠道出血事件的风险方面更有效（HR = 1.38; 95% CI 1.13-1.68; P < 0.05）。结论：对于合并CKD的非瓣膜性房颤患者，DOAC的使用可适度降低心血管死亡、大出血和颅内出血的风险。在终末期肾病患者中，DOACs在降低大出血、胃肠道出血和颅内出血的风险方面提供了更显著的益处。对于非终末期肾病患者，DOAC与全因死亡率、心血管死亡率、大出血和颅内出血发生率较低相关，而VKA与胃肠道出血风险增加相关。
{"title":"Comparison of outcomes of direct oral anticoagulants versus vitamin K antagonists for atrial fibrillation and chronic kidney disease: a systematic review and meta-analysis","authors":"Bing Luo, Yueyun Jiang, Minyi Tan, Jingyan Yang, Yue Fan, Yili Chen","doi":"10.1016/j.ijcrp.2025.200511","DOIUrl":"10.1016/j.ijcrp.2025.200511","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically evaluate the efficacy and safety of direct oral anticoagulants (DOAC) compared to vitamin K antagonists (VKA) for anticoagulation in patients with atrial fibrillation (AF) and chronic kidney disease (CKD).</div></div><div><h3>Methods</h3><div>PubMed, Embase, Web of Science, and the Cochrane Library were searched from their inception through May 2025 to collect relevant clinical studies comparing the use of DOAC versus VKA for the treatment of patients with AF combined with chronic kidney disease. Literature screening, data extraction, analysis, quality evaluation, and risk of bias assessment were conducted by independent reviewers. The outcomes of interest included all-cause mortality, cardiovascular death, stroke or systemic embolism, major bleeding, gastrointestinal bleeding, intracranial bleeding, myocardial infarction, and stroke. Analysis was performed using RevMan 5.4 software, with I<sup>2</sup> statistics employed to assess heterogeneity.</div></div><div><h3>Results</h3><div>16 studies were included in the analysis. Compared with VKA, DOAC can significantly reduced the risks of cardiovascular mortality (HR = 0.78; 95 %CI 0.70–0.87; P < 0.05), major bleeding (HR = 0.79; 95 %CI 0.64–0.97; P < 0.05), and intracranial hemorrhage (HR = 0.50; 95 %CI 0.37–0.66; P < 0.05). No significant differences were observed between the DOAC and VKA groups regarding all-cause death (HR = 0.98; 95 %CI 0.81–1.19; P = 0.82), stroke or systemic embolism (HR = 0.84; 95 %CI 0.68–1.04; P = 0.12), gastrointestinal bleeding (HR = 0.87; 95 %CI 0.61–1.24; P = 0.43), myocardial infarction (HR = 0.98; 95 %CI 0.78–1.23; P = 0.84), or stroke (HR = 0.85; 95 %CI 0.72–1.00; P = 0.06). Overall, DOACs demonstrated superior efficacy in reducing cardiovascular mortality, major bleeding, and intracranial hemorrhage. Among patients with end-stage renal disease, those treated with DOACs showed a tendency toward reduced major bleeding (HR = 0.58; 95 % CI 0.50–0.68; P < 0.05), gastrointestinal hemorrhage (HR = 0.65; 95 %CI 0.48–0.98 P < 0.05), and intracranial hemorrhage (HR = 0.56; 95 % CI, 0.38–0.82; P < 0.05). For patients without end-stage renal disease, the DOAC group had greater benefits in reducing the risks of all-cause death (HR = 0.91; 95 %CI 0.84–0.99; P = 0.03), cardiovascular mortality (HR = 0.77; 95 %CI 0.69–0.86; P < 0.05), major bleeding (HR = 0.85; 95 %CI 0.77–0.83; P < 0.05, and intracranial hemorrhage (HR = 0.42; 95 % CI, 0.28–0.65; P < 0.05). Conversely, the VKA group was more effective in reducing the risk of gastrointestinal hemorrhage events (HR = 1.38; 95 % CI 1.13–1.68; P < 0.05).</div></div><div><h3>Conclusion</h3><div>In patients with non-valvular AF complicated by CKD, the use of DOAC is associated with a moderate reduction in the risks of cardiovascular mortality, major bleeding, and intracranial hemorrhage. Among patients with end-stage renal disease, DOACs offer more significant ","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"27 ","pages":"Article 200511"},"PeriodicalIF":2.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-10DOI: 10.1016/j.ijcrp.2025.200514
Kang Yuan , Xianshu Huo , Mengdi Xie , Huaiming Wang , Siyu Sun , Kejia Deng , Rui Liu , Xinfeng Liu
The CHA2DS2-VASc score is a risk assessment score to predict cardio-embolic stroke (CES), suggesting shared genetic susceptibility. This study aimed to explore the shared genetic association of genetically predicted CHA2DS2-VASc score and CES using multiple analytic frameworks. We conducted a comprehensive analysis of genetic data from 13 traits of CHA2DS2-VASc score and CES using summary statistics from large-scale genome-wide association studies (GWAS). We employed statistical methods such as linkage disequilibrium score regression (LDSC), cross-trait analysis, bidirectional Mendelian randomization, colocalization analysis and gene-based association analysis to explore genetic correlations and identify pleiotropic single nucleotide polymorphisms (SNPs) and shared genes. LDSC and Mendelian randomization analysis revealed a significant genetic correlation between CHA2DS2-VASc score and CES. Cross-trait and colocalization analysis identified 9 potential loci and 13 significant independent SNPs. Gene-based association analysis reported 9 genes significant across at least three methods, with IL6R being the shared gene identified by all four methods, highlighting potential shared biological mechanisms involving immune responses and inflammatory activities. In conclusion, our study revealed shared genetic associations between the genetically predicted CHA2DS2-VASc score and CES, which was supported by causal relationship, shared loci, and genetic correlation analyses.
{"title":"Shared genetic associations between CHA2DS2-VASc score and cardio-embolic stroke: Insights from mendelian randomization based bioinformatics analysis","authors":"Kang Yuan , Xianshu Huo , Mengdi Xie , Huaiming Wang , Siyu Sun , Kejia Deng , Rui Liu , Xinfeng Liu","doi":"10.1016/j.ijcrp.2025.200514","DOIUrl":"10.1016/j.ijcrp.2025.200514","url":null,"abstract":"<div><div>The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is a risk assessment score to predict cardio-embolic stroke (CES), suggesting shared genetic susceptibility. This study aimed to explore the shared genetic association of genetically predicted CHA<sub>2</sub>DS<sub>2</sub>-VASc score and CES using multiple analytic frameworks. We conducted a comprehensive analysis of genetic data from 13 traits of CHA<sub>2</sub>DS<sub>2</sub>-VASc score and CES using summary statistics from large-scale genome-wide association studies (GWAS). We employed statistical methods such as linkage disequilibrium score regression (LDSC), cross-trait analysis, bidirectional Mendelian randomization, colocalization analysis and gene-based association analysis to explore genetic correlations and identify pleiotropic single nucleotide polymorphisms (SNPs) and shared genes. LDSC and Mendelian randomization analysis revealed a significant genetic correlation between CHA<sub>2</sub>DS<sub>2</sub>-VASc score and CES. Cross-trait and colocalization analysis identified 9 potential loci and 13 significant independent SNPs. Gene-based association analysis reported 9 genes significant across at least three methods, with IL6R being the shared gene identified by all four methods, highlighting potential shared biological mechanisms involving immune responses and inflammatory activities. In conclusion, our study revealed shared genetic associations between the genetically predicted CHA<sub>2</sub>DS<sub>2</sub>-VASc score and CES, which was supported by causal relationship, shared loci, and genetic correlation analyses.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"27 ","pages":"Article 200514"},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-09DOI: 10.1016/j.ijcrp.2025.200509
Sazzli Kasim , Putri Nur Fatin Amir Rudin , Xue Ning Kiew , Nurulain Ibrahim , Nafiza Mat Nasir , Lim Bing Feng , Hanis Hamidi , Khairul Shafiq Ibrahim , Raja Ezman Raja Shariff , Suraya Abdul-Razak , Kazuaki Negishi , Sorayya Malek
Objectives
This study aimed to develop and validate a machine learning (ML)–based model for cardiovascular disease (CVD) risk prediction in a Malaysian cohort representative of the Southeast Asian population.
Methods
Data from the Responding to Increasing Cardiovascular Disease Prevalence (REDISCOVER) Study, including 10,044 participants, were analyzed, with 4,299 cases retained after exclusions. The dataset was split into training (70 %) and validation (30 %) subsets. Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM) models were developed using feature selection techniques such as recursive feature elimination (RFE) and sequential backward elimination (SBE). Model performance was evaluated using the area under the curve (AUC), sensitivity, specificity, calibration, and Net Reclassification Index (NRI).
Findings
Among the models evaluated, the SVM model with SBE-selected features performed best, achieving an AUC of 0.800. This was higher than the Framingham Risk Score (FRS; AUC = 0.693), Revised Pooled Cohort Equations (RPCE; AUC = 0.744), and WHO CVD charts (AUC = 0.741). NRI analysis showed significant improvements compared to FRS and RPCE (17.29 % and 14.23 %, respectively; p < 0.00001). Calibration analyses indicated initial overprediction by ML models, which was mitigated by Platt scaling.
Conclusion
ML-based models incorporating regionally relevant variables demonstrated improved discrimination and reclassification compared with conventional risk scores in this Malaysian cohort. Further external validation is needed to establish their utility across broader Southeast Asian populations.
{"title":"Enhancing cardiovascular risk prediction in Asian populations: A machine learning approach integrated with digital health platforms","authors":"Sazzli Kasim , Putri Nur Fatin Amir Rudin , Xue Ning Kiew , Nurulain Ibrahim , Nafiza Mat Nasir , Lim Bing Feng , Hanis Hamidi , Khairul Shafiq Ibrahim , Raja Ezman Raja Shariff , Suraya Abdul-Razak , Kazuaki Negishi , Sorayya Malek","doi":"10.1016/j.ijcrp.2025.200509","DOIUrl":"10.1016/j.ijcrp.2025.200509","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to develop and validate a machine learning (ML)–based model for cardiovascular disease (CVD) risk prediction in a Malaysian cohort representative of the Southeast Asian population.</div></div><div><h3>Methods</h3><div>Data from the Responding to Increasing Cardiovascular Disease Prevalence (REDISCOVER) Study, including 10,044 participants, were analyzed, with 4,299 cases retained after exclusions. The dataset was split into training (70 %) and validation (30 %) subsets. Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM) models were developed using feature selection techniques such as recursive feature elimination (RFE) and sequential backward elimination (SBE). Model performance was evaluated using the area under the curve (AUC), sensitivity, specificity, calibration, and Net Reclassification Index (NRI).</div></div><div><h3>Findings</h3><div>Among the models evaluated, the SVM model with SBE-selected features performed best, achieving an AUC of 0.800. This was higher than the Framingham Risk Score (FRS; AUC = 0.693), Revised Pooled Cohort Equations (RPCE; AUC = 0.744), and WHO CVD charts (AUC = 0.741). NRI analysis showed significant improvements compared to FRS and RPCE (17.29 % and 14.23 %, respectively; p < 0.00001). Calibration analyses indicated initial overprediction by ML models, which was mitigated by Platt scaling.</div></div><div><h3>Conclusion</h3><div>ML-based models incorporating regionally relevant variables demonstrated improved discrimination and reclassification compared with conventional risk scores in this Malaysian cohort. Further external validation is needed to establish their utility across broader Southeast Asian populations.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"27 ","pages":"Article 200509"},"PeriodicalIF":2.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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