International Journal of Cardiology Cardiovascular Risk and Prevention最新文献_第8页

Efficacy and safety of antihypertensive drugs deprescribing in older adults: A systematic review and meta-analysis of randomized controlled trials 老年人降压药的有效性和安全性：随机对照试验的系统回顾和荟萃分析

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-30 DOI: 10.1016/j.ijcrp.2025.200570

Amal A. Alsubaiei , Saud A. Alyahya , Ahmed Emara , Shaikha J. Aldeyain , Mohammad F. Alenezi , Rawan A. Almutairi , Batoul H. Aljaber , Izuddin A. Rawashdeh , Abdel-Rahman Qamar , Abdullah M. Alharran

Background

Although antihypertensive therapy is beneficial, aggressive treatment in frail, multimorbid older adults may increase adverse outcomes such as falls and hypotension. Deprescribing has emerged as a potential strategy to reduce these risks, but evidence regarding its safety remains limited. This systematic review and meta-analysis assessed the clinical outcomes of antihypertensive deprescribing in older adults.

Methods

PubMed, Scopus, CENTRAL, and Web of Science were searched for randomized controlled trials (RCTs) published up to October 2025 comparing antihypertensive deprescribing with usual care. Primary outcomes were all-cause mortality, cardiovascular mortality, and all-cause hospitalizations. Secondary outcomes included major adverse cardiovascular events (MACE), serious adverse events (SAEs), and falls. Pooled risk ratios (RRs) were calculated using a random-effects model.

Results

Four RCTs involving 2173 participants were included. Deprescribing showed no significant difference versus usual care in all-cause mortality (RR 1.02, 95 % CI 0.93–1.12), cardiovascular mortality (RR 1.11, 95 % CI 0.80–1.55), or all-cause hospitalizations (RR 0.95, 95 % CI 0.85–1.05). No significant differences were observed for MACE (RR 1.09, 95 % CI 0.90–1.33), MI (RR 0.76, 95 % CI 0.42–1.38), stroke (RR 1.12, 95 % CI 0.66–1.89), SAEs (RR 1.08, 95 % CI 0.90–1.30), or falls (RR 1.00, 95 % CI 0.89–1.13).

Conclusion

In older adults, a strategy of deprescribing antihypertensive drugs was not associated with an increased risk of mortality, MACE, or other SAEs. Despite that these findings provide reassuring evidence for deprescribing strategies, the current evidence base remains limited and uncertain, warranting caution and strict clinical monitoring.

背景：虽然降压治疗是有益的，但对体弱多病的老年人进行积极治疗可能会增加跌倒和低血压等不良后果。开处方已成为降低这些风险的潜在策略，但关于其安全性的证据仍然有限。本系统综述和荟萃分析评估了老年人抗高血压处方的临床结果。方法检索spubmed、Scopus、CENTRAL和Web of Science截至2025年10月发表的随机对照试验（rct），比较降压药与常规治疗。主要结局是全因死亡率、心血管死亡率和全因住院。次要结局包括主要不良心血管事件（MACE）、严重不良事件（SAEs）和跌倒。综合风险比（rr）采用随机效应模型计算。结果共纳入4项随机对照试验，共2173名受试者。在全因死亡率（RR 1.02, 95% CI 0.93-1.12）、心血管死亡率（RR 1.11, 95% CI 0.80-1.55）或全因住院率（RR 0.95, 95% CI 0.85-1.05）方面，处方解除与常规护理没有显著差异。MACE （RR 1.09, 95% CI 0.90-1.33）、MI （RR 0.76, 95% CI 0.42-1.38）、卒中（RR 1.12, 95% CI 0.66-1.89）、SAEs （RR 1.08, 95% CI 0.90-1.30）或跌倒（RR 1.00, 95% CI 0.89-1.13）无显著差异。结论：在老年人中，降压药处方与死亡率、MACE或其他SAEs的风险增加无关。尽管这些发现为处方策略提供了可靠的证据，但目前的证据基础仍然有限和不确定，需要谨慎和严格的临床监测。

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引用次数: 0

Life’s Essential 8 and cardiovascular health: Protective effects on chronic respiratory diseases 生命必需品和心血管健康：对慢性呼吸系统疾病的保护作用

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-24 DOI: 10.1016/j.ijcrp.2025.200567

Jianli Ma , Xiyu Cao , Zhipeng Ma , Xiao Liu , Hualing Wang , Ke Liu , Xinyu Li , Chuantao Zhang

Background

Chronic respiratory diseases (CRDs) pose a global health challenge. While individual lifestyle factors are known to influence CRDs risk, the collective role of comprehensive cardiovascular health (CVH) metrics remains less clear. Life’s Essential 8 (LE8) provides a holistic measure of CVH, but its association with CRDs and related mortality is not well-established at the population level.

Methods

The observational study was based on the US National Health and Nutrition Examination Survey (NHANES 2007–2018). We adjusted for confounding factors and used survey-weighted logistic regression analysis to assess the association between LE8 and the risk of CRDs and the subtypes. Restricted cubic splines (RCS) evaluated non-linear relationships. Subgroup and sensitivity analyses were also conducted. Cox models investigated LE8’s impact on all-cause and chronic lower respiratory diseases (CLRDs) mortality.

Results

The observational study included 30,863 participants. After adjusting for confounders, survey-weighted logistic regression demonstrates a negative association between LE8 and the risk of CRDs and the four subtypes, with emphysema showing the most significant association (OR = 0.96, 95 % CI: 0.95, 0.97, P < 0.001). RCS suggests a non-linear relationship between LE8 and CRDs. Subgroup and sensitivity analyses confirm the robustness of the results. Compared to individuals with low CVH, those with high CVH have lower risks of all-cause mortality and CLRDs mortality (HR = 0.82, 95 % CI: 0.71, 0.93, P = 0.003; HR = 0.27, 95 % CI: 0.08, 0.88, P = 0.030).

Conclusion

LE8 inversely correlates with CRDs, and high CVH protects against all-cause and CLRDs mortality.

慢性呼吸系统疾病（CRDs）是一个全球性的健康挑战。虽然已知个人生活方式因素会影响心血管疾病的风险，但综合心血管健康（CVH）指标的集体作用仍不太清楚。生命基本8 （Life 's Essential 8, LE8）提供了CVH的整体衡量指标，但其与CRDs和相关死亡率的关系在人群水平上尚未得到证实。方法观察性研究基于美国国家健康与营养检查调查（NHANES 2007-2018）。我们调整了混杂因素，并使用调查加权逻辑回归分析来评估LE8与CRDs风险和亚型之间的关系。限制三次样条（RCS）评估非线性关系。并进行了亚组分析和敏感性分析。Cox模型研究了LE8对全因和慢性下呼吸道疾病（clrd）死亡率的影响。结果观察性研究包括30,863名参与者。在调整混杂因素后，调查加权逻辑回归显示LE8与CRDs和四种亚型的风险呈负相关，其中肺气肿的相关性最显著（OR = 0.96, 95% CI: 0.95, 0.97, P < 0.001）。RCS提示LE8与CRDs之间存在非线性关系。亚组分析和敏感性分析证实了结果的稳健性。与低CVH个体相比，高CVH个体的全因死亡率和clrd死亡率风险较低（HR = 0.82, 95% CI: 0.71, 0.93, P = 0.003; HR = 0.27, 95% CI: 0.08, 0.88, P = 0.030）。结论le8与冠心病呈负相关，高CVH可降低全因死亡率和冠心病死亡率。

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引用次数: 0

Prognostic value of the left atrioventricular coupling index for adverse cardiac outcomes in hypertrophic cardiomyopathy 肥厚性心肌病患者左房室耦合指数对不良心脏预后的预测价值

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-24 DOI: 10.1016/j.ijcrp.2025.200566

Sittinop Titichoatrattana , Ing-orn Arunakul , Paisit Kosum , Aree Maitaothong , Em-on Puripun , Monravee Tumkosit , Yongkasem Vorasettakarnkij , Pairoj Chattranukulchai , Nonthikorn Theerasuwipakorn

Background

Hypertrophic cardiomyopathy (HCM) involves left atrial remodeling linked to adverse outcomes such as death, heart failure, and atrial fibrillation (AF). The left atrioventricular coupling index (LACI) reflects atrial–ventricular interaction, but its prognostic role in HCM is unclear. The objective of this study is to evaluate the prognostic value of cardiac magnetic resonance imaging (CMR)-derived LACI and identify optimal cut-offs for predicting adverse outcomes in HCM.

Methods

This retrospective cohort study included HCM patients who underwent CMR with at least 1 year of follow-up. LACI was calculated as the ratio of left atrial to left ventricular end-diastolic volume. Associations between LACI and outcomes were analyzed using Cox regression. The primary outcome was a composite endpoint of all-cause death and hospitalization for heart failure (HHF). Secondary outcomes included all-cause death, HHF, and new-onset AF. Receiver operating characteristic (ROC) analysis determined optimal LACI cut-offs.

Results

Among 183 patients (median age 61 years; 59 % male) followed for 4.2 years, 53 (29 %) reached the primary endpoint. Elevated LACI independently predicted the primary composite endpoint (≥0.41: aHR 2.24, 95 %CI: 1.19, 4.24, p = 0.013), HHF (≥0.44: aHR 4.54, 95 %CI: 1.69, 12.19, p = 0.003), and new-onset AF (≥0.44: aHR 3.06, 95 %CI: 1.26, 7.43, p = 0.003) but not all-cause death.

Conclusion

CMR-derived LACI independently predicted adverse outcomes in HCM, offering a reproducible marker for improved risk stratification.

肥厚性心肌病（HCM）涉及左心房重构，与死亡、心力衰竭和心房颤动（AF）等不良结局相关。左房室耦合指数（LACI）反映房室相互作用，但其在HCM中的预后作用尚不清楚。本研究的目的是评估心脏磁共振成像（CMR）衍生的LACI的预后价值，并确定预测HCM不良结局的最佳截止值。方法本回顾性队列研究纳入了接受CMR治疗的HCM患者，随访至少1年。LACI计算为左房容积与左室舒张末期容积之比。采用Cox回归分析LACI与预后之间的关系。主要终点是全因死亡和心力衰竭住院（HHF）的复合终点。次要结局包括全因死亡、HHF和新发房颤。受试者工作特征（ROC）分析确定了最佳LACI截止值。结果183例患者（中位年龄61岁，59%为男性）随访4.2年，53例（29%）达到主要终点。升高的LACI独立预测主要复合终点（≥0.41:aHR 2.24, 95% CI: 1.19, 4.24, p = 0.013）、HHF（≥0.44:aHR 4.54, 95% CI: 1.69, 12.19, p = 0.003）和新发AF(≥0.44:aHR 3.06, 95% CI: 1.26, 7.43, p = 0.003)，但不能预测全因死亡。结论cmr衍生的LACI可独立预测HCM的不良结局，为改善风险分层提供了可重复的标记。

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引用次数: 0

Efficacy and safety of proprotein convertase subtilisin/kexin type 9 inhibitors for adults with familial hypercholesterolemia: A network meta-analysis 蛋白转化酶枯草杆菌素/kexin 9型抑制剂治疗成人家族性高胆固醇血症的疗效和安全性：网络荟萃分析

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-24 DOI: 10.1016/j.ijcrp.2025.200568

Weiwei Ding , Lingyao Sun , Yun Shi, Lei Tian

Purpose

The comparative efficacy and safety profiles of PCSK9 inhibitors in familial hypercholesterolemia (FH), including genotype-dependent treatment responses, remain unclear.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Meta-Analyses guidelines. A network meta-analysis of randomized clinical trials evaluating the use of PCSK9 inhibitors for the treatment of FH patients, including subgroup analyses of efficacy, was performed.

Results

Fifteen randomized clinical trials (n = 2954 patients) were included. All PCSK9 inhibitors significantly improved lipid parameters compared to control. In heterozygous FH (HeFH) populations, ongericimab showed the greatest reductions in LDL-C (mean difference [MD]: −74.98 %), ApoB (MD: −64.64 %), and Lp(a) (MD: −59.66 %), with SUCRA rankings of 68.7 %, 63.6 %, and 95.0 %, respectively. However, these results are based on a single trial and require further validation. No significant lipid-lowering effects were observed in HoFH patients. In terms of safety, lerodalcibep showed the most favorable profile for injection-site reactions and ALT >3 × ULN, with SUCRA values of 98.5 % and 96.7 %, respectively. Inclisiran was associated with a significantly higher risk of injection-site reactions.

Conclusion

PCSK9 inhibitors generally show favorable efficacy and safety in FH patients. However, comparative rankings and point estimates should be interpreted with caution due to funnel plot asymmetry for LDL-C and imbalances in trial data. Ongericimab demonstrated promising results in HeFH, but further validation is required. Inclisiran's efficacy may be underestimated due to short-term follow-up. Monotherapy with PCSK9 inhibitors has limited efficacy in HoFH patients, highlighting the need for combination therapies.

目的PCSK9抑制剂治疗家族性高胆固醇血症（FH）的比较疗效和安全性，包括基因型依赖的治疗反应，尚不清楚。方法本系统评价按照meta分析指南的首选报告项目进行。对随机临床试验进行网络荟萃分析，评估PCSK9抑制剂治疗FH患者的使用，包括疗效的亚组分析。结果纳入15项随机临床试验（n = 2954例）。与对照组相比，所有PCSK9抑制剂均显著改善了脂质参数。在杂合子FH （HeFH）人群中，ongericimab显示LDL-C（平均差值[MD]: - 74.98%）， ApoB （MD: - 64.64%）和Lp(a) （MD: - 59.66%）的最大降低，SUCRA排名分别为68.7%，63.6%和95.0%。然而，这些结果是基于单一试验，需要进一步验证。在HoFH患者中未观察到明显的降脂效果。在安全性方面，莱罗达西别普在注射部位反应和ALT >；3 × ULN方面表现出最有利的特征，SUCRA值分别为98.5%和96.7%。Inclisiran与注射部位反应的风险显著升高相关。结论pcsk9抑制剂对FH患者普遍具有良好的疗效和安全性。然而，由于LDL-C的漏斗图不对称和试验数据的不平衡，比较排名和点估计应该谨慎解释。昂吉瑞单抗在HeFH中显示出令人鼓舞的结果，但需要进一步验证。由于短期随访，可能低估了Inclisiran的疗效。PCSK9抑制剂单药治疗对HoFH患者的疗效有限，因此需要联合治疗。

{"title":"Efficacy and safety of proprotein convertase subtilisin/kexin type 9 inhibitors for adults with familial hypercholesterolemia: A network meta-analysis","authors":"Weiwei Ding , Lingyao Sun , Yun Shi, Lei Tian","doi":"10.1016/j.ijcrp.2025.200568","DOIUrl":"10.1016/j.ijcrp.2025.200568","url":null,"abstract":"<div><h3>Purpose</h3><div>The comparative efficacy and safety profiles of PCSK9 inhibitors in familial hypercholesterolemia (FH), including genotype-dependent treatment responses, remain unclear.</div></div><div><h3>Methods</h3><div>This systematic review was conducted in accordance with the Preferred Reporting Items for Meta-Analyses guidelines. A network meta-analysis of randomized clinical trials evaluating the use of PCSK9 inhibitors for the treatment of FH patients, including subgroup analyses of efficacy, was performed.</div></div><div><h3>Results</h3><div>Fifteen randomized clinical trials (n = 2954 patients) were included. All PCSK9 inhibitors significantly improved lipid parameters compared to control. In heterozygous FH (HeFH) populations, ongericimab showed the greatest reductions in LDL-C (mean difference [MD]: −74.98 %), ApoB (MD: −64.64 %), and Lp(a) (MD: −59.66 %), with SUCRA rankings of 68.7 %, 63.6 %, and 95.0 %, respectively. However, these results are based on a single trial and require further validation. No significant lipid-lowering effects were observed in HoFH patients. In terms of safety, lerodalcibep showed the most favorable profile for injection-site reactions and ALT >3 × ULN, with SUCRA values of 98.5 % and 96.7 %, respectively. Inclisiran was associated with a significantly higher risk of injection-site reactions.</div></div><div><h3>Conclusion</h3><div>PCSK9 inhibitors generally show favorable efficacy and safety in FH patients. However, comparative rankings and point estimates should be interpreted with caution due to funnel plot asymmetry for LDL-C and imbalances in trial data. Ongericimab demonstrated promising results in HeFH, but further validation is required. Inclisiran's efficacy may be underestimated due to short-term follow-up. Monotherapy with PCSK9 inhibitors has limited efficacy in HoFH patients, highlighting the need for combination therapies.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200568"},"PeriodicalIF":2.1,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925352","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}

引用次数: 0

Housing distance, salt intake and cardiovascular risk in rural Aceh Tamiang: Insights utilizing the WHO 10-year non-laboratory assessment 居住距离、盐摄入量和亚齐Tamiang农村心血管风险：利用世卫组织10年非实验室评估的见解

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-21 DOI: 10.1016/j.ijcrp.2025.200560

Nadya Keumala Fitri , Bahagia Willibrordus Maria Nainggolan , Yusrina Br Saragih , Dina Keumala Sari

Background

Assessing cardiovascular disease (CVD) risk is a major challenge in rural areas due to limited access and resources. Addressing this issue is crucial for developing effective public health interventions.

Methods

This cross-sectional study utilized the World Health Organization (WHO) 10-year cardiovascular risk assessment charts. Variables included housing distance to the nearest community health center (CHC), salt consumption, and physical activity. Data were analyzed using logistic regression.

Findings

Among 1000 participants, 24.6 % were classified as high-risk. Significant predictors included salt consumption (odds ratio [OR] = 3.87, 95 % CI: 2.46–6.06) and distance to the CHC (OR = 2.2, 95 % CI: 1.44–3.35). The predicted probability of high CVD risk is related to with both housing distance (Estimate = 0.098, SE = 0.018, z = 5.45, p < 0.001) and salt consumption (Estimate = 1.524, SE = 0.158, z = 9.63, p < 0.001).

Conclusion

This study highlights the significance of modifiable factors, specifically higher salt consumption and greater distance to a CHC, on CVD risk in a rural Indonesian population.

由于获取途径和资源有限，评估心血管疾病（CVD）风险在农村地区是一项重大挑战。解决这一问题对于制定有效的公共卫生干预措施至关重要。方法本研究采用世界卫生组织（WHO） 10年心血管风险评估图。变量包括到最近的社区卫生中心（CHC）的住房距离、盐摄入量和身体活动。数据采用逻辑回归分析。在1000名参与者中，24.6%的人被列为高危人群。显著预测因子包括盐摄入量（比值比[OR] = 3.87, 95% CI: 2.46-6.06）和与CHC的距离（OR = 2.2, 95% CI: 1.44-3.35）。预测的心血管疾病高风险概率与居住距离（估计值= 0.098,SE = 0.018, z = 5.45, p < 0.001）和食盐摄入量（估计值= 1.524,SE = 0.158, z = 9.63, p < 0.001）有关。结论：本研究强调了印尼农村人群心血管疾病风险的可改变因素的重要性，特别是较高的盐摄入量和距离CHC较远。

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引用次数: 0

Global burden of non-rheumatic calcific aortic valve disease in adults aged 60 years and older, with projections to 2041: insights from the Global Burden of Disease Study 2021 60岁及以上成人非风湿性钙化主动脉瓣疾病的全球负担，预测到2041年：来自2021年全球疾病负担研究的见解

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-18 DOI: 10.1016/j.ijcrp.2025.200565

Jie Tan , Xiaoqing Fu , Xiaoqi Li , Xiaorui Zhao , Wenqi Huang , Jing Huang , Li Xu

Background

This study aimed to explore the most recent trends in NRCAVD burden among adults aged 60 years and older and to further predict trends up to 2041.

Methods

We estimated the age-standardized incidence (ASIR), prevalence (ASPR), disability-adjusted life years (DALYs) (ASDALYsR) and death rates (ASDR) of NRCAVD in adults aged ≥60 years from 1990 to 2021 using data from the 2021 Global Burden of Disease Study. Temporal trends were quantified using average annual percent change and projections to 2041 were made using the Nordpred model.

Results

Globally, in 2021, NRCAVD affected 11.78 million older adults (ASPR: 1122.7/100,000), with 0.84 million new cases (ASIR: 77.3/100,000), resulting in 132,764 deaths (ASDR: 13.7/100,000) and an ASDALYsR of 182 per 100,000. From 1990 to 2021, global ASIR and ASPR increased significantly (22.1 % and 24.8 %, respectively), while ASDALYsR and ASDR declined. High-income regions exhibited the greatest disease burden, notably High-income North America and Western Europe. Marked sex-based differences existed, with males showing higher burden compared to females. Projections indicate that by 2041, the absolute number of cases will rise by 72.1 %.

Conclusions

The global burden of NRCAVD in older adults is substantial and varies by age, gender, socio-demographic index, and region. Despite declining age-standardized rates, the absolute burden of NRCAVD will increase, highlighting the need for early screening and improved treatment access.

本研究旨在探讨60岁及以上成人NRCAVD负担的最新趋势，并进一步预测到2041年的趋势。方法利用2021年全球疾病负担研究的数据，估计1990年至2021年年龄≥60岁成人NRCAVD的年龄标准化发病率（ASIR）、患病率（ASPR）、残疾调整生命年（DALYs）（ASDALYsR）和死亡率（ASDR）。使用年均百分比变化量化了时间趋势，并使用Nordpred模式进行了到2041年的预估。结果在全球范围内，2021年NRCAVD影响了1178万老年人（ASPR: 1122.7/10万），新发病例84万（ASIR: 77.3/10万），导致132764例死亡（ASDR: 13.7/10万），ASDALYsR为182 /10万。从1990年到2021年，全球ASIR和ASPR显著上升（分别为22.1%和24.8%），而ASDALYsR和ASDR下降。高收入地区表现出最大的疾病负担，特别是高收入的北美和西欧。存在明显的性别差异，男性的负担高于女性。预测表明，到2041年，病例的绝对数量将增加72.1%。结论全球老年人NRCAVD负担巨大，且因年龄、性别、社会人口指数和地区而异。尽管年龄标准化率下降，但NRCAVD的绝对负担将增加，这突出了早期筛查和改善治疗机会的必要性。

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引用次数: 0

Global burden and cross-country inequalities of alcoholic cardiomyopathy: A 1990–2021 analysis 酒精性心肌病的全球负担和跨国不平等：1990-2021年分析

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-15 DOI: 10.1016/j.ijcrp.2025.200561

Mingze Zheng , Chuang Sun , Ming Li , Hongwei Xiang , He Ren , Jin Cheng

Introduction

Alcoholic cardiomyopathy (ACM) remains a significant yet understudied contributor to global cardiovascular disease, with substantial socioeconomic influences on its epidemiology. This study investigates the global burden, temporal trends, and health inequalities of ACM across 204 countries.

Methods

Utilizing the Global Burden of Disease 2021 data (1990–2021), we analyzed age-standardised mortality (ASMR), prevalence (ASPR), and disability-adjusted life years (ASDR) for populations aged ≥15 years. A trend analysis employed the estimated annual percentage change (EAPC), while inequality metrics (Slope Index of Inequality, Concentration Index) assessed socioeconomic disparities using the socio-demographic index (SDI).

Results

Globally, ACM caused 47,073 deaths and 2.19 million DALYs in 2021, with an overall decreasing trend (ASMR EAPC: −1.72 %). High-middle SDI regions bore the highest burden (ASDR: 88.27/100,000), particularly Eastern Europe (ASDR: 510.47). We identified a distinct nonlinear relationship with SDI: burden peaked at SDI≈0.75 (p < 0.001), with Eastern Europe showing the steepest rise/decline. Inequality analysis revealed persistent concentration in high-SDI regions (positive concentration indices: 0.51–0.60), though relative inequalities decreased over time. Kazakhstan exhibited the most rapid burden increase (ASMR EAPC: +11.15 %), while Southern Latin America showed maximal decline (ASMR EAPC: −6.69 %).

Conclusions

ACM disparities are strongly linked to socioeconomic development, highlighting the need for targeted alcohol policies in high-burden regions and equitable healthcare resource allocation.

酒精性心肌病（ACM）仍然是全球心血管疾病的一个重要但尚未得到充分研究的因素，其流行病学具有重大的社会经济影响。本研究调查了204个国家的全球负担、时间趋势和ACM的健康不平等。方法利用全球疾病负担2021数据（1990-2021），分析年龄≥15岁人群的年龄标准化死亡率（ASMR）、患病率（ASPR）和残疾调整生命年（ASDR）。趋势分析采用估计的年百分比变化（EAPC），而不平等指标（不平等斜率指数，集中指数）使用社会人口指数（SDI）评估社会经济差异。结果在全球范围内，2021年ACM导致47073人死亡，219万DALYs，总体呈下降趋势（ASMR EAPC: - 1.72%）。中高SDI地区负担最重（ASDR: 88.27/10万），特别是东欧（ASDR: 510.47）。我们发现了与SDI之间明显的非线性关系：负担在SDI≈0.75时达到峰值（p < 0.001），东欧表现出最急剧的上升/下降。不平等分析显示，尽管相对不平等随着时间的推移而减少，但高sdi地区的浓度持续存在（阳性浓度指数：0.51-0.60）。哈萨克斯坦的负担增长最快（ASMR EAPC: + 11.15%），而拉丁美洲南部的负担下降最快（ASMR EAPC: - 6.69%）。结论sacm差异与社会经济发展密切相关，强调高负担地区需要有针对性的酒精政策和公平的医疗资源分配。

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引用次数: 0

Efficacy and comparative performance of machine learning models for stroke risk prediction in hypertensive patients: A systematic review and meta-analysis 高血压患者卒中风险预测的机器学习模型的疗效和比较性能：系统回顾和荟萃分析

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-15 DOI: 10.1016/j.ijcrp.2025.200564

Pooya Eini , Mohammad Rezayee , Milan Kassulke , Jason Tremblay

Background

Stroke poses a significant health burden among hypertensive patients, where traditional risk models often lack precision. Machine learning (ML) has shown promise in enhancing prediction accuracy by integrating diverse data sources.

Methods

Following PRISMA guidelines, we searched 5 databases from inception to September 2025. Eligible studies reported the performance of ML models in hypertensive cohorts. Data were pooled using random-effects models, with heterogeneity assessed via I², subgroup analyses, meta-regression, and leave-one-out sensitivity. The risk of bias was evaluated using PROBAST + AI, and the evidence quality was assessed using the GRADE approach.

Results

Ten studies (n = 13,299 stroke cases) were included. Pooled sensitivity was 0.88 (95 % CI: 0.80–0.93), specificity 0.88 (95 % CI: 0.77–0.94), positive likelihood ratio 7.1 (95 % CI: 3.4–15.1), negative likelihood ratio 0.14 (95 % CI: 0.08–0.26), and AUC-ROC 0.94 (95 % CI: 0.91–0.96), indicating good discriminative ability. Heterogeneity was high for both sensitivity (I² = 79.5 %) and specificity (I² = 76.8 %), potentially due to variations in study design and populations. Subgroup analyses showed consistent performance in Chinese studies (sensitivity 0.85, specificity 0.84) and those using multimodal features (sensitivity 0.84, specificity 0.83), with higher sensitivity for ischemic/hemorrhagic-specific models (0.90). Meta-regression explained 73.9 % of variance and No publication bias was detected (Deeks' p = 0.654).

Conclusion

ML models demonstrate good performance for stroke prediction in hypertensive patients. However, heterogeneity underscores the need for standardized approaches. This evidence, rated moderate by GRADE, supports ML integration in clinical practice for improved prevention.

背景中风是高血压患者的重要健康负担，传统的风险模型往往缺乏准确性。机器学习（ML）已经显示出通过整合不同的数据源来提高预测准确性的希望。方法按照PRISMA指南检索5个数据库，检索时间为成立至2025年9月。符合条件的研究报告了ML模型在高血压队列中的表现。使用随机效应模型汇总数据，通过I2、亚组分析、meta回归和遗漏敏感性评估异质性。使用PROBAST + AI评估偏倚风险，使用GRADE方法评估证据质量。结果纳入10项研究（n = 13299例）。合并敏感性为0.88 (95% CI: 0.80 ~ 0.93)，特异性为0.88 (95% CI: 0.77 ~ 0.94)，阳性似然比为7.1 (95% CI: 3.4 ~ 15.1)，阴性似然比为0.14 (95% CI: 0.08 ~ 0.26)， AUC-ROC为0.94 (95% CI: 0.91 ~ 0.96)，表明鉴别能力较好。敏感性（I2 = 79.5%）和特异性（I2 = 76.8%）的异质性都很高，可能是由于研究设计和人群的差异。亚组分析显示，中国研究（敏感性0.85，特异性0.84）和使用多模态特征的研究（敏感性0.84，特异性0.83）表现一致，对缺血/出血特异性模型的敏感性更高（0.90）。meta回归解释了73.9%的方差，未发现发表偏倚（Deeks’p = 0.654）。结论ml模型对高血压患者脑卒中有较好的预测效果。然而，异质性强调了标准化方法的必要性。该证据被GRADE评为中等，支持ML整合到临床实践中以改善预防。

{"title":"Efficacy and comparative performance of machine learning models for stroke risk prediction in hypertensive patients: A systematic review and meta-analysis","authors":"Pooya Eini , Mohammad Rezayee , Milan Kassulke , Jason Tremblay","doi":"10.1016/j.ijcrp.2025.200564","DOIUrl":"10.1016/j.ijcrp.2025.200564","url":null,"abstract":"<div><h3>Background</h3><div>Stroke poses a significant health burden among hypertensive patients, where traditional risk models often lack precision. Machine learning (ML) has shown promise in enhancing prediction accuracy by integrating diverse data sources.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, we searched 5 databases from inception to September 2025. Eligible studies reported the performance of ML models in hypertensive cohorts. Data were pooled using random-effects models, with heterogeneity assessed via I<sup>2</sup>, subgroup analyses, meta-regression, and leave-one-out sensitivity. The risk of bias was evaluated using PROBAST + AI, and the evidence quality was assessed using the GRADE approach.</div></div><div><h3>Results</h3><div>Ten studies (n = 13,299 stroke cases) were included. Pooled sensitivity was 0.88 (95 % CI: 0.80–0.93), specificity 0.88 (95 % CI: 0.77–0.94), positive likelihood ratio 7.1 (95 % CI: 3.4–15.1), negative likelihood ratio 0.14 (95 % CI: 0.08–0.26), and AUC-ROC 0.94 (95 % CI: 0.91–0.96), indicating good discriminative ability. Heterogeneity was high for both sensitivity (I<sup>2</sup> = 79.5 %) and specificity (I<sup>2</sup> = 76.8 %), potentially due to variations in study design and populations. Subgroup analyses showed consistent performance in Chinese studies (sensitivity 0.85, specificity 0.84) and those using multimodal features (sensitivity 0.84, specificity 0.83), with higher sensitivity for ischemic/hemorrhagic-specific models (0.90). Meta-regression explained 73.9 % of variance and No publication bias was detected (Deeks' p = 0.654).</div></div><div><h3>Conclusion</h3><div>ML models demonstrate good performance for stroke prediction in hypertensive patients. However, heterogeneity underscores the need for standardized approaches. This evidence, rated moderate by GRADE, supports ML integration in clinical practice for improved prevention.</div></div>","PeriodicalId":29726,"journal":{"name":"International Journal of Cardiology Cardiovascular Risk and Prevention","volume":"28 ","pages":"Article 200564"},"PeriodicalIF":2.1,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925353","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}

引用次数: 0

Relationship between stroke onset timing and clinical outcomes in ischemic and hemorrhagic strokes: a systematic review 缺血性和出血性脑卒中发病时间与临床结局的关系：一项系统综述

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-14 DOI: 10.1016/j.ijcrp.2025.200559

Paria Heidari , Negar Heidari , Habibolah Khazaie , Sabra Margaret Abbott , Azad Maroufi , Amir Abdolmaleki , Nader Salari , Masoud Mohammadi , Amir Sharafkhaneh

Background

Cerebrovascular accident (CVA) is a critical medical pathology caused by the interruption of cerebral blood flow and leads to neuronal injury or neurodegeneration. Generally, CVAs are classified into two primary categories of ischemic and hemorrhagic. Investigation of circadian rhythm variation at the time of CVA onset is a critical subject for patient management, clinical treatment, and further scientific research. This systematic review aimed to investigate the relationship between the timing of stroke onset and patient outcomes in both ischemic and hemorrhagic strokes.

Methods

Following searching strategy designation, international databases of Embase, PubMed, Scopus, WoS, ScienceDirect, and Google Scholar were searched using the MeSH-based keywords. No time restrictions were applied in this regard (by December 8, 2024). All English-based observational studies reporting the risk of CVA at various daytimes were enrolled for screenings and quality control. Finally, eligible studies were selected for data extraction and categorization.

Results

According to the reports, ischemic strokes strictly occur in morning hours (06:00 to 12:00) while some studies recorded a bimodal pattern (dual peaks during morning and evening). It was also established that the strokes at night were more severe and yielded more unfavorable results. Scattered reports were found regarding the hemorrhagic strokes; some papers revealed the highest incidence in the early morning hours, while others reported the late evening or nighttime occurrence. In addition, some studies showed that nighttime hemorrhagic strokes are usually associated with greater severity and unfavorable clinical outcomes.

Conclusion

This study clarified the effect of cyclic pattern on the incidence and outcome of stroke. These trends seem greatly accounted for improvement of prevention strategies, management of treatments, and enhancement of patient outcomes.

脑血管意外（cerebrovascular accident， CVA）是由脑血流中断引起的一种重要的医学病理，可导致神经元损伤或神经变性。一般来说，cva分为缺血性和出血性两大类。研究CVA发病时的昼夜节律变化对患者管理、临床治疗和进一步的科学研究至关重要。本系统综述旨在探讨缺血性和出血性卒中患者卒中发病时间与预后之间的关系。方法采用基于mesh的关键词对Embase、PubMed、Scopus、WoS、ScienceDirect、b谷歌Scholar等国际数据库进行检索。在这方面没有时间限制（到2024年12月8日）。所有以英语为基础的观察性研究均报告了不同白天发生CVA的风险，并纳入了筛查和质量控制。最后，选择符合条件的研究进行数据提取和分类。结果缺血性脑卒中主要发生在早晨（06:00 - 12:00），也有研究记录了双峰模式（早晚双峰）。研究还发现，夜间中风更严重，产生的不良后果也更多。有关出血性中风的零星报道；一些论文揭示了清晨的发病率最高，而另一些则报道了深夜或夜间的发病率。此外，一些研究表明，夜间出血性中风通常与更严重和不利的临床结果相关。结论本研究明确了循环模式对脑卒中发病率和转归的影响。这些趋势似乎在很大程度上说明了预防策略的改进、治疗的管理和患者预后的提高。

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引用次数: 0

Comment on “phenotype-specific associations of circulating adipokine levels with carotid atherosclerosis: a systematic review and meta-analysis” 对“循环脂肪因子水平与颈动脉粥样硬化的表型特异性关联：系统回顾和荟萃分析”的评论

IF 2.1 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Cardiology Cardiovascular Risk and Prevention

Pub Date : 2025-12-11 DOI: 10.1016/j.ijcrp.2025.200563

Zhenxing Deng , Bin Cao

引用次数: 0