BMC Cardiovascular Disorders最新文献

Background: Heart failure (HF) is a clinical syndrome with high global incidence and mortality, imposing a substantial economic burden. While creatinine (Cr) and body weight (BW) individually influence HF progression, the prognostic role of the creatinine-to-body weight ratio (CWR) remains unclear. This study investigates the association between CWR and mortality in HF patients, aiming to identify high-risk individuals and inform prognosis.

Methods: Patient data were extracted from the MIMIC-IV database. Participants were first stratified into CWR index quartiles to categorize the cohort. The primary endpoints were 30- and 365-day all-cause mortality, while secondary endpoints included 90- and 180-day mortality. Kaplan-Meier curves with log-rank tests were then used to compare survival across quartiles. Next, Cox proportional hazards regression (with sequential model adjustment) and restricted cubic spline (RCS) analysis assessed the association between CWR and prognosis. Sensitivity analyses were subsequently conducted to examine the robustness of the non-linear relationship, and subgroup analyses explored potential effect modifications. Finally, time-dependent receiver operating characteristic (ROC) curve analyses compared the predictive performance of CWR against traditional markers.

Results: Among 4,371 participants (median age: 75 years; 54.8% male), higher CWR index values were significantly associated with increased all-cause mortality risks at 30, 90, 180, and 365 days, as demonstrated by Kaplan-Meier survival curves (log-rank P < 0.01). Building on these results, Cox regression analysis further revealed that individuals in the highest CWR index quartile had an elevated risk of death compared to those in lower quartiles. Additionally, restricted cubic spline (RCS) analysis showed a robust biphasic nonlinear association between the CWR index and mortality, identifying 0.05 as a key threshold where the risk relationship changes. Specifically, for most patients (CWR ≤ 0.05), mortality risk increases with rising CWR values until it plateaus, whereas for those with CWR > 0.05 (n = 320), a distinct pathophysiological state may emerge, marked by a sharp increase in risk. The underlying mechanisms require further investigation.

Conclusion: CWR demonstrates a robust biphasic association with mortality, identifying 0.05 as a critical threshold separating a risk-plateau phase from extreme high-risk. Its stable prognostic value suggests CWR may integrate acute hemodynamic and chronic metabolic stress, though prospective validation is warranted.

Background: The Metabolic Score for Visceral Fat (METS-VF) is a novel index reflecting visceral adiposity and metabolic dysfunction, but its association with incident cardiovascular disease (CVD) in adults with Cardiovascular-Kidney-Metabolic (CKM) syndrome stages 0-3 remains unclear. This study aimed to explore this association and quantify the mediating effect of estimated glucose disposal rate (eGDR).

Methods: Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), we prospectively followed 3,815 adults with CKM syndrome stages 0-3 (baseline 2015) until 2020. The METS-VF profiles comprised baseline METS-VF, cumulative METS-VF, and change patterns identified by latent class growth modeling (LCGM). To investigate associations and underlying mechanisms, Cox proportional-hazards regression, weighted quantile sum (WQS) regression, and mediation analysis were employed. Sensitivity analyses (stratification by CKM syndrome stage and demographics, inverse probability weighting [IPW], Fine-Gray model) were used to support the robustness of the results.

Results: Over a mean 4.4-year follow-up, 18.7% of participants developed CVD. In the fully adjusted model, elevated METS-VF profiles were associated with an increased risk of CVD: baseline METS-VF in the fourth quartile (HR = 1.615, 95% confidence interval (CI): 1.243-2.097), cumulative METS-VF in the fourth quartile (HR = 1.824, 95% CI: 1.397-2.381), and stable high-level METS-VF (Class 3) (HR = 1.288, 95% CI: 1.033-1.610). All associations remained significant following false discovery rate (FDR) correction. Stratified analyses showed stronger associations between METS-VF profiles and incident CVD in late-stage (vs. early-stage) CKM syndrome, with the association more pronounced in males-females only had significant associations in the highest quartile. WQS regression identified Metabolic Score for Insulin Resistance (METS-IR) as the primary contributing factor, with weights of 0.397 in 2011 and 0.375 in 2015. Mediation analysis indicated that eGDR mediated 65.38% of the baseline and 56.72% of the cumulative effects (both P < 0.001). Supplementary mediation analysis using body mass index (BMI)-based METS-VF_BMI produced consistent findings.

Conclusions: METS-VF profiles are independently associated with incident CVD in CKM syndrome stages 0-3, more strongly in late stages. eGDR significantly mediates this relationship, supporting the "obesity-metabolism-vascular" axis. METS-VF may aid CVD risk stratification in CKM syndrome populations, and targeting insulin sensitivity may mitigate CVD risk.