BACKGROUND: The effect of plasma hepcidin concentrations on the long-term risk of developing adverse cardiovascular outcomes in people with type 2 diabetes mellitus (T2DM) is unclear.
METHODS: We followed for a median of 55.6 months 213 outpatients with established T2DM (45.5% women, mean age 69 ± 10 years; BMI 28.7 ± 4.7 kg/m2; median diabetes duration 11 years). Baseline plasma ferritin and hepcidin concentrations were measured with an electrochemiluminescence immunoassay and mass spectrometry-based assay, respectively. The primary study outcome was a composite of all-cause mortality or incident nonfatal cardiovascular events (inclusive of myocardial infarction, permanent atrial fibrillation, ischemic stroke, or new hospitalization for heart failure).
RESULTS: 42 patients developed the primary composite outcome over a median follow-up of 55.6 months. After stratifying patients by baseline hepcidin tertiles [1st tertile: median hepcidin 1.04 (IQR 0.50-1.95) nmol/L, 2nd tertile: 3.81 (IQR 3.01-4-42) nmol/L and 3rd tertile: 7.72 (IQR 6.37-10.4) nmol/L], the risk of developing the primary composite outcome in patients in the 3rd tertile was double that of patients in the 1st and 2nd tertile combined (unadjusted hazard ratio [HR] 2.32, 95%CI 1.27-4.26; p = 0.007). This risk was not attenuated after adjustment for age, sex, adiposity measures, smoking, hypertension, statin use, antiplatelet medication use, plasma hs-C-reactive protein and ferritin concentrations (adjusted HR 2.53, 95%CI 1.27-5.03; p = 0.008).
CONCLUSIONS: In outpatients with T2DM, higher baseline hepcidin concentrations were strongly associated with an increased long-term risk of overall mortality or nonfatal cardiovascular events, even after adjustment for established cardiovascular risk factors, plasma ferritin concentrations, medication use, and other potential confounders.

BACKGROUND: Patients with hypertension and diabetes are more susceptible to cardiovascular diseases (CVD) and mortality. This study aimed to evaluate the individual and combined effects of hypertension and diabetes on cardiovascular events and mortality in a Middle Eastern population-based cohort.
METHODS: Fifteen-year follow-up data were collected for 6323 adults aged 35 years and older who were free from CVD at baseline. The subjects were categorized into different groups according to hypertension and diabetes at baseline. Cox proportional hazards regression was implemented to estimate hazard ratios (HRs) of hypertension and diabetes for cardiovascular events (CVE), CVD mortality, and all-cause mortality. Population-attributable hazard fraction (PAHF) was used to assess the proportion of hazards of CVE and mortality attributable to hypertension or diabetes.
RESULTS: The incidence rates (95% CI) of CVE, CVE mortality, and all-cause mortality in the total population were 13.77(12.84-14.77), 3.01(2.59-3.49), and 9.92(9.15-10.77) per 1000 persons per year respectively. The HR of hypertension for CVE in the diabetic population was 1.98 (1.47-2.66) with a PAHF of 27.65(15.49-39.3). When the HRs and PAHF of diabetes were evaluated in hypertensive patients, they were statistically significant for CVE, CVE mortality, and all-cause mortality.
CONCLUSIONS: Our study indicated that the joint effect of diabetes and hypertension is the dramatic increased risk of CVE. A considerable fraction of the excess risk of CVE in patients with diabetes was attributable to hypertension, on the other hand, diabetes was associated with a substantial hazard fraction of CVE and mortality in hypertensive patients.

OBJECTIVE: To evaluate the predictive power of the high-sensitivity C-reactive protein (hs-CRP) to albumin (Alb) ratio for cardiovascular events in patients receiving maintenance hemodialysis (MHD) for end-stage renal disease (ESRD).
METHODS: This retrospective study enrolled 202 ESRD patients undergoing MHD at Bobai County People\'s Hospital from November 2020 to November 2022, with follow-up extending to November 2023. Patients were divided into two groups based on the occurrence of cardiovascular events during follow-up: the occurrence group (n = 92) and the non-occurrence group (n = 110). Clinical data were compared between these groups. Independent risk factors for cardiovascular events post-MHD were identified using a multivariate logistic regression model. The hs-CRP/Alb ratio\'s predictive utility was assessed through receiver operating characteristic (ROC) curve analysis, establishing an optimal cutoff value. A decision tree prediction model was developed to further delineate the probability of cardiovascular events.
RESULTS: The occurrence group was older and had a longer duration of dialysis compared to the non-occurrence group (P < 0.05). They also showed a higher prevalence of diabetic and hypertensive nephropathy and a higher proportion of smokers (all P < 0.05). Notably lower levels of hemoglobin (HGB), triglycerides, total cholesterol, low-density lipoprotein, albumin (Alb), and calcium were detected (all P < 0.05), whereas β2-microglobulin (β2-mg), hs-CRP, phosphorus, and the hs-CRP/Alb ratio were markedly increased (all P < 0.05). Multivariate analysis revealed diabetic nephropathy or hypertensive nephropathy, a high hs-CRP/Alb ratio, and elevated phosphorus levels as risk factors for cardiovascular events, while high hemoglobin levels were protective (P < 0.05). The ROC analysis indicated the hs-CRP/Alb ratio (AUC = 0.884) outperformed other predictors with an optimal cutoff at 0.111. Patients with a hs-CRP/Alb ratio ≥ 0.111 were found to have a 29-fold increased risk of cardiovascular events (95% CI: 11.304-74.842).
CONCLUSIONS: The hs-CRP/Alb ratio is a significant predictive biomarker for cardiovascular events in ESRD patients undergoing MHD. An elevated hs-CRP/Alb ratio is associated with an increased risk of cardiovascular events, underscoring its utility in this patient population.

BACKGROUND: The coronary artery calcium score (CACS) and ratio of the pulmonary artery to aorta diameters (PA:A ratio) measured from chest CT scans have been established as predictors of cardiovascular events and chronic obstructive pulmonary disease (COPD) exacerbations, respectively. However, little is known about the reciprocal relationship between these predictors and outcomes. Furthermore, the prognostic implications of COPD subtypes on clinical outcomes remain insufficiently characterized.
OBJECTIVE: How can these two chest CT-derived parameters predict subsequent cardiovascular events and COPD exacerbations in different COPD subtypes?
METHODS: Using COPDGene study data, we assessed prospective cardiovascular disease (CVD) and COPD exacerbation risk in COPD subjects (Global Initiative for Chronic Obstructive Lung Disease spirometric grades 2-4), focusing on CACS and PA:A ratio at study enrollment, with logistic regression models. These outcomes were analyzed in three COPD subtypes: 1,042 Non-emphysema-predominant COPD (NEPD; low attenuation area at -950 Hounsfield units [LAA-950]<5%), 1,324 Emphysema-predominant COPD (EPD; LAA-950≥10%), and 465 Intermediate Emphysema COPD (IE; 5≤LAA-950<10%).
RESULTS: Our study indicated significantly higher overall risk for cardiovascular events in subjects with higher CACS (≥median; Odds Ratio (OR): 1.61, 95% Confidence Interval (CI)=1.30-2.00) and increased COPD exacerbations in those with higher PA:A ratios (≥1; OR: 1.80, 95% CI=1.46-2.23). Notably, NEPD subjects showed a stronger association between these indicators and clinical events compared to EPD (with CACS/CVD, NEPD vs. EPD, OR 2.02 vs. 1.41; with PA:A ratio/COPD exacerbation, NEPD vs. EPD, OR 2.50 vs. 1.65); the difference in odds ratios between COPD subtypes was statistically significant for CACS/CVD.
CONCLUSIONS: Two chest CT parameters, CACS and PA:A ratio, hold distinct predictive values for cardiovascular events and COPD exacerbations that are influenced by specific COPD subtypes.
BACKGROUND: ClinicalTrials.gov Identifier: NCT00608764.

UNASSIGNED: It is well documented that menopause is linked to an increased risk of cardiovascular (CV) events; however, the results of studies focusing on the association between premature ovarian insufficiency (POI) and the risk of CV events are controversial. The aim of this systematic review and meta-analysis was to assess the risk of CV events among women with POI compared to women with menopausal aged 50-54 years.
UNASSIGNED: A systematic literature search of PubMed (including Medline), Scopus, and Web of Science was conducted from 1990 to 2022 to retrieve observational studies published in English-language. The studies\' quality was assessed using structured standard tools. Primary-outcome was the pooled risk of the composite outcome of CV events.
UNASSIGNED: We included 16 studies involving 40,549 women who suffered from POI and 1,016,633 women as controls. After adjustment for hormone therapy, the pooled risk of composite outcome of CV events and coronary heart disease, among women with the POI was significantly 1.3 (Pooled-adjusted hazard ratio (HR) = 1.35, 95% CI: 1.06-1.63, I 2 : 0%) and 1.4 (Pooled adjusted HR = 1.42, 95% CI: 1.17-1.66, I 2 : 0%) fold higher than women with menopausal age 50-54 years. There was no difference between the groups regarding the risk of stroke and death due to CV events between two groups. There was not sufficient data for pooled analysis of other specific CV events.
UNASSIGNED: In conclusion, POI is associated with an increased risk of CV events, particularly coronary heart disease. Our findings extend prior work with data supporting POI as a risk-enhancing factor for CV events. However, more studies are needed to confirmed these findings.

Familial hypercholesterolemia (FH) is the most common monogenic disorder in humans. It affects millions of people globally, increasing the risk of developing cardiovascular disease (CVD) at a younger age due to elevated levels of low-density lipoprotein cholesterol (LDL-C) from birth. While effective traditional and novel treatments are available, the most significant challenge with FH is the lack of timely diagnosis. As a result, many patients remain undertreated leading to an increased risk of CVD. To mitigate risk, initiating early and aggressive LDL-C-lowering therapies is recommended. Moreover, given its autosomal dominant inheritance patterns, it is also recommended to perform cascade lipid and/or genetic testing of all first-degree relatives. This review highlights the importance of early FH diagnosis and available treatment options. Greater awareness and improved screening efforts can help diagnose and treat more individuals, ultimately reducing the CVD risk associated with FH.

As the prevalence of cardiovascular disease continues to increase, early identification of patients at high risk of major adverse cardiovascular events (MACE) using reliable diagnostic modalities is important. Transcatheter aortic valve implantation (TAVI) is a minimally invasive percutaneous procedure used to replace the aortic valve with a bioprosthetic one, often without the need for surgery. Extra coronary calcification in the ascending and/or descending thoracic aorta, aortic arch, and abdominal aorta has recently been identified as a method to quantify the extent of atherosclerotic cardiovascular disease. However, its definitive role in the prediction of MACE remains unclear. We performed a comprehensive review to summarize the current literature on the diagnostic and predictive value of thoracic and abdominal aortic calcification, as quantified in computed tomography, for the association, risk stratification, and prediction of MACE and after TAVI procedures. Despite increasing evidence, the predictive role of thoracic calcification still remains unproven, with a need for carefully tailored studies to confirm these findings.

UNASSIGNED: In the in-clinic blood pressure (BP) recording setting, a sizable number of individuals with normal BP and approximately 30% of patients with chronic renal disease (CKD) exhibit elevated outpatient BP records. These individuals are known as masked hypertension (MHTN), and when they are on antihypertensive medications, but their BP is not controlled, they are called masked uncontrolled hypertension (MUHTN). The masked phenomenon (MP) (MHTN and MUHTN) increases susceptibility to end-organ damage (a two-fold greater risk for cardiovascular events and kidney dysfunction). The potential extension of the observed benefits of MP therapy, including a reduction in end-organ damage, remains questionable.
UNASSIGNED: This review aims to study the diagnostic methodology, epidemiology, pathophysiology, and significance of MP management in end-organs, especially the kidneys, cardiovascular system, and outcomes. To achieve the purposes of this non-systematic comprehensive review, PubMed, Google, and Google Scholar were searched using keywords, texts, and phrases such as masked phenomenon, CKD and HTN, HTN types, HTN definition, CKD progression, masked HTN, MHTN, masked uncontrolled HTN, CKD onset, and cardiovascular system and MHTN. We restricted the search process to the last ten years to search for the latest updates.
UNASSIGNED: MHTN is a variant of HTN that can be missed if medical professionals are unaware of it. Early detection by ambulatory or home BP recording in susceptible individuals reduces end-organ damage and progresses to sustained HTN. Adherence to the available recommendations when dealing with masked phenomena is justifiable; however, further studies and recommendation updates are required.
Blood pressure tells us how much force the heart exerts on the blood vessels as it pumps blood. Normal blood pressure should be 120/80 mmHg, which generally decreases when a person is sleeping or sitting. High blood pressure or hypertension occurs when the blood pressure is too high. Hidden or masked hypertension (MH) is a type of high blood pressure. Masked hypertension was described as having high blood pressure readings even though the doctor’s office or in-clinic showed normal blood pressure readings.This review aimed to teach people about various kinds of high blood pressure, focusing on hidden (masked) hypertension and how to recognise it, as well as its consequences, treatment, and new information.

UNASSIGNED: Dyslipidemia is a critical driver in the development of coronary heart disease (CHD), which further exacerbates the risk of major adverse cardiovascular events (MACEs). Chinese herbal medicine (CHM) plays an important role in the regulation of lipid levels and improvement of prognosis. However, few systematic reviews report whether the efficacy of CHM therapy for regulating lipid levels and lowering cardiovascular events is associated with baseline lipid levels.
UNASSIGNED: Randomized controlled trials assessing efficacy of CHM for lipid profiles and MACEs among patients with CHD were searched in six databases. Two authors independently extracted studies according to a predesigned form. Cochrane risk of bias tool and Grading of Recommendations Assessment, Development, and Evaluation system were used to assess the methodological quality of the included studies. The primary outcomes were blood lipid levels and MACEs including cardiovascular mortality, non-fatal myocardial infarction, revascularization, angina pectoris, heart failure, and non-fatal stroke across baseline lipid levels. The secondary outcomes were individual components of the primary outcomes.
UNASSIGNED: A total of 23 trials with 7,316 participants were included in this study. Altogether 377 cardiovascular events occurred in 3,670 patients in the CHM group, while 717 events occurred in 3,646 patients in the Western medicine-alone group. Compared with the Western medicine alone, additional CHM significantly lowered low-density lipoprotein cholesterol (LDL-C) [MD = -0.46, 95% CI (-0.60 to -0.32), P < 0.00001, I 2 = 96%]. The risk reduction in MACEs associated with CHM vs. Western medicine therapy was 0.52 [95% CI (0.47-0.58), P < 0.00001, I 2  = 0%], but varied by baseline LDL-C level (P = 0.03 for interaction). Triglycerides (TG) level was also significantly lowered by additional CHM vs. Western medicine alone [MD = -0.27, 95% CI (-0.34 to -0.20), P < 0.00001, I 2 = 81%], and risk reduction for MACEs also varied with baseline TG, with greater risk reduction in higher baseline TG subgroups (P = 0.03 for interaction). Similar results were observed with total cholesterol and high-density lipoprotein cholesterol.
UNASSIGNED: Compared with Western medicine alone, additional CHM was associated with lower risk of cardiovascular events and improvement of lipid profiles. Risk reduction for cardiovascular events was associated with baseline LDL-C and TG levels.
UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023425791.

UNASSIGNED: Osteoprotegerin (OPG) is a secretory glycoprotein known for its involvement in bone metabolism and immune regulation. Research has extended OPG\'s significance in cardiovascular diseases (CVDs). Elevated OPG levels have been associated with increased cardiovascular risks, prompting interest in its role as a potential biomarker.
UNASSIGNED: This study summarizes several studies that investigated the relationship between OPG levels and the incidence of CVD. The studies indicate that higher plasma levels of OPG are associated with an increased incidence of all-cause death, cardiovascular death, and heart failure, even after adjusting for clinical confounders. Moreover, the findings suggest that OPG has the potential to serve as a predictive biomarker for adverse cardiovascular events in the patient population studied. The findings suggest that OPG could aid in risk stratification, allowing clinicians to identify high-risk patients who might benefit from intensified preventive measures or tailored therapeutic interventions. Therefore, early identification of individuals at risk for adverse cardiovascular events could lead to improved patient outcomes and reduced disease burden.
UNASSIGNED: OPG\'s role in bone health and immune regulation has expanded to potential use as a biomarker for adverse cardiovascular events in stable coronary artery disease (CAD) patients. Despite limitations, its association with cardiovascular risks highlights its importance in risk assessment and personalized interventions.