Given the inconsistent evidence regarding hearing aid use and reduced dementia risk, this study evaluates whether hearing aid use, particularly effective use, is associated with lower probable dementia risk among hearing-impaired older adults. Using harmonized longitudinal data from 61,089 hearing-impaired participants (aged 55+ years) from seven cohorts (CHARLS, KLOSA, SHARE, ELSA, TILDA, HRS, and MHAS), we employ IPTW-corrected Cox models stratified by country income. Over a 6.5-year average follow-up (8,911 events), hearing aid use is associated with reduced dementia risk (hazard ratio [HR] = 0.91, 95% confidence interval [CI] 0.88-0.94). This association is confined to participants reporting effective hearing improvement (HR = 0.86, 95% CI 0.80-0.93), whereas those reporting poor hearing improvement show no reduced risk (HR = 0.98, 95% CI 0.90-1.07). The association is stronger in middle-income countries (HR = 0.76) and among subgroup populations, including those aged <70 years, women, those who are unmarried, and those with lower education. Quality hearing rehabilitation is a potential public health priority for addressing the dementia burden.

Background Randomized trials have shown that potassium-enriched salt substitutes can lower blood pressure and reduce cardiovascular risk. Although several within-trial cost-effectiveness analyses of these salt substitutes have been reported, the long-term health and economic impacts among Chinese stroke survivors remain unclear. Methods We adapted the China Cardiovascular Disease Prevention Model to estimate the lifetime health and economic impacts of replacing regular salt with a potassium-enriched salt substitute among Chinese adult stroke survivors from a healthcare sector perspective. Key inputs were drawn from the Salt Substitute and Stroke Study in China (N = 15,249), New Rural Cooperative Medical Scheme, Global Burden of Disease Study, and published literature. Outcomes included quality-adjusted life years (QALYs), direct healthcare costs (2023 USD), and incremental costs per QALY gained, all discounted at 3% annually. We conducted extensive sensitivity analyses to explore the robustness of the findings. Findings Among 24·1 million Chinese stroke survivors (mean age 64·3 years; 46·5% women), salt substitution was projected to prevent 454,559 recurrent stroke events (a 3·7% reduction) and 482,632 stroke deaths (a 15·0% reduction). The intervention also reduced coronary heart disease events by 72,902 (a 3·8% reduction) and increased life expectancy by 0·74 years over the lifetime horizon. The intervention was estimated to yield 10·79 million additional QALYs (a 5·7% increase) and $417·28 million lower direct healthcare costs (a 0·8% decrease). Results were robust across all sensitivity analyses. Interpretation Salt substitution was deemed cost-saving—producing better health outcomes at lower costs. Comprehensive adoption of potassium-enriched salt substitutes among Chinese stroke survivors could save lives, improve quality of life, and reduce healthcare costs. Funding China-NNSF: 72293585; Australia-NHMRC: APP1049417, APP1164206; China-NKRDP: 2023YFC3605000.

Background Hearing impairment is a common treatable condition and risk factor for various adverse health outcomes. Associations between hearing impairment and physical functioning have been documented in populations from developed countries, but evidence in the Chinese population remains limited. This study aims to examine both cross-sectional and longitudinal associations of hearing impairment and physical functioning among Chinese older adults. Methods We utilized data from the China Health and Retirement Longitudinal Study 2011–2015. Hearing impairment was assessed by a self-reported question, and physical functioning was evaluated with the Short Physical Performance Battery (SPPB), including gait speed, time of 5 chair stands, and balance. We examined mean differences in physical functioning using generalized estimating equations, with linear models for continuous outcomes and ordinal logistic models for balance. Longitudinal trajectories were modeled to compare rates of change between participants with different hearing statuses. Results Among 11620 participants aged 60 years or above, hearing impairment was associated with a lower SPPB composite score, slower gait speed, longer chair stand time, and higher odds of poor balance. Physical functioning declined with increasing years after age 60 among participants with both normal and impaired hearing; however, no significant differences in their rates of change were observed. Conclusion Our findings suggest that self-reported hearing impairment was associated with cross-sectional differences but not with differential longitudinal changes of physical functioning outcomes among Chinese older adults. Future research with a longer follow-up duration is warranted, and rising awareness of hearing health among older adults is called for.

The one-year SINEMA trial demonstrated improved blood pressure (BP) control and reduced mortality up to 72 months after the intervention. This article aims to assess between-arm differences in mean annual cumulative BP and to explore whether the associations between cumulative BP and biofunctional outcomes differed by trial arm. Post-hoc secondary analysis of the SINEMA cluster-randomized trial, which recruited 1299 adults with stroke from 50 rural villages in Hebei, China, between 2017 and 2018. The 12-month intervention was followed by observational assessments at 72 and 84 months post-baseline. BP was measured during each face-to-face follow-up, assessed by blinded assessors at baseline, 12, 72, and 84 months. Mean annual cumulative systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were calculated. Biofunctional outcomes included health-related quality of life, modified Rankin Scale, activities of daily living, physical function, and cognition function. Among 897 participants (mean age 62.7 years; 40.8% female) with complete data across all assessment, the intervention arm demonstrated significantly lower mean annual cumulative SBP (−2.2 mm Hg; 95% CI, −3.9 to −0.6), DBP (−1.6 mm Hg; 95% CI, −2.4 to −0.7), and MAP (−1.8 mm Hg; 95% CI, −2.8 to −0.8), not PP, compared with usual care. Significant associations between cumulative BP and biofunctional outcomes were observed in the control arm while not in the intervention arm. Interaction effects between trial arm and cumulative BP were significant for multiple outcomes, most prominently for cumulative SBP. The one-year SINEMA intervention was associated with lower cumulative BP burden over 72-84 months but did not improve overall biofunctional outcomes. Secondary analyses revealed that the association between cumulative BP burden and biofunctional decline differed by intervention arm, suggesting cumulative BP exposure may be an important long-term risk indicator and the intervention may modify BP-outcome relationships through mechanisms requiring further investigation.

Background:Achieving universal health coverage in the Asia-Pacific requires stronger, more equitable access to high-quality cardiovascular disease (CVD) services. Yet, despite the region's vast diversity in health systems and resources, there is limited consolidated evidence describing how CVD care is organised, financed, and delivered across Asia-Pacific. Methods:This document synthesises evidence from a systematic review and Global Burden of Disease data, structured using Donabedian's framework. It provides: (1) an overview of health system structures for CVD care across the Asia-Pacific; (2) case studies illustrating how system processes influence CVD prevention and treatment; and (3) country-level assessments of health system performance, spending efficiency, and associated cardiovascular outcomes, alongside forecasts of health expenditure and CVD burden from 2022 to 2050. Findings:Many low-to-middle income countries (LMICs) in the Asia-Pacific face challenges in ensuring accessible, high-quality CVD services without substantial policy action and investment. Fragmented primary and secondary care systems, uneven financing models, and limited quality infrastructure have contributed to stalled improvements in cardiovascular health. In contrast, high-income countries must address rising cardiometabolic multimorbidity in ageing populations, requiring transitions from acute inpatient care to integrated, multidisciplinary community-based models that improve quality while managing costs. Interpretation:These findings underscore the need for tailored, equity-focused strategies that enhance access, quality, and efficiency of CVD care across diverse health system contexts, accelerating progress in a populous yet resource-constrained region. Funding:This Commission is partly supported by funding from SingHealth Duke-National University of Singapore Cardiovascular Sciences Academic Clinical Programme, the National Medical Research Council of Singapore, and the Stafford Fox Foundation.

Artificial intelligence is increasingly acting as a first interpreter of biomedical research, shaping how evidence is applied to patient care. Simultaneously, science is reaching broader, non-specialist human audiences. In both cases, interpretive errors and generalization bias can skew clinical decision-making and endanger public health. Rather than waiting passively for more advanced AI to solve these problems, we contend that science itself can adapt by modernizing its reporting standards.

Background:Understanding epidemiological trends of the cardiovascular risk factors is integral in designing effective countermeasures in tackling cardiovascular diseases (CVD) in the Asia-Pacific. The study aims to examine the cardiovascular risk factor burden in the Asia-Pacific from 1990 to 2023, stratified by geographic subregion, sociodemographic index, and age-sex strata, to identify the region-specific risk factor targets for CVD prevention. Methods:Estimates from the Global Burden of Disease Study 2023 were used to quantify cardiovascular mortality and disability-adjusted life years (DALYs) attributable to environmental/occupational, behavioural, and metabolic risk factors across 39 Asia-Pacific countries. Findings:In 2023, cardiovascular risk factors contributed to 197.1 million DALYs, with an age-standardised DALY rate of 4463.7 per 100,000 population in the Asia-Pacific, which is 16.4% higher than the global estimate. Between 1990 and 2023, age-standardised DALYs declined by 34.9%, yet crude risk-attributable DALYs rose by 61.5%, as the demographic forces of population ageing (87.3%) and growth (45.3%) overwhelmed the gains from risk exposure reduction (-71.1%). Among risk factor categories, metabolic risk factors contributed to the fastest rise in CVD morbidity (74.3%), followed by behavioural (49.5%), and environmental/occupational risk factors (44.6%). The leading risk factors were high systolic blood pressure, dietary risks, air pollution and high LDL cholesterol. Interpretation:The improvements in cardiovascular risk factor exposure in the Asia-Pacific have been offset by population growth and ageing. The metabolic-centric pattern in risk factors demands for strategies in tackling the region's high priority metabolic risk factor targets. Funding:SingHealth Duke-National University of Singapore Cardiovascular Sciences Academic Clinical Programme, the National Medical Research Council of Singapore, and the Stafford Fox Foundation.

Background:Non-communicable diseases (NCDs) account for the majority of premature mortality in low- and middle-income countries, yet early detection remains limited within Pakistan's primary healthcare system. Lady Health Workers (LHWs) represent a large, trusted, community-based workforce with potential to support digital NCD screening. This study assessed the feasibility, acceptability, and early implementation of NCD-SCAN, a mobile application integrating validated tools for cardiovascular, metabolic, cerebrovascular, lifestyle, and mental health risk assessment. Methods:We conducted a prospective mixed-methods implementation study in Karachi and Hyderabad, Pakistan, between June and August 2024. NCD-SCAN integrates validated instruments including RAPID, QVSFS, the Rose Angina Questionnaire, Global Adult Tobacco Survey items, the International Physical Activity Questionnaire, Refined Food Frequency Questionnaire, and the WHO-5 Well-Being Index. Formative qualitative data from 13 focus group discussions involving 128 LHWs informed application development. A separate cohort of 22 LHWs received standardized training and conducted household-based screenings. Quantitative data were analysed descriptively, while qualitative data from the formative phase and post-pilot feedback were analyzed thematically. Implementation determinants were examined using the Consolidated Framework for Implementation Research (CFIR). Results:LHWs screened 1,087 community members, with no reported data loss or technical failures. 77% of individuals were classified as medium or high risk for at least one NCD domain. High proportions of screen-positive results were observed for stroke symptoms (83.7%), poor mental well-being (64.4%), hypertension (46.3%), angina (32.8%), and diabetes risk (30.1%). LHWs reported strong community trust and perceived that the application enhanced their counselling capacity and professional credibility. Training and repeated use improved usability and confidence. Key facilitators included the application's multilingual design, integration into existing LHW workflows, and strong community engagement, while barriers included indirect costs, limited digital access, and weak referral linkages. Suggested improvements included physician-supported referral pathways and culturally adapted multimedia content. Conclusion:Community-based digital NCD screening through Pakistan's LHW programme is feasible and acceptable. The NCD-SCAN application supported structured risk assessment and frontline counselling; however, downstream impact will depend on strengthened referral pathways, service readiness, and financial protection mechanisms. These findings support further hybrid implementation-effectiveness evaluations to inform national digital NCD prevention strategies in low-resource settings.

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality globally. Low-density lipoprotein cholesterol is a causal risk factor for atherosclerotic cardiovascular disease, with multiple classes of cholesterol-lowering therapies effective at reducing atherosclerotic cardiovascular disease risk. Despite robust efficacy data from randomized trials, real-world implementation of guideline-recommended lipid-lowering therapies is suboptimal. Barriers to the implementation of guideline lipid-lowering therapy recommendations exist at the healthcare systems level, the medical therapy level, and the patient level. A combination of strategies, including the incorporation of quality improvement and cost-effectiveness analysis among payers, pharmacist-based educational initiatives, digital health tools directed towards patients, the simplification of drug regimens via polypill, and emerging novel therapies, including PCSK9 gene silencing and editing technologies, may bridge these implementation gaps. This review highlights challenges and solutions to alleviating barriers to optimal implementation of guideline-recommended lipid-lowering therapies.

East and Southeast Asia's (ESEA) rapidly aging population creates an urgent need for comprehensive health data to inform policies promoting healthy aging. However, a synthesis of the region's community-based longitudinal aging studies is lacking. We conducted a systematic search for community-based longitudinal aging studies in ESEA. Studies were included if they followed community-dwelling adults with a mean age of 50+ at baseline, had nationally representative samples or sampled from at least two geographic areas, were health focused, and offered English documentation. We identified 30 eligible studies across 10 countries, regions, or territories, mostly concentrated in Japan, Mainland China, Singapore, and South Korea. While recent studies incorporate biomarkers and performance measurements, significant gaps were found. No eligible studies exist for several countries (e.g., Myanmar, Cambodia, and Indonesia), physical frailty is rarely assessed, data access is inconsistent, and no multi-national studies were identified. Although data infrastructure for longitudinal aging studies exists in ESEA, there are critical gaps in geographic representation, measurement harmonization, and data access. Future efforts must enhance regional coordination, standardize core measures, and improve data-sharing mechanisms to promote and support healthy aging in ESEA.

Background Multimorbidity is rising and comorbid hypertension and type 2 diabetes is the most common among older adults. Although pharmacological therapy is the mainstay, non-pharmaceutical interventions are essential for disease control. We conducted a systematic review to synthesize evidence from randomized controlled trials in older adults on non-pharmacological approaches by intervention strategy and delivery setting. Methods Following PRISMA 2020, we searched PubMed, Embase, and Cochrane CENTRAL (until October 2024) for randomized controlled trials enrolling adults ≥60 years with both conditions. Risk of bias was assessed with RoB 2; heterogeneity precluded meta-analysis and findings were synthesized narratively. Results A total of 3449 studies were screened, and 16 trials were included in final analyses. Interventions were classified as exercise (n = 3), diet (n = 2), self-monitoring (n = 1), multi-strategy (n = 3), or comprehensive lifestyle modification (n = 7), delivered via hospital (n = 6), community (n = 6), or telehealth (n = 4) models. Most trials (∼75%) reported a statistically significant effect on their prespecified primary outcomes, mainly blood pressure or HbA1c. Effects were most consistent for comprehensive lifestyle modification, especially those combining individualized planning with technology-assisted support. By setting, hospital interventions tended to yield short-term physiological gains, whereas community and telehealth models emphasized adherence and sustained engagement. Only two trials included post-intervention follow-up. Conclusion Comprehensive behaviorally informed interventions combining individualized planning with technology-assisted support were the most effective for older adults with hypertension and diabetes multimorbidity. Studies targeting this population remain limited with no long-term follow-up. Innovations in strategy optimization and adaptation to contexts and assessment of sustained effects are needed in multimorbidity management.

Background:The cardiovascular-kidney-liver-metabolic (CKLM) framework represents the multi-organ interplay of systemic metabolic disorders that drive the global burden of cardiovascular diseases (CVD). Methods:This study is a descriptive epidemiological analysis of the Global Burden of Disease Study 2023 that examines the trends in mortality and disability-adjusted life years (DALYs) associated with atherosclerotic CVD, chronic kidney disease (CKD), type 2 diabetes (T2D), obesity and metabolic dysfunction-associated steatotic liver disease (MASLD), from 1990 to 2023, across 204 countries and territories. Epidemiological trends were stratified by age, sex, region, and sociodemographic index (SDI). Findings:In 2023, the global CKLM burden contributed to 626.7 million DALYs, with an age-standardized DALY rate of 6944.3 per 100,000 population. Atherosclerotic CVD was the largest contributor to the CKLM burden (3924.2 [95% Uncertainty Interval {UI}: 3666.9-4181.4]), followed by obesity (1500.0 [95% UI: 730.4-2206.5]), T2D (956.7 [95% UI: 794.4-1142.4]), CKD (523.8 [95% UI: 468.0-590.1]), and MASLD (39.6 [95% UI: 31.2-49.9]). From 1990 to 2023, CKLM-related age-standardized DALYs fell 24.4%, primarily driven by improvements in atherosclerotic CVD (41.5% decrease), while rapid increases were seen in T2D (37.5% increase) and obesity (23.3% increase). Disparities in CKLM burden exist across SDI, geography, and age-sex categories. Interpretation:Improvements in the global CKLM burden, driven by gains in CVD prevention, are offset by the rising burden of upstream CKLM drivers including obesity, T2D, CKD and MASLD. Population-focused strategies for prevention need to target shared risk factors driving the CKLM syndemic to achieve the greatest reduction in overall morbidity and mortality. Funding:This research was supported by the NMRC Research Transition Award and the CSDU Clinician-Scientist Grant.

Introduction: Intrinsic capacity (IC), encompassing all physical and mental capacities of an individual, is key to healthy aging. Despite increasing emphasis on person-centered care for older adults with cardiometabolic multimorbidity (CMM), the joint effect of IC and CMM on mortality risk is poorly understood. Methods: We included participants aged 65 years and older recruited from five waves of the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2014, with follow-up to 2018. IC was assessed across five domains: cognition, locomotor, sensory function, psychological well-being, and vitality. IC scores were calculated as a percentage of the maximum possible (100) and dichotomized by the median. CMM was defined as the presence of two or more diseases among hypertension, diabetes, stroke or CVD, or heart disease at baseline. We used Cox proportional hazards models to examine the individual and joint effects of IC and CMM on all-cause mortality risk. All models were adjusted for demographics, lifestyles, and Activities of Daily Living. Results: Among 21,097 participants (mean age 84.9 years, 56.0% female), 11,753 deaths were recorded over a median follow-up duration of 3.7 (IQR: 1.6–7.5) years. We found either having CMM (Hazard Ratio = 1.13, 95% CI: 1.04–1.21) or low IC (HR = 1.35, 95% CI: 1.29–1.41) was significantly associated with a higher mortality risk, respectively. In the joint analysis ( P -interaction = 0.026), compared to those with high IC and no CMM, participants with low IC combined with having CMM exhibited the highest mortality risk (HR = 1.40, 95% CI: 1.27–1.55). Conclusions: Low IC and having CMM were jointly associated with a higher all-cause mortality risk among older Chinese adults.

BACKGROUND:Despite growing evidence of primary care-based interventions for chronic disease management in resource-limited settings, long-term post-trial effects remain inconclusive. We investigated the association of a 12-month system-integrated technology-enabled model of care (SINEMA) intervention with mortality outcomes among patients experiencing stroke at 6-year post-trial. METHODS AND FINDINGS:This study (clinicltiral.gov registration number: NCT05792618) is a long-term passive observational follow-up of participants and their spouse of the SINEMA trial (clinicaltrial.gov registration number: NCT03185858). The original SINEMA trial was a cluster-randomized controlled trial conducted in 50 villages (clusters) in rural China among patients experiencing stroke during July 2017-July 2018. Village doctors in the intervention arm received training, incentives, and a customized mobile health application supporting monthly follow-ups to participants who also received daily free automated voice-messages. Vital status and causes of death were ascertained using local death registry, standardized village doctor records, and verbal autopsy. The post-trial observational follow-up spanned from 13- to 70-months post-baseline (up to April 30, 2023), during which no intervention was requested or supported. The primary outcome of this study was all-cause mortality, with cardiovascular and stroke cause-specific mortality also reported. Cox proportional hazards models with cluster-robust standard errors were used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs), adjusting for town, age, and sex in the main analysis model. Analyses were conducted on an intention-to-treat basis. Of 1,299 patients experiencing stroke (mean age 65.7 years, 42.6% females) followed-up to 6 years, 276 (21.2%) died (median time-to-death 43.0 months [quantile 1-quantile 3: 26.7-56.8]). Cumulative incidence of all-cause mortality was 19.0% (121 among 637) in the intervention arm versus 23.4% (155 among 662) in the control arm (HR 0.73; 95% CI 0.59, 0.90; p = 0.004); 14.4% versus 17.7% (HR 0.73; 95% CI 0.58, 0.94; p = 0.013) for cardiovascular cause-specific mortality; and 6.0% versus 7.9% (HR 0.71; 95% CI 0.44, 1.15; p = 0.16) for stroke cause-specific mortality. Although multisource verification was used to verify the outcomes, limitations exist as the survey- and record-matching-based nature of the study, unavailability of accurate clinical diagnostic records for some cases and the potential confounders that may influence the observed association on mortality. CONCLUSIONS:Despite no observed statistically difference on stroke cause-specific mortality, the 12-month SINEMA intervention, compared with usual care, significantly associated with reduced all-cause and cardiovascular cause-specific mortality during 6 years of follow-up, suggesting potential sustained long-term benefits to patients experiencing stroke.

Globally, health information system (HIS) development projects face challenges regarding technology infrastructure, financing, user resistance, and interoperability. While these challenges are well-described in literature, most studies on HIS digitalization focus on the development of national and hospital HISs, with little focus on HISs in primary care. We described the HISs of two primary care clinics in Manila, Philippines in terms of data management procedures, governance, training and equipment, information culture, and health worker data skills, and investigated health workers' experiences during digitalization.This convergent mixed-methods descriptive study included two clinics: a nongovernmental organization (NGO)-operated clinic and a government-operated public health center (PHC). We surveyed eight health workers in the NGO clinic and six in PHC using the Performance of Routine Information System Management (PRISM) Community HIS evaluation tools from the World Health Organization and MEASURE Evaluation and conducted in-depth interviews among the same participants to explore their HIS experiences.Respondents in both clinics provided low scores on governance, indicating deficiencies in HIS strategy and documentation. PHC scored higher on data management, training, and equipment compared with the NGO clinic, whereas information culture scores were similar. Survey results reflected differences in IT infrastructure and services, stemming from PHC's larger size and funding. Interviews corroborated the survey results, highlighting barriers such as inadequate training and resources and the critical roles of internal communication and joint data stewardship, as described by the Filipino term "damayan," which means working together in times of adversity. Additionally, interviews revealed expected benefits from digitalization, negative impact on workflow, and limited communication with external organizations.The findings highlight critical areas for enhancing HIS implementation and digitalization in primary care clinics in the Philippines. Addressing governance gaps, resource deficiencies, and communication barriers can improve HIS performance and help build digital resilience.

BACKGROUND:Depression and anxiety are the most common mental disorders in China, contributing to a substantial disease burden. METHODS:This cross-sectional survey was conducted in 240 villages from three provinces in rural China among adults aged 30 years and older. Depression and anxiety were based on self-reported diagnosis, self-reported use of medications, identified diagnosis from health insurance claims, and assessment via validated questionnaires. Prevalence, awareness and treatment rates were estimated. Logistic regression models were used to identify potential risk factors. RESULTS:A total of 6474 participants were included in this study, with 38.9 % aged ≥60 years and 50.9 % being female. The crude prevalence of depression and anxiety among middle-aged and older individuals was 4.9 % and 2.9 %, respectively. Individuals from Heilongjiang had a higher prevalence than those from Shanxi and Hubei for both depression (8.5 % vs. 4.6 % and 1.7 %) and anxiety (4.6 % vs. 2.8 % and 1.3 %). Many risk factors were significantly associated with an increased risk of depression and anxiety. Among individuals with depression, 33 (10.3 %) out of 321 were aware of being diagnosed, and 18 (5.6 %) used antidepressants. Among those with anxiety, 38 (20.0 %) out of 190 were aware of a diagnosis, and 21 (11.1 %) received treatment with anxiolytics. CONCLUSIONS:The extremely low awareness and treatment rates indicate a significant unmet need for mental health services. Government and other stakeholders should raise the awareness of mental health among the communities and implement strategies to improve accessibility to services, to reduce health inequities and the stigma associated with mental disorders.

In developing nations, primary healthcare (PHC) is the first crucial level of contact for patients including emergencies. We examined the capacity of PHC for cardiovascular diseases (CVDs) prevention and management in Kenya from health workforce experiences in order to inform strategies for strengthening their capability and associated implications for measures of accessibility. The study was conducted in urban and rural settings of Nairobi and Machakos counties, Kenya. The cross-sectional study adopted purposive sampling applying mixed methods approach through health facility survey and key informant interviews. Despite the rural–urban populations variations, a higher proportion of rural facilities (81.2

ABSTRACT Background This aimed to quantify the association between dual trajectory patterns combining seven central adiposity (CA) indices and fasting plasma glucose (FPG) with cardiovascular disease (CVD) risk in adults, and to compare their predictive performance. Methods The Kailuan Study, a prospective study initiated in June 2006, included 39 772 adults without pre‐existing CVD as of 2010. Dual trajectories of seven CA indices combined with FPG were recorded from 2006 to 2010 to predict CVD risk from 2010 to 2021. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD. Results During a median follow‐up of 11.0 years, 2715 incident CVD events were recorded. Four distinct patterns of CA indices (waist circumference, waist‐to‐height ratio, abdominal volume index, body roundness index) and three distinct patterns of other CA indices (waist‐to‐hip ratio, conicity index, A body shape index) combined with FPG were identified. Compared with the lowest‐risk group, the highest‐risk group exhibited a significantly higher CVD risk (adjusted HRs [95% CIs]: 2.41 [2.02–2.86], 2.57 [2.18–3.05], 2.25 [1.92–2.63], 2.35 [2.01–2.73], 2.08 [1.74–2.49], 1.97 [1.72–2.26], 1.81 [1.58–2.07], respectively). Overall, the predictive capabilities were generally similar, with the combination of waist circumference and FPG showing a slightly better predictive performance compared with other patterns. Conclusions Distinct patterns of dual trajectories involving seven CA indices combined with FPG were associated with CVD risk. The results suggest that the combination of waist circumference and FPG may have greater clinical significance in predicting CVD risk.

The Simplified Cardiovascular Management Program (SimCard), a cluster-randomized controlled trial conducted in Tibet, China, demonstrated significant reduction in systolic blood pressure (SBP) compared to usual care among people with or at high risk of developing cardiovascular diseases (CVD). This study conducted a comprehensive economic evaluation for within-trial incremental cost per mmHg reduction in SBP at 12 months and per Quality-Adjusted Life Year (QALY) gained over the 10-year timeframe through a Markov-based CVD model. We reported expenses in 2023 CNY, using China’s 2023 per-capita gross domestic product of CNY 89,358 as the cost-effectiveness threshold. We performed both one-way and probabilistic sensitivity analyses. During the trial period, the intervention group experienced a greater reduction in SBP, with a mean difference of 4.37 mmHg (95