Objectives To examine the risk of severe cardiovascular (CV) events in patients with chronic obstructive pulmonary disease (COPD) across different time periods following COPD exacerbations and the incidence rate of cardiopulmonary events in a real-world setting in China.Design Retrospective cohort study.Setting Regional electronic health records database from Yinzhou District of Ningbo City, China.Participants A total of 14 713 patients aged ≥40 years with a first COPD diagnosis between 1 January 2014 and 1 March 2022.Primary and secondary outcome measures The risk of severe CV events (ie, hospitalisation and a primary or secondary discharge code for acute coronary syndrome, heart failure decompensation, cerebral ischaemia, arrhythmia and CV-related death) during different exposed time periods following a COPD exacerbation, the incidence rate of overall cardiopulmonary events (ie, severe exacerbation of COPD, all-cause mortality, inpatient CV events, inpatient ischaemic stroke and inpatient tachyarrhythmia/atrial fibrillation) and the incidence rate stratified by COPD exacerbation history.Results We included a total of 14 713 patients. During a median (IQR) follow-up of 2.8 (4.0) years, 20.1% experienced severe CV events. Compared with the unexposed period, the risk of severe CV events was the highest in the first 10 days following a COPD exacerbation (adjusted HR 10.00, 95% CI 8.16 to 12.25). The risk of severe CV events decreased over time but remained significantly elevated up to 90 days post exacerbation. We found that 32.7% of COPD patients experienced cardiopulmonary events, with a crude incidence rate of 9.38 (95% CI 9.09 to 9.69) per 100 person-years.Conclusion This study is the largest retrospective cohort study investigating CV and cardiopulmonary events among patients with COPD in China. Our findings highlight an elevated risk of CV events closer to the time of COPD exacerbations and show that nearly one-third of COPD patients experience cardiopulmonary events.

Background: The prognostic value of cardiac output measured by the estimated Fick method and thermodilution in patients with postcapillary pulmonary hypertension (pc-PH) is unclear. We aimed to compare the correlations and consistency of cardiac output (CO) evaluated by the estimated Fick method and thermodilution, and to assess the prognostic validity of these two cardiac index (CI)-based methods with regard to all-cause mortality in patients with pc-PH. Methods: CO was simultaneously measured by thermodilution and the estimated Fick method using a Swan-Ganz catheter in 257 patients with pc-PH. Oxygen consumption was calculated by Dehmer, LaFarge, and Bergstra formulae. Results: The CO measured by the estimated Fick method combined with the three formulae, and by thermodilution exhibited moderate correlations (r = 0.706, r = 0.688, r = 0.702, respectively; all P < 0.010). The 95% limits of agreement were -2.73 to 1.51, -2.99 to 1.36, and -2.42 to 2.02 L/min, respectively. CI measured by thermodilution was associated with the mortality (HR: 0.75 [95% CI: 0.58-0.98]; P = 0.034). After adjustment, the risk of all-cause mortality was higher in the low CI group assessed by the Dehmer formula (HR: 1.92 [95% CI: 1.10-3.37]; P = 0.022) compared to the high CI group. Conclusions: There were moderate positive correlations and poor agreements between the CO measured by the estimated Fick method and thermodilution in patients with pc-PH. Thermodilution was superior to the estimated Fick method in improving risk stratification for all-cause mortality.

Chemotherapy-induced cardiotoxicity and heart failure have become significant concerns in cancer treatment. Advancements in cancer therapies have increased survival rates, with consequent increase in the prevalence of chemotherapy-induced cardiotoxicity and subsequent heart failure. Guideline-directed medical therapy (GDMT) has emerged as a crucial approach for managing these conditions. GDMT encompasses evidence-based medications and interventions backed by clinical guidelines that aim to optimize the treatment and outcomes of heart failure. This review critically summarizes the existing evidence on the roles of GDMT in the management and prevention of chemotherapy-induced cardiotoxicity and heart failure.

To explore the association of ventricle epicardial fat volume (EFV) calculated by cardiac magnetic resonance (CMR) and the insulin resistance indicator of triglyceride–glucose (TyG) index in patients with chronic HF (CHF), this retrospective cohort study included adult CHF patients with confirmed diagnosis of heart failure from January 2018 to December 2020. All patients underwent 3.0T CMR, and EFV were measured under short-axis cine. Spearman correlation, multivariate linear regression, and restricted cubic spline (RCS) regression were used to analyze their association. There were 516 patients with CHF, of whom 69.8

Abstract Background Heart failure (HF) significantly impacts quality of life and healthcare systems worldwide. Assessing left ventricular mechanical dyssynchrony (LVMD) is crucial for understanding cardiac function and optimizing treatments like cardiac resynchronization therapy (CRT). Phase analysis using gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has shown promise in predicting outcomes, yet recent comprehensive reviews are lacking. Objective To systematically assess the prognostic value of phase analysis by gated SPECT MPI in the HF population through a systematic review. Methods We conducted a systematic review by collecting studies from databases including PubMed, CINAHL, and Web of Science. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Systematic reviews were conducted using Review Manager Software 5.4 and STATA 16.0. Results A total of 2004 patients from seven studies were included in our review and analysis. The systematic review indicated that patients with predetermined clinical events had higher PSD [MD = 6.45, 95% CI (5.83, 7.07), p < 0.00001] and PBW [MD = 7.91, 95% CI (5.64, 10.19), p < 0.00001]. The diagnosis of LVMD determined by PSD [HR = 1.05, 95% CI (1.01, 1.08), p = 0.007] was a strong predictor of endpoint events compared to PBW [HR = 1.95, 95% CI (0.48, 7.89), p = 0.35]. Conclusions The analysis demonstrated that phase information obtained from gated SPECT MPI is of significant prognostic value in patients with heart dysfunction. It effectively enhances clinical risk models, providing reliable guidance for patient treatment.

ABSTRACT Aims This study aimed to investigate the clinical value of the glucose‐albumin ratio (GAR) in predicting the prognosis of cancer patients prescribed anthracycline‐based chemotherapy. Methods We included cancer patients who underwent anthracycline‐based chemotherapy, drawn from the population‐based cohort Clinical Data Analysis Reporting System of Hong Kong between January 2000 and December 2019. Demographics, medical history, baseline laboratory, and metabolic indicators, including GAR, were collected. We employed random survival forests (RSF) with the variable importance (VIMP) method to rank the importance of these variables. Cox proportional hazards regression was used to assess the association between GAR levels and event risks. Results A total of 18,700 patients were included in the analysis. The top 2 factors for predicting overall cardiovascular event risk were GAR and fasting blood glucose (FBG). Our results revealed that a higher GAR was significantly associated with poorer cardiovascular prognosis in patients with cancer prescribed with anthracycline‐based chemotherapy. Compared to the lowest quartile, higher GAR levels were significantly associated with increased risk of all‐cause mortality, major adverse cardiovascular events, hospitalization of heart failure, and cardiovascular mortality regardless of the adjustments (all p trend < 0.001). Conclusion GAR is a potential biomarker for predicting the prognosis of cancer patients undergoing anthracycline‐based chemotherapy. Monitoring GAR levels before and during treatment may help identify patients at higher risk of adverse outcomes, facilitating personalized treatment strategies and improving clinical management.

Early-life cardiovascular risk factors (CVRFs) are known to be associated with target organ damage during adolescence and premature cardiovascular morbidity and mortality during adulthood. However, contemporary data describing whether the prevalence of CVRFs and treatment and control rates have changed are limited. This study aimed to examine the temporal trends in the prevalence, treatment, and control of CVRFs among US adolescents over the past 2 decades. This is a serial cross-sectional study using data from nine National Health and Nutrition Examination Survey cycles (January 2001—March 2020). US adolescents (aged 12 to 19 years) with information regarding CVRFs (including hypertension, elevated blood pressure [BP], diabetes, prediabetes, hyperlipidemia, obesity, overweight, cigarette use, inactive physical activity, and poor diet quality) were included. Age-adjusted trends in CVRF prevalence, treatment, and control were examined. Joinpoint regression analysis was performed to estimate changes in the prevalence, treatment, and control over time. The variation by sociodemographic characteristics were also described. A total of 15,155 US adolescents aged 12 to 19 years (representing ≈ 32.4 million people) were included. From 2001 to March 2020, there was an increase in the prevalence of prediabetes (from 12.5

Insulin-like growth factor-binding protein 5 (IGFBP5) has been shown to be useful for the diagnosis and treatment of multiple tumors and cerebrovascular diseases. However, it is unknown whether IGFBP5 is involved in myocardial repair following myocardial infarction (MI). Here we show high expression of IGFBP5 in multiple models of ischemic and hypoxic injury. IGFBP5 affected the proliferation of neonatal rat cardiomyocytes (NRCMs) and the cardiomyocyte apoptosis induced by oxygen-glucose deprivation (OGD). Subsequently, heart-specific IGFBP5 knockdown inhibited myocardial apoptosis and increased cardiomyocyte proliferation in mice with MI. During the chronic remodeling stage, heart-specific regulation of IGFBP5 ameliorated pathological cardiac remodeling and dysfunction. Mechanistically, IGFBP5 regulated cardiomyocyte survival through the insulin-like growth factor 1 (IGF1) receptor (IGF1R)/protein kinase B (PKB/AKT) pathway. In summary, our results provide mechanistic insights into the effect of IGFBP5 on cardiomyocyte during cardiac repair. IGFBP5 may represent a therapeutic target for myocardial ischemic injury. IGFBP5 regulates cardiomyocyte proliferation and apoptosis during cardiac repair in mice by activating the IGF1R/AKT signalling pathway, representing a potential therapeutic target for myocardial ischemic injury.

The early identification and appropriate management may provide clinically meaningful and substained benefits in patients with acute heart failure (AHF). This study aimed to develop an integrative nomogram with myocardial perfusion imaging (MPI) for predicting the risk of all‐cause mortality in AHF patients.

The purpose of this study is to explore the prognostic values of ventricle epicardial fat volume (EFV) calculated by cardiac magnetic resonance in patients with chronic heart failure (CHF). A total of 516 patients with CHF (left ventricular ejection fraction ≤ 50%) were recruited, and 136 (26.4%) of whom experienced major adverse cardiovascular events (MACE) within median follow-up of 24 months. The target marker-EFV was found to be associated with MACE in both univariate and multivariable analysis adjusted for various clinical variables (p < 0.01), regardless as a continuous variable and categorized by X-tile program. EFV also showed promising predictive ability, with an area under the curve of 0.612, 0.618, and 0.687 for the prediction of 1-year, 2-year, and 3-year MACE, respectively. In conclusion, EFV could be a useful prognostic marker for CHF patients, helping to identify individuals at greater risk of MACE.

Background Traditional Chinese Medicine (TCM) is widely used to treat heart failure (HF). Syndrome differentiation is a unique and crucial component in TCM practice for guiding disease diagnosis and treatment strategies as well as clinical research. The major bottlenecks in TCM syndrome differentiation are the diversity of the syndrome differentiation criteria and the broad spectrum of syndrome patterns, hindering evidence-based studies for clinical research. In the present study, we aim to develop an evidence-based questionnaire for the diagnosis of HF and establish a definitive set of criteria for syndrome differentiation. Methods We designed a TCM syndrome differentiation questionnaire for heart failure (SDQHF) based on the "TCM expert consensus for diagnosis and treatment of heart failure" (expert consensus), literature review, and various clinical guidelines. To test the reliability and efficiency of the questionnaire, we performed a large-scale multiple-center clinical trial with the recruitment of 661 HF patients. Cronbach's alpha was used to assess the internal consistency of the SDQHF. Content validity was conducted through expert review. Principal component analysis (PCA) was applied to evaluate the construct validity. We constructed a proposed model for syndrome differentiation for HF based on the PCA results. Tongue analysis was performed to verify the accuracy of syndromes derived from the proposed model and the expert consensus. An evidence-based practical questionnaire for TCM syndrome differentiation patients was developed and validated with the data from 661 HF patients. Results The syndrome differentiation criteria were constructed with five syndrome elements (qi-deficiency, yang-deficiency, yin-deficiency, blood stasis, and phlegm retention). The results revealed good convergent and discriminant validity, satisfactory internal consistency, and feasibility. The significant discoveries include: (1) A total of 91% of the derived TCM syndromes from the proposed model matched with the characterized tongue images of the syndrome patterns; (2) Qi Deficiency Syndrome is the dominant syndrome pattern for HF patients, followed by Yang-Qi Deficiency Syndrome and Qi-yin deficiency Syndrome, and finally, Yin-Yang Dual Deficiency Syndrome; (3) The majority of the HF patients had the combination of Blood Stasis and Phlegm Retention Syndromes; (4) The "Yin-Yang Dual Deficiency" Syndrome was a valid syndrome for HF, suggesting that this syndrome pattern should be included in the criteria for syndrome differentiation; and (5) Through the validation of the expert consensus, several recommendations were proposed to improve the accuracy of syndrome differentiation of HF. Conclusions The proposed SDQHF and the criteria could be a reliable and valid tool for syndrome differentiation of heart failure with high accuracy. It is recommended to use the proposed model for evidence-based study on Chinese Medicine to diagnose and treat HF. Trial registration number: The trial was registered at the Chinese Clinical Trial Registry, http://www.chictr.org.cn . (Registration No.: ChiCTR1900021929); Date: 2019-03-16.

Background:Di(2-ethylhexyl) phthalate (DEHP) a parent compound that is metabolized into 4 phthalate metabolites, which correlate to adverse cardio-metabolic risk factors. This study aimed to explore the links between urinary DEHP metabolites and serum lipids in the U.S. general adult population. Methods:In this cross-sectional study, data on 11 urinary phthalate metabolites from the 2005-2018 National Health and Nutrition Examination Surveys (NHANES) were analyzed. Multivariate linear regression and restricted cubic spline (RCS) were used to examine the relationship between phthalate metabolites [specific DEHPs: mono-(2-ethyl-5-carboxy-pentyl) phthalate (MECPP), mono-(2-ethyl-5-hydroxy-hexyl) phthalate (MEHHP), mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-oxo-hexyl) phthalate (MEOHP)] and serum lipids (triglycerides [TG], total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], and high-density lipoprotein cholesterol [HDL-C]). To identify mixed exposure effects of phthalate metabolites, quantile g-computation (QG-C) and weighted quantile sum (WQS) regression were employed for the lipid profiles. Results:A total of 9141 adults were included in the analysis. MECPP, MEHHP, MEHP, and MEOHP in the highest quartile had a negative relationship with HDL-C compared to the lowest quartile (All P for trend <0.05). TG showed a significant positive relation with MECPP, MEHHP, and MEOHP (All P for trend <0.05), but there was no notable association with MEHP. RCS demonstrated a linear relationship of DEHP metabolites with HDL-C, TC, TG, and LDL-C (all P for nonlinearity >0.05). The WQS index of DEHP metabolites showed independent correlations with HDL-C [β = -0.26, 95%CI (-0.43, -0.09), P = 0.002], TC [β = 0.55, 95%CI (0.13, 0.98), P = 0.011], and TG [β = 2.40, 95%CI (0.85, 3.96), P = 0.003]. Conclusion:Our study suggests that environmental DEHP exposure may affect serum HDL-C and TG levels in the general adult population. Further research is warranted to confirm these findings and illuminate the underlying mechanisms of DEHP exposure on lipids.

Journal Article Sex-specific characteristics and outcomes in hospitalized heart failure with preserved ejection fraction: the China Cardiovascular Association Database-Heart Failure Center Registry Get access Anping Cai, Anping Cai Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China https://orcid.org/0000-0003-3953-5881 Search for other works by this author on: Oxford Academic PubMed Google Scholar Weida Qiu, Weida Qiu Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Shuang Xia, Shuang Xia Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Yingling Zhou, Yingling Zhou Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Jiyan Chen, Jiyan Chen Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Ning Tan, Ning Tan Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Zhiping Gao, Zhiping Gao Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Yanqiu Ou, Yanqiu Ou Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Weimin Li, Weimin Li Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Heilongjiang, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Yuhua Liao, Yuhua Liao Department of Cardiology, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Hubei, China Search for other works by this author on: Oxford Academic PubMed Google Scholar ... Show more Yugang Dong, Yugang Dong Department of Cardiology, Center for Translational Medicine, Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, ChinaNHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Xinli Li, Xinli Li Department of Cardiology, The First Affiliated Hospital to Nanjing Medical University, Jiangsu, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Jingmin Zhou, Jingmin Zhou Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Yingqing Feng, Yingqing Feng Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China Corresponding author. Email: fyq1819@163.com, gdghllw@163.com, yangjiefu2011@126.com Search for other works by this author on: Oxford Academic PubMed Google Scholar Liwen Li, Liwen Li Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China Corresponding author. Email: fyq1819@163.com, gdghllw@163.com, yangjiefu2011@126.com Search for other works by this author on: Oxford Academic PubMed Google Scholar Jiefu Yang Jiefu Yang Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1, Dahua Road, Dongcheng District, Beijing 100730, China Corresponding author. Email: fyq1819@163.com, gdghllw@163.com, yangjiefu2011@126.com Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, Volume 44, Issue 44, 21 November 2023, Pages 4715–4718, https://doi.org/10.1093/eurheartj/ehad619 Published: 04 October 2023 Article history Received: 28 January 2023 Revision received: 03 July 2023 Accepted: 08 September 2023 Published: 04 October 2023

目的 分析两种不同方式注射替罗非班治疗急性ST段抬高型心肌梗死(STEMI)患者的效果及对心功能的影响.方法 选取 2018 年 1 月至 2022 年 5 月在北京市大兴区中西医结合医院急诊内科接受急诊经皮冠状动脉介入治疗术(PCI)治疗的STEMI患者 80 例,按随机数表法分为对照组(n=40)和观察组(n=40).对照组采用静脉注射替罗非班,观察组则采用冠状动脉内注射给药.比较两组STEMI患者血流分级情况、心功能指标[每搏输出量(SV)、左室射血分数(LVEF)、左心室收缩末期容积(LVESV)]、心肌损伤指标[肌酸同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)]及不良事件发生情况.结果 观察组术后的血流分级优于对照组,且TIMI≥Ⅱ级获得率高于对照组,差异有统计学意义(P<0.05);观察组术后的SV、LVEF高于对照组,LVESV则低于对照组,差异有统计学意义(P<0.05);观察组术后 12、24 h的心肌损伤指标(cTnI、CK-MB)均低于对照组,差异有统计学意义(P<0.05);观察组不良事件总发生率(7.50%)低于对照组(32.50%),差异有统计学意义(P<0.05).结论 较静脉注射给药,冠状动脉内注射替罗非班能给更有效地改善STEMI患者的血流状况与心功能,降低心肌损伤指标,减少不良事件的发生.

Background: Cerebral ischemia-reperfusion injury (CIR) following a stroke results in secondary damage and is a leading cause of adult disability. The present study aimed to identify hub genes and networks in CIR to explore potential therapeutic agents for its treatment. Methods: Differentially expressed genes based on the GSE23163 dataset were identified, and weighted gene co-expression network analysis was performed to explore co-expression modules associated with CIR. Hub genes were identified by intersecting immune gene profiles, differentially expressed genes, and modular genes. Gene Ontology, Kyoto Encyclopedia of Genes and Genomes pathway, and transcription factor-microRNA-gene regulatory network analyses were then conducted in selected crucial modules. Subsequently, their expression levels in animal models were verified using real-time quantitative polymerase chain reaction and Western blotting. Finally, potential drug molecules were screened for, and molecular docking simulations were performed to identify potential therapeutic targets. Results: Seven hub genes-namely, Ccl3, Ccl4, Ccl7, Cxcl1, Hspa1a, Cd14, and Socs3-were identified. Furthermore, we established a protein interaction network using the STRING database and found that the core genes selected through the cytohubba plugin remained consistent. Animal experiments showed that at the transcriptional level, all seven genes showed significant differences (p < 0.001, fold change vs sham, 5-200). At the translational level, however, only Ccl3, Ccl4, Ccl7, Hspa1a, and Socs3 showed significant differences, while Cxcl1 and Cd14 did not. Nifedipine, with the highest predicted score, was identified as a therapeutic agent and successfully docked with the protein encoded by the hub genes. Conclusions: The expression of Ccl3, Ccl4, Ccl7, Hspa1a, and Socs3 was significantly different in CIR tissues compared to normal tissues both at the transcriptional and translational levels. Systems biology approaches indicated that these could be possible CIR marker genes, providing a stepping stone for further experimental studies.

Pathological cardiac hypertrophy is a well-recognized risk factor for cardiovascular diseases (CVDs). Although lots of efforts have been made to illustrate the underlying molecular mechanisms, many issues remain undiscovered. Recently, intercellular communication by delivering small molecules between different cell types in the progression of cardiac hypertrophy has been reported, including bioactive nucleic acids or proteins. These extracellular vesicles (EVs) may act in an autocrine or paracrine manner between cardiomyocytes and noncardiomyocytes to provoke or inhibit cardiac remodeling and hypertrophy. Besides, EVs can be used as novel diagnostic or prognostic biomarkers in cardiac hypertrophy and also may serve as potential therapeutic targets due to its biocompatible nature and low immunogenicity. In this chapter, we will first summarize the current knowledge about EVs from different cells in pathological cardiac hypertrophy. Then, we will focus on the value of EVs as therapeutic agents and biomarkers for pathological myocardial hypertrophy.

Abstract Background The triglyceride glucose (TyG) index, an indicator of insulin resistance, is often associated with adverse outcomes in various cardiovascular diseases, while hypertension is associated with an increased risk of cardiovascular diseases. As the loss of muscle mass in people with hypertension is poorly understood, the current study aimed to explore the relationship between TyG index and muscle mass in hypertensive population. Methods We analyzed data from hypertensive adult participants in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. The TyG index and body mass index (BMI)-adjusted skeletal muscle mass index (SMI) were calculated and the relationship between the two was evaluated using multivariable linear regression and restricted cubic spline (RCS) regression models. Results A total of 1633 participants in the dataset were included for the final analysis. In the multivariable regression analysis, the adjusted β of SMI with a 95% confidence interval (CI) for the highest TyG index quartile was − 5.27 (− 9.79 to − 0.75), compared with the lowest quartile. A negative linear relationship between TyG index and SMI was plotted by RCS regression (nonlinear P = 0.128). Stratified models of non-smoking women of different ages also demonstrated that SMI decreased as TyG index increased (all P for trend < 0.05). Conclusion This linear and negative correlation between TyG index and SMI in hypertensive patients suggests that insulin resistance adversely affects muscle mass.

Background The influence of sarcopenic obesity (SO) on overall survival in older adults with hypertension has not been addressed. The aim of this study was to investigate the prevalence and mortality predictive value of various body composition phenotypes, focusing mainly on SO, in older adults with hypertension. Methods We included 1105 hypertensive patients aged ≥ 60 years from the National Health and Nutrition Examination Survey 1999–2004. Sarcopenia was broadly defined based on low lean mass (LLM; as measured by dual-energy X-ray absorptiometry), and was defined using appendicular lean mass (ALM) divided by height squared (ALM/height 2 ), weight (ALM/weight), and body mass index (BMI; ALM/BMI), respectively. Obesity was defined as BMI ≥ 30 kg/m 2 , body fat percentage ≥ 30/42%, or waist circumference ≥ 102/88 cm. The prevalence of LLM with obesity was estimated according to each ALM index (ALMI). Multivariable Cox regression analysis and sensitivity analysis were used to examine the association between various body composition phenotypes and all-cause mortality. Results In older adults with hypertension, the prevalence of LLM with obesity by the ALM/height 2 index (9.8%) was lower relative to the ALM/weight (11.7%) and ALM/BMI indexes (19.6%). After a median follow-up of 15.4 years, 642 deaths occurred. In the fully adjusted models, LLM with obesity was significantly associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.14–2.49, P = 0.008; HR 1.48, 95% CI 1.04–2.10, P = 0.028; HR 1.30, 95% CI 1.02–1.66, P = 0.037; respectively) compared with the normal body phenotype, with no statistical differences found in individuals with LLM or obesity alone. Sensitivity analysis confirmed the robustness of the results. Conclusions The prevalence of LLM with obesity markedly differed in older adults with hypertension according to the 3 different ALMIs, varying from 9.8%, 11.7%, to 19.6%. Patients with both LLM and obesity had a higher risk of all-cause mortality. Further large, prospective, cohort studies are warranted to validate these findings and uncover underlying mechanisms.