Why lower low-density lipoprotein cholesterol (LDL-C) was associated with a decreased atherosclerotic cardiovascular disease (ASCVD) risk but an increased hemorrhagic stroke (HS) risk in hypertensive adults remains unclear. We examined whether the inverse LDL-C-HS association partly arises from its effect on ASCVD. We estimated separable effects of LDL-C on HS outside (ie, separable direct effect) or only through its effect on ASCVD (ie, separable indirect effect) in hypertensive adults from the Chinese Multiprovincial Cohort Study. We quantified such effects using numbers needed to treat (NNT) to prevent or cause an extra HS based on the restricted mean event-free time until a 25-year follow-up. Low-density lipoprotein cholesterol <70 mg/dL was not associated with an increased HS risk compared to LDL-C $\ge$70 mg/dL regarding total and separable direct effects. However, a small separable indirect effect (ie, NNT to harm: 9722 participants) was noted and validated via a series of sensitivity analyses. Moreover, modified effects were observed, particularly among patients 35-49 years, men, and those with SBP $\ge$140 mm Hg. These results suggest the inverse LDL-C-HS association in hypertensive adults is partly due to its effect on ASCVD. A better understanding of such associations would provide more enlightening into stroke prevention.

Objective To examine recent patterns regarding oral anticoagulant (OAC) use among patients hospitalised with atrial fibrillation (AF) and quantify the impact of insurance coverage for non-vitamin K oral anticoagulants (NOACs) on quality of care and care inequality regarding OAC use among hospitalised patients with AF.Design Interrupted time series analysis.Setting Hospitals in China.Participants A total of 36 393 patients hospitalised with non-valvular AF were involved between 2015 and 2019 across China.Primary and secondary outcome measures Outcome was the impact of insurance coverage for NOACs on quality of care regarding OAC prescription using interrupted time series analysis with segmented regression models.Results OAC prescription rate during hospitalisation was 52.1% (31.3% for warfarin and 20.8% for NOACs) in patients with high-risk AF and 66.3% (29.8% for warfarin and 36.5% for NOACs) in low-risk patients. Insurance coverage for NOACs was associated with an immediate 10.9% (95% CI 7.6% to 14.3%) increase in NOAC prescription and a 0.33% (95% CI 0.08% to 0.58%) increase in the slope of the secular trend of NOAC prescription among all the patients. Disparities in NOAC prescription among hospitals decreased from 18.9 before the insurance coverage for NOACs to 3.4 after that. Similar results were found in patients with high risk of stroke.Conclusion A large gap exists between clinical practice and guideline recommendations regarding OAC prescription among patients hospitalised with AF in China. Insurance coverage may be an effective healthcare strategy to improve quality of care and reduce care disparities regarding OAC prescription among patients with AF.Trial registration number NCT02309398.

Background Macrophages play a crucial role in the pathological process after myocardial infarction (MI). However, pharmacological therapy targeting this pathway remains undefined. Curcumol, a natural compound extracted from the Curcumae Rhizoma, has demonstrated anti-tumor and anti-inflammatory activities. Therefore, this study aimed to explore the potential of curcumol as a therapeutic agent for MI. Methods Wild-type (WT) mice were administered with curcumol orally following left coronary artery ligation. The effects of curcumol on post-MI inflammatory responses were evaluated through phenotypic analysis, histology, and flow cytometry. RNA sequencing, surface plasmon resonance (SPR), and molecular docking were utilized to identify the molecular target of curcumol. Functional studies were further conducted using stimulator of interferon genes (STING) knockout (Sting-/-) mice. Results Curcumol treatment improved the survival rate in mice following MI while enhancing cardiac function and mitigating adverse post-infarction ventricular remodeling. Transcriptomic analysis and SPR indicated curcumol directly bound to STING. Functional assays demonstrated that the cardio-protective effects of curcumol were mediated via STING, as these effects were diminished in Sting-/- mice. Mechanistically, curcumol disrupted STING-TBK1 interaction, suppressing downstream signaling activation and type I interferon responses. Notably, curcumol exhibited stronger inhibition of activated STING signaling in macrophages and superior cardioprotective effects compared to the STING inhibitor H-151. Conclusion Curcumol targets STING to suppress type I interferon responses, improving cardiac function post-MI. These findings highlight curcumol as a promising therapeutic candidate for MI treatment.

BACKGROUND:In patients with acute coronary syndromes (ACS) requiring percutaneous coronary intervention (PCI), abnormally elevated platelet counts are often associated with an increased risk of stent thrombosis and bleeding. AIMS:To explore the associations between clinical benefits and PCI in patients with ACS and elevated platelet counts. METHODS:Between July 2017 and December 2019, 50,009 patients with ACS were enrolled in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project. This study included patients with platelet count≥300×109/L. The primary outcome was net adverse clinical events (NACE), including major adverse cardiovascular or cerebrovascular events (MACCE; all-cause death, myocardial infarction, ischaemic stroke and stent thrombosis) and major bleeding during the index hospitalization. The difference in the risk of NACE between PCI and non-PCI groups was analysed using multivariable analysis and inverse probability of treatment weighting. RESULTS:Among 4501 patients, PCI rates decreased as platelet count increased, with 3029 patients ultimately undergoing PCI. These patients exhibited a lower rate of NACE (adjusted odds ratio [OR]: 0.53, 95% confidence interval [95% CI]: 0.37-0.77; P=0.001) and a reduced risk of MACCE (OR: 0.44, 95% CI: 0.29-0.67; P<0.001). No significant differences in major bleeding were observed (adjusted OR: 1.40, 95% CI: 0.62-3.16; P=0.417). Inverse probability of treatment weighting confirmed these findings. CONCLUSION:In patients with ACS and increased platelet counts who have more complex thrombohaemorrhagic profiles, PCI can effectively reduce the risk of ischaemic events without increasing the risk of bleeding. CLINICAL TRIAL REGISTRATION:https://clinicaltrials.gov/study/NCT02306616.

Evidence-based treatment strategies for patients with cardiovascular disease and diabetes have been updated in recent years. However, substantial gaps remain between guideline recommendations and clinical practice, which justify the urgent need to improve the quality of care for patients with these conditions. The Chinese Society of Cardiology and the Chinese Society of Diabetes, in collaboration with the American Heart Association and the American Diabetes Association, designed the China Diabetes Cardiovascular project. The China Diabetes Cardiovascular project is a nationwide registry study aimed at improving the quality of care for patients with acute coronary syndrome and diabetes in China. Launched in 2021, this project has enrolled 36 hospitals across mainland China. Patients with a primary discharge diagnosis of comorbid acute coronary syndrome and diabetes will be eligible to participate. Pre-defined performance measures will be adopted to evaluate the quality of care for these patients. Multiple quality improvement strategies will be adopted, including providing monthly quality reports based on these measures, conducting a series of training courses, and distributing educational materials. A comprehensive dataset, encompassing patients’ characteristics, medical history, treatment before and during the current hospitalization, and discharge medications for secondary prevention, will be collected through a web-based data collection platform. This project has the potential to improve the quality of care and reduce the care disparities in the management of patients with these diseases. Moreover, with its comprehensive data collection, this project will provide a strong foundation for exploring key clinical questions.

The relationship between blood pressure (BP) levels and adverse outcomes in patients with atrial fibrillation (AF) is incompletely understood. Our study aims to elucidate the relationship between BP levels upon admission and in-hospital outcomes in patients hospitalized with AF. Based on the Improving Care for Cardiovascular Disease in China-AF (CCC-AF) project, patients hospitalized with AF collected from 236 hospitals in China from 2015 to 2019 were included in current analysis. A total of 60 390 patients hospitalized with AF were included. Using systolic BP (SBP)/diastolic BP (DBP) of 130–139/80–89 mmHg upon admission as the reference, SBP/DBP ≥160/100 mmHg was associated with an increased risk of stroke/transient ischemic attack (TIA) (adjusted OR, 1.65; 95

OBJECTIVE:To validate whether incorporating existing polygenic risk scores (PRSs) derived from East Asian or trans-ancestry populations into clinical risk equations improves stroke risk stratification in Chinese adults. METHODS:Participants from the Chinese Multi-provincial Cohort study with genotyped data (n = 2931) were included. Four well-established PRSs (i.e., PRS-GBMI, PRS-GIGA, PRS-ChinaPAR, and PRS-MEGA) from either the predominantly Chinese or trans-ancestry populations were constructed and evaluated by assessing their associations with stroke and its subtypes. We tested the incremental predictive capability of the four PRSs for the 10- and 20-year risk of stroke and its subtypes after adding PRSs to recalibrated China-PAR stroke risk equations, based on discrimination, calibration, and reclassification. RESULTS:Over a median follow-up period of 28.2 years, 340 stroke events were recorded. Higher PRSs were generally associated with a higher stroke risk, though only the highest quantile group of PRS-GIGA showed statistical significance (hazard ratio (HR): 1.79, 95% confidence interval (CI): 1.05-3.07). Adding PRS-GIGA to the recalibrated China-PAR stroke risk equations (i.e., the base model) yielded a moderate improvement in 20-year stroke risk, with 17.2% (95% CI: 3.8%-30.6%) more participants correctly categorized into their corresponding risk groups. However, for ischemic stroke, adding PRS-GIGA, PRS-ChinaPAR, and PRS-MEGA to the base model could correctly categorize 18.7%-23.8% more participants into their corresponding 10-year risk groups and 27.8%-32.5% more participants into their corresponding 20-year risk groups. Adding PRSs did not improve prediction for hemorrhagic stroke. CONCLUSION:Adding existing PRSs, particularly PRS-GIGA, to clinical risk equations can improve all stroke and ischemic stroke risk stratification in Chinese adults.

BACKGROUND:Although the current guidelines discourage the use of anticoagulation after percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), the recommendations are not well supported by evidence. We aimed to evaluate the association between postprocedural parenteral anticoagulant therapy and clinical outcomes in such patients. METHODS:We recruited NSTE-ACS patients registered in the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome registry from November 1, 2014 to December 31, 2020. The patients were categorized according to whether postprocedural parenteral anticoagulant therapy was used after PCI. The primary outcomes were in hospital all-cause death and any bleeding. RESULTS:Among included 14,427 eligible NSTE-ACS patients, 6,244 patients (43.3%) treated with postprocedural parenteral anticoagulant therapy were younger, with better cardiac function and lower bleeding risk score, less likely to have comorbidities, and had a longer median duration of hospital stay than those treated without postprocedural parenteral anticoagulant therapy. After inverse probability of treatment weighting adjustment for baseline differences, postprocedural parenteral anticoagulant therapy was not associated with a reduction of in hospital all-cause death (adjusted OR, 0.73; 95% CI, 0.43-1.22). However, the risk of in hospital any bleeding was higher in the postprocedural parenteral anticoagulant therapy group (adjusted OR, 1.31; 95% CI, 1.02-1.70). The subgroup analysis was consistent with the primary results. CONCLUSIONS:Postprocedural parenteral anticoagulant therapy is not associated with a reduced risk of in hospital all-cause death but increased risk of any bleeding in patients with NSTE-ACS after PCI.

Cardiac rupture (CR) is fatal mechanical complication of ST-segment elevation myocardial infarction (STEMI). We systematically analyzed the clinical features of STEMI patients with CR, as well as predictors and treatments associated with risk of CR in contemporary era. In this nationwide database, 49,284 patients admitted within 48 h after STEMI were enrolled, and were stratified according to CR status. We analyzed patients' clinical characteristics, case fatality rate, and independent correlates of CR. A total of 188 (0.38%) patients had CR, of which 42.6% died during hospitalization. Older age, female gender, higher heart rate, history of diabetes, and worse cardiac function were risk factors of CR in patients with STEMI, while a previous history of myocardial infarction was associated with a reduced risk of CR. CR patients were less likely to undergo primary percutaneous coronary intervention (PCI). After adjustment, primary PCI was associated with 56% decreased risk of CR (OR 0.44, 95% CI 0.29-0.67). This result was consistent in the propensity-score matching analysis and inverse probability of treatment weighting analysis. CR was associated with high in-hospital mortality among STEMI patients. Multiple factors were associated with CR occurrence, primary PCI was associated with lower risk of CR, indicating that early intervention targeting the risk factors and implementation of primary PCI may improve its prognosis. Clinical trial registration ClinicalTrials.gov; Number: NCT02306616; URL: www.clinicaltrials.gov

Background Atrial fibrillation (AF) is the most common arrhythmia in patients with heart failure (HF). Epidemiological data regarding HF in patients with AF are lacking. We describe the epidemiology, clinical features, treatment strategies, and in‐hospital outcomes in patients with AF and HF. Methods and Results Patients with HF and nonvalvular AF in the Improving Care for Cardiovascular Disease in China‐AF cohort from February 2015 to December 2019 were included. Patients were stratified by left ventricular ejection fraction into HF with reduced EF, HF with mildly reduced EF, and HF with preserved EF groups. The primary outcome was the occurrence of hospitalization for major adverse cardiovascular events, including death, cardiogenic shock, cardiac arrest, and stroke. Overall, 16 562 patients with AF and HF were included (mean age: 72.35±11.07 years; 46.1% female). HF with preserved EF (63.1%) accounted for the largest proportion, followed by HF with mildly reduced EF (19.0%) and HF with reduced EF (17.9%). Different HF subtypes in patients with AF had unique baseline demographic and clinical characteristics after multinomial logistic regression analysis. Compared with the HF with preserved EF group, hospitalization for major adverse cardiovascular events was increased in the HF with mildly reduced EF group (odds ratio=1.55 [95% CI, 1.18–2.03]) and HF with reduced EF group (odds ratio 1.60 [95% CI, 1.21–2.13]) after adjusting for confounders. Conclusions In this large Chinese AF registry, the distribution of HF differed from the non‐AF population. Patients with AF with different types of HF have unique demographic and clinical characteristics. Occurrence rates of in‐hospital outcomes were higher in patients with HF with mildly reduced EF and patients with HF with reduced EF compared with the HF with preserved EF group. Registration URL: http://www.clinicaltrials.gov; Unique identifier: NCT02309398.

BACKGROUND:The prognosis of patients with coronary artery disease is adversely affected by elevated fasting plasma glucose (FPG) levels. However, the relationship between FPG levels and in-hospital cardiac arrest (IHCA) remains unclear. OBJECTIVES:The objective of this study was to investigate the association between FPG levels and IHCA in patients diagnosed with acute coronary syndrome (ACS). METHODS:Data from a total of 31,726 ACS patients fitted with inclusion and exclusion criteria across 241 hospitals in the Improving Care for Cardiovascular Disease in China-ACS project from November 2014 to July 2019 were collected. Different logistic regression models were utilized to examine the associations of FPG levels with IHCA. Sensitivity analyses were then conducted to assess the robustness of the findings. Marginal effect analyses were also employed to evaluate the impact of different therapies. RESULTS:A total of 335 cases of IHCA and 293 in-hospital mortality were recorded throughout the study. A non-linear relationship between FPG levels and IHCA was identified after adjusting for the covariates. Specifically, a significant association was found between elevated FPG levels (≥6.1 mmol/L) and an increased risk of IHCA. These findings remained consistent across different subgroup analyses including both the diabetic and non-diabetic patients. Additionally, the marginal effect analyses revealed that percutaneous coronary intervention could lower the high FPG-related risk. CONCLUSIONS:The study findings showed a positive correlation between FPG levels and a higher incidence of IHCA, irrespective of the presence of diabetes.

Background Lipoprotein(a) (Lp(a)) is considered to be a causal risk factor of atherosclerotic cardiovascular disease (ASCVD), but whether there is an independent or joint association of Lp(a) and atherosclerotic plaque with ASCVD risk remains uncertain. This study aims to assess ASCVD risk independently or jointly conferred by Lp(a) and carotid atherosclerotic plaque. Methods and Results A total of 5471 participants with no history of cardiovascular disease at baseline were recruited and followed up for ASCVD events (all fatal and nonfatal acute coronary and ischemic stroke events) over a median of 11.5 years. Independent association of Lp(a), or the joint association of Lp(a) and carotid plaque with ASCVD risk, was explored using Cox proportional hazards models. Overall, 7.6% of the participants (60.0±7.9 years of age; 2649 [48.4%] men) had Lp(a) ≥50 mg/dL, and 539 (8.4/1000 person‐years) incident ASCVD events occurred. Lp(a) concentrations were independently associated with long‐term risk of total ASCVD events, as well as coronary events and ischemic stroke events. Participants with Lp(a) ≥50 mg/dL had a 62% higher risk of ASCVD incidence (95% CI, 1.19–2.21) than those with Lp(a) <10 mg/dL, and they exhibited a 10‐year ASCVD incidence of 11.7%. This association exists even after adjusting for prevalent plaque. Moreover, participants with Lp(a) ≥30 mg/dL and prevalent plaque had a significant 4.18 times higher ASCVD risk than those with Lp(a) <30 mg/dL and no plaque. Conclusions Higher Lp(a) concentrations are independently associated with long‐term ASCVD risk and may exaggerate cardiovascular risk when concomitant with atherosclerotic plaque.

Background The atherogenic index of plasma (AIP) has been demonstrated to be significantly associated with the incidence of prediabetes and diabetes. This study aimed to investigate the association between the AIP and undiagnosed diabetes in acute coronary syndrome (ACS) patients. Methods Among 113,650 ACS patients treated with coronary angiography at 240 hospitals in the Improving Care for Cardiovascular Disease in China-ACS Project from 2014 to 2019, 11,221 patients with available clinical and surgical information were included. We analyzed these patients’ clinical characteristics after stratification according to AIP tertiles, body mass index (BMI) and low-density lipoprotein cholesterol (LDL-C) levels. Results The AIP was independently associated with a greater incidence of undiagnosed diabetes. The undiagnosed diabetes was significantly greater in the T3 group than in the T1 group after adjustment for confounders [T3 OR 1.533 (1.199–1.959) p < 0.001]. This relationship was consistent within normal weight patients and patients with an LDL-C level ≥ 1.8 mmol/L. In overweight and obese patients, the AIP was significantly associated with the incidence of undiagnosed diabetes as a continuous variable after adjustment for age, sex, and BMI but not as a categorical variable. The area under the receiver operating characteristic curve (AUC) of the AIP score, triglyceride (TG) concentration, and HDL-C concentration was 0.601 (0.581–0.622; p < 0.001), 0.624 (0.603–0.645; p < 0.001), and 0.493 (0.472–0.514; p = 0.524), respectively. A nonlinear association was found between the AIP and the incidence of undiagnosed diabetes in ACS patients (p for nonlinearity < 0.001), and this trend remained consistent between males and females. The AIP may be a negative biomarker associated with undiagnosed diabetes ranging from 0.176 to 0.738. Conclusion The AIP was significantly associated with the incidence of undiagnosed diabetes in ACS patients, especially in those with normal weight or an LDL-C level ≥ 1.8 mmol/L. A nonlinear relationship was found between the AIP and the incidence of undiagnosed diabetes, and this trend was consistent between male and female patients. The AIP may be a negative biomarker associated with undiagnosed diabetes and ranges from 0.176 to 0.738.

Abstract Background and Aims Acute coronary syndrome (ACS) is an acute and critical condition of coronary heart disease (CHD) with high mortality and poor prognosis. The prevalence of non-obstructive ACS is about 5% ∼ 15%. Among patients with non-obstructive ACS, which patients are more prone to poor prognosis is a concern. Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease, and due to its special pathophysiological mechanism, non-obstructive ACS may not be uncommon in CKD patients. Therefore, the aim of this study was to investigate the relationship between renal function, the occurrence and prognosis of non-obstructive ACS. Method Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS), a hospital-based medical quality improvement project, is a hospital-based medical quality improvement project to improve the compliance of ACS guidelines in China and improve the prognosis of patients. It was jointly sponsored by the American Heart Association (AHA) and the Chinese Society of Cardiology (CSC) in 2014, with 240 hospitals participating, representing different levels of ACS management in Chinese hospitals. We analyzed patients who underwent coronary angiography from November 2014 to July 2019 in CCC-ACS. Patients were divided into eGFR <60 ml/min·1.73 m² and eGFR≥60 ml/min·1.73 m² groups according to estimated glomerular filtration rate (eGFR) calculated by the EPI formula. According to the results of coronary angiography, the patients were divided into obstructive ACS group and non-obstructive ACS group (obstructive ACS group was defined as at least one coronary artery stenosis ≥ 50%; the others were non-obstructive ACS group). Outcome was defined as in-hospital all-cause mortality and in-hospital MACEs. Results A total of 77 586 patients were included, including 2 292 patients (3.0%) with non-obstructive ACS and 75 294 patients (97.0%) with obstructive ACS. After adjusting for confounding factors using a multivariate logistic regression model, patients with eGFR<60 ml/min·1.73 m² had an approximately 20% increased risk of non-obstructive ACS compared with patients with eGFR≥60 ml/min·1.73 m². The comparison of in-hospital outcomes between the patients with non-obstructive ACS and obstructive ACS is shown in Fig. 1. In-hospital outcomes showed that although the obstructive ACS group had a worse in-hospital prognosis than the non-obstructive ACS group, and the eGFR<60 ml/min·1.73 m² group had a worse in-hospital prognosis than the eGFR≥60 ml/min·1.73 m² group, further grouping of patients showed that the non-obstructive ACS group with eGFR<60 ml/min·1.73 m² had a worse prognosis than the obstructive ACS group with eGFR≥60 ml/min·1.73 m². Confounding factors adjusted for non-obstructive ACS showed that lower eGFR was associated with a higher risk of in-hospital MACEs. After analyzing the in-hospital medication and discharge medication of patients, it was found that the standardized cardiovascular drug therapy was inadequate in patients with non-obstructive ACS. Conclusion Patients with non-obstructive ACS have worse renal function than patients with obstructive ACS, and the proportion of patients with eGFR<60 ml/min·1.73 m² is higher. In patients with non-obstructive ACS, the risk of in-hospital MACEs significantly increased as eGFR decreased. This suggests that we may consider giving standardized cardiovascular drug therapy to patients with non-obstructive ACS, especially those with non-obstructive ACS combined with abnormal renal function, in order to improve the prognosis of patients. This needs to be confirmed by more randomized controlled trial results.

IMPORTANCE Baseline findings from the China Dialysis Calcification Study (CDCS) revealed a high prevalence of vascular calcification (VC) among patients with end-stage kidney disease; however, data on VC progression were limited. OBJECTIVES To understand the progression of VC at different anatomical sites, identify risk factors for VC progression, and assess the association of VC progression with the risk of cardiovascular events and death among patients receiving maintenance dialysis. Design, Setting, and ParticipantsThis cohort study was a 4-year follow-up assessment of participants in the CDCS, a nationwide multicenter prospective cohort study involving patients aged 18 to 74 years who were undergoing hemodialysis or peritoneal dialysis. Participants were recruited from 24 centers across China between May 1, 2014, and April 30, 2015, and followed up for 4 years. A total of 1489 patients receiving maintenance dialysis were included in the current analysis. Data were analyzed from September 1 to December 31, 2021. ExposuresPatient demographic characteristics and medical history; high-sensitivity C-reactive protein laboratory values; serum calcium, phosphorus, and intact parathyroid hormone (iPTH) values; and previous or concomitant use of medications. MAIN OUTCOMES AND MEASURES The primary outcome was progression of VC at 3 different anatomical sites (coronary artery, abdominal aorta, and cardiac valves) and identification of risk factors for VC progression. Participants received assessments of coronary artery calcification (CAC), abdominal aortic calcification (AAC), and cardiac valve calcification (CVC) at baseline, 24 months, 36 months, and 48 months. Secondary outcomes included (1) the association between VC progression and the risk of all-cause death, cardiovascular (CV)-related death, and a composite of all-cause death and nonfatal CV events and (2) the association between achievement of serum calcium, phosphorus, and iPTH target levels and the risk of VC progression. RESULTS Among 1489 patients, the median (IQR) age was 51.0 (41.0-60.0) years; 59.5% of patients were male. By the end of 4-year follow-up, progression of total VC was observed in 86.5% of patients; 69.6% of patients had CAC progression, 72.4% had AAC progression, and 33.4% had CVC progression. Common risk factors for VC progression at the 3 different anatomical sites were older age and higher fibroblast growth factor 23 levels. Progression of CAC was associated with a higher risk of all-cause death (model 1 [adjusted for age, sex, and body mass index]: hazard ratio [HR], 1.97 [95% CI, 1.16-3.33]; model 2 [adjusted for all factors in model 1 plus smoking status, history of diabetes, and mean arterial pressure]: HR, 1.89 [95% CI, 1.11-3.21]; model 3 [adjusted for all factors in model 2 plus calcium, phosphorus, intact parathyroid hormone, and fibroblast growth factor 23 levels and calcium-based phosphate binder use]: HR, 1.92 [95% CI, 1.11-3.31]) and the composite of all-cause death and nonfatal CV events (model 1: HR, 1.98 [95% CI, 1.19-3.31]; model 2: HR, 1.91 [95% CI, 1.14-3.21]; model 3: HR, 1.95 [95% CI, 1.14-3.33]) after adjusting for all confounding factors except the presence of baseline calcification. Among the 3 targets of calcium, phosphorus, and iPTH, patients who achieved no target levels (model 1: odds ratio [OR], 4.75 [95% CI, 2.65-8.52]; model 2: OR, 4.81 [95% CI, 2.67-8.66]; model 3 [for this analysis, adjusted for all factors in model 2 plus fibroblast growth factor 23 level and calcium-based phosphate binder use]: OR, 2.76 [95% CI, 1.48-5.16]), 1 target level (model 1: OR, 3.71 [95% CI, 2.35-5.88]; model 2: OR, 3.62 [95% CI, 2.26-5.78]; model 3: OR, 2.19 [95% CI, 1.33-3.61]), or 2 target levels (model 1: OR, 2.73 [95% CI, 1.74-4.26]; model 2: OR, 2.69 [95% CI, 1.71-4.25]; model 3: OR, 1.72 [95% CI, 1.06-2.79]) had higher odds of CAC progression compared with patients who achieved all 3 target levels. CONCLUSIONS AND RELEVANCE In this study, VC progressed rapidly in patients undergoing dialysis, with different VC types associated with different rates of prevalence and progression. Consistent achievement of serum calcium, phosphorus, and iPTH target levels was associated with a lower risk of CAC progression. These results may be useful for increasing patient awareness and developing appropriate strategies to improve the management of chronic kidney disease-mineral and bone disorder among patients undergoing dialysis.

Aim: Experimental studies report that intermediate-density lipoprotein (IDL), the precursor of low-density lipoprotein, promotes atherosclerotic plaque formation. However, whether IDL is involved in the development of atherosclerosis in humans is still unclear. The aim of this community-based study is to examine the association between IDL particle (IDL-P) concentrations and the 5-year progression of carotid atherosclerosis. Methods: Baseline IDL-P concentrations were measured using nuclear magnetic resonance spectroscopy in 927 participants aged 45-74 years with no history of cardiovascular disease (CVD) at baseline. To estimate the association between baseline IDL-P concentrations and 5-year progression of carotid atherosclerosis, indicated by atherosclerotic plaque progression and changes in total plaque area (TPA), multivariable-adjusted regression was employed. Results: During the 5-year follow-up period, 45.8% of participants developed new plaques. Baseline IDL-P concentrations were significantly associated with the progression of carotid atherosclerosis. Participants in the highest quartile of IDL-P concentrations exhibited 1.36-fold (95% confidence interval [CI]: 1.09-1.68) increased progression of carotid plaque and 1.67-fold (95% CI: 1.04-2.69) higher TPA than those in the lowest quartile. These relationships were independent of baseline concentrations of low-density lipoprotein particles and verylow-density lipoprotein particles and their subclasses. Conclusions: Elevated IDL-P concentrations were independently associated with the progression of carotid atherosclerosis, suggesting that IDL-P is a novel risk factor for the development of atherosclerosis.

Background: Although important progress has been made in understanding Lp(a) (lipoprotein[a])-mediated stroke risk, the contribution of Lp(a) to the progression of vulnerable plaque features associated with stroke risk remains unclear. This study aims to evaluate whether Lp(a) is associated with carotid plaque progression, new-onset plaque features, and plaque vulnerability in a prospective community-based cohort study. Methods: Baseline Lp(a) levels were measured using latex-enhanced turbidimetric immunoassay among 804 participants aged 45 to 74 years and free of cardiovascular disease in the Chinese Multi-provincial Cohort Study—Beijing project. Carotid atherosclerosis was measured twice by B-mode ultrasonography over a 10-year interval during the 2002 and 2012 surveys to assess the progression of total, vulnerable and stable plaques, and plaque vulnerability. The total plaque area and plaque vulnerability score were calculated. Results: The median baseline Lp(a) level was 10.20 mg/dL (interquartile range, 6.20 to 17.18 mg/dL). Modified Poisson regression analysis showed that Lp(a) ≥50 mg/dL was significantly associated with 10-year progression of total carotid plaque (relative risk [RR], 1.41 [95% CI, 1.21–1.64]; E -value=2.17), vulnerable plaque (RR, 1.93 [95% CI, 1.54–2.41]), and stable plaque (RR, 1.51 [95% CI, 1.11–2.07]) compared with Lp(a) <50 mg/dL. Moreover, among participants without plaque at baseline, Lp(a) ≥50 mg/dL was related to an increased total plaque area (β=0.36 [95% CI, 0.06–0.65]; P =0.018) and increased plaque vulnerability score (β=0.30 [95% CI, 0.01–0.60]; P =0.045) in multivariable linear regression. Conclusions: Elevated Lp(a) levels were associated with 10-year carotid plaque progression and plaque vulnerability, providing a basis for Lp(a) as a treatment target for stroke prevention.

BACKGROUND:Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China. METHODS:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed. RESULTS:A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43-0.68; P <0.001). At discharge, the prescription rate of OAC was 45.2% (16,757/37,087) in eligible patients with high stroke risk and 60.7% (2778/4578) in eligible patients with low stroke risk. OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time (all P <0.001). Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies, including catheter ablation (adjusted odds ratio [OR] 11.63, 95% confidence interval [CI] 10.04-13.47; P <0.001), electronic cardioversion (adjusted OR 2.41, 95% CI 1.65-3.51; P <0.001), and anti-arrhythmic drug use (adjusted OR 1.45, 95% CI 1.38-1.53; P <0.001). CONCLUSIONS:In hospitals participated in the CCC-AF project, >70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov, NCT02309398.

Aim To establish a rat model of DOR combined with chronic unpredictable mild stress (CUMS), and to explore the effect of chronic adverse psychological stress on ovarian reserve dysfunction, so as to provide experimental basis for further research. Methods The rats were randomly divided into control group, CUMS group, DOR group and DOR +CUMS group, with 10 rats in each group,given fed normally, chronic mild unpredictable stress, Tripterygium glycoside tablets and Tripterygium glycoside tablets with CUMS intervention in proper order for 21 days. We observed the body mass, estrous cycle, behavioral testing, the hematoxylin and eosin (H&E) staining of ovarian tissue,the serum levels (E2, FSH, 5-HT and GnRH)and Apoptotic granulosa cells of ovarian tissue. Results After an 21-days exposure, in DOR group or DOR+CUMS group the serum levels of E2 was reduced and the FSH was raised. In DOR group, the estrous cycle was disordered, the ovary was slightly atrophied and the ovarian tissue structure was not clear, the number of follicles and the content of follicular fluid were small, the cell layers was reduced, and inflammatory cell infiltration was visible, the change was more obvious in DOR+CUMS group. In CUMS group and DOR+CUMS group, the OFT, SPT and 5-HT were lower and the GnRH was higher than in control group. About the TUNEL, the AI in the DOR group, the CUMS group and DOR+CUMS group were higher. Conclusions Our outcomes state that we could established an rat model of psychological stress-induced DOR successfully which can be used for further study.