Poor left ventricular ejection fraction (LVEF) is associated with an increased risk of left ventricular (LV) thrombus formation. However, the effect of LVEF on thrombus resolution remains unclear. We prospectively enrolled patients from 2020 to 2022 and retrospectively from 2010 to 2020 at the National Center for Cardiovascular Diseases, China. Patients with LV thrombus diagnosed within the last 3 months were included. The primary outcome was the resolution of LV thrombus at 12 weeks. Hazard ratios (HRs) and 95

AIMS:Pulmonary abnormalities are commonly reported in heart failure (HF) and may have prognostic implications. Current evidence is limited to high-income countries. We examined the relationship between forced expiratory volume in 1 second (FEV1), HF burden, and long-term clinical outcomes in a diverse multi-national HF cohort. METHODS AND RESULTS:In a sub-study within the multinational Global Congestive Heart Failure registry, which collected clinical data including spirometry from HF participants in 28 high-, middle-, and low-income countries, and followed for a median 3.8 (IQR 2.1, 5.0) years. Baseline FEV1 was transformed into z-scores standardized for age, sex, and height. The association between baseline FEV1 with all-cause mortality, cardiovascular (CV) deaths, and all-cause hospitalizations was examined. FINDINGS:The analysis included 3359 HF participants (mean age 61.9 [SD 14.1] years, 66.4% males). Participants with lower FEV1 z-scores, even within the normal range (z-score>-2), showed increasing burden of HF, cardiac structural and functional impairment, and lower health-related quality of life. FEV1 z-score ≤ -2 was independently associated with higher risks of all-cause (HR 2.20 [95%CI 1.61-3.01]), CV mortality (HR 2.45 [1.64-3.66]), and hospitalizations (HR 1.40 [1.12-1.74]). The effect sizes were comparable to those of other major prognostic factors. The association was consistent across populations from diverse socio-economic development, HF aetiology, HF types, and airflow obstruction. CONCLUSION:In a diverse, multi-national HF cohort, reductions in FEV1 were independently associated with higher HF burden and poor health outcomes. The effect of lower FEV1 was generalizable across the HF spectrum and comparable to other major established HF prognostic factors.

OBJECTIVE:Gastrointestinal (GI) bleeding is a serious complication among patients with cardiovascular disease (CVD). This study aimed to evaluate sex differences in the odds of GI bleeding. METHODS:We analyzed data from an international case-control study of adults with CVD (n = 4721; 1807 women and 2914 men), conducted between September 3, 2015, and December 20, 2022. Cases presented with overt GI bleeding; controls had no prior GI bleeding. Baseline characteristics were compared by sex. Sequential multivariable logistic regression was used to assess the association between sex and GI bleeding, followed by sex-stratified analyses and tests for sex×factor interactions. RESULTS:Female sex was independently associated with lower adjusted odds of GI bleeding compared with male sex (aOR 0.82, 95% CI 0.72-0.95). While most established factors were associated with GI bleeding in both sexes, Coronary artery disease was associated with higher odds of GI bleeding only in women (aOR 1.44; P-interaction = 0.004). CONCLUSIONS:Among patients with CVD, female sex is independently associated with lower odds of GI bleeding. Several factors were shared between sexes, although some sex-specific associations were observed.

The cardiovascular–kidney–metabolic (CKM) syndrome is a major public health challenge driven by intertwined cardiometabolic and renal dysfunction. Diet-related inflammation and oxidative stress may accelerate biological aging, as reflected by DNA methylation age acceleration, thereby contributing to CKM progression and mortality. However, these pathways have not been comprehensively examined. We analysed data from the National Health and Nutrition Examination Survey (NHANES) 1999–2002, including non-pregnant adults aged ≥ 20 years with complete dietary, epigenetic, and cardiometabolic data. Dietary inflammatory potential and antioxidant capacity were assessed using the Dietary Inflammatory Index (DII) and Dietary Oxidative Balance Score (DOBS), derived from 24-hour dietary recall data. DNA methylation age acceleration (DNAmAA) was quantified using multiple established epigenetic clocks. Cardiovascular–kidney–metabolic (CKM) syndrome was defined and staged according to contemporary criteria. Associations of dietary indices with DNAmAA, CKM stages, and all-cause and cause-specific mortality were examined using weighted regression and Cox proportional hazards models. Mediation analyses were performed to evaluate the role of DNAmAA in linking dietary patterns with CKM progression and mortality. All analyses accounted for the complex NHANES survey design and relevant confounders. Participants with higher dietary inflammatory potential (higher DII) and lower antioxidant capacity (lower DOBS) exhibited less favourable sociodemographic and cardiometabolic profiles and more advanced CKM stages at baseline. Higher DII was consistently associated with accelerated epigenetic aging across multiple DNAmAA measures, whereas higher DOBS showed protective associations. Pro-inflammatory and pro-oxidative dietary patterns were associated with increased odds of advanced CKM stages and higher risks of all-cause and cardiovascular mortality, while anti-inflammatory and antioxidant dietary patterns were associated with lower risks. Mediation analyses demonstrated that GrimAge acceleration and DunedinPoAm partially mediated the associations of dietary indices with CKM progression and mortality, supporting a role for biological aging in linking diet-related inflammation and oxidative stress to adverse CKM outcomes. Dietary inflammatory and oxidative potential is associated with epigenetic aging, CKM progression, and mortality, partly mediated by GrimAge and DunedinPoAm. Improving dietary quality may represent a modifiable strategy to reduce CKM burden.

BACKGROUND & AIMS:Gastrointestinal bleeding (GIB) is common in patients with cardiovascular (CV) disease, but a complete understanding of subsequent outcomes is unknown. We assessed outcomes after GIB in patients with CV disease. METHODS:INTERBLEED is an international multicenter prospective study comparing adults with CV disease (coronary or peripheral arterial disease, heart failure, atrial fibrillation, cerebrovascular disease, or venous thromboembolic disease) with GIB to those without. Outcomes included major adverse cardiovascular events (MACE; myocardial infarction, stroke, or CV-related death), all-cause death, and recurrent GIB at 12 months. Multivariable regression modelling yielded odds ratios (ORs) with 95% confidence intervals (CIs), and reverse Kaplan-Meier curves were created. RESULTS:A total of 3814 patients were enrolled: 1612 patients with GIB and 2202 without. On multivariable analyses, patients with CV disease experiencing GIB were more likely to die within 12 months (OR, 2.29; 95% CI, 1.24-4.19). GIB was associated with recurrent GIB (OR, 4.28; 95% CI, 2.80-6.53) but not MACE. However, resumption of antithrombotic therapy between 4 and 7 days (OR, 0.37; 95% CI, 0.17-0.83) or 8 and 30 days (OR, 0.37; 95% CI, 0.17-0.81) after GIB were associated with lower odds of MACE within 12 months compared with discontinuation or lack of resumption within 60 days. Any antithrombotic use after enrollment was associated with lower all-cause death (OR, 0.45; 95% CI, 0.28-0.71). Neither antithrombotic use nor early resumption was associated with higher odds of recurrent GIB. CONCLUSIONS:GIB in patients with CV disease is independently associated with subsequent morbidity and mortality. Patterns in antithrombotic resumption were associated with outcomes. Further research into optimal antithrombotic management after GIB is essential.

Background and Objectives Considerable evidence has shown that alterations in gut microbiota composition are associated with atrial fibrillation (AF). However, the causal associations remain largely unresolved. This study aims to reveal the causality between gut microbiota and AF. Methods We incorporated data from the largest genome-wide association studies (GWASs) of gut microbiota composition (involving 18,304 individuals) and GWASs of AF (comprising 60,620 cases and 970,216 controls) in European individuals. A two-sample Mendelian randomization framework was designed to investigate the role of gut microbiota in the development of AF. The inverse variance weighted method was applied for the main causal estimate. Complementary sensitivity analyses were utilized to confirm the robustness of the results. Finally, gene ontology enrichment analyses and Kyoto Encyclopedia of genes and genomes pathway analysis are used to investigate the bio-function. Results Among all gut microbiota, five microbial taxa, namely Lachnospiraceae FCS020 , Rikenellaceae RC9 gut group , Catenibacterium , Victivallis , and Erysipelatoclostridium were identified to be causally associated with the higher risk of AF. Besides, genetically predicted eight microbial taxa, namely Lachnospiraceae NK4A136 group , Howardella , Intestinibacter bartlettii , Alloprevotella , Anaerostipes , Odoribacter , Ruminococcus (gnavus group) , and Ruminiclostridium 5 can prevent AF. Conclusion Our study provides evidence of the causal effect of the gut microbiota on AF, highlighting causal microbial taxa. Our results may offer novel insights into gut microbiota-mediated mechanisms and interventions of AF.

Background:Many studies have revealed the observational associations between lipoprotein(a) (Lp(a)) concentrations and the incidence of cardiovascular diseases (CVDs). However, the causal associations remain unclear. Methods:Public summary data were analyzed using a Mendelian randomization (MR) design to assess the causal associations between Lp(a) levels and risks of nine CVDs and evaluate the potential impact of aspirin on Lp(a) levels. The principal analysis was conducted employing the random-effects inverse-variance weighted (IVW) method. Furthermore, the weighted median and MR-Egger approaches were used as the sensitivity analysis. Additionally, the significantly associated single nucleotide polymorphisms (SNPs) in salicylic acid (INTERVAL and EPIC-Norfolk, n = 14,149) were chosen to assess the potential effects of aspirin on lowering Lp(a) levels. Results:The IVW analysis showed that the per standard deviation (SD) increment in Lp(a) level was causally associated with a higher risk of coronary artery disease (odds ratio (OR), 1.237; 95% confidence interval (CI), 1.173-1.303), atrial fibrillation (OR, 1.030; 95% CI, 1.011-1.050), heart failure (OR, 1.074; 95% CI, 1.053-1.096), hypertension (OR, 1.006; 95% CI, 1.004-1.008), and peripheral artery disease (OR, 1.001; 95% CI, 1.001-1.001) (all p < 0.001). The investigation did not reveal any significant heterogeneities or instances of horizontal pleiotropy. Furthermore, for each SD increase in salicylic acid concentration, there was a corresponding 5.4% reduction in Lp(a) levels (OR: 0.946, 95% CI: 0.900-0.993; p = 0.022). Conclusions:A causal nexus was discerned between Lp(a) levels and an increased risk of conditions including coronary artery disease, atrial fibrillation, heart failure, hypertension, and peripheral artery disease. Furthermore, administering aspirin may be a potential therapeutic to reduce these CVD risks among individuals with elevated Lp(a) levels.

Background The association between DNA methylation age acceleration (DNAmAA) and cardiovascular‐kidney‐metabolic (CKM) syndrome stages and long‐term mortality in the population with CKM syndrome remains unclear. Methods and Results This cohort study included 1889 participants from the National Health and Nutrition Examination Survey (1999–2002) with CKM stages and DNA methylation age data. DNAmAA was calculated as residuals from the regression of DNA methylation age on chronological age. The primary outcome was all‐cause mortality, with cardiovascular and noncardiovascular mortality as secondary outcomes. Proportional odds models assessed the associations between DNAmAAs and CKM stages, and Cox proportional hazards regression models estimated the associations between DNAmAAs and mortality. Significant associations were found between DNAmAAs and advanced CKM stages, particularly for GrimAge2Mort acceleration (GrimAA) (odds ratio [OR], 1.547 [95% CI, 1.316–1.819]). Over an average follow‐up of 14 years, 1015 deaths occurred. Each 5‐unit increase in GrimAA was associated with a 50% increase in all‐cause mortality (95% CI, 1.39–1.63), a 77% increase in cardiovascular mortality (95% CI, 1.46–2.15), and a 42% increase in noncardiovascular mortality (95% CI, 1.27–1.59). With the lowest GrimAA tertile as a reference, the highest GrimAA tertile showed hazard ratios of 1.95 (95% CI, 1.56–2.45) for all‐cause mortality, 3.06 (95% CI, 2.13–4.40) for cardiovascular mortality, and 1.65 (95% CI, 1.20–2.29) for noncardiovascular mortality. Mediation analysis indicated that GrimAA mediates the association between various exposures (including physical activity, Healthy Eating Index‐2015 score, hemoglobin A1c, etc.) and mortality. Conclusions GrimAA may serve as a valuable biomarker for assessing CKM stages and mortality risk in individuals with CKM syndrome, thereby informing personalized management strategies.

Background: Atrial fibrillation Better Care (ABC) pathway is recommended by guidelines on atrial fibrillation (AF) and exerts a protective role against adverse outcomes of AF patients. We hypothesize that cluster analysis, an unsupervised machine learning technique, could comprehensively evaluate multiple clinical characteristics of patients, and define clusters of ABC criteria efficacy in patients with AF. Methods: We used data from an observational cohort that included 2,016 patients with AF. We utilized 46 baseline variables for cluster analysis and got the optimal clusters through the K-prototypes algorithm. We evaluated the management patterns and adverse outcomes of identified phenotypes. We assessed the effectiveness of the ABC criteria in reducing adverse outcomes of these phenotypes. Results: Cluster analysis identified AF patients into three distinct groups with markedly different clinical characteristics and outcomes. The clusters were as followed: Cluster 1, old patients with atherosclerotic-comorbidities (n = 964); Cluster 2, young females with valve-comorbidities (n = 407), and Cluster 3, paroxysmal AF patients with low comorbidities (n = 644). The clusters showed significant differences in MACNE, all-cause death, stroke, cardiovascular death, and hospital readmission for heart failure. All clusters showed that full adherence to the ABC pathway was associated with a significant reduction in the risk of MACNE (all P< 0.05). Adherence to the different ‘A’/’B’/’C’ criteria alone showed differential clinic impact for three clusters. Conclusion: Cluster analysis of the Chinese AF cohort further elucidated the heterogeneity of AF. We proposed suggestions for optimizing risk stratification and integrated management of AF patients.

BACKGROUND:Seasonality in the incidence of congenital hypothyroidism (CH) has been identified in several countries and different conclusions have been drawn. The objective of this study was to examine whether this seasonality is also observable in China and how it manifests across different temperate zones. METHODS:Data on CH cases and screened neonates between January 1, 2014, and September 30, 2022, by year and season, were sourced from the Chinese Newborn Screening Information System. The overall CH incidence and incidence across different temperate zones was analyzed by using the seasonal unit root test, seasonal decomposition, and deterministic seasonal means regression model. RESULTS:A total of 29,259 CH cases were reported nationwide from season one of 2014 to season three of 2022. Quarterly CH incidence showed an upward time trend and significant seasonality among all zones, but with different patterns. Overall, season one was the peak period with an incidence rate of 7.09 per 10,000 neonates, whilst season two was the trough period with an incidence rate of 5.89. Subtropical, warm, and medium temperate zones had one peak period in season one, whilst the tropical zone had two peak periods in seasons one and three. In comparison, the plateau zone had a trough season in season one. CONCLUSION:Our study found the quarterly CH incidence exhibited clear seasonality, temperate zone-specific patterns, and an upward time trend in China. This finding is particularly concerning given China's decline in the number of births, underscoring the urgency of allocating resources appropriately in screening programs.

AIMS:This study aimed to identify and quantify the importance of risk factors for gastrointestinal (GI) bleeding in patients with CV disease. METHODS:We conducted a case-control study in 9 countries in Asia, America, Europe, and Australia. Cases were patients with CV disease with GI bleeding. Controls were patients with CV without a history of GI bleeding. All participants completed a baseline standardized assessment. We calculated adjusted odds ratios (ORs) and average population attributable fractions (aPAFs) with 95% confidence intervals (CIs). RESULTS:Between September 2015 and December 2022, we enrolled 2,519 cases and 2,202 controls. Independent risk factors for GI bleeding were age (age 71+: OR 4.16, 95% CI 3.48-4.97; age 61-70: OR 1.69, 95% CI 1.39-2.04; age ≤60 as reference), underweight (OR 3.38, 95% CI 2.24-5.10; aPAF 1.6%, 95% CI 1.0-2.0%), current smoker (OR 1.31; 95% CI 1.09-1.58; aPAF 1.5%, 95% CI 0.6-2.5); chronic kidney disease (OR 1.86, 95% CI 1.62-2.14; aPAF 8.8%, 95% CI 7.0-9.6%), prior stroke (OR 1.56, 95% CI 1.30-1.88, aPAF 2.6%, 95% CI 1.2-4.0%), glucocorticoids (OR 1.71, 95% CI 1.34-2.16, aPAF 1.8%, 95% CI 1.3-2.9%), NSAIDs or COX-2 inhibitors (OR 1.82, 95% CI 1.45-2.29; aPAF 2.2%, 95% CI 1.3-3.0%), liver disease (OR 3.68, 95% CI 2.77-4.89; aPAF 3.5%, 95% CI 2.8-4.2%), peptic ulcer disease (OR 3.38, 95% CI 2.66-4.31; aPAF 4.8%, 95% CI 3.8-5.7%), diverticular disease (OR 1.81, 95% CI 1.46-2.24; aPAF 2.8%, 1.9-3.6%) and antithrombotic therapy within 6 months (aPAF 7.6%, 95% CI 4.3-12.8%). Overall aPAF adjusted for age, sex and region was 37.3% (95% CI 33.0-42.2%). CONCLUSION:Potentially modifiable risk factors are associated with only about one third of the aPAF for GI bleeding.

This study evaluated the safety, tolerability, pharmacodynamics, and pharmacokinetics of recombinant neorudin (EPR-hirudin [EH]) in patients with acute coronary syndrome (ACS), providing a basis for further therapeutic research. This open-label, single-center, nonrandomized, nonblinded, and noncontrolled trial categorized 24 patients with nonprogressive ACS who met the screening criteria into 3 groups. They received an intravenous injection of neorudin (0.4 mg/kg), followed by an intravenous drip at doses of 0.15, 0.30, and 0.45 mg/kg/h for 3 days in the low-, medium-, and high-dose groups, respectively. The safety, tolerability, pharmacodynamics, and pharmacokinetics of EH were assessed after treatment, indicating that neorudin was safe and well tolerated in nonprogressive ACS. No serious adverse events or clinical composite end points were observed. The activated partial thromboplastin time and thrombin time increased significantly and dose dependently following EH administration across all groups compared to pretreatment values. Conversely, thrombin activity significantly decreased after drug administration but returned to baseline levels shortly after drug withdrawal. Within the administered dose range, neorudin exposure increased with the dose, and its half-life was approximately 2 hours. Neorudin was found to be safe and tolerable for treating patients with nonprogressive ACS, demonstrating therapeutic efficacy at doses up to 0.45 mg/kg/h over a 3-day period.

Background The benefit-risk profile of direct oral anticoagulants (DOAC) therapy in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) has not been well established yet. This study aimed to evaluate the efficacy and safety of DOAC compared with vitamin K antagonists (VKA) in patients with HCM and AF. Methods PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov were searched to identify studies comparing DOAC with VKA in patients with HCM and AF. The primary endpoint was thromboembolic events. The relative risks and standard errors were pooled by random-effect models using the generic inverse variance method. Results Seven observational studies involving 9395 patients were included in this meta-analysis. Compared to the VKA group, the DOAC group displayed a similar risk of thromboembolic events [RR (95%CI): 0.93 (0.73–1.20), p = 0.59] and ischemic stroke [RR (95%CI): 0.65 (0.33–1.28), p = 0.22]. The incidence of major bleeding was comparable between the two groups [RR (95%CI): 0.75 (0.49–1.15), p = 0.19]. Meanwhile, DOAC therapy was superior to VKA therapy in reducing the incidences of all-cause death [RR (95%CI): 0.44 (0.35–0.55), p < 0.001], cardiovascular death [RR (95%CI): 0.41 (0.22–0.75), p = 0.004], and intracranial hemorrhage [RR (95%CI): 0.42 (0.24–0.74), p = 0.003]. Conclusion In patients with HCM and AF, DOAC therapy was similar to VKA therapy in reducing the risk of thromboembolic events, without increasing bleeding risk. In addition, the DOAC group displayed significant advantages in reducing mortality and intracranial hemorrhage compared with the VKA group. Further randomized controlled trials are needed to provide more evidence for DOAC therapy in this population.

Background: Standard scoring system for bleeding risk assessment has not been developed in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). This study aims to develop a practical nomogram for bleeding risk evaluation in patients with AF and ACS or undergoing PCI who received both oral anticoagulant (OAC) and antiplatelet therapy (APT). Methods: A total of 930 patients with AF and ACS/PCI receiving both OAC and APT were consecutively recruited and followed up for 1 year. The primary endpoint was defined according to the bleeding academic research consortium (BARC) criteria as major bleeding (BARC 3a, 3b, 3c, and 5). Potential prognostic variables of the primary endpoint were selected by the LASSO method and incorporated in a multivariable logistic regression model. A nomogram visualizing the logistic regression model was then generated. Discrimination was evaluated and compared by the receiver operating characteristic (ROC) curves and c-indexes. Calibration was assessed by the Hosmer-Lemeshow tests, Brier scores and calibration plots. Results: During 1-year follow-up, BARC type 3 or 5 bleeding occurred in 36 patients (3.9%). Four key predictors of the primary endpoint (previous bleeding history, hemoglobin, N-terminal pro-B type natriuretic peptide, and left atrial diameter) were selected by the LASSO method and integrated to construct a nomogram for bleeding risk prediction. This nomogram displayed good discrimination with a c-index of 0.740 (95% CI: 0.639-0.841). Bootstrap resampling was undertaken for internal validation and the bias-corrected c-index was 0.726. Compared to the HAS-BLED score, the nomogram displayed a significant improvement in bleeding risk prediction (c-statistics: 0.740 vs. 0.575, p<0.001). According to the Hosmer-Lemeshow test and the Brier score, the calibration of this nomogram was good. Conclusion: In patients with AF and ACS or undergoing PCI who received both OAC and APT, a simple 4-variable nomogram provide a practical tool for 1-year BARC type 3 or 5 bleeding prediction.

Background Given the increasing attention to glycemic variability (GV) and its potential implications for cardiovascular outcomes. This study aimed to explore the impact of acute GV on short-term outcomes in Chinese patients with ST-segment elevation myocardial infarction (STEMI). Methods This study enrolled 7510 consecutive patients diagnosed with acute STEMI from 274 centers in China. GV was assessed using the coefficient of variation of blood glucose levels. Patients were categorized into three groups according to GV tertiles (GV1, GV2, and GV3). The primary outcome was 30-day all-cause death, and the secondary outcome was major adverse cardiovascular events (MACEs). Cox regression analyses were conducted to determine the independent correlation between GV and the outcomes. Results A total of 7136 patients with STEMI were included. During 30-days follow-up, there was a significant increase in the incidence of all-cause death and MACEs with higher GV tertiles. The 30-days mortality rates were 7.4% for GV1, 8.7% for GV2 and 9.4% for GV3 (p = 0.004), while the MACEs incidence rates was 11.3%, 13.8% and 15.8% for the GV1, GV2 and GV3 groups respectively (p < 0.001). High GV levels during hospitalization were significantly associated with an increased risk of 30-day all-cause mortality and MACEs. When analyzed as a continuous variable, GV was independently associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.679, 95% confidence Interval [CI] 1.005–2.804) and MACEs (HR 2.064, 95% CI 1.386–3.074). Additionally, when analyzed as categorical variables, the GV3 group was found to predict an increased risk of MACEs, irrespective of the presence of diabetes mellitus (DM). Conclusion Our study findings indicate that a high GV during hospitalization was significantly associated with an increased risk of 30-day all-cause mortality and MACE in Chinese patients with STEMI. Moreover, acute GV emerged as an independent predictor of increased MACEs risk, regardless of DM status.

This study aimed to determine the optimal high-sensitivity cardiac troponin I (hs-cTnI)-based algorithm for early diagnosis of non-ST-elevation myocardial infarction (NSTEMI) in Chinese patients. We prospectively enrolled 1,606 patients with suspected NSTEMI from three emergency departments across China, collecting blood samples at 0, 1, and 3 h post-admission. Patients were classified using the 0/1-h and 0/3-h algorithms. The 2015 and 2020 ESC 0/1-h algorithms rapidly triaged 70% of patients with high negative predictive value (NPV) (99.7%) and sensitivity (99.5%). The 0/3-h algorithm showed higher specificity (93.8%) but lower NPV (96.8%) and sensitivity (91.2%). An optimized 0/1-h algorithm improved specificity to 92.1% while maintaining high NPV (99.7%) and sensitivity (99.2%). Low 30-day and 180-day all-cause mortality and major adverse cardiac event (MACE) rates were observed in rule-out groups for all algorithms. The ESC 0/1-h algorithm is a safe and efficient triage method for patients with suspected NSTEMI, with optimization further enhancing specificity and efficiency for the Chinese population.

Objectives We aimed to explore the impact of adherence to Life's Simple 7 (LS7) metrics on risk of obstructive sleep apnea (OSA), and the impact of inflammation on the association, in adults in the United States.Methods Data from 13,825 community-dwelling adults aged ≥ 20 years recruited in the National Health and Nutrition Examination Surveys (NHANES) 2005–2008, 2015–2018 was analyzed. The LS7 score was calculated based on the AHA definition of LS7 metrics. The diagnosis of OSA was based on self-reported symptoms of sleep disturbance using a standard questionnaire. The Multivariable Apnea Prediction (MAP) Index score was also calculated to assess the risk of OSA. Log-binominal regression and negative binomial regression were performed to estimate the associations between LS7 and OSA and MAP index, with odds ratios (ORs) and prevalence ratios (PRs) and their 95% confidence intervals (CIs) calculated. Mediation analysis was performed to estimate the mediating effects of inflammatory indicators on the associations.Results A total of 4473 participants (32.4%) had OSA, and the mean MAP index was 0.39. In fully adjusted log-binominal regression models, with total score < 6 as the reference, the ORs (95% CIs) for risk of OSA were 0.90 (0.73, 1.10), 0.76 (0.65, 0.89), 0.78 (0.64, 0.95), and 0.45 (0.38, 0.54) for total score = 6, total score = 7, total score = 8, and total score > 8, respectively (P for trend < 0.001). When LS7 score was analyzed as a continuous variable, each 1-point increase in LS7 score was associated with a 15% decrease in OSA risk (P < 0.001). In negative binominal regression models, the adjusted PRs (95% CIs) for the MAP index were 0.93 (0.90, 0.97), 0.87 (0.84, 0.91), 0.80 (0.77, 0.84), and 0.55 (0.53, 0.57) for total score = 6, total score = 7, total score = 8, and total score > 8, respectively (P for trend < 0.001). For each 1-point increase in LS7 score, the risk of OSA decreased by 13% (P < 0.001). Consistent results were observed in subgroup analysis. Mediation analysis indicated that inflammatory factors, including blood cell count, neutrophil count, and C-reactive protein, positively mediated the association of LS7 with OSA, with a mediation proportion of 0.022 (P = 0.04), 0.02 (P = 0.04), and 0.02 (P = 0.02), respectively.Conclusions In a nationally representative sample of US adults, adherence to LS7 metrics was independently associated with reduced OSA risk. Inflammation plays a mediating role in the association between LS7 and OSA.