Addressing the alarming link between nonalcoholic fatty liver disease and cardiovascular mortality in men

This editorial discusses the key findings presented in Batta and Hatwal’s recent paper titled“Excess cardiovascular mortality in men with non-alcoholic fatty liver disease:A cause for concern!”,which was published in the World Journal of Cardiology.Their original article highlights a notable correlation between nonalcoholic fatty liver disease(NAFLD)and increased cardiovascular mortality risk in men.The present commentary explores the implications of their findings,discussing potential mechanisms,risk factors,and the urgent need for integrated clinical approaches to mitigate the dual burden of these diseases.Emphasis should be placed on the importance of early detection,lifestyle modifications,and interdisciplinary collaboration for improving patient outcomes.This editorial aims to highlight the broad implications of NAFLD for cardiovascular health and to advocate for increased awareness and proactive management strategies within the medical community.

Vitamin d deficiency and metabolic syndrome:The joint effect on cardiovascular and all-cause mortality in the United States adults

BACKGROUND The long-term impact of vitamin D deficiency and metabolic syndrome(MetS)on cardiovascular disease(CVD)and all-cause mortality are still a matter of debate.AIM To test the hypotheses that lower serum 25 hydroxyvitamin D[25(OH)D]concentrations(a marker of vitamin D level)and MetS have a long-term impact on the risk of CVD and all-cause mortality,and individuals with vitamin D deficiency can be identified by multiple factors.METHODS A sample of 9094 adults,20 to 90 years of age,who participated in the Third National Health and Nutrition Examination Survey(NHANES III,1988 to 1994)were followed through December 2015 was analyzed.The associations of serum 25(OH)D concentrations and MetS with CVD and all-cause mortality were analyzed longitudinally using Cox regression models.Classification and regression tree(CART)for machine learning was applied to classify individuals with vitamin D deficiency.RESULTS Of 9094 participants,30%had serum 25(OH)D concentrations<20 ng/mL(defined as vitamin D deficiency),39%had serum 25(OH)D concentrations between 20 to 29 ng/mL(insufficiency),and 31%had serum 25(OH)D concentrations≥30 ng/mL(sufficiency).Prevalence of MetS was 28.4%.During a mean of 18 years follow-up,vitamin D deficiency and MetS were significantly associated with increased risk of CVD and all-cause mortality.Subjects with both vitamin D deficiency and MetS had the highest risk of CVD mortality(HR=1.77,95%CI:1.22-2.58)and all-cause mortality(HR=1.62,95%CI:1.26-2.09),followed by those with both vitamin D insufficiency and MetS for CVD mortality(HR=1.59,95%CI:1.12-2.24),and all-cause mortality(HR=1.41,95%CI:1.08-1.85).Meanwhile,vitamin D sufficiency significantly decreased the risk of CVD and all-cause mortality for those who even had MetS.Among the total study sample,CART analysis suggests that being non-Hispanic Black,having lower serum folate level,and being female were the first three predictors for those with serum 25(OH)D deficiency.CONCLUSION Vitamin D deficiency and MetS were significantly associated with increased risk of CVD and allcause mortality.There was a significant joint effect of vitamin D deficiency and MetS on the risk of mortality.Findings of the CART analysis may be useful to identify individuals positioned to benefit from interventions to reduce the risk of CVD and all-cause mortality.

Effect of dapagliflozin on uric acid in patients with chronic heart failure and hyperuricemia

BACKGROUND Patients with chronic heart failure(CHF)frequently develop hyperuricemia,an elevated serum uric acid level,associated with adverse outcomes.Dapagliflozin,a sodium-glucose cotransporter-2 inhibitor,demonstrates reduction in cardiovascular mortality and hospitalization in patients with CHF and ejection fraction(HFrEF),irrespective of diabetes.However,dapagliflozin’s effect on the uric acid levels in patients with CHF and hyperuricemia remain unclear.AIM To investigate the effects of dapagliflozin on uric acid levels in CHF patients with hyperuricemia.METHODS We conducted a randomized,double-blind,placebo-controlled trial in 200 patients with CHF and hyperuricemia,with HFrEF and serum uric acid levels≥7 mg/dL(≥416μmol/L).The participants were randomly assigned to receive a daily dose of 10 mg dapagliflozin or placebo for 24 months.The primary endpoint was the change in serum uric acid level from baseline to 24 months.Secondary endpoints included changes in left ventricular ejection fraction(LVEF),Nterminal pro-B-type natriuretic peptide(NT-proBNP),and quality of life(QoL)scores,as well as the incidence of cardiovascular death and hospitalization for heart failure.RESULTS At 24 months,dapagliflozin significantly reduced serum uric acid levels by 1.2 mg/dL(71μmol/L)compared with placebo(95%CI:-1.5 to-0.9;P<0.001).Dapagliflozin also significantly improved LVEF by 3.5%(95%CI:2.1-4.9;P<0.001),NT-proBNP by 25%(95%CI:18-32;P<0.001),and QoL scores by 10 points(95%CI:7-13;P<0.001)and reduced the risk of cardiovascular death and hospitalization for heart failure by 35%(95%CI:15–50;P=0.002)compared with the placebo.Adverse events were similar between the two groups,except for a higher rate of genital infections in the dapagliflozin group(10%vs 2%,P=0.01).CONCLUSION Dapagliflozin significantly lowered serum uric acid levels and improved the clinical outcomes in patients with CHF and hyperuricemia.Therefore,dapagliflozin may be a useful therapeutic option for this high-risk population.

Hidden risks associated with conventional short intermittent hemodialysis:A call for action to mitigate cardiovascular risk and morbidity

The development of maintenance hemodialysis(HD)for end stage kidney disease patients is a success story that continues to save many lives.Nevertheless,intermittent renal replacement therapy is also a source of recurrent stress for patients.Conventional thrice weekly short HD is an imperfect treatment that only partially corrects uremic abnormalities,increases cardiovascular risk,and exacerbates disease burden.Altering cycles of fluid loading associated with cardiac stretching(interdialytic phase)and then fluid unloading(intradialytic phase)likely contribute to cardiac and vascular damage.This unphysiologic treatment profile combined with cyclic disturbances including osmotic and electrolytic shifts may contribute to morbidity in dialysis patients and augment the health burdenof treatment. As such, HD patients are exposed to multiple stressors including cardiocirculatory,inflammatory, biologic, hypoxemic, and nutritional. This cascade of events can be termed thedialysis stress storm and sickness syndrome. Mitigating cardiovascular risk and morbidityassociated with conventional intermittent HD appears to be a priority for improving patientexperience and reducing disease burden. In this in-depth review, we summarize the hidden effectsof intermittent HD therapy, and call for action to improve delivered HD and develop treatmentschedules that are better tolerated and associated with fewer adverse effects.

Mortality in relation to changes in physical activity in middle-aged to older Chinese:An 8-year follow-up of the Guangzhou Biobank Cohort Study

Background:Physical activity(PA)is generally encouraged.Studies from developed countries in the West have shown that maintenance of adequate PA or increasing PA are associated with lower mortality risk.It is unclear whether these associations apply to an older Chinese population.Hence,we examined the changes in PA prospectively among a middle-aged and older Chinese population over an average of 4 years and explored their subsequent mortality risks.Methods:Metabolic equivalent scores of PA among participants in the Guangzhou Biobank Cohort Study were calculated.Participants were divided into 3 groups related to PA level,and changes in PA were classified into 9 categories.Information on vital status and causes of death from March 2008 to December 2012(the first repeated examination)until December 31,2017,was obtained via record linkage with the Death Registry.Results:Of 18,104 participants aged 61.21±6.85 years(mean±SD),1461 deaths occurred within 141,417 person-years.Compared to participants who maintained moderate PA,those who decreased PA from moderate or high levels to a low level had increased risks for all-cause mortality(hazard ratio(HR)=1.47,95%confidence interval(95%CI):1.11-1.96).Participants who maintained a high level of PA(HR=0.83,95%CI:0.70-0.98)or increased PA from low to high levels(HR=0.71,95%CI:0.52-0.97)showed lower all-cause mortality risks.Those who maintained low PA levels showed a higher all-cause mortality risk,whereas those who increased their PA levels showed a non-significantly lower risk.Similar results were found for cardiovascular disease risk.Conclusion:Even at an older age,maintaining a high PA level or increasing PA from low to high levels results in lower mortality risks,suggesting that substantial health benefits might be achieved by maintaining or increasing engagement in adequate levels of PA.The increased risk of maintaining a low PA level or decreasing PA to a low level warrants the attention of public health officials and clinicians.

Short Term Use of Empagliflozin Does Not Improve Left Ventricular Function in Non-Diabetic Hypertensive Patients: Results from a Non-Randomised Controlled Trial

Background: A selective inhibitor of sodium-glucose cotransporter 2 (SGLT2), empagliflozin, has demonstrated its effects in reducing cardiovascular mortality and hospitalization rates for heart failure in type 2 diabetes patients. However, the cardiac-intrinsic mechanism for this cardiovascular benefit has not been sufficiently studied. We therefore aimed to investigate the effect of empagliflozin on left ventricular function in a group of patients with grade I hypertension. Methods: We carried out a single-arm non-randomized clinical trial at the National Obesity Centre in Yaoundé over a period of 8 months (October 2016 to May 2017), where patients were assigned to receive 25 mg of empagliflozin once daily. Cardiac ultrasound, 24-hour ambulatory blood pressure measurement, resting electrocardiography and biological assessment were carried out at baseline and at the end of a 6-week treatment period with empagliflozin. The primary outcome was the improvement of the left ventricular relaxation evaluation criteria. Ethical approval was obtained from the Centre Regional Ethics Committee in Yaoundé, Cameroon. Results: A total of 11 patients were treated (median observation time, 6 weeks). We noted a non-significant improvement in the early lateral annular velocity from 9.7 [9.2 - 11.4] cm/s to 9.1 [8.8 - 10.2] cm/s, p =0.21. We also noted a non-significant improvement of the mitral profile (E/A) from 0.71 [0.63 - 0.78] cm/s to 0.81 [0.58 - 0.88] cm/s, p = 0.08. There were no differences in E/E’ ratio, 5.0 [4.1 - 6.3] vs 5.6 [4.9 - 7.4], p = 0.07. There was a non-significant drop in both systolic (p = 0.06) and diastolic (p = 0.09) blood pressure. We also observed on ECG a drop of the PR interval from 200 [157 - 200] ms to 160 [143 - 186] ms, p = 0.04. Conclusion: Short-term treatment with empagliflozin does not show an improvement of the left ventricular function in grade I hypertensive patients with diastolic dysfunction. Trial registration: This study was retrospectively registered on Clinical Trial Registry with ClinicalTrials.gov Identifier: NCT04203914.

Cardiovascular morbidity and mortality as a confounder of prognosis in thyroid cancer

Thyroid cancer(TC)constitutes more than 95%of all endocrine tumors.Differentiated thyroid carcinoma(DTC),which includes the papillary and follicular types,constitutes about 90%of all TCs and 2.1%of all cancers.The incidence of DTC has increased significantly worldwide,with papillary cancer leading this trend and being the most prevalent.Whereas the prognosis of patients with DTC is generally favorable,with the overall 5-year survival rate reaching up to 95%,long-term follow-up also discloses increased propensity for cardiovascular and cerebrovascular risk factors,morbidity,and mortality.Cardiovascular events are linked to TC particularly in subjects aged 45 years or more.The present review and analysis seek to highlight the significance of cardiovascular disease in the overall prognosis among TC survivors and explore potential mechanisms which might link treatment choices in DTC to cardiovascular risk and disease outcome.

The predictive value of monocyte to HDL cholesterol ratio on clinical outcomes in type 2 diabetes mellitus patients undergoing elective percutaneous coronary intervention

Background Monocyte to high density lipoprotein ratio（MHR） has been considered as a novel parameter related with adverse renal and cardiovascular outcomes.In this study we investigated the association of MHR with major adverse clinical events（MACEs） in patients with type 2 diabetes mellitus（T2DM） undergoing elective percutaneous coronary intervention（PCI）.Methods Consecutive T2 DM patients treated with elective PCI were prospectively recruited between July 2008-January 2016 in Department of Cardiology of Panyu Central Hospital.Subjects were categorized into two groups：as patients who developed MACEs（MACEs＋） and patients who did not develop MACEs（MACEs-） during hospitalization.MACEs were defined as the composite end points,including all-cause mortality,or acute heart failure,or target vessel revascularization,or stroke or recurrent angina.Results A total of 418 patients were included in the study.64 patients developed MACEs（15.3%）.In the MACEs（＋） patients,monocytes were higher（1.12 [0.78-1.42] vs.0.72 [0.68-0.92] 109/L,P 〈 0.01） and HDL cholesterol levels were lower（0.87 [0.72-1.21] vs.0.96 [0.81-1.11] mmol/L,P 〈 0.01）.In addition,MHR was significantly higher in the MACEs（＋） group（1.12 [0.91-2.09] vs.0.73[0.54-0.93] 109 mmol/L,P 〈 0.01）.The cutoff value of MHR for predicting MACEs was 22,with a sensitivity of 81% and a specificity of 75.1%（area under the curve0.79,P 〈 0.001）.In multivariate logistic regression analysis,MHR remained an independent factor correlated with MACEs（OR = 3.97,95%CI = 1.38-11.5,P 〈 0.01）.Conclusion Higher MHR levels may predict MACEsdevelopment after elective PCI in T2 DM patients.