Rationale, Criteria, and Impact of Identifying Extreme Risk in Patients with Atherosclerotic Cardiovascular Disease

Assessment of the overall risk of atherosclerotic cardiovascular disease(ASCVD)is the first step in managing dyslipidemia and is an important reference for the target and intensity of treatment.Recently,different guidelines and consensuses on the management of this condition have successively recommended further risk stratification among patients with ASCVD,and a new“extreme risk”category has been proposed to identify patients who may obtain greater benefit from more intensive lipid-lowering therapy.The definition and terminology of extreme risk varies among different guidelines and consensuses;however,they all recommended an aggressive lipid-lowering therapeutic approach and/or a more stringent low-density lipoprotein cholesterol target for patients at extreme risk.Regardless of the definitions,this general approach may have a remarkable effect on the treatment of this condition in clinical practice.To help clinicians and patients to better understand the new strategy for the secondary prevention of ASCVD,this review provides a summary highlighting the necessity of further risk stratification among ASCVD patients,how patients at extreme risk can be identified,and the potential impact of applying the new“extreme risk”category in clinical practice.

Clinical Significance of Serum Uric Acid Combined with Cystatin C Detection in Patients with Different Levels of Hypertension with High Risk Degree and Above

Objective: To explore the clinical significance of serum uric acid combined with cystatin C detection in high risk degree of hypertension of different grades. Methods: The patients who were treated in the Department of Cardiovascular Medicine of our hospital from January to December 2022 were selected as the study subjects, and the high risk and extremely high risk groups of grade I, II and III hypertension were selected for comparative analysis to explore their clinical significance. Results: There was a statistically significant difference in the number of patients with extremely high risk of grade II hypertension between men and women (P 0.05), which showed that there was no specificity in the concentration detection of serum uric acid and cystatin C in different grades of hypertension;there was no significant difference in serum uric acid concentration between grade II and grade III of hypertension with high risk grade and cystatin C concentration between grade I and grade III of hypertension with high risk grade (P > 0.05), but there was significant difference in the concentration detection of serum uric acid and cystatin C between the other groups (P < 0.05), which indicates that the detection of serum uric acid and cystatin C has important clinical significance in the high risk degree of hypertension. Conclusion: In the comparison of the detection of blood uric acid and cystatin C in different levels of hypertension with extremely high risk, the difference of cystatin C in grade I and grade III was not statistically significant, and the rest were statistically significant;therefore, the detection of serum uric acid and cystatin C can provide reliable laboratory data for clinical diagnosis and treatment of the extremely high risk degree of different levels of hypertension.

Compound extreme inundation risk of coastal wetlands caused by climate change and anthropogenic activities in the Yellow River Delta,China

The coastal wetlands of the Yellow River Delta(YRD)in China are crucial for their valuable resources,environmental significance,and economic contributions.However,these wetlands are also vulnerable to the dual threats of climate change and human disturbances.Despite substantial attention to the historical shifts in YRD's coastal wetlands,uncertainties remain regarding their future trajectory in the face of compound risks from climate change and anthropogenic activities.Based on a range of remote sensing data sources,this study undertakes a comprehensive investigation into the evolution of YRD's coastal wetlands between 2000 and 2020.Subsequently,the potential fate of coastal wetlands is thoroughly analyzed through the Land Use/Cover Change(LUCC)simulation using System Dynamic-Future Land Use Simulation(SD-FLUS)model and the extreme water levels projection integrated future sea-level rise,storm surge,and astronomical high tide in 2030,2050,and 2100 under scenarios of SSP1-2.6,SSP2-4.5,and SSP5-8.5.Results revealed that YRD's coastal wetlands underwent a marked reduction,shrinking by 1688.72 km²from 2000 to 2020.This decline was mostly attributed to the substantial expansion in the areas of artificial wetlands(increasing by 823.78 km2),construction land(increasing by 767.71 km²),and shallow water(increasing by 274.58 km²).Looking ahead to 2030-2100,the fate of coastal wetlands appears to diverge based on different scenarios.Under the SSP1-2.6 scenario,the area of coastal wetland is projected to experience considerable growth.In contrast,the SSP5-8.5 scenario anticipates a notable decrease in coastal wetlands.Relative to the inundated area suffered from the current extreme water levels,the study projects a decrease of 6.8%-10.6%in submerged coastal wetlands by 2030 and 9.4%-18.2%by 2050 across all scenarios.In 2100,these percentages are projected to decrease by 0.4%(SSP2-4.5)and 27.1%(SSP5-8.5),but increase by 35.7%(SSP1-2.6).Results suggest that coastal wetlands in the YRD will face a serious compound risk from climate change and intensified human activities in the future,with climate change being the dominant factor.More effcient and forward-looking measures must be implemented to prioritize the conservation and management of coastal wetland ecosystems to address the challenges,especially those posed by climate change.