Genome-wide identification and expression analysis revealed key transcription factors as potential regulators of high-temperature adaptation of Coriolopsis trogii.

Transcription factors (TFs) play a crucial role in gene expression, and studying them can lay the foundation for future research on the functional characterization of TFs involved in various biological processes. In this study, we conducted a genome-wide identification and analysis of TFs in the thermotolerant basidiomycete fungus, Coriolopsis trogii. The TF repertoire of C. trogii consisted of 350 TFs, with C2H2 and Zn2C6 being the largest TF families. When the mycelia of C. trogii were cultured on PDA and transferred from 25 to 35 °C, 14 TFs were up-regulated and 14 TFs were down-regulated. By analyzing RNA-seq data from mycelia cultured at different temperatures and under different carbon sources, we identified 22 TFs that were differentially expressed in more than three comparisons. Co-expression analysis revealed that seven differentially expressed TFs, including four Zn2C6s, one Hap4_Hap_bind, one HMG_box, and one Zinc_knuckle, showed significant correlation with 729 targeted genes. Overall, this study provides a comprehensive characterization of the TF family and systematically screens TFs involved in the high-temperature adaptation of C. trogii, laying the groundwork for further research into the specific roles of TFs in the heat tolerance mechanisms of filamentous fungi.

Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General principles and special considerations.

To achieve a consensus on optimal blood pressure (BP) targets for older adults remains challenging, necessitating a trade-off between cardiovascular benefits and the risk of impaired organ perfusion. Evidence suggests that age and frailty have a minimal influence on the cardiovascular benefits of intensive BP control in community-dwelling elderly. Nonetheless, an increased incidence of acute kidney injury with intensive BP control has been observed in octogenarians. Therefore, it is recommended to maintain systolic BP below 130 mmHg for hypertensive patients aged 65-80 years. If well-tolerated, a systolic BP target below 120 mmHg can be recommended for patients with chronic kidney disease (CKD). However, no conclusive evidence supports a stringent BP target for patients aged 80 years and older. The selection of antihypertensive medications for elderly patients requires consideration of their cardiovascular condition and potential contraindications. Combination therapy may be necessary to achieve the desired BP target. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the primary choices for patients with CKD. Newer generation mineralocorticoid receptor antagonists may further reduce the risk of cardiovascular or renal events in this population. In conclusion, managing hypertension in elderly patients requires a personalized approach that balances cardiovascular benefits with potential risks, considering individual health profiles and tolerability.

Genome-wide characterization of regulator of chromosome condensation 1 (RCC1) gene family in Artemisia annua L. revealed a conservation evolutionary pattern.

BACKGROUND: Artemisia annua is the major source for artemisinin production. The artemisinin content in A. annua is affected by different types of light especially the UV light. UVR8, a member of RCC1 gene family was found to be the UV-B receptor in plants. The gene structures, evolutionary history and expression profile of UVR8 or RCC1 genes remain undiscovered in A. annua. RESULTS: Twenty-two RCC1 genes (AaRCC1) were identified in each haplotype genome of two diploid strains of A. annua, LQ-9 and HAN1. Varied gene structures and sequences among paralogs were observed. The divergence of most RCC1 genes occurred at 46.7 - 51 MYA which overlapped with species divergence of core Asteraceae during the Eocene, while no recent novel RCC1 members were found in A. annua genome. The number of RCC1 genes remained stable among eudicots and RCC1 genes underwent purifying selection. The expression profile of AaRCC1 is analogous to that of Arabidopsis thaliana (AtRCC1) when responding to environmental stress. CONCLUSIONS: This study provided a comprehensive characterization of the AaRCC1 gene family and suggested that RCC1 genes were conserved in gene number, structures, constitution of amino acids and expression profiles among eudicots.

Uncovering the Key Features of Dysprosium Flows and Stocks in China.

Dysprosium (Dy) is a critical rare earth element and plays an indispensable role in clean energy technologies, such as wind turbines and electric vehicles. However, its flows and stocks in the whole life cycle and potential barriers to sustainable supply remain unclear, although the demand for Dy is increasing and its reserves are limited. This study aims to track China's Dy cycle for the period of 2000 to 2019 by employing dynamic material flow analysis. The results show that (1) demand for Dy had increased by 117-fold, with an accumulative use of 37,317 tons, of which 50% was obtained from illegal mining; (2) 33% of the overall Dy resource was used in wind turbines in 2019, followed by air conditioners and electric vehicles (22 and 17%, respectively); (3) China's net Dy export had increased by 10-fold from 2000 to 2019, with Dy concentrates and final products being the dominant import and export products, respectively. Illegal mining, inadequate recycling policies, and limited Dy supply sources are potential barriers influencing sustainable Dy supply.

May Measurement Month 2019: an analysis of blood pressure screening results from Taiwan.

To bolster the awareness of high blood pressure (BP) and to monitor the trend of hypertension control rate. Similar to May Measurement Month (MMM) 2017 and 2018 campaigns, we conducted the MMM 2019 campaign in 643 community pharmacies across Taiwan, and recruited adults aged 20 years or over in May and June of 2019. After filling in an anonymous questionnaire regarding medical history and lifestyle habits and having 10-min sitting rest, pharmacists took triplicate upper-arm BP readings on participants using an automated oscillometric sphygmomanometer. The means of the second and third BP readings were used as the screening BP estimates. Hypertension was defined if one of the followings was met: use of antihypertensive medications, systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg. Controlled BP was defined as BP of <140/90 mmHg. Of the 24 851 participants enrolled (mean age, 55.8 ± 15.2 years), 12 427 (50.0%) were women. Among 12 351 (49.7%) participants with hypertension, 10 463 (84.7%) were aware of their high BP, and 10 142 (82.1%) received antihypertensive medications. While 59.2% of all hypertensive participants had controlled BP, the BP control rate was 72.0% in treated hypertensive participants. MMM campaigns offer a feasible way to monitor the trends in both awareness and control of hypertension. This nationwide annual BP screening campaign, from 2017 to 2019, demonstrated continued improvement in hypertension control in Taiwan.

May Measurement Month 2018: an analysis of blood pressure screening results from Taiwan.

To raise awareness of hypertension in the general population, we have held an annual community-based nationwide campaign for blood pressure (BP) screening. The 2018 May Measurement Month (MMM) campaign in Taiwan followed a similar protocol as the 2017 MMM campaign. We recruited adults aged 20 years and older at about 800 community pharmacies across Taiwan. After a 10-min seated rest, volunteers-consisting of community pharmacists-took three BP readings using automated BP devices. The means of the 2nd and 3rd BP readings were used as the screening BP estimates. Hypertension was defined as current use of antihypertensive medications, or the screening BP of ≥140/90 mmHg. Of the 15 365 enrolled participants with a mean age of 56.8 ± 16.4 years, 53.3% were women. After imputation, we found 48.1% of the individuals had hypertension. Among participants with hypertension, 83.7% were aware, 55.0% had controlled BP, and 81.3% were medically treated, of whom 67.7% had controlled BP (<140/90 mmHg). In contrast to the global results, our results showed that the participants with diabetes mellitus, prior myocardial infarction, or stroke had higher BP than those without these comorbidities. The annual campaign experience enables us to establish a feasible approach to raising awareness and to assessing the management of hypertension in the general population. Whether the regular annual BP screening campaign makes a lasting effect on hypertension-related disease burden awaits verification.

Prevalence, Treatment, Control and Monitoring of Hypertension: A Nationwide Community-Based Survey in Taiwan, 2017.

BACKGROUND: Inadequate awareness and control remain the major obstacles for hypertension management worldwide. This observational study intended to assess the current status of hypertension management in Taiwan. METHODS: The Taiwan May Measurement Month (MMM) campaign was a nationwide survey for public alertness to hypertension initiated in 2017 and conducted in local pharmacies. Participants were asked about body habitus, comorbidities, smoking/drinking, use of anti-hypertensive drugs, and frequency of self-measured blood pressure (SMBP) monitoring. Three blood pressure (BP) readings were then measured by trained pharmacists. The mean BP was obtained by averaging all readings. RESULTS: BP recordings were obtained from 49,522 participants (average age, 56.9 ± 16.0 years), of whom 26.1% had an elevated pharmacist-measured BP (≥ 140/90 mmHg). The rate of BP control, defined as pharmacist-measured BP < 140/90 mmHg at the MMM visit, was 63.1% among treated hypertensive participants (n = 21,410). Participants who had uncontrolled hypertension were associated with a higher body mass index, currently smoking/drinking, diabetes, and stroke. More active SMBP monitoring (≥ weekly) was more often implemented in the participants with advanced age and cardiovascular diseases. More active SMBP (≥ weekly) was associated with lower measured BP among treated hypertensive participants but not overall control rate (control rate: 56.4% for ≥ weekly vs. 55.8% for < weekly, p = 0.363). CONCLUSIONS: In the Taiwan MMM 2017, the hypertension control rate surpassed 60% in treated hypertensive participants. Suboptimal BP control was related to cardiovascular risk factors and prior stroke. Treated hypertensives had a lower measured BP but similar hypertension control rate for more active versus less active SMBP.

May Measurement Month 2017: Results from Taiwan-East Asia.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. Given the consistent 30% unawareness rate across all hypertension surveys in Taiwan, we collaborated with the International Society of Hypertension to launch the MMM campaign. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Over 1200 community pharmacies joined in this campaign, where participants were recruited to obtain BP measurements using automated oscillometric sphygmomanometers. Triplicate BP readings of right or left brachial artery were obtained after sitting for 10 min. A total of 52 514 individuals were screened during MMM17. After multiple imputation, 28 123 (53.8%) had hypertension. Of individuals not receiving antihypertensive medication, 5226 (17.8%) were hypertensive. Of individuals receiving antihypertensive medication, 8121 (35.7%) had uncontrolled BP. As compared with underweight individuals, adjusted systolic BP and diastolic BP raised by 6.1 and 4.1 mmHg, respectively, in overweight ones; while by 9.4 and 5.6 mmHg, respectively, in obese ones. May Measurement Month(MMM)17 was the largest BP screening campaign undertaken in Taiwan. The substantial numbers of unidentified and uncontrolled hypertensive patients, though lower than prior surveys in Taiwan, are challenging. Whether the continued MMM campaign would raise hypertension awareness at the national level awaits verification.

Metal-organic framework-derived bamboo-like nitrogen-doped graphene tubes as an active matrix for hybrid oxygen-reduction electrocatalysts.

In this work, large size (i.e., diameter > 100 nm) graphene tubes with nitrogen-doping are prepared through a high-temperature graphitization process of dicyandiamide (DCDA) and Iron(II) acetate templated by a novel metal-organic framework (MIL-100(Fe)). The nitrogen-doped graphene tube (N-GT)-rich iron-nitrogen-carbon (Fe-N-C) catalysts exhibit inherently high activity towards the oxygen reduction reaction (ORR) in more challenging acidic media. Furthermore, aiming to improve the activity and stability of conventional Pt catalysts, the ORR active N-GT is used as a matrix to disperse Pt nanoparticles in order to build a unique hybrid Pt cathode catalyst. This is the first demonstration of the integration of a highly active Fe-N-C catalyst with Pt nanoparticles. The synthesized 20% Pt/N-GT composite catalysts demonstrate significantly enhanced ORR activity and H(2) -air fuel cell performance relative to those of 20% Pt/C, which is mainly attributed to the intrinsically active N-GT matrix along with possible synergistic effects between the non-precious metal active sites and the Pt nanoparticles. Unlike traditional Pt/C, the hybrid catalysts exhibit excellent stability during the accelerated durability testing, likely due to the unique highly graphitized graphene tube morphologies, capable of providing strong interaction with Pt nanoparticles and then preventing their agglomeration.

Measuring ecosystem services supply and demand in rural areas: cases from China's key counties to receive assistance in pursuing rural revitalization.

There is a considerable challenge to meeting the Sustainable Development Goals (SDGs) of ending poverty and maintaining ecosystems' function in rural areas, largely due to that the rural people's livelihood relied heavily on fragile ecosystems. China is ambitious to solve this issue by enacting economic stimulus policies such as ecological protection compensation and payment for ecosystem services (ESs). However, these interventions are generally based on stockholders' willingness and lack of scientific basis. Here, we firstly combined InVEST model and social-economic data to evaluate the ecosystem services supply and demand (ESSD), by taking 25 key counties to receive assistance in pursuing rural revitalization in Sichuan province as the study cases. The coupling coordination degree model was then employed to measure the coordination relationship of ESSD. Finally, the driving factors were analyzed based on correlation analysis and stepwise regression method. The results showed that all ESs, except carbon sequestration, were oversupplied with significant spatial heterogeneity. From 2000 to 2020, the supply of all ESs increased, in which the food production had the most notable increase ratio amounting to 48.20%, while the demand of water retention and air purification decreased substantially. Due to the inconsistency between cultivated land area and population changes, significant spatial heterogeneity existed in the coordination relationship of food production. The counties with the highest and the lowest annual average coordination index were Yanyuan (0.9950) and Rangtang (0.1208), respectively. The rural employees and the agricultural gross output value were the key positive factors influencing the quantity and coordination of ESSD, while ecological compensation and financial expenditure had no significant impact, further indicating that these policies were not linked to the performance of ecosystems' function. Finally, policy implications were raised. This study provides a scientific framework for enacting the interventions towards ecological sustainability and poverty ending from ESSD perspective.

The role of wearable home blood pressure monitoring in detecting out-of-office control status.

Ambulatory blood pressure (ABP) and home blood pressure (HBP) monitoring is currently recommended for management of hypertension. Nonetheless, traditional HBP protocols could overlook diurnal fluctuations, which could also be linked with adverse cardiovascular outcomes. In this observational study, we studied among a group of treated hypertensive patients (N = 62, age: 52.4 ± 10.4 years) by using out-of-office ABP and wearable HBP. They received one session of 24-h ABP measurement with an oscillometric upper-arm monitor, and totally three sessions of 7-day/6-time-daily wearable HBP measurement separated in each month with HeartGuide. Controlled hypertension is defined as an average BP <130/80 mmHg for both daytime ABP and HBP. There was substantial reliability (intraclass correlation coefficient, ICC 0.883-0.911) and good reproducibility (Cohen's kappa = 0.600) for wearable HBP measurement, especially before breakfast and after dinner. Among all patients, 27.4% had both uncontrolled HBP and ABP, 30.6% had uncontrolled HBP only, while 6.5% had uncontrolled ABP only. Female gender and increased numbers of anti-hypertensive agents are correlated with controlled hypertension. Patients with uncontrolled hypertension had a significantly higher maximal daytime blood pressure, which was previously signified as an imperial marker for cardiovascular risk. In conclusion, wearable HBP monitoring in accordance with a dedicated daily-living schedule results in good reliability and reproducibility. Patients with an uncontrolled wearable HBP should benefit from repeated HBP or ABP measurement for risk stratification.

A comparative analysis of chloroplast genomes revealed the chloroplast heteroplasmy of Artemisia annua.

Artemisia annua L. is the main source of artemisinin, an antimalarial drug. High diversity of morphological characteristics and artemisinin contents of A. annua has affected the stable production of artemisinin while efficient discrimination method of A. annua strains is not available. The complete chloroplast (cp) genomes of 38 A. annua strains were assembled and analyzed in this study. Phylogenetic analysis of Artemisia species showed that distinct intraspecific divergence occurred in A. annua strains. A total of 38 A. annua strains were divided into two distinct lineages, one lineage containing widely-distributed strains and the other lineage only containing strains from northern China. The A. annua cp genomes ranged from 150, 953 to 150, 974 bp and contained 131 genes, and no presence or absence variation of genes was observed. The IRs and SC junctions were located in rps19 and ycf1, respectively, without IR contraction observed. Rich sequence polymorphisms were observed among A. annua strains, and a total of 60 polymorphic sites representing 14 haplotypes were identified which unfolding the cpDNA heteroplasmy of A. annua. In conclusion, this study provided valuable resource for A. annua strains identification and provided new insights into the evolutionary characteristics of A. annua.

The association of a panel of circulating markers with hypertensive disorders of pregnancy: the jury is still out.

Comparison between using either sFlt-1/PlGF ratio or proposed panel of biomarkers. The latter is proposed by using statistical and machine learning methods. The levels of both sFlt-1 and PlGF are measured in pg/mL. sFlt-1 soluble fms-like tyrosine kinase-1, PlGF placental growth factor, PPV positive predictive value, NPV negative predictive value.

Co-benefits assessment of integrated livestock and cropland system based on emergy, carbon footprint and economic return.

The rapid specialization of livestock production contributes to spatially decoupled crop and livestock production. Relinking croplands and livestock to promote wastes and by-products exchange has been suggested to provide opportunities for sustainable intensification of agriculture systems. However, the environmental and economic performances of such crop-livestock systems remain highly context specific and unclear. This study proposed an emergy-LCA-based framework to study the GHG mitigation and ecological and economic benefits of the integrated crop planting and livestock feeding systems, by taking wheat maize rotation-swine systems (WMRS), tea-swine systems (TS) and citrus alfalfa intercropping-swine systems (CAIS) as the empirical cases. The results showed the three case modes can generally promote GHG mitigation and ecological and economic benefits. CAIS had the lowest carbon footprint per kcal product (0.12 g CO2-eq kcal-1), followed by TS (0.61 g CO2-eq kcal-1) and MWRS (0.66 g CO2-eq kcal-1). The significant difference in this indicator can be attributed to their different upstream input and manure management. Due to the lower dependence on purchased resources, CAIS also had the best performance on emergy-based sustainability and economic benefits. Based on our results, the policy implications, including promoting wastes and by-products exchange, choosing reasonable manure treatment mode and conducting systematic planning have been suggested to provide opportunities for GHG mitigation and sustainable intensification of agro-systems.

Developing population identification tool based on polymorphism of rDNA for traditional Chinese medicine: Artemisia annua L.

BACKGROUND: Artemisia annua, a well-known traditional Chinese medicine, is the main source for production of artemisinin, an anti-malaria drug. A. annua is distributed globally, with great diversity of morphological characteristics and artemisinin contents. Diverse traits among A. annua populations impeded the stable production of artemisinin, which needs an efficient tool to identify strains and assess population genetic homogeneity. PURPOSE: In this study, ribosomal DNA (rDNA), were characterized for A. annua for strains identification and population genetic homogeneity assessment. METHODS: The ribosomal RNA (rRNA) genes were identified using cmscan and assembled using rDNA unit of LQ-9 as a reference. rDNA among Asteraceae species were compared performing with 45S rDNA. The rDNA copy number was calculated based on sequencing depth. The polymorphisms of rDNA sequences were identified with bam-readcount, and confirmed by Sanger sequencing and restriction enzyme experiment. The ITS2 amplicon sequencing was used to verify the stability of ITS2 haplotype analysis. RESULTS: Different from other Asteraceae species, 45S and 5S linked-type rDNA was only found in Artemisia genus. Rich polymorphisms of copy number and sequence of rDNA were identified in A. annua population. The haplotype composition of internal transcribed spacer 2 (ITS2) region which had moderate sequence polymorphism and relative short size was significantly different among A. annua strains. A population discrimination method was developed based on ITS2 haplotype analysis with high-throughput sequencing. CONCLUSION: This study provides comprehensive characteristics of rDNA and suggests that ITS2 haplotype analysis is ideal tool for A. annua strain identification and population genetic homogeneity assessment.

Techno-ecological synergies of hydropower plants: Insights from GHG mitigation.

Hydropower is a source of climate-friendly energy; however, its ecological impacts have been criticized. Few studies have considered the greenhouse gas (GHG) emissions resulting from ecosystem restoration. This study proposes a techno-ecological synergy framework based on life cycle assessment (LCA) to evaluate 34 hydropower plants (HPs) in the upper reaches of the Yangtze River from GHG supply and demand side perspectives. Our results show that the demand unit carbon footprint of the 34 HPs ranged from 5.43 to 49.36 g CO2-eq/kWh, while the imputed GHG emissions from ecosystem restoration occupied 1.22 % to 30.35 %. The unit carbon footprint of large HPs were larger than those of small HPs, and both were positively correlated with the installed capacity of the HPs. All the HPs were unsustainable at the local scale and relied on regional ecosystem supplies. The Sobol' sensitivity analysis and Monte Carlo simulations demonstrated the reliability of our results. Finally, our results were used to consider the related policy implications.

Increased mortality with intensive control in patients with higher baseline SBP and lower Framingham risk.

OBJECTIVE: In the Systolic Blood Pressure Intervention Trial (SPRINT), the relative reduction in primary outcome with intensive blood pressure (BP) control was numerically smallest in the highest baseline SBP tertile. In this post hoc analysis of SPRINT, the goal was to explore whether the effects of intensive BP treatment varied among patients with different baseline SBP and cardiovascular risks. METHODS: Patient-level data from 9361 randomized participants in SPRINT were used. Heterogeneity between treatment and patient characteristics were examined stratified by different baseline SBP levels. Cumulative incidences of primary outcome and all-cause death were compared between treatment groups for patients with baseline SBP at least 160 mmHg and lower Framingham risk. RESULTS: For participants with a baseline SBP of at least 160 mmHg, intensive treatment was associated with a higher rate of all-cause death as compared with standard treatment (1.86 vs. 1.62% per year). After adjustment for age and sex, intensive treatment was associated with significantly increased all-cause death compared with standard treatment [hazard ratio (95% CI) for intensive group: 3.12 (1.00-9.69); P = 0.049] in participants with an SBP of at least 160 mmHg and a Framingham risk score of 31.3% or less (average of median and geometric mean). Patient outcomes were otherwise similar regarding age, use of antihypertensive therapy, cardiovascular disease or chronic kidney disease. CONCLUSION: Among the SPRINT participants with a baseline SBP of at least 160 mmHg and a lower Framingham risk score, targeting an SBP of less than 120mmHg compared with less than 140mmHg resulted in a significantly higher rate of all-cause death.

Standardized home blood pressure monitoring: Rationale behind the 722 protocol.

Home blood pressure (HBP) has been recognized as a prognostic predictor for cardiovascular events, and integrated into the diagnosis and management of hypertension. With increasing accessibility of oscillometric blood pressure devices, HBP monitoring is easy to perform, more likely to obtain reliable estimation of blood pressures, and feasible to document long-term blood pressure variations, compared to office and ambulatory blood pressures. To obtain reliable HBP estimates, a standardized HBP monitoring protocol is essential. A consensus regarding the optimal duration and frequency of HBP monitoring is yet to be established. Based on the current evidence, the "722" protocol, which stands for two measurements on one occasion, two occasions a day (morning and evening), and over a consecutive of 7 days, is most commonly used in clinical studies and recommended in relevant guidelines and consensus documents. HBP monitoring based on the "722" protocol fulfills the minimal requirement of blood pressure measurements to achieve agreement of blood pressure classifications defined by office blood pressures and to predict cardiovascular risks. In the Taiwan HBP consensus, the frequency of repeating the "722" protocol of HBP monitoring according to different scenarios of hypertension management, from every 2 weeks to 3 months, is recommended. It is reasonable to conclude that the "722" protocol for HBP monitoring is clinically justified and can serve as a basis for standardized HBP monitoring.

Greenhouse gas emission mitigation potential from municipal solid waste treatment: A combined SD-LMDI model.

Fast urbanization and economic prosperity generate huge amount of municipal solid waste (MSW). It is therefore critical to identify the determinants of greenhouse gas (GHG) emissions from MSW treatment and prepare potential GHG mitigation measures. A combined System Dynamics - Logarithmic Mean Divisia Index model is developed to identify the driving forces of GHG emission generated from MSW treatment and explore the mitigation potentials. Shanghai, a typical megacity in China is selected as a case study. Results showed that economic development, population scale and emission intensity were driving forces to induce GHG emissions from MSW treatment, while generation intensity and treatment structure were the factors to mitigate GHG emissions from MSW during 2000-2017. Scenario analysis further revealed that landfill gas utilization and MSW separation improvement were the most effective measures in reducing GHG emissions from MSW treatment, leading to about 88.07% and 85.48% of reduction compared with the business-as-usual scenario in 2050. Scenarios of improving incineration rate, reducing per capita MSW generation and restricting population growth will reduce GHG emissions by 72.29%, 30.06% and 0.30%, respectively. Utilizing landfill gas, improving MSW separation and promoting green behaviors are suggested to mitigate GHG emissions from MSW treatment.

Efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction in Taiwan.

The clinical efficacy of ticagrelor versus clopidogrel has not been replicated in East Asian populations. The pronounced bleeding risk with ticagrelor was of concern given the increased bleeding tendency in Asian populations. This study evaluated efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction (NSTEMI) in the entire Taiwan. We used the Taiwan National Health Insurance Research Database to identify 6203 patients aged ≥ 20 years with NSTEMI hospitalization and prescription of dual antiplatelets at discharge between January 2014 and December 2014. Cohorts of ticagrelor and clopidogrel were matched 1:1 based on propensity score matching to balance baseline covariates. The primary composite efficacy endpoints included death from any cause, non-fatal myocardial infarction, and non-fatal stroke. The secondary efficacy endpoints were the individual components. The primary safety endpoint was major bleeding requiring hospitalization. The incidence of primary efficacy endpoint was 20.3% in the ticagrelor users and 20.7% in the clopidogrel users (adjusted HR 0.94; 95% CI 0.73-1.22), with the median (interquartile range, IQR) follow-up period of 5.2 (2.3-8.5) months. The incidence of primary safety endpoint was 2.3% in the ticagrelor users and 3.2% in the clopidogrel users (adjusted HR 0.67; 95% CI 0.33-1.35). Regarding the secondary efficacy endpoint, patients treated with ticagrelor had significantly lower incidence of stroke (adjusted HR 0.44; 95% CI 0.21-0.94; p = 0.033). In this nationwide Taiwanese cohort of NSTEMI, treatment with ticagrelor after discharge, as compared to clopidogrel, had similar rates of ischemic composite events and major bleeding. Nevertheless, the median follow-up time was only 5.2 months, and the reduced stroke events with ticagrelor compared to clopidogrel needs further verification.