Fluorescence Detection of Pb2+ in Environmental Water Using Biomass Carbon Quantum Dots Modified with Acetamide-Glycolic Acid Deep Eutectic Solvent.

In this study, a novel green fluorescent probe material, nitrogen-doped carbon quantum dots (N-CQDs), was prepared by a one-step hydrothermal synthesis method using walnut green skin as a carbon source and acetamide-glycolic acid deep eutectic solvent (AGADES) as a modifier. By covalent coupling, the amide chromophore in AGADES is designed to cover the surface of walnut green skin carbon quantum dots (W-CQDs), forming a fluorescence energy resonance effect and improving the fluorescence performance of the carbon quantum dots. The prepared N-CQDs have a uniform particle size distribution, and the fluorescence quantum efficiency has increased from 12.5% to 32.5%. Within the concentration range of 0.01~1000 µmol/L of Pb2+, the linear detection limit is 1.55 nmol/L, which can meet the trace detection of Pb2+ in the water environment, and the recycling rate reaches 97%. This method has been successfully applied to the fluorescence detection and reuse of Pb2+ in actual water bodies, providing new ideas and methods for the detection of heavy metal ions in environmental water.

Estimated pulse wave velocity and cognitive outcomes: A post hoc analysis of SPRINT-MIND.

BACKGROUND: Arterial stiffness has been confirmed to be associated with cognitive impairment. Carotid-femoral pulse wave velocity (cfPWV) is widely regarded as the gold standard for assessing arterial stiffness, yet it is not readily accessible. In response, the use of estimated pulse wave velocity (ePWV) has been proposed as a more accessible and cost-effective alternative. ePWV not only offers ease of calculation but also covers a broader spectrum of vascular aging processes, some of which may be distinct from those detected by cfPWV. The aim of our study was to investigate the association between ePWV and cognitive outcomes in SPRINT-MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension). METHODS: This study was a post-hoc analysis of the SPRINT-MIND. The primary endpoint was a composite outcome including probable dementia and mild cognitive impairment (MCI). The calculation of ePWV was based on age and mean blood pressure. The association between ePWV and cognitive outcomes was assessed using Cox regression analysis. The response of ePWV to antihypertensive treatment at 12 months was used to define treatment efficacy. RESULTS: 8563 patients were enrolled. The ePWV was found to be independently associated with risk of probable dementia (Tertile 3 vs. Tertile 1: HR, 95% CI: 1.70, 1.08-2.68, P = 0.023, P for trend = 0.013), MCI (Tertile 3 vs. Tertile 1: HR, 95% CI: 2.35, 1.71-3.23, P < 0.001, P for trend < 0.001), and the composite outcome of probable dementia or MCI (Tertile 3 vs. Tertile 1: HR, 95% CI: 2.17, 1.65-2.86, P < 0.001, P for trend < 0.001). The combined effect of treatment allocation and the response of ePWV to treatment exhibited that intensive/ePWV responders had the lowest risk of the primary outcome (Log-rank P = 0.002). CONCLUSION: EPWV demonstrated independent predictive value for cognitive outcomes in SPRINT-MIND.

Association between the ZJU index and risk of new-onset non-alcoholic fatty liver disease in non-obese participants: a Chinese longitudinal prospective cohort study.

Background: Non-alcoholic fatty liver disease (NAFLD) is increasingly observed in non-obese individuals. The ZJU (Zhejiang University) index has been established as a new and efficient tool for detecting NAFLD, but the relationship between the ZJU index and NAFLD within non-obese individuals still remains unclear. Methods: A post-hoc evaluation was undertaken using data from a health assessment database by the Wenzhou Medical Center. The participants were divided into four groups based on the quartile of the ZJU Index. Cox proportional hazards regression, Kaplan-Meier analysis and tests for linear trends were used to evaluate the relationship between the ZJU index and NAFLD incidence. Subgroup analysis was conducted to test the consistency of the correlation between ZJU and NAFLD in subsgroups. Receiver operative characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the ZJU index, compared with the Atherogenic index of plasma (AIP) and Remnant lipoprotein cholesterol (RLP-C) index. Results: A total of 12,127 were included in this study, and 2,147 participants (17.7%) developed NAFLD in 5 years follow-up. Participants in higher ZJU quartiles tended to be female and have higher liver enzymes (including ALP, GGT, ALT, AST), GLU, TC, TG, LDL and higher NAFLD risk. Hazard Ratios (HR) and 95% confidence intervals (CI) for new-onset NAFLD in Q2, Q3, and Q4 were 3.67(2.43 to 5.55), 9.82(6.67 to 14.45), and 21.67(14.82 to 31.69) respectively in the fully adjusted model 3. With increased ZJU index, the cumulative new-onset NAFLD gradually increased. Significant linear associations were observed between the ZJU index and new-onset NAFLD (p for trend all<0.001). In the subgroup analysis, we noted a significant interaction in sex, with HRs of 3.27 (2.81, 3.80) in female and 2.41 (2.21, 2.63) in male (P for interaction<0.01). The ZJU index outperformed other indices with an area under the curve (AUC) of 0.823, followed by AIP (AUC=0.747) and RLP-C (AUC=0.668). Conclusion: The ZJU index emerges as a promising tool for predicting NAFLD risk in non-obese individuals, outperforming other existing parameters including AIP and RLP-C. This could potentially aid in early detection and intervention in this specific demographic.

Corrigendum: Comparison of cerebrospinal fluid space between probable normal pressure hydrocephalus and Alzheimer's disease.

[This corrects the article DOI: 10.3389/fnagi.2023.1241237.].

Risk assessment and partitioning behavior of PFASs in environmental matrices from an e-waste recycling area.

OBJECTIVE: Perfluoroalkyl and polyfluoroalkyl substance (PFAS) contamination and their human exposure risks are a major concern. However, knowledge of PFAS contamination in environments near e-waste recycling sites and their health risk assessment are scarce. METHODS: We measured the concentrations of PFASs in soil (n = 12), water (n = 12) and atmospheric samples (n = 26) by LCP-MS/MS, analyzed the source apportionment of PFASs by PCA, and investigated the child health risk assessment from an e-waste recycling area (Guiyu) and a reference area (Haojiang). RESULTS: We found high concentrations of PFASs in the atmosphere and low concentrations of PFASs in soil. The average concentration of perfluoro-n-heptanoic acid (PFHpA) (9.43 ng/L) was highest among PFASs in water. The concentrations PFASs in the atmosphere and water were higher in the e-waste recycling area than in the reference area (p < 0.05). According to Multi-Linear regression model, we found that daily intake doses for PFASs in air of PFODA [ß (95 % CI): -0.217 (-0.332, -0.048), p < 0.05] and PFBS [ß (95 % CI): -0.064 (-0.106, -0.006), p < 0.05] were negatively associated with child BMI. PFBA [ß (95 % CI: -1.039 (-2.454, -0.010), p < 0.05] was negatively correlated with child head circumference. CONCLUSION: The concentrations of PFASs in the water and atmosphere are higher in the e-waste recycling site than in the reference area. We found that their intake affected growth and development in children. We need to reduce pollution from PFASs in the e-waste recycling area while maintaining a focus on their impact on child health.

Comparison of cerebrospinal fluid space between probable normal pressure hydrocephalus and Alzheimer's disease.

Introduction: Idiopathic normal pressure hydrocephalus (INPH) is a potentially reversible syndrome characterized by complex symptoms, difficulty in diagnosis and a lack of detailed clinical description, and it is difficult to distinguish from Alzheimer's disease (AD). The objective of this study was to design a method for measuring the actual amount of hydrocephalus in patients with INPH and to evaluate INPH. Methods: All subjects underwent a 3D T1-weighted MRI. Statistical parametric mapping 12 was used for preprocessing images, statistical analysis, and voxel-based morphometric gray matter (GM) volume, white matter (WM) volume, and cerebrospinal fluid (CSF) volume analysis. The demographic and clinical characteristics of the groups were compared using a t-test for continuous variables and a chi-square test for categorical variables. Pearson's correlation analysis and Bonferroni's statistic-corrected one-way ANOVA were used to determine the relationship among demographic variables. Receiver operating characteristic (ROC) curves were used to assess the accuracy of the callosal angle (CA), WM ratio, and CSF ratio in distinguishing probable INPH from AD. Results: The study included 42 patients with INPH, 32 patients with AD, and 24 healthy control subjects (HCs). There were no differences among the three groups in basic characteristics except for Mini-Mental State Examination (MMSE). There was a correlation between the intracranial CSF ratio and CA. The WM ratio and CSF ratio in patients with INPH and AD were statistically different. Furthermore, the combination of CA, WM ratio, and CSF ratio had a greater differential diagnostic value between INPH and AD patients than CA alone. Conclusion: INPH can be accurately assessed by measuring intracranial CSF ratio, and the addition of WM ratio and CSF ratio significantly improved the differential diagnostic value of probable INPH from AD compared to CA alone.

Physical properties of natural deep eutectic solvent and its application in remediation of heavy metal lead in soil.

At present, solvent extraction is an effective method to remove heavy metals from soil, which has certain practical significance. The physical properties such as density, viscosity and conductivity of NADESs with different proportions synthesized based on the double solid components of glycolic acid (GA) and L-proline (L-PRO) and the physical properties of NADESs aqueous solution at the lowest eutectic point (3:1) were studied. The extraction effect of NADESs on soil heavy metal Pb2+ under different conditions was studied. The results showed that under the conditions of atmospheric pressure of 101.33 kPa, the lowest eutectic melting point, DESs concentration of 0.6 mol·L-1, extraction temperature of 313.15 K and extraction time of 4 h, the extraction rate of Pb2+ by NADESs was 95.28%. In addition, the internal structure of DESs was characterized by IR and NMR, which indicated that intermolecular hydrogen bonds were formed. and the interaction between DESs and Pb2+ was analyzed by quantum chemical calculation, which showed that the hydroxyl group of GA was more likely to form coordination bond with Pb2+, and chelation occurred between them. This kind of DESs provides a new idea for the removal of heavy metals in soil.

Association between admission heart rate and major adverse cardiovascular events in acute myocardial infarction participants with different left ventricular ejection fraction.

BACKGROUND: This study intended to investigate the independent effect of admission heart rate (HR) on the risk of major adverse cardiovascular events (MACEs) in acute myocardial infarction (AMI) patients with different left ventricular ejection fraction (LVEF) levels. METHODS: The study was a secondary analysis of the Acute Coronary Syndrome Quality Improvement in Kerela Trial. The relationship between admission HR and 30-day adverse outcomes in AMI patients with different LVEF levels was detected using a Logistic regression model. Interaction tests were used to compare the effects of different subgroups on HR and MACEs. RESULTS: Our study enrolled 18,819 patients. In both partially and fully adjusted models (Model1 and Model2), the risk of MACEs was highest in patients with HR ≥ 120 (OR: 1.62, 95%CI: (1.16, 2.26), P = 0.004, Model1; OR: 1.46, 95%CI: (1.00, 2.12), P = 0.047, Model2). There was a significant interaction between LVEF and HR (P for interaction = 0.003). Meanwhile, the trend test for this association showed that HR was positively and significantly associated with the MACEs in LVEF≥40% group (OR (95%CI): 1.27 (1.12, 1.45), P < 0.001). However, in LVEF<40% group, the trend test was not statistically significant (OR (95%CI): 1.09 (0.93, 1.29), P = 0.269). CONCLUSION: This study found that elevated admission HR was associated with a significantly higher risk for MACEs in patients admitted with AMI. Elevated admission HR was significantly associated with the risk of MACEs in AMI patients without low LVEF but not those with low LVEF (<40%). LVEF levels should be considered when evaluating the association between admission HR and the prognosis of AMI patients in the future.

Weight cycling and risk of clinical adverse events in patients with heart failure with preserved ejection fraction: a post-hoc analysis of TOPCAT.

Background: Previous studies hardly evaluated the association of variability of body mass index (BMI) or waist circumference with clinical adverse events and investigated whether weight cycling had an effect on the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). Methods: This study was a post-hoc analysis of TOPCAT. Three outcomes were evaluated: the primary endpoint, cardiovascular disease (CVD) death, and heart failure hospitalization. Among them, CVD death and hospitalization were outcomes of heart failure. Kaplan-Meier curves were used to describe the cumulative risk of outcome and were tested using the log-rank test. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95%CIs for outcomes. We also performed a subgroup analysis, and several subgroups were compared. Results: A total of 3,146 patients were included. In the Kaplan-Meier curves, the coefficients of variation of both BMI and waist circumference were grouped according to quartiles, with the Q4 group having the highest cumulative risk (log-rank P < 0.001). In the coefficient of BMI variation and the outcomes, the HRs for group Q4 of coefficient of variation of BMI were 2.35 (95%CI: 1.82, 3.03) for the primary endpoint, 2.40 (95%CI: 1.69, 3.40) for death, and 2.33 (95%CI: 1.68, 3.22) for HF hospitalization in model 3 (fully adjusted model) compared with group Q1. In the coefficient of waist circumference variation and the outcomes, group Q4 had increased hazard of the primary endpoint [HR: 2.39 (95%CI: 1.84, 3.12)], CVD death [HR: 3.29 (95%CI: 2.28, 4.77)], and HF hospitalization [HR: 1.98 (95%CI 1.43, 2.75)] in model 3 (fully adjusted model) compared with group Q1. In the subgroup analysis, there was a significant interaction in the diabetes mellitus subgroup (P for interaction = 0.0234). Conclusion: Weight cycling had a negative effect on the prognosis of patients with HFpEF. The presence of comorbid diabetes weakened the relationship between waist circumference variability and clinical adverse events.

Genetic correlation, causal relationship, and shared loci between vitamin D and COVID-19: A genome-wide cross-trait analysis.

Observational studies have shown that vitamin D supplementation reduces the risk of COVID-19 infection, yet little is known about the shared genomic architectures between them. Leveraging large-scale genome-wide association study (GWAS) summary statistics, we investigated the genetic correlation and causal relationship between genetically determined vitamin D and COVID-19 using linkage disequilibrium score regression and Mendelian randomization (MR) analyses, and conducted a cross-trait GWAS meta-analysis to identify the overlapping susceptibility loci of them. We observed a significant genetic correlation between genetically predicted vitamin D and COVID-19 (rg = -0.143, p = 0.011), and the risk of COVID-19 infection would decrease by 6% for every 0.76 nmol L-1 increase of serum 25 hydroxyvitamin D (25OHD) concentrations in generalized MR (OR = 0.94, 95% CI: 0.89-0.99, p = 0.019). We identified rs4971066 (EFNA1) as a risk locus for the joint phenotype of vitamin D and COVID-19. In conclusion, genetically determined vitamin D is associated with COVID-19. Increased levels of serum 25OHD concentration may benefit the prevention and treatment of COVID-19.

Blood lead levels of children exposed to e-waste: a systematic review and meta-analysis.

Blood lead levels (BLLs) have been decreasing worldwide for decades. However, systematic reviews and quantitative syntheses of BLLs in electronic waste (e-waste)-exposed children are lacking. To summarize temporal trend of BLLs among children in e-waste-recycling areas. Fifty-one studies met the inclusion criteria and included participants from six countries. Meta-analysis was performed using the random-effects model. Results showed that among e-waste-exposed children, the total geometric mean (GM) BLL was 7.54 µg/dL (95% CI: 6.77, 8.31). Children's BLLs displayed a decreasing temporal trend, from 11.77 µg/dL in phase I (2004-2006) to 4.63 µg/dL in phase V (2016-2018). Almost 95% of eligible studies found that children exposed to e-waste had significantly higher BLLs than reference groups. The difference of children's BLLs between the exposure group and the reference group was from 6.60 µg/dL (95% CI: 6.14, 7.05) in 2004 to 1.99 µg/dL (95% CI: 1.61, 2.36) in 2018. For subgroup analyses, except for Dhaka and Montevideo, the BLLs of children from Guiyu in the same survey year were higher than those of children from other regions. Our findings indicate that the gap between BLLs of children exposed to e-waste and those of reference group children is closing, and we appeal that the critical value for blood lead poisoning in children should be lowered in key e-waste-dismantling areas of developing countries, such as Guiyu.

Preparation of carbon quantum dots from ionic liquid modified biomass for the detection of Fe3+ and Pd2+ in environmental water.

A new type of green carbon quantum dots (ILB-CQDs) was prepared by hydrothermal method using ionic liquid as a modifier and grape skin as carbon source, and was obtained from hydrogen-bonded lattice structure ionic liquid preparation, which makes the CQDs in a ring-like stable structure with a stability period of more than 90 day. There is also the catalytic effect of the ionic liquid on cellulose, which makes the prepared CQDs show good advantages, such as uniform particle size, high quantum yield (26.7%), and very good fluorescence performance. This is a smart material for the selective detection of Fe3+ and Pd2+. It has a detection limit of 0.001 nM for Fe3+ and 0.23 µM for Pd2+ in pure water. It has a detection limit of 3.2 nmol/L for Fe3+ and 0.36 µmol/L for Pd2+ in actual water, both of which meet the requirements of WHO drinking water standards. And there is to achieve more than 90% of water restoration effect.

Epidemiological evidence for the effect of environmental heavy metal exposure on the immune system in children.

Heavy metals exist widely in daily life, and exposure to heavy metals caused by environmental pollution has become a serious public health problem worldwide. Due to children's age-specific behavioral characteristics and imperfect physical function, the adverse health effects of heavy metals on children are much higher than in adults. Studies have found that heavy metal exposure is associated with low immune function in children. Although there are reviews describing the evidence for the adverse effects of heavy metal exposure on the immune system in children, the summary of evidence from epidemiological studies involving the level of immune molecules is not comprehensive. Therefore, this review summarizes the current epidemiological study on the effect of heavy metal exposure on childhood immune function from multiple perspectives, emphasizing its risks to the health of children's immune systems. It focuses on the effects of six heavy metals (lead (Pb), cadmium (Cd), arsenic (As), mercury (Hg), nickel (Ni), and manganese (Mn)) on children's innate immune cells, lymphocytes and their subpopulations, cytokines, total and specific immunoglobulins, and explores the immunotoxicological effects of heavy metals. The review finds that exposure to heavy metals, particularly Pb, Cd, As, and Hg, not only reduced lymphocyte numbers and suppressed adaptive immune responses in children, but also altered the innate immune response to impair the body's ability to fight pathogens. Epidemiological evidence suggests that heavy metal exposure alters cytokine levels and is associated with the development of inflammatory responses in children. Pb, As, and Hg exposure was associated with vaccination failure and decreased antibody titers, and increased risk of immune-related diseases in children by altering specific immunoglobulin levels. Cd, Ni and Mn showed activation effects on the immune response to childhood vaccination. Exposure age, sex, nutritional status, and co-exposure may influence the effects of heavy metals on immune function in children.

Current status of indoor dust PBDE pollution and its physical burden and health effects on children.

Polybrominated diphenyl ethers (PBDEs) are widely detected in indoor dust, which has been identified as a more important route of PBDE exposure for children than food intake. The physical burden and health hazards to children of PBDE exposure in house dust have not been adequately summarized; therefore, this article reviews the current status of PBDE pollution in indoor dust associated with children, highlighting the epidemiological evidence for physical burden and health risks in children. We find that PBDEs remain at high levels in indoor dust, including in homes, schools, and cars, especially in cars showing a significant upward trend. There is a trend towards an increase in the proportion of BDE-209 in household dust, which is indicative of recent PBDE contamination. Conversely, PBDE congeners in car and school indoor dust tended to shift from highly brominated to low brominated, suggesting a shift in current pollution patterns. Indoor dust exposure causes significantly higher PBDE burdens in children, especially infants in early life, than in adults. Exposure to dust also affects breast milk, putting infants at high risk of exposure. Although evidence is limited, available epidemiological studies suggest that exposure to indoor dust PBDEs promotes neurobehavioral problems and cancer development in children.

Relationship between orthostatic blood pressure changes and intensive blood pressure management in patients with hypertension.

INTRODUCTION: The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that closely controlling blood pressure (BP) could decrease cardiovascular outcome risk without increasing the orthostatic hypotension rate. We aimed to evaluate the association between baseline orthostatic BP change and major adverse cardiovascular event (MACE) occurrence. METHODS: We conducted a post hoc analysis using SPRINT data including 9329 patients with hypertension. The SPRINT trial was a two-arm, multicentre, randomised clinical trial designed to test whether an intensive treatment aimed at reducing systolic BP (SBP) to <120 mm Hg would reduce cardiovascular disease risk. Orthostatic BP change was defined as baseline standing systolic BP (SBP)-baseline mean seated SBP, or diastolic BP (DBP)-baseline mean seated DBP. RESULTS: We found a U-shaped relationship between orthostatic BP changes and MACE occurrence. All lowest risk points were around 0 mm Hg. On the left side of the inflection point, MACE risk decreased with orthostatic BP change decrease (HR=0.99, 95% CI (0.98 to 1.00), p=0.04, SBP change) (HR=0.97, 95% CI (0.95 to 0.99), p<0.01, DBP change); on the right side, MACE risk increased with orthostatic BP change increase (HR=1.02, 95% CI (1.01 to 1.06), p<0.01, SBP change) (HR=1.01, 95% CI (1.00 to 1.03), p=0.16, DBP change). There was no significant interaction effect between orthostatic SBP (p for interaction=0.37) or DBP changes (p for interaction=0.33) and intensive BP management. CONCLUSIONS: Orthostatic DBP increase and SBP decrease were associated with an increased MACE risk. The benefits of intensive BP management were also consistent across different orthostatic BP change ranges.

Kindergarten indoor dust metal(loid) exposure associates with elevated risk of anemia in children.

Exposure to metals and metalloids in indoor dust is associated with adverse health effects in young children, but there is limited evidence for an association with anemia, which is at high risk in children. The aim of this study was to investigate the association between exposure to multiple metal(loid)s in indoor dust in kindergartens and the risk of anemia in children. In 2021, 2165 children from 25 kindergartens in eastern China were included in the study and had their hemoglobin (Hb) measured. Indoor dust samples were collected from the children's kindergartens, and the concentrations of 11 metals and metalloids in the samples were measured using inductively coupled plasma mass spectrometry (ICP-MS). The daily exposure dose (DED) of dust was used to assess the risk of metal(loid) exposure in the children. The results showed that of the 2165 children with available data, 351 (16.2 %) met the WHO definition of anemia. In multiple linear regression and logistic regression analyses, we found that for each quartile of DED increase in Cd inhalation, child Hb levels decreased by 2.703 g/L (95 % CI: -4.055, -1.351), and the risk of anemia increased 1.602-fold (95 % CI: 1.087, 2.360). Mn ingestion was associated with increased odds of anemia [odds ratio (OR) = 1.760 (95 % CI: 1.217, 2.544)]. Interaction analysis indicated that metal(loid)s exposure effects were modified by child sex, age, and body mass index (BMI). Cluster analysis found that children at high risk of metal(loid) exposure in the school environment tended to have lower Hb levels and higher prevalence of anemia compared with those at low risk, although this was not statistically significant. These findings suggest that child school exposure to metal(loid)s in indoor dust is associated with an increased risk of developing anemia in children, modified by child sex, age, and BMI.

Association between the atherogenic index of plasma and major adverse cardiovascular events among non-diabetic hypertensive older adults.

BACKGROUND: Literature on the association between the atherogenic index of plasma (AIP) and the risk of major adverse cardiovascular events (MACEs) among non-diabetic hypertensive older adults is quite limited. METHODS: A post-hoc analysis of data obtained from the Systolic Blood Pressure Intervention Trial was performed. The predictive value of AIP on the risk of MACEs among non-diabetic hypertensive older adults was assessed to evaluate whether the benefit of intensive blood pressure (BP) control in preventing MACEs is consistent in different AIP subgroups. RESULTS: In this study, 9323 participants with AIP were included, out of which 561 (6.02%) had composite cardiovascular outcomes during a median of 3.22 years of follow-up. Patients in the highest AIP quartile had a significantly increased risk of the primary outcome. In the fully adjusted Model 3, the adjusted hazard ratios (HRs) of the primary outcome for participants in Q2, Q3, and Q4 of AIP were 1.32 (1.02, 1.72), 1.38 (1.05, 1.81), and 1.56 (1.17, 2.08) respectively. Consistently, the trend test for the association between AIP quartiles and the primary outcome showed that a higher AIP quartile was associated with a significantly higher risk of the primary outcome (adjusted HR (95%CI) in model 3:1.14 (1.04, 1.25), P = 0,004). However, within each AIP quartile, absolute event rates were lower in the intensive treatment group. No evidence was found for the interaction between intensive BP control and AIP for the risk of the primary outcome (P for interaction = 0.932). CONCLUSION: This study found that elevated AIP was independently and positively associated with the risk of MACEs among non-diabetic hypertensive older adults. The benefits of intensive BP control in managing cardiovascular events were consistent in different AIP subgroups.

Effect of body size and intensive blood pressure management on cardiovascular and serious adverse events.

BACKGROUND: Previous studies have shown that obese hypertensive patients have a lower risk of cardiovascular events than normal-weight patients, and that the performed hypertension treatment affects cardiovascular outcomes depending on the patient's body size. This study aimed to investigate the relationship between the BMI and cardiovascular outcomes and safety endpoints in hypertensive patients with intensive or standard blood pressure (BP) management. METHODS: We used data from the Systolic Blood Pressure Intervention Trial (SPRINT). Cox proportional hazards models were used to analyze the data. The primary endpoint was cardiovascular disease (CVD) death, and the safety endpoint was serious adverse events. RESULTS: In total, 9284 patients were included in our analysis. Thirty-seven patients in the intensive arm and 65 patients in the standard arm had CVD death. After multivariable adjustment, the BMI was not associated with the incidence of CVD death in the standard arm [hazard ratio 0.96, 95% confidence interval (CI) 0.91-1.02]. In the intensive arm, the incidence of CVD death decreased (hazard ratio 0.86, 95% CI 0.78-0.96) first and, then, increased (hazard ratio 1.15, 95% CI 1.07-1.25) with an increase in the BMI (inflection point, 32.33 kg/m2). CONCLUSION: Intensive BP management in overweight, class I, and class II obese patients significantly reduced the cardiovascular outcomes without increasing the safety risks. Nevertheless, further clinical evidence is needed to verify the effectiveness of intensive BP management in patients with normal weight and class III obesity.

The Impact of Cognitive Function on the Effectiveness and Safety of Intensive Blood Pressure Control for Patients With Hypertension: A post-hoc Analysis of SPRINT.

Background: Poor cognitive function can predict poor clinical outcomes. Intensive blood pressure control can reduce the risk of cardiovascular diseases and all-cause mortality. In this study, we assessed whether intensive blood pressure control in older patients can reduce the risk of stroke, composite cardiovascular outcomes and all-cause mortality for participants in the Systolic Blood Pressure Intervention Trial (SPRINT) with lower or higher cognitive function based on the Montreal Cognitive Assessment (MoCA) cut-off scores. Methods: The SPRINT evaluated the impact of intensive blood pressure control (systolic blood pressure <120 mmHg) compared with standard blood pressure control (systolic blood pressure <140 mmHg). We defined MoCA score below education specific 25th percentile as lower cognitive function. And SPRINT participants with a MoCA score below 21 (<12 years of education) or 22 (≥12 years of education) were having lower cognitive function, and all others were having higher cognitive function. The Cox proportional risk regression was used to investigate the association of treatment arms with clinical outcomes and serious adverse effects in different cognitive status. Additional interaction and stratified analyses were performed to evaluate the robustness of the association between treatment arm and stroke in patients with lower cognitive function. Results: Of the participants, 1,873 were having lower cognitive function at baseline. The median follow-up period was 3.26 years. After fully adjusting for age, sex, ethnicity, body mass index, smoking, systolic blood pressure, Framingham 10-year CVD risk score, aspirin use, statin use, previous cardiovascular disease, previous chronic kidney disease and frailty status, intensive blood pressure control increased the risk of stroke [hazard ratio (HR) = 1.93, 95% confidence interval (CI): 1.04-3.60, P = 0.038)] in patients with lower cognitive function. Intensive blood pressure control could not reduce the risk of composite cardiovascular outcomes (HR = 0.81, 95%CI: 0.59-1.12, P = 0.201) and all-cause mortality (HR = 0.93, 95%CI: 0.64-1.35, P = 0.710) in lower cognitive function group. In patients with higher cognitive function, intensive blood pressure control led to significant reduction in the risk of stroke (HR = 0.55, 95%CI: 0.35-0.85, P = 0.008), composite cardiovascular outcomes (HR = 0.68, 95%CI: 0.56-0.83, P < 0.001) and all-cause mortality (HR = 0.62, 95%CI: 0.48-0.80, P < 0.001) in the fully adjusted model. Additionally, after the full adjustment, intensive blood pressure control increased the risk of hypotension and syncope in patients with lower cognitive function. Rates of hypotension, electrolyte abnormality and acute kidney injury were increased in the higher cognitive function patients undergoing intensive blood pressure control. Conclusion: Intensive blood pressure control might not reduce the risk of stroke, composite cardiovascular outcomes and all-cause mortality in patients with lower cognitive function.

Hb Levels and Sex Differences in Relation to Short-Term Outcomes in Patients With Acute Myocardial Infarction.

Background: Women had worse outcomes after acute myocardial infarction (AMI), and physiologically, women had lower hemoglobin values. We examined whether there were sex-related differences in the relationship between hemoglobin levels and adverse outcomes in patients with acute myocardial infarction. Method: We conducted a post-hoc analysis of data from the Acute Coronary Syndrome Quality Improvement in Kerala (ACS-QUIK) Study. We explored the relationship between baseline hemoglobin level and 30-days adverse outcomes by logistic regression model, generalized additive model (GAM) and two-piecewise linear regression model. We used multiple imputation, based on five replications and a chained equation approach method in the R multiple imputation procedure, to account for missing data. The primary outcome were 30-day major adverse cardiovascular events (MACEs) defined as death, reinfarction, stroke, and major bleeding. The secondary outcomes were 30-day major bleeding, 30-day stroke and 30-day cardiovascular death (CVD death). Results: Twenty thousand, five hundred fifty-nine patients with AMI were included in our analysis. Baseline hemoglobin level was associated with major bleeding [OR: 0.74, 95%CI (0.60, 0.92) P < 0.01], CVD death [OR: 0.94, 95%CI (0.90, 0.99) P < 0.01], and MACEs [OR: 0.95, 95%CI (0.92, 0.99) P < 0.01]. There was no significant relationship between baseline hemoglobin level and stroke incidence in both men [OR: 1.02, 95%CI (0.90, 1.14) P = 0.77] and women [OR: 1.15, 95%CI (0.96, 1.37) P = 0.18]. Baseline hemoglobin level was associated with major bleeding [OR: 0.71, 95%CI (0.58, 0.85) P < 0.01] in male patients, however we did not find the same relationship in female patients [OR: 0.89, 95%CI (0.56, 1.41) P = 0.61]. GAM and two-piecewise linear regression model showed the relationships of hemoglobin level with major bleeding, CVD death, and MACEs were non-linear (non-linear P < 0.05), and the threshold value were 13, 14.8, and 14.3 g/dL for MACEs and CVD death, respectively. Conclusion: Baseline hemoglobin level was one of the independent predictors of prognosis in South Asia patients with acute myocardial infarction. Moreover, its impact on prognosis was largely different depending on the patients' sex.