Fostering dialogue: a phenomenological approach to bridging the gap between the "voice of medicine" and the "voice of the lifeworld".

This article adopts Husserl's transcendental phenomenology to explore the complex relationship between patients and physicians. It delves into the coexistence of two distinct voices in the realm of medicine and health: the "voice of medicine" and the "voice of life-world." Divided into three sections, the article emphasizes the importance of shifting from a scientific-medical attitude to a more personalistic approach in physician-patient interactions. This shift aims to prevent depersonalization and desubjectification. Additionally, it highlights the equal and irreducible nature of patients while acknowledging the vital role physicians hold in the realm of illness. The article stresses the need for a balanced and equitable relationship between both parties, rooted in the shared life-world. Moreover, empathy is underscored as a crucial element in fostering meaningful dialogue, wherein understanding diverse perspectives and attitudes towards illness is paramount. The article argues that differences between patients and physicians are necessary for empathy, while shared similarities form its foundation. Ultimately, a harmonious relationship facilitates empathy and enables the constitution of a new sense of life for both patients and physicians.

Associations of risk factor burden and genetic predisposition with the 10-year risk of atrial fibrillation: observations from a large prospective study of 348,904 participants.

BACKGROUND: Understanding the effects of risk factor burden and genetic predisposition on the long-term risk of atrial fibrillation (AF) is important to improve public health initiatives. However, the 10-year risk of AF considering risk factor burden and genetic predisposition is unknown. METHODS: A total of 348,904 genetically unrelated participants without AF at baseline from the UK were categorized into three groups: index ages 45 years (n = 84,206), 55 years (n=117,520), and 65 years (n=147,178). Optimal, borderline, or elevated risk factor burden was determined by body mass index, blood pressure, diabetes mellitus, alcohol consumption, smoking status, and history of myocardial infarction or heart failure. Genetic predisposition was estimated using the polygenic risk score (PRS), constructed using 165 predefined genetic risk variants. The combined effects of risk factor burden and PRS on the risk of incident AF in 10 years were estimated for each index age. Fine and Gray models were developed to predict the 10-year risk of AF. RESULTS: The overall 10-year risk of AF was 0.67% (95% CI: 0.61-0.73%) for index age 45 years, 2.05% (95% CI: 1.96-2.13%) for index age 55 years, and 6.34% (95% CI: 6.21-6.46%) for index age 65 years, respectively. An optimal risk factor burden was associated with later AF onset regardless of genetic predisposition and sex (P < 0.001). Significant synergistic interactions were observed for risk factor burden with PRS at each index age (P < 0.05). Participants with an elevated risk factor burden and high PRS had the highest 10-year risk of AF in reference to those who had both an optimal risk factor burden and a low PRS. At younger ages, optimal risk burden and high PRS might also lead to later onset of AF, compared to the joint effect of elevated risk burden and low/intermediate PRS. CONCLUSIONS: Risk factor burden together with a genetic predisposition is associated with the 10-year risk of AF. Our results may be helpful in selecting high-risk individuals for primary prevention of AF and facilitating subsequent health interventions.

Reframing Anorexia Nervosa: A Phenomenological Exploration of the Self-Other Relationship with Husserl's Intersubjective Theory.

This paper explores the overlooked contributions of Husserl's Phenomenology of intersubjectivity in understanding anorexia nervosa. It highlights the intricate relationship between the self and others, emphasizing their mutual constitution while acknowledging inherent differences. The distorted body image approach often overlooks this perspective, leading to psychopathological issues in individuals with anorexia nervosa. By integrating subjective experience and external observation, a more balanced and equal intersubjective relationship can be established. Utilizing this philosophical framework allows for a deeper understanding of the disorder's dynamics and sheds new light on the subjective experiences of individuals with anorexia nervosa in relation to others.

Relationship between glucosamine use and the risk of lung cancer: data from a nationwide prospective cohort study.

BACKGROUND: Research on glucosamine shows anti-inflammatory and anti-cancer benefits with minimal adverse effects. We aimed to explore the relationship between use of glucosamine and risk of lung cancer and lung cancer mortality based on data from the large-scale nationwide prospective UK Biobank cohort study. METHODS: Participants were enrolled between 2006 and 2010 and followed-up to 2020. The Cox proportional hazards model was used to assess the relationship between glucosamine use and risk of lung cancer and lung cancer mortality. Subgroup analyses and sensitivity analyses were performed to explore the potential effect modifications and the robustness of the main findings. RESULTS: 439 393 participants (mean age 56 years; 53% females) with a mean follow-up of 11 years were included for analyses. 82 603 (18.80%) participants reported regular use of glucosamine at baseline. During follow-up, 1971 (0.45%) lung cancer events were documented. Glucosamine use was significantly associated with a decreased risk of lung cancer (hazard ratio (HR) 0.84, 95% CI 0.75-0.92; p<0.001) and lung cancer mortality (HR 0.88, 95% CI 0.81-0.96; p=0.002) in fully adjusted models. A stronger association between glucosamine use and decreased lung cancer risk was observed in participants with a family history of lung cancer when compared with those without a family history. CONCLUSION: Regular use of glucosamine was significantly related with decreased risk of lung cancer and lung cancer mortality, based on data from this nationwide prospective cohort study.

Comparative effectiveness and safety of direct acting oral anticoagulants in nonvalvular atrial fibrillation for stroke prevention: a systematic review and meta-analysis.

PURPOSE: To systematically review available evidence of indirect comparisons from RCTs and direct comparisons from observational studies regarding the comparative effectiveness and safety of DOACs in patients with AF. METHODS: Electronic databases including EMBASE, MEDLINE, and PUBMED were searched up to June 5th, 2020. Primary endpoints included effectiveness (stroke or systemic embolism [SE]) and safety (major bleeding) outcomes. Bucher methods and random-effects models were conducted for indirect and direct comparisons among DOACs, respectively. Ranking probability analyses and the number needed to treat for net effect (NNTnet) were applied. RESULTS: A total of 36 studies, involving 7 RCTs (n = 60,292 patients) and 29 observational studies (n = 1,164,821 patients), were included for analyses. Regarding the risk of stroke/SE, no significant differences were found from indirect comparisons of RCTs among the DOACs. For major bleeding, apixaban tended to be safer than rivaroxaban and dabigatran based on both direct and indirect comparisons (all p < 0.05; evidence quality: very low to moderate). Ranking probability analysis showed that apixaban had a high probability of being the best treatment in decreased risk of stroke/SE and major bleeding (80.30% and 91.30%, respectively). Likewise, apixaban was found to have the highest net clinical benefit (0.02, 95% CI: 0.014-0.029) and smallest NNTnet (48, 95% CI: 35-74). CONCLUSIONS: Apixaban appeared to have a favorable effectiveness-safety profile compared with the other DOACs in AF for stroke prevention, based on evidence from both direct and indirect comparisons. However, additional high-quality evidence is needed to support firm recommendations on clinical decision-making.

Impact of HBV infection on the association between HOTAIR SNPs and the risk of hepatocellular carcinoma: A mediation and interaction analysis.

Previous studies have demonstrated that single nucleotide polymorphisms (SNPs) rs12427129 and rs3816153 in HOX transcript antisense intergenic RNA (HOTAIR) might interact with hepatitis B virus (HBV) infection to increase the risk of hepatocellular carcinoma (HCC). However, it is unclear whether HBV infection is a potential mediator between HOTAIR rs12427129, rs3816153, and HCC. This study, including 1262 HCC cases and 1559 controls, aimed to use a four-way decomposition method to quantify the interaction and mediation effects of HBV infection in the association between rs12427129, rs3816153, and HCC. We found that rs12427129 and rs3816153 were associated with a risk of HBV infection among the controls (CC: CT+TT, adjusted odds ratio (OR)=1.77, 95% confidence interval (CI)=1.32-2.36 and GG: GT+TT, adjusted OR=0.63, 95% CI=0.48-0.82). The four-way decomposition revealed that rs12427129, rs3816153, and HBV infection had statistically significant reference interaction on HCC (excess risk (95% CI): -0.362 (-0.530, -0.195), p<0.001 and excess risk (95% CI): 0.433 (0.059, 0.808), p=0.023), and the proportion attributed to reference interaction were 110.82% and 125.27%, respectively. The pure indirect effect suggested that the rs3816153 GT + TT genotype can reduce the risk of HCC by 21.79% (excess risk (95% CI): -0.075 (-0.142, -0.009), p=0.026) when HBV infection as a mediator. Our findings suggested that HBV infection interacts or mediates with the association between rs12427129, rs3816153, and HCC. This would provide a new perspective for exploring the underlying biological mechanism between HOTAIR SNPs, HBV infection, and HCC.

The molecular genetic basis of atrial fibrillation.

As the most common cardiac arrhythmia, atrial fibrillation (AF) is a major risk factor for stroke, heart failure, and premature death with considerable associated costs. However, no available treatment options have optimal benefit-harm profiles currently, reflecting an incomplete understanding of the biological mechanisms underlying this complex arrhythmia. Recently, molecular epidemiological studies, especially genome-wide association studies, have emphasized the substantial genetic component of AF etiology. A comprehensive mapping of the genetic underpinnings for AF can expand our knowledge of AF mechanism and further facilitate the process of locating novel therapeutics for AF. Here we provide a state-of-the-art review of the molecular genetics of AF incorporating evidence from linkage analysis and candidate gene, as well as genome-wide association studies of common variations and rare copy number variations; potential epigenetic modifications (e.g., DNA methylation, histone modification, and non-coding RNAs) are also involved. We also outline the challenges in mechanism investigation and potential future directions in this article.

SNP-SNP and SNP-environment interactions of potentially functional HOTAIR SNPs modify the risk of hepatocellular carcinoma.

HOX transcript antisense intergenic RNA (HOTAIR) has been widely regarded as a functional lncRNA contributing to multiple cancers. However, few studies have examined the effect of single nucleotide polymorphisms (SNPs) in HOTAIR on the occurrence and development of hepatocellular carcinoma (HCC). In this study, three potentially functional HOTAIR SNPs (rs17105613, rs12427129, and rs3816153) were selected using bioinformatic tools. A case-control study including 1262 cases and 1559 controls was conducted to explore the association of HOTAIR SNPs with the risk of HCC in a Southern Chinese population. We found that SNPs rs12427129 and rs3816153 were associated with the risk of HCC in dominant genetic models (CC: CT + TT, adjusted odds ratio (OR) = 0.72, 95% confidence interval (CI) = 0.57-0.90 and GG: GT + TT, adjusted OR = 1.30, 95%CI = 1.08-1.57). Additionally, SNP-environment interactions for rs12427129, rs3816153, and HBsAg status were found to enhance the risk of HCC, with FDR-P as an additive interaction equal to 0.0006 and 0.0144, respectively. In multifactor dimensionality reduction (MDR) analysis, the three-factor model (HBsAg status, rs12427129 and rs3816153) yielded the highest test accuracy of 77.74% (permutation P < 0.001). Interestingly, the effect of rs12427129 and rs3816153 on the risk of HCC could be modified by HBsAg status, while the rs12427129 CT/TT genotype could antagonize the detrimental effect of rs3816153 GT/TT genotype on HCC. Our findings suggest that rs12427129 and rs3816153, including their SNP-SNP and SNP-environment interaction with HBsAg status, potentially play important roles on the susceptibility to HCC.

Short-term acceptability of the Woman's Condom and influencing factors among internal migrants in China.

BACKGROUND: The Woman's Condom, a newly designed condom for women, has obtained market approval in China, but it remains relatively unfamiliar to the migrant population. The aim of this study is to evaluate the short-term acceptability of the Woman's Condom and influencing factors among internal migrants. METHODS: A longitudinal study was conducted among 1800 migrants in Beijing, Chongqing, and Shanghai in China between August 2013 and August 2014.Three-level model was implemented with the Statistical Analysis System software (v.9.4 SAS Institute) to analyze within-individual changes, between-individuals effects, and between-group effects. RESULTS: Three-level model analysis revealed statistically higher short-term acceptability of the Woman's Condom among subjects who lived in Shanghai (ß = 6.50, t = 2.76, p < 0.01), unmarried and not in a cohabiting relationship (ß = 3.05, t = 2.76, p < 0.01) than those who lived in Beijing, married and in a cohabiting relationship. Female (ß = - 1.69, t = - 7.55, p < 0.01) and lower educational attainment (ß = - 2.30, t = - 1.94, p = 0.05) were negatively related, while occupations of education, health, and civil staff (ß = 1.50, t = 2.92, p < 0.01) were positively related to acceptability. It was predicted that migrants' acceptability of the Woman's Condom would significantly increase over time (ß = 1.09, t = 5.54, p < 0.01). CONCLUSIONS: The findings indicate that the Woman's Condom enjoyed relatively high short-term acceptability among migrants in China. In order to popularize the Women's Condoms in migrants, more publicity, consultation and training in open and prosperous areas should be strengthened.

A Novel Hierarchical Coding Progressive Transmission Method for WMSN Wildlife Images.

In the wild, wireless multimedia sensor network (WMSN) communication has limited bandwidth and the transmission of wildlife monitoring images always suffers signal interference, which is time-consuming, or sometimes even causes failure. Generally, only part of each wildlife image is valuable, therefore, if we could transmit the images according to the importance of the content, the above issues can be avoided. Inspired by the progressive transmission strategy, we propose a hierarchical coding progressive transmission method in this paper, which can transmit the saliency object region (i.e. the animal) and its background with different coding strategies and priorities. Specifically, we firstly construct a convolution neural network via the MobileNet model for the detection of the saliency object region and obtaining the mask on wildlife. Then, according to the importance of wavelet coefficients, set partitioned in hierarchical tree (SPIHT) lossless coding is utilized to transmit the saliency image which ensures the transmission accuracy of the wildlife region. After that, the background region left over is transmitted via the Embedded Zerotree Wavelets (EZW) lossy coding strategy, to improve the transmission efficiency. To verify the efficiency of our algorithm, a demonstration of the transmission of field-captured wildlife images is presented. Further, comparison of results with existing EZW and discrete cosine transform (DCT) algorithms shows that the proposed algorithm improves the peak signal to noise ratio (PSNR) and structural similarity index (SSIM) by 21.11%, 14.72% and 9.47%, 6.25%, respectively.

Comparison of common burden tests for genetic association studies of rare variants.

Common burden tests have different statistical performance in genetic association studies of rare variants. Here, we compare the statistical performance of burden tests, such as CMC, WST, SUM and extension methods, using the computer-simulated datasets of rare variants with different parameters of sample sizes, linkage disequilibrium (LD), and different numbers of mixed non-associated variants. The simulation results showed that the type I error for all methods is near 0.05. When the rare variants had the same direction of effect, the higher LD and the less non-associated variants, the higher the power of these method, except the data adaptive SUM test. When the direction was different, the power was significantly reduced for all methods. The methods that consider the direction yielded larger statistical power than those methods without considering the effect direction, except the strong LD condition. And the larger the sample size, the larger the power. The statistical performance of burden tests is affected by a variety of factors, including the sample size, effect direction of variants, non-associated variants, and LD. Therefore, when choosing the method and setting the collection unit and weight, the prior biological information of genetic variation should be integrated to improve study efficiency.

High Dietary Intake of Iron Might Be Harmful to Atrial Fibrillation and Modified by Genetic Diversity: A Prospective Cohort Study.

Some studies suggest an association between iron overload and cardiovascular diseases (CVDs). However, the relationship between dietary iron intake and atrial fibrillation (AF) remains uncertain, as does the role of genetic loci on this association. The study involved 179,565 participants from UK Biobank, tracking incident atrial fibrillation (AF) cases. Iron intake was categorized into low, moderate, and high groups based on dietary surveys conducted from 2009 to 2012. The Cox regression model was used to estimate the risk of AF in relation to iron intake, assessing the hazard ratio (HR) and 95% confidence interval (95% CI). It also examined the impact of 165 AF-related and 20 iron-related genetic variants on this association. Pathway enrichment analyses were performed using Metascape and FUMA. During a median follow-up period of 11.6 years, 6693 (3.97%) incident AF cases were recorded. A total of 35,874 (20.0%) participants had high iron intake. High iron intake was associated with increased risk of AF [HR: 1.13 (95% CI: 1.05, 1.22)] in a fully adjusted model. Importantly, there were 83 SNPs (11 iron-related SNPs) that could enhance the observed associations. These genes are mainly involved in cardiac development and cell signal transduction pathways. High dietary iron intake increases the risk of atrial fibrillation, especially when iron intake exceeds 16.95 mg. The association was particularly significant among the 83 SNPs associated with AF and iron, the individuals with these risk genes. Gene enrichment analysis revealed that these genes are significantly involved in cardiac development and cell signal transduction processes.

Dietary Inflammatory Index and Dietary Diversity Score Associated with Sarcopenia and Its Components: Findings from a Nationwide Cross-Sectional Study.

Little is known about the independent and joint effects of the energy-adjusted dietary inflammatory index (E-DII) and dietary diversity score (DDS) on sarcopenia and its components (low muscle mass, low muscle strength, and low physical performance). A total of 155,669 UK Biobank participants with ≥1 (maximum 5) 24 h dietary assessments were included in this cross-sectional analysis. We used logistic regression models to investigate the associations of E-DII and DDS with sarcopenia and its three components. We further examined the joint effects of E-DII and DDS on sarcopenia and its components using additive and multiplicative interaction analyses. We observed that lower E-DII and higher DDS were associated with lower odds of sarcopenia and its components. There were significant joint associations of E-DII and DDS with sarcopenia and low physical performance (p-interaction < 0.05) on the multiplicative interactive scale. Our study suggests that lower dietary inflammatory potential and higher dietary diversity might be important protective factors against sarcopenia and its components. More cases of sarcopenia and low physical performance might be preventable by adherence to a more anti-inflammatory diet combined with a higher dietary diversity.

Regular use of fish oil supplements and course of cardiovascular diseases: prospective cohort study.

Objective: To examine the effects of fish oil supplements on the clinical course of cardiovascular disease, from a healthy state to atrial fibrillation, major adverse cardiovascular events, and subsequently death. Design: Prospective cohort study. Setting: UK Biobank study, 1 January 2006 to 31 December 2010, with follow-up to 31 March 2021 (median follow-up 11.9 years). Participants: 415 737 participants, aged 40-69 years, enrolled in the UK Biobank study. Main outcome measures: Incident cases of atrial fibrillation, major adverse cardiovascular events, and death, identified by linkage to hospital inpatient records and death registries. Role of fish oil supplements in different progressive stages of cardiovascular diseases, from healthy status (primary stage), to atrial fibrillation (secondary stage), major adverse cardiovascular events (tertiary stage), and death (end stage). Results: Among 415 737 participants free of cardiovascular diseases, 18 367 patients with incident atrial fibrillation, 22 636 with major adverse cardiovascular events, and 22 140 deaths during follow-up were identified. Regular use of fish oil supplements had different roles in the transitions from healthy status to atrial fibrillation, to major adverse cardiovascular events, and then to death. For people without cardiovascular disease, hazard ratios were 1.13 (95% confidence interval 1.10 to 1.17) for the transition from healthy status to atrial fibrillation and 1.05 (1.00 to 1.11) from healthy status to stroke. For participants with a diagnosis of a known cardiovascular disease, regular use of fish oil supplements was beneficial for transitions from atrial fibrillation to major adverse cardiovascular events (hazard ratio 0.92, 0.87 to 0.98), atrial fibrillation to myocardial infarction (0.85, 0.76 to 0.96), and heart failure to death (0.91, 0.84 to 0.99). Conclusions: Regular use of fish oil supplements might be a risk factor for atrial fibrillation and stroke among the general population but could be beneficial for progression of cardiovascular disease from atrial fibrillation to major adverse cardiovascular events, and from atrial fibrillation to death. Further studies are needed to determine the precise mechanisms for the development and prognosis of cardiovascular disease events with regular use of fish oil supplements.

DJAN: Deep Joint Adaptation Network for Wildlife Image Recognition.

Wildlife recognition is of utmost importance for monitoring and preserving biodiversity. In recent years, deep-learning-based methods for wildlife image recognition have exhibited remarkable performance on specific datasets and are becoming a mainstream research direction. However, wildlife image recognition tasks face the challenge of weak generalization in open environments. In this paper, a Deep Joint Adaptation Network (DJAN) for wildlife image recognition is proposed to deal with the above issue by taking a transfer learning paradigm into consideration. To alleviate the distribution discrepancy between the known dataset and the target task dataset while enhancing the transferability of the model's generated features, we introduce a correlation alignment constraint and a strategy of conditional adversarial training, which enhance the capability of individual domain adaptation modules. In addition, a transformer unit is utilized to capture the long-range relationships between the local and global feature representations, which facilitates better understanding of the overall structure and relationships within the image. The proposed approach is evaluated on a wildlife dataset; a series of experimental results testify that the DJAN model yields state-of-the-art results, and, compared to the best results obtained by the baseline methods, the average accuracy of identifying the eleven wildlife species improves by 3.6 percentage points.

A Lightweight Automatic Wildlife Recognition Model Design Method Mitigating Shortcut Learning.

Recognizing wildlife based on camera trap images is challenging due to the complexity of the wild environment. Deep learning is an optional approach to solve this problem. However, the backgrounds of images captured from the same infrared camera trap are rather similar, and shortcut learning of recognition models occurs, resulting in reduced generality and poor recognition model performance. Therefore, this paper proposes a data augmentation strategy that integrates image synthesis (IS) and regional background suppression (RBS) to enrich the background scene and suppress the existing background information. This strategy alleviates the model's focus on the background, guiding it to focus on the wildlife in order to improve the model's generality, resulting in better recognition performance. Furthermore, to offer a lightweight recognition model for deep learning-based real-time wildlife monitoring on edge devices, we develop a model compression strategy that combines adaptive pruning and knowledge distillation. Specifically, a student model is built using a genetic algorithm-based pruning technique and adaptive batch normalization (GA-ABN). A mean square error (MSE) loss-based knowledge distillation method is then used to fine-tune the student model so as to generate a lightweight recognition model. The produced lightweight model can reduce the computational effort of wildlife recognition with only a 4.73% loss in accuracy. Extensive experiments have demonstrated the advantages of our method, which is beneficial for real-time wildlife monitoring with edge intelligence.

Association between Family Environment and Adolescents' Sexual Adaptability: Based on the Latent Profile Analysis of Personality Traits.

Sexual adaptation plays an important role in psychosexual health. Our study aimed to investigate the relationship between the family environment and sexual adaptability among adolescents with different personality traits. A cross-sectional study was conducted in Shanghai and Shanxi province. A total of 1106 participants aged 14-19 was surveyed in 2019, including 519 boys and 587 girls. Univariate analyses and mixed regression models were performed to assess the association. Girls had a significantly lower average score of sexual self-adaptation compared to boys (4.01 ± 0.77 vs. 4.32 ± 0.64, p < 0.001). We found that the family environment did not impact boys' sexual adaptation in different personality groups. For girls in a balanced group, expressiveness factors improved their sexual adaptability (p < 0.05), intellectual-cultural orientation and organization promoted social adaptability (p < 0.05) and active-recreational orientation and control decreased their social adaptability (p < 0.05). In the high-neuroticism group, cohesion facilitated sexual control (p < 0.05), while conflict and organization reduced sexual control ability, and active-recreational orientation decreased sexual adaptation (p < 0.05). No factors associated with the family environment were found to influence sexual adaptability in groups with low neuroticism and high ratings in other personality factors. Compared with boys, girls demonstrated lower sexual self-adaptability, and their overall sexual adaptability was more susceptible to the family environment.

Ambient air pollution associated with incident asthma, subsequent cardiovascular disease and death: A trajectory analysis of a national cohort.

No previous study has examined the impact of air pollution on the cardiovascular disease (CVD) trajectory, especially among asthmatic subjects. Based on the UK Biobank cohort, we retrieved 292,227 adults free of asthma and CVD aged 37-73 years at recruitment (2006-2010). Annual mean concentrations of particulate matter (PM10 and PM2.5) and nitrogen oxides (NO2 and NOx) were assessed at each individual's addresses. We used multi-state models to estimate the associations of air pollution with the trajectory from healthy to incident asthma, subsequent CVD, and death. During a median follow-up of 11.7 years, a total of 6338 (2.2%) participants developed asthma, among which, 638 (10.1%) subsequently proceeded to CVD. We observed significant impacts of various air pollutants on the CVD dynamic transitions, with a more substantial effect of particulate matter pollutants than gaseous air pollutants. For example, the hazard ratios (95% confidence intervals) for per interquartile range increase in PM2.5 and PM10 were 1.28 (1.13, 1.44) and 1.27 (1.13, 1.43) for transitions from incident asthma to subsequent CVD. In conclusion, long-term air pollution exposure could affect the CVD trajectory. Distinguishing the effect of air pollutants on CVD transition stages has great significance for CVD health management and clinical prevention, especially among asthma patients.

Associations of Life's Essential 8 and fine particulate matter pollution with the incidence of atrial fibrillation.

Both unhealthy lifestyle factors and ambient air pollution have been closely linked with the risk of atrial fibrillation (AF). We retrieved 250,898 participants without AF at baseline from UK Biobank. LE8 was determined by 8 metrics, and was characterized as low, moderate and high cardiovascular health (CVH). Exposure to PM2.5 was estimated at the geocoded residential address of each participant. During a median follow-up of 12.46 years, we identified 14,743 (5.9%) incident AF cases. Participants with moderate and high CVH showed a decreased risk of incident AF compared to those with low CVH. Of the LE8 metrics, ideal body mass index (BMI) and blood pressure (BP) were associated with a decrease of 11.57% and 11.46% AF cases. High PM2.5 exposure was associated with an 8% increased risk of AF as compared to low PM2.5 exposure. Compared with those who had low CVH and high PM2.5 exposure, participants with a high CVH and low PM2.5 exposure had the lower AF incidence. Our study found higher CVH is protective, while higher PM2.5 might be one risk factor of AF. Adherence to the LE8 guidelines may help reduce the incidence of AF, especially in those with lower PM2.5 exposure.

Relation of Life's Essential 8 to the genetic predisposition for cardiovascular outcomes and all-cause mortality: results from a national prospective cohort.

AIMS: To evaluate the independent, mediating, interactive, and associated effects of Life's Essential 8 (LE8) and genetic predisposition on the risk of cardiovascular outcomes and all-cause mortality. METHODS AND RESULTS: We retrieved a total of 254 783 individuals from the UK Biobank. LE8 was determined by eight metrics (nicotine exposure, physical activity, diet, sleep, body mass index, blood pressure, blood glucose, and blood lipids), and was characterized as low, moderate, and high cardiovascular health (CVH). Genetic predisposition was estimated using the polygenic risk score (PRS). Cox regressions were performed to evaluate the associations between LE8, PRS, and outcomes. During a median follow-up of 12.53 years, all-cause mortality occurred in 10 257 of 197 473 participants, cardiovascular mortality in 2074 of 215 675, and incident cardiovascular disease (CVD) in 71 774 of 215 675. Individuals with moderate or high CVH experienced a lower risk [hazard ratios (HRs) 0.33 to 0.81] of adverse health outcomes compared with their counterparts with low CVH. A substantial proportion (16.1∼69.8%) of health outcomes could be attributable to moderate or high LE8, and up to 51.2% of the associations between PRS and adverse outcomes were mediated by LE8. In high PRS group, individuals with high CVH had lower CVD mortality (HR: 0.26, 95% confidence interval: 0.18, 0.39), compared to those with low CVH. CONCLUSION: Ideal CVH was associated with lower risks of cardiovascular outcomes and all-cause mortality, with a more pronounced association observed in individuals with high PRS for CVD. Improving CVH according to LE8 guidelines should be encouraged, especially for those with PRS that indicate high CVD risk.

In the UK Biobank cohort of over 250 000 people, we found that participants achieved high scores on the Life's Essential 8 (LE8) guidelines had better health outcomes. The study also found that following LE8 guidelines helped reduce the risk of cardiovascular diseases, especially for those with a genetic predisposition to the condition. Thus, adopting a healthy lifestyle, as per the LE8 guidelines, could improve cardiovascular health and reduce the risk of death, even more than genetics alone. Furthermore, the study found that for every increase of one point in the LE8 score, the risk of adverse health outcomes decreased by 2­5%.