PLOS ONE: [sortOrder=DATE_NEWEST_FIRST, sort=Date, newest first, q=subject:"Cardiology"]PLOShttps://journals.plos.org/plosone/webmaster@plos.orgaccelerating the publication of peer-reviewed sciencehttps://journals.plos.org/plosone/search/feed/atom?sortOrder=DATE_NEWEST_FIRST&unformattedQuery=subject:%22Cardiology%22&sort=Date,+newest+firstAll PLOS articles are Open Access.https://journals.plos.org/plosone/resource/img/favicon.icohttps://journals.plos.org/plosone/resource/img/favicon.ico2024-03-28T17:11:10ZComparison of nutritional value of snakehead fish from Guangdong and Deqing varietiesZeguo ZengMiao ZhengMengxiao ZhaoJing GuoShuifa ZhuXianguo ZouQingxiang Zeng10.1371/journal.pone.03012032024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Zeguo Zeng, Miao Zheng, Mengxiao Zhao, Jing Guo, Shuifa Zhu, Xianguo Zou, Qingxiang Zeng</p>
Environmental pollution and overfishing of wild fish resources have led to a significant decrease in snakehead fish, thus leading to the increased demand for breeding the snakehead fish. Guangdong and Deqing snakehead fish are two common consumed varieties. However, their nutritional value was unclear. Therefore, this study aimed to evaluate the nutritional value of snakehead fish from Guangdong and Deqing varieties feeding with different fodders by analyzing and comparing the proximate composition, fatty acids and amino acids. Results showed that the contents of carbohydrate, energy and fat contents in Guangdong variety were lower than that in Deqing variety feeding commercial fodder or offal. Besides, Guangdong variety contained the highest contents of polyunsaturated fatty acids (27.99 ± 1.99%) and EPA + DHA (2.70 ± 0.04%), as well as total essential amino acid content (2550.29), compared to Deqing variety feeding commercial fodder or offal. Overall, snakehead fish from Guangdong variety displayed the highest nutritional value, and thus was a reasonable choice for farmers and consumers. The findings of this study would help farmers to choose the suitable feeding variety and patterns of snakehead fish from the perspective of fish nutritional value, which is beneficial to the sustainable fish farming.Association of spironolactone use with risk of urinary tract cancer in the general population: A matched population-based cohort studyLiang-Cheng ChenHsuan-Ju YangBen-Hui YuMoon-Sing LeeHon-Yi LinWen-Yen ChiouDai-Wei LiuFeng-Chun HsuChia-Hui ChewShih-Kai Hung10.1371/journal.pone.03003912024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Liang-Cheng Chen, Hsuan-Ju Yang, Ben-Hui Yu, Moon-Sing Lee, Hon-Yi Lin, Wen-Yen Chiou, Dai-Wei Liu, Feng-Chun Hsu, Chia-Hui Chew, Shih-Kai Hung</p>
Purpose <p>The correlation between spironolactone usage and cancer risk has sparked interest. The objective of this study is to examine the association between spironolactone use and the incidence of urinary tract cancer in the general population.</p> Methods <p>We conducted a matched population-based cohort study. The study population was obtained from the Taiwan National Health Insurance Research Database (TNHIRD) during the period from 2000 to 2016. The multivariate Cox proportional hazard model was performed to examine the impact of spironolactone use on the risk of urinary tract cancer. A total of 8,608 individuals exposed to spironolactone were exact matched by 1:1 ratio with unexposed controls on factors including age, gender, comorbidities, CCI scores and socioeconomic status. The incidences of urinary tract cancer, including prostate, renal and bladder cancer, were estimated in both spironolactone exposed and non-exposed cohorts.</p> Results <p>After adjusting for confounding variables, the multivariate Cox regression analysis showed no significant association between spironolactone exposure and urinary tract cancer incidence, including bladder (adjusted hazard ratio [aHR] = 1.19, 95% confidence interval [CI] = 0.72–1.96, p = 0.50), renal (aHR = 1.75, 95% CI = 0.99–3.07, p = 0.053), and prostate cancer (aHR = 0.67, 95% CI = 0.43–1.04, p = 0.07). When the population was stratified into low (cumulative dose < = 29,300 mg) and high (cumulative dose >29,300 mg) dose of spironolactone, only high dose of spironolactone use was significantly associated with a reduced risk of prostate cancer (aHR = 0.45, 95% CI = 0.23–0.89, p = 0.02), while being associated with an elevated risk of renal cancer (aHR = 2.09, 95% CI = 1.07–4.08, p = 0.03). However, no clear cumulative dose-response relationship was observed in theses associations.</p> Conclusions <p>High cumulative dose of spironolactone may be potentially associated with a decreased incidence of prostate cancer and an increased incidence of renal cancer, while no significant association was observed with bladder cancer incidence. However, given the lack of support from the dose-response pattern, the available evidence is inconclusive to establish a definitive association between spironolactone use and urinary tract cancer.</p>Risk factors for catheter-associated bloodstream infection in hemodialysis patients: A meta-analysisHuajie GuoLing ZhangHua HeLili Wang10.1371/journal.pone.02997152024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Huajie Guo, Ling Zhang, Hua He, Lili Wang</p>
Objective <p>This meta-analysis aimed to elucidate the risk factors contributing to catheter-associated bloodstream infection in hemodialysis patients.</p> Methods <p>Comprehensive literature searches were conducted in both English and Chinese databases, which encompassed PubMed, Cochrane Library, Embase, CNKI, Wanfang Data, VIP Database and China Biomedical Literature Database. The search timeframe extended from each database’s inception to March 8, 2023. Two independent researchers executed literature screening, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Statistical analysis of the data was performed using RevMan 5.3 software, facilitating the identification of significant risk factors associated with catheter-related bloodstream infections in hemodialysis patients. This meta-analysis is registered with PROSPERO under the registration number CRD42023406223.</p> Results <p>Forty-nine studies were incorporated into this meta-analysis, from which 22 risk factors were examined. Through the analysis, 17 risk factors exhibited statistical significance (<i>P</i> < 0.05): age (OR = 1.52, 95% CI [0.49, 4.68]), diabetes (OR = 2.52, 95% CI [1.95, 3.25]), kidney disease (OR = 3.45, 95% CI [1.71, 6.96]), history of catheter-associated infection (OR = 2.79, 95% CI [1.96, 3.98]), hypertension (OR = 1.43, 95% CI [1.08, 1.91]), dialysis duration (OR = 3.06, 95% CI [1.70, 5.50]), catheter placement site (OR = 1.91, 95%CI [1.35, 2.70]), catheter duration (OR = 2.06, 95% CI [1.17, 3.60]), number of catheterizations (OR = 4.22, 95% CI [3.32, 5.37]), catheter types (OR = 3.83, 95% CI [2.13, 6.87]), CD4<sup>+</sup> cells (OR = 0.33, 95% CI [0.18, 0.63]), albumin (ALB, OR = 2.12, 95% CI [1.15, 3.91]), C-reactive protein (CRP, OR = 1.73, 95% CI [1.47, 2.03]), hemoglobin (Hb, OR = 1.48, 95% CI [0.54, 4.07]), procalcitonin (PCT, OR = 1.05, 95% CI [1.03, 1.06]), inadequate hand hygiene (OR = 5.32, 95% CI [1.07, 26.37]), and APACHE II scores (OR = 2.41, 95% CI [1.33, 4.37]).</p> Conclusion <p>This meta-analysis suggests that age, diabetes, kidney disease, history of catheter-associated infection, hypertension, dialysis duration, catheter placement site, catheter duration, number of catheterizations, catheter type, CD4<sup>+</sup> cells, albumin, C-reactive protein, hemoglobin, procalcitonin, inadequate hand hygiene, and APACHE II scores significantly influence the incidence of catheter-associated bloodstream infection in hemodialysis patients.</p>Sex-related differences in pre-dialysis trajectories and dialysis initiation: A French nationwide retrospective studyMaxime RaffrayLouise BourasseauCécile VigneauCécile CouchoudClémence BéchadeFrançois GlowackiSahar Bayaton behalf of the REIN registry10.1371/journal.pone.02996012024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Maxime Raffray, Louise Bourasseau, Cécile Vigneau, Cécile Couchoud, Clémence Béchade, François Glowacki, Sahar Bayat, on behalf of the REIN registry </p>
Background <p>In the last two decades, sex and gender differences have been documented in chronic kidney disease (CKD) management, including access to renal replacement therapy and its outcomes. The objectives of this study were to 1) compare the pre-dialysis healthcare utilization in men and women, and 2) examine the sex-specific factors associated with emergency dialysis start.</p> Methods <p>Adult patients with CKD who started dialysis in France in 2015 were extracted from the Renal Epidemiology and Information Network registry. Patients were matched to the French National Health Data System database to extract healthcare utilization data for the 2 years before dialysis start. Frequencies and monthly rates of consultations and hospitalizations were compared between men and women. Logistic regression analyses were performed separately in the two groups.</p> Results <p>Among the 8856 patients included, 3161 (35.7%) were women. Median age (71 years) and estimated glomerular filtration rate (8.1 and 7.7 ml/min for men and women) were similar between groups at dialysis start. Monthly consultations rates with a general practitioner and nephrology-related care were similar between women and men. Some sex-specific differences were found: higher frequencies of consultations with a psychiatrist in women and more frequent hospitalizations for circulatory system diseases in men. Emergency dialysis start rate was 30% in both groups. Emergency dialysis start was associated with acute nephropathy, compared with slowly progressive nephropathy, in women but not in men (OR = 1.48, p<0.01 vs 1.15, p = 0.18).</p> Conclusions <p>This study found similar quantitative pre-dialysis healthcare utilization in men and women. To better understand sex/gender differences in CKD care trajectories, future research should focus on patients with CKD who are unknown to nephrology services, on patients receiving conservative care and on the sex/gender-specific mechanisms underlying care decision-making.</p>Pubertal timing: A life course pathway linking early life risk to adulthood cardiometabolic healthMaria E. BleilBradley M. AppelhansSteven E. GregorichRobert A. HiattGlenn I. RoismanCathryn Booth-LaForce10.1371/journal.pone.02994332024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Maria E. Bleil, Bradley M. Appelhans, Steven E. Gregorich, Robert A. Hiatt, Glenn I. Roisman, Cathryn Booth-LaForce</p>
Objective <p>To evaluate a series of prospective life course models testing whether the timing of pubertal development is a pathway through which prepubertal risk factors may influence adulthood cardiometabolic health.</p> Methods <p>Subjects were 655 female participants in the NICHD Study of Early Child Care and Youth Development (SECCYD) and recent SECCYD 30-year follow-up, the Study of Health in Early and Adult Life (SHINE). Prepubertal risk factors included maternal menarcheal age, child race/ethnicity, child health status indicators, and child adversity indicators. Pubertal timing was indexed by breast development onset (Tanner stage [TS] II), pubic hair onset (TS II) and menarcheal age. Adulthood cardiometabolic risk (CMR) was indexed by a composite of waist circumference, systolic blood pressure, diastolic blood pressure, hemoglobin A1c, C-reactive protein, and high-density lipoprotein.</p> Results <p>Inspection of paths between the prepubertal risk factors, pubertal timing indicators, and adulthood CMR composite showed later breast development onset (-0.173, <i>p</i> < .01), later pubic hair onset (-0.182, <i>p</i> < .01), and later menarche (-0.145, <i>p</i> < .01) each predicted lower adulthood CMR, and each pubertal timing indicator mediated effects of prepubertal risk factors on adulthood CMR. Specifically, the timing of breast development onset and menarche mediated effects of maternal menarcheal age, Black (vs. White), Asian/PI (vs. White), child BMI percentile, and child SES on adulthood CMR (all <i>p</i>s < .05), and the timing of pubic hair onset mediated effects of maternal menarcheal age, Black (vs. White), and child BMI percentile on adulthood CMR (all <i>p</i>s < .10).</p> Conclusion <p>Findings in the current study contribute to the broader literature by identifying pubertal development and its timing as a potentially important pathway through which early life exposures may shape adulthood cardiometabolic health and disease. These findings have important implications for novel opportunities for increased surveillance and potential intervention focusing on pubertal development as a target to improve health more broadly.</p>The joint profiles of cardiorespiratory fitness and muscle strength on daily physical activity levels in patients with symptomatic peripheral artery disease: A cross-sectional studyPaulo LonganoEduardo Caldas CostaRenan Massena CostaBreno Quintella FarahNelson WoloskerGabriel Grizzo CucatoMarilia Almeida CorreiaHélcio KanegusukuRaphael Mendes Ritti-Dias10.1371/journal.pone.02982892024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Paulo Longano, Eduardo Caldas Costa, Renan Massena Costa, Breno Quintella Farah, Nelson Wolosker, Gabriel Grizzo Cucato, Marilia Almeida Correia, Hélcio Kanegusuku, Raphael Mendes Ritti-Dias</p>
Introduction <p>In peripheral artery disease (PAD) patients, the joint profile of low strength and cardiorespiratory fitness on movement behaviors, specifically physical activity levels and sedentary time, remains unclear.</p> Purpose <p>To investigate the joint profiles between cardiorespiratory and neuromuscular fitness and daily physical activity among PAD patients.</p> Methods <p>Cross-sectional study in a sample of 155 PAD patients. We measured their physical activity level per week using accelerometers, assessed their muscle strength through a sit-to-stand test and cardiorespiratory fitness through a six-minute walk test. Patients were categorized into three groups: those with high strength and cardiorespiratory fitness (NC, n = 28), those with at least one component classified as low (1C, n = 88), and those with both components classified as low fitness (2C, n = 39).</p> Results <p>The patients in the 1C and 2C groups spent less time engaged in low-light and moderate activities compared to the NC group (low-light: NC: 2291 ± 680 minutes/week vs. 1C: 1826 ± 649 minutes/week vs. 2C: 1885 ± 651 minutes/week, p = .005; moderate: NC: 2617 ± 796 minutes/week vs. 1C: 2071 ± 767 minutes/week vs. 2C: 2092 ± 776 minutes/week, p = .005) and the patients in the 2C group spent less time engaged in vigorous activities compared to the NC and 1C groups (NC: 155 ± 148 minutes/week vs. 1C: 110 ± 110 minutes/week vs. 2C: 64 ± 70 minutes/week, p = .003).</p> Conclusion <p>PAD patients with low strength and/or cardiorespiratory fitness are more likely to spend less time engaging in low-light and moderate physical activities and patients with low fitness in both components are more likely to spend less time engaging in vigorous physical activity.</p>Lower autonomic arousal as a risk factor for criminal offending and unintentional injuries among female conscriptsSofi OskarssonAnneli AnderssonBridget M. BertoldiAntti LatvalaRalf Kuja-HalkolaBrittany EvansAdrian RaineChristopher J. PatrickHenrik LarssonCatherine Tuvblad10.1371/journal.pone.02976392024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Sofi Oskarsson, Anneli Andersson, Bridget M. Bertoldi, Antti Latvala, Ralf Kuja-Halkola, Brittany Evans, Adrian Raine, Christopher J. Patrick, Henrik Larsson, Catherine Tuvblad</p>
Background <p>Lower autonomic arousal is a well-known correlate of criminal offending and other risk-taking behaviors in men, but few studies have investigated this association in women.</p> Aim <p>To test associations between autonomic arousal and criminal offending as well as unintentional injuries among female conscripts.</p> Methods <p>All women born 1958–1994 in Sweden who participated in voluntary military conscription (n = 12,499) were identified by linking Swedish population-based registers. Predictors were resting heart rate (RHR) and systolic blood pressure (SBP). Covariates were height, weight, and physical energy capacity. Main outcomes were criminal convictions (any, violent, and non-violent) from the National Crime Register. Secondary outcome was unintentional injuries requiring medical treatment or causing death. We used survival analyses to test for associations between predictors and outcomes.</p> Results <p>Low RHR, relative to high RHR, was associated with an increased risk of any criminal conviction, non-violent criminal convictions, and unintentional injuries. Low SBP, relative to high SBP, was associated with an increased risk of violent criminal convictions.</p> Conclusions <p>Results support lower autonomic arousal, particularly lower RHR, as a correlate of criminal offending among women that warrants further examination, as the reported findings have potential implications for the prediction of future female crime.</p>Cause and preventability of in-hospital mortality after PCI: A statewide root-cause analysis of 1,163 deathsFrancesco MoroniMilan SethHameem U. ChangeziMilind KarveDilip S. AroraManoj SharmaElizabeth PielstickerAaron D. BermanDaniel LeeM. Imran QureshiLorenzo AzzaliniDevraj SukulHitinder S. Gurm10.1371/journal.pone.02975962024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Francesco Moroni, Milan Seth, Hameem U. Changezi, Milind Karve, Dilip S. Arora, Manoj Sharma, Elizabeth Pielsticker, Aaron D. Berman, Daniel Lee, M. Imran Qureshi, Lorenzo Azzalini, Devraj Sukul, Hitinder S. Gurm</p>
Background <p>Mortality is the most devastating complication of percutaneous coronary interventions (PCI). Identifying the most common causes and mechanisms of death after PCI in contemporary practice is an important step in further reducing periprocedural mortality.</p> Objectives <p>To systematically analyze the cause and circumstances of in-hospital mortality in a large, multi-center, statewide cohort.</p> Methods <p>In-hospital deaths after PCI occurring at 39 hospitals included in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) between 2012 and 2014 were retrospectively reviewed using validated methods. A priori PCI-related mortality risk was estimated using the validated BMC2 model.</p> Results <p>A total of 1,163 deaths after PCI were included in the study. Mean age was 71±13 years, and 507 (44%) were women. Left ventricular failure was the most common cause of death (52% of cases). The circumstance of death was most commonly related to prior acute cardiovascular condition (61% of cases). Procedural complications were considered contributing to mortality in 235 (20%) cases. Death was rated as not preventable or slightly preventable in 1,045 (89.9%) cases. The majority of the deaths occurred in intermediate or high-risk patients, but 328 (28.2%) deaths occurred in low-risk patients (<5% predicted risk of mortality). PCI was considered rarely appropriate in 30% of preventable deaths.</p> Conclusions <p>In-hospital mortality after PCI is rare, and primarily related to pre-existing critical acute cardiovascular condition. However, approximately 10% of deaths were preventable. Further research is needed to characterize preventable deaths, in order to develop strategies to improve procedural safety.</p>Multiple cardiovascular risk factor care in 55 low- and middle-income countries: A cross-sectional analysis of nationally-representative, individual-level data from 280,783 adultsAlpha Oumar DialloMaja E. MarcusDavid FloodMichaela TheilmannNicholas E. RahimAlan KinlawNora FranceschiniTil StürmerDessie V. TienMohsen Abbasi-KangevariKokou AgoudaviGlennis Andall-BreretonKrishna AryalSilver BahendekaBrice BicabaPascal BovetMaria DorobantuFarshad FarzadfarSeyyed-Hadi GhamariGladwell GathechaDavid GuwatuddeMongal GurungCorine HouehanouDismand HouinatoNahla HwallaJutta JorgensenGibson KagarukiKhem KarkiJoao MartinsMary MayigeRoy Wong McClureSahar Saeedi MoghaddamOmar MwalimKibachio Joseph MwangiBolormaa NorovSarah Quesnel-CrooksAbla SibaiLela SturuaLindiwe TsabedzeChea WessehPascal GeldsetzerRifat AtunSebastian VollmerTill BärnighausenJustine DaviesMohammed K. AliJacqueline A. SeiglieEmily W. GowerJennifer Manne-Goehler10.1371/journal.pgph.00030192024-03-27T14:00:00Z2024-03-27T14:00:00Z<p>by Alpha Oumar Diallo, Maja E. Marcus, David Flood, Michaela Theilmann, Nicholas E. Rahim, Alan Kinlaw, Nora Franceschini, Til Stürmer, Dessie V. Tien, Mohsen Abbasi-Kangevari, Kokou Agoudavi, Glennis Andall-Brereton, Krishna Aryal, Silver Bahendeka, Brice Bicaba, Pascal Bovet, Maria Dorobantu, Farshad Farzadfar, Seyyed-Hadi Ghamari, Gladwell Gathecha, David Guwatudde, Mongal Gurung, Corine Houehanou, Dismand Houinato, Nahla Hwalla, Jutta Jorgensen, Gibson Kagaruki, Khem Karki, Joao Martins, Mary Mayige, Roy Wong McClure, Sahar Saeedi Moghaddam, Omar Mwalim, Kibachio Joseph Mwangi, Bolormaa Norov, Sarah Quesnel-Crooks, Abla Sibai, Lela Sturua, Lindiwe Tsabedze, Chea Wesseh, Pascal Geldsetzer, Rifat Atun, Sebastian Vollmer, Till Bärnighausen, Justine Davies, Mohammed K. Ali, Jacqueline A. Seiglie, Emily W. Gower, Jennifer Manne-Goehler</p>
The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representative population-based surveys (2009–2019) with measured blood pressure (BP) and diabetes biomarker. We restricted our analysis to non-pregnant individuals aged 40–69 years and defined three mutually exclusive groups (i.e., hypertension only, diabetes only, and both hypertension-diabetes) to compare individuals living with concurrent hypertension and diabetes to individuals with each condition separately. We included 90,086 individuals who lived with hypertension only, 11,975 with diabetes only, and 16,228 with hypertension-diabetes. We estimated the percentage of individuals who were aware of their diagnosis, used pharmacological therapy, or achieved appropriate hypertension and diabetes management. A greater percentage of individuals with hypertension-diabetes were fully diagnosed (64.1% [95% CI: 61.8–66.4]) than those with hypertension only (47.4% [45.3–49.6]) or diabetes only (46.7% [44.1–49.2]). Among the hypertension-diabetes group, pharmacological treatment was higher for individual conditions (38.3% [95% CI: 34.8–41.8] using antihypertensive and 42.3% [95% CI: 39.4–45.2] using glucose-lowering medications) than for both conditions jointly (24.6% [95% CI: 22.1–27.2]).The percentage of individuals achieving appropriate management was highest in the hypertension group (17.6% [16.4–18.8]), followed by diabetes (13.3% [10.7–15.8]) and hypertension-diabetes (6.6% [5.4–7.8]) groups. Although health systems in LMICs are reaching a larger share of individuals living with both hypertension and diabetes than those living with just one of these conditions, only seven percent achieved both BP and blood glucose treatment targets. Implementation of cost-effective population-level interventions that shift clinical care paradigm from disease-specific to comprehensive CVD care are urgently needed for all three groups, especially for those with multiple CVD risk factors.Steatotic liver disease and its newly proposed sub-classifications correlate with progression of the coronary artery calcium scoreAryoung KimDanbee KangSung Chul ChoiJuhee ChoDong Hyun SinnGeum-Youn Gwak10.1371/journal.pone.03011262024-03-26T14:00:00Z2024-03-26T14:00:00Z<p>by Aryoung Kim, Danbee Kang, Sung Chul Choi, Juhee Cho, Dong Hyun Sinn, Geum-Youn Gwak</p>
Background & aims <p>A new nomenclature, Steatotic Liver Disease (SLD), has been proposed by consensus with sub-classifications and requires evidence-based validation. We assessed whether the presence and severity of SLD, as well as its sub-classifications, are associated with the progression of coronary atherosclerosis.</p> Methods <p>This longitudinal cohort study included 13,811 adults who participated in repeated regular health screening examinations between January 1, 2004 and December 31, 2021 that included assessments of their coronary artery calcium (CAC) scores. SLD was defined using abdominal ultrasonography and classified as metabolic dysfunction associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and cryptogenic SLD. SLD severity was assessed using fibrosis-4 (FIB-4) scores. The progression of CAC scores was measured using multidetector CT scans.</p> Results <p>The average duration of follow-up was 5.8 years. During follow-up, the annual rate of CAC progression in participants with and without SLD was 18% (95% CI 17%–19%) and 14% (95% CI 13%–14%) (p < 0.01), respectively. The multivariable ratios of progression rates when we compared participants with cryptogenic SLD, MASLD, or MetALD with those without SLD were 0.98 (95% CI 0.95–1.01), 1.03 (95% CI 1.03–1.04), and 1.07 (95% CI 1.04–1.09), respectively. The multivariable ratios of progression rates when we compared participants with SLD with FIB-4 score <1.3 and SLD with FIB-4 score ≥1.3 with those without SLD were 1.03 (95% CI 1.02–1.04), and 1.05 (95% CI 1.04–1.06), respectively.</p> Conclusions <p>SLD was associated with a higher risk of coronary atherosclerosis, and the risk differed by sub-classifications and severity. These findings suggest that the newly proposed definition has clinical relevance in terms of stratifying cardiovascular disease risk.</p>Impact of extracorporeal membrane oxygenation-related complications on in-hospital mortalityEunae ByunPil Je KangSung Ho JungSeo Young ParkSang Ah LeeTae-Won KwonYong-Pil Cho10.1371/journal.pone.03007132024-03-25T14:00:00Z2024-03-25T14:00:00Z<p>by Eunae Byun, Pil Je Kang, Sung Ho Jung, Seo Young Park, Sang Ah Lee, Tae-Won Kwon, Yong-Pil Cho</p>
Introduction <p>Although extracorporeal membrane oxygenation (ECMO) is a well-established treatment for supporting severe cardiopulmonary failure, the morbidity and mortality of patients requiring ECMO support remain high. Evaluating and correcting potential risk factors associated with any ECMO-related complications may improve care and decrease mortality. This study aimed to assess the predictors of ECMO-related vascular and cerebrovascular complications among adult patients and to test the hypothesis that ECMO-related complications are associated with higher in-hospital mortality rates.</p> Methods <p>This single-center, retrospective study included 856 ECMO runs administered via cannulation of the femoral vessels of 769 patients: venoarterial (VA) ECMO (<i>n</i> = 709, 82.8%) and venovenous (VV) ECMO (<i>n</i> = 147, 17.2%). The study outcomes included the occurrence of ECMO-related vascular and cerebrovascular complications and in-hospital death. The association of ECMO-related complications with the risk of in-hospital death was analyzed.</p> Results <p>The incidences of ECMO-related vascular and cerebrovascular complications were 20.2% and 13.6%, respectively. The overall in-hospital mortality rate was 48.7%: 52.8% among VA ECMO runs and 29.3% among VV ECMO runs. Multivariable analysis indicated that age (<i>P</i> < 0.01), cardiopulmonary cerebral resuscitation (<i>P</i> < 0.01), continuous renal replacement therapy (<i>P</i> < 0.01), and initial platelet count [<50×10<sup>3</sup>/μL (<i>P</i> = 0.02) and 50–100(×10<sup>3</sup>)/μL (<i>P</i> < 0.01)] were associated with an increased risk of in-hospital death. ECMO-related vascular and cerebrovascular complications were not independently associated with higher in-hospital mortality rates for VA or VV ECMO runs.</p> Conclusion <p>ECMO-related vascular and cerebrovascular complications were not associated with an increased risk of in-hospital death among adult patients.</p>Associations between hypertension with reproductive and menopausal factors: An integrated women’s health programme (IWHP) studyLaureen Yi-Ting WangWin P. P. ThuYiong Huak ChanSusan LoganMichael S. KramerJane A. CauleyEu-Leong Yong10.1371/journal.pone.02998402024-03-25T14:00:00Z2024-03-25T14:00:00Z<p>by Laureen Yi-Ting Wang, Win P. P. Thu, Yiong Huak Chan, Susan Logan, Michael S. Kramer, Jane A. Cauley, Eu-Leong Yong</p>
Background <p>Women are less likely to have classic cardiovascular risk factors than men, and events during their reproductive and menopausal years may increase hypertension risk. The aim of this study is to examine woman-specific factors, including menstrual, reproductive and pregnancy complications, in relation to the prevalence of hypertension in mid-life Asian women.</p> Methods <p>This is a cross-sectional study of 1146 healthy women aged 45–69 years, from a multi-ethnic Asian cohort. The women completed an extensive questionnaire that included their sociodemographic details, medical history, lifestyle and physical activity, and reproductive and menopausal history. They also underwent objectively measured physical performance tests and a dual X-ray absorptiometry scan. Hypertension was defined as a systolic BP ≥140 and/or diastolic BP ≥90mm Hg, past diagnosis by a physician, or use of antihypertensive medications. Multivariable logistic regression was used to assess the independent risk factors for hypertension.</p> Results <p>The average age of the 1146 women analysed was 56.3 (SD 6.2) years, and 55.2 percent of them were hypertensive. The prevalence of gestational diabetes and gestational hypertension was 12.6% and 9.4%, respectively. Besides age, abnormal menstrual cycle length at 25 years of age (OR:2.35, CI:1.34–4.13), preeclampsia (OR:2.46, CI:1.06–5.74), increased visceral adiposity (OR:4.21, CI:2.28–7.79) and reduced physical performance (OR:2.83, CI:1.46–5.47) were independently associated with hypertension in Asian women.</p> Conclusions <p>Our findings highlight the necessity of including features of menstrual and reproductive history as possible indicators of hypertension risk in cardiovascular disease risk assessment and prevention among Asian women. Reducing visceral adiposity and exercise to improve physical performance may help women avoid developing hypertension.</p>The relationship between a series of inflammatory markers on the risk of heart failure in different gender groups: Analysis from NHANES 2015–2018Ting ChengDongdong YuXingying QiuWenwei OuYangGeng LiLi ZhouZehuai Wen10.1371/journal.pone.02969362024-03-25T14:00:00Z2024-03-25T14:00:00Z<p>by Ting Cheng, Dongdong Yu, Xingying Qiu, Wenwei OuYang, Geng Li, Li Zhou, Zehuai Wen</p>
Background <p>A better understanding of the level-grade inflammation for the development and worsening of heart failure (HF) in different gender groups is an unmet need. We performed an updated analysis on the impact of a series of systemic inflammation markers on HF.</p> Methods <p>This compensatory cross-sectional study enrolled participants from the National Health and Nutrition Examination Survey (NHANES) 2015–2018. HF was based on the self-reported questions. Univariate and multivariate logistic regression were used to investigate the association between systemic immune-inflammation index (SII), high sensitivity C-reactive protein (hs-CRP), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and HF. For patients of different genders, <i>P</i> for trend was used to analyze potential linear trend relationships and the restricted cubic splines (RCS) were used to describe non-linear relationships. The additive interaction was evaluated by the relative excess risk due to interaction (RERI), attributable proportion (AP), and the synergy index (SI). The multiplicative interaction was evaluated by odds ratio (OR) and 95% confidence interval (CI) of product-term.</p> Results <p>A total of 5,830 participants from the NHANES database were divided into two groups: the HF group (n = 210) and the non-HF group (n = 5620). After gender stratification, hs-CRP (OR: 1.01, 95% CI: 1.00–1.03), SII (OR: 1.00, 95% CI: 1.00–1.01), NLR (OR: 1.22, 95% CI: 1.11–1.35) and LMR (OR: 0.79, 95% CI: 0.65–0.93) were independent meaningful factors for HF in males, there was no non-linear relationship between the three factors (SII, NLR, hs-CRP, all <i>P</i> for non-linear > 0.05) and the prevalence of HF, but we detected a non-linear relationship between LMR and the prevalence of HF in males (<i>P</i> for non-linear < 0.05). An additive interaction of hs-CRP and NLR on the risk of HF in males (RERI (OR): 0.67, 95% CI: 0.12–1.34; AP (OR): 0.14, 95% CI: 0.02–0.24; SI (OR): 1.22, 95% CI: 1.03–1.44).</p> Conclusions <p>In summary, hs-CRP, NLR, and LMR are superior meaningful markers for HF in males. SII may be a meaningful systemic inflammation warning marker for HF, which needs to be discriminated against with caution. Only detected a non-linear relationship between LMR and the prevalence of HF in males. NLR and hs-CRP may have an additive interaction in the prevalence of male HF patients. The outcome compensated for previous studies that still needed more studies for validation.</p>Health-seeking behaviour and beliefs around sore throat in The Gambia: A qualitative studyMaria Suau SansMuhammed MannehIsatou CeesayAmat BittayeGabrielle de CrombruggheAlexander J. KeeleyThushan I. de SilvaJennifer PalmerEdwin P. ArmitageMichael Markson behalf of the MRCG Strep A Study Group10.1371/journal.pgph.00022572024-03-25T14:00:00Z2024-03-25T14:00:00Z<p>by Maria Suau Sans, Muhammed Manneh, Isatou Ceesay, Amat Bittaye, Gabrielle de Crombrugghe, Alexander J. Keeley, Thushan I. de Silva, Jennifer Palmer, Edwin P. Armitage, Michael Marks, on behalf of the MRCG Strep A Study Group </p>
Group A <i>Streptococcus</i> (Strep A) bacteria causes a broad spectrum of diseases. The most common manifestations of Strep A infection are sore throat and pus-producing skin infections such as impetigo. Complications of Strep A infection can lead to inflammation in the bones, muscles, joints, and internal organs causing acute rheumatic fever and rheumatic heart disease (RHD). In The Gambia, the RHD burden is thought to be very high. However, epidemiological data is minimal, and Strep A control programmes do not exist. This study aimed to explore common beliefs and practices related to sore throats among primary caregivers of children, and healthcare providers in a community with a high Strep A disease burden. Four informal conversations with providers and fifteen semi-structured interviews with caregivers were conducted in the peri-urban area of Sukuta, The Gambia. Sampling was purposive and gradual, beginning from households identified to have recently experienced sore throat through a parallel cohort study. Themes explored in qualitative analysis included: sore throat causal attributions and diagnoses, care practises, health-seeking behaviour, and perceived barriers to using the biomedical sector. We found that sore throats were typically perceived to affect one child in a family, disproportionately or exclusively. Sore throats were rarely perceived as life-threatening, and awareness of links between sore throat and ARF or RHD was not reported among caregivers or providers in this study population. Most cases of sore throat were initially managed at home using traditional medicine which delayed resort to antibiotics, though in two instances of severe pain with the presence of exudate, fear that the child’s life was at risk prompted care-seeking through the formal health system. Our findings can inform the development of tailored strategies to increase community knowledge of the potential long-term consequences of sore throats and appropriate care-seeking, alongside improvements in the health system, to prevent Strep A sequelae effectively.Incidence of type 2 diabetes, cardiovascular disease and chronic kidney disease in patients with multiple sclerosis initiating disease-modifying therapies: Retrospective cohort study using a frequentist model averaging statistical frameworkAlan J. M. BrnabicSarah E. CurtisJoseph A. JohnstonAlbert LoAnthony J. ZagarIlya LipkovichZbigniew KadziolaMegan H. MurrayTimothy Ryan10.1371/journal.pone.03007082024-03-22T14:00:00Z2024-03-22T14:00:00Z<p>by Alan J. M. Brnabic, Sarah E. Curtis, Joseph A. Johnston, Albert Lo, Anthony J. Zagar, Ilya Lipkovich, Zbigniew Kadziola, Megan H. Murray, Timothy Ryan</p>
Researchers are increasingly using insights derived from large-scale, electronic healthcare data to inform drug development and provide human validation of novel treatment pathways and aid in drug repurposing/repositioning. The objective of this study was to determine whether treatment of patients with multiple sclerosis with dimethyl fumarate, an activator of the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway, results in a change in incidence of type 2 diabetes and its complications. This retrospective cohort study used administrative claims data to derive four cohorts of adults with multiple sclerosis initiating dimethyl fumarate, teriflunomide, glatiramer acetate or fingolimod between January 2013 and December 2018. A causal inference frequentist model averaging framework based on machine learning was used to compare the time to first occurrence of a composite endpoint of type 2 diabetes, cardiovascular disease or chronic kidney disease, as well as each individual outcome, across the four treatment cohorts. There was a statistically significantly lower risk of incidence for dimethyl fumarate versus teriflunomide for the composite endpoint (restricted hazard ratio [95% confidence interval] 0.70 [0.55, 0.90]) and type 2 diabetes (0.65 [0.49, 0.98]), myocardial infarction (0.59 [0.35, 0.97]) and chronic kidney disease (0.52 [0.28, 0.86]). No differences for other individual outcomes or for dimethyl fumarate versus the other two cohorts were observed. This study effectively demonstrated the use of an innovative statistical methodology to test a clinical hypothesis using real-world data to perform early target validation for drug discovery. Although there was a trend among patients treated with dimethyl fumarate towards a decreased incidence of type 2 diabetes, cardiovascular disease and chronic kidney disease relative to other disease-modifying therapies–which was statistically significant for the comparison with teriflunomide–this study did not definitively support the hypothesis that Nrf2 activation provided additional metabolic disease benefit in patients with multiple sclerosis.