Iokfai Cheang

Background:Glycemic abnormalities are highly prevalent in chronic heart failure (CHF) and exacerbate adverse cardiac remodeling. Epicardial fat volume (EFV) and the triglyceride-glucose (TyG) index may both reflect metabolic-cardiovascular interactions, but their combined prognostic utility in CHF patients with dysglycemia remains unexplored.Methods:We analyzed 516 CHF patients stratified by glycemic status: normal glucose (n = 230), prediabetes (n = 174), and diabetes (n = 112). Baseline characteristics, echocardiography (TTE), and cardiac magnetic resonance (CMR) data were assessed. The primary endpoint was defined as a composite of heart-failure hospitalization or all-cause mortality and was evaluated during a follow-up period of up to 3 years. Associations between EFV, TyG index, and primary endpoint were evaluated using stratified, joint, and incremental prognostic models.Results:Diabetic CHF patients were generally older, had higher smoking rates, worse renal function, and poorer nutritional status. CMR and TTE revealed more severe cardiac structural and functional impairments in dysglycemic groups, including reduced left ventricular ejection fraction (LVEF) and elevated EFV. EFV predicted primary endpoint with increasing accuracy across glycemic strata (AUC: 0.631–0.711 at 1–3 years), with the strongest predictive performance in diabetes. A significant correlation between TyG index and EFV was observed in diabetic patients (r = 0.24, p = 0.00021). Joint EFV (cutoff: 74.68 mL/m²) and TyG (median: 8.48) analysis showed that high TyG alone or combined high EFV/TyG conferred the highest the risk of primary endpoint (p for trend < 0.001), while isolated EFV elevation did not. Incorporating EFV into TyG-based models significantly improved prediction (AUC increased from 0.698 to 0.729 at 1 year). Net reclassification and integrated discrimination improvements confirmed the incremental prognostic value of EFV, particularly in diabetes and over longer follow-up.Conclusion:In CHF patients with glycemic dysregulation, EFV and TyG index synergistically enhance clinical endpoint prediction, with EFV providing significant incremental prognostic value beyond TyG. These metrics may improve risk stratification and personalized management in comorbid heart failure and dysglycemia.

Background: Heart failure with preserved ejection fraction (HFpEF) disproportionately affects elderly women, with potential contributions from sex‐specific hormonal and physiological factors. We aimed to evaluate sex‐specific prognostic differences, comorbidity impacts, and guideline‐directed medical therapy effects in elderly patients with HFpEF. Methods: Retrospective analysis of 603 patients (age ≥60 years, male: 51.6%, mean age: 79.10±9.19 years) newly diagnosed with HFpEF at Huadong Hospital, Fudan University (from July 2019 to June 2024) with follow‐up through December 2024. The primary outcome was all‐cause mortality. Results: The overall mortality rate was 14.2/100 person‐years (women: 15.4 versus men: 13.2). Based on the gender and etiology phenotype classification for HFpEF, patients with types I/IV HFpEF had better survival (10.0/12.4 per 100 person‐years) versus those with types II/III/V (17.1/22.9/24.2 per 100 person‐years). Sex‐specific mortality peaks differed, with men having type V in 30.3/100 person‐years and women having type III in 28.2/100 person‐years. In Cox regression analysis, after adjusting for age, sex, body mass index, and hypertension, type 2 diabetes and stages 4 or 5 chronic kidney disease predicted mortality in men only (chronic kidney disease 4 or 5: hazard ratio [HR], 3.24, type 2 diabetes: HR, 2.34; both adjusted P 0.1). After adjusting for age, body mass index, hypertension, type 2 diabetes, and renal dysfunction, angiotensin receptor neprilysin inhibitors reduced mortality in women (HR, 0.57; adjusted P =0.027), while sodium‐glucose cotransporter‐2 inhibitors reduced mortality in men (HR, 0.25; adjusted P =0.021). Conclusions: Mortality patterns, comorbidity impacts, and treatment responses in elderly patients with HFpEF exhibit significant sex disparities. This underscores the need for sex‐tailored management to optimize outcomes. These findings should be interpreted with caution given the retrospective design.

Purpose: Triple therapy of chronic obstructive pulmonary disease (COPD), consisting of inhaled corticosteroid (ICS), long-acting β 2-agonist (LABA) and long-acting muscarinic antagonist (LAMA) has shown benefits in patients with COPD. However, little is known about the use of triple therapy in Chinese patients. This study aims to describe the treatment patterns and the utilization of triple therapy in COPD patients based on real-world data from China. Patients and Methods: This retrospective study included patients with COPD from the Yinzhou database. Patients aged ≥ 40 years with a diagnosis of COPD were included. Different combinations of ICS, LAMA and LABA prescribed during follow-up were categorized as single, dual, or triple therapies. Descriptive analysis was performed to depict the treatment patterns of each therapy. Results: A total of 7888 patients were prescribed at least one COPD therapy during the follow-up. Among them, 29.1% were prescribed triple therapy (ICS+LABA+LAMA) with a median (IQR) treatment duration of 3.27 (7.17) months. The majority (68.6%) of patients were prescribed dual therapy with ICS+LABA, while 27.3% and 23.3% of patients were prescribed single therapy with ICS or LAMA, respectively. Regarding treatment sequences during follow-up, 30.1% of patients received dual therapy with ICS+LABA, followed by 11.4% receiving only triple therapy and 10.4% receiving single therapy with ICS alone. Conclusion: Our study assessed treatment patterns and triple therapy utilization among patients with COPD in China. The majority of patients were treated with ICS+LABA dual therapy. Triple therapy was also widely used, with most patients transitioning from other treatment modalities.

Background: Anthracycline‐based chemotherapy is a vital treatment for various cancers but carries notable risks of cardiotoxicity. This study aimed to assess how different body mass index values and glycemic status influence the risk of major adverse cardiovascular events (MACE) in chemotherapy‐naïve adult patients with cancer treated with anthracyclines. Methods: This retrospective cohort included 11 393 chemotherapy‐naïve patients who initiated anthracycline‐based chemotherapy between 2000 and 2019. Follow‐up began from the first anthracycline dose. Body mass index was categorized as underweight/normal weight (2 ), overweight (25–29.9 kg/m ² ), and obese (≥30 kg/m ² ). Glycemic status was classified as normoglycemic or diabetes/prediabetes (diabetes: hemoglobin A1c ≥6.5% or fasting glucose ≥126 mg/dL; prediabetes: hemoglobin A1c 5.7%–6.4% or fasting glucose 100–125 mg/dL). Results: Over a median follow‐up of 8.7 years, 985 (8.64%) patients experienced MACE. Obesity was significantly associated with an increased risk of MACE (hazard ratio [HR], 1.38 [95% CI, 1.10–1.73], reference: underweight/normal weight) and heart failure hospitalization, and diabetes/prediabetes also significantly predicted MACE (HR, 1.28 [95% CI, 1.10–1.50], reference: normoglycemic). Notably, overweight (HR, 0.85 [95% CI, 0.80–0.91]) and obesity (HR, 0.85 [95% CI, 0.74–0.96]) were associated with lower risk of all‐cause mortality. Joint analysis revealed that patients with both obesity and diabetes/prediabetes had the highest risk of MACE (HR, 1.74 [95% CI, 1.28–2.37]) and heart failure hospitalization (HR, 1.99 [95% CI, 1.41–2.81]). Conclusions: In patients with cancer undergoing anthracycline‐based chemotherapy, both body mass index and glycemic status significantly affect cardiovascular risks, with the highest risk observed in those with concurrent obesity and diabetes/prediabetes, emphasizing the need for tailored risk assessment and management.

Aims: This study aimed to investigate the clinical value of the glucose‐albumin ratio (GAR) in predicting the prognosis of cancer patients prescribed anthracycline‐based chemotherapy.Methods: We included cancer patients who underwent anthracycline‐based chemotherapy, drawn from the population‐based cohort Clinical Data Analysis Reporting System of Hong Kong between January 2000 and December 2019. Demographics, medical history, baseline laboratory, and metabolic indicators, including GAR, were collected. We employed random survival forests (RSF) with the variable importance (VIMP) method to rank the importance of these variables. Cox proportional hazards regression was used to assess the association between GAR levels and event risks.Results: A total of 18,700 patients were included in the analysis. The top 2 factors for predicting overall cardiovascular event risk were GAR and fasting blood glucose (FBG). Our results revealed that a higher GAR was significantly associated with poorer cardiovascular prognosis in patients with cancer prescribed with anthracycline‐based chemotherapy. Compared to the lowest quartile, higher GAR levels were significantly associated with increased risk of all‐cause mortality, major adverse cardiovascular events, hospitalization of heart failure, and cardiovascular mortality regardless of the adjustments (all p trend < 0.001).Conclusion: GAR is a potential biomarker for predicting the prognosis of cancer patients undergoing anthracycline‐based chemotherapy. Monitoring GAR levels before and during treatment may help identify patients at higher risk of adverse outcomes, facilitating personalized treatment strategies and improving clinical management.

Background: The effect of glycated hemoglobin (HbA _1c ) variability on adverse outcomes in patients with heart failure (HF) is unclear. We aim to investigate the predictive value of HbA _1c variability on the risks of all‐cause death and HF rehospitalization in patients with HF irrespective of their diabetic status. Methods and Results: Using a previously validated territory‐wide clinical data registry, HbA _1c variability was assessed by average successive variability (ASV) or SD of all HbA _1c measurements after HF diagnosis. Multivariable Cox proportional hazards models were used to estimate the adjusted hazard ratio (HR) and its corresponding 95% CI. A total of 65 950 patients with HF were included in the study. Over a median follow‐up of 6.7 (interquartile range, 4.0–10.6) years, 34 508 patients died and 52 446 required HF rehospitalization. Every unit increment of variability in HbA _1c was significantly associated with higher HF rehospitalization (HR ASV, 1.20 [95% CI, 1.18–1.23]) and all‐cause death (HR ASV, 1.50 [95% CI, 1.47–1.53]). Diabetes significantly modified the association between HbA _1c variability and outcomes ( P _interaction 1c variability in patients with HF without diabetes conferred a higher risk of rehospitalization (HR ASV, 1.92 [95% CI, 1.70–2.17] versus HR ASV, 1.19 [95% CI, 1.17–1.21]), and all‐cause death (HR ASV, 3.90 [95% CI, 3.31–4.61] versus HR ASV, 1.47 [95% CI, 1.43–1.50] compared with patients with diabetes). Conclusions: HbA _1c variability is significantly associated with greater risk of rehospitalization and all‐cause death in patients with HF, irrespective of their diabetic status. These observations were more pronounced in patients with HF without diabetes.

Background: Systemic oxidative stress is involved in the development of hypertension, whereas carotenoids are a group of natural antioxidants. Our study aims to evaluate the relationships between the serum concentrations of major carotenoids and mortality in hypertensive adults. Methods and Results: Data on 5 serum carotenoids from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 2001–2006 were included. Outcome measures (all‐cause and cardiovascular mortality) were identified from the National Death Index through December 31, 2019. Multiple Cox proportional hazards regression and restricted cubic spline analyses were performed to determine the association between carotenoid levels and outcomes. A total of 8390 hypertensive adults were included in the analysis. At a median follow‐up duration of 16.6 years, all‐cause and cardiovascular mortality occurred in 4005 (47.74%) and 1205 (14.36%) participants, respectively. Compared with the lowest quartiles, the highest quartiles of 5 major serum carotenoids were associated with lower risk of all‐cause mortality, with multivariable‐adjusted hazard ratios (HRs) of 0.63 (95% CI, 0.56–0.71) for α‐carotene, 0.70 (95% CI, 0.61–0.80); for β‐carotene, 0.67 (95% CI, 0.58–0.76); for β‐cryptoxanthin, 0.74 (95% CI, 0.64–0.86) for lycopene; and 0.72 (95% CI, 0.63–0.83) for lutein/zeaxanthin. For cause‐specific mortality, this association with the fourth quartile of serum carotenoids was evident for a reduced rate of cardiovascular mortality, with a 32% reduction for α‐carotene (HR, 0.68 [95% CI, 0.55–0.86]), a 29% reduction for β‐cryptoxanthin (HR, 0.71 [95% CI, 0.56–0.89]), and a 26% reduction for lycopene (HR, 0.74 [95% CI, 0.59–0.94]), but not for β‐carotene and lutein/zeaxanthin. In addition, we found that serum α‐carotene, β‐carotene, β‐cryptoxanthin, and lutein/zeaxanthin levels were nonlinearly related to all‐cause mortality with inflection points of 2.43, 8.49, 5.12, and 14.17 μg/dL, respectively. Serum α‐carotene, β‐cryptoxanthin, and lutein/zeaxanthin concentrations showed nonlinear associations with cardiovascular mortality with inflection points of 2.31, 5.26, and 15.40 μg/dL, respectively. Conclusions: Findings suggest that higher serum carotenoid concentrations were associated with lower risks of all‐cause and cardiovascular mortality in hypertensive adults.