Xue-Feng Shan

Adolescence is a critical stage in the development of cardiovascular disease. The American Heart Association has introduced a state-of-the-art algorithm called “Life Essential 8” (LE8) designed to quantify cardiovascular health (CVH). Research on the association of trace metal elements with cardiovascular disease in adolescents is inconsistent. This study aims to examine the association between trace metal elements and ideal CVH in adolescents. This cross-sectional study included 5724 adolescents who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. CVH was assessed using Life’s Essential 8 (LE8) developed by the American Heart Association (AHA). Exposure factors were trace metal elements (iron, iodine, cadmium, lead, mercury, selenium, and manganese). More than half of the adolescents had non-ideal CVH and only 40.8% achieved ideal CVH scores. Of the CVH measures, high blood glucose (96.1%), body mass index (81.3%), blood pressure (77.4%), and physical activity (65.0%) had high proportions of “ideal” values. However, diet, lipids and nicotine intake had lower rates of achieving the ideal CVH criteria (26.9%, 42.6% and 47.6%, respectively). The results of regression logistic showed that iron and mercury were negatively associated with the occurrence of non-ideal CVH (adjusted ORs of 0.997 [95% CI 0.995,0.999] and 0.913 [95% CI 0.840,0.991], and that urinary iodine, blood cadmium, lead, and selenium were positively associated with the occurrence of non-ideal CVH (adjusted ORs of 1.432 [95% CI 1.054,1.945], 3.845 [95% CI 2.278,6.491], and 1.010 [95% CI 1.003,1.017], respectively). No correlation between manganese and CVH was observed. There is an urgent need to intervene in the CVH of children and adolescents. It is important to emphasize the need to maintain adequate iron intake while reducing iodine, cadmium, lead, and selenium intake.

The rising prevalence of hypertension underscores the urgent need for effective management strategies. While niacin-based medications and supplements have shown promise in improving outcomes among patients with hypertension, the impact of dietary niacin intake on prognosis remains an area requiring further investigation. Using data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2016, this study examined the association between dietary niacin intake and mortality risk among 13,237 individuals with hypertension. During a median follow-up of 103 months, 3,151 participants (23.80%) died from all causes, and 864 (7.89%) died from cardiovascular diseases. In multivariable-adjusted Cox proportional hazards models, dietary niacin intake was independently associated with a lower risk of both all-cause mortality (HR = 0.993, 95% CI: 0.986–1.000, p = 0.036) and cardiovascular mortality (HR = 0.984, 95% CI: 0.971–0.997, p = 0.017). Niacin intake was categorized into quartiles: Q1 (< 15.5 mg/day), Q2 (15.5–21.1 mg/day), Q3 (21.1–28.2 mg/day), and Q4 (> 28.2 mg/day). Cox regression analysis indicated that participants in the Q3 group had a significantly lower risk of all-cause mortality compared to those in Q1 (HR = 0.788, 95% CI: 0.657–0.944, p = 0.010). Moreover, restricted cubic spline (RCS) analysis revealed a U-shaped association between dietary niacin intake and all-cause mortality (P for nonlinearity = 0.016). These findings highlight the potential benefits of dietary niacin in reducing mortality risk among hypertensive individuals and suggest that moderate increases in dietary niacin intake may represent a feasible strategy for reducing mortality risk in this population.

Backgrounds: Hypertension stands as the predominant global cause of mortality. A notable deficiency exists in terms of predictive models for mortality among individuals with hypertension. We aim to devise an effective nomogram model that possesses the capability to forecast all-cause mortality within hypertensive populations.Methods: The data for this study were drawn from nine successive cycles of the National Health and Nutrition Examination Survey (NHANES) spanning the years from 1999 to 2016. The dataset was partitioned into training and validation sets at a 7:3 ratio. We opted for clinical practice-relevant indicators, applied the least absolute shrinkage and selection operator (LASSO) regression to identify the most pertinent variables, and subsequently built a nomogram model. We also employed concordance index, receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) to assess the model’s validity.Results: A total of 17,125 hypertensive participants were included in this study with a division into a training set (11,993 individuals) and a validation set (5,132 individuals). LASSO regression was applied for the training set to obtain nine variables including age, monocytes, neutrophils, serum albumin, serum potassium, cardiovascular disease, diabetes, serum creatinine and glycated hemoglobin (HbA1C), and constructed a nomogram prediction model. To validate this model, data from the training and validation sets were used for validation separately. The concordance index of the nomogram model was 0.800 (95% CI, 0.792–0.808, p < 0.001) based on the training set and 0.793 (95% CI, 0.781–0.805, p < 0.001) based on the validation set. The ROC curves, calibration curves, and DCA curves all showed good predictive performance.Conclusion: We have developed a nomogram that effectively forecasts the risk of all-cause mortality among American adults in hypertensive populations. Clinicians may use this nomogram to assess patient’s prognosis and choose a proper intervention in a timely manner.

Ischemic heart disease (IHD) has a high mortality in the population. Although serum creatinine (Cr) and serum total bilirubin (TBil) are rapid and readily available biomarkers in routine blood tests, there is a lack of literature on the prognostic value of combined Cr and TBil tests for IHD. This study aimed to evaluate a combined equation based on Cr and TBil to predict the long-term risk of death in IHD and to find indicators sensitive to the prognosis of IHD patients. In this study, 2625 patients with IHD were included, and the combined value and combined equations of Cr and TBil were obtained by logistic regression analysis based on Cr and TBil collected at the time of admission. Patients were divided into four groups according to the quartiles of the combined value. COX proportional hazard regression model was used to analyze the risk factors for long-term death in IHD patients. Receiver operating characteristic (ROC) curves were used to evaluate the prognostic effect of Cr, TBil and combined value on long-term death events. Logistic regression analysis was performed for long-term death events with Cr and TBil as independent variables, and the logit regression model was Logit(P) = 0.0129×TBil+0.007×Cr-0.417. Multifactorial Cox regression analysis showed that high values of the equation were independent risk factors for long-term death events (all-cause death: HR 1.457, 95% CI 1.256–1.689, P<0.001; cardiovascular death: HR 1.452, 95% CI 1.244–1.695, P<0.001). Combined Cr and TBil value are more valuable in predicting long-term death (AUC: 0.609, 95% CI 0.587–0.630, P<0.001). Combined Cr and TBil assay is superior to single biomarkers for predicting long-term death in patients with IHD. High values of the equation are independent predictors of long-term death and can be used to identify patients at high risk for IHD.