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Background: An association between increased aortic root dimensions (ARD) and elevated risk of cardiovascular mortality has been reported in the general population. However, evidence regarding the association between ARD and mortality in patients with acute heart failure (AHF) is limited. Methods: In a nationwide prospective cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study, ARD was measured during diastole using echocardiography and indexed to body mass index (BMI). Cox proportional hazard models were used to validate the association between BMI-indexed ARD and mortality. Additionally, the relationship between BMI-indexed ARD and mortality was presented using restricted cubic spline in all populations, and both sexes. Results: A total of 2125 participants with ARD were included in the final analysis, among of 38.4 % were women, with a median age of 67 years. Over a median follow-up period of 54.4 (interquartile range: 30.1 to 59.7) months, 895 deaths occurred, with 750 attributed to cardiovascular causes and 145 to non-cardiovascular causes. Compared to the highest tertile group of BMI-indexed ARD, the lowest tertile group had a lower risk of cardiovascular mortality (hazard ratio [HR], 0.71; 95 % confidence interval [CI], 0.58 to 0.87; P

Background Poor cardiovascular‐kidney‐metabolic (CKM) health is associated with premature mortality and excess morbidity in the United States. Adverse social conditions have a prominent impact on cardiometabolic diseases during the life course. We aim to examine the association between social risk profile (SRP) and CKM multimorbidity among US adults. Methods and Results We used data from the National Health and Nutrition Examination Survey from 1999 to 2018. The definition of CKM syndrome is the coexistence of subclinical or clinical cardiovascular disease, chronic kidney disease, and metabolic disorders. We classified participants by 4 CKM stages according to the different clinical severity of different forms of CKM syndrome. We calculated the summed number of positive SRP measures, including employed, high‐income level, food secure, high education attainment, private insurance, owning a house, and married, as SRP scores and classified them into 4 levels by quartiles: low (0–2), lower‐middle (3–4), upper‐middle (5–6), and high (7–8). A total of 18 373 US adults, aged 20 to 79 years, were included in our analyses. There were 2567 (9.4%) participants with low SRP score level. Most individual SRP measures and a combined SRP score were associated with CKM stages. Compared with high SRP score level, low SRP level was associated with higher odds of having CKM stage 1 (odds ratio [OR], 1.34 [95% CI, 1.06–1.70]), CKM stage 2 (OR, 2.03 [95% CI, 1.59–2.58]), CKM stage 3 (OR, 5.28 [95% CI, 3.29–8.47]), and CKM stage 4 (OR, 5.97 [95% CI, 4.20–8.49]). Conclusions Cumulative social disadvantage, denoted by higher SRP burden, was associated with higher odds of CKM multimorbidity, independent of demographic and lifestyle factors.

Background: Patients with acute heart failure (HF) are at high risk of 30-day readmission. Little is known about the characteristics and associated factors of 30-day readmissions among patients with acute HF in China. Methods: We enrolled consecutive patients hospitalized for acute HF and discharged from 52 hospitals in China from August 2016 to May 2018. We describe the rate of 30-day readmission, the time interval from discharge to readmission, and the causes of readmission. We also analyzed the factors associated with readmission risk by fitting multivariate Cox proportional hazards models. Results: We included 4875 patients with a median age of 67 years (interquartile range, 57–75), 3045 (62.5%) of whom were male. Within 30 days after discharge, 613 (12.6%) patients were readmitted for all causes, with a median from discharge to readmission of 12 (6–21) days. Most readmissions were attributed to cardiovascular causes (71.1%) and 60.0% to HF-related causes. Readmission occurred within 14 days of discharge in more than half of the patients (56.4%). Diabetes (hazard ratio [HR]: 1.25, 95% confidence interval [95% CI]: 1.06–1.50), anemia (HR: 1.26, 95% CI: 1.03–1.53), high New York Heart Association classification (HR: 1.48, 95% CI: 1.08–2.01), elevated N-terminal pro-B type natriuretic peptide (HR: 1.67, 95% CI: 1.24–2.25), and high-sensitivity cardiac troponin T (HR: 1.26, 95% CI: 1.01–1.58) were associated with increased risks of readmission. High systolic blood pressure (HR: 0.56, 95% CI: 0.38–0.81) and Kansas City Cardiomyopathy Questionnaire-12 scores (HR: 0.64, 95% CI: 0.44–0.94) were associated with decreased risk of readmission. Conclusions: In China, almost one in eight patients with acute HF were readmitted within 30 days after discharge, mainly due to cardiovascular reasons, and approximately three-fifths of the readmissions occurred in the first 14 days. Both clinical and patient-centered characteristics were associated with readmission.

Objective:. This systematic review and meta-analysis aimed to evaluate the efficacy of berberine treatment in improving blood glucose, blood lipids, and blood pressure as well as the associated safety profile. Methods:. PubMed, Embase, Cochrane Library, WanFang Data, and the China National Knowledge Infrastructure database were searched from the establishment of the database to December 31, 2021, to identify randomized, double-blind trials that examined the effect of berberine alone or as add-on treatment on blood glucose, blood lipids, and blood pressure with an intervention period of at least 3 months. Two researchers independently screened articles, extracted data, and assessed the quality of each study according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The efficacy outcomes included fasting blood glucose (FPG), 2-hour post-prandial glucose (2hPG), glycated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SBP), and diastolic blood pressure (DBP). The safety outcome was the incidence of the total number of adverse events. Results:. A total of 17 articles enrolling 1,485 participants were included in the meta-analysis. The intervention duration ranged from 12 to 24 weeks. Sixteen trials reported results for blood glucose, 14 trials reported results for blood lipids, and 7 reported results for blood pressure. Compared with placebo or baseline treatment, berberine alone or as add-on therapy significantly reduced FPG (by 0.35 mmol/L; 95% confidence interval (CI): 0.13–0.58 mmol/L; P = 0.002; I2 = 89.0%, n = 16), 2hPG (by 1.50 mmol/L; 95% CI: 0.50–2.49 mmol/L, P = 0.003, I2 = 84.1%, n = 4), HbA1c (by 0.45%, 95% CI: 0.24%–0.65%, P < 0.001, I2 = 82.8%, n = 9), TC (by 0.48 mmol/L; 95% CI: 0.36–0.60 mmol/L, P < 0.001, I2 = 72.3%, n = 13), TG (by 0.22 mmol/L; 95% CI: 0.13–0.31 mmol/L, P < 0.001, I2 = 57.1%, n = 14), and LDL-C (by 0.41 mmol/L; 95% CI: 0.34–0.48 mmol/L, P < 0.001, I2 = 35.0%, n = 12). The effect on blood glucose and blood lipids remained consistent when confined to high-quality trials. There is no significant effect of berberine treatment on HDL-C, SBP, and DBP. The incidence of the total number of adverse events was similar between the berberine group and the control group (risk ratio (RR) = 1.00, 95% CI: 0.84–1.19, P = 0.961). Gastrointestinal disorder was the most common adverse event in the berberine group and most adverse events were alleviated or disappeared as the dose was decreased or the intervention time was prolonged. Conclusions:. Short-term berberine treatment significantly improved blood glucose and blood lipid profiles without raising safety concerns. A rigorously designed randomized controlled trial could be considered to examine the feasibility of the long-term application of berberine treatment in the prevention of cardiovascular disease.

Abstract Aims This study aimed to evaluate the cumulative high‐sensitivity cardiac troponin T (hs‐cTNT) from admission to 12 months after discharge and its association with mortality after 12 months among patients with acute heart failure (HF). Methods We used data from the China Patient‐Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (China PEACE 5p‐HF Study), which enrolled patients hospitalized primarily for HF from 52 hospitals between 2016 and 2018. We included patients who survived within 12 months and had hs‐cTNT data at admission (within 48 h of admission) and 1 and 12 months after discharge. To evaluate the long‐term cumulative hs‐cTNT, we calculated cumulative hs‐cTNT levels and cumulative times of high hs‐cTNT level. Patients were divided into groups according to the quartiles of cumulative hs‐cTNT levels (Quartiles 1–4) and cumulative times of high hs‐cTNT levels (0–3 times). Multivariable Cox models were constructed to examine the association of cumulative hs‐cTNT with mortality during the follow‐up period. Results We included 1137 patients with a median age of 64 [interquartile range (IQR), 54–73] years; 406 (35.7%) were female. The median cumulative hs‐cTNT level was 150 (IQR, 91–241) ng/L*month. Based on the cumulative times of high hs‐cTNT levels, 404 (35.5%) patients were with zero time, 203 (17.9%) with one time, 174 (15.3%) with two times, and 356 (31.3%) with three times. During a median follow‐up of 4.76 (IQR, 4.25–5.07) years, 303 (26.6%) all‐cause deaths occurred. The increasing cumulative hs‐cTNT level and cumulative times of high hs‐cTNT level were independently associated with excess all‐cause mortality. Compared with Quartile 1 group, Quartile 4 had the highest hazard ratio (HR) of all‐cause mortality [4.14; 95% confidence interval (CI): 2.51–6.85], followed by Quartile 3 (HR: 3.35; 95% CI: 2.05–5.48) and Quartile 2 (HR: 2.47; 95% CI: 1.49–4.08) groups. Similarly, taking the patients with zero time of high hs‐cTNT level as the reference, the HRs were 1.60 (95% CI: 1.05–2.45), 2.61 (95% CI: 1.76–3.87), and 2.86 (95% CI: 1.98–4.14) in patients who had one, two, and three times of high hs‐cTNT level, respectively. Conclusions Elevated cumulative hs‐cTNT from admission to 12 months after discharge was independently associated with mortality after 12 months among patients with acute HF. Repeated measurements of hs‐cTNT after discharge may help monitor the cardiac damage and identify patients with high risk of death.

Background Improving health status is one of the major goals in the management of heart failure (HF). However, little is known about the long‐term individual trajectories of health status in patients with acute HF after discharge. Methods and Results We enrolled 2328 patients hospitalized for HF from 51 hospitals prospectively and measured their health status via the Kansas City Cardiomyopathy Questionnaire–12 at admission and 1, 6, and 12 months after discharge, respectively. The median age of the patients included was 66 years, and 63.3% were men. Six patterns of Kansas City Cardiomyopathy Questionnaire–12 trajectories were identified by a latent class trajectory model: persistently good (34.0%), rapidly improving (35.5%), slowly improving (10.4%), moderately regressing (7.4%), severely regressing (7.5%), and persistently poor (5.3%). Advanced age, decompensated chronic HF, HF with mildly reduced ejection fraction, HF with preserved ejection fraction, depression symptoms, cognitive impairment, and each additional HF rehospitalization within 1 year of discharge were associated with unfavorable health status (moderately regressing, severely regressing, and persistently poor) (P