Clinical Cardiology最新文献

{"title":"Comments on “Association Between F-SIRI and Adverse Prognosis in Patients With Chronic Heart Failure”","authors":"Çağrı Zorlu","doi":"10.1002/clc.70181","DOIUrl":"https://doi.org/10.1002/clc.70181","url":null,"abstract":"<p>We read with interest the article by Liu et al. published in Clinical Cardiology (2025; DOI: 10.1002/clc.70166), which explores the prognostic value of the fibrinogen and systemic inflammation response index (F-SIRI) in patients with chronic heart failure (CHF) [<span>1</span>] The study provides valuable insights into the role of inflammation and coagulation in CHF risk stratification. However, we would like to raise several points for clarification and discussion to enhance the interpretation of the findings.</p><p>The authors determined F-SIRI cut-off values (SIRI ≥ 1.22, fibrinogen ≥ 2.55 g/L) using a Receiver Operating Characteristic (ROC) curve with 100 random splits and threefold cross-validation. While this approach is robust, the rationale for selecting these specific cut-offs and their generalizability across diverse CHF populations is unclear. Could the authors provide further details on how these thresholds were validated externally or compared to existing literature? For instance, studies like Xia et al. used different SIRI cut-offs for cardiovascular outcomes, which may affect the reproducibility of F-SIRI [<span>2</span>]. Additionally, the single measurement of F-SIRI at admission may not capture dynamic inflammatory changes, as acknowledged in the limitations. Have the authors considered serial measurements to assess the stability of F-SIRI's prognostic value?</p><p>The study reports a significant association between higher F-SIRI levels and all-cause mortality (adjusted HR 2.37, 95% CI 1.46–3.83, <i>p</i> < 0.001) but no significant association with major adverse cardiac and cerebral events (MACCEs) or cardiovascular death after multivariate adjustments. This discrepancy is puzzling, as inflammation and coagulation are established contributors to cardiovascular events in CHF [<span>3, 4</span>]. For example, the CANTOS trial demonstrated that targeting inflammation reduces cardiovascular events in patients with elevated inflammatory markers [<span>5</span>]. Could the authors elaborate on potential reasons why F-SIRI predicts all-cause mortality but not cardiovascular-specific outcomes? Specifically, were non-cardiovascular causes of death (e.g., infections and malignancies) analyzed separately to explain this finding?</p><p>The multivariate Cox models adjusted for numerous confounders, including demographics, comorbidities, and medications. However, the study does not account for the severity of heart failure, such as New York Heart Association (NYHA) functional class or specific etiologies (e.g., ischemic vs. non-ischemic CHF). These factors significantly influence prognosis and inflammatory markers [<span>6</span>]. Could the authors clarify whether NYHA class or heart failure etiology was considered in the analysis? Additionally, the lack of significant differences in left ventricular ejection fraction (LVEF) across F-SIRI groups (<i>p</i> = 0.3596) is surprising, given the known association between inflammation and re","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response by Deng et al. Regarding Article, “C-Reactive Protein–Albumin–Lymphocyte (CALLY) Index as an Independent Risk Factor for Postoperative Atrial Fibrillation Recurrence”","authors":"Ye Deng,&nbsp;Yuan Ji,&nbsp;Ling Sun","doi":"10.1002/clc.70184","DOIUrl":"https://doi.org/10.1002/clc.70184","url":null,"abstract":"<p>We thank the authors for their thoughtful comments on our article “C-Reactive Protein–Albumin–Lymphocyte (CALLY) Index as an Independent Risk Factor for Postoperative Atrial Fibrillation Recurrence” [<span>1</span>] and appreciate the opportunity to address their considerations.</p><p>First, Repeat ablations were performed in a subset of patients with recurrent AF, during which the status of pulmonary vein isolation was assessed. Regrettably, the sample size of these cases was insufficient to warrant a formal subgroup analysis. However, we hypothesize that a higher CALLY index may indicate inherently poorer atrial substrate properties—specifically, that an activated inflammatory state could facilitate myocardial fibrosis and the formation of reentrant circuits, thereby predisposing to AF recurrence. This hypothesis, of course, necessitates validation through further clinical and preclinical investigations.</p><p>Second, we concur that the CALLY index, which incorporates albumin levels, may reflect an activated inflammatory state that encompasses hepatic processes. Accumulating evidence suggests potential crosstalk between the liver and heart in the context of cardiovascular disease: for instance, cardiovascular conditions have been shown to exacerbate liver fibrosis in patients with fatty liver disease, with Ly6Chi monocytes playing a pivotal role [<span>2</span>]. It is reasonable to hypothesize that such liver-heart interactions may contribute to AF recurrence, potentially mediated by the inflammatory pathways captured by the CALLY index. As you suggested, advanced imaging modalities (e.g., cardiac magnetic resonance imaging) would undoubtedly help elucidate the intricate relationships between the CALLY index, myocardial inflammation, and AF recurrence. This constitutes a pivotal direction for our subsequent research endeavors.</p><p>Third, our baseline data revealed no significant association between alcohol consumption and AF recurrence. This is also consistent with previous study [<span>3</span>]. We acknowledge that larger-scale and multicenter studies are warranted to more thoroughly explore the potential role of alcohol and other lifestyle factors in AF recurrence.</p><p>Finally, we thank the authors for their insightful comments, which have improved our work's clarity and interpretative depth, thereby enhancing its clinical value in guiding AF treatment.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tolerability and Adverse Effects in a Specialized Heart Failure Guideline-Directed Medical Therapy Optimization Program","authors":"Claudia Mae Velasco,&nbsp;Gladys Baksh,&nbsp;Michele Haydo,&nbsp;Heather Reesor,&nbsp;John Boehmer,&nbsp;Omaima Ali","doi":"10.1002/clc.70179","DOIUrl":"https://doi.org/10.1002/clc.70179","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Utilization of heart failure (HF) guideline-directed medical therapy (GDMT) to target doses is suboptimal, with studies citing adverse effects (AEs), physiological factors, and therapeutic inertia as potential contributing factors. The objective of our study was to explore tolerability and GDMT titration-limiting AEs in a specialized heart failure optimization program implemented at our institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We studied the baseline characteristics of 254 patients who successfully completed our program and analyzed the frequency and severity of the four most common GDMT-related AEs: hypotension, bradycardia, hyperkalemia, and renal dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients who achieved target doses were younger, more likely to have nonischemic HF, less likely to have a recent HF-related hospitalization, had less coronary artery disease, and were more likely to be obese. Multivariate analyses revealed significant associations between beta blocker suboptimal dosing (&lt; 50% of target dose) and older age (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.0–1.07; <i>p</i> = 0.031), presence of atrial fibrillation (OR: 2.57; 95% CI: 1.18–5.58; <i>p</i> = 0.017), and absence of hypertension (OR: 0.39; 95% CI: 0.17–0.89; <i>p</i> = 0.025). For angiotensin converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor neprilysin inhibitors, suboptimal dosing was associated with the presence of atrial fibrillation (OR: 2.08; 95% CI: 1.04–4.17; <i>p</i> = 0.039). Of the patients who completed the program, 59.1% encountered at least one AE that hindered the titration to target GDMT doses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings highlight the complexities of GDMT optimization within a specialized program and the need for standardized definitions of GDMT-related AEs and management strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Atrial Fibrillation-Related Mortality Among Older Adults With Obstructive Sleep Apnea in the United States, 1999–2020","authors":"Ibrahim Nagmeldin Hassan,&nbsp;Mohamed Ibrahim,&nbsp;Siddig Yaqub,&nbsp;Muhsin Ibrahim,&nbsp;Haythem Abdalla,&nbsp;Ghada Aljaili,&nbsp;Wafa Osman,&nbsp;Nagmeldin Abuassa,&nbsp;Hamza Ashraf,&nbsp;Maryam Shoukat","doi":"10.1002/clc.70178","DOIUrl":"https://doi.org/10.1002/clc.70178","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) and obstructive sleep apnea (OSA) frequently coexist and synergistically increase cardiovascular risk. While their pathophysiologic interplay is well established, national data on mortality trends involving both conditions are scarce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed mortality data from the CDC WONDER platform (1999–2020), including adults aged ≥ 25 years with AF (ICD-10 I48.x) listed as the underlying cause of death and OSA (G47.33) as a contributing condition. Age-adjusted mortality rates (AAMRs) and average annual percent changes (AAPCs) were calculated using Joinpoint regression, stratified by sex, race/ethnicity, urbanization, region, and age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 32,142 AF-related deaths with OSA were identified. The overall AAMR was 0.60 per 100 000, increasing significantly over time (AAPC: 16.69%, 95% CI: 15.62–17.77). Mortality rose across all demographic groups, with the steepest increases among adults ≥ 85 years (AAPC: 19.40%), females (AAPC: 17.77%), rural residents (AAPC: 17.51%), and White individuals (AAPC: 16.95%). Regionally, the Midwest (AAMR: 0.79) and West (0.72) had the highest rates. State-level variation ranged from 1.90 (Oregon) to 0.19 (Mississippi). Despite lower absolute AAMRs among Hispanic and Asian populations, significant upward trends were observed. OSA appears frequently underdiagnosed or untreated in high-risk groups, potentially exacerbating AF mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AF-related mortality involving OSA has risen sharply over the past two decades, outpacing many other cardiovascular trends. These findings underscore the urgent need for integrated AF-OSA screening and treatment pathways, with attention to underserved and disproportionately affected populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70178","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Sudden Cardiac Death Related Mortality in Adults in the United States: A CDC WONDER Database Analysis, 1999–2020","authors":"Riya Bhagwan,&nbsp;Rayyan Nabi,&nbsp;Shree Rath,&nbsp;Sohaib Aftab Ahmad Chaudhry,&nbsp;Shehdev Meghwar,&nbsp;Diya Rathi,&nbsp;Sandhiya Prem Kumar,&nbsp;Neha Bhagwan Das,&nbsp;Peter Collins,&nbsp;Hasan Ahmad,&nbsp;Raheel Ahmed","doi":"10.1002/clc.70180","DOIUrl":"https://doi.org/10.1002/clc.70180","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sudden cardiac death (SCD) is a leading cause of mortality in the United States, with significant variations across demographic and geographic factors. This study analyzes trends in SCD-related mortality among adults (&gt; 25 years) from 1999 to 2020 using the CDC WONDER database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We extracted data on SCD-related deaths (ICD-10 code I46.1) and calculated age-adjusted mortality rates (AAMR) per 100 000 population, stratified by sex, race/ethnicity, urbanization, and census region. Joinpoint regression was performed to estimate the annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 279 599 SCD-related deaths were recorded from 1999 to 2020. Overall AAMR declined significantly (AAPC: −1.20%; 95% CI: −1.58% to −0.82%) until 2018, followed by a sharp increase from 2018 to 2020 (APC: +6.93%; 95% CI: +3.04% to +10.96%). Declines were most pronounced in American Indian/Alaska Native populations (−3.67%), while the highest increases post-2018 were observed in Hispanic (+13.1%) and Asian/Pacific Islander groups (+12.3%). Urban areas experienced greater post-2018 increases compared to rural areas. Regional disparities were evident, with the West showing the steepest rise in mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While SCD mortality declined from 1999 to 2018, a concerning reversal has emerged since 2018, particularly in specific racial/ethnic groups and urban areas. Further research is needed to investigate underlying causes, including the potential impact of COVID-19, healthcare disparities, and lifestyle factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Demonstrate the Association Between the Inflammation and Atrial Fibrillation Recurrence","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/clc.70177","DOIUrl":"https://doi.org/10.1002/clc.70177","url":null,"abstract":"<p>Previous studies have reported an association between atrial fibrillation (AF) and systemic inflammation. In the present study, the authors investigated the prognostic value of the CALLY index—a composite marker reflecting both systemic inflammation and nutritional status—in predicting AF recurrence following catheter ablation [<span>1</span>]. They demonstrated that the CALLY index was an independent predictor of post-ablation AF recurrence. While this is an intriguing finding, several concerns merit consideration.</p><p>The authors' hypothesis is based on the assumption that systemic inflammation, as represented by the CALLY index, contributes to the development of AF [<span>1</span>]. However, the mechanisms underlying AF recurrence may differ from those responsible for the initial onset of AF. In particular, pulmonary vein reconnection is widely recognized as a primary cause of AF recurrence after ablation [<span>2</span>]. Did the authors assess the presence of pulmonary vein reconnection in patients with recurrent AF? It is possible that the CALLY index is more closely associated with non-pulmonary vein foci of AF recurrence [<span>3</span>].</p><p>As the CALLY index includes albumin and C-reactive protein levels, it may reflect hepatic function rather than cardiac-specific inflammation. The direct relationship between the CALLY index and cardiac pathology thus remains unclear. Advanced imaging modalities—such as cardiac magnetic resonance imaging or computed tomography—may help elucidate the relationship among the CALLY index, myocardial inflammation, and AF recurrence.</p><p>How the CALLY index could be used to guide strategies for preventing AF recurrence remains uncertain. If the index reflects impaired hepatic function, interventions such as alcohol restriction might be beneficial [<span>4</span>]. However, in the present study, the prevalence of alcohol consumption did not differ significantly between patients with and without AF recurrence [<span>1</span>].</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Equity in Left Atrial Appendage Occlusion Outcomes for Hispanic/Latino Patients","authors":"Syed Muhammad Rayyan,&nbsp;Bakhtiyar Ameer,&nbsp;Mueed Iqbal,&nbsp;Muhammad Abdul Haseeb Khan,&nbsp;Farmanullah Khan","doi":"10.1002/clc.70176","DOIUrl":"https://doi.org/10.1002/clc.70176","url":null,"abstract":"&lt;p&gt;We read with great interest the article published by Fleurestil and his colleagues. Fleurestil and colleagues have provided valuable insights into in-hospital outcomes after left atrial appendage occlusion (LAAO) among Hispanic/Latino patients using the National Inpatient Sample (NIS). Yet, in striving for equitable stroke prevention, several further considerations merit attention [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;While the authors note absence of echocardiographic and catheterization details, they do not address variability in device selection (e.g., Watchman vs. Amplatzer), catheter access routes, or operator experience. Each device has distinct learning curves and complication profiles, and proficiency varies markedly across centers. Future studies should partner with the NCDR LAAO Registry—which captures device type, sheath size, fluoroscopy time, and operator volume—to determine whether specific techniques or low-volume operators disproportionately contribute to the elevated infectious and vascular complications seen in Hispanic/Latino groups [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;By design, NIS only captures index hospitalization events. Yet device-related thrombus, late pericardial effusions, and stroke recurrence often manifest weeks to months later. Incorporating linkage to claims data (e.g., Medicare Part A/B) or designing a prospective, multicenter registry with mandatory 12-month follow-up would illuminate whether early in-hospital disparities translate into divergent long-term safety and efficacy outcomes.&lt;/p&gt;&lt;p&gt;Though Fleurestil et al. briefly cite insurance status and language barriers, they do not quantify health literacy, immigration status, or neighborhood deprivation. Embedding validated instruments—such as the Rapid Estimate of Adult Literacy in Medicine (REALM) [&lt;span&gt;3&lt;/span&gt;] or Area Deprivation Index [&lt;span&gt;4&lt;/span&gt;]—into future LAAO registries would allow risk adjustment for social determinants and guide culturally tailored peri-procedural education.&lt;/p&gt;&lt;p&gt;Administrative coding cannot verify periprocedural anticoagulation regimens or post-implant adherence. Given that suboptimal anticoagulant use may drive both bleeding and thrombotic events, prospective studies should incorporate pharmacy fill data and wearable adherence monitors. Moreover, qualitative interviews could uncover patient-level barriers to compliance, enabling development of targeted interventions (e.g., bilingual mobile reminders).&lt;/p&gt;&lt;p&gt;With only 6814 Hispanic/Latino cases (4.9%), the study risks type II error for less frequent outcomes and cannot explore heterogeneity within the Hispanic/Latino umbrella (e.g., Caribbean vs. Central American ancestry). Pooling data across international centers, or applying Bayesian hierarchical models, would enhance power and allow disaggregation by cultural background, socioeconomic bracket, and comorbidity clusters.&lt;/p&gt;&lt;p&gt;Clinical endpoints—mortality, bleeding, vascular complications—while critical, overlook quality-of-life and patient satisf","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70176","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Patients With Acute Coronary Syndrome Face Higher Mortality on Weekends Versus Weekdays? A Comprehensive Analysis of Demographic, Geographic, and Temporal Trends in the United States","authors":"Abdalhakim Shubietah,&nbsp;Abubakar Nazir,&nbsp;Mohamed S. Elgendy,&nbsp;Ameer Awashra,&nbsp;Jehad Zeidalkilani,&nbsp;Mohammad Alqadi,&nbsp;Suleiman Khreshi","doi":"10.1002/clc.70175","DOIUrl":"https://doi.org/10.1002/clc.70175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The impact of a “weekend effect” on US acute coronary syndrome (ACS) mortality remains uncertain. We compared weekend and weekday age-adjusted mortality rates (AAMRs) and analyzed demographic, geographic, and temporal trends from 1999 to 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a national analysis of ACS deaths (age ≥ 25 years) using CDC WONDER (ICD-10: I20.0; I21.0–I21.4; I21.9; I22.0–I22.9; I24.8; I24.9). Crude and AAMRs (per 100 000; 2000 U.S. standard) were calculated, and trends were assessed by joinpoint regression to estimate annual percent changes (APCs) and average APCs (AAPCs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1999 to 2020, there were 3, 101, 451 ACS deaths: 2, 222, 468 on weekdays (AAMR 46.4; 95% CI 46.39–46.51) and 878, 983 on weekends (AAMR 18.4), a 2.5:1 ratio. Both periods saw two-phase declines—APCs of ≈ –6.4%/year before 2009–2010 and –3.3 to –3.7%/year thereafter (all <i>p</i> &lt;  0.001). Disparities persisted: Black adults had the highest AAMRs (20.9 weekend; 53.2 weekday), rural rates exceeded urban (28.7 vs. 15.8; 72.0 vs. 40.2), men exceeded women (23.8 vs. 14.0; 60.2 vs. 35.4), and rates rose steeply with age (weekend 0.3–223.0; weekday 0.7–561.0). After 2009, declines slowed, and weekday deaths in Black adults rose after 2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The weekend effect on ACS mortality is minimal, with weekday deaths far outnumbering weekend deaths. Persistent—and sometimes widening—disparities by race, rurality, sex, and age highlight the need for equity-focused interventions, strengthened rural cardiac care, and targeted prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Educational Inequality and Income Inequality With Metabolic Diseases and Cause-Specific Mortality","authors":"Jingya Niu,&nbsp;Xiaotong Li,&nbsp;Qiaoyun Chen,&nbsp;Wei Yang,&nbsp;Lixia Suo,&nbsp;Zhu Chen","doi":"10.1002/clc.70173","DOIUrl":"https://doi.org/10.1002/clc.70173","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Educational attainment and economic status are important socioeconomic characteristics and are associated with metabolic diseases and premature death risk. However, their relative importance and contributions to premature death remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected from ten survey waves of the National Health and Nutrition Examination Survey from 1999 to 2018. Deaths before age 75 from all-cause and cause-specific mortality were ascertained from linkage to the National Death Index with follow-up through 2019. Weighted Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for death by educational attainment and income level. Population-attributable fractions (PAFs) were calculated to quantify the proportional contributions of low income and low educational attainment to mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over an average of 10.1 years of follow-up, 4310 premature deaths were confirmed from 43 637 participants. Low income and low educational attainment were associated with increased risks of all-cause and cause-specific mortality, respectively. The associations between low educational attainment and mortality risk disappeared after mutual adjusting for income and education. However, among those with high school education or above, the adjusted HRs of middle income and low income were 1.81 (95% CI, 1.48–2.21) and 2.88 (95% CI, 2.31–3.59) for all-cause mortality. The PAF showed that low educational attainment did not contribute to mortality, while 33.0% of premature deaths were attributable to low income.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Income had a greater impact on mortality risk than education. The disparities in mortality risk could be reduced by narrowing the income differentials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epicardial Fat Thickness as a Marker of Coronary Artery Disease in Diabetics: A Single Center Study","authors":"Abdul Nadeem Akhter,&nbsp;Fnu Aisha,&nbsp;Aimen Binte Moazzam,&nbsp;Sardar Humayun Babar Khan,&nbsp;Jahanzeb Malik,&nbsp;Abida Parveen","doi":"10.1002/clc.70171","DOIUrl":"https://doi.org/10.1002/clc.70171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Epicardial fat thickness (EFT) is a visceral fat depot with pro-inflammatory properties, located adjacent to coronary vessels, and has been proposed as a marker of coronary artery disease (CAD). This study aimed to evaluate the association between EFT and the presence and severity of CAD in patients with type 2 diabetes mellitus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study was conducted at the Abbas Institute of Medical Sciences (AIMS) between January 2020 and March 2025 (Study ID: AIMS/25/007). A total of 2340 diabetic patients (mean age: 58.3 ± 9.6 years) were included. EFT was measured using transthoracic echocardiography, and CAD presence and severity were assessed via coronary angiography. Logistic regression analysis was used to evaluate associations, with results expressed as odds ratios (OR) with 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Elevated EFT (≥ 5 mm) was observed in 1281 patients (54.7%). CAD was present in 1121 individuals (47.9%), with significantly higher rates in those with elevated EFT (65.7% vs. 26.3%, <i>p</i> &lt; 0.001). EFT ≥ 5 mm was associated with a 5.38-fold increased odds of CAD (95% CI: 4.59–6.30, <i>p</i> &lt; 0.001). Moreover, patients with elevated EFT had a significantly higher prevalence of multi-vessel CAD, indicating a correlation between EFT and disease severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In diabetic patients, elevated EFT is significantly associated with both the presence and severity of CAD. EFT measurement via echocardiography may serve as a simple, noninvasive tool for cardiovascular risk stratification and early intervention planning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}