Sleep duration, baseline cardiovascular risk, inflammation and incident cardiovascular mortality in ambulatory U.S. Adults: National health and nutrition examination survey

Introduction: The interplay between sleep duration and inflammation on the baseline and incident cardiovascular (CV) risk is unknown. We sought to evaluate the association between sleep duration, C-reactive protein (CRP), baseline CV risk, and incident CV mortality. Methods: We used data from the National Health and Nutrition Examination Survey 2005-2010 linked with the cause of death data from the National Center for Health Statistics for adults aged ≥18 years. The associations between self-reported sleep duration and CRP, 10-year atherosclerotic CV disease risk score (ASCVD) and CV mortality were assessed using Linear, Poisson and Cox proportional hazard modeling as appropriate. Results: There were 17,635 eligible participants with a median age of 46 years (interquartile range [IQR] 31, 63). Among them, 51.3% were women and 46.9% were non-Hispanic Whites. Over a median follow-up of 7.5 years (IQR 6.0, 9.1), 350 CV deaths occurred at an incident rate of 2.7 per 1000-person years (IQR 2.4, 3.0). We observed a U-shaped associations between sleep duration and incident CV mortality rate (P-trend=0.011), sleep duration and 10-year ASCVD risk (P-trend \u3c0.001), as well as sleep duration and CRP (P-trend \u3c0.001). A self-reported sleep duration of 6-7 hours appeared most optimal. We observed that those participants who reported \u3c6 or \u3e7 hours of sleep had higher risk of CV death attributable to inflammation after accounting for confounders. Conclusions: There was a U-shaped relationship of incident CV mortality, 10-year ASCVD risk, and CRP with sleep duration. These findings suggest an interplay between sleep duration, inflammation, and CV risk

Relative Predictive Value of Circulating Immune Markers in US Adults Without Cardiovascular Disease: Implications for Risk Reclassification

OBJECTIVE: To investigate the relative predictive value of circulating immune cell markers for cardiovascular mortality in ambulatory adults without cardiovascular disease. METHODS: We analyzed data of participants enrolled in the National Health and Nutrition Examination Survey from January 1, 1999, to December 31, 2010, with the total leukocyte count within a normal range (4000-11,000 cells/μL [to convert to cells ×10 RESULTS: Among 21,599 participants eligible for this analysis, the median age was 47 years (interquartile range, 34-63 years); 10,651 (49.2%) participants were women, and 10,713 (49.5%) were self-reported non-Hispanic white. During a median follow-up of 9.6 years (interquartile range, 6.8-13.1 years), there were 627 cardiovascular deaths. MLR had the best predictive value for cardiovascular mortality. The addition of elevated MLR (≥0.3) to the 10-year ASCVD risk score improved the classification by 2.7%±1.4% (P=.04). Elevated MLR had better predictive value than C-reactive protein and several components of the 10-year ASCVD risk score. CONCLUSION: Among ambulatory US adults without preexisting cardiovascular disease, we found that MLR had the best predictive value for cardiovascular mortality among circulating immune markers. The addition of MLR to the 10-year risk score significantly improved the risk classification of participants

ASSOCIATION BETWEEN BASELINE CARDIOVASCULAR RISK AND SLEEP DURATION IN AMBULATORY US ADULTS: INSIGHTS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

Background: Baseline CV risk may partially explain the significant variability in sleep duration across a population. We evaluated the association between baseline CV risk and self-reported sleep duration. Methods: We used data from National Health and Nutrition Examination Survey (NHANES) 2005-2010 and linked cause of death from National Center for Health Statistics for adults aged ≥18 years. The 10-year atherosclerotic CV disease risk score (ASCVD) was used to assess baseline CV risk and self-reported sleep duration was the outcome. We excluded participants with prevalent CV disease, defined as self-reported coronary artery disease, heart failure or stroke. Continuous variables were represented as medians with interquartile range (IQR). Non-linearity was accounted for using restricted cubic spline models. Results: There were 14,079 eligible participants. Mean age was 46±19 years with 52% women and 46% non-Hispanic Whites. The median 10-year ASCVD risk was 3.5% (0.5, 14.4). There was a U-shaped relationship with 10-year ASCVD risk score and the sleep duration such that participants with a sleep-duration of 6-7 hours had the lowest risk (P-trend\u3c0.001, Figure). The median 10-year ASCVD risk among participants with \u3c6, 6-7 and \u3e7 hours of sleep were 4.6% (0.9, 15.7), 3.3% (0.6, 12.3) and 3.3% (0.4, 17.3), respectively. Conclusion: Least 10-year ASCVD risk is associated with a self-reported sleep duration of 6-7 hours in ambulatory US adults without prevalent CV disease

Trends and In-Hospital Outcomes of Patients Admitted with ST Elevation Myocardial Infarction and Chronic Total Occlusions: Insights from a National Database.

Chronic total occlusion (CTO) is seen in a minority of ST-elevation myocardial infarction (STEMI) patients and is implicated in poor outcomes due to double jeopardy. There is no large national data evaluating the trend and outcomes of STEMI patients who have a CTO (STEMI-CTO). We analyzed the Nationwide In-patients sample database from 2008 to 2011 and compared the trends, clinical characteristics, and in-hospital outcomes of STEMI patients with and without CTO. An increasing trend of CTO was seen in STEMI patients from 2008 to 2011. STEMI-CTO patients were younger, more likely develop cardiogenic shock, undergo percutaneous coronary intervention and thrombolysis. In this large, contemporary, national database, we also found that STEMI-CTO patients were more likely to have iatrogenic cardiac & vascular complications and undergo percutaneous mechanical circulatory support. We did not find significant difference in in-hospital deaths between STEMI-CTO patients and those without CTO

Therapeutic Hypothermia is Associated With A Decrease in All-Cause Mortality in Cardiac Arrest Due To Shockable Rhythm

BACKGROUND: The benefits of therapeutic hypothermia (TH) in comatose patients post cardiac arrest remain uncertain. While some studies have shown benefit, others have shown equivocal results. We pooled data from randomized controlled trials to better study the outcomes of TH. METHODS: Electronic research databases were queried up till September 21, 2021. Randomized controlled trials comparing TH (32°C to 34°C) with control (normothermia or temperature ≥ 36°C) in comatose post cardiac arrest patients were included. RESULTS: The study included ten RCT\u27s with 3988 subjects (1999 in the therapeutic hypothermia arm, and 1989 in the control arm). There was no difference in all-cause mortality between TH and control (OR 0.83; 95% confidence interval [CI]: 0.66 to 1.05; p = 0.08; I2 = 41%). There was no difference in the odds of poor neurological outcomes (OR 0.78; 95% CI: 0.61 to 1.01; p= 0.07; I2 = 43%). Subgroup analysis showed a decrease in all-cause mortality and poor neurological outcomes with therapeutic hypothermia in shockable rhythms (OR 0.55; 95% CI: 0.37 to 0.80; p = 1.00; I2 = 0% and OR 0.48; 95% CI 0.32 to 0.72; p = 0.92; I2 = 0% respectively). CONCLUSION: Therapeutic hypothermia may be beneficial in reducing mortality and poor neurological outcomes in comatose post-cardiac arrest patients with shockable rhythms

Therapeutic Hypothermia is Associated With A Decrease in All-Cause Mortality in Cardiac Arrest Due To Shockable Rhythm.

BACKGROUND: The benefits of therapeutic hypothermia (TH) in comatose patients post cardiac arrest remain uncertain. While some studies have shown benefit, others have shown equivocal results. We pooled data from randomized controlled trials to better study the outcomes of TH. METHODS: Electronic research databases were queried up till September 21, 2021. Randomized controlled trials comparing TH (32°C to 34°C) with control (normothermia or temperature ≥ 36°C) in comatose post cardiac arrest patients were included. RESULTS: The study included ten RCT\u27s with 3988 subjects (1999 in the therapeutic hypothermia arm, and 1989 in the control arm). There was no difference in all-cause mortality between TH and control (OR 0.83; 95% confidence interval [CI]: 0.66 to 1.05; p = 0.08; I2 = 41%). There was no difference in the odds of poor neurological outcomes (OR 0.78; 95% CI: 0.61 to 1.01; p= 0.07; I2 = 43%). Subgroup analysis showed a decrease in all-cause mortality and poor neurological outcomes with therapeutic hypothermia in shockable rhythms (OR 0.55; 95% CI: 0.37 to 0.80; p = 1.00; I2 = 0% and OR 0.48; 95% CI 0.32 to 0.72; p = 0.92; I2 = 0% respectively). CONCLUSION: Therapeutic hypothermia may be beneficial in reducing mortality and poor neurological outcomes in comatose post-cardiac arrest patients with shockable rhythms