Poorer outcomes have been reported with COVID-19 and influenza coinfections. As the COVID-19 pandemic rages on, protection against influenza by vaccination is becoming increasingly important. This study examines how COVID-19 has influenced influenza vaccination intentions from a global perspective. A literature search was conducted on Embase, PubMed, and CNKI from 1 January 2019 to 31 December 2021 for articles reporting rates of influenza vaccination pre-COVID-19 (19/20 season), and intention and/or uptake of influenza vaccination post-COVID-19 (20/21 season). The changes in vaccination intention and reasons for changes were reported. Subgroup analyses were performed by region, gender, age, and occupation. Newcastle Ottawa Scale was used for quality assessment of the articles. Twenty-seven studies with 39,193 participants were included. Among 22 studies reporting intention to vaccinate in 20/21, there was increased intention to vaccinate (RR 1.50, 95% CI 1.32–1.69, p < 0.001) regardless of age, gender, and occupation. The remaining five studies reporting vaccination intention and uptake in 20/21 showed a similar increase (RR 1.68, 95%CI 1.20–2.36). Important determinants include historical vaccine acceptance, and perception of influenza severity and vaccine safety. The COVID-19 pandemic has increased intention to vaccinate against influenza internationally. The pandemic could be a window of opportunity to promote influenza vaccination and decrease vaccine hesitancy.

Cardiovascular diseases (CVDs) are the leading cause of global mortality. Understanding epidemiologic trends in the modifiable risk factors driving CVDs is essential in designing effective countermeasures. The aim of this study was to forecast geospatial trends of modifiable cardiovascular risk factors, namely high systolic blood pressure (SBP), high fasting plasma glucose, high body mass index (BMI), high low-density lipoprotein cholesterol, and tobacco use from 2025 to 2050. Historical data on disability-adjusted life years (DALYs) and mortality from the GBD (Global Burden of Disease) 2021 study were used to forecast the burden associated with modifiable cardiovascular risk factors from 2025 to 2050. Trends across GBD super-regions, sex, sociodemographic index, and age groups were examined. In 2050, high SBP (1,694.2 [95% uncertainty interval [UI]: 1,454.6-1,933.9] per 100,000 population) will contribute to the highest age-standardized DALYs, followed by high low-density lipoprotein cholesterol (657.6 [95% UI: 511.9-803.3] per 100,000 population), high BMI (495.2 [95% UI: 330.8-659.6] per 100,000 population), tobacco use (493.7 [95% UI: 378.2-609.1] per 100,000 population), and high fasting plasma glucose (466.7 [95% UI: 311.9-621.5] per 100,000 population). Although age-standardized DALY rates will fall across all cardiovascular risk factors from 2025 to 2050, overall crude DALYs associated with cardiovascular risk factors are projected to rise within the same period. High SBP (rising by 99 million DALYs; 44.1% increase), and high BMI (increasing by 44 million DALYs; 88.0% increase) will have the greatest rise in crude DALYs from 2025 to 2050. Although the projected decline in age-standardized DALYs of modifiable cardiovascular risk factors suggest improved management of CVDs, crude DALYs will continue to rise due to population growth and aging.

Background: The double burden of malnutrition, described as the coexistence of malnutrition and obesity, is a growing global health issue. This study examines the combined effects of obesity and malnutrition on patients with acute myocardial infarction (AMI). Methods: Patients presenting with AMI to a percutaneous coronary intervention-capable hospital in Singapore between January 2014 and March 2021 were retrospectively studied. Patients were stratified into the following: (1) nourished nonobese, (2) malnourished nonobese, (3) nourished obese, and (4) malnourished obese. Obesity and malnutrition were defined according to the World Health Organization definition (body mass index ≥27.5 kg/m ² ) and Controlling Nutritional Status score, respectively. The primary outcome was all-cause mortality. The association between combined obesity and nutritional status with mortality was examined using Cox regression, adjusted for age, sex, AMI type, previous AMI, ejection fraction, and chronic kidney disease. Kaplan-Meier curves for all-cause mortality were constructed. Results: The study included 1829 AMI patients, of which 75.7% were male and mean age was 66 years. Over 75% of patients were malnourished. Majority were malnourished nonobese (57.7%), followed by malnourished obese (18.8%), nourished nonobese (16.9%), and nourished obese (6.6%). Malnourished nonobese had highest all-cause mortality (38.6%), followed by the malnourished obese (35.8%), nourished nonobese (21.4%), and nourished obese (9.9%, P <0.001). Kaplan-Meier curves demonstrated least favorable survival in malnourished nonobese group, followed by malnourished obese, nourished nonobese, and nourished obese. With nourished nonobese group as the reference, malnourished nonobese had higher all-cause mortality (hazard ratio, 1.46 [95% CI, 1.10–1.96], P =0.010), but only a nonsignificant increase in mortality was observed in the malnourished obese (hazard ratio, 1.31 [95% CI, 0.94–1.83], P =0.112). Conclusions: Among AMI patients, malnutrition is prevalent even in the obese. Compared to nourished patients, malnourished AMI patients have a more unfavorable prognosis especially in those with severe malnutrition regardless of obesity status, but long-term survival is the most favorable among nourished obese patients.

There is emerging evidence that malnutrition is associated with poor prognosis among patients with acute coronary syndrome (ACS). This study seeks to elucidate the prognostic impact of malnutrition in patients with ACS and provide a quantitative review of most commonly used nutritional assessment tools. Medline and Embase were searched for studies reporting outcomes in patients with malnutrition and ACS. Nutritional screening tools of interest included the Prognostic Nutrition Index, Geriatric Nutritional Risk Index, and Controlling Nutritional Status. A comparative meta-analysis was used to estimate the risk of all-cause mortality and cardiovascular events based on the presence of malnutrition and stratified according to ACS type, ACS intervention, ethnicity, and income. Thirty studies comprising 37,303 patients with ACS were included, of whom 33.5% had malnutrition. In the population with malnutrition, the pooled mortality rate was 20.59% (95% CI: 14.95%-27.67%). Malnutrition was significantly associated with all-cause mortality risk after adjusting for confounders including age and left ventricular ejection fraction (adjusted HR: 2.66, 95% CI: 1.78-3.96, P = 0.004). There was excess mortality in the group with malnutrition regardless of ACS type (P = 0.132), ethnicity (P = 0.245), and income status (P = 0.058). Subgroup analysis demonstrated no statistically significant difference in mortality risk between individuals with and without malnutrition (P = 0.499) when using Controlling Nutritional Status (OR: 7.80, 95% CI: 2.17-28.07, P = 0.011), Geriatric Nutritional Risk Index (OR: 4.30, 95% CI: 2.78-6.66, P < 0.001), and Prognostic Nutrition Index (OR: 4.67, 95% CI: 2.38-9.17, P = 0.023). Malnutrition was significantly associated with all-cause mortality risk following ACS, regardless of ACS type, ethnicity, and income status, underscoring the importance of screening and interventional strategies for patients with malnutrition.

Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease. The relationship between Lp(a) and major adverse cardiovascular events (MACE) in the context of high-sensitivity C-reactive protein (hs-CRP) levels remains controversial due to conflicting results from previous studies. This systematic review and meta-analysis aimed to clarify the association between Lp(a) and risk of MACE across different hs-CRP levels in both primary and secondary prevention settings. We performed a systematic review by searching MEDLINE (PubMed), Embase (Ovid), Cochrane CENTRAL (Wiley), and Web of Science (Clarivate) from their inception to February 2024. Eligible studies reported the association of Lp(a) with MACE stratified by hs-CRP level. Data extraction and quality assessment were systematically conducted. Meta-analyses used random-effects models to compute pooled HRs for individuals with low (<2 mg/L) and high (≥2 mg/L) hs-CRP levels. Subgroup analyses were performed in primary and secondary prevention populations. Nine publications encompassing 11 studies that involved 562,301 participants met the inclusion criteria. The mean proportion of females was 39.9% and the weighted mean age for the entire cohort was 61.2 years. Elevated Lp(a) was significantly associated with MACE risk in both low and high hs-CRP groups, with pooled HR of 1.26 (95% CI: 1.11-1.42) and 1.33 (95% CI: 1.20-1.47), respectively. In the primary prevention group, the pooled HR for low and high hs-CRP groups was 1.33 (95% CI: 1.06-1.66) and 1.43 (95% CI: 1.13-1.82), respectively (subgroup difference, P = 0.65). The corresponding HRs for the secondary prevention population were 1.13 (95% CI: 1.00-1.27) and 1.31 (95% CI: 1.12-1.52), respectively (subgroup difference P = 0.13). Elevated Lp(a) is associated with an increased risk of MACE independent of hs-CRP levels in both primary and secondary prevention populations.

Background: Metabolic dysfunction‐associated steatotic liver disease (MASLD) and chronic kidney disease (CKD) are important cardiovascular risk factors. However, the prognostic impact of coexisting MASLD and CKD remains understudied. Methods: This study cohort used the NHANES (National Health and Nutrition Examination Survey) 2007 to 2018 database, examining outcomes in adults with varying MASLD and CKD statuses. The primary outcome was all‐cause mortality. Secondary outcomes included coronary heart disease, heart failure, stroke, and cancer. Cox regression model was constructed to investigate the relationship between MASLD/CKD and all‐cause mortality, adjusted for age, prior coronary heart disease, body mass index, smoking, poverty‐to‐income ratio, lipid‐lowering and glucose‐lowering medications. Sensitivity analysis was performed with hepatic fibrosis and CKD. Results: Among 14 818 participants (mean follow‐up: 6.9 ± 3.4 years), a majority of participants had MASLD(−)/CKD(−) (50.8%), followed by MASLD(+)/CKD(−) (34.8%), MASLD(+)/CKD(+) (7.7%), and MASLD(−)/CKD(+) (6.7%). MASLD(+)/CKD(+) (n = 1142) had the highest rates of obesity (77.6%), hypertension (77.5%), dyslipidemia (67.0%), and diabetes (49.7%), with the highest risk of coronary heart disease (risk ratio [RR], 1.79 [95% CI, 1.13–2.82], P = 0.013) and heart failure (RR 2.33 [95% CI, 1.07–5.08], P = 0.033). Socioeconomic disparities were observed, with lower‐income individuals predominantly in the group with MASLD(+)/CKD(+) ( P < 0.001). MASLD(+)/CKD(+) (adjusted hazard ratio [aHR], 3.28 [95% CI, 1.89–5.70], P < 0.001) and MASLD(−)/CKD(+) (aHR, 2.18 [95% CI, 1.33–3.66], P = 0.002) phenotypes were independent mortality predictors. Although MASLD(−)/CKD(+) and MASLD(+)/CKD(+) had unfavorable 10‐year prognoses, survival was worse in those with both hepatic fibrosis and CKD ( P < 0.001). Conclusions: MASLD(+)/CKD(+) phenotype increases the risk of cardiometabolic multimorbidity and independently predicts mortality. Mortality risk increased progressively in individuals with both advanced hepatic fibrosis and CKD.