Limited evidence exists on the combined and mediating effects of systemic inflammation on the association between insulin resistance and cardiovascular events in patients with diabetes and chronic coronary syndrome (CCS). This secondary analysis of a multicenter prospective cohort included 4419 diabetic CCS patients. Triglyceride–glucose index (TyG) and high-sensitivity C-reactive protein (hsCRP) were applied to evaluate insulin resistance and systemic inflammation, respectively. The primary endpoint was major adverse cardiac event (MACE). Associations of TyG and hsCRP with cardiovascular events were estimated using Cox regression. A mediation analysis was performed to assess whether hsCRP mediates the relationship between TyG and cardiovascular events. Within a median 2.1-year follow-up period, 405 MACEs occurred. Patients with high levels of TyG and hsCRP experienced the highest MACE risk (hazard ratio = 1.82, 95% confidence interval: 1.24–2.70, p = 0.002) compared to individuals with low levels of both markers. HsCRP significantly mediated 14.37% of the relationship between TyG and MACE (p < 0.001). In diabetic CCS patients, insulin resistance and systemic inflammation synergically increased the risk of cardiovascular events, and systemic inflammation partially mediated the association between insulin resistance and clinical outcomes. Combining TyG and hsCRP can help identify high-risk patients. Controlling inflammation in patients with insulin resistance may bring added benefits.

This study sought to investigate the prevalence and prognostic significance of malnutrition in patients with an abnormal glycemic status and coronary artery disease (CAD). This secondary analysis of a multicenter prospective cohort included 5710 CAD patients with prediabetes and 9328 with diabetes. Four objective tools were applied to assess the nutritional status of the study population. The primary endpoint was all-cause death. The association of malnutrition with clinical outcomes was examined using Cox proportional hazards regression. The proportion of malnutrition varied from 8% to 57% across the assessment tools. Diabetic patients were more likely to be malnourished than prediabetic patients. During a median follow-up of 2.1 years, 456 all-cause deaths occurred. The adjusted hazard ratios and 95% confidence interval for all-cause deaths of moderate–severe malnutrition defined by different tools ranged from 1.59 (1.03, 2.46) to 2.08 (0.92, 4.73) in prediabetic patients and 1.51 (1.00, 2.34) to 2.41 (1.78, 3.27) in diabetic patients. In conclusion, malnutrition is not rare in CAD patients with abnormal glycemic status. Moderate–severe malnutrition strongly predicted all-cause death regardless of the assessment tool. Assessing the nutritional status for all CAD patients with prediabetes and diabetes to identify individuals at high risk of all-cause death may help the risk assessment and prognosis improvement.

Background: Evidence on factors associated with guideline-directed secondary prevention med-ication (GDPM) after percutaneous coronary intervention (PCI) and its effect on the prognosis of patients with coronary artery disease (CAD) is lacking in China. Aims: To ascertain predictors of GDPM in real-world clinical practice and to assess the effect of GDPM on clinical outcomes. Design: A retrospective cohort study. Methods: Consecutive patients admitted to Fuwai Hospital between January 2013 and December 2013 were recruited. GDPM comprised aspirin, clopidogrel, statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers. The primary outcome was five-year major adverse cardiovascular event (MACE) (cardiac death, myocardial infarction [MI] and unplanned revascularization). Multivariable logistic regression was used to identify predictors of prescribing GDPM. Multivariable Cox regression was used to examine the relation-ship between GDPM and clinical outcomes. Results: 10,067 patients were followed up for a median of 5.0 years (interquartile range: 4.3-5.2), 45.1% were prescribed with GDPM. Presenting with ST-segment elevation MI (adjusted OR = 3.252 [2.832-3.736]), prior MI (adjusted OR = 2.174 [1.948-2.425]), more stents implanted (adjusted OR = 1.063 [1.022-1.106]), overweight (adjusted OR = 1.136 [1.038-1.243]), obe-sity (adjusted OR = 1.274 [1.100-1.476]), diabetes (adjusted OR = 1.225 [1.115-1.344]), and hypertension (adjusted OR = 3.556 [3.196-3.956]) predicted the prescription of GDPM. Advanced age (adjusted OR = 0.556 [0.379-0.816]) was associated with lower prescription rate of GDPM. Patients with GDPM had lower rate of 5-year MACE (adjusted HR = 0.889 [0.808- 0.978]) relative to those without GDPM. Conclusions: Despite the benefit of GDPM in improving the prognosis of CAD patients undergo- ing PCI, gaps still exist in GDPM prescription in real-world clinical practice. Our study deter-mined target populations for physicians to strive to promote the application of GDPM.