Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality, and while the association between the urinary albumin-to-creatinine ratio (UACR) and cardiovascular risk is recognized, the specific impact of UACR on the long-term survival of ASCVD patients remains not fully understood. The aim of this study is to investigate the influence of UACR on the long-term risk of all-cause mortality in patients with ASCVD. This study included ASCVD patients from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Mortality outcomes were ascertained by linkage to the National Death Index as of December 31, 2019. UACR risk was stratified into three levels: Group 0 (UACR < 30 mg/g), Group 1 (30–300 mg/g), and Group 2 (>300 mg/g). The primary outcome was all-cause mortality, with cardiovascular mortality as a secondary outcome. Cox proportional hazards, adjusted for demographic factors, traditional cardiovascular risk factors, and secondary prevention medications for ASCVD, were used to analyze the cumulative risk of outcomes. Propensity score matching was employed for risk adjustment, and sensitivity analyses were conducted based on cohorts with chronic coronary syndrome (CCS), stroke, heart failure, and non-heart failure. Among the 1,737 patients with a median follow-up of 10 years, 1,026 all-cause deaths and 351 cardiovascular deaths were recorded. After full model adjustment, higher UACR levels were associated with increased risks of all-cause mortality (Group 1: hazard ratio (HR), 1.601; 95 % confidence interval (CI), 1.382–1.855; Group 2: HR, 2.378; 95 % CI, 1.884–3.001; both P < 0.001 for trend) and cardiovascular mortality (Group 1: HR, 2.080; 95 % CI, 1.631–2.652; Group 2: HR, 2.883; 95 % CI, 1.951–4.260; both P < 0.001 for trend). Propensity score matching confirmed these findings, showing significantly elevated all-cause mortality risks in high-risk UACR groups (with a cutoff of 30 mg/g: HR, 1.468 (95 %CI, 1.254–1.719), P < 0.001; with a cutoff of 300 mg/g: HR, 1.935 (95 %CI, 1.399–2.675), P < 0.001). All sensitivity analyses were consistent with the results of the overall cohort. UACR is an important prognostic indicator for predicting the long-term outcomes of ASCVD patients, with its impact being independent of eGFR.

Background: Despite statins and other medications central to atherosclerotic cardiovascular disease (ASCVD) secondary prevention, stable coronary artery disease (SCAD) patients remain at significant cardiovascular risk, partly due to residual inflammation risk (RIR). This study aims to assess if adding Guanxinning to standard ASCVD therapy further mitigates RIR in SCAD patients. Methods: In a prospective, randomized, single-blind endpoint design, 50 patients with SCAD who received ASCVD standardized treatment strategy were randomly assigned to either take Guanxinning tablets (4 tablets, thrice daily) or no Guanxinning tablets and were followed up for an average of 12 weeks. The primary outcomes were changes in inflammation-related indicators, including interleukin-2 (IL-2), IL-4, IL-6, tumor necrosis factor-α (TNF-α), and high sensitivity C-reactive protein (hs-CRP). Results: Compared with the control group, the intervention group showed significantly greater decreases in the levels of IL-2, IL-6, TNF-α, and hs-CRP (all P < 0.05). However, there was no significant difference in the IL-4 level between the two groups (P > 0.05). Compared with the control group, there were also significant improvements in endothelial function-related indicators (vascular endothelial growth factor (VEGF), nitric oxide (NO), and peroxisome proliferator-activated receptor-γ (PPAR-γ)), blood lipid profile (total cholesterol (Tch), low-density lipoprotein cholesterol (LDL-C)), and chest pain related scores (angina and Traditional Chinese medicine syndrome scores) in the intervention group (all P< 0.05). There was no significant difference in the triglyceride (TG) and carotid intima-media thickness between the two groups (P< 0.05). Compared to the control group, there was no significant difference in the white blood cell line, liver and kidney function, anemia, and bleeding in the intervention group (all P< 0.05). Conclusion: The addition of Guanxinning tablets (4 tablets, thrice daily) to the standard treatment strategy for ASCVD was associated with a reduction in the RIR in patients with SCAD and demonstrated good safety. Plain Language Summary: In the quest for a heart-healthy life, even with statins at our side, some folks with stable heart troubles still face a sneaky foe: lingering inflammation. Our study explored whether adding Guanxinning, a traditional Chinese medicine, to the standard treatment might help. Over 12 weeks, patients who took Guanxinning along with their usual heart meds showed promising signs of reduced inflammation and improved heart health markers. These preliminary positive signs hint at the potential benefits of Guanxinning, which, however, need further studies to confirm. Fortunately, it appears to be safe to use Guanxinning alongside conventional treatments for now. As we delve deeper into the mysteries of heart health, every promising discovery brings us one step closer to developing better therapeutic strategies.

Background: Long‐term antithrombotic strategies for patients with chronic coronary syndrome with high‐risk factors represent an important treatment dilemma in clinical practice. Our aim was to conduct a network meta‐analysis to evaluate the efficacy and safety of long‐term antithrombotic strategies in patients with chronic coronary syndrome. Methods and Results: Four randomized studies were included (n=75167; THEMIS [Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study], COMPASS [Cardiovascular Outcomes for People Using Anticoagulation Strategies], PEGASUS‐TIMI 54 [Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54], and DAPT [Dual Anti‐platelet Therapy]). The odds ratios (ORs) and 95% CIs) were calculated as the measure of effect size. The results of the network meta‐analysis showed that, compared with aspirin monotherapy, the ORs for trial‐defined major adverse cardiovascular and cerebrovascular events were 0.86; (95% CI, 0.80–0.93) for ticagrelor plus aspirin, 0.89 (95% CI, 0.78–1.02) for rivaroxaban monotherapy, 0.74 (95% CI, 0.64–0.85) for rivaroxaban plus aspirin, and 0.72 (95% CI, 0.60,–0.86) for thienopyridine plus aspirin. Compared with aspirin monotherapy, the ORs for trial‐defined major bleeding were 2.15 (95% CI, 1.78–2.59]) for ticagrelor plus aspirin, 1.51 (95% CI, 1.23–1.85) for rivaroxaban monotherapy, and 1.68 (95% CI, 1.37–2.05) for rivaroxaban plus aspirin. For death from any cause, the improvement effect of rivaroxaban plus aspirin was detected versus aspirin monotherapy (OR, 0.76; 95% CI, 0.65–0.90), ticagrelor plus aspirin (OR, 0.79; 95% CI, 0.66–0.95), rivaroxaban monotherapy (OR, 0.82; 95% CI, 0.69–0.97), and thienopyridine plus aspirin (OR, 0.58; 95% CI, 0.41–0.82) regimens. Conclusions: All antithrombotic strategies combined with aspirin significantly reduced the incidence of major adverse cardiovascular and cerebrovascular events and increased the risk of major bleeding compared with aspirin monotherapy. Considering the outcomes of all ischemic and bleeding events and all‐cause mortality, rivaroxaban plus aspirin appears to be the preferred long‐term antithrombotic regimen for patients with chronic coronary syndrome and high‐risk factors.

Aims: Nicorandil, which is a mitochondrial ATP-sensitive potassium channel opener, is believed to improve perioperative myocardial injury (PMI) in patients undergoing percutaneous coronary intervention (PCI), but recent studies have shown that nicorandil treatment did not improve functional and clinical outcomes in patients with angina pectoris who underwent elective PCI. We performed a meta-analysis to investigate the protective effect of nicorandil on perioperative injury in patients with angina pectoris who underwent elective PCI. Methods: The Medline, EMBASE, and Cochrane databases were searched for randomized clinical trials examining the effects of nicorandil. Two investigators independently selected suitable trials, extracted data, and assessed trial quality. Results: Seven studies of patients undergoing elective PCI, comprising a total of 979 patients, were included in this review. The results showed that nicorandil did not reduce the levels of markers of myocardial injury (standardized mean difference [SMD] 0.31 [95%CI −0.6, 1.22] for creatine kinase-MB [CK-MB] and 1.29 [95%CI −2.18, 4.76] for troponin I [TNI]), perioperative complications (relative risk [RR] 0.91 [95%CI 0.46–1.81]), target vessel revascularization (RR 0.79 [95%CI 0.50–1.25]) or major adverse cardiac events (MACE) (RR 0.83 [95%CI 0.49–1.43]). Nicorandil did reduce the corrected TIMI frame count (SMD-0.30 [95%CI −0.52, −0.09]). Conclusion: Although nicorandil did not reduce the overall incidence of perioperative complications and the incidence of major adverse cardiac events (MACE) in patients with angina pectoris who underwent elective PCI, it could still improve no reflow and slow coronary flow.