Ischemic heart disease (IHD) continues to be the foremost contributor to global morbidity and mortality. This analysis aims to report an updated assessment of prevalence, deaths, and disability-adjusted life years (DALYs) due to IHD and its attributable risk factors in 204 countries and territories from 1990 to 2021, by age, sex, and socio-demographic index (SDI). This analysis used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. IHD was defined as acute myocardial infarction, chronic stable angina, chronic IHD, and heart failure due to IHD. Major indicators used in this study were prevalence, death and DALYs. All estimates were reported as absolute counts and age-standardized rates per 100,000 population, along with their 95% uncertainty intervals (UIs). Globally, IHD accounted for 254.3 (95%UI: 221.4 to 295.5) million prevalent cases, 9.0 (95%UI: 8.3 to 9.5) million deaths and 188.4 (95%UI: 177.0 to 198.1) million DALYs in 2021. There was a noticeable decline in the global age-standardized death rate (ASDR) [-31.6% (95%UI: -34.9 to -28.3)] and age-standardized DALYs (ASRDALYs) [-28.8% (95%UI: -32.5 to -25.2)] from 1990 to 2021, with an estimated annual percentage change of -1.3 (95%CI: -1.34 to -1.26) and − 1.2 (95%CI: -1.25 to -1.16), respectively. In 2021, the global prevalence, death, and DALY rates of IHD were higher among males across all age groups, while death and DALY rates reaching a peak in the oldest group for both sexes. Regionally, we found a nonlinear but negative association between age-standardized prevalence rate (ASPR) and SDI. Nationally, similar negative associations were observed between ASRDALYs and SDI. High systolic blood pressure and high low-density lipoprotein cholesterol were the factors contributing most to the deaths and DALYs due to IHD. Despite declining global age-standardized death and DALYs rates of IHD, sustained multilevel prevention strategies remain essential. This requires population-wide risk factor reduction, targeted interventions for high-risk populations, and strengthened community healthcare networks to ensure accessible, guideline-based management.

Background: The coronary angiography-derived index of microvascular resistance (caIMR) correlates well with the index of microcirculatory resistance (IMR), which predicts microvascular obstruction (MVO). However, the relationship between caIMR and MVO remains unclear.Aim: To evaluate the predictive ability of caIMR of MVO after ST-segment elevation myocardial infarction (STEMI).Methods: CaIMR was calculated using computational flow and pressure simulation in patients with STEMI in whom MVO status had been assessed by cardiac magnetic resonance (CMR) after successful primary percutaneous intervention at Peking University First Hospital between December 2016 and August 2019. The clinical, biochemical, echocardiographic, and CMR characteristics were assessed according to MVO status. The predictive value of the clinical parameters and caIMR was evaluated.Results: Fifty-three eligible patients were divided into an MVO group (n = 32) and a no-MVO group (n = 21). The caIMR tended to be higher in the MVO group (41.6 U vs. 30.1 U; p = 0.136). CaIMR and peak cardiac troponin-I (cTNI) were independent predictors of MVO (per 1-U increment in caIMR: odds ratio [OR] 1.044, 95% confidence interval [CI] 1.004–1.086, p = 0.030; per 1 ng/L increase in peak cTNI: OR 1.018, 95% CI 1.003–1.033, p = 0.022). In receiver-operating characteristic curve analysis, when a cut-off value of 45.17 U was used, caIMR had some ability to predict MVO (area under the curve 0.622, 95% CI 0.478–0.752, p = 0.127).Conclusions: CaIMR and peak cTNI were independent predictors of short-term MVO in patients with STEMI who had undergone successful primary percutaneous coronary intervention and may help to identify those at high risk of MVO.

Background: It is generally accepted that for patients with multivessel disease and myocardial infarction, complete revascularization is preferable than culprit‐only revascularization. However, existing studies comparing coronary physiology‐guided versus angiography‐guided complete revascularization percutaneous coronary intervention (PCI) present conflicting conclusions. Methods: The investigation involved a comprehensive search of PubMed/Medline, Embase, and the Cochrane library for studies comparing coronary physiology‐guided with angiography‐guided PCI in patients with MI‐MVD. Clinical endpoints, including major adverse cardiovascular events, all‐cause mortality, recurrent MI, major adverse cardiac and cerebral event, planned revascularization, repeated revascularization, average stent number per patient, heart failure, and contrast nephropathy during any follow‐up period post PCI, were considered for analysis. Odds ratios (ORs) and mean differences with 95% confidence intervals (CIs) were calculated for binary and continuous variables, respectively. The analyses were conducted using Review Manager 5.1. Results: Our analysis included a total of 2493 patients from 5 studies. The physiology‐guided PCI group exhibited a lower rate of planned revascularization (OR: 0.10, 95% CIs: 0.07–0.14, p ≤ 0.001, and I ² = 96.6%) and average stent number per patient (mean difference: −0.47, 95% CIs: −0.56–−0.38, p ≤ 0.001, and I ² = 58.6%). However, there were no significant differences between the two groups regarding major adverse cardiac event (MACE) (OR: 0.89, 95% CIs: 0.63–1.26, p = 0.520, and I ² = 67.8%), all‐cause mortality (OR: 0.65, 95% CIs: 0.38–1.12, p = 0.120, and I ² = 50.5%), recurrent MI (OR: 0.74, 95% CIs: 0.28–2.00, p = 0.558, and I ² = 77.2%), major adverse cardiac and cerebral event (MACCE) (OR = 0.77, 95% CIs: 0.43–1.37, p = 0.378, and I ² = 0%), repeated revascularization (OR = 1.47, 95% CIs: 0.54–3.99, p = 0.452, and I ² = 76.5%), heart failure (OR: 1.04, 95% CIs: 0.43–2.56, p = 0.924, and I ² = 0%), and contrast nephropathy (OR: 1.26, 95% CIs: 0.27–5.81, p = 0.766, and I ² = 0%). Conclusions: Among patients with MI‐MVD, physiology‐guided PCI appeared to reduce the need for planned revascularization without triggering repeated revascularization, leading to fewer stents compared with angiography‐guided PCI. Other prespecified clinical outcomes including MACE, all‐cause mortality, recurrent MI, MACCE, heart failure, and contrast nephropathy were not significantly different between these two approaches.

SGLT2 inhibitors (SGLT2is) improve outcomes in patients with heart failure (HF), but their effects may depend on background medical therapy. The Heart Fail

Background: Vascular aging (VA) is a promising concept for cardiovascular risk assessment, but the optimal vascular indicator for vascular age calculation remains uncertain. This study aimed to compare VA indices on the basis of different vascular indicators for predicting cardiovascular events. Methods: This prospective study included 3561 participants from a Chinese community‐based cohort. Four distinct VA indices including brachial–ankle pulse wave velocity (baPWV), carotid intima‐media thickness, carotid plaque, or ankle–brachial index, and conventional risk factors were calculated to predict age. ΔAge was defined as the residual from a linear regression of vascular age on chronological age. Supernormal VA and early VA were defined by the 10th and 90th percentiles of ΔAge, respectively. Cox proportional hazards models were used to investigate associations with major adverse cardiovascular events (MACEs). Results: During a mean 7.2‐year follow‐up, 294 participants experienced MACEs. After multivariable adjustment, only baPWV‐based ΔAge was associated with MACE (hazard ratio [HR] per SD, 1.14 [95% CI, 1.02–1.27]). Early VA phenotype based on baPWV was associated with a higher risk of MACEs (HR, 1.44 [95% CI, 1.05–1.97]), whereas supernormal VA phenotype was not protective. VA indices based on carotid intima‐media thickness, carotid plaque, or ankle–brachial index showed no significant associations with MACEs. Conclusions: In this Chinese community‐based cohort, baPWV was the superior indicator for calculating VA indices, compared with carotid intima‐media thickness, carotid plaque, and ankle–brachial index. baPWV‐based ΔAge and early VA phenotype were independently associated with cardiovascular events, while other indicators were not. baPWV‐based VA demonstrates clinical utility for improving cardiovascular risk stratification.