In the last two decades, there has been a discernible shift in the distribution of mortality attributed to cardiovascular disease (CVD) between developing and developed nations; in developed nations, the percentage of deaths caused by CVD decreased from 48% in 1990 to 43% in 2010, while in developing nations, they increased from 18% to 25%. In Indonesia, CVD death has increased substantially and remained elevated in the last ten years. Current behavioral and metabolic risk factors, including hyperglycemia, obesity, dyslipidemia, hypertension, and smoking, enhance the risk of CVD mortality, according to several studies. We undertook a study to determine whether the increase in mortality and incidence of CVD can be attributed to changes in the most common metabolic and behavioral risk factors from 2000 to 2019 across 34 Indonesian provinces. Data from 34 province for CVD incidence and mortality and data on changes in metabolic and behavioural risk factors between 2000 and 2019 in Indonesia were obtained from the Global Burden study (GBD) by The Institute of Health Metrics and Evaluation (IHME). A statistical model was applied to calculate the fatalities attributable to the risk factors change using Population attributable fractions (PAF) and baseline year death numbers. Furthermore, we ran multivariate regressions on Summary Exposure Value of risk factors associated with the increasing mortality, incidence rates in a lag year analysis. R software used to measure heteroscedasticity-consistent standard errors with coeftest and coefci. Covariates were added to adjusted models, including the Socio-demographic Index, Primary health care facilities coverage, and GDP per capita. The age-standardized mortality rate for CVD from 2000 to 2019 in Indonesia, increased from 356.05 to 412.46 deaths per 100,000 population among men and decreased from 357.52 to 354.07 deaths per 100,000 population among women, resulting in an increase of 270.928 per 100,0000 inhabitants of CVD deaths. In the same period, there was an increase in exposure to risk factors such as obesity by +9%, smoking by +1%, dyslipidemia by +1.3%, hyperglycemia by +2%, and hypertension by +1.2%. During this time span, an additional 14,517 men and 17,917 women died from CVD, which was attributable to higher obesity exposure. We apply multivariate regression with province-fixed and year-fixed analysis and find strong correlation between hyperglycemia in women (6; 95%CI 0 to 12, death per 1-point increase in hyperglycemia exposure) with an increasing death rate in ischemic heart disease. We also performed a year lag analysis and discovered a robust association between high low density lipoprotein (LDL) levels in men and women and the growing incidence of ischemic heart disease. The association between a 10-year lag of high LDL and the incidence of ischemic heart disease was five times stronger than that observed for other risk factors, particularly in men (5; 95%CI 2 to 8, incidence per 1-point increase in high LDL exposure). Hyperglycemia in women is an important risk factor associated with increasing mortality due to Ischemic Heart Disease (IHD) in Indonesia This study also revealed that the presence of high LDL in both men and women were associated with an increase incidence of IHD that manifested several years subsequent to exposure to the risk factor. Additionally, the highest cardiovascular death portion were attributed to obesity. These findings suggest that policymakers should control high LDL and hyperglycemia 10 years earlier prior to the occurrence of IHD and employ personalized therapy to regulate associated risks.

Background: In-stent restenosis (ISR) remains a significant challenge despite advancements in percutaneous interventions, often leading to adverse clinical outcomes. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential biomarker for predicting ISR, offering opportunities for improved risk stratification and treatment personalization. This systematic review and meta-analysis assess the predictive value of NLR in ISR, providing insights into its clinical applicability. Methods: Systematic literature search was conducted in scientific databases until 21st July 2024. Observational studies evaluating NLR in stented patients were included. Random effect meta-analysis and linear regression model were used to investigate odds ratios (OR) as predictor and linear dose-response relationship of ISR. Sensitivity and specificity of NLR to predict this outcome were pooled and a summary receiver operating characteristics (sROC) curve was generated. This study was already registered in the PROSPERO (ID: CRD42024555123). Results: 15 studies with 3 889 patients were included. High NLR was associated with increased risk of ISR in coronary and non-coronary stenting [aOR = 1.61 (95%CI 1.14–2.25); aOR = 1.69 (95%CI 1.52–1.87)]. One unit increase of NLR is equal to 30% and 44% increased risk of ISR in coronary and non-coronary patients. Included studies showing NLR as a robust predictor of ISR with sensitivity and specificity of 70.5% (95%CI 60.1%-79.2%) and 74.1% (95%CI 56.7%-86.2%) for coronary stenting and 77.7% (95%CI 69.8%-84.0%) and 66.4% (95%CI 49.6%-79.8%) non-coronary stenting, with AUC of 0.77 (0.70–0.82) in the coronary and 0.79 (0.70–0.85) in the non-coronary sub-groups. Conclusion: In conclusion, NLR yields promising predictive and prognostic potentials in predicting ISR in coronary and non-coronary stents. Additionally, NLR appears to be more proficient in predicting early ISR compared to late ISR in both coronary and non-coronary stents.

Objective: To determine the incidence, onset, risk factors and mortality of pulmonary embolism in total knee replacement patients. Method: The systematic review was conducted in September 2022, and comprised search on PubMed, ScienceDirect, Scopus and Crossref databases for studies published from 1977 till September 7, 2022, in the English language related to the incidence of pulmonary embolism after primary total knee replacement. Cochrane Handbook for Systematic Reviews of Interventions was used to assess risk of bias, and the Newcastle-Ottawa Scale was used to assess the quality of evidence. Results: Of the 3,910 studies initially identified, 66(1.68%) were analysed in detail, which together had 13,258,455 total knee replacement patients. Pulmonary embolism was reported in 76,515(0.58%) cases. The onset of pulmonary embolism ranged 2-150 days post-surgery. Patients with older age, diabetes mellitus, higher body mass index, atrial fibrillation, previous venous thromboembolism, high Charlson Comorbidity Index score, hypertension, arrhythmia and chronic heart failure were at significantly higher risk (p<0.05). The overall mortality rate of pulmonary embolism in such cases ranged 10.53-100%. Conclusion: Pulmonary embolism is a rare complication after orthopaedic surgery, but it has a very high mortality rate. By recognising the risk factors, attending physicians can optimise the use of chemoprophylaxis, thus preventing pulmonary embolism. Key Words: Venous thromboembolism, Orthopaedic, Pulmonary, Arrhythmias, Cardiac, Bibliometrics, Comorbidity.

Acute limb ischemia (ALI) is associated with a high risk of limb loss and mortality, even after surgical intervention. Recent findings suggest the beneficial role of the neutrophil-to-lymphocyte ratio (NLR) in predicting limb amputation and mortality in ALI patients. This current study aims to evaluate the role of NLR in predicting all-cause mortality (ACM) and amputations due to vascular events in patients with ALI. A systematic literature search was conducted across several databases. Meta-analysis with a random-effects model was used to quantitatively estimate the pooled odds ratio, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), while a bivariate meta-analysis was used to generate the summary receiver operating characteristic (ROC) curve. Five observational studies met predefined criteria. Patients with high NLR had a 7.5 times higher risk of 30-d and a 3.4 times higher risk of 2-y amputation compared to those with low NLR. The pooled sensitivity for 30-d and 2-y amputation was 81.3% and 71.0%, while the pooled specificity was 73.8% and 63.5%, respectively. For 30-d ACM, patients with high NLR had a nine times higher risk, while the risk was 1.5 times higher for 2-y ACM. The pooled sensitivity for predicting 30-d and 2-y ACM was 81.5% and 58.8%, with pooled specificity of 76.0% and 59.3%, respectively. NLR is a valuable predictor of short-term outcomes in patients with ALI, with higher predictive performance for 30-d amputation and ACM compared to 2-y outcomes. Its simplicity and availability make it a valuable tool in emergency settings.

To evaluate the impact of perioperative blood pressure variability (BPV) on cardiovascular outcomes and mortality in cardiac surgery patients. Literature searches were performed across scientific databases up to December 31, 2024. Studies reporting perioperative BPV in patients undergoing cardiac surgery and its association with mortality and clinical outcomes were included. Fifteen studies with 16,407 patients were included. Increased BPV was significantly associated with higher rates of 30-day mortality, acute kidney injury (AKI), prolonged intensive care unit stay, and cognitive dysfunction. Among patients with fewer comorbidities and perioperative risk, 30-day mortality ranged from 0.2% to 0.5%, while in patients with higher risk, it increased from 42.4% to 60.7% (p < 0.001). Elevated BPV was linked to a 23.2% higher risk of AKI per unit increase in blood pressure (BP) standard deviation (SD) and a 15% increased incidence of postoperative delirium. The findings emphasize the critical need for precise perioperative BP control, with advanced metrics like BP fragmentation providing valuable insights into patient risk. Perioperative BPV appears to be a crucial factor influencing postoperative outcomes in cardiac surgery patients. Effective management of BPV may help reduce complications and improve patient outcomes, highlighting the potential benefits of tailored hemodynamic strategies. However, further research is needed to establish standardized BPV thresholds and optimal management approaches.