Triglyceride- glucose (TyG) index, a marker of insulin resistance, has been shown to be associated with the incidence of cardiometabolic diseases including hypertension. However, the prognostic role of TyG index is unknown. Hence, we aim to determine the association of TyG index with major adverse cardiovascular events (MACE) in hypertensive patients. Systematic searching was conducted on 3 databases up till November 2024. We included studies with hypertensive patients despite their comorbidities. Outcome measured is MACE and its individual components. Random effect model meta-analysis is done to pool the results with similar reference point. Twenty observational studies with a total of 451,455 patients of 40 – 70 years old are included. Meta-analysis result shows that higher TyG index is associated with a statistically significant increased risk of MACE (HR 1.90, CI: 1.41 – 2.57, I² 88 %), myocardial infarction (HR 1.55, CI: 1.27 – 1.88, I² 0 %), stroke (HR 1.84, CI: 1.41 – 2.39, I² 62 %), all- cause mortality (HR 1.86, CI: 1.70 – 2.03, I² 0 %) and cardiovascular mortality (HR 1.08, CI: 1.04 – 1.11, I² 0 %). Subgroups of older and younger population, male and female gender, diabetic and non- diabetic population, and higher BMI patients retains the statistically significant risk of MACE (p < 0.05). U- shaped phenomena of TyG index is also demonstrated with the risk of all- cause mortality. TyG index is a reliable prognostic marker of MACE in hypertensive patients and can be utilized in population despite their age, diabetic status, and gender.

Background: Peripartum Cardiomyopathy (PPCM) is a rare yet fatal cardiac disease associated with pregnancy. PPCM has been shown to have similar etiopathogenesis with hypertensive disorders of pregnancy (HDP). Hence, this study aims to study the association between HDP and the development of PPCM. Methods: Three databases (PubMed, Scopus, Cochrane Library) were searched and screened based on prespecified inclusion and exclusion criteria. Predictors of PPCM evaluated were HDP (preeclampsia, superimposed preeclampsia, chronic hypertension, and gestational hypertension) and its clinical features (severe preeclampsia, age, parity, serum creatinine, etc.). Data were analyzed using the random effects model of pooled odds ratios (ORs) with the Mantel Haenszel method, and publication bias was assessed with a funnel plot. Results: A total of 13 observational studies with 11,951 PPCM cases from 7 countries were identified. All types of HDP were associated with significantly increased odds of developing PPCM, and severe preeclampsia was associated with the highest OR of 13.33 (CI: 5.95 – 29.83, p < 0.01). Additionally, superimposed preeclampsia, chronic hypertension, preeclampsia, and lastly gestational hypertension were associated with increased odds of PPCM with OR 5.77, 4.73, 4.70, and 3.13, respectively. Other clinical features being statistically significant for PPCM development included advanced age > 35 years and multiple pregnancies (p < 0.05). No significant difference in creatinine level was found between PPCM and no PPCM group. No publication bias was found based on funnel plot assessment. Conclusion: HDP, especially severe preeclampsia, is associated with increased odds of PPCM development; hence, a low threshold for PPCM screening in this high-risk group is required.

Background: Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive cause of diastolic heart failure associated with poor prognosis. Currently available treatment, tafamidis, a TTR stabilizer, is highly effective and tolerable but is not cost-effective. Hence, we aim to evaluate the efficacy and safety of a mechanistically similar but more affordable TTR stabilizer, diflunisal, in patients with ATTR-CA. Methods: Systematic searching until June 2024 was done on 3 databases to include patients with ATTR-CA of any type (hereditary or wild-type). Efficacy and safety of diflunisal are assessed by baseline to follow-up mean difference of specific clinical parameters and mortality risk reduction comparing intervention to the control group is evaluated by the generic inverse variance model. The proportion of discontinuation rate and adverse effects are evaluated with a single-arm inverse variance model. Statistical analyses are done with a random effect model conducted on RevMan and R software. Results: Twelve studies comprising 539 ATTR-CA patients with a mean of 70 years old are included. The majority of them are male with NYHA I–II severity and are being followed up for approximately 12 months. For diflunisal efficacy outcomes, we found no statistically significant changes in BNP, troponin I, LVEF, GLS, IVSD, PWD, and E wave from baseline to diflunisal posttreatment, however, we found a statistically significant posttreatment increase of transthyretin level (MD 9.34 mg/dL; CI 1.54–17.14; I² 0%; p 0.02). We also found a statistically significant 77% (CI 58–87%; I² 34%; p < 0.001) risk reduction of mortality in the diflunisal group compared to the control group. For diflunisal safety outcomes, we found a statistically significant reduction of eGFR, hemoglobin, and platelet count (MD − 5.55, − 0.32, − 11.61, respectively, p < 0.01) but no statistically significant change in creatinine level. Pooled proportions of discontinuation rate of diflunisal therapy is 24% (CI 15–36%; I² 72%; p < 0.01) and adverse events causing therapy discontinuation are renal impairment (21%), GI impairment (13%), bleeding (6%), and fluid retention (6%). Conclusion: Diflunisal therapy is beneficial in treating ATTR-CA patients but is associated with adverse effects that require therapy discontinuation. Hence, careful monitoring during diflunisal therapy is necessary.