Aims: We aimed to assess the association between serum 25-hydroxyvitamin D (25(OH)D) levels with all-cause and cardiovascular mortality in patients with nonalcoholic fatty liver disease (NAFLD). Methods: We performed a retrospective cohort study based on the US National Health and Nutrition Examination Survey 2001–2016 on adults aged ≥20 years. NAFLD was determined as a US Fatty Liver Index score ≥ 30 in the absence of other liver conditions. Weighted Cox proportional hazards regression models were applied to explore the relationship between serum 25(OH)D levels and mortality. Results: 898 all-cause deaths and 305 cardiovascular deaths were recorded over a median follow-up of 8.7 years. Compared with those in the severe deficiency group (below 25.0 nmol/L), the fully adjusted HRs and 95% CIs of NAFLD patients with sufficient serum 25(OH)D concentrations (≥75.0 nmol/L) were 0.36 (0.22, 0.60) for all-cause mortality and 0.14 (0.07, 0.29) for cardiovascular mortality. Each one-unit increase in the natural log-transformed serum 25(OH)D concentration was related to a 41% lower risk for all-cause deaths (HR = 0.59, 95% CI: 0.46, 0.77) and a 65% lower risk for cardiovascular deaths (HR = 0.35, 95% CI: 0.22, 0.58). Conclusions: Among NAFLD patients, increased serum 25(OH)D levels were independently associated with reduced risk for all-cause and cardiovascular deaths.

Background: Although exposure to ozone (O ₃ ) and fine particulate matter with a diameter of ≤2.5 μm (PM _2.5 ) has been associated with increased cardiovascular events and hospitalizations, their association with in‐hospital outcomes among patients with acute myocardial infarction remains uncertain. Methods: A time‐stratified case‐crossover study was conducted using patients with acute myocardial infarction admitted to hospitals in Beijing from 2013 to 2019. Daily levels of O ₃ and PM _2.5 and its components (sulfate, nitrate, ammonium, organic matter, and black carbon) were assessed. Conditional logistic regression estimated exposure–response relationships between pollutants and in‐hospital death. The relative excess risk due to interaction was used to quantify interactions between O ₃ and each PM _2.5 component. Results: O ₃ exhibited a threshold effect: When the concentration on the admission day exceeded 90 μg/m ³ , in‐hospital mortality risk increased significantly. PM _2.5 and each component showed linear exposure–response relationships. At a 2‐day moving average, each 10 μg/m ³ increase in PM _2.5 was associated with a 1.4% (95% CI, 0.9%–1.9%) increase in in‐hospital death. Significant positive multiplicative interactions were observed between O ₃ and all PM _2.5 components, with notable synergistic effects for O ₃ –organic matter (relative excess risk due to interaction, 0.155 [95% CI, 0.053–0.258]) and O ₃ –black carbon (relative excess risk due to interaction, 0.137 [95% CI, 0.033–0.240]). The effects of O ₃ were stronger in summer, while the effects of PM _2.5 components were more pronounced in winter. Joint exposure resulted in a higher mortality burden than single‐pollutant exposure. Conclusions: Short‐term exposure to O ₃ and PM _2.5 components increases in‐hospital mortality risk in patients with acute myocardial infarction, with synergistic effects between ozone and organic matter or O ₃ and black carbon.

Background: Since the foundation of appropriate use criteria (AUC) for coronary revascularization, the proportion of inappropriate (later revised as “rarely inappropriate”) percutaneous coronary interventions (PCIs) varied in different populations. However, the pooled inappropriate PCI rate remains unknown. Methods: We searched the PubMed, Cochrane, Embase, and Sinomed databases for studies related to AUC and PCIs. Studies that reported inappropriate/rarely appropriate PCI rates were included. A random effects model was employed in the meta-analysis because of the high statistical heterogeneity. Results: Thirty-seven studies were included in our study, of which eight studies reported the appropriateness of acute PCIs or PCIs in acute coronary syndrome (ACS) patients, 25 studies reported the appropriateness of non-acute/elective PCIs or PCIs in non-ACS/stable ischemic heart disease (SIHD) patients, and 15 studies reported both acute and non-acute PCIs or did not distinguish the urgency of PCI. The pooled inappropriate PCI rate was 4.3% (95% CI: 2.6–6.4%) in acute scenarios, 8.9% (95% CI: 6.7–11.0%) in non-acute scenarios, and 6.1% (95% CI: 4.9–7.3%) overall. The inappropriate/rarely appropriate PCI rate was significantly higher in non-acute than acute scenarios. No difference in the inappropriate PCI rate was detected based on the study location, the country’s level of development, or the presence of chronic total occlusion (CTO). Conclusions: The worldwide inappropriate PCI rate is generally identical but comparatively high, especially under non-acute scenarios.

(1) Background: Acute myocardial infarction (AMI) imposes a great burden on global health. Few studies have demonstrated the effects of valley concentration of air pollutants on AMI hospital admissions. (2) Methods: Hospitalizations for AMI from 1 May 2014 to 31 December 2019 were analyzed. Generalized additive models (GAM) were used to quantify the exposure–response association between the hourly peak, mean, and valley concentration of six air pollutants and AMI hospital admissions. Stratification analyses were conducted to identify the susceptible population. (3) Results: Hourly peak, mean, and valley concentrations of PM_2.5, PM₁₀, SO₂, NO₂, and CO were significantly associated with AMI hospital admissions. Each 10-unit increase in the hourly valley concentration of them led to 0.50% (0.35–0.66%), 0.44 % (0.32–0.56%), 0.84% (0.47–1.22%), 1.86% (0.73–3.01%), and 44.6% (28.99–62.10%) excess risk in AMI hospital admissions, respectively. In addition, the effects of hourly valley concentration were larger than mean and peak concentrations. The effects in the female or older than 65 groups were larger than that in the male or younger than 65 groups. (4) Conclusions: PM_2.5, PM₁₀, SO₂, NO₂, and CO exposure contributed to increased AMI hospital admissions. Hourly valley concentration might be a more potent indicator of adverse cardiovascular events. Females and individuals older than 65 were more susceptible to ambient air pollutant exposure.

While air pollution is known as a risk factor for acute myocardial infarction (AMI) incidence, its impact on AMI subtypes—ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI)—remains incompletely understood. This study analyzed 149,632 AMI hospital admissions (70,730 STEMI and 69,594 NSTEM) in Beijing, China, from 2013 to 2019 using a time-stratified case-crossover design to evaluate the association between daily concentrations of six air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃) and daily hospital admissions for total AMI, STEMI, and NSTEMI. Elevated levels of PM_2.5, PM₁₀, SO₂, NO₂, and CO were significantly associated with increased admission risk for total AMI, STEMI, and NSTEMI, with the strongest lag effects observed at lag0 for STEMI and at lag1 for NSTEMI. Subgroup analyses showed enhanced effects of PM_2.5, SO₂, and NO₂ for total AMI and SO₂ for NSTEMI among individuals with asthma. Additionally, a stronger effect of PM₁₀ on STEMI was observed among individuals with stroke. These findings demonstrate that air pollutants differentially impact AMI subtypes through distinct temporal patterns and population vulnerabilities, underscoring the necessity of incorporating AMI subtype classification and individual susceptibility factors in environmental health risk assessments and related public health policies.

Background: The incidence of myocardial infarction (MI) is rising among young individuals. This study aimed to identify the profile of standard modifiable risk factors (SMuRFs) and their impact on long-term survival in very young MI patients (≤35 years). Methods: The VYTAL-MI study (Very Young Tracking and Analysis of Long-term Myocardial Infarction Outcomes) is a retrospective cohort analysis of MI patients aged ≤35 years, admitted to Beijing Anzhen Hospital and Peking Union Medical College Hospital between December 1 ¹⁹²⁰ , 2011, and December 1 ¹⁹²⁰ , 2021. SMuRFs (hypertension, diabetes, hypercholesterolemia, smoking) were documented. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, recurrent MI, ischemia-driven revascularization, and ischemic stroke. Cox proportional hazard models were used to assess associations between SMuRFs and outcomes. Results: Among 690 patients (median age 33 years [interquartile range, IQR: 30-34]; 95% male), only 8% had no SMuRFs. Smoking was most common (76%), followed by hypercholesterolemia (43%), hypertension (40%), and diabetes (12%). The most frequent combination was smoking and hypercholesterolemia (16.4%). Over a median follow-up of 6.3 years (IQR: 4.0-8.6), MACCE occurred in 165 patients (23.9%). Patients with ≥3 SMuRFs had significantly higher cumulative hazards ( P =0.003). Hypertension (hazard ratio, HR: 1.50; 95% confidence interval, CI: 1.09-2.06; P =0.014) and diabetes (HR: 1.67; 95% CI: 1.10-2.54; P =0.016) were independently associated with increased risk, while hypercholesterolemia (HR: 1.24; 95% CI: 0.91-1.68; P =0.177) and smoking (HR: 1.06; 95% CI: 0.72-1.55; P =0.776) showed no significant association. Conclusions: Very young MI patients exhibited a high burden of SMuRFs, particularly smoking. Hypertension and diabetes increased long-term event risk. Targeted SMuRF management is essential to improve survival in this population. What is known: Targeting standard modifiable cardiovascular risk factors, including hypertension, diabetes, hypercholesterolemia, and smoking, is crucial for improving outcomes in myocardial infarction. Limited data exist on the pattern of standard modifiable risk factors in very young myocardial infarction patients aged ≤35 years, and how these factors influence long-term outcomes. What the study adds: Very young myocardial infarction patients exhibited a substantial burden of standard modifiable risk factors, with smoking being notably prevalent. Increased standard modifiable risk factors exposure was associated with an elevated risk of major adverse cardiovascular and cerebrovascular events Hypertension and diabetes were linked to a higher risk of major adverse cardiovascular and cerebrovascular events, while smoking and hypercholesterolemia did not show a significant independent effect. Registration: URL: http://www.chictr.org.cn ; Unique identifier: ChiCTR2400085600.